International Journal of General Medicine最新文献

Background and purpose: Research is still underway to determine the effect of blood pressure variability (BPV) on the prognosis of acute ischaemic stroke (AIS). The posterior circulation is vulnerable to BPV due to its unique anatomy. Our study systematically evaluated the effects of daily BPV and cerebral perfusion on 90-day prognosis of patients with acute posterior circulation cerebral infarction (PCCI) and further investigated their association.

Methods: The study included 462 patients diagnosed with PCCI. Cerebral perfusion was assessed by F.MTT (focus mean transit time), rCBV (relative cerebral blood volume) and rCBF (relative cerebral blood flow). Blood pressure (BP) was recorded twice daily and the daily BPV was calculated with standard deviation (SD) and coefficient of variation (CV). Subsequently, the correlation between daily BPV, cerebral perfusion and 90-day prognosis was examined using logistic regression modelling. Potential non-linear relationships were assessed through the use of smooth curve fitting. Assessment to explore the relationship between cerebral perfusion levels and daily BPV using stepwise logistic regression analysis. Finally, mediation analysis was performed to test the relationship between CT perfusion (CTP) mediated BPV and 90-day adverse prognosis.

Results: The study included 363 participants. Multivariate logistic regression analysis revealed that higher daily BPV and poorer cerebral perfusion were negatively associated with 90-day adverse prognosis in patients with PCCI (P < 0.05). In addition, poor cerebral perfusion was associated with higher daily BPV (MAP-SD: OR 1.15, 95% CI [1.03-1.27], P = 0.011; MAP-CV: OR 1.17, 95% CI [1.05 ~ 1.3], P = 0.004). Meanwhile, mediation analysis showed that rCBF mediated the association between daily BPV and 90-day adverse prognosis (indirect effect estimate = 0.918, direct effect estimate = 0.0621).

Conclusion: Our study demonstrated that daily BPV and cerebral perfusion were positively associated with 90-day adverse prognosis in patients with PCCI, which was partly mediated by rCBF.

Objective: To analyse the correlation between real-time cerebral state index (CSI) and postoperative emergence agitation (EA) in children undergoing surgery for decayed teeth during recovery from general anaesthesia, and to explore the feasibility of CSI in predicting EA during perioperative care.

Methods: A retrospective case-control study was performed for paediatric patients who underwent radical surgery for decayed teeth under general anaesthesia at the Stomatology Outpatient Department of the Children's Hospital of Shanxi from January 2022 to December 2022. According to the presence or absence of EA in children during recovery from general anaesthesia, the enrolled patients were divided into two groups: the agitation group (Group A) and the non-agitation group (Group NA). All paediatric patients were monitored for CSI using a combined-type multifunctional monitor of HXD-I Multi-parameter Monitor after the induction of tracheal intubation under intravenous anaesthesia.

Results: There were 16 cases (40%) of EA among the affected children. At post-extubation (T6), the subcortical excitability index (SCEi) (95[71-99] vs 46[15-78]), cortical excitability index (CEi) (45[34-77] vs 32[10-49]) and anxiety index (ANXi) (49[41-58] vs 41[30-49]) of Group A were significantly higher than those of Group NA, while memory index (Mi) (10[8-14] vs 12[9-14]) was smaller than in the latter group, with statistically significant differences between groups (P<0.05). Additionally, as shown in the receiver operating characteristic curve, at T6, the area under the curve of SCEi, CEi, ANXi and Mi in predicting EA separately was 0.762, 0.771, 0.709 and 0.711, with sensitivity of 82.9%, 87.0%, 84.3% and 63.6%, and specificity of 70.4%, 43.5%, 46.8% and 77.2%, respectively.

Conclusion: Post-extubation SCEi, CEi, ANXi and Mi were significantly associated with EA occurrence in children undergoing decayed tooth surgery under general anaesthesia, with SCEi and ANXi showing relatively better predictive performance.

