Purtscher-like retinopathy is a rare retinal microangiopathy characterised by sudden visual loss, cotton wool spots, retinal whitening and variable retinal haemorrhage in the absence of trauma. Giant cell arteritis is an ophthalmic emergency that usually presents with ischaemic optic neuropathy or retinal arterial occlusion or choroidal ischaemia; however, in very rare cases, it may mimic Purtscher-like retinopathy. We report the case of a 60-year-old man who presented with sudden painless vision loss in the left eye. Fundus examination showed marked optic disc oedema, cotton wool spots, arterial narrowing and multiple discrete white retinal lesions in the posterior pole. Optical coherence tomography demonstrated inner retinal thickening and hyperreflectivity, whereas fluorescein angiography revealed markedly delayed retinal perfusion, capillary nonperfusion, branch retinal arterial occlusion, nasal/inferotemporal choroidal hypoperfusion and optic disc hyperfluorescence. Her erythrocyte sedimentation rate was 52 mm/h, and temporal artery biopsy confirmed giant cell arteritis. The patient received intravenous methylprednisolone followed by oral corticosteroids. Visual acuity did not improve over the first week, although optic disc oedema decreased. This case should not be interpreted as isolated or pure Purtscher-like retinopathy; rather, it represents Purtscher-like retinal findings occurring within a broader giant cell arteritis-related retinal and choroidal ischaemic process. The report broadens the spectrum of ocular presentations of giant cell arteritis and highlights the need to consider occult giant cell arteritis in the differential diagnosis of older patients with sudden painless visual loss and retinal ischaemic signs suggestive of Purtscher-like retinopathy.

ObjectivesCircadian rhythms regulate human health, and observational studies have linked their disruption to hypertension; however, confounding factors and reverse causality limit causal interpretation. We aimed to evaluate the existing evidence linking circadian gene sets and hypertension using Mendelian randomization.MethodsTwo-sample Mendelian randomization was performed using genome-wide association study summary-level data from non-overlapping European ancestry samples. Genetic variants of 1276 circadian genes (CGDB) were instrumental variables; the outcome was hypertension genome-wide association study data from the UK Biobank (ieu-b-5144; 463,010 participants). Single nucleotide polymorphisms were selected at p<5 × 10[-8] (mean F-statistic: 276.5). Inverse variance weighting was the primary method used. Benjamini-Hochberg false discovery rate correction was applied across all 1276 genes. Sensitivity analyses were performed using heterogeneity testing, Mendelian randomization-Egger regression, Mendelian Randomization Pleiotropy RESidual Sum and Outlier, Steiger directionality testing, and leave-one-out analyses.ResultsMendelian randomization identified 39 nominally significant associations (inverse variance weighting, p < 0.05). After false discovery rate correction, four genes reached statistical significance: PHOSPHO1 (odds ratio = 0.988, 95% confidence interval: 0.983-0.993), BAIAP3 (odds ratio = 1.009, 95% confidence interval: 1.005-1.014), OSGIN2 (odds ratio = 0.990, 95% confidence interval: 0.986-0.995), and ZDHHC18 (odds ratio = 1.012, 95% confidence interval: 1.007-1.018). The remaining nominal associations did not survive false discovery rate correction and were classified as exploratory. Functional enrichment implicated circadian rhythm, apoptosis, and glycosaminoglycan biosynthesis pathways. Sensitivity analyses did not reveal significant heterogeneity or pleiotropy.ConclusionsThese findings are hypothesis-generating and require experimental validation. PHOSPHO1, BAIAP3, OSGIN2, and ZDHHC18 demonstrated statistically significant associations with hypertension risk after false discovery rate correction and should be prioritized for follow-up. Other nominal findings should be interpreted as exploratory.

