Medicine最新文献

{"title":"The characteristics of depression and sleep among Chinese high school students: A cross-sectional study.","authors":"Herun Han, Ziwen Mu, Qiran Li, Hongtao Zeng, Yixuan Ma, Zhihua Liu, Chen Li, Yuxuan Zhou, Zhiguang Guo, Meng Lv, Xiao Zhou","doi":"10.1097/MD.0000000000051117","DOIUrl":"10.1097/MD.0000000000051117","url":null,"abstract":"<p><p>Mental health and sleep problems are among the most significant burdens of illnesses for adolescents in China. This study aimed to investigate the characteristics of depression and sleep quality among high school students and compare sleep quality across students with varying levels of depression. A cross-sectional study was performed to collect data on depression and sleep quality using a paper questionnaire including a self-rating depression scale (SDS) and Pittsburgh Sleep Quality Index (PSQI). Among all the 537 high school students, 57.0% (306 participants) experienced depression and 47.5% (255 participants) suffered from poor sleep quality. Males showed significantly greater SDS scores than females (55.2 ± 7.2 vs 53.8 ± 6.8, P = .027). Significantly greater PSQI score in high school students with moderate-to-severe depression than those with mild depression and nondepression (5.2 ± 2.7 vs 5.3 ± 2.4 vs 6.2 ± 2.3, F = 3.5, P = .032). In contrast, an adjusted logistic regression model indicated that depression severity was not an independent significant predictor of poor sleep quality after adjusting for age, sex, and BMI (all P > .05). Overall, high school students exhibited a high prevalence of depression and poor sleep quality, with those experiencing moderate-to-severe depression showing the poorest sleep quality in unadjusted comparisons. However, depression severity did not remain an independent significant predictor of poor sleep quality after adjustment. Depression and sleep problems among high school students should receive greater attention, particularly for high school students with moderate-to-severe depression.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51117"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207294","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 effects of antihypertensive drugs on thyroid diseases: A trans-ancestry drug-target Mendelian randomization study.","authors":"Xiao-Hong Wang, Yue-Yang Zhang, Qin Wan","doi":"10.1097/MD.0000000000051090","DOIUrl":"10.1097/MD.0000000000051090","url":null,"abstract":"<p><p>Thyroid disorders frequently coexist with cardiovascular disease, including hypertension, but whether long-term modulation of antihypertensive drug targets influences thyroid disease risk remains uncertain. We aimed to evaluate the associations of 7 antihypertensive drug-target classes with thyroid diseases in European and East Asian populations using a trans-ancestry drug-target Mendelian randomization (MR) framework. We performed a two-sample, trans-ancestry drug-target MR analysis of 7 antihypertensive target classes. Target-proximal single-nucleotide polymorphisms associated with systolic blood pressure (SBP) were used as genetic proxies. Estimates were scaled per 1-mm Hg genetically predicted increase in SBP; the putative effect of target inhibition that lowers SBP was therefore interpreted in the opposite direction. Summary statistics were obtained for 4 primary thyroid diseases, benign thyroid tumors where available, and 3 thyroid-related proteins in European and East Asian datasets. Hypertension was used as a positive-control outcome. Random-effects inverse-variance weighting was the primary method, with Wald ratio estimation for single-nucleotide polymorphism instruments and weighted-median, Cochran's Q, MR-Egger, and Mendelian Randomization Pleiotropy RESidual Sum and Outlier analyses as sensitivity assessments. Within the European populace, genetic surrogates for β-blockers exhibit (odds ratio = 0.93; 95% confidence interval = 0.87-0.99) a close association with heightened susceptibility to thyroid carcinoma, whereas KCNH2 (1.15; 1.01-1.32) demonstrates an inverse correlation with thyroid cancer risk. Moreover, calcium channel blockers exhibit a conspicuous linkage with an elevated incidence of hyperthyroidism (0.97; 0.96-0.99) alongside a diminished likelihood of thyroid cancer (1.07; 1.03-1.10). CYP17A1 exerts a protective influence against hyperthyroidism (1.04; 10.1-1.07) and Graves disease (1.10; 1.05-1.16) but manifests a pathogenic effect concerning hypothyroidism (0.99; 0.97-1.00) and thyroid cancer (0.92; 0.86-0.98). Conversely, KCNJ11 demonstrates a proximate correlation between diminished hypothyroidism risk and augmented thyroid cancer susceptibility (0.83; 0.73-0.95). Analogous estimations were noted for CYP17A1 within the East Asian cohort. Genetically proxied perturbation of several antihypertensive drug targets was associated with thyroid disease risk, with CYP17A1 showing the broadest cross-ancestry pattern. These estimates reflect lifelong target-proximal genetic effects rather than the clinical effects of prescribed drugs and should be considered hypothesis-generating pending replication, pharmacoepidemiological studies, and randomized clinical trials.