Kidney stone disease (KSD) is a common urological condition. For the patient, it typically presents with severe colicky flank pain and can have a substantial impact on quality of life, work productivity, and livelihood. For the clinician, they can present a diagnostic conundrum particularly in the absence of appropriate imaging, and the cost burden to the healthcare system can be significant. Investigations serve to rule out underlying metabolic, structural or pathological abnormalities, as well as identify the size, number, location, type and associated features of stone. KSD treatment can be complex, encompassing a spectrum of conservative, dietary, medical, and surgical approaches. This article provides an overview of the risk factors, clinical features, diagnosis, prevention and management of KSD. We conclude with a review of the recent innovations in this field.
Staphylococcus aureus bacteremia (SAB) bloodstream infection (BSI) is a common complication among patients treated in the intensive care unit (ICU), predisposing them to high morbidity and mortality. The mortality rate at one and three months is 18% and 27%, respectively, and the recurrence and reinfection rate reaches 9%. This study aims to analyze prognostic factors for ICU patients with SAB BSI and establish a prediction model.
A total of 210 SAB BSI patients admitted to the ICU from January 2020 to December 2023 were retrospectively selected. Patients were randomly divided in a 3:2 ratio into a modeling group (n = 126) and a validation group (n = 84). Within the modeling group, patients were further categorized into the good prognosis group (n = 75) and the poor prognosis group (n = 51) based on their prognosis outcomes. Univariate and binary logistic regression analyses were conducted to identify prognostic factors for SAB BSI patients. A prediction model was constructed using SPSS, receiver operating characteristic (ROC) curves were generated with R programming language, and calibration and decision curve analysis (DCA) curves were utilized to assess the model’s application value.
Inappropriate initial antibiotic therapy, infection source, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and central venous catheter placement showed significant differences (p < 0.05). The results of binary logistic regression analysis indicated that inappropriate initial antibiotic therapy, infection source, APACHE II score, and central venous catheter placement were prognostic factors for SAB BSI patients (p < 0.05). The model equation was Logit(P) = –3.549 + (0.871X1) + (0.959X2) + (0.070X3) + (0.832X4). The model in the modeling group and the validation group showed a calibration curve with a slope close to 1, which indicates good consistency between the predicted risk and the actual risk. The ROC analysis results indicated that in the validation group, the model had an area under the curve of 0.7857 with a standard error of 0.0331 (95% confidence interval (CI): 0.7229–0.8518, p < 0.001) and a Youden’s index of 0.61, resulting in a sensitivity of 80.96% and a specificity of 79.64%. The decision curve analysis (DCA) curve demonstrated that the model had a clear positive net benefit.
Inappropriate initial antibiotic therapy, infection source, APACHE II score, and central venous catheter placement are prognostic factors for SAB BSI patients receiving care in the ICU. This study successfully established and validated a prediction model for SAB BSI.
Tracheostomy insertion is becoming increasingly common in the UK. As patients with tracheostomies may be encountered in any healthcare setting, it is vital that doctors of all grades and specialties are familiar with the basic components of a tracheostomy and their management. This article aims to ‘demystify’ tracheostomies to enable the reader to feel more confident and competent at managing these patients in their clinical practice.
Studies investigating different classes of vasopressors for septic shock are ongoing, and discrepancies persist among the increasing number of meta-analyses. This umbrella review and evidence map aim to provide a comprehensive overview of the current evidence and to evaluate the highest-quality evidence regarding the efficacy and safety of vasopressors in the treatment of septic shock.
We searched PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews from inception to August 2024. We included meta-analyses of randomized controlled trials that compared vasopressors for the treatment of adult patients with septic shock. The methodological quality of the included meta-analyses was assessed using A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). The quality of evidence for each outcome was evaluated using the modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The best available evidence was identified using the Jadad decision algorithm.
A total of thirty-one eligible meta-analyses were included. The comparison of norepinephrine with vasopressin was the most frequently studied, followed by comparisons of norepinephrine with dopamine. Norepinephrine was found to be superior to dopamine in reducing mortality, heart rate, and the incidence of arrhythmia. Methylene blue demonstrated a reduction in mortality, even though this finding was supported by low GRADE evidence. Meta-analyses comparing norepinephrine with phenylephrine, epinephrine, and angiotensin II showed no significant differences in mortality, also with low GRADE evidence. The addition of vasopressin to norepinephrine was associated with comparable mortality, a lower risk of arrhythmia, and a higher risk of digital ischemia, with moderate GRADE evidence. In contrast, the addition of terlipressin showed no significant differences.
Current evidence fails to demonstrate superior efficacy of alternative vasoactive agents compared to norepinephrine across all evaluated outcome indicators. Considering both the reduced risk of arrhythmias and the increased risk of digital ischemia associated with vasopressin, clinicians should individualize therapy based on patient-specific factors. In addition, our evidence maps identify gaps in the existing literature, highlighting areas for future research.
Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating respiratory condition marked by chronic symptoms and frequent exacerbations, contributing to significant morbidity and mortality. The advent of molecular microbiology and next-generation sequencing (NGS) has expanded our understanding of the lung microbiome, and integration of microbiome datasets with other omics reveals important microbial-metabolic-immuno-inflammatory interactions that influence COPD pathogenesis. Recent studies have highlighted dysbiosis of the airway microbiome, with shifts in bacterial, viral, and fungal communities playing a crucial role in disease progression, exacerbations and clinical outcomes. Moreover, microbiome changes are observed in COPD associated overlap syndromes, complicating diagnosis and treatment. This review synthesizes current microbiome research in COPD, focusing on its clinical relevance, including its potential as a diagnostic and prognostic tool. We additionally discuss the challenges of integrating microbiome data into clinical practice, emphasizing the need for personalized, precision medicine approaches to optimize COPD management and improve patient outcomes.
As the global population ages, age-related chronic obstructive pulmonary disease (COPD) and sarcopenia present significant clinical and economic concerns. Emerging evidence suggests that these conditions are interrelated; however, potential confounding factors may impact observational investigations. Therefore, this study employed a bi-directional Mendelian randomization analysis to systematically investigate the causal relationship—rather than merely conducting a correlation analysis, between sarcopenia-related traits and COPD and hospitalization risk.
Univariate, two-sample, and bi-directional Mendelian randomization (MR) analyses were performed using data from genome-wide association studies. The data on Sarcopenia features, including appendicular lean mass (ALM), hand grip strength (HGS), usual walking pace (UWP), and moderate-to-vigorous physical activity (MVPA) were acquired from the UK Biobank. However, data on COPD and hospitalization risk were sourced from the FinnGen consortium. Inverse-variance weighted (IVW) MR and sensitivity analyses were performed to evaluate causal relationships. Additionally, the observed findings were validated using an independent COPD dataset sourced from the UK Biobank.
The forward MR analysis using IVW revealed a significant negative causality between ALM, HGS, UWP, MVPA, and COPD (all p < 0.05, all pFDR < 0.05) (False Discovery Rate, FDR), as well as with COPD-related hospitalization (all p < 0.05, all pFDR < 0.05). These findings were corroborated by validation analyses. Furthermore, reverse MR assessment demonstrated that COPD alleviates UWP (p = 0.001, pFDR = 0.015); however, validation analysis did not confirm this result. Moreover, additional MR analyses yielded similar trends in causal relationships as evidenced by robust sensitivity tests.
Our study supported a unidirectional, negative causality between sarcopenia-related traits and COPD and hospitalization risk. This provides possible evidence that sarcopenia increases the risk of COPD and hospitalization at the genetic level. Our findings suggest that improving sarcopenia may serve as a promising strategy for minimizing the incidence of COPD and hospitalization risk, thereby reducing the health burden on these patients.
Bilateral spontaneous carotid artery dissections are rare, comprising only 10% of spontaneous carotid artery dissection cases. They occur when there is a tear in the innermost lining of the artery called the tunica intima. An intramural hematoma may form which can lead to vessel lumen narrowing or occlusion, causing an acute ischaemic stroke.
We present a case of a man in his 50s with bilateral spontaneous internal carotid artery dissection who presented with a sudden onset of headache, neck pain, and right arm weakness. After being treated, the patient presented again after 3 weeks with neck pain on the right side, headache, and transient left arm weakness. He was treated with anticoagulation followed by antiplatelet therapy.
At 6 months, the computed tomography angiogram (CTA) of carotid and vertebral arteries showed a largely resolved left internal carotid artery dissection (ICAD) and a resolved right ICAD. At the 7 years follow up, the patient continues to do well as he has not had any more transient ischaemic attacks or strokes.
This case demonstrates that carotid artery dissections should be considered when a patient presents with these symptoms, even if they present bilaterally in a short period, and can be investigated with a CTA or magnetic resonance angiogram, with treatment by antiplatelets or anticoagulation.
Delivery of reperfusion therapies such as thrombolysis and mechanical thrombectomy have revolutionised the treatment for acute ischaemic stroke with reduction in disability and mortality. Extended time windows for thrombolysis for patients presenting beyond 4.5 hours including wake up stroke have now increased the eligibility for these treatments. Tenecteplase has emerged as alternative thrombolytic agent to alteplase, with practical advantages. Mechanical thrombectomy is now available to a wider group of patients than previously considered such as patients presenting beyond 6 hours up to 24 hours, those with large core anterior circulation infarcts and posterior circulation stroke. Advances in brain imaging and their application to determine salvageable brain tissue is crucial in delivery of these interventions. Systems of care to enhance the delivery of these time critical treatments such as pre-hospital video triage and mobile stroke units may play a vital role in maximising population benefits from high-quality hyper-acute stroke care. The purpose of this review is to highlight the expansion of evidence for acute therapeutic interventions for ischaemic stroke and technologies to facilitate their delivery.
