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The association between DNA methylation status and Epstein-Barr virus infection in laryngeal carcinomas.
IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-03-20 DOI: 10.2478/rjim-2025-0005
Irina Elisaveta Hotoboc, Alina Fudulu, Irina Huica, Iulia Virginia Iancu, Raluca Grigore, Serban Vifor Gabriel Bertesteanu, Coralia Bleotu, Gabriela Anton, Anca Botezatu

Introduction: Infection with Epstein-Barr virus is a known risk factor for laryngeal carcinogenesis; it might influence DNA methylation acting as an epigenetic driver in this type of malignancy.

Methods: Paired laryngeal tissues (neoplastic and peri-neoplastic) harvested from 24 patients were included in the study. Eleven patients expressing latent/lytic EBV genes were considered positive. 5-mC% was determined using ELISA technique and TSGs (PDLIM4, WIF1, DAPK1) promoters' methylation percentages were quantified by qMS-PCR. DNMTs (DNMT1 and DNMT3B) expression levels were quantified in qRT-PCR.

Results: Overall, in laryngeal neoplastic samples vs peri-neoplastic ones, lower 5mC% (p=0.004) and higher TSGs promoters hypermethylation were found (p<0.0001). Significant correlation between PDLIM4 and DAPK1 promoter methylation and 5-mC% (PDLIM4 p=0.0186; DAPK1 p=0.0259) was noted. Higher 5-mC% (p=0.0041), lower PDLIM4 gene promoter methylation (p=0.0017) and overexpression of DNMTs (DNMT1: p=0.0018, respectively DNMT3B: p=0.0017) were associated with EBV infection. Also, significant differences between EBV-positive and EBV-negative cases based on tumor stage (T) were noted for 5mC% in both T1/T2 (p=0.0364) and T3/T4 stages (p=0.0275), and for PDLIM4 promoter methylation in T1/T2 stages (p=0.0121).

Conclusion: Future studies are needed to more effectively illustrate the interplay between EBV infection and these epigenetic mechanisms. Notably, our study highlighted a correlation between EBV and epigenetic changes in laryngeal carcinoma.

导言:感染爱泼斯坦-巴氏病毒是喉癌发生的一个已知风险因素;它可能会影响 DNA 甲基化,成为此类恶性肿瘤的表观遗传驱动因素:研究包括从 24 名患者身上采集的配对喉组织(肿瘤和肿瘤周围)。11例表达潜伏/溶解性EBV基因的患者被视为阳性。采用 ELISA 技术测定 5-mC% ,并通过 qMS-PCR 定量 TSGs(PDLIM4、WIF1、DAPK1)启动子的甲基化百分比。qRT-PCR 定量了 DNMTs(DNMT1 和 DNMT3B)的表达水平:结果:总体而言,在喉肿瘤样本与肿瘤周围样本中,发现了较低的 5mC% (p=0.004) 和较高的 TSGs 启动子高甲基化水平(pC):未来的研究需要更有效地说明 EBV 感染与这些表观遗传机制之间的相互作用。值得注意的是,我们的研究强调了喉癌中 EBV 与表观遗传学变化之间的相关性。
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引用次数: 0
Silent strike: stroke in context of endocarditis - brain imaging as a catalyst for diagnosis.
IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-27 DOI: 10.2478/rjim-2025-0003
Iulia-Cosmina Stoican, Dorin Dragoș, Atena Papagheorghe, Suzana Maria Guberna, Sorin Tuta, Maria Mirabela Manea

Introduction: Endocarditis is a pathology which is rarely encountered in clinical practice that presents itself in various manners, thus posing a great challenge for the clinician in the process of formulating a timely diagnosis, especially given its potentially lethal evolution. The diagnosis of infective endocarditis is based on Modified Duke Criteria. A wide array of complications may accompany endocarditis, including septic or thrombotic emboli to various territories - those occluding branches of cerebral arteries result in ischemic strokes, which may be demonstrated by brain imaging and the symptoms which may range from mild mental status alteration to deep coma. Objective: Assessment of brain imaging as a diagnostic tool for bacterial endocarditis.

Materials and methods: This is a nested case-control study, in which 84 patients with ischemic stroke were enrolled, half of them having endocarditis related stroke (cases), and the other half stroke due to cardioembolism from other sources or to large-artery atherosclerosis (controls).

