International Journal Of General Medicine[JOURNAL]
Sun
200 papers
Short-Term Prognosis in Acute Asthma Exacerbations: A Comparative Evaluation of Machine Learning Models Using Spirometry and Tracheal Respiratory Sound Analysis.
Güçsav MO, Güllü MK, Özgür S … +4 more , Topaloğlu İ, Unat ÖS, Serçe Unat D, Erbaycu AE
Int J Gen Med · 2026 · PMID 42199980 · Full text
PURPOSE: Acute asthma exacerbations are a common cause of emergency department visits and require rapid risk stratification to guide disposition decisions. Although spirometry is the primary objective method used to asse...
PURPOSE: Acute asthma exacerbations are a common cause of emergency department visits and require rapid risk stratification to guide disposition decisions. Although spirometry is the primary objective method used to assess clinical severity, it may not reliably predict clinical outcomes. In this context, machine learning-based approaches have gained increasing attention for improving prognostic assessment in emergency settings. To evaluate the prognostic relevance of spirometric parameters, tracheal respiratory sound-derived acoustic features, and machine learning-based classification models for short-term outcomes in adults presenting to the emergency department with acute asthma exacerbations. PATIENTS AND METHODS: In this prospective cohort study, adults with acute asthma exacerbations underwent spirometry and tracheal respiratory sound recording before and after emergency department treatment. Short-term prognosis was defined as hospitalization during the index visit or emergency department re-presentation within seven days. Changes in spirometric and acoustic features were analyzed, and machine learning models incorporating demographic, spirometric, acoustic, and combined feature sets were developed and compared. RESULTS: Baseline airflow limitation at presentation was the strongest determinant of short-term prognosis. Patients with poor outcomes had significantly lower pre-treatment and post-treatment FEV and PEF values. Acoustic feature changes showed minimal correlation with ΔFEV and ΔPEF; however, selected frequency-domain features differed between prognosis groups, indicating complementary physiological information. Machine learning models incorporating spirometric variables achieved the highest performance, with accuracy up to 84.4% and balanced classification metrics. Sound-based models demonstrated moderate but clinically meaningful performance (accuracy approximately 67-77%), while multimodal models did not outperform spirometry-only models. CONCLUSION: In acute asthma exacerbations, baseline spirometric impairment remains the most reliable predictor of short-term outcomes. Tracheal respiratory sound analysis combined with machine learning may provide complementary prognostic information, particularly when spirometry is unavailable or unreliable, supporting its role as a clinical decision-support tool rather than a replacement for conventional assessment.
Hypervirulent and Drug-Resistant : Clinical Challenges and Alternative Treatment Strategies.
Bani Abdel-Rahman S, Altarawneh H, Alfreahat HAH … +19 more , Alhazmi KA, Alharbi OS, Gazzaz M, Alharthi TM, Ismaeel LA, Halabi WS, Sharif AT, Redwan B, Alkuwaity KK, Alhazmi W, Saleh BH, Alqarni MA, Alsaedi A, Alhussainy NH, Niyazi HA, Niyazi HA, AbdulMajed H, Juma NA, Ibrahem K
Int J Gen Med · 2026 · PMID 42186451 · Full text
is a major opportunistic pathogen responsible for a wide range of hospital- and community-acquired infections, including respiratory tract infections, urinary tract infections, meningitis, and liver abscesses. Among its...
is a major opportunistic pathogen responsible for a wide range of hospital- and community-acquired infections, including respiratory tract infections, urinary tract infections, meningitis, and liver abscesses. Among its emerging forms, hypervirulent (hvKp) has gained global attention due to its heightened virulence and ability to cause severe infections in healthy individuals. hvKp differs from classical (cKp) in its clinical presentation, often causing metastatic infections, liver abscesses without biliary disease, and multiple-site involvement. Despite initial antibiotic susceptibility, the recent convergence of hvKp virulence traits with antimicrobial resistance genes-especially those conferring multidrug resistance (MDR) and carbapenem resistance-poses a serious therapeutic challenge. This review highlights the epidemiological and clinical distinctions between hvKp and cKp, emphasizing the limitations of current diagnostic markers like the string test. Furthermore, it explores novel therapeutic strategies beyond conventional antibiotics, focusing on promising alternatives such as bacteriophage therapy and antimicrobial peptides (AMPs). Several phages, including PSKP16, vB_Kpn_F13, and phage cocktails, have demonstrated potent activity against hvKp strains, including biofilm-forming and carbapenem-resistant isolates. Likewise, AMPs such as Osmin, AA139-nanoformulations, and scorpion venom-derived Cm38 show efficacy in preclinical models. These emerging approaches hold potential to combat the rising threat of hvKp, especially strains that are extensively drug-resistant. Continued research and investment are essential to translate these findings into clinical practice and ensure effective management of hypervirulent and resistant infections.
Precision Thyroid Oncology: A Review of Multi-Omics Biomarkers and Spatiotemporal Technologies.
Huang L, Deng X, Xi Z … +3 more , Huan X, Mao J, Li X
Int J Gen Med · 2026 · PMID 42179850 · Full text
Thyroid cancer (TC), the most prevalent endocrine malignancy worldwide, encompasses a broad spectrum of biological behaviors ranging from indolent microcarcinomas to lethal anaplastic variants. Despite advancements in st...
