Hasil untuk "Internal medicine"

Cuimei Wei, Yaohui Huang, Ping Xi et al.

Abstract Objective The strong correlation between the ratio of residual cholesterol to high-density lipoprotein cholesterol (RC/HDL-c) and major cardiovascular events has been extensively studied. However, the role of this ratio in diabetic retinopathy (DR) has not been investigated. Hence, this present study aims to examine the association between the RC/HDL-c ratio and DR in patients diagnosed with type 2 diabetes mellitus (T2DM). Methods This study conducted a cross-sectional analysis involving a total of 1942 patients diagnosed with T2DM in two Taiwanese hospitals, spanning from April 2002 to November 2004. The primary objective was to explore the independent association between the RC/HDL-c ratio and the presence of DR, as well as proliferative diabetic retinopathy (PDR), using a binary logistic regression model. To accurately determine the shape of the association between these variables, we utilized a generalized additive model (GAM) and employed smooth curve fitting techniques. The data was downloaded from the website: https://journals.plos.org/plosone . Results Our study comprised participants with an average age of 64.06 ± 11.32 years, with males accounting for 43.05% of the total. Among the patients, 35.12% were found to have DR, while PDR was present in 18.23% of cases. The average RC/HDL-c ratio was calculated as 0.67 ± 0.39. Utilizing a fully adjusted logistic regression model, we investigated the potential association between the TC/HDL-c ratio and both DR and PDR. However, no statistically significant association was observed (DR: OR 1.060; 95% CI 0.707, 1.588; PDR: OR 1.258; 95% CI 0.773, 2.047). Interestingly, we did discover a non-linear association between the RC/HDL-c ratio and DR. Employing a two-piece logistic regression model and a recursive algorithm, we identified an inflection point at 0.460. When the RC/HDL-c ratio fell below 0.460, each 1-unit increase in the ratio was associated with an 11.8-fold increase in the adjusted odds of developing DR (OR = 12.824; 95% CI 3.583, 45.897). Moreover, a non-linear association between the RC/HDL-c ratio and PDR was observed, with an inflection point occurring at 0.90. When the RC/HDL-c ratio was below 0.90, a one-unit increase in the ratio was linked to a 1.46-fold increase in the adjusted odds of PDR (OR = 2.459; 95% CI: 1.245, 4.857). Conclusion This study contributes valuable insights into the intricate association between the RC/HDL-c ratio and both DR and PDR in individuals diagnosed with T2DM. By identifying a non-linear association, our findings enhance the existing knowledge surrounding the link between the RC/HDL-c ratio and the development of DR and PDR.

Tao Sun, Jun Liu

BackgroundThis study seeks to investigate the association between the triglyceride-glucose index (TyG), triglyceride glucose index to high-density lipoprotein cholesterol ratio (TyG/HDL-c), and the risk of diabetes in individuals with nonalcoholic fatty liver disease (NAFLD).MethodsThis retrospective study encompassed 457 NAFLD patients from The Central Hospital of Shaoyang, monitored over a three-year period. Missing data were addressed using multiple imputation, and the Synthetic Minority Over-sampling Technique (SMOTE) was employed to balance the dataset. Multicollinearity analysis was conducted to evaluate the collinearity among variables, while principal component analysis was utilized to examine the distribution of variables in both the original and balanced datasets. A multivariate logistic regression model was used to assess the association between TyG, TyG/HDL-c, and the risk of diabetes in NAFLD patients, adjusting for various covariates. Subgroup analysis was performed to identify differences across diverse populations, and restricted cubic splines (RCS) were used to explore potential non-linear relationships. The receiver operating characteristic (ROC) curve examined the diagnostic value of individual and combined indicators in assessing the risk of diabetes in NAFLD patients.ResultsUpon adjustment for all covariates, TyG was found to significantly elevate the risk of diabetes among patients with NAFLD (OR = 1.96, 95% CI: 1.67-2.30, P < 0.001), with a notable non-linear relationship observed (threshold: 2.39, P-nonlinear = 0.002). Similarly, TyG/HDL-c significantly increased diabetes risk (OR = 1.90, 95% CI: 1.60-2.26, P < 0.001), also demonstrating a distinct non-linear association (threshold: 2.20, P-nonlinear < 0.001). Subgroup analyses revealed significant interactions between TyG and TyG/HDL-c across different gender subgroups (P for interaction < 0.05). The ROC curve analysis indicated that the combined use of TyG and TyG/HDL-c provided superior diagnostic performance for assessing diabetes risk in NAFLD patients (Area Under the Curve [AUC]: 0.703, 95% CI: 0.665-0.740), compared to the use of TyG (AUC: 0.694, 95% CI: 0.656-0.732) or TyG/HDL-c (AUC: 0.693, 95% CI: 0.655-0.731) independently.ConclusionBoth TyG and TyG/HDL-c are significantly associated with an increased risk of diabetes in NAFLD patients, exhibiting non-linear relationships. Furthermore, these associations vary significantly across gender subgroups, their combined use enhances risk assessment, supporting their clinical utility in evaluating diabetes risk.