Results: Brain imaging revealed statistically significant differences between the two cohorts, endocarditis related stroke being more strongly associated with multiple territories involvement, multiple lesions coexistence, watershed lesions, and a greater extent of ischemia all these may serve as valuable diagnostic clues. Among these findings, the presence of multiple lesions has been the most sensitive tool (Sn = 0.786, Sp = 0.857, LR+ = 5.497, LR- = 0.25), while the involvement of multiple arterial territories had the highest specificity and positive likelihood ratio for endocarditis-related stroke (Sn = 0.738, Sp = 0.929, LR+ = 10.394, LR- = 0.282). A larger ischemic lesion as quantified by pc-ASPECTS score (more than by the ASPECTS score) also increases the likelihood of endocarditis as the cause of ischemic stroke, with an AUROC of 0.7361 (95% CI 0.629-0.843).

Conclusions: Early brain imaging could play a crucial role in endocarditis, helping the clinician to suspect this diagnosis. Further studies are needed to understand the role of early brain imaging when Modified Duke Criteria fail to establish the diagnosis.

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引用次数: 0
Clinical skills learning through medical students' lenses, during and after a pandemic - a qualitative study.
IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-02-27 DOI: 10.2478/rjim-2025-0002
Laura Elena Marin, Andreea Maila Măgdălin, Cristian Băicuș

The Coronavirus disease of 2019 (COVID-19) pandemic caused significant disruptions in medical education, particularly in clinical training, as students were restricted from direct patient interactions. This study explores medical students' experiences in learning semiology remotely and their perspectives on the role of online education in medical training. We conducted interviews with 16 medical students in their last year of study. Interviews were audio-recorded and the transcription was verbatim. Thematic analysis was performed. We identified four main themes: "Acquiring clinical skills during pandemic times", "Students' perception about semiology", "Mapping the role of online learning in medicine", and "Future perspectives for a better semiology learning". Students reported significant anxiety and fear regarding direct patient interactions, alongside a perceived deficiency in clinical skills. They mostly managed to overcome them during the following years. They considered that their teachers offered them as much as possible when it comes to the process of learning, giving the pandemic context. They were able to identify different traits of online learning when it comes to medical subjects except semiology. In some cases, they experienced a lack of understanding from their tutors in regard to their inadequate clinical skills. Programs should be implemented in order to consolidate COVID-19 students' clinical knowledge through residency. Online learning cannot be implemented for medical semiology, given the fact that hands-on procedures cannot be substituted.

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引用次数: 0
Penicillin allergy management strategies relevant for clinical practice - a narrative review. 与临床实践相关的青霉素过敏管理策略-叙述性回顾。
IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-01 DOI: 10.2478/rjim-2024-0035
Ileana-Maria Ghiordanescu, Nicolas Molinari, Ana-Maria Forsea, Rik Schrijvers, Cyrille Hoarau, Pascal Demoly

Penicillin allergy is the most commonly reported drug allergy, with prevalence rates ranging from 6% to 31% across various populations and geographic areas. The penicillin allergy label is linked to higher mortality and morbidity rates, extended hospital stays, increased readmission rates, and a greater reliance on second-line antibiotics. Research indicates that nearly 99% of those labeled as penicillin-allergic can tolerate the drug. However, alternative antibiotics are often prescribed without confirming the allergy, largely due to legal concerns regarding re-exposure. Even when a negative challenge test is conducted, non-allergist providers may remain hesitant to reintroduce penicillin. To address the considerable gap between reported and actual penicillin allergies, as well as to ensure the prompt use of penicillins by non-allergists, various management strategies have emerged in recent years. Although several comprehensive reviews have examined these strategies, selecting and applying the most suitable for routine practice is difficult. This narrative review focuses on the most relevant data regarding the efficiency of key penicillin allergy risk assessment tools, particularly those of clinical significance, and discusses their readiness for implementation in non-allergist settings.

青霉素过敏是最常见的药物过敏,在不同人群和地理区域的患病率从6%到31%不等。青霉素过敏标签与较高的死亡率和发病率、延长的住院时间、增加的再入院率以及对二线抗生素的更大依赖有关。研究表明,近99%被标记为青霉素过敏的人可以耐受这种药物。然而,替代抗生素通常在没有确认过敏的情况下开处方,这主要是由于法律上对再次暴露的担忧。即使进行了阴性激发试验,非过敏专科医生也可能对重新引入青霉素犹豫不决。为了解决报告和实际青霉素过敏之间的巨大差距,以及确保非过敏专科医生及时使用青霉素,近年来出现了各种管理策略。尽管对这些策略进行了几次全面的审查,但选择和应用最适合日常实践的策略是困难的。这篇叙述性综述的重点是关于关键青霉素过敏风险评估工具效率的最相关数据,特别是那些具有临床意义的数据,并讨论了它们在非过敏医师环境中实施的准备情况。
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引用次数: 0
Predictors of survival and functioning of arteriovenous fistula in patients on hemodialysis during a one-year follow-up. 一年随访期间血液透析患者动静脉瘘的生存和功能预测因素。
IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-25 DOI: 10.2478/rjim-2024-0033
Radojica V Stolic, Marija Milic, Vekoslav Mitrovic, Milica Mirovic, Tatjana Pesic, Kristina Z Dugalic, Jelena Zivic, Andriana Karanovic, Maja V Sipic, Kristina Bulatovic, Suzana Milutinovic

