Journal of International Medical Research最新文献

ObjectiveThe objective of this study was to evaluate the effects of dexmedetomidine on respiratory and hemodynamic parameters in patients receiving high-flow nasal cannula therapy.MethodsThis retrospective observational study included 206 adult patients who received dexmedetomidine during high-flow nasal cannula therapy between November 2019 and September 2023. Patients in whom dexmedetomidine was initiated during mechanical ventilation and those with incomplete data were excluded. Dexmedetomidine was administered intravenously at a median dose of 0.2 (0.2-0.3) mcg/kg/h for 3.0 (2.0-5.0) days. Primary outcomes were changes in respiratory rate and the partial pressures of carbon dioxide and oxygen. Secondary outcomes included hemodynamic changes, adverse events, and discontinuation of dexmedetomidine.ResultsRespiratory rate and the partial pressure of carbon dioxide remained stable over 24 h, whereas the partial pressure of oxygen significantly increased at 3 h (p = 0.007). Dexmedetomidine led to significant reductions in systolic blood pressure and heart rate (p < 0.001). Hypotension occurred in 31.6% of patients, and vasopressors were required in 28.2%. Dexmedetomidine was discontinued in 26.7% of patients because of adverse events.ConclusionsDexmedetomidine administration was associated with improved oxygenation without compromising respiratory drive in patients receiving high-flow nasal cannula, although careful monitoring is warranted because of potential hemodynamic effects.

ObjectiveThis study was conducted to investigate the effectiveness of using drainage tubes after high tibial osteotomy.MethodsClinical data of 164 patients who underwent high tibial osteotomy were retrospectively analyzed. Patients were divided into two groups: group A, in which drainage tubes were not placed, and group B, in which drainage tubes were placed postoperatively. C-reactive protein, hemoglobin, and hematocrit levels; hidden, visible, and total blood losses at 24 h postoperatively; visual analog scale scores at 24, 48, and 72 h postoperatively; complications; range of motion; Western Ontario and McMaster Universities Arthritis index at 6 months postoperatively; and differences in patellar diameter, edge of tibial tubercle diameter, and ankle diameter were compared.ResultsAt 24 h postoperatively, the hemoglobin and hematocrit levels in group A were significantly higher than those in group B. Total, hidden, and visible blood losses at 24 h postoperatively were significantly lower in group A than in group B. There were no significant differences in the other indices.ConclusionsThe findings suggested that using drainage tubes after high tibial osteotomy offered no evident advantages. In contrast, they increased postoperative blood loss, which is not conducive to early recovery.

This study aimed to characterize the clinical presentation, ophthalmologic findings, and final diagnoses of patients with primary intracranial mass lesions who initially presented with visual symptoms. We conducted a retrospective observational case series at the Neuro-ophthalmology Department of Chi Mei Medical Center, Taiwan, analyzing adult patients who presented with visual disturbances between January 2021 and August 2023 and were subsequently diagnosed with intracranial mass lesions. Demographic characteristics, ophthalmologic findings, imaging results, treatment modalities, and visual outcomes were analyzed. Thirteen patients were included (six men; mean age: 45.2 ± 13.1 years). Blurred vision (61.5%) was the most frequent presenting symptom. Visual field defects (76.9%) and optic disc pallor (53.9%) were common findings. Pituitary adenoma was the most predominant tumor type (38.5%). The results indicate that visual symptomatology may represent an early manifestation of primary intracranial mass lesions. Prompt neuroimaging and multidisciplinary management are essential for achieving timely diagnosis and optimal clinical outcomes.

IntroductionThe National Early Warning Score (NEWS) was introduced in 2012 by the Royal College of Physicians in the United Kingdom. It improves the assessment accuracy in acute illness and facilitates early detection of clinical deterioration. This study aimed to evaluate the prognostic value of NEWS in predicting outcomes among patients diagnosed with coronavirus disease 2019 (COVID-19) and to analyze the clinical characteristics and risk factors associated with mortality.MethodsThis retrospective cohort study analyzed the clinical data from patients with COVID-19 admitted to the emergency resuscitation room of Beijing Luhe Hospital, Capital Medical University, between December 2022 and January 2023. Data included initial laboratory test results obtained within 1 h of admission, chest computed tomography findings, NEWS, Modified Early Warning Score (MEWS), and quick Sequential Organ Failure Assessment (qSOFA) score. Receiver operating characteristic curves were used to evaluate the predictive performance of NEWS, MEWS, and qSOFA for 30-day all-cause mortality. Patients were categorized into survivor and nonsurvivor groups. Differences in laboratory parameters and imaging features between the two groups were compared, and logistic regression was employed to identify independent risk factors for prognosis.ResultsA total of 446 patients were enrolled, including 219 survivors and 227 nonsurvivors. The area under the receiver operating characteristic curve (AUROC) for predicting mortality was 0.945 (95% confidence interval: 0.926-0.963) for NEWS, which was significantly higher than those for MEWS (0.903, 95% confidence interval: 0.877-0.929) and qSOFA (0.902, 95% confidence interval: 0.881-0.923) (p < 0.05). No significant difference was observed between the AUROCs of MEWS and qSOFA. Multivariate logistic regression analysis identified NEWS, white blood cell count, platelet count, D-dimer level, comorbidities (respiratory diseases and diabetes), and clinical classification as independent risk factors for COVID-19 prognosis (all p < 0.05). Moreover, the proportion of patients with bilateral lung involvement exceeding 50% on chest computed tomography was significantly higher in the nonsurvivor group (81.8%, p < 0.001).ConclusionEarly application of NEWS combined with key laboratory indicators is valuable for assessing disease severity and predicting prognosis in patients with COVID-19.

