The Journal Of International Medical Research[JOURNAL]
Sun
200 papers
Modifiable risk factors for tinnitus: A Mendelian randomization study.
Zheng K, Zheng Y, Lei Y … +1 more , Lin J
J Int Med Res · 2026 Jun · PMID 42334208 · Full text
ObjectiveThe topic of tinnitus has received considerable scholarly interest. Contributing factors to the development of tinnitus encompass aging, exposure to loud noise, smoking, and hearing impairment. Nevertheless, the...
ObjectiveThe topic of tinnitus has received considerable scholarly interest. Contributing factors to the development of tinnitus encompass aging, exposure to loud noise, smoking, and hearing impairment. Nevertheless, the precise risk factors, particularly those that can be modified, remain uncertain. This study aimed to explore the potential genetic factors that may be associated with an increased susceptibility to tinnitus.MethodsMendelian randomization analyses were performed using data from the United Kingdom Biobank and the FinnGen Biobank data infrastructure. The present study examined the correlation between 13 prevalent life factors, which were identified as potential risk factors for tinnitus through a comprehensive review of the literature. The inverse-variance weighted model was employed to analyze the associations. To mitigate database source bias and strengthen the reliability of our findings, data from the United Kingdom Biobank were used for the discovery cohort, whereas data from FinnGen were used for the validation cohort. Subsequently, a meta-analysis was conducted to combine the findings, thereby bolstering the robustness of the results.ResultsIn the United Kingdom Biobank discovery cohort, waist circumference (odds ratio = 1.37, 95% confidence interval 1.09-1.71, p = 0.006), waist-to-hip ratio (odds ratio = 1.71, 95% confidence interval 1.17-2.50, p = 0.005), fasting glucose (odds ratio = 0.70, 95% confidence interval 0.54-0.90, p = 0.007), and fasting insulin (odds ratio = 2.07, 95% confidence interval 1.07-4.01, p = 0.03) showed significant associations with tinnitus. In the FinnGen validation cohort, smoking was associated with tinnitus (odds ratio = 1.20, 95% confidence interval 1.03-1.40, p = 0.018). However, in the meta-analysis combining both cohorts, only waist circumference remained significantly associated with tinnitus (odds ratio = 1.27, 95% confidence interval 1.08-1.49, p = 0.003).ConclusionsOur findings indicate a causal relationship between waist circumference, an indicator of central obesity, and tinnitus. This implies that abdominal obesity could serve as a modifiable target for the prevention of tinnitus. Other factors that initially appeared to be associated did not demonstrate consistent results across different cohorts, underscoring the critical role of meta-analysis in Mendelian randomization studies.
Depth of anesthesia monitoring: Current evidence, clinical impact, and future directions.
Yu H, Gao B, Li Y
J Int Med Res · 2026 Jun · PMID 42333677 · Full text
Depth of anesthesia monitoring has become an important component of modern anesthetic practice. Electroencephalography-based technologies, such as the bispectral index, entropy, and Narcotrend, allow clinicians to assess...
Depth of anesthesia monitoring has become an important component of modern anesthetic practice. Electroencephalography-based technologies, such as the bispectral index, entropy, and Narcotrend, allow clinicians to assess the level of consciousness more objectively and guide anesthetic titration more precisely. This narrative review summarizes current evidence on the relationship between depth of anesthesia monitoring and major perioperative complications. Available evidence suggests that maintaining an appropriate depth of anesthesia reduces the risk of intraoperative awareness, hypotension associated with excessively deep anesthesia, postoperative delirium, and cognitive dysfunction. Electroencephalography-guided anesthesia appears particularly beneficial in older patients, individuals with cardiovascular disease, and other high-risk populations. Although several limitations remain, including algorithm variability and differential sensitivity to anesthetic agents, the integration of multimodal monitoring, brain network analysis, and artificial intelligence is expected to improve the accuracy and individualization of anesthesia management in the future.
Cavernous hemangioma mimicking schwannoma in the sacral intervertebral foramen: A case report.
Li Z, Han C, Xiong Z … +8 more , Wang Z, Tan M, Yu J, Ma M, Wang W, Wang Y, Di G, Jiang X
J Int Med Res · 2026 Jun · PMID 42333512 · Full text
Sacral epidural cavernous hemangioma involving the intervertebral foramen is exceptionally rare and may closely mimic more common benign nerve sheath tumors on magnetic resonance imaging. We report the case of a woman in...
