Journal of International Medical Research最新文献

{"title":"Exosomal micro ribonucleic acid-154-5p derived from vascular smooth muscle cell mediates intracranial aneurysm phenotype in vitro via myosin light chain kinase targeting.","authors":"Jinhai Song, Wenkang Luan, Liang Chu, Pengjie Pan, Yao Qian, Yunpeng Lu","doi":"10.1177/03000605261483185","DOIUrl":"10.1177/03000605261483185","url":null,"abstract":"<p><p>ObjectiveThe molecular pathogenesis of intracranial aneurysms remains undefined despite its central role in aneurysmal subarachnoid hemorrhage, a major cause of stroke and shock. Although exosomal micro ribonucleic acids have emerged as key regulators in intracranial aneurysm progression, the specific contributions of micro ribonucleic acid-154-5p remain underexplored.MethodsUsing quantitative reverse transcription polymerase chain reaction, we assessed the micro ribonucleic acid-154-5p expression in intracranial aneurysm specimens. Transmission electron microscopy was used to validate the extracted exosome. Exosomal transfer was confirmed using Cy3-labeled micro ribonucleic acid tracing and quantitative reverse transcription polymerase chain reaction. Functional impacts on vascular smooth muscle cells were evaluated using Cell Counting Kit-8, apoptosis, and 5-ethynyl-2'-deoxyuridine assays. Target genes were identified via ribonucleic acid pull-down and luciferase reporter assays.ResultsHerein, micro ribonucleic acid-154-5p levels were upregulated in intracranial aneurysms. Furthermore, micro ribonucleic acid-154-5p promotes the intracranial aneurysm phenotype in vascular smooth muscle cells. H₂O₂-exposed vascular smooth muscle cells secrete exosomal micro ribonucleic acid-154-5p, which can be transferred to other vascular smooth muscle cells. Exosomal micro ribonucleic acid-154-5p promotes the development of intracranial aneurysms phenotype in vascular smooth muscle cells by targeting myosin light chain kinase.ConclusionsExosomal micro ribonucleic acid-154-5p is a novel potentially associated and promising therapeutic target for intracranial aneurysm management. However, the current study is limited to in vitro evidence.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261483185"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891790","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":"Agnuside against spatial learning and memory deficits in a mouse model of vascular dementia.","authors":"Shao-Fa Li, Hui-Min Wei, Jin-Yong Teng, Xiao-Qin Huang, Zai-Zhi Yang, Ju-Fang Chen, Yu-Ji Huang, Ying Wu","doi":"10.1177/03000605261483194","DOIUrl":"https://doi.org/10.1177/03000605261483194","url":null,"abstract":"<p><p>ObjectiveVascular dementia is the second most common cause of cognitive impairment in older adults, yet effective pharmacological treatments remain limited. Agnuside, a naturally occurring compound with antioxidant and anti-inflammatory properties, has shown vascular-protective potential; however, its role in vascular dementia remains unclear.MethodsA mouse model of permanent bilateral common carotid artery occlusion was established to evaluate the effects of Agnuside. Cognitive function was assessed using the Morris water maze. Cerebral blood flow, tissue injury, and hippocampal cornu ammonis 1 neuronal apoptosis were evaluated using laser speckle imaging, triphenyltetrazolium chloride staining, Nissl staining, and terminal deoxynucleotidyl transferase dUTP nick-end labeling. Transcriptomic and pathway enrichment analyses were performed, and key targets were validated using quantitative real-time polymerase chain reaction and Western blotting.ResultsAgnuside improved spatial learning and memory, increased cerebral blood flow, reduced histopathological damage, and decreased neuronal apoptosis. Angiogenesis-related genes (Mmp3, IL1RN, and ALAS2) were differentially expressed, and selected genes were validated using quantitative real-time polymerase chain reaction. The PI3K-AKT and MAPK pathways were significantly enriched, and Agnuside restored AKT and ERK1/2 phosphorylation.ConclusionsAgnuside exerts neurovascular protective effects in mice with vascular dementia, likely through modulation of angiogenesis-related genes and activation of AKT/ERK signaling. These findings provide evidence that Agnuside serves as a potential therapeutic candidate for vascular dementia.