Journal of International Medical Research最新文献

{"title":"Effect of nefopam on postoperative catheter-related bladder discomfort after transurethral resection of the bladder under general anesthesia: A randomized controlled trial.","authors":"Ji Yong Yeom, Yeong Uk Kim, Jinkyung Kim, Juhee Min, Heewon Ma, Eunkyung Choi","doi":"10.1177/03000605261495728","DOIUrl":"10.1177/03000605261495728","url":null,"abstract":"<p><p>ObjectiveCatheter-related bladder discomfort is a common complication following transurethral resection of bladder tumor and may impair postoperative recovery. This study evaluated the effect of intraoperative nefopam on catheter-related bladder discomfort and postoperative recovery quality.MethodsIn this prospective, randomized, double-blind trial, patients undergoing transurethral resection of bladder tumor under general anesthesia were allocated to either Group N (nefopam, 20 mg) or Group S (normal saline). Catheter-related bladder discomfort was assessed using a 4-point scale at multiple postoperative time points. Catheter-related bladder discomfort was defined based on a score ≥1, and moderate-to-severe catheter-related bladder discomfort was defined based on a score ≥2. Postoperative recovery quality was evaluated using the Quality of Recovery 15 questionnaire.ResultsIn total, 72 patients were analyzed. The cumulative incidence of catheter-related bladder discomfort (score ≥1) was 80.6% in Group N and 94.4% in Group S (risk difference, -13.9%; 95% confidence interval, -30.0% to 2.0%; <i>p</i> = 0.076). Longitudinal analysis of catheter-related bladder discomfort severity revealed significant time and group × time interaction effects (both <i>p</i> < 0.001), with lower odds of greater catheter-related bladder discomfort severity in Group N during the early postoperative period. Moderate-to-severe catheter-related bladder discomfort (score ≥2) occurred in 16.7% of the patients in Group N and 58.3% of those in Group S (risk difference, -41.7%; 95% confidence interval, -58.6% to -19.5%; odds ratio, 0.14; 95% confidence interval, 0.05-0.43; <i>p</i> < 0.001). The Quality of Recovery 15 score at 24 h was higher in Group N than in Group S (133.5 ± 11.25 vs. 124.3 ± 14.1; mean difference, 9.2 points; 95% confidence interval, 3.2-15.2; <i>p</i> = 0.003).ConclusionsIntraoperative nefopam did not significantly reduce the cumulative incidence of catheter-related bladder discomfort; however, it was associated with lower early postoperative catheter-related bladder discomfort severity and a lower incidence of moderate-to-severe catheter-related bladder discomfort. Quality of Recovery 15 scores at 24 h were also higher in the nefopam group.<b>Registration:</b> This study was registered with the Clinical Research Information Service (https://cris.nih.go.kr/, KCT0011457).</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261495728"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137014","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":"Associations between advanced lung cancer inflammation index score and kidney outcomes in intensive care unit patients with diabetes: A retrospective cohort study.","authors":"Xiaoyu Wang, Tingting Su, Yang Lu, Lu-Huai Feng","doi":"10.1177/03000605261494871","DOIUrl":"https://doi.org/10.1177/03000605261494871","url":null,"abstract":"<p><p>ObjectiveAcute kidney injury is commonly observed in critically ill patients with diabetes and is associated with adverse outcomes. The advanced lung cancer inflammation index score, which reflects nutritional and inflammatory status, has not been well studied in relation to acute kidney injury and subsequent kidney events in this population.MethodsWe conducted a retrospective cohort study using the Medical Information Mart for Intensive Care IV database. Adult intensive care unit patients with diabetes were included. Associations of log-transformed advanced lung cancer inflammation index scores with acute kidney injury and major adverse kidney events within 30 days were assessed using logistic regression and Cox models, respectively. Restricted cubic spline analyses, eXtreme gradient boosting with SHapley Additive exPlanations interpretation, subgroup analyses, and sensitivity analyses were performed to evaluate model-based contribution, effect modification, and robustness.ResultsIn total, 2337 critically ill patients with diabetes were included in the acute kidney injury occurrence analysis, of whom 1624 developed acute kidney injury. Each 1-SD increase in log-transformed advanced lung cancer inflammation scores was associated with lower odds of acute kidney injury (odds ratio, 0.90; 95% confidence interval, 0.81-0.99). Among the 1624 patients with acute kidney injury, 750 developed major adverse kidney events within 30 days. Higher log-transformed advanced lung cancer inflammation index scores were associated with a lower hazard of major adverse kidney events within 30 days (hazard ratio, 0.89; 95% confidence interval, 0.82-0.96). Dose-response analyses revealed a consistent inverse association between the advanced lung cancer inflammation index score and adverse kidney outcomes, particularly major adverse kidney events within 30 days. Machine-learning interpretation supported the contribution of the advanced lung cancer inflammation index score to model output for kidney outcomes, and sensitivity analyses yielded similar results.ConclusionsAmong intensive care unit patients with diabetes, higher advanced lung cancer inflammation index scores were associated with lower odds of acute kidney injury and a lower hazard of major adverse kidney events within 30 days after acute kidney injury. The advanced lung cancer inflammation index score may serve as a simple marker for inflammation and nutritional status associated with short-term kidney outcomes; however, its clinical utility requires validation in independent cohorts.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261494871"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136968","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":"Sjögren's disease and depression.","authors":"José R Galindo-Donaire, Adriana E Vázquez-Hernández, Gabriela Hernández-Molina","doi":"10.1177/03000605261494354","DOIUrl":"https://doi.org/10.1177/03000605261494354","url":null,"abstract":"<p><p>Depression is a major and under-recognized comorbidity in Sjögren's disease, contributing to disease burden and impaired quality of life. This narrative review summarizes current evidence regarding the prevalence, pathophysiological mechanisms, clinical impact, assessment, and treatment of depression in patients with Sjögren's disease. Reported prevalence rates range widely from 3.2% to 78.6%, largely owing to methodological heterogeneity, although meta-analytic data demonstrate a significantly increased risk of depression in patients with Sjögren's disease than in healthy controls. Etiology is multifactorial, involving chronic pain, fatigue, dryness, psychosocial stressors, and immune-mediated mechanisms. Elevated inflammatory cytokines, altered serotonergic pathways, antibodies, gut dysbiosis, and neuroimaging abnormalities are the potential underlying links to depression. Furthermore, depression is associated with greater symptom burden, autonomic dysfunction, sleep disturbances, fatigue, reduced health-related quality of life, and impaired functional status. Patient-reported outcomes often correlate more closely with depression than with systemic disease activity. Although several screening instruments are available, their validation in patients with Sjögren's disease remains limited. Management requires a multidisciplinary approach integrating psychological interventions, lifestyle modification, and pharmacologic treatment. Selective serotonin reuptake inhibitors and other agents with low anticholinergic burden are preferred. Optimization of systemic disease control may provide additional benefits. Early recognition and comprehensive management of depression are essential to improve outcomes in patients with Sjögren's disease.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261494354"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127700","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":"The relationship between work self-efficacy and work participation in employees with chronic pain: Analysis of cross-sectional data from the Pain-at-Work trial.","authors":"Wendy J Chaplin, Victoria Abbott-Fleming, Daniel F McWilliams, Gordon Taylor, Paul McNamee, David A Walsh, Karen Walker-Bone, Holly Blake","doi":"10.1177/03000605261494344","DOIUrl":"https://doi.org/10.1177/03000605261494344","url":null,"abstract":"<p><p>ObjectiveWork participation among employees with chronic pain is influenced by psychological, clinical, and workplace factors. Self-efficacy is a potentially modifiable attribute; however, its role in presenteeism remains underexplored. This study examined the association between work-related self-efficacy and work participation, with a primary focus on presenteeism, among employees living with chronic pain.MethodsWe analyzed cross-sectional baseline data of 280 employed adults with chronic pain participating in the Pain-at-Work trial in England. Two