Frontiers in Medicine最新文献

{"title":"Age-indexed cumulative risk of high myopia estimated from axial length and early axial elongation: a 7-year school-based longitudinal cohort study.","authors":"Jing Yang, Hui Li, Bei Du, Desheng Song, Nan Jin, Ruihua Wei","doi":"10.3389/fmed.2026.1939322","DOIUrl":"https://doi.org/10.3389/fmed.2026.1939322","url":null,"abstract":"<p><strong>Purpose: </strong>To develop and validate age-indexed models estimating the cumulative risk of high myopia, defined as axial length (AL) ≥ 26.0 mm, using routinely collected ocular biometry, and to evaluate their potential for clinical risk stratification.</p><p><strong>Methods: </strong>This 7-year school-based longitudinal cohort included 7,052 Chinese children aged 6-16 years at baseline who participated in a school-based screening program in Tianjin, China, from 2018 to 2024. Discrete-time survival models with age as the timescale estimated cumulative risk from ages 9 to 18 years. Two models were tested: baseline AL plus sex and baseline AL plus first-year axial elongation (ΔAL) plus sex. Performance was assessed in a participant-level temporal holdout test set using iAUC, iBrier, calibration, and decision-curve analysis, and by school-level internal-external cross-validation using iAUC and iBrier.</p><p><strong>Results: </strong>Overall, 577 participants (8.2%) developed high myopia. In the temporal holdout test set (<i>n</i> = 5,245), the AL + ΔAL model outperformed the AL-only model, with higher discrimination [iAUC, 0.919 [95% CI, 0.902-0.933] vs. 0.851 [95% CI, 0.833-0.869]] and lower prediction error [iBrier, 0.074 [95% CI, 0.068-0.081] vs. 0.087 [95% CI, 0.080-0.095]]. Calibration was close to ideal, decision-curve analysis showed clinical net benefit, and school-level validation confirmed stable performance.</p><p><strong>Conclusions: </strong>Routine AL measurement, particularly when combined with early axial elongation, enables accurate age-specific risk estimation of AL-defined high myopia and provides a transparent basis for timely and proportionate myopia-control decisions.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1939322"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223669","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":"A systematic review and meta-analysis of the timing of rehabilitation training intervention for recipients of extracorporeal membrane oxygenators.","authors":"Zhen Cheng, Liping Du, Shuangqin Zheng, Xiaoheng Zheng, Lingling Cheng, Mengfei Zhang, Chenmo Shi, Tianyu Zhang, Wei Zheng, Aili Shi","doi":"10.3389/fmed.2026.1919668","DOIUrl":"https://doi.org/10.3389/fmed.2026.1919668","url":null,"abstract":"<p><strong>Objective: </strong>To systematically evaluate the effects of early versus delayed rehabilitation training interventions (RTI) on clinical outcomes in patients receiving extracorporeal membrane oxygenation (ECMO).</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), non-randomized controlled studies, and observational cohort studies comparing early and delayed RTI in patients receiving ECMO. We searched databases including Embase, PubMed, Web of Science, ScienceDirect, China National Knowledge Infrastructure, China Science and Technology Journal Database, and China Biology Medicine disc from inception to 1 April 2025. Study selection, data extraction, and quality assessment were performed independently by two reviewers. Outcomes included complications, intensive care unit (ICU) and hospital length of stay (LOS), duration of mechanical ventilation, ECMO duration, and in-hospital mortality.</p><p><strong>Results: </strong>Twelve studies (five RCTs, four non-RCTs, and three cohort studies) were included. Compared with delayed RTI, early RTI significantly reduced the risk of complications [risk ratio (RR) = 0.43, 95% CI: 0.26-0.69, <i>P</i> < 0.001], shortened ICU LOS [mean difference (MD) = -1.12 days, 95% CI: -1.30 to -0.94, <i>P</i> < 0.001], and reduced hospital LOS (MD = -4.69 days, 95% CI: -8.11 to -1.27, <i>P</i> = 0.007). No significant differences were found in mechanical ventilation duration (MD = 0.14 days, <i>P</i> = 0.914), ECMO duration (MD = -1.77 days, <i>P</i> = 0.136), or in-hospital mortality (RR = 0.72, <i>P</i> = 0.097). Sensitivity analysis excluding one study demonstrated a greater reduction in hospital LOS significant (MD = -5.82 days, 95% CI: -9.34 to -2.30, <i>P</i> = 0.001), while other outcomes remained unchanged.</p><p><strong>Conclusions: </strong>Early RTI is associated with reduced complications and improved recovery outcomes (ICU/hospital stay) in ECMO patients compared with delayed RTI. However, due to the limited number and moderate quality of included studies, these findings should be interpreted with caution. High-quality RCTs are needed to confirm these results.