Journal of International Medical Research最新文献

BackgroundGastric cancer remains a major global health challenge due to its high mortality rate and complex pathophysiological mechanisms. Emerging evidence highlights that dysregulated lipid metabolism contributes to gastric cancer progression and prognosis, but the associations between lipid metabolism-associated genes, gastric cancer patient survival, and tumor immune microenvironment remodeling are not fully elucidated.MethodsWe analyzed publicly available omics and clinical data, including RNA sequencing data from 371 gastric cancer samples in The Cancer Genome Atlas database and 433 gastric cancer samples in the Gene Expression Omnibus database. We first curated the top 100 lipid metabolism-associated genes based on relevance scores. Then, univariate Cox regression was used to identify genes significantly associated with overall survival. Consensus clustering was applied to these survival-related genes to define gastric cancer molecular subtypes. Copy number variation analysis was performed to assess genomic alterations of these genes in tumor samples. A prognostic risk model was constructed using least absolute shrinkage and selection operator regression and validated via multivariate Cox regression. Immune infiltration analysis using CIBERSORT and ESTIMATE algorithms was conducted to explore associations between lipid metabolism-associated genes and tumor immune microenvironment characteristics.ResultsA total of 3911 differentially expressed genes were identified between gastric cancer and adjacent normal tissues. Among the top 100 lipid metabolism-associated genes, 43 were significantly linked to patient survival, most of which were considered as poor prognostic factors. Copy number variation analysis revealed frequent copy number gains of these genes in tumor samples. Consensus clustering stratified patients into two molecular subtypes (LMAGcluster A and LMAGcluster B), with LMAGcluster A showing significantly worse survival outcomes (median survival: 2.6 years vs. 8.3 years in LMAGcluster B, p < 0.001). LMAGcluster A was also characterized by elevated infiltration of pro-tumor immune cells, such as regulatory T cells and follicular helper T cells. The prognostic model based on 14 key lipid metabolism-associated genes exhibited robust predictive performance, with area under the receiver operating characteristic curve values of 0.702-0.761 in The Cancer Genome Atlas cohort and 0.621-0.638 in the Gene Expression Omnibus cohort for 1-, 3-, and 5-year survival.ConclusionLipid metabolism-associated genes are closely associated with gastric cancer prognosis and tumor immune microenvironment remodeling. The identified gene-based molecular subtypes and prognostic model provide novel insights into gastric cancer progression, and the 14 key genes may serve as potential biomarkers and therapeutic targets.

BackgroundThis study examined the relationship of patients' sex, age, body mass index, history of hypertension, various lipid indices, atherogenic index of plasma, bilirubin-lipid composite index 1, and bilirubin-lipid composite index 2 with the degree of coronary artery stenosis. The study aim was to identify factors associated with coronary stenosis and provide new perspectives for the diagnosis and treatment of coronary artery disease.MethodsA total of 175 patients who visited Qinghai Affiliated Hospital and underwent their first coronary angiography examination were included. Basic demographic information and laboratory measurements were collected. The atherogenic index of plasma and two bilirubin-lipid composite indices were calculated using biochemical indicators, and a correlation analysis of these data with post-imaging Gensini scores was performed using statistical analysis.ResultsTotal bilirubin, triglycerides, high-density lipoprotein, atherogenic index of plasma, and both bilirubin-lipid composite indices showed statistically significant differences between the observation and control groups. Binary multivariate logistic regression showed that the atherogenic index of plasma and both bilirubin-lipid composite indices had statistically significant and independent positive effects on coronary heart disease risk. Single-factor Spearman linear regression indicated that the atherogenic index of plasma and both bilirubin-lipid composite indices were positively correlated with the Gensini score, while total bilirubin was negatively correlated with the Gensini score. Receiver operating characteristic curve analysis showed a diagnostic specificity of 83.7% and sensitivity of 57.9% for coronary heart disease.ConclusionsHigher values of the atherogenic index of plasma and both bilirubin-lipid composite indices were associated with an increased risk of coronary heart disease and showed an independent positive correlation with the severity of coronary stenosis. Serum total bilirubin decreased with increasing severity of coronary stenosis, demonstrating an independent negative correlation. The diagnostic value of coronary heart disease was higher when the atherogenic index of plasma was >0.06, bilirubin-lipid composite index 1 was >1.89, or bilirubin-lipid composite index 2 was <3.69.Trial registration: Retrospectively registered.

Pupil-sparing third-nerve palsy is often attributed to diabetic microvascular ischemia; however, brainstem infarction can present with a similar pattern. We report the case of a patient with acute painless horizontal diplopia and partial right oculomotor palsy characterized by impaired adduction, mild vertical limitation, partial ptosis, and mildly impaired convergence, with equally reactive pupils. On left gaze, the right eye failed to adduct and the contralateral eye did not demonstrate abducting nystagmus. Brain magnetic resonance imaging revealed a small dorsal paramedian midbrain infarction on diffusion-weighted imaging, and diffusion-tensor tractography demonstrated reduced integrity of the ipsilateral medial longitudinal fasciculus. The patient received dual antiplatelet therapy for 21 days, followed by aspirin, high-intensity statin therapy, and intensive glycemic control. Diplopia resolved within 4 weeks and remained absent at the 3-month follow-up. This case broadens the clinico-radiological spectrum of midbrain infarction and underscores that pupil-sparing third-nerve palsy does not exclude a central lesion. The combination of adduction deficit, impaired convergence, and absent contralateral abducting nystagmus should lower the threshold for urgent brain magnetic resonance imaging with diffusion-weighted imaging; diffusion-tensor tractography may be helpful where available.

