International Journal of General Medicine最新文献

Objective: To identify pre-treatment optical coherence tomography (OCT) biomarkers predictive of recurrence in eyes with diabetic macular edema (DME) after anti-VEGF therapy.

Methods: This retrospective cohort study included 122 eyes with DME treated with anti-VEGF monotherapy (ranibizumab; Novartis Pharma Schweiz AG, Basel, Switzerland) at Pinghu First People's Hospital (January 2020 - December 2023). The treatment protocol consisted of 3 monthly loading doses followed by a pro re nata (PRN) regimen. Patients were stratified into recurrence (n=54) and non-recurrence (n=68) groups based on predefined criteria during 12 months of follow-up. Baseline OCT parameters were compared, and multivariate logistic regression was used to identify independent predictors. A combined model's predictive performance was assessed using receiver operating characteristic (ROC) curve analysis.

Results: The recurrence group had significantly higher baseline central retinal thickness (452.7±84.3 vs 391.5±70.2 μm, P=0.002), subretinal fluid (SRF) prevalence (63.0% vs 36.8%, P=0.008), proportion with ≥5 hyperreflective foci (HRF) (68.5% vs 35.3%, P<0.001), and ellipsoid zone (EZ) disruption rate (57.4% vs 30.9%, P=0.006), and required more injections (6.4±1.3 vs 4.8±1.2, P<0.001). Multivariate analysis confirmed HRF ≥5 (OR=3.52, P<0.001), SRF presence (OR=2.89, P=0.007), and EZ disruption (OR=2.41, P=0.023) as independent risk factors. Their combined model predicted recurrence with an AUC of 0.841.

Conclusion: HRF, SRF, and EZ integrity are key OCT biomarkers for DME recurrence. A combined model aids risk stratification for personalized management.

Objective: To investigate the factors that contribute to neonatal hyperbilirubinemia (NHB), develop a prediction model and predictive factors, which provide reference base for the early detection of NHB.

Methods: A retrospective study was done to collect clinical data of 683 neonates and their mothers which delivered in the hospital's obstetrics department between January 2019 and January 2023, of these neonates 216 were hyperbilirubinemic and 467 were not. Clinical data and laboratory results of newborns and their mothers were collected and analysed. Multifactorial logistic regression analysis was utilised to develop an early prediction model and identify determinants of newborn hyperbilirubinemia.

Results: The logistic regression model revealed that Delayed meconium (OR=4.024, P=0.002), maternal age (OR=1.106, P<0.01), maternal-infant blood group incompatibility (OR=4.457, P=0.001), Gestational Diabetes Mellitus (GDM) (OR=5.356, P=0.03), Pre-pregnancy co-morbidity (OR=2.810, <0.01), and Weight Growth Rate (WGR) during pregnancy (OR=28.367, P=0.048) were independent risk factors for NHB; 25-(OH)D3 (OR=0.880, P=0.002). The Conjoint predictor ROC curve is below 0.851 (P<0.01, 95% CI:0.821-0.882). The highest Youden's index was 0.55, with a sensitivity of 0.81 and a specificity of 0.76, indicating that the predictor had a decent predictive effect.

Conclusion: This study identified the risk factors and protective factors associated with NHB. Additionally, a joint prediction model was developed to more accurately predict the risk of hyperbilirubinemia which can serve as a foundation for the clinical identification of pertinent susceptibility factors and the development of intervention measures.

Objective: To develop and validate a machine learning-driven predictive model for intrapartum fever in parturients receiving neuraxial labor analgesia, integrating comprehensive clinical and hematological markers.

Methods: Among 15,760 parturients (2022-2024), 11,032 (70%) were allocated to the training cohort (834 [7.6%] febrile cases) and 4728 (30%) to the testing cohort (364 [7.7%] febrile cases). A three-stage variable screening process was applied, including Pearson correlation analysis (|r| > 0.15), LASSO regression with 10-fold cross-validation, and SHAP value analysis (top 75% importance). Seven machine learning algorithms, namely Logistic Regression (LR), Decision Tree (DT), Random Forest (RF), eXtreme Gradient Boosting (XGBoost), Support Vector Machine (SVM), Multilayer Perceptron (MLP), and Elastic Net (ENET), were evaluated via accuracy, ROC AUC, and cost-benefit analysis.