Sacral epidural cavernous hemangioma involving the intervertebral foramen is exceptionally rare and may closely mimic more common benign nerve sheath tumors on magnetic resonance imaging. We report the case of a woman in her mid-50s who presented with a 1-month history of nocturnal left lower-extremity pain and mild weakness. Contrast-enhanced lumbar magnetic resonance imaging revealed a strongly enhancing nodular lesion in the left S2 foraminal region, and schwannoma was considered preoperatively. The patient underwent microsurgical resection through a posterior midline approach. Intraoperatively, the lesion was dark red, soft, and hypervascular, raising suspicion for a vascular malformation rather than schwannoma. Frozen-section analysis suggested hemangioma, and postoperative histopathology confirmed cavernous hemangioma. The patient experienced marked postoperative relief of radicular pain, and follow-up analysis indicated complete symptom resolution without radiological evidence of residual lesion. This case emphasizes that cavernous hemangioma should be included in the differential diagnosis of sacral foraminal masses. Purely epidural cavernous hemangiomas centered in the sacral foramen are particularly rare and frequently misdiagnosed preoperatively as schwannoma; thus, careful preoperative planning, anticipation of intraoperative hypervascularity, and frozen-section histology may help guide safe resection.
Recurrent urticaria induced by aspirin in a post-stent patient: A case study and literature review.
Xu YY, Feng Y, Li LC … +2 more , Zhang S, Mao KL
J Int Med Res · 2026 Jun · PMID 42333511 · Full text
This report describes the case of a male in his early 60s with coronary heart disease who developed recurrent urticaria following the initiation of antiplatelet and lipid-lowering therapy. Through sequential drug dechall...
This report describes the case of a male in his early 60s with coronary heart disease who developed recurrent urticaria following the initiation of antiplatelet and lipid-lowering therapy. Through sequential drug dechallenge and rechallenge, aspirin was identified as the probable cause. Despite initial treatment with cetirizine and reintroduction of aspirin, the patient's symptoms recurred, necessitating readmission. A multidisciplinary team, including clinicians and clinical pharmacists, optimized the treatment strategy by replacing aspirin with ticagrelor and cilostazol for antiplatelet therapy, discontinuing and reintroducing atorvastatin to rule out drug allergy, and administering desloratadine citrate and methylprednisolone for antiallergic treatment. The patient's urticaria resolved completely without recurrence, and aspirin was identified as the probable cause using the adverse drug reaction causality assessment scale. Although aspirin was reintroduced on Day 2, the concurrent use of multiple drugs, including corticosteroids and antihistamines, may have influenced the timing and severity of the subsequent urticaria recurrence. Postdischarge follow-up confirmed sustained remission, highlighting the importance of collaborative care in managing drug-induced urticaria and maintaining cardiovascular safety.
Efficacy and safety of superficial radiotherapy in the treatment of cutaneous warts: A meta-analysis.
Deng YY, Li CX, Li GL … +1 more , Tao XH
J Int Med Res · 2026 Jun · PMID 42333510 · Full text
ObjectiveTo systematically evaluate clinical evidence concerning the efficacy and safety of superficial radiotherapy in the treatment of cutaneous warts.MethodsEight major international clinical literature databases were...
ObjectiveTo systematically evaluate clinical evidence concerning the efficacy and safety of superficial radiotherapy in the treatment of cutaneous warts.MethodsEight major international clinical literature databases were queried according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for superficial radiotherapy studies published prior to 9 August 2025. Randomized controlled trials, prospective/retrospective controlled studies, and case series with sample sizes ≥10 were included. The primary outcome was the cure rate, whereas secondary outcomes included recurrence rate and adverse reactions. Risk or odds ratio with 95% confidence interval were pooled using random-effects or fixed-effects models as appropriate. Heterogeneity was assessed using the I statistic. Subgroup analysis was performed based on monotherapy versus combination therapy. Publication bias was evaluated using funnel plots and Egger's test, and the Grading of Recommendations Assessment, Development and Evaluation system was applied to assess the quality of evidence.ResultsThe overall cure rate for cutaneous warts using superficial radiotherapy was 81% (95% confidence interval: 0.76-0.85, < 0.05), whereas the recurrence rate was 14% (95% confidence interval: 0.10-0.18, < 0.05). For superficial radiotherapy monotherapy, the cure rate was 76% (95% confidence interval: 0.69-0.83, < 0.05), and recurrence rate was 21% (95% confidence interval: 0.04-0.38, < 0.05). Compared with superficial radiotherapy monotherapy, combination therapy was associated with a higher cure rate (odds ratio = 4.08, 95% C confidence interval: 2.43-6.83, < 0.05) and lower recurrence rate (odds ratio = 0.23, 95% confidence interval: 0.08-0.65, < 0.05).ConclusionsSuperficial radiotherapy monotherapy is an effective treatment for cutaneous warts, associated with low recurrence rates and infrequent adverse reactions. Combination therapy is associated with a higher cure rate and a lower recurrence rate than superficial radiotherapy monotherapy. Further studies comparing combination and superficial radiotherapy monotherapy are necessary for a more rigorous evaluation of the long-term recurrence rates associated with these therapies. The study was retrospectively registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (Registration Number: INPLASY202650102).
