Medical sciences (Basel, Switzerland)最新文献

Background and Aims: Although combined general anesthesia and epidural analgesia are used in open surgery to promote rehabilitation and expectoration, as well as to prevent postoperative pulmonary complications, their effect in thoracoscopic esophagectomy remains unclear. This study aimed to address this issue. Patients and Methods: We enrolled 150 patients who underwent thoracoscopic esophagectomy between May 2017 and July 2025. Patient characteristics and postoperative outcomes, including maximum numerical rating scale (NRS) after surgery and pneumonia, were compared between the use and non-use of epidural analgesia. Epidural analgesia was not administered in patients using antithrombotic/anticoagulant drugs or in those with a history of thoracic spine surgery. Postoperative analgesia involved the scheduled administration of acetaminophen in all cases, with patient-controlled analgesia using opioids administered to the non-epidural analgesia group. Results: Epidural analgesia was administered to 113 patients (75.3%). The most common levels of epidural catheter placement were Th8/Th9 in 55 patients (36.7%) and Th7/Th8 in 41 patients (27.3%). Laparoscopy was performed in 129 patients (86.0%). Median NRS was five, and pneumonia occurred in 16 patients (10.7%). The epidural anesthesia group had a higher proportion of squamous cell carcinoma (88.5% vs. 73.0%, p = 0.024), lower lymphocyte counts (1680 vs. 2065, p = 0.020), diabetes (16.8% vs. 37.8%, p = 0.007), and hypertension (54.9% vs. 81.1%, p = 0.006), and circular stapler anastomosis (83.2% vs. 62.2%, p < 0.001). No significant differences were observed in the postoperative NRS, pneumonia, or length of postoperative hospital stay. Conclusions: There was no significant difference in the postoperative NRS and pneumonia between those with or without epidural analgesia in thoracoscopic esophagectomy.

Background: Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) share core features of cognitive rigidity, anxiety, and altered reward processing. Pharmacological options remain limited, and combined modulation of serotonergic and dopaminergic systems may provide new therapeutic directions. This naturalistic study explored the combined use of lurasidone and fluvoxamine in individuals with restrictive AN (AN-r) and comorbid OCD.

Methods: Forty-five female inpatients with AN-r and OCD were followed for six months. Participants received either lurasidone + fluvoxamine (n = 14) or heterogeneous SSRI/antipsychotic regimens (n = 31). Primary outcomes were the Recovery Assessment Scale (RAS) and Body Uneasiness Test Global Severity Index (BUT-GSI). Secondary outcomes included the Eating Disorder Examination-Questionnaire (EDE-Q) and Eating Disorder Inventory-3 (EDI-3). Bayesian repeated-measures ANOVAs were conducted, reporting BF₁₀, BFInclusion, and P(M│data) values, with multiple imputation applied to manage missing data.

Results: Analyses indicated time-related changes across primary outcomes (RAS and BUT-GSI), with moderate-to-strong evidence (BF¹⁰ = 4.2-18.6) supporting overall improvement during treatment. Secondary and exploratory measures showed weaker or inconsistent trends (BF₁₀ < 3). No evidence emerged for group-by-time interactions exceeding anecdotal strength.

Conclusions: Within the constraints of this small, all-female inpatient cohort, the findings illustrate directional, time-related changes compatible with global rehabilitation effects rather than drug-specific efficacy. The study demonstrates the feasibility-and methodological challenges-of applying Bayesian longitudinal modeling to incomplete clinical datasets. Future randomized or adaptive trials incorporating objective endpoints and data-quality pipelines are warranted to test whether serotonergic-dopaminergic-σ-1 synergy provides genuine clinical benefit in the AN-OCD spectrum.

Background: Regenerative therapies have emerged in recent years. In particular, their utility in managing androgenetic alopecia-the most prevalent hair loss condition worldwide, affecting up to half of adults-is an active area of research. Navigating this space can be challenging for physicians due to widespread commercialization, lack of high-quality evidence, and an evolving regulatory landscape.

Objective: To critically review recently published evidence (2020-2025) on platelet-rich plasma, photobiomodulation, stem cells, and exosomes for the treatment of androgenetic alopecia.

