Medical Science Monitor最新文献

Chemotherapy-induced peripheral neuropathy (CIPN) is the primary dose-limiting toxicity in albumin-bound paclitaxel chemotherapy regimens. Current assessment methods based on clinical scales are limited by strong subjectivity and insufficient sensitivity, while most emerging technologies remain in the preclinical stage. Therefore, the development of objective and non-invasive imaging biomarkers is urgently needed. This review focuses on the transformative role of non-invasive imaging techniques in addressing unmet clinical needs such as the accurate imaging assessment of CIPN, and systematically analyzes the complementary value of musculoskeletal ultrasound (MSUS) and magnetic resonance imaging (MRI) in evaluating nervous system damage induced by albumin-bound paclitaxel-related CIPN. For key peripheral nerves including the radial nerve, ulnar nerve, median nerve, and common peroneal nerve, MSUS can visualize morphological abnormalities and hemodynamic changes in real time through high-frequency probes, enabling rapid, radiation-free anatomical assessment, and serial monitoring. MRI can detect early neurostructural damage, nerve edema, and abnormal nerve fascicle signals, while also evaluating soft-tissue lesions in the nerve trajectory area. Future research should conduct systematic validation of standardized imaging data to clarify the clinical value of these techniques as predictive biomarkers for risk stratification of CIPN. This article aims to construct a novel clinical diagnostic approach for CIPN, provide a more precise and efficient diagnostic pathway for patients with peripheral neuropathy symptoms, further support the timely formulation and implementation of targeted clinical treatment plans, and ultimately contribute to improving patient prognosis.

BACKGROUND Patellofemoral pain syndrome (PFPS) limits physical activity and quality of life, especially during weight-bearing tasks. Although high-load resistance exercises are recommended for rehabilitation, they may worsen symptoms in pain-sensitive individuals. Low-intensity blood flow restriction (BFR) training has emerged as a potential alternative. However, its effects on functional performance and mechanical properties remain unclear. MATERIAL AND METHODS In this assessor-blinded, randomized controlled trial, 41 individuals with PFPS were randomly assigned to either the experimental group (EG, n=20) or the control group (CG, n=19). The EG performed multi-joint resistance exercises combined with BFR, while the CG performed the same program without BFR. Both groups completed the same multi-joint resistance exercise program twice weekly for 6 weeks. Outcome measures included pressure pain threshold (PPT), muscle mechanical properties such as tone and stiffness in the vastus medialis and vastus lateralis, isometric knee extensor strength, and balance ability. Balance was evaluated using the Y-Balance Test and the stair-descending task. RESULTS The EG showed significantly greater improvements in knee strength, PPT, and balance (P<0.05). Notably, significant increases in muscle tone were observed in the vastus medialis and lateralis muscles, as well as muscle stiffness in the vastus medialis and semitendinosus muscles. CONCLUSIONS Low-intensity BFR multi-joint resistance exercise may be an effective intervention for improving physical function, pain, and mechanical properties in patients with PFPS.

BACKGROUND Clinical trials provide opportunities for patients with cancer to access novel treatment regimens in many developing countries. Next-generation sequencing (NGS) plays a key role in the treatment of various cancer types in today's clinical practice. The aim of this study is to investigate accessibility of clinical trials and NGS in Turkish oncology clinics. MATERIAL AND METHODS This cross-sectional survey was conducted among medical oncologists in 86 oncology centers across Turkey. Responses to a 14-item questionnaire were analyzed based on the centers. Final analyses included 86 oncology centers across 38 cities (n=86). These centers were classified as public (n=63) and private (n=23) hospitals and as those in the 3 largest metropolitan areas (n=33) or in other cities (n=53). RESULTS The median numbers of ongoing clinical trials were 1 (0-50) and 2 (0-50) in public and private hospitals, respectively (P=0.961), and clinical trials actively recruiting were 0 (0-42) and 0 (0-30) in public and private hospitals, respectively (P=0.862). Hospitals located in the largest metropolitan areas had significantly higher median numbers of ongoing clinical trials, 2 (0-50) vs 0 (0-25) (P=0.002), and actively recruiting trials, 2 (0-42) vs 0 (0-25) (P=0.008), compared with hospitals in other cities The availability of NGS was also higher in metropolitan hospitals (75.8%) than in other cities (20.8%) (P<0.001). CONCLUSIONS Geographic location creates significant inequalities in the number of clinical trials and access NGS in oncology centers, in contrast to the uniform coverage provided by general health insurance. Tailored region-specific improvements are required to enhance cancer care in Turkey.

