Journal of International Medical Research最新文献

BackgroundThis study examined disease-specific quality of life among people living with chronic hepatitis B virus infection in northern Ghana, where the condition remains highly endemic.MethodUsing a cross-sectional design, 264 individuals with chronic hepatitis B virus infection were recruited from 1 regional hospital and 3 district hospitals. Data were collected through structured interviews using the validated hepatitis B virus quality of life (HBQoL) instrument and analyzed using descriptive statistics and logistic regression.ResultParticipants had a mean age of 38 years (±16.5), with a nearly equal sex distribution. The overall global HBQoL mean score was 63.6 (±20.0), reflecting a moderate quality of life. Regression analysis identified age, hepatitis B virus profile, and the presence of complications as significant predictors. Each additional year of age increased the odds of better quality of life by 2.8% (odds ratio = 1.028, p = 0.002). Hepatitis B envelope antigen negativity was inversely associated with high quality of life (odds ratio = 0.344, p = 0.013). Additionally, the absence of hepatitis B virus complications was associated with lower odds of good quality of life in this population (odds ratio = 0.300, p = 0.001).ConclusionsThe findings suggest that psychosocial and clinical interventions should complement biomedical care. Addressing the unique quality of life challenges of people living with the hepatitis B virus is essential for holistic management in Ghana and similar settings.

ObjectiveThis study aimed to evaluate the clinical outcomes of a new implant restoration approach for patients with limited interocclusal space in the posterior region.Materials and methodsA total of 37 patients (19 females and 18 males) were enrolled in this study, receiving 62 implants. A locking taper implant (Bicon) was placed during the first-stage procedure, positioned >2 mm under the bone. An extraoral cementation technique was used to cement the crown and abutment. The survival and success rates of the implant restorations were evaluated based on plaque index, modified bleeding index, probing depth, marginal bone loss, and the patient's subjective satisfaction.ResultsThe success rate of the new implant restorations was 96.7% at the 1-year follow-up, with patients reporting satisfactory outcomes. Marginal bone loss and soft tissue changes were not significantly different at different depths of placement (p > 0.05).ConclusionsThe use of a locking taper implant along with appropriate prosthetic strategies may be an effective approach for the prosthetic rehabilitation of patients with limited interocclusal space and reduced occlusal vertical dimensions.

Hypoparathyroidism is a rare endocrine condition characterized by insufficient secretion of parathyroid hormone (PTH), resulting in abnormally low calcium levels (hypocalcemia) and elevated phosphate levels (hyperphosphatemia) in the blood. This report describes a man in his late 30s with a chronic skin condition marked by dryness and desquamation. He occasionally experienced mild perioral numbness. Over the past year, he developed recurrent neuromuscular irritability, including worsening perioral numbness, tingling or numbness in the hands and feet, and muscle spasms consistent with tetany. He was diagnosed with hypoparathyroidism, and his symptoms improved markedly after calcium and calcitriol supplementation. Genetic testing revealed a novel heterozygous c.2298C>G (p. Tyr766Ter) mutation in exon 18 of the fibroblast growth factor receptor 1 gene. This case report aimed to describe this novel mutation and its potential role in the pathogenesis of primary hypoparathyroidism and to discuss relevant diagnostic and therapeutic management strategies. In addition, it broadens our understanding of genetic mutations associated with hypoparathyroidism and provides clinically relevant diagnostic information that may benefit future patients with the similar genetic alteration. Furthermore, it underscores the importance of genetic analysis in elucidating the heterogeneity and complexity of hypoparathyroidism, thereby supporting the development of more precise and tailored treatment approaches.