Inverse association between peripheral natural killer cells and thyroid autoimmunity in cases of miscarriage: Evidence from a cross-sectional study.
Guo X, Yang T, Wang J … +3 more , Zhong X, Zhao S, Huang G
J Int Med Res · 2026 Jun · PMID 42333509 · Full text
ObjectiveTo examine the association between the percentage of peripheral natural killer cells and thyroid autoimmunity in women with a history of miscarriage and assess whether B-cells mediate this association.MethodsThi...
ObjectiveTo examine the association between the percentage of peripheral natural killer cells and thyroid autoimmunity in women with a history of miscarriage and assess whether B-cells mediate this association.MethodsThis retrospective cross-sectional study was conducted on 927 women with a history of miscarriage treated at the Affiliated Hospital of Guizhou Medical University (2021-2023). Peripheral T-cell, B-cell, and natural killer cell subsets and thyroid antibodies were assessed. Multivariable logistic regression, restricted cubic splines, and mediation analyses were performed.ResultsWomen with thyroid autoimmunity had lower percentage of peripheral natural killer cells and higher percentage of B-cells than those without thyroid autoimmunity (both < 0.001). The percentage of peripheral natural killer cells demonstrated a consistent inverse association with thyroid autoimmunity after adjustment (adjusted odds ratios: 0.00; 95% confidence interval: 0.00-0.02; all < 0.001). Restricted cubic spline analysis indicated a nonlinear dose-response relationship that was stronger in women aged ≥35 years and in those without recurrent miscarriages. B-cells partially mediated the association between the percentage of peripheral natural killer cells and thyroid autoimmunity (31.4% of the total effect; ab = -0.166; < 0.001).ConclusionLower percentage of peripheral natural killer cells is linked to higher odds of thyroid autoimmunity in women with a history of miscarriage, and B-cells partly explain this relationship, supporting the use of peripheral immune profiling to identify thyroid autoimmunity risk.
Kimura disease presenting as epiglottic masses: A case report.
Cui LZ, Bai J, Wei YF … +1 more , Song Q
J Int Med Res · 2026 Jun · PMID 42330124 · Full text
BackgroundKimura disease presents considerable diagnostic and therapeutic challenges because of its rarity, polymorphic early manifestations, recalcitrant clinical course, high recurrence rate, and potential for multiorg...
BackgroundKimura disease presents considerable diagnostic and therapeutic challenges because of its rarity, polymorphic early manifestations, recalcitrant clinical course, high recurrence rate, and potential for multiorgan involvement.Case presentationA Chinese woman in her late 40s presented with a 3-year history of foreign body sensation in the pharynx and a 6-month history of dysarthria. Laryngoscopy revealed a smooth mass on the epiglottis. Laboratory investigations demonstrated elevated peripheral blood eosinophil counts and serum immunoglobulin E levels. The mass, together with the epiglottic cartilage, was surgically resected. Histopathological examination of paraffin-embedded specimens confirmed the diagnosis of Kimura disease. Postoperatively, low-dose corticosteroid therapy was administered. No recurrence was observed during follow-up.ConclusionThis case provides novel insights into Kimura disease and underscores the importance of including this condition in the differential diagnosis of epiglottic masses. Systemic glucocorticoids represent a valuable therapeutic option. Importantly, close long-term follow-up is essential for optimal patient management.
Dynamic needle tip positioning may improve first-attempt success rate in short-axis radial artery cannulation: A systematic review and meta-analysis of randomized trials.
Mao K, Cai M, Liang J … +7 more , Yang G, Ye Y, Lin J, Tang M, Chen L, Huang J, Chen W
J Int Med Res · 2026 Jun · PMID 42319179 · Full text
BackgroundUltrasound-guided radial artery cannulation is routinely performed; however, the optimal imaging approach remains debated. The short-axis out-of-plane approach facilitates vessel centering; however, it limits c...
