European Journal of Medical Research最新文献

Background: Chronic inflammation and insulin resistance underpin frailty; the C-reactive protein-triglyceride-glucose index (CTI) integrates these processes. We assessed the association between CTI and frailty in a nationally representative Chinese population.

Methods: We analyzed 9,555 adults aged ≥ 45 years from the nationally representative 2015 China Health and Retirement Longitudinal Study (CHARLS). Frailty was assessed using a 32-deficit frailty index (FI), computed on a 0-1 scale and multiplied by 100 for presentation (scaled from 0 to100); frailty was defined as FI ≥ 25 (equivalently ≥ 0.25).Associations were estimated using survey-weighted linear regression (FI, continuous) and survey-weighted logistic regression (frailty). Nonlinearity was examined with restricted cubic splines; where supported, segmented regression was used to identify an inflection point.

Results: Each 1-unit higher CTI was associated with a 0.71-point higher FI (95% CI 0.37-1.05; p < 0.001) and 15% higher odds of frailty (OR, 1.15; 95% CI 1.04-1.27; p = 0.006). Compared with the lowest tertile, the highest tertile had a higher FI (β, 0.91; 95% CI 0.30-1.51; p = 0.0035) and greater odds of frailty (OR, 1.22; 95% CI 1.02-1.45; p = 0.029). Spline analyses demonstrated an overall positive association; piecewise models identified a threshold near CTI ≈7.95 (null association below; positive above).

Conclusions: CTI is independently associated with frailty in a population-representative cohort. Therefore, CTI-based approaches may facilitate risk stratification in aging populations, while longitudinal validation is warranted to establish prognostic value.

Background: Pathology of the long head of the biceps tendon (LHBT) is a common source of anterior shoulder pain. Nanoscopic techniques allow minimally invasive tenotomy under local or regional anesthesia. Suprascapular nerve block (SSNB) provides targeted intraarticular analgesia and may facilitate awake shoulder procedures.

Purpose: To evaluate the feasibility, procedural tolerance, visualization quality, and short-term clinical outcomes of nanoscopic LHBT tenotomy performed under SSNB in elderly patients with isolated LHBT-related pain.

Methods: Eight patients (mean age 72.5 ± 2.7 years; range 68-76) with ≥ 12 months of isolated LHBT-related pain were included after screening 30 candidates. All had LHBT tendinopathy or partial tear confirmed by ultrasound or MRI and had failed ≥ 3 physiotherapy cycles and ≥ 2 corticosteroid injections. Procedures were performed with the Arthrex NanoScope under ultrasound-guided SSNB (6 mL). Pain (VAS) and function (Constant Score, CS) were recorded preoperatively and at 1 day, 2 weeks, and 6 weeks postoperatively. Exploratory one-way ANOVA was used to assess temporal improvements.

Results: All procedures were completed without sedation, conversion, or complications. Mean operative time was 12 min. VAS improved from 7.8 preoperatively to 4.2 (day 1), 4.0 (2 weeks), and 3.4 (6 weeks). CS improved from 51.5 to 68.4, 70.2, and 71.8, respectively. ANOVA demonstrated significant temporal change (VAS: F = 158.4, p < 0.0001; CS: F = 355.5, p < 0.0001). Visualization quality averaged 4.5/5. Mean patient satisfaction at 6 weeks was 4.6/5, with return to daily activity at 10 days. No Popeye deformity was observed.

Conclusion: Nanoscopic LHBT tenotomy under SSNB is feasible, safe, and well tolerated in elderly patients selected for isolated LHBT pathology. Early pain and function outcomes improved consistently. Larger comparative studies with longer follow-up are required.

Level of evidence iv: Trial registration RNN/60/25/KE.

Background: The impact of serum uric acid (UA) levels and fluctuations on functional outcomes following endovascular treatment (EVT) for acute ischemic stroke (AIS) is still controversial. This study investigated the relationship between the dynamic changes in UA levels during hospitalization and functional outcomes in patients with AIS who underwent EVT.

Methods: A single-center retrospective cohort study enrolled 962 AIS patients who received EVT at Xuanwu Hospital from January 2015 to January 2024. Multivariate logistic regression model and restricted cubic spline were used to analyze and explore the correlation between UA levels and functional outcomes. Additionally, a meta-analysis integrated current cohort evidence from three studies, involving 2353 patients. The primary outcome was the favorable outcome (modified Rankin scale scores[mRS] 0-2) during follow-up at day 90. The secondary outcomes included excellent outcome (mRS 0-1), symptomatic intracranial hemorrhage (sICH), any ICH, and all-cause mortality at day 90.

