International Journal of General Medicine最新文献

Aim: In order to better understand the incidence of IBD in China, we conducted a retrospective study to analyze the clinical information of IBD patients in Shanghai, China.

Methods: From January 2014 to December 2021, patients diagnosed with IBD and hospitalized were enrolled. The demographic, clinical features, symptoms, laboratory tests and treatment data of the patients were retrospectively analyzed.

Results: This study included 454 patients with UC and 333 patients with CD. The rate of hospitalization for IBD showed an escalating trend throughout the period, the number of hospitalizations was significantly higher in CD patients than in UC patients. The male patients had more complications than the female patients (p < 0.05). Definitive diagnosis of IBD in older patients was difficult (p < 0.05), and misdiagnosis was common. The incidence of complications and extraintestinal manifestations in elderly IBD patients was lower, but the incidence of intestinal obstruction was higher (p < 0.05). There was a significant correlation between the disease activity grades of IBD and fibrinogen, hemoglobin, albumin. Elderly IBD patients presented with lower rates of immunosuppressant, biologics, surgery or enteral nutrition.

Conclusion: This study analyzed the incidence, characteristics and treatment of IBD patients in Shanghai, and provided evidence-based evidence for doctors to more effectively diagnose and treat IBD in the future.

Background: Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal condition that has a detrimental impact on one's quality of life because of acid reflux causing damage to the esophagus. Primary symptoms consist of heartburn and regurgitation, although patients may also encounter chest pain, nausea, and dysphagia. Medical students may be particularly susceptible due to stressful lifestyles and unhealthy habits. This study investigates the prevalence of GERD among medical students in Egypt and explores associated risk factors.

Subjects and methods: This is a cross-sectional observational study that was conducted among undergraduate medical students at 21 medical schools across Egypt. The study included 602 participants from medical schools. The study utilized a pre-designed, self-administered questionnaire that includes questions about sociodemographic and lifestyle attributes, accompanied by the GERDQ questionnaire used to diagnose gastroesophageal reflux disease.

Results: A total of 602 undergraduate medical students completed the questionnaire. The prevalence of GERD was found to be 28.4%, with heartburn and regurgitation being the most prevalent symptoms among participants. Univariate and multivariate logistic regression revealed family history of GERD and stress after medical school enrollment as significant predictors of GERD symptoms (p=0.043 and p=0.044, respectively).

Conclusion: GERD has become increasingly common among medical students in Egypt. Contributing factors include medical students' stressful lifestyles and familial predispositions. To address this, it is essential to implement counseling programs and raise awareness as initial steps toward reducing GERD prevalence.

Objective: This study aims to investigate the association between preoperative serum uric acid to high-density lipoprotein cholesterol ratio (UHR) and the occurrence of postoperative acute kidney injury (AKI) in patients who underwent coronary artery bypass grafting (CABG).

Methods: A prospective observational study was conducted at Fujian Heart Medical Center between May 2022 and December 2023, recruiting patients scheduled for CABG. Participants were categorized into two groups based on AKI occurrence post-surgery. Univariate and multivariate logistic regression analyses were performed to identify predictor variables for AKI after CABG. A nomogram was constructed based on these predictors, and its calibration was evaluated using the receiver operating characteristic curve (ROC) and Hosmer-Lemeshow goodness of fit test. The diagnostic value of UHR in AKI after CABG was explored using the area under the curve (AUC).

Results: The study included 301 CABG patients, of whom 72 (23.92%) developed AKI. After adjusting for age, gender, body mass index, and extracorporeal circulation, binary logistic regression analysis revealed that a higher UHR value was an independent risk factor for developing AKI after CABG (OR=7.410, 95% CI: 3.829-14.855), P <0.05. The prediction nomogram demonstrated excellent discriminability, with an AUC of 0.87 and good calibration (Hosmer-Lemeshow test, P <0.05). Compared with other clinical indicators, ROC analysis indicated that UHR had the largest AUC (0.821), corresponding to 70.8% sensitivity and 79.0% specificity.

Conclusion: Higher UHR was associated with an increased risk of AKI after CABG and may serve as a prospective biomarker for predicting AKI.

