Medicine最新文献

{"title":"Association between timely and standardized nursing pain management and outcomes in terminal cancer patients: A retrospective cohort study.","authors":"Hongmei Nie, Lu Xiao, Lu Mo, Li Xian, Zhiwei Xiao","doi":"10.1097/MD.0000000000051112","DOIUrl":"https://doi.org/10.1097/MD.0000000000051112","url":null,"abstract":"<p><p>Effective pain management is essential for terminal cancer patients in emergency settings, yet nursing protocol adherence remains suboptimal. This study aimed to evaluate the association between key nursing process indicators and pain relief outcomes in terminal cancer patients presenting to the emergency department (ED) and to examine clinical outcomes according to adherence to an optimized nursing pain management workflow. We conducted a retrospective cohort study involving 724 terminal cancer patients who visited the ED of the Affiliated Hospital of Southwest Medical University between January 2017 and December 2023. Eligible patients presented with pain as a primary complaint and had complete clinical and nursing documentation. Data were extracted on demographics, cancer type, pain scores, timing of analgesic administration, and reassessment practices. The primary outcome was effective pain relief, defined as a ≥2-point reduction on the numeric rating scale within 1 hour of analgesia. Multivariate logistic regression was used to identify independent predictors. Patients were stratified into an optimized care group (completion of pain assessment within 30 minutes, analgesia within 30 minutes, and reassessment within 1 hour) and a routine care group. Of the 724 patients included, 58.2% achieved effective pain relief. Multivariate analysis revealed that timely pain assessment (odds ratio [OR] = 1.84, 95% confidence interval [CI]: 1.26-2.69), analgesic administration within 30 minutes (OR = 2.24, 95% CI: 1.57-3.21), opioid use (OR = 1.52, 95% CI: 1.06-2.20), and documented pain reassessment (OR = 1.69, 95% CI: 1.22-2.35) were independently associated with improved pain outcomes. Patients in the optimized care group (n = 286) had significantly higher pain relief rates (75.9% vs 46.6%, P < .001), faster relief onset (29.6 ± 11.3 vs 52.7 ± 15.9 minutes, P < .001), shorter ED stays (3.4 ± 1.1 vs 4.7 ± 1.4 hours, P < .001), and lower 72-hour revisit rates (7.3% vs 21.0%, P < .001). Timely and standardized nursing interventions were associated with more favorable pain relief and emergency department care-efficiency outcomes among terminal cancer patients. These findings support the integration of structured nursing protocols into emergency palliative care, although prospective studies are needed to determine their causal effects.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51112"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206900","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":"Comparative outcomes of arteriovenous accesses with and without tunneled hemodialysis catheters: A retrospective cohort study.","authors":"Heng Su, Ting-Wei Lin, Jian-Han Chen, Hsuan-Yin Wu","doi":"10.1097/MD.0000000000051077","DOIUrl":"https://doi.org/10.1097/MD.0000000000051077","url":null,"abstract":"<p><p>This study compared patency rates of arteriovenous accesses with and without concurrent tunneled hemodialysis catheter (THC) use, addressing limited research on combined outcomes. A retrospective cohort analysis was conducted on patients undergoing arteriovenous access creation at a single hospital between January 2021 and December 2022. Primary outcomes were the 6-month primary patency rate and functional dialysis success. Secondary outcomes were the factors associated with each of these endpoints. Statistical analyses employed t tests, chi-square tests, logistic regression, and Kaplan-Meier survival curves. A total of 319 vascular accesses were included. The 6-month patency rate was significantly higher in the access-only group than in the access + THC group (87.04% vs 78.20%, P = .04). THC usage (odds ratio [OR] = 0.49, 95% confidence interval [CI]: 0.25-0.95, P = .03), graft usage (OR = 0.38, 95% CI: 0.18-0.82, P = .01), and higher hemoglobin levels (OR = 0.80, 95% CI: 0.65-0.96, P = .02) were associated with reduced patency rates. Functional dialysis success at 6 months did not differ significantly between groups (87.96% vs 83.89%, P = .21). However, older age (OR = 0.96, 95% CI: 0.93-0.99, P = .01), use of a cubital artery to an autologous vein (OR = 0.39, 95% CI: 0.19-0.82, P = .01) or graft (OR = 0.40, 95% CI: 0.17-0.97, P = .04), and higher hemoglobin levels (OR = 0.81, 95% CI: 0.66-0.99, P = .03) were associated with a lower likelihood of functional dialysis success. Concurrent THC use was independently associated with reduced 6-month primary patency without a corresponding reduction in the short-term delivery of dialysis, suggesting an increased need for interventions to maintain the access. Judicious use of THCs and careful consideration of the vascular access type are important to optimize vascular access outcomes in patients undergoing hemodialysis.