This study aimed to examine the association between adherence to the Planetary Health Diet (PHD) and the prevalence of chronic neck-back pain. This cross-sectional analysis used baseline data from 97,543 participants in the UK Biobank with complete dietary, outcome, and covariate data. The PHD score was constructed from up to five 24-h dietary recalls. Chronic neck-back pain was defined as self-reported neck/shoulder or back pain in the previous month lasting ≥3 months and interfering with daily activities. Multivariable logistic regression, restricted cubic splines, and subgroup analyses were performed. Overall, 22.5% of participants reported chronic neck-back pain. In the primary analysis, each 10-point increase in the PHD score was associated with lower odds of prevalent chronic neck-back pain (OR = 0.99, 95% CI: 0.97-1.00). In participants aged < 60 years, the association was stronger (OR = 0.97, 95% CI: 0.96-0.99). The highest PHD quartile showed 7% lower odds of prevalent chronic neck-back pain compared with the lowest quartile (OR = 0.93, 95% CI: 0.88-0.98).Effect modification analyses revealed that the protective effect was most pronounced in women aged < 60 years (OR=0.96, 95% CI: 0.94-0.98). Sensitivity analyses using alternative outcome definitions (ICD-10 codes, single-site pain) and exposure thresholds confirmed the robustness of these findings. Higher adherence to the Planetary Health Diet was associated with lower odds of prevalent chronic neck-back pain, particularly among adults aged < 60 years, with an approximately linear dose-response pattern. These findings provide the first prospective evidence that a sustainable, plant-centric dietary pattern may be associated with a lower risk of chronic spinal pain. However, further validation in independent populations is needed before broad clinical application can be recommended.
To evaluate the literature regarding the efficacy of various repair and reconstruction surgical techniques for chronic quadriceps tendon ruptures (QTRs) in native knees and to assess their associated outcomes. A comprehensive literature search of the EMBASE, PubMed/MEDLINE, and Cochrane databases was conducted from October 2023 to November 2024 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical studies that analyzed outcomes following surgical intervention of chronic QTRs with Level IV or greater evidence were included. We excluded case reports and QTRs in the setting of total knee arthroplasty. Quality assessment was conducted using Methodological Index for Non-Randomized Studies criteria. Ten studies published between 1981 and 2022 were included. Described techniques included direct tendon repair, lengthening procedures, and various graft and mesh augmentations. Reported failure rates ranged from 0 to 33%. Extensor lag remained a common reported complication (5 of 10 studies). The current body of literature on the surgical management of chronic QTRs is characterized by significant heterogeneity in surgical technique and a predominantly low quality of evidence. The various surgical techniques described suffer from limited follow-up and inconsistently reported outcome measures. Level IV, systematic review of Level III and IV studies.
Chronic rupture of the Achilles tendon, including neglected primary lesions and re-ruptures, remains a demanding clinical condition, particularly in active individuals. Endoscopic-assisted procedures with flexor hallucis longus tendon transfer have gained increasing popularity. This study aims to evaluate the clinical and functional outcomes of isolated endoscopic-assisted flexor hallucis longus tendon transfer in patients with high functional demands over an 11-year period. This retrospective study included 35 patients (29 males, 6 females; mean age 48.3 ± 11.6 years) who underwent isolated endoscopic-assisted flexor hallucis longus tendon transfer for treatment of chronic rupture of the Achilles tendon between 2014 and 2024. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score, the Achilles Tendon Total Rupture Score, and the single-leg heel-rise test. The mean follow-up was 20.0 ± 11.3 months. Rates of return to sports, running and work were evaluated. The Wilcoxon signed-rank test was used to compare pre and postoperative scores. The Spearman correlation coefficient was used to analyze the association between functional outcomes and both patient age and time from injury to surgery. Significant improvement was observed in functional scores: the American Orthopaedic Foot and Ankle Society score increased from a median of 49 to 97, and the Achilles Tendon Total Rupture Score from 18 to 95 (both P < .001). The heel-rise test was completed by 97.1% of patients. All previously active patients returned to sport, and 96.9% resumed work. Weak, nonsignificant negative correlations were observed between functional outcomes and both age and time to surgery. Three postoperative complications (8.6%) were observed. Endoscopic-assisted flexor hallucis longus tendon transfer is an effective treatment option for chronic Achilles tendon ruptures in demanding patients. It provides excellent functional outcomes, a high rate of return to previous activity levels, and a low rate of complications.Level of Evidence: Level IV.