Background: Hepatocellular carcinoma (HCC) triggered by Hepatitis B virus (HBV) remains a significant clinical challenge, necessitating novel therapeutic interventions. Copper ionophores, recognized for introducing an innovative type of programmed cell death termed cuproptosis, present promising potentials for cancer therapy. Nevertheless, The role of cuproptosis-related lncRNAs (CRLRs) in HBV-HCC has not been clearly elucidated.

Methods: This study utilised univariate Cox, least absolute shrinkage and selection operator (LASSO), and multivariable Cox regression analyses to establish a signature for CRLRs in HBV-HCC. This prognostic model was validated with an independent internal validation cohort, combined with clinical parameters, and used to construct a nomogram for patient survival predictions. Gene Ontology (GO) and Gene Set Enrichment Analysis (GSEA) were employed to explore associated biological pathways. Additionally, a protein-protein interaction (PPI) network was developed, and implications for tumour mutational burden (TMB) and drug response were examined. A comprehensive bioinformatics analysis of these hub CRLRs was performed, followed by experimental validation through quantitative real-time PCR (qRT-PCR) and functional cellular assays.

Results: The nomogram showed high predictive accuracy for HBV-HCC patient survival. GO and GSEA analyses indicated that these lncRNAs are involved in pathways related to cancer and oestrogen metabolism. A PPI network consisting of 201 nodes and 568 edges was developed, and the TMB and drug response differed significantly between high- and low-risk groups. Analyses identified three hub CRLRs, SOS1-IT1, AC104695.3, and LINC01269, which were significantly differentially expressed in HCC tissues. In vitro, LINC01269 was found to enhance HCC cell proliferation, invasion, and migration.

Conclusion: The first systematic exploration of the roles of CRLRs in HBV-HCC demonstrates their critical involvement in the disease's pathogenesis and possible therapeutic implication. The distinct expression patterns and significant biological pathways suggest that these lncRNAs may facilitate novel therapeutic targets.

Background: Growing research has demonstrated that alterations in Th2 and Th17 cell composition were linked to systemic juvenile rheumatoid arthritis (sJRA). Nevertheless, whether these associations indicate a causal link remains unclear, and the potential effects of Th2/Th17-related molecules have not been clarified.

Methods: Mendelian randomization (MR) alongside transcriptome examination was implemented to ascertain the links between the Th2/Th17 cells and sJRA. Subsequently, we established an innovative machine learning (ML) framework encompassing 12 ML approaches and their 111 permutations to generate a unified Th2/Th17 classifier, which underwent verification across three separate cohorts. The hub Th2/Th17-related genes' level in the sJRA patients was substantiated via qRT-PCR. Lastly, the SHapley Additive exPlanations (SHAP) in conjunction with the XGBoost algorithm to pinpoint ideal Th2/Th17-linked genes.

Results: Based on MR analyses of two sJRA GWAS, 2 immunophenotypes (lymphocyte and IgD+ B cell) were causally linked to sJRA. Based on IOBR algorithms, we revealed that lymphocyte Th2/Th17 proportion was markedly changed in sJRA from seven cohorts. WGCNA and differential analysis in two merged GEO cohorts identified 64 Th2/Th17-related genes. Based on the average AUC (0.844) and model stability in four cohorts, we converted 12 ML techniques into 111 combinations, from which we chose the optimal algorithm to generate an ML-derived diagnostic signature (Th2/Th17 classifier). qRT-PCR verified results. Moreover, immune cell infiltration and functional enrichment analysis suggested hub Th2/Th17-related gene potentially mediated sJRA onset. XGBoost algorithm and SHAP detected HRH2 as crucial genetic markers, which may be an important target for sJRA.

Conclusion: A diagnostic model (Th2/Th17 classifier) via 111 ML algorithm combinations in six independent cohorts was generated and validated, which stands as an effective instrument for sJRA detection. The identification of essential immune components and molecular cascades, along with HRH2, could emerge as vital therapeutic targets for sJRA intervention, providing an enhanced understanding of its fundamental processes.