Results: In this cohort study, a significant inverse U-shaped nonlinear association was observed between baseline UA levels and favorable outcomes. When patients were classified into quartiles by ΔUA (ΔUA, between admission and lowest measurement during hospitalization), patients with the largest decrease in UA had significantly lower proportions of favorable and excellent outcomes at 90 days and a higher risk of any ICH, compared to those with an increase or minimal decrease in UA. Meta-analysis results showed that higher baseline UA levels were positively associated with excellent outcomes.

Conclusions: The baseline UA levels and their dynamic changes during hospitalization are correlated with the functional outcomes of stroke and may serve as predictors of intracranial hemorrhage risk and 90-day functional outcome in AIS patients undergoing EVT.

Objective: This study aimed to identify novel sepsis biomarkers by evaluating serum interleukin-1 receptor type 2 (IL1R2) for its diagnostic and prognostic utility, in light of the limitations of current markers like PCT and CRP.

Methods: A single-center retrospective analysis was conducted involving 55 sepsis patients and 42 non-sepsis controls. Serum IL1R2 levels, measured via ELISA within 24 h of admission, were compared against clinical data, including SOFA scores, 28-day mortality, and laboratory parameters (PCT, CRP). Diagnostic performance was assessed using ROC curve analysis, while prognostic utility was determined via Kaplan-Meier analysis. A cecal ligation and puncture (CLP) was used to track IL1R2 dynamics over time.

Results: Sepsis patients exhibited significantly elevated serum IL1R2 levels compared to controls. IL1R2 demonstrated strong diagnostic power (AUC = 0.908), outperforming PCT and CRP. Furthermore, higher IL1R2 levels correlated with increased SOFA scores and predicted poorer 28-day survival. In the CLP model, serum IL1R2 rose within 4 h post-sepsis, peaked within 24 h, returned to baseline by day 3, and fell below normal by day 7.

Conclusion: Serum IL1R2 is a promising biomarker, offering a superior ability to correlate with disease severity and predict 28-day mortality.

Purpose: Predicting local recurrence after stereotactic body radiation therapy (SBRT) for lung cancer remains challenging. This study aims to develop a machine learning (ML)-based prognostic model for local control (LC) prediction by comparing different ML algorithms.

Methods: Clinical data from 158 lung cancer patients treated with SBRT were retrospectively analyzed. Six ML methods, including Boruta, RSF, GBM, LASSO, CoxBoost, and univariate Cox regression were systematically applied to perform variables selection, and the final prognostic model was constructed using multivariate Cox regression analysis. A benchmark model incorporating clinical stage plus treatment dose was also used for comparison. The performance of different models was evaluated using the C-index, Akaike Information Criterion (AIC), and time-dependent AUC. The optimal model was further evaluated comprehensively through receiver operating characteristic (ROC) analysis, calibration plots assessment, and decision curve analysis (DCA). The evaluation was validated through internal cross-validation to ensure robust reliability.

Results: The LASSO-Cox model achieved the highest C-index (0.718) and time-dependent AUC, shared the lowest AIC with the CoxBoost-Cox model, and outperformed the conventional stage plus treatment dose model (0.718 vs. 0.634). The LASSO-Cox model demonstrated moderate discriminatory ability, good calibration (predicted vs. observed outcomes), and clinical utility in DCA.

Conclusions: ML demonstrates certain potential in LC prediction after SBRT. Nevertheless, it is worth noting that the study relies solely on internal validation and lacks external validation; therefore, further validation in independent cohorts is required before the model can be responsibly considered for clinical implementation.

Objective: To explore the relevant mechanisms and principles by which liraglutide alleviates sepsis-associated encephalopathy (SAE) through reducing neuronal injury, glial cell activation and mitochondrial dysfunction.

Methods: Adult male C57BL/6 J mice were included in this study. C57BL/6 J mice were randomly divided into three groups: cecal ligation and puncture (CLP) group, CLP + liraglutide group, and sham operation group. One hour before CLP, mice in each group were treated with PBS or intracerebroventricular (i.c.v.) liraglutide. On the day after CLP, the brains of the mice were removed for immunohistochemistry, transmission electron microscopy, and Western blot analysis. Modified neurological severity scores were performed on the mice at 0, 1, 3, and 5 days after CLP surgery. The weight loss and food intake and survival rate of the animals in each group were monitored until euthanasia. In vitro experiments used BV2 and HT22 cells to detect the migration of BV2 cells.

