International Journal Of General Medicine[JOURNAL]
Sun
200 papers
The Impact of Trait Anxiety on Blood Pressure Variability and Target Organ Damage in Hypertensive Patients: A Cross-Sectional Study.
Bai H, Xu M, Jiang C
Int J Gen Med · 2026 · PMID 42404297 · Full text
BACKGROUND: Hypertension is a leading global cardiovascular risk factor. Blood pressure variability (BPV) and target organ damage (TOD) are strong predictors of adverse cardiovascular outcomes. Trait anxiety is associate...
BACKGROUND: Hypertension is a leading global cardiovascular risk factor. Blood pressure variability (BPV) and target organ damage (TOD) are strong predictors of adverse cardiovascular outcomes. Trait anxiety is associated with sympathetic nervous system hyperactivity and hypothalamic-pituitary-adrenal axis dysregulation, both of which may elevate BPV and promote TOD. However, evidence linking trait anxiety to 24-hour BPV and subclinical TOD in hypertension remains limited. This study aimed to investigate the independent association of trait anxiety with BPV and TOD in hypertensive patients, and to clarify its clinical significance and novelty relative to existing literature. OBJECTIVE: This study aimed to investigate the relationship between trait anxiety and both target organ damage (TOD) and blood pressure variability (BPV) in hypertensive patients. METHODS: A cross-sectional observational study was conducted including 285 hypertensive patients. Trait anxiety was measured using the State-Trait Anxiety Inventory (STAI). Ambulatory blood pressure monitoring (ABPM) was performed to assess 24-hour BPV. Cardiac-ankle vascular index (CAVI) and left ventricular mass index (LVMI) were measured on the same day as ABPM after 15 minutes of supine rest to evaluate vascular and cardiac TOD. Multivariate regression and partial correlation analyses were used to examine independent associations. RESULTS: Among the 285 hypertensive patients, 142 were classified into the low trait anxiety group and 143 into the high trait anxiety group, with well-balanced baseline characteristics between groups. Compared with the low anxiety group, patients with high trait anxiety exhibited significantly higher 24-hour systolic and diastolic blood pressure variability (BPV), as well as elevated left ventricular mass index (LVMI) and cardio-ankle vascular index (CAVI) (all P<0.05). Further partial correlation and multivariate regression analyses demonstrated that trait anxiety was independently and strongly associated with 24-hour average real variability (ARV) of systolic blood pressure, 24-hour ARV of diastolic blood pressure, LVMI, and CAVI (all P<0.001). These associations remained statistically significant after adjustment for age, gender, BMI, hypertension duration, medication use, and laboratory confounders. CONCLUSION: Trait anxiety is independently associated with increased 24-hour BPV and early TOD in hypertensive patients. As a modifiable psychological risk factor, trait anxiety may contribute to cardiovascular remodeling beyond mean blood pressure levels. Routine screening and anxiety intervention may help improve BPV control and reduce TOD progression. These findings provide new evidence for integrated psychological and cardiovascular management of hypertension.
Multimodal Neuroimaging Mechanisms of Apathy in Alzheimer's Disease: A Narrative Review of Structural, Functional, and Molecular Evidence.
You X, Guo Z
Int J Gen Med · 2026 · PMID 42404296 · Full text
Apathy is the most common neuropsychiatric symptom in Alzheimer's disease (AD) and is conceptualized as a pathological reduction of goal-directed motivation and behavior. It is currently believed that apathy has an indep...
Apathy is the most common neuropsychiatric symptom in Alzheimer's disease (AD) and is conceptualized as a pathological reduction of goal-directed motivation and behavior. It is currently believed that apathy has an independent neurobiological basis rather than merely accompanying cognitive decline. This narrative review synthesizes evidence from structural, functional, and molecular neuroimaging studies published up to 2025, identified through targeted PubMed searches and reference tracking, without applying formal systematic inclusion/exclusion criteria. Existing imaging evidence indicates that the core mechanism of apathy lies in the specific impairment of the prefrontal-basal ganglia motivational circuit: gray matter atrophy and hypometabolism in the anterior cingulate cortex (ACC) and orbitofrontal cortex are closely associated with impaired motivation integration and reward evaluation, whereas structural damage to the dorsolateral prefrontal cortex contributes to executive planning deficits. Functional network analysis further reveals suppression of the default mode network and ineffective compensation of the central executive network. Molecular imaging studies confirm that structural degeneration of the locus coeruleus, dopaminergic presynaptic transmission dysfunction, and synergistic pathological accumulation of amyloid-beta and Tau proteins in the motivational circuit collectively constitute the neurobiological basis of apathy. Furthermore, computational modeling has already been employed as an analytical framework to dissect these mechanisms, revealing altered effort-based decision-making and abnormal frontoparietal connectivity. Given the frequent impairment in self-awareness (anosognosia) regarding their own apathy in AD, informant-based assessments are essential for accurate clinical evaluation. Ultimately, integrating these multimodal biomarkers may facilitate early identification and stratified interventions, including dopaminergic and noradrenergic pharmacotherapies as well as non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS).
The Predictive Value of the Combined FVC/DLCO Ratio and 1-Minute Heart Rate Recovery After Exercise in Stable Chronic Obstructive Pulmonary Disease with Pulmonary Hypertension.
