International Journal of General Medicine最新文献

Background: Type 2 diabetes mellitus (T2DM) is associated with diabetic retinopathy (DR). The complement system maintains the normal physiologic microenvironment of the retina. The relationship between serum complement levels and clinical features of DR remains unclear.

Methods: Clinical characteristics of 252 patients with T2DM including 101 with non-DR (NDR), 79 with nonproliferative DR (NPDR), and 72 with proliferative DR (PDR) were prospectively analyzed. Serum complement levels were compared between NDR and DR patients. The correlation between clinical characteristics and complement levels in DR patients was analyzed. A multifactorial logistic analysis was constructed to predict the risk of developing DR in T2DM.

Results: Serum C4, CFB, CFI, C3 and C5 levels were higher in DR patients than in NDR patients (all P < 0.05). In T2DM patients, C3 and C4 levels were higher in PDR patients than in DR patients (all P < 0.05), and MBL levels were not statistically different between the two cohorts (P > 0.05). These complement components or fragments were positively correlated with the duration of diabetes, glycosylated hemoglobin (HbA1c), and triglycerides (TG) (all P < 0.05). C3, C5, the duration of diabetes, HbA1c, and TG were the independent risk factors for DR in T2DM patients. The ROC model showed good value for predicting the risk of developing DR in T2DM with an area under the curve of 0.887.

Conclusion: Serum complements C3 and C5 are predictive factors for DR in patients with T2DM. The prediction model constructed by the clinical characteristics of patients with T2DM and complement can better distinguish between NDR and DR, and can be used as a potential biomarker for assessing the risk of developing DR.

Purpose: To investigate the efficiency and safety of afatinib in combination with bevacizumab in patients with non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) G719X, S768I, and L861Q mutations.

Patients and methods: We retrospective studied treatment naïve patients with local advanced or metastatic non-small cell lung cancer harboring EGFR G719X, S768I, and L861Q mutations from January 2017 to August 2021. EGFR tyrosine kinase inhibitors (TKIs) were the first-line treatment in all patients. The demographic, clinical data and treatment results were collected and analyzed.

Results: A total of 12 Chinese patients were studied. There were seven EGFR G719X mutations, three of the seven patients with single mutation and the others with compound mutations. Four patients had EGFR S768I mutations and one of them with single mutation. Four patients had EGFR L861Q/P mutations and one of them with compound mutations. The overall response rate of the EGFR TKIs treatment was 58.33% (7/12). The median progression-free survival (PFS) was 11.0 months, and median overall survival (OS) was 35.40 months. Two of five (40%) patients had required EGFR T790M mutations after TKIs were resistant. The side effects were mild to moderate hand-foot-syndrome, hypertension, and proteinuria.

Conclusion: Afatinib in combination with bevacizumab are effective and safe in the management of patients with NSCLC harboring EGFR G719X, S768I, L861Q/P single or compound mutations.

Background: Parkinson's disease (PD) is a prevalent neurodegenerative disorder characterized by the progressive loss of dopaminergic neurons. This study aims to discover potential new genetic biomarkers for PD.

Methods: Transcriptome data from a total of 56 patients with PD and 61 healthy controls were downloaded from the Gene Expression Omnibus (GEO) database. Differential gene expression (DEG) analysis, weighted gene co-expression network analysis (WGCNA), and three machine learning algorithms (LASSO, Random Forest, SVM-RFE) were employed to identify pivotal PD-associated genes. Additionally, RT-qPCR experiments were conducted to validate our findings in clinical specimens. Functional enrichment analysis and Gene Set Enrichment Analysis (GSEA) were performed to explore the functional and pathway mechanisms of the identified genes in PD. Molecular docking studies revealed potential small-molecule drug targets for the key genes.

Results: The results from the three machine learning algorithms identified ELL-Associated Factor 2 (EAF2) as a key gene in PD. Gene expression analysis indicated that EAF2 is significantly downregulated in PD patients, and the receiver operating characteristic (ROC) analysis validated the diagnostic potential of EAF2. The results from RT-qPCR on clinical specimens confirmed the findings from public database analyses. Functional enrichment analysis suggested that EAF2 is involved in dopamine biosynthesis and synaptic transmission for PD pathology. Additionally, EAF2 expression correlated significantly with immune cell infiltration. Furthermore, molecular docking results indicated that Acalabrutinib, Tirabrutinib Hydrochloride, and Ibrutinib are potential targeted therapeutic agents for EAF2.

Conclusion: These findings underscore EAF2 as a novel diagnostic biomarker and potential therapeutic target for PD, warranting further mechanistic studies and clinical validation.