C. Tatarelli, M. Breccia, M. Santopietro et al.

Background With increasing life expectancy, there has been a progressive rise in the proportion of patients (pts) aged ≥80 years diagnosed with myeloproliferative neoplasms (MPNs). However, data specifically focusing on very elderly pts with polycythemia vera (PV) remain limited. Aim: To describe the clinical characteristics and disease course of PV in a real-life cohort of pts aged ≥80 years. Methods: Between 1/2000 and 06/2024, 125 consecutive pts aged ≥80 years were diagnosed with PV across nine hematology centers. These pts were enrolled in the retrospective and prospective databases of the Latial group for Ph-negative MPNs. Diagnoses were reviewed according to WHO 2022 criteria. Results: Main characteristics at diagnosis are shown in the Table. Bone marrow (BM) biopsy was performed in 18 of 114 evaluable pts (15.8%). Median JAK2 V617F allele burden was 38.8% (IQR 11.4–65). At diagnosis, symptoms were reported in 24 of 81 evaluable pts (29.6%), with pruritus present in 10 (41.6%). A history of thrombotic events was found in 33 pts (26.4%). Hydroxyurea (HU) was initiated in 121 pts, typically within one month from diagnosis (IQR 0.1–3.8). HU was discontinued in 23 pts (18.8%), mainly due to intolerance (16/23). Of these, only 3 pts (13%) received ruxolitinib as 2nd line therapy, while 13 (56.6%) received no further cytoreductive treatment. During follow-up, thrombotic events occurred in 11 pts (8.8%), and disease progression to fibrotic or blastic phase was observed in 4 cases. At the last follow-up, 34 pts had died, 33 were lost to follow-up, 58 were alive. The 60- and 120-month cumulative overall survival (OS) rates were 71% (95%CI 82.2–59.8) and 31.9% (95%CI 49.2–14.6), respectively. Conclusion: This real-life cohort study of very elderly PV patients reveals key insights into current clinical practice. BM biopsy was infrequently performed, and nearly all pts received HU promptly after diagnosis. However, there was a noticeable hesitancy in initiating 2nd line therapy with ruxolitinib following HU discontinuation. The high rate of pts lost to follow-up, likely due to challenges in accessing care, limits the robustness of survival analysis. Nevertheless, the observed OS was comparable to that of the general population in the same age group.  

Feifan Zhang, Zhiwei Sun, Zhenyu Zhang et al.

Abstract E2F family genes are common transcription factors, abnormal in several malignant tumors. However, their complex involvement in colorectal cancer, particularly in prognosis, immune infiltration, and mutational landscape, remains unclear. We conducted a study using gene expression data from the TCGA and GEO datasets to examine the abnormal expression of E2Fs in colorectal cancer. And we performed consensus clustering and differential gene expression analyses to identify E2Fs-related genes. Then, we used Lasso regression and multivariate Cox regression to create a prognostic risk model for colorectal cancer. We analyzed the differences between the E2Fs-based gene risk and various clinical characteristics, gene mutations, immune cell infiltration, immunotherapy responses, and drug sensitivity using clinicopathological data, single-cell RNA sequences, multiple immune algorithms. Finally, we have developed a prognostic risk model that includes FMO5, NDUFA11, LIPG, FIGNL1, MOGAT2, and GZMB. We observed significant differences in clinical characteristics, immune cell infiltration, gene mutation landscapes, immunotherapy responses, and drug sensitivity between the high-risk and low-risk groups. The novel E2Fs-based gene risk model shows significant potential for contributing to the evaluation of prognosis and predicting immunotherapeutic outcomes for colorectal cancer patients.