The sustained progression of chronic obstructive pulmonary disease (COPD) may not be independently driven by a single process such as chronic inflammation, oxidative stress, or cell death, but rather originates from a cross-amplification network among "mitochondrial dysfunction-oxidative stress-regulated cell death." In the context of mitochondrial damage, excessive generation of reactive oxygen species (ROS), damage and release of mitochondrial DNA (mtDNA), and dysregulation of mitochondrial quality control (MQC) collectively promote airway epithelial injury, sustained inflammation, alveolar destruction, and tissue remodeling. Furthermore, regulated cell death modalities such as apoptosis, necroptosis, pyroptosis, and ferroptosis are not isolated from each other but are coupled under a shared context of mitochondrial stress, exhibiting different dominant patterns across various cell types and disease stages. Adopting an integrated perspective encompassing mitochondrial dysfunction, amplified oxidative stress, and the regulated cell death (RCD) cross-network, this article synthesizes current research regarding COPD-related mechanisms, with a focus on mitochondrial damage markers, RCD activity indicators, mechanism-oriented patient stratification, and potential therapeutic strategies targeting mitochondrial homeostasis and cell death pathways. This framework facilitates the transition of COPD understanding from the traditional chronic inflammation model to a more stratified and translationally promising mitochondrial-cell death network model.
In this cross-sectional observational study, we evaluated whether serum and urinary Golgi membrane protein 1 (GOLM1/GP73) could serve as biomarkers for CKD. Chronic kidney disease (CKD) lacks simple biomarkers reflecting both systemic burden and tubular health. GP73 is stress-responsive, but its utility across CKD and acute kidney injury (AKI) has not been systematically evaluated. We enrolled 32 healthy individuals and 172 kidney disease patients: CKD stages 1-3 (n = 70), 4-5 (n = 42), dialysis-dependent stage 5D (n = 40), and AKI or acute-on-chronic kidney disease (n = 20). Serum G73, urinary G73, urinary creatinine, and conventional renal markers were measured. Logistic regression, AUC, decision curve analysis (DCA), and ordinal regression were used. Kidney biopsies (n = 20) were immunostained for GP73. Serum G73 progressively increased from healthy controls to CKD stages 4-5, with a modest decrease in CKD stage 5D (median: healthy 47.2, CKD1-3 62.2, CKD4-5 96.1, CKD5D 89.9 ng/mL; P < 0.001), whereas urinary G73 and the urine G73-to-creatinine ratio progressively declined (both P < 0.001). Adding serum G73 to a clinical model (age, sex, BMI, hypertension, diabetes, CKD duration) significantly improved discrimination of advanced CKD (CKD4-5/5D vs. 1-3): AUC increased from 0.81 to 0.85 (DeLong P = 0.026), with net DCA benefit across 0-85% thresholds. Adding serum G73 to a non-renal clinical covariate model improved discrimination for advanced CKD; however, sensitivity analyses showed no meaningful incremental value beyond eGFR or serum creatinine for this eGFR-defined endpoint. Serum G73 alone showed modest ability to distinguish AKI/AonC from CKD (AUC 0.59-0.75). Kidney GP73 immunostaining was weak and unchanged across stages. Serum G73 independently associates with CKD severity and adds diagnostic value to conventional models, especially for advanced CKD. The contrasting decline in urinary G73 and lack of increased renal tissue expression are consistent with a predominantly extra-renal contribution to circulating G73, while urinary G73 reflects tubular function. Serum and urinary G73 are useful non-invasive biomarkers that could improve CKD staging.
