International Journal of General Medicine最新文献

Background: Major depressive disorder (MDD) is a complex neuropsychiatric condition characterized by persistent low mood, reduced voluntary activity, and cognitive impairment. Mitochondria, often described as cellular power plants, play a fundamental role in maintaining normal neuronal function and emotional stability. Mitochondrial homeostasis encompasses multiple dimensions, including oxidative stress, apoptosis, biogenesis, and dynamics. Accumulating evidence indicates significant impairment of neuronal mitochondrial function in depressive patients, manifested as aberrant energy metabolism, exacerbated oxidative stress, and disrupted mitochondrial dynamics.

Discussion: This narrative review synthesizes current evidence from both clinical and preclinical studies aims to explore the mechanisms by which acupuncture therapy restores mitochondrial homeostasis. Specifically, acupuncture ameliorates mitochondrial membrane permeability and structural integrity, enhances energy metabolism, attenuates damage induced by oxidative stress and mitophagy, and regulates mitochondrial dynamic processes (such as fission and fusion). These coordinated effects collectively constitute a key biological mechanism through which acupuncture exerts its antidepressant actions.

Conclusion: This study elucidates a mechanism-based therapeutic strategy, clarifying how acupuncture counteracts depression through multi-target regulation of mitochondrial function. These findings underscore the translational value of acupuncture in clinical treatment regimens for major depressive disorder, offering a theoretical framework.

Objective: To evaluate the prognostic value of the systemic immune-inflammation index (SII) and prognostic nutritional index (PNI) in predicting healing outcomes in patients with diabetic foot ulcers (DFUs) treated with Moist Exposed Burn Ointment (MeBo).

Methods: This retrospective study analyzed 273 DFU patients treated at the First Hospital of Qinhuangdao (January 2022-December 2024). Patients were categorized into complete healing (n=123) and non-healing (n=150) groups based on 12-week outcomes. Univariate and multivariate logistic regression analyses were conducted to identify predictors of healing. Receiver operating characteristic (ROC) curve analysis evaluated the discriminative abilities of SII and PNI.

Results: Compared to the non-healing group, the complete healing group exhibited significantly lower SII (1444.82±560.26 vs. 2979.88±1357.18, P<0.001) and higher PNI (38.17±5.20 vs. 31.65±5.54, P<0.001). ROC analysis indicated that SII had strong predictive ability (AUC=0.920, P<0.001; optimal threshold 1901.48), with 86.0% sensitivity and 83.7% specificity. PNI showed moderate predictive capacity (AUC=0.811, P<0.001). Notably, the combined model (SII+PNI) demonstrated superior predictive performance (AUC=0.940), achieving 89.3% sensitivity and 87.0% specificity.

Conclusion: SII and PNI are robust prognostic biomarkers for DFU patients treated with MeBo. Elevated SII acts as a risk factor for non-healing, while higher PNI serves as a protective factor. Integrating these indices into clinical practice may facilitate early risk assessment and guide therapeutic strategies to improve healing outcomes.

Purpose: To investigate the current status of return to work (RTW) and its influencing factors among young and middle-aged patients with Stanford Type A aortic dissection (STAAD) after cardiac surgery.

Methods: A cross-sectional study was conducted, encompassing a sample of 208 participants who underwent cardiac surgery for STAAD in Guangdong Provincial People's Hospital from July 2024 to August 2025. All participants completed a general information questionnaire, Return-to-Work Self-Efficacy Questionnaire, Hospital Anxiety and Depression Scale, Brief Illness Perception Questionnaire, and Social Support Rating Scale. Univariate analyses, binary logistic regression analyses, and a random forest model (RFM) were used to identify independent factors influencing RTW.

Results: A total of 208 participants completed the assessment, with only 82 (39.4%) returning to work. Binary logistic regression analysis revealed that being the primary household breadwinner (OR = 4.79, 95% CI: 1.70-13.51), performing non-manual work (OR = 3.96, 95% CI: 1.34-11.73), objective support (OR = 1.48, 95% CI: 1.03-2.11), subjective support (OR = 1.54, 95% CI: 1.04-2.30), return-to-work self-efficacy (OR = 10.68, 95% CI: 4.21-27.13) and NYHA functional class III (OR = 0.155, 95% CI: 0.03-0.77) were independent factors influencing RTW in young and middle-aged STAAD patients after cardiac surgery (all P < 0.05). The variable importance ranking for the RFM is as follows: return to work self-efficacy, objective support, subjective support, NYHA functional class, primary household breadwinner, and nature of work.

