The Journal Of International Medical Research[JOURNAL]
Sun
200 papers
Point-of-care ultrasound for central venous catheter confirmation and complications in the emergency department: A systematic review and meta-analysis.
Zhu X, Yang G, Jin Y … +6 more , Ye Y, Lin J, Tang M, Chen L, Chen W, Wang X
J Int Med Res · 2026 Apr · PMID 41968084 · Full text
BackgroundCentral venous catheter malposition and pneumothorax remain clinically important complications after insertion. Many emergency departments still rely on post-procedural chest radiography, which may delay cathet...
BackgroundCentral venous catheter malposition and pneumothorax remain clinically important complications after insertion. Many emergency departments still rely on post-procedural chest radiography, which may delay catheter use. We evaluated the diagnostic accuracy and workflow impact of point-of-care ultrasound for confirming central venous catheter position and detecting complications in the emergency department.MethodsWe conducted a systematic review and diagnostic test accuracy meta-analysis (International Prospective Register of Systematic Reviews (PROSPERO): CRD420251065638) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Test Accuracy Studies (PRISMA-DTA) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The PubMed, Embase, Cochrane Library, Web of Science Core Collection, and Scopus databases were searched from inception to 1 December 2025. Studies were considered eligible for inclusion if they enrolled adults undergoing internal jugular or subclavian central venous catheter insertion in emergency department settings and compared bedside point-of-care ultrasound (cardiac/contrast-enhanced "swirl/bubble" techniques and/or lung ultrasound) with chest radiography and/or computed tomography. For catheter malposition, pooled sensitivity and specificity were estimated using a bivariate random-effects model; pneumothorax accuracy and time outcomes were summarized descriptively due to sparse events.ResultsA total of eight prospective studies (801 central venous catheter insertions) were included. Seven studies contributed estimable 2 × 2 data for malposition. Point-of-care ultrasound showed pooled sensitivity of 0.81 (95% confidence interval: 0.50-0.95) and specificity of 0.99 (95% confidence interval: 0.96-1.00), with hierarchical summary receiver operating characteristic-area under the curve of 0.99 (95% confidence interval: 0.97-0.99), positive likelihood ratio of 137.83 (95% confidence interval: 22.04-862.02), negative likelihood ratio of 0.19 (95% confidence interval: 0.06-0.62), and diagnostic odds ratio of 737.34. Heterogeneity was substantial (I: sensitivity = 73.85% and specificity = 83.37%). Pneumothorax specificity was consistently high (97.2%-100%), while sensitivity varied and was often nonestimable in zero-event studies. Pneumothorax severity was rarely reported in the primary studies. Reported time savings versus chest radiography ranged from ∼5-284 min (commonly ∼20-60 min). Deeks' test suggested no significant publication bias ( = 0.86), although power was limited.ConclusionsIn emergency department settings, point-of-care ultrasound provides highly specific and rapid confirmation for detecting central venous catheter malposition, supporting prompt rule-in decisions and potential workflow acceleration. Given heterogeneous sensitivity and limitations of reference standards, negative results should be interpreted cautiously, with confirmatory imaging reserved for equivocal examinations or high-risk scenarios.
Irreducible inguinal hernia containing a noncommunicating rudimentary uterine horn: A case report.
Lan H, Li G, Zhou L … +2 more , Lv J, Huang X
J Int Med Res · 2026 Apr · PMID 41968083 · Full text
Müllerian duct anomalies presenting within an inguinal hernia are exceptionally rare in adult women. We report a case of an irreducible inguinal hernia containing a noncommunicating (type III) rudimentary uterine horn wi...
Müllerian duct anomalies presenting within an inguinal hernia are exceptionally rare in adult women. We report a case of an irreducible inguinal hernia containing a noncommunicating (type III) rudimentary uterine horn with the ipsilateral fallopian tube and discuss its diagnosis and management. A woman in her 40s (gravida2 para1) presented with a 20-year history of a painless, irreducible mass in her right inguinal region. Physical examination revealed a firm, fixed, nontender solid mass measuring approximately 3 × 4 cm, while pelvic examination was unremarkable. Ultrasonography indicated a unicornuate uterus with a contralateral solid mass, and pelvic magnetic resonance imaging subsequently identified a noncommunicating rudimentary uterine horn with the right fallopian tube herniating into the inguinal canal, which was confirmed during laparoscopic exploration. Laparoscopic transabdominal preperitoneal hernia repair was performed, involving excision of the herniated rudimentary horn and ipsilateral fallopian tube followed by a tension-free repair. The operative time was 95 min with an estimated blood loss of <50 mL, and the postoperative recovery course was uneventful. This case highlights that congenital Müllerian duct anomalies should be considered in the differential diagnosis of irreducible inguinal masses in adult women. Magnetic resonance imaging is the imaging modality of choice, and laparoscopic transabdominal preperitoneal repair enables simultaneous management of the hernia and associated anomalies, facilitating individualized intraoperative decisions regarding the round ligament.
Association between serum vitamin D levels and functional outcomes in ischemic stroke patients: A systematic review and meta-analysis.
Zhou Y, Peng Y, Li Z … +5 more , Ta W, Chen Q, Zhao T, Mao G, Wei H
J Int Med Res · 2026 Apr · PMID 41968082 · Full text
ObjectiveTo evaluate the correlation between serum vitamin D levels and neurological function prognosis, including the overall cognitive level, in patients with ischemic stroke in a meta-analysis using Pearson or Spearma...
