Medical Science Monitor最新文献

BACKGROUND Non-functioning adrenal adenomas (NFA) are prevalent tumors often associated with metabolic disturbances compared to the general population. This study aimed to evaluate cardiovascular disease (CVD) risk in 106 patients with NFA using SCORE2 and SCORE2-OP algorithms. MATERIAL AND METHODS The study sample comprised of 106 patients with NFA. CVD risk was assessed using SCORE2 and SCORE2-OP charts. The study population was divided across different categories: low-to-moderate risk, high-risk, very high-risk of CVD. Anthropometric measurements, metabolic indices, lipid profiles, and carbohydrate metabolism parameters were analyzed across different CVD risk groups. RESULTS Very high-risk patients had a higher waist-to-hip ratio (WHR) value (0.95; 0.89-0.98) compared to low-to-moderate risk patients (0.89; 0.84-0.91; P=0.0049). Also, high-risk patients had a higher WHR value (0.92; 0.87-0.97) compared to low-to-moderate risk patients (0.89; 0.84-0.91; P=0.032). Patients with low-to-moderate CVD risk had significantly lower fasting glucose levels compared to patients with high CVD risk (5.35; 5.08-5.61 vs 5.78; 5.39-6.03; P=0.0093) as well as compared to patients with very high risk (5.35; 5.08-5.61 vs 5.83; 5.22-6.28; P=0.0230). There was no significant difference in lipid parameters and atherogenic indices between the groups based on CVD risk according to SCORE2 and SCORE2-OP. CONCLUSIONS Elevated fasting glucose levels are significantly associated with higher CVD risk in NFA patients, particularly in high and very high-risk group. Systolic blood pressure and WHR were identified as cost-effective measures for predicting of CVD among NFA patients. Metabolic indices did not show any significant differences across CVD risk groups.

BACKGROUND Sarcopenia, characterized by loss of skeletal muscle mass and function, is linked to poor outcomes in cancer patients. In breast cancer, sarcopenia has been associated with reduced treatment tolerance and survival. However, its impact on patients with locally advanced breast cancer receiving neoadjuvant chemotherapy is understudied. This study aimed to assess sarcopenia's impact on outcomes in 226 women with advanced breast cancer, pre- and post-chemotherapy. MATERIAL AND METHODS This retrospective cohort study included 226 patients with stage II-III breast cancer who received neoadjuvant chemotherapy (NAC) between 2015 and 2021. Sarcopenia was assessed using psoas muscle area (PMA) from pre- and post-NAC computed tomography scans, with a 25th percentile cut-off (415.4 mm²). Pathological response was evaluated using the Miller-Payne grading system, and survival outcomes were analyzed using Kaplan-Meier curves. Statistical significance was set at P<0.05. RESULTS The mean PMA decreased significantly after NAC (502.8 mm2 to 454.3 mm², P<0.001). Pre-NAC, sarcopenia was present in 24.8% of patients. This increased to 40.7% after NAC. Sarcopenia was more prevalent in obese patients (P<0.001), but no significant association was found between sarcopenia and pathological complete response (pCR) or survival outcomes. Although pre- and post-NAC sarcopenia did not affect recurrence or mortality, non-sarcopenic patients were more likely to achieve pCR (P=0.012). Hematologic toxicity was higher in sarcopenic patients with comorbidities (P<0.05). CONCLUSIONS Sarcopenia significantly increases after NAC but does not independently impact pathological response, recurrence, or survival in locally advanced breast cancer. Obesity and comorbid conditions are key factors influencing sarcopenia, highlighting the need for comprehensive management to mitigate treatment-related sarcopenia.