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251025533, PROSPERO CRD420251025533.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1919668"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223666","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":"Case Report: When muscle edema is not a myositis flare: <i>Legionella</i> pneumonia complicated by rhabdomyolysis and acute kidney injury in long-standing polymyositis.","authors":"Jing Zhang, Lina Zhang, Sheng-Guang Li, Yadan Zou, Ting Long, Ruohan Yu, Yanfeng Zhang, Ji Li","doi":"10.3389/fmed.2026.1952498","DOIUrl":"https://doi.org/10.3389/fmed.2026.1952498","url":null,"abstract":"<p><p><i>Legionella pneumophila</i> is an important cause of severe community-acquired pneumonia and can produce extrapulmonary manifestations that obscure the primary diagnosis. Diagnostic error is especially likely in patients with established idiopathic inflammatory myopathy, because fever, myalgia, weakness, creatine kinase elevation and muscle edema may be attributed to autoimmune flare. We report a 70-year-old woman with a 25-year history of polymyositis receiving long-term corticosteroids and azathioprine who developed high fever, severe bilateral thigh pain and progressive proximal weakness after recent travel. On transfer, she had anuria with bladder distension, dark urine, diffuse posterior-thigh muscle edema, pneumonia, hyponatremia, metabolic acidosis, myoglobinemia and acute kidney injury. <i>Legionella</i> pneumonia with rhabdomyolysis and multifactorial acute kidney injury was suspected clinically, and Legionella-active antimicrobial therapy, hydration, urinary drainage and urine alkalinization were started before microbiological confirmation. A targeted sequencing-based respiratory pathogen assay on sputum collected on Day +4 detected <i>L. pneumophila</i> (145 sequences; estimated concentration <10^3 copies/mL) and respiratory syncytial virus A (266,036 sequences; 10^5 copies/mL), raising the possibility of viral-bacterial coinfection. <i>Legionella</i> urinary antigen, targeted PCR and culture were not documented. After infection and renal injury stabilized, methylprednisolone and intravenous immunoglobulin were used because residual inflammatory myopathy activity remained in the differential. However, creatine kinase and myoglobin had already declined, so subsequent improvement cannot be attributed specifically to immunomodulation. Creatinine fell from 538 μmol/L on Day 0 to 110 μmol/L on Day +9 and 78 μmol/L on Day +30; follow-up chest CT on Day +14 showed marked improvement. This case shows that muscle MRI edema is contextual rather than etiologic. In immunosuppressed myositis patients, pneumonia plus hyponatremia, myoglobinuria and renal injury should prompt early Legionella-active treatment while autoimmune activity is reassessed after infection control.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1952498"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223679","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":"Development and preliminary psychometric evaluation of a spectacle trial-wear questionnaire for distance single-vision prescriptions.","authors":"Meina Huang, Zheyi Chen","doi":"10.3389/fmed.2026.1935095","DOIUrl":"https://doi.org/10.3389/fmed.2026.1935095","url":null,"abstract":"<p><strong>Background: </strong>Existing vision questionnaires were not designed to standardize immediate patient appraisal of a distance single-vision spectacle prescription during trial wear. This study developed and preliminarily evaluated the Adult Spectacle Trial-Wearing Experience Scale (ASTWES) for this decision point.</p><p><strong>Methods: </strong>Candidate items were informed by a structured literature search and interviews with eye-care and dispensing professionals, refined through two Delphi rounds, cognitively debriefed with 10 target patients, and piloted in 150 adults. Item reduction used corrected item-total correlations and principal-axis factoring with promax rotation. The independent formal psychometric evaluation sample comprised 393 adults within the prespecified 18-35-year age range; ordinal confirmatory factor analysis (CFA), robust maximum-likelihood sensitivity analysis, and reliability coefficients were used. An eligible subsample of 98 participants provided a 1-month satisfaction rating for exploratory association analyses.