Annals of medicine最新文献

Background and aims: Systemic inflammation is closely linked to the development and progression of various cancers, as well as poorer patient outcomes. The role of the c-reactive protein to albumin ratio (CAR) as a predictor of poor prognosis in renal cell carcinoma (RCC) remains insufficiently recognized.

Methods: A literature search was conducted in major English-language databases, including PubMed, EMBASE, and the Cochrane Library, with the search updated to 25 June 2025. Both the odds ratio (OR) and diagnostic odds ratio (DOR) were employed to evaluate the prognostic performance of CAR.

Results: This meta-analysis ultimately included 10 studies with a total of 2478 patients with RCC. The results showed that high baseline CAR was significantly associated with poor prognosis or recurrence of RCC. The sensitivity of 0.73 (95% confidence interval [CI]. 0.69-0.77); specificity of 0.69 (95% CI: 0.64-0.74) and DOR of 6.0 (95% CI: 5.0-8.0) were pooled estimated from patient-based analyses. Subsequently, the combined positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were calculated with the results of 2.4 (95% CI: 2.0-2.8) and 0.39 (95% CI: 0.33-0.46), respectively. Furthermore, the area under the curve (AUC) of the summary receiver operating characteristic (SROC), which reflects prognostic accuracy, was 0.77 (95% CI: 0.73-0.81). In addition, subgroup analysis indicated that elevated CAR was more predictive of overall survival (OS) in RCC patients in China.

Conclusions: Our findings indicate that an elevated CAR serves as a strong predictor of poor prognosis or recurrence in patients with RCC.

Background: Autonomic dysfunction, including orthostatic hypotension and postural tachycardia syndrome, has emerged as a COVID-19 complication. This nationwide propensity score-matched cohort study investigated COVID-19's impact on subsequent prescriptions of autonomic dysfunction in Japan.

Patients and methods: Using a claims database covering 16 million residents identified between 2020 and 2022, propensity-score matching (PSM) created comparable groups of COVID-19 patients and controls. PSM used age, sex, calendar month, comorbidities, and baseline medications, with nearest-neighbor 1:1 with replacement. The primary composite outcome was the first outpatient prescription of midodrine, fludrocortisone, amezinium methylsulfate, and droxidopa. Cox proportional hazards models yielded hazard ratios (HRs) with 95% confidence intervals (CIs). Effect modifications were examined by subgroups.

Results: Among 3,074,329 matched pairs, over a median follow-up of 8 months, 13011 composite outcome were observed, and COVID-19 infection was associated with a 36% relative increase in prescriptions (HR 1.36, 95%CI 1.32-1.41). The risk persisted beyond one year, with the strongest association observed for fludrocortisone (576 events, HR 1.71, 95%CI 1.44-2.02), although the frequency was the highest in midodrine prescription (7009 events, HR 1.28, 95%CI 1.22-1.34). Subgroup analysis revealed higher risks among older individuals, males, those with myocardial infarction, heart failure, and antihypertensive medications.

Conclusions: COVID-19 infection is significantly associated with increased initiation of pharmacotherapy for autonomic dysfunction, with sustained risk beyond one year. These findings highlight the to manage autonomic dysfunction among COVID-19 survivors and informing clinical care and public health planning.

Background: The maxillary sinus (MS) exhibits interindividual anatomical variation influenced by sex, age, and craniofacial morphology. Understanding these variations is essential for surgical, endodontic, and implant planning. However, morphometric data for Saudi subpopulations, particularly from northern regions such as Ha'il, remain limited.

Objective: To assess MS morphometric dimensions using cone-beam computed tomography (CBCT) in a Saudi subpopulation from the Ha'il region and to evaluate variations according to sex, age, and laterality.

Methods: A retrospective CBCT-based cross-sectional study analysed 1,018 scans of Saudi adults aged 18-70 years. Sinus width, length, area, and perimeter were measured bilaterally on standardised coronal sections. Statistical analyses included Mann-Whitney U, Wilcoxon signed-rank, Kruskal-Wallis, and repeated-measures ANCOVA tests, with significance set at p < 0.05.

Results: Males demonstrated significantly larger MS dimensions than females, particularly for area (p = 0.043), perimeter (p = 0.045), and width after covariate adjustment (p = 0.007). No significant age-related differences were observed across adult groups. Although right-left differences were statistically significant for all parameters (p < 0.01), the magnitude of asymmetry was minimal and clinically insignificant. Overall, MS dimensions remained stable throughout adulthood with a slight right-sided laterality predominance.

