Medicine最新文献

IgA nephropathy is the most common primary glomerular disease worldwide, with inflammation and autoimmune response mechanisms permeating the entire disease development process. The advancement of genome-wide association studies has enabled deeper understanding of the disease mechanisms and genetic susceptibility. Therefore, this study aims to explore the causal relationship between 731 immune cell types and the disease through Mendelian randomization (MR) analysis. This 2-sample MR study investigated bidirectional causal relationships using summary statistics for immune cells characteristics from the Genome-Wide Association Study (GWAS) catalog and IgA nephropathy from the FinnGen dataset. The study primarily utilized the Inverse Variance Weighted method for its main outcome. Additionally, the robustness of the results is further enhanced by analyses of heterogeneity, pleiotropy, and multiple sensitivity tests. After adjusting for false discovery rate (FDR), the study results revealed a bidirectional causal relationship between CD8 on terminally differentiated CD8+ T cells (OR = 0.77, 95% CI = 0.67-0.88, P = .0001) and CD4 on CD28+ CD4+ T cells (OR = 0.75, 95% CI = 0.64-0.87, P = .0001) with the risk of IgA nephropathy. CD64 on CD14+ CD16+ monocytes (OR = 0.66, 95% CI = 0.51-0.85, P = .0013) is considered a protective factor, while the percentages of CD8+ and CD8dim T cells (1.38, 95% CI = 1.17-1.63, P = .0002) in leukocytes are viewed as risk factors. This study employed genetic variation as an instrumental variable to explore the genetic association between immune cells and IgA nephropathy, aiming to offer new insights into early prevention and personalized treatment of the disease.

Cysteine cathepsins are a family of lysosomal proteases that are often overexpressed in several human malignancies and haves been linked to cellular genomic alterations, disturbances in genomic stability, and the onset and spread of cancer. Recent studies have shown alterations in cysteine cathepsins in malignant ovarian tumors. However, it remains unclear whether there is a causal relationship between ovarian cancer, and its subtypes, and the cathepsin family. This study utilized two-sample Mendelian randomization (MR) analysis to examine this potential causal relationship. Genetic instruments derived from publicly available genetic summary data were used for the analyses. For MR analysis, the inverse-variance weighted method, weighted median method, and MR-Egger regression were employed. Multivariate MR analysis was performed concurrently. Univariate MR analysis indicated a strong correlation between decreased incidence of low-grade serous ovarian cancer and elevated levels of cathepsin L2 (odds ratio = 0.803, 95% confidence interval = 0.685-0.942, P = .007), whereas clear cell ovarian cancer showed a strong correlation with elevated levels of cathepsin H (odds ratio = 1.149, 95% confidence interval = 1.036-1.274, P = .008). Multivariate analysis, adjusted for 9 different cathepsins as covariates, confirmed the genetic relationships between cathepsin L2 and low-grade serous ovarian cancer and between cathepsin H and clear cell ovarian cancer. Our results suggest a causal relationship between cathepsins and ovarian malignancy and its subtypes. Cathepsin L2 has a protective effect on low-grade serous ovarian cancer, whereas cathepsin H is an adverse risk factor for clear cell ovarian cancer.

Background: Extracorporeal shock wave therapy (ESWT) has emerged as a contemporary modality in physiotherapy, demonstrating efficacy in addressing musculoskeletal disorders. Despite its potential, the clinical efficacy of ESWT in the context of cervical spondylosis remains understudied, with a dearth of robust empirical evidence. To bridge this gap, the present study was designed to evaluate the therapeutic impact of focused ESWT (fESWT) on pain alleviation and functional improvement in individuals afflicted with cervical spondylosis.

Method: A multicenter, randomized controlled clinical study was conducted, collecting data from 5 clinical studies on the treatment of cervical spondylosis with fESWT from June 2021 to March 2024. The inclusion criteria were patients diagnosed with cervical spondylosis, aged 20 to 70, without severe underlying diseases such as heart disease, hypertension, diabetes, etc. The exclusion criteria included pregnant women, nursing women, patients with bleeding tendencies, or those with cardiac pacemakers. The control group underwent a sham fESWT, while the experimental group received fESWT administered via the Duolith SD1 Tower device. The main observation indicators included the Visual Analogue Scale (VAS) for pain scoring, Neck Disability Index (NDI) scoring, cervical range of motion (ROM) scoring, and the Short Form-36 (SF-36) quality of life survey scoring.

