The Journal Of International Medical Research[JOURNAL]
Sun
200 papers
Simultaneous antegrade-retrograde endoscopic procedures for the placement of thermo-expandable metallic stents in the treatment of ureteral stenosis in kidney transplantation patients: A cohort study.
Zhang X, Ji C, Hu W
J Int Med Res · 2026 Jun · PMID 42286860 · Full text
ObjectiveTo evaluate the efficacy and safety of simultaneous antegrade-retrograde endoscopic rendezvous procedure for thermo-expandable metallic stent (Memokath 051) placement in treating post-kidney transplantation uret...
ObjectiveTo evaluate the efficacy and safety of simultaneous antegrade-retrograde endoscopic rendezvous procedure for thermo-expandable metallic stent (Memokath 051) placement in treating post-kidney transplantation ureteral stenosis.MethodsA retrospective single-arm cohort study was conducted in six female patients with distal ureteral strictures after kidney transplantation treated between 2022 and 2024. A dual-endoscope technique was used for stent deployment. Surgical parameters, laboratory indicators, and complications were recorded, with a follow-up period of 1-20 months. Paired t-tests or Wilcoxon tests were applied for statistical analyses.ResultsAll stents were successfully placed, with a mean operative time of 173.0 min and mean hospital stay of 8.8 days. Hydronephrosis was significantly relieved in all patients. Postoperative estimated glomerular filtration rate was significantly higher than the preoperative rate 0.04), whereas no significant differences were found between the pre- and postoperative creatinine levels or leukocyte counts. A mild but clinically insignificant hemoglobin drop occurred on postoperative day 1 0.02). One patient experienced stent migration that was successfully repositioned, and another developed recurrent urinary tract infections that were controlled using antibiotics. All stents remained patent at the final follow-up.ConclusionThe simultaneous antegrade-retrograde endoscopic approach for Memokath 051 placement appears to be a safe and effective minimally invasive option for post-transplant ureteral stenosis; this finding warrants confirmation in further large-scale multicenter studies.
Metandienone abuse induces hepatotoxicity via dysregulated inflammation and metabolic dysfunction.
Ye Y, Li J, Chen Z … +2 more , Xue X, Xi J
J Int Med Res · 2026 Jun · PMID 42286859 · Full text
ObjectiveTo explore the effects and mechanisms of metandienone abuse on hepatotoxicity.MethodsHepG2 cells were treated with 1 μg/mL metandienone for 24 h. Cell viability and apoptosis were detected via Cell Counting Kit-...
ObjectiveTo explore the effects and mechanisms of metandienone abuse on hepatotoxicity.MethodsHepG2 cells were treated with 1 μg/mL metandienone for 24 h. Cell viability and apoptosis were detected via Cell Counting Kit-8 and terminal deoxynucleotidyl transferase dUTP nick end labeling assays, respectively. Cellular morphology was assessed via transmission electron microscopy. Genetic changes were analyzed using transcriptome sequencing. Meanwhile, metandienone (0.1 mg·g·d) was administered via gavage to mice for 14 days. Liver pathology was examined via hematoxylin and eosin, periodic acid-Schiff, and transmission electron microscopy. Serum alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, albumin, total cholesterol, triglyceride, lactate dehydrogenase, and creatine kinase were measured.ResultsCell Counting Kit-8 assay confirmed that cell viability decreased to 88.01% after 24 h of metandienone treatment. Terminal deoxynucleotidyl transferase dUTP nick end labeling assay showed that the apoptosis rate increased to 25.08%, compared with 4.94% in the NC group. RNA transcriptome data showed that the expression levels of 221 genes in the metandienone group altered significantly; these genes were closely related to liver metabolism, oxidative stress, inflammatory response, and immune regulation. Meanwhile, exposure to metandienone-induced liver injury was characterized by hepatocyte steatosis and inflammation, accompanied by significant increases in serum alanine aminotransferase and aspartate aminotransferase.ConclusionThe abuse of anabolic hormones leads to liver function damage, and the mechanism may be related to inflammatory responses and metabolism.
Causal effects of 32 eating habits on ischemic stroke risk and post-stroke functional outcome: A Mendelian randomization study.
Xu X, Zang X, Liu H … +6 more , Zhang X, Yu N, Wang W, Han L, Chen C, Chen F
J Int Med Res · 2026 Jun · PMID 42286858 · Full text
ObjectiveTo assess the causal effects of specific eating habits on ischemic stroke risk and functional outcomes using Mendelian randomization.MethodsThis two-sample Mendelian randomization study used genetic variants ass...
ObjectiveTo assess the causal effects of specific eating habits on ischemic stroke risk and functional outcomes using Mendelian randomization.MethodsThis two-sample Mendelian randomization study used genetic variants associated with 32 eating habits as instrumental variables. Summary-level data were obtained from large-scale genome-wide association studies of individuals of European ancestry. The primary analysis used the inverse-variance weighted method, supplemented by sensitivity analyses to assess pleiotropy and multivariable Mendelian randomization to evaluate mediation via lipids and blood pressure.ResultsAfter multiple-testing correction, genetically predicted higher intake of cheese (odds ratio = 0.70, 95% confidence interval: 0.57-0.86), dried fruit (odds ratio = 0.57, 95% confidence interval: 0.41-0.80), and muesli (odds ratio = 0.20, 95% confidence interval: 0.07-0.54) showed potential protective associations with ischemic stroke risk. Sensitivity analyses supported the robustness of the findings, and multivariable Mendelian randomization indicated that the effects of cheese and muesli remained significant after adjustment for cardiovascular risk factors. No causal associations were observed for post-stroke recovery.ConclusionThis study provides genetically derived causal evidence suggesting that higher consumption of cheese, dried fruit, and muesli may reduce the risk of ischemic stroke. Further studies are warranted to validate these food-specific dietary recommendations.