Thyroid cancer (TC), the most prevalent endocrine malignancy worldwide, encompasses a broad spectrum of biological behaviors ranging from indolent microcarcinomas to lethal anaplastic variants. Despite advancements in standard care, critical clinical "bottlenecks" persist, including the diagnostic ambiguity of Bethesda III/IV nodules, the rising prevalence of radioiodine-refractory (RAI-R) differentiated TC, and the dismal survival rates of anaplastic thyroid carcinoma (ATC). The rapid evolution of biomarkers has catalyzed a paradigm shift from traditional anatomical-pathological staging to a sophisticated "Molecular Taxonomy" model, providing the cornerstone for precision oncology. This review systematically delineates the multi-dimensional landscape of TC biomarkers, encompassing genomic and transcriptomic drivers (eg, BRAF, RAS, TERT, RET, NTRK), epigenetic regulators (miRNAs, lncRNAs, circRNAs, and DNA methylation), and the proteomic interface. We highlight the transformative role of Liquid Biopsy 2.0-including ctDNA-based minimal residual disease (MRD) detection and exosomal multi-omics-in enabling non-invasive, longitudinal surveillance. Furthermore, we explore how cutting-edge technologies, such as single-cell sequencing and spatial transcriptomics, are deciphering intratumoral heterogeneity and redefining the "functional invasive front". Clinical translation is addressed through the lens of personalized management: from the use of genomic classifiers (eg, ThyroSeq v3) in preoperative triage to biomarker-guided "de-escalation" or "intensification" of therapy. Finally, we discuss the imperative of addressing ancestry-specific molecular divergence (specifically in Asian cohorts). However, significant challenges remain, including the high cost of multi-omics integration and the lack of standardized protocols for clinical implementation. We conclude by envisioning a future integrated with multimodal AI models, patient-derived organoids (PDOs), and metabolic reprogramming markers, aiming to provide a holistic framework for the "early screening-precise diagnosis-tailored therapy-dynamic monitoring" continuum in thyroid oncology.
Imaging Biomarkers of Cognitive Impairment in Sarcopenia: A Narrative Review.
Lei WX, Zhu JJ, Jiang YT … +7 more , Peng XH, Sun HR, Tan J, Zhou XH, Huang MX, Lei H, Zhao H
Int J Gen Med · 2026 · PMID 42163859 · Full text
Sarcopenia is characterized by progressive declines in muscle strength, mass, and physical function. Mild cognitive impairment (MCI), also referred to as mild neurocognitive disorder (mNCD), involves a measurable reducti...
Sarcopenia is characterized by progressive declines in muscle strength, mass, and physical function. Mild cognitive impairment (MCI), also referred to as mild neurocognitive disorder (mNCD), involves a measurable reduction in cognitive abilities that does not substantially interfere with daily independence, thereby distinguishing it from dementia. With global population aging, both conditions have emerged as prevalent health concerns, and understanding cognitive status among individuals with sarcopenia has become increasingly important. This narrative review synthesizes current neuroimaging findings related to cognitive impairment in sarcopenia, examining both the mechanistic underpinnings and clinical relevance of this association. Particular emphasis is placed on the Muscle-Brain Axis, which provides a foundational framework for understanding how imaging biomarkers may bridge sarcopenia and cognitive decline. Within the imaging domain, this article focuses on Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET), reviewing their applications in detecting and characterizing cognitive impairment among patients with sarcopenia.
Prevalence and Sex-Specific Distribution of Electrocardiographic Variants in Normotensive Nigerian University Students: A Cross-Sectional Study.
Egharevba JE, Okema JN, Nwanaga CU … +4 more , Onyebuagu PC, Acomo G, Pitua I, Bongomin F
Int J Gen Med · 2026 · PMID 42163858 · Full text
BACKGROUND: Electrocardiographic (ECG) variants occurring in the absence of known cardiac disease are common in healthy young adults but remain poorly characterized in sub-Saharan African populations. Contemporary ECG re...
