Tag: pubmed

Medicine (Baltimore). 2025 Nov 7;104(45):e45644. doi: 10.1097/MD.0000000000045644.

ABSTRACT

BACKGROUND: At present, laparoscopic cholecystectomy (LC) is the primary treatment for gallstone. Although the application of LC has been widespread in developed countries, the cost-effectiveness of LC in high-altitude, low-resource regions remains unclear.

METHODS: We aimed to determine the cost-effectiveness of LC in the Qinghai Province and to provide a reference for other high-altitude area. We included 124 patients treated from 2018 to 2022 in Qinghai Traffic Hospital. We collected their demographic and clinical information and used the EuroQol Five Dimensions questionnaire to assess their quality of life. We performed cost-effectiveness analysis to evaluate LC and open cholecystectomy (OC). We also performed sensitivity and threshold analyses to determine the robustness of the results.

RESULTS: The OC and LC group demonstrated no significant differences in demographic characteristics. However, the hospital costs, the length of stay and quality-adjusted life years were significantly different between 2 groups (P < .05). The average cost was $1293 for LC and $2480 for OC. When the willingness to pay value is $2328 per quality-adjusted life year, the probability is >0.9, while when the willingness to pay value is $2793 per length of stay, the probability is >0.8.

CONCLUSION: LC is less expensive and more effective than OC from the patient and society perspectives. Although there are some obstacles, it is feasible to promote LC in high-altitude, low-resource areas.

PMID:41204610 | DOI:10.1097/MD.0000000000045644

Medicine (Baltimore). 2025 Nov 7;104(45):e45392. doi: 10.1097/MD.0000000000045392.

ABSTRACT

To evaluate the efficacy and safety of intraoperative optical coherence tomography (iOCT)-guided partial internal limiting membrane (ILM) peeling combined with inferior flap coverage for the treatment of idiopathic macular holes (IMH). This prospective, randomized, controlled clinical trial included patients with Gass stage 4 IMH, aged 50 or older, who had not undergone prior vitreoretinal surgery. Patients were randomized into 2 groups: the experimental group received iOCT-guided partial ILM peeling with inferior flap coverage, and the control group underwent standard ILM peeling. Outcome measures included best-corrected visual acuity, optical coherence tomography (OCT), optical coherence tomography angiography (OCTA), multifocal electroretinography, and microperimetry at 2 weeks and 6 months postoperatively. A total of 34 eyes were enrolled, with 18 in the experimental group and 16 in the control group. There was a significant improvement in best-corrected visual acuity and reduction in central foveal thickness in both groups, with no statistically significant differences between groups at any time point. The hole closure rate was also comparable, with 83.3% in the experimental group and 75.0% in the control group at 2 weeks, and 94.4% and 87.5% at 6 months, respectively. Functional outcomes, as measured by OCTA, microperimetry, and multifocal electroretinography, showed significant improvements in both groups without significant intergroup differences. iOCT-guided partial ILM peeling with inferior flap coverage is a feasible and safe surgical approach for IMH, with outcomes not statistically different from the standard ILM peeling technique. The novel technique may offer subtle benefits in preserving retinal structure and function, warranting further investigation.

PMID:41204608 | DOI:10.1097/MD.0000000000045392

Medicine (Baltimore). 2025 Nov 7;104(45):e45157. doi: 10.1097/MD.0000000000045157.

ABSTRACT

BACKGROUND: To evaluate the impact of extracorporeal diaphragm pacing (EDP) therapy on diaphragm function in critically ill patients reliant on mechanical ventilation.

METHODS: Patients were randomly divided into an observation group (39 cases) and a control group (40 cases) using a random number table. Both groups received bedside rehabilitation interventions. Additionally, the observation group underwent EDP therapy 6 times weekly for 2 weeks. Diaphragm activity, diaphragm thickness, arterial oxygen tension (PaO2), arterial carbon dioxide tension (PaCO2), and Oxygenation Index (OI) were measured at baseline and 2 weeks postenrollment or upon extubation.

