Journal of Medicine and Life最新文献

Neuroscience has advanced over the years largely due to animal experiments, particularly in mice. These experiments are generally challenging and require thorough preparation to be successfully carried out. The training required to perform procedures on mice must be rigorous to minimize the risk of errors that could lead to experimental failure and, equally important, to prevent unnecessary suffering of the animals involved. In this study, we present a detailed description of the surgical procedure for intrahippocampal injection in mice using a motorized stereotaxic system equipped with synchronized drilling and microinjection modules. The protocol emphasizes precise anatomical targeting, controlled infusion parameters, and standardized procedural steps designed to enhance reproducibility and minimize tissue trauma. Key aspects of the technique include stereotaxic atlas alignment, skull reference acquisition, controlled drilling to the dura mater, and microinjection of small tracer volumes under physiologically relevant conditions. This methodological framework provides a reliable platform for investigating brain parenchymal transport mechanisms, including intramural periarterial drainage pathways implicated in neurodegenerative disorders such as Alzheimer's disease.

Contemporary orthopedic education faces reduced clinical exposure, increasing procedural complexity, and growing emphasis on patient safety. Simulation-based learning (SBL) offers a structured alternative to traditional apprenticeship models, enabling deliberate practice and competency-based assessment. This study evaluated the educational impact of a structured, hands-on, simulation-based orthopedic workshop on the development of technical and non-technical competencies among medical students. We conducted a prospective pre-post interventional study including 70 medical students across all 6 years of training. Participants completed pre- and post-intervention assessments evaluating self-confidence in musculoskeletal trauma management, perceived technical skills, non-technical competencies (communication, teamwork, situational awareness), motivation toward orthopedics, and theoretical knowledge through a 10-item multiple-choice questionnaire. Statistical analysis employed non-parametric testing (Wilcoxon signed-rank, Mann-Whitney U, Kruskal-Wallis). Effect sizes were calculated using r = Z/√N, with values > 0.5 indicating large effects. Internal reliability was assessed using Cronbach's alpha. Significant improvements were observed across all evaluated domains (all P < 0.001), with large effect sizes (r > 0.5). Confidence in musculoskeletal trauma management demonstrated the greatest increase (median 4 pre-workshop vs. 9 post-workshop). Theoretical knowledge improved in most domains. Internal consistency of the assessment instrument was excellent (Cronbach's alpha 0.896-0.961). Senior students demonstrated higher baseline and post-intervention scores compared to junior cohorts (P < 0.05). No significant gender-based differences were identified, except in procedural risk recognition (P < 0.001). Participation in a structured simulation-based orthopedic workshop was associated with meaningful multidimensional educational gains, including enhanced perceived technical competence, strengthened non-technical skills, increased confidence, and improved knowledge acquisition.

Preeclampsia (PE) remains a major cause of maternal and fetal morbidity and mortality worldwide, with placental dysfunction and angiogenic imbalance playing central roles in disease pathogenesis. Emerging evidence highlights epigenetic regulation and angiogenic biomarkers, including placental growth factor (PlGF), as key contributors to disease heterogeneity and risk stratification. A systematic review of studies published between 2022 and 2025 was conducted in accordance with PRISMA 2020 guidelines to synthesize current evidence on epigenetic mechanisms and biomarker potential in PE. In addition, a supplementary exploratory analysis was performed using laboratory-derived PlGF data to assess analytical variability and biological associations. Non-parametric methods were applied, including Mann-Whitney U testing to compare PlGF distributions by analytical sample classification and Kendall's tau correlation to evaluate associations with gestational age and the sFlt-1/PlGF ratio. The systematic review identified consistent epigenetic alterations involving DNA methylation, histone modifications, and non-coding RNAs across maternal and placental tissues. Supplementary analysis demonstrated significantly higher and more variable PlGF concentrations in analytically classified measured samples compared with accepted samples (P = 0.03), suggesting an influence of analytical factors on biomarker distribution. PlGF levels showed a positive association with gestational age (τ = 0.32, P = 0.04) and an inverse association with the sFlt-1/PlGF ratio (τ = -0.41, P = 0.02). These findings support PlGF as a biologically relevant marker of gestational progression and angiogenic balance while underscoring the importance of rigorous analytical quality control. Integrating epigenetic insights with robust biomarker analysis may enhance personalized risk stratification in preeclampsia.