Methods: A scoping review was conducted using PubMed, Embase (Ovid) and the Cochrane Controlled Register of Trials in February and November of 2025. Combination therapies were excluded.

Results and conclusions: Platelet-rich plasma is the most studied modality, with emerging investigations into newer formulations such as leukocyte-rich and pure platelet-rich plasma. However, recent studies are limited by inconsistent reporting of cellular composition, short follow-up durations, and a lack of comparative data on treatment protocols. The efficacy of photobiomodulation as a monotherapy remains debated, with inconsistent reporting of device parameters. Stem cells and exosomes show promising, though still limited, clinical evidence in inducing hair regrowth. Standardization of these therapies is crucial, with emphasis on transparency, reproducibility, and patient safety.

Background/objectives: The Fibroblast Growth Factor Receptor 1 (FGFR1, MIM*136350) is a protein member of the fibroblast growth factor receptor (FGFR) family, with various biological functions, such as the normal development control. It contains an extracellular site for the ligand (three Ig-like domains, IgI, IgII, IgIII), a single transmembrane and a cytoplasmic protein tyrosine kinase (TK) domain. Variants in this gene have been associated with a wide spectrum of genetic disorders, including the clinical entity known as FGFR1-related Hartsfield or Hartsfield syndrome (HRTFDS, MIM#615465), which is an autosomal dominant or recessive disorder characterized by the clinical association of split-hand/foot malformation (SHFM) and holoprosencephaly (HPE). Dysmorphic facies, including cleft/lip palate, genitourinary anomalies, cardiovascular defects and intellectual disability/developmental delay (ID/DD) can also be a part of the clinical picture.

Methods: The malformation phenotype of HRTFDS has been reviewed in 26 previously reported patients in terms of single congenital defects, mutational spectrum, impacted protein domains and inheritance. Molecular basis, clinical management, main differential diagnoses and genetic counseling were also illustrated.

Results: SHFM was identified in every patient. The other main associated features included craniofacial defects, skeletal malformation identified at radiography, genitourinary anomalies, HPE and cardiovascular disorders. FGFR1 causative variants mainly impact the TK domain and have a smaller impact on other protein sites (IgII, IgIII).

Conclusions: This study extensively recapitulates the malformation phenotype associated with HRTFDS and the underlying molecular perturbations. A multidisciplinary clinical approach is fundamental, in which genetic counseling can have an important role. However, our results are partial and refer to a restricted number of patients, pointing out the necessity of other descriptions and similar research. Additional studies will expand clinical and molecular knowledge as well as further clarify the biological mechanisms.

Background/Objectives: The use of linezolid in drug-resistant tuberculosis has shown good effectiveness but has a high risk of adverse drug reactions (ADRs). Linezolid-related ADRs have been widely reported and may affect their therapeutic effect. This systematic review aimed to describe linezolid-related ADRs in drug-resistant tuberculosis. Methods: This literature review was conducted on PubMed, Scopus, ProQuest, and Sage without year limitation, up to June 2023. Study quality was assessed using the JBI checklist to evaluate method quality and risk of bias in the included articles. Inclusion criteria included studies assessing linezolid-correlated ADRs in drug-resistant tuberculosis patients with individual regimens, having access to the full text, and using the English or Indonesian language. Potential reporting bias was minimized by comprehensive database search and duplicate screening. Results: Initially, we identified 650 potential studies. Upon further assessment for relevance and eligibility, seven articles were selected for analysis. From seven articles, it was shown that all articles were reporting about linezolid-correlated ADRs. The three main ADRs are hematologic toxicity, peripheral neuropathy, and optic neuritis. In addition, gastrointestinal disorder and hyperlactatemia are reported as ADRs too. Varied doses of linezolid were used in the seven articles; they range from 300 mg to 1200 mg, with 600 mg/twice daily and 1200 mg/day being dominant. Conclusions: Linezolid-associated ADRs are dose- and duration-dependent. Hematological toxicity most commonly occurs at the beginning of treatment, while peripheral neuropathy and optic neuritis appear after long-term use. Therefore, intensive monitoring and therapeutic drug monitoring are essential to ensure the safety of linezolid therapy.

