Journal of International Medical Research最新文献

ObjectiveAcute myocardial infarction is a leading cause of global mortality. Early detection and accurate risk stratification in patients with stable angina pectoris are crucial for improving clinical outcomes. This study aimed to identify novel lipid biomarkers for predicting the risk of acute myocardial infarction in patients with stable angina pectoris using nontargeted lipidomics.MethodsThis cross-sectional study enrolled 260 participants (40 non-cardiovascular disease controls, 180 patients with stable angina pectoris, and 40 patients with acute myocardial infarction) from August 2022 to December 2023. Plasma samples were analyzed via nontargeted lipidomics. Orthogonal partial least squares discriminant analysis was used to assess the differences in lipid profiles between the three groups. Random forest regression was used to identify key lipid metabolites. Independent associations between selected variables and the risks of cardiovascular disease and acute myocardial infarction were assessed using stepwise multivariate logistic regression. Model performance was evaluated using receiver operating characteristic curves.ResultsLipidomic analysis identified two specific phosphatidylethanolamine species, phosphatidylethanolamine(37:4) and phosphatidylethanolamine(17:0/20:4), as progressively elevated from non-cardiovascular disease controls to patients with stable angina pectoris and further to patients with acute myocardial infarction. Notably, in the multivariate models, phosphatidylethanolamine(17:0/20:4) emerged as an independent predictor of acute myocardial infarction risk in patients with stable angina pectoris (odds ratio = 3.13, 95% confidence interval: 1.33-7.38), while phosphatidylethanolamine(37:4) was independently associated with the overall cardiovascular disease risk (odds ratio = 4.01, 95% confidence interval: 1.30-12.38). Integrating these phosphatidylethanolamine species with conventional clinical parameters significantly improved the predictive accuracy for the risks of cardiovascular disease (area under the curve = 0.93) and acute myocardial infarction (area under the curve = 0.88).ConclusionThis study demonstrates the potential of nontargeted lipidomics in discovering novel lipid biomarkers for predicting acute myocardial infarction risk in patients with stable angina pectoris. The identified phosphatidylethanolamine species provide a basis for improving cardiovascular risk stratification and may serve as targets for future therapeutic interventions.

ObjectiveThe association between serum lipid levels and clinical outcomes following intracerebral hemorrhage remains unclear.MethodsData from consecutive patients hospitalized with intracerebral hemorrhage were prospectively collected between May 2005 and May 2018 and retrospectively analyzed. We documented the participants' baseline characteristics, clinical features, risk factors, routine laboratory test results, and outcomes at 12 months post-intracerebral hemorrhage.ResultsA total of 1450 patients with intracerebral hemorrhage were included in the final analysis. In the unadjusted model, triglyceride levels were negatively associated with the risk of poor outcomes when analyzed as a continuous variable (odds ratio, 0.83; 95% confidence interval: 0.73-0.94; P = 0.005) and a categorical variable (comparing levels above the median vs. below the median; odds ratio, 0.658; 95% confidence interval: 0.532-0.820; P < 0.001). Consistent results were observed in the fully adjusted model: triglyceride levels remained significantly negatively associated with unfavorable outcomes (continuous variable: odds ratio, 0.87; 95% confidence interval: 0.760-0.999; P = 0.049 and quartile-based categorical variable: odds ratio, 0.699; 95% confidence interval: 0.546-0.893; P = 0.005). Restricted cubic spline analysis revealed linear and nonlinear relationships between triglyceride levels and outcomes (P for linearity = 0.0005 and P for nonlinearity = 0.0075), with the most pronounced trend observed in patients aged 70-100 years.ConclusionsLow admission triglyceride levels are an independent predictor of poor 12-month outcomes in patients with intracerebral hemorrhage.