Conclusion: RTW rate among young and middle-aged STAAD patients following cardiac surgery remains low. Early identification of high-risk individuals is crucial for clinical care and rehabilitation planning. These findings provide a basis for developing targeted multidisciplinary rehabilitation strategies aimed at improving outcomes for vocational reintegration.

Purpose: It is well recognized that the proteomic plays a critical role in hepatocellular carcinoma (HCC) progression. However, the mechanisms of these proteins, particularly those regulated by phosphorylation, remain incompletely understood. This study aims to systematically characterize stage-specific molecular features of HCC to elucidate the key proteins and post-translational modification (PTM) networks that drive malignant transformation, and to identify candidate core biomarkers and therapeutic targets.

Patients and methods: Relative quantitative proteomics and TMT-labeled quantitative phosphoproteomics were used to identify hepatocellular carcinoma tissue (HCT), adjacent noncancerous tissue (ANT), and liver cirrhosis tissue (LCT). Functional enrichment analysis was performed with the Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO); upstream kinases were predicted using PhosphoSitePlus (PSP), and protein-protein interaction (PPI) data were downloaded from STRING for network scoring and downstream analyses.

Results: Integrated profiling revealed coordinated alterations in protein abundance and phosphorylation in HCT that were absent between ANT and LCT, indicating non-linear, multi-pathway convergence during tumorigenesis. A multi-tier scoring scheme prioritized 12 overlapping core driver proteins, including fructose-bisphosphate aldolase B (ALDOB), fumarylacetoacetase (FAH), argininosuccinate synthase (ASS1), cytochrome P450 2C8 (CYP2C8), and cytochrome P450 4A11 (CYP4A11). These proteins were significantly enriched in lipid, amino-acid, and carbohydrate metabolic pathways. Notably, glyceraldehyde-3-phosphate dehydrogenase (GAPDH) showed unchanged total protein abundance but a marked reduction in phosphorylation in HCT vs. LCT, indicating stage-specific regulation dominated by post-translational modification. Kinase prediction further suggested potential cross-pathway reprogramming of phosphorylation signaling.

Conclusion: The cytochrome P450 enzymes CYP4A11 and CYP2C8 (lipid metabolism), the amino-acid metabolism enzymes ASS1 and FAH, and the carbohydrate metabolism enzymes ALDOB and GAPDH were identified as key regulatory proteins in HCC progression. Aberrant phosphorylation of ALDOB and phosphorylation-dependent regulation of GAPDH, together with cross-pathway signaling rewiring, provide novel mechanistic insights into HCC pathogenesis.

Objective: Neutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR), Red-cell-distribution width (RDW) and Platelet-distribution width(PDW) have been proved to be related to the severity of a variety of diseases and poor prognosis. But their predictive value in neonatal pneumonia is still unknown. Therefore, this study explored the predictive value of NLR, PLR, RDW and PDW in the adverse prognosis of neonatal pneumonia.

Methods: We retrospectively analyzed 132 neonates with pneumonia treated in our hospital from April 2022 to October 2024. At the same time, 50 healthy newborns delivered in our hospital during the same period were selected as the control group. The levels of NLR, PLR, RDW and PDW in children with different disease severity and prognosis were analyzed; The correlation between NLR, PLR, RDW, PDW levels and disease severity was analyzed, and the predictive value for the adverse prognosis of neonatal pneumonia.

Results: Among 132 children, 65 were mild, 44 moderate and 23 severe; 26 cases had poor prognosis. The levels of NLR, PLR, RDW and PDW in children with different disease severity were significantly different (P<0.05). Spearman test showed that NLR, PLR, RDW, PDW were significantly positively correlated with the severity of neonatal pneumonia (P<0.05). Multivariate logistic regression analysis showed that NLR, PLR, RDW and PDW were the related factors influencing the poor prognosis of neonatal pneumonia (p<0.05). ROC curve analysis showed that the value of combined prediction of four indicators for poor prognosis of neonatal pneumonia was higher than that of single indicators, and the sensitivity of combined prediction was 100%, and the specificity was 94.9%.

Conclusion: NLR, PLR, RDW, PDW were positively correlated with the severity of neonatal pneumonia, and the value of combined prediction of poor prognosis was higher.

