Open Medicine最新文献

Objectives: To analyze differences in coagulation function and plasma inflammatory factors between type 2 diabetes mellitus (T2DM) patients with and without ischemic stroke (IS), and explore related mechanisms.

Methods: 50 patients with T2DM complicated with IS (experimental group, EG) and 50 patients with simple T2DM (control group, CG) were retrospectively included, while 30 healthy volunteers served as the blank group (BG). The expression levels of plasma interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and nuclear factor-κB (NF-κB) in the EG were significantly elevated as against the CG and the BG (p<0.05).

Results: As against the CG and the BG, activated partial thromboplastin time (APTT) and prothrombin time (PT) levels were significantly reduced, while the plasma fibrinogen (FIB) and D-Dimer (DD) levels were significantly elevated in the EG; The incidence of postoperative complications in the EG (13.46 %) was significantly reduced as against the CG (21.15 %) (p<0.05). IL-6 was notably negatively correlated with APTT (p=0.002, r=-0.432); it was extremely significantly negatively correlated with PT (p=0.000, r=-0.536); it was notably positively correlated with plasma FIB content (p=0.001, r=0.445).

Conclusions: The coagulation function and peripheral blood inflammatory markers in patients with T2DM complicated by IS were significantly different compared to those in patients with T2DM alone and healthy volunteers. The correlation between inflammatory markers and coagulation indicators (e.g., the negative correlation between IL-6 and APTT/PT) identified in this study holds important clinical significance. It provides new insights for thrombosis risk stratification and personalized antithrombotic treatment in T2DM patients. Monitoring the levels of inflammatory markers may optimize thrombosis prevention strategies and enhance the precision of clinical diagnosis and treatment.

Objectives: Severe tricuspid regurgitation (TR) can be a phenotypic manifestation of an underlying disease process that is the primary driver of patient prognosis. Associated clinical signs such as small vein pulsations are similarly prognostic. Systolic propulsion of the eyeballs is an extreme manifestation of severe TR with only seven reported cases in the literature. We herein report two additional cases, review the available literature, and discuss prognostic implications of this phenomenon.

Case presentation: Two patients with severe tricuspid regurgitation and systolic propulsion of the eyeballs are described in a comprehensive manner. Unlike previous reports, we include contemporary high-quality images and video of the phenomenon in addition to the most in-depth review of the literature on this subject to date.

Conclusions: Systolic propulsion of the eyeballs is a manifestation of severe tricuspid regurgitation in the background of profound right ventricular dysfunction. We believe this is a rare clinical sign that carries ominous prognostic implications.

Objectives: Total knee and hip replacements are among the most common surgical procedures. Optimization of the treatment process is of great relevance and requires verification of effectiveness in different settings. The PROMISE study was carried out to achieve this.

Methods: An optimized treatment process was implemented in 3 German hospitals with different levels of care. A total of 1,887 patients were included. The WOMAC Score was established as the outcome parameter at 3, 6 and 12 months after surgery. A mixed model for repeated measurements was used to estimate site-specific effects as well as the limits of the corresponding confidence intervals. To demonstrate homogeneous results across all sites, these outcomes needed to fall within a range defined by the overall effect ± the minimally clinically important difference (MCID), using a 95 % confidence interval.

Results: All site-specific results ranged from (points [CI-limits]) -29.2 [-29.7; -28.7] to -24.4 [-24.5; -24.3] and were therefore within the range defined by the overall treatment effect and the MCID (25.4 ± 10).

Conclusions: We could demonstrate homogeneous site-specific effects of the optimized process in the three most different settings of the German healthcare system. Therefore, an essential prerequisite for a system-wide rollout has been met.

Objectives: This study aimed to design and evaluate a computationally constructed multiepitope vaccine targeting Simian Virus 40 (SV40) by predicting and selecting immunogenic B-cell and T-cell epitopes derived from the VP1 and VP2 capsid proteins using bioinformatics approaches.

Methods: B and T-cell epitopes from VP1 and VP2 were predicted and screened for antigenicity, non-allergenicity, and non-toxicity. Structural modeling and validation were performed using PSIPRED, trRosetta, and a Ramachandran plot. Population coverage was assessed using the IEDB. Molecular docking with TLR3 and TLR5, immune simulations, in silico cloning, and molecular dynamics simulations were used to evaluate binding, expression, and structural stability.

