Frontiers in Medicine最新文献

{"title":"Bidirectional ventricular tachycardia unmasked by beta-blockade in pheochromocytoma presenting as hypertensive optic neuropathy: a case report and literature review.","authors":"Jianhua Xie, Qin Yuxue, Hai Huang, Xiaojia Luo","doi":"10.3389/fmed.2026.1942798","DOIUrl":"https://doi.org/10.3389/fmed.2026.1942798","url":null,"abstract":"<p><strong>Background: </strong>Pheochromocytoma is a catecholamine-secreting neuroendocrine tumor that can produce life-threatening cardiovascular complications. Bidirectional ventricular tachycardia (BVT) is a rare arrhythmia with a narrow differential diagnosis, classically associated with digitalis toxicity and catecholaminergic polymorphic ventricular tachycardia, and only exceptionally reported as the presenting feature of pheochromocytoma.</p><p><strong>Case presentation: </strong>A 51-year-old woman presented with acute visual impairment secondary to hypertensive optic neuropathy; her blood pressure was 220/138 mmHg. Within 24 h of initiating sodium nitroprusside and metoprolol, she developed bidirectional ventricular tachycardia followed by torsades de pointes. Marked blood-pressure lability, dramatically elevated plasma free metanephrines and catecholamines, and a left adrenal mass on computed tomography established the diagnosis of pheochromocytoma. After alpha-adrenergic blockade with phenoxybenzamine, laparoscopic adrenalectomy was performed, and histopathology confirmed the diagnosis. No ventricular arrhythmia recurred, and blood pressure normalized without antihypertensive medication.</p><p><strong>Conclusion: </strong>Bidirectional ventricular tachycardia may be the initial manifestation of pheochromocytoma and may be unmasked by beta-blockade administered before alpha-blockade. Unexplained BVT accompanied by blood-pressure fluctuations should prompt biochemical screening and adrenal imaging. Etiologic treatment is curative, whereas antiarrhythmic therapy alone is insufficient. We review the previously published cases to contextualize this rare phenotype.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1942798"},"PeriodicalIF":3.6,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13687284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149265345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-onset digestive system cancers attributable to the GBD composite dietary risk in China, 1990-2023: burden, trends, and projections.","authors":"Ping Li, Xiao Tong","doi":"10.3389/fmed.2026.1972611","DOIUrl":"10.3389/fmed.2026.1972611","url":null,"abstract":"<p><strong>Background: </strong>Digestive system cancers attributable to the aggregate dietary risk category defined by the Global Burden of Disease (GBD) study represent an important public health concern among Chinese adults aged 25-49 years. This study evaluated their burden, temporal trends, age-period-cohort patterns, and model-based projections.</p><p><strong>Methods: </strong>Data on deaths and disability-adjusted life years (DALYs) attributable to the GBD aggregate dietary risk category were obtained for Chinese individuals aged 25-49 years from 1990 to 2023. Joinpoint regression was used to analyze temporal trends, an age-period-cohort (APC) model was used to estimate age, period, and cohort effects, and a Bayesian age-period-cohort (BAPC) model was used to project the burden through 2050.</p><p><strong>Results: </strong>In 2023, these cancers were associated with 7,134 deaths and 349,764 DALYs. The burden among males was more than twice that among females. Age-standardized mortality and DALY rates declined significantly from 1990 to 2023 across all analyzed age and sex groups. The APC analysis showed lower relative risks in more recent periods and younger birth cohorts. The BAPC model projected substantial increases in the absolute numbers of deaths and DALYs by 2050, accompanied by increases in the corresponding age-standardized rates.</p><p><strong>Conclusion: </strong>Although age-standardized mortality and DALY rates declined from 1990 to 2023, the BAPC model projected increases in both the absolute burden and age-standardized rates of digestive system cancers attributable to the aggregate dietary risk category through 2050. These findings represent conditional model-based projections and support continued attention to sex-specific dietary-risk prevention and control strategies.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1972611"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237723","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 insulin resistance-related metabolic indices with albuminuria in primary hypertension without diabetes: a retrospective cross-sectional study.","authors":"Yan Zhuo, Pengjie Gao, Suining Xu, Suhang Shang, Yiran Yan, Kamila Kamili, Xiyang Li, Danni Wang, Jianfeng Han, Gang Tian","doi":"10.3389/fmed.2026.1959589","DOIUrl":"10.3389/fmed.2026.1959589","url":null,"abstract":"<p><strong>Background: </strong>Insulin resistance-related metabolic indices have been associated with albuminuria in general populations and in patients with diabetes, but evidence in patients with primary hypertension without diabetes remains limited. Whether mean arterial pressure (MAP) statistically accounts for part of these associations is unclear.