Medicine最新文献

{"title":"Neonatal nemaline myopathy associated with NEB variants and a favorable 3-year outcome: A case report.","authors":"Zhengxi Liu, Ya Luo, Guiping Li, Run Li, Xiaokuan Cao","doi":"10.1097/MD.0000000000051234","DOIUrl":"https://doi.org/10.1097/MD.0000000000051234","url":null,"abstract":"<p><strong>Rationale: </strong>Nemaline myopathy (NM) is a rare congenital myopathy characterized by muscle weakness and hypotonia. Severe neonatal disease may involve respiratory failure and bulbar dysfunction. Variants in the nebulin gene (NEB) are a common genetic cause, but genotype-phenotype relationships and prognosis remain variable.</p><p><strong>Patient concerns: </strong>A female neonate developed cyanosis, bradycardia, respiratory distress, and hypotonia shortly after birth. She required invasive mechanical ventilation and later experienced recurrent respiratory deterioration, difficulty weaning from ventilatory support, poor feeding, vomiting and choking, weak sucking and swallowing, and diminished primitive reflexes.</p><p><strong>Diagnoses: </strong>The clinical phenotype and trio whole-exome sequencing findings supported a clinical diagnosis of NM associated with NEB variants. Sequencing identified a maternally inherited pathogenic frameshift variant, c.23910_23911delAG (p.Arg7970SerfsTer9), and 2 missense variants classified as variants of uncertain significance: maternally inherited c.5615C>T (p.Pro1872Leu) and paternally inherited c.19550G>A (p.Arg6517His). Muscle biopsy, allelic phasing, and functional studies were unavailable; therefore, the molecular diagnosis was not definitive.</p><p><strong>Interventions: </strong>The patient received invasive and noninvasive respiratory support, oxygen therapy, feeding and symptomatic management, serial neurological assessments, and neurological rehabilitation.</p><p><strong>Outcomes: </strong>The Neonatal Behavioral Neurological Assessment score increased from 25 on day 7 to 30 on day 14 and 36 on day 28. Respiratory function, feeding, and muscle tone gradually improved, allowing respiratory support to be withdrawn. Denver Developmental Screening Test assessments performed at 6-month intervals after discharge identified no reported developmental abnormalities. At 3 years of age, no apparent hypotonia, movement disorder, or other clinically evident motor impairment was observed.</p><p><strong>Lessons: </strong>Neonatal NM associated with NEB variants may present with life-threatening respiratory and bulbar dysfunction yet be followed by a favorable early developmental course. Trio whole-exome sequencing may facilitate etiological evaluation, but NEB variants require cautious interpretation when histopathological, phasing, and functional evidence is unavailable. A severe neonatal presentation should not be regarded as indicating an invariably poor prognosis, and continued neuromuscular, respiratory, feeding, orthopedic, and developmental surveillance remains warranted.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51234"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270439","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":"Pulmonary infection caused by Nocardia cyriacigeorgica and influenza A virus coinfection in an immunocompetent patient: A case report.","authors":"Zhengfan Yu, Yanmei Zhang, Lijie Qiu, Leqiang Wang","doi":"10.1097/MD.0000000000051059","DOIUrl":"https://doi.org/10.1097/MD.0000000000051059","url":null,"abstract":"<p><strong>Rationale: </strong>Pulmonary nocardiosis (PN) is an opportunistic infection caused by Nocardia species. It is characterized by a lack of specificity in both clinical symptoms and imaging findings. Most cases occur in individuals with compromised immune systems or underlying pulmonary diseases. In contrast, our patient did not present with any of these risk factors.</p><p><strong>Patient concerns: </strong>A 60-year-old immunocompetent male was admitted with a 5-month history of recurrent cough and expectoration. His respiratory symptoms worsened, and he developed a fever 9 days prior to hospitalization.</p><p><strong>Diagnoses: </strong>Nocardia cyriacigeorgica was identified in the sputum culture, as well as in the targeted next-generation sequencing and culture of the bronchoalveolar lavage fluid, while influenza A virus was detected by nucleic acid detection.