Ultrasound-guided percutaneous renal biopsy: Free-hand versus puncture attachment.
Lv Y, He G, Feng L … +12 more , Cheng X, Deng J, Zhu Y, Wang S, Yu G, Tu Q, Yu X, Wu Y, Zhang X, Lai L, Zhu Q, Jiang Y
J Int Med Res · 2026 Jun · PMID 42286857 · Full text
ObjectiveUltrasound-guided percutaneous renal biopsy is a common diagnostic tool for renal disease. This study investigated the safety and efficiency of free-hand and puncture attachment approaches for ultrasound-guided...
ObjectiveUltrasound-guided percutaneous renal biopsy is a common diagnostic tool for renal disease. This study investigated the safety and efficiency of free-hand and puncture attachment approaches for ultrasound-guided percutaneous renal biopsy.MethodsThis retrospective, single-center study included 110 patients who underwent ultrasound-guided percutaneous renal biopsy. The patients were divided into the free-hand or puncture attachment group, depending on whether a puncture attachment was used.ResultsThe number of glomeruli obtained in the free-hand group was similar to that in the puncture attachment group. Two patients had no glomeruli visible under the microscope and could not be diagnosed. The most common etiologies were immunoglobulin A nephropathy (42 patients; 38.2%) and hypertensive nephropathy (27 patients; 24.5%). Most participants received individual antihemorrhagic treatments. Only three patients had postoperative complications, including gross hematuria, perinephric hematoma, and transient fever, with no significant difference between the free-hand and puncture attachment groups. After biopsy, the number of urinary red blood cells rapidly increased during the first micturition and then decreased during the third micturition.ConclusionsThe rates of hematuria and glomerular yield after renal biopsy were similar between the free-hand and puncture attachment groups. The free-hand approach could be a safe and efficient technique for patients undergoing ultrasound-guided percutaneous renal biopsy without puncture attachment.
Association between electrolyte disturbance score and 30-day severe disturbance of consciousness and in-hospital mortality in intensive care unit patients with intracerebral hemorrhage: A retrospective observational cohort study.
Wang H, Zhou H, Zhao P … +6 more , Chen M, Mao J, Tang J, Huang C, Li Y, Cha Z
J Int Med Res · 2026 Jun · PMID 42286856 · Full text
ObjectivesIntracerebral hemorrhage is a cerebrovascular disease associated with high mortality and disability rates. Electrolyte disorders are common in intensive care unit patients; however, most current studies have fo...
ObjectivesIntracerebral hemorrhage is a cerebrovascular disease associated with high mortality and disability rates. Electrolyte disorders are common in intensive care unit patients; however, most current studies have focused on the association between a single electrolyte abnormality and intracerebral hemorrhage prognosis, lacking a comprehensive quantitative assessment of multiple electrolyte disturbances. This study aimed to explore the prognostic value of a multielectrolyte disturbance scoring system for adverse outcomes in intensive care unit patients with intracerebral hemorrhage.MethodsThis retrospective observational cohort study analyzed data from the Medical Information Mart for Intensive Care IV database. A scoring system covering six electrolytes was constructed, with scores assigned according to the abnormal range, number of concurrent abnormalities, and duration. Multivariate logistic and Cox regression analyses were used to evaluate the association between the score and 30-day severe disturbance of consciousness or in-hospital mortality. Subgroup analyses and restricted cubic spline analyses were further performed.ResultsAmong 1540 patients, 321 (20.84%) developed 30-day severe disturbance of consciousness. The electrolyte disturbance score was significantly higher in patients with disturbance of consciousness than in those without disturbance of consciousness. Multivariate regression analysis (Model 3, adjusted for all covariates) showed that, compared with T1, both T2 and T3 were associated with an increased risk of 30-day severe disturbance of consciousness and in-hospital mortality. Subgroup analyses confirmed a stable association across most subgroups. Restricted cubic spline analysis revealed a nonlinear positive correlation between the score and both outcomes, with accelerated risk elevation when the score exceeded 2.ConclusionThe constructed electrolyte disturbance scoring system is a reliable prognostic tool for predicting 30-day severe disturbance of consciousness and in-hospital mortality in intensive care unit patients with intracerebral hemorrhage. A score >2 was associated with a significantly accelerated risk of adverse outcomes, providing a practical threshold for clinical intervention and individualized management.
Nasopharyngeal hirudiniasis, a rare cause of masked hemoptysis in an older patient: A case report.
