International Journal of General Medicine最新文献

Objective: To evaluate the accuracy and clinical value of endoscopic ultrasonography (EUS) in the diagnosis of gastrointestinal stromal tumors (GIST).

Methods: This single-center retrospective study analyzed 100 GIST patients at a tertiary hospital (2022.12-2025.02). Sample size was justified by pre-experimental results (EUS sensitivity 90%, MSCT 80%, α=0.05, β=0.2) to detect ≥10% diagnostic efficacy difference. All patients underwent preoperative EUS and multi-slice spiral computed tomography (MSCT) scans. The diagnostic results of EUS, MSCT, and postoperative pathology were compared. The examination time and detection status were recorded, and diagnostic performance metrics such as sensitivity and specificity, as well as the accuracy rates of localization and qualitative diagnosis, were calculated. Additionally, the imaging characteristics of EUS were analyzed.

Results: EUS was significantly superior to MSCT in sensitivity (94.92% vs 88.14%), specificity (87.80% vs 73.17%) and localization accuracy (90.00% vs 68.00%) (p<0.05). Although the EUS examination time was longer (10.11 ± 2.37 vs 5.96 ± 1.85 min, P<0.05), However, its ability to recognize the typical features of GIST (hypoechoic mass, clear boundary) is stronger, and the misdiagnosis rate is lower.

Conclusion: Clinical decisions should prioritize EUS for initial evaluation of suspected submucosal GISTs, while reserving MSCT for assessing tumor extent and metastasis, balancing diagnostic efficacy with examination time considerations.

Background: Managing pre-operative anemia is an essential element of the Enhanced Recovery After Surgery program. In developing nations, a high prevalence of pre-operative anemia and worse outcomes are predicted for patients undergoing hip arthroplasty. However, this area remains a significant research gap in these healthcare settings.

Purpose: The study aims to determine the prevalence, related factors, and outcomes of pre-operative anemia in hip arthroplasty patients.

Methods: This retrospective observational study used descriptive statistics to determine the prevalence of pre-operative anemia and employed multivariable logistic regression to identify its associated factors. Propensity score matching (PSM) was applied to reduce confounding before outcome comparisons, with inverse probability of treatment weighting (IPTW) used as a sensitivity analysis. The primary outcome was post-operative complications, with secondary and tertiary outcomes focusing on infection conditions, length of stay, clinical symptoms, and care demands.

Results: The study involved 769 patients, with a pre-operative anemia prevalence of 41.1%. Pre-operative factors related independently to anemia included aging, body mass index, creatinine levels, hip fractures, hyponatremia, and atrial fibrillation. After PSM, those with pre-operative anemia had significantly higher rates of post-operative composite complications (37.6% and 25.9%, p=0.017), infection complications (22.8% and 11.2%, p=0.003), urinary tract infections (10.2% and 3.6%, p=0.017), and sepsis (14.2% and 6.1%, p=0.012). Additionally, these patients experienced post-operative anemia (89.8% vs 74.6%, p<0.001), a higher need for blood transfusions (44.7% vs 10.7%, p<0.001), and a longer post-operative length of stay (7.2 vs 6.8 days, p<0.001). These findings remained consistent after IPTW adjustment.

Conclusion: In our setting, pre-operative anemia is highly prevalent among patients undergoing hip arthroplasty and is associated with adverse post-operative outcomes. Therefore, this study emphasizes the need to identify these patients as high risk for post-operative complications.

Introduction: Postoperative hypothermia is a common complication following abdominal surgery under general anesthesia. It is associated with delayed recovery, increased postoperative complications, and prolonged hospitalization. However, comprehensive research on its risk factors remains limited. This study aimed to identify key perioperative factors associated with postoperative hypothermia to guide prevention strategies.

Methods: This retrospective cohort study included 256 patients who underwent abdominal surgery under general anesthesia. Patients were categorized into a hypothermia group (core temperature < 36°C, n = 66) and a normothermia group (n = 190) based on postoperative core temperature measured upon PACU admission. Demographic data, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, anesthesia details, surgical duration, ventilation time, warming measures, baseline temperature, blood loss, and postoperative surgical site infection were collected. The hypothermia group was further divided into mild (≤ 2 episodes) and severe (> 2 episodes) subgroups based on hypothermia frequency within 24 hours postoperatively. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors.

