Frontiers in Medicine最新文献

{"title":"A preliminary study on the clinical characteristics of lacrimal duct obstruction in patients with a history of anterior uveitis.","authors":"Peng Wang, Hai Tao, Fei Wang, Fang Bai, Xibin Zhou, Lihua Wang, Chuan Liu, YiFei Huang","doi":"10.3389/fmed.2025.1630425","DOIUrl":"10.3389/fmed.2025.1630425","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to investigate the clinical features of lacrimal duct obstruction (LDO) in patients with a history of anterior uveitis (AU) and explore preventive strategies by analyzing their demographic, anatomical, and surgical outcome profiles.</p><p><strong>Methods: </strong>We retrospectively reviewed 40 LDO patients (58 eyes) with a history of AU, treated between 2020 and 2024, comparing them to non-AU LDO controls. Data included demographics, AU-epiphora temporal relationships, obstruction characteristics (location, extent, and adhesions), and surgical outcomes. Statistical analysis evaluated differences between groups.</p><p><strong>Results: </strong>The mean age was 49.88 ± 10.18 years, with 30 women (75%) and 10 men (25%). Proximal lacrimal canalicular obstruction (<4 mm from lacrimal punctum) occurred in 32 cases (80%), comprising 16 cases of lacrimal punctal atresia, 6 cases of proximal lacrimal canalicular obstruction, and 10 cases with a combination of both conditions. Additional cases included one (2.5%) middle lacrimal canalicular obstruction and two (5%) distal lacrimal canalicular obstructions. In total, three (7.5%) had proximal and distal lacrimal canalicular obstructions, one (2.5%) had proximal and middle lacrimal canalicular obstruction, and one (2.5%) had middle and distal lacrimal canalicular obstruction. Among 11 patients with ankylosing spondylitis, the onset of AU averaged 10.02 ± 9.34 years, with epiphora preceding uveitis by an average of 3.24 ± 3.42 years. Intraoperatively, 32 patients (80%) showed extensive adhesive LDO. Surgical procedures included laser canaliculoplasty with lacrimal stent intubation (55 eyes), dacryocystorhinostomy with lacrimal stent intubation (one eye), and retrograde canalicular trephination combined with dacryocystorhinostomy and lacrimal stent intubation (two eyes). Treatment outcomes showed a complete cure in 8 cases (20%), improvement in 21 cases (52.5%), and no effect in 11 cases (27.5%). The surgical success rates were significantly lower in uveitis patients compared to controls (<i>p</i> < 0.001), with extensive adhesions observed intraoperatively in 80% of uveitis cases.</p><p><strong>Conclusion: </strong>In patients with a history of AU, LDO predominantly affects the proximal lacrimal structures, often resulting in severe adhesions and poor surgical outcomes, with a cure rate of only 20%. The temporal link between epiphora and AU onset suggests shared pathophysiology. Targeted research is critical to clarify AU-LDO mechanisms and optimize prevention.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1630425"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, regional, and national burden and trends of HIV/AIDS among women of childbearing age from 1990 to 2021: results from Global Burden of Disease 2021.","authors":"Mingjie Tang, Jun Shao, Yanjie Jiang, Yinghong Li, Shiwei Li, Yilin Song, Wenxuan Wu, Jiqin Tang, Zhaoming Chen","doi":"10.3389/fmed.2025.1605092","DOIUrl":"10.3389/fmed.2025.1605092","url":null,"abstract":"<p><strong>Background: </strong>Human immunodeficiency virus (HIV) is one of the key factors contributing to global morbidity and mortality. Women of childbearing age (WCBA) represent a high-risk population for HIV/AIDS, presenting a substantial challenge to global public health systems. A comprehensive understanding of the AIDS burden in this demographic is essential for developing targeted screening and treatment strategies to effectively control mother-to-child transmission.