</p><p><strong>Interventions: </strong>Along with antiviral therapy with peramivir, a combination antibiotic regimen of trimethoprim-sulfamethoxazole (TMP-SMX), etimicin, and meropenem was administered during hospitalization. Following discharge, oral TMP-SMX was continued as maintenance therapy.</p><p><strong>Outcomes: </strong>Regular follow-ups with the patient revealed that subsequent chest computed tomography (CT) scans showed a gradual reduction in the extent of the lesions, and the patient demonstrated a good clinical response and radiological improvement.</p><p><strong>Lessons: </strong>This case highlights the diagnostic complexity of PN. The radiological manifestations are diverse, commonly including pulmonary consolidation, nodules, and cavities, making it difficult to differentiate from other diseases. Early, precise diagnosis and prompt combined therapy are of vital importance in severe Nocardia pulmonary infection.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51059"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270459","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 kidney injury and 30-day unplanned cirrhosis readmissions: A nationwide Readmissions Database retrospective cohort study.","authors":"Asad Ali Ahmed Cheema, Eliza Aisha, Muhammad Munhib Shehzad, Ayesha Naveed, Ayesha Wasim, Syed Muhammad Ibrahim Shah Bokhari, Yaseen Ali Khan, Fatima Jawed, Muhammad Usman Hashmi, Ahsan Raza Raja, Sajeela Khan, Haider Imran","doi":"10.1097/MD.0000000000051220","DOIUrl":"https://doi.org/10.1097/MD.0000000000051220","url":null,"abstract":"<p><p>30-day unplanned readmissions after hospitalization for liver cirrhosis are common. Acute kidney injury (AKI) may be associated with higher early readmission risk. Using the Nationwide Readmissions Database 2016 to 2017, we identified adults with an index cirrhosis admission from January through November by International Classification of Diseases Tenth Revision Clinical Modification (ICD-10-CM) codes. AKI was defined by N17.x during the index stay. Unplanned 30-day readmissions were identified after excluding planned readmissions and trauma-related hospitalizations. Survey-weighted multivariable logistic regression adjusted for patient, clinical, and hospital factors. Among 1,68,816 index admissions, AKI occurred in 25.6%. Overall, 25.0% had unplanned 30-day readmission, higher with AKI than without (26.0% vs 24.2%; absolute difference 1.8 percentage points). AKI was independently associated with readmission (adjusted odds ratio 1.10, 95% confidence interval 1.05-1.16). AKI admissions had longer length of stay (median 6 vs 4 days), higher inflation-adjusted charges ($58,507 vs $32,587), and nonhome discharge (34% vs 16%; all P < .001). Readmissions occurred at a median of 12 days and had 7.72% in hospital mortality. Ascites and chronic kidney disease were strong predictors. AKI was associated with readmission among patients without chronic kidney disease but not among those with it (interaction P < .001). AKI during the index admission was associated with unplanned 30-day readmission, although the association was modest in magnitude, and marked a high-risk cirrhosis population with greater resource use. Because of the observational, retrospective design, causality cannot be established.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51220"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270218","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":"Cardiovascular risk profile and treatment patterns in patients with type 2 diabetes in specialized cardiology outpatient care in Colombia: A retrospective cross-sectional study.","authors":"Lucia Suarez Maestre, Ingrith Paola Hoyos Montaño, Zenen David Rúa Osorio, Carlos Renowitzky Zabarain, Alex Dominguez Vargas, Henry J González-Torres","doi":"10.1097/MD.0000000000051307","DOIUrl":"https://doi.org/10.1097/MD.0000000000051307","url":null,"abstract":"<p><p>Type 2 diabetes mellitus (T2DM) is strongly associated with cardiovascular morbidity, yet real-world evidence integrating cardiovascular comorbidities, metabolic characteristics, echocardiographic findings, and treatment patterns remains limited in Colombia. This study characterized the cardiovascular profile and treatment patterns of patients with T2DM attending specialized cardiology care and explored factors associated with glycated hemoglobin (HbA1c) >7%. A