Journal of International Medical Research最新文献

{"title":"Serial platelet parameter dynamics in sepsis and the prognostic value of day 7 measurements: A retrospective study.","authors":"Jian Niu, Yinhua Gong, Juanjuan Cui, Xiaoping Huang, Yiling Zhu","doi":"10.1177/03000605261492990","DOIUrl":"https://doi.org/10.1177/03000605261492990","url":null,"abstract":"<p><p>BackgroundSepsis is a significant public health concern associated with high prevalence and mortality rates. This study aimed to evaluate the prognostic value of platelet count, plateletcrit level, mean platelet volume, and platelet distribution width in patients with sepsis.MethodsThe study cohort included 48 patients diagnosed with sepsis, who were allocated to the sepsis group, and 34 patients admitted with infections who did not meet the diagnostic criteria for sepsis, who were allocated to the infection group. Complete blood count was performed for all patients, which included evaluation of platelet count and other parameters (plateletcrit level, mean platelet volume, and platelet distribution width) as well as C-reactive protein levels within 24 h of admission and again on days 3 and 7. Patients in the sepsis group were monitored until discharge or death and categorized into two subgroups based on outcomes: survivors (39 patients) and nonsurvivors (9 patients).ResultsStatistically significant differences were identified in the platelet count, plateletcrit level, mean platelet volume, and platelet distribution width between the sepsis and infection groups (all <i>p</i> < 0.05). Platelet count and plateletcrit level exhibited negative correlations with the Sequential Organ Failure Assessment score (<i>r</i> = -0.657 and -0.638, all <i>p</i> < 0.05), whereas mean platelet volume and platelet distribution width exhibited positive correlations (<i>r</i> = 0.331 and 0.298, all <i>p</i> < 0.05). Additionally, platelet count and plateletcrit level were inversely associated with C-reactive protein levels (<i>r</i> = -0.346 and -0.327, all <i>p</i> < 0.05). Receiver operating characteristic curve analysis revealed that platelet counts had the highest diagnostic value for sepsis, with an area under the curve of 0.864, sensitivity of 94.12%, and specificity of 73.47%. In the dynamic monitoring of platelet parameters, significant differences in platelet count and plateletcrit level were observed in the prognosis group by day 7.ConclusionAdmission platelet count and related parameters serve as specific diagnostic predictors of sepsis. Dynamic monitoring of platelet count and plateletcrit level on day 7 can guide aggressive management strategies to improve outcomes in patients with sepsis.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261492990"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127722","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 different positions on sensory and motor blockade in patients undergoing anorectal surgery under spinal anesthesia.","authors":"Nazli Karami, Alireza Mahoori, Aynaz Ashour Mohammadi","doi":"10.1177/03000605261494863","DOIUrl":"https://doi.org/10.1177/03000605261494863","url":null,"abstract":"<p><p>Background and objectivesBenign anorectal diseases are prevalent in the general population. Currently, spinal anesthesia is mainly performed in the lateral and sitting positions and is rarely performed in the prone or jackknife positions. This study compared the effects of the prone, lateral, and sitting positions on sensory and motor blocks in patients undergoing anorectal surgery under spinal anesthesia.Materials and methodsIn this prospective comparative study, 75 ASA I and II class patients aged >18 years who underwent anorectal surgery were included, with 25 patients in each group. Spinal anesthesia was administered at the L3-L4 or L4-L5 intervertebral space using a No. 25 Quincke needle and 10 mg of 0.5% hyperbaric bupivacaine in the prone, lateral, or sitting position. Outcomes related to sensory and motor blocks and the anesthesia success rate were compared among the three groups.ResultsSensory block reached T10 in most patients in the prone (44%) and lateral (52%) groups, compared with L1 in the sitting group (56%; p = 0.004). Motor block depth (Bromage 3) was observed in 44% (prone), 48% (lateral), and 84% (sitting) of patients (p = 0.04). Sensory block onset was slower in the prone (2.92 ± 0.87 min) and lateral (2.72 ± 0.87 min) vs. sitting (1.94 ± 1.92 min; p = 0.001). Sensory block duration was longer in the prone (79.96 ± 14.42 min) and lateral (80.28 ± 16.55 min) vs. sitting (67.64 ± 15.99 min; p = 0.007). Motor block duration was shorter in the prone (75.64 ± 12.59 min) and lateral (74.12 ± 14.20 min) vs. sitting (87.30 ± 18.24 min; p = 0.005). Hemodynamic stability was better in the prone and lateral positions (p = 0.0001). First-attempt success was higher in the sitting group (76%) vs. prone (36%) and lateral (68%) positions (p = 0.009).ConclusionThe prone and lateral positions provide higher sensory block levels and better hemodynamic stability, whereas the sitting position is associated with faster sensory block onset, deeper motor block, and higher first-attempt success. The choice of position should be individualized according to surgical requirements and patient characteristics.