QJM: An International Journal of Medicine最新文献

Enhanced external counterpulsation (EECP) is a non-invasive circulatory support device that has been shown to improve perfusion in cardiovascular diseases; however, its effectiveness in ischemic stroke is yet to be explored. This systematic review and meta-analysis were proposed to evaluate the effectiveness of EECP on cerebral blood flow (CBF) and other functional outcomes in ischemic stroke patients. PubMed, CNKI, Web of Science, Embase, CINAHL, Wangfang, Chinese Medicine, and Sinomed databases were searched up to June 2025. Studies evaluating the effect of EECP on CBF, daily living activities, disability degree, and neurological impairment. Data were pooled using RStudio (version 4.5.1) with both a common-effect model and a Hartung-Knapp (HK) random-effects model, applying the generic inverse variance method. Fifteen studies comprising 506 participants were included. While the common-effect model suggested a statistically significant improvement in CBF, this effect was no longer significant after applying the more conservative HK adjustment (MD = 0.15; 95% CI: -0.13 to 0.44; p = 0.1485). This indicates that current evidence supports a possible, but not definitive, effect of EECP on CBF. EECP showed significant improvement in daily living activities (MD = 23.53; 95% CI: 14.65 to 32.40; p = 0.0002), disability degree (MD = -1.88; 95% CI: -2.64 to -1.11; p = 0.0009), and neurological function (MD = -5.42; 95% CI: -8.90 to -1.94; p = 0.0060). High heterogeneity was observed across outcomes. Overall, EECP shows promising potential as an adjunct rehabilitation therapy for ischemic stroke, particularly in improving functional outcomes. However, the non-significant CBF findings under the HK model and the substantial heterogeneity highlight the need for rigorously designed, high-quality studies to better define EECP's clinical efficacy and optimal treatment protocols.

Background: Non-small cell lung cancer (NSCLC) remains the leading cause of cancer-related deaths in the U.S. While racial and ethnic disparities in outcomes are known, long-term trends and the specific contribution of clinical and socioeconomic factors remain unclear.

Aim: To quantify the long-term racial/ethnic disparities in NSCLC mortality (2000-2020) and assess the relative contribution of modifiable clinical and socioeconomic factors to these inequities.

Design: A retrospective population-based cohort study.

Methods: Data for 548,526 NSCLC patients diagnosed between 2000 and 2020 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Cumulative incidence of death was analyzed using the Fine and Gray model. Multivariable cause-specific hazard regression quantified the contribution of stage, tumor grade, treatment status, and household income to racial/ethnic disparities.

Results: The five-year cumulative mortality rate was highest among Black patients (83.5%), followed by American Indian/Alaska Native (AI/AN , 82.0%), White (79.5%), Hispanic (79.5%), and Asian or Pacific Islander (API , 77.1%) patients. Cancer-directed surgery, stage at diagnosis, and household income were significant contributors to disparities, explaining up to 29.04% of Black-White and 19.97% of AI/AN-White disparities in all-cause mortality. Relative disparities decreased over time, but absolute disparities widened, particularly between Black and White patients.

Conclusions: Significant racial and ethnic disparities in NSCLC mortality have persisted over the past two decades. Addressing modifiable factors like late-stage diagnosis and ensuring equitable access to high-quality, cancer-directed treatments are essential steps toward promoting health equity.s.

Background: Cytomegalovirus (CMV) colitis is typically associated with impaired cellular immunity, but has been increasingly recognized in elderly individuals or those with subtle immune dysfunction. Sheehan syndrome, a form of postpartum hypopituitarism, leads to chronic hormonal deficiencies and lifelong glucocorticoid replacement, which may contribute to mild but clinically relevant immune vulnerability. Reports of CMV colitis in patients with Sheehan syndrome are extremely rare.

Case presentation: We report a 70-year-old woman who presented with several days of right lower quadrant abdominal pain and diarrhea. Physical examination and imaging revealed no evidence of acute appendicitis or other surgical conditions. Despite empirical antibiotic therapy, her symptoms persisted, prompting upper and lower endoscopy, which demonstrated multiple ulcerative lesions throughout the gastrointestinal tract. Histopathological examination with immunohistochemical staining confirmed CMV colitis. Further evaluation revealed long-standing Sheehan syndrome with secondary hypothyroidism, adrenal insufficiency, and suppressed gonadotropins. She had been receiving cortisone replacement for several years. The patient was treated with intravenous ganciclovir followed by oral valganciclovir, resulting in complete clinical resolution.

Discussion: This case highlights that CMV colitis can occur in older adults without classical immunosuppressive risk factors and that endocrine disorders such as Sheehan syndrome may contribute to subtle immune impairment. Chronic hypopituitarism combined with long-term glucocorticoid replacement may create a permissive environment for CMV development. Clinicians should consider CMV colitis when evaluating persistent gastrointestinal symptoms in elderly patients with endocrine dysfunction or chronic corticosteroid use.