医学最新文献

Purpose: Cystic fibrosis (CF) is a genetic disease primarily affecting the lungs and digestive system. Individuals with advanced CF lung disease may require transplantation to survive. Family members often take on significant caregiving roles, facing both emotional and practical challenges throughout the transplantation process. This study explores the experiences of such family members to inform and improve supportive care practices.

Method: Employing a naturalistic, exploratory design, this qualitative study used purposive sampling to recruit 19 family members of lung transplant recipients with CF. Data were collected through semi-structured interviews and analysed using reflexive thematic analysis.

Results: The analysis identified three main themes and eight subthemes: (I) balancing hope and despair on the waiting list, (II) navigating challenges and finding relief after the transplantation, and (III) unmet support and informational needs before and after transplantation.

Conclusion: This study highlights the emotional burden and caregiving responsibilities shouldered by family members of individuals with CF who have undergone lung transplantation. The findings emphasise the importance of person- and family-centred interventions, including support for palliative care discussions. A more structured and inclusive framework is essential to address the often-overlooked needs of families throughout the transplantation process.

There has been a considerable controversy about vaccination practices of children with special health-care needs (CSHCNs) in China. We aim to describe current vaccination recommendations, immunization status, and vaccination safety of CSHCNs in Wuxi. We conducted a cross-sectional study of CSHCNs aged <18 y visiting the vaccination consultation clinic (VCC) at Wuxi Children's Hospital in 2020-2023. Demographic information was collected from Electronic Medical Records, vaccination data was obtained from Vaccination Integrated Service Management Information System of Jiangsu Province, China. Safety monitoring data was acquired from China National Adverse Events Following Immunization Information System (CNAEFIS). Descriptive data were presented as percentages, and Poisson test was used to compare the cumulative incidence of AEFIs between groups. Four thousand one hundred and twenty-two participants were included and the majority (73.0%) were under 12 months. The top three diseases consulted were those relating to the certain conditions originating in the perinatal period, developmental anomalies, and diseases of the blood or blood-forming organs. Only 6.1% had previously received all age-eligible vaccine doses before seeking evaluation. According to the vaccination guidance issued by the VCC, 59.9% were recommended to continue vaccine normally, partial vaccination was recommended for 37.2%, and 4.1% were advised to delay. A total of 3927 CSHCNs received 62,744 vaccine doses after consultation. None had serious adverse events and the cumulative incidence of AEFIs was higher than the general population of children. Specialist consultation is helpful to improve the vaccine uptake. Further research on strategies to improve the vaccination coverage of CSHCNs is warranted.

Background: Oral food challenges are indicated when food allergies cannot be confirmed by clinical history or investigations, such as blood or skin-prick tests. However, few studies have examined adults' experiences of oral food challenges.

Methods: Semi-structured, individual interviews were conducted with 18 adults who had undergone an oral food challenge at a UK hospital.

Results: Three main themes were identified using thematic analysis, describing experiences before, during, and after testing: "A limited and scared life," "facing fear and uncertainty in a safe environment," and "living with revised boundaries." Prior to the test, participants described a life characterized by fear of reactions, hypervigilance, planning and restrictive diets, limiting social participation. During testing, participants experienced an emotional rollercoaster, confronting something previously avoided, which could potentially cause a severe reaction. After testing, participants reported reduced fear and uncertainty following clarification of their allergies, leading to greater freedom, and for those who tested negative, a return to viewing food as a source of pleasure, rather than fear.

Conclusions: Oral food challenges reduce fear and uncertainty surrounding allergies, providing clarity about which foods trigger reactions. Greater availability of oral food challenges would enable adults with suspected allergies to live less restricted and more enjoyable lives.

Background: Tuberculosis screening is recommended for people living with HIV. The QuantiFERON-TB test measures the cell-mediated response against M. Tuberculosis. The Gold-In-Tube measures the response of CD4+ T-cells, often leading to indeterminate results. The new Gold-Plus (QFT-GP) also measures CD8+ T-cells response, thus reducing uncertainties. However, studies on people living with HIV, that would benefit from a test independent from CD4+ T-cells, are scarce.

Objective: This study addresses this gap by evaluating the performance of QFT-GP specifically in a large cohort of people living with HIV in a low TB-endemic setting.

Methods: We retrospectively evaluated the frequency of indeterminate QFT-GP tests in a cohort of people living with HIV with at least one test. We collected demographic data, CD4+ and CD8+ T-cell count at nadir and at the time of testing, and history of prior TB infection or treatment. We correlated the QFT-GP results to the CD4+ T-cell count.

