International Journal of General Medicine最新文献

Purpose: People with fatty liver are at high risk for pulmonary nodules, but the underlying mechanism is unclear. This study aimed to investigate the occurrence of lung nodules in fatty liver patients and explore influencing factors.

Patients and methods: We retrospectively analyzed 57,119 individuals who underwent health checkups at the People's Hospital of Guangxi from May 2020 to May 2024. Patients with fatty liver were divided into pulmonary nodule and no pulmonary nodule groups. Univariate and multifactorial analyses were conducted using physical examination data, laboratory test indexes, and imaging information. Logistic regression analysis was used to identify independent predictors of pulmonary nodules in fatty liver patients.

Results: A total of 20,042 patients with fatty liver were included in the study, with 12,334 (61.5%) in the lung nodule group and 7708 (38.5%) in the non-lung nodule group. Age, gender, systolic and diastolic blood pressure were significantly higher in the pulmonary nodule group, while body weight, waist circumference, hemoglobin, uric acid, and glutamyltransferase were lower. Multifactorial logistic regression analysis showed that male gender, body weight, age, and diastolic blood pressure were significant factors influencing lung nodule development in fatty liver patients.

Conclusion: Fatty liver disease is independently associated with an increased incidence of pulmonary nodules, highlighting its importance in lung cancer screening and prevention.

Purpose: Acute coronary syndrome (ACS), comprising unstable angina and acute myocardial infarction, is the most dangerous and fatal form of coronary heart disease. This study evaluates serum bile acids (BAs) and amino acids (AAs) as potential predictors of AMI in UA patients.

Patients and methods: A total of 72 Non-Coronary Artery Disease (NCAD) patients, 157 UA patients, and 79 AMI patients were analyzed. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) measured 15 bile acids and 19 amino acids. The data was split into training and validation sets (7:3). Univariate and multivariate analyses were performed. Diagnostic value and clinical benefits were assessed using receiver operating characteristic (ROC) curves, decision curve analysis, and metrics such as the area under the curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI).

Results: Orthogonal partial least squares discriminant analysis (OPLS-DA) of serum BAs and AAs effectively differentiated NCAD, UA, and AMI groups. The differences in serum BA and AA profiles between UA and AMI patients were primarily driven by four metabolites: deoxycholic acid (DCA), histidine (His), lysine (Lys), and phenylalanine (Phe). Together, they had an AUC of 0.830 (0.768 in the validation cohort) for predicting AMI in UA patients. After adjusting for multiple confounding factors, DCA, His, Lys, and Phe were independent predictors distinguishing UA from AMI. The results of AUC, IDI, and NRI showed that adding these four biomarkers to a model with clinical variables significantly improved predictive value, which was confirmed in the validation cohort.

Conclusion: These findings highlight the association of DCA, His, Lys, and Phe with AMI, suggesting their potential role in AMI pathogenesis.

Background: This study analyzed the expression and diagnostic value of hsa_circ_101209 in plasma of pregnant women with in deep vein thrombosis (DVT).

Methods: By circRNA microarray detection and GO/KEGG analysis, hsa_circ_14797 targeting miRNA-mRNA network was predicted. Sixty women with DVT were selected as the DVT group, and 60 women without DVT as the non-DVT group. hsa_circ_14797 in plasma was detected, as well as D-dimer (D-D) concentration and P-selectin expression. Target genes that may be regulated by hsa_circ_14797 were predicted, and GO analysis and KEGG pathway enrichment analysis were performed.

Results: hsa_circ_14797 was highly expressed in DVT. hsa_circ_14797 in plasma of DVT patients was positively correlated with D-D (r = 0.358, P = 0.001). The AUC of plasma hsa_circ_14797, D-D, and P-selectin for maternal DVT diagnosis were 0.787 (95% CI: 0.710-0.864), 0.882 (95% CI: 0.821-0.943), and 0.825 (95% CI: 0.754-0.895), respectively. The AUC of hsa_circ_14797 combined with D-D was 0.886 (95% CI: 0.828-0.944). The AUC of hsa_circ_14797 combined with P-selectin was 0.904 (95% CI: 0.853-0.954). The AUC of P-selectin combined with D-D was 0.935 (95% CI: 0.893-0.978). The AUC of hsa_circ_14797 combined with D-D and P-selectin was 0.953 (95% CI: 0.920-0.986). The functions of hsa_circ_14797 included the biological processes of angiogenesis, vascular development, and vascular morphology. The enrichment pathways included PI3K-Akt pathway, TGF-β pathway, and cytokine-cytokine receptor interaction.

