Medical Science Monitor最新文献

BACKGROUND Acute mesenteric ischemia (AMI) still has high mortality rates despite improvements in diagnosis and treatment. The aim of the present study was to determine the factors affecting mortality and the role of laboratory findings in predicting mortality in patients with an AMI diagnosis who were followed up and treated in our clinic. MATERIAL AND METHODS The study included 46 patients diagnosed with AMI between 2011 and 2019. Patients' data were examined retrospectively. The patients who died and those who were alive were compared. To determine the risk factors for mortality, we examined age, sex, accompanying diseases, clinical features, American Society of Anesthesiologists (ASA) classification, laboratory and radiological findings, symptoms, time delay laparotomy, surgical procedure used, and the etiology of the ischemia. RESULTS Mortality rates were significantly associated with the etiology, ASA classification, and resected intestinal area (P<0.001, P=0.031, and P=0.024, respectively). Mortality rates were significantly higher in the patients who had comorbid diabetes mellitus, cerebrovascular disease, and chronic renal failure (P=0.012, P=0.05, and P=0.05, respectively). Creatinine, urea, lymphocyte-monocyte ratio (LMR), and hemoglobin-albumin-lymphocyte-platelet (HALP) values were significantly different between alive and dead patient groups (P<0.001, P<0.001, P=0.011, and P=0.029, respectively). No significant differences were found for other parameters. CONCLUSIONS Etiology, ASA classification, larger resection area, some accompanying diseases, and the time from diagnosis to surgery appeared to be risk factors for mortality. In addition, high urea, creatinine, low LMR, and low HALP score were associated with mortality.

BACKGROUND Postoperative pain following total knee arthroplasty (TKA) is a substantial clinical challenge, often complicating recovery. Electroacupuncture (EA) has garnered interest as a potential intervention, yet its definitive efficacy and safety profile in the context of TKA remain subjects of ongoing academic debate, necessitating a systematic synthesis of existing evidence. MATERIAL AND METHODS This meta-analysis systematically evaluated the impact of EA on post-TKA pain. A comprehensive literature search was conducted across 8 databases up to July 20, 2025. Statistical analysis of included randomized controlled trials (RCTs) was performed using Review Manager 5.3.0. Sixteen RCTs involving 1142 patients were ultimately included, assessing pain scores, biochemical markers, rescue analgesic use, and adverse events. RESULTS The analysis demonstrated that EA significantly reduced resting pain on postoperative days 1, 3, and 7, and movement-related pain throughout the first postoperative week (all P<0.00001). EA also significantly increased ß-endorphin levels and decreased prostaglandin E2 levels (P<0.00001). Furthermore, EA application led to a reduction in rescue analgesic requirements (RR=0.46, P=0.01) and a lower incidence of adverse events (RR=0.45, P=0.002). The certainty of the evidence for these outcomes ranged from moderate to very low. CONCLUSIONS This meta-analysis provides supportive evidence that EA can be an effective and safe adjunctive therapy for mitigating pain and reducing analgesic reliance after TKA, particularly during the initial postoperative week. However, the conclusions are tempered by the limited quality of some included studies, underscoring the necessity for further rigorously designed, high-quality RCTs to fortify these findings.