Conclusion: CBCT-based morphometric assessment of the MS in a Saudi subpopulation from the Ha'il region revealed significant sex-related differences, minimal laterality-related asymmetry, and stable dimensions across adult age groups. These region-specific normative data enhance anatomical understanding and support improved diagnostic accuracy and procedural safety in implantology, oral surgery, maxillofacial practice, and forensic applications.

Background: The testis is a male-specific organ that plays a central role in spermatogenesis and androgen secretion. Testicular ageing is a hallmark of male senescence. However, the underlying mechanisms, as well as strategies to prevent, delay, or reverse this process, remain incompletely understood.

Discussion: As a critical component of male ageing, testicular ageing has attracted broad scientific attention, with ongoing efforts to identify effective strategies to delay or prevent its onset, though therapeutic efficacy remains limited. In this review, we summarise the biological and clinical features of testicular ageing, discuss its underlying molecular and cellular mechanisms, and highlight emerging strategies aimed at mitigating age-related testicular dysfunction, with the goal of advancing understanding and improving therapeutic outcomes.

Conclusions: Testicular ageing is a defining feature of male senescence, marked by progressive structural deterioration and declining steroidogenic and spermatogenic capacity. Although lifestyle, pharmacological, and stem-cell-based interventions show promise, their clinical applicability remains limited. A deeper mechanistic understanding and well-designed, large-scale prospective studies are essential to establish effective strategies for delaying or preventing testicular ageing.

Background: Early spontaneous abortion (ESA) is recognized as the most common complication during pregnancy and is often linked to dysfunction in the trophoblast and placenta. Studies suggest that downregulation of trophoblast oestrogen-related receptor gamma (ESRRG) may play a significant role in the impairment of placental function. In light of these findings, we evaluated the impact of ESRRG on trophoblast and placental function in ESAs, aiming to uncover new targets for diagnosis and treatment.

Patients/materials and methods: Bioinformatics methods were used to analyse differentially expressed genes in the trophoblast of ESA patients and normal controls. ESA Patients and controls were recruited and the villus tissues were collected. Protein and mRNA levels were determined by western blot and qRT-PCR, respectively. Mitochondrial morphological changes in trophoblasts were observed via transmission electron microscopy. CCK8 and Transwell assays were conducted with ESRRG-knockdown HTR-8/SVneo cells. MitoSOX staining, JC-1 assays and ATP quantification were used to assess mitochondrial function in vitro. In addition, Esrrg was overexpressed in ICR female mice, and the number of embryos in the uterus was determined.

Results: The expression of ESRRG was significantly decreased in the placental villous tissue of ESA patients, accompanied by abnormal mitochondrial morphology and decreased ATP levels in trophoblast cells. Impaired proliferation, invasion, migration and tube formation abilities were observed in ESRRG-downregulated HTR-8/SVneo cells, as well as impaired mitochondrial function. ESRRG overexpression was associated with improved trophoblast functionality in a lipopolysaccharide-induced abortion model in ICR mice, leading to an increased number of retained embryos in the uterus.

Conclusion: In summary, this study revealed that ESRRG downregulation plays an important role in ESA, providing new targets for diagnosis and treatment.

Background: Many patients with hypertensive nephropathy progress to chronic kidney disease (CKD). Targeting the core pathophysiological pathway of endothelin-1 activation, this study aimed to elucidate response patterns to the endothelin receptor type A/B (ETA/ETB) antagonist bosentan and construct a personalized prediction model.

Methods: This single-centre retrospective cohort study enrolled 166 patients with hypertension-related nephropathy confirmed by renal biopsy. Risk stratification was performed based on a pathological injury scoring. Three efficacy trajectories were identified using latent variable growth mixture models. Efficacy drivers were screened via random forest algorithms. Finally, early response thresholds were established using receiver operating characteristic (ROC) curves.

Results: Patients in the high-damage group exhibited significantly lower creatinine reduction than those in the low-damage group. Trajectory analysis revealed three patterns: sustained improvement (65.1%), with a 12-month creatinine reduction of 110.8 μmol/L, and deterioration (12.0%), with a deterioration inflection point at 5.3 ± 1.7 months and a subsequent creatinine increase of 40.2 μmol/L. Pathological injury score was the primary determinant of efficacy and was significantly negatively correlated with creatinine reduction (r = -0.61). Early response threshold analysis indicated that ΔCr_3M ≥ 42.3 μmol/L predicted 12-month efficacy, with an area under the curve (AUC) of 0.79. The early target-achievement group demonstrated significantly greater creatinine reduction than the nonachievement group. Compared with the non-sodium-glucose cotransporter-2 inhibitor (SGLT2i) group, the SGLT2i group demonstrated a 59% reduction in creatinine, while the diabetic subgroup showed a 47.1% smaller reduction than the nondiabetic subgroup.