BACKGROUND Inherited deficiencies in antithrombin (AT), protein C (PC), and protein S (PS) increase the risk of venous thromboembolism (VTE). The efficacy and safety of direct oral anticoagulants (DOACs) in severe VTE cases after mechanical thrombectomy are uncertain. This study aimed to evaluate the use of DOACs combined with mechanical thrombectomy in 55 patients with VTE, including 11 patients with confirmed deep vein thrombosis (DVT) and pulmonary thromboembolism (PE), 27 patients with DVT alone, and 17 with pulmonary thromboembolism alone, from a single center between January 2016 and December 2023. MATERIAL AND METHODS All patients with symptomatic VTE confirmed by computed tomography underwent mechanical thrombectomy. Fourteen patients with reduced AT (n=4), PC (n=6), and PS (n=4) function were classified as group 1, while the remaining 41 without thrombophilia were classified as group 2. The outcomes, including recurrent VTE, bleeding events, and all-cause mortality, were compared between patients with and without thrombophilia. RESULTS DOAC use was similar between the groups. One patient in the thrombophilia group switched DOACs due to bleeding, while 7 in the non-thrombophilia group changed due to bleeding or recurrent VTE. Recurrent VTE was higher in the non-thrombophilia group (7.1% vs 17.1%; P=0.664), while bleeding events were more frequent in the thrombophilia group (35.7% vs 17.1%; P=0.259); however, neither difference was statistically significant. All-cause mortality was similar between groups (7.1% vs 6.7%; P=0.903). CONCLUSIONS The study found no difference in the efficacy and safety of DOACs between VTE patients with and without inherited thrombophilia undergoing mechanical thrombectomy.

BACKGROUND The study aims to explored the impact of short-term mindfulness meditation training on physiological and psychological stress levels in patients with gastrointestinal tumors during the perioperative period. MATERIAL AND METHODS We randomly allocated 78 participants to either the experimental group (n=39) or the control group (n=39). The control group received perioperative nursing, while the experimental group engaged in a daily mindfulness meditation practice from the second day of admission until the fifth day after surgery, excluding the day of surgery. The pre- and post-intervention physiological stress levels of serum cortisol, blood pressure, and heart rate were assessed. The State Anxiety Inventory Scale (SAI), Visual Analog Scale (VAS), and Five Facet Mindfulness Questionnaire (FFMQ) were utilized to measure psychological stress. The rehabilitation and additional indices were also observed. RESULTS The serum cortisol and SAI in both groups showed an increasing trend on the 3rd day after surgery, followed by a decreasing trend. On the 5th day after surgery, significant reductions were observed in cortisol (t=-2.054, P=0.043) and VAS (t=-2.29, P=0.025). The experimental group exhibited lower levels of cortisol and SAI compared to the control group, while the FFMQ score gradually increased with intervention. Additionally, the experimental group demonstrated significantly shortened hospital stays (t=-3.157, P=0.002) and reduced requirements for postoperative analgesics. CONCLUSIONS Perioperative short-term mindfulness meditation can improve the mindfulness ability of patients with gastrointestinal tumors, relieve anxiety and tension, reduce serum cortisol, regulate blood pressure and heart rate, generally reduce perioperative psychological and physiological stress responses, and control hospital time and cost.

Vertical transmission, or mother-to-child transmission, of bacterial, viral, or parasitic infection is rare due to the success of the barrier functions of the placental maternal-fetal interface, which provides physical, molecular, and immunological mechanisms to protect the developing fetus. Infections in pregnancy that can cross the placenta and reach the fetus can cause fetal loss, stillbirth, or prematurity or can lead to congenital infection, malformation of organs, and neonatal disease at birth. The acronym TORCH stands for Toxoplasma gondii, other, rubella, cytomegalovirus, and herpes simplex virus (HSV). Within the TORCH category of 'other,' there are increasing emerging viral pathogens that can pass from mother to fetus, including Ebola virus, Zika virus, and emerging arbovirus infections, including West Nile virus and Rift Valley fever virus. Although SARS-CoV-2 has rarely been reported to show transplacental spread, the recent COVID-19 pandemic has highlighted the importance of surveillance of new human pathogens with rapidly evolving transmission patterns. This article reviews the protective roles of the placental maternal-fetal interface, the concept of TORCH infections, and the emergence of viral pathogens currently causing concerns for vertical transmission from mother to fetus.

