International Journal of General Medicine最新文献

{"title":"Nurse-Led Closed-Loop Infection Prevention and Control and Healthcare-Associated Infection Outcomes: A Retrospective Pre-Post Study.","authors":"Jing Che, Haiping Zhang, Yangjuan Xi, Lu Zhang, Pan Zhang, Na Duan","doi":"10.2147/IJGM.S631153","DOIUrl":"https://doi.org/10.2147/IJGM.S631153","url":null,"abstract":"<p><strong>Background: </strong>Healthcare-associated infections (HAIs) remain a major patient-safety challenge. Although infection prevention and control (IPC) programs are central to HAI prevention, evidence regarding comprehensive nurse-led IPC models in routine clinical practice remains limited. Unlike isolated educational or compliance-focused interventions, the present framework integrates nurse-led risk assessment, continuous surveillance, bedside auditing, performance feedback, and closed-loop quality improvement. This study evaluated the association between implementation of this framework and infection-related outcomes.</p><p><strong>Methods: </strong>This single-center retrospective observational pre-post study used electronic medical record data collected from July 2023 to May 2026. A total of 768 hospitalized patients were included: 410 in the pre-implementation period and 358 after hospital-wide implementation of a nurse-led closed-loop IPC program. The primary outcome was HAI incidence. Secondary outcomes included IPC compliance, multidrug-resistant organism (MDRO) detection, device-associated infections, length of hospital stay, and all-cause in-hospital mortality.</p><p><strong>Results: </strong>HAI incidence decreased from 22.0% to 7.8% after implementation (RR=0.36, 95% CI: 0.24-0.53; p<0.001). Significant reductions were observed in ventilator-associated pneumonia (4.6% vs 1.7%; p=0.021), catheter-associated urinary tract infection (7.8% vs 1.7%; p<0.001), surgical site infection (6.3% vs 3.1%; p=0.035), and MDRO detection (23.4% vs 9.5%; p<0.001). Overall IPC compliance increased from 57.8% to 81.3% (p<0.001), and mean hospital stay decreased from 12.08±3.30 to 8.83±2.36 days (p<0.001). In-hospital mortality decreased from 6.3% to 4.5%, but not significantly.</p><p><strong>Conclusion: </strong>In this single-center retrospective pre-post study, implementation of a nurse-led closed-loop IPC framework was associated with lower HAI incidence, reduced MDRO detection, shorter hospitalization, and improved IPC compliance. These findings suggest that structured nursing leadership may strengthen routine IPC implementation; however, residual confounding, temporal changes, and the single-center observational design limit causal inference and generalizability. Further multicenter controlled studies are warranted.</p>","PeriodicalId":14131,"journal":{"name":"International Journal of General Medicine","volume":"19 ","pages":"631153"},"PeriodicalIF":2.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting MASLD in Gallstone Patients: An Interpretable Machine Learning Model with External Validation.","authors":"Ziwen Pan, Xiaoqing Chen","doi":"10.2147/IJGM.S628985","DOIUrl":"https://doi.org/10.2147/IJGM.S628985","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have shown a higher prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in individuals with gallstones, as both conditions share common risk factors, including hyperlipidemia, obesity, physical inactivity, and diabetes. This study aimed to develop and validate a machine learning (ML)-based model for predicting MASLD risk in gallstone patients.</p><p><strong>Methods: </strong>A multicenter retrospective cross-sectional study was conducted, enrolling 390 gallstone patients from the Guanggu Branch of our hospital (January 2023-August 2025) as the internal cohort for model development. An external validation cohort of 134 subjects from the Shouyi Branch, matched in timeframe, was also included. The Synthetic Minority Oversampling Technique (SMOTE) was applied to address class imbalance in the internal training set. Feature selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression and the Boruta algorithm, followed by model development and validation using seven ML algorithms. Model performance was evaluated using calibration curves, and decision curves. The Support Vector Machines (SVM)-based diagnostic model was further interpreted using SHapley Additive exPlanations (SHAP).