Journal of International Medical Research最新文献

Montgomery T-tube tracheal stent placement is a well-established treatment for severe subglottic stenosis. This procedure is typically performed using a rigid bronchoscope under general anesthesia. However, a major limitation of this approach is the requirement for neck hyperextension, which is not feasible in patients with cervical spine injuries. This report details a complex case of subglottic stenosis in a patient with a cervical spinal cord injury and incomplete paraplegia, in whom conventional Montgomery T-tube tracheal stent placement was difficult to achieve. We performed Montgomery T-tube tracheal stent implantation under conscious sedation with oxygen support provided by high-flow nasal cannula, minimizing the risks of general anesthesia and cervical manipulation. The successful outcome suggests that the combination of conscious sedation and high-flow nasal cannula may represent a safe and practical strategy for treating carefully selected complex airway cases. Although this case highlights a promising pathway, further studies are required to confirm the efficacy of this strategy and define its clinical indications in larger patient populations.

This case report describes an exceptionally rare occurrence of severe acute respiratory distress syndrome following laparoscopic appendectomy in a previously healthy 57-year-old male. The patient presented with acute appendicitis and underwent an uncomplicated surgical procedure. Approximately 4 h postoperatively, he developed rapid respiratory deterioration with severe hypoxemia, fulfilling the Berlin criteria for severe acute respiratory distress syndrome (partial pressure of arterial oxygen/fraction of inspired oxygen ratio, 99.2). Other causes, including aspiration, pulmonary embolism, and cardiac failure, were excluded. The patient was managed in the intensive care unit with lung-protective ventilation in accordance with the Acute Respiratory Distress Syndrome Network (ARDSNet) protocol along with antibiotics and corticosteroids. He demonstrated rapid clinical improvement, was extubated on postoperative day 7, and discharged on postoperative day 8. This case highlights that severe acute respiratory distress syndrome, although rare, can complicate routine surgical procedures and underscores the importance of early recognition and multidisciplinary management in achieving favorable outcomes.

ObjectiveThis study aimed to investigate whether coenzyme Q10 is effective in preventing exercise-induced oxidative stress and muscle damage.MethodsFourteen randomized controlled studies examining the effects of supplementation with coenzyme Q10 analogs on postexercise oxidative stress and muscle damage were identified through searches in literature databases, including PubMed, the Cochrane Library, Embase, and Web of Science, and then the quality of the included studies was assessed. Quantitative and qualitative analyses were performed.ResultsThe study screened 14 randomized controlled trials that included a total of 433 subjects. The results demonstrated that oral coenzyme Q10 elevated blood coenzyme Q10 concentration (standardized mean difference: 2.710, 95% confidence interval: 1.57-3.85, p < 0.00001) and reduced blood malondialdehyde concentration (standardized mean difference: -0.289, 95% confidence interval: -0.541 to -0.038, p = 0.024). Additionally, oral coenzyme Q10 was found to reduce blood creatine kinase values (standardized mean difference: -1.532, 95% confidence interval: -2.856 to -0.209, p = 0.023), suggesting a potential protective effect on skeletal muscle. The metabolism-related blood lactate and maximal oxygen uptake levels were not affected by coenzyme Q10 (standardized mean difference: -0.68, 95% confidence interval: -1.89 to 0.53, p = 0.271; standardized mean difference: -0.156, 95% confidence interval: -0.79 to 0.478, p = 0.630).ConclusionsCoenzyme Q10 may reduce exercise-induced oxidative stress on blood malondialdehyde and exert a protective effect on muscle; however, no effect was observed from the anaerobic and aerobic metabolism of the organism.