Results: A total of 320 subjects were included in the study, with 160 in the experimental group and 160 in the control group. Post-treatment, the VAS and NDI scores in the experimental group were significantly lower than those in the control group (P < .05), while the cervical range of motion (ROM) and SF-36 scores were significantly higher than in the control group (P < .05). The overall treatment efficacy rate in the experimental group exceeded 90%, markedly higher than the approximately 70% rate in the control group (P < .05). There was no significant difference in the incidence of adverse reactions between the 2 groups.

Conclusion: The fESWT has shown promising therapeutic effects in the treatment of cervical spondylosis. It effectively reduces patient pain, improves cervical function, and enhances the quality of life, making it worthy of clinical promotion and application.

Background: Trans-oral robotic surgery (TORS) and trans-oral laser microsurgery (TLM) have been increasingly employed for the diagnosis and identification of primary occult cancers in the head and neck region. This systematic review and meta-analysis aimed to evaluate the application and effectiveness of tonsillectomy with TORS and TLM in detecting these cancers.

Methods: We searched PubMed, EMBASE, and the Cochrane Library for eligible studies using TORS or TLM in identifying the unknown primary sites of occult head and neck cancer, published from inception to September 2023. Two investigators independently screened articles based on inclusion and exclusion criteria.

Results: From 2282 articles identified, 20 individual studies meeting the inclusion criteria were included in this meta-analysis. Primary tumors were identified by TORS/TLM in 65% (364/561) of patients. The initial identification rates of lingual tonsillectomy (n = 219) and palatine tonsillectomy (n = 83) were 39% and 15%, respectively. The identification rates of primary sites for trans-oral surgical techniques were 60.7% (95% CI, 49.4-72%) for TORS and 75.7% (95% CI, 60.7-90.7%) for TLM. Seventy-nine point six percent (467/587) of the tumors were associated with human papilloma virus (HPV). The detection rate of HPV+ tumors was 79% (173/220) and the detection rate of HPV- tumors was 10% (5/52). The most common complication was nasogastric/gastrostomy, accounting for 6% (29/481). The length of hospital stay reported varied from 1 to more than 7 days.

Conclusion: This is a latest systematic review of the detection rates of head and neck squamous cell carcinoma of unknown primary sites by tongue base mucosectomy (TBM) via TORS and TBM via TLM. This study confirmed that TBM via TLM performed better than TBM-TORS in the detection rate of the primary. In particular, TBM via TLM showed significant advantages in detecting primary lesions in HPV-positive head and neck squamous cell carcinoma of unknown primary patients.

Previous research has demonstrated a close connection between the development of bone neoplasms and variations in the abundance of specific gut microbiota. It remains unclear, however, how the gut microbiota and bone neoplasms are causally related. Hence, in our study, we aim to clarify this relationship between gut microbiota and 2 neoplasms, malignant neoplasm of bone and articular cartilage (MNBAC) and benign neoplasm of bone and articular cartilage (BNBAC), by employing a two-sample Mendelian randomization (MR) approach. In this study, single nucleotide polymorphisms (SNPs) from genome-wide association studies-pooled data related to bone neoplasms and gut microbiota abundance were evaluated. The inverse variance weighted was employed as the major method for assessing the aforementioned causal relationship. Furthermore, the horizontal multiplicity was evaluated utilizing the Mendelian randomization pleiotropy residual sum and outlier and the MR-Egger intercept test. Finally, inverse MR analysis was performed to assess reverse causality. Inverse variance weighted results indicate a potential genetic relationship between 4 gut microbiota and MNBAC, and 3 gut microbiota and BNBAC. On the one hand, Eubacterium eligens group (OR = 0.16, 95% CI = 0.04-0.67, P = .01), Odoribacter (OR = 0.23, 95% CI = 0.06-0.84, P = .03), Slackia (OR = 0.35, 95% CI = 0.13-0.93, P = .04), and Tyzzerella3 (OR = 0.44, 95% CI = 0.24-0.82, P = .01) exhibited a protective effect against MNBAC. On the other hand, of the 3 gut microbes identified as potentially causally related to BNBAC, Oscillibacter (OR = 0.79, 95% CI = 0.63-0.98, P = .03) and Ruminococcus torques group (OR = 0.62, 95% CI = 0.39-0.98, P = .04) were regarded as protective strains of B, while Eubacterium ruminantium group (OR = 1.24, 95% CI = 1.04-1.47, P = .02) was considered to be a risk factor for increasing the incidence of BNBAC. Additionally, the bone neoplasms were not found to have a reverse causal relationship with the above 7 gut microbiota taxa. Four gut microbiota showed causal effects on MNBAC, and 3 gut microbiota demonstrated causality in BNBAC, providing insights into the design of future interventions to reduce the burden of neoplasms.