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261483194"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081113","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":"Immunometabolic interactions in gynecologic cancers: Mechanisms, biomarkers, and therapeutic implications.","authors":"Agapiti H Chuwa, David H Mvunta","doi":"10.1177/03000605261476189","DOIUrl":"https://doi.org/10.1177/03000605261476189","url":null,"abstract":"<p><p>This narrative review synthesizes current evidence on immunometabolic interactions in gynecologic cancers, with emphasis on their implications for tumor biology, therapeutic response, and global cancer care. Emerging data indicate that systemic metabolic dysfunction is closely integrated with tumor microenvironment immune remodeling. Key features include enhanced glycolysis, nutrient competition, lipid accumulation, and hypoxia, which collectively impair cytotoxic T-cell function, promote immune exhaustion, and support immunosuppressive myeloid phenotypes.Although gynecologic malignancies share common immunometabolic hallmarks, distinct tumor-specific patterns are evident. Cervical cancer is characterized by human papillomavirus-associated metabolic reprogramming and immune checkpoint activation; ovarian cancer demonstrates dependence on lipid metabolism and omental adipose interactions; and endometrial cancer is strongly associated with obesity-driven insulin resistance and endocrine-inflammatory signaling. This review evaluates potential biomarkers and therapeutic strategies, including metformin, statins, and immune checkpoint inhibitor-based combinations, and clearly distinguishes between preclinical findings and clinically established interventions. Current evidence for metabolic targeting remains largely exploratory, with variable degrees of clinical validation across tumor types. In addition, this review highlights implementation challenges in low- and middle-income countries, particularly limited access to advanced molecular diagnostics and immunotherapies, and discusses opportunities for scalable, low-cost metabolic approaches. Finally, we outline future research priorities, including spatial multiomics, longitudinal metabolic profiling, and computational modeling approaches to improve patient stratification and predictive accuracy. Overall, immunometabolism represents a promising but evolving framework for improving understanding and management of gynecologic cancers, with important implications for both precision oncology and global health equity.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261476189"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982762","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":"Disentangling the association between chronic pain and sarcopenia-related traits: A bidirectional Mendelian randomization study.","authors":"Weijie Wang, Qiankun Zhang, Zhenhua Wu","doi":"10.1177/03000605261478538","DOIUrl":"10.1177/03000605261478538","url":null,"abstract":"<p><p>ObjectiveThis study aimed to investigate the potential causal relationships between chronic pain and three key sarcopenia-related quantitative traits: (a) hand grip strength; (b) usual walking pace; and (c) appendicular lean mass, using bidirectional two-sample Mendelian randomization.MethodsWe conducted bidirectional two-sample Mendelian randomization using summary-level data from large-scale genome-wide association studies to assess the genetically predicted associations between chronic pain, including multisite chronic pain and chronic widespread musculoskeletal pain, and the aforementioned sarcopenia-related traits.ResultsMendelian randomization revealed that multisite chronic pain was significantly associated with an increased risk of low hand grip strength (odds ratio = 1.70; <i>p</i> < 0.001) and decreased usual walking pace (odds ratio = 0.81; <i>p</i> < 0.001); chronic widespread musculoskeletal pain was also significantly associated with decreased usual walking pace (odds ratio = 0.15; <i>p</i> < 0.001). Additionally, higher left hand grip strength was significantly associated with a lower risk of multisite chronic pain (odds ratio = 0.90; <i>p</i>< 0.001) and chronic widespread musculoskeletal pain (odds ratio = 0.99; <i>p</i> = 0.002); higher right hand grip strength was significantly associated with a lower risk of multisite chronic pain (odds ratio = 0.91; <i>p</i> = 0.002); and higher usual walking pace was significantly associated with a lower risk of multisite chronic pain (odds ratio = 0.49; <i>p</i> < 0.001) and chronic widespread musculoskeletal pain (odds ratio = 0.92; <i>p</i> < 0.001). No significant causal associations were detected for appendicular lean mass in either direction (all <i>p</i> > 0.05).ConclusionThis study provides genetic evidence supporting potential causal links between chronic pain and key phenotypic components of sarcopenia.