Medical Science Monitor最新文献

BACKGROUND Acute cerebral infarction significantly impacts patients' physical, cognitive, and psychological health. Evidence-based nursing (EBN) interventions offer a patient-centered approach to address these multifaceted challenges. This study evaluated the effectiveness of EBN in improving psychological outcomes, cognitive function, independence in daily living, and quality of life in patients with acute cerebral infarction. MATERIAL AND METHODS A retrospective study was conducted on 256 patients with acute cerebral infarction between January 2022 and December 2023. Patients were assigned to either the control group (routine care, n=126) or the observation group (EBN care, n=130). Clinical outcomes, including Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Chinese version of the Mini-Mental State Assessment (CMMS), Activities of Daily Living (ADL), and World Health Organization Quality of Life Assessment (WHOQOL-BREF) scores, were compared before and after intervention. Statistical analyses were performed using SPSS version 27.0, with significance set at P<0.05. RESULTS The observation group demonstrated significantly greater improvements across all measured outcomes compared to the control group (P<0.05). Post-intervention HAMD and HAMA scores decreased substantially in the observation group, indicating reduced psychological distress. Similarly, CMMS and ADL scores improved markedly, reflecting enhanced cognitive function and greater independence. Quality-of-life scores across physical, social, psychological, and environmental domains were significantly higher in the observation group. CONCLUSIONS EBN interventions significantly improve psychological outcomes, cognitive function, daily living independence, and quality of life in patients with acute cerebral infarction. These findings support the integration of EBN into routine stroke care to optimize patient recovery and overall prognosis.

BACKGROUND Surface conditioning methods play a critical role in enhancing adhesion by creating micro-mechanical and chemical bonds between resin cement and ceramics. This study aimed to evaluate the effects of different surface treatments on micro-tensile bond strength (MTBS) between resin cement and glass-infiltrated zirconia (GLZR), as well as surface changes in topography, roughness, and elemental properties assessed by energy-dispersive X-ray analysis (EDAX). MATERIAL AND METHODS Thirty GLZR blocks were fabricated and divided into 3 groups (n=10) according to the applied surface treatment: laboratory grit-blasting (LGB), laboratory silica coating (LSC), and hydrofluoric acid etching (HFAE). After treatment, specimens were bonded to composite blocks with resin cement, and MTBS was tested using a universal testing machine. Surface roughness was measured; morphological and elemental changes were examined by scanning electron microscopy (SEM) and EDAX. RESULTS The LSC group exhibited the highest MTBS (28.23±1.53 MPa), followed by the LGB group (20.27±2.33 MPa) and the HFAE group (10.41±1.46 MPa). Surface roughness was highest in the LGB group (Ra=9.34±1.23 μm). SEM analysis revealed prominent crater formation in the LGB and LSC groups, whereas the HFAE group showed minimal topographic change. EDAX indicated increased silica content in the LSC group and reduced zirconia content in the LGB group; these findings were linked to enhanced chemical bonding. CONCLUSIONS Among the tested surface treatments, laboratory silica coating significantly improved both surface chemistry and MTBS, making it the most effective method for strengthening resin-zirconia adhesion.

BACKGROUND Postoperative delirium affects recovery. Dexmedetomidine shows promise in reducing it, but the ideal dose is unclear. MATERIAL AND METHODS We performed a systematic review of randomized controlled trials and meta-analyses. Studies from PubMed, Embase, Web of Science, and the Cochrane Library were retrieved. Only trials involving adults (≥18 years) were considered. The effectiveness of high (loading dose, >0.5 µg/kg) and low doses (loading dose, ≤0.5 µg/kg) of dexmedetomidine in preventing delirium was examined, along with the incidence of delirium and adverse events like hypotension and bradycardia. RESULTS High-dose dexmedetomidine was associated with a lower delirium incidence compared to low-dose. The incidence of bradycardia or hypotension did not differ significantly between the 2 groups. However, some included studies had small sample sizes, focused on intraoperative use, or had potential data bias and heterogeneity in the low-dose group. CONCLUSIONS High-dose dexmedetomidine may be more effective in reducing postoperative delirium without increasing the risk of bradycardia or hypotension. But due to study limitations, more randomized controlled trials are required to confirm these findings.

BACKGROUND Physical activity (PA) is essential for individuals with Parkinson's disease (PD) to maintain functional independence and quality of life. However, difficulties in accurately measuring PA complicate the identification of effective and beneficial interventions. Understanding the discrepancies between self-reported and objectively measured PA is critical for clinical practice. This study compared self-reported and objectively measured PA among people with PD, considering their participation in functional physical rehabilitation (FPR). MATERIAL AND METHODS The International Physical Activity Questionnaire and Actigraph GT3X+ were used to measure PA. Patients with PD (n=47) in stages II or III of the disease according to the Hoehn and Yahr scale, aged 64.37±7.12 years, with disease duration of 6.29±4.02 years were divided into 2 groups: participating (Group A) and not participating (Group B) in FPR. The FPR program combined motor symptom-targeted therapy with task-oriented training to improve functional independence and quality of life. RESULTS Comparing self-reported weekly PA with the objective showed statistically significant differences (P<0.05) in both groups - the self-reported PA was 8.61% higher in Group A and 56.70% higher in Group B. In Group A, declared PA was higher than the objective in all intensity zones: by 19.50% in high, by 10.52% in moderate, and by 7.35% in low. In Group B, declared PA was higher than the objective by 250% in high-intensity, by 90.66% in moderate-intensity, and by 48.32% in low-intensity. CONCLUSIONS We found significant differences between self-reported and objectively measured PA in people with PD, based on their participation in FPR. Participation in FPR seems to improve the accuracy of PA self-assessment, demonstrating the importance of objective PA measurement in clinical practice.

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.