Journal of clinical medicine research最新文献

Background: Previous studies developed the SeizCT primer and optimized models, both demonstrating similar values for the area under the receiver operating characteristic curve (AuROC). The optimized model incorporates Glasgow Coma Scale (GCS) change from baseline instead of categorized GCS at emergency department (ED) presentation. This study aimed to validate these two models for predicting positive computed tomography (CT) findings in patients with non-traumatic seizures.

Methods: A retrospective cross-sectional study was conducted among adult patients (≥ 18 years) with non-traumatic seizures who underwent CT brain imaging in the ED at Lampang Hospital. Data were collected between December 2023 and July 2024 based on parameters from the SeizCT primer and optimized models. External validation compared model performance using AuROC, calibration, decision curve analysis (DCA), and confusion matrices.

Results: The validation cohort included 312 patients (210 (67.3%) male; mean age 53 years). Positive CT findings were found in 58 patients (18.6%). The SeizCT primer model had an AuROC of 0.7218 (95% confidence interval (CI): 0.6476, 0.7961), while the SeizCT optimized model achieved 0.7394 (95% CI: 0.6663, 0.8124). An equivalence test showed statistically equivalent discrimination between the two models (P < 0.015), with the optimized model demonstrating better calibration (slope: 0.582 vs. 0.701; P = 0.002; observed-to-expected ratio: 0.934 vs. 0.971; P = 0.030).

Conclusions: Both models demonstrated fair to acceptable discrimination after external validation. The SeizCT optimized model is recommended, as it showed superior calibration and its incorporation of GCS change from baseline offers greater clinical applicability.

Background: Preterm birth (PB) continues to be a leading cause of neonatal morbidity and mortality, with isthmic-cervical insufficiency (ICI) being among the most serious contributory factors. ICI is often a precursor for PB, and monitoring and diagnosis of this event can largely be achieved through cervicometry and elastography, especially with the use of the E-Cervix index. The aim of this study was to assess the effectiveness of integrating elastography and cervicometry, specifically the E-Cervix index, in predicting PB risk in pregnant women with ICI during the second trimester.

Methods: A prospective cohort study was performed on 250 pregnant women during their second trimester, including 150 women with ICI alongside 100 control women. Cervical elastography was done to assess the stiffness of the cervix coupled with transvaginal ultrasound cervicometry to obtain the length of the cervix. The E-Cervix index was also computed to enhance the discrimination accuracy of lower predictive values. Analysis was done on Statistical Package for the Social Sciences version 27.0 and Statistical Software for Data Analysis version 17.0.

Results: This study investigated the effectiveness of combining cervical elastography and cervicometry, utilizing the E-Cervix index, to assess the risk of PB in pregnant women diagnosed with ICI. The main group (n = 150) had a significantly younger mean age (30.24 ± 5.68 years) compared to the control group (32.17 ± 6.00 years, P = 0.011). Women with ICI showed shorter cervical lengths (2.6 ± 0.5 cm vs. 3.5 ± 0.4 cm, P < 0.001) and higher elasticity contrast index (6.5 ± 1.2 vs. 4.2 ± 0.9, P < 0.001). A significantly higher rate of PB (16% vs. 8%, P = 0.047) was observed in the main group. However, early diagnosis through combined elastography and cervicometry, followed by timely interventions, effectively contributed to a reduction in early PB rates, emphasizing the clinical value of integrated diagnostic approach.

Conclusion: The combined use of elastography and cervicometry, particularly through the E-Cervix index, provides accurate risk assessment for preterm delivery in women with ICI. This approach demonstrates strong diagnostic performance and supports timely clinical decision-making, enhancing early intervention and improving outcomes in high-risk pregnancies.

Background: Alcohol withdrawal syndrome (AWS) carries a high risk of morbidity and mortality that often requires critical care admission and monitoring. Dexmedetomidine is a known sedative that can help with patient symptoms and potentially reduce Clinical Institute Withdrawal Assessment of Alcohol Scale Revised (CIWA-Ar) scores. This study looks at two groups - the use of dexmedetomidine versus non-dexmedetomidine - in the management of AWS patients to assess the length of intensive care unit (ICU) stay, length of stay (LOS) in hospital, mortality and readmission rate.

