Frontiers in Medicine最新文献

{"title":"Case Report: Adjunctive hemoadsorption therapy in a patient with Takotsubo cardiomyopathy and hyperinflammation.","authors":"Jose O Castro","doi":"10.3389/fmed.2025.1680632","DOIUrl":"https://doi.org/10.3389/fmed.2025.1680632","url":null,"abstract":"<p><strong>Introduction: </strong>Takotsubo cardiomyopathy (TCM) is a transient, stress-related cardiac dysfunction that mimics acute coronary syndrome and is typically seen in postmenopausal women. While emotional and physical stressors are common triggers, inflammatory or infectious stimuli have also been proposed, although the underlying mechanisms remain incompletely understood. In the context of critical illness, systemic inflammation may exacerbate cardiac dysfunction and contribute to multiorgan failure. Hemoadsorption has emerged as a promising adjunctive therapy option aimed at mitigating hyperinflammation by removing circulating cytokines and other inflammatory mediators, and has shown potential benefit in various inflammatory conditions.</p><p><strong>Case description: </strong>A 77-year-old woman with hypertension, diabetes, and a permanent pacemaker presented with acute dyspnea and subsequently experienced cardiac arrest. Post-resuscitation, she was found to have anterolateral ST elevations, apicomedial akinesis, and severely reduced LVEF (22%), consistent with Takotsubo cardiomyopathy. Despite appropriate antimicrobial therapy and supportive care, she developed worsening fever, marked hemodynamic instability, hyperlactatemia (14 mmol/L), atrial fibrillation, raising suspicion for a systemic hyperinflammatory response. Hemoadsorption therapy with CytoSorb was initiated in a stand-alone configuration, alongside corticosteroids and targeted temperature management. The patient showed marked improvement in hemodynamics, organ function, and urine output within 48 h, without the need for renal replacement therapy. She was later extubated and discharged home.</p><p><strong>Conclusion: </strong>This case highlights a rare presentation of suspected inflammation-triggered Takotsubo cardiomyopathy complicated by rapid clinical deterioration. The use of CytoSorb hemoadsorption was associated with stabilization of vital parameters and recovery of organ function. Although causality cannot be confirmed, this case supports the early consideration of hemoadsorption as a feasible and potentially beneficial adjunct in select critically ill patients with suspected hyperinflammation. Further research is needed to clarify its role in TCM and related syndromes.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1680632"},"PeriodicalIF":3.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250625","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":"Exclusion and inequity: a national analysis of disability-inclusive admission criteria in Saudi medical schools.","authors":"Anwar A Sayed","doi":"10.3389/fmed.2025.1667625","DOIUrl":"https://doi.org/10.3389/fmed.2025.1667625","url":null,"abstract":"<p><strong>Introduction: </strong>Equitable access to medical education is essential for building a diverse and inclusive healthcare workforce. Despite national disability legislation in Saudi Arabia, the extent to which undergraduate medical programs implement inclusive admission criteria remains unclear. This study evaluates the inclusiveness of admission policies for students with disabilities across all undergraduate MBBS programs in Saudi Arabia.</p><p><strong>Methods: </strong>A cross-sectional review of the official admission policies of 32 universities was conducted. Data were extracted from university websites to identify whether institutions provided inclusive pathways, accommodations for disability, or used exclusionary language or environmental/institutional barriers related to disability.</p><p><strong>Results: </strong>Only 6 of 32 universities-exclusively public institutions-had formal disability-inclusive policies. The remaining schools either lacked inclusive provisions, support structures or required medical fitness documentation that could exclude applicants with physical, sensory, or mental impairments. Private universities showed no evidence of inclusive admissions.</p><p><strong>Discussion: </strong>Most Saudi medical schools maintain exclusionary, ambiguous, or unsupportive admission practices, undermining national commitments to disability rights and global Sustainable Development Goals (SDGs 4 and 10). Urgent institutional reforms are needed to dismantle barriers and ensure transparency, equity, supportive environments, and accessibility for applicants with disabilities in health professions education.