</p><p><strong>Methods: </strong>We retrospectively analysed cross-sectional data from 509 hospitalised cardiology patients with primary hypertension without diabetes at a single tertiary centre who underwent urinary albumin-to-creatinine ratio (UACR) testing. Albuminuria was defined as a UACR ≥30 mg/g. Associations of the triglyceride-glucose body mass index (TyG-BMI), metabolic score for insulin resistance (METS-IR), and triglyceride-glucose (TyG) index with albuminuria and log₁₀-transformed UACR were examined using multivariable logistic and linear regression. Restricted cubic splines (RCS) assessed the shape of the associations. Supplementary logistic models additionally adjusted for MAP, and exploratory indirect-effect analyses assessed statistical indirect components involving MAP.</p><p><strong>Results: </strong>Among the 509 participants, 99 (19.4%) had albuminuria. After multivariable adjustment, the odds ratios (ORs) for albuminuria per 1-SD increment in TyG-BMI, METS-IR, and the TyG index were 1.610 [95% confidence interval (CI), 1.262-2.055], 1.557 (95% CI, 1.215-1.995), and 1.436 (95% CI, 1.128-1.829), respectively. Corresponding Q4-vs.-Q1 ORs were 2.464 (95% CI, 1.228-4.943), 2.665 (95% CI, 1.268-5.600), and 2.137 (95% CI, 1.092-4.181), with overall categorical <i>P</i>-values of 0.018, 0.059, and 0.099, respectively. RCS analyses showed significant overall associations for all three indices, with no statistical evidence of departure from linearity. All three indices were positively associated with log₁₀-transformed UACR. After additional MAP adjustment, the continuous associations with albuminuria were attenuated but remained statistically significant for all three indices, whereas the overall tests across quartiles were not statistically significant for any of the three indices. Exploratory analyses suggested statistical indirect components involving MAP for TyG-BMI and METS-IR, but not for the TyG index.</p><p><strong>Conclusions: </strong>Higher TyG-BMI, METS-IR, and TyG index values were associated with albuminuria and higher UACR in patients with primary hypertension without diabetes. Exploratory analyses suggested statistical indirect components involving MAP for TyG-BMI and METS-IR, but did not establish temporal ordering or causal mediation.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1959589"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237730","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: <i>Klebsiella pneumoniae</i>-associated pyogenic spondylitis and occult intrahepatic cholangiocarcinoma during calculous cholangitis.","authors":"Zheng Yang, Yuhe Yan, Hui Wang, Hua Zhou, Mengyi Zheng","doi":"10.3389/fmed.2026.1967835","DOIUrl":"10.3389/fmed.2026.1967835","url":null,"abstract":"<p><strong>Background: </strong><i>Klebsiella pneumoniae</i> is a common Gram-negative pathogen in biliary tract infections and may cause deep-seated infection following bacteremia, although vertebral involvement is uncommon. Severe biliary infection and stone disease may also complicate the recognition of coexisting hepatic malignancy.</p><p><strong>Case presentation: </strong>A 51-year-old woman presented with calculous acute obstructive suppurative cholangitis complicated by septic shock and multiorgan dysfunction. Blood and bile cultures yielded <i>Klebsiella pneumoniae</i>, and her condition improved after urgent biliary drainage and antimicrobial therapy. During a subsequent admission, she developed progressive low-back pain. Lumbar magnetic resonance imaging showed abnormalities involving the L3/4 vertebrae and adjacent paravertebral tissues, initially raising suspicion of spinal tuberculosis. Vertebral biopsy demonstrated focal suppurative inflammation, and metagenomic next-generation sequencing of the same tissue detected 33,735 <i>K. pneumoniae</i>-specific reads, with a relative abundance of 82.18% and genome coverage of 59.7%, together with multiple hypervirulence-associated determinants. These findings supported a diagnosis of <i>K. pneumoniae</i>-associated pyogenic spondylitis. Meanwhile, serial hepatobiliary imaging showed regression of the right hepatic abnormalities as the infection improved, whereas a focal lesion in the left liver persisted. Subsequent imaging raised suspicion of cholangiocarcinoma, and histopathologic examination after surgical resection confirmed poorly differentiated intrahepatic cholangiocarcinoma.</p><p><strong>Conclusion: </strong>This case underscores the importance of maintaining diagnostic vigilance even after an initial diagnosis has been established. New focal symptoms or abnormalities that persist or follow a different clinical course should not be automatically attributed to the original disease process, and the possibility of additional coexisting diagnoses should remain under consideration.