International Journal of Clinical Practice最新文献

Background

Lactylation, a novel post-translational modification of proteins, has been shown to promote tumor growth and inhibit the antitumor response of the tumor microenvironment (TME) in various ways. However, the complex mechanism of this modification in gastric cancer, particularly nonhistone lactylation and its interplay with tumor metabolism and immune escape, remains enigmatic.

Methods

Using single-cell RNA sequencing data and the AddModuleScore algorithm, we screened for lactylation-related genes at the single-cell level. We then integrated 10 machine learning algorithms and 101 combinations of these to construct a lactylation-related gene signature (LRS) model. The results were validated in the GEO dataset. Ultimately, we identified genes with prognostic predictive value, forming three gene feature profiles. We further analyzed the associations between lactylation-related gene risk scores and clinical features, mutation profiles, biological functions, immune cell infiltration, and immunotherapy response. For the core genes, we explored in-depth biological mechanisms through bioinformatics analysis and in vitro experiments.

Results

We identified 119 lactylation-related genes at the single-cell level. Utilizing a computational framework with 101 combinations of machine learning algorithms, we successfully constructed a risk prediction model that includes three lactylation-associated genes. This model showed excellent performance in prognosis prediction and clinical translation. The study also found significant differences in clinical features, biological functions, immune cell infiltration, immune checkpoint expression, and immunotherapy response among patients in different risk groups.

Conclusions

The LRS model demonstrates significant potential for improving the management of gastric cancer patients and enhancing treatment outcomes, particularly in the areas of immunotherapy and immune escape. This discovery highlights the clinical importance of overall lactic acidification in gastric cancer and provides a foundation for mechanistic studies and targeted therapeutic strategies.

Background

The global cancer survivor population is growing rapidly. Heavy metals like lead (Pb), cadmium (Cd), and mercury (Hg) can affect cancer progression and mortality, but systematic studies on their impact are limited.

Method

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) (2005–2018) on 2,369 cancer survivors. Serum levels of Pb, Cd, and Hg were measured using mass spectrometry. We used Kaplan–Meier (KM) curves and Cox regression models to study the effects of these metals on mortality.

Results

Higher serum levels of Pb and Cd were associated with increased all-cause, cancer-specific, and noncancer mortalities, as shown by KM curves. Cox regression showed that cancer survivors with higher levels of Pb and Cd had significantly higher risks of all-cause (hazard ratios [HRs]: 2.37 and 3.17), cancer-specific (HRs: 2.45 and 3.37), and noncancer mortalities (HRs: 2.73 and 3.80). Combined high levels of Pb and Cd were linked to the highest risks of all-cause and noncancer mortalities compared with low exposure levels. Hg exposure was not significantly linked to mortality outcomes. Survivors with high levels of both Pb and Cd had greater risks of all-cause, cancer-specific, and noncancer mortalities than those exposed to just one metal.

Conclusion

Cancer survivors with higher serum levels of Pb and Cd face increased mortality risks. The lack of a significant association between Hg exposure and mortality is notable. The synergistic effect of Pb and Cd on mortality risk highlights the importance of considering multiple heavy metal exposures when assessing health risks in this population.

Introduction

Vagal modulation is achieved directly by transcutaneous auricular vagus nerve stimulation, whereas breathing exercises stimulate arterial baroreceptors. In this study, we aimed to compare these two methods, which have similar effects.

Methods

88 healthy participants aged 18–35 were randomly divided into breathing exercises (Group BE) and vagus stimulation (Group VNS). Thoracic expansion exercise was performed in the BE group. In the VNS group, biphasic electrical stimulation was applied to both ears with a pulse width of 300 ms, a frequency of 10 Hz, and 20 min. Pulmonary function tests were measured on the first and last days. Heart rate, systolic and diastolic blood pressure, RMSSD, PNN50, LF/HF, LF Power, and HF Power values were measured before and after each of the 10 sessions for both groups.

Results

Heart rate decreased significantly in both groups, with significant superiority in the BE group compared to that in the VNS group. In both groups, blood pressure values decreased significantly. RMSSD, PNN50, and HF values increased significantly in the VNS group, while LF and LF/HF values decreased significantly in the BE group. In pulmonary function test results, the FEV1 value increased significantly in both groups. A significant increase in the FVC value was observed in both groups, but the BE group was superior. The two groups had no significant superiority in the FEV1/FVC value.