</p><p><strong>Methods: </strong>Utilizing GBD 2021 data, this study systematically evaluated epidemiological trends in HIV/AIDS incidence, prevalence, mortality, and disability-adjusted life years (DALYs) among WCBA. The analysis employed a multidimensional stratification approach, examining temporal patterns, age distributions, geographic variations, and Socio-demographic Index (SDI). Additionally, a comprehensive analytical approach was employed, which included the estimated annual percentage change (EAPC), Joinpoint regression, decomposition analysis, and predictive modeling using the Nordpred method. Decomposition analysis quantified contributions from population growth, aging, and epidemiological changes.</p><p><strong>Results: </strong>From 1990 to 2021, the numbers of incidence, prevalence, mortality, and DALYs of HIV/AIDS among WCBA increased significantly. In 2021, the global age-standardized rates for incidence (ASIR), prevalence (ASPR), mortality (ASMR), and DALYs (ASDALYR) were 34.73 (95% uncertainty interval [UI]: 30.03 to 40.54) per 100,000, 830.87 (95% UI: 784.57 to 884.29) per 100,000, 13.39 (95% UI: 10.34 to 17.56) per 100,000, and 829.75 (95% UI: 658.24 to 1,063.9) per 100,000, respectively. ASIR showed a downward trend, while ASPR exhibited an upward trend. Geographically, the highest persistent burden was observed in Sub-Saharan Africa. High-middle SDI region, Eastern Europe, and Pakistan had the fastest growth in incidence. Decomposition analysis showed that the increase in HIV/AIDS indicators among WCBA was mainly caused by population, and epidemiological changes. Nordpred analysis predicts modest decline in ASIR, ASPR, and ASMR by 2046.</p><p><strong>Conclusion: </strong>From 1990 to 2021, substantial rise in incident cases, prevalent cases, mortality, and DALYs has established HIV/AIDS among WCBA as a critical global public health burden. This burden exhibits marked disparities across geographic regions, countries, and age groups. In high-burden areas, particularly Sub-Saharan Africa, public health practitioners must strengthen international cooperation and prioritize expanding HIV testing and antiretroviral therapy access, women's empowerment, and removing socio-cultural barriers.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1605092"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674319","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":"Natural active ingredients targeted inflammatory cytokines and major blinding eye diseases: a two-sample Mendelian randomization and molecular docking analysis.","authors":"Ying Shao, Yicheng Lu, Yue Gu, Yujia Chen, Chen Li","doi":"10.3389/fmed.2025.1427144","DOIUrl":"10.3389/fmed.2025.1427144","url":null,"abstract":"<p><strong>Objectives: </strong>Previous studies have reported that a few inflammatory cytokines have associations with ocular diseases. The objective of this study is to explore the causal relationship between 41 inflammatory cytokines and five ocular diseases using Mendelian randomization (MR) method and study the interaction between five natural active ingredients and inflammatory cytokines through molecular docking.</p><p><strong>Methods: </strong>The two-sample MR study employed genetic variances related to age-related macular degeneration (AMD), glaucoma, diabetic retinopathy (DR), myopia, and cataract. These variances were sourced from a comprehensive, publicly accessible genome-wide association study (GWAS). Additionally, inflammatory cytokines were derived from a GWAS summary that included 8,293 healthy individuals. The study primarily used the inverse variance weighted (IVW) method to investigate the causality between exposures and outcomes. To further bolster the final results, a variety of methods were concurrently used, including MR-Egger, weighted median, simple mode, weighted mode, and MR-PRESSO. A protein-protein interaction (PPI) network was constructed, and corresponding protein interaction relationships were analyzed utilizing the STRING database. Molecular docking served as an evaluation tool, confirming the binding between components and targets. This process was performed using AutoDock and PyMOL software.