Frontiers in Medicine最新文献

{"title":"Precision fluid therapy in sepsis: fluid responsiveness vs. fluid tolerance.","authors":"Ali Araghi","doi":"10.3389/fmed.2026.1980813","DOIUrl":"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}

{"title":"Cultural context of professional identity formation: a perspective of health profession educators in Botswana.","authors":"Molefhi Abotseng, Enoch Sepako, Keikantse Matlhagela, Matshidiso Matome, Gaonyadiwe Lubinda, Ludo Badlangana","doi":"10.3389/fmed.2026.1916041","DOIUrl":"10.3389/fmed.2026.1916041","url":null,"abstract":"<p><p>In Botswana, the phrase \"<i>motho ke motho ka batho-\"</i>I am because you are\" is culturally a way of life and core to who we are as a people. As Batswana, our relationships and the evolution of our individual and collective identities are built on this key concept of <i>Botho/Ubuntu</i>. For us, <i>Botho</i> dictates that one does not merely \"become\" but \"becomes with\" in relation to identity formation, and by extension, professional identity formation (PIF). In this paper, the authors share their perspectives on professional identity formation (PIF) for health professions educators in the context of scarce African and non-Western epistemologies in the literature. The authors' guiding question and focus is: are the existing models/frameworks of PIF contextually relevant? If not, how can they be enriched and contextualized? This is one of the key tensions in the PIF discourse. The authors contend that contextualizing PIF efforts must integrate holistic cultural lenses and local ontologies into the current PIF models. We illustrate how leveraging indigenous knowledge frameworks encapsulated in the <i>Botho</i> belief system could contextualize existing PIF frameworks using a model we have termed, \"<i>Mabogo Dinku</i>\". The phrase <i>Mabogo Dinku</i> is derived from a prominent Setswana proverb, \"<i>mabogo dinku a a thebana</i>\", meaning, working together towards a common goal. The model is in a pictorial form and highlights the interconnectivity between the different frameworks. The model suggests that if any of the frameworks are misapplied the whole <i>Botho</i> belief system weakens and so too the concept of \"becoming with\".</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1916041"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223774","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":"Investigating risk factors and developing a predictive model for venous thromboembolism in patients with sepsis.","authors":"Yu Han, Yage Shi, Liu Liu, Bingjie Ding, Mengjuan Li, Ao Xia, Jingyuan Liu, Juanjuan Song, Ao Xie, Dong Miao, Hu Zhou","doi":"10.3389/fmed.2026.1890418","DOIUrl":"10.3389/fmed.2026.1890418","url":null,"abstract":"<p><strong>Background: </strong>Patients with sepsis are at high risk for venous thromboembolism (VTE). However, existing assessment tools designed for general medical or surgical populations may inadequately capture the specific risk profile of septic patients. This study aimed to identify independent predictors of VTE in sepsis and develop a sepsis-specific prediction model.</p><p><strong>Methods: </strong>In this retrospective cohort study, adult patients with sepsis diagnosed at a single center (2015-2024) were enrolled. Candidate predictors and treatments were restricted to data available within the first 24 h of diagnosis. After exclusions, 157 VTE cases and 703 matched non-VTE controls formed the prediction cohort, which was split into training (<i>n</i> = 602) and validation (<i>n</i> = 258) sets. The Synthetic Minority Oversampling Technique was applied to the training set. LASSO regression followed by multivariable logistic regression identified independent factors for the nomogram. Model performance was assessed via discrimination, calibration, and decision curve analysis and compared with the Padua and Caprini scores in the validation cohort.</p><p><strong>Results: </strong>Among 3,228 sepsis patients, 157 (4.86%) developed VTE. Multivariable analysis identified four independent predictors: surgery within 3 months, central venous catheterization within 24 h, history of VTE ≥1 year prior, and absence of early anticoagulant therapy (all <i>P</i> < 0.001). The resulting nomogram showed excellent discrimination (AUC: 0.905, 95% CI: 0.875-0.935 in training; 0.909, 95% CI: 0.867-0.951 in validation) and good calibration. Decision curve analysis supported its clinical utility. In the validation cohort, the nomogram significantly outperformed the Padua (AUC: 0.712) and Caprini (AUC: 0.738) scores, demonstrating superior incremental predictive value (<i>P</i> < 0.001 for net reclassification improvement and integrated discrimination improvement).