International Journal of General Medicine最新文献

Background: Patients with ST-segment elevation myocardial infarction (STEMI) and type 2 diabetes mellitus (T2DM) are at increased risk of heart failure after percutaneous coronary intervention (PCI). Early identification of high-risk individuals remains challenging. This study aimed to develop a prediction model integrating two-dimensional speckle tracking imaging (2D-STI) and clinical variables to improve risk stratification.

Methods: A total of 328 T2DM patients with STEMI who underwent PCI were retrospectively analyzed. Clinical, laboratory, and 2D-STI parameters were collected within one week after PCI. Heart failure within one year was the study endpoint. LASSO regression followed by Boruta analysis was used to identify key predictors. A multivariable logistic model was established, visualized by a nomogram, and evaluated using ROC curves, reclassification indices, calibration, and decision curve analysis.

Results: Heart failure occurred in 62 patients (18.9%). Six variables-GLS, HbA1c, BMI, eGFR, hs-CRP, and diabetes duration-were identified as core predictors. GLS showed the highest individual discriminative ability (AUC = 0.798). The combined model achieved an AUC of 0.861, significantly outperforming the base model (AUC = 0.803, P < 0.001). Adding GLS improved reclassification (NRI = 0.216; IDI = 0.057). The model demonstrated good calibration and favorable clinical utility.

Conclusion: Integrating GLS with clinical, metabolic, inflammatory, and renal indicators significantly improves early prediction of post-PCI heart failure in T2DM patients with STEMI, offering a practical tool for individualized risk assessment.

Ischemic stroke (IS) is a severe cerebrovascular disease characterized by high incidence, disability, and mortality rates. Despite continuous advancements in medical technology, the clinical treatment of IS continues to face significant challenges. The pathological mechanisms of IS are complex and diverse, involving processes such as oxidative stress, neuroinflammation, and apoptosis. Traditional Chinese Medicine (TCM), a longstanding therapeutic system, has demonstrated unique advantages in IS treatment. The classical formula Buyang Huanwu Decoction (BYHWD) has become a commonly used prescription for treating stroke and its sequelae, particularly in East Asia. BYHWD, through its multi-pathway and multi-target mechanisms of action, can significantly enhance treatment efficacy while reducing adverse reactions. Exploring the molecular mechanisms of BYHWD offers the potential for a more comprehensive therapeutic strategy for global patients suffering from IS. This article outlines the key signaling pathways and therapeutic targets involved in the treatment of IS with BYHWD, including the PI3K-Akt pathway, autophagy, Nrf2, VEGF, inflammasome, the Notch pathway, NF-κB, and ferroptosis. Additionally, it summarizes the role of BYHWD in ameliorating neurological deficits through the regulation with synaptic plasticity, as well as the current progress in clinical applications and the development and utilization status of its derived preparations. This review aims to provide a solid theoretical foundation for further in-depth research and development of BYHWD, guiding the development of anti-IS drugs based on the holistic treatment concept of TCM formulas.

Background: Patients with coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) face a markedly increased risk of unplanned readmission due to metabolic disturbances and chronic inflammation. The cholesterol-to-lymphocyte ratio (CLR), reflecting both dyslipidemia and inflammatory status, may serve as a useful marker for risk stratification. This study aimed to evaluate the predictive value of CLR for 1-year unplanned readmission in CAD patients with T2DM.

Methods: We conducted a single-center retrospective cohort study of patients hospitalized from January to December 2023 who were diagnosed with CAD and T2DM by coronary angiography. Demographic characteristics, comorbidities, medication use, and laboratory findings were collected, and CLR was calculated. Least absolute shrinkage and selection operator (LASSO) regression was applied to identify key predictors. Logistic regression, multilayer perceptron (MLP), and extreme gradient boosting (XGBoost) models were developed to assess predictive performance. Model discrimination and calibration were evaluated using AUC, accuracy, sensitivity, specificity, and calibration curves. Variable importance was further explored with SHAP value analysis.

