Journal of International Medical Research最新文献

ObjectiveAlthough humans are widely exposed to polycyclic aromatic hydrocarbons, current evidence on the association between urinary polycyclic aromatic hydrocarbon metabolites and sleeping troubles remains limited. Herein, we aimed to investigate the effects of urinary polycyclic aromatic hydrocarbon metabolites on sleep-related issues.MethodsThis retrospective cross-sectional study analyzed data from 3262 adults (≥20 years) enrolled in the National Health and Nutrition Examination Survey cycles (2005-2006, 2007-2008, and 2011-2012). The association between urinary polycyclic aromatic hydrocarbon metabolites and sleeping troubles was assessed using 11 distinct machine learning algorithms. Subsequently, network toxicology was conducted to identify critical protein targets, which were subsequently validated through molecular docking analyses.ResultsBoth the Random Forest and CatBoost algorithms exhibited superior performance, identifying four key pollutants: 1-hydroxypyrene, 2-hydroxyfluorene, 3-hydroxyfluorene, and 3-hydroxyphenanthrene. Molecular docking analysis further revealed that the critical targets through which polycyclic aromatic hydrocarbons influence sleep include androgen receptor, B-cell lymphoma, nuclear receptor subfamily 3 group C member 1, and transient receptor potential vanilloid 1.ConclusionsOur findings revealed an association between environmentally relevant polycyclic aromatic hydrocarbon metabolites and sleep disturbances. We also explored the underlying mechanisms using network toxicology. Our findings provide a foundation for in vivo validation in preclinical animal models and the development of sleep interventions targeting polycyclic aromatic hydrocarbons.

ObjectivesTo examine the impact of rowing across the Atlantic on the mental health of an all-female crew.MethodsThis prospective cohort study included four female rowers (mean age, 32.3 ±4.3 years) who rowed 3000 miles across the Atlantic within 46 days. Validated mental health questionnaires were completed pre-race, during the race, and post-race to screen for depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and exercise addiction (Exercise Addiction Inventory) as well as examine personality traits (International Personality Item Pool-Neuroticism, Extraversion, and Openness-60) and mood states (Profile of Mood States-Short Form). Additionally, personal accounts were collected. Descriptive statistics, generalized estimating equations, and correlations were used for analysis.ResultsDescriptive analysis revealed positive screening results for anxiety pre-race and major depression post-race in one rower and exercise addiction in another rower. Mood states deteriorated during the race, with subscores for tension-anxiety increasing over time. Scores of neuroticism decreased over time. Personal accounts of the participants provided insights into the challenges faced during this arduous race.ConclusionThe results demonstrated the importance of mental health screening in our cohort. Mood states deteriorated during the race, with declining scores for personality traits of neuroticism, reflecting a reduction in negative emotions, which may have been beneficial in our specific team environment. Personal accounts demonstrated good team coherence despite challenging race and environmental conditions.

BackgroundFrailty is an increasingly recognized comorbidity in chronic kidney disease and is associated with adverse outcomes. Although extensively studied in dialysis populations, its prevalence and associated factors in nondialysis chronic kidney disease remain less well-defined. This study aimed to estimate frailty prevalence and identify associated demographic, clinical, and laboratory factors in adults with nondialysis chronic kidney disease.MethodsThis cross-sectional study used data from the National Health and Nutrition Examination Survey 2007-2018, including 9156 adults with nondialysis chronic kidney disease. Frailty status (robust, prefrail, and frail) was assessed using a modified Fried phenotype. Survey-weighted multinomial logistic regression was applied to explore associations with demographic, clinical, and laboratory variables.ResultsThe robust group comprised 30.3% of participants, the prefrail group 67.2%, and the frail group 2.5%. Most participants were in early-stage chronic kidney disease (G1-G2). Frailty was associated with older age, hypertension, cardiovascular disease, and lower education level. Laboratory findings associated with frailty included lower albumin and hemoglobin, higher blood urea nitrogen, lower bilirubin, reduced globulin, decreased lymphocyte count, and elevated monocyte count.ConclusionsFrailty and prefrailty are highly prevalent even in early-stage chronic kidney disease. These findings highlight the need for early screening and integrated care strategies targeting modifiable clinical and sociodemographic factors.

