Frontiers in Medicine最新文献

{"title":"Patient satisfaction and associated factors in Addis Ababa's public referral hospitals: insights from 2023.","authors":"Dawit Abebe, Sinetibeb Mesfin, Luna Abebe Kenea, Yosef Alemayehu, Kostr Andarge, Temsegen Aleme","doi":"10.3389/fmed.2024.1456566","DOIUrl":"10.3389/fmed.2024.1456566","url":null,"abstract":"<p><strong>Background: </strong>Currently, patient satisfaction is a major concern in the healthcare system of Ethiopia. Patient satisfaction with nursing care is considered an important factor in explaining patients' service quality. Satisfied patients are more likely to have a good relationship with nurses, which suggests improved quality of care.</p><p><strong>Objective: </strong>To assess the prevalence of patient satisfaction and its associated factors among admitted patients in Addis Ababa city public referral hospitals, Ethiopia 2023.</p><p><strong>Methods and materials: </strong>An institutional-based cross-sectional study design was employed among 471 randomly selected patients from June 1 to July 30, 2023. Interviewer-administered a structured questionnaire was used to collect data. Patient satisfaction was measured by using the Newcastle Nursing Care Satisfaction Scale. Bivariable and multivariable logistic regressions were used to identify the factors associated with patient satisfaction.</p><p><strong>Result: </strong>471 participants responded among 506 selected patients yielding a response rate of 93%. The satisfaction of patients was 47.8% (95% CI = 42.9, 52.2%) Multiple logistic regression showed that participants aged 26-35 were less likely to be satisfied with nursing care [AOR = 0.25, 95% CI: 0.11, 0.56]. In contrast, those in the surgical ward [AOR = 3.85, 95% CI: 1.98, 7.45] and ophthalmology ward [AOR = 4.27, 95% CI: 1.81, 10.05] were more satisfied. No previous admission [AOR = 0.13, 95% CI: 0.07, 0.26], having no comorbidities [AOR = 13.4, 95% CI: 7.06, 25.4], and shorter admission duration [AOR = 9.14, 95% CI: 3.46, 24.11] were found to be factors with a significant association with patient nursing satisfaction.</p><p><strong>Conclusion: </strong>Overall, just under one in every two admitted patients were satisfied, indicating areas for potential improvement in nursing care. Specific factors such as patients in the age range of 26 to 35 reported significantly lower levels of satisfaction, whereas patients in the surgical and ophthalmology wards, as well as those without comorbidities and with shorter hospital stays, reported significantly higher levels of satisfaction. These findings emphasize the importance of targeted strategies to enhance nursing care.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"11 ","pages":"1456566"},"PeriodicalIF":3.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618049","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":"Changes in corneal curvature and astigmatism in senile cataract patients after phacoemulsification.","authors":"Yan-Hui Xiao, Yue-Qi Liu, Zhi-Gang Chen","doi":"10.3389/fmed.2024.1481285","DOIUrl":"10.3389/fmed.2024.1481285","url":null,"abstract":"<p><strong>Purpose: </strong>Analysis of changes in corneal curvature and astigmatism after phacoemulsification for senile cataracts.</p><p><strong>Methods: </strong>Retrospective collection of clinical data from patients who underwent uncomplicated phacoemulsification at the First Affiliated Hospital of Soochow University. The changes in total corneal curvature, anterior surface curvature, posterior surface curvature, and astigmatism were measured by the Sirius system. The axial length was measured by Lenstar 900.</p><p><strong>Results: </strong>The total corneal curvature and anterior surface curvature at 3 months were all larger than those before phacoemulsification, and the difference was statistically significant (<i>p</i> < 0.05). Compared with preoperative results, there was no significant change in corneal posterior surface curvature and astigmatism 3 months after surgery (<i>p</i> > 0.05). Changes in corneal curvature and astigmatism were not significantly correlated with age at 3 months after surgery (<i>p</i> > 0.05). Postoperative astigmatism was increased with the growth of axial length, while corneal curvature was decreased (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Phacoemulsification can lead to increased postoperative corneal curvature in elderly cataract patients, and with the growth of the axial length, the corneal astigmatism was increased.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"11 ","pages":"1481285"},"PeriodicalIF":3.