Medical Science Monitor最新文献

BACKGROUND Identifying patients at higher risk of acute ischemic cerebrovascular events (AICE) following central retinal artery occlusion (CRAO) is crucial for secondary prevention of stroke. This study aimed to investigate whether a low ankle-brachial index value is associated with an increased risk of AICE after CRAO. MATERIAL AND METHODS We prospectively analyzed patients who were admitted to our hospital because of CRAO between February 2019 and March 2023 and whose ankle-brachial index was no greater than 1.40. We explored the potential association between the index and risk of AICE (defined as ischemic stroke or transient ischemic attack) within 1 year after occlusion. Patients were classified into 2 groups according to whether their index was low (≤0.90) or normal (0.91-1.40). RESULTS Of the 335 patients in the final analysis, 110 (32.8%) had an ankle-brachial index of ≤0.90 and 89 (26.6%) experienced AICE during 1-year follow-up. In univariable analysis, patients with a low index had a significantly higher AICE incidence than those with a normal index (36.4% vs 21.8%, P<0.01). Multivariable logistic regression analysis, adjusting for variables associated with low index, identified low index as an independent predictor of AICE after CRAO (OR 1.864, 95% CI 1.095-3.174, P=0.022). CONCLUSIONS Low values of the ankle-brachial index may independently predict higher risk of AICE after CRAO. This index may serve as a non-invasive screening tool for patients with CRAO who require intensified secondary stroke prevention.

BACKGROUND A tooth preparation's clinical requirements and geometric configurations should take precedence over material characteristics when advocating for putty reline impression techniques for permanent restorations, since they require a technically sensitive spacer for light body elastomer. We evaluated the linear dimensional accuracy of vinyl polysiloxane-based putty reline impressions with different spacer acquisition techniques in short-span and long-span fixed partial dentures (FPD). MATERIAL AND METHODS A typodont tooth set simulated a 3-unit (short-span) and a 5-unit (long-span) FPD. Between respective prepared abutments, 31 coordinates were identified and measured based on angles (line/point) and surfaces (curved/flat). Sixty impressions (dual stage 2-step putty reline technique) were divided into 5 groups (n=12/group): group PP (pre-preparation putty), group GP (gouging putty), group PS (polythene spacer), group CT (conventional temporary), and group MT (modified temporary), depending on spacer acquisition method. Coordinates measurements were conducted using a measuring microscope. Descriptive and inferential statistical tests (ANOVA, post hoc Tukey) determined between-group and within-group differences, at P≤0.05 significance level. RESULTS In short-span FPD, compared with control, the number of significantly different coordinates group-wise were GP (4 coordinates), PP (2 coordinates), and PS, CT, and MT (1 each). In long-span FPD, compared with control, the number of significantly different coordinates group-wise were group GP (12 coordinates), group PP (10 coordinates), group PS (5 coordinates), and group CT and group MT (4 each). CONCLUSIONS Different spacer acquisition methods produce varied thickness of spacers for relining of putty. CT and MT, when used as spacers, provided maximum accurate coordinates for angles (line/point) and surfaces (curved/flat).

BACKGROUND The precedence effect (PE) is a physiological phenomenon for accurate sound localization in a reverberant environment. Physiological studies of PE have mostly focused on the central nucleus of the inferior colliculus (CNIC), which receives ascending and descending projections, as well as projections from the shell of the inferior colliculus (IC) and contralateral IC. However, the role of the dorsal cortex of the IC (DCIC), which receives ascending and descending projections to ensure sound information processing and conduction on PE formation, remains unclear. Therefore, this study aimed to understand the role, if any, of the DCIC on PE formation in male Sprague Dawley rats. MATERIAL AND METHODS In vivo, 16-channel electrophysiological recordings were performed in anesthetized rats to investigate neuronal responses in the CNIC, after inducing electrolytic lesions in the DCIC. In vitro, the expression of inhibitory gamma-aminobutyric acid (GABA)ergic receptors in the CNIC was analyzed by Western blot. RESULTS After inducing electrolytic lesions in the DCIC, normalized neural responses of the CNIC to lagging stimuli were significantly increased (P<0.05), half-maximal inter-stimuli delays were shortened (P<0.05), and the expression of GABA A receptor a1 and GABA B receptor 2 decreased (P<0.05). Furthermore, neurons in the CNIC showed a contralateral preference when paired sounds in the free field were presented. CONCLUSIONS Our study suggests that the DCIC could modulate PE formation in the CNIC, potentially involving inhibitory GABAergic mechanisms. This study showed the role of the DCIC on PE formation and proposed a potential structure for identifying likely mechanisms of the PE in the IC.

