Medical Science Monitor最新文献

Post-stroke psychiatric disorders (PSPD), including depression, anxiety, and cognitive impairment, significantly hinder stroke survivors' rehabilitation and quality of life, with traditional interventions often showing limited efficacy. Brain-computer interface (BCI) technology has emerged as a promising tool for neurological regulation and rehabilitation, showing substantial potential in PSPD assessment and intervention. This narrative review comprehensively synthesizes the latest research advances in BCI applications for PSPD, covering underlying mechanisms, principal applications, clinical studies, technical challenges, and prospective directions. It highlights BCI's substantial potential in objective assessment, targeted neuromodulation, and promotion of neuroplasticity, while also addressing unresolved issues such as heterogeneous patient responses, technical limitations, and integration into routine clinical practice. By integrating current evidence and clarifying both achievements and gaps, this review provides theoretical insights and practical guidance for future basic and clinical research in the field.

BACKGROUND This study explores the clinical efficacy of endoscopic mastoidectomy revision surgery in treating discharging surgical cavities, analyzes the causes of discharging surgical cavities, and summarizes the key technical points. MATERIAL AND METHODS A retrospective analysis was performed on the clinical data of 47 patients who underwent endoscopic revision mastoidectomy in the Department of Otolaryngology, Nanshan People's Hospital of Shenzhen from January 2020 to December 2024. Preoperative examinations included temporal bone computed tomography and pure-tone audiometry. Surgery was performed under general anesthesia with continuous irrigating mode of the endoscope. Operation time, complications, dry ear time, dry ear rate, and hearing improvement were recorded, with a follow-up of 6 to 18 months. RESULTS The average age of the 47 patients was 38.74±11.28 years, with 53.19% male and 46.81% female patients. The main causes included insufficient opening of the surgical cavity, recurrence of cholesteatoma, poor drainage of the surgical cavity, and lesions at the tympanic orifice of the eustachian tube. Average operation time was 125.17±45.05 minutes, and the average dry ear time was 75.16±31.44 days. Postoperative dry ear rate was 100%, with no serious complications. Hearing was significantly improved, and there was no recurrence of cholesteatoma during the follow-up period. CONCLUSIONS Endoscopic revision mastoidectomy can effectively treat discharging mastoid cavity and improve the dry ear rate and hearing by thoroughly removing lesions and optimizing cavity anatomy. Techniques such as continuous irrigating mode and concentrated growth factor combined with hydroxyapatite obliteration help improve surgical safety and prognosis.

BACKGROUND This in vitro study evaluated the effect of different surface treatments on the bond strength of polyetheretherketone (PEEK) and polyether-ketone-ketone (PEKK) polymers to resin cement. MATERIAL AND METHODS CAD/CAM-fabricated PEEK and PEKK specimens (7×7×2 mm) were divided into 8 groups (n=10 per group; total n=80), with 4 groups per material: control, argon plasma, sandblasting with 125-µm Al₂O₃, and sandblasting followed by argon plasma. Surface characteristics were analyzed using scanning electron microscopy (SEM), energy-dispersive spectroscopy (EDS), and atomic force microscopy (AFM). All specimens were treated with a methyl methacrylate-based adhesive (Visio.link) and luted with resin cement (RelyX U200), then stored in air for 1 h. Shear bond strength was measured using a universal testing machine. Data were analyzed using Kolmogorov-Smirnov, Levene, one-way ANOVA, Bonferroni, and independent t tests (alpha=0.05).   RESULTS Surface treatment significantly affected bond strength (P<0.05). The highest bond strengths for both polymers were achieved with sandblasting followed by argon plasma treatment. Although PEKK showed slightly higher bond strengths than PEEK, the difference was not statistically significant (P>0.05). The lowest bond strengths were observed in the control groups (PEEK: 7.1±0.6 MPa; PEKK: 7.6±1.2 MPa), while the highest values were recorded after combined sandblasting and argon plasma treatment (PEEK: 12.2±2.4 MPa; PEKK: 12.6±2.4 MPa).   CONCLUSIONS Surface treatment significantly influences the bond strength of PEEK and PEKK to resin cement. Argon plasma application after sandblasting markedly enhanced shear bond strength for both materials.