Paula-Anca Sulea, Ioan Tilea, Florin Stoica et al.

Background: Age-related vascular stiffening increases cardiovascular risk by altering ventricular–arterial coupling (VAC). Physical activity, a modifiable factor, may improve cardiovascular health. This pilot study evaluated the relationship between physical activity evaluation and VAC, measured by the carotid–femoral pulse wave velocity to global longitudinal strain (cfPWV/GLS) ratio, in a Romanian primary care cohort. Methods: The prospective cohort analysis was performed on 81 adults (49 females, mean age 50.27 ± 12.93 years). Physical activity was quantified through anamnesis using metabolic equivalents (METs) according with Compendium of Physical Activities, and patients were stratified into four groups: G1 (METs < 1.5, <i>n</i> = 39), G2 (METs = 1.5–2.9, <i>n</i> = 2), G3 (METs = 3–5.9, <i>n</i> = 23), and G4 (METs ≥ 6, <i>n</i> = 17). Demographic and echocardiographic data were recorded to explore associations between physical activity and VAC. Results: The cfPWV/GLS ratio differed significantly across groups (<i>p</i> = 0.012), with the lowest values present in the moderate-intensity group (G3). VAC ≥ 0.391 can predict sedentary lifestyles (AUC = 0.730; CI: 0.617–0.833, <i>p</i> > 0.001). Multivariate analysis revealed that age, arterial age, and hypertension independently predict VAC. Conclusions: Higher physical activity is inversely associated with VAC (cfPWV/GLS ratio) and can predict sedentary lifestyles. Encouraging moderate-to-vigorous exercise in primary care may improve cardiovascular function and aid prevention.

Jefferson W. Chen, Alex B. Valadka, M. Ross Bullock et al.

Ilana B. Richman, Taara V. Prasad, Cary P. Gross

Although national guidelines recommend lung cancer screening for adults at high risk, only a small proportion of eligible adults in the US have been screened. The goal of this study was to understand barriers to screening among a specific but important population: patients who have been referred for screening, but who have not completed the test. We used semi-structured interviews to explore barriers to screening among patients at two academic, safety-net primary care practices. We included patients who had been referred for screening at least 6 months prior but who had not completed the test. Among interviewees (N = 16) a consistent theme was a lack of knowledge about the purpose and process of screening. Despite being referred for lung cancer screening, participants expressed that they knew little about how screening was performed or what it was intended to achieve. Preferences and values also played a role in why some participants did not return for screening. Our findings suggest that lack of knowledge about screening is an important barrier to use, as patients are unlikely to prioritize a test if they know little about it.

Huapeng Lu, Qinling Yang, Fang Tian et al.

Objective. To study the association between sleep duration and the incidence of type 2 diabetes mellitus (T2DM) and to provide a theoretical basis for the prevention of T2DM through a meta-analysis. Methods. PubMed, Web of Science, Scopus, Embase, Cochrane Library, ProQuest, CNKI, Wanfang, VIP, and SINOMED were searched from their inception until May 2020. All cohort studies on the relationship between sleep duration and T2DM in adults were included. According to the inclusion and exclusion criteria, two authors independently assessed the literature and extracted the data. Metaregression and publication bias were evaluated, and sensitivity and meta-analyses were conducted with RevMan 5.3. Results. A total of 17 studies were collected, involving 737002 adults. The incidence of T2DM was 4.73% in short sleep duration (SSD) (t≤6 h), 4.39% in normal sleep duration (NSD) (6 h<t<9 h), and 4.99% in long sleep duration (LSD) (t≥9 h). The meta-analysis demonstrated that SSD increased the risk of T2DM compared with NSD (RR=1.22, 95% CI: 1.15-1.29, P<0.001), LSD increased the risk of T2DM compared with NSD (RR=1.26, 95% CI: 1.15-1.39, P<0.001), and the risk of T2DM has no significant difference between SSD and LSD (RR=0.97, 95% CI: 0.89-1.05, P=0.41). The sensitivity of each study was robust and the publication bias was weak. Conclusion. SSD or LSD can increase the risk of T2DM.

