Medical Science Monitor最新文献

BACKGROUND This study sought to evaluate the diagnostic performance of the non-invasive fibrosis scores Fibrosis-4 Index (FIB-4) and Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) in predicting liver fibrosis among patients with chronic hepatitis B (CHB) in immune-tolerant, inactive, and gray zone phases. MATERIAL AND METHODS This retrospective cross-sectional study included 230 patients with CHB, as determined by laboratory and clinical criteria, and who underwent liver biopsy. Patients were grouped based on FIB-4 and APRI fibrosis scores of <3 and ≥3. The FIB-4 and APRI scores were calculated, and their diagnostic accuracy was assessed, using receiver operating characteristic (ROC) curve analysis. RESULTS The mean age of the patients was 44.4±12.2 years, and 53.9% were female. A total of 37.4% (86/230) of the patients met the criteria for treatment. Both FIB-4 (1.53±0.90 vs 0.91±0.55, P=0.003) and APRI (0.44±0.23 vs 0.29±0.15, P=0.001) scores were significantly higher in patients with fibrosis score ≥3. The area under the curve (AUC) was 0.70 (cut-off >1.06) for FIB-4 and 0.68 (cut-off >0.38) for APRI. Both scores had a negative predictive value of 87%. The difference between AUC values was not statistically significant (P=0.80). CONCLUSIONS FIB-4 and APRI are helpful non-invasive tools for ruling out advanced fibrosis in CHB patients. However, due to their limited diagnostic power, they should be considered as supportive tools rather than definitive alternatives to liver biopsy.

BACKGROUND The timing of growth plays a crucial role in effective orthodontic treatment planning. This is also true for cervical vertebral maturation (CVM), which does not always align with chronological age (CA). This study evaluated the correlation between indices of CVM and CA in 240 lateral cephalometric radiographs (LCRs) of male and female Yemeni children and adolescents, 8 to 19 years of age. MATERIAL AND METHODS A prospective study of 240 LCRs of 120 males and 120 females aged 8 to 19 years, was conducted from December 2022 to October 2023 using Baccetti's method, with some modifications to CVM. The superior, inferior, posterior, and anterior borders of second, third, and fourth cervical vertebrae were traced to identify the inferior concavity depth and shape of the vertebrae. CVM stages were assessed at 6 different growing times. Pearson correlation coefficient was used, and a P value of <0.05 indicated statistical significance. RESULTS Spearman correlation revealed a statistically significant association between CVM stage and CA (r=0.887; P<0.000). Significant differences between males and females were found in cervical stage (CS) 4 and CS5 (P<0.05). Mean CA at CS4 was 13.18±1.58 years for males and 12.15±1.10 years for females, and the mean CA at CS5 was 16.33±1.29 years for males and 15.23±1.62 years for females. CONCLUSIONS Pubertal growth spurts occurred at 10.25-13.18 years in males and 10.04-12.15 years in females, indicating females achieve maturation earlier than males. This research provides a reliable framework for orthodontic treatment planning.

This publication has been retracted by the Editor due to the identification of non-original figure images and manuscript content that raise concerns regarding the credibility and originality of the study and the manuscript. Reference: Zhongfei Shen, Yun Xu, Xiaohong Jiang, Zhijian Wang, Yanjun Guo, Weiwei Pan, Jie Hou. Avicularin Relieves Depressive-Like Behaviors Induced by Chronic Unpredictable Mild Stress in Mice. Med Sci Monit, 2019; 25: 2777-2784. DOI: 10.12659/MSM.912401.

BACKGROUND Surface electromyography (sEMG) of pelvic floor muscles (PFM) offers insights into neuromuscular control but lacks standardized normative values. This study aimed to evaluate baseline and contractile sEMG signal characteristics - including root mean square (RMS) amplitude in microvolts and normalized to maximum voluntary contraction (%MVC) - in a healthy control (H) group, pelvic floor dyssynergia (DS) group, and urinary incontinence (UI) group. MATERIAL AND METHODS A retrospective analysis included 68 women (H=28, UI=22, DS=18). UI was confirmed by the International Consultation on Incontinence Questionnaire-Short Form, and DS diagnosed via anorectal manometry. sEMG was recorded with a intravaginal probe using the Glazer protocol. RMS and %MVC were analyzed using Bayesian multivariate regression adjusted for age and BMI. RESULTS No significant differences were found at baseline rest or rapid contractions (P>0.05). The DS group showed higher RMS during tonic contractions vs H group (Δ=4.20, 95% BCI [0.99, 7.29], P<0.05) and UI (Δ=3.44, 95% BCI [0.48, 6.20], P<0.05), and impaired post-tonic relaxation vs H group (Δ=1.13, 95% BCI [0.10, 2.15], P<0.05). Normalized to %MVC, DS group showed lower rapid contraction activity than H group (Δ=-10.49, 95% BCI [-19.46, -1.86], P<0.05). H group outperformed UI group in tonic contraction (P<0.05). CONCLUSIONS DS showed higher RMS amplitudes during tonic contractions, impaired relaxation, and reduced %MVC efficiency, indicating paradoxical activity. UI patterns were heterogeneous, highlighting its multifactorial nature. Reliance on raw RMS alone may misclassify dysfunctions; multiparametric assessment and validation in larger cohorts are needed.