Introduction: The mortality rate of hemodialysis patients is extremely high and it is significantly affected by vascular access dysfunction. Our research aimed to determine predictive parameters of arteriovenous fistula functioning and survival in a one-year follow-up period.

Methods: The research was organized as a prospective, one-year study, which included 120 dialysis patients who were followed for one year. We recorded the demographic and gender structure, clinical parameters, and laboratory findings significant for the survival and functioning of arteriovenous fistulas. Laboratory findings are presented as the mean values of the analysis at the beginning and the end of the one-year control period.

Results: Univariable regression analysis confirmed the predictive significance of anastomosis positioning, type of vascular access, length of hemodialysis treatment, hemoglobin, Kt/V index values, and creatinine concentration for one-year survival, but multivariable regression analysis confirmed predictive significance only for length of treatment. Univariable regression analysis revealed significant predictors of vascular access function for the length of hemodialysis treatment, diastolic blood pressure, leukocytes, platelets, hemoglobin, creation of an arteriovenous fistula by a nephrologist, starting hemodialysis with a fistula and not with a central venous catheter, multivariable regression analysis confirmed predictive significance for the length of dialysis treatment and creation of an arteriovenous fistula by a nephrologist.

Conclusion: A prognostically important parameter for the one-year survival of a patient on hemodialysis is the length of dialysis treatment. In contrast, predictive parameters for the functioning of an arteriovenous fistula are the length of dialysis and the creation of a fistula by a nephrologist.

导读:血液透析患者死亡率极高,受血管通路功能障碍的影响显著。我们的研究旨在确定动静脉瘘功能和一年随访期生存率的预测参数。方法:本研究是一项为期一年的前瞻性研究,包括120名透析患者,随访一年。我们记录了对动静脉瘘存活和功能有重要意义的人口统计学和性别结构、临床参数和实验室结果。实验室结果以一年对照期开始和结束时分析的平均值表示。结果:单变量回归分析证实吻合口位置、血管通路类型、血液透析治疗时间、血红蛋白、Kt/V指数值、肌酐浓度对1年生存率有预测意义,多变量回归分析证实仅治疗时间有预测意义。单变量回归分析揭示了血液透析治疗时间长度、舒张压、白细胞、血小板、血红蛋白、肾科医生产生动静脉瘘、用瘘开始血液透析而不使用中心静脉导管的血管通路功能的显著预测因素,多变量回归分析证实了透析治疗时间长度和肾科医生产生动静脉瘘的预测意义。结论:透析治疗时间是影响血液透析患者一年生存率的重要预后参数。相比之下,预测参数的功能动静脉瘘是透析的长度和创建一个瘘肾科医生。
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引用次数: 0
Extremely elevated erythrocyte sedimentation rates: Associations with patients' diagnoses and clinical characteristics. 红细胞沉降率异常升高:与患者诊断和临床特征的关系
IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-25 DOI: 10.2478/rjim-2024-0034
Esen Nur Holoğlu, Mehmet Uzunlulu, Cundullah Torun

Introduction: The aim of the study was to assess the etiological distribution of patients with an erythrocyte sedimentation rate (ESR) over 100 mm/hour and to evaluate differences in demographic, comorbidity, laboratory characteristics, and clinical outcomes.

Methods: This retrospective observational clinical study included patients aged 18 years and older who were admitted to the internal medicine inpatient clinic between May 1, 2015 and June 1, 2021 and had ESR values above 100 mm/h. Demographic data, comorbidities, laboratory parameters, imaging studies, histopathological findings, microbiological and serological data, along with in-hospital and post-discharge mortality, were collected from the hospital's electronic database. Two independent clinicians evaluated the data to identify diagnoses associated with elevated ESR. Patients were divided into six categories based on the most likely diagnosis.

