International Journal of General Medicine最新文献

Background: A full examination of gastrointestinal tract is an essential prerequisite for effectively detecting gastrointestinal lesions. However, there is a lack of efficient tools to analyze and recognize gastric anatomy locations, preventing the complete portrayal of entire stomach. This study aimed to evaluate the effectiveness of artificial intelligence in identifying gastric anatomy sites by analyzing esophagogastroduodenoscopy images.

Methods: Using endoscopic images, we proposed a system called the Artificial Intelligence of Medicine (AIMED) through convolutional neural networks and MobileNetV3-large. The performance of artificial intelligence in the recognition of anatomic sites in esophagogastroduodenoscopy images was evaluated by considering many cases. Primary outcomes included diagnostic accuracy, sensitivity, and specificity.

Results: A total of 160,308 images from 27 categories of the upper endoscopy anatomy classification were included in this retrospective research. As a test group, 16031 esophagogastroduodenoscopy images with 27 categories were used to evaluate AIMED's performance in identifying gastric anatomy sites. The convolutional neural network's accuracy, sensitivity, and specificity were determined to be 99.40%, 91.85%, and 99.69%, respectively.

Conclusion: The AIMED system achieved high accuracy with regard to recognizing gastric anatomy sites, and it could assist the operator in enhancing the quality control of the used endoscope. Moreover, it could contribute to a more standardized endoscopic performance. Overall, our findings prove that artificial-intelligence-based systems can be indispensable to the endoscopic revolution (Clinical trial registration number: NCT04384575 (12/05/2020)).

Purpose: The connection between thyroid disorders and the health of bone is an endocrinological dilemma for physicians. Several studies have been conducted to examine the correlation between levothyroxine use and the risk of fracture. Different results have been obtained in these studies. The objective of the present study is to evaluate the impact of prolonged thyroid hormone replacement therapy on bone health in postmenopausal women.

Patients and methods: We obtained demographic data, laboratory results, and anthropometric measurements of patients from the hospital database. After the exclusion of patients, 59 patients with post-procedural hypothyroidism (n = 59) and a control group (n = 45) were evaluated. The patient group consisted of individuals who had undergone thyroid surgery for a benign condition and had been on levothyroxine treatment for a minimum of 5 years. Densitometric measurements of bone mass in the hip and spine were performed by bone mineral densitometry.

Results: Groups were similar in age, PTH, vitamin D, bone-specific ALP, and BMI (p>0.05). The control group had a significantly lower total T score-F than the hypothyroidism group (-0.77±1.3 to -0.29±1.02, p= 0.041). However, total T score-LV, total gr/cm2-LV, and total gr/cm2-F were similar in both groups.

Conclusion: This study showed that long-term levothyroxine therapy, which aims to maintain TSH levels within the normal reference range, is associated with increased bone mineral density (BMD) in postmenopausal women compared with the control group. Thus, to maintain bone health and prevent osteoporosis, it is important that postmenopausal women on long-term levothyroxine replacement undergo medical follow-up to prevent TSH suppression.

Background: Axillary lymph node (ALN) is the most common metastasis path for breast cancer, and ALN dissection directly affects the postoperative staging and prognosis of breast cancer patients. Therefore, additional research is needed to accurately predict ALN metastasis before surgery and construct predictive models to assist in surgical decision-making and optimize patient care.

Methods: We retrospectively analyzed the clinical data, radiomics, and pathomics of the patients diagnosed with breast cancer in the Breast Cancer Center of Hubei Cancer Hospital from January 2017 to December 2022. The study participants were randomly assigned to either the training queue (70%) or the validation queue (30%). Logistic regression (ie generalized linear regression model [GLRM]) and random forest model (RFM) were used to construct an ALN prediction model in the training queue, and the discriminant power of the model was evaluated using area under curve (AUC) and decision curve analysis (DCA). Meanwhile, the validation queue was used to evaluate the ALN prediction performance of the constructed model.

Results: Out of the 422 patients encompassed in the study, 18.7% were diagnosed with ALN by postoperative pathology. The logical model included shear wave elastography (SWE) related to maximum, minimum, centre, ratio 1, pathomics (Feature 1, Feature 3, and Feature 5) and a nomogram of the GLRM was drawn. The AUC of GLRM was 0.818 (95% CI: 0.757~0.879), significantly lower than that of RFM's AUC 0.893 (95% CI: 0.836~0.950).

