Journal of International Medical Research最新文献

ObjectiveThis study was designed to examine the relationship between fecal incontinence and accelerated aging, determine its association with mortality risk, and evaluate whether accelerated aging mediates the link between fecal incontinence and mortality.MethodsThis cohort study used data from the National Health and Nutrition Examination Survey. Accelerated aging was quantified using phenotypic age acceleration. Multivariable linear regression models, Cox proportional hazards models, and mediation analysis were employed to assess the associations between fecal incontinence, phenotypic age acceleration, and mortality.ResultsAmong 12,581 United States adults, the overall prevalence of fecal incontinence was 8.38%. Fecal incontinence was positively associated with phenotypic age acceleration (β: 0.98, 95% confidence interval: 0.43, 1.58) and increased risks of all-cause mortality (hazard ratio: 1.24, 95% confidence interval: 1.07, 1.44) and cardiovascular mortality (hazard ratio: 1.28, 95% confidence interval: 1.01, 1.63). Mediation analysis indicated that phenotypic age acceleration accounted for 9.56% of the effect of fecal incontinence on all-cause mortality.ConclusionAccelerated aging partially mediated the association between fecal incontinence and all-cause mortality in the United States population. These findings suggest new pathways for mitigating the broader health impacts of fecal incontinence.

ObjectiveTo systematically identify drug-induced esophageal ulcer and address existing knowledge gaps.MethodsWe conducted a real-world study using the Food and Drug Administration Adverse Event Reporting System database from Q1 2004 to Q4 2024. Disproportionality analyses were performed to evaluate drug-induced esophageal ulcer risk. Data for each drug were merged and screened using the RxNax platform to recalculate drug exposure, proportional reporting ratio, reporting odds ratio, and chi-squared values. High-risk drugs classified by anatomical therapeutic chemical classification system were cross-checked with Side Effect Resource, product labels, and published literature.ResultsA total of 12,763 drug-induced esophageal ulcer cases were identified. Forty-nine high-risk drugs, spanning nine anatomical therapeutic chemical classification system classes, were detected, including antineoplastics and immunomodulators (Class L), systemic anti-infectives (Class J), and drugs affecting the musculoskeletal system (Class M). Aspirin, alendronic acid, and doxycycline were most frequently reported; doxycycline, clindamycin, and alendronic acid generated the strongest safety signals. Antineoplastics/immunomodulators (anatomical therapeutic chemical classification system L) had the highest cumulative proportional reporting ratio, primarily driven by tacrolimus, mycophenolic acid, and sunitinib. Notably, tacrolimus, sunitinib, meclofenamic acid, clopidogrel, and erlotinib were associated with esophageal ulcers but remain unlabeled for this risk.ConclusionsThis study provides a comprehensive drug-induced esophageal ulcer risk profile, highlighting high-risk drugs beyond commonly recognized agents. These findings can inform safer prescribing practices, patient counseling, and targeted pharmacovigilance.

In cholestatic drug-induced liver injury, serum liver function tests typically demonstrate concurrent elevations in alkaline phosphatase and γ-glutamyltransferase, with or without increases in alanine aminotransferase, aspartate aminotransferase, and total bilirubin. Isolated elevation of alkaline phosphatase is rare. Herein, we report a case of drug-induced liver injury characterized by isolated alkaline phosphatase elevation for clinicians. Following treatment with ursodeoxycholic acid, the patient achieved complete recovery. Clinicians should recognize that drug-induced liver injury may also present as an isolated elevation of alkaline phosphatase.

ObjectiveTo evaluate the prognostic value of the uric acid-to-high-density lipoprotein cholesterol ratio in predicting postoperative survival in patients with hepatocellular carcinoma and to develop a nomogram to assist in clinical decision-making and patient management.MethodsA total of 422 patients who underwent hepatectomy at Meizhou People's Hospital between May 2011 and January 2023 were included. The optimal cutoff value for uric acid-to-high-density lipoprotein cholesterol ratio was determined using the R package 'survminer,' and patients were stratified into two groups accordingly. The prognostic significance of uric acid-to-high-density lipoprotein cholesterol ratio was evaluated using Kaplan-Meier survival analysis and Cox proportional hazards regression models. A prognostic nomogram was subsequently constructed. The predictive performance of the nomogram was assessed using the concordance index, and its clinical utility was evaluated via decision curve analysis.ResultsThe optimal cutoff value for uric acid-to-high-density lipoprotein cholesterol ratio was 253.9. Survival analysis demonstrated significantly longer survival in the low-uric acid-to-high-density lipoprotein cholesterol ratio group. Cox regression analysis identified uric acid-to-high-density lipoprotein cholesterol ratio, advanced lung cancer inflammation index, and tumor-node-metastasis classification stage as independent prognostic factors for postoperative survival in patients with hepatocellular carcinoma. A predictive nomogram incorporating these variables was developed and validated using calibration curves, time-dependent receiver operating characteristic analysis, and decision curve analysis. The results confirmed that the nomogram demonstrated superior predictive accuracy and greater net benefit compared with models based on any of the individual variables alone.ConclusionsUric acid-to-high-density lipoprotein cholesterol ratio may serve as a potential prognostic biomarker for postoperative survival in patients with hepatocellular carcinoma. The established nomogram may provide a practical tool for prognostic assessment in clinical practice.