</p><p><strong>Results: </strong>In the study cohort, 15.46% of gallstone patients were diagnosed with MASLD. Seven variables were identified as significant predictors of comorbid MASLD in patients with gallstones. Among the seven ML models, the SVM algorithm achieved the highest AUC (0.902; 95% confidence interval: 0.857-0.946). The model's performance was confirmed in both the internal and external validation groups, with AUC values exceeding 0.7 in both cases. Calibration curves indicated strong model calibration. SHAP interpretation revealed that the top three predictive features were AIP, hyperlipidemia, and hemoglobin.</p><p><strong>Conclusion: </strong>A predictive model for concurrent MASLD risk in gallstone patients was developed and validated using seven clinical indicators.</p>","PeriodicalId":14131,"journal":{"name":"International Journal of General Medicine","volume":"19 ","pages":"628985"},"PeriodicalIF":2.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine Blood Biomarkers and CD4⁺ T-Cell States in Atherosclerosis: A Narrative Review and Conceptual Framework.","authors":"Xiaowei Chu, Chaomin Kong, Xuedong Bai, Sisi Wu, Hongyang Dong, Lixia Yao, Caixia Lyu","doi":"10.2147/IJGM.S642383","DOIUrl":"https://doi.org/10.2147/IJGM.S642383","url":null,"abstract":"<p><strong>Background: </strong>Atherosclerosis (AS) is a chronic inflammatory disease driven by complex immune responses. Among the involved immune cells, CD4⁺ T cells are closely associated with plaque progression. An imbalance between inflammatory and regulatory T-cell responses can sustain vascular inflammation. However, the relationship between routinely measured blood biomarkers and these T-cell states remains unclear.</p><p><strong>Main body: </strong>This narrative review examines how LDL-C, HDL-C, HbA1c, high-sensitivity C-reactive protein (hsCRP) and creatinine relate to biological processes involved in CD4⁺ T-cell regulation. We propose the T-cell Perturbation Index (TPI) as an unvalidated conceptual framework for generating hypotheses about these relationships. The candidate variables are informed by heterogeneous human and experimental studies. These studies do not provide comparable estimates from which numerical weights can be derived. The symbolic expression therefore assigns no numerical coefficients or individual immune-state classifications.</p><p><strong>Conclusion: </strong>The TPI organizes questions about the joint association of routine blood markers with CD4⁺ T-cell states in atherosclerosis. Whether these measurements capture reproducible immune variation remains unknown. Evaluation against direct immune measurements is required, and any clinical or prognostic application would require separate evidence.</p>","PeriodicalId":14131,"journal":{"name":"International Journal of General Medicine","volume":"19 ","pages":"642383"},"PeriodicalIF":2.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fructose-Induced Bladder Remodeling: Histopathological Evidence from an Experimental Rat Model.","authors":"Mehmet Ali Ergül, Volkan Sabur","doi":"10.2147/IJGM.S637797","DOIUrl":"https://doi.org/10.2147/IJGM.S637797","url":null,"abstract":"<p><strong>Background: </strong>High-fructose diets have been associated with metabolic and lower urinary tract abnormalities, but direct histopathological evidence and the tissue changes observed after fructose withdrawal remain incompletely characterized. This study evaluated the impact of high-fructose exposure on bladder histopathology and related urinary biochemical alterations in a rat model.</p><p><strong>Methods: </strong>Twenty-four male Wistar rats were randomly allocated to three groups (n=8 each): control, fructose withdrawal, and continuous fructose exposure. The withdrawal group received a 60% fructose solution and fructose-rich diet for 4 weeks, followed by standard chow and tap water for 2 weeks, whereas the continuous-exposure group received fructose for 6 weeks. At week 6, a single 24-hour urine sample was collected, and bladder tissue was evaluated by blinded semiquantitative histopathological scoring. One-way ANOVA with Bonferroni-adjusted post hoc comparisons, Kruskal-Wallis testing, Jonckheere-Terpstra trend testing, and Spearman correlation were used as appropriate.