BACKGROUND: Electrocardiographic (ECG) variants occurring in the absence of known cardiac disease are common in healthy young adults but remain poorly characterized in sub-Saharan African populations. Contemporary ECG reference standards are predominantly derived from Caucasian cohorts, and their direct application to individuals of African descent risks misclassification of physiologically normal findings as pathological, with consequent unnecessary investigations and healthcare burden. OBJECTIVE: To determine the prevalence and sex-specific distribution of ECG variants among apparently healthy, normotensive undergraduate students at a Nigerian federal university, and to assess associations between ECG variant status and demographic variables. METHODS: A cross-sectional study was conducted among 102 normotensive undergraduate students (55 males, 47 females; mean age 22.4 ± 2.8 years) at the Federal University of Technology, Owerri (FUTO), Imo State, Nigeria. Resting 12-lead ECGs were acquired using standardized protocols and interpreted by a blinded, board-certified cardiologist applying pre-specified diagnostic criteria. Sex-stratified comparisons used chi-square or Fisher's exact tests with Bonferroni correction. Logistic regression assessed independent predictors of key variants. RESULTS: Excluding normal sinus rhythm, at least one ECG variant was identified in 71 participants (69.6%; 95% CI 59.8-78.3%). Juvenile T-wave pattern was the most prevalent variant (37.3%; 95% CI 27.9-47.4%), followed by high QRS voltage (22.5%; 95% CI 14.7-32.0%). Juvenile T-wave pattern was more prevalent in females (48.9% vs 27.3%; p=0.02 uncorrected; OR 0.41, 95% CI 0.19-0.91), while high QRS voltage predominated in males (30.9% vs 12.8%; p=0.02 uncorrected; OR 3.18, 95% CI 1.18-8.55); neither finding survived Bonferroni correction (threshold p<0.006) and both are considered exploratory. Twelve participants (11.8%) exhibited borderline QTc prolongation; structured clinical evaluation confirmed no true pathological QTc prolongation in any participant. Early repolarization was absent in this cohort. Age and BMI were not independently associated with variant prevalence. CONCLUSION: ECG variants occur in approximately 70% of healthy, normotensive predominantly Igbo university students in south-eastern Nigeria and demonstrate sex-specific patterns. These findings contribute population-specific descriptive data and highlight the need for ethnically informed ECG interpretation to reduce diagnostic misclassification in this population. Multi-center studies across Nigerian and West African cohorts are required to confirm and generalize these observations.
BCG Vaccination Modulates Long-Term TNF-α and sCD40L in COVID-19: An Exploratory Longitudinal Study.
Fávero C, Barbosa G, Pellegrini V … +4 more , Melo D, Shariat SF, Pascoal LB, Reis LO
Int J Gen Med · 2026 · PMID 42157880 · Full text
BACKGROUND: Bacillus Calmette-Guérin (BCG) vaccination exerts non-specific immunomodulatory effects through trained immunity, potentially modulating inflammatory responses in COVID-19. Tumor necrosis factor-alpha (TNF-α)...
BACKGROUND: Bacillus Calmette-Guérin (BCG) vaccination exerts non-specific immunomodulatory effects through trained immunity, potentially modulating inflammatory responses in COVID-19. Tumor necrosis factor-alpha (TNF-α) and soluble CD40 ligand (sCD40L) are key inflammatory and pro-thrombotic mediators implicated in COVID-19 pathogenesis. METHODS: A randomized, placebo-controlled trial was conducted involving young, healthy adults with mild COVID-19 (BATTLE trial). Intradermal BCG vaccination or placebo was administered during the acute phase of infection. Plasma TNF-α and sCD40L levels were measured at days 7 and 45, and at 6 months post-intervention in a subset of participants, total n=13; BCG n=7; placebo n=6. The sCD40L/TNF-α ratio was calculated to explore the balance between adaptive immune activation and systemic inflammation. RESULTS: At day 7, BCG-vaccinated individuals exhibited higher TNF-α (p=0.01) and sCD40L (p=0.018) levels compared with the placebo group. In the placebo group, TNF-α showed a transient decline by day 45 (p=0.040), whereas sCD40L remained stable throughout follow-up (all p>0.05). In contrast, BCG recipients demonstrated a sustained reduction in both mediators from day 45 to 6 months (TNF-α: p=0.0012 at day 45 and p=0.0017 at 6 months; sCD40L: p=0.024 at day 45 and p=0.05 at 6 months). The sCD40L/TNF-α ratio increased transiently at day 45 in the BCG group (p=0.035), suggesting a temporary predominance of adaptive immune activation. CONCLUSION: BCG vaccination induced a distinct and durable modulation of TNF-α and sCD40L in mild COVID-19, consistent with the concept of trained immunity. This immune profile may support faster resolution of inflammation and potentially reduce the risk of inflammatory complications. Larger and more diverse controlled trials are needed to confirm these findings and clarify their clinical implications.
Multigene Screening of B-Vitamin Metabolism Pathways in Hypertensive Disorders of Pregnancy: Toward Precision Prenatal Care.
Zhang T
Int J Gen Med · 2026 · PMID 42157879 · Full text
Hypertensive disorders of pregnancy (HDP) are among the most common and serious complications of pregnancy, exerting substantial effects on both maternal and fetal health. B vitamins particularly folate, vitamin B6, and...
Hypertensive disorders of pregnancy (HDP) are among the most common and serious complications of pregnancy, exerting substantial effects on both maternal and fetal health. B vitamins particularly folate, vitamin B6, and vitamin B12 are essential to multiple metabolic pathways, most notably homocysteine metabolism, which is closely associated with vascular function and blood pressure regulation. Although understanding of HDP pathophysiology has advanced, early prediction and personalized management remain difficult because of the complex interplay between genetic and environmental factors. Recent progress in multigene screening technologies has offered new insights into how genetic polymorphisms involved in B vitamin metabolism may contribute to HDP risk. This review synthesizes current evidence on the relationships between B vitamin-related gene variants and HDP, with a focus on the potential of multigene screening for early risk stratification, targeted nutritional intervention, and individualized clinical management. Integrating genetic screening into routine prenatal care may improve prevention and treatment outcomes by enabling care strategies tailored to genetic susceptibility. This strategy may help resolve the inconsistent results of B‑vitamin supplementation trials by enabling genotype‑targeted care. Overall, this review highlights the promise of B vitamin multigene screening as a clinical tool for advancing precision medicine approaches to hypertensive disorders of pregnancy and ultimately improving maternal and fetal health.
