Health Science Reports最新文献

Background and aims: Multidisciplinary teams (MDTs) represent a key trend in global cancer care. This study aims to discuss the applicability and benefits of two MDT models in a Chinese tertiary cancer hospital, the classical MDT consultation meeting model and the MDT clinic model, regarding process and efficiency, physicians' preferences, and patients' satisfaction.

Methods: We conducted a user-side cross-sectional survey among patients in MDT clinics (n = 520) and consultation meetings (n = 123) via convenience sampling. The survey captured basic information, treatment results, and satisfaction (5-point Likert scale). On the provider side, semistructured interviews were conducted among 28 physicians on MDTs, focusing on the team's working mode and communication style.

Results: Since 2005, the hospital has established 15 MDTs. The classical model, operating on a fixed schedule, is valued by physicians for educating young staff. Since 2020, MDT clinics in 8 disciplines have streamlined the appointment process and involved patients directly in discussions. The majority of physicians (25/28) affirmed that this model has improved the efficiency of developing diagnostic and treatment plans. The overall satisfaction of patients with the MDT clinic was (4.66 ± 0.54), which was higher than their satisfaction with the classical MDT model (4.53 ± 0.53). In the MDT clinic model, non-local patients reported greater satisfaction (4.68 ± 0.58) than did local patients (4.65 ± 0.53), while the opposite was true of the classical MDT model. Patients with more complex tumor types (F = 2.35), longer wait times (F = 9.53), or no clear treatment plan (t = 9.49) reported lower satisfaction with both models (p < 0.05).

Conclusion: For regional hubs featuring the necessary resources, the establishment of a multidisciplinary clinic model for diagnosis and treatment is strongly encouraged. The classical MDT meeting is indispensable for complex case deliberation and physician training, while the multidisciplinary clinic model can be utilized to enhance patient-centered care and satisfaction.

Background and aims: Heyde syndrome, a triad of anemia from gastrointestinal (GI) bleeding, aortic valve stenosis, and acquired von Willebrand syndrome, primarily affects individuals over 65. Management requires a multidisciplinary approach, including medical therapy, endoscopic intervention, and valve replacement. Despite advances, many aspects remain unclear. This review explores the epidemiology, pathophysiology, and management of Heyde syndrome while highlighting areas for future research.

Methods: A comprehensive search of PubMed and Google Scholar focused on English-language human studies, including case reports, clinical trials, reviews, and expert guidelines. Additional literature on Von Willebrand syndrome and GI angiodysplasia was reviewed. The final search was completed on April 5, 2025.

Results: Aortic valve replacement improves outcomes and hematologic abnormalities. Transcatheter aortic valve replacement (TAVR) showed lower rates of life-threatening bleeding, fewer perioperative complications, and reduced transfusions compared to surgical replacement. Guidelines recommend dual antiplatelet therapy (DAPT) for 3-6 months post-TAVR, with 79%-86% of patients experiencing no recurrence of GI bleeds. Management of intestinal angiodysplasia often shows high recurrence rates due to persistent lesions and vWS-2A. Surgical valve replacement also improves bleeding control, even with anticoagulation. Aortic valve replacement should be first-line therapy in severe aortic stenosis with chronic GI bleeding.

Conclusion: Heyde syndrome remains a complex and often underrecognized condition in elderly populations. Continued research is critical to deepen understanding and improve patient outcomes, allowing for more personalized and effective care strategies.

Background: Obesity is an escalating worldwide health issue, and bariatric surgery has demonstrated efficacy as a strategy for substantial weight reduction and metabolic improvement. Nesfatin-1, an anorexigenic peptide, is associated with appetite control and energy balance; nevertheless, its response following bariatric surgery is variable. This meta-analysis assesses the effects of bariatric surgery on BMI and nesfatin-1 concentrations in individuals with obesity.

Methods: A comprehensive literature search was performed in PubMed, Scopus, Embase, and Web of Science, according to PRISMA criteria. Included were studies examining pre- and post-surgical alterations in BMI and nesfatin-1 levels. A random-effects meta-analysis was conducted to evaluate aggregated effect sizes, heterogeneity, and possible publication bias.

Results: Seven trials with a total of 237 patients were examined. Bariatric surgery resulted in a substantial decrease in BMI (-10.23, 95% CI: -13.00 to -7.46; p < 0.001), exhibiting moderate-to-high heterogeneity (I² = 84.16%). Nesfatin-1 levels demonstrated a non-significant increase following surgery (10.22, 95% CI: -3.42 to 23.86; p = 0.14) and considerable heterogeneity (I² = 99.98%). The funnel plot indicated little publication bias, however the Galbraith plot identified probable outlier research that contributed to variability.

