Frontiers in Medicine最新文献

{"title":"Predictive value of systemic inflammatory index (SII) for the time to negative nucleic acid conversion in patients with mild COVID-19 by the omicron wave.","authors":"Yuyan Fan, Ning Yang, Jialu Zhuo, Ting Han","doi":"10.3389/fmed.2024.1474236","DOIUrl":"https://doi.org/10.3389/fmed.2024.1474236","url":null,"abstract":"<p><strong>Objective: </strong>Inflammatory indices are pivotal markers in gaging the harm of the COVID-19 trajectory. The definitive impact of inflammatory indices on forecasting the period required for a negative shift in nucleic acid status during the Omicron wave remains ambiguous. This research endeavors to delineate the relationship between the Systemic Inflammatory Index (SII) and the timeline for conversion to negative nucleic acid status in Omicron variant-infected patients, and to scrutinize the prognostic validity of SII for such conversion.</p><p><strong>Methods: </strong>Adult patients hospitalized at the Shanghai Public Health Clinical Center with mild cases attributed to the Omicron variant were studied from March to December 2022. They were stratified into early-conversion (with mild cases attributed to (>10 days) groups). Analyzing patient information, clinical traits, and laboratory results, we divided patients into two groups. We used logistic regression to find the link between SII and virus test timing and built ROC curves to measure predictive value via AUC.</p><p><strong>Results: </strong>A total of 2,603 patients were enrolled. Univariate analysis found big differences in pulse rates, respiratory rates, prealbumin levels, HS-CRP levels, IL-6 levels, SII, and PNI (<i>p</i> < 0.05) between the groups. Adjusting for confounders, logistic regression revealed that the highest SII group had a 1.46 greater risk of not clearing a 10-day PCR test than the lowest group (OR = 1.46; 95% CI, 1.173-1.817, <i>p</i> = 0.001). Each one-unit rise in SII raised the risk of 10-day PCR failure by 0.1% (<i>p</i> < 0.0001). The ROC curve showed SII's AUC as 0.603 (95% CI: 0.576-0.630), predicting virus test turn-around with a cut-off of 920.5, 61.9% specificity, and 52.5% sensitivity. Compared to other indicators such as IL-6 and HS-CRP, SII exhibited the highest AUC value and specificity.</p><p><strong>Conclusion: </strong>In mild cases caused by the Omicron wave, there was a discernible link between the SII and the period leading to a negative nucleic acid test outcome, with higher SII values indicating an increased risk of prolonged conversion time. SII might help guide treatment better than other indicators by predicting disease course.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"11 ","pages":"1474236"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the gap: enhancing blood regulatory functions in African contexts through comparative analysis.","authors":"Washington T Samukange, Verena Kluempers, Chancelar Kafere, Kristina Heinrich, Joanna Atemnkeng, Alireza Khadem Broojerdi, Florence Tirane, Edwin Nkansah, Shani Maboko, Linda Nhukarume, Khamusi Mutoti, Noel Aineplan, Helga Gardasdottir, Aukje K Mantel-Teeuwisse, Jens Reinhardt","doi":"10.3389/fmed.2025.1519719","DOIUrl":"https://doi.org/10.3389/fmed.2025.1519719","url":null,"abstract":"<p><strong>Introduction: </strong>Independent assessments of blood regulatory systems, facilitated by tools such as the WHO's Global Benchmarking Tool (GBT) plus Blood expedites development of National Regulatory Authorites (NRAs) and thus promotes increased access to safe, effective, and quality blood, blood components, and products. The aim of this study was to assess and compare the status of implementation and performance of the regulatory functions for registration and marketing authorization as well as the system for approval of blood, blood components and plasma for fractionation or processes.</p><p><strong>Methods: </strong>We did this by conducting assisted self-benchmarking in 12 African countries using the GBT plus Blood (registration and marketing authorization function, 34 sub-indicators and approval of blood, blood components, and plasma for fractionation or processes function, 24 sub-indicators). Comparative assessments of WHO-designated maturity level 3 (ML3) NRAs for medicines and vaccines against non-designated NRAs were made.