BACKGROUND:The cognitive consequences of COVID-19 in patients with dementia remain uncertain. This study examined whether COVID-19 infection was associated with cognitive decline. METHODS:From October 2020 to October 2022, COVID-19-naïve patients with dementia were recruited from a hospital-based memory clinic in Taipei. During follow-up, patients who developed COVID-19 were classified as the infected group, while others served as controls. For controls, baseline and follow-up were defined as two consecutive annual cognitive assessments. For infected patients, baseline and follow-up were the nearest assessments before and after COVID-19 infection, respectively. The mean assessment interval was approximately one year in both groups. Outcomes included the Mini-Mental State Examination (MMSE), Clinical Dementia Rating Sum of Boxes (CDR-SB), and Cognitive Abilities Screening Instrument (CASI). Linear mixed-effects models assessed whether cognitive trajectories differed by COVID-19 status. RESULTS:After excluding patients without eligible follow-up data, infected patients were matched with controls by age and sex. Overall, 44 patients with dementia who developed COVID-19 and 22 who remained uninfected were included in the study. Baseline demographic characteristics and cognitive scores were comparable. The mean age was 84.1 years, with 36% (24/66) male. At follow-up, cognitive performance did not differ significantly between infected and control groups. Within-group analyses showed significant declines in MMSE, CDR-SB, and CASI in the infected group, whereas controls declined significantly only in CASI. In adjusted mixed-effects models, the COVID-19 × time interaction was not significant (β = -0.427, p = 0.676), suggesting no significant difference in MMSE decline trajectory between groups. Higher education was associated with higher MMSE scores (β = 0.553, p = 0.002). Sensitivity analyses supported these findings. CONCLUSION:After accounting for age, sex, education, and assessment interval, COVID-19 infection was not associated with faster cognitive decline. Participants with more education generally had higher MMSE scores, but education did not significantly alter the rate of decline.
BACKGROUND:Early prediction of recovery in sudden sensorineural hearing loss (SSNHL) remains challenging. Early hearing improvement (EHI) may serve as a simple prognostic marker, but its quantitative relationship with complete recovery (CR) has not been well defined. We investigated the association between EHI and CR and explored whether this relationship differed according to pretreatment hearing severity. METHODS:We conducted a retrospective case-control study of adults hospitalized for a first episode of unilateral SSNHL at a tertiary referral center in Taiwan between 2012 and 2022. Patients who achieved CR, defined as a final four-frequency pure-tone average ≤25 dB HL, were matched by pretreatment hearing grade to patients without CR. EHI was defined as the change in pure-tone average from baseline to the first follow-up audiogram within two weeks. Multivariable linear probability models and logistic regression were used to evaluate the association between EHI and CR. RESULTS:The study included 240 patients (120 with CR and 120 without CR). Younger age and a shorter onset-to-treatment interval were independently associated with a higher probability of CR (age: β per 1-year increase, -0.009; 95% CI, -0.013 to -0.005; p < 0.001; onset-to-treatment interval: β per 1-day increase, -0.013; 95% CI, -0.018 to -0.009; p < 0.001). Mean EHI was 14.9 ± 19.1 dB and increased with pretreatment hearing grade. Each 1-dB increase in EHI was associated with a 1.5% higher probability of CR (β = 0.015, 95% CI 0.012-0.017; p < 0.001). The strength of this association progressively decreased as pretreatment hearing severity increased. Findings were consistent in sensitivity analyses using logistic regression. CONCLUSION:Early hearing improvement within two weeks is a readily obtainable and quantitatively informative predictor of complete recovery in SSNHL. Its prognostic value is greatest in patients with less severe pretreatment hearing loss and diminishes with increasing hearing severity.