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617024","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 COVID-19 severity levels and associated factors among patients admitted to the treatment centers in Southern Ethiopia.","authors":"Lire Lemma Tirore, Mihretu Tagesse Sergindo, Abriham Shiferaw Areba, Aklilu Habte Hailegebireal, Mitiku Desalegn","doi":"10.3389/fmed.2024.1403615","DOIUrl":"10.3389/fmed.2024.1403615","url":null,"abstract":"<p><strong>Background: </strong>COVID-19, a highly impactful infectious disease, has been observed to result in psychological distress, organ impairment, and mortality. The severity and consequences of the illness appear to vary based on geographical location and individual characteristics. Understanding the disease and optimizing resource distribution through early classification depend on having data on the severity of COVID-19 patients. There is a dearth of information in this particular region regarding the severity of COVID-19 patients and related factors. Therefore, this study used an ordinal logistic regression model to determine the severity levels of COVID-19 and its associated components.</p><p><strong>Materials and methods: </strong>A retrospective follow-up study was conducted on COVID-19 patients admitted between May 30, 2020, and October 15, 2021, at care centers in southern Ethiopia. 845 patients were included in this research. The mean (standard deviation) and median (interquartile range) were used to summarize the data. A multivariable ordinal logistic regression model was used to study the association between independent variables and COVID-19 severity levels.</p><p><strong>Results: </strong>In terms of the severity of the disease, 12.07% of patients had severe COVID-19, 7.81% had critical disease, and 6.39% had moderate disease. 8.28% of the 845 patients died, while 88.88% of them made a full recovery. Older age (> = 40 years) (AOR = 5.75, 95% CI = 3.99, 8.27), comorbidities (AOR = 4.17, 95% CI = 3.03, 5.88), and low oxygen saturation (AOR = 3.44, 95% CI = 2.23, 5.56) were significantly linked to higher odds of experiencing more severe levels of COVID-19 compared to their counterparts.</p><p><strong>Conclusion: </strong>7.81% of patients were critically ill, while more than one-tenth (12.07%) were considered severely ill. Low oxygen saturation, comorbidities, and advanced age were found to be significantly associated with COVID-19 severity. Therefore, it is crucial to manage comorbidities, provide special treatment, and provide COVID-19 patients with underlying medical issues more attention due to the higher risk of poor outcomes. To speed up their recovery, medical professionals should regularly monitor and provide specialized care to older COVID-19 patients. In order to identify patients who are more likely to experience a severe illness and to better manage their treatment, it is imperative that oxygen saturation levels in COVID-19 patients be promptly identified and monitored.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"11 ","pages":"1403615"},"PeriodicalIF":3.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618260","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":"Exome sequencing data reanalysis of 200 hypertrophic cardiomyopathy patients: the HYPERGEN French cohort 5 years after the initial analysis.","authors":"Hager Jaouadi, Victor Morel, Helene Martel, Pierre Lindenbaum, Lorcan Lamy de la Chapelle, Marine Herbane, Claire Lucas, Frédérique Magdinier, Habib Gilbert, Jean-Jacques Schott, Stéphane Zaffran, Karine Nguyen","doi":"10.3389/fmed.2024.1480947","DOIUrl":"10.3389/fmed.2024.1480947","url":null,"abstract":"<p><strong>Background: </strong>Approximately half of hypertrophic cardiomyopathy (HCM) patients lack a precise genetic diagnosis. The likelihood of identifying clinically relevant variants increased over time.</p><p><strong>Methods: </strong>In this study, we conducted a gene-centric reanalysis of exome data of 200 HCM cases 5 years after the initial analysis. This reanalysis prioritized genes with a matched HCM entry in the OMIM database and recently emerging HCM-associated genes gathered using a text mining-based literature review. Further classification of the identified genes and variants was performed using the Clinical Genome Resource (ClinGen) resource and American College of Medical Genetics and Genomics (ACMG) guidelines to assess the robustness of gene-disease association and the clinical actionability of the prioritized variants.</p><p><strong>Results: </strong>As expected, the majority of patients carried variants in <i>MYBPC3</i> and M<i>YH7</i> genes, 26% (<i>n</i> = 51) and 8% (<i>n</i> = 16), respectively, in accordance with the initial analysis. The vast majority of pathogenic (P) and likely pathogenic (LP) variants were found in <i>MYBPC3</i> (22 out of 40 variants) and <i>MYH7</i> (8 out of 16 variants) genes. Three genes-not included in the initial analysis-were identified: <i>SVIL</i>, <i>FHOD3</i>, and <i>TRIM63</i>. Considering only patients with unique variants in the last three genes, there was a 9% enhancement in variant identification. Importantly, <i>SVIL</i> variant carriers presented apical and septal HCM, aortopathies, and severe scoliosis for one patient. Ten patients (5%) carried variants in the <i>FHOD3</i> gene, six in hotspot regions (exons 12 and 15). We identified seven variants within the <i>TRIM63</i> gene in 12 patients (6%). Homozygous variants were detected in 2.5% of the cohort in <i>MYBPC3</i> (<i>n</i> = 1), <i>MYL3</i> (<i>n</i> = 1), and <i>TRIM63</i> (<i>n</i> = 3) genes.