Medicine最新文献

{"title":"Delayed serum sickness-like reaction mimicking septic shock after antivenom therapy: A case report.","authors":"Xiaobin Wang, Wenkai Bin","doi":"10.1097/MD.0000000000051039","DOIUrl":"https://doi.org/10.1097/MD.0000000000051039","url":null,"abstract":"<p><strong>Rationale: </strong>Antivenom is the key specific treatment for clinically significant snakebite envenoming. Delayed serum sickness-like reactions after antivenom therapy may be overlooked after discharge and can resemble infection or septic shock.</p><p><strong>Patient concerns: </strong>A woman in her early 60s returned approximately 7 days after antivenom therapy with generalized urticarial and purpuric maculopapular rash, pruritus, fever, vomiting, fatigue, dizziness, hypotension, and thrombocytopenia.</p><p><strong>Diagnoses: </strong>The patient was initially managed for suspected sepsis and septic shock because of circulatory instability, elevated high-sensitivity C-reactive protein, elevated serum amyloid A, elevated procalcitonin, and inflammatory changes on chest computed tomography. The timing after antivenom exposure, rash pattern, decreased complement C3 and C4, proteinuria, and subsequent clinical course supported a severe delayed serum sickness-like reaction as an important contributor. Infection could not be completely excluded because systematic pathogen testing was not completed during the acute phase.</p><p><strong>Interventions: </strong>The patient received empirical anti-infective therapy, vasopressor support, fluid resuscitation, hydrocortisone, ebastine, albumin supplementation, and other supportive care.</p><p><strong>Outcomes: </strong>After 7 days of treatment, blood pressure stabilized, rash and pruritus largely resolved, platelet count and inflammatory markers improved, and follow-up laboratory findings showed substantial recovery.</p><p><strong>Lessons: </strong>Delayed antivenom-related serum sickness-like reactions may mimic septic shock and may be accompanied by elevated procalcitonin. In patients who develop rash and hypotension within days after antivenom therapy, clinicians should treat possible sepsis promptly while reassessing antivenom exposure, skin findings, complement levels, urinalysis, microbiological evidence, and treatment response.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51039"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270267","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":"Clinical outcomes and recovery impact of implementing enhanced recovery after surgery (ERAS) pathway in elderly patients with gynecological malignant tumors.","authors":"Aifen Wang, Luqi Ying, Xin Sun, Rong Zhang, Luwen Zhao","doi":"10.1097/MD.0000000000051279","DOIUrl":"https://doi.org/10.1097/MD.0000000000051279","url":null,"abstract":"<p><p>Perioperative management is critical for optimizing recovery outcomes in elderly patients with gynecological malignant tumors, a demographic often facing significant health challenges. The Enhanced Recovery After Surgery (ERAS) pathway has been proposed as a multifaceted approach designed to enhance recovery and minimize complications during the perioperative phase, particularly in vulnerable populations such as the elderly. Patients who underwent traditional perioperative management at the affiliated hospital of Chengde Medical University between January 2011 and December 2018 were selected as the conventional group. Patients who underwent ERAS perioperative management between January 2019 and July 2025 were selected as the ERAS group. Postoperative recovery and complications were then compared between the groups. The ERAS and control groups involved 149 and 90 patients, respectively. Patient characteristics were not significantly different between the 2 groups (P > .05). However, the ERAS group showed a lower volume of intraoperative fluid rehydration and a shorter time to first postoperative flatus, time to first defecation, duration of postoperative hospitalization, and interval time between surgery and the first postoperative chemotherapy session. The Visual Analogue Scale score at 24 hours postoperatively was also significantly lower in the ERAS group (P < .05). Meanwhile, there was no significant between-group difference in the incidence of postoperative complications and the 30-day readmission rate (all P > .05). Use of the ERAS pathway during the perioperative period does not increase the occurrence of postoperative complications and can accelerate recovery, shorten the postoperative hospitalization duration, and help with earlier initiation of postoperative chemotherapy in elderly patients with gynecological malignant tumors.