Frontiers in Medicine最新文献

{"title":"Efficacy and safety of dietary supplements for the treatment of ulcerative colitis, a network meta-analysis.","authors":"Rong Xu, Zhiyu Zhang, Ying Li, Zhijiu Wu","doi":"10.3389/fmed.2026.1816535","DOIUrl":"https://doi.org/10.3389/fmed.2026.1816535","url":null,"abstract":"<p><strong>Background: </strong>In recent years, the application of dietary supplements in the treatment of ulcerative colitis (UC) has attracted more and more scholars' attention, and a number of studies have shown that dietary supplements have a non-negligible role in improving the clinical symptoms and quality of life of UC patients. This article aims to compare the efficacy and safety of dietary supplement therapy of UC through a comprehensive network meta-analysis method.</p><p><strong>Methodology: </strong>A comprehensive literature search was conducted in multiple databases, including PubMed, the Cochrane Library, Embase, and Web of science, from their inception up to 30 October 2025. Network and routine meta-analyses using the mvmeta package in Stata 16.0 and Stata 12.0 software, and literature quality and risk of bias assessed using RevMan 5.3 software.</p><p><strong>Result: </strong>A total of 24 randomized controlled trials were conducted with 1,491 participants and 14 dietary supplements. The results showed that probiotics [MD = -1.64, 95% CI (-2.91 to -0.38)] and selenium [MD = -2.43, 95% CI (-4.85 to -0.01)] had significant advantages compared with conventional medical treatment or placebo in reducing clinical activity index. Flaxseed extract [MD = -1.53, 95% CI (-2.82 to -0.24)] and vitamin A [MD = -1.93, 95% CI (-3.82 to -0.04)] had a clear advantage over conventional medical treatment or placebo in reducing the Mayo score; at the same time, in terms of IBDQ, probiotics [MD = 7.78, 95% CI (1.39 to 14.17)], flaxseed extract [MD = 8.58, 95% CI (2.31 to 14.85)], resveratrol [MD = 9.18, 95% CI (2.45 to 15.91)], curcumin [MD = 25.80, 95% CI (2.00 to 49.60)], butyrate [MD = 20.50, 95% CI (9.80, 31.20)] with higher scores compared to conventional drugs or placebo, indicating an improved quality of life for patients; synbiotics [MD = -0.69, 95% CI (-1.16 to -0.23)], flaxseed extract [MD = -0.8, 95% CI (-1.16 to -0.44)], and <i>Achillea wilhelmsii</i> [MD = -2.95, 95% CI (-3.52 to -2.38)] all showed significant advantages compared with conventional medical therapy or placebo for reducing C-reactive protein levels.</p><p><strong>Conclusion: </strong>Various dietary supplements have shown differentiated efficacy in adjuvant UC therapy. Probiotics and selenium are effective in improving clinical symptoms; flaxseed extract showed consistent benefits in improving Mayo score, IBDQ score, and reducing CRP, ESR, and FCAL, and had a wide range of application prospects. Butyrate and curcumin have significant effects in improving quality of life; synbiotics and <i>Achillea wilhelmsii</i> have outstanding advantages in reducing CRP. Due to the limitations of the number and quality of included studies, the above conclusions still need to be validated by more high-quality, large-sample RCTs.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1816535"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835959","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":"From neuroinflammation to neuroprotection: a bibliometric analysis of anesthesia-associated postoperative cognitive dysfunction to guide clinical research (2000-2024).","authors":"Xingcen Wang, Zhiwei Yang, Ting Tang, Huijuan Huang, Jianzhi Shi, Jie He, Hua Zhang","doi":"10.3389/fmed.2026.1822901","DOIUrl":"https://doi.org/10.3389/fmed.2026.1822901","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative cognitive dysfunction is a common complication following anesthesia and surgery, particularly in elderly patients, yet its pathophysiology and optimal prevention strategies remain incompletely understood. This study employs bibliometric methods to analyze research trends in anesthesia-associated POCD from 2000 to 2024.</p><p><strong>Methods: </strong>A systematic review of 923 publications from the Web of Science Core Collection, cross-validated with the PubMed database, was conducted. Bibliometric analyses were performed using the R package \"bibliometrix,\" VOSviewer, and CiteSpace to evaluate publication trends, key contributors, collaborative networks, co-citation patterns, and keyword evolution.