Journal of Medicine and Life最新文献

Autism Spectrum Disorder (ASD) in adult women without intellectual or language impairments is frequently under-recognized, due to subtler manifestations, greater use of compensatory social strategies, and reliance on diagnostic frameworks developed from male presentations. Diagnostic overshadowing, where autistic traits are misattributed to other psychiatric conditions, further delays accurate identification. This narrative review aims to critically evaluate recent evidence on the diagnostic challenges of ASD in adult women without intellectual or language impairments, assess the performance of widely used screening tools, and present recommendations for improving gender-sensitive diagnostic practices. A structured literature search was applied (PubMed, PsycINFO, Scopus; January 2010-July 2025; English language) targeting studies on females aged ≥18 years without intellectual or language impairment. Diagnostic accuracy, screening tools, camouflaging, misdiagnosis, and psychosocial outcomes were examined. Original research, meta-analyses, and systematic reviews were included, and a narrative synthesis approach was chosen due to study heterogeneity. Female-typical presentations often include subtle social-communication differences, context-specific restricted interests, and higher camouflage levels than males, which decrease the sensitivity of standard screening tools. Women are more likely to receive prior psychiatric diagnoses before ASD is recognized, contributing to mental health burdens and poorer functional outcomes. Current adult ASD screening tools have limited capacity to detect female phenotypes. Integrating camouflaging assessment, nuanced developmental histories, and updated, gender-inclusive screening instruments is essential to improving diagnostic equity.

Stroke, which is a leading cause of disability, is presumed to affect hearing by impacting the auditory pathways or hearing organs, influencing communication and socialization. We analyzed data from the National Health Interview Survey (NHIS) from 2015-2018, including 118,625 individuals. Hearing function and activity limitations were evaluated by self-reported measures. Various statistical tests and regression analyses were used to compare and investigate the data between the different groups. Stroke patients had a higher prevalence of hearing dysfunction, with 23.8% reporting excellent hearing versus 46.9% among non-stroke individuals (P < 0.001). Additionally, stroke patients exhibited higher rates of little trouble hearing (19.9% vs. 10.9%), moderate trouble hearing (10.5% vs. 4.2%), much trouble hearing (8.7% vs. 2.2%), and deafness (0.8% vs. 0.3%) when compared to non-stroke subjects (P < 0.001 for all). Several factors were identified as significant contributors to hearing impairment among stroke patients, including male gender (OR = 1.58; 95% CI, 1.39-1.8; P < 0.001), diabetes (OR = 1.2; 95% CI, 1.04-1.38; P = 0.01), smoking (OR = 1.44; 95% CI, 1.2-1.73; P < 0.001), and sinusitis (OR = 1.45; 95% CI, 1.23-1.7; P <0.001). Stroke among subjects with hearing impairment was strongly related to limitation in leisure and social activities (OR = 2.5; 95% CI, 2.30-2.84). Our study demonstrates significantly higher rates of hearing impairment among stroke patients compared to non-stroke individuals, which adversely impacts their participation in leisure and social activities.

Simple, non-invasive, and affordable ambulatory fetal monitoring methods have been integrated into routine prenatal care, with the potential to enhance maternal-fetal health surveillance. Although conventional prenatal care is the basis of pregnancy monitoring, more and more studies are presenting complementary approaches that aim to identify early, potentially pathological changes in fetal status. The use of portable devices, such as a handheld fetal Doppler (for at-home detection of fetal heartbeats) and a pulse oximeter (for maternal heart rate assessment), has been proposed as additional tools in the context of pregnancy monitoring. These devices may influence patients' behavior regarding seeking medical care and using health services. Access to instruments that allow minimal monitoring at home for pregnant women could facilitate the earlier identification of possible changes, especially in situations where access to direct medical consultations is delayed or restricted. The ease of use and availability of these devices in the broader market raise the question of their integration into a standardized prenatal monitoring framework. This study investigated the feasibility and patients' perceptions of using handheld Dopplers during pregnancy. An observational analytical study was conducted between January 2019 and December 2023 at the Polizu Clinical Hospital in Bucharest, involving 1,127 pregnant women who met the inclusion criteria (gestational age between 14 and 27 weeks + 6 days and absence of major psychiatric disorders). Of these, 101 women completed a questionnaire regarding fetal monitoring in the second trimester. Responses were analyzed with a focus on the perceived usefulness of the handheld Doppler at home. The majority of participants (79.2%) considered the device helpful, 76.2% reported that it provided them with peace of mind, and 22.8% noted that it led to greater involvement from their partner or family. These findings demonstrate the good acceptability of the tested device, especially among pregnant women in their first pregnancy or with a perceived increased risk, and support the opportunity to integrate this type of monitoring into current obstetric practice. Furthermore, ambulatory and home fetal monitoring solutions provide valuable support in the management of modern pregnancies, but they cannot replace clinical assessment and specialist supervision.

