Open Medicine最新文献

Introduction: This narrative review describes the scientific evidence on drug-induced gingival overgrowth (DIGO) in kidney transplant patients treated with immunosuppressive agents, particularly Cyclosporine A, focusing on its prevalence, pathogenetic mechanisms, and clinical management strategies.

Content: This study was conducted including PubMed, Scopus, and Web of Science, highlighting clinical studies and case reports.

Summary: DIGO is an oral complication in transplant patients treated with cyclosporine A, and its frequency may increase when combined with calcium channel blockers. However, tacrolimus has shown a lower incidence of DIGO compared with Cyclosporine A, making it a favorable therapeutic alternative in immunosuppressive regimens for renal transplant patients. Mycophenolate mofetil, despite being less directly linked to DIGO, can exacerbate gingival changes when combined with other immunosuppressants by promoting inflammation and connective tissue remodeling. Sirolimus is associated with a lower risk of DIGO compared with calcineurin inhibitors; however, some isolated cases have been reported, particularly in patients previously exposed to Cyclosporine A or when used in combination with calcium channel blockers. Management strategies include proper oral hygiene, dose adjustment or medication substitution, and, in some cases surgical intervention.

Outlook: The fundamental keys to reducing its incidence and severity are a personalized immunosuppressive regimen with a multidisciplinary approach.

Objectives: The study aimed to investigate the nephroprotective effects of visnagin on renal ischemia-reperfusion (I/R) injury and the role of M1/M2 macrophage polarization in this process.

Methods: Forty-two adult rats were divided into six groups: Control, Visnagin30 mg/kg, Visnagin60 mg/kg, I/R, I/R + Visnagin30 mg/kg, I/R + Visnagin60 mg/kg (n=7). Bilateral renal ischemia was induced by clamping for 25 min, followed by 2 h of reperfusion. Visnagin or vehicle was administered to the animals intraperitoneally 2 h before reperfusion. At the end of the study, kidney samples were collected for analysis of oxidative stress, inflammatory cytokines, apoptotic protein expression, and M1/M2 macrophage polarization.

Results: I/R injury increased malondialdehyde (MDA), chemiluminescence (CL), IL-1β, and IL-6 levels while decreasing glutathione (GSH) in renal tissue, indicating enhanced oxidative stress (p<0.001) and inflammation (p<0.05). Histopathological examination showed glomerular atrophy, tubular degeneration, and intertubular hemorrhage. Visnagin treatment at 60 mg/kg significantly reduced MDA, CL, and IL-1β levels, and increased GSH (p<0.05). Immunohistochemically, visnagin decreased Bax (p<0.001), caspase-3 (p<0.01), and TNF-α (p<0.01) expressions elevated by I/R injury. Furthermore, visnagin reversed I/R induced M1/M2 macrophage polarization (CD86↑, CD163↓), decreasing CD86 (p<0.05) and increasing CD163 immunodensity (p<0.05).

Conclusions: Visnagin treatment (60 mg/kg) exerts promising nephroprotective effects in renal I/R injury by reducing oxidative stress, inflammation, apoptosis, and modulating M1/M2 macrophage polarization.

Objectives: This study assessed the relationship between glycated serum protein (GSP) and post-reflux swallow-induced peristaltic wave (PSPW) index and esophageal baseline impedance (BI) in patients with diabetes mellitus (DM) with gastroesophageal reflux disease (GERD).

Methods: General clinical data of patients in the DM and DM/GERD groups were compared. Multifactorial Logistic regression analyses were performed to screen for independent factors on GERD in DM patients, and odds ratio (OR) was calculated. The risk of GERD was assessed using a spline regression model constructed on the basis of GSP, PSPW and BI. Predictive efficacy was analyzed using Receiver operating curve (ROC) curve analysis.