work-specific self-efficacy items assessed confidence in managing pain at work and confidence that working would not worsen their condition. Work participation was measured using presenteeism scores of the Work Productivity and Activity Impairment Questionnaire, which was the primary outcome analyzed in multivariable linear regression models. Models were adjusted for pain severity, mood (assessed using the Patient Health Questionnaire 2 and Generalized Anxiety Disorder 7 scale), workplace social support, age, and sex.ResultsLower work self-efficacy was significantly associated with higher presenteeism. Confidence in managing pain at work showed the strongest association (β = -2.70, 95% confidence interval: -3.98 to -1.43; <i>p </i>< 0.001), while confidence that working would not exacerbate pain was also independently associated with lower presenteeism (β = -1.41, 95% confidence interval: -2.43 to -0.39; <i>p</i> = 0.007). Pain severity remained a strong independent predictor of presenteeism. Mood, workplace social support, and sex were not significant predictors.ConclusionHigher work self-efficacy is associated with lower presenteeism among employees with chronic pain, independent of pain severity and psychological distress. Confidence in managing symptoms at work appeared to be a strong influential factor. These findings are clinically relevant for the management of working-age patients with chronic pain, highlighting the importance of addressing both pain control and work-related confidence along with organizational strategies that enable employees to implement self-management skills.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261494344"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136964","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":"Association between platelet-to-high-density lipoprotein cholesterol ratio and incident stroke among adults with hypertension: A longitudinal CHARLS cohort study.","authors":"Siyi Jiang, Ying Cui, Shengwei Jia, Li Li, Zhihao Xu, Yang Yang, Min Li","doi":"10.1177/03000605261496762","DOIUrl":"https://doi.org/10.1177/03000605261496762","url":null,"abstract":"<p><p>ObjectivePrevious studies that have used data from the China Health and Retirement Longitudinal Study have linked the platelet-to-high-density lipoprotein cholesterol ratio to stroke in broader middle-aged and older populations. We evaluated whether this association persisted among adults with hypertension who were stroke-free at baseline and assessed platelet count and high-density lipoprotein cholesterol levels separately.MethodsThis retrospective secondary analysis used longitudinal data from the China Health and Retirement Longitudinal Study, with 2011 as the baseline year and 2013, 2015, 2018, and 2020 as the follow-up years. The primary cohort included 3963 adults aged ≥45 years who met the criterion for hypertension at baseline and were explicitly stroke-free at baseline and for whom complete and valid data were available for the platelet-to-high-density lipoprotein cholesterol ratio, follow-up, and primary-model covariates. Incident stroke was based on questionnaire-reported physician diagnosis without independent confirmation using medical records, neuroimaging, or stroke subtype adjudication. Cox models evaluated the platelet-to-high-density lipoprotein cholesterol ratio continuously and stratified by quartiles. Component, selection-bias, community-cluster robust, spline, and additional-adjustment analyses were performed.ResultsDuring 34,637.3 person-years of follow-up, 551 participants reported incident stroke. Each 1-SD increase in the platelet-to-high-density lipoprotein cholesterol ratio was associated with a higher stroke hazard in Model 3 (hazard ratio, 1.15; 95% confidence interval, 1.07-1.24; <i>p</i> < 0.001). A comparison of quartile 4 versus quartile 1 data yielded a hazard ratio of 1.33 (95% confidence interval, 1.05-1.69; <i>p</i> = 0.018<i>; p</i> for trend = 0.007). Platelet count was positively associated with stroke (hazard ratio per 1-SD increase, 1.16; 95% confidence interval, 1.07-1.25), while the inverse high-density lipoprotein cholesterol association attenuated after mutual adjustment. Community-cluster robust inference was similar. Restricted cubic spline analysis revealed an overall association between the platelet-to-high-density lipoprotein cholesterol ratio and hazard of first incident stroke (<i>p</i> = 0.006), with no evidence of departure from linearity (<i>p</i> for nonlinearity = 0.812).ConclusionsA higher baseline platelet-to-high-density lipoprotein cholesterol ratio was associated with a higher hazard of first incident stroke among adults who met the criterion for hypertension at baseline and were stroke-free at baseline. The observational design and nonadjudicated outcome preclude causal or clinical-prediction claims; independent validation is required.