Medical Science Monitor最新文献

BACKGROUND This computer-aided design and computer-aided manufacturing (CAD/CAM) study aimed to evaluate the effects of thermocycling on deep margin elevation relocation of subgingival cavity outlines in 80 molar teeth using advanced lithium disilicate ceramic. MATERIAL AND METHODS Eighty mandibular molar teeth were prepared for deep margin elevation below the cementoenamel junction. The following types of restorations were subsequently applied to each group: glass ionomer filling, bulk-fill flowable resin composite, bioactive resin composite, and nanohybrid resin composite. Full-coverage crowns with standardized preparation and a shoulder finish line were prepared to receive CAD/CAM-milled advanced lithium disilicate crowns. Samples were examined at 6 equidistant points via digital microscope on each proximal surface at the restoration-tooth and crown-restoration interfaces before and after thermocycling for 15 000 cycles. Data were analyzed using one-way analysis of variance, at a level of significance of 0.05. RESULTS The vertical marginal gap was significantly higher after aging and was the highest for glass ionomer filling, 9.091 (±1.147) and 9.936 (±6.376) µm, followed by nanohybrid resin composite, 3.59 (±1.03) and 3.87 (±0.97) µm, bioactive resin composite, 3.17 (±0.81) and 2.59 (±0.21) µm, and bulk-fill flowable resin composite, 1.89 (±0.60) and 2.42 (±0.64) µm, at the cervical and apical interfaces, respectively. CONCLUSIONS Thermocycling significantly changed the marginal adaptation of all restorative materials. Highest values for marginal adaptation were recorded in the glass ionomer filling group, followed by nanohybrid composite and bioactive resin groups, whereas lowest values were recorded among the bulk-fill flowable resin composite group at cervical and apical interfaces.

Chimeric antigen receptor (CAR) T cells are genetically engineered T lymphocytes that express a synthetic receptor that recognizes a tumor cell surface antigen, which causes the T lymphocyte to kill the tumor cell. As of December 2024, the US Food and Drug Administration (FDA) approved six CAR T-cell therapies, with ten CAR T-cell therapies commercially available globally, which target the CD19 and B-cell maturation antigen (BCMA) molecules and with approved indications that include B-cell acute lymphoblastic leukemia (ALL), large B-cell lymphoma (LBCL), follicular lymphoma, mantle cell lymphoma, chronic lymphocytic leukemia (CLL), and multiple myeloma. Pharmaceutical and economic forecasts have shown that the global CAR T-cell therapy market was worth USD 4.6 billion in 2024, with a projected USD 25 billion by 2035. However, there are several challenges in treating hematologic malignancies with CAR T-cell therapy, which include reduced treatment efficacy and durability in some patients, acute and long-term adverse effects, lack of effective salvage treatments, limited access to CAR T-cell therapies due to cost and availability, and the rare association with developing myeloid malignancies. A tumor-infiltrating lymphocyte (TIL) therapy, lifileucel, is FDA-approved for advanced melanoma. The T-cell receptor (TCR) therapy, afamitresgene autoleucel, is FDA-approved for advanced synovial sarcoma. The results from ongoing studies and clinical trials are awaited in solid tumors (melanoma, sarcomas, and carcinomas). This article reviews recent developments and ongoing challenges in adoptive T-cell therapies, including CAR T-cell therapies, in lymphoid and solid organ malignancies.