</p><p><strong>Results: </strong>The percentage of implemented sub-indicators was higher for the registration and marketing authorization function with an average implementation score of 73% (range: 51%-92%) compared to the approval of blood, blood components, and plasma for fractionation or processes function which had an average implementation score of 45% (range: 6%-65%). The comparison of group averages for the ML3-designated NRAs against the non-designated NRAs revealed a higher score 91% (range: 71%-100%) for ML3-designated NRAs as opposed to a lower score of 71% (range: 49%-100%) for the non-designated NRAs for the registration and marketing authorization function. This pattern, however, was not observed for the comparison of group averages for the approval of blood, blood components, and plasma for fractionation or processes function where the ML3-designated NRAs scored 47% (range 19%-72%) against 46% (range 23%-88%) for the non-ML3-designated NRAs.</p><p><strong>Conclusion: </strong>Most of the NRAs excelled in implementing sub-indicators for the registration and marketing authorization (of plasma-derived medicines) function. All NRAs exhibited notable flaws in regulating blood, blood components, plasma for fraction, and approval of processes, indicating nascent regulatory frameworks. This study highlights the urgent need for WHO and African countries to prioritize formal benchmarking of NRAs using the GBT plus Blood to enhance their regulatory capacities in blood and blood product regulation.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1519719"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of osteopenia as prognostic marker for survival and recurrence in patients with gastrointestinal cancers: a systematic review and meta-analysis.","authors":"Xinmei Zou, Yang Wang","doi":"10.3389/fmed.2025.1527829","DOIUrl":"https://doi.org/10.3389/fmed.2025.1527829","url":null,"abstract":"<p><strong>Background: </strong>Early detection, systematic prevention, and personalized therapy are crucial to reduce mortality in patients with gastrointestinal (GI) cancers. This systematic review and meta-analysis aimed to clarify the predictive value of osteopenia and osteosarcopenia as prognostic markers of survival and recurrence in patients with GI cancers.</p><p><strong>Methods: </strong>Medline, Google Scholar, and Science Direct databases were searched for English-language studies that included patients who underwent surgical resection following a pathologically diagnosed GI cancer and reported the association between osteopenia and osteosarcopenia on the overall survival (OS) and recurrence-free survival (RFS). Meta-analysis was done using STATA 14.2, and the results were reported as pooled hazard ratios (HR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic and the Chi-square test. Study quality was evaluated using the Newcastle Ottawa Scale (NOS).</p><p><strong>Results: </strong>A comprehensive literature search yielded 23 eligible studies, primarily from Japan. Osteopenia emerged as a significant risk factor for both OS (pooled HR 2.20, 95% CI: 1.74-2.79) and RFS (pooled HR 2.15, 95% CI: 1.60-2.89). Patients with osteosarcopenia exhibited threefold higher mortality rates (pooled HR 2.96, 95% CI: 1.99-4.40) and heightened risk of recurrence (pooled HR 2.75, 95% CI: 1.79-4.24). Subgroup analyses underscored the consistency of these associations across diverse contexts.</p><p><strong>Conclusion: </strong>This meta-analysis establishes osteopenia and osteosarcopenia as robust prognostic indicators for survival and recurrence in GI cancers. Integrating musculoskeletal assessments into routine oncological care is imperative for timely interventions and optimized patient outcomes.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1527829"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between aquaporin 3 and transforming growth factor-beta 1 levels in decidual tissue and serum of patients with missed abortion.","authors":"JinLing Yuan, JianXin Dong, Wanting Li, YingMo Zu, YanJuan Guo, Ying Zhang, Yan Chen","doi":"10.3389/fmed.2025.1540257","DOIUrl":"https://doi.org/10.3389/fmed.2025.1540257","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the expression of aquaporin 3 (AQP3) and transforming growth factor-β1 (TGF-β1) in the decidual tissue and serum of patients with missed abortion (MA) and explore their clinical significance, evaluating their potential as diagnostic biomarkers for MA.</p><p><strong>Methods: </strong>A total of 40 MA patients (case group) and 40 induced abortion (IA) patients (control group) were included. Immunohistochemistry (IHC), Western blot (WB), and reverse transcription quantitative PCR (RT-qPCR) were used to detect the protein and mRNA expression of AQP3 and TGF-β1 in decidual tissue. Serum levels of AQP3 and TGF-β1 were measured by ELISA. The diagnostic efficacy was assessed using receiver operating characteristic (ROC) curve analysis.