Open Medicine最新文献

Objective: This study aimed to investigate the effect of sevoflurane combined with propofol anesthesia on the anesthesia effect and adverse reactions in children undergoing acute appendicitis surgery.

Methods: A total of 104 children with acute appendicitis who underwent surgery were included and assigned into the observation group (sevoflurane combined with propofol anesthesia, 55 cases) and the control group (propofol anesthesia, 49 cases). The two groups were compared in terms of anesthesia effects, recovery quality, and the occurrence of adverse reactions, while observing changes in patients' hemodynamics and stress levels during anesthesia.

Results: Riker sedation and agitation scores were reduced in the observation group compared to the control group. The time to disappearance of pain and eyelash reflexes and the induction time of anesthesia were shortened, and heart rate and mean arterial pressure improved in the observation group. Cortisol, norepinephrine, and adrenocorticotropic hormone decreased in the observation group (P < 0.05). The occurrence of adverse reactions was not significantly different between the two groups (P > 0.05).

Conclusion: The combination of sevoflurane and propofol anesthesia in children with acute appendicitis can enhance the anesthesia effect and recovery quality and stabilize the body's hemodynamics and stress state.

Background: Inflammation plays a pivotal role in modulating the pathophysiological progression of myocardial injury and the subsequent repair and remodeling of the infarcted myocardium. Cathepsin B, a member of the cysteine protease family, has been recognized for its ability to initiate various signaling cascades essential to inflammatory processes. This study aims to investigate whether cathepsin B influences cardiomyocyte survival under inflammatory conditions.

Methods: Mice were randomly divided into four groups (n = 6 per group) based on whether they received an intraperitoneal injection of Ca-074 Me (50 mg/kg) and whether myocardial ischemia/reperfusion (I/R) surgery was performed.

Results: The cathepsin B-specific inhibitor Ca-074 Me significantly attenuated myocardial infarction caused by I/R in vivo and reduced hypoxia-induced cardiomyocyte apoptosis in vitro. Mechanistically, Ca-074 Me appeared to inhibit caspase-3 signaling, thereby mitigating cardiomyocyte apoptosis under chemical hypoxia induced by cobalt chloride or physical oxygen deprivation.

Conclusion: Targeted inhibition of cathepsin B may represent an innovative strategy for the amelioration of myocardial injury.

Objective: This study aims to comprehensively evaluate the Charlson Comorbidity Index (CCI), Logistic Organ Dysfunction System (LODS) score, Acute Physiology Score III (APS III), Simplified Acute Physiology Score II (SAPS II), and Sequential Organ Failure Assessment (SOFA) in order to provide a more scientifically rigorous and effective tool for predicting mortality risk among sepsis patients in the Intensive Care Unit (ICU).

Methods: The demographic information and sepsis-related data were extracted from the MIMIC-IV database for patients admitted to the ICU with a diagnosis of sepsis. The predictive performance of CCI, LODS, APS III, SAPS II, and SOFA scoring systems in terms of ICU mortality was evaluated by comparing receiver operating characteristic (ROC) curves. Multivariate regression identified predictors, later validated with a nomogram. Finally, the dataset was divided into a training set and a validation set at a ratio of 7:3 to assess the clinical utility of the prediction model through ROC curves.

Results: The study enrolled a total of 17,226 patients with a median age of 67.65 (55.79, 78.82) years; among them, males accounted for 57.69%. Within this cohort, a total of 1,115 (6.47%) individuals succumbed during their admission to the ICU. The ROC curve demonstrated that both APS III and LODS score exhibited robust predictive value for ICU mortality. Multivariate regression analysis revealed that CCI, APS III score, LODS score, respiratory rate, body temperature, and race served as potential predictors. Combining these variables into a nomogram showed strong clinical utility, with AUCs of 0.803 (training set) and 0.797 (validation set).

Conclusions: Organ failure scores hold significant clinical relevance in predicting mortality among sepsis patients in the ICU. Augmenting predictive accuracy can be achieved by integrating the CCI, APS III score, LODS score, mean respiratory rate, and body temperature during the initial 24 h following ICU admission.

Objective: This study aims to delineate the mechanisms through which intraperitoneal injection of gentamicin (GEN) influences the inner ear cells of mice by employing single-cell RNA sequencing (scRNA-seq) technology.