BACKGROUND Prolonged pre-procedural fasting before percutaneous tracheostomy is traditionally practiced to reduce aspiration pneumonia risk in critically ill patients; however, its clinical impact remains unclear. This study primarily evaluated the effect of fasting duration on aspiration pneumonia and secondarily assessed respiratory, nutritional, and clinical outcomes. MATERIAL AND METHODS This single-center retrospective observational study included 222 adult intensive care unit (ICU) patients who underwent percutaneous tracheostomy with enteral nutrition. Patients were grouped by fasting duration (<1 h, 1-4 h, 5-12 h, >12 h). Clinical, respiratory, nutritional, and outcome variables were analyzed. RESULTS The incidence of aspiration pneumonia ranged from 40.2% to 54.5%, with no significant differences between fasting groups (P=0.421). Patients fasting >12 hours had higher mechanical ventilation FiO₂ requirements 48 hours after tracheostomy compared with those fasting <1 hour (47.7% vs 39.1%; P=0.001). The time to reach caloric targets was substantially longer in the prolonged-fasting group (33.5±24.4 vs 2.4±9.0 hours; P<0.001). No significant differences were observed in ICU stay, hospital stay, or mortality. CONCLUSIONS Prolonged pre-tracheostomy fasting did not reduce the incidence of aspiration pneumonia but was associated with increased oxygen requirements and delayed nutritional recovery. Avoiding unnecessary interruptions of enteral nutrition and using shorter, individualized fasting strategies may optimize outcomes in critically ill patients. These findings indicate that routinely applied prolonged fasting durations offer no clinical benefit and may adversely affect metabolic and respiratory stability in this patient population.

BACKGROUND Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system characterized by inflammation, demyelination, gliosis, and neuroaxonal loss. This study aimed to evaluate the factors associated with kinesiophobia (fear of movement) in multiple sclerosis patients, including disability, fatigue, anxiety, depression, physical activity, and quality of life. MATERIAL AND METHODS A cross-sectional study was conducted in Prešov between March 2021 and March 2024 enrolling 148 patients with MS (105 women and 43 men; mean age 42.21±9.84 years; range 21-71). Disability was assessed using the Expanded Disability Status Scale (EDSS) (median [IQR] 4.00 [2.50]; range 1-6). Kinesiophobia was measured using the Tampa Scale for Kinesiophobia, physical activity with the Godin Leisure-Time Exercise Questionnaire, and health-related quality of life with the Short Form-36 Health Survey. Fatigue was evaluated using the Modified Fatigue Impact Scale, while depressive and anxiety symptoms were assessed using the Zung Self-Rating Depression Scale and the Beck Anxiety Inventory. RESULTS In the final adjusted model, higher anxiety levels (ß=0.252, 95% CI: 0.053 to 0.331), lower physical activity (ß=-0.353, 95% CI: -0.208 to -0.086), and older age (ß=0.205, 95% CI: 0.022 to 0.258) emerged as significant independent predictors of kinesiophobia in MS patients. CONCLUSIONS These findings highlight kinesiophobia as a clinically relevant problem in MS. Its severity is strongly influenced by anxiety, as well as reduced physical activity and older age, underscoring the need for integrated behavioral and rehabilitative approaches.

BACKGROUND Post-dural puncture headache (PDPH) is a common complication of spinal anesthesia in cesarean delivery. While demographic and procedural factors are well recognized, the role of systemic inflammatory indices in pregnant women has not been clearly defined. MATERIAL AND METHODS This retrospective cohort study included 821 pregnant women who underwent elective cesarean delivery under spinal anesthesia between January 2020 and December 2024. PDPH was diagnosed using the ICHD-3 criteria. Preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and systemic inflammation response index (SIRI) were evaluated using correlation, logistic regression, and receiver operating characteristic (ROC) analyses. RESULTS PDPH occurred in 133 patients (16.2%). Median NLR values were lower in the PDPH group compared with controls (2.63 vs 3.82, P<0.001). NLR showed a moderate negative correlation with PDPH (ρ=-0.41, P<0.001). After adjustment for potential confounders, only NLR showed a significant association with PDPH (OR 0.51, 95% CI 0.39-0.66, P<0.001). ROC analysis demonstrated a moderate discriminatory performance (AUC 0.76), and a cutoff of ≤3.14 achieved 88.7% sensitivity and 92.1% negative predictive value. CONCLUSIONS Lower preoperative NLR values showed an association with PDPH after cesarean delivery under spinal anesthesia. Identification of a clinically relevant cutoff suggests that NLR may be a practical biomarker for perioperative risk assessment in obstetric anesthesia. Further prospective, multicenter studies are needed to confirm these findings.

