Medicine最新文献

{"title":"Comparative evaluation of large language models for text-based diagnostic reasoning in fetal central nervous system MRI: A retrospective single-center diagnostic accuracy study.","authors":"Runze Yu, Miao Peng, Huiying Li, Simeng Liu, Tong Su, Hanjie Guan, Yufeng Shen, Yuhui Deng, Deli Zhao","doi":"10.1097/MD.0000000000050485","DOIUrl":"https://doi.org/10.1097/MD.0000000000050485","url":null,"abstract":"<p><p>Fetal magnetic resonance imaging (MRI) plays an important role in evaluating prenatal central nervous system (CNS) abnormalities, but expert interpretation and counseling remain challenging. Large language models (LLMs) may support text-based diagnostic reasoning, yet their performance in fetal CNS MRI has not been well characterized. The study aimed to compare ChatGPT, Gemini, and DeepSeek in text-based diagnostic reasoning for fetal CNS MRI cases. This retrospective single-center study included 85 fetal MRI cases with postnatal diagnostic confirmation. Each case was converted into a standardized text summary containing MRI findings and essential clinical information, without image input. The 3 LLMs generated ranked differential diagnoses, diagnostic reasoning, management recommendations, prognostic counseling points, and clinical cautions. Anonymized outputs were independently evaluated under blinded conditions for principal diagnosis matching, diagnostic accuracy, clinical reasoning quality, clinical suggestion utility, and communication style and safety. DeepSeek achieved the highest principal diagnosis matching rate (66/85, 77.6%), followed by Gemini (59/85, 69.4%) and ChatGPT (52/85, 61.2%). The overall difference was significant (Cochran's Q = 6.2553, P = .0438), although no pairwise comparison remained significant after Holm correction. DeepSeek showed the highest diagnostic accuracy and reasoning quality, whereas Gemini performed best in clinical suggestion utility and communication style and safety. Exploratory correlation analyses suggested model-specific associations among evaluation metrics. LLM performance in fetal CNS MRI text-based reasoning was multidimensional and model-dependent. These findings support further supervised evaluation of LLMs as text-based decision-support tools but do not support autonomous clinical diagnosis or counseling.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50485"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897067","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":"Analysis of endometrial histopathological classifications and associated factors in infertile women with heterogeneous endometrial echogenicity.","authors":"Saihua Ma, Rong Dong, Jiao Liu, Jingyu Xu, Baojuan Wang, Linlin Fan, Zheng Gong, Tian Xia","doi":"10.1097/MD.0000000000050528","DOIUrl":"https://doi.org/10.1097/MD.0000000000050528","url":null,"abstract":"<p><p>Infertility is a key reproductive health challenge, with endometrial lesions as a major cause. Heterogeneous endometrial echo is an initial screening tool, and hysteroscopy plus pathology is the diagnostic gold standard. This study explored pathological subtypes, risk factors of heterogeneous echo in infertile women, and predictive models' performance. This study analyzes the histopathological classifications and associated influencing factors of endometrial tissue in infertile women with heterogeneous endometrial echogenicity identified on ultrasound. It also seeks to explore the clinical value of such echogenic patterns in diagnosing endometrial lesions, thereby providing evidence-based support for the clinical diagnosis and management of these patients. This was a cross-sectional study that enrolled infertile patients undergoing hysteroscopy due to heterogeneous endometrial echogenicity. We analyzed the histopathological classifications of the endometrium and its associated influencing factors. A total of 312 infertile women with heterogeneous endometrial echo were retrospectively analyzed. Clinical data, hysteroscopic findings, and pathology results were collected. Group comparisons, Spearman correlation, logistic regression, receiver operating characteristic curves/confusion matrices, neural network, and restricted cubic spline were used. A total of 227 (72.8%) had endometrial lesions (chronic endometritis: 175, 56.09%; polyps: 85, 27.24%; hyperplasia: 106; fibroids: 2); 85 (27.24%) were negative. Body mass index, infertility duration, and endometrial thickness correlated positively with lesions (P < .05); infertility type correlated negatively (r=-0.158, P = .005). Body mass index (BMI) and endometrial thickness were independent risk factors. The exploratory neural network analysis identified endometrial thickness as the most important predictor (normalized importance score = 0.301), followed by BMI (0.245) and age (0.229). The internally validated multivariable logistic regression model achieved the area under the receiver operating characteristic curve of 0.701 (0.637-0.760) and the area under the precision-recall curve of 0.859 (0.808-0.902). At the Youden-optimal threshold of 0.733, sensitivity and specificity were 0.652 and 0.670, respectively. Restricted cubic spline analysis suggested a nonlinear association, with the estimated adjusted odds ratios increasing modestly above the 10-mm reference value. Chronic endometritis and polyps are common in these women. BMI, endometrial thickness, and infertility duration are key risk factors. BMI and endometrial thickness were independently associated with endometrial lesions, while the internally validated prediction model showed modest discrimination, emphasizing ultrasound monitoring and weight management for diagnosis/treatment.