ObjectiveTo evaluate the correlation between serum vitamin D levels and neurological function prognosis, including the overall cognitive level, in patients with ischemic stroke in a meta-analysis using Pearson or Spearman correlation coefficients.MethodsPubMed, Cochrane Library, Web of Science, and Embase databases were searched for relevant studies published from inception to June 2025. Stata version 16.0. was used to conduct the meta-analysis.ResultsA total of fifteen studies involving 2030 participants aged 18-94 years were included. The meta-analysis demonstrated a significant inverse association between serum vitamin D levels and stroke severity and outcomes, as reflected by the admission Modified Rankin Scale score, admission National Institutes of Health Stroke Scale score, and Modified Rankin Scale score at 3 months (combined Fisher's Z/r: -0.37/-0.35, 95% confidence interval: -0.68 to -0.06; -0.46/-0.43, 95% confidence interval: -0.55 to -0.37; and -0.21/-0.21, 95% confidence interval: -0.38 to -0.05, respectively). Higher serum vitamin D levels may be positively correlated with post-stroke cognitive improvement (combined Fisher's Z = 0.34, 95% confidence interval: 0.24 to 0.45).ConclusionSerum vitamin D levels in patients with ischemic stroke were significantly negatively correlated with neurological function prognosis and, possibly, better cognitive outcomes.
Pseudohypoparathyroidism in a Chinese girl: A case report.
Zhao XM, Yang JR, Yin H … +2 more , Yang CQ, Song Y
J Int Med Res · 2026 Apr · PMID 41968081 · Full text
Pseudohypoparathyroidism is a rare genetic disorder characterized by hypocalcemia, hyperphosphatemia, and elevated serum intact parathyroid hormone levels. The taxonomy of pseudohypoparathyroidism is intricate, with hete...
Pseudohypoparathyroidism is a rare genetic disorder characterized by hypocalcemia, hyperphosphatemia, and elevated serum intact parathyroid hormone levels. The taxonomy of pseudohypoparathyroidism is intricate, with heterogeneous clinical presentations and lack of specificity. A school-age Chinese girl was admitted with a 2-day history of fever and a single episode of seizure, with no clinical features of Albright hereditary osteodystrophy. Physical examination revealed positive Chvostek's and Trousseau's signs, with no other significant abnormalities. Laboratory tests revealed hypocalcemia, elevated intact parathyroid hormone levels, and transient hypokalemia (2.8 mmol/L). Whole-exome sequencing showed a 2.1-Kb deletion of exons 4-6 in syntaxin 16 (); however, her parents did not exhibit any such alterations. The patient was finally diagnosed with pseudohypoparathyroidism and administered calcium gluconate perfusion, calcitriol, and elemental calcium. After discharge, her calcitriol and elemental calcium dosages were gradually tapered in the outpatient setting. By the 1-year follow-up, hypocalcemia had been largely corrected; however, her intact parathyroid hormone level remained above the normal reference range. This case of sporadic pseudohypoparathyroidism type Ib with a 2.1-Kb deletion underscores that pseudohypoparathyroidism can present as fever-induced seizure with transient hypokalemia, highlighting the importance of metabolic and genetic screening in children who experience seizures.
Relationship between A Body Shape Index and sleep disorders among the U.S. population: A cross-sectional analysis of the National Health and Nutrition Examination Survey data.
Liu A, Li Y, Zhang X … +4 more , Lv N, Yang HL, Hao C, Wu D
J Int Med Res · 2026 Apr · PMID 41968080 · Full text
BackgroundAccumulating evidence suggests that sleep disorders are strongly associated with obesity, particularly visceral adiposity. A Body Shape Index has been recognized as a more accurate anthropometric indicator for...
BackgroundAccumulating evidence suggests that sleep disorders are strongly associated with obesity, particularly visceral adiposity. A Body Shape Index has been recognized as a more accurate anthropometric indicator for assessing overall obesity and visceral fat levels. This study aimed to explore the potential relationship between obesity and sleep disorders in a representative sample of the U.S. adult population.MethodsThis retrospective study involved data from 25,057 adults aged 20 years and older who participated in the National Health and Nutrition Examination Survey between 2005 and 2016. Multivariate logistic regression models, restricted cubic spline analysis, and subgroup stratification were used to analyze the association between A Body Shape Index and sleep disorders.ResultsAmong the 25,057 participants, 6310 reported experiencing sleep disorders. After adjusting for potential confounders, the results revealed that a unit increase in A Body Shape Index was associated with a 10% higher likelihood of sleep disorders (odds ratio = 1.1, 95% confidence interval: 1.02-1.18, p<0.05). When A Body Shape Index was categorized into tertiles, individuals in the highest tertile exhibited a significantly higher prevalence of sleep disorders compared with those in the lowest tertile (odds ratio = 1.13, 95% confidence interval: 1.04-1.23, p <0.05). Restricted cubic spline analysis revealed a nonlinear relationship between A Body Shape Index and sleep disorders (p=0.004). Additionally, subgroup analysis demonstrated a statistically significant interaction between age and A Body Shape Index categories (p<0.05).ConclusionThese findings demonstrate a positive association between A Body Shape Index and the prevalence of sleep disorders. A Body Shape Index may serve as a practical and simple anthropometric marker for identifying individuals at increased risk of sleep disorders.
