International Journal of General Medicine最新文献

Background: This study aimed to construct machine-learning models for prediction of severe dysphagia after ischemic stroke based on clinical features and identify significant clinical predictors.

Methods: Patients hospitalized with dysphagia after ischemic stroke in Affiliated Hospital of Jiangnan University were retrospectively analyzed and randomly divided into training and validation sets at a ratio of 7:3. Additional patients from Huai'an Hospital were selected as test set. 19 relevant clinical characteristics were collected. According to the water swallowing test (WST), patients were divided into severe dysphagia group and non-severe dysphagia group. K-nearest neighbor (KNN), decision tree (DT), random forest (RF), support vector machine (SVM), light gradient boosting machine (LGBM), and extreme gradient boosting (XGBoost) were applied to predict severe dysphagia. Receiver operating characteristic (ROC) curves were plotted, the area under the ROC (AUC) was calculated to assess predictive power, and DeLong's test was used to compare the AUCs among six models. Finally, an optimal model was obtained, and significant clinical predictors of severe dysphagia after stroke were screened.

Results: A total of 724 patients were enrolled, 422 in training set, 182 in validation set and 120 in test set, respectively, with no statistically differences in baseline information (P>0.05). In the training set, the AUCs of KNN, DT, RF, SVM and XGBoost were higher than that of LGBM (P<0.05). In the validation and test sets, the AUCs of XGBoost were also higher. The performance metrics of XGBoost were better in terms of accuracy, precision, recall, and F1-score. Therefore, XGBoost was the best model, with good clinical practicality. Furthermore, the top five features based on XGBoost were NIHSS score, BI, BMI, age and time since stroke onset.

Conclusion: Among all clinical feature-based machine-learning models for the prediction of severe dysphagia after ischemic stroke, XGBoost had the best predictive value.

Purpose: To evaluate the effectiveness and safety of anticoagulation regimens in COVID-19 critically ill patients with new-onset Atrial fibrillation (Afib) during their intensive care unit (ICU) stays.

Methods: A multicenter, retrospective cohort study included critically ill patients with COVID-19 admitted to the ICUs. Patients with new-onset Afib were categorized into two groups based on anticoagulation doses (Prophylaxis vs Treatment). The primary outcome was the bleeding rate; other outcomes were considered secondary. Logistic, negative binomial regression, and Cox proportional hazards regression analyses were applied as appropriate after PS matching.

Results: A total of 107 patients were eligible. After PS matching (1:1 ratio), 56 patients were included in the final analysis. A higher odd for major and minor bleeding were observed in the patients who received treatment doses of anticoagulation; however, it did not reach the statistically significant (OR 1.46; 95% CI 0.29, 7.42; P=0.65 and OR 2.04; 95% CI 0.17, 24.3; P=0.57, respectively). The hospital length of stay and in-hospital mortality showed no differences between the two groups (beta coefficient -0.00; CI -0.38, 0.37; P=0.99 and HR 1.12, 95% CI 0.58-2.14; p = 0.74, respectively). On the other hand, patients in the treatment group had a statistically significant higher requirement of RBCs transfusion than patients who received a prophylaxis dose (beta coefficient 1.17; 95% CI 0.11, 2.22, P=0.03).

Conclusion: The use of treatment anticoagulation doses in COVID-19 critically ill patients with new-onset Afib did not show better effectiveness over prophylactic anticoagulation doses; however, patients who received treatment anticoagulation doses had higher RBCs transfusion requirements. Our results must be cautious; thus, larger randomized interventional studies with a larger sample size are required to confirm our findings.

Purpose: Conventional cardiovascular risk factors may contribute to the development of valvular heart disease (VHD). The present study sought to investigate the distribution of conventional modifiable cardiovascular risk factors (smoking, hypertension, hyperlipidemia, and diabetes) in various VHDs, the impact of risk factors on outcomes, and the prognostic indicators in patients with distinct burdens of risk factors.

Patients and methods: The study included 11862 patients with moderate or greater VHD. The primary outcome was a composite of all-cause mortality, hospitalization for heart failure, and myocardial infarction within two years.

Results: Of 11862 patients with VHD, the mean age was 61.77 ± 13.51 years, and 44.4% were female. The prevalences of smoking, hypertension, hyperlipidemia, and diabetes were 14.9%, 45.0%, 13.4%, and 14.5% in the total cohort. Patients with zero, one, two, three, or four risk factors accounted for 39.4%, 38.2%, 17.7%, 4.3%, and 0.3%, respectively. The number of conventional risk factors was independently associated with two-year outcome in patients with mitral regurgitation (MR; three/four vs zero: hazard ratio [HR, 95% confidence interval (CI)]: 1.600 [1.106-2.315], P = 0.013; two vs zero: HR [95% CI]: 1.153 [0.867-1.532], P = 0.328; one vs zero: HR [95% CI]: 0.892 [0.687-1.159], P = 0.393). Stratified by the etiology of mitral valve lesions, each one risk factor increase was independently related to a 17.3% higher risk of adverse events in secondary MR. In patients with three or four risk factors, females had a significantly poorer outcome than males (P = 0.002).