In recent years, probiotics, as a class of biologically active microorganisms, have increasingly attracted attention for their potential in treating neurodegenerative diseases (NDDs). To comprehensively assess the effects of probiotics on clinical symptoms and systemic inflammation regulation in various NDDs, this systematic review conducted a detailed search of the Cochrane Library, Embase, PubMed, and Web of Science databases, ultimately including 22 eligible randomized controlled trials (RCTs), with 4 RCTs for Alzheimer's Disease (AD), 10 RCTs for Parkinson's Disease (PD), 2 RCTs for Multiple Sclerosis (MS), and 2 RCTs for Mild Cognitive Impairment (MCI), and intervention durations ranging from 4 to 16 weeks. The comprehensive analysis indicates that probiotics help improve clinical symptoms related to NDDs, including gastrointestinal function, cognitive function, quality of life, and mental health. Additionally, probiotics generally have a positive effect on reducing systemic inflammation and enhancing antioxidant capacity in patients. In conclusion, existing evidence supports the promising potential of probiotics in treating NDDs. However, further large-scale, high-quality studies are needed to explore specific differences in efficacy among various probiotic strains, dosages, and modes of administration. Moreover, considering that lifestyle and dietary habits may modulate the effects of probiotics, these external factors should also be included in research considerations to gain a more comprehensive understanding of the mechanisms and application strategies of probiotics in NDDs treatment.

Background: To investigate the applicability of MR-based automated segmentation techniques in evaluating cortical and hippocampal changes in adults with temporal lobe epilepsy (TLE), specifically emphasizing the affected hemisphere.

Methods: A retrospective analysis involved 48 cases diagnosed with TLE based on clinical and EEG criteria. The cohort comprised 30 patients with hippocampal sclerosis (HS) and 18 with nonlesional temporal lobe epilepsy (TLE-NL) on MR. 30 healthy volunteers constituted the control group. FreeSurfer software facilitated the segmentation of cortical regions and hippocampal subfields, generating numerical values for cortical thickness and hippocampal subfield volumes on the left hemisphere. Independent sample Wilcoxon rank-sum tests enabled pairwise comparisons of cortical thickness and hippocampal subfield volumes between the control, TLE-NL, and HS groups.

Results: Significant differences emerged in hippocampal total volume and volumes of the head, body, and tail regions between the control and HS groups and the TLE-NL and HS groups. Cortical thickness of 6 regions exhibited statistical differences between the control and TLE-NL groups, while 15 regions showed distinctions between the control and HS groups. 2 regions displayed variations in cortical thickness between the TLE-NL and HS groups.

Conclusion: MRI-based automated segmentation techniques provide valuable insights into cortical and hippocampal structural variations in distinct TLE subtypes. This methodology effectively delineates changes in cortical regions and hippocampal subfields, augmenting clinical comprehension of TLE progression.

Objective: Patients with end-stage renal disease (ESRD) are at an increased risk for emotional issues, with depression being the most prevalent psychological concern, significantly impacting their quality of life. This study aimed to explore the mediating effect of psychological resilience on the relationship between depression and quality of life in maintenance hemodialysis (MHD) patients.

Methods: This cross-sectional study aimed to explore the mediating effect of psychological resilience on the relationship between depression and quality of life in MHD patients in Baoding, China. Conducted from January 2024 to July 2024, the study involved a questionnaire survey of 215 MHD patients across five hospitals in Baoding. Data were collected using General information questionnaire, Hemodialysis Patient Depression Scale, Psychological Resilience Scale, and Quality of Life Scale, and structural equation modeling using AMOS 21.0 was employed to analyze the mediating effect.

Results: The scores for depression, psychological resilience, and quality of life in these MHD patients were 9.37±4.6, 30.58±6.1, and 59.48±9.3, respectively. Depression had a negative correlation with quality of life, while psychological resilience had a positive correlation with quality of life (with correlation coefficients of -0.453 and 0.578, respectively, all P<0.01). Psychological resilience played a mediating role in the relationship between depression and quality of life (β=-0.13, P<0.05), with the mediating effect analysis showing a significant indirect effect of depression on quality of life. The direct and indirect effects of depression on quality of life were -0.34 and -0.13, respectively, with a total effect of -0.47. The mediating effect accounted for 27.7% of the total effect. Interpretation: PHQ-9 scores range from 0 to 27, with higher scores indicating more severe depressive symptoms. CD-RISC scores range from 0 to 100, with higher scores reflecting greater psychological resilience. SF-12 scores range from 0 to 100, with higher scores indicating a better quality of life.