In 2021, the US Preventive Services Task Force (USPSTF) called for increased efforts at tobacco control, smoking-cessation treatments, and annual lung cancer screening with low-dose computed tomography (LDCT), targeted at high-risk populations. In January 2024, the American Cancer Society (ACS) published an update on the previous 2013 lung cancer screening guidelines and recommends annual lung cancer screening with lung LDCT for individuals aged 50-80 years who are asymptomatic but who currently smoke or have previously smoked. Although rates of tobacco smoking have been falling in some countries, the incidence of lung cancer in individuals who have never smoked now represents the 7th most common cancer and the 5th leading cause of cancer-related death. Because there is evidence that lung cancer screening with LDCT reduces lung cancer mortality in individuals with a substantial smoking history, there is now increasing interest in evaluating LDCT for lung cancer screening in those who have never smoked. In 2024, the International Association for the Study of Lung Cancer (IASLC) published a five-year (2023-2027) roadmap for the global use of LDCT in screening for lung cancer. This editorial aims to highlight some recent guidelines and current approaches to lung cancer screening in smokers and non-smokers.

BACKGROUND Young adults with minor ischemic stroke (MIS) often experience early onset and mild symptoms but face a high recurrence rate. Research into risk factors and etiology of young adult MIS in developing countries is limited. We investigated these aspects in young non-cardiogenic MIS patients from the Chinese Han population and identified risk factors for initial stroke and long-term poor prognosis. MATERIAL AND METHODS Data from MIS patients aged 18 to 50 years and a healthy control group at The First Affiliated Hospital of Anhui Medical University and The Third People's Hospital of Hefei City from January 2019 to July 2023 were analyzed. Risk factors and stroke etiology were compared. ROC curves assessed the predictive ability of original and modified Essen Stroke Risk Scores (ESRS). RESULTS Among 155 patients, 25 (16.1%) experienced recurrence within a year. Patients with MIS differed significantly from the control group in sex, hypertension history, diabetes, dyslipidemia, smoking, higher biomarkers (SBP, TG, VLDL-C, hs-CRP, WBC, RBC, NEUT, HB), and lower HDL-C. Univariate analysis found dyslipidemia, moderate to severe vascular stenosis, resting heart rate, and modified ESRS scores linked to recurrence. Multivariate analysis identified dyslipidemia, vascular stenosis, and resting heart rate as key risk factors. Large artery atherosclerosis was the most common stroke etiology (59.2%). ROC curves revealed areas under the curve for ESRS, modified ESRS-1, and modified ESRS-2 as 0.550, 0.660, and 0.937, respectively. CONCLUSIONS MIS was associated with a high recurrence rate and specific risk factors. Improved ESRS effectively predicted stroke recurrence within 1 year, with large artery atherosclerosis being the predominant etiology.

BACKGROUND The leuko-glycemic index (LGI) combines the white blood cell count and blood glucose levels and is calculated by multiplying the 2 values and dividing them by 1000. This study aimed to compare the prognostic value of the LGI in 199 patients with acute pulmonary embolism (APE) with and without diabetes mellitus. MATERIAL AND METHODS This study was conducted retrospectively on 199 patients who were admitted to the Emergency Department of Sakarya Training and Research Hospital between January 1, 2019, and December 31, 2022, and received a diagnosis of APE by pulmonary angiography. The patients were divided into 2 groups, diabetic and nondiabetic, based on their medical history. The groups were compared in terms of mortality according to the optimal cut-off value of LGI. RESULTS Of the 199 patients with APE included in the study, 61% were women and 39% were men. Mortality was higher in the diabetic group, and a simplified Pulmonary Embolism Severity Index score ≥1 was an independent predictor of all-cause mortality during the 30-day follow-up in the nondiabetic group (P=0.024). Multivariate logistic regression analysis showed that LGI was not an independent predictor of all-cause mortality during the first 30 days of follow-up in either group (P>0.05). CONCLUSIONS Mortality was higher in patients with diabetes and APE. However, the LGI was not an independent predictor of mortality in patients with or without diabetes. Since there are not enough studies on this subject, this result needs to be supported by additional research.

