International Journal of General Medicine最新文献

Background: The length of intensive care unit (ICU) stay is an important index reflects the prognosis of severe pneumonia (SP) combined with respiratory failure (RF). Blood transfusion can alleviate tissue hypoxia in ICU patients, but blood transfusion can affect the prognosis of patients. The objective of this study was to evaluate the effect of immune-nutritional indices (pan-immune inflammation value (PIV), systemic immune inflammation index (SII), system inflammation response index (SIRI), neutrophil-to-albumin ratio (NAR), and prognostic nutritional index (PNI)) on length of stay in patients treated with and without transfusion.

Methods: Total of 3425 pneumonia combined with respiratory failure patients were retrospectively analyzed. Medical records (age, gender, body mass index, history of smoking, history of alcohol drinking, hypertension, diabetes mellitus, lung diseases, invasive mechanical ventilation, blood transfusion, APACHE II score, and laboratory test results) were collected, the relationship between this information and prolonged ICU stay was analyzed.

Results: The average length of ICU stay was 5.32 (2.94, 9.36) days, there were 2521 (73.6%) patients with non-prolonged ICU stay (<9 days) and 904 (26.4%) with prolonged ICU stay (≥9 days). The levels of PIV, SII, and SIRI in prolonged ICU stay patients were higher than those of non-prolonged ICU stay in patients with and without blood transfusion, respectively. Multivariate logistic regression analysis showed that high SII (odds ratio (OR): 2.115, 95% confidence interval (CI): 1.428-3.131, p<0.001), and invasive mechanical ventilation (OR: 10.205, 95% CI: 5.623-18.524, p<0.001) were associated with prolonged ICU stay in patients with blood transfusion; and low PNI (OR: 1.378, 95% CI: 1.073-1.769, p=0.012), invasive mechanical ventilation (OR: 3.566, 95% CI: 2.666-4.771, p<0.001) were associated with prolonged ICU stay in patients without blood transfusion.

Conclusion: High SII level and invasive mechanical ventilation were independently associated with prolonged ICU stay in patients treated with blood transfusion; and low PNI level and invasive mechanical ventilation were independently associated with prolonged ICU stay in patients without blood transfusion.

Purpose: Related studies have pointed out that cell adhesion may play an important role for treating Polycystic Ovary Syndrome (PCOS). This study aimed to identify and analyze the biomarkers associated with cell adhesion-related genes (CRGs) for treating PCOS and their biological mechanisms.

Patients and methods: In this study, GSE80432 was used to identify differentially expressed genes (DEGs) (PCOS vs control group) through differential expression analysis. Then, the DEGs were overlapped with 1531 CRGs to obtain the cross - genes. Subsequently, the Support Vector Machine-Recursive Feature Elimination combined with the least absolute shrinkage and selection operator was utilized to obtain candidate genes, and the genes with AUC greater than 0.7 and consistent expression trends in the two datasets were defined as biomarkers. Finally, a nomogram was constructed, and enrichment analysis, regulatory network, drug prediction, the association between biomarkers and PCOS, and reverse transcription quantitative PCR (RT-qPCR) were carried out respectively.

Results: A total of 10 cross-genes were identified, and 2 biomarkers (DSG2 and TH11) were screened out from them. RT-qPCR analysis showed that the expression of THBS1 was increased in PCOS samples, while there was no significant difference in DSG2. In addition, enrichment analysis indicated that both DSG2 and THBS1 were enriched in the B-cell receptor signaling pathway. Then, based on these two biomarkers, lncRNA-miRNA-mRNA (81 nodes and 135 edges) and TFs biomarker networks (38 nodes and 38 edges), such as MIR17HG'-has-miR-7-5p'-THBS1, TFDP1-DSG2, were constructed respectively. By predicting drugs targeting biomarkers, 61 drugs were predicted to target DSG2, while 133 drugs were predicted to target THBS1. Moreover, a stronger association between THBS1 and PCOS was detected (inference score = 27.15).

Conclusion: In this study, 2 biomarkers (DSG2 and THBS1) were identified, providing a potential theoretical basis for PCOS treatment.

Objective: This study aimed to evaluate the relationship between serum fibroblast growth factor 23 (FGF23) and dipeptidyl peptidase 4 (DPP4) levels, and the severity and prognosis of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD).

