Journal of International Medical Research最新文献

{"title":"The C-reactive protein-albumin-lymphocyte index as a predictor of new-onset atrial fibrillation after ST-segment elevation myocardial infarction: A retrospective cohort study.","authors":"Mengchao Jin, Siliang Peng, Kun Liu, Jiayu Yin, Feng Li, Yang Zhang","doi":"10.1177/03000605261487233","DOIUrl":"https://doi.org/10.1177/03000605261487233","url":null,"abstract":"<p><p>ObjectiveNew-onset atrial fibrillation is a common complication following ST-segment elevation myocardial infarction and is associated with poor prognosis. The C-reactive protein-albumin-lymphocyte index, a composite biomarker reflecting inflammation, nutritional status, and immune function, has not been fully evaluated for its predictive value for new-onset atrial fibrillation.MethodsThis single-center retrospective study included 665 consecutive patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention between January 2023 and October 2025. The C-reactive protein-albumin-lymphocyte index was calculated from admission laboratory values. New-onset atrial fibrillation was defined as the first documented episode of atrial fibrillation within 30 days after percutaneous coronary intervention. Multivariable logistic regression, receiver operating characteristic curve analysis, and reclassification metrics were used to assess its predictive performance.ResultsNew-onset atrial fibrillation occurred in 56 patients (8.4%). In the multivariable model adjusting for age, heart rate, left atrial diameter, infarct-related artery-right coronary artery, left ventricular ejection fraction, fasting blood glucose, and C-reactive protein-albumin-lymphocyte index, five variables remained independently associated with new-onset atrial fibrillation: left atrial diameter (odds ratio = 1.179), infarct-related artery-right coronary artery (odds ratio = 1.992), left ventricular ejection fraction (odds ratio = 0.933), fasting blood glucose (odds ratio = 1.321), and C-reactive protein-albumin-lymphocyte index (odds ratio = 0.813) (all p < 0.05). Among individual biomarkers, the C-reactive protein-albumin-lymphocyte index demonstrated the highest predictive ability (area under the curve = 0.743; 95% confidence interval: 0.685-0.801). Adding the C-reactive protein-albumin-lymphocyte index to a baseline model comprising age, heart rate, left atrial diameter, infarct-related artery-right coronary artery, left ventricular ejection fraction, and fasting blood glucose significantly improved reclassification (net reclassification improvement = 0.7323; p < 0.001; integrated discrimination improvement = 0.0593; p = 0.005).ConclusionsIn this retrospective single-center cohort, a lower admission C-reactive protein-albumin-lymphocyte index was independently associated with clinically documented 30-day new-onset atrial fibrillation after percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction and may provide incremental predictive information, whereas external validation is required before clinical application.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261487233"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Next-generation dental implant surface modifications for osseointegration: From nanoengineering to clinical translation.","authors":"Sukumaran Anil, Vishnupriya K Sweety, Anjali Mol, Aman Singh, Namrata Suresh, Nandita Suresh","doi":"10.1177/03000605261489355","DOIUrl":"https://doi.org/10.1177/03000605261489355","url":null,"abstract":"&lt;p&gt;&lt;p&gt;This narrative review, prepared in accordance with the Scale for the Assessment of Narrative Review Articles, surveys next-generation dental implant surface modifications for osseointegration, from nanoengineering to clinical translation. Peri-implantitis affects approximately 19.53% of patients and 12.53% of implants. Because peri-implant tissue destruction reflects a dysregulated host inflammatory response to an unavoidable, lifelong microbial challenge rather than bacterial colonization alone, the design target is shifting from surfaces that are simply bactericidal to surfaces that regulate inflammation while supporting bone integration. Surface design has evolved from machined titanium through sandblasted and acid-etched (SLA) platforms and the superhydrophilic SLActive surface to nanoengineered, bioactive, and stimuli-responsive architectures. SLActive surfaces prevent hydrocarbon adsorption so that near-zero water contact angles are retained, whereas unprotected SLA surfaces progressively lose hydrophilicity with storage time. Electrochemically anodized titanium dioxide nanotube arrays elicit diameter-dependent cellular responses. Tubes with diameters of 70 to 