Annals of Medicine and Surgery最新文献

Cytopenias - particularly anemia, leukopenia, and thrombocytopenia - are common hematological manifestations among individuals living with human immunodeficiency virus (HIV) and serve as critical markers of disease severity, progression, and treatment response. These hematologic complications often vary across populations due to a complex interplay of genetic, environmental, nutritional, and socioeconomic factors. Ethnoracial diversity significantly influences the expression and outcomes of these cytopenias, necessitating population-specific investigations to guide accurate diagnosis and effective clinical management. In this review, we explore and contrast the hematological profiles of HIV-infected individuals of African and Russian descent, highlighting key differences in prevalence patterns, underlying mechanisms, and associated comorbidities. African populations frequently exhibit higher rates of anemia and benign ethnic neutropenia, which can obscure diagnostic clarity. Meanwhile, Russian populations face unique challenges, including alcohol-induced marrow suppression and coinfections such as hepatitis C, which exacerbate leukopenia and thrombocytopenia. These disparities are further compounded by differences in healthcare access, nutritional status, and the timing of HIV diagnosis and treatment initiation.

Background: Social anxiety disorder (SAD) is a common psychiatric condition marked by an intense fear of negative evaluation and social avoidance, which can significantly impair quality of life. Recent research has highlighted the importance of emotion regulation in the development and maintenance of SAD. Artistic creativity has been suggested as a potential factor that can enhance emotion regulation and reduce social anxiety. This study aimed to investigate the relationship between artistic creativity, emotion regulation difficulties, and social anxiety in adults.

Methods: This correlational, descriptive study was conducted with a sample of 320 participants, including university students and professional or semi-professional artists from Tehran. Participants were selected through convenience sampling. Data were collected using the Torrance Tests of Creative Thinking, the Difficulties in Emotion Regulation Scale, and the Liebowitz Social Anxiety Scale. Pearson correlation and multiple regression analyses were performed using SPSS version 26.

Results: The results revealed a significant negative correlation between artistic creativity and both emotion regulation difficulties (r = - 0.42, P < 0.01) and social anxiety (r = - 0.38, P < 0.01). Additionally, multiple regression analysis showed that artistic creativity significantly predicted 18% of the variance in emotion regulation difficulties and 15% of the variance in social anxiety (P < 0.01).

Conclusion: These findings suggest that enhancing artistic creativity may serve as a protective factor in improving emotion regulation and reducing social anxiety. It is recommended that creative arts programs be incorporated into mental health promotion initiatives, particularly in academic and cultural settings.

Objective: This study investigated the current status of fertility information needs among breast cancer patients of childbearing age and the related influencing factors, to provide a scientific basis for developing targeted interventional strategies.

Method: This cross-sectional study included 196 women of childbearing age with breast cancer who were undergoing treatment in the breast surgery department. Data were collected via the General Information Questionnaire, Fertility Information Needs Questionnaire, Reproductive Concerns After Cancer Scale, Fertility Intention Scale, and Marriage Adjustment Test.

Results: Among married women of childbearing age who have breast cancer, the fertility information needs score was found to be 106.68 ± 8.52. Main factors influencing fertility information needs include age (β = - 0.152, P < 0.001), number of children (β = - 0.113, P < 0.001), fertility consultation (β = - 0.239, P < 0.05), tumor stage (β = - 0.436, P < 0.001), level of reproductive concerns (β = 0.182, P < 0.05), fertility intention (β = 0.44, P < 0.001), and marital adjustment (β = 0.151, P < 0.05). Together, these factors explained 40.5% of the variance in fertility information needs among married women with breast cancer (F = 32.199, P <0.001).

Conclusions: The findings suggest that fertility information needs among breast cancer patients of childbearing age warrant attention, and healthcare providers should develop personalized intervention programs to enhance patients' knowledge and reduce fertility-related concerns.

Neutrophils play a dual role in breast cancer progression, acting as anti-tumorigenic (N1) or pro-tumorigenic (N2) subtypes based on cues from the tumor microenvironment (TME). This review examines the mechanisms driving neutrophil polarization, focusing on how the TME promotes N2 dominance to support tumor growth, angiogenesis, and metastasis. Therapeutic strategies targeting these processes, including cytokine modulation, immune checkpoint inhibitors, and small-molecule drugs, are discussed. Emerging insights into neutrophil biology highlight the potential to reprogram N2 neutrophils into N1 phenotypes, offering promising avenues for enhancing cancer immunotherapy and improving breast cancer outcomes. Neutrophils are critical components of the tumor microenvironment, influencing breast cancer progression through distinct subtypes: anti-tumorigenic N1 and pro-tumorigenic N2 neutrophils. This review delves into the polarization of neutrophils by tumor-derived factors and their contrasting roles in breast cancer biology. N2 neutrophils drive angiogenesis, immunosuppression, and metastasis, while N1 neutrophils counteract these processes. Current therapeutic approaches, including TGF-β inhibitors, chemokine modulation, and immune checkpoint therapies, aim to shift the balance toward N1 neutrophils.