Identification of Key Genes and Exploration of Therapeutic Targets for Chronic Tendon Injury Based on Bioinformatics and Machine Learning.
Cheng Z, Ren W, Wang Y … +6 more , Zhao H, Jiang L, Pu X, Zhang Y, Wang Y, Kang Q
Int J Gen Med · 2026 · PMID 42157878 · Full text
BACKGROUND: Chronic tendon injury (CTI) is a common musculoskeletal disorder with complex molecular mechanisms, and currently lacks effective targeted therapeutic strategies. A comprehensive analysis of its key pathogeni...
BACKGROUND: Chronic tendon injury (CTI) is a common musculoskeletal disorder with complex molecular mechanisms, and currently lacks effective targeted therapeutic strategies. A comprehensive analysis of its key pathogenic genes and regulatory networks is crucial for the precise diagnosis and treatment of CTI. METHODS: Differentially expressed genes (DEGs) in CTI and normal tendon tissue were identified using the GEO database, and intersected with genes derived from WGCNA to identify candidate genes. Subsequently, functional enrichment analysis was performed, and four machine learning algorithms were employed to further determine key genes. Finally, a systematic functional analysis of the key genes was performed, including assessments of diagnostic value, regulatory network construction, computational drug prediction and molecular docking. RESULTS: A total of 271 candidate genes were identified, which were significantly enriched in focal adhesion, ECM-receptor interaction, and p53 signaling pathway. Subsequently, three key genes (, and ) were prioritized through machine learning analysis, and their marked upregulation in CTI samples was verified by qRT-PCR and immunohistochemical analysis. Furthermore, their expression levels were positively correlate with natural killer T cell infiltration. TF-mRNA-miRNA regulatory network revealed the predicted TFs (such as ) and the miRNAs that interact with the key genes. Ultimately, drug screening and molecular docking identified several potential lead compounds and confirmed their stable binding patterns. CONCLUSION: This study systematically revealed three key genes in CTI through comprehensive bioinformatics analysis. The diagnostic model, regulatory network, and predicted targeted drugs constructed based on these findings laid a solid theoretical foundation for subsequent translational medical research.
Prevalence of Cardiometabolic Abnormalities Among Male Licensed Pilots and Community Health Examination Participants in China: A Cross-Sectional Comparison.
Fan X, Shen Y, Wei Q … +1 more , Ling Y
Int J Gen Med · 2026 · PMID 42157877 · Full text
BACKGROUND: Metabolic abnormalities are common in adult populations, but comparative data between licensed pilots and community health examination participants in China remain limited. This study descriptively compared c...
BACKGROUND: Metabolic abnormalities are common in adult populations, but comparative data between licensed pilots and community health examination participants in China remain limited. This study descriptively compared cardiometabolic abnormality profiles between male licensed pilots and male community health examination participants. METHODS: This retrospective cross-sectional study used routine health examination data collected between July 2025 and September 2025, including 495 male licensed pilots undergoing aviation health examinations and 750 male adults undergoing community health examinations at the same hospital. The analysis was restricted to men because the aviation cohort was overwhelmingly male and female pilot data were too sparse for meaningful comparison. Crude and age-adjusted logistic regression models were used to compare cohorts, with age as the only adjustment variable. FDR correction, cohort-by-age interaction testing, and exact-age matched sensitivity analysis were performed. RESULTS: Compared with the community cohort, the aviation cohort had lower prevalence of TG abnormality (8.3% vs. 18.1%), low HDL-C abnormality (12.1% vs. 18.5%), TC abnormality (7.5% vs. 15.5%), FPG abnormality (5.7% vs. 9.6%), and BP abnormality (2.2% vs. 33.1%). After age adjustment and FDR correction, aviation cohort membership remained associated with lower odds of TG abnormality (adjusted OR = 0.42, 95% CI: 0.29-0.61), low HDL-C abnormality (adjusted OR = 0.62, 95% CI: 0.45-0.87), TC abnormality (adjusted OR = 0.52, 95% CI: 0.35-0.77), and BP abnormality (adjusted OR = 0.05, 95% CI: 0.03-0.10). LDL-C, FPG, and BMI abnormalities were not significantly associated with cohort type after age adjustment. The overall burden of metabolic abnormalities was lower in the aviation cohort. CONCLUSION: Male licensed pilots showed lower prevalence and lower overall burden of selected cardiometabolic abnormalities compared with male community health examination participants. The marked BP difference should be interpreted cautiously in the context of aeromedical certification, fitness-for-duty requirements, healthy-worker selection, and potential BP recording differences. These findings should be interpreted as descriptive population-level differences rather than causal effects.
A Retrospective Study of Preventive Anticoagulant Therapy Among Trauma Patients in Yichang Area Through Clinical Data Review and Clinician Survey.