Pulsatile tinnitus (PT) caused by sigmoid sinus (SS) wall anomalies, most commonly diverticulum and dehiscence, represents a prevalent and potentially reversible venous etiology. This narrative review summarizes contemporary concepts in diagnosis and treatment and proposes a practical framework for clinical decision-making. The characteristic features of venous-type PT are first outlined, with emphasis on strict clinicoradiologic correlation using high-resolution temporal bone computed tomography and magnetic resonance venography to distinguish SS wall abnormalities from other vascular causes, such as dural arteriovenous fistulas (AVFs), high-riding jugular bulbs, and idiopathic intracranial hypertension. Patient selection, contraindications, and clinical "red flags" are then discussed, with particular attention to scenarios in which transmastoid surgery may be ineffective or pose substantial risk and in which systemic therapy or venous sinus stenting should be prioritized. The main transmastoid strategies include sinus wall resurfacing, tailored re-roofing with autologous bone, and diverticulectomy with multilayer reconstruction. These strategies are compared with endovascular approaches in terms of their technical principles, indications, and reported outcomes. Particular attention is given to reconstructive materials, such as polymethylmethacrylate cement, hydroxyapatite, and bone grafts, with consideration of their short- to midterm performance and the current limitations of evidence regarding long-term durability. Integrating these considerations, a stepwise algorithm is proposed to guide the selection of conservative, surgical, or endovascular treatment based on symptom profiles and imaging findings. In carefully selected patients, these strategies can achieve high rates of PT improvement and meaningful gains in quality of life, while highlighting the need for prospective outcome studies with long-term follow-up.
BACKGROUND:Although urban-rural differences in dementia prevalence have been widely reported, little is known about whether vascular risk factors and health behaviors relate differently to cognitive function across urban and rural populations. This study investigated urban-rural differences in these factors and their associations with cognition. METHODS:We analyzed data on demographics, vascular risk factors, lifestyle factors, laboratory measures, and comprehensive neuropsychological assessments. Suboptimal cognition was defined as >1 SD below appropriate norms; predictors were examined using Firth's penalized likelihood logistic regression, followed by interaction analyses to assess region-specific associations. RESULTS:Overall, 1,284 non-demented older adults were included, comprising 949 and 335 from the rural and urban cohort, respectively. Compared with the urban cohort, participants in the rural cohort were younger (70.1 ± 6.8 vs 71.3 ± 3.6 years, p < 0.001), more often male (49.6% vs 30.4%, p < 0.001), and less educated (4.0 ± 4.6 vs 14.2 ± 3.1 years, p < 0.001). In the rural cohort, higher systolic blood pressure (1.02, 95% confidence interval (CI) 1.01-1.04), and male sex (2.56, 1.49-4.44) were associated with suboptimal global cognition, whereas smoking cessation was protective (0.40, 0.20-0.79). Low physical activity (1.95, 1.35-2.80) further predicted suboptimal visuospatial function. No statistically significant associations were observed in the urban cohort after correction for multiple comparisons. Interaction analyses indicated that the associations between smoking cessation and global cognition (p = 0.013) and between low physical activity and visuospatial function (p = 0.033) differed significantly between the rural and urban cohorts, with stronger associations in the rural cohort. CONCLUSION:Health behaviors showed stronger associations with cognitive function in rural than in urban cohort, warranting region-tailored prevention strategies. Urban-rural comparisons were based on two independent community cohorts; future studies using a single population-based cohort are needed to validate these findings.
BACKGROUND:Acute radiation dermatitis (ARD) is common during head-and-neck radiotherapy (RT) and may impair skin-related quality of life (QoL). Whether intensity-modulated proton therapy (IMPT) improves patient-reported skin outcomes compared with volumetric modulated arc therapy (VMAT) remains uncertain. We compared longitudinal outcomes of skin toxicity between RT modalities and identified significant predictors of ARD and skin-related QoL. METHODS:This prospective and non-randomized cohort study enrolled adults with newly diagnosed head-and-neck cancer receiving curative-intent VMAT or IMPT at Kaohsiung Chang Gung Memorial Hospital. Skin-related QoL was assessed using Skindex-16 at baseline, end of RT, and 3 months after RT. ARD was graded weekly using Common Terminology Criteria for Adverse Events version 5.0. Longitudinal outcomes were analyzed using linear mixed-effects models, and predictors of ARD grade ≥2 and ≥10-point worsening in Skindex-16 Global score were evaluated using multivariable regression. RESULTS:Among 158 patients, 113 received VMAT and 45 received IMPT; the mean age was 56.5 years, and 130 patients (82.3%) were men. Clinically meaningful Global score worsening occurred in 37.0% of patients at the end of RT and 7.0% at 3 months after RT. Skindex-16 scores worsened significantly at the end of RT and improved by 3 months across all domains (all p<0.01), with no significant difference between VMAT and IMPT or time-by-modality interactions. Maximum ARD severity was comparable between VMAT and IMPT (grade 2: 30.0% vs 29.5%; grade 3: 7.0% vs 4.8%; p=0.85). Advanced nodal disease (N2-3) and RT dose ≥66 Gy independently predicted ARD grade ≥2 and Skindex-16 Global score worsening. CONCLUSION:Acute patient-reported skin toxicity during contemporary head-and-neck RT was not associated with RT modality but with nodal extent and RT dose. These findings support risk-adapted planning and proactive supportive care, although interpretation is limited by the non-randomized design and lack of skin-specific dosimetry.
