International Journal of General Medicine最新文献

Purpose: To our knowledge, there have been no comparative studies evaluating the associations of frailty defined using the Tilburg Frailty Indicator (TFI), frailty phenotype by Fried et al, and FRAIL scale with all-cause mortality in Turkiye. In this study, we aimed to evaluate the ability of these instruments in predicting all-cause mortality in outpatients admitted to the outpatient geriatrics clinic of a university hospital.

Patients and methods: This historical prospective study was performed in the geriatrics outpatient clinic of a university hospital in Istanbul, Turkiye. Consecutive older adults (aged ≥ 70 years) who provided written informed consent were enrolled in the study. The survival status of participants was checked electronically using the official death registry system. Univariate analyses and multivariate Cox regression analyses were performed to determine the independent predictors of mortality.

Results: A total of 198 participants with a median age of 77 years were enrolled. During the median follow-up period of 2236 days, 54 (27.3%) patients died. In univariate analyses, male sex, history of falls in the previous year, dependency in instrumental activities of daily living, malnutrition, and frailty with respect to the phenotype by Fried et al, FRAIL scale, and TFI were associated with mortality. In multivariate Cox regression analyses, frailty according to each of the three frailty instruments, male sex, older age, history of falls, and malnutrition or malnutrition risk were independently associated with mortality. The Fried scale was the best frailty tool among the three frailty instruments used to predict all-cause mortality.

Conclusion: The findings of this study suggest that frailty, determined using each of the three instruments used in the present study, is independently associated with all-cause mortality in patients admitted to the outpatient geriatrics clinic of a university hospital in Turkiye. The Fried scale appears to be the best for predicting all-cause mortality.

Background: Severe sepsis is a systemic inflammatory response syndrome caused by infection, and the Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II) scoring system is widely used to assess the severity of severe patients. Hybrid blood purification treatment (HBPT) and ulinastatin (UTI) have shown good efficacy in a variety of inflammatory diseases, and miR-146a and miR-155 were found to be closely related to inflammatory reaction. The purpose of this study was to investigate the effect of HBPT combined with UTI in the treatment of patients with severe sepsis, especially the effects on APACHE II score and miR-146a and miR-155 levels.

Methods: We carried out a retrospective analysis of clinical data with severe sepsis admitted to our hospital from January 2020 to June 2022. The patients were divided into an HBPT or HBPT+UTI group according to the treatment records. The APACHE II score, miR-146a level, miR-155 level, inflammatory factors, and rehabilitation status of both groups were analyzed and compared before and after treatment.

Results: A total of 150 were included in the analysis, there were 77 participants in HBPT+UTI and 73 in HBPT group. After treatment, the APACHE II score and levels of miR-146a, miR-155, and inflammatory factors were significantly lower than that before treatment. Furthermore, the HBPT+UTI group showed significantly lower values than the HBPT group (all P < 0.05). The recovery time of serum amylase, the disappearance time of abdominal pain, and the length of hospitalization in the HBPT+UTI group were significantly shorter than those in the HBPT group (all P < 0.05).

Conclusion: UTI treatment combined with the administration of HBPT could improve the APACHE II score, alleviate the inflammatory reaction, and significantly improve the short-term prognosis of the patients with severe sepsis.

Purpose: Spontaneous pneumothorax (SP), which is usually characterized by sudden chest pain and shortness of breath, can occur at any age. In this study, patients with SP across various age groups were enrolled, and their clinical features and prognoses were compared.

Patients and methods: The patients were divided into three groups: neonates (n=52), adolescents/adults (n=76), and elderly (n=70). All patients were followed up for two years. The patients' clinical characteristics, treatments, laboratory indicators on admission, and symptoms over two years were collected and compared. Additionally, as most patients in the elderly group had chronic obstructive pulmonary disease (COPD), data about patients' lung function tests and medication were also analyzed.