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50528"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897075","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":"Gastric perforation repaired by hepatic round ligament: Case report and literature review.","authors":"Ribal Aby Hadeer, Angela Assaad, Hadi Farhat, Hany Maalouf, Oussama Chibly, Fidaa Alwan","doi":"10.1097/MD.0000000000050482","DOIUrl":"https://doi.org/10.1097/MD.0000000000050482","url":null,"abstract":"<p><strong>Rationale: </strong>Gastric perforation is a rare but life-threatening complication of gastric cancer, often presenting with acute peritonitis and requiring emergent surgical repair. The conventional treatment relies on an omental patch (Graham's technique); however, this approach is not always feasible, particularly in patients with advanced disease or omental involvement.</p><p><strong>Patient concerns: </strong>We report the case of a 44-year-old male with advanced gastric adenocarcinoma complicated by peritoneal carcinomatosis who presented with acute abdomen following stent insertion.</p><p><strong>Diagnosis: </strong>Imaging confirmed gastric perforation and generalized peritonitis.</p><p><strong>Interventions: </strong>During emergent laparoscopic exploration, the omentum was unsuitable due to carcinomatous infiltration. Instead, the hepatic round ligament was mobilized and used as a patch to seal the perforation, achieving effective closure. The patient initially recovered well postoperatively; however, he later deteriorated due to progression of his underlying malignancy and died on postoperative day 16.</p><p><strong>Outcomes and lessons: </strong>This case highlights the hepatic round ligament as a viable alternative to the omentum in repairing gastric perforations, particularly in malignant or hostile abdominal environments. Wider application of this technique warrants further study to establish its safety and long-term outcomes.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50482"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897447","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 eight urinary metals and trouble sleeping: A cross-sectional study.","authors":"Qiong Ma, Jian-Zheng Liu, Xiu-E Shi, Li-Li Li, Xiao-Wei Feng, Xiang Fan, Mi Fu, Jian-Min Lv","doi":"10.1097/MD.0000000000050551","DOIUrl":"https://doi.org/10.1097/MD.0000000000050551","url":null,"abstract":"<p><p>While toxic heavy metals have been linked to sleep disorders, the role of less-studied metals remains unclear. We aimed to explore the associations of 8 urinary metals with trouble sleeping and to identify potential gender-specific patterns. This study included 10,012 adults from the National Health and Nutrition Examination Survey 2005-2018. Urinary concentrations of tungsten, arsenic, thallium, cesium, antimony, molybdenum, cobalt, and cadmium were measured. Trouble sleeping was self-reported. We employed weighted logistic regression, restricted cubic spline models, and weighted quantile sum regression to evaluate single and mixed-metal effects. Among participants, 50.2% were male and 25.3% reported trouble sleeping. Higher urinary tungsten levels were associated with increased likelihood of trouble sleeping in males (odds ratios: 1.28-1.30). Arsenic, thallium, and cesium showed inverse associations, with notable gender differences. Weighted quantile sum analysis supported the positive association of tungsten and the inverse associations of arsenic and cesium. No significant associations were found for antimony, molybdenum, cobalt, or cadmium. Urinary tungsten is cross-sectionally associated with trouble sleeping in males, while arsenic, thallium, and cesium show inverse associations, with gender-specific patterns. Further research using validated tools is warranted to validate these associations, elucidate the underlying biological mechanisms, and highlight the significance of assessing combined metal exposures in relation to sleep health.