European Journal of Medical Research最新文献

Objective: This study aimed to explore the effects of thrombectomy and thrombolytic therapy beyond the standard time window on granulocyte colony-stimulating factor (G-CSF) expression and postoperative brain function in patients with acute cerebral infarction.

Methods: Sixty patients with acute cerebral infarction, who met the defined time window criteria, were randomly assigned to either the observation group (n = 30) or the control group (n = 30). The observation group underwent thrombectomy using the TREVO stent, while the control group received intravenous thrombolysis with rt-PA, a human tissue plasminogen activator. Comparative analyses between the two groups focused on G-CSF levels, NIHSS scores, MoCA scores, and the modified thrombolysis in cerebral infarction (mTICI) scale. Multivariate linear regression was performed to adjust for confounding factors including age, sex, and comorbidities. The Pearson correlation method was employed to assess the correlation between post-thrombectomy outcomes and G-CSF expression, as well as the impact on postoperative brain function.

Results: At 72 h and 90 days post-procedure, both groups demonstrated an increase in G-CSF levels and MoCA scores, accompanied by a decrease in NIHSS scores. Notably, the observation group exhibited significantly higher G-CSF levels and MoCA scores compared to the control group, alongside significantly lower NIHSS scores (P < 0.05). Multivariate analysis confirmed the treatment group as an independent predictor of improved outcomes (P < 0.05). The rate of successful vascular recanalization was substantially higher in the observation group (90.00%) compared to the control group (56.67%). There was a significant positive correlation between NIHSS scores, MoCA scores, mTICI, and post-thrombectomy G-CSF expression (P < 0.05).

Conclusion: In patients with acute cerebral infarction beyond the conventional time window, the use of TREVO stent thrombectomy and recanalization is effective, resulting in marked improvements in cognitive function. Moreover, G-CSF appears to play a critical role in the pathophysiology of acute cerebral infarction, establishing a strong association between G-CSF expression and postoperative brain function in affected individuals.

Background: Currently, due to the invasive nature of colonoscopy and the associated pain, people avoid undergoing the procedure, making it difficult to detect the majority of potential early stage colorectal carcinoma/precancerous lesions or advanced adenoma. Advanced colorectal adenoma is the main precursor to the development of colorectal carcinoma. Therefore, improving advanced colorectal adenoma detection rate can significantly decrease the development and morbidity of colorectal carcinoma. Accordingly, a non-invasive method to screen high-risk people for colonoscopy in clinical practice is urgently needed.

Main text: With the development of medical technology, screening methods for colorectal carcinoma are emerging rapidly, and diverse non-invasive methods are being developed. Cell-free DNA (cfDNA), commonly referred to as liquid biopsy, has promising application prospects as a minimally invasive strategy for early screening of colorectal cancer. CfDNA has already been applied in the field of prenatal diagnosis, advanced carcinoma, and organ transplantation, and the application cfDNA in advanced colorectal adenoma is at the cutting-edge of current research. Thus, this review summarizes the progress in research on different biological characteristics of cfDNA and its utility in the screening of advanced colorectal adenoma, including sizes of cfDNA molecules, end signature of cfDNA (preferred ends, end motifs, jagged ends), nucleosomal footprints, cfDNA topology, cfDNA methylation, and cfDNA integrity.

Conclusions: We hope that this review will advance this promising research field.

Objectives: To quantitatively assess the differences in parameters of dynamic contrast-enhanced MRI (DCE-MRI) in HER2-zero, HER2-low, or HER2-positive tumors, and to build optimal model for early prediction of HER2-low breast cancer (BC).

Materials and methods: Clinical and DCE-MRI data from 220 BC patients receiving neoadjuvant chemotherapy (NACT) were retrospectively analyzed. Quantitative and semi-quantitative DCE-MRI parameters were compared in the HER2-zero, HER2-low, or HER2-positive groups before and after early NACT. Empirical models were developed to predict HER2-low BC using logistic regression analysis and receiver operating characteristic (ROC) analysis.