</p><p><strong>Results: </strong>Urothelial hyperplasia (p<0.001), lamina propria inflammation (p=0.025), edema (p=0.008), vascular congestion (p=0.018), smooth muscle hypertrophy (p=0.025), and total histopathological injury score (p<0.001) differed among groups, with the highest total score in the continuous-exposure group. Detrusor fibrosis (p=0.332) and calcification (p=0.592) did not differ significantly. Urinary calcium (p<0.001), oxalate (p=0.023), calcium-to-creatinine ratio (p=0.044), and citrate-to-creatinine ratio (p=0.006) also differed among groups.</p><p><strong>Conclusion: </strong>Six weeks of high-fructose exposure was associated with inflammatory and hypertrophic bladder changes in rats. Lower injury scores after 4 weeks of exposure followed by 2 weeks of withdrawal indicate attenuation, but the unequal cumulative exposure does not establish reversibility. Functional and molecular studies with exposure-matched controls are required.</p>","PeriodicalId":14131,"journal":{"name":"International Journal of General Medicine","volume":"19 ","pages":"637797"},"PeriodicalIF":2.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biliary Microbiology and Antimicrobial Treatment Modification in Patients Undergoing Percutaneous Cholecystostomy for Acute Cholecystitis: A Single-Centre Retrospective Cohort Study.","authors":"Berkan Acar, Ali Muhtaroğlu, Selman Alkan, Elif Yılmaz, Serdar Acar, Yavuz Çekiç, Mehmet Yıldız","doi":"10.2147/IJGM.S638067","DOIUrl":"https://doi.org/10.2147/IJGM.S638067","url":null,"abstract":"<p><strong>Objective: </strong>To describe bile culture yield, organism distribution and antimicrobial treatment modification in patients undergoing percutaneous cholecystostomy (PC) for acute cholecystitis who were unsuitable for early cholecystectomy.</p><p><strong>Methods: </strong>We retrospectively reviewed 84 consecutive patients who underwent PC between December 2021 and December 2025. Index bile cultures were classified as positive, no growth, or not obtained. We analysed organisms, polymicrobial growth, empirical antimicrobial therapy, treatment modification and clinical outcomes by culture status and disease severity.</p><p><strong>Results: </strong>Bile was cultured in 71 patients (84.5%), and 33 cultures were positive (46.5% of sampled patients; 39.3% of the cohort). Seven positive cultures (21.2%) were polymicrobial. The leading isolates were <i>Escherichia coli</i> (n=13), <i>Enterococcus faecium</i> (n=9) and <i>Klebsiella pneumoniae</i> (n=8). Ceftriaxone plus metronidazole was the most common empirical regimen (52/84, 61.9%). Treatment was modified in 20 patients (23.8%); half of the modified regimens contained a carbapenem. Modification was more frequent among patients requiring intensive care (46.2% versus 13.8%; crude odds ratio [OR] 5.36, 95% confidence interval [CI] 1.83-15.67) and those with Tokyo grade III disease (41.9% versus 13.2%; crude OR 4.75, 95% CI 1.63-13.81). No statistically significant difference was detected between the positive-culture and no-growth groups in treatment modification (24.2% versus 23.7%), in-hospital adverse events (24.2% versus 31.6%), 30-day mortality (12.1% versus 13.2%) or 90-day mortality among evaluable patients (6/32 [18.8%] versus 10/37 [27.0%]).</p><p><strong>Conclusion: </strong>Bile obtained during PC had a substantial microbiological yield and grew predominantly enteric organisms. Treatment modification was more frequent in clinically severe disease, but no statistically significant difference was detected between positive-culture and no-growth groups. Bile culture should inform a structured reassessment of antimicrobials after source control, rather than automatic treatment escalation.</p>","PeriodicalId":14131,"journal":{"name":"International Journal of General Medicine","volume":"19 ","pages":"638067"},"PeriodicalIF":2.