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50551"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897512","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":"Factors associated with recurrence after argon plasma coagulation combined with electrosurgical resection for intestinal polyps: A retrospective cohort study.","authors":"Chunyan Hu, Min Miu, Xia Zhou, Lei Shi, Jing Ren","doi":"10.1097/MD.0000000000050544","DOIUrl":"https://doi.org/10.1097/MD.0000000000050544","url":null,"abstract":"<p><p>Intestinal polyps may recur after endoscopic removal, and postoperative surveillance is important for reducing the risk of colorectal neoplasia. Although several studies have evaluated recurrence after conventional polypectomy or electrosurgical resection alone, evidence regarding recurrence after argon plasma coagulation (APC) combined with electrosurgical resection remains limited. This study aimed to identify factors associated with intestinal polyp recurrence after APC combined with electrosurgical resection. This single-center retrospective cohort study was conducted at the Affiliated Hospital of Southwest Medical University from March 2019 to April 2024. We included 330 adult inpatients who underwent argon plasma coagulation combined with electrosurgical resection for intestinal polyps and completed postoperative colonoscopic follow-up. The primary outcome was postoperative intestinal polyp recurrence detected by follow-up colonoscopy. Demographic, clinical, laboratory, and endoscopic characteristics were collected, and factors associated with recurrence were evaluated using univariable and multivariable logistic regression analyses. Among the 330 included patients, 230 were male (69.7%), the mean age was 56.89 ± 11.25 years, and the mean follow-up duration was 15.58 ± 10.63 months. According to postoperative colonoscopic follow-up, 225 patients were classified into the recurrence group and 105 into the non-recurrence group. In multivariable logistic regression analysis, male sex (odds ratio [OR]: 2.195, 95% confidence interval [CI]: 1.236-3.899, P = .007), polyp number ≥ 4 (OR: 2.117, 95% CI: 1.160-3.862, P = .015), and history of cholecystectomy (OR: 3.699, 95% CI: 1.184-11.554, P = .024) were independently associated with postoperative recurrence of intestinal polyps. In this single-center retrospective cohort study, male sex, polyp number ≥ 4, and history of cholecystectomy were independently associated with postoperative intestinal polyp recurrence after argon plasma coagulation combined with electrosurgical resection. These findings may help inform postoperative surveillance strategies, but further prospective studies are needed for validation.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50544"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897452","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":"Causal relationship between trace elements and pityriasis rosea: A Mendelian randomization analysis.","authors":"Tingting Yu, Xinyue Mou, Yi Luo, Liping Cao, Peixin Chen, Hai Yu, Chun Yang, Jing Xu","doi":"10.1097/MD.0000000000050519","DOIUrl":"https://doi.org/10.1097/MD.0000000000050519","url":null,"abstract":"<p><p>Pityriasis rosea (PR) represents a frequently occurring, acute, self-limiting papulosquamous disorder with complicated and undetermined pathogenesis, and there are no definite tissue markers or drug targets. Thus, the clinical treatment of this disease is challenging. Recent studies have partly unraveled correlations of trace elements with the onset and development of skin diseases. This study utilized the Mendelian randomization (MR) strategy to excavate the causality between trace elements and PR. A forward and multivariate MR analysis was implemented on trace elements and PR to infer the causal relationship between them, with inverse variance weighted (IVW) as the dominant analytical method, supplemented by other methods (heterogeneity, pleiotropy, and leave-one-out sensitivity tests) to ensure data stability. The results of MR analysis, mainly based on the IVW method, suggested a causation between vitamin A and PR and indicated vitamin A as a protective factor against PR (IVW: P = .023; odds ratio [OR] = 0.677; OR < 1; 95% confidence interval: 0.245-0.897). The multivariate MR analysis suggested that vitamin A could independently act on PR (P = .018; OR = 0.426; 95% confidence interval: 0.001-35.620). Vitamin A is causally associated with PR and serves as a protective factor against the disease, providing valuable insights for subsequent clinical diagnosis, treatment, and scientific research.