BACKGROUND This retrospective study of 128 patients admitted to an intensive care unit (ICU) who required renal replacement therapy (RRT) aimed to compare outcomes from 3 treatment approaches: intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT) with heparin, and CRRT with citrate anticoagulation. MATERIAL AND METHODS We analyzed data from 128 medical histories of patients treated in the Department of Anesthesiology and Intensive Care of the Regional Specialist Hospital (RSH) in Olsztyn between January 2003 and December 2011. Depending on the type of renal replacement therapy and anticoagulation used, the patients were assigned to one of the 3 cohorts: cohort I - 41 patients receiving IHD (IHD), cohort II - 40 patients receiving CRRT with heparin anticoagulation (unfractionated and low-molecular-weight heparin) (HEP), and cohort III - 47 patients receiving CRRT with citrate anticoagulation (CITR). RESULTS No statistically significant differences were found in ICU, 90-day, in-hospital, and long-term mortality (ie, at the end of the observation period [31/12/2020]), between IHD, HEP, and CITR cohorts (P=0.744, P=0.763, P=0.833, P=0.958, respectively). Patients in the IHD cohort were significantly more likely to be dependent on long-term dialysis treatment than all the other patients combined after discharge from the hospital (P=0.001). CONCLUSIONS The renal replacement modality and the type of anticoagulation did not affect mortality. However, IHD was associated with a higher percentage of long-term dialysis-dependent patients after hospital discharge.

BACKGROUND Periscapular pain involves the muscles surrounding the shoulder blade, which can result from trauma, overuse or repetitive use, and poor posture. This study aimed to evaluate the prevalence of periscapular pain and the association between it and seating posture while using electronic devices, utilizing the American Shoulder and Elbow Score (ASES). MATERIAL AND METHODS This was a cross-sectional study conducted using an online questionnaire. The calculated sample size required 372 participants. The questionnaire was divided into 3 sections; sociodemographic information, risk factors for periscapular and shoulder pain, and ASES used for periscapular pain and disability assessment. RESULTS We included 379 patients. The lifetime prevalence of periscapular pain was 82.1%, and 48.5% reported current periscapular pain. Females were more likely to experience it (P value <.001). Most respondents who experienced periscapular pain worked in jobs that combined office and fieldwork (away from the office). Periscapular pain was significantly associated with forward tilt of the neck while using electronic devices (P=0.017). The mean ASES was 62.18. As age advances, worse ASESs were reported. CONCLUSIONS Periscapular shoulder pain is a very common and under-acknowledged problem among the general population, and poor posture while using an electronic device is significantly associated with periscapular pain.

