Medicine最新文献

{"title":"Histopathological findings in laparoscopic sleeve gastrectomy specimens and their relation to preoperative endoscopy: A retrospective cross-sectional study of 954 patients.","authors":"Moaz Abulfaraj, Murad M Aljiffry, Mohammed F Alhazmi, Ashraf A Maghrabi, Rana Y Bokhary, Abdulrahman Faihan A Alotaibi, Rania A Fouad, Mohamed El-Sherbiny, Hasnaa Ali Ebrahim, Tagwa Salah Ahmed Mohammed Ali, Dalia Mahmoud Abdelmonem Elsherbini","doi":"10.1097/MD.0000000000051246","DOIUrl":"https://doi.org/10.1097/MD.0000000000051246","url":null,"abstract":"<p><p>Laparoscopic sleeve gastrectomy (LSG) is the most frequently performed bariatric surgery. Although it is generally considered safe, a thorough preoperative assessment is essential to minimize the risk of complications. The need for histopathological examination of resected gastric specimens in bariatric surgery remains a subject of debate, particularly regarding the role of preoperative esophagogastroduodenoscopy (EGD). This study aimed to determine the prevalence of histopathological findings in resected specimens following sleeve gastrectomy and to assess their agreement with preoperative EGD findings at a tertiary center. This retrospective cross-sectional study examined patients who underwent LSG between 2009 to 2021. The data included demographics, comorbidities, preoperative EGD findings, and routine postoperative histopathology of the resected specimens. Diagnostic accuracy of preoperative EGD was assessed against resected-specimen histopathology. Among the 954 patients who underwent LSG, 67.1% were female, and 84.7% were Saudi nationals. Abnormal histopathological findings were observed in 45.5% (434/954) of the resected specimens, with gastritis being the predominant finding, present in 98.2% (426/434) of these. Preoperative EGD was performed in a subgroup of 357 patients (37.4%); in these, gastritis was the most prevalent EGD finding (50.1%). Helicobacter pylori was identified in 9.5% of patients who underwent preoperative EGD and in 8.0% of all resected specimens. Less common histopathological findings were metaplasia (0.6%), gastrointestinal stromal tumors (0.3%), gastric polyps (0.2%) and grade 1 gastric carcinoid (0.1%). Among the 357 patients who underwent preoperative EGD, sensitivity was 99.5%, specificity 98.3%, positive predictive value 98.4%, negative predictive value 99.4% and accuracy 98.9% against resected-specimen histopathology. Gastritis is the most prevalent histopathological finding in resected specimens following sleeve gastrectomy and on preoperative EGD, although significant pathologies are infrequent. In the selected subgroup of patients who underwent preoperative EGD, a normal EGD showed high agreement with normal histopathology of the resected specimen; these findings do not support omitting histopathological examination of resected specimens, and prospective multicenter studies are needed. Helicobacter pylori was frequently identified and was strongly associated with gastritis in unadjusted analyses; premalignant findings were too few to assess.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51246"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149287475","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":"Cost-effectiveness of 13-valent pneumococcal vaccine for children under 5 years of age at high altitude in China: A modeling analysis.","authors":"Zizhe Guo, Hui Zhou, Chonggang Huang, Haiyan Xiong, Ruiyao Ding, Jin Xu, Xingxing Du, Xiaoqing Liu, Guiyan Ma, Xiaolin Li, Hailian Yuan, Guang Hu, Kezhong A","doi":"10.1097/MD.0000000000051156","DOIUrl":"10.1097/MD.0000000000051156","url":null,"abstract":"<p><strong>Background: </strong>Pneumococcal disease poses a significant health burden in China, especially in economically underdeveloped areas in western China, such as the Qinghai-Tibet Plateau. Globally, Pneumococcal Conjugate Vaccines (PCV) have greatly reduced the burden of pneumococcal disease, but PCV has not yet been included in the National Immunization Program (NIP) in China. Consequently, most of the population remains unvaccinated with PCV. This study aimed to evaluate the cost-effectiveness of introducing 13-valent Pneumococcal Conjugate Vaccine (PCV13) into the NIP and to provide a basis for decision-making for the government and health administrative departments of Qinghai Province.