Frontiers in Medicine最新文献

{"title":"Extracorporeal membrane oxygenation in acute respiratory distress syndrome caused by elderly tuberculous meningitis: a case report and review of the literature","authors":"Zhaokun Shi, Xue Zhu, Wenwei Gao, Shuhui Yu, Liying Zhan","doi":"10.3389/fmed.2024.1457413","DOIUrl":"https://doi.org/10.3389/fmed.2024.1457413","url":null,"abstract":"Diagnosing and clinical management of tuberculous meningitis (TBM) are still challenging for clinicians. Analysis of cerebrospinal fluid (CSF) is an important diagnostic tool for patients with suspected central nervous system (CNS) diseases. Acute respiratory distress syndrome (ARDS), an inflammatory lung injury, can be treated by mechanical ventilation, fluid management, and even extracorporeal membrane oxygenation (ECMO). In addition, metagenomic next-generation sequencing (mNGS) can facilitate the detection of atypical, rare pathogens in clinical specimens. We report a case of a 65-year-old man with ARDS caused by TBM. He was admitted with a fever and shaking. Despite aggressive initial treatment, the patient progressed rapidly and developed ARDS. Without positive results of mNGS and culture, anti-tuberculosis (TB) treatment was started. In order to improve oxygenation levels, he was placed on veno-venous ECMO for 8 days. On day 47, the tracheotomy catheter was pulled out and sealed. The patient was conscious and could communicate with family members as normal.","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triple planetary crisis: why healthcare professionals should care","authors":"Fathima Rizka Ihsan, Jacqueline G. Bloomfield, Lynn V. Monrouxe","doi":"10.3389/fmed.2024.1465662","DOIUrl":"https://doi.org/10.3389/fmed.2024.1465662","url":null,"abstract":"Humanity currently faces an ecological crisis with devastating consequences to all living species. While climate change is estimated to lead to 250,000 extra deaths per year between 2030 and 2050, pollution is known to cause 9 million premature deaths: a figure much greater than the deaths caused by AIDS, tuberculosis and malaria combined. The healthcare sector is both burdened by, and contributes to, the impact of climate change and environmental degradation. Amidst glaring evidence of the interdependence of human health and the eco system, there is an urgent call for healthcare professionals to concern themselves with the triple planetary threat humanity currently faces. Without immediate mitigative measures, the future seems uncertain. Some healthcare systems at local, national and global levels have taken numerous initiatives to address, mitigate and adapt to these changes, however, these are not sufficient. A lack of awareness among healthcare professionals of the ecological crisis, its interconnectedness, and the role of healthcare in it, plays a significant role in the lack responsibility of healthcare professionals in this space. Therefore, this paper presents a discussion of the current landscape of the triple threat of climate change, loss of biodiversity, and pollution, while emphasising the contribution of healthcare professionals to it. Furthermore, interrelated concepts such as planetary health and eco-anxiety are briefly discussed. This perspective paper also presents several key prospective research areas that may lay the foundation for motivating healthcare professionals to play an active role in preventing and mitigating the ecological crises humanity currently faces.","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Signaling pathways that activate hepatic stellate cells during liver fibrosis","authors":"Youtian Zhang, Long Ren, Yinting Tian, Xiaohu Guo, Fengxian Wei, Yawu Zhang","doi":"10.3389/fmed.2024.1454980","DOIUrl":"https://doi.org/10.3389/fmed.2024.1454980","url":null,"abstract":"Liver fibrosis is a complex process driven by various factors and is a key feature of chronic liver diseases. Its essence is liver tissue remodeling caused by excessive accumulation of collagen and other extracellular matrix. Activation of hepatic stellate cells (HSCs), which are responsible for collagen production, plays a crucial role in promoting the progression of liver fibrosis. Abnormal expression of signaling pathways, such as the TGF-β/Smads pathway, contributes to HSCs activation. Recent studies have shed light on these pathways, providing valuable insights into the development of liver fibrosis. Here, we will review six signaling pathways such as TGF-β/Smads that have been studied more in recent years.","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The development of a machine learning model to train junior ophthalmologists in diagnosing the pre-clinical keratoconus","authors":"Yang Jiang, Hanyu Jiang, Jing Zhang, Tao Chen, Ying Li, Yuehua