Journal of International Medical Research最新文献

BackgroundTo explore the clinical value of preoperative transrectal three-dimensional ultrasound in diagnosing the internal opening and classifying complex anal fistulas, and to evaluate its impact on surgical efficacy.MethodsA total of 42 patients with complex anal fistulas were divided into an observation group and a control group. The control group underwent conventional transrectal ultrasound examination, while the observation group underwent three-dimensional transrectal ultrasound examination. Perioperative data were recorded and compared between the two groups.ResultsThe observation group showed significantly higher diagnostic accuracy (p = 0.014) and a higher cure rate (66.67% vs. 42.86%) than the control group. Anal sphincter function improved postoperatively in both groups, with the observation group achieving superior outcomes at 6 months. The observation group also demonstrated lower Wexner incontinence scores (p = 0.015), shorter hospitalization and wound healing times, and higher SF-36 scores in bodily pain, general health, and health transition domains. However, postoperative complication rates and 6-month recurrence rates were similar between the two groups.ConclusionPreoperative transrectal three-dimensional ultrasound can accurately identify the internal opening and fistula tract of complex anal fistulas, which is beneficial for improving treatment efficacy.

BackgroundAbdominal aortic calcification, a subclinical marker of atherosclerosis, shares pathophysiological pathways with musculoskeletal decline. Although grip strength is an established predictor of cardiovascular outcomes, its association with abdominal aortic calcification in sex-specific analysis remains underexplored.MethodsThis cross-sectional study analyzed data from 1683 adults in National Health and Nutrition Examination Survey 2013-2014. Abdominal aortic calcification was quantified via dual-energy X-ray absorptiometry using Kauppila scores (L1-L4), with abdominal aortic calcification defined as a score >0. Muscle strength was evaluated using a standardized grip strength measurement (Takei dynamometer). Multivariable logistic regression, adjusted for demographic, metabolic, and lifestyle factors, were used to examine sex-specific associations. Restricted cubic splines were applied to evaluate dose-response relationships.ResultsAmong 903 men (mean age, 58.3 ± 12.0 years) and 780 women (mean age, 57.2 ± 11.9 years), each 1-kg increase in grip strength was associated with a 1.8% reduction in abdominal aortic calcification risk (odds ratio, 0.982; 95% confidence interval: 0.971-0.993) in men and a 2.6% reduction (odds ratio, 0.974; 95% confidence interval: 0.955-0.993) in women. Dose-response curves demonstrated linear inverse relationships (p < 0.05). Subgroup analyses confirmed consistency of this association across age, body mass index, hypertension, and diabetes status (all p for interaction > 0.05).ConclusionMuscle strength exhibits an independent, dose-dependent inverse association with the prevalence of abdominal aortic calcification, which persists across demographic subgroups. These findings support the use of grip strength as a practical biomarker for abdominal aortic calcification risk stratification and highlight musculoskeletal health as a potential target for interventions to prevent vascular calcification.

ObjectiveDepressive symptoms are a common disorder influenced by various factors, including genetic, environmental, and psychosocial aspects. This study aimed to explore the association between depressive symptoms and the number of close friends.MethodsThis cross-sectional study employed data from the 2005-2008 National Health and Nutrition Examination Survey. Weighted logistic regression was used to analyze the relationship between the number of close friends and depressive symptoms, and restricted cubic spline plots were constructed. Subgroup and sensitivity analyses were also performed.ResultsThis study included 5564 participants. After grouping participants based on the number of close friends into tertiles, a negative association was found between the number of close friends and depressive symptoms. After adjustment, the group with a higher number of close friends exhibited a 48% lower risk of depressive symptoms. An approximately L-shaped relationship was observed (nonlinear P = 0.001). Depressive symptoms decreased with an increasing number of close friends up to 10, beyond which the association plateaued.ConclusionAn approximately L-shaped relationship exists between the number of close friends and depressive symptoms. When the number of close friends was ≤10, a higher number of close friends was associated with a lower level of depressive symptoms.

