Irish Journal of Medical Science最新文献

Backround and aim: Lichen planus (LP) is a chronic inflammatory dermatosis with an unclear pathogenesis. Recent studies suggest that iron metabolism, oxidative stress, and ferroptosis mechanisms may play a role in the development of LP. Transferrin Receptor 2 (TFR2), an important receptor in iron homeostasis, may contribute to these processes.

Methods: TFR2 immunoreactivity was evaluated using immunohistochemical methods on skin biopsies obtained from patients diagnosed with cutaneous LP (n = 45) and healthy controls (n = 30). Staining intensity was measured with QuPath image analysis software using 3,3'-diaminobenzidine (DAB). In addition, histopathological findings and staining localization were examined.

Results: In healthy skin samples, TFR2 expression was limited, showing only weak staining in the basal epidermis and mild cytoplasmic positivity around the dermal vasculature (mean DAB intensity: 22.0% ± 5.5). In contrast, LP lesions exhibited pronounced epidermal irregularities, hyperkeratosis, inflammatory infiltration, and significantly increased TFR2 expression (mean DAB intensity: 57.0% ± 5.9; p < 0.05). Notably, strong cytoplasmic staining was observed in the epidermal basal layer and dermal inflammatory cells.

Conclusion: This study demonstrated a significantly increased expression of TFR2 in LP lesions compared to healthy skin. The findings suggest that TFR2 may contribute to the pathogenesis of LP through the ferroptosis mechanism mediated by oxidative stress. However, further advanced studies evaluating specific markers related to ferroptosis are needed to better clarify this relationship.

Background: Anal intraepithelial neoplasia (AIN) is a precursor to anal squamous cell carcinoma (ASCC). Although rare in the general population, the incidence of anal cancer is increasing particularly in high risk groups. While emerging evidence based management strategies are evolving, there is increasing recognition of the need for specialized, regionalized services to improve patient outcomes. This nationwide survey was conducted to determine the current AIN care landscape and to gauge opinion on development of centralised regional pathways for its management.

Methods: A structured survey was developed using SurveyMonkey® and distributed by email to 60 currently practicing consultant colorectal surgeons in the Republic of Ireland. Participation was voluntary. A total of 20 responses were received and included in the analysis.

Results: Of the 20 respondents, 95% (n = 19) reported managing patients with AIN; however, 65% (n = 13) saw fewer than 10 cases per annum. Anal mapping was widely practiced n = 19 by all respondents who manage AIN patients, with a median of 12 biopsies per procedure (range 3-24). Common biopsy sites included perianal skin 83% (n = 15), anal verge 61% (n = 11), dentate line 28% (n = 5), and the squamocolumnar junction 22% (n = 4). The use of acetic acid and anoscopy was less frequent (25% for each, n = 5). Histopathology reporting was reported to be inconsistent and varied depending on the reporting pathologist, with terminology ranging from AIN to high-grade squamous intraepithelial lesion (HSIL). Treatment approaches varied: 84.2% offered surgical excision, 57.8% topical therapies, and 47.3% ablation. Imiquimod and 5-fluorouracil (5-FU) were the most commonly used topical agents. All respondents indicated a willingness to refer patients to a specialised centre should a regional AIN service be established.

Conclusion: There is significant variation in the investigation, terminology, and management of AIN among colorectal surgeons in Ireland. These findings highlight the need for standardised national guidelines and support the idea of consolidating care for patients with AIN in specialised regional centres to provide consistency in the investigation and management of this condition in Ireland.

Background: Muscle architecture, including thickness, pennation angle, and fascicle length, underpins function and adaptation, but its relationship with aerobic capacity in young adults remains unclear.

Objective: To compare lower extremity muscle architecture and aerobic capacity between regularly exercising and non-exercising young adults, and to examine associations between architectural parameters and maximal oxygen uptake(VO₂max).

Methods: Fifty-two healthy participants (18-35 years) were included:26 in the exercise group (EG) and 26 in the non-exercise group(NEG). The EG had been performing supervised exercise at the university fitness center for 6-18 months, at least three times per week, whereas the NEG had not engaged in any structured exercise for at least six months. Ultrasound imaging was used to assess muscle thickness, pennation angle, and fascicle length of the rectus femoris(RF), vastus intermedius(VI), vastus medialis(VM), vastus lateralis(VL), tibialis anterior(TA), hamstring, gastrocnemius medialis(GM), and gastrocnemius lateralis(GL). VO₂max, as an indicator of aerobic capacity, was assessed using open-circuit spirometry during a treadmill test.

