Current Medical Science最新文献

Objective: Iodinated contrast media (ICM) are widely used in medical imaging, particularly in computed tomography (CT) and magnetic resonance imaging (MRI) examinations, to increase image quality and improve diagnostic accuracy. Despite their clinical utility, ICM are associated with various adverse drug reactions (ADRs), including allergic reactions and other systemic effects. This study aimed to evaluate ICM-related ADRs through the Chinese spontaneous reporting system (SRS) and provide reference information for clinical practice.

Methods: We analyzed ADRs related to ICM on the basis of data from the SRS in Wuhan, China, from January 1, 2018, to December 31, 2023.

Results: A total of 2,166 ADR reports related to four ICM (iodixanol, iohexol, ioversol, and iomeprol) were analyzed to assess the proportion and severity of adverse reactions. The results revealed that the majority of the ADRs were mild, with the most common symptoms being rash (54.76%) and itching (35.18%). Gastrointestinal and respiratory symptoms were also noted, although less frequently. Anaphylactic shock was documented in 48 patients, accounting for 9.69% of severe adverse reactions. The incidence of ADRs was greater in summer. Circulatory system diseases were the most prevalent underlying conditions in patients who experienced ADRs. Treatment primarily involved symptomatic management, including corticosteroids and antihistamines, with adrenaline administered in severe cases.

Conclusions: This study highlights the importance of monitoring high-risk patients, especially elderly patients and those with preexisting conditions, and underscores the need for timely intervention in severe reactions. Future prospective studies are necessary to facilitate the selection of more appropriate ICM for individual patients.

Spleen-Stomach disorders are prevalent clinical conditions in Traditional Chinese Medicine (TCM). The complex diagnostic and treatment model used in TCM is based on a "symptom-pattern-disease-formula" framework that heavily relies on practitioners' experience. However, this model faces several challenges, including ambiguous knowledge representation, unstructured data, and difficulties with knowledge sharing. Recent advancements in artificial intelligence, natural language processing, and medical knowledge engineering have significantly improved research on knowledge graphs (KGs) and intelligent diagnosis and treatment systems for these disorders, making these technologies crucial for modernizing TCM. This article systematically reviews two core research pathways related to Spleen-Stomach disorders. The first pathway focuses on constructing knowledge graphs for "structured knowledge representation". This includes ontology modeling, entity recognition, relation extraction, graph fusion, semantic reasoning, visualization services, and an ensemble model to predict treatment efficacy. The second pathway involves the development of intelligent diagnosis and treatment systems, with a focus on "clinical applications". This pathway includes key technologies such as quantitative modeling of TCM, the four diagnostic methods (inspection, auscultation-olfaction, interrogation, and palpation), semantic analysis of classical texts, pattern differentiation algorithms, and multimodal consultation recommenders. Through the synthesis and analysis of current research, several ongoing challenges have been identified. These include inconsistent models and annotation of TCM clinical knowledge, limited semantic reasoning capabilities, insufficient integration between KGs and intelligent diagnostic models, and limited clinical adaptability of existing intelligent diagnostic systems. To address these challenges, this review suggests future research directions that include enhancing heterogeneous multisource knowledge integration techniques, deepening semantic reasoning through collaborative reasoning frameworks that incorporate large language models, and developing effective cross-disease transfer learning strategies. These directions aim to improve interpretability, reasoning accuracy, and clinical applicability of intelligent diagnosis and treatment systems for Spleen-Stomach disorders in TCM.

Objective: This study aimed to investigate the virulence characteristics of Klebsiella pneumoniae (KP) strains isolated from children to analyze the genetic relatedness between pediatric and local adult CRKP isolates and to identify clinical risk factors associated with high-risk strains.

Methods: KP strains and corresponding clinical data were collected at a tertiary provincial children's hospital in Henan province from January 2021 to May 2023. The molecular and clinical characteristics of pediatric carbapenem-resistant KP (CRKP) strains were analyzed. Genomic data from local adult isolates were integrated, and the virulence profiles of pediatric and adult isolates were compared. Clinical risk factors for isolating high-risk strains were initially screened via LASSO regression and then evaluated via multivariate binomial regression.

