Journal of clinical medicine research最新文献

The ABO and Rhesus blood systems have been studied extensively in relation to various diseases, including cancers. Recent evidence suggests that ABO blood group may influence susceptibility to oral potentially malignant disorders (OPMDs) and oral cancers, particularly oral squamous cell carcinoma (OSCC). The current review explores the association of ABO and Rhesus blood groups with oral cancers, summarizing epidemiological, molecular, and immunological studies to elucidate potential mechanisms underlying this relationship.

Background: A previous study developed a predictive model for identifying positive findings on computed tomography (CT) brain imaging in patients with non-traumatic seizures. One key predictor was the Glasgow Coma Scale (GCS), categorized into three groups (≤ 8, 9 - 13, >13). However, in real-world practice, some bedridden patients have low baseline GCS, which may lead to overprediction and unnecessary CT imaging. The original model yielded a false positive of 16.6%, exceeding the predefined threshold of less than 15%. This study aimed to improve the model by replacing categorized GCS with GCS change from baseline to reduce false positives below 15%, while maintaining false negatives below 5%.

Methods: This diagnostic predictive study included patients with non-traumatic seizures who underwent CT brain imaging at the emergency department between November 2019 and November 2023. The original predictors were retained, with GCS change from baseline replacing the categorized GCS. Multivariable logistic regression analysis was used to estimate multivariable odds ratios. Discriminative performance was assessed using the area under the receiver operating characteristic (AuROC) curve. A trade-off between sensitivity and specificity was applied to identify a probability cut-off that met the target for false positives and false negatives. The revised model was named the "SeizCT optimized model".

Results: Of the 625 patients included, 18.9% had positive CT findings. The majority were male (74.9%) with a mean age of 55 years. The SeizCT optimized model incorporated six predictors: prior stroke (> 3 months), current cancer, GCS change from baseline, alcohol withdrawal symptoms, epilepsy, and focal neurological deficit. The model demonstrated an AuROC of 0.8221 (95% confidence interval (CI): 0.7813, 0.8629). Using a threshold probability of 22.57%, it outperformed the original model (AuROC of 0.8156; 95% CI: 0.7586, 0.8727) with narrower confidence intervals. It achieved a false negative of 4.8% and a false positive of 14.4%.

Conclusions: The SeizCT optimized model showed improved performance over the original tool, reducing both false positives and false negatives within the predefined thresholds. External validation is recommended.

Background: The main study aims are to determine the incidence of congenital ear abnormalities in children in Kazakhstan and their risk factors. This research examined the medical treatment given to children with congenital malformations and the medical and social aspects impacting them and their parents. It also evaluated congenital ear deformity children's quality of life.

Methods: This retrospective, cross-sectional study was conducted in two public health maternity hospitals in Kazakhstan and aimed to investigate 975 consecutive children delivered therein. The study utilized hospital records to assess various factors related to neonatal health and outcomes in the sampled population.

Results: The study revealed significant associations between congenital ear malformation and various factors: parental consanguinity (P = 0.001), maternal alcohol consumption (P = 0.020), cesarean section (P = 0.000), stillbirth/prenatal mortality (P = 0.005), and maternal medication use (P = 0.002). Surgical interventions comprised 68% of treatments, with non-surgical methods covering all cases, emphasizing a comprehensive approach. Maternal alcohol consumption (P = 0.005) and drug use (P = 0.002) showed notable associations with congenital malformations. Cesarean section (P = 0.048) and lower gestational age (P = 0.001) were linked to prenatal complications. Maternal behaviors like smoking (P = 0.010) and vitamin intake (P = 0.009) also impacted neonatal health.

Conclusions: These findings stress the importance of targeted interventions to mitigate risks in at-risk populations. Congenital ear malformations, influenced by genetics and environment, require targeted interventions. Surgical and non-surgical treatments address physical challenges, emphasizing holistic care for improved quality of life and well-being.

Chronic kidney disease (CKD) affects an estimated 15% of all adults in Central Europe. Those affected are at high risk of cardiovascular disease and death. Inflammatory rheumatic systemic diseases manifest themselves extra-articularly with varying frequency. This article summarized the prevalence and pathogenetic mechanisms of CKD in rheumatic systemic diseases. The following databases were searched for references: PubMed, Web of Science, Cochrane Library, Scopus. The search period spanned from 1975 to 2025. Kidney involvement is almost always present in systemic lupus erythematosus and certain types of systemic vasculitis. In the context of rheumatic diseases, there are additional mechanisms that can contribute to enhancing the functional and structural integrity of the kidneys. These mechanisms include inflammation and an increase in cardiovascular risk. The prevalence of CKD is disproportionately high in certain entities of the rheumatic form. Given the disproportionately high prevalence of CKD in relevant entities of the inflammatory rheumatic group and the associated increase in the risk of cardiovascular disease and death, CKD screening should be an integral part of the care of affected patients.

