Medical Science Monitor最新文献

BACKGROUND The optimal antithrombotic regimen for patients with atrial fibrillation (AF) and multivessel disease undergoing complex percutaneous coronary intervention (PCI) remains controversial, particularly with high ischemic and complex coronary anatomy. MATERIAL AND METHODS We retrospectively recruited 56 AF patients with SYNTAX scores >22 who underwent PCI January 2018-December 2023. Patients were grouped by antithrombotic strategy 1 year after PCI, as follows: oral anticoagulant (OAC) alone (monotherapy group, n=32) or OAC plus antiplatelet therapy (APT; dual-therapy group, n=24). RESULTS Baseline demographics, comorbidities, and coronary disease severity were comparable. At 1-year follow-up, composite endpoint rates were significantly higher in the dual-therapy group (66.7%) than monotherapy group (28.1%, P=0.006). Revascularization rates were notably higher in the dual-therapy group (50.0% vs 12.5%, P=0.003), including target lesion (33.3% vs 9.4%, P=0.041) and target vessel revascularization (37.5% vs 9.4%, P=0.019). One year after index PCI, continued dual therapy was associated with a significantly increased risk of revascularization (HR: 4.003, 95% CI: 1.287-12.450, P=0.017) in univariate Cox regression analysis. CONCLUSIONS In AF patients with complex coronary artery disease, continuation of OAC plus APT beyond 1 year after PCI was associated with higher adverse clinical outcomes and greater need for repeat revascularization, compared with OAC alone, suggesting long-term OAC monotherapy represents a safer and equally effective alternative for selected high-risk patients. However, given the retrospective design and limited sample size of our study, OAC monotherapy warrants prospective validation in AF patients with complex PCI, as our retrospective results should be regarded as hypothesis-generating.

BACKGROUND Obstructive sleep apnea (OSA) is associated with increased risk of systemic comorbidities, leading to significant morbidity and mortality. This study investigates predictors of all-cause and OSA-related mortality, emphasizing the interplay of clinical symptoms, polysomnographic findings, and comorbidities. The aim of this study was to identify and compare predictors of all-cause and OSA-related mortality over 5, 10, and 15 years of follow-up. MATERIAL AND METHODS In this single-center study conducted at our Sleep Medicine Department between 2005 and 2019, 4025 patients with suspected OSA underwent polysomnography and were enrolled in this longitudinal study. Patients were categorized based on their mortality status, with a follow-up time of up to 15 years, and the cause of death if applicable. Based on the underlying cause of death, we identified 2 study groups: all-cause mortality (n=853) and OSA-related mortality (n=460). We performed Cox regression analyses to evaluate predictors of mortality. RESULTS Prevalence of OSA was high - 75.6% in the cohort: 929 patients with mild OSA (23.1%), 770 with moderate OSA (19.1%), and 1343 with severe OSA (33.4%). Survival rates were 89.7%, 81.9%, and 78.8% at 5, 10, and 15 years, respectively. Cardiovascular causes dominated mortality (33.3%), followed by cancer (26.5%). We compared the apnea-hypopnea index (AHI) a well-known, widely used metric for indicating the severity of OSA, in 0-5, 0-10, and 0-15 years of observation of all-cause mortality and OSA-related mortality. Comparing the AHI during rapid eye movement (REM) sleep, non-rapid eye movement (NREM) sleep, and total sleep time (TST), AHIREM was associated with a higher mortality risk than AHINREM and AHITST. Sleepiness (HR 1.17 95% CI: 1.09-1.26), episodes of stroke (HR 1.77 95% CI: 1.38-2.28), and use of new oral anticoagulants (HR 1.71 95% CI: 1.21-2.43) were associated with mortality at 15 years. CONCLUSIONS OSA management requires a holistic approach that extends beyond AHI, integrating clinical symptoms, comorbidities, and polysomnographic indices.