ObjectiveAlzheimer's disease and mild cognitive impairment involve brain atrophy, but neurotransmitter changes and their clinical implications are not well defined. This study aimed to examine the relationship between gray matter atrophy and neurotransmitter distributions and to build machine-learning models using gray matter-neurotransmitter co-localization as features.MethodsAmong 262 participants from the Alzheimer's Disease Neuroimaging Initiative (140 with Alzheimer's disease, 50 with mild cognitive impairment, and 72 controls), we used structural magnetic resonance imaging and voxel-based morphometry (family-wise error < 0.05), and JuSpace toolbox was used to assess the spatial correlation between gray matter atrophy and 13 neurotransmitter maps. We applied a train/validation/fixed test split (the test set was never used for selection or training); features were screened by univariate regression and least absolute shrinkage and selection operator regression, and models trained with nested 10-fold cross-validation were evaluated by the area under the receiver operating characteristic curve.ResultsBoth Alzheimer's disease and mild cognitive impairment showed gray matter loss in temporal, frontal, and cingulate areas. Atrophy was correlated with serotonergic, dopaminergic, and glutamatergic systems (false-discovery rate < 0.05). In mild cognitive impairment, reduced metabotropic glutamate receptor 5/μ-opioid receptor-gray matter correlation was associated with higher depression scores (r = -0.44, p = 0.001; r = -0.44, p = 0.001). The Random Forest model achieved an area under the receiver operating characteristic curve of 0.821, and Shapley additive explanations analysis confirmed key feature contributions.ConclusionNeurotransmitter-linked gray matter changes contribute to the pathology of Alzheimer's disease and mild cognitive impairment. The machine-learning model accurately differentiates these conditions, suggesting its utility for early diagnosis and disease staging.

ObjectiveTo describe patients with severe asthma treated with or eligible for monoclonal antibodies, assessing the health and economic burden using the Italian National Healthcare Service (SSN) administrative data.MethodsFrom 4.6 million inhabitants, among patients with asthma from 1 January to 31 December 2022, those with severe asthma were identified by monoclonal antibody dispensation (cohort A) and by eligibility for monoclonal antibodies, defined as continuous treatment with medium- or high-dose inhaled corticosteroids and long-acting beta agonists and the occurrence of exacerbations (cohort B-narrow and cohort B-broad according to "narrow" and" broad" definitions, respectively). One-year exacerbations, healthcare utilization, and direct costs were assessed.ResultsOf the 128,621 patients with asthma (51.8% women; mean age, 54 years), patients with severe asthma were identified as follows: cohort A (n = 3046; 2.4%), cohort B-narrow (n = 3517; 2.7%), and cohort B-broad (n = 7621; 5.6%). Compared with cohort A, patients in cohorts B-narrow and B-broad were older, had more comorbidities, experienced more moderate/severe exacerbations (70.9%-57.3% vs. 46.7%), and had higher hospitalization rates and greater drug use but fewer specialist visits. The annual SSN costs averaged €7512 for cohort A versus €2911-€2351 for cohorts B-narrow and B-broad. Cohort A incurred higher costs for asthma drugs, whereas cohorts B-narrow and B-broad incurred higher costs for concomitant drugs, hospitalizations, and specialist care.ConclusionsA significant disease burden exists in patients with uncontrolled severe asthma who are potentially eligible for monoclonal antibodies in Italy.

ObjectiveTo analyze the clinical features, diagnosis, and treatment of cerebral arteriovenous malformation with arterial stenosis and moyamoya disease.MethodsA 50-year-old man with a 20-year history of hypertension and multiple cerebral infarctions was admitted following the detection of cerebral artery stenosis. Imaging revealed a right posterior communicating artery aneurysm, severe stenosis of the right internal carotid artery (C6 segment), bilateral middle cerebral artery occlusion, and moyamoya vessels. The diagnosis was confirmed by cerebral angiography. The patient underwent stent-assisted aneurysm coiling and carotid stenting with balloon angioplasty.ResultsPostoperative antiplatelet, antihypertensive, and lipid-lowering therapies were administered. The patient recovered well without new neurological deficits and was discharged in stable condition. Follow-up assessment is ongoing.ConclusionDigital subtraction angiography remains the gold standard for diagnosing such complex cerebrovascular diseases. Endovascular intervention combined with medication can improve clinical outcomes, and regular follow-up assessment is essential to prevent complications.

BackgroundThe red cell distribution width-to-albumin ratio (RAR) is a novel composite biomarker that reflects both inflammatory and nutritional status. Although the RAR has been associated with various chronic disease outcomes, its relationship with mortality risk in adults with reduced muscle mass has not been systematically evaluated.MethodsWe analyzed data from 1494 adults with reduced muscle mass enrolled in 6 cycles of the US National Health and Nutrition Examination Survey (2003-2006 and 2011-2018). Kaplan-Meier survival analysis, Cox proportional hazards regression, restricted cubic spline models, and time-dependent receiver operating characteristic curves were used to comprehensively assess the association between RAR and mortality risk. Subgroup and interaction analyses were conducted to evaluate the robustness of the findings.ResultsDuring a median follow-up of 104 months, a higher RAR was linearly associated with increased risks of all-cause and cardiovascular mortality. Compared with Q1, Q4 was associated with a 154% and 216% higher risk of all-cause and cardiovascular mortality, respectively. These associations were generally consistent across subgroups, with a significant interaction by sex indicating stronger associations among men. Time-dependent area under the curve analyses demonstrated that the RAR outperformed the neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and neutrophil-to-albumin ratio at most time points, with the exception that the neutrophil-to-lymphocyte ratio slightly exceeded RAR for 5-year cardiovascular mortality.ConclusionRAR is positively associated with mortality risk in adults with reduced muscle mass. RAR may serve as a practical biomarker for risk stratification in this population.

