International Journal of General Medicine最新文献

Background: Gastric cancer (GC) remains a major cause of cancer related mortality worldwide. Tumor mechanics, reflecting the physical and mechanical properties that influence tumor cell behavior and the tumor microenvironment (TME), play important roles in cancer progression. However, the prognostic relevance of tumor mechanics-related genes (MRGs) in GC remains unclear.

Methods: GC datasets from TCGA and GEO were analyzed to identify differentially expressed genes (DEGs). WGCNA was conducted to identify MRGs-related modules. Univariate Cox regression and three machine learning algorithms were applied to screen prognostic genes and construct a prognostic model. Pan-cancer analysis, immune infiltration, tumor mutation burden (TMB), immunophenotypic score (IPS), and somatic mutation analyses were performed to explore TME characteristics. Additionally, drug sensitivity and ceRNA network analyses were conducted. Finally, the prognostic genes were verified using RT-PCR.

Results: Eight mechanics-related genes (SERPINE1, CYP1B1, LOX, HEYL, VCAN, IGFBP7, TWIST2, and ATP1B2) were identified through integrated computational analysis. The resulting model demonstrated prognostic potential for 2-, 3-, and 5-year survival prediction. High-risk patients exhibited increased immunosuppressive infiltration compared with low-risk patients. Drug sensitivity analysis revealed significant differences in therapeutic responses across risk groups. Finally, the differential expression of several prognostic genes was preliminarily confirmed by RT-PCR in limited tissue samples.

Conclusion: This study identifies eight tumor mechanics-related genes as prognostic biomarkers for GC through comprehensive bioinformatic analyses. These findings may provide preliminary insights into prognostic assessment and targeted therapy for GC, although further validation with larger sample sizes is required to substantiate their clinical applicability.

Purpose: This study aimed to investigate the impact of shift characteristics, resident workload, and physician attributes on diagnostic expenditures in low-acuity patients (green triage category) emergency department (ED) patients.

Methods: A retrospective cross-sectional analysis was conducted in a high-volume tertiary ED over one month, including 22,427 green-triage visits managed by 71 emergency medicine residents. Resident characteristics (age, gender, seniority, shift group, post-night shift status), patient demographics, and diagnostic expenditures (laboratory, imaging, electronic medication orders, total cost) were extracted from the hospital information system. Non-parametric tests were used for group comparisons given non-normal distribution patterns, and cost determinants were analyzed using a Gamma generalized linear model with a log-link function.

Results: Diagnostic expenditures demonstrated significant variability across physician and patient characteristics. Female residents were associated with higher laboratory (1.27 vs 0.87 USD; p<0.001), imaging (1.35 vs 1.01 USD; p<0.001), and medication-order costs (p<0.001). Compared with junior residents, mid-level trainees generated the highest total expenditures, whereas senior residents exhibited a cost-attenuating effect (exp(β)=0.74). Unadjusted analyses indicated greater total spending during night shifts (2.8 USD vs 2.39-2.43 USD; p=0.011); however, after adjustment for resident- and patient-level covariates, night-shift status was associated with lower expenditures (exp(β)=0.76). Post-night-shift status independently correlated with reduced laboratory and medication-order costs. Resident workload showed a strong inverse association with expenditures, with increasing daily patient volume linked to lower total diagnostic costs (rho=-0.226; p<0.001). Among patient factors, advancing age increased total cost by approximately 6% per year (exp(β)=1.06). Repeat ED utilization emerged as the most powerful cost determinant, with each additional prior visit associated with more than a threefold increase in diagnostic spending (exp(β)>3; p<0.001). Female patients consistently incurred higher costs across all categories (p<0.001).

Conclusion: Diagnostic spending in low-acuity ED encounters is shaped by both clinical and operational dynamics. Resident workload, seniority level, and gender independently influence cost patterns, while patient age and repeat admissions are strong drivers of increased expenditures. These findings highlight several potentially modifiable determinants-particularly workload distribution and trainee supervision-that may support more cost-conscious diagnostic practices in busy emergency departments.