RESULTS: Both groups showed significant improvements in diaphragm activity, PaO2, PaCO2, and OI compared to baseline (P <.05). The observation group had significantly better outcomes in diaphragm thickness (0.22 ± 0.03), diaphragm activity (13.96 ± 0.73), PaCO2 (37.59 ± 5.66), and OI (271.10 ± 17.25) compared to the control group (0.20 ± 0.02, 12.24 ± 0.99, 47.25 ± 5.64, 248.60 ± 15.26), with statistical significance (P <.05).

CONCLUSION: EDP therapy offers benefits in improving diaphragm function in critically ill patients on mechanical ventilation. It enhances diaphragm strength and endurance, increases diaphragm activity, improves pulmonary ventilation, and reduces mechanical ventilation duration.

PMID:41204603 | DOI:10.1097/MD.0000000000045157

Medicine (Baltimore). 2025 Nov 7;104(45):e45468. doi: 10.1097/MD.0000000000045468.

ABSTRACT

Diet is an important factor influencing chronic constipation and diarrhea. This investigation proposes to examine the correlation between the Planetary Health Diet Index (PHDI), a new dietary scoring system, and the risk of chronic constipation and diarrhea in the general population. Data on 13,669 adults (≥20 years) were extracted from the 2005 to 2010 National Health and Nutrition Examination Survey. The PHDI was calculated by two 24-hour dietary recall interviews and consisted of scores from 15 food groups with a total score range of 0 to 140. Multivariable logistical regression analyses were employed to examine the correlation between PHDI and chronic constipation/diarrhea, and presented as odds (OR) and 95% confidence interval. Subgroup evaluations were carried out according to population and disease characteristics. The weighted quantile sum analysis was applied to evaluate the effect of total PHDI and its components on chronic constipation. Among these 13,669 participants, 1027 reported chronic constipation, 1061 had chronic diarrhea, and 11,581 maintained normal bowels. The second (63.69-66.67) (OR = 0.73 [0.57-0.92]) and third (>66.67) tertiles (OR = 0.68 [0.54-0.85]) of PHDI were connected to lower odds of chronic constipation versus the first tertile of PHDI (<63.69). No significant correlation was identified between PHDI and chronic diarrhea (P > .05). There was a nonlinear link of PHDI with chronic constipation (Poverall < .001, Pnonlinear < .001), and the risk of chronic constipation in individuals decreased with the increase in PHDI. Subgroup analysis indicated that the connection between PHDI and chronic constipation risk was more obvious in populations aged <65 years, those without diabetes, and those with dyslipidemia (P < .05). The weighted quantile sum analysis demonstrated that the overall mixed exposure effect of PHDI on the risk of chronic constipation was 0.96 (95% confidence interval: 0.94-0.97) (P < .001). Among the contributions of each component to PHDI, “added sugar and fruit juices” contributed the most to the effect of PHDI, followed by “saturated oils and transfat,” while “legumes” and “nuts and seeds” contributed the least. A high PHDI is correlated with a lower risk of chronic constipation in the general population, which may suggest the potential benefits of dietary modification.

PMID:41204594 | DOI:10.1097/MD.0000000000045468

Medicine (Baltimore). 2025 Nov 7;104(45):e45711. doi: 10.1097/MD.0000000000045711.

