Journal of International Medical Research最新文献

BackgroundThis study employed Mendelian randomization to investigate the relationships between pathogenic infections, immunophenotypes, and Hashimoto's thyroiditis, providing deeper insights into infection-induced Hashimoto's thyroiditis development beyond the limitations of small, inconclusive observational studies.MethodsData on pathogenic infections, immune cells, and Hashimoto's thyroiditis were obtained from public databases. The inverse variance weighted method was used as the primary analytical approach, with robustness of the findings confirmed through heterogeneity and pleiotropy tests.ResultsMendelian randomization analysis demonstrated a causal relationship between anti-polyomavirus 2 IgG seropositivity and Hashimoto's thyroiditis (inverse variance weighted: odds ratio = 1.145, 95% confidence interval: 1.069-1.225, p = 9.90e-05). There was insufficient evidence to support a reverse causal relationship (inverse variance weighted: odds ratio = 1.092, 95% confidence interval: 0.892-1.337, p = 3.94e-01). The proportion of variation in genetically predicted anti-polyomavirus 2 IgG seropositivity mediated by CD20⁺ IgD⁺ CD38^- B cells was 6.36% (95% confidence interval: 1.38%-11.35%).ConclusionMendelian randomization analysis revealed that polyomavirus 2 infection significantly contributed to the development of Hashimoto's thyroiditis, mediated by CD20⁺ IgD⁺ CD38⁻ B cells. However, no causal associations were observed between Hashimoto's thyroiditis and other commonly studied pathogens, including human herpesvirus 6, hepatitis C virus, Epstein-Barr virus, and Helicobacter pylori.

ObjectiveIn this study, we aimed to investigate the prognostic significance of the expression of lymphocyte activation gene 3 and CD73 in advanced or metastatic hepatocellular carcinoma as well as its predictive effect on disease control rates in patients receiving sorafenib.MethodsData from 79 patients diagnosed with hepatocellular carcinoma in 3 different oncology centers between 2012 and 2021 were analyzed. Of these patients, 67 were included in this study based on the inclusion and exclusion criteria. The correlation between the expression of lymphocyte activation gene 3 and CD73 and clinical features was analyzed.ResultsOf the 67 patients included in the study, 80.6% were males, and the median age at diagnosis was 65 (55-73) years. A baseline alpha-fetoprotein level of <400 ng/mL and the presence of lymphocyte activation gene 3 expression were correlated with better survival (p = 0.001 and p = 0.049, respectively). CD73 expression was observed in 45.8% of patients whose disease was under control with sorafenib, while 80% of patients who did not respond to sorafenib showed CD73 expression (p = 0.02).ConclusionsPositive lymphocyte activation gene 3 expression was correlated with better survival in patients with advanced or metastatic hepatocellular carcinoma. In addition, CD73 expression in patients with advanced or metastatic hepatocellular carcinoma was a negative predictive factor in those receiving sorafenib.

Neurobrucellosis is a severe and rare complication of human brucellosis, particularly in the pediatric population. It manifests with diverse clinical presentations, with meningoencephalitis being the most common. Limited cases have been reported in Saudi Arabia. Here, we present the case of an 11-year-old boy diagnosed with neurobrucellosis who developed diplopia, inward deviation of the left eye, and ophthalmoplegia. Cerebrospinal fluid analysis revealed pleocytosis, elevated protein levels, and high opening pressure. Brain magnetic resonance imaging demonstrated microabscesses with nodular enhancement, dural thickening in the quadrigeminal cistern, and swelling with edema of the left optic nerve. To the best of our knowledge, this is the first reported case of a patient with brain microabscesses secondary to Brucella infection in Saudi Arabia. This case highlights the need for heightened awareness of neurobrucellosis as a differential diagnosis in children presenting with unusual neurological symptoms in endemic regions.

Retrosternal pain is a common symptom encountered in clinical practice. Although it is most frequently attributed to cardiac or esophageal disease, it is rarely considered an airway-related condition. Herein, we report the case of a patient who presented with fever, cough, retrosternal pain, dyspnea, and nausea accompanied by vomiting. The retrosternal pain was persistent and nonradiating and was aggravated by coughing. Based on the combination of retrosternal pain, fever, and dyspnea, viral myocarditis was strongly suspected. However, bronchoscopy performed after hospital admission revealed diffuse tracheobronchial ulcerations, and the patient was ultimately diagnosed with tracheobronchial ulcers and invasive pulmonary aspergillosis caused by Aspergillus infection. Following effective anti-Aspergillus treatment, the patient's retrosternal pain gradually improved, suggesting that the pain was attributable to tracheobronchial ulceration. This case is rare and highlights the potential for diagnostic misinterpretation. We present this case to raise awareness of airway-related causes of retrosternal pain and to improve diagnostic accuracy.