Chen S, Zou M, Chen M … +2 more , Feng M, Wan P
Int J Gen Med · 2026 · PMID 42157876 · Full text
BACKGROUND: Trauma-induced coagulopathy is one of the important causes for deaths after trauma. This study aimed to explore the current state of preventive anticoagulation therapy and the clinical factors affecting the a...
BACKGROUND: Trauma-induced coagulopathy is one of the important causes for deaths after trauma. This study aimed to explore the current state of preventive anticoagulation therapy and the clinical factors affecting the application of anticoagulation guidelines. METHODS: This study retrospectively involved 787 trauma patients treated at our hospital from January 2017 to November 2022 via review of medical records. A questionnaire survey was assigned to the clinicians to evaluate the current methods and opinions on preventive anticoagulation therapy. The time of the first anticoagulation therapy refers to the time from admission to the initiation of the first anticoagulation treatment. RESULTS: A total of 787 trauma patients were included in this study, of whom 68.74% received anticoagulant therapy, mainly using low-molecular-weight heparin calcium. Thrombotic events happened in 14.61% of these patients. Binary logistic regression analysis showed that age, injury severity score, length of hospital stay, presence or absence of thrombotic events, and whether or not lower extremity vascular ultrasound and pulmonary CT re-examination were performed were significant factors affecting the use or non-use of anticoagulation therapy. A significant association was found between the daily dose of anticoagulant (P < 0.001) and the occurrence of thrombotic events, as well as between the time of the first anticoagulation therapy (P < 0.001) and the occurrence of thrombotic events. Logistic regression analysis showed that age, department of first visit, daily dose of anticoagulant drugs, time of first anticoagulation and the lower extremity vascular ultrasound and lung CT were reexamined were significant factors affecting the occurrence of thrombotic events (P<0.05). The questionnaire showed that 97% of physicians consider prophylactic anticoagulant therapy for trauma patients but there were significant differences in the choice and practice of anticoagulant therapy among different departments. CONCLUSION: The current study showed that multiple factors may significantly associate with the use or non-use of anticoagulation therapy and the occurrence of thrombotic events. There were also significant differences in the method and opinions in treating trauma patients and using anticoagulation therapy among different clinicians from different departments.
The Mechanosensation-Metabolism-Inflammation Axis: The Central Role of Piezo1 and TRPV4 in Hypertension-Related Atherosclerosis.
Mu YY, Liu TT, Xu JL … +3 more , Li PC, Qian Y, Zhang W
Int J Gen Med · 2026 · PMID 42157875 · Full text
Atherosclerosis is a core independent risk factor for cardiovascular events. The abnormal hemodynamic microenvironment mediated by hypertension is a key initiating factor for its development and progression, and mechanos...
Atherosclerosis is a core independent risk factor for cardiovascular events. The abnormal hemodynamic microenvironment mediated by hypertension is a key initiating factor for its development and progression, and mechanosensitive ion channels are the core molecules connecting vascular mechanical forces to intracellular biochemical signals. Piezo1 and Transient Receptor Potential Vanilloid 4 (TRPV4), as important mechanosensitive ion channels in blood vessels, are widely expressed in vascular endothelial cells, smooth muscle cells, and immune cells. They can sense and be activated by abnormal circumferential stress and shear stress under hypertensive conditions. This review systematically synthesizes current evidence to test the central hypothesis that Piezo1 and TRPV4 form a functionally synergistic signaling axis, converting pathological mechanical forces into sustained Ca⁺ influx, which subsequently drives an integrated network of metabolic imbalance and chronic inflammation in hypertension-related atherosclerosis. It focuses on the activation modes of these channels by abnormal mechanical forces in hypertension and the subsequent early Ca⁺ signaling dysregulation. The regulatory pathways of channel-mediated lipid and glucose metabolism disorders are deeply analyzed. The specific mechanisms by which both channels participate in the regulation of endothelial dysfunction, inflammatory infiltration, foam cell formation, and plaque stability in atherosclerosis through key signaling pathways such as NF-κB, NLRP3, and YAP/TAZ are comprehensively summarized. Furthermore, intervention strategies using natural compounds targeting this channel axis are discussed. Research indicates that Piezo1 and TRPV4 form a functionally synergistic signaling axis. By converting abnormal mechanical forces into sustained Ca⁺ influx, they drive metabolic imbalance and chronic inflammation in vascular cells, realizing a functional transition from physiological protection to pathological damage. The cell-specific, environment-dependent regulatory characteristics and the bidirectional interaction network of these two channels constitute an important pathological regulatory mechanism for hypertension-related atherosclerosis. This review aims to establish a complete regulatory network of "mechanosensation-ion channel-calcium signal-metabolic inflammation-atherosclerosis" and provide an integrated framework for clarifying the molecular mechanisms of hypertension-associated atherosclerosis, and exploring potential targets and intervention strategies for the precise prevention and treatment of the disease.
Tamoxifen Combined with Hormone Replacement in Women with Thin Endometrium Receiving Frozen-Thawed Embryo Transfer for Promoting Endometrial Growth: A Double-Blinded, Randomized Controlled Trial.
