Objective The study aimed to evaluate the efficacy of a multimodal intervention on urodynamic outcomes, urinary incontinence severity, and pelvic floor muscle strength in individuals with overactive bladder after incomplete spinal cord injury. Methods A single-blind randomized controlled trial was conducted on 74 male participants diagnosed with overactive bladder and incomplete spinal cord injury. Participants were randomly assigned to an experimental group or a control group. Treatment was conducted for 8 weeks, three sessions per week. Outcomes were assessed at baseline, post-intervention, and the 8-week follow-up. Results The experimental group showed significantly greater improvements in the measured outcomes compared with the control group (P < 0.001). Conclusion Incorporating a multimodal regimen demonstrated significant efficacy in enhancing bladder capacity, continence, and muscle function in individuals with overactive bladder due to incomplete spinal cord injury. Clinical trial registry (ID: NCT07008157). https://clinicaltrials.gov/study/NCT07008157?cond=Spinal%20Cord%20Injuries&intr=Multimodal%20Rehabilitation%20Program&viewType=Card&rank=1
Objective Dengue is a major vector-borne viral infection and a frequent cause of pediatric hospitalization in endemic settings. This study described the clinical and laboratory characteristics of hospitalized children with laboratory-confirmed dengue in northern Vietnam and examined factors associated with dengue with warning signs (DWS). Methods This hospital-based cross-sectional study included retrospective and prospective components. Medical records were retrospectively reviewed for eligible children aged 0–16 years admitted from 1 September to 29 December 2022, whereas eligible children in the same age group were prospectively enrolled from 30 December 2022 to 31 August 2023. DWS was classified according to the World Health Organization 2009 criteria and the Vietnamese Ministry of Health guideline. Multivariable logistic regression was used to identify factors associated with DWS. Results Among 319 children, 126 (39.5%) met the criteria for DWS. In the multivariable analysis, age >10 years (adjusted odds ratio [aOR] 2.17, 95% confidence interval [CI] 1.28–3.66; p = 0.004), urban residence (aOR 2.88, 95% CI 1.27–6.51; p = 0.011), platelet count ≤100 × 10 9 /L (aOR 3.34, 95% CI 1.86–5.97; p < 0.001), and AST ≥100 U/L (aOR 2.83, 95% CI 1.58–5.05; p < 0.001) were independently associated with DWS. Among children with DWS, the most frequently observed warning signs were abdominal pain or tenderness (64.3%), persistent vomiting (31.7%), and mucosal bleeding (25.4%). Conclusions DWS was common among hospitalized children with dengue at a tertiary children's hospital in northern Vietnam. Older age, urban residence, thrombocytopenia, and elevated aspartate aminotransferase may help identify children who require closer monitoring during hospitalization.
Objective To develop and validate an explainable machine learning prediction model for perioperative hypothermia in patients undergoing cesarean delivery for placenta previa, and to identify key predictive factors to support clinical individualized temperature management and nursing decision-making. Methods This study is a retrospective secondary analysis conducted using BioStudies public databases. Ten machine learning algorithms, including logistic regression, decision tree, and random forest, were used to build hypothermia prediction models. Accuracy, precision, recall, F1-score, and AUC were selected as evaluation metrics to screen for the optimal model, and LIME was applied to generate individualized explanations for single-sample prediction outputs. A total of 167 real-world patients served as the independent test cohort, while 1000 synthetic data cases generated by the Synthetic Data Vault (SDV) algorithm served as the training cohort. Results Performance comparisons across models showed the random forest model reached an AUC of 0.781 in the training set, but only 0.638 in the test set, a sign of severe overfitting. Gradient boosting models had a universally low test set recall of below 0.25, carrying a high risk of missed diagnosis. The logistic regression (LR) model exhibited the optimal overall performance: it attained the highest test-cohort accuracy among all evaluated models, with an AUC of 0.705, F1-score of 0.430, and recall of 0.327. Feature importance analysis found intraoperative blood loss to be the strongest predictor of hypothermia, followed by body weight as the second core contributing factor. LIME can intuitively visualize feature contributions for individual sample predictions. These outputs enable nurses to develop tailored warming intervention regimens. Conclusion The logistic regression prediction model developed in this study may serve as a clinically useful tool with adequate generalization capacity and clinical interpretability for identifying hypothermia risk in patients undergoing cesarean delivery for placenta previa.