Thoracic endovascular aortic repair (TEVAR) has become the primary treatment for Stanford type B aortic dissection. The differential diagnosis of postoperative periaortic masses typically focuses on hematoma, endoleak, or graft infection. We report the case of a patient who underwent repeat TEVAR for stent-graft fracture 8 years after the index procedure. A periaortic hypodense lesion identified on preoperative computed tomography (CT) was initially interpreted as a hematoma but rapidly progressed into a large soft-tissue mass shortly after the secondary intervention, accompanied by a marked elevation in serum lactate dehydrogenase. Imaging evaluation revealed a discordant pattern: restricted diffusion on magnetic resonance imaging (MRI) with absent enhancement on contrast-enhanced ultrasound (CEUS). Positron emission tomography/computed tomography (PET/CT) demonstrated markedly increased metabolic activity within the lesion. Core needle biopsy confirmed the diagnosis of Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) with a TP53 mutation. Diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI) occurring around a vascular graft and forming a well-defined mass is extremely rare. No previously reported case has simultaneously met the three criteria of a vascular graft background, Epstein-Barr virus-encoded small RNA (EBER) positivity, and the formation of a well-defined mass. Through retrospective analysis of the imaging features in this case, we aim to enhance clinicians' awareness of this rare entity, thereby facilitating earlier diagnosis and reducing misdiagnosis.
Delirium is a frequent yet often underrecognised complication in hospitalised patients, particularly in those with renal impairment. Cefepime, a broad-spectrum cephalosporin, has been increasingly associated with neurotoxicity, manifesting as confusion, hallucinations, and agitation. This case report describes a 63-year-old woman with chronic kidney disease secondary to autosomal dominant polycystic kidney disease who developed acute confusional symptoms after initiating cefepime during treatment of a urinary tract infection associated with infected renal cysts. Following clinical improvement of the underlying infection, she developed temporal disorientation and visual hallucinations within 24-48 hours of cefepime initiation, which resolved within 24 hours of drug discontinuation. The Naranjo Adverse Drug Reaction Probability Scale classified the association as "probable" (score: 6). Although alternative contributors to delirium were present, including acute infection and renal dysfunction, the temporal relationship between cefepime exposure and symptom onset, together with rapid symptom resolution after withdrawal, supported cefepime-induced neurotoxicity as the most likely diagnosis. This case reinforces the importance of considering cefepime-induced neurotoxicity in the differential diagnosis of delirium, particularly in patients with renal dysfunction. Close clinical monitoring and early recognition are essential to prevent misdiagnosis and unnecessary interventions. Further studies are needed to refine risk assessment and explore safer therapeutic alternatives.
Chronic atrophic gastritis (CAG) is a precancerous gastric lesion characterized by persistent inflammatory injury, glandular atrophy, and impairment of gastric mucosal barrier-associated integrity. Huangjin Shuangshen Decoction (HJSS) has shown therapeutic potential in gastritis-related disorders, but its effects on CAG and the underlying mechanism remain unclear. This study investigated whether HJSS alleviates CAG by modulating inflammation-associated barrier dysfunction. CAG was induced in mice by MNNG combined with ranitidine and irregular feeding, followed by treatment with different doses of HJSS, with folic acid as a positive control. Histopathology, gastric function indices, inflammatory mediators, apoptosis-related markers, and barrier-associated molecules were assessed in vivo. MNNG-injured GES-1 cells treated with HJSS-medicated serum were used for in vitro validation. Transcriptomic analysis, network pharmacology, and pharmacological inhibition were integrated to explore the underlying mechanisms. HJSS alleviated gastric mucosal atrophy and histopathological injury, improved gastric functional impairment, reduced inflammatory burden, and attenuated apoptosis-associated epithelial injury in experimental CAG. HJSS also promoted the recovery of gastric mucosal barrier-associated molecules, including CFTR, ZO-1, MUC5AC, Occludin, and Claudin-1. Integrated transcriptomic and network pharmacology analyses highlighted an inflammation-barrier framework involving TNF-related signaling and CFTR-associated regulation. In vitro, HJSS mitigated MNNG-induced epithelial injury, whereas CFTR inhibition attenuated the HJSS-associated restoration of CFTR and ZO-1. HJSS was further associated with suppression of TNF/NF-κB signaling and reduced p65 nuclear translocation. HJSS alleviates MNNG-induced CAG by attenuating inflammatory injury and promoting the recovery of gastric mucosal barrier-associated molecular features. Its protective effects are associated with suppression of TNF/NF-κB signaling and involvement of CFTR-associated regulation, supporting an inflammation-barrier mechanism underlying the action of HJSS in CAG.