single-center, retrospective cross-sectional study included 138 adults with confirmed T2DM attending a high-complexity cardiology outpatient clinic in Barranquilla, Colombia, during 2023 to 2024. Patients were classified as HbA1c ≤7% or >7% using the most recent value documented at the latest outpatient visit. Clinical, laboratory, electrocardiographic, echocardiographic, and prescribed medication variables were evaluated. Univariable analyses were followed by an exploratory multivariable logistic regression model using the enter method. Mean age was 67.3 ± 11.5 years, 71.7% were male, and 70.3% had HbA1c >7%. Patients with HbA1c >7% were older (68.6 ± 11.6 vs 64.2 ± 10.9 years; P = .034) and had higher total cholesterol (203.5 ± 48.1 vs 181.7 ± 42.8 mg/dL; P = .010) and low-density lipoprotein cholesterol (124.9 ± 36.1 vs 106.0 ± 39.1 mg/dL; P = .010). Cerebrovascular disease occurred in 11.3% of patients with HbA1c >7% and none with HbA1c ≤7% (P = .034). The absence of prespecified echocardiographic abnormalities was less frequent with HbA1c >7% (15.5% vs 34.1%; P = .014). Sodium-glucose cotransporter-2 (SGLT2) inhibitor use was documented in 16.7% overall and was more frequent with HbA1c ≤7% (26.8% vs 12.4%; P = .037). In the exploratory multivariable model, total cholesterol was associated with HbA1c >7% (adjusted odds ratio [OR] per 10 mg/dL = 1.10; 95% confidence interval [CI], 1.01-1.20; P = .033), whereas the absence of prespecified echocardiographic abnormalities was inversely associated (adjusted OR = 0.36; 95% CI, 0.15-0.88; P = .026). SGLT2 inhibitor use was not significant after adjustment (adjusted OR = 0.56; 95% CI, 0.20-1.58; P = .274). In this Colombian real-world cohort, HbA1c >7% was common. Higher total cholesterol was positively associated with HbA1c >7%, whereas the absence of prespecified echocardiographic abnormalities was inversely associated with this outcome. The association with SGLT2 inhibitor use did not persist after adjustment. These cross-sectional findings support integrated cardiometabolic assessment in specialized outpatient care.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51307"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270201","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 ABO and Rh blood groups with diabetic polyneuropathy: A retrospective cross-sectional study.","authors":"Hatice Karaer Ünaldı, Volkan Savıcı, Emine Emektar, Osman Korucu, Sinem Fidan Buçin, Melike Bilir, Burcu Karabulut, Ömer Akbudak, Beyza Betül Bilgehan","doi":"10.1097/MD.0000000000051286","DOIUrl":"https://doi.org/10.1097/MD.0000000000051286","url":null,"abstract":"<p><p>ABO blood group antigens have been associated with various cardiovascular and inflammatory diseases; however, their relationship with peripheral nervous system disorders remains unclear. The primary aim of this study was to investigate the association between ABO and Rh blood groups and diabetic polyneuropathy in a large hospital-based population; the secondary aim was to evaluate the potential association of these blood groups with nondiabetic polyneuropathy. In this retrospective study, records of individuals with available ABO and Rh blood group data between January 2014 and December 2025 were reviewed. Participants were categorized into 3 groups: controls without peripheral neuropathy, patients with polyneuropathy without diabetes mellitus (nondiabetic polyneuropathy), and patients with diabetic polyneuropathy. A total of 21,427 individuals were included after applying the eligibility criteria and data cleaning. Blood group distributions were compared among the groups, and multinomial logistic regression analysis was performed to evaluate associations with disease status after adjustment for age, sex, and Rh factor. The study included 18,150 controls, 1697 patients with nondiabetic polyneuropathy, and 1580 patients with diabetic polyneuropathy. No significant differences were observed among the 3 groups in terms of ABO blood group distribution or Rh factor. After adjustment for age, sex, and Rh factor, no significant association was found between ABO blood groups and nondiabetic polyneuropathy. In contrast, blood group A was associated with higher odds of diabetic polyneuropathy compared with blood group O (adjusted OR 1.171, 95% CI 1.031-1.330; P = .015). The Rh factor was not significantly associated with either condition after adjustment for the available covariates. Blood group A was associated with diabetic polyneuropathy, whereas no significant association was found between ABO blood groups and nondiabetic polyneuropathy. Given the etiological heterogeneity of nondiabetic polyneuropathy and the retrospective nature of the study, these findings should be interpreted with caution and further evaluated in prospective studies with appropriate control groups and etiologically more homogeneous patient populations.