International Journal of General Medicine最新文献

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.

Background: Acute primary angle closure (APAC) is a leading cause of irreversible blindness. Recent studies suggest lens zonular laxity plays a critical role in APAC pathogenesis, though its clinical detection remains challenging due to overlapping symptoms with cataract. This study investigates the prevalence of subclinical zonular degeneration in APAC patients and its correlation with ocular biometric parameters.

Methods: This retrospective cohort study included 65 APAC patients (mean age 62.3 ± 8.7 years) undergoing phacoemulsification at Zibo Central Hospital (November 2021-May 2023). Patients were stratified into three groups based on intraoperative zonular status: normal zonula (APAC-NZ, n=14), mild zonular laxity (APAC-ZL, n=39), and significant zonular laxity (APAC-SZL, n=12). Preoperative axial length (AL), lens thickness (LT), and anterior chamber depth (ACD) were measured using IOLMaster 5.0 and swept-source UBM.

Results: A high prevalence (78.5%, 51/65) of undiagnosed zonular degeneration was observed. Significant differences were found in sitting ACD (2.25 ± 0.17 mm vs 1.75 ± 0.19 mm), supine ACD (1.72 ± 0.11 mm vs 1.27 ± 0.12 mm), and LT (5.10 ± 0.28 mm vs 5.41 ± 0.38 mm) between APAC-NZ and APAC-SZL groups (P<0.05). Similar differences were noted between APAC-SZL and APAC-ZL groups (P<0.05).

Conclusion: This study introduces a novel stratification of APAC patients by zonular laxity severity and reveals distinct biometric profiles across subgroups. We demonstrate a high prevalence of undiagnosed zonulopathy in APAC patients, associated with thicker lenses and shallower anterior chambers. A key limitation is the subjective classification of zonular laxity, based solely on intraoperative observations. Future studies should develop objective imaging protocols for improved detection and management.

Background: Extubating from mechanical ventilation is crucial in acute respiratory distress syndrome (ARDS). Heparin-binding protein (HBP) has been closely linked to ARDS development. We aimed to evaluate the association between HBP trajectories and extubation outcomes in ARDS patients.

Patients and methods: This was a retrospective study of ARDS patients who were ready for extubation. Group-based trajectory modeling was applied to identify subgroups with similar HBP trajectories in this cohort. Logistic regression was used to elucidate the relationship between different trajectories and extubation success.

Results: Overall, this study enrolled 267 patients from September 2023 to March 2025. Five HBP trajectories were identified including traj1 (HBP stable at extremely low level), traj2 (HBP stable at low level), traj3 (HBP descending from a high level to a low level), traj4 (HBP stable at moderate level), and traj5 (HBP stable at high level). The rates of successful extubation were 86.27%, 61.91%, 71.11%, 50.00%, and 40.98% respectively (P < 0.001). In addition, Logistic regression indicated that patients in traj2, traj3, traj4, and traj5 was associated with significantly decreased extubation success compared to those in traj1 group (odd ratio [OR] = 0.239, 95% confidence interval [CI]: 0.091-0.630; OR = 0.195, 95% CI: 0.054-0.706; OR = 0.143, 95% CI: 0.056-0.368; OR = 0.081, 95% CI: 0.030-0.220, respectively).

Conclusion: In mechanically ventilated ARDS patients, distinct HBP trajectories demonstrate significant associations with extubation outcomes, suggesting their potential utility in refining extubation protocols in critical care settings.

Bee venom (BV) is a promising candidate against breast and lung, including leukemia. Leukemia is a malignancy related to blood cells that causes abnormal production of leukocytes (WBCs) from bone marrow (BM). Leukemia requires a multimodal treatment approach, including stem cell transplantation, immunotherapy, and chemotherapy. Due to several limitations of current therapies such as drug resistance, severe side effects, high costs, limited targeted treatment options, age-related restrictions, after treatment defects, and the genetic heterogeneity of leukemia, there is a need to explore alternatives such as BV, either as whole or its component(s), or its use in conjugation with other treatments. BV's components such as melittin, found as 40-60% of BV's dry mass, exhibit anti-cancer activity such as pro-apoptotic, anti-proliferative, and cell membrane disruption. BV is a potent inducer of apoptosis, while inhibiting cell survival processes such as the Akt/ERK. BV can be considered as the potent anti-leukemia candidate. Various studies have demonstrated BVs effectiveness on leukemia cell lines such as HL-60, K562, Jurkat cell line, U937 cells, CCRF-CEM, K562, THP-1 cell lines, in a dose-time-cell line-dependent manner. This review aims to comprehend the current research assessing the effectiveness of apitherapy in leukemia through in vitro studies. The limitations of present studies and future possibilities exploring the synergistic effect of BV with the conventional treatments and targeted delivery of BV aimed at enhancing the effectiveness of treating leukemia are also highlighted.

Background: There is significant heterogeneity in the proportion of molecular subtypes of endometrial cancer and its relationship with clinicopathological characteristics among different races and regions. It aims to analyze the differences in the clinicopathological characteristics of different molecular subtypes of endometrial cancer in Eastern Guangdong Province, China.