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261478538"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13539023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880666","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":"Play to move: A mixed-methods prospective observational study of exergaming versus traditional exercise interventions in children with Down syndrome.","authors":"Elise Baron, Nina Ulaganathan, Sri Kurniawan","doi":"10.1177/03000605261484837","DOIUrl":"10.1177/03000605261484837","url":null,"abstract":"<p><p>ObjectiveChildren with Down syndrome often face challenges associated with physical activity engagement and motor skill development. This study examined the effectiveness of an augmented reality exergaming application compared with that of traditional paper-based exercise recommendations for promoting physical activity in children with Down syndrome.MethodsUsing a mixed-methods design, this prospective, observational study investigated the experiences of participants in a 6-week exercise intervention by comparing the effectiveness of an exergaming application (n = 3) with the provision of a paper handout with recommended exercises (n = 2). Five children with Down syndrome participated in the study, with physical assessments conducted pre- and post-intervention via telehealth, weekly interviews, and activity tracking.ResultsThematic analysis revealed that the exergaming application provided initial novelty and motivation that decreased over time; however, session duration increased. Paper handouts served as reminders but not motivators. Participants preferred activities involving upper-body movements over more challenging, whole-body movements, and familiar, simplified movements over novel complex tasks. All application group participants demonstrated improvement in the 2-min step test.ConclusionExergaming may help improve physical fitness in children with Down syndrome; however, it requires specific design considerations to sustain long-term engagement and activity initiation.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261484837"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900212","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":"Clinical and epidemiological characteristics of dengue with warning signs among hospitalized children in Vietnam: A cross-sectional study.","authors":"Yen Nguyen Thi Ngoc, Phong Nguyen Doan, Trung Nguyen Quang, Lien Tran Thi, Linh Dang Viet, Nhung Pham Thi, Linh Dang Phuong, Chuc Dang Van","doi":"10.1177/03000605261481613","DOIUrl":"10.1177/03000605261481613","url":null,"abstract":"<p><p>ObjectiveDengue is a major vector-borne viral infection and a frequent cause of pediatric hospitalization in endemic settings. This study described the clinical and laboratory characteristics of hospitalized children with laboratory-confirmed dengue in northern Vietnam and examined factors associated with dengue with warning signs (DWS).MethodsThis hospital-based cross-sectional study included retrospective and prospective components. Medical records were retrospectively reviewed for eligible children aged 0-16 years admitted from 1 September to 29 December 2022, whereas eligible children in the same age group were prospectively enrolled from 30 December 2022 to 31 August 2023. DWS was classified according to the World Health Organization 2009 criteria and the Vietnamese Ministry of Health guideline. Multivariable logistic regression was used to identify factors associated with DWS.ResultsAmong 319 children, 126 (39.5%) met the criteria for DWS. In the multivariable analysis, age >10 years (adjusted odds ratio [aOR] 2.17, 95% confidence interval [CI] 1.28-3.66; <i>p</i> = 0.004), urban residence (aOR 2.88, 95% CI 1.27-6.51; <i>p</i> = 0.011), platelet count ≤100 × 10⁹/L (aOR 3.34, 95% CI 1.86-5.97; <i>p</i> < 0.001), and AST ≥100 U/L (aOR 2.83, 95% CI 1.58-5.05; <i>p</i> < 0.001) were independently associated with DWS. Among children with DWS, the most frequently observed warning signs were abdominal pain or tenderness (64.3%), persistent vomiting (31.7%), and mucosal bleeding (25.4%).ConclusionsDWS was common among hospitalized children with dengue at a tertiary children's hospital in northern Vietnam. Older age, urban residence, thrombocytopenia, and elevated aspartate aminotransferase may help identify children who require closer monitoring during hospitalization.