Medical Science Monitor最新文献

BACKGROUND Patients with acute ischemic stroke receiving intravenous thrombolysis require intensive secondary prevention; however, poor medication adherence and inadequate lipid control in real-world practice often compromise long-term outcomes. This study evaluated the effects of a clinical pharmacist-led medication management program on medication adherence, lipid control, and functional outcomes in patients with acute ischemic stroke receiving intravenous thrombolysis. MATERIAL AND METHODS We retrospectively analyzed data from a prospective stroke database collected between January and October 2023. Patients treated with intravenous thrombolysis were assigned to either a control group or a pharmacist-led intervention group. Outcomes included 1-month lipid profiles and low-density lipoprotein cholesterol (LDL-C) reduction, and 3-month medication adherence and clinical outcomes. RESULTS A total of 190 patients were included (93 control, 97 intervention). Baseline characteristics, including statin use and length of hospital stay, were comparable. At 1 month, the intervention group had lower LDL-C levels than the control group (2.11 [1.64-2.53] vs 2.33 [1.80-2.96] mmol/L; P=0.037) and a greater reduction from baseline (0.98 [0.38-1.46] vs 0.70 [0.22-1.31] mmol/L; P=0.044). Multivariate analysis confirmed the pharmacist-led intervention as an independent predictor of greater LDL-C reduction (ß=0.239 mmol/L; P=0.016). Medication adherence at 3 months was higher in the intervention group and independently associated with optimal adherence (adjusted OR, 3.03; 95% CI, 1.53-5.99; P=0.001). Functional outcomes did not differ significantly. CONCLUSIONS Clinical pharmacist-led medication management was associated with improved medication adherence and early lipid control in patients with acute ischemic stroke receiving intravenous thrombolysis.

BACKGROUND This study aimed to evaluate the effect of SnapShot Freeze 2 (SSF2) on reducing pulsation artifacts in coronary artery imaging of patients with high heart rates, compared with SnapShot Freeze (SSF) and not using SSF (no-SSF). MATERIAL AND METHODS End-diastolic (70-80% phase) and end-systolic (40-50% phase) images from 50 patients with heart rates above 80 bpm who underwent coronary computed tomography angiography (CCTA) in the Department of Radiology at our hospital between January and June 2023 were included. Subjective, objective, and artificial intelligence (AI)-enabled assessments were performed to evaluate image quality across coronary artery segments, artifact indices, and number of coronary artery segments detected by the AI system for images processed with each algorithm. RESULTS SSF2 yielded significantly higher subjective image-quality scores than SSF and no-SSF in both diastolic and systolic phases (all P<0.001). The artifact index was significantly lower in SSF2 images (F=25.645, P<0.05 for diastolic phases; F=6.959, P<0.05 for systolic phases). In the AI-enabled evaluation, SSF2 images contained significantly more analyzable coronary artery segments than those reconstructed with SSF or without motion correction (all P<0.05), indicating improved image interpretability after SSF2 reconstruction. CONCLUSIONS SSF2 may improve coronary artery image quality and reduce motion artifacts in patients with high heart rates during CCTA. These findings suggest that SSF2 enhances both subjective assessment and AI-based diagnostic performance, although further multicenter studies are warranted to confirm its clinical impact.