Abd Alkareem AA, Alharbi M, Alabdlilrazzak A … +2 more , Alras A, Alibrahim MM
J Int Med Res · 2026 Jun · PMID 42277618 · Full text
Leeches commonly inhabit freshwater environments and feed on blood; however, pharyngeal leech infestation in humans remains an unusual cause of hemoptysis that poses significant diagnostic challenges. We report the case...
Leeches commonly inhabit freshwater environments and feed on blood; however, pharyngeal leech infestation in humans remains an unusual cause of hemoptysis that poses significant diagnostic challenges. We report the case of a male patient in his early 60s presenting with a 2-week history of persistent hemoptysis and pharyngeal discomfort. Physical examination revealed a transient, mobile structure behind the uvula that initially mimicked a blood clot. Flexible nasopharyngoscopy subsequently demonstrated a moving foreign body attached to the nasopharyngeal wall. The organism, identified as a 3-cm leech, was successfully removed using curved forceps without anesthesia, leading to immediate symptom resolution. This case underscores the necessity of considering parasitic infestation in the differential diagnosis of unexplained upper airway bleeding. It highlights the importance of obtaining a detailed environmental history regarding untreated freshwater exposure and utilizing endoscopy as a gold standard diagnostic tool.
Evaluation of body mass index, waist-to-hip ratio, and waist-to-height ratio as predictors of insulin resistance in Syrian adult women: A cross-sectional study.
Zam W, Farkoh H, Makhoul J … +1 more , Youssef J
J Int Med Res · 2026 Jun · PMID 42270572 · Publisher ↗
ObjectiveBody mass index, waist-to-hip ratio, and waist-to-height ratio are widely used anthropometric indices for assessing obesity-related metabolic risk; however, their relative contributions to insulin resistance rem...
ObjectiveBody mass index, waist-to-hip ratio, and waist-to-height ratio are widely used anthropometric indices for assessing obesity-related metabolic risk; however, their relative contributions to insulin resistance remain debated and vary across different ethnicities.MethodsThis prospective cross-sectional study evaluated the correlations of body mass index, waist-to-hip ratio, and waist-to-height ratio with insulin resistance, measured by the homeostasis model assessment of insulin resistance, among 70 Syrian adult women aged 17-46 years who were consecutively recruited from the outpatient clinic in Homs governorate.ResultsScatter plots and correlation analyses were performed indicating that different anthropometric parameters are associated, to varying degrees, with the occurrence and progression of insulin resistance. Among studied anthropometric obesity indicators, body mass index has a weak, non-significant correlation with homeostasis model assessment of insulin resistance (r = 0.18, p = 0.1338), whereas waist-to-height ratio (r = 0.62, p = 0.0001) was found to be the most closely associated with occurrence of insulin resistance. Receiver operating characteristic analysis further demonstrated that waist-to-height ratio had the highest predictive accuracy for insulin resistance (area under the curve = 0.82), outperforming body mass index (area under the curve = 0.78) and waist-to-hip ratio (area under the curve = 0.74).ConclusionTherefore, waist-to-height ratio appears to be a simple and effective anthropometric tool for identifying individuals at higher risk of insulin resistance in Syrian adult women. However, as our study was only conducted on women, further investigations in men are warranted to justify its widespread adoption in clinical practice.
A pilot study investigating the bacterial and fungal community shifts in facial skin in rosacea.
Tang X, Shen Z, Li B … +1 more , Yuan J
J Int Med Res · 2026 Jun · PMID 42270571 · Full text
ObjectiveThis study aimed to characterize the bacterial and fungal communities in the facial skin of patients with rosacea versus healthy controls and assess their association with skin oil content.MethodsIn this prospec...
ObjectiveThis study aimed to characterize the bacterial and fungal communities in the facial skin of patients with rosacea versus healthy controls and assess their association with skin oil content.MethodsIn this prospective observational study, facial skin samples from eight individuals (six patients with rosacea and two healthy controls) across three skin oil types were analyzed using 16S rRNA and internal transcribed spacer sequencing. Analyses included alpha/beta diversity, compositional profiling, and cross-kingdom correlations.ResultsPatients with rosacea exhibited higher bacterial diversity (Shannon index: 2.26 ± 1.12) than controls (0.71 ± 0.07). Fungal communities underwent extreme restructuring with near-complete species replacement between individuals (Bray-Curtis ∼1.0). Skin oil content was a key determinant of microbial diversity. Cross-kingdom bacteria-fungi correlations were weak and nonsignificant.ConclusionsRosacea is associated with distinctive cross-kingdom microbiome alterations, featuring increased bacterial diversity and profound fungal reorganization. These findings challenge prevailing dysbiosis paradigms and highlight the potential for therapeutic strategies targeting both bacterial and fungal elements.
Predictive utility of the baseline Tp-e interval for early arrhythmic events in acute myocardial infarction: A cohort study.
Gandamsetty S, Taggarshe Surkunda S, Shetty AA … +3 more , Pai DD, Chaudhuri S, Shastry BA
J Int Med Res · 2026 Jun · PMID 42270570 · Full text
ObjectiveAcute myocardial infarction is a major cause of early cardiovascular morbidity and mortality, with arrhythmias contributing to adverse outcomes. This study evaluated the predictive utility of the baseline T wave...
