Frontiers in Medicine最新文献

{"title":"Possible association of pyogenic liver abscess with an inflamed sigmoid colonic lipoma: a case report and literature review.","authors":"Khaireddine Dhouioui, Mohamed Abu Awad, Mohamed Hedi Mraidha, Soumaya Mrabet, Dorra Chiba, Raida Harbi, Elhem Ben Jazia, Moncef Mokni, Sabri Youssef","doi":"10.3389/fmed.2026.1957072","DOIUrl":"10.3389/fmed.2026.1957072","url":null,"abstract":"<p><strong>Background: </strong>Pyogenic liver abscess (PLA) is a severe infectious condition that is often associated with an identifiable biliary or gastrointestinal source. Benign colonic lesions are rarely considered during the etiological evaluation of PLA.</p><p><strong>Case presentation: </strong>We report the case of a 47-year-old man admitted with febrile diarrhea. Contrast-enhanced computed tomography (CT) demonstrated confluent hepatic abscesses involving segments II, III, and IV, measuring 10 cm × 9 cm × 7 cm, without a CT-detectable biliary source. The etiological investigation identified an approximately 2 cm inflammatory sigmoid lesion that was initially considered suspicious for malignancy. Laparoscopic oncologic segmental low sigmoid colectomy was performed because malignancy could not be confidently excluded based on superficial endoscopic biopsies. Histopathological examination confirmed a 1.2 cm submucosal lipoma composed of mature univacuolar adipocytes without cytologic atypia, necrosis, or abscess formation. The colonic wall directly opposite the lipoma showed acute neutrophil-rich inflammation extending from the mesocolic/subserosal tissues through the muscularis propria, together with focal superficial epithelial abrasion/erosion of the overlying mucosa and exposure of the lamina propria. Deep or transmural mucosal ulceration, ischemic necrosis, intramural abscess, microorganisms, perforation, and diverticular disease were not demonstrated in the available histopathological sections. Blood cultures were negative. Culture of the hepatic abscess aspirate isolated <i>Klebsiella pneumoniae.</i> The colonic lesion itself was not cultured, and no microbiological or molecular comparison with the hepatic isolate was performed. No phenotypic or molecular testing for a hypervirulent <i>K. pneumoniae</i> phenotype was conducted.</p><p><strong>Conclusion: </strong>This case describes a possible association between PLA and an inflamed sigmoid submucosal lipoma with focal superficial epithelial abrasion/erosion. A causal relationship cannot be established from the available evidence. The clinical implication is that colonic evaluation, including colonoscopy when clinically appropriate, may be considered in otherwise unexplained PLA, particularly when no biliary or other common source is identified. This single case does not establish small colonic lipomas as infectious sources of PLA.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1957072"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215477","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 internal validation of a nomogram for estimating concurrent superficial vein thrombosis at presentation in patients with lower extremity varicose veins.","authors":"Lei Jiao, Zhen Zhou, Hongsheng Yin","doi":"10.3389/fmed.2026.1889714","DOIUrl":"10.3389/fmed.2026.1889714","url":null,"abstract":"<p><strong>Background: </strong>Superficial vein thrombosis (SVT) is a clinically relevant complication of lower extremity varicose veins. This study aimed to develop and internally validate a parsimonious nomogram for estimating the probability of concurrent SVT at presentation.</p><p><strong>Methods: </strong>This single-center retrospective study included 423 patients with lower extremity varicose veins, including 91 with SVT. Twenty-four candidate variables were evaluated using LASSO regression, the Boruta algorithm, and a genetic algorithm for feature selection. Variables retained by all three methods were entered into multivariable logistic regression to construct the full model, and a reduced model excluding fibrinogen (FIB) was assessed for parsimony. Model performance was compared with the Caprini score and internally validated using 1,000 bootstrap resamples.</p><p><strong>Results: </strong>Age, interleukin-6, C-reactive protein, D-dimer, and FIB were identified as consensus-selected variables. The full model had an AUC of 0.844 (95% CI, 0.797-0.891). Removing FIB produced minimal changes in discrimination (<i>Δ</i>AUC = 0.007; 95% CI, -0.004 to 0.017; <i>P</i> = 0.224), calibration, Brier score, or decision curves. The four-variable model was therefore selected for nomogram presentation. Its AUC was 0.837 (95% CI, 0.790-0.884), compared with 0.722 (95% CI, 0.663-0.782) for the Caprini score (<i>Δ</i>AUC = 0.115; 95% CI, 0.040-0.190; <i>P</i> = 0.003). The optimism-corrected AUC was 0.837. Adding the Caprini score to the full model numerically increased the AUC from 0.844 to 0.871 (<i>Δ</i>AUC = 0.027; 95% CI, 0.000-0.055; <i>P</i> = 0.054).