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261496762"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137039","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":"Assessing the accuracy of ChatGPT-5.6 in American College of Radiology Thyroid Imaging Reporting and Data System feature scoring and classification from synthetic free-text thyroid ultrasound reports.","authors":"Ziman Chen, Yingli Wang","doi":"10.1177/03000605261494875","DOIUrl":"https://doi.org/10.1177/03000605261494875","url":null,"abstract":"<p><p>ObjectivesThe American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) provides a standardized framework for thyroid nodule risk stratification based on predefined ultrasound features. This study aimed to evaluate the accuracy and robustness of ChatGPT-5.6 Sol in extracting and scoring ACR TI-RADS features and classifying thyroid nodules from synthetic free-text ultrasound reports.MethodsA primary dataset of 100 synthetic thyroid ultrasound reports was constructed, with each report describing 1 nodule and the 5 ACR TI-RADS feature categories. ChatGPT-5.6 Sol was evaluated using a structured prompting strategy for feature identification, feature scoring, total score calculation, and final Thyroid Imaging Reporting and Data System classification. A less-directive prompt was also tested for total score calculation and final classification. Robustness was further assessed using a 30-case synthetic challenge set balanced across TR1 to TR5. Outputs were compared with reference annotations based on the 2017 ACR TI-RADS criteria. Accuracy was reported with Wilson 95% confidence intervals, and final-category agreement was assessed using Cohen's kappa.ResultsIn the primary dataset, accuracy for both feature identification and scoring was 100.0% for each ACR TI-RADS feature category (100/100; 95% confidence interval: 96.3%-100.0%). Total score calculation and final classification were also correct in all cases (100/100; 95% confidence interval: 96.3%-100.0%), with a Cohen's κ of 1.000. In the challenge set, feature identification, feature scoring, total score calculation, and final classification were correct in all 30 cases (30/30; 95% confidence interval: 88.6%-100.0%), with a Cohen's κ of 1.000. The less-directive prompt produced identical total score and classification accuracy in both datasets, with no discordant cases.ConclusionsChatGPT-5.6 Sol demonstrated high accuracy and consistent ACR TI-RADS-based classification across both synthetic datasets. Large language models may have potential for standardized Thyroid Imaging Reporting and Data System interpretation of free-text ultrasound reports; however, further validation in larger and more diverse settings is needed to establish generalizability.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261494875"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136927","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":"Effects of adenosine on oxidative stress and inflammation in patients with coronary heart disease underlying percutaneous coronary intervention.","authors":"Xing Li, Caixia Wang, Xin Nie, Sihao Zhou, Sheng Gong","doi":"10.1177/03000605261416674","DOIUrl":"10.1177/03000605261416674","url":null,"abstract":"<p><p>ObjectiveTo determine whether rapid intracoronary adenosine administration attenuates percutaneous coronary intervention (PCI)-induced systemic inflammation and oxidative stress in patients with coronary artery disease.MethodsThis prospective, randomized controlled trial enrolled patients undergoing coronary angiography (coronary angiography group) or PCI. Patients undergoing PCI were assigned to receive intracoronary adenosine (PCI + adenosine group) or placebo (PCI group). Blood levels of inflammatory markers (e.g. cytokines), anti-inflammatory mediators, and oxidative stress indicators (superoxide dismutase and malondialdehyde) were measured before and 24 h after the procedure.ResultsCompared to the coronary angiography group, patients undergoing PCI who received placebo exhibited concurrent elevations in inflammatory and anti-inflammatory markers at 24 h. Intracoronary adenosine significantly suppressed the rise in the levels of inflammatory markers (e.g. interleukin-6 reduced by 35% vs. placebo) and enhanced anti-inflammatory responses (e.g. interleukin-10 increased by 40% vs. placebo). Following PCI, oxidative stress was evident in placebo-treated patients, as reflected by decreased superoxide dismutase activity (15% reduction) and increased malondialdehyde levels (30% elevation). Adenosine restored superoxide dismutase activity to near-baseline levels and reduced malondialdehyde elevation by 85% compared to placebo.ConclusionsIntracoronary adenosine mitigates PCI-associated systemic inflammation and oxidative stress by rebalancing inflammatory pathways and preserving redox homeostasis. These findings highlight its potential as a therapeutic adjunct for improving clinical outcomes following PCI and warrant further validation in large-scale trials.