BackgroundUltrasound-guided radial artery cannulation is routinely performed; however, the optimal imaging approach remains debated. The short-axis out-of-plane approach facilitates vessel centering; however, it limits continuous needle-tip visualization, whereas the long-axis in-plane approach enables tip visualization but can be technically demanding. Dynamic needle tip positioning is a modified short-axis out-of-plane strategy designed to improve needle-tip tracking.MethodsWe conducted searches across PubMed, Embase, the Cochrane Library, Scopus, and Web of Science databases from inception through 1 January 2026. Randomized controlled trials involving adults that have compared the short-axis out-of-plane (dynamic needle tip positioning or traditional non-dynamic needle tip positioning) and long-axis in-plane approaches were included. The primary outcome was first-attempt success. Secondary outcomes included total success; time to cannulation; and hematoma, posterior wall puncture, and vasospasm incidences. Random-effects models were used, with prespecified subgroup analysis stratified by dynamic needle tip positioning. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD420251276500). Small-study effects were assessed using Egger's regression for outcomes reported in ≥10 studies.ResultsThirteen trials (1482 participants) were included. Overall, first-attempt success rates did not differ between the short-axis out-of-plane and long-axis in-plane (relative risk = 0.99, 95% confidence interval: 0.85-1.15) approaches. Subgroup analysis showed higher first-attempt success rates with the dynamic needle tip positioning short-axis out-of-plane approach than with the long-axis in-plane approach (relative risk = 1.22, 95% confidence interval: 1.13-1.32), whereas the non-dynamic needle tip positioning short-axis out-of-plane approach demonstrated no advantage (relative risk = 0.88, 95% confidence interval: 0.72-1.09). Total success rates were similar (relative risk = 0.99, 95% confidence interval: 0.95-1.02), and time to cannulation did not differ (mean difference (short-axis out-of-plane-long-axis in-plane)) = -3.52 s, 95% confidence interval: -11.09 to 4.05). Hematoma incidence was comparable (relative risk = 1.79, 95% confidence interval: 0.89-3.58). Overall, posterior wall puncture incidence did not differ; however, the non-dynamic needle tip positioning short-axis out-of-plane approach increased the posterior wall puncture risk compared with the long-axis in-plane approach (relative risk = 3.29, 95% confidence interval: 1.33-8.11). Vasospasm incidence was similar overall using both approaches (relative risk = 0.74, 95% confidence interval: 0.38-1.43), with a lower incidence reported in the dynamic needle tip positioning trials (relative risk = 0.27, 95% confidence interval: 0.09-0.80).ConclusionsThe short-axis out-of-plane and long-axis in-plane approaches showed comparable overall efficacy. The dynamic needle tip positioning-based short-axis out-of-plane approach may improve first-attempt success rates and reduce the incidence of vasospasm without an apparent increase in posterior wall puncture risk, whereas the traditional short-axis out-of-plane approach may involve a higher posterior wall puncture risk. These findings suggest that needle-tip tracking is as important as the imaging plane itself; however, larger pragmatic trials are needed to confirm this finding.
Primary testicular neuroendocrine tumor: Diagnostic challenges and WHO 2022 classification insights.
Garousi V, Khalaj F, Mirzaian E
J Int Med Res · 2026 Jun · PMID 42319038 · Full text
Primary testicular neuroendocrine tumors are exceedingly rare, comprising less than 1% of testicular neoplasms. Their nonspecific presentation and overlap with other testicular tumors make diagnosis challenging. We repor...
Primary testicular neuroendocrine tumors are exceedingly rare, comprising less than 1% of testicular neoplasms. Their nonspecific presentation and overlap with other testicular tumors make diagnosis challenging. We report the case of a 21-year-old male with a painless left testicular mass. Imaging revealed a hypervascular lesion with calcifications, while serum markers (alpha-fetoprotein, beta-human chorionic gonadotropin, and lactate dehydrogenase) were normal. Radical orchiectomy demonstrated a 3-cm well-circumscribed tumor composed of monotonous cells with "salt-and-pepper" chromatin and low mitotic activity. Immunohistochemistry confirmed neuroendocrine differentiation (synaptophysin, chromogranin, INSM1 positive; Ki-67 < 1%). This profile established the diagnosis of a well-differentiated testicular neuroendocrine tumor, classified under the 2022 WHO framework as "prepubertal-type." Although indolent, these tumors require long-term follow-up due to the risk of late metastasis. Radical orchiectomy remains the treatment of choice. This case emphasizes the critical role of histopathology and immunoprofiling in diagnosis and contributes to refining the clinical understanding of this rare entity.
Association between weight-to-waist ratio and total bone mineral density in US adults: A cross-sectional study of the National Health and Nutrition Examination Survey 2011-2018.