</p><p><strong>Results: </strong>The results indicated that IL-18 (OR: 1.134, 95% CI: 1.009-1.275, <i>P</i> = 0.034) and PDGF-BB (OR: 0.804, 95% CI: 0.678-0.954, <i>P</i> = 0.012) had protective effect on AMD; Genetically predicted RANTES had protective effect on glaucoma (OR: 0.886, 95% CI: 0.810-0.969, <i>P</i> = 0.008); IL-10 had protective effect on DR (OR: 0.871, 95% CI: 0.759-0.999, <i>P</i> = 0.048); GROa may be associated with increased myopia risk (OR: 1.230, 95% CI: 1.046-1.446, <i>P</i> = 0.012); Eotaxin (OR: 1.089, 95% CI: 1.018-1.165, <i>P</i> = 0.013), FGF2 (OR: 1.183, 95% CI: 1.004-1.393, <i>P</i> = 0.045) and GROa (OR: 1.053, 95% CI: 1.000-1.109, <i>P</i> = 0.049) were associated with increased cataract risk, while IL-1RA may be associated with decreased cataract risk. PPI network showed GROa, FGF2, IL-18, IL-1RA, IL-10, and Eotaxin interact closely. Molecular docking simulation showed that most of the compounds have good binding activities with critical targets.</p><p><strong>Conclusion: </strong>The present study identified inflammatory cytokines with causal relationships to five ocular diseases, revealing potential compounds for treating these diseases, providing a theoretical basis for further clinical practice.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1427144"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674322","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":"Baseline predictors for 28-day COVID-19 severity and mortality among hospitalized patients: results from the IMPACC study.","authors":"Jintong Hou, Benjamin Haslund-Gourley, Joann Diray-Arce, Annmarie Hoch, Nadine Rouphael, Patrice M Becker, Alison D Augustine, Al Ozonoff, Leying Guan, Steven H Kleinstein, Bjoern Peters, Elaine Reed, Matt Altman, Charles R Langelier, Holden Maecker, Seunghee Kim, Ruth R Montgomery, Florian Krammer, Michael Wilson, Walter Eckalbar, Steven E Bosinger, Ofer Levy, Hanno Steen, Lindsey B Rosen, Lindsey R Baden, Esther Melamed, Lauren I R Ehrlich, Grace A McComsey, Rafick P Sekaly, Joanna Schaenman, Albert C Shaw, David A Hafler, David B Corry, Farrah Kheradmand, Mark A Atkinson, Scott C Brakenridge, Nelson I Agudelo Higuita, Jordan P Metcalf, Catherine L Hough, William B Messer, Bali Pulendran, Kari C Nadeau, Mark M Davis, Ana Fernandez Sesma, Viviana Simon, Monica Kraft, Chris Bime, Carolyn S Calfee, David J Erle, Impacc Network, Lucy F Robinson, Charles B Cairns, Elias K Haddad, Mary Ann Comunale","doi":"10.3389/fmed.2025.1604388","DOIUrl":"10.3389/fmed.2025.1604388","url":null,"abstract":"<p><strong>Introduction: </strong>The coronavirus disease 2019 (COVID-19) pandemic threatened public health and placed a significant burden on medical resources. The Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC) study collected clinical, demographic, blood cytometry, serum receptor-binding domain (RBD) antibody titers, metabolomics, targeted proteomics, nasal metagenomics, Olink, nasal viral load, autoantibody, SARS-CoV-2 antibody titers, and nasal and peripheral blood mononuclear cell (PBMC) transcriptomics data from patients hospitalized with COVID-19. The aim of this study is to select baseline biomarkers and build predictive models for 28-day in-hospital COVID-19 severity and mortality with most predictive variables while prioritizing routinely collected variables.</p><p><strong>Methods: </strong>We analyzed 1102 hospitalized COVID-19 participants. We used the lasso and forward selection to select top predictors for severity and mortality, and built predictive models based on balanced training data. We then validated the models on testing data.</p><p><strong>Results: </strong>Severity was best predicted by the baseline SpO₂/FiO₂ ratio obtained from COVID-19 patients (test AUC: 0.874). Adding patient age, BMI, FGF23, IL-6, and LTA to the disease severity prediction model improves the test AUC by an additional 3%. The clinical mortality prediction model using SpO₂/FiO₂ ratio, age, and BMI resulted in a test AUC of 0.83. Adding laboratory results such as TNFRSF11B and plasma ribitol count increased the prediction model by 3.5%. The severity and mortality prediction models developed outperform the Sequential Organ Failure Assessment (SOFA) score among inpatients and perform similarly to the SOFA score among ICU patients.