Methods: This retrospective cohort study was conducted at Geisinger Health System, a tertiary care, academic health care system, between January 2016 and December 2022. This study did not require ethics approval according to the Institutional Review Board (IRB). The patients assessed included those aged 18 years or older with a documented CIWA-Ar score requiring admission to the ICU or ICU step-down unit. Exclusion criteria included ICU admission for alternative indications, a prior history of seizure disorder, or patients who left against medical advice.

Results: A total of 994 patients were identified to have met the inclusion criteria; 371 patients were in the non-dexmedetomidine group and 623 in the dexmedetomidine group. Primary outcomes assessed were hospital LOS (5.0 (3.0 - 9.0) vs. 10 (6.0 - 16.0), P < 0.0001) and days in the ICU (1.9 (1.0 - 3.4) vs. 4.9 (2.9 - 9.0), P < 0.0001), respectively. Secondary outcomes assessed were lorazepam equivalent usage, and readmission within 30, 60 and 90 days, which were not statistically significant when accounting for ICU LOS.

Conclusions: Among patients treated for AWS, dexmedetomidine use appeared to be associated with longer hospital and ICU stays, while benzodiazepine requirements remained unchanged. These associations may reflect differences in illness severity, emphasizing the need for future prospective evaluation.

Background: There are limited investigations on the general pathogen features, clinical characteristics, and predicted clinical markers of secondary lower respiratory tract infection of chronic respiratory disorders.

Methods: A total of 154 adult inpatients with chronic respiratory diseases between 2019 and 2022 were enrolled. Clinical data were retrospectively collected and analyzed. Multivariate logistic regression analysis was used to analyze the susceptibility factors of infection secondary to chronic respiratory diseases.

Results: Among the patients with chronic respiratory diseases, the most prevalent condition was chronic obstructive pulmonary disease (44.2%, 68/154). Cough, expectoration, chest tightness, and wheezing were the predominant symptoms irrespective of infection. Pseudomonas aeruginosa accounted for 37% (20/54) in pathogen infection. Aspergillus fumigatus was the primary cause of filamentous fungal infection. The combination of low body mass index, increased tricuspid regurgitation pressure, and decreased lymphocyte count could accurately predict infection secondary to chronic respiratory diseases (area under curve (AUC): 0.788, 95% confidence interval (CI): 0.689 - 0.887, P = 0.000).

Conclusions: This study focused and explored the common features between secondary infections of various chronic respiratory diseases. The prediction model is expected to enable timely detection and treatment of secondary infections in clinical practice.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder with significant global morbidity and mortality. COPD is increasingly recognized as a systemic inflammatory condition that predisposes patients to multiple comorbidities, including tuberculosis (TB). There are limited data on how comorbidities in COPD influence the development of TB.

Methods: We conducted a nationwide, retrospective cohort study using data from Taiwan's National Health Insurance Research Database (NHIRD) between 2011 and 2021. Patients aged ≥ 40 years with a diagnosis of COPD, confirmed by ≥ 3 outpatient visits or ≥ 1 hospitalization, were included. Individuals with prior TB were excluded. Non-COPD controls were matched 1:1 using propensity score matching for demographics and comorbidities. The primary outcome was incident TB (ICD-9-CM 010-018). Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for TB, accounting for a variety of comorbidities.

Results: A total of 117,989 COPD patients and an equal number of matched controls were analyzed. During follow-up, TB incidence was significantly higher in the COPD group (3.20 vs. 1.45 per 10,000 person-years). COPD was associated with a 74% increased risk of TB (aHR 1.74; 95% confidence interval (CI): 1.42 - 2.14; P < 0.001). Stratified analysis demonstrated that TB risk rose progressively with age and was markedly amplified by comorbidities. Notably, pneumoconiosis conferred a nearly sevenfold higher TB risk among COPD patients (aHR 6.94; 95% CI: 2.72 - 17.71; P < 0.001), followed by lung cancer (aHR 1.81; 95% CI: 1.07 - 3.05; P < 0.027) and rheumatoid arthritis (aHR 2.05; 95% CI: 1.01 - 4.12; P < 0.046).

Conclusion: After adjustment for available covariates, COPD was associated with an increased risk of TB; however, residual confounding due to factors such as corticosteroid use, immunosuppressive therapy, and smoking cannot be excluded.