ObjectiveTo explore the potential involvement of PANoptosis-related genes in gastric cancer susceptibility through multiomics analyses.MethodsSummary-data-based Mendelian randomization was performed by integrating blood-derived methylation, gene expression, and protein quantitative trait loci data with genome-wide association study results. The findings were further evaluated in The Cancer Genome Atlas cohort, followed by protein-protein interaction analysis, drug prediction, and molecular docking.ResultsSummary-data-based Mendelian randomization and colocalization analyses identified several traits suggestively associated with gastric cancer risk. Genetically predicted higher expression of apoptosis and caspase activation inhibitor (AVEN) and hepatocyte growth factor (HGF) as well as higher HGF protein levels were associated with increased risk, whereas higher levels of protein phosphatase 2 regulatory subunit B beta (PPP2R2B) appeared to be protective. Multiomics integration suggested epigenetic regulation of HGF and PPP2R2B. The Cancer Genome Atlas analysis corroborated the dysregulation of these candidates, with high AVEN expression associated with poorer survival. Protein-protein interaction and drug prediction analyses highlighted functional networks and potential therapeutics, supported by molecular docking demonstrating strong HGF-binding affinities. However, these associations did not reach statistical significance in the independent validation cohort, possibly due to limited statistical power.ConclusionsThis study identified AVEN, HGF, and PPP2R2B as potential candidate genes for gastric cancer. These findings require further validation in larger cohorts.

ObjectiveIn the pathogenesis of the post-injury period following nonpenetrating traumatic brain injuries (TBIs; post-TBIs), pathological metabolic changes in the oxidative status are important, as a complete understanding of their interactions can explain the concept of how oxidative metabolic-related differences develop, thereby supporting effective treatment.MethodsThis case-control study included 63 patients (mean age ± SD, 36.19 ± 11.4 years) in the post-TBI group and 32 healthy controls. Participants were tested for creatine kinase, adenosine triphosphate, and adenosine diphosphate levels using enzyme-linked immunosorbent assays and for pyruvate and lactate levels using a spectrophotometric method according to standard manufacturer protocols.ResultsThis study found abnormally decreased adenosine triphosphate and adenosine diphosphate levels in the general nonpenetrating post-TBI group versus controls. The median total adenosine triphosphate levels were 600.4 ± 46.96 in the general clinical group and 745.7 ± 49.83 mkmol/L in controls (p < 0.0001, t = 13.69, 95% confidence interval: 124.0 to 166.5). The median total adenosine diphosphate levels were 247.6 ± 33.09 in the general clinical group and 273.9 ±31.98 mkmol/L in controls (p = 0.0004, t = 3.734, 95% confidence interval: 12.20 to 40.26). Compared with controls, elevated creatine kinase levels were found in the general clinical group (p < 0.0001, t = 7.030, 95% confidence interval: -39.78 to -22.19). The median total creatine kinase (mean ± SD) levels were 129.6 ± 21.37 in the general clinical group and 98.61 ± 19.74 IU/L in controls. Higher creatine kinase (p < 0.0001, t = 4.779, 95% confidence interval: 13.16 to 32.23) and lower adenosine triphosphate levels (p < 0.001, t = 4.997, 95% confidence interval: -70.74 to -30.31) were found to be more pronounced after brain contusion compared with those following mild TBIs.ConclusionsNonpenetrating post-TBIs showed higher creatine kinase levels associated with lower adenosine triphosphate-adenosine diphosphate levels, indicating oxidative dyshomeostasis at 12-month post-injury follow-ups, which could play a pathogenetic role in post-TBIs progression.

ObjectiveTo compare the radiological and functional outcomes of the newly proposed lateral articular line approach with those of the traditional extended anterolateral approach in the management of Schatzker type II-III tibial plateau fractures involving the posterolateral quadrant.MethodsThis single-center retrospective cohort study included 90 patients who underwent open reduction and internal fixation using either lateral articular line approach (n = 45) or extended anterolateral approach (n = 45). Perioperative data (operative time, blood loss, and incision length), radiological outcomes (articular depression and posterior tibial slope), and functional recovery (Rasmussen knee scores and range of motion) were evaluated up to 12 months postoperatively.ResultsCompared with the extended anterolateral approach, the lateral articular line approach significantly reduced operative time (72.47 vs. 87.73 min, p < 0.001), blood loss (80.11 vs. 133.33 mL, p < 0.001), and incision length (6.0 vs. 15.0 cm, p < 0.001). The lateral articular line approach also achieved better reduction quality with smaller final articular depression (0.55 vs. 1.55 mm, p < 0.001) and yielded higher Rasmussen knee scores and greater range of motion at all follow-up assessments (all p < 0.05). Complication rates were comparable between the two groups.ConclusionThe lateral articular line approach offers a minimally invasive and reliable alternative to the extended anterolateral approach for Schatzker type II-III tibial plateau fractures with posterolateral involvement, providing superior reduction quality, faster recovery, and less surgical trauma.