Results: The study included 441 patients, 52.6% of whom were female, and the mean age was 72.6 years. The etiological distribution was as follows: infectious diseases (34%), malignancies (31.5%), undiagnosed cases (15.9%), renal diseases (9.8 %), other causes (5 %), and rheumatologic diseases (3.8%). Etiological distributions did not differ by gender, age, or ESR ranges. The in-hospital mortality rate was 3.6%, and the overall mortality rate from hospitalization to the data collection date was 64.4%. Mortality was higher in patients with malignancies (81.3%) compared to other etiologies (p<0.001). Patients who died had higher mean age, ferritin levels, having diabetes mellitus, heart failure, or malignancy, and lower hemoglobin and lymphocyte levels compared to survivors (p<0.05 for all).

Conclusion: Most patients with an ESR over 100 mm/hour had significant underlying medical conditions, with infectious diseases and malignancies comprising two-thirds of the cases.

本研究的目的是评估红细胞沉降率(ESR)超过100 mm/小时的患者的病因分布,并评估人口统计学、合并症、实验室特征和临床结果的差异。方法:本回顾性观察性临床研究纳入2015年5月1日至2021年6月1日在内科住院部就诊且ESR值大于100 mm/h的18岁及以上患者。从医院的电子数据库中收集了人口统计数据、合并症、实验室参数、影像学检查、组织病理学发现、微生物学和血清学数据以及院内和出院后死亡率。两名独立的临床医生对数据进行评估,以确定与ESR升高相关的诊断。根据最可能的诊断将患者分为六类。结果:纳入441例患者,女性占52.6%,平均年龄72.6岁。病因分布如下:传染病(34%)、恶性肿瘤(31.5%)、未确诊病例(15.9%)、肾脏疾病(9.8%)、其他原因(5%)和风湿病(3.8%)。病因分布不因性别、年龄或ESR范围而异。住院死亡率为3.6%,住院至数据收集日的总死亡率为64.4%。与其他病因相比,恶性肿瘤患者的死亡率更高(81.3%)(结论:大多数ESR超过100 mm/小时的患者有明显的潜在疾病,其中感染性疾病和恶性肿瘤占三分之二的病例。
{"title":"Extremely elevated erythrocyte sedimentation rates: Associations with patients' diagnoses and clinical characteristics.","authors":"Esen Nur Holoğlu, Mehmet Uzunlulu, Cundullah Torun","doi":"10.2478/rjim-2024-0034","DOIUrl":"https://doi.org/10.2478/rjim-2024-0034","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of the study was to assess the etiological distribution of patients with an erythrocyte sedimentation rate (ESR) over 100 mm/hour and to evaluate differences in demographic, comorbidity, laboratory characteristics, and clinical outcomes.</p><p><strong>Methods: </strong>This retrospective observational clinical study included patients aged 18 years and older who were admitted to the internal medicine inpatient clinic between May 1, 2015 and June 1, 2021 and had ESR values above 100 mm/h. Demographic data, comorbidities, laboratory parameters, imaging studies, histopathological findings, microbiological and serological data, along with in-hospital and post-discharge mortality, were collected from the hospital's electronic database. Two independent clinicians evaluated the data to identify diagnoses associated with elevated ESR. Patients were divided into six categories based on the most likely diagnosis.</p><p><strong>Results: </strong>The study included 441 patients, 52.6% of whom were female, and the mean age was 72.6 years. The etiological distribution was as follows: infectious diseases (34%), malignancies (31.5%), undiagnosed cases (15.9%), renal diseases (9.8 %), other causes (5 %), and rheumatologic diseases (3.8%). Etiological distributions did not differ by gender, age, or ESR ranges. The in-hospital mortality rate was 3.6%, and the overall mortality rate from hospitalization to the data collection date was 64.4%. Mortality was higher in patients with malignancies (81.3%) compared to other etiologies (p<0.001). Patients who died had higher mean age, ferritin levels, having diabetes mellitus, heart failure, or malignancy, and lower hemoglobin and lymphocyte levels compared to survivors (p<0.05 for all).</p><p><strong>Conclusion: </strong>Most patients with an ESR over 100 mm/hour had significant underlying medical conditions, with infectious diseases and malignancies comprising two-thirds of the cases.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Epidemiology of kidney biopsy from regional referral center in Romania: 10-year review. 罗马尼亚地区转诊中心肾活检流行病学:10年回顾。
IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-12-25 DOI: 10.2478/rjim-2024-0032
Yuriy Maslyennikov, Crina Claudia Rusu, Diana Moldovan, Alina Potra, Dacian Tirinescu, Maria Ticala, Andrada Barar, Urs Alexandra, Cosmina Ioana Bondor, Ina Kacso

Purpose: To provide epidemiologic data on kidney biopsy from Romania.