</p><p><strong>Results: </strong>Research output has grown steadily since 2000, with notable acceleration after 2018. The United States leads in productivity and influence, followed by China and Germany. Duke University is the most prolific institution. The British Journal of Anaesthesia and Anesthesiology are the core journals in this field. Keyword analysis reveals an evolution from early focus on surgical types and cognitive assessment toward neuroinflammation as the central pathological mechanism, with increasing attention to the delirium-POCD continuum, anesthetic optimization, and multimodal prevention. Emerging frontiers include the intersection of POCD with Alzheimer's disease pathology, the role of the gut-brain axis, and the translation of mechanistic insights into targeted neuroprotective strategies.</p><p><strong>Conclusion: </strong>This bibliometric analysis delineates the evolution of POCD research from descriptive epidemiology to mechanistic and translational inquiry. Neuroinflammation has emerged as the unifying pathological hub. Key challenges include heterogeneity in diagnostic criteria, difficulty isolating anesthesia effects from surgical trauma, and the gap between preclinical findings and clinical efficacy. Future research priorities should focus on harmonizing diagnostic standards, validating biomarkers, and conducting large-scale multi-center trials to translate mechanistic discoveries into perioperative brain health strategies.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1822901"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836285","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: Systemic amyloidosis unmasked by progressive hepatomegaly after splenectomy for non-traumatic spleen rupture in a patient with chronic liver disease.","authors":"Li-Ping Sheng, Ya-Yun Zhang, Ming Zhang, Bo-Zhi Lin, Rui-Fang Ma, Li-Na Han, Hui Liu, Feng-Qin Hou, Gui-Qiang Wang","doi":"10.3389/fmed.2026.1807002","DOIUrl":"https://doi.org/10.3389/fmed.2026.1807002","url":null,"abstract":"<p><strong>Background: </strong>Non-traumatic splenic rupture (NSR) is a rare manifestation of systemic amyloid light-chain amyloidosis (AL amyloidosis), a plasma cell dyscrasia best known for its cardiorenal involvement. This case is unique because the diagnostic clue from NSR was initially overlooked until the underlying disease unfolded into a multisystem disorder. The diagnostic clues were further obscured by the presence of chronic hepatitis B (HBV) and primary biliary cholangitis (PBC). The pitfalls and challenges, as well as the pathogenic link between AL amyloidosis and coexisting conditions, i.e., chronic HBV infection and PBC, are discussed.</p><p><strong>Case summary: </strong>A 46-year-old woman presented initially with non-specific upper gastrointestinal symptoms. Initial workup established the diagnosis of chronic HBV infection and PBC, but the disease progressed despite etiological therapy. NSR occurred 4 months later, and splenectomy pathology was inconclusive. The disease progressed, manifesting as cardiac dysfunction, acute kidney injury, subnephrotic-range proteinuria, and hepatomegaly. Serum and urinary-free light-chain levels and ratios were abnormal. Cardiac MRI suggested myocardial hypertrophy. Biopsy of the liver, bone marrow, and re-examination of the splenic specimen showed extensive amyloid deposition. She was diagnosed with multisystem AL amyloidosis (Mayo 2012 Stage III) and started on daratumumab, leading to significant clinical improvement.</p><p><strong>Conclusion: </strong>This case highlights the risk of \"premature\" attribution of manifestations of rare diseases to common comorbidities. While NSR should always be considered a sentinel event for systemic amyloidosis, the diagnostic clues can be easily overlooked in complex patients with overlapping diagnoses. A high index of suspicion and targeted histological evaluation of splenic tissue are imperative to avoid diagnostic delay and enable earlier treatment initiation for this serious disease.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1807002"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836308","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":"When medical training amplifies therapeutic nihilism: a cross-national study of healthcare professional attitudes toward stroke recovery in Central Africa.","authors":"Ibrahim Npochinto Moumeni, Abdel-Nasser Njikam Moumeni, Bristher Orlister Tchuidjio Ketchogué, Michael Temgoua, Yacouba Njankouo Mapoure","doi":"10.3389/fmed.2026.1795929","DOIUrl":"https://doi.org/10.3389/fmed.2026.1795929","url":null,"abstract":"<p><strong>Background: </strong>Healthcare professionals' beliefs about stroke recovery profoundly influence rehabilitation outcomes. While therapeutic pessimism has been documented in high-income countries, no study has quantified these attitudes in sub-Saharan Africa or examined their correlation with clinical practice patterns.