Journal of International Medical Research最新文献

ObjectiveThis study aimed to compare bone metabolism markers between patients with hip fracture who had and did not have type 2 diabetes mellitus (T2DM).MethodsA total of 743 patients with hip fractures were enrolled in this case-control study and were further divided into T2DM and non-T2DM groups. Biochemical parameters, including fasting blood glucose, triglycerides, and total cholesterol, and bone metabolism parameters, including total serum procollagen type N-terminal propeptide and age-related type I cross-linked C-telopeptide, were collected and compared. Correlations between fasting blood glucose and triglyceride levels and bone metabolism parameters were assessed via Spearman correlation analysis.ResultsThe fasting blood glucose and triglyceride levels in the T2DM group were significantly higher than those in the non-T2DM group. In addition, the total serum procollagen type N-terminal propeptide and age-related type I cross-linked C-telopeptide levels in the T2DM group were significantly lower than those in the non-T2DM group.ConclusionsThe fasting blood glucose levels were negatively correlated with the total serum procollagen type N-terminal propeptide and age-related type I cross-linked C-telopeptide levels. In addition, our study speculated that good glycemic control may be beneficial for bone metabolism.

Behavioral and psychological symptoms of dementia significantly impact patient outcomes, caregiver burden, and healthcare costs. Current pharmacologic treatments are limited by efficacy and safety concerns. Cobenfy, a novel combination of xanomeline and trospium chloride, has shown efficacy in schizophrenia and presents a promising alternative for treating behavioral and psychological symptoms of dementia. This editorial explores the potential role of Cobenfy in the management of behavioral and psychological symptoms of dementia. To date, no trials of Cobenfy for behavioral and psychological symptoms of dementia have been completed; however, multiple trials are underway to investigate this medication for psychosis and agitation in Alzheimer's disease. Cobenfy may offer a safer pharmacologic option for behavioral and psychological symptoms of dementia compared with existing treatments. Further research in older adult populations is warranted.

Xeroderma pigmentosum is a rare autosomal recessive genetic disorder characterized by hypersensitivity to ultraviolet radiation and increased risk of skin cancer. Impaired DNA repair mechanisms are considered to be involved in the occurrence and development of this distinct disorder. We present the case of a 48-year-old Chinese woman with facial and chest tumors; these lesions had been rapidly growing over the past 6 months. Pathological biopsy and immunohistology indicated malignant melanoma in facial and chest tumors and squamous cell carcinoma in chest tumors. Using whole-exome sequencing, a site mutation c.2218_2220del (p.Glu)740del in the XPC gene was confirmed. To treat the infection and skin carcinoma, antibiotics and plastic surgery were employed. The identified XPC variant has not been previously reported in Chinese or global populations, expanding the mutational spectrum of this gene and providing valuable data for genetic counseling of affected families.

ObjectivesThe pleiotropic effects of lipid-lowering therapies on mental health remain incompletely understood. This study aimed to investigate the causal impact of genetically proxied inhibition of three major lipid-lowering drug targets, 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR), Niemann-Pick C1-like protein 1 (NPC1L1), and proprotein convertase subtilisin/kexin type 9 (PCSK9), on a spectrum of psychiatric disorders using a drug-target Mendelian randomization approach.MethodsWe used genetic variants located within or near the HMGCR, NPC1L1, and PCSK9 gene regions that are associated with low-density lipoprotein cholesterol levels as proxies for pharmacological inhibition. Summary-level data were obtained from large-scale genome-wide association studies for seven psychiatric outcomes: anorexia nervosa, anxiety, bipolar disorder, major depressive disorder, neuroticism, obsessive compulsive disorder, and schizophrenia. The inverse-variance weighted method was employed as the primary Mendelian randomization approach, supplemented by multiple sensitivity analyses to assess robustness.ResultsGenetically proxied inhibition of HMGCR was associated with an increased risk of major depressive disorder (odds ratio = 1.16; 95% confidence interval: 1.07-1.25; p = 4.5e-04). In contrast, NPC1L1 inhibition was associated with a decreased risk of major depressive disorder (odds ratio = 0.88; 95% confidence interval: 0.84-0.92; p = 8.1e-08). PCSK9 inhibition was significantly associated with an increased risk of major depressive disorder (odds ratio = 1.16; 95% confidence interval: 1.06-1.26; p = 8.2e-04) and bipolar disorder (odds ratio = 1.28; 95% confidence interval: 1.19-1.38; p = 9.4e-12). No significant associations were observed between these targets and the remaining psychiatric outcomes.ConclusionsThis study provides genetic evidence that lipid-lowering drug targets exert distinct effects on psychiatric disorders. These findings highlight the importance of further clinical and mechanistic studies, particularly given the widespread use of lipid-lowering therapies in aging populations who are vulnerable to mental health conditions.