Objective To evaluate the long-term patency outcomes of radiocephalic arteriovenous fistulas treated with percutaneous transluminal angioplasty for radial artery stenosis, with a particular focus on the clinical impact of percutaneous transluminal angioplasty–induced radial artery rupture and its endovascular management. Methods This single-center retrospective analysis involved all patients diagnosed with arteriovenous fistula dysfunction and radial artery stenosis who were treated with arterial percutaneous transluminal angioplasty at our department from January 2021 to September 2024. In total, 56 patients were ultimately included in the study. Results Technical success was achieved in all patients. Radial artery rupture occurred in 10 of the 56 patients (17.86%) during percutaneous transluminal angioplasty and was successfully managed using prolonged low-pressure balloon inflation combined with localized external compression, without the need for covered stent implantation or surgical repair. At 1 year, primary patency rates were 40.0% in the rupture group and 39.1% in the normal group ( p = 0.53), whereas the corresponding secondary patency rates were 90.0% and 87.0%, respectively ( p = 0.35). Conclusion Percutaneous transluminal angioplasty is an effective treatment for radiocephalic arteriovenous fistula dysfunction caused by radial artery stenosis. Although dilation-induced radial artery rupture was relatively common in our cohort, it may be safely managed with prolonged low-pressure balloon inflation and localized compression without routine stent implantation or surgical intervention. Importantly, radial artery rupture did not appear to compromise long-term access-circuit patency. These findings apply to overall access-circuit outcomes rather than lesion-level durability. Controlled arterial rupture during percutaneous transluminal angioplasty appears to be a manageable procedural event that was not associated with worse overall access-circuit outcomes in this cohort.
Objective This study aimed to evaluate the clinical efficacy and safety of Artemisia annua pollen allergen sublingual immunotherapy combined with symptomatic medication in patients with seasonal allergic rhinoconjunctivitis or seasonal allergic rhinoconjunctivitis with asthma. Methods This open-label, observational cohort study was conducted from November 2024 to May 2025 and included a total of 500 patients diagnosed with A. annua pollen–induced seasonal allergic rhinoconjunctivitis; after accounting for dropouts, 354 patients remained eligible for analyses, including 228 patients with isolated seasonal allergic rhinoconjunctivitis and 126 patients with seasonal allergic rhinoconjunctivitis and asthma. Participants received A. annua pollen sublingual immunotherapy plus standard symptomatic treatment and were followed up during the 2025 pollen season. Primary outcomes included changes in the total rhinoconjunctivitis symptom, total medication, combined symptom–medication, and visual analog scale scores from that at baseline (2024 pollen season). For patients with concomitant asthma, asthma daytime symptom and asthma nighttime symptom scores were also recorded. Efficacy was assessed by comparing scores between the two pollen seasons, and safety was evaluated based on occurrence of adverse events. This study was retrospectively registered via the National Medical Research Registration System (PID: 332836, syncing to ChiCTR); the formal registration number is pending administrative review. Results Mean pollen concentrations during the 2024 and 2025 pollen seasons were 15.07 grains/m 3 (duration: 64 days) and 15.48 grains/m 3 (duration: 61 days), respectively, indicating comparable exposure levels. Compared with baseline, total rhinoconjunctivitis symptom, total medication, combined symptom–medication, and visual analog scale scores decreased significantly in both groups (isolated seasonal allergic rhinoconjunctivitis and seasonal allergic rhinoconjunctivitis with asthma groups, all p < 0.001). Among patients with comorbid asthma, asthma daytime symptom and asthma nighttime symptom scores also improved significantly ( p < 0.001). Adverse events occurred in 64 patients with isolated seasonal allergic rhinoconjunctivitis and 11 patients with seasonal allergic rhinoconjunctivitis and asthma; all adverse events resolved spontaneously or with minimal intervention, and no serious adverse events were reported. Conclusion These findings suggest that A. annua pollen sublingual immunotherapy significantly improves seasonal symptoms in seasonal allergic rhinoconjunctivitis patients, maintains lung function stability in those with concomitant controlled asthma, and demonstrates a favorable safety profile.