Results: Age, BMI, duration of anesthesia and surgery, absence of prewarming, blood loss, transfusion, and surgical site infection were significantly associated with postoperative hypothermia in univariate analysis. Multivariate analysis confirmed that BMI, lack of prewarming, and blood loss were independent predictors of postoperative hypothermia.

Conclusion: Postoperative hypothermia after abdominal surgery is influenced by multiple perioperative factors. Strategies targeting modifiable risk factors-particularly prewarming, temperature monitoring, and optimization of intraoperative blood loss-may reduce hypothermia incidence and support improved postoperative recovery.

Objective: To develop an interpretable machine learning model for predicting arteriovenous fistula (AVF) stenosis in hemodialysis patients using inflammatory biomarkers and identify key influencing factors.

Methods: A retrospective cohort study was conducted on 974 end-stage renal disease patients undergoing hemodialysis with AVF at The Central Hospital of Wuhan (2017-2024). Clinical data (demographics, comorbidities, inflammatory markers) were collected. After data preprocessing (imputation, normalization, feature selection), eight machine learning models including Logistic Regression (LR) were built and validated via 10-fold cross-validation. SHAP (SHapley Additive Explanations) was used to interpret model outputs.

Results: The LR model outperformed others with an AUC of 0.833 (95% confidence interval [CI]: 0.796-0.868), an accuracy of 0.782 (95% CI: 0.751-0.811), and an F1 score of 0.756 (95% CI: 0.718-0.791). Key factors associated with AVF stenosis included AVF surgical history, thrombosis history, comorbidities, smoking, alcohol consumption, monocyte-to-high-density lipoprotein cholesterol ratio (MHR), and platelet-to-high-density lipoprotein cholesterol ratio (PHR) (p < 0.05). SHAP visualization showed these factors significantly impacted model predictions, with MHR/PHR correlating with reduced stenosis risk when elevated.

Conclusion: The LR model based on inflammatory biomarkers effectively predicts AVF stenosis. Integrating SHAP (SHapley Additive Explanations) values enhances the interpretability of the model, thus providing a practical tool for clinical risk stratification and early intervention of AVF stenosis in hemodialysis patients.

Purpose: Crescentic glomerulonephritis (GN) is a rapidly progressive kidney disease associated with a high risk of end-stage renal disease (ESRD). This study aimed to assess whether systemic inflammation and nutritional status, as measured by the systemic immune-inflammation index (SII) and prognostic nutritional index (PNI) at diagnosis, can predict one-year renal survival in patients with crescentic GN.

Methods: This retrospective study included 82 adult patients with biopsy-proven Type 1 or Type 3 crescentic GN. Baseline SII and PNI were calculated from pre-treatment blood samples. Clinical, laboratory, and histopathological data were collected. Patients were followed for 12 months and classified into two groups based on the development of ESRD.

Results: The cohort (63.4% male) had a mean age of 53.65 ± 15.87 years; 26 patients (31.7%) progressed to ESRD. Multivariate analysis identified elevated SII [OR: 1.79; 95% CI: 1.22-18.81; p = 0.03], low PNI [OR: 0.92, 95% CI: 0.96-0.99; p = 0.03], hypoalbuminemia [OR: 0.36, 95% CI: 0.15-0.84; p = 0.02], reduced estimated glomerular filtration rate [OR: 0.93, 95% CI: 0.88-0.98; p = 0.009], anemia [OR: 0.37; 95% CI: 0.22-0.63; p < 0.001], higher crescent ratio [OR: 1.05, 95% CI: 1.02-1.09; p = 0.02], and plasmapheresis requirement [OR: 0.074, 95% CI: 0.016-0.349; p = 0.001] as independent predictors of ESRD. Receiver operating characteristic analysis determined cutoff values of 176.38 for SII (area under the curve [AUC]: 0.679, p = 0.01) and 31.88 for PNI (AUC: 0.650, p = 0.03). Glomerulosclerosis ratio and interstitial fibrosis/tubular atrophy were not independently associated with ESRD (p = 0.13 and p = 0.14, respectively).