Advanced biliary tract cancer (BTC) is an aggressive malignancy, and often presents with poor prognostic outcomes despite standard chemotherapy. This study aimed to evaluate the preliminary efficacy and safety of toripalimab in combination with gemcitabine + oxaliplatin (GEMOX) as a first-line treatment option for advanced BTC.
This prospective, single-arm, single-center study enrolled 35 patients with advanced BTC. The patients received toripalimab in combination with GEMOX as first-line treatment at Zhejiang Cancer Hospital, China, between February 2021 and April 2023. Each patient received 1 to 11 treatment cycles, and the objective response rate (ORR) was evaluated before and after chemotherapy using the Response Evaluation Criteria for Solid Tumors (RECIST) version 1.1. Progression-free survival (PFS) and overall survival (OS) were assessed using the Kaplan-Meier method. Furthermore, adverse events and their severity were recorded to evaluate the safety profile of the treatment.
A study cohort of 35 patients was enrolled (median age, 57 years), including 15 men and 20 women. Of them, 18 had intrahepatic cholangiocarcinoma, 14 had gallbladder cancer, and 3 had hilar cholangiocarcinoma. Metastatic lesions were most commonly observed in the lymph nodes, liver, and pelvis. The ORR was 20% (95% confidence interval [CI] 8.4%–36.9%), including 2 for complete response (CR) and 5 for partial response (PR). The median PFS and OS were found to be 8.5 and 16.5 months, respectively. All patients experienced adverse events, with 11 (31.42%) of the patients having grade 3 or higher adverse events. The most commonly observed adverse events included increases in alanine aminotransferase (ALT) and aspartate aminotransferase (AST), leukopenia, neutropenia, and thrombocytopenia.
Toripalimab combined with GEMOX showed preliminary antitumor activity and an acceptable safety profile in patients with advanced BTC, warranting further validation in larger cohorts.
Chinese Clinical Trial Registry (ChiCTR2600117154).
Inferior vena cava (IVC) anomalies are uncommon, with absent infrarenal IVC reported as one of the rarest congenital vascular anomalies. They are associated with deep vein thrombosis (DVT) particularly in younger patients, which can have serious complications if not recognised and treated appropriately.
We describe the case of a 35-year-old male with absent infrarenal IVC presenting with acute DVT.
Radiologists and clinicians should understand the relationship between IVC anomalies and DVT, particularly in younger patients.
This case highlights the importance of multi-modality diagnostic and interventional imaging techniques in assessing and treating patients effectively.
Myosin heavy chain 9-related disease (MYH9-RD) is a rare inherited disorder characterised by macrothrombocytopenia, often misdiagnosed as immune thrombocytopenia (ITP). Early identification is crucial to prevent unnecessary treatments and to ensure appropriate monitoring. The present case aims to highlight the diagnostic challenges and clinical management of MYH9-RD in a toddler, emphasising the importance of early genetic testing.
We discuss a 13.5-month-old girl with macrothrombocytopenia lacking Döhle bodies, who initially received intravenous immunoglobulin (IVIg) and corticosteroids without any response. Within two months, whole-exome sequencing identified a pathogenic MYH9 mutation (c.287C>T; p.Ser96Leu).
One year later, the patient remains clinically stable without significant bleeding. The occurrence of petechial rash exhibited a more pronounced correlation with platelet mass index (PMI) values compared to platelet count (PLT), underscoring its significance in clinical evaluation.
MYH9-RD should be considered in cases of IVIg-resistant thrombocytopenia accompanied by macrothrombocytes. Timely genetic testing can facilitate accurate diagnosis and may help avoid unnecessary procedures, while routine renal and auditory monitoring is important for managing the S96L variant.
Falls and high fall risk in older adults are key signals of unmet underlying health issues as well as further fall recurrence and injury. With reference to contemporary National Institute of Health and Care Excellence (NICE) guidance, World Guidelines and National Audit of Inpatient Falls (NAIF) reporting data, this commentary presents an analysis of current progress, opportunity and forward challenge in service implementation and delivery for two focused key UK National Health Service (NHS) hospital-based groups—(1) Hospital inpatients and (2) Accident and Emergency (A&E) attendees—target groups with UK evidence of preventative and health benefit from prompt comprehensive assessment and management. For inpatients, the National Audit of Inpatient Falls (NAIF) is an operational evidence-based hospital service resource delivering and monitoring progress at the NHS national and trust level. For hospital A&E attendees with a fall, the basis for a comparable, consistent, cost-effective NHS falls prevention service design and audit process is demonstrable from UK research evidence, but unresolved challenges in service implementation remain, and a standardised audit system is still lacking. Forward strategies involving clear leadership and audit are proposed.