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261494863"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127637","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":"Quality of life and its modifying factors in patients with thyroid eye disease in Western China: A cross-sectional study.","authors":"Xin Zhang, Wen-Juan Luo, Qiu-Hui Mei, Yuan-Su Yang, Wei-Min He, Yun-Xia Gao, Jie Ren","doi":"10.1177/03000605261494375","DOIUrl":"https://doi.org/10.1177/03000605261494375","url":null,"abstract":"<p><p>BackgroundThyroid eye disease is a common chronic autoimmune ocular disorder. Relevant quality of life studies are limited in socioeconomically and medically distinct regions of Western China. The present study aimed to address the regional gap and support targeted clinical public health strategies for long-term thyroid eye disease management.MethodsThis cross-sectional survey was conducted among 306 patients with thyroid eye disease from 12 provinces, municipalities, and autonomous regions in Western China. Data were collected using a general demographic questionnaire, Graves' Ophthalmopathy Quality of Life (GO-QOL) questionnaire, Huaxi Emotional-Distress Index, and Athens Insomnia Scale. Multivariate linear regression was performed to identify independent factors.ResultsThe mean total GO-QOL score was 41.19 ± 19.38. Multivariate analysis revealed that GO-QOL of patients with diplopia, photophobia/epiphora, restricted eye movement, and other ocular symptoms were lower by 9.024, 8.867, 9.416, and 4.159 points, respectively, than those of individuals without these symptoms (all <i>p</i> < 0.001, except for \"other symptoms\" where <i>p</i> = 0.006). For each 1-point increase in the Huaxi Emotional-Distress Index and Athens Insomnia Scale scores, the GO-QOL score decreased by 0.810 points (<i>p</i> < 0.001) and 0.543 points (<i>p</i> = 0.007), respectively. Compared with patients with a Clinical Activity Score <3, those with a Clinical Activity Score ≥3 had a mean GO-QOL score that was 5.626 points lower (<i>p</i> = 0.041). The GO-QOL of patients with junior high school education was 5.434 points higher than that of those with a bachelor's degree or higher <i>(p = </i>0.028).ConclusionThe quality of life of patients with thyroid eye disease in Western China remains relatively low. Low educational level, ocular symptoms (diplopia, photophobia/epiphora, and restricted motility), disease activity, emotional distress (anxiety/depression), and sleep disorders are independent risk factors for poorer quality of life. These findings support a shift from single-modality ophthalmic care approach to a multidimensional, multidisciplinary strategy, integrating ocular symptom control, psychological support, and sleep improvement for long-term regional care of patients with thyroid eye disease.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261494375"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136953","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":"Comparison of connective tissue graft using two acellular dermal matrix thicknesses in a modified vestibular incision subperiosteal tunnel access-based procedure for gingival recession: An exploratory randomized controlled trial.","authors":"Peisen Li, Qiang Chen, Yuehan Shen, Tianqing Ding, Qingyun Xu, Xingru Ye","doi":"10.1177/03000605261495779","DOIUrl":"10.1177/03000605261495779","url":null,"abstract":"<p><p>ObjectiveTo compare connective tissue graft with thick and thin acellular dermal matrices in a modified vestibular incision subperiosteal tunnel access-based procedure, using gingival thickness at the selected target site 18 months postoperatively as the primary endpoint.MethodsIn this single-center exploratory randomized trial, 36 adults with recession type 1 gingival recession were allocated in a 1:1:1 ratio to connective tissue graft, thick acellular dermal matrices (1.0-1.2 mm), and thin acellular dermal matrices (0.4-0.6 mm) groups. Longitudinal continuous outcomes were analyzed using linear mixed models. Pairwise comparisions at 18 months were performed using Welch tests with within-outcome Bonferroni adjustment. Postoperative visual analogue scale pain scores and Landry healing scores were analyzed nonparametrically. Missing-data scenarios and two one-sided tests were post hoc.ResultsAmong the 47 individuals assessed, 11 were excluded and 36 were randomized (12 per group); 18-month primary-endpoint data were available for 35 patients. The mean (SD) gingival thickness was 1.708 (0.334) mm in the connective tissue graft group, 1.708 (0.450) mm in the thick acellular dermal matrices group, and 1.273 (0.410) mm in the thin acellular dermal matrices group. The mean gingival thickness in the connective tissue graft group exceeded that in the thin acellular dermal matrices group by 0.436 mm (95% confidence interval: 0.108 to 0.763; adjusted <i>p</i> = 0.036); the difference in the gingival thickness between the thick acellular dermal matrices and thin acellular dermal matrices groups was not statistically significant after adjustment (adjusted <i>p</i> = 0.073). Connective tissue graft and thick acellular dermal matrices groups had comparable observed means; however, the trial was not powered for