ObjectiveThis study aimed to evaluate the safety profile of progesterone by analyzing adverse event data from the Food and Drug Administration Adverse Event Reporting System (FAERS) between 2004 and 2024.Materials and methodsThis retrospective, observational pharmacovigilance study was based on data from the FAERS database. A total of 1827 adverse event reports associated with progesterone were retrieved. Disproportionality analysis methods, including the reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and multi-item gamma Poisson shrinker, were used to evaluate the frequency, signal strength, and time-to-onset of adverse events.ResultsAmong 24,589,239 adverse event reports in the reporting system, 1827 were associated with progesterone, covering 22 system organ classes and 152 preferred terms. The most frequently reported preferred terms were maternal exposure during pregnancy (151 cases), spontaneous abortion (144 cases), and abnormal product odor (114 cases). The top three preferred terms showing the strongest signals were decidual cast (reporting odds ratio: 2825.23), chondrodermatitis nodularis chronica helicis (reporting odds ratio: 3897.61), and autoimmune dermatitis (reporting odds ratio: 1519.29). Most adverse events occurred within 30 to 180 days after exposure. Newly identified preferred terms associated with progesterone included acute eosinophilic pneumonia, meningioma, and autoimmune dermatitis.ConclusionsThis study identified notable safety concerns associated with progesterone use and detected several rare adverse events. These findings underscore the need for continued monitoring, updated prescribing guidelines, and further investigation into progesterone formulations and adverse event mechanisms.

BackgroundTo determine the safety and performance of an antimicrobial/antithrombogenic peripherally inserted central catheter, a retrospective cohort study was conducted.MethodsData were collected using chart audits by clinicians in the US, UK, and EU in 2021 and 2022 for patients requiring an antimicrobial/antithrombogenic peripherally inserted central catheter. The primary outcome endpoint was successful completion of treatment without elective device removal due to adverse events. The secondary outcome endpoint was the incidence of device-related adverse events. Following the initial analysis of the index study, which included adult and pediatric patients, data from additional pediatric cases were collected. Charts lacking primary endpoint data were excluded. Standard descriptive statistics and analyses of categorical variables were performed without adjustment and with minimal stratification.ResultsA total of 38 healthcare providers collected data for 175 evaluable cases, of which 54.3% were male. The duration of use ranged from less than 1 day to 253 days. Treatment was successfully completed without elective device removal due to adverse events in 90.3% of cases. In 18 cases (10.3%), the patients experienced adverse events, with a total of 21 device-related adverse events reported, corresponding to 5 events per 1000 catheter days. None of the reported events were deemed serious or unexpected.ConclusionsThese findings suggest the potential for safe use of the antimicrobial/antithrombogenic peripherally inserted central catheter in the pediatric patient population, with no elective device removal due to adverse events in 90% of cases. No cases of central line-associated bloodstream infection, thrombosis, or anaphylaxis were reported; however, these findings should be interpreted with caution given the moderate sample size and the rarity of such events in general practice. Owing to the limitations of this study, including the risk of bias inherent to retrospective studies, prospective controlled trials with rigorous outcome assessments are needed to confirm these observations.

ObjectiveSurgery for aphakic eyes without capsular bag support is challenging and remains a key area of research for ophthalmologists. This retrospective study introduces a novel surgical method for suture fixation of intraocular lenses in such eyes.MethodsThe modified surgery was performed on eight eyes without a natural lens. The two haptic tabs of the three-piece intraocular lens were secured with two crystal sutures using a wireless junction-defined as a connection point where the loop or haptic is anchored to the eye wall without knots through techniques such as intrascleral pocket embedding, flanged end creation, or sutureless tuck-without creating a scleral flap.ResultsAll eight patients demonstrated improved postoperative visual acuity. The intraocular lenses were reliably fixed, properly centered, and well positioned. No serious complications occurred after the surgery.ConclusionsThis modified technique appears to offer procedural simplification and a favorable trend in postoperative visual acuity improvement. However, its long-term safety and efficacy require confirmation through larger, controlled studies.