Alexandre Perez, Elles van derLouw, Janak Nathan et al.

Abstract Background Diffuse intrinsic pontine glioma (DIPG) is one of the most devastating diseases among children with cancer, thus novel strategies are urgently needed. Aims We retrospectively evaluated DIPG patients exposed to the carbohydrate restricted ketogenic diet (KD) with regard of feasibility, safety, and overall survival (OS). Methods and results Searches of MEDLINE and Embase identified five hits meeting the search criteria (diagnosis of DIPG and exposure to KD). One additional case was identified by contact with experts. Individual patient data were extracted from publications or obtained from investigators. The inclusion criteria for analysis of the data were defined as DIPG patients who were exposed to the KD for ≥3 months. Feasibility, as described in the literature, was the number of patients able to follow the KD for 3 months out of all DIPG patients identified. OS was estimated by the Kaplan‐Meier method. Five DIPG patients (males, n = 3; median age 4.4 years; range, 2.5‐15 years) meeting the inclusion criteria were identified. Analysis of the available data suggested that the KD is generally relatively well tolerated. Only mild gastro‐intestinal complaints, one borderline hypoglycemia (2.4 mmol/L) and one hyperketosis (max 7.2 mmol/L) were observed. Five out of six DIPG patients identified adhered for ≥3 months (median KD duration, 6.5 months; range, 0.25‐2 years) to the diet. The median OS was 18.7 months. Conclusion Our study provides evidence that it may be feasible for pediatric DIPG patients to adhere for at least 3 months to KD. In particular cases, diet modifications were done. The clinical outcome and OS appear not to be impacted in a negative way. KD might be proposed as adjuvant therapy when large prospective studies have shown feasibility and safety. Future studies might ideally assess the impact of KD on clinical outcome, quality of life, and efficacy.

Javadi V, Shiari R, Rahmani K et al.

Vadood Javadi,1 Reza Shiari,1 Khosro Rahmani,1 Nazanin Farahbakhsh2 1Pediatric Rheumatology Department, Mofid Children&rsquo;s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Pediatric Pulmonology Department, Mofid Children&rsquo;s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IranCorrespondence: Reza ShiariMofid Children&rsquo;s Hospital, Shariati Ave, Tehran, IranTel/Fax +982122227033Email shiareza@yahoo.comAbstract: Kawasaki disease is a mysterious childhood vasculitis. It presents with multi-systemic involvement in which the prolonged high-grade fever and mucocutaneous and lymph node manifestations are the prominent features. Sometimes, the disease has an unusual, atypical or incomplete presentation. Herein, we present a child with hilar lymphadenopathy as a manifestation of Kawasaki disease.Keywords: Kawasaki disease, children, lymphadenopathy, pulmonary, mediastinum

Rong Zhang, Yonghao Xu, Ling Sang et al.