Background: Fine particulate matter (PM2.5) is a major component of ambient air pollution and is a significant environmental health concern. The conjunctiva is continuously exposed to airborne pollutants but the direct effects of PM2.5 on conjunctival epithelial repair remain poorly understood. This study investigated whether PM2.5 disrupts conjunctival epithelial homeostasis and examined the functional role of interleukin-8 (IL-8) in this process. Methods: Immortalized human conjunctival epithelial cells (IM-HConEpiC) were exposed to PM2.5. Cell viability, apoptosis, epithelial migration, inflammatory mediators and cytokine profiles were evaluated using biochemical, functional and cytokine array analyses. The functional role of IL-8 was also determined using recombinant IL-8 supplementation and neutralization assays. Results: PM2.5 exposure reduced conjunctival epithelial cell viability in a time- and concentration-dependent manner and induced mild apoptotic responses. More importantly, PM2.5 markedly impaired epithelial migration and wound closure. Cytokine profiling revealed that PM2.5 selectively remodeled inflammatory mediators, rather than eliciting a generalized inflammatory response. IL-8 was identified as the most prominently suppressed cytokine. Functional gain- and loss-of-function studies identified IL-8 as a key regulator of conjunctival epithelial repair. Specifically, recombinant IL-8 significantly restored PM2.5-induced impairment of epithelial migration and partially rescued the reduction in cell viability, whereas neutralization of endogenous IL-8 impaired epithelial migration under basal conditions, supporting a critical role for IL-8 in maintaining conjunctival epithelial homeostasis. Conclusion: PM2.5 compromises conjunctival epithelial homeostasis, primarily by impairing epithelial repair, rather than inducing extensive cell death. This study identified IL-8 as an important regulator of conjunctival epithelial repair and suggests that suppression of IL-8 contributes to PM2.5-induced conjunctival dysfunction.
BACKGROUND:To assess the association of sedentary time and physical activity with the occurrence of colorectal adenomas in asymptomatic participants. METHODS:We conducted a case-control study at Taipei Veterans General Hospital, Taiwan to examine sedentary time, physical activity, and their joint effects on colorectal adenoma risk among asymptomatic participants. Conditional logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS:Among 5,982 asymptomatic adults undergoing health screening, shorter sedentary time was independently associated with a lower risk of colorectal adenoma (n=3,616), after adjusting for other risk factors, including physical activity. The ORs (95% CIs) for each category of sedentary time >450, 300-450, and <300 minutes/day were 1.00 (reference), 1.10 (0.90-1.34), and 0.52 (0.40-0.69), respectively (p trend <0.001). Joint analysis demonstrated that higher physical activity was associated with a lower risk of colorectal adenoma, particularly among individuals with a sedentary time of 300-450 minutes/day. Moreover, within the moderate- and high physical activity categories, shorter sedentary time was consistently associated with additional risk reduction. A similar pattern was observed for advanced adenoma subgroup. CONCLUSION:Sedentary time was independently associated with increased colorectal adenoma risk, whereas reducing sedentary time may lower advanced adenoma risk and augment the benefits of moderate- to high-physical activity among asymptomatic population in Taiwan.