Osteonecrosis of the femoral head (ONFH) is a challenging condition that mainly affects young and middle-aged adults, causing pain, disability, and joint collapse. Current treatment options include medications, physical therapy, and surgical interventions such as core decompression and total hip replacement. However, there is growing interest in regenerative medicine for managing ONFH. This study evaluated the outcomes of core decompression augmented with adult autologous live cultured osteoblasts (AALCO) in patients with early-stage ONFH. Patients diagnosed with ONFH, Ficat-Arlet Grades 1, 2, and 3, underwent a staged procedure involving bone marrow aspiration and the cultivation of 48 million osteoblastic lineage cells. Subsequently, this culture was injected following core decompression and curettage of the necrotic area in the femoral heads. Patients were then followed for 18 to 26 months and evaluated for radiological progression of the disease and changes in functional outcome using the Harris Hip Score (HHS) and Visual Analog Scale (VAS). Forty-eight hips (34 patients with 14 bilateral ONFH) were included in the study and followed up for 18 to 26 months. During this period, 29 patients (40 hips) exhibited progressive signs of healing, resulting in a significant improvement in the mean HHS and a reduction in VAS scores. Core decompression augmented with implantation of autologous live cultured osteoblasts is a reliable treatment approach for managing the early stages of ONFH in young patients caused by various factors. The method aims to halt disease progression through osteoblastic stem cell-mediated new bone formation, leading to improved functional outcomes and potentially delaying or avoiding the need for total hip arthroplasty.

Systemic mastocytosis (SM) is a rare clonal mast cell disease characterized by heterogeneous clinical presentations and molecular features that vary across different regions; however, data from Central-Eastern Europe remain limited. This study aimed to describe the demographic, clinical, laboratory, and molecular characteristics of Romanian adults diagnosed with SM and followed at the national reference center for mast cell disorders in Bucharest, while also exploring real-world management patterns and outcomes. We conducted a retrospective observational study including 162 adult patients evaluated between January 2006 and March 2025 who met the 2022 World Health Organization criteria for SM. Data extracted from electronic medical records included WHO subtype, KIT mutation status, serum tryptase levels, organ involvement, treatment history, and survival outcomes. A descriptive statistical approach was used, with continuous variables expressed as medians and interquartile ranges, and categorical variables as counts and percentages. A subset of eight patients underwent bone marrow flow cytometry immunophenotyping to assess the diagnostic contribution of CD2 and CD25. Among the entire cohort, indolent SM was the most frequent form (53.1%), followed by cutaneous mastocytosis (17.3%), smoldering SM (5.6%), aggressive SM (3.7%), and SM with associated hematologic neoplasm (8%). The KIT D816V mutation was detected in 43% of tested individuals, and the median baseline serum tryptase was 20.55 μg/L. Common organ-related findings included osteoporosis (17.9%), osteopenia (21.7%), cutaneous lesions (29%), and hepatomegaly (4%). First-line symptomatic therapy (H₁/H₂ antihistamines ± montelukast) was administered to 77% of patients, while four patients with advanced disease received midostaurin treatment. Immunophenotyping confirmed aberrant expression of CD2 and CD25 in all eight analyzed cases. This first national series from Romania underscores the predominance of indolent SM and the clinical burden of organ involvement, reinforcing the need for early diagnosis and personalized, risk-adapted therapeutic approaches.

Psoriasis is a chronic inflammatory cutaneous disease with a complex pathogenesis that remains incompletely understood. New data suggest that psoriasis severity may be more accurately assessed by examining inflammation, oxidative stress, and hormones, although further research is needed to substantiate the clinical value of these biomarkers. The multifactorial causes of psoriasis encompass metabolic deregulations, such as lipid alterations that favor inflammation, exacerbate immune cell activity, and worsen the disease symptomatology. The pathophysiological link between psoriasis and obesity may be revealed through a crosstalk between adipocytes and the immune system, mediated by diverse soluble mediators, including adipokines. In this autoimmune disease, dermal mesenchymal stem cells (MSCs) are potential cellular players that connect autoimmune mechanisms, inflammation, and dysregulation of lipid metabolism. Networks of soluble factors, immune and non-immune cells, and MSCs mediate the inflammatory state in psoriasis. In many recent studies, the relapse has been associated with the potential role of MSCs in this process, endorsing MSCs as a new therapeutic reservoir in psoriasis. Thus, in our review, we aimed to evaluate the potential connection between autoimmunity, inflammation, and dermal mesenchymal stem cells, along with dysregulation of lipid metabolism, to elucidate the identity of psoriasis and identify potential new diagnostic and/or therapeutic targets.

Cervical cancer remains one of the leading causes of cancer-related death among women globally, despite being largely preventable through human papillomavirus (HPV) vaccination and regular screening. While many European countries have made significant progress in reducing incidence and mortality, Romania continues to report the highest rates within the European Union. This narrative review synthesized data from PubMed, Web of Science, Embase, and Google Scholar to evaluate cervical cancer screening policies across Europe, with a particular focus on Romania. The review included studies on HPV vaccination, cytology- and HPV-based screening, national program implementation, and public health strategies. Countries with organized, population-based screening programs and high HPV vaccine coverage, such as the Netherlands, Finland, and the UK, demonstrate lower incidence and mortality. In contrast, Romania faces persistent systemic barriers: limited public awareness, insufficient infrastructure, low screening participation (<20%), and suboptimal HPV vaccine uptake. Efforts to align national policies with WHO and EU cancer control strategies remain fragmented. Romania illustrates the deep disparities in cervical cancer prevention within Europe. Strategic reforms, including transitioning to HPV-based screening, expanding access to vaccination, enabling self-sampling, and enhancing public education, are critical. Integration into broader EU frameworks such as Europe's Beating Cancer Plan may accelerate progress. While the tools for cervical cancer prevention are well established, Romania's case underscores the need for systemic, context-specific interventions to reduce disease burden and promote equity across Europe.