Shi Q, Mei J, Yan G … +8 more , Kong N, Liu J, Shen X, Sun Y, Lu F, Jiang Y, Sun H, Huang C
Int J Gen Med · 2026 · PMID 42153152 · Full text
BACKGROUND: Thin endometrium continues to pose a significant challenge in assisted reproductive technology (ART) cycles, necessitating further exploration of therapeutic approaches. Tamoxifen (TMXF) has been primarily us...
BACKGROUND: Thin endometrium continues to pose a significant challenge in assisted reproductive technology (ART) cycles, necessitating further exploration of therapeutic approaches. Tamoxifen (TMXF) has been primarily used in ovarian stimulation therapy and can also be implemented as an endometrial preparation protocol, potentially improving endometrial thickness. Does TMXF combined with hormone replacement therapy (HRT) in women with thin endometrium receiving frozen-thawed embryo transfer (FET) improve the endometrial thickness and pregnancy outcome compared to hormone replacement alone? METHODS: This single-centre prospective double-blind randomized controlled trial ran between March 2020 and October 2022. In it, 120 patients with thin endometrium were randomized to TMXF-HRT and control HRT groups at a 1:1 ratio. The primary outcome was endometrium thickness. The secondary outcomes include embryo implantation rate, miscarriage rate and live birth rate. This trial is registered at the ClinicalTrials.gov, number NCT04292886 (Registration Date: March 1, 2020). RESULTS: Endometrial thickness was significantly greater in the TMXF-HRT group than in the HRT alone group (7.80 ± 0.93 vs 6.93 ± 0.80 mm, P < 0.001), and multivariate analysis confirmed a positive effect of TMXF supplementation on endometrial thickness. However, no significant differences were observed between the two groups in embryo implantation rate or live birth rate. CONCLUSION: TMXF combined with HRT can significantly increase endometrial thickness and has the potential to improve clinical pregnancy outcomes (the difference was not statistically significant).
Restaging pN Classification in Early Gastric Cancer with Inadequate Lymph Node Retrieval: Multi-Institutional Development and Prognostic Validation of a Revised Staging System.
Nie X, Li G, Liu Z … +15 more , Ke B, Yang Z, Ye Z, Zhang T, Wang X, Yang K, You Q, Zhou T, Li Y, Zhang R, Ren P, Wang W, Tian Y, Zhang K, Deng J
Int J Gen Med · 2026 · PMID 42153151 · Full text
OBJECTIVE: This study aimed to propose and validate a new and practical lymph node (LN) staging strategy to mitigate staging migration due to examined LN (ELN) retrieval and improve the accuracy of prognostic evaluation...
OBJECTIVE: This study aimed to propose and validate a new and practical lymph node (LN) staging strategy to mitigate staging migration due to examined LN (ELN) retrieval and improve the accuracy of prognostic evaluation for early gastric cancer (EGC) patients. BACKGROUND: EGC patients often face staging inaccuracies due to inadequate ELNs, as there is no clear standard for ELN retrieval requirements. METHODS: From an initial cohort of 7001 EGC patients across fifteen large institutions in China, 6566 eligible patients were included as the training and validation cohort after applying predefined exclusion criteria. We analyzed these data to determine the optimal cutoff value for the number of ELNs, construct a prediction model, and propose a new LN staging method distinct from that of the latest AJCC guidelines. Subsequently, 2094 patients (from 2326 with survival data available in the multicenter dataset) and 1944 patients (from 5262 initially retrieved from the SEER database after exclusions) were included as independent test cohorts to evaluate model performance, including the correlation between ELNs and metastatic LNs (MLNs) and survival differences. RESULTS: This study found that ≤20 ELNs were inadequate for accurate LN evaluation in EGC patients. In the test cohort, MLNs was positively associated with ELNs. A model was constructed, and accurate MLNs could be displayed after correction for patients with inadequate ELNs. Survival analysis revealed significant differences between patients with different pN (pN ) stages in both the multicenter test cohort and the SEER test cohort. CONCLUSION: Model-corrected pN staging may improve staging migration and survival prediction than the AJCC staging, showing great clinical applicability for EGC patients with ELN ≤ 20.
The Relationship Between Magnetic Resonance Diffusion Tensor Imaging Parameters and Muscle Dysfunction in Patients with Osteoporosis: A Cross-Sectional Retrospective Study [Letter].
Zeng XY, Zhang QA
Int J Gen Med · 2026 · PMID 42147749 · Full text
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A Systematic Review of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Epidemiology and Treatment Strategies.
Wang B, Zhan J, Liao W … +3 more , Huang Z, Luo J, Cheng X
Int J Gen Med · 2026 · PMID 42147748 · Full text
Skin and mucosa detachment is a symptom of toxic epidermal necrolysis (TEN), a severe cutaneous adverse reaction with a high mortality and infection rates. Toxic epidermal necrolysis disease's associated variables and tr...
Skin and mucosa detachment is a symptom of toxic epidermal necrolysis (TEN), a severe cutaneous adverse reaction with a high mortality and infection rates. Toxic epidermal necrolysis disease's associated variables and treatment approaches have been the subject of several investigations in recent years; nonetheless, the causes and treatment approaches of TEN remain unclear. With the goal of provide new insights and approaches for the prevention and management of toxic epidermal necrolysis, this study examines the epidemiology, associated risk factors, and advancements in therapy.