Results: VO₂max was significantly higher in the EG(46.95 ± 6.23 mL·kg⁻¹·min⁻¹) than in the NEG(37.29 ± 5.07; p < 0.001). Pennation angles of the VI (p = 0.002), VL (p = 0.003), and TA (p = 0.023) were greater in the EG. VO₂max correlated positively with muscle thickness (RF, VI, VL, TA), VI pennation angle, and TA fascicle length (p < 0.05).

Conclusions: Regular exercise appears to promote architectural adaptations in lower-extremity muscles that may support improved aerobic capacity. Muscle architecture may therefore represent a meaningful physiological marker of training status in young adults.

Background: Cadmium (Cd) is a major environmental and industrial pollutant that exhibits a significant health risk to humans and animals. Renal toxicity is a prevalent adverse effects of cadmium exposure. Rebamipide (REBA) is pharmacological agent known for its potent antioxidants properties.

Aim: This study aimed to investigate the potential reno-protective effects of rebamipide against cadmium-induced nephrotoxicity.

Main methods: Fifty rats were allocated into five groups; (1) a normal control group; (2) cadmium chloride group (5 mg/kg, single dose, i.p.); (3) a group treated with rebamipide (100 mg/kg, p.o.) for nine days (seven days before and two days after a single cadmium dose); (4) a group treated with rebamipide (200 mg/kg, p.o.) for nine days (seven days before and two days after a single cadmium dose); and (5) a group treated with rebamipide only (200 mg/kg, p.o.) for nine days.

Key findings: Cadmium administration significantly increased serum urea, creatinine, and the renal injury marker KIM-1. It also elevated inflammatory mediators, including tumor necrosis factor-α (TNF-α), nuclear factor kappa B (NF-κB), and inducible nitric oxide synthase (iNOS). Concurrently, cadmium halted catalase (CAT), superoxide dismutase (SOD) activities, and reduced glutathione (GSH) level, while increasing malondialdehyde (MDA) content. Furthermore, cadmium dysregulated autophagy, decreasing Beclin-1 and increasing microtubule-associated protein 1 light chain 3 (MAP-LC3) levels. Treatment with rebamipide effectively improved renal histology, reduced inflammatory markers, and restored the balance of all the aforementioned oxidative and autophagic parameters.

Conclusion: Rebamipide acts as a promising preventive agent against cadmium-induced nephrotoxicity, through its potent antioxidant and anti-inflammatory mechanisms.

Background: Malnutrition is a common geriatric syndrome among older adults and is linked to other geriatric syndromes, such as dementia, falls, frailty, and sarcopenia. In 2019, the Global Leadership Initiative on Malnutrition (GLIM) introduced new criteria for diagnosing malnutrition.

Aim: This study aimed to compare the relationship between malnutrition and other geriatric syndromes using the GLIM and Mini Nutritional Assessment Short Form (MNA-SF).

Methods: This retrospective observational study included 228 geriatric outpatients enrolled between April 2023 and June 2024. MNA-SF 0-7 scores indicate malnutrition. The GLIM criteria were applied, except for low muscle mass, which was substituted by low hand-grip strength (GLIM-HG). Frailty, depression, chronic pain, polypharmacy, probable sarcopenia, urinary incontinence, and falls were also evaluated.

Results: Malnutrition rates were 6.6%, 21.1%, and 29.8% according to the MNA-SF, GLIM, and GLIM-HG, respectively. After screening for malnutrition using the MNA-SF, a second evaluation with the GLIM was performed for patients with malnutrition and at risk of malnutrition. Malnutrition was 17.5% with two-step GLIM. MNA-SF, GLIM, and two-step GLIM were significantly associated with falls, depression, probable sarcopenia, and frailty. According to the MNA-SF, malnutrition showed the strongest association with falls, depression, and frailty. The agreement between MNA-SF and GLIM was moderate (κ = 0.383; 95% CI: 0.232-0.533), whereas the agreement between GLIM and two-step GLIM was strong (κ = 0.888; 95% CI: 0.812-0.964).

Conclusion: The GLIM criteria are useful in outpatient settings. Applying GLIM after nutritional risk screening may help reduce the risk of overdiagnosis.