Journal of International Medical Research最新文献

Objective: To evaluate the value of the urocortin (UCN) level to predict preterm delivery in women with threatened preterm labour.

Methods: This prospective cohort study included 96 women with a singleton pregnancy between 28 and 34 weeks of gestation who were admitted with threatened preterm labour. The participants were monitored until delivery. The UCN level was compared between those with preterm and with full-term deliveries.

Results: The mean UCN level was higher for preterm deliveries (96 ± 24.34 pg/mL) than for full-term deliveries (62.62 ± 23.63 pg/mL). A UCN cutoff level of 92 pg/mL had 20% sensitivity, 100% specificity, 100% positive predictive value, and 10% negative predictive value. Thus, 17.7% of women had a UCN level ≥ 92 pg/mL, and all delivered preterm. Among the 82.3% of women who had a UCN level < 92 pg/mL, 88.6% delivered preterm, and 11.4% delivered at full term. Moreover, 88.2% of women who had a UCN level ≥ 92 pg/mL delivered within 7 days and only 11.8% delivered after 7 days. However, 58.2% of women with a UCN level < 92 pg/mL delivered within 7 days and 41.8% delivered after 7 days.

Conclusion: A UCN cutoff level of ≥92 pg/mL predicts preterm delivery within 7 days of admission.

The primary etiology of pyomyositis is predominantly Staphylococcus aureus, although Gram-negative bacteria may also be involved on rare occasions. The prognosis for pyomyositis caused by Gram-negative bacteria is more unfavorable than that of infections caused by Staphylococcus aureus. Among Gram-negative bacteria, members of the Enterobacteriaceae family, including Escherichia coli, Klebsiella species, and Salmonella species, have the capacity to produce gas. Gas-forming myositis is a rare phenomenon that primarily affects immunocompromised patients and is associated with a poor prognosis. To the best of our knowledge, no previous reports of gas-forming pyomyositis in an immunocompetent patient exist. We herein present the first documented case of Salmonella-induced gas-forming pyomyositis of the iliacus muscle in a healthy young man with no underlying diseases or comorbidities. Additionally, we reviewed cases of gas-forming pyomyositis in the literature and cases of pyomyositis caused by Gram-negative bacteria in immunocompetent patients.

Nirmatrelvir/ritonavir is a novel drug combination authorized by the US Food and Drug Administration for the treatment of coronavirus disease 2019 (COVID-19). This report describes the case of a patient with a prior history of kidney transplantation who received nirmatrelvir/ritonavir. In this case, sirolimus use was successfully stopped before nirmatrelvir/ritonavir treatment, and the nirmatrelvir/ritonavir trough concentration was determined. During nirmatrelvir/ritonavir treatment, the sirolimus trough concentration remained stable. This case highlights the risk associated with the concomitant administration of sirolimus and nirmatrelvir/ritonavir. Providers should therefore be cautious when prescribing nirmatrelvir/ritonavir to kidney transplant recipients currently receiving sirolimus, with caution exercised based on creatinine clearance.

Lumbar burst fractures account for 21% to 58% of all thoracolumbar fractures. L5 lumbar burst fractures are rare, comprising 1.2% of spinal burst fractures. This report discusses the optimal treatment for an adolescent with an L5 lumbar burst fracture and neurological symptoms caused by a high-fall injury, which involved surgical decompression and spinal fixation. Complete decompression and fixation of the L5 lumbar burst fracture, complicated by neurological symptoms, were achieved using arthroscopic-assisted uniportal spinal surgery (AUSS) combined with percutaneous pedicle screw fixation (PPSF). The AUSS approach, used alongside PPSF, significantly improved the vertebral canal occupation rate, increased the anterior edge height ratio of the damaged vertebra, and alleviated the lower back pain and nerve root symptoms postoperatively. AUSS combined with PPSF is a minimally invasive technique for treating lumbar burst fractures, effectively relieving compression of the vertebral canal and nerves caused by fracture fragments.

Cytomegalovirus (CMV) infection typically affects immunocompromised individuals. However, CMV-associated enteritis involving the entire small intestine is rare in immunocompetent patients. We report a case of a 60-year-old immunocompetent woman with a history of diabetes mellitus who presented with diarrhea for 3 weeks. Abdominal computed tomography and stool tests revealed panenteritis accompanied by protein-losing enteropathy. Enteroscopy revealed ulcerative mucosa throughout the small intestine, and subsequent biopsies confirmed CMV-associated enteritis. Initial treatment with intravenous ganciclovir was complicated by pancytopenia, leading to its discontinuation and a switch to oral valganciclovir. This adjustment led to significant clinical improvement and symptom resolution. This case highlights the importance of considering CMV-associated enteritis in immunocompetent patients presenting with unexplained gastrointestinal symptoms and demonstrates the effectiveness of oral valganciclovir following ganciclovir-induced pancytopenia.