</p><p><strong>Conclusion: </strong>Our study revealed that no variants were found in the <i>ACTC1</i>, <i>TPM1</i>, and <i>TNNI3</i> genes in the HYPERGEN cohort. However, we identified variants in five out of the eight HCM core genes, with a high prevalence in young patients. We identified variants in three recent HCM-associated genes (<i>SVIL</i>, <i>FHOD3</i>, and <i>TRIM63</i>) in 35 patients, with 18 patients carrying unique variants (9%). Our results further emphasize the usefulness of exome data reanalysis, particularly in genotype-negative patients.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"11 ","pages":"1480947"},"PeriodicalIF":3.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11565434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647261","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 value of ultrasonographic factors in predicting cesarean following induction.","authors":"Guangpu Liu, Chaofan Zhou, Zhifen Yang, Jingya Zhang","doi":"10.3389/fmed.2024.1430815","DOIUrl":"10.3389/fmed.2024.1430815","url":null,"abstract":"<p><p>This study aimed to develop and validate a prediction model of cesarean following induction of labor (IOL). A nomogram for the prediction of cesarean following IOL for singleton, cephalic term deliveries was created by comparing combinations of ultrasonographic and nonultrasonographic factors in a retrospective manner using patient data collected from a Chinese hospital between July, 2017 and December, 2023. Model discrimination and calibration were evaluated using the area under the receiver operating characteristic curve (AUROC) and a calibration curve. Subsequently, decision curve analysis (DCA) was conducted to pinpoint the optimal probability threshold for the predictive model to exhibit practical significance for clinical decision-making. A total of 738 women were included. The inclusion of ultrasound factors yielded a higher AUC when combined with nonultrasonographic factors. Of the three ultrasonographic factors analyzed, the most predictive factor for cesarean following IOL was fetal head circumference. After generating a nomogram with eight validated factors, including maternal age, gestational age, height, prior caesarean delivery, previous vaginal delivery, modified Bishop score, body mass index at delivery, and fetal head circumference by ultrasound, the trained and validated AUC values were 0.826 (95% confidence interval 0.786-0.867) and 0.883 (95% confidence interval 0.839-0.926), respectively. Decision curve analysis indicated that the model provided net benefits of between 0% and 80% of the probability threshold, indicating the benefits of using the model to make decisions concerning patients who fall within the identified range of the probability threshold. Our nomogram based on obstetric factors and fetal head circumference as obtained by ultrasound could be used to help counsel women who are considering IOL. The model demonstrates favorable net benefits within a probability threshold range of 0 to 80%.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"11 ","pages":"1430815"},"PeriodicalIF":3.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618089","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":"Elevated hematologic ratios are correlated with acne severity: a national, retrospective cohort study.","authors":"Vered Wiesel, Sarah Weissmann, Bracha Cohen, Inbal Golan-Tripto, Amir Horev","doi":"10.3389/fmed.2024.1475117","DOIUrl":"10.3389/fmed.2024.1475117","url":null,"abstract":"<p><strong>Background: </strong>Prior studies demonstrated conflicting results regarding hematologic ratios in acne patients. We sought to further characterize hematologic ratios in acne patients, according to demographics and acne severity.</p><p><strong>Methods: </strong>National, retrospective cohort study of 122,822 patients using medical records from 2005 to 2024 of patients insured with the largest public healthcare organization in Israel, Clalit Health Maintenance Organization.</p><p><strong>Results: </strong>Moderate-severe acne patients had higher neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) than mild acne patients at diagnosis and 12-18 months before diagnosis. A multivariable regression confirmed the significance of the correlation of increased NLR and PLR with acne severity. Adults and females had higher NLR and PLR than children and males, respectively, at diagnosis, and 12-18 months before diagnosis.</p><p><strong>Conclusion: </strong>Acne severity was significantly associated with elevated NLR and PLR. NLR and PLR may also serve as indicators of upcoming acne severity, as they were elevated 12-18 months before diagnosis. These biomarkers may contribute to the diagnosis, management, and follow-up of patients with acne.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"11 ","pages":"1475117"},"PeriodicalIF":3.