Real-world treatment of hyperkalemia among patients in emergency department in China (POETRY-E): A study protocol for multicenter, prospective, observational study.
Yangyang F, Yao W, Yili D … +5 more , Miao G, Huadong Z, Xuezhong Y, Jun X, Zhaoxing T
J Int Med Res · 2026 Apr · PMID 41968079 · Full text
ObjectiveHyperkalemiaF is associated with fatal cardiac arrhythmias, all-cause mortality, and frequent emergency department visits among patients with hyperkalemia. A recent Chinese epidemiological study suggested that t...
ObjectiveHyperkalemiaF is associated with fatal cardiac arrhythmias, all-cause mortality, and frequent emergency department visits among patients with hyperkalemia. A recent Chinese epidemiological study suggested that the severity of hyperkalemia increases with comorbidities. Diagnosis, testing, and overall management of patients with hyperkalemia in the emergency department require strengthening. However, the lack of evidence from the emergency department and consensus guidelines has led to poorly characterized treatment patterns for hyperkalemia. The present study will evaluate the real-world effectiveness of different treatment options among patients with hyperkalemia in the emergency department across China.MethodsThis multicenter, prospective, observational study plans to collect primary data from 600 patients diagnosed with hyperkalemia who present to the emergency department in 15-20 tertiary hospitals across China. Patients aged ≥18 years with serum potassium levels ≥5.5 mmol/L will be included. Patients previously enrolled in any other clinical study within 3 months before enrollment will be excluded. Eligible patients will be enrolled, assessed at baseline, and followed up until discharge from the emergency department or death. The primary objective will be to determine the real-world effectiveness of potassium-lowering treatment (monotherapy/combination therapy), calculated as the mean change in serum potassium levels from baseline to 5 ± 1 h after treatment initiation. The secondary objectives will assess the clinical burden, calculated as the number of patients with baseline serum potassium levels ((5.5, 6.0), (6.0, 6.5), (6.5, 7.0), and (≥7.0) mmol/L), real-world treatment patterns, serum potassium testing, and the duration between baseline testing and treatment initiation. Exploratory objectives will further evaluate clinical outcomes among patients with different baseline serum potassium levels as described above and the proportion of patients recovering to normal serum potassium levels.DiscussionThe POETRY-E study is the first prospective observational study to evaluate the real-world effectiveness of different potassium-lowering treatment regimens among patients with hyperkalemia in the Chinese emergency department setting. This study addresses the overall burden and management among patients with hyperkalemia in China. Name of the Registry: Chinese Clinical Trial Registry ChiCTR2100053100.
Somatosensory evoked potential monitoring for position-related brachial plexus injury during cerebellopontine angle tumor resection: A retrospective cohort study.
Jiang X, Yin Y, Hou X … +2 more , Liu J, Li P
J Int Med Res · 2026 Apr · PMID 41963095 · Full text
ObjectiveTo evaluate the utility of intraoperative somatosensory evoked potential monitoring for detecting position-related brachial plexus injury during cerebellopontine angle tumor resection, identify independent risk...
ObjectiveTo evaluate the utility of intraoperative somatosensory evoked potential monitoring for detecting position-related brachial plexus injury during cerebellopontine angle tumor resection, identify independent risk factors, and assess the effectiveness of somatosensory evoked potential-guided interventions.MethodsThis retrospective cohort study included 45 patients who underwent cerebellopontine angle microsurgery in the lateral or semilateral position. Median nerve somatosensory evoked potentials were continuously monitored. Patients were stratified according to somatosensory evoked potential changes. Clinical characteristics, surgical variables, and protective positioning measures were compared. Cox regression was performed to identify independent risk factors.ResultsSomatosensory evoked potential alterations occurred in 14 patients (31.1%). Following repositioning, 13 patients recovered intraoperatively; 9 patients returned to baseline within 46-110 min (mean, 64 ± 20.5 min) and 4 patients within 2 h. Changes in latency and threshold across time points were statistically significant (p<0.01 and p<0.0001, respectively). One patient without somatosensory evoked potential recovery developed mild, transient symptoms that resolved within 5 weeks. Independent risk factors included age ≥60 years (hazard ration = 2.78), body mass index ≥25 kg/m (hazard ration = 3.02), operative time ≥5 h (hazard ration = 3.65), intraoperative temperature <36.5°C (hazard ration = 2.31), and absence of protective positioning (hazard ration = 3.87) (all p<0.05).ConclusionsOur findings suggest that routine somatosensory evoked potential monitoring during lateral decubitus cerebellopontine angle tumor resection may help mitigate brachial plexus injury and improve surgical safety.
Association between cardiometabolic index and high-sensitivity C-reactive protein: A cross-sectional study from National Health and Nutrition Examination Survey 2015 to 2018.
Yan Y, Tang Y
J Int Med Res · 2026 Apr · PMID 41963094 · Full text
ObjectiveHigh-sensitivity C-reactive protein, a key inflammatory biomarker, can indicate the risk of cardiovascular diseases. The cardiometabolic index has been associated with metabolic and cardiovascular outcomes; howe...
