Frontiers in Medicine最新文献

{"title":"Potential of digital applications for self-management and other outcomes in inflammatory rheumatic diseases: a systematic literature review.","authors":"Alina Volkmar, Cay-Benedict von der Decken, Stefan Kleinert, Kirsten Karberg, Georg Gauler, Michael Klennert, Jana Klennert, Peer Malte Aries, Sonja Froschauer, Sarah Wildenhain, Theresia Muth, Susanna Späthling-Mestekemper, Christoph Kuhn, Wolfgang Vorbrüggen, Martin Welcker, Peter Bartz-Bazzanella, Matthias Englbrecht","doi":"10.3389/fmed.2025.1617151","DOIUrl":"https://doi.org/10.3389/fmed.2025.1617151","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory rheumatic diseases (IRDs) are chronic autoimmune conditions affecting the musculoskeletal system, leading to pain, disability, and reduced quality of life. Despite advances in medical treatments, barriers such as delayed diagnosis, workforce shortages, and low adherence to self-management strategies remain critical challenges. Digital health applications are emerging as promising tools to enhance disease management. The aim of this study was to conduct a systematic literature review (SLR) to evaluate self-care outcomes associated with digital health applications in IRDs.</p><p><strong>Methods: </strong>We conducted a systematic literature review according to PRISMA guidelines across four electronic databases (PubMed, Embase, CINAHL, Cochrane) from inception to July 2024. Randomized controlled trials (RCTs) and systematic reviews focusing on digital interventions to promote self-management and self-care in individuals with IRDs were included. Key outcomes were extracted and the quality of the included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist.</p><p><strong>Results: </strong>Fifteen RCTs with a total of 1912 participants were analyzed. Primary outcomes, including self-management/self-care, showed mixed results. Some studies demonstrated significant improvements in self-efficacy, pain reduction, depression/anxiety symptoms, and physical function, while others showed no notable changes. Secondary outcomes, including disease activity and medication adherence, revealed heterogeneous findings. Variability in study design, sample size, and intervention duration posed challenges for drawing definitive conclusions about the effectiveness of digital interventions.</p><p><strong>Discussion: </strong>Digital health applications show promise as cost-effective and scalable solutions to complement standard IRD care by empowering patients in their disease management. However, significant heterogeneity and limited generalizability highlight the need for more robust and long-term research to validate the efficacy of specific tools and identify best options for improving outcomes. Tailored digital interventions could bridge the gap in care for IRD patients and support their autonomy.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1617151"},"PeriodicalIF":3.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12285587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698167","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":"Research progress on the diagnostic value of fecal calprotectin in colorectal tumors.","authors":"Wei Jing, Jiangshan Sun, Qingzheng Wu, Xiuli Zhang","doi":"10.3389/fmed.2025.1626197","DOIUrl":"https://doi.org/10.3389/fmed.2025.1626197","url":null,"abstract":"<p><p>Fecal Calprotectin (FC), a calcium-binding protein secreted by neutrophils and macrophages and belonging to the S100 protein family, has gained increasing utilization in recent years for the diagnosis and monitoring of intestinal diseases due to its high expression and stability in inflammatory responses. In the field of colorectal tumors, the diagnostic value of FC has gradually emerged. Within colorectal tumors, colorectal cancer (CRC) is an area of significant research focus. Studies have demonstrated significantly elevated FC levels in patients with CRC, a phenomenon potentially linked to chronic inflammation and immune cell infiltration within the tumor microenvironment. FC exhibits notable advantages in colorectal tumor diagnosis, characterized by high sensitivity and moderate specificity. Emerging research has revealed correlations between FC levels and colorectal tumors staging as well as left-sided versus right-sided tumor localization, with elevated FC levels associated with malignant transformation, local inflammation, and advanced tumor stages (T3 and T4). The diagnostic performance of fecal calprotectin (FC) as a non-invasive marker for colorectal tumors has not yet been established. However, due to its association with inflammation, FC holds promise for playing a more significant role in the screening, staging, and localization of colorectal tumors.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1626197"},"PeriodicalIF":3.