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51090"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207223","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 one-stop administrative and logistics services with patient satisfaction in smart hospitals: A multicenter cross-sectional study.","authors":"Yerong Cai, Meixing Li, Zifen Deng, Lishu Luo","doi":"10.1097/MD.0000000000051204","DOIUrl":"10.1097/MD.0000000000051204","url":null,"abstract":"<p><p>This study aims to examine whether the quality of one-stop administrative and logistics services is associated with patient satisfaction in smart hospitals and identify indicators that may merit attention in service redesign. This multicenter cross-sectional study included 837 service users at 4 sites in 3 public hospitals in Dongguan, China (January 2023-December 2025). A 27-item questionnaire covered 9 service-experience domains. Overall satisfaction (0-10) was the primary outcome; high satisfaction (score ≥ 8) was a secondary outcome. Eight operational indicators were extracted from work-order systems. Analyses included confirmatory factor analysis, hierarchical linear and logistic regression with site fixed effects, structural equation modeling, and an exploratory gradient-boosting analysis. Mean age was 47.2 years; 57.1% were women. Cronbach α ranged from 0.72 to 0.79. The prespecified 9-domain structure showed satisfactory fit in this sample; independent psychometric validation is needed. In the fully adjusted linear model (n = 774), first-contact resolution (β = 0.31; 95% confidence interval [CI], 0.23-0.38) and problem closure (β = 0.29; 95% CI, 0.25-0.33) were positively associated with satisfaction. Convenience, reliability, responsiveness, transparency, and digital access were also positively associated (β, 0.12-0.19). Longer response time (β = -0.26), complaint or second feedback (β = -0.20), and repeated visits (β = -0.16) were negatively associated. Problem closure showed the strongest association with high satisfaction (odds ratio, 2.87; 95% CI, 2.18-3.82). In structural equation modeling, the standardized direct association between digital access and satisfaction was 0.08 (P = .052), and the summed standardized indirect associations through convenience, responsiveness, and problem closure were 0.35. The exploratory, unvalidated ranking placed problem closure, convenience, responsiveness, reliability, and digital access highest. Service-process quality was associated with patient satisfaction. First-contact resolution, problem closure, and related indicators are candidate targets for prospective evaluation. The cross-sectional design precludes causal interpretation, and the instrument requires independent validation.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51204"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206976","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":"Acute ischemic stroke despite NOAC therapy in atrial fibrillation: Clinical factors associated with AIS in a 2-center observational case-control study.","authors":"Zeynep Bastug Gul, Nasrullah Danisman, Ebru Ozbezen Kiziltan, Gulhan Yildirim Ozdemir, Vasfiye Kabeloglu, Serkan Yazan, Mehmet Gul","doi":"10.1097/MD.0000000000051189","DOIUrl":"10.1097/MD.0000000000051189","url":null,"abstract":"<p><p>Acute ischemic stroke (AIS) can occur in patients with non-valvular atrial fibrillation (AF) despite treatment with non-vitamin K antagonist oral anticoagulants (NOACs). This study evaluated clinical, treatment-related, inflammatory, and echocardiographic factors associated with AIS in NOAC-treated patients with AF. This retrospective, 2-center case-control study included 322 patients with non-valvular AF who had received NOAC therapy for at least 3 months. Of these, 112 were hospitalized with AIS and 210 were outpatient controls without AIS at the study assessment. Group differences and factors associated with AIS were evaluated using multivariable logistic regression. ROC analyses were exploratory. Patients with AIS were older than controls and more often had hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease, prior stroke, and prescribed reduced-dose NOAC use. In the adjusted analysis, prior stroke (OR = 32.79), coronary artery disease (OR = 3.47), prescribed reduced-dose NOAC use (OR = 2.55), female sex (OR = 2.26), diabetes mellitus (OR = 1.99), and C-reactive protein (OR per mg/L = 1.10) were associated with AIS. HAS-BLED (area under the curve = 0.881, 95% CI = 0.844-0.918) and CHA2DS2-VASc (area under the curve = 0.840, 95% CI = 0.795-0.885) distinguished AIS cases from controls in exploratory ROC analyses. Among NOAC-treated patients with AF, prior stroke and cardiovascular comorbidities were strongly associated with AIS. Prescribed reduced-dose NOAC use was also associated with AIS. Inflammatory markers measured during acute stroke had limited additional value. Because this was a case-control study, the findings do not estimate stroke incidence or future stroke risk and require prospective validation.