Conclusion: Depression, psychological resilience, and quality of life in MHD patients were at a moderately low level. Depression in MHD patients can indirectly affect their quality of life through psychological resilience, suggesting that healthcare professionals should take measures to reduce depression levels, enhance psychological resilience, and ultimately improve the quality of life for these patients. Psychological resilience was identified as a significant mediator in this relationship, highlighting its potential as a target for interventions aimed at improving the mental well-being and quality of life of MHD patients. These results underscore the importance of integrating psychological support into the care of MHD patients.

Background: This study challenges the prevailing view that hemolytic diseases of the newborn (HDN) associated with the Rh blood group system are more severe than those caused by the ABO system. The objective was to assess the effectiveness of exchange transfusion (ET) in managing HDN, with a focus on comparing treatment outcomes between ABO and Rh incompatibility cases.

Methods: A study enrolled 125 neonates diagnosed with hyperbilirubinemia, comprising 66 males and 59 females. The gestational age of the neonates ranged from 33 to 41 weeks, and their birth weights varied between 2.11 to 4.3 kilograms. Based on the etiology of hemolysis, the study categorized 73 cases as ABO group and 52 as Rh group.

Results: Post- ET, there was a significant reduction in serum total bilirubin (STB), serum indirect bilirubin (SIB), and platelet (PLT) counts (P<0.001). Pre- ET, differences in SIB and PLT were noted between neonates with ABO and Rh incompatibilities (P<0.05). There was no statistically significant disparities in the therapeutic effects of ET on STB, SIB, and PLT levels when comparing male and female neonates across both the ABO and Rh incompatibility groups.

Conclusion: Our study demonstrated that ET is efficacious in reducing bilirubin levels and platelet counts in neonates presenting with ABO and Rh blood group incompatibilities. Notably, the effectiveness of ET was found to be independent of the neonates' gender, a finding that underscores the universal applicability of this treatment approach. Our study observation contradicts the prevalent belief that HDN associated with the Rh system is inherently more severe than that linked to the ABO system. This revelation underscores the imperative for the swift implementation of ET in managing cases of severe hyperbilirubinemia.

Purpose: To establish a pragmatic and effective predictive model for monitoring the recovery of radiation enteritis (RE) in cervical cancer patients undergoing concurrent chemoradiotherapy (CCRT).

Methods: This study included 105 cervical cancer patients undergoing CCRT. We assessed baseline clinicopathologic characteristics, evaluated the effects of CCRT on circulating immune cells, tumor biomarkers, and inflammatory cytokines, and developed a predictive scoring system, the Immune-Tumor-Score (ITS), using the LASSO-Cox regression model. The model performance of LASSO-Cox and nomogram was compared via ROC curve and calibration curve.

Results: The median age of the patients was 55 years, with 53.3% having a normal BMI and 46.7% having positive lymph nodes. Post-CCRT, significant decreases were observed in lymphocyte counts, T-cell subpopulations, and tumor markers (CA125, TPA, SCCA, CYFRA21). The CD4/CD8 ratio and IL10 levels were significantly higher post-CCRT, while inflammation indexes (NLR, ELR) increased, and LMR decreased. The ITS, derived from 11 significant parameters, effectively predicted RE recovery, outperforming a traditional nomogram. Higher ITS scores correlated with shorter RE recovery times, as validated by Kaplan-Meier analyses and ROC curves (AUC = 0.822).

Conclusion: The ITS system provides a robust and reliable tool for predicting RE recovery in cervical cancer patients undergoing CCRT, surpassing traditional models in accuracy and reliability. This tool enables better patient management by allowing for timely interventions and personalized treatment strategies. Future research should focus on validating these findings in larger cohorts and integrating additional clinical parameters to enhance the predictive power of the ITS.