Medical Science Monitor最新文献

BACKGROUND For patients with end-stage renal disease, arteriovenous fistulas (AVFs) are often used for hemodialysis, but stenosis can impair their function. Traditional inpatient procedures to address AVF stenosis are effective but resource-intensive, prompting the need for alternative approaches like day surgery to optimize care and reduce costs. This study evaluated the feasibility of a day surgery model for AVF stenosis treatment in maintenance hemodialysis (MHD) patients, aiming to develop a cost-effective and high-quality care model. MATERIAL AND METHODS A prospective cohort study was conducted with 186 MHD patients undergoing AVF stenosis intervention between July 2022 and May, 2023. Patients were divided into a day surgery group (n=112) and a ward group (n=74). Various preoperative, intraoperative, and postoperative parameters were recorded, including AVF patency, complications, and rehospitalization rates. Follow-up assessments were conducted on postoperative days 1, 3, 7, and 30, with long-term patency evaluated at 6 and 12 months. RESULTS The day surgery group achieved a technical success rate of 99.11% and a complication rate of 3.57%, compared to 97.30% and 1.35% in the ward group. The day surgery group also had significantly shorter waiting times for beds, shorter hospital stays, and lower hospitalization costs (P<0.01). No significant differences were found between the groups in preoperative or postoperative parameters. CONCLUSIONS The day surgery model for AVF stenosis intervention in MHD patients is a viable option, showing comparable success and complication rates to inpatient surgery while significantly reducing hospital stays and costs.

The broad ligament, a double-layered peritoneum attaching the lateral uterus to the pelvic sidewall, plays a vital role in pelvic anatomy. Small bowel herniation through a defect in the broad ligament, known as broad ligament herniation, involving protrusion of viscera through defects in this ligament, is rare but can lead to severe complications. This systematic review aims to evaluate the presentation, diagnosis, management, and factors associated with broad ligament herniation. Following PRISMA guidelines, a systematic search was conducted in PubMed and Cumulative Index to Nursing and Allied Health Literature databases using the terms "broad ligament AND hernia" and "broad ligament AND herniation". Case reports and series with detailed anatomical descriptions were included. Articles not in English or without full-text access were excluded. Extracted data included patient demographics, history of abdominal surgeries, herniated organs, and classification. Results were synthesized to identify patterns and risk factors. A total of 71 articles met the inclusion criteria, with patients predominantly aged 30 to 49 years. A history of abdominal surgery and multiparity were noted to be key risk factors. The small bowel was the most herniated organ (90% of cases). The fenestra type defect accounted for 88.9% of cases, and CT imaging emerged as the preferred diagnostic modality. Detailed surgical and medical histories are crucial in diagnosing broad ligament herniation. Future research should focus on pathogenesis and standardized classification systems to improve management strategies.

BACKGROUND As the population ages, comorbidities among elderly patients are becoming a significant problem, due to associated risks and mortality. Medication adherence is crucial for controlling chronic diseases and improving patient outcomes; therefore, it is important to understand medication adherence among hospitalized patients. MATERIAL AND METHODS A cross-sectional study was conducted from June 2023 to April 2024 in 2 tertiary hospitals in Wuhu City, Anhui Province, China. Patients were divided into 2 age groups: 45 to 60 years and over 60 years. Data were collected using a self-designed sociodemographic questionnaire, the 4-item Morisky Medication Adherence Scale (MMAS-4), frailty scale, social frailty scale, and subjective cognitive decline questionnaire 9 (SCD-Q9). RESULTS A total of 963 inpatients were recruited, with 18.0% being middle-aged and 82.0%, elderly. The prevalence of medication adherence was 50.2%. Univariate analysis showed that medication adherence was significantly associated with place of residence, having relatives as medical personnel, physical frailty, social frailty, and subjective cognitive symptoms. Correlation analysis revealed that medication adherence was significantly negatively correlated with physical frailty, social frailty, and subjective cognitive symptoms. Binary logistic regression confirmed significant associations between medication adherence and physical frailty, social frailty, and subjective cognitive symptoms. CONCLUSIONS This study investigated medication adherence and its influencing factors among hospitalized patients with comorbidities in Anhui Province, China, identifying several influencing factors. Therefore, targeted interventions should be implemented by the government and relevant departments to improve patients' medication adherence.

