Journal of clinical medicine research最新文献

Background: Chronic obstructive pulmonary disease (COPD) is a frequent cause of atrial fibrillation (A-fib). A paroxysm of A-fib will protract the patients' stay at hospital and increase their lethality risk considerably. Despite extensive research done in this field, the predictors of A-fib recurrence in COPD patients have not been definitively studied.

Methods: Our single-institution prospective study involved 569 patients hospitalized for COPD exacerbation. Depending on whether they developed an A-fib paroxysm while in hospital, we divided the patients into two groups: group I (the main one) was composed of 111 COPD patients whose electrocardiogram (ECG) showed an A-fib paroxysm during hospitalization, and group II (the comparison group) comprised 458 COPD patients who had no A-fib paroxysm in their entire hospitalization period. All the patients were given a comprehensive clinical, laboratory, and instrumental examination that included a complete blood count and blood chemistry test, coagulogram, room air oxygen saturation test, external respiration test, standard ECG, echocardiogram, Holter daily ECG monitoring, and a chest computed tomography (CT) scan.

Results: In exacerbated COPD patients, arterial hypertension (AH) would increase their risk of developing an A-fib paroxysm by a factor of 3.74 (confidence interval (CI) 2.78 - 4.19). Arrhythmic patients' Charlson Comorbidity Index was veritably higher (5 (3 - 6) points) than in the comparison group (3 (2 - 5) points) (P = 0.004). A-fib patients had considerably lower oxygen saturation on room air (SpO₂) (91.8% (89-95%)) than non-arrhythmic patients (95.2% (91-97%)). Right atrial area enlargement would increase exacerbated COPD patients' risk of developing an A-fib paroxysm by a factor of 1.34 (1.16 - 1.56). A-fib patients were found to have a veritably raised level of C-reactive protein to 21.0 mg/L (5.65 - 35.2 mg/L), compared to non-arrhythmic patients with 8.3 mg/L (1.31 - 16.4 mg/L).

Conclusion: The development of an A-fib paroxysm in patients hospitalized for exacerbated COPD is predicted by Charlson Comorbidity Index above 4, right atrial area enlargement, and heightened C-reactive protein.

Background: Thiamine responsive disorder (TRD), a clinical condition which improves with the administration of vitamin B1, has been proposed in pediatrics to detect the atypical and diverse symptoms of vitamin B1 deficiency which has been widely overlooked. Previous studies were not conducted in internal medicine and in developed countries. Therefore, the aim of this study was to determine the characteristics of Japanese TRD patients in internal medicine.

Methods: This case-control study was conducted at Department of General Medicine in the Jikei University Kashiwa Hospital from January 2018 to December 2022. Participants were tested for whole blood total vitamin B1, serum albumin levels, and total lymphocyte count; started newly on a vitamin B1 preparation for treating patients' signs and symptoms; and re-visited the hospital to evaluate drug effectiveness. Signs and symptoms were chosen whether they had been suspected to be a vitamin B1 deficiency by the treating physicians. All enrolled patients were assessed recovery status by the clinician at that time, and one of the authors assigned them to a TRD or not using a two-point scale (getting better vs. no change or getting worse) based on all the information available from electronic medical records.

Results: A total of 35 patients were enrolled (median age 48 years; 31.4% male). A univariate logistic regression analysis showed that sex was associated with TRDs (female: unadjusted odds ratio (OR) = 0.08, 95% confidence interval (CI): 0.0043 - 0.55, P = 0.007), which was the same as the result of a multivariate logistic regression analysis with forced entry method (female: adjusted OR = 0.03, 95% CI: 0.0009 - 0.32, P = 0.002). In addition, there was an atypical symptom of vitamin B1 deficiency such as orthostatic dysregulation (OD): lightheadedness and syncope in the TRDs albeit being nonsignificant.

Conclusions: Japanese TRD patients in internal medicine were associated with sex, and had a symptom of OD. Further well-designed, large-scale studies are needed to explore the features of TRDs in internal medicine.

Background: The cardio-ankle vascular index (CAVI) is a physiological marker that indicates systemic arterial stiffness, and several reports have demonstrated its usefulness as a predictor of cardiovascular disease (CVD). However, there have been no studies examining the clinical significance of CAVI limited to elderly patients with obesity. This prospective study aimed to determine the clinical significance of CAVI as a CVD risk factor in Japanese elderly patients with obesity.