Abstract Background Intraoperative Extracorporeal membrane oxygenation (ECMO) is increasingly being applied as life-support for lung transplantation patients. However, factors associated with this procedure in lung transplantation patients have not yet been characterized. The aim of this study was to identify preoperative factors of intraoperative ECMO support during lung transplantation and to evaluated the outcome of lung transplantation patients supported with ECMO. Methods Patients underwent lung transplantation treated with and without ECMO in Guangzhou Institute of Respiratory Diseases between January 2015 to August 2018 were retrospectively reviewed. Patient demographics and clinical variables were collected and analyzed. Multivariate logistic regression was performed to identify factors independently associated with intraoperative extracorporeal membrane oxygenation support during lung transplantation. Results During the study period, 138 patients underwent lung transplantation at our institution, the mean LAS was (56.63 ± 18.39) (range, 32.79 to 88.70). Fourty four patients were treated with veno-venous/veno-arterial ECMO. Among the patients, 32 patients wean successfully ECMO after operation, 12 patients remain ECMO after operation, and 32 patients (62.74%) survived to hospital discharge. In multiple analysis, the following factors were associated with intraoperative ECMO support: advanced age, high PAP before operation, duration of mechanical ventilation before operation, a higher APACHE II and primary diagnosis for transplantation. The overall survival rates at 1, 3, and 12 months were 90.91, 72.73, and 56.81% in the ECMO group, and 95.40, 82.76, and 73.56% in the non-ECMO group, respectively (log-rank P = 0.081). Patients who underwent single lung transplant had a lower survival rates in ECMO group as compared with non-ECMO group at 1, 3, and 12 months (90.47% vs 98.25, 71.43% vs 84.21, and 52.38% vs 75.44%) (log-rank P = 0.048). Conclusions The preoperative factors of intraoperative ECMO support during lung transplantation included age, high PAP before operation, preoperative mechanical ventilation, a higher APACHE II and primary diagnosis for transplantation based on multivariate analysis.

Hong Jun Kim, Suk-young Lee, Dae Sik Kim et al.

Background/Aims Patients with pancreatic cancer (PC) generally have poor clinical outcomes. Early determination of their prognosis is crucial for developing a therapeutic strategy. Recently, various inflammatory markers have been validated as prognostic indicators for many cancers, including PC. However, few studies have evaluated these markers together. Thus, the purpose of this study was to comprehensively evaluate the value of inflammatory markers as prognostic indicators in patients with advanced PC treated with gemcitabine-based chemotherapy as the first line regimen. Methods This was a single-center retrospective study evaluating 302 patients with advanced PC who began first line treatment between November 2004 and August 2016. These patients were monitored until June 2017. Survival rates were assessed with univariate and multivariate analyses. Continuous variables were separated using the normal range or ideal cut-off levels determined by receiver operating curve analyses. Results Among inflammatory markers evaluated, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and C-reactive protein (CRP) to albumin ratio (CRP-albumin ratio) were independent predictors of overall survival (hazard ratio, 1.712, 1.345, and 1.454, respectively). Difference in survival rates was significant (p < 0.001) among three groups divided by the number of marker-related risks. Conclusions Baseline inflammatory markers including NLR, PLR, and CRP-albumin ratio are useful in predicting survival rates in patients with PC. Combining these three markers is proven to be valuable.

Ann-Christine Persson, Inga-Lill Boman, Lena Dahlberg et al.

Abstract Background: There is lack of knowledge on how occupational therapists (OTs) assess daily time management (DTM) for persons with dementia (PwDs) and on which aspects affect prescription of time assistive technology (AT). Aim: To explore OTs’ experiences of assessing the need for and prescribing time AT for PwDs. Material and methods: Focus group interviews with OTs that prescribe time AT for PwDs analyzed via qualitative content analysis. Results: A main category and four categories were identified. The categories illustrated a complex and time-consuming prescription process, which was facilitated if the PwD was supported by a significant other (SO). Support from a SO was especially important during implementation and follow-up. OTs had to take individual responsibility for staying informed about time AT. Organizational limitations and time constraints were barriers for OTs striving to work according to national prescription guidelines. Conclusions and significance: High demands are made on SO’s participation during the prescription process. PwDs with no support from SOs are at risk not receiving or fully benefitting from time AT. To avoid inequalities, specific forms of support need to be developed and targeted at PwDs without SOs to ensure that they have sufficient opportunities to access and use time AT.

Magdali del Rocío Murillo Bacilio, Araceli Miroslava Palta González, María Isabel León Pesántez et al.