A significant gap exists within current guidelines for the treatment of chronic total occlusion (CTO), which has yielded poor prognostic outcomes. Intravascular lithotripsy (IVL) has emerged as a novel strategy implemented during percutaneous coronary intervention (PCI), but evidence to support its use is limited. We aimed to review the outcomes of IVL for CTO PCI. Databases including PubMed, Cochrane, Scopus, EBSCOhost, and ProQuest were searched for studies implementing IVL for CTO PCI. The quality of studies was assessed using the Cochrane Risk Of Bias In Non-randomized Studies of Interventions and JBI tools. An inverse variance, random-effects meta-analysis was conducted in RStudio version 2023.03.0+386 yielding pooled proportions and means along with their 95% confidence intervals (CIs). Where applicable, sensitivity and subgroup analyses were performed. Five studies with 611 patients were included. Technical success was achieved in 97% (95% CI: 94-100%; I²=18%) of cases. Procedural success was achieved in 94% (95% CI: 90-97%; I²=27%), and the subgroup with a Japanese CTO score >2.8 yielded a significantly higher success rate (95% [95% CI: 93-97%] vs 91% [95% CI: 85-96%]; p=0.04). Major adverse cardiovascular events (MACE) occurred in 3% (95% CI: 2-5%; I²=0%) of cases within the in-hospital follow-up subgroup and in 6% (95% CI: 1-12%; I²=0%) of cases within the discharge follow-up subgroup. Mortality occurred in 1% (95% CI: 0-4%; I²=55%) of cases within the in-hospital subgroup and 0% (95% CI: 0-52%) of cases within the discharge subgroup. Perforation as a complication occurred in 5% (95% CI: 1-9%; I²=54%) of cases. The pooled mean procedural time was 122.94 minutes (95% CI: 102.24-143.64 minutes; I²=90%), and the mean contrast volume used was 154 mL (95% CI: 140.84-167.16 mL; I²=69%). IVL yielded high technical and procedural success, and comparable procedural times and contrast volume in CTO PCI. MACE, mortality, and perforation occurred in small proportions of patients. Further studies are needed to strengthen evidence and explore which subtype of CTO would benefit most from IVL.
Alexithymia is one of the most common psychological characteristics observed in patients with chronic obstructive pulmonary disease (COPD) and is associated with poorer health outcomes. The negative impact of alexithymia on physical illness is reflected in more severe clinical symptoms and poorer quality of life, which adversely affect clinical outcomes and further increase disease burden, potentially contributing to a cycle of worsening health status. Therefore, timely identification of the psychological characteristics of patients with COPD, along with early psychological support, may help improve the quality of life of patients with COPD. To explore the latent profiles of alexithymia among patients with COPD and to analyze their associated factors. This cross-sectional study recruited 312 patients with COPD using convenience sampling between October 2024 and March 2025. Sociodemographic characteristics, physiological and disease-related information, psychospiritual information, environmental factors, and alexithymia scores were collected. Latent profile analysis, univariate analysis, and multinomial logistic regression were conducted to identify alexithymia profiles and examine factors associated with profile membership. The results of this study showed that patients with COPD were categorized into three alexithymia profiles: high (28.85%), moderate (63.46%), and low (7.69%). COPD duration, depression, activity intensity, self-perceived social support, psychological resilience, and anxiety were associated with different alexithymia profiles among patients with COPD. This single-center cross-sectional study identified three preliminary alexithymia profiles (high, moderate, and low) among patients with COPD. Due to potential selection bias resulting from convenience sampling, these findings require validation in multicenter studies before generalization. The observed associations among COPD duration, depression, activity intensity, social support, resilience, and anxiety provide empirical evidence to inform the development of tailored patient classification and targeted support strategies for early identification, with the goal of improving quality of life in this population.
