Journal of International Medical Research最新文献

ImportanceThe role of anticoagulant therapy as an adjuvant treatment for sepsis remains controversial. Although observational studies have often suggested benefits, large-scale randomized controlled trials have yielded conflicting results, and the risk-to-benefit profile across different anticoagulant agents remains unclear.ObjectiveTo evaluate the efficacy and safety of anticoagulant therapy and its effect on all-cause mortality and major bleeding events in adult patients with sepsis as well as explore differences between study designs and anticoagulant types.Data sources: A systematic search was conducted in PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases from inception to 7 August 2025.Study selection: Randomized controlled trials and observational studies comparing any systemic anticoagulant therapy with placebo or standard care in adult patients with sepsis or septic shock were included.Data extraction and synthesis: Two reviewers independently extracted data and assessed the risk of bias. The primary outcomes were all-cause mortality and major bleeding events. Data were pooled using a random-effects model, and results were reported as relative risk with 95% confidence intervals.Main outcomes and results: In total, 10 studies (8 randomized controlled trials and 2 observational studies) involving 7480 patients were included. In the primary analysis of eight randomized controlled trials, anticoagulant therapy was not associated with a significant reduction in all-cause mortality (relative risk, 0.96; 95% confidence interval, 0.78-1.18; I² = 50.9%). Conversely, anticoagulant therapy was associated with a nonsignificant trend toward an increased risk of major bleeding (relative risk, 1.19; 95% confidence interval, 0.85-1.66; I² = 13.5%). Subgroup analyses revealed significant differences between randomized controlled trials and observational studies (p = 0.018) and suggested potential differences in efficacy among anticoagulant types (p = 0.10).Conclusions and relevance: In this systematic review and meta-analysis, anticoagulant therapy did not significantly reduce mortality in a broad population of patients with sepsis and may increase the risk of bleeding. The routine use of anticoagulants in unselected septic patients is not supported. Future research should focus on specific agents such as heparin in well-defined, high-risk patient subgroups. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD420251123750).

BackgroundThis study aimed to investigate the association between age at menarche and adult obesity among adults in the United States.MethodsData were obtained from the 1999-2018 National Health and Nutrition Examination Survey. A total of 19,170 female participants were included. Adult obesity was assessed using body mass index, weight-adjusted waist index, waist circumference, and waist-to-height ratio. To examine the association between age at menarche and adult obesity, weighted multivariable linear regression analyses were performed using continuous or categorical variables, and age at menarche was classified as early, normal, or late. Subgroup analyses stratified by age, race, and economic status were also conducted. Potential nonlinear associations between age at menarche and adult obesity were evaluated using restricted cubic spline analysis.ResultsData from 19,170 females were analyzed. Multivariable linear regression analyses demonstrated a negative association between age at menarche and obesity indicators in adulthood. Restricted cubic spline analysis indicated that the associations between age at menarche and body mass index as well as waist-to-height ratio were nonlinear.ConclusionsAmong the 19,170 participants, age at menarche was negatively associated with the risk of obesity in adulthood. Increased attention should be given to the physical condition of girls with early menarche, and preventive interventions should be implemented as early as possible to reduce the risk of obesity.

BackgroundGlucocorticoids, primarily cortisol, mediated by the hypothalamic-pituitary-adrenal axis, significantly influence metabolic responses, including insulin resistance, lipolysis, and body fat distribution. Dehydroepiandrosterone sulfate, an adrenal androgen precursor, often counteracts some of cortisol's metabolic effects. An imbalance between these hormones is hypothesized to impact body composition. This study aimed to investigate the relationship between cortisol and dehydroepiandrosterone sulfate levels, their ratio, and body composition in a Korean population.MethodsIn total, 802 Korean adults participated in this study between 2018 and 2023. Data on sociodemographic and lifestyle factors, body composition, blood pressure, and metabolic variables were assessed. Cortisol and dehydroepiandrosterone sulfate levels were measured and analyzed using partial correlation and multiple logistic regression, adjusting for age, sex, and other relevant confounders, to determine their relationship with body composition.ResultsCortisol levels were negatively correlated with body weight, waist circumference, and body mass index after adjustment, and this correlation was more significant in women than in men. Dehydroepiandrosterone sulfate levels showed positive correlations with height, body weight, and waist circumference. The cortisol/dehydroepiandrosterone sulfate ratio demonstrated a negative association with height and body weight. Logistic regression analysis revealed that elevated cortisol levels and a high cortisol/dehydroepiandrosterone sulfate ratio were significant positive predictors of central obesity in men.ConclusionsElevated cortisol levels are associated with lower adiposity, particularly in women. Dehydroepiandrosterone sulfate levels are positively correlated with height and body mass. The prediction of central obesity is positively associated with cortisol levels and the cortisol/dehydroepiandrosterone sulfate ratio in men and negatively associated with dehydroepiandrosterone sulfate levels.