Background: The aim of this study was to compare cancer-specific survival (CSS) and overall survival (OS) after partial cystectomy (PC) versus radical cystectomy (RC) in patients with stage T2N0M0 non-urothelial carcinoma of the bladder (NUCB).

Methods: Data on patients with stage T2N0M0 NUCB treated with PC or RC were retrospectively retrieved from the Surveillance, Epidemiology, and End Results (SEER) database from 2007 to 2015. Propensity score matching (PSM) was used to create matched cohorts, which were used to calculate OS and CSS.

Results: Among 999 histologically confirmed NUCB patients (752 in PC group and 247 in RC group), significant differences were found in age, marital status, tumor-related features, and treatment modalities. After 1:1 PSM, 169 pairs were obtained. In the matched cohort, the RC group had significantly higher 1-year, 3-year, and 5-year OS and CSS rates than the PC group (OS: P = 0.002; CSS: P = 0.004). Cox regression analysis showed that older age, unmarried status, and PC were independent risk factors for poor prognosis, while RC was associated with improved survival (OS: hazard ratio (HR) = 0.34, 95% confidence interval (CI): 0.26 - 0.44, P < 0.001; CSS: HR = 0.47, 95% CI: 0.31 - 0.72, P < 0.001). T2b-stage patients had lower cancer-specific mortality than T2a-stage patients (P = 0.01). Subgroup analysis indicated that RC generally led to better survival, except in the neuroendocrine carcinoma subgroup for OS (P = 0.085) and the other carcinoma subgroup for CSS (P = 0.132).

Conclusions: This study reveals that RC is associated with superior CSS and OS compared to PC in patients with NUCB. Patient-related factors (age and marital status) and histological subtype significantly influence prognosis, highlighting the need for personalized treatment strategies.

Background: Chronic obstructive pulmonary disease (COPD) and atrial fibrillation (Afib) are frequently comorbid, with COPD patients exhibiting a higher risk of Afib-related hospitalizations. This study investigated the relationship between COPD and Afib, focusing on 30-day readmission rates and outcomes.

Methods: We conducted a retrospective cohort study using the Nationwide Readmissions Database (NRD) from 2016 to 2020. We included adult patients (≥ 18 years) with a primary diagnosis of Afib while excluding those with December discharges to ensure a complete 30-day follow-up. We compared patients with and without COPD, analyzing 30-day readmission rates, length of stay (LOS), hospital costs, in-hospital mortality, and associated factors using multivariable Cox and logistic regression models.

Results: A total of 1,064,982 patients admitted with Afib were included, of which 873,070 had no COPD, and 191,912 had it. COPD patients were older (73.19 vs. 70.82 years), had a shorter LOS (coefficient = -0.05, P = 0.002, 95% confidence interval (CI): -0.08 to -0.02), and had a higher comorbidity burden (Elixhauser comorbidity index: 5.13 vs. 3.43, P < 0.0001). The 30-day readmission rate was significantly higher in the COPD group (16.0% vs. 9.0%, P < 0.001). Logistic regression revealed that COPD increased the odds of readmission (odds ratio: 1.35, 95% CI: 1.32 to 1.39, P < 0.001).

Conclusion: COPD is a significant risk factor for 30-day readmission and in-hospital mortality among Afib patients, underscoring the need for integrated approaches targeting both diseases.

Background: Migraine, vestibular migraine (VM), and tension-type headache (TTH) are commonly associated with dizziness, vertigo, and postural instability, which increases patients' risk of falling and contributes to anxiety and depression. However, the vestibular pathophysiology underlying these primary headache disorders remains unclear. This study aimed to assess the saccular and utricular functions using vestibular evoked myogenic potentials (VEMPs), to investigate the peripheral and central vestibular involvement across these headaches.

Methods: A total of 353 patients diagnosed with migraine, VM, or TTH, based on the International Classification of Headache Disorders, third edition (beta version, ICHD-3β), were recruited from the Dizziness and Headache Clinic at People's Hospital of Weifang between December 2019 and September 2022. All participants underwent standardized clinical assessments and demographic data collection. VEMP tests were performed using 95 dB air-conducted sound stimuli to evaluate peripheral and central vestibular functions prior to enrollment.