The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is extensively used internationally for assessing disabilities across diverse cultures and health conditions; however, psychometric validation of its Arabic version remains scarce. This study aimed to evaluate the psychometric properties regarding the Arabic WHODAS 2.0 using Rasch analysis, providing the first validation evidence of reliability, validity, dimensionality, and item functioning among individuals with disabilities in Arabic-speaking populations.
This cross-sectional study included 486 Arabic-speaking participants. Rasch analysis was performed using WINSTEPS software to assess item fit, item and person reliability, unidimensionality, separation indices, differential item functioning (DIF), and category functioning.
The Arabic WHODAS 2.0 showed strong person (0.80) and item (0.99) reliability, with adequate item-person targeting. Most items fit the Rasch model, except for World Health Organization Disability Assessment Schedule 5 (WHODAS5), which displayed misfit and disorder thresholds. Principal component analysis supported unidimensionality (53.4% variance explained), and no significant DIF was detected across the demographic groups.
The Arabic version of the WHODAS 2.0 is a reliable and valid tool for assessing disability in Arabic-speaking populations. Overall, it demonstrated strong psychometric properties, although the WHODAS5 requires revision. This scale is suitable for clinical and research use, with recommendations for further qualitative validation and longitudinal testing.
The incidence of major adverse cardiovascular events (MACE) following percutaneous coronary intervention (PCI) remains high among patients with acute ST-segment elevation myocardial infarction (STEMI). The Pan-Immune-Inflammation Value (PIV), an indicator of systemic inflammatory status, has demonstrated prognostic utility across multiple diseases and may serve as an indicator of risk of STEMI patients undergoing PCI. This study aimed to investigate the predictive value of PIV for MACE within one year following PCI in patients with acute STEMI.
A retrospective analysis was conducted on 200 patients diagnosed with acute STEMI who underwent PCI at the Hainan General Hospital between January 2022 and December 2023. Based on the occurrence of MACE within one year post-PCI, patients were categorized into a MACE group (n = 148) and a non-MACE group (n = 52). Univariate and multivariate logistic regression analyses were conducted to identify factors influencing MACE occurrence in STEMI patients following PCI, and the predictive value of PIV was assessed using receiver operating characteristic (ROC) curve analysis.
There were no statistically significant differences between groups in gender, smoking status, body mass index (BMI), red and white blood cell counts, Left Atrium Diameter (LAD), Left Ventricular End-Diastolic Diameter (LVDd), total protein, albumin, triglycerides (TG), and total cholesterol (TC) (p > 0.05). However, significant differences were observed in age, heart rate, left ventricular ejection fraction (LVEF), and PIV (p < 0.05). Multivariate logistic regression analysis identified age, heart rate, PIV, and LVEF as independent predictors of MACE within one year post-PCI in patients with STEMI (p < 0.05). ROC curve analysis showed that the predicted area under the curve (AUC) for PIV in predicting the occurrence of MACE was 0.866 (p < 0.001) (95% confidence interval (CI): 0.809–0.922), with a standard error of 0.029, and a Youden index of 0.62. At this threshold, the sensitivity was 77.70%, and the specificity was 84.60%.
PIV demonstrates high predictive value for MACE within one year after PCI in patients with STEMI. It may serve as a valuable biomarker for assessing the risk of percutaneous coronary atherosclerosis events in this population. Further multi-center studies are warranted to validate its clinical utility.
Deep learning radiomics (DLRadiomics) can capture a wide range of tumor and lesion characteristics, providing valuable insights into biological behavior, pathophysiological status, and patient prognosis. This study integrated clinical data with deep learning-derived features into a machine learning survival model to assess the effectiveness of hepatectomy and transarterial chemoembolization (TACE) treatments in hepatocellular carcinoma (HCC) patients.
This study included pathologically confirmed HCC patients who received either hepatectomy or TACE between January 2013 and December 2022. We utilized three deep learning-based algorithms (ResNet50, ResNet18, and DenseNet121) with contrast-enhanced computed tomography (CT) images to predict the overall survival time. Deep learning features were extracted from these predictive models. Furthermore, a combined survival model was developed by incorporating clinical factors with the deep learning features for two treatment regimens separately. The areas under the curves (AUC) of the receiver operating characteristic (ROC) curves were used to assess the discrimination of the model at different time points. Additionally, nomograms were constructed to predict patient prognosis undergoing different treatment regimens, and their survival risk was evaluated using the Kaplan-Meier analysis.