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51279"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270293","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":"Comparative performance of pre- and post-endoscopic risk scores for outcome prediction in endoscopy-confirmed upper gastrointestinal bleeding in the emergency department: A retrospective single-center study.","authors":"Emre Oner, Niyazi Ilhan, Yasar Catal, Sinan Genc, Ayca Koca, Muge Gunalp","doi":"10.1097/MD.0000000000051268","DOIUrl":"https://doi.org/10.1097/MD.0000000000051268","url":null,"abstract":"<p><p>Upper gastrointestinal bleeding (UGIB) requires early risk stratification, but commonly used scores were developed for different clinical moments and endpoints. We compared albumin, international normalized ratio, mental status, systolic blood pressure, age ≥65 years (AIMS65), Glasgow-Blatchford score (GBS), pre-Baylor, full Baylor, pre-Rockall, and full Rockall for the prediction of 30-day mortality, red-cell transfusion, endoscopic therapy, and rebleeding in an endoscopy-confirmed emergency department cohort. We retrospectively evaluated consecutive adults with suspected UGIB who underwent endoscopy and had an upper gastrointestinal bleeding source confirmed in the emergency department pathway between January 1, 2016 and 1 June 1, 2019. Thirty-day mortality was ascertained from hospital records and national death records. Rebleeding was defined as recurrent hematemesis and/or melena, or hemodynamic instability with rebleeding confirmed on repeat endoscopy, as documented in the available follow-up records. Score discrimination was assessed with receiver operating characteristic analysis. The analytic cohort comprised 347 patients (mean age 65.54 ± 15.82 years; 62.6% male). Index-hospital disposition included direct discharge after endoscopy in 27 patients (7.8%), discharge after hospitalization in 282 (81.3%), and in-hospital death in 38 (11.0%); the separate 30-day mortality endpoint used for receiver operating characteristic analysis comprised 46 deaths (13.3%). Blood transfusion occurred in 205 patients (59.1%), endoscopic therapy in 29 (8.4%), and rebleeding in 71 (20.5%). AIMS65 showed the highest area under the curve (AUC) for 30-day mortality (0.724, 95% confidence interval [CI] 0.647-0.802). GBS showed the highest AUC for transfusion (0.784, 95% CI 0.734-0.834) and rebleeding (0.703, 95% CI 0.639-0.767). For endoscopic therapy, only GBS reached nominal statistical significance, but discrimination was limited (AUC 0.604, 95% CI 0.551-0.656). In this selected cohort of endoscopy-confirmed ED patients with UGIB, score performance was outcome-specific rather than uniform across all endpoints. AIMS65 showed the highest mortality discrimination, whereas GBS showed the highest discrimination for transfusion and rebleeding. Endoscopic therapy prediction remained weak. These scores should be interpreted as structured adjuncts to clinical and endoscopic assessment, not as standalone decision rules.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51268"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270296","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":"Determining the cognitive function differences between different types of physically active students: Cross-sectional analysis.","authors":"Abdullah Al Mutairi, Mohammed Al-Ramadan, Mahdi I Abo Qarin, Mohammed S Al-Abbas, Nawaf A Al Qahtani, Mohamed A Al Maghraby, Mohammad Ahsan, Turki Abualait","doi":"10.1097/MD.0000000000051091","DOIUrl":"https://doi.org/10.1097/MD.0000000000051091","url":null,"abstract":"<p><p>Physical activity plays a vital role in improving mental health. Cognitive functions, including memory, attention, and problem-solving, can be influenced by various factors and interventions. This study aimed to determine cognitive function differences among different types of physically active students. A cross-sectional study was conducted at Imam Abdulrahman Bin Faisal University, Dammam. A convenience sampling method was employed to recruit 99 participants (42 minimally and 57 hyperactive active). Inclusion criteria were: age between 20 to 30 years, enrollment as a physical therapy student, willingness to provide informed consent, and ability to complete computerized