We report a rare case of a left anterior descending artery originating from the right coronary sinus. The original left anterior descending artery was small and appeared occluded; it was initially misdiagnosed as a chronic total occlusion lesion. However, a displaced left anterior descending artery was identified during angiographic evaluation. Although a left main coronary artery arising from the right coronary sinus is uncommon (prevalence of 0.03%), to the best of our knowledge, this is the first reported case of an ectopic left anterior descending artery originating from the right coronary sinus.

ObjectiveHepatocellular carcinoma is a leading cause of cancer mortality, and early detection remains limited by the low sensitivity of alpha-fetoprotein. This study aimed to identify serum-derived exosomal microRNAs with diagnostic potential for hepatocellular carcinoma and to explore their regulatory molecular networks.MethodsThis observational case-control study included 50 patients with hepatocellular carcinoma and 50 matched healthy controls. Serum exosomes were isolated and verified by transmission electron microscopy, nanoparticle tracking analysis, and flow cytometry for CD9, CD63, and CD81. High-throughput small RNA sequencing (three hepatocellular carcinoma samples vs three control samples) identified differentially expressed microRNAs. Predicted target genes were analyzed using protein-protein interaction networks based on the Search Tool for the Retrieval of Interacting Genes/Proteins database, Gene Ontology analysis, and Kyoto Encyclopedia of Genes and Genomes pathway enrichment. Candidate microRNAs were validated by reverse transcription quantitative polymerase chain reaction, and diagnostic performance was evaluated using receiver operating characteristic analysis.ResultsSeven differentially expressed microRNAs were identified, and bioinformatic network analysis revealed forkhead box O1 and serine/arginine-rich splicing factor 11 as central hub genes potentially targeted by hsa-miR-27a-3p and hsa-miR-493-3p, respectively. Reverse transcription quantitative polymerase chain reaction confirmed significant upregulation of miR-27a-3p (P = 0.003) and downregulation of miR-493-3p (P = 0.014) in hepatocellular carcinoma. Receiver operating characteristic analysis demonstrated high diagnostic accuracy for miR-493-3p (area under the curve = 0.840) and miR-27a-3p (area under the curve = 0.827). Importantly, the combined biomarker panel (alpha-fetoprotein, miR-27a-3p, and miR-493-3p) achieved markedly improved performance (area under the curve = 0.943), outperforming alpha-fetoprotein alone (area under the curve = 0.828).ConclusionsSerum exosomal miR-27a-3p and miR-493-3p exhibit strong diagnostic potential and are associated with forkhead box O1 and serine/arginine-rich splicing factor 11. These findings highlight their promise as complementary biomarkers and provide new insight into exosome-mediated molecular regulation in hepatocarcinogenesis.

Hepatobronchial fistula is an uncommon but potentially life-threatening complication that can occurs following microwave ablation for hepatocellular carcinoma. The complication is associated with a significant mortality rate. We report the case of a patient with alcoholic cirrhosis and recurrent hepatic carcinoma who developed a delayed pyogenic liver abscess and hepatobronchial fistula and was treated using an uncommon treatment approach. The abscess in segment VIII, adjacent to the diaphragm, progressed to hepatobronchial fistula due to infection caused by Citrobacter freundii. Despite septic shock, acute liver injury, and delayed abscesses, the patient achieved complete oncologic and infectious resolution through ultrasound-guided percutaneous transhepatic drainage combined with lavage, thereby avoiding the need for high-risk surgery. Overall, the present case report highlights the viability of minimally invasive strategies for treating hepatobronchial fistula. In addition, this report emphasizes the significance of diaphragmatic protection during microwave ablation and the need for individualized treatment for postoperative complications.