Wang N, Xing J, Zheng Y … +4 more , Wang J, Liu L, Tian Y, Cui Z
Int J Gen Med · 2026 · PMID 42404295 · Full text
OBJECTIVE: To evaluate the predictive value of combining the pulmonary function index forced vital capacity to diffusing capacity of the lung for carbon monoxide ratio (FVC/DLCO) with 1‑minute heart rate recovery (HRR1)...
OBJECTIVE: To evaluate the predictive value of combining the pulmonary function index forced vital capacity to diffusing capacity of the lung for carbon monoxide ratio (FVC/DLCO) with 1‑minute heart rate recovery (HRR1) in stable chronic obstructive pulmonary disease (COPD) complicated by pulmonary hypertension (PH), and to develop a machine learning‑based prediction model. METHODS: A total of 159 stable COPD patients (COPD group) and 52 stable COPD patients with PH (COPD+PH group) were enrolled. Baseline data were collected. Predictive performance of FVC/DLCO and HRR1 alone and in combination (logistic regression) was assessed. Four machine learning models (Random Forest, XGBoost, LightGBM, SVM) were trained using all features. RESULTS: The COPD+PH group showed significantly higher FVC/DLCO and lower HRR1. The combined FVC/DLCO+HRR1 model achieved an AUC of 0.781 (95% CI: 0.709-0.853), outperforming either marker alone. The Random Forest model performed best (AUC = 0.923, 95% CI: 0.881-0.961; accuracy 0.892; sensitivity 0.871; specificity 0.912), with good calibration. FVC/DLCO and HRR1 were the top two predictors. CONCLUSION: Combining FVC/DLCO with HRR1 enhances predictive accuracy for PH in stable COPD. The Random Forest model shows excellent performance, but external validation is needed before clinical implementation.
Vaginal Microecological Imbalance, Human Papillomavirus Infection, and Cervical Carcinogenesis: Mechanisms and Clinical Implications.
Gao W, Liu Y, Wang Q … +3 more , Xiao H, Wang F, Wang L
Int J Gen Med · 2026 · PMID 42404294 · Full text
The vaginal microecology serves as a critical barrier for female reproductive tract health, with its dysbiosis being closely linked to persistent HPV infection and the initiation and progression of cervical cancer. This...
The vaginal microecology serves as a critical barrier for female reproductive tract health, with its dysbiosis being closely linked to persistent HPV infection and the initiation and progression of cervical cancer. This review systematically outlines the composition and functions of the vaginal microbiota and delves into the multifaceted mechanisms by which microecological imbalance promotes human papillomavirus (HPV) acquisition, persistence, and oncogenic transformation. These mechanisms include dysregulation of local and systemic immunity, chronic inflammation, alterations in microbial metabolites, and disruption of the epithelial barrier. Furthermore, the article synthesizes recent advancements in novel strategies for cervical cancer prevention, auxiliary diagnosis, and treatment based on microecological modulation. The overarching aim is to provide a consolidated theoretical foundation and identify potential therapeutic targets for the precise prevention and management of cervical cancer, highlighting the pivotal role of maintaining or restoring vaginal microbial homeostasis.
Trofinetide Use and Treatment Patterns Among Children Aged 2-4 Years with Rett Syndrome in the United States: A Retrospective Specialty Pharmacy Linked Claims Database Analysis.
Rashid N, Yakkala VK, Doshi D … +1 more , Rajagopalan K
Int J Gen Med · 2026 · PMID 42404293 · Full text
INTRODUCTION: Rett syndrome (RTT) is a rare, X-linked neurodevelopmental disorder that primarily affects females. Trofinetide (TROF) was approved for RTT in individuals aged ≥2 years. Although the DAFFODIL trial examined...
INTRODUCTION: Rett syndrome (RTT) is a rare, X-linked neurodevelopmental disorder that primarily affects females. Trofinetide (TROF) was approved for RTT in individuals aged ≥2 years. Although the DAFFODIL trial examined TROF efficacy in children aged 2-4 years, real-world evidence in this age group remains limited. METHODS: A retrospective cohort study was conducted using linked medical and pharmacy claims from 01/01/2021-09/30/2024 (study period). Individuals aged 2-4 years with RTT who initiated TROF during 04/01/2023-03/31/2024 (identification period) were included (index date=first TROF RX). Outcomes included baseline characteristics, prescriber specialty, TROF persistence (≤90-day allowable gap), dosing patterns based on shipped/dispensed RXs (BID, mg; % target daily dose [%TDD]), time on treatment, and restarts among non-persistent individuals. Variables were summarized descriptively. Kaplan-Meier analyses assessed the time to treatment non-persistence. RESULTS: Among 159 individuals, 65.4% were persistent and 34.6% were non-persistent; 14.5% of non-persistent individuals restarted TROF. Mean±SD age was 3.2±0.8 vs 3.3±0.7 years in persistent vs non-persistent groups. Females comprised 95.2% vs 87.3%, respectively. Child neurology was the most common prescriber specialty (54.8% vs 63.6%). Non-persistent individuals had higher rates of dysphagia (34.5% vs 16.3%), gastrostomy (20.0% vs 3.8%), and breathing irregularities (16.4% vs 1.9%). Mean BID dose and %TDD were similar between groups across shipments. Median (IQR) time on treatment was 13.3 (6.1-17.2) months in the persistent group vs 4.4 (0.8-12.6) months in the non-persistent group. Kaplan-Meier analysis showed >87.5% remained on TROF beyond 3 months and >65.0% remained on TROF through end of available follow-up. CONCLUSION: In routine US practice, approximately two-thirds of children aged 2-4 years initiating TROF remained persistent during available follow-up, with sustained use beyond 1 year and a subset (14.5% of non-persistent children) restarting after discontinuation. Non-persistent children had significantly higher baseline rates of dysphagia, gastrostomy, and breathing irregularities, suggesting that early disease-related multisystem complications may be associated with reduced treatment continuity. These findings complement DAFFODIL and provide early real-world evidence on TROF persistence, restarts, and dosing patterns in this young RTT population.
