Medical Science Monitor最新文献

BACKGROUND Achilles tenotomy is the final and most critical step of the Ponseti method for correcting equinus deformity in idiopathic congenital talipes equinovarus (CTEV). The procedure can be performed using either a needle or a scalpel; however, it remains uncertain whether these 2 percutaneous techniques provide different levels of tendon relaxation and radiological correction. MATERIAL AND METHODS This retrospective study included 130 feet of 90 patients with CTEV treated by the Ponseti method between January 2022 and December 2024. Patients underwent percutaneous Achilles tenotomy either with a 16-gauge needle under topical anesthesia or with a No. 15 scalpel blade under general anesthesia. Only patients with at least 1 year of follow-up were included. Lateral foot radiographs obtained in maximum dorsiflexion at 1 year postoperatively were used to measure the tibiocalcaneal, talocalcaneal, and talo-first metatarsal angles. Maximum ankle dorsiflexion was measured with a goniometer. The results were compared between the 2 tenotomy groups and with the unaffected feet of the same patients. RESULTS No significant differences were observed between the needle and scalpel groups in any radiological parameter or in maximum dorsiflexion (P>0.05). Compared with the unaffected feet, the tibiocalcaneal angle was significantly higher (P<0.001), while the talocalcaneal angle was significantly lower (P<0.001), in both tenotomy groups. The talo-first metatarsal angle showed no significant difference (P=0.099). CONCLUSIONS The 2 techniques - percutaneous Achilles tenotomy with a needle and with a scalpel - provided comparable radiological and functional outcomes. Although clinical correction is satisfactory, persistent differences in tibiocalcaneal and talocalcaneal angles suggest that mild structural deviations may remain despite successful treatment.

BACKGROUND Stress is an intrinsic aspect of the medical field. This study aimed to identify the factors influencing stress coping strategies among physicians in Poland's Silesian Voivodeship (region), considering variables such as sex, type of specialization, personality type, and psychophysical well-being. MATERIAL AND METHODS The study involved 655 Polish physicians and used various research instruments, including the Mini COPE-Coping Inventory, the Resiliency Assessment Scale, the Framingham Type A Scale, and the Wellbeing Scale. A multivariate data analysis model helped identify determinants of the stress coping strategies used by these doctors. RESULTS Findings indicated that higher resilience levels, particularly among women, were associated with the use of problem-oriented strategies, such as planning, active coping, and acceptance. Emotion-focused behaviors, religious engagement, and seeking emotional and instrumental support were notably linked to women in non-surgical specializations. In contrast, behavioral disengagement, self-blame, denial, and substance use correlated with lower resilience and well-being levels and were more common among men. The demonstrated links between determining factors, especially resilience levels and coping with stress can influence the design of targeted training modules on mental resilience in medical education or the creation of specialized support programs for at-risk subgroups. CONCLUSIONS Stress coping strategies used among Polish doctors in Poland's Silesian region are influenced by resilience, sex, specialization, and psychophysical well-being. Adaptive coping strategies are more prevalent among individuals with higher resilience, particularly women with non-surgical specialties. Conversely, maladaptive strategies are mainly associated with men experiencing lower well-being and resilience levels.

BACKGROUND This study evaluated the real-world diagnostic performance and limitations of noninvasive prenatal testing (NIPT) in detecting fetal copy number variations (CNVs) within a large multicenter cohort in Shaanxi Province. MATERIAL AND METHODS This retrospective observational study analyzed 18 525 cases of NIPT at the First Affiliated Hospital of Xi'an Jiaotong University, a referral center for NIPT, from June 2023 to November 2024. Karyotype analysis and CNV sequencing were conducted on the fetuses and/or parents, with follow-up on pregnancy outcomes. RESULTS Abnormal CNVs were detected in 218 cases (1.18%; 218/18525), of which 129 women (59.17%; 129/218) opted for invasive diagnostic confirmation from 38 hospitals in 7 prefectural-level cities. The positive predictive value (PPV) for aberrant CNVs following NIPT was only 48.06% (62/129; 95% CI, 39.4-56.7%), with 28.57% (18/62) possessing pathogenic CNVs. We noted that PPV estimates were based on self-selected confirmatory testing, which might inflate or deflate performance estimates. The detection efficiency varied significantly by chromosomal location; chromosome 18 showed the highest PPV at 83.33% (15/18; P<0.05), notably within the 18p11.23-p11.31 segment. Furthermore, smaller CNVs (<5 Mb) demonstrated a higher concordance rate (PPV 54.74%; 52/95) than larger fragments (>10 Mb). Regional analysis indicated Hanzhong and Xi'an demonstrated elevated PPVs, while Yulin showed the highest incidence of pathogenic CNVs. CONCLUSIONS NIPT demonstrates moderate performance for fetal CNV detection, with a PPV of approximately 48%. Its clinical utility is maximized when combined with ultrasound findings, which significantly increase the predictive value. The stakeholders should be aware of this limitation when interpreting results.