cognitive tests. Exclusion criteria included: history of neurological or psychiatric disorders, current use of medications affecting cognitive function, self-reported visual or motor impairments affecting test performance, and inability to understand the study procedures. Physical activity was measured using the International Physical Activity Questionnaire short form. Cognitive functions, including working memory and attention, were assessed through computerized tests of memory automaticity and the Flanker task on a laptop screen. Data were analyzed using the Statistical Package for the Social Sciences (IBM SPSS version 28.0.1.0, New York). One-way analysis of variance was used to determine differences between groups, and Pearson correlation coefficient tests were used to examine relationships between variables. There were no significant differences in cognitive function between minimally active and hyperactive participants. (Attention [F = 1.75, P = .19], Working memory (Accuracy in consistent 1 and 2 [F = .53, P = .47], [F = 3.57, P = .06]; Accuracy in varied 1 and 2 [F = 1.54, P = .22], [F = 1.48, P = .23]; Response time in consistent 1 and 2 [F = .001, P = .97], [F = .11, P = .74]; Response time in varied 1 and 2 [F = .036, P = .85], [F = 1.80, P = .18])). No significant relationship was observed between cognitive function and physical activity. The study findings revealed that neither minimal physical activity nor hyperphysical activity significantly affects cognitive functions in physical therapy students. The results indicate that physical activity is not responsible for improvement in cognitive tasks within the recruited population. While physical activity may help enhance cognitive functions during the early and middle parts of life and also protect against age-related cognitive decline in older age, more research is needed.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51091"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270297","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":"Comparative efficacy of common adjuvant treatments after resection of colorectal liver metastases: A systematic review and network meta-analysis.","authors":"Yuzheng Zhou, Qianru Wang, Likun Liu, Xinwen Wang, Meiping Xue, Jie Xu, Jinyang Bai, Xiaojuan Wang","doi":"10.1097/MD.0000000000051187","DOIUrl":"https://doi.org/10.1097/MD.0000000000051187","url":null,"abstract":"<p><strong>Background: </strong>Although adjuvant strategies such as systemic chemotherapy, regional nonsystemic chemotherapy, and ablation have been applied, the optimal adjuvant therapeutic strategy for resectable colorectal liver metastases remains uncertain in terms of overall survival and disease-free survival. This network meta-analysis aimed to determine the optimal adjuvant therapeutic strategy for patients with colorectal liver metastases.</p><p><strong>Methods: </strong>We searched potentially eligible studies in PubMed, Embase, Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure databases until July 2026. Pooled disease-free survival (DFS) and overall survival (OS) were estimated using R software.</p><p><strong>Results: </strong>Eighteen studies including 18 reports were included. For the DFS, except for adjuvant hepatic arterial infusion chemotherapy (CT, HAIC) concomitant with intravenous CT, adjuvant CT and perioperative CT significantly improved DFS compared with surgery and adjuvant HAIC. There was no statistical difference between all therapeutic strategies for OS. Adjuvant HAIC concomitant with intravenous CT had the highest probability of being the best treatment for improving DFS (85.01%), followed by perioperative CT (11.75%) and adjuvant CT (3.17%); however, adjuvant HAIC concomitant with intravenous CT had the highest probability of being the best adjuvant treatment for improving OS (52.46%), followed by perioperative CT (40.25%) and adjuvant HAIC (5.25%).</p><p><strong>Conclusion: </strong>Adjuvant CT may be the best for improving DFS, but perioperative CT may be the best for improving OS. However, the results should be validated further.