</p><p><strong>Conclusion: </strong>This study identifies clinical data and laboratory biomarkers of COVID-19 severity and mortality using machine learning models. The study identifies SpO₂/FiO₂ ratio to be the most important predictor for both severity and mortality. Several biomarkers were identified to modestly improve the predictions. The results also provide a baseline of SARS-CoV-2 infection during the early stages of the coronavirus emergence and can serve as a baseline for future studies that inform how the genetic evolution of the coronavirus affects the host response to new variants.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1604388"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674386","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":"Pediatric sequential organ failure assessment for predicting outcomes in ECMO-bridged pediatric heart transplant recipients: experience from the largest pediatric heart transplant center in China.","authors":"Wang-Zi Li, Xian-Ming Zhou, Wei Su, Cheng Zhou, Guo-Hua Wang, Jia-Wei Shi, Nian-Guo Dong","doi":"10.3389/fmed.2025.1631616","DOIUrl":"10.3389/fmed.2025.1631616","url":null,"abstract":"<p><strong>Objective: </strong>Advanced heart failure in children sometimes requires mechanical circulatory support as a bridge to transplantation, with extracorporeal membrane oxygenation (ECMO) remaining a critical option despite its associated risks. The pediatric Sequential Organ Failure Assessment (pSOFA) may have potential in evaluating prognosis in ECMO-bridged candidates.</p><p><strong>Methods: </strong>188 Children underwent orthotopic heart transplantation in Union hospital, Tongji Medical College, Huazhong University of Science and Technology, between January 2018 and April 2025 were studied retrospectively, with 24 received ECMO assistance as a bridge to transplant. Patients were divided into two groups according to outcomes while discharged. Serial pediatric Sequential Organ Failure Assessment and other medical data during bridging were collected for comparison.</p><p><strong>Results: </strong>66.7% of the 24 patients survived to discharge, with mortality linked to younger age (<i>p</i> = 0.034), higher pre-ECMO pSOFA scores (<i>p</i> = 0.019), and congenital heart disease. ECMO cannulation was mostly peripheral (66.7%), with left heart decompression in 87.5%. External cardiopulmonary resuscitation (50% of cases) increased mortality risk (<i>p</i> = 0.027). The death group had higher peak/trough/average pSOFA scores, reinforcing its predictive value. Non-survivors had more complications (ECMO reuse, septic shock, neurological issues) after heart transplant. pSOFA trends distinguished outcomes: survivors showed declining scores (<i>p</i> = 0.006), and average pSOFA ≤8 predicted better survival (<i>p</i> = 0.003). ECPR patients had worse baselines but might recover with optimized management. Findings support pSOFA-guided risk stratification in ECMO-bridged HTx.</p><p><strong>Conclusion: </strong>Continuous pSOFA monitoring effectively risk-stratifies ECMO-bridged pediatric transplant candidates, identifying high-risk patients after transplant. Planned ECMO initiation yields better outcomes than ECPR. These findings warrant prospective validation to optimize bridging strategies.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1631616"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674324","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":"Exogenous lipoid pneumonia due to medical aspiration of paraffin oil: a case report and literature review.","authors":"Mingshuang Li, Conglin Ren, Cangsong Chen","doi":"10.3389/fmed.2025.1596160","DOIUrl":"10.3389/fmed.2025.1596160","url":null,"abstract":"<p><p>This case report describes a case of exogenous lipoid pneumonia (ELP) due to medical aspiration of paraffin oil. An 87-year-old male was hospitalized with bedridden, dysphagic dysphagia. Two days after being given nasal paraffin oil, the patient developed high fever and respiratory distress. Blood gas analysis showed a PaCO₂ of 33 mmHg in the room air. CT scan of