Methods: This study included a total of 402 Japanese elderly patients with obesity (mean age ± standard deviation: 72 ± 5 years; mean body mass index ± standard deviation: 27.6 ± 2.2 kg/m²) and no history of CVD events. The patients were divided into two groups: the high CAVI group (group H: n = 193) and the low CAVI group (group L: n = 209) (cut-off value: 9.0). The patients' background factors were compared between groups, and the usefulness of the CAVI as a predictor of primary CVD events was assessed.

Results: Group H showed a significantly higher visceral fat area, as measured by abdominal computed tomography, compared to group L. A significant relation with biomarkers, such as homeostasis model assessment of insulin resistance (HOMA-IR); preheparin serum lipoprotein lipase mass (pre-LPL mass) concentration, one of the coronary risk factors; and urinary 8-iso-prostaglandinF2α (U-8-iso-PGF2α) concentration, an indicator of oxidative stress in vivo, was observed. The multiple Cox proportional hazards regression analysis for the incidence of primary CVD events (median follow-up period: 100 months) indicated that group H had a significantly higher risk of developing primary CVD events than group L (hazard ratio: 2.40; 95% confidence interval: 1.37 - 4.24; P = 0.002). However, high HOMA-IR, low pre-LPL mass, and high U-8-iso-PGF2α were also selected as significant predictors of primary CVD events.

Conclusions: The results of this study indicated that the CAVI increases in the presence of visceral fat accumulation and is significantly associated with key CVD risk factors, such as insulin resistance, low pre-LPL mass, and elevated oxidative stress in Japanese elderly patients with obesity. Furthermore, high CAVI is considered a useful predictor of primary CVD events in such patients.

Background: The optimal treatment strategy for chronic obstructive pulmonary disease (COPD) remains debated, especially when choosing between triple therapy and long-acting beta agonist (LABA) + long-acting muscarinic antagonist (LAMA). This study aimed to develop a model that simulates real-world prescription patterns and compares the effectiveness of these two treatment options.

Methods: This population-based cohort study used Taiwan's National Health Insurance Research Database to follow COPD patients who had been on LABA plus inhaled corticosteroids (ICSs) for more than 28 days. These patients were followed until they either upgraded to triple therapy or switched to LABA plus LAMA. The study enrolled patients from 2013 to 2021. Cox proportional hazard models were used to evaluate the risk of seven individual outcomes, including mortality, COPD exacerbations, acute respiratory failure, pneumonia, and respiratory-related admissions, adjusting for fixed and time-dependent variables.

Results: Among the 20,997 included patients (mean (standard deviation (SD)) age: 66.06 (11.54) years; 12,977 males (61.80%)), 16,792 (79.97%) were in the triple therapy group, and 4,205 (20.03%) were in LABA plus LAMA group. The triple therapy group showed significantly higher relative risks in several outcomes: composite outcome (adjusted hazard ratio (aHR): 1.162; 95% confidence interval (CI): 1.098 - 1.230; P < 0.0001), acute respiratory failure (aHR: 1.315; 95% CI: 1.047 - 1.653; P = 0.0186), severe acute exacerbation (aHR: 1.346; 95% CI: 1.078 - 1.682; P = 0.0088), pneumonia (aHR: 1.221; 95% CI: 1.109 - 1.344; P < 0.0001) and respiratory-related admission (aHR: 1.264; 95% CI: 1.157 - 1.382; P < 0.0001), indicating superior effectiveness of LABA plus LAMA in these indicators.

Conclusions: In conclusion, in COPD patients, the combination of LABA plus LAMA can significantly improve many major symptoms and reduce the frequency of exacerbations.

Infertility, characterized by the failure to achieve clinical pregnancy after 12 months or more of regular unprotected sexual intercourse, has emerged as a substantial global reproductive health challenge. According to recent epidemiological studies, this condition affects approximately 15-20% of couples within the reproductive age group worldwide. Notably, thyroid dysfunction has been identified as a significant contributing factor, being present in 5-10% of infertile couples. Although the well-established association between thyroid dysfunction and human infertility has been extensively documented in the literature, the precise underlying mechanisms remain incompletely understood and continue to be a subject of ongoing scientific investigation. In this review, we comprehensively examine the current literature regarding the impact of abnormal thyroid function on reproductive health and explore potential therapeutic interventions for thyroid dysfunction-associated infertility. This analysis aims to identify promising research directions and advance treatment strategies for managing infertility related to thyroid disorders.