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut Microbiota-Immune-Inflammation Axis as a Putative Pathogenic Axis in Chronic Insomnia: Mechanistic Dissection of NLRP3 Inflammasome and NF-κB Signaling.","authors":"Jindi Ma, Zhitao Hou","doi":"10.2147/IJGM.S645057","DOIUrl":"https://doi.org/10.2147/IJGM.S645057","url":null,"abstract":"<p><p>Chronic insomnia represents one of the most prevalent sleep disorders worldwide, yet current symptomatic treatments largely fail to target its root pathophysiology. Moving beyond conventional neurocentric frameworks, converging evidence positions gut microbiota dysbiosis as a potential upstream contributor to insomnia via the microbiota-gut-brain axis, with immune-inflammatory cascades serving as proposed mediating pathway. Mechanistically, disrupted gut microbial communities compromise intestinal mucosal barrier integrity, enabling lipopolysaccharide translocation that activates TLR4-mediated NF-κB signaling. This triggers systemic low-grade inflammation, marked by elevated pro-inflammatory cytokines IL-1β, IL-6, IL-17 and TNF-α, reduced anti-inflammatory IL-4 and IL-10, and Th17/Treg immune imbalance. Centrally, circulating inflammatory signals activate the NLRP3 inflammasome, driving caspase‑1‑dependent pyroptosis and a pro‑inflammatory microglial activation state (conventionally described as \"M1‑like\" polarization), which disrupts sleep-wake neural circuitry and hypothalamic-pituitary-adrenal axis homeostasis. Dysregulated PI3K/Akt signaling and aberrant microbial metabolites-including depleted short-chain fatty acids and a pathological shift in tryptophan metabolism toward the neurotoxic kynurenine pathway-further amplify the vicious cycle between sleep disturbance and neuroinflammation. This review systematically maps the full pathological cascade from intestinal dysbiosis to central insomnia phenotypes, and compares translational strategies including psychobiotic strains, fecal microbiota transplantation, dietary intervention and traditional Chinese medicine formulas targeting this axis. Collectively, this work proposes an integrated microbiota-immune-sleep regulatory framework, offering novel mechanistic insights and microbiome-based therapeutic avenues for precision insomnia management.</p>","PeriodicalId":14131,"journal":{"name":"International Journal of General Medicine","volume":"19 ","pages":"645057"},"PeriodicalIF":2.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Osteomyelitis in Saudi Arabia's Adult Population: A Nationwide Cross-Sectional Study of Knowledge and Attitudes.","authors":"Yousef M Alammari, Abdullah Alghamdi, Abdulwahed A Alotay, Abdulrahman Alanazi, Mohammad Alhajery, Rayan A Qutob, Tariq Yousef Alhomoud, Osama Thamer Al-Ahmari, Ammar Yasser Al Qahtani, Muath Alamri, Muthana Saleh Alamri, Assaf Shabib Alotaibi, Faris Al Murdhi, Faris Sultan Almohammed, Meshal Alzakari","doi":"10.2147/IJGM.S611699","DOIUrl":"https://doi.org/10.2147/IJGM.S611699","url":null,"abstract":"<p><strong>Background: </strong>Osteomyelitis (OM) is a severe bone infection causing progressive destruction. This nationwide cross-sectional study evaluated public knowledge and attitudes regarding OM among Saudi Arabian adults to identify sociodemographic gaps and guide targeted health education.</p><p><strong>Methods: </strong>Saudi residents aged ≥18 years completed a validated electronic survey. Knowledge was evaluated using a 7-item score (good awareness defined as ≥60% correct). Bivariate testing and multivariable binary logistic regression were conducted using SPSS version 26 (significance set at p ≤ 0.05).</p><p><strong>Results: </strong>Among 1206 respondents (97.0% Saudi; 58.7% bachelor's degree), overall awareness was low, with only 38.4% demonstrating good knowledge. Key misconceptions included misclassifying OM as autoimmune (25.3%) or contagious via blood transfusion (26.0%). Multivariable regression revealed that younger age (18-29 years: aOR = 6.85, 95% CI: 2.38-19.72, p < 0.001) and bachelor's education (aOR = 1.42, 95% CI: 1.10-1.83, p = 0.007) were independent predictors of good awareness. Most participants recognized OM as a serious condition (73.4%) and agreed early detection prevents complications (86.2%).