Methods: Retrospective observational study of kidney biopsy records for adult patients from a referral center in the north-western part of Romania, reported for 2014-2023.

Results: 556 biopsies were performed, corresponding to an incidence of 12 biopsies/m person-year with over 50% increase over the last reported year. Optimal core for optic microscopy was available in 81.4%, immunofluorescence was performed in 86.3%, and electron microscopy in 35.2% of patients. The mean age at biopsy was 47.12 years, and 53.8% were males. Indications for kidney biopsy were nephrotic syndrome in 63.1% of patients, nephritic in 25.9% of patients, asymptomatic urinary abnormalities in 2.9%, acute kidney injury/rapid progressive renal failure in 3.6%, and chronic kidney disease in 1.4%. The most frequent diagnostic categories were membranous nephritis (14.7%), IgA nephropathy (13.9%), focal segmental glomerulosclerosis (11,1%), minimal change disease (12,2%), lupus nephritis (10,9%), vasculitis (7.6%), and membranoproliferative glomerulonephritis (8%). The age of diagnosis increased for IgA Nephropathy over time while it decreased for membranous nephritis.

Conclusions: Our study adds data for the completion of the kidney biopsy map in our region.

目的:提供罗马尼亚肾活检的流行病学资料。方法:回顾性观察研究2014-2023年罗马尼亚西北部转诊中心成年患者肾活检记录。结果:共行活组织检查556例,发病率为12例/m人/年,较上一报告年度增加50%以上。81.4%的患者在光学显微镜下获得最佳核心,86.3%的患者在免疫荧光下获得最佳核心,35.2%的患者在电子显微镜下获得最佳核心。活检时的平均年龄为47.12岁,53.8%为男性。肾活检的适应症为肾病综合征(63.1%)、肾病(25.9%)、无症状尿路异常(2.9%)、急性肾损伤/快速进行性肾衰竭(3.6%)和慢性肾病(1.4%)。最常见的诊断类型是膜性肾炎(14.7%)、IgA肾病(13.9%)、局灶节段性肾小球硬化(11.1%)、微小病变(12.2%)、狼疮性肾炎(10.9%)、血管炎(7.6%)和膜性增生性肾小球肾炎(8%)。随着时间的推移,IgA肾病的诊断年龄增加,而膜性肾炎的诊断年龄减少。结论:我们的研究为完成本地区的肾活检图谱增加了数据。
{"title":"Epidemiology of kidney biopsy from regional referral center in Romania: 10-year review.","authors":"Yuriy Maslyennikov, Crina Claudia Rusu, Diana Moldovan, Alina Potra, Dacian Tirinescu, Maria Ticala, Andrada Barar, Urs Alexandra, Cosmina Ioana Bondor, Ina Kacso","doi":"10.2478/rjim-2024-0032","DOIUrl":"https://doi.org/10.2478/rjim-2024-0032","url":null,"abstract":"<p><strong>Purpose: </strong>To provide epidemiologic data on kidney biopsy from Romania.</p><p><strong>Methods: </strong>Retrospective observational study of kidney biopsy records for adult patients from a referral center in the north-western part of Romania, reported for 2014-2023.</p><p><strong>Results: </strong>556 biopsies were performed, corresponding to an incidence of 12 biopsies/m person-year with over 50% increase over the last reported year. Optimal core for optic microscopy was available in 81.4%, immunofluorescence was performed in 86.3%, and electron microscopy in 35.2% of patients. The mean age at biopsy was 47.12 years, and 53.8% were males. Indications for kidney biopsy were nephrotic syndrome in 63.1% of patients, nephritic in 25.9% of patients, asymptomatic urinary abnormalities in 2.9%, acute kidney injury/rapid progressive renal failure in 3.6%, and chronic kidney disease in 1.4%. The most frequent diagnostic categories were membranous nephritis (14.7%), IgA nephropathy (13.9%), focal segmental glomerulosclerosis (11,1%), minimal change disease (12,2%), lupus nephritis (10,9%), vasculitis (7.6%), and membranoproliferative glomerulonephritis (8%). The age of diagnosis increased for IgA Nephropathy over time while it decreased for membranous nephritis.</p><p><strong>Conclusions: </strong>Our study adds data for the completion of the kidney biopsy map in our region.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142897157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of Smoking on MicroRNAs in Significant Coronary Artery Disease. 吸烟对重大冠状动脉疾病微RNA的影响
IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-11-15 DOI: 10.2478/rjim-2024-0031
Shokoufeh Hajsadeghi, Aida Iranpour, Shayan Mirshafiee, Reza Nekouian, Maryam Mollababaei, Hamed Motevalli, Seyyed Amir Yasin Ahmadi, Mohammad Sedigh Dakkali

Background: Given the importance of coronary artery disease (CAD) and the range of cardiovascular disease phenotypes in smokers, as well as the potential genetic and epigenetic factors, we were motivated to explore the impact of smoking on some selected microRNAs associated with significant CAD.