BACKGROUND Transsphincteric fistulas are common pathologies that present a challenge for both surgeons and patients. This study compared 2 reliable methods - transanal advancement flap repair (TAFR) and hybrid seton placement (HSP) - in treatment of transsphincteric fistulas and determined the most appropriate options. MATERIAL AND METHODS In this retrospective study, 84 patients who underwent surgery for transsphincteric anal fistulas between July 2022 and December 2024 were evaluated. Patient archive data, preoperative medical history, and physical examination findings were reviewed. Postoperative symptoms and recovery were assessed using the Cleveland Clinic Incontinence Scoring (CCIS) and Fecal Incontinence Quality of Life (FIQL) scores to evaluate incontinence status and changes in daily life. RESULTS We included 84 patients: 21 females and 63 males, with a mean age of 45.1 years (range: 21-69). TAFR was performed on 36 patients, while 48 patients underwent HSP. Postoperative recurrence was observed in 7 patients. FIQL scores significantly improved postoperatively in both surgical groups, whereas no significant change was observed in CCIS scores. Notably, the TAFR group demonstrated greater improvement in FIQL scores compared to the HSP group (P=0.001). Additionally, anal soiling was significantly more frequent in the hybrid seton group compared to the advancement flap group (P=0.03). CONCLUSIONS Both hybrid seton and transanal advancement flaps are reliable surgical methods that yield good outcomes in treating transsphincteric anal fistulas. However, our results suggest that anal soiling occurs less frequently and quality of life improves more in patients treated with transanal advancement flaps, as reflected by higher postoperative FIQL scores.

Arthrogryposis multiplex congenita (AMC) is a highly heterogeneous constellation of disorders defined by non-progressive congenital multiple joint contractures, typically manifesting across multiple limbs. The pathology results in significant functional impairment, including restricted range of motion, chronic arthralgia, and secondary musculoskeletal deformities like scoliosis. Given that AMC is an umbrella designation encompassing over 300 distinct etiologies, the profound clinical variability poses substantial diagnostic and therapeutic challenges. The relative rarity of AMC and the absence of consensus-based, longitudinal treatment protocols create a critical void in standardized clinical management across the lifespan of patients. This comprehensive narrative review synthesizes the contemporary literature and clinical evidence to establish a structured, life-course management paradigm, extending from neonatal screening through to adult care. We advocate for an evidence-based approach that recalibrates therapeutic goals to emphasize maximal functional capacity and societal participation rather than strict anatomical normalization. Key aspects addressed include early-life neuroplasticity, the principles of staged and minimally- invasive surgical correction, and the need for seamless, lifelong, multidisciplinary care coordination. Furthermore, the review critically examines persistent clinical dilemmas concerning hip and knee contracture management, and proposes algorithmic pathways for addressing recurrent foot deformities. By integrating the latest advancements in molecular genetics, surgical innovations, and rehabilitative science, this work serves as an authoritative resource, offering clinically applicable strategies to optimize long-term outcomes for individuals living with AMC.