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51286"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270225","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":"Isolated necrotizing scleritis revealing silent pulmonary granulomatosis with polyangiitis: A case report of rare diagnostic clue.","authors":"Nabaa Ihsan Awadh, Faiq I Gorial, Ahmed Dheyaa Al-Obaidi, Mohammed Alghannami, Karam Fareed Nawara, Marafi Jammaa Ahmed, Aya Ahmed Shimal, Ibtisam Hussein Al Obaidi","doi":"10.1097/MD.0000000000051271","DOIUrl":"https://doi.org/10.1097/MD.0000000000051271","url":null,"abstract":"<p><strong>Rationale: </strong>Granulomatosis with polyangiitis (GPA) is a rare, life-threatening vasculitis characterized by necrotizing granulomatous inflammation. Isolated necrotizing anterior scleritis as the sole initial manifestation is distinctly rare. The presence of a clinically silent pulmonary mass without ear, nose, and throat or renal involvement makes this presentation exceptional and diagnostically challenging.</p><p><strong>Patient concerns: </strong>A 31-year-old man presented with recurrent unilateral necrotizing anterior scleritis resistant to corticosteroids and immunosuppressants, without systemic symptoms.</p><p><strong>Diagnoses: </strong>This single-patient case report, prepared in accordance with CAse REport guidelines, revealed mildly elevated anti-proteinase 3 antibodies (25 AU/mL) in laboratory tests. Chest computed tomography unexpectedly showed a 5-cm solitary pulmonary mass. Histopathology demonstrated necrotizing granulomatous inflammation with multinucleated giant cells and vasculitis, confirming GPA.</p><p><strong>Interventions: </strong>The patient was treated with pulsed intravenous methylprednisolone followed by monthly cyclophosphamide, then transitioned to rituximab maintenance therapy.</p><p><strong>Outcomes: </strong>He achieved marked improvement in ocular inflammation and visual function, with no new systemic manifestations during follow-up.</p><p><strong>Lessons: </strong>This case illustrates a rare diagnostic pathway in which isolated, treatment-resistant necrotizing scleritis led to the detection of clinically silent pulmonary GPA. It highlights the importance of considering systemic vasculitis in atypical or refractory scleritis and underscores the critical role of tissue biopsy when serologic findings are mild or nonspecific. Furthermore, this first documented Middle Eastern case adds educational value for ophthalmologists and rheumatologists, illustrating that early multidisciplinary evaluation and timely rituximab therapy can prevent irreversible ocular damage and systemic progression.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51271"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270317","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":"Stepwise acupuncture exploration followed by ultrasound-guided needle-knife release combined with local infiltration for chronic intercostal muscle-related myofascial pain: A case report.","authors":"Yuyang Ou, Dan Li, Guanghan Li, Hui Li","doi":"10.1097/MD.0000000000051333","DOIUrl":"https://doi.org/10.1097/MD.0000000000051333","url":null,"abstract":"<p><strong>Rationale: </strong>Intercostal muscle-related myofascial pain can be difficult to localize when superficial tenderness is absent because the muscles lie deep to the thoracic musculature and close to the pleura. We report a case in which stepwise muscle-specific acupuncture provided ancillary localization information before targeted treatment.</p><p><strong>Patient concerns: </strong>A 73-year-old man presented with a 3-year history of persistent right posterolateral chest wall heaviness and dull pain, predominantly involving the fourth to tenth intercostal spaces. The resting numerical rating scale (NRS) score was 8, and no definite superficial tender point was identified.