</p><p><strong>Objective: </strong>To quantify therapeutic pessimism among Central African healthcare professionals using a validated assessment instrument and examine its relationship with rehabilitation intensity preferences and treatment discontinuation patterns.</p><p><strong>Methods: </strong>Cross-sectional survey of 776 participants across six Central African countries: physiotherapy students (<i>n</i> = 217), medical students (<i>n</i> = 197), physiotherapy specialists (<i>n</i> = 138), physicians (<i>n</i> = 101), and stroke families (<i>n</i> = 123). We developed and validated the Central Africa Stroke Beliefs Assessment Scale (CASBAS) and Rehabilitative Negativity Index (RNI, range 0-100) to quantify therapeutic attitudes during a standardized 2-month data collection period (November 2023-January 2024).</p><p><strong>Results: </strong>Medical students demonstrated severe therapeutic nihilism (mean RNI = 78.3 ± 12.4) with only 10% expecting lifelong recovery potential, contrasting sharply with stroke families (mean RNI = 31.2 ± 18.7, 40% expecting lifelong recovery, <i>p</i> < 0.001). Systematic underestimation of optimal rehabilitation intensity was pervasive: 65-70% of healthcare professionals recommended 1-3 h/week despite neuroplasticity evidence supporting >10 h/week. These limiting beliefs correlated with premature treatment discontinuation (80% cessation within 3 months) and demonstrated a clear inverse relationship between professional training level and recovery expectations, revealing what we term \"Rehabilitative Negativity Syndrome\" (RNS).</p><p><strong>Conclusion: </strong>Central African healthcare professionals demonstrate systematic therapeutic pessimism substantially exceeding documented rates in high-income settings. The RNI provides the first validated quantitative framework for measuring these attitudes. Medical education paradoxically amplifies therapeutic nihilism, creating barriers to evidence-based intensive rehabilitation. These findings establish baseline data essential for targeted curriculum reform and suggest that professional pessimism may constitute a modifiable determinant of stroke outcomes.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1795929"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836272","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":"SPIO-enhanced MRI for differentiating metastatic from reactive hyperplastic lymph nodes in breast cancer: diagnostic performance and association with VEGF-C expression.","authors":"Tao Wu, Angela Wu, Hui Xiong, Jiaying Deng, Zhewen Zhang, Dan Gong, Jun Luo, Dan Wu","doi":"10.3389/fmed.2026.1800084","DOIUrl":"https://doi.org/10.3389/fmed.2026.1800084","url":null,"abstract":"<p><strong>Background: </strong>Accurate assessment of lymph node status is essential for staging and treatment planning in breast cancer. Conventional morphological imaging criteria have limited sensitivity and specificity. Superparamagnetic Iron Oxide (SPIO)-enhanced MRI offers a functional imaging alternative exploiting macrophage-mediated iron uptake. This study evaluated the diagnostic performance of SPIO-enhanced MRI in differentiating metastatic from reactive hyperplastic lymph nodes and explored the association between MRI signal characteristics and Vascular Endothelial Growth Factor C (VEGF-C) expression.</p><p><strong>Methods: </strong>Sixty female breast cancer patients (January-May 2024) underwent preoperative plain and SPIO-enhanced MRI (Resovist, 0.2 mL/kg, 12-h delay). Among 112 harvested lymph nodes, Hematoxylin and Eosin staining, Prussian Blue staining, and VEGF-C immunohistochemistry were performed. The Percentage of Signal Intensity Loss (PSIL) was calculated on T2*-weighted images. The primary diagnostic analysis was patient-level using mean PSIL with receiver operating characteristic analysis.