Objective To evaluate the diagnostic efficacy of computed tomography–guided percutaneous biopsy combined with metagenomic next-generation sequencing in patients with blood culture-negative systemic infections and to assess the clinical impact of using this combined strategy for etiological confirmation and guidance of targeted antimicrobial therapy. Methods This single-center retrospective observational cohort study enrolled 78 patients who met the Sepsis-3 consensus criteria for suspected systemic infection and had negative conventional microbiological work-ups (at least two sets of blood cultures) between April 2022 and March 2025. All patients underwent computed tomography–guided biopsy of radiologically identified infectious foci, with specimens processed concurrently for conventional culture and metagenomic next-generation sequencing. Diagnostic performance was benchmarked against the final comprehensive clinical diagnosis, and the influence of metagenomic next-generation sequencing findings on antimicrobial therapy modification was analyzed. Sample size calculation, based on a prior study estimating an metagenomic next-generation sequencing detection rate of 85% (α = 0.05, β = 0.2), indicated a minimum of 68 cases; accordingly, 78 patients were enrolled. Results Computed tomography–guided biopsy was technically successful in all 78 patients (100%). The pathogen detection rate of metagenomic next-generation sequencing (91.0%, 71/78) was significantly higher than that of conventional culture (55.1%, 43/78; p < 0.001). Using the final clinical diagnosis as the reference standard, metagenomic next-generation sequencing achieved a sensitivity of 94.7% (95% confidence interval: 86.9–98.5), specificity of 100.0% (95% confidence interval: 29.2–100.0), positive predictive value of 100.0% (95% confidence interval: 94.9–100.0), and negative predictive value of 42.9% (95% confidence interval: 9.9–81.6). Among the 35 culture-negative specimens, metagenomic next-generation sequencing established a definitive microbiological diagnosis in 28 cases (80.0%) and detected polymicrobial infections in 11 cases (14.1% of the cohort). Antimicrobial therapy was rationally adjusted based on metagenomic next-generation sequencing results in 69.2% (54/78) of the patients. Conclusions The integration of computed tomography–guided precision biopsy with metagenomic next-generation sequencing offers a highly effective diagnostic approach for blood culture-negative systemic infections. This synergistic strategy improves etiological diagnosis by providing high-yield target specimens that enable comprehensive, unbiased pathogen screening, facilitates differentiation between infectious and non-infectious etiologies, and supplies critical evidence for guiding precision antimicrobial therapy. These findings highlight the growing role of interventional radiology in the contemporary framework of precision infectious disease management.
Objective The molecular pathogenesis of intracranial aneurysms remains undefined despite its central role in aneurysmal subarachnoid hemorrhage, a major cause of stroke and shock. Although exosomal micro ribonucleic acids have emerged as key regulators in intracranial aneurysm progression, the specific contributions of micro ribonucleic acid-154-5p remain underexplored. Methods Using quantitative reverse transcription polymerase chain reaction, we assessed the micro ribonucleic acid-154-5p expression in intracranial aneurysm specimens. Transmission electron microscopy was used to validate the extracted exosome. Exosomal transfer was confirmed using Cy3-labeled micro ribonucleic acid tracing and quantitative reverse transcription polymerase chain reaction. Functional impacts on vascular smooth muscle cells were evaluated using Cell Counting Kit-8, apoptosis, and 5-ethynyl-2′-deoxyuridine assays. Target genes were identified via ribonucleic acid pull-down and luciferase reporter assays. Results Herein, micro ribonucleic acid-154-5p levels were upregulated in intracranial aneurysms. Furthermore, micro ribonucleic acid-154-5p promotes the intracranial aneurysm phenotype in vascular smooth muscle cells. H 2 O 2 –exposed vascular smooth muscle cells secrete exosomal micro ribonucleic acid-154-5p, which can be transferred to other vascular smooth muscle cells. Exosomal micro ribonucleic acid-154-5p promotes the development of intracranial aneurysms phenotype in vascular smooth muscle cells by targeting myosin light chain kinase. Conclusions Exosomal micro ribonucleic acid-154-5p is a novel potentially associated and promising therapeutic target for intracranial aneurysm management. However, the current study is limited to in vitro evidence.
