Medicine最新文献

{"title":"Assessing the knowledge and awareness of community pharmacists toward direct oral anticoagulant therapy in Saudi Arabia: A cross-sectional study.","authors":"Ahmed Basilim","doi":"10.1097/MD.0000000000044977","DOIUrl":"10.1097/MD.0000000000044977","url":null,"abstract":"<p><p>Direct oral anticoagulants (DOACs) have transformed the management of thromboembolic disorders owing to their favorable pharmacologic profiles and ease of use. Despite their increasing use, data on the knowledge of DOACs among community pharmacists are limited, particularly in Saudi Arabia, where pharmacists assume substantial clinical responsibilities. Therefore, this study aimed to assess community pharmacists' knowledge of DOAC therapy in Saudi Arabia, focusing on 3 domains: safety, efficacy, and patient counseling. A cross-sectional survey of 390 community pharmacists across Saudi Arabia was conducted between October and December 2024 using a validated 19-item questionnaire. The percentage awareness score was calculated across 3 domains. The data analysis involved using t-tests and analysis of variance to evaluate the associations between demographic/professional variables and knowledge levels. The mean percentage awareness score was 53.65%, indicating moderate knowledge. Pharmacists showed better understanding of efficacy (56.10%) than of safety (52.82%), or counseling (52.74%). Male pharmacists and those who participated in anticoagulation-related workshops had significantly higher scores than did females and nonparticipants in workshops (P < .002 and < .005, respectively). Education level, experience, and DOAC dispensing frequency were not significantly associated with knowledge. Key gaps included confusion regarding international normalized ratio monitoring, DOAC contraindications, and reversal agents. Community pharmacists in Saudi Arabia possessed moderate knowledge of DOACs; however, notable deficiencies persisted, particularly in the safety and counseling domains. Targeted educational interventions, including case-based and workshop-style learning, are recommended to enhance clinical competency and ensure safe anticoagulation practices in outpatient settings.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44977"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239030","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":"Is there an association between dietary antioxidant capacity, phytochemical index, inflammatory index, and ongoing pregnancy in in vitro fertilization patients?: A cross-sectional study.","authors":"Nagihan Kircali-Haznedar, Sezcan Mümüşoğlu, Yavuz Emre Şükür, Pelin Bilgiç","doi":"10.1097/MD.0000000000044901","DOIUrl":"10.1097/MD.0000000000044901","url":null,"abstract":"<p><p>This study aimed to describe the association between the total antioxidant capacity, phytochemical index (PI), and dietary inflammatory index (DII) of the diet and ongoing pregnancy rate in infertile couples undergoing in vitro fertilization treatment. The study has a prospective cross-sectional design. Couples who met the inclusion criteria and underwent embryo transfer within the first 3 months after the interview were included. Total dietary antioxidant capacity, PI, and DII were calculated using a 1-year food frequency questionnaire. In addition, serum antioxidant and oxidant capacity, oxidative stress index, and C-reactive protein were assessed in venous blood. A total of 189 couples were included. Among these couples, the ongoing pregnancy rate was 32.3% (61/189). A significant difference was found between the DII scores of participants in the groups with and without ongoing pregnancy (P = .040 for males; P = .036 for females). A multivariate logistic regression analysis, adjusted for potential confounders, revealed no significant association between 1-year food frequency questionnaire derived dietary antioxidant capacity, DII, and ongoing pregnancy (P = .185 for females, P = .491 for males; P = .411 for females, P = .258 for males respectively). However, the PI was negatively associated with ongoing pregnancy (odds ratios: 0.169, 95% confidence intervals: 0.040-0.725, P = .027). The findings of the present study indicated an inverse association between the PI and ongoing pregnancy, underscoring the necessity for further research to investigate the impact of diet, particularly the PI and dietary inflammation, on reproductive outcomes.