Association Between Admission Diastolic Blood Pressure and Clinical Outcomes in Elderly Patients with Severe/Critical COVID-19: A Retrospective Cohort Study.
Qu F, Wang L, Wei D … +3 more , Zhang Q, Liu J, Cheng W
Int J Gen Med · 2026 · PMID 42404292 · Full text
BACKGROUND: Elderly patients aged ≥65 years remain disproportionately vulnerable to severe COVID-19, with 30-day mortality rates ranging from 32% to 59% during the Omicron wave despite the variant's reduced overall virul...
BACKGROUND: Elderly patients aged ≥65 years remain disproportionately vulnerable to severe COVID-19, with 30-day mortality rates ranging from 32% to 59% during the Omicron wave despite the variant's reduced overall virulence. While blood pressure abnormalities are common in critically ill COVID-19 patients, the prognostic significance of admission diastolic blood pressure (DBP) as an independent predictor of short-term mortality in this population has not been systematically evaluated. OBJECTIVE: To investigate the association between DBP and clinical outcomes in this vulnerable population. METHODS: This retrospective cohort study included 240 consecutive elderly patients (aged ≥65 years) with severe/critical COVID-19 admitted to the Hospital from December 24, 2022 to January 24, 2023. Patients were categorized by admission DBP into three groups: hypotension (<70 mmHg), optimal range (70-89 mmHg), and poor control (≥90 mmHg). The primary outcome was 30-day mortality. Multivariable logistic regression analysis was performed to identify independent predictors of mortality. RESULTS: The full predictive model incorporating admission DBP category, age, chronic kidney disease, secondary infection, and oxygen saturation demonstrated good discrimination (AUC 0.880, 95% CI: 0.832-0.926). The Hosmer-Lemeshow goodness-of-fit test yielded χ=19.077 (P=0.015), and the optimal discrimination threshold determined by Youden's index yielded a sensitivity of 85.7% and a specificity of 84.6%. CONCLUSION: In elderly patients with severe/critical COVID-19, admission hypotension was a strong independent predictor of 30-day mortality. These findings suggest that careful blood pressure monitoring and avoidance of excessive DBP reduction may improve outcomes in this vulnerable population.
Intraoperative Urine Tests and STONE Score Predict Postoperative SIRS (Systemic Inflammatory Response Syndrome) After PCNL in Patients with Negative Preoperative Urine Culture.
Wen J, Liu C, Lu K … +2 more , Chen W, Gao R
Int J Gen Med · 2026 · PMID 42404291 · Full text
OBJECTIVE: This study aimed to identify predictors of postoperative systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL) in patients with negative preoperative midstream urine cult...
OBJECTIVE: This study aimed to identify predictors of postoperative systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL) in patients with negative preoperative midstream urine culture (PMUC), and to assess the predictive value of intraoperative renal pelvic urine tests, urinary sediment examination, and the STONE score. METHODS: Clinical data were retrospectively collected from PMUC-negative patients with complex renal calculi who underwent first-stage single-tract PCNL at the First Affiliated Hospital of Fujian Medical University. Patients were classified into SIRS and non-SIRS groups according to the occurrence of postoperative SIRS within 72 hours. SIRS was used as an indicator of early postoperative systemic inflammatory response, as not all cases met Sepsis-3 criteria for organ dysfunction. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of postoperative SIRS. A nomogram was subsequently developed and assessed for calibration and discrimination. RESULTS: A total of 126 patients (89 males and 37 females) were included, and 29 developed postoperative SIRS. Multivariate logistic regression identified intraoperative leukocyte esterase (LE) positivity (OR = 2.324, 95% CI 1.164-4.641, p = 0.017), elevated intraoperative white blood cell (WBC) count (OR = 5.855, 95% CI 1.209-28.357, p = 0.028), positive stone culture (OR = 15.929, 95% CI 1.792-141.600, p = 0.013), and higher STONE score (OR = 1.948, 95% CI 1.125-3.375, p < 0.017) as independent risk factors. The nomogram demonstrated good calibration (Hosmer-Lemeshow p > 0.05) and strong discriminative ability, with an AUC of 0.935. CONCLUSION: Intraoperative leukocyte esterase, intraoperative white blood cell count, positive stone culture, and higher STONE score were independently associated with postoperative SIRS after first-stage PCNL in PMUC-negative patients. The nomogram may assist in early risk stratification in this population.