Background/Objectives: Adults with congenital heart disease (ACHD) are at increased risk for mental health problems, particularly depression and anxiety. Emerging evidence suggests that psychological rather than purely medical factors may play a decisive role in explaining individual differences in emotional adjustment. However, comprehensive models integrating multiple cognitive and emotional domains remain scarce. This study aimed to identify the psychological variables most strongly associated with depressive and anxiety symptoms in ACHD when considered simultaneously to inform priorities for psychosocial interventions. Methods: A total of 1136 ACHD (aged 18-85 years; 59.7% female) from the National Register for Congenital Heart Defects, Berlin, completed an online survey assessing depression, anxiety, emotion regulation, illness perceptions, and illness identity. Correlational and multiple regression analyses were conducted, controlling for sociodemographic characteristics, CHD severity, and secondary diseases. Significance level for regression models was set at p < 0.025 due to Bonferroni correction. Results: Rumination showed the strongest positive correlations with both depression and anxiety, whereas acceptance was most negatively correlated. In multiple regression analyses, rumination (highest unique variance explanation with semi-partial R² = 0.068 resp. 0.072) and illness engulfment emerged as the most strongly associated predictors of depressive and anxiety symptoms. Illness-related concerns were not significant predictors. Conclusions: The findings highlight the key role of repetitive negative thinking and an engulfed illness identity in the development of emotional distress among ACHD. Psychotherapeutic interventions targeting rumination, fostering psychological distance from illness identity, and promoting a multifaceted self-concept may be particularly beneficial in this population.

Introduction: This pilot randomized trial evaluated the feasibility of the Manual Diaphragm Release Technique (MDRT) in neurocritical patients on invasive mechanical ventilation (IMV) and explored its immediate effects on diaphragmatic kinematics to inform future trials.

Methods: Adult neurocritical patients receiving IMV and ventilated in an assisted mode (pressure-support ventilation, PSV) at the time of enrollment were randomized to receive a single session of MDRT plus standard physiotherapy vs. a sham maneuver plus standard physiotherapy. The primary outcome was the feasibility of applying MDRT in neurocritical care patients under IMV, operationalized by the recruitment rate, protocol adherence, and incidence of intervention-related adverse events. The exploratory secondary outcomes were immediate diaphragmatic kinematics (contraction and relaxation velocities and inspiratory and expiratory excursions), which were measured by ultrasound to provide preliminary effect-size estimates for future trials.

Results: Twenty neurocritical patients (10 in each group) were randomized and all completed the protocol. Baseline characteristics were comparable between groups. The study demonstrated high feasibility with 80% recruitment rate, 100% adherence, and a mean intervention time of 6.2 ± 1.1 min. No adverse events were observed during or after the intervention. Adjusted analyses revealed no detectable differences in diaphragmatic kinematics between groups after the single session. The adjusted mean differences were 0.1 mm/s (95% CI: -0.3 to 0.5; p = 0.50) for contraction velocity and 0.2 mm/s (95% CI: -0.05 to 0.45; p = 0.11) for relaxation velocity. For diaphragmatic excursion, the difference was 0.5 mm (95% CI: -1.2 to 2.2; p = 0.55) during inspiration and 1.0 mm (95% CI: -0.1 to 2.1; p = 0.08) during expiration.

Conclusions: MDRT was found to be feasible for use in neurocritical patients under mechanical ventilation. Although no immediate effects on diaphragm kinematics were detected, these preliminary findings support the rationale for larger, adequately powered trials to further investigate cumulative or long-term effects.

Trial registration: The trial is registered in ReBEC-Brazilian Registry of Clinical Trials under ID: RBR-3ngffwr.

Background: Intestinal angioedema is an important drug-induced adverse effect that is often misdiagnosed due to vague and nonspecific symptoms. This study aimed to identify drugs with potential to cause intestinal angioedema by performing a disproportionality analysis, supplemented with literature review.

Methods: Using OpenVigil, we extracted relevant individual case safety reports from the United States Food and Drug Administration Adverse Event Reporting System (FAERS) database. Drugs with signal of disproportionate reporting (SDR) of intestinal angioedema were identified. A literature review was performed using PubMed and Embase databases to identify potential suspect drugs.