BACKGROUND Chiari malformation type 1 occurs when the cerebellar tonsils are pushed into the spinal canal, which can result in syringomyelia. This retrospective study from a single center evaluated outcomes in 89 patients with Chiari malformation type-I (CM-I) and syringomyelia treated with an arachnoid-preserving technique between 2016 and 2023. MATERIAL AND METHODS A retrospective analysis was conducted at a tertiary referral center, involving 88 adult patients and 1 adolescent patient aged 14 to 61 years, with diagnosis by MRI and treated for CM-I with syringomyelia between 2016 and 2023, using the arachnoid-preserving technique. Patients' demographics, clinical presentations, radiological findings, surgical details, and postoperative outcomes were analyzed. Primary outcomes were postoperative complications, while secondary outcomes included neurological improvement (measured by the visual analog scale) and patient satisfaction. RESULTS The study included 89 patients, with 69 female (77.5%) and 20 male (22.5%) patients. A significant reduction in syrinx size was observed in 83.3% of patients, with complete resolution in 16.7%. Mean surgery duration was 90 min, and average hospitalization duration was 2.75 days. All patients experienced significant improvements in neurological symptoms, such as headache, neck pain, numbness, and weakness. High levels of patient satisfaction were reported, with 100% of patients satisfied with their surgical outcomes. The incidence of complications, such as cerebrospinal fluid leakage and arachnoiditis, was notably lower than those by traditional methods. CONCLUSIONS The linear, arachnoid-preserving suboccipital decompression technique offers a safe, effective, and rapid alternative for managing CM-I with syringomyelia, demonstrating a notable reduction in postoperative complications and significant improvements in neurological outcomes.

BACKGROUND Dental caries removal is conventionally done using carbide burs, but non-metallic polymer burs have recently been developed with the aim of being more selective and causing less pain. The objective of the study is to evaluate and compare the effectiveness of caries removal, time taken, and patient compliance during restorations using smart bur and carbide burs in pediatric patients. MATERIAL AND METHODS A clinical study was designed and conducted at the Pedodontics Outpatient Department, with a focus on 40 children between 6 and 12 years old, who were split into 2 groups consisting of 20 children each: group 1, using a carbide conventional rotary bur, and group 2, using a smart bur. Efficiency of caries removal was assessed using the Ericson scale. The Face Leg Activity Cry Consolability (FLACC) and Wong-Baker FACES pain rating scale (WBS) were used to assess the intensity of pain, and the behavior of children was assessed using the Frankel behavior rating scale (FBRS). RESULTS A statistically significant difference (P<0.001) was noted in the time taken for caries excavation and Ericson scale (P=0.04), with higher scores observed in the smart bur group. The smart bur group generally reported lower WBS and FLACC scores than the carbide bur group, during caries excavation, restoration and local anesthesia administration, and this difference was very highly significant (P<0.001). CONCLUSIONS Pain perception among children was lesser and overall satisfaction was higher in smart bur group whereas caries removal efficiency was higher in conventional carbide bur group.