the chest showed multiple ground glass opacity with solid lesions. The patient then underwent bronchoscopy, and large quantities of oily turbid fluid was found in the bronchoalveolar lavage fluid (BALF). Further cytological analysis of the BALF showed 35% phagocytes, 60% neutrophils, and 5% lymphocytes. The patient was diagnosed with ELP based on a history of paraffin oil exposure, CT imaging of the chest, and cytological examination. Despite our aggressive anti-inflammatory and anti-infective treatment, the patient eventually passed away due to advanced age and multiple complications. Aspiration of oily substances is the most important risk factor for ELP. For people at high risk of misadministration, a suitable naso-intestinal tube is more appropriate for feeding and medication.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1596160"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12270848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674391","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":"Ultrasound-guided modified thoracoabdominal nerve block for postoperative analgesia in laparoscopic renal cyst decompression: a randomized double-blind controlled trial.","authors":"Mengning Wan, Jun Dong, Ke Wei, Juying Jin, Jun Cao, Baohong Yuan","doi":"10.3389/fmed.2025.1582428","DOIUrl":"10.3389/fmed.2025.1582428","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic renal cyst decompression (LRCD) is a common procedure in urology, but postoperative pain remains a significant challenge. While regional nerve blocks provide more targeted pain relief, there is no universally accepted pain management strategy for LRCD. The ultrasound-guided modified thoracoabdominal nerve block (M-TAPA) may offer effective analgesia by blocking the anterior and lateral branches of the intercostal nerves (T5-T12). However, its efficacy in LRCD has not been thoroughly evaluated.</p><p><strong>Objective: </strong>This study aimed to assess the efficacy and safety of unilateral M-TAPA in reducing postoperative pain and opioid consumption in patients undergoing LRCD, and to evaluate its potential benefits in enhancing recovery.</p><p><strong>Methods: </strong>In this randomized, double-blind, controlled trial, 61 patients undergoing LRCD were assigned to either the M-TAPA group (<i>n</i> = 31) or the Control group (<i>n</i> = 30). The M-TAPA group received ultrasound-guided nerve block, while the Control group received a placebo injection. Postoperative pain was assessed using the numerical rating scale (NRS) over a 48-h period. Additional outcomes included opioid consumption and opioid-related side effects, such as nausea and vomiting.</p><p><strong>Results: </strong>The M-TAPA group had significantly lower NRS scores at all time points compared to the Control group, with the largest difference observed at 6 h postoperatively (4.27 ± 0.83 in the Control group vs. 2.19 ± 0.54 in the M-TAPA group). Repeated measures ANOVA revealed a significant interaction between time and treatment (<i>F</i> = 20.813, <i>p</i> < 0.001). Opioid consumption was reduced by 22% in the M-TAPA group over 48 h (<i>p</i> < 0.001), and the need for antiemetic drugs was significantly lower (<i>p</i> = 0.020). No M-TAPA-related complications were observed.</p><p><strong>Conclusion: </strong>M-TAPA was found to be an effective method for reducing postoperative pain and opioid consumption in patients undergoing LRCD.</p><p><strong>Clinical trial registration: </strong>www.chictr.org.cn.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1582428"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674403","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 research on cycloastragenol in the treatment of brain metastases from lung cancer: mechanistic exploration of radiotherapy sensitization and amelioration of brain injury.","authors":"Yanyan Tao, Jingwen Chang, Xinyi Zhu, Jingjing Han, Xinru Wang, Yun Sheng, Ziyi Sun, Fang Liu, Yu Tao, Hongyan Wu, Chen Yu, Hao Liu, Fangtian Fan","doi":"10.3389/fmed.2025.1616894","DOIUrl":"10.3389/fmed.2025.1616894","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the radiosensitizing and toxicity-reducing effects of Cycloastragenol (CAG) in the radiotherapy of lung cancer brain metastases.