</p><p><strong>Results: </strong>The final questionnaire contained 9 items in 3 correlated domains: clarity and focus, comfort and stability, and environmental adaptation. Retained pilot-item loadings ranged from 0.694 to 0.890. The correlated three-factor model was supported under both CFA estimators, whereas a single-factor model fit poorly. Subscale Cronbach's alpha values ranged from 0.769 to 0.803. Omega hierarchical was 0.641, favoring subscale-first interpretation. The overall mean item score correlated with 1-month satisfaction (Spearman rho = 0.753, <i>p</i> < 0.001); its exploratory AUC was 0.850 (bootstrap 95% CI 0.772-0.918).</p><p><strong>Conclusions: </strong>ASTWES is a concise candidate questionnaire with preliminary evidence of a correlated three-domain structure, acceptable internal consistency, and short-term clinical association in Chinese adults aged 18-35 years. Further independent patient-centered content evaluation and external validation are needed before routine use or fixed decision thresholds are considered.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1935095"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223747","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":"Prolonged infusion of meropenem for suspected intracystic infection in polycystic kidney disease during pregnancy: a case report.","authors":"Bingqing Ruan, Danjia Xie, Liangqi Yan, Nianying Deng","doi":"10.3389/fmed.2026.1856558","DOIUrl":"https://doi.org/10.3389/fmed.2026.1856558","url":null,"abstract":"<p><strong>Background: </strong>Intrarenal cyst infection in polycystic kidney disease (PKD) is hard to confirm and harder to treat during pregnancy, when lipid-soluble antibiotics are generally avoided.</p><p><strong>Case: </strong>A pregnant woman at approximately 10 weeks' gestation presented with recurrent fever and flank pain for over one month, with acute exacerbation one day prior to admission. Laboratory tests revealed progressively elevated C-reactive protein (CRP) levels despite repeatedly negative cultures. Serial ultrasound showed a right upper-pole renal cyst that evolved to exhibit internal septations and debris.</p><p><strong>Treatment and outcome: </strong>Cyst aspiration was avoided; meropenem 1 g every 8 h was initiated on admission and converted to prolonged infusion (1 g infused over more than 3 h) on Day 4, followed by step-down oral amoxicillin-clavulanate, for a total antimicrobial course of 32 days. Fever resolved and CRP normalized; pregnancy continued uneventfully.</p><p><strong>Conclusion: </strong>In a pregnant patient with suspected PKD cyst infection, prolonged-infusion meropenem was followed by clinical improvement. The favorable response observed supports further evaluation of this therapeutic strategy, despite the absence of microbiological confirmation.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1856558"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223775","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":"Admission C-reactive protein-to-albumin ratio and serum creatinine in relation to in-hospital mortality in non-HIV tuberculous meningitis: a retrospective cohort study.","authors":"Wengao Zeng, Xiangzhi Xiao, Qing Liu, Yan Ouyang, Jue Hu, Zhen Wang, Qiong Wu","doi":"10.3389/fmed.2026.1905776","DOIUrl":"https://doi.org/10.3389/fmed.2026.1905776","url":null,"abstract":"<p><strong>Background: </strong>The independent and joint associations of admission C-reactive protein-to-albumin ratio (CAR) and serum creatinine with mortality in tuberculous meningitis (TBM) remain uncertain.</p><p><strong>Methods: </strong>We analyzed a single-center retrospective cohort of non-HIV patients hospitalized with TBM from October 2013 to January 2024. Exposure measurements were the first tests within 24 h of admission, before acute interventions. Multivariable logistic regression modeled both exposures continuously, adjusted for age nonlinearly and prespecified covariates, and tested exposure nonlinearity and interaction. Covariate-only multiple imputation generated 20 datasets. Cohort-specific upper-quartile groups were descriptive. An adult sensitivity analysis used estimated glomerular filtration rate (eGFR) calculated with the 2021 CKD-EPI equation.</p><p><strong>Results: </strong>Among 1,574 eligible patients, 187 died in hospital. The primary analysis included 1,563 patients and all 187 deaths; 11 survivors lacked CAR (<i>n</i> = 3) or creatinine (<i>n</i> = 8), without overlap. Creatinine showed evidence of nonlinearity (<i>P</i> = 0.022), whereas CAR did not (<i>P</i> = 0.105). The linear CAR estimate was near the null (adjusted odds ratio [OR] per doubling, 1.02; 95% confidence interval [CI] 0.88-1.18); the interaction <i>P</i> value was 0.065. Relative to serum creatinine of 48 µmol/L, adjusted ORs for death were 1.31 (95% CI: 1.11-1.55) at 65 µmol/L, 1.49 (1.15-1.92) at 80 µmol/L, and 1.62 (1.17-2.24) at 100 µmol/L. Descriptive group mortality ranged from 9.02% when both markers were below their 75th percentiles to 19.38% when both were at or above them. Among 1,372 adults, the OR per 10 mL/min/1.73 m² lower eGFR was 1.045 (0.984-1.109; <i>P</i> = 0.150).