BACKGROUND The Carhart effect consists of a reduction in bone conduction thresholds associated with conductive hearing loss. The aim of this study was to evaluate the role of the Carhart effect in predicting outcomes from surgery in 3 age groups. MATERIAL AND METHODS This study included 532 patients with conductive hearing loss due to otosclerosis, otitis media with effusion, and chronic otitis media who underwent surgery between 2010 and 2020. RESULTS The depth of the Carhart effect is a favorable prognostic factor for changes in BC (bone conduction) thresholds after ear surgery in younger patients. A deep Carhart effect in older people is an unfavorable prognostic factor for improving BC thresholds. The restoration of physiological amplification of the sound that was transmitted through the ossicular chain led to a statistically significant change in the Carhart effect and a strong positive correlation between the change in the Carhart effect and the change in average BC thresholds. The influence of the Carhart effect on the postoperative change in the ABG (air-bone gap) is most noticeable when the physiological strengthening of the middle ear is maintained. CONCLUSIONS This findings from this study have shown that the depth of the Carhart effect is one of many factors that should be considered when predicting the results of ear surgery. The depth of the Carhart effect is a favorable prognostic factor for the postoperative changes in BC threshold and for change in the ABG when the physiological strengthening of the middle ear is maintained.

BACKGROUND Butorphanol, an opioid receptor agonist and antagonist, is widely used for post-cesarean section analgesia in the form of intravenous or intramuscular injection, but nasal sprays are less used. This study aimed to evaluate the analgesic effect of butorphanol nasal spray on uterine contraction pain after cesarean section and explore its effect on postpartum prolactin secretion. MATERIAL AND METHODS We randomly divided 120 patients scheduled for cesarean section into 3 groups (40 per group): intranasal saline (control), butorphanol intranasal (BI), and butorphanol pumped intravenously (BV). The same analgesic pump protocol was used in all groups. The visual analog scale (VAS) and Ramsay sedation scale (RASS) were used to evaluate analgesic and sedation levels 6, 12, and 24 h postoperatively. We recorded the start time of breastfeeding, number of PCIA presses, consumption of butorphanol, and preoperative and postoperative serum prolactin levels. RESULTS At 6 h postoperatively, the BI and BV groups had lower VAS and higher RASS (P<0.05) than the control group, no difference between the BI and BV groups, but the consumption of butorphanol was lower in the BI group (P<0.05). The analgesic and sedative effects in the BI group were lower than those in the BV group at 12 h (P<0.05). No difference in the start time of breastfeeding, serum prolactin levels among the 3 groups (P>0.05). CONCLUSIONS Patients may prefer butorphanol tartrate nasal spray because they can obtain satisfactory analgesia in the early postoperative period, with high non-invasive comfort and reduced use of opioids. No effect on prolactin levels or lactation initiation was observed.

BACKGROUND Studies on patients with obesity who lose a considerable amount of body fat show that the severity of knee pain and movement limitation is decreased. This study aimed to analyze the effects of weight loss on knee pain and quality of life in patients with obesity. MATERIAL AND METHODS The study included patients aged 18-65 years with a body mass index (BMI) of 30 kg/m² and above, who expressed knee pain in daily life routines and applied to the Obesity Center of Adana City Training and Research Hospital as of June 2018. The retrospective analysis included age, sex, weight, height, annual radiological imaging follow-up scores (Kellgren-Lawrence), visual analog scale (VAS) scores, EuroQol-5D (EQ-5D) scores, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores of the patients throughout the 5-year follow-up period. RESULTS The mean age of the 89 patients was 50.3±10.5 years, and 82% were women. The initial BMI, EQ-5D, VAS, and WOMAC scores differed significantly from the scores at year 5 (P=0.0001). Receiver operating characteristic analysis showed the probability of reducing the progression of knee joint degeneration was 74% if the BMI reduction was greater than 13.3% over the 5-year follow-up period. CONCLUSIONS The overall interpretation of the results was that a 13.3% or greater reduction in BMI in the first year, despite an increase in the following years, triggered improvements in various aspects of pain and functionality scores, improved quality of life, and reduced KOA progression.