Ectopic splenosis is a disorder caused by the overflow of splenic myeloid cells or intravascular migration after splenic trauma or splenectomy. It is often asymptomatic and detected incidentally during imaging evaluation. Splenosis lacks specificity on clinical imaging examinations such as ultrasound, computed tomography, and magnetic resonance imaging and is often confused with tumors. We report the case of a primigravida (G1P0) in her early 30s with multiple hypoechoic masses in her upper abdomen that were detected during routine prenatal ultrasound at 23 + 1 weeks of gestation, with a recommendation for follow-up monitoring. Tumor marker analysis showed normal results. The patient remained asymptomatic without abdominal pain or fever, and monitoring showed normal fetal heart rate. The patient was admitted to our hospital, and we conducted a multidisciplinary consultation. We used misoprostol and a Cook balloon to induce labor; the patient delivered vaginally successfully. In this case report, we aimed to highlight the significance of taking detailed medical history and using the "minimal intervention" approach for managing pregnancy-complicated splenosis, highlighting the pivotal role of multimodal imaging evaluation.

ObjectiveThis study was conducted to evaluate the predictive value of endoscopic measurements of cardia opening diameter and sliding hernia length for diagnosing gastroesophageal reflux disease.MethodsA total of 233 patients with typical gastroesophageal reflux disease symptoms who underwent endoscopy and esophageal pH-impedance monitoring between September 2017 and September 2023 were enrolled in this study. Cardia opening diameter and sliding hernia length were measured during endoscopy under adequate gastric insufflation. Using esophageal pH-impedance monitoring as the gold standard (with acid exposure time >4% as the diagnostic criterion for gastroesophageal reflux disease), the correlation between cardia opening diameter/sliding hernia length and gastroesophageal reflux disease-related parameters was analyzed. A nomogram prediction model was subsequently developed.ResultsThe optimal cutoff values for predicting pathological acid reflux were cardia opening diameter >2 cm and sliding hernia length >1 cm (area under the receiver operating characteristic curve = 0.648 for both). Compared with patients with a cardia opening diameter ≤2 cm, those with a cardia opening diameter >2 cm had significantly higher acid exposure time (6.8% vs. 2.5%), DeMeester score (25.7 vs. 10.9), and number of reflux episodes (108 vs. 59) (all p < 0.001). Similarly, sliding hernia length >1 cm was associated with more severe reflux parameters (p < 0.05) and was more prevalent in males (72.4% vs. 43.6%). Univariate and multivariate logistic regression analyses demonstrated that a nomogram incorporating age, body mass index, and sliding hernia length exhibited good predictive performance (area under the curve = 0.739).ConclusionEndoscopically assessed cardia opening diameter and sliding hernia length are useful functional predictors of gastroesophageal reflux disease. The integrated prediction model may serve as a valuable diagnostic aid, especially in primary care or resource-limited settings.

ObjectivePostoperative pain is one of the most common complications after anorectal surgery and can delay recovery, lengthen hospital stay, and reduce patient comfort. Non-steroidal anti-inflammatory drugs are widely used due to their strong analgesic and opioid-sparing effects but are associated with gastrointestinal, renal, and bleeding risks. Magnesium may provide analgesic benefits with fewer adverse effects. However, evidence regarding its efficacy in the oral form and direct comparison with non-steroidal anti-inflammatory drugs remains limited. In this study, we aimed to compare the analgesic effectiveness of oral magnesium with that of oral ketorolac to identify the more suitable analgesic drug in these patients.MethodsIn this double-blind, randomized controlled trial, 104 patients undergoing anorectal surgery were randomly divided into 2 groups. Group 1 received oral magnesium (250 mg daily), and Group 2 received oral ketorolac (10 mg daily). The medicine was given to the patients 2 h after the operation and then every 12 h for 10 days. Pain levels were measured at 24-hour intervals after the surgery using the visual analog scale.ResultsBoth treatments significantly reduced postoperative pain over time (p < 0.001). The ketorolac group showed lower mean pain scores on days 1, 3, and 5 (p < 0.001), whereas no significant differences were observed on postoperative days 7 and 10 (p = 0.089 and 0.092, respectively). Narcotic consumption was higher in the magnesium group than in the ketorolac group (p < 0.001).ConclusionsOral magnesium demonstrated a clinically meaningful analgesic effect comparable to that of oral ketorolac from postoperative day 5 onward, suggesting that it is a safe non-opioid alternative for postoperative pain management in anorectal surgery. Further multicenter trials with larger samples are warranted to confirm these findings.