ObjectiveAcute myocardial infarction is a major cause of early cardiovascular morbidity and mortality, with arrhythmias contributing to adverse outcomes. This study evaluated the predictive utility of the baseline T wave peak-T wave end interval for arrhythmic events within 48 h in patients presenting with the first episode of acute myocardial infarction.MethodsIn this analytical cohort study, 196 patients with acute myocardial infarction were enrolled. Clinical characteristics, electrocardiographic findings, echocardiographic findings, angiographic findings, arrhythmias, complications, and in-hospital mortality were recorded.ResultsThe mean age of the patients was 62.1 ± 10.3 years, and 69.4% were male. Arrhythmias occurred in 65.3% of patients, most commonly ventricular tachycardia (21.8%). Multivariable logistic regression identified higher Killip class (III-IV) and prolonged T wave peak-T wave end interval as the independent predictors of arrhythmias. A T wave peak-T wave end cutoff ≥98 ms showed a sensitivity of 77.3%, specificity of 52.9%, and diagnostic accuracy of 69%. The T wave peak-T wave end and T wave peak-T wave end/QT ratios were significantly higher among nonsurvivors, along with greater clinical severity.ConclusionA prolonged baseline T wave peak-T wave end interval (≥98 ms) and higher Killip class independently predict early arrhythmias in acute myocardial infarction.
Chronic myeloid leukemia in resource-limited settings: Navigating treatment challenges amid limited tyrosine kinase inhibitor access.
Aamir Z, Kaleem B, Hassan SJ … +4 more , Hafeez A, Jabeen A, Zehra SA, Mansoor N
J Int Med Res · 2026 Jun · PMID 42270569 · Publisher ↗
ObjectivesChronic myeloid leukemia presents unique management challenges in resource-limited settings such as Pakistan, where access to advanced molecular monitoring and newer tyrosine kinase inhibitors remains limited....
ObjectivesChronic myeloid leukemia presents unique management challenges in resource-limited settings such as Pakistan, where access to advanced molecular monitoring and newer tyrosine kinase inhibitors remains limited. This study evaluates the outcomes in patients with chronic myeloid leukemia in Pakistan, where first-generation tyrosine kinase inhibitors remain the primary mode of treatment due to the lack of newer interventions and insufficient molecular surveillance facilities.MethodsThis retrospective cohort study analyzed 73 patients with chronic myeloid leukemia treated at the Indus Hospital and Health Network, Karachi, Pakistan, between 2018 and 2025. Patients were stratified according to the European Treatment and Outcome Study long-term survival score, and treatment responses were compared using hematologic and molecular remission.ResultsThe proportion of males and females was almost equal. Conventional karyotypes were observed in 92.9% of cases. With imatinib as the first-line therapy, optimal response and treatment failure was observed in 31.3% and 45.3% cases, respectively. A lower complete hematologic response was associated with intermediate-risk scores and atypical fluorescence in situ hybridization results. The intent to change therapy was found to be a powerful predictor of better overall response (adjusted odds ratio: 23.620, -value: 0.0001). Only two patients transitioned to blast crisis.ConclusionAlthough there are promising trends of improvement in progression-free survival, the high rates of treatment failure as well as the lack of access to advanced treatment regimens and monitoring remain major concern. Strengthening public-private collaborations and international partnerships is essential to ensure equitable access to advanced therapies and improve long-term outcomes in patients with chronic myeloid leukemia in low- and middle-income countries.
Risk factors and predictive model for futile recanalization after mechanical thrombectomy in patients with acute ischemic stroke: A multicenter retrospective study.
Mei S, Zhou F, Zhan X … +8 more , Wu B, Zhang Y, Yang J, Li B, Xu M, Wu Q, Li F, Gu L
J Int Med Res · 2026 Jun · PMID 42270568 · Full text
ObjectiveTo identify risk factors for futile recanalization after mechanical thrombectomy in patients with acute ischemic stroke and develop an interpretable nomogram for risk stratification.MethodsThis multicenter retro...
ObjectiveTo identify risk factors for futile recanalization after mechanical thrombectomy in patients with acute ischemic stroke and develop an interpretable nomogram for risk stratification.MethodsThis multicenter retrospective study included 350 patients with acute ischemic stroke who underwent mechanical thrombectomy. A development cohort consisting of 260 patients was derived from two centers, and an external validation cohort comprising 90 patients was obtained from an independent center. Futile recanalization was defined as a 90-day modified Rankin Scale score >2 despite successful recanalization. Clinical, imaging, and perioperative variables were collected. The development cohort was randomly divided into training and test cohorts in a 7:3 ratio. Least absolute shrinkage and selection operator regression and multivariable logistic regression were used to identify independent predictors, and a nomogram was developed. Model performance was evaluated using receiver operating characteristic analysis, calibration assessment including calibration curve, calibration slope, calibration intercept, and Brier score, and decision curve analysis. External validation was performed to evaluate model generalizability.ResultsOf 350 included patients, 152 (43.43%) experienced futile recanalization. Higher baseline National Institutes of Health Stroke Scale score, lower Alberta Stroke Program Early CT Score, elevated admission blood glucose levels, poor collateral circulation, and longer onset-to-recanalization time were identified as independent predictors of futile recanalization. The nomogram demonstrated acceptable discriminative ability, with area under the receiver operating characteristic curve values of 0.84 (95% confidence interval: 0.78-0.84), 0.86 (95% confidence interval: 0.78-0.86), and 0.8 (95% confidence interval: 0.7-0.8) in the training, test, and external validation cohorts, respectively. Calibration was satisfactory, and decision curve analysis indicated potential clinical utility.ConclusionsThis multicenter retrospective study developed a nomogram with acceptable discriminative ability, satisfactory calibration, and potential clinical utility for predicting futile recanalization after mechanical thrombectomy in acute ischemic stroke. The model may support perioperative risk stratification and individualized management; however, further validation in larger prospective cohorts is warranted.