Results: Patients of HER2-low BC have a lower pCR rate compared with HER2-zero and HER2-positive (17.9% vs. 10.4% vs. 29.5%, p < 0.001), predominantly in the HR (hormone receptor) negative group (22.2% vs. 7.7% vs. 40.5%, p < 0.001). Before NACT, HER2-low BC exhibited higher Kep, Ktrans, Washin, and lower TME intratumoral perfusion characteristics, and higher Kep and lower TME in peritumoral region compared to HER2-zero and HER2-positive BC patients. Notably, after early NACT, changes in intratumoral perfusion (Kep) and in peritumoral perfusion (Ktrans, Washin) were more pronounced in the HER2-low group compared to HER2-zero and HER2-positive group. The ROC curves (AUC) for the pre-NACT intratumoral, peritumoral, and combined perfusion models were 0.675(95% CI 0.600-0.750), 0.661(95% CI 0.585-0.738), 0.731(95% CI 0.660-0.802). The combined pre-and-post-NACT perfusion model further improved predictive performance accordingly, with AUCs of 0.764 (95% 0.637-0.865), 0.795 (95% CI 0.711-0.878), 0.850 (95% CI 0.774-0.926).

Conclusions: The study revealed perfusion heterogeneity between different HER2 statuses and identified the best imaging model as a non-invasive tool to predict HER2-low BC, which can help pre-treatment clinical decision-making.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been widely used in the diagnosis and treatment of biliary and pancreatic diseases, and its success rate and therapeutic effect are considerable, and its use in patients with gastrointestinal tract reconstruction is also increasing. The anatomical structure of the digestive tract has been changed in these patients, which makes the use of endoscopic retrograde cholangiopancreatography technically more challenging. The aim of this study was to investigate the efficacy of transendoscopic retrograde cholangiopancreatography in patients after gastrointestinal reconstruction and its risk factors for postoperative complications.

Methods: A retrospective analysis was conducted on clinical data of 522 patients who underwent ERCP for diagnostic and therapeutic purposes after gastrointestinal reconstruction surgery at Zhongnan Hospital, Wuhan University, from January 2017 to December 2023. Univariate analysis, multicollinearity testing, and binary logistic regression were performed to explore the factors associated with ERCP efficacy and complications.

Results: A total of 522 patients were included in the study. The success rate of intubation was 96.93% (506/522), the success rate of cannulation was 91.09% (466/506), and the therapeutic success rate was 95.28% (444/466). Multivariate logistic regression analysis of failed intubation showed that independent risk factors included total gastrectomy (P = 0.000, OR = 7.114, 95% CI 2.454-20.622), gastrojejunostomy (P = 0.000, OR = 46.881, 95% CI 10.250-214.423), and the use of a forward-viewing endoscope (P = 0.010, OR = 2.322, 95% CI 1.228-4.389). Post-ERCP complications included hyperamylasemia in 67 cases (12.84%), acute pancreatitis in 13 cases (2.49%), acute cholangitis in 3 cases (0.57%), bleeding in 3 cases (0.57%), and perforation in 2 cases (0.38%). Univariate analysis of the complications showed that a history of cholecystectomy (P = 0.042, OR = 1.800, 95% CI 1.015-3.193) was an independent risk factor for hyperamylasemia; difficult cannulation (P = 0.000, OR = 47.619, 95% CI 13.317-170.275) was an independent risk factor for acute pancreatitis; and a history of pancreatitis (P = 0.040, OR = 42.75, 95% CI 3.399-537.620) was an independent risk factor for bleeding.

Conclusions: ERCP performed in patients after gastrointestinal reconstruction at our hospital achieved a high success rate. Total gastrectomy, gastrojejunostomy, and the use of a forward-viewing endoscope were independent risk factors for failed intubation. A history of cholecystectomy, recurrent cannulation, and a history of pancreatitis were identified as independent risk factors for hyperamylasemia, acute pancreatitis, and bleeding, respectively.

Background: Spontaneous intracerebral hemorrhage (sICH) is a critical and disabling form of stroke and accounts for an obvious number of stroke-related deaths and disabilities globally. Hematoma growth is a key target for therapeutic intervention because of its association with poor outcomes. Recently, the STOP-MSU trial showed that intravenous tranexamic acid (TA) did not reduce hematoma growth or improve clinical outcomes when administered within 2 h of intracerebral hemorrhage symptom onset. This study aims to evaluate the efficacy of TA in reducing hematoma growth and improving clinical outcomes in patients with spontaneous sICH by incorporating the findings from the latest STOP-MSU trial and consolidating past research to clarify the overall efficacy and safety of TA on sICH.