Conclusion: More than one of five VHD patients had at least two conventional cardiovascular risk factors. The increasing number of risk factors indicated poor prognosis in patients with significant MR. Optimizing risk factor control may improve secondary prevention as well as long-term outcomes of VHD.

Purpose: The aim of this study is to investigate the underlying molecular mechanism of oxidative stress (OS) involved in aortic dissection (AD).

Methods: Datasets of AD and OS-related genes were obtained from the Gene Expression Omnibus (GEO) and the GeneCards database, respectively. Differential expression analysis and weighted gene correlation network analysis (WGCNA) were employed to screen genes. After enrichment analysis, a protein-protein interaction (PPI) network was constructed, and machine learning algorithms were used to determine signature genes. Comprehensive bioinformatics analyses on the signature genes were executed, and a clinical prediction model was established and evaluated. External datasets, in vitro experiment, and Mendelian randomization (MR) analysis were applied to validation.

Results: We identified CCL2, ITGB4, MYC, SOCS3, SPP1 and TEK as OS-related signature genes in AD. The area under the ROC curve of all the signature genes was greater than 0.75. The clinical prediction model based on the signature genes showed satisfactory diagnostic efficacy in both training and validation cohorts. In validation cohort and in vitro experiment, CCL2, MYC, SPP1 and TEK were further validated. However, the MR results showed no causal association between the expression of the signature genes and AD.

Conclusion: This study demonstrated that OS participates in and affects the progression of AD. Six biomarkers associated with OS could be perceived as crucial targets for the diagnosis and treatment of AD.

Diabetic kidney disease (DKD) is a form of kidney damage resulting from diabetes and represents a common, severe complication of the disease. Globally, DKD is a leading cause of chronic kidney disease (CKD). DKD occurs in both type 1 and type 2 diabetes patients, with early clinical manifestations including microalbuminuria and hypertension. As the condition progresses, symptoms such as massive proteinuria, hypoalbuminemia, and severe edema may appear. The key to treating DKD lies in controlling blood glucose and blood pressure, reducing proteinuria, and slowing the deterioration of kidney function. Acupuncture, a traditional Chinese medicine treatment, has shown some therapeutic effects on DKD through mechanisms such as regulating blood glucose, improving renal blood flow and microcirculation, antioxidation and anti-inflammation, and modulating gut microbiota.

Background: Intestinal obstruction (IO) is a surgical emergency with high morbidity and mortality. The leading causes in adults include adhesions, incarcerated hernias, and tumors.

Methods: This three-year retrospective study reviewed adult patients with IO treated at Mogadishu Somalia Turkey Training and Research Hospital from June 1, 2019, to June 1, 2022.

Results: Of the patients studied, 67% were male, with a male-to-female ratio of 2:1. The most common symptoms were nausea and vomiting (93.2%), abdominal distension (90.2%), and inability to pass stool or gas (70.8%). Surgical management was required for 95.1% of patients, with only 4.9% managed conservatively. The most frequent postoperative complication was surgical site infection. Hospital stays for 52% of patients ranged from 8 to 14 days. The overall mortality rate was 4.9%.

Discussion: IO remains a critical surgical emergency worldwide, requiring urgent intervention. Aggressive treatment of hernias and timely surgical intervention for mechanical obstruction are essential to reduce complications and mortality. Delayed presentations contribute to higher mortality rates.

Conclusion: Small bowel obstruction was more frequent than large bowel obstruction, with fibrous adhesions and incarcerated hernias as the leading causes. Adhesiolysis and bowel resection with anastomosis were the most common surgical procedures. Further research using prospective study designs is recommended to improve understanding and outcomes.

Purpose: Obstructive Sleep Apnea Syndrome (OSAS) is considered a notable independent risk factor for cardiometabolic disorders. The current study aimed to investigate the efficacy of new anthropometric indices, A Body Shape Index (ABSI) and the Body Roundness Index (BRI), in assessing cardiovascular risk (CVR) and cardiovascular disease (CVD) among OSAS patients and to compare them with traditional indices.

Materials and methods: The records of 281 patients who consulted our sleep center were retrospectively reviewed. Patients were categorized according to OSA severity using AHI values. They were also classified based on cardiovascular conditions (CVR and CVD). ABSI, BRI, and traditional indices [such as body mass index (BMI), neck circumference (NC)] of the patient groups were evaluated.