Methods: A total of 113 patients with both T2DM and CHD (T2DM+CHD group) and 74 patients with T2DM without CHD (T2DM-only group) who underwent coronary angiography between January 2021 and June 2023 were enrolled. Based on Gensini scores, the T2DM+CHD group was further divided into three subgroups: mild (n=38), moderate (n=46), and severe (n=29) lesions. Serum levels of FGF23 and DPP4 were determined using enzyme-linked immunosorbent assay (ELISA). Correlation analysis and logistic regression were conducted to assess the association between biomarker levels and both disease severity and prognosis. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of these biomarkers.

Results: Serum levels of FGF23 and DPP4 were significantly higher in the T2DM+CHD group than in the T2DM-only group (P<0.05), and increased progressively with the severity of CAD (P<0.05). A positive correlation was observed between the levels of these biomarkers and CAD severity (r=0.714 for FGF23; r=0.437 for DPP4; P<0.05). Patients with poor prognosis exhibited increased left atrial diameter (LAD) and biomarker levels, along with reduced left ventricular ejection fraction (LVEF) (P<0.05). Multivariate analysis identified increased LAD, moderate-to-severe CAD, and elevated levels of FGF23/DPP4 as independent risk factors for poor prognosis, while higher LVEF served as a protective factor (P<0.05). Moreover, a combined predictive model using both FGF23 and DPP4 demonstrated superior diagnostic performance (AUC=0.921; P<0.05) compared to the use of each biomarker individually.

Conclusion: Elevated serum levels of FGF23 and DPP4 are significantly associated with both the severity and poor prognosis of CAD in patients with T2DM and CHD. These findings suggest that FGF23 and DPP4 may serve as valuable biomarkers for risk stratification and clinical decision-making in this patient population.

Background: Neonatal white-centered retinal hemorrhage (NWCRH) is characterized by white or yellowish-white central spots within retinal hemorrhages, resembling Roth spots. Elucidating the etiological factors may enhance preventive strategies and deepen understanding of NWCRH. This study examined correlations between NWCRH and perinatal maternal conditions, delivery factors, and neonatal characteristics.

Methods: From January 2013 to December 2015, neonates delivered at the Department of Obstetrics at Zhongshan People's Hospital underwent RetCam III fundus screening within four days postpartum were enrolled. Demographic and clinical information of neonates and mothers were collected, and univariate and multivariate logistics regression analyses were used to explore the influencing factors of NWCRH and its severity.

Findings: WCRH was identified in 574 out of 3606 neonates (15.92%), with retinal hemorrhage detected in 868 cases (24.07%). For Grade I retinal hemorrhage, 441 cases were documented, with WCRH present in 169 cases (38.32%). For Grade II retinal hemorrhage, 239 cases were recorded, with 223 (93.31%) exhibiting WCRH. In Grade III retinal hemorrhage, 182 out of 188 cases (96.81%) displayed WCRH. In the multivariate analysis of Groups II and III, neonatal blood type B was found to be statistically significant for Roth spot formation. In the univariate analysis of maternal factors, gestational diabetes and hypertension were associated with an increased risk of Roth spots.

Conclusion: This study identified key risk factors for the formation of neonatal Roth spots, including mode of delivery, umbilical cord around the neck, and blood group B. Given its potential long-term effects on vision, early screening and preventive measures are recommended. For neonates with a history of umbilical cord around the neck and rapid delivery, fundus screening can facilitate timely intervention and improve neonatal eye health.

Objective: Epithelial cell adhesion molecule (EpCAM) and glypican-3 (GPC3) are associated with a poor survival rate in hepatocellular carcinoma (HCC). Predicting aggressive HCC non-invasively should be investigated using preoperative gadoxetic acid-enhanced MRI and clinical characteristics.

Methods: This retrospective study examined 134 patients with confirmed cases of HCC who had undergone gadolinic acid-enhanced MRI before surgery. The data were collected between November 2017 and December 2021. Significant parameters were subjected to quantitative analysis and univariate testing. HCC characterized by poor differentiation and progenitor traits was identified by the positive expression of EpCAM and/or GPC3. Independent influencing variables for different subtypes of invasive HCC were identified by multivariate analysis. The diagnostic performance of variables was measured using ROC analysis.

Results: Cases with EpCAM and GPC3 expression were classified into four subtypes based on IHC staining. Among them, EpCAM+/GPC3+ HCC had the highest risk. Significant predictors of HCC expressing aggressive markers included tumor size (p = 0.01), AFP level (p = 0.008), MVI (p = 0.003), satellite nodule (p = 0.002), proliferative pattern (p = 0.04), and arterial peripheral enhancement (p = 0.03). By integrating all of these relevant variables, the resulting diagnostic accuracy was enhanced to 0.914 (95% CI 0.830-0.960) with a sensitivity of 0.964 (95% CI 0.922-1.000) and a specificity of 0.833 (95% CI 0.365-0.911).