The complexity of cancer care is continuously increasing in the era of personalized medicine and there is a paradigm shift in the diagnosis and management of cancer. This is the era of precision oncology whose main objective is to identify cancer patients who are candidates for specific targeted therapies. This advanced approach to cancer care formulates treatment strategies for cancer patients based on the specific molecular characteristics of a malignant tumor which are identified through advanced molecular testing. This is the age of advanced prognostic and predictive biomarkers. Targeted therapies represent a groundbreaking shift in cancer therapy and are the cornerstone of precision oncology. Termed "tumor agnostic therapy", these drugs can treat different cancer types across multiple organs which demonstrate the same molecular alterations. A targeted drug in a specific cancer may be effective in another non-related cancer if the same genomic alteration is present. Pathologists need to appreciate these radical and exciting changes and adapt their practices as they will be required to be collaborative clinicians in the new era with a role in diagnosis, prognostication, and treatment of cancer. Pathologists need to become familiar with the ever-expanding number of new biomarkers and their crucial role in cancer care. They need to understand and adapt to new technologies such as Next Generation Sequencing and Comprehensive Genomic Profiling, liquid biopsies, DNA and transcriptome studies etc. They also need to familiarize themselves with tumor agnostic therapies, and concepts such as tumor heterogeneity and resistance to therapy. They can no longer be just morphologists but assume a central role in cancer care. Pathologists in developing countries and resource limited settings who may not currently have access to advanced molecular techniques need to be aware of and understand these fundamental shifts in cancer care and especially their role in the new era. The major changes in cancer care in the era of personalized medicine are discussed in this review mainly for the benefit of pathologists working in LMICs.

Background: The evaluation of a prolonged activated partial thromboplastin time (APTT) traditionally relies on a diagnostic cascade, including mixing studies to screen for inhibitors, specific factor activity assays, and specialized tests like lupus anticoagulant detection. Activated partial thromboplastin time-based clot waveform analysis (CWA-APTT) has emerged as an optical technique that captures the entire kinetic profile of clot formation, offering potential for enhanced diagnostic triage and monitoring. However, conventional analysis of CWA-APTT parameters, particularly peak-related metrics, is confounded by variables like fibrinogen concentration, limiting their specificity for accurately quantifying coagulation factor activity. Furthermore, the diagnostic utility of time-distribution parameters remains underexplored, especially for distinguishing between factor deficiencies and phospholipid-dependent inhibitors. This study aims to improve the correlation between peak-related parameters in APTT-based clotting curves and coagulation factor activity through novel data analysis methods and to investigate the potential clinical utility of time-distribution parameters in distinguishing sample types.

Methods: A total of 263 blood samples collected from patients with hemophilia A, hemophilia B, or lupus anticoagulant positivity were used to perform CWA-APTT. Normalization methods were applied to process the characteristic parameters in CWA-APTT. Then, the correlation between the processed peak-related parameters and coagulation factor activity was analyzed, and the ability of time-distribution parameters to distinguish different sample types was investigated.

Results: Following normalization, peak-related parameters more accurately reflect coagulation factor activity. Time-distribution parameters can also monitor coagulation factor activity and exhibit a certain degree of sample specificity. Combined analysis of time-distribution parameters enhances the ability to distinguish sample types, achieving a higher concordance rate in curve feature recognition compared to APTT correction tests.

Conclusion: This study innovatively explored new applications of CWA-APTT characteristic parameters. It was found that normalization enables peak-related parameters to more accurately reflect coagulation factor activity, and multi-parameter combined analysis can significantly enhance the ability of CWA-APTT to distinguish clinical samples.

Purpose: To evaluate whether tumor zonal origin is associated with clinical, pathological, and prognostic outcomes in patients with prostate cancer (PC) treated with radical prostatectomy (RP).

Patients and methods: This retrospective cohort study analyzed 488 patients who underwent RP at UNICAMP between 1997 and 2017. Tumor zonal origin was defined by the dominant (index) lesion, identified through standardized whole-mount pathological analysis based on the highest ISUP grade and largest tumor volume. The primary endpoint was a composite of biochemical recurrence and/or metastasis, selected to capture clinically significant disease relapse and ensure statistical robustness in a long-term cohort. Associations were assessed using the Mann-Whitney U-test and the Chi-square test. Multivariate logistic regression was performed to identify independent predictors of progression (p < 0.05).

Results: The index tumor originated in the peripheral zone (PZ) in 79.9% of cases and in the transition zone (TZ) in 6.5%. During follow-up, 38.3% of patients experienced biochemical recurrence or metastasis. Tumor location was not significantly associated with biochemical recurrence or metastasis (p = 0.428). Independent predictors included clinical stage (risk classification), pathological ISUP grade, positive surgical margins, and extra prostatic extension. Notably, biopsy ISUP grade and lymph node status were not independently predictive. The limited representation of TZ tumors may have constrained the statistical power to detect subtle prognostic differences.

Conclusion: Within the limitations of this cohort, tumor zonal origin was not independently associated with biochemical recurrence or metastasis following RP. Established pathological factors remain the primary determinants of disease progression.