</p><p><strong>Methods: </strong>We used a decision-tree Markov model to estimate the cost-effectiveness of adding a 4-dose PCV13 schedule to the NIP compared to the current situation where it is available only in the private market (status quo). The analysis focused on the 2022 birth cohort in Qinghai Province and was conducted from a societal perspective. The results were presented in terms of cases and deaths prevented, quality-adjusted life years gained, and the incremental cost-effectiveness ratio. We conducted 1-way, scenario, and probabilistic sensitivity analyses to explore model uncertainty.</p><p><strong>Results: </strong>Introducing PCV13 into the NIP was projected to prevent approximately 7493 pneumococcal cases (a 75.60% reduction) and 146 pneumococcal deaths (a 93.59% reduction) in the first 5 years of the 2022 Qinghai Province birth cohort. At the current price of US $68.00 per dose of PCV13, introducing PCV13 into the NIP was found to be cost-effective and showed cost savings. One-way and scenario sensitivity analyses indicated robust results, and probabilistic sensitivity analysis showed a 99% probability of cost-effectiveness.</p><p><strong>Conclusion: </strong>The introduction of PCV13 into the NIP is a cost-effective strategy for Qinghai Province. We recommend reducing the vaccine price through government bulk tenders and large-scale procurement to further improve cost-effectiveness and suggest introducing PCV13 into the immunization program of Qinghai in due course.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51156"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270355","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":"Comparative perioperative and follow-up outcomes of three laparoscopic reconstructive procedures for pediatric duplex kidney: A retrospective cohort study.","authors":"Hongchao Chai, Jingru Wang, Jingtao Li, Yun Zhou","doi":"10.1097/MD.0000000000051168","DOIUrl":"10.1097/MD.0000000000051168","url":null,"abstract":"<p><p>This study aimed to describe and compare perioperative characteristics, postoperative recovery, complications, and observed follow-up outcomes among children undergoing 3 laparoscopic renal-preserving reconstructive procedures selected according to anatomical and functional characteristics. This retrospective cohort study included children with duplex kidney who underwent laparoscopic renal-preserving reconstructive surgery between January 2016 and December 2025. Patients were divided into 3 groups according to the surgical procedure performed. Baseline characteristics, preoperative anatomical findings, surgical indications, operative outcomes, postoperative recovery, complications, and follow-up outcomes were compared among the groups. Additional pairwise comparison was performed between pelvic-level end-to-side ureteroureterostomy (UU) and upper-pole ureteral bladder reimplantation. A total of 91 children were included: 29 who underwent renal pelvic-level upper-pole ureter to lower-pole renal pelvis anastomosis, 36 who underwent pelvic-level end-to-side UU, and 26 who underwent upper-pole ureteral bladder reimplantation. Baseline demographic characteristics were comparable among the 3 groups. Significant differences were observed in anatomical features and surgical indications. Markedly dilated or obstructed upper-pole ureters were more frequent in the renal pelvic-level ureteropyelostomy and pelvic-level end-to-side UU groups, whereas distal upper-pole ureteral abnormality and reflux-related indications were more common in the upper-pole ureteral bladder reimplantation group. Operative time differed significantly among the 3 groups, with the shortest time observed in the pelvic-level end-to-side UU group. Estimated blood loss was also lowest in this group. Pairwise comparison showed that pelvic-level end-to-side UU was associated with significantly shorter operative time and lower estimated blood loss than upper-pole ureteral bladder reimplantation. Laparoscopic renal pelvic-level upper-pole ureter to lower-pole renal pelvis anastomosis, pelvic-level end-to-side UU, and upper-pole ureteral bladder reimplantation appear to be feasible and effective renal-preserving reconstructive procedures for pediatric duplex kidney when selected according to anatomical and functional characteristics. Pelvic-level end-to-side UU was associated with shorter operative time and lower estimated blood loss than upper-pole ureteral bladder reimplantation when a suitable ipsilateral recipient ureter was available. No statistically significant between-group differences were detected in postoperative recovery, complications, or the measured follow-up outcomes. These findings should be interpreted in the context of anatomy-based procedure selection rather than as evidence of equivalent effectiveness.