A man in his early 50 s presented with a 7-day history of progressive, symmetrical weakness that began in the lower limbs and ascended to involve the upper limbs. His symptoms were accompanied by distal paresthesia and complete areflexia. Three weeks prior to presentation, he experienced a self-limiting febrile illness associated with dark urine and elevated transaminase levels, which resolved spontaneously. On admission, laboratory investigations demonstrated elevated liver enzyme levels and positive anti-hepatitis E virus Immunoglobulin M antibodies, confirming acute hepatitis E virus infection. Nerve conduction studies were consistent with the acute inflammatory demyelinating polyneuropathy variant of Guillain-Barré syndrome. The patient was treated with intravenous immunoglobulin (0.4 g/kg/day for 5 days) and was closely monitored for respiratory and autonomic complications. Gradual neurological improvement was observed, along with normalization of liver function tests. To the best our knowledge, this case represents the first documented occurrence of hepatitis E virus-associated Guillain-Barré syndrome in Egypt after a careful review of the literature. It underscores the importance of considering hepatitis E virus infection in the differential diagnosis of Guillain-Barré syndrome, particularly in patients presenting with elevated liver enzymes or a recent history of hepatitis in hepatitis E virus-endemic regions. Early recognition and prompt initiation of immunotherapy may improve neurological recovery and clinical outcomes in this rare but clinically significant association.

ObjectiveThis study aimed to evaluate the clinical outcomes and safety of combined duloxetine and tolterodine therapy in patients with mixed urinary incontinence.MethodsA retrospective analysis was conducted on patients with mixed urinary incontinence treated between January 2021 and December 2023. Patients received tolterodine (4 mg/day) and duloxetine (40 mg twice daily). Clinical outcomes were assessed at weeks 4 and 12 using the Overactive Bladder Symptom Score, International Consultation on Incontinence Questionnaire-Short Form, pad tests, and bladder diaries. Patient satisfaction was evaluated using the Clinical Global Impression scale.ResultsThe study included 115 patients (mean age: 46.6 ± 13.4 years). Significant improvements were observed in Overactive Bladder Symptom Score, International Consultation on Incontinence Questionnaire-Short Form scores, and pad weights at weeks 4 and 12 compared to baseline (p < 0.001). Daily micturition, nocturia, urgency, and incontinence episodes significantly decreased, whereas mean voided volume increased. According to Clinical Global Impression scores, 73.9% of patients reported partial or complete improvement. Treatment-related adverse events were observed in 12.1% of patients.ConclusionThe combination therapy of duloxetine and tolterodine appears to be safe and potentially beneficial, reducing symptom scores and incontinence episodes. However, these findings need to be supported by controlled studies.

Furazolidone is a nitrofuran antibiotic commonly used in the treatment of Helicobacter pylori infection. Although gastrointestinal symptoms are well-documented adverse effects, furazolidone-associated drug-induced interstitial lung disease is extremely rare. Herein, we report a case of a 54-year-old Chinese woman who developed fever, dry cough, and dyspnea on day 4 of furazolidone-containing quadruple therapy. Chest computed tomography revealed diffuse bilateral interlobular septal thickening and small pleural effusions. An extensive workup excluded other causes. The Naranjo adverse drug reaction probability scale score was 6, indicating a probable association with furazolidone. Discontinuation of the drug and initiation of glucocorticoid therapy resulted in rapid clinical and radiological improvement. This case highlights that furazolidone can cause drug-induced interstitial lung disease and that early recognition and intervention are crucial for a favorable outcome.