International Journal of General Medicine最新文献

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.

Objective: The postoperative prognosis (ie pregnancy and recurrence) of patients with intrauterine adhesions(IUA) has always been a concern for women of childbearing age, and there is a lack of prevention and treatment strategies. This study aimed to develop an IUA pregnancy and recurrence (IUA-PR) prediction model to guide clinical decision-making.

Materials and methods: A retrospective analysis was conducted on 387 patients diagnosed with IUA between January 2021 and December 2023. Radiomic features were extracted from ultrasound images using manually designed feature sets, and peripheral blood parameters were integrated with these radiomic features to construct a classification model. The least absolute shrinkage and selection operator (LASSO) combined with the Bayesian information criterion (BIC) was employed to identify nonzero-coefficient features from the radiomic dataset. The predictive efficacy of the developed model was systematically evaluated via the area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA).

Results: A total of five peripheral blood inflammatory indices and six ultrasound radiomic parameters were finally used to construct the IUA-PR prediction model. Among them, the nomogram constructed based on platelet/lymphocyte ratio(PLR), neutrophil/lymphocyte ratio(NLR), aggregate index of systemic inflammation(AISI), ultrasound radiomic score (Rad-score), and postoperative menstrual status showed an AUC of 0.886 for predicting pregnancy outcomes. Additionally, the recurrence prediction model established with systemic inflammatory response index(SIRI), systemic immune-inflammation index(SII), Rad-score, and postoperative menstrual status achieved an AUC of 0.720 in the testing set.

Conclusion: We have successfully developed the IUA-PR prediction model constructed based on peripheral blood inflammatory parameters and ultrasound radiomics. Renowned for its convenience and low cost, this model, particularly the generalized linear regression model, exhibits superior predictive performance in forecasting postoperative pregnancy and recurrence, thereby assisting patients in guiding their postoperative fertility decisions.

With the growing number of elderly patients undergoing surgical procedures, the use of neuromuscular blocking agents (NMBAs) in geriatric anesthesia has become increasingly relevant. Aging is associated with physiological and pathological changes that affect drug pharmacokinetics and pharmacodynamics, including reduced renal and hepatic function, altered body composition, and decreased plasma protein levels. These changes influence the onset, duration, and recovery from neuromuscular blockade, increasing the risk of postoperative residual curarization (PORC) and respiratory complications. This narrative review summarizes current knowledge on the use of depolarizing and non-depolarizing NMBAs in elderly patients, including benzylisoquinolines (atracurium, cisatracurium, mivacurium) and aminosteroids (rocuronium, vecuronium, pancuronium, pipecuronium). Age-related differences in drug metabolism, distribution, and elimination are discussed, along with the clinical implications for dosing, recovery, and safety. The role of reversal agents, including neostigmine and sugammadex, is emphasized, highlighting their efficacy and safety profiles in older adults. Special attention is given to neuromuscular monitoring, particularly objective quantitative methods as a critical tool to prevent residual blockade. Individualized management strategies, careful agent selection, and vigilant monitoring are essential to optimize safety and outcomes in elderly patients. Despite age-related pharmacological changes, appropriate use of short-acting or organ-independent NMBAs, combined with reversal agents and neuromuscular monitoring, allows for effective and safe anesthesia in the geriatric population. Future research should focus on large-scale studies to better define age-specific NMBA dosing and monitoring guidelines.

Objective: This study investigates the potential of the pan-immune-inflammatory value (PIV) as a predictive indicator for myocardial infarction (MI) risk in unstable angina pectoris (UAP) patients and its association with major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI).

Methods: UAP patients diagnosed with MI underwent PCI and were monitored for MACE, including mortality, recurrent MI, revascularization, cerebrovascular accidents, and heart failure admissions. Clinical profiles and PIV levels were recorded. Multivariate logistic regression and receiver operating characteristic (ROC) analyses were conducted to identify variables associated with MI and MACE risk.