100 nm drive approximately 10-fold elongation of mesenchymal stem cells and selective osteogenic differentiation and enhance bone bonding 9-fold in vivo. Bioactive coatings incorporating nanostructured hydroxyapatite, therapeutic ion-doped bioactive glasses (niobium, cerium, and zinc), and immobilized growth factors such as bone morphogenetic protein 2 and vascular endothelial growth factor actively direct cellular behavior. Antimicrobial strategies, including silver nanoparticles, antimicrobial peptides (GL13K and HHC-36), and photodynamic or photothermal therapies, address microbial colonization while preserving osteogenic potential. However, ensuring lifelong efficacy remains the key challenge for any release-based approach. Stimuli-responsive systems employ pH-responsive gating, zeolitic imidazolate framework-8 metal-organic framework carriers, and enzyme-cleavable linkers to enable microenvironment-triggered release. Additive manufacturing advances, including triply periodic minimal surface lattices and four-dimensional (4D)-printed shape-memory nickel-titanium constructs, enable patient-specific geometries with tailored porosity gradients. In contrast, femtosecond laser texturing, plasma treatments, and atomic layer deposition provide atomic- to micro-scale control. Emerging graphene oxide derivatives, modified polyetheretherketone, and zirconia-based ceramics further broaden the design landscape. Despite robust preclinical evidence, translational progress remains constrained by regulatory complexity, manufacturing scalability, and limited long-term clinical data. Herein, we synthesize preclinical and clinical evidence, identify research gaps, propose artificial intelligence-guided design directions, and outline pathways for translating next-generation surfaces into routin","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261489355"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Another Etiology of persistent pupillary fluctuations: A case of pesticide poisoning.","authors":"Haitao Yu, Yangyang Zheng, Mingliang Lu, Chao Li, Ming Fang","doi":"10.1177/03000605261485126","DOIUrl":"10.1177/03000605261485126","url":null,"abstract":"<p><p>ObjectiveThis report details a rare and severe case of intentional pyridaben poisoning, highlighting the diagnostic challenges posed by its presentation with coma and anisocoria, and the successful treatment strategy employing extracorporeal blood purification.Case summaryA patient in early 50 s was found unconscious and admitted to the emergency department. Neurological examination revealed coma and bilateral, fixed, dilated pupils, initially raising strong suspicion for a catastrophic cerebrovascular accident. However, normal neuroimaging and subsequent arterial blood gas analysis revealed profound metabolic acidosis (pH 7.21, lactate >17 mmol/L) with compensatory hyperventilation. Further history from relatives suggested a suicidal attempt following familial discord, later confirmed by the discovery of a pyridaben container at her home. Toxicological monitoring is essential for confirming the diagnosis; however, this test could not be performed at our institution. We have therefore acknowledged this limitation in the Discussion section. The patient's condition deteriorated with refractory hypotension and generalized seizures. Management included endotracheal intubation, mechanical ventilation, vasopressor support, and seizure control. A combination of hemoperfusion (HP) and continuous renal replacement therapy (CRRT) was initiated for enhanced toxin elimination and metabolic correction. The patient showed remarkable improvement; lactate levels normalized within 13 h, and she regained full consciousness with intact neurological function 23 h post-admission. She was successfully weaned from the ventilator on day 4 and was discharged after a full recovery.ConclusionThis case underscores that pyridaben poisoning can mimic brainstem herniation, but the finding of unexplained severe lactic acidosis is a pivotal diagnostic clue. A multifaceted management approach, including early extracorporeal blood purification with HP and CRRT, can be life-saving and lead to complete neurological recovery even in the most severe presentations.