With the evolution of medical models and diverse healthcare service needs, nurse-led clinics (NLCs) have gained increasing attention. China began experimenting with NLCs in 1997 and their development has accelerated in recent years. This study reviews the current status, management practices, and innovative advancements in NLCs in China and compares them with those in other countries or regions. It analyses the existing challenges and obstacles to the development of NLCs in China, offering valuable insights for promoting their growth. Additionally, this study provides references that can guide the development of NLCs worldwide.

Surgical resection is the cornerstone of treatment for locally advanced gastric cancer (LAGC). Hence, downstaging of the tumor with neoadjuvant therapy is critical for R0 resection and prolongs the overall survival. Data from related studies are lacking, and the literature is scarce. Therefore, a single arm-study was performed on PD-1 inhibitor and apatinib plus S-1 and oxaliplatin as neoadjuvant chemotherapy for patients with LAGC. The findings are expected to serve as a reference for neoadjuvant therapy for LAGC. We assessed 130 LAGC patients using PD-1 inhibitor, apatinib plus S-1, and oxaliplatin as neoadjuvant chemotherapy from January 2021 to October 2022. A total of 104 patients received gastric transcatheter chemoembolization (GTC). The primary endpoint was the rate of clinical complete response, pathological complete response, and safety, while the secondary endpoints were the R0 resection rate and objective response rate of the disease and the disease control rate. A total of 130 patients completed the clinical assessment, of which 6 patients (4.6%) achieved clinical complete response, 87 patients (66.9%) achieved partial response, 30 patients (23.0%) achieved stable disease, and 7 patients (5.5%) experienced progressive disease. The overall response rate was 71.5% (93/130), and the disease control rate was 94.5% (123/130). A remarkable downstaging effect was observed in this study. Downstaging of the T stage and N stage was achieved in 71.5% and 80% of the patients, respectively, which translated into a high R0 resection rate. The findings revealed that 125 patients underwent R0 resection, and the R0 resection rate was 96.1%. According to the observed results, 21.6% of the patients achieved pathological complete response after neoadjuvant chemotherapy. Gastric transcatheter chemoembolization in the first cycle of neoadjuvant therapy was beneficial for tumor regression (P < .001). All adverse events were relieved and disappeared after symptomatic treatment, and no grade 4 adverse events were noted. PD-1 inhibitor and apatinib plus S-1 and oxaliplatin are safe and effective as neoadjuvant treatment of LAGC. Gastric transcatheter chemoembolization is useful for tumor regression during neoadjuvant therapy.

Background: Numerous cohort studies have explored the association between age-related macular degeneration (AMD) and Parkinson disease (PD). However, a comprehensive meta-analysis on this topic is currently lacking. This study aims to address this gap by conducting a meta-analysis of existing cohort studies to investigate the relationship between AMD and the risk of developing PD.

Methods: Relevant studies were systematically identified through thorough searches of the PubMed, Web of Science, Embase, and Cochrane Library databases. Two investigators independently conducted data extraction. Cohort studies meeting the eligibility criteria and providing risk and precision estimates regarding AMD and the risk of PD were included. Pooled hazard ratio (HR) accompanied by 95% confidence interval (CI) were calculated using either a random-effects model or a fixed-effects model. Sensitivity analyses, involving the exclusion of 1 study at a time, were performed to assess the robustness of the findings. Publication bias was evaluated using Egger test.