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261481613"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911727","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":"Clinical characteristics, pathogen distribution, and in-hospital outcomes in patients with pyogenic liver abscess: A comparative analysis of diabetic versus non-diabetic patients.","authors":"Yaya Zhao, Xiaoqing Ma, Li Sun, Hong Qi, Xuan Yang","doi":"10.1177/03000605261484838","DOIUrl":"https://doi.org/10.1177/03000605261484838","url":null,"abstract":"<p><p>ObjectiveTo compare clinical characteristics, etiology, imaging findings, treatment, and in-hospital outcomes between patients with pyogenic liver abscess with and without diabetes to support individualized clinical management.MethodsThis retrospective study included 63 patients diagnosed with pyogenic liver abscess between February 2023 and December 2025 at a tertiary hospital in Xi'an, China. The patients were divided into diabetic and non-diabetic groups. Clinical data, laboratory findings, imaging features, pathogen distribution, treatment, and in-hospital outcomes were compared. Multivariate logistic regression was performed to determine risk factors for percutaneous drainage.ResultsIn total, 63 patients were enrolled; there were no significant differences in sex, age, and inflammatory indicators between the two groups. Alanine transaminase and aspartate transaminase levels were significantly higher in the non-diabetic group, whereas albumin levels were significantly lower in the diabetic group (<i>p</i> = 0.04). The detection rate of <i>Klebsiella pneumoniae</i> was significantly higher in the diabetic group (52.2% vs. 15.0%, <i>p</i> = 0.001). The proportion of patients undergoing puncture and drainage was significantly higher (47.8% vs. 22.5%, <i>p</i> = 0.04) and the length of hospital stay was significantly longer (14.0 (9.0, 17) vs. 10 (9.0, 12.75) days, <i>p</i> = 0.01) in the diabetic group. There was no significant difference in the incidence of sepsis between the two groups. Multivariate regression analysis revealed that <i>K. pneumoniae</i> infection was an independent risk factor for the need for percutaneous drainage (odds ratio = 8.73, 95% confidence interval: 2.36-32.34, <i>p</i> = 0.001).ConclusionDiabetic patients with pyogenic liver abscess characteristically exhibit a predominance of <i>K. pneumoniae</i> infection and a longer hospital stay. Non-diabetic patients present prominent transaminitis and higher <i>Escherichia coli</i> infection rates. <i>K. pneumoniae</i> infection, rather than diabetes itself, is an independent factor associated with drainage requirement in this cohort. Tailored therapeutic strategies are recommended for this patient population based on diabetes status.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261484838"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075043","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":"Efficacy and safety of <i>Artemisia annua</i> pollen sublingual immunotherapy in patients with seasonal allergic rhinoconjunctivitis with or without comorbid asthma: A real-world study.","authors":"Wendong Hao, Xin Liu, Na Gao, Cairong Bai","doi":"10.1177/03000605261484860","DOIUrl":"10.1177/03000605261484860","url":null,"abstract":"<p><p>ObjectiveThis study aimed to evaluate the clinical efficacy and safety of <i>Artemisia annua</i> pollen allergen sublingual immunotherapy combined with symptomatic medication in patients with seasonal allergic rhinoconjunctivitis or seasonal allergic rhinoconjunctivitis with asthma.MethodsThis open-label, observational cohort study was conducted from November 2024 to May 2025 and included a total of 500 patients diagnosed with <i>A. annua</i> pollen-induced seasonal allergic rhinoconjunctivitis; after accounting for dropouts, 354 patients remained eligible for analyses, including 228 patients with isolated seasonal allergic rhinoconjunctivitis and 126 patients with seasonal allergic rhinoconjunctivitis and asthma. Participants received <i>A. annua</i> pollen sublingual immunotherapy plus standard symptomatic treatment and were followed up during the 2025 pollen season. Primary outcomes included changes in the total rhinoconjunctivitis symptom, total medication, combined symptom-medication, and visual analog scale scores from that at baseline (2024 pollen season). For patients with concomitant asthma, asthma daytime symptom and asthma nighttime symptom scores were also recorded. Efficacy was assessed by comparing scores between the two pollen seasons, and safety was evaluated based on occurrence of adverse events. This study was retrospectively registered via the National Medical Research Registration System (PID: 332836, syncing to ChiCTR); the formal registration number is pending administrative review.ResultsMean pollen concentrations during the 2024 and 2025 pollen seasons were 15.07 