BACKGROUND The global rise in the elderly population has amplified the urgency to address age-related nutritional risks, as malnutrition among older hospitalized patients contributes to poor clinical outcomes and shows the need for targeted nutritional interventions. This study aimed to assess the clinical nutrition management of elderly hospitalized patients. MATERIAL AND METHODS A total of 227 hospitalized patients who received nutrition consultations in the Department of Geriatrics at Peking University People's Hospital from May 2017 to September 2020 were included in this study. We conducted a retrospective review of their medical records, collecting basic clinical information, nutritional status, consultation times and recommendations, compliance with clinical advice, and changes in blood biochemical indicators. RESULTS Among 227 patients, 160 (68.75% male and 73.49% female) were at nutritional risk. Those with type 2 diabetes, pulmonary infections, gastrointestinal diseases, chronic kidney disease, and anemia had a higher incidence of nutritional risk (* P<0.05). Of these, 204 adhered to the nutritionists' intervention plan, with the highest implementation rate for health education (98.73%) and the lowest for oral nutritional supplements (ONS) at 83.87%. Noncompliance included 69% failing to take oral supplements and 22% refusing tube feeding. Patients following nutritional advice had significantly shorter hospital stays (P=0.03, P=0.00). After the intervention, total protein and albumin improved, with low-risk patients showing higher levels in total enteral nutrition (* P<0.05). No significant differences were found in high-risk patients (P>0.05). CONCLUSIONS Effective clinical nutrition management for elderly patients requires enhanced dietary supply practices, standardized consultation implementation, and the active involvement of patients' families in nutritional planning, ultimately improving overall healthcare outcomes.

BACKGROUND Approximately 70% to 84% of patients with spinal cord injury (SCI) have varying degrees of bladder dysfunction, which can lead to upper urinary tract complications. Urodynamics is the standard method for evaluating bladder function after SCI. The effect of robot-assisted gait therapy (RAGT) on urinary function is rarely reported in the literature. The aim of this study was to evaluate the changes in urodynamics in SCI patients undergoing RAGT. MATERIAL AND METHODS The study included 35 SCI patients (26 males and 9 females) with neurological impairment at between 3 months and 2 years after injury. Simple randomization was used by tossing a coin. The rehabilitation program was performed for 7 weeks in 30-minute sessions with exoskeleton EKSO-GT or Locomat Pro; while in the control group, a dynamic parapodium was used instead of RAGT. In all patients, at the beginning and the end of therapy, urodynamics were assessed. The parameters, including cystometric bladder capacity (CBC), the first, normal, and strong desire to void (FD, ND, SD), maximum and average flow rate, post-void residual volume (PRV) and compliance, and external urethral sphincter function were analyzed. RESULTS A decreasing trend in micturition time was observed in all patients undergoing RAGT. Compliance in patients with complete SCI did not change, or in some cases decreased (up to 3 ml/cm). In patients with incomplete SCI, flow rates (average and maximum) increased while micturition time decreased. In patients with incomplete injury in the RAGT group, the lowest increases or decreases in CBC, FD, ND, and SD were observed in patients with L-level SCI lesions. CONCLUSIONS The improvement in bladder parameters observed in the study indicates that RAGT should be considered as an option in neurogenic bladder treatment.