BACKGROUND Mumps, a viral infection from the Paramyxoviridae family, is a rare but significant cause of sensorineural hearing loss (SNHL), especially in children. While typically unilateral, mumps-induced SNHL can result in profound single-sided deafness, for which cochlear implantation may be considered when hearing aids are ineffective. This study aimed to evaluate outcomes of cochlear implantation in patients with single-sided deafness caused by mumps. MATERIAL AND METHODS This retrospective study included 14 patients (10 women, 4 men; mean age 39.4) with single-sided deafness caused by mumps. Inclusion criteria included a hearing threshold ≥90 dB and no benefit from hearing aids. Audiometric evaluations and speech discrimination tests were conducted preoperatively and 12 months postoperatively. Surgical procedures followed the 6-step Skarżyński method with a round window approach. RESULTS Implants were successfully placed in all patients, with full electrode insertion achieved in 92.9% of cases. The mean time from hearing loss to implantation was 28.1 years. Postoperative speech discrimination improved significantly: from 0-10% preoperatively to 48.9% word-recognition score without and 66.8% word-recognition score with an active processor. Hearing preservation was achieved in 11 out of 12 evaluable patients, with partial preservation in 58% and minimal in 33%. CONCLUSIONS Cochlear implantation in patients with mumps-induced single-sided deafness provides substantial auditory benefits, particularly in speech perception. Favorable surgical outcomes were achieved even in cases with cochlear ossification. Given the scarcity of evidence specific to this etiology, the present findings underscore the effectiveness of cochlear implantation and warrant further validation through large-scale, prospective investigations.

BACKGROUND Preterm infants are highly susceptible to brain injury due to the immaturity of their neurological systems. Parental knowledge, attitudes, and practices (KAP) play a pivotal role in early detection and prevention. This study, conducted in Inner Mongolia, China, evaluated parental KAP regarding brain injury prevention in preterm infants and explored associated influencing factors. MATERIAL AND METHODS A cross-sectional survey was conducted between January 2019 and December 2022 at the Maternal and Child Health Hospital of Inner Mongolia. Parents of preterm infants completed structured questionnaires. Multivariate logistic regression identified factors associated with KAP scores. RESULTS A total of 527 valid responses were analyzed. Mean parental age was 32.75±4.35 years. Average scores indicated moderate knowledge (9.40±2.96), generally positive attitudes (34.37±5.01), and moderately proactive practices (22.46±4.28). Parental age, care for late preterm infants, caregiving for children aged 1-2 years, unemployment, self-employment, and monthly household income >10 000 CNY were significantly associated with KAP scores (P<0.05). Positive attitudes and breastfeeding duration <1 month were independently associated with proactive caregiving practice. CONCLUSIONS Parental KAP related to brain injury prevention in preterm infants remains insufficient. Clinically, these gaps may hinder timely intervention and neurodevelopmental outcomes. Integrating structured, family-centered education into neonatal care is critical for empowering parents and optimizing early neuroprotective strategies. Enhancing KAP among parents could be a cost-effective approach to mitigating long-term neurological sequelae in this vulnerable population.

BACKGROUND Autologous bone grafts are commonly associated with higher complication rates than alloplastic materials in cranioplasty. While previous systematic reviews have shown favorable outcomes with alloplastic grafts, there is limited comparative data on the performance of different alloplastic materials. This systematic review and network meta-analysis aims to assess the efficacy of alloplastic materials used in cranioplasty, focusing on complications, re-surgery, and implant exposure. MATERIAL AND METHODS Following PRISMA and PRISMA for network meta-analyses (NMA), we searched PubMed/MEDLINE, Embase, Scopus, and Web of Science (January 2015-January 2025). Eligibility criteria were adult cranioplasty cohorts comparing 2 or more alloplastic materials and reporting at least 1 pre-specified outcome: infection, overall complications, implant exposure, or re-surgery. Data extracted a priori included study design, indication, implant material (polyetheretherketone, titanium, hydroxyapatite, polymethylmethacrylate [porous and hard], ultra-high-molecular-weight polyethylene), follow-up, and event counts per outcome. Random-effects models estimated pooled effects; NMA generated P-scores/SUCRA ranks. Heterogeneity (I²), transitivity, and incoherence were assessed. Risk of bias was measured with the Newcastle-Ottawa Scale. RESULTS From 1025 studies, 24 studies met the inclusion criteria. The highest complication rates were reported for polymethylmethacrylate, hydroxyapatite, and titanium, although differences were not statistically significant. SUCRA rankings suggested the lowest infection rates with polyetheretherketone and titanium. Meta-regression indicated that polymethylmethacrylate was associated with higher incidence of infection. Network analysis showed titanium had maximum implant exposure. Polymethylmethacrylate (P-score=0.79) and hydroxyapatite (P-score=0.73) carried the highest re-surgery risks. CONCLUSIONS Polymethylmethacrylate and hydroxyapatite were associated with higher infection and re-surgery rates, while titanium showed greater implant exposure.