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50519"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897472","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":"Pathological lead points in pediatric secondary intussusception: A single-center retrospective observational study of five common etiologies.","authors":"Jinrong Chen, Fengguang Ye, Weicheng Huang, Yanhui Wang, Huafang Li, Xiuhui Cai, Wenyou Chen","doi":"10.1097/MD.0000000000050310","DOIUrl":"https://doi.org/10.1097/MD.0000000000050310","url":null,"abstract":"<p><p>While most pediatric intussusceptions are idiopathic, secondary cases differ significantly in clinical presentation, treatment strategies, and prognosis due to the presence of pathological lead points (PLPs). Accurate PLP identification is crucial for optimizing diagnosis and treatment. This study aims to compare clinical and imaging features across PLP types to improve recognition and intervention efficiency for secondary intussusception. This study investigates common PLPs in pediatric secondary intussusception and compare their epidemiological characteristics, clinical manifestations, imaging features, treatment responses, and recurrence patterns, with the goal of enhancing preoperative PLP identification and optimizing individualized management strategies. In this single-center retrospective observational study, we analyzed clinical data from 3013 intussusception patients treated at Zhangzhou Hospital Affiliated to Fujian Medical University between January 2018 and December 2023. Among them, 111 cases confirmed surgically/pathologically as secondary intussusception were categorized into 5 PLP groups: Meckel diverticulum, intestinal polyps, intestinal duplication, lymphoma, and Henoch-Schönlein purpura (HSP). Comparisons were made across groups regarding gender, age, symptoms, intussusception type, ultrasound findings, air enema success rate, intestinal necrosis, and recurrence. Secondary intussusception accounted for 3.7% of total cases. PLP types showed distinct age and sex distributions and differences in selected clinical and therapeutic features. Meckel diverticulum and duplication predominated in males < 2 years, polyps in females aged 2 to 6 years, and lymphoma/HSP in children ≥ 6 years. The PLP group showed significantly lower enema success (52.0% vs 90.9%, P < .001), higher necrosis (10.8%), and recurrence rates (45.9%) versus idiopathic cases. Ultrasound demonstrated varying diagnostic accuracy: higher for Meckel diverticulum/polyps but limited for lymphoma/HSP. Each PLP type exhibited distinct intussusception patterns, recurrence modes, and treatment requirements. Pediatric secondary intussusception has identifiable etiologies, and PLP types were associated with differences in onset age, imaging features, and clinical pathways. High suspicion for PLPs is warranted in recurrent cases, older children, and those with atypical imaging. While ultrasound provides valuable PLP detection, its limitations suggest the need for a multiparameter predictive model to enable precise preoperative identification and personalized treatment optimization.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50310"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897497","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":"Quality and reliability of cervical spondylotic myelopathy-related content on TikTok and Bilibili: A cross-sectional analysis.","authors":"Dawen Ying, Jiongbiao Zhong, Minzheng Ying, Min Yi, Qifang Zeng","doi":"10.1097/MD.0000000000050566","DOIUrl":"https://doi.org/10.1097/MD.0000000000050566","url":null,"abstract":"<p><p>Short-video platforms such as TikTok and Bilibili have become widely used sources of health information. This study assessed the informational content, quality, and reliability of videos related to cervical spondylotic myelopathy (CSM) on these platforms. A cross-sectional search was conducted on October 1, 2025, using the Chinese-language equivalent of \"cervical spondylotic myelopathy\" as the sole search term. For each eligible video, data on duration, user interaction metrics, uploader identity, and content themes were collected. Video quality and reliability were evaluated using the Global Quality Scale (GQS) and the modified DISCERN (mDISCERN) instrument. Group differences were analyzed using the Mann-Whitney U and Kruskal-Wallis tests, and correlations were examined using Spearman analysis. In total, 274 videos met the inclusion criteria. Most videos addressed diagnosis (76.28%) and treatment (74.82%), while prognostic information was scarce (16.06%). The median GQS score was 3.00 (interquartile range [IQR]: 2.00-3.00), and the median mDISCERN score was 4.00 (IQR: 3.00-4.00). TikTok videos achieved significantly higher GQS and mDISCERN scores than those on Bilibili (P < .001). Videos produced by specialized healthcare professionals (SHPs) obtained the best evaluation scores (P < .05). Engagement indicators showed no significant correlation with GQS or mDISCERN scores (P > .05). The overall educational value of CSM-related videos was suboptimal. Content created by SHPs demonstrated superior quality and reliability. Video engagement metrics were not associated with video quality or reliability. Greater professional involvement and preferential presentation of evidence-based content warrant further investigation as potential approaches to improving the dissemination of high-quality CSM information on these platforms.