Post-stroke fatigue is a prevalent sequela of stroke that substantially impairs patients' quality of life and rehabilitation progress, yet its mechanisms and management remain heterogeneous. This narrative review synthesizes current evidence on neuroimmune pathways implicated in post-stroke fatigue and appraises emerging mechanism-targeted interventions. Studies published between 2003 and 2025 were included; all were sourced from PubMed, Web of Science, or Scopus. Search terms included "post-stroke fatigue", "neuroinflammation", "pharmacological interventions", "neuromodulation", and related terms. Only full-text, English-language articles were considered; studies were selected according to their focus on post-stroke fatigue mechanisms or interventions. Convergent data implicate low-grade, cytokine-mediated inflammation; dysregulation of the monoaminergic system - particularly dopamine and serotonin; and hyperactivity of the hypothalamic-pituitary-adrenal axis. Interventions aligned with these pathways show promise, including immunomodulation with interleukin-1 receptor antagonists; neuromodulation with transcranial direct current stimulation and repetitive transcranial magnetic stimulation; pharmacotherapy with selective serotonin reuptake inhibitors or modafinil; and non-pharmacological strategies such as aerobic exercise and cognitive behavioral therapy. A neuroimmune-informed, mechanism-targeted approach may improve outcomes in post-stroke fatigue. Priorities include standardized definitions, harmonized outcome measures, and adequately powered trials to confirm effectiveness across phenotypes.

BACKGROUND This study compared the clinical efficacy and complication profiles of classical midline versus paramedian incision techniques in coccygectomy for chronic refractory coccygodynia. We hypothesized that the paramedian approach would reduce wound-related complications and improve early postoperative pain and function. MATERIAL AND METHODS A retrospective cohort of 41 patients (32 women, 9 men) who underwent coccygectomy between 2015 and 2023 was analyzed. Patients were divided into a classical midline incision group (n=18) and a paramedian incision group (n=23). Outcomes included wound healing time, wound dehiscence, surgical site infections, intraoperative blood loss, visual analog scale (VAS) pain scores, and Oswestry Disability Index (ODI). Statistical comparisons were performed. RESULTS The paramedian group had significantly lower wound dehiscence rates than the midline group (0% vs 27.8%, P=0.01). There were fewer surgical site infections in the paramedian group than in the midline group (4.3% vs 22.2%), but the difference was not statistically significant (P=0.16). Early postoperative pain at 3 months was significantly lower in the paramedian group than midline group (mean VAS 3.22 vs 4.06, P=0.045). Long-term VAS and ODI scores showed no significant difference. Mean wound healing time was shorter in the paramedian group (4.46 vs 5.12 months), with higher, yet not significant, patient satisfaction. Intraoperative blood loss and operative duration were similar. CONCLUSIONS Both incision techniques offer comparable long-term outcomes. However, the paramedian approach provides better early pain relief and fewer wound complications, representing a safer, more effective alternative for refractory coccygodynia.

BACKGROUND Plantar fasciitis is a common cause of chronic heel pain. Corticosteroid injections provide short-term relief but carry long-term risks of fascia degradation. Zhengqing Fengtongning (ZQFTN), a sinomenine hydrochloride-based herbal extract, shows anti-inflammatory effects in musculoskeletal disorders, although evidence for plantar fasciitis remains limited. Ultrasound-guided injection enables precise pathological targeting. MATERIAL AND METHODS In this single-center RCT, 54 patients with chronic plantar fasciitis were randomized to ultrasound-guided ZQFTN (n=27) or corticosteroid (n=27) injections. Primary outcomes included VAS pain scores, AOFAS foot function, and plantar fascia thickness via ultrasound at baseline, 1 week, 1 month, and 3 months. RESULTS Both groups demonstrated significant improvements over time: within-group analyses showed progressive reductions in VAS scores (P<0.05) and increases in AOFAS scores (P<0.05) at all follow-up points, alongside significant thinning of plantar fascia thickness at 1 and 3 months (P<0.05). Between-group comparisons revealed that at 3 months, the observation group exhibited significantly lower VAS scores (P<0.05) and higher AOFAS scores (P<0.05) than the control group. Ultrasonographic measurements further indicated more pronounced reductions in plantar fascia thickness in the observation group at 1 month (P<0.05) and 3 months (P<0.05). CONCLUSIONS Ultrasound-guided injection therapy ensures precise targeting of the pathological fascia, with Zhengqing Fengtongning demonstrating superior long-term efficacy and a better safety profile compared to corticosteroids.