BACKGROUND Swallowing is a complex behavior involving the musculoskeletal system and higher-order brain functions. We investigated the effects of different modalities of repetitive transcranial magnetic stimulation (rTMS) on the unaffected hemisphere and observed correlation between suprahyoid muscle activity and cortical activation in unilateral stroke patients when swallowing saliva, based on functional near-infrared spectroscopy (fNIRS). MATERIAL AND METHODS From November 2022 to March 2023, twenty-five patients with unilateral stroke were screened using computed tomography or magnetic resonance imaging and identified via a video fluoroscopic swallow study. Finally, patients were divided into rTMS (n=10) and iTBS (n=10) groups. Both groups received 2 weeks of stimulation on unaffected suprahyoid motor cortex. Surface electromyographic measured peak amplitude and swallowing time of bilateral suprahyoid muscles, and penetration-aspiration scale was assessed at baseline and after treatment. fNIRS monitored oxyhemoglobin beta values (OBV) in the primary motor, sensory, and bilateral prefrontal cortex (PFC). RESULTS Both groups showed significant improvements in penetration-aspiration scale, peak amplitude, and swallowing time, compared with baseline (P<0.001), and increased OBV in unaffected regions (P<0.05), especially PFC (P<0.001). No significant OBV increases were seen in affected regions (P>0.05). After treatment, OBV in the unaffected PFC was significantly higher than in the unaffected primary sensory and motor cortex regions for both groups (P<0.05). No significant differences were observed between groups in outcome measures (P>0.05). CONCLUSIONS rTMS and iTBS significantly improved swallowing function in unilateral stroke, relying on compensation by the unaffected cortex, particularly the PFC. iTBS may outperform rTMS by shortening treatment sessions and improving efficiency.

BACKGROUND The 6-item Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) is a method for evaluating disease activity in ankylosing spondylitis (AS). This study included 78 patients with active and inactive AS and aimed to evaluate anterior and posterior segment ocular changes. MATERIAL AND METHODS Seventy-eight patients and 70 control subjects were enrolled in this study. All participants underwent a complete ophthalmic evaluation. The patients were subdivided into 2 groups according to their BASDAI scores: the active group (BASDAI³4) (n: 38) and the inactive group (BASDAI<4) (n: 40). RESULTS Endothelial cell density (ECD) and hexagonality (HEX) decreased, while coefficient of variation (CV) and average cell size (AVG) increased significantly in AS patients compared with the control cases (P 0.001). However, there was no statistically significant difference between active and inactive groups related to these parameters. Central corneal thickness (CCT) and corneal volume were significantly lower in AS patients (P 0.001, P 0.04), without any statistically significant difference between active and inactive groups. Tear break-up time (TBUT) and Schirmer test results were lower and the findings of corneal fluorescein staining and ocular surface disease index scores (OSDI) were higher in AS patients compared with the control cases, without any significant differences between the active and inactive groups (P 0.001). Choroidal thickness was significantly higher in all 5 points investigated - subfoveal (P 0.018), 1000 Nasal (N) (P 0.003), 2000 N (P 0.001), 1000 Temporal (T) (P 0.007), and 2000 T (P 0.013)  in AS patients compared with the control group. CONCLUSIONS AS can cause anterior and posterior changes, even in the absence of uveitis. Therefore, more attention should be paid to ocular surgery and follow-up of ocular diseases in AS patients.