BackgroundPostoperative pain following liver resection remains a clinical challenge, and the optimal analgesic strategy is still debated.ObjectiveTo determine whether a single intrathecal morphine injection provides superior analgesia and opioid-sparing effects compared with conventional systemic or regional techniques in adult patients undergoing liver surgery.MethodsPubMed, Embase, Web of Science citation index, and the Cochrane Library were searched from inception to August 2025 for randomized controlled trials comparing intrathecal morphine with alternative analgesic regimens in liver resection. The primary outcome was pain intensity at rest 24 h after surgery (standardized mean difference). Secondary outcomes included pain intensity at 48 and 72 h and cumulative opioid consumption within 24 h postoperatively. Random-effects meta-analyses and I² statistics were used to assess pooled effects and heterogeneity.ResultsEleven randomized controlled trials (n = 535) met the inclusion criteria. Intrathecal morphine reduced 24-h postoperative pain scores with a moderate effect (standardized mean difference = -0.64; 95% confidence interval: -0.84 to -0.44; p < 0.001; I² = 55%) and decreased 24-h opioid consumption by 11.6 mg morphine equivalents (95% confidence interval: -19.3 to -3.9 mg; p = 0.003; I² = 96%). Differences in pain intensity at 48 and 72 h were not statistically significant. Adverse-event profiles were comparable between groups.ConclusionA single dose of intrathecal morphine provides clinically meaningful early analgesia and opioid-sparing benefits after liver resection without increasing adverse events. Incorporating intrathecal morphine into multimodal analgesic protocols may accelerate recovery; however, further high-quality trials are warranted to refine dosing and identify optimal patient selection.

Background and objectiveAlbuminuria is a critical early warning marker for the development of chronic kidney disease. The neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) has been identified as a novel biomarker for the assessment of both inflammatory status and lipid metabolism. The present study was designed to explore the association between NHR and albuminuria.MethodsWe conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey between 2017 and 2020. In total, 7772 eligible adult participants were included. Multivariate logistic regression models, threshold effect analysis, and sensitivity and subgroup analyses were performed to analyze the association between NHR and albuminuria.ResultsWe found a notable positive association between the NHR and the likelihood of albuminuria. In fully adjusted models, each unit rise in the NHR was associated with a 1.13-fold higher likelihood of albuminuria (1.13 (1.09-1.18)). When classified according to quartiles, participants in the highest NHR quartile had a markedly elevated likelihood of albuminuria compared with those in the lowest quartile (2.01 (1.59-2.53)). The smooth curve analysis suggested a nonlinear relationship, with a threshold at 4.58. In subgroup analyses, the positive association between NHR and albuminuria differed significantly across race categories (interaction test p = 0.0166).ConclusionAn increased level of NHR was significantly associated with an elevated odds ratio for the occurrence of albuminuria in our study. NHR may be an efficacious biomarker for the assessment of albuminuria risk, and future studies should further investigate its predictive value.

ObjectivesThis study aimed to develop a multimodal predictive model that integrates clinical data, radiomics, and three-dimensional deep learning to forecast acute respiratory distress syndrome in patients with acute pancreatitis.MethodsThis retrospective study analyzed data from 759 patients with acute pancreatitis treated at three hospitals. Radiomics features were extracted from three-dimensional computed tomography images, and a three-dimensional deep learning model was developed using convolutional networks. These components were combined with clinical data using the XGBoost algorithm to construct a multimodal model. The performance of the model was compared with that of single-modal models and traditional scoring systems (Modified Computed Tomography Severity Index, Ranson score, and Bedside Index for Severity in Acute Pancreatitis), using area under the curve as the primary metric. Model interpretability was enhanced using variable importance analysis, SHapley Additive exPlanations, local interpretable model-agnostic explanations, calibration plots, and decision curve analysis.ResultsThe multimodal model achieved area under the curve values of 0.872 (training set) and 0.876 (test set), outperforming traditional scores (Modified Computed Tomography Severity Index: 0.747 and 0.759; Ranson score: 0.575 and 0.568; and Bedside Index for Severity in Acute Pancreatitis: 0.748 and 0.757, respectively) and single-modal models (radiomics: 0.638 and 0.727 and deep learning: 0.756 and 0.727, respectively).ConclusionBy integrating clinical tabular data, radiomics, and deep learning features, the multimodal model can predict the risk of acute respiratory distress syndrome in patients with acute pancreatitis at an early stage.