BACKGROUND:The increasing global prevalence of pediatric myopia has led to the widespread use of atropine for myopia control. Despite its proven efficacy, variable treatment responses and complex interactions among refractive error, treatment duration, and dosage make individualized treatment challenging. Therefore, clinicians require decision support tools for personalized treatment management. METHOD:This retrospective study analyzed 1,545 pediatric myopic eyes treated with topical atropine at Shin Kong Wu Ho-Su Memorial Hospital (Taipei, Taiwan) between 2005 and 2008. The multivariate adaptive regression splines (MARS) approach was used to examine associations between baseline clinical characteristics, atropine exposure, changes in the spherical equivalent (SE), and myopic progression. Eight clinical predictors including age, sex, Baseline SE, intraocular pressure (IOP), IOP changes, treatment duration, and cumulative and average monthly atropine dosages were used. The model performance was evaluated via repeated cross-validation and benchmarked against standard linear regression. RESULTS:Baseline SE was the strongest predictor of myopic progression, followed by cumulative atropine exposure and average monthly dosage. The MARS model demonstrated robust predictive performance (root mean square error = 0.540) and identified the baseline SE, cumulative atropine exposure, and average monthly dosage as the principal predictors of myopic progression. The average monthly dosage showed a nonlinear V-shaped relationship with a transition point near 11.66 mg/month. CONCLUSION:The baseline refractive status and atropine exposure were the principal factors associated with treatment response and may support individualized myopia management. The observed V-shaped pattern may reflect the treatment transition characteristics of the historical high-concentration atropine era (0.1-1.0%), during which the atropine dosage was frequently adjusted according to the clinical response. This nonlinear pattern suggests that the treatment response varied across different levels of atropine exposure, warranting further clinical interpretation. Therefore, children receiving intermediate monthly dosages may represent a heterogeneous group undergoing physician-directed dose escalation, resulting in an apparent nonlinear relationship. Accordingly, this pattern most likely reflects real-world treatment strategies, rather than the intrinsic pharmacological effects of intermediate atropine dosages. These findings should be used for hypothesis generation and require prospective validation before influencing clinical dosing decisions.
Agitation is among the most disabling behavioral and psychological symptoms of dementia, contributing substantially to caregiver burden, institutionalization, and healthcare utilization. Considering the modest efficacy and significant adverse effects associated with psychotropic medications, person-centered approaches (PCAs) and non-pharmacological interventions are recommended as first-line management strategies. We conducted a comprehensive search on PubMed, Medline, Embase, PsycINFO, CINAHL, and the Cochrane Library for systematic reviews, meta-analyses, and randomized controlled trials evaluating PCA and non-pharmacological interventions for agitation in dementia published before September 30, 2025. The quality of evidence and strength of recommendations were evaluated using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) framework. Moderate-quality evidence supports the use of massage or touch therapy, particularly individualized music therapy, tailored activity programs, and multicomponent interventions. By contrast, sensory-based approaches such as aromatherapy and Snoezelen demonstrated inconsistent or low-quality evidence. The organizational-level implementation of PCA and structured need-driven assessments are associated with improved quality of life and appear to enhance the effectiveness of subsequent non pharmacological interventions. The most consistent and clinically meaningful benefits were observed when individualized strategies were preceded by systematic PCA- based assessment. Overall, PCA-guided, multifaceted non-pharmacological interventions provide the preferred foundation for managing agitation in dementia, reducing reliance on pharmacotherapy while promoting care quality, dignity, and overall wellbeing. Future efforts should focus on optimizing implementation through structured staff training, interdisciplinary collaboration, and technology-assisted assessment models to improve feasibility and scalability across diverse care settings.