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261485126"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968917","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":"Drug-induced sleep endoscopy-defined upper-airway collapse phenotypes and the presence of cardiometabolic comorbidity in adults with obstructive sleep apnea: A single-center retrospective cross-sectional study.","authors":"Wei-Hung Chang, Mei-Chen Yang, Chung Lee","doi":"10.1177/03000605261480899","DOIUrl":"https://doi.org/10.1177/03000605261480899","url":null,"abstract":"<p><p>ObjectiveTo evaluate whether upper-airway collapse phenotypes recorded during drug-induced sleep endoscopy were associated with the presence of cardiometabolic comorbidity in adults with polysomnography-confirmed obstructive sleep apnea.MethodsThis single-center retrospective cross-sectional study analyzed 360 drug-induced sleep endoscopy evaluation records from 355 adults. The primary outcome was at least one documented diagnosis of hypertension, diabetes mellitus, coronary artery disease, or cerebrovascular disease. Baseline supine velum-oropharynx-tongue base-epiglottis severity was coded as grade 0, 1, or 2; site-level collapse was defined as grade ≥1. Logistic regression was adjusted for age, sex, body mass index, apnea-hypopnea index, all velum-oropharynx-tongue base-epiglottis sites, and complete concentric velum collapse. Sensitivity analyses examined severity, pattern, repeated identifiers, multiplicity, model fit, and incremental value.ResultsCardiometabolic comorbidity was present in 156/360 records (43.3%). Epiglottic collapse was less frequent with than without comorbidity (17.3% vs. 29.4%). In the primary model, epiglottic collapse showed a nominal inverse association (adjusted odds ratio = 0.55; 95% confidence interval: 0.32-0.95; p = 0.031), but the Holm-adjusted p value across adjusted drug-induced sleep endoscopy predictors was 0.153. In exploratory sensitivity analyses, complete, but not partial, epiglottic collapse showed lower estimated odds (complete vs. none: adjusted odds ratio = 0.42; 95% confidence interval: 0.22-0.80; p = 0.008). The clinical model area under the receiver operating characteristic curve was 0.675 vs. 0.694 after adding drug-induced sleep endoscopy variables; the likelihood-ratio test was not significant (p = 0.203).ConclusionsEpiglottic collapse showed an exploratory inverse cross-sectional association with documented cardiometabolic comorbidity. The association did not remain significant after multiplicity correction and should not be interpreted as protective, temporal, or predictive. Protocolized prospective validation is required.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261480899"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a nomogram for preoperative prediction of malignant risk in thyroid follicular tumors based on multimodal ultrasound and clinical features: A retrospective observational study.","authors":"Hou Tingkun, Song Hongyan, Zheng Ran, Wang Yanfang, Nie Fang","doi":"10.1177/03000605261467637","DOIUrl":"10.1177/03000605261467637","url":null,"abstract":"<p><p>BackgroundPreoperative differentiation of thyroid follicular tumors remains challenging because cytology has a limited ability to assess capsular and vascular invasion. This study aimed to develop a nomogram integrating multimodal ultrasound and clinical features to predict the risk of malignancy in follicular thyroid tumors.MethodsA total of 483 patients with pathologically confirmed follicular thyroid tumors were retrospectively enrolled. Follicular thyroid adenoma was defined as the benign group, whereas follicular tumor of uncertain malignant potential and follicular thyroid carcinoma were combined into the high-risk group. Clinical data and multimodal ultrasound features were collected. Independent predictors were identified using univariate and multivariate logistic regression analyses, and a nomogram was constructed. Model performance was evaluated using the area under the receiver operating characteristic curve, calibration curve, Hosmer-Lemeshow test, and decision curve analysis.ResultsSex, lesion multiplicity, preoperative thyroglobulin, halo characteristics, \"nodule-in-nodule\" appearance, and trabecular structure were identified as independent predictors of malignancy (all p < 0.05). The nomogram demonstrated excellent discrimination, with an area under the receiver operating characteristic curve of 0.94 (95% confidence interval: 0.90-0.97). Internal validation using 1000 bootstrap resamples yielded a mean area under the receiver operating characteristic curve of 0.928 (95% confidence interval: 0.915-0.934). Calibration analysis showed good agreement between predicted and observed outcomes (Hosmer-Lemeshow test, p = 0.578). Decision curve analysis indicated a significant net clinical benefit across a threshold probability range of 15%-85%.ConclusionIn this exploratory retrospective study, the proposed nomogram showed preliminary potential for the preoperative prediction of malignant risk in thyroid follicular tumors. However, because of the lack of external validation, these findings should be considered hypothesis-generating. The model requires validation in independent cohorts before clinical application.