This study reported a case of disseminated intravascular coagulation secondary to postpartum hemorrhage complicated by autoimmune hemolytic anemia. A pregnant woman in her early 40s was admitted to The Third Central Hospital of Tianjin with regular contractions in July 2022. The direct antiglobulin test was positive for IgG and C3d. Following the delivery of a baby girl, she developed severe postpartum hemorrhage, and the obstetric disseminated intravascular coagulation score exceeded 8 points. She was diagnosed with disseminated intravascular coagulation secondary to postpartum hemorrhage and warm-antibody type autoimmune hemolytic anemia (IgG + C3). The patient underwent methylprednisone therapy, emergency selective bilateral uterine artery embolization, and transfusion with suspended and washed red blood cells. Subsequently, routine coagulation parameters normalized, and the urine color gradually cleared. Therefore, glucocorticoids, uterine artery embolization, and blood transfusion may be effective for managing disseminated intravascular coagulation secondary to postpartum hemorrhage complicated by autoimmune hemolytic anemia.

BackgroundPrevious research has shown that red cell distribution width and serum albumin concentrations may serve as possible indicators of inflammation and nutritional status. Nevertheless, the relationship between erectile dysfunction and the red cell distribution width to serum albumin ratio (RAR) remains unclear. This study aimed to investigate the association between RAR and erectile dysfunction in a nationally representative cohort of US adults.MethodsData for this study were obtained from the National Health and Nutrition Examination Survey conducted between 2001 and 2004. The RAR was calculated by dividing red cell distribution width by serum albumin. Subgroup analyses, restricted cubic spline analysis, and multivariable logistic regression were performed to evaluate the association between RAR and erectile dysfunction. Additionally, receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of RAR for erectile dysfunction.ResultsThe study included 3633 participants, of whom 1026 individuals reported erectile dysfunction. After adjustment for various covariates, a significant positive association was observed between the RAR and erectile dysfunction (odds ratio: 1.68, 95% confidence interval: 1.16-2.44, p = 0.012). Higher quartiles of RAR were significantly associated with an increased risk of erectile dysfunction (T3 compared to T1: odds ratio: 1.68, 95% confidence interval: 1.16-2.44, p = 0.012). A smooth curve fitting analysis suggested a linear relationship between RAR and erectile dysfunction, and the positive association between RAR and erectile dysfunction prevalence was further confirmed by interaction tests and stratified analysis. Furthermore, the receiver operating characteristic analysis demonstrated that RAR outperformed conventional serological markers (area under the curve: 0.690). In contrast, albumin yielded an area under the curve of 0.650, red cell distribution width resulted in an area under the curve of 0.656, the platelet-to-albumin ratio had an area under the curve of 0.538, and neutrophil-to-albumin ratio demonstrated an area under the curve of 0.572.ConclusionThe investigation identifies RAR as a biomarker positively correlated with erectile dysfunction, with particular utility in disease stratification. These findings highlight the potential significance of maintaining an appropriate level of RAR in improving erectile dysfunction.

ObjectiveSarcopenia is a progressive skeletal muscle disorder characterized by declines in muscle mass and function. This study developed a novel composite biomarker, the triglyceride glucose-frailty index, which integrates metabolic and frailty-related measures, and examined its association with sarcopenia in adults.MethodsData from 2334 participants in the National Health and Nutrition Examination Survey were analyzed. Multivariable logistic regression was used to evaluate the association between triglyceride glucose-frailty index and sarcopenia after adjustment for key covariates. Restricted cubic spline analyses and subgroup analyses were conducted to assess nonlinearity and consistency. Machine learning models were developed to predict sarcopenia, and model performance was evaluated using the area under the curve, accuracy, and F1-score. SHapley Additive exPlanations analysis was applied to improve model interpretability.ResultsAfter full adjustment, higher triglyceride glucose-frailty index was significantly associated with an increased risk of sarcopenia (odds ratio = 1.468, 95% confidence interval: 1.246-1.730, p < 0.0001), showing a clear dose-response relationship. Subgroup analyses demonstrated consistent associations across populations. Among the machine learning models, XGBoost showed the best predictive performance, with an area under the curve of 0.978. SHapley Additive exPlanations analysis identified triglyceride glucose-frailty index as the second most important predictor after race.ConclusionsTriglyceride glucose-frailty index is a strong and independent predictor of sarcopenia. This composite biomarker may serve as a practical tool for improved risk stratification and early prevention in clinical settings.