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51187"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270299","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":"The economic burden of myopia diagnosis and treatment: A cross-sectional cost-of-illness study in Yantai, China.","authors":"Yuelin Sun, Xiaosong Cheng, Cong Sun, Naibao Hu, Xiaoxiang Jin, Xiaoyue Wang, Fei Wang, Guiqiang Wang","doi":"10.1097/MD.0000000000051282","DOIUrl":"https://doi.org/10.1097/MD.0000000000051282","url":null,"abstract":"<p><strong>Background: </strong>Myopia has become a major global public health and economic issue. Population-based cost-of-illness evidence from prefecture-level cities in China remains limited. This study aimed to quantify the direct economic burden of myopia diagnosis and treatment among individuals aged 6 to 55 years in Yantai, China, and to identify factors associated with per-capita direct myopia expenditure.</p><p><strong>Methods: </strong>A cross-sectional cost-of-illness study was conducted between September and November 2021 in Yantai. A multistage sampling strategy was used to recruit students and their parents from primary schools, middle schools, high schools/vocational schools, and universities. Questionnaire data on demographic characteristics, myopia status, correction methods, healthcare utilization, and costs were collected. A gamma generalized linear model with a log link was used to examine factors associated with total myopia expenditure.</p><p><strong>Results: </strong>A total of 30,024 participants were included in the analysis (from 30,378 who participated). The prevalence of myopia was 36.81% (n = 11,053), with a higher rate in females (38.70%) than in males (34.95%). Spectacles were the most common correction method (94.93%). The median annual direct cost per myopic patient was 300.00 Chinese Yuan (CNY), accounting for 60.00% of total medical expenses. Children aged 6 to 10 years had the highest annual direct cost (829.50 CNY). In the gamma generalized linear model, among myopic patients with positive expenditures, age and educational level were significant predictors of the direct economic burden. For each 1-year decrease in age, the annual per capita direct cost increased by approximately 38.53 CNY (P < .01). Compared with those with postgraduate education or above, patients with primary school education or below and those with junior high school education incurred an additional 1154.61 and 226.67 CNY, respectively (P < .01), whereas gender had no significant effect (P = .39).</p><p><strong>Conclusion: </strong>Myopia imposes a substantial economic burden in Yantai, especially among younger individuals, those with early-onset myopia, individuals with lower educational attainment, and those using expensive correction methods.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51282"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270348","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":"Clinical outcomes of ultrasound-guided transforaminal cervical nerve root block for cervical spondylotic radiculopathy: A retrospective observational study.","authors":"Juan Du, Wang-Yan Yang, Mian-Rong Xue, Xue Yang, Hai-Qiang Ren","doi":"10.1097/MD.0000000000051308","DOIUrl":"https://doi.org/10.1097/MD.0000000000051308","url":null,"abstract":"<p><p>Cervical spondylotic radiculopathy causes neck and upper-extremity pain, sensory disturbances, and functional impairment. Evidence on short-term outcomes after ultrasound-guided transforaminal cervical nerve root block (TF-CNRB) remains limited. This study examined changes in pain, neck-related disability, patient-reported improvement, analgesic use, and documented adverse events after TF-CNRB. This single-center retrospective observational study included 42 patients with cervical spondylotic radiculopathy who underwent ultrasound-guided TF-CNRB between January 2024 and December 2025. Eligible patients had a baseline Numeric Rating Scale (NRS) score ≥4 and persistent symptoms despite at least 4 weeks of conservative treatment. Patients received a single TF-CNRB and were assessed at baseline and at 1 week, 1 month, and 3 months after the procedure. The primary outcome was pain intensity measured using the NRS. Secondary outcomes included the Neck Disability Index (NDI), Patient Global Impression of Change, analgesic use, and adverse events. Changes in NRS and NDI scores were evaluated using repeated-measures analyses. All 42 patients completed the 3-month follow-up. The mean NRS score decreased from 6.07 ± 0.95 at baseline to 3.17 ± 1.38 at 1 week, 3.40 ± 1.13 at 1 month, and 3.52 ± 1.13 at 3 months (overall P < .001). The mean NDI decreased from 19.3 ± 4.4% to 9.0 ± 4.2%, 9.2 ± 4.1%, and 9.7 ± 3.9%, respectively (all P < .001). The prespecified NDI minimal clinically important difference (≥5.42 percentage points) was