equivalence. Postoperative visual analog scale scores were lower in both acellular dermal matrices groups than in the connective tissue graft group, and thin acellular dermal matrices group had a higher day-7 healing score than the thick acellular dermal matrices group.ConclusionsThe 18-month gingival thickness was greater in the connective tissue graft group than in the thin acellular dermal matrices group after multiplicity adjustment, whereas the mean values of the connective tissue graft and thick acellular dermal matrices groups were comparable. The study did not establish equivalence, and the root-coverage estimates were too imprecise to demonstrate comparability. Acellular dermal matrices avoided palatal donor-site harvesting and were associated with lower postoperative visual analog scale pain scores.Trial registrationChinese Clinical Trial Registry (WHO Primary Registry), ChiCTR2600124861.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261495779"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127699","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":"Cardiac diagnostic modalities in polycythemia vera: A narrative review.","authors":"Engy Elsayed, Ahmed Elsabagh, Ibrahim Elmakaty, Abdelrahman Ahmed Elsayed, Basant M Elsayed, Mohamed Elmarasia, Awni Alshurafa, Mohamed A Yassin","doi":"10.1177/03000605261495786","DOIUrl":"https://doi.org/10.1177/03000605261495786","url":null,"abstract":"<p><p>Polycythemia vera is a chronic myeloproliferative neoplasm in which erythrocytosis, Janus kinase-signal transducer and activator of transcription activation, inflammation, endothelial dysfunction, and abnormal blood-cell activation converge to increase cardiovascular risk. This narrative review examines how electrocardiography, echocardiography, coronary angiography, cardiac magnetic resonance imaging, and right-heart catheterization contribute to recognition and characterization of cardiac involvement in polycythemia vera. Reported abnormalities include QT and P-wave changes, atrial arrhythmias, acute coronary syndromes, subclinical biventricular dysfunction, pulmonary hypertension, intracardiac thrombosis, and hypertrophic remodeling. Large observational datasets in myeloproliferative neoplasms also exhibit clinically important burdens of myocardial infarction, heart-failure hospitalization, bleeding, and echocardiographic pulmonary hypertension, although polycythemia vera-specific estimates remain limited. Baseline cardiovascular testing is increasingly relevant before novel therapies and trial enrollment; however, an abnormal test should prompt confirmation, reversible-cause assessment, and protocol-specific review rather than be treated as a universal contraindication. Hematocrit control and low-dose aspirin reduce thrombotic events, while evidence that cytoreductive therapy reverses electrocardiography or imaging abnormalities remains sparse. A symptom- and risk-directed diagnostic approach, integrated with hematology and cardiology assessment, is therefore more defensible than routine universal cardiac screening.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261495786"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220480","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 admission serum phosphate levels and outcomes after endovascular treatment in acute basilar artery occlusion: A subgroup analysis of the BASILAR registry.","authors":"Diwen Zhang, Xin Zou, Miao Chai, Sheng Zhou, Shan Wang, Wei Ma, Zhenqian Liu, Fei Gao, Bo Zheng, Lingyu Zhang, Haoxuan Zhu, Lilan Wang, Guojian Liu, Linyu Li, Chawen Ding, Jiaxing Song, Mingrui Zhou, Juan Peng, Shuangzhi Wang","doi":"10.1177/03000605261495197","DOIUrl":"https://doi.org/10.1177/03000605261495197","url":null,"abstract":"<p><p>ObjectiveThis study aimed to investigate the association between admission serum phosphate levels and clinical outcomes in patients with acute basilar artery occlusion undergoing endovascular treatment.MethodsThis study was a subgroup analysis of the BASILAR registry. In total, 342 patients with acute basilar artery occlusion undergoing endovascular treatment whose admission serum phosphate levels were available were included. Participants were stratified into three groups according to tertiles of admission serum phosphate levels: (a) Tertile 1 (≤0.89 mmol/L); (b) Tertile 2 (0.90-1.09 mmol/L); and (c) Tertile 3 (>1.09 mmol/L). The primary outcome was a modified Rankin Scale score of 0-2 at 90 days. Safety outcomes included 90-day mortality and symptomatic intracranial hemorrhage within 48 h.ResultsIn total, 342 eligible patients were included and stratified into three groups based on serum phosphate level tertiles. Compared with Tertile 1, patients in Tertile 3 (adjusted odds ratio: 3.04, 95% confidence interval: 1.39-6.66, <i>p</i> = 0.006) and Tertile 2 (adjusted odds ratio: 2.61, 95% confidence interval: 1.21-5.66, <i>p</i> = 0.015) had significantly higher odds of achieving modified Rankin scale scores of 0-2 at 90 days. No significant differences were observed in mortality or symptomatic intracranial hemorrhage between the three groups. Restricted cubic spline analysis revealed a significant nonlinear, inverted U-shaped association between serum phosphate levels and modified Rankin scale scores of 0-2 (<i>p</i> for nonlinearity = 0.016).ConclusionsAdmission serum phosphate levels within the high-normal range were associated with favorable 90-day clinical outcomes in patients with acute basilar artery occlusion undergoing endovascular treatment, suggesting that serum phosphate level is as a prognostic biomarker in this population.