Conclusion: SII and PNI are independent but moderate predictors of one-year renal survival in crescentic GN. Incorporating these readily available biomarkers with histological evaluation may enhance risk stratification and help guide early, aggressive immunosuppressive therapy.

Purpose: To compare the clinicopathologic characteristics, Multi-slice Spiral CT (MSCT) vascular features, and angiogenesis profiles among mucinous gastric carcinoma (MGC), gastric carcinoma with <50% extracellular mucin pool (LEMPC), and non-mucinous gastric carcinoma (NMGC), and to explore imaging-angiogenesis associations underlying subtype-specific enhancement patterns.

Patients and methods: Clinical, radiological, and pathological data from patients with MGC, LEMPC, and NMGC were analyzed in a three-group comparative design. Microvessel density (MVD) and the expression of vascular endothelial growth factor A (VEGF-A), hypoxia-inducible factor-1 alpha (HIF-1α), and epidermal growth factor (EGF) were evaluated by immunohistochemistry in cancerous and corresponding paracancerous normal tissues. Correlations between MSCT features and histopathological parameters were assessed.

Results: Overall survival was lower in the MGC group than in the NMGC group (P = 0.021). Enhanced MSCT demonstrated significant intergroup differences in maximum tumor diameter, mucosal integrity, calcification, and enhancement parameters (including range, features, maximum value, and ratio), with MGC more frequently showing intact mucosal lines, calcifications, and layered enhancement. Angiogenesis-related assessments showed lower MVD in MGC than in NMGC (P < 0.001). VEGF-A and EGF expression in cancerous tissues was lower in MGC / LEMPC than in NMGC (P = 0.002, P < 0.001), while HIF-1α expression was similar across all groups. These findings paralleled the lower MSCT enhancement indices observed in MGC.

Conclusion: MGCs, marked by poor differentiation and poor prognosis, exhibit intact mucosal lines, frequent calcification, and stratified enhancement on enhanced MSCT. Reduced MSCT enhancement indices are associated with low angiogenesis, concomitant with decreased VEGF-A and EGF expression.

Objective: Effectively managing postprandial blood glucose is significant for impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM). We developed a streamlined and real-world framework and evaluated how meal timing and staple food type affect postprandial glycemic responses (PPGRs) and the influencing factors on inter-individual differences of PPGR.

Materials and methods: We conducted a prospective observational study involving 33 patients with IGT and T2DM. Over a 1-week free-living period, participants completed 7 standardized meal tests: glucose solutions at breakfast, lunch, and dinner; steamed bread, rice, noodles, and oats at lunch. Linear mixed-effects models were used to compare PPGR differences of meal timing and staple food type effects. Linear regression models were applied to explore factors influencing inter-individual heterogeneity in PPGRs.

Results: Participants deemed the framework simple and well tolerated. Meal timing had no significant effect on PPGR at 120 minutes (time effect P = 0.110) or 180 minutes (time effect P = 0.097). HOMA-IR was positively associated with the meal timing variability index (adjusted: β = 9.10, 95% CI: 3.01-15.20, P = 0.005). Staple food types affected 120- and 180-minute incremental area under the curve (iAUC), relative peak glucose, and glucose fluctuation amplitude (staple food type effect P < 0.001), but had no significant effects on time to peak or coefficient of variation (staple food type effect P > 0.05). Those born in northern China had a significantly higher refined staple food sensitivity index (adjusted: β = 267.14, 95% CI: 59.18-475.09, P = 0.014).

Conclusion: The framework enables convenient, outpatient-based assessment of PPGRs and is highly acceptable to patients. We need to focus not only on the group-level general characteristics of PPGRs but also analyze their individual-level heterogeneity; this emphasizes the critical role of personalized nutrition.

Background: Fear of progression (FoP) is one of the most prevalent psychological responses among patients with chronic kidney disease (CKD), impairing mental health and quality of life. However, research on the heterogeneity of illness perceptions among CKD patients remains limited, and the relationship between distinct perception profiles and FoP is not yet well understood. This study aimed to identify latent profiles of illness perception in CKD patients and examine their associations with FoP.