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617546","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 clinical significance of the Neutrophil-to-Lymphocyte Ratio as a novel inflammatory biomarker for assessing the severity of intervertebral disc degeneration.","authors":"Kai Guo, Jianhua Zeng, Jiawei Lu, Youfeng Guo, Peipei Shan, Yufeng Huang, Desheng Wu","doi":"10.3389/fmed.2024.1446124","DOIUrl":"10.3389/fmed.2024.1446124","url":null,"abstract":"<p><strong>Purpose: </strong>Inflammation is integral to the pathogenesis of intervertebral disc degeneration, yet the role of systemic inflammatory markers in this process remains underexplored. This study aims to explore the association between the Neutrophil-to-Lymphocyte Ratio (NLR) and the severity of disc degeneration.</p><p><strong>Patients and methods: </strong>A retrospective analysis was conducted on 375 patients diagnosed with lumbar disc degeneration between April 2018 and May 2021. All patients underwent a complete blood cell count examination. We applied the Pfirrmann grading system for cumulative disc grading, stratifying patients into two groups: a high-score group (cumulative grade > 17) and a low-score group (cumulative grade ≤ 17), based on the median cumulative grade. The association between the NLR and and the severity of disc degeneration was further analyzed using correlation analysis and logistic regression models. Furthermore, the predictive capacity of the NLR for lumbar disc degeneration was assessed using the Receiver Operating Characteristic (ROC) curve.</p><p><strong>Results: </strong>We found a significant positive correlation between high NLR levels and severe disc degeneration. The high-score group exhibited a significantly higher NLR compared to the low-score group [2.63 (1.91-4.18) vs. 2.04 (1.38-2.74), respectively, <i>p</i> < 0.001]. Significant correlations were found between NLR and patient characteristics (including age, BMI, VAS, NSAIDs usage, hemoglobin) and the cumulative grading. Logistic regression analysis identified age and NLR as independent predictors of the severity of disc degeneration. The ROC curve analysis demonstrated a good predictive capability of NLR for lumbar disc degeneration.</p><p><strong>Conclusion: </strong>NLR could serve as a promising biomarker for assessing the severity of lumbar disc degeneration and offer potential benefits in both early diagnosis and treatment strategies.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"11 ","pages":"1446124"},"PeriodicalIF":3.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618104","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":"Prediction of cardiovascular events and all-cause mortality using race and race-free estimated glomerular filtration rate in African Americans: the Jackson Heart Study.","authors":"Haiping Wang, Jiahui Cai, Hao Fan, Clarissa J Diamantidis, Bessie A Young, Aurelian Bidulescu","doi":"10.3389/fmed.2024.1432965","DOIUrl":"10.3389/fmed.2024.1432965","url":null,"abstract":"<p><strong>Background: </strong>New Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations without a race adjustment were developed to estimate the glomerular filtration rate (eGFR). We aimed to compare the performance of five CKD-EPI eGFR equations, with or without race, in predicting cardiovascular disease (CVD) events and all-cause mortality in Black Americans from the Jackson Heart Study.</p><p><strong>Methods: </strong>JHS is an ongoing population-based prospective cohort study of African Americans in the Jackson, Mississippi, metropolitan area. Five CKD-EPI equations were used to estimate GFR at baseline using serum creatinine (Cr) or cystatin C (cys), including 2009 eGFRcr(ASR [age, sex, race]), 2021 eGFRcr(AS [age and sex]), 2012 eGFRcr-cys(ASR), 2021 eGFRcr-cys(AS), 2012 eGFRcys(AS). Endpoints were incident CVD events and all-cause mortality. Cox proportional hazards regression was used to assess the associations between different eGFRs and outcomes adjusting for atherosclerotic risk factors. Harrell's C-statistics and Net Reclassification Index (NRI) were used to assess the predictive utility.</p><p><strong>Results: </strong>Among 5,129 participants (average age 54.8 ± 12.8 yrs), 1898 were male (37.0%). eGFRcr(AS) provided lower estimates and resulting in a greater proportion of participants categorized as CKD than eGFRcr(ASR), eGFRcr-cys(ASR), eGFRcr-cys(AS) and eGFRcys(AS). A median follow-up of 13.7 and 14.3 years revealed 411 (9.3%) CVD incidents and 1,207 (23.5%) deaths. Lower eGFRs were associated with CVD incidents and all-cause mortality. eGFRcr-cys(ASR), eGFRcr-cys(AS) and eGFRcys(AS) were strongly associated with incident CVD events and all-cause mortality than eGFRcr(ASR) and eGFRcr(AS). A significant discrimination improvement was found in C-statistics for predicting incident CVD events and all-cause mortality after adding each eGFR measure to the basic model including atherosclerotic risk factors. Across a 7.5% 10-year risk threshold, eGFRcys(AS) improved net classification of all-cause mortality (NRI: 2.19, 95%CI: 0.08, 4.65%).