ObjectiveTo analyze the characteristics and risk factors of blood-borne occupational exposures among healthcare workers at Shaoxing Second Hospital from 2020 to 2025 and to inform targeted prevention and control strategies.MethodsA retrospective analysis was performed on 252 blood-borne occupational exposure events reported from January 2020 to December 2025. Occupational distribution, occurrence patterns, exposure routes, high-risk operations, pathogens, and postexposure prophylaxis data were statistically analyzed.ResultsThe annual standardized incidence of blood-borne occupational exposures increased year by year. Nurses and staff with <5 years of service were the highest-risk groups. Sharp instrument injuries accounted for 92.46% of exposures. Hepatitis B virus was the dominant known pathogen (25.78%), whereas the hepatitis B virus postexposure prophylaxis rate was only 21.21%.ConclusionsThese findings indicate that healthcare workers at this hospital exhibit distinct high-risk features for blood-borne occupational exposures. To mitigate occupational exposure risks, a systematic and precise prevention program, hierarchical management of high-risk groups, and regular hepatitis B virus immune monitoring are recommended.

This narrative review synthesizes current evidence on extracorporeal shock wave therapy for pain management in musculoskeletal rehabilitation, emphasizing its analgesic mechanisms, clinical applications, and safety. As a noninvasive physical therapy, extracorporeal shock wave therapy is increasingly used for pain relief in conditions such as chronic low back pain, plantar fasciopathy, knee osteoarthritis, rotator cuff injury, and myofascial pain syndrome. Its analgesic effects arise through multiple pathways, including peripheral neuroregulation characterized by degeneration and subsequent regeneration of sensory nerve fibers, reduction of pro-inflammatory mediators, improved local blood flow, and, according to emerging functional magnetic resonance imaging data, modulation of central pain networks. Evidence from randomized controlled trials and meta-analyses supports the efficacy of extracorporeal shock wave therapy in reducing pain intensity and improving function across these disorders. The safety profile of extracorporeal shock wave therapy is favorable, with most adverse events being mild and transient local reactions. Nonetheless, standardized treatment parameters are lacking, and data on vulnerable populations remain sparse. This review aims to serve as a scientific reference for extracorporeal shock wave therapy in musculoskeletal pain management and to identify priorities for future research.

BackgroundIn the intensive care unit, sedation plays a crucial role in managing critically ill patients, particularly those undergoing invasive procedures. Common sedatives such as propofol and sufentanil are administered to ensure comfort and alleviate pain among intensive care unit patients. However, prolonged sedation is associated with risks, including delayed recovery, increased susceptibility to infections, and challenges in monitoring critical conditions. This study investigated the effect of sedation using only propofol, only sufentanil, and a combination of both on short-term outcomes in intensive care unit patients.MethodsIn total, 300 adult intensive care unit patients, both postoperative and nonpostoperative, were included in this retrospective study. The observation period was 10 days from intensive care unit admission. In addition to baseline clinical data, intensive care unit length of stay, delta Sequential Organ Failure Assessment score, occurrence of pulmonary infiltrates on chest X-ray, onset of acute kidney injury, and need for reintubation were assessed as study outcomes.ResultsResults showed that patients sedated using sufentanil alone or in combination with propofol had a longer length of intensive care unit stay and exhibited higher delta Sequential Organ Failure Assessment scores, which worsened over a 10-day period compared with those who were not sedated or administered propofol alone. Additionally, new pulmonary infiltrates occurred more frequently in patients sedated with a combination of propofol and sufentanil than in those who were administered propofol alone or no sedation. Patients who were administered sufentanil alone were reintubated more often than those who were not sedated or were administered propofol alone.ConclusionsThe use of sufentanil, alone or combined with propofol, is associated with poorer short-term outcomes in ICU patients. These findings highlight the need for careful evaluation of sedation strategies in critically ill patients.

BackgroundThis study aimed to identify risk factors and develop an advanced risk assessment model to evaluate the risk of nodular thyroid disease in coal miners.MethodsIn April 2021, 1708 coal miners undergoing physical examinations at the Huainan Energy Occupational Disease Prevention and Treatment Hospital in Anhui Province were enrolled in this study. Comprehensive clinical data were collected, including general information, laboratory test results, and imaging examination findings. A novel Nonlinear Inverse Nearest Manifold Projection model was developed to assess the risk of nodular thyroid disease. This model employs advanced nonlinear mapping techniques to project high-dimensional data into a low-dimensional manifold space, capturing the intrinsic structure and patterns of the data to identify disease risk factors more accurately. The performance of the Nonlinear Inverse Nearest Manifold Projection model was compared with several established risk assessment models.ResultsThe Nonlinear Inverse Nearest Manifold Projection model demonstrated exceptional performance, achieving high scores in both F1 score and the area under the precision-recall curve metrics. It significantly outperformed other risk assessment models, highlighting its superior capability in identifying nodular thyroid disease risk factors among coal miners.ConclusionsThe Nonlinear Inverse Nearest Manifold Projection model is a highly effective tool for assessing the risk of nodular thyroid disease in coal miners, offering substantial clinical utility.

