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Introduction: The treatment for acute lymphoblastic leukemia (ALL) is based upon combining chemotherapy, tyrosine kinase inhibitors, and bispecific monoclonal antibodies. Screening throughout the measurable residual disease is the main tool to establish the prognosis and risk of relapse. Induction protocols include a combination of steroids, anthracyclines, vinca alkaloids, and, in the pediatric-inspired schemes, asparaginase.

Methods: A retrospective study included clinical records of patients with ALL who received treatment based on Hyper-CVAD (adult scheme) or CALGB10403 (pediatric scheme) between 2018 and 2023.

Results: A total of 460 clinical records of patients were collected. 50.2% were male. The average age was 34 years old. 20.7% (n = 95) received the pediatric scheme, while 79.3% (n = 365) received the adult scheme. Pediatric scheme patients presented a higher ratio of complete remissions (67.4%) than adult scheme (57.3%) (p = 0.047). When comparing survival according to groups, pediatric scheme patients presented higher survival rates than adult patients (log rank 0.000).

Conclusions: The introduction of bearable and accessible schemes with the choice of outpatient administration is ideal for the health systems of Latin America. Along with the treatment selection, strict screening through a standardized technique remains the main prognosis factor for the treatment of adult ALL.

Introduction: Micro-RNAs (miRNAs) participate in different biological processes, including fetal hypoxia. In this work, we aimed to evaluate the existence of a miRNA differential expression profile in maternal blood of pregnancies affected with late-onset fetal growth restriction (LO-FGR).

Methods: In a prospective study, a group of 35 fetuses were evaluated with Doppler ultrasound after 36 weeks. These included 15 fetuses with LO-FGR defined as fetal birth weight <10th centile plus a cerebroplacental ratio (CPR) <0.6765 MoM and 20 normal fetuses (normal BW plus a normal CPR). Afterward, for every pregnancy, maternal blood plasma was collected at birth, miRNAs were extracted, and full miRNA sequencing was performed using 20 of the indicated samples (12 with LO-FGR and 8 normal), determining the existence of differentially expressed miRNAs. Finally, this differential expression was validated in a wider population of 35 fetuses by means of quantitative reverse transcription polymerase chain reaction.

Results: Full mRNA sequencing showed that FGR mothers expressed differential expression of several miRNA. The highest differences were seen for miR-486-5p/3p, miR-516a/b-5p, miR-19a/b-3p, miR-296-5p, miR-10b-5p, miR-205-5p, and Let-7g-5p. However, PCR validation only confirmed significant differences in miR-486-5p/3p.

Conclusion: Mothers delivering FGR fetuses express a miRNA profile, which includes differential expression of miR-486-5p/3p. This information might improve our understanding of the pathophysiological processes involved in late-onset FGR. Future validation and feasibility studies will be required to propose maternal blood miRNAs as a valid tool in the diagnosis and management of FGR.

Introduction: A large number of studies have been carried out for the etiology of atherosclerosis and many risk factors have been identified, including environmental factors and heavy metals, which are related to the pathogenesis. This study aimed to determine the effects of heavy metals, which have activation and inhibition effects on various metabolic pathways, on atherosclerosis by examining coronary arteries obtained from autopsy series.

Methods: Coronary arteries of 28 autopsy cases were analyzed by inductively coupled plasma mass spectrometry method. Sixteen of the cases had coronary atherosclerotic plaques and 12 of the coronaries were normal. Twenty trace metal concentrations were examined from the samples obtained.

Results: Twenty-eight coronary artery samples (16 with atherosclerosis, 12 normal) were analyzed using ICP-MS. Levels of Mg, K, Ca, P, Fe, Zn, Al, S, As, Pt, Sb, Hg were significantly higher in atherosclerotic arteries (e.g., Ca: 51,384 vs. 1,723 ppm, p = 0.005; P: 30,791 vs. 3,443 ppm, p = 0.003; Hg: 3.2 vs. 0 ppm, p < 0.001). Elements such as lead, cobalt, and cadmium remained below detection limits in both groups.

Conclusion: Heavy metals through inflammation, oxidative stress, and disrupted antioxidant pathways are independent risk factors that increase the risk of atherosclerosis. These findings provide tissue-level evidence that heavy metal accumulation may contribute to atherosclerosis through oxidative stress, inflammation, and disruption of antioxidant defenses.