Background: To study the correlation analysis between serum procalcitonin (PCT) and Ankylosing Spondylitis Disease Activity Score (ASDAS) in ankylosing spondylitis (AS) patients with hip involvement.

Methods: This prospective study collected 100 r-axSpA patients and 52 healthy controls. The BASRI-hip score was used to categorize r-axSpA patients into groups with no hip involvement (BASRI-hip=0, 1), mild involvement (BASRI-hip=2), and moderate-to-severe involvement (BASRI-hip=3, 4). Clinical characteristics of the groups were compared. The correlation between PCT, ASDAS, and BASRI-hip was assessed using the Spearman correlation analysis. ROC (Receiver Operating Characteristic) curves were produced to determine the area under the curve (AUC) of PCT and ASDAS in predicting the occurrence of hip involvement and the degree of hip involvement. Factors influencing hip involvement in r-axSpA were analyzed by multifactorial logistic regression.

Results: PCT levels were higher in r-axSpA patients than in healthy controls (p < 0.001). PCT and ASDAS were higher in the group with moderate-to-severe r-axSpA hip involvement than in the group without involvement and the group with mild involvement, while mild involvement was higher than that in the group without involvement (p < 0.05). Spearman correlation showed a positive correlation between PCT, ASDAS, and the degree of hip involvement. The area under the ROC curve (AUC) of PCT, ASDAS were 0.723 and 0.754 in predicting hip involvement, respectively; and the AUC of the severity of hip involvement were 0.733 and 0.718, respectively. PCT (OR = 1.11, 95% CI 1.04-1.18, p < 0.01) and ASDAS (OR = 6.19, 95% CI 1.52-235.12, p = 0.011) were the risk factors for hip involvement.

Conclusion: PCT and ASDAS show positive correlation with hip involvement in r-axSpA, and have a certain predictive value to react to hip involvement in r-axSpA.

Purpose: Certain trace minerals, such as zinc (Zn) and magnesium (Mg), may play a role in glucose regulation and insulin signaling pathways. However, population data from the Middle East are scarce and may differ in terms of dietary and metabolic profiles from those previously studied. We examined the association of circulating and dietary Zn and Mg with prediabetes, insulin resistance, and β-cell function in Saudi adults.

Methods: A cross-sectional study of 1009 Saudi adults aged ≥ 18 years (861 participants with normoglycemia, 148 participants with prediabetes) recruited from Riyadh and Almadinah cities, Saudi Arabia. Demographic data, anthropometry, fasting glucose, insulin, serum Zn and Mg were measured. Dietary intakes were estimated from two 24-h recalls and a validated food-frequency questionnaire. Insulin resistance and β-cell function were assessed with HOMA-IR and HOMA-β. Between-group differences, partial correlations, and multivariable logistic and linear regression (adjusted for age, sex, BMI, physical activity, energy, dietary supplement use, and lipid profile) analyses were conducted.

Results: Compared to participants with normoglycemia, those with prediabetes had higher Serum Zn (119.9 ±33.5 vs 112.4 ±23.3 µg dL, P<0.001), whereas serum Mg was not significantly different. Fasting glucose, insulin, and HOMA-IR were all elevated in prediabetes (P<0.001). Low serum Mg (<1.7 mg dL) was independently associated with higher odds of prediabetes (OR =1.9, 95% CI 1.3-2.8).

Conclusion: Lower serum magnesium was linked to higher odds of prediabetes, while higher serum Zn was associated with greater insulin resistance; dietary Zn showed no significant associations. Given the low prevalence of Zn deficiency, intake-status associations may be attenuated. Mg status appears more consistently tied to glucose regulation, highlighting the need for targeted nutrition strategies and further research on zinc's metabolic role.

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.