Advancements in Image-Based Artificial Intelligence in the Diagnosis and Treatment of Head and Neck Squamous Cell Carcinoma: A Narrative Review.
Wu B, Gu J, Chen T
Int J Gen Med · 2026 · PMID 42147747 · Full text
Head and neck squamous cell carcinoma (HNSCC) remains a significant global health challenge. Early detection, accurate diagnosis, and individualized treatment planning are essential for improving patient outcomes and enh...
Head and neck squamous cell carcinoma (HNSCC) remains a significant global health challenge. Early detection, accurate diagnosis, and individualized treatment planning are essential for improving patient outcomes and enhancing quality of life. Artificial intelligence (AI), including radiomics and deep learning, has shown substantial potential in the early screening, accurate diagnosis, and treatment response prediction of HNSCC. In this review, we summarize the commonly used types of medical imaging and outline the basic workflows of radiomics and deep learning in medical image analysis. We then review the applications of AI in the clinical diagnosis and treatment of HNSCC across various aspects, including screening, diagnosis, staging and grading, pre-treatment evaluation, and prognostic prediction. We further discuss the convergence of AI with emerging imaging modalities, including hyperspectral imaging, optical coherence tomography, and Fourier transform infrared spectroscopy. Notably, most studies included in this review are retrospective and single-center in design, with limited external validation, underscoring the urgent need for prospective, multicenter research to facilitate clinical translation.
Multi-Omics Identification of Key Immune Molecules in Gestational Diabetes Mellitus: FKBP5 and HLA-DQA1 as Candidate Biomarkers.
Zhang J, Qin Y, Chen N … +1 more , Wang J
Int J Gen Med · 2026 · PMID 42147746 · Full text
BACKGROUND: Gestational diabetes mellitus (GDM) is a major metabolic complication of pregnancy in which immune dysregulation has been implicated. The Systemic Immune-Inflammation Index (SII) has been significantly associ...
BACKGROUND: Gestational diabetes mellitus (GDM) is a major metabolic complication of pregnancy in which immune dysregulation has been implicated. The Systemic Immune-Inflammation Index (SII) has been significantly associated with GDM risk, highlighting the importance of the placental immune microenvironment in GDM pathogenesis. Yet comprehensive cross-modality integration of immune molecular data remains limited. This study aimed to systematically identify and validate key placental immune molecules in GDM. PATIENTS AND METHODS: Bulk transcriptome data (training set: 10 GDM/10 controls; validation set: 32 GDM/31 controls) and single-cell data (4 donors, 2 GDM/2 controls) were obtained from GEO. Differential expression, GO/KEGG enrichment, and ssGSEA-based immune infiltration analyses were performed. Three machine-learning algorithms (LASSO, SVM-RFE, Random Forest) were applied for feature selection, and consensus genes were validated in the independent validation cohort and in clinical samples by qRT-PCR (30 GDM/30 controls). A nomogram model was built and assessed by AUC, calibration curves, the Hosmer-Lemeshow test, and the Brier score. Candidate drugs were identified via CMap, with molecular docking and 100-ns molecular dynamics simulations. RESULTS: Bulk analysis identified 378 differentially expressed genes (190 up, 188 down) enriched in immune response, cytokine production, and insulin signalling. Three-algorithm consensus nominated CLEC12A, FKBP5 and HLA-DQA1; however, CLEC12A failed to replicate in the independent validation cohort and was therefore not advanced to qRT-PCR. FKBP5 and HLA-DQA1 retained significant downregulation in GDM placentas across the training set, validation set, and clinical samples (qRT-PCR P<0.001). Both genes correlated with immune infiltration patterns including activated B cells. The AUCs in both training and validation sets were modest, indicating preliminary discriminative ability. The nomogram showed acceptable calibration (Hosmer-Lemeshow P=0.342; Brier score=0.118). CONCLUSION: FKBP5 and HLA-DQA1 are candidate biomarkers with preliminary diagnostic evidence warranting validation in larger multi-centre cohorts.
Gut Microbiota Metabolite, Trimethylamine N-Oxide, Aggravates Cognitive Impairment in Cerebral Ischemia-Reperfusion Injury.
Li W, Jiang J, Zhou J … +2 more , Li P, Duan X
Int J Gen Med · 2026 · PMID 42147745 · Full text
PURPOSE: Cerebral ischemia-reperfusion injury (CIRI) causes neuronal inflammation, oxidative stress, and cognitive impairment. We hypothesized that gut microbiota dysbiosis exacerbates post-ischemic cognitive deficits, w...