ObjectiveHigh-sensitivity C-reactive protein, a key inflammatory biomarker, can indicate the risk of cardiovascular diseases. The cardiometabolic index has been associated with metabolic and cardiovascular outcomes; however, its direct relationship with high-sensitivity C-reactive protein remains unclear. This study aimed to explore this association and identify influencing factors in adult population.MethodsThis retrospective cross-sectional study used data from the 2015-2018 National Health and Nutrition Examination Survey. A multivariate logistic regression model was applied to assess the association between cardiometabolic index and high-sensitivity C-reactive protein levels (>3.0 mg/L) in 3970 adults, with adjustment for demographic characteristics, comorbidities, and lifestyle factors.ResultsCardiometabolic index was independently associated with high-risk high-sensitivity C-reactive protein (adjusted odds ratio = 1.11, 95% confidence interval: 1.03-1.19, p = 0.007). Subgroup analyses indicated that the association was more pronounced in females and non-Hispanic Black participants (p values for interaction were <0.001 and 0.004, respectively). Restricted cubic spline curves confirmed a nonlinear relationship between cardiometabolic index and high-risk high-sensitivity C-reactive protein (nonlinearity p < 0.001).ConclusionCardiometabolic index demonstrated a significant positive association with high-risk high-sensitivity C-reactive protein in US adults, serving as a marker linking cardiometabolic status to chronic inflammation. Further studies are needed to validate causality and explore cardiometabolic index-guided prevention.
Demographics and mortality trends of hypertensive heart failure in the United States, 2006-2020: Insights from the CDC WONDER database.
Faizan M, Singh P, Haleem SM … +8 more , Zaman A, Humayun MA, Mubariz M, Faisal AR, Akhtar FN, Laiba F, Maity R, Dhali A
J Int Med Res · 2026 Apr · PMID 41956996 · Full text
ObjectiveTo comprehensively examine hypertension- and heart failure-related mortality rates in the United States to develop a targeted approach to health policy development.MethodsWe analyzed death certificates from the...
ObjectiveTo comprehensively examine hypertension- and heart failure-related mortality rates in the United States to develop a targeted approach to health policy development.MethodsWe analyzed death certificates from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database, focusing on mortality caused by hypertensive heart failure in adults aged ≥25 years from 2006 to 2020. Age-adjusted mortality rates per 1,000,000 and annual percent changes were calculated and categorized by year, sex, race, urban status, age group, and census region.ResultsA total of 268,545 deaths occurred due to hypertensive heart failure between 2006 and 2020. The overall age-adjusted mortality rates increased from 60.5 in 2006 to 134.9 in 2020. Males had higher age-adjusted mortality rates than women (76.6 vs. 73.8). Older-aged people exhibited significantly higher age-adjusted mortality rates than young and middle-aged adults. Age-adjusted mortality rates were highest in non-Hispanic Blacks/African Americans and lowest in non-Hispanic Asians/Pacific Islanders (126.8-43.6). Furthermore, age-adjusted mortality rates were highest in individuals from nonmetropolitan areas and the Western region.ConclusionFollowing a period of decline, the age-adjusted mortality rates increased until 2020. The highest age-adjusted mortality rates were observed in non-Hispanic Blacks and nonmetropolitan areas. An urgent restructuring of healthcare policy is needed to reduce heart failure-associated mortality.
Evaluating the impact of statin therapy on chronic obstructive pulmonary disease outcomes: A retrospective cohort study from a tertiary care hospital in India.
Chari HS, Padukone AM, Magazine R … +3 more , Chakravarthy PK, Kalra A, Chogtu B
J Int Med Res · 2026 Apr · PMID 41956995 · Full text
ObjectiveChronic obstructive pulmonary disease is a common condition marked by significant disability and frequent exacerbations. Statins, owing to their anti-inflammatory and immunomodulatory effects, may offer therapeu...
ObjectiveChronic obstructive pulmonary disease is a common condition marked by significant disability and frequent exacerbations. Statins, owing to their anti-inflammatory and immunomodulatory effects, may offer therapeutic benefits in chronic obstructive pulmonary disease management. This retrospective cohort study evaluated the impact of statin use on chronic obstructive pulmonary disease outcomes in a subset of Indian population.MethodsPatients diagnosed with chronic obstructive pulmonary disease from January 2015 to December 2019 were divided into two equal groups of 83 patients each: statin users and nonusers. Primary outcomes included the annual exacerbation rate and number of hospitalizations, while secondary outcomes assessed exacerbation severity, emergency room visits, and duration of hospital stay over 1 year.ResultsStatin users showed a lower annual exacerbation rate (2.98 ± 1.9) compared to nonusers (3.51 ± 2.1), although this difference was not statistically significant (p = 0.058). Similarly, statin users had fewer hospitalizations (173 vs. 186; p = 0.493). However, the total duration of inpatient stays was significantly reduced in the statin group (1343 vs. 1518 days; p = 0.001). Outpatient and emergency visits were also lower among statin users, although these differences were not statistically significant.ConclusionStatin use in patients with chronic obstructive pulmonary disease exhibited a trend toward improved outcomes, particularly in reducing hospital stay duration, suggesting potential benefits that warrant further investigation.
Correlation of E-cadherin, vimentin, CD206, programmed cell death receptor 1, and programmed cell death ligand 1 expressions with clinicopathological factors and prognosis in oral squamous cell carcinoma.
Lai ZY, Ma J, Yin JY … +3 more , Zhu XA, Zhou JP, Tao DT
J Int Med Res · 2026 Apr · PMID 41956994 · Full text
ObjectiveOral squamous cell carcinoma is the most common malignant tumor occurring in the head and neck region. Current treatment principles are based on radical surgery, supplemented by radiotherapy and chemotherapy. Ho...
