医学最新文献

Background: Whether perineal injury severity independently determines postpartum sexual quality of life (SQoL) is unclear. This study evaluated perineal tears and body image as determinants of SQoL and sexual resumption timing.

Methods: A total of 173 women (2-24 months postpartum, vaginal delivery) completed an online questionnaire including the SQoL-F and Body Image Scale (BIS). Women with perineal tear/episiotomy (PT/E; n = 118) were compared with those with an intact perineum (n = 51) using multivariate regression.

Results: SQoL-F scores were similar between groups (71.1 ± 23.3 vs 76.9 ± 24.0; p = 0.10), though PT/E delayed sexual resumption (p = 0.04). On multivariate analysis, SQoL-F was independently associated with dyspareunia (β = -10.96; p < 0.001), body image disturbance (β = -0.93; p < 0.001), and pre-pregnancy sexual satisfaction (β = +4.99; p = 0.001), but not tear type. Delayed resumption was independently associated with OASI (OR = 7.02; p = 0.02), first/second-degree tears (OR = 2.20; p = 0.04), and lower pre-pregnancy relationship satisfaction (OR = 0.50; p = 0.048).

Conclusions: Postpartum SQoL is primarily determined by dyspareunia and body image disturbance rather than perineal tear severity. OASI carries a substantial risk of delayed sexual resumption, warranting dedicated postpartum counseling.

Objective: To explore how professional women undergoing assisted reproductive technology (ART) experience and manage conflicts between treatment demands and professional identity; and to identify ways healthcare professionals can support them.

Methods: Following COREQ guidelines, semi-structured, in-depth interviews were conducted with 18 professional women undergoing ART in a tertiary care hospital. Reflexive Thematic Analysis bolstered by interdisciplinary investigator triangulation (clinical and basic science) ensured thematic confirmability.

Results: Analysis revealed Gendered Occupational Asymmetry (female occupational burden regardless of clinical aetiology), the Insider Paradox (the role reversal for healthcare professionals) and the Workplace Panopticon (constant self-surveillance to preserve professional authority). Interestingly, work simultaneously often acted as a Sanctuary of Competence, providing psychological respite. Finally, narratives exposed an Existential Rumination (mourning past personal-professional decisions) and permanent temporal career stalling. These themes were further mapped onto a 'A Day in the Life' structural framework to illustrate compounding daily burdens.

Conclusions: Current clinical lifestyle directives inadequately account for the rigid psycho-socioeconomic structures governing professional women. Based on identified themes, we propose targeted measures for healthcare professionals to deliver patient-centric care by integrating occupational awareness and identity-sensitive counselling into routine ART practice, thereby potentially reducing distress and improving treatment experience.

Background: Although treatment approaches have been explored in internet gaming disorder (IGD), however, little is known about the specific neural activity that is associated with treatment outcomes. This study aims to establish a treatment-sensitive network that reliably predicts treatment outcomes across different interventions for IGD.

Methods: Resting-state fMRI data were collected from 90 individuals with IGD who received one of three different intervention protocols (mindfulness meditation, approach bias modification, or retrieval-aversive conditioning training). Connectome-based predictive modelling (CPM) was used to build a treatment-sensitive network to predict individual symptom reduction, then validated them on the external dataset.

Results: The negative (r = 0.401, p <.001) and combined network (r = 0.480, p <.001) can significantly predict a reduction of addiction severity (baseline minus post-test). Specifically, the negative network was primarily centred on the motor, subcortical, and salience networks. The positive network primarily involved cerebellar-related connections. Incorporating these into a combined model significantly improved predictive accuracy, suggesting that cerebellar-related connectivity may contribute to the prediction of intervention-related clinical improvement. Finally, the treatment-sensitive network was validated in a separate data.

Conclusions: This study established a treatment-sensitive network based on the whole-brain connectome. These findings provide valuable empirical evidence for identifying biomarkers for IGD treatment and advance personalised therapeutic strategies.

Clinical trials registration: The trial protocol was pre-registered with the Chinese Clinical Trial Registry (www.chictr.org.cn; ChiCTR2300077831(MM), ChiCTR2300075869(ApBm), ChiCTR2500095444(R-AC), ChiCTR2400090834(SAE)).

Introduction: Resting‑state fMRI is widely used to map brain connectivity, yet the field lacks a clear, data‑driven standard for acquisition duration. We compared traditional Single‑Band (SB) imaging with an accelerated Multiband factor 4 (MB4) protocol to identify a time‑efficient approach for capturing stable network topology.

Methods: Twenty‑five healthy young adults completed two sessions one month apart, each including counterbalanced 13‑minute SB and MB4 scans. Test-retest reliability was evaluated across multiple durations using Portrait Divergence, a multiscale graph‑theoretic metric. Supplementary analyses compared Portrait Divergence with the field-standard Intraclass Correlation Coefficient, assessed robustness across preprocessing pipelines and parcellation schemes, and examined MB4's ability to capture both cortical and subcortical connectivity.

Results: MB4 consistently outperformed SB across all tested durations, with peak topological stability at 9 minutes. Stability declined beyond this point, likely due to cumulative motion artefacts. Supplementary analyses confirmed MB4's robustness across preprocessing strategies and atlas choices and demonstrated effective whole‑brain coverage.

Conclusions: In healthy young adults, MB4 captures network topology more effectively than SB and reaches peak stability at 9 minutes before declining, challenging the assumption that longer scans are always better. These findings require validation in clinical, paediatric, and geriatric cohorts.