</p><p><strong>Results: </strong>The protein expression of AQP3 and TGF-β1 in the decidual tissue of the MA group was significantly higher than that of the IA group, with a 2.3-fold and 2.5-fold increase, respectively (<i>p</i> < 0.01), and their mRNA expression was also significantly upregulated (<i>p</i> < 0.01). Serum levels of AQP3 and TGF-β1 increased by 2.3-fold and 3.3-fold, respectively (<i>p</i> < 0.01). ROC analysis demonstrated that serum AQP3 (AUC = 0.887) and TGF-β1 (AUC = 0.949) exhibited high diagnostic accuracy for MA, with the combined detection achieving an AUC of 0.976, sensitivity of 92.5%, and specificity of 97.5%.</p><p><strong>Conclusion: </strong>AQP3 and TGF-β1 are significantly overexpressed in the decidual tissue and serum of MA patients and may play a role in the pathogenesis of MA by regulating trophoblast function. The combined detection of these two biomarkers holds promise as potential diagnostic tools for MA, offering new directions for early clinical management.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1540257"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of dienogest treatment on endometrioma-related clinical symptoms and endometrioma size: retrospective cohort study.","authors":"Ufuk Atlihan, Onur Yavuz, Can Ata, Huseyin Aytug Avsar, Selcuk Erkilinc","doi":"10.3389/fmed.2025.1581661","DOIUrl":"https://doi.org/10.3389/fmed.2025.1581661","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the efficacy and long-term safety of treatment with dienogest in patients with endometrioma.</p><p><strong>Methods: </strong>Patients with endometrioma-related chronic pelvic pain were included in this retrospective study from March 2018 to March 2023. Enrolled patients received 2 mg of dienogest once daily. Data from 180 patients were analyzed. Group 2 (<i>n</i> = 104, 57.8%), comprising patients undergoing long-term therapy (>12 months), was compared with group 1 (<i>n</i> = 76, 42.2%), consisting of patients undergoing short-term therapy (<2 months), regarding their response to changes in endometrioma size and visual analog scale (VAS) scores. Statistical analysis was performed using the SPSS version 26.0 software. Non-normally distributed parameters were analyzed using the Mann-Whitney U test. In the evaluation of the data, apart from identifying statistical methods, the t-test was used in comparison of paired groups, and the matched t-test was used in the determination of changes before and after treatment. The Chi-square test and Fisher's precision test were used in the analysis of categorical data. Categorical variables are presents as percentages, and quantitative variables are summarized as mean (95% confidence intervals) and median (minimum-maximum). <i>p</i>-values of <0.05 were considered statistically significant.</p><p><strong>Results: </strong>Findings at T0 (baseline) and T1 (sixth month) visits, in which the entire study cohort could be included, were compared. Then, patients who continued treatment at visits every 6 months after T1 (>12 months) were compared one by one with the findings at T0. The reduced libido was 4.3 times higher in the long-term group, but the weight gain was higher in the short-term group. Analysis within all patients and individual groups (short term vs. long term) showed a significant decrease in endometrioma size and VAS scores between T0 and T1 visit findings. Similarly, the findings of T2 and each subsequent visit of the patients in the long-term group were compared with the initial findings and a significant reduction in endometrioma size and VAS scores was observed.</p><p><strong>Conclusion: </strong>Although the effectiveness of dienogest treatment for endometrioma seems to begin in the sixth month, its effectiveness maximizes in patients whose treatment duration is over 1 year.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1581661"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting liver metastasis in pancreatic neuroendocrine tumors with an interpretable machine learning algorithm: a SEER-based study.","authors":"Jinzhe Bi, Yaqun Yu","doi":"10.3389/fmed.2025.1533132","DOIUrl":"https://doi.org/10.3389/fmed.2025.1533132","url":null,"abstract":"<p><strong>Background: </strong>Liver metastasis is the most common site of metastasis in pancreatic neuroendocrine tumors (PaNETs), significantly affecting patient prognosis. This study aims to develop machine learning algorithms to predict liver metastasis in PaNETs patients, assisting clinicians in the personalized clinical decision-making for treatment.