</p><p><strong>Conclusion: </strong>A nomogram based on age, interleukin-6, C-reactive protein, and D-dimer showed good internally validated performance for estimating the probability of concurrent SVT at presentation. Because validation was limited to bootstrap resampling within a single-center cohort, independent external validation is required before clinical application.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1889714"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215610","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":"Assessing early therapeutic response in extrapulmonary tuberculosis using [18F]FDG-PET/CT imaging.","authors":"Dev Kartan, Ziba Ahangarani Farahani, Søren Hess, Rikke Søndergaard, Oke Gerke, Isik Somuncu Johansen","doi":"10.3389/fmed.2026.1908921","DOIUrl":"10.3389/fmed.2026.1908921","url":null,"abstract":"<p><strong>Introduction: </strong>Monitoring treatment response in extrapulmonary tuberculosis (EPTB) remains challenging due to limited microbiological accessibility and the lack of validated biomarkers. [18F]FDG positron emission tomography/computed tomography [(18F)FDG-PET/CT] enables assessment of metabolic disease activity and has been explored in infectious diseases, but evidence supporting its use in EPTB is limited.</p><p><strong>Methods: </strong>We conducted a prospective observational study including adults diagnosed with EPTB at a tertiary referral center in Denmark between 2016 and 2018. Participants underwent baseline and follow-up [18F]FDG-PET/CT imaging after completion of the intensive treatment phase. Clinical data and laboratory parameters, including C-reactive protein (CRP), hemoglobin, leukocytes, albumin, and alanine aminotransferase were collected at baseline and during follow-up. Changes in standardized uptake values (SUVmax) and laboratory markers were analyzed descriptively.</p><p><strong>Results: </strong>Seventeen patients were included. Metabolically active disease was detected in all participants at baseline. Most patients (11 out of 14) demonstrated a reduction in lesion number and SUVmax at follow-up, indicating a metabolic response to therapy. However, persistent [18F]FDG uptake was observed in a subset of patients (3 out of 14). Median CRP levels declined from 12 mg/L (range: 0.3-190) at baseline to 3.6 mg/L (range: 0.9-20) at week 8 and remained low thereafter, broadly paralleling PET/CT findings. In several cases, residual metabolic activity did not result in treatment prolongation.</p><p><strong>Discussion: </strong>Serial [18F]FDG-PET/CT demonstrated changes in metabolic activity during treatment with reductions in lesion number and SUVmax in most patients. However, SUVmax reflects focal metabolic activity rather than total disease burden, and persistent uptake after the intensive treatment phase was observed in some patients. Larger prospective studies incorporating standardized response criteria and volumetric PET measures are needed before [18F]FDG-PET/CT can be implemented as a routine biomarker for treatment response in EPTB.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1908921"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215683","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":"Acupuncture combined with transcutaneous auricular vagus nerve stimulation for chronic postpartum insomnia comorbid with emotional disorders: a case report.","authors":"Qin Lyu, Re-Yi-Han-Gu-Li Ju-Lai-Ti, Shu-Min Wang, Miao-Miao Jing, Yi-Fei Li, E Zhou, Tian-Yu Bai","doi":"10.3389/fmed.2026.1918028","DOIUrl":"10.3389/fmed.2026.1918028","url":null,"abstract":"<p><p>Postpartum women constitute a vulnerable population in whom insomnia comorbid with emotional disorders such as anxiety and depression is disproportionately prevalent, attributable to hormonal fluctuations, environmental changes, and social role transitions. This comorbidity significantly increases their long-term risk of mental health disorders. Given the safety concerns of sedative-hypnotic medications, non-pharmacological therapies are the first-line treatment for this population. We report the case of a 34-year-old woman with chronic postpartum insomnia comorbid with emotional disorders, who provided written informed consent for the publication of her de-identified clinical data and received 4 weeks of combined acupuncture and transcutaneous auricular vagus nerve stimulation (taVNS) treatment. Clinical assessments were performed at baseline, week 2, week 4 (end of treatment), and week 8 (4-week post-treatment follow-up) using validated