Yang J, Liu J, Wei H … +2 more , Wang W, Li X
J Int Med Res · 2026 Jun · PMID 42316961 · Full text
ObjectiveTo investigate the association between the weight-to-waist ratio and total bone mineral density in US adults.MethodsThis cross-sectional study included 7005 adults from the National Health and Nutrition Examinat...
ObjectiveTo investigate the association between the weight-to-waist ratio and total bone mineral density in US adults.MethodsThis cross-sectional study included 7005 adults from the National Health and Nutrition Examination Survey 2011-2018. The weight-to-waist ratio was calculated as body weight divided by waist circumference, and total bone mineral density was measured using dual-energy X-ray absorptiometry. Survey-weighted multivariable linear regression and restricted cubic spline analyses were conducted to evaluate the association between the weight-to-waist ratio and total bone mineral density after adjustment for demographic, socioeconomic, lifestyle, and clinical covariates.ResultsA higher weight-to-waist ratio was significantly associated with greater total bone mineral density across all models. In the fully adjusted model, each 1-unit increase in the weight-to-waist ratio was associated with a 0.39 g/cm increase in total bone mineral density (95% confidence interval: 0.35-0.42; P < 0.001). Participants in the highest weight-to-waist ratio quartile had significantly higher total bone mineral density than those in the lowest quartile (β = 0.09, 95% confidence interval: 0.08-0.10; P < 0.001). Restricted cubic spline analysis indicated a significant positive linear association. The association was stronger in men than in women (P for interaction <0.001).ConclusionsA higher weight-to-waist ratio was independently associated with greater total bone mineral density in US adults, particularly among men. The weight-to-waist ratio may provide complementary anthropometric information regarding skeletal health, although prospective studies are needed to confirm causality.
Acute diffuse facial edema as the first clinically recognized manifestation of Hashimoto's thyroiditis: A case report.
Wang Y, Yue H, Han X … +1 more , Liang S
J Int Med Res · 2026 Jun · PMID 42316960 · Full text
We report a case of acute diffuse facial edema as the first clinically recognized manifestation of Hashimoto's thyroiditis in a young woman. The patient presented with sudden-onset nonpitting facial swelling, although sh...
We report a case of acute diffuse facial edema as the first clinically recognized manifestation of Hashimoto's thyroiditis in a young woman. The patient presented with sudden-onset nonpitting facial swelling, although she had experienced mild systemic symptoms, including constipation and cold intolerance, for several months. Laboratory evaluation revealed markedly elevated thyroid-stimulating hormone levels, reduced free thyroxine concentrations, and positive thyroid autoantibodies, confirming primary hypothyroidism secondary to Hashimoto's thyroiditis. Levothyroxine therapy resulted in rapid improvement of the facial edema and restoration of euthyroid status during follow-up. This case highlights that hypothyroidism may present with atypical cutaneous manifestations and suggests that thyroid function testing should be considered in patients presenting with unexplained localized swelling.
Mortality prediction by quick Sequential Organ Failure Assessment, National Early Warning Score 2, Shock Index, and Modified Shock Index in suspected sepsis: A retrospective study.
Wang X, Wang Y, She J … +1 more , Miao H
J Int Med Res · 2026 Jun · PMID 42316959 · Full text
ObjectiveTo compare the predictive performance of quick Sequential Organ Failure Assessment, National Early Warning Score 2, Shock Index, and Modified Shock Index for in-hospital mortality in adult emergency department p...
ObjectiveTo compare the predictive performance of quick Sequential Organ Failure Assessment, National Early Warning Score 2, Shock Index, and Modified Shock Index for in-hospital mortality in adult emergency department patients with sepsis.MethodsThis retrospective observational study included 187 adult patients who presented to the emergency department and met the Sepsis-3 definition of sepsis between January 2022 and December 2023. The predictive performance of quick Sequential Organ Failure Assessment, National Early Warning Score 2, Shock Index, and Modified Shock Index was evaluated using receiver operating characteristic curve analysis, DeLong's test, and diagnostic performance metrics, including sensitivity, specificity, positive predictive value, and negative predictive value. Multivariable logistic regression was performed as an exploratory secondary analysis.ResultsAmong 187 patients, 37 (19.8%) died during hospitalization. Non-survivors showed greater physiological derangement at emergency department presentation, including higher respiratory rate, heart rate, and lactate levels and lower oxygen saturation. National Early Warning Score 2 demonstrated the highest discriminatory performance for in-hospital mortality (area under the curve, 0.94), followed by quick Sequential Organ Failure Assessment (area under the curve, 0.82), Modified Shock Index (area under the curve, 0.79), and Shock Index (area under the curve, 0.77). Pairwise comparisons using DeLong's test showed that National Early Warning Score 2 performed significantly better than the other evaluated tools. In exploratory multivariable analysis, quick Sequential Organ Failure Assessment ≥2, Modified Shock Index ≥1.3, lactate >2.0 mmol/L, and chronic kidney disease were independently associated with in-hospital mortality.ConclusionsNational Early Warning Score 2 showed the best predictive performance for in-hospital mortality in adult emergency department patients with sepsis and may be a useful tool for early risk stratification in this setting.