Pleomorphic hyalinizing angiectatic tumor of soft tissue (PHAT) is a rare, low-grade neoplasm of uncertain lineage that predominantly affects the lower limbs of middle-aged adults. We report the case of a male in his early 20s who presented with a progressively enlarging, mildly tender mass above the right knee, present for 6 years. Imaging studies revealed a well-circumscribed lesion with obvious contrast enhancement on magnetic resonance imaging and marked internal vascularity on color Doppler ultrasound, located anterior to the distal quadriceps femoris. Extended excision was performed, and histopathologic examination confirmed the diagnosis of pleomorphic hyalinizing angiectatic tumor of soft tissue with negative surgical margins (R0 resection). The patient remained disease-free at the short-term follow-up (as of mid-2025). This report highlights the clinicopathologic features that differentiate pleomorphic hyalinizing angiectatic tumor of soft tissue from mimics such as myofibroma and intramuscular hemangioma, particularly in younger patients and at unusual anatomical locations.

ObjectiveThis study aimed to evaluate the correlations between the triglyceride glucose-body mass index, the bedside index for severity in acute pancreatitis score, and the C-reactive protein-to-lymphocyte ratio with disease severity, as well as their prognostic value, in patients with hyperlipidemic acute pancreatitis.MethodsThis retrospective cohort study analyzed 247 patients diagnosed with hyperlipidemic acute pancreatitis. Participants were stratified according to the 2012 Atlanta criteria into mild (n = 108), moderately severe (n = 71), and severe (n = 68) groups. Based on 28-day outcomes, patients were categorized into poor prognosis (n = 90) and good prognosis (n = 157) groups. We compared baseline data and performed Spearman correlation analysis, Cox univariate/multivariate regression, and receiver operating characteristic analysis.ResultsThe triglyceride glucose-body mass index, bedside index for severity in acute pancreatitis, and C-reactive protein-to-lymphocyte ratio significantly increased with disease severity (p < 0.05) and demonstrated strong positive correlations (p < 0.01). Multivariate Cox regression identified triglyceride glucose-body mass index (hazard ratios = 1.62, 95% confidence intervals: 1.33-1.97), bedside index for severity in acute pancreatitis (hazard ratios = 1.92, 95% confidence intervals: 1.43-2.57), and C-reactive protein-to-lymphocyte ratio (hazard ratios = 2.05, 95% confidence intervals: 1.62-2.60) as independent predictors of poor prognosis. The combination of all three markers yielded the highest predictive accuracy (area under the curve = 0.987) for predicting 28-day poor prognosis, a finding that was robust on internal validation.ConclusionsThe triglyceride glucose-body mass index, bedside index for severity in acute pancreatitis score, and C-reactive protein-to-lymphocyte ratio are valuable tools for assessing disease severity and predicting prognosis in hyperlipidemic acute pancreatitis. Their combined use may potentially enhance early risk stratification and guide clinical decision-making.

