Journal of International Medical Research最新文献

The popliteal artery segment is particularly challenging for endovascular treatment. Stents used for treating popliteal artery lesions are usually associated with an increased risk of stent fracture and re-occlusion. The Supera stent is designed to withstand mechanical stress, with a low risk of fracture. A man in his mid-70s with left popliteal artery occlusion was treated with a Supera stent implantation. After 5 months, he revisited our hospital complaining of left leg pain. Preprocedural computed tomography angiography showed popliteal artery occlusion associated with a Supera stent fracture. A new Supera stent was implanted at the previous stent fracture site. However, 3 months after the second procedure, computed tomography angiography showed popliteal artery re-occlusion associated with a repeated fracture of the Supera stent. A femoral-popliteal bypass was performed. At the 6-month follow-up, computed tomography angiography showed a patent graft. Our findings indicated that recurrent fractures occurred after additional Supera stenting at the previous Supera stent fracture site. Careful observation is necessary after deploying a new Supera stent for treating a Supera stent fracture because of the possibility of a repeated fracture.

Objectives: Central nervous system complications of acute pancreatitis (AP) can result in cerebral edema (CE). We assessed the risk of serious outcomes and health care features associated with CE in patients hospitalized with AP.

Methods: We conducted a retrospective cohort study using the National Inpatient Sample database. Patients were divided into the AP-CE group that developed CE and the AP-only group that did not. Outcome data were analyzed using Stata software.

Results: Among 543,464 patients hospitalized with AP, 220 (0.04%) developed CE. In multivariate analysis, primary outcomes included increased length of hospital stay (adjusted odds ratio [aOR] 10.1; 95% confidence interval [CI] 0.50-19.70), hospital charges (aOR USD 208,713; 95% CI 27,095-390,330), and risk of death (aOR 17.17; 95% CI 5.88-50.07) in the AP-CE group. Secondary outcomes showed patients with AP-CE had a significantly increased risk of serious complications, particularly cardiac arrest (aOR 64.24; 95% CI 24.27-170.02), and higher hospital resource utilization.

Conclusion: Patients with AP who develop CE face worse outcomes, including increased mortality risk, prolonged hospital stay, and greater resource utilization. Timely identification and effective management of CE in AP may reduce mortality and ease the health care burden associated with this neurological complication.

Objective: The cardiac return assist blanket (CRAB) has been designed to increase central venous pressure (CVP) to manage severe hypotension associated with anaphylaxis. This interventional study aimed to identify the relationship between CRAB pressure and CVP. CRAB pressure was also compared with the change in CVP associated with a straight leg raise (SLR), the Trendelenburg position, and 1 L of compound sodium lactate.

Methods: Sixteen healthy, fasted volunteers were exposed to CRAB pressure at 10, 20, 30, and 40 cmH₂O, the SLR, and 15 degrees of the Trendelenburg position. The volunteers were then fed and hydrated with 1 L of CSL over 30 minutes and the protocol was repeated.

Results: The initial 10 cmH₂O of CRAB pressure increased CVP by 3.7 mmHg (95% confidence interval 2.7, 4.7). Each subsequent 10-cmH₂O rise in CRAB pressure increased CVP by 0.9 mmHg (95% confidence interval 0.55, 1.25). The SLR, Trendelenburg position, and 1 L of CSL increased CVP by 0.97 , 0.75 , and 0.69 mmHg, respectively.

Conclusions: The CRAB controllably increases CVP, and 40 cmH₂O of CRAB pressure increases CVP by 6.41 mmHg. The effect of the CRAB is greater than that with the SLR, Trendelenburg position, or 1 L of CSL.This trial was registered with the ANZCTR (ACTRN12621000840886: https://www.anzctr.org.au).

Objective: This study compared the clinical efficacy of off-pump coronary artery bypass grafting (OPCAB) with percutaneous coronary intervention (PCI) in the treatment of left main coronary artery and/or triple-vessel disease (LM and/or TVD).

Methods: We retrospectively enrolled 1484 consecutive patients with LM and/or TVD in Shanxi Cardiovascular Hospital from January 2015 to December 2022 and divided them into the OPCAB group (n = 583) and the PCI group (with second-generation drug-eluting stents) (n = 901). Propensity score matching was used for 316 equally matched pairs of patients in the groups. The outcomes were all-cause and cardiac mortality, angina recurrence, and major adverse cardiac and cerebrovascular events, which comprised non-lethal myocardial infarction, stroke, and repeat revascularization.

Results: The mean follow-up was 3.93 years in the OPCAB group and 4.19 years in the PCI group. There were no significant differences in all-cause mortality, cardiac mortality, major adverse cardiac and cerebrovascular events, or non-lethal myocardial infarction between the groups. The incidence of repeat revascularization and angina recurrence was higher in the PCI group than in the OPCAB group. However, the incidence of stroke was higher in the OPCAB group than in the PCI group.

Conclusions: OPCAB may be a favorable coronary revascularization strategy for LM and/or TVD.

Idiopathic eosinophilia, characterized by unexplained peripheral blood eosinophilia after ruling out secondary causes, is an extremely rare condition. Cryptococcal meningitis is a life-threatening opportunistic infection that primarily affects immunocompromised individuals, such as those with advanced AIDS or leukemia. In this report, we present a unique case of idiopathic eosinophilia concurrent with cryptococcal meningitis, which, to the best of our knowledge, is the first such case described globally.

Objective: This systematic review aimed to provide a comprehensive overview of the application of machine learning (ML) in predicting multiple adverse drug events (ADEs) using electronic health record (EHR) data.

Methods: Systematic searches were conducted using PubMed, Web of Science, Embase, and IEEE Xplore from database inception until 21 November 2023. Studies that developed ML models for predicting multiple ADEs based on EHR data were included.