</p><p><strong>Conclusions: </strong>A sepsis-specific nomogram incorporating recent surgery, early catheterization, previous VTE, and absence of early anticoagulation demonstrated good discrimination and calibration. It outperformed the Padua and Caprini tools in internal validation. External validation is required before clinical implementation.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1890418"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223832","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 temporal validation of a nomogram for estimating the risk of malignancy in surgically managed adnexal masses after hysterectomy.","authors":"Le Xin, Anrui Yang, Ming Wang, Ying Zhang","doi":"10.3389/fmed.2026.1915489","DOIUrl":"10.3389/fmed.2026.1915489","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Adnexal masses discovered after hysterectomy are common, but the proportion that is malignant is low, and existing risk-stratification systems such as O-RADS were not developed or validated in this population. We aimed to develop and temporally validate a nomogram estimating the probability of malignancy among patients who have already been selected for surgical management of a post-hysterectomy adnexal mass.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively studied consecutive patients who underwent re-operation for an adnexal mass after prior benign hysterectomy at Beijing Obstetrics and Gynecology Hospital between January 2010 and October 2025. Patients operated from January 2010 to September 2023 formed the development cohort (&lt;i&gt;n&lt;/i&gt; = 233; 50 malignant, 183 benign); those operated from October 2023 to October 2025 formed the temporal validation cohort (&lt;i&gt;n&lt;/i&gt; = 48; 20 malignant, 28 benign). Fourteen candidate predictors were screened by LASSO regression with 10-fold cross-validation. Final coefficients were obtained from unpenalised logistic regression on the selected predictors; the intercept of the seven-variable model was recalibrated on the development cohort because the originally reported intercept was inconsistent with the scaling of the continuous predictors. Performance was assessed by discrimination, calibration (intercept, slope, Brier score) and decision-curve analysis, with 1,000 bootstrap resamples for optimism correction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The seven-variable nomogram comprises age (per 10 years), BMI (per 10 kg/m&lt;sup&gt;2&lt;/sup&gt;), tumour size (ordinal), cystic components, enriched blood flow/enhancement, elevated CA125 (≥70 U/mL) and cyst duration (per 5 years). In the development cohort the AUC was 0.959 (95% CI 0.922-0.990) for the seven-variable model and 0.937 (0.885-0.979) for a simplified three-variable model (cystic components, enhancement, elevated CA125); the difference favoured the full model (&lt;i&gt;Δ&lt;/i&gt;AUC -0.023, 95% CI -0.045 to -0.005; DeLong &lt;i&gt;p&lt;/i&gt; = 0.021). In the temporal validation cohort the AUC was 0.905 (0.791-0.985) and 0.929 (0.846-0.986), respectively (&lt;i&gt;Δ&lt;/i&gt;AUC +0.022, 95% CI -0.040 to 0.097; &lt;i&gt;p&lt;/i&gt; = 0.517). Calibration was adequate in development (intercept 0.00, slope 1.02) and showed no statistically significant miscalibration in validation (intercept 0.29, 95% CI -0.71 to 1.28; slope 0.71, 95% CI 0.34 to 1.08). At the pre-specified 0.5 threshold the full model missed 8 of 50 malignancies in development and 6 of 20 in validation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;We present a parsimonious nomogram that estimates malignancy risk in post-hysterectomy adnexal masses among patients already selected for surgery, with internal and temporal validation. Because all participants underwent surgery, the model cannot be used to justify non-operative management; independent external and prospective validation in unselected cohorts is required before any clinic","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1915489"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677894/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223782","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 hybrid deep learning-based OCR model for handwritten medical