scales including the PSQI, ISI, and HAMA, among others. After 4 weeks of treatment, the patient demonstrated significant improvements in objective sleep quality and anxiety symptoms, while subjective insomnia perception and depressive symptoms remained partially unresolved. Notably, all clinical outcomes continued to improve to near-normal levels during the follow-up period without any additional intervention, and no adverse events were recorded. This case demonstrates that combined acupuncture and taVNS is a safe and effective intervention for chronic postpartum insomnia comorbid with emotional disorders, with a favorable sustained therapeutic effect after treatment cessation, offering a valuable alternative for non-pharmacological management in this population.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1918028"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215722","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":"Still teaching 1948: the unfinished decolonization of Nigerian medical education.","authors":"Iveren Winifred Nyinoh, Ogo Agbor Ogo","doi":"10.3389/fmed.2026.1914199","DOIUrl":"10.3389/fmed.2026.1914199","url":null,"abstract":"<p><strong>Background: </strong>Despite growing global momentum to decolonize health professions education, Nigerian medical education remains underrepresented in mainstream decolonization scholarship.</p><p><strong>Approach: </strong>This is a narrative, interpretive perspective informed by selected Nigerian medical education literature and the authors' professional experience, rather than a systematic, scoping, or integrative review. It examines why the visibility gap exists, what it obscures, and traces the field's evolution from its colonial curriculum origin to current reform efforts.</p><p><strong>Key arguments: </strong>We argue that this limited visibility does not reflect an absence of reform, but a disconnect between locally driven educational innovations and terminology through which decolonization is recognized globally. Reforms are framed through alternative nomenclatures, such as community-based medical education, leaving them less legible. Nigerian medical education remains shaped by colonial legacies reflected in the 1948 University of London curriculum, Eurocentric biomedical dominance, Northern hegemony in knowledge production, publication inequalities, physician brain drain linked to neo-colonial dynamics of professional training, and chronic institutional underinvestment. At the same time, the Core Curriculum and Minimum Academic Standards signal a shifting landscape in curriculum reform.</p><p><strong>Implications: </strong>These challenges are structural and epistemological rather than merely curricular. Realizing emerging possibilities requires coordinated action from students, institutions, researchers, funders, regulators, and policy makers to move beyond symbolic diversification towards transformation that re-centers Nigerian and African perspectives in defining educational priorities. As a narrative perspective rather than a systematic evidence synthesis, the claims advanced here are best read as conceptual and hypothesis-generating and are not intended as an exhaustive account of the evidence base.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1914199"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215589","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":"Associations of systemic inflammatory indices with rheumatoid arthritis and all-cause mortality: a NHANES study with independent hospital-based replication.","authors":"Lin Wang, Hao Yu, Yuanyuan Cao, Li Yu","doi":"10.3389/fmed.2026.1968785","DOIUrl":"10.3389/fmed.2026.1968785","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease associated with substantial morbidity and increased mortality. Although several composite inflammatory indices have been proposed as accessible biomarkers, their associations with RA and long-term prognosis remain incompletely understood.</p><p><strong>Methods: </strong>We analyzed 15,545 adults from five NHANES cycles (2001-2010), including 1,075 participants with self-reported RA. Survey-weighted multivariable logistic regression was used to assess associations between inflammatory indices and prevalent RA. Among participants with RA, survey-weighted Kaplan-Meier and Cox regression analyses were used to evaluate all-cause mortality. Restricted cubic spline analyses examined potential nonlinear associations. An independent retrospective hospital-based cohort was used to assess the directional consistency of key RA-related associations.