Conclusion: hsa_circ_14797, D-D, and P-selectin in plasma of DVT pregnant patients are increased, and hsa_circ_14797 in plasma is positively correlated with D-D. hsa_circ_14797 combined with D-D and P-selectin can improve the accuracy of diagnosis of DVT and contribute to the early diagnosis of DVT.

Objective: This study aimed to analyze the changes in insomnia characteristics among the general population and explore associated factors during the COVID-19 pandemic and post-pandemic periods.

Methods: A cross-sectional study was conducted using an anonymous online survey. Questionnaires were administered at two-time points (T1: March 1-31, 2022; T2: March 1-31, 2023), which included an Insomnia Severity Index (ISI) and questions related to sleep risk factors, including the COVID-19 pandemic, familial influences, work and study conditions, social activities, physical health, use of electronic devices before sleep, sleep environment, food intake and exercise before sleep, etc. Insomnia characteristics were compared at two points, with logistic regression testing associations with sociodemographic covariates and risk factors. Six machine learning models were employed to develop a predictive model for insomnia, namely logistic regression, random forest, neural network, support vector machine, CatBoost, and gradient boosting decision tree.

Results: The study obtained 2769 and 1161 valid responses in T1 and T2, respectively. The prevalence of insomnia increased from 23.4% in T1 to 34.83% in T2. Univariate analyses indicated the factors of the COVID-19 pandemic, familial influences, social activity, physical health, food intake, and exercise before sleep significantly differed in T1 (p<0.05) between insomnia and non-insomnia groups. In T2, significant differences (p<0.05) were observed between the two groups, including the factors of the COVID-19 pandemic, family structure, work and study conditions, social activity, and physical health status. The random forest model had the highest prediction accuracy (90.92% correct and 86.59% correct in T1 and T2, respectively), while the pandemic was the most critical variable at both time points.

Conclusion: The prevalence and severity of insomnia have worsened in the post-pandemic period, highlighting an urgent need for effective interventions. Notably, the COVID-19 pandemic and physical health status were identified as significant risk factors for insomnia.

Background: This is a hospital-based, single-center, cross-sectional study to investigate the status quo of hyperuricaemia (HUA) in general adults in Shenzhen, a booming seaside city in the South China.

Methods: All health adults (≥18 years old) undergoing health examination from 2020 Oct 1 to 2021 September 30 in a general hospital were enrolled. Their medical records were investigated and analyzed.

Results: Total 4604 participants (2938 males and 1756 females) were included and analyzed. We found that although the participants in Shenzhen were younger than the people included the analogous study in the adjacent cities (total 38.41 ± 10.33 years, 39.11 ± 10.18 in males and 37.24 ± 10.47 in females), the prevalence of HUA reached to amazing 34.7% (43.5% in males and 20.1% in females). Moreover, great HUA-related gender difference was found in terms of age-related variation trends of HUA prevalence (P < 0.001), indices of laboratory examination (P < 0.01) and influence factors (P < 0.001).

Conclusion: These results raise alarm bells for the HUA problem in the booming seaside city with young population like Shenzhen in China (2020-2021). Effective measures are appealed to reduce the high prevalence of HUA of Shenzhen. In addition, during analyses of the data, we found that both the prevalence of HUA and age of the population need to be seriously considered. Accordingly, we propose a more representative index, namely "Prevalence-Age Index (PAI = Prevalence of HUA/Average age)" to be used in the future HUA-related investigations.

Objective: Respiratory distress syndrome threatens neonates' life. This study probed the predictive value of lung ultrasound scores combined with serum angiopoietin-like protein 4 (ANGPTL4) levels on neonatal respiratory distress syndrome (NRDS) severity and prognosis.

