Medical Science Monitor最新文献

BACKGROUND Breast density and stiffness are imaging biomarkers that reflect tissue composition. Magnetic resonance elastography (MRE) quantifies tissue stiffness, whereas computed tomography (CT) attenuation in Hounsfield units (HU) shows parenchymal density. This study evaluated the relationship between MRE stiffness and CT attenuation in normal breast tissues. MATERIAL AND METHODS In this single-center study, 48 women (aged 29-56 years) who underwent breast magnetic resonance imaging (MRI) with routine 3T MRE and non-contrast chest CT within ±1 month were included. MRE was performed using a 3T scanner with a 19-cm internal pneumatic driver. The corresponding CT attenuation values were measured from the matched parenchymal regions. Correlation, regression, and tissue-specific reference analyses were performed. RESULTS MRE stiffness correlated strongly with CT attenuation (r=0.834, P<0.001). The regression model (kPa=2.402+0.009·HU+0.005·Age) explained 70.1% of the stiffness variance. Fibroglandular tissue showed higher stiffness (2.95±0.43 kPa) and HU (34.6±10.8) than fatty tissue (1.85±0.32 kPa and -89.7±17.3 HU, respectively; P<0.001).The reference stiffness ranges were 2.17-3.77 kPa for fibroglandular and 1.30-2.44 kPa for fatty parenchyma. CONCLUSIONS Breast parenchymal stiffness measured using 3T MRE correlates closely with CT attenuation, confirming that both parameters reflect complementary aspects of tissue density. These findings support MRE as a reliable non-invasive biomarker for quantitative breast tissue characterization.

BACKGROUND Unilateral biportal endoscopy (UBE) is a novel surgical treatment for lumbar disc herniation (LDH). Some patients experience persistent residual low back pain (rLBP) after surgery. We aimed to identify risk factors for rLBP after UBE. MATERIAL AND METHODS This retrospective study analyzed 203 patients with LDH who underwent UBE in our department between January 2020 and August 2024. Inclusion criteria were a diagnosis of LDH treated by UBE and at least 1 year of follow-up. Exclusion criteria were severe spinal infection, previous spinal surgery, severe systemic disease, or incomplete follow-up data. Two groups were established based on visual analog scale scores at 1 year postoperatively: rLBP (score ≥3) and non-rLBP (score <3). Demographic characteristics, clinical outcomes, and imaging features were compared between groups. Logistic regression analyses were performed to identify rLBP risk factors. RESULTS There were 44 patients in the rLBP group (mean age, 52.59 years; ~43.2% women) and 159 patients in the non-rLBP group (mean age, 49.66 years; ~55.3% women). Postoperative rLBP was observed in 21.7% (44/203) of patients. Multivariate logistic regression analysis identified severe preoperative low back pain (P<0.001), high-grade facet joint osteoarthritis (FJOA) (P=0.005), and Modic type 1 changes (P=0.04) as independent risk factors for postoperative rLBP. CONCLUSIONS In patients with LDH, severe preoperative low back pain, high-grade FJOA, and Modic type 1 changes are predictive factors for rLBP after UBE. These parameters may be useful indicators for surgical decision-making and providing targeted treatment in high-risk populations.