Deep learning continues to advance imaging-based diagnosis in oral and maxillofacial radiology. This narrative review has synthesized recent deep learning applications for detecting, classifying, and segmenting jaw cystic lesions and maxillofacial tumors on panoramic radiographs and cone-beam computed tomography scans. It has summarized representative one-stage detectors and convolutional neural network/transformer-based classifiers, along with segmentation methods, reported performance metrics, and key use-case considerations. In addition to this synthesis, the review has critically examined dataset constraints, spectrum and site bias, device-related heterogeneity, annotation inconsistency, and gaps in model explainability as well as described how these limitations restrict generalizability. Practical considerations for clinical implementation are also discussed, including workflow placement, quality assurance, and governance, followed by emerging research directions such as federated learning, multimodal fusion, and radiomics-deep learning combinations, each evaluated in terms of feasibility and current evidence maturity. Key evaluation metrics are interpreted in the context of dental imaging. Overall, current findings suggest that deep learning may enhance early and consistent recognition of jaw lesions, support surgical planning through automated delineation, and promote standardized interpretation, provided that models undergo external validation, reporting remains transparent, and deployment is guided by appropriate clinical oversight.

ObjectiveThe relationship between periodontal disease and adipokines has been extensively investigated. Using a Mendelian randomization approach, this study aimed to determine whether circulating leptin and resistin levels are causally implicated in the etiology of periodontal disease and whether the genetic risk of periodontal disease influences circulating adipokine levels.MethodsWe obtained genetic data regarding circulating leptin and resistin and periodontal disease from comprehensive genome-wide association study meta-analyses. We selected single nucleotide polymorphisms associated with periodontal disease and adipokine levels at a stringent genome-wide significance threshold (P < 5 × 10^-6) as instrumental variables. Linkage disequilibrium clumping was applied, and F-statistics were calculated for all single nucleotide polymorphisms included in the Mendelian randomization study. Data analyses were performed using the inverse variance-weighted (IVW) method implemented in R software.ResultsThe genetic risk of periodontal disease showed a positive effect on circulating resistin levels (IVW: odds ratio = 1.061, 95% confidence interval = 1.013-1.111, P = 0.013). However, no evidence supported a causal influence of circulating leptin or resistin levels on the risk of periodontal disease (IVW: leptin, odds ratio = 0.989, 95% confidence interval = 0.869-1.124, P = 0.861; resistin, odds ratio = 0.947, 95% confidence interval = 0.854-1.051, P = 0.304). Furthermore, the genetic risk of periodontal disease showed no causal association with circulating leptin levels (IVW: odds ratio = 1.021, 95% confidence interval = 0.993-1.050, P = 0.141).ConclusionsThese findings suggest that periodontal disease may exert a causal effect on circulating resistin levels. In contrast, circulating leptin and resistin levels do not appear to causally influence the risk of periodontal disease.

Although labor epidural analgesia can effectively alleviate pain during childbirth, some women may experience a decrease in the effectiveness of the initially effective epidural analgesia or a complete loss of effectiveness (disappearance of the epidural block level) during labor. For cases where the analgesic effect is insufficient after the administration of additional medication or where the epidural block level is completely lost, it is recommended to replace the epidural catheter. When reinserting the epidural catheter, combined spinal-epidural anesthesia should be considered for labor analgesia, as this combination can shorten the onset time and reduce the failure rate. However, for some women who had received epidural analgesia for a long time, due to the expansion of the epidural space caused by local anesthetics, spinal anesthesia may be challenging. Therefore, we propose the use of an extended spinal needle among these patients as a modification of the standard practice to facilitate successful spinal anesthesia.