prescriptions.","authors":"Omar Z Ameer, Mahmood Hameed Majeed, Safa L Kailan, Saif Mohamed Baraa Alsabti, Ali M Elhenidy","doi":"10.3389/fmed.2026.1856485","DOIUrl":"https://doi.org/10.3389/fmed.2026.1856485","url":null,"abstract":"<p><p>The current trend involving the use of paper-based medical prescriptions and the exchange of such by the social media is a major problem in automated and accurate text extraction in healthcare processes. This paper suggests a complete smart pipeline to digitize the images of medical prescriptions with lightweight deep learning-based classification, specialized Optical Character Recognition (OCR) engines, and comparative benchmarking of results using a large language model (LLM). The web scraped images of medical prescriptions are initially processed through a GhostNetV2 classifier to differentiate between handwritten and digital medical prescriptions. According to this choice, digital images are sent to PaddleOCR, and handwritten images are considered in Tesseract OCR so that each image could be processed by the best suitable recognition engine. The OCR outputs from both branches are benchmarked against GPT-4o (OpenAI) as an independent baseline to assess competitive performance and provide error-rate context. Experimental analysis shows that the suggested adaptive routing strategy is characterized by the fact that it has a high classification rate and the character and word error rates are significantly lower than those single-OCR techniques. The system is competitive with, though does not exceed, the raw accuracy of a state-of-the-art LLM-based OCR baseline (GPT-4o), while offering practical advantages in cost, transparency, and on-premises deployability that the black-box, per-call LLM baseline does not. The findings verify that the combination of lightweight classifiers and multi-OCR decision routing and multi-LLM-aided comparative benchmarking offers a scalable and robust solution to real-world medical prescriptions digitization, which adds to better automation, accuracy, and safety in healthcare information processing.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1856485"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223649","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 of early neutrophil-to-lymphocyte ratio trajectories with cardiac recovery and live ICU discharge in patients with sepsis-induced cardiomyopathy: a retrospective cohort study.","authors":"Baochao Pan, Ying Sun, Guiying Yang, Hepeng Fu, Xue Li, Yazhao Sun","doi":"10.3389/fmed.2026.1952142","DOIUrl":"10.3389/fmed.2026.1952142","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Sepsis-induced cardiomyopathy (SIC) is characterized by potentially reversible myocardial dysfunction accompanied by a profound systemic inflammatory response. However, the prognostic significance of early dynamic changes in the neutrophil-to-lymphocyte ratio (NLR) in patients with SIC remains unclear. This study aimed to identify distinct early NLR trajectories and examine their associations with cardiac recovery and live discharge from the intensive care unit (ICU).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-center retrospective cohort study included patients with SIC admitted to the Department of Critical Care Medicine, Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine. NLR values were collected at ICU admission and at 24, 48, and 72 h thereafter. Latent class mixed modeling was used to identify distinct 72-h NLR trajectories. A 72-h landmark design was applied. The primary outcome was live ICU discharge within 28 days, with ICU death treated as a competing event and analyzed using Fine-Gray regression. The secondary outcome was cardiac recovery by days 5-7, defined as a follow-up left ventricular ejection fraction (LVEF) of ≥50% or an absolute increase of ≥10 percentage points from baseline. Multivariable logistic regression was used to evaluate the association between NLR trajectories and cardiac recovery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 510 patients contributed 2,040 longitudinal NLR measurements. Three distinct trajectories were identified: low-stable (&lt;i&gt;n&lt;/i&gt; = 230, 45.1%), high-decreasing (&lt;i&gt;n&lt;/i&gt; = 170, 33.3%), and persistent-high (&lt;i&gt;n&lt;/i&gt; = 110, 21.6%). The geometric mean NLR changed from 7.85 to 6.16, from 18.47 to 8.01, and from 14.95 to 22.87, respectively, during the first 72 h. Live ICU discharge occurred in 85.7%, 67.1%, and 36.4% of