Results: A total of 973 patients were included, comprising 769 without readmission (NRG) and 204 with readmission (RG). CLR was significantly higher in the RG group (3.63 vs 3.07, P < 0.001). Six predictors were selected by LASSO: sex, age, atrial fibrillation, β-blocker use, oral anticoagulant use, and CLR. Among the models, XGBoost achieved the best performance in the test set (AUC = 0.81, accuracy = 0.72) with good calibration. SHAP analysis identified CLR as the most influential variable (mean absolute SHAP = 0.42), contributing most strongly to readmission risk. Regular outpatient use of β-blockers and oral anticoagulants was protective, while atrial fibrillation, younger age, and female sex were associated with increased risk.

Conclusion: CLR showed a moderate ability to assist risk prediction of 1-year unplanned readmission in patients with CAD and T2DM in this exploratory single-center study. Further external validation is warranted.

Mycoplasma pneumoniae (MP) is a significant respiratory pathogen in children, often causing refractory and severe pneumonia. Sensitive, rapid, and portable diagnostic tools are crucial for guiding clinical management. Although traditional methods like culture, ELISA, and PCR are widely used, they suffer from drawbacks such as lengthy turnaround times, complex procedures, or reliance on laboratory equipment. Consequently, Point-of-care testing (POCT) technologies, valued for their speed, portability, and ease of use, have emerged as a key research focus for MP diagnosis. This review systematically summarizes advancements in POCT platforms, covering: (1) immunological methods; (2) molecular biology methods; and (3) biosensor technologies. Their sensitivity, specificity, and clinical performance are comparatively analyzed. Colloidal gold immunochromatography delivers results within 15 minutes but exhibits limited sensitivity. Molecular methods like LAMP and CRISPR-coupled systems achieve single-copy detection limits via isothermal amplification and gene editing, with processing times under 1 hour. Biosensors enable high-sensitivity automated detection through integrated signal amplification and microfluidics. Despite these advantages, POCT development faces challenges including cost-sensitivity tradeoffs, standardization barriers, and sample matrix interference. Future directions encompass multi-modal detection, AI-assisted interpretation, multiplex pathogen screening, and dynamic drug resistance gene monitoring. These innovations will expand POCT device deployment in primary care and home settings. This will ultimately improve effectiveness in controlling respiratory infections.

Purpose: To investigate the prevalence and preoperative and intraoperative risk factors associated with postoperative urinary retention (POUR) in patients undergoing elective spinal surgery.

Methods: A cross-sectional, descriptive-analytical study was conducted at a tertiary hospital in China between October and November 2025. A total of 177 adult patients undergoing elective cervical, lumbar, or scoliosis surgery with planned postoperative catheter removal were included. Data collected included demographic and clinical characteristics. Univariate and multiple logistic regression analyses were performed to examine associations between preoperative factors and POUR.

Results: POUR occurred in 14.7% of patients. Multiple analysis identified three independent risk factors for POUR: intraoperative infusion volume exceeding 2000 mL (OR = 6.714, 95% CI: 1.980-22.764, P = 0.002), lower preoperative Barthel Index scores (OR = 0.379, 95% CI: 0.243-0.590, P < 0.001), and lower preoperative serum albumin levels (OR = 0.086, 95% CI: 0.008-0.881, P = 0.039).

Conclusion: Higher intraoperative fluid administration, lower functional status, and preoperative hypoalbuminemia are significant risk factors for POUR following spinal surgery. These findings provide a basis for future research aimed at developing predictive tools and targeted perioperative strategies to identify and manage patients at risk for POUR.

Background: Central obesity is a major contributor to cardiometabolic diseases. The sarcopenia index (SI), derived from serum creatinine and cystatin C, is a biomarker reflecting muscle mass, but its relationship with obesity phenotypes across age and sex remains unclear.

Objective: To examine the association between SI and central versus peripheral obesity, determine whether SI is independently associated with central obesity, and identify optimal SI cut-off values in a large Chinese population.

Methods: This retrospective cross-sectional study analyzed 10,054 adults undergoing health examinations at Xiamen Chang Gung Hospital. Anthropometric data, biochemical profiles, and body composition by bioelectrical impedance analysis were collected. Participants were categorized as non-obese, peripheral obese, or central obese based on body fat percentage and visceral fat degree. Logistic regression assessed associations between SI tertiles and central obesity stratified by age and sex. Receiver operating characteristic (ROC) curves determined optimal SI cut-off values.

