AIMS/BACKGROUND:Long-term venous access is essential for administering chemotherapy in gynecological cancers, and the use of arm ports is becoming more common due to their practical advantages. However, postoperative complications remain a significant clinical concern. Currently, investigations specifically predicting the risk of arm port-related complications in gynecological oncology patients are limited. The advances of precision medicine warrant the development of individualized risk prediction tools to optimize clinical decision-making. METHODS:This retrospective analysis enrolled 476 patients who underwent arm ports (APs) implantation in the Gynaecology Department, The Fourth Hospital of Hebei Medical University, between July 2022 and October 2024. Patients were randomly divided into a training set (n = 334) and a validation set (n = 142) using computer-generated random numbers. Univariate and multivariate logistic regression analyses were used to identify independent risk factors, and the significant variables were incorporated into a prediction model. A nomogram of the prediction model was generated. Furthermore, the prediction model was internally validated using the Bootstrap method. The model's discriminative performance, calibration, and clinical utility were determined using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA), respectively. RESULTS:The overall postoperative complication rate was found to be 12.18% (58/476). Multivariate logistic regression analysis identified preoperative neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] = 1.53, 95% confidence interval [CI]: 1.20-1.96), history of ipsilateral arm surgery (OR = 5.02, 95% CI: 2.06-12.23), and planned chemotherapy cycles (OR = 1.52, 95% CI: 1.26-1.85) as independent risk factors of postoperative complications (all p < 0.05). The nomogram prediction model constructed based on these factors demonstrated superior performance, yielding an area under the curve (AUC) of 0.819 (95% CI: 0.756-0.882) in the training set and 0.869 (95% CI: 0.793-0.945) in the validation set. The calibration curve showed good agreement between predicted probabilities and the actual observed incidence of postoperative complications. DCA indicated that the model showed greater clinical benefit than either treating all or treating no patients across a moderate range of threshold probabilities. CONCLUSION:The proposed prediction model demonstrates fair to good capability in assessing the risk of postoperative complications following AP implantation in gynecological oncology patients. It supports clinicians in identifying high-risk individuals before surgery and enabling the implementation of targeted preventive approaches.
AIMS/BACKGROUND:Malnutrition represents a major clinical concern in geriatric populations and is strongly associated with adverse outcomes and increased mortality, particularly among patients admitted to the intensive care unit (ICU). This study aimed to compare the predictive performance of the modified Nutrition Risk in the Critically Ill (mNUTRIC) score and the Prognostic Nutritional Index (PNI) for 30-day mortality in geriatric ICU patients. METHODS:This retrospective study included 704 geriatric patients admitted to the ICU between December 2023 and June 2025 with a length of stay exceeding 24 hours. The mNUTRIC score and PNI were calculated using data obtained within the first 24 hours following ICU admission. Demographic and clinical characteristics were also evaluated and compared between groups according to these nutritional scoring systems. The primary outcome was 30-day mortality. RESULTS:Of the 704 patients, 301 (42.76%) died during ICU follow-up, and 257 patients (36.51%) died within 30 days. Both the mNUTRIC score and PNI differed significantly between survivors and non-survivors (p < 0.001 for both). Patients with high mNUTRIC scores demonstrated significantly higher rates of both 30-day mortality and ICU mortality compared with those with low scores (p < 0.001 for all comparisons). Receiver operating characteristic (ROC) curve analysis showed that the mNUTRIC score had an area under the curve (AUC) of 0.753, with a cut-off value of 5.5, sensitivity of 0.743, and specificity of 0.638. In contrast, PNI demonstrated the lowest predictive performance among the evaluated scores, with an AUC of 0.624 and a cut-off value of 36.175. CONCLUSION:Both the mNUTRIC score and PNI are useful for predicting 30-day mortality and clinical outcomes in geriatric ICU patients; however, the mNUTRIC score demonstrates superior predictive performance. Future research should further investigate their integration with established scoring systems and their utility in longitudinal trend monitoring.
