Medicine最新文献

{"title":"Anti-GBM/ANCA double-positive crescentic nephritis in an elderly patient presenting with heart failure-like symptoms: A case report.","authors":"Meijuan Shi, Guoqing Shi, Hongmei Liu, Yao Huang, Nan Luo, Yumei Ge, Jie Zhu","doi":"10.1097/MD.0000000000051225","DOIUrl":"10.1097/MD.0000000000051225","url":null,"abstract":"<p><strong>Rationale: </strong>Anti-glomerular basement membrane (anti-GBM) antibody disease and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis represent the 2 leading causes of rapidly progressive glomerulonephritis (RPGN). The coexistence of these conditions is rare, typically progresses rapidly, and has a poor prognosis. Elderly patients often present with nonspecific systemic symptoms, increasing the likelihood of misdiagnosis and treatment delay.</p><p><strong>Patient concerns: </strong>A 74-year-old woman presented with a one-month history of intermittent shortness of breath, worsening progressively over ten days, accompanied by nausea and vomiting. She denied hemoptysis, gross hematuria, rash, or arthralgia.</p><p><strong>Diagnoses: </strong>Initial assessment suggested heart failure. However, laboratory results revealed severe renal impairment (creatinine: 1025.99 μmol/L). Renal biopsy demonstrated crescent formation in over 80% of glomeruli, with immunofluorescence showing linear immunoglobulin G deposits along glomerular capillary loops. Serological testing revealed markedly elevated anti-GBM antibody (>400 RU/mL) and MPO-ANCA (108.4 RU/mL) levels, together with a perinuclear ANCA (P-ANCA) pattern on indirect immunofluorescence, supporting the diagnosis of anti-GBM glomerulonephritis with concomitant MPO-ANCA positivity.</p><p><strong>Interventions: </strong>Treatment included methylprednisolone pulse therapy, cyclophosphamide, and 3 plasma exchange sessions. Additional supportive measures comprised hemodialysis, antihypertensive therapy, and management of renal anemia.</p><p><strong>Outcomes: </strong>Although the patient's uremic symptoms improved markedly, renal function did not recover. She was discharged on hemodialysis and was subsequently transitioned to maintenance peritoneal dialysis. By January 2026, the anti-GBM antibody level had decreased markedly to 4.27 RU/mL, below the positive cutoff, and MPO-ANCA had also become negative. At the last follow-up in April 2026, the patient remained dialysis-dependent and experienced recurrent hospitalizations for pneumonia, heart failure, and acute pancreatitis.</p><p><strong>Lessons: </strong>This case emphasizes that elderly patients with anti-GBM/ANCA double-positive crescentic glomerulonephritis may initially present with nonspecific symptoms, increasing the risk of incorrect diagnosis. Although combination therapy resulted in symptomatic improvement and serological remission, renal function failed to recover and dialysis dependence persisted. Screening for anti-GBM antibody and ANCA should therefore be considered in patients with unexplained rapidly progressive deterioration of kidney function or active urinary sediment, and renal biopsy should be performed promptly when clinically indicated.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51225"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined and simultaneous use of Nefecon and irbesartan in treatment-naïve primary IgA nephropathy: A retrospective study.","authors":"Li Tian, Huaying Pei, Yanpeng Li, Wen Xue, Ning Lu, Xuzhi Liang, Shaomei Li","doi":"10.1097/MD.0000000000051223","DOIUrl":"10.1097/MD.0000000000051223","url":null,"abstract":"<p><p>Nefecon is a targeted-release formulation of the corticosteroid budesonide. It is specifically engineered to selectively target the ileal gut-associated lymphoid tissue to reduce galactose-deficient IgA1 (Gd-IgA1) production and IgA immune complex formation. Irbesartan is an angiotensin II receptor blocker that is widely used to reduce proteinuria in chronic kidney disease. The study aimed to investigate the effects of the concomitant administration of both drugs in treatment-naïve patients with primary IgA nephropathy (IgAN). We conducted a retrospective study of 12 patients with primary IgAN at a single institution who received a 6-month combination therapy with Nefecon and irbesartan. Irbesartan was administered at a fixed dose of 150 mg/day, and Nefecon was given at a dosage of 16 mg/day. Treatment effectiveness was assessed by evaluating the alterations in 24-hour urinary protein and estimated glomerular filtration rate (eGFR). We measured the levels of Gd-IgA1 and analyzed the correlations between Gd-IgA1 and clinical outcomes. Linear mixed models assessed urinary protein, albumin, creatinine, and eGFR over time. Estimated mean urinary protein reductions from baseline were -28.28% (1 month), -32.78% (3 months), and -51.46% (6 months) (P < .001). eGFR was stable at 1 month (+4.08 mL/min/1.73 m2) but rose significantly at 3 months (+10.40) and 6 months (+8.80) (P = .009). Gd-IgA1 levels before and 1 month after treatment were 15.81 ± 1.43 and 15.16 ± 1.71 U/mL. Changes in Gd-IgA1 at 1 month correlated with changes in urinary protein (r = 0.664, P = .018). Urinary dysmorphic red blood cells decreased from 108.5 (37.5, 308.8) to 14 (6, 74.2) cells/μL at 6 months (P = .012). In treatment-naïve patients with primary IgAN, combined use of Nefecon and irbesartan was associated with reduced proteinuria and stable kidney function. However, given the single-arm design, these changes cannot be attributed to the combination itself and may reflect the effects of either agent alone, natural fluctuation of proteinuria, or regression to the mean. Although early changes in Gd-IgA1 correlated with reduced proteinuria, this exploratory finding requires confirmation. In addition, subgroup findings - such as the sex-based difference in proteinuria reduction - are exploratory and hypothesis-generating. These retrospective observational findings require confirmation in adequately powered controlled studies.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51223"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated tendon repair and staged skin grafting for a severe forearm degloving injury: A case report from a low-resource setting.","authors":"Garuun Mohamed Abdikadir, Moise Mvuye Manishimwe, Mahmoud Bakheet Abdulrahman, Fadlalla Ali Khalid, Chinyere Nkemjika Anyanwu, Emeka Godson Anyanwu","doi":"10.1097/MD.0000000000051328","DOIUrl":"10.1097/MD.0000000000051328","url":null,"abstract":"<p><strong>Rationale: </strong>Upper-limb degloving injuries are uncommon but can cause substantial functional impairment, particularly when accompanied by tendon injury. Their management is especially challenging in resource-constrained settings where microsurgical reconstructive options may be limited.</p><p><strong>Patient concerns: </strong>A 21-year-old, right-handed man presented 2 hours after a road traffic collision with an extensive degloving injury involving the right forearm, wrist, and dorsal thumb.</p><p><strong>Diagnoses: </strong>Examination and operative exploration demonstrated exposed underlying structures and rupture of the flexor digitorum superficialis tendon slips. Radiographs also revealed a concomitant distal humerus fracture.</p><p><strong>Interventions: </strong>Following resuscitation, the patient underwent urgent wound exploration, extensive irrigation and debridement, primary tendon repair, and partial wound closure. The residual dorsal thumb defect was subsequently covered with a split-thickness skin graft harvested from the right thigh. The distal humerus fracture was managed conservatively with immobilization.</p><p><strong>Outcomes: </strong>The postoperative course was uncomplicated. At 6 weeks, the wounds and skin graft had healed satisfactorily, thumb and finger movements were preserved, and the patient had regained useful hand function following physiotherapy. The concomitant distal humerus fracture remained under conservative management with immobilization during this period.</p><p><strong>Lessons: </strong>Early debridement and tendon repair combined with staged split-thickness skin grafting can provide satisfactory wound coverage and early functional recovery in selected upper-limb degloving injuries when microsurgical reconstruction is unavailable.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51328"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing theoretical knowledge related to surgical and clinical skills in Syrian medical students: A cross-sectional study.","authors":"Jamal Ataya, Abdullah Ismail, Alyamama Kousa, Zein Shahoud, Rawan Alhalbi, Rita Ghanem, Yahia Ranjous, Mazen Zaitouna","doi":"10.1097/MD.0000000000051241","DOIUrl":"10.1097/MD.0000000000051241","url":null,"abstract":"<p><p>Clinical and surgical skills are crucial for medical students in the Faculty of Medicine to become competent healthcare professionals. Some of these skills include diagnostic understanding, decision-making patient treatment, suturing, and wound care. Our research aims to enhance students' clinical and surgical knowledge to improve healthcare training. A descriptive cross-sectional study was conducted in September 2021 to assess the competence of undergraduate medical students and recent graduates of clinical and surgical skills in Syria. An electronic survey was used for data collection because of the logistical challenges. Participants included fourth-, fifth-, and sixth-year students from public and private universities as well as recent graduates. The survey consists of 3 sections: personal information, internal clinical skills, and surgical skills. Of 550 surveys collected, 500 were included in the final sample. The average test score was 8.78/20, indicating a low level of medical knowledge. Gender and university showed a significant association with knowledge level. Damascus and Aleppo scores were higher. Factors, such as financial status, marital status, work status, and academic year, were not significantly associated. Accuracy varied in surgical skill assessment, with suture specification being the most accurate and umbilical hernia CT image scoring the lowest. Clinical skill assessment showed varying accuracy, with initial patient examination being the most accurate, while jugular venous pulse and early signs of DIC showed lowest accuracy. Our study revealed a gap between theoretical knowledge and practical application among Syrian medical students. To address this, we recommend enhanced skills training through small-group sessions in well-equipped laboratories, along with ongoing assessments and clear objectives for teaching basic clinical skills.