patients in the three groups, respectively. Compared with the low-stable group, the adjusted subdistribution hazard ratios for live ICU discharge were 0.49 [95% confidence interval (CI), 0.38-0.63; &lt;i&gt;P&lt;/i&gt; &lt; 0.001] for the high-decreasing group and 0.25 (95% CI, 0.17-0.37; &lt;i&gt;P&lt;/i&gt; &lt; 0.001) for the persistent-high group. Cardiac recovery occurred in 80.4%, 61.8%, and 42.7% of patients, respectively. The corresponding adjusted odds ratios were 0.48 (95% CI, 0.29-0.79; &lt;i&gt;P&lt;/i&gt; = 0.004) and 0.27 (95% CI, 0.14-0.51; &lt;i&gt;P&lt;/i&gt; &lt; 0.001). Associations with live ICU discharge were consistent across predefined subgroups. Septic shock showed an exploratory interaction with the association between NLR trajectories and cardiac recovery (P for interaction=0.034). Sensitivity analyses yielded similar results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Early 72-h NLR trajectories were independently associated with cardiac recovery and live ICU discharge in patients with SIC. A persistent-high trajectory identified patients with the poorest prognosis, whereas a high-decreasing trajectory was associated with intermediate outcomes. Serial assessment","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1952142"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223650","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":"Pulmonary hypertension optimal screening in interstitial lung disease (PHOS-ILD): a scoring system for the detection of pulmonary hypertension in patients with interstitial lung disease.","authors":"Theodoros Karampitsakos, Evan Wasserman, Eleni Stagaki, Abhay Thottassery, Jorden Smith, Huda Asif, Brian Soto, Christian Arce Guzman, Jalen Hammonds, Anna Papasarantou, Agamemnon Bakakos, Ourania Papaioannou, Apostolos Matsioulas, Foteini Karakontaki, Konstantinos Loverdos, Eirini Kefalidou, Brenda M Juan-Guardela, Jose D Herazo-Maya, Adriano R Tonelli, Debabrata Bandyopadhyay","doi":"10.3389/fmed.2026.1908302","DOIUrl":"10.3389/fmed.2026.1908302","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hypertension (PH) is a common comorbidity of interstitial lung disease (ILD). Timely detection may improve outcomes through implementation of PH specific treatments.</p><p><strong>Methods: </strong>Retrospective, multicenter study aiming to identify features that predict PH in patients with ILD. In the derivation cohort (ILD cohort-University of South Florida), we identified predictors of PH in ILD and created a scoring system using the rounded value of odds ratio for each significant parameter. Correlation with hemodynamic parameters was investigated in the derivation and validation cohort (Idiopathic Pulmonary Fibrosis cohort-Cleveland Clinic).</p><p><strong>Results: </strong>We included 164 patients with ILD that underwent right heart catheterization (RHC) [derivation cohort: <i>n</i> = 118, median age (years, 95% CI): 69.0 (65.9-71.0), female gender: 65 (54.6%), median mean pulmonary arterial pressure (mPAP) (mmHg, 95% CI): 25.0 (23.0-27.0), median pulmonary vascular resistance (PVR) [Wood units (WU), 95% CI]: 3.6 (3.0-4.3), validation cohort: <i>n</i> = 46, median age (95% CI): 63.0 (60.0-66.0), female gender: 17 (37%), median mPAP (mmHg, 95% CI): 20.5 (18.0-27.2), median PVR (WU, 95% CI): 3.1 (2.2-3.4)]. Parameters and optimal cut-offs that significantly predicted precapillary PH in the derivation cohort were: age>42 years, heart rate recovery (HRR) at 1 min ≤ 15 bpm in 6-min walk test (6 MWT), 6-min walk distance (6 MWD) ≤ 270 meters, B-type natriuretic peptide (BNP) > 136 pg/mL, pulmonary artery to ascending aorta diameter ratio (PA/AA) > 1 in high-resolution computed tomography (HRCT), main PA diameter > 29 mm in HRCT, right ventricular systolic pressure > 42 mmHg on echocardiogram. We created a PH detection model that ranged from 0 to 28. The optimal cut-off threshold for the detection of PH was > 14 (80% sensitivity, 68% specificity, AUC: 0.78). A simplified scoring system without BNP and main PA diameter (range: 0-21) maintained the same AUC. The simplified scoring system exhibited positive correlation with mean pulmonary artery pressure both in the derivation (rho = 0.47, <i>p</i> < 0.0001) and validation cohort (rho = 0.36, <i>p</i> = 0.013).</p><p><strong>Conclusion: </strong>This study demonstrates that incorporation of demographic, functional, imaging, and echocardiographic characteristics can optimize the early identification of precapillary PH in patients with ILD, paving the way to structured screening strategies. Timely detection of PH might lead to timely implementation of emerging PH specific treatments in patients with ILDs.