ABSTRACT

Maternal smoking around birth (MSAB) has been associated with various adverse health outcomes in offspring, including an increased risk of kidney diseases. This study aims to investigate the potential causal relationship between MSAB and the risk of kidney diseases in descendants using Mendelian randomization (MR) methods, providing insights into the epidemiological background of kidney diseases and the application of MR in this context. We conducted a 2-sample MR analysis utilizing publicly available data from large-scale genome-wide association studies on MSAB (n = 397,732), breastfeeding (n = 352,094), and various kidney diseases, including acute kidney injury (AKI) (n = 482,266), chronic kidney injury (n = 482,858), glomerulonephritis (n = 500,348), renal malignancies (n = 463,010), and chronic kidney disease (n = 493,235). We employed multiple MR methods, including inverse variance weighted (IVW), weighted median, weighted mode, and MR Egger regression, to assess the causal effects. We used the odds ratio (OR) as our measure and conducted multivariable MR analysis to account for the confounding effect of breastfeeding. To ensure the reliability and stability of our results, we conducted sensitivity analyses, which included Cochran Q test, MR Egger, and leave-one-out analysis. The MR-IVW results indicated a strong positive causal association between MSAB and the risk of AKI (OR = 11.47, 95% confidence interval [CI]: 2.58-51.02, P-fdr = .008) and renal malignancies (OR = 1.02, 95% CI: 1.01-1.04, P-fdr = .01) in offspring. A potential causal relationship with glomerulonephritis was also observed (OR = 8.63, 95% CI: 1.13-65.88, P-fdr = .08). After adjusting for breastfeeding using multivariable MR, the associations between MSAB and AKI (OR: 13.43, 95% CI: 2.72-66.25, PIVW = .001) as well as renal malignancies (OR: 1.02, 95% CI: 1.01-1.04, PIVW = .005) remained statistically significant. This suggests that maternal smoking during pregnancy significantly increases the risk of AKI and renal malignancies in their children. Our study provides compelling evidence for a causal link between maternal smoking and an increased risk of kidney diseases in offspring, emphasizing the importance of addressing maternal smoking as a modifiable risk factor. Future research should focus on elucidating the underlying biological mechanisms and exploring interventions to mitigate the impact of maternal smoking on offspring health.

PMID:41204590 | DOI:10.1097/MD.0000000000045711

BMC Public Health. 2025 Nov 7;25(1):3834. doi: 10.1186/s12889-025-25111-y.

ABSTRACT

BACKGROUND: Reproductive tract infections (RTIs) remain a major public health concern among women of reproductive age, but limited evidence exists on their association with knowledge, attitudes, and practices (KAP) in university settings. This study examined the prevalence of RTIs and their relationship with KAP and sociodemographic factors among university-affiliated women.

METHODS: A cross-sectional survey was conducted from October 2023 to March 2024 among 457 women aged 18-48 years at a large comprehensive university in Tianjin, China, including students, faculty, administrative staff, and contracted workers. Participants were recruited through stratified convenience sampling and completed a validated 23-item KAP questionnaire, followed by standardized clinical examination and standardized clinical assessment with targeted laboratory testing. Associations between KAP, sociodemographic characteristics, and RTI prevalence were assessed using descriptive statistics and chi-square tests.

RESULTS: The mean KAP score was 50 (SD 14); 34.5% of participants were categorized as low, 46.3% as medium, and 19.0% as high. Overall RTI prevalence was 37.6%, with endometritis (17.7%) and salpingitis (17.2%) most common. Higher KAP levels were inversely associated with RTI prevalence (p < 0.001). Marked gradients were observed by education and expenditure: prevalence was 24.5% among women with a master’s degree or above versus 50.8% among college students, and 70.7% among those with monthly expenditure < 2,000 RMB.

CONCLUSIONS: Institutional affiliation alone did not confer adequate sexual health; persistent occupational and socioeconomic gradients indicate that structural socioeconomic and cultural barriers-rather than educational access per se-drive disparities. Equity-oriented, culturally appropriate, KAP-based interventions and longitudinal evaluation are warranted.

PMID:41204406 | DOI:10.1186/s12889-025-25111-y

BMC Cancer. 2025 Nov 7;25(1):1728. doi: 10.1186/s12885-025-15109-5.

ABSTRACT

BACKGROUND: While most studies on hematopoietic stem cell transplantation (HSCT) have focused on its negative impact, recent research has highlighted the concept of post-traumatic growth (PTG), where individuals experience positive psychological changes after a traumatic event. However, research on PTG in HSCT recipients remains limited. This study aimed to examine PTG as the primary outcome among HSCT recipients and identify key psychosocial and clinical predictors.