ObjectiveTo evaluate the association between the uric acid-to-albumin ratio and adverse clinical outcomes in patients with hypertrophic cardiomyopathy.MethodsThis retrospective, observational single-center study included 124 patients with hypertrophic cardiomyopathy (58 with obstructive and 66 with nonobstructive hypertrophic cardiomyopathy) and 60 age- and sex-matched healthy controls. Baseline clinical, laboratory, and echocardiographic parameters were analyzed. A composite endpoint comprising cardiovascular death, heart failure hospitalization, and appropriate implantable cardioverter-defibrillator shocks was assessed. Logistic regression analyses were used to identify independent associations, and receiver operating characteristic analysis was performed to evaluate discriminative ability.ResultsThe uric acid-to-albumin ratio was higher in patients with obstructive hypertrophic cardiomyopathy than in those with nonobstructive hypertrophic cardiomyopathy and controls (1.56 ± 0.15 vs 1.21 ± 0.08 vs 1.15 ± 0.11; p < 0.001). Adverse events occurred in 32 patients with hypertrophic cardiomyopathy (25.8%) and were more frequent in the obstructive group (34.5% vs 18.2%; p = 0.038). In multivariable analysis, higher uric acid-to-albumin ratio (per 0.1 increase; OR, 1.50; 95% confidence interval: 1.18-1.90; p = 0.001) and septal thickness (OR, 1.65; 95% confidence interval: 1.30-2.10; p < 0.001) were independently associated with adverse outcomes. Receiver operating characteristic analysis yielded an area under the curve of 0.717 (p < 0.001).ConclusionsElevated uric acid-to-albumin ratio was independently associated with adverse outcomes in hypertrophic cardiomyopathy and may serve as a simple and inexpensive biomarker for risk stratification.

BackgroundKnee osteoarthritis presents with posterior knee pain, stiffness, and restricted mobility, potentially affecting periarticular muscle biomechanics. We ultrasonographically assessed the gastrocnemius medialis properties in patients with knee osteoarthritis compared with those in healthy controls.MethodsThis study comprised 76 participants divided into symptomatic patients with knee osteoarthritis and gastrocnemius medialis involvement and healthy controls. Gastrocnemius medialis morphology (thickness and pennation angle) was evaluated using conventional ultrasound, whereas shear touch elastography was applied to assess tissue stiffness via elasticity (Gmean).ResultsGastrocnemius medialis thickness was similar between the groups (p = 0.343); however, patients with knee osteoarthritis exhibited significantly smaller pennation angles (p < 0.001) and lower Gmean values (p = 0.009). Sex-stratified analysis revealed a reduced pennation angle in females (p = 0.003) and a smaller pennation angle (p = 0.036) and lower Gmean value (p = 0.013) in males with knee osteoarthritis.ConclusionPatients with knee osteoarthritis demonstrated significantly decreased gastrocnemius medialis pennation angles and Gmean values compared with those in controls, with sex-specific differences: males exhibited lower Gmean values, whereas females showed no difference. Gastrocnemius medialis ultrasonography may serve as an effective tool for detecting knee osteoarthritis-related biomechanical changes, supporting clinical assessment and rehabilitation planning.

Infectious endophthalmitis after ocular surgery is a rare complication that can result in severe vision loss. Moraxella nonliquefaciens is an opportunistic pathogen that rarely causes ocular infections. We report a rare case of Moraxella nonliquefaciens endophthalmitis complicated by secondary angle-closure glaucoma occurring years after trabeculectomy and cataract surgery. Cycloplegia resulted in deepening of the anterior chamber and opening of the angles. Metagenomic next-generation sequencing of the aqueous humor identified Moraxella nonliquefaciens. Following multiple intravitreal vancomycin injections and vitrectomy with posterior capsulectomy, direct communication between the anterior chamber and the vitreous cavity was established, leading to resolution of the condition. The patient's visual acuity was fully restored. We hypothesize that persistent infection with Moraxella nonliquefaciens may damage the lens zonules, resulting in zonular laxity and weakness; however, this represents only one possible mechanistic explanation and may play a secondary role in the development of secondary angle-closure glaucoma. Ophthalmologists should be aware that patients with Moraxella nonliquefaciens endophthalmitis may be at risk of zonular laxity and secondary angle-closure glaucoma, particularly years after trabeculectomy and cataract surgery. Prompt recognition and intervention may be vision-saving.