BACKGROUND Pathology of the long head of the biceps tendon (LHBT) frequently accompanies rotator cuff tears. Whether concurrent LHBT tenotomy during arthroscopic rotator cuff repair (RCR) adversely affects postoperative shoulder proprioception or upper-limb strength remains uncertain; intra-individual evidence is limited. MATERIAL AND METHODS A prospective intra-individual comparison was conducted at a single center between May 2018 and December 2021. Consecutive adults who underwent arthroscopic RCR with LHBT tenotomy were evaluated at a postoperative visit. Standardized assessments were performed by a single team. Primary outcomes included shoulder joint-position sense, measured by active position reproduction at predefined targets, and maximum isometric strength, measured with a handheld dynamometer. Statistical analysis included normality testing, paired tests, effect sizes, and 95% confidence intervals (CIs) with Holm adjustment. RESULTS Seventy-seven patients were analyzed (mean age 58.1 years; 73% women; 69% right side). Side-to-side differences were small. Representative metrics included elbow flexion Δ=-0.56 (95% CI, -1.05 to -0.06; P=0.028) and shoulder flexion Δ=-0.87 (95% CI, -1.41 to -0.33; P=0.002). Absolute proprioception error at 30° rotation was modestly lower on the operated side (Δ=-2.00°; 95% CI, -3.68° to -0.32°; P=0.020). Other targets showed no clinically meaningful differences. Effect sizes were small. CONCLUSIONS In patients with clinical indications for tenotomy, concurrent LHBT tenotomy during arthroscopic RCR was unrelated to measurable deficits in shoulder proprioception or upper-limb strength. These findings support clinical acceptability of tenotomy when indicated. Comparative studies are warranted to refine patient selection.

BACKGROUND Post-COVID-19 condition (long COVID) is characterized by persistent symptoms following acute infection. Given the limited efficacy of pharmacologic treatments, there is growing interest in complementary, non-contact interventions. Virtual pet-assisted therapy (VAT), a virtual reality-based adaptation of animal-assisted therapy, may offer a novel strategy for symptom management in this population. MATERIAL AND METHODS A prospective intervention was conducted in the long COVID clinic at Juntendo University Hospital between July and December 2023. Adult patients with long COVID engaged with a virtual dog for 10 minutes prior to their clinical consultation. Twelve symptoms considered potentially responsive to short-term intervention were self-rated on a 10-point scale before and after the session, with scores representing mean values. RESULTS Forty-two participants (median age: 46 years; 71.4% female) were included in the analysis. The mean total symptom score decreased by 7.2%, from 34.6 points before the intervention to 32.1 points after (P=0.004). Fatigue scores decreased by 9.5% (from 6.3 to 5.7, P=0.004), dyspnea decreased by 17% (from 2.3 to 1.9, P=0.038), memory impairment decreased by 13% (from 4.8 to 4.2, P=0.015), and tinnitus decreased by 22% (from 2.3 to 1.8, P=0.012). CONCLUSIONS VAT could be a feasible and well-tolerated intervention worth further investigation as a potential adjunct for alleviating key symptoms of long COVID, particularly those with psychological components. Although this preliminary study is limited by the lack of a control group, it serves as a pilot study that demonstrates the potential of VAT.

BACKGROUND Secretory otitis media (SOM), a common otorhinolaryngological disorder, impairs hearing and quality of life. Eustachian tube balloon dilatation (ETBD) is increasingly used, and its combination with tympanic membrane catheterization (TMC) may enhance outcomes. This study compared ETBD alone with ETBD combined with TMC in adult SOM. MATERIAL AND METHODS Ninety patients (110 ears) with SOM were randomized equally into 2 groups between September 2020 and September 2022. The balloon-only group received ETBD, while the balloon plus catheterization group underwent ETBD combined with TMC. Clinical efficacy was defined as symptom resolution, effusion clearance, and hearing recovery. Eustachian tube function was assessed by manometry (R score) and Eustachian Tube Score (ETS). The Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) assessed symptom burden of ear pressure, pain, tinnitus, and muffled hearing. Serum procalcitonin, high-sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6) were measured by ELISA. Hearing thresholds were determined using pure-tone audiometry. Six-month recurrence was defined as the reappearance of effusion or symptoms following tympanic membrane healing, determined by otoscopy, tympanometry, and symptom verification. RESULTS The effective rate was significantly higher in the ETBD combined with TMC group (95.56%) than the ETBD-only group (77.78%, P<0.05). Combination therapy yielded greater improvements in R scores, ETS, ETDQ-7, and hearing thresholds, and greater reductions in procalcitonin, hs-CRP, and IL-6 (all P<0.05). Recurrence was lower (4.44% vs 22.22%, P<0.05), with comparable complication rates (P>0.05). CONCLUSIONS ETBD combined with TMC significantly enhanced ET function, symptom relief, inflammatory control, and hearing recovery while reducing recurrence, supporting its adoption in adult SOM management.

