International Journal of Medical Sciences最新文献

Diabetes mellitus is the main cause of end-stage renal disease (ESKD), and most patients need hemodialysis (HD) treatment after they progress to uremia. Patients with diabetes and HD have obvious blood glucose fluctuation, hyperglycemia and hypoglycemia may both related to the higher mortality. Therefore, maintaining blood glucose stability is the main treatment strategy to improve the prognosis of patients. It is challenging to evaluate the blood glucose control of patients with diabetes and HD. The traditional blood glucose detection methods have certain limitations, they may be affected by many factors in HD patients. The application of continuous glucose monitoring (CGM) system is gradually recognized, CGM can monitor blood glucose real-time, timely, and predictive capabilities, there are fewer factors that are affected blood glucose in HD patients.

Arbutin, predominantly derived from the bearberry plant, exhibits promising immunomodulatory properties. Given its ability to influence the programmed cell death-ligand 1/ programmed cell death-1 (PD-L1/PD-1) pathway, it is emerging as a potential alternative treatment for cancer. A reduced expression of PD-L1, as seen after arbutin treatment, can bolster immune responses critical step in effective tumor immunotherapy. However, the molecular mechanism by which arbutin inhibits PD-L1 is still incompletely known. The expression of PD-L1 was decreased after tumor cells were treated with arbutin. Arbutin can downregulate the expression of PD-L1 on the cell surface via the protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway. The findings suggest the protective role of arbutin and provide novel insights into immunotherapy, which involves inhibiting the AKT/mTOR signaling pathway. Arbutin might serve as a potential therapeutic agent alone or in combination with other treatments.

Background: SARS-CoV-2 causes a global pandemic, with severe and critically ill COVID-19 patients often experiencing poor prognoses. Severe infection with SARS-CoV-2 is associated with oxidative stress (OS) and inflammation. Detecting markers of macromolecular damage caused by OS may provide valuable insights into disease progression. Methods: This study included 187 patients with laboratory-confirmed SARS-CoV-2 infection, categorized into non-severe, severe, and critically ill COVID-19 groups. We monitored the changes in serum indexes such as oxidized low-density lipoprotein (OxLDL), OxLDL/LDL-C ratio, advanced oxidation protein products (AOPP), 3-nitrotyrosine (3-NT), 8-hydroxydeoxyguanosine (8-OHdG), lipoprotein-associated phospholipase A₂ (Lp-PLA₂) and thromboxane B₂ (TXB₂) in patients with different clinical types. Results: 48 non-severe patients, 90 severe patients, and 49 critically ill patients were enrolled. Compared with the non-severe group, OxLDL level and OxLDL/LDL-C ratio were increased in severe COVID-19 patients and critically ill COVID-19 patients, while 3-NT and TXB₂ concentrations were lower in critically ill COVID-19 patients. Critically ill COVID-19 patients also exhibited lower concentrations of Lp-PLA₂ and a higher OxLDL/LDL-C ratio compared to severe COVID-19 patients. No significant differences were observed in AOPP and 8-OHdG concentrations. Spearman's correlation analysis revealed that CRP was associated with OxLDL, OxLDL/LDL-C ratio, AOPP, 3-NT, TXB₂, and Lp-PLA₂ (P <0.05). OxLDL was identified as an independent risk factor for progression from non-severe to severe/critically ill COVID-19. OxLDL and OxLDL/LDL-C ratio demonstrated good discriminatory value between non-severe and severe/critically ill COVID-19, with the OxLDL/LDL-C ratio also distinguishing between severe and critically ill patients. Conclusion: Patients with severe and critically ill COVID-19 exhibit elevated levels of oxidative damage to lipoproteins. OxLDL and the OxLDL/LDL-C ratio can serve as biomarkers for assessing disease severity in COVID-19 patients.

Background: To evaluate the predictive effect of transvaginal ultrasound measurement of cervical length and cervical elasticity examination on cervical insufficiency in twin pregnancies. Methods: Data from twin pregnant women in our hospital were collected retrospectively, including relevant vaginal ultrasound parameters (e.g., cervical length, cervical elasticity score, and the strain value of each part of the cervix). We assessed the risk factors using receiver operating characteristic curve analysis to evaluate the predictive effect of each factor on the occurrence of cervical insufficiency. Results: A total of 284 pregnant women with twin pregnancies, including 142 with cervical insufficiency and 142 without cervical insufficiency, were included. Significant differences between the two groups were observed in the use of assisted reproductive technology, age, history of second-trimester miscarriage, etc. The cervical length of pregnant women with cervical insufficiency was significantly shorter at 22-24 weeks of gestation. Cervical length had the largest area under the receiver operating characteristic curve for predicting cervical insufficiency at that time. The area under the curve of cervical insufficiency predicted by the cervical elasticity score at 12-14 weeks of pregnancy was greater than that predicted by the cervical length at the same time, and the area under the curve of cervical insufficiency predicted by the elasticity score and pre-pregnancy body mass index during the same period was the largest. Conclusions: The cervical elasticity score at 12-14 weeks of gestation effectively predicted the occurrence of cervical insufficiency. The combination of the cervical elasticity score and pre-pregnancy body mass index predicted cervical insufficiency in women with twin pregnancies.

