Medicine最新文献

{"title":"Tobacco and alcohol use, fruit and vegetable consumption, physical activity habits, and participation in routine checkups and cancer screenings among adults aged 40 and older with and without chronic diseases: A cross-sectional study.","authors":"Elif Nur Yildirim-Ozturk, Mehmet Uyar","doi":"10.1097/MD.0000000000050430","DOIUrl":"https://doi.org/10.1097/MD.0000000000050430","url":null,"abstract":"<p><p>The study aimed to investigate tobacco and alcohol use, fruit and vegetable consumption, physical activity habits, and participation in routine checkups and cancer screenings in adults aged 40 years and older with and without a diagnosis of chronic disease. It also aimed to compare the frequentist and Bayesian statistical methods used for comparisons and to evaluate the practical significance of these associations using effect sizes. The study was cross-sectional. The data used in the study came from the Turkey Health Survey-2022 and 12,555 people were included in this study. A total of 29 variables were used, and chronic diseases was taken as a grouping variable. Both frequentist and Bayesian methods, including bivariate analyses and multivariable logistic regression models, were utilized. In the study group, 52% were female, 42.8% were overweight, and 46.8% had good general health. Overall, the findings indicate that people with chronic diseases tend to use less tobacco and alcohol, do less physical activity, and have more routine checkups and cancer screenings. Fruit and vegetable/salad consumption was similar between the groups. While frequentist and Bayesian bivariate tests yielded similar results, multivariable logistic regression highlighted critical divergences, with the Bayesian approach acting as a more conservative filter against weak predictors. Furthermore, evaluating the absolute magnitude of these associations revealed strictly small to moderate effect sizes. This study suggests that while behavioral shifts following a chronic disease diagnosis are statistically detectable, the real-world changes might be modest. Public health interventions could benefit from offering targeted programs tailored to patients' limitations rather than generic advice. Methodologically, future health research and policy-making may benefit from placing more emphasis on effect sizes alongside frequentist or Bayesian approaches.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50430"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897570","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":"Renal outcomes associated with sodium-glucose cotransporter 2 inhibitor use in kidney transplant recipients with type 2 or posttransplant diabetes: A propensity score overlap weighting retrospective cohort study.","authors":"Guillermo Edinson Guzmán, Fabio Figueroa, Santiago Granados, Oriana Arias-Valderrama, Juan Lukas Ordóñez, Carlos Eduardo Durán","doi":"10.1097/MD.0000000000050385","DOIUrl":"https://doi.org/10.1097/MD.0000000000050385","url":null,"abstract":"<p><p>Posttransplant diabetes mellitus (PTDM) increases the risk of graft failure and mortality. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve cardiovascular and renal outcomes in type 2 diabetes mellitus (T2DM), but evidence in kidney transplant recipients (KTRs) with T2DM or PTDM remains limited. We conducted a retrospective cohort study including adult KTRs with pretransplant T2DM or PTDM. Exposure was defined as continuous SGLT2i use for ≥90 days. The primary outcome was a composite of graft loss, all-cause mortality, or a ≥2-fold increase in serum creatinine relative to the week-4 posttransplant value occurring >3 months after baseline. Secondary outcomes included longitudinal changes in HbA1c, estimated glomerular filtration rate (eGFR), and urine protein-to-creatinine ratio (UPCR), as well as adverse events (acute kidney injury [AKI] and urinary/genital infections). Propensity score overlap weighting was used to balance baseline covariates, and time-to-event analyses were performed using an overlap-weighted Cox regression model. A total of 185 patients were included (116 SGLT2i users and 69 non-users), with a mean follow-up of 121 months. The primary composite outcome occurred less frequently in the SGLT2i group (P < .001). In an overlap-weighted Cox regression model, SGLT2i use was associated with a lower hazard of the composite endpoint (HR 0.30, 95% CI: 0.17-0.55; P < .001). Safety outcomes did not differ significantly between groups, including urinary sepsis/hospitalization categories, ketoacidosis, and genital infections. Among KTRs with T2DM or PTDM, SGLT2i use was associated with a lower combined risk of graft loss, all-cause mortality, or doubling of serum creatinine, without an increased incidence of adverse events.