Stroke has emerged as the second leading cause of mortality. Insomnia after stroke is a highly prevalent complication of stroke with a complex mechanism, impacting daily activities and hindering neurological function rehabilitation while also increasing the risk of stroke recurrence. With the development of molecular biology, intestinal flora has garnered considerable interest in the past few years because of its significant implications for human physiology and pathology. Numerous studies have emphasized the crucial function of intestinal flora in the pathological changes associated with insomnia after stroke. It can influence sleep patterns following a stroke by modulating various pathways, including the hypothalamic-pituitary-adrenal (HPA) axis, immune responses, and neural mechanisms. Disruption of intestinal flora can adversely affect post-stroke sleep quality, while sleep after stroke can also lead to intestinal flora imbalance. Based on the intestinal flora, this paper explores the involvement of hypothalamic-pituitary-adrenal axis (HPA axis), immune pathway and neural pathway in insomnia after stroke, aiming to offer insights for the prevention, treatment, and research of post-stroke insomnia.

Objective: The objective of this study aimed to investigate the risk factors for poor wound healing (PWH) after posterior lumbar spinal fusion. Currently, there is limited research on the application of machine learning in analyzing PWH after spinal surgery. Thus, our primary aim is to using machine learning identify these risk factors and construct a clinical risk prediction model.

Methods: We retrospectively reviewed 2516 patients who underwent posterior lumbar spinal fusion at Guangxi Medical University's Second Affiliated Hospital between August 2021 and August 2023. The data was divided into test and validation groups in a 7:3 ratio. In the test group, logistic regression analysis, support vector machine (SVM), random forest (RF), decision tree (DT), XGboost, Naïve Bayes (NB), k-Nearest Neighbor (KNN), and Multi-Layer Perceptron (MLP) were used to identify specific variables. The top six models from the eight machine learning models with the highest area under curve (AUC) values were selected and used to construct a dynamic nomograms model. Model performance was evaluated using receiver operating characteristic (ROC) and calibration curves. The model's internal performance was then verified in the validation group using ROC and calibration curves.

Results: Data from 2516 patients were collected, with 411 eligible cases selected. By combining logistic regression analysis with six machine learning algorithms, this study identified six predictors associated with PWH: subcutaneous lumbar spine index(SLSI), albumin, postoperative glucose, cerebrospinal fluid leakage(CSFL), neutrophil (NEU), and C-reactive protein(CRP). These predictors were used to develop a prediction model, visually represented through a nomogram. The AUC value in the test group was 0.981, and the C-index of the model was 0.986 (95% CI 0.966-0.995), indicating excellent predictive capability. Calibration curve analysis showed good consistency between nomogram-predicted values and actual measurements.

Conclusion: SLSI, albumin, postoperative glucose, CSFL, NEU and CRP were identified as significant risk factors for PWH after posterior lumbar spinal fusion. The developed prediction model exhibited excellent predictive accuracy and usefulness.

Purpose: Acute upper respiratory infections (AURI) represent a daily challenge in primary care practice. Mucus production may impair during AURI. Sobrerol is a muco-active agent that improves rheological characteristics and exerts other ancillary activities. The aim of this retrospective case-series study was to compare the efficacy and safety of different uses of sobrerol (only oral, only nebulized, and combined or standard treatment for infections alone) in patients with AURIs.

Patients and methods: The present clinical experience retrospectively collected clinical data of patients with AURIs visited by ten primary care doctors (pediatricians and general practitioners) over a long period. Patients could take standard therapy for infections, or as add-on: oral sobrerol, nebulized sobrerol, or combined oral and nebulized aerosol during the infection for 3 days.

Results: Patients treated with combined oral and nebulized sobrerol experienced less intense symptoms, mainly concerning cough (p < 0.001) and nasal complaints (p = 0.043). In addition, the patients taking the combined therapy reported a more rapid disappearance of cough and nasal symptoms at day 7 than patients treated with the other options (OR 4.47 and 3.16, respectively).

Conclusion: The current retrospective and observational study showed that a three-day combined (oral and nebulized) sobrerol course may represent a valuable add-on option in patients with AURIs.

Purpose: General physicians are required to demonstrate diverse leadership skills depending on their environment. It is essential for them to understand the characteristics of the medical institutions to which they belong and put this understanding into practice. Leadership skills are acquired through experience and training, and their acquisition is a goal in various medical training programs. However, these leadership skills are difficult to acquire because the specific leadership skills required in clinical practice, education, and research are not well defined. For example, in clinical practice, general physicians need to lead initiatives to improve patient outcomes, resource utilization, and the quality of medical care. However, the specific leadership skills required for these tasks are not explicitly defined. Based on the survey results on the leadership types that general physicians value in clinical practice, research, and education, in addition to expert opinions and a literature survey, we aimed to establish the leadership type necessary in general medicine.

Patients and methods: A cross-sectional anonymous questionnaire survey was conducted from February 2 to 29, 2024, using Google Forms sent through email, targeting members of the Japan Society of Hospital General Medicine. The survey comprised multiple-choice and descriptive questions.