Results: This study assessed the potential neuroprotective impacts of i.c.v. administration of Liraglutide, a glucagon-like peptide 1 receptor (GLP-1R) agonist, in septic mice. Liraglutide administered intracerebroventricularly alleviated neurological impairments and reduced glial cell activations, neuronal loss, as well as degeneration in the hippocampal regions of septic mice. Liraglutide was shown in vitro to suppress the interaction between neurons and microglia when the cells were stimulated with LPS. Liraglutide also inhibited mitochondrial damage and oxidative stress in hippocampus neurons. Mechanistically, Liraglutide restored the diminished p-AKT levels while simultaneously reversing STAT3 phosphorylation in hippocampal neurons.

Conclusion: GLP-1R agonist Liraglutide may have neuroprotective properties on SAE.

Background: Extracorporeal membrane oxygenation (ECMO) is a life-saving intervention for patients with severe respiratory and/or cardiac failure. In patients with severe pneumonia, severe septic shock led to the need for vasopressor and inotropic drugs to maintain the patients' circulatory function. The vasoactive inotropic score (VIS) is calculated as a weighted sum of all administered vasopressor and inotropic medications and quantifies the amount of pharmacological cardiovascular support. This study aimed to evaluate the association between preoperative VIS score and clinical outcomes among adult severe pneumonia patients with sepsis undergoing ECMO support.

Methods: Adult patients diagnosed with severe pneumonia complicated with sepsis from January 2013 to June 2022 were obtained from the Chinese Society of Extracorporeal Life Support (CSECLS) registry database. The study endpoints included in-hospital mortality and failure of weaning for ECMO. Restricted cubic spline (RCS) was used to explore the association between VIS and the risk of adverse clinical outcomes. A backward stepwise logistic multivariable regression was used for assessing influence factors of study endpoints. Unadjusted and adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated to identify the association.

Results: Among 825 enrolled patients, there were 386 cases of in-hospital mortality and 241 cases of ECMO weaning failure. Patients in the in-hospital death group were older, had a higher SOFA score, lower mean arterial pressure, and higher VIS. A linear relationship existed between VIS and the risk of in-hospital death as well as the risk of failed weaning from ECMO support. Regardless of whether patients received VV-ECMO assistance or VA-ECMO support, as the VIS level increased, both the risk of in-hospital mortality and the risk of ECMO weaning failure also increased linearly. In the further subgroup analysis, the results were found to be robust.

Conclusion: Linear correlation existed between VIS score and the risk of in-hospital death as well as the risk of ECMO weaning failure in adult patients with severe pneumonia combined with sepsis. With the increase of VIS score, the risk of in-hospital death and ECMO weaning failure also increased. VIS may be a useful practical tool for risk stratification of adverse clinical outcomes.

Background: This study aimed to develop and validate a novel nomogram that incorporates the neutrophil percentage-to-albumin ratio (NPAR) for predicting 30-day and 90-day unfavorable outcomes in acute-on-chronic liver failure (ACLF) patients.

Methods: We retrospectively enrolled 641 ACLF patients from the First Affiliated Hospital of Anhui Medical University between January 2017 and June 2024, randomly assigning them to training (n = 448) and validation (n = 193) cohorts. Univariate Cox regression, the Least Absolute Shrinkage and Selection Operator (LASSO) regression, and multivariate Cox analysis identified seven independent predictors: bacterial infection, hepatic encephalopathy, age, prothrombin time (PT), total bilirubin (TBIL), lymphocyte count, and NPAR.

Results: The nomogram demonstrated superior predictive performance in the training cohort, with area under the curve (AUC) values of 0.874 (95% CI 0.838-0.910) and 0.877 (95% CI 0.845-0.909) for 30-day and 90-day outcomes, respectively, and a concordance index (C-index) of 0.825 (95% CI 0.796-0.853), significantly outperforming the MELD, MELD-Na, CLIF-C ACLFs and COSSH-ACLF II scores. Calibration curves showed strong concordance between predicted and observed survival probabilities, and decision curve analysis confirmed broad clinical applicability. We have also validated the predictive value of the new model for ACLF in a validation cohort (n = 193). Compared with COSSH-ACLF II, the model exhibited significant improvements in net reclassification index (NRI) and integrated discrimination improvement (IDI) (P < 0.001). Risk stratification effectively categorized patients into low-, intermediate-, and high-risk groups, revealing varied survival rates. In addition, a user-friendly dynamic web-based calculator was developed.