Conclusion

As a result, auricular vagus stimulation seems superior to breathing exercises in increasing the parasympathetic system activity, reducing sympathetic activity, and partially increasing respiratory functions.

Clinical Trial Registration

NCT06531954

Introduction

The Quality of Life Scale for Patients with Aplastic Anemia (QLS-AA), a self-reporting tool, assesses the quality of life among patients with aplastic anemia (AA). This study aimed to compare the QLS-AA with the commonly used 36-item Short Form Health Survey (SF-36) questionnaire.

Methods

In this cross-sectional study, we administered the SF-36 and QLS-AA to 306 patients with AA in two hospitals in China.

Results

The ceiling and floor effects of SF-36 (range 0%–38.89% and 0%–56.54%, respectively) were higher than those of QLS-AA (range 0.65%–1.31% and 0%, respectively). The Cronbach’s α coefficients for SF-36 ranged from 0.622 to 0.911, with principal component analysis (PCA) identifying two factors accounting for 62.481% of the variance. For QLS-AA, Cronbach’s α coefficients ranged from 0.793 to 0.932, and PCA revealed a single factor explaining 79.815% of the variance. There was a significant positive correlation between two scales (r = 0.743; p < 0.001). Both scales had discriminant validity in disease duration, work/study situation, economic dependence, blood transfusion situation, and degree of anemia. In addition, the QLS-AA showed sensitivity to the marital status.

Conclusions

Both the SF-36 and the QLS-AA are viable instruments for assessing the QoL in patients with AA. Nevertheless, the QLS-AA exhibited superior performance in psychometric testing.

Trial Registration

ClinicalTrials.gov identifier: ChiCTR2100047575

Background

Alcohol has been associated with cardiovascular disease, and excessive amounts are implicated in worsening heart failure outcomes. The knowledge, patterns, and associations of alcohol use among heart failure patients have not been established in Ghana.

Methods

This descriptive, cross-sectional study was conducted at the Ho Teaching Hospital among adult patients with acutely decompensated heart failure in the medical and emergency wards. All patients who presented with heart failure to the facility from September 2022 to August 2023 were recruited. Information needed was obtained using a structured questionnaire. The systolic and diastolic functions were determined using 2D echocardiography.

Results

Among the 315 patients, 33.7% used varying types and quantities of alcohol, with the local gin being the most patronized (62.2%).

Additionally, 65.1% of all heart failure patients who used alcohol also used herbal medicines (mostly orally and alcohol-based), and this was statistically significantly different from the patients who did not use alcohol (p < 0.05). There was a higher proportion of more severe forms of diastolic dysfunction among patients who used alcohol compared to those who did not (χ² = 125.039, p = 0.011), and this was also significantly demonstrated in concomitant alcohol and herbal medication use (χ² = 243.039, p = 0.001).

Conclusion

This study revealed that a third of patients with acute heart failure indulge in alcohol use above acceptable limits, with associated moderate to severe diastolic dysfunction in almost all of them. Herbal medication used in alcohol drinking patients was associated with HFpEF.

Objective

Observational studies indicate that psoriasis (PSO) patients have an increased risk of depression; however, potential confounding factors and reverse causality limit these findings, leaving the exact causal relationship between these two conditions remain to be determined. The objective of this study is to investigate the causal relationship between PSO and depression using a two-sample Mendelian randomization (MR) approach.

Methods

Summary statistics from multiple genomewide association studies (GWAS) in European populations were analyzed using Z-scores to assess correlations between PSO and depression. MR design, which uses genetic variants as instrumental variables, was employed to examine causality, with primary analyses conducted using the inverse variance weighted (IVW) method. Additional MR Steiger (testing causal direction) and colocalization (identifying shared genetic variants) analyses were performed to verify the robustness of genetic variants associated with both conditions.

Results

The results revealed a positive relationship, with genetic susceptibility to PSO correlating to a higher depression risk (OR: 1.348, 95% CI: 1.141–1.592, p = 0.004). This finding was consistently supported by multiple MR methods, including MR-Egger and MR-PRESSO. The MR Steiger method supported a causal link, while colocalization identified a shared causal variant (rs12189871) between the two conditions.