ObjectivePrimary bilateral macronodular adrenal hyperplasia (PBMAH) is a rare cause of Cushing syndrome. Recent evidence, particularly the 2023 European Society of Endocrinology guidelines, clinically classifies cortisol excess into overt Cushing syndrome and mild autonomous cortisol secretion. Germline mutations in the Armadillo repeat-containing 5 (ARMC5) gene have been identified in 20%-55% of patients with PBMAH. This study aimed to describe the clinical, radiological, and biochemical characteristics of PBMAH; classify cortisol secretion according to updated guidelines; and evaluate surgical and conservative treatment outcomes.MethodsThis retrospective cohort study included 58 patients with bilateral adrenal macronodules who underwent ARMC5 genetic testing at a tertiary center between 2023 and 2025. Clinical, imaging, laboratory, and genetic data were collected. Mild autonomous cortisol secretion was defined according to the 2023 European guidelines as a post-dexamethasone suppression test cortisol level >1.8 μg/dL in the absence of overt Cushing syndrome features. Postoperative and follow-up data, including hormonal assessments and remission criteria, were recorded.ResultsA total of 58 patients were included; 14 (23.7%) were male, and the mean age was 57.7 years (39-73). Four patients (6.9%) with overt Cushing syndrome carried germline ARMC5 mutations, three of whom belonged to the same family, supporting an autosomal dominant pattern of inheritance. Among them, 34 patients with mild autonomous cortisol secretion and 20 patients with nonfunctional PBMAH were managed conservatively. Unilateral laparoscopic adrenalectomy was performed in five patients, all of whom achieved biochemical and clinical remission during follow-up (median, 14 months). No postoperative adrenal insufficiency or persistent hypercortisolism was observed.ConclusionPBMAH demonstrates a broad clinical spectrum, ranging from nonfunctional disease to overt Cushing syndrome. The updated classification of cortisol secretion (mild autonomous cortisol secretion vs. overt Cushing syndrome) improves clinical stratification and supports treatment decision-making. ARMC5 genetic analysis contributes to diagnostic confirmation, facilitates cascade family screening, and enables identification of asymptomatic carriers. Unilateral adrenalectomy is effective in patients with overt Cushing syndrome, whereas surveillance is appropriate for those with mild autonomous cortisol secretion or nonfunctional PBMAH.

Cryptococcosis is an invasive mycosis and can disseminate an infection in immunocompromised hosts. The main sites of infection include the central nervous system and lungs; skeletal infections are rarely reported. We describe the case of a Chinese man in his early 40s with a 1-year history of dermatomyositis and prolonged use of corticosteroids and immunosuppressants. During re-examination of a previously discovered pulmonary nodule, lung computed tomography revealed that the nodule had grown in size, and a bone scan revealed local bone abnormalities and mass formation in the left scapula. The initial diagnosis was lung cancer with bone metastasis; therefore, both lesions were resected. The final histopathological diagnosis was disseminated cryptococcosis. This case presents a rare and atypical manifestation of pulmonary and skeletal cryptococcosis. Thus, cryptococcal infection should be considered in the differential diagnosis in patients presenting with immune insufficiency.

This study characterizes a multigenerational family with X-linked Emery-Dreifuss muscular dystrophy associated with a novel FHL1 mutation (c.746G>A, p.Cys249Tyr). Among 21 family members, 5 were affected and 3 had died. The affected individuals exhibited progressive limb weakness and muscle atrophy; classical joint contractures were absent or minimal. The proband presented with mild muscle wasting and sinus tachycardia without structural cardiac abnormalities. Electromyography revealed myopathic changes with preserved nerve conduction. Thigh magnetic resonance imaging demonstrated bilateral reduction of muscle volume with fatty infiltration, and muscle biopsy confirmed variable fiber size, degeneration, and mild fibrosis consistent with a myogenic pattern. Genetic testing identified six affected members carrying the hemizygous FHL1 c.746G>A variant, resulting in a cysteine-to-tyrosine substitution at codon 249. These findings expand the genotypic and phenotypic spectrum of FHL1-related X-linked Emery-Dreifuss muscular dystrophy, highlight the marked clinical and genetic heterogeneity of the disorder, and provide important insights into early diagnosis, phenotype prediction, and genetic counseling of the affected families.

