International Journal Of General Medicine[JOURNAL]
Sun
200 papers
Immunological and Inflammatory Characteristics of Severe Cutaneous Adverse Drug Reactions: A Retrospective Study.
Luo Q, Mou XD, Cao D … +1 more , Cheng WH
Int J Gen Med · 2026 · PMID 41913904 · Full text
BACKGROUND: Severe cutaneous adverse drug reaction (SCADR) is a life-threatening immune-mediated disorder, yet humoral immune markers and inflammatory biomarkers have not been systematically characterized across major SC...
BACKGROUND: Severe cutaneous adverse drug reaction (SCADR) is a life-threatening immune-mediated disorder, yet humoral immune markers and inflammatory biomarkers have not been systematically characterized across major SCADR phenotypes. This study aims to identify the immunological and inflammatory characteristics of SCADR. METHODS: We retrospectively enrolled 60 SCADR patients (2015-2024) and two control cohorts (60 mild drug eruption patients and 60 age- and sex-matched healthy subjects). Baseline serum IgG, IgA, IgM, complement C3/C4, C-reactive protein (CRP), and procalcitonin (PCT) were measured prior to treatment, and between-group comparisons, correlation analyses, and subtype analyses [Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) vs DRESS] were performed. RESULTS: SCADR patients had lower IgG (8.8±4.1g/L) and complement levels (C3 1.01±0.37g/L; C4 0.21±0.12g/L) than controls (<0.05), alongside markedly elevated CRP (median: 31.1mg/L) and PCT (0.68µg/L) (<0.001). PCT was higher in SJS/TEN than drug reaction with eosinophilia and systemic symptoms (DRESS) (0.85 vs 0.45µg/L, =0.04), whereas eosinophil counts were higher in DRESS. C3 correlated positively with CRP (r=0.60, <0.001). No significant associations were observed between immunoglobulins and PCT, and PCT and CRP were largely independent. CONCLUSION: SCADR is associated with concurrent alterations in humoral immune markers and acute-phase inflammatory biomarkers. Differences in biomarker patterns between SJS/TEN and DRESS may help with early clinical phenotyping. Prospective multicenter studies are needed to validate these findings and clarify their clinical significance subsequently.
Difference in Clinical Features and Risk Factors of Ischemic Stroke Between Young and Elderly Adults: A Retrospective Observation from an Island Population.
Li L, Liu J, Xu Y … +4 more , Dong J, He S, Dai F, Liu H
Int J Gen Med · 2026 · PMID 41913903 · Full text
PURPOSE: The incidence of ischemic stroke in young adults has been increasing. However, there is a lack of in-depth understanding of relevant clinical features, particularly in specific geographic and climatic settings....
PURPOSE: The incidence of ischemic stroke in young adults has been increasing. However, there is a lack of in-depth understanding of relevant clinical features, particularly in specific geographic and climatic settings. This study aimed to comprehensively investigate the clinical features, including etiology and characteristics, of ischemic stroke in young adults compared with elderly patients from an island population characterized by a subtropical monsoon climate. PATIENTS AND METHODS: A total of 1,010 patients with ischemic stroke were included and divided into a young group (454 patients, aged 18-50 years) and an elderly group (556 patients, aged >50 years). Clinical and radiological data were collected and compared between the two groups. Continuous and categorical variables were compared using the -test (or non-parametric tests) and chi-square test, respectively. Binary logistic regression analyses were used to investigate differences between the two groups. RESULTS: Body mass index, leukocyte count, lymphocyte count, uric acid, and triglyceride levels were higher in the young group than in the elderly group, whereas vitamin B12 levels were lower. In addition, the proportions of cardiogenic embolism, other etiologies and unexplained strokes, and infarcts in the basal ganglia region were significantly higher in the young group. These results suggest age-related differences in clinical characteristics within this island study population. CONCLUSION: High body mass index, leukocyte count, uric acid, triglyceride levels, and low vitamin B12 levels are associated with ischemic stroke in young adults. Young adult patients had a higher prevalence of basal ganglia infarction, with a different subtype distribution from elderly patients. These findings highlight the importance of considering geographic specificity and age-related differences when developing stroke prevention and management strategies, formulating public health policies, and allocating medical resources for ischemic stroke.
Prognostic Outcomes by Ishak Fibrosis Score Grouping in Biliary Atresia After Kasai Surgery.
Huang L, Hao YX, Tang CY … +10 more , Xia XR, Zheng ZB, Du Q, Gong Y, Zhou WK, Zhu DW, Li ZP, Leng MD, Liu YM, Jin Z
Int J Gen Med · 2026 · PMID 41909607 · Full text
OBJECTIVE: This study aimed to assess the native liver survival (NLS) of biliary atresia (BA) patients with varying Ishak scores post Kasai portoenterostomy (KPE). METHODS: A prospective cohort study analyzed 83 BA patie...
OBJECTIVE: This study aimed to assess the native liver survival (NLS) of biliary atresia (BA) patients with varying Ishak scores post Kasai portoenterostomy (KPE). METHODS: A prospective cohort study analyzed 83 BA patients who underwent KPE. Patients were stratified into Mild Fibrosis Group (Ishak 1-2, n=20), Moderate Fibrosis Group (Ishak 3-4, n=39), and Cirrhosis Group (Ishak 5-6, n=24) based on postoperative Ishak scores. At the 6-month postoperative follow-up, clinical characteristics and liver function test outcomes were compared between groups to evaluate postoperative recovery profiles. RESULTS: Generalized estimating equations (GEE) revealed time-dependent declines in ALT, AST, ALP, and Total Bile Acid (TBA) across groups (<0.05), with cirrhosis patients exhibiting higher GGT and bilirubin levels vs. mild fibrosis (<0.05). 6-month Clearance of Jaundice (CoJ) differed significantly: 55.0% (mild) vs. 38.5% (moderate) vs. 8.3% (cirrhosis) (P=0.003). Six-month NLS sharply declined with fibrosis severity: 80.0% (mild) vs. 16.7% (cirrhosis) (<0.001). Multivariate logistic regression identified lower Ishak scores and younger surgical age as independent predictors of survival (<0.05). CONCLUSION: KPE improved liver function, but the Cirrhosis Group had poorer outcomes. Hepatic fibrosis severity correlated negatively with NLS, highlighting the importance of early surgery.