</p><p><strong>Results: </strong>Among 15,545 participants, 1,075 had self-reported RA. In the fully adjusted models, participants in the highest RAR quartile had greater odds of prevalent self-reported RA than those in the lowest quartile (OR, 1.86; 95% CI, 1.33-2.60), whereas higher CALLY was inversely associated with RA (Q4 vs. Q1: OR, 0.58; 95% CI, 0.43-0.78); both associations remained significant after FDR correction. Among participants with self-reported RA, higher RAR was associated with a greater hazard of all-cause mortality (Q4 vs. Q1: HR, 2.48; 95% CI, 1.62-3.77), whereas higher CALLY was associated with a lower mortality hazard (Q4 vs. Q1: HR, 0.44; 95% CI, 0.31-0.61), with both associations remaining significant after FDR correction. Restricted cubic spline analyses suggested nonlinear associations for several inflammatory indices. In the independent hospital-based cohort, several key RA-related inflammatory indices showed directionally consistent associations, supporting the reproducibility of the principal RA-related findings.</p><p><strong>Conclusion: </strong>RAR and CALLY showed the most consistent associations with both prevalent RA and all-cause mortality. These accessible inflammatory indices may warrant further evaluation as markers of systemic inflammatory and nutritional status in RA, but prospective validation is needed before clinical application.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1968785"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215781","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":"Editorial: Real world-evidence in radioligand therapy: above and beyond a tongue twister.","authors":"Ilaria Grassi, Chiara Maria Grana, Maddalena Sansovini","doi":"10.3389/fmed.2026.2002519","DOIUrl":"https://doi.org/10.3389/fmed.2026.2002519","url":null,"abstract":"","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"2002519"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215658","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":"Intracranial metastasis following intrahepatic remission in primary hepatic small cell neuroendocrine carcinoma: a case report.","authors":"Jing Cui, Yukai Gao","doi":"10.3389/fmed.2026.1928042","DOIUrl":"10.3389/fmed.2026.1928042","url":null,"abstract":"<p><strong>Background: </strong>Hepatogenic small cell neuroendocrine carcinoma (HP-SCNEC) is a highly aggressive rare malignancy, with central nervous system (CNS) metastasis being a major cause of treatment failure. This case report describes a patient with extensively metastatic HP-SCNEC, aiming to explore the clinical features of rapid brain metastasis following complete remission of intrahepatic lesions, as well as corresponding multidisciplinary treatment strategies.</p><p><strong>Method: </strong>A retrospective analysis of the diagnostic and therapeutic process in a 60-year-old female patient with HP-SCNEC. At initial presentation, the patient exhibited multiple intrahepatic metastases, abdominal lymph node involvement, and adrenal metastases. First-line therapy comprised the programmed death receptor-1 (PD-1) inhibitor sintilimab combined with etoposide and cisplatin. Following disease progression, whole-brain radiotherapy was administered for newly identified brain metastases, concurrently with systemic treatment adjustment to albumin-bound paclitaxel combined with anlotinib.</p><p><strong>Results: </strong>Following 6 cycles of immunotherapy combined with chemotherapy and 2 cycles of immunotherapy combined with anti-angiogenic therapy, the patient achieved radiographic complete remission of hepatic lesions. However, merely 16 days after achieving this remission, the patient presented with new-onset neurological symptoms, and subsequent imaging confirmed multiple new brain metastases. After undergoing whole-brain radiotherapy combined with an adjusted systemic treatment regimen, intracranial lesions were effectively controlled. The patient remained stable during subsequent maintenance therapy with Anlotinib.</p><p><strong>Conclusion: </strong>This case demonstrates that even when HP-SCNEC abdominal lesions achieve deep remission through intensified immunotherapy combined with chemotherapy, patients remain at extremely high risk for early brain metastases, highlighting the \"intracranial sanctuary\" effect caused by the blood-brain barrier. For such patients, prevention and monitoring of central nervous system metastases must be prioritized during initial treatment. Following brain metastasis, a multimodal comprehensive strategy centered on radiotherapy combined with intracranial active drugs should be adopted. This case provides important reference for the comprehensive management of this rare malignant tumor.