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51241"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case report of thyroid sarcomatoid carcinoma.","authors":"Lei Zhang, Lijing Ran, Lulu Zhao, Linxue Qian","doi":"10.1097/MD.0000000000051191","DOIUrl":"10.1097/MD.0000000000051191","url":null,"abstract":"<p><strong>Rationale: </strong>Sarcomatoid carcinoma represents a rare subtype of highly aggressive malignant neoplasm. Sarcomatoid carcinoma of the thyroid is extremely uncommon, accounting for merely 1% to 2% of all thyroid malignancies. It is marked by rapid progression and unfavorable prognosis, with a median survival of only 5 to 6 months. Additional case data are required to assist clinicians in the diagnosis and treatment of this rare disorder.</p><p><strong>Patient concerns: </strong>A 65-year-old male presented with fever and left cervical pain. Physical examination identified a hard palpable mass within the left thyroid lobe.</p><p><strong>Diagnoses: </strong>Thyroid ultrasonography revealed a hypoechoic nodule within the left lobe, with an anterior-posterior-to-transverse diameter ratio >1; circumferential calcification and scattered intranodular blood flow signals were observed. Additionally, enlarged and fused left cervical lymph nodes were identified. Computed tomography demonstrated that a left thyroid mass was compressing the trachea. A percutaneous fine-needle aspiration biopsy combined with immunohistochemical staining (showing positivity for both cytokeratin and vimentin) ultimately confirmed the diagnosis of thyroid sarcomatoid carcinoma.</p><p><strong>Interventions: </strong>Following multidisciplinary team consultation, the patient underwent 4 cycles of combination therapy with sintilimab, paclitaxel, and anlotinib.</p><p><strong>Outcomes: </strong>The patient achieved disease remission after combination therapy but ultimately died of disease progression 9 months post-diagnosis.</p><p><strong>Lessons: </strong>This sarcomatoid carcinoma of the thyroid case presents typical clinical and ultrasonographic manifestations. Pathological assessment combined with immunohistochemistry facilitates definitive diagnosis. The adopted combination regimen yielded temporary disease control. This case provides valuable references for the individualized diagnosis and management of this rare thyroid malignancy.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51191"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of preoperative systemic immune-inflammation index and geriatric nutritional risk index with prolonged postoperative length of stay in older patients with hip fracture: A retrospective cohort study.","authors":"Jinguang Zhang, Xiao Yu, Dongxu Sun","doi":"10.1097/MD.0000000000051293","DOIUrl":"10.1097/MD.0000000000051293","url":null,"abstract":"<p><p>This study aimed to evaluate the associations of the preoperative systemic immune-inflammation index (SII), geriatric nutritional risk index (GNRI), and their joint exposure with prolonged postoperative length of stay (LOS) in older patients undergoing hip fracture surgery. This retrospective cohort study included older patients who underwent surgery for hip fracture. SII was calculated from preoperative platelet, neutrophil, and lymphocyte counts, and GNRI from albumin and body weight. High SII was defined as above the cohort-specific 75th percentile, GNRI ≤98 as nutritional risk, and prolonged postoperative LOS as above the cohort-specific 75th percentile. Logistic regression was used to assess associations of SII, GNRI, and their joint exposure with prolonged postoperative LOS, adjusting for age, sex, Charlson comorbidity index, fracture type, and preoperative waiting time. Interaction, discrimination, subgroup, and sensitivity analyses were also performed. Among 653 patients, higher log(SII) was associated with greater odds of prolonged postoperative LOS (OR = 2.23, 95% confidence interval [CI] 1.68-2.94), as was each 10-point decrease in GNRI (OR = 1.84, 95% CI 1.26-2.68). Compared with patients with non-high SII and no nutritional risk, those with both high SII and GNRI-defined nutritional risk had substantially higher odds of prolonged postoperative LOS (OR = 10.16, 95% CI 5.52-18.67). Each 1-point increase in the SII-GNRI risk burden score was associated with higher odds (OR = 3.30, 95% CI 2.42-4.51; P for trend <.001). Multiplicative interaction was not significant (P = .138), whereas exploratory OR-based additive interaction measures were positive. The clinical model area under the receiver operating characteristic curve increased from 0.697 to 0.774 after adding SII-GNRI joint exposure. Findings were generally consistent across subgroup and sensitivity analyses. Coexisting high SII and GNRI-defined nutritional risk may identify older patients with higher odds of prolonged postoperative LOS after hip fracture surgery. Joint assessment of inflammatory and nutritional status may provide additional information for perioperative risk stratification. Given the single-center retrospective design, cohort-derived thresholds, and lack of validation, these findings are preliminary and require confirmation in independent populations.