BACKGROUND Clear cell renal cell carcinoma (ccRCC) is the most common renal malignancy, often associated with poor prognosis due to metastasis and treatment resistance. The Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway is a major oncogenic driver in ccRCC, but its upstream regulators remain unclear. Outer dense fiber of sperm tails 3B (ODF3B), initially identified in sperm flagella, shows aberrant expression in a subset of human malignancies, and emerging transcriptomic data suggest notable dysregulation of ODF3B in ccRCC, although its functional role in this tumor type remains unknown. MATERIAL AND METHODS ODF3B expression was analyzed using data from The Cancer Genome Atlas (TCGA) and validated in ccRCC cell lines. Prognostic significance was evaluated through clinicopathological and survival analyses. Functional assays, including Cell Counting Kit 8, colony formation, wound healing, Transwell assay, and flow cytometry, were performed after ODF3B knockdown in 786-O and OSRC-2 cells. Pathway enrichment analyses and Western blotting were used to explore mechanisms, and rescue experiments were conducted with the STAT3 agonist Colivelin TFA. RESULTS ODF3B was markedly upregulated in ccRCC tissues and cells, with high expression correlating with advanced stage, metastasis, and poor survival. ODF3B silencing suppressed proliferation, migration, and invasion while enhancing apoptosis, accompanied by reduced BCL2 and increased cleaved caspase-3. Bioinformatics revealed strong enrichment of JAK/STAT signaling in tumors with high expression of ODF3B. Mechanistically, ODF3B knockdown decreased phosphorylation of JAK1/2/3 and STAT3, whereas STAT3 activation rescued proliferative and anti-apoptotic effects. CONCLUSIONS ODF3B acts as a novel oncogenic driver in ccRCC by activating JAK/STAT signaling. Its overexpression predicts aggressive features and poor prognosis, highlighting ODF3B as a potential therapeutic target.

Anesthetic techniques have a measurable influence on immune function during the perioperative period, with potential consequences for infection risk, tissue repair, and oncological outcomes. The key pathways implicated include mTOR (mechanistic target of rapamycin), NF-kappaB (nuclear factor kappa-light-chain-enhancer of activated B cells), and JAK/STAT (Janus kinase-signal transducer and activator of transcription), which together shape cytokine release, T-cell responsiveness, macrophage function, and natural killer cell-mediated cytotoxicity. Available studies indicate that several anesthetic agents can attenuate innate and adaptive immunity, potentially compromising host defense, while in selected contexts a controlled reduction in perioperative inflammation may confer benefit. Particular emphasis is placed on cancer surgery, in which anesthetic choices may influence perioperative control of micrometastases and, consequently, long-term oncological outcomes. Despite growing interest, the evidence base is limited by methodological heterogeneity, short follow-up intervals, and the predominance of preclinical data. To address these gaps, we propose practical considerations for tailoring anesthesia to patients at immunological or oncological risk and outline priorities for future research. These include standardized perioperative immune biomarkers, harmonized protocols, and multicenter randomized trials integrating mechanistic and clinical endpoints. Understanding how anesthetic techniques shape perioperative immunity offers an opportunity to refine anesthetic decision-making and develop evidence-based strategies aimed at improving short- and long-term patient outcomes. This article aims to review the effect of anesthetic techniques and medications on the immune response during the perioperative period.

Schizophrenia is a complex psychiatric disorder in which persistent negative symptoms, depressive features, and cognitive difficulties often remain despite adequate antipsychotic treatment. These unmet clinical needs have led to increasing interest in the use of antidepressants as adjunctive therapy. Randomized trials and observational studies suggest that certain selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are associated with modest improvements in negative symptoms, depressive symptoms, affective instability, and overall functioning when combined with second-generation antipsychotics (SGA). Findings from other antidepressant classes have been less consistent, reflecting differences in pharmacological profiles and study designs. Safety considerations, including metabolic risk, drug interactions, and the potential to aggravate psychotic symptoms, remain essential when deciding on augmentation. Although the literature is heterogeneous, available data suggest that antidepressant add-on strategies provide additional benefit for selected patients with inadequate response to antipsychotic monotherapy. Clinical considerations and research priorities are summarized to inform individualized decision-making. This article aims to review the role of antidepressant augmentation of antipsychotic treatment in patients with schizophrenia.