Zhou, Youxin Chen, Fusheng Li","doi":"10.3389/fmed.2024.1458356","DOIUrl":"https://doi.org/10.3389/fmed.2024.1458356","url":null,"abstract":"PurposeThis study aims to evaluate the diagnostic performance of a machine learning model (ML model) to train junior ophthalmologists in detecting preclinical keratoconus (PKC).MethodsA total of 1,334 corneal topography images (The Pentacam HR system) from 413 keratoconus eyes, 32 PKC eyes and 222 normal eyes were collected. Five junior ophthalmologists were trained and annotated the images with or without the suggestions proposed by the ML model. The diagnostic performance of PKC was evaluated among three groups: junior ophthalmologist group (control group), ML model group and ML model-training junior ophthalmologist group (test group).ResultsThe accuracy of the ML model between the eyes of patients with KC and NEs in all three clinics (99% accuracy, area under the receiver operating characteristic (ROC) curve AUC of 1.00, 99% sensitivity, 99% specificity) was higher than that for Belin-Ambrósio enhanced ectasia display total deviation (BAD-D) (86% accuracy, AUC of 0.97, 97% sensitivity, 69% specificity). The accuracy of the ML model between eyes with PKC and NEs in all three clinics (98% accuracy, AUC of 0.96, 98% sensitivity, 98% specificity) was higher than that of BAD-D (69% accuracy, AUC of 0.73, 67% sensitivity, 69% specificity). The diagnostic accuracy of PKC was 47.5% (95%CI, 0.5–71.6%), 100% (95%CI, 100–100%) and 94.4% (95%CI, 14.7–94.7%) in the control group, ML model group and test group. With the assistance of the proposed ML model, the diagnostic accuracy of junior ophthalmologists improved with statistical significance (<jats:italic>p</jats:italic> &amp;lt; 0.05). According to the questionnaire of all the junior ophthalmologists, the average score was 4 (total 5) regarding to the comprehensiveness that the AI model has been in their keratoconus diagnosis learning; the average score was 4.4 (total 5) regarding to the convenience that the AI model has been in their keratoconus diagnosis learning.ConclusionThe proposed ML model provided a novel approach for the detection of PKC with high diagnostic accuracy and assisted to improve the performance of junior ophthalmologists, resulting especially in reducing the risk of missed diagnoses.","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between systemic immune-inflammation index and cataract among outpatient US adults","authors":"Jin Huang, Hongjiang Wu, Fang Yu, Fangkun Wu, Chen Hang, Xiaoya Zhang, Yiting Hao, Hao Fu, Hongting Xu, Rong Li, Ding Chen","doi":"10.3389/fmed.2024.1469200","DOIUrl":"https://doi.org/10.3389/fmed.2024.1469200","url":null,"abstract":"BackgroundWhile several studies have noted a higher SII correlates with multiple diseases, research on the association between SII and cataract remains limited. Our cross-sectional study seeks to examine the association between SII and cataract among outpatient US adults.MethodsThis compensatory cross-sectional study utilized NHANES data from 1999 to 2008 cycles, conducting sample-weighted multivariate logistic regression and stratified analysis of subgroups.ResultsAmong 11,205 adults included in this study (5,571 [46.2%] male; 5,634 [53.8%] female), 2,131 (15.2%) had cataract and 9,074 (84.8%) did not have cataract. A fully adjusted model showed that SII higher than 500 × 10<jats:sup>9</jats:sup>/L was positively correlated with an increased risk of cataracts among women (OR, 1.27; 95% CI, 1.02–1.59) (<jats:italic>p</jats:italic> = 0.036). However, no difference was found in the men subgroup, and there was no significant interaction between SII and sex.ConclusionOur results indicated that a SII higher than 500 × 10<jats:sup>9</jats:sup>/L was positively correlated with an increased risk of cataracts in women. This study is the first to specifically investigate the impact of a high SII on cataract risk in outpatient adults in the United States. By effectively addressing inflammation, it is possible to mitigate cataract progression and significantly enhance patient outcomes.","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refractive errors in Tianjin youth aged 6–18 years: exploring urban–rural variations and contributing factors","authors":"Xin-He Fang, De-Sheng Song, Nan Jin, Bei Du, Rui-Hua Wei","doi":"10.3389/fmed.2024.1458829","DOIUrl":"https://doi.org/10.3389/fmed.2024.1458829","url":null,"abstract":"PurposeRefractive errors, particularly myopia, constitute a significant global public health concern, contributing to morbidity and disability. A more comprehensive understanding of the determinants of refractive errors and the differences between urban and rural areas is essential to develop effective preventive measures for youth. This