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51189"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207272","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 24 hour mean blood glucose levels with mortality in patients with acute pancreatitis: A retrospective cohort study.","authors":"Jialin Song, Shengwei Tian","doi":"10.1097/MD.0000000000051018","DOIUrl":"https://doi.org/10.1097/MD.0000000000051018","url":null,"abstract":"<p><p>This study aims to investigate the impact of 24 hour mean blood glucose (24h MBG) levels on the mortality of patients hospitalized with acute pancreatitis (AP) and to explore the clinical implications of this association. A retrospective examination of clinical datasets of AP patients was performed using the Medical Information Mart for Intensive Care-IV database. The optimal 24h MBG levels threshold was determined by the X-tile tool. Univariate and multivariate logistic regression analyses were used to assess the prognostic significance of 24h MBG levels. A survival analysis was carried out, and Kaplan-Meier survival curves were constructed to show survival probabilities over time. To strengthen result validity and reduce covariate confounding, a 1:1 propensity score matching (PSM) technique was implemented. An external validation was also performed with a cohort of 766 AP patients from the eICU database. A total of 977 subjects were enrolled in this study. The 24h MBG level's optimal cutoff for predicting in-hospital mortality was determined to be 146 mg/dL. Following PSM analysis, 336 pairs of subjects were identified, achieving equilibrium in most baseline characteristics. Kaplan-Meier survival analysis demonstrated that patients with 24h MBG of 146 mg/dL or higher exhibited significantly elevated rates of in-hospital, 30-day, and 90-day mortality compared to those with 24h MBG below 146 mg/dL (P < .05). Multivariate logistic regression analysis, after adjusting for potential confounding factors, indicated that patients with 24h MBG of 146 mg/dL or higher had a markedly increased odds of in-hospital mortality relative to those with a mean BG below 146 mg/dL (odds ratio = 3.9, 95% confidence interval: 1.86~8.21, P < .001). Consistent results were observed in the PSM-adjusted cohort. Our findings indicate a significant correlation between 24h MBG levels and mortality in patients who have suffered from AP. The results presented in this study are significant and emphasize the necessity for healthcare providers to take into account the impact of 24h MBG levels in effectively managing mortality.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51018"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206853","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":"Cross-sectional associations of insulin resistance-related indices with self-reported anxious days among U.S. adults: NHANES 2007 to 2012.","authors":"Weidong Zhang, Yifan Bu, Xiaolin Ji, Jiatai Li, Xiaoyang Hu","doi":"10.1097/MD.0000000000051098","DOIUrl":"https://doi.org/10.1097/MD.0000000000051098","url":null,"abstract":"<p><p>Anxiety is a common mental health condition that substantially impairs quality of life. Emerging evidence suggests that insulin resistance may be related to anxiety symptoms. However, the associations between commonly used insulin resistance-related indices and anxiety symptom burden remain insufficiently characterized in nationally representative populations. We conducted a cross-sectional analysis using data from 5623 U.S. adults aged 20 years and older from the 2007 to 2012 National Health and Nutrition Examination Survey. Anxiety-related symptom burden was assessed as the number of days during the past 30 days that participants reported feeling anxious, tense, or worried. This single self-reported item was analyzed as a continuous outcome and does not constitute a clinical diagnosis of an anxiety disorder. Four insulin resistance-related indices, including the homeostatic model assessment of insulin resistance, triglyceride-glucose index, metabolic score for insulin resistance (METS-IR), and triglyceride/high-density lipoprotein cholesterol ratio, were calculated using standardized laboratory and anthropometric measurements. Survey-weighted multivariable linear regression models were used to examine the associations between these indices and anxiety symptom burden, and restricted cubic spline analyses were performed to explore potential nonlinear patterns. In fully adjusted models, higher levels of homeostatic model assessment of insulin resistance, triglyceride-glucose index, triglyceride/high-density lipoprotein cholesterol ratio, and METS-IR were associated with a greater number of self-reported anxious days, with corresponding β values of 0.11, 0.93, 0.11, and 0.08, respectively. Pairwise Spearman correlation coefficients among the 4 insulin resistance-related indices ranged from 0.465 to 0.899. Quartile-based analyses showed generally similar patterns, although the association for METS-IR was borderline in the fully adjusted model. Restricted cubic spline analyses suggested possible nonlinear associations for some indices. In this nationally representative cross-sectional study, higher insulin resistance-related indices were associated with a greater number of self-reported days of feeling anxious, tense, or worried among U.S. adults. Because the outcome was based on a single nondiagnostic self-reported item, the findings should not be interpreted as evidence of increased clinical anxiety-disorder risk or as support for clinical anxiety discrimination.