Differences in sex development among individuals with a female phenotype and an absent uterus: Diagnostic approach.
Jibladze A, Asanidze E, Vash-Margita A … +1 more , Kristesashvili J
J Int Med Res · 2026 Jun · PMID 42316958 · Full text
ObjectiveTo describe individuals with differences in sex development presenting with a female phenotype and an absent uterus and identify specific diagnostic characteristics that improve diagnostic accuracy and optimize...
ObjectiveTo describe individuals with differences in sex development presenting with a female phenotype and an absent uterus and identify specific diagnostic characteristics that improve diagnostic accuracy and optimize patient care.Materials and MethodsThis descriptive comparative study included retrospective and prospective clinical data collected between 2023 and 2025 at the Reproductive Medicine Center "Universe," Tbilisi, Georgia. Among 233 individuals evaluated for primary amenorrhea, 26% with a female phenotype and an absent uterus who were evaluated for Complete Androgen Insensitivity Syndrome, Mayer-Rokitansky-Küster-Hauser syndrome, and ovotesticular disorder of sex development were included in the final sample. All participants underwent clinical, hormonal, genetic, and imaging assessment. Laparoscopy and histomorphological examination were performed when indicated.ResultsMayer-Rokitansky-Küster-Hauser syndrome accounted for 57.4%, Complete Androgen Insensitivity Syndrome for 37.7%, and ovotesticular disorder of sex development for 4.9% of the cases. Complete Androgen Insensitivity Syndrome patients exhibited preserved breast development with absent or sparse pubic hair, whereas Mayer-Rokitansky-Küster-Hauser syndrome and ovotesticular disorder of sex development patients exhibited normal pubic hair and breast development. Vaginal length was shortest in patients with Mayer-Rokitansky-Küster-Hauser, intermediate in those with complete androgen insensitivity syndrome, and variable in patients with ovotesticular disorder of sex development. Complete Androgen Insensitivity syndrome patients demonstrated male-range testosterone levels; Mayer-Rokitansky-Küster-Hauser patients exhibited female-range hormone profiles, and ovotesticular disorder of sex development patients were observed to have nonspecific endocrine patterns. Ovotesticular disorder of sex development was confirmed histomorphologically.ConclusionAn integrated diagnostic approach combining specific clinical features, hormonal profiles, imaging, karyotyping, and histomorphology enables accurate differentiation of Mayer-Rokitansky-Küster-Hauser, complete androgen insensitivity syndrome, and ovotesticular disorder of sex development.
Preoperative hypoalbuminemia as a prognostic factor in patients with gastric cancer undergoing radical gastrectomy: Construction of a nomogram.
Qu ZW, Zhang Y, Guo MY
J Int Med Res · 2026 Jun · PMID 42316957 · Full text
ObjectiveTo investigate the association of preoperative hypoalbuminemia (serum albumin <35 g/L) with clinicopathological characteristics and survival outcomes in patients with gastric cancer undergoing radical gastrectom...
ObjectiveTo investigate the association of preoperative hypoalbuminemia (serum albumin <35 g/L) with clinicopathological characteristics and survival outcomes in patients with gastric cancer undergoing radical gastrectomy and to construct a nomogram based on prognostically relevant clinicopathological variables.MethodsThis retrospective cohort study included patients with gastric cancer who underwent radical gastrectomy. Clinicopathological variables and survival outcomes were compared between groups. Univariate and multivariable analyses were performed to identify variables associated with prognosis, and a nomogram was constructed based on significant predictors.ResultsPreoperative hypoalbuminemia was significantly associated with adverse clinicopathological characteristics, including anemia, lymphocyte depletion, advanced American Joint Committee on Cancer stage, vascular invasion, and perineural invasion. Kaplan-Meier analysis showed that hypoalbuminemia was associated with poorer overall survival. In multivariable Cox regression analysis, lymph node metastasis remained independently associated with overall survival, whereas preoperative hypoalbuminemia was not an independent prognostic factor.ConclusionsPreoperative hypoalbuminemia may reflect unfavorable nutritional and inflammatory status and was associated with adverse clinicopathological characteristics and poorer survival in univariate analysis. However, it was not independently associated with overall survival after multivariable adjustment. Lymph node metastasis remained an independent prognostic factor.