Conclusions: This nomogram that integrates inflammatory and nutritional indicators provides a high-precision tool for short-term prognosis assessment in ACLF patients and is expected to guide clinical management.

Background: Insulin resistance and chronic inflammation are closely associated with cognitive impairments. This study systematically investigates the relationship between biomarkers of insulin resistance/chronic inflammation and cognitive dysfunction in patients with non-disabling ischemic cerebrovascular events (NICE).

Methods: We collected demographic information and clinical data from 236 patients with NICE. Based on Montreal Cognitive Assessment (MoCA) scores, participants were categorized into normal cognitive function (NCF) and VCI groups. Propensity score matching (PSM) was applied to balance baseline characteristics. Differences in chronic inflammatory markers and insulin resistance levels were compared between groups. LASSO regression was used to identify independent risk factors, while restricted cubic spline (RCS) analysis was performed to validate dose-response relationships. A nomogram model was constructed using LASSO-selected predictors, and its performance was evaluated by ROC curves, calibration plots, and decision curve analysis (DCA). Internal validation was performed through simple cross-validation, with both accuracy and Kappa statistics reported.

Results: Among 236 NICE patients, 115 (48.73%) were diagnosed with VCI. Following propensity score matching, the VCI group exhibited significantly higher levels of insulin resistance and chronic inflammation compared to the NCF group. LASSO regression identified the metabolic score for insulin resistance (METS-IR) as an independent risk factor for cognitive impairment (OR = 1.11, 95% CI: 1.06-1.17). RCS confirmed a linear negative correlation between METS-IR and MoCA scores (P for overall = 0.014, P for non-linear = 0.715). Mediation analysis revealed that the systemic Immune-Inflammation Index (SII) partially mediated the association between METS-IR and MoCA scores. The nomogram model demonstrated good discrimination (AUC = 0.78, 95% CI: 0.72-0.83), with calibration plots showing high consistency between predicted and observed probabilities (Hosmer-Lemeshow test P = 0.718). DCA confirmed a favorable clinical net benefit. Cross-validation results demonstrated favorable model accuracy and consistency (accuracy = 0.71, Kappa value = 0.43).

Conclusions: Cognitive impairment in NICE patients is strongly associated with elevated insulin resistance and chronic inflammation. METS-IR exhibits a linear negative association with cognitive function, serving as an independent risk predictor. The constructed nomogram provides a reliable tool for early VCI detection with robust discrimination and calibration. Notably, SII partially mediates the association between METS-IR and cognition, highlighting inflammatory pathways as a candidate target for future interventional studies.

Objective: To evaluate the association between very high high-density lipoprotein cholesterol (HDL-C) levels and cardiovascular mortality in a general adult population.

Methods: In this retrospective cohort study, 3,758 adults undergoing lipid profiling at a tertiary care center were categorized into five HDL-C groups: Very Low (< 30 mg/dL), Low (30-49 mg/dL), Normal (50-69 mg/dL), High (70-89 mg/dL), and Very High (≥ 90 mg/dL in men or ≥ 110 mg/dL in women). Demographic, clinical, and laboratory data were collected. The primary outcome was cardiovascular mortality over a median follow-up of 5.9 years. Kaplan-Meier survival curves and Cox proportional hazards models were used to assess associations, adjusting for age, sex, comorbidities, and medications.

Results: The Very High HDL-C group demonstrated the highest cardiovascular mortality rate (11.3 per 1,000 person-years) and significantly reduced survival compared to the Normal group (log-rank p = 0.00028). Multivariable analysis revealed that very high HDL-C was associated with increased cardiovascular mortality (adjusted HR: 1.52; 95% CI 1.04-2.24; p = 0.03). Subgroup analyses showed elevated risk in older adults, diabetics, and non-statin users.

Conclusion: Extremely high HDL-C levels were independently associated with increased cardiovascular mortality, suggesting a U-shaped relationship. These findings warrant cautious interpretation of high HDL-C values in clinical practice.