The Impact of Oxidative Stress Imbalance on Ovarian Function and Its Mechanisms.
Zhang S, Wang F, Yang H … +2 more , Wang L, Ge R
Int J Gen Med · 2026 · PMID 42404290 · Full text
Oxidative stress, defined as an imbalance between reactive oxygen species (ROS) production and antioxidant defenses, plays a critical role in female reproductive health, particularly in ovarian function. This review prov...
Oxidative stress, defined as an imbalance between reactive oxygen species (ROS) production and antioxidant defenses, plays a critical role in female reproductive health, particularly in ovarian function. This review provides a comprehensive and updated synthesis of the impact of oxidative stress on ovarian physiological processes, including follicular development, oocyte quality, steroid hormone synthesis, luteal function, and ovarian aging. We delve into the underlying molecular mechanisms-mitochondrial dysfunction, endoplasmic reticulum stress, inflammatory signaling (NF-κB, NLRP3), and epigenetic alterations-and discuss how these pathways converge to drive specific cell death modalities (apoptosis, pyroptosis, ferroptosis) in granulosa cells and oocytes. The review consolidates current knowledge on diagnostic biomarkers, associated pathological conditions (polycystic ovary syndrome, premature ovarian insufficiency, endometriosis), and emerging intervention strategies. What distinguishes this review from existing literature is its systematic integration of mechanistic pathways with clinical phenotypes, its explicit discussion of conflicting evidence and knowledge gaps, and its forward-looking perspective on targeted therapies (mitochondria‑directed antioxidants, stem cell‑derived exosomes, traditional Chinese medicine) and lifestyle interventions. Our aim is to provide a theoretical foundation for understanding oxidative stress‑mediated ovarian dysfunction and to offer practical insights for future research and clinical management.
Navigating Alzheimer's Disease in Primary Care: Practical Strategies for Diagnosis and Management.
Larson ST, Susman JL
Int J Gen Med · 2026 · PMID 42404289 · Full text
Alzheimer's disease (AD), the most common form of dementia, is a neurodegenerative disorder that primarily affects older adults. Because the number of Americans 65 years of age and older living with AD is expected to inc...
Alzheimer's disease (AD), the most common form of dementia, is a neurodegenerative disorder that primarily affects older adults. Because the number of Americans 65 years of age and older living with AD is expected to increase and the availability of specialty physicians, such as neurologists and geriatricians, is limited, the role of primary care in diagnosing and managing patients with AD is expected to grow. Several guidelines for primary care providers are available for the evaluation, diagnosis, and treatment of patients with AD. However, there is no single concise and convenient reference tool for use in the primary care setting. In the primary care setting, clinicians are responsible for identifying patients at risk or demonstrating signs of cognitive impairment, administering cognitive tests, identifying appropriate referrals, and, in some cases, ordering blood-based biomarker testing. Although definitive testing and treatment identification may occur in the specialty care setting, in addition to serving as the hub to coordinate the multidisciplinary care team, primary care clinicians remain responsible for guiding patients and caregivers through shared decision-making regarding treatment, as well as the myriad responsibilities related to comorbidities, patient and caregiver psychological well-being, social support, and safety. This review aims to provide practical recommendations to primary care clinicians for the diagnosis, management, and long-term care of patients with AD.
The Need for Community-Based Multimodal Screening for Chronic Disease and Cancer in Rural Kansas.
Neely JA, Schmidt JR, Ziaei ES … +4 more , Elliott KG, Durrett RD, McMann L, Ventura CAI
Int J Gen Med · 2026 · PMID 42389682 · Full text
This commentary argues that community-based, multimodal screening is a practical and evidence-aligned response to the disproportionate burden of chronic disease and cancer in rural Kansas, where structural barriers conti...
This commentary argues that community-based, multimodal screening is a practical and evidence-aligned response to the disproportionate burden of chronic disease and cancer in rural Kansas, where structural barriers continue to limit access to preventive care. It highlights blood pressure screening as an effective entry point for broader detection of cardiovascular, metabolic, hematologic, and mental health risk, while emphasizing the clinical value of pairing such efforts with laboratory and psychosocial assessment.
Awareness and Understanding of Ionizing and Non-Ionizing Radiation Modalities Among Patients in Saudi Arabia.
Arif WM
Int J Gen Med · 2026 · PMID 42382339 · Full text
BACKGROUND: Medical diagnostic procedures involving the radiation use are important component of modern healthcare systems, enabling accurate diagnosis, staging and monitoring of many conditions or diseases. Patients' un...