<b>Clinical Trial Registration</b>: Chinese Clinical Trial Registry (ChiCTR); identifier: ChiCTR1800019349.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261416674"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167138","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":"Early plasma cell-free DNA and monocyte human leukocyte antigen-DR expression for predicting 28-day mortality in sepsis: A single-center prospective cohort study with internal validation.","authors":"Xiaolong Peng, Zhen Zhang, Liang Li, Ruiting Chen, Lei Zhang","doi":"10.1177/03000605261489320","DOIUrl":"https://doi.org/10.1177/03000605261489320","url":null,"abstract":"<p><p>ObjectiveSepsis remains associated with substantial short-term mortality, and conventional severity indicators may not fully capture biological heterogeneity related to tissue injury, inflammation, and immune suppression. This study evaluated whether early plasma cell-free DNA and monocyte human leukocyte antigen-DR (mHLA-DR) expression could improve the prediction of 28-day mortality in adult intensive care unit patients with sepsis.MethodsThis single-center prospective observational cohort study enrolled consecutive adult intensive care unit patients meeting Sepsis-3 criteria. Plasma cell-free DNA and mHLA-DR were measured within 24 h of intensive care unit admission. The primary outcome was 28-day all-cause mortality. Multivariable logistic regression was used to assess associations adjusted for age, Sequential Organ Failure Assessment score, blood lactate levels, and septic shock. Clinical baseline, single biomarker, and combined biomarker models were compared using the area under the receiver operating characteristic curve, DeLong test, net reclassification improvement, integrated discrimination improvement, Brier score, calibration, bootstrap internal validation, and decision curve analysis.ResultsThe final combined analysis set included 307 patients, of whom 89 died within 28 days (28.99%). Nonsurvivors had higher cell-free DNA and lower mHLA-DR than survivors. After adjustment, each 1-SD increase in ln( cell-free DNA) was associated with higher mortality risk, whereas each 1-SD increase in ln(mHLA-DR) was associated with lower mortality risk. Adding both biomarkers to the clinical baseline model increased the area under the receiver operating characteristic curve from 0.79 to 0.88, improved reclassification, reduced prediction error, and provided higher estimated net benefit across part of the evaluated threshold-probability range.ConclusionsEarly cell-free DNA and mHLA-DR provided complementary prognostic information for 28-day mortality in patients with sepsis. The combined model demonstrated improved internally validated prediction performance. However, external validation is required before clinical implementation.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261489320"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110926","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":"Early platelet change and 28-day mortality after the day-7 landmark among intensive care unit patients with diagnosis-coded heart failure: A MIMIC-IV cohort study.","authors":"Shenglan Liu, Shiyun Fu, Shengjie Zhang, Chengyu Zhang","doi":"10.1177/03000605261494418","DOIUrl":"https://doi.org/10.1177/03000605261494418","url":null,"abstract":"<p><p>ObjectiveTo assess the association between platelet percent-decrease patterns during the first 168 h after intensive care unit admission and 28-day mortality after a day-7 landmark among intensive care unit patients with a diagnosis of heart failure.MethodsThis retrospective cohort study used Medical Information Mart for Intensive Care IV (MIMIC-IV) version 3.1 records from one US center (2008-2022). The day-7 risk set comprised patients who were not recorded as having died before the landmark. Platelet percent decrease from the first to the last available daily mean during the first 168 h