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261495197"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127734","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":"Distinguishing Meniere's disease from vestibular migraine: A comprehensive review of symptoms and diagnostic insights.","authors":"Han Li, Xinjun Yu, Wenchao Li","doi":"10.1177/03000605261491433","DOIUrl":"https://doi.org/10.1177/03000605261491433","url":null,"abstract":"<p><p>Meniere's disease and vestibular migraine are common episodic vestibular syndromes whose overlapping vertigo, auditory, and migraine-associated features can complicate differential diagnosis. In this narrative review, we compared the diagnostic criteria, symptom patterns, pathophysiology, and complementary test findings of these syndromes. Vestibular migraine is diagnosed clinically based on recurrent vestibular symptoms, migraine history, temporal association with migraine features, and exclusion of alternative causes; audiological and vestibular evaluations are not required. In contrast, diagnosis of definite Meniere's disease is made if the patient exhibits episodic vertigo with audiometrically documented low- to medium-frequency sensorineural hearing loss and fluctuating aural symptoms. Therefore, serial audiometry plays a direct role in the diagnosis of Meniere's disease, whereas caloric testing, video head impulse testing, vestibular-evoked myogenic potentials, and hydrops imaging provide supportive rather than standalone discriminatory evidence. Emerging studies have identified distinct cytokine and immune signatures between Meniere's disease and vestibular migraine. In one research cohort, an interleukin-1 beta, CC motif chemokine ligand 3, CC motif chemokine ligand 22, and CXC motif chemokine ligand 1 cytokine panel has demonstrated high discriminatory performance (area under the curve = 0.995), whereas multiomic studies have identified divergent immune-cell pathways. However, external validation and standardized clinical thresholds are required before these approaches can be adopted for routine diagnosis. In practice, differentiation should be anchored in longitudinal history and consensus criteria, supplemented by serial hearing assessment and targeted vestibular or imaging studies when clinically indicated.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261491433"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110900","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 and internal validation of a day-28 clinical risk stratification model for retinopathy of prematurity in preterm infants: A retrospective cohort study.","authors":"Zheng Guo, Yixuan Wu, Jian Chen, Daoman Xiang","doi":"10.1177/03000605261492551","DOIUrl":"https://doi.org/10.1177/03000605261492551","url":null,"abstract":"<p><p>ObjectiveThis study aimed to develop and internally validate a day-28 clinical risk stratification model for retinopathy of prematurity in preterm infants.MethodsThis single-center retrospective cohort study included preterm infants who underwent retinopathy of prematurity screening between January 2019 and January 2026. Postnatal day 28 was defined as a fixed analytic prediction landmark rather than the scheduled date of the first ophthalmic examination. Candidate predictors were restricted to routine perinatal and early neonatal variables available from birth through day 28. The primary outcome was any-stage retinopathy of prematurity diagnosed during subsequent screening. Severe retinopathy of prematurity and treatment-requiring retinopathy of prematurity were exploratory secondary outcomes. Multivariable logistic regression was used to develop the model. Discrimination, calibration, internal validation using 1000-bootstrap resamples, risk stratification, and decision curve analysis were performed.ResultsIn total, 760 preterm infants were included. Any-stage retinopathy of prematurity occurred in 209 infants (27.5%), severe retinopathy of prematurity in 64, and treatment-requiring retinopathy of prematurity in 28. The apparent area under the curve was 0.868 (bootstrap percentile 95% confidence interval: 0.839-0.895), and the optimism-corrected area under the curve was 0.862. Apparent calibration in the development cohort was summarized by an intercept of 0.000, slope of 1.000, observed-to-expected ratio of 1.000, Brier score of 0.122, and Hosmer-Lemeshow <i>χ</i>² of 5.32 (<i>p</i> = 0.723). Observed retinopathy of prematurity rates were 5.6%, 24.8%, and 62.8% in the low-, intermediate-, and high-risk groups, respectively. No infant in the low-risk group developed treatment-requiring retinopathy of prematurity (0/373; negative predictive value: 100.0%, 95% confidence interval: 99.0-100.0).ConclusionThe day-28 clinical risk stratification model demonstrated promising apparent and internally validated discrimination and acceptable apparent calibration for identifying preterm infants at risk of retinopathy of prematurity. It may support follow-up planning; however, it must not replace guideline-based retinopathy of prematurity screening. External validation is required before routine clinical use.