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698171","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":"Comparison of analgesic effects between betamethasone and dexamethasone in total knee arthroplasty: a prospective randomized controlled trial.","authors":"Kai Qin, Xiangxiang Sun, Qunli Dou, Bowei Li, Guoyang Bai, Xiaobo Sun, Jianbing Ma, Chao Xu, Yuanchi Huang","doi":"10.3389/fmed.2025.1575417","DOIUrl":"https://doi.org/10.3389/fmed.2025.1575417","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroids such as dexamethasone and betamethasone are widely used for local infiltration analgesia in total knee arthroplasty (TKA). However, the analgesic efficacy of these two glucocorticoids in TKA cocktail therapy remains unknown. Therefore, this study aims to compare the analgesic efficacy and safety of betamethasone and dexamethasone in TKA through a prospective randomized controlled trial (RCT).</p><p><strong>Methods: </strong>A total of 120 patients were randomly assigned to three groups: Control (Con) group, Dexamethasone (Dex) group and Betamethasone (Beta) group. The primary outcome was the postoperative visual analog scale (VAS); the secondary outcomes were the knee range of motion (ROM).</p><p><strong>Results: </strong>Compared with the Con group, the VAS scores of the Dex group during walking were decreased significantly at 12 and 24 h postoperatively, while the Beta group showed a decrease at 12, 24, 48 h and 2 weeks postoperatively. In terms of dynamic VAS scores at 12, 24, 48 h and 2 weeks postoperatively the Beta group was superior to the Dex group. At 48 h and 2 weeks postoperatively, the ROM in the Beta group was better than Dex group. There were no significant differences among the three groups in terms of inflammatory markers and incidence of postoperative adverse event.</p><p><strong>Conclusion: </strong>Our prospective RCT demonstrates that betamethasone exhibits better analgesic effects than dexamethasone in the cocktail therapy of TKA and does not incur additional complications, providing a medication basis for the local application of glucocorticoids in TKA.</p><p><strong>Clinical trial registration: </strong>https://www.chictr.org.cn, identifier ChiCTR2300072533.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1575417"},"PeriodicalIF":3.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698085","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":"Effect of combined colloid preloading and crystalloid coloading versus combined colloid and crystalloid coloading on maternal cardiac output during spinal anesthesia for cesarean section under combined prophylactic noradrenaline infusion.","authors":"Xiang Gao, Yu Huang, Sumei Hu, Chuantao Lin, Yi You, Shihong Huang, Ming Liu, Jianying Yan","doi":"10.3389/fmed.2025.1421947","DOIUrl":"https://doi.org/10.3389/fmed.2025.1421947","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Hypotension is a common complication of spinal anesthesia during cesarean section, and no single intervention has been shown to eliminate maternal hypotension. Fluid loading strategies combined with vasopressor drug regimens can achieve this goal by maximizing cardiac output (CO) and minimizing the fall in systemic vascular resistance (SVR). However, the optimal fluid volume, type, and timing of administration have not been fully elucidated. Therefore, this study aimed to use Vigileo techniques in order to compare the effects of different fluid loading strategies on CO fluctuation under a norepinephrine infusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We recruited 102 healthy term parturients scheduled for elective cesarean section under spinal anesthesia for this randomized double-blind study and divided them into two groups: the colloid preload followed by crystalloid coload group (500 ml each; Group 1, &lt;i&gt;n&lt;/i&gt; = 51), and the colloid and crystalloid coload group (500 ml each; Group 2, &lt;i&gt;n&lt;/i&gt; = 51). The infusion of norepinephrine was started after intrathecal injection. Vigileo was used to monitor invasive hemodynamic indices. Our primary outcome was standardized maternal cardiac output (CO) readings taken from spinal anesthesia until delivery. The secondary outcome measures were stroke volume (SV), systolic blood pressure (SBP), heart rate (HR), number of episodes of hypotension, hypertension, bradycardia, nausea/vomiting and total norepinephrine dose. Neonatal outcome was assessed by recording Apgar scores 1 and 5 min after delivery and by measuring umbilical arterial (UA) blood gases. Continuous hemodynamic monitoring was performed during the first 15 min after spinal anesthesia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Baseline CO, SV, and SBP were similar for both groups. Before spinal anesthesia, CO (6.84 ± 1.18 vs. 5.51 ± 0.96 L/min, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) was significantly higher in group 1 than group 2, but this increase was not sustained after spinal anesthesia (&lt;i&gt;P&lt;/i&gt; &gt; 0.05). SV (75.98 ± 13.01 vs. 66.37 ± 12.42 mL, &lt;i&gt;P&lt;/i&gt; &lt; 0.001) and SBP (124.84 ± 11.61 