Conclusion: Bariatric surgery markedly decreases BMI, underscoring its importance in obesity management. The impact on nesfatin-1 levels remains ambiguous due to significant variability and variances specific to each studies. Additional study employing standardized procedures and extended follow-up durations is necessary to clarify the function of nesfatin-1 in post-surgical metabolic control.

Introduction: Studies on the responses of older people who have experienced disasters are contradictory, suggesting two opposing theoretical approaches: the vulnerability and resilience approaches. Therefore, this qualitative study examines the impact of the media on Iranian elderly people during the Gaza war in 2024.

Methods: This qualitative study employed purposive sampling to select 12 elderly participants aged 65 years and older. Data collection was done from September to December 2024 through semi-structured interviews. The interviews were transcribed, and the data analysis was conducted following the steps outlined by Graneheim and Lundman.

Results: Results revealed three major themes: emotional exhaustion, physical stress responses, and resilience through social connection. Participants reported symptoms such as sleep disturbances, elevated blood pressure, and persistent anxiety after prolonged exposure to war-related media. Despite these challenges, some individuals demonstrated adaptive coping strategies, including limiting media intake and engaging in community support programs. These findings highlight the dual impact of media exposure-both distressing and mobilizing-among elderly populations.

Conclusion: It is necessary to strengthen the elderly's resilience to reduce the psychological and physical stress effects of war news on them. This can be achieved by practicing stress control and management, emphasizing social connections, developing a proper understanding of the media environment, and, most importantly, monitoring the contents broadcast by the media. Implementing a violent content label to give the audience the right to choose can help prevent media-related risks. These measures are crucial for this purpose.

Introduction: Toxoplasma gondii is a worldwide-distributed zoonotic parasite, causing latent infections in humans. Increasing evidence has suggested a possible link between toxoplasmosis and diabetes mellitus (DM), though data from Iran are limited. This study was conducted to determine the seroprevalence of latent T. gondii infection and its association with diabetes in Qazvin province, north-western Iran.

Materials and methods: In this case-control study, 350 patients with type 2 diabetes mellitus and 350 non-diabetic controls were recruited from clinical laboratories in Qazvin province. Anti-T. gondii IgG antibodies were detected by enzyme-linked immunosorbent assay (ELISA). Data on sociodemographic variables and exposures were obtained by structured questionnaires. Statistical analyses, such as χ ², t-test, and logistic regression, were performed using the STATA software version 17.

Results: Overall, 21.1% (148/700) of the participants were seropositive for T. gondii IgG antibodies. Compared with the controls, diabetic patients had a significantly higher seroprevalence of infection (27.7% vs. 14.6%). Seropositivity was positively associated with older age and rural residence, whereas no association was found with respect to sex, education, occupation, or dietary habits (consumption of raw or undercooked meat, raw eggs, and unwashed vegetables). Multivariate logistic regression, adjusted for age and residence, identified diabetes status as a significant factor associated with T. gondii seropositivity (adjusted OR = 2.62, 95% CI: 1.74-3.95, p < 0.001).

Conclusions: The results indicated a higher seroprevalence of latent T. gondii infection in diabetic patients from Qazvin province, suggesting an epidemiological association between toxoplasmosis and diabetes. Significant correlates identified included age and living environment. These findings underscore a notable epidemiological link between latent toxoplasmosis and type 2 diabetes, highlighting the need for integrated public health attention to this association in endemic regions.

Background and aims: One of the important complications of knee and hip replacement arthroplasty is prosthetic joint infection (PJI), which is usually accompanied by negative culture that leads to severe consequences compared to positive ones. This study aims to evaluate the arbitrary use or mistreatment of antibiotics for therapeutic purposes before the final diagnosis of PJI and its effect on the culture result and the process of diagnosis and treatment of these infections.

Method: A comprehensive search was performed in PubMed/MEDLINE, EMBASE, and Scopus using the following keywords: "PJI," "Antibiotic therapy," "False negative," and "Culture." We included clinical trials, cohort, case-control, and cross-sectional studies written in English.

Results: Among the nine reviewed studies, all mentioned the therapeutic use of antibiotics as an important reason for negative culture results in PJI. Five studies examined the minimum recommended time for discontinuing antibiotic therapy, which varied from 4 days to 3 months. Four studies evaluated the type and dosage of antibiotics, and one study discussed the effect of antibiotics on tissue-infecting microorganisms.