Psoriasis, one of the most prevalent dermatological diseases, is a chronic inflammatory condition influenced by genetic and environmental factors, such as lifestyle and nutrition. Regarding lifestyle, body weight, smoking, and alcohol consumption have been studied in the last decades, for their association with the risk of developing psoriasis and with its severity. Moreover, the association between diabetes mellitus and psoriasis severity is also under research. In our observational cross-sectional study, we examined a convenience sample of 282 patients with psoriasis vulgaris, aged 18 to 79 years. The Psoriasis Area and Severity Index (PASI) score ranged from 1 to 54, with a mean of 8.34 ± 6.69; patient body mass index (BMI) ranged from 18.80 to 57.19, with a mean of 25.96 ± 5.21, and increased with patient age. A direct correlation was observed between BMI and psoriasis severity; non-smokers generally had lower PASI scores, although the association was not statistically significant (P = 0.944). Similarly, PASI scores were generally higher in alcohol consumers, but this association was also not statistically significant (P = 0.983). A non-statistically significant increase in PASI scores was also observed in patients with diabetes as a comorbidity. Based on our study conducted on a convenience sample from a Romanian hospital, it appears that higher BMI, alcohol consumption, and smoking are associated with increased PASI score values. However, further research is needed to understand the underlying mechanisms better.

There are variations among healthcare providers regarding the gestational age considered the threshold of viability. Currently, the World Health Organization sets the lower limit of viability at 22 weeks of gestation, or a birth weight of 500 g, or a birth length of 25 cm. Neonates are not autonomous. The present study aimed to evaluate the factors involved in healthcare professionals' management decisions in cases of neonates born at the margins of viability. A narrative review was conducted, including articles published between 2005 and 2025. We included 55 manuscripts and used the SANRA quality scale for assessment. The various approaches currently used worldwide raise concerns about their potential impact on the quality of care provided to these infants. We explored survey-based evidence regarding perceptions of the limit of viability and therapeutic decisions that raise ethical issues. The lack of coherent national guidelines and legislation represents an important burden for our healthcare system. Clinicians are faced with a dilemma regarding the correct management of infants at the limit of viability: whether to prolong treatment despite possible neurological impairment or to indicate discontinuation of treatment. Prenatal counseling for parents before delivery, along with a multidisciplinary approach, is required.

Androgen deprivation therapy (ADT) has long been a cornerstone of treatment for patients with locally advanced or metastatic hormone-sensitive prostate cancer. The efficacy of ADT plus radiotherapy (RT) compared to ADT alone remains unclear due to conflicting results in existing literature. The study aimed to systematically evaluate the effectiveness of ADT combined with RT versus ADT alone in patients with prostate cancer (clinically node positive, locally advanced disease, metastatic disease), focusing on overall survival (OS), prostate-specific mortality (PSM), progression-free survival (PFS), and the risk of complications. A comprehensive search of PubMed, Embase, Web of Science, and Scopus was conducted between 1^st January 2000 and 15^th October 2024 to identify studies comparing ADT alone to ADT combined with RT. Hazard ratios (HRs) and relative risks (RRs) with 95% confidence intervals (CIs) were calculated for the outcomes. The certainty of the evidence was assessed using the standard GRADE approach. A total of 8 studies met the inclusion criteria (6 RCTs and 2 cohort studies). These studies included 18,456 patients. The combination of ADT and RT significantly improved OS (HR = 0.75, 95% CI, 0.63, 0.90), PFS (HR = 0.41, 95% CI, 0.20, 0.84), and reduced PSM (HR = 0.52, 95% CI, 0.34, 0.78) compared to ADT alone. Subgroup analysis showed greater OS (HR = 0.66, 95% CI, 0.59, 0.75) and PSM (HR = 0.43, 95% CI, 0.39, 0.49) in patients with locally advanced or node-positive disease. ADT + RT was also associated with increased risks of genitourinary (RR = 1.80, 95% CI, 1.15, 2.82), gastrointestinal (RR = 4.18, 95% CI, 1.46, 11.96), and sexual dysfunction-related complications (RR = 1.10, 95% CI, 1.02, 1.18). The overall certainty of evidence was judged to be 'moderate' for survival outcomes and 'low' for risk of complications. Combining ADT with radiation therapy RT significantly improved survival, compared to ADT alone, especially in patients with locally advanced or node-positive prostate cancer, yet with moderate GRADE certainty. However, this combination also increased the risk of complications. The results advocate that our findings are most applicable to high-risk non-metastatic and cN+ disease and do not support routine addition of RT to ADT in unselected metastatic patients. Therefore, further research is needed to refine treatment protocols and identify the optimal timing and patient subgroups for this approach.