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261492551"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194877","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":"Impact of early fluid intake and urine output on mortality in acute pancreatitis: A retrospective cohort study.","authors":"Lilei Liu, Xiaotong Han, Xiang Li, Fang Yu, Xingwen Zhang, Jing Xu, Xiangying Wang, Yanjun Lei, Yan Xiao, Zhanhong Tang","doi":"10.1177/03000605261494353","DOIUrl":"https://doi.org/10.1177/03000605261494353","url":null,"abstract":"<p><p>ObjectiveTo evaluate the associations between early fluid-related parameters, including fluid intake, fluid balance, and urine output, within the first 24 h after intensive care unit admission and mortality among critically ill patients with acute pancreatitis.MethodsWe conducted a retrospective cohort study using the publicly available Medical Information Mart for Intensive Care III database. Adult patients with acute pancreatitis admitted to the intensive care unit between 2001 and 2012 were included. Fluid intake, fluid balance, and urine output during the first 24 h after intensive care unit admission were extracted and categorized into four predefined levels. Multivariable logistic regression models were used to assess the associations between early fluid-related parameters and in-hospital mortality, adjusting for baseline demographic characteristics and indicators of disease severity. Generalized propensity score analyses were additionally performed to evaluate the distribution of fluid-related exposures and the potential influence of measured severity-related confounding. Sensitivity analyses using E-values were conducted to assess the potential impact of unmeasured confounding.ResultsAmong critically ill patients with acute pancreatitis, higher early fluid intake levels were associated with increased in-hospital and 28-day mortality after adjustment for baseline characteristics and disease severity. Conversely, higher urine output levels were associated with lower in-hospital and 28-day mortality. Early fluid balance showed weaker and less consistent associations with mortality. Generalized propensity score analyses demonstrated nonrandom distributions of fluid intake, fluid balance, and urine output according to baseline severity-related characteristics, indicating the presence of confounding by indication in early fluid management. After adjustment for measured confounding factors, the observed associations between fluid intake, urine output, and mortality remained consistent. However, residual confounding could not be completely excluded.ConclusionIn critically ill patients with acute pancreatitis, early fluid intake and urine output were associated with mortality outcomes. These parameters may represent potential markers of disease severity, physiological reserve, and response to initial resuscitation rather than direct determinants of outcome. Further prospective studies are required to clarify their clinical significance.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261494353"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167153","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":"Application of bedside ultrasound guidance in difficult diagnostic lumbar puncture in infectious diseases: Technical specifications, clinical evidence, and practical prospects.","authors":"Huifang Zhou, Linyue Yang, Taotao Sun, Huiru Chen, Junping Wang","doi":"10.1177/03000605261496628","DOIUrl":"https://doi.org/10.1177/03000605261496628","url":null,"abstract":"<p><p>Diagnostic lumbar puncture is a core procedure in the diagnosis and management of infectious diseases. However, in patients with complex anatomical conditions, such as obesity and spinal deformities, the traditional blind puncture method is often challenging to perform, resulting in a substantially higher failure rates and increased complication risks. Bedside ultrasound guidance provides a precise, visual solution to these challenges and represents an emerging tool for improving clinical practice. This narrative review aimed to comprehensively examine the clinical value of ultrasound-guided lumbar puncture in infectious diseases, focusing on the current evidence base, core ultrasound technical principles, standardized pre-puncture assessment procedures, and clinical implementation strategies. Furthermore, it sought to empower infectious disease physicians to utilize safe, efficient, and scalable auxiliary techniques while outlining future directions. Compared with traditional landmark-based methods, ultrasound guidance significantly improves the first-attempt puncture success rate by approximately 20%-30%. Its key technical advantages include real-time visualization of the needle tip, identification of the optimal insertion point, and reduction of procedural complications.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 10","pages":"3000605261496628"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172289","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}