vs. 116.57 ± 7.57 mmHg, &lt;i&gt;P&lt;/i&gt; &lt; 0.001); followed a similar trend in the study. Only the largest percentage change in maternal HR (4.89 ± 11.89 vs. 10.38 ± 14.07, &lt;i&gt;P&lt;/i&gt; = 0.036) was significantly different between the two groups. There were no significant differences between the two groups in terms of the maximum CO, SV, SBP, or HR after spinal anesthesia (&lt;i&gt;P&lt;/i&gt; &gt; 0.05). The maternal side effects and neonatal outcomes, were similar in two groups (&lt;i&gt;P&lt;/i&gt; &gt; 0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In combination with prophylactic norepinephrine infusion, 500-mL colloid preloading and 500-mL crystalloid coloading can significantly increase CO before spinal anesthesia for cesarean sections and provide improved hemodynamic stability after spinal anesthesia, with no difference in maternal or neonatal outcomes as compared to colloid and crystalloid coloading.&lt;/p&gt;","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1421947"},"PeriodicalIF":3.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698092","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":"The association between high atherogenic index of plasma and impaired lung function: a population-based study.","authors":"Liang Yang, Yuanzhou Wu, Ling Chen, Zizhao Li, Wenfei Zhu, Ziyan Zhang, Hui Li, Yang Huang, Qunqing Chen","doi":"10.3389/fmed.2025.1589605","DOIUrl":"https://doi.org/10.3389/fmed.2025.1589605","url":null,"abstract":"<p><strong>Objective: </strong>Although AIP is a recognized cardiovascular risk marker, its association with pulmonary function and sex-specific differences remains unclear. This study investigated whether elevated AIP is independently associated with reduced lung function and examined potential sex-specific patterns.</p><p><strong>Methods: </strong>Data from 4,565 participants in the NHANES 2007-2012 dataset were analyzed using a cross-sectional design. AIP served as the exposure variable, with five lung function metrics (including FEV₁, FVC, and FEV₁/FVC ratio) as outcomes. Weighted multiple linear regression, threshold effect analysis, subgroup comparisons, and XGBoost modeling were performed to assess associations.</p><p><strong>Results: </strong>Multivariable regression showed a significant negative association between AIP and FEV₁ (β = -121.3 mL/unit, <i>p</i> < 0.001) and FVC (β = -147.1 mL/unit, <i>p</i> < 0.001), with no significant link to FEV₁/FVC ratio. Subgroup analysis revealed a U-shaped non-linear association in females, with inflection points at AIP values of 0.77 (FEV₁) and 0.78 (FVC), beyond which declines in lung function plateaued. Males exhibited a consistent negative correlation across all AIP levels.</p><p><strong>Conclusion: </strong>Elevated AIP is independently associated with reduced lung function, particularly non-linear effects in females. These findings support AIP as a potential adjunct marker for pulmonary function assessment in clinical practice.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1589605"},"PeriodicalIF":3.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698183","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":"Cardiovascular health score and its association with postoperative delirium: evidence from the Kailuan study.","authors":"Zhen-Hua Wang, Yu Jiang, Tao Fang, Jin-Qiu Li, Tai Wang, Chun-Yang Zhou, Rong Wang, Wen-Tao Cai, Hai Liu","doi":"10.3389/fmed.2025.1577424","DOIUrl":"https://doi.org/10.3389/fmed.2025.1577424","url":null,"abstract":"<p><strong>Background: </strong>Identifying modifiable risk factors for postoperative delirium (POD) is essential for prevention and management. The Ideal Cardiovascular Health Score (CHS), a composite measure of cardiovascular health, has been shown to reduce the risk of various chronic diseases. However, its association with POD has not been extensively explored. This study aims to examine the relationship between CHS and the risk of POD in a cohort of surgical patients.</p><p><strong>Methods: </strong>Data from the Kailuan Study, a large longitudinal cohort, were used for this analysis. A total of 1,082 participants aged 18-98 years, who underwent non-cardiac surgery under general anesthesia from 2016 to 2021, were included. The CHS was calculated based on seven cardiovascular health metrics: smoking status, body mass index (BMI), physical activity, diet, blood pressure, fasting blood glucose (FBG), and total cholesterol (TC). POD was diagnosed using the Confusion Assessment Method (CAM). Multivariable logistic regression was employed to assess the association between CHS scores and POD, adjusting for potential confounders.</p><p><strong>Results: </strong>Among the 1,082 participants, 120 developed POD. Higher CHS scores were inversely associated with the risk of POD. Participants with a CHS ≥ 10 had 55% lower odds of developing POD compared to those with a CHS ≤ 7 (OR = 0.45; 95% CI: 0.23-0.89). This protective effect was observed across various subgroups, including age, sex, and alcohol consumption status. Specific CHS components, such as normal blood pressure (OR = 0.49; 95% CI: 0.31-0.78) and FBG < 5.6 mmol/L (OR = 0.65; 95% CI: 0.47-0.94), were independently associated with reduced POD risk.