Mechanical biocompatibility reflects the ability of a prosthetic mesh to integrate within host tissues while maintaining appropriate mechanical behavior. This retrospective study analyzed 213 patients who underwent incisional hernia repair to assess the clinical performance of polypropylene, polyester, and composite meshes. Evaluated variables included defect size, operative duration, suture type, mesh type, and patient comorbidities. Outcomes comprised hospitalization length and postoperative complications. No statistically significant differences were found among mesh types regarding hospitalization time or complication rates, suggesting comparable clinical and mechanical biocompatibility. Polyester meshes were more frequently used for smaller defects, whereas polypropylene meshes predominated for larger defects, reflecting technical rather than clinical considerations. Age showed a moderate positive correlation with hospitalization duration. In univariate analysis, operative procedures lasting approximately 2 hours were associated with higher complication rates; however, in multivariable logistic regression, chronic pulmonary disease (COPD) emerged as the only independent predictor of postoperative complications. Mesh type, operative duration, and surgical technique were not independently associated with adverse outcomes. These findings indicate that postoperative evolution in incisional hernia repair depends primarily on patient-related factors and intraoperative mechanical conditions rather than on the intrinsic polymer composition of the mesh.

This study investigated the therapeutic effectiveness of the Berard Auditory Integration Training (AIT) protocol, a neurosensory intervention believed to address underlying auditory processing deficits that often contribute to the high comorbidity of learning disabilities (LD) and attention-deficit/hyperactivity disorder (ADHD), for treating children diagnosed with both conditions. A prospective, single-arm interventional study was conducted using a standardized 10-day AIT program with the Earducator device on ten pediatric participants with dual diagnoses. Measurements were taken at baseline, mid-intervention, post-intervention, and a 15-day follow-up using a validated behavioral observation checklist and an academic skills assessment. Quantitative analysis demonstrated marked improvements across all domains, with hyperactivity and attention-deficit scores significantly decreasing from severe to mild-moderate levels, and academic skills such as letter recognition and language showing consistent improvement. Furthermore, qualitative parental reports corroborated these findings, noting improvements in social interaction, reduced auditory sensitivity, and better adaptive behaviors. The findings provide preliminary evidence that AIT serves as an effective adjunctive therapy for reducing core ADHD symptoms and fostering academic and behavioral gains in children with LD, thus justifying the need for larger, randomized controlled trials.

This observational single-center study, conducted from 2021 to 2024, evaluated patient tolerance of laryngeal electromyography (LEMG) using a standardized post-procedural questionnaire completed by 97 patients undergoing LEMG for suspected laryngeal neuromuscular dysfunction. After the procedure, patients completed a structured questionnaire designed to assess procedural tolerance across five domains: overall perception, pain intensity (visual analogue scale [VAS]), anxiety, cooperation, and post-procedural discomfort. A total tolerance score (range 0-21) was calculated for each patient. We additionally analyzed the correlation between tolerance scores and specific patient variables, including age, sex, and body mass index (BMI). Based on the total tolerance score, 32 patients (32.99%) reported excellent tolerance, 33 (34.02%) good tolerance, 9 (9.28%) poor tolerance, and 3 (3.09%) very poor tolerance. Female patients demonstrated a significantly better tolerance than male patients. No significant association was observed between tolerance score and age or BMI. No significant discomfort affecting swallowing/breathing, or voice, or any important external bleeding was reported. LEMG is generally well tolerated when performed using a standardized technique. Patient tolerance varies between individuals and appears to be influenced more by subjective factors. The structured questionnaire proved useful and provides a more extensive assessment of LEMG tolerability in clinical practice. However, because this is a single-center study, further research is needed to validate this tolerance questionnaire.

Urinary incontinence remains a major functional complication after radical prostatectomy. Although laparoscopic radical prostatectomy (LRP) provides perioperative advantages over open radical prostatectomy (ORP), its impact on continence recovery remains uncertain. This study aimed to compare urinary continence recovery at 3, 6, and 12 months after ORP and LRP and to explore clinical predictors of postoperative continence. This retrospective two-centre cohort included 75 consecutive patients undergoing ORP (n = 50) or LRP (n = 25) between January 2022 and December 2024, performed by the same surgical team. Continence was defined as 0-1 pad/day and assessed at predefined intervals. Between-group differences were expressed as absolute risk differences with 95% confidence intervals (CIs). Prespecified multivariable logistic regression models were constructed, with Firth penalized regression applied at 12 months due to sparse events. Baseline oncologic characteristics were comparable, with higher body mass index (BMI) in the ORP group (P < 0.001). LRP was associated with shorter operative time, lower blood loss, and reduced hospitalization (all P < 0.001). Continence rates did not differ significantly at 3 months (62% vs. 64%), 6 months (72% vs. 76%), or 12 months (86% vs. 88%). Surgical approach was not independently associated with continence at any time point, whereas higher BMI was consistently associated with persistent incontinence. Continence recovery was broadly similar between ORP and LRP. Despite perioperative advantages of LRP, functional outcomes were more strongly associated with patient-related factors than with surgical access. Larger prospective studies are warranted.