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51293"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of sleep disturbance and emotion regulation with perceived workplace safety and fatigue among male firefighters with prior occupational accidents: A cross-sectional study.","authors":"Ahmet Erhan Bakirci","doi":"10.1097/MD.0000000000051154","DOIUrl":"10.1097/MD.0000000000051154","url":null,"abstract":"<p><p>Firefighters bear a high burden of sleep disturbance and occupational accidents, yet how their individual health states relate to their own appraisal of workplace safety and fatigue is unclear. This cross-sectional study examined whether sleep disturbance, sleep quality, and emotion-regulation capacity are associated with perceived workplace safety and fatigue-related status in this group. One hundred five active-duty male firefighters from urban brigades in the Marmara region of Türkiye, all with a documented occupational accident history, completed the Basic Scale on Insomnia Complaints and Quality of Sleep, a single-item Sleep Quality Scale, the Emotion Regulation Skills Questionnaire, and the Perceived Workplace Safety/Fatigue Status tool (PWSFS), an exploratory, author-developed composite scored 20 to 100, with higher scores being more favorable (Cronbach α = 0.71 in this sample). Pearson correlations and a multiple linear regression of the PWSFS total score on the 3 predictors, adjusted for age and fire-service experience, were computed. The mean Basic Scale on Insomnia Complaints and Quality of Sleep was 12.2 (standard deviation 5.0), and the mean PWSFS was 73.2 (standard deviation 11.2). Greater sleep disturbance was associated with less favorable perceived safety and fatigue status (r = -.81, 95% confidence interval - .87 to - .74, P < .001), whereas better sleep quality (r = .52, P < .001) and greater emotion-regulation skills (r = .44, P < .001) showed weaker associations. The model accounted for 67% of the variance (F(5, 99) = 39.74, P < .001), and sleep disturbance was the only unique correlate (β = -.81, P < .001); neither sleep quality (P = .46) nor emotion regulation (P = .47) contributed independently. The association persisted in reduced-content analyses but was attenuated when sleep- and fatigue-related items were removed (safety-awareness subset r = -.58, R2 = .38, β = -.77). Among firefighters with prior occupational accidents, sleep disturbance was the measured individual-level variable most strongly associated with perceived workplace safety and fatigue. Because the design was cross-sectional and relied on single-source self-report, and because the outcome was measured with an exploratory, author-developed composite, these associations are provisional and cannot support causal inference. Sleep may nonetheless warrant attention in occupational safety and fatigue-management efforts; longitudinal, multi-source research is needed to confirm these findings.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51154"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between triglyceride-glucose index and total trabecular bone score in US adults: A cross-sectional study.","authors":"Haichao Xu, Hao Xu, Jianyang Luo, Jianfeng Zhao","doi":"10.1097/MD.0000000000051014","DOIUrl":"10.1097/MD.0000000000051014","url":null,"abstract":"<p><p>This study examines the association between the triglyceride-glucose (TyG) index and trabecular bone score (TBS) among US adults. In this cross-sectional analysis of National Health and Nutrition Examination Survey 2005 to 2008, the descriptive cohort included 3880 adults with TBS and fasting laboratory data; 3571 with positive fasting-subsample weights contributed to survey-weighted regression. TyG was calculated as ln(triglycerides [mg/dL] × glucose [mg/dL]/2) and is dimensionless. Covariate missingness was handled by multiple imputation. The primary model excluded bone mineral density (BMD) to avoid overadjustment; BMD-adjusted, complete-case, and renal-function sensitivity models were fitted. In the primary model, higher TyG was associated with lower TBS (β per 1-unit increase = -0.0097; 95% confidence interval = -0.0182 to -0.0012; P = .026). Restricted cubic spline showed nonlinearity (P-overall < .001; P-nonlinear < .001). Notably, across TyG quartiles, spine BMD remained stable (P = .104), whereas TBS declined substantially (from 1.446 to 1.310, P < .001), suggesting TyG specifically associates with bone quality rather than quantity. An exploratory two-segment knot at TyG 8.58 requires validation and is not a clinical threshold. Higher TyG is modestly associated with lower TBS, independent of BMD. While causal inference is precluded by cross-sectional design, TyG - calculated from routine labs at no extra cost - may serve as a pragmatic signal to prompt TBS evaluation in metabolically unhealthy patients, particularly obese males, even when BMD is normal. Longitudinal validation is needed.