Objective To determine how well shear wave elastography performs as a diagnostic tool for determining the pathological response to neoadjuvant chemotherapy in breast cancer. Methods Through April 2025, a systematic search of PubMed, MEDLINE, Cochrane Library, China National Knowledge Infrastructure, and SinoMed was used to perform a diagnostic meta-analysis. Included were studies of individuals with breast cancer receiving neoadjuvant chemotherapy with shear wave elastography evaluation. The diagnostic performance of shear wave elastography was assessed using a hierarchical summary receiver operating characteristic model and a bivariate random-effects model. The Quality Assessment of Diagnostic Accuracy Studies-2 was used to evaluate the quality of the study. Results The study includes 15 trials with 1402 patients. For predicting pathological response to neoadjuvant chemotherapy, the pooled sensitivity and specificity of shear wave elastography were 0.68 (95% confidence intervals: 0.49–0.86) and 0.73 (95% confidence intervals: 0.60–0.87), respectively. 13.06 (95% confidence intervals: 8.42–20.25) was the pooled diagnostic odds ratio. The hierarchical summary receiver operating characteristic study showed a moderate diagnostic performance with an area under the curve of 0.85 (95% confidence intervals: 0.82–0.88). Conclusions Shear wave elastography may be a helpful supplementary imaging modality in clinical treatment monitoring and showed moderate diagnostic performance for assessing pathological response to neoadjuvant chemotherapy in breast cancer. To confirm its clinical value, more extensive prospective investigations are required. PROSPERO registration number: CRD420261435666.
Objective IPX203 is a newly approved oral carbidopa–levodopa formulation designed to prolong the therapeutic effect and reduce complications associated with the standard immediate-release formulation. Immediate-release carbidopa–levodopa remains the current standard of care but has a short duration of action. This study aimed to evaluate the efficacy and safety of IPX203 compared with immediate-release carbidopa–levodopa in patients with advanced Parkinson's disease. Methods This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in the International Prospective Register of Systematic Reviews (registration number: CRD42024623230). A comprehensive search of PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, ScienceDirect, Scopus, and Embase identified randomized controlled trials comparing IPX203 with immediate-release carbidopa–levodopa. The primary outcomes were changes from baseline in “Good On-time” (periods of effective symptom control with minimal dyskinesia) and “Off-time” (periods when medication effects wear off and symptoms return). Secondary outcomes included scores on Part III of the Movement Disorder Society–Unified Parkinson's Disease Rating Scale and adverse events. Results A total of 466 records were screened, resulting in the inclusion of three randomized controlled trials involving 560 participants. Compared with immediate-release carbidopa–levodopa, IPX203 increased total “Good On-time” and reduced “Off-time.” Scores on Part III of the Movement Disorder Society–Unified Parkinson’s Disease Rating Scale demonstrated greater improvement in motor function with IPX203. The incidence of adverse events was comparable between the two groups, although treatment-emergent adverse events and treatment discontinuations were more frequent in the IPX203 group. Conclusion Compared with immediate-release carbidopa–levodopa, IPX203 increased “Good On-time,” reduced “Off-time,” improved motor function as measured by Part III of the Movement Disorder Society–Unified Parkinson’s Disease Rating Scale, and demonstrated a comparable safety profile.
Objective This study aimed to investigate the potential causal relationships between chronic pain and three key sarcopenia-related quantitative traits: (a) hand grip strength; (b) usual walking pace; and (c) appendicular lean mass, using bidirectional two-sample Mendelian randomization. Methods We conducted bidirectional two-sample Mendelian randomization using summary-level data from large-scale genome-wide association studies to assess the genetically predicted associations between chronic pain, including multisite chronic pain and chronic widespread musculoskeletal pain, and the aforementioned sarcopenia-related traits. Results Mendelian randomization revealed that multisite chronic pain was significantly associated with an increased risk of low hand grip strength (odds ratio = 1.70; p < 0.001) and decreased usual walking pace (odds ratio = 0.81; p < 0.001); chronic widespread musculoskeletal pain was also significantly associated with decreased usual walking pace (odds ratio = 0.15; p < 0.001). Additionally, higher left hand grip strength was significantly associated with a lower risk of multisite chronic pain (odds ratio = 0.90; p < 0.001) and chronic widespread musculoskeletal pain (odds ratio = 0.99; p = 0.002); higher right hand grip strength was significantly associated with a lower risk of multisite chronic pain (odds ratio = 0.91; p = 0.002); and higher usual walking pace was significantly associated with a lower risk of multisite chronic pain (odds ratio = 0.49; p < 0.001) and chronic widespread musculoskeletal pain (odds ratio = 0.92; p < 0.001). No significant causal associations were detected for appendicular lean mass in either direction (all p > 0.05). Conclusion This study provides genetic evidence supporting potential causal links between chronic pain and key phenotypic components of sarcopenia.