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50566"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897607","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":"Weight-adjusted waist index and all-cause and cardiovascular mortality in chronic kidney disease: A cohort study with mediation analysis of systemic inflammation.","authors":"Hao Zhou, Xue Zhang, Wanjun Zhang, Guanping Liu, Hairong Wang","doi":"10.1097/MD.0000000000050613","DOIUrl":"https://doi.org/10.1097/MD.0000000000050613","url":null,"abstract":"<p><p>The weight-adjusted waist index (WWI), a recently proposed marker reflecting central fat distribution independent of body weight, has emerged as a potential indicator of metabolic and cardiovascular risk. Considering the high burden of inflammation and metabolic disturbance in chronic kidney disease (CKD), we examined whether elevated WWI is associated with all-cause and cardiovascular disease (CVD) mortality among CKD patients and whether systemic inflammation, assessed by the neutrophil-to-lymphocyte ratio (NLR), mediates this relationship. Data were obtained from the National Health and Nutrition Examination Survey 1999 to 2018 cycles. WWI was calculated based on anthropometric measurements. Weighted multivariate Cox proportional hazards models were applied to examine the associations of WWI with mortality. Robustness was verified through WWI quartile-based survival curves and subgroup analyses. Mediation analysis was used to evaluate the indirect effect of NLR on the WWI-mortality relationship. A total of 5582 CKD participants were included. WWI levels were significantly and independently associated with increased risks of all-cause mortality (adjusted hazard ratio = 1.17, 95% confidence interval (CI): 1.09-1.26, P < .001) and CVD mortality (adjusted hazard ratio = 1.24, 95% CI: 1.09-1.41, P = .001). WWI showed a linear positive relationship with both outcomes (nonlinearity P > .05). Mediation analysis indicated that NLR exerted a modest but significant indirect effect on all-cause mortality (β = -9.94, 95% CI:-20.90--2.85, P < .001), explaining 6.66% of the total effect. Elevated WWI was independently associated with higher risks of all-cause and CVD mortality in CKD. NLR partially mediated these associations. Therefore, assessing both central adiposity and inflammatory burden may aid in identifying high-risk CKD patients and guide clinical strategies for improving long-term outcomes.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50613"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897550","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":"Global trends in gastric cancer burden among adolescents and young adults: A population-based observational study using GBD 2021 data.","authors":"Maoqiang Liu, Zhen-Zhen Peng, Wei Liu, Tao Zhang","doi":"10.1097/MD.0000000000050506","DOIUrl":"https://doi.org/10.1097/MD.0000000000050506","url":null,"abstract":"<p><p>Gastric cancer (GC) in adolescents and young adults (AYA; 15-39 years) is rare but clinically distinct. Contemporary global estimates and temporal drivers - particularly age-period-cohort (APC) effects and socioeconomic differentials - remain unclear. We conducted a secondary analysis using data from the Global Burden of Disease 2021 database and quantified the incidence, mortality, and disability-adjusted life years of AYA GC across 204 countries and territories from 1990 to 2021. Age-standardized rates and estimated annual percentage changes (EAPCs) were calculated using log-linear regression. APC models were used to describe age-, period-, and cohort-related patterns. Disease burden was stratified by Socio-demographic Index (SDI), and Global Burden of Disease (GBD)-attributed deaths related to diets high in sodium and smoking were examined within the GBD comparative risk assessment framework. From 1990 to 2021, the global AYA GC burden declined substantially, yet disparities by sex, SDI, and cohort persisted. Globally, the age-standardized incidence rate of AYA GC decreased from 2.45 per 1,00,000 population in 1990 to 1.41 per 1,00,000 population in 2021, with an EAPC of -2.04% (95% confidence interval [CI]: -2.21 to -1.88). Deaths declined from 38.15 × 103 to 24.27 × 103, with an EAPC of -2.75% (95% CI: -2.94 to -2.57). The age-standardized disability-adjusted life year rate decreased from 99.73 to 46.64 per 1,00,000 population, with an EAPC of -2.54% (95% CI: -2.63 to -2.46). Males consistently had higher burdens than females. Incidence was positively correlated with SDI over time (r = 0.2393, P < .001), whereas mortality was negatively correlated with SDI in the 2021 cross-sectional analysis (r = -0.3092, P < .001). APC analysis showed a positive age effect peaking at 35 to 39 years and a net drift of -2.18% per year. Within the GBD comparative risk assessment framework, the GBD-attributed proportion of AYA GC deaths related to diets high in sodium was approximately 15% in East Asia in 2021, while the GBD-attributed proportion related to smoking exceeded 10% in parts of Central and Eastern Europe.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50506"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897569","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}