was categorized as stable/increase, percent decrease ≤0%; mild decline, percent decrease >0% and ≤30%; or marked decline, percent decrease >30%. Logistic regression was used to estimate odds ratios for 28-day mortality after the landmark. Supportive analyses examined measurement processes, alternative platelet definitions, narrower heart-failure coding, and an independent 72-h landmark.ResultsAmong 14,762 platelet-classifiable patients in the day-7 risk set, 1736 died within 28 days after the landmark. Observed mortality was 8.66%, 13.14%, and 30.06% in the stable/increase, mild-decline, and marked-decline groups, respectively. Among 14,710 Model 3 complete cases (1729 deaths), adjusted odds ratios were 1.54 (95% confidence interval: 1.37-1.74) for mild decline and 3.51 (95% confidence interval: 2.99-4.12) for marked decline. Adjusted mortality probabilities were 9.08%, 13.07%, and 24.27%, respectively. For marked decline, the odds ratio was 2.69 after adjustment for measurement processes and 2.37 among patients who remained in the intensive care unit on day 7. In the independent 72-h analysis, odds ratios were 1.02 (95% confidence interval: 0.92-1.14) and 1.23 (95% confidence interval: 1.05-1.44).ConclusionsGreater platelet decline was associated with higher mortality after the day-7 landmark. The weaker associations at the 72-h landmark and attenuation after accounting for measurement processes indicate that the magnitude of this association depends on the observation window and may partly reflect prolonged critical illness and monitoring intensity.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261494418"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127653","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":"Association of the Planetary Health Diet Index with self-reported infertility among U.S. women: An exploratory analysis of adiposity indices.","authors":"Rongze Sun, Jian Liu, Xiaoyu Liu, Boning Liu, Xinyu Zhang, Enzhi Fan","doi":"10.1177/03000605261493759","DOIUrl":"https://doi.org/10.1177/03000605261493759","url":null,"abstract":"<p><p>ObjectiveTo examine the association between adherence to the Planetary Health Diet Index and self-reported infertility among U.S. women of reproductive age and, secondarily, to explore adiposity-related indirect associations involving the body mass index, waist-to-height ratio, weight-adjusted waist index, and body roundness index.MethodsThis cross-sectional study included 2256 women aged 18-44 years from the 2013-2018 National Health and Nutrition Examination Survey. Planetary Health Diet Index scores were derived from two 24-h dietary recalls, and infertility was identified based on self-reported Reproductive Health Questionnaire responses. Associations were estimated using multivariable logistic regression that incorporated survey weights, strata, and primary sampling units. Restricted cubic spline analyses were performed to assess functional form. Exploratory survey-replicate statistical decompositions were used to evaluate adiposity-related indirect probability contrasts.ResultsAmong the 2256 female study participants, 310 reported infertility. In the fully adjusted model, a 10-point higher Planetary Health Diet Index score was associated with an odds ratio of 0.895 for self-reported infertility (95% confidence interval, 0.768-1.043; <i>p</i> = 0.149). Compared with women in the lowest weighted Planetary Health Diet Index quartile, those in the highest quartile had lower odds of self-reported infertility (odds ratio, 0.536; 95% confidence interval, 0.309-0.931; <i>p</i> = 0.028). Restricted cubic spline analyses did not provide clear evidence of a nonlinear association. Exploratory statistical decompositions yielded negative indirect estimates through all four adiposity indices; however, every corresponding 95% confidence interval included the null.ConclusionsHigher Planetary Health Diet Index scores demonstrated an inverse association with self-reported infertility, with the clearest evidence observed for the highest-versus-lowest weighted quartile; however, the continuous association was imprecisely estimated, and no clear exposure-response pattern was identified. Adiposity-related indirect estimates were exploratory and imprecise. Given the cross-sectional design, causal and temporal interpretations cannot be derived. Prospective studies are needed to clarify the temporality and potential explanatory processes.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261493759"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127662","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}