Methods: Eight-week-old Kunming mice were randomly assigned to three groups: a normal control group, a GEN group, and a GEN + dexamethasone (DEX) group. The mice received continuous intraperitoneal injections of the corresponding drugs for 10 days. Auditory brainstem response (ABR) was assessed to evaluate hearing threshold shifts, and cochlear tissues were harvested for scRNA-seq. The Seurat analysis workflow was employed for data quality control, dimensionality reduction clustering, and differential gene expression analysis.

Results: ABR results demonstrated a significant elevation in hearing thresholds in the GEN group, whereas thresholds in the DEX group showed improvement but remained elevated compared to the NOR group (P < 0.05). Single-cell sequencing revealed notable alterations in the populations of outer hair cells, supporting cells, and immune cells in the GEN group. Analysis of differentially expressed genes identified significant downregulation of cell-specific genes Gbp6, Ppfia4 in hair cells of the GEN group, alongside upregulation of inflammation-related genes Nnat, Gh, indicating that hair cell damage and enhanced immune responses may be pivotal mechanisms underlying GEN-induced ototoxicity.

Conclusion: Utilizing scRNA-seq technology, this study uncovers substantial transcriptional changes induced by GEN in cochlear hair cells, supporting cells, and immune cells in mice, highlighting the role of inflammation and oxidative stress, TNF signaling pathways in its ototoxicity. DEX partially ameliorates hair cell damage.

Aim: The aim of this study was to assess the prognostic performance of the C-reactive protein-to-albumin ratio (CAR) in predicting mortality and amputation of peripheral artery disease (PAD) patients undergoing endovascular therapy (EVT).

Methods: We conducted a systematic search from the inception date to June 12, 2025, in eight databases and a manual search to cover gray literature. High and low CAR were defined according to the optimal cut-off from each study. Meta-analysis was performed to pool prognostic performance.

Result: A total of 1,451 subjects from five observational studies were included. The prevalence of mortality and amputation was 4.7 and 21.4%, respectively. Pre-procedural high CAR was associated with a higher risk of mortality (risk ratio [RR] 3.11; 95% confidence interval [CI] 1.22-8.18; I ² = 40%) and amputation (RR 3.62; 95% CI 1.98-6.63; I ² = 10%). The area under the receiver operating characteristic (ROC) curve of the summary ROC curve of high CAR was 0.75 (sensitivity 77% and specificity 56%) for mortality and 0.85 (sensitivity 85% and specificity 52%) for amputation. The positive predictive value of CAR to predict mortality and amputation was 29.9 and 10.5%, respectively, while the negative predictive value was 90.5 and 97.8%, respectively.

Conclusion: CAR was a potential prognostic biomarker to predict mortality and amputation in PAD patients undergoing EVT.

Background: Abdominal bloating is a very common and often quite debilitating complaint affecting nearly 18% of people worldwide. There is very little known about whether or not breathing exercises can help reduce bloating.

Methods: In a prospective study, we investigated the effects of breathing exercises using either a PDF of written instructions on diaphragmatic breathing or a biofeedback respiratory practice device (Calmigo^®) on abdominal bloating. Participants were randomized to either intervention and asked to practice three times daily for 3 min each time for 6 weeks. Bloating was evaluated at baseline and every week for 7 weeks via online self-reported surveys.

Results: Eighty-five participants were randomized to either written instructions (n = 36) or Calmigo^® (n = 45). There was no difference between the two groups at baseline in demographic features, anxiety, depression, or bloating severity. While bloating improved at all time points, it was statistically significant in the 4 weeks in the Calmigo^® group and at weeks 3, 4, and 5 in the written instructions group. Higher baseline anxiety and lower depression symptoms were predictive of improvement in bloating at 4 weeks.

Conclusion: Brief breathing exercises, either using written instructions or Calmigo^®, improve bloating symptoms. These could be considered in the management of functional abdominal bloating.

Background: Coronary collateral circulation (CCC) plays a vital role in preserving myocardial perfusion in patients with chronic total occlusion (CTO). Reliable biomarkers for evaluating CCC are needed. This study aimed to investigate the combined diagnostic value of serum uric acid-to-albumin ratio (UAR) and C-reactive protein (CRP) in assessing the CCC status.

Methods: We enrolled 220 patients undergoing coronary angiography and categorized them into three groups: CTO (n = 80), coronary heart disease (CHD, n = 100), and controls (n = 40). Serum UAR and CRP levels were measured. Logistic regression and receiver operating characteristic curve analyses were performed to determine associations with CCC quality.

