Annals of Medicine and Surgery最新文献

Fusobacterium nucleatum (Fn) is increasingly recognized as a clinically meaningful driver in colorectal cancer (CRC), with recent multi-cohort sequencing studies detecting Fn in 35-45% of tumors and levels approaching 50% in stage II-III cases. Meta-analyses including more than 4000 patients consistently link Fn positivity to higher recurrence risk, shorter overall survival, and reduced response to fluoropyrimidine-based chemotherapy. The Fna C2 lineage shows the strongest association with malignancy, appearing in 29.2% of CRC samples compared with 4.8% of healthy controls (P < 5.6 × 10^-15). Engineered Bifidobacterium strains, which naturally accumulate in tumor hypoxic zones at densities near 10⁷ CFU/g, provide a platform for delivering CRISPR antimicrobials capable of reducing targeted microbes by 95-99% in vivo. These findings support efforts to eliminate oncogenic Fn within CRC tumors using precision microbial therapeutics.

Oral cancer, particularly oral squamous cell carcinoma, remains a serious health concern, with a poor prognosis and a late diagnosis. Leukoplakia, erythroplakia, lichen planus, and submucous fibrosis are examples of oral potentially malignant illnesses. However, traditional diagnostic approaches are typically laborious, subjective, and unreliable, leading to delayed diagnosis - when therapy options are limited and survival is compromised. In oral cancer, artificial intelligence (AI) and precision medicine are becoming game-changing technologies that enhance individualized care, treatment planning, and diagnostic precision. Machine learning and deep learning algorithms, particularly convolutional neural networks, can analyze massive, complex datasets from fluorescence to hyperspectral imaging, revealing patterns that are beyond human detection. Recent trials have shown AI systems based on smartphones have demonstrated expert-level accuracy in identifying oral lesions in recent experiments. Through the discovery of biomarkers and the integration of several omics, AI-driven precision medicine also makes customized treatments possible. Nonetheless, issues with patient privacy, data bias, and the opaque "black box" nature of AI systems persist. The future of proactive and individualized oral cancer therapy relies on creating Explainable AI and strong ethical frameworks that encourage transparency, trust, and equitable integration.

Post-myocardial infarction (MI) ventricular remodeling is a major cause of heart failure, despite advances in revascularization and pharmacotherapy. Circulating microRNAs (miRNAs) are emerging as biomarkers for risk stratification and therapeutic targeting. This letter reviews their role in apoptosis, inflammation, and fibrosis, highlights studies from Europe, Asia, and North America, and discusses technological advances, including exosome-based miRNA panels and machine learning models. Limitations include analytical variability, limited geographic representation, and lack of integration into clinical care. Recommendations include standardizing methods, conducting large international studies, and developing actionable miRNA algorithms. Integrating miRNA profiling into post-MI care has the potential to improve risk assessment, personalize therapy, and reduce the burden of heart failure.

Cancer accounts for over 10 million deaths annually, with solid tumors responsible for nearly 90% of cases worldwide. Systemic cytokine administration remains limited by severe toxicity, high-dose interleukin-2 (IL-2) therapy induces grade 3-4 adverse effects in >60% of patients, and treatment-related mortality is around 4%. In this context, engineered Lactobacillus strains designed to express tumor-killing cytokines such as IL-12, IL-15, and TRAIL represent a novel biotherapeutic strategy that combines microbial safety with precision immune activation. Experimental evidence shows that Lactobacillus plantarum secreting IL-12 reduces colorectal tumor volume by 65%, L. casei expressing TRAIL decreases pancreatic tumor mass by 40%, and L. reuteri producing IL-15 enhances CD8+ T-cell infiltration by 45% and improves survival by 30% in murine models. These data illustrate that cytokine-expressing probiotics can replicate the efficacy of systemic cytokine therapy while avoiding dose-limiting toxicity. Integrating synthetic biology tools such as inducible promoters and biosafety kill switches further refines control and containment, making this a viable candidate for translational development. The convergence of immunotherapy and microbiome engineering thus establishes engineered Lactobacillus as a novel, locally acting, and low-toxicity antitumor biotherapeutic with the potential to reshape next-generation cancer treatment.

Background: Interstitial lung disease (ILD) is a progressive disorder with high mortality and limited therapeutic options. National trends in the place of death among adults with ILD in the United States (U.S) remain poorly described, despite increasing emphasis on palliative and end-of-life care.