BACKGROUND:Although malnutrition is common among critically ill patients with sepsis, it is unclear whether early nutritional supplementation is beneficial. We investigated the effects of early calorie and protein delivery in critically ill patients with sepsis. METHODS:Adult patients with sepsis who required mechanical ventilation in a surgical intensive care unit (ICU) between January 2021 and December 2022 were enrolled. Nutritional risk in these patients was evaluated using the modified Nutrition Risk in the Critically ill (m-NUTRIC) score. Participants were divided into two groups based on whether they received <50% or ≥50% of their estimated calorie needs within the first 5 days of their ICU stay. The primary outcome was 28-day ICU mortality. RESULTS:Among the 258 participants (195 men and 63 women; mean age, 64.8 ± 13.7 years), within the first 5 days of their ICU stay, 63.2% and 36.8% of the patients received <50% and ≥50% of their estimated calorie needs, respectively. The 28-day ICU mortality rate did not differ significantly between the two groups. Multivariate logistic regression revealed that the use of continuous renal replacement therapy (odds ratio [OR] = 4.07, 95% CI, 1.10-15.09; p = 0.036) and the duration of mechanical ventilation (OR = 1.05, 95% CI, 1.01-1.10; p = 0.020) were independent predictors of 28-day ICU mortality. Providing early nutritional support of ≤50% of the estimated calorie needs did not affect 28-day ICU mortality in these patients ( p = 0.229). CONCLUSION:Achieving at least 50% of the estimated calorie needs within the first 5 days of ICU stay did not improve 28-day ICU survival in this cohort of critically ill patients with sepsis. Further investigations are needed to elucidate whether early nutritional interventions are beneficial for this population.
BACKGROUND:Acral melanoma (AM) is a rare cutaneous malignancy associated with poor survival. However, prognostic differences between AM and nonacral cutaneous melanoma (NAM) remain unclear. Therefore, we conducted a systematic review and meta-analysis to compare survival outcomes between patients with AM and those with NAM. METHODS:PubMed, EMBASE, and the Cochrane Library were comprehensively searched for studies published between January 2000 and December 2025. Studies comparing the 5-year overall survival (OS) and 5-year relapse-free survival (RFS) between AM and NAM were included. Subgroup analyses were performed by disease stage and ethnicity to assess their impact on melanoma prognosis. RESULTS:Twenty studies (18 retrospective and two prospective cohort studies) involving 568 346 patients were included. The meta-analysis demonstrated that AM was associated with significantly lower 5-year OS than NAM (risk ratio [RR]: 0.89; 95% CI: 0.86-0.92; p < 0.00001). In subgroup analyses, compared with NAM, AM was associated with poorer 5-year OS in both stage II (RR: 0.92; 95% CI: 0.88-0.96; p = 0.0003) and stage III disease (RR: 0.85; 95% CI: 0.75-0.96; p = 0.01). Additionally, patients from darker-skinned populations with AM had poorer 5-year OS than those from White populations (RR: 0.89; 95% CI: 0.83-0.95; p = 0.0006). CONCLUSION:Patients with AM exhibited markedly lower 5-year OS than those with NAM, particularly among patients with stage II and III. Moreover, individuals from darker-skinned populations with AM had poorer survival outcomes than those from White populations.
BACKGROUND:The World Health Organization's goal of hepatitis C virus (HCV) elimination by 2030 remains a challenge. While type 2 diabetes mellitus (T2DM) is associated with HCV infection, identifying unrecognized cases in low-endemic areas is difficult. This study evaluates the feasibility and outcomes of a hospital-based microelimination referral program in T2DM patients and explores chronic kidney disease (CKD) stage as a potential risk stratifier. METHODS:In this prospective study (March 2022-May 2023), T2DM patients enrolled in a pay-for-performance program underwent routine anti-HCV antibody screening. Seropositive patients were referred to hepatologists for HCV-RNA testing and direct-acting antiviral (DAA) evaluation. We used multivariable logistic regression to identify baseline predictors of HCV viremia and piecewise generalized estimating equations (GEE) to assess the impact of viremia and DAA therapy on estimated glomerular filtration rate (eGFR) trajectories. RESULTS:Among 4402 T2DM patients, 104 (2.4%) were anti-HCV positive. Seroprevalence increased across CKD stages 1 to 5 (1.8%, 2.3%, 2.6%, 3.5%, and 7.8%; p = 0.014). Furthermore, among anti-HCV-positive patients, the proportion of advanced CKD (stages 3-5) significantly increased in those with higher Fibrosis-4 (FIB-4) index scores ( p = 0.020). Multivariable analysis of HCV viremia identified lower diastolic blood pressure (odds ratio [OR], 0.968; p = 0.017), total cholesterol (OR, 1.012; p = 0.015), triglycerides (OR, 0.991; p = 0.008), and alanine aminotransferase (OR, 1.011; p = 0.006) as independent predictors. While untreated viremia initially appeared to accelerate eGFR decline, this effect was attenuated after adjusting for age and glycated hemoglobin (HbA1c). Moreover, eGFR decline trajectories did not change significantly following DAA therapy. CONCLUSION:An in-hospital referral program for T2DM patients is feasible for HCV microelimination, using CKD staging as a practical risk stratifier. Despite DAA renal safety, diabetes-associated kidney damage may drive post-cure renal progression, necessitating continuous metabolic management.