</p><p><strong>Methods: </strong>We collected data on eligible PaNETs patients from the Surveillance, Epidemiology, and End Results (SEER) database for the period from 2010 to 2021. The Boruta algorithm and the Least Absolute Shrinkage and Selection Operator (LASSO) were used for feature selection. We applied 10 different machine learning algorithms to develop models for predicting the risk of liver metastasis in PaNETs patients. The model's performance was assessed using a variety of metrics, including the area under the receiver operating characteristic curve (AUC), the area under the precision-recall curve (AUPRC), decision curve analysis (DCA), calibration curves, accuracy, sensitivity, specificity, F1 score, and Kappa score. The SHapley Additive exPlanations (SHAP) were employed to interpret models, and the best-performing model was used to develop a web-based calculator.</p><p><strong>Results: </strong>The study included a cohort of 7,463 PaNETs patients, of whom 1,356 (18.2%) were diagnosed with liver metastasis at the time of initial diagnosis. Through the combined use of the Boruta and LASSO methods, T-stage, N-stage, tumor size, grade, surgery, lymphadenectomy, chemotherapy, and bone metastasis were identified as independent risk factors for liver metastasis in PaNETs. Compared to other machine learning algorithms, the gradient boosting machine (GBM) model exhibited superior performance, achieving an AUC of 0.937 (95% CI: 0.931-0.943), an AUPRC of 0.94, and an accuracy of 0.87. DCA and calibration curve analyses demonstrate that the GBM model provides better clinical decision-making capabilities and predictive performance. Furthermore, the SHAP framework revealed that surgery, N-stage, and T-stage are the primary decision factors influencing the machine learning model's predictions. Finally, based on the GBM algorithm, we developed an accessible web-based calculator to predict the risk of liver metastasis in PaNETs.</p><p><strong>Conclusion: </strong>The GBM model excels in predicting the risk of liver metastasis in PaNETs patients, outperforming other machine learning models and providing critical support for developing personalized medical strategies in clinical practice.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1533132"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Volume-controlled inverse ratio ventilation improves safe apnea time in obese patients during the induction of general anesthesia: a randomized controlled trial.","authors":"Yonghai Zhang, Bin Li, Chang Xu, Yan Wu, Ling Ma, Fan Yang, Hanxiang Ma, Xinli Ni","doi":"10.3389/fmed.2025.1574634","DOIUrl":"https://doi.org/10.3389/fmed.2025.1574634","url":null,"abstract":"<p><strong>Background: </strong>Inverse ratio ventilation theoretically increases oxygenation in obese patients. However, it is unknown whether the use of inverse ratio ventilation prolongs the safe apnea time during the induction of anesthesia. The primary objective of our study was to compare the safe apnea time between obese surgical patients receiving inverse ratio ventilation and conventional ratio ventilation during the induction of anesthesia.</p><p><strong>Methods: </strong>This study is a prospective, randomized controlled trial. Forty obese patients who underwent elective operation under general anesthesia with endotracheal intubation were randomly allocated into the conventional ratio ventilation (CRV) group (<i>n</i> = 20) and inverse ratio ventilation (IRV) group (<i>n</i> = 20). After the patients were preoxygenated through a face mask for 3 min, anesthesia induction was performed. When the patients lost consciousness and spontaneous breathing disappeared, non-invasive positive pressure ventilation was performed for 5 min, and the inspiratory-to-expiratory (I:E) ratio was set as 1:2 in the CRV group and 2:1 in the IRV group. Heart rate, systolic blood pressure, diastolic blood pressure, and pulse oxygen saturation were recorded at four time points: (i) before pre-oxygenation (T₀), (ii) pre-oxygenation for 3 min (T₁), (iii) non-invasive positive pressure ventilation for 3 min (T₂), and (iv) non-invasive positive pressure ventilation for 5 min (T₃). Arterial blood was collected at T₀, T₁, and T₃ for arterial blood gas analysis, and arterial oxygen partial pressure and carbon dioxide partial pressure were recorded. The patient's expiratory oxygen fraction at T₁, T₂, and T₃ were recorded. Peak airway pressure, plateau pressure and mean airway pressure were record at T₂ and T₃. The safe apnea time was recorded in both groups.