</p><p><strong>Results: </strong>Of 112 lymph nodes from 60 patients, 47 were metastatic and 65 reactive hyperplastic. Reactive nodes showed marked signal attenuation (mean PSIL 64.7 ± 12.0%) compared with metastatic nodes (11.6 ± 7.8%; <i>p</i> < 0.001). Patient-level ROC analysis yielded an area under the curve of 0.84 (95% CI: 0.73-0.95). At a data-derived optimal cutoff of 42% (Youden index), sensitivity was 83%, specificity 85%, positive predictive value 80.0%, negative predictive value 87.2%, and overall diagnostic accuracy 84.0%. Histopathological Prussian Blue grading supported differential iron uptake patterns between groups. High VEGF-C expression (≥++) was more prevalent in metastatic than hyperplastic nodes (85.1% vs. 12.3%; <i>p</i> < 0.001). PSIL showed a moderate inverse correlation with VEGF-C grade (Spearman <i>r</i> = -0.67; <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>SPIO-enhanced MRI demonstrated favorable diagnostic performance for differentiating metastatic from reactive hyperplastic lymph nodes at the patient level. The imaging characteristics were associated with supportive histopathological findings and VEGF-C expression patterns. These findings warrant validation in larger, multicenter studies using currently available iron oxide agents.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1800084"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836301","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":"Incidence and risk factors of acute kidney injury among neurocritical patients in high-altitude regions: a retrospective cohort study.","authors":"Quzhen Danzeng, Yingyu Pan, Zihan Lin, Jinwei Wang, Nan Li, Guoying Lin, Dong Wu","doi":"10.3389/fmed.2026.1756455","DOIUrl":"https://doi.org/10.3389/fmed.2026.1756455","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a frequent complication in intensive care unit (ICU) patients with acute brain injury. High-altitude hypoxia may aggravate renal vulnerability, but relevant evidence is limited. This study aims to investigate the incidence, risk factors, and outcomes of AKI among neurocritical patients at high altitude.</p><p><strong>Methods: </strong>Adult neurocritical patients admitted to the ICU of People's Hospital of Xizang Autonomous Region (3,650 m) from January 2022 to February 2024 were retrospectively analyzed. AKI was defined using the 2012 KDIGO serum creatinine criteria. Multivariable logistic regression identified independent predictors, and hemoglobin levels were modeled with linear spline regression. Propensity score matching (PSM) was performed to evaluate the impact of specific interventions.</p><p><strong>Results: </strong>Among 390 patients, 83 (21.3%) developed AKI within 7 days of ICU admission. Independent predictors included older age (OR = 1.058 [1.032-1.087], <i>p</i> < 0.001), higher body mass index (OR = 1.130 [1.030-1.242], <i>p</i> = 0.010), lower Glasgow Coma Scale score (OR = 0.859 [0.795-0.924], <i>p</i> < 0.001), hypotension (OR = 2.659 [1.257-5.579], <i>p</i> = 0.010), contrast agent (OR = 2.480 [1.263-4.867], <i>p</i> = 0.008), high-dose loop diuretics (OR = 1.985 [1.117-3.555], <i>p</i> = 0.020), and baseline eGFR (OR = 1.033 [1.015-1.052], <i>p</i> < 0.001). Both low (<100 g/L, OR = 4.707 [1.020-19.686], <i>p</i> = 0.037) and high (>180 g/L, OR = 2.031 [1.093-3.790], <i>p</i> = 0.025) hemoglobin levels increased AKI risk. PSM sensitivity analysis confirmed the association of high-dose loop diuretics with AKI (OR = 2.009, <i>p</i> = 0.011), while the effect of contrast agents lost significance after matching (OR = 1.505, <i>p</i> = 0.215). Patients with AKI had higher in-hospital mortality (34.9% vs. 11.7%, <i>p</i> < 0.001) and greater hospitalization costs (148.5 vs. 119.4 × 1,000 CNY, <i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>At high altitude, AKI is common in neurocritical patients and independently associated with adverse outcomes. Beyond traditional risk factors, altitude-related erythrocytosis significantly contribute to AKI risk, suggesting that tailored renal protection strategies are necessary in high-altitude neurocritical care.