AIMS/BACKGROUND:Patients with concomitant heart failure (HF) and type 2 diabetes mellitus (T2DM) are at high risk for adverse clinical outcomes. Glycemic variability (GV) has emerged as a crucial metric for assessing dysglycemia. However, its determinants in this specific patient population remain poorly characterized. This study aimed to investigate factors associated with GV in hospitalized patients with HF and T2DM. METHODS:A total of 150 patients hospitalized with T2DM and HF were enrolled. Clinical and laboratory data were collected, and multiple linear regression analysis was performed to identify independent factors associated with four GV indices: standard deviation of blood glucose (SDBG), coefficient of variation (CV), mean of daily differences (MODD), and mean amplitude of glycemic excursions (MAGE). RESULTS:Multivariate analysis revealed that C-peptide level was significantly negatively associated with all four GV indices (SDBG: β = -0.219, p < 0.001; log(CV): β = -0.080, p < 0.001; MODD: β = -0.176, p < 0.001; MAGE: β = -0.284, p < 0.001). Age showed significant positive associations with SDBG (β = 0.020, p < 0.001), log(CV) (β = 0.009, p < 0.001), and MODD (β = 0.027, p < 0.001). Diabetes duration was significantly positively associated with SDBG (β = 0.028, p < 0.001), log(CV) (β = 0.011, p < 0.001), and MODD (β = 0.029, p < 0.001). Glycated hemoglobin (HbA1c) was significantly positively associated with SDBG (β = 0.062, p = 0.002), MODD (β = 0.125, p < 0.001), and MAGE (β = 0.196, p < 0.001). Log-transformed N-terminal pro-B-type natriuretic peptide (NT-proBNP) (log(NT-proBNP)) was significantly positively associated with all GV indices (SDBG: β = 0.085, p = 0.002; log(CV): β = 0.046, p = 0.002; MODD: β = 0.090, p = 0.009; MAGE: β = 0.162, p = 0.003). Additionally, family history of diabetes was positively associated with SDBG (β = 0.184, p = 0.001), log(CV) (β = 0.088, p = 0.004), and MODD (β = 0.175, p = 0.012). A history of cardiovascular disease was positively associated with MAGE (β = 0.265, p = 0.024). Body mass index (BMI) was negatively associated with MODD (β = -0.036, p < 0.001) but positively associated with MAGE (β = 0.037, p = 0.007). The regression models explained 34.9% to 49.6% of the variance across the different GV indices. CONCLUSION:Glycemic variability in hospitalized patients with T2DM and HF is influenced by multiple clinical and metabolic factors. C-peptide level, age, diabetes duration, HF severity (reflected by NT-proBNP), and overall glycemic control are primary factors associated with GV. These findings suggest that clinical management should adopt individualized strategies that account for the heterogeneity and distinct characteristics of different GV indices.
AIMS/BACKGROUND:Psychological distress is highly prevalent among patients undergoing maintenance hemodialysis and may adversely affect treatment adherence and overall quality of life. Evidence-based nursing (EBN) practices and cognitive behavioral theory (CBT)-based approaches have each shown potential value in dialysis care. However, evidence regarding their integration into routine nursing practice in real-world clinical settings remains limited. This study aims to examine the impact of exposure to a structured nursing care pathway incorporating EBN and CBT-informed supportive nursing on psychological, quality-of-life, and selected clinical stability outcomes in patients receiving maintenance hemodialysis. METHODS:This single-center retrospective cohort study included 236 adult patients with chronic renal failure undergoing maintenance hemodialysis between March 2023 and February 2024. Patients were classified according to the nursing care pathway received during routine clinical practice: standard care or a structured nursing care pathway integrating EBN and CBT-informed supportive communication. Propensity score matching (1:1) was applied to balance baseline demographic, clinical, laboratory, and psychological characteristics. Outcomes assessed over a 12-week observation period included nutritional markers (hemoglobin and serum albumin), the Kt/V, psychological status (Self-Rating Anxiety Scale and Self-Rating Depression Scale), quality of life (Generic Quality of Life Inventory-74), and dialysis-related complications. RESULTS:After propensity score matching, 186 patients (93 per group) were included in the final analysis. Renal function indicators, electrolyte levels, and inflammatory markers remained stable in both groups throughout follow-up, with no significant between-group differences. Anxiety and depression scores were lower at follow-up in the structured nursing care pathway group than in the standard nursing care group (both p < 0.001), and both groups showed reductions in these scores from baseline (both p < 0.001). At follow-up, the structured nursing care pathway group had higher quality-of-life scores in the physical, psychosocial, and social domains (all p < 0.05), whereas no significant between-group difference was observed in the material well-being domain (p > 0.05). Dialysis adequacy and nutritional indicators were maintained within clinically acceptable ranges in both groups. The incidence of dialysis-related complications was lower in the structured care group, although statistical significance was not observed. CONCLUSION:In a real-world clinical setting, exposure to a structured nursing care pathway incorporating EBN and CBT-informed supportive communication was associated with more favorable psychological outcomes and selected quality-of-life domains among patients undergoing maintenance hemodialysis, without compromising clinical stability. These findings suggest the potential value of optimizing nursing care pathways to address psychosocial needs in hemodialysis care.
AIMS/BACKGROUND:Knee hyperextension during walking is a common clinical concern in stroke patients that worsens lower limb dysfunction and reduces quality of life. This condition is commonly managed through repetitive transcranial magnetic stimulation (rTMS) and lower limb rehabilitation robots. This study aims to explore the therapeutic effect of combining rTMS with lower limb rehabilitation robots on knee hyperextension in stroke patients. METHODS:This retrospective study included 158 stroke patients who underwent rehabilitation treatment in the Department of Rehabilitation Medicine, Shanghai Tianyou Hospital between January 2024 and May 2025. Based on the treatment, the patients were divided into a rTMS group, a lower limb rehabilitation robot (UGO) group, and a repetitive transcranial magnetic stimulation combined with lower limb rehabilitation robot (rTMS+UGO) group. Brunnstrom staging and knee hyperextension angle were applied to evaluate lower limb motor recovery and knee joint alignment. The lower limb motor function was assessed with the Fugl-Meyer Assessment for Lower Extremity (FMA-LE) score, and balance was examined using the Berg balance scales. The modified Barthel Index (MBI) was used to evaluate activities of daily living. Quadriceps and hamstring co-contraction patterns were assessed using surface electromyography and isokinetic muscle strength testing. RESULTS:After 4 weeks of treatment, the Brunnstrom stage, FMA-LE, Berg score, and MBI score were significantly higher in all three groups compared with before treatment (p < 0.05). The therapeutic effect in the combined-treatment (rTMS+UGO) group was significantly better than that observed in the rTMS and UGO groups (p < 0.05). The knee hyperextension angle decreased over time in all three groups. However, after 4 weeks, the knee hyperextension angle was significantly lower in the rTMS+UGO group than in the rTMS and UGO groups (p < 0.05). Isokinetic muscle strength testing showed that, after 4 weeks of treatment, peak torque (PT), peak torque relative to body weight (PT/W), and total work (TW) during knee extension were significantly higher in all three groups (p < 0.05), with the greatest improvement observed in the combined-treatment group (p < 0.05). Surface electromyography findings showed that average electromyographic (AEMG) of the affected vastus medialis and rectus femoris was higher (p < 0.05) whereas AEMG of the affected hamstring muscles and gastrocnemius was substantially lower after treatment in the three groups (p < 0.05). Additionally, these therapeutic effects were more pronounced in the combined-treatment group than in the other two groups (p < 0.05). CONCLUSION:Both rTMS and lower limb rehabilitation robotics can reduce knee hyperextension in stroke patients with hemiplegia to a certain extent. However, their combination demonstrates a more pronounced therapeutic effect, substantially improving lower limb motor function and enhancing the stability of the knee joint.
