SAGE Open Medicine最新文献

Background: Medulloblastoma is a highly malignant primary neuroembryonic tumor characterized by its unique anatomical location, cellular origin, and clinical manifestations, serving as a major contributor to childhood mortality. The disease exhibits biological heterogeneity, with significant variability in cells of origin, genetic mutation profiles, and prognoses across different subgroups, posing challenges for effective treatment. Aberrant DNA methylation has been identified as a promoter of tumorigenesis, influencing the tumor microenvironment and patient prognosis.

Objective: This study aimed to investigate epigenetic changes in different medulloblastoma subtypes by integrating genomics, transcriptomics, epigenetics, and clinicopathological data to identify potential therapeutic targets and drugs that could significantly improve patient outcomes.

Methods: We obtained medulloblastoma transcriptomic and methylation data (GSE85217 and GSE85212) from the NCBI GEO database and performed differential gene expression and methylation analysis using the limma and ChAMP packages. Functional pathway enrichment was assessed via GO and KEGG analysis. A prognostic model was constructed using LASSO regression, while WGCNA and GSEA were employed to analyze key gene modules and signaling pathways. In addition, CIBERSORT and Gene set variation analysis (GSVA) were used to evaluate the immune microenvironment and drug sensitivity.

Results: We identified 1135 differentially expressed genes and 2582 differentially methylated sites, with inhibin beta B and ubiquitin-specific peptidase 2 significantly upregulated in Group 3/Group 4 subtypes. The prognostic model comprised 25 genes, and risk stratification effectively distinguished high- and low-risk patients (AUC 0.76-0.78). Immune analysis revealed decreased plasma cells and monocytes in the high-risk group, alongside increased naïve B cells and M0 macrophages. Drug prediction suggested that atovaquone and embelin may reverse tumor progression.

Conclusion: Inhibin beta B and ubiquitin-specific peptidase 2 are key marker genes for predicting medulloblastoma patient prognosis stratification, with their expression patterns closely linked to molecular subtypes and the immune microenvironment. This study provides novel molecular targets and strategies for precision therapy and prognostic assessment in medulloblastoma.

Background: Intraoperative localization of ureteral strictures and safe placement of double-J stents are pivotal steps during laparoscopic reconstruction, yet practical guidance on these steps is limited.

Objective: To introduce a simple and feasible new method of using ureteroscopy-assisted localization and indwelling double-J tubes in laparoscopic repair of middle and lower ureteral stenosis, and to confirm its safety and effectiveness.

Methods: We conducted a single-center, two-period retrospective comparison of patients undergoing laparoscopic reconstruction for middle or lower ureteral stricture. The control cohort (2010-2017) used conventional laparoscopic localization with trocar-assisted guidewire/stent placement, whereas the experimental cohort (2018-2023) used ureteroscopy-assisted localization with transureteral guidewire/stent placement under simultaneous laparoscopic visualization. Primary outcomes were time to localize the stricture and time to place the double-J stent.

Results: A total of 49 patients were included in the experimental cohort and 56 in the control cohort. Ureteroscopy assistance shortened stricture localization time (138 ± 24 versus 174 ± 12 min; mean difference [MD] -36; 95% CI -43.5 to -28.5; p=0.02) and double-J stent placement time (5.2 ± 0.6 versus 9.8 ± 2.4 min; MD -4.6; 95% CI -5.26 to -3.94; p=0.01). Estimated blood loss, drain duration, time to first flatus, and stent malposition rates were similar between groups.

Conclusions: Ureteroscopy-assisted localization and transureteral stent placement may streamline laparoscopic reconstruction for middle and lower ureteral strictures by reducing operative time without compromising safety. Prospective studies with longer follow-up are warranted. Ureteroscopy-assisted double-J stent.

Objective: To identify the independent risk factors for postpartum stress urinary incontinence by combining pelvic floor ultrasound parameters with clinical information.

Methods: Pelvic floor examination and clinical data were collected from 152 postpartum women who underwent pelvic floor ultrasound at Yancheng Third People's Hospital between December 2023 and September 2024. Independent risk factors for postpartum stress urinary incontinence were identified using multivariate logistic regression analysis. A nomogram model was constructed using R 4.3.1 software and the rms package to evaluate the correlation between the identified factors and the disease.