Methods: A systematic review and meta-analysis were conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guidelines. We included randomized controlled trials (RCTs) comparing TA to placebo in adult patients with sICH. Databases such as PubMed, Medline, and Cochrane were searched up to May 2024. Key outcomes analyzed included hematoma expansion, mortality within 90 days, thromboembolic events, and favorable functional outcomes. Data were pooled using a random-effects model and analyzed using the "metafor" package in RStudio.

Results: Five RCTs involving 1419 patients were included. The meta-analysis showed no significant difference in hematoma expansion (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.74-1.03), mortality within 90 days (OR 1.03, 95% CI 0.86-1.24), thromboembolic events (OR 1.07, 95% CI 0.69-1.64), and favorable functional outcomes (modified Rankin Scale of 0-2 at 90 days; OR 1.04, 95% CI 0.88-1.22) between the TA and placebo groups.

Conclusions: TA does not significantly reduce hematoma growth or improve clinical outcomes in patients with sICH. Despite its affordability and availability, the routine use of TA in sICH is not supported by current evidence.

Background: MicroRNAs (miRNAs) are involved in the synthesis of proprotein convertase subtilisin-kexin type 9 (PCSK9), one of the regulators of low-density lipoprotein cholesterol (LDL-C) metabolism, and are directly involved in the atherosclerotic process. The aim of this study was to verify whether treatment with PCSK9 inhibitors (PCSK9i) and changes in the expression of miRNAs involved in PCSK9 metabolism are associated with arterial wall properties in stable post-myocardial infarction (MI) patients with insufficiently regulated LDL-C levels and significantly increased Lp(a) levels.

Methods: Ninety-five patients after MI were enrolled and randomized to a placebo (N = 31) or PCSK9i group (N = 64). The treatment group received subcutaneous alirocumab 150 mg or evolocumab 140 mg, every 2 weeks. Blood for biochemical and epigenetic analysis was taken and ultrasound measurements of flow-mediated dilation of brachial artery (FMD), carotid intima-media thickness (c-IMT) and pulse wave velocity (PWV) were performed initially and after 6 months of treatment. The expression of the selected 5 miRNAs (miR-191-5p, miR-224-5p, miR-337-3p, miR-483-5p, and miR-552-3p) was quantified using quantitative polymerase chain reaction.

Results: A decrease in c-IMT was associated with a decrease in the expression of miR-337-3p (ρ = 0.329; p = 0.010) and miR-483-5p (ρ = 0.324; p = 0.012). We did not detect any associations between miRNA changes and FMD or PWV.

Conclusions: Our results suggest that changes in the selected miRNAs are associated with changes in the morphological properties of the arterial wall. We have shown that the decrease in miR-483-5p expression present a good indicator of the regression of morphological atherosclerotic change. The trial registration: The study is registered with CinicalTrials under the number NCT04613167, date of registration November 2nd, 2020. Approval for this study was obtained from the National Medical Ethics Committee of the Republic of Slovenia (reference number: KME 0120-357/2018/8).

Background: Elevated lipoprotein (a) [Lp (a)] and fibrinogen (Fib) are important factors contributing to the pathogenesis of atherosclerosis. Carotid plaque is a manifestation of carotid atherosclerosis, and previous studies have shown that Fib has a synergistic effect on Lp (a)-induced events. However, the effect of the combined action of Lp (a) and fibrinogen on carotid plaque has not been elucidated.

Methods: This was a cross-sectional study that screened a total of 3913 patients who attended the First Affiliated Hospital of Xinjiang Medical University with confirmed diagnosis of coronary artery disease (CAD) and carotid ultrasonography during 2019-2024. General clinical information, physical examination data, and laboratory tests were collected from the patients. Based on the results of carotid ultrasonography, the patients were divided into a group with carotid plaque (1123 cases) and a group without carotid plaque (2790 cases). Multifactorial logistic regression analysis was used to explore the correlation between Lp (a) and Fib levels and carotid plaque and the interrelationship between them.

