Journal of International Medical Research最新文献

ObjectiveDermatofibrosarcoma protuberans is a low-to-intermediate-grade malignancy with high postoperative recurrence risk. It is often misdiagnosed as superficial venous malformation due to nonspecific manifestations and clinical features similar to those of other soft tissue tumors. Ultrasound examination is crucial for dermatofibrosarcoma protuberans evaluation; however, its value in differentiating dermatofibrosarcoma protuberans from superficial venous malformation remains underinvestigated.MethodsThis retrospective study analyzed and compared the clinical and ultrasonographic features between 41 histopathologically confirmed dermatofibrosarcoma protuberans cases and 41 superficial venous malformation cases. Clinical data included sex, age, tumor size, and location. Ultrasound findings were categorized into five types, and the following features were evaluated: shape, boundary, pattern, invasion depth, and vascularity.ResultsThe dermatofibrosarcoma protuberans tissues had significantly larger maximum diameters than superficial venous malformations (p < 0.05). Anatomically, dermatofibrosarcoma protuberans predominantly occurred on the trunk, while superficial venous malformations were more common on the extremities (p < 0.05). Dermatofibrosarcoma protuberans tissues mostly invaded both dermis and hypodermis, whereas superficial venous malformations primarily involved the hypodermis (p < 0.05). Dermatofibrosarcoma protuberans tissues had clearer boundaries (p < 0.05) and were more likely to show hyperechoic cord-like structures (type 4), while superficial venous malformations frequently presented network structures (type 3) (p < 0.05).ConclusionsUltrasound can provide valuable morphological features to assist in the differential diagnosis of dermatofibrosarcoma protuberans and superficial venous malformation, improving preoperative assessment accuracy and guiding treatment planning.

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.

ObjectiveThis study aimed to investigate the association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio and nonalcoholic fatty liver disease in non-obese individuals, using data from the National Health and Nutrition Examination Survey.MethodsThis cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (2017-2023), including 6265 eligible participants. The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol was calculated, and nonalcoholic fatty liver disease was diagnosed using liver ultrasound transient elastography. The association between the ratio and nonalcoholic fatty liver disease was assessed using multivariable logistic regression and restricted cubic spline models. Threshold effect analysis was conducted to evaluate potential nonlinear relationships, while subgroup analyses and interaction tests were performed to assess consistency across demographic groups. Sensitivity analyses were also conducted using alternative controlled attenuation parameter thresholds to ensure the robustness of the findings.ResultsAmong the 6265 participants (mean age, 44.32 years), 1355 (21.62%) had nonalcoholic fatty liver disease. Restricted cubic spline analysis revealed a nonlinear dose-response relationship between the ratio and nonalcoholic fatty liver disease risk (P for nonlinearity <0.0001). When the ratio was below 3.4, the odds ratio was 2.17 (95% confidence interval, 1.51-3.12, P < 0.0001), indicating a strong positive association. However, when the ratio exceeded 3.4, the relationship plateaued (odds ratio, 1.40; 95% confidence interval, 1.11-1.75; P = 0.003). Subgroup analyses showed that the association was more pronounced among non-Hispanic White females aged over 60 years, although further validation is needed. Sensitivity analyses using controlled attenuation parameter thresholds of 248 and 288 dB/m showed similar patterns, supporting the stability of the observed associations.ConclusionsIn non-obese adults, higher levels of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio are associated with a greater prevalence of nonalcoholic fatty liver disease, with the strongest association observed when the ratio was below 3.4. As this study is cross-sectional, causal relationships cannot be inferred. This ratio may serve as a simple indicator for identifying individuals at higher risk of nonalcoholic fatty liver disease, but further longitudinal studies are needed to confirm these findings.

BackgroundAlthough coronavirus disease 2019 and influenza are recognized risk factors for thrombotic conditions, the incidence of acute ischemic stroke following these infections since 2022 remains unknown.MethodsPatients aged ≥65 years with no prior history of stroke, coronavirus disease 2019, or influenza who developed acute ischemic stroke from 3 days before to 28 days after a coronavirus disease 2019 or influenza diagnosis were identified using PCORnet and HealthVerity data collected from 1 January to 31 December 2022. Demographic characteristics, underlying conditions, level of care, outcomes, and acute ischemic stroke incidence were described and compared between patients with early acute ischemic stroke occurring from -3 to 7 days from the diagnosis date and late acute ischemic stroke occurring from 8 to 28 days.ResultsAmong 245,352 patients in PCORnet and 639,396 patients in HealthVerity aged ≥65 years with COVID-19, the incidence of early acute ischemic stroke following coronavirus disease 2019 (PCORnet: 962 per 100,000; HealthVerity: 447 per 100,000) and influenza (PCORnet: 589 per 100,000; HealthVerity: 387 per 100,000) was significantly higher than that of late acute ischemic stroke (coronavirus disease 2019 PCORnet: 81 per 100,000; HealthVerity: 141 per 100,000; influenza PCORnet: 75 per 100,000; HealthVerity: 15 per 100,000) (all p < 0.01).ConclusionsAlthough acute ischemic stroke incidence may have declined since 2020-2021, the persistent risk of acute ischemic stroke associated with acute coronavirus disease 2019 and influenza underscores the importance of continued monitoring and preventive strategies in older adults.