Results: Key predictors were neutrophil-lymphocyte ratio (NLR, SHAP=0.27), white blood cell count (WBC, SHAP=0.22), and primiparity (SHAP=0.18), with fever cases showing elevated NLR (7.71 vs 4.60, P<0.001) and vaginal exams (3.24 vs 2.29, P<0.001). Notably, the Random Forest (RF) model achieved a high test AUC of 0.94 but a reduced specificity of 0.57, which may increase false-positive risks (eg, unnecessary antimicrobial use). In contrast, Logistic Regression (LR) and Elastic Net (ENET) showed consistent generalizability (test AUC=0.87) with better specificity (0.69), making them more suitable for broad clinical application. Cost-benefit analysis identified a 3:2 ratio as optimal, with RF maintaining sensitivity across extreme thresholds.

Conclusion: This study establishes a robust model integrating inflammatory and obstetric parameters, with RF as the top performer for risk stratification. The framework enables targeted intervention, addressing a critical gap in intrapartum fever management. Future directions include prospective validation and real-time biomarker integration.

Background: Pediatric vascular trauma is uncommon but devastating, and risk is amplified in conflict zones with constrained systems. Evidence from Somalia is limited.

Objective: To describe patterns, mechanisms, anatomic distribution, management, and outcomes of pediatric vascular trauma over five years at a tertiary referral center in Mogadishu.

Methods: Retrospective study of patients ≤18 years with traumatic vascular injury (April 2019-April 2024). Variables included demographics, mechanism, injury site, time-to-presentation, procedures, transfusion, complications, limb salvage, and mortality. Diagnostics followed ATLS-guided pathways (clinical exam/Doppler/CTA). Standard open vascular techniques (primary repair, end-to-end anastomosis, interposition autologous vein/PTFE) were used. Ethical approval MSTH/16842.

Results: Fifty-four patients were included (83.3% male; 70.4% aged 13-18). Penetrating injuries predominated (81.5%: firearms, blast, stab, shrapnel). Commonly injured vessels were brachial (25.9%) and superficial femoral arteries (22.2%). Primary repair (40.7%) and vein grafting (35.2%) were most used. Limb salvage was 98.1% (53/54); one in-hospital death (1.9%). Delayed presentation (>6 h) and associated injuries correlated with worse outcomes.

Conclusion: In Somalia's conflict context, pediatric vascular trauma is largely penetrating and limb-threatening but shows excellent limb salvage with timely surgery. Findings support earlier referral, blood-bank capacity, standardized imaging pathways, and advanced vascular training to further reduce mortality.

Background: Mobility impairment is a common consequence of multimorbidity in older adults, especially among those with diabetes mellitus and hypertension. Although robotic exoskeletons have shown promising results in neurological rehabilitation, evidence regarding their use in non-neurological multimorbid populations remains scarce.

Objective: To evaluate the feasibility and effectiveness of Keeogo exoskeleton-assisted rehabilitation, in combination with conventional therapy, on functional mobility in older adults with multimorbidity.

Patients and methods: This single-arm pilot study recruited 13 participants aged 51-89 years with at least two physician-diagnosed chronic conditions and lower-limb weakness. Participants completed eight sessions of conventional therapy plus Keeogo-assisted training over a 4-week period. Functional outcomes were assessed pre- and post-intervention using the Short Physical Performance Battery (SPPB), Barthel Index (BI), Timed Up and Go (TUG), and Five-Time Sit-to-Stand Test (FTSST).

Results: Significant improvements were observed in SPPB scores (from 2.23 to 4.15, p = 0.0019), BI scores (from 52.69 to 60.00, p = 0.044), TUG (from 149.75 to 85.37 seconds, p = 0.006), and FTSST (from 65.14 to 33.85 seconds, p = 0.006). Subgroup analyses showed greater functional gains among participants with ≥3 chronic conditions, diabetes, or hypertension. No adverse events were reported.

Conclusion: Keeogo exoskeleton-assisted rehabilitation combined with conventional therapy was feasible and associated with short-term gains in functional mobility and independence in older adults with multimorbidity. Further randomized controlled trials with larger cohorts are warranted to confirm efficacy, evaluate long-term outcomes, and determine cost-effectiveness.

Purpose: To establish a stage-specific diagnostic model for chronic obstructive pulmonary disease (COPD) high-risk individuals by characterizing immune dysregulation through integrated cytokine and lymphocyte profiling.

