Open Medicine最新文献

Introduction/objective: Gestational diabetes mellitus (GDM) influences adverse maternal and fetal outcomes. Nutritional therapy and exercise are the first steps to maintain normal glucose levels. During pregnancy, metabolic status influences placental development.

Methods: This systematic review focused only on the morphology of the placenta and its microscopic changes in GMD under dietary therapy. A systematic search was performed on the main databases from inception to September 2024 (PROSPERO ID: CRD42024581621). Only original articles on GDM in diet and exercise treatment that reported at least one outcome of interest (microscopic features and macroscopic morphology of the placenta) were included.

Results: A total of 716 studies were identified, and nine met the inclusion criteria. The analysis confirmed that despite dietary control, some morphological changes in the placenta, including villus immaturity, chorangiosis, and fibrinoid necrosis, occurred at a different rate. In addition, the included studies reported an increase in placental weight in the diet-controlled GDM group.

Conclusion: Therefore, the results of the present qualitative analysis show that pregnant women with diet-controlled GDM, despite adequate glycemic control, abnormal placental development may persist. Our findings remark on the importance of the correct diet-managed GDM pregnancy monitoring due to the placental morphology abnormalities related to GMD.

Background: Health literacy (HL) and irrational beliefs about happiness significantly influence adults' health-related quality of life (HRQoL). The purpose of this study was to examine whether irrational happiness mediates the relationship between HL and HRQoL among adults. Methods: A total of 686 adults (468 women and 218 men; mean age = 22.30  ±  6.83 years) completed self-report questionnaires, including the Health Literacy Scale-Short Form, the EUROHIS-QOL 8, and the Irrational Happiness Beliefs Scale. Data were analyzed using structural equation modeling and bootstrapping methods. Results: HL had both direct (β = 0.260, p < 0.01) and indirect effects on HRQoL. HL directly predicted irrational happiness (β = -0.369, p < 0.01), which in turn directly predicted HRQoL (β = -0.318, p < 0.01). Specifically, irrational happiness significantly mediated the relationship between HL and HRQoL (bootstrap coefficient = 0.117, 95% CI = 0.071-0.175). Conclusion: These findings suggest that interventions aiming to enhance adults' HRQoL should consider not only improving HL but also addressing irrational beliefs about happiness.

Introduction: Global cancer cases are increasing, but fortunately, cancer is becoming more treatable. By 2050, the number of cancer cases is projected to reach 35 million. These numbers are certainly correlated with the aging population, early diagnoses due to screenings, and the broad current treatment options. However, life-saving therapies are often gonadotoxic, significantly impacting the lives of cancer patients. Fertility preservation following life-saving oncological treatments is one of the challenges faced by patients with cancer.

Material and method: We analyzed 73 articles to investigate the current state of fertility preservation in oncology, also evaluating the medico-legal implications.

Results: The data indicate a growing trend of cancer recoveries and survivorship with opportunities to access fertility preservation through various methods, which are not entirely known or consistently offered to patients in the appropriate manner.

Conclusions: The ethical and medico-legal aspects are numerous and seem to be still evolving.

Background information: Delayed graft function (DGF), defined as the need for dialysis within the first week of a kidney transplant, is a common complication, particularly in extended criteria donor transplants, where its incidence ranges from 21 to 31%.

Objectives: We observed a prolonged case of DGF in a 47-year-old patient with chronic kidney disease (CKD) resulting from diabetic nephropathy. The patient, classified in a moderate immunologic mismatch group, received a marginal deceased donor kidney.

Results: For the first 4 weeks post-transplantation, graft function was impaired. After 29 days of anuria, the transplanted kidney began to recover. The literature review found few clinical cases of DGF extending beyond 1 month. Our patient had several risk factors for DGF, including diabetes mellitus, pre-transplant hemodialysis, and moderate immunologic mismatch. Additionally, the marginal graft increased the risk of ischemia-reperfusion injury and glycocalyx damage. However, it remains unclear how these factors influenced the duration of DGF. The exact cause of the extended DGF in this case remains unknown. Although the literature identifies key risk factors for DGF, data on factors leading to prolonged kidney dysfunction are lacking. Therefore, decisions to remove a non-functioning transplanted kidney should not be made hastily.