BACKGROUND Neural tube defects (NTDs) are among the most common congenital malformations and arise from disruption of early neurulation. Phosphoric acid is a widely used food additive; however, its potential effects on early neural tube development have not previously been evaluated in experimental neurulation models. This proof-of-concept study aimed to investigate the embryotoxic and teratogenic effects of phosphoric acid on neural tube development in a chick-embryo model of neurulation, at a single tested concentration. MATERIAL AND METHODS Fertilized pathogen-free chicken eggs (n=30) were randomly allocated into 2 groups. Control embryos (n=15) received no injection, whereas embryos in the experimental group (n=15) were injected beneath the embryonic disc with 0.25 mM phosphoric acid, at Hamburger-Hamilton stage 9. Embryos were incubated for 72 hours, after which survival was recorded and neural tube development was evaluated macroscopically and histopathologically. Statistical comparisons were performed using Fisher's exact test. RESULTS All control embryos survived (15/15, 100%) and exhibited normal neural tube closure. In the phosphoric acid-treated group, survival was significantly reduced (10/15, 66.7%; P=0.0421). Among surviving treated embryos, 80% (8/10) demonstrated NTDs, including cranial and caudal closure abnormalities (P<0.001). Histopathological examination confirmed incomplete neural fold closure, irregular notochord morphology, and disrupted somite organization in affected embryos. CONCLUSIONS Phosphoric acid exposure at the tested concentration and developmental stage markedly reduced embryo survival and induced a high incidence of neural tube closure defects in a chick-embryo model. These findings provide the first experimental proof-of-concept evidence that phosphoric acid can directly disrupt early neurulation in a vertebrate neurulation model. However, vehicle-controlled replication, dose-response analyses, and exposure-bridging studies are required to distinguish teratogenic specificity from general embryotoxicity and to assess potential relevance to human embryogenesis.

BACKGROUND This study aimed to compare muscle load, comfort, usability, and time-on-task between parallel, vertical, and lateral wheelchair handle orientations on 3 ground types in 28 healthy adults pushing a 65-kg wheelchair load. The novelty of this study lies in integrating electromyographic (EMG) activity with subjective discomfort and usability measures to simultaneously evaluate physiological demand and functional performance. MATERIAL AND METHODS We used a randomized crossover design with within-participant comparisons. The study included 28 healthy adults simulating caregiving tasks. Muscle load, discomfort (Borg CR-10), usability (System Usability Scale, SUS), and time-on-task were compared among 3 handle orientations on 3 ground types while pushing a wheelchair loaded with 65 kg. Muscle load was primarily determined by the activation levels of the extensor carpi radialis (ECR), bilateral flexor carpi ulnaris (FCU), and biceps brachii (BB). RESULTS Handle orientation and ground type significantly affected EMG amplitudes in the ECR, FCU, and BB muscles (P<0.05). Parallel handles produced greater muscle activation and higher perceived discomfort than vertical and lateral handles, particularly on ramps (P<0.05). Vertical handles resulted in lower SUS scores compared to parallel and lateral handles (P<0.05). Additionally, time-on-task on the twisting cone path was longer with vertical handles than lateral handles. CONCLUSIONS In healthy wheelchair attendants, parallel handles increased upper-limb muscle load and discomfort, especially on ramps. Vertical handles reduced forearm muscle load but decreased usability, while lateral handles produced moderate activation and improved turning control, supporting ergonomic design strategies.