Results: Five studies were included, encompassing a total of 4,771,416 individuals. Among these, 128,771 individuals had AMD, while 4,642,645 individuals did not. The pooled analysis revealed a significant increase in the risk of developing PD for individuals with age-related macular degeneration (hazard ratio [HR] = 1.44; 95% confidence interval [CI]: 1.22-1.71; I2 = 47.3%). Sensitivity analysis confirmed the robustness of the results. For the exploration of the relationship between nAMD and the risk of developing PD, 2 cohorts were included. The pooled analysis demonstrated a significantly elevated risk of PD for individuals with nAMD (HR = 2.21; 95% CI: 1.55-3.16; I2 = 0%).

Conclusion: This meta-analysis suggests a significant association between AMD and an increased risk of PD. These findings offer fresh perspectives on PD's etiology and pathogenesis, but should be interpreted with caution given the limitations in establishing causality.

During retrograde autologous priming (RAP), some patients develop hypotension and hemodynamic instability, which impedes the procedure. This study aimed to demonstrate the effects of RAP on transfusion requirements and the development of hemodynamic instability. Overall, 443 patients who were operated upon for coronary artery bypass surgery (CABG) between January 2017 and December 2022 were enrolled and examined, including 162 who underwent RAP (RAP group) and 281 who did not (non-RAP group). Further, data regarding demographic characteristics, preoperative and intraoperative characteristics, and postoperative outcomes of both groups were analyzed. The demographic characteristics and intraoperative data were similar between both groups. Meanwhile, the amount of intraoperative and postoperative blood transfusion and postoperative drainage was lower in the RAP group than in the non-RAP group (P = .001 and .001, respectively). The length of intensive care unit (ICU) stay was shorter in the RAP group, whereas the length of overall hospital stay was the same in both groups. In 17% of the RAP patients, the procedure was terminated following hemodynamic instability. Further, regression analysis revealed body surface area (BSA) and baseline central venous pressure (CVP) as risk factors for the development of hemodynamic instability. In the receiver operating characteristic (ROC) curve analysis, the cutoff values for BSA and CVP were found to be 1.73 (sensitivity = 84.2%, specificity = 80.3%, the area under the ROC curve [AUC] = 0.905) and 4.5 (sensitivity = 97.7%, specificity = 99.7%, AUC = 0.994), respectively. Our finding suggest that RAP is associated with a reduction in the requirement in blood transfusion during both intra-and postoperative periods, as well as a decrease in postoperative drainage. Additionally, the risk of hemodynamic instability during RAP appears to be minimal in patients with a body surface area (BSA) >1.73 and a baseline CVP exceeding 4.5.

Clonal hematopoiesis (CH), which is characterized by variants of hematopoietic stem cells, increases the risk of subsequent myeloid neoplasms (MNs). This study aimed to investigate the prevalence and characteristics of CH variants in breast cancer (BC) patients treated with cytotoxic therapy (CT), focusing on those who developed MNs after cytotoxic therapy (MN-pCT). We retrospectively analyzed 107 BC patients from a biobank and sequenced peripheral blood and bone marrow samples from 31 CH-associated genes at 2 time points. We analyzed changes in CH for paired samples: T0 to T1 (before and after CT) and T1 to T2 (after CT vs greater CT exposure). Additionally, we compared CH variants in patients with and without MN-pCT. 29% of patients harbored CH variants that were restricted to 8 genes and DNMT3A was the most frequent variant. Among 54 patients with paired samples (T1 to T2), the variant allele frequency (VAF) of CH variants significantly increased after greater CT exposure (P = .02). However, there were no significant changes in VAF before and after CT. Five of the 9 patients who developed MN-pCT harbored CH variants. TP53 was the most frequently mutated gene, but it did not significantly affect MN-pCT risk compared to patients without CH variants. Although the presence of CH did not directly predict MN-pCT development in patients with BC, CT induced changes in CH genes. Further studies are required to determine the role of specific CH variants in the risk of MN-pCT and their potential as predictive biomarkers.