Objective: We aimed to examine the relationship between the weight-adjusted waist index (WWI) and obstructive sleep apnea (OSA), a condition often caused by obesity, which remains unclear.

Methods: In this cross-sectional study, we analyzed data from the National Health and Nutrition Examination Survey among adults in the United States (US) aged 20 to 65 years, covering the periods 2005 to 2008 and 2015 to 2018. The study included 8278 participants; we used multivariate logistic regression, restricted cubic splines, and subgroup analyses to explore the relationship between WWI and OSA.

Results: After adjusting for all covariates, each unit increase in WWI was associated with a 30% increase in OSA prevalence (odds ratio = 1.30, 95% confidence interval: 1.20-1.40).

Conclusions: These findings suggest that WWI, an index reflecting abdominal obesity, can provide important insights into OSA risk assessment. Its strong association with OSA highlights its potential utility in predicting OSA prevalence, particularly among diverse subpopulations. The WWI was associated with a higher prevalence of OSA among US adults and may serve as a valuable tool for risk assessment, early screening, and intervention strategies in clinical practice.

For gastric leiomyomas measuring ≥5 cm, endoscopic resection is necessary. The larger size of these tumors significantly impairs the resection field of view, increasing the risk of intraoperative bleeding and perforation and potentially leading to incomplete tumor removal. The combination of dental floss and tissue clip traction techniques is commonly used for resecting mucosal lesions but is rarely reported for submucosal tumors. We recently completed a case of endoscopic resection of a giant gastric leiomyoma in the body of the stomach, approximately 7 cm in length, using endoscopic submucosal dissection with dental floss clip traction. The dissection was carefully controlled within the muscularis propria layer, avoiding damage to the serosa. No bleeding or perforation occurred. A special technique was employed to avoid damage to the muscle layer. By combining this technique with tissue forceps, better traction stability may have been achieved. During the traction process, slight tension was consistently maintained between the swelling and the muscle layer, preventing perforation due to traction. The resection field remained clear throughout the procedure, which lasted 50 minutes in total. The final outcome was satisfactory. This method may be worthy of clinical application.

Expiratory central airway collapse is a degenerative tracheobronchial disease that is often overlooked because of its nonspecific clinical features. A man was admitted for evaluation of tracheal nodules. Following bronchoscopic biopsy, a significant increase in airway pressure occurred during anesthesia recovery. Laryngospasm was suspected, and tracheal intubation was performed. Bronchoscopy revealed an almost completely collapsed tracheal lumen. A Y-shaped silicone stent was placed using a rigid bronchoscope to support the airway, allowing spontaneous ventilation to resume. A retrospective review of the images suggested a diagnosis of excessive dynamic airway collapse. The silicone stent was removed after 2 weeks because of discomfort, and no subsequent dyspnea was observed. This case highlights that excessive dynamic airway collapse is easily missed. Anesthesiologists must be educated on this condition, maintain a thorough understanding of the patient's state and illness, and have emergency airway equipment readily available to restore ventilation promptly in cases of severe airway collapse.

Objective: To analyze the early- to mid-term clinical efficacy of personalized 3D-printed structural metal spacer technology in reconstructing massive bone defects during complex total knee arthroplasty (TKA) and revision surgery.

Methods: A single-center retrospective study was conducted on nine patients with severe bone defects who underwent TKA between 2018 and 2024. The general condition, surgical details, and clinical improvement of these patients were recorded and analyzed by clinical doctors.

Results: The average surgical duration was 183.9 minutes (range, 125-240 minutes), with intraoperative blood loss of 133.3 mL (range, 100-200 mL). The average hospital stay was 18.2 days (range, 10-42 days), and the follow-up duration was 13.2 months (range, 2-57 months). The preoperative average American Knee Society Score of 51.2 points (range, 15-74 points) improved significantly to 95.0 points (range, 81-106 points) at the last follow-up. No cases of vascular or nerve injury, infection, fracture, or prosthetic loosening were observed.

Conclusion: The precise manufacturing of customized spacers that seamlessly integrate with the patient's skeletal structure ensures stability, adaptability, and improved surgical outcomes.

Extraskeletal orbital mesenchymal chondrosarcoma is an extremely rare and highly aggressive tumor. We herein report a case involving a woman in her early 20s diagnosed with orbital mesenchymal chondrosarcoma. This case report aims to increase recognition and understanding of this condition.