</p><p><strong>Conclusion: </strong>A higher CHS score is associated with a lower risk of POD, highlighting the potential protective role of cardiovascular health in preventing postoperative complications.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1577424"},"PeriodicalIF":3.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698071","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":"CXCL16/CXCR6 axis arises as a potential peripheral biomarker of early COPD development - results from a pilot study.","authors":"Patrice Marques, Irene Bocigas, Elena Domingo, Vera Francisco, Julia Tarrasó, Laura Piqueras, Jaime Signes-Costa, Cruz González, Maria-Jesus Sanz","doi":"10.3389/fmed.2025.1636360","DOIUrl":"https://doi.org/10.3389/fmed.2025.1636360","url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) is mainly caused by long-term exposure to cigarette smoke. Since systemic inflammation is an important component of COPD pathophysiology, its characterization is essential for developing new biomarkers and pharmacological approaches. We have previously reported CXCL16/CXCR6 axis upregulation, a key element of leukocyte trafficking in COPD. Given the paucity of data on early-stage COPD patients (GOLD 1), we investigated CXCL16/CXCR6 axis expression in this population and in individuals at risk for developing COPD.</p><p><strong>Design: </strong>Blood samples were collected from 27 GOLD 1 patients, 27 symptomatic smokers with normal lung function (pre-COPD), and 14 non-smokers. CXCR6 expression was assessed in platelets, leukocytes, and leukocyte-platelet aggregates by flow cytometry. Plasma CXCL16 levels were measured by ELISA and lung function by spirometry.</p><p><strong>Results: </strong>CXCL16 plasma levels and CXCR6 expression on platelets, classical monocytes, B-cells, and leukocyte-platelet aggregates were higher in GOLD 1 patients than in non-smokers and pre-COPD subjects. While CXCR6 expression was similar between the pre-COPD group and non-smokers, plasma levels of CXCL16 were higher in the former. Finally, CXCL16/CXCR6 axis expression negatively correlated with FEV1/FVC ratio.</p><p><strong>Conclusion: </strong>This pilot study provides the first evidence that the CXCL16/CXCR6 axis is upregulated in early-COPD development. Increased CXCL16 plasma levels in GOLD 1 patients and pre-COPD subjects suggest CXCL16 as a potential peripheral biomarker of early COPD development. Given the importance of the CXCL16/CXCR6 axis in leukocyte trafficking, it may emerge as a druggable target to attenuate lung immune cell infiltration and prevent COPD development and progression.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1636360"},"PeriodicalIF":3.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698086","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":"Diagnostic value of dual-tracer PET/CT with [¹⁸F]FDG and PSMA ligands in prostate cancer: an updated systematic review.","authors":"Cesare Michele Iacovitti, Marco Cuzzocrea, Alessio Rizzo, Matteo Bauckneht, Roberto C Delgado Bolton, Gaetano Paone, Giorgio Treglia","doi":"10.3389/fmed.2025.1607227","DOIUrl":"https://doi.org/10.3389/fmed.2025.1607227","url":null,"abstract":"<p><strong>Background: </strong>Prostate-specific membrane antigen (PSMA) ligand PET/CT has significantly improved prostate cancer (PCa) imaging. However, in patients with poorly differentiated PCa or neuroendocrine transdifferentiation, [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG) PET/CT may provide additional diagnostic information. This systematic review evaluates the diagnostic value of combining [¹⁸F]FDG PET/CT with PSMA ligand PET/CT in PCa patients.</p><p><strong>Methods: </strong>A systematic literature search of studies assessing the added diagnostic value of dual-tracer [¹⁸F]FDG and PSMA ligands PET/CT in PCa patients was conducted using PubMed/MEDLINE and Cochrane Library databases and available information was summarized.</p><p><strong>Results: </strong>Fourteen studies (<i>n</i> = 901 patients) met the inclusion criteria. The dual-tracer approach identified [¹⁸F]FDG-positive/PSMA-negative (FDG+/PSMA-) lesions in a subset of patients, particularly those with Gleason Score (GS) ≥ 9. However, in patients with GS < 8, [¹⁸F]FDG PET/CT did not significantly improve lesion detection over PSMA ligand PET/CT alone.The presence of FDG+/PSMA- lesions correlated with aggressive tumor biology, increased risk of metastases, and worse prognosis.</p><p><strong>Conclusion: </strong>Literature data showed that [¹⁸F]FDG PET/CT may serve as a valuable complementary imaging modality for high risk PCa patients potentially influencing staging and treatment decisions. Future prospective studies are warranted to further elucidate the prognostic significance and cost-effectiveness of combining [¹⁸F]FDG PET/CT with PSMA ligand PET/CT in PCa patients.