Methods: The NRDS group (n = 115) and control group (n = 30) were established. In both groups, lung ultrasound scores and serum ANGPTL4 levels, lung ultrasound scores and serum ANGPTL4 levels of newborns with NRDS of different severity, the risk factors affecting the poor prognosis of NRDS neonates, and the value of serum ANGPTL4 levels combined with lung ultrasound scores in determining the severity and prognosis of newborns with NRDS were analyzed.

Results: The NRDS groups had higher lung ultrasound scores and serum ANGPTL4 levels, and lower Apgar scores than the control group; lung ultrasound scores and serum ANGPTL4 levels were higher in the moderate and severe groups than in the mild group, and those were higher in the severe group than in the moderate group (all p < 0.05). The logistic regression analysis showed that high lung ultrasound scores, and high serum ANGPTL4 levels were risk factors for NRDS poor prognosis (OR > 1, p < 0.05), and high Apgar scores are the protective factor for poor prognosis in NRDS neonates (OR < 1, p < 0.05). The area under the curve of lung ultrasound scores combined with serum ANGPTL4 levels to assess the severity and prognosis of NRDS neonates exhibited a higher assessed value than the single test.

Conclusion: Lung ultrasound scores and serum ANGPTL4 levels are closely related to the severity and prognosis of NRDS neonates, and the combination of the two improves the assessed value of the severity and prognosis of NRDS neonates. The study provided a reference for the disease severity assessment of NRDS and the prediction of its prognosis.

Purpose: Glucose metabolism is associated with several endocrine disorders. Anti-diabetes drugs are crucial in controlling diabetes and its complications; nevertheless, few studies have been carried out involving endocrine function. This study aimed to investigate the association between anti-diabetes drugs and endocrine parameters.

Patients and methods: We performed a study of 180 consecutive patients with type 2 diabetes who attended a medical center. Laboratory measurements of metabolic values and endocrine parameters were assessed after a stable treatment regimen of more than 12 weeks. The differences in various endocrine parameters were compared between subjects with or without certain anti-diabetes drugs, with the administrated anti-diabetes drugs being analyzed to find independent risks associated with elevated endocrine parameters.

Results: After maintaining stable treatment, acceptable glycemic control was noted with an average HbA1c of 7.55% in females and 7.43% in males. Participants taking sulfonylurea (55.8 vs 26.34 ng/L, P=0.043), dipeptidyl peptidase-4 inhibitor (DPP4i) (47.14 vs 32.26 ng/L, P=0.096), or sodium-glucose co-transporter 2 inhibitor (SGLT2i) (64.58 vs 28.11 ng/L, P=0.117) had higher plasma renin concentrations compared to those without this drug but the aldosterone levels did not differ, as well as for other adrenal tests and thyroid function. Under linear regression modeling, SGLT2i was found to be independently associated with a risk of high renin level (beta coefficient: 30.186, 95% confidence interval: 1.71─58.662, P=0.038), whereas sulfonylurea only had borderline associations (B: 21.143, 95% CI: -2.729─45.014, P=0.082). Additionally, renin-angiotensin-aldosterone system (RAAS) blockade (B: 36.728, 95% CI: 12.16─61.295, P=0.004) or diuretics (B: 47.847, 95% CI: 2.039─93.655, P=0.041) was also independently associated with increased renin levels.

Conclusion: SGLT2i was the only class of anti-diabetes drugs independently associated with elevated renin levels, with results similar to RAAS blockade and diuretics. Although SGLT2i appears to protect reno- and cardio-function, the clinical impact of increased renin warrants further precise study for verification.

Objective: We aimed to address the predictive value of urinary kidney injury molecule-1 (KIM-1), tissue inhibitor of metalloproteinases-2 (TIMP-2) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) for contrast-induced acute kidney injury (CI-AKI) in elderly patients after percutaneous coronary intervention (PCI).