Results: Notably, 286 physicians responded to the survey (response rate: 12.5%); 82.9% were males. Of these, 56.3% said they could explain what leadership constitutes, and 57.0% wanted to attend leadership training. When asked about the most-demanded leadership types in each scenario, democratic and transformational leadership were the most selected in clinical practice (52.4%) and in education and research (26.6% and 31.8%, respectively), respectively.

Conclusion: Transformational leadership was the most important leadership type in education and research, indicating that many general physicians face challenges in these areas. Therefore, developing strategies to improve leadership skills in education and research within general medicine is crucial.

Objective: This study aimed to explore the factors influencing pulmonary fibrosis in patients with acute diquat poisoning through logistic regression analysis.

Methods: A retrospective analysis was conducted on 68 cases of acute diquat poisoning due to suicidal intent admitted to our hospital from February 2020 to March 2023. Patients were divided into a combined group (28 cases with pulmonary fibrosis) and an acute diquat poisoning group (40 cases without). A healthy control group consisted of 40 individuals. General data were compared among the three groups, and laboratory indicators were analyzed. Single and multiple logistic regression analyses were performed to identify risk factors for pulmonary fibrosis.

Results: There were no significant differences in gender, age, BMI, poisoning status, or treatment timing among the groups (P > 0.05). The combined group had significantly higher diquat ingestion dose, SIRS score, SOFA score, and APACHE II score compared to the poisoning group (P < 0.05). In the acute poisoning group, these scores were also higher than in the healthy controls (P < 0.05). Laboratory indicators, including Hb, PLT, ALP, DBil, ALB, BUN, Glu, BNP, and pH, showed no significant differences (P > 0.05). However, WBC, ALT, TBil, DBil, Cr, K+, Tn I, and Lac levels were significantly higher in the combined group compared to the acute poisoning group (P < 0.05). Logistic regression analysis identified factors influencing pulmonary fibrosis as diquat ingestion dose, K+, ALT, PaO2, Lac, and HCO3-.

Conclusion: The factors influencing pulmonary fibrosis in acute diquat poisoning include diquat ingestion dose, K+, ALT, PaO2, Lac, and HCO3-. These findings enhance understanding of pulmonary fibrosis pathogenesis and may inform clinical management for affected patients.

Background: People in China have gradually entered old age society, and the number of lung cancer cases is expected to increase annually among the elderly. This study aimed to retrospectively explore the association between perioperative factors and short-term outcomes in elderly patients with non-small cell lung cancer (NSCLC).

Methods: A total of 490 elderly patients with NSCLC between January 1, 2003, and December 31, 2009, were selected. Perioperative factors were grouped and analyzed according to postoperative complications (PPCs) and length of hospital stay. A logistic regression analysis model was used to screen for the independent predictors of patient prognosis. The primary endpoint was postoperative complications and the secondary endpoint was postoperative hospital stay.

Results: Of all patients, 344 (70.2%) developed postoperative complications, and the average length of stay after surgery was 14.0±5.6 days. Perioperative fentanyl equivalents>28.7μg/kg and duration of surgery>4.4h were associated were associated with an increased risk of postoperative complications (P < 0.05); intraoperative blood loss (IBL) > 200 mL was associated with extended hospital stay (P < 0.05).

Conclusion: This study suggested that Perioperative factors may affect the short-term prognosis of elderly NSCLC patients after surgery. Perioperative fentanyl equivalents>28.7μg/kg, surgery duration, and IBL may be independent predictors of short-term outcomes in elderly patients.

Objective: Pertussis is a highly contagious respiratory disease, and early diagnosis and timely treatment are crucial for reducing complications and transmission. In this study, we analyzed the prevalence of pertussis and assessed the value of the WBC and lymphocyte percentage in its screening.

Methods: A retrospective analysis was conducted on global pertussis data from the past decade. Patients who recently underwent pertussis nucleic acid detection and complete blood count (CBC) in our hospital were selected. Based on the results, 538 patients were classified into the pertussis group, and 595 into the control group. White blood count (WBC) and lymphocyte percentages were compared, diagnostic efficacy was calculated, and evaluate their application value in the diagnosis of pertussis.

Results: In the past decade, the global incidence of pertussis first decreased, then increased. In China and Zhejiang province, it fluctuated but showed an upward trend recently. In Zhejiang Province, pertussis was more prevalent in summer and winter and rose last year. Between 2018 and 2020, most pertussis cases in China were infants under 1 year old. Last year, only 1.12% of patients in our hospital were infants, with more patients over 5 years old. WBC, lymphocyte percentage, and platelet count (PLT) was higher in the pertussis group (P < 0.05). Logistic regression showed that WBC, lymphocyte percentage, and PLT were correlated with pertussis infection. Sequential analysis showed that the WBC, lymphocyte percentage, and Youden's index for both combined were 0.124, 0.082, and 0.044, respectively.

Conclusion: The global incidence of pertussis is rising, with significant increases among adolescents and adults. Improved prevention and control strategies are needed. WBC and lymphocyte percentage serve as auxiliary diagnostic indicators, but their efficacy is limited.