Conclusion: The prediction models based on machine learning (ML) algorithms and multiomics have shown good performance in predicting ALN metastasis, and RFM shows greater advantages compared to traditional GLRM. The findings of this study can help clinicians identify patients with higher risk of ALN metastasis and provide personalized perioperative management to assist preoperative decision-making and improve patient prognosis.

Background and objectives: A pathological increase in intestinal permeability causes muscle loss and physical decline by inducing systemic inflammation and oxidative stress. However, most relevant studies investigate older adults, and the appropriate data across age spans remain elusive. This study aimed to examine the associations of intestinal permeability with muscle loss and physical decline across a large span of ages. We measured plasma zonulin, a marker of increased intestinal permeability, from adolescents to octogenarians in association with muscle health and gait speed.

Research methods and procedures: In this cross-sectional, observational study, we recruited healthy men, including young (age=18-35 years, n=135), middle-aged (age=35-59 years, n=118), and older (age=60-90 years, n=163) adults for evaluating - handgrip strength (HGS), skeletal muscle mass index (SMI), and gait speed. We also measured plasma zonulin, c-reactive proteins (CRP), and 8-isoprostanes using ELISA assays.

Results: Plasma zonulin gradually increased from young and middle-aged to older adults (all p<0.05). Conversely, HGS and gait speed were progressively reduced from young and middle-aged to older adults (all p<0.05). In addition, older adults also exhibited lower SMI than young and middle-aged men (both p<0.05). Plasma zonulin exhibited significant negative correlations with HGS and gait speed and positive correlations with CRP and 8-isoprostanes in middle-aged and older men (all p<0.05). We also found significant areas under the curve for the efficacy of plasma zonulin in diagnosing low HGS (<27kg) and gait speed (0.8 m/s). After adjustment for age, plasma zonulin demonstrated robust negative correlations with HGS and gait speed and positive correlations with CRP and 8-isoprostanes in the cumulative cohort.

Conclusion: Altogether, an increasing intestinal leak from middle age onward contributes to muscle weakness and physical decline. Our data is clinically relevant in understanding and treating physical dependency in middle-aged and older adults.

Purpose: Outbreak of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic, leading to over 6 million deaths worldwide. Pregnant women suffer from a higher risk facing the pandemic COVID-19, while their related clinical information is limited.

Methods: The clinical information of SARS-CoV-2 positive (n = 30) and negative pregnant women (n = 134) in Tianjin First Central Hospital (from November 30, 2022, to January 20, 2023) were collected. All statistical analyses were conducted in R language, employing t test or Chi-square test methods.

Results: Significantly higher heart rate, temperature, and intrapartum hemorrhage were observed in positive pregnant women, besides fetal placentation grading, umbilical cord around the neck, cardiac B-scan ultrasound, and ultrasonic examination of lower limb vessels were significantly differential between positive and negative individuals. As for coagulation test, significantly higher activated partial thromboplastin time (APTT), Thrombin Time (TT), and D-dimer (DD2) were found in SARS-CoV-2 positive patients. Liver function test results indicated that six indicators were significantly differential between positive and negative individuals.

Conclusion: Compared to negative pregnant women, significantly abnormal liver function and coagulopathy were observed in positive patients. As the unique vulnerable population, SARS-CoV-2 infected pregnant women should be payed more attention in clinical practice.

Objective: Elevated serum pentraxin-3 levels are generally considered a risk factor for atherosclerosis. However, there is limited data on the relationship between pentraxin-3 and cerebral infarction (CI) accompanied by intracranial atherosclerotic stenosis (ICAS). This study aims to investigate the association between pentraxin-3 (PTX-3) and short-term recurrence in cerebral infarction caused by ICAS patients within one year.

Methods: A prospective observational study was conducted. Cerebral infarction accompanied by intracranial atherosclerotic stenosis (CI-ICAS) patients were selected from January 2020 to December 2023. Recurrent ischemic stroke (RIS) is defined as a new neurological deficit that appears after a period of clinical stabilization, lasting more than 24 hours, with an attributable new ischemic lesion that can be confirmed by CT or MRI. Serum pentraxin-3 levels were determined on admission. Multivariate logistic regression analysis was used to investigate the relationship between serum pentraxin-3 and RIS.

Results: Among 398 patients enrolled, 112 cases (28.1%) had recurrence within one year. The elevation of serum PTX-3 level in patients accompanied with ICAS was independently correlated with recurrent stroke. Therefore, it is worth considering the possibility of intervening in higher PTX-3 levels. Serum pentraxin-3 was significantly higher in patients with RIS (15.16 vs 10.21 µmol/L, P<0.001). Correlation analysis showed that PTX-3 was correlated with age, LDL, Hs-CRP, Baseline NIHSS score, and Hcy (P < 0.001). Univariate logistic regression analysis showed that pentraxin-3 remained an independent predictor of recurrent ischemic stroke after adjusting for major confounding factors (OR = 1.21, 95% CI: 1.06-1.39, P = 0.007).