Results: Ten studies met the inclusion criteria. Twenty ML methods were reported, most commonly random forest (RF, n = 9), followed by AdaBoost (n = 4), eXtreme Gradient Boosting (n = 3), and support vector machine (n = 3). The mean area under the summary receiver operator characteristics curve (AUC) was 0.76 (95% confidence interval [CI] = 0.26-0.95). RF combined with resampling-based approaches achieved high AUCs (0.9448-0.9457). The common risk factors of ADEs included the length of hospital stay, number of prescribed drugs, and admission type. The pooled estimated AUC was 0.72 (95% CI = 0.68-0.75).

Conclusions: Future studies should adhere to more rigorous reporting standards and consider new ML methods to facilitate the application of ML models in clinical practice.

Objective: This study aimed to investigate the role of RAB32 in glioblastomas and its molecular mechanisms that regulate gliomas.

Methods: The expression and prognostic value of RAB32 were evaluated using western blotting and the Gene Expression Profiling Interactive, Chinese Glioma Genome Atlas, and The Cancer Genome Atlas databases. Lentivirus containing sh-RAB32 or OE-RAB32 was used to manipulate RAB32 expression in glioma cells. The effects of RAB32 on cell proliferation, migration, and invasion were determined by western blotting, cell counting kit-8, plate cloning, wound healing, and transwell assays. Gene set enrichment analysis was used to screen for associations between the JAK/STAT3 signaling pathway and RAB32. The role of this pathway was verified using JAK/STAT3 inhibitors.

Results: RAB32 expression was significantly upregulated in patients with glioma and in glioma cell lines. The expression level was positively correlated with the glioma grade and served as an independent prognostic factor. In vitro experiments revealed that RAB32 knockdown inhibited glioblastoma cell proliferation, migration, and invasion, while the opposite effects were observed with overexpression and could be inhibited by the JAK/STAT3 inhibitor BP-1-102.

Conclusion: RAB32 promotes malignant progression of glioblastoma cells through the JAK/STAT signaling pathway, providing new possibilities for therapeutic targets for glioblastoma.

Objective: This study investigated a method for assessing movement patterns in patients with functionally limited temporomandibular disorders using minimal equipment. The aim was to enable clinicians to better understand temporomandibular joint function, support treatment decision-making, and provide data for documenting disease progression.

Methods: This retrospective, observational study included 45 patients with functionally limited temporomandibular disorders (Group A) and 40 healthy volunteers (Group B). Video data of temporomandibular joint movements were recorded. Measurements, including maximum mouth opening distance, maximum offset distance, maximum offset angle, direction of offset, and fluctuation graphs of offset angle and distance, were obtained using manual methods and an automatic measurement program. The results were statistically analyzed.

Results: Statistically significant differences were observed between patients and the control group in the manually measured mouth opening distance and offset distance, as well as in the automatically measured offset distance and offset angle.

Conclusion: Automated testing methods can effectively assess the motor function of functionally limited temporomandibular joints, providing more objective, data-driven, and graphical testing indexes. Further research is warranted to explore their practical significance.

Objective: Peripheral refraction is associated with myopia development. Due to a varying prevalence of myopia across different ethnic groups, the aim of the present study was to investigate the peripheral refraction profile in an Arabic population.

Methods: Adults attending an optometry clinic were recruited into this cross-sectional study. Peripheral refraction of the right eyes was measured using an open field autorefractor under noncycloplegic conditions along the temporal-nasal meridians (15° and 35°) in participants with emmetropia, or low, moderate, or high myopia. Refractions were converted into power vector components, including the spherical equivalent of central refraction, J0 and J45 astigmatism. STROBE guidelines were followed for study reporting.

Results: A total of 138 adults (aged 20-29 years) were enrolled. Relative peripheral refractive error (RPRE) varied between refractive groups and increased with eccentricity. The RPRE was more hyperopic in myopia groups, with the nasal visual field being more hyperopic. A significant relationship was found between RPRE and central refraction, but not with J0 and J45 scores.

Conclusions: Participants with moderate myopia exhibited more hyperopic RPRE compared with previous findings in other ethnic groups. Hyperopic RPRE was significantly associated with myopia. Accurate RPRE measurement are essential for designing personalized lenses to slow down myopia progression. This study provides an RPRE baseline in the population investigated, which will be useful for future studies on personalized lens design, including spectacles and contact lenses.

Objective: To identify the correlation between serum inflammatory cytokines and immune markers in children with severe hand, foot and mouth disease (HFMD).

Methods: Paediatric patients with severe or mild HFMD from Linping Campus, the Second Affiliated Hospital of Zhejiang University, were included in this retrospective study. Data comprising demographic characteristics, clinical symptoms and signs, laboratory findings and other factors were collected. Serum interleukin (IL)-1, IL-6, IL-10, tumour necrosis factor (TNF)-α, and interferon (IFN)-γ levels were measured by enzyme-linked immunosorbent assay at 1, 3, and 5 days after admission. Risk factors were screened using multivariate logistic regression analysis.

Results: A total of 200 patients with HFMD (120 severe and 80 mild cases) were included. Younger age and longer fever duration were associated with severe HFMD, as were increased white blood cell, neutrophil and platelet counts, blood glucose, immunoglobulin (Ig)M and IgG. IL-6 and IL-10 levels were higher in patients with severe versus mild HFMD on days 1, 3 and 5. TNF-α was higher in the severe group on day 3. Increased white blood cell and neutrophil counts, IL-6, IL-10, and IgG levels, age, fever duration, and blood glucose level were found to be risk factors associated with the occurrence of severe HFMD.

Conclusions: Inflammatory cytokines and immune indexes may be related to the occurrence of severe HFMD.