ObjectiveEarly and accurate detection of carotid vulnerable plaques is essential for preventing ischemic stroke. This study developed an automated deep learning framework using ultrasound images and compared the performance of various You Only Look Once models.MethodsA retrospective multicenter dataset of 1610 carotid ultrasound images from 368 patients was collected from 17 September 2024 to 17 March 2025. Plaques were classified as stable or vulnerable using standardized ultrasound criteria. The dataset was stratified and divided into training, validation, and test sets at a 6:2:2 ratio, with strict patient-level separation to prevent data leakage. Four You Only Look Once models (versions 7, 8, 9, and 10) were trained under identical conditions. Performance was evaluated using mean average precision at various intersection-over-union thresholds as well as precision, recall, and F1 score.ResultsYou Only Look Once version 9 showed the best overall performance, achieving the highest mean average precision at intersection-over-union thresholds of 0.5 and 0.95 in the validation set. Similar results were observed in the test set, with superior detection accuracy for both stable and vulnerable plaques. You Only Look Once version 9 also achieved the highest precision, recall, and F1 score.ConclusionThe You Only Look Once version 9-based framework enables accurate and efficient carotid plaque detection and classification, supporting real-time assessment of plaque vulnerability and the prevention of ischemic stroke.

Indwelling urinary catheterization, which is widely used in urological surgeries, predisposes patients to complications such as catheter-associated urinary tract infection, urethral trauma, and catheter-related bladder discomfort. Catheter-related bladder discomfort presents as suprapubic burning, dysuria, restlessness, or delirium; however it remains underrecognized in clinical practice, leading to suboptimal management during surgery. This narrative review summarizes the current evidence relating to the pathogenesis of catheter-related bladder discomfort, which is primarily associated with urothelial injury, muscarinic receptor-mediated detrusor overactivity, and neurogenic inflammation. In addition, the review identifies high-risk factors, including male sex, catheter diameter ≥18 Fr, and transurethral procedures. We highlight the need for uniform approaches to perioperative management, including preoperative pharmacoprophylaxis, intraoperative interventions, and postoperative therapies. Implementing these evidence-based approaches is essential to mitigate the incidence of catheter-related bladder discomfort and improve recovery and surgical outcomes in urological patients.

BackgroundHelicobacter pylori infection has been associated with diverse extraintestinal morbidities, including cardiometabolic diseases. Insulin resistance is a key pathogenic factor involved in the development of various metabolic diseases. This study aimed to investigate the association between Helicobacter pylori infection and insulin resistance.MethodsThis cross-sectional study analyzed two independent cohorts: 2918 participants from the US National Health and Nutrition Examination Survey (1999-2000) and 912 inpatients from Southern China. Helicobacter pylori infection was determined using serum antibodies (National Health and Nutrition Examination Survey), ¹³C-urea breath test, or rapid urease test (China cohort). Insulin resistance was assessed using the triglyceride-glucose index or homeostasis model assessment of insulin resistance. Multivariate linear regression models were used to analyze the associations.ResultsIn the National Health and Nutrition Examination Survey cohort, Helicobacter pylori positivity was initially associated with a higher triglyceride-glucose index (coefficient = 1.17, p = 0.001); however, this association lost statistical significance after full adjustment, and no significant association was observed with the homeostasis model assessment of insulin resistance index (coefficient = 0.03, p = 0.900). Similarly, in the Southern China cohort, no significant relationship was found between Helicobacter pylori infection status and the triglyceride-glucose index (coefficient = 0.06, p = 0.689).ConclusionsHelicobacter pylori infection is not consistently associated with insulin resistance. Further studies are needed to clarify its role in metabolic diseases.

ObjectiveThis study aimed to systematically elucidate the role of gut microbial metabolites in the development and progression of ovarian cancer.MethodsPublic databases, including GutMgene, were used to screen and integrate gut microbial metabolite-target genes with ovarian cancer-related genes, ultimately identifying 59 key intersection genes. A gut microbiota-metabolite-gene regulatory network was constructed, and Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses, protein-protein interaction network analysis, and evaluations of the drug-likeness and toxicity of key metabolites were performed.ResultsA total of 72 key genes associated with immune regulation were identified. Enrichment analyses demonstrated that these genes were significantly involved in immune-related processes, including T cell activation and the Toll-like receptor signaling pathway. Protein-protein interaction network analysis identified five core genes: STAT3, IL6, TNF, AKT1, and TP53. Drug-likeness analysis suggested that metabolites such as butyric acid and indole-3-propionic acid exhibit potential drug-like properties.ConclusionGut microbiota-derived metabolites may influence ovarian cancer progression and the immune microenvironment by regulating core genes such as TP53 and AKT1 and pathways including Toll-like receptor signaling. These findings provide a potential basis for microbiota-targeted interventions in ovarian cancer.