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51168"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270360","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 retrospective comparative study of a full-course precision MDT nursing studio model integrating rational emotive behavior therapy for standardized health management during pregnancy.","authors":"Li Zhang, Hongying Tao, Lingna Zhu, Shoufu Liu, Yanhui Yang","doi":"10.1097/MD.0000000000050992","DOIUrl":"10.1097/MD.0000000000050992","url":null,"abstract":"<p><p>This study evaluates the clinical application of a full-course precision multidisciplinary team (MDT) nursing studio model integrating rational emotive behavior therapy (REBT) during standardized health management in pregnancy and explores its associations with maternal psychological status, antenatal care adherence, implementation-related indicators, and maternal and neonatal outcomes. This single-center retrospective comparative study included 210 pregnant women who received standardized antenatal health management from June 2024 to December 2025. Participants were classified into a conventional care group (n = 102) and an intervention group (n = 108) according to the nursing management model documented in routine clinical records. The intervention group received the MDT-REBT model in addition to routine care. Outcomes included maternal psychological indicators, health management performance, implementation- and acceptability-related indicators, and maternal and neonatal outcomes. Compared with the conventional care group, the intervention group had significantly lower generalized anxiety disorder-7, Patient Health Questionnaire-9, fear of childbirth, and perceived stress scores, as well as lower rates of moderate-to-severe anxiety and depression (all P < .01). Adherence to antenatal visits, gestational weight management, health education compliance, exercise compliance, dietary management compliance, sleep management compliance, self-monitoring compliance, and mean number of antenatal visits were all significantly better in the intervention group (all P < .05). Follow-up completion, attendance at nutritional counseling and psychological support sessions, stage-specific follow-up attendance, management compliance, and satisfaction were also significantly higher, whereas withdrawal/noncompletion was lower (all P < .01). Multivariable analyses showed that the intervention model was independently associated with better antenatal care adherence, improved gestational weight management, and lower generalized anxiety disorder-7 scores. Several maternal and neonatal outcomes showed numerical between-group differences, but most were not statistically significant. The full-course precision MDT nursing studio model integrating REBT was associated with improved maternal psychological status, better antenatal care adherence, enhanced pregnancy health management performance, and more favorable implementation-related indicators during pregnancy. These observational findings do not establish causality, and no clinical effectiveness conclusion can be drawn for maternal or neonatal endpoints that were not statistically significant. Further prospective multicenter studies are needed to confirm these findings.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e50992"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270213","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":"Strategies for establishing and developing overseas teaching hospitals: A mixed-methods case study of Nanjing Medical University.","authors":"Jingjing Ding, Wenbo Wu, Xiaowen Yang, Florenly Florenly, Jiyong Liu, Xi Zhang, Ying Liu, Yun Chen, Rongbin Yu","doi":"10.1097/MD.0000000000051281","DOIUrl":"10.1097/MD.0000000000051281","url":null,"abstract":"<p><p>China is an important base for international medical education and attracts a large number of Bachelor of Medicine/Bachelor of Surgery international students, who often face language barriers, cultural differences, and mismatches in disease spectrum during clinical internships. To address these challenges, Nanjing Medical University (NMU) explored establishing overseas teaching hospitals guided by cultural adaptation theory. This mixed-methods study combined expert interviews (medical education, hospital management, clinical medicine, and cross-cultural communication) to develop selection criteria and an evaluation indicator system for overseas teaching hospitals, and a questionnaire survey to assess internship effectiveness after implementation at Royal Prima Hospital (Indonesia). NMU developed a trial selection method and evaluation indicators and implemented them at Royal Prima Hospital. Student evaluations improved after implementation, with notable gains in teaching and training activities (e.g., lectures, case discussions, and skills-center use). NMU has successfully established China's first teaching hospital in overseas by formulating detailed selection criteria and an evaluation system, thus improving the teaching quality and meeting the needs of international students. This study indicates that the evaluation system and internship program developed through expert interviews have effectively enhanced students' clinical skills and career adaptability. This approach offers a practical reference for medical schools planning overseas clinical training sites.