study aimed to compare the prevalence and risk factors of refractive errors among youth in urban and rural Tianjin, China.MethodsThis school-based cross-sectional study was conducted in 2022. Elementary, middle, and high school students aged 6–18 years from both urban and rural areas of Tianjin were included. All participants underwent visual acuity testing and refractive measurement and completed comprehensive questionnaires.ResultsA total of 346,146 participants (176,628 boys) were included in this investigation (50.36% for urban and 49.64% for rural, respectively). Myopia, hyperopia, astigmatism, and anisometropia were present in 56.8, 9.7, 56.64, and 21.3% of urban students, respectively. Similarly, rural students had a prevalence of 57.6, 11.5, 56.48, and 22.0% for the respective conditions. Compared to rural students, after adjusting for age, sex, and other significant variables, urban students were 1.05 times more likely to have myopia (95% CI: 1.03–1.07, <jats:italic>p</jats:italic> &amp;lt; 0.0001), 0.71 times less likely to have hyperopia (95% CI: 0.69–0.73, <jats:italic>p</jats:italic> &amp;lt; 0.0001), and 1.02 times more likely to have astigmatism (95% CI: 0.69–0.73, <jats:italic>p</jats:italic> &amp;lt; 0.0001). There was no significant association between anisometropia and residence (OR: 1.00, 95% CI: 0.98–1.02, <jats:italic>p</jats:italic> = 0.9850). Sociodemographic and physiological factors contribute to the disparities in the prevalence of refractive errors between urban and rural areas. Age, increased near-work activities, and Decreased outdoor time were identified as risk factors for myopia, astigmatism, and anisometropia. Conversely, the absence of a parental history of refractive errors emerged as a protective factor for myopia and astigmatism among students. Lower parental education levels were negatively correlated with the risk of myopia and anisometropia in their children. Specifically, the lower the parental education, the greater the risk of myopia in their offspring. For urban students only, lower parental education was associated with an increased risk of astigmatism.ConclusionCrude prevalence estimates May not accurately reflect the true burden of refractive error due to confounding factors such as age and sex. Accounting for these factors revealed that urban students were more likely to have myopia and astigmatism but less likely to have hyperopia compared to their rural counterparts. These disparities highlight the importance of considering geographical variations when implementing strategies for myopia control and prevention.","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between ABO blood groups and hematological myeloid neoplasms in adolescents and adults","authors":"Miao Zhou, Tongyu Li, Yongcheng Sun, Guifang Ouyang, Wanchuan Zhuang, Ping Zhang","doi":"10.3389/fmed.2024.1456695","DOIUrl":"https://doi.org/10.3389/fmed.2024.1456695","url":null,"abstract":"BackgroundPrior research suggests a potential link between ABO blood types and susceptibility to various malignancies. The correlation between ABO blood types and hematological myeloid neoplasms, however, remains inadequately explored.ObjectiveThis study investigates the association between ABO blood groups and the incidence of hematological myeloid neoplasms in adolescents and adults.MethodsIn this retrospective clinical study, 1,022 adolescent and adult cases of myeloid neoplasms diagnosed at our institution were initially considered. After excluding conditions potentially linked to ABO blood types from prior studies, 792 eligible cases were analyzed. These cases were categorized based on disease subtypes and compared with a control group for blood type distribution.ResultsOur findings reveal a significantly higher prevalence of blood type A in patients with myeloid neoplasms compared to the control group, except for chronic myelocytic leukemia and myeloproliferative neoplasms. Conversely, the prevalence of blood type AB in myeloid neoplasms was notably lower than in the control group.ConclusionThe study suggests a potential association between ABO blood types and the risk of developing hematological myeloid neoplasms in adolescents and adults. Further research is warranted to elucidate the underlying mechanisms of this relationship.","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative bibliometric analysis of artificial intelligence-assisted polyp diagnosis and AI-assisted digestive endoscopy: trends and growth in AI gastroenterology (2003–2023)","authors":"Ziye Peng, Xiangyu Wang, Jiaxin Li, Jiayi Sun, Yuwei Wang, Yanru Li, Wen Li, Shuyi Zhang, Ximo Wang, Zhengcun Pei","doi":"10.3389/fmed.2024.1438979","DOIUrl":"https://doi.org/10.3389/fmed.2024.1438979","url":null,"abstract":"IntroductionArtificial