Background: Allergic rhinitis (AR) is a prevalent condition significantly impacting children's health globally. Allergen immunotherapy (AIT), via sublingual (SLIT) or subcutaneous (SCIT) routes, offers disease modification, but direct pediatric comparisons are limited. This systematic review evaluates the relative efficacy and safety of SLIT versus SCIT in children with AR based on randomized clinical trial (RCT) evidence.

Methods: A systematic literature search (PubMed, Embase, Cochrane Library, Scopus; July 2024) identified RCTs comparing SLIT vs SCIT, or either vs control, in children (≤18 years) with AR. Data on study design, participants, interventions, outcomes (symptom/medication scores, safety, adherence, immunological markers), were extracted. Methodological quality was assessed using the Cochrane Risk of Bias tool version 2 (RoB-2). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results: Seven RCTs met inclusion criteria. Both SLIT and SCIT effectively reduced AR symptoms and medication use versus controls. Comparative efficacy was nuanced: several studies found comparable reductions in symptom/medication scores, while others suggested potential SCIT advantages for specific outcomes (asthma symptoms, Total Rhinitis Symptom Score from baseline). SLIT consistently showed a more favorable safety profile (mainly local reactions), whereas SCIT carried a higher risk of systemic reactions. Limited data suggested potential SLIT benefits in asthma prevention. Adherence data from included RCTs were sparse.

Conclusion: Both SLIT and SCIT are effective for pediatric AR. SLIT offers comparable efficacy for many outcomes with better safety/convenience, while SCIT may have advantages for certain outcomes but requires clinic administration. Treatment choice requires individualization based on efficacy, safety, adherence potential, and patient/family factors. Further high-quality, long-term comparative trials are needed.

The vascular endothelial glycocalyx is a critical structural and functional component. It maintains endothelial integrity, orchestrates hemodynamic regulation, enables selective blood component filtration, and mediates mechanotransduction. Existing in a dynamic equilibrium, this glycoprotein-polysaccharide matrix provides an interactive platform for intravascular reactions and actively participates in innate immune responses (eg, neutrophil chemotaxis and adhesion). During localized tissue infection, pathogen-derived chemokines become enriched within the endothelial glycocalyx, establishing a chemotactic gradient that directs neutrophil recruitment. Intriguingly, neutrophil-derived proteolytic enzymes and reactive oxygen species released during degranulation reciprocally degrade the glycocalyx architecture, thereby amplifying chemokine liberation and creating a self-reinforcing feedback loop that potentiates neutrophil extravasation and directional migration. This review systematically analyzes two distinct mechanistic models elucidating the dual role of the endothelial glycocalyx in neutrophil chemotaxis. These conceptual frameworks advance our understanding of the spatiotemporal regulation of innate immune responses at the vascular interface while highlighting potential therapeutic targets for inflammatory disorders associated with glycocalyx dysfunction.

Purpose: Viral myocarditis (VMC) is a leading cause of heart failure and dilated cardiomyopathy in children. Pyroptosis, an inflammatory form of programmed cell death mediated by NOD-like receptor pyrin domain-containing 3 (NLRP3) inflammasomes, has been implicated in myocardial injury. However, the diagnostic significance of combined gene and protein expression analysis remains unclear. This study aimed to clarify the role of NLRP3 inflammasome-mediated pyroptosis in pediatric VMC and assess whether integrated gene-protein profiling could enhance diagnostic prediction.

Patients and methods: A total of 100 children were enrolled, including a case group (n=50, children with viral myocarditis hospitalized between September 2023 and September 2024) and a control group (n=50, patients with dilated cardiomyopathy during the same time period). The expression levels of proteins interleukin-1β (IL-1β), NLRP3, Gasdermin D (GSDMD) and Caspase-1, and genes GSDMD, NLRP3, and Caspase-1 in myocardial tissues were measured through enzyme-linked immunosorbent assay, immunohistochemistry, real-time polymerase chain reaction, and Western blotting.