Methods: A total of 60 individuals were selected in four groups including non-smoker without significant CAD (S-A-), non-smokers with significant CAD (S-A+), smokers without significant CAD (S+A-) and smokers with significant CAD (S+A+). Micro-RNA expression was investigated using real-time PCR. General linear model was used to calculate fold change (FC) considering SA- as the reference group.

Results: For mir-34a, down-regulation was observed in S+A- (FC =0.13, P =0.007) and S+A+ (FC =0.23, P =0.036) groups. For mir-126-3p, down-regulation was observed in S-A+ group (FC =0.05, P =0.024). For mir-199, up-regulation was observed for S+A- group (FC =9.38, P =0.007). The only significant interaction between pack-years of smoking and number of significantly narrowed vessels (≥75% stenosis) was for mir-199 which was in favor of down-regulation (P =0.006), while the main effects were in favor of up-regulation (P <0.05).

Conclusion: Mir-34a expression may be affected by smoking, whereas mir-126-3p expression may be affected by atherosclerosis, the most common reason of CAD. The significant down-regulation of mir-199 for the interaction of smoking dose and severity of CAD was a notable finding showing the harmful consequence of this interaction. Further studies are needed for this micro-RNA.

背景:鉴于冠状动脉疾病(CAD)的重要性和吸烟者心血管疾病表型的范围,以及潜在的遗传和表观遗传因素,我们有动机探索吸烟对某些与明显CAD相关的microRNA的影响:方法: 我们共选取了 60 人,分为四组,包括无明显 CAD 的非吸烟者(S-A-)、有明显 CAD 的非吸烟者(S-A+)、无明显 CAD 的吸烟者(S+A-)和有明显 CAD 的吸烟者(S+A+)。使用实时 PCR 检测微 RNA 表达。以SA-为参照组,使用一般线性模型计算折叠变化(FC):结果:mir-34a在S+A-组(FC =0.13,P =0.007)和S+A+组(FC =0.23,P =0.036)出现下调。对于 mir-126-3p,在 S-A+ 组观察到下调(FC =0.05,P =0.024)。对于 mir-199,在 S+A- 组观察到上调(FC =9.38,P =0.007)。吸烟包年与明显狭窄血管(狭窄程度≥75%)数量之间的唯一显着交互作用是对 mir-199 的交互作用,该交互作用有利于下调(P =0.006),而主效应则有利于上调(P 结论:Mir-34a 的表达可能受 S+A- 组的影响(FC =9.38,P =0.007):Mir-34a 的表达可能受到吸烟的影响,而 mir-126-3p 的表达可能受到动脉粥样硬化的影响,动脉粥样硬化是导致 CAD 的最常见原因。值得注意的是,mir-199 在吸烟剂量和 CAD 严重程度的交互作用下明显下调,这表明这种交互作用会产生有害后果。对这种微RNA还需要进一步研究。
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引用次数: 0
Capillaroscopic Insights: Exploring the Connection Between Microvascular Changes and Pulmonary Manifestations in Systemic Sclerosis. 毛细血管镜的洞察力:探索系统性硬化症微血管变化与肺部表现之间的联系。
IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-24 DOI: 10.2478/rjim-2024-0030
Camelia Palici, Ananu Florentin Vreju, Cristina Elena Biţă, Ștefan Cristian Dinescu, Alesandra Florescu, Anca Emanuela Muşetescu, Andreea Lili Barbulescu, Paulina Lucia Ciurea

Background: Systemic sclerosis (SSc) is a complex connective tissue disease characterized by microangiopathy, immune dysregulation, and fibrosis. Early detection of microvascular abnormalities using nailfold videocapillaroscopy (NVC) is crucial in assessing disease progression and associated disease's involvement such as interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH).

Objective: This study aims to explore the relationships correlation between NVC patterns, clinical manifestations, and systemic complications in SSc.

Methods: We analyzed the data of 63 patients, predominantly female (95%), with a mean age of 49 years and an average disease duration of 42 months. Patients were categorized into early, active, and late patterns based on NVC findings. Clinical features, including digital ulcers (DU), ILD, and PAH, were assessed. Pearson correlation analyses were performed to evaluate the relationships between capillary loss, neoangiogenesis, ILD, and PAH.