Conclusion: The research demonstrated that combining biochemical and radiological data allows for accurate prognosis and patient management, along with non-invasive detection of aggressive HCC with high accuracy.

Background: Plaque psoriasis is a chronic, recurrent, immune-mediated inflammatory skin disease. This study aimed to investigate effectiveness of interleukin (IL)-17A inhibitor treatment and effectiveness after treatment interruption in plaque psoriasis patients and analyze the related factors.

Methods: This study retrospectively collected clinical characteristics and related treatment status of plaque psoriasis patients treated with IL-17A inhibitors, and evaluated the treatment effectiveness, reasons for treatment interruption, effectiveness after treatment interruption, and risk factors affecting treatment effectiveness.

Results: This study ultimately included 106 patients with plaque psoriasis, including 61 males (57.55%) and 45 females (42.45%), aged 41.0 (31.0-54.0) years and with a disease duration of 12.0 (8.0-20.0) months. Among them, 71 cases (67%) achieved PASI90 after receiving IL-17A inhibitor treatment, and 35 cases (33.02%) achieved PASI75. A total of 50 patients (50/106, 47.17%) interrupted treatment, 23 patients (23/50, 46%) maintained a therapeutic effect of PASI90 or above, and 27 patients (27/50, 54%) had a therapeutic effect lower than PASI75, with median time of treatment interruption of 1.0 (1.0-3.5) months. Univariate analysis findings showed that duration of IL-17A inhibitor treatment interruption and reasons for interruption had significant statistical significance on treatment effectiveness (all P<0.05). In multivariate analysis, treatment interruption (OR=7.154, 95% CI: 2.528-20.24) and reasons such as stress/anxiety (OR: 14.889, 95% CI: 1.160-23.480) were risk factors affecting treatment effectiveness.

Conclusion: Interleukin (IL)-17A inhibitor treatment interruption plays critical effects on the treatment of plaque psoriasis. Early and long-term adherence to IL-17A inhibitor treatment can control the course of the disease and improve the long-term health of psoriasis patients.

Purpose: This study aimed to evaluate reliability and validity of the Chinese version of the Impact on Participation and Autonomy Questionnaire (IPA-C) for people with stroke.

Methods: The English version of the IPA (IPA-E) was translated into the Chinese version using the protocol for linguistic validation of patient-reported outcome instruments. In total, 421 patients diagnosed with first-ever stroke participated in this study. A cross-sectional study with a test-retest subsample was conducted. Three reliability evaluation methods were used to assess the reliability of IPA-C. Internal consistency reliability was evaluated by calculating the Cronbach's alpha and split-half reliability. Split-half reliability was recorded using the Guttman split-half coefficient. Item reliability was assessed using test-retest reliability. Validity content and construct validity were used to assess the IPA-C validity.

Results: IPA-E consists of five domains: autonomy indoors, family role, autonomy outdoors, social life and relationships, and work and education opportunities. In this study, the domain 'work and educational opportunities' and the item 'My chances of having an intimate relationship are' were excluded from the analysis. Because they were not applicable to most participants. So, the first part (IPA-C-I), contained 25 items across 4 subscales (Autonomy Indoors, Family Role, Autonomy Outdoors, Social Life and Relationships). The second part (IPA-C-II), the experience of problems, contains further 7 questions, which are 7 domains (mobility, self-care, activities, economic management, leisure, social life and relationships, and helping others). The Cronbach's alphas of the IPA-C-I was 0.962, IPA-C-II was 0.823, and 0.968 (autonomy indoors), 0.966 (Family role), 0.870 (Autonomy outdoors), 0.913 (Social life and relationships). The Guttman Split-Half Coefficient of the IPA-C-I was 0.792. Item reliabilities estimated from the test-retest ranged from 0.915 to 0.975. The overall content validity index was 0.949. Four factors emerged from the 25 items, accounting for 82.918% of the variance with item loadings above 0.40.

Conclusion: The IPA-C can be considered a valid and reliable instrument for assessing participation and autonomy in patients with stroke. Later, researchers could choose IPA-C as a good tool to evaluate perceived participation and problems in stroke patients. However, in patients with a variety of diagnoses and other cultural backgrounds, further assessment of psychometric properties is needed.