METHODS: Adult HSCT recipients within 1 year of transplantation at a university hospital in Seoul were enrolled from March 2018 to March 2022. Participants completed structured questionnaires, and treatment-related data were extracted from electronic medical records. Data were analyzed using descriptive statistics, t-tests, analysis of variance, Pearson’s correlation, and multiple regression analysis.

RESULTS: Overall, 106 patients were enrolled. The average PTG score was 73.75, with higher scores observed in autologous transplant recipients compared to those who received transplants from sibling and unrelated donor transplants. Significant factors influencing PTG included marital status (β=-2.91, p < .001), positive changes after transplantation (β=-0.196, p < .009), rumination (β = 0.298, p < .001), transplant type (β = 0.268, p < .001), and social support (β = 0.191, p < .006), with the regression model explaining 53% of the variance (F = 20.773, p < .001).

CONCLUSIONS: Our findings underscore the need for tailored interventions that address key factors influencing PTG in HSCT recipients. They also highlight the essential role of oncology nurses in assessing psychosocial needs and implementing individualized, evidence-based care strategies to support psychological recovery and promote PTG.

PMID:41204401 | DOI:10.1186/s12885-025-15109-5

BMC Cardiovasc Disord. 2025 Nov 7;25(1):792. doi: 10.1186/s12872-025-05248-9.

ABSTRACT

INTRODUCTION: Heavy metal pollution is a concerning cardiovascular risk factor and a major public health concern. While traditional cardiovascular disease (CVD) risk factors are well-established, environmental exposures are less recognized, despite their growing significance.

METHODS: Adhering to PROSPERO and PRISMA guidelines, a search was conducted across PubMed, Cochrane, and Embase until April 2025 for studies involving patients with heart disease or stroke who were exposed to heavy metals. Primary outcomes were the events of CVD, CHD, and stroke. Proportions of events within populations with 95% confidence intervals were pooled. R software was used for the analysis, with statistical significance set at p < 0.05.

RESULTS: We included 16 studies involving 324,331 participants. The cadmium subgroup showed a pooled proportion of 0.09 (95% CI: 0.01-0.17), with individual values ranging from 0.01 to 0.22; the arsenic subgroup showed a pooled proportion of 0.04 (95% CI: 0.04-0.04). The overall pooled proportion was 0.08 (95% CI: 0.01-0.15). Six studies found cases of CHD in groups exposed to cadmium and arsenic, with combined rates of 0.10 (95% CI: 0.00-0.22) for cadmium and 0.00 (95% CI: 0.00-0.00) for arsenic. The overall pooled proportion was 0.08 (95% CI: 0.00-0.18). Ten studies assessed CVD proportions by metal exposure. Arsenic showed a pooled proportion of 0.06 (95% CI: 0.00-0.18), cadmium 0.14 (95% CI: 0.00-0.31), lead 0.08 (95% CI: 0.01-0.14), and mercury 0.05 (95% CI: 0.04-0.06). The overall pooled proportion was 0.10 (95% CI: 0.03-0.17).

CONCLUSION: This study emphasizes the significance of the toxic environmental metals contributing to cardiovascular risk beyond behavioural risk factors.

PMID:41204397 | DOI:10.1186/s12872-025-05248-9

J Orthop Surg Res. 2025 Nov 7;20(1):967. doi: 10.1186/s13018-025-06446-z.

ABSTRACT

AIM: The demand for total hip arthroplasty and hemiarthroplasty is rising, increasing the incidence of periprosthetic femoral fractures. This study aimed to assess clinical outcomes, including mortality, length of stay, and the impact of periprosthetic femoral fractures on mobility and frailty at one-year follow-up.

METHODS: A retrospective analysis of prospectively collected data was conducted looking at periprosthetic femoral fractures at a tertiary referral center from 2018 to 2024. The data collected included comorbidities, fracture classification, treatment method, length of stay, and discharge destination. The mortality rates at 30 days and one year were calculated. Mobility and frailty were assessed via the New Mobility Score and Clinical Frailty Scale before fracture and at one year. Statistical analysis included chi-square and Wilcoxon signed rank tests.