Results: The early pattern group (mean mRSS 2.36) exhibited minimal microvascular damage and systemic involvement, with no DUs. In the active pattern group (mean mRSS 10.40), 34.38% had diffuse cutaneous SSc (dcSSc), with 15.63% presenting DUs, 65.63% ILD, and 37.5% PAH. The late pattern group (mean mRSS 18.00) showed the most severe disease, with 80% having DUs, 70% dcSSc, 90% ILD, and 70% PAH. Pearson correlation analyses revealed strong correlations between capillary loss and ILD (r = 0.7255) and PAH (r = 0.6369). A moderate correlation was found between neoangiogenesis and PAH (r = 0.5592).

Conclusion: The study demonstrates that progressive microvascular damage in SSc, as visualized by NVC, correlates strongly with the severity of systemic complications. Early detection of capillary loss and neoangiogenesis using NVC is critical for timely interventions, which could improve patient outcomes by mitigating the progression of ILD and PAH.

背景:系统性硬化症(SSc)是一种以微血管病变、免疫失调和纤维化为特征的复杂结缔组织疾病。使用甲襞显像毛细血管镜(NVC)早期检测微血管异常对评估疾病进展和相关疾病(如间质性肺病(ILD)和肺动脉高压(PAH))至关重要:本研究旨在探讨 NVC 模式、临床表现和 SSc 全身并发症之间的相关性:我们分析了 63 名患者的数据,其中女性占大多数(95%),平均年龄 49 岁,平均病程 42 个月。根据 NVC 结果将患者分为早期、活动期和晚期。临床特征包括数字溃疡(DU)、ILD 和 PAH。对毛细血管缺失、新血管生成、ILD 和 PAH 之间的关系进行了皮尔逊相关分析:结果:早期模式组(平均 mRSS 2.36)的微血管损伤和全身受累程度最小,无 DU。在活动模式组(平均 mRSS 10.40)中,34.38% 患有弥漫性皮肤 SSc(dcSSc),15.63% 出现 DUs,65.63% 患有 ILD,37.5% 患有 PAH。晚期模式组(平均 mRSS 18.00)的病情最为严重,其中 80% 患有 DUs,70% 患有 dcSSc,90% 患有 ILD,70% 患有 PAH。皮尔逊相关性分析显示,毛细血管缺失与 ILD(r = 0.7255)和 PAH(r = 0.6369)之间存在很强的相关性。新血管生成与 PAH 之间存在中度相关性(r = 0.5592):该研究表明,通过 NVC 观察到的 SSc 进行性微血管损伤与全身并发症的严重程度密切相关。使用 NVC 早期检测毛细血管缺失和新生血管生成对于及时干预至关重要,可通过缓解 ILD 和 PAH 的进展改善患者预后。
{"title":"Capillaroscopic Insights: Exploring the Connection Between Microvascular Changes and Pulmonary Manifestations in Systemic Sclerosis.","authors":"Camelia Palici, Ananu Florentin Vreju, Cristina Elena Biţă, Ștefan Cristian Dinescu, Alesandra Florescu, Anca Emanuela Muşetescu, Andreea Lili Barbulescu, Paulina Lucia Ciurea","doi":"10.2478/rjim-2024-0030","DOIUrl":"https://doi.org/10.2478/rjim-2024-0030","url":null,"abstract":"<p><strong>Background: </strong>Systemic sclerosis (SSc) is a complex connective tissue disease characterized by microangiopathy, immune dysregulation, and fibrosis. Early detection of microvascular abnormalities using nailfold videocapillaroscopy (NVC) is crucial in assessing disease progression and associated disease's involvement such as interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH).</p><p><strong>Objective: </strong>This study aims to explore the relationships correlation between NVC patterns, clinical manifestations, and systemic complications in SSc.</p><p><strong>Methods: </strong>We analyzed the data of 63 patients, predominantly female (95%), with a mean age of 49 years and an average disease duration of 42 months. Patients were categorized into early, active, and late patterns based on NVC findings. Clinical features, including digital ulcers (DU), ILD, and PAH, were assessed. Pearson correlation analyses were performed to evaluate the relationships between capillary loss, neoangiogenesis, ILD, and PAH.</p><p><strong>Results: </strong>The early pattern group (mean mRSS 2.36) exhibited minimal microvascular damage and systemic involvement, with no DUs. In the active pattern group (mean mRSS 10.40), 34.38% had diffuse cutaneous SSc (dcSSc), with 15.63% presenting DUs, 65.63% ILD, and 37.5% PAH. The late pattern group (mean mRSS 18.00) showed the most severe disease, with 80% having DUs, 70% dcSSc, 90% ILD, and 70% PAH. Pearson correlation analyses revealed strong correlations between capillary loss and ILD (r = 0.7255) and PAH (r = 0.6369). A moderate correlation was found between neoangiogenesis and PAH (r = 0.5592).</p><p><strong>Conclusion: </strong>The study demonstrates that progressive microvascular damage in SSc, as visualized by NVC, correlates strongly with the severity of systemic complications. Early detection of capillary loss and neoangiogenesis using NVC is critical for timely interventions, which could improve patient outcomes by mitigating the progression of ILD and PAH.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142507039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Non-Steroidal Anti-Inflammatory Drugs: What Is the Actual Risk of Chronic Kidney Disease? A Systematic Review and Meta-Analysis. 非甾体抗炎药:慢性肾病的实际风险是多少?系统回顾与元分析》。
IF 1.6 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-16 DOI: 10.2478/rjim-2024-0029
Saeed Soliman, Rabab Mahmoud Ahmed, Marwa Mostafa Ahmed, Abeer Attia, Amin Roshdy Soliman