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51281"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270276","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":"Fractional amplitude of low-frequency fluctuations (fALFF) changes in children with anisometropic amblyopia: A resting-state fMRI study.","authors":"Xueliang Yu, Lisheng Zhao, Weizhao Lu, Di Chen, Dandan Li, Xiujuan Li, Shengdong Nie, Yi Wang, Baojian Wang","doi":"10.1097/MD.0000000000051299","DOIUrl":"10.1097/MD.0000000000051299","url":null,"abstract":"<p><p>This study aimed to explore changes in spontaneous brain activity in children with anisometropic amblyopia (CAA) using the fractional amplitude of low-frequency fluctuation (fALFF) analysis method and to determine whether anisometropic amblyopia is associated with changes in brain function. Resting-state functional magnetic resonance imaging data were collected from 16 children with anisometropic amblyopia (CAA group) and 10 healthy children (HC group). fALFF was used to assess spontaneous brain activity. Group differences in fALFF were analyzed using a two-sample t test, with age, sex, and head motion included as covariates. The statistical threshold was set at a voxel-level P < .001 (uncorrected), combined with a cluster-level family-wise error correction at P < .05. Partial Pearson correlation analyses, controlling for age and sex, were used to examine the relationships between fALFF values in regions showing significant group differences and clinical measures (best-corrected visual acuity of the amblyopic eye and magnitude of anisometropia) in the CAA group. Given the exploratory nature of the study, no correction for multiple comparisons was applied. Compared with the HC group, the CAA group showed higher fALFF values in the right middle occipital gyrus and left paracentral lobule. The fALFF value in the left middle frontal gyrus was lower in the CAA group than in the HC group. There were no significant correlations between clinical information and mean fALFF values in the CAA group. This study suggests that CAA may exhibit aberrant spontaneous brain activity within visual and frontal networks, as measured by fALFF. The absence of a direct correlation with standard clinical measures suggests that fALFF may capture distinct, network-level neural alterations in amblyopia. However, whether fALFF can serve as a reliable neuroimaging biomarker remains hypothetical and requires confirmation in larger, well-powered studies with comprehensive visual-function assessments.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51299"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270283","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":"Identification of genetically supported candidate therapeutic targets for angina pectoris using mendelian randomization.","authors":"Zixuan Wang, Dexin Wang, Longke Ran, Guangchao Zang, Lingfang Jiang","doi":"10.1097/MD.0000000000051280","DOIUrl":"10.1097/MD.0000000000051280","url":null,"abstract":"<p><p>Angina pectoris is a heterogeneous clinical syndrome that may reflect obstructive coronary atherosclerosis, coronary vasomotor dysfunction, microvascular dysfunction, or myocardial oxygen supply-demand imbalance. We used Mendelian randomization (MR) to prioritize circulating proteins that may influence the broad risk of angina while distinguishing atherosclerosis-related pathways from other potential mechanisms. This study aimed to identify genetically supported candidate therapeutic targets for angina pectoris and characterize the relative strength and potential mechanisms of the evidence supporting each candidate. The primary analysis combined European cis-protein quantitative trait locus instruments with a broad genome-wide association study -defined angina phenotype. Steiger testing, Bayesian co-localization, phenotypic scanning, external validation, supplementary European trans- protein quantitative trait locus and Asian-ancestry