Conclusions: Bosentan may improve glomerular haemodynamics in patients with hypertensive nephropathy. We propose pathological and early-response thresholds that could guide dynamic, precision interventions before critical inflection points, potentially paving the way for an upgrade from static to proactive management. These findings require validation in larger cohorts.

Background: Tuberculosis infection (TBI) is a significant cause of bronchiectasis (BE). Identifying risk factors for radiological BE (RBE) could enhance the early detection of high-risk individuals following TB infection. This study aimed to develop and validate a novel Inflammation-Nutrition Risk Score (INRS) and a corresponding nomogram model to predict the risk of RBE after TBI.

Patients and methods: We enrolled 2,210 post-TBI patients from two medical centres. Data from 1,825 patients at Wuhan Jinyintan Hospital were used to develop the INRS and the RBE nomogram. An independent cohort of 385 patients from Wuhan Union Hospital served as an external validation set.

Results: The INRS was derived from four parameters: PNI, HALP score, Lg(SII) and CAR. Multivariate analysis identified the following independent risk factors for RBE: age ≥60 years (OR = 1.19, p = 0.030), current smoking (OR = 1.71, p = 0.009), COPD (OR = 3.13, p < 0.001), RDW-CV ≥12.8% (OR = 1.09, p = 0.005), ALB <35.5 g/L (OR = 1.04, p = 0.003) and INRS ≥1.86 (OR = 5.04, p < 0.001). The RBE nomogram model demonstrated strong discriminatory power, accuracy and clinical utility across the development, internal validation and external validation cohorts.

Conclusion: In post-TBI patients, the INRS represents a novel predictive biomarker for RBE. The INRS-based nomogram is a clinically applicable and efficient tool for risk stratification and guiding follow-up management to prevent RBE progression.

Background: The treatment strategy for intestinal non-Hodgkin lymphoma (NHL) and the role of surgery warrant reevaluation.

Methods: This study analyzed clinical data from a cohort of 12,047 patients diagnosed with intestinal NHL, extracted from the Korean National Health Insurance System database between 2002 and 2021.

Results: Among these patients, 3,566 (29.6%) were categorized into the surgery group, while 8,481 (70.4%) were included in the nonsurgery group. Surgery was independently associated with both prolonged overall survival (OS) and a favorable prognosis in multivariate analysis (Hazard Ratio [HR] = 0.645, 95% Confidence Interval [CI] = 0.598-0.695, p <.001). The median OS was longer in patients who underwent lymph node dissection during surgery than in patients who did not undergo lymph node dissection (10-year OS with lymph node dissection 63.17% vs. surgery without lymph node dissection 54.78%, p < .001).

Conclusions: To our knowledge, this is the first Korean population-based nationwide study to describe the clinical impact of surgery on the OS of patients with intestinal NHL. A prospective randomized study evaluating strategies to improve the survival of intestinal NHL patients is needed.

Purpose: There remains a lack of epidemiological data and evidence regarding risk factors for intracranial arterial dissection (IAD) worldwide, making it difficult to make a more timely and accurate clinical diagnosis. We aimed to identify risk factors, clinical and imaging features of spontaneous IAD (sIAD) using a case-control design.

Methods: We collected data on sIAD patients admitted to Tongji Hospital in Wuhan, China from June 2017 to June 2024. Non-IAD ischemic stroke (IS) and non-IAD intracerebral hemorrhage (ICH) patients served as control groups. Logistic regression models analyzed the three data sets, with results expressed as odds ratio (OR) and 95% confidence interval (CI).

Results: After screening, 71 patients with sIAD, 84 patients with non-IAD IS and 102 patients with non-IAD ICH were included in this study. The findings showed that the participants with diabetes had a lower likelihood of sIAD than non-IAD IS (OR = 0.145, 95%CI = 0.030-0.702). Compared with non-IAD ICH patients, individuals with sIAD had lower systolic blood pressure on admission (OR = 0.941, 95%CI = 0.900-0.983) and less likely to be young (OR = 0.911, 95%CI = 0.855-0.970). Serological data showed that compared with non-IAD ICH patients, elevated triglyceride (OR = 0.326, 95%CI = 0.179-0.594) were associated with the reduced likelihood of sIAD, whereas the opposite was true for uric acid levels (OR = 1.007, 95%CI = 1.000-1.014). In imaging, sIAD patients showed the largest number of arterial lumen dilatation, followed by stenosis with dilatation.

Conclusions: Diabetes may be associated with a reduced likelihood of sIAD. Differences in serologic markers may help in the differential diagnosis of sIAD from other cerebrovascular events.