Methods: One hundred thirty-six patients who underwent PCI were separated into the CI-AKI group (n = 36) and the non-CI-AKI group (n = 100) based on CI-AKI occurrence after operation, and their general data were collected. Blood and urine specimens were collected before operation (at the time of admission) and 6 h, 12 h, 24 h and 48 h after the operation and preserved for future use. Serum creatinine (Scr) levels were tested and an estimated glomerular filtration rate (eGFR) was counted. Urinary KIM-1, TIMP-2 and sTREM-1 levels were assessed and the preoperative and general data as well as postoperative urinary KIM-1, TIMP-2 and sTREM-1 levels were compared. The early diagnostic value of urinary KIM-1, TIMP-2 and sTREM-1 at 6 hours postoperatively for CI-AKI was analyzed by receiver operating characteristic (ROC) curve.

Results: After 48 h of operation, Scr in the CI-AKI group was higher versus the non-CI-AKI group. At 24 h and 48 h postoperatively, eGFR in the CI-AKI group was lower versus the non-CI-AKI group; urinary KIM-1 and sTREM-1 in the CI-AKI group were higher in contrast to the non-CI-AKI group; TIMP-2 in the CI-AKI group was higher versus that in the non-CI-AKI group. ROC curve analysis showed that the areas under the curve (AUCs) for urine KIM-1, TIMP-2, and sTREM-1 in diagnosing CI-AKI at 6 hours postoperatively were 0.852 (95% CI: 0.768-0.936), 0.810 (95% CI: 0.723-0.898), and 0.874 (95% CI: 0.804-0.943), and the cut-off values were 45.93 ng/L, 1.63 ng/mL, and 61.48 ng/L, respectively, with sensitivities of 66.70%, 58.30%, and 72.20%, and specificities of 95.00%, 93.00%, and 91.00%, respectively (all P < 0.05).

Conclusion: Urinary KIM-1, TIMP-2 and sTREM-1 can respond to early changes in renal function after PCI and have good application value in the early diagnosis of CI-AKI.

Objective: This study investigated the efficacy of comprehensive management and predictable inflammatory markers for idiopathic retroperitoneal fibrosis (iRPF)-related hydronephrosis outcomes.

Methods: Patients with iRPF-related hydronephrosis underwent surgical (ureteral stent and/or nephrostomy tube placement) and medical (corticosteroid-based multiple immunosuppressants) management were classified according to stent-indwelling outcomes. Univariate analysis of clinical profiles was conducted to screen possible predictors of hydronephrosis remission.

Results: In a series of 38 patients, 52.6% achieved hydronephrosis remission and stent/tube removal (stent-free group). The median indwelling time in the stent-free group (12 months) was significantly lower than that in the treatment-failure group (37 months, p<0.05). Mean retroperitoneal mass diameters was significantly reduced (anteroposterior by 11.66 mm (95% CI 2.31-21.01), transverse by 15.41 mm (95% CI 3.37-27.46), suprainferior by 30.53 mm (95% CI 4.87-56.19); p<0.05) during the treatment course, in line with mean renal pelvis width (by 36.2%) and renal function parameters (serum creatinine by 16.9%, blood urea nitrogen by 12.9%). Renal function improved (36.9%) or remained stable (44.7%) in most patients, the mean estimated glomerular filtration rate increasing by 8.7% (from 55.4 mL/min/1.73 m² to 60.2 mL/min/1.73 m²). At the initial diagnosis, median serum immunoglobulin IgG and CRP levels were significantly higher in the stent-free group than in the treatment-failure group (IgG 17.55 g/L vs. 13.50 g/L, CRP 19.60 mg/L vs. 3.15 mg/L; p<0.05). Decline in serum IgG (-5.80 g/L vs. -2.30 g/L), CRP (-18.93 mg/L vs. -1.72 mg/L) and erythrocyte sedimentation rate (-22.00 mm/h vs. -1.50 mm/h) levels in the stent-free group surpassed those in the treatment-failure group (p<0.05).

Conclusion: Comprehensive management benefits iRPF patients with hydronephrosis by preserving renal function. The 24-month scale might guide stent/tube removal. Elevated inflammatory markers (IgG and CRP) at the initial iRPF diagnosis and IgG, CRP, and erythrocyte sedimentationrate (ESR) variations associated with hydronephrosis outcomes.