Accessory cavitated uterine mass: A case report of eight patients.
Wang F, Liu Q, Zhao Y … +4 more , Ma F, Gong Z, Wang H, Zheng J
J Int Med Res · 2026 Jun · PMID 42316956 · Full text
To investigate the clinical characteristics, key diagnostic features, surgical management strategies, and postoperative outcomes of accessory cavitated uterine mass, with the aim of improving diagnostic accuracy and stan...
To investigate the clinical characteristics, key diagnostic features, surgical management strategies, and postoperative outcomes of accessory cavitated uterine mass, with the aim of improving diagnostic accuracy and standardizing clinical management. A retrospective analysis was conducted on eight patients with accessory cavitated uterine mass who underwent surgical treatment at Gansu Provincial Maternity and Child Care Hospital between February 2023 and August 2025. Clinical presentation, imaging findings, surgical procedures, pathological results, and postoperative outcomes were systematically reviewed. The patient ages ranged from 19 to 39 years, and all presented with dysmenorrhea. Severe pain was reported in five patients (62.5%). Preoperative ultrasonography and pelvic magnetic resonance imaging suggested accessory cavitated uterine mass in all cases. Lesions were located on the left side in six patients (75%). The mean lesion diameter was 3.1 ± 0.62 cm. All patients successfully underwent laparoscopic excision without intraoperative or postoperative complications. During follow-up through October 2025, no recurrences were observed. Complete resolution of dysmenorrhea was achieved in seven patients. Accessory cavitated uterine mass primarily affects young women, with progressively worsening dysmenorrhea being the hallmark clinical presentation. Ultrasound combined with magnetic resonance imaging is the key diagnostic method. Laparoscopic excision is an effective, fertility-preserving treatment option with favorable postoperative outcomes.
Postinfectious polyneuritis cranialis: A case report.
Zhu H, Pu K, Xiong X … +2 more , Huang J, Wu J
J Int Med Res · 2026 Jun · PMID 42316955 · Full text
Polyneuritis cranialis is characterized by the simultaneous or sequential inflammation of multiple cranial nerves, which may occur unilaterally or bilaterally. Although it is often related to infection, its exact etiolog...
Polyneuritis cranialis is characterized by the simultaneous or sequential inflammation of multiple cranial nerves, which may occur unilaterally or bilaterally. Although it is often related to infection, its exact etiology remains unclear. Due to its nonspecific clinical manifestations, diagnosis typically relies on the exclusion of other conditions. Herein, we report a case of postinfectious polyneuritis cranialis. The patient presented to our hospital with restricted mouth opening, dysphagia, coughing while drinking, dysarthria, and posterior neck pain following a finger injury. Laboratory tests showed markedly elevated inflammatory markers. Neurological examination revealed involvement of cranial nerves V, IX, X, and XII. Motor nerve conduction studies of the facial nerve suggested partial facial nerve damage. Brain magnetic resonance imaging demonstrated mild nonspecific white matter changes. After exclusion of alternative diagnoses, the patient was diagnosed with polyneuritis cranialis. The patient's condition improved following corticosteroid pulse therapy and was subsequently discharged. This case highlights that the diagnosis of polyneuritis cranialis remains one of exclusion and is often clinically challenging. When encountering patients with rapidly progressive cranial nerve palsies, polyneuritis cranialis should be included in the differential diagnosis after more common structural or systemic etiologies have been excluded.
Effect of virtual reality on pain and anxiety during colonoscopy: A randomized control trial.
Sun Y, Ying S, Qin J … +2 more , Li G, Zhong X
J Int Med Res · 2026 Jun · PMID 42315333 · Full text
ObjectiveTo evaluate the effect of virtual reality on pain and anxiety during sedation-free colonoscopy in adults aged 18-70 years.MethodsIn this randomized controlled trial, patients were assigned to either a virtual re...