BACKGROUND Although propofol is widely used for painless gastrointestinal endoscopy, cardiopulmonary adverse events associated with its use are still common. Ciprofol is a novel intravenous anesthetic with respiratory and hemodynamic stability. The aim of this study was to evaluate the benefits of ciprofol combined with nalbuphine for painless gastrointestinal endoscopy in reducing the occurrence of cardiopulmonary adverse events and improving postendoscopic recovery. MATERIAL AND METHODS In this single-center randomized study, a total of 128 patients undergoing painless gastrointestinal endoscopy were randomly assigned to 2 groups: propofol combined with nalbuphine or ciprofol combined with nalbuphine. All patients received 0.15 mg/kg nalbuphine intravenously before the study drugs were administered. The propofol group received a bolus of 2 mg/kg propofol intravenously, whereas the ciprofol group received a bolus of 0.4 mg/kg ciprofol intravenously. The primary endpoint was the incidence of intraprocedural cardiopulmonary adverse events (hypotension, bradycardia, and hypoxemia). RESULTS The ciprofol group demonstrated a significantly lower rate of cardiopulmonary adverse events during induction, compared with the propofol cohort (4.8% vs 18.7%; P=0.028). Furthermore, ciprofol administration was associated with lower procedural complications, including injection pain, cough reflex, and body movement (P=0.011). CONCLUSIONS Ciprofol-nalbuphine sedation demonstrates a superior safety profile, with fewer hemodynamic and respiratory perturbations and improved procedural tolerance, compared with propofol-nalbuphine in painless gastrointestinal endoscopy, while maintaining equivalent sedative efficacy and enhanced recovery characteristics.

BACKGROUND Perianal abscess (PA) and fistula-in-ano (FIA) are common in children, particularly infants. Despite their frequency, their pathophysiology, diagnostic accuracy, and optimal treatment remain debated. This study aimed to evaluate recurrence rates after surgical treatment of PA and FIA and identify clinical factors associated with fistula formation, including ultrasound findings, antibiotic therapy, abscess size, and symptom duration in otherwise healthy pediatric patients. MATERIAL AND METHODS We retrospectively reviewed 108 pediatric patients (0-17 years) treated surgically for PA and/or FIA between January 2019 and February 2024 at a tertiary care center. Inclusion criteria were PA diagnosis and incision and drainage as primary management. Data included intraoperative findings, recurrence, antibiotic use, ultrasound results, symptom duration, and abscess size (infants only). RESULTS Intraoperative FIA was identified in 19/108 patients (17.8%). Overall recurrence occurred in 29 patients (26.9%). Recurrence of PA was more frequent in those with initial FIA (36.8%) than without (24.7%) but was not significant (P>0.05). However, FIA recurrence was significantly higher in patients with initial FIA (31.6% vs 10.1%, P=0.024). Among 99 patients undergoing ultrasound, diagnostic accuracy for PA was 100%. Regarding FIA, there were 3 false negatives and 5 false positives; in 67 cases, no definitive conclusion was provided. Antibiotic therapy, abscess size, and symptom duration showed no significant association with recurrence or FIA development. CONCLUSIONS Initial intraoperative detection of FIA significantly predicts future recurrence. Antibiotic use, symptom duration, and abscess size were not predictive. Findings highlight the need for improved diagnostic tools and standardized management protocols in pediatric PA and FIA.

BACKGROUND Pretreatment nutritional and inflammatory indices can affect tolerance and response to neoadjuvant chemotherapy (NAC) in locally advanced and early-stage HER2‑positive breast cancer. Markers that predict different outcomes for anthracycline‑containing versus anthracycline‑free regimens could help tailor personalized treatment. This study examined whether pre‑treatment nutritional and inflammatory indices can distinguish response and survival differences between 2 NAC regimens - ddAC‑THP versus TCHP - in HER2‑positive breast cancer. MATERIAL AND METHODS This single‑center retrospective cohort study included 112 women with HER2‑positive invasive breast cancer treated with ddAC‑THP (n=72) or TCHP (n=40). Baseline serum albumin, lymphocyte, neutrophil, monocyte, C‑reactive protein, and cholesterol levels were used to calculate CONUT, mGPS, CAR, NPS, and PNI. Pathological complete response (pCR) rates, treatment metrics, and overall survival (OS) were compared. RESULTS Baseline characteristics and pCR rates (ddAC‑THP: 55.6%; TCHP: 50.0%; P=0.71) were similar. TCHP patients showed better overall survival (97.5% vs 84.7%; P=0.02). CAR had the strongest ability to differentiate between regimens (AUC 0.76; 95% CI 0.67-0.84; P<0.001), while NPS showed inverse prediction (AUC 0.25; P<0.001). CONUT, mGPS, NLR, LMR, and PNI did not have significant predictive power. There was a trend toward better survival with TCHP, but it did not reach statistical significance (log-rank P=0.065). CONCLUSIONS CAR showed modest discriminative ability between treatment groups in this cohort, while other indices had limited utility. The anthracycline-free TCHP regimen was associated with better observed overall survival than ddAC-THP, although time-to-event analysis showed only a borderline difference in survival.