Background: To investigate the timing and extent of surgery for rib fractures in polytrauma patients. Methods: Data from polytrauma patients who underwent early and partial rib fracture fixation after successful resuscitation were retrospectively analyzed. The study encompassed demographic data, clinical data, and outcomes. Results: In total, 71 patients with polytrauma were included. ISS ranged from 16 to 50 with a mean score of 25.3±7.5. The median lactate level was 3.6 mmol/L (IQR: 3.1 to 4.5), the median base deficit (BD) was 8.2 mmol/L (IQR: 6.4 to 9.8) and the shock index (SI) median was 1.2 (IQR: 0.9 to 1.3). Total fractured ribs in 71 patients were 726; individually, the minimum and maximum number of fractured ribs was 3 and 22, respectively (median, 10; mean, 10.2 ± 4.0). The average time to surgery was 42.9±42.6 h. Specifically, 41(57.7%) received the surgery within 24h and 52 (73.2%) patients received the surgery within 3 days following successful resuscitation. A total of 246 (33.9%) ribs underwent open reduction and internal fixation with plate, 3.46 ribs for each patient, with high frequencies of the 6th (49, 19.9%), 5th (46, 18.7%), 4th and 7th ribs (both 36, 14.6%). The average length of ICU stay was 11.5 ± 7.5 days and the duration of hospitalization was 16.3 ± 9.9 days. No surgical site infection or mortality was observed. Conclusions: Early and partial rib fracture fixation to restore the relative stability of the thorax is safe and effective for polytrauma patients after successful resuscitation. This surgery strategy is called semi-damage control surgery.

Purpose: To investigate the influence of different keratometry (K) measurements on the postoperative outcomes of cataract surgery with extended depth-of-focus (EDOF) intraocular lens (IOL) implantation. Methods: A retrospective cohort study was conducted, and patients who received cataract surgery and one type of EDOF IOL implantation were included. The patients were then categorized according to K measurements, and 70 and 30 eyes were included in the biometric-K and topographic-K groups, respectively. The primary outcomes were postoperative uncorrected distance visual acuity (UDVA), spherical equivalent (SE) and cylinder power. A generalized linear model was applied to compare the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of the outcomes between groups. Results: One month after surgery, the UDVA was 0.15 and 0.07 in the biometric-K group and topographic-K group, respectively. Furthermore, the final SEs were -0.42 D and -0.13 D in the biometric-K group and topographic-K group, respectively, and the final cylinder powers were -0.35 D and -0.13 D in the biometric-K group and topographic-K group, respectively. According to the multivariate analysis, the topographic-K group presented a significantly better UDVA (P = 0.044) and significantly lower cylinder power (P = 0.031) than the biometric-K group. Angle kappa was significantly correlated with high postoperative astigmatism in the topographic-K group (P = 0.033), whereas angle kappa, steep K, and corneal cylinder powers were significantly correlated with high postoperative astigmatism in the biometric-K group (all P < 0.05). Conclusion: Topography-based K measurements yielded better refractive outcomes than biometric-based K measurements did.

Purpose: To evaluate the potential risk factors for poor dry eye disease (DED) outcomes after intense pulse light (IPL) treatment. Methods: A retrospective case-control study was conducted, and patients who received IPL were enrolled. A total of 63 eyes were included in the present study after exclusion and were divided into a fair outcome group and a poor outcome group according to posttreatment improvements in DED-related signs and symptoms. The primary outcomes are the pretreatment parameters between the two groups. The Mann‒Whitney U test and generalized linear model were adopted to analyze the differences in pretreatment indices between the two groups. Results: Both the fluorescein stain results and the Schirmer II test results after IPL treatment were significantly better than those before IPL treatment (both P < 0.05). Nevertheless, the overall DED-related symptoms did not significantly improve after IPL treatment (P = 0.834). In terms of indicators of poor outcomes after IPL treatment, the rates of advanced age, female sex, previous refractive surgery, lower pretreatment noninvasive tear break-up time (NITBUT) and greater meibomian gland loss were significantly greater in the poor outcome group (all P < 0.05). Female sex and previous refractive surgery were associated with less improvement in DED-related symptoms (all P < 0.05), whereas advanced age, a lower pretreatment NITBUT and a higher meibomian gland loss rate were related to poor DED sign improvement (all P < 0.05). Conclusion: The major limitations are the retrospective design, small study population, and absence of detailed posttreatment exams. In conclusion, old age, female sex, previous refractive surgery, a lower NITBUT, and a higher meibomian gland loss rate are associated with worse outcomes after IPL treatment.