Tandem occlusions after emergent stenting in acute ischemic stroke: A retrospective cohort study from a comprehensive stroke center's experience (TOESIS study).
Le TM, Tran CC, Nguyen GL … +3 more , Nguyen NH, Nguyen TT, Tran LBM
J Int Med Res · 2026 Jun · PMID 42270567 · Full text
ObjectiveIn acute tandem occlusion, emergent stenting has recently become an endovascular treatment option combined with mechanical thrombectomy to achieve recanalization. However, data on the beneficial endovascular man...
ObjectiveIn acute tandem occlusion, emergent stenting has recently become an endovascular treatment option combined with mechanical thrombectomy to achieve recanalization. However, data on the beneficial endovascular management of tandem occlusion in two vascular territories remain limited. The purpose of this study was to compare improvements in clinical outcomes between two vascular territories 3 months after emergent stenting.MethodsThis retrospective cohort study included consecutive patients with acute ischemic stroke who underwent emergent extracranial stenting at our hospital. The primary outcomes were the rate of favorable outcome at 3 months and the incidence of postprocedural hemorrhagic transformation.ResultsPosttreatment outcomes were evaluated in 145 eligible patients who underwent emergent extracranial stenting between December 2020 and June 2025. At 3 months postprocedure, 108 patients (74.5%) had favorable outcomes, of whom 97 (66.9%) achieved good outcomes. Smoking, dyslipidemia, National Institutes of Health Stroke Scale score ≥12, diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score ≤6, and procedural complications (p < 0.05) were significantly associated with poor outcomes.ConclusionsIn summary, emergent stenting for tandem occlusions involving both vascular territories appears to be an essential recanalization method associated with improved clinical outcomes at the 3-month follow-up.
Peripheral blood inflammatory indices and their association with hospitalization status in acute exacerbation of chronic obstructive pulmonary disease: A retrospective observational study.
Ucar Y, Yonar A, Karabulut KU
J Int Med Res · 2026 Jun · PMID 42261002 · Full text
ObjectiveChronic obstructive pulmonary disease is a progressive inflammatory lung disease characterized by chronic bronchitis and emphysema. This study aimed to evaluate the levels of composite inflammatory markers, incl...
ObjectiveChronic obstructive pulmonary disease is a progressive inflammatory lung disease characterized by chronic bronchitis and emphysema. This study aimed to evaluate the levels of composite inflammatory markers, including systemic immune-inflammation index, systemic inflammatory response index, pan-immune-inflammation value, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, hemoglobin-to-red cell distribution width ratio, hemoglobin-to-monocyte ratio, and hemoglobin-to-white blood cell count ratio, in patients presenting with acute exacerbation of chronic obstructive pulmonary disease.MethodsThis retrospective observational study included patients aged ≥40 years who presented to a tertiary Chest Diseases clinic between 2022 and 2024 with acute exacerbation of chronic obstructive pulmonary disease. Patients were categorized into two groups (outpatient treatment and hospitalization groups) according to the management strategy used. Hematological parameters and composite inflammatory indices were calculated and compared between the groups.ResultsIn total, 314 patients were included; 80.3% of them were male. Hospitalized patients were significantly older and had higher white blood cell counts, C-reactive protein levels, neutrophil-to-lymphocyte ratios, platelet-to-lymphocyte ratios, systemic immune-inflammation indices, systemic inflammatory response indices, and pan-immune-inflammation values than outpatients (all < 0.001). In contrast, the hemoglobin-to-red cell distribution width, hemoglobin-to-monocyte, and hemoglobin-to-white blood cell count ratios were significantly lower in hospitalized patients (all < 0.001).ConclusionsComposite inflammatory indices derived from routine blood tests may reflect the systemic inflammatory burden during acute exacerbation of chronic obstructive pulmonary disease and may support the clinical assessment of hospitalization risk.
The incremental prognostic value of platelet-to-neutrophil and platelet-to-lymphocyte ratios in patients with sepsis: A retrospective cohort study.
Ni C, Ye F, Zhang X … +3 more , Song J, Yang H, Cai J
J Int Med Res · 2026 Jun · PMID 42251504 · Publisher ↗
ObjectiveThis study aimed to systematically investigate the independent predictive value of the platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio for 28-day all-cause mortality in patients with sepsis and to...
