Annals of Medicine and Surgery最新文献

Artificial intelligence (AI) is redefining the precision of surgical wound closure through innovations in deep learning, computer vision, and robotic control. These technologies enable automated wound assessment, trajectory planning, and suturing assistance, with applications emerging across the United States, the United Kingdom, Japan, and India. Yet, the art of closure balancing tension, perfusion, and tissue integrity remains a fundamentally human skill. This work additionally highlights the current gap between theoretical AI capabilities and clinical validation, clarifies tissue-specific and interpretability challenges, and outlines concrete research pathways, including prospective trials, interpretable AI, and multimodal fusion systems. This letter discusses the clinical and technical aspects of AI-guided wound closure, emphasizing the importance of maintaining surgeon oversight. It argues that AI can enhance, but not supplant, human judgment, aligning with international guidelines on transparency and safety in AI deployment. Widespread clinical adoption will require rigorous validation, equitable access, and adherence to frameworks such as the TITAN Guidelines to ensure ethical and effective integration into surgical practice.

Background: Stress fractures are a common overuse injury among physically active populations, yet data on their incidence and characteristics in military trainees remain limited. This study describes epidemiology, anatomical distribution, and management of stress fractures in military students at a tertiary military medical center.

Methods: We performed a retrospective cohort review of 109 male military students diagnosed with stress fractures between January 2020 and August 2025. Demographics, risk factors, fracture sites, and treatment modalities were extracted from electronic medical records and imaging archives; tibial stress fractures were additionally graded using the Fredericson MRI system. Descriptive statistics, including means, standard deviations, frequencies and percentages, and inferential analyses such as chi-square tests, independent-samples t-tests and Mann-Whitney U tests, were conducted using SPSS version 25.0.

Results: The mean age of the cohort was 19.68 ± 1.33 years; 76.1% were under 20 years of age. All fractures involved the lower part of the body, with the tibia most frequently affected (69.7%), followed by the femur (11.0%), foot (8.3%), and hip (8.3%). Anatomically, the right proximal tibia (13.8%) and left proximal tibia (11%) were the most common sites; bilateral injuries accounted for 12.9% of cases. Conservative management was undertaken in 70.6% of cases; 29.4% required surgical intervention, most commonly open reduction and internal fixation. Operative management was significantly associated with fracture location, with hip and femoral fractures more frequently treated surgically than tibial fractures [χ²(5, N = 109) = 37.8, P < 0.001]. Age and body mass index did not differ significantly between operatively and non-operatively managed patients.

Conclusion: While conservative therapy suffices for most, nearly one-third of fractures required surgical stabilization. These findings support early imaging-based diagnosis, graduated training protocols, and targeted prevention strategies to reduce injury burden and maintain operational readiness.

Introduction: Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality worldwide, with high hospitalization and death rates. Early and accurate assessment of disease severity in emergency settings is crucial for guiding treatment and reducing associated costs and mortality. The confusion, urea, respiratory rate, blood pressure, and age ≥ 65 (CURB-65) and quick Sequential Organ Failure Assessment (qSOFA) scoring systems are commonly used tools for prognostication, each with unique strengths. This study aims to compare the predictive capabilities of CURB-65 and qSOFA for intensive care unit (ICU) admission, mortality, and hospital stay duration among CAP patients.

Methods: This cross-sectional, prospective study was conducted over a year at a tertiary hospital. Ninety-three adult CAP patients meeting the inclusion criteria were enrolled. Data on clinical presentation, CURB-65, and qSOFA scores were recorded upon emergency admission. Patients were followed until discharge or death. Statistical analyses, including chi-square tests and area under the receiver operating characteristic (AUROC) curves, were used to compare outcomes predicted by the two scoring systems.

Discussion: Both scoring systems demonstrated utility in predicting adverse outcomes, with qSOFA outperforming CURB-65 for ICU admission (AUROC: 0.817 vs. 0.810). However, CURB-65 was superior in predicting mortality (AUROC: 0.582 vs. 0.535) and hospital stay duration (AUROC: 0.848 vs. 0.829). Positive CURB-65 and qSOFA scores correlated significantly with higher ICU admissions, mortality, and longer hospital stays. Clinical features and comorbidities, such as chronic obstructive pulmonary disease and diabetes, were more prevalent in patients with higher scores.

Conclusion: Both CURB-65 and qSOFA effectively predict ICU admission, mortality, and hospital stay duration in CAP patients. While qSOFA is more sensitive for ICU admission, CURB-65 provides better mortality and length-of-stay predictions, underscoring their complementary roles in clinical decision-making.