Results: A total of 3913 patients were included, including 2666 males and 1247 females, and the incidence of carotid plaque was 28.7%, with significant differences in Lp (a) and Fib levels between the two groups with and without carotid plaque (P < 0.05) and a significant interaction effect. Multiple logistic regression analysis showed that for every tenfold increase in plasma Lp (a) levels (i.e., an increase of one logarithmic unit), the incidence of carotid plaque could increase by about 32% or so. After stratified analysis for age and sex, it was observed that carotid plaque was significantly associated with plasma Lp (a) levels in men and in patients aged < 60 years (male: OR = 1.301, 95% CI 1.051-1.611; age < 60 years: OR = 1.373, 95% CI 1.076-1.753). Plasma Fib levels were associated with carotid plaque in patients of different sexes and age groups, and there was a significant synergistic effect of Lp (a) and Fib on carotid plaque (P_interaction < 0.05).

Conclusions: Elevated levels of Lp (a) and Fib are independent risk factors for combined carotid plaque in patients with coronary artery disease, and there is a synergistic effect of both on carotid plaque. Therefore, plasma Lp (a) and Fib levels of patients should be focused on for better treatment of carotid plaque and prevention of ischemic stroke.

Background: Disturbances in serum osmolality are associated with poor prognosis in many diseases and are more likely to occur in patients with traumatic brain injury (TBI). However, studies correlating serum osmolality and patient prognosis are lacking. Therefore, this study investigated the correlation between serum osmolality and in-hospital all-cause mortality in patients with TBI based on a large sample of TBI patients from the Medical Information Mart for Intensive Care-IV (MIMIV-IV) database.

Methods: Patients were categorized into 4 groups based on serum osmolality levels and the association between serum osmolality and in-hospital all-cause mortality was assessed by constructing univariate and multivariate logistic regression analyses. Restricted cubic spline (RCS) curves were plotted to further assess nonlinear associations between study variables and outcomes. Kaplan-Meier analysis was used to assess the survival of patients in each group, and differences between groups were assessed by the log-rank test. Sensitivity analysis was used to assess whether this association was established in different populations.

Results: This study covered 1587 patients. The Q3 group had the lowest in-hospital mortality (7.6%). After fully adjusting for confounders, either lower or higher serum osmolality levels were associated with in-hospital all-cause mortality (Q1 vs. Q3: OR, 2.244 [1.333-3.857] p = 0.003; Q4 vs. Q3: OR, 2.160 [1.295-3.681] p = 0.004). The RCS curves showed a U-shaped correlation, with the inflection point located at a serum osmolality of 295.4 mmol/L level.

Conclusions: There was a U-shaped relationship between serum osmolality and in-hospital all-cause mortality in TBI patients. Patients had the lowest in-hospital mortality when serum osmolarity was maintained at 295.4 mmol/L.

Background: The global COVID-19 pandemic was initiated by the appearance of the novel coronavirus SARS-CoV-2 in 2019, presenting a spectrum of clinical manifestations from asymptomatic cases to severe pneumonia and multi-organ dysfunction, with some cases leading to death induced by hyperinflammatory responses. Neurological manifestations have been reported in more than one-third of COVID-19 patients, particularly in severe instances. While vaccines are pivotal in combating infectious diseases and enhancing public health, reports have linked Guillain-Barré syndrome (GBS) to COVID-19 vaccination and infection. This study seeks to analyze four cases of GBS associated with COVID-19.

Methods: Clinical and demographic data were collected from all patients diagnosed with GBS from a biobank, including patients with severe COVID-19 and those with autoimmune conditions resulting from COVID-19 infection or vaccination, who were referred to Alzahra University Hospital in Isfahan, Iran, between October 2020 and December. 2023.

Results: Clinical and demographic data of affected patients are presented. This includes a unique family case involving a daughter who passed away due to GBS following AstraZeneca vaccination, her mother who succumbed to post-COVID-19 GBS, and her father who passed away from severe COVID-19 a year earlier.

Conclusions: These cases provide valuable insights into investigating potential genetic or epigenetic influences on GBS and hyperinflammation. Furthermore, the occurrence of GBS following exposure to COVID-19 and vaccination suggests shared pathways of autoimmunity induction by SARS-CoV-2 and vaccines.