Results: MI patients had higher PIV (409.07 ± 127.63 vs 284.44 ± 126.96 × 10^{1 8}/L², P < 0.001) and LDL-C (2.91 ± 1.04 vs 2.31 ± 1.06 mmol/L, P < 0.001) levels. Both PIV (OR = 1.008, P < 0.001) and LDL-C (OR = 1.694, P < 0.001) were significant predictors of MI. ROC analysis showed that PIV had stronger discriminatory capacity (AUC = 0.755) than LDL-C (AUC = 0.661), with their combined model improving predictive performance (AUC = 0.787). In PCI-treated MI patients, those developing MACE had higher PIV (452.66 ± 105.24 vs 378.45 ± 133.53 × 10^{1 8}/L², P = 0.001) and TC levels (4.84 ± 0.39 vs 4.66 ± 0.42 mmol/L, P = 0.010). Both TC (OR = 3.337, P = 0.007) and PIV (OR = 1.005, P = 0.001) were independently associated with MACE. The combined model (AUC = 0.721) outperformed individual markers.

Conclusion: PIV is independently associated with MI risk in UAP patients and MACE following PCI. Combining PIV with lipid markers may enhance clinical risk assessment and inform management strategies.

Objective: This study analyzes the value of serum Gasdermin D (GSDMD) as a novel biomarker for the early diagnosis and disease progression of heart failure.

Methods: We conducted a retrospective analysis of clinical data and laboratory results to compare the GSDMD levels among the heart failure group, other cardiac disease group, and healthy control group. We investigates the correlation between GD and other indicators, as well as the independent risk factors for heart failure. Receiver operating characteristic (ROC) curve analysis was conducted to compare the diagnostic value of serum GSDMD, N-terminal pro-B-type natriuretic peptide (NT-ProBNP), ejection fraction (EF) in patients.

Results: There were statistically significant differences in serum GSDMD, EF and other laboratory tests among the three groups (P<0.05). Among heart failure patients with different cardiac function classifications, the serum levels of NT-ProBNP, GSDMD increased with the increase in cardiac function classification. Serum GSDMD was correlated with all indicators (P<0.05) in subjects. Serum GSDMD and NT-ProBNP were independent risk factors while EF was an independent protective factor for heart failure. The AUCs of serum GSDMD, NT ProBNP, and EF for diagnosing heart failure were 0.819, 0.970, and 0.831, respectively, while the AUC of their combined diagnosis of heart failure was 0.986.

Conclusion: This study suggests that Serum GSDMD, as a novel sensitive biomarker, has the potential for early diagnosis and disease progression assessment of heart failure.

Purpose: Iron deficiency anemia (IDA) is a major public health concern. Intravenous (IV) iron supplementation serves as an effective alternative when oral iron therapy fails or is not tolerated. This study aimed to evaluate the efficacy, safety, and impact on quality of life of ferric carboxymaltose in the treatment of IDA.

Methods: In this prospective observational study conducted between June 2023 and February 2025, a total of 528 patients with IDA-unresponsive or intolerant to oral iron-received IV ferric carboxymaltose. Doses were calculated using the Ganzoni formula. Hematological parameters and quality of life were assessed pre- and 30 days post-treatment using laboratory tests and the WHOQOL-BREF questionnaire. Adverse events were recorded during a 30-day follow-up.

Results: The mean age was 41.56 ± 12.33 years, with 92.4% female participants. Hemoglobin increased from 9.17 ± 1.36 to 13.12 ± 0.82 g/dL, and ferritin exhibited a substantial rise from 6.23 ± 4.38 to 178.91 ± 123.99 ng/mL (both p < 0.001). Mild side effects occurred in 11.36% of cases; no serious adverse events were observed. Significant improvements were recorded in physical and psychological domains of quality of life (p < 0.001). Hypophosphatemia was more frequent in patients receiving > 1750 mg of iron and with pre-treatment phosphorus levels < 3.05 mg/dL.

Conclusion: IV ferric carboxymaltose is a safe and effective therapy for IDA, offering rapid hematological recovery and improved quality of life. However, hypophosphatemia remains a concern at higher doses, warranting close monitoring and further investigation.