Prognostic Utility of the Cytokine Profile for Predicting Major Adverse Cardiovascular Events in Acute Myocardial Infarction Following Percutaneous Coronary Intervention.
Yang J, Zhang B, Li L … +2 more , Wu Y, Lu Y
Int J Gen Med · 2026 · PMID 41909606 · Full text
OBJECTIVE: This study aimed to assess the clinical utility and prognostic value of a panel of serum cytokines for predicting major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) a...
OBJECTIVE: This study aimed to assess the clinical utility and prognostic value of a panel of serum cytokines for predicting major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). METHODS: We enrolled 232 AMI patients who underwent PCI. Based on the occurrence of MACE during follow-up, patients were categorized into a poor prognosis group (n=127) and a good prognosis group (n=105). Serum levels of interleukin IL-1β, IL-6, IL-8, IL-10, and tumor necrosis factor-alpha (TNF-α) were measured. Spearman correlation analysis was employed to evaluate the relationships between cytokine levels and MACE risk. Nine distinct machine learning models, incorporating all identified independent risk factors for MACE, were developed and evaluated. RESULTS: Levels of high-sensitivity C-reactive protein (hs-CRP), IL-6, IL-8, and TNF-α were significantly elevated in patients who developed MACE compared to those who did not. IL-6 emerged as a relatively strong predictor of MACE, with an area under the curve (AUC) of 0.82 (95% CI: 0.77-0.87). The IL-6/IL-10 ratio also demonstrated predictive value for MACE (AUC=0.74, 95% CI: 0.69-0.80). Furthermore, significant differences were observed between initial presentation and readmission levels for the IL-8/IL-10 and TNF-α/IL-10 ratios in patients readmitted for AMI following MACE. Among the nine machine learning models constructed, the XGBoost and Logistic Regression models, which incorporated all independent risk factors, demonstrated robust performance, both AUC values exceeded 0.8. CONCLUSION: AMI patients with elevated serum cytokine levels exhibited a lower 1-year survival rate. Serum cytokine profiles show significant predictive value for MACE following PCI in AMI patients.
Neutrophil Extracellular Traps in Dry Eye: A Comprehensive Review of Pathogenic Mechanisms and Implications for Targeted Therapy.
Guo X, Wang C, Liu W … +4 more , Sun Y, Su L, Wang H, Liu B
Int J Gen Med · 2026 · PMID 41909605 · Full text
Dry eye (DE) is a multifactorial ocular surface disease characterized primarily by tear film instability and ocular discomfort. Nearly all forms of DE exhibit elevated inflammatory markers in tear fluid, accompanied by c...
Dry eye (DE) is a multifactorial ocular surface disease characterized primarily by tear film instability and ocular discomfort. Nearly all forms of DE exhibit elevated inflammatory markers in tear fluid, accompanied by clinical signs of tear dysfunction including reduced secretion and shortened breakup time. Although the pathophysiology of dry eye disease remains incompletely understood, accumulating evidence implicates neutrophil extracellular traps (NETs) as key pathogenic drivers. Robust clinical associations and mechanistic studies have established causal links between NETs and ocular surface pathology. This review summarizes current research on the role of NETs in the development of dry eye, aiming to identify potential therapeutic targets.
Data-Driven Culture in Medicine and Surgery: Policy Pathways to Learning Health Systems.
Reis LO, Moretti TBC
Int J Gen Med · 2026 · PMID 41909604 · Full text
The transition toward data-driven medicine represents a structural inflection point for health systems, redefining how quality, equity, and innovation are jointly pursued. Robotic-assisted surgery, when integrated within...
The transition toward data-driven medicine represents a structural inflection point for health systems, redefining how quality, equity, and innovation are jointly pursued. Robotic-assisted surgery, when integrated within real-world data infrastructures and effective governance, should be understood not merely as a technological upgrade but as a policy instrument capable of transforming surgical delivery at scale. The diversification of robotic platforms following patent expiration has altered the economic and strategic calculus, enabling broader adoption beyond elite or private settings. Brazil's decision to incorporate robotic-assisted radical prostatectomy into its Unified Health System (SUS) exemplifies how universal health systems can intentionally integrate advanced surgical technologies with equity objectives, industrial development, and national innovation strategies. This policy-oriented conceptual analysis synthesizes selected literature, policy frameworks, and health system experiences to examine the governance, implementation, and equity implications of data-driven surgery, with an emphasis on universal health systems and low- and middle-income countries. We argue that from a global health and policy perspective, data-driven surgery should be governed as a public asset, anchored in transparency, interoperability, and outcomes accountability, rather than as a market-driven luxury. Real-world data capture has enabled the systematic assessment of surgical performance, the personalization of care pathways, and the scaling of best practices across institutions. In principle, these developments offer a pathway toward more precise, efficient, and equitable surgical care. Health systems that fail to integrate robotics, artificial intelligence, and data governance risk widening inequities and forfeiting innovation sovereignty. Conversely, those that adopt a system-level, policy-led approach can transform surgical care into a lever for both population health and sustainable technological development. Challenges include digital infrastructure gaps, workforce readiness, regional disparities, and ethical concerns related to data governance and privacy.