Results: No significant differences were found between the two groups regarding age, gender, or clinical history (P>0.05). Compared with the control group, the case group exhibited significantly higher expression of NLRP3, Caspase-1, GSDMD, and IL-1β at both protein and gene levels (P<0.05). Correlation analyses confirmed that these markers were positively associated with the presence of VMC. (P<0.05). Receiver operating characteristic (ROC) analysis revealed that the combined detection of gene and protein expression achieved a higher area under the curve (AUC) than any single indicator, demonstrating superior diagnostic accuracy.

Conclusion: NLRP3 inflammasome-mediated pyroptosis plays a crucial role in the pathogenesis of viral myocarditis in children. The combined assessment of gene and protein expression levels provides a novel and more reliable approach for early diagnosis and risk evaluation of pediatric VMC, highlighting the potential of inflammasome-related biomarkers as therapeutic targets.

Background: Sickle cell anaemia (SCA) is a hereditary haemoglobin disorder associated with high morbidity. Hydroxyurea (HU) has become a key disease-modifying therapy for SCA.

Objective: To evaluate the effects of HU on liver and kidney functions, along with haematological parameters, in SCA patients aged 15 years and above in Sana'a city.

Methods: A cross-sectional study was conducted on 72 patients with SCA who received HU. Participants filled out questionnaires regarding risk factors and complications, and data were collected through interviews and laboratory tests. Statistical analysis was performed using SPSS.

Results: The study included 72 SCA patients (55.6% males). Most participants showed stable liver enzymes, but mild elevations in AST (36.1%) and ALT (33.3%) were observed, likely related to SCA-induced hemolysis rather than HU toxicity. Elevated bilirubin levels (direct, indirect, and total) were common (81.9%, 86.1%, and 76.4%, respectively), reflecting the hemolytic nature of SCA. Regarding renal function, 51.4% of patients had low creatinine levels, which may reflect glomerular hyperfiltration and tubular dysfunction typical in SCA rather than HU toxicity. No significant adverse effects on renal function were attributed to HU.

Conclusion: Hydroxyurea was well tolerated and showed no evidence of inducing major hematological, hepatic, or renal toxicity. Slight effects on renal function, including lower creatinine levels, were observed and may reflect underlying disease physiology rather than drug-related changes. However, as this was a cross-sectional study, causal relationships could not be established, and longitudinal studies are recommended to assess long-term hepatic and renal outcomes.

Purpose: Triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, has emerged as a potential predictor of cardiovascular and metabolic diseases. However, its relationship with renal function impairment (RFI) and the influence of age and sex remain unclear. This study aimed to investigate the association between the TyG index and RFI in a large Chinese adult population and to evaluate its potential as an independent risk marker across sex and age groups.

Patients and methods: We conducted a cross-sectional study involving 21,224 adults aged 16-93 years who underwent health examinations at a tertiary hospital in China. Anthropometric and laboratory data were collected. RFI was defined as an estimated glomerular filtration rate of <60 mL/min/1.73 m² or urinary albumin-to-creatinine ratio of ≥30 mg/g. Logistic regression models were used to assess the association between TyG index quartiles and RFI after adjusting for confounders.

Results: The overall prevalence of RFI was 23.5% with a higher prevalence observed in men than in women. Higher TyG index quartiles were associated with increased body mass index (BMI), mean arterial pressure (MAP), triglyceride, fasting glucose, and RFI prevalence. After adjustment for BMI and MAP, the TyG index remained significantly associated with RFI only in females aged ≥50 years (adjusted odds ratio for Q4 vs Q1: 1.603, 95% confidence interval: 1.313-1.957, p < 0.001).

Conclusion: An elevated TyG index was independently associated with RFI in older women. Owing to its simplicity and cost-effectiveness, TyG index may be a useful tool for early screening of renal risk, particularly among postmenopausal women. Nonetheless, longitudinal studies are needed to confirm a causal relationship.