BACKGROUND:Robotic pancreaticoduodenectomy (RPD) has emerged as a promising approach for complex pancreatic surgeries. Artery-first approach pancreaticoduodenectomy (AFAPD) prioritizes the early assessment of arterial involvement to improve surgical outcomes. This study compares the clinical, perioperative, and oncological outcomes of AFAPD and traditional portal vein-first pancreaticoduodenectomy (tPD) in patients undergoing RPD. METHODS:A retrospective analysis was conducted on 151 patients who underwent RPD at a tertiary center in Taiwan from June 2019 to July 2025. Patients were categorized into robotic tPD (n = 81) and AFAPD (n = 70) groups. Propensity score matching (PSM, 1:1) was performed to reduce selection bias. Survival outcomes were analyzed through the Kaplan-Meier method and compared using the log-rank test, and Cox proportional hazards models were employed to estimate hazard ratios with 95% confidence intervals. RESULTS:After PSM, no significant difference was observed in the baseline characteristics of both groups. In the matched cohort, no significant differences were found between the two groups in terms of operative time (518.5 vs 480.0 minutes, p = 0.269) or estimated blood loss (200 vs 150 mL, p = 0.106). However, compared with the tPD group, the AFAPD group was associated with a significantly lower rate of delayed gastric emptying (DGE, 15.4% vs 36.5%, p = 0.027). Other complications, such as postpancreatectomy hemorrhage (3.8% vs 11.5%, p = 0.289) and abdominal abscess (1.9% vs 7.7%, p = 0.375), showed lower trends in the AFAPD group than in the tPD group but did not reach statistical significance in the matched cohort. The AFAPD group also had a higher incidence of chylous leakage (19.2% vs 7.7%, p = 0.146) than the tPD group. Overall survival was significantly shorter in the AFAPD group than in the tPD group because of the retrospective design of this study and the recent adoption of the AFAPD approach (15.47 vs 36.15 months, p < 0.001). CONCLUSION:Robotic AFAPD provides perioperative outcomes comparable to those yielded by tPD while significantly reducing DGE. While it has a higher trend of chylous leakage than tPD, it remains a technically superior approach for ensuring early arterial assessment and surgical radicality.
BACKGROUND:Modified type III cordectomy provides satisfactory oncological and voice outcomes in selected patients with early glottic cancer. However, the factors associated with local recurrence following this procedure remain unclear. This study investigated the predictors of local recurrence following modified type III cordectomy and evaluated subsequent salvage management. METHODS:Patients who underwent modified type III cordectomy for glottic cancer at a tertiary referral center between 2006 and 2022 were retrospectively reviewed. Clinicopathological factors, including tumor stage, pathology, morphology, involved subsites, surgical margin status, and history of biopsy or surgery, were analyzed for their association with local recurrence. Salvage treatment outcomes were evaluated. RESULTS:A total of 58 patients were included in this study. The cohort was predominantly male (95%) with a median age of 61 years. The mean follow-up period was 78 months. Local recurrence occurred in 13 patients (22%) at a mean interval of 22 months after surgery. Tumor pathology and morphology were significantly associated with recurrence. Spindle cell carcinoma (SpCC) and endophytic tumors were associated with a substantially higher risk of recurrence than conventional squamous cell carcinoma and exophytic lesions. All recurrent tumors were treated with salvage transoral laser microsurgery (TLM), and six patients received postoperative radiotherapy. Successful salvage with laryngeal preservation was achieved in 11 (85%) patients. CONCLUSION:Endophytic morphology and SpCC pathology are significant predictors of local recurrence after modified type III cordectomy. Careful postoperative surveillance is particularly important in these patients. Primary treatment with TLM preserves multiple salvage treatment options and enables high rates of laryngeal preservation in patients with recurrent disease.