</p><p><strong>Conclusion: </strong>Public awareness of osteomyelitis in Saudi Arabia is markedly low, particularly among older adults and individuals without higher education. Targeted educational strategies integrated into primary healthcare and diabetic foot screening programs are urgently needed.</p>","PeriodicalId":14131,"journal":{"name":"International Journal of General Medicine","volume":"19 ","pages":"611699"},"PeriodicalIF":2.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acupuncture in Cerebral Ischemia-Reperfusion Injury: A Mechanistic Narrative Review of Innate Immune Sensing and Regulated Cell Death-Related Inflammatory Amplification.","authors":"Wei Jiang, Huihui Liu","doi":"10.2147/IJGM.S646501","DOIUrl":"10.2147/IJGM.S646501","url":null,"abstract":"<p><p>Cerebral ischemia-reperfusion injury (CIRI) can continue after recanalization because disruption of neurovascular-unit compartmental integrity exposes damage-associated molecular patterns (DAMPs) and couples innate immune sensing to regulated cell death. This mechanism-oriented narrative review integrates CIRI biology with experimental evidence on acupuncture while distinguishing pathway association from mechanistic necessity. HMGB1-TLR4 signaling, extracellular ATP-P2X7 signaling, and aberrant DNA sensing can translate tissue damage into inflammatory transcription, inflammasome activation, and interferon-related responses. Pyroptosis, necroptosis, and ferroptosis can further amplify inflammatory and oxidative injury through membrane-pore formation or rupture, release of intracellular contents, and lipid peroxidation. Acupuncture-specific mechanistic evidence derives predominantly from electroacupuncture in rodent middle cerebral artery occlusion/reperfusion models. Functional support is comparatively stronger for α7 nicotinic acetylcholine receptor-dependent signaling, caspase-1/GSDMD-related pyroptotic execution, Nrf2-SLC7A11/GPX4 antioxidant defense, and TFEB-dependent lysosomal iron regulation; recent NCOA4 perturbation data also strengthen the ferritinophagy evidence. By contrast, P2X7, ATP-binding cassette transporter A1, microRNA-223, and cGAS-STING remain less uniformly validated, and direct acupuncture evidence for AIM2 signaling and necroptosis remains lacking. Clinical studies support acupuncture primarily as an adjunctive intervention for functional recovery and do not establish inflammasome activation, pyroptosis, ferroptosis, or other animal-defined molecular events as mediators of clinical benefit. Future studies should distinguish pretreatment from post-onset therapy, standardize acupoint and stimulation parameters, and combine cell-specific perturbation, time-resolved sampling, and clinically accessible intermediate phenotypes to determine whether experimentally defined mechanisms translate into neurological recovery.</p>","PeriodicalId":14131,"journal":{"name":"International Journal of General Medicine","volume":"19 ","pages":"646501"},"PeriodicalIF":2.3,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fried Frailty Phenotype and 6-Month Risk of First All-Cause Rehospitalisation Among Older Outpatients with Heart Failure and LVEF >40%: A Multicentre Prospective Cohort Study.","authors":"Huan Thanh Nguyen, Duyen Hoang Mai Nguyen, Linh Nu Ngoc Doan, Tra Thanh Nguyen, Huy Quang Nguyen, Loi Phuc Luu","doi":"10.2147/IJGM.S648750","DOIUrl":"10.2147/IJGM.S648750","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) with left ventricular ejection fraction (LVEF) >40% is common in older adults and carries a substantial risk of post-discharge rehospitalisation. However, the prognostic association of the Fried frailty phenotype with short-term rehospitalisation remains incompletely characterised.</p><p><strong>Methods: </strong>We conducted a multicentre prospective cohort study of adults aged ≥60 years with HF and LVEF >40% who were enrolled 1-3 months after HF hospitalisation at two tertiary HF outpatient clinics in Ho Chi Minh City, Vietnam. Frailty was assessed at enrolment using the Fried frailty phenotype and defined as meeting ≥3 criteria. For prognostic analyses, robust and pre-frail participants were combined into a non-frail group and compared with frail participants. Participants were followed for 6 months from enrolment to ascertain first all-cause rehospitalisation. Cox proportional hazards regression assessed the association between frailty and rehospitalisation, and the incremental prognostic contribution of frailty was evaluated using Harrell's C-statistic and the likelihood-ratio test.