Results: Six hundred and ninety five patients were included (males/females 72.5/27.5%), median age was 51 ± 14 years. Only 1,2% of tests were indeterminate, and there was no association with the CD4+ or CD8+ T-cell count at the moment of the test or at the nadir.

Conclusions: QFT-GP has few indeterminate results, even in patients with a low CD4+ T-cell count.

Vaccine adjuvants and delivery systems have long been used in DNA vaccines to enhance immunogenicity. In this study, we developed a DNA vaccine delivery platform by combining N-2-hydroxypropyl trimethyl ammonium chloride chitosan/carboxymethyl chitosan nanoparticles (N-2-HACC/CMCS NPs) with a genetically engineered M13 phage containing the HA gene of H9N2 AIV (HA-M13). The composite NPs (HA-M13/N-2-HACC/CMCS) had an average particle size of 135.24 ± 4.36 nm, and the HA gene encapsulated in the composite NPs could be expressed in vitro. Additionally, the N-2-HACC/CMCS NPs exhibited high stability and effectively protected the HA gene and M13 phage from degradation while sustaining antigen release. Furthermore, the N-2-HACC/CMCS NPs promoted the maturation of DC2.4, enhanced MHC I and MHC II pathways and improved cellular, humoral, and mucosal immune responses. Mice immunized with HA-M13/N-2-HACC/CMCS via nasal and intramuscular injections presented higher anti-H9N2 AIV antibody titers than those given the commercial vaccine. Lymphocyte proliferation, as well as the levels of the cytokines IL-2, IL-4, IFN-γ, CD4⁺, and CD8⁺ T lymphocyte levels, also significantly increased. The nanovaccine provided effective protection against H9N2 AIV infection for 154 days postimmunization, surpassing the 120-day protection provided by the commercial vaccine. Consequently, the N-2-HACC/CMCS NPs loaded with M13 phages exhibit significant potential as vaccine adjuvants and mucosal immune delivery system.

China's immunization policy was updated in 2020, replacing the sequence of MR (at 8-12 months) and MMR (at 18-24 months) with a comprehensive two-dose MMR schedule.This study aims to evaluate the safety of this policy shift by comparing the incidence of Adverse Events Following Immunization (AEFI) before and after the adjustment.Methods: A retrospective analysis was conducted using AEFI surveillance data from Jiangsu Province. The study compared two cohorts: the "pre-adjustment" group (MR at 8 months, MMR at 18 months) and the "post-adjustment" group (MMR at both 8 and 18 months). Incidence rates of non-serious reactions (fever, fatigue, local redness, and swelling) and serious reactions (allergic rash, febrile seizures, etc.) were analyzed using Chi-square tests and rate ratios (RR). Results: The transition to a two-dose MMR schedule was associated with an increase in reported mild AEFIs. Specifically, at the 8-month dose, the incidence of fever, fatigue, local redness, and swelling was significantly higher in the MMR8 group compared to the MR8 group (P < .001). The incidence of allergic rash also showed a 31% increase in the MMR8 group (45.39 per 100,000) compared to the MR8 group (34.71 per 100,000), though it remained below global safety thresholds. Crucially, there were no statistically significant differences in the incidence of serious AEFIs, such as thrombocytopenic purpura (P = .670) or febrile seizures (P = .915), between the two strategies. Furthermore, serious reactions as a whole category showed no statistically significant difference between MR8 and MMR8 (P = .710). The implementation of a two-dose MMR immunization schedule in Jiangsu Province is safe. While the shift was associated with an increase in mild, self-limiting reactions, it did not lead to an increase in serious adverse events. These findings support the continued use of the two-dose MMR strategy to provide broader protection against measles, mumps, and rubella without compromising vaccine safety.

Background: Although both the immune and hematopoietic systems play important roles in prostate cancer (PCa), few studies have comprehensively investigated the combined influence of these systems on PCa risk.

Method: The datasets used to construct causal networks for evaluation via Mendelian randomization and mediation Mendelian randomization (MMR). Nine analytical approaches were applied to evaluate the causal associations.

Result: The findings revealed that red blood cell count (RBC) and red cell distribution width (RDW) were related to a modest increased risk of PCa, while mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) were related to a modest reduced risk. Further, MMR analyses identified that HLA-DR on dendritic cells mediated the causal effect of RBC on PCa, with a mediated proportion of 12.09%, and that IgD⁺ CD38^- B cell % B cell mediated the effects of RDW and MCHC on PCa, with mediating proportions of 15.07% and 25.96%, respectively. Moreover, the IgD⁺ CD38^- B cell % lymphocytes mediated the causal effect of MCHC on PCa, with a mediated proportion of 29.03%.