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1908302"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227675","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":"Prenatal ultrasonography diagnosis of fetal microtia with tympanic ring agenesis: a case report.","authors":"Jie Li, Yanpeng Song","doi":"10.3389/fmed.2026.1969602","DOIUrl":"10.3389/fmed.2026.1969602","url":null,"abstract":"<p><p>Microtia is frequently accompanied by middle ear anomalies, among which absence of the tympanic ring is relatively rare and seldom diagnosed prenatally. Previous reports have mainly focused on external ear anomalies, with limited experience in the prenatal diagnosis and postnatal verification of middle ear osseous abnormalities.We report a case of fetal microtia complicated by absence of the tympanic ring diagnosed by prenatal ultrasound. A systematic examination at 24 weeks of gestation revealed abnormal unilateral auricular morphology, with size and shape inconsistent with a normal fetus at the same gestational age; normal auricular structures were poorly visualized, and the external auditory canal was not clearly demonstrated. On the affected side, the middle ear tympanic ring was not visualized, with absence of its ossification center, suggesting microtia complicated by absence of the tympanic ring. After prenatal counseling, the woman chose to terminate the pregnancy. Post-induction CT confirmed findings consistent with prenatal ultrasound.This case verifies at the histological level that the external and middle ear share a common origin, and demonstrates that prenatal ultrasound can clearly display fetal external and middle ear structures, holding important clinical value for diagnosing microtia with absence of the tympanic ring. Recognition of the ultrasound features of tympanic ring absence may improve prenatal detection and provide a reliable basis for perinatal management and genetic counseling. Prenatal ultrasound is an effective method for diagnosing fetal microtia and assessing concomitant absence of the tympanic ring, helping improve prenatal recognition of occult middle ear anomalies and reduce missed diagnoses. This study clarifies the diagnostic value of postnatal CT verification and provides new practical evidence for the prenatal diagnostic pathway of such congenital anomalies.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1969602"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223815","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":"Nurses' perspectives on perioperative pulmonary rehabilitation for patients with lung cancer in the pre-implementation phase: a CFIR 2.0-guided study.","authors":"Chunxiao Yang, Yi Liu, Fanfan Li, Chunmei Tan, Xiaoqiong Liu, Wenping Gong, Shirong Ma","doi":"10.3389/fmed.2026.1904755","DOIUrl":"10.3389/fmed.2026.1904755","url":null,"abstract":"<p><strong>Background: </strong>Despite strong evidence supporting perioperative pulmonary rehabilitation (PR) for patients undergoing lung cancer surgery, little is known about factors that may influence implementation prior to program rollout, particularly in resource-constrained settings. Guided by the updated Consolidated Framework for Implementation Research (CFIR 2.0), this study aimed to identify anticipated barriers and facilitators to inform program refinement and future implementation strategies.</p><p><strong>Methods: </strong>A descriptive qualitative design was used. Semi-structured interviews were conducted with nurses from the thoracic surgery department of a tertiary hospital in China (September-November 2025). Guided by the four CFIR 2.0 domains (innovation, outer setting, inner setting, individuals), directed content analysis was performed based on nurses' perspectives.</p><p><strong>Results: </strong>Sixteen nurses were interviewed, representing diverse roles: Ward/ICU frontline staff nurses, charge nurses, unit secretaries, administrative nurses and nurse managers. Relevant constructs included 22 of the 29 CFIR 2.0 constructs and 8 subconstructs. Facilitators spanned: innovation (source, evidence base, relative advantage, trialability); outer setting (financing, policy, external pressure); inner setting (relational connections, communication, culture, incentive systems); and individual factors (team needs, leadership/practitioner capability, motivation). Barriers comprised: innovation (adaptability, complexity, cost); outer setting (local condition, partnerships and connections); inner setting (structural characteristics, compatibility, access to knowledge and information); and individuals (recipient needs, capability). Notably, implementation concerns differed across nursing roles, reflecting role heterogeneity and underscoring the need for tailored implementation strategies.