Medicine

Almudimeegh, Almuntsrbellah; Almukhadeb, Eman; Nagshabandi, Khalid Nabil; Alshehri, Naif; Almusa, Hala Abdullah; Aldosari, Omar; Aldakhil, Ibrahim

doi: 10.1097/md.0000000000043109pmid: 40587688

The pursuit of aesthetic enhancement through cosmetic dermatology has increased globally, influenced by societal beauty standards and social media. Self-esteem plays a pivotal role in shaping individuals’ choices for cosmetic dermatology procedures. To examine the relationship between self-esteem and preferences for cosmetic dermatologic procedures among the Saudi population, utilizing the Rosenberg Self-Esteem Scale. A cross-sectional survey was conducted among 919 participants in Saudi Arabia. The modified Arabic version of the Rosenberg Self-Esteem Scale assessed self-esteem levels. Demographic data, skincare habits, and cosmetic procedure preferences were analyzed using χ2 and multivariate regression tests. Low self-esteem was prevalent in 26% of participants and significantly associated with specific skincare habits (e.g., applying routines to hands and neck) and prior cosmetic procedures targeting visible body areas (P < .05). Participants without a history of cosmetic procedures were 1.72 times more likely to exhibit low self-esteem (adjusted odds ratio = 1.718; P = .002), whereas those not planning future procedures showed a decreased likelihood of low self-esteem (adjusted odds ratio = 0.501; P < .001). The study highlights a significant relationship between low self-esteem and increased engagement in cosmetic-seeking behaviors. Understanding these psychological factors can guide practitioners toward more patient-centered care.

Zhang, Qiushun; Zhang, Guangying; Zhang, Feng; Li, Wenzhuo; Li, Dongmei; Zhao, Yifeng

doi: 10.1097/md.0000000000042162pmid: 40587696

Rationale: For limb Gustilo type IIIC injuries with a Mangled Extremity Severity Score (MESS) ≥7, amputation is often necessary. However, due to advancements in surgical techniques, limb preservation is also feasible for some of these patients. There is still no consensus on the reliability of existing scoring systems for determining amputation or limb preservation. Patient concerns: A patient presented with a Gustilo type IIIC injury of the thigh, absolute indications for amputation (thermal ischemia duration nearly 19 hours, MESS score of 11), but had slow oozing of blood on needling the end of the toe. Diagnoses: Gustilo type IIIC injury of the thigh with prolonged ischemia and high MESS score. Interventions: The treatment plan was immediately changed from amputation to limb preservation. The femur was overlapped, the limb was shortened by 5 cm in one stage and fixed with an external frame. The femoral artery defect (up to 6 cm) was managed with direct end-to-end anastomosis after freeing. After viability was confirmed, a second stage lengthened the limb to normal length and internal fixation was performed for the femoral stem fracture. Outcomes: The limb was successfully preserved, and good lower limb function was achieved. Lessons: Even for Gustilo type IIIC injuries with a MESS score ≥7, if slow oozing of blood is observed at the end of the needled limb, active limb preservation should be considered. One-stage limb shortening to rapidly restore blood flow and 2-stage lengthening to recover limb length are practical techniques conducive to successful limb preservation.

Gao, Hang; Yi, Tingting; Hu, Bo; Lv, Zhiquan; Ma, Linyu; Wang, Shouyong

doi: 10.1097/md.0000000000043019pmid: 40587734

Studies into the mechanisms of cardiopulmonary bypass-associated acute lung injury have not presented breakthroughs for many years, resulting in the stagnation of management strategies and clinical medicine measures. This is a key factor affecting the prognoses of open-heart surgery patients. Future studies should focus on key targets of inflammation, such as neutrophils, macrophages, and the glycocalyx cell coat, and further explore advanced technologies, such as gene editing and single-cell sequencing, to reveal the underlying mechanisms of cardiopulmonary bypass-associated acute lung injury and to find effective prevention and treatment strategies.

