Clinical and Investigative Medicine最新文献

Purpose: Pheochromocytoma (PHEO), a neuroendocrine tumour characterized by catecholamine hypersecretion, poses significant peri-operative challenges due to unpredictable intra-operative hemodynamic instability (IHI). This investigation sought to characterize clinicopathological predictors of IHI and develop a risk-stratification tool to optimize surgical management.

Methods: In this retrospective cohort study, 98 patients with histologically confirmed PHEO underwent comprehensive predictor screening via univariate and least absolute shrinkage and selection operator (LASSO) regression analyses. Cohort stratification allocated 70% (69 patients) to model development and 30% (29 patients) for validation. Predictive performance was rigorously assessed through receiver operating characteristic (ROC) analysis, bootstrap-corrected calibration curves (1,000 iterations), and decision curve methodology.

Results: Multivariable modelling identified three independent predictors of IHI: plasma normetanephrine (NMN) level (OR 1.84 [95% CI 1.04 to 3.33]), total bilirubin (TBIL; 9.75 [SD 5.36] versus 7.50 [SD 2.96] µmol/L, P < 0.05), and maximum diameter (MaxD; 5.17 [SD 2.14] versus 4.25 [SD 1.53] cm, P < 0.05). The composite nomogram demonstrated robust discriminative capacity, achieving area under curve of 0.76 (0.90 sensitivity) and 0.80 (0.73 sensitivity) in training and validation cohorts, respectively. Bootstrap validation revealed excellent calibration accuracy, while decision curve analysis confirmed superior net benefit versus NMN level-only predictions across clinical probability thresholds.

Conclusion: By integrating biochemical, anatomical, and functional parameters, this triparametric risk-stratification model enables pre-operative identification of high-risk PHEO patients, developing personalized peri-operative management strategies to mitigate catecholamine-driven complications.

Background: MicroRNA-210 (miR-210) has been implicated in various diseases through its regulation of the Janus kinase-signal transducer and activator of transcription (JAK-STAT) signalling pathway. Despite this, its specific involvement in preeclampsia remains poorly understood. This study aims to investigate the role and pathogenesis of miR-210 and the JAK-STAT signalling pathway in patients with preeclampsia.

Methods: In this study, 28 patients diagnosed with preeclampsia were allocated into a treatment group. Additionally, 22 pregnant women with preeclampsia were included as controls. Real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) was used to assess the expression levels of miR-210, JAK2, and STAT3 mRNA. Human placental chorionic trophoblast cells were cultured in vitro and divided into three groups based on miR-210 transfection: the mimic, inhibition, and untransfected groups.

Results: Compared with the control group, the expression level of miR-210 in the placenta of patients with preeclampsia was significantly higher (P < 0.05), and the levels of inflammatory factors such as interleukin (IL)-6 were positively correlated with the expression level of miR-210 in placental tissue. Analysis of CCK8 cell proliferation experiments showed that the cell proliferation rate in the mimic group was significantly higher compared to the inhibition and untransfected groups (P < 0.05). Flow cytometry analysis showed that the cell apoptosis rate in the mimic group was significantly lower than those of the inhibition and untransfected groups (P < 0.05). Compared with the untransfected group, the mRNA and protein expression levels of JAK2 and STAT3 in the mimic group were significantly higher, while those in the inhibition group were significantly lower (P < 0.05).

Conclusion: In patients with preeclampsia, miR-210 may be involved in the proliferation and apoptosis of human placental trophoblast cells, which may be associated with the JAK2-STAT3 pathway and inflammatory responses. Further studies are warranted to clarify the precise molecular mechanisms underlying these associations.

Objective: This study aimed to investigate the risk factors for suicide and the prognosis of osteosarcoma patients with tumours located in the extremities, trunk, head, and facial bones.

Methods: We retrospectively analyzed data from 3,873 patients to assess risk factors for suicide. Of these patients, 2,062 were selected for survival analysis, with overall survival (OS) as the primary endpoint. Logistic and Cox regression analyses were used to investigate associations between variables, adjusting for confounders such as age, sex, tumour stage, and histological type. Results: Six patients (0.15%) died by suicide (6/3,873). After adjusting for other confounders, age 40-59 years (adjusted odds ratio [aOR] 14.42, P = 0.002) and chondroblastic osteosarcoma (aOR = 5.821, P = 0.012) were identified as independent risk factors. Five-year OS rates were comparable across age groups (e.g., <20 years: 58%, >59 years: 37%, all P < 0.05). Among histological types, patients with parosteal osteosarcoma had the highest 5-year OS rate (e.g., parosteal osteosarcoma: 84% versus osteosarcoma not otherwise specified: 49%, P < 0.001). Multivariable Cox regression revealed that age and histology exhibited significant associations with the survival outcomes.

Conclusions: In osteosarcoma patients with tumours in the extremities, trunk, head, and facial bones, age and histological type were independent risk factors for both suicide and survival outcomes. These findings highlight the need for clinicians to consider both clinical and psychological risk factors in patient management and underscore the importance of providing mental health counselling, particularly for those at high risk for suicide.

Background: The long-term immune and metabolic effects of COVID-19 in vaccinated populations remain incompletely characterized. This study aimed to analyze dynamic changes in lymphocyte subpopulations (T, B, and Natural Killer [NK] cells [TBNK]) and key metabolic indicators among college students post-Omicron infection with prior vaccination.