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1967835"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237741","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":"Sugammadex versus anticholinesterase reversal of neuromuscular blockade in adult surgical patients: a systematic review and meta-analysis.","authors":"Faris Suleiman Saleh Aldobekhi, Mohammed Fahad Aldhahi, Fahad Awadh Almalki, Mohammed Aljahdali, Hassan Alshamrani, Somaia Sameer Akbar, Sultan Awwadh Almalki","doi":"10.3389/fmed.2026.1891778","DOIUrl":"10.3389/fmed.2026.1891778","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Residual neuromuscular blockade after general anaesthesia is a cause of postoperative pulmonary complications and delayed recovery. Sugammadex, a relaxant-binding agent, is a fast-acting antidote for aminosteroid neuromuscular block which works through encapsulation, in contrast to acetylcholinesterase inhibitors like neostigmine. This study evaluated the effectiveness, postoperative recovery and complications associated with sugammadex versus conventional anticholinesterase reversal drugs in adult surgical patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;This systematic review and meta-analysis was done based on the PRISMA 2020 statement. Databases like PubMed/MEDLINE and Scopus were used to search the literature from January 2000 to December 2025. Studies comparing the use of sugammadex to anticholinesterase agents in adult surgical patients were included, both randomised and non-randomised. Two independent reviewers screened, extracted data and assessed the risk of bias. Analyses were carried out in RevMan 5.3 software using random-effect models; the odds ratio (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes were used with 95% confidence intervals (CI). Evidence certainty was assessed using the GRADE approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Total of ten studies (&lt;i&gt;n&lt;/i&gt; = 4,082) were included; 5 randomised control trials and 5 observational studies. There was no statistically significant reduction in postoperative pulmonary complications with sugammadex compared to anticholinesterase (3 studies, &lt;i&gt;n&lt;/i&gt; = 688; OR 0.75, 95% CI 0.47-1.20; &lt;i&gt;p&lt;/i&gt; = 0.23; I&lt;sup&gt;2&lt;/sup&gt; = 77%). There was faster recovery of neuromuscular function with sugammadex, however, there was very high heterogeneity among the studies and the pooled estimate cannot be interpreted as one single effect size (2 studies; I&lt;sup&gt;2&lt;/sup&gt; = 100%). Recovery time after surgery was reduced (3 studies, &lt;i&gt;n&lt;/i&gt; = 260; MD -6.66 min, 95% CI -6.96 to -6.35; &lt;i&gt;p&lt;/i&gt; &lt; 0.00001; I&lt;sup&gt;2&lt;/sup&gt; = 87%) and time to first bowel movement was also earlier (2 studies, &lt;i&gt;n&lt;/i&gt; = 559; MD -13.81 h, 95% CI -19.16 to -8.45; &lt;i&gt;p&lt;/i&gt; &lt; 0.00001; I&lt;sup&gt;2&lt;/sup&gt; = 0%). There were no statistically significant differences for PACU stay (MD 1.55 min, 95% CI -1.60 to 4.69), readmission rate (OR 0.93, 95% CI 0.62-1.39) and postoperative nausea/vomiting (OR 0.86, 95% CI 0.48-1.56).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Faster neuromuscular recovery, shorter recovery time after surgery and early return of bowel function was associated with the use of sugammadex rather than the anticholinesterase agents. There were no differences found for postoperative pulmonary complications, PACU stay, readmission rate or nausea and vomiting. These results are based on small number of clinically heterogeneous studies, in which only 2-4 studies were used in pooling and thus should be considered as preliminary results.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Systematic review registered: &lt;/strong&gt;CRD","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1891778"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237796","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":"A homozygous variant in the <i>GJB2</i> gene as a potential phenocopy of Waardenburg syndrome: case report.","authors":"Yuehua Wu, Yupeng Chen, Zimeng Guo, Lang Xie, Tao Yang, Longnian Li","doi":"10.3389/fmed.2026.1925409","DOIUrl":"10.3389/fmed.2026.1925409","url":null,"abstract":"<p><p>Waardenburg syndrome (WS) is a neurocristopathy primarily characterized by congenital hearing loss and multisystem pigmentary abnormalities. We report a 12-year-old Han Chinese girl who presented with moderate-to-severe sensorineural hearing loss, a wide nasal root, diffuse hypopigmentation of the hair, and facial freckles-features partially similar to the WS phenotype. However, her calculated W-index was 1.87, below the diagnostic threshold for dystopia canthorum (>1.95), and her overall clinical presentation did not meet the diagnostic criteria for any WS subtype. Whole-exome sequencing (WES) and subsequent familial Sanger sequencing identified a homozygous <i>GJB2</i> variant, c.109G > A (p.Val37Ile), in the proband, with both parents confirmed as heterozygous carriers. Based on the integrated clinical and genetic evidence, the patient was diagnosed with <i>GJB2</i>-related autosomal recessive nonsyndromic hearing loss (DFNB1A). Her WS-like features were interpreted as a possible phenocopy. This case highlights that in patients with hearing loss exhibiting incomplete or atypical WS features, comprehensive genetic testing-including analysis of <i>GJB2</i>-is crucial to differentiate phenocopies, establish an accurate etiology, and provide a basis for precise diagnosis and genetic counseling.