BACKGROUND Indirect ceramic restorations often need multiple firings to match the shade of natural teeth or need after-correction and ceramic addition during the clinical trial stage. Many studies have examined how multiple firings affect the mechanical characteristics of zirconia-veneered prostheses. The effect of firing number on adhesion between these core and heat-pressed lithium disilicate veneering ceramics is unclear. This study aimed to evaluate and compare the effects of repeat firings on the planar interface shear bond strength (SBS) using the Schmitz-Schulmeyer test between zirconia core and veneering heat-pressed lithium disilicate. MATERIAL AND METHODS Forty standard-sized rectangular zirconia framework specimens were fabricated using the Schmitz-Schulmeyer test, a test to assess bonding quality, and categorized into 4 groups: control, 1 firing cycle, 2 firing cycles, and 3 firing cycles. The additional firing cycles aimed to simulate clinical scenarios. SBS was tested using a universal testing machine. RESULTS The study found that mean SBS values were similar across experimental groups, with the control group showing slightly higher values. Analysis using ANCOVA revealed no significant difference in mean SBS between groups, but maximum load significantly influenced SBS. Regression analysis and Pearson correlation confirmed the significant relationship between maximum load and SBS (P<0.0001). CONCLUSIONS There was no apparent effect on the SBS from increasing the firing from 1 to 3 cycles, indicating that the study's hypothesis was not supported. The mode of failure, which was largely adhesive, did not tend to vary as the number of firing cycles rose, despite the fact that some samples in all groups showed mixed failure.

BACKGROUND Transitional cell bladder carcinoma (tcBC) is the predominant form of bladder cancer, making up around 95% of reported cases. Prognostic factors for older individuals with tcBC differ from those affecting younger patients. The main purpose of this study was to establish a prognostic competing risk model for elderly patients with tcBC. MATERIAL AND METHODS We conducted a retrospective analysis using data from the SEER database, randomly assigning patients to training and validation groups. We applied proportional subdistribution hazard (SH) to assess risk factors for cancer-related mortality (CSM). A competitive risk model was created to predict cancer-specific survival in elderly patients with tcBC. Model validation involved evaluating the area under the receiver operating curve, the consistency index, and a calibration curve. The Kaplan-Meier (K-M) curve was then used to compare mortality risk between high-risk and low-risk groups identified by the model. RESULTS This study randomly assigned 61 293 patients from the SEER database into training (42 905 patients) and validation (18 388 patients) groups in a 7: 3 ratio. Using a proportional subdistribution hazards model, we identified prognostic risk factors such as age, race, sex, marital status, TNM staging, grade, and metastatic status in brain, bone, liver, and lung. We developed a competitive risk model to predict 5-year cancer-specific survival (CSS) in elderly tcBC patients, achieving consistency index (C-index) values of 0.814 and 0.815 for the training and validation groups, respectively. Kaplan-Meier (K-M) analysis revealed 5-year survival probabilities of 35.1% (high-risk) and 42.2% (low-risk) in the training group, with similar rates of 35.7% and 42.0% in the validation group, both showing statistically significant differences (log-rank P<0.01). CONCLUSIONS We successfully established a competitive risk model for forecasting cancer-specific survival in elderly tcBC patients, primarily relying on these identified risk factors. The validation outcomes indicate the model's accuracy and dependability, making it a highly efficient predictive instrument. This tool enables making personalized clinical decisions for both medical professionals and patients.

BACKGROUND Remote exercise have emerged as a promising solution to overcome barriers to physical activity participation in pre-frail older adults, such as limited mobility and accessibility issues. Pre-frail older adults often face barriers to physical activity due to limited mobility and accessibility, underscoring the need for remote exercise alternatives. This study aimed to evaluate and compare the efficacy of remote versus in-person exercise in improving physical function in pre-frail older adults. MATERIAL AND METHODS Ninety pre-frail older adults aged 65 years and above were recruited, and randomly assigned to 3 groups: the remote exercise group (REG, n=30), the in-person exercise group (IPEG, n=30), and the control group (CG, n=30). The REG and IPEG groups underwent identical exercise, including balance, strength, and gait training, conducted twice weekly for 8 weeks. The REG received live, real-time instructions via video conferencing, while the IPEG participated in identical sessions conducted at a local facility. Outcome measures included assessments of balance, lower-limb strength, gait ability, and fall efficacy. RESULTS Both the REG and IPEG groups demonstrated significant improvements in balance, gait ability, lower-limb strength, and fall efficacy compared to the CG (P<0.05). No significant differences were found between the REG and IPEG groups across all outcome measures, indicating that remote exercise were as effective as in-person sessions. CONCLUSIONS Remote exercise effectively enhanced balance, strength, gait, and fall efficacy in pre-frail older adults, providing a viable alternative to traditional in-person programs and addressing healthcare disparities.