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1667625"},"PeriodicalIF":3.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250700","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 bilateral quadratus lumborum block with liposomal bupivacaine for post-cesarean analgesia: a protocol for an open-label randomized controlled trial.","authors":"Wenru Ma, Yinhuan Liu, Yan Li, Kongjuan Zhu, Youjia Yu, Yanting Wang","doi":"10.3389/fmed.2025.1654019","DOIUrl":"https://doi.org/10.3389/fmed.2025.1654019","url":null,"abstract":"<p><strong>Background: </strong>Effective postoperative pain management is essential for optimizing maternal comfort and recovery following cesarean delivery. However, achieving adequate analgesia remains a challenge due to suboptimal pain control and medication-related adverse effects. This study aims to evaluate the efficacy of bilateral quadratus lumborum block using liposomal bupivacaine for post-cesarean analgesia.</p><p><strong>Methods: </strong>This single-center, open-label, randomized controlled trial will enroll 201 adult parturients undergoing lower segment transverse cesarean section. Participants will be randomized in a 1:1:1 ratio into three groups (<i>n</i> = 67 each): Group LB will receive bilateral quadratus lumborum block with liposomal bupivacaine under ultrasound guidance. Group R-P will receive bilateral quadratus lumborum block with ropivacaine in combination with patient-controlled intravenous analgesia. Group P will receive standard patient-controlled intravenous analgesia without regional nerve block. The primary outcome is postoperative pain intensity, assessed using the Visual Analogue Scale during standardized movement at 12, 24, 48, and 72 h postoperatively. A generalized estimating equation model will be used to assess the overall effect of treatment group on pain scores over time. Secondary outcomes include patient-reported Quality of Recovery-15 scores at 24 and 48 h postoperatively; Visual Analogue Scale for pain at rest, measured at 12, 24, 48, and 72 h postoperatively; need for rescue analgesia; postoperative anxiety (assessed by Visual Analogue Scale at 72 h); subjective sleep quality; maximum walking duration; patient satisfaction with analgesia; incidence of nausea and vomiting; postoperative sufentanil consumption and length of hospital stay. Safety outcomes include allergic reactions, wound infection, lightheadedness, headache, circumoral numbness, tongue paresthesia, drowsiness, irritability, blood pressure fluctuations (hypotension, hypertension), respiratory depression (hypoventilation), and cardiac events (bradycardia, tachycardia, arrhythmia, cardiac arrest). Data will be analyzed using a modified intention-to-treat approach.</p><p><strong>Discussion: </strong>This study aims to provide high-quality evidence on the efficacy of bilateral single-injection quadratus lumborum block with liposomal bupivacaine, compared with standard intravenous analgesia alone and combined with quadratus lumborum block using ropivacaine.</p><p><strong>Ethics and dissemination: </strong>Ethics approval was obtained from the Ethics Committee of the Affiliated Hospital of Qingdao University (QYFYEC2024-297). All parturients will provide written informed consent. The results of this study will be published in a peer-reviewed journal.</p><p><strong>Clinical trial registration: </strong>Identifier ChiCTR2500095835.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1654019"},"PeriodicalIF":3.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250728","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":"Harmonizing health: a global analysis of pharmaceutical regulatory activities by international regulatory organizations.","authors":"Agnes Dangy-Caye, Alice Mousset, Adem Kermad, Louise Bouché-Bazerolle, Magda Bujar, Maria-Lucia De Lucia, Neil McAuslane, Rebecca Lumsden","doi":"10.3389/fmed.2025.1636269","DOIUrl":"https://doi.org/10.3389/fmed.2025.1636269","url":null,"abstract":"<p><strong>Introduction: </strong>This study demonstrates the role of six international organizations ICH, WHO, PIC/S, IPRP, ICMRA and IMDRF in shaping global health policies and advancing pharmaceutical progress. These six key organizations have been selected based on three criteria: focus on healthcare regulation, international scope, and no geographic restriction on membership. This analysis aimed to map the complementarity of these organizations' activities.