BACKGROUND Due to the chronic effects of excess growth hormone (GH) and insulin-like growth factor-1 (IGF-1), patients with acromegaly (AC) may develop acromegalic cardiomyopathy with biventricular hypertrophy, systolic and diastolic dysfunction, resulting in congestive heart failure. This study aimed to evaluate the echocardiographic parameters of left ventricular (LV) diastolic function and impedance cardiography (ICG) parameters of cardiovascular hemodynamics in patients with AC. MATERIAL AND METHODS A total of 33 patients (male to female ratio: 1.2; mean age 47 years) newly diagnosed with AC based on the blood hormone levels and imaging study findings were included into this observational cohort study. The echocardiographic parameters of LV diastolic function included early diastolic velocity of the average mitral annulus (e'avg), ratio of early diastolic mitral inflow velocity to early diastolic mitral annular tissue velocity (E/e'ratio), mitral flow early (E) and late (A) phase ratio (E/A). The ICG parameters included stroke volume index (SI), cardiac index (CI), acceleration index (ACI), systemic vascular resistance index (SVRI), total arterial compliance index (TACI) and thoracic fluid content (TFC). RESULTS Poorer parameters of LV diastolic function corresponded to the parameters assessed via ICG: 1) lower ratio E/A was associated with lower SI (P<0.001), CI (P=0.007), VI (P=0.04), ACI (P=0.02), TACI (P=0.005) and higher SVRI (P<0.001), 2) lower E/e' ratio was associated with higher TFC (P=0.03); 3) lower e'avg was associated with lower SI (P=0.01) and CI (P=0.048) and higher SVRI (P=0.03), despite normal LV ejection fraction. CONCLUSIONS Impaired LV diastolic function in AC is associated with impaired pumping function of the heart and higher afterload as assessed on ICG.

BACKGROUND This study aimed to investigate the expression of RSPO3 and ß-catenin in preeclampsia and the relationship between RSPO3 and b-catenin levels and maternal-fetal outcomes. MATERIAL AND METHODS We enrolled 60 pregnant women with preeclampsia and 60 pregnant women without preeclampsia. We collected peripheral blood from the patients upon admission; placenta and cord blood were collected after delivery. The expression of RSPO3 and ß-catenin in maternal blood, cord blood, and placenta was measured. We used the Spearman method to examine the correlations between clinical characteristics and RSPO3. Logistic regression modeling was used to identify the independent risk factors for preeclampsia. RESULTS RSPO3 and ß-catenin levels were decreased in the peripheral blood, cord blood, and placentas of women with preeclampsia, with significant differences (P<0.05). The preeclampsia group had more adverse pregnancy outcomes. RSPO3 level of the preeclampsia group was negatively correlated with systolic blood pressure (r=-0.4654, P<0.001) and diastolic blood pressure (r=-0.4617, P<0.001) in cord blood, and systolic blood pressure (r=-0.5373, P<0.05) and diastolic blood pressure (r=-0.4898, P<0.05) in maternal blood. CONCLUSIONS RSPO3 and ß-catenin were decreased in preeclampsia, RSPO3 was negatively correlated with blood pressure, and RSPO3 could be a risk factor for the development of preeclampsia.

BACKGROUND Non-occlusive mesenteric ischemia (NOMI) is difficult to diagnose and has a high mortality rate. We aimed to determine the qualitative and quantitative parameters of computed tomography (CT) that can determine patient prognosis and contribute to early diagnosis in order to reduce mortality. MATERIAL AND METHODS The biphasic CT images of 40 patients, mean age 72.7±12 years, 24 men (60%), 14 women 14 (40%), with a diagnosis of NOMI were analyzed retrospectively. Patients were divided into survivor and non-survivor groups. Qualitative CT parameters, consisting of vascular, intestinal, and mesenteric and peritoneal findings, comorbidities, and surgical resection were compared using Fisher's exact test. Quantitative CT parameters of superior mesenteric artery (SMA), celiac trunk, inferior vena cava (IVC), superior mesenteric vein (SMV) diameters, and intestinal wall density difference (delta HU) in arterial and venous phases were compared with patient prognosis by using ANOVA. RESULTS Pneumatosis intestinalis (P=0.012), paper-thin bowel wall (P=0.015), and pale mesentery (P=0.008) were higher in the non-survivor group. In the survivor group, mesentery congestion (P=0.003), bowel wall thickening (P=0.001), bowel wall enhancement (P=0.044), and enhancing mucosa and submucosa of bowel wall (P=0.042) were higher. The celiac trunk, SMA, SMV, IVC, and IMA diameters, artery wall density, and delta HU were statistically significantly lower in the non-survivor group. The IVC diameter was correlated with patient prognosis (P=0.000). CONCLUSIONS A systematic evaluation of CT parameters can make important contributions to the early diagnosis and management of patients with NOMI.