This study recruited 409 HCC patients who received either hepatectomy (n = 278, 57 [49–66]; 239 men) or TACE (n = 131, 62 [51–69.5]; 111 men). ResNet50 achieved the highest AUC of 0.866 (95% confidence interval (CI): 0.815–0.917) in the training set and 0.793 (95% CI: 0.675–0.912) in the testing cohort. Overall, six models were constructed to assess overall survival for hepatectomy and TACE treatments, with the combined models exhibiting superior discriminative performance. The C-index for the combined hepatectomy model was 0.836 (95% CI: 0.776–0.897) in the training cohort and 0.861 (95% CI: 0.755–0.967) in the testing cohort. The C-index for the combined TACE model was 0.840 (95% CI: 0.792–0.888) in the training cohort and 0.834 (95% CI: 0.759–0.910) in the testing cohort. Two nomograms were created to help clinicians in selecting a treatment method by examining the difference scores between treatments.
The machine learning models can potentially predict differences in outcomes between hepatectomy and TACE. Furthermore, prognostic models using deep learning-based features can effectively predict survival risk in HCC patients.
Lipoprotein(a) [Lp(a)] is recognized as a cardiovascular risk indicator; however, its connection to peripheral arterial disease (PAD) in individuals with type 2 diabetes mellitus (T2DM) is not well established. This research seeks to explore how Lp(a) concentrations relate to the occurrence of PAD in T2DM patients.
A retrospective analysis was conducted on 590 patients diagnosed with T2DM who were admitted to Hefei First People’s Hospital from January 2022 to August 2024. Participants were grouped into tertiles according to their Lp(a) levels. The diagnosis of PAD was made using the ankle-brachial index (ABI), with an ABI <0.9 considered indicative of PAD. The association between Lp(a) concentrations and PAD was examined using multivariate logistic regression models, subgroup analyses, receiver operating characteristic (ROC) curves, and restricted cubic spline (RCS) plotting.
Compared to lower Lp(a) levels, the group with higher Lp(a) levels exhibited a higher prevalence of PAD (p = 0.001). Multivariate logistic regression analysis indicated that, after stepwise adjustment for all confounding factors, the risk of PAD in the higher Lp(a) group was 1.961 times that of the lower Lp(a) group (odds ratio [OR] = 1.961, 95% confidence interval [CI]: 1.071–3.588, p = 0.029). Additionally, for each 1 standard deviation increase in Lp(a) or each unit increase in the normalized Lp(a) (Log10Lp(a)), the risk of PAD increased by 25.7% and 80.3%, respectively (OR: 1.257, 95% CI: 1.016–1.555, p = 0.035; OR: 1.803, 95% CI: 1.013–3.209, p = 0.045). Subgroup analysis revealed a stratified association between Lp(a) and PAD risk across multiple subgroups (p < 0.05). ROC analysis demonstrated that Lp(a) had a certain predictive ability for PAD prevalence (area under the curve (AUC): 0.622, 95% CI: 0.568–0.677, p < 0.001). RCS analysis indicated that there was no evidence of a nonlinear relationship between Log10Lp(a) and PAD risk, regardless of the logistic regression model used (p for nonlinearity > 0.05).
A significant correlation was observed between elevated Lp(a) levels and an increased risk of PAD in patients with T2DM.
Acute heart failure (AHF) is a prevalent critical condition in the emergency department. Conventional treatment approaches typically emphasise independent medical practices and lack structured physician-nurse collaborative education, which may adversely impact patient prognosis. This study aimed to evaluate the effectiveness of a physician-nurse collaborative education management model in patients with AHF in the emergency department.
A retrospective cohort study was conducted on 110 patients with AHF admitted to Tongxiang First People’s Hospital between January 2022 and January 2024. The control group (n = 47) received routine care, while the observation group (n = 63) received a physician-nurse collaborative education management intervention. Self-care ability, emotional status, quality of life, New York Heart Association (NYHA) functional classification, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, length of hospital stay, 3-month readmission rate, and incidence of adverse events were compared between groups.
At baseline, no significant differences were observed between the two groups in the Self-Care of Heart Failure Index (SCHFI), Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Minnesota Living with Heart Failure Questionnaire (MLHFQ), NYHA functional classification, or NT-proBNP levels (all p > 0.05). Six months after discharge, both groups showed significant increases in SCHFI scores (p < 0.05), with the observation group achieving higher scores (p < 0.001). SDS and SAS scores decreased in both groups, but were significantly lower in the observation group (p < 0.001). MLHFQ scores improved in both groups (p < 0.05), with greater improvement in the observation group (p < 0.001). Furthermore, the observation group demonstrated better NYHA functional classification (p < 0.05), lower NT-proBNP levels (p < 0.05), shorter hospitalisation duration (p < 0.001), and reduced 3-month readmission rates and overall adverse event incidence (p < 0.05).