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51098"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206833","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":"Numerical investigation of the impact of neural stem cells on brain tumors.","authors":"Pius Erheyovwe Bubu, Val Hyginus Udoka Eze, Kelechi John Ukagwu, Vidya Sankarapandian, Saidi Odoma, Awafung Emmanuel Adie, Nansamba Fridah Mirembe","doi":"10.1097/MD.0000000000051105","DOIUrl":"https://doi.org/10.1097/MD.0000000000051105","url":null,"abstract":"<p><p>Malignant brain tumors, including glioblastoma and medulloblastoma, remain highly treatment-resistant. Neural stem cells (NSCs) are being investigated as tumor-tropic therapeutic vectors, but the temporal interaction between tumor and NSC populations requires quantitative characterization before model-based treatment hypotheses can be interpreted reliably. This study aimed to develop and numerically evaluate a reproducible 2-population model of tumor-NSC dynamics and to quantify the influence of NSC persistence and NSC-mediated tumor killing on simulated tumor burden. A normalized system of 2 coupled nonlinear ordinary differential equations was used: dT/dt = rT(1 - T) - βTN and dN/dt = αN(1 - N) - γTN. The baseline simulation used r = 0.20000 day-1, α = 0.05000 day-1, β = 0.35000 day-1, γ = 0.30000 day-1, T0 = 0.50000, and N0 = 0.40000. Explicit Euler integration was performed with Δt = 0.01 day over 20 days. A descriptive nonlinear regression fit, Fourier spectral analysis, 1-parameter sensitivity analyses, and joint α-β sensitivity analysis were applied to the simulated trajectory. In the baseline simulation, tumor density decreased from 0.5000 to a minimum of 0.4772 at day 2.59 (4.57% below the initial value) and subsequently increased to T20 = 0.8273, while NSC density declined from 0.4000 to N20 = 0.0247. The descriptive regression reproduced the simulated tumor trajectory with R2 = 0.9973 and root mean square error = 0.00590. Increasing α from 0.05 to 0.10 day-1 reduced T20 by 12.6% relative to baseline, and increasing β from 0.35 to 0.50 day-1 reduced T20 by 19.9%. Jointly setting α = 0.10 and β = 0.50 day-1 yielded T20 = 0.4427, 46.5% below the baseline terminal tumor density. The Fourier spectrum was dominated by the zero and low-frequency components, with no distinct oscillatory peak over the 20-day window. The model indicates that NSC persistence and NSC-mediated tumor killing materially influence terminal tumor burden, but the baseline parameterization produces only transient early suppression followed by tumor regrowth as the NSC population declines. The results are population-level, model-based estimates rather than tumor-type-specific clinical efficacy measures. Tumour-specific calibration, spatial migration, immune interactions, and experimental validation are required before translational conclusions can be drawn.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51105"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207107","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":"Three traditional Chinese patent medicines combined with transarterial chemoembolization for primary liver cancer: A systematic review and Bayesian network meta-analysis.","authors":"Wei Jiang, Jun Luo, Chenguang Wu, Yan An, Yinzhong Dai, Junwei Shi, Chengying Lan, Jinfeng Qi, Shimei Hua, Huihui Liu","doi":"10.1097/MD.0000000000051136","DOIUrl":"https://doi.org/10.1097/MD.0000000000051136","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the objective response rate (ORR) and disease control rate of 3 Chinese herbal medicines (Compound Banmao Capsule, Huaier Granule, and Jinlong Capsule) combined with transarterial chemoembolization (TACE) for primary liver cancer using Bayesian network meta-analysis.</p><p><strong>Methods: </strong>We systematically searched randomized controlled trials (RCTs) across the Cochrane Library, Embase, PubMed, Web of Science, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang databases from their inception to January 10, 2025. Two researchers independently screened the literature, extracted data, and assessed study quality using predefined inclusion and exclusion criteria. A Bayesian network meta-analysis was performed using RStudio to synthesize and hierarchically rank interventions by effect size in the included RCTs. This review was registered with PROSPERO (CRD420251019361).</p><p><strong>Results: </strong>Thirty-one RCTs involving 2604 patients with primary liver cancer were included. The network meta-analysis showed that, compared with TACE alone: Compound Banmao Capsule ranked highest for ORR (OR = 1.50, 95% CI: 1.08, 2.08), followed by Huaier Granule (OR = 1.47, 95% CI: 1.05, 2.05) and Jinlong Capsule (OR = 1.30, 95% CI: 1.02, 1.65). For disease control rate, the ranking was Compound Banmao Capsule (OR = 1.21, 95% CI: 0.76, 1.93), Jinlong Capsule (OR = 1.17, 95% CI: 0.85, 1.59), and Huaier Granule (OR = 1.12, 95% CI: 0.66, 1.91).