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51077"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207187","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":"Complete remission of minimal change disease after antiviral monotherapy in a patient with immune-active chronic hepatitis B: A case report.","authors":"Tae Won Lee, Ha Nee Jang, Dae Hyun Song, Sehyun Jung, Seunghye Lee, Se-Ho Chang, Dong Jun Park","doi":"10.1097/MD.0000000000050999","DOIUrl":"https://doi.org/10.1097/MD.0000000000050999","url":null,"abstract":"<p><strong>Rationale: </strong>Minimal change disease (MCD) is characterized by diffuse podocyte foot process effacement on electron microscopy, minimal structural changes on light microscopy, and the absence of immune complex deposition on immunofluorescence. In adults, MCD accounts for approximately 10% to 25% of nephrotic syndrome cases and is typically idiopathic, although secondary causes such as infections, medications, malignancies, and immune disorders have been reported. The association between hepatitis B virus (HBV) infection and glomerular disease has been well established in membranous nephropathy and mesangial proliferative glomerulonephritis. However, HBV-associated MCD is rare.</p><p><strong>Patient concerns: </strong>A 42-year-old woman presented with a 1-week history of generalized edema and weight gain. Physical examination revealed severe bilateral pretibial pitting edema, and laboratory evaluation revealed hypoalbuminemia and nephrotic-range proteinuria.</p><p><strong>Diagnoses: </strong>The urine protein-to-creatinine ratio was elevated to 4.3, while renal function remained unchanged. Serological testing was positive for hepatitis B surface antigen and hepatitis B e-antigen, with a high viral load (HBV deoxyribonucleic acid 505,437 IU/mL), consistent with immune-active chronic hepatitis B infection. Renal biopsy showed nearly normal glomerular architecture on light microscopy, diffuse podocyte foot process effacement on electron microscopy, and no significant immune complex deposition on immunofluorescence, confirming MCD.</p><p><strong>Interventions: </strong>Antiviral therapy with tenofovir alafenamide 25 mg orally once daily was initiated and continued throughout the 3-year follow-up period.</p><p><strong>Outcomes: </strong>Proteinuria progressively improved, and complete remission was achieved at 8 months (urine protein-to-creatinine ratio, 0.2). The patient maintained sustained remission with persistent viral suppression during a 3-year follow-up.</p><p><strong>Lessons: </strong>Complete remission of MCD was temporally associated with antiviral monotherapy in a patient with immune-active HBV. Although potential confounding factors such as spontaneous remission or the supportive effects of concurrent angiotensin receptor blocker therapy cannot be entirely excluded, this case suggests that viral suppression may play a role in restoring podocyte function. Renal biopsy is essential for accurate diagnosis and treatment planning because corticosteroid therapy may exacerbate viral replication and hepatic injury. Antiviral monotherapy may represent a reasonable initial therapeutic strategy in select patients with biopsy-proven MCD and active hepatitis B infection.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e50999"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207152","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":"Individualized multimodal pain management for chronic perineal pain: A case report.","authors":"Xuemeng Ren, Lixin Cong","doi":"10.1097/MD.0000000000051175","DOIUrl":"https://doi.org/10.1097/MD.0000000000051175","url":null,"abstract":"<p><strong>Rationale: </strong>Persistent perineal pain is a challenging clinical condition that may substantially impair sleep, urination, daily activities, and psychological well-being. Accurate assessment and individualized multimodal management are essential for improving symptom control and patient participation in care.</p><p><strong>Patient concerns: </strong>A 68-year-old woman presented with chronic perineal pain and tenderness that had persisted for 3 years. The pain significantly interfered with her sleep, urination, and daily activities.