BACKGROUND The aim of this study was to evaluate if there are any intercultural differences between Polish and African students in perceiving some ethical issues of intensive therapy. Moreover, the influence of traits included in the Light Triad Scale (LTS) on these issues was checked. MATERIAL AND METHODS Forty-two Polish (PL) and 40 African (mainly Zimbabwe) English division (ED) first-year nursing students fulfilled a short survey containing LTS and 3 questions (with possible answers 1=strongly disagree to 5=strongly agree): (1) "Brain death does not exist". (2) "I would like to be an organ donor for transplantation if my brain dies". (3) "Each patient should be intensively treated even if the treatment is a source of extra suffering and there is no hope for full recovery". RESULTS The acceptance for being an organ donor was significantly lower in the ED group (r=-0.528; P<0.001). Moreover, LTS Kantianism (perceiving others as "ends in themselves") correlated negatively with answers to the question "Brain death does not exist" (rho=-0.283; P=0.010*). It means those who do not believe in brain death tend to have lower Kantianism level. CONCLUSIONS There are numerous factors affecting attitudes toward organ donation in different countries (differences in education, traditional and religious beliefs, legal and ethical issues). According to the data, personality is another important field. What is interesting, there is no correlation between consideration of brain death and attitude toward becoming a donor. ED students usually believe in brain death but still rarely accept organ donation.

BACKGROUND The primary goal of anal fistula treatment is eradication of the fistula while preserving continence and minimizing the risk of recurrence. Although fistulotomy is effective for simple fistulas, management of complex trans-sphincteric fistulas remains challenging. Sphincter-sparing techniques show variable outcomes, with high recurrence rates and risk of incontinence. This study evaluated a hybrid technique combining core-out fistulectomy with trans-sphincteric laser ablation to improve healing while preserving sphincter function. MATERIAL AND METHODS This retrospective pilot study included 20 adult patients with magnetic resonance imaging (MRI)-confirmed trans-sphincteric fistulas ( RESULTS Twenty patients (12 males; mean age 40.5 years) underwent the procedure. The overall healing rate was 90% (18/20). Mean healing time was 6.4 weeks, with a mean follow-up of 9.9 months. Two patients experienced recurrence. No significant postoperative complications or continence disturbances were observed. The mean time to return to work was 8.9 days, and all patients resumed normal daily activities the day after surgery. CONCLUSIONS Core-out fistulectomy combined with trans-sphincteric laser ablation appears to be a safe and effective treatment for selected trans-sphincteric fistulas. Larger prospective studies with longer follow-up are needed to confirm these findings.

BACKGROUND Hip fractures in geriatric patients carry high morbidity and mortality due to advanced age, frailty, and multiple comorbidities. Accurate preoperative risk assessment is therefore essential. The hemoglobin-albumin-lymphocyte-platelet (HALP) score and prognostic nutritional index (PNI) are emerging immunonutritional biomarkers reflecting inflammatory and nutritional status. This study aimed to evaluate and compare the prognostic value of preoperative HALP and PNI scores for predicting 6-month mortality and postoperative complications in elderly hip fracture patients. MATERIAL AND METHODS This retrospective cohort included 549 patients aged≥³65 years who underwent surgical repair of proximal femoral fractures between January 2021 and July 2024. Demographic characteristics, comorbidities, fracture type, and preoperative laboratory data were analyzed. HALP and PNI scores were calculated from admission blood tests. Independent predictors of 6-month all-cause mortality were identified using Cox regression, and receiver-operating characteristic (ROC) analysis determined optimal cut-off values. RESULTS The mean age was 78±9 years, and 51.9% were female. Six-month mortality was 16.4%. Non-survivors had significantly lower HALP and PNI scores (P<0.001). In multivariate Cox analysis, coronary artery disease (HR 2.57, 95% CI 1.66-4.00), postoperative complications (HR 3.97, 95% CI 2.57-6.15), and lower HALP levels (HR 3.11, 95% CI 1.19-8.13) were independently associated with mortality. Additionally, ROC analysis identified a HALP cut-off value of 0.176 for predicting mortality. CONCLUSIONS The HALP score showed modest prognostic value for 6-month mortality and can complement established clinical predictors. Its use in preoperative evaluation could help identify higher-risk patients, but its discriminatory ability should be interpreted with caution.

BACKGROUND Missed appointments (patient no-shows) are a critical challenge undermining healthcare system efficiency globally. This study aims to characterize the patient no-show phenomenon in Poland, identify factors associated with missed appointments, and propose potential measures to reduce the no-show phenomenon in the Polish healthcare system. MATERIAL AND METHODS A nationwide cross-sectional survey was conducted using computer-assisted web interviews (CAWI) from August 1 to 4, 2025. The study used quota sampling stratified by sex, age, and residence to obtain a nationwide sample of 1162 Polish adults aged 18 to 96 years. A self-prepared questionnaire was used. RESULTS Among all respondents, 88.5% used healthcare services within the previous 12 months. Among healthcare users (n=1014), 14% missed appointments without cancellation. Forgetting appointments (42.3%) and communication barriers (27.5%) were identified as the primary reasons for no-shows. Text message (SMS) reminder systems received 62.5% support, while 67.5% endorsed the implementation of a penalty fee for public system non-attendance. Multivariable analysis revealed significantly (P<0.05) increased odds of no-shows among adults aged under 60 years of age, parents with children <18 years (aOR, 2.09; 95% CI, 1.28-3.40), and individuals with moderate (aOR, 1.80; 95% CI, 1.19-2.72) or poor financial status (aOR, 2.60; 95% CI, 1.47-4.60). CONCLUSIONS This study showed a relatively high prevalence of missed appointments in Poland. Young age, parental responsibilities, and economic constraints were associated with higher odds of no-shows. Findings support expanding digital notification systems and multi-channel communication infrastructure to reduce no-shows, rather than using punitive approaches.