Conclusion

These findings suggest a potential causal relationship between PSO and depression, highlighting the need for depression screening in PSO patients.

Purpose

Depression is a frequent comorbidity in individuals with chronic obstructive pulmonary disease (COPD) and is associated with adverse clinical outcomes, including an increased risk of exacerbations and death. This study aimed to describe national trends in the prevalence of depression among COPD hospitalizations in Spain, from 2016 to 2023, to assess sex-related differences, to evaluate its impact on hospital outcomes, and to determine how the COVID-19 pandemic modified these associations.

Patients and Methods

We carried out a population-based cohort study using data from the Spanish National Hospital Discharge Database (RAE-CMBD). All admissions of patients aged 40 years or older with a diagnosis of COPD were included. Depression was identified through International Classification of Diseases, Tenth Revision (ICD-10) codes. We analyzed temporal changes and sex-stratified patterns and factors independently associated with in-hospital mortality (IHM).

Results

During the study period, 2,545,151 hospitalizations with COPD were recorded nationwide, of which 106,337 (4.17%) included a diagnosis of depression. The prevalence rose progressively, remaining consistently higher in women. Female patients exhibited greater frequencies of anxiety, obesity, and personality disorders, whereas men showed higher rates of alcohol (17.9% vs. 6.1%; p < 0.001) and tobacco use (58.5% vs. 43.4%; p < 0.001) and a greater proportion of suicide attempts (0.11% vs. 0.06%; p < 0.001). Men were also older (74.1 vs. 73.3 years; p < 0.001) and had higher Charlson Comorbidity Index (CCI) values (1.31 vs. 1.01; p < 0.001). ICU admissions (5.0% vs. 4.6%; p < 0.001) and IHM (7.8% vs. 5.6%; p < 0.001) were more common in men. In multivariable models, older age and greater comorbidity burden were the strongest predictors of IHM in both sexes. COVID-19 infection and dementia increased the odds of death, whereas anxiety and obesity were inversely associated with mortality.

Conclusion

Between 2016 and 2023, depression among COPD hospitalizations in Spain increased steadily, with clear sex-based differences in prevalence, clinical profile, and hospital outcomes. The results emphasize the need to integrate mental health screening and management into routine COPD care.

Background

Patients with critical illnesses frequently experience tachyarrhythmias as a result of excessive sympathetic hyperactivity and high levels of inflammatory cytokines. Ultrashort-acting β-blockers like landiolol are commonly utilized in intensive care units (ICUs) because of their unique features.

Methods

Electronic databases (Cochrane Library, PubMed, Web of Science, and Embase) were searched for randomized controlled trials (RCTs) from inception to September 1, 2025 assessing the efficacy of landiolol in critically ill patients. The primary outcome was new-onset arrhythmias. All-cause mortality, heart rate (HR), length of ICU and hospital stay, and need for norepinephrine following landiolol therapy were the secondary outcomes. Trial sequential analysis (TSA) was performed to further evaluate the robustness of findings. The quality of evidence was evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method.

Results

Nine studies totaling 836 patients were included. Overall, our meta-analysis exhibited that landiolol might considerably lower the incidence of new-onset arrhythmias when compared to the control treatment (9 studies [836 patients]; odds ratio [OR], 0.44; 95% confidence interval [CI] 0.23 to 0.82; p = 0.01), and TSA agreed with this finding. We also observed that landiolol could reduce HR (mean difference [MD], −6.41, 95% CI, −8.63 to −4.18, p < 0.001). However, there was no considerable decrease in requirement of norepinephrine dose (MD, 0.04, 95% CI, −0.01 to 0.09, p = 0.11), length of hospital stay (MD, −0.87, 95% CI, −7.40 to 5.65, p = 0.79), or all-cause mortality (OR, 1.10, 95% CI, 0.62 to 1.96, p = 0.75). Additionally, the length of ICU stay in the landiolol group was longer than that in the control group (MD, 0.19; 95% CI 0.01 to 0.37; p = 0.03).

Conclusion

New-onset arrhythmias and HR were significantly reduced in critical illness patients receiving landiolol.