</p><p><strong>Methods: </strong>A brain metastasis model of lung cancer was established using stereotactic brain localization. After successful modeling, varying doses of CAG (5 mg/kg, 10 mg/kg, 20 mg/kg) were administered via intraperitoneal injection to evaluate its antitumor efficacy. Radiotherapy (3 Gy per session, total 10 sessions) was combined with CAG (20 mg/kg) to assess its radiosensitizing effects. Small-animal <i>in vivo</i> imaging was employed to evaluate antitumor efficacy and radiosensitization. Cognitive changes in mice were assessed using the novel object recognition test and the cylinder test. Neuroinflammatory responses in brain tissues were detected via immunofluorescence and qPCR. Transcriptome sequencing and network pharmacology were utilized to identify potential targets and mechanisms, while molecular docking validated interactions between CAG and key targets. Both <i>in vitro</i> and <i>in vivo</i> studies were conducted to elucidate the mechanisms underlying CAG's adjuvant effects in radiotherapy, including enhancing efficacy and mitigating toxicity.</p><p><strong>Results: </strong>1. CAG significantly suppressed the growth of Lewis lung carcinoma (LLC) brain xenografts. 2. CAG markedly enhanced the radiotherapeutic efficacy against lung cancer brain metastases. 3. CAG ameliorated radiation-induced brain injury in tumor-bearing mice by attenuating pro-inflammatory polarization of microglia/macrophages. 4. CAG inhibited the activity of the JAK/STAT signaling pathway in LLC brain tumor tissues, thereby downregulating the expression of neutrophil chemotaxis-associated cytokines, including CXCL3 and CCL5. 5. CAG alleviated radiation-induced brain injury in tumor-bearing mice by suppressing the IKK/NF-κB signaling pathway in LLC brain tumor tissues, which further modulated microglial/macrophage pro-inflammatory polarization.</p><p><strong>Conclusion: </strong>CAG ameliorates neuroinflammation, enhances the therapeutic efficacy of radiotherapy for lung cancer brain metastases, and mitigates radiation-induced brain tumor injury by suppressing the activity of the JAK/STAT and IKK/NF-κB signaling pathways within metastatic lesions.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1616894"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674326","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":"Antibiotic prophylaxis may be still required among transperineal prostate biopsies of diabetics: a cohort study.","authors":"Feiyue Ma, Yu Zhang","doi":"10.3389/fmed.2025.1618631","DOIUrl":"10.3389/fmed.2025.1618631","url":null,"abstract":"<p><strong>Background: </strong>Transperineal prostate biopsy (TP-PB) is considered the gold standard for suspected prostate cancer patients. However, the rate of transperineal prostate biopsy-related urinary tract infections (UTIs) has been calculated to be as high as 3%. This study aimed to discuss the incidence of transperineal prostate biopsy -related infections among diabetic patients who underwent antibiotic prophylaxis (AP) or not.</p><p><strong>Methods: </strong>The monocentric, comparative, observational cohort study was carried out at Xiangshan County First People's Hospital Medical Health Group, China between January 2021 and January 2023. The study included 246 diabetic men suspected of having prostate cancer who underwent transperineal prostate biopsy. One group was transperineal prostate biopsy with no antibiotic prophylaxis (Group A-no AP, <i>n</i> = 120, 48.8%), and the other was given a 3 days of oral antibiotics (Group B-AP, <i>n</i> = 126, 51.2%). Data on primary symptoms, urine culture (UC), urinary tract infections incidence, and prostate biopsy -related sequela were gathered 2 weeks following the prostate biopsy.