Medical Science Monitor最新文献

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.

BACKGROUND The search for biomarkers to predict the clinical course and mortality of patients with sepsis in the intensive care unit (ICU) remains ongoing. In this study, we aimed to investigate the effectiveness of nucleated red blood cell (NRBC) count and percentage in predicting clinical outcomes and mortality in patients with sepsis monitored in the ICU. MATERIAL AND METHODS This retrospective study included 160 patients with sepsis who were followed in the ICU between March 2023 and March 2024 and stayed for more than 48 hours. Laboratory values and clinical outcomes were compared. RESULTS Eighty-one patients (50.625%) died. The Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores were higher, and the Glasgow Coma Scale scores were lower, in the mortality group (P<0.001 for all). NRBC counts at ICU admission, at discharge, and 48 hours before discharge were significantly higher in patients who died (P=0.029, P=0.004, and P=0.02, respectively). Receiver operating characteristic curve analysis revealed the highest area under the curve (AUC) for NRBC at discharge (AUC=0.631) with a cut-off of 10 NRBC/µL. NRBC at admission had an AUC of 0.6, with a cut-off value of 20 NRBC/µL and specificity of 0.848. CONCLUSIONS NRBC values, when combined with established scoring systems, may aid in guiding sepsis management. Future studies are needed to further evaluate the process and determine cut-off values.

BACKGROUND Postoperative delirium (POD) is a clinically significant complication in elderly orthopedic patients that is associated with adverse outcomes and may be differentially affected by transfusion type. However, systematic comparisons in hip arthroplasty (HA) patients remain limited. This study evaluated the effect of 2 types of intraoperative blood transfusions on the incidence of POD in elderly patients undergoing HA. MATERIAL AND METHODS We retrospectively analyzed the medical records of 544 elderly patients (age ≥65 years) who underwent HA with intraoperative transfusion at our orthopedic center between 2018 and April 2025. Baseline characteristics were balanced between groups using inverse probability of treatment weighting (IPTW) derived from propensity score matching. The primary outcome was the incidence of POD, while secondary outcomes included postoperative complications such as deep vein thrombosis and pulmonary infection, as well as the length of hospital stay. RESULTS Following IPTW adjustment, generalized linear regression analysis revealed that the autologous transfusion group had a significantly lower incidence of POD compared to the allogeneic transfusion group (4.2% vs 11.9%; adjusted OR=0.32, 95% CI: 0.13-0.79, P=0.014). No significant differences were found between the groups in secondary outcomes. CONCLUSIONS This study suggests that autologous transfusion is associated with a significantly reduced risk of POD compared to allogeneic transfusion in elderly patients undergoing HA. These results indicate that autologous transfusion may be the best alternative for this patient population, although further large-scale studies are necessary to validate its definitive clinical benefits.

BACKGROUND Patellofemoral pain (PFP) syndrome is a common cause of anterior knee pain. Excessive tibial external rotation during knee flexion increases patellofemoral stress, and uncontrolled tibiofemoral rotation is associated with PFP syndrome. Assessing knee flexion with and without tibiofemoral joint rotation control (TFRC) may help clinicians detect impaired rotational control and guide interventions. However, few studies have compared knee flexion angles under both conditions between individuals with and without PFP syndrome. This study compared active knee flexion angles with and without TFRC and evaluated tibial external rotation using the distance between the examination table and the lateral malleolus (DBTL). MATERIAL AND METHODS A total of 24 male participants (12 with PFP and 12 without PFP) underwent knee flexion angle assessments under both TFRC and non-TFRC conditions. To minimize hip movement, the examiner manually stabilized the femoral epicondyle of the test leg to keep the patella facing forward. DBTL was measured during knee flexion without TFRC to assess tibial external rotation. Data were analyzed using a 2-way repeated-measures analysis of variance (ANOVA) for knee flexion angles and independent t-tests for DBTL comparisons. RESULTS No significant differences in knee flexion angles were observed without TFRC. However, with TFRC, the PFP group exhibited significantly reduced knee flexion angles (P<0.01). The PFP group also showed significantly higher DBTL (P<0.01), indicating greater tibial external rotation. CONCLUSIONS These results suggest that uncontrolled tibiofemoral joint rotation may represent a characteristic movement pattern in individuals with PFP and underscore the importance of considering TFRC in clinical assessments in PFP syndrome.

BACKGROUND We suggest that testing a large language model (LLM) chatbot in terms of the accuracy of the references it provides could be a powerful, quantifiable means of rating its inherent degree of misinformation, since the accuracy of the bibliographic data can be directly verified. Given the growing reliance on artificial intelligence (AI) tools in academic research and clinical decision-making, such a rating could be extremely useful. MATERIAL AND METHODS In this study, we compared 3 versions of ChatGPT and 3 versions of Gemini by asking them to provide references about 25 highly cited topics in otorhinolaryngology (those with "guidelines" in the title). Answers were sought on 3 consecutive days to assess the variability and consistency of responses. In total, the 6 chatbots returned 1947 references, which were carefully checked against PubMed, Web of Science, and Google Scholar, and rated according to accuracy. Ratings were given based on correct authorship, complete bibliographic details, and proper DOI numbers. RESULTS Common discrepancies noted were wrong author names and erroneous DOI numbers. Across the 6 chatbots, ChatGPT-4.1 (with web search enabled) achieved the best accuracy, with a score of 51%, with Gemini 2.5 Pro being second at 41%. The 2 versions with a web search facility performed better than the 4 versions without. Topics having higher citation counts were associated with lower error rates, suggesting that more widely disseminated scientific findings result in more accurate references. CONCLUSIONS Our findings provide a solid benchmark for rating AI-driven bibliographic retrieval and underline the need for further refinement before these tools can be reliably integrated into academia and clinical applications.

The human body acquires D-amino acids from multiple sources, with intestinal microbiota being the most significant contributor, followed by dietary intake and limited synthesis within the nervous system. Microbiota-derived D-amino acids can either be excreted directly in feces or absorbed into the systemic circulation, thereby influencing host metabolism and immune responses. Dietary intake, particularly from fermented or processed foods, also contributes to circulating levels of D-amino acids. With advances in analytical methodologies such as chiral chromatography and high-resolution mass spectrometry, it is now possible to detect trace concentrations of D-amino acids in plasma, urine, and tissue samples, allowing their clinical relevance to be more fully appreciated. The kidney plays a critical role in regulating systemic D-amino acid balance, as it exhibits stereoselective handling by actively reabsorbing some and excreting others into urine. This selective regulation means that alterations in D-amino acid profiles can provide valuable insight into renal physiology and pathophysiology. Clinical studies have demonstrated that specific D-amino acid patterns, including increased fractional excretion of D-serine, are associated with diseases such as diabetic nephropathy, IgA nephropathy, and chronic kidney disease. Beyond serving as biomarkers, emerging evidence suggests that D-amino acids directly influence renal outcomes: excessive D-serine has been shown to cause tubular injury, while other microbiota-derived D-amino acids may modulate immunity or confer protection in acute kidney injury. This review aims to summarize the sources and metabolism of D-amino acids and their roles as biomarkers in kidney disease.