Introduction: The therapeutic use of monoclonal antibodies (mAbs) has significantly increased since the first mAb was introduced. Despite their therapeutic benefits, mAbs have been accompanied by a rise in adverse effects, affecting various organ systems including the skin. This systematic review consolidates the current literature on the incidence, characteristics, and management of adverse dermatological events (ADEs) post-mAb treatment, focusing on Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), erythema multiforme (EM), and fixed drug eruption (FDE).

Methods: A comprehensive PubMed search from 1980 to January 2024 included studies on mAbs causing SJS, TEN, EM, or FDE in humans. Screening was conducted using Covidence, and data were extracted on demographics, mAb details, rash characteristics, and treatment.

Results: Of the initial 2002 articles, 29 met the inclusion criteria, highlighting 31 cases of ADEs. The onset of these rashes was delayed, often occurring significantly after starting mAb therapy, with a mean onset time considerably longer than that associated with traditional drugs. Additionally, neither patient sex nor concurrent medication use affected the likelihood of developing these reactions.

Conclusion: This review underscores the prolonged timeline for the onset of ADEs from mAbs, distinct from reactions induced by traditional drugs, aligning with the characteristics of progressive immunotherapy-related mucocutaneous eruption. The lack of correlation with patient sex or concurrent medications reaffirms the inherent risk of mAbs. These findings highlight the need for clinicians to monitor and educate patients about the potential for delayed dermatological reactions from mAb treatment to ensure timely management and better outcomes.

Introduction: Neonatal exposure to pain can lead to altered pain perception in later years of life. Despite the availability of measures to alleviate pain, routine use is lacking. We decided to conduct a quality improvement (QI) study to increase the use of analgesia during venipuncture, a common procedure in neonatal intensive care units, from a baseline of 0% to 50% over 8 weeks.

Methods: Fishbone analysis was used to identify the potential barriers, which were targeted to bring improvement through Plan-Do-Study-Action (PDSA) cycles. In the first cycle, education and training of healthcare providers were conducted for 3 weeks, followed by the second cycle, wherein the mother's own milk was made available bedside for analgesia use. In the third cycle, a small amount of pasteurized donor human milk was kept separately for analgesia, and 25% dextrose was made available in the fourth cycle as a last resort. The 2nd-4th PDSA cycles were performed for a period of 2 weeks each.

Results: The use of analgesia improved to 26% from baseline after the first cycle and subsequently to 46%, 50%, and 53% after the second, third, and fourth cycles, respectively. During the sustenance phase, in the initial 2 months, there was a decrease in analgesia use, but with prompt interventions and timely remediation, it increased up to 60%, which was sustained for the subsequent 3 months.

Conclusion: Using the QI model, we were able to identify lacunae in current care and drive a culture change, leading to an increase in the use of analgesia during venipuncture.

Introduction: In patients receiving hemodialysis, protein-energy wasting may be frequent and is associated with nutritional and metabolic alterations. This study aimed to describe the effects of a new therapeutic strategy, i.e., oral nutritional supplements (ONS) associated with a polyester-polyarylate (PEPA) membrane, on nutritional markers in high-risk patients with intradialytic parenteral nutrition (IDPN) history.

Methods: Patients, who received individually IDPN (M-6 to M0) then ONS (M0 to M6), were followed over a 12-month period.

Results: There was no change in serum albumin over time. The BMI increased between M-6 and M6. Food intake showed increase between M0 and M3. Quality-of-life score was stable between M0 and M6. None of the adverse events was judged related to ONS, PEPA, or research procedure.

Conclusion: This study focusing on a new therapeutic strategy composed of ONS and PEPA membrane replacing IDPN to maintain nutritional markers in high-risk patients receiving hemodialysis might warrant further research with robust methodology.

Introduction: Pleuroperitoneal leakage is a rare but dramatical cause of pleural effusion; it can lead to the cessation of peritoneal dialysis. It typically manifests as respiratory distress and reduced drainage volumes.

Case presentation: In this article, we report a case of pleuroperitoneal leak in a patient undergoing continuous ambulatory peritoneal dialysis who presented to the emergency with shortness of breath, lower limb edema, and weight gain. The diagnosis was established through pleural puncture, revealing that the pleural fluid is transudative with elevated glucose level which is pathognomonic for this condition, "sweet hydrothorax." Furthermore, the composition of this fluid was almost identical to the peritoneal dialysis effluent. The management of this case involved temporarily discontinuing peritoneal dialysis and performing pleurodesis. The evolution was favorable, and peritoneal dialysis was resumed 2 weeks later.