BACKGROUND Percutaneous transforaminal endoscopic discectomy (PTED) has been widely applied for lumbar disc herniation (LDH) in recent years; however, the achievement of bilateral decompression through a conventional unilateral PTED approach remains a key challenge. This retrospective study evaluated outcomes after unilateral PTED among patients with lumbar stenosis due to a large central LDH and concomitant bilateral neurological symptoms. MATERIAL AND METHODS From January 2018 to December 2020, 34 patients aged 22 to 54 years with large central LDH and concomitant bilateral neurological symptoms received treatment via unilateral PTED. The visual analog scale (VAS), Oswestry Disability Index (ODI), and dural sac area were used to assess clinical efficacy before and after surgery. At the final follow-up, modified MacNab criteria were used to evaluate the satisfaction rate. RESULTS Intraoperative blood loss was 81.56±14.72 mL (range, 50-110). Operative time was 85.12±13.43 min (range, 65-113). Length of hospitalization was 32.06±9.52 h (range, 24-72). Follow-up duration was 34.21±6.54 months (range, 24-48). VAS and ODI scores for low back and leg pain significantly improved at all postoperative time points (P<0.05). The satisfaction rate, based on modified MacNab criteria, was 91.2%. Cerebrospinal fluid leakage occurred in 1 patient, and postoperative symptom recurrence occurred in 1 patient. CONCLUSIONS This study confirms that unilateral PTED can achieve bilateral decompression with safe and reliable outcomes in the treatment of large central LDH and concomitant bilateral neurological symptoms, substantially relieving low back and leg pain and improving limb function.

BACKGROUND This study aimed to evaluate the effectiveness of prolotherapy in patients diagnosed with lateral epicondylitis and to objectively assess changes in tendon elasticity using shear-wave elastography (SWE). MATERIAL AND METHODS This was a prospective, single-center, observational clinical study. Thirty-six patients diagnosed with lateral epicondylitis were included. Each received 3 prolotherapy sessions at 3-week intervals. The elasticity and thickness of the common extensor tendon (CET) were evaluated using SWE both before and after treatment. Pain intensity was measured using the Visual Analog Scale (VAS). The same orthopedic surgeon performed all prolotherapy injections, and the same radiologist performed all SWE evaluations. Data normality was assessed with the Shapiro-Wilk test. Normally distributed variables were analyzed using the t-test or Paired Sample t-test, while the Mann-Whitney U or Wilcoxon Signed-Rank tests were used for non-normal data. Correlations were evaluated using Pearson's or Spearman's correlation coefficient, and P<0.05 was considered statistically significant. RESULTS Prolotherapy resulted in a significant increase in CET elasticity (kPa) and tendon thickness (P<0.01). Male patients exhibited greater tendon thickness and stiffness than female patients. Overall, SWE proved to be a reliable quantitative tool for tracking treatment response. CONCLUSIONS Prolotherapy is an effective treatment for lateral epicondylitis, contributing to pain reduction and structural improvement of the tendon. SWE offers a non-invasive, reliable imaging technique for objectively tracking changes in tendon elasticity. The combination of these methods provides valuable clinical and structural insights into the management of lateral epicondylitis.

BACKGROUND Sarcopenia, the age-related loss of muscle mass and function, is a major geriatric concern. This study evaluated the impact of Baduanjin, resistance band, and mixed exercise on muscle mass and physical function in elderly sarcopenic patients. MATERIAL AND METHODS Eighty sarcopenic individuals were randomly assigned to Baduanjin, resistance band, mixed exercise, or control groups (n=20 each). Interventions were conducted 3×/week for 30 minutes over 12 weeks. Appendicular skeletal muscle mass (ASM), ASM index (ASMI), handgrip strength (HGS), gait speed (GS), Short Physical Performance Battery (SPPB) scores, and timed up-and-go test (TUGT) were measured before and after the intervention. RESULTS Before the intervention, the groups were comparable. Post-intervention within-group comparisons indicated significant improvements in ASM and ASMI in the resistance band and mixed exercise groups (P<0.05). Between-group comparisons of change scores revealed greater increases in ASM and ASMI in the resistance band group compared to the control group (P<0.05). Furthermore, post-intervention within-group comparisons shows that improvements (P<0.05) were noted in HGS, GS, TUGT, and SPPB across all exercise groups. Between-group comparisons of change scores revealed that the resistance band and mixed exercise groups demonstrated greater enhancements in HGS, GS, and TUGT compared to the control group (p<0.05). Additionally, changed balance scores in SPPB and SPPB were significantly higher in the resistance band group than in the control group (P<0.05). CONCLUSIONS Resistance band and mixed exercise improved muscle mass and overall physical function. Baduanjin specifically enhanced balance. These findings support tailored exercise prescriptions for sarcopenia management.