</p><p><strong>Results: </strong>Forty patients completed the study. Baseline parameters were comparable between the two groups. Safe apnea time was significantly longer (210.40 ± 47.47 vs. 153.80 ± 41.54 s, mean difference [95% CI], 56.55 [28.00-85.10], <i>p</i> = 0.0003) and the expired O₂ fraction was higher (87.60 ± 2.39 vs. 91.60 ± 1.79, mean difference [95% CI], 4.00 [2.65-5.35], <i>p</i> < 0.0001) at T₃ in the IRV group compared to the CRV group.</p><p><strong>Conclusion: </strong>Volume-controlled inverse ratio ventilation at an I:E ratio of 2:1, compared to conventional ratio ventilation, provided a longer safe apnea time and higher expired O₂ fraction in obese patients during the induction of anesthesia.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1574634"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Macular pucker and cataract treated with phacoemulsification and IOL implantation combined with small-gauge pars plana vitrectomy: a comparison of outcomes with and without femtosecond laser assistance.","authors":"Howard Wen-Haur Chao, Cheng-Kuo Cheng, Shiow-Wen Liou, Hsiao-Ming Chao","doi":"10.3389/fmed.2025.1497776","DOIUrl":"https://doi.org/10.3389/fmed.2025.1497776","url":null,"abstract":"<p><strong>Objectives: </strong>Age-related cataracts and macular pucker are increasingly common. Standard treatment combines phacoemulsification, IOL implantation and small gauge vitrectomy. Recent advancements and acceptance of femtosecond laser (FSL) assistance in cataract surgery have improved precision and outcomes. However, evidence regarding the efficacy and safety of FSL-assisted phacovitrectomy, particularly in Oriental patient populations with distinct anatomical and genetic characteristics, remain limited. This study aims to address this critical gap by comparing the safety and post-operative outcomes of 23- or 25-gauge phacovitrectomy for stage 3 macular pucker and medium density cataract with versus without FSL-assistance (FSLA), in an Oriental patient cohort.</p><p><strong>Methods: </strong>Patients with stage 3 macular pucker and medium-density cataract were recruited and divided into two age-matched groups: group 1 (<i>n</i> = 13) underwent conventional phacovitrectomy without FSLA, and Group 2 (<i>n</i> = 13) underwent phacovitrectomy with FSLA. Evaluations included pre- and postoperative best-corrected visual acuity (BCVA; Snellen E and LogMAR), cataract surgical time, phacoemulsification energy cost, corneal wavefront data, endothelial cell density (ECD), and surgical complications.</p><p><strong>Results: </strong>Significant improvements in postoperative visual acuity were observed in both groups (<i>P</i> < 0.05), with Group 2 (FSLA) demonstrating superior outcomes (0.48 ± 0.05/-0.45 ± 0.06; Snellen E/logMAR) compared to Group 1 (0.26 ± 0.07/-0.66 ± 0.15; Snellen E/logMAR). FSLA significantly reduced surgical duration (429.46 s vs. 740.00 s) and cumulative dissipated energy (CDE; 18.90 ± 1.59 vs. 25.24 ± 1.42) without significantly altering higher-order aberrations (0.24 to 0.22 μm). Although ECD decreased postoperatively in both groups, FSLA phacovitrectomy resulted in significantly less endothelial cell loss (227.77 ± 46.85 cells/mm²) compared to conventional phacovitrectomy (389.15 ± 47.87 cells/mm²). No serious complications were reported in either group.</p><p><strong>Conclusion: </strong>FSLA phacovitrectomy presents a safe and more efficient alternative over traditional procedures for Oriental patients with medium density nuclear cataract patients with stage 3 macular pucker. Through enhanced IOL centration, shortened surgical times and decreased ECD loss, FSLA led to superior postoperative visual outcomes compared to traditional phacovitrectomy. This study addresses a critical gap in the literature by providing evidence for the benefits of FSLA in Oriental populations, offering valuable insights into its applicability in patients with distinct anatomical variations.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1497776"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Independent prognostic importance of endothelial activation and stress index (EASIX) in critically ill patients with heart failure: modulating role of inflammation.","authors":"Fang Yin, Kai Wang","doi":"10.3389/fmed.2025.1560947","DOIUrl":"https://doi.org/10.3389/fmed.2025.1560947","url":null,"abstract":"<p><strong>Background: </strong>The connection between endothelial activation and stress index (EASIX) and risk of mortality in critically ill patients with heart failure (HF) remains unclear. This research sought to explore this relationship.