Methods: Five hundred and sixty-three endometrial cancer patients in Meizhou People's Hospital from January 2018 to August 2024 were collected. The relationship of molecular subtypes (DNA polymerase epsilon (POLE) mutant, mismatch repair deficiency (dMMR), p53 abnormal, and non-specific molecular profile (NSMP)) and clinicopathological characteristics (age, reproductive history, menopausal status, and pathological data covered histological type, tumor differentiation, muscular infiltration, lymphovascular invasion, perineural invasion) were analyzed.

Results: The molecular subtypes dMMR, p53 abnormal, POLE mutant, and NSMP were detected in 197 (35.0%), 155 (27.5%), 52 (9.2%), and 159 (28.2%) patients, respectively. There were statistically significant differences in distributions of histological types (p = 0.012, χ²= 14.073), tumor differentiation (p < 0.001, χ²= 16.457), and disease stage (p = 0.019, χ²= 9.796) in NSMP and non-NSMP cases. The proportion of POLE mutant in endometrioid carcinoma was higher than those of other histological types, while the proportion of p53 abnormal was relatively high in high-grade and highly invasive histological types. The proportion of p53 abnormal subtype was relatively high among patients with mixed carcinoma. In addition, the proportions of poor tumor differentiation in the dMMR and p53 abnormal groups were higher than that in the NSMP group.

Conclusion: The distribution of molecular subtypes among patients with different histopathological types shows significant differences. The proportion of POLE mutant type in endometrioid carcinoma is higher than that of other histological types, while the proportion of p53 abnormal type is relatively high in high-grade and highly invasive histological types such as serous carcinoma and clear cell carcinoma. It provides valuable reference for guiding the diagnosis and treatment of endometrial cancer by integrating molecular subtypes with clinicopathological characteristics.

Background: Chronic periodontitis (CP) and non-alcoholic fatty liver disease (NAFLD) are increasingly prevalent worldwide. Although mechanisms remain incompletely defined, recent studies suggest a close association between these two diseases. This review systematically outlines potential links between periodontitis and NAFLD, emphasizing their pathological mechanisms and interactions within an oral-gut-liver framework.

Methods: We reviewed observational, interventional, and mechanistic studies evaluating associations between periodontal status/treatment and NAFLD-related outcomes, integrating evidence on dysbiosis, inflammatory mediators, microbial metabolites, oxidative stress, microRNA regulation, and gut barrier function.

Results: Across epidemiological studies, periodontitis is associated with higher risk and greater severity of NAFLD. Mechanistically, oral dysbiosis, especially enrichment of oral pathobionts, is linked to hepatic steatosis and fibrosis. Translocation of microbial products and the resulting cytokine release drive systemic inflammation, impair gut barrier integrity, and induce hepatocellular injury. Microbial metabolites (such as short-chain fatty acids (SCFAs) and trimethylamine N-oxide (TMAO)) and oxidative stress contribute to metabolic dysregulation. Emerging evidence suggests that microRNAs (miRNAs) function as epigenetic regulators linking periodontal inflammation and bone remodeling to immune-metabolic pathways relevant to non-alcoholic fatty liver disease (NAFLD). However, direct evidence on whether treating periodontitis can improve NAFLD outcomes remains limited. Despite heterogeneity in study designs and diagnostic criteria, cumulative evidence supports periodontitis as a modifiable risk factor for the progression of NAFLD.

Conclusion: CP and NAFLD appear to be linked through systemic inflammation, dysbiosis, and metabolic disturbances. Future research should prioritize microbiome modulation, advance interdisciplinary care models, and develop personalized prevention and treatment strategies. Integrating oral and liver health within comprehensive management may provide new options for preventing and treating these frequently coexisting diseases.

Purpose: This study aimed to identify key risk factors and develop an explainable machine learning (ML) model for predicting early dysphagia in patients with acute ischemic stroke (AIS).

Patients and methods: In this cross-sectional study, 1041 patients with AIS were recruited from two tertiary hospitals. Participants were classified into a non-dysphagia group (n = 736) and a dysphagia group (n = 305). Feature selection was carried out using the Boruta algorithm and logistic regression. The dataset was randomly partitioned into a training set (n = 728) and a test set (n = 313) in a 7:3 ratio. Six ML models were trained with 10-fold cross-validation. Model performance was evaluated based on the area under the receiver operating characteristic curve (AUC-ROC), sensitivity, specificity, accuracy,positive predictive value (PPV), negative predictive value (NPV), F1-score and Youden's index. Key predictors were interpreted using SHapley Additive exPlanations (SHAP) analysis.

Results: The incidence of early dysphagia with AIS was 29.3%. The Random Forest (RF) model demonstrated the best overall performance, with an AUC-ROC of 0.952 (95% CI: 0.927-0.976). The significant risk factors identified were Activities of Daily Living (ADL) grade, National Institutes of Health Stroke Scale (NIHSS) score, multifocal lesions, hypoalbuminemia, coronary heart disease, and lesion hemisphere.

Conclusion: ML models may serve as reliable assessment tools for predicting dysphagia in patients with AIS. The RF model demonstrated the best predictive performance. This predictive model could assist clinical healthcare providers in delivering early warnings and developing individualized treatment plans for high-risk patients.