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1756455"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13144066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836313","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":"Deciphering molecular responses to radiofrequency microneedling in a 3D human skin model: new insights and modulation by aftercare treatment.","authors":"Sebastian Huth, Yvonne Marquardt, Laura Huth, Sina Djahed, Jens Malte Baron","doi":"10.3389/fmed.2026.1799214","DOIUrl":"https://doi.org/10.3389/fmed.2026.1799214","url":null,"abstract":"<p><strong>Background: </strong>Radiofrequency microneedling (RFMN) is an emerging therapeutic approach that enhances skin rejuvenation by delivering targeted thermal injury to the dermal and subdermal layers while sparing the epidermis. However, the molecular mechanisms underlying its biological effects especially in comparison to medical microneedling remain poorly understood. In this study, we aimed to investigate, for the first time, the molecular and histological responses to RFMN using a standardized three-dimensional (3D) human skin model. As a secondary objective, we assessed the modulatory effects of RFMN aftercare treatment with a dexpanthenol-containing ointment.</p><p><strong>Methods: </strong>We investigated the molecular and histological responses to RFMN utilizing a previously established standardized human 3D skin model composed of primary dermal fibroblasts and epidermal keratinocytes. Histological assessments and transcriptomic analyses employing next-generation sequencing were conducted 48 and 120 h after RFMN treatment. In addition, the effects of a topical dexpanthenol-containing ointment administered immediately following RFMN on wound healing and gene regulation were evaluated.</p><p><strong>Results: </strong>Histological analysis of RFMN-treated 3D skin models showed dermal coagulation zones that disappeared after post-treatment with a dexpanthenol-containing ointment. Transcriptomic profiling 48 h after RFMN showed an early pro-inflammatory response with upregulated chemokines and cytokines (e.g., CCL7, CXCL2, IL24) and downregulated matrix metalloproteinases and barrier genes, indicating controlled inflammation and skin renewal initiation. Aftercare with the dexpanthenol-containing ointment elicited distinct gene expression changes at 120 h post-RFMN, including increased expression of cytokines (IL37), matrix metalloproteinases (MMP3, MMP8), and epidermal regeneration markers (LCE1B, VEGFA), consistent with accelerated wound healing, re-epithelialization, and inflammation modulation.</p><p><strong>Conclusion: </strong>In conclusion, this study elucidates the molecular and histological effects of RFMN and highlights the benefits of dexpanthenol-containing topical post-treatment, which may further shorten the already brief downtime. These findings support the optimization of clinical protocols for safer and more effective skin rejuvenation.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1799214"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836336","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":"Efficacy of <i>Mycobacterium vaccae</i> and vitamin D combination therapy in initial smear-negative pulmonary tuberculosis: a prospective study.","authors":"Renkui Gu, Luyao Wang","doi":"10.3389/fmed.2026.1778652","DOIUrl":"https://doi.org/10.3389/fmed.2026.1778652","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of adjunctive <i>Mycobacterium vaccae</i> (<i>M. vaccae</i>) and vitamin D in patients with initial smear-negative pulmonary tuberculosis (PTB) and to explore their effects on immune responses.</p><p><strong>Methods: </strong>In this prospective cohort study, 391 patients with initial smear-negative pulmonary tuberculosis were consecutively enrolled and followed for 4 months. Patients were assigned to one of three treatment groups: standard anti-tuberculosis therapy (control), standard therapy plus <i>M. vaccae</i> vaccination, and standard therapy combined with <i>M. vaccae</i> and vitamin D. Cytokine levels [interferon-γ (IFN-γ), interleukin-4 (IL-4), IL-17, IL-10], T cell subset ratios [Th1/Th2, Th17/regulatory T cells (Treg)], and clinical outcomes were prospectively assessed.</p><p><strong>Results: </strong>The combined therapy group showed significant increases in IFN-γ and Th1/Th2 ratio, and decreases in IL-4, IL-17, IL-10, and an increase in the Th17/Treg ratio, indicating a shift toward Th1-dominant immunity. Clinically, lesion absorption (54.33%) and cavity closure (71.13%) rates were highest in the combined group, with a total effective rate of 89.76%, surpassing the control (76.12%) and <i>M. vaccae</i> (79.23%) groups (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Adjunctive therapy with <i>M. vaccae</i> and vitamin D enhances immune function and improves clinical outcomes in initial smear-negative PTB, suggesting a synergistic immunotherapeutic effect.