achieved by 88.1%, 85.7%, and 83.3% of patients, respectively. At the same follow-up points, 73.8%, 73.8%, and 71.4% of patients reported being \"markedly improved\" or \"improved\" on the Patient Global Impression of Change. Analgesic use was reported by 14.3%, 11.9%, and 19.0% of patients, respectively. No serious procedure-related adverse events were documented in the available clinical records. Pain and neck-related disability were lower during the 3 months after ultrasound-guided TF-CNRB. Most patients achieved a clinically meaningful NDI reduction, and more than 70% reported favorable global improvement. No serious adverse events were documented, but the sample size and retrospective ascertainment limit conclusions about safety. The uncontrolled design precludes causal inference regarding treatment effectiveness. Larger prospective controlled studies are warranted.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51308"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Douyin videos on childhood asthma: A cross-sectional content analysis.","authors":"Xiaohui J, Shenggang Ding, Haihan Zheng","doi":"10.1097/MD.0000000000051290","DOIUrl":"https://doi.org/10.1097/MD.0000000000051290","url":null,"abstract":"<p><p>This study aims to evaluate the information quality of childhood asthma-related videos on the Douyin (China-market counterpart of international TikTok) short-video platform. On June 1, 2025 (Beijing time, logged-out, and non-personalized account context), we searched Douyin using the Chinese search term \",\" selecting the top 200 videos and ultimately including 175 videos for quality evaluation. Structured content integrity assessment tools and an instrument for judging the quality of written consumer health information on treatment choices (DISCERN) were used. The correlation between video quality and characteristics (duration, likes, comments, and shares) was analyzed. Two independent investigators performed title-and-content screening with predefined operational exclusion criteria. Inter-rater reliability was calculated before consensus adjudication. Most childhood asthma videos were created by self-identified health professionals. Content integrity scores were as follows: definition (0.325 ± 0.21), symptoms (0.521 ± 0.32), risk factors (0.294 ± 0.50), evaluation (0.425 ± 0.45), management (1.24 ± 0.47), and outcomes (0.864 ± 0.38). Among evaluated videos, 160 (91.4%) had a DISCERN score ≤50. Given that DISCERN was developed for written health information and has not been formally validated for short-form video, categorical labels (\"fair,\" \"poor,\" and \"very poor\") are interpreted descriptively only. No significant differences in DISCERN dimension scores were found across 3 sorting criteria. Duration-stratified analyses within the final n = 175 dataset showed that videos with 60 to 300 seconds exhibited higher DISCERN information-reliability and overall-quality scores compared with videos ≤60 seconds; the >300 seconds stratum contained only 4 videos, and only descriptive statistics are reported for this subgroup. Top-ranked subgroup analyses were subsets sampled from the primary 175-video dataset rather than independent samples. Our analysis reveals that the quality of the sampled set of childhood-asthma-related videos retrieved from Douyin is suboptimal and lacks comprehensive information; findings cannot be generalized to all childhood-asthma-related content hosted on this platform. These findings reflect content-level deficits rather than inherent hazards of the Douyin platform.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51290"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270397","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":"Position-specific patterns of head injuries in soccer: A 20-year media-based retrospective study.","authors":"Erdem Atalay, Ümit Şimşek, Tuğrul Kılıboz","doi":"10.1097/MD.0000000000051314","DOIUrl":"https://doi.org/10.1097/MD.0000000000051314","url":null,"abstract":"<p><p>Soccer is a high-contact sport in which player-to-player collisions, particularly during aerial duels, may result in head injuries and concussions. Players in certain soccer positions may be at higher risk of serious head injuries because of their exposure to higher kinetic forces and frequent uncontrolled collisions. This retrospective descriptive study included 215 cases of soccer-related head trauma reported in the media between 2005 and 2024. The dataset was compiled