Association Between Genotype and Plasma Levels of EPCR in Type 2 Diabetes Mellitus in Jazan Region, Saudi Arabia: A Case-Control Study.
Alattas N, Essawi K, Mobarki AA … +8 more , Dobie G, Hakami W, Musawi S, Alhakami FA, Habibullah MM, Alyahyawi Y, Madkhali AM, Hamali HA
Int J Gen Med · 2026 · PMID 41909603 · Full text
BACKGROUND: Type 2 diabetes mellitus (T2DM) is a major health burden in Saudi Arabia. Its prevalence is estimated at 16.4% to 28% among adults. It is characterized by chronic hyperglycemia inducing low-grade inflammation...
BACKGROUND: Type 2 diabetes mellitus (T2DM) is a major health burden in Saudi Arabia. Its prevalence is estimated at 16.4% to 28% among adults. It is characterized by chronic hyperglycemia inducing low-grade inflammation, which drives various physiological changes, including endothelial dysfunction. The endothelial protein C receptor (EPCR) is a membrane-bound receptor expressed on normal endothelial cells and is released upon endothelial dysfunction into the blood as soluble EPCR (sEPCR). Increased cleavage and release of EPCR is associated with the EPCR rs867186 polymorphism. Therefore, the current study aimed to investigate the pattern and frequency of EPCR rs867186 polymorphism and plasma levels of sEPCR in patients with T2DM and healthy controls. MATERIALS AND METHODS: The current case-control study was performed in Jazan region, Saudi Arabia. Two hundred and thirty-four blood samples were collected from the 136 patients with T2DM and 98 healthy controls for DNA analysis and hematological and biochemical assessments. RESULTS: The plasma levels of sEPCR were significantly elevated in T2DM patients compared to controls, despite no association being found between sEPCR levels and the genotype in either cohort. The pattern of EPCR rs867186 polymorphism revealed AA in 83.8% (n=196) and AG in 16.2% (n=38) of total cohorts (n=234), with comparable genotype distribution between patients and controls. CONCLUSION: This study highlights a significant elevation in plasma levels of sEPCR in patients with T2DM, indicating increased shedding of membrane EPCR and suggesting endothelial dysfunction. Importantly, the levels of sEPCR were not associated with rs867186 polymorphism. These findings suggest that sEPCR could be a useful biomarker for predicting early inflammation and endothelial dysfunction in T2DM.
Red Blood Cell Distribution Width-to-Albumin Ratio (RAR) Is an Independent Predictor of Mortality in Non-Anemic Elderly with Hip Fractures.
Ning T, Liu Z, Pan L … +4 more , Wang H, Liang G, Yu R, Cao Y
Int J Gen Med · 2026 · PMID 41909602 · Full text
BACKGROUND: Hip fractures in elderly patients are associated with high morbidity and mortality, and effective prognostic biomarkers to guide risk stratification remain scarce. The red blood cell distribution width-to-alb...
BACKGROUND: Hip fractures in elderly patients are associated with high morbidity and mortality, and effective prognostic biomarkers to guide risk stratification remain scarce. The red blood cell distribution width-to-albumin ratio (RAR), reflecting both inflammatory and nutritional status, has shown predictive value in other diseases but has not been evaluated in hip fractures. METHODS: This retrospective single-center study analyzed 622 elderly patients with hip fractures (aged ≥70 years) treated at Peking University First Hospital between 2015 and 2021. Patients were stratified into quartiles according to RAR (Q1-Q4), and mortality outcomes were assessed at 30 days, 3 months, 6 months, and 1 year after surgery. The prognostic significance of RAR was examined using Kaplan-Meier survival analysis, Cox proportional hazards models, and receiver operating characteristic (ROC) curves. RESULTS: Mortality increased progressively across RAR quartiles, with patients in the highest quartile (Q4) showing a 1-year mortality rate of 21.13%, compared with 4.08% in the lowest quartile (Q1) (P<0.001). Multivariable Cox regression analysis demonstrated that RAR was an independent predictor of mortality in non-anemic patients (Q4 vs. Q1: HR=12.52, 95% CI 3.18-49.24, P<0.001), whereas no significant association was observed in anemic patients (Q4 vs. Q1: HR=1.89, 95% CI 0.83-4.30, P=0.129). ROC analysis further indicated that RAR provided superior discriminatory performance compared with red blood cell distribution width (RDW) alone. CONCLUSION: RAR represents a novel and independent predictor of postoperative mortality in elderly non-anemic patients with hip fractures, offering greater predictive accuracy than RDW alone. Incorporating RAR into clinical risk stratification models may improve prognostic assessment and support individualized treatment planning. Validation through multicenter prospective studies and further investigation of underlying mechanisms are warranted.
A Balancing Act in Corneal Epithelial Repair: A MAPK-JUN/EGR1/TFAP2A Network Regulates Ferroptotic Cell Fate.
Jiang H, Chen Z, Luan W … +2 more , Li J, Yin N
Int J Gen Med · 2026 · PMID 41909601 · Full text
OBJECTIVE: To explore the role of ferroptosis in the process of corneal epithelial repair and to elucidate the underlying molecular regulatory mechanisms. METHODS: This study performed transcriptomic analysis based on th...