AIMS/BACKGROUND:Urticaria is a common inflammatory skin disease that significantly impairs the quality of life and mental health of adolescents and young adults. Despite its increasing impact, comprehensive long-term epidemiological data focusing specifically on the young population across diverse Asian regions remain limited. This study aimed to assess the burden of urticaria among adolescents and young adults in Asia from 1990 to 2021, and to project its changes through 2036. METHODS:A repeated cross-sectional analysis using Global Burden of Disease (GBD) Study 2021 data was conducted to estimate the burden of urticaria prevalence, incidence, and disability-adjusted life years (DALYs) among Asian adolescents and young adults (ages 10-24) from 1990 to 2021. Data analysis was performed from November 2024 to April 2025. RESULTS:From 1990 to 2021, the prevalence, incidence, and DALYs for urticaria increased among Asian adolescents and young adults, with rates consistently higher in females. In 2021, there were 16,347,995 new cases (95% uncertainty interval [UI]: 12,625,370 to 21,681,388). The prevalence rose from 863.13 (95% UI: 761.99 to 983.08) to 877.84 (95% UI: 775.68 to 1000.20) per 100,000 population (average annual percent change [AAPC] = 0.055%, 95% confidence interval [CI]: 0.053% to 0.056%). The incidence increased from 1525.51 (95% UI: 1341.63 to 1728.55) to 1552.60 (95% UI: 1369.05 to 1758.22) per 100,000 population (AAPC = 0.057%, 95% CI: 0.055% to 0.057%). The DALY rate grew from 51.74 (95% UI: 34.15 to 74.31) to 52.78 (95% UI: 34.65 to 76.09) per 100,000 population (AAPC = 0.064%, 95% CI: 0.063% to 0.065%). Overall, Central Asia has the highest age-standardized prevalence, incidence, and DALYs. Health inequality assessments indicated that the disease burden has intensified in low socio-demographic index (SDI) regions due to unequal medical resources. The incidence is projected to continue rising over the next 15 years, reaching 1568.89 (95% prediction interval [PI]: 1552.24 to 1592.05) per 100,000 population by 2036. CONCLUSION:Over the past three decades, urticaria has shown significant increases in prevalence, incidence, and DALYs across the region, with females exhibiting higher morbidity rates than males. This trend is expected to persist through 2036. These findings underscore the urgent need for targeted public health interventions and more equitable distribution of medical resources to mitigate the escalating disease burden, particularly in high-burden, low-SDI regions.
AIMS/BACKGROUND:Early neurological deterioration (END) after thrombolysis is a serious complication in acute ischemic stroke (AIS); however, its early identification remains challenging. This study aimed to investigate the value of amplitude-integrated electroencephalography (aEEG) combined with CD4+/CD8+ ratio in assessing END in patients with AIS. METHODS:The study enrolled 210 AIS patients who underwent thrombolysis at Shangyu People's Hospital of Shaoxing, China, between May 2020 and May 2025. Based on whether the National Institutes of Health Stroke Scale (NIHSS) score at 24 hours post-thrombolysis increased by ≥4 points compared to the score at admission, patients were divided into an END group (score increase ≥4, n = 61) and a non-END group (score increase <4, n = 149). Clinical data were compared between the two groups. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of the aEEG score and CD4+/CD8+ ratio, both individually and in combination, for END after thrombolysis. Multivariate logistic regression analysis was performed to identify factors influencing END post-thrombolysis. Furthermore, two predictive models were constructed and their predictive efficacy evaluated: Model 1 (excluding aEEG score and CD4+/CD8+ ratio) and Model 2 (including aEEG score and CD4+/CD8+ ratio). RESULTS:The onset-to-needle time in the END group was significantly longer than in the non-END group. NIHSS score at admission, white blood cell count (WBC), Systemic Inflammation Response Index (SIRI), and aEEG score were significantly higher in the END group, while the CD4+/CD8+ ratio was significantly lower (p < 0.001). The area under the ROC curve (AUC) was 0.755 for the aEEG score, 0.776 for the CD4+/CD8+ ratio alone, and 0.862 for their combination. Multivariate logistic regression analysis showed that prolonged onset-to-needle time, higher NIHSS score at admission, increased WBC count, elevated SIRI, and higher aEEG score were independent risk factors for END after thrombolysis, with an increased CD4+/CD8+ ratio serving as a protective factor (p < 0.05). Both Model 1 and Model 2 demonstrated good goodness-of-fit (p = 0.856 and 0.997, respectively), with AUCs of 0.944 and 0.991. In Model 2, the variance inflation factor (VIF) for all six influencing factors ranged from 1.070 to 1.383. CONCLUSION:The aEEG score and the CD4+/CD8+ ratio have a significant influence on the occurrence of END in AIS patients after thrombolysis, and their combination improves predictive performance.