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44901"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239039","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":"Risk factors for Hirschsprung's disease in infancy: A study from the NHANES database.","authors":"Yan Zhang, Xiaohui Zhang, Chaoying Li, Shanpo Wei, Jin Tao, Man Yang","doi":"10.1097/MD.0000000000044601","DOIUrl":"10.1097/MD.0000000000044601","url":null,"abstract":"<p><p>Hirschsprung's disease is one of common intestinal diseases in infancy, usually accompanied by symptoms such as constipation, abdominal distension, and intestinal dysfunction. The occurrence of Hirschsprung's disease is related to a variety of factors, including congenital diseases, intestinal nerve development abnormalities, intestinal microbiota dysbiosis, and environmental factors. Infancy is a critical stage for intestinal development, and the intestinal function is not fully stable. Exploring the risk factors for Hirschsprung's disease will provide theoretical support for early diagnosis and intervention. This study utilized data from the National Health and Nutrition Examination Survey in the United States to analyze risk factors for Hirschsprung's disease in infants aged 1 to 2 years. Potential variables considered included race, birth weight, breastfeeding status, dietary habits, and immune function. Logistic regression models were employed to assess the association between these variables and the risk of congenital Hirschsprung colon and to adjust for potential confounders. The study found that race, cholesterol levels, and sodium intake were significantly associated with the risk of Hirschsprung's disease in infants. Non-Hispanic Black infants exhibited a higher risk (P = .042). Cholesterol levels were negatively correlated with the disease risk (P = .028), while increased sodium intake showed a potential protective effect (P = .003). Additionally, although factors such as vitamin E and body mass index were not statistically significant, they may still have potential implications for intestinal development. Based on National Health and Nutrition Examination Survey data, this study identifies race, cholesterol levels, and sodium intake as significant risk factors for Hirschsprung's disease in infancy. Non-Hispanic Black infants are at a higher risk, while increased sodium intake may offer a protective effect.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44601"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239042","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":"A prediction model for stroke risk based on explainable machine learning.","authors":"Qinggui Li, Xiao Wang, Qian Ye, Liping Li, Xiaopu He, Lingling Liu","doi":"10.1097/MD.0000000000044718","DOIUrl":"10.1097/MD.0000000000044718","url":null,"abstract":"<p><p>This study aims to develop a prediction model based on machine learning algorithms to predict the risk of stroke by analyzing physical activity and other risk factors. We conducted a retrospective analysis of 134 stroke patients treated at the Department of Neurology, the First Affiliated Hospital of Nanjing Medical University, from July 1, 2021, to May 31, 2023, and 354 non-stroke individuals recruited from the Fenghuang Community Health Screening Program in Nanjing during the same period. Eight machine learning models, including extreme gradient boosting, support vector machine, random forest (RF), neural network, Naive Bayesian, logistic regression, K-nearest neighbor, and decision tree, were used to build the prediction models. Variables were selected using the least absolute shrinkage and selection operator and the multivariable logistic regression analysis. The models were evaluated using receiver operating characteristic (ROC) curves, area under the ROC curve, precision-recall (PR) curves, area under the PR curve, accuracy, sensitivity, specificity, and precision. Shapley Additive Explanations were employed to determine feature importance. The results demonstrated that the RF algorithm performed well in terms of area under the ROC curve (0.96), area under the PR curve (0.92), specificity (0.97), and precision (0.92). Shapley Additive Explanations analysis revealed that the number of weekly exercise days had the most significant impact on stroke risk, followed by calf circumference, past medical history, gender, body mass index, and Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls score. The RF algorithm demonstrated strong predictive performance for stroke risk and may guide clinical decision-making.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44718"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239043","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":"Decoding the association between mucosal-associated invariant T cells and prostate cancer via multi-omics analysis.","authors":"Lichuan Lai, Rensheng Huang, Keke Si, Junming Huang, Lianli Yin","doi":"10.1097/MD.0000000000044781","DOIUrl":"10.1097/MD.0000000000044781","url":null,"abstract":"<p><p>Prostate cancer (PCa) is a highly heterogeneous malignancy characterized by significant variations in gene expression among distinct cell populations. Traditional sequencing technologies often obscure these differences, necessitating advanced approaches for a comprehensive understanding. Single-cell RNA sequencing (scRNA-seq) and Mendelian randomization (MR) analysis have emerged as powerful tools for unraveling the intricacies of PCa, enabling the identification of unique biological features at the individual cell level. In this study, droplet-based scRNA-seq analysis was performed on 4 PCa samples and 4 normal adjacent to tumor samples. The dataset, obtained from the NCBI GEO database, comprised 13,139 cells, facilitating the identification of diverse cell types and their respective gene expression patterns. Robust analysis pipelines, including pseudotemporal ordering, regional plot analysis, MR analysis, and comprehensive gene expression dynamics, were employed to investigate the tumor microenvironment, immune landscape, and potential causal associations with PCa susceptibility. Our scRNA-seq analysis revealed altered immune landscapes in PCa, underscoring the significance of T cells, particularly mucosal-associated invariant T (MAIT) cells. The study unveiled heterogeneity within the tumor microenvironment and identified key genes, such as ZFP36L2, associated with PCa susceptibility. MR analysis provided insights into the potential causal effects of MAIT cells on PCa, supported by analyses of gene expression dynamics and metabolic landscapes. ZFP36L2 emerged as a pivotal regulator, validated through various experimental approaches, including real-time quantitative polymerase chain reaction, western blot, and immunohistochemistry. Our findings underscore the significance of MAIT cells, presenting a novel diagnostic modality for advancing the diagnosis and treatment strategies of PCa. The identified genes, particularly ZFP36L2, offer potential avenues for precision medicine and targeted therapies.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44781"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239061","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":"Construction of decision tree prediction model and group intervention for the mindfulness level of community pre-frail elderly: A cross-sectional study.","authors":"Hao Zheng, Junrong Xu, Fei Li, Yi Qin, Daoxun Zheng","doi":"10.1097/MD.0000000000044878","DOIUrl":"10.1097/MD.0000000000044878","url":null,"abstract":"<p><p>Pre-frailty, a reversible state before frailty, is key for intervention. Mindfulness, a protective factor against frailty, is underexplored in community-dwelling pre-frail older adults. This study identified its influences, built predictive models, and proposed stratified interventions. 156 pre-frail older adults meeting inclusion and exclusion criteria were recruited from 5 communities in Nanning City, Guigang City, and Yulin City between August 2024 and February 2025 via convenience sampling. Data were collected using a General Demographic Questionnaire, the Chinese Frailty Scale, and the Mindful Attention Awareness Scale (Chinese version). Univariate analysis and multiple linear stepwise regression were employed to identify influencing factors, and a decision tree algorithm was applied to construct the prediction model. The mean mindfulness score among community-dwelling pre-frail older adults was 70.46 ± 9.80 (95% CI: 68.91-72.01), indicating a moderate level. Multiple linear stepwise regression identified monthly income as the primary influencing factor (β = 0.208, P = .011). Secondary factors significantly associated with mindfulness levels were medical burden, place of residence, and insomnia, with no evidence of multicollinearity (P < .05, VIF < 5). The decision tree model comprised 4 layers, 11 nodes, and 6 terminal nodes. Monthly income emerged as the most significant predictor (root node F = 18.645, P < .001), using healthcare burden, insomnia status, number of children, and educational attainment as additional classification nodes. Both methods consistently verified monthly income as the primary predictor. Establishing a targeted intervention framework integrating \"Economic Support-Sleep Management-Intergenerational Support\" was recommended. prioritizing support for the low-income group with medical burdens through integrated measures including economic assistance, pain management, bundled medical-psychological services, and community care centers; promoting \"sleep-mindfulness\" combined interventions and adapting urban community support models to rural settings to bridge urban-rural gaps; These findings provide evidence-based guidance for enhancing mental health and delaying frailty progression in this population.