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50385"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897582","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":"Reconstruction of a 2‑year neglected chronic patellar tendon rupture using peroneus longus autograft with suture anchor and cerclage wire augmentation: A case report and technical note.","authors":"Mao-Yi Yang, Li-Wei Hung","doi":"10.1097/MD.0000000000050545","DOIUrl":"https://doi.org/10.1097/MD.0000000000050545","url":null,"abstract":"<p><strong>Rationale: </strong>Chronic patellar tendon rupture with complete tendon loss is difficult to reconstruct when primary repair is impossible. We report reconstruction using an ipsilateral peroneus longus (PL) autograft in a 4-strand \"M-shaped\" configuration with suture-anchor fixation and temporary cerclage augmentation.</p><p><strong>Patient concerns: </strong>A 17-year-old male had progressive anterior knee pain, instability, and inability to actively extend the left knee for 2 years after trauma.</p><p><strong>Diagnoses: </strong>Examination showed patella alta, a palpable infrapatellar gap, and complete loss of active extension. Radiographs showed an Insall-Salvati ratio of 1.28. Magnetic resonance imaging confirmed chronic complete patellar tendon rupture without a repairable stump.</p><p><strong>Interventions: </strong>A 21-cm ipsilateral PL autograft was folded into a 4-strand construct and anchored to the inferior patella and tibial tubercle. Patellar height was deliberately overcorrected, and a transpatellar-tibial cerclage wire protected the reconstruction during staged rehabilitation.</p><p><strong>Outcomes: </strong>At 1 year, after wire removal, the Insall-Salvati ratio was 1.08. The patient regained full active extension without lag, near-full flexion, and recreational activity participation without pain or donor-site morbidity. Asymptomatic wire breakage occurred at 6 months.</p><p><strong>Lessons: </strong>A multi-strand PL autograft with anchor fixation and temporary cerclage augmentation may restore patellar height and extensor function in chronic patellar tendon rupture with complete tendon loss.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50545"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897586","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":"Acquired hemophilia a caused by complicated urinary tract infection due to flavobacterium odoratum: A case report and literature review.","authors":"Di Chen, Ping Yuan, Mingqiang Ren","doi":"10.1097/MD.0000000000050501","DOIUrl":"https://doi.org/10.1097/MD.0000000000050501","url":null,"abstract":"<p><strong>Rationale: </strong>Acquired hemophilia A (AHA) is a rare bleeding disorder characterized by the development of autoantibodies directed against coagulation factor VIII (FVIII). Approximately 50% of cases are idiopathic, while the remaining are associated with autoimmune conditions, malignancies, or infections. To date, there have been no reported cases of AHA secondary to Flavobacterium odoratum (Frullania odoratum) infection.</p><p><strong>Patient concerns: </strong>A male patient underwent ureteroscopic lithotripsy with double-J stent placement. Postoperatively, he developed hematuria, a right medial thigh hematoma, fever, and abnormal coagulation parameters, including prolonged activated partial thromboplastin time (APTT).</p><p><strong>Diagnoses: </strong>The diagnosis of AHA was confirmed based on prolonged APTT, markedly reduced FVIII:C, and detection of a factor VIII inhibitor. Additionally, the patient had a complicated urinary tract infection caused by multidrug-resistant F.odoratum, which preceded the onset of AHA.</p><p><strong>Interventions: </strong>Doxycycline was administered to treat the catheter-associated urinary tract infection caused by F.odoratum. Hemostatic control was achieved with activated prothrombin complex concentrate. Immunosuppressive therapy for AHA included dexamethasone and cyclophosphamide.</p><p><strong>Outcomes: </strong>At discharge, bleeding had resolved, APTT normalized, FVIII activity returned to normal levels, the FVIII inhibitor was undetectable, and the infection was successfully controlled.</p><p><strong>Lessons: </strong>AHA is a rare but potentially life-threatening condition. Early recognition, prompt treatment, and identification of underlying triggers are crucial to reducing mortality and improving outcomes. This is the first reported case of AHA associated with F. odoratum infection. Clinicians should consider this pathogen in patients with long-term indwelling urinary catheters who present with unexplained infections or bleeding diatheses.