Methods: In this cross-sectional study, a total of 428 CKD patients were recruited from four tertiary hospitals through convenience sampling between May 1, 2023, and April 30, 2024. Participants completed questionnaires assessing demographic and clinical characteristics, illness perception, FoP, psychological flexibility, family resilience, and social support. Latent profile analysis was conducted to identify illness perception profiles, multinomial logistic regression was used to examine predictors of profile membership, and stratified regression analyses were performed to assess the associations between illness perception profiles and FoP.

Results: Latent profile analysis identified three distinct illness perception profiles. Multinomial logistic regression analysis indicated that CKD stage, number of concomitant symptoms, psychological flexibility, family resilience, and social support significantly predicted the latent profiles of illness perception (P < 0.05). Stratified regression analysis further demonstrated that illness perception profiles were independently predicted FoP after controlling for key demographic and clinical variables.

Conclusion: CKD patients exhibit heterogeneity in illness perception. Illness perception profiles were associated with FoP. Distinct illness perception profiles are associated with FoP, and are influenced by key psychosocial factors. These findings support the development of tailored, perception-based interventions to reduce FoP among CKD patients.

Introduction: Although catheter ablation is a cornerstone in arrhythmia management, hospital readmissions, emergency room (ER) visits, and complications remain a significant clinical burden. Defining their frequency and predictors is essential to optimize patient follow-up and outcomes after ablation.

Methods: To evaluate the rates and predictors of 90-day hospital readmissions and emergency room visits following catheter ablation, as well as procedure-related complications, among patients undergoing catheter ablation, a retrospective cohort study was conducted at King Abdulaziz Cardiac Center (Riyadh, Saudi Arabia), including adult patients undergoing catheter ablation between June 2022 and June 2024. Data were extracted from BestCare electronic medical records and analyzed using Fisher's exact tests and logistic regression.

Results: Among 176 patients, 13 (7.4%) were readmitted and 23 (13.1%) visited the ER, predominantly due to arrhythmia recurrence (61.5% and 60.9%, respectively). Recurrent events occurred in a subset of patients and were significantly more frequent among older individuals and those with a higher comorbidity burden (p<0.01).

Conclusion: Ninety-day readmissions and ER visits after catheter ablation were infrequent, mostly due to arrhythmia recurrence. Independent predictors included older age and comorbidity burden, underscoring the need for risk stratification and structured follow-up strategies to reduce preventable healthcare utilization.

Purpose: This study aimed to identify the current status and barriers to exercise rehabilitation among Chinese patients with acute musculoskeletal injury.

Patients and methods: This single-center, sequential explanatory mixed-methods evaluation included a quantitative survey and qualitative semi-structured interviews. The quantitative survey was distributed online to patients who had acute musculoskeletal injury within five years. For the qualitative component, patients and their families, as well as physiotherapists, orthopedic surgeons, coaches, and personal trainers were recruited. Interview guides were inductively developed and revised based on data analysis. Thematic analysis was conducted using the Capability, Opportunity, and Motivation Behavior model.

Results: Among 284 participants, only 65.1% visited the hospital, 22.9% sought rehabilitation services, and 6.0% completed training after injury. The most common reasons for not going to the hospital (92.9%) or rehabilitation department (70.1%) was underestimation of the injury severity. However, one year after injury, 65.7% still experienced abnormalities at the injury sites, and 46.9% had changed their sport habits. In total, 23 participants were interviewed. Barriers of exercise rehabilitation included patient's lack of knowledge about the requirement of exercise rehabilitation guidance and instruction from orthopedic surgeons, difficulty with mobility and enough time, insufficient number of qualified physiotherapists or clinics, underestimation of injury severity, low expectation of rehabilitation, and cost reasons.

Conclusion: This study provides novel evidence on systemic and behavioral barriers to exercise rehabilitation in China, supporting efforts in education for both orthopedic providers and patients, expanding the workforce of qualified specialists, and integrated referral and remote-supervision models.