Primary hyperparathyroidism is characterized by hypercalcemia and hypophosphatemia caused by excessive parathyroid hormone secretion. Gitelman syndrome, a rare autosomal recessive salt-losing tubulopathy, presents with hypokalemia, hypomagnesemia, hypocalciuria, and secondary hyperaldosteronism. The coexistence of these conditions leads to an atypical clinical picture and may result in a refractory hypercalcemic crisis that responds poorly to standard therapies. We describe a case of refractory hypercalcemia accompanied by hypophosphatemia, elevated parathyroid hormone levels, hypokalemia, hypomagnesemia, and, notably, hypocalciuria that was inconsistent with the degree of hypercalcemia. The patient experienced recurrent hypercalcemic crises that required treatment with zoledronic acid and denosumab after conventional interventions failed. The diagnosis was ultimately confirmed through postoperative pathology and genetic testing. This case emphasizes that hypocalciuria in the setting of persistent hypercalcemia-especially when severe hypomagnesemia is present-should raise suspicion for underlying Gitelman syndrome. Early identification of this coexistence is essential, as optimal management requires surgical treatment of primary hyperparathyroidism followed by targeted correction of electrolyte abnormalities associated with Gitelman syndrome, ultimately improving clinical outcomes.

A woman in her early 50s presented with an 8-month history of bilateral lower limb weakness and a 3-month history of unsteady gait. Imaging revealed a dumbbell-shaped mass near T1-T3, initially diagnosed as a schwannoma. Intraoperatively, a highly vascular dark red tumor was discovered, and only partial resection was performed due to bleeding risk. Pathology confirmed an epidural cavernous hemangioma. Symptoms had significantly improved at the 2-month follow-up without recurrence. This case highlights the importance of comprehensive preoperative imaging to prevent misdiagnosis and optimize surgical planning for atypically located tumors.

ObjectiveThis study aimed to compare the clinical and angiographic outcomes of aneurysms with an incorporated branch treated using traditional endovascular coiling or a flow diverter device.MethodsThis single-center retrospective cohort study was conducted at Yixing People's Hospital from January 2015 to December 2023. The final analysis included 63 aneurysms treated with a pipeline embolization device (with or without coils) and 69 treated with endovascular coiling (with or without traditional stents).ResultsOverall, 26 aneurysms (41.3%) in the pipeline embolization device group and 44 (63.8%) in the coiling group achieved complete or near complete occlusion (p = 0.009). At follow-up, 16 branches (25.4%) in the pipeline embolization device group and 12 (17.4%) in the coiling group were occluded (p = 0.523). The stent-assisted coiling subgroup showed a significantly higher aneurysm occlusion rate than the pipeline embolization device group (p = 0.004), whereas no significant difference in branch occlusion rate was observed between the two groups (p = 0.285).ConclusionsFor aneurysms with incorporated branches, stent-assisted coil embolization achieves a higher aneurysm occlusion rate than with pipeline embolization device treatment, without a corresponding increase in branch artery occlusion. If the incorporated branch is considered sacrifiable (its loss would not result in significant neurological deficits), stent-assisted coiling should be regarded as the preferred treatment option.

ObjectiveObesity is linked to decreased quality of sexual life and the development of sexual behavior in adulthood. Because bariatric treatment is considered a promising method for young women with obesity, the purpose of this study was to assess the sexual behavior of women indicated for bariatric treatment and compare them with women indicated for conservative obesity treatment.MethodsThis cross-sectional study included 74 women with obesity who were indicated for bariatric treatment (mean age = 29.39 years, SD = 5.26 years; average body mass index =42.57 kg/m²) and 65 women with obesity (mean age = 31.23 years, SD = 5.22 years; average body mass index = 32.77 kg/m²) who preferred conservative treatment. Their data were compared with those of a control sample selected from the general population.ResultsWomen treated with bariatric surgery reported a higher number of sexual partners over their lifetime (N = 13.10) and a higher number of casual sexual experiences for one night (N = 6.97) than women treated with conservative therapies.ConclusionsWomen seeking bariatric treatment show specific differences in their sexual partnerships compared with other women with obesity.

An unusual case of infective endocarditis caused by a strain of extended-spectrum β-lactamase Escherichia coli O25b:H4-B2-ST131 originating from a urinary tract infection is described. This paper has thoroughly analyzed the distinctive genotypic, phenotypic, and phylogenetic elements of the strain, correlating them with the patient's severe clinical presentation, diagnostic course, and successful outcome achieved through intensive antibiotic and surgical management, culminating in mitral valve replacement. Additionally, we proposed a hypothesis regarding the pathophysiology of infective endocarditis caused by extended-spectrum β-lactamase Escherichia coli, based on genotypic and phylogenetic analyses. A host-related explanatory approach was also assessed. Understanding the importance of early and real-time genotyping and molecular characterization of an Escherichia coli strain with a potential mechanism for developing infective endocarditis may help guide future clinical practice.