</p><p><strong>Conclusion: </strong>Implementation of perioperative PR for patients undergoing lung cancer surgery is influenced by multilevel factors spanning innovation, outer setting, inner setting, and individuals determinants. Differences in concerns across nursing roles highlight the importance of role-tailored implementation strategies. These findings provide a foundation for optimizing implementation approaches and may facilitate the sustainable integration of evidence-based PR into routine practice, particularly in resource-constrained healthcare settings.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1904755"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223827","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":"Global research trends and emerging themes of ketamine in perioperative neurocognitive disorders: a bibliometric analysis.","authors":"Jun Kang, Ziwei Wang, Jiaxuan Bi, Yongli Duo, Wenjun Yan","doi":"10.3389/fmed.2026.1960353","DOIUrl":"10.3389/fmed.2026.1960353","url":null,"abstract":"<p><strong>Background: </strong>Within the contemporary perioperative neurocognitive disorder (PND) framework, postoperative neurocognitive outcomes include postoperative delirium, delayed neurocognitive recovery, and postoperative neurocognitive disorder. Interest in ketamine and its enantiomers has increased, but the clinical literature on perioperative neurocognitive outcomes remains heterogeneous. This study mapped the global research landscape, collaboration structure, thematic evolution, and recently intensified research themes at the intersection of ketamine and PNDs.</p><p><strong>Methods: </strong>Publications indexed in the Web of Science Core Collection (WoSCC) and Scopus were retrieved using a prespecified search strategy. English-language articles and reviews published from 2006 to 2025 were included. Records were integrated and deduplicated using a Python-based bibliographic consolidation workflow. VOSviewer 1.6.20 was used for collaboration, citation, and author-keyword analyses, whereas CiteSpace 6.4.R2 Advanced was used for keyword burst detection. A WoSCC-only sensitivity analysis assessed robustness to database composition.</p><p><strong>Results: </strong>After database restrictions, 559 records remained (WoSCC, <i>n</i> = 191; Scopus, <i>n</i> = 368); removal of 127 cross-database duplicates yielded 432 unique publications with 13,085 citations. Of these, 283 publications (65.5%) were published during 2021-2025. China contributed the largest number of publications (<i>n</i> = 152), whereas the United States had the highest citation count (6,255) and country-level total link strength (66). The most frequent author keywords were delirium (77), postoperative delirium (74), ketamine (65), esketamine (57), and postoperative cognitive dysfunction (55). \"Intraoperative ketamine\" showed the strongest keyword burst (strength = 4.05; 2021-2023), while recent bursts extending through 2025 included mechanisms, dysfunction, ketamine, esketamine, reliability, and delayed neurocognitive recovery. The WoSCC-only sensitivity analysis showed broadly similar patterns, including a 9/10 overlap among the top keywords (Spearman's <i>ρ</i> = 0.784).</p><p><strong>Conclusions: </strong>Research on ketamine and perioperative neurocognitive outcomes has expanded rapidly, particularly since 2020. Recent literature increasingly emphasizes esketamine, contemporary neurocognitive terminology, mechanistic questions, and delayed neurocognitive recovery. These bibliometric patterns represent research attention rather than evidence of clinical efficacy. Future studies should distinguish ketamine formulations and enantiomers, use standardized PND definitions and outcome windows, and prioritize adequately powered multicenter designs.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1960353"},"PeriodicalIF":3.6,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223793","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}