Journal of International Medical Research最新文献

{"title":"A single-cell atlas of peripheral immunity suggests immune subset attrition during tuberculosis dissemination.","authors":"Hairui Jiang, Chunlong Liu, Chunling Liu, Dapeng Wang","doi":"10.1177/03000605261480907","DOIUrl":"10.1177/03000605261480907","url":null,"abstract":"<p><p>ObjectiveThis study investigated immune lineage remodeling and intercellular communication to elucidate the mechanisms driving the progression from active tuberculosis to disseminated tuberculosis.MethodsWe integrated single-cell RNA-sequencing datasets of peripheral blood mononuclear cells from healthy controls, patients with active tuberculosis, and patients with disseminated tuberculosis (n = 3 for each group) to perform cellular clustering, functional assessment, and communication network analyses.ResultsAnalysis identified 16 clusters across 5 major lineages. Although global cellular proportions remained statistically stable across patient cohorts, disease progression was characterized by distinct cell-intrinsic transcriptomic shifts and subset-specific remodeling. This landscape was highlighted by the systematic peripheral depletion of homeostatic \"guardian\" monocytes, alongside functional disruptions in natural killer and B-cell states, and a severe-stage-specific accumulation of exhausted T cells. Consequently, circulating intercellular communication networks were broadly attenuated in infected groups, featuring diminished receptor-ligand interactions between peripheral dendritic cells and naïve CD8⁺ T cells, driven by cell-intrinsic transcriptional rewiring rather than shifts in underlying cell frequencies.ConclusionsTuberculosis progression involves profound peripheral immune remodeling marked by the systemic attrition of circulating homeostatic populations and altered blood interactome dynamics. This preliminary atlas provides an exploratory framework for potential therapeutic interventions in severe tuberculosis.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261480907"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual representation bias in artificial intelligence-generated depictions of anesthesia, pain, and intensive care professionals.","authors":"Muzeyyen Beldagli, Ahmet Ozan Aydin, Mehmet Alperen Avci, Selma Kahyaoglu, Taner Tunc, Yavuz Yigit, Serkan Tulgar","doi":"10.1177/03000605261470625","DOIUrl":"10.1177/03000605261470625","url":null,"abstract":"<p><p>ObjectiveTo evaluate the demographic and hierarchical representation biases in artificial intelligence-generated depictions of healthcare professionals in anesthesiology, pain medicine, and intensive care, with a focus on sex, age group, skin tone, ethnicity, and professional role hierarchy.MethodsThis cross-sectional comparative study analyzed 4400 artificial intelligence-generated images produced by 4 text-to-image models (DALL·E 3, Midjourney, Leonardo AI, and Gemini). Ten professional roles in anesthesiology, pain medicine, and intensive care, ranging from trainees to department heads, were evaluated. Two independent anesthesiologists with clinical experience in anesthesiology and intensive care assessed each image using a structured digital evaluation form, recording sex, age group, skin tone, ethnicity, and professional role hierarchy. Statistical comparisons were performed using chi-square test with Bonferroni-adjusted post hoc proportion analyses.ResultsMale representation predominated across roles and models (mean: 68.5%), with leadership positions showing the highest male proportion (up to 90.0%). Light skin tones (mean: 70.6%) and Caucasian ethnicity (mean: 68.0%) were the most commonly depicted categories. Younger individuals (age: <40 years) were overrepresented (mean: 53.1%), whereas individuals aged >60 years were rarely depicted (<3.0%) and appeared mainly in leadership roles. Significant differences in sex representation were observed in 9 out of 10 professional roles across artificial intelligence models, with the exception of the anesthesia specialist role (<i>p</i> = 0.051).ConclusionsText-to-image artificial intelligence systems consistently reproduced results with demographic and hierarchical biases in depictions of healthcare professionals in anesthesiology, pain medicine, and intensive care. The predominance of male, light skin tone, and Caucasian ethnicity, particularly in senior roles, highlights the need for more diverse training datasets and greater transparency in the development of artificial intelligence systems.