Results: UAR and CRP levels were significantly elevated in the CTO group compared to CHD and control groups. Among CTO patients, those with well-developed CCC had significantly lower UAR and CRP levels. Both biomarkers were identified as independent predictors of the CCC status. Combined use of CRP and UAR improved diagnostic specificity to 91.1%.

Conclusion: This is the first study to demonstrate the diagnostic utility of combining UAR and CRP for evaluating CCC in CTO patients. The dual-marker approach enhances diagnostic accuracy and may support more precise clinical decision-making in coronary artery disease.

Objectives: The administration of subcutaneous low molecular weight heparin (LMWH) injections frequently causes injection pain, disrupting the comfort of patients. No studies were found evaluating the effect of the application of local vibration in the management of pain relating to subcutaneous LMWH injection. The aim of this study is to examine the effect on injection pain of the local vibration technique applied to the injection site during subcutaneous LMWH injection.

Methods: The patients were randomly assigned to an experimental (vibration) group (n = 32), a placebo control group (n = 30), and a nonintervention control group (n = 31). Participants in the experimental group were given slight vibration to the injection site before the injection was administered; for participants in the placebo group, the device was placed on the injection site but with the vibration button kept switched off, while for the nonintervention control group, routine subcutaneous LMWH injection was administered. The level of pain felt by the participants during the administration of the injection was assessed with a visual analog scale.

Results: The pain score of the participants during the subcutaneous LMWH injection was found to be significantly lower in the vibration group than in the control group (p < 0.001) and the placebo control group (p = 0.005), but there was no significant difference between the control and placebo control groups (p = 0.435).

Conclusion: It was found that the local vibration technique applied to the site of subcutaneous LMWH injection was effective in reducing the pain developing in relation to the injection. Healthcare professionals can use the vibration technique in the management of the pain relating to subcutaneous heparin injection.

Background: This meta-analysis evaluates the diagnostic accuracy of machine learning-derived FFRCT (ML-FFRCT) for CAD, using invasive coronary angiography-derived fractional flow reserve (ICA-FFR) as the gold standard to provide evidence for clinical translation.

Methods: We systematically searched PubMed and Embase for relevant studies. Study quality was assessed using QUADAS-2 in RevMan 5.3. Diagnostic performance was evaluated by pooling sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under the curve (AUC) using Stata 14.0. Meta-regression and subgroup analyses were conducted based on the publication year, country, study design, sample source, and sample size.

Results: The pooled SEN was 0.84 (95% CI: 0.79-0.87) and SPE was 0.83 (95% CI: 0.77-0.88). The PLR and NLR were 4.95 (95% CI: 3.58-6.84) and 0.20 (95% CI: 0.15-0.26), respectively. The DOR was 25.15 (95% CI: 14.87-42.52) and the AUC was 0.90 (95% CI: 0.87-0.93), indicating high diagnostic accuracy. Deeks' funnel plot revealed no significant publication bias.

Conclusions: ML-FFRCT demonstrates high SEN and SPE in diagnosing CAD. These findings support its potential as a promising noninvasive tool for CAD assessment.

Objective: This study investigated the relationship between serum magnesium, phosphorus, and calcium and low-gradient severe aortic stenosis (LG-AS).

Methods: Dobutamine stress echocardiography (DSE) and resting echocardiography were performed on 73 patients with LG-AS. A projected aortic valve area (AVA_proj) ≤ 1 cm² or indexed AVAI_proj < 0.60 cm²/m² was defined as true-severe AS. Serum magnesium, phosphorus, and calcium were compared. The correlation between serum micronutrients and resting echocardiographic parameters was analyzed. The efficacy of serum micronutrients and resting echocardiographic parameters in predicting true-severe AS in LG-AS was assessed.

Results: DSE diagnosed true-severe AS in 43 patients and pseudo-severe AS in 30 patients. AVA and AVAI were smaller, and the mean pressure gradient (PG) was higher in patients with true-severe AS. Serum calcium and phosphorus were higher, and serum magnesium was lower in patients with true-severe AS. Serum calcium was positively correlated with AVA and AVAI. Serum magnesium had a moderately strong correlation with mean PG. Serum micronutrients had good predictive value for true-severe AS and AVAI, and mean PG improved the predictive value of serum micronutrients.

Conclusion: Serum micronutrients have diagnostic values for true-severe AS in patients with LG-AS.