BACKGROUND: Medical diagnostic procedures involving the radiation use are important component of modern healthcare systems, enabling accurate diagnosis, staging and monitoring of many conditions or diseases. Patients' understanding of ionizing versus non-ionizing imaging modalities, associated risks, and radiation safety is essential for informed consent and shared decision-making. AIM: This study aims to assess patients' awareness, knowledge, perceptions, confidence, and educational needs regarding ionizing and non-ionizing radiation used in medical imaging. METHODS: A cross-sectional questionnaire-based design was adopted in this study. Participants included patients who have undergone various medical imaging procedures, and were aged above 18 years. An online validated 28-item questionnaire was used to collect the data from 1256 adult patients. Descriptive statistics and inferential analyses, including ANOVA and -tests, were performed with significance set at < 0.05. RESULTS: Although 77.6% recognized natural ionizing radiation, 40.8% misclassified MRI as ionizing and 41.3% misclassified CT as non-ionizing. Only 34.1% identified CT as the highest-dose procedure. Mean risk awareness score was 4.13 (SD 0.78) and confidence score was 4.15 (SD 0.79). Older age, higher education, and female gender were significantly associated with greater awareness ( = 9.74, = 0.001). CONCLUSION: Despite high perceived awareness and confidence regarding ionizing radiation, significant misconceptions about imaging modalities and radiation dose still persist among patients in Saudi Arabia. This suggests the need for structured, standardized radiation-risk communication before imaging procedures to improve patient understanding and informed consent.
Development and Validation of an Interpretable Machine Learning Model Based on Peripheral Blood Biomarkers for Esophageal Cancer Risk Prediction.
Wang Q, Shen L, Qiu W … +5 more , Shi Q, Zhang Y, Shen K, Zhang J, Qiu H
Int J Gen Med · 2026 · PMID 42382338 · Full text
BACKGROUND: Noninvasive, low-cost prescreening tools are needed to improve risk stratification for esophageal cancer (EC) before endoscopic confirmation. We developed and validated explainable machine-learning (ML) model...
BACKGROUND: Noninvasive, low-cost prescreening tools are needed to improve risk stratification for esophageal cancer (EC) before endoscopic confirmation. We developed and validated explainable machine-learning (ML) models using routine peripheral blood biomarkers. METHODS: This dual-center retrospective case-control study enrolled 454 participants (198 EC cases, 256 non-EC controls) from two hospitals between March 2021 and June 2025. Data were randomly split 7:3 into training (n=319) and validation (n=135) sets. LASSO regression selected nine features (SIRI, MLR, AST, ADA, CREA, UA, K, PT, and TT). Seven algorithms-logistic regression, decision tree, random forest (RF), XGBoost, LightGBM, support vector machine, and artificial neural network-were trained with 10-fold cross-validation and grid-search hyperparameter tuning. Performance was assessed by discrimination, calibration, clinical utility, and confusion matrices, with Shapley additive explanations (SHAP) for interpretation. RESULTS: Baseline demographics and comorbidities were comparable between groups. In the validation set, RF performed best (AUC=0.973; accuracy=0.926; sensitivity=0.881; specificity=0.961; F1-score=0.912), achieved the lowest Brier score (0.059), and showed favorable net benefit. SHAP analysis identified creatinine and SIRI as the most influential features, where lower creatinine and higher SIRI increased predicted EC risk. CONCLUSION: This explainable RF model showed excellent discrimination and good calibration. As a retrospective case-control study using healthy controls, it is intended as a prescreening tool to guide endoscopic referral rather than a diagnostic test, and requires prospective external validation before clinical use.
Screening for Abdominal Aortic Aneurysm in Elderly Male Patients with Coronary Artery Disease During Standard Transthoracic Echocardiography.
Lei Y, Zhang L, Wang M … +6 more , Wang L, Su J, Zhou M, Wang X, Qi X, Xue Y
Int J Gen Med · 2026 · PMID 42382337 · Full text
PURPOSE: No studies on abdominal aortic aneurysm (AAA) screening in elderly male patients with coronary artery disease (CAD) in China have been conducted. This study aims to determine AAA prevalence, identify risk factor...
PURPOSE: No studies on abdominal aortic aneurysm (AAA) screening in elderly male patients with coronary artery disease (CAD) in China have been conducted. This study aims to determine AAA prevalence, identify risk factors, and assess transthoracic echocardiography (TTE) as a screening modality to optimize screening strategies and enhance early diagnosis. PATIENTS AND METHODS: This observational study prospectively enrolled male CAD patients aged ≥65 who had coronary angiography at Liaocheng People's Hospital from January to June 2024. All underwent routine TTE with abdominal aortic diameter measurements for AAA screening. AAA prevalence was calculated, and clinical characteristics were compared using appropriate tests. Univariate and multivariate logistic regression analyses were done to find independent risk factors. RESULTS: 384 elderly male CAD patients were included, all completing AAA screening via TTE in 2.1±1.7 minutes on average. AAA was detected in 23 patients (6.0%), and 361 had no evidence. 4 AAA cases (17.4%) with aneurysms ≥50 mm were referred to vascular surgery. Multivariate analysis identified age, smoking history, hypertension, and multivessel coronary disease as independent risk factors. The overall AAA prevalence was 6.0% (23/384), and it was 16.8% (16/95) in patients with concurrent multivessel disease, hypertension, and smoking history. CONCLUSION: This study shows a relatively high AAA prevalence among elderly male CAD patients in China and identifies multivessel disease as a potential independent risk factor for the first time, although this finding should be interpreted cautiously. TTE, a non - invasive and easily implementable tool, is effective in AAA detection and suitable for routine cardiac evaluations of CAD patients. These findings provide a basis for AAA screening in this high - risk population, potentially improving early detection, reducing rupture risk, and enhancing patient outcomes.