BackgroundPeripheral arterial disease is a common vascular condition characterized by the narrowing of peripheral arteries, leading to reduced blood flow and increased risk of cardiovascular events such as myocardial infarction, stroke, and limb amputation. Despite its impact, peripheral arterial disease remains underdiagnosed, making early identification crucial for improving outcomes. The neutrophil percentage-to-albumin ratio, reflecting systemic inflammation and nutritional status, has been proposed as a potential biomarker for assessing peripheral arterial disease risk.MethodsThis study used data from the National Health and Nutrition Examination Survey from 1999 to 2004, including 2864 participants after excluding those with missing data on peripheral arterial disease status, neutrophil percentage-to-albumin ratio, and covariates. Peripheral arterial disease was diagnosed using the ankle-brachial index, with an ankle-brachial index value less than 0.90 indicating peripheral arterial disease. Neutrophil percentage-to-albumin ratio was calculated as the percentage of neutrophils in total white blood cells divided by serum albumin levels. Logistic regression models were used to examine the association between neutrophil percentage-to-albumin ratio and peripheral arterial disease, adjusting for potential confounders, including age, sex, race, educational level, body mass index, hypertension, hyperlipidemia, diabetes, and smoking. A nonrestricted cubic spline analysis was used to assess the nonlinear relationship between neutrophil percentage-to-albumin ratio and peripheral arterial disease.ResultsElevated neutrophil percentage-to-albumin ratio was significantly associated with an increased peripheral arterial disease risk. In the unadjusted model, the highest neutrophil percentage-to-albumin ratio quartile (Q4) had an odds ratio of 2.67 (95% confidence interval, 1.78-4.01; P < 0.001). This association remained significant after adjusting for age, sex, and other confounders, with an odds ratio of 1.86 (95% confidence interval, 1.21-2.85; P = 0.004) in the fully adjusted model. Cubic spline analysis revealed a threshold at a neutrophil percentage-to-albumin ratio of 13.71, above which peripheral arterial disease risk increased significantly. Subgroup analyses indicated stronger associations in individuals with hypertension, hyperlipidemia, and diabetes.ConclusionElevated neutrophil percentage-to-albumin ratio is associated with an increased peripheral arterial disease risk, with a threshold effect at a neutrophil percentage-to-albumin ratio of 13.71. Neutrophil percentage-to-albumin ratio may serve as a valuable, cost-effective biomarker for early peripheral arterial disease detection and risk stratification, particularly in high-risk populations.

ObjectiveThis study aimed to investigate the associations between fine particulate matter and its major chemical components and cognitive function among middle-aged and older adults in China.MethodsWe conducted a nationwide prospective cohort study using data from the China Health and Retirement Longitudinal Study (2011-2018). Cognitive function was repeatedly assessed through standardized tests of memory and mental status. Annual average concentrations of fine particulate matter and its five major components (sulfate, nitrate, ammonium, black carbon, and organic matter) were estimated at the city level. Fixed-effects models and restricted cubic spline analyses were used to evaluate associations, and random forest models were used to rank the relative importance of components.ResultsHigher exposure to fine particulate matter and several of its major components was significantly associated with lower cognitive scores. Among these components, sulfate exhibited the strongest adverse association with cognitive function. The findings were consistent across multiple sensitivity analyses, including those restricted to provincial capitals and those adjusting for potential confounders.ConclusionsExposure to fine particulate matter and its chemical components may contribute to cognitive impairment among middle-aged and older adults in China. Sulfate appears to be particularly detrimental. These results highlight the need for targeted air pollution control policies that address specific fine particulate matter components to mitigate the burden of cognitive impairment.

PurposeFirst-phase ejection fraction has been established as an innovative indicator for detecting early left ventricular systolic changes. This study aimed to use first-phase ejection fraction to assess early changes in the left ventricular systolic function in patients with cirrhosis.MethodsIn this cross-sectional study, 122 patients with cirrhosis were stratified into the following groups based on Child-Turcotte-Pugh scores: group B1 (Child-Turcotte-Pugh class A, n = 35), group B2 (Child-Turcotte-Pugh class B, n = 43), and group B3 (Child-Turcotte-Pugh class C, n = 44). Thirty-nine healthy controls (group A) were enrolled for comparison. Basic information, clinical biochemical parameters, and ultrasound parameters were collected.ResultsCompared with groups A, B1, and B2, group B3 showed significantly decreased left ventricular ejection fraction (all p < 0.05). Groups B2 and B3 showed significantly decreased absolute values of global longitudinal strain compared with groups A and B1 (all p < 0.05). Compared with group B2, group B3 demonstrated more pronounced decrease in absolute values of global longitudinal strain (p < 0.05). First-phase ejection fraction was significantly increased in group B1 compared with that in group A (p < 0.05). In contrast, first-phase ejection fraction was significantly decreased in groups B2 and B3, with group B3 showing a further significant decrease compared with group B2 (p < 0.05). First-phase ejection fraction, ejection fraction, and global longitudinal strain demonstrated significant negative correlations with Child-Turcotte-Pugh class (r = -0.619, -0.429, and -0.608, respectively; p < 0.05). The prevalence of cirrhotic cardiomyopathy was significantly higher in group B3 than in group B1. The area under the receiver operating characteristic curve for first-phase ejection fraction in diagnosing cirrhotic cardiomyopathy was superior to that for ejection fraction and global longitudinal strain.ConclusionFirst-phase ejection fraction sensitively detects early alterations in left ventricular systolic function in cirrhotic patients and may facilitate early identification of cirrhotic cardiomyopathy.