ObjectiveThis study aimed to systematically investigate the independent predictive value of the platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio for 28-day all-cause mortality in patients with sepsis and to further evaluate their incremental discriminatory capacity when added to conventional prognostic scoring models.MethodsThis single-center retrospective cohort study involved 287 adult patients diagnosed with sepsis according to the Sepsis-3 criteria. Patients were stratified into high- and low-level groups based on the median values of platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio, and baseline characteristics, and clinical outcomes were compared between groups. Univariate and multivariate Cox proportional hazards regression models were used to assess the independent associations of platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio with 28-day mortality risk. To evaluate predictive performance, multiple models were constructed and compared, including Sequential Organ Failure Assessment score alone, Acute Physiology and Chronic Health Evaluation II score alone, each combined separately with platelet-to-neutrophil ratio or platelet-to-lymphocyte ratio, and a composite model integrating Acute Physiology and Chronic Health Evaluation II, day-3 lactate level, platelet-to-neutrophil ratio, and platelet-to-lymphocyte ratio. Model performance was rigorously assessed using receiver operating characteristic curves, calibration plots, decision curve analysis, integrated discrimination improvement, and net reclassification improvement, enabling a comprehensive evaluation of discrimination, calibration, clinical utility, and the incremental value of novel biomarkers.ResultsMultivariate Cox regression analysis revealed that lower platelet-to-neutrophil ratio (hazard ratio = 0.97, 95% confidence interval: 0.95-0.99, p = 0.012) and higher platelet-to-lymphocyte ratio (hazard ratio = 1.01, 95% confidence interval: 1.01-1.01, p = 0.043) were independently associated with increased 28-day all-cause mortality. Kaplan-Meier survival analysis confirmed significantly higher cumulative mortality in the low-platelet-to-neutrophil ratio and high-platelet-to-lymphocyte ratio groups (log-rank p < 0.05). The composite model incorporating Acute Physiology and Chronic Health Evaluation II, day-3 lactate level, platelet-to-neutrophil ratio, and platelet-to-lymphocyte ratio demonstrated superior predictive accuracy, with an area under the receiver operating characteristic curve (area under the curve) of 0.824 (95% confidence interval: 0.778-0.871), significantly outperforming both the Acute Physiology and Chronic Health Evaluation II only model (area under the curve: 0.746, p < 0.001) and the Sequential Organ Failure Assessment only model (area under the curve: 0.667, p < 0.001). Decision curve analysis showed that this model provided greater clinical net benefit across a broad range of threshold probabilities. Furthermore, both integrated discrimination improvement and net reclassification improvement analyses confirmed statistically significant improvements in discrimination and reclassification accuracy after the inclusion of platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio (both p < 0.001).ConclusionPlatelet-to-neutrophil ratio and platelet-to-lymphocyte ratio are independent predictors of 28-day mortality in patients with sepsis. Incorporating these readily available and cost-effective inflammatory markers into traditional prognostic systems-such as Acute Physiology and Chronic Health Evaluation II-and combining them with dynamic lactate monitoring substantially enhances the discrimination, calibration, and clinical utility of risk prediction models. These findings provide robust evidence supporting the use of platelet-to-neutrophil ratio and platelet-to-lymphocyte ratio for early risk stratification and individualized prognostic assessment in clinical practice.
Low body mass index is related to post-lumbar puncture headache in Chinese adults: A cross-sectional study.
Li R, Liu X, Yang N … +5 more , Zhang G, Zhao H, Liu C, Wu Z, Qiao B
J Int Med Res · 2026 Jun · PMID 42251503 · Full text
ObjectivePost-lumbar puncture headache is a common complication following lumbar puncture. Although several risk factors have been established, the role of low body mass index remains controversial. This study aimed to e...
ObjectivePost-lumbar puncture headache is a common complication following lumbar puncture. Although several risk factors have been established, the role of low body mass index remains controversial. This study aimed to evaluate the association between body mass index and post-lumbar puncture headache in Chinese adults undergoing lumbar puncture.MethodsIn total, 499 patients who underwent lumbar puncture at the Department of Neurology between January 2022 and March 2024 were enrolled. Data on demographic characteristics, blood pressure, lumbar puncture history, and cerebrospinal fluid parameters were collected. Univariate and multivariate logistic regression models were employed to assess the relationship between body mass index and post-lumbar puncture headache. Subgroup analyses were conducted to evaluate the consistency of this association across sex, age, blood pressure, cerebrospinal fluid volume, and cerebrospinal fluid protein levels.ResultsPost-lumbar puncture headache occurred in 13% (65/499) of patients; among these, 63.1% were female. Compared with those without post-lumbar puncture headache, those with a headache were younger (<0.001), had lower body mass index (=0.003), lower systolic and diastolic blood pressures (=0.001 and =0.001), lower cerebrospinal fluid protein level (<0.001), and greater cerebrospinal fluid collection volume (<0.001). No significant association was found between primary disease classification and post-lumbar puncture headache (=0.164). In univariate logistic regression analysis, the risk of post-lumbar puncture headache significantly decreased with increasing body mass index values (odds ratio = 0.9, 95% confidence interval: 0.84-0.97, = 0.003). After multivariable adjustment for sex, age, blood pressure, cerebrospinal fluid protein level, and cerebrospinal fluid volume, the association remained significant (odds ratio = 0.92, 95% confidence interval: 0.85-0.99, =0.033). Further analysis, in which patients were grouped by body mass index levels and assessed using two multivariate regression models, revealed that individuals with a low body mass index had a significantly higher risk of post-lumbar puncture headache. In Model I, adjusted for sex and age, the odds ratio was 3.2 (95% confidence interval: 1.41-7.23, =0.005); in Model II, further adjusted for systolic pressure, diastolic pressure, cerebrospinal fluid protein level, and cerebrospinal fluid collection volume, the odds ratio was 3.14 (95% confidence interval: 1.36-7.25, =0.007). The findings were robust across both models. The findings were consistent in the subgroup analyses.ConclusionLower body mass index is significantly associated with an increased risk of post-lumbar puncture headache. These findings underscore the importance of considering body mass index in preoperative risk assessment and postoperative management for patients undergoing lumbar puncture. However, due to the cross-sectional study design, causal inference cannot be established.