The physician-nurse collaborative education management model significantly enhances self-care ability, alleviates anxiety and depression, promotes cardiac functional recovery, and improves quality of life in AHF patients. Moreover, it reduces hospitalisation duration, readmission rates, and adverse events, supporting its potential for broader clinical application.
Increased adenosine deaminase (ADA) activity in cerebrospinal fluid (CSF) has been used as a biomarker of tuberculous meningitis and other etiologies, including viral, fungal, and neoplastic meningitis. Gout can influence inflammatory pathways, altering biochemical markers such as ADA. This report describes a unique case of varicella-zoster virus (VZV) meningitis with gout associated with elevated ADA levels.
A 37-year-old man presented with a one-week history of headache, fever, and chills. His medical history included gout, diagnosed three years earlier. CSF analysis from the first lumbar puncture revealed lymphocytic pleocytosis, elevated protein, mildly decreased glucose, and ADA activity of 7.4 IU/L. The patient developed worsening headache and vomiting, prompting a second lumbar puncture. Repeat CSF analysis showed persistent lymphocytosis, mildly decreased glucose, and increased ADA activity (9.1 IU/L). The patient also experienced an acute gout flare during hospitalization, which required antigout therapy. The subsequent CSF polymerase chain reaction (PCR) confirmed VZV meningitis.
The patient responded well to symptomatic treatment. Serum ADA levels were also elevated (14.7 IU/L), likely reflecting systemic inflammation due to gout.
Systemic inflammation, which includes the meninges and joints, had been postulated to increase protein diffusion through the vascular walls and had been associated with increased ADA activity in CSF and serum. To the best of our knowledge, this is one of the few reports on VZV meningitis and gout associated with elevated ADA levels.
The global prevalence of diabetes mellitus (DM) continues to rise, with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) being the most common subtypes. T1DM is characterised by the autoimmune destruction of pancreatic β-cells leading to absolute insulin deficiency, whereas T2DM is associated with insulin resistance and relative insulin insufficiency, often linked to lifestyle factors. Both subtypes are frequently misdiagnosed or underdiagnosed due to insufficient screening awareness, outdated diagnostic processes, and poor patient compliance, leading to delayed interventions and increased complication risks. This review examines information-management-based blood glucose control pathways, focusing on their role in improving the diagnostic rates of newly diagnosed T1DM and T2DM. It specifically examines the applications of key technologies: electronic health records (EHRs) for integrating multi-source data (e.g., autoantibodies for T1DM, metabolic indicators for T2DM), mobile health (mHealth) applications for real-time monitoring and targeted screening reminders, artificial intelligence (AI) for developing subtype-specific risk prediction models, Internet of Things (IoT) devices for capturing subtype-specific glycemic patterns, and blockchain for secure data sharing. Furthermore, the review describes how these technologies enhance early detection by optimising screening workflows, improving patient adherence, and facilitating accurate subtype differentiation. Despite demonstrated potential, challenges include data security, technological accessibility, and system interoperability. Future research should prioritise personalised pathways for each subtype, integrate multi-omics data, refine AI algorithms for subtype-specific diagnosis, and strengthen policy support to develop a precise, efficient early screening system for DM.
Asthma is a common and refractory chronic inflammatory disease of the airways, with its acute episodes governed by a multitude of factors. The postulation that skin barrier damage poses a direct threat to respiratory system health is gaining traction. In fact, asthma is closely associated with various skin barrier dysfunction–associated diseases such as atopic dermatitis and atopic eczema. Patients with atopic eczema frequently exhibit concomitant atopic dermatitis, whereas asthma is often accompanied by allergic rhinitis, constituting the classic pattern of the “allergic march”. Mechanistically, these conditions share key pathological features, including genetic susceptibility (such as filaggrin (FLG) gene mutations), immune dysregulation characterized by a predominantly T helper 2 (Th2) type inflammatory response, and epithelial barrier dysfunction. Environmental factors, such as dust mite allergens, induce systemic sensitization by damaging the skin barrier, subsequently triggering airway inflammation. Targeted therapies have shown significant efficacy in both severe asthma and atopic dermatitis, highlighting a potential pathogenic pathway shared by the two conditions. In this paper, we review the relationships between asthma and skin barrier damage from a mechanistic viewpoint, thereby providing an important theoretical basis for the early prevention and precise treatment strategies of allergic diseases with overlapping pathogenic pathways.
Allergic rhinitis (AR) is an upper respiratory disease that affects inflammation levels, nasal function, and mental health in patients. However, the effect of AR severity on these indicators remains obscure. This study aimed to explore the impacts of AR severity on levels of inflammatory factors, nasal function, anxiety and depression.