ObjectiveOral squamous cell carcinoma is the most common malignant tumor occurring in the head and neck region. Current treatment principles are based on radical surgery, supplemented by radiotherapy and chemotherapy. However, the 5-year survival rate for patients remains approximately 50%. Therefore, further research into the molecular mechanisms underlying oral squamous cell carcinoma development is needed to identify more effective treatment methods.MethodsIn this study, immunohistochemical techniques were used to quantitatively analyze the expression levels of E-cadherin, vimentin, CD206, programmed cell death receptor 1 (PD-1), and programmed cell death ligand 1 (PD-L1) in 45 pathological sections of oral squamous cell carcinoma. The results showed that the expression levels of vimentin, CD206, and programmed cell death ligand 1 were significantly associated with overall survival. Additionally, Cox multivariate analysis indicated that the M2 macrophage marker, CD206, is an independent risk factor for poor prognosis in oral squamous cell carcinoma. Furthermore, correlation analysis revealed that E-cadherin expression was negatively correlated with vimentin, CD206, and programmed cell death ligand 1 expression levels. Vimentin expression was positively correlated with programmed cell death receptor 1 and programmed cell death ligand 1 expressions.ResultsImmunohistochemical examination indicated that M2 macrophages are an independent risk factor for poor prognosis in oral squamous cell carcinoma and are closely associated with overall survival. Furthermore, they may influence the development and progression of oral squamous cell carcinoma tumors by inducing epithelial-mesenchymal transition in oral squamous cell carcinoma tumor cells. Third, programmed cell death ligand 1 expression has an adverse impact on oral squamous cell carcinoma prognosis and is significantly correlated with the expression levels of CD206, E-cadherin, and vimentin.ConclusionsThis study indicates that programmed cell death receptor 1/programmed cell death ligand 1 and CD206 expressions are independent risk factors for poor oral squamous cell carcinoma prognosis; however, whether programmed cell death receptor 1/programmed cell death ligand 1 expression influences the occurrence and development of oral squamous cell carcinoma through M2 macrophages requires further investigation.
Half-duration tourniquet plus intra-articular tranexamic acid injection reduces blood loss and improves early recovery after total knee arthroplasty.
Liu F, He B, Wang F … +3 more , Wang X, Jia S, Wang N
J Int Med Res · 2026 Apr · PMID 41954189 · Publisher ↗
BackgroundTotal knee arthroplasty is often complicated by perioperative blood loss. Tourniquets reduce visible bleeding; however, prolonged use may increase hidden blood loss. Intra-articular tranexamic acid may enhance...
BackgroundTotal knee arthroplasty is often complicated by perioperative blood loss. Tourniquets reduce visible bleeding; however, prolonged use may increase hidden blood loss. Intra-articular tranexamic acid may enhance hemostasis without increasing the risk.MethodsWe retrospectively analyzed 85 unilateral primary total knee arthroplasties for osteoarthritis (September 2022 to March 2025). All patients received 1 g intravenous tranexamic acid before incision and were nonrandomly assigned to either of three groups based on evolving institutional protocols and surgeon discretion during the study period as follows: (a) Group A (full-duration tourniquet, n = 28); (b) Group B (half-duration tourniquet, n = 27); and (c) Group C (half-duration tourniquet plus 2 g intra-articular tranexamic acid, n = 30). The primary outcome was postoperative day 3 hemoglobin level; secondary outcomes were calculated blood loss, transfusion, pain scores, early Hospital for Special Surgery knee score (function), and perioperative complications.ResultsA total of eighty-five unilateral primary total knee arthroplasties were analyzed (Group A, n = 28; Group B, n = 27; and Group C, n = 30). Baseline variables were comparable across the three groups. On postoperative day 3, hemoglobin level was highest in Group C (10.97 ± 0.69 g/dL) compared with those in Groups A (9.89 ± 0.80) and B (10.05 ± 0.58) (overall 0.001; Groups C vs. A/B, both 0.001). Total blood loss decreased stepwise (Group A, 1403 ± 136 mL; Group B, 1163 ± 124 mL; and Group C, 770 ± 121 mL; all pairwise 0.001); a similar pattern was observed for hidden blood loss (Group A, 1388 ± 137 mL; Group B, 929 ± 128 mL; and Group C, 529 ± 121 mL; all pairwise 0.001). Intraoperative blood loss was lowest in Group A (median 15 mL) compared with those in Groups B (220 mL) and C (230 mL) (0.001). Transfusion rates were 28.6% in Group A, 14.8% in Group B, and 3.3% in Group C (overall = 0.024). Postoperative pain, as indicated by visual analog scale scores, was lowest in Group C (scores on postoperative days 1 and 3: 4.95 ± 0.85 and 3.57 ± 0.61, respectively) compared with those in Groups B (scores on postoperative days 1 and 3: 6.02 ± 1.22 and 4.63 ± 0.87, respectively) and A (scores on postoperative days 1 and 3: 7.86 ± 0.85 and 6.54 ± 1.00, respectively) (both time points 0.001). Based on a comparison of the Hospital Special Surgery knee scores of the three groups, Group C demonstrated superior early functional outcomes (scores: 62.33 ± 2.71 at postoperative 1 week and 83.73 ± 3.14 at postoperative 1 month) compared with Groups B (scores: 56.81 ± 3.11 at postoperative 1 week and 79.11 ± 3.64 at postoperative 1 month) and A (47.86 ± 3.39 at postoperative 1 week and 72.36 ± 3.72 at postoperative 1 month) (all 0.01). However, the 6-month Hospital for Special Surgery knee scores of the three groups were comparable (Group A: 89.93 ± 2.42; Group B, 89.96 ± 2.53; and Group C, 91.13 ± 2.06; = 0.09). Overall complication rates did not differ between the three groups (Group A, 7.1%; Group B, 7.4%; Group C, 3.3%; = 0.734).ConclusionIn total knee arthroplasty patients, the combination of a half-duration tourniquet with intra-articular tranexamic acid may provide superior perioperative blood management compared with a full-duration tourniquet or half-duration tourniquet alone. This strategy may reduce total and hidden postoperative blood loss, reduce hemoglobin loss, and lower transfusion rates. Additionally, it may reduce postoperative pain and promote earlier recovery of knee function. In addition, this treatment combination did not cause a significant increase in complications, including thrombosis or infection.