analyses, phenotype-stratified MR, two-step mediation MR, enrichment analysis, bulk RNA-seq, protein-protein interaction analysis, and exploratory single-cell transcriptomic analyses were used to evaluate robustness and biological context. Seven protein-angina associations met the primary Bonferroni threshold; 6 proteins (LPA, TMEM106B, APOA5, TIRAP, PCSK9, and SWAP70) were retained after TGFB1 failed Steiger filtering. Independent external MR supported LPA in UK Biobank and LPA, PCSK9, and APOA5 in FinnGen. Phenotype-stratified analyses generally supported associations across stable angina, unstable angina, coronary artery disease, and myocardial infarction, although instrument availability and the strength of evidence differed among proteins. Two-step MR supported indirect pathways through coronary artery calcification for LPA, through LDL cholesterol for PCSK9, and through triglycerides for APOA5, but not through C-reactive protein for TIRAP. Exploratory single-cell analyses localized TMEM106B, TIRAP, and SWAP70 to relevant vascular and immune cell populations and provided limited, context-dependent functional support. LPA, PCSK9, and APOA5 have the strongest convergent genetic and external-replication evidence and appear to influence angina risk predominantly through atherosclerotic lipid-related pathways. TMEM106B, TIRAP, and SWAP70 remain potentially novel, genetically supported candidates with exploratory cellular evidence but without direct experimental validation. These candidates should not be considered established therapeutic targets until proteomic, functional, rescue, and clinical studies are completed.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51280"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270337","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":"Prognostic value of the hemoglobin, albumin, lymphocyte, and platelet score in nonmetastatic renal cell carcinoma after nephrectomy.","authors":"Zheng Huang, Dan Chen","doi":"10.1097/MD.0000000000051294","DOIUrl":"10.1097/MD.0000000000051294","url":null,"abstract":"<p><p>The hemoglobin, albumin, lymphocytes, and platelets (HALP) score is a comprehensive indicator that reflects the body's systemic nutritional and immune-inflammatory status. Previous studies have found HALP score to be a strong predictor of several cancers. However, its predictive efficacy in nonmetastatic renal cell carcinoma (RCC) has been poorly studied. Patients diagnosed with nonmetastatic RCC who underwent nephrectomy at West China Hospital of Sichuan University between 2009 and 2013 were included in this study. The relationship between the HALP score and overall survival (OS) was initially observed using restricted cubic splines (RCS), with the cutoff value determined through the Maximally Selected Log-Rank Statistic. Logistic regression was utilized to explore the correlation between the HALP score and clinicopathological factors. Propensity score matching (PSM) was then employed to balance baseline characteristics of the groups. Finally, Cox regression analysis was conducted to assess the independent prognostic value of the HALP score. A total of 1164 patients were included. The cutoff score for the HALP score was determined to be 38.3. Logistic regression found that a lower HALP score was associated with poor clinicopathological factors, specifically worse Eastern Cooperative Oncology Group (ECOG) status, larger tumor size, advanced pT stage, and high Fuhrman grade. After PSM, Cox regression analysis confirmed the independent predictive value of a higher HALP score for better OS (HR = 0.50, 95% CI 0.34-0.75, P < .001). The HALP score emerges as a vital prognostic tool for assessing OS in RCC patients post-nephrectomy, effectively encapsulating the combined effects of systemic nutritional and immune-inflammatory factors.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51294"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270364","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":"Development and validation of an interpretable machine learning model for early prediction of mortality in ICU patients with chronic obstructive pulmonary disease and heart failure.","authors":"Jiayi Shen, Yucheng Liu, Yikun Chen","doi":"10.1097/MD.0000000000051224","DOIUrl":"10.1097/MD.0000000000051224","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease and heart failure frequently coexist, and the mortality risk for patients with these comorbidities is significantly elevated in the intensive care unit (ICU) setting. Therefore, developing an interpretable model for early mortality prediction is crucial to