ObjectiveThis study aimed to evaluate the clinical efficacy and safety of endoscope-assisted nasal bone reduction performed in the outpatient clinic and determine whether this technique offers advantages over conventional closed reduction methods.MethodsWe conducted a retrospective review of 64 patients who underwent endoscope-assisted nasal bone reduction between May 2022 and December 2024 at a tertiary university hospital. Patient demographics, injury characteristics, surgical details, and postoperative outcomes were analyzed. Outcomes were assessed via clinical examination, facial computed tomography, and patient-reported satisfaction scores at 3 months postoperatively.ResultsAll procedures were successfully performed under local anesthesia without the need for general anesthesia or conversion to open surgery. Direct endoscopic visualization allowed real-time confirmation of fracture reduction. At 3 months, 87.5% of the patients had achieved favorable nasal symmetry, and >80% reported "excellent" satisfaction. The revision rate was 14.1%, and the incidence of saddle nose deformity was 1.6%. No significant complications such as infection, persistent bleeding, or major deformities were observed.ConclusionsEndoscope-assisted nasal bone reduction provides advantages over traditional closed reduction in terms of enhanced accuracy, improved patient satisfaction, and feasibility of early intervention in the outpatient setting.

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital coronary anomaly. This case report describes an adult male with anomalous origin of the left coronary artery from the pulmonary artery, in whom transthoracic echocardiography revealed mitral valve prolapse without apparent anomalies of the coronary ostia. The definitive anatomical diagnosis was established using invasive coronary angiography and coronary computed tomography angiography. This case underscores the indispensable value of multimodality imaging in the diagnosis of anomalous origin of the left coronary artery from the pulmonary artery.

ObjectiveTo address challenges such as blurred boundaries and irregular shapes in brain tumor magnetic resonance imaging scans, we developed a lightweight detection framework to enhance automated diagnosis and meet real-time clinical requirements.MethodsWe proposed an improved You Only Look Once version 12 (YOLOv12n)-based model featuring three modules. First, the Attention-based C2f with Frequency-domain Feed-Forward Network (A2C2f-DFFN) module was incorporated into the backbone network; it combined an attention mechanism with a frequency-domain feedforward network to enhance global context modeling and detailed feature reconstruction. Second, the C2f with Token Statistics Self-Attention and Dynamic Tanh (C2TSSA-DYT) module was employed in the feature fusion neck; it utilized statistical self-attention and a dynamic Tanh activation function to improve robustness in complex backgrounds. Finally, the dynamic upsampling operator was adopted in the feature reconstruction stage; it dynamically generated sampling weights to effectively prevent boundary blurring and detail loss.ResultsOn the Kaggle brain tumor dataset, our method achieved 93.2% precision, 88.4% recall, and 94.1% mean average precision at IoU threshold 0.5 (mAP@0.5), surpassing YOLOv12n and other lightweight models. It showed excellent performance in patients with glioma and pituitary tumor cases using only 6.0 Giga Floating-point Operations Per Second (GFLOPs) and 2.76 M parameters for efficient real-time inference.ConclusionThe enhanced YOLOv12n framework proposed in this study achieved good balance between accuracy and efficiency in brain tumor detection tasks, demonstrating strong robustness, which makes it suitable for use in clinical computer-aided diagnosis systems.

ObjectiveThis study used Global Burden of Disease 2021 data to assess the global, regional, and national burden of congenital genitourinary anomalies across 204 countries and territories from 1990 to 2021.MethodsThis cross-sectional study estimated the burden of congenital genitourinary anomalies using prevalence, morbidity, mortality, disability-adjusted life years, and age-standardized rates, including the age-standardized incidence rate, age-standardized death rate, and age-standardization rate. Incidence and prevalence were derived from DisMod-MR 2.1, and a Bayesian age-period-cohort model projected trends until 2035. Analyses were stratified by sex, age, and socio-demographic index.ResultsFrom 1990 to 2021, the global age-standardized prevalence of female and male congenital genitourinary anomalies increased annually by 0.72% and 0.51%, respectively, with rising disability-adjusted life years across all sociodemographic index regions. Male congenital genitourinary anomalies consistently had higher age-standardized death rates, incidence rates, and age-standardization rates than female cases. By 2021, congenital genitourinary anomalies caused approximately 9700 deaths and affected approximately 5.2 million people, while age-standardized incidence and death rates slightly declined over three decades (age-standardized incidence rate: 18.21 to 17.69 per 100,000; age-standardized death rate: 0.15 to 0.12 per 100,000). Projections to 2035 show continued declines in incidence and death rates.ConclusionsDespite falling morbidity and mortality, congenital genitourinary anomalies remain a severe global burden. Governments and the public must recognize its gravity and prioritize targeted reproductive health initiatives.

Familial hypocalciuric hypercalcemia is an autosomal dominant genetic disorder characterized by mild to moderate hypercalcemia, mild hypermagnesemia, and normal or inappropriately elevated parathyroid hormone levels. Familial hypocalciuric hypercalcemia 1 is the most prevalent form of familial hypocalciuric hypercalcemia and is typically caused by heterozygous loss-of-function mutations in the calcium-sensing receptor (CaSR) gene. Homozygous CaSR mutations are more commonly associated with neonatal severe primary hyperparathyroidism. We report the case of a female patient in her early 40s harboring a novel homozygous frameshift mutation in the CaSR gene (c.2603_2604insTT), resulting in familial hypocalciuric hypercalcemia 1. The patient presented with persistent hypocalciuria, hypercalcemia, and primary hyperparathyroidism, along with a family history of consanguinity. This case highlights the phenotypic variability associated with CaSR mutations and broadens the clinical spectrum of homozygous CaSR-related disorders. Increased clinical awareness of atypical genetic presentations is essential to avoid misdiagnosis and to ensure appropriate management of patients with familial disorders of calcium homeostasis.