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are common cause of acute kidney injury, but chronic kidney disease (CKD) risk of NSAIDs is controversial. Prior systematic reviews are outdated with some methodological flaws. We conducted this systematic review to clarify the association between chronic NSAIDs use and occurrence and/or progression of CKD.

Methods: MEDLINE, Cochrane Library, Web of Science and Science direct were searched for observational and interventional studies from inception to May 2023. Qualitative synthesis was performed. The meta-analysis used pooled odds ratios (OR) and hazard ratios (HR) to estimate the association between chronic NSAID use and CKD occurrence or progression.

Results: Forty studies with a total of 1757118 participants were included in the systematic review; of them 39 studies were suitable for meta-analysis. 56% of our included studies were recent, published within the last 10 years. The meta-analysis revealed a significant association between chronic NSAIDs use and CKD occurrence and progression. The pooled odds ratio was 1.24 (95% CI: 1.11-1.39, p <0.001, I² = 91.21%), and the pooled hazard ratio was 1.50 (95% CI: 1.31-1.7, p <0.001, I² = 90.77%). The pooled hazard ratio (HR) for individuals with no CKD at baseline was 1.31 (95% CI, 1.26-1.40), while for those with preexisting CKD, the HR was significantly higher at 1.67 (95% CI, 1.38-2.02). The HR for individuals with no specific chronic disease was 1.6 (95% CI, 1.32-1.94). For populations with diabetes mellitus (DM) and/or hypertension (HTN), the HR was 1.35 (95% CI, 1.27-1.43), and for those with rheumatic disease, the HR was 1.36 (95% CI, 0.88-2.10).

Conclusions: Long-term NSAID use increases the risk of chronic kidney disease (CKD) occurrence and progression, especially in individuals with pre-existing CKD, who have a 67% risk compared to the general population's 60%. A patient-centered approach for safe and effective pain management is crucial, with special caution for those with pre-existing CKD.

背景:非甾体抗炎药(NSAIDs)是导致急性肾损伤的常见原因,但非甾体抗炎药导致慢性肾病(CKD)的风险却存在争议。之前的系统综述已经过时,存在一些方法上的缺陷。我们进行了这项系统性综述,以澄清长期服用非甾体抗炎药与慢性肾脏病的发生和/或进展之间的关联:方法:检索了 MEDLINE、Cochrane Library、Web of Science 和 Science direct 中从开始到 2023 年 5 月的观察性和干预性研究。进行了定性综合。荟萃分析采用汇总的几率比(OR)和危险比(HR)来估计长期使用非甾体抗炎药与慢性肾脏病发生或进展之间的关系:系统综述纳入了 40 项研究,共有 1757118 人参与;其中 39 项研究适合进行荟萃分析。在纳入的研究中,有 56% 是最近 10 年内发表的。荟萃分析表明,长期服用非甾体抗炎药与慢性肾脏病的发生和发展之间存在显著关联。汇总的几率比为 1.24(95% CI:1.11-1.39,p p 结论:长期使用非甾体抗炎药会增加慢性肾功能衰竭发生和发展的风险:长期使用非甾体抗炎药会增加慢性肾脏病(CKD)发生和发展的风险,尤其是已患有慢性肾脏病的患者,其风险为 67%,而普通人群的风险为 60%。以患者为中心的安全有效的疼痛治疗方法至关重要,对已有慢性肾脏病的患者要特别谨慎。
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Romanian Journal of Internal Medicine
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