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261467637"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individualized nutritional intervention combined with tailored resistance exercise in hospitalized frail older adults: A prospective, single-arm pilot before-and-after study.","authors":"Lingyan Chen, Liyu Xu, Caijuan Si, Zewei Hu, Yanyan Wang, Xiufang Hong","doi":"10.1177/03000605261484797","DOIUrl":"10.1177/03000605261484797","url":null,"abstract":"<p><p>ObjectiveTo evaluate the preliminary effects of a screening-guided, individualized nutritional intervention combined with tailored resistance exercise on nutritional status, physical function, and frailty in hospitalized frail older adults and explore baseline factors associated with response magnitude.MethodsThis prospective, single-arm pilot before-and-after study enrolled 120 hospitalized frail older adults (mean age: 87.03 ± 5.65 years). Nutritional status was stratified using the Mini Nutritional Assessment-Short Form (MNA-SF). Patients at a risk of malnutrition or those with malnutrition (MNA-SF score ≤ 11) received individualized oral nutritional supplementation, whereas well-nourished patients (MNA-SF score ≥ 12) underwent weekly monitoring. Resistance exercise included standardized Theraband training, performed 3 times weekly for 20-30 min, with intensity individualized using the Borg Rating of Perceived Exertion. Outcomes were assessed at baseline and after 12 weeks. The minimal clinically important difference (MCID) for Short Physical Performance Battery (SPPB) was defined as an improvement of ≥1 point. Baseline factors associated with SPPB MCID achievement were analyzed using multivariate logistic regression.ResultsCompared with baseline, significant within-group changes were observed in serum transferrin, prealbumin, and albumin levels as well as MNA-SF scores (all <i>p</i> < 0.05). Significant within-group changes were also observed in SPPB, performance-oriented mobility assessment, activities of daily living, and instrumental activities of daily living scores; grip strength; and gait speed (all <i>p</i> < 0.05). In multivariate analysis, SPPB MCID achievement was associated with higher baseline educational level (adjusted odds ratio: 1.962, 95% confidence interval: 1.060-3.634, <i>p</i> = 0.032) and lower baseline performance-oriented mobility assessment score (adjusted odds ratio: 1.808, 95% confidence interval: 1.076-3.039, <i>p</i> = 0.025).ConclusionIn this single-arm pilot study, a screening-guided, individualized nutritional intervention combined with tailored resistance exercise was associated with within-group changes in nutritional status and physical function in hospitalized frail older adults. Higher educational level and lower baseline mobility function were associated with greater magnitude of response.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261484797"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900775","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":"Context-dependent roles of osteopontin in aging-related neurological disorders.","authors":"Dong Huang, Zhen Zhang, Xili Gong","doi":"10.1177/03000605261476190","DOIUrl":"10.1177/03000605261476190","url":null,"abstract":"<p><p>Osteopontin (encoded by secreted phosphoprotein 1) is a multifunctional matricellular phosphoglycoprotein that has emerged as an important mediator in the aging nervous system. During aging, osteopontin interacts with microglial priming, vascular remodeling, myelin repair, and innate immune responses and is consistently implicated in major late-life neurological disorders. However, its biological effects are highly context dependent. Depending on its cellular source, proteolytic processing, receptor interactions, anatomical distribution, and disease stage, osteopontin may either exacerbate chronic neuroinflammation and tissue injury or promote phagocytic clearance, neuronal survival, remyelination, neuroplasticity, and tissue repair. This review critically synthesizes studies indexed in PubMed and Google Scholar through 3 April 2026 on the role of osteopontin in brain aging, Alzheimer's disease and related dementias, Parkinson's disease and Lewy body disorders, cerebrovascular disease, vascular cognitive impairment, cerebral small vessel disease, and amyotrophic lateral sclerosis. In Alzheimer's disease, cerebrospinal fluid and plasma osteopontin concentrations increase from the prodromal to symptomatic stages, whereas microglial or perivascular secreted phosphoprotein 1 expression correlates with amyloid pathology, synaptic