Aim: To investigate the involvement of circular RNA (circRNA) in the pathogenesis of rheumatic valvular heart disease (RVHD) and its potential use as a diagnostic biomarker.

Methods: Three differentially expressed circRNAs in RVHD were selected. Four pairs of RVHD valve tissues and non-RVHD valve tissues were verified. Plasma samples from 41 RVHD patients and 39 healthy controls were analyzed to investigate the relationship between hsa_circ_0008882 expression levels and clinical-pathological characteristics in RVHD patients, evaluating its diagnostic value for RVHD. Additional plasma samples from 47 RVHD patients and 30 controls, along with 38 valve tissues, were collected to validate the expression of downstream target genes CAMTA2 and APLN. LASSO regression combined with multivariate logistic regression analysis was employed to identify independent risk factors. The interaction between hsa_circ_0008882 and hsa-miR-4739 was validated through dual luciferase reporter assays.

Results: The expression of hsa_circ_0008882 was significantly upregulated in both plasma and valve tissue samples from RVHD patients. Plasma hsa_circ_0008882 demonstrated moderate discriminatory ability for RVHD, with an AUC of 0.707 (95% CI: 0.591-0.823), a sensitivity of 58.5%, and a specificity of 82.1% at the optimal cutoff value. Its expression level showed significant positive correlations with multivalvular heart disease, left atrial diameter, and pulmonary artery systolic pressure. After LASSO regression screening, multivariate analysis confirmed hsa_circ_0008882 as an independent risk factor for RVHD (OR = 3.73, 95% CI: 1.75-7.95). Mechanistic exploration revealed that hsa_circ_0008882 directly binds to hsa-miR-4739, and its potential target genes CAMTA2 and APLN were both upregulated in plasma and tissue samples from RVHD patients.

Conclusion: Hsa_circ_0008882 plays an essential role in RVHD, and its plasma expression levels may serve as a potential auxiliary diagnostic indicator for RVHD.

Background: Septic cardiomyopathy (SCM) is a life-threatening complication of sepsis with no specific therapeutic options. Recent evidence suggests that PANoptosis, a programmed cell death pathway, contributes to myocardial injury in sepsis. Compound Tinglizi Decoction (CTLZC), a traditional Chinese herbal formula, has shown potential cardioprotective effects, yet the underlying biochemical mechanisms remain unclear.

Methods: A rat model of SCM was established to investigate the effect of CTLZC-containing serum on myocardial injury. Primary cardiomyocytes were treated with CTLZC-containing serum, and SIRT3 expression was modulated via overexpression and knockdown plasmids. Cell viability, PANoptosis markers, and chaperone-mediated autophagy (CMA) proteins were assessed through CCK-8, TUNEL staining, RT-qPCR, Western blotting, ELISA, and Co-IP assays.

Results: CTLZC-containing serum enhanced cardiomyocyte viability and significantly upregulated SIRT3 expression. It inhibited the expression of PANoptosis-related molecules (AIM2, ZBP1, RIPK1, RIPK3, FADD, and caspase-8) and promoted the expression of CMA-related proteins HSC70 and LAMP2A. SIRT3 knockdown reversed these effects and increased the release of biochemical markers of myocardial injury (LDH, CK-MB) and inflammatory cytokines (TNF-α, IL-1β, IL-18). Co-IP confirmed that AIM2 interacts with HSC70, indicating lysosomal degradation via CMA.

Conclusion: CTLZC-containing serum attenuates inflammatory and cell death responses in septic cardiomyopathy, likely through a SIRT3-associated modulation of chaperone-mediated autophagy and PANoptosis. These findings highlight the biochemical regulatory role of SIRT3 in mediating autophagic and inflammatory pathways during SCM, offering new insights into potential therapeutic targets.