International Journal of General Medicine最新文献

Purpose: To investigate the prognostic value of human epididymis protein 4 (HE4) in patients with acute myocardial infarction (AMI).

Patients and methods: A total of 212 consecutive patients diagnosed with AMI in the Department of Cardiovascular Medicine of Hunan Provincial People's Hospital from June 2020 to May 2021 were enrolled. We determined plasma HE4 levels at baseline. The patients were followed up regularly and the occurrence of major adverse cardiac events (MACE) was recorded after discharge.

Results: After a mean follow-up period of 242 (159-427) days, 67 patients had MACE. Multivariate Cox regression analysis showed that HE4 was an independent predictor of MACE in patients with AMI [HR = 1.004 (1.002-1.007), P = 0.002]. Kaplan-Meier survival curves showed that patients with HE4 levels > 532.9 pmol/L had higher MACE compared with patients with ≤ 532.9 pmol/L HE4 levels (HR=4.044, 95% CI 2.373-6.890, P <0.001). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of HE4 for predicting MACE was 0.734 (95% CI: 0.669-0.792, P < 0.001).

Conclusion: Human epididymis protein 4 (HE4) might be a novel biomarker for predicting the prognosis of patients with AMI.

Objective: To explore the types of pathogens causing lower respiratory tract infections (LTRIs) in children and construction of a predictive model for monitoring secondary asthma caused by LTRIs.

Methods: Seven hundred and seventy-five children with LTRIs treated from June 2017 to July 2024 were selected as research subjects. Bacterial isolation and culture were performed on all children, and drug sensitivity tests were conducted on the isolated pathogens; And according to whether the child developed secondary asthma during treatment, they were divided into asthma group (n = 116) and non-asthma group (n = 659); Using logistic regression model to analyze the risk factors affecting secondary asthma in children with LTRIs, and establishing machine learning (ie nomogram and decision tree) prediction models; Using ROC curve analysis machine learning algorithms to predict AUC values, sensitivity, and specificity of secondary asthma in children with LTRIs.

Results: 792 pathogenic bacteria were isolated from 775 children with LTRIs through bacterial culture, including 261 Gram positive bacteria (32.95%) and 531 Gram negative bacteria (67.05%). Logistic regression model analysis showed that Glycerophospholipids, Sphingolipids and radiomics characteristics were risk factors for secondary asthma in children with LTRIs (P < 0.05). The AUC, sensitivity, and specificity of nomogram prediction for secondary asthma in children with LTRIs were 0.817(95CI: 0.760-0.874), 82.3%, and 76.6%, respectively; The AUC of decision tree prediction for secondary asthma in children with LTRIs is 0.926(95% CI: 0.869-0.983), with a sensitivity of 96.7% and a specificity of 87.8%.

Conclusion: LTRIs in children are mainly caused by Staphylococcus aureus, Streptococcus pneumoniae, Staphylococcus epidermidis, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa; In addition, machine learning combined with multi-omics prediction models has shown good ability in predicting LTRIs combined with asthma, providing a non-invasive and effective method for clinical decision-making.

Objective: To analyze the relationship between the cardiopulmonary function and prognosis of patients with coronary heart disease after percutaneous coronary intervention (PCI).

Methods: A total of 153 patients with coronary heart disease who underwent PCI from January 2018 to April 2020 were enrolled in this study. Through careful assessment, cardiopulmonary exercise test (CPX) was performed 5 to 7 days after PCI. Patients were followed up every 3 months by outpatient examination or telephone visiting for 3 years after discharge. Clinical outcomes were followed up, including cardiac death, rehospitalization, heart failure, atrial fibrillation, stroke and transient ischemic attack. A single clinical event was defined as a poor prognosis and divided into a good prognosis group and a poor prognosis group according to the prognosis. By comparing the cardiorespiratory fitness (CRF) variables and clinical parameters, the variables that may affect the prognosis of patients were determined.

Results: CRF decreased significantly in the poor prognosis group, and peak VO2, VO2/kg AT, PETCO2 and OUES decreased compared with the good prognosis group, and the differences were statistically significant. Heart rate reserve (HRR) increased in the poor prognosis group compared with the good prognosis group, and the difference was statistically significant. Among them, peak VO2 and acute myocardial infarction were independent risk factors for poor prognosis.

Conclusion: Peak VO2 is an independent risk factor for the prognosis of cardiovascular disease after PCI for coronary heart disease.

Purpose: Glioblastoma (GBM) is associated with metabolic disturbances, yet the relationships between metabolites with GBM have not been comprehensively explored. This study aims to fill this gap by integrating Mendelian randomization (MR) analysis with clinical validation.

