International Journal of General Medicine最新文献

Background: Hemoglobin H (Hb H) disease is a common type of α-thalassemia, characterized by anemia caused by abnormal hemoglobin synthesis, and its hematological phenotype show significant heterogeneity. The purpose is to explore the relationship between genotypes and hematological parameters in Hb H disease, in order to provide scientific basis for the prevention and treatment of Hb H disease.

Methods: A total of 497 Hb H disease patients at Meizhou People's Hospital from December 2016 to December 2023, were retrospectively analyzed. Genotype testing was performed to determine the types of α-thalassemia and β-thalassemia. The hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and hemoglobin electrophoresis results of the patients were collected to evaluate their hematological manifestations. The relationship between genotypes and hematological manifestations was analyzed.

Results: There were 449 (90.3%) cases with deletional Hb H disease and 48 (9.7%) with non-deletional Hb H disease. The detection rate of Hb H was higher in patients with non-deletional Hb H disease than in those with deletional Hb H disease (73.8% vs 66.8%). The proportion of severe anemia in patients with Hb H disease combined with β-thalassemia was lower than that of patients with isolated Hb H disease (11.1% vs 26.9%). Non-deletional Hb H disease exhibited more severe anemia compared to those with deletional Hb H disease (low Hb, p=0.002), accompanied by significantly higher MCV (p<0.001) and MCH (p=0.001). The degree of microcytosis and hypochromia in Hb H disease patients without β-thalassemia is less severe than that in patients with β-thalassemia.

Conclusion: Non-deletional Hb H disease exhibited higher detection rate of Hb H and proportion of severe anemia, and patients with --^SEA/α^CSα have the highest proportion of severe anemia. There are differences in the genotypes distribution of Hb H disease among different populations.

Background: Sepsis patients face a high risk of myocardial injury, which increases the risk of death. Therefore, the rapid and accurate assessment of myocardial injury risk is crucial for improving prognosis.

Objective: To construct and validate a risk prediction model for sepsis-induced myocardial injury (SMCI).

Methods: Patients were randomly assigned to a training cohort and an internal validation cohort in a 7:3 ratio. Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression were used to identify independent predictors for the construction of a nomogram. The model's discrimination, calibration, and clinical applicability were evaluated using area under curve (AUC), Hosmer-Lemeshow tests, decision curve analysis (DCA) and clinical impact curve (CIC). Meanwhile, internal validation was conducted.

Results: The study included 370 patients, with 262 in the training cohort and 108 in the validation cohort. 3 independent risk factors were identified, including Log myoglobin (Myo), Log B-type natriuretic peptide (BNP), and Log interleukin-6 (IL-6) and a nomogram incorporating these factors was constructed. The AUC in the training and validation cohorts was 0.856 and 0.853, respectively. The Hosmer-Lemeshow test indicated good calibration in both cohorts, while DCA and CIC demonstrated strong clinical applicability.

Conclusion: The nomogram based on Log Myo, Log BNP, and Log IL-6 may serve as a practical tool for the early identification of high-risk patients by facilitating the rapid calculation of SMCI risk.

Alzheimer's disease (AD) is a central nervous system disorder marked by the extracellular accumulation of β-amyloid (Aβ) plaques in the cerebral cortex and the intracellular aggregation of hyperphosphorylated tau protein, manifesting as progressive cognitive decline and neurodegeneration. The pathological mechanisms of AD are intricate, in clinical treatment, cholinesterase inhibitors have been widely used for many years as symptomatic therapy, alleviating symptoms by improving neurotransmitter levels, but they cannot halt disease progression. Anti-Aβ monoclonal antibodies belong to disease-modifying therapies, although they have achieved breakthrough advances in recent years, strict monitoring requirements must be followed. In recent years, numerous studies have revealed a "U-shaped" association between uric acid (UA) levels and AD risk, along with population heterogeneity. Furthermore, fluctuations in UA levels exert a "bidirectional effect" on AD. At physiological concentrations, UA may confer neuroprotective benefits through antioxidant activity, inhibition of neuroinflammation, preservation of the blood-brain barrier (BBB), regulation of autophagy, and promotion of the clearance of Aβ and tau proteins. Conversely, abnormal UA levels may accelerate AD progression by inducing oxidative stress, activating inflammatory responses, and compromising the BBB. We conducted a comprehensive literature review across multiple medical databases, including PubMed, Embase, Cochrane Library, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), and Wanfang Data. The selected articles underwent critical evaluation, summarization, and incorporation into this review to highlight research achievements in this domain. This narrative review summarizes current pharmacological treatments for AD and UA, encompassing traditional Chinese medicine (TCM) monomers, compounds, and Western medications. It also thoroughly explores and elucidates the complex mechanism underlying the "bidirectional effect" of UA levels and metabolic pathways on AD, offering insights and theoretical support for future AD drug development.