BACKGROUND Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening hyperinflammatory syndrome. The immunopathology of cytotoxic lymphocytes in sHLH is complex and differs from primary HLH. This study aimed to characterize the distribution and perforin expression of key cytotoxic lymphocyte subsets in sHLH and assess their clinical and longitudinal significance. MATERIAL AND METHODS In this single-center observational study, peripheral blood from 19 patients with newly diagnosed sHLH and 10 healthy controls was analyzed using multi-color flow cytometry. Proportions of NK cells, CD8⁺ T cells, and CD56⁺ T cells, along with intracellular perforin expression, were quantified. Six patients were re-assessed after achieving complete response. RESULTS Compared with controls, sHLH patients showed a significantly lower proportion of NK cells, while the percentage of perforin-expressing CD56⁺ T cells was significantly increased. Among sHLH subtypes, NK-cell proportion was significantly lower in lymphoma-associated HLH than in non-lymphoma cases. Longitudinally, CD8⁺ T-cell proportion decreased significantly in patients in remission. NK-cell proportion correlated positively with fibrinogen, a key diagnostic and disease activity marker. Perforin expression in CD56⁺ T cells correlated negatively with alanine aminotransferase, while perforin in CD8⁺ T cells correlated positively with soluble interleukin-2 receptor. CONCLUSIONS sHLH exhibits a distinct immunological profile characterized by reduced NK-cell proportion and increased perforin expression in CD56⁺ T cells, diverging from the primary HLH model. These findings suggest that monitoring cytotoxic lymphocyte dynamics may be valuable for assessing disease activity and treatment response in sHLH, although further validation in larger cohorts is warranted.

BACKGROUND Intrauterine devices (IUDs) are widely used for contraception and are generally well tolerated. A rare complication is spontaneous fracture of the IUD while in situ. This study aimed to evaluate the prevalence of spontaneous IUD fractures and compare occurrence between 2 IUD types. MATERIAL AND METHODS This retrospective study included 463 women who underwent IUD insertion and follow-up between January 1, 2011, and December 31, 2021. Two IUDs were evaluated: Type 1, a copper IUD with a gold core (375 mm²), and Type 2, a copper IUD (300 mm²) without a gold core. Spontaneous fractures were identified based on symptoms or routine annual ultrasonography. Statistical analyses included descriptive statistics, normality testing, and comparisons using chi-square, t-tests, or Mann-Whitney U tests. A p value <0.05 was considered significant. RESULTS Among 463 patients, 183 used a Type 1 IUD and 280 used Type 2. Spontaneous fractures were observed in 12 of 183 Type 1 users (6.56%, 95% CI: 2.97-10.15%), while no fractures occurred among Type 2 users. Overall fracture prevalence was 2.59% (95% CI: 1.49-4.48%). Fractured arms were often located in the uterine cornua (n=9) and cervical canal (n=3). Fragments in the canal were removed using Novak extraction, while those in the cornua required hysteroscopy. CONCLUSIONS Spontaneous IUD fractures can occur without symptoms and must be considered during follow-up. Prompt recognition is essential to avoid complications. Hysteroscopy and Novak extraction are effective for fragment removal. Clinicians should consider routine ultrasonographic evaluation to detect asymptomatic IUD fractures, especially in users of Type 1 devices.

BACKGROUND Visual illusions provide insight into visual perception processes. We examined the McCollough effects (ME) and watercolor effects (WE) in patients with early Alzheimer disease (AD) and cognitively healthy older adults, and evaluated the influence of acetylcholinesterase inhibitors in the AD mild dementia (MD) stage. MATERIAL AND METHODS We included 28, 27, and 26 patients with MD, amnestic mild cognitive impairment (MCI), and normal cognition (control group), respectively. Participants completed the CDR, MMSE, ADAS-Cog 13, Ishihara test, and ME and WE evaluations. ME was evaluated by identifying chromatic changes in vertical, horizontal black, and white line patterns. WE was evaluated by identifying white or colored sections. RESULTS Regarding ME, white vertical lines appeared red, with no significant differences between groups (H=0.834, P=0.659). Differences were observed in perception of white horizontal lines as green (H=10.27, P=0.006). All in the control group, 25 of 27 in MCI group, and 22 of 28 in MD group reported seeing WE (Fisher exact 6.66, P=0.024). In binary logistic regression, cognitive tests and Ishihara results predicted perception of WE. Regarding MD, no significant differences were reported between patients taking or not taking acetylcholinesterase inhibitors (chi-square 0.749, P=0.38; P=0.19, P=1.00, respectively). CONCLUSIONS Perceptions of ME and WE differed significantly between cognitively normal participants and those with early AD, offering insights into the functional alterations of the visual system and ongoing neurodegeneration. The ME after-effect of red horizontal lines might represent very early AD changes, which could aid in a better understanding of AD visual perception.