</p><p><strong>Methods: </strong>MIMIC-IV database (version 3.1) was utilized to provide clinical data. Due to the non-normal distribution, EASIX was logarithmic. An optimal cut-off value for log2(EASIX) was determined to serve as an indicator of mortality risk under the maximally selected rank statistics. Kaplan-Meier survival analysis and Cox regression models were used to assess the link between log2(EASIX) and mortality within 1 year. Subgroup analyses were performed to ascertain the prognostic impact of log2(EASIX) in various patient groups. Mediation analysis was employed to uncover and elucidate causal pathways connecting log2(EASIX) to mortality.</p><p><strong>Results: </strong>It encompassed 7,901 patients. According to the Kaplan-Meier curves, increased log2(EASIX) levels correlated with a higher likelihood of all-cause mortality (<i>p</i> < 0.001). Cox models and subgroup analyses further revealed that groups with high log2(EASIX) levels exhibited a greater mortality risk than those with lower levels (hazard ratio (HR): 1.62, 95% CI: 1.47-1.78), a trend that persisted across most subgroups, with the exception of varying levels of APS III, body mass index, white blood cell counts, or albumin (p for interaction < 0.05 for all). Subsequent mediation analysis suggested that blood urea nitrogen and red cell distribution width partially mediated the relationship between log2(EASIX) and mortality with 17.3% and 36.5% of the mediating effect.</p><p><strong>Conclusion: </strong>It found an independent association between elevated log2(EASIX) levels and a higher risk of 1 year all-cause mortality in ICU patients suffering from HF, with a stronger effect observed in patients with low levels of APS III or white blood cell counts, or high levels of body mass index or albumin. This association may be partially mediated by blood urea nitrogen and red cell distribution width.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1560947"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncovering potential biomarkers of endometriosis: transcriptomic and single-cell analysis.","authors":"Yuqiu Liu, Guanwen Gao, Wei Tian, Qingfeng Lv, Degao Liu, Changzhong Li","doi":"10.3389/fmed.2025.1528434","DOIUrl":"https://doi.org/10.3389/fmed.2025.1528434","url":null,"abstract":"<p><strong>Background: </strong>The link between programmed cell death (PCD) and mitochondria has been documented in various diseases. However, its role in endometriosis (EMS) remains unexplored. This study aims to identify potential biomarkers in EMS associated with both PCD and mitochondrial functions.</p><p><strong>Methods: </strong>This analysis incorporates datasets related to EMS, PCD-related genes (PCD-RGs), and mitochondria-related genes (MRGs) sourced from public repositories. To uncover potential biomarkers, differential expression analysis, weighted gene co-expression network analysis (WGCNA), Boruta feature selection, expression validation, and diagnostic assessments were conducted. Functional analyses, immune infiltration profiling, and the construction of regulatory networks further elucidated the mechanisms through which these biomarkers may influence EMS. Finally, single-cell data were leveraged to examine the expression and functionality of these biomarkers at a granular level.</p><p><strong>Results: </strong>Apoptosis-inducing factor mitochondria-associated 1 (AIFM1) and pyruvate dehydrogenase kinase 4 (PDK4) were identified as potential biomarkers, with PDK4 upregulated and AIFM1 downregulated in EMS. Both genes demonstrated strong diagnostic potential. Enrichment analyses indicated their involvement in pathways associated with the cell cycle. Immune infiltration analyses revealed that AIFM1 had a significant positive correlation with resting dendritic cells and a negative correlation with M2 macrophages, whereas PDK4 was positively associated with M2 macrophages and inversely related to follicular helper T cells. Moreover, AIFM1 and PDK4 were regulated by 16 miRNAs (e.g., hsa-mir-16-5p) and 18 lncRNAs (e.g., LINC00294). Single-cell analysis further revealed dynamic expression trends of these potential biomarkers across cell differentiation stages, including gametocytes, monocytes, mesenchymal stem cells, and neutrophils.</p><p><strong>Conclusion: </strong>In this study, potential biomarkers (AIFM1 and PDK4) related to PCD and mitochondria were identified in EMS, offering valuable insights for the diagnosis and therapeutic strategies for the disease.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1528434"},"PeriodicalIF":3.1,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12078282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144077173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}