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51014"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of treatment preferences among orthopedic surgeons and physical medicine and rehabilitation specialists for lateral epicondylitis: A cross-sectional survey study.","authors":"Dağhan Koyuncu, Eser Kalaoğlu, Mehmet Yağız Yenigün, Yekta Furkan Altın, Muhammed Yusuf Afacan, Burak Orpak, Alican Barış","doi":"10.1097/MD.0000000000051317","DOIUrl":"10.1097/MD.0000000000051317","url":null,"abstract":"<p><p>Lateral epicondylitis is a common musculoskeletal disorder that lacks a universally accepted treatment algorithm. Thus, management strategies may vary among medical specialties. This study aimed to evaluate current treatment approaches for lateral epicondylitis and compare the preferences of orthopedic surgeons and physical medicine and rehabilitation (PM&R) specialists. A cross-sectional survey was conducted among orthopedic surgeons and PM&R specialists in Türkiye. The questionnaire included items regarding diagnostic methods, treatment preferences, injection practices, and perceptions of injection therapy outcomes. Treatment approaches to lateral epicondylitis were compared between specialties. A total of 101 physicians participated in the study, including 51 orthopedic surgeons and 50 PM&R specialists. Physical examination was the most commonly preferred diagnostic method (98%). The most frequently preferred first-line treatment was a combination of rest, nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy (88.1%). Second-line treatment preferences differed significantly between specialties (P < .001). Orthopedic surgeons more frequently preferred injection therapy (72.5%), whereas PM&R specialists more commonly preferred extracorporeal shock wave therapy (ESWT) (52.0%). PM&R specialists reported transitioning to injection therapy earlier (P = .016) and more frequently reported using ultrasound guidance than orthopedic surgeons (70.2% vs 4.3%, P < .001). No statistically significant between-specialty difference was detected in perceived short-term (P = .224) or long-term (P = .546) effectiveness ratings. The most frequently selected first-line treatment was the same in both specialties, whereas reported second-line treatment preferences differed. Orthopedic surgeons more frequently selected injection therapy, whereas PM&R specialists more frequently selected ESWT. These findings reflect self-reported treatment preferences and perceptions and should not be interpreted as evidence of treatment effectiveness or as nationally representative estimates. Level IV, cross-sectional survey study.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51317"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep duration, sarcopenia, and incident depressive symptoms in Chinese middle-aged and older adults: A prospective cohort study based on CHARLS.","authors":"Jiaran Jiang, Quan Zhou, Chuanxia Zhang, Yiming Ma","doi":"10.1097/MD.0000000000051177","DOIUrl":"10.1097/MD.0000000000051177","url":null,"abstract":"<p><p>Sarcopenia and depressive symptoms are prevalent health issues in middle-aged and older adults, yet the mechanisms linking them remain unclear. This study aimed to investigate the association between sarcopenia and incident depressive symptoms and to examine the potential mediating role of sleep duration. We conducted a prospective cohort study using data from the China Health and Retirement Longitudinal Study from 2011 to 2015. A total of 5346 participants aged 45 years and older without baseline depressive symptoms were included. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale, with a cutoff of ≥10 indicating depression. Sleep duration was self-reported. Cox proportional hazards models, restricted cubic spline regression, and bootstrap mediation analysis were employed. During a 4-year follow-up, 1482 participants (27.72%) developed incident depressive symptoms. After adjusting for confounders, both possible sarcopenia and confirmed sarcopenia were significantly associated with an increased risk of depressive symptoms (hazard ratio [HR] = 1.21, 95% confidence interval [CI]:1.02-1.44 and HR = 1.36, 95% CI:1.04-1.78, respectively). Longer sleep duration was independently associated with a lower risk of depression (HR = 0.93, 95% CI: 0.90-0.96). However, the mediating effect of sleep duration became non-significant after covariate adjustment (P = .302). Sarcopenia was independently associated with incident depressive symptoms, but sleep duration did not significantly mediate this association after adjustment. These exploratory findings should be interpreted cautiously. These findings suggest that interventions targeting sarcopenia prevention and management may confer beneficial effects on mental well-being in aging populations.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51177"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}