AIMS/BACKGROUND:Although laparoscopic surgery for colon cancer offers advantages over open surgery, such as minimal invasion and faster recovery, the transverse colon presents unique challenges due to its special anatomical location and complex vascular and lymphatic drainage. This study aimed to identify independent risk factors and to develop a corresponding combined predictor for perioperative complications following laparoscopic radical resection of transverse colon cancer. METHODS:Retrospective clinical data from 170 patients with transverse colon cancer who underwent laparoscopic colectomy at The First People's Hospital of Yongkang between January 2020 and July 2025 were analyzed. According to the Clavien-Dindo classification system, patients were divided into a complication group (Clavien-Dindo grade ≥I) and a non-complication group. Baseline demographics, surgical variables, and occurrence of perioperative complications were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for complications. The combination of these independent risk factors was then assessed as a composite predictor. Its predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS:Among the cohort, 43 patients experienced complications (complication group) while 127 did not (non-complication group). Univariate logistic regression analysis revealed that age, presence or absence of comorbid diabetes mellitus, type of abdominal anastomosis, and operation time were associated with perioperative complications following laparoscopic colectomy for transverse colon cancer (p < 0.05). Multivariate logistic regression analysis revealed that comorbid diabetes mellitus (odds ratio [OR] = 4.656, 95% confidence interval [CI]: 1.715-12.640, p = 0.003), extracorporeal anastomosis (OR = 5.943, 95% CI: 2.497-14.142, p < 0.001), and an operation time exceeding 3 hours (OR = 4.520, 95% CI: 1.929-10.595, p < 0.001) were independent risk factors for perioperative complications. The area under the ROC curve (AUC) for the predictor combining these three factors was 0.825 (95% CI: 0.752-0.897, p < 0.001), demonstrating superior predictive efficacy compared to any single factor alone. CONCLUSION:Comorbid diabetes mellitus, extracorporeal anastomosis, and operation time >3 hours are independent risk factors for perioperative complications in patients undergoing laparoscopic resection of transverse colon cancer. The combination of these three risk factors shows good predictive value and holds promise for guiding targeted clinical interventions to improve patient outcomes.
AIMS/BACKGROUND:Hemodialysis is the primary form of treatment for patients with chronic renal failure. The lengthy dialysis process and rigid treatment schedule often lead to poor patient adherence. This study aims to explore the effects of interdisciplinary collaborative nursing and routine nursing on hemodialysis compliance in patients with chronic renal failure. METHODS:This retrospective analysis included clinical data of 136 patients with chronic renal failure who underwent hemodialysis in Zibo Central Hospital from April 2021 to January 2022. The patients were divided into a control group and an observation group according to the type of nursing care given. The control group received routine nursing, whereas the observation group received nursing intervention based on an interdisciplinary collaborative nursing model. Hemodialysis compliance, anxiety, awareness of disease, and health-related quality of life among the patients were evaluated. RESULTS:Compared to the control group, the observation group exhibited significantly higher levels of hemodialysis compliance and disease knowledge (p < 0.05). The anxiety level of the observation group was significantly lower than that of the control group (8.04 ± 5.06 vs. 12.49 ± 4.87; p < 0.001). In terms of quality of life, the observation group scored higher than the control group in physical, psychological, social, and environmental domains (p < 0.05). CONCLUSION:The interdisciplinary collaborative nursing enhances hemodialysis compliance in patients with chronic renal failure, ameliorates their anxiety, and improves their health-related quality of life. This research provides a theoretical basis for the design and selection of clinical management plans in the future.
AIMS/BACKGROUND:Phaeochromocytoma is a rare catecholamine-secreting neuroendocrine tumour arising from chromaffin cells of the adrenal medulla or from extra-adrenal paraganglionic tissue, in which case it is termed paraganglioma. Its clinical presentations are highly variable with up to 10-20% of patients being asymptomatic or having non-specific symptoms, therefore leading to frequent misdiagnosis. The aim of this case report is to present a rare and diagnostically challenging presentation as well as highlight the need to maintain a high index of suspicion in patients with unexplained cardiovascular symptoms. CASE PRESENTATION:A 54-year-old female presented with acute chest pain and atrial fibrillation, initially suggestive of acute coronary syndrome. However, coronary angiography demonstrated unobstructed coronary arteries, and electrocardiogram (ECG) changes resolved. Persistent symptoms and refractory hypertension prompted further investigation, which revealed a left adrenal mass and significantly elevated urinary metanephrines, consistent with a diagnosis of phaeochromocytoma. RESULTS:After the diagnosis was confirmed by Endocrinology, treatment with phenoxybenzamine was initiated and titrated to 10 mg twice daily, resulting in stabilisation of her blood pressure and heart rate. Bisoprolol was added for further rate control. Following preoperative optimisation, the patient later underwent an uncomplicated laparoscopic adrenalectomy. At follow-up, she remained in sinus rhythm with a normalised blood pressure and resolution of symptoms. CONCLUSION:This case highlights the diagnostic challenge posed by phaeochromocytoma, which can mimic myocardial infarction and myocarditis due to catecholamine-induced cardiac effects.