Patients and methods: Summary data from genome-wide association study (GWAS) of cerebrospinal fluid (CSF) metabolites, plasma metabolites, and GBM were obtained separately. A total of 338 CSF metabolites and 1400 plasma metabolites were utilized as exposures. Concurrently, GBM was designated as the outcome. A two-sample bidirectional MR study was conducted to investigate the potential association. The inverse variance weighted (IVW) analyses were conducted as causal estimates, accompanied by a series of sensitivity analyses to evaluate the robustness of the results. Additionally, metabolite levels in clinical plasma and CSF samples were quantified using liquid chromatography-mass spectrometry to validate the findings.

Results: MR analysis identified eight CSF metabolites and six plasma metabolites that were closely associated with GBM. Among these, elevated levels of 7-alpha-hydroxy-3-oxo-4-cholestenoate (7-HOCA) in both CSF and plasma were found to promote GBM. In terms of clinical validation, compared to the control group, 7-HOCA levels were significantly higher in both the CSF and plasma of GBM group.

Conclusion: This study provides a comprehensive analysis of the metabolic factors contributing to GBM. The identification of specific metabolites, particularly 7-HOCA, that have vital roles in GBM pathogenesis suggests new biomarkers and therapeutic targets, offering potential pathways for improved diagnosis and treatment of GBM.

Background: This study aims to explore the correlation between bone metabolism indices and osteoporotic thoracolumbar vertebrae fracture (OTVF) in postmenopausal women.

Methods: A total of 447 female patients with postmenopause and underwent OTVF in our hospital were selected as group A. Three hundred eighty-seven out-patients without fractures were selected as group B. Bone metabolism index including the serum levels of total Serum procollagen type N-terminal propeptide (tPINP), the age-related type I cross linked C-telopeptide (β-CTX) and 25-hydroxyvitamin D (25-OHD) were collected and compared. The relation between bone metabolism indices and OTVF was analyzed.

Results: The mean tPINP in group A was 61.72 ± 28.43, which was notably higher than group B (P < 0.01). Meanwhile, greater β-CTX were higher founded in group A than group B (0.778 ± 0.316 vs 0.669 ± 0.303 μg/l). However, the 25-OHD in group A was significantly lower than that in group B (P < 0.05). Multivariate logistic regression analysis revealed that the serum level of tPINP (OR: 0.008, P = 0.011), the serum level of β-CTX (OR: 0.805, P = 0.002) and the serum level of 25-OHD (OR: -0.029, P = 0.003) were independently correlated with postmenopausal OTVF.

Conclusion: Bone metabolic markers play an important role in predicting OTVF. As a reflection of bone mass and bone strength, BMD is inadequate in predicting OTVF. High expression of bone metabolism indicators β-CTX, tPINP and relatively low expression of 25-OHD suggest an increased risk of OTVF. Early detection of postmenopausal bone metabolism abnormalities can be used for early intervention to reduce the incidence of OTVF.

Introduction: Most studies have shown a declining incidence of upper gastrointestinal bleeding (UGIB) in recent years. Data regarding mortality were controversial; in non-variceal bleeding, the increasing age of the population, increased use of anti-thrombotic and anticoagulant therapy in patients with cardiovascular diseases, and the use of non-steroidal anti-inflammatory drugs are counterbalanced by the progress in endoscopic therapy with stable mortality.

Material and method: We performed a retrospective, cross-sectional study that included patients admitted with UGIB in Clinical Emergency Hospital Craiova during 2013-2020.

Results: 3571 patients with UGIB were selected; a trend toward increased admission for UGIB from 2013 to 2019 was noted, with a significant decrease in 2020. Non-variceal bleeding remains the most frequent form, with a slight increase in variceal bleeding, of Mallory-Weiss syndrome and angiodysplasia, and a 3-fold decrease for unknown etiology bleeding (with no endoscopy performed) during the 2017-2020 period as compared to 2013-2016. There was a trend toward decreased mortality, with lower mortality in 2017-2020 (12.83%) compared to 2013-2016 (17.41%). The mortality for variceal bleeding and peptic ulcer bleeding has declined, but mortality for non-variceal bleeding has slightly increased during 2013-2020. Mortality has decreased in admissions during regular hours/after hours and weekdays/weekends, but the difference (off-hours and weekend effects) had increased. The percentage of endoscopies performed in the first 24 hours after admission and the rate of therapeutic endoscopy increased during 2017-2020; the median time between admission and endoscopy was 17.0 hours during 2017-2020 and 59.1 hours during 2013-2016. The proportion of patients who needed emergency surgery for uncontrolled bleeding has significantly declined since 2013-2015, with an average value of 1% in the last 5 years of the study.

Conclusion: Increased admissions for UGIB, with lower mortality, especially for peptic ulcer bleeding and variceal bleeding were noted; higher percentages of therapeutic endoscopies and endoscopies performed during the first 24 hours after admission were also recorded.