Results: Statistically significant differences were found in TG, hs-CRP, GSP, PSPW, and BI between patients in the DM and DM/GERD groups. PSPW and BI (OR=0.99, p<0.01) were independent protective factors, and elevated GSP was an independent risk factor for the development of GERD. A linear relationship was validated between GSP and PSPW and BI and the prevalence risk of developing GERD in patients with DM, all with good predictive efficacy.

Conclusions: GSP, PSPW, and BI show significant correlations with the onset and progression of GERD in patients and all demonstrate good predictive efficacy. However, due to the small size of the patient cohort, the generalizability of these findings requires further validation.

Background: Sepsis-induced myopathy (SIM)significantly contributes to long-term disability and mortality among sepsis survivors. A comprehensive understanding of both the molecular mechanisms and rehabilitation strategies is crucial for effective management.

Methods: A review of pertinent studies was conducted, focusing on the molecular pathogenesis, therapeutic strategies, and rehabilitation interventions for SIM, with particular attention to clinical and translational advancements.

Results: Current management strategies encompass infection control, modulation of inflammation, nutritional support, and structured rehabilitation programs, including early mobilization and physiotherapy. Emerging therapies that target inflammation, cellular protection, and regeneration - such as stem cell therapy and gene-editing techniques - demonstrate potential. Furthermore, advancements in personalized medicine, including genomics, transcriptomics, and individualized metabolic interventions, may further improve outcomes.

Conclusions: Optimizing both mechanistic and rehabilitation strategies is essential for enhancing functional recovery and quality of life in patients with SIM. An integrated clinical and molecular approach presents the most promising path forward. Keywords: sepsis-induced myopathy, sepsis.

Objectives: This meta-analysis evaluates Janus Kinase (JAK) inhibitors' efficacy and safety in large vessel vasculitis (LVV), encompassing Giant Cell Arteritis (GCA) and Takayasu's Arteritis (TAK).

Methods: Registered on PROSPERO (CRD42024575313), four databases were systematically searched for randomized controlled trials (RCTs) and observational studies. Outcomes included remission/relapse rates and adverse events, assessed with sensitivity/publication bias analyses.

Results: Five studies (107 patients: 65 GCA, 42 TAK) showed pooled 12-month remission rates of 80.1 % (95 % CI: 68.3-92.0), with subgroup rates of 87.3 % (GCA) and 69.6 % (TAK). Relapse rates were 11.3 % overall (2.5 % GCA vs. 22.9 % TAK). Adverse event-related discontinuation was 4.4 %, with subgroup rates of 4.0 % (GCA) and 4.2 % (TAK).

Conclusions: JAK inhibitors demonstrate favorable efficacy and safety in LVV.

Lung cancer presents a major global public health challenge due to its high incidence and mortality rates, highlighting the urgent need for effective treatment strategies. Radiotherapy, a cornerstone in lung cancer treatment, faces significant limitations due to both intrinsic and acquired radioresistance in tumors. Recent researches have identified long non-coding RNAs (lncRNAs) as critical regulatory factors that significantly affect the radiosensitivity of lung cancer cells. These lncRNAs are involved in key biological processes, including DNA damage repair, apoptotic signaling, cell cycle progression, tumor microenvironment remodeling. This review comprehensively summarizes and discusses the molecular mechanisms by which lncRNAs influence radiosensitivity and assesses their potential as predictive biomarkers for radiotherapy. Additionally, it analyzes the potential of lncRNA-based intervention strategies to overcome radioresistance and enhance radiotherapy regimens. The goal is to provide a robust theoretical foundation for advancing precision radiotherapy in lung cancer. In summary, lncRNAs function as multidimensional regulators of lung cancer radiosensitivity and represent promising targets for radiosensitization in the precision medicine era.

Objectives: Diabetic retinopathy (DR) is a severe complication of diabetes mellitus (DM) leading to vision loss and blindness, which typically develops 12-20 years after the diagnosis of DM. Anxiety and depression frequently co-occur with chronic medical conditions like DM and DR, impacting their onset, course, and prognosis. This study aimed to examine the link between anxiety, depression, DR, and macular changes.