Results: Compared with adolescents/adults (6.45±0.24 days), patients with SP in the neonate and elderly groups had more comorbidities, resulting in a longer hospital stay (13.85±0.34 days in neonates and 9.50±0.36 days in the elderly). The main comorbidities in the latter two groups were neonatal asphyxia (17/52) and COPD (48/70), respectively. During the two-year follow-up period, elderly patients with SP had more long-term respiratory symptoms, including coughing, expectoration, and dyspnea, than those in the other two groups. Analysis of the main subgroup (48 COPD cases) in the elderly group revealed that, in the two years after the occurrence of pneumothorax, acute exacerbation times increased; group E cases/(A+B) cases were 4/44, 4/44, 5/43, and 7/41 every 6 months respectively. Additionally, lung function indexes (FEV1, FVC, MEF_25,50,75) decreased.

Conclusion: Compared to adolescents and adults, newborn and elderly patients with SP are more prone to comorbid lung diseases and longer hospitalization times. The prognosis of neonates is significantly better than the other groups. Increased frequency of acute exacerbations and a deteriorating trend in pulmonary function were observed in patients with COPD after discharge.

Purpose: Rheumatoid arthritis (RA) is linked to cardiovascular disease (CVD), due to chronic inflammation and traditional CVD risk factors. This study evaluates CVD and related risk factors in RA patients compared to age and gender-matched controls without inflammatory diseases, and differences within RA patients with and without CVD.

Patients and methods: This retrospective case-control study reviewed medical records of 405 RA patients (cases) and 950 control patients who attended rheumatology clinics in two branches of a private hospital between January 2021 and January 2024 to assess cardiovascular disease prevalence and associated risk factors.

Results: RA patients, with a mean age of 59 (± 23) years, disease duration of 89.5 months, and a female-to-male ratio of 4:1, exhibited a higher prevalence of CVD compared to controls (p = 0.01), despite similar classical risk factors. Logistic regression identified RA as an independent risk factor for CVD (p = 0.02, odds ratio = 1.9). RA patients with CVD were typically older males (p < 0.001), presenting with higher rates of hypertension (p < 0.001), hyperlipidemia (p < 0.001), diabetes (p = 0.002), and chronic kidney disease (p < 0.001). Arrhythmias (p < 0.001) and heart failure (p < 0.001) were prevalent among this subgroup, along with elevated creatinine levels and reduced glomerular filtration rates (p < 0.001 each). Treatment patterns indicated lower use of methotrexate (p = 0.003) and higher use of leflunomide (p = 0.02) among RA patients with CVD.

Conclusion: CVD in RA patients is multifactorial, involving both chronic systemic inflammation and classical CVD risk factors. Further research is necessary to advance our understanding of CVD in RA patients and to optimize treatment strategies for improved outcomes.

Objective: Esophageal squamous cell carcinoma (ESCC) has a high incidence and mortality rate. Postoperative positive surgical margins (PSM) often correlate with poor prognosis. This study aims to develop and validate a predictive model for PSM positivity in ESCC patients, with the potential to guide preoperative planning and improve patient outcomes.

Methods: We conducted a retrospective analysis of 1776 patients who underwent esophageal cancer surgery at the First Affiliated Hospital of Jilin University between January 2015 and December 2023. Patients with visible residual tumors (R2) or microscopic residual tumors (R1) at the surgical margins were classified as having PSM. High-dimensional pathological features were extracted from digital pathological sections using CellProfiler software. The selected features were used to develop a predictive model based on decision trees and generalized linear regression, and the model was validated in an independent cohort. Clinically significant pathological factors (P < 0.05) were included in multivariate logistic regression for further validation. The model's performance was assessed using calibration curves and receiver operating characteristic (ROC) curves, generated with the Bootstrap method. Decision curve analysis (DCA) was employed to evaluate the clinical utility of the predictive model.

Results: A total of 229 patients (12.89%) were diagnosed with PSM. Logistic regression analysis identified multifocal lesions, vascular invasion, and pathomics-based features as independent predictors of PSM. The predictive model, represented by a decision tree, demonstrated good discrimination with an area under the ROC curve of 0.899 (95% CI: 0.842-0.956, P < 0.001), and a strong calibration curve between the predicted probability and the actual probability. Additionally, the nomogram demonstrated slightly inferior discrimination with an area under the ROC curve of 0.803 (95% CI: 0.734-0.872, P < 0.001) in the training cohort.