BACKGROUND Low back pain (LBP) is a leading cause of disability worldwide, yet the relationship between muscle morphology, strength imbalances, and chronic LBP remains incompletely understood. This study investigated cross-sectional area (CSA) and strength differences in trunk and hip muscles between chronic LBP patients and healthy controls. MATERIAL AND METHODS Fifty patients with chronic LBP (age 53±13.5) and 30 (age 42.3±8.3) healthy controls underwent lumbosacral magnetic resonance imaging to measure CSA of paravertebral (psoas major, quadratus lumborum, erector spinae, multifidus), abdominal (rectus abdominis), and hip muscles (iliacus, gluteus maximus). Isokinetic dynamometry assessed trunk and hip flexor/extensor strength. Statistical analyses included t tests confirmed with Cohen's d and Pearson correlations. RESULTS Patients with LBP showed smaller psoas major CSA at L2/L5 and rectus abdominis CSA at S2/S3 than controls (all P<0.05), with no differences in quadratus lumborum, erector spinae, multifidus, iliacus, or gluteus maximus. Trunk flexor and extensor strength was lower in LBP patients, with a reduced trunk flexor/trunk extensor ratio (0.77±0.20 vs 0.96±0.16, P<0.001); hip flexor/extensor ratios showed a trend toward imbalance (left hip flexor/hip extensor: 0.60±0.15 vs 0.67±0.12, P=0.047). CSA-strength correlations were stronger in patients with LBP, particularly for the psoas major (r=0.42-0.58, P<0.05). CONCLUSIONS Chronic LBP is associated with selective atrophy of the psoas major and rectus abdominis, alongside significant strength deficits in trunk and hip flexors. CSA-strength correlations in LBP patients suggest morphological changes exacerbate functional imbalances, contributing to LBP pathophysiology. These findings highlight the importance of targeted rehabilitation addressing trunk and hip musculature to restore strength symmetry and mitigate disability.

BACKGROUND We analyzed the epidemiological traits and risk factors of severe scrub typhus cases in Dali, China, to form a theoretical basis for local prevention and control. MATERIAL AND METHODS We analyzed the epidemiological characteristics of patients with scrub typhus admitted to our hospital from January 1, 2015, to December 31, 2024. Based on the severity of scrub typhus, the patients were divided into a severe scrub typhus group (n=89) and mild scrub typhus group (n=370). Logistic regression analysis was used to identify the risk factors for severe scrub typhus. RESULTS This study included 459 patients with scrub typhus in the Dali region (191 males and 268 females), with the peak incidence concentrated from July to October. Multivariate logistic regression analysis demonstrated that a blood urea nitrogen level over 7.3 mmol/L (P=0.040, OR=1.12), platelet count of 71×10⁹/L or lower (P=0.036, OR=0.98), and concurrent liver injury (P=0.033, OR=2.70) were risk factors for the progression to severe scrub typhus. When these 3 factors were combined, the area under the receiver operating characteristic curve reached a maximum value of 0.81 (95% CI: 0.75-0.86). CONCLUSIONS Scrub typhus in the Dali region occurs predominantly from July to October, with a higher prevalence among female patients in rural areas. Patients with blood urea nitrogen level over 7.3 mmol/L, platelet count of 71×10⁹/L or lower, and concurrent liver injury are at an increased risk of progressing to a severe condition.

BACKGROUND The incidence of fragility hip fractures (FHF) is increasing in older adults, and delirium often follows physical stress such as FHF. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the reference standard for diagnosing delirium in Thailand but requires specialized expertise. The Delirium Diagnostic Tool-Provisional (DDT-Pro) - a reliable and valid alternative that does not require specialist training - has not been evaluated in older Thai patients with FHF. This study aimed to translate and cross-culturally adapt the DDT-Pro to create a Thai version (DDT-Pro-TH), then determine its validity and reliability. MATERIAL AND METHODS A multidisciplinary team of nonpsychiatrists (orthopedists, geriatricians, anesthesiologists, physiatrists) and 2 DDT-Pro psychiatry experts performed forward and backward translation. Patients with FHF were informed about and consented to participation in this cross-sectional validation study. The DDT-Pro-TH and DSM-5 were independently utilized for delirium assessment before surgery and on postoperative days 1 and 2. Delirium diagnosed by DSM-5 served as the reference standard; DDT-Pro-TH positivity was defined as a score of 6 or lower. Validity was assessed with the area under the curve (AUC); reliability was measured using Cronbach's alpha and Cohen's kappa statistics. RESULTS One hundred ten patients with FHF participated. Internal consistency reliability (Cronbach's alpha) was 0.819 (95% CI, 0.783-0.851). Inter-rater reliability (Cohen's kappa) was 0.974 (95% CI, 0.962-0.982). Concurrent validity (AUC vs Thai DSM-5) was 0.959 (95% CI, 0.903-0.987). CONCLUSIONS The Thai version of the DDT-Pro is a highly reliable and valid instrument for diagnosing delirium in older patients with FHF.