The clinical data of 188 patients with AR from January 2022 to January 2025 were collected and retrospectively analyzed. The patients were divided into mild group (n = 90) and moderate/severe group (n = 98) based on the severity of AR. Meanwhile, 79 healthy individuals matched in age, gender, and body mass index (BMI) with the AR patients were included in the control group. Nasal airway resistance (NAR) and nasal mucociliary clearance time (NMCT) were detected. Hospital Anxiety and Depression (HAD) scale was applied for the assessment of anxiety and depression. Serum level of C-reactive protein (CRP) was measured using an automatic biochemical analyzer. Serum procalcitonin (PCT) and nasal lavage fluid levels of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) were measured using commercial assay kits.
Compared with the control group, the CRP, PCT, IL-1β, TNF-α, NAR, NMCT, and HAD anxiety and depression scores in AR patients were significantly increased (both p < 0.05). Compared with the mild group, the moderate/severe group exhibited increased levels of inflammatory biomarkers, NAR, NMCT, and HAD anxiety and depression scores (p < 0.05). In the mild group, anxiety and depression were correlated with the NAR, CRP, PCT, IL-1β, and TNF-α (p < 0.05); NMCT was correlated with the depression (p < 0.05). In moderate/severe group, anxiety and depression were correlated with the NAR, NMCT, CRP, PCT, IL-1β, and TNF-α (p < 0.05). The correlation between anxiety and depression and nasal function and inflammatory factors in moderate/severe group were stronger than those in mild group.
The anxiety/depression and inflammation levels in AR patients increase, while the nasal function decreases, with the deteriorating severity of the disease. Anxiety and depression are correlated with nasal function and inflammation levels, with a more prominent correlation detected in patients with moderate/severe AR than those with mild disease.
Lobar pneumonia (LP) remains a significant cause of morbidity in children. Early and accurate assessment of the disease severity is crucial for optimal management, yet readily available and specific biomarkers are lacking. This study aimed to analyze the dynamic changes of aspartate aminotransferase/alanine aminotransferase (De Ritis) ratio in children with LP, and to explore their relationship with the disease severity.
A total of 120 children with LP admitted to the Affiliated Hospital of Xuzhou Medical University from June 2020 to June 2025 were divided into a common pneumonia group (n = 69) and a severe pneumonia group (n = 51) according to the severity of the disease. Hierarchical multiple linear regression was used to analyze the effects of baseline De Ritis ratio, gender, age, body mass index (BMI) and pulmonary lobe lesions on the ΔDe Ritis ratio before treatment and 14 days after treatment. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic efficacy of De Ritis ratio in children with LP before treatment. The dose–response relationship between De Ritis ratio and the condition of LP children was analyzed using a restricted cubic spline. The clinical decision curve was used to analyze the diagnostic efficacy of De Ritis ratio in children with LP.
Repeated measures analysis of variance showed that the De Ritis ratio had significant time effect, between-group effect and time–group interaction effect (all p < 0.001). The De Ritis ratio of the two groups decreased significantly with treatment, with the decline (ΔDe Ritis ratio) being significantly higher in the severe pneumonia group than in the common pneumonia group at each time point (p < 0.05). The results of hierarchical multiple linear regression showed that baseline De Ritis ratio (β < 0), gender, age, BMI and lobar lesions (all β > 0) had a significant effect on De Ritis ratio (p < 0.05). The area under the curve (AUC) for the De Ritis ratio was 0.908, with an optimal cutoff value of 1.52. The restricted cubic spline analysis revealed a non-linear dose-response relationship between De Ritis ratio and LP (pnonlinear < 0.001). According to the clinical decision curve analysis, De Ritis ratio demonstrated substantial clinical utility in the diagnosis of LP.
De Ritis ratio possesses significant clinical value in the evaluation of LP and its dynamic alterations show a consistent relationship with the severity of the condition.
With the growing need for high-quality end-of-life care in China, this study aimed to evaluate the practical palliative care skills of nurses across 17 pilot institutions in Hangzhou, identify the key factors influencing these skills, and explore their interrelationships. The ultimate goal was to inform the development of a targeted training and assessment system that can support and enhance palliative care team development in China.
This study used a convergent mixed-methods design integrating quantitative and qualitative approaches. From February to May 2022, 723 nurses from 17 palliative care pilot institutions in Hangzhou, China, were surveyed using structured scales assessing their palliative care knowledge, perceived difficulty, and self-reported practice. Descriptive, univariate, and multivariate analyses were performed. Semi-structured interviews were subsequently conducted with eight nurses to gain deeper insights into their practical experiences and challenges.
Quantitative findings indicated that palliative care practice competency was at an upper-intermediate level (64.17 ± 15.99). Multivariate linear regression identified gender, age, and willingness to volunteer in palliative care as significantly affecting nurses’ palliative care practice ability. Qualitative analysis demonstrated three core themes: (1) cognitive understanding present but specialized knowledge lacking; (2) behavioral gaps in technical skills and symptom management; and (3) structural barriers, including absence of guidelines and restrictive policies. Integrated results highlighted that personal willingness, cognitive awareness, social support, and training opportunities were consistent determinants of competency.