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50501"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897123","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":"Latent profiles of workplace violence exposure and predictive modeling of sleep disorders among emergency department nurses: A nationwide cross-sectional study.","authors":"Qingli Chen, Mei Yuan, Wei Zhang, Le Tong","doi":"10.1097/MD.0000000000050549","DOIUrl":"https://doi.org/10.1097/MD.0000000000050549","url":null,"abstract":"<p><p>Workplace violence and sleep disorders are common among emergency department (ED) nurses, yet heterogeneity in violence exposure and its relationship with sleep disorders remains poorly understood. This nationwide cross-sectional study included 1540 Chinese ED nurses. Latent profile analysis identified violence exposure patterns, while LASSO, 7 machine learning algorithms, and SHAP were used for sleep disorder prediction and model interpretation. Three violence profiles were identified: low-level (87.0%), moderate multi-form (10.3%), and high multi-form exposure (2.7%). Sleep disorders affected 59.3% of participants. Random forest showed the highest predictive performance (ROC AUC = 0.624). SHAP analysis showed greater predictive contributions from emotional exhaustion, cynicism, and occupational characteristics than from violence exposure profiles. Workplace violence exposure among ED nurses was heterogeneous. Burnout-related and occupational characteristics provided stronger predictive information for sleep disorder status than violence profiles. External validation and longitudinal studies are needed to assess generalizability and temporal relationships.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50549"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897231","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":"National trends in the prevalence of depression and suicidal ideation stratified by academic achievement among adolescents, 2006 to 2022 in South Korea: A nationwide cross-sectional study.","authors":"Jinyoung Jeong, Jaeyu Park, Jaehyeong Cho, Hyesu Jo, Jeongseon Oh, Hyunjee Kim, Jiyeon Oh, Sooji Lee, Jiseung Kang, Hanseul Cho, Lee Smith, Ho Geol Woo, Dong Keon Yon","doi":"10.1097/MD.0000000000050516","DOIUrl":"https://doi.org/10.1097/MD.0000000000050516","url":null,"abstract":"<p><p>Although severe depression and suicidal ideation among adolescents could be driven by excessive academic competition, research on this problem is still insufficient. Therefore, this study aims to analyze the relationship between academic achievement, depression, and suicidal ideation based on large-scale data. This study utilized data from the nationwide Korea Youth Risk Behavior Web-based Survey conducted from 2006 to 2022, investigating a total of 1,138,802 adolescents. Weighted proportions with 95% confidence intervals (CIs) and crude numbers and percentages were utilized to analyze and present the results in various formats. To accurately assess the association of academic achievement with depression and suicidal ideation, weighted odds ratios and their 95% CIs were calculated using weighted logistic regression analysis. Compared to students with high academic achievement, those with moderate achievement showed a 1.12 (95% CI = 1.11-1.13) times higher risk of depression, while those with low achievement had a 1.54 (1.52-1.56) times higher risk. Similarly, students with low academic achievement had a 1.49 (95% CI = 1.47-1.51) times higher risk of suicidal ideation. The prevalence of both depression and suicidal ideation decreased before the coronavirus disease 2019 pandemic but steadily increased during the pandemic. Females experienced higher rates of depression in each academic achievement group (high: weighted odds ratio = 1.49 [95% CI = 1.46-1.52]; middle: 1.59 [1.56-1.63]; low: 1.72 [1.69-1.75]) and suicidal ideation (high: 1.60 [1.57-1.64]; middle: 1.63 [1.59-1.68]; low: 1.82 [1.78-1.86]) than males. This study suggests that academic achievement can be associated with depression and suicidal ideation. Therefore, implementing mental health and educational programs targeting students with lower academic achievement may be crucial.