Imaizumi, Ken; Kasajima, Hiroyuki; Terashima, Kazutoshi; Furukawa, Naoe; Ito, Keiichiro; Fukasawa, Takumu; Odagiri, Tadashi; Yamana, Daisuke; Tsuruga, Yosuke; Umehara, Minoru; Kurushima, Michihiro; Nakanishi, Kazuaki

doi: 10.1097/md.0000000000043099pmid: 40587691

This study investigates the association between prophylactic negative-pressure wound therapy (pNPWT) using the open method and incisional surgical site infection (SSI) following emergency lower gastrointestinal surgery. We retrospectively examined 210 consecutive patients who underwent emergency surgery for lower gastrointestinal tract perforation or necrosis at a single center between January 2018 and March 2023. Outcomes were compared between patients who received pNPWT and those who received conventional wound management. Propensity score analyses included multivariate analysis using the propensity score in the crude cohort, inverse probability of treatment weighting, and 1:2 nearest-neighbor matching. The primary endpoint was the incidence of incisional SSI and the secondary endpoints were wound healing time, postoperative hospital stay, identification of incisional SSI risk factors, and determination of optimal pNPWT management. In the crude cohort (pNPWT = 41, conventional = 169), incisional SSI occurred in 11 (26.8%) and 65 (38.5%) patients, respectively (P = .227). After propensity score analyses, pNPWT was significantly associated with a reduction in incisional SSI, with odds ratios (95% confidence interval) of 0.344 (0.147–0.804; P = .002), 0.260 (0.103–0.794; P = .002), and 0.285 (0.106–0.763; P = .012) in the multivariate analysis, inverse probability of treatment weighting, and propensity score-matched cohort (pNPWT = 30, conventional = 60), respectively. Wound healing time and postoperative hospital stay did not differ significantly between the groups. Risk factors for incisional SSI were poor American Society of Anesthesiologists Physical Status and perforation, with the addition of conventional wound management. Early application of pNPWT (≤2 days postoperatively) further reduced the incidence of SSI (17.6% vs 71.4%; P = .010). In propensity score analyses, pNPWT was associated with a significant reduction in incisional SSI in contaminated abdominal wounds after lower gastrointestinal surgery. Early application may enhance its effectiveness. pNPWT should be considered for high-risk patients undergoing emergency abdominal surgery.

Liu, Yuhan; Zhang, Songyun; Liu, Xiantao; Zhou, Lixia; Wang, Zhuning

doi: 10.1097/md.0000000000042626pmid: 40587672

Rationale: Juvenile haemochromatosis type 2A (JH 2A) is an autosomal recessive genetic disorder characterized by disrupted iron metabolism regulation and progressive iron overload due to HJV gene variation. The rapid onset and swift progression of JH 2A significantly reduce patients’ survival time. Due to the atypical clinical manifestations, early diagnosis and treatment of JH 2A pose challenges for clinical doctors. Patient concerns: An 11-year-old male, student, was hospitalized for a 2-week history of obvious fatigue accompanied by chest tightness after the activity. The patient’s chest tightness symptoms improved after rest and there was no joint pain. Diagnosis: The patient’s serum iron parameters were elevated and the liver magnetic resonance imaging (MRI) suggested liver iron overload. After genetic testing, the patient was diagnosed as HJV Y46X/C321X compound heterozygous mutation. He was diagnosed with JH 2A. Interventions: The patient was treated with prompt and regular phlebotomy treatment and limit the intake of foods with high iron content. The patient’s condition improved. Outcomes: The patient’s liver injury was reversed, the patient’s growth and development proceeded without further complications. Lessons: Early phlebotomy treatment can reverse the progression of the disease. Nevertheless, the nonparallel phenomenon of serum ferritin and liver iron deposition observed during maintenance treatment has prompted a reconsideration of the assessment of the curative effect of phlebotomy treatment. Liver R2* may be equally important.

