International Journal of General Medicine最新文献

Objective: To explore the effect of conventional cardiology drug therapy combined with sacubitril/valsartan sodium on improving cardiac function in patients with heart failure.

Methods: A retrospective analysis was conducted on data from heart failure patients diagnosed and treated in our hospital between March 2022 and December 2023. Patients were divided into a control group and an experimental group based on treatment methods. The control group received conventional cardiology drug therapy, while the experimental group received conventional cardiology drug therapy combined with sacubitril/valsartan sodium. Cardiac function indicators and related clinical outcomes were compared between the two groups before and after treatment.

Results: The overall clinical efficacy rate in the experimental group was significantly higher than in the control group (P < 0.05). After treatment, the experimental group exhibited higher levels of LVEF, SV, and CO, while LVESD and LVEDD levels were significantly lower compared to the control group (P < 0.05). Levels of NT-proBNP, Hcy, and cTnI in the experimental group were significantly lower than in the control group after treatment (P < 0.05). Additionally, levels of NE, ALD, and AngII in the experimental group were significantly lower than those in the control group post-treatment (P < 0.05). The 6-minute walk test (6 MWT) performance was better in the experimental group, and their MLHFQ (Minnesota Living with Heart Failure Questionnaire) scores were lower than those in the control group (P < 0.05). The incidence of adverse events was similar between the two groups (P > 0.05).

Conclusion: Conventional cardiology drug therapy combined with sacubitril/valsartan sodium significantly improves cardiac function in patients with heart failure. It achieves this by modulating neuroendocrine function, counteracting adverse effects, and promoting the reversal of ventricular remodeling. The treatment also demonstrates good safety, effectively enhancing patients' exercise capacity and quality of life.

Gastroesophageal reflux disease (GERD) is a common clinical digestive disorder with a complex pathological mechanism. Traditional understanding of its mechanisms primarily focuses on factors such as lower esophageal sphincter dysfunction, impaired esophageal clearance, delayed gastric emptying, and abnormal gastric acid secretion. In recent years, the introduction of the brain-gut axis (BGA) theory has provided a new perspective for the systematic understanding of GERD's pathogenesis. However, there remains a significant lack of understanding regarding the specific mechanisms of BGA in GERD, particularly in terms of the interactions between the nervous, endocrine, and immune systems, and how they influence the symptoms and progression of gastroesophageal reflux. This paper aims to review the abnormal mechanisms of the nervous, endocrine, and immune systems in GERD based on the BGA theory, clarify the relationships between these systems in the development of GERD, and explore the current gaps in knowledge and future research directions. Studies have shown that GERD patients often present with neurological abnormalities such as central nervous system hypersensitivity, autonomic nervous imbalance, and enteric nervous system remodeling. Additionally, activation of the HPA axis and prolonged elevation of cortisol exacerbate esophageal injury, while local and systemic immune inflammation further induces visceral hypersensitivity, creating a stress-induced "neuroimmune loop". Based on the BGA mechanism, future individualized treatments for GERD, which integrate the regulation of central nervous function, endocrine levels, and the immune microenvironment, may provide new strategies and clinical interventions, leading to breakthroughs in relevant therapies.

Introduction: Postoperative pulmonary embolism (PE) is a severe and potentially fatal complication following thoracic surgery. Existing prediction methods often lack accuracy and timeliness. This study aimed to develop an early and reliable multifactorial prediction model for PE using multicenter data to identify high-risk patients.

Methods: We retrospectively analyzed data from 977 patients who underwent pulmonary surgery at three medical centers. Independent risk factors for PE were identified, and a logistic regression model was constructed and validated both internally and externally.

Results: Significant predictors included older age, upper lobe lesions, open thoracic surgery, longer surgical duration, greater intraoperative blood loss, and elevated D-dimer and fibrinogen levels. The model demonstrated excellent discrimination, with AUC values of 0.97, 0.95, and 0.94 in the training, internal validation, and external validation sets, respectively. Calibration curves showed strong consistency between predicted and observed outcomes (p > 0.05). In the external validation cohort, risk stratification based on the 85th percentile of estimated risk effectively distinguished between high-risk and low-risk groups.

Conclusion: This predictive model, integrating surgical and coagulation related factors, shows strong potential for early PE detection and clinical utility. Further prospective studies are warranted to confirm its effectiveness in improving patient outcomes.

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity. While pharmacological and behavioral therapies remain first-line treatments, their limitations in efficacy, tolerability, and long-term adherence underscore the need for innovative interventions. Growing evidence highlights the role of the microbiota-gut-brain axis (MGBA) in ADHD pathophysiology, particularly involving immune dysregulation, neurotransmitter imbalance, metabolic disruption, and epigenetic alterations. Fecal microbiota transplantation (FMT), as a microbiota-based intervention, has shown promise in restoring MGBA homeostasis and modulating neural function through multiple mechanisms. This review summarizes current preclinical and clinical research on FMT in ADHD, covering its effects on neuroinflammation, neurotransmitter pathways, vagus nerve and HPA axis signaling, and epigenetic reprogramming. Although preclinical models and early human data indicate potential behavioral benefits and mechanistic plausibility, methodological heterogeneity, limited sample sizes, and incomplete mechanistic validation pose significant challenges. Future research should prioritize protocol standardization, randomized controlled trials, biomarker discovery, and ethical regulation to facilitate the safe and effective clinical translation of FMT in ADHD treatment.