</p><p><strong>Diagnoses: </strong>Clinical and imaging evaluations excluded more plausible cardiopulmonary, pleural, osseous, spinal, herpetic, or neuropathic causes. More than 1 month of sequential acupuncture targeting the trapezius, rhomboid, multifidus, erector spinae, and serratus muscles produced no meaningful improvement. When exploration reached the suspected deep intercostal layer, ultrasound-guided acupuncture reproduced the habitual pain and produced mild relief. This response was interpreted as hypothesis-generating localization information rather than confirmatory evidence and contributed to a provisional diagnosis of intercostal muscle-related myofascial pain.</p><p><strong>Interventions: </strong>The patient underwent 4 weekly sessions of ultrasound-guided needle-knife release combined with local infiltration of 0.25% lidocaine and compound betamethasone. The intercostal anatomy and needle tip were monitored in real time using an out-of-plane approach.</p><p><strong>Outcomes: </strong>The NRS score decreased from 8 to 5 immediately after the first treatment and further decreased to 1 one week after the fourth treatment. Pain completely resolved at the 1-, 3-, and 6-month follow-ups, with no treatment-related adverse events.</p><p><strong>Lessons: </strong>Stepwise muscle-specific acupuncture may provide ancillary localization information when conventional examination cannot identify a deep chest wall pain generator. Ultrasound-guided needle-knife release combined with local infiltration targeting the suspected intercostal muscle was associated with sustained improvement and may represent a potential treatment approach for selected patients with deep intercostal muscle-related myofascial pain.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51333"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270357","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":"Early postnatal complications in small-for-gestational-age infants by gestational age and SGA severity: A retrospective cohort study.","authors":"Kazumasa Fuwa, Yuta Watanabe, Yuki Sato, Hidetoshi Go, Koichiro Hara, Ryoji Aoki, Midori Hijikata, Satomi Tanabe, Masako Aoki, Aya Okahashi, Nobuhiko Nagano, Ichiro Morioka","doi":"10.1097/MD.0000000000051138","DOIUrl":"https://doi.org/10.1097/MD.0000000000051138","url":null,"abstract":"<p><p>Small-for-gestational-age (SGA) infants commonly experience hematological complications and hypoglycemia. This study investigated how the frequencies of these complications varied according to SGA severity and gestational age. This single-center retrospective cohort study included SGA infants admitted to a neonatal intensive care unit from 2019 to 2020. Infants were categorized by SGA severity (severe or mild) and gestational age (preterm or term). Frequencies of neutropenia, polycythemia, thrombocytopenia, and hypoglycemia were compared using unadjusted analyses. Unadjusted risk ratios with 95% confidence intervals (CIs) were calculated, and exploratory receiver operating characteristic analyses were performed with cutoffs selected by maximizing the Youden index. Among 147 SGA infants (68 severe and 79 mild; 65 preterm and 82 term), neutropenia occurred in 8.2%, polycythemia in 2.7%, thrombocytopenia in 11.6%, and hypoglycemia in 45.6%. In unadjusted comparisons, neutropenia, thrombocytopenia, and hypoglycemia were more frequent among severe than mild SGA infants and among preterm than term SGA infants. Only 4 infants had polycythemia, and no clear association was detected. The area under the receiver operating characteristic curve was 0.86 (95% CI = 0.74-0.97) for neutropenia, 0.74 (95% CI = 0.60-0.88) for thrombocytopenia, and 0.75 (95% CI = 0.67-0.83) for hypoglycemia. The selected cutoffs were ≤34 weeks for neutropenia (sensitivity, 83.3%; specificity, 80.0%) and thrombocytopenia (sensitivity, 58.8%; specificity, 79.2%), and ≤37 weeks for hypoglycemia (sensitivity, 92.5%; specificity, 46.3%). Neutropenia, thrombocytopenia, and hypoglycemia were more frequent among severe SGA and preterm SGA infants in unadjusted comparisons. The gestational-age cutoffs were exploratory findings that require confirmation in larger external cohorts before clinical use.