remodeling, and cognitive decline. However, under specific conditions, osteopontin also enhances macrophage-mediated amyloid-beta clearance. In stroke, elevated circulating osteopontin predicts poor clinical outcomes, whereas experimental studies demonstrate that appropriately timed exogenous osteopontin, regulatory T cell-derived osteopontin, and osteopontin-mediated autophagic and reparative pathways promote white-matter repair, peri-infarct plasticity, and blood-brain barrier integrity. Evidence from Parkinson's disease, Lewy body disease, frontotemporal dementia, and amyotrophic lateral sclerosis further supports the role of osteopontin as both a candidate biomarker and a regulator of selective neuronal vulnerability. Rather than being uniformly detrimental or protective, osteopontin should be regarded as a context-dependent regulator of age-related neuroimmune remodeling. This perspective reconciles seemingly conflicting findings and supports the development of therapeutic strategies that are tailored to disease stage, protein fragment, and cell type rather than broadly targeting osteopontin.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261476190"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880619","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":"Heterogeneous associations between domain-specific physical activity and sarcopenia risk in diabetic adults: A causal forest analysis.","authors":"Dengqin Song, Tongqiang Yi, Yixin Hu, Yuqin Wang, Dong Zhou, Yike Yuan, Linli Ma, Hongci Chen, Pengfei Xia","doi":"10.1177/03000605261483168","DOIUrl":"10.1177/03000605261483168","url":null,"abstract":"&lt;p&gt;&lt;p&gt;BackgroundModerate-to-vigorous physical activity has been associated with lower sarcopenia prevalence, whereas sedentary behavior may be associated with elevated risk. However, evidence remains limited regarding whether these associations persist in diabetic populations, whether dose-response relationships are maintained, and which subgroups exhibit the most pronounced associations with sarcopenia risk.MethodsCross-sectional associations between domain-specific moderate-to-vigorous physical activity, sedentary behavior, and sarcopenia risk were examined using progressive multivariable linear and logistic regression, with continuous skeletal muscle mass index scores and binary sarcopenia status as outcomes. Restricted cubic spline analyses characterized dose-response relationships. Stratified subgroup analyses with interaction terms assessed consistency across age, sex, body mass index, and race/ethnicity. Causal forest algorithms estimated individual-level heterogeneity in association magnitude, reported as conditional average association effects rather than treatment effects.ResultsBased on 1230 participants, sarcopenia prevalence was 18.46%, with notably higher rates observed among individuals with obesity, those of Mexican American ethnicity, and those with lower educational attainment. Following full covariate adjustment, both occupational moderate-to-vigorous physical activity (β = -0.020, 95% confidence interval: -0.034 to -0.006, p = 0.007) and leisure-time moderate-to-vigorous physical activity (β = -0.018, 95% confidence interval: -0.032 to -0.003, p = 0.018) demonstrated independent inverse associations with sarcopenia risk, where β denotes multivariable linear regression coefficients for the continuous skeletal muscle mass index outcome (negative values indicating lower skeletal muscle mass index and higher sarcopenia risk). Dose-response analyses further identified activity thresholds beyond which progressively more favorable associations were apparent. Causal forest estimation indicated that total physical activity exhibited the most pronounced inverse association with sarcopenia risk (mean conditional average association effect: -0.0547). Exploratory subgroup analyses suggested potential heterogeneity in association magnitude, with point estimates directionally consistent with more pronounced inverse associations among adults aged ≥51 years, females, and individuals with obesity. These patterns are preliminary and would benefit from prospective verification before more definitive conclusions are drawn.ConclusionsIn this cross-sectional, observational analysis, physical activity was inversely associated with sarcopenia risk across diverse subpopulations of adults with diabetes. Exploratory causal forest analyses suggested potentially more pronounced inverse associations among older adults, females, and individuals with obesity, although these patterns should be regarded as hypothesis-generating because the cross-sectional