Tinnitus is a prevalent condition often associated with hearing loss. Tinnitus may persist throughout an individual's life and can result in a range of negative outcomes, including annoyance, anxiety, depression, insomnia, heightened auditory sensitivity, difficulties with concentration, and, in severe cases, suicidal ideation. Although not all individuals experiencing tinnitus require medical intervention, approximately 20% of them pursue clinical assistance. In addition to lidocaine, no pharmacological agents have demonstrated sustained efficacy in the management of tinnitus. Traditional Chinese Medicine (TCM) has shown promise for alleviating tinnitus. Consequently, this review aimed to synthesize the latest findings from both animal and clinical studies, while also examining the potential for comprehensive treatment approaches for tinnitus using TCM based on the understanding of its pathophysiology and neuroimaging mechanisms.

Purpose: Enhancing community knowledge about risk factors and warning signs for stroke and heart attack is important for effective prevention and control. This study evaluated the effects of home-based health education and healthy lifestyle interventions delivered by community health workers (CHWs) on knowledge of risk factors and warning signs for stroke and heart attack.

Patients and methods: We conducted a 1:1 cluster-randomized trial in twelve villages in rural Morogoro, Tanzania. Participants in the intervention received monthly home-based health education and healthy lifestyle promotion from CHWs for 6 months, followed by bi-monthly follow-up visits until 12 months. Participants in the control group followed the standard of care. Knowledge regarding risk factors and warning signs for stroke and heart attack was assessed through two independent cross-sectional surveys, one before and another after the intervention. The analyses were adjusted for baseline factors.

Results: Both intervention and control groups experienced an increase in mean knowledge scores between baseline and evaluation survey, with a significant increase in the intervention group. Mean knowledge for risk factors increased by 4.0 (SD 2.7) in the intervention compared to 2.5 (SD 3.1) in the control group. That of warning signs increased by 3.1 (SD 2.4) in the intervention group compared to 2.4 (SD 2.8) in the control group. Overall, mean knowledge of risk factors and warning signs increased by 7.1 (SD 4.3) in the intervention group and by 4.9 (SD 5.3) in the control group. After adjusting for selected baseline characteristics, participants in the intervention group experienced a 2.1 greater increase in mean knowledge of risk factors and warning signs [difference in differences 2.1 (95% CI, 1.4 to 2.8)].

Conclusion: CHWs' home-delivered health education and healthy lifestyle promotion interventions resulted in a significant enhancement in knowledge of risk factors and warning signs for stroke and heart attack. These findings provide insight into the potential of CHW-led interventions in the prevention and control of stroke and heart attacks in Tanzania.

Clinical trial registration: Pan African Clinical Trial Registry (PACTR201801002959401).

The gut microbiota, often termed the "second genome", demonstrates profound therapeutic potential through its intricate biological network connecting multiple distal organs. Although microbial diversity is strongly correlated with intestinal health, its systemic implications on overall physiological homeostasis remain incompletely understood. This review synthesizes the latest evidence from clinical trials, randomized controlled trials (RCTs), systematic reviews, and meta-analyses to elucidate the biological pathways and therapeutic applications of the gut-liver axis. Through comprehensive schematic illustrations, we delineate the molecular mechanisms underlying bidirectional gut-liver communication, including microbial metabolite signaling, immune modulation networks, and enterohepatic circulation dynamics. Although interventional studies have confirmed the beneficial physiological effects of microbial modulation, current mechanistic insights are predominantly derived from animal models with limited clinical translation. While large-scale cohort studies with long-term follow-up data remain imperative, the existing evidence strongly supports the clinical value of microbiome-targeted strategies for treating hepatic diseases and related complications. These findings establish a critical theoretical framework for the development of next-generation microbial therapeutics targeting the gut-liver axis. The novelty of this review lies in its systematic classification of gut microbiota and their metabolites in the pathogenesis and treatment of various liver diseases, its detailed elaboration on signaling pathways, and its dedicated focus on the role of Traditional Chinese Medicine (TCM) in modulating the gut-liver axis.

Purpose: The lactate-to-albumin ratio (LAR) has recently emerged as a significant predictor of 28-day mortality in sepsis. This study aims to determine the prognostic value of LAR for 28-day mortality and identify prognostic models for sepsis patients.

Patients and methods: A prospective study was conducted on patients admitted to the Intensive Care Unit at Thong Nhat Hospital, Vietnam. The study included patients aged 16 years and older diagnosed with sepsis according to the Sepsis-3 consensus guidelines. The primary outcome was all-cause mortality within 28 days from the time of sepsis diagnosis. Multivariable logistic regression estimated odds ratios (ORs). Bayesian model averaging (BMA) was used to identify candidate models. Discrimination was evaluated by the area under the curve (AUC), and calibration was assessed.