ObjectiveThis study compared the perioperative outcomes following neoadjuvant immunochemotherapy in elderly (≥70 years) and non-elderly patients with esophageal squamous cell carcinoma.MethodsThis retrospective study included patients with locally advanced esophageal squamous cell carcinoma who underwent neoadjuvant immunochemotherapy followed by esophagectomy (July 2020-June 2024). Patients were stratified into elderly (≥70 years) and non-elderly groups. Primary outcomes included 30-day mortality, 90-day mortality, 30-day readmission rate, and R0 resection rate. Secondary outcomes included pathological complete response, major pathological response, post-neoadjuvant pathological tumor/node stages, tumor regression grade, and complications.ResultsAmong 73 patients (25 elderly, 48 non-elderly), no 30-day or 90-day mortality occurred in either group. The 30-day readmission rates (P = 0.331) and R0 resection rates (P > 0.999) were comparable between the two groups. Secondary outcomes, including pathological complete response (P = 0.685), major pathological response (P = 0.417), post-neoadjuvant pathological tumor stage (P = 0.732), post-neoadjuvant pathological node stage (P = 0.124), and tumor regression grade (P = 0.081), also showed no significant differences. The rates of complications, including severe (P = 0.825), pulmonary (P = 0.314), and cardiac (P = 0.269) complications; anastomotic leakage (P > 0.999); recurrent laryngeal nerve palsy (P > 0.999); and wound complications (P > 0.999), were similar between the two groups.ConclusionElderly and non-elderly patients exhibited similar 30- and 90-day mortality, readmission, and R0 resection rates as well as comparable pathological responses and complication profiles following neoadjuvant immunochemotherapy. These findings indicate that age alone cannot exclude elderly patients from receiving neoadjuvant immunochemotherapy, and patients should undergo thorough individualized assessment and optimization.

ObjectiveTo evaluate the long-term changes in pulmonary function, exercise capacity, mental health status, and health-related quality of life in individuals with mild coronavirus disease 2019 (COVID-19) over a 12-month period and to assess the implications for post-COVID rehabilitation and healthcare strategies.MethodThis prospective, longitudinal cohort study included 33 patients diagnosed with mild COVID-19. The following pulmonary function tests were used to assess mild COVID-19: the 6-minute walk test, Zung Self-Rating Depression Scale, Zung Self-Rating Anxiety Scale, and 36-Item Short-Form General Health Survey. Repeated measures analysis of variance and linear regression analyses were utilized to evaluate changes over time and identify factors associated with exercise capacity.ResultsPulmonary function parameters showed significant improvement over 12 months (p < 0.001). The 6-minute walk distance increased significantly from 401.7 ± 12.3 m at 3 months to 523.8 ± 10.4 m at 12 months (p < 0.001); however, it remained below the normative values. Notably, the forced vital capacity, forced expiratory volume in one second, and sex were identified as independent predictors of the 6-minute walk distance at 12 months (p < 0.05).ConclusionPatients recovering from mild COVID-19 may experience persistent impairments in pulmonary function, exercise capacity, and mental health up to 1 year postdischarge. These findings underscore the importance of long-term rehabilitation and monitoring for mild COVID-19 patients who are often overlooked in post-COVID healthcare strategies.

Distal renal tubular acidosis can present with acute-onset quadriparesis caused by severe hypokalemia, and primary Sjögren's syndrome is a significant potential cause of distal renal tubular acidosis in such patients. The extrahepatic manifestations of chronic hepatitis C virus infection can mimic those of primary Sjögren's syndrome, creating a diagnostic dilemma. Here, we present the case of a woman in her mid-20s who presented with sudden-onset quadriparesis. Laboratory investigations showed severe hypokalemia, normal anion gap metabolic acidosis, and positivity for antinuclear and anti-Ro/Sjögren's syndrome-related antigen A antibodies. Further evaluation confirmed a positive hepatitis C virus antibody test but a negative viral load. A diagnosis of primary Sjögren's syndrome with distal renal tubular acidosis was established, accounting for the hypokalemia. Potassium supplementation and correction of acid-base disturbances led to significant patient improvement. This case highlights the importance of including autoimmune conditions such as primary Sjögren's syndrome in the differential diagnosis of patients presenting with hypokalemic quadriparesis and distal renal tubular acidosis, even in the absence of glandular symptoms. Early diagnosis and management are essential to improve outcomes.