through the systematic monitoring of online news sources using Inoreader. Demographic data, injury mechanisms, and associations between loss of consciousness (LOC) and fractures were analyzed. Pearson chi-square test, Fisher-Freeman-Halton exact test, and Student t test were used for statistical comparison. The mean age of injured players was 27.37 ± 5.43 years, and 86% were professional players. Injuries occurred most frequently among defenders (38.1%), followed by forwards (24.2%) and goalkeepers (14.4%). LOC was reported in 31.6% of the cases and was more frequent among goalkeepers (45.2%; P = .047). LOC was significantly associated with higher proportions of hospital presentation, hospitalization, and imaging, as well as a lower likelihood of continuing participation after the injury (all P < .001). The most common injury mechanism was head-to-head collision (51.6%). Injuries were most frequent during the 31 to 45 minutes (17.2%) and 76 to 90 minutes (18.1%) match intervals. Fractures occurred in 24.2% of cases, most commonly in the nasal (48.1%) and zygomatic (40.4%) bones. Publicly reported soccer-related head injuries showed position-specific patterns, with defenders and forwards accounting for the largest proportion of cases, and goalkeepers showing the highest proportion of LOC. Head-to-head collisions were the most frequently reported mechanism. These findings should be interpreted as descriptive patterns rather than estimates of position-specific injury risk and may be used to inform future prospective studies and preventive strategies.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51314"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270408","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":"Minocycline in acute stroke: A systematic review and meta-analysis of randomized controlled trials and trial sequential analysis.","authors":"Muhammad Shahzaib, Muhammad Roshaan, Gaaitri Lohano, Marium Fawad, Haram Nabeel, Muhammad Noraiz Abbas Khan, Muhammad Rehan Zahid, Muhammad Nabeel, Nimra Afzal, Muhammad Shahryar, Eman Shahzad, Prince Kusimw'iragi","doi":"10.1097/MD.0000000000051287","DOIUrl":"https://doi.org/10.1097/MD.0000000000051287","url":null,"abstract":"<p><strong>Background: </strong>Minocycline has emerged as a potential adjunctive neuroprotective therapy in acute stroke owing to its anti-inflammatory, antiapoptotic, and blood-brain barrier-stabilizing effects. We aimed to evaluate the efficacy and selected safety-related outcomes of minocycline in acute stroke, including ischemic and hemorrhagic subtypes.</p><p><strong>Methods: </strong>This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Major databases were searched through March 20, 2026 for randomized controlled trials comparing minocycline with control or standard care in acute stroke. Risk ratios (RRs) and mean differences were pooled with 95% confidence intervals (CIs). Risk of bias was assessed using ROB 2, certainty of evidence using Grading of Recommendations Assessment, Development, and Evaluation, and robustness using trial sequential analysis.</p><p><strong>Results: </strong>Nine trials including 2186 participants were analyzed. Minocycline significantly reduced 3-month National Institutes of Health Stroke Scale scores in acute ischemic stroke (mean difference -2.43, 95% CI -4.42--0.44; P = .0169), but not in intracerebral hemorrhage. Functional independence at 3 months showed a favorable signal in ischemic stroke (modified rankin scale 0 to 2: risk ratio 1.40, 95% CI 1.05-1.86; P = .0219), while favorable outcome defined as modified rankin scale 0 to 1 was not significantly improved. Barthel Index also favored minocycline in ischemic stroke, although overall results were not statistically significant. Mortality, recurrent vascular events, hemorrhagic transformation, hematoma volume, perihematomal edema, and Matrix Metalloproteinase-9levels were not significantly altered. Trial sequential analysis indicated insufficient evidence for definitive conclusions.</p><p><strong>Conclusion: </strong>Minocycline may improve neurological recovery in acute ischemic stroke; however, these findings remain exploratory because of substantial heterogeneity, low-certainty evidence, and inconclusive trial sequential analysis. Larger standardized trials are required.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51287"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270338","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}