OBJECTIVE: To explore the role of ferroptosis in the process of corneal epithelial repair and to elucidate the underlying molecular regulatory mechanisms. METHODS: This study performed transcriptomic analysis based on the zebrafish corneal epithelial repair dataset (GSE193784). We intersected differentially expressed genes with the core weighted gene co-expression network analysis (WGCNA) module, and integrated Gene Ontology (GO)/Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis, protein-protein interaction (PPI) network construction, and cross-referencing with the FerrDb v2 database to screen for key ferroptosis-related molecules involved in the repair process. Subsequently, using an Erastin-induced ferroptosis model in human corneal epithelial cells (HCE-T), we performed in vitro validation via RT-qPCR. Additionally, we compared the identified transcriptomic signatures with the latest mammalian and human single-cell atlases to assess cross-species conservation. RESULTS: A total of 252 differentially expressed genes (DEGs) were identified, Intersection with the antiquewhite1 WGCNA module, which is most highly correlated with corneal epithelial repair, yielded 99 overlapping genes. Functional enrichment analysis revealed their significant roles in transcriptomic reprogramming, with a prominent enrichment in the MAPK signaling pathway. Further cross-screening using a PPI network and the FerrDb v2 database pinpointed three core biological factors: , and . In vitro experimental verification revealed their differential expression patterns of JUN downregulation, EGR1 upregulation and TFAP2A downregulation under ferroptosis stress. Cross-species bioinformatic comparisons demonstrated that this MAPK-driven transcriptomic reprogramming is highly consistent with the hyper-proliferative and highly plastic cellular states observed during mammalian and human corneal repair. CONCLUSION: This study found that JUN, EGR1 and TFAP2A, the core biological factors in the corneal epithelial repair process, are closely related to ferroptosis. This suggests that key biological factors enriched in the MAPK pathway may affect corneal epithelial repair by regulating ferroptosis.
Red Blood Cell Distribution Width as a Risk Factor for Late Arteriovenous Fistula Thrombosis in Maintenance Hemodialysis Patients: A Retrospective Cohort Study.
Chen X, Chen M, Lv Z … +3 more , Shen J, Jiang Q, Zhou R
Int J Gen Med · 2026 · PMID 41909600 · Full text
OBJECTIVE: To investigate the predictive value of red blood cell distribution width (RDW) for late thrombosis in arteriovenous fistula (AVF). METHODS: A retrospective analysis was conducted on data from 50 patients with...
OBJECTIVE: To investigate the predictive value of red blood cell distribution width (RDW) for late thrombosis in arteriovenous fistula (AVF). METHODS: A retrospective analysis was conducted on data from 50 patients with late AVF thrombosis admitted to Yangpu Hospital between June 2017 and May 2022 were collected. 60 patients with AVF but without thrombosis were recruited from the same institution during the same study period were selected as the control group. The correlation between RDW and other data was analyzed. Statistically significant risk factors were analyzed by multivariate logistic regression. The ROC curve was used to evaluate the value of RDW in predicting late AVF thrombosis. RESULTS: The values of RDW and leukocyte count in the thrombosis group were higher than those in the control group (P < 0.01). The levels of CRP, PLR, NLR, and neutrophils in the thrombosis group were higher than those in the control group (P < 0.05). Pearson correlation analysis showed that RDW was positively correlated with CRP, red blood cell count, PLR, NLR, and blood phosphorus. Multivariate logistic regression analysis showed that RDW (OR = 1.774, 95% CI: 1.055-2.983, P< 0.05) was an independent risk factor for late AVF thrombosis. ROC curve analysis displayed that the area under the curve (AUC) for RDW was 0.702 (95% CI: 0.59 6-0.808, P<0.001). The optimal predictive cutoff value for RDW, calculated according to the Youden index, is 15.30%. Using RDW ≥ 15.30% to predict late AVF thrombosis yielded a sensitivity of 60.00% and a specificity of 98.30%. CONCLUSION: RDW exhibits distinct expression patterns in late AVF thrombosis and demonstrates significant diagnostic potential. Incorporating this marker into existing diagnostic algorithms may enhance early risk prediction. However, further validation in large-scale, prospective multicenter studies is required to establish its clinical utility in routine practice.
A Multimodal Ultrasound Radiomics Study for Discriminating Benign and Malignant Breast Lesions Classified as BI-RADS Category 4.
Li D, Chang S, Sun C … +3 more , Lin F, Zhang Z, Chen Q
Int J Gen Med · 2026 · PMID 41909599 · Full text
PURPOSE: This study evaluates multimodal radiomics feature fusion integrating intratumoral and peritumoral radiomics derived from B-mode ultrasound (US) and Virtual Touch Tissue Imaging and Quantification (VTIQ) to diffe...
PURPOSE: This study evaluates multimodal radiomics feature fusion integrating intratumoral and peritumoral radiomics derived from B-mode ultrasound (US) and Virtual Touch Tissue Imaging and Quantification (VTIQ) to differentiate benign from malignant BI-RADS category 4 breast lesions. PATIENTS AND METHODS: A retrospective analysis was conducted on 264 patients. Radiomic features were extracted from intratumoral and peritumoral regions (1 mm, 3 mm, 5 mm) and VTIQ elastography. Three fusion strategies were compared: (i) B-mode US + peritumoral features, (ii) B-mode US + VTIQ, and (iii) triple fusion (B-mode US + peritumoral + VTIQ). Features were selected via LASSO regression, and models (LR, SVM, RF) were developed and validated on separate training (n = 184) and test (n = 80) cohorts. RESULTS: The B-mode US model achieved area under the curve (AUC) values of 0.890 (training) and 0.844 (test), surpassing the VTIQ model (training AUC = 0.850, test AUC = 0.812). Fusion of B-mode US and VTIQ features improved performance to AUCs of 0.913 and 0.874, respectively. Among peritumoral margins, the 3 mm region provided the best discrimination, with AUCs of 0.893 (training) and 0.871 (test). Integration of B-mode US with peritumoral features further improved performance (AUC = 0.908 training, 0.859 test). The triple-fusion model (B-mode US + peritumoral + VTIQ) achieved the highest diagnostic accuracy, with AUCs of 0.933 in the training cohort and 0.903 in the test cohort. CONCLUSION: Multimodal feature fusion significantly enhances the differentiation of benign and malignant breast lesions, supporting its potential for clinical decision-making.