Methods: In this cross-sectional study, 116 participants (34 healthy controls, 56 high-risk individuals, and 26 stable COPD patients) underwent comprehensive immunological evaluation. Peripheral blood cytokine levels (IL-6, IL-8, TNF-α) and lymphocyte subsets-including programmed cell death protein 1-positive (PD-1⁺) CD4⁺ T cells and effector memory regulatory T cells (emTregs)-were quantified via flow cytometry and multiplex immunoassays. A multivariable logistic regression model was developed to identify predictors of high-risk COPD, incorporating variables selected through hierarchical likelihood ratio testing and variance inflation factor (VIF)-based multicollinearity adjustment. Statistical validation included receiver operating characteristic (ROC) curve analysis, sensitivity-specificity assessment, and effect size calculations (Cohen's f).

Results: Threshold-driven immunological alterations were identified in high-risk individuals, marked by a 7.8-fold elevation in PD-1⁺CD4⁺ T cells (p < 0.001) and increased IL-6 levels (median difference: 1.064 pg/mL, p < 0.001). Effector memory Tregs exhibited progressive depletion from healthy to stable COPD stages (p < 0.001). The final regression model-incorporating PD-1⁺CD4⁺ T cells, age, and emTregs-demonstrated robust diagnostic accuracy (AUC = 0.912; 95% CI: 0.848-0.975), with 80.9% sensitivity and 79.3% specificity. PD-1+CD4+ T cells and age independently predicted high-risk status (adjusted odds ratio = 1.17, 95% CI: 1.05-1.30, p = 0.005; adjusted odds ratio = 1.11, 95% CI: 1.03-1.20, p = 0.007).

Conclusion: This study delineates a threshold-triggered immune signature preceding clinical COPD, providing a validated diagnostic framework for early detection. By integrating lymphocyte exhaustion markers and cytokine dynamics, the model bridges a critical gap in identifying subclinical immune dysfunction, enabling targeted interventions prior to irreversible lung damage.

Objective: This study examines subclinical cardiac dysfunction in hyperuricemic populations by comparing echocardiographic parameters-including left ventricular diastolic dysfunction (LVDD), which reflects impaired ventricular relaxation, and left ventricular strain parameters, sensitive markers of early systolic dysfunction-between gout patients and asymptomatic hyperuricemic controls, and identifying echocardiographic and clinical predictors of cardiac impairment.

Methods: A cross-sectional study was conducted involving 202 hyperuricemic patients (100 gout and 102 asymptomatic hyperuricemic patients) from a tertiary rheumatology center (June 2021-May 2023). A comprehensive evaluation included conventional echocardiography and two-dimensional speckle-tracking. Biochemical indexes such as serum uric acid (SUA), lipid profiles, and renal function markers, along with demographic data, were collected. Group comparisons, univariate and multivariate regression analyses, and receiver operating characteristic (ROC) analyses assessed associations between echocardiographic parameters and clinical variables.

Results: Gout patients had a significantly higher prevalence of LVDD (31.00% vs 10.78%, P<0.001), a lower left ventricular ejection fraction (LVEF) (60.01±3.92 vs 65.85±3.78, P<0.001), and a lower absolute value of global longitudinal strain (GLS) (17.72 vs 19.68, P<0.001) compared to asymptomatic hyperuricemic patients. SUA positively correlated with GLS (β=0.236, P<0.05) in gout patients, while body mass index (BMI) and total cholesterol negatively correlated with LVEF (β=-0.248; -0.280, respectively, both P<0.05). In asymptomatic patients, triglycerides positively correlated with GLS and global circumferential strain (β=0.355; 0.310, both P<0.05). Risk factors for LVDD differed: gout patients showed BMI, creatinine, and course-dependent risks, while asymptomatic patients exhibited BMI and β2 microglobulin-related risks.

Conclusion: Distinct echocardiographic profiles and risk factor patterns in gout versus asymptomatic hyperuricemia suggest differing mechanisms of cardiac involvement, underscoring the need for tailored cardiovascular monitoring in hyperuricemic populations.

Background: Postpartum hemorrhage (PPH) remains a major contributor to maternal morbidity and mortality worldwide. Early identification of high-risk women is crucial for implementing targeted interventions. This study aimed to develop and validate a predictive nomogram that integrates key maternal and perinatal risk factors to estimate the risk of PPH.

Methods: In this retrospective study, 336 pregnant women who delivered at our hospital from January 2022 to January 2024 were included. PPH was defined as blood loss >500 mL after vaginal delivery or >1000 mL after cesarean section. Independent predictors were identified using forward stepwise multivariable logistic regression and incorporated into a nomogram. Discrimination was evaluated by the area under the receiver operating characteristic curve (AUC) and concordance index (C-index); calibration by the Hosmer-Lemeshow test and calibration curves; clinical utility by decision curve analysis (DCA). Internal validation used 1000 bootstrap resamples.