AIMS/BACKGROUND:Hounsfield unit (HU) measurements on computed tomography (CT) offer quantitative information on tissue composition, yet their dynamic changes during CT-guided transthoracic core needle biopsy (TCNB) have not been previously investigated. This study aimed to determine whether the post-biopsy change in HU (ΔHU) at the needle tract can predict histopathological outcomes in thoracic lesions, serving as a surrogate marker of tissue viability and vascularity. METHODS:This study retrospectively included 166 patients who underwent CT-guided TCNB between June 2023 and November 2025. Non-contrast CT images (2-mm slices) obtained immediately before and after biopsy were analyzed. Regions of interest were placed along the biopsy tract, avoiding air and necrotic components. ΔHU was calculated by subtracting pre-biopsy from post-biopsy HU values. Two radiologists independently measured HU, with excellent interobserver agreement (α = 0.849). ΔHU values were compared across histopathological groups (malignant, necrotic, inflammatory), and diagnostic performance was assessed using receiver operating characteristic (ROC) analysis. RESULTS:Malignant lesions demonstrated higher attenuation values pre-biopsy (median 32 [interquartile range (IQR) 25-40] HU) and post-biopsy (41 [35-49.25] HU) compared with necrotic (31.5 [24.5-35] HU and 25 [20-30] HU) and inflammatory lesions (27 [12-35] HU and 25 [12-37] HU), respectively (p < 0.001). ΔHU was positive in malignant lesions (10 [7-13] HU), negative in necrotic lesions (-3.5 [-6 to -1.25] HU), and minimal in inflammatory lesions (1 [-2 to 2] HU) (p < 0.001). ΔHU showed excellent discriminatory ability for malignancy (area under the curve [AUC] = 0.956), with a sensitivity of 94% and a specificity of 78%. CONCLUSION:ΔHU measurement during TCNB may serve as a quantitative biomarker with potential to differentiate malignant from necrotic or inflammatory thoracic lesions. Incorporating ΔHU may provide additional information that could enhance diagnostic confidence and guide biopsy targeting, although prospective studies are needed to confirm its impact on clinical decision-making.
AIMS/BACKGROUND:Primary ciliary dyskinesia (PCD) is a rare autosomal recessive disorder characterised by structural or functional abnormalities of the cilia, which prevent proper oscillation. Patients typically present with symptoms such as chronic respiratory infections, bronchiectasis, and, in approximately half of the cases, inversion of internal organs. Due to its diverse clinical manifestations and lack of specificity, PCD is often misdiagnosed or underdiagnosed, and diagnosis in the neonatal period remains notably challenging. Therefore, this study aimed to analyse the clinical characteristics of the two cases, optimise PCD treatment, and improve the accuracy and timeliness of PCD diagnosis. CASE PRESENTATION:This article reports two cases of twin sisters at 34+3 weeks of gestation who were diagnosed with PCD during the neonatal period. The patients, twin girls conceived naturally, were transferred to Department of Pediatrics after cesarean delivery at Pu'er People's Hospital on 26 September 2024, at 11:24, due to cyanosis and shortness of breath after birth. Prenatal examination at 13 weeks revealed "dextrocardia with abdominal situs inversus" in both fetuses. Delivery was by emergency cesarean section due to premature rupture of membranes. After birth, the twins presented with respiratory distress symptoms, including cyanosis and shortness of breath. Bedside chest radiography revealed hyaline membrane disease, dextrocardia, and abdominal situs inversus. Treatments such as non-invasive ventilator-assisted ventilation and anti-infective therapy were initiated after admission. However, the patients repeatedly experienced breathing difficulties, alternating atelectasis in both lungs, difficulty weaning from the ventilator, and episodes of desaturation. RESULTS:Peripheral blood genetic testing confirmed a Dynein Axonemal Heavy Chain 5 (DNAH5) gene mutation as the cause of PCD. Following treatment with non-invasive ventilator-assisted ventilation, oxygen therapy in an incubator, nebulization (e.g., hypertonic saline), patting back and sputum aspiration, prone position ventilation, and postural drainage, both patients improved and were discharged. CONCLUSION:In neonates with unexplained respiratory distress, especially those with situs inversus, early refinement of diagnostic tools, including genetic testing, is crucial to confirm PCD promptly, enable timely intervention, and prevent irreversible lung injury.