</p><p><strong>Diagnoses: </strong>Clinical assessment suggested chronic perineal pain with neuropathic involvement of the pudendal nerve and lumbosacral or sacral nerve roots. The diagnosis was established based on the patient's clinical manifestations, physical examination findings, and comprehensive evaluation.</p><p><strong>Interventions: </strong>The patient received a multimodal pain management approach, including oral pregabalin, computed tomography-guided sacral canal catheterization with targeted nerve-root adhesiolysis and ozone injection, continuous pain assessment, psychological support, pelvic floor muscle training, and individualized rehabilitation guidance.</p><p><strong>Outcomes: </strong>At the two-week follow-up, the visual analog scale score decreased from 8/10 to 3/10, and the pain no longer interfered with sleep. Approximately 3 weeks after discharge, the pain temporarily increased to 5/10 and subsequently stabilized at 4/10 at the one-month follow-up while the patient continued oral pregabalin.</p><p><strong>Lessons: </strong>Individualized multimodal pain management may effectively reduce pain intensity and improve sleep and daily functioning in patients with persistent perineal pain. Continuous assessment, patient participation, psychological support, and rehabilitation strategies are important components of comprehensive pain management.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51175"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207218","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":"Repetitive transcranial magnetic stimulation for the treatment of restless legs syndrome: A meta-analysis.","authors":"Zhenchao Dong, Xiaojun Zhang, Jiaqin Zhang, JinTao Yuan, Hanbo Li, Weigang Tang, Wei Jiang, Wei Xu","doi":"10.1097/MD.0000000000051088","DOIUrl":"https://doi.org/10.1097/MD.0000000000051088","url":null,"abstract":"<p><strong>Background: </strong>The benefit of repetitive transcranial magnetic stimulation (rTMS) in patients with Restless Legs Syndrome (RLS) is uncertain. This study was performed to explore the therapeutic effect of rTMS in treating RLS.</p><p><strong>Methods: </strong>Databases including PubMed, EMbase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang database were searched from their inception to May 1, 2026. Eligible studies comparing rTMS with sham stimulation were included. Data were analyzed using Review Manager Version 5.3.</p><p><strong>Results: </strong>Four studies were included in the meta-analysis. The overall pooled analysis confirmed that rTMS could effectively reduce International RLS-Rating Scale (IRLS-RS) scores (mean difference [MD] = 6.46, 95% confidence interval [CI]: 4.44 -8.48, P < .00001) and Pittsburgh sleep quality index (PSQI) scores (MD = 4.80, 95% CI: 3.51-6.08, P < .00001) at different follow-up periods. Meanwhile, the overall pooled analysis confirmed that rTMS could effectively reduce IRLS-RS scores (MD = 7.79, 95% CI: 3.90-11.68, P < .0001) and PSQI scores (MD = 5.58, 95% CI: 3.81-7.35, P < .00001) in the subgroup analysis by RLS subtype. However, rTMS showed no significant effect on PSQI scores in primary RLS (MD = 1.86, 95% CI: -2.65-6.37, P = .42). In addition, the overall pooled analysis confirmed that both low-frequency and high-frequency rTMS could effectively reduce IRLS-RS scores (MD = 7.79, 95% CI: 3.90-11.68, P < .0001) and PSQI scores (MD = 5.58, 95% CI: 3.81-7.35, P < .00001). Finally, the overall pooled analysis confirmed that rTMS could not significantly reduce Hamilton anxiety scale and Hamilton depression scale scores in subgroup analyses of follow-up period, RLS subtype, or rTMS frequency (P > .05).</p><p><strong>Conclusion: </strong>rTMS might alleviate core limb discomfort symptoms measured by IRLS-RS and improve sleep quality assessed by PSQI in patients with RLS. However, rTMS might not be effective in improving symptoms of anxiety and depression. To further confirm the conclusion, more large randomized controlled trials are necessary.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51088"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207252","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":"Completed clinical trials of p53-targeted therapeutic strategies in cancer: A cross-sectional ClinicalTrials.gov registry analysis.","authors":"Nasser M Alorfi, Nouf M Alourfi","doi":"10.1097/MD.0000000000050949","DOIUrl":"10.1097/MD.0000000000050949","url":null,"abstract":"<p><p>The tumor suppressor gene TP53 is one of the most frequently altered genes in human cancers and plays a central role in regulating cell cycle arrest, apoptosis, and genomic stability. Therapeutic strategies targeting the p53 pathway have been investigated to restore or exploit p53 function in human malignancies. However, the characteristics, reporting completeness, and clinical development patterns of completed trials evaluating p53-targeted therapeutic strategies have not been comprehensively summarized. This study aims to characterize the design, therapeutic strategies, reporting completeness, and primary objectives of completed clinical trials investigating p53-targeted therapeutic strategies for cancer. A cross-sectional registry analysis of ClinicalTrials.gov was conducted using the search terms \"Cancer\" AND \"p53 gene therapy.