Conclusion: Our study successfully established and validated a pathology-based predictive model for PSM risk, which could enhance preoperative evaluation and inform treatment strategies for ESCC.

Purpose: This study aimed to examine the association between the systemic immune-inflammation index (SII) (ie, neutrophil count × platelet count/lymphocyte count), the age-adjusted Charlson comorbidity index (ACCI), and overall survival (OS) in non-small cell lung cancer (NSCLC) patients undergoing first-line platinum-based chemotherapy (PBC), with a particular emphasis on the role of SII in supporting ACCI.

Patients and methods: This retrospective study enrolled 353 cases treated between July 2013 and November 2020. Mann-Whitney U-test and Kruskal-Wallis test were employed to compare parameters between high and low SII groups. The cut-off values for SII and ACCI were determined using the X-tile software. Prognostic significance was evaluated through the utilization of Kaplan-Meier curves and Cox regression analysis.

Results: In a univariate Cox regression analysis, sex, age, TNM, lymph node, therapy, SII, and ACCI were associated with OS. After adjusting for confounders in the multivariate analysis, TNM, SII, and ACCI remained independent prognostic factors for OS. Furthermore, within the ACCI subgroups (ACCI<5 or ACCI≥5), a high SII was significantly associated with an increased risk of death. Patients with both a high ACCI and a high SII had the highest risk of death (p < 0.001), with a loss of approximately ten months of survival during the first three years after treatment.

Conclusion: SII was proven to be valuable in predicting OS and, when complemented by ACCI, can help tailor prognostic assessment and treatment strategies in assessing the survival of NSCLC patients with first-line PBC.

Background and objective: Raised serum glucose-phosphate ratio on admission is associated with severity and poor outcome of aneurysmal subarachnoid hemorrhage and severe traumatic brain injury. However, its role in acute ischemic stroke (AIS) remains still unknown. Therefore, this prospective study aimed to investigate the association between admission serum glucose-phosphate ratio and the severity and 1-year clinical outcome of AIS.

Methods: All the patients with AIS were enrolled from the Third China National Stroke Registry III. Participants were classified into four groups according to quartiles of admission serum glucose-phosphate ratio levels. Multiple regression models and restricted cubic splines were performed to evaluate the association between serum glucose-phosphate ratio and the severity and 1-year outcome of patients with AIS.

Results: Among the 5,541 participants, the mean age was 62.3 years, and 69.4% patients were men. As the quartiles of admission serum glucose-phosphate ratio increased, the median NIHSS score raised, the percentage of moderate and severe stroke elevated, and rates of poor functional outcomes and recurrent stroke raised at one-year follow-up. After adjusting conventional risk factors, the highest admission serum glucose-phosphate ratio-level quartile group showed an association of poor functional outcome and stroke recurrence [OR (95% CI): 1.67 (1.28, 2.17) and HR (95% CI): 1.44 (1.08, 1.92), respectively], relative to the lowest group. Restricted cubic splines showed no significant nonlinear relationship between serum glucose-phosphate ratio and adverse outcomes of AIS.

Conclusion: Admission serum glucose-phosphate ratio may be a potential blood biomarker for reflecting stroke severity, predicting poor functional outcomes, and stroke recurrence.

Objective: To explore the imaging manifestations and clinical application value of contrast-enhanced ultrasound (CEUS) in liver metastases of middle and low rectal cancer by performing CEUS in patients. Additionally, we compared the results of CEUS with those of abdominal contrast-enhanced computed tomography (CECT) to assess the reliability of diagnosing liver metastases in patients with middle and low rectal cancer.

Methods: Hepatic CEUS was performed in 1095 patients with middle and low rectal cancer, and all patients underwent abdominal CECT examinations to determine the presence or absence of liver metastases. The results of both examinations were compared to evaluate the value of hepatic CEUS for detecting liver metastases in patients with middle and low rectal cancer.

Results: Among 1095 patients with middle and low rectal cancer, 132 were diagnosed with liver metastases of middle and low rectal cancer. 130 cases of liver metastases of rectal cancer were identified using hepatic CEUS, whereas 126 cases were identified using abdominal CECT. The detection rates of hepatic CEUS and abdominal CECT for liver metastases of middle and low rectal cancer showed no statistically significant differences (P > 0.05). The Kappa value for the diagnosis of liver metastases of middle and low rectal cancer between hepatic CEUS and abdominal CECT was 0.974 (P < 0.001), indicating good consistency between the two imaging modalities in detecting liver metastases of middle and low rectal cancer.