</p><p><strong>Methods: </strong>For this purpose, a mapping of activities was performed, which identified 10 domains: clinical, convergence and reliance, digital, generics and biosimilars, innovative therapies, medical devices, non-clinical, pharmacovigilance, public health, and quality. Five main types of outputs were also identified: collaborative work, guidance, information, standards and norms, and training.</p><p><strong>Results: </strong>Key takeaways show that the most active domains among international regulatory organizations are quality, public health, convergence and reliance, and pharmacovigilance. But emerging priorities, such as digital health and innovative therapies, are also captured, demonstrating the regulatory framework is constantly evolving. A focus on one of the domains has been made, convergence and reliance, to demonstrate the impact to be part in one of these international organizations: a detailed analysis showcases the advantages of ICH membership, especially its positive impact on reducing submission lag times for new active substances in member countries. Collaboration between international organizations strengthens global regulatory systems. Our study evaluated the interaction between regional and international memberships. Participation in regional organizations correlated with membership in international organizations, suggesting these memberships facilitate involvement in global regulatory framework activities. Global harmonization of technical standards across regulatory frameworks is extremely challenging. Therefore, additionally a comparison was made between ICH members and non-members to observe any influence of ICH on broader multinational engagement. ICH member countries were found to be more active participants in the international regulatory organizations compared to non-member countries.</p><p><strong>Discussion: </strong>This research highlights the critical role of international regulatory organizations in harmonizing global regulatory frameworks and fostering pharmaceutical innovation. Their collaborative efforts and synergies contribute to a robust and cohesive regulatory landscape, ultimately benefiting patients worldwide. By promoting cooperation and knowledge sharing, these organizations ensure the safety, efficacy, and quality of medicines and healthcare products on a global scale.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1636269"},"PeriodicalIF":3.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250709","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":"Application analysis of Six Sigma DMAIC model in new nurse training and effects of nutritional diet nursing on postoperative nutritional status in the elderly patients with fracture.","authors":"Fangfang Xiong, Jiao Tang, Han Han, Xue Wang, Jing Cao, Xianglei Wang, Qinghua Zhao","doi":"10.3389/fmed.2025.1657619","DOIUrl":"https://doi.org/10.3389/fmed.2025.1657619","url":null,"abstract":"<p><strong>Background: </strong>In the current medical system, the insufficient efficiency of the standardized training for new nurses is a major issue. At the same time, elderly patients with fractures are prone to nutritional deficiencies after surgery, which seriously affects their rehabilitation process and treatment outcomes.</p><p><strong>Objectives: </strong>This study evaluated the application of the Six Sigma DMAIC model in the training of new nurses, as well as the impact of nutritional diet nursing on the postoperative nutritional status in the elderly patients with fractures.</p><p><strong>Methods: </strong>This was a prospective intervention study. From September 2021 to September 2022, 260 newly recruited female nurses were randomly divided into the study group and the control group using a random number table method. The control group received traditional training management model, while the study group received training using the Six Sigma DMAIC model. In addition, from November 2022 to November 2023, a total of 80 elderly patients with fractures received treatment were divided into two groups: one group received conventional nursing, and the other group received nutritional diet nursing.