Background: Oxaliplatin (OXA) is among the most common chemotherapy drugs and is the base component of the FOLFOX regimen (OXA + leucovorin + 5-fluorouracil) and CapeOX regimen (OXA + capecitabine). Resistance to and failure of these two OXA-based regimens often results in poor outcomes in patients with colorectal cancer (CRC). Nitrendipine (NTD) is a first-line antihypertensive drug commonly used in hypertension and coronary heart disease with confirmed low toxicity and side effects. However, the potential benefits of NTD for CRC progression and therapy remain unclear.

Methods: Cell counting kit-8 (CCK-8) detection, colony formation assay, wound-healing assay, Transwell assay, SynergyFinder webtool, and subcutaneous tumor models were used to assess the effect of NTD with OXA on CRC inhibition in vitro and in vivo. Bioinformatics tools including Human Protein Atlas (HPA), quantitative real-time polymerase chain reaction, western blotting analyses, lentivirus transfection, and rescue experiment were used to investigate the mechanism(s) of the related action.

Results: Utilizing murine and human CRC cell lines, the in vitro and in vivo experiment demonstrated that NTD inhibited cell proliferation, migration, and invasion, and the synergy scores calculated by SynergyFinder indicated that NTD exhibited synergistic activity with the chemotherapeutic drug OXA. The CCK-8 detection, animal model, and rescue experiment results demonstrated that NTD suppressed CRC progression and potentiated OXA therapeutic effect by downregulating calcium voltage-gated channel subunit alpha1 D (CACNA1D).

Conclusions: This study presents novel data on first-line antihypertensive NTD, exerting inhibitory effects on cell proliferation and migration in CRC and revealing synergistic activity with OXA by downregulating CACNA1D. NTD may be a candidate as a promising chemosensitizer as an OXA new combination to improve the efficacy and safety of CRC therapy.

Aim: The aim of this study is to determine the effect of vitamin D replacement therapy on sleep habits in restless legs syndrome (RLS) patients with vitamin D deficiency.

Methods: The study was conducted between September 1, 2018, and September 1, 2019, at the Pediatrics outpatient clinic of Bezmialem Vakif University. 46 cases with RLS and 43 healthy controls between these dates were included in the study. The Children's Sleep Habits Questionnare was filled out retrospectively by parents.

Results: While vitamin D supplementation was given to 20 children with RLS who were found to have vitamin D deficiency, the 26 patients without vitamin D deficiency did not receive supplementation. There was no significant difference between the treatment groups in terms of gender, age, and pre-treatment sleep habits. Compared to the pre-treatment period, post-treatment bedtime resistance, sleep onset delay, sleep anxiety, parasomnias, daytime sleepiness, and CSHQ total score were significantly improved in RLS cases with vitamin D deficiency. There were no significant differences in RLS patients without vitamin D supplementation. Other comparisons also showed no difference between groups.

Conclusion: There was no difference between the sleep habits of RLS cases with and without vitamin D deficiency. Sleep habits improved positively after vitamin D supplementation in patients with vitamin D deficiency compared to the pre-treatment period. There was no difference in the sleeping habits of RLS patients without vitamin D deficiency during the same period. Vitamin D supplementation can improve sleep habits in patients with RLS.

Purpose: Emergence agitation (EA) after (adeno)tonsillectomy (AT) surgery impairs recovery in children. Adequate analgesia plays a crucial role in reducing EA incidence. This study investigated whether hydromorphone infusion (30 μg/kg) during anesthesia induction could reduce EA following AT surgery for obstructive sleep apnea in children.

Patients and methods: A total of 186 ASA I-III children aged 3-7 years undergoing AT surgery were enrolled in a blinded randomized trial comparing hydromorphone (30 μg/kg) to fentanyl (4 μg/kg). The primary outcome was EA incidence within 30 min post-extubation. Secondary outcomes included pediatric anesthesia emergence delirium (PAED), face, legs, activity, crying, consolability (FLACC), Ramsay sedation scores, extubation time, rescue analgesia incidence, and adverse events.

Results: The incidence of EA was significantly lower in the hydromorphone group [48.4% (45/93) vs 64.5% (60/93); absolute difference: 16.1%; 95% CI: 18.9-29.5%; P = 0.027]. Hydromorphone improved PAED, FLACC, and Ramsay scores and reduced moderate-to-severe pain and rescue analgesia. No postoperative complications occurred in either group.

Conclusion: Hydromorphone at 30 μg/kg effectively reduces the incidence of EA within 30 min post-extubation in children after AT surgery compared to fentanyl. It shows superior analgesia and has a low incidence of adverse effects.