ObjectiveFatty liver is known to aggravate hepatic ischemia-reperfusion injury; however, the relationship between the preoperative controlled attenuation parameter measured by transient elastography and ischemia-reperfusion injury after hepatectomy has not been fully clarified. This study aimedt to explore the association between controlled attenuation parameter-defined hepatic steatosis and hepatic ischemia-reperfusion injury after hepatectomy.MethodsIn this single-center retrospective study, 1461 patients who underwent hepatectomy between 2022 and 2024 were included and stratified into four groups according to controlled attenuation parameter-based steatosis grades. The primary endpoints were peak alanine aminotransferase and aspartate aminotransferase levels within 3 days after surgery. Secondary endpoints comprised additional postoperative laboratory indices and short-term clinical outcomes, including complications and mortality. Data were analyzed using multivariable linear regression, restricted cubic spline modeling to explore nonlinear associations, and propensity score matching to compare patients with grade 3 and grade 0 steatosis.ResultsCompared with the nonsteatotic group, only patients with severe fatty liver (controlled attenuation parameter > 292 dB/m) exhibited significantly higher postoperative alanine aminotransferase and aspartate aminotransferase levels. However, restricted cubic spline analysis did not demonstrate a significant positive dose-response relationship between controlled attenuation parameter and liver enzyme levels. In multivariable models, severe fatty liver was independently associated with elevated peak alanine aminotransferase, whereas no consistent association was observed for aspartate aminotransferase. After propensity score matching, severe steatosis remained associated with higher alanine aminotransferase, without significant differences in aspartate aminotransferase or major short-term clinical outcomes.ConclusionsPreoperative controlled attenuation parameter assessment is most valuable for identifying patients with severe hepatic steatosis, who appear more susceptible to aggravated ischemia-reperfusion injury after hepatectomy, rather than for predicting ischemia-reperfusion injury severity across the full controlled attenuation parameter spectrum.

Macular telangiectasia type 2 is a genetically complex disorder with variable penetrance and expressivity. Although several causative genes have been identified, the genetic basis remains unknown in most affected individuals. Genetic and metabolomic studies have implicated dysregulated serine and lipid metabolism in disease pathogenesis. Serine deficiency promotes the accumulation of cytotoxic 1-deoxysphingolipids, which damage Müller cells, photoreceptors, and retinal pigment epithelium. Emerging evidence suggests that the retinal pigment epithelium plays a more important role in disease development than previously recognized. Macular telangiectasia type 2 has traditionally been considered a primary neurodegenerative disorder with secondary vascular abnormalities. However, optical coherence tomography angiography findings have indicated that vascular changes may occur earlier than previously appreciated and may develop in parallel with neurodegeneration rather than as a secondary consequence. Furthermore, there is a strong structure-function correlation between ellipsoid zone loss on optical coherence tomography and retinal sensitivity measured using microperimetry. This relationship supported the acceptance by the US Food and Drug Administration of ellipsoid zone loss area, a structural surrogate endpoint, for the approval of the ciliary neurotrophic factor implant (revakinagene taroretcel-Lwey) in macular telangiectasia type 2 patients. Several therapeutic strategies targeting the underlying metabolic abnormalities are also under investigation. These include serine supplementation, fenofibrate to reduce 1-deoxysphingolipid production, and gene replacement therapy. In addition, growing evidence suggests that mitochondrial dysfunction and impaired cellular energy metabolism contribute to disease pathogenesis and warrant further investigation as potential therapeutic targets.