Comparative Retrospective Analysis of Immunotherapy Combined with Anti-Angiogenic Agents and Nab-Paclitaxel in Metastatic Gastroesophageal Junction Adenocarcinoma.
Hong D, Wei Y, Guo Z … +5 more , Wang Z, Wu X, Li W, Shi Y, Zhang Y
Int J Gen Med · 2026 · PMID 41909598 · Full text
OBJECTIVE: Recent years have seen breakthrough progress in the use of immune checkpoint inhibitors in cancer therapy, offering new hope for patients with advanced gastric cancer. However, there remains insufficient real-...
OBJECTIVE: Recent years have seen breakthrough progress in the use of immune checkpoint inhibitors in cancer therapy, offering new hope for patients with advanced gastric cancer. However, there remains insufficient real-world evidence regarding the efficacy and safety of combining immune checkpoint inhibitors with anti-angiogenic drugs and chemotherapy in the second-line setting. There is a pressing clinical need for dedicated studies to validate its application value. The present investigation systematically evaluated the clinical efficacy and safety profile of a multimodal therapeutic strategy integrating second-line immunotherapeutic agents, cytotoxic chemotherapy, and anti-angiogenic therapy in patients with metastatic gastroesophageal junction adenocarcinoma. METHODS: A retrospective analysis was conducted on 84 patients treated in the oncology department. Patients were divided into two groups: the observation group (sintilimab + apatinib + albumin-bound paclitaxel, n = 42) and the control group (apatinib + albumin-bound paclitaxel, n = 42). Outcomes included median overall survival (mOS), median progression-free survival (mPFS), objective response rate (ORR), disease control rate (DCR), and adverse event incidence. RESULTS: Baseline characteristics (age, gender, Eastern Cooperative Oncology Group score, tumor location, histology, Lauren classification, human epidermal growth factor receptor 2 status, programmed death-ligand 1 expression, metastatic status, and prior treatment) showed no significant differences ( > 0.05), ensuring comparability. After follow-up, there was no significant difference in ORR or DCR between the two groups ( > 0.05): the observation group exhibited an ORR of 42.85% and DCR of 85.71%, compared to 38.09% and 75.57% in the control group, respectively. Furthermore, there was no significant difference in the overall incidence of adverse events or immune-related adverse events between the groups ( > 0.05). The incidence of immune-related adverse events was 21.43% (observation group) vs. 23.81% (control group), with no statistical significance ( = 0.798). The observation group had significantly longer mPFS (12.0 months vs. 9.0 months, hazard ratio (HR) = 0.455, 95% confidence interval [CI]: 0.217-0.956; = 0.028), though mOS showed no difference (HR = 0.384, 95% CI: 0.131-1.125; = 0.062). Kaplan-Meier analysis confirmed superior PFS in the observation group. CONCLUSION: The combination of an anti-PD-1 monoclonal antibody with chemotherapy and anti-angiogenic agents demonstrated preliminary efficacy and favorable safety in second-line gastric cancer patients. This study, using real-world data, validates the clinical benefit of this triple regimen, addresses the evidence gap in second-line treatment options, provides new insights for personalized combination strategies in advanced gastric cancer, and holds significant value for guiding clinical practice.
Establishment of Serum 25-Hydroxyvitamin D Reference Range for Healthy Adult Men Not Using Vitamin D Supplements in Alqurayyat, Saudi Arabia.
Aldaham AMS, Beheiry A, Hamza AA … +8 more , Albalawi MH, Alanazi AM, Alanazi AS, Albilasi MM, AlRuwaili AM, ALabdali AM, Alanazi AS, Alanazi MR
Int J Gen Med · 2026 · PMID 41909597 · Full text
BACKGROUND: Vitamin D is a secosteroid, a lipid-soluble vitamin that is involved in various physiological responses, including skeletal metabolism and immune response. Vitamin D [25(OH)D] in the blood is also influenced...
BACKGROUND: Vitamin D is a secosteroid, a lipid-soluble vitamin that is involved in various physiological responses, including skeletal metabolism and immune response. Vitamin D [25(OH)D] in the blood is also influenced by environmental factors, lifestyle, and is genetically determined. While there is abundant sunlight in every part of Saudi Arabia throughout the year, hypovitaminosis D is prevalent. The locally obtained reference interval has not yet been defined among the people of Alqurayyat. The study was conducted to identify population-specific serum 25(OH)D reference ranges among healthy adult Saudi men in Alqurayyat who do not receive vitamin D supplements. MATERIALS AND METHODS: The study was a cross-sectional design conducted between December 2022 and August 2023. 204 apparently healthy Saudi men aged 18-45 years were selected after eliminating statistical exceptions. Participants were taken from voluntary blood donors at Alqurayyat General Hospital. Serum 25(OH)D was measured by chemiluminescence immunoprecipitation assay done on the UniCel DxI 800 analyzer. The extreme values were also removed by the Tukey method. The reference range was derived using the 95% central distribution, which is the 2.5th and 97.5th percentiles. RESULTS: The 25(OH)D mean was 12.47 ±4.84 ng/mL (95% CI: 11.77-13.17 ng/mL). The calculated reference interval was 4.22-26.14 ng/mL, which is significantly lower than the international norms. Vitamin D was low in 93%, under 20 ng/mL, with 7% between 20-29 ng/mL. None of the subjects had adequate levels (>30 ng/mL). CONCLUSION: The high prevalence of vitamin D deficiency (93%) in this population of non-supplementing healthy adult men is one of the key health issues of the population. The calculated reference range is quite low compared to international standards, which probably shows local lifestyle and cultural conditions restricting productive sun exposure. More research and specific treatment are justified.