Fixed prosthetic restorations, particularly those made entirely of zirconia, are widely used in clinical dental practice for the restoration of natural teeth. Their success largely depends on the design of the tooth preparation, especially the type of finish line, as well as the restoration's ability to withstand occlusal forces during mastication. Over 12 months, a total of 21 extracted teeth were initially collected, from which six were selected for this study. To achieve the objective of the study, three teeth were prepared with a horizontal finish line (shoulder), and the remaining three were prepared without a defined finish line (vertical preparation). For each prepared tooth, three full-contour zirconia crowns were fabricated. To ensure accurate comparison and standardization of occlusal force application during mechanical testing, all crowns were designed with identical morphology. The force application device used in mechanical testing was digitally designed to replicate the anatomy of the antagonistic teeth corresponding to each tested crown. Samples I and III showed significant structural changes, including horizontal fractures at the cervical level. Samples II, 1, and 2 exhibited no visible damage. The maximum recorded compressive forces at which structural failure occurred varied widely, ranging between 180 N and 2537 N. Consequently, all samples that recorded fracture values below 1000 N were analyzed separately for interpretation. The findings of this experimental study indicate that tooth preparation design significantly influences the compressive strength of monolithic zirconia crowns. Both preparation types-shouldered and shoulderless-demonstrated high resistance values, with a slight advantage observed in favor of the preparations with a defined finish line (shoulder).

Trauma remains a leading cause of mortality worldwide, with uncontrollable bleeding contributing significantly to preventable deaths. This study assessed the utility of the shock index (SI) in predicting clinical outcomes in trauma patients. A retrospective analysis was conducted on 122 trauma patients admitted to King Abdullah University Hospital, Jordan. Patients were categorized into two groups based on their SI: normal (SI < 0.9) and elevated (SI> 0.9). Clinical outcomes, including the need for interventions, blood transfusions, and neurological status, were compared between the groups. Patients with elevated SI had worse neurological outcomes (17% vs. 1.1%, P < 0.001), higher rates of airway interventions (23% vs. 4.3%, P = 0.005), increased incidence of pneumothorax/hemothorax (P = 0.005), and a greater need for blood transfusions (10% vs. 1.1%, P = 0.046). Elevated SI was associated with overall hemodynamic instability and worse clinical outcomes, supporting its use as a rapid assessment tool in trauma care. Elevated SI was strongly associated with worse clinical outcomes in trauma patients, including increased need for interventions and higher complication rates. SI proves to be a simple yet effective tool for the rapid assessment of trauma severity, while holding the potential to improve early triage and decision-making within emergency care settings.

Preterm birth (PTB; < 37 weeks) affects ²10 % of pregnancies and is the leading cause of neonatal mortality. Whether maternal high-risk human papillomavirus (hr-HPV) infection contributes to spontaneous PTB is unsettled. Romania, with Europe's highest cervical-cancer burden, offers a relevant setting to explore this association. We prospectively followed 151 women enrolled before 14 weeks' gestation at a tertiary maternity hospital (January 2021-May 2022). Cervical samples were tested with the Cepheid Xpert HPV assay, which detects 14 high-risk HPV types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68). Maternal age, parity, smoking, body mass index, and comorbidities were recorded. PTB was defined as delivery < 37 weeks (very PTB < 34 weeks). Multivariable logistic regression estimated adjusted odds ratios (aOR) for PTB associated with hr-HPV, and Kaplan-Meier curves compared time-to-delivery between infected and uninfected pregnancies. hr-HPV DNA was detected in 60/151 pregnancies (39.7 %). PTB occurred in 28.3 % of hr-HPV-positive versus 13.2 % of hr-HPV-negative women (P = 0.02); very PTB rates were 8.3 % and 2.2 %, respectively. Median gestational age and birth weight were lower among infected mothers (38.0 weeks vs 39.0 weeks, P = 0.04; 3025 g vs 3230 g, P = 0.03), while Apgar scores were comparable. After adjustment for maternal covariates, hr-HPV remained independently associated with PTB (aOR = 2.38; 95% CI 1.07-5.29; P = 0.033), and survival analysis confirmed a higher cumulative hazard of early delivery (log-rank P = 0.021). First-trimester hr-HPV carriage approximately doubled the odds of preterm birth in this Romanian cohort, independent of established risk factors. Although genotype-specific risks require confirmation, the data align with emerging evidence that HPV infection itself-not only post-treatment cervical changes-may promote spontaneous PTB. If corroborated, these findings extend the public-health value of HPV vaccination beyond cancer prevention and support closer obstetric surveillance of hr-HPV-positive pregnancies.