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50516"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897262","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":"Evaluation of artificial intelligence for pulmonary embolism detection on CTPA: A single-center retrospective study comparing AI, radiologists, and AI-assisted interpretation.","authors":"Huiyang Zhang, Minjie Dong, Hongbo Li, Xiang Li, Yan Jiang, Yulei Wan","doi":"10.1097/MD.0000000000050543","DOIUrl":"https://doi.org/10.1097/MD.0000000000050543","url":null,"abstract":"<p><p>Pulmonary embolism (PE) is a life-threatening condition commonly diagnosed with computed tomography pulmonary angiography (CTPA). Although artificial intelligence (AI) has been applied for PE detection, its performance relative to physician-only and AI-assisted interpretation remains incompletely characterized. The study aimed to evaluate the diagnostic performance and reading time across 3 CTPA interpretation strategies: AI alone, physician-only reading, and AI-assisted physician reading. We retrospectively analyzed CTPA images from 50 patients diagnosed with PE at a single center and randomly divided them into 2 groups: one group (n = 25) was reviewed by radiologists from different levels, and the other group (n = 25) was reviewed by radiologists with AI assistance. Then, AI independently reviewed all images. The reference standard was established by consensus among 3 senior radiologists. Diagnostic performance and reading time were compared across the 3 reading paradigms. AI alone achieved an overall sensitivity of 91.24% and precision of 96.12%; sensitivity declined from 100% in grade 1 to 2 vessels to 86.32% in grade ≥6 vessels. Compared with physician-only reading, AI-assisted reading increased sensitivity and precision for junior radiologists (64.28%-75.51% and 81.82%-89.16%, respectively) and intermediate radiologists (80.67%-92.34% and 88.47%-97.31%, respectively). AI assistance also reduced mean reading time at both experience levels (both P < .05). In this small, single-center retrospective exploratory study, AI-assisted CTPA interpretation was associated with higher lesion-level sensitivity and precision and shorter reading times than physician-only interpretation. Larger prospective multicenter studies are required to validate these findings and assess their generalizability.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50543"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897449","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":"High-grade B-cell lymphoma presenting with bulbar palsy and Tapia syndrome: A case report.","authors":"Han Luo, Zengxia Zhao, Bo Liu","doi":"10.1097/MD.0000000000050500","DOIUrl":"https://doi.org/10.1097/MD.0000000000050500","url":null,"abstract":"<p><strong>Rationale: </strong>Bulbar palsy and Tapia syndrome (ipsilateral recurrent laryngeal and hypoglossal nerve palsy) are rarely the initial manifestations of lymphoma. Motor neuron disease is often the primary consideration in such cases, potentially leading to diagnostic delay.</p><p><strong>Patient concerns: </strong>A 46-year-old male was admitted to the hospital on April 16, 2020, with the chief complaint of \"dysphagia for 7 days.\"</p><p><strong>Diagnosis: </strong>High-grade B-cell lymphoma.</p><p><strong>Interventions: </strong>The patient received swallowing function rehabilitation training after admission. On May 12, 2020, a biopsy of a painful mass in the right mandibular area was performed. On May 20, 2020, systemic anti-tumor therapy was administered based on immunohistochemistry and FISH results.</p><p><strong>Outcomes: </strong>At the 2-month follow-up, the patient showed further weight loss, extensive extranodal and multi-organ involvement, indicating a poor prognosis.</p><p><strong>Lessons: </strong>Lymphoma can present with isolated bulbar palsy and Tapia syndrome, mimicking motor neuron disease. Recognizing B symptoms and atypical neuroimaging findings is essential for early diagnosis. Furthermore, the etiology of carotid stenosis in lymphoma patients is often multifactorial, and treatment decisions must balance stroke prevention against bleeding and other tumor-related risks.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50500"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897601","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":"Incidental noninvasive diagnosis of isolated persistent left superior vena cava in asymptomatic adults: A case report.","authors":"Dian Zhang, Meifang Pan","doi":"10.1097/MD.0000000000050511","DOIUrl":"https://doi.org/10.1097/MD.0000000000050511","url":null,"abstract":"<p><strong>Rationale: </strong>Isolated persistent left superior vena cava (IPLSVC) is an extremely rare congenital malformation with a low overall prevalence in the general population. Most patients present without typical clinical manifestations, leading to a relatively high rate of missed diagnoses in clinical practice. Owing to abnormal venous drainage, IPLSVC is frequently complicated with lesions of the cardiac conduction system, which may further induce arrhythmias.</p><p><strong>Patient concerns: </strong>A 37-year-old asymptomatic male patient accidentally discovered IPLSVC through chest echocardiography and computed tomography (CT) scans during a routine physical examination. The patient has no history of cyanosis, breathing difficulties, chest pain, or family history of heart disease.