Non-HDL/HDL Cholesterol Ratio as a Protective Factor for Functional Recovery Following Intracerebral Hemorrhage: A Prospective Cohort Study.
Gu T, Yu C, Zha Z … +6 more , Rao C, Zhang X, Wen M, Huo Y, He C, Zhu L
Int J Gen Med · 2026 · PMID 41909596 · Full text
PURPOSE: Whether lipid profiles influence functional recovery after intracerebral hemorrhage (ICH) is unclear. This study investigated the association between the non-high-density lipoprotein to high-density lipoprotein...
PURPOSE: Whether lipid profiles influence functional recovery after intracerebral hemorrhage (ICH) is unclear. This study investigated the association between the non-high-density lipoprotein to high-density lipoprotein cholesterol ratio (NHHR) and 90-day functional outcomes in patients with ICH. PATIENTS AND METHODS: This single-center, prospective, observational cohort study enrolled 200 patients with acute ICH. Fasting blood samples were collected within 24 hours of admission for lipid profiling, and NHHR was calculated as (total cholesterol high-density lipoprotein cholesterol [HDL-C])/HDL-C. The primary outcome was functional status at 90 days, assessed using the modified Rankin Scale (mRS). Based on the mRS scores, patients were classified into two groups: favorable outcome (mRS ≤ 2, functional independence) and poor outcome (mRS > 2, functional dependence or death). RESULTS: Of the 200 patients, 81 (40.5%) had poor outcomes at 90 days. The poor outcome group exhibited significantly lower baseline NHHR compared to the favorable outcome group (2.54 vs. 2.75, ). After multivariable adjustment, a higher NHHR remained independently associated with reduced odds of poor outcome (adjusted odds ratio = 0.608; 95% confidence interval: 0.401-0.921; ). As a standalone predictor, NHHR exhibited high sensitivity (85.2%) but low specificity (39.5%) for predicting poor outcome, with an optimal cutoff of ≤3.185. Its discriminative ability was modest (area under the curve [AUC] = 0.590; 95% CI: 0.510-0.670; 2). However, combining NHHR with the NIHSS score substantially improved prognostic performance (AUC = 0.863; 95% CI: 0.804-0.923; < 0.001), an effect that remained stable after internal validation (bootstrap-corrected AUC = 0.851; 95% CI: 0.789-0.914). CONCLUSION: A higher baseline NHHR independently predicts favorable 90-day outcomes after ICH, supporting a "protective lipid paradox" distinct from ischemic stroke. As a simple and readily available biomarker, NHHR offers complementary prognostic information to established clinical scales and may aid early risk stratification.
Assessing the Lower Incidence of Invasive Pneumococcal Diseases in Japan During the COVOD-19 Pandemic.
Seki M, Shimada D
Int J Gen Med · 2026 · PMID 41909595 · Full text
During the COVID-19 pandemic from 2020 to 2023 in Japan, in our hospital there were seven cases of invasive pneumococcal diseases (IPDs) in this COVID-19 pandemic period although 14 IPD cases were treated in 2019, 2024,...
During the COVID-19 pandemic from 2020 to 2023 in Japan, in our hospital there were seven cases of invasive pneumococcal diseases (IPDs) in this COVID-19 pandemic period although 14 IPD cases were treated in 2019, 2024, and 2025, such as pre-/post- COVID-19 pandemic period. Of these total 21 IPD patients, five (23.8%) died, and they were all treated during pre-/post-pandemic period. Only 2 of the 21 patients (9.5%) children had been vaccinated. Furthermore, compared with survivors, those who died were younger (54.0 vs 69.4 years old, p = 0.0011), had lower white blood cell counts (3672.1 vs 12117.3/µL, p = 0.0011), and had higher C-reactive protein levels (34.5 vs 22.1 mg/dL, p = 0.0010). Two or more bacteria were isolated, and multiple and/or broad antimicrobial agents were used in fatal cases. These data suggested that IPD cases decreased and might have been less pathogenic during the COVID-19 pandemic period than in the pre-/post-COVID-19 pandemic period. In addition, those who died were younger, more septic due to multiple bacterial infections, and received more and broader antimicrobial agents than survivors. No adult patients received pneumococcal vaccination, which suggests that low vaccination rates lead to the high mortality of adult IPD patients.
Apical-Predominant Myocardial Fibrosis in Hypertensive Heart Disease Revealed by CMR Feature Tracking and T1 Mapping.
Cheng J, Xie C, Pan L … +5 more , Hu X, Lv X, Yu D, Li Y, Liao J
Int J Gen Med · 2026 · PMID 41909594 · Full text
OBJECTIVE: To evaluate the utility of cardiac magnetic resonance feature tracking (CMR-FT) and T1 mapping in quantifying myocardial injury in early hypertensive heart disease, focusing on segmental parameter differences....