Background: Preoperative biliary drainage is used to alleviate obstructive jaundice before pancreaticoduodenectomy in jaundiced patients, but its effect on reducing the short-term postoperative complications is still controversial.

Methods: Data were collected retrospectively from patients (n = 292) with benign and malignant diseases around the ampulla who underwent pancreaticoduodenectomy in this study. Intergroup comparisons were performed using statistical methods such as t-tests and chi-square tests. The optimal preoperative total bilirubin was identified through receiver operating characteristic curve analysis.

Results: A total of 292 patients (jaundiced patients:141, non-jaundice:151) were collected in this study. Compared with non-jaundice patients, the incidence of postoperative bleeding events (P = 0.004), short-term complications (P = 0.038), and severe short-term complications (P = 0.025) was significantly increased in jaundiced patients. The incidence of short-term postoperative complications in patients with severe jaundice was not statistically different from that in patients with mild jaundice after preoperative biliary drainage. In patients with mild jaundice, there was no statistically significant difference between the direct surgery group and the preoperative biliary drainage group. When the preoperative total bilirubin in preoperative biliary drainage patients decreased to 151.8μmol/L, the incidence of severe short-term postoperative complications was significantly reduced (P = 0.047).

Conclusion: Preoperative biliary drainage can effectively improve liver function and decrease the short-term complications after pancreaticoduodenectomy for severe jaundiced patients. Routine preoperative biliary drainage is not recommended in patients with mild jaundice. It is recommended to reduce the total bilirubin to less than 151.8μmol/L, which can effectively decrease the severe short-term postoperative complications.

Gout, a prevalent metabolic disorder characterized by elevated uric acid levels, has numerous adverse health implications. Current medical therapies can control symptoms and lower uric acid, yet they are often limited by adverse effects and incomplete long-term efficacy. Traditional Chinese Medicine (TCM) has a long history of application in gout and is reported to provide advantages in both prevention and management. To evaluate its role from a modern biomedical perspective, this review systematically examined literature retrieved from PubMed, CNKI, and Web of Science up to 2024, covering randomized controlled trials, observational studies, and mechanistic investigations. The reviewed evidence indicates that TCM interventions, including classical herbal formulations and acupuncture, have been associated with improvements in inflammatory regulation, uric acid metabolism, symptom relief, and recurrence prevention. Moreover, experimental studies suggest potential protective effects on renal function and joint structures. By integrating clinical data with mechanistic insights, this review aims to provide a comprehensive overview of the therapeutic potential of TCM in gout and to outline directions for future translational and clinical research.

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder characterized by impaired skin barrier function and immune dysregulation. Despite advancements in understanding its pathogenesis, clinical management remains challenging due to high recurrence rates, complex symptom control, and diminished quality of life, particularly highlighting the lack of standardized protocols for skin barrier repair. Compromised skin barrier integrity in AD leads to increased transepidermal water loss (TEWL) and heightened susceptibility to irritants and allergens, exacerbating inflammation. Thus, restoring skin barrier function is pivotal in AD management. Current therapeutic strategies predominantly prioritize anti-inflammatory treatments while undervaluing barrier repair. Traditional care models relying on qualitative symptom assessments inadequately guide personalized interventions, necessitating an integrated approach combining barrier restoration and immunomodulation. Although diverse barrier repair methods and moisturizers are available, systematic evaluation and evidence-based selection criteria remain limited. This review aims to comprehensively summarize the structure and function of the skin barrier in AD, the role of skin barrier dysfunction in AD pathogenesis, current barrier repair strategies, and evidence-based emollient selection criteria. By analyzing existing research, we provide clinical recommendations for skin barrier restoration and long-term management in AD patients, while proposing future research directions. Emphasis should be placed on developing multi-omics-driven personalized barrier interventions and constructing a "barrier-immune-environment" interaction model to advance precision medicine in AD care.

Purpose: As a predominant contributor to disability and premature mortality worldwide, ischemic stroke (IS) urgently requires breakthroughs in early diagnostic biomarkers. The synergistic regulatory roles of pyroptosis and hypoxia, two critical pathological mechanisms in IS, require systematic exploration.