Osteopontin (encoded by secreted phosphoprotein 1) is a multifunctional matricellular phosphoglycoprotein that has emerged as an important mediator in the aging nervous system. During aging, osteopontin interacts with microglial priming, vascular remodeling, myelin repair, and innate immune responses and is consistently implicated in major late-life neurological disorders. However, its biological effects are highly context dependent. Depending on its cellular source, proteolytic processing, receptor interactions, anatomical distribution, and disease stage, osteopontin may either exacerbate chronic neuroinflammation and tissue injury or promote phagocytic clearance, neuronal survival, remyelination, neuroplasticity, and tissue repair. This review critically synthesizes studies indexed in PubMed and Google Scholar through 3 April 2026 on the role of osteopontin in brain aging, Alzheimer's disease and related dementias, Parkinson's disease and Lewy body disorders, cerebrovascular disease, vascular cognitive impairment, cerebral small vessel disease, and amyotrophic lateral sclerosis. In Alzheimer's disease, cerebrospinal fluid and plasma osteopontin concentrations increase from the prodromal to symptomatic stages, whereas microglial or perivascular secreted phosphoprotein 1 expression correlates with amyloid pathology, synaptic remodeling, and cognitive decline. However, under specific conditions, osteopontin also enhances macrophage-mediated amyloid-beta clearance. In stroke, elevated circulating osteopontin predicts poor clinical outcomes, whereas experimental studies demonstrate that appropriately timed exogenous osteopontin, regulatory T cell-derived osteopontin, and osteopontin-mediated autophagic and reparative pathways promote white-matter repair, peri-infarct plasticity, and blood–brain barrier integrity. Evidence from Parkinson's disease, Lewy body disease, frontotemporal dementia, and amyotrophic lateral sclerosis further supports the role of osteopontin as both a candidate biomarker and a regulator of selective neuronal vulnerability. Rather than being uniformly detrimental or protective, osteopontin should be regarded as a context-dependent regulator of age-related neuroimmune remodeling. This perspective reconciles seemingly conflicting findings and supports the development of therapeutic strategies that are tailored to disease stage, protein fragment, and cell type rather than broadly targeting osteopontin.
ObjectiveThe lactate-to-albumin ratio has been associated with adverse outcomes in various diseases. However, the impact of the lactate-to-albumin ratio on the prognosis of critically ill patients with chronic kidney disease remains unclear. Therefore, this study aimed to investigate the predictive ability of the lactate-to-albumin ratio for 28-day all-cause mortality in critically ill patients with chronic kidney disease.MethodsThis retrospective cohort study included 4271 critically ill patients with chronic kidney disease from the Medical Information Mart for Intensive Care IV database. The exposure factor was the lactate-to-albumin ratio, and the outcome was the 28-day mortality rate. Hazard ratios were computed along with their corresponding 95% confidence intervals using multivariate Cox regression.ResultsMultivariable Cox regression revealed that, compared with the Tertile 1 group, the hazard ratio for 28-day mortality was 1.55 (95% confidence interval: 1.26-1.92, p < 0.001) in the Tertile 2 group and 1.91 (95% confidence interval: 1.54-2.36, p < 0.001) in the Tertile 3 group. Kaplan-Meier analysis demonstrated that the higher lactate-to-albumin ratio group had higher 28-day, 90-day, and 1-year mortality rates (p < 0.001).ConclusionsIn our study population, the lactate-to-albumin ratio was independently associated with 28-day all-cause mortality, and this ratio may provide incremental prognostic value when combined with established severity of illness scores.
