International Journal of General Medicine最新文献

Objective: This study aimed to analyze the correlation between serum levels of Procalcitonin (PCT) and C-reactive protein (CRP) and the occurrence and severity of Bronchopulmonary Dysplasia (BPD) in Extremely Low Birth Weight (ELBW) and Very Low Birth Weight (VLBW) neonates, and to identify associated risk factors.

Methods: A retrospective analysis was conducted on 213 ELBW/VLBW neonates admitted between January 2021 and January 2024. According to BPD diagnosis, they were categorized into a control group (n=62, without BPD) and an observation group (n=151, with BPD). The observation group was further stratified by severity into mild (n=71), moderate (n=46), and severe (n=34) BPD. Serum PCT and CRP levels were compared across groups. The correlation between these biomarkers and BPD severity was analyzed, and risk factors for BPD were investigated.

Results: PCT and CRP levels were significantly higher in the observation group than in the control group (P<0.05). A significant increasing trend in both PCT and CRP levels was observed with worsening BPD severity (P<0.05). Spearman analysis confirmed positive correlations between BPD severity and PCT (r=0.354) and CRP (r=0.472) levels (P<0.05). Multivariate logistic regression identified intrauterine infection, gestational age <28 weeks, assisted ventilation >2 weeks, infectious pneumonia, and FiO₂ >40% as independent risk factors for BPD (P<0.05).

Conclusion: In this retrospective study, elevated serum PCT and CRP levels were positively associated with the severity of BPD in ELBW/VLBW neonates. The identified risk factors, including intrauterine infection, gestational age <28 weeks, prolonged assisted ventilation, infectious pneumonia, and high FiO₂, are independently associated with BPD. These findings suggest that monitoring these biomarkers and risk factors may warrant intensified clinical attention.

Purpose: Heart rate recovery, measured during exercise testing, is an important marker of cardiovascular function. The Heart Rate Recovery Index, a recently proposed parameter derived from heart rate recovery, has shown predictive outcomes in patients undergoing cardiac resynchronization therapy. However, its role in heart failure identification remains unexplored. This study aimed to assess differences in the heart rate recovery index between patients with heart failure and individuals without heart failure undergoing exercise testing.

Patients and methods: 194 patients (mean age 58.3 ± 11.7 years; 57.7% men) with heart failure or other cardiovascular conditions requiring exercise testing were prospectively enrolled and underwent cycle ergometer testing. The index was calculated as the ratio between heart rate acceleration and deceleration time during exercise testing. Differentiation ability was assessed using receiver operating characteristic curve analysis. Subgroup and two-step cluster analyses examined heart rate recovery index differences across heart failure phenotypes and severity.

Results: Heart Rate Recovery Index was significantly lower in heart failure patients compared to those without (1.87 ± 0.68 vs 2.65 ± 1.08, p < 0.01). An optimal HRRI cut-off of 2.225 identified heart failure, while a lower cut-off of 1.555 differentiated patients with mildly reduced and reduced ejection fraction from those with preserved ejection fraction (AUC = 0.647). The index correlated significantly with systolic and diastolic parameters on echocardiography. In multivariable analysis, it remained an important predictor of heart failure (p < 0.01). Cluster analysis identified four phenotypic groups, with the index helping to differentiate early or less severe from advanced heart failure, according to the ejection fraction.

Conclusion: HRRI is a simple parameter that distinguishes the heart failure status and provides discrimination across its phenotypes. Its strong correlation with echocardiographic and functional markers supports its potential role in the assessment and characterization of heart failure.

Objective: Mast cells drive allergic diseases (asthma, rhinitis, dermatitis) via degranulation and pro-inflammatory mediator release. This review explores acupuncture's role in modulating mast cells to alleviate allergic symptoms.

Methods: We screened PubMed and Embase databases from January 2010 to January 2025 to search for published studies. The search keywords used are as follows: ["acupuncture" or "electroacupuncture"], ["allergic disease" or "asthma" or "allergic rhinitis" or "dermatitis" or "urticaria"], ["mast cell"]. 365 peer-reviewed studies on human/animal models were included, and articles that did not meet the requirements were excluded.