Results: Participants were classified into non-PPH (n = 281) and PPH (n = 55) groups. Independent predictors of PPH included advanced maternal age (≥35 years), uterine atony, various placental abnormalities (previa, abruption, adhesion, and retained placenta), adverse obstetric history, cesarean delivery, higher prenatal weight, instrumental delivery, birth canal tears, multiple gestations, macrosomia, coagulopathy, uterine fibroids, and adverse psychological status (all p < 0.05). The nomogram achieved an AUC of 0.786 (95% CI: 0.695-0.865) and a corrected C-index of 0.796. Calibration was excellent (Hosmer-Lemeshow, p = 0.912), and DCA confirmed its clinical utility.

Conclusion: This internally validated nomogram showed strong predictive performance for PPH using routinely collected clinical and psychosocial data. Future studies should conduct external validation and prospective multicenter evaluation to confirm its generalizability and clinical applicability.

Objective: To evaluate the clinical utility of lung ultrasound (LUS) scoring in assessing the severity of bronchopulmonary dysplasia (BPD) in preterm infants and to explore its correlation with therapeutic strategies.

Methods: We conducted a retrospective analysis of clinical data from preterm infants born at our hospital between February 2023 and January 2024. Based on clinical diagnosis, infants were categorized into a BPD group and a non-BPD control group. All infants underwent LUS examinations. We compared LUS scores and clinical characteristics between the two groups and performed correlation analyses to investigate the relationship between LUS findings and subsequent treatment plans.

Results: The two groups were comparable in baseline characteristics (P>0.05). The LUS score was significantly higher in the BPD group than in the control group (P<0.05). Univariate regression analysis indicated that lower gestational age, cesarean delivery, lower birth weight, birth asphyxia, invasive ventilation, presence of retinopathy of prematurity (ROP), neonatal respiratory distress syndrome (NRDS), patent ductus arteriosus (PDA), higher fluid intake/output in the first week, and higher LUS scores were all associated with increased BPD risk. Multivariate logistic regression analysis confirmed that lower gestational age and higher LUS scores were independent risk factors for BPD (P<0.05). The area under the curve (AUC) for LUS scoring in diagnosing BPD was 0.928. An optimal LUS score cutoff value of 32 was identified, yielding a sensitivity of 80.11% and a specificity of 85.94%. Spearman correlation analysis revealed a positive correlation between LUS scores and the intensity of the therapeutic interventions employed (P<0.05).

Conclusion: A higher LUS score is an independent risk factor for BPD in preterm infants. As a non-invasive, simple, and real-time tool, LUS scoring holds significant clinical value for the early diagnosis of BPD and for guiding the formulation of treatment strategies.

Purpose: The incidence of aspiration pneumonia is increasing in the rapidly aging population of Japan. Although dental care is crucial, little is known about the collaboration between hospitalists and dental professionals. Therefore, this study aimed to clarify the state of dental involvement in aspiration pneumonia management and identify challenges that need to be addressed.

Patients and methods: An observational cross-sectional survey was administered to hospitalists in the Japanese Society of Hospital General Medicine between August and November 2023. We collected data via an anonymous, self-administered web-based questionnaire. Baseline data (eg, age, hospital type, presence of an oral surgery department, number of full-time dentists, and presence of dental hygienists) and dental referral practices were analyzed.

Results: Of the 352 respondents, 305 (86.7%) were male, and the median age was 48 years. An oral surgery department was present in the workplaces of 234 (66.4%) respondents, and 141 (40.1%) referred patients to dental services. Referrals were significantly associated with the presence of an oral surgery department (50.4% vs 19.5%, P<0.001), full-time dentists (50.7% vs 20.8%, P<0.001), dental hygienists (49.8% vs 20.0%, P<0.001), and university hospitals (52.6% vs 35.3%, P<0.001). The most common reasons for referrals were oral health care (89.4%), denture adjustment (60.2%), and swallowing assessment (43.3%). Conversely, non-referral reasons included reliance on other professionals (45.0%), lack of referral habits (43.1%), and the absence of onsite dentists (41.2%).

Conclusion: Access to dental resources and regular oral assessments in the management of aspiration pneumonia benefit both hospitals and patients. Hospitals and patients benefit from accessible dental resources and routine oral assessments. Strengthening referral habits and expanding dental staff may improve the outcomes of patients with aspiration pneumonia.