Laparoscopy, as the most frequently chosen surgical technique in the world, carries specific complications and distinctions in anesthetic management. Complications of laparoscopy, particularly perceptible as disorders of the physiology of the cardiovascular, respiratory, and nervous systems, are caused by the specific technical conditions required for this type of operation. To facilitate surgical access and to clarify the surgical field, it is necessary to create a splenic emphysema, consisting of filling the peritoneal cavity with carbon dioxide (CO₂). This results in an increase in intra-abdominal pressure (IAP) and increased diffusion of CO₂ into the blood, causing a state of hypercarbia. The impact of these disturbances is of great importance in the pathological functioning of the above-mentioned organ systems. The anesthetist, in addition to the need to induce a state of general anesthesia, must be aware of and understand the pathological impact of increased intracranial pressure (ICP) and hypercarbia to adjust patient monitoring accordingly and implement appropriate treatment targeting the specific complications occurring during laparoscopy. Complications and contraindications important from the anesthetist's point of view are also described. The 51 articles and reference texts were used for this purpose, which, combined with the authors' knowledge and experience, is intended to be a valuable resource for use by anesthesiology staff. This article aims to explain the effects of laparoscopy on human physiology and to compare and contrast methods of airway management, mechanical ventilation, the type of muscle relaxation used, and postoperative management in patients undergoing laparoscopic surgery.

BACKGROUND Complete placenta previa (CPP) is a life-threatening condition with increasing incidence worldwide. This retrospective study investigated the impact of prior cesarean delivery on pregnancy outcomes in women with CPP. MATERIAL AND METHODS The data of 476 patients with CPP who underwent cesarean delivery in a tertiary hospital in Shanghai, China, from January 2013 to December 2022 were retrospectively analyzed. Patients were divided into prior cesarean delivery and no-prior cesarean delivery groups. Diagnosis of CPP was confirmed by last preoperative ultrasound/MRI. Maternal characteristics, intrapartum conditions, maternal complications, and neonatal outcomes were compared between groups. Independent predictors of hemorrhage were analyzed by logistic regression analysis. RESULTS The prior cesarean delivery group had significantly higher maternal age (36 [3.7)] vs 34.2 [4.2)], P=0.012), rates of intraoperative bleeding (982.9 [202.9] vs 588.8 [134.2], P=0.001), hysterectomy (6.4% vs 0.9%, P=0.002), premature birth (60.9% vs 36.6%, P<0.001), and neonatal hospitalization (13.5% vs 6.3%, P=0.008). The no-prior cesarean delivery group had higher rates of assisted reproduction (30.0% vs 3.8%, P<0.001) and endometriosis history (14.1% vs 8.3%, P<0.001). Multivariate logistic regression showed a history of cesarean delivery (adjusted odds ratio (aOR) 1.67), 2 or more previous cesarean deliveries (aOR 5.22), anterior placenta (aOR 2.53), abnormal percreta (aOR 5.24), and antepartum bleeding (aOR 1.90) were strongly associated with massive hemorrhage (P<0.05). CONCLUSIONS Prior cesarean delivery increases risks of hemorrhage, hysterectomy, premature birth, and neonatal hospitalization in patients with CPP. Independent risk factors for hemorrhage in these patients include prior cesarean delivery (especially 2 or more), anterior placenta, abnormal placentation, and prenatal bleeding.