Journal of International Medical Research最新文献

Objective: To investigate the safety and efficacy of laquinimod in treating relapsing-remitting multiple sclerosis (RRMS).

Methods: An extensive electronic search was conducted across PubMed, Embase, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov to identify suitable studies. Risk of bias was assessed using Cochrane's Risk of Bias tool. Statistical analysis was performed using RevMan 5.4.1.

Results: The meta-analysis of four randomized controlled trials including 3665 patients found that laquinimod significantly reduced the annualized relapse rate compared with placebo (mean difference = -0.08, 95% confidence interval [CI] = -0.12, -0.04, I² = 0%). For disability progression confirmed at 3 months, laquinimod provided a significant advantage over placebo (hazard ratio [HR] = 0.75, 95% CI = 0.59, 0.96, I² = 25%), whereas no benefit was achieved at 6 months (HR = 0.69, 95% CI = 0.45, 1.06, I² = 66%). Laquinimod was also significantly better than placebo in maintaining a relapse-free status (risk ratio [RR] = 1.14 95% CI = 1.06, 1.22, I² = 10%). Laquinimod had a comparable safety profile as placebo (RR = 1.06, 95% CI = 0.81, 1.39, I² = 33%).

Conclusions: These findings support the efficacy of laquinimod in managing RRMS but necessitate careful monitoring during treatment.

Objective: To investigate the diagnostic value of high-resolution melting (HRM) analysis for oncology-associated epidermal growth factor receptor (EGFR) gene mutations.

Methods: We systematically searched Embase, PubMed, and Web of Science for HRM and EGFR mutation detection studies published through September 2024. True and false positives and negatives were extracted to evaluate the diagnostic accuracy of HRM to detect EGFR mutations. The study was registered at INPLASY (INPLASY202490062).

Results: Twenty-six articles were obtained from 416 references. The overall diagnostic sensitivity and specificity were high at 0.95 [95% confidence interval (CI), 0.94-0.96] and 0.99 (95% CI, 0.99-0.99), respectively. Other indicators, including the positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio, were 144.91 (95% CI: 69.07-304.04), 0.08 (95% CI: 0.04-0.13), and 2405.21 (95% CI: 1231.87-4696.13), respectively. The Q value of the summary receiver operating characteristic curve was 0.979, and the area under the curve was 0.997.

Conclusion: As a pre-screening method, the high specificity, sensitivity, low cost, rapid turnaround, and simplicity of HRM make it a good alternative for clinical practice, but positive results must still be obtained for diagnostic confirmation. This study provides a transparent overview of relevant studies in design and conduct.

Inflammatory linear verrucous epidermal nevus (ILVEN) is a rare type of epidermal nevus characterized by an inflammatory appearance, intense pruritus, and a tendency to be resistant to treatment. We present here, the case of a 7-year-old boy who presented with a widespread inflammatory skin lesion on the right side of his body, with some of the eruption following Blaschko's lines. He also had an associated contracture in the ipsilateral limb and short stature. Initially, we suspected this may be a rare case of CHILD syndrome in a boy. However, after further investigation, we confirmed the diagnosis as a severe form of ILVEN.

Objective: To conduct a metabolomics analysis in patients with spondyloarthritis (SpA) and compare results with those from healthy controls. The overall goal was to identify small-molecule substances that may have potential pathogenic and diagnostic significance in SpA.

Methods: This was an observational, cross-sectional, single-centre study that included patients with axial (ankylosing spondylitis [AS]), peripheral (psoriatic arthritis [PsA]) and healthy controls.

Results: The study included 50 patients with AS, 50 patients with PsA, and 164 controls. When compared with healthy controls, patients with SpA showed significant differences in 35 metabolites, primarily associated with amino acid and lipid metabolism. However, only two differences were found between the AS and PsA cohorts (glucose and glycerol).

Conclusions: Our data suggest that patients with SpA exhibit significant disruptions in amino acid and lipid metabolism. The large number of identified metabolites offers promising opportunities, both for discovering new SpA biomarkers and for gaining a deeper understanding of the pathophysiology of these chronic inflammatory diseases.

Visceral leishmaniasis (VL) is a parasitic disease that can trigger haemophagocytic syndrome (HPS), making its prompt diagnosis crucial. The application of metagenome next-generation sequencing (mNGS) provides a rapid diagnostic approach, particularly for patients with negative bone marrow aspiration results. We present here, a case of a male patient in his early 50s who presented with fever and abdominal pain. Routine examinations failed to identify its specific cause. However, diagnosis through mNGS helped prevent a potentially fatal outcome.