Radiation and chemical-induced cancer are of increasing concern as the various activities of humans continuously elevate the levels of radiation and toxic chemicals in the environment. The prevention of this incidence using alternative medicines-phytopreparations, therefore, becomes pertinent as conventional approaches tend to produce various unwanted side effects. To achieve this, there is a need to understand the various mechanisms of action through which phytopreparations exhibit their protective effects. This systematic review, therefore, aims to explore the mechanism of action of various phytopreparations in the prevention of induced radiation and chemical (chromium) cancer. A systematic review approach following the stipulated guidelines by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to identify research papers published between 2015 and 2025. Four databases, namely Europe PubMed Central (PMC), PubMed, Springer Open, and Wiley Online Library were used to search for related open access papers. A total of 621 research papers were reviewed for suitability to the review objective; however, only five papers met the inclusion criteria, and an additional two papers were sourced from ResearchGate. Thus, a total of seven papers were finally included in the analysis. This review highlights the mechanisms of action of various phytopreparations in the prevention of radiation and chromium-induced cancer. The major mechanisms of phytopreparations' action in the prevention of induced radiation and chromium oncogenesis majorly involve regulating pro and anti-inflammatory cytokines, improving cell-to-cell communication, and preventing damage to DNA structure.

Background: Molnupiravir (MOV) is recommended for the treatment of patients with coronavirus disease 2019 (COVID-19) who are ineligible for remdesivir treatment. However, data regarding laboratory-based adverse events (AEs) associated with MOV use in hospitalized patients are limited. In this study, we evaluated MOV-associated laboratory abnormalities, including increased creatine phosphokinase (CPK) and decreased hemoglobin (Hb) levels (e.g., anemia), and evaluated related risk factors in hospitalized COVID-19 patients.

Methods: We reviewed retrospective data for 78 adult inpatients with COVID-19 who received MOV upon admission at Fukuoka University Chikushi Hospital. Individuals with MOV treatment history, early discontinuation, or premature discharge were excluded. Data were collected on demographics, Charlson Comorbidity Index, bacterial coinfection, concomitant medications, COVID-19 severity, oxygen therapy, and length of hospital stay. The AEs were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 Japanese Clinical Oncology Group. Multivariate analyses were conducted to identify risk factors for elevated CPK levels and anemia.

Results: The median age of the study population was 82 years (interquartile range: 74 - 89 years; men: 56.4%), and 17.9% had bacterial coinfection. Twenty-seven patients (34.6%) experienced ≥ 1 AE, and MOV was discontinued in two patients because of a mild rash and CPK elevation. Elevated CPK levels and anemia each occurred in 11 patients (14.1%). Severe AEs (grade ≥ 3) were observed in one patient with grade 4 CPK elevation and in another with grade 3 anemia. Multivariate analysis showed that bacterial coinfection tended to increase CPK levels (adjusted odds ratio (aOR): 3.30, 95% confidence interval (CI): 0.75 - 13.32, P = 0.10) and was significantly associated with anemia (aOR: 5.40, 95% CI: 1.27 - 23.69, P = 0.022).

Conclusions: MOV exhibits a generally favorable safety profile in hospitalized COVID-19 patients, with low treatment discontinuation rates and mild laboratory abnormalities. Elevated CPK levels and anemia may reflect the complications of bacterial coinfection rather than direct MOV toxicity; however, these results should be interpreted with caution because of the small sample size and single-center, non-controlled study design. Further multicenter prospective studies are warranted to determine the relationship between CPK elevation, anemia, and MOV treatment in COVID-19 patients.

Background: Previous studies have reported inconsistent findings on the relationship between telomere length and metabolic syndrome (MS). The aim of the work was to study leukocyte telomere length in young patients without cardiovascular diseases and its relationship with MS and its components.

Methods: This study included 450 Caucasian patients with a median age of 30 (21 - 42) years. Glycemic parameters and lipid profile components were determined using the CardioChek PA (USA, 2017). Integral metabolic indices were calculated in all patients. To investigate leukocyte telomere length, 45 were randomly selected from the total cohort of 450 participants.