BACKGROUND Total laparoscopic hysterectomy (TLH) is a minimal invasive procedure for benign, premalignant and early-stage malignant uterine conditions. Uterine manipulators are commonly used to facilitate uterine mobilizations and improve surgical exposure, but their necessity and potential impact on intraoperative and postoperative complications remain debated. Despite conflicting findings, evidence from large retrospective cohorts comparing manipulator-assisted versus manipulator-free TLH remains limited. The aim of this study is to compare intraoperative and postoperative outcomes of TLH performed with and without using uterine manipulators. MATERIAL AND METHODS A retrospective cohort analysis of consecutive TLH for benign, premalignant, and early-stage endometrial cancer indications was conducted. Patients were categorized by uterine manipulator use (manipulator group, n=244; manipulator-free group, n=166). Demographics, uterine weight, operative time, hemoglobin change, intraoperative injuries, and postoperative complications were extracted from electronic records. Statistical comparisons were performed using chi-square or Mann-Whitney U tests (P<0.05). RESULTS Baseline characteristics were comparable between the groups. Mean uterine weight was 349.55±324.35 g (range 44-1354 g) in the manipulator group and 356±324.42 g (range 47-1440 g) in the non-manipulator group (P=0.842). Mean operative time did not differ significantly (79.6±26.07 vs 76.6±25.16 min; P=0.259). Intraoperative complications, vaginal lacerations, postoperative complications rates (13.9% vs 12.7%; P=0.708), hemoglobin changes, and hospital stay were comparable. Vaginal cuff hematomas were rare and similar between groups; no dehiscence occurred. CONCLUSIONS Expert laparoscopic surgeons can safely perform TLH without the use of a uterine manipulator. This approach does not appear to increase the risk of morbidity, compared with the use of a manipulator.

The oxysterol-binding protein-related proteins (ORPs) represent an evolutionarily conserved family of lipid-binding and transport proteins that serve as critical regulators of cellular lipid homeostasis, membrane trafficking, and signaling networks in eukaryotes. Accumulating evidence demonstrates that ORPs exert profound influence on oncogenic processes through their ability to modulate tumor cell proliferation, survival, and metastatic potential via distinct molecular mechanisms. Our review provides an integrated analysis of ORP family members, highlighting their structurally conserved oxysterol-binding domains and functionally divergent roles in cancer biology: (1) oncogenic ORPs (ORP2-5) that drive tumor progression through lipid metabolic reprogramming; (2) tumor-suppressive ORP8 that constrains malignant transformation; (3) immunomodulatory ORP9 involved in pancreatic cancer microenvironment regulation; and (4) ORP6/7 and ORP10/11 that govern cell motility and metabolic pathways respectively, with emerging but incompletely understood roles in neoplasia. Importantly, we discuss the translational relevance of ORP targeting, exemplified by the development of specific pharmacological inhibitors (Orpinolide and Ornithogalum saundersiae steroidal saponin-1) that disrupt oxysterol-binding protein/ORP4-mediated lipid transfer in cancer cells. By synthesizing current knowledge across solid tumors and hematologic malignancies, this work establishes a conceptual framework for understanding ORP-mediated oncogenesis and explores their potential as therapeutic targets in precision oncology approaches.