Results: Molecular docking with human receptors TLR3 and TLR5, revealing strong binding affinities of -1,008.3 kcal/mol and -1,309.2, and further validated using MD simulation analysis. The in silico expression analysis, performed using the SnapGene tool, indicated high expression levels in the pBR322 vector. The immune simulation analysis showed that the vaccine has a high capacity to induce an immune response in the host.

Conclusions: The designed vaccine demonstrated high immunogenic potential; further in vitro and in vivo studies are needed to verify the antigenic potential and safety of the designed vaccine.

Objectives: This study aims to systematically evaluate the incremental value of admission eosinopenia EOS(-) in enhancing the predictive efficacy of early-stage acute respiratory distress syndrome (ARDS) risk models for ICU patients.

Methods: This study employed a single-center retrospective cohort design, enrolling 482 adult ICU patients between 2020 and 2023. Using Cox proportional hazards regression, we constructed and compared three models: Model 1 (baseline clinical model) included age, pneumonia, sepsis, and SOFA score; Model 2 added lymphocytes and eosinophils to Model 1; Model 3 further adjusted for BMI and diabetes. Predictive performance was assessed using the C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI), and validated internally.

Results: C-statistics for Models 1, 2, and 3 were 0.683, 0.710, and 0.729, respectively. Model 3 demonstrated optimal performance (NRI=0.185, p=0.004), with an adjusted C-statistic of 0.695. Multivariate analysis identified age, pneumonia, and sepsis as independent ARDS risk factors, while EOS(-) showed non-independence. Results from competing risks analysis were consistent with the primary analysis conclusions.

Conclusions: Although eosinopenia is not an independent predictor of ARDS, it provides incremental information for early risk stratification based on conventional clinical factors, thereby aiding in the identification of high-risk patients.

Background: Streptococcus intermedius is a major human pathogen associated with invasive diseases such as meningitis and endocarditis. These infections may lead to inflammation, fever, and cardiac damage. At present, no effective vaccine exists for prevention.

Objectives: This study aimed to design a stable, non-allergenic, and antigenic chimeric multi-epitope vaccine against S. intermedius using Immunoinformatics approaches.

Methods: Twelve B-cell, five helper T lymphocyte (HTL), and five cytotoxic T lymphocyte (CTL) epitopes were predicted using advanced immunoinformatics tools. These epitopes were assembled into a single vaccine candidate. The construct was evaluated in silico for its antigenicity, allergenicity, and physicochemical stability. A 3D structural model of the vaccine was generated and validated. Molecular docking and dynamics simulations were conducted to assess interactions between the vaccine and immune receptors: TLR4, TLR3, MHC-I, and MHC-II.

Results: The final vaccine candidate demonstrated favorable antigenic and non-allergenic properties, along with high stability. Structural validation confirmed proper folding. Docking analyses revealed strong binding affinities between the vaccine and target immune receptors. Molecular dynamics simulations indicated stable complexes, supporting the construct's immunological compatibility.

Conclusions: The designed chimeric multi-epitope vaccine shows strong potential to elicit an immune response against S. intermedius. These findings provide a foundation for further experimental validation through in vivo and clinical trials.

Objectives: To characterize the patterns, risk factors, and reporting trends of adverse drug reactions (ADRs) in a tertiary care hospital in China to inform targeted medication safety interventions.

Methods: A single-center, retrospective analysis was conducted on 5,564 ADR reports extracted from the National Adverse Drug Reaction Monitoring System (2019-2024). Reports were assessed for causality using the WHO-UMC criteria. Descriptive statistics and chi-squared tests were employed to analyze demographics, reporting trends, causative drugs, administration routes, and clinical outcomes.

Results: The mean patient age was 62.4 years, with males slightly predominating (52.5 %). ADR reporting increased markedly over the study period, with pharmacists becoming the primary reporters (93.1 % in 2024). Intravenous infusion was the most common route (67.3 %). Antineoplastic agents were the predominant drug class implicated (34.2 %), followed by anti-infectives (10.8 %) and cardiovascular drugs (9.4 %). Statistically significant associations were found between ADR outcomes and both the type of ADR (new/serious vs. general, p<0.001) and the administration route (intravenous vs. oral, p<0.001). No significant association was observed between patient age and ADR outcomes (p=0.244).