The aim of this study was to review the neurobiological mechanisms, epidemiology, and therapeutic interventions for non-suicidal self-injury (NSSI), emphasizing the pain addiction model and electroencephalographic biomarkers as frameworks for precision intervention. A narrative review of the literature was conducted using PubMed, Web of Science, CNKI, and Wanfang Data up to October 2025. Search strategy employed the terms "non-suicidal self-injury," "pain addiction," "electroencephalography," "endogenous opioid system," and "HPA axis." Selection criteria prioritized original human studies, high-quality systematic reviews, and mechanistic investigations. Pain addiction and electroencephalography (EEG) were selected as focal variables based on their explanatory power: pain addiction elucidates NSSI perpetuation through endogenous opioid-mediated reward sensitization and dopaminergic reinforcement, while event-related potentials (ERPs) provide temporal precision in mapping cognitive-affective dysregulation underlying emotional impulsivity and regulatory deficits. Global adolescent NSSI prevalence averages 17.2%, with Chinese rates reaching 24.7% and trends toward earlier onset. Neurobiological substrates include fronto-limbic dysregulation, hypoactive hypothalamic-pituitary-adrenal (HPA) axis function with blunted cortisol reactivity, and endogenous opioid system alterations producing widespread hypoalgesia. EEG/ERP studies demonstrate increased N2 amplitude with decreased P3 amplitude and prolonged latency during negative stimuli processing, reflecting impaired conflict monitoring and attentional resource allocation. Dialectical behavior therapy shows established efficacy, while repetitive transcranial magnetic stimulation and opioid antagonists demonstrate therapeutic potential. NSSI emerges from neurobiological vulnerability within pain-reward-emotion circuits interacting with psychosocial factors. The pain addiction framework and EEG signatures provide translatable targets for biomarker development and personalized intervention. Future research requires multimodal neuroimaging, longitudinal designs, and genetic integration to establish predictive algorithms and precision therapeutics.

The immune system plays a vital role in defending the body against infections and tumors, inspiring the development of innovative therapies like immune checkpoint inhibitors (ICIs) that have transformed the treatment of advanced cancers. Pembrolizumab, a monoclonal antibody targeting the programmed cell death 1 (PD-1) receptor, is a powerful ICI effective against various malignancies but frequently associated with immune-related adverse events (irAEs). In this report, we present a case of organizing pneumonitis that developed 3 months after initiation of pembrolizumab treatment for non-small cell lung cancer (NSCLC). A 64-year-old woman with NSCLC, undergoing maintenance therapy with pembrolizumab, presented with multiple lung consolidations. Her medical history included thalassemia minor, a pre-pyloric ulcer, hiatal hernia, and a history of smoking. Extensive microbiological testing, including bronchoalveolar lavage, was negative, and her condition did not improve with broad-spectrum antibiotics. This led to a suspected diagnosis of pembrolizumab-induced pneumonitis. Treatment with high-dose corticosteroids resulted in full clinical and radiological resolution. This case underscores the importance of monitoring for irAEs during ICI therapy, as differential diagnosis between immunotherapy-induced organizing pneumonia and tumor progression is challenging in patients with advanced lung cancer.

Background: This preliminary study investigated the effect of aged garlic extract (AGE) on acetic acid (AA) and/or 5-fluorouracil (5-FU)-induced oral mucositis in tumor-bearing mice, and whether AGE affects the antitumor activity of 5-FU.

Methods: There were four mouse groups: control, AA, AA + 5-FU, and AA + 5-FU + AGE. Mouse squamous cell carcinoma cells (SCCVII) were used to develop tumors in mice, except for the control group. Oral mucositis was induced in tumor-bearing mice by intraperitoneal injection with 5-FU (18 mg/kg) for 9 days and/or topical application of 50% AA to the dorsal tongue for 1 day. Mucositis was treated with AGE (2.0 g/kg/day) for 10 days in AA + 5-FU + AGE group, while the other groups received saline (0.2 mL/day). The wound healing and antitumor effects of AGE were examined. Whole transcriptome analysis and ingenuity pathways analysis (IPA) of the tongue and tumor samples were used to investigate the mechanisms behind the wound healing and antitumor effects of AGE.