Introduction and importance: Congenital diaphragmatic hernia (CDH) is a rare condition in adults, often presenting with nonspecific respiratory symptoms and is easily misdiagnosed. CDH results from pleuroperitoneal canal closure failure during gestation, with Bochdalek hernias comprising the majority and Morgagni hernias (MHs) being rare. This case underscores the importance of considering CDH in adults with respiratory symptoms, especially following trauma.

Case presentation: A 50-year-old woman presented with a 4-month history of intermittent dyspnea worsened by physical exertion, abdominal pain, distention, and constipation. She had a history of a road traffic accident 6 months ago. On physical examination, breath sounds were diminished over the right lung base. Imaging revealed a right-sided diaphragmatic hernia with bowel loops herniated into the thoracic cavity, causing lung compression. Surgical intervention via thoracotomy confirmed a diaphragmatic defect of 15 × 10 cm and hypoplasia of the right lung lobes. Herniated contents were reduced, and the diaphragmatic defect was repaired with mesh. Postoperatively, the patient showed significant symptom relief and was doing well at follow-up.

Clinical discussion: Adult-onset CDH poses a diagnostic challenge and may lead to life-threatening complications. Right-sided MHs are rare. Imaging, especially CT, plays a key role in diagnosis. Prompt surgical intervention provides excellent outcomes and prevents life-threatening complications such as strangulation or cardiorespiratory compromise.

Conclusion: A high index of suspicion should be maintained by clinicians for CDH in adults having unclear respiratory or abdominal symptoms, especially after trauma. Early identification and surgical intervention can prevent complications and lead to favorable outcomes.

Background: Lucid dreaming (LD), which involves being aware of and controlling one's dreams, is of particular interest in the study of consciousness and has potential therapeutic applications. In this narrative review, we highlight the neurobiological aspects of LD, specifically its mechanisms associated with the activation of prefrontal and parietal areas, increased gamma oscillations, and the influence of cholinergic and dopaminergic signaling, primarily during rapid eye movement (REM) sleep.

Objective: To evaluate human data on brain mechanisms and clinical effects, synthesizing the neurobiological foundations and therapeutic possibilities of LD, including remarkably controlled lucid dreams.

Methods: A narrative review of peer-reviewed research involving clinical groups [e.g., post-traumatic stress disorder (PTSD), chronic nightmares, Parkinson's] and healthy individuals (18-45) was synthesized. Objective lucidity verification [vented eye movements, electroencephalography (EEG)/functional magnetic resonance imaging] was a requirement for inclusion criteria. Neurobiological indicators (gamma, alpha, beta waves, and prefrontal cortex/parietal activation), therapeutic benefits (e.g., frequency of nightmares, PTSD and anxiety scores, motor and cognitive gains), and safety and ethical considerations (dissociation and sleep disruption) were among the outcomes evaluated.

Results: LD demonstrates efficacy in modulating nightmares, improving cognitive functions, and potentially alleviating some symptoms in PTSD and neurodegenerative disorders, albeit with methodological constraints. Developments in portable EEG and virtual reality headsets will refine LD research, while interdisciplinary approaches are necessary to address potential risks of dissociation and privacy concerns.

Conclusion: Although evidence remains preliminary, LD shows promise as a therapeutic remedy for PTSD and anxiety symptoms, including a reduction in nightmares. It combines neuroscience and self-agency, highlighting the need for more funding and public awareness campaigns to harness its scientific and clinical prospects. Larger randomized trials with a variety of groups and standardized induction techniques are necessary to verify long-term efficacy and safety.

Introduction and importance: Chronic Myelomonocytic Leukemia (CMML) is a rare clonal hematopoietic disorder with overlapping features of myelodysplastic syndromes and myeloproliferative neoplasms. Its diagnosis becomes more challenging when coexisting with other hematologic malignancies. We report a rare dual pathology of CMML and plasma cell myeloma in an elderly female, highlighting the complexity of diagnosis and management.

Case presentation: An 82-year-old female, previously treated for cervical cancer, presented with bilateral buttock pain, gait disturbance, and weakness. Laboratory findings revealed marked leukocytosis (WBC 85 × 10³/μl), monocytosis (30.1%), anemia, thrombocytopenia, hypercalcemia, and renal dysfunction. Imaging showed sclerotic bone lesions and bilateral hydronephrosis. Bone marrow biopsy revealed 20-25% CD138⁺ plasma cells alongside features of CMML, including myeloid hyperplasia and atypical megakaryocytes. Next-generation sequencing detected NRAS and TET2 mutations. She underwent leukapheresis, hydroxyurea for cytoreduction, and bortezomib-dexamethasone for myeloma. Her course was complicated by cytopenias requiring transfusions. She was discharged to a skilled nursing facility upon stabilization.