Diabetic retinopathy and kidney involvement in adults with type 2 diabetes in high-altitude Tibet: A cross-sectional subanalysis of the China National Diabetic Chronic Complications Study.
Yang L, Zhang Z
J Int Med Res · 2026 Apr · PMID 41954188 · Full text
ObjectiveTo estimate the prevalence, severity, awareness, and clinical correlates of diabetic retinopathy among adults with type 2 diabetes living at very high altitude in Tibet.MethodsThis cross-sectional, community-bas...
ObjectiveTo estimate the prevalence, severity, awareness, and clinical correlates of diabetic retinopathy among adults with type 2 diabetes living at very high altitude in Tibet.MethodsThis cross-sectional, community-based subanalysis used prospectively collected data from the China National Diabetic Chronic Complications Study data. Adults with physician-diagnosed type 2 diabetes from three Tibet sites (3650-4300 m) with ≥1 gradable nonmydriatic fundus photograph were included (N = 320). Diabetic retinopathy was centrally graded using the International Clinical scale. Vision-threatening diabetic retinopathy was defined as severe nonproliferative or proliferative diabetic retinopathy. Kidney indices included the urinary albumin-to-creatinine ratio and estimated glomerular filtration rate. Parsimonious multivariable logistic regression (complete-case n = 318) was used to evaluate correlates of any diabetic retinopathy.ResultsThe prevalence of any diabetic retinopathy was 16.6% (95% confidence interval: 12.9-21.0), whereas vision-threatening diabetic retinopathy was observed in 4.4% of participants (95% confidence interval: 2.6-7.2). Diabetic retinopathy was predominantly nonproliferative, and proliferative diabetic retinopathy was rare (0.3%). Only 36.5% of participants with diabetic retinopathy reported prior awareness. Higher urinary albumin-to-creatinine ratio and estimated glomerular filtration rate <60 mL/min/1.73 m were independently associated with diabetic retinopathy, whereas glycated hemoglobin was not significant after adjustment.ConclusionsIn community-dwelling Tibetans with type 2 diabetes living at very high altitude, diabetic retinopathy is common, awareness is low, and markers of kidney damage are strongly associated with diabetic retinopathy, supporting integrated retinal-renal screening.
Prognostic value of the triglyceride-glucose index in patients with acute ischemic stroke undergoing endovascular treatment.
Yang K, Xu Q, Peng X … +3 more , Xu X, Guo Y, Xu J
J Int Med Res · 2026 Apr · PMID 41954187 · Full text
ObjectiveThis study aimed to assess the prognostic significance of the triglyceride-glucose index in predicting clinical outcomes in patients with acute ischemic stroke undergoing endovascular thrombectomy.MethodsThis st...
ObjectiveThis study aimed to assess the prognostic significance of the triglyceride-glucose index in predicting clinical outcomes in patients with acute ischemic stroke undergoing endovascular thrombectomy.MethodsThis study analyzed 811 patients with anterior circulation large-vessel occlusion who underwent endovascular thrombectomy for acute ischemic stroke. The triglyceride-glucose index was calculated as ln (fasting blood glucose (mg/dL) × fasting triglycerides (mg/dL)/2). A favorable outcome at 90 days was defined as a modified Rankin Scale score of 0-2.ResultsA higher triglyceride-glucose index was significantly associated with an unfavorable prognosis (odds ratio: 1.831, 95% confidence interval: 1.346 to 2.492), demonstrating a linear relationship. Incorporation of the triglyceride-glucose index into baseline models significantly improved risk classification and discrimination, as reflected by net reclassification improvement and integrated discrimination improvement (both p<0.05). This association remained significant across key subgroups, including older patients (odds ratio: 1.823, 95% confidence interval: 1.320 to 2.519), patients with successful reperfusion (odds ratio: 1.797, 95% confidence interval: 1.351 to 2.392), and those with high Alberta Stroke Program Early CT Score (odds ratio: 1.712, 95% confidence interval: 1.294 to 2.265).ConclusionThe triglyceride-glucose index is an independent predictor of functional outcome in patients with acute ischemic stroke undergoing endovascular thrombectomy, highlighting its potential for risk stratification.
Integrated intraoperative strategies to prevent anastomotic leakage after laparoscopic low anterior resection: The roles of left colic artery preservation, reinforcement suturing, and transanal tube placement.
Lie C, Qian S, Chi Z
J Int Med Res · 2026 Apr · PMID 41954186 · Full text
Anastomotic leakage is a major complication following laparoscopic low anterior resection in patients with low rectal cancer. This study investigated the preventive effects of three intraoperative techniques, including t...