AIMS/BACKGROUND:Acromioclavicular (AC) joint dislocation is associated with severe pain, functional impairment, and postoperative complications. This study aimed to compare the efficacy and safety of TightRope with hook plate fixation for Rockwood type III injuries and to develop a postoperative complication prediction model. METHODS:This retrospective study enrolled 178 patients with acute Rockwood type III AC joint dislocation who underwent surgical treatment at Tongliao People's Hospital, China, between January 2020 and December 2023. Among them, 93 patients received arthroscopic TightRope fixation and 85 underwent conventional hook plate fixation. Perioperative parameters, radiographic outcomes, functional recovery, and complication rates were compared between the two groups. Linear regression was employed to identify factors influencing key recovery indicators, and a logistic regression model was constructed to predict complications. RESULTS:The TightRope group exhibited significantly less intraoperative trauma, as indicated by reduced blood loss and shorter incision length (both p < 0.001). Postoperative infection was less frequent with TightRope (2.15% vs. 10.59%). At 6 months postoperatively, radiographic parameters-including coracoclavicular distance (CCD), acromioclavicular distance (ACD), and acromioclavicular index (ACI)-and functional outcomes (American Shoulder and Elbow Surgeons [ASES], Constant-Murley, and University of California, Los Angeles [UCLA] scores) demonstrated improvement in the TightRope group, along with lower visual analog scale (VAS) pain scores (all p < 0.05). Linear regression analysis identified operation type, intraoperative blood loss, and implant displacement as independent predictors of recovery. Logistic regression revealed TightRope as an independent protective factor for complications (odds ratio [OR] = 0.42, p = 0.028), whereas blood loss (OR = 1.86, p = 0.017) and ACD (OR = 1.34, p = 0.042) were independent risk factors. The prediction model showed good discrimination in the training set (area under the curve [AUC] = 0.84, 95% confidence interval [CI]: 0.76-0.92) and validation set (AUC = 0.76, 95% CI: 0.64-0.89), with satisfactory calibration (Hosmer-Lemeshow p = 0.177, p = 0.477) and clinical utility demonstrated by decision curve analysis. CONCLUSION:Compared with hook plate fixation, the TightRope technique offers superior stabilization, improved functional recovery, and reduced complication rates in the management of acromioclavicular joint (ACJ) dislocations. The proposed predictive model provides a valuable tool for preoperative risk assessment and surgical decision-making.
AIMS/BACKGROUND:Congenital adrenal hyperplasia (CAH) results from 21-hydroxylase deficiency (21-OHD), which is the most frequent form of CAH and often presents with atypical symptoms. Patients with non-classic 21-OHD (NC-21-OHD) are particularly susceptible to diagnostic challenges, including misdiagnosis and underdiagnosis. This study reports a case of NC-21-OHD and underscores the associated challenges in its diagnosis, treatment, and clinical management. CASE PRESENTATION:This study reports a 56-year-old male patient who presented with fatigue lasting over a year. Initial ultrasound revealed a hypoechoic mass above the left kidney, and further evaluation, including renal tumor evaluation and computed tomography angiography, indicated thickening of the adrenal glands and multiple lesions. Endocrinological assessment revealed reduced luteinizing and follicle-stimulating hormone levels, along with elevated dehydroepiandrosterone sulfate and abnormal corticotropin, ultimately diagnosing the patient with primary adrenal insufficiency. Furthermore, genetic screening identified heterozygous mutations in the CYP21A2 (cytochrome P450, family 21, sub-family A, polypeptide 2) gene, confirming CAH due to NC-21-OHD. The patient was treated with hydrocortisone at a dosage of 20 mg twice a day. RESULTS:Hydrocortisone therapy resulted in a significant alleviation of fatigue symptoms and a substantial reduction in 17α-hydroxyprogesterone (17-OHP) levels, thereby enhancing the patient's confidence in disease management. CONCLUSION:This case emphasizes the significance of early recognition of nonspecific symptoms, prompt diagnosis, and timely treatment in managing CAH to enhance the overall quality of life and reproductive health in affected individuals.
AIMS/BACKGROUND:The incidence of hyperuricemia is increasing globally, and febuxostat is a commonly used therapeutic agent. Investigating the relationship between febuxostat therapy and cardiovascular events in patients with hyperuricemia is of significant clinical value. This study aimed to construct a cardiovascular event prediction model for patients with hyperuricemia treated with febuxostat and to analyze factors associated with cardiovascular events, to provide a basis for clinical risk management. METHODS:This single-center retrospective cohort study enrolled patients with hyperuricemia who were treated with febuxostat at Quzhou Municipal People's Hospital between January 2021 and January 2024 and were followed up at 3, 6, and 12 months after treatment. Baseline information, including age, body mass index, and medical history, was collected. Univariate and multivariate analyses were performed using binary logistic regression to identify influencing and predictive factors, and a cardiovascular event risk prediction model was established. The predictive performance and clinical applicability of the model were evaluated using nomograms, receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). RESULTS:A total of 700 patients with hyperuricemia receiving febuxostat were included, and the incidence of cardiovascular events during follow-up was 19.0%. Multivariate logistic regression analysis identified age (odds ratio [OR] = 1.05), prior hypertension (OR = 5.10), and body mass index (BMI, OR = 1.22) as independent predictors of cardiovascular events. Based on these variables, the established prediction model demonstrated good discriminatory ability, with a high area under the curve (AUC). The AUC of the nomogram model was 0.80 (0.74-0.85) in the training set and 0.78 (0.69-0.87) in the validation set. The calibration curve showed good agreement (Hosmer-Lemeshow test, p > 0.05). Decision curve analysis indicated a significant net clinical benefit. CONCLUSION:The cardiovascular event prediction model developed in this study demonstrates good predictive performance and may serve as a useful clinical tool for cardiovascular risk assessment in patients with hyperuricemia. Age, BMI, and prior hypertension are important independent risk factors for cardiovascular events in patients with hyperuricemia. Future multicenter, long-term prospective studies are warranted to further validate the generalizability of this model and the cardiovascular safety of febuxostat treatment.