The use of artificial intelligence is changing the landscape of breast cancer surgery through enhanced precision, accuracy, and personalized treatment strategies. This narrative review assessed artificial intelligence applications across the surgical stages of care in breast cancer surgery, including preoperative planning, intraoperative assistance, and postoperative care. A structured literature search of PubMed, Scopus, and Web of Science over the past 15 years was conducted to identify studies on artificial intelligence applications across all stages of breast cancer surgery. In the preoperative phase, artificial intelligence contributes to tumor detection, segmentation, and surgical margin assessment through advanced imaging and predictive modeling. During surgery, real-time image-guided systems and robotic platforms powered by machine learning enable greater accuracy and intraoperative decision support. Postoperatively, artificial intelligence-driven tools aid in complication prediction, recurrence monitoring, and follow-up personalization, thereby improving patient outcomes and reducing variability in care. Integration of multimodal artificial intelligence approaches from imaging, robotics, and predictive analytics across the surgical continuum can help highlight translational gaps and evaluate clinical readiness, providing insights that have not been emphasized in previous reviews. Despite these advancements, many artificial intelligence applications remain in early research stages or have limited clinical use, facing challenges in data standardization, model interpretability, ethics, and integration into practice. Clinical impact depends on infrastructure, surgeon expertise, and regulations. Nevertheless, interdisciplinary collaboration allows artificial intelligence to enhance accuracy, reduce complications, and improve patient-centered care in breast cancer surgery.

BackgroundThe World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a widely used instrument for assessing functioning and disability across various health conditions. However, there is limited research on its validation in the context of potentially life-threatening maternal conditions.ObjectiveTo validate the Tigrigna version of WHODAS 2.0 in women with potentially life-threatening maternal conditions during the immediate postpartum period.MethodsThis cross-sectional study was conducted in hospitals in Tigray, Ethiopia. The Tigrigna version of the WHODAS 2.0 was administered to 121 women with potentially life-threatening maternal conditions. Internal consistency was evaluated using Cronbach's alpha, convergent validity was preliminarily assessed using Spearman's correlation, and construct validity was assessed using confirmatory factor analysis.ResultThe 36-item Tigrigna version showed adequate internal consistency for all domain scores, with Cronbach's alpha values ranging from 0.89 to 0.96 and a summary score Cronbach's alpha of 0.98. Except for Domains 1 and 2, convergent validity between the 36-item and 12-item versions was demonstrated by strong correlations between similar constructs, with correlation coefficients ranging from 0.86 to 0.96. Confirmatory factor analysis indicated a poor or suboptimal fit for the six-domain model, with a root mean square error of approximation of 0.13, a comparative fit index of 0.84, and a Tucker-Lewis index of 0.82.ConclusionThis preliminary validation suggests that the Tigrigna version of WHODAS 2.0 demonstrates acceptable reliability and validity for assessing disability in women with a history of potentially life-threatening maternal conditions.

ObjectiveAlthough biologic therapies targeting cytokines have revolutionized the treatment of rheumatoid arthritis, immune cell surface markers remain underexplored as therapeutic targets. We combined Mendelian randomization with clinical evidence to identify causal immune cell phenotypes as potential causal contributors to rheumatoid arthritis and as candidate drugs and therapeutic targets.MethodsWe analyzed genome-wide association study summary statistics from rheumatoid arthritis cohorts (discovery: 12,555 cases/240,862 controls; replication: 14,361 cases/43,923 controls) as well as 731 immune cell traits. The primary analysis used inverse-variance weighted Mendelian randomization. Clinical trial evidence was further used to explore the therapeutic potential of identified targets. Associations with p < 0.05 were considered nominally significant, while Bonferroni correction was applied to determine statistical significance (p < 6.83 × 10^-5).ResultsAnalysis of the discovery cohort identified 92 nominally associated immune phenotypes, with 10 surviving multiple testing correction. Replication analysis showed 88 nominal associations, with 4 passing the correction. Meta-analysis revealed suggestive evidence for 17 phenotypes. Five immune markers (CD28, CD27, CX3CR1, CD3, and human leukocyte antigen (HLA)-D-related (DR)) emerged as potential diagnostic and therapeutic targets, supported by clinical trial evidence.ConclusionsThis study identified immune biomarkers as potential diagnostic and therapeutic targets for rheumatoid arthritis, providing a framework for prioritizing targetable pathways beyond cytokine blockade and offering new therapeutic avenues.