Results: Central obesity was present in 24.4% of participants and correlated with adverse cardiometabolic profiles. Individuals with central obesity exhibited lower SI levels, most notably in men <50 years and women ≥50 years. After multivariable adjustment, the lowest SI tertile was independently associated with central obesity in younger men (adjusted OR 1.27; 95% CI 1.06-1.52) and older women (adjusted OR 3.03; 95% CI 2.04-4.50). SI demonstrated moderate discriminatory ability in women (AUC 0.687; optimal cut-off 79.52) but limited performance in men (AUC 0.534; cut-off 96.60).

Conclusion: Lower SI is independently associated with a higher prevalence of central obesity, particularly among younger men and older women. SI may provide a simple and practical supplementary marker for identifying individuals at risk of central adiposity, especially in women. Prospective studies are needed to validate its predictive utility.

Objective: To evaluate whether cord blood C-X-C motif chemokine ligand 10 (CXCL10) and Matrix Metalloproteinase 8 (MMP8) predict bronchopulmonary dysplasia (BPD) in preterm infants.

Methods: In this retrospective cohort study (January 2019-December 2023), we enrolled 272 preterm infants (22-32 weeks' gestation; birth weight 631-1493 g) admitted to Baoding Maternal and Child Health Hospital. Mean gestational age was 27.31 ± 1.97 weeks and mean birth weight 1,166.44 ± 245.63 g. Neonates were classified into BPD (n = 90) and non-BPD (n = 182) groups. Cord-blood CXCL10 and MMP-8 were quantified by enzyme-linked immunosorbent assay (ELISA). Associations were evaluated using Spearman correlation, multivariable logistic regression, and receiver operating characteristic (ROC) curve analysis.

Results: Infants who developed BPD had lower birth weight and Apgar scores at 1 and 5 minutes, and were more likely to be born at < 28 weeks' gestation, to have neonatal respiratory distress syndrome (NRDS), to require FiO₂ ≥ 30%, and to receive prolonged mechanical ventilation (all P < 0.05). Cord blood CXCL10 and MMP8 levels were significantly higher in the BPD group (P < 0.001) and were positively correlated with each other (r = 0.332, P < 0.001). Multivariable analysis identified low birth weight, low Apgar scores, NRDS, prolonged mechanical ventilation, and elevated CXCL10 and MMP8 as independent risk factors for BPD. The combined CXCL10 and MMP8 model achieved an AUC of 0.902, significantly outperforming either biomarker alone.

Conclusion: Elevated cord blood CXCL10 and MMP8 levels are strongly associated with BPD development. Their combined measurement may help identify preterm infants at risk, although external validation is warranted.

Purpose: This study aimed to investigate the association between CYP17A1 gene polymorphisms and coronary artery disease (CAD) risk in a Chinese population.

Patients and methods: A total of 2221 subjects (1363 CAD patients and 858 controls) were enrolled. Five single-nucleotide polymorphisms (SNPs) (rs11191548, rs17115100, rs4409766, rs6162, and rs6163) were genotyped. To account for multiple testing across genetic models, the false discovery rate (FDR) correction was applied. A nomogram incorporating CYP17A1 genetic variants and clinical characteristics was developed to predict CAD risk.

Results: In the overall population, preliminary association analyses identified three SNPs (rs11191548, rs17115100, rs4409766) with genotype distributions significantly different between cases and controls under recessive models. These associations remained significant after FDR correction for multiple testing across all 5 SNPs and 3 genetic models tested (all q = 0.035). Subsequent multivariate logistic regression, adjusted for clinical confounders, confirmed independent protective effects: the CC genotype of rs11191548 (OR = 0.507, 95% CI: 0.352-0.730, P < 0.001), the CC genotype of rs4409766 (OR = 0.557, 95% CI: 0.394-0.786, P = 0.001), and the TT genotype of rs17115100 (OR = 0.632, 95% CI: 0.473-0.844, P = 0.002). The integrated nomogram achieved an area under the curve (AUC) of 0.727-0.728 for CAD risk prediction. Moreover, exploratory sex-stratified analyses indicated potential sex-specific associations, with some variants linked to CAD risk in either males or females at a nominal significance level.