BACKGROUND Coronary artery ectasia (CAE) is frequently present with coronary artery disease (CAD). However, it is not clear why some patients with CAD progress to CAE while others do not. The pathogenesis of CAE is still poorly elucidated. C-reactive protein (CRP) and serum uric acid are well-known markers of inflammation. We aimed to investigate the possible associations among CRP, uric acid, and CAE in patients with CAD. MATERIAL AND METHODS We retrospectively evaluated data from 2400 patients undergoing coronary angiography. Seventy-four patients with CAE and CAD and 124 patients with only CAD detected on coronary angiography examination were included in this study. Univariate and multivariate logistic regression analyses were performed to evaluate the associated parameters of CAE in patients with CAD. RESULTS Patients with CAE and CAD were younger than patients with only CAD (63±9.5 vs 66.1±9.4, P=0.028). Male sex was more prevalent in patients with CAE and CAD than in patients with only CAD (86.5% vs 74.2%; P=0.029). CRP and uric acid were higher in patients with CAE and CAD compared to the patients with only CAD (10.9±12.8 vs 6.6±6.4; P=0.004; 5.9±1.4 vs 5.2±1.5; P=0.002, respectively). In multivariate regression analysis, age [P=0.029,OR(95% CI) 0.958(0.921-0.996)], CRP [P=0.010,OR (95% CI) 1.058 (1.014-1.103)], and uric acid [P=0.002,OR (95%CI) 1.527 (1.173-1.988)] were associated with CAE in patients with CAD. CONCLUSIONS The CRP and uric acid levels were higher in patients with CAE and CAD compared to the patients who only had CAD. Also, CRP and uric acid were associated with CAE. These results reflect the higher-grade vascular inflammation relative to atherosclerotic involvement in the presence of concomitant CAE in patients with CAD.

BACKGROUND Periodontal disease and rheumatoid arthritis (RA) are closely related, and periodontal therapy can potentially improve RA activity. However, it is not clear in which RA patient populations are more effective periodontal therapy for RA treatment. This study aimed to evaluate the effects of treatment for periodontal disease in 30 patients with rheumatoid arthritis and the titers of antibodies to Porphyromonas gingivalis (P. gingivalis). MATERIAL AND METHODS Thirty patients with RA with mild to severe periodontitis were divided into 3 groups based on the timing of periodontal therapy initiation. RA activity was assessed at baseline and at 3, 6, 9, and 12 months for comparison across groups. Additionally, serum P. gingivalis antibody titers were measured at baseline, patients were divided into 3 groups based on their levels, and their RA activity was compared after 12 months. RESULTS Patients who started periodontal therapy concurrently with RA treatment initiation at baseline showed greater improvement in RA activity, measured by disease activity score, including 28 joints using C-reactive protein (DAS28-CRP), from baseline to 3 months than those who started periodontal therapy after RA treatment. Additionally, RA activity by DAS28-CRP after 12 months of RA treatment with periodontal therapy was significantly improved in patients with higher baseline serum IgG antibody titers against P. gingivalis than in those with lower titers. CONCLUSIONS Treatment for periodontal disease in patients with RA is more effective in patients with early-phase RA and higher serum P. gingivalis antibody titers.