Clinical and Investigative Medicine最新文献

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.

Introduction: Thrombocytopenia occurs frequently in patients with acute cholangitis and is considered a risk factor for poor prognosis. The present study aimed to investigate the relationship of thrombocytopenia with 60-day mortality and cholangitis disease severity.

Methods: This was a single-centre, retrospective, observational cohort study. We analyzed 498 patients with acute cholangitis who were admitted to our hospital between July 2013 and July 2021. The correlation between admission platelet count and disease severity and prognosis were analyzed.

Results: In this study, the incidence of thrombocytopenia (platelet count <100×10⁹/L) and severe thrombocytopenia (platelet count <50×10⁹/L) in acute cholangitis was 31.12% and 7.43%, respectively. Median platelet count in the thrombocytopenia group was 64×10⁹/L (IQR 42, 79). Compared with the no-thrombocytopenia group, the thrombocytopenia group had a higher proportion of grade III cases, incidences of complications (including respiratory failure, circulatory failure, bacteremia), and higher Acute Physiologic Assessment and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores (all P < 0.05). The 60-day mortality rate was significantly higher in the thrombocytopenia group than that in the no-thrombocytopenia group (12.90% vs. 2.33%, P < 0.001). Binary logistic regression analysis demonstrated that platelet count on admission was a risk factor for mortality. Receiver operating characteristic (ROC) curve analysis showed 84×10⁹/L as the optimal platelet count cut-off value for predicting 60-day mortality with acute cholangitis (Assessment area under the ROC curve [AUC] 0.79; sensitivity 76.4%, specificity 71.4%).

Conclusion: Platelet count is a readily available, prognostic marker that can identify acute cholangitis patients at risk of poorer outcomes.

Background: The dietary intake of live microbes is inextricably linked to human health. The aim of this study was to investigate a potential relationship between low-level dietary live microbe (LDLM) intake and periodontitis.

Methods: According to the Sanders dietary live microbial classification system and the Centers for Disease Control and Prevention and American Academy of Periodontology periodontitis case definitions, this observational study included a total of 3,116 adults from the National Health and Nutrition Examination Survey (NHANES) database with complete periodontal data and LDLM intake. Univariate analysis, multivariable logistic regression analysis, and restricted cubic spline regression were performed to analyze the association between periodontitis and LDLM.

Results: After adjusting for all covariates, LDLM was found to be associated with periodontitis prevalence (P = 0.05 for trend) but not with periodontitis severity. The results of the restricted cubic spline analysis showed a non-linear relationship between LDLM and periodontitis prevalence (P = 0.05). Periodontitis prevalence was lowest with LDLM consumption of 2,923.89 g per day.

Conclusion: LDLM intake showed a statistically significant non-linear relationship with periodontitis prevalence, with the lowest prevalence of periodontitis at an intake of 2,923.89 g per day.

[Table: see text].

[Table: see text].