ObjectiveTo evaluate the effect of virtual reality on pain and anxiety during sedation-free colonoscopy in adults aged 18-70 years.MethodsIn this randomized controlled trial, patients were assigned to either a virtual reality group or a control group. The primary outcomes were pain, measured using the visual analog scale, and anxiety, assessed using the self-rating anxiety scale. Secondary outcomes included vital signs, procedural success and duration, patient satisfaction, virtual reality acceptability, and willingness to undergo future colonoscopies.ResultsCompared with the control group, the virtual reality group showed significantly lower pain, anxiety, heart rate, and blood pressure during the procedure (all < 0.05). No significant differences were observed in respiratory rate, cecal intubation time, or total procedure duration ( > 0.05). Insertion success rates were identical. Importantly, a higher proportion of virtual reality participants expressed willingness to undergo future colonoscopies ( < 0.05), a patient-centered outcome relevant to screening adherence.ConclusionVirtual reality effectively reduces pain and anxiety during colonoscopy without compromising procedural outcomes. The inclusion of both subjective and physiological measures strengthens the evidence supporting the effects of virtual reality.Trial registration: This randomized controlled trial was retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR; registration number ChiCTR2400079076).
High baseline neutrophil-to-lymphocyte ratio is associated with better adalimumab response in patients with rheumatoid arthritis.
Zhu J, Hu J, Dai S … +5 more , Liu Y, He D, He C, Na H, Peng W
J Int Med Res · 2026 Jun · PMID 42315332 · Full text
ObjectiveTo identify factors associated with adalimumab response in patients with rheumatoid arthritis, particularly focusing on the clinical characteristics and neutrophil-to-lymphocyte ratio.MethodsThis prospective stu...
ObjectiveTo identify factors associated with adalimumab response in patients with rheumatoid arthritis, particularly focusing on the clinical characteristics and neutrophil-to-lymphocyte ratio.MethodsThis prospective study included 189 patients with rheumatoid arthritis. Associations between treatment response and various demographic, clinical, therapeutic, disease activity, and serological parameters were analyzed, including serum concentrations of proinflammatory cytokines. Treatment response was assessed using the Disease Activity Score in 28 joints at week 24.ResultsBaseline neutrophil-to-lymphocyte (odds ratio = 3.1, 95% confidence interval: 1.04-7.50, p = 0.019) was identified as an independent predictor of favorable response to adalimumab. Among good responders, neutrophil-to-lymphocyte levels decreased significantly following initiation of tumor necrosis factor inhibitor treatment (p < 0.001). Patients achieving Disease Activity Score in 28 joints-defined remission at week 24 had significantly higher baseline neutrophil-to-lymphocyte values than non-remitters (p < 0.001). A significantly greater proportion of patients in the high-neutrophil-to-lymphocyte group attained remission compared with the low-neutrophil-to-lymphocyte group (62.1% vs. 39.2%, p < 0.001).ConclusionsA higher baseline neutrophil-to-lymphocyte is associated with improved response to adalimumab therapy in rheumatoid arthritis. These findings support the potential use of baseline neutrophil-to-lymphocyte as a clinically applicable biomarker for predicting therapeutic outcomes following adalimumab treatment.
A novel homozygous c.257del variant in a Chinese family with Nasu-Hakola disease: A case study and literature review.
Liu Q, Lin RR, Gao PR … +2 more , Chen DF, Li HL
J Int Med Res · 2026 Jun · PMID 42315331 · Full text
Nasu-Hakola disease is a rare autosomal recessive disorder characterized by progressive cognitive decline and bone cyst formation and is commonly associated with triggering receptor expressed on myeloid cells 2 () varian...
Nasu-Hakola disease is a rare autosomal recessive disorder characterized by progressive cognitive decline and bone cyst formation and is commonly associated with triggering receptor expressed on myeloid cells 2 () variants. Herein, we report a novel frameshift variant in a middle-aged man from a consanguineous Chinese family who presented with early-onset dementia and right ankle pain. Neuroimaging and skeletal examinations revealed cerebral atrophy and bone cystic lesions. Whole-exome sequencing followed by Sanger confirmation identified a homozygous c.257del (p.D86Afs*103) variant. The patient was diagnosed with Nasu-Hakola disease, and his cognitive deterioration continued despite treatment with donepezil and memantine. Functional assays in human embryonic kidney 293T cells demonstrated preserved mRNA expression of the mutant construct but markedly reduced protein levels compared with that of wild-type. We also conducted a descriptive literature review of 54 previously reported cases of homozygous or compound heterozygous variants to highlight the variability in neurodegenerative and skeletal phenotypes. To the best of our knowledge, this is the first report of a c.257del variant in a Chinese family. Our findings expand the mutational spectrum of Nasu-Hakola disease and highlight substantial phenotypic heterogeneity, emphasizing the importance of early genetic testing in patients with unexplained early-onset dementia, even in the absence of bone lesions.
The Trojan horse of off-label glucagon-like peptide-1 receptor agonist use: Protecting patients through responsible practice.
Belančić A, Jelaković B
J Int Med Res · 2026 Jun · PMID 42315330 · Full text
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