Conclusion: The elevation of serum pentraxin-3 level in patients with ischemic stroke was independently correlated with the recurrence of stroke within one year. Therefore, intervention in serum pentraxin-3 levels may be worth considering.

Osteosarcopenia (OS) is a geriatric syndrome characterized by the concurrent presence of osteoporosis and sarcopenia, predominantly affecting the elderly population. Osteoporosis (OP) is a systemic skeletal disorder characterized by decreased bone mass, compromised bone microarchitecture, and heightened bone fragility, substantially elevating fracture risk. Sarcopenia (SP) is defined by decreased muscle mass, strength, and/or functional capacity. Both conditions are age-related degenerative diseases with overlapping pathophysiological mechanisms, commonly co-occurring in elderly individuals and substantially increasing fracture risk. Denosumab, a targeted anti-osteoporotic agent, mediates therapeutic effects by inhibiting bone resorption through the RANK-RANKL-OPG (RRO) pathway, consequently enhancing bone mineral density. International studies indicate that Denosumab not only treats osteoporosis but also improves sarcopenia-related metrics, suggesting its potential as a sarcopenia treatment. However, research focusing on the Chinese population remains limited. Additionally, the pathophysiological mechanisms of sarcopenia and the pathways through which Denosumab ameliorates sarcopenia are not yet fully understood, warranting further experimental investigation. In summary, Denosumab's therapeutic efficacy in osteoporosis treatment and its potential impact on sarcopenia are of substantial research interest. However, research and literature on these topics in China remain notably scarce. This article aims to offer a systematic review and critical analysis of these topics.

Background: Exercise therapy could improve physical and psychological health in patients with chronic kidney disease (CKD). This study aimed to investigate knowledge, attitudes and practices (KAP) towards exercise therapy among patients with CKD stage 5 on regular hemodialysis.

Methods: The cross-sectional study was conducted between August 1st and 30th, 2023; KAP and demographic characteristics of CKD-5 patients were assessed with self-distributed questionnaire and analyzed using logistic regression and structural equation modeling (SEM). A higher score represented better knowledge, more positive attitude, and more proactive practice.

Results: In 513 collected questionnaires, mean scores for knowledge, attitudes, and practices were 9.5 ± 4.1 (possible range: 0-13), 31.9 ± 5.0 (possible range: 9-45), and 21.7 ± 9.3 (possible range: 9-45). Multivariate logistic regression analysis showed that education (OR = 1.8, 95% CI: 1.1-3.0, P = 0.02), income (OR = 1.7, 95% CI: 1.1-2.6, P = 0.02), and family support (OR = 3.8, 95% CI: 2.0-7.1, P < 0.001) were independently associated with higher knowledge scores. Knowledge score (OR = 5.1, 95% CI: 1.7-15.1, P < 0.001) and attitude score (OR = 7.3, 95% CI: 3.7-14.2, P < 0.001) were independently associated with higher practice scores. According to SEM, knowledge directly influenced attitude (β=1.3, P < 0.001), while attitude influenced practice (β=0.8, P < 0.001).

Conclusion: Patients with CKD-5 who underwent regular hemodialysis demonstrated insufficient knowledge, passive attitude and inactive practices towards exercise therapy. Improving knowledge and attitude through educational interventions might result in better practice.

Despite advancements in the treatment of heart failure (HF) and modest improvements in survival rates over the past few decades, mortality rate remains significantly high. HF not only imposes a significant economic burden on patients' families but also presents a substantial challenge to society at large. Therefore, effective treatment and prevention strategies are crucial. Numerous studies have demonstrated that histamine H2 receptor antagonists (H2RAs) can benefit patients with HF through various mechanisms. These mechanisms encompass promoting sodium and water excretion, vasodilation, enhancing cardiac output, reducing levels of inflammatory cytokines, improving ventricular remodeling, and reducing mortality rate. Additionally, H2RAs exert beneficial effects on typical risk factors and may prevent the onset of HF. This review aims to elucidate the mechanisms underlying the treatment and prevention of HF using H2RAs. For patients requiring either prevention or management of HF, and who concurrently have acid-related diseases, H2RAs may represent a suitable therapeutic option.