Method: We analyzed U.S. mortality data (1999-2023) from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) for adults aged ≥45 years with ILD. Deaths were categorized by location, and sociodemographic associations and temporal trends were assessed using multinomial logistic and Joinpoint regression.

Result: A total of 388 120 ILD-related deaths occurred between 1999 and 2023. ILD mortality increased steadily over the study period, with an average annual percentage change of 2.75% (95% CI, 2.55-2.97; P < 0.000001). Nearly half occurred in hospitals (48.5%), followed by home (31.2%), hospice/nursing facilities (17.4%), and outpatient/emergency room (ER) (2.9%). The proportion of inpatient deaths declined from 60.7% in 1999 to 41.4% in 2023. In contrast, home deaths nearly doubled from 21.5% to 38.6%, while hospice/nursing facility deaths increased from 14.3% in 1999 to a peak of 19.5% in 2018, ending at 17.0% in 2023. Outpatient or ER deaths remained relatively stable throughout the study period. Adults ≥85 years most often died in hospice/nursing facilities, whereas those aged 75-84 years most often died in hospitals.

Conclusion: Deaths in ILD have shifted away from hospitals toward home and hospice, while demographic disparities persist. These findings demand urgent end-of-life planning and equitable, targeted palliative care.

Background: Adenomyosis is a benign disease characterized by the invasion of endometrial glands and stroma into the uterine myometrium, commonly presenting with abnormal uterine bleeding.

Methods: This paper retrospectively analyzes three cases of adenomyosis complicated by venous thromboembolism (VTE) in patients hospitalized at our hospital from 2023 to 2025, and discusses its high-risk factors and treatment strategies in combination with the literature review. Inclusion criteria: patients diagnosed with adenomyosis and having a history of menorrhagia complicated by venous thromboembolism. Exclusion criteria: VTE caused by other diseases; patients in menopause.

Result: Case 1 involved a 47-year-old female who developed thrombosis in the right basilic vein after laparoscopic total hysterectomy. Case 2 was a 47-year-old female who experienced lower extremity venous thrombosis following treatment with gonadotropin-releasing hormone agonists (GnRH-a) combined with a levonorgestrel-releasing intrauterine system. Case 3 was a 49-year-old female who developed portal vein, splenic vein, and superior mesenteric vein thrombosis after long-term norethisterone therapy. Clinical experience indicates that GnRH-a combined with dienogest (DNG) can effectively control symptoms and preserve the uterus, but thrombotic risks require vigilance. Through case analysis and literature review, this article emphasizes the importance of individualized treatment plans.

Conclusion: Patients with adenomyosis presenting with an enlarged uterus and menorrhagia are prone to developing VTE. When VTE occurs, total hysterectomy is often selected as the treatment. We attempted a combined regimen of GnRH-a, DNG, and anticoagulant therapy, which was effective in one case.

Objective: Effective postoperative pain management in patients with substance use disorder undergoing orthopedic surgery remains challenging. This study aimed to compare the analgesic efficacy and safety of pethidine and ketorolac in this specific population.

Methods: In this prospective comparative study, 62 patients with substance use disorder undergoing orthopedic fracture repair were randomized into two groups. The ketorolac group (n = 31) received 30 mg of intravenous ketorolac every 6 hours (maximum 120 mg/24 hours), while the pethidine group (n = 31) received 50 mg of intravenous pethidine every 6 hours (maximum 200 mg/24 hours). Pain intensity was assessed using the Visual Analog Scale (VAS) at baseline, 30 minutes, 1 hour, and 24 hours postoperatively.

Results: Demographic characteristics, fracture patterns, and substance use profiles were comparable between groups. Both groups showed a significant pain reduction from baseline to 24 hours postoperatively. The mean reduction in VAS scores was 4.0 ± 1.15 in the ketorolac group and 4.25 ± 0.99 in the pethidine group (P = 0.35). No significant differences in analgesic efficacy were observed at any time point. Both medications were well tolerated with no reported adverse effects.

Conclusion: Both pethidine and ketorolac provided effective postoperative analgesia in patients with substance use disorder undergoing orthopedic fracture surgery, with comparable efficacy and safety profiles. The choice between these analgesics should consider individual patient characteristics and the potential for substance misuse.