ObjectiveThis study aimed to investigate the relationship between the cardiometabolic index and the prevalence of endometriosis among reproductive-age women in the United States. This cross-sectional population-based study used data from the National Health and Nutrition Examination Survey (NHANES) 2003-2006.MethodsWe conducted a cross-sectional analysis using data from 1156 women aged 20-54 years who participated in NHANES 2003-2006. Cardiometabolic index was calculated as the product of the waist-to-height ratio and the triglyceride-to-high-density lipoprotein cholesterol ratio. Logistic regression models adjusted for demographic, reproductive, and lifestyle factors were used to assess the association between cardiometabolic index and self-reported endometriosis. Structural equation modeling was applied to explore potential mediating and moderating effects.ResultsA significant inverse association between cardiometabolic index and endometriosis was observed. In the fully adjusted model, each one-unit increment in cardiometabolic index corresponded to a 42% reduction in the odds of self-reported endometriosis (odds ratio = 0.58, 95% confidence interval = 0.38-0.91, p < 0.05). Compared with women in the lowest cardiometabolic index quartile, those in the highest quartile exhibited a 51% (precise value: 50.6%) lower prevalence of endometriosis (odds ratio = 0.49, 95% confidence interval = 0.29-0.83). Additionally, the use of oral contraceptives significantly moderated the cardiometabolic index-endometriosis relationship p for interaction <0.05.ConclusionsCardiometabolic index is significantly and inversely associated with endometriosis among US women of reproductive age. However, given the cross-sectional design of this study, these findings should be considered preliminary, and causal inferences cannot be drawn.

BackgroundUrinary volatile organic compounds can accurately reflect individual exposure levels. This study investigated the association between urinary volatile organic compounds and cancer from both single- and combined-exposure perspectives and identified the volatile organic compounds most strongly associated with cancer.MethodsThis cross-sectional study analyzed data from 6056 US adults from the National Health and Nutrition Examination Survey 2011-2018 cycles, including 546 individuals with cancer. Logistic regression and restricted cubic spline models were used to evaluate associations for individual volatile organic compound exposures. Subgroup and interaction analyses were conducted to assess differences among populations. Least absolute shrinkage and selection operator, weighted quantile sum, and Bayesian kernel machine regression models were applied to evaluate mixture associations and to identify volatile organic compounds most strongly associated with cancer.ResultsNine urinary volatile organic compound metabolites were significantly associated with cancer. Among them, N-acetyl-S-(3,4-dihydroxybutyl)-L-cysteine, a metabolite of 1,3-butadiene, and 2-aminothiazoline-4-carboxylic acid, a metabolite of cyanide, exhibited nonlinear dose-response relationships. Subgroup and interaction analyses indicated that age and body mass index were important effect modifiers of these associations. Mixture exposure analyses revealed that higher overall volatile organic compounds exposure levels were associated with a higher prevalence of cancer, with N-acetyl-S-(3,4-dihydroxybutyl)-L-cysteine contributing most strongly to the observed association.ConclusionThis study provides epidemiological evidence of an association between urinary volatile organic compounds and cancer, with N-acetyl-S-(3,4-dihydroxybutyl)-L-cysteine consistently showing the strongest association. These findings highlight the potential public health relevance of exposure to specific volatile organic compounds.

Disseminated superficial porokeratosis with dermal amyloid deposits is exceptionally rare, with only 12 documented cases worldwide. The pathogenesis involves keratinocyte degeneration, resulting in amyloid deposition. A 76-year-old Chinese male presented with a 10-year history of multiple annular brown pruritic macules on the extremities and trunk, along with dense pruritic papules on the bilateral anterior tibial regions. Histopathological examination revealed cornoid lamella, dyskeratotic cells, and dermal amyloid deposits. Treatment with topical corticosteroids, 3% boric acid, and oral acitretin improved pruritus and pigmentation over 4 months; however, lesions recurred after discontinuation. Concomitant hyperuricemia (523 μmol/L) suggests a potential novel role of purine metabolism in amyloidogenesis, an association that has not been previously reported.

ObjectivePrevious studies have reported inconsistent findings regarding alterations in lipid profiles among patients with acne vulgaris (acne). This meta-analysis aimed to resolve these inconsistencies.MethodsA systematic search was conducted in Web of Science, Scopus, and PubMed. Lipid profile levels were compared between patients with acne and healthy controls. Mean values and standard deviations for total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein were used to calculate standardized mean differences with 95% confidence intervals.ResultsA total of 916 articles were initially identified, of which 38 studies comprising 2485 patients met the eligibility criteria. The pooled analysis demonstrated that patients with acne had significantly higher levels of total cholesterol (pooled standardized mean difference = 0.92, 95% confidence interval: 0.55-1.28), triglycerides (pooled standardized mean difference = 0.82, 95% confidence interval: 0.51-1.14), and low-density lipoprotein (pooled standardized mean difference = 1.52, 95% confidence interval: 1.11-1.92) as well as significantly lower high-density lipoprotein levels (pooled standardized mean difference = -0.45, 95% confidence interval: -0.69 to -0.21). Subgroup and meta-regression analyses were performed to identify the sources of significant heterogeneity. Subgroup analyses further revealed significant alterations in lipid profiles among female patients and in studies conducted in Egypt and Saudi Arabia.ConclusionAlterations in lipid profiles were observed in patients with acne.