RESULTS: A total of n = 79 patients met the inclusion criteria (mean age 79.6 ± 9.5 years). There was a preponderance of females (35:44, M: F, p = 0.311). Vancouver B2 was the most common fracture pattern (n = 38). Surgical fixation was performed in n = 58 patients. Mortality rate at 30-day and one-year were 7.5% (n = 6) and 16.4% (n = 12) respectively. The mean Charlson Comorbidity Index was 4.39, with a score greater than 5 associated with higher one-year mortality (p = 0.031). Nursing home residency increased by 16%. The median New Mobility Score decreased from 7 to 5 (p < 0.001). The median Clinical Frailty Scale score increased from 4 to 5 (p < 0.001).

CONCLUSION: Periprosthetic femoral fractures affect elderly, comorbid patients and are associated with high mortality. We observed measurable and significant decreases in mobility and frailty. Prompt treatment and early mobilization should be prioritized to improve outcomes.

PMID:41204374 | DOI:10.1186/s13018-025-06446-z

Pilot Feasibility Stud. 2025 Nov 7;11(1):137. doi: 10.1186/s40814-025-01721-6.

ABSTRACT

BACKGROUND: Systematic reviews have demonstrated the scarcity of well-designed evaluations investigating outdoor nature-based play and learning provision for children in the early childhood education and care (ECEC) sector. This study investigated the feasibility of evaluating outdoor nature-based play and learning provision across urban ECEC settings in Scotland.

METHODS: Seventy-seven ECEC settings in Glasgow, Scotland, were contacted to participate in a mixed-methods feasibility and pilot quasi-experimental non-equivalent control study. The evaluation involved ECEC settings with three different models of outdoor nature-based provision. Children aged 3 and 4 years old at participating ECEC settings were eligible. The feasibility of recruitment/retention of ECEC settings and children, propensity score matching in place of participant randomisation, outcome measures, routine monitoring procedures, and study design acceptability were investigated. Outcome measures were completed at baseline and 7 weeks later: anthropometric measures, Strength and Difficulties Questionnaire (SDQ), Preschool Gross Motor Quality Scale, and wrist-worn accelerometer. Feasibility was investigated using descriptive statistics, outcome measure completion rates, and thematic analysis of semi-structured interviews with 15 ECEC educators.

RESULTS: Ten percent (8/77) of ECEC settings expressed a willingness to participate, and six were taken forward for recruitment of children: two traditional ECEC settings, two fully outdoor ECEC settings, and two satellite ECEC (where the outdoor space is not adjacent to the physical premises) settings. Twenty-three percent of children (53/228) provided consent to participate in the study. Data of 46 children were collected at baseline. The retention rate of children at follow-up was 69.8% (37/53). We found few participants were matched on their propensity score. Excluding SDQ assessments and wrist-worn accelerometer, all outcome measures met the green progression category (70% or more completed). Routine monitoring tools, ‘learning journals’, provided a cross-sectional description of how children progress against curriculum outcomes. Practitioners found the pilot study design acceptable in terms of the limited intrusiveness to their daily operations and the level of participation required; however, they suggested that the wrist-worn accelerometers should be reconsidered.

CONCLUSION: Overall, the study design was accepted by practitioners; however, before an effectiveness evaluation, it is recommended that the recruitment process be improved. The quasi-experimental approach to randomisation should be reviewed considering the outcomes an effectiveness study wishes to investigate (e.g. balance or prosocial behaviour), identification of appropriate covariates, and appropriate sample size. It is recommended that the ‘learning journals’ be used within a case study design monitoring children’s progress against curriculum outcomes. This feasibility study will inform an effectiveness evaluation and support policy making and service delivery in the Scottish ECEC sector.

PMID:41204361 | DOI:10.1186/s40814-025-01721-6