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1925409"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237645","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":"Primary gastric tuberculosis mimicking gastric lymphoma: a case report and multimodality imaging findings.","authors":"Zhengguo Wan, Yuanyuan Sun, Penghua Liu, Wen Jia","doi":"10.3389/fmed.2026.1956199","DOIUrl":"10.3389/fmed.2026.1956199","url":null,"abstract":"<p><p>Gastric tuberculosis represents a rare form of extrapulmonary tuberculosis. Owing to its non-specific clinical presentation, the condition is highly prone to misdiagnosis. It can mimic peptic ulcer disease or malignancy, typically manifesting as ulcerative lesions or gastric outlet obstruction, whereas less frequent presentations include massive gastrointestinal haemorrhage and gastric perforation. Consequently, establishing a definitive diagnosis remains challenging. This case report aims to augment the current understanding of this entity. Herein, we describe a 50-year-old female who presented with unexplained epigastric pain persisting for over nine months. Despite having undergone two prior gastroscopic examinations, the aetiology remained elusive and her symptoms persisted. Endoscopy revealed superficial gastritis and a submucosal lesion in the gastric body. Subsequent evaluation at our institution using endoscopic ultrasonography (EUS), computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated gastric wall thickening, initially suggestive of gastric lymphoma. However, EUS-guided biopsy of the posterior gastric wall, with histopathological examination via haematoxylin and eosin (H&E) staining, disclosed chronically active mucosa with necrotizing granulomatous inflammation, numerous multinucleated giant cells, and occasional acid-fast bacilli (AFB), leading to a diagnosis of gastric tuberculosis. Given the non-specific symptomatology and imaging features that differ only subtly from those of gastric adenocarcinoma, lymphoma, and other submucosal tumours, the definitive diagnosis of gastric tuberculosis relies primarily on histopathological and immunohistochemical evaluation. By summarizing the imaging characteristics observed in this case, this report seeks to heighten clinical awareness and facilitate the recognition of this rare condition.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1956199"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237672","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: Successful treatment of verruciform acanthotic vulvar intraepithelial neoplasia with 5-aminolevulinic acid photodynamic therapy.","authors":"Yitao Qian, Wenjing Zha, Jie Shen, Ke Li, Szeman Cheung, Yiwu Yu, Jianhua Huang, Ting Lyu, Fei Miao, Hongwei Wang, Lei Shi","doi":"10.3389/fmed.2026.1949400","DOIUrl":"10.3389/fmed.2026.1949400","url":null,"abstract":"<p><p>Verruciform acanthotic vulvar intraepithelial neoplasia (vaVIN) is a rare, human papillomavirus (HPV)-independent, p53 wild-type intraepithelial precursor of the vulva, and standardized therapies for this disease are currently lacking. We report the case of a 68-year-old woman who presented with a 2-year history of multiple warty papules and vulvar pruritus and was diagnosed with vaVIN on the basis of histopathology (verruciform acanthosis with compact orthokeratosis, hypogranulosis, and superficial keratinocyte pallor with minimal cytologic atypia) and immunohistochemistry (HPV negativity, a p53 wild-type pattern, and non-block p16 expression) analyses. She underwent 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and achieved complete clinical remission, with no recurrence during the follow-up period. To our knowledge, reports on the use of photodynamic therapy for vaVIN are scarce. This case suggests that ALA-PDT may be a promising alternative treatment option for vaVIN.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1949400"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237683","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":"Reasons for encounter and recommended interventions in an interprofessional integrative oncology counseling program in outpatient care: a mixed-methods analysis of 1,693 consultation letters.","authors":"Andreas Schmitt, Regina Stolz, Holger Mauch, Franziska Mergel, Barbara Grün, Mirjam Krug, Cornelia Mahler, Stefanie Joos, Jan Valentini","doi":"10.3389/fmed.2026.1907654","DOIUrl":"10.3389/fmed.2026.1907654","url":null,"abstract":"<p><strong>Introduction: </strong>Complementary and integrative healthcare (CIH) approaches play an increasingly important role in oncology care, involving a wide range of healthcare professionals and therapeutic methods. While patient demand for CIH and the evidence base for individual interventions have grown considerably, the implementation of structured counseling services for the effective and safe use of CIH remains limited. To address this gap, a controlled, multicenter implementation study was conducted at four Comprehensive Cancer Centers (CCC) in Germany to establish an outpatient, interprofessional, evidence-based counseling service for CIH (CCC-Integrativ). This mixed-methods study investigates the specific reasons for encounter (RfE) and the recommended interventions during these consultations.