Anastomotic leakage is a major complication following laparoscopic low anterior resection in patients with low rectal cancer. This study investigated the preventive effects of three intraoperative techniques, including the preservation of the left colic artery, reinforcement suturing, and transanal decompression tube placement. A total of 88 patients undergoing laparoscopic rectal cancer surgery were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to assess the associations between these interventions and the occurrence of anastomotic leakage. The overall anastomotic leakage rate was 7.95%. Left colic artery preservation, reinforcement suturing, and transanal decompression tube placement each showed a lower anastomotic leakage incidence (5.3%, 6.3%, and 7.4%, respectively) compared with nonapplication. The combined use of all three measures resulted in zero anastomotic leakage. Multivariate analysis confirmed a consistent protective trend, with left colic artery preservation demonstrating the strongest effect. Preserving the left colic artery, reinforcing the anastomosis, and reducing intraluminal pressure act synergistically to reduce the risk of anastomotic leakage. Their integrated use may offer an effective strategy to enhance anastomotic safety in rectal surgery.
Three-dimensional-printed shape-memory composite scaffold for meniscus repair.
Jiatong L, Haochi L, Yulong Q … +4 more , Jie W, Sufen Y, Mingyang Z, Tian Y
J Int Med Res · 2026 Apr · PMID 41954185 · Full text
ObjectiveThe meniscus has poor intrinsic healing capacity, particularly in avascular regions. Meniscal injury is strongly associated with progressive knee dysfunction, chronic pain, and accelerated osteoarthritis develop...
ObjectiveThe meniscus has poor intrinsic healing capacity, particularly in avascular regions. Meniscal injury is strongly associated with progressive knee dysfunction, chronic pain, and accelerated osteoarthritis development. Current treatments, such as allografts and partial meniscectomy, are limited by donor scarcity and secondary joint degeneration. Therefore, this study aimed to develop a regenerative meniscal scaffold with integrated biomechanical and biological functionality.MethodsA biomimetic composite scaffold was fabricated via low-temperature three-dimensional printing using poly(D,L-lactic acid-co-trimethylene carbonate) and bacterial cellulose. Native meniscal architecture was reproduced using micro-computed tomography-based modeling, and interconnected porosity was designed to promote cell infiltration. Material integration employed dichloromethane as a shared solvent, enabling dual-ink (poly(D,L-lactic acid-co-trimethylene carbonate) + bacterial cellulose) co-printing. Scaffold performance was assessed using scanning electron microscopy morphology, porosity and water absorption assays, mechanical testing, Fourier-transform infrared spectroscopy, and cytocompatibility studies with rat bone mesenchymal stem cells.ResultsThe scaffold exhibited a tensile modulus of 16.6 MPa and compressive modulus of 2.97 MPa, closely matching native meniscal mechanics. Porosity reached 63.57% ± 5.72%, supporting cell adhesion, while water absorption exceeded 138% after 7 days. Notably, the scaffold exhibited temperature-responsive shape memory behavior, allowing minimally invasive implantation and anatomic recovery at 37°C. Bone mesenchymal stem cells exhibited 95% viability (live/dead staining), significant proliferation (cell counting kit-8), and spontaneous chondrogenic differentiation (SRY-box transcription factor 9/collagen type II (SOX9/COLII) expression) without exogenous induction.ConclusionThis three-dimensional-printed poly(D,L-lactic acid-co-trimethylene carbonate)/bacterial cellulose composite scaffold integrates biomimetic mechanics, shape-memory functionality, and pro-chondrogenic bioactivity, offering a promising strategy for meniscal regeneration. Further studies are warranted to confirm long-term efficacy and clinical translational potential.
The quality and reliability of YouTube video resources concerning patient education for Parkinson's disease: An electronic media-based study.
Liu X, Wang S, Gan L … +2 more , Wang Y, Jiang L
J Int Med Res · 2026 Apr · PMID 41935028 · Full text
BackgroundParkinson's disease is a progressive neurodegenerative disorder that contributes to the growing global health burden. YouTube has emerged as a ubiquitous source of health information among patients and their ca...
BackgroundParkinson's disease is a progressive neurodegenerative disorder that contributes to the growing global health burden. YouTube has emerged as a ubiquitous source of health information among patients and their caregivers. Despite the increasing use of video-sharing platforms, the educational quality and reliability of Parkinson's disease-related videos remain unknown.MethodsThis cross-sectional study evaluated 147 Parkinson's disease-related YouTube videos. The research team collected general video information, and three instruments (Global Quality Score, modified DISCERN tool, and Patient Education Materials Assessment Tool) were applied to assess overall quality, reliability, and content understandability and actionability. Descriptive analyses were conducted overall, followed by detailed comparisons across the videos. Finally, using the Spearman correlation coefficient, we explored potential correlations between general video information and video quality and reliability.ResultsIn this study, we observed moderate overall quality and reliability when assessed using the Global Quality Score, modified DISCERN tool, and Patient Education Materials Assessment Tool instruments.ConclusionsOur findings demonstrated that YouTube contains substantial publicly available Parkinson disease-related content; however, the quality and reliability of the content varies and is generally inadequate to facilitate patient education. To better serve patients with Parkinson disease and their caregivers, multifaceted actions from healthcare professionals, science communicators, and internet platforms are necessary to elevate the quality and visibility of credible content.
