International Journal of General Medicine最新文献

Purpose: This retrospective study aimed to evaluate the efficacy of ulinastatin in the treatment of COVID-19 patients compared to conventional therapy.

Patients and methods: A total of 437 COVID-19 patients admitted to the Respiratory Oncology Department of our hospital between December 31, 2022, and July 8, 2023, were included in the study. Patients were classified into the observation group (n=62) receiving ulinastatin in addition to standard treatment and the control group (n=347) receiving standard treatment only. Clinical information, laboratory results, and treatment outcomes were collected and analyzed.

Results: The observation group showed an improvement in lymphocyte count compared to the control group. The clinical improvement rate in patients receiving ulinastatin for 7 days or longer was 92.1%, significantly higher than that of patients treated for less than 7 days (62.5%) and those receiving standard treatment (71.0%). No significant difference in total length of hospitalization was observed between the two groups, and no related adverse events occurred in either group.

Conclusion: Ulinastatin treatment improves lymphocyte counts in severe COVID-19 patients, and the clinical improvement rate is significantly higher with treatment duration of 7 days or longer. Larger-scale randomized controlled trials are warranted to further explore the role of ulinastatin in the management of COVID-19.

Objective: To investigate the associations of anemia-related parameters, with in-hospital mortality after acute coronary syndrome (ACS), as well as factors associated with prior anemia (PA) and hospital-acquired anemia (HAA) in patients with ACS.

Methods: This was a retrospective cohort study conducted between June 2021 and May 2023. The data of patients diagnosed with ACS who were hospitalized and treated in our hospital were recorded, including age and sex, smoking and comorbidity status, laboratory findings, CHA2DS2-VASc scores, prior medication use, left ventricular ejection fraction, ACS type, the synergy between percutaneous intervention with taxus drug-eluting stents and cardiac surgery (SYNTAX) scores, stent thrombosis status and mortality status. Mortality was assessed according to in-hospital death. Patients were grouped based on anemia presence (PA and HAA).

Results: A total of 329 patients were included in the study. Of these, 219 (66.56%) were in the no anemia group, 58 (17.63%) in the PA group, and 52 (15.81%) in the HAA group. The mean age of all participants was 61.27±12.45 years and 76.29% of them were male. 14 (4.26%) patients died during hospitalization. Multivariable logistic regression analysis had revealed that, prior coronary artery disease (OR: 3.779, 95% CI: 1.141-12.508, p=0.030), PA (OR: 7.043, 95% CI: 1.574-31.517, p = 0.011), HAA (OR: 5.857, 95% CI: 1.260-27.236, p=0.024) and high WBC (OR: 1.190, 95% CI: 1.028-1.378, p=0.020) were independently associated with the increased risk of in-hospital mortality.

Conclusion: Consequently, the risk of in-hospital mortality is higher in patients with a previous history of coronary artery disease, PA, HAA and high WBC, and additional precautions should be taken in these patients.

Purpose: Tuberculosis meningitis (TBM) has emerged as the most lethal type of disease. The prognosis of meningitis is often related to disease severity and early therapeutic intervention.

Methods: Patients were screened for primary TBM and received a quadruple regimen comprising isoniazid (standard dose of 300 mg/day and high dose of 600 mg/day), rifampin, ethambutol, and pyrazinamide. Further, the indices and prognosis factors of diseased patients were analyzed, using 12-month treatment mortality as the primary observation endpoint. Several predictors included demographic data, clinical presentation, ancillary tests, treatment changes, and isoniazid dose. The data were analyzed using a least absolute shrinkage, the selection operator regression, and multi-factor logistic regression.

Results: Among the selected TBM patients (n=119), 18 patients were dead at the end of December. A total of 68 influencing factors were screened, in which 5 clinical factors were included as potential prognostic factors, including older age, presence of nausea, high MRC grade, imaging suggestive of cerebral infarction, and dose of isoniazid (300 mg/day). The AUC value was recorded as 0.8316832. The validation set confirmed the model's robustness, with an AUC of 0.887 and good calibration performance. These findings highlight the model's potential for clinical application in optimizing isoniazid dosing. The model demonstrated the advantage of predicting the therapeutic outcome of patients.

Conclusion: In summary, the model could be suitable for evaluating the risk of death within 12 months in TBM patients towards assessing the severity and treatment needs of patients. The isoniazid dose is an important factor affecting the prognosis of these patients.

Background: This research utilized a combination of gene databases associated with ferroptosis and online gene expression data from ischemic stroke samples to pinpoint ferroptosis-related genes (FRGs) in ischemic stroke cases.