</p><p><strong>Results: </strong>Two years later, the study group outperformed the control group in terms of theoretical and practical assessment scores, critical thinking ability, self-efficacy, and training satisfaction, with significant difference (<i>p</i> < 0.05). Compared to the conventional nursing group, the nutritional diet nursing group had shorter incision drying time, shorter drainage placement time, and shorter healing time, with significant difference (<i>p</i> < 0.01). After nursing, the levels of albumin, prealbumin, total protein, and immunoglobulins were higher in the intervention group compared to the routine nursing group, with significant difference (<i>p</i> < 0.05). Compared to the routine nursing group, the intervention group also had a lower incidence of complications, with significant difference (<i>p</i> < 0.05 and <i>p</i> = 0.03).</p><p><strong>Conclusion: </strong>The Six Sigma DMAIC model effectively improves the quality of nurse training, while nutritional diet nursing enhances postoperative healing, nutritional status, and immune function in elderly fracture patients.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1657619"},"PeriodicalIF":3.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250684","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":"Interocular symmetry and asymmetry in ocular health and disease.","authors":"Hongli Cui, Zhengwei Zhang","doi":"10.3389/fmed.2025.1626329","DOIUrl":"https://doi.org/10.3389/fmed.2025.1626329","url":null,"abstract":"<p><p>In various ocular tissues, the presence of symmetry and asymmetry not only influences physiological functions but also demonstrates significant correlations with the pathogenesis and progression of multiple ophthalmic disorders. Under healthy conditions, ocular structures typically maintain a high degree of bilateral symmetry, ensuring stability and efficacy in visual perception. However, subtle interocular asymmetries may emerge due to factors including aging and environmental exposures, providing critical biological insights into visual functionality and ocular health maintenance. Under pathological circumstances, specific structural asymmetries often serve as early indicators of disease progression. Quantitative analysis of multilayer structural alterations using advanced ophthalmic imaging modalities offers valuable reference data for early disease detection and therapeutic interventions. A comprehensive investigation of ocular symmetry and asymmetry facilitates precise characterization of normative ocular architecture, thereby establishing a theoretical foundation for elucidating disease mechanisms and developing early diagnostic strategies. This multidimensional approach enhances our understanding of ocular pathophysiology and informs evidence-based clinical decision-making.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1626329"},"PeriodicalIF":3.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250752","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":"Identification of shared biomarkers and potential therapeutic targets for antiphospholipid syndrome and recurrent miscarriage by integrated bioinformatics analysis and machine learning.","authors":"Su Zhang, Yifang Zhang, Jing Xu, Weitao Hu, Xiaolan Huang, Xiaoqing Chen","doi":"10.3389/fmed.2025.1639277","DOIUrl":"https://doi.org/10.3389/fmed.2025.1639277","url":null,"abstract":"<p><strong>Background: </strong>Antiphospholipid syndrome (APS) is a group of clinical syndromes of thrombosis or adverse pregnancy outcomes caused by antiphospholipid antibodies that can increase the probability of miscarriage occurring in pregnant women. However, the mechanism of recurrent miscarriage (RM) induced by APS is not fully understood. The aim of this study was searching for potential shared genes in RM and APS.</p><p><strong>Methods: </strong>We downloaded the APS and RM datasets from the GEO database and conducted differential expression analysis to obtain differentially expressed genes (DEGs). Their common DEGs were then identified. Functional enrichment analyses were performed on the common DEGs, follow by the construction of protein-protein interaction (PPI) networks. Next, machine learning was utilized to screen for their common key genes. Receiver operating characteristic curves (ROC) were applied to assess the diagnostic value of key genes. In addition, we performed immune infiltration analysis to understand the changes in their immune microenvironment. Subsequently, the Drug Gene Interaction Database (DGIdb) was searched for potential therapeutic drugs. Finally, the expression of key genes was verified by clinical samples.