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261470625"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13535063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148865329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 interpretability of a machine learning model for postoperative hypothermia prediction in placenta previa Cesarean section: A retrospective cohort study.","authors":"Yu Zhu, Daoqing Xie, Renrui Liang, Cheng-Mao Zhou","doi":"10.1177/03000605261485739","DOIUrl":"10.1177/03000605261485739","url":null,"abstract":"<p><p>ObjectiveTo develop and validate an explainable machine learning prediction model for perioperative hypothermia in patients undergoing cesarean delivery for placenta previa, and to identify key predictive factors to support clinical individualized temperature management and nursing decision-making.MethodsThis study is a retrospective secondary analysis conducted using BioStudies public databases. Ten machine learning algorithms, including logistic regression, decision tree, and random forest, were used to build hypothermia prediction models. Accuracy, precision, recall, F1-score, and AUC were selected as evaluation metrics to screen for the optimal model, and LIME was applied to generate individualized explanations for single-sample prediction outputs. A total of 167 real-world patients served as the independent test cohort, while 1000 synthetic data cases generated by the Synthetic Data Vault (SDV) algorithm served as the training cohort.ResultsPerformance comparisons across models showed the random forest model reached an AUC of 0.781 in the training set, but only 0.638 in the test set, a sign of severe overfitting. Gradient boosting models had a universally low test set recall of below 0.25, carrying a high risk of missed diagnosis. The logistic regression (LR) model exhibited the optimal overall performance: it attained the highest test-cohort accuracy among all evaluated models, with an AUC of 0.705, F1-score of 0.430, and recall of 0.327. Feature importance analysis found intraoperative blood loss to be the strongest predictor of hypothermia, followed by body weight as the second core contributing factor. LIME can intuitively visualize feature contributions for individual sample predictions. These outputs enable nurses to develop tailored warming intervention regimens.ConclusionThe logistic regression prediction model developed in this study may serve as a clinically useful tool with adequate generalization capacity and clinical interpretability for identifying hypothermia risk in patients undergoing cesarean delivery for placenta previa.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261485739"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of extended-release carbidopa-levodopa (IPX203) versus immediate-release carbidopa-levodopa for Parkinson's disease: A systematic review.","authors":"Ahmed Attar, Hasen H Aljadani, Khalid F Barwais, Abdalmajed A Alqsair, Faisal A Alharbi, Harith M Alharith, Abdullah A Fallatah, Mumen H Halabi, Alqassem Y Hakami, Nirmeen Zagzoog","doi":"10.1177/03000605261477638","DOIUrl":"10.1177/03000605261477638","url":null,"abstract":"<p><p>ObjectiveIPX203 is a newly approved oral carbidopa-levodopa formulation designed to prolong the therapeutic effect and reduce complications associated with the standard immediate-release formulation. Immediate-release carbidopa-levodopa remains the current standard of care but has a short duration of action. This study aimed to evaluate the efficacy and safety of IPX203 compared with immediate-release carbidopa-levodopa in patients with advanced Parkinson's disease.MethodsThis systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in the International Prospective Register of Systematic Reviews (registration number: CRD42024623230). A comprehensive search of PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, ScienceDirect, Scopus, and Embase identified randomized controlled trials comparing IPX203 with immediate-release carbidopa-levodopa. The primary outcomes were changes from baseline in \"Good On-time\" (periods of effective symptom control with minimal dyskinesia) and \"Off-time\" (periods when medication effects wear off and symptoms return). Secondary outcomes included scores on Part III of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale and adverse events.ResultsA total of 466 records were screened, resulting in the inclusion of three randomized controlled trials involving 560 participants. Compared with immediate-release carbidopa-levodopa, IPX203 increased total \"Good On-time\" and reduced \"Off-time.\" Scores on Part III of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale demonstrated greater improvement in motor function with IPX203. The incidence of adverse events was comparable between the two groups, although treatment-emergent adverse events and treatment discontinuations were more frequent in the IPX203 group.ConclusionCompared with immediate-release carbidopa-levodopa, IPX203 increased \"Good On-time,\" reduced \"Off-time,\" improved motor function as measured by Part III of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale, and demonstrated a comparable safety profile.