Background: Mitochondria play a central, multifunctional role in cancer progression. However, the mechanism of mitochondrial genes in epithelial ovarian cancer (EOC) remains unclear. This study aimed to screen candidate mitochondrial genes in EOC and then to investigate their biological functions and potential mechanisms.

Methods: We downloaded Gene Expression Omnibus RNA-seq profiles and identified mitochondrial differentially expressed genes in EOC by bioinformatics analysis. Transcription factor A, mitochondrial (TFAM) expression in EOC tissues was determined by immunohistochemistry. In vitro assays were applied to clarify TFAM function in EOC.

Results: The bioinformatics analysis results showed that the mitochondrial genes TFAM, HSPE1, and CYC1 were significantly upregulated (P < 0.05) in EOC, and their upregulation was associated with a poor prognosis. TFAM was highly expressed in EOC tissues and significantly associated with clinical stage (P = 0.004), lymph node metastasis (P = 0.043), and overall survival (P < 0.05). Silencing TFAM in EOC cells significantly inhibited cell proliferation and migration and induced cell apoptosis (P < 0.05).

Conclusion: TFAM promotes EOC cell secretion of VEGF-A, VEGF-C, VEGF-D, lymphangiogenesis, and EOC lymph node metastasis. Our results may provide new insights into the biological functions and potential mechanisms of TFAM in EOC, which might provide new targets for EOC diagnosis and treatment.

Background and objective: Early nutritional support holds paramount importance for postoperative gastric cancer (GC) patients. Peptidase M20 domain containing 1 (PM20D1) is a secretory enzyme associated with glucose and lipid metabolism. However, there is a dearth of clinical studies delving into the connection between PM20D1, lipid metabolism, and inflammatory factors in GC patients who have received enteral nutrition (EN). This research aimed to investigate the serum levels of PM20D1 in GC patients following early EN and their potential associations with lipid metabolism, nutritional markers, and inflammatory factors.

Methods: This prospective observational study enrolled 180 GC patients between May 2020 and July 2022. On the first postoperative day, all patients received EN support, which was maintained for a duration of 5 days. Serum levels of PM20D1, interleukin (IL)-6, IL-1β, and C-reactive protein were measured on the sixth day after surgery using an enzyme-linked immunosorbent assay. Data on demographics, clinical statistics, lipid metabolism, nutritional parameters, and the prognostic nutritional index (PNI) were collected. Patients were followed up for 12 months, and both overall survival and disease-free survival were recorded.

Results: In the low PNI group, the serum levels of PM20D1, albumin (ALB), and blood lymphocytes (BL) showed significant reductions. Pearson analysis revealed a negative correlation between PM20D1 and IL-6 levels, whereas a positive correlation emerged between PM20D1 and ALB and BL levels. Furthermore, PM20D1 demonstrated potential as a biomarker for diagnosing poor nutritional status (PNI < 43) in GC patients and was a risk factor for poor nutritional status in GC patients.

Conclusion: Serum PM20D1 remarkably declined in GC patients after early EN and was associated with poor nutritional status.

Background: The specific role of lysophosphatidic acid 2 (LPA₂) in deep vein thrombosis (DVT) remains unclear.

Methods: An inferior vena cava annulus retraction model of DVT was established in wild-type (WT) and global LPA₂ knockout (Lpar2 ^-/- ) mice. We examined the incidence of DVT, wet weight of thrombus, length of thrombus, assessed endothelial permeability through Evans blue dye assay in vivo, cell viability, and endothelial cell (EC) permeability of mouse inferior vena cava ECs in vitro. Proteomics, histopathology, immunohistochemistry, and western blotting were employed to investigate the role of LPA₂ in DVT.

Results: Lpar2 deficiency increased vascular endothelial permeability and promoted the progression of DVT. Histological examination revealed aggravated inflammation in the thrombus of Lpar2 ^-/- DVT mice. In vitro, Lpar2 ^-/- resulted in increased permeability of ECs. Proteomic results indicated that DVT after Lpar2 ^-/- may be related to tight junction (TJ) protein. LPA₂ agonist, 2-[4-(1,3-dioxo-1H,3H-benzoisoquinolin-2-yl)butylsulfamoyl] benzoic acid, significantly reduced vascular endothelial permeability as well as increased expression of the vascular endothelial TJ protein zonula occludens-1.

Conclusion: These data provide a novel mechanism of endothelial barrier protection of LPA₂ in DVT.