Conclusion: Using antibiotics for therapeutic purposes is the leading cause of false-negative cultures in joint prosthesis infections, which reduces the sensitivity of the culture in different ways, such as bacterial biofilm formation. Discontinuing antibiotics at least 2 weeks before sampling can help increase the sensitivity of the culturing. More studies should be done on other factors related to the effect of antibiotics on culture results, including the type of antibiotic and microorganism. With the available data, it can only be said that beta-lactams are the most common antibiotics used as therapeutic agents, leading to negative culture results. According to the Al-Mayahi study, therapeutic antibiotics increase the possibility of non-fermenting Gram-negative bacteria growth.

Background and aims: Due to the burden of influenza, significant efforts have been made to understand its geographical and temporal patterns to advise influenza prevention. Influenza temporal patterns have been affected since the emergence of COVID-19, presumably attributed to nonpharmacological interventions (NPIs). Understanding the changes in influenza activity before and during the COVID-19 pandemic in different climate regions is urgently needed to inform decision-making in future influenza control measures and prevention policies.

Methods: This study analysed influenza surveillance data (2012-2022) collected from the FluNet database to compare the patterns of long-term influenza activity in nine selected temperate and tropical countries. The long-term influenza activity in each country was compared before and after the emergence of COVID-19. The level of NPI stringency was measured using the stringency index (SI). Interrupted time series (ITS) analyses were performed to quantify the impact of COVID-19 NPIs on the changes in influenza patterns before and after the stringent implementation of NPIs in the selected countries.

Results: Before the COVID-19 pandemic, influenza activity in temperate countries appeared in winter, while the seasonality patterns in tropical countries were irregular and lasted longer than in temperate countries. During the pandemic, influenza cases decreased drastically in all selected countries, even though the amount of influenza testing remained adequate. The ITS results confirmed a significantly inverse relationship between stringency of NPIs and influenza activity. Although influenza cases have reemerged following the removal of NPIs, the patterns of influenza activity worldwide remain undergoing transitioning shifts post-pandemic. International collaboration is needed to continue monitoring future changes in influenza patterns to prevent large outbreaks.

Conclusion: There has been a change in the temporal patterns of influenza activity worldwide after the pandemic. NPIs have shown a significant effect in reducing influenza activity in all selected countries.

Background and aims: This study evaluated the accuracy of a standalone augmented reality (AR) navigation system using the Microsoft HoloLens 2 for total hip arthroplasty (THA). The system integrates infrared (IR) tracking and a preoperative 3D CT model for intraoperative visualization and guidance. The aim was to assess whether this AR-based solution could achieve clinically acceptable accuracy for use as a surgical navigation tool.

Methods: A dedicated AR application was developed to perform six-degrees-of-freedom pose estimation using inside-out tracking. Registration accuracy was assessed using six femur replicas with predefined target points. The registration pipeline combined landmark-based initialization with iterative surface refinement. Target registration error (TRE) was calculated for each point, and the influence of anatomical region, axis, surgical approach (anterior vs. posterior), and user experience level was analyzed.

Results: The system achieved a mean TRE of 3.61 ± 2.18 mm. Significant variations in accuracy were observed between anatomical regions (p = 0.019) and along different axes (p < 0.001), with the highest errors noted along the anteroposterior axis and in distal femoral regions. No significant differences were found between anterior and posterior approaches or among users with varying levels of experience, indicating operator-independent performance.

Conclusion: The AR navigation system demonstrated consistent and accurate registration performance across users and approaches. With a mean TRE of ~3 mm, the system meets accuracy requirements for potential clinical application in THA. Further cadaveric validation is recommended to confirm surgical feasibility and applicability.

Background: HDV, a defective virus dependent on hepatitis B for assembly, can lead to severe liver diseases and an increased risk of progressing to complications such as hepatocellular carcinoma. Given the high prevalence of HDV in Gabon, especially in central Africa, understanding the epidemiology and associated risks is crucial.

Aim: This study aimed to assess the serological and molecular features of HDV among HBsAg-positive patients in the urban and rural areas of Gabon.

Method: The study was conducted from April 2019 to December 2022 in the Franceville area and from January to June 2023 in the Libreville area. We enrolled 145 newly diagnosed HBsAg-positive individuals in Franceville (101) and Libreville (44). Plasma samples were collected for serological and molecular analyses, including tests for HDV antibodies and RNA detection.

Result: The results showed an overall HDV prevalence of 26.2%, with higher rates in Libreville (18/44; 40.9%) compared to Franceville (20/101; 19.8%). Molecular analysis identified the circulation of genotypes I, VII, and VIII, with a predominance of replicative forms. The prevalence of replicative HDV RNA activity was 29.4%, indicating a need for accessible treatment options. Demographic analysis revealed a predominantly male population with an average age of 40.

Conclusion: These findings provide valuable insights into the epidemiology of HDV in Gabon and emphasise the importance of targeted interventions and further research to address public health challenges associated with HDV infection in the region.