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261477638"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence-assisted perioperative risk prediction, decision support, and supervised automation in anesthesia: A narrative review.","authors":"Ran An, Bingbing Meng, Xun Lu","doi":"10.1177/03000605261491422","DOIUrl":"https://doi.org/10.1177/03000605261491422","url":null,"abstract":"<p><p>Artificial intelligence is increasingly being investigated as a tool for supporting personalized perioperative care. This narrative review, guided by the Scale for the Assessment of Narrative Review Articles principles, examines clinically relevant applications of artificial intelligence and related automation in anesthesiology, with emphasis on three linked functions: risk prediction, clinical decision support, and supervised automation. We performed a structured search of PubMed, Web of Science, and Scopus databases and identified English-language literature published from January 2010 through June 2026. We prioritized clinical studies, guidelines, systematic reviews, and representative methodological studies. A central distinction of this review is that machine-learning prediction, rule-based decision support, conventional feedback control, and genuinely adaptive artificial intelligence-enabled control are not treated as equivalent technologies. Current evidence is strongest for selected prediction tasks and supervised systems that improve process measures such as time within a physiological target range. However, evidence that these technologies improve patient-centered outcomes remains less consistent. Model discrimination alone is insufficient; calibration, actionable thresholds, false-positive burden, external validation, clinical utility, dataset shift, missing data, and workflow consequences must also be considered. The proposed three-level framework is intended to provide anesthesiologists and perioperative teams with a practical way to connect technical capability with bedside action. Near-term implementation should prioritize interpretable prediction and low-burden decision support, whereas closed-loop systems should remain under clinician supervision. Future studies should emphasize prospective multicenter validation, clinically meaningful endpoints, transparent reporting, and post-deployment monitoring rather than technical performance alone.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261491422"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial peripherally inserted central catheter tip position accuracy by puncture arm and associated factors in female patients with breast cancer: A retrospective cohort study.","authors":"Min Zhang, Xue Liu, Lu Ruan, Xiaohong Pei, Qingquan Bi","doi":"10.1177/03000605261490822","DOIUrl":"https://doi.org/10.1177/03000605261490822","url":null,"abstract":"<p><p>ObjectiveTo examine the association between puncture arm and initial peripherally inserted central catheter tip positioning accuracy in female breast cancer patients and to explore related factors associated with malposition.MethodsThis retrospective cohort study included 402 female breast cancer patients undergoing chemotherapy requiring peripherally inserted central catheter placement. Patients were categorized into left-arm and right-arm groups. Demographic, clinical, and operator variables were analyzed. Pre-procedural anxiety status was evaluated using the Perioperative Anxiety Scale-7. Placement accuracy was assessed radiographically. Multivariate logistic regression identified independent predictors, and model performance was evaluated using receiver operating characteristic curve analysis.ResultsIn the matched cohort, initial tip accuracy was higher in the right-arm group (90.4%) than in the left-arm group (80.8%; <i>P</i> = 0.013). Left-arm selection, advanced age, compromised vascular condition, high pre-procedural anxiety, and limited operator experience were identified as independent factors associated with initial tip accuracy (<i>P</i> < 0.05). The multivariable descriptive model showed an apparent area under the curve of 0.825.ConclusionsIn this single-center retrospective cohort, right-arm puncture was associated with higher initial peripherally inserted central catheter tip positioning accuracy than left-arm puncture in female breast cancer patients. However, because breast cancer-specific factors influencing arm selection, including surgery laterality and axillary lymph node management, radiotherapy, and lymphedema-related factors, were not systematically collected, this association should not be interpreted as a causal effect of puncture side alone. These findings are hypothesis-generating and underscore the need for individualized peripherally inserted central catheter planning that considers clinical feasibility, venous condition, patient anxiety, treatment-related arm-selection factors, and operator experience.