A disintegrin and metalloproteinase domain-containing protein 9 (ADAM9) functions as a membranous bridge, forming cell-cell and cell-matrix connections that regulate tumor aggressiveness in various cancer types, including prostate cancer (PCa). Elevated ADAM9 levels in PCa were identified as a prognostic marker for biochemical recurrence (BCR) in patients who had undergone a radical prostatectomy (RP). However, impacts of genetic variants of ADAM9 on clinicopathological development and BCR remain unclear. Herein, we recruited 702 patients with PCa to evaluate associations of single-nucleotide polymorphisms (SNPs) of ADAM9 with the risk of BCR and clinicopathological development. We genotyped four loci of ADAM9 SNPs located in the promoter and intron regions using a TaqMan allelic discrimination assay, including rs10105311 (C/T), rs7006414 (T/C), rs6474526 (T/G), and rs78451751 (T/C) in 702 Taiwanese PCa patients. Our results showed that the risk of postoperative BCR was 1.508-fold higher in patients carrying the T/C genotype in ADAM9 rs7006414 compared to those with the homozygous T/T genotype, a phenomenon more pronounced in younger PCa patients (aged ≤ 65 years). Furthermore, patients with at least one polymorphic G allele in ADAM9 rs6474526 had a 2.016-fold increased risk of developing an advanced clinical primary tumor stage, particularly in a subpopulation without BCR. Clinical observations from the Genotype-Tissue Expression (GTEx) database showed increased ADAM9 expression in whole blood tissues among individuals carrying the polymorphic C allele of rs7006414 and the G allele of rs6474526. Additionally, data from The Cancer Genome Atlas indicated that elevated ADAM9 levels were observed in PCa tissues compared to corresponding matched normal tissues. Our findings suggest that the rs7006414 and rs6474526 genetic variants of ADAM9 may influence ADAM9 expression and are associated with BCR and clinicopathological development in PCa patients after an RP.

The chronic non-healing diabetic wound (DW) has remained a challenge to both the society and individuals. Previous studies suggested dietary moderate consumption of quercetin (QCT) are beneficial in preventing diabetic complications, including non-healing DW. However, there were few studies that have investigated QCT-related underlying molecular mechanisms against DW. In the present study, we for the first-time combined network pharmacology with molecular docking and experimental validation to investigate QCT-related therapeutic targets and mechanisms for treating DW. Finally, 191 QCT-related targets and 1750 DW-related pathogenetic targets were obtained from online databases. After removing duplicates, a total of 90 potential therapeutic targets of quercetin for treating DW were ultimately identified. Furthermore, 7 targets with higher degree including IL-6, EGFR, SRC, TNF, AKT1, JUN and MMP9 were predicted as central therapeutic targets of QCT for treating DW. Functional enrichment analysis demonstrated that QCT exerted strong levels of multitargeting regulatory activity. In addition, the KEGG enrichment analysis indicated that several signaling pathways including AGE-RAGE signaling pathway in diabetic complications, IL-17, PI3k-AKT, TNF, HIF-1, VEGF were predicted as key regulators of QCT for treating DW. Molecular docking results suggested that QCT had strong binding activity with the predicted targets. In addition, verification experiments suggested that QCT could significantly attenuated the expression of inflammatory cytokines and the regulation of PI3K-AKT signaling pathway was probably a vital mechanism involved in the pharmacological mechanism of QCT for treating DW. Taken together, combined network pharmacological with experimental validation, we for the first time systematically investigated associated-therapeutic targets and potential pathways of QCT for DW treatment. Our study might provide theoretical basis for DW treatment.

MicroRNAs (miRNAs)-based therapies hold great promise for cancer treatment, challenges such as expression variability, off-target effects, and limited clinical effectiveness have led to the withdrawal of many clinical trials. This review investigates the setbacks in miRNA-based therapies by examining miR-21, miR-34, and miR-155, highlighting their functional complexity, off-target effects, and the challenges in delivering these therapies effectively. Moreover, It highlights recent advances in delivery methods, combination therapies, and personalized treatment approaches to overcome these challenges. This review highlights the intricate molecular networks involving miRNAs, particularly their interactions with other non-coding RNAs, such as long non-coding RNAs (lncRNAs) and circular RNAs (circRNAs), emphasizing the pivotal role of miRNAs in cancer biology and therapeutic strategies. By addressing these hurdles, this review aims to steer future research toward harnessing the potential of miRNA therapies to target cancer pathways effectively, enhance anti-tumor responses, and ultimately improve patient outcomes in precision cancer therapy.