intelligence is already widely utilized in gastroenterology. This study aims to comprehensively evaluate the research hotspots and development trends within the field of AI in gastroenterology by employing bibliometric techniques to scrutinize geographical distribution, authorship, affiliated institutions, keyword usage, references, and other pertinent data contained within relevant publications.MethodsThis investigation compiled all pertinent publications related to artificial intelligence in the context of gastrointestinal polyps and digestive endoscopy from 2003 to 2023 within the Web of Science Core Collection database. Furthermore, the study harnessed the tools CiteSpace, VOSviewer, GraphPad Prism and Scimago Graphica for visual data analysis. The study retrieved a total of 2,394 documents in the field of AI in digestive endoscopy and 628 documents specifically related to AI in digestive tract polyps.ResultsThe United States and China are the primary contributors to research in both fields. Since 2019, studies on AI for digestive tract polyps have constituted approximately 25% of the total AI digestive endoscopy studies annually. Six of the top 10 most-cited studies in AI digestive endoscopy also rank among the top 10 most-cited studies in AI for gastrointestinal polyps. Additionally, the number of studies on AI-assisted polyp segmentation is growing the fastest, with significant increases in AI-assisted polyp diagnosis and real-time systems beginning after 2020.DiscussionThe application of AI in gastroenterology has garnered increasing attention. As theoretical advancements in AI for gastroenterology have progressed, real-time diagnosis and detection of gastrointestinal diseases have become feasible in recent years, highlighting the promising potential of AI in this field.","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Considerations on the basis of medical reasoning for the use in AI applications","authors":"Adamantios Koumpis, Adam S. L. Graefe","doi":"10.3389/fmed.2024.1451649","DOIUrl":"https://doi.org/10.3389/fmed.2024.1451649","url":null,"abstract":"This study discusses the integration of artificial intelligence (AI) and machine learning (ML) in medical reasoning and decision-making, with a focus on the challenges and opportunities associated with the massive consumption of data required for training AI systems, and contrasts this with the limited data typically available to medical practitioners. We advocate for a balanced approach that includes small data and emphasize the importance of maintaining the art of clinical reasoning amid technological advancements. Finally, we highlight the potential of multidisciplinary research in addressing the complexities of medical reasoning and suggest the necessity of careful abstraction and conceptual modeling in AI applications.","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of autologous platelet-rich gel formed by calcium gluconate combined with hormone therapy for endometrial repair after hysteroscopic transcervical resection of adhesion surgery and successful pregnancy: case report and literature review","authors":"Yunying Li, Yingxue Han, Xiaojuan Su, Junjuan Cao, Junxia Liu, Wenjuan Zhang","doi":"10.3389/fmed.2024.1436089","DOIUrl":"https://doi.org/10.3389/fmed.2024.1436089","url":null,"abstract":"IntroductionIntrauterine adhesion (IUA), a common gynecological disease, is mainly caused by traumatic or infectious factors that lead to basal endometrial layer physiological repair disorders. IUA is mostly treated via hysteroscopic transcervical resection of adhesion and although it can restore uterine cavity shape, its endometrial repair effectiveness is limited. The figures showed that after surgery, patients with IUA have a high recurrence rate. Therefore, quick endometrial damage repair is key to successful treatment.Case presentationA 34-year-old patient visited our hospital after experiencing amenorrhea for 4 months following an induced abortion and had a fertility requirement. Based on the American Fertility Society intrauterine scores, the patient was diagnosed with moderate IUA. She underwent transcervical resection of adhesion, followed by autologous platelet-rich gel intrauterine perfusion and periodic estrogen–progesterone treatment for three menstrual cycles. No complications developed during treatment and the patient’s endometrium was significantly repaired, with successful pregnancy being achieved.ConclusionAutologous platelet-rich gel promoted endometrial repair and acted as a mechanical barrier to prevent intrauterine adhesion. This approach May offer new insights into IUA treatment.","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142266433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}