Dysembryoplastic neuroepithelial tumor (DNET) and low-grade astrocytoma (LGA) could present very similar MRI findings. DNET have good seizure control after surgical removal and low malignant potential, while LGA may recur or progress This study was designed to obtain more accurate pretreatment diagnosis of DNET and LGA based on MRI findings. We retrospectively enrolled patients with pathologically proven DNET and LGA from 2000–2024. Individual qualitative and quantitative MRI features were evaluated in both tumors, especially T2-weighted signal intensity ratio(T2SR), which compared tumor T2-weighted signal with normal cerebral white matter. The diagnostic performance of conventional qualitative models including meaningful qualitative MRI features and combined quantitative model including T2SR and ADC (apparent diffusion coefficient) value was evaluated using area under curve (AUC). In total, 70 patients (30 DNET, 40 LGA) with mean age of 23.2±11.3(15–57) years and 36 men (51.4%),34 women(48.6%). For individual MRI features, DNET had more FLAIR (fluid attenuated inversion recovery) ring sign [16 (53.3%) versus 12 (30.0%), p = 0.049], higher ADC value [2076.2 (53.4) versus 1660.1(71.9), p <0.001], and higher T2SR (3.56±0.12 versus 2.68±0.63, p < 0.001). The AUC of the T2SR and ADC value was 0.886(0.811-0.962) and 0.824(0.724-0.924), respectively. The combined quantitative model had higher discriminative performance than conventional qualitative model (AUC: 0.905 versus 0.727, p = 0.011). Our study suggested that quantitative MRI features including T2SR and ADC values enhanced discrimination of DNET and LGA and could potentially serve as complementary imaging marker for improving preoperative diagnostic accuracy.
Respiratory syncytial virus (RSV) is an RNA virus transmitted via droplets and affects individuals across all age groups. Although RSV is increasingly being recognized as a key pathogen in adults, differentiating RSV infection from other acute viral infections solely on the basis of clinical features is challenging. Polymerase chain reaction is the gold standard for RSV detection. Notably, RSV accounts for 2% to 10% of all hospitalizations due to respiratory tract infections in adults. Among hospitalized adults with RSV infection, 18.9% require intensive care, experiencing a disease burden similar to that of influenza. Severe RSV infection disproportionately affects older adults with multiple comorbidities, such as chronic heart failure and chronic obstructive pulmonary disease. This review focused on the manifestations and outcomes of RSV infection and on advances in the development of RSV vaccines. We comprehensively searched PubMed for relevant studies published between 1991 and 2024. Evidence specific to RSV treatments remains limited, with supportive care being the mainstay of management. In 2023, two protein subunit vaccines were approved for individuals aged ≥60 years; in addition, an mRNA-based vaccine that exerts substantial protective effects against severe RSV disease received approval in the United States. The development of novel antiviral therapies and vaccines holds promise for mitigating the burden of RSV infection. However, further research is required to evaluate the real-world effectiveness of vaccines, particularly in high-risk hospitalized patients requiring intensive care or mechanical ventilation, to optimize implementation strategies.
Background: Studies have examined the connection between blood metabolites, osteoporosis (OP), and hypertension; however, there is not enough data to pinpoint their precise cause. Methods: OP and associated traits served as outcomes, with hypertension serving as the exposure variable. The main methodology was the random-effects inverse variance weighted (IVW) technique. Horizontal pleiotropy and heterogeneity of outcomes were assessed by sensitivity testing. Finally, to find putative mediating metabolites, a two-step Mendelian randomization (MR) analysis was carried out. Results: IVW analysis revealed a substantial negative connection between hypertension and lumbar spine bone mineral density (odds ratio [OR] = 0.961, 95% CI: 0.927-0.997; p < 0.05) and heel bone mineral density (OR = 0.982, 95% CI: 0.971-0.992; p < 0.001), as well as a strong positive correlation with OP (OR = 1.165, 95% CI: 1.067-1.273, p < 0.001). Sensitivity analysis validated the robustness of the results. The blood metabolites (R)-3-hydroxybutyrylcarnitine, 1-(1-enyl-palmitoyl)-GPE (p-16:0), hydroxyasparagine, adenosine 5’-diphosphate (ADP) to 5-oxoproline ratio, sphinganine-1-phosphate levels, and sphingosine-1-phosphate levels showed preliminary suggestive mediating effects on the association between hypertension and decreased bone mineral density in statistics. Conclusion: Our study revealed a positive correlation between hypertension and OP and suggested that blood metabolites may play a mediating role in it. These findings provide clues for a deeper understanding of the potential mechanisms between hypertension and bone health and lay a scientific foundation for exploring targeted intervention strategies in the future.