Conclusion: The rs11191548, rs17115100, and rs4409766 variants of the CYP17A1 gene were found to be associated with CAD in a Chinese population.

Objective: This study aimed to develop a comprehensive machine learning (ML)-based prediction model for intrahepatic cholestasis of pregnancy (IHCP) by integrating multi-modal data including demographic characteristics, laboratory biochemical indicators, and ultrasonic echocardiographic parameters. The model was designed to stratify ICP severity and remain applicable in settings lacking total bile acid (TBA) testing, which addresses current diagnostic gaps and may support the reduction of adverse perinatal outcomes.

Methods: A retrospective cohort of 750 pregnant women (525 in training, 225 in testing) between July 2020 and October 2023 from the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture was recruited for the study. Seven ML algorithms (Logistic regression, Decision Tree, Random Forest [RF], Extreme Gradient Boosting [XGBoost], Regularized Support Vector Machine [RSVM], Multilayer Perceptron [MLP], and Elastic Net [ENET]).

Results: The RF model exhibited superior performance, achieving ROC-AUC of 0.90 (training) and 0.86 (testing), with sensitivity and specificity both ≥0.93 in the testing cohort. Key predictors included pruritus, TBA, glycocholic acid, alkaline phosphatase, and ultrasonic indicators (ventricular wall mean thickness, myocardial echogenicity). Notably, the model retained efficacy without TBA, maintaining precision ≥0.75 across recall values of 0.6-0.9.

Conclusion: The multi-modal RF model effectively predicts IHCP, enables severity stratification, and enhances accessibility in resource-limited settings, providing valuable support for targeted clinical interventions and may support the reduction of adverse perinatal outcomes.

Objective: To compare the safety and efficacy of drug-coated balloon angioplasty (DCBA) versus conventional balloon angioplasty (CBA) in the treatment of autologous arteriovenous fistula (AVF) stenosis in hemodialysis (HD) patients.

Methods: A prospective observational cohort study was conducted on 189 hemodialysis (HD) patients aged 18-80 years with arteriovenous fistula (AVF) stenosis admitted to Nanjing Drum Tower Hospital Group Suqian Hospital from June 2022 to December 2024. The cohort included 107 male (56.6%) and 82 female (43.4%) patients. Patients were stratified into the conventional balloon angioplasty (CBA) group (n = 92) and the drug-coated balloon angioplasty (DCBA) group (n = 97) based on the intervention received. All patients underwent ultrasound-guided percutaneous transluminal angioplasty (PTA), with the DCBA group receiving additional paclitaxel-coated balloon dilation after conventional pre-dilatation. The primary endpoint was 6-month target lesion primary patency (TLPP); secondary outcomes included 3-month TLPP, stenotic segment diameter, HD blood flow, AVF blood flow (AVFB), serum levels of vascular endothelial growth factor-A (VEGF-A), angiotensin II (Ang II), monocyte chemoattractant protein-1 (MCP-1), and complication rates.

Results: Baseline characteristics were comparable between the two groups (all P>0.05). Clinical success rates were 100.00% in both groups. 1-month (P=0.571) and 3-month (P=0.350) TLPP showed no significant differences, but the DCBA group had a significantly higher 6-month TLPP (91.75% vs 80.43%, P=0.022). At 1 and 6 months postoperatively, the DCBA group exhibited larger stenotic segment diameter, higher HD blood flow, and higher AVFB than the CBA group (all P<0.001). Serum VEGF-A, AngII, and MCP-1 levels in the DCBA group were significantly lower than those in the CBA group at 1 and 6 months postoperatively (all P<0.001). There were no significant differences in total complication rates (17.53% vs 13.04%, P=0.350) or individual complication incidences (all P>0.05) between the two groups.

Conclusion: Our study suggests that DCBA is superior to CBA in treating AVF stenosis, as it improves long-term hemodynamic parameters, suppresses inflammatory factor levels, and enhances 6-month TLPP while maintaining equivalent safety. It may be a preferred intervention for AVF stenosis in HD patients.