ObjectiveTo evaluate the demographic and hierarchical representation biases in artificial intelligence-generated depictions of healthcare professionals in anesthesiology, pain medicine, and intensive care, with a focus on sex, age group, skin tone, ethnicity, and professional role hierarchy.MethodsThis cross-sectional comparative study analyzed 4400 artificial intelligence-generated images produced by 4 text-to-image models (DALL·E 3, Midjourney, Leonardo AI, and Gemini). Ten professional roles in anesthesiology, pain medicine, and intensive care, ranging from trainees to department heads, were evaluated. Two independent anesthesiologists with clinical experience in anesthesiology and intensive care assessed each image using a structured digital evaluation form, recording sex, age group, skin tone, ethnicity, and professional role hierarchy. Statistical comparisons were performed using chi-square test with Bonferroni-adjusted post hoc proportion analyses.ResultsMale representation predominated across roles and models (mean: 68.5%), with leadership positions showing the highest male proportion (up to 90.0%). Light skin tones (mean: 70.6%) and Caucasian ethnicity (mean: 68.0%) were the most commonly depicted categories. Younger individuals (age: <40 years) were overrepresented (mean: 53.1%), whereas individuals aged >60 years were rarely depicted (<3.0%) and appeared mainly in leadership roles. Significant differences in sex representation were observed in 9 out of 10 professional roles across artificial intelligence models, with the exception of the anesthesia specialist role (p = 0.051).ConclusionsText-to-image artificial intelligence systems consistently reproduced results with demographic and hierarchical biases in depictions of healthcare professionals in anesthesiology, pain medicine, and intensive care. The predominance of male, light skin tone, and Caucasian ethnicity, particularly in senior roles, highlights the need for more diverse training datasets and greater transparency in the development of artificial intelligence systems.
Leukotrichia refers to whitening or depigmentation of hair resulting from reduced or absent melanin in the hair shaft. Although often considered a cosmetic finding, it may reflect underlying alterations in follicular melanocyte biology and therefore have diagnostic, prognostic, and therapeutic relevance. The clinical spectrum includes congenital and genetic disorders, including piebaldism, Waardenburg syndrome, tuberous sclerosis complex, and pigment dilution syndromes; autoimmune and inflammatory conditions, including vitiligo and follicular vitiligo, alopecia areata, and Vogt-Koyanagi-Harada disease; nevus- and melanoma-associated immune phenomena; drug-induced changes; and postinflammatory, traumatic, laser-associated, and idiopathic types. This narrative review, based on a structured literature search of biomedical databases, summarizes current evidence on terminology, follicular biology, mechanisms, etiologic spectrum, diagnostic approach, management, and prognosis of leukotrichia. Leukotrichia is best regarded as a final manifestation of diverse mechanisms, including congenital absence of melanocytes, immune-mediated melanocyte destruction, collapse of follicular immune privilege, melanocyte stem cell depletion, functional inhibition of melanogenesis, and structural injury to the follicular pigmentary unit. In vitiligo, hair depigmentation may indicate depletion of the follicular melanocyte reservoir and has been associated with a poorer response to medical and phototherapeutic interventions. In other settings, it may reflect stable developmental absence or structural injury with limited potential for repigmentation. Management is primarily cause-directed, and hair repigmentation should be evaluated separately from surrounding skin repigmentation in both clinical practice and research. Key priorities include standardization of terminology, development of specific outcome measures, independent reporting of hair and skin responses, and identification of predictive biomarkers for restoration of follicular pigmentation.
Background Gestational trophoblastic disease refers to a group of tumors defined by abnormal trophoblastic proliferation. This disease produces a distinct tumor marker, beta-human chorionic gonadotropin, which can be useful for diagnosis and follow-up. The objective of this study was to investigate the variations in serum beta-human chorionic gonadotropin levels after uterine evacuation as well and the progression of gestational trophoblastic neoplasia. Materials and methods This retrospective cohort study was conducted at Tu Du Hospital, Vietnam, between January 2019 and December 2020. All patients diagnosed with molar pregnancy were analyzed retrospectively based on serial serum beta-human chorionic gonadotropin levels following uterine evacuation. Post-evacuation outcomes, including relapsed molar pregnancy and gestational trophoblastic neoplasia, were also monitored. Results We enrolled 560 patients with molar pregnancy, including 298 with complete hydatidiform mole and 262 with partial hydatidiform mole. Severe symptoms were more common in those with complete hydatidiform mole. Over the follow-up period, 97 cases of gestational trophoblastic neoplasia were noted. The data show that the median time to gestational trophoblastic neoplasia diagnosis was 8.75 ± 4.41 (4–26) weeks. In terms of variations in the serum beta-human chorionic gonadotropin levels, the generalized estimating equation model showed a faster decline in the complete hydatidiform mole group than in the partial hydatidiform mole group. Similarly, regression in serum beta-human chorionic gonadotropin levels was significantly more rapid in patients who progressed to gestational trophoblastic neoplasia than in those with relapsed molar pregnancy (−11,593 vs. −20,651.22 and −12,946.26 vs. −46,329.23 mUI/mL, p < 0.001). Conclusions Surveillance of serum beta-human chorionic gonadotropin levels remains essential for gestational trophoblastic neoplasia monitoring in patients with molar pregnancy following surgical evacuation. The post-evacuation serum beta-human chorionic gonadotropin level regression curve helps distinguish gestational trophoblastic neoplasia from hydatidiform moles. Further evidence is required to strengthen these findings.