Conclusion: Hepatic CEUS can be used to diagnose liver metastases in middle and low rectal cancer, providing crucial imaging evidence for clinical treatment planning. It exhibited higher sensitivity than that of abdominal CECT in diagnosing liver metastases of middle and low rectal cancer, enabling the identification of higher number of liver metastases of middle and low rectal cancer cases.

Objective: Intradialytic hypotension (IDH), a common complication of hemodialysis (HD), is associated with increased cardiovascular risk, morbidity, and mortality. Fatigue is one of the most frequent symptoms of IDH, and deteriorates the quality of life of patients. This study aimed to evaluate the efficacy and safety of electronic moxibustion for improving IDH and its associated symptoms.

Methods: We prospectively recruited 32 end-stage renal disease patients with IDH who underwent regular HD at our hospital's dialysis center between April 2019 and April 2020. A randomized, controlled, two-arm crossover trial was performed to evaluate the efficacy of adding one-hour electronic moxibustion during HD. The outcome measurements included patients' subjective assessment of the degree of fatigue, recovery time of fatigue from HD, cold intolerance before and after each intervention, frequency of IDH episodes and nursing interventions needed during HD, and blood pressure changes during HD.

Results: Thirty (94%) patients completed the study. Intervention with electronic moxibustion improved the degree of fatigue (95% CI, -2.95 to -0.18, p = 0.027), specifically in patients prescribed with midodrine (95% CI, -4.20 to -0.53, p = 0.013). The short-term use of electronic moxibustion during HD did not significantly alter the frequency of IDH or reduce the degree of decrease in blood pressure. Serious adverse effects were not observed. One patient complained of heat, whereas two patients had local transient erythema and pruritus.

Conclusion: Electronic moxibustion appears to be safe and efficacious for improving IDH-related fatigue, thus acting as an adjuvant therapy in HD units to enhance patient comfort and treatment adherence. Further studies with larger sample sizes are required to confirm the benefits of this novel technique.

Background and aims: Increasing interest in hypnotherapy's application for a wide range of health conditions has spurred a rise in global research and publications. This study aims to visualize development patterns and current research hotspots in clinical hypnotherapy practice using scientometric methods, and to predict future research directions based on the keyword trending topics analysis.

Methods: Data on hypnotherapy applications and mechanisms in clinical settings between 1994 and 2023 were gathered from Scopus, Web of Science, and PubMed, followed by analysis and visualization using the VOSviewer, Bibliometrix package in R, and CiteSpace.

Results: A total of 1,549 publications were examined, indicating a steady annual increase with an average growth rate of 8.5%, reaching a high of 134 publications in 2022. The United States was the primary research hub. Collectively, 1,464 distinct institutions involving 3,195 scholars contributed to this research theme. Collaboration was predominantly confined to the same country, institution, and/or research team. High-frequency keywords included "Pain", "Irritable Bowel Syndrome (IBS)", and "Anxiety". Systematic review and/or meta-analysis have emerged as favored research methods. fMRI and EEG were commonly used techniques for exploring the neuropsychological mechanisms underlying hypnotherapy. "Self-Hypnosis", "Virtual Reality", and "Meditation" were predicted as trending topics, indicating that patients' self-managed hypnosis practice, virtual reality hypnotherapy, and exploration of the variations in mechanisms between meditation and hypnotherapy might be emerging topics and/or future key research directions within the current field.

Conclusion: The use of hypnotherapy for diverse clinical issues, particularly pain, IBS, and comorbid anxiety, is garnering global attention. The evidence-based approach is widely used to assess the quality of clinical evidence for hypnotherapy. Researchers are keen on innovating traditional hetero-hypnosis, with a shift towards more cost-effective self-hypnosis and immersive virtual reality hypnotherapy. Promoting and reinforcing collaborative research efforts across countries, institutions, and teams is warranted.