OBJECTIVE: To evaluate the utility of cardiac magnetic resonance feature tracking (CMR-FT) and T1 mapping in quantifying myocardial injury in early hypertensive heart disease, focusing on segmental parameter differences. METHODS: A total of 156 hypertensive patients were enrolled and divided into a left ventricular hypertrophy (LVH) group (n=63) and a non-hypertrophy (Non-LVH) group (n=93) based on the left ventricular mass index (LVMI). All patients underwent CMR examination. Left ventricular function, myocardial strain, global and segmental native T1 values, and extracellular volume (ECV) were obtained using post-processing software. Parameters were compared between the two groups, with special attention to differences among myocardial segments to identify regional characteristics of fibrosis distribution. RESULTS: Compared with the Non-LVH group, the LVH group showed significantly lower absolute values of global longitudinal strain (GLS; median: -10.80% vs -15.75%), global circumferential strain (GCS), and global radial strain (GRS) (all P <0.05), while global native T1 (median: 1080 ms vs 1036 ms) and ECV (median: 29.8% vs 27.0%) were significantly elevated (P <0.05). Notably, myocardial fibrosis exhibited an apical-predominant distribution pattern, with the most significant parameter differences observed in the apical segments. For instance, in the LVH group, ECV in the apical septal segment (segment 14) was significantly higher [33.50% (30.40, 36.15) vs 26.70% (26.70, 27.90) in Non-LVH, P=0.001], and native T1 in the apical anterior segment (segment 13) was elevated [1105.65 ± 72.31 ms vs 1039.80 ± 47.77 ms, P=0.006], suggesting a possible apical-predominant pattern of myocardial fibrosis.These changes correlated with high diagnostic accuracy for LVH: GLS showed the highest AUC (0.91) in ROC analysis. In the LVH group, global ECV positively correlated with native T1 and LGE positivity, and negatively with GCS and GLS (P <0.05). CONCLUSION: CMR-FT and T1 Mapping techniques can effectively and quantitatively assess myocardial injury and fibrosis in hypertensive patients. Global longitudinal strain (GLS) is a sensitive parameter for diagnosing left ventricular hypertrophy (LVH), and myocardial fibrosis in patients with hypertension-induced LVH exhibits an apical-predominant distribution pattern.This spatial pattern, if validated prospectively, could serve as a potential imaging biomarker for monitoring in hypertensive patients.
Development and Validation of an Explainable Machine Learning Model for Predicting Repeat Catheter Ablation for Atrial Fibrillation: A Single-Center Retrospective Cohort Study.
Shang S, Lv H, Ma G … +4 more , Wei M, Wang K, Lu Y, Tang B
Int J Gen Med · 2026 · PMID 41909593 · Full text
BACKGROUND: Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia worldwide. Catheter ablation is the first-line therapy for symptomatic/refractory AF, yet post-procedural recurrence remains extreme...
BACKGROUND: Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia worldwide. Catheter ablation is the first-line therapy for symptomatic/refractory AF, yet post-procedural recurrence remains extremely common, driving a high rate of repeat ablation procedures. Repeat ablation is associated with elevated medical costs, incremental procedural risks, and impaired quality of life and clinical outcomes in affected patients. Existing clinical risk scores for predicting repeat AF ablation have limited discriminative ability, poor interpretability, and suboptimal clinical utility. This study aimed to develop and validate an explainable machine learning model, using routine clinical and echocardiographic features, to predict the risk of requiring repeat catheter ablation for AF. METHODS: A retrospective cohort of 1073 patients undergoing AF ablation from 2012 to 2023 was analyzed, with data split into training (70%) and testing (30%) sets. Feature selection was performed using LASSO regression and the Boruta algorithm, followed by the construction of eight machine learning models. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, F1 score, balanced accuracy, Brier score, and clinical utility via decision curve analysis. Interpretability was enhanced using Shapley Additive Explanations (SHAP). RESULTS: Among 1073 patients undergoing AF ablation, 352 (32.8%) required a second procedure. LASSO regression combined with the Boruta algorithm identified nine predictive features: NT-proBNP, age, globulin (GLO), direct bilirubin (DBIL), left ventricular ejection fraction (LVEF), cystatin C (Cys-C), smoking history, creatine kinase (CK), and urea. Among the eight models evaluated, XGBoost demonstrated the best overall performance, achieving an AUC of 0.811 (95% CI: 0.762-0.859) in the testing cohort, with a sensitivity of 0.748, specificity of 0.726, and Brier score of 0.1682. It also outperformed alternative models in terms of F1 score and clinical net benefit. SHAP analysis confirmed NT-proBNP and age as the most influential predictors, alongside non-linear contributions from the remaining variables. CONCLUSION: The XGBoost model may provide a useful and interpretable tool for predicting repeat AF ablation, providing clinical insights to guide patient management and optimize procedural outcomes.
Gut Microbiota, Insulin Resistance, and Alzheimer's Disease: A Narrative Review of Mechanistic Links and Therapeutic Perspectives.
Li X, Liu F, Zhu Y … +1 more , Shi H
Int J Gen Med · 2026 · PMID 41890703 · Full text
Alzheimer's disease (AD) is increasingly regarded as a "neurometabolic syndrome" wherein systemic insulin resistance exacerbates cerebral glucose hypometabolism, tau hyperphosphorylation, and neuroinflammation. We hypoth...