</p><p><strong>Results: </strong>Among 313 participants, the median age was 72.0 years (interquartile range, 66.0-81.0), 53.4% were male, and 190 (60.7%) were frail. First all-cause rehospitalisation occurred in 118 participants (37.7%): 33 of 123 non-frail participants (26.8%) and 85 of 190 frail participants (44.7%). Frailty was associated with a higher risk of rehospitalisation in univariable analysis (HR, 1.89; 95% CI, 1.27-2.83) and after adjustment for prespecified covariates (adjusted HR, 1.80; 95% CI, 1.09-2.95; p = 0.021). Adding frailty increased Harrell's C-statistic from 0.717 to 0.723, corresponding to a change of 0.006 (95% CI, -0.004 to 0.027), and improved overall model fit according to the likelihood-ratio test (p = 0.017).</p><p><strong>Conclusion: </strong>Frailty was common and associated with a higher 6-month risk of first all-cause rehospitalisation among older outpatients with HF and LVEF >40%. Adding frailty improved overall model fit, whereas the estimated change in discrimination was small and its confidence interval included no improvement. The models were not internally or externally validated; independent validation is warranted.</p>","PeriodicalId":14131,"journal":{"name":"International Journal of General Medicine","volume":"19 ","pages":"648750"},"PeriodicalIF":2.3,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13643380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cytokine Concentrations in Seminal Plasma and Blood in HIV Infection: Differential Modulation by Antiretroviral Therapy and Association with HIV RNA Levels and CD4⁺T Cell Count.","authors":"Dongmei Gao, Zilaiguli Mijiti, Ningning Zhu, Yaping Xu, Lin Gao","doi":"10.2147/IJGM.S628368","DOIUrl":"https://doi.org/10.2147/IJGM.S628368","url":null,"abstract":"<p><strong>Background and objectives: </strong>The complex cytokine network in seminal fluid during human immunodeficiency virus (HIV) infection remains incompletely understood. This study aimed to investigate inflammatory cytokine levels in the semen of individuals with chronic HIV infection and assess the effects of antiretroviral therapy ART on cytokine networks.</p><p><strong>Materials and methods: </strong>A total of 26 HIV infected individuals were recruited, including 16 treatment-naïve (TN) patients, 10 patients receiving ART for over 2 years with plasma HIV viral loads of < 20 copies/mL (CR group), and 4 healthy controls (HC). Differences in inflammatory cytokine levels were analyzed using the Olink assay in paired seminal plasma and blood samples, along with correlations between cytokine levels and indicators of disease progression. Moreover, differences in cytokine networks between seminal plasma and blood plasma were analyzed, and the effects of ART on these networks were evaluated.</p><p><strong>Results: </strong>HIV infection and ART altered cytokine networks in seminal plasma compared with those in HC. The levels of semen cluster 1 (interferon-γ, IL-12B, MCP-2, MCP-4, and Flt3L) in the TN group were significantly higher than those in the HC group. HIV infection was associated with increased rigidity of the seminal cytokine network, and significant differences were observed between the cytokine networks of seminal and blood plasma, both with and without ART. Additionally, seminal plasma levels of Flt3L, MCP-4, IL-1alpha, OSM, TWEAK, VEGFA, transforming growth factor-alpha, HGF, NT-3, IL-4, IL-17C, beta-NGF, FGF-19, and TRAIL were significantly correlated with baseline HIV RNA levels and CD4⁺ T cell counts.</p><p><strong>Conclusion: </strong>ART had a greater effect on cytokine levels in blood plasma than in seminal plasma. Seminal plasma also exhibited higher concentrations of cytokines associated with indicators of HIV disease progression than blood plasma.</p>","PeriodicalId":14131,"journal":{"name":"International Journal of General Medicine","volume":"19 ","pages":"628368"},"PeriodicalIF":2.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}