Background: Alzheimer's disease is a degenerative condition that causes patients to experience progressive memory decline and a significant decline in overall cognitive ability at any given moment. The increase in the elderly population has resulted in a notable surge in the prevalence of Alzheimer's disease, as has the global impact of the disease. Significant clinical efficacy of traditional Chinese medicine in combination with Western medicine for the treatment of Alzheimer's disease has been demonstrated in previous studies. The main purpose of this trial is to assess the effectiveness and safety of Shenxiong Huanglian Detoxification Granule combined with donepezil in individuals diagnosed with mild-to-moderate Alzheimer's disease.

Methods: This is a multicenter, pragmatic, randomized controlled trial. A total of 386 eligible individuals with mild to moderate Alzheimer's disease will receive random assignment and equal access to the test or control group. The effectiveness and safety of Shenxiong Huanglian Detoxification Granule in combination with donepezil will be observed. The primary outcome is the alteration in scores acquired from the Alzheimer's Disease Assessment Scale-Cognitive Subscale. Secondary outcomes include the assessments of the Traditional Chinese Medicine Syndrome score scale, Mini-Mental State Examination, Clinical Dementia Rating, and Activity of Daily Living scale. We will also analyze blood biomarkers of Alzheimer's disease, inflammatory indicators, oxidative stress indicators, and hemorheology indicators. In addition, safety assessments will be conducted at baseline, after 12 weeks, and after 24 weeks of treatment.

Discussion: These findings will offer reliable clinical evidence regarding the effectiveness and safety of Shenxiong Huanglian Detoxification Granule in combination with donepezil for treating patients with mild-to-moderate Alzheimer's disease. Additionally, this study will support the integration of traditional Chinese and Western medicine into mainstream treatment for Alzheimer's disease, promoting a multitarget strategy.

Trial registration: Chinese Clinical Trial Registry, Registration Number: ChiCTR2300072768. Registered on 25 June 2023. https://www.chictr.org.cn/showproj.html?proj=195457.

Background: A full examination of gastrointestinal tract is an essential prerequisite for effectively detecting gastrointestinal lesions. However, there is a lack of efficient tools to analyze and recognize gastric anatomy locations, preventing the complete portrayal of entire stomach. This study aimed to evaluate the effectiveness of artificial intelligence in identifying gastric anatomy sites by analyzing esophagogastroduodenoscopy images.

Methods: Using endoscopic images, we proposed a system called the Artificial Intelligence of Medicine (AIMED) through convolutional neural networks and MobileNetV3-large. The performance of artificial intelligence in the recognition of anatomic sites in esophagogastroduodenoscopy images was evaluated by considering many cases. Primary outcomes included diagnostic accuracy, sensitivity, and specificity.

Results: A total of 160,308 images from 27 categories of the upper endoscopy anatomy classification were included in this retrospective research. As a test group, 16031 esophagogastroduodenoscopy images with 27 categories were used to evaluate AIMED's performance in identifying gastric anatomy sites. The convolutional neural network's accuracy, sensitivity, and specificity were determined to be 99.40%, 91.85%, and 99.69%, respectively.

Conclusion: The AIMED system achieved high accuracy with regard to recognizing gastric anatomy sites, and it could assist the operator in enhancing the quality control of the used endoscope. Moreover, it could contribute to a more standardized endoscopic performance. Overall, our findings prove that artificial-intelligence-based systems can be indispensable to the endoscopic revolution (Clinical trial registration number: NCT04384575 (12/05/2020)).

Purpose: The connection between thyroid disorders and the health of bone is an endocrinological dilemma for physicians. Several studies have been conducted to examine the correlation between levothyroxine use and the risk of fracture. Different results have been obtained in these studies. The objective of the present study is to evaluate the impact of prolonged thyroid hormone replacement therapy on bone health in postmenopausal women.

Patients and methods: We obtained demographic data, laboratory results, and anthropometric measurements of patients from the hospital database. After the exclusion of patients, 59 patients with post-procedural hypothyroidism (n = 59) and a control group (n = 45) were evaluated. The patient group consisted of individuals who had undergone thyroid surgery for a benign condition and had been on levothyroxine treatment for a minimum of 5 years. Densitometric measurements of bone mass in the hip and spine were performed by bone mineral densitometry.

Results: Groups were similar in age, PTH, vitamin D, bone-specific ALP, and BMI (p>0.05). The control group had a significantly lower total T score-F than the hypothyroidism group (-0.77±1.3 to -0.29±1.02, p= 0.041). However, total T score-LV, total gr/cm2-LV, and total gr/cm2-F were similar in both groups.

Conclusion: This study showed that long-term levothyroxine therapy, which aims to maintain TSH levels within the normal reference range, is associated with increased bone mineral density (BMD) in postmenopausal women compared with the control group. Thus, to maintain bone health and prevent osteoporosis, it is important that postmenopausal women on long-term levothyroxine replacement undergo medical follow-up to prevent TSH suppression.