Refractory nail lichen planus treated successfully with the Janus kinase 1 inhibitor abrocitinib: A case report.
Wang L, Lei X, Li L … +1 more , Cheng Q
J Int Med Res · 2026 Jun · PMID 42251502 · Full text
Nail lichen planus is a chronic inflammatory condition that may be isolated to the nail, resulting in longitudinal nail ridging, trachyonychia, and splinter hemorrhages, and may be highly refractory to conventional treat...
Nail lichen planus is a chronic inflammatory condition that may be isolated to the nail, resulting in longitudinal nail ridging, trachyonychia, and splinter hemorrhages, and may be highly refractory to conventional treatment. The management of nail lichen planus remains challenging because of the lack of standardized treatment guidelines, and the efficacy of existing therapies, both topical and systemic, is often inconsistent or unsatisfactory. Emerging reports have suggested that abrocitinib, a selective Janus kinase 1 inhibitor, may be safe and effective in treating severe nail lichen planus. This report describes the case of a woman in her late 40s with refractory nail lichen planus who was successfully treated with abrocitinib.
Postoperative transfusion-related acute lung injury in a young woman with corpus luteum cyst rupture: Case report and literature review.
Wang J, Yang S, Cao H … +2 more , Khaoula B, Liu R
J Int Med Res · 2026 Jun · PMID 42251501 · Full text
This case study examines a 22-year-old unmarried woman who experienced shock resulting from rupture of a corpus luteum cyst. During the perioperative period, the patient received multiple transfusions of red blood cells...
This case study examines a 22-year-old unmarried woman who experienced shock resulting from rupture of a corpus luteum cyst. During the perioperative period, the patient received multiple transfusions of red blood cells and fresh frozen plasma. Subsequently, the patient developed transfusion-related acute lung injury 6 h following the final blood transfusion. The findings indicated that the inflammatory characteristics of antiphospholipid syndrome and deep vein thrombosis were closely associated with the onset of transfusion-related acute lung injury. Surgical procedures and multiple perioperative blood transfusions, particularly those involving fresh frozen plasma, were identified as significant contributors to the acute onset of transfusion-related acute lung injury. It is crucial for healthcare professionals to improve blood transfusion management and increase awareness of transfusion-related acute lung injury, especially in African countries with limited medical resources.
Diagnostic and therapeutic challenges in a patient with coexisting ankylosing spondylitis and Löfgren's syndrome: A case report.
Chen L, Liu Y, Yang L … +1 more , Wang L
J Int Med Res · 2026 Jun · PMID 42251500 · Full text
Löfgren's syndrome is an acute variant of sarcoidosis, characterized by the classic triad of erythema nodosum, bilateral hilar lymphadenopathy, and arthralgia or arthritis. Its low incidence in the Chinese population con...
Löfgren's syndrome is an acute variant of sarcoidosis, characterized by the classic triad of erythema nodosum, bilateral hilar lymphadenopathy, and arthralgia or arthritis. Its low incidence in the Chinese population contributes to limited clinical awareness and diagnostic challenges. We report the case of a Chinese man with long-standing ankylosing spondylitis who had been experiencing recurrent joint swelling, pain, and fever over the past year. At the most recent presentation, he had developed tender, erythematous subcutaneous nodules on the limbs, clinically consistent with erythema nodosum, and was diagnosed with ankylosing spondylitis and Löfgren's syndrome. A comprehensive review of his treatment course revealed a favorable response to glucocorticoid therapy. Notably, he had received adalimumab for ankylosing spondylitis over the past year, and the temporal relationship suggested that adalimumab precipitated Löfgren's syndrome relapse. We further reviewed the literature comparing Löfgren's syndrome between Western and Asian populations. Our findings indicate that Asian Löfgren's syndrome patients are more likely to receive a delayed diagnosis and often require lengthier glucocorticoid therapy. These differences may stem from genetic predispositions influencing disease expression and immune response. Therefore, we recommend that glucocorticoid regimens for Löfgren's syndrome in Chinese patients be carefully titrated and monitored. In a similar manner, when Löfgren's syndrome coexists with other rheumatic immune diseases, tumor necrosis factor-α inhibitors such as adalimumab should be used with heightened vigilance to minimize disease relapse.
V-pattern and accommodative convergence/accommodation ratio in consecutive esotropia after surgery for intermittent exotropia: A comparison of bilateral lateral rectus recession and unilateral recession-resection.