Recently analysed data from global population and epidemiological studies from 2022 and 2023 have shown that global incidence and mortality rates from cancer are escalating due to population growth and an increasingly aging population. There were up to 20 million new cancer diagnoses and 9.7 million deaths from cancer in 2022, with projections for cancer diagnoses to reach 35.3 million by 2050. However, recent analysis of the 2022 GLOBOCAN estimates of global and national cancer burden data by gender for 36 cancer sites in 185 countries showed that out of an estimated 18.7 million new cancer cases, 37.8% (7.1 million) were associated with 30 modifiable risk factors: 45.4% (4.3 million) in men and 29.7% (2.7 million) in women. Lung, stomach, and cervical cancer were the leading preventable cancers, and the main preventable risk factors for cancer included tobacco smoking (15.1%), infections with oncogenic viruses (10.2%), and alcohol consumption (3.2%). A third important recent finding is that while mortality rates from cancer have been falling in high-income countries such as the US, possibly due to better screening, diagnosis, and management, cancer incidence and mortality are increasing in low-income and middle-income countries. Finally, some recent lessons have been learned from the COVID-19 pandemic on cancer 'displacement' due to the disruption of cancer diagnostic and management services. This editorial presents four recently identified global trends in cancer incidence and mortality, including modifiable cancer risk factors that may affect individual lifestyle choices and inform global public health policy.

BACKGROUND With the increasing use of large language model (LLM) chatbots in healthcare, evaluating their ability to provide reliable and understandable information in multiple languages is critical, particularly in fields such as anesthesia, where patient education is essential. The study primarily aimed to compare the quality of ChatGPT 4.0's and DeepSeek V3's English responses, with secondary aims to evaluate content and communication differences between English and Turkish responses. MATERIAL AND METHODS Anesthesiologists proficient in both languages were recruited as experts. Ten frequently asked questions in anesthesia were selected and translated for evaluation. Responses from ChatGPT 4.0 and DeepSeek V3 in both English and Turkish were assessed for overall quality and content quality (accuracy, comprehensiveness, and safety) and communication quality (understanding, empathy/tone, and ethics), and Turkish and English responses were compared by the evaluators. RESULTS Eleven experts evaluated the responses. English responses of ChatGPT 4.0 were superior to the English responses of DeepSeek V3 in overall (P<0.001). English responses of ChatGPT 4.0 were superior to the Turkish responses in the terms of overall, content, and communication quality (P<0.001 each) and English responses of DeepSeek V3 were superior to the Turkish responses in the terms of overall (P<0.001), content (P<0.001) and communication (P=0.001) quality. CONCLUSIONS ChatGPT 4.0 performed better than DeepSeek V3 in the English language in terms of overall quality of responses to 10 frequently asked questions in the field of anesthesia and the English responses provided by ChatGPT 4.0 and DeepSeek V3 outperformed the Turkish responses.

BACKGROUND Preoperative mouthwashes are recommended to reduce viral transmission during aerosol-generating procedures (AGP) in dental settings. However, their effectiveness may be compromised due to dilution by continuous water flow from dental unit waterlines (DUWL). This study evaluated the virucidal efficacy of various mouthwashes when delivered through DUWL using a novel 3D-printed dental aerosol model, with human coronavirus OC43 (hCoV-OC43) as a surrogate for SARS-CoV-2. MATERIAL AND METHODS Five mouthwashes - 0.12% chlorhexidine digluconate (CHX), 0.07% cetylpyridinium chloride (CPC), 1% hydrogen peroxide (HP), 0.2% povidone-iodine (PVP-I), and Oral7® - were assessed using suspension and carrier tests at 3 exposure times (30 s, 2 min, and 5 min). Viral infectivity was measured by median tissue culture infectious dose (TCID₅₀/mL), and log reduction values (LRVs) were calculated. The most effective mouthwashes were further evaluated in a novel 3D-printed aerosol model simulating mouthwash delivery through DUWL during AGP. RESULTS All tested mouthwashes significantly reduced viral infectivity within 30 s. CPC, PVP-I, and Oral7® achieved >4 log₁₀ reductions (>99.99%) in suspension and aerosol tests. However, only PVP-I and Oral7® appeared to be non-cytotoxic to the host cells. CONCLUSIONS PVP-I and Oral7® mouthwashes, when delivered via DUWL, rapidly and effectively reduced aerosolized surrogate SARS-CoV-2 within 30 s in this study, while remaining non-cytotoxic to the host cells. These findings support their potential integration into clinical infection control protocols during AGP.