desig","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261483168"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919955","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":"A compound heterozygous combination of SLC34A2 variants in pulmonary alveolar microlithiasis: A case report and literature review.","authors":"Zhizhen Zou, Ping Mei, Lixu Yan, Hongmei Wu, Yue Xing, Xiaosong Ben, Weifeng Zhan","doi":"10.1177/03000605261485371","DOIUrl":"10.1177/03000605261485371","url":null,"abstract":"<p><p>Pulmonary Alveolar Microlithiasis (PAM) is a rare hereditary lung disorder characterized by the intra-alveolar deposition of calcium phosphate microliths. It is primarily familial and follows an autosomal recessive inheritance pattern, with no significant gender disparity in incidence. In its early stages, PAM is often asymptomatic, and most cases are detected incidentally through abnormal imaging findings during routine health examinations. We report a case of a male patient in his mid-50 s with a 10-year history of exertional dyspnea and cough unresponsive to conventional therapy. Initially diagnosed and treated for emphysema in early 2024, the patient was readmitted two months later with progressive dyspnea and cyanosis. The diagnosis of PAM was confirmed by typical medical imaging and pathological examination. Genetic analysis identified a previously unreported compound heterozygous combination of SLC34A2 variants: a c.910A > T (p.Lys304*) nonsense variant in exon 8 and a heterozygous ∼5.5 kb copy-number deletion at 4p15.2 (encompassing exons 2-6), thereby expanding the catalogue of reported PAM-associated genetic combinations. No recurrence was observed during one-year follow-up after bilateral lung transplantation.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261485371"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956007","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":"Normalized risk-based evaluation of machine learning-based classification models: A multiclass approach with applications in medical devices.","authors":"Julius Wiggerthale, Martin Haimerl, Christoph Reich","doi":"10.1177/03000605261486667","DOIUrl":"https://doi.org/10.1177/03000605261486667","url":null,"abstract":"<p><p>ObjectiveMachine learning is increasingly integrated into safety-critical domains such as medical applications. In this context, regulatory frameworks require the assessment and minimization of risks associated with incorrect model predictions. However, classical evaluation methods often focus on quantifying error frequencies, which do not reflect the heterogeneous impact of different types of errors. To address this deficiency, we elaborate an approach for assessing machine learning-based multiclass classification models that conforms to regulatory requirements in the field of medical devices. Additionally, we aim to demonstrate its applicability in a concrete application scenario as an exemplary reference.MethodsHerein, we provide weighted balanced accuracy <math><mi>W</mi><mi>B</mi><msub><mi>A</mi><mi>n</mi></msub></math> as a risk-based approach for assessing machine learning models for multiclass classification. <math><mi>W</mi><mi>B</mi><msub><mi>A</mi><mi>n</mi></msub></math> is systematically based on regulatory requirements for medical devices. It incorporates core properties such as the representation of risks as a multiplicative combination of likelihood and severity and the relationship between development and real-world scenarios. We demonstrate the application of <math><mi>W</mi><mi>B</mi><msub><mi>A</mi><mi>n</mi></msub></math> using X-ray based detection of lung diseases as a reference scenario.ResultsOur analysis shows that <math><mi>W</mi><mi>B</mi><msub><mi>A</mi><mi>n</mi></msub></math> achieves a risk-based assessment in the lung disease scenario as a reference. <math><mi>W</mi><mi>B</mi><msub><mi>A</mi><mi>n</mi></msub></math> systematically operationalizes the definition of risk from corresponding regulatory requirements and allows the assessment to be adapted according to risk levels that have to be elaborated in the context of the risk-management process.ConclusionAlthough this study uses only a single use case to demonstrate the practical applicability of our approach, it shows the impact of a risk-based approach when assessing the performance of machine learning multiclass classification models in medical applications. Without such an approach, regulatory requirements cannot be implemented in a fully comprehensive way. Consequently, the clinical impact cannot be adequately assessed when applying the model in real-world scenarios.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261486667"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}