Yang, Guo; Zhong, Jia Lin; Xing, Yang; Li, Chuan Wei; Wang, Hao; Xiao, Jun

doi: 10.1097/md.0000000000043038pmid: 40587711

Objective: The objective of this study was to evaluate the role of macrophages in myocardial repair following myocardial infarction (MI) through a bibliometric analysis of post-MI macrophage research. Methods: A comprehensive dataset was compiled from the Web of Science Core Collection, including articles published up to December 30, 2023. The analysis involved co-authorship networks and keyword co-occurrence, with visualization facilitated by VOSviewer and key terms identified through CiteSpace. Results: The study encompassed 1342 publications, highlighting the United States, China, and Germany as leading contributors to the field. Circulation Research emerged as the most active journal in publishing related studies. The prevalent themes were inflammation and atherosclerosis, indicating their significance in macrophage involvement post-MI. Conclusion: This study provides a detailed understanding of macrophage involvement in MI, outlining significant countries, institutions, journals, and publications. It offers valuable insights into macrophage function in MI, contributing to the broader understanding of myocardial repair mechanisms.

Kökenek Ünal, Tuba Dilay; Kaplan Yilmaz, Müzeyyen Burcu; Kandemir, Olçay; Yora, Samet; Taheri, Serpil

doi: 10.1097/md.0000000000043077pmid: 40587726

Breast cancer is one of the most common cancers in women worldwide. Several therapy modalities have been created recently; however, resistance to therapy is a major issue. Cancer stem cell functions and regulations are important in tumor progression, invasion, metastasis, and therapy resistance. The expression levels of cancer stem cell genes CD44, CD24, and related miRNAs miR590-3p, miR599, and miR399-3p were aimed to be investigated before and after neoadjuvant therapy in breast cancer patients in this cross-sectional observational study. This study included 80 samples from 40 female patients. The expression of CD44 and CD24 genes and miR590-3p, miR599, and miR399-3p was analyzed by qPCR in pre- and posttreatment biopsies from breast carcinoma patients. Correlations between expression levels and other pathologic parameters, including molecular subtypes, grade, stage, metastasis, recurrence, pathologic response to therapy, and disease-free and overall survival, were investigated. CD44 and CD24 mRNA expression levels decreased significantly after treatment. However, miR590-3p expression increased after treatment. Patients with complete pathologic responses had upregulated CD24 and downregulated miR590-3p and miR399-3p levels in initial biopsies. Univariate analysis showed that increased expression levels of miR590-3p, miR599, and miR399-3p were significantly associated with shorter disease-free survival. A better understanding of the role of cancer stem cells in cancer can result in more promising results and patient-tailored therapy options. This study highlights the significant value of cancer stem cells and related miRNAs in response to therapy and recurrence.

Chen, Xi-Yu; Zhou, Yang; Qing, Lun-Xue; Hua, Yi-Ni; Xiong, Zhi-Hao; Yan, Hao-Yue; Li, Wei-Jia; Zhou, Li; Ni, Jin-Xia

doi: 10.1097/md.0000000000043083pmid: 40587667

In economically less-developed areas, the public is likely to neglect the physical and psychological health of middle-aged and elderly Chinese women by the public. Comorbidities such as multi morbidity and depression are becoming a severe global challenge. This paper aims to explain the impact of depression on multimorbidity in middle-aged and elderly Chinese women with urban–rural differences. In the China Health and Retirement Longitudinal Study 2020, a total of 6317 participants older than 45-year-old were included in this study. First, the Kruskal–Wallis H test and χ² test were used to determine the frequency and correlation between variables, depression, and multimorbidity. Second, logistic regression was used to measure the impact of depression on multimorbidity and identify the confounding factors. Finally, subgroup analysis explained the urban–rural differences. Of the 6317 individuals included, 65.5% of the multimorbidity participants had suffered from minor depression and 82.6% had major depression. Four binary logistic regression models with a good degree of fit were established to indicate that the prevalence of multimorbidity was increased after excluding the confounding factors of residence. In the subgroup analysis, marital status, depression, and self-rated health make sense in urban–rural differences. This study found that depression was more strongly associated with multimorbidity in urban women than in rural ones. In summary, urban women with depression experience multimorbidity with ease. The elderly population (≥60-year-old), unmarried rural women, and urban women with middle school education are more susceptible; in other words, these people might face more serious challenges in China.