BACKGROUND Sudden sensorineural hearing loss (SSNHL) is an otological emergency with incompletely understood pathophysiology. Evidence suggests microcirculatory dysfunction and oxidative stress contribute to cochlear injury; however, their interrelationship remains insufficiently characterized. MATERIAL AND METHODS This prospective case-control study enrolled 100 patients with SSNHL and 100 age- and sex-matched healthy controls. Perfusion-related surrogate parameters, including cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT), were assessed using dynamic contrast-enhanced magnetic resonance perfusion imaging. Peripheral microcirculation was evaluated by laser Doppler flowmetry. Systemic oxidative stress markers malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) were quantified in serum. Experimental validation was performed using a rat ischemia-reperfusion model to assess cochlear oxidative stress, apoptosis, and auditory brainstem response thresholds. RESULTS Compared with controls, SSNHL patients exhibited reduced CBF and CBV, prolonged MTT, and lower peripheral microcirculatory perfusion (all P<0.05). Oxidative stress was increased in SSNHL, reflected by elevated serum MDA levels and reduced SOD and GSH-Px activities. Animal model showed ischemia-reperfusion induced parallel alterations, including increased cochlear oxidative stress, reduced antioxidant enzyme activity, increased apoptotic cell burden, and elevated auditory brainstem response thresholds. Perfusion-related parameters correlated with oxidative stress markers. Multivariable regression analysis demonstrated independent associations between perfusion profiles, oxidative imbalance, and hearing thresholds. CONCLUSIONS SSNHL is associated with unfavorable perfusion-related surrogate parameters and heightened oxidative stress accompanied by reduced antioxidant defenses. Clinical and experimental findings suggest microcirculatory dysfunction and oxidative imbalance are interrelated features of SSNHL-associated cochlear injury. Causal inference cannot be established, and further mechanistic studies are warranted.

BACKGROUND Glycemic variability is increasingly recognized as an important contributor to the development of diabetes-related complications in patients with type 2 diabetes mellitus (T2DM). Continuous subcutaneous insulin infusion (CSII) is effective in improving glycemic control; however, fluctuations in blood glucose can persist. Mulberry twig alkaloids (MTA), a traditional Chinese medicine component with hypoglycemic properties, have shown potential benefits in regulating glucose metabolism. This study aimed to evaluate whether MTA combined with CSII could further improve glycemic variability and symptoms recognized by traditional Chinese medicine (TCM) in patients with T2DM. MATERIAL AND METHODS Sixty hospitalized patients with T2DM were randomly assigned to a control group (CSII alone, n=30) or an MTA group (MTA tablets plus CSII, n=30). Flash glucose monitoring was used to assess glycemic variability indicators, including mean blood glucose (MBG), standard deviation of blood glucose (SDBG), coefficient of variation (CV), mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD), time in range (TIR, 3.9-10 mmol/L), time above range (TAR), and time below range (TBR) over 14 days. TCM symptom scores were evaluated before and after treatment. RESULTS After 14 days, MODD, MAGE, TAR, and TBR were significantly lower in the MTA group compared with the control group (all P<0.05), while TIR was significantly higher (P<0.01). Additionally, the TCM symptom score was markedly reduced in the MTA group compared with the control group (P<0.05). CONCLUSIONS Our findings suggested that CSII combined with mulberry twig alkaloids can improve blood glucose variability and relive TCM symptoms in T2DM patients.