Conclusion: Patients on peritoneal dialysis who present with significant pleural effusion, especially if it is unilateral, should prompt clinicians to consider the possibility of a pleuroperitoneal leak.

Introduction: In rare cases, idiopathic nephrotic syndrome (NS) and type 1 diabetes coexist, with diabetes typically preceding NS or presenting almost simultaneously with an acute onset requiring immediate insulin therapy.

Case presentation: We report a unique case of a 5.1-year-old male who developed idiopathic NS and experienced glycosuria during steroid treatments for relapses, initially attributed to steroid-induced hyperglycemia. At age 10.2, he developed persistent glycosuria without steroid administration, and an oral glucose tolerance test confirmed diabetes. Despite positive anti-insulinoma-associated protein-2 antibodies, the patient maintained non-insulin-dependent glycemic control until, 13 months later, rapid-onset hyperglycemia necessitated insulin therapy, leading to a diagnosis of slowly progressive type 1 diabetes (SPT1D).

Conclusion: This case represents the first reported instance of steroid-sensitive relapsing NS followed by SPT1D in childhood.

Introduction: Takayasu arteritis (TA) and multiple sclerosis (MS) are both immune-mediated diseases that can coexist, with TA causing vascular inflammation and MS involving demyelination driven by aberrant T-cell activity. The overlap of these conditions highlights shared immune mechanisms, such as T-cell dysregulation and cytokine release, underscoring the need for a nuanced understanding of their interplay, which is explored in a narrative review of reported cases.

Case presentation: We narrate all reported cases of TA in patients with MS and report the case of a 57-year-old woman with MS with suspected bilateral optic neuritis and typical contrast-medium enhancement in both optic nerves. Because of normal visual acuity on both eyes, malignant hypertension, and fundoscopic findings indicative of hypertensive retinopathy, we diagnosed hypertensive retinopathy with secondary contrast-medium enhancement of the optic nerves. We established antihypertensive medication and searched for secondary causes of hypertension and highly elevated erythrocyte sedimentation rate, which led to the finding of large vessel wall inflammation and the diagnosis of TA.

Conclusion: TA can present with a variety of ocular symptoms, including hypertensive retinopathy, retinal ischemia, and anterior ischemic optic neuropathy, often mimicking other diseases. While rare, the coexistence of TA and MS, including cases associated with interferon-beta therapy, suggests shared immune mechanisms and underscores the need for careful monitoring of patients with MS receiving immunomodulatory treatments. The broad spectrum of potential causes for optic nerve abnormalities necessitates a thorough evaluation to avoid misdiagnosis and ensure appropriate treatment.

Introduction: Appointment "no-shows" (NS) are a significant issue for glaucoma patients, potentially leading to loss to follow-up, disease progression, and irreversible vision loss. This study investigates sociodemographic and clinical risk factors associated with NS at a tertiary academic eye center.

Methods: A retrospective review of 100 glaucoma patients at the University of Pittsburgh Medical Center (UPMC) Vision Institute over 1 year was conducted. Patients were categorized as NS if they missed any glaucoma service appointment and as never no-show (NNS) if no appointments were missed. Baseline demographic, medical, and ophthalmic data were collected. Socioeconomic disadvantage was measured using the area deprivation index (ADI) based on residential ZIP codes.

Results: Of 100 patients, 35 were classified as NS and 65 as NNS. NS patients had significantly higher ADI scores (79 vs. 65; p = 0.03) and were more frequently Black (54% [19/35] vs. 26% [17/65]; p = 0.01). Medical comorbidities were more common in NS patients (83% [29/35] vs. 48% [31/65]; p < 0.001), as were mental health diagnoses (34% [12/35] vs. 8% [5/65]; p < 0.001). Insurance type, glaucoma type, intraocular pressure, and visual acuity were not significantly different between groups.

Conclusion: Higher socioeconomic disadvantage, Black race, medical comorbidities, and mental health diagnoses were associated with appointment NS among glaucoma patients. These findings highlight the need for targeted interventions to address these risk factors, improve follow-up adherence, and reduce the risk of disease progression.