Results: Body weight was increased significantly in AA + 5-FU + AGE group compared to AA + 5-FU group. Moreover, tumor volume was significantly decreased in AA + 5-FU + AGE group than that in the other groups. In AA + 5-FU group, toluidine blue-positive area (wound area) in the tongue was the largest, and the size and weight of the salivary glands were decreased compared to other groups. In contrast, wound area was significantly reduced, and the size and weight of the salivary glands were increased in AA + 5-FU + AGE group compared to AA + 5-FU group. Therefore, AGE treatment could heal tongue ulcers and salivary gland damage in AA + 5-FU + AGE group. Whole transcriptome analysis and IPA data suggested that AGE could heal 5-FU-induced oral mucositis by promoting normal cell differentiation and keratinization, and it may also enhance the antitumor effects of 5-FU through the activation of B cells in mouse tumors.

Conclusion: AGE could alleviate AA and 5-FU-induced oral mucositis in mice while potentially enhancing the antitumor activity of 5-FU. Therefore, AGE might be useful in the treatment of oral mucositis in cancer patients receiving 5-FU-based therapies.

Background: Cardiovascular disease (CVD) remains a leading global cause of mortality. Statins, particularly rosuvastatin (RSV), are widely used to reduce low-density lipoprotein cholesterol (LDL-C) level and prevent atherosclerotic CVD. RSV is highly liver-selective, hydrophilic, and primarily transported via organic anion transport proteins, rendering it less prone to cytochrome P450-mediated drug interactions. However, the concurrent use with magnesium oxide (MgO), a common antacid and laxative, has been shown to decrease RSV absorption by up to 50%, raising concerns regarding the clinical efficacy of RSV in patients taking MgO.

Methods: This multicenter, randomized, parallel-group comparative trial included outpatients prescribed both RSV and MgO at Fukuoka University Chikushi and Fukuoka Tokushukai Hospitals. Patients were randomly assigned to the control group with simultaneous administration or the intervention group with staggered administration of MgO at least 2 h after RSV. Data on demographics and serum levels of LDL-C, total cholesterol, high-density lipoprotein cholesterol, and triglycerides were collected at baseline and 12 weeks after study initiation. Medication adherence was monitored using a self-reported medication checklist, and patients with ≥ 80% compliance were included in the final analysis.

Results: A total of 45 patients, including 25 and 20 patients in the control and intervention groups, respectively, completed the study. The median ages were 78 and 76 years in the control and intervention groups, respectively. The baseline demographics and clinical parameters, including LDL-C, were not significantly different between the two groups. After 12 weeks, the rate of change in LDL-C level was not significantly between the control and intervention groups (P = 0.9091).

Conclusion: The concurrent use of RSV and MgO did not significantly impact the reduction in LDL-C levels compared with the staggered administration. Simplifying administration without altering efficacy can improve medication adherence, particularly in elderly patients and those with polypharmacy, by reducing treatment complexity.

Background: Although guidelines recommend gradual blood pressure (BP) reduction in asymptomatic markedly elevated BP (AMEBP), short-acting oral antihypertensives are often used despite limited evidence - driven by healthcare providers' concerns or institutional policies - thereby increasing system burden. This study aimed to identify practical regimens enabling safe, timely discharge and continuity of care.

Methods: This retrospective cohort included patients with AMEBP (systolic BP > 180 mm Hg and/or diastolic BP > 110 mm Hg), who presented to the emergency department (ED) of Lampang Hospital between January and December 2023. Oral regimens included captopril, hydralazine, metoprolol (25 mg each), or combinations. The outcome was mean arterial pressure (MAP) reduction within 60 min, classified as no reduction (< 10%), appropriate reduction (10-15%), or over-reduction (> 15%). Inverse probability of treatment weighting (IPTW) adjusted for regimen selection, and multinomial odds ratios (mORs) with 95% confidence intervals (CIs) were reported.

Results: Among 158 patients (mean age 60 years; 67.1% female), baseline MAP was 142.4 ± 16.2 mm Hg. Captopril and hydralazine monotherapy were most likely to achieve appropriate reduction (captopril: mOR: 2.91; 95% CI: 0.96, 8.76; P = 0.058; hydralazine: mOR: 2.76; 95% CI: 0.84, 9.11; P = 0.096). Metoprolol was associated with inappropriate response, while captopril plus hydralazine had highest odds of over-reduction (mOR: 3.04; 95% CI: 1.02, 9.00; P = 0.045).

Conclusions: Although urgent BP reduction is not routinely recommended in the ED, oral captopril appears to be a reasonable first-line option when clinically necessary, while hydralazine may be a suitable alternative. Combination of these two drugs should be used with caution due to the risk of excessive MAP reduction.