BACKGROUND The Smovey Vibroswing exercise device consists of a circular tube containing 4 steel balls, partly covered by a cushioning handle, to strengthen the arm and shoulder muscles. This study aimed to compare the effects of using a Smovey Vibroswing versus dumbbell exercises on muscle activity and body composition of the upper limbs in 23 women under 30 years of age. MATERIAL AND METHODS Subjects were 23 women under the age of 30 years, residing in South Korea, with no musculoskeletal diseases or shoulder surgeries in the past year. Shoulder flexion-extension and abduction-adduction exercises were conducted using Smovey Vibroswing or 2-kg dumbbells. Electromyography (EMG) was used to measure muscle activity in the upper extremities. Data analysis was performed using two-way ANOVA with repeated measures, considering differences significant at P<.05. RESULTS Exercise using the Smovey Vibroswing provided vibratory stimulation that improved muscle activity, coordination, and stability in the upper arm muscles of women under 30 years of age. Muscle activation in specific muscles, such as the anterior deltoid, biceps brachii, and brachioradialis, was significantly higher during Smovey exercises compared to dumbbell exercises (P<.05). CONCLUSIONS The vibratory stimulation of Smovey was found to improve upper-limb muscle activity and positively affect stability and coordination in women. These findings suggest that Smovey can serve as a safer, more controllable alternative for resistance exercise. This study highlights the need for standardized Smovey exercise programs, especially tailored for varying ages and fitness levels.

BACKGROUND Different temperature conditions can affect the efficiency of irrigation solutions and consequently the ability of canal sealers to bond to root canal walls. The aim of this endodontic study was to evaluate the effect of irrigation solutions at different temperatures on the bond strength of a bioceramic-based root canal sealer. MATERIAL AND METHODS Root canal preparations were completed through irrigation with the following solutions: Group 1 was irrigated with 5 ml NaOCl (sodium hypochlorite) +5 ml EDTA (Ethylenediamine tetra-acetic acid) (22°C); Group 2 was irrigated with 5 ml NaOCl +5 ml EDTA (37°C); Group 3 was irrigated with 5 ml NaOCl +5 ml GA (Glycolic acid) (22°C); Group 4 was irrigated with 5 ml NaOCl +5 ml GA (37°C), Group 5 was irrigated with 20 ml Dual Rinse® HEDP (Etidronate) - NaOCl mixture (22°C); and Group 6 was irrigated with 20 ml of Dual Rinse® HEDP mixture (37°C). Obtained test specimens were subjected to the push-out test. Three-way ANOVA was used to compare bond strength values. RESULTS The main effect of temperature (P<0.05), the main effect of the solution (P<0.05), and the main effect of the section (P<0.05) were significantly associated with the mean values of the bond strength. Heating irrigation solutions increased the bond strength of bioceramic-based canal sealers. CONCLUSIONS The bond strengths of the solutions increased as the temperature increased. EDTA solution significantly increased the bond strength compared to Dual Rinse® HEDP solution. Meanwhile, the bond strengths in the apical region were lower than those in the middle region.

BACKGROUND The VICON Toolkit enables three-dimensional (3D) motion capture for gait analysis. Statistical parametric mapping (SPM) is a voxel-based neuroimaging approach used to identify region-specific effects. This study aimed to apply SPM to analyze the joint angles of the hip, knee, and ankle during gait in 20 post-stroke patients using the VICON motion capture system. MATERIAL AND METHODS A total of 20 post-stroke patients participated in the study. A 10-camera VICON motion capture system (250 Hz) was used to record 3D kinematic data. Joint angles were assessed in the sagittal, frontal, and transverse planes using SPM. The data were normalized to 100% of the gait cycle, and a paired t test was performed to assess asymmetry between affected (AS) and unaffected sides (UAS), with P<0.05 considered statistically significant. RESULTS Significant asymmetry was observed in the hip and knee joint angles in the sagittal plane. The hip joint showed differences during 0-39% of the stance phase and 40-100% of the swing phase. The knee joint exhibited differences during 98-100% of the stance phase and 0-79% of the swing phase (P<0.05). CONCLUSIONS The study highlights the importance of addressing asymmetry in the hip and knee joints in post-stroke rehabilitation programs. The findings indicate the need for improving hip and knee joint mobility to enhance functional gait outcomes. The use of SPM provides a more comprehensive analysis of gait asymmetry, offering insights that go beyond traditional spatiotemporal methods.

Pelvic organ prolapse (POP) is a women's health problem in both developed and developing countries. Various studies have found that the occurrence of POP is related to the supporting structures of the pelvic floor, including type III collagen levels. Most studies reported no correlation between collagen 3 alpha 1 (COL3A1) rs1800255 gene polymorphism and the occurrence of POP. However, the studies carried out still need to be clarified in terms of the type of research, the involvement of women of various ages, the method of diagnosing POP, and differences in the measurement of COL3A1 rs1800255 gene polymorphism. Prospectively, as the outcomes of the trials are still inconsistent, more research is required to determine which patients are at risk of pelvic organ prolapse and would benefit from preventive interventions, particularly those using collagen. This article aims to review the relationship between COL3A1 rs1800255 gene polymorphism and female pelvic organ prolapse.