Alzheimer's disease (AD) is increasingly regarded as a "neurometabolic syndrome" wherein systemic insulin resistance exacerbates cerebral glucose hypometabolism, tau hyperphosphorylation, and neuroinflammation. We hypothesize that gut microbiota dysbiosis produces metabolites that are associated with peripheral insulin sensitivity, potentially contributing to disruptions in cerebral insulin signaling and an increased risk of AD. We conducted integrated search of PubMed, Web of Science, and Scopus to synthesize evidence showing: (i) consistent taxonomic shifts in AD, highlighting reduced Firmicutes and increased Proteobacteria and Bacteroidetes, depletion of and enrichment of and ; (ii) functional consequences of dysbiosis, leading to lower short-chain fatty acids, altered secondary bile‑acid signaling, elevated lipopolysaccharide and trimethylamine‑N‑oxide, and perturbed tryptophan catabolism; (iii) these microbial metabolites compromising gut and blood-brain barrier integrity, thereby triggering chronic inflammation, potentially modulating the PI3K‑Akt‑GSK‑3β pathway, and linking peripheral insulin resistance to cerebral dysfunction; and (iv) a translational discussion of therapeutic strategies that target both microbiota and insulin pathways, including dietary modulation, probiotics and prebiotics, fecal microbiota transplantation, intranasal insulin, metformin, and metabolite-based agents, show promise. This review uniquely integrates taxonomic, functional, and therapeutic literature to propose a mechanistic microbiota-insulin resistance-AD axis and highlights the need for longitudinal and interventional trials.
AK3 as a Hypoxia-Angiogenesis-Related Prognostic Biomarker and Therapeutic Target in Clear Cell Renal Cell Carcinoma.
Zhou D, Zheng M, Cui D … +2 more , Guan B, Luo C
Int J Gen Med · 2026 · PMID 41890702 · Full text
BACKGROUND: Clear cell renal cell carcinoma is driven by hypoxia adaptation and pathological angiogenesis mediated by VHL inactivation and HIF signaling. Current treatments including VEGF-targeted therapy and immune chec...
BACKGROUND: Clear cell renal cell carcinoma is driven by hypoxia adaptation and pathological angiogenesis mediated by VHL inactivation and HIF signaling. Current treatments including VEGF-targeted therapy and immune checkpoint blockade often face resistance or inadequate response, highlighting the need for new biomarkers linked to tumor metabolism and therapy sensitivity. METHODS: A comprehensive machine learning approach was combined with Weighted Gene Co-Expression Network Analysis of TCGA and single-cell datasets to identify hypoxia- and angiogenesis-related prognostic genes. Among them, AK3 was selected for functional validation in ccRCC tissues and cell lines, with mechanistic studies performed in vitro and in vivo. RESULTS: AK3 was significantly downregulated in ccRCC and associated with poor prognosis. AK3 overexpression inhibited tumor cell proliferation and migration by suppressing PI3K/AKT/GSK3β signaling and reduced tumor progression in nude mice. Furthermore, AK3 enhanced oxaliplatin sensitivity by increasing reactive oxygen species and reducing lipid droplet accumulation, implicating its role in metabolic and redox regulation. CONCLUSION: AK3 functions as a hypoxia-angiogenesis-related tumor suppressor in ccRCC, linking energy metabolism to therapeutic response. AK3 expression may serve as a prognostic biomarker and a predictor of chemotherapy sensitivity, providing a basis for future stratified treatment or combination therapy strategies in ccRCC.
Combined Maternal and Offspring Vitamin D3 Supplementation Ameliorates Autism-Like Behaviors via VDR Pathway Activation, Neuroinflammatory Suppression, and Metabolic Homeostasis Restoration.
Li Q, Zhang J, Lyu X … +7 more , Zou L, Yuan M, Yan J, Wan X, Yang Y, Xu W, Xie J
Int J Gen Med · 2026 · PMID 41890701 · Full text
BACKGROUND: Autism Spectrum Disorder (ASD) is a widespread neurodevelopmental disorder with no approved medications targeting its core symptoms. Based on the "dual-hit" hypothesis combining Maternal Immune Activation (MI...
BACKGROUND: Autism Spectrum Disorder (ASD) is a widespread neurodevelopmental disorder with no approved medications targeting its core symptoms. Based on the "dual-hit" hypothesis combining Maternal Immune Activation (MIA) and Maternal Separation (MS), this study investigated whether combined maternal and offspring vitamin D3 supplementation could ameliorate autism-like behaviors by modulating the VDR pathway, neuroinflammation, and metabolic homeostasis. MATERIALS AND METHODS: A "dual-hit" ASD mouse model was established in C57BL/6 offspring by combining maternal immune activation (MIA) with maternal separation (MS). Pregnant mice were randomly allocated into three groups (n = 5 per group): Control, Model (MIA+MS), and Intervention (MIA+MS + high vitamin D diet). Offspring in the intervention group continued to receive vitamin D supplementation post-weaning (from 3 weeks of age) until 8 weeks. Offspring behavioral tests were conducted on postnatal days 42-56, with the litter serving as the unit of analysis. Serum, brain tissue, colon contents, and liver samples were subsequently collected and analyzed using ELISA, Western blot, LC-MS, and immunohistochemistry. RESULTS: Compared with controls, MIA+MS offspring exhibited significant social deficits, anxiety, and repetitive behaviors. Combined vitamin D supplementation markedly improved social preference (P<0.0001), reduced anxiety (P<0.001), and decreased repetitive behaviors (P < 0.05). It also upregulated VDR expression in the brain (P<0.01), reduced neurotoxic metabolites (indoxyl sulfate, 6-phosphogluconic acid, and kynurenine pathway intermediates), lowered pro-inflammatory cytokines (IL-1β (P<0.001), IL-6 (P<0.001), TNF-α (P<0.001)), and restored carnitine metabolic homeostasis by modulating TMLHE expression and function. CONCLUSION: Combined maternal and offspring vitamin D3 supplementation significantly improves autism-like behaviors in a "dual-hit" ASD model. The observed protective effects may involve activation of the VDR pathway, reduction of neuroinflammation and neurotoxic metabolites, and systemic restoration of immune and metabolic homeostasis. These findings suggest the potential utility of vitamin D in ASD prevention and intervention, warranting further investigation.
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