Patients and methods: We integrated two IS peripheral blood transcriptomic datasets (GSE66724 and GSE58294) to identify differentially expressed genes (DEGs) linked to pyroptosis and hypoxia. Co-expression networks were constructed using weighted gene co-expression network analysis. Diagnostic biomarkers were identified through the Least Absolute Shrinkage and Selection Operator, Support Vector Machine, and Random Forest algorithms, with validation performed in an independent cohort (GSE16561) and real-time quantitative PCR (RT-qPCR). Single-cell sequencing (GSE174574) was used to map cellular expression patterns of diagnostic genes. Candidate drugs were identified through the Connectivity Map (CMAP) database, with molecular docking validating their target protein interactions.

Results: We identified 32 pyroptosis-related and 50 hypoxia-related DEGs, with enrichment analyses indicating their involvement in inflammatory responses, NF-κB signaling, and tumor necrosis factor pathways. Cross-algorithm validation identified matrix metalloproteinase-9 (MMP9) as a diagnostic biomarker. RT-qPCR revealed significantly elevated MMP9 levels in the peripheral blood of IS patients (p < 0.01). Immune microenvironment profiling showed positive correlations between MMP9 expression and macrophage/neutrophil infiltration. Single-cell sequencing confirmed predominant MMP9 expression in granulocytes. Drug prediction via CMAP and molecular docking identified Benperidol and Fluspirilene as high-affinity ligands for MMP9.

Conclusion: This study employed multi-omics analysis followed by experimental validation to provide robust and systematic evidence supporting the diagnostic value and therapeutic potential of MMP9 in IS.

Lifestyle counseling in primary care is a critical intervention for addressing chronic disease risk factors and promoting health behavior change. This review evaluated the effectiveness of lifestyle counseling and propose strategies to simplify its implementation in family medicine practices. A structured narrative synthesis approach was used, integrating evidence from diverse study designs and settings. A comprehensive search was conducted across PubMed, Cochrane Library, Scopus, and Psychological Information databases for studies published in English language were included. Thematic analyzed was performed under three domains: Why? What? and How? Findings showed that lifestyle counseling significantly improves patient outcomes, including reduced stress, enhanced treatment adherence, and better chronic disease management. Counseling also addresses psychosocial factors, promotes self-efficacy, and decreases health-risk behaviors. Practical solutions include brief interventions, shared decision-making, and leveraging self-monitoring tools. Systemic barriers, such as time constraints and inadequate physician training, limit widespread adoption. To overcome these challenges, healthcare providers can apply evidence-based frameworks, prioritize patient-centered care, and utilize standardized training. This review highlights the importance of integrating lifestyle counseling into routine primary care to address non-communicable diseases and improve patient outcomes. Future research should explore long-term outcomes, cultural adaptations, and cost-effectiveness to refine implementation strategies. By addressing these gaps, healthcare providers can enhance patient adherence and improve health outcomes, ultimately contributing to better population health. By making counseling a routine part of primary care, could results in reduced chronic disease burden and improve population health.

Background: More and more Research has shown that Hashimoto's thyroiditis (HT) is significantly associated with recurrent miscarriage (RM), but the specific mechanism is not yet clear. This study aimed to identify the key shared biomarkers between HT and RM using bioinformatics methods, reveal the potential molecular mechanisms they were involved in and the characteristics of the immune microenvironment, and provide new theoretical basis and potential diagnostic and therapeutic targets for the association between these two diseases.

Methods: This study adopted an integrated transcriptomic analysis strategy. First, the HT thyroid tissue dataset (GSE138198) and RM endometrial tissue datasets (GSE165004 and GSE26787) were obtained from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were screened, and the intersection was taken to identify key genes. Further verification was conducted through the protein-protein interaction (PPI) network to screen candidate biomarkers. Subsequently, the final biomarkers were determined through consistency verification of expression levels. Gene Set Enrichment Analysis (GSEA) was used to reveal biomarker-related pathways, and the ssGSEA algorithm was applied to quantify immune cell infiltration for analyzing its association with the immune microenvironment. Finally, targeted drugs were predicted via molecular docking, and experimental verification was performed using an HT animal model.

Results: CFL1 and TRAPPC1 were identified as biomarkers, and their expression levels were up-regulated in disease groups. A nomogram with superior diagnostic performance was constructed to predict the occurrence of RM. In the GSE138198 dataset, biomarkers CFL1 and TRAPPC1 were found to be enriched in multiple pathways, like "graft-versus-host disease", "autoimmune thyroid disease", and "antigen processing and presentation". In the GSE165004 dataset, biomarkers were enriched in multiple pathways, like "ribosome", "Huntington's disease", and "cell adhesion molecules (CAMs)". Additionally, the abundance of infiltration of monocytes and eosinophils infiltration showed significant differences between HT and RM patients (p < 0.05). Biomarkers showed significant positive correlations with monocytes and eosinophils in HT and RM, respectively. Moreover, artenimol and S-palmitoyl-L-cysteine might be potential therapeutic drugs for HT and RM.

Conclusion: CFL1 and TRAPPC1 were found to be common biomarkers for HT and RM in this study. These genes were thoroughly investigated and analyzed, yielding novel insights for both fundamental experimental research and early clinical diagnosis and treatment of disease.