Methods: A cross-sectional study was conducted at the Clinic for Ophthalmology, University Clinical Center Niš, Serbia, involving 80 adult participants, naïve to psychiatric and invasive ophthalmological therapy, divided into two groups: 40 patients with DR, and 40 healthy controls. Ophthalmic examinations, biochemical measurements, and assessments of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and Montgomery and Asberg Depression Rating Scale (MADRS) were performed.

Results: Results indicated that patients with DR had significantly higher levels of anxiety and depression compared to controls. The study found no significant correlation between HADS and MADRS scores with patients' gender, type of therapy, or the type of DR. However, a higher HADS and MADRS score was observed in patients with left-side OCT macular edema.

Conclusions: The study highlights the complex interaction between psychiatric disorders and somatic illnesses, emphasizing the need for comprehensive care strategies that address both physical and mental health to improve patient outcomes.

Objectives: Delirium is a common but frequently underdiagnosed complication in adult intensive care units (ICU), associated with increased morbidity, mortality, and healthcare costs. Early detection using validated tools is essential. This study aim to translate, adapt, and validate the Confusion Assessment Method for Intensive Care Units flowsheet (CAM-ICU flowsheet) into European Portuguese.

Methods: A methodological, cross-sectional, descriptive-correlational study was conducted in a northern Portuguese ICU. The CAM-ICU flowsheet was translated and back-translated, followed by expert validation. Forty-two adult ICU patients on invasive mechanical ventilation were assessed using the adapted tool by two trained observers. Diagnostic accuracy was evaluated using DSM-5 criteria as the gold standard. Statistical analysis included sensitivity, specificity, kappa coefficient, and ROC curves.

Results: Delirium was detected in 57.1 % of patients. The CAM-ICU flowsheet in European Portuguese demonstrated high interobserver agreement (κ=0.952), excellent sensitivity (100 %), and specificity (81.8-86.3 %). ROC AUC ranged from 0.909 to 0.932. The inattentiveness feature was the core for the presence or absence of delirium.

Conclusions: The CAM-ICU flowsheet in European Portuguese was validated to assess delirium in nonverbal ICU patients on mechanical ventilation through this study and demonstrated to be a reliable and valid tool.

Objectives: Congenital acute megakaryoblastic leukemia (AMKL) is an extremely rare and aggressive malignancy with poor prognosis.

Case presentation: We report a female neonate with Down syndrome (DS) who presented with respiratory distress and hepatomegaly at birth. Laboratory evaluation revealed hyperleukocytosis (253.45 × 10⁹/L) and bone marrow studies confirmed AMKL with trisomy 21. Remarkably, spontaneous hematologic remission occurred within 2 months without chemotherapy.

Conclusions: This case highlights the unique clinical course of DS-associated AMKL and underscores the potential for spontaneous regression in congenital leukemia.

Objectives: To develop a comprehensive understanding of psychological distress and associated sociocultural and disease related factors among South Asian Individuals with COPD.

Methods: A convergent mixed methods study was used. The quantitative sample included 408 and qualitative sample included 22 individuals (11 patients and 11 family caregivers). Hospital Anxiety and Depression Scale was used for quantitative data collection and semi-structured interviews for qualitative phase. Descriptive and regression analyses were used for quantitative data and reflexive thematic analysis for qualitative data. Qualitative and quantitative data were integrated using merging integration procedure and statistics-theme joint display.

Results: The mean depression score was 10.91 ± 2.42 and the anxiety score was 9.91 ± 2.69. Quantitative and qualitative integrated data showed that factors affecting psychological distress included sex, education level, primary decision maker in the household, years of living with COPD, financial constraints, fears of the future, self-care struggles, interrupted family decision-making process, and relational support.

Conclusions: Individuals with COPD reported moderate to high levels of psychological distress influenced by societal, family, and disease related factors. Community based programs are also needed for providing adequate mental health and counselling resources to patients and their family caregivers.