AIMS/BACKGROUND:Providing effective nursing interventions alongside pharmacological treatment is essential for enhancing children's cooperation, alleviating clinical symptoms, and promoting recovery. This study aims to investigate the effects of therapeutic play combined with emotional soothing care on clinical outcomes, nutritional status, and sleep quality in children with acute diarrhea, and to inform a comprehensive nursing strategy for clinical management. METHODS:This retrospective study included 148 children with acute diarrhea admitted to the Women and Children's Hospital of Ningbo University between June 2023 and May 2025. Participants were grouped according to the nursing intervention received: children receiving emotional soothing care were assigned to the control group (n = 78), whereas those receiving therapeutic play combined with emotional soothing care were assigned to the observation group (n = 70). Baseline characteristics and clinical data were extracted from the medical record system and comparatively analyzed between groups. RESULTS:The observation group demonstrated significantly shorter diarrhea cessation time, abdominal pain cessation time, and length of hospital stay compared with the control group (p < 0.05). No statistically significant difference in fever resolution time was observed between the groups (p > 0.05). In the viral etiology subgroup, the observation group showed significantly shorter diarrhea cessation time, shorter abdominal pain cessation time, and a shorter length of hospital stay compared to the control group (p < 0.05). In the bacterial etiology subgroup, diarrhea cessation time and abdominal pain cessation time were also significantly shorter in the observation group (p < 0.05), whereas the difference in length of hospital stay between groups was not statistically significant (p > 0.05). Following the intervention, serum albumin (Alb), prealbumin (PA), and hemoglobin (Hb) levels in the observation group were significantly higher than those in the control group (p < 0.05). Post-intervention scores for sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbances, daytime dysfunction, and the total Chinese version of the Pittsburgh Sleep Quality Index (PSQI) score were significantly lower in the observation group than those in the control group (p < 0.05). Although the incidence rates of dehydration, electrolyte imbalance, diaper rash, perianal breakdown, and dyspnea were lower in the observation group than those in the control group, these differences did not reach statistical significance (p > 0.05). The proportion of children experiencing at least one adverse clinical outcome was compared between the observation group and the control group (p < 0.05). CONCLUSION:Therapeutic play combined with emotional soothing care is associated with improved clinical outcomes, enhanced nutritional status, and better sleep quality in children with acute diarrhea, thereby facilitating overall recovery.
AIMS/BACKGROUND:There remain significant challenges in assessing the risk of primary nephrotic syndrome (PNS) and concomitant acute kidney injury (AKI) in adult males. AKI is characterized by decreased glomerular filtration rate. This study investigates the levels of serum sex hormones, bone morphogenetic protein-7 (BMP-7), and retinol-binding protein (RBP) and their significance in adult male patients with PNS and concomitant AKI. METHODS:This retrospective analysis enrolled 86 adult male PNS patients admitted to Wuxi No.2 People's Hospital between January 2020 and November 2023 as the PNS group, and 80 healthy adult males as the healthy group. Serum levels of sex hormones-estradiol (E2), testosterone (T), follicle-stimulating hormone (FSH), and luteinizing hormone (LH)-as well as bone morphogenetic protein-7 (BMP-7) and RBP were compared between the two groups. Furthermore, PNS patients were stratified into PNS groups with or without AKI cohorts based on glomerular filtration rate. Additionally, the levels of these parameters were compared between the subgroups. RESULTS:In the PNS group, the levels of E2 and RBP were 66.67 ± 18.87 pg/mL and 56.65 ± 17.23 mg/L, respectively, both significantly higher than those in the healthy group (p < 0.05). Conversely, FSH and BMP-7 levels were 3.84 ± 1.02 IU/L and 1.83 ± 0.44 ng/mL, respectively, both significantly lower than those in the healthy group (p < 0.05). Within the PNS group, patients with AKI demonstrated significantly higher E2 levels of 69.93 ± 9.95 pg/mL than non-AKI patients (p < 0.05). FSH and BMP-7 levels were substantially lower (3.45 ± 0.96 IU/L and 1.57 ± 0.35 ng/mL) than in non-AKI patients (p < 0.05). However, RBP level was considerably higher (62.23 ± 12.01 mg/L) in those with AKI (p < 0.05). Furthermore, serum creatinine (Scr), blood urea nitrogen (BUN), and cystatin C (Cys C) levels were 167.23 ± 34.43 μmol/L, 11.14 ± 2.23 mmol/L, and 2.02 ± 0.72 mg/L, respectively, all significantly higher in patients with AKI than in non-AKI (p < 0.05). Regression analysis identified E2, BMP-7, and RBP as independent predictors for assessing AKI risk in PNS patients, with corresponding odds ratios (ORs) (95% confidence interval (CI)) values of 1.092 (1.016-1.175), 0.021 (0.002-0.184), and 1.095 (1.032-1.162), respectively (p < 0.05). CONCLUSION:Male patients with PNS exhibit abnormal serum sex hormone, BMP-7, and RBP levels, which are associated with AKI. E2, BMP-7, and RBP levels demonstrate significant predictive potential in assessing AKI risk in PNS.