Results: Acupuncture inhibited mast cell degranulation, reducing histamine and IgE levels. It downregulated pro-inflammatory cytokines (TNF-α, IL-4, IL-5, IL-13) and upregulated anti-inflammatory IL-10, via suppressing NF-κB, MAPK (p38, ERK), and TLR4/MyD88 pathways. Clinically, it improved asthma (FEV1/PEF elevation), allergic rhinitis, and atopic dermatitis. Preclinically, it reduced eosinophil infiltration and inhibited NLRP3/caspase-1-mediated pyroptosis, further mitigating inflammation.

Conclusion: Acupuncture alleviates allergic disorders by targeting mast cells and inflammatory cascades, supporting its potential as a safe, effective therapeutic option.

Background: Type 2 Diabetes Mellitus (T2DM) is associated with chronic hyperglycemia that contributes to oxidative stress and alterations in hemostatic and hematological pathways, potentially leading to measurable changes in routine blood parameters. These biomarkers may provide early indications of metabolic or vascular complications. This study investigates the association between glycated hemoglobin (HbA1c) levels and hematological and hemostatic abnormalities in Saudi adults with T2DM.

Methods: This retrospective study analyzed laboratory records of 651 adult patients categorized into four glycemic groups based on HbA1c levels: normal (<5.7%), prediabetes (5.7-6.4%), controlled diabetes (6.5-7.9%), and uncontrolled diabetes (≥8.0%). Hemostatic parameters and red and white blood cell indices were compared across groups. Multiple regression analysis was performed to evaluate associations between demographic and clinical characteristics and hematological outcomes.

Results: Statistically significant differences in platelet counts were observed between the prediabetes group and both the controlled and uncontrolled diabetes groups. Red and white blood cell counts were significantly higher in the controlled and uncontrolled groups than in the normal and prediabetes groups. Regression analysis further identified sex, age, and comorbidity as key predictors of several hematological markers.

Conclusion: This study demonstrates significant hematological variations across HbA1c-defined glycemic groups, indicating that worsening glycemic control is associated with measurable changes in platelet counts and red and white blood cell parameters. These findings suggest that routine hematological profiles may serve as supportive indicators for identifying patients at increased risk of glycemic deterioration or hematologic complications, offering potential value in early clinical assessment and monitoring of T2DM.

In the pathogenesis of cardiovascular diseases (CVDs), ferroptosis is increasingly implicated as a key mechanism. This iron-driven, regulated cell death is characterized by the accumulation of lipid peroxides and a deficiency in glutathione. This comprehensive review delineates the molecular underpinnings of ferroptosis-encompassing dysregulated iron metabolism, GPX4 inactivation, and lipid peroxidation-and elucidates its pivotal role in a spectrum of cardiac pathologies. Notably, ferroptosis contributes to oxidative stress, mitochondrial dysfunction, and inflammatory responses, accelerating myocardial damage and functional decline. Emerging evidence indicates that several drugs targeting the ferroptosis pathway including iron chelators, antioxidants, and small-molecule inhibitors such as ferrostatin-1 and liproxstatin-1, demonstrate cardioprotective effects in preclinical models. However, translational challenges remain, including context-dependent roles of regulators like p53 and AMPK, and the need for organelle-specific interventions. This review synthesizes current knowledge and proposes ferroptosis as a promising target for precision medicine in CVDs, urging further research into biomarkers and combination therapies to mitigate the global burden of cardiovascular morbidity and mortality.

Purpose: This study aimed to determine the incidence, clinician misdiagnosis rate, radiologist missed-diagnosis rate, and lesion distribution of isolated medial longitudinal fasciculus infarction (IMLFI).

Patients and methods: A retrospective analysis was conducted on 14,385 patients hospitalized with ischemic stroke at the General Hospital of Ningxia Medical University between 2020 and 2023. The objectives were to estimate the incidence of IMLFI, assess clinician misdiagnosis and radiologist missed-diagnosis rates based on initial clinical and imaging reports, and characterize the anatomical distribution of lesions.

Results: IMLFI accounted for 0.17% (24/14,385) of all ischemic stroke cases. Among these patients, 70.83% (17/24) were male, with a mean age of 60.88 ± 10.25 years. Nineteen patients presented with internuclear ophthalmoplegia (INO). Most cases (75.00%, 18/24) were initially evaluated in the Emergency Department by neurologists, while the remaining 25.00% (6/24) were first assessed in the Department of Ophthalmology. The overall initial clinical misdiagnosis rate was 41.67% (10/24), with the most frequent misdiagnoses being oculomotor nerve palsy (50.00%) and peripheral vertigo (40.00%). On initial radiological evaluation, diffusion-weighted imaging (DWI) lesions were missed in 37.50% (9/24) of cases. Anatomically, lesions were distributed in the caudal midbrain (20.83%, 5/24), the midbrain-pontine junction (4.17%, 1/24), and the rostral pons (45.83%, 11/24).