Results: During 2004-2024, 303 cases of intestinal angioedema were reported to FAERS. Fourteen suspect medications showed SDR; of these, seven drugs were also reported in the literature to have caused intestinal angioedema, including angiotensin-converting enzyme inhibitors, losartan, and acetylsalicyclic acid. A literature search identified 89 relevant articles, providing details of 121 cases. Some drugs linked to intestinal angioedema in the literature did not show SDR.

Conclusions: Disproportionality analysis as well as a literature review showed that most patients were middle-aged females on antihypertensive therapy. The results will assist health professionals in determining the temporal association of acute abdomen with the suspected drug, potentially avoiding unnecessary interventions and their attendant complications.

Background: Interleukin-6 (IL-6) is a key inflammatory cytokine implicated in atherosclerotic plaque progression and carotid vulnerability. Although elevated IL-6 levels have been linked to cerebrovascular risk, its prognostic value in patients undergoing carotid endarterectomy (CEA) remains undefined. This systematic review aimed to investigate the available evidence on the relationship between IL-6 levels, surgical outcomes and mechanistic evidence in CEA patients. Materials and Methods: The review followed the PRISMA statement and AMSTAR-2 critical appraisal guidelines, with the protocol registered on PROSPERO (CRD420251120023). PubMed/MEDLINE, Scopus, and Web of Science were systematically searched up to July 2025 using the terms "interleukin-6" and "carotid endarterectomy". Original studies in humans assessing IL-6 in relation to clinical outcomes after CEA or mechanistic evidence were included without language or date restrictions. Study quality was evaluated using the Cochrane Risk of Bias 2 and NHLBI tools, and evidence certainty was appraised using the GRADE framework. Given the heterogeneity of studies, only a qualitative synthesis was performed. Results: From 1232 records identified, 13 studies encompassing 1396 patients met the inclusion criteria. Most were prospective observational cohorts, with a mean participant age of 68.52 years and 81.16% male predominance. Perioperative stroke and mortality rates were uniformly low (≤2%), consistent with contemporary registry data. Across studies, elevated IL-6 levels-whether systemic or plaque-derived-were consistently associated with symptomatic carotid disease, plaque vulnerability, and adverse long-term outcomes. However, not all studies presented quantitative data on IL-6 levels, limiting the ability to draw definitive prognostic conclusions. Conclusions: Current evidence supports a mechanistic link between IL-6-mediated inflammation and carotid plaque instability, yet robust clinical validation in surgical populations is lacking. Future large-scale, prospective studies incorporating IL-6 measurement are warranted to establish its prognostic utility, guide anti-inflammatory therapeutic strategies, and refine postoperative risk stratification in patients undergoing CEA.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) commonly coexists with type 2 diabetes (T2D), but their independent contributions to redox imbalance, inflammation and immune signaling remain uncertain.

Objectives: This study aimed to evaluate whether the presence of MASLD alone, and the presence of T2D within MASLD, are independently associated with high-risk profiles of oxidative/antioxidant markers, peripheral blood mononuclear cell (PBMC) gene expression and adipocytokines.

Methods: A total of 190 participants were categorized via abdominal ultrasound as controls (n = 46), MASLD (n = 83) or MASLD with T2D (n = 61). Measurements included advanced oxidation protein products (AOPP) and paraoxonase-1 (PON1) activity in serum; messenger ribonucleic acids expression of cluster of differentiation 36 (CD36), Toll-like receptor 9 (TLR9), and glutathione peroxidase-1 in PBMC; and adiponectin, leptin, and resistin in plasma. Biomarker values were adjusted and statistical comparisons among groups were performed using the Quade test. Subsequently, biomarkers were stratified into tertiles to examine associations between high-risk biomarker levels and the presence of MASLD or T2D in patients with MASLD using multivariate binary logistic regression.

Results: Multivariate analysis showed that MASLD presence was independently associated with both increased AOPP and decreased resistin levels in the circulation. Furthermore, T2D presence in patients with MASLD was independently associated with increased CD36 and decreased TLR9 gene expression in PBMCs, as well as elevated circulating leptin levels.

Conclusions: Collectively, these findings underscore the complex interplay between oxidative stress, insulin resistance, inflammation, and immune signaling in the pathogenesis of MASLD, which are fundamental factors contributing to this condition.