Nephrotic syndrome can occur secondary to malignancy, and its resolution is sometimes observed following tumor resection. We herein report the case of a 67-year-old Asian man who presented with membranous nephropathy associated with carcinoma of the ampulla of Vater. The patient initially presented with edema, hypoalbuminemia, and significant proteinuria with positive PLA2R antibody. Following surgical removal of the tumor, his urinary protein levels normalized, his serum albumin returned to normal, and the nephrotic syndrome achieved complete remission. This case underscores the importance of screening for secondary causes, such as malignancies, in patients with nephrotic syndrome. For those with malignancy-associated nephrotic syndrome, prompt and targeted treatment of the underlying tumor is critical to avoid missing the window for surgical intervention. This report aims to provide insights into the diagnosis and management of tumor-associated nephrotic syndrome, contributing to a better understanding of this rare clinical entity.

Complete staghorn calculi present one of the most challenging conditions in managing upper urinary tract stones. The complexity of treatment increases significantly when combined with severe scoliosis, particularly in patients with a Cobb angle exceeding 90°. This case report describes the treatment of a patient with severe scoliosis, characterized by a Cobb angle greater than 90°, who also presented with complete staghorn calculi. The patient successfully underwent single-stage, totally ultrasound-guided, tubeless mini-percutaneous nephrolithotomy, achieving excellent stone clearance without complications. This report aims to enhance the understanding of diagnosing and managing severe scoliosis in patients with complete staghorn calculi and to highlight the efficacy and safety of totally ultrasound-guided mini-percutaneous nephrolithotomy as a surgical approach.

Giant cell arteritis and subacute thyroiditis are often regarded as clinically distinct diseases with differing pathogenesis. We report a rare case of coexisting giant cell arteritis and subacute thyroiditis that were both successfully managed using glucocorticoid therapy. Ultrasound plays a vital role in the diagnosis and treatment of these diseases. A review of the literature revealed that cases of giant cell arteritis complicated by subacute thyroiditis are very rare, and their pathogenesis and association are still unclear. We summarized the clinical features of giant cell arteritis complicated with subacute thyroiditis and found that none of the patients had symptoms associated with polymyalgia rheumatica. Subacute thyroiditis could be misdiagnosed as giant cell arteritis, and ultrasound is a useful tool for distinguishing the two diseases. Glucocorticoids are effective in the active period in patients with giant cell arteritis complicated with subacute thyroiditis. This case report would encourage clinicians to pay more attention to this phenomenon.

Ureteral endometriosis is a rare manifestation of endometriosis that involves the infiltration of endometrial tissue into the ureters, leading to ureteral obstruction and potential renal dysfunction. However, its preoperative diagnosis is difficult. Herein, we report the case of a woman in her early 50s who presented with severe hydronephrosis of the right kidney, ureteral dilation, and suspicion of a ureteral tumor based on initial imaging studies. However, the pathological results after resection of the right kidney and right ureter revealed the presence of endometrial tissue in an ectopic location. This case highlights the importance of considering endometriosis as a differential diagnosis in cases of ureteral obstruction, even in atypical clinical scenarios, and emphasizes the need for prompt diagnosis and intervention to prevent irreversible renal damage and optimize patient outcomes.

Objective: To study the classification performance of a pre-trained convolutional neural network (CNN) with transfer learning by artificial joint ultrasonography images in rheumatoid arthritis (RA).

Methods: This retrospective study focused on abnormal synovial vascularity and created 870 artificial joint ultrasound images based on the European League Against Rheumatism/Outcome Measure in Rheumatology scoring system. One CNN, the Visual Geometry Group (VGG)-16, was trained with transfer learning using the 870 artificial images for initial training and the original plus five additional images for second training. The models were then tested for the ability to classify joints using real joint ultrasound images obtained from patients with RA. The study was registered in UMIN Clinical Trials Registry (UMIN000054321).

Results: A total of 156 clinical joint ultrasound images from 74 patients with RA were included. The initial model showed moderate classification performance, but the area under curve (AUC) for grade 1 synovitis was particularly low (0.59). The second model showed improvement in classifying grade 1 synovitis (AUC 0.73).

Conclusions: Artificial images may be useful for training VGG-16. The present novel approach of using artificial images as an alternative to actual images for training a CNN has the potential to be applied in medical imaging fields that face difficulties in collecting real clinical images.