International Journal of General Medicine最新文献

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.

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.