grains/m³ (duration: 64 days) and 15.48 grains/m³ (duration: 61 days), respectively, indicating comparable exposure levels. Compared with baseline, total rhinoconjunctivitis symptom, total medication, combined symptom-medication, and visual analog scale scores decreased significantly in both groups (isolated seasonal allergic rhinoconjunctivitis and seasonal allergic rhinoconjunctivitis with asthma groups, all <i>p</i> < 0.001). Among patients with comorbid asthma, asthma daytime symptom and asthma nighttime symptom scores also improved significantly (<i>p</i> < 0.001). Adverse events occurred in 64 patients with isolated seasonal allergic rhinoconjunctivitis and 11 patients with seasonal allergic rhinoconjunctivitis and asthma; all adverse events resolved spontaneously or with minimal intervention, and no serious adverse events were reported.ConclusionThese findings suggest that <i>A. annua</i> pollen sublingual immunotherapy significantly improves seasonal symptoms in seasonal allergic rhinoconjunctivitis patients, maintains lung function stability in those with concomitant controlled asthma, and demonstrates a favorable safety profile.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261484860"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891671","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":"Indobufen-based dual antiplatelet therapy after percutaneous coronary intervention: A systematic review and network meta-analysis.","authors":"Aparna Gopinath, Jungwook Heo, Afifa Fatima, Amarsimha Yerrajonna, Hannah George, Riyazuddin Mohd, Tawfiq Turjman, Uchechi Blessing Azuwike, Dany Pierre Clitandre Bien-Aimé, Jean Antoni Sebastien Lefevre, Lavinia Rech, Mihret Derbie Asfaw, Joy Rita Ekumbal, Lima Dalil, Mirza Muhammad Hadeed Khawar","doi":"10.1177/03000605261484562","DOIUrl":"10.1177/03000605261484562","url":null,"abstract":"<p><p>ObjectiveIndobufen has been proposed as an aspirin substitute within dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI), but has been compared only with aspirin plus clopidogrel. We aimed to estimate the comparative safety and efficacy of indobufen-based DAPT against contemporary antiplatelet strategies after PCI.MethodsIn a systematic review and frequentist random-effects network meta-analysis, we searched PubMed/MEDLINE, Embase, and CENTRAL from inception to May 2026 for randomised controlled trials of adults undergoing PCI with drug-eluting stents that compared antiplatelet strategies mapping onto seven pre-specified nodes, with aspirin plus clopidogrel as the reference. Crude per-arm event counts were extracted in duplicate. The connected primary safety outcome was major bleeding (Bleeding Academic Research Consortium [BARC] type 3/5); efficacy outcomes (myocardial infarction, stent thrombosis, all-cause death, stroke) were analysed per component. Odds ratios (ORs) with 95% confidence intervals (CIs) and P-scores were estimated.ResultsEleven trials enrolling more than 55, 000 patients were included. Indobufen plus clopidogrel did not differ significantly from aspirin plus clopidogrel for major bleeding (OR 1.05, 95% CI 0.62-1.78), myocardial infarction (0.91, 0.29-2.89), stent thrombosis (1.27, 0.34-4.74), or stroke (0.96, 0.27-3.44). In a disconnected direct comparison, indobufen reduced BARC 2-5 bleeding (OR 0.62, 0.45-0.84). The significant between-strategy differences concerned others: aspirin plus ticagrelor showed higher major bleeding (2.07, 1.46-2.94) and clopidogrel monotherapy lower (0.38, 0.22-0.64). Every comparison across clusters depended on a single bridging trial, and no network contained closed loops, precluding assessment of inconsistency.ConclusionsIndobufen-based DAPT was comparable, not superior, to aspirin plus clopidogrel across bleeding and ischaemic outcomes, with no signal of increased ischaemic risk. Because only one randomised trial has directly tested indobufen and all comparisons with ticagrelor-based or monotherapy strategies rest on a single bridging trial, the findings primarily support indobufen as a reasonable aspirin-sparing alternative within clopidogrel-based DAPT. Its relative position against other contemporary bleeding-reduction strategies remains unproven. These results reinforce the need for individualised antiplatelet therapy guided by patient-specific ischaemic and bleeding risk.INPLASY registration number: INPLASY202680037.</p>","PeriodicalId":16129,"journal":{"name":"Journal of International Medical Research","volume":"54 9","pages":"3000605261484562"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905978","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}