BACKGROUND The choice of prosthetic valve for surgical mitral valve replacement (SMVR) remains a clinical challenge, particularly in balancing long-term survival with anticoagulation risk and prosthesis durability. In Taiwan, newer-generation tissue valves were introduced in recent years, providing additional options for patients and clinicians. MATERIAL AND METHODS We conducted a nationwide, retrospective cohort study using Taiwan's National Health Insurance Research Database from 2000 to 2017. Adult patients who underwent SMVR were categorized based on the prosthesis type: mechanical valve (MV), porcine bioprosthetic valve (PV), or newer-generation durable-tissue valve (DV). Propensity-score matching (PSM) was applied to minimize baseline differences. Outcomes analyzed included all-cause mortality, index hospitalization cost, length of hospital stay, and re-operation rates within 3 years. RESULTS Among 10 406 patients (5301 MV, 4300 PV, 805 DV), the DV group was older than in the MV group but younger and healthier than in the PV group. After PSM, DV was associated with significantly lower all-cause mortality compared to PV (HR: 0.61; 95% CI: 0.50-0.74; P<0.001) and MV (HR: 0.72; 95% CI: 0.60-0.88; P=0.002). Hospitalization costs and length of stay were highest for PV, moderate for DV, and lowest for MV. Within 3 years, DV showed the lowest re-operation rate (0.75%) compared to MV (1.96%; OR: 2.66, 95% CI: 1.17-6.09) and PV (3.21%; OR: 4.42, 95% CI: 1.94-10.03). CONCLUSIONS In this retrospective cohort, newer durable-tissue valves were associated with favorable early survival, lower short-term re-operation rates, and moderate hospitalization costs compared to older prostheses. However, the limited follow-up, potential confounding, heterogeneity of valve models, and era-related improvements in care preclude definitive conclusions about long-term durability or superiority. These real-world findings highlight the need for individualized prosthesis selection and longer-term prospective studies to confirm these observations.

Arthropod-borne viruses (arboviruses) are RNA viruses that depend on transmission to humans and other vertebrates through the bites of infected mosquitoes, ticks, and sand flies. On March 31, 2022, the World Health Organization (WHO) Global Arbovirus Initiative identified the need for risk mapping as a crucial source of evidence for arbovirus disease surveillance and provided updated recommendations to improve current management. On May 20, 2025, the 78th World Health Assembly of the WHO adopted the Pandemic Agreement to highlight the importance of pandemic preparedness. The arbovirus diseases dengue, chikungunya, Zika, and yellow fever have been identified as an escalating global threat in urbanized areas, as indicated by new global risk maps for Aedes-borne arboviruses. On July 4, 2025, the WHO published its first global guidelines for managing infections by the four most significant arboviruses: dengue virus, chikungunya virus, Zika virus, and yellow fever virus. This article aims to review the changing global distribution of arbovirus transmission, the increased risk to human health from arbovirus diseases, and the potential for both epidemics and future pandemics, which have led to recent WHO recommendations and warrant the inclusion of arbovirus diseases as candidates for Disease X.