\" Completed studies available as of 1 July 2025 were screened for eligibility. Trials investigating p53-targeted therapeutic strategies, including p53 gene therapy and other therapeutic approaches directly targeting the p53 pathway, were included. Data extracted included study design, cancer type, therapeutic strategy, clinical phase, enrollment, and primary outcome measures. Descriptive statistics were used to summarize study characteristics; no inferential statistical analyses were performed. Twenty-three completed studies met the eligibility criteria, including 20 (87.0%) interventional and 3 (13.0%) observational studies. The included studies evaluated diverse p53-targeted therapeutic strategies, including adenoviral vector-mediated p53 gene therapy, chemotherapy combinations, immunotherapeutic approaches, biomarker-guided treatment strategies, and molecularly targeted therapies. Early-phase clinical development predominated, with Phase I studies accounting for the largest proportion of completed trials. Enrollment information was available for 17 (73.9%) studies, whereas six (26.1%) did not report participant numbers. Primary outcome measures were reported for 15 (65.2%) studies, while eight (34.8%) lacked clearly defined primary outcomes. Five studies (21.7%) had publicly posted study results on ClinicalTrials.gov, whereas 18 (78.3%) had no posted results available. Reported primary endpoints predominantly focused on safety, dose escalation, treatment feasibility, and biomarker evaluation. Completed clinical trials investigating p53-targeted therapeutic strategies remain predominantly in the early stages of clinical development and have primarily focused on evaluating safety, feasibility, and preliminary biological activity rather than definitive treatment efficacy. Variability in registry reporting, including incomplete enrollment, primary outcome, and study result reporting, limits comprehensive assessment of the current evidence base.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e50949"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207208","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":"Retrospective observational study of transcatheter arterial chemoembolization (TACE) combined with PD-1 inhibitor and tyrosine kinase inhibitor (TKI) in advanced hepatocellular carcinoma.","authors":"Guohui Xu, Jianlong Zhang, Xiaojun Li, Shilan Fan, Xiao Wu, Cuncai Zhou","doi":"10.1097/MD.0000000000050965","DOIUrl":"10.1097/MD.0000000000050965","url":null,"abstract":"<p><p>Transcatheter arterial chemoembolization (TACE) induces tumor necrosis and antigen release, but the resulting hypoxic microenvironment upregulates programmed death-ligand 1and vascular endothelial growth factor, providing a biological rationale for adding a programmed death-1 (PD-1) inhibitor and a TKI. The study aims to assess the effectiveness and safety of a treatment regimen consisting of TACE, tyrosine kinase inhibitors, and PD-1 inhibitors in patients diagnosed with advanced hepatocellular carcinoma (HCC) that cannot be treated surgically. This retrospective observational study (Jiangxi Cancer Hospital, Jan 2021-Jun 2023) enrolled 52 advanced HCC patients, with 45 included in final analysis. Primary endpoints were progression-free survival (PFS) and overall survival (OS); secondary endpoints covered objective response rate, Disease Association for the Study of the Liver and safety. Survival was analyzed via Kaplan-Meier method and Cox proportional hazards regression. The cohort comprised 38 men and 7 women with a mean age of 50.9 ± 12.06 years, and 36 patients (80.0%) were hepatitis B virus antigen positive. At 6 months, the PFS rate stood at 71.1%, while at twelve months, it was recorded at 51.7%. The median PFS reached 12.4 months (95% confidence interval: 9.8-15.0), while the median OS was found to be 24.2 months (95% confidence interval: 20.1-28.3). The objective response rate was 44.4% and Disease Association for the Study of the Liver was 91.1%. Barcelona Clinic Liver Cancer (BCLC) staging significantly affected prognosis, with median PFS for BCLC A, B, C, and D being 19.2, 16.5, 12.1, and 4.8 months, respectively (log-rank P = .016). Median PFS for first-, second-, and third-line treatments were 17.1, 12.6, and 3.2 months, respectively (log-rank P < .001). Patients with positive node expression had significantly shorter PFS (5.1 vs 9.9 months, HR = 2.89, P = .005) and OS (14.9 vs 25.0 months, HR = 3.24, P = .002) compared to those with negative node expression. No grade 5 adverse events occurred. TACE combined with tyrosine kinase inhibitor and PD-1inhibitors shows promising efficacy and acceptable safety for advanced HCC. BCLC staging, treatment line and node status significantly affect outcomes, with earlier intervention yielding greater survival benefit. These exploratory findings from a small retrospective single-arm study require confirmation in larger prospective trials.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e50965"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207257","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":"The effects of multiregional fascial mobilization on heart rate and physiological parameters in patients with obstructive sleep apnea: A randomized controlled trial.","authors":"Engin Ramazanoglu, Funda Mete Cavus, Dogan Burak Endamli, Mehmet Kabak, Baris Cil","doi":"10.1097/MD.0000000000051172","DOIUrl":"10.1097/MD.0000000000051172","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea (OSA) is associated with increased sympathetic activity and an elevated cardiovascular risk. Noninvasive interventions targeting autonomic regulation may offer complementary therapeutic strategies.</p><p><strong>Methods: </strong>This randomized controlled trial aimed to investigate the acute effects of multiregional fascial mobilization on the physiological parameters of patients with OSA. Patients with polysomnography-confirmed moderate-to-severe OSA (apnea-hypopnea index ≥ 15 events/hour) were randomly assigned to an intervention group that received a standardized 16-minute multiregional fascial mobilization protocol or a control group that rested quietly in the supine position for the corresponding period without receiving manual or tactile intervention. The intervention targeted the cervical, thoracic, and abdominal regions, under controlled conditions. The primary outcomes included heart rate, systolic and diastolic blood pressure, and peripheral oxygen saturation. Measurements were obtained at baseline, immediately post-intervention, and 5 and 15 minutes post-intervention.</p><p><strong>Results: </strong>A total of 95 male patients (mean age: 48.12 ± 10.21 years) completed the study. Baseline characteristics were comparable between the groups, except for heart rate. After adjustment for baseline heart rate using mixed analysis of covariance, no significant group × time interaction was observed for heart rate (P = .476, partial ηp2 = .008). Similarly, no significant group × time interactions were observed for systolic blood pressure, diastolic blood pressure, or peripheral oxygen saturation (all P > .05). Although significant time effects were observed for some physiological parameters, the magnitude of these effects varied across outcomes, and none was accompanied by a significant group × time interaction. Therefore, these temporal changes were not interpreted as intervention-specific effects. No adverse events were reported.</p><p><strong>Conclusion: </strong>Heart rate changed significantly over time following the interventions; however, after adjustment for baseline heart rate, the pattern of change did not differ significantly between the fascial mobilization and control groups. Similarly, no significant between-group differences in changes over time were observed for blood pressure or oxygen saturation. These findings do not demonstrate a specific acute effect of multiregional fascial mobilization on the physiological parameters assessed. Further studies using advanced measures of autonomic function and longer follow-up periods are warranted.