Anatomical factors of the sinuses significantly impact the progression of chronic rhinosinusitis (CRS). This study aims to investigate the correlation between morphological sinus features and the risk of CRS onset to provide evidence-based support for clinical management. This multicenter study enrolled 716 CRS patients and 115 healthy individuals from January 2019 to December 2023. CRS patients were categorized into eosinophilic CRS (eCRS) and non-eosinophilic CRS (NeCRS) based on pathological results. The deep learning model nnU-Net v2 was trained for automated segmentation of sinuses. Morphological features were extracted and then screened using PyRadiomics. Subsequently, logistic regression, random forest, and multi-layer perceptron (MLP) were used to build CRS risk and subgroup evaluation models. CRS patients exhibited larger sinus volumes, surface areas, and multiple 2D/3D diameters compared to healthy individuals, while sphericity of maxillary and sphenoid sinuses was lower. A CRS risk prediction model was built using 20 morphological indicators. In the test cohort, the AUC values for the logistic regression, random forest, and MLP models were 0.884 (95% CI: 0.818-0.938), 0.890 (95% CI: 0.819-0.963), and 0.888 (95% CI: 0.822-0.952), respectively. Subgroup analysis showed that, although 18 indicators were selected for predicting the risk of CRS subtypes, the performance of all three models was relatively poor. Multiple morphological sinus features are closely associated with the risk of CRS and could serve as significant indicators for assessing CRS risk. However, there are no significant differences in sinus morphology between eCRS and NeCRS patients.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
The rising prevalence of obesity introduces challenges in surgical contexts, including endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP). However, the impact of obesity on ESS outcomes remains underexplored. This study aims to evaluate the association between obesity and surgical complexity, operative duration, postoperative quality of life (QOL), in patients with CRSwNP undergoing ESS. A retrospective analysis was conducted on 310 adult patients who underwent ESS for CRSwNP at a tertiary medical center between 2013 and 2023. Patients were categorized into two groups: Nonobese (BMI < 30 kg/m²) and obese (BMI ≥ 30 kg/m²). Outcomes assessed included operative time, postoperative complications, and QOL using the Sinonasal Outcome Test (SNOT-22). Of the 310 patients, 62 (20%) were obese. Obese patients had significantly higher preoperative Lund-Mackay scores (18.5 ± 4.7 vs. 16 ± 5.5, p = 0.036), longer operative durations (179 ± 61 vs. 162 ± 59 min, p = 0.034), and worse postoperative SNOT-22 scores (38 ± 26 vs. 24 ± 22, p = 0.041) compared to nonobese patients. However, only six obese patients completed paired pre- and postoperative snot-22 data. They were also more likely to require prolonged oral steroid use (> 3 months) (37% vs. 21%, p = 0.013) and biological treatments (21% vs. 8%, p = 0.01). No significant differences were observed in immediate postoperative complications or hospital stays. Obesity was not associated with increased surgical risk or delayed recovery following ESS for CRSwNP. However, obese patients had more severe disease and achieved less symptom improvement, highlighting the need for tailored postoperative care and adjunct therapies to optimize outcomes.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
Chronic rhinosinusitis with nasal polyps (CRSwNP) impacts patients' concentration, ability to work, and overall quality of life. Current treatment options include topical and oral medications, and surgery. Recent evidence supports the efficacy of biologics in improving symptoms and quality of life. This study addresses the lack of consensus in the ASEAN region, providing guidance for otolaryngologists on appropriate CRSwNP management. A modified Delphi panel was conducted to gather expert opinion and establish consensus on the use of biologics and management of CRSwNP among otolaryngologists in the ASEAN region. Statements were developed based on a literature review and inputs from a Steering Committee of eight experts from Malaysia, Singapore, and Thailand. A three-stage process was utilized for consensus generation: two online surveys for voting by at least 12 panelists from seven ASEAN countries, followed by moderated online Consensus Meetings with the Steering Committee. Consensus was achieved on 61/69 statements (88%). In Rounds 1 and 2, 37/67 statements (55%) and 13/28 statements (46%) achieved consensus, respectively. During the moderated Consensus Meetings, consensus was achieved on 12/16 statements (75%). Key aspects addressed include symptoms, comorbidities, diagnosis, and treatment pathways, with a focus on biologics. Eligibility criteria and considerations for biologic use were also defined. Insights from this Delphi consensus provide guidance on biologic use for managing CRSwNP in the ASEAN region. Future efforts, such as developing a regional guideline, continued medical education, and further research are essential for appropriate biologic use.