</p><p><strong>Results: </strong>We identified a total of 52 common DEGs. Functional enrichment analyses indicated that neutrophil extracellular trap formation, cellular and molecular imbalances in the immune system may be a common mechanism in the pathophysiology of APS and RM. Machine learning identified <i>CCR1</i>, <i>MNDA</i>, <i>S100A8</i> and <i>CXCR2</i> as common key genes. The key genes were highly expressed in both APS and RM. In addition, we utilized the Drug Gene Interaction Database (DGIdb) to screen for potential therapeutic drugs targeting the key genes. Finally, we validated the expression of key genes by immunohistochemical staining and RT-qPCR.</p><p><strong>Conclusion: </strong><i>CCR1</i>, <i>MNDA</i>, <i>S100A8</i> and <i>CXCR2</i> are shared biomarkers between RM and APS. Meanwhile, our study further elucidated the biological mechanism between APS and RM.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1639277"},"PeriodicalIF":3.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250703","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 encapsulated fecal microbiota transplantation and FMT via rectal enema for irritable bowel syndrome: a double-blind, randomized, placebo-controlled trial (CAP-ENEMA FMT Trial).","authors":"Natsuda Aumpan, Soonthorn Chonprasertsuk, Bubpha Pornthisarn, Sith Siramolpiwat, Patommatat Bhanthumkomol, Navapan Issariyakulkarn, Pornpen Gamnarai, Phubordee Bongkotvirawan, Arti Wongcha-Um, Varocha Mahachai, Ratha-Korn Vilaichone","doi":"10.3389/fmed.2025.1648944","DOIUrl":"https://doi.org/10.3389/fmed.2025.1648944","url":null,"abstract":"<p><strong>Introduction: </strong>Irritable bowel syndrome (IBS) is a functional bowel disorder. Gut dysbiosis involves in pathogenesis of IBS. Limited studies compared efficacy of fecal microbiota transplantation (FMT) via different routes of administration. This study aimed to compare efficacy of encapsulated FMT, FMT via rectal enema, and placebo in IBS patients.</p><p><strong>Methods: </strong>In this double-blind, randomized, placebo-controlled study, we enrolled patients aged 18-70 years with IBS defined by Rome IV criteria at Thammasat university, Thailand. Patients were randomized into three groups: (1) encapsulated FMT (six capsules twice daily for two consecutive days, total 50 g of stool), (2) FMT via rectal enema (50 g of stool in 200 mL of isotonic saline), or (3) placebo. Primary endpoint was clinical response defined by ≥50-point decrease in IBS-symptom severity score (IBS-SSS) at 4 weeks. Secondary outcomes were quality of life and changes of fecal microbiota composition after treatment. The study was registered with ClinicalTrials.gov, number NCT06201182.</p><p><strong>Results: </strong>From August 20, 2020, to February 15, 2024, 45 patients were randomized to receive encapsulated FMT (<i>n</i> = 15), FMT via rectal enema (<i>n</i> = 15), or placebo (<i>n</i> = 15). There was no difference in patient characteristics and baseline IBS-SSS between groups. Encapsulated FMT provided significantly improved IBS-SSS (166.7 ± 73.7 vs. 269.3 ± 69.5, <i>p</i> = 0.001), clinical response (86.7 vs. 26.7%, <i>p</i> = 0.001), and quality of life (31.7 ± 4.8 vs. 25.1 ± 5.2, <i>p</i> < 0.001) at 4 weeks compared with placebo. FMT via rectal enema demonstrated better IBS-SSS (168.7 ± 101.9 vs. 269.3 ± 69.5, <i>p</i> = 0.004), clinical response (73.3 vs. 26.7%, <i>p</i> = 0.011), and quality of life (30.2 ± 5.0 vs. 21.0 ± 7.4, <i>p</i> < 0.001) than placebo. Clinical response and quality of life between encapsulated FMT and FMT via rectal enema were not different. No serious adverse event was observed. Minor adverse events such as bloating and diarrhea were not different between all groups.</p><p><strong>Conclusions: </strong>Higher clinical response and quality of life were demonstrated in both FMT groups than placebo. Either encapsulated FMT or FMT via rectal enema was safe and could provide favorable outcomes for IBS patients.</p><p><strong>Clinical trial registration: </strong>https://clinicaltrials.gov/study/NCT06201182, Identifier: NCT06201182.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1648944"},"PeriodicalIF":3.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250759","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 acute gastrointestinal injury and mortality in elderly patients with gram-positive bacterial bloodstream infection in the intensive care unit: a retrospective 7-year study from a research hospital in China.","authors":"Yuanqi Liang, Chulong Ma, Tingting Ma, Fan Lin, Tailin Guo","doi":"10.3389/fmed.2025.1634980","DOIUrl":"https://doi.org/10.3389/fmed.2025.1634980","url":null,"abstract":"<p><strong>Background: </strong>Gram-positive bacterial bloodstream infections (GPB-BSI) are associated with high mortality in elderly ICU patients, yet prognostic factors remain understudied. Acute gastrointestinal injury (AGI), a common complication in critical illness, may exacerbate outcomes through gut-organ crosstalk. This study investigates the prognostic impact of AGI severity on 30-day mortality in elderly ICU patients with GPB-BSI.