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261490822"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wilms tumor with rare spinal metastasis treated with surgery and chemotherapy: A case report.","authors":"Ying Bi, HaiYang Jiang, ShangHu Qu, Chen Hu, Yong Zhu, LongGuo Dai, ChongJian Zhang, Yu Bai","doi":"10.1177/03000605261466854","DOIUrl":"https://doi.org/10.1177/03000605261466854","url":null,"abstract":"<p><p>Nephroblastoma, also known as Wilms tumor, is the most common type of kidney cancer found in pediatric patients. The majority of cases (75%) occur in children aged 1-5 years, with a peak incidence at approximately 3 years of age. Hematogenous spread primarily involves the lungs (81%), followed by the liver and lungs (15%) and other sites (4%). Additionally, the tumor can spread to regional lymph nodes. In contrast to clear cell sarcoma and other renal malignancies, Wilms tumor rarely metastasizes to the brain and bones. A 4-year-old boy was diagnosed with left nephroblastoma and received one round of neoadjuvant chemotherapy followed by radical removal of the left kidney. Post-surgery, he underwent seven additional cycles of chemotherapy. However, the cancer recurred 5 years and 10 months later, presenting as a rare occurrence of spinal metastasis and paraplegia in both legs. The child underwent surgery to remove the tumor from the L3 vertebra along with spinal canal and nerve root decompression, bone graft fusion, and internal fixation using a nail-rod system. Following four cycles of adjuvant chemotherapy, imaging confirmed complete remission, and his paraplegic symptoms improved significantly. However, 1 year after treatment, the child experienced tumor recurrence (bilateral lung metastasis). This case illustrates that in patients with nephroblastoma accompanied by uncommon spinal metastasis and symptoms of spinal cord compression, timely surgical intervention to alleviate the compression and remove the tumor, followed by chemotherapy can result in favorable treatment outcomes and considerably enhance the child's quality of life.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261466854"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrative network toxicology and transcriptomic analyses identify <i>DCP1B</i> and <i>HAS2</i> as key prognostic biomarkers in formaldehyde-associated Wilms tumor.","authors":"Gui Jun Li, Sheng Zhang, Li Na Chang, Zhong Xian Li, Yang Yang Duan, Qi Liu","doi":"10.1177/03000605261488784","DOIUrl":"https://doi.org/10.1177/03000605261488784","url":null,"abstract":"<p><p>Background and objectivesWilms tumor, a common childhood malignancy, has been hypothesized to be associated with environmental factors such as formaldehyde exposure. As a potential endocrine disruptor with reported pro-proliferative effects, the molecular mechanism underlying the role of formaldehyde in Wilms tumor remains unclear. This study systematically investigated the mechanisms linking formaldehyde exposure to Wilms tumor using network toxicology and transcriptomic analysis.MethodsTranscriptomic data were obtained from The Cancer Genome Atlas and Gene Expression Omnibus databases, whereas formaldehyde-related targets were predicted using the Search Tool for Interactions of Chemicals and Comparative Toxicogenomics databases. Candidate genes were screened through differential expression (|log2FC| > 2.5, <i>p</i> < 0.05) and weighted gene coexpression network analyses. Prognostic key genes were identified using univariate and Lasso-Cox regression, with nomogram construction and survival analysis. Single-cell RNA sequencing data (GSE223373) were further analyzed to characterize cellular heterogeneity and the cell-type-specific expression patterns of the identified key genes.ResultsSeventy-nine candidate genes associated with Wilms tumor were identified using multidimensional intersection analysis. These genes were significantly involved in pathways such as microRNAs in cancer and the cell cycle. Univariate Cox and Lasso-Cox regression analyses identified <i>DCP1B</i> and <i>HAS2</i> as key genes closely associated with the prognosis of patients with Wilms tumor. Kaplan-Meier survival analysis demonstrated that higher expressions of <i>DCP1B</i> and <i>HAS2</i> were significantly associated with better overall survival in these patients. The nomogram model constructed based on the two key genes demonstrated excellent calibration (area under the curve > 0.8) and clinical applicability. Network analysis identified <i>NEAT1</i>, the hsa-let-7 microRNA, and transcription factors such as <i>PDX1</i> and <i>E2F1</i> were as core regulatory nodes. Single-cell analysis demonstrated pronounced stromal expansion within Wilms tumor specimens and further revealed that <i>DCP1B</i> was preferentially enriched in tumor epithelial cells, whereas <i>HAS2</i> exhibited a stromal-skewed distribution, predominantly within mesangial cells.Conclusions<i>DCP1B</i> and <i>HAS2</i> were identified as key prognostic genes for Wilms tumor. These findings suggest that formaldehyde exposure is associated with Wilms tumor pathogenesis through the potential involvement of cancer-associated microRNA pathways and cell cycle signaling, which could contribute to dysregulated cell proliferation and apoptosis.