Visceral pain is often refractory and debilitating. Effective therapy for visceral pain remains undetermined or even elusive. Recently, dexmedetomidine (DEX) has been found to be promising as an adjuvant in relieving visceral pain. DEX, a highly selective alpha-2 adrenoreceptor agonist, is increasingly used during the perioperative period. DEX induces sedation, analgesia, anxiolysis, sympathetic tone inhibition, and intestinal barrier protection. It has shown favorable analgesic effects in clinical and animal studies and is a useful adjuvant treatment for visceral pain. It can be delivered via intravenous injections, intraspinal administration, intraperitoneal spraying, or other routes, and it exerts antinociceptive effects on visceral pain. This article reviews the mechanisms, dose, and modes of administration of dexmedetomidine in managing visceral pain associated with surgery. Moreover, we highlight the clinical evidence of DEX on visceral pain therapy in recent years. We also address the various protocols and routes for using DEX in the treatment of visceral pain, aiming to provide a foundation and direction for clinical practice and basic research.

BACKGROUND Malnutrition is a serious concern in patients with liver cirrhosis that is complicated by acute variceal bleeding due to portal hypertension. The Controlling Nutritional Status (CONUT) score is a screening tool used to evaluate altered nutritional status and predict adverse outcomes in patient populations. This study aimed to assess nutritional status using the CONUT score in 151 patients with cirrhosis and esophageal-gastric variceal bleeding (EVB). MATERIAL AND METHODS Clinical data from 151 patients with cirrhotic EVB admitted between January 2023 and October 2024 were analyzed. Nutritional status was assessed using the CONUT score. General linear model analysis was used to explore associations between nutritional, coagulation, and inflammatory indices. RESULTS Based on CONUT scores, 2.6% (n=4) of patients had normal nutrition, 15.9% (n=24) had mild malnutrition, and 81.5% (n=123) had moderate-to-severe malnutrition. Patients showed significant coagulation impairment, including prolonged prothrombin time (PT) and international normalized ratio (INR), reduced prothrombin activity (PTA), and elevated D-dimer (all P<0.05). Inflammatory markers, including interleukin-6 (IL-6), were also significantly elevated (P<0.05). CONUT scores were positively correlated with PT (rs=0.508, P<0.05), INR (rs=0.515, P<0.05), and IL-6 (rs=0.211, P<0.05) and negatively correlated with PTA (rs=-0.432, P<0.05). General linear model analysis identified PT (OR=1.214), INR (OR=0.172), D-dimer (OR=3.460), and IL-6 (OR=1.439) as independent risk factors for malnutrition (all P<0.05). CONCLUSIONS Moderate-to-severe malnutrition is highly prevalent in patients with cirrhotic EVB and is independently associated with coagulation dysfunction and systemic inflammation. These findings highlight the need for strengthened nutritional monitoring and individualized interventions to improve patient prognosis.

BACKGROUND Acute mesenteric ischemia (AMI) still has high mortality rates despite improvements in diagnosis and treatment. The aim of the present study was to determine the factors affecting mortality and the role of laboratory findings in predicting mortality in patients with an AMI diagnosis who were followed up and treated in our clinic. MATERIAL AND METHODS The study included 46 patients diagnosed with AMI between 2011 and 2019. Patients' data were examined retrospectively. The patients who died and those who were alive were compared. To determine the risk factors for mortality, we examined age, sex, accompanying diseases, clinical features, American Society of Anesthesiologists (ASA) classification, laboratory and radiological findings, symptoms, time delay laparotomy, surgical procedure used, and the etiology of the ischemia. RESULTS Mortality rates were significantly associated with the etiology, ASA classification, and resected intestinal area (P<0.001, P=0.031, and P=0.024, respectively). Mortality rates were significantly higher in the patients who had comorbid diabetes mellitus, cerebrovascular disease, and chronic renal failure (P=0.012, P=0.05, and P=0.05, respectively). Creatinine, urea, lymphocyte-monocyte ratio (LMR), and hemoglobin-albumin-lymphocyte-platelet (HALP) values were significantly different between alive and dead patient groups (P<0.001, P<0.001, P=0.011, and P=0.029, respectively). No significant differences were found for other parameters. CONCLUSIONS Etiology, ASA classification, larger resection area, some accompanying diseases, and the time from diagnosis to surgery appeared to be risk factors for mortality. In addition, high urea, creatinine, low LMR, and low HALP score were associated with mortality.