Results: Among the 205 collected KP isolates, 87 (42.4%) were CRKP, and 118 (57.6%) were carbapenem-sensitive KP (CSKP). The predominant carbapenem resistance gene was bla_KPC-2 (89.7%), followed by bla_NDM-1 (5.7%) and bla_IMP-4 (4.6%). Ten sequence types (STs) were identified among the CRKP isolates, with ST11-KL47-KPC2 (52.9%) being the predominant genotype. Screening for virulence genes revealed that 55 (63.2%) CRKP isolates carried both the hypervirulence-associated genes iuc and rmpA2. Single-nucleotide polymorphism (SNP) analysis revealed that 34 of these strains had fewer than 10 SNPs. Phylogenetic and population genetic analyses revealed close genomic relatedness between pediatric and adult CRKP strains. Young age and exposure to invasive procedures were identified as independent risk factors for the isolation of iuc⁺rmpA2⁺ CRKP.

Conclusions: The ST11-KL47-KPC2 genotype was the predominant CRKP isolate in pediatric patients. The close genomic relatedness between pediatric and adult CRKP isolates suggests a common ancestor that has disseminated across populations. The high prevalence and clonal transmission of pediatric iuc⁺rmpA2⁺ CRKP strains warrant heightened clinical vigilance.

Objective: To compare the impact of different reconstruction algorithms on the image quality of 60 kVp head and neck CT angiography (CTA) using subjective and objective metrics, with a focus on vessel edge sharpness.

Methods: This prospective study enrolled 45 patients who underwent ultra-low-voltage (60 kVp) head and neck CTA. Image datasets were reconstructed with filtered back-projection (FBP), ClearView (CV) and ClearInfinity (CI) algorithms at low (30%), medium (50%), and high (70%) strengths. Image quality was assessed subjectively and objectively via the Kruskal‒Wallis test for multiple comparisons. Objective parameters, including edge rise slope (ERS) and edge rise distance (ERD), were analyzed via the Friedman test of multiple comparisons statistics.

Results: Subjective assessments favored the CI50 reconstruction algorithm, demonstrating superior or satisfactory results compared to the other algorithms, with significantly better vessel delineation, edge definition and diagnostic confidence (all P < 0.05). Objective analysis revealed that the CV50 and CV70 algorithms significantly reduced ERS and/or elevated ERD (both P < 0.05). However, the CI50 algorithm maintained comparable vessel edge sharpness (P > 0.05) across all evaluated head and neck vascular segments when compared with the FBP algorithm.

Conclusions: The CI50 reconstruction algorithm optimizes image quality in 60 kVp head and neck CTA. It provides vessel edge sharpness comparable to FBP while offering superior vessel delineation, edge definition, and diagnostic confidence compared to FBP and CV algorithm. These findings suggest that CI50 has the potential to improve diagnostic accuracy in low-dose vascular imaging.

Objective: Uric acid (UA) to high-density lipoprotein (HDL) ratio (UHR) has recently been proposed as a novel biomarker of inflammation. This study aimed to investigate the association between the UHR and carotid atherosclerosis (CAS) in patients with type 2 diabetes mellitus (T2DM).

Methods: In this single-center, retrospective cross-sectional study, 379 patients with T2DM were enrolled and categorized into two groups: 259 T2DM patients with CAS (T2DM-CAS) and 120 T2DM patients without CAS (T2DM-WCAS). Carotid intima‒media thickness (CIMT) and carotid atheromatous plaques (CAPs) were assessed via Doppler ultrasound. UHR values were compared between the groups, and receiver operating characteristic (ROC) curve analysis was employed to evaluate their diagnostic performance.

Results: The UHR was significantly greater in the T2DM-CAS group than in the T2DM-WCAS group (P < 0.001). Multivariate logistic regression analysis identified the UHR as an independent risk factor for T2DM-CAS (P < 0.001). The area under the ROC curve (AUC) for UHR to detect CAS was 0.750, with an optimal cut-off value of 0.35.

Conclusion: The UHR is an independent risk factor for CAS in patients with T2DM and may serve as a valuable biomarker for predicting CAS in this population.

Objective: Rho guanine nucleotide exchange factor 15 (ARHGEF15) is a member of the RhoGEF family that activates the Rho protein. High ARHGEF15 expression is associated with poor prognosis in patients with pancreatic cancer. Although ARHGEF15 is abundantly expressed in endothelial cells, its detailed functions remain unknown. This study aimed to elucidate the effects of ARHGEF15 on endothelial cells and the underlying molecular mechanisms involved.