</p><p><strong>Diagnoses: </strong>Transthoracic echocardiography showed coronary sinus dilatation, and chest CT confirmed the absence of the right superior vena cava and the confluence of the right innominate vein into the left superior vena cava. Combined with imaging findings and clinical manifestations, the patient was diagnosed with IPLSVC.</p><p><strong>Interventions: </strong>Complete echocardiography and chest CT were performed to confirm the diagnosis, inform the patient of relevant procedural risks, recommend regular follow-up examinations and ambulatory electrocardiogram monitoring, and retain imaging data for subsequent diagnosis and treatment.</p><p><strong>Outcomes: </strong>The patient experienced no discomfort during follow-up. Regular reexaminations and long-term cardiac monitoring were recommended.</p><p><strong>Lessons: </strong>Although IPLSVC patients are often asymptomatic in the early stages, it may increase the risk of central venous access, cardiothoracic surgery, and pacemaker implantation. Noninvasive echocardiography can provide a basis for early diagnosis of asymptomatic patients and has certain clinical significance. This case helps clinicians further understand IPLSVC in asymptomatic patients, confirms the screening value of routine cardiac ultrasound, and provides practical references for the diagnosis, follow-up, and clinical management of similar cases.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50511"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897618","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":"Successful pregnancy after in vitro fertilization-embryo transfer in a patient with cytochrome P450 oxidoreductase deficiency and a double uterus: Case report.","authors":"Shimin Wang, Xiuping Zhang, Jiayao Chen, Ningxin Zhang, Xueqing Wu","doi":"10.1097/MD.0000000000050581","DOIUrl":"https://doi.org/10.1097/MD.0000000000050581","url":null,"abstract":"<p><strong>Rationale: </strong>Cytochrome P450 oxidoreductase deficiency (PORD) is a rare autosomal recessive disorder caused by mutations in the POR gene, leading to impaired steroid hormone synthesis and a wide range of multisystem abnormalities. The condition is often associated with reproductive malformations and endocrine disorders, presenting clinically with symptoms such as infertility, menstrual irregularities, and adrenal dysfunction, and may be accompanied by skeletal malformations. Only a very limited number of patients have achieved successful pregnancies through assisted reproductive technology, and there is currently no standardized treatment strategy.</p><p><strong>Patient concerns: </strong>A 29-year-old woman presented with \"7 years of infertility without contraception.\"</p><p><strong>Diagnoses: </strong>Genetic analysis identified compound heterozygous POR mutations (c.1820A>G/c.1474G>A), confirming PORD. Pelvic imaging revealed uterus didelphys. Endocrine evaluation demonstrated insulin resistance and adrenal dysfunction, and the patient fulfilled the diagnostic criteria for polycystic ovary syndrome.</p><p><strong>Interventions: </strong>Following unsuccessful long-protocol ovulation induction, a modified gonadotropin-releasing hormone antagonist protocol was implemented with metformin co-treatment for insulin sensitization. Stepwise glucocorticoid therapy (oral prednisone 5 mg/day → dexamethasone 0.5 mg/day → transition to hydrocortisone 20 mg/day during pregnancy) was administered for adrenal progesterone regulation. All embryos underwent vitrification, with subsequent single frozen-thawed blastocyst transfer.</p><p><strong>Outcomes: </strong>Ovarian stimulation yielded 24 oocytes, resulting in 7 blastocysts. Successful singleton implantation was achieved. The pregnancy progressed without maternal metabolic or fetal complications, culminating in term delivery (39 weeks and 4 days) of a healthy male neonate (birth weight 3250 g, Apgar scores 9/10).</p><p><strong>Lessons: </strong>This case demonstrates that pregnancy attainment in complex PORD requires protocol individualization using gonadotropin-releasing hormone antagonists to mitigate premature luteinization, dynamic glucocorticoid titration to control adrenal steroid excess, and metabolic optimization addressing insulin resistance. The co-occurrence of POR mutations should be investigated in assisted reproductive technology failures with polycystic ovary syndrome-like presentations, particularly when accompanied by skeletal or genital tract anomalies.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 36","pages":"e50581"},"PeriodicalIF":2.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897627","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}