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51138"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270411","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":"Primary tubal choriocarcinoma with extrauterine implantation masquerading as ectopic pregnancy: A case report and literature review.","authors":"Ping Li, Yu Zhang, Jing Zhao, Xiaohui Zhao, Yiqi Jiang, Xia Yang, Peijuan Wang, Jie Fang","doi":"10.1097/MD.0000000000051163","DOIUrl":"https://doi.org/10.1097/MD.0000000000051163","url":null,"abstract":"<p><strong>Rationale: </strong>Gestational trophoblastic neoplasia, particularly choriocarcinoma, is a rare but aggressive malignancy arising from trophoblastic tissue. Primary tubal choriocarcinoma is exceptionally uncommon and often presents a diagnostic challenge owing to its similarity to ectopic pregnancy.</p><p><strong>Patient concerns: </strong>A 29-year-old woman presented with irregular menses. Clinical suspicion of ectopic pregnancy was raised due to extremely high β-human chorionic gonadotropin levels and suggestive ultrasonographic findings.</p><p><strong>Diagnoses: </strong>Laparoscopic surgical exploration revealed a hemorrhagic mass involving the right fallopian tube and the pelvic sidewall. Histopathological examination confirmed a diagnosis of primary tubal choriocarcinoma with pelvic peritoneal implantation. The patient was classified as International Federation of Gynecology and Obstetrics stage III.</p><p><strong>Interventions: </strong>Following diagnosis, the patient underwent multiple cycles of combination chemotherapy, specifically 5-fluorouracil + actinomycin D.</p><p><strong>Outcomes: </strong>Serial β-human chorionic gonadotropin monitoring demonstrated an excellent response to treatment, with normalization within 2 months. The patient remained in sustained remission throughout the follow-up period.</p><p><strong>Lessons: </strong>This case highlights the diagnostic challenge of differentiating gestational choriocarcinoma from ectopic pregnancy, especially in the context of primary tubal involvement, and underscores the critical role of histopathological examination in establishing a definitive diagnosis.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51163"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270428","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 triglyceride-glucose and its related indices with circadian syndrome: Evidence from a prospective cohort study.","authors":"Junjun Qin, Cheng Ni","doi":"10.1097/MD.0000000000051301","DOIUrl":"https://doi.org/10.1097/MD.0000000000051301","url":null,"abstract":"<p><p>This study aimed to investigate the association of the triglyceride glucose (TyG) index and its related indices, TyG-body mass index, TyG-waist circumference, and TyG-waist-to height ratio (TyG-WHtR), with incident circadian syndrome (CircS) in a middle-aged and elderly Chinese population. This study employed a prospective cohort design using data from the China Health and Retirement Longitudinal Study, collected in 2011 and 2015. We utilized 4 separate logistic regression models to assess the potential impact of each independent variable on CircS. Restricted cubic spline (RCS) analysis is used to examine the linearity assumption and dose-response relationships. Receiver operating characteristic (ROC) curve analysis was employed to compare the diagnostic accuracy and efficiency of TyG, TyG-BMI, TyG-WC, and TyG-WHtR in identifying CircS. During the 4-year follow-up period, 796 new cases of CircS were identified among the participants, representing 22.3% of the total cohort. After adjusting for potential covariates, nonlinear associations between TyG, TyG-BMI, TyG-WC, and TyG-WHtR with the risk of CircS were identified, exhibiting a significant dose-response relationship. TyG, TyG-WC, and TyG-WHtR exhibited an inverted U-shaped curve relationship with CircS, while the relationship between TyG-BMI and CircS was close to linear. Meanwhile, receiver operating characteristic analysis indicated that TyG-BMI demonstrated better diagnostic performance. This study provides important evidence that TyG, TyG-BMI, TyG-WC, and TyG-WHtR are significant risk factors for CircS. Moreover, we found that TyG-BMI may serve as an important potential biomarker for diagnosing new-onset CircS.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51301"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270173","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}