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261488784"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodality cardiac imaging in advanced heart failure: Diagnosis, risk stratification, and therapeutic guidance.","authors":"Shouli Xia, Youshi Wu, Hussain Asif, Saifane Zakaria, Weiyong Sheng","doi":"10.1177/03000605261489329","DOIUrl":"https://doi.org/10.1177/03000605261489329","url":null,"abstract":"<p><p>Advanced heart failure represents a high-risk clinical stage in which imaging is used not only to document ventricular dysfunction but also to clarify etiology, assess right-sided reserve, define valvular and pulmonary vascular contributions, stratify risk, and determine suitability for advanced therapies. In this narrative review, guided by the Scale for the Assessment of Narrative Review Articles, we summarized the contemporary role of echocardiography, cardiac magnetic resonance, cardiac computed tomography, and selected nuclear imaging techniques in the evaluation of patients with advanced heart failure. A focused literature search of PubMed and major cardiology society guidance was performed to identify clinically relevant publications on multimodality imaging in advanced heart failure, durable mechanical circulatory support, transplantation, valvular intervention, and risk stratification. Echocardiography remains the first-line modality for bedside assessment of ventricular performance, congestion, filling pressures, and valve disease. Cardiac magnetic resonance is particularly useful for tissue characterization, fibrosis assessment, etiologic clarification, and arrhythmic risk evaluation. Cardiac computed tomography provides high-value anatomical information for procedural planning, including left ventricular assist device implantation and structural interventions. Nuclear imaging plays a more selective role in viability assessment and evaluation of infiltrative or inflammatory cardiomyopathies. A practical multimodality strategy should be question-driven rather than test-driven, with each modality selected according to the next management decision. This approach may improve clinical usefulness, reduce redundant testing, and better support individualized management in advanced heart failure.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261489329"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-traumatic neurogenic thoracic outlet syndrome: Clinical presentation and surgical outcomes-A retrospective cohort study.","authors":"Mohammed Yassin Rasul, Bawan Bakr Wahab, Ako Nooralddin Abdalla, Aram Baram","doi":"10.1177/03000605261488728","DOIUrl":"https://doi.org/10.1177/03000605261488728","url":null,"abstract":"<p><p>ObjectivePost-traumatic neurogenic thoracic outlet syndrome remains an underreported condition, particularly in high-trauma and resource-limited settings. This study aimed to characterize the clinical presentation of post-traumatic neurogenic thoracic outlet syndrome and evaluate functional outcomes, recurrence, and factors associated with outcomes following surgical decompression.MethodsThis retrospective cohort study included 400 consecutive patients with post-traumatic neurogenic thoracic outlet syndrome who underwent supraclavicular thoracic outlet decompression between 2007 and 2024. Patients with arterial or venous thoracic outlet syndrome were excluded. All patients underwent first-rib resection with anterior and middle scalenectomy and excision of associated anomalous osseous structures when present. Functional outcomes were assessed using the disabilities of the arm, shoulder, and hand score. Recurrence-free survival was evaluated using Kaplan-Meier analysis, and multivariable regression was used to identify factors associated with recurrence and functional improvement. The follow-up duration ranged from 24 to 60 months.ResultsThe mean participant age was 36.1 ± 9.5 years, and 255 patients (63.7%) were women. Falls from height (27.3%), physical assault (26.0%), pedestrian injury (24.8%), and road traffic accidents (22.0%) were the principal trauma mechanisms. Cervical ribs were present in 37.0% and elongated transverse processes in 30.8% of the study participants. The mean disabilities of the arm, shoulder, and hand score decreased from 54.8 ± 9.0 preoperatively to 9.8 ± 6.0 postoperatively (<i>p</i> < 0.001). During follow-up, 120 patients (30.0%) developed recurrence. Cervical rib was associated with increased recurrence (odds ratio: 1.50, 95% confidence interval: 1.05-2.10; <i>p</i> = 0.02) and less functional improvement (β = -2.1; <i>p</i> = 0.04). Pneumothorax requiring chest-tube drainage occurred in 2.0%; no major neural or vascular injuries or perioperative deaths were recorded.ConclusionsIn this retrospective cohort, supraclavicular decompression was associated with substantial functional improvement in selected patients with persistent post-traumatic neurogenic thoracic outlet syndrome. Cervical rib may be associated with recurrence and less favorable functional recovery. Prospective multicenter studies are warranted to confirm these findings.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261488728"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}