AIMS/BACKGROUND:Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoimmune disorder of the neuromuscular junction that is frequently associated with small-cell lung cancer (SCLC). It is characterized by proximal muscle weakness, reduced deep tendon reflexes, and autonomic symptoms, all of which can significantly impair quality of life and complicate oncologic management. Early recognition and timely intervention are crucial to improving clinical outcomes. CASE PRESENTATION:We report a case of a 76-year-old man with extensive-stage SCLC and chronic renal insufficiency whose LEMS worsened during durvalumab immunotherapy. Despite continued chemotherapy and immunotherapy, his symptoms progressively worsened. Chemotherapy failed to improve his neurological condition, with subsequent recurrent episodes of muscle weakness. Subsequent administration of intravenous immunoglobulin (IVIG) combined with pyridostigmine led to marked neurological improvement and restoration of muscle strength to grade 5, enabling continuation of antitumor therapy. The patient subsequently received three cycles of second-line lurbinectedin chemotherapy, during which inflammatory responses, anemia, and venous thrombosis developed but were effectively managed with supportive treatment. RESULTS:Following chemotherapy and immunotherapy, the patient's limb muscle strength recovered to grade 5, followed by recurrent muscle weakness symptoms. Hematologic and biochemical parameters gradually normalized, and inflammatory markers returned to baseline. At discharge, his clinical condition was stable. CONCLUSION:This case highlights the importance of early recognition and standardized management of paraneoplastic LEMS in enhancing functional recovery and enabling the safe continuation of antitumor therapy.
AIMS/BACKGROUND:It remains unclear whether vascular characteristics or hemodynamics of the vertebrobasilar artery (VBA) among patients with left- and right-sided hemifacial spasm (HFS) lesions correlate with the risk of HFS occurrence and disease severity. This study aims to investigate the correlation of VBA characteristics with the incidence risk and severity of HFS. METHODS:A total of 60 patients with HFS who were admitted to Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between January and October 2024 were retrospectively enrolled in the HFS group. Another 59 healthy individuals who underwent physical examinations were assigned to the control group. Data on the characteristics of the VBA were collected for both groups, and the correlation between these characteristics and the occurrence risk of HFS was analyzed. In addition, patients in the HFS group were further stratified according to the lesion side (left vs right) and HFS severity grade (mild vs moderate vs severe) for subgroup analysis and comparison of VBA imaging features. RESULTS:The diameters of the left vertebral artery (VA), right VA, and basilar artery in the HFS group were all found to be larger than those in the control group, and the difference in the diameter of the left VA between the two groups was more significant (p < 0.05). Multivariate logistic regression analysis demonstrated that the diameter of the left VA (odds ratio [OR] = 4.014, 95% confidence interval [CI]: 1.997-8.070), the diameter of the right VA (OR = 3.890, 95% CI: 2.217-6.825), and the diameter of the basilar artery (OR = 2.022, 95% CI: 1.008-4.058) were independent influencing factors for the occurrence of HFS (p < 0.05). There were no statistically significant differences in the diameters of the VA and basilar artery among patients with severe, moderate, and mild HFS (p > 0.05). CONCLUSION:The diameters of the left VA, right VA, and basilar artery are significantly correlated with the occurrence of HFS, while the severity of the disease shows no correlation with the diameter of the ipsilateral VA. This suggests that the morphological changes of the VBA system may play an important role in the pathogenesis of HFS.
AIMS/BACKGROUND:Pharmacological therapy can enhance the therapeutic efficacy of radiofrequency ablation (RFA) for atrial fibrillation (AF) and reduce the risk of recurrence. Dronedarone and amiodarone are two commonly prescribed adjuvant medications. However, no consensus exists on which agent demonstrates superior efficacy. This study aimed to compare the effects of dronedarone and amiodarone on the prognosis of patients undergoing RFA for AF, thereby providing evidence-based guidance for clinical medication selection. METHODS:A retrospective analysis was conducted on AF patients who underwent RFA in Tianjin Fourth Central Hospital between August 2022 and May 2023. Patients were assigned to a dronedarone group (n = 50), and an amiodarone group (n = 59) based on the postoperative medication received. Postoperatively, patients were treated with either dronedarone hydrochloride tablets or amiodarone hydrochloride tablets for 6 months. Long-term electrocardiographic monitoring (7-day duration via 5G network) was performed at 1, 3, 6, and 12 months postoperatively to assess recurrence of atrial arrhythmias. Follow-up assessments at the same intervals included thyroid, liver, and renal function, left atrial diameter (LAD), left ventricular ejection fraction (LVEF), and QT interval. RESULTS:No statistically significant difference was observed in AF recurrence between the two groups (p > 0.05). The incidence of thyroid dysfunction was significantly lower in the dronedarone group compared with the amiodarone group (p < 0.05), whereas other adverse events showed no significant difference (p > 0.05). In both groups, postoperative LVEF was significantly higher than preoperative values (p < 0.05), and LAD was significantly reduced (p < 0.05). Comparing the two groups, postoperative LAD was significantly smaller in the dronedarone group than in the amiodarone group (p < 0.05), while postoperative LVEF exhibited no statistically significant difference (p > 0.05). CONCLUSION:Dronedarone and amiodarone are similarly effective in reducing the AF recurrence after RFA. However, dronedarone is associated with a lower risk of thyroid dysfunction and confers greater improvement in left atrial remodelling.