Results: Maximal Valsalva state posterior urethrovesical angle (RVA), bladder neck descent, and Young's modulus of the resting posterior lip of the urethral sphincter were identified as independent risk factors for postpartum stress urinary incontinence (p < 0.05). The areas under the receiver operating characteristic curve for RVA, bladder neck descent, and posterior lip of the urethral sphincter were 0.840, 0.867, and 0.914, respectively, indicating high diagnostic efficiency. The nomogram model demonstrated that the risk of developing stress urinary incontinence increased with higher RVA and bladder neck descent values and lower posterior lip of the urethral sphincter values, with posterior lip of the urethral sphincter showing the strongest correlation with the disease.

Conclusion: RVA (Valsalva), bladder neck descent, and posterior lip of the urethral sphincter are independent risk factors for postpartum stress urinary incontinence. The nomogram model based on these factors demonstrated high diagnostic performance (area under the curve = 0.984), suggesting potential utility for clinical application. However, this model is preliminary and requires validation in larger, multicenter cohorts before widespread use.

Objective: Predictors of mortality in severe traumatic brain injuries (TBI) in pediatric patients are not well explored. We investigate traditional and novel prognostic predictors in pediatric patients with severe TBI. The primary outcome was in-hospital mortality.

Methods: A retrospective study of children ⩽18 years old with a Glasgow Coma Scale ⩽8 was conducted at a level I pediatric trauma center. Predictors of mortality included interventions within 72 h, Pediatric Risk of Mortality (PRISM) III at 24 h, and the pediatric Sequential Organ Failure Assessment (pSOFA) score over 3 days. Novel prognostic models included a combined PRISM III and pSOFA score, a model that combined the two prognostic scores with medical interventions, and a combined medical and surgical intervention model. Categorical and continuous variables were analyzed using Fisher's exact test and the Mann-Whitney U test, respectively. Receiver operating characteristic curves and area under the curve (AUC) were used to assess the predictive performance of prognostic scores.

Results: There were 97 patients with severe TBI included in this study. The combined PRISM-pSOFA day 2 model was the strongest predictor of mortality (AUC = 0.973), but did not provide a statistically significant benefit over PRISM III, which served as the referent model. While the PRISM III (AUC = 0.968) had a higher predictive ability than the pSOFA-day 2 (AUC = 0.940), the difference was not statistically significant.

Conclusion: Predicting outcomes is essential for guiding care decisions and standardizing research. The pSOFA-day 2 score offers a comparable mortality prediction to PRISM III and serves as a practical, easy alternative that can be especially helpful when the PRISM III score is unavailable or difficult to calculate due to resource limitations.

Sepsis-induced cardiomyopathy (SCM), a frequent complication of septic shock with mortality exceeding 40%, arises from catecholamine-driven cardiotoxicity, sympathetic hyperactivity, and inflammation-mediated biventricular dysfunction. Short-acting β₁-blockers (esmolol, landiolol) offer a targeted therapeutic approach by reducing heart rate (target: 80-95 bpm), myocardial oxygen demand, and proinflammatory cytokines while improving diastolic perfusion-leveraging ultra-short half-lives (t₁/₂ = 4-9 min) for rapid reversibility during instability. Clinical evidence remains divergent: a landmark single-center RCT demonstrated significant 28-day mortality reduction (49.4% vs 80.5%; p < 0.001), improved hemodynamics, and reduced vasopressor requirements in hemodynamically stabilized patients, whereas premature termination of a multicenter trial revealed harm (increased vasopressor needs, mortality trend) when initiated during persistent hypoperfusion (lactate > 2 mmol/L). Current limitations include heterogeneous trial designs, small samples, and undefined benefiting phenotypes. Thus, cautious short-acting β-blockade is supported only for selected SCM patients with hemodynamic stability (MAP ⩾65 mmHg, normalized lactate, LVEF >35%), necessitating future precision trials with AI phenotyping to guide mechanism-targeted application.

Objectives: Blood-derived immune-inflammatory markers have been identified as promising tools in many conditions. This study aims to determine the perioperative factors and hematologic indices associated with the occurrence of delayed recover after pancreatic and biliary surgeries (PBS).