ObjectiveST-segment elevation myocardial infarction is a life-threatening coronary artery disease associated with extensive myocardial injury. Circular RNAs are emerging regulators in cardiovascular disease. This study examined circ-0049271 expression in ST-segment elevation myocardial infarction, its clinical associations, and responsiveness to oxidative stress.MethodsFifty-five ST-segment elevation myocardial infarction patients and 35 healthy controls were enrolled. Blood was collected before percutaneous coronary intervention and at 0.5 and 48 h after the intervention. circ-0049271 expression was measured using quantitative reverse transcription polymerase chain reaction, and its correlations with the Gensini score, ischemic duration, cardiac biomarkers, and left ventricular ejection fraction were assessed. Human umbilical vein endothelial cells were exposed to hydrogen peroxide to assess circular RNA regulation under oxidative stress.Resultscirc-0049271 expression was elevated in ST-segment elevation myocardial infarction patients versus controls (p < 0.001) and remained high after percutaneous coronary intervention. It was correlated positively with the Gensini score (r = 0.444), creatine kinase-myocardial band (r = 0.427), and serum potassium (r = 0.322) and negatively with left ventricular ejection fraction (r = -0.281). Receiver operating characteristic analysis yielded an area under the curve of 0.788. In human umbilical vein endothelial cells, circ-0049271 expression increased in a dose-dependent manner with hydrogen peroxide treatment, with elevated oxidative stress markers and reduced superoxide dismutase activity.Conclusionscirc-0049271 is upregulated in ST-segment elevation myocardial infarction and is correlated with myocardial injury, coronary lesion burden, and oxidative stress, supporting its potential as a diagnostic biomarker and therapeutic target in acute myocardial infarction.

ObjectiveThis case-control study aimed to investigate whether peri-appendiceal inflammation is associated with orifice stenosis and appendiceal body thickening in patients with ulcerative colitis.MethodsData from patients with ulcerative colitis-including demographics, symptoms, medications, clinical signs, diagnosis, laboratory tests, colonoscopy findings, and abdominal computed tomography-were recorded and analyzed. Orifice stenosis was defined as apparent narrowing or disappearance of the appendiceal orifice compared with the nearest cecal fold. A thickened appendiceal body was defined as an appendiceal >6 mm with or without surrounding inflammatory changes on computed tomography. The severity of peri-appendiceal inflammation was scored using the Mayo endoscopic score.ResultsA total of 169 patients with ulcerative colitis were included, of whom 17.2% (29/169) had appendiceal orifice stenosis. Appendiceal orifice stenosis was associated with age (odds ratio: 1.042, P = 0.008) and the peri-appendiceal inflammation score (odds ratio: 3.382, P < 0.001). Among 42 patients who underwent abdominal computed tomography, 69.0% (29/42) had appendiceal body thickening. None of these 29 patients had a positive McBurney sign or a flare of acute appendicitis. Appendiceal width was associated with the peri-appendiceal inflammation score (odds ratio: 4.172, P = 0.006).ConclusionsAppendiceal orifice stenosis and appendiceal body thickening are prevalent in patients with ulcerative colitis. Peri-appendiceal inflammation is associated with the severity of stenosis and appendiceal width, suggesting it may serve as an indirect indicator of appendiceal inflammation related to ulcerative colitis.

This narrative review examines the role of systemic (oral) therapies in diabetic retinopathy, summarizing their biological rationale, clinical evidence, and practical considerations. We framed mechanistic pathways across the retinal neurovascular unit, distinguishing direct effects on the endothelium, pericytes, Müller glia, retinal pigment epithelium, neurons, and immune cells from indirect downstream actions. We appraised the following key therapeutic oral classes: (a) peroxisome proliferator-activated receptor alpha agonists (fenofibrate), which consistently demonstrate prevention-of-worsening signals; (b) protein kinase C beta inhibitors (ruboxistaurin), showing mixed efficacy but reduced vision-threatening outcomes in specific subsets; (c) redox transcription modulators (APX3330/Ref-1), exhibiting binocular prevention-of-worsening signals; (d) vascular adhesion protein-1/ amine oxidase copper-3 inhibitors, with variable phase-2 results; and (e) rho kinase inhibitors (OPL-0401), which have shown neutral primary endpoints to date. We highlighted that upstream, pleiotropic agents may require longer treatment durations and progression-focused endpoints, whereas therapies targeting permeability/leukostasis targets may yield earlier but subtle signals. We discussed trial-design considerations, including binocular outcomes, prevention-focused endpoints, and patient selection, along with integration into clinical practice-addressing safety, comorbidities, and adherence advantages of oral delivery. Finally, we outlined current gaps-such as limited phase-3 data beyond fenofibrate, endpoint heterogeneity, and the need for robust prevention trials-and proposed a concise research agenda. As a narrative synthesis, this review emphasizes clinical interpretation rather than quantitative meta-analytic estimation.