</p><p><strong>Conclusions: </strong>Admission creatinine had a nonlinear adjusted association with in-hospital mortality in non-HIV TBM. CAR yielded a near-null linear estimate, and the interaction analysis did not establish effect modification. Unmeasured neurological severity limits interpretation; these results do not define kidney dysfunction, a clinical cutoff, or a clinically useful prediction model.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1905776"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223729","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":"Correction: Best evidence summary for the management of epidermal growth factor receptor inhibitor-induced skin toxicity symptoms in cancer patients.","authors":"Kexuan Li, Xiuyue Qiu, Jiayu Zhang, Yingshuyi Zhou, Youfen Fan, Qionghui Sun","doi":"10.3389/fmed.2026.1927907","DOIUrl":"https://doi.org/10.3389/fmed.2026.1927907","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.3389/fmed.2025.1665823.].</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1927907"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227666","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":"ADH7 and plasma proteins mediate smoking-related esophageal cancer: genetic causality and therapeutic insight.","authors":"Liangbin Pan, Xiangzhe Yang, Qingxu Hao, Kai Xie, Haitao Ma","doi":"10.3389/fmed.2026.1745748","DOIUrl":"https://doi.org/10.3389/fmed.2026.1745748","url":null,"abstract":"<p><strong>Background: </strong>Smoking has been linked to alterations in plasma protein profiles and increased risk of esophageal cancer (EC). However, the precise mediating roles of plasma proteins in this relationship remain unclear. This study explores the mediation effects of plasma proteins in smoking-associated EC, utilizing genetic proxies to uncover potential biological mechanisms underpinning this association.</p><p><strong>Methods: </strong>Genetic correlation and Mendelian randomization (MR) analyses were applied to examine the association between smoking traits and EC. Pathway enrichment analysis explored circulatory protein changes in smokers. A two-step mediation MR analysis identified key plasma proteins involved in smoking-related EC pathogenesis. Survival analysis assessed the impact of transcriptional levels of mediators on EC prognosis, while phenome-wide association studies (PheWAS) evaluated the safety of targeted molecules and investigated potential pleiotropy. The expression and function of ADH7 were evaluated by qRT-PCR and <i>in vitro</i> experiments.</p><p><strong>Results: </strong>Genetic correlation analysis showed significant links between smoking and EC, supported by MR findings that confirmed a causal relationship. Smoking was found to influence pathways related to cytokine signaling, immune activation, and the STAT pathway. Five plasma proteins (ADH7, CPXM1, FUT3, GZMM, LYPD3) were identified as mediators in smoking-driven EC risk. Among these, ADH7 emerged as a key protein and was consistently associated with smoking traits; high ADH7 mRNA expression in EC tumor tissue was associated with reduced progression-free survival. PheWAS inferred that ADH7-targeted interventions might pose risks of neurological or psychiatric side effects, though these were not statistically significant. qRT-PCR and immunohistochemistry showed that ADH7 was downregulated in EC tissues relative to adjacent normal mucosa, and functional assays demonstrated that overexpression of ADH7 suppressed the proliferative and migratory capacity of EC cells. Serum ELISA further revealed that circulating ADH7 concentrations were elevated in smokers and in EC patients, with the highest levels observed in smoking EC patients, supporting a role for smoking-driven elevation of circulating ADH7 in EC risk.</p><p><strong>Conclusions: </strong>This study reveals a compartment-specific, dual role for ADH7 in smoking-related EC: elevated circulating ADH7, driven in part by smoking, is associated with increased EC risk, whereas ADH7 acts as a tumor suppressor within esophageal tumor tissue. These findings provide novel genetic and mechanistic insights into smoking-related EC pathogenesis and highlight the importance of distinguishing circulating from tissue-level protein function when interpreting biomarker-disease associations.