Description More than 45% of Americans have at least 1 chronic disease, with chronic disease also being a leading cause of death in the United States. In primary care settings, about 75% of visits are for management of multiple chronic diseases. Due to the increasing medical complexity of patients who present to primary care, these numbers make it more challenging for Primary Care Clinicians (PCCs) to manage these conditions alone and point to the need for innovative solutions to chronic disease care. One evidence-based innovation is team-based care to improve the treatment of these conditions. Clinicians such as clinical pharmacists, registered dietitians, behavioral health clinicians, oral health clinicians, and health educators have an important role in primary care to co-manage the patient population, but often, the primary care setting underutilizes these other health care team members. Therefore, if the PCC understands how the psychological and behavioral aspects of health behavior change and chronic disease management fit within a team-based care model, care may improve. Team-based care has been implemented and studied in many ways, but with the Accreditation Council for Graduate Medical Education recently necessitating significant behavioral health training and practice opportunities for medical residents in primary care residency training programs, new and innovative approaches to training medical residents in behavioral health are needed to meet the health behavior change needs of their future populations upon graduation. This article provides an overview of health behavior change theories and translates theory into primary care practice within medical education through case examples. Our goal is to provide PCCs in primary care specialties such as Family Medicine, Pediatrics, and Internal Medicine with evidence-based and inventive behavioral treatment approaches to increase their ability to holistically treat chronic conditions in primary care through collaboration with other health care team members as well as train upcoming PCCs in these important practices.
Helminth infections are among the most prevalent causes of chronic inflammation in humans, but only a small subset of these infections is causally linked to cancer. This discrepancy challenges the long-standing assumption that chronic inflammation is intrinsically carcinogenic and suggests that additional constraints govern inflammation-driven tumorigenesis in parasitic diseases. This review aims to explain why most helminths fail to induce malignancy despite long-term inflammatory host responses, and why opisthorchiid liver trematodes represent a rare and informative exception. We seek to integrate primary experimental, epidemiological, and pathological evidence into a unified conceptual settings applicable to helminth-associated cancers. We introduce the concept of a "pro-oncogenic inflammation threshold," proposing that carcinogenesis emerges only when multiple dimensions converge simultaneously: sustained inflammatory intensity and quality, prolonged exposure, genotoxic stress, tissue-specific vulnerability, and permissive environmental cofactors. Most helminths remain below this threshold because of evolutionary selection that favors host survival, the absence of direct genotoxins, and effective immunoregulatory mechanisms. In contrast, opisthorchiids exceed this threshold through chronic mechanical injury to bile ducts, secretion of genotoxic and mitogenic metabolites, synergy with dietary nitrosamines, perturbation of the biliary microbiome, and failure of reparative homeostasis. Helminth-induced cancers represent a neglected category of tropical disease that remains poorly integrated into global oncology strategies because of disciplinary fragmentation and a mutation-centric cancer paradigm. Setting helminth-associated carcinogenesis in a One Health context highlights actionable prevention opportunities at the human-animal-environment interface. Chronic helminth-induced inflammation is therefore a conditional, rather than universal, driver of cancer.
Periodontitis is a chronic inflammatory disorder that gives rise to tissue damage and loss due to the complex interaction between pathogenic bacteria and the host's immune response. The aim of this study is to determine the lipid peroxidation, total antioxidant (AO) capacity (TAC), and superoxide dismutase (SOD) levels in patients diagnosed with chronic gingivitis and chronic periodontitis and in periodontally healthy control subjects. The subjects were divided into three groups. Blood sample and saliva were collected. TAC, MDA, and SOD levels were estimated by spectrophotometric methods. SOD in the saliva samples was analyzed by using the enzyme-linked immunosorbent assay (ELISA) kit method. The mean age of the study population in the control group was 45.21 ± 13.12, which in the gingivitis group was 44.12 ± 9.10 and in the periodontitis group was 42.19 ± 12.11. TAC and SOD levels were significantly reduced in both serum and saliva in the periodontitis compared to control and the gingivitis group. MDA levels were significantly increased in the serum and the saliva of the periodontitis compared to control and the gingivitis group. Oxidative stress, or the imbalance between oxidants and AO, is a major factor in the development and course of periodontitis.