BACKGROUND Percutaneous kyphoplasty and vertebroplasty are the most commonly used minimally invasive procedures for Kümmell disease. However, they are not always effective in treating Kümmell disease with segmental instability. This study aimed to evaluate the efficacy of short-segment bone cement-augmented pedicle screw fixation combined with bone grafting in the treatment of Kümmell disease with segmental instability. MATERIAL AND METHODS The study included 23 patients treated with short-segment bone cement-augmented pedicle screw fixation combined with bone grafting between January 2021 and January 2024. The Oswestry Disability Index (ODI), visual analog scale (VAS) score, vertebral anterior height, and kyphotic Cobb angle were evaluated. The operation time, hospital stay, intraoperative blood loss, and complications were recorded. RESULTS The VAS scores, ODI scores, vertebral anterior height, and kyphotic Cobb angles showed statistically significant differences between before and 1 week after surgery and between before surgery and at final follow-up (P<0.05). VAS and ODI at the final follow-up were lower than those measured 1 week postoperatively (P<0.05), but no significant difference was found in the vertebral anterior height and kyphotic Cobb angle (P>0.05). Twenty-one patients (91.3%) had achieved solid fusion at final follow-up. No serious complications were observed in any of the cases. CONCLUSIONS Short-segment bone cement-augmented pedicle screw fixation combined with bone grafting is a safe and effective treatment for Kümmell disease with segmental instability. This approach can achieve significant pain relief and functional improvement, provide satisfactory correction of kyphosis and vertebral height restoration, and result in a low complication rate.

BACKGROUND Non-ST-segment elevation myocardial infarction (NSTEMI) has a with high incidence rate and a high mortality rate in elderly patients, and inflammation plays an important role. As a useful inflammatory marker, the relationship between the inflammatory burden index (IBI) and in-hospital death of elderly patients with NSTEMI remains unclear. The aim of this study was to investigate the predictive value of IBI for in-hospital death in elderly patients with NSTEMI. MATERIAL AND METHODS This single-center study retrospectively enrolled patients diagnosed with NSTEMI between February 2021 and February 2025. All patients were ≥75 years old and did not receive percutaneous coronary intervention (PCI) treatment during hospitalization. Patients were divided into 2 groups according to whether cardiogenic death occurred during hospitalization. IBI was calculated as the product of C-reactive protein and the neutrophil-to-lymphocyte ratio. RESULTS This study enrolled a total of 418 patients, with a mean age of 79.60±3.67 years. During the hospitalization period, cardiogenic death occurred in 43 (10.3%) patients. After adjusting for possible confounding factors, multivariate logistic regression analysis showed that IBI (OR=2.22, 95% CI: 1.64-3.00) was an independent risk factor for in-hospital death in elderly patients with NSTEMI. Restricted cubic spline suggested a non-linear dose-response relationship between IBI and in-hospital death. The results of ROC showed that the area under the curve of IBI was 0.760. CONCLUSIONS In elderly patients with NSTEMI, IBI demonstrated an independent association with in-hospital mortality, with modest discriminatory performance. There is a non-linear dose-response relationship between IBI and in-hospital death in elderly patients with NSTEMI.

BACKGROUND Hyperuricemia in patients undergoing maintenance hemodialysis (MHD) has been associated with an increased risk of cardiovascular disease, although its role remains controversial. This study aims to evaluate the prevalence of hyperuricemia and its association with cardiovascular disease risk factors among patients undergoing MHD in Southwest China. MATERIAL AND METHODS This study included 99 patients who underwent MHD at the Blood Purification Center of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. We statistically analyzed the general characteristics, physical indicators, biochemical markers, and cardiac ultrasound parameters. We examined the correlation between serum uric acid levels and cardiovascular risk factors. RESULTS Logistic regression analysis revealed that heavy smoking and higher abdominal fat thickness, waist circumference, and systolic blood pressure were significantly associated with elevated serum uric acid levels. Multivariate linear regression analysis revealed that, compared with patients with normal uric acid levels, those with elevated levels showed gradual increases in triglycerides, C-reactive protein, parathyroid hormone, homocysteine, left ventricular posterior wall thickness, interventricular septum thickness, and left ventricular end-diastolic diameter. In contrast, high-density lipoprotein cholesterol levels and left ventricular ejection fraction progressively decreased. CONCLUSIONS In patients undergoing maintenance hemodialysis, hyperuricemia is closely associated with heavy smoking and abdominal obesity. These associations may increase cardiovascular risk through multiple pathways, including changes in biochemical markers (eg, triglycerides, C-reactive protein) and alterations in cardiac structure. Moreover, this risk increased proportionally with higher serum uric acid levels.