Conclusions: Antineoplastic drugs and intravenous administration are key ADR risk factors. Enhanced monitoring of high-risk medications and optimized infusion protocols are needed. Limitations include retrospective single-center design and reporting biases.

Objectives: The aim of this study was to explore the predictive value of the C-reactive protein-to-body mass index ratio (CBR) in the prognosis of all-cause mortality in patients with heart failure (HF) with different ejection fractions.

Methods: We included 1196 HF patients from the First Affiliated Hospital of Kunming Medical University after exclusion criteria. Based on the optimal cut-off value from the ROC curves, patients were categorised into low CBR group and high CBR group. The predictive value of the CBR for the prognosis of all-cause mortality in patients with different types of HF was assessed using Kaplan-Meier curves, Cox proportional hazards analyses, cubic spline plots and ROC curves analyses.

Results: Kaplan‒Meier analyses showed that the high CBR group had the highest cumulative incidence of all-cause mortality regardless of the type of HF patients. Multivariate Cox regression analysis revealed that the CBR was an independent predictor of prognosis for all-cause mortality in patients with all types of HF. The cubic spline plots showed a roughly positive association between the CBR and all-cause mortality. The ROC curves showed that for all types of HF patients, the area under the curve for the CBR was the largest relative to individual CRP and BMI.

Conclusions: Regardless of the type of HF patients, the CBR can be a good predictor of prognosis for all-cause mortality in patients with a higher CBR associated with a higher risk of all-cause mortality.

Objectives: To develop and validate machine learning (ML) models for identifying key predictors and estimating the risk of intraoperative hypotension (IOH) in elderly patients undergoing general anesthesia.

Methods: This secondary analysis included 1,720 elderly surgical patients from a randomized controlled trial. Data were split chronologically into training sets. Feature selection was performed using univariate analysis and the Boruta algorithm. Eight ML models - logistic regression, Bayesian model, K-nearest neighbor, support vector machine, neural network, classification and regression tree, extreme gradient boosting, and random forest - were developed with cross-validation, hyperparameter tuning, and random oversampling. Model performance was evaluated using ROC, PRC, calibration, and decision curve analyses, and interpretability was enhanced using SHapley Additive exPlanations (SHAP).

Results: Key predictors included anesthesia protocol, Charlson comorbidity index, preoperative sodium, creatinine, BUN/creatinine ratio, intraoperative drug use (e.g., sevoflurane, lidocaine, morphine), preoperative MAP and MHR, surgical and anesthesia duration, and surgical site. The random forest model achieved the best performance (accuracy=0.9917; MCC=0.9832; AUC-ROC=0.9998; AUC-PRC=0.9998).

Conclusions: A robust ML-based model was established to accurately predict IOH in elderly patients. These findings may support individualized anesthesia management and targeted preventive strategies to reduce IOH incidence.

Objectives: To evaluate the preventive and corrective effects of vitamin D on antioxidant defense and blood rheology in rats with streptozotocin (STZ)-induced diabetes mellitus.

Methods: Forty male rats (10 weeks old, ∼200 g) were randomly assigned to four groups: Group I - Intact controls; Group II - Diabetic rats (STZ only); Group III - Preventive (vitamin D for 14 days before STZ and continued throughout the experiment); Group IV - Therapeutic (vitamin D from day 3 post-STZ). DM was induced with streptozotocin (30 mg/kg), and vitamin D was administered orally at 300 IU/day, according to a previous dose-control experiment. Data from the 21st experimental day were evaluated. Blood samples collected at this point were used to determine catalase (CAT), superoxide dismutase (SOD), and blood rheological parameters.

Results: Vitamin D supplementation enhanced antioxidant-related parameters and improved blood rheological indices, particularly when administered therapeutically.

Conclusions: Vitamin D shows therapeutic potential in attenuating oxidative imbalance and improving blood rheology in streptozotocin-induced diabetes mellitus.