Results: Of the 281 patients recruited, 218 (77.6%) were diagnosed with OSAS. The distribution of cardiovascular conditions among the OSAS patients was: CVD (20%), CVR (39.8%), and control (40.2%). The new index BRI (Odds ratio-OR: 2.641, 95% CI: 1.24-5.62) has shown better predictive ability for CVR compared to traditional measures, while NC (OR: 1.320, 95% CI: 1.09-1.60) was the only predictor of CVD. Additionally, the BRI had a higher AUC value (0.656) than traditional indices in terms of diagnostic performance in distinguishing CVR. Another new index ABSI was not found to be significant in evaluating cardiovascular conditions.

Conclusion: BRI, one of the new indices, is a useful anthropometric parameter in the CVR assessment of OSAS patients, offering better predictive ability than traditional measurements.

Objective: The objective of this study is to examine the correlation between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune inflammation index (SII), systemic inflammation response index (SIRI) and pan-immune-inflammation value (PIV) with the outcome following 3 months of thrombolysis in individuals diagnosed with acute ischemic stroke.

Methods: A retrospective analysis was conducted on a cohort of 762 patients who received intravenous thrombolysis between January 2019 and December 2022. The values of NLR, PLR, LMR, SII, SIRI and PIV were calculated based on relevant blood indices obtained upon admission. Logistic regression analysis using R software was employed to examine the correlation between SIRI, SII, PIV, and poor prognosis following 3 months of thrombolysis, with their distribution analyzed across the study population and various outcomes. Receiver operating characteristic (ROC) curves were utilized to analyze and evaluate their predictive efficacy for adverse outcomes.

Results: The unfavorable prognosis group exhibited significant differences from the favorable prognosis group in various hematological markers, including PLR, NLR, LMR, SII, SIRI, and PIV, as indicated by ROC values of 0.613 (95% confidence interval (CI), 0.564-0.661), 0.707 (95% CI, 0.663-0.751), 0.614 (95% CI, 0.567-0.662), 0.715 (95% CI, 672-0.758), 0.631 (95% CI, 0.584-0.679), and 0.569 (95% CI, 0.520-0.619) respectively. (4) Conclusions: PLR, NLR, LMR, SII, SIRI, and PIV demonstrated associations with adverse outcomes at the 3-month mark in patients who underwent intravenous thrombolysis, with NLR (ROC is 0.707) and SII (ROC is 0.715) showing the most pronounced significance and PIV (ROC is 0.569) exhibiting the least significance.

Objective: To enhance the understanding of rhabdomyolysis (RM) caused by snakebites and to promptly identify and intervene in the risk factors associated with RM.

Methods: A retrospective analysis involving 209 snakebite victims who visited our hospital for snakebite cases was conducted. Among these, 43 were related to RM, while 166 did not exhibit RM (NRM). The clinical characteristics, treatment, and prognostic outcomes of both groups were statistically analyzed, with the aim of interpreting the risk factors associated with snakebites concurrent with RM through logistic regression analysis.

Results: Snakebite incidents commonly manifest during the summer and autumn seasons, predominantly affecting middle-aged and elderly populations, with injuries mostly occurring in the limbs. Creatine kinase (CK), CK isoenzyme MB, and lactate dehydrogenase indicators exhibited significantly elevated levels in the RM group compared to the NRM group (P < 0.05). Moreover, the RM Group displayed heightened susceptibility to complications such as osteofascial compartment syndrome, multiple organ dysfunction (MODS), acute kidney injury, etc. (P < 0.05). Debridement and blood purification procedures were more frequently administered to the RM group in comparison to the NRM group (P < 0.05). Notably, visitation beyond 6 hours post-bite and hemoglobin levels below 90 mg/dl emerged as independent risk factors for those with RM following snakebites, while female gender and albumin levels >40 g/L were identified as protective factors against such occurrences.

Conclusion: Snakebite victims with RM have more severe clinical conditions, necessitating prolonged treatment duration, and exhibit heightened mortality rates in comparison to those without RM.

Purpose: Ulcerative colitis (UC) is an idiopathic, chronic inflammatory disease that primarily affects the large intestine. Coagulation abnormalities have been detected in UC patients. This study aimed to evaluate coagulation-related parameters in patients with UC.

Patients and methods: A total of 364 UC patients were analyzed with 163 female and 201 male. Disease activity was determined according to the Truelove and Witts criteria. The fibrinogen (FIB), D-dimer, fibrin/fibrinogen degradation products (FDP), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were evaluated.

Results: We found higher D-dimer, FDP, FIB levels in severe UC compared with non-severe patients.The area under the curve (AUC) of D-dimer was 0.852 (95% CI 0.805 to 0.898) and the optimum cut-off point was 0.585, with a sensitivity of 80.6% and a specificity of 78.9%. Furthermore, D-dimer and FIB are positively correlated with ESR and CRP levels.

Conclusion: Our results indicate that D-dimer, FDP, and FIB levels are potential biomarkers for disease severity in UC patients.