Methods: By employing Random Forest (RF) and Support Vector Machine (SVM) models based on these genes, an overlap of genes from both models was identified as "Hub" genes. Through consensus clustering analysis using Hub genes, two distinct clusters of FRGs were revealed in ischemic stroke samples. Examination of the correlation between these molecular subtypes and the immune microenvironment highlighted a close link between gene expression levels and immune cell infiltration. Significantly different gene expression and functions within the FRG clusters underscored the pivotal role of Hub genes in the immune microenvironment. A gene diagnostic model related to ferroptosis was developed and validated to elucidate the significance of the identified genes.

Results: The results demonstrated that the Hub gene-based classification model effectively differentiated between ischemic stroke patients and normal samples, achieving an AUC of 0.900, signifying clinical relevance.

Conclusion: This study successfully identified ferroptosis-related genes in ischemic stroke, offering insights that could contribute to the formulation of future comprehensive treatment approaches.

Aim: Tracheotomy has become more prevalent in clinical settings, and effectively managing postoperative complications plays a crucial role in determining patient outcomes. However, there is a scarcity of clinical research focusing on the development of intratracheal granuloma after tracheotomy, and there is insufficient theoretical support for early detection in clinical settings. This study investigates the relationship between clinical factors and the occurrence and location of intratracheal granuloma.

Methods: Clinical parameters from 872 patients who underwent tracheotomy between January 1, 2010, and December 30, 2018, were collected from the Hospital Information System. A retrospective analysis was conducted, focusing on factors such as age, gender, smoking history, comorbidities, primary lesion location, benign versus malignant primary disease, pulmonary infection, duration of tracheal intubation prior to tracheotomy, surgical method and other factors.

Results: Intratracheal granuloma was observed in 50 (5.73%) cases of all tracheotomy patients. Factors such as smoking history, primary lesion location, and pulmonary infection were associated with the occurrence of intratracheal granuloma. Additionally, multivariate logistic regression identified smoking, pulmonary disease and pulmonary infection as independent risk factors for the development of intratracheal granuloma following tracheotomy. Regarding the location of the granuloma, 42 cases (84%) were found in the proximal trachea, while the remaining cases were located in the distal trachea. Univariate analysis indicated that age, gender, smoking history, and primary lesion location were related to the location of intratracheal granuloma. The median interval between the detection of intratracheal granuloma and tracheotomy was 52 days.

Conclusion: Considering the occurrence and location of intratracheal granulomas following tracheotomy, along with the associated risk factors outlined above, it is imperative that clinicians give these issues due attention in practice. Furthermore, approximately 50% of intratracheal granulomas develop within 52 days post-tracheotomy, offering valuable insights for clinicians in formulating effective follow-up strategies.

Objective: To retrospectively compare the efficacy of Sacubitril/Valsartan and Benazepril in the treatment of heart failure in patients following acute myocardial infarction.

Methods: A retrospective analysis of clinical data was conducted for 103 patients with heart failure following acute myocardial infarction admitted to our hospital from January 2021 to January 2024. All patients met complete inclusion and exclusion criteria. Based on the treatment interventions received, they were divided into a control group (n=51) and an observation group (n=52). All patients received percutaneous coronary intervention (PCI) and conventional drug treatment upon admission. The control group received additional treatment with benazepril, while the observation group received Sacubitril/Valsartan on top of the baseline treatment. A comparison was made between the two groups in terms of clinical treatment outcomes, cardiac function indicators [left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDD), left ventricular ejection fraction (LVEF)], levels of inflammatory markers [high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6)], N-terminal pro-B-type natriuretic peptide (NT-proBNP), incidence of adverse reactions, major adverse cardiac events (MACEs), and 6-minute walking distance (6MWD).

Results: No patients were lost to follow-up. After six months of treatment, the observation group demonstrated significantly greater improvements in left ventricular function parameters (LVESV, LVEDD, and LVEF) and reductions in inflammatory markers (hs-CRP, IL-6) and NT-proBNP levels compared to the control group (P < 0.05). The observation group also had a significantly lower incidence of major adverse cardiac events (MACEs) (11.54% vs 31.37%, P < 0.05) and a greater improvement in 6-minute walking distance (P < 0.05). The incidence of adverse reactions was comparable between the two groups (P > 0.05).

Conclusion: Sacubitril/Valsartan is a safe and effective treatment for heart failure post-AMI, offering significant improvements in cardiac function, inflammatory response, exercise capacity, and a reduction in MACE risk.