</p><p><strong>Conclusion: </strong>eGFR based on creatinine omit race has the lowest mean and detects more CKD patients in Black population. The eGFRs incorporating cystatin C strengthens the association between the eGFR and the risks of incident CVD and all-cause mortality. Cystatin C-based eGFR equations might be more appropriate for predicting CVD and mortality among Black population.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"11 ","pages":"1432965"},"PeriodicalIF":3.1,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618057","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":"RIRS with FV-UAS vs. ESWL for the management of 1-2 cm lower pole renal calculi in obese patients: a prospective study.","authors":"Chao Men, Miao Xu, Si-Cong Zhang, Qing Wang, Jie Wu, Yun-Peng Li","doi":"10.3389/fmed.2024.1464491","DOIUrl":"10.3389/fmed.2024.1464491","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with flexible vacuum-assisted ureteral access sheath (FV-UAS) versus extracorporeal shock wave lithotripsy (ESWL) for the management of 1-2 cm lower pole renal calculi (LPC) in obese patients.</p><p><strong>Patients and methods: </strong>This prospective, randomized study included 149 obese patients with 1-2 cm LPC. Patients were allocated into two groups: 76 patients underwent RIRS with FV-UAS, and 73 patients received ESWL. The parameters assessed included stone-free rate (SFR), retreatment rate, complications, operative time, and pain intensity measured by the visual analog scale (VAS). Stone-free status was defined as the absence of stones on computed tomography or residual fragments smaller than 4 mm at 4 weeks post-procedure.</p><p><strong>Results: </strong>The baseline characteristics of the two groups were comparable. The SFR was significantly higher in the RIRS group, reaching 86.8%, compared to 63.0% in the ESWL group (<i>p</i> = 0.034). Furthermore, the retreatment rate was significantly lower in the RIRS group, at 5.2%, versus 24.7% in the ESWL group (<i>p</i> < 0.001). The average operative time for RIRS was notably longer, at 65.3 ± 6.4 min, compared to 25.3 ± 7.8 min for ESWL (<i>p</i> < 0.001). The complication rates were 9.2% for the RIRS group and 6.8% for the ESWL group, with no statistically significant difference (<i>p</i> = 0.326). All complications were classified as Grade I or II according to the modified Clavien classification system. No significant differences were observed between the two groups regarding pain VAS scores and the composition of the stones.</p><p><strong>Conclusion: </strong>RIRS with FV-UAS demonstrated superior efficacy, evidenced by a higher SFR and reduced retreatment rates compared to ESWL, despite a longer operative duration. Both treatment modalities showed comparable safety profiles. RIRS with FV-UAS emerges as a viable, effective, and reproducible intervention for managing 1-2 cm LPC in obese patients, providing significant clinical advantages.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"11 ","pages":"1464491"},"PeriodicalIF":3.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618080","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 causal role of gastroesophageal reflux disease in endometriosis: a bidirectional Mendelian randomization study.","authors":"Zunlin Shi, Zhi Li, Kana Wang, Fan Yang","doi":"10.3389/fmed.2024.1440157","DOIUrl":"10.3389/fmed.2024.1440157","url":null,"abstract":"<p><p>Observational studies have reported an association between gastroesophageal reflux disease (GERD) and endometriosis. We conducted a two-sample and bidirectional Mendelian randomization analysis to determine whether those associations are causal. Two-sample and bidirectional MR analyses were performed using summary statistics from the European Individual Genome-Wide Association Study (GWAS). The inverse variance weighting (IVW) method is used as the main analysis method to evaluate causality. Sensitivity analyses were performed to assess heterogeneity, horizontal versatility, and stability. The results showed no significant causal association between GERD in women with endometriosis in the UK Bank database [ratio (OR) ≈ 0, 95% adjusted interval (CI) 1.0007∼1.0044, <i>P</i> = 0.006] and Finn databases [ratio (OR) = 1.29, 95% adjusted interval (CI) 0.99∼1.67, <i>P</i> = 0.06]. However, when studying the Finn database only for endometriosis, which is confined to the uterus, a significant increase in GERD was limited to the risk of endometriosis in the uterus [ratio (OR) = 1.47, 95% adjusted interval (CI) 1.00∼2.17, <i>P</i> = 0.05]. Sensitivity analysis showed that the results were robust and did not detect multi efficacy or heterogeneity. Meanwhile, reverse MR analysis showed that endometriosis did not increase the risk of GERD. This MR study supports a causal relationship between GERD and an increased risk of endometriosis confined to the uterus. Therefore, patients with gastric esophageal reflux should be treated with gynecological examination to avoid and prevent the development of endometriosis.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"11 ","pages":"1440157"},"PeriodicalIF":3.1,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142618098","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}