Nurses in Hangzhou demonstrate moderate levels of palliative care competency; however, notable gaps impede high-quality service delivery. There is an urgent need for systematic training, particularly in symptom management and communication skills. Multilevel efforts involving government, healthcare institutions, and the wider community are essential. Priorities include optimizing resource allocation, refining insurance policies, establishing specialized training systems, and enhancing public education to foster informed and rational understanding of end-of-life care.
The detection rate of isolated terminal ileal ulcers (ITIU) is increasing during colonoscopy. However, its clinical significance remains unknown. This study aimed to explore the detection rate and risk factors of ITIU in individuals undergoing colonoscopy and evaluate the outcomes of patients with nonspecific ITIU.
Overall, 11,504 consecutive individuals who underwent colonoscopy at Department of Gastroenterology, General Hospital of Northern Theater Command between 1 July 2021 and 31 December 2022 were retrospectively screened. Among the individuals who completed terminal ileum (TI) intubation, the detection rate of ITIU was calculated. Furthermore, among the individuals with complete baseline data, logistic regression analyses were performed to identify the independent factors associated with ITIU. At least one-year follow-up outcome after the index colonoscopy was evaluated in patients with nonspecific ITIU who received and did not receive empiric therapy.
Overall, 9649 individuals completed TI intubation with an ITIU detection rate of 1.3% (123/9649). Among them, 1709 individuals had complete baseline data and were further selected in the risk factor analysis. Compared with the non-ITIU group, the ITIU group was significantly younger (56 vs. 46, p = 0.010). Multivariate logistic regression analyses also demonstrated that age ≤50 years (adjusted odds ratio [aOR] = 1.947, 95% confidence interval [CI] = 1.056–3.587, p = 0.033) was independently associated with ITIU. There was no significant difference in clinical symptoms (p = 1.000) or colonoscopic findings (p = 0.560) between patients with nonspecific ITIU who received empiric therapy and observational follow-up.
ITIU is not rare during colonoscopy. Young individuals may have a higher probability of suffering from ITIU. Empiric therapy may not be necessary for patients with nonspecific ITIU.
Stroke recurrence remains a significant challenge in post-stroke management, with traditional prediction models often showing limited accuracy. This study aims to compare the performance of multiple machine learning (ML) algorithms that integrate routine clinical variables with imaging-derived features in predicting stroke recurrence risk, and to identify the optimal predictive model.
This retrospective cohort study enrolled 350 patients with ischemic stroke who were admitted to The Fifth People’s Hospital of Jinan between January 2018 and December 2021. Patients were divided into three groups based on the time of first stroke onset: Group A (n = 110), Group B (n = 120), and Group C (n = 120). Routine clinical variables (age, gender, hypertension, and diabetes) and imaging features (infarct size and location) were collected. Four ML-based algorithms—logistic regression, random forest (RF), support vector machine (SVM), and extreme gradient boosting (XGBoost)—were used to construct predictive models. The predictive performance of these models was evaluated by area under the curve (AUC), sensitivity, specificity, and accuracy.
The XGBoost model showed the superior predictive performance, achieving the highest AUC of 0.86, followed by the random forest model (0.82), support vector machine model (0.78), and logistic regression model (0.75). The most influential predictors for stroke recurrence were found to be infarct size, history of hypertension, and fasting blood glucose levels.
ML-based algorithms that integrate routine clinical variables with imaging-derived data can predict stroke recurrence risk effectively, with the XGBoost model demonstrating superior predictive performance, which may further support more individualized clinical decision-making.
The adoption of standardized nursing terminology (SNT) is crucial for ensuring efficient information delivery and data sharing among nursing staff, as well as effective nursing care. This study aims to assess nurses’ Knowledge–Attitude–Practice regarding SNT, and identify key influencing factors of SNT application.
This study involves the development of a questionnaire for a survey based on the Knowledge–Attitude–Practice (KAP) model, combined with literature research and Delphi method. A cross-sectional survey was conducted among 515 nursing staff from 26 departments.
The resulting questionnaire consisted of 29 items, with a Cronbach’s α coefficient of 0.959. The scores for Knowledge–Attitude–Practice of nurses toward SNT were 12.73 ± 4.61, 35.05 ± 5.70, and 31.72 ± 9.93, respectively. Multiple linear regression analysis indicated that the position title, education level and years of work were independent influencing factors of the SNT levels among the surveyed nurses. The three most frequently mentioned barriers by nursing staff were increased workload, insufficient support from information systems, and a lack of nursing informatics professionals.
This study indicates that nursing staff hold positive attitudes toward SNT, but their awareness and practical application remain insufficient. Strengthening competency-based training and urgently optimizing nursing information systems are therefore necessary.