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1928042"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Melanocyte-associated mTORC1-related molecular features in an atypical large congenital melanocytic naevus.","authors":"Ruize Tang, Jing Yang, Xingran Liu, Ru-Lin Huang","doi":"10.3389/fmed.2026.1962371","DOIUrl":"10.3389/fmed.2026.1962371","url":null,"abstract":"<p><p>Congenital melanocytic naevi (CMN) are usually associated with activating alterations in <i>NRAS</i> or <i>BRAF</i>, but some extensive lesions lack detectable canonical hotspot variants. We report a 9-year-old boy with a large craniofacial CMN involving the face, scalp, upper eyelid and bulbar conjunctiva, with deep extension, mechanical ptosis and secondary amblyopia. Histology showed benign dermal melanocytic proliferation, and magnetic resonance imaging showed no neurocutaneous melanosis. High-depth whole-exome sequencing detected no canonical <i>NRAS</i> or <i>BRAF</i> hotspot variant at or above the prespecified reporting threshold. A maternally inherited <i>TSC2</i> c.1307C>T (p.Pro436Leu) variant was classified as a variant of uncertain significance. Multiplex immunofluorescence showed greater <i>p</i>-S6 positivity among SOX10-positive cells in lesional tissue than in marginal normal skin. Single-cell RNA sequencing showed cell-type-specific variation in mechanistic target of rapamycin complex 1 (mTORC1) scores within the lesion; naevus cells had higher scores than fibroblasts and pericytes but not endothelial or hair follicle cells. These single-patient findings provide descriptive evidence of lesion-associated mTORC1-related molecular features and support pathway-level profiling in atypical CMN, without establishing disease-specific mTORC1 hyperactivation or causality for the <i>TSC2</i> variant.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1962371"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215284","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":"Tip perfusion index for monitoring perioperative stress responses in patients undergoing laparoscopic cholecystectomy: a prospective cohort study.","authors":"Xiaolin Wang, Jingjing Zhang, Sufang Jiang, Jiaojiao Yang, Ya Liu","doi":"10.3389/fmed.2026.1921275","DOIUrl":"10.3389/fmed.2026.1921275","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to characterize peri-stimulus changes in the Tip Perfusion Index (TPI) and conventional hemodynamic parameters during elective laparoscopic cholecystectomy and to compare their response dynamics among patients without major comorbidities, patients with hypertension, and patients with type 2 diabetes mellitus.</p><p><strong>Methods: </strong>Ninety patients undergoing elective laparoscopic cholecystectomy were prospectively enrolled and classified as Control, Hypertension, or Diabetes (<i>n</i> = 30 each). TPI, BP, and HR were recorded at six perioperative time points (T0-T5) under standardized general anesthesia and CO2 pneumoperitoneum. In a randomly selected subcohort (<i>n</i> = 5 per group), plasma E, NE, and COR were measured from T0 to T4. Data were analyzed using Chi-square tests, one-way ANOVA, mixed-design repeated-measures ANOVA, and repeated-measures correlation.</p><p><strong>Results: </strong>Demographic and baseline parameters were comparable among the three groups (<i>P</i> > 0.05). Following endotracheal intubation and pneumoperitoneum, TPI decreased from the corresponding pre-stimulus values, whereas blood pressure and heart rate increased. Mixed-design repeated-measures ANOVA showed significant Group×Time interactions for DBP (<i>P</i> = 0.030) and HR (<i>P</i> = 0.002), but not for TPI (<i>P</i> = 0.069) or SBP (<i>P</i> = 0.619). Repeated-measures correlation showed inverse associations between TPI and hemodynamic parameters and stress hormones, except for cortisol in the Diabetes group, where the association did not reach statistical significance (<i>P</i> = 0.057). In the separate threshold-based analysis, all participants met the predefined TPI-positive response criterion during both stimuli. During pneumoperitoneum, TPI response time differed significantly among the three groups (<i>P</i> < 0.001), with the longest mean response time observed in the Diabetes group, whereas no significant between-group differences in response time were observed for SBP, DBP, or HR (all <i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>TPI showed consistent peri-stimulus changes during endotracheal intubation and pneumoperitoneum and may provide complementary information on peripheral vascular responses during surgical stress. The prolonged threshold-based TPI response time observed in patients with diabetes during pneumoperitoneum suggests a potential difference in response timing that warrants further investigation.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1921275"},"PeriodicalIF":3.6,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215635","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}