Methods: Included in this study were 106 patients with PBS who were divided into prolonged hospitalization group (≤5 days; n = 48) and short hospitalization group (>5 days; n = 58) between January 2020 and April 2023 in a tertiary hospital in Saudi Arabia. The clinico-demographic characteristics, laboratory parameters and blood-derived immune-inflammatory markers (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), aggregate index of systemic inflammation, and systemic inflammatory response index) of the patients with and without prolonged hospitalization were compared by independent sample t-test, Mann-Whitney U-test, chi-square test, and Fisher's exact test as appropriate. Receiver operating characteristic (ROC) analysis was used to establish a cut-off level of postoperative PLR and SII values to predict prolonged hospitalization. Perioperative factors associated with prolonged hospitalization were evaluated by univariable and stepwise multivariable logistic regression analyses.

Results: Of the 106 patients undergoing PBS, 48 patients (45.28%) had prolonged hospitalization. Both postoperative PLR and SII in patients with prolonged hospitalization were significantly higher than those in patients without. The ROC curve showed that the optimal cut-off value of postoperative SII to predict prolonged hospitalization was 1073.17, with 0.792 sensitivity and 0.483 specificity. In addition, the optimal cut-off value of postoperative PLR to predict prolonged hospitalization was 227.55, with 0.604 sensitivity and 0.638 specificity. Stepwise multivariate analysis showed that postoperative SII (>1073.17) was an independent predictor for prolonged hospitalization (odds ratio = 3.527, 95% confidence interval: 1.491-8.434, p = 0.004), together with intraoperative blood transfusion requirement and preoperative prothrombin time.

Conclusions: Our findings demonstrated an association between the higher level of postoperative SII and delayed recovery, suggesting that it may be a useful parameter for identifying patients at risk of delayed recovery after PBS.

Background: Dysmenorrhea is a common menstrual health problem among adolescents, often managed through pharmacological and non-pharmacological strategies. However, the factors that predict adolescents' choice between these management approaches remain poorly understood, particularly in settings where traditional and modern practices coexist. This study examined the predictors of pharmacological and non-pharmacological management practices among school-going female adolescents in Ghana.

Methods: A cross-sectional survey was conducted among 490 female students aged 13-24 years in 2 senior high schools within the Effutu and Agona West Municipalities. Participants were recruited using simple random sampling. For minors (aged 13-17 years), written informed consent was obtained from Legally Authorized Representatives and written assent from participants; adult participants (aged 18-24 years) provided written informed consent directly. Exclusion criteria included diagnosed gynecological disorders, inability to provide informed assent or parental/guardian consent, and cognitive impairments. Data were collected using a structured questionnaire and analyzed with chi-square tests and logistic regression.

Results: The prevalence of dysmenorrhea was 82.4%. Pharmacological management was significantly associated with dysmenorrhea experience (χ² = 11.51, p = 0.003). Pain intensity emerged as a strong predictor, with adolescents reporting moderate (Exp(B) = 1.7, p = 0.03) and severe pain (Exp(B) = 2.42, p < 0.01) more likely to use medications. Non-pharmacological practices were significantly associated with program of study (χ² = 28.75, p = 0.001), while demographic factors showed no significant associations.

Conclusion: Pain severity drives pharmacological management, whereas educational exposure influences non-pharmacological choices. Comprehensive menstrual health education is needed across academic programs to promote effective, evidence-based management of dysmenorrhea among adolescents in Ghana.

Introduction: Orthopaedic procedures are associated with the highest rates of opioid use among surgical specialties. Factors such as time constraints, communication barriers, and variable patient preferences are recognised challenges. There is limited research explicitly addressing the drivers for opioid prescribing in surgical patients or seeking to understand how health professionals engage patients in decision-making. This study aimed to explore patient and healthcare professional perceptions of the role of opioids in pain management in the orthopaedic context.

Methods: This research adopted a qualitative study design underpinned by critical realism. Interviews were conducted with patients and healthcare professionals involved in the care of patients with pain in an orthopaedic setting at a metropolitan tertiary hospital in South Australia. Analysis of the interviews was informed by a reflexive thematic analysis approach.

Findings: Forty participants (20 patients and 20 healthcare professionals) participated in this study between June and October 2020. A total of three themes, with sub-themes were identified (1) The patient as an individual; (2) the acute care setting; and (3) patient engagement and education. It was clear from both patient and healthcare professional participants that individual patient factors influence patients' understandings of opioids and pain management as well as the acute care setting. Additionally, all participants described the importance of patient engagement and education for improvement in pain management and opioid use.