Wu, Ben; Li, Weixin; Xu, Shuling; Chen, Rumeng; Ding, Yining; Xu, Rong; Wu, Zhu; Bao, Meihua; He, Binsheng; Li, Sen

doi: 10.1097/md.0000000000042998pmid: 40587687

Studies on the relationship between body mass index (BMI) and different disease phenotypes have either not included systematic causal inference or have mostly focused on European populations. This highlights the importance of conducting Mendelian randomization (MR) phenome-wide association study to explore the associations between BMI and various diseases in East Asian populations. MR phenome-wide association study was utilized in this study to identify possible causal associations between BMI and 159 clinical outcomes in East Asian populations. The main statistical metrics used were odds ratio (OR) and 95% confidence interval (95% CI), employing the MR inverse variance weighted method as the principal causal inference model. Complementing these findings were analyses such as weighted median, MR-Egger, and other sensitivity analyses. Elevated BMI correlated positively with various diseases, including cardiovascular diseases like myocardial infarction (OR = 1.49; 95% CI: 1.26–1.76) and peripheral arterial disease (OR = 1.69; 95% CI: 1.34–2.13), endocrine disorders like type 1 diabetes (OR = 2.29; 95% CI: 1.39–3.77), as well as increased risk of cataracts (OR = 1.19; 95% CI: 1.09–1.31). Concurrently, BMI was associated with a reduced risk of respiratory-related diseases like pneumonia (OR = 0.75; 95% CI: 0.63–0.89), as well as cancers like breast cancer (OR = 0.67; 95% CI: 0.53–0.84) and prostate cancer (OR = 0.66; 95% CI: 0.53–0.81). BMI is causally associated with specific systemic disorders in East Asian populations. This study contributes to understanding health inequalities across various races and populations and provides insights into global health issues.

Hu, Yudong; Wang, Xiaofeng; Chen, Yujie; Li, Jun; Zhong, Yong; Zhu, Faming; Yuan, Ye; Ye, Jin; Yang, Fan

doi: 10.1097/md.0000000000043079pmid: 40587736

Urosepsis is the most serious type of urinary tract infection, and its incidence is gradually increasing. The pathogenic flora that emerge in urosepsis associated with urinary stones are complex, virulent, and resistant to antibiotics, and empirical antibiotics are not always effective in treating them. This study aims to analyze the distribution of pathogenic bacteria, as well as the sensitivity of antibiotics to these bacteria, in patients with urosepsis associated urinary stones. The case data of patients treated at our single-center hospital between July 2015 and February 2025 were retrospectively collected. We examined the differences in clinical characteristics between the urine pathogenic bacteria culture-positive and culture-negative groups, and characterized the distribution of pathogenic bacteria and antibiotic sensitivity rates. We acquired 64 patients with a mean age of 57.9 ± 15.5 years, including 20 males and 44 females. Forty cases (62.5%) yielded positive urine culture results, and 24 cases (37.5%) had negative urine cultures. Female patients and patients with diabetes had a 32.7% and 43.1% higher culture-positive rate than males and those without diabetes, P = .012 and P = .003, respectively. Fifty culture results were screened, including 33 cases (66%) of gram-negative bacteria, 10 cases (20%) of gram-positive bacteria, and 7 cases (14%) of fungi. The most common gram-negative bacteria were Escherichia coli (E coli) (n = 25, 50%), followed by Proteus mirabilis (P mirabilis) (n = 5, 10%). The most common gram-positive bacteria were Enterococcus faecium (E faecium) (n = 8, 16%). The antibiotic sensitivity test indicated that E coli was most susceptible to tigecycline (100%), nitrofurantoin (100%), ertapenem (92%), imipenem (92%), meropenem (92%), and amikacin (92%). Antibiotics to which E faecium was highly susceptible included vancomycin (100%) and daptomycin (100%). Among patients with urinary-stone-associated urosepsis, women and those with diabetes are likelier to exhibit urine culture-positive pathogens, with the principal pathogens being gram-negative bacteria, mainly E coli. Carbapenems have the highest overall susceptibility to gram-negative bacteria.