</p><p><strong>Methods: </strong>A single-center retrospective cohort study analyzed 117 ICU patients aged ≥60 years with culture-confirmed GPB-BSI (2018-2024). Data on demographics, microbiology, comorbidities, organ dysfunction, and antimicrobial therapy were collected. Multivariable Cox regression and ROC analyses assessed associations between AGI, clinical variables, and mortality.</p><p><strong>Results: </strong>The 30-day mortality rate was 50.4% (59/117). AGI severity independently predicted mortality: Grades I-II (aHR = 2.80, 95% CI = 1.05 ~ 7.46) and Grades III-IV (aHR = 6.89, 95%CI = 2.34 ~ 20.29). A combined SOFA-AGI score improved prognostic accuracy compared to SOFA score(AUC = 0.749 vs 0.729). Coagulase-negative staphylococci (60.3%) dominated isolates, predominantly hospital-acquired (79.4%) and catheter-related (47.0%). High resistance to penicillins (92.1%), fluoroquinolones (79.4%), and macrolides (77.0%) contrasted with retained susceptibility to linezolid (96.8%), tigecycline (92.9%), and vancomycin (94.4%).</p><p><strong>Conclusion: </strong>AGI severity is an independent predictor of mortality in elderly GPB-BSI patients. The diagnostic accuracy for mortality improves when gastrointestinal dysfunction assessment is incorporated into the SOFA score. These findings underscore the critical need for enhanced clinical attention to gastrointestinal function protection in geriatric critical ill patients.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1634980"},"PeriodicalIF":3.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250714","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":"Assessment of knowledge, attitudes, practices, and self-efficacy toward evidence-based medicine among resident physicians: a cross-sectional study from Qatar.","authors":"Wafa Mohammed Ahmed, Mohamed Aabdien, Abdelaziz Mohamed, Mohamed Iheb Bougmiza","doi":"10.3389/fmed.2025.1651632","DOIUrl":"https://doi.org/10.3389/fmed.2025.1651632","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence-based medicine (EBM) is essential for delivering high-quality healthcare. However, no studies have yet assessed the practice of evidence-based medicine among resident doctors in Qatar. This study aimed to examine the key factors influencing EBM practice, focusing on the physicians' self-efficacy, self-reported knowledge, and their attitudes toward EBM.</p><p><strong>Methodology: </strong>An analytical cross-sectional study design was used, using a total population sampling method. Data were gathered through a validated questionnaire to assess EBM practices among resident physicians at HMC. Descriptive statistics, bivariate analysis, and multivariate analysis were used to analyze the data.</p><p><strong>Results: </strong>A total of 355 resident physicians participated in the survey. The average age of the participants was 28.3 years. The overall EBM practice score averaged 38, indicating a moderate level of practice according to the Bloom scale. Significant associations were found between EBM practice and physician age, gender, work experience, and prior EBM training. The majority of participants demonstrated moderate knowledge of EBM but had low attitudes toward its application. Additionally, the resident physicians exhibited low self-efficacy in applying EBM.</p><p><strong>Conclusion: </strong>While the work environment in Qatar is highly supportive of EBM practice and the resident physicians possess strong academic qualifications, their overall practice of EBM remains moderate. This could be attributed to their relatively young age, limited experience, and unfavorable attitudes toward EBM, along with low self-efficacy. There is a need for targeted training workshops to improve EBM skills and attitudes among resident physicians, which could enhance their practice and, ultimately, improve patient outcomes in Qatar.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1651632"},"PeriodicalIF":3.1,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250612","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}