BACKGROUND:Systemic inflammation and nutritional status are key determinants of prognosis in oral squamous cell carcinoma (OSCC). The neutrophil-to-lymphocyte ratio and serum albumin in peripheral blood are established markers reflecting host immune response and nutritional condition, respectively. The lymphocyte-albumin-neutrophil ratio (LANR), a composite index integrating these parameters, has emerged as a potential prognostic biomarker in several cancers; however, its role in OSCC remains unclear. This study aimed to evaluate the prognostic value of preoperative LANR in OSCC. METHODS:We retrospectively analyzed OSCC patients who underwent radical surgery between 2007 and 2017, randomly dividing them into training and validation cohorts by a 2:1 ratio. LANR was calculated by multiplying the absolute lymphocyte count by the serum albumin level and dividing by the absolute neutrophil count. The primary outcomes were 5-year overall survival (OS) and disease-free survival (DFS). Survival-associated factors were identified through univariate and multivariate Cox regression analyses, serving as the foundation for constructing a predictive nomogram model. RESULTS:This study included a total of 660 patients, with 440 assigned to the training cohort and 220 to the validation cohort. A LANR cutoff value of 18.7 effectively stratified patients into distinct prognostic groups, demonstrating significant differences in survival outcomes. A low LANR independently predicted worse OS (hazard ratio [HR]: 1.54, 95% CI: 1.04-2.28; p = 0.03) and DFS (HR: 1.54, 95% CI: 1.08-2.19; p = 0.017). The LANR-based nomogram demonstrated strong predictive performance, with concordance indices of 0.75 and 0.71 in the training and validation cohorts, respectively. CONCLUSION:Preoperative LANR serves as an independent prognostic marker in patients with OSCC. Incorporating LANR into risk models may enhance patient stratification and guide treatment strategies.
BACKGROUND:To assess the efficacy of short-term insulin therapy compared with exenatide therapy in glycemic control, remission rate, and β-cell function in patients newly diagnosed with type 2 diabetes and severe hyperglycemia. METHODS:Patients with newly diagnosed type 2 diabetes and a glycated hemoglobin (HbA1c) level >9% were treated with insulin injections for 10 to 14 days, after which oral glucose tolerance tests (OGTTs) were performed. The patients were randomized in an open-label design to receive either insulin therapy or exenatide therapy for a further 24 weeks. The OGTT was repeated 6 months after randomization to re-evaluate β-cell function and insulin sensitivity. The participants were followed for another year to evaluate long-term glycemic control. RESULTS:We randomized 40 patients into the insulin group (n = 22) and the exenatide group (n = 18). One patient in the exenatide group withdrew before the intervention, resulting in 22 and 17 patients in the insulin and exenatide groups, respectively. Body weight was significantly higher in the insulin group than in the exenatide group at baseline (75.8 ± 14.3 vs 60.5 ± 12.2 kg, p = 0.011). The mean HbA1c levels were similar between the insulin and exenatide groups at 6 months (6.74 ± 1.12% vs 6.88 ± 0.76%; p = 0.681) and 12 months after randomization (6.62 ± 0.69% vs 7.05 ± 0.72%; p = 0.119). By 1 year after the intervention, the remission rates were 18.2% (n = 4) in the insulin group and 5.9% (n = 1) in the exenatide group ( p = 0.025). The median time to relapse was 6.5 months in the insulin group and 5.0 months in the exenatide group ( p = 0.685). Compared with the exenatide group, the insulin group had better homeostasis model assessment of β-cell function index, insulinogenic index, and total insulin secretion during the OGTT. CONCLUSION:Insulin therapy may improve β-cell function and reduce remission rates compared with exenatide therapy in patients newly diagnosed with type 2 diabetes and severe hyperglycemia.