PURPOSE: Cerebral ischemia-reperfusion injury (CIRI) causes neuronal inflammation, oxidative stress, and cognitive impairment. We hypothesized that gut microbiota dysbiosis exacerbates post-ischemic cognitive deficits, with trimethylamine N-oxide (TMAO) acting as a potential mediator. METHODS: In the primary experiment, mice received an antibiotic cocktail for 28 days to induce gut dysbiosis prior to bilateral common carotid artery occlusion (BCCAO), a model of CIRI (n = 12 per group). Gut microbial composition was analyzed using 16S rRNA sequencing, and cognitive function was assessed with the Morris water maze. Functional enrichment analyses (Kyoto Encyclopedia of Genes and Genomes and Clusters of Orthologous Groups) and microbiota-metabolite database mapping were used to identify candidate metabolites. In a separate validation cohort (n = 6 per group), TMAO (6.5 mg/day) was administered intraperitoneally for 7 days before BCCAO. RESULTS: Antibiotic treatment markedly altered microbial diversity and composition, characterized by an expansion of Proteobacteria and a reduction in Lactobacillus. Bioinformatic analyses identified TMAO, a metabolite associated with Proteobacteria/Enterobacteria, as a potential mediator. Mice with antibiotic-induced dysbiosis subjected to CIRI exhibited impaired spatial memory, as indicated by fewer platform crossings and reduced time spent in the target quadrant. Similarly, TMAO pretreatment reproduced these cognitive deficits in BCCAO mice. CONCLUSION: Antibiotic-induced gut dysbiosis appears to exacerbate CIRI-related cognitive impairment, at least in part through elevated TMAO levels. These findings highlight a potential microbiota-metabolite axis as a target for therapeutic intervention.
Development and Validation of a Nomogram Model for Assessing the Impact of Continuous Lumbar Drainage Volume on Prognosis in Patients with Acute Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage.
Wen T, Su J, Yang X … +2 more , Tan J, He Z
Int J Gen Med · 2026 · PMID 42147744 · Full text
PURPOSE: This study aimed to analyze the influence of volume during continuous lumbar drainage on the prognosis of patients with acute hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) and to develop and vali...
PURPOSE: This study aimed to analyze the influence of volume during continuous lumbar drainage on the prognosis of patients with acute hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) and to develop and validate a prognostic nomogram model. PATIENTS AND METHODS: The clinical data of patients with acute hydrocephalus after aSAH at a single center were retrospectively collected. The modified Rankin Scale score at 6 months after discharge was used as the prognostic outcome. Clinical data were included in the univariate analysis. Significant variables were incorporated into a multivariate logistic regression analysis. On the basis of the independent factors identified, an individualized prognostic nomogram was developed and internally validated. RESULTS: In total, 164 patients were included. Multivariate analysis revealed high World Federation of Neurological Surgeons scores (OR: 3.20), high modified Fisher grades (OR: 3.39), shunt dependence (OR: 8.05), and cerebral vasospasm (OR: 22.65) as independent risk factors for poor prognosis. Continuous lumbar drainage volume (OR: 0.61) was determined to be an independent protective factor. A nomogram model incorporating these independent factors was successfully constructed. The model demonstrated good predictive performance, with area under the receiver operating characteristic curve values greater than 0.86 in the training and test sets. Internal validation indicated high discriminative ability (C-index: 0.935) and good calibration. CONCLUSION: Increasing the volume of continuous lumbar drainage within the patient's tolerance range is an independent protective factor. The nomogram effectively integrates multiple independent factors and provides a potentially effective reference tool for individualized prognosis prediction in patients with acute hydrocephalus after aSAH.
Association of Dynamic Changes in the Neutrophil-to-Lymphocyte Ratio with Mortality in Patients on Maintenance Hemodialysis: A Retrospective Cohort Study.
Ergun G
Int J Gen Med · 2026 · PMID 42137227 · Full text
INTRODUCTION: Chronic inflammation is a major contributor to excess mortality in patients on maintenance hemodialysis (HD). Although elevated baseline neutrophil-to-lymphocyte ratio (NLR) has been associated with adverse...
INTRODUCTION: Chronic inflammation is a major contributor to excess mortality in patients on maintenance hemodialysis (HD). Although elevated baseline neutrophil-to-lymphocyte ratio (NLR) has been associated with adverse outcomes, the prognostic significance of longitudinal changes in NLR (ΔNLR) remains unclear. Therefore, we investigated whether dynamic changes in NLR provide incremental prognostic information in HD patients. MATERIALS AND METHODS: In this retrospective cohort study, 64 HD patients were screened. After excluding patients who died before the 12-month reassessment or had incomplete laboratory data, 59 patients were included in the final analysis. ΔNLR was defined as the difference between 12-month and baseline NLR values. The primary endpoint was all-cause mortality during a 24-month follow-up. Kaplan-Meier analysis was performed using categorical ΔNLR (≤0 vs >0), and Cox proportional hazards models were used to evaluate the association between continuous ΔNLR and mortality. RESULTS: During follow-up, 12 patients (20.3%) died. Kaplan-Meier analysis did not demonstrate significant survival differences between ΔNLR categories (log-rank p = 0.312). However, ΔNLR analyzed as a continuous variable was significantly associated with mortality in univariable (HR 1.78, 95% CI 1.31-2.41, p < 0.001) and multivariable analyses. CONCLUSION: Dynamic increases in NLR were associated with mortality when analyzed as a continuous variable in patients on maintenance HD. These findings suggest that longitudinal assessment of NLR may provide clinically relevant prognostic information beyond single time-point measurements.
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