Objective To characterize the clinical features of primary intestinal follicular lymphoma and provide insights into its diagnosis and management. Methods We retrospectively analyzed the clinical, endoscopic, imaging, pathological, and long-term follow-up data of eight patients with primary intestinal follicular lymphoma who were admitted between January 2019 and August 2025. Results The mean patient age was 58.13 years, and 75.00% of patients were women. Abdominal pain (62.50%) was the most common clinical manifestation, and 62.50% of patients presented with severe complications, including gastrointestinal bleeding or obstruction. Lesions were distributed across multiple intestinal segments. The most characteristic endoscopic finding was lymphoid follicle-like elevation (50.00%), which could be mistaken for a polyp. Histopathological examination showed that 62.50% of lesions were confined to the mucosa or submucosa. All specimens were positive for cluster of differentiation 20, B-cell lymphoma 2, and B-cell lymphoma 6. Asymptomatic patients were managed with a watch-and-wait strategy and had favorable outcomes, whereas patients requiring surgery because of severe complications associated with deeper infiltration had poorer outcomes. Conclusion Primary intestinal follicular lymphoma is a rare, predominantly indolent B-cell lymphoma whose diagnosis relies on histopathological and immunohistochemical evaluation. Although outcomes in this small series were generally favorable, patients with severe complications may have poorer outcomes. Larger multicenter prospective studies incorporating genetic profiling are needed to validate these observations and further inform individualized management strategies.
Objective This study investigated immune lineage remodeling and intercellular communication to elucidate the mechanisms driving the progression from active tuberculosis to disseminated tuberculosis. Methods We integrated single-cell RNA-sequencing datasets of peripheral blood mononuclear cells from healthy controls, patients with active tuberculosis, and patients with disseminated tuberculosis (n = 3 for each group) to perform cellular clustering, functional assessment, and communication network analyses. Results Analysis identified 16 clusters across 5 major lineages. Although global cellular proportions remained statistically stable across patient cohorts, disease progression was characterized by distinct cell-intrinsic transcriptomic shifts and subset-specific remodeling. This landscape was highlighted by the systematic peripheral depletion of homeostatic “guardian” monocytes, alongside functional disruptions in natural killer and B-cell states, and a severe-stage-specific accumulation of exhausted T cells. Consequently, circulating intercellular communication networks were broadly attenuated in infected groups, featuring diminished receptor–ligand interactions between peripheral dendritic cells and naïve CD8 + T cells, driven by cell-intrinsic transcriptional rewiring rather than shifts in underlying cell frequencies. Conclusions Tuberculosis progression involves profound peripheral immune remodeling marked by the systemic attrition of circulating homeostatic populations and altered blood interactome dynamics. This preliminary atlas provides an exploratory framework for potential therapeutic interventions in severe tuberculosis.