Background: Substance use disorders constitute a major public health crisis in the United States. While overall stroke mortality has declined significantly, trends in stroke mortality among individuals with documented substance use are incompletely understood across demographic and geographic strata.

Objective: To compare stroke mortality trends between individuals with and without documented substance use from 1999 to 2023, and to identify demographic and geographic subgroups with elevated burden.

Methods: We conducted a comparative retrospective analysis using the CDC WONDER database, examining death certificates from 1999 to 2023. Deaths were identified using ICD-10 codes for stroke and substance use. Age-adjusted mortality rates (AAMRs) per 100 000 were calculated using joinpoint regression, stratified by sex, race/ethnicity, age, census region, and urban-rural status.

Results: From 1999 to 2023, stroke accounted for 4 456 273 deaths (average AAMR: 82.85 per 100 000), while stroke with documented substance use resulted in 294 474 deaths (average AAMR: 5.03 per 100 000). Overall stroke AAMR declined from 129.52 to 61.77 per 100 000 (AAPC: - 3.06%, 95% CI: - 3.66% to -2.45%, P <0.001), whereas substance-related stroke AAMR increased from 1.39 to 6.83 per 100 000 (AAPC: 6.64%, 95% CI: 4.93% to 8.38%, P <0.001). Females demonstrated steeper relative increases than males (AAPC: 8.42% vs. 6.27%), with the most dramatic acceleration among older adults ≥65 years (AAPC: 7.36%). Geographic patterns revealed highest rates in Midwest and Western states, with Oregon consistently demonstrating the highest state-level rates (14.28 per 100 000 in 2021-2023). Non-metropolitan areas experienced disproportionate burden compared to metropolitan areas (11.02 vs. 6.38 per 100 000 in 2020).

Conclusions: This study identified divergent mortality trends, with declining overall stroke mortality contrasted by a nearly five-fold increase in stroke deaths with documented substance use. These patterns may reflect true epidemiological changes, improved documentation practices, or both, indicating potential for integrated surveillance and targeted interventions in high-burden populations.

Prolonged armed conflict has raised significant concern about the mental health of military personnel and veterans. Conditions such as post-traumatic stress disorder and depression affect approximately 14-16% of U.S. service members deployed to Afghanistan and Iraq. Other prevalent mental health issues include suicide, traumatic brain injury, substance use disorder, and aggression. Despite the availability of mental health services, stigma remains a major barrier to care, with nearly 60% of affected personnel avoiding treatment. This review examines how stigma influences help-seeking behavior in military populations. A systematic search of PubMed and Scopus was conducted using terms such as "stigma," "health care-seeking behavior," "military personnel," and "mental health," limited to English-language studies published between January 2000 and November 2024. Additional data were obtained from cited references and recent conference materials. The findings indicate that stigma in the military manifests in three main forms: public, self-, and institutional stigma, each of which contributes uniquely to reluctance toward seeking care. There is a consistent negative correlation between stigma and treatment seeking. Programs emphasizing education, peer support, and leadership engagement have shown promise in improving attitudes. Initiatives such as the Real Warriors Campaign and evidence-based treatments like Trauma-Informed Guilt Reduction contribute to reducing stigma and promoting recovery. A multifaceted approach involving policy reform, anti-stigma training, and culturally competent interventions is essential to improving mental health outcomes and service engagement among military members.

The glymphatic system plays a critical role in central nervous system waste clearance, and its impairment is increasingly linked to neuroinflammation and accelerated disease progression. The latest 2025 evidence reveals that inflammatory microglial activation, perivascular aquaporin-4 disorganization, and impaired cerebrospinal fluid-interstitial fluid exchange contribute to dysfunctional neuro-clearance, fostering protein aggregation and neuronal injury. Emerging data also highlight the potential for drug-mediated modulation of glial metabolism, vascular inflammation, and aquaporin-4 stability to support early neuro-barrier protection and glymphatic flow recovery.