Results: This study included 170 participants with a median age of 73 years and a male predominance (54.1%). The overall 28-day mortality rate was 57.6%. The median LAR was 2.2, with a statistically significant difference between the survival and mortality groups (p < 0.001). Multivariate logistic regression analysis revealed that LAR was independently associated with 28-day mortality (OR, 2.74; 95% CI, 1.09-6.86; p = 0.017). The AUC for LAR was 0.81 (95% CI 0.75-0.87; p < 0.001) with a cut-off point of 1.2 (sensitivity 91%, specificity 57%). BMA identified three clinically applicable models: LAR combined with age and respiratory infection (AUC 0.855), LAR combined with respiratory infection (AUC 0.839), and LAR combined with age and respiratory infection and SOFA score (AUC 0.864). Internal validation also represented the stability and reproducibility of these models with AUC 0.848, 0.836, and 0.854, respectively.

Conclusion: In this single-center cohort, higher LAR was independently associated with 28-day mortality, and BMA identified simple LAR-based models with good internal discrimination and calibration. These findings require further external validation before routine clinical implementation.

Objective: To evaluate the necessity of routine nasobiliary cholangiography (NBC) after Endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones (CBDS) by comparing outcomes between patients with and without post-ERCP NBC.

Methods: Consecutive patients who underwent ERCP with CBDS extraction between January 2021 and June 2024. We compared the outcomes of patients who underwent NBC versus those who did not receive NBC after ERCP for CBDS extraction. The primary outcome was the incidence rate of residual stones (detected within≤6 months). Secondary outcomes included recurrence of CBDS (more than 6 months), hospitalization duration, antibiotic use duration, and overall cost. Multivariate logistic regression was used to identify independent predictors, reported with odds ratios (ORs) and 95% confidence intervals (CIs).

Results: The overall residual stone rate was 5.2% (16/308). The residual stone rate was 7.1% (10/141) in the NBC group, compared to 3.6% (6/167) in the no-NBC group, with no statistically significant difference between the groups (p=0.168). Post-ERCP NBC significantly increased costs (p<0.01). Large stone diameter (OR=5.48, 95% CI: 1.16-25.87) was an independent predictor for residual stones.

Conclusion: Routine NBC after ERCP for CBDS may not be necessary as it did not reduce residual stone rates but increased costs. NBC should be considered selectively for patients with large stone diameter (>11.06 mm) or multiple stones.

Gastric Antral Vascular Ectasia (GAVE) is a rare but clinically significant cause of chronic gastrointestinal bleeding and transfusion-dependent anemia, particularly in older women. Patients with comorbidities, such as cirrhosis, chronic kidney disease, or autoimmune disorders, are at risk of developing GAVE. Pharmacological therapies demonstrate limited efficacy in the management of GAVE. They are primarily utilized as a temporary measure, serving as a bridge to definitive therapy. Additionally, these agents may be considered for patients with contraindications to endoscopic or surgical interventions. Endoscopic therapy remains the first-line approach for GAVE. Among the available modalities, argon plasma coagulation (APC) and endoscopic band ligation (EBL) are most widely employed due to their proven effectiveness and safety profiles. However, both APC and EBL recurrence rates remain high, especially in diffuse or severe cases. Radiofrequency ablation (RFA) has emerged as a promising alternative, particularly for recurrent cases; however, long-term outcomes require further validation. Surgical interventions (eg, antrectomy) are reserved for refractory cases but carry higher risks.

Background: Sepsis patients face a high risk of new-onset atrial fibrillation (NOAF), which increases mortality. Thus, it is significant to construct a risk prediction model for early risk stratification.

Objective: To construct and validate a risk prediction model for NOAF in sepsis.

Methods: A total of 423 sepsis patients were randomly divided into training (n=299) and validation (n=124) cohorts. Predictors were selected using least absolute shrinkage and selection operator (LASSO) regression, and independent risk factors were identified by multivariate logistic regression to construct a nomogram. Model performance was assessed by the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow test, and calibration curves. Clinical utility was evaluated using decision curve analysis (DCA) and clinical impact curves (CIC).

Results: Log interleukin-6 (Log IL-6), blood urea nitrogen (BUN), and heart rate (HR) were identified as independent risk factors for NOAF. The nomogram demonstrated strong discriminative ability, with AUCs of 0.925 in the training cohort and 0.866 in the validation cohort. Calibration was good in both cohorts, and DCA and CIC indicated favorable clinical utility across a range of threshold probabilities.

Conclusion: A risk prediction model incorporating Log IL-6, BUN, and HR effectively could predict NOAF in sepsis patients, with good discrimination, calibration, and potential clinical applicability for early risk identification. However, prior to further clinical application, additional multicenter, prospective studies are required for external validation.