ObjectiveEsophageal cancer is among the most rapidly spreading malignancies worldwide. Early detection of esophageal cancer is critical for disease prevention and for improving overall population health. Most studies have used statistical methodologies to assess the esophageal cancer risk, and only a few studies have used prediction models.MethodsThe esophageal cancer dataset, comprising 3985 patient records with 85 demographic, pathological, and follow-up features, was obtained from Kaggle. A comprehensive data-engineering pipeline was implemented, including the removal of null and low-variance features, elimination of identifier variables to prevent data leakage, mode-based imputation, label encoding, and data standardization. Feature relevance was assessed using Mutual Information, and the top 31 clinically meaningful features were retained for model development. Six machine learning classifiers-Support Vector Machine, Gaussian Naïve Bayes, k-nearest neighbors, AdaBoost, Multilayer Perceptron, and LightGBM (Gradient Boosting Machine)-were trained and evaluated. A stratified 10-fold cross-validation was applied to maintain class balance, and GridSearchCV was used for hyperparameter optimization. Model interpretability was assessed using Shapley Additive Explanations (SHAP) for global and local feature attribution and Local Interpretable Model-Agnostic Explanations (LIME) for instance-level explanations. Furthermore, the top features identified by SHAP and LIME were used to retrain the LightGBM model to evaluate performance under reduced dimensionality.ResultsAmong all evaluated classifiers, LightGBM exhibited the highest and most stable performance, achieving an accuracy of 99.87% prior to hyperparameter tuning and 99.74% following stratified cross-validated tuning, with near-perfect precision, recall, F1-score, and area under the curve values. Explainability analyses indicated that clinically relevant variables, including tumor staging, smoking-related factors, and follow-up indicators, played a significant role in model predictions. The SHAP-selected top-20 feature model maintained high predictive performance (99.76%), demonstrating that the classifier remained robust despite dimensionality reduction.ConclusionsThe proposed LightGBM-based model demonstrates exceptional predictive accuracy and strong interpretability, suggesting its potential utility for the early detection of esophageal cancer using machine learning approaches.

ObjectivesThis study aimed to comprehensively investigate the possible associations between neutrophil- and high-density lipoprotein cholesterol (HDL-C)-related inflammatory markers and the incidence of sarcopenia among adults in the United States.MethodsThis cross-sectional study analyzed data from 8878 participants in the National Health and Nutrition Examination Survey. The potential associations between neutrophil- and HDL-C-related inflammatory markers and sarcopenia were evaluated using multiple statistical methods, including weighted logistic regression analysis, sensitivity analyses, restricted cubic spline models, and subgroup analyses. A receiver operating characteristic curve was employed to thoroughly analyze the predictive accuracy of various inflammatory markers for sarcopenia risk.ResultsAll examined inflammatory markers were significantly associated with sarcopenia. The association between the neutrophil-to-HDL-C ratio and sarcopenia was nonlinear, with risk increasing notably beyond a certain threshold (breakpoint = 2.791), whereas the neutrophil percentage-to-albumin ratio demonstrated a linear association. Further threshold effect analyses identified specific breakpoints for neutrophil-to-HDL-C ratio, platelet-to-HDL-C ratio, lymphocyte-to-HDL-C ratio, and monocyte-to-HDL-C ratio. Notably, the area under the curve value for neutrophil-to-HDL-C ratio exceeded those for other inflammatory markers in receiver operating characteristic analysis (area under the curve = 0.632, 95% confidence interval: 0.612-0.652), suggesting its potential as a promising predictor of sarcopenia prevalence.ConclusionsThe findings suggest positive associations between inflammatory biomarkers and sarcopenia, with the neutrophil-to-HDL-C ratio demonstrating superior predictive performance.