Conclusions: This study demonstrates the complex factors that influence pain management and opioid perceptions within the orthopaedic context. We recommend that patient engagement and education is the critical factor to navigating individual patients and the acute care setting when it comes to pain and pain management.

Objectives: To evaluate the efficacy of intensive care unit ventilators versus dedicated noninvasive ventilators when used for noninvasive ventilation.

Methods: This was a secondary analysis of data from a multicenter prospective observational study. Eligible patients were recruited from 17 hospitals in China between September 2017 and September 2021. Inclusion criteria were restricted to those receiving noninvasive ventilation for acute hypoxemic respiratory failure. The type of ventilator used was determined at the discretion of the treating clinicians. The primary objective was to compare clinical outcomes between intensive care unit ventilators and dedicated noninvasive ventilation ventilators for noninvasive ventilation delivery. Key outcomes included noninvasive ventilation failure rate, 28-day mortality, intensive care unit length of stay, and hospital length of stay.

Results: A total of 2054 patients were enrolled, with 5% (n = 103) receiving noninvasive ventilation via intensive care unit ventilators and 95% (n = 1951) via dedicated noninvasive ventilation ventilators. No significant difference was observed in the overall noninvasive ventilation failure rate between the two groups (46% versus 38%, p = 0.15). However, the median time from noninvasive ventilation initiation to endotracheal intubation was shorter in the intensive care unit ventilator group (9 h, interquartile range: 3-25) compared with the dedicated noninvasive ventilation ventilator group (21 h, interquartile range: 6-65). The 28-day cumulative incidence of noninvasive ventilation failure was significantly higher in the intensive care unit ventilator group (log-rank test p = 0.01; crude hazard ratio = 1.43, 95% confidence interval: 1.06-1.91; adjusted hazard ratio = 1.41, 95% confidence interval: 1.04-1.93). No significant difference was found in 28-day mortality between the groups (16% versus 17%, p = 0.79). The 28-day cumulative incidence of mortality also did not differ (log-rank test p = 0.65; crude hazard ratio = 0.84, 95% confidence interval: 0.52-1.34; adjusted hazard ratio = 0.95, 95% confidence interval: 0.58-1.55).

Conclusions: The use of intensive care unit ventilators for noninvasive ventilation is uncommon in China. Based on low-level evidence, intensive care unit ventilators are not associated with a difference in mortality compared with dedicated noninvasive ventilation ventilators, but are linked to earlier endotracheal intubation.

Background: The practice of self-medication with antibiotics is expanding globally, particularly in developing countries. This practice is associated with increasing rates of health-related problems, including antibiotic resistance.

Objective: A survey was conducted to investigate knowledge, attitudes, and practices regarding self-medication with antibiotics among senior undergraduate pharmacy students in Jordan.

Methods: A cross-sectional study was performed by using a validated questionnaire for data collection. This questionnaire was randomly distributed online to senior undergraduate pharmacy students from a range of universities. Respondents' knowledge of, attitudes towards, and practice of self-medication with antibiotics were thus assessed. Data analysis was performed using IBM SPSS version 24.0 (IBM Corp., Armonk, NY, USA).

Results: Among the 250 respondents, who represented a response rate of 66.3%, 80.8% had self-medicated with antibiotics. The majority (85.6%) of antibiotics used for such self-medication were purchased from pharmacy drug stores. The most frequently used antibiotic for self-medication during the prior 6 months was amoxicillin (53.2%), ciprofloxacin (42.4%), and metronidazole (34.4%). Respiratory health issues were the most common reason for self-medication, with tonsilitis (90%) being major reason, then skin infections (34%). About 34% of students had changed their dose during treatment, while 30% kept some antibiotics for future use. Additionally, the majority of students (69.6%) recommended antibiotics to others without prescription, with 24% of students using antibiotics despite receiving advice that these were not required. The mean score for students' attitudes was 4.06, which indicated a positive attitude towards antibiotics use. The undergraduate senior pharmacy students had good knowledge and positive attitudes yet demonstrated poor practice with regard to antibiotic use, as the prevalence of self-medication was alarmingly high.

Conclusion: This malpractice highlights the importance of identifying effective and urgent interventions to be performed at different levels, including by educational and regulatory authorities, to mitigate the misuse of antibiotics.