improving the prognosis and management of these patients. This study developed models based on the Medical Information Mart for Intensive Care IV database (3167 patients) and performed external validation using the eICU Collaborative Research Database (1781 patients). Least absolute shrinkage and selection operator regression combined with the Boruta algorithm was used to screen clinical features within the first 24 hours of ICU admission. Based on the selected features, 5 machine learning models (eXtreme Gradient Boosting, Categorical Boosting, Light Gradient Boosting Machine, Random Forest, and Support Vector Machine) were constructed and compared for their performance in predicting 28-day all-cause mortality. The optimal model was interpreted using the Shapley Additive Explanations framework. In internal validation, the Categorical Boosting model demonstrated the best overall performance, achieving an area under the receiver operating characteristic curve of 0.788, with a sensitivity of 0.482 and a specificity of 0.900. In independent external validation, the model's area under the receiver operating characteristic curve was 0.739. Feature selection identified 14 key predictive variables. Shapley Additive Explanations analysis revealed that the Sequential Organ Failure Assessment score, Simplified Acute Physiology Score II score, anion gap, vasopressor use, and respiratory rate were the top 5 features contributing most to the model's predictions. This study developed and validated an interpretable machine learning model based on multicenter data for the early prediction of 28-day mortality risk in ICU patients with chronic obstructive pulmonary disease and heart failure. The model demonstrates good discriminative ability and reasonable generalizability, with its interpretability analysis clarifying core predictive factors to aid in clinical risk stratification and intervention.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51224"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270377","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":"Efficacy and safety of GLP-1 receptor agonists in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH): A systematic review and meta-analysis.","authors":"Mohammed Alfawaz, Dareen Bajamaan, Lama Alghamdi, Yara Alorfi, Saud Khared, Nada Ameen, Rahaf Alamri, Mohammed Abuladel, Rayan Alshehri, Shaima Altowairqi","doi":"10.1097/MD.0000000000051306","DOIUrl":"10.1097/MD.0000000000051306","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are increasingly prevalent liver diseases closely linked to obesity, type 2 diabetes mellitus, and cardiometabolic risk. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may improve hepatic and metabolic outcomes through weight reduction, improved glycemic control, and reductions in hepatic steatosis. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of GLP-1 RAs in adults with MASLD or MASH.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed, Web of Science, Scopus, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched for English-language studies published between January 2019 and December 2025. Eligible studies included adults with MASLD or MASH treated with GLP-1 RAs and reporting hepatic, metabolic, or safety outcomes. Pooled estimates were calculated using random-effects models.</p><p><strong>Results: </strong>Nine studies involving 795 participants were included. GLP-1 RA therapy was associated with significant reductions in liver fat content (mean difference [MD]: -3.17; 95% CI: -4.06 to -2.29), body weight (MD: -4.68; 95% CI: -6.88 to -2.47), alanine aminotransferase (MD: -15.17; 95% CI: -21.29 to -9.05), aspartate aminotransferase (MD: -9.89; 95% CI: -13.65 to -6.13), and HbA1c (MD: -0.78; 95% CI: -1.07 to -0.49). Adverse events were more frequent with GLP-1 RAs, particularly nausea and vomiting, while serious adverse events did not differ significantly between groups.</p><p><strong>Conclusion: </strong>GLP-1 RAs are associated with meaningful improvements in hepatic steatosis, liver enzymes, body weight, and glycemic control in patients with MASLD or MASH. These findings support their potential role, particularly in patients with coexisting obesity or type 2 diabetes. However, further long-term, adequately powered trials are needed to clarify their effects on fibrosis regression, histological outcomes, and liver-related clinical events.</p>","PeriodicalId":18549,"journal":{"name":"Medicine","volume":"105 43","pages":"e51306"},"PeriodicalIF":2.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149270449","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}