ObjectivePreeclampsia is a major contributor to maternal morbidity worldwide, and early identification of women at risk of major adverse maternal outcomes is essential. However, commonly used biomarkers are costly and poorly accessible. Complete blood count-derived inflammatory ratios are inexpensive and widely available, but their prognostic value remains unclear. Therefore, this study aimed to evaluate whether complete blood count-derived inflammatory ratios are associated with major adverse maternal outcomes (a diagnostic-prognostic question) and whether they can differentiate women with preeclampsia.MethodsWe conducted a Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020-compliant systematic review of observational studies, prospectively registered in International Prospective Register of Systematic Reviews (CRD420251275277). We conducted an extensive search across Scopus, PubMed, Web of Science, and Lens.org for studies published between January 2015 and December 2025. Eligible studies enrolled women with preeclampsia and assessed at least one complete blood count-derived inflammatory ratio (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, or delta neutrophil index ) in association with at least one major adverse maternal outcome. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation. Owing to substantial heterogeneity in designs, ratios, cutoffs, timing, and outcomes, no meta-analysis was performed, and findings were synthesized narratively.ResultsFifteen studies comprising 11,224 participants were included, of whom 5950 were women with preeclampsia and 1700 were normotensive controls. The remaining participants formed other comparison groups within large screening or hospital cohorts. Neutrophil-to-lymphocyte ratio was the most consistently evaluated marker and demonstrated good-to-excellent discrimination for severe disease and multiorgan complications (area under the curve range: 0.70-0.99). An elevated neutrophil-to-lymphocyte ratio was associated with hemolysis elevated liver enzymes low platelets syndrome, eclampsia, acute kidney injury, and intensive care unit admission. Platelet-to-lymphocyte ratio showed inconsistent patterns, with lower values particularly reported in women with hemolysis elevated liver enzymes low platelets syndrome. Evidence for systemic immune-inflammation index and systemic inflammation response index was limited, and substantial heterogeneity in cut-off values was observed.ConclusionsComplete blood count-derived inflammatory ratios, particularly neutrophil-to-lymphocyte ratio, demonstrated potential as low-cost adjunctive markers of risk in women with preeclampsia. However, the evidence is limited by heterogeneity, predominantly retrospective designs, severity-only and composite outcomes, and sparse outcome-specific data. These ratios should not currently be used as standalone clinical decision tools, and prospective validation in high-burden settings is required before implementation.
Chronic kidney disease is a progressive condition that impairs renal function and can ultimately lead to kidney failure. Its progression involves multiple intermediate stages, making conventional survival models inadequate for capturing the complexity of disease transitions. This study aimed to model chronic kidney disease progression using a continuous-time multistate Markov process to evaluate stage-specific transition dynamics and the effects of clinical and demographic factors. A retrospective cohort study of 194 patients with chronic kidney disease, comprising 1506 clinic visits at Jimma Medical Center between February 2019 and February 2024, was conducted. The multistate Markov framework was used to estimate transition intensities, transition probabilities, mean sojourn times, and next-state probabilities and to assess the effects of clinical and demographic characteristics on transitions between chronic kidney disease stages. Transition probabilities indicated an increasing likelihood of progression to more advanced stages over time, accompanied by decreasing probabilities of remaining in the same stage. The mean sojourn times in stages 1, 2, 3, and 4 were 4.33, 4.44, 5.79, and 4.57 months, respectively. Patients with hypertension were significantly more likely to transition from stage 4 to stage 5 than those without hypertension (hazard ratio = 2.62, 95% confidence interval: 1.79–3.84). Diabetes, hypertension, and cardiovascular disease were the primary factors associated with chronic kidney disease progression. Mean sojourn times and next-state probabilities complemented transition intensities by describing the expected duration of each chronic kidney disease stage and the likelihood of subsequent transitions. These findings provide insights into chronic kidney disease progression and may support stage-specific management and intervention strategies.
Aluminum phosphide poisoning is a highly lethal toxicological emergency associated with an extremely high mortality rate, and no specific antidote is currently available. Aluminum phosphide rapidly releases phosphine gas after coming into contact with gastric acid, which strongly inhibits mitochondrial cytochrome c oxidase, leading to severe cellular metabolic disorder, lactic acidosis, refractory shock, and progressive multiple organ dysfunction syndrome. In severe cases, the mortality rate can approach 100%. We report the case of a man in his early 40s who intentionally ingested 25.2 g of aluminum phosphide, equivalent to approximately 16 times the human lethal dose (based on a lethal dose of 1.5 g). The patient rapidly developed fulminant multiple organ dysfunction syndrome, including refractory cardiogenic shock, acute respiratory distress syndrome, acute kidney injury, liver dysfunction, hypocalcemia, and secondary ventilator-associated pneumonia caused by Citrobacter koseri infection. He received a series of timely critical interventions, including ultra-early gastric lavage with liquid paraffin, sequential hemoperfusion, continuous venovenous hemofiltration, mechanical ventilation with prone positioning, circulatory support, corticosteroids, and targeted antimicrobial therapy. The patient achieved complete clinical recovery and was discharged 18 days after admission. No organ or neurological sequelae were observed at the 1-month follow-up. This rare and successful rescue demonstrates that even ultra-severe aluminum phosphide poisoning can be reversed with standardized, sequential, and comprehensive critical care support without relying on advanced life-support devices such as extracorporeal membrane oxygenation. This study provides a practical and valuable therapeutic strategy for the management of severe aluminum phosphide poisoning in resource-limited clinical settings.