Purpose: Aplastic anemia (AA) is a bone marrow failure syndrome with an unclear pathogenesis. Abnormal T cell immunity is one of the mechanisms involved in AA, and CD3ζ is an important signaling molecule for T cell activation. Single-nucleotide polymorphisms (SNPs) in CD3ζ 3'-untranslated region (3'-UTR) were associated with some immune-related disease occurrence and affect CD3ζ protein level. In this study, our aim was to analyze whether CD3ζ 3'-UTR SNPs were associated with AA susceptibility and had influence on CD3ζ protein level and provide new research data for exploring the pathogenesis of aplastic anemia.

Patients and methods: We screened the genotypes of SNPs in 101 healthy individuals and 91 AA patients by PCR-RFLP and sequencing. In addition, the effect of specific CD3ζ 3'-UTR SNPs was analyzed by flow cytometry and dual luciferase assay.

Results: Four SNPs of CD3ζ 3'-UTR, 1184 C >G (rs3738212), 1292 delG (rs3831958), 1403 G >C (rs1052230) and 1410 A >T (rs1052231) were identified from Chinese healthy individuals and AA patients in which rs3738212 was not previously reported. Increased risk of AA was observed in female AA who with heterozygous genotype of linkage disequilibrium SNP (rs3831958, rs1052230 and rs1052231). Different genotypes of rs3738212 have sex-biases feature in AA, higher 1184 CC frequency in male AA and higher 1184 CG frequency in female AA. Furthermore, rs3738212 could upregulate CD3ζ protein level.

Conclusion: This study first identified sex-specific CD3ζ 3'-UTR SNPs that were associated with risk of AA. Our data also demonstrated that rs3738212 could upregulate CD3ζ protein level.

Background: Blood flow restriction training (BFRT) can produce effects similar to high-intensity exercise at lower intensities, making it a potentially more suitable method for older adults with sarcopenia. This study aims to determine the efficacy of the intervention on improving physical fitness in older adults with sarcopenia when blood flow restriction (BFR) and aerobic exercise (AE) are combined (BFR-AE) and to explore the related metabolic and signaling mechanisms.

Methods: This is a three-arm, parallel, randomized controlled trial. A total of 171 participants, aged 60 to 90 years, with sarcopenia will be randomly assigned (1:1:1) into one of three groups: a control group, an AE group, and a BFR-AE group. The participants in the control group will maintain their usual diet and activity habits. Those in the AE and BFR-AE groups will undergo a 12-week program of AE and BFR-AE respectively. The primary outcomes will include two long-term indicators: the 6-minutes walking test and 30-s chair stand test. Secondary outcomes will include additional long-term measures (eg, appendicular skeletal muscle mass index, handgrip strength, five-time chair stand test, lower extremity knee extensor and flexor muscle strength, sleep quality, emotion status, serum metabonomic and signal proteins), as well as instantaneous indicators (eg, blood pressure, heart rate, saturation of pulse oxygen, rating of perceived exertion, pain score and blood lactate concentration), adherence to exercise, and adverse events. Outcomes will be assessed at one of or all the time points of baseline, 12 and 24 weeks.

Discussion: It is expected that, after 12 weeks of intervention, both exercise groups will show improvements in cardiorespiratory and muscular fitness, with the BFR-AE group demonstrating greater benefits than the AE group alone.

Objective: We assessed the predictive value of blood neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) in predicting the onset of acute kidney injury (AKI) in sepsis patients in the intensive care unit (ICU).

Methods: In this retrospective analysis, we examined the medical records of sepsis patients admitted to the ICU. After ICU admission, blood samples were taken at 0 h, 6 h, 12 h, 24 h, and 48 h. Using an enzyme-linked immunosorbent assay, the concentrations of serum creatinine, NGAL, and IL-18 were determined.

Results: This study comprised a total of 197 participants, 104 of whom had AKI and 93 of whom did not. Blood concentrations of NGAL and IL-18 increased prior to serum creatinine levels. Between 6-48 hours after ICU administration, NGAL and IL-18 levels in the AKI group were considerably higher than those in the non-AKI group, and creatinine levels between the two groups were significantly different after 48 hours. Based on receiver operating characteristic (ROC) curve analysis, the area under the curve of NGAL and IL-18 for predicting AKI was 0.781 and 0.883, respectively.

Conclusion: Blood NGAL and IL-18 are potential biomarkers for the early prediction of AKI in sepsis patients in the ICU.