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1778652"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835976","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":"Postoperative sarcopenia in older patients with hip fractures: incidence and associated risk factors in a retrospective cohort study.","authors":"Hang Yin, Chao Qin, Qi Tang, Guoli Wu, He Diao","doi":"10.3389/fmed.2026.1766120","DOIUrl":"https://doi.org/10.3389/fmed.2026.1766120","url":null,"abstract":"<p><strong>Objective: </strong>Sarcopenia significantly impacts the quality of life in older adults. Given the lack of large-scale studies on risk factors for postoperative sarcopenia in older hip fracture patients, this study investigated its incidence and associated risk factors.</p><p><strong>Materials and methods: </strong>This retrospective study enrolled older patients who were admitted for surgical treatment of hip fractures.</p><p><strong>Results: </strong>Out of the 325 enrolled patients, 264 (81.23%) were identified as being at risk for postoperative sarcopenia. The average sarcopenia score was 5.01 ± 1.61. Significant differences (<i>p</i> < 0.05) were observed across age, marital status, education levels, living arrangements, exercise habits, masticatory function, the number of chronic diseases, albumin levels, and activities of daily living (ADL) scores. Multivariate regression analysis identified age, education levels, activities of daily living (ADL) scores, and masticatory function as independent risk factors for sarcopenia.</p><p><strong>Conclusion: </strong>This study identified several risk factors for sarcopenia following hip fracture surgery in older adults, providing a basis for targeted clinical interventions to mitigate postoperative muscle loss.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1766120"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836062","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":"Three surgical approaches for retroperitoneal transvaginal natural orifice transluminal endoscopic surgery (vNOTES).","authors":"Lu Huang, Xiong Xiao, Dan Feng, Yan Li, Qiannan Hou, Li He, Yonghong Lin","doi":"10.3389/fmed.2026.1780428","DOIUrl":"https://doi.org/10.3389/fmed.2026.1780428","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the safety, efficacy, advantages, and limitations of three surgical approaches performed through the anterior, lateral, and posterior vaginal fornix for retroperitoneal transvaginal natural orifice transluminal endoscopic surgery (vNOTES).</p><p><strong>Method: </strong>We included women who underwent vNOTES retroperitoneal surgery between January 2019 and September 2025. The anterior, lateral, and posterior vaginal fornix approaches were used for retroperitoneal vNOTES. Demographic data, operative characteristics, and perioperative outcomes were retrospectively evaluated.</p><p><strong>Results: </strong>A total of 89 patients successfully underwent vNOTES retroperitoneal surgery. The surgical approaches included 13 procedures via the anterior fornix, 16 via the lateral fornix, and 60 via the posterior fornix. The anterior fornix approach was primarily used for lateral suspension for pelvic organ prolapse (POP). All procedures were completed safely, with the longest follow-up exceeding 2 years, and no cases of mesh exposure were observed. Overall, three patients (23.08%) experienced Grade I complications. The lateral fornix approach was primarily used for lymphadenectomy, and all procedures were completed safely. A total of four cases (25.00%) of Grade I complications and one case (6.25%) of Grade II complications were recorded. The posterior fornix approach was primarily used for sacrocolpopexy and sacrospinous ligament fixation (SSLF), with all procedures completed safely. In the sacrocolpopexy group, three Grade I complications (30.77%) and one Grade III complication (7.69%) were observed. In the SSLF group, eight Grade I complications (17.02%) were recorded.</p><p><strong>Conclusion: </strong>In this retrospective study, retroperitoneal vNOTES was demonstrated to be a safe and feasible approach. By using different vaginal fornix incisions, it can be adapted to a wide range of procedures, including surgeries for POP and resection of both pelvic and para-aortic lymph nodes.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1780428"},"PeriodicalIF":3.1,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13147183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147836101","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}