</p><p><strong>Results: </strong>A total of 246 patients were involved, including 120 in Group A (67.4 ± 7.2 years) and 126 in Group B (68.5 ± 7.0 years) (<i>p</i> = 0.215). Prostate-specific antigen (PSA) levels were 16.1 ± 23.8 vs. 15.9 ± 22.3 ng/ml (<i>p</i> = 0.942), and the prostate cancer detection rate was 58% vs. 57.5% (<i>p</i> = 0.847). The incidence of asymptomatic bacteriuria was significantly higher (8/120, 6.7%) in Group A vs. Group B (1/126, 0.8%) (RR 8.4, 95% CI: 1.1-72.5, <i>p</i> < 0.001). Similarly, urinary irritation symptoms occurred in 30/120 (25.0%) vs. 5/126 (4.0%) patients (RR 6.3, 95% CI: 3.0-21.6, <i>p</i> < 0.001), fever in 9/120 (7.5%) vs. 1/126 (0.8%) (RR 9.5, 95% CI: 1.3-81.3, <i>p</i> = 0.001), and UTIs in 5/120 (4.2%) vs. 1/126 (0.8%) (RR 5.3, 95% CI: 0.63-47.2, <i>p</i> = 0.001), respectively. Notably, sepsis was not detected in either group.</p><p><strong>Conclusion: </strong>Antibiotic prophylaxis could decrease the incidence of transperineal prostate biopsy-related infections among diabetic patients.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1618631"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674372","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":"For-profit growth and academic decline: a retrospective nationwide assessment of Brazilian medical schools.","authors":"Bruno B Andrade, Klauss Villalva-Serra, Rodrigo C Menezes, Luiz F Quintanilha, Katia de Miranda Avena","doi":"10.3389/fmed.2025.1617885","DOIUrl":"10.3389/fmed.2025.1617885","url":null,"abstract":"<p><strong>Background: </strong>The rapid and predominantly for-profit expansion of medical schools in Brazil over the past decade has raised widespread concerns about the erosion of academic standards in medical education.</p><p><strong>Methods: </strong>This nationwide, retrospective study analyzed academic performance indicators from all Brazilian medical schools participating in the 2013, 2016, 2019, and 2023 cycles of the National Student Performance Exam (<i>Exame Nacional de Desempenho dos Estudantes</i> - ENADE), a standardized national exam used to assess students' knowledge at the end of undergraduate programs. We also included the Indicator of Difference between Observed and Expected Performance (<i>Indicador de Diferença entre os Desempenhos Observado e Esperado;</i> IDD), which estimates the value added by institutions by comparing student performance at graduation with their academic background at entry. Data were sourced from publicly available datasets provided by the Brazilian Ministry of Education. We compared trends across public, non-profit private, and for-profit private institutions, using descriptive statistics, non-parametric tests, correlation analysis, and Bayesian mixed-effects regression models to assess the impact of institutional category and class size on academic performance.</p><p><strong>Results: </strong>The number of for-profit medical schools in Brazil nearly doubled between 2013 and 2023. These institutions consistently demonstrated lower ENADE scores compared to public and non-profit peers. Although IDD scores showed some early gains, they declined significantly in 2023, particularly among new medical schools taking the ENADE for the first time, most of which were for-profit. Larger class sizes were negatively correlated with both ENADE and IDD scores. Regression models showed that public institutions outperformed for-profit schools by an average margin of more than 21 ENADE points, while class size emerged as a modest but statistically significant negative predictor of IDD.</p><p><strong>Conclusion: </strong>Our findings reveal that the unregulated expansion of for-profit medical schools in Brazil has been accompanied by a decline in academic performance, as measured by national benchmarks. These patterns suggest a structural misalignment between the commercial logic of expansion and the core educational mission of medical training. Regulatory reforms are urgently needed to realign the growth of medical education with principles of academic quality and social accountability.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"12 ","pages":"1617885"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12271132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674318","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}