Machine Learning-Based Prediction Model for Type 2 Diabetic Peripheral Neuropathy: Role of Bilateral Brachial-Ankle Pulse Wave Velocity and Anthropometric Indicators.
Zhang Z, Sun L, Wang Y … +1 more , Wang Y
Int J Gen Med · 2026 · PMID 42382336 · Full text
PURPOSE: Establishing a machine learning model to predict diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM) and exploring the role of bilateral brachial-ankle pulse wave velocity and a...
PURPOSE: Establishing a machine learning model to predict diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM) and exploring the role of bilateral brachial-ankle pulse wave velocity and anthropometric indices. PATIENTS AND METHODS: Clinical data of 966 T2DM patients were retrospectively analyzed. According to sensory nerve conduction test results, they were divided into a DPN group and a non-DPN group. The BorutaShap method was employed to screen influencing factors, based on which nine machine learning models were established and compared. Interpretative analysis was performed using the SHAP (SHapley Additive exPlanations) package in Python. The mean absolute SHAP value of feature parameters was defined as their importance and ranked accordingly. The relationship between each feature and DPN was determined based on SHAP values, and quantitative analysis was conducted for continuous variables. RESULTS: Among 966 T2DM patients, 469 were diagnosed with DPN and 13 influencing factors identified. Of nine machine learning models, the Support Vector Machine (SVM) model performed best (accuracy 0.74[95% CI: 0.69-0.79], AUC 0.82[95% CI: 0.77-0.87], recall 0.66[95% CI: 0.58-0.74], precision 0.80[95% CI: 0.73-0.86], F1 0.72[95% CI: 0.66-0.78]). SHAP analysis of the SVM model showed left brachial-ankle pulse wave velocity (LBAPWV) as the most influential predictor (SHAP=0.70), followed by gender, Glucose 0min, fT3, diabetes duration, and hip circumference. Right brachial-ankle pulse wave velocity (RBAPWV) contributed less (SHAP=0.20). Risk factors included LBAPWV, Gender, Glucose 0min, Diabetes duration, Insulin therapy, RBAPWV, UACR, Smoking, Height, and In-hospital blood glucose value; protective factors were fT3, Hip circumference, and C-peptide 180min. CONCLUSION: Machine learning enables robust DPN prediction. Our model revealed asymmetric importance between LBAPWV and RBAPWV, with LBAPWV showing stronger DPN associations. Hip circumference was a protective anthropometric predictor. These findings enhance DPN risk stratification.
Clinical Characteristics and Independent Risk Factors of Primary Gastrointestinal Lymphoma Complicated with Gastrointestinal Complications.
Ying CL, Zhao TQ, Pu QX … +2 more , Wan LY, Liu W
Int J Gen Med · 2026 · PMID 42376129 · Full text
BACKGROUND: This study aimed to investigate the clinical characteristics and risk factors of primary gastrointestinal lymphoma (PGIL) in patients with gastrointestinal complications (GICs). METHODS: A retrospective analy...
BACKGROUND: This study aimed to investigate the clinical characteristics and risk factors of primary gastrointestinal lymphoma (PGIL) in patients with gastrointestinal complications (GICs). METHODS: A retrospective analysis was conducted on the clinical data of 148 patients with PGIL admitted to Yichang Central People's Hospital from January 2019 to August 2025. Univariable and multivariable logistic regression models were utilized to identify independent risk factors for GICs. RESULTS: Patients with PGIL exhibited a high incidence (58.1%) of GICs, primarily bleeding, obstruction, and perforation. Bleeding predominantly involves gastric ulcerative lesions, whereas obstruction and perforation frequently affect the small intestine, with obstruction typically presenting endoscopically as protruding lesions. Compared to the non-GIC cohort, patients with GICs showed a significantly higher proportion of diffuse large B-cell lymphoma (DLBCL), poorer performance status (ECOG ≥ 2), and advanced tumor invasiveness. Furthermore, the GICs group demonstrated marked metabolic depletion, elevated systemic inflammation, significant bowel wall thickening, and lymphadenopathy. Crucially, multivariable analysis identified four independent risk factors for developing GICs: history of hypertension (odds ratio [OR] =3.724, CI: 1.149-12.074), primary intestinal site (OR=3.551, 95% CI: 1.240-10.170), deep lesion infiltration into the muscularis or serosa (OR=3.615, 95% CI: 1.132-11.546), and anemia (OR=4.288, 1.457-12.615). CONCLUSION: The high incidence of GICs in patients with PGIL is multifactorial. Early risk stratification and tailored interventions are crucial for patients presenting with hypertension, anemia, intestinal involvement, or deep tumor infiltration at the initial diagnosis to optimize therapeutic outcomes.
Comparative Analysis of Clinical Characteristics and Antimicrobial Resistance of IA-BSI Caused by and .
Huang X, Huang L, Xiao M … +1 more , Zhou X
Int J Gen Med · 2026 · PMID 42376128 · Full text
OBJECTIVE: To investigate the clinical characteristics and antimicrobial resistance differences in patients with Intra-abdominal infection-associated bloodstream infection (IA-BSI) caused by () and (). METHODS: A total...