Recurrent aquaporin 4-immunoglobulin G-positive neuromyelitis optica spectrum disorder in a patient with long-standing rheumatoid arthritis: A case report.
Jiang X, Chen J, Wen Y … +2 more , Yuan L, Zhang J
J Int Med Res · 2026 Mar · PMID 41915816 · Full text
Neuromyelitis optica spectrum disorder is an autoimmune astrocytopathy that primarily affects the optic nerves and spinal cord. Its association with rheumatoid arthritis is remarkably rare, with only 15 documented cases...
Neuromyelitis optica spectrum disorder is an autoimmune astrocytopathy that primarily affects the optic nerves and spinal cord. Its association with rheumatoid arthritis is remarkably rare, with only 15 documented cases reported globally to date. This report describes the unique case of a 34-years-old woman with rheumatoid arthritis who developed concurrent aquaporin 4-immunoglobulin G-positive relapsing neuromyelitis optica spectrum disorder. The case underscores the substantial risk of initial misdiagnosis as stroke in patients with autoimmune diseases presenting with acute or atypical neurological deficits. We explored the potential shared immunopathological mechanisms between the two disorders and propose integrated therapeutic strategies for concurrent management. Importantly, this report strongly advocates prompt magnetic resonance imaging of the brain and spinal cord, along with aquaporin 4-immunoglobulin G serological testing, in rheumatoid arthritis patients presenting with optic neuritis, a critical omission in current rheumatological guidelines.
Factors influencing malnutrition in critically ill patients: A systematic review and meta-analysis.
Chen J, Xu Y, Wang M … +2 more , Sun B, Zheng G
J Int Med Res · 2026 Mar · PMID 41915815 · Full text
ObjectiveThis study aimed to conduct a systematic review and perform a meta-analysis to identify the factors influencing malnutrition in critically ill patients. It sought to resolve inconsistencies in existing research...
ObjectiveThis study aimed to conduct a systematic review and perform a meta-analysis to identify the factors influencing malnutrition in critically ill patients. It sought to resolve inconsistencies in existing research and address the lack of comprehensive and systematic integration, thereby providing a reference for healthcare professionals to identify the risk of malnutrition in critically ill patients at an early stage and formulate targeted preventive measures.MethodsStudies were identified through searches of online databases, including PubMed, Embase, Web of Science Core Collection, Cochrane Library, CNKI, and WanFang. The quality of included studies was evaluated using the Newcastle-Ottawa scale and the Agency for Healthcare Research and Quality scale. A meta-analysis was performed using RevMan 5.4 software. This research project was registered in the PROSPERO system, with the registration number CRD420251140462.ResultsThe initial search identified 3856 records. After removing duplicates, 3049 records were retained for screening, and 10 studies were ultimately included in the final analysis. The quality assessment showed that eight studies were of high quality and two were of medium quality. The results of the meta-analysis indicated that anemia (odds ratio: 1.48, 95% confidence interval: 1.23-1.78), parenteral nutrition (odds ratio: 4.93, 95% confidence interval: 2.69-9.03), enteral nutrition (odds ratio: 3.2, 95% confidence intervals: 1.04-9.83), and advanced age (odds ratio: 1.24, 95% confidence intervals: 1.01-1.51) were key risk factors for malnutrition in critically ill patients.ConclusionAnemia, nutritional support (including enteral nutrition and parenteral nutrition), and advanced age were identified as significant risk factors for malnutrition in critically ill patients and should be prioritized in clinical practice Particular attention should be given to monitoring and correcting anemia in critically ill patients, optimizing nutritional support plans, and conducting continuous nutritional screening and assessment. These measures can help reduce the incidence of malnutrition and improve patient prognosis.
Introducing a modified neodymium:yttrium aluminum garnet posterior capsulotomy technique: Case series study of a continuous ascending linear shot pattern.
Lytvynchuk L, Alami Ouali M, Stieger K … +3 more , Saksonov S, Stakhurska Bilynska T, Lumi X
J Int Med Res · 2026 Mar · PMID 41915814 · Full text
ObjectiveNeodymium:yttrium aluminum garnet laser capsulotomy is the gold standard treatment for posterior capsule opacification. Herein, we described a novel technique that has the potential to enhance the efficacy and s...
ObjectiveNeodymium:yttrium aluminum garnet laser capsulotomy is the gold standard treatment for posterior capsule opacification. Herein, we described a novel technique that has the potential to enhance the efficacy and safety of this procedure.MethodsThe technique utilizes multiple continuous ascending linear pattern laser shots, beginning at the bottom and forming successive horizontal rows upward. This approach results in a circular capsulotomy with minimal residual cloudiness along the edge of the intraocular lens optic.ResultsA total of 26 eyes from 23 patients with posterior capsule opacification were treated. The mean age of the participants was 73 ± 9.8 years. The average total energy used was 118.3 mJ. The average pretreatment best-corrected visual acuity was 0.45 ± 0.47 logMAR scale, which improved to 0.40 ± 0.53 following treatment. In 84% of cases, the optical axis was clear at the end of the intervention. Three patients reported subjective floaters, and two eyes required revision procedures. We did not observe any complications after the treatment.ConclusionsThe continuous ascending linear pattern posterior capsulotomy technique offers several potential advantages, including increased efficiency with lower energy usage, a larger optical opening, fewer capsule remnants, and reduced subjective complaints. Further studies involving a larger number of cases are required to evaluate this technique thoroughly.
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