ObjectiveTo investigate the clinical profiles and outcomes of pediatric patients with hemorrhagic stroke in southern China.MethodsThis retrospective cohort study reviewed the medical records of children hospitalized with hemorrhagic stroke at a tertiary center in southern China. The disability rate was calculated as the proportion of patients with a modified Rankin scale score of 3-5.ResultsA total of 159 children (111 male and 48 female) were included. Prolonged coagulation time and cerebrovascular malformations were the most common etiologies. Disturbance of consciousness was the most frequent presenting symptom, whereas seizures predominated in children younger than 3 years and headache in older children. Computed tomography scans frequently showed temporal, parietal, or frontal lobe hemorrhages, and 60.4% of patients had multisite involvement, which was more prevalent in males. Management included conservative treatment (56.9%), surgery (33.8%), and embolization (9.4%). The mortality rate was 7.6%. Among the 108 survivors with follow-up, 78.7% achieved favorable outcomes (modified Rankin scale ≤2), whereas 21.3% developed disability, most commonly movement disorders.ConclusionsPediatric hemorrhagic stroke in southern China exhibits distinct clinical profiles and varied etiologies. Despite the high rate of favorable outcomes, a substantial proportion of children experience disability, highlighting the need for optimized management strategies.

IntroductionGlucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed the management of type 2 diabetes and obesity by improving glycemic control, promoting weight loss, and reducing cardiovascular risk. This study aimed to evaluate national trends in GLP-1 RA utilization and expenditure in Croatia between 2010 and 2024.MethodsWe conducted a nationwide, retrospective analysis using the International Medical Statistics and IQVIA pharmaceutical databases. Utilization was measured in defined daily doses per 1000 inhabitants per day, and financial expenditure was expressed in euros. Trends were contextualized within evolving clinical evidence, guideline recommendations, and healthcare reimbursement policies.ResultsTotal noninsulin antidiabetic drug consumption more than doubled between 2010 and 2024, with the use of GLP-1 RAs rising from negligible at the time of market entry to that worth 15.99 defined daily doses per 1000 inhabitants per day in 2024, representing 16.1% of total prescriptions. Expenditure on GLP-1 RAs reached 42.07 million euros in 2024, accounting for 42.7% of total noninsulin antidiabetic spending. Semaglutide emerged as the dominant agent according to both utilization and cost, followed by dulaglutide and liraglutide. Obesity-specific indications were underutilized, largely due to lack of reimbursement.ConclusionsGLP-1 RA prescribing has increased substantially in Croatia over the past decade, reflecting their growing therapeutic importance. However, economic constraints, restrictive reimbursement, and sociocultural barriers continue to limit access, particularly in obesity care. Our findings highlight the need to align reimbursement frameworks and clinical practice with emerging evidence to maximize the cardiometabolic and public health benefits of GLP-1 RAs.

ObjectiveTo assess the association between serum galectin-3 levels and echocardiographic changes in hospitalized patients with coronavirus disease 2019 across different disease severities and stages, including the post- coronavirus disease 2019 period.MethodsThis retrospective observational study included 86 adults with reverse transcription polymerase chain reaction-confirmed coronavirus disease 2019 who were treated at the First University Clinic of Tbilisi State Medical University. Patients were divided into four groups: moderate disease within the first week of symptom onset (n = 21), severe disease during weeks 2-3 (n = 20), critical illness not requiring mechanical ventilation (n = 20), and post- coronavirus disease 2019 status 2 months after infection (n = 25). Serum galectin-3 was measured using an enzyme-linked immunosorbent assay, and transthoracic echocardiography was performed in all patients. Clinical, laboratory, and echocardiographic variables were compared across groups, and associations with galectin-3 were assessed using Spearman rank correlations. Group comparisons were performed using independent-samples t tests and one-way analysis of variance. Because normality and homogeneity of variance were not formally assessed and no adjustment for multiple testing was applied, the findings were interpreted as exploratory.ResultsGalectin-3 levels increased across the acute disease groups and were highest in critically ill nonventilated patients, whereas lower levels were observed in the post- coronavirus disease 2019 group. Nominally significant between-group differences were observed in ascending aortic diameter, left ventricular volumes and mass, left atrial diameter, pulmonary artery diameter, and selected right heart functional parameters. Galectin-3 showed nominally significant correlations with atrial dimensions, right ventricular fractional area change, and selected left ventricular structural parameters, although the pattern varied across groups.ConclusionsSerum galectin-3 was associated with selected echocardiographic abnormalities, with patterns varying according to coronavirus disease 2019 severity and disease stage. Combined assessment of galectin-3 and echocardiographic findings may help characterize cardiovascular involvement. However, because of the small subgroup sizes, unadjusted multiple comparisons, unassessed assumptions of parametric tests, and exclusion of mechanically ventilated patients, these findings are hypothesis-generating and should be interpreted with caution.