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44878"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239067","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":"Analysis of the current situation and influencing factors of empathy for pain among nursing interns: A multi-center cross-sectional study.","authors":"Qiang Li, Fuhai Xia, Yuanjingmei Wang, Xi Chen, Li Li, Guangsen Chen, Xuefen Wang, Gen Li, Liqin Xu","doi":"10.1097/MD.0000000000044849","DOIUrl":"10.1097/MD.0000000000044849","url":null,"abstract":"<p><p>This study investigates the current situation of empathy for pain and analyze its influencing factors among nursing interns. This study is a multi-center cross-sectional study. A cluster sampling method was used to recruit 423 nursing interns from 4 tertiary hospitals in Wuhan, Hubei Province, China from September to October 2024 as participants, and the general information questionnaire, Chinese version of the empathy for pain scale and meaning in life questionnaire were used to investigate. Pearson correlation analysis was used to analyze the relationship between variables. Multiple linear regression analysis was used to explore the influencing factors of empathy for pain among nursing interns. The score of empathy for pain was (3.02 ± 0.68). The score of meaning in life was (43.55 ± 9.42). Empathy of pain was positively correlated with meaning in life and all dimensions (all P < .01). Multiple regression results showed that received humanistic care related courses education, had operating room internship experience, had pain experience, interpersonal relationship in internship work, doting and ignoring family parenting patterns and sense of meaning in life were the main influencing factors of empathy for pain (all P < .01), which explained 46.50% of the variance. The empathy for pain of nursing interns is at a high level, but it still needs to be further improved. The key influencing factors including humanistic care education, operating room internship experience, pain experience, interpersonal relationship in internship work, family parenting patterns, and meaning in life. Integrating these factors into nursing curricula may enhance empathy.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44849"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239076","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":"Depression increases the risk of asthma: Evidence from a cross-sectional study and two-sample Mendelian randomization analysis.","authors":"Manli Ran, Yu Zhang, Wang Zhang, Minjian Wang, Siying Luo","doi":"10.1097/MD.0000000000044972","DOIUrl":"10.1097/MD.0000000000044972","url":null,"abstract":"<p><p>Depression and asthma are both serious public health issues and are prone to comorbidity. However, the correlation and causality between these conditions remain unclear. Data from the 2005 to 2023 National Health and Nutrition Examination Survey were analyzed. Weighted multivariate logistic regression was used to assess the depression-asthma association, including both crude (unadjusted) and adjusted models (controlling for age, sex, and other covariates). Subgroup analyses were performed to explore risk variations. Mendelian randomization (MR) analyses were primarily conducted using genetic instruments derived from European populations, with the random effect inverse-variance weighted method as the main approach, supplemented by weighted median, MR-Egger, simple mode, and weighted mode analyses. Sensitivity analyses examined heterogeneity, horizontal pleiotropy, and result robustness. The observational study included 38,127 participants. Moderate (OR = 1.56, 95% CI 1.35-1.80, P < .001), moderately severe (OR = 1.97, 95% CI 1.59-2.44, P < .001), and severe (OR = 2.02, 95% CI 1.48-2.76, P < .001) depression were associated with increased asthma risk (P for trend < .001). Interaction effects were noted by age and gender. MR analysis indicated genetically predicted depression causally increases asthma risk (OR = 1.29, 95% CI 1.19-1.40, P < .001) with no significant horizontal pleiotropy in two-sample MR studies. Depression may be a causal factor for asthma. Increased attention is needed for asthma risk in depressed patients, especially men and the elderly. Further validation in large, prospective cohort studies is required.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44972"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239082","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":"Comparative study on the efficacy of menadione, zoledronic acid, and calcitriol in combination with PKP for the treatment of osteoporotic vertebral compression fractures in extremely elderly patients.","authors":"Huajun Yu, Hongtao Hou, Yan Jin","doi":"10.1097/MD.0000000000044952","DOIUrl":"10.1097/MD.0000000000044952","url":null,"abstract":"<p><p>This study compares the efficacy and safety of menadione and zoledronic acid, both used in conjunction with calcitriol, in patients with osteoporotic vertebral compression fractures following percutaneous kyphoplasty (PKP) in an extremely elderly population. Patients with osteoporotic vertebral compression fractures (OVCF) were assigned into 4 groups. The basic treatment group received PKP and calcitriol for osteoporosis