BACKGROUND Deep venous thrombosis (DVT) is one of the most common peripheral vascular diseases. AngioJet pharmacomechanical thrombectomy has been widely used to treat DVT. This study evaluated outcomes of patients with DVT after pharmacomechanical thrombectomy and determined potential risk factors associated with prognosis. MATERIAL AND METHODS A retrospective review was conducted to enroll patients with DVT who received AngioJet pharmacomechanical thrombectomy from July 2018 to May 2020. Clinical data and outcome measures, including baseline demographic information, procedure details, adverse events, incidence of post-thrombotic syndrome (PTS), and Villalta scores were collected. The logistic regression modeling began with a univariate analysis to identify factors with statistically significant differences. Multivariate analysis revealed predictive factors of the development of PTS. RESULTS Eighty-nine patients were recruited and divided into 2 groups according to the presence of PTS: 22 patients in the PTS group and 67 patients in the non-PTS group. All cases were technically successful. Total median dosage of thrombolytic agents was 260 million units (range, 160-440 million units) and median duration of hospital stay was 5 days (range, 2-15 days). No major adverse events were observed. Univariate analysis showed statistical significance for all factors tested, except age, sex, and leg varicosities at baseline between the groups. Multivariate logistic regression confirmed that only time from onset to treatment (OR=1.745; 95% CI=1.316-2.315) was associated with incidence of PTS after pharmacomechanical thrombectomy. CONCLUSIONS AngioJet pharmacomechanical thrombectomy is an effective therapeutic approach for DVT. Time from onset to treatment was an independent factor in predicting development of PTS.

BACKGROUND Urinary tract infections (UTIs) are common during pregnancy and can negatively impact maternal and neonatal health. Hypertension in pregnancy is a leading cause of maternal morbidity. UTIs can contribute to hypertension development through mechanisms like inflammation, leading to endothelial dysfunction and impaired placental development. This study aimed to evaluate the association between bacteriuria and hypertension in pregnant women. MATERIAL AND METHODS This multicenter study was conducted at 2 hospitals in Indonesia from 2022 to 2023, including 742 pregnant women who met the inclusion criteria. The women were grouped based on bacteriuria and hypertension status. The bacteriuria-positive group had 322 women, of which 125 had hypertension. The bacteriuria-negative group included 421 women, with 101 having hypertension. Statistical analysis was performed to determine the odds ratio (OR) and prevalence ratio. RESULTS Women with bacteriuria were twice as likely to develop hypertension compared to those without (OR=2.01, 95% CI: 1.47-2.76, P<0.001). In the hypertensive group, 55.3% had bacteriuria compared to 38.1% in the normotensive group. Conversely, women without bacteriuria had a reduced likelihood of developing hypertension (OR=0.5, 95% CI: 0.38-1.02, P<0.001). CONCLUSIONS This study highlights a significant association between bacteriuria and increased hypertension risk in pregnancy. Given that bacteriuria is routinely screened for, it can be a valuable tool for identifying women at higher risk of hypertensive disorders. Monitoring bacteriuria-positive women is recommended to help manage and potentially prevent hypertensive complications during pregnancy.

BACKGROUND Dietary supplements (DS) are increasingly popular worldwide, with 78% of Polish adults reporting their use, and nearly half using them regularly. The wide availability, selection, and affordability contribute to this prevalence. However, misinformation and potential health risks from incorrect usage highlight the importance of health literacy in making informed choices about DS. This study aims to assess the knowledge and practices related to dietary supplement use among Polish patients. MATERIAL AND METHODS A cross-sectional survey was conducted in 2024 on a representative sample of 1,074 Polish adults, excluding healthcare professionals, using the computer-assisted web interview method. The questionnaire assessed respondents' understanding of DS, sources of information, purchasing habits, and consultations with healthcare professionals. RESULTS Most respondents (71.79%) believed they understood what a dietary supplement is. Women and individuals with higher education were more likely to claim understanding (p=0.001, p<0.00001). The Internet was the most common information source (38.64%), followed by mass media and healthcare professionals. Women and older respondents more often consulted doctors and pharmacists (p=0.002, p=0.004). Brick-and-mortar pharmacies were the preferred purchasing location (61.64%), with men more likely to use online pharmacies (p=0.0002). CONCLUSIONS The study indicates high awareness of dietary supplements among Polish adults, with significant differences based on gender and education. Despite the Internet being a major information source, healthcare professionals remain crucial for informed decision-making. Efforts are needed to enhance public health literacy and ensure safe DS use.