Conclusion: IMLFI is a rare clinical entity with a high risk of both clinical misdiagnosis and radiological oversight. Lesions are predominantly located from the caudal midbrain to the rostral pons, highlighting the need for increased clinical and radiological awareness of this condition.

Background: Female infertility is a distressing event to couples, and it is mainly caused by ovulatory disorders, pituitary gland dysfunction, fallopian tube blockage, and uterine abnormalities. This study aimed to determine the prevalence, risk factors, and types of female infertility among patients visiting Orotta National Referral Maternity Hospital.

Methodology: This analytic cross-sectional hospital-based study was conducted among patients at Orotta National Referral Maternity Hospital. Data were collected using an interviewer-administered questionnaire. Patients were investigated with hormone analysis and hysterosalpingography. Data was analyzed by SPSS version 26, bivariable and multivariable analysis, in which a p-value < 0.05 was considered significant.

Results: The prevalence of infertility was reported as 11.6% and 80.8% had primary infertility. Besides, bilaterally blocked tubes were reported in 4.9%. Maternal age greater than 35 years (AOR: 7.99; 95% CI: 1.20-53.25, p<0.03) showed a significant association with secondary type of infertility. Besides, patients from the Gash Barka region (AOR: 2.55; 95% CI: 1.07-6.07; p<0.03), and menstrual disorder (AOR: 20.35; 95% CI: 7.35-56.39; p<0.001) were found as risk factors of ovulatory dysfunction, but body mass index of 18.5-25 (AOR: 0.19; 95% CI: 0.04-0.88; p<0.03) were protective. Furthermore, urban residence (AOR: 4.1; 95% CI: 1.71-9.67; p<0.001) and previous pelvic inflammatory diseases (AOR: 2.96; 95% CI: 1.03-8.46; p<0.04) were associated with higher rate of female tubal infertility.

Conclusion: Primary infertility was predominant, and maternal age > 35 years was associated with secondary infertility. Besides, abnormal body mass index and irregularity of menses were related to increased risk for ovarian infertility. In addition, urban residence and previous pelvic inflammatory diseases were risk factors for female tubal infertility. Enhancing community awareness about the risk factors of infertility and early treatment of pelvic inflammatory diseases is highly recommended. Determining the risk factors for female infertility in the Eritrean context is essential to guide clinicians' management and to review the existing infertility guidelines and treatment modalities for further policy implementation. This result has clinical significance of developing guidelines on women's health.

Background: Gastric cancer (GC) remains a major cause of cancer related mortality worldwide. Tumor mechanics, reflecting the physical and mechanical properties that influence tumor cell behavior and the tumor microenvironment (TME), play important roles in cancer progression. However, the prognostic relevance of tumor mechanics-related genes (MRGs) in GC remains unclear.

Methods: GC datasets from TCGA and GEO were analyzed to identify differentially expressed genes (DEGs). WGCNA was conducted to identify MRGs-related modules. Univariate Cox regression and three machine learning algorithms were applied to screen prognostic genes and construct a prognostic model. Pan-cancer analysis, immune infiltration, tumor mutation burden (TMB), immunophenotypic score (IPS), and somatic mutation analyses were performed to explore TME characteristics. Additionally, drug sensitivity and ceRNA network analyses were conducted. Finally, the prognostic genes were verified using RT-PCR.

Results: Eight mechanics-related genes (SERPINE1, CYP1B1, LOX, HEYL, VCAN, IGFBP7, TWIST2, and ATP1B2) were identified through integrated computational analysis. The resulting model demonstrated prognostic potential for 2-, 3-, and 5-year survival prediction. High-risk patients exhibited increased immunosuppressive infiltration compared with low-risk patients. Drug sensitivity analysis revealed significant differences in therapeutic responses across risk groups. Finally, the differential expression of several prognostic genes was preliminarily confirmed by RT-PCR in limited tissue samples.