treatment. Experimental group 1 received menadione capsules in addition to the control treatment; experimental group 2 received zoledronic acid; experimental group 3 received both menadione soft capsules and zoledronic acid. The outcomes were assessed at 3, 6, and 12 months postoperatively, measuring visual analog scale (VAS) scores, Oswestry disability index (ODI), bone mineral density, anterior vertebral height ratio, correction of Cobb angle, inflammatory markers, biochemical markers of bone turnover, risk of refracture, and adverse drug reactions. At 3, 6, and 12 months postoperatively, both VAS and ODI scores in experimental groups 1, 2, and 3 were significantly lower than baseline and the basic treatment group. However, group 3 showed significantly lower scores than both groups 1 and 2 (all P < .05). Bone mineral density in experimental groups 1, 2, and 3 increased significantly compared to baseline and was higher than the basic treatment group, with no significant difference between groups 1 and 2, but group 3 showed significantly higher values than both groups 1 and 2 (all P < .05). Levels of SVCAM-1, SICAM-1, UNTX, and SBAP in experimental groups 1, 2, and 3 decreased significantly at 3, 6, and 12 months post-treatment compared to baseline and the basic treatment group, with group 3 showing significantly lower levels than groups 1 and 2 (all P < .05). The refracture rates within 12 months were 10.00% (4/40), 7.50% (3/40), 7.50% (3/40), and 2.50% (1/40) for groups 1, 2, 3, and the basic treatment group, respectively, with no significant difference (P > .05). In extremely elderly patients with osteoporotic vertebral compression fractures, the combination of calcitriol with menadione soft capsules and zoledronic acid post-PKP significantly improves bone mineral density, promotes new bone formation, and effectively alleviates pain, with good short-term safety.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44952"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239084","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":"In-hospital unexpected cerebral herniation-New neurosurgical quality control standards: A case report.","authors":"Liyang Hang, Xingming Zhong, Yong Cai","doi":"10.1097/MD.0000000000044855","DOIUrl":"10.1097/MD.0000000000044855","url":null,"abstract":"<p><strong>Rationale: </strong>In-hospital unexpected cerebral herniation (IHUCH) refers to abrupt, unanticipated cerebral herniation in patients who were previously considered stable. Its sudden onset may lead to delayed recognition and poor outcomes.</p><p><strong>Patient concerns: </strong>A 50-year-old man was transferred to our institution after a motor vehicle collision. The patient's Glasgow Coma Scale score remained between 13 and 14 upon admission. At the sixth day, without warning, he acutely lost consciousness, dropping to Glasgow Coma Scale 6, with left pupillary dilatation and loss of light reflex.</p><p><strong>Diagnoses: </strong>Initial computed tomography revealed: left frontotemporal traumatic subdural hemorrhage, right-sided epidural hemorrhage, traumatic subarachnoid hemorrhage, right temporal bone fracture, left traumatic intraparenchymal hematoma, pneumocephalus, and basal skull fracture. Without surgical indications, day 6 emergency computed tomography demonstrated the compression of the left lateral ventricle with rightward midline shift, effacement of the suprasellar cistern and perimesencephalic cisterns, and marked cerebral edema.</p><p><strong>Interventions: </strong>Urgent left decompressive craniectomy with evacuation of subdural hematoma was performed. Postoperatively, the patient's intracranial hypertension remained refractory. As conservative measures failed, a contralateral decompressive craniectomy was performed the next day, opposite the initial surgical site.</p><p><strong>Outcomes: </strong>Despite prompt surgical decompression, the patient remained in a persistent comatose state. After 5 months of comprehensive neuro-rehabilitation without neurological improvement, the family elected to withdraw life-sustaining treatment and the patient was discharged home.</p><p><strong>Lessons: </strong>This case illustrates how IHUCH can occur even under close neuro-monitoring. Key risk factors include postoperative hematoma recurrence, bilateral frontal lobe contusions, delayed traumatic intracranial hematoma, paradoxical cerebral herniation, chronic subdural hygroma, and tumor. Integrating IHUCH into neurosurgical quality control standards, augmented by continuous multimodal intracranial pressure monitoring, may enhance early detection and improve outcomes.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"104 40","pages":"e44855"},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12499735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239090","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}