International Journal of General Medicine最新文献

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.

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.