Results: The selected patients were divided into two groups according to the presence of MS. The median telomere length in MS patients (7.36 (6.96 - 8.67) pn) was significantly lower than in the comparison group (8.72 (8.37 - 8.96) pn) (P = 0.016). Correlation analysis was performed to assess the relationship between telomere length and various traditional cardiovascular risk factors (sex, age, smoking, and blood pressure levels), MS components, and integral metabolic indices. Several linear regression analysis models were constructed to assess the independent associations between various factors and telomere length. Age, smoking, neck circumference, triglycerides, high-density lipoprotein levels, LAP index, and the presence of dyslipidemia were significantly associated with telomere length.

Conclusion: Our results are consistent with the notion of shorter leukocyte telomere length in individuals with MS and support an association with dyslipidemia in premature shortening of telomere length. The causal relationship between these changes requires further study.

Background: This systematic review aimed to evaluate the efficacy of medical-grade honey (MGH) in eliminating and inhibiting Pseudomonas aeruginosa (P. aeruginosa) biofilms, which are known for their resistance to conventional antibiotics and significant role in chronic infections.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered in PROSPERO (CRD42024614542), a systematic search was conducted across PubMed, ProQuest, Scopus, and EBSCO using terms related to P. aeruginosa, biofilm, and MGH. Inclusion criteria encompassed in vitro studies assessing MGH's effect on P. aeruginosa biofilms, with reported outcomes including biofilm inhibition and eradication. Data extraction and risk-of-bias assessment were performed independently by two reviewers using the Quality Assessment Tool for In Vitro Studies (QUIN) tool. Publication bias was estimated through forest plot.

Results: A total of 1,934 records were identified from four databases. After screening and full-text review, six in vitro studies met the inclusion criteria for qualitative synthesis, and five were eligible for meta-analysis. All studies evaluated the effect of MGH, including Manuka and Surgihoney, on P. aeruginosa biofilms using crystal violet staining and spectrophotometric analysis. Pooled results showed that MGH significantly reduced biofilm formation (standardized mean difference (SMD) = -4.98; 95% confidence interval (CI): -6.72 to -3.25) and effectively disrupted established biofilms (SMD = -4.44; 95% CI: -6.62 to -2.26). Subgroup analysis revealed stronger effects on American Type Culture Collection (ATCC) strains than clinical isolates, with low within-subgroup heterogeneity. MGH also demonstrated significant superiority compared to active biofilm controls, although sterility control comparisons showed high variability. Mechanistic analysis found that Medihoney outperformed sugar solutions and methylglyoxal (MGO) alone, suggesting that its antibiofilm activity results from synergistic bioactive compounds. Overall, these findings support MGH as a potent antibiofilm agent, warranting further research for clinical application against P. aeruginosa biofilm infections.

Conclusion: MGH exhibits consistent and substantial anti-biofilm activity against P. aeruginosa in vitro, affecting both biofilm formation and established biofilms. These findings support its potential application as a topical therapeutic agent in managing biofilm-related infections, particularly in chronic wounds. Future research should prioritize standardized application protocols and investigate synergistic effects with conventional antimicrobials through clinical trials.

Middle ear surgery is a daily routine procedure in otolaryngology. Pain control, along with a bloodless and non-moving operative field during the surgery, is crucial for achieving better surgical outcomes and can be achieved easily under general anesthesia (GA). Nevertheless, local anesthesia (LA), especially if done as office-based surgery, is an ideal alternative to GA in certain scenarios. Despite the well-established nature of LA for middle ear surgery, only a small percentage of otolaryngologists choose to use it, and few publications in the literature address this topic. This article reviews the literature for the feasibility of performing middle ear surgeries in an office base setting. A scoping review of the literature was conducted on middle ear surgery under LA in an office-based setting, focusing on feasibility, advantages, surgical techniques, limitations, and outcomes, to provide a concise guide for its implementation. LA will avoid the rare but serious complications of GA, and there are cost savings of approximately 50% in LA, which is crucial for the sustainability of healthcare systems. It is an ideal alternative to GA in certain scenarios, including decreased access to operative rooms, staff shortage or contraindications for GA. Also, surgeons can appreciate hearing improvement and the need for prosthesis adjustment with instant feedback during the surgery or prevent significant complications such as a dead ear under LA. Office-based surgery for middle ear under LA is feasible and the present work offers a brief guide for beginners with some tips and tricks to ensure optimal patient care and outcomes.