Clinical discussion: This case illustrates the diagnostic complexity of overlapping hematologic malignancies. The coexistence of CMML and myeloma, although rare, was confirmed through integrated morphologic, immunophenotypic, and molecular analysis. The presence of NRAS and TET2 mutations supported CMML. Treatment required balancing cytoreduction with supportive care, especially given her renal dysfunction and marrow suppression.

Conclusion: Dual hematologic malignancies demand a multidisciplinary approach. In elderly patients with cytopenias and monocytosis, thorough diagnostic workup is crucial. This case emphasizes the need for personalized therapy in complex hematologic overlap syndromes.

Introduction: Systemic lupus erythematosus (SLE), a multisystemic disease with a global prevalence of 20-150/100 000, predominantly affecting women may have a familial clustering, suggesting a strong genetic predisposition and emphasizing the role of heritable factors in disease pathogenesis. In tuberculosis-endemic regions, pleural effusions are frequently misattributed to tuberculosis, leading to delays in the correct diagnosis and appropriate treatment.

Case presentation: A 42-year-old female with a history of continuous chest pain, aggravated on inspiration, intermittent fever with night sweats, chills and rigor, long standing joint pain involving small joints of hand, knee, and elbow with swelling and elbow has a family history of SLE and was started on anti-tuberculosis therapy, which showed no improvement. Examination was suggestive of pleura involvement. Investigations showed strongly positive antinuclear antibody with a homogeneous pattern and mitotic spindle enhancement. The autoantibody profile showed positivity for anti-dsDNA, anti-Smith, U1-RNP, SSA (Ro), SSB (La), Ro-52, histone, and nucleosome antibodies. Rheumatoid factor was also positive, while KU antibody and DFS70 were borderline positive. Antimalarial drug, corticosteroid, and immune-suppressants with supportive management were given.

Discussion: Familial SLE is uncommon but clearly delineated, with first-degree relatives at far greater risk. Misdiagnosis with tuberculosis is typical in endemic areas due to the overlap of symptoms like pleuritis and fever. Diagnosis can only be made early by a thorough immunologic workup and family history.

Conclusion: This case highlights the importance of considering SLE in patients with unresolved pleural and joint symptoms, especially in the presence of a strong family history. Early recognition of familial SLE can avoid misdiagnosis and lead to better outcomes through timely initiation of immunosuppressive therapy.

Introduction: There is a high prevalence of vitamin deficiency in our healthy population; however, age-related cognitive decline is an emerging global health concern, especially with an aging population and rising cases of dementia. Many trials have been performed to assess the improvement in cognitive functions of people, especially those of older age, by daily multivitamin supplementation. Studies have shown that daily multivitamin intake significantly improves memory in older adults and reduces the risk of cognitive decline.

Methods: A comprehensive search was conducted across PubMed, Embase, and Google Scholar databases from 2003 to 2023. Studies were included based on predefined PICO criteria, focusing on older adults with cognitive decline receiving multivitamin supplementation compared to placebo, with cognitive improvement as the outcome. Nineteen studies meeting the inclusion criteria, comprising randomized trials, reviews, cohort, and cross-sectional designs, were analyzed.

Results: The findings reveal mixed outcomes. Multivitamin supplementation was associated with cognitive improvements, particularly in memory, global cognition, and attention, mainly in individuals with baseline deficiencies or mild cognitive impairment. B-complex vitamins and antioxidant-rich formulas showed the most promising effects. However, in well-nourished or healthy populations, results were often neutral. Variability in study design, supplement composition, assessment tools, and duration were key contributors to these inconsistencies.

Conclusion: The use of multivitamins shows potential cognitive benefits in specific subgroups, particularly the elderly with nutritional deficiencies or early cognitive decline. However, universal cognitive enhancement cannot be concluded. Personalized, targeted supplementation guided by nutritional status may represent the future of cognitive health strategies.

Artificial intelligence (AI) is beginning to aid in several components of the intraoperative workflow, including navigation, instrument tracking, ultrasound analysis, video segmentation, and MRI reconstruction. Early studies demonstrate technical promise but are based on small, single-center datasets with limited heterogeneity and generalizability, and often lead to model overfitting. External validation is rare, and few trials measure the impact on decision-making, complications, or the extent of resection. Differences in annotation standards, imaging protocols and reporting also contribute to the slow speed of translation. Physical, ethical, and regulatory barriers add complexity, especially in settings with limited resources. Recent FDA, EU, and WHO guidance emphasizes lifecycle monitoring, transparency, and real-world evidence, raising the bar for clinical adoption. Progress will require shared databases, standardized reporting, and multicenter implementation studies that track workflow and patient outcomes. Intraoperative AI will definitely not replace a surgeon's judgment, but if carefully developed and rigorously tested, it may provide meaningful clinical value.