Methods: A prospective observational cohort of 71 male students infected with the Omicron variant of COVID-19 (Beijing, China; March-April 2022) and 18 uninfected controls was followed for 2 years. TBNK subsets and metabolic parameters (uric acid, lipid profiles, β2-microglobulin) were analyzed at 3, 6, 12, and 24 months post-infection.

Results: Immunologically, total lymphocytes were elevated at 3 months when compared with controls (P = 0.0063). Total T cells declined at 6 and 12 months but rebounded by 24 months (P < 0.0001). NK cells increased until 12 months, then declined (P < 0.0001). B cells decreased persistently (P < 0.05). Metabolically, uric acid and lipid parameters (total cholesterol, LDL-C, lipoprotein [a]) showed significant fluctuations, with notable increases at 1 year post-infection (P < 0.05). β2-microglobulin levels decreased significantly over time (P < 0.0001).

Conclusion: Omicron infection induces immune and metabolic disturbances lasting at least 1 year, with gradual but incomplete recovery by 2 years. The interplay between immune dysregulation and metabolic alterations may contribute to the long-term health effects of COVID-19. Monitoring both lymphocyte and metabolic dynamics may guide the long-term management of post-COVID-19 sequelae.

Background: Post-operative deep vein thrombosis (DVT) significantly compromises outcomes in prostate cancer (PCa) surgery patients. This study aimed to develop and validate a clinically applicable nomogram for individualized DVT risk stratification.

Methods: In this retrospective matched case-control study, 500 PCa patients (150 DVT, 350 non-DVT) undergoing surgery (2018-2023) were analyzed after rigorous DVT confirmation via duplex ultrasonography (92.2% adherence) and radiologist adjudication (κ = 0.86). To address the inflated DVT incidence due to case-control sampling, inverse probability weighting corrected sampling bias (weighted DVT incidence 12.3% versus true 12.1%), with post-weighting covariate balance confirmed by a standardized mean difference <0.08. Independent predictors were identified through multivariate logistic regression, with nomogram construction and validation (bootstrap optimism correction; temporal validation cohort n = 103). Decision curve analysis (DCA) evaluated clinical utility by quantifying net benefit across threshold probabilities (5%-80%).

Results: Age (OR 1.045 [95% CI 1.022-1.072] per year), surgery duration (OR 1.018/10 [95% CI 1.011-1.025 per min), preoperative D-dimer (OR 1.315 [95% CI 1.192-1.451] for every 0.1 mg/L), prostate-specific antigen density (PSAD; OR 4.805 [95% CI 2.761-8.365] per unit), and advanced tumour stage (T3-T4, OR 3.512 [95% CI 2.012-6.115]) were significant predictors. The nomogram demonstrated excellent discrimination (optimism-corrected area under the curve [AUC] = 0.942; temporal validation AUC=0.918) and calibration (slope = 0.94). Clinical thresholds: age ≥68.3 years, surgery ≥159.7 min, D-dimer ≥0.92 mg/L, PSAD ≥2.95 ng/mL/cm³. DCA revealed optimal clinical utility at 10%-60% risk thresholds, with a maximum net benefit (0.111) at 10% threshold probability, consistently outperforming default treatment strategies.

Conclusions: This validated nomogram integrates five readily available clinical variables to precisely quantify DVT risk in PCa surgical patients. It enables personalized preoperative risk assessment, facilitating targeted prophylaxis to mitigate thromboembolic complications beyond guideline-compliant prevention.

Background: This study aimed to evaluate the predictive value of multiparametric transthoracic echocardiography (TTE) in patients with moderate to severe sepsis-associated acute respiratory distress syndrome (SA-ARDS), with a focus on right ventricular function and myocardial strain.

Methods: This single-centre retrospective cohort study was conducted at a tertiary academic medical centre. Data were collected for adult patients admitted to the ICU between June 2020 and June 2024, who developed sepsis within the first 24 hours of ICU admission.

Results: A total of 1,163 patients with moderate to severe SA-ARDS were included, with a mean age of 67.4 (SD 14.0) years. Diabetes and chronic lung disease were the most common comorbidities. Clinical predictors of non-recovery included severe ARDS (p = 0.003), and lower PaO₂/FIO₂ ratios (p < 0.001). In contrast, echocardiographic predictors of recovery included higher tricuspid annular plane systolic excursion (TAPSE) (p < 0.001) and lower right ventricular systolic pressure (RVSP) (p = 0.023), higher right ventricular fractional area change (RV-FAC) (p < 0.001), and more negative global longitudinal strain (GLS) (p < 0.001) compared to the non-recovery group. The combined model integrating RV-FAC, GLS, and right ventricular free wall longitudinal strain (RVFWLS) demonstrated superior predictive performance (area under the receiver operating characteristic curve (AUC) = 0.879 [95% CI 0.854-0.904]), outperforming traditional TTE parameters (TAPSE + RVSP, AUC = 0.783, p < 0.001).

Conclusion: Multiparametric echocardiography, particularly RV-FAC, GLS, and RVFWLS, provides a robust tool for predicting SA-ARDS recovery. These findings emphasize the critical role of right ventricular adaptability and myocardial deformation in prognosis.