The burden of sarcopenia in India continues to be of significant concern. Its diagnosis is challenging due to the lack of standardized cutoffs for assessing muscle strength, quantity, and function among Indians. This consensus aims to identify features of sarcopenia in Indians and provide culturally relevant recommendations for its management. An expert panel from diverse medical specialties across India arrived at a consensus using the modified Delphi method. The panel recommended that a baseline handgrip strength (HGS) cutoff value of <27.5 kg in males and 18.0 kg in females be defined as low muscle strength for the Indian population. All patients with comorbidities should be screened for sarcopenia. In people with sarcopenia, resistance exercise and nutrition with specialized nutrients such as protein, beta-hydroxy-beta-methylbutyrate (HMB), and micronutrients for at least 3 months were recommended as key interventions.

Objective: Exploring novel relevant factors associated with recurrent ischemic stroke.

Methods: This is a retrospective study, patients were divided into first-ever ischemic stroke group and recurrent ischemic stroke groups. We conducted a comparative analysis of baseline data between the two groups. Multifactorial logistic regression analysis was performed to identify factors associated with recurrent ischemic stroke. Grouped according to butyryl cholinesterase levels, to elucidate the relationship between butyryl cholinesterase levels and stroke recurrence.

Results: A total of 2029 patients were included, with 1174 in the first-ever ischemic stroke group and 855 in the recurrent ischemic stroke group. Age, hypertension, diabetes, alanine aminotransferase, and lipoprotein(a) were identified as risk factors for recurrent ischemic stroke (ALL p<0.05). Erythrocyte count, butyryl cholinesterase, low-density lipoprotein, and non-atherosclerotic type of large arteries were found to be negative associated with recurrent ischemic stroke (ALL p<0.05). Subgroup analyses indicated that butyryl cholinesterase levels were significantly negatively associated with recurrent ischemic stroke in males (OR=0.814, p<0.001, 95% CI: 0.761 ~ 0.871), especially under 60 years (OR=0.781, p<0.001, 95% CI: 0.708 ~ 0.862). After adjusting for multifactorial regression analyses, the recurrent rate in the lowest quartile of butyryl cholinesterase levels was 2.281 times that of the highest quartile (OR=2.281, p<0.05, 95% CI: 1.318 ~ 3.948).

Conclusion: Age, hypertension, diabetes, alanine aminotransferase, and lipoprotein(a) are independent risk factors for the recurrence of ischemic stroke. The inverse association between butyryl cholinesterase levels and stroke recurrence suggests butyryl cholinesterase may serve as a potential target for therapeutic intervention to improve the prognosis of ischemic stroke.

Background: The conditional survival rate is a dynamic estimation method that changes over time. Our research aimed to assesses the conditional disease-specific survival rate and conditional recurrence-free survival rate among patients who undergoing radical gastrectomy for gastric cancer after neoadjuvant chemotherapy.

Methods: This study included 260 patients who undergoing gastrectomy with D2 lymph node dissection after preoperative chemotherapy. The 2-year conditional disease-specific survival rate (CDS2) indicates that patients who have survived for x years after initial treatment will survive for another 2 years, calculated as follows: CDS2 = Disease-Specific Survival (DSS) (x + 2)/ Disease-Specific Survival (x). Similarly, the 2-year conditional recurrence free survival rate (CRFS2) formula is as follows: CRFS2 = Recurrence-Free Survival (RFS) (x + 2)/ Recurrence-Free Survival (x). Cox proportional risk regression analysis was used to identify factors related to DSS and RFS.

Results: The 1-, 3-, and 5-year actuarial DSS rates were 82%, 57.6%, and 50.7%, respectively. According to conditional disease-specific survival rate (CDS) estimation, the CDS2 of patients who have already survived for 1 year, 3 years, and 5 years is 70.2%, 88%, and 93.3%, respectively. The RFS actuarial rates for 1 year, 3 years, and 5 years were 73.1%, 52.5%, and 46.4%, respectively. According to conditional recurrence free survival rate (CRFS) estimation, the CRFS2 of patients who survived for 1 year, 3 years, and 5 years without recurrence was 71.8%, 88.4%, and 100%, respectively. Lymph vessel infiltration, ypN stage, tumor differentiation, TRG grading, and surgical type are risk factors for DSS and RFS.

Conclusion: The CDS and CRFS of patients undergoing gastrectomy with D2 lymph node dissection after neoadjuvant chemotherapy demonstrate gradual increase over time. Patients with adverse tumor characteristics exhibited the most substantial improvement in both CDS and CRFS.