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51172"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207292","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":"Association of baseline non-severe anemia with clinical outcomes following the first recorded diagnosis of systemic sclerosis: A matched cohort study.","authors":"Yi-Chen Lai, Hsiu-Lan Weng, Kuo-Chuan Hung, I-Chia Teng, Kuo-Mao Lan, I-Wen Chen","doi":"10.1097/MD.0000000000051159","DOIUrl":"https://doi.org/10.1097/MD.0000000000051159","url":null,"abstract":"<p><p>Systemic sclerosis (SSc) carries the highest mortality among systemic autoimmune diseases, yet the prognostic significance of anemia around the time of the first recorded SSc diagnosis is unclear. We examined whether baseline anemia is associated with early mortality and complications. This retrospective matched cohort study identified female adults with a first recorded SSc diagnosis between January 2010 and December 2024 from the TriNetX Research Network. Patients were required to have at least 5 years of pre-index observation without a documented SSc diagnosis. The network comprised 140 healthcare organizations, with approximately 70% of patients in the United States across all 9 census regions and 30% at international sites. Anemia was defined as hemoglobin (Hb) ≥8.0 and <12.0 g/dL and non-anemia as ≥12.0 g/dL, measured within ±30 days of diagnosis. For the Hb-stratified analysis, the anemia cohort was categorized as Hb ≥10.0 to <12.0 g/dL or ≥8.0 to <10.0 g/dL. One-to-one propensity score matching balanced baseline characteristics, and Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs). The primary outcome was all-cause mortality during days 31 to 365 among patients surviving the 30-day landmark period; secondary outcomes were sepsis, acute kidney injury, intensive care unit admission, pulmonary fibrosis, and elevated C-reactive protein (≥10 mg/L). After matching, 5410 patients remained in each cohort. Baseline anemia was significantly associated with higher 1-year mortality (HR, 2.54; 95% CI, 1.99-3.22; P < .001) and with increased risks of sepsis (HR, 3.20; 95% CI, 2.38-4.30), acute kidney injury (HR, 2.24; 95% CI, 1.80-2.78), intensive care unit admission (HR, 1.92; 95% CI, 1.47-2.51), and elevated C-reactive protein (HR, 1.55; 95% CI, 1.37-1.74; all P < .001); no significant association was observed for pulmonary fibrosis (HR, 1.06; 95% CI, 0.96-1.17; P = .229). Associations persisted in sensitivity analyses and over 3-year follow-up. Mortality risk showed a graded pattern across Hb strata (Hb ≥10.0-<12.0 g/dL: HR, 1.66; Hb ≥8.0-<10.0 g/dL: HR, 3.33). Baseline anemia was associated with increased mortality and acute systemic complications following the first recorded SSc diagnosis; these observational findings warrant prospective validation.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51159"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206879","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":"Association between frailty and multisite chronic pain in middle-aged and older adults: A population-based cross-sectional study with mediation analysis.","authors":"Yating Cheng, Yang Ji, Yuning Bai","doi":"10.1097/MD.0000000000051255","DOIUrl":"https://doi.org/10.1097/MD.0000000000051255","url":null,"abstract":"<p><p>The corrected modified frailty index (CMFI), based on the accumulation of multidimensional health impairments, provides a more comprehensive reflection of an individual's overall frailty. Although chronic pain is associated with aging, its relationship with CMFI, in population-based cohorts remains unclear. This cross-sectional study included 5821 participants aged ≥45 years from the 2011 baseline wave of the China Health and Retirement Longitudinal Study. Chronic pain, including low back pain, multisite pain, and the number of pain sites, was assessed via self-reported questionnaires. Frailty was assessed using the CMFI. Weighted logistic regression models, restricted cubic splines, and mediation analyses were employed to investigate associations and the potential roles of depression and C-reactive protein. Analysing data from 5281 participants, higher CMFI was strongly associated with increased risk and burden of chronic pain. Compared with the lowest quartile, the highest CMFI quartile showed significantly higher risks of low back pain (odds ratio = 11.6, 95% confidence interval [CI]: 8.96-15.0), multisite pain (odds ratio = 17.0, 95% CI: 13.1-22.2), and a greater number of pain sites (incidence rate ratio = 11.5, 95% CI: 8.90-14.8). Associations varied across subgroups defined by age, education, and residence. Depression mediated approximately 30% of these associations. Higher CMFI levels were associated with greater risk and burden of chronic pain, with depression potentially accounting for part of the association. These findings highlight the importance of incorporating mental health assessments into frailty and pain management among the middle-aged and older adults included in China Health and Retirement Longitudinal Study.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51255"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206848","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}