Methods: The ARHGEF15 gene was overexpressed or knocked down in human umbilical vein endothelial cells (HUVECs), and the results were validated via qRT-PCR and Western blotting. CCK8 and MTT assays were used to evaluate cell proliferation. Wound healing and transwell assays were used to assess cell migration. The activation of STAT3 signaling was examined by Western blotting, and STATTIC was used to inhibit STAT3 signaling.

Results: ARHGEF15 overexpression promoted the migration of HUVECs, and ARHGEF15 knockdown inhibited the migration of HUVECs. Neither the overexpression nor the knockdown of ARHGEF15 affected HUVEC proliferation. Furthermore, ARHGEF15 increased STAT3 phosphorylation in HUVECs. STATTIC treatment prevents ARHGEF15 overexpression-induced STAT3 phosphorylation and HUVEC migration.

Conclusion: ARHGEF15 increases HUVEC migration by regulating STAT3 signaling.

Bcl-2 family proteins (BFPs) are essential regulators of regulated cell death (RCD), and their dysregulation is implicated in a wide range of disorders, including cancer, neurodegenerative diseases, and autoimmune conditions. Recent studies have shown that BFPs also play critical roles in autophagy, calcium homeostasis, neuronal function, and mitochondrial dynamics, underscoring their multifaceted contributions to cellular health. In this review, we summarize the current knowledge concerning the physiological roles and structural diversity of BFPs, with a particular focus on key multidomain proteins such as Bak, Bax, and Bok. Our findings highlight persistent challenges and knowledge gaps, especially concerning the interactions between BFPs and diverse cellular pathways. In conclusion, BFPs act as fundamental regulators of cell survival and apoptosis. While significant progress has been made in elucidating their molecular mechanisms, important questions remain-particularly regarding the precise structural dynamics of pore formation, the influence of the mitochondrial lipid composition, and the balance between pro- and anti-apoptotic members. Finally, the therapeutic potential of BFP-targeted drugs, including BH3 mimetics, offers promising avenues for treating cancer and other diseases characterized by aberrant regulation of apoptosis.

Objective: Accumulating evidence suggests that transmembrane 4 L6 family member 1 (TM4SF1) is associated with the development of various cancers; yet comprehensive studies on TM4SF1 in cervical cancer are lacking. Therefore, we aimed to evaluate the prognostic value of TM4SF1 in cervical cancer, elucidate its potential oncogenic functions in this disease, and further explore its feasibility as a therapeutic target.

Methods: The expression profiles and clinical information of cervical cancer patients were obtained from The Cancer Genome Atlas (TCGA) database. The expression levels of TM4SF1 were compared between cervical cancer and normal cervical tissues using the Wilcoxon rank-sum test. Kaplan-Meier analysis was employed to assess the prognostic value of TM4SF1. Furthermore, functional enrichment analyses were performed to explore the associated signaling pathways and biological functions. The methylation status of TM4SF1 was analyzed using the UALCAN and MethSurv databases. In addition, in vitro experiments were conducted to preliminarily validate the role and mechanisms of TM4SF1 in cervical cancer.

Results: TM4SF1 was overexpressed in nearly all tumors, and its overexpression was associated with poor prognosis in cervical cancer. Moreover, the correlation between TM4SF1 expression and the expression of immune cell infiltration markers and immune checkpoint genes suggested that it had potential applications in cancer immunotherapy. Western blot analysis and immunohistochemistry revealed significantly elevated protein levels of TM4SF1 in cervical cancer tissues and cells. Further studies revealed that the knockdown of TM4SF1 significantly inhibited the migration, invasion, and epithelial-mesenchymal transition (EMT) of HeLa and SiHa cells, as well as promoted their apoptosis.

Conclusion: TM4SF1 may serve as a potential prognostic biomarker and therapeutic target for cervical cancer.

Obesity is a common noncommunicable disease characterized by persistent low-grade chronic inflammation and is associated with various metabolic disturbances, including insulin resistance and diabetes. The search for effective obesity treatments has led to growing interest in the role of amino acids in metabolic regulation. Tryptophan (TRP), an essential amino acid, participates in several biological pathways, including the kynurenine, 5-hydroxytryptamine (5-HT, also known as serotonin), and indole pathways. Recent evidence underscores the significance of TRP metabolism in obesity, showing that various metabolites and enzymes in its metabolic pathways are altered in individuals with obesity. These changes influence physiological processes, mood regulation, and overall metabolic health. This review provides a comprehensive overview of TRP metabolism. It highlights the potential of targeting TRP metabolism as a therapeutic strategy for managing obesity and its related metabolic and psychological comorbidities.