Results: Sleep disturbances and psychiatric comorbidities (i.e., anxiety and depression) were significantly more prevalent in TTH patients compared to those with VM and migraine. VM patients also demonstrated higher rates of psychiatric comorbidities than migraine patients. The average headache duration in VM patients was 7.14 years, which was notably longer than the average dizziness duration of 4.03 years. Transient vertigo was reported in 22% of VM patients and 17.65% of TTH patients. The prevalence of occipital and/or neck pain was significantly higher in VM patients than in migraine patients. Absent ocular VEMP (oVEMP) responses, both unilateral and bilateral, were found at a significantly higher rate in VM patients compared to migraine patients. Additionally, cervical VEMP (cVEMP) asymmetry ratios (ARs) were significantly higher in VM patients compared to TTH patients, and marginally higher than in migraine patients (P = 0.05). Prolonged cVEMP latencies (right p13, n23, and interpeak intervals) were observed in both VM and migraine compared to TTH. Left-sided latencies were significantly prolonged in migraine than TTH.

Conclusions: Psychiatric comorbidities were most pronounced in TTH, followed by VM and migraine. Both VM and TTH were associated with transient vertigo, exposing patients to drop-attack risk. The significantly higher occipital and/or neck pain reported in VM than in migraine may suggest the cervical neurovascular involvement in its pathophysiology. VEMP results indicate peripheral vestibular dysfunctions in VM patients and lower brainstem involvement in both VM and migraine patients, with the right-sided abnormalities more severe than the left-sided ones.

Non-peptide gonadotropin-releasing hormone (GnRH) receptor antagonists exhibit remarkable potency and specificity in inhibiting GnRH receptor activity. The orally administered versions of these drugs, notably elagolix and relugolix, have obtained official clearance in various countries for treating moderate-to-severe endometriosis-related pain. Concurrently, linzagolix and opigolix (ASP1707) continue to advance through late-stage clinical trials. The primary objective of this review is to comprehensively evaluate the clinical efficacy and safety profile of oral GnRH antagonists, specifically elagolix, relugolix, linzagolix, and opigolix, for the management of endometriosis-associated pain. Specifically, this study summarizes and analyzes their effectiveness in alleviating dysmenorrhea and non-menstrual pelvic pain, evaluates the dose-dependent impacts on bone mineral density and adverse effects such as hot flushes, and explores the role of add-back therapy in improving treatment safety and patient adherence. Research has demonstrated that oral GnRH antagonists effectively alleviate endometriosis-related pain while enhancing patients' quality of life. Furthermore, when combined with add-back therapy, these medications enhance treatment safety and contribute to greater patient compliance. Compared to alternative hormonal treatments, oral GnRH antagonists emerge as a particularly promising approach for managing endometriosis.

[This retracts the article DOI: 10.14740/jocmr2541e.][This retracts the article DOI: 10.14740/jocmr3470w.][This retracts the article DOI: 10.14740/jocmr2443w.].

Background: Epidemiological studies have reported that hyperuricemia is associated with the development of metabolic syndrome, hypertension, dyslipidemia, type 2 diabetes, and chronic kidney disease (CKD). Renal uric acid (UA) reabsorption is mainly mediated by urate transporter 1 (URAT1) in renal proximal tubule epithelial cells. Recently, URAT1 was found to be expressed in the liver and adipose tissue in addition to the kidney. UA enters such organs via URAT1 and induces inflammation and oxidative stress, which may lead to metabolic disorders. We investigated the effects of long-term treatment with the novel uricosuric drug, a highly selective inhibitor of URAT1, dotinurad, on metabolic parameters and renal function.

Methods: We retrospectively picked up patients who had taken dotinurad for the treatment of asymptomatic hyperuricemia for more than 2 years. We compared metabolic parameters and renal function at baseline with the data at 6, 12, 18, and 24 months after starting dotinurad.

Results: Pharmacologically, dotinurad decreases serum UA, by selectively inhibiting URAT1 and decreasing renal reabsorption of UA, which was supported by our result that dotinurad significantly increased urine UA and reduced serum UA. In addition to UA-lowering, dotinurad was associated with improvements in body weight, liver function, hepatic steatosis index as the marker for metabolic dysfunction-associated steatotic liver disease (MASLD), serum lipids, and albuminuria. The ATP-binding cassette transporter G2 (ABCG2) regulates renal and intestinal excretion of UA and uremic toxins and strongly affects renal function. Our study also indicates that switching from xanthine oxidase inhibitors, which inhibit ABCG2, to dotinurad, which does not inhibit ABCG2, was beneficial for albuminuria and maintaining the estimated glomerular filtration rate.

Conclusion: Dotinurad may improve obesity, MASLD, serum lipids, and CKD by blocking the entry of UA via URAT1 to the adipose tissue, liver, and kidney.