Conclusion: This study identifies eight tumor mechanics-related genes as prognostic biomarkers for GC through comprehensive bioinformatic analyses. These findings may provide preliminary insights into prognostic assessment and targeted therapy for GC, although further validation with larger sample sizes is required to substantiate their clinical applicability.

Purpose: This study aimed to investigate the impact of shift characteristics, resident workload, and physician attributes on diagnostic expenditures in low-acuity patients (green triage category) emergency department (ED) patients.

Methods: A retrospective cross-sectional analysis was conducted in a high-volume tertiary ED over one month, including 22,427 green-triage visits managed by 71 emergency medicine residents. Resident characteristics (age, gender, seniority, shift group, post-night shift status), patient demographics, and diagnostic expenditures (laboratory, imaging, electronic medication orders, total cost) were extracted from the hospital information system. Non-parametric tests were used for group comparisons given non-normal distribution patterns, and cost determinants were analyzed using a Gamma generalized linear model with a log-link function.

Results: Diagnostic expenditures demonstrated significant variability across physician and patient characteristics. Female residents were associated with higher laboratory (1.27 vs 0.87 USD; p<0.001), imaging (1.35 vs 1.01 USD; p<0.001), and medication-order costs (p<0.001). Compared with junior residents, mid-level trainees generated the highest total expenditures, whereas senior residents exhibited a cost-attenuating effect (exp(β)=0.74). Unadjusted analyses indicated greater total spending during night shifts (2.8 USD vs 2.39-2.43 USD; p=0.011); however, after adjustment for resident- and patient-level covariates, night-shift status was associated with lower expenditures (exp(β)=0.76). Post-night-shift status independently correlated with reduced laboratory and medication-order costs. Resident workload showed a strong inverse association with expenditures, with increasing daily patient volume linked to lower total diagnostic costs (rho=-0.226; p<0.001). Among patient factors, advancing age increased total cost by approximately 6% per year (exp(β)=1.06). Repeat ED utilization emerged as the most powerful cost determinant, with each additional prior visit associated with more than a threefold increase in diagnostic spending (exp(β)>3; p<0.001). Female patients consistently incurred higher costs across all categories (p<0.001).

Conclusion: Diagnostic spending in low-acuity ED encounters is shaped by both clinical and operational dynamics. Resident workload, seniority level, and gender independently influence cost patterns, while patient age and repeat admissions are strong drivers of increased expenditures. These findings highlight several potentially modifiable determinants-particularly workload distribution and trainee supervision-that may support more cost-conscious diagnostic practices in busy emergency departments.

Background: To study the correlation analysis between serum procalcitonin (PCT) and Ankylosing Spondylitis Disease Activity Score (ASDAS) in ankylosing spondylitis (AS) patients with hip involvement.

Methods: This prospective study collected 100 r-axSpA patients and 52 healthy controls. The BASRI-hip score was used to categorize r-axSpA patients into groups with no hip involvement (BASRI-hip=0, 1), mild involvement (BASRI-hip=2), and moderate-to-severe involvement (BASRI-hip=3, 4). Clinical characteristics of the groups were compared. The correlation between PCT, ASDAS, and BASRI-hip was assessed using the Spearman correlation analysis. ROC (Receiver Operating Characteristic) curves were produced to determine the area under the curve (AUC) of PCT and ASDAS in predicting the occurrence of hip involvement and the degree of hip involvement. Factors influencing hip involvement in r-axSpA were analyzed by multifactorial logistic regression.

Results: PCT levels were higher in r-axSpA patients than in healthy controls (p < 0.001). PCT and ASDAS were higher in the group with moderate-to-severe r-axSpA hip involvement than in the group without involvement and the group with mild involvement, while mild involvement was higher than that in the group without involvement (p < 0.05). Spearman correlation showed a positive correlation between PCT, ASDAS, and the degree of hip involvement. The area under the ROC curve (AUC) of PCT, ASDAS were 0.723 and 0.754 in predicting hip involvement, respectively; and the AUC of the severity of hip involvement were 0.733 and 0.718, respectively. PCT (OR = 1.11, 95% CI 1.04-1.18, p < 0.01) and ASDAS (OR = 6.19, 95% CI 1.52-235.12, p = 0.011) were the risk factors for hip involvement.

Conclusion: PCT and ASDAS show positive correlation with hip involvement in r-axSpA, and have a certain predictive value to react to hip involvement in r-axSpA.