ObjectiveDelirium is a frequent complication in acute heart failure and is associated with poor outcomes in the intensive care unit. Machine learning methods can leverage high-dimensional clinical data to support early risk stratification; however, models specifically designed to predict delirium in acute heart failure are limited, underscoring the need for reliable and clinically applicable tools.MethodsPatients with acute heart failure were identified using International Classification of Diseases codes, and delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit. Baseline clinical data were subjected to feature selection using least absolute shrinkage and selection operator, Boruta and recursive feature elimination. Eight machine learning models were developed, and the optimal model was evaluated for discrimination, calibration and clinical utility, with SHapley Additive exPlanations used to interpret predictor contributions.ResultsTen key predictors were identified using three feature selection methods. The gradient boosting machine model demonstrated favourable discrimination and calibration in both internal and external validation cohorts, although the areas under the receiver operating characteristic curve of the neural network and Light Gradient Boosting Machine models were not significantly different from those of the gradient boosting model in the DeLong comparisons. SHapley Additive exPlanations identified the Glasgow Coma Scale score, Sequential Organ Failure Assessment score and sedative use as major contributors to risk prediction. The final model was implemented as an online risk calculator to provide individualised risk estimates.ConclusionsThe model showed acceptable performance for estimating delirium risk in patients with acute heart failure and may support early intensive care unit risk stratification. The web-based calculator enables individualised assessment; however, prospective multi-centre validation is needed before broad clinical implementation.

ObjectiveAnthracycline-related cardiotoxicity may involve systemic inflammatory responses, and the neutrophil-to-lymphocyte ratio may change during chemotherapy as a marker for inflammatory and immune status. Considering this, we designed the present study to assess the predictive value of neutrophil-to-lymphocyte ratio combined with left atrial reservoir longitudinal strain for subclinical cancer therapy-related cardiac dysfunction during anthracycline chemotherapy in patients with breast cancer.MethodsThis prospective observational study enrolled 85 patients with breast cancer undergoing anthracycline chemotherapy. Neutrophil-to-lymphocyte ratio and left atrial reservoir longitudinal strain were measured before chemotherapy (T0), after the second cycle (T2), and after the fourth cycle (T4). Subclinical cancer therapy-related cardiac dysfunction was defined as a normal left ventricular ejection fraction with a ≥15% decrease in left ventricular global longitudinal strain compared with that at baseline. The predictive efficacy of the relative decrease in left atrial reservoir longitudinal strain, T2 neutrophil-to-lymphocyte ratio, and their combined model for subclinical cancer therapy-related cardiac dysfunction at T4 was evaluated using receiver operating characteristic curves.ResultsWe found that 29.41% of the patients developed subclinical cancer therapy-related cardiac dysfunction. Multivariate analysis showed that both T2 neutrophil-to-lymphocyte ratio (odds ratio = 1.611, p = 0.002) and relative decrease in left atrial reservoir longitudinal strain (odds ratio = 1.426, p < 0.001) were independent predictors. Receiver operating characteristic analysis revealed an area under the curve of 0.896 for the combined model.ConclusionsThis study provides preliminary evidence for an association of T2 neutrophil-to-lymphocyte ratio and relative decrease in left atrial reservoir longitudinal strain with subclinical cancer therapy-related cardiac dysfunction during anthracycline chemotherapy in patients with breast cancer. In this cohort, their combined use suggested good predictive value.