OBJECTIVE: To investigate the clinical characteristics and antimicrobial resistance differences in patients with Intra-abdominal infection-associated bloodstream infection (IA-BSI) caused by () and (). METHODS: A total of 276 patients with Intra-abdominal infection-associated bloodstream infection (IA-BSI) were retrospectively enrolled from a single center, including 185 cases in the group and 91 cases in the group. The chi-square test and Mann-Whitney -test were used to compare clinical characteristics and antimicrobial resistance profiles between the two groups, and Kaplan-Meier curves were plotted to evaluate 30-day prognosis. RESULTS: (1) The group had higher Pitt scores, SOFA scores, and carbapenem-resistant (CR) rates (<0.05); (2) The group showed significantly higher ESBL-positive rates and quinolone resistance rates (<0.05); (3) The CR group had higher Pitt and SOFA scores, with an inapplicability rate of empirical therapy of 90.0% and a mortality rate of 60.0%; (4) No statistically significant difference in 30-day mortality was observed between the and groups (=0.24). CONCLUSION: There are heterogeneities in clinical characteristics and antimicrobial resistance profiles between patients with IA-BSI caused by and . Patients infected with present with more severe conditions, higher carbapenem resistance rates and greater treatment difficulty, whereas is characterized by high ESBL-positive rates and high quinolone resistance rates. This study provides evidence for clinical selection of antimicrobial agents, and further multicenter studies are needed for validation.
Retrospective Analysis of Inflammatory Biomarker Patterns and Platelet Dynamics in Hospitalized Adults.
Chen L, Huang S
Int J Gen Med · 2026 · PMID 42376127 · Full text
BACKGROUND: Systemic inflammation is common in hospitalized adults and may arise from infectious or non-infectious conditions. Several biomarkers, including WBC, neutrophil count, CRP, PCT, IL-6, and NLR, are widely used...
BACKGROUND: Systemic inflammation is common in hospitalized adults and may arise from infectious or non-infectious conditions. Several biomarkers, including WBC, neutrophil count, CRP, PCT, IL-6, and NLR, are widely used in clinical practice but may provide non-equivalent clinical information. Platelets are active participants in inflammatory responses, yet relationships between inflammatory biomarkers and platelet dynamics in hospitalized populations remain incompletely characterized. METHODS: This single-center retrospective study included 321 hospitalized adults between December 2024 and December 2025. Baseline biomarkers included WBC, absolute neutrophil count, platelet count, CRP, PCT, IL-6, and dNLR, analyzed according to availability. Spearman correlation assessed biomarker relationships. Infection-related and non-infectious diagnoses, classified using primary clinical diagnoses and available clinical documentation, were compared using the Mann-Whitney -test. Longitudinal associations between inflammatory changes and platelet dynamics were evaluated using changes during hospitalization. RESULTS: WBC and neutrophil count were strongly correlated (r = 0.95, p < 0.0001). CRP was moderately correlated with PCT (r = 0.34, p = 0.002), and PCT was positively correlated with IL-6 (r = 0.55, p < 0.001). Age was not significantly associated with CRP (r = -0.12, p = 0.153) but showed a modest correlation with dNLR (r = 0.165, p = 0.003). CRP, PCT, and IL-6 were higher in infection-related diagnoses than in non-infectious conditions (all p < 0.05). In longitudinal analyses, increases in PCT were associated with decreases in platelet counts (r = -0.45, p < 0.0001), while CRP showed a weaker inverse association with platelet changes (r = -0.21, p = 0.034). CONCLUSION: Inflammatory biomarkers in hospitalized adults demonstrated heterogeneous correlation patterns consistent with partially distinct inflammatory responses rather than a single uniform inflammatory signal. Leukocyte-based markers and cytokine-associated biomarkers represented partially independent components of systemic inflammation. Dynamic increases in inflammatory activity were associated with platelet decline during hospitalization.
Symptom Clusters and Sentinel Symptoms in Heart Failure Patients: A Cross-Sectional Survey.
Li Y, Xu M, Jia W … +3 more , Ma J, Guo S, Yao L
Int J Gen Med · 2026 · PMID 42369567 · Full text
PURPOSE: To explore the symptom clusters of heart failure (HF) patients, identify the sentinel symptom of each symptom cluster, and provide a basis for the implementation of precise symptom management. PATIENTS AND METHO...
PURPOSE: To explore the symptom clusters of heart failure (HF) patients, identify the sentinel symptom of each symptom cluster, and provide a basis for the implementation of precise symptom management. PATIENTS AND METHODS: The study participants were recruited using convenience sampling from inpatients admitted to the cardiology department between November 2024 and January 2025, including patients admitted for acute HF, chronic HF, and acute decompensation of chronic HF. The General Information Questionnaire and the Memorial Symptom Assessment Scale were used for the survey. Symptom clusters were explored using principal component analysis, sentinel symptoms were explored using the Apriori algorithm. RESULTS: A total of 354 HF patients participated in the study. Four symptom clusters were identified in HF patients: the nocturnal respiratory distress symptom cluster, the low perfusion symptom cluster, the upper airway irritation symptom cluster, and the gastrointestinal symptom cluster. Three sentinel symptoms were explored: waking up breathless at night, sweating and cough. CONCLUSION: HF patients have a variety of symptoms in the form of four symptom clusters, waking up breathless at night, sweating and cough are the sentinel symptoms. Medical staff can take sentinel symptoms as the focus of symptom cluster evaluation and targeted intervention, which can improve the efficiency of symptom cluster management and reduce patients' symptom burden.