BACKGROUND Postoperative pain following total knee arthroplasty (TKA) is a substantial clinical challenge, often complicating recovery. Electroacupuncture (EA) has garnered interest as a potential intervention, yet its definitive efficacy and safety profile in the context of TKA remain subjects of ongoing academic debate, necessitating a systematic synthesis of existing evidence. MATERIAL AND METHODS This meta-analysis systematically evaluated the impact of EA on post-TKA pain. A comprehensive literature search was conducted across 8 databases up to July 20, 2025. Statistical analysis of included randomized controlled trials (RCTs) was performed using Review Manager 5.3.0. Sixteen RCTs involving 1142 patients were ultimately included, assessing pain scores, biochemical markers, rescue analgesic use, and adverse events. RESULTS The analysis demonstrated that EA significantly reduced resting pain on postoperative days 1, 3, and 7, and movement-related pain throughout the first postoperative week (all P<0.00001). EA also significantly increased ß-endorphin levels and decreased prostaglandin E2 levels (P<0.00001). Furthermore, EA application led to a reduction in rescue analgesic requirements (RR=0.46, P=0.01) and a lower incidence of adverse events (RR=0.45, P=0.002). The certainty of the evidence for these outcomes ranged from moderate to very low. CONCLUSIONS This meta-analysis provides supportive evidence that EA can be an effective and safe adjunctive therapy for mitigating pain and reducing analgesic reliance after TKA, particularly during the initial postoperative week. However, the conclusions are tempered by the limited quality of some included studies, underscoring the necessity for further rigorously designed, high-quality RCTs to fortify these findings.

BACKGROUND Prolonged pre-procedural fasting before percutaneous tracheostomy is traditionally practiced to reduce aspiration pneumonia risk in critically ill patients; however, its clinical impact remains unclear. This study primarily evaluated the effect of fasting duration on aspiration pneumonia and secondarily assessed respiratory, nutritional, and clinical outcomes. MATERIAL AND METHODS This single-center retrospective observational study included 222 adult intensive care unit (ICU) patients who underwent percutaneous tracheostomy with enteral nutrition. Patients were grouped by fasting duration (<1 h, 1-4 h, 5-12 h, >12 h). Clinical, respiratory, nutritional, and outcome variables were analyzed. RESULTS The incidence of aspiration pneumonia ranged from 40.2% to 54.5%, with no significant differences between fasting groups (P=0.421). Patients fasting >12 hours had higher mechanical ventilation FiO₂ requirements 48 hours after tracheostomy compared with those fasting <1 hour (47.7% vs 39.1%; P=0.001). The time to reach caloric targets was substantially longer in the prolonged-fasting group (33.5±24.4 vs 2.4±9.0 hours; P<0.001). No significant differences were observed in ICU stay, hospital stay, or mortality. CONCLUSIONS Prolonged pre-tracheostomy fasting did not reduce the incidence of aspiration pneumonia but was associated with increased oxygen requirements and delayed nutritional recovery. Avoiding unnecessary interruptions of enteral nutrition and using shorter, individualized fasting strategies may optimize outcomes in critically ill patients. These findings indicate that routinely applied prolonged fasting durations offer no clinical benefit and may adversely affect metabolic and respiratory stability in this patient population.