ObjectiveThe red cell distribution width-to-albumin ratio reflects systemic inflammatory burden and nutritional status. However, its prognostic value in critically ill patients with gastrointestinal bleeding has not been well established. This study assessed the association between the red cell distribution width-to-albumin ratio and mortality and developed a multivariable model for early risk stratification and mortality estimation.MethodsThis retrospective cohort study included adult intensive care unit patients with a primary diagnosis of gastrointestinal bleeding from the Medical Information Mart Intensive Care IV database, with external validation performed using the electronic intensive care unit Collaborative Research Database. Covariates for Cox proportional hazards models examining 28-day and 90-day mortality were selected using the least absolute shrinkage and selection operator in combination with clinical judgment. Kaplan-Meier survival analyses, receiver operating characteristic curves, and restricted cubic spline modeling were performed. Predictors identified by the Boruta algorithm were incorporated into a nomogram for early mortality estimation.ResultsA total of 1620 patients were included, with a 28-day mortality of 18.6%. Non-survivors exhibited substantially higher red cell distribution width-to-albumin ratio values. After full adjustment, the red cell distribution width-to-albumin ratio remained significantly associated with 28-day mortality (hazard ratio 1.12, 95% confidence interval 1.07-1.18) and 90-day mortality (hazard ratio 1.14, 95% confidence interval 1.09-1.20; both p < 0.001). Higher red cell distribution width-to-albumin ratio was associated with markedly reduced survival, and restricted cubic spline modeling showed an approximately linear increase in mortality risk across the red cell distribution width-to-albumin ratio spectrum. The nomogram constructed from key predictors-including the red cell distribution width-to-albumin ratio-demonstrated strong discrimination in internal validation (area under the curve 0.814) and maintained stable performance in external validation (area under the curve 0.826).ConclusionsThe red cell distribution width-to-albumin ratio may serve as a pragmatic early indicator for risk stratification in critically ill patients with gastrointestinal bleeding. The multivariable nomogram incorporating the red cell distribution width-to-albumin ratio may support individualized mortality risk estimation and showed stable performance across independent cohorts.

ObjectiveTo evaluate the independent and combined associations of nighttime sleep duration and midday napping duration with all-cause mortality and premature death in Chinese older adults and to examine potential sex-specific differences.MethodsThis longitudinal cohort study analyzed 11,054 adults aged ≥60 years from the China Health and Retirement Longitudinal Study 2018-2020. Sleep is a key factor in the health of older adults, but prior research has focused on nighttime sleep in Western populations, with limited attention to the culturally common practice of midday napping in China and no systematic analysis of sex differences. Nighttime sleep and daily midday napping durations were collected using standardized questionnaires. Two-year all-cause mortality and premature death were tracked as the primary outcomes. Cox regression, restricted cubic spline analysis, and multiple sensitivity analyses were performed. The proportional hazards assumption was verified using Schoenfeld residuals (all p > 0.05).ResultsAfter adjustment for covariates (age, sex, education level, marital status, smoking, alcohol consumption, and number of chronic diseases), daily napping ≥60 min was independently associated with a higher risk of all-cause mortality (overall hazard ratio = 1.289, p = 0.013; males: hazard ratio = 1.298, p = 0.049). The "long sleep + long nap" pattern (>8 h nighttime sleep + ≥60 min nap) was associated with the highest risk of all-cause mortality (hazard ratio = 3.048, p < 0.001). Males with 8-10 h of nighttime sleep had an elevated risk of all-cause mortality (hazard ratio = 3.095, p = 0.001), whereas females with 4-6 h of nighttime sleep had a lower risk of premature death (hazard ratio = 0.522, p = 0.039). Restricted cubic spline analysis confirmed a nonlinear U-shaped association between nighttime sleep duration and all-cause mortality.ConclusionsIn Chinese older adults, prolonged daily napping (≥60 min) was associated with a higher risk of mortality after adjustment for covariates. Sex-specific differences were observed, although the formal interaction test did not reach statistical significance (p = 0.112). Nighttime sleep of 6-8 h and avoiding daily napping ≥60 min may be associated with a lower risk of mortality; however, as this was an observational study, causal inference cannot be established.