Application of Epicardial Fat Volume for Identifying Hemodynamically Significant Coronary Artery Disease: A Retrospective Study.
Lu W, Zhang Z, Wang L … +1 more , Wang Z
Int J Gen Med · 2026 · PMID 42369566 · Full text
BACKGROUND: With the widespread application of coronary computed tomography angiography (CCTA), exploring novel biomarkers in imaging data to optimize the risk stratification of hemodynamically significant coronary arter...
BACKGROUND: With the widespread application of coronary computed tomography angiography (CCTA), exploring novel biomarkers in imaging data to optimize the risk stratification of hemodynamically significant coronary artery disease (HS-CAD) has become a research hotspot. HS-CAD was defined as ≥50% stenosis on CCTA with a corresponding reversible perfusion defect on single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). Although coronary artery calcium score (CACS) is routinely used, it is difficult to fully reflect the biological activity and functional impact of plaques. This single-center retrospective study aimed to investigate the association between epicardial fat volume (EFV) and HS-CAD, and to evaluate its incremental diagnostic value over clinical risk factors and the CACS. METHODS: A single-center retrospective study included 140 patients who underwent both CCTA and SPECT-MPI. EFV and CACS were quantitatively assessed. Univariable and multivariable logistic regression analyses were performed to identify independent predictors. RESULTS: Among the included patients, 50 (35.7%) had HS-CAD. The HS-CAD group had a higher prevalence of smoking and significantly greater EFV and CACS (all P<0.05). Multivariable analysis identified smoking history (OR=5.79;95% CI:2.14-15.66; indicating that smokers had nearly 6-fold higher odds of HS-CAD), CACS (OR=1.91 per 100-unit increase;95% CI:1.35-2.70), and EFV (OR=1.04 per cm increase;95% CI:1.02-1.07) as independent predictors (all P<0.01). The optimal EFV cutoff for predicting HS-CAD was 91.98 cm, with a sensitivity of 0.53 (95% CI: 0.42-0.63) and specificity of 0.96 (95% CI: 0.91-1.00). The area under the curve (AUC) for identifying HS-CAD was 0.78 for EFV alone and 0.79 for CACS alone. The combination of smoking history and CACS yielded an AUC of 0.84, which significantly improved to 0.90 after adding EFV. The combined model also showed good calibration and provided a net clinical benefit. CONCLUSION: EFV is independently associated with HS-CAD and provides incremental diagnostic value over clinical risk factors and CACS in this single-center retrospective study. These findings suggest that EFV may serve as a valuable biomarker for improving non-invasive risk stratification, warranting prospective validation in multicenter studies.
Knowledge, Attitudes, and Practices of Hypertensive Patients with Aortic Dissection and Aortic Aneurysm Towards Aortic Dissection and Its Prevention: A Mediation Analysis.
Zhang Y, Zhang B, Wang L … +1 more , Yuan J
Int J Gen Med · 2026 · PMID 42369565 · Full text
PURPOSE: To investigate the knowledge, attitudes, and practices (KAP) of hypertensive patients with aortic dissection (AD) and aortic aneurysm regarding AD and its prevention. PATIENTS AND METHODS: This cross-sectional s...
PURPOSE: To investigate the knowledge, attitudes, and practices (KAP) of hypertensive patients with aortic dissection (AD) and aortic aneurysm regarding AD and its prevention. PATIENTS AND METHODS: This cross-sectional study was conducted at Henan Chest Hospital between September 15, 2023, and December 15, 2023. Patients with hypertension and either Stanford type A or B AD, ascending aortic aneurysm, or abdominal aortic aneurysm were invited to participate. RESULTS: A total of 619 participants were included, of whom 521 (84.17%) were male. Their knowledge, attitude, and practice scores were 4.12±1.25 (range: 0-22), 35.41±3.92 (range: 10-50), and 28.07±2.96 (range: 8-40), respectively. Mediation analysis revealed that knowledge directly influenced attitudes (β = 0.338, P = 0.010), and attitudes directly influenced practices (β = 0.458, P = 0.005). Moreover, knowledge had an indirect effect on practices through attitudes (β = 0.155, P = 0.006). In the subgroup of patients with confirmed aortic dissection (n = 605), the mediation pattern was replicated. CONCLUSION: Hypertensive patients with AD and aortic aneurysm demonstrated markedly insufficient disease-related knowledge alongside relatively favorable attitudes and moderately engaged self-reported practices toward AD prevention. This imbalance suggests that certain preventive behaviors may occur despite limited disease-specific understanding, indicating a possible separation between knowledge and action. However, given the cross-sectional and self-reported nature of the data, the findings should be interpreted as descriptive patterns rather than evidence of causal relationships or intervention effectiveness.
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