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1607227"},"PeriodicalIF":3.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698090","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":"Early dynamic changes in platelet counts and 28-day mortality in sepsis patients: a retrospective cohort study using dynamic latent class model and generalized additive mixture model analysis.","authors":"Yong Han, Jie Liu, Zhenhua Huang, Haofei Hu, Haiyan Yin","doi":"10.3389/fmed.2025.1596134","DOIUrl":"https://doi.org/10.3389/fmed.2025.1596134","url":null,"abstract":"<p><strong>Objective: </strong>This study investigates the relationship between early dynamic changes in platelet (PLT) counts and 28-day mortality in Chinese patients with sepsis, addressing the limitations of previous studies that focused on single baseline measurements.</p><p><strong>Methods: </strong>In this retrospective cohort study, 266 sepsis patients admitted to Shenzhen Second People's Hospital from January 2023 to December 2024 were included. A dynamic latent class model analyzed the patterns of PLT count changes during the first week of hospitalization. The Cox proportional hazards regression model assessed the link between these dynamic changes and 28-day mortality, supported by sensitivity and subgroup analyses for robustness. The GAMM model compared PLT change trajectories over 7 days between the mortality and survival groups.</p><p><strong>Results: </strong>After adjusting for various variables, participants with gradually increasing PLT counts (class 2), decreasing counts (class 3), and persistently low counts (class 4) had hazard ratios (HRs) for 28-day mortality of 1.687 (95% CI:0.380, 7.494), 3.710 (95% CI:1.124, 12.251), and 4.258 (95% CI:1.435, 12.636) respectively, compared to those with persistently high PLT counts (class 1). The GAMM model revealed that PLT counts for patients who died were significantly lower and had a downward trend, while the survival group's counts trended upward; the difference between the two groups generally exhibited an upward trend after admission, with a calculated average daily increase of 12.919 × 10⁹/L.</p><p><strong>Conclusion: </strong>Early dynamic changes in PLT counts (1-7 days) are independently associated with 28-day mortality in sepsis patients. Those with low and declining PLT counts are at a higher risk. By dynamically monitoring early changes in PLT may help identify high-risk patients and inform personalized treatment strategies, improving outcomes.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1596134"},"PeriodicalIF":3.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698091","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":"Enhancing clinical competency in infectious disease training: a longitudinal study of Mini-CEX implementation for medical interns.","authors":"Xiaohao Wang, Hu Li, Yi Liu, Dazhi Zhang, Dachuan Cai, Shan Zhong","doi":"10.3389/fmed.2025.1582218","DOIUrl":"https://doi.org/10.3389/fmed.2025.1582218","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the effectiveness of the Mini-Clinical Evaluation Exercise (Mini-CEX) in assessing and improving clinical competencies among medical interns during a 4-week infectious disease rotation.</p><p><strong>Methods: </strong>Forty-six medical interns were assessed using Mini-CEX at the start and end of their rotation. The tool evaluated seven domains: history taking, physical examination, clinical judgment, humanistic care, communication skills, organizational effectiveness, and overall competence. Teaching physicians were trained uniformly before the trial. After the internship, interns and teaching physicians completed questionnaires and interviews.</p><p><strong>Results: </strong>During the internship period when Mini-CEX was implemented, significant improvements were observed in interns' clinical skills across multiple domains. For example, the average scores of interns in history taking increased from 5.12 ± 0.89 to 6.22 ± 1.01, and in physical examination from 3.97 ± 0.69 to 5.24 ± 0.86. Interns showed high acceptance and satisfaction with Mini-CEX. The implementation of Mini-CEX also improved teaching effectiveness, with enhanced teacher-student interactions.</p><p><strong>Conclusion: </strong>Mini-CEX is a feasible and effective tool for clinical skill development in infectious disease training. Its structured feedback mechanism aligns with competency-based medical education (CBME) goals. Future studies should explore its scalability across disciplines and integration with complementary assessment tools.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1582218"},"PeriodicalIF":3.1,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12283664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698105","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}