Chen L, Xu Y, Sheng X … +2 more , Hao R, Zhang W
J Int Med Res · 2026 Jun · PMID 42251499 · Full text
ObjectiveTo delineate a clinically actionable phenotype of consecutive esotropia with V-pattern following surgery for intermittent exotropia and to determine whether the initial surgical approach-bilateral lateral rectus...
ObjectiveTo delineate a clinically actionable phenotype of consecutive esotropia with V-pattern following surgery for intermittent exotropia and to determine whether the initial surgical approach-bilateral lateral rectus recession versus unilateral recession-resection-is associated with differential patterns of V-pattern presentation and accommodative convergence/accommodation behavior among patients who develop consecutive esotropia. Clarifying these associations may inform postoperative surveillance and the selection of secondary surgical strategies in consecutive esotropia complicated by pattern deviation.MethodsWe retrospectively reviewed patients who developed consecutive esotropia after surgery for intermittent exotropia and were evaluated/managed at our center between 2016 and 2024. Thirty-four patients with consecutive esotropia had previously undergone bilateral lateral rectus recession (bilateral lateral rectus recession group), and twenty-six had previously undergone recession-resection (recession-resection group). Intermittent exotropia stage and consecutive esotropia clinical data were extracted, including ocular motility (with emphasis on abduction limitation), refractive status, presence and magnitude of V-pattern, and accommodative convergence/accommodation ratio measured using the gradient method. Comparisons were performed between groups at each stage and within individuals across the intermittent exotropia-to-consecutive esotropia transition.ResultsBaseline distance exodeviation was comparable between groups (bilateral lateral rectus recession: 38.92 ± 12.78 at 6 m and 36.47 ± 13.47 at 33 cm; recession-resection: 39.04 ± 12.91 at 6 m and 40.60 ± 10.54 at 33 cm), whereas near exodeviation was greater in the recession-resection group than in the bilateral lateral rectus recession group. No patient demonstrated a preoperative pattern deviation. Among consecutive esotropia cases, V-pattern was observed more frequently in the bilateral lateral rectus recession-derived consecutive esotropia cohort than in the recession-resection-derived cohort (15/34 vs. 3/26). During intermittent exotropia stage, accommodative convergence/accommodation ratios did not differ between groups; however, accommodative convergence/accommodation ratios increased after consecutive esotropia onset and were higher in the bilateral lateral rectus recession-derived consecutive esotropia cohort than in the recession-resection-derived cohort. These findings indicate that, once consecutive esotropia develops, the postoperative phenotype may vary according to initial procedure, with a stronger association between bilateral lateral rectus recession-derived consecutive esotropia and both V-pattern presentation and elevated accommodative convergence/accommodation.ConclusionsAmong patients who developed consecutive esotropia after intermittent exotropia surgery, bilateral lateral rectus recession-derived consecutive esotropia was more commonly accompanied by V-pattern and a higher accommodative convergence/accommodation ratio than recession-resection-derived consecutive esotropia. The increase in accommodative convergence/accommodation from the intermittent exotropia stage to the consecutive esotropia stage suggests that accommodative mechanisms may contribute to the consecutive esotropia-with-pattern phenotype and should be assessed when planning postoperative monitoring and secondary correction. Importantly, this study characterizes phenotypic differences among consecutive esotropia cases and does not estimate the incidence of consecutive esotropia or V-pattern consecutive esotropia after bilateral lateral rectus recession or recession-resection.
Primary tubercular chorioretinitis: A case report.
Chen J
J Int Med Res · 2026 Jun · PMID 42237072 · Full text
Intraocular tuberculosis often evades diagnosis owing to its nonspecific clinical features and frequent absence of systemic signs. We describe a rare case of primary tubercular chorioretinitis in an immunocompetent woman...
Intraocular tuberculosis often evades diagnosis owing to its nonspecific clinical features and frequent absence of systemic signs. We describe a rare case of primary tubercular chorioretinitis in an immunocompetent woman in her early 20s who presented with acute vision loss, ocular pain, and redness in the left eye. Multimodal imaging demonstrated active inflammation arising within-not at the margin of-pre-existing focal chorioretinal atrophy, accompanied by retinal vasculitis and choroidal hypoperfusion. Systemic workup revealed no extrapulmonary involvement; however, interferon-gamma release assay was strongly positive. Following initiation of standard four-drug antitubercular therapy, adjunctive oral corticosteroids were administered, achieving complete resolution of intraocular inflammation and marked visual recovery, with no recurrence during long-term follow-up. This case highlights intralesional reactivation within chorioretinal atrophy as a distinctive imaging hallmark suggestive of tubercular etiology. Recognition of this pattern may facilitate earlier diagnosis of intraocular tuberculosis, particularly in endemic regions or in patients lacking overt systemic disease. Given the potential for irreversible vision loss, timely initiation of antitubercular therapy-guided by multimodal imaging and immunologic testing-is critical. Our findings underscore the need to consider ocular tuberculosis in the differential diagnosis of posterior uveitis, even in immunocompetent individuals with isolated ocular symptoms, and advocate for heightened awareness of this subtle yet pathognomonic feature to improve diagnostic precision and clinical outcomes.
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