Conclusion: RBC, RDW, MCH, and MCHC were related to the risk of PCa. Immune cells act as major mediators in this relationship.

Background: The endometriosis painful symptoms-4 dimensions ENDOPAIN-4D is a multidimensional questionnaire designed to assess endometriosis-related pain. This study aimed to translate, culturally adapt, and validate ENDOPAIN-4D for European Portuguese.

Methodology: Translation and content validity assessment were assessed in 32 women with endometriosis. For psychometric validation, 386 patients completed an online sociodemographic and clinical questionnaire, the Portuguese ENDOPAIN-4D, and the Endometriosis Health Profile Questionnaire-30 (EHP-30). Statistical analyses included descriptive statistics, exploratory factor analysis, internal consistency, item-total correlation, and concurrent validity.

Results: Factor analysis of the "usual pain" dimension supported the original four-factor structure, accounting for 63.7% of variance (Cronbach's α = 0.91). A novel three-factor structure was identified for the "worst pain" dimension, previously psychometrically untested, with good internal consistency (Cronbach's α = 0.83) and acceptable item-total correlations. Concurrent validity with the EHP-30 ranged from weak to strong across domains.

Conclusions: The Portuguese ENDOPAIN-4D is a culturally adapted and validated instrument for multidimensional pain assessment in European Portuguese women with endometriosis, with validity likely limited for other Portuguese-speaking communities. The newly identified three-factor structure for worst pain may aid individualized pain management and follow-up in clinical and psychosomatic care. Further studies should evaluate concurrent validity and the stability and responsiveness of the new algorithms.

Most immune-system created antibodies balance good binding and stability with low toxicity and self-reactivity. Quantifying the nativeness of a candidate sequence - its likelihood of belonging to natural immune repertoires - has thus emerged as a valuable strategy for hit selection from synthetic libraries, optimization and humanization, and for guiding de novo design toward developable candidates. We previously introduced AbNatiV, a transformer-based VQ-VAE for nativeness assessment, which proved effective across multiple nanobody engineering tasks. However, AbNatiV1 operated on unpaired sequences, limiting applicability to conventional VH-VL antibodies. Moreover, its performance on nanobody nativeness was constrained by the limited number and diversity of nanobody repertoires available at the time. Here, we sequenced new camelid repertoires, curated additional recent datasets, and present AbNatiV2: an enhanced architecture comprising various models each trained on ≥20 million sequences. AbNatiV2 improves nanobody nativeness classification across held-out and diverse test sets, and more robustly detects nativeness changes upon CDR grafting. We also introduce p-AbNatiV2, a cross-attention model fine-tuned on 3.7 million paired human sequences. p-AbNatiV2 provides residue- and sequence-level humanness for VH/VL pairs and learns pairing-likelihood via noise-contrastive training. On held-out tests, it assigns the native pair a higher score in 74% of cases, substantially outperforming recent pairing models. Together, AbNatiV2 and p-AbNatiV2 extend nativeness assessment and engineering to both nanobodies and conventional antibodies, supporting design decisions at single-residue, Fv-sequence, and paired-domain levels. AbNatiV2 is available as downloadable software and webserver.

Objective: To conduct a comprehensive assessment of physical, functional, emotional, cognitive, nutritional, metabolic, and sexual health in mid-aged women.

Methods: This cross-sectional study was conducted at the Universidad Espíritu Santo Clinic (UEES Clinic), Ecuador, as part of a multidisciplinary integrated health initiative. Women aged 40-60 years were recruited through social media outreach by the UEES Research Center and Clinic between 1 October 2024 and 1 October 2025. Interested participants scheduled a clinical evaluation by telephone. Assessments included laboratory tests (complete blood count, FSH, estradiol, HDL-C, triglycerides, glucose, and thyroid hormones [T3, T4]); validated surveys: Menopause Rating Scale (MRS) for climacteric symptoms and quality of life; Center for Epidemiologic Studies Depression Scale, 10-item version (CESD-10) for depressive mood; short Everyday Memory Questionnaire-Revised (EMQ-R) for cognition; and FSFI-6 for sexual function. Participants also underwent anthropometric measurements, body composition analysis, muscle strength testing, and dietary assessment.

Discussion: This methods paper describes a multidisciplinary approach for the comprehensive health evaluation of mid-aged women. It enables early identification of factors affecting quality of life and provides a replicable framework relevant to both local and broader Latin American contexts, serving as a model for similar initiatives across the region.