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1745748"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223692","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":"Abdominal allergic reaction syndrome: a tentative definition.","authors":"Meiyi You, Xinglan Liao, Xueqi Li, Lan Guan, Zhaoxing Tian","doi":"10.3389/fmed.2026.1929771","DOIUrl":"https://doi.org/10.3389/fmed.2026.1929771","url":null,"abstract":"<p><strong>Background: </strong>Some patients with acute abdominal pain present with imaging findings suggestive of severe intestinal pathology, yet they remain hemodynamically stable and respond to corticosteroids rather than surgery. Recognizing this pattern early can prevent unnecessary laparotomy.</p><p><strong>Cases: </strong>Three female patients (aged 91, 78, and 57 years) admitted to the emergency department presented with acute abdominal pain and diffuse bowel wall edema on a CT scan. Despite alarming imaging results, all three patients remained hemodynamically stable. The symptoms improved rapidly with intravenous methylprednisolone, and all patients were discharged without surgery.</p><p><strong>Conclusions: </strong>We propose Abdominal Allergic Reaction Syndrome (AARS) as a preliminary recognition framework for this clinico-radiological pattern. AARS is not intended to replace specific diagnoses such as immunoglobulin A (IgA) vasculitis or lupus enteritis. Rather, it serves as an early identifier at a stage when the underlying etiology remains unclear. The core features (hemodynamic stability and clinico-radiological mismatch, supported by normal lactate levels) may help emergency physicians avoid unnecessary surgery while proceeding with the diagnostic workup. The term \"allergic\" is used here in its broader immunological sense (encompassing all type I-IV hypersensitivity reactions) and is not restricted to IgE-mediated reactions.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1929771"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223700","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":"Precision fluid therapy in sepsis: fluid responsiveness vs. fluid tolerance.","authors":"Ali Araghi","doi":"10.3389/fmed.2026.1980813","DOIUrl":"https://doi.org/10.3389/fmed.2026.1980813","url":null,"abstract":"<p><p>Intravenous fluid is the most frequently administered drug in septic shock and one of the least precisely dosed. Two decades of trials have progressively dismantled the assumption that more fluid is better: protocolized early goal-directed therapy failed to improve on contemporary usual care, high-volume bolus protocols caused frank harm where organ support was limited, and restrictive strategies applied after an initial resuscitation have proven neutral rather than superior. What has replaced a universal volume prescription is a pair of questions that must be asked separately for each patient and repeated over time: will this patient's cardiac output actually rise with more fluid (fluid responsiveness), and can the lungs, kidneys, and venous system absorb that volume without harm (fluid tolerance)? This narrative review examines how to answer both questions in the modern intensive care unit. We ground the discussion in Guytonian venous return physiology and in the revised Starling model, in which sepsis-induced glycocalyx degradation makes infused crystalloid a short-acting drug with a cumulative side-effect profile. Using an index case of a mechanically ventilated patient with pneumococcal septic shock, atrial fibrillation, lung-protective tidal volumes, obesity, and acute kidney injury, we show why the two most widely used bedside indices, respiratory variation in inferior vena cava diameter and pulse pressure variation, are physiologically invalid in precisely the patients in whom the fluid decision is hardest, and why maintenance infusions and fluid creep deserve the same scrutiny as boluses. We make the case for direct stroke volume measurement paired with a reversible dynamic challenge, most commonly a passive leg raise, as the one approach that remains interpretable across arrhythmia, low tidal volume, spontaneous respiratory effort, and elevated intra-abdominal pressure, and we discuss dynamic arterial elastance as a complementary tool for predicting whether arterial pressure will follow flow. We review the outcome evidence, including the FRESH trial and supporting meta-analyses, the emerging literature on sepsis endotypes and subphenotypes, and the 2026 Surviving Sepsis Campaign recommendations. Finally, we address fluid tolerance and de-resuscitation, where venous congestion assessment and lung ultrasound are increasingly used, and outline where the evidence remains thin.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1980813"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223745","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}