Background: Since physicians have primary responsibility for medical treatment, their perspectives of palliative care quality in nursing homes can provide important knowledge for service evaluation and enhancement in this context. However, few studies exist that include their perspectives.

Objectives: The aim was to investigate physicians' perspectives of the quality of palliative care in Norwegian nursing homes.

Methods: A cross-sectional study conducted between November 2022 and December 2023, which included 77 nursing home physicians (response rate 43.5%) in Norway. Data were collected using a questionnaire comprising questions about demographic variables and perceptions of quality of care, as measured by the short form of the instrument Quality from the Patients' Perspective for Palliative Care (QPP-PC), adapted for healthcare personnel. Descriptive analyses and Wilcoxon signed rank tests were performed.

Results: Nursing home physicians scored subjective importance of the care significantly higher than their perception of the quality of actual care received in the two dimensions; medical-technical competence and sociocultural atmosphere and for nine out of the 24 items and three out of seven additional symptom-specific questions. A need for improvement was identified in care areas such as symptom relief for pain, depression and anxiety, existential care, understanding patients' perspective, waiting time, individualized care, cooperation, and continuity.

Conclusion: The results show that provision of high-quality palliative care in nursing homes can be challenging and that the physicians identified several areas for improvement. The results can provide direction for future quality improvement. However, the findings need to be confirmed in a larger sample.

The integration of Artificial Intelligence (AI) into psychiatry is progressing rapidly, with promising yet underexplored applications in suicide prevention. While most existing studies have focused on suicide risk prediction, AI could be applied more broadly across the suicide prevention continuum. This review explores AI's potential in improving the detection of suicidal ideation (SI), enhancing clinician training, and expanding patient access to psychotherapeutic support. Studies suggest that AI models may identify SI more sensitively than clinicians by detecting subtle linguistic or semantic cues. Furthermore, AI-based virtual patients have been shown to improve clinicians' confidence and accuracy in suicide risk assessments, particularly when used alongside traditional training methods. On the patient side, CBT-inspired AI tools offer scalable, on-demand support, but most remain unregulated and clinically unvalidated. Despite their perceived empathy and availability, such tools pose ethical and clinical risks. Many patients use AI tools without professional guidance, a trend clinicians often underestimate. This disconnect calls for urgent regulatory oversight and professional engagement. Without clear clinical validation, AI-based tools may evolve outside medical frameworks, exposing vulnerable individuals to preventable harm. Psychiatry must not only adapt but also lead, ensuring that innovation is harnessed responsibly to serve patients with empathy, safety, and scientific rigor.

Introduction: Aortic cross‑clamping and mild hypothermic circulatory arrest (MHCA) are commonly used strategies in proximal thoracic aortic aneurysm surgery. This study compared these approaches in elective procedures for patients with a distal ascending aortic diameter of 40-50 mm. The primary outcome was a composite of 30‑day mortality, stroke, or acute kidney injury, with secondary outcomes including long‑term survival and postoperative complications.

Material and methods: This single‑center observational cohort included patients treated between 2016 and 2024. Distal ascending aortic diameters were assessed on preoperative computed tomography, and clinical data were obtained from SWEDEHEART. Patients were assigned to aortic cross‑clamp (n = 261) or MHCA (n = 138). Propensity score matching was performed in a 1:1 ratio to balance baseline characteristics.

Results: The composite primary outcome occurred in 15 patients (3.8%) and was more common with MHCA than with cross‑clamp (6.5% vs 2.3%, p = 0.035). Two patients (0.5%), both in the MHCA group, died within 30 days. After matching, the odds ratio for the composite endpoint was 2.4 (95% CI, 0.66-11.5), indicating no significant difference. Long‑term survival was similar between groups (log‑rank p = 0.33).

Conclusions: Both strategies were associated with low perioperative risk and comparable long‑term survival. These results support flexible operative planning, allowing the distal anastomotic technique to be chosen based on individual anatomy and surgical preference.

Objectives: Cardiac surgery using cardiopulmonary bypass (CPB) induces a systemic inflammatory response that affects common inflammatory markers, including C-reactive protein (CRP), white blood cell count (WBC), and body temperature, complicating postoperative diagnosis of infections. The objective of this study was to assess the incidence of postoperative infections and evaluate the performance of clinically used biomarkers.

Design: This was a bidirectional cohort study including patients undergoing cardiac surgery with CPB between 1st of February 2020 and 22nd of September 2021. Patients with postoperative infection were compared to patients without. Multivariable logistic regression was used to identify independent predictors of postoperative infections. Receiver operating characteristic (ROC) curves evaluated the diagnostic ability of current biomarkers to detect infection.

Results: A total of 1,222 patients were included. The incidence of postoperative infections (during hospitalisation and/or late infection) was 17.3%. Patients with postoperative infection had more comorbidities, underwent more complex procedures, and had higher mortality (90-day mortality 3.8% vs 1.5%, p = 0.045; 1-year mortality 5.7% vs 2.7%, p = 0.032). CRP, WBC, and temperature performed poorly in detecting postoperative infection, although peak CRP (OR 1.069, p < 0.001) and peak temperature (OR 2.408, p = 0.005) were independent predictors of postoperative infection. Peak temperature occurred on postoperative day 5 in infected patients versus day 2 in those without infection.

Conclusion: Postoperative infections following cardiac surgery with CPB remain common and are associated with increased postoperative complications and mortality. Common inflammatory biomarkers perform poorly in detecting infection. Improved diagnostic tools are needed to facilitate early detection and treatment.