</p><p><strong>Methods: </strong>Patients enrolled in the CCC-Integrativ study received three CIH consultations within a three-month period, the first of which was conducted jointly by specifically trained physicians and nurses. After each session, a consultation letter was prepared summarizing the main patient RfE and recommendations. All consultation letters were analyzed using qualitative content analysis, and the results were subsequently analyzed quantitatively.</p><p><strong>Results: </strong>A total of 1,693 consultation letters from 603 oncology patients were analyzed. The most frequent reasons for encounter included general weakness and fatigue (56%), chemotherapy-induced peripheral neuropathy (40%), sleep disturbances (37%), and general pain (36%). Nearly all patients received counseling on lifestyle modifications, including nutrition (95%), physical activity (93%), and stress management (81%). Additionally, an average of 15 specific CIH interventions were recommended per patient, encompassing naturopathic nursing interventions (97%), herbal medicines and teas (79%), acupressure (79%), and mindfulness-based movement therapies (44%).</p><p><strong>Discussion: </strong>Interprofessional outpatient counseling on CIH in oncology addresses a wide spectrum of patient RfE, provides guidance on lifestyle modifications, and offers specific, individualized CIH interventions to help patients manage burdensome symptoms. These findings suggest that interprofessional integrative counseling services can play a crucial role in outpatient oncology care by providing a holistic approach tailored to individual needs. Furthermore, structured integrative oncology counseling may serve a valuable navigational role within outpatient care settings.</p>","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1907654"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237693","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 triage-stage prediction models for short-term critical outcomes among adult emergency department patients entering observation or hospital-based care: a retrospective study.","authors":"Mingwei Wu, Yao Liu, Chengli Zhou, Jinfeng Li","doi":"10.3389/fmed.2026.1921692","DOIUrl":"10.3389/fmed.2026.1921692","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Risk stratification at emergency department triage may help identify patients who require closer assessment or monitoring. However, prediction models that rely only on information available at the triage stage remain less well evaluated. This study aimed to develop and internally validate machine learning models based on triage-stage information for predicting short-term critical outcomes in adult emergency department patients and to interpret a representative explainable model using SHAP analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective observational study included 1,842 consecutive adult patients who completed standardized electronic triage and subsequently entered an emergency observation or hospital-based care pathway at a tertiary general hospital between January 2022 and December 2025. The prediction time point and landmark were defined as completion of electronic emergency triage. Only patients who were free of all outcome components at the landmark were included, and candidate predictors were restricted to routinely available information recorded no later than triage completion. The primary outcome was the first critical event occurring during the subsequent 72 h: intensive care unit admission, endotracheal intubation or invasive mechanical ventilation, cardiopulmonary resuscitation, objectively documented escalation involving an implemented resuscitation-level intervention, or in-hospital death. Additional sensitivity analyses restricted the outcome to intensive care unit admission, intubation or invasive ventilation, cardiopulmonary resuscitation, or death and refitted the model without emergency triage level. The cohort was randomly divided into a development cohort and a 30% hold-out cohort. Because the hold-out cohort had already been examined during the original analysis, it was not considered an independent validation set. The primary internal-validation analysis therefore consisted of 10 repetitions of nested cross-validation within the development cohort, using five stratified outer folds for performance estimation and four stratified inner folds for preprocessing and hyperparameter tuning. Logistic regression, random forest, support vector machine, XGBoost, and LightGBM were evaluated using the same resampling framework. The previously examined exploratory hold-out cohort was retained only for secondary exploratory analysis. Model performance was assessed using discrimination, calibration, classification metrics, Brier score, decision-curve analysis, and SHAP-based interpretation. Bootstrap optimism correction was additionally used to assess overfitting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All 1,842 included patients were event-free at triage completion, and 214 experienced a short-term critical outcome during the subsequent 72-hour period, corresponding to an event rate of 11.6%. The development cohort included 1,289 patients with 150 events, and the previously examined exploratory hold-ou","PeriodicalId":12488,"journal":{"name":"Frontiers in Medicine","volume":"13 ","pages":"1921692"},"PeriodicalIF":3.6,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149237682","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}