Introducción: La neoplasia pseudopapilar sólida del páncreas es una patología poco frecuente, que se presenta en mujeres jóvenes y es de comportamiento incierto. La prevalencia es del 1-2% y el tratamiento es quirúrgico. En el presente caso se describe a una paciente de sexo femenino de 10 años de edad que muestra esta patología y su correspondiente manejo. Caso clínico: Paciente de sexo femenino, de 10 años de edad, con antecedentes de una nefrectomía hace 6 años por hidronefrosis, refiere dolor abdominal localizado en egigastrio tipo cólico y pérdida de peso. En los estudio de imagen a nivel peritoneal se observa lesión de aspecto ocupativo de tipo sólido neoplásico con área central de probable necrosis y que desplaza en sentido posterior  al páncreas así como al estómago y se asocia con adenomegalias peritoneales y retroperitoneales. Evolución: La paciente fue sometido a una espleno-pancreatectomía distal. El estudio anatomo-patológico concluyó en neuplasia pseudo papilar sólida del páncreas. Continúa en valoración por consulta externa. Conclusión: Neoplasia Pseudopapilar sólida del Páncreas debe ser sospechada en pacientes con una masa sólida o quística pancreática con un estudio de imágenes compatibles.

Rebeca Eriksen, Rachel Gibson, Maria Aresu et al.

Abstract Introduction Type 2 diabetes (T2D) is multifactorial involving lifestyle, environmental and genetic risk factors. This study aims to investigate the impact of genetic interactions with alcohol and diet quality on glycated haemoglobin A1c (HbA1c) independent of obesity, in a British population. Methods Cross‐sectional study of 14 089 white British participants from Airwave Health Monitoring Study and a subsample of 3733 participants with dietary data. A T2D genetic risk score (GRS) was constructed, and its interactions with diet on HbA1c were assessed. Results GRS was associated with a higher HbA1c% (β = 0.03, P < 0.0001) and a higher risk of prediabetes (OR = 1.09, P < 0.0001) and T2D (OR = 1.14, P = 0.006). The genetic effect on HbA1c% was significantly higher in obese participants (β = 1.88, Pinteraction = 0.03). A high intake of wholegrain attenuated the effect on HbA1c% in high‐risk individuals Pinteraction = 0.04. Conclusion The genetic effect on HbA1c was almost doubled in obese individuals, compared with those with a healthy weight, and independent of weight, there was a modest offset on HbA1c in high‐genetic‐risk individuals consuming a diet high in wholegrain. This supports the importance of a healthy diet high in wholegrains and along with maintaining a healthy weight in controlling HbA1c among high‐genetic‐risk groups.

Sang Hoon Lee, M. Park, B. Park et al.

1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Republic of Korea 2Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Inchon-ro, Seongbuk-gu, Seoul 136-705, Republic of Korea

Wally R. Smith, J. Betancourt, M. Wynia et al.

Ali eBaioui, Ali eBaioui, Ali eBaioui et al.

BackgroundPatients with obsessive-compulsive disorder (OCD) have highly idiosyncratic triggers. To fully understand which role this idiosyncrasy plays in the neurobiological mechanisms behind OCD, it is necessary to elucidate the impact of individualization regarding the applied investigation methods.This functional magnetic resonance imaging (fMRI) study explores the neural correlates of contamination/washing-related OCD with a highly individualized symptom provocation paradigm. Additionally, it is the first study to directly compare individualized and standardized symptom provocation. MethodsNineteen patients with washing compulsions created individual OCD hierarchies, which later served as instructions to photograph their own individualized stimulus sets. The patients and 19 case-by-case matched healthy controls participated in a symptom provocation fMRI experiment with individualized and standardized stimulus sets created for each patient. ResultsOCD patients compared to healthy controls displayed stronger activation in the basal ganglia (nucleus accumbens, nucleus caudatus, pallidum) for individualized symptom provocation. Using standardized symptom provocation, this group comparison led to stronger activation in the nucleus caudatus. The direct comparison of between-group effects for both symptom provocation approaches revealed stronger activation of the orbitofronto-striatal network for individualized symptom provocation.ConclusionsThe present study provides insight into the differential impact of individualized and standardized symptom provocation on the orbitofronto-striatal network of OCD washers. Behavioral and neural responses imply a higher symptom-specificity of individualized symptom provocation.

D. Forsythe, B. Buchanan, J. Osheroff et al.