</p><p><strong>Conclusion: </strong>For ORR, the combination of the 3 Chinese herbal medicines with TACE showed superior efficacy to TACE monotherapy, with Compound Banmao Capsule demonstrating the greatest therapeutic potential among the interventions evaluated.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51136"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207030","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":"Third lumbar transverse process syndrome with acute abdominal pain as the main clinical manifestation: A case report.","authors":"Guangcheng Wei, Ningjuan Yan, Guodong Zhao, Tao Liu, Ming Chen, Weikai Qin, Yong Zhao","doi":"10.1097/MD.0000000000051067","DOIUrl":"https://doi.org/10.1097/MD.0000000000051067","url":null,"abstract":"<p><strong>Rationale: </strong>Third lumbar transverse process syndrome is an uncommon musculoskeletal cause of referred abdominal pain. Because acute abdominal pain is appropriately evaluated first for visceral, vascular, urinary, and surgical emergencies, a spinal or paraspinal pain generator may be overlooked.</p><p><strong>Patient concerns: </strong>A 66-year-old man presented with persistent left lower-quadrant abdominal pain radiating to the left lower back. Baseline pain intensity was 7/10 on a VAS, and the pain was aggravated by postural change, standing, and walking.</p><p><strong>Diagnoses: </strong>Serial laboratory tests, endoscopy, ultrasonography, CT/CTA, and specialist consultations did not identify a visceral, urinary, surgical, or hemodynamically significant vascular disorder sufficient to explain the pain. Targeted musculoskeletal examination showed focal tenderness and increased soft-tissue tension around the left L3 transverse process, movement-related pain, and a visually estimated compensatory apparent leg-length discrepancy. These findings supported a clinical diagnosis of third lumbar transverse process syndrome presenting as referred abdominal pain.</p><p><strong>Interventions: </strong>The patient received Tuina manual therapy, two acupotomy closed-release procedures at palpation-defined tender points in the left lumbar and gluteal regions, and adjunctive pharmacotherapy.</p><p><strong>Outcomes: </strong>At discharge on February 9, 2021, the abdomen was soft without tenderness or rebound tenderness. Abdominal pain had resolved completely at the 2-week follow-up. Routine annual telephone follow-up of former inpatients was then conducted once yearly for 3 years, with no recurrence reported.</p><p><strong>Lessons: </strong>After urgent abdominal and vascular disorders have been excluded, history taking and targeted examination of the lumbar transverse processes may identify a musculoskeletal source of otherwise unexplained abdominal pain.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51067"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207048","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":"Bridging primary and palliative care: A cross-sectional study of the relationship between perceived access to family physicians and caregiver burden.","authors":"Emre Vuraloglu","doi":"10.1097/MD.0000000000051115","DOIUrl":"https://doi.org/10.1097/MD.0000000000051115","url":null,"abstract":"<p><p>This study aimed to examine the association between access to family physicians and caregiver burden among individuals providing care for terminal-stage cancer patients receiving palliative care. This cross-sectional study was conducted in the palliative care unit of a tertiary-level training and research hospital in Turkey between October and December 2025. Data were collected using the Zarit Burden Interview and the Perceived Access to Health Care Questionnaire. The relationships between variables were analyzed using Spearman correlation and multivariable linear regression analyses. Daily caregiving hours (P < .001) and total duration of caregiving (P < .001) showed a positive correlation with caregiver burden. A negative correlation was found between the overall perceived access to family physicians score and caregiver burden (ρ = -0.320, P < .001). In multivariable analysis, daily caregiving hours (β = 0.606, P < .001) and total caregiving duration (β = 0.377, P < .001) were identified as independent predictors increasing caregiver burden, whereas the affordability subdimension of the Perceived Access to Health Care Questionnaire demonstrated a protective effect (β = -0.685, P = .021). Caregiver burden increased with longer daily caregiving hours and total duration of care, whereas higher overall perceived access to family physicians was associated with lower caregiver burden. These findings suggest that strengthening the integration of primary care with palliative care may play a crucial role in alleviating caregiver burden. The study provides an original contribution to the international literature on primary care-based palliative care integration, supported by empirical data from Turkey.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 42","pages":"e51115"},"PeriodicalIF":2.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207062","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}