BACKGROUND Maxillofacial fractures represent one of the most common forms of traumatic injuries, affecting both function and aesthetics, and are associated with significant morbidity and long-term sequelae. The incidence and distribution of these fractures vary considerably depending on demographic, socioeconomic, and geographic factors. This retrospective study from a single center aimed to evaluate the presentation, imaging findings, and outcomes in 195 patients with maxillofacial fractures treated with closed reduction or open reduction with internal fixation (ORIF). MATERIAL AND METHODS Clinical and radiographic data from 195 patients were reviewed, including age, sex, etiology, fracture site, and treatment modality. Fractures were managed with ORIF using titanium miniplates and screws, intermaxillary fixation (IMF) with screws and elastics, dental splints for selected pediatric cases, or closed reduction for midfacial fractures. Statistical analysis included chi-square or Fisher's exact tests, with P<0.05 considered significant. RESULTS The most common cause of injury was traffic accidents (63.1%), followed by assaults (19.5%) and falls (17.4%). Mandibular fractures were most frequent, particularly in the parasymphysis (29.2%) and symphysis (24.6%) regions. ORIF was performed in 75.4% of cases, IMF in 23.1%, and splints in 9.7%. Significant associations were found between fracture etiology, sex, and treatment modality (P<0.05). CONCLUSIONS Maxillofacial fractures primarily affect young men and are predominantly caused by traffic accidents. Mandibular fractures, especially in the parasymphysis and symphysis regions, are the most common type, and often require ORIF. These findings emphasize the importance of road safety measures and trauma care resources in regions with limited healthcare access.

BACKGROUND Peripheral intravenous (IV) access is a fundamental pre-hospital procedure performed by emergency medical services (EMS) personnel and remains the primary route for drug administration. Pediatric IV cannulation is often challenging in out-of-hospital settings. The aim of this study was to evaluate the frequency of peripheral intravenous access being established in pre-hospital settings by EMS staff in pediatric patients. MATERIAL AND METHODS This retrospective study analyzed 6331 records of emergency medical services (EMS) dispatches involving patients under 18 years of age between 2020 and 2022. The study protocol included an assessment of cannulation rate depending on the patient's age, case characteristics, ICD 10 (International Classification of Diseases, Tenth Revision) diagnosis and whether the patient required transport to a hospital. RESULTS Peripheral intravenous access was established in 1073 of 6331 pediatric patients (16.94%). The cannulation rate increased significantly with age, from 1.03% in infants (<1 year) to 75.12% in adolescents (12-18 years) (p<0.001). Logistic regression analysis identified age, trauma (OR=1.96), poisoning (OR=3.88), and transfer by Helicopter Emergency Medical Services (HEMS) (OR=5.86) as predictors of IV cannulation (p<0.001). CONCLUSIONS The overall rate of peripheral intravenous access establishment in pediatric patients in pre-hospital settings is relatively low, with the lowest rates observed in children under 1 year of age. Age, trauma, poisoning, and referral to HEMS teams significantly increased the likelihood of cannulation. It is essential to develop evidence-based algorithms and targeted training to support EMS personnel in managing vascular access in critically ill children.

BACKGROUND Schizophrenia is a heterogeneous disorder characterized by varying degrees of positive and negative symptoms. Rather than relying on outdated categorical subtypes, current research emphasizes dimensional approaches. This study aimed to investigate differences in prefrontal cortex activation between patients with predominantly positive symptom schizophrenia (PSZ) and predominantly negative symptom schizophrenia (NSZ), as defined by the Positive and Negative Syndrome Scale (PANSS)-derived Bipolar Index (PBI). MATERIAL AND METHODS A total of 36 patients with PSZ (PBI>0) and 35 patients with NSZ (PBI<0) were recruited. All patients underwent functional near-infrared spectroscopy (fNIRS) measurements during the verbal fluency task. Hemodynamic changes in the prefrontal cortex were analyzed using a general linear model. The relationship between ß values of specific channels and Brief Psychiatric Rating Scale factor scores was examined. RESULTS The results showed no significant differences in hemodynamic responses between the PSZ and NSZ groups in the different regions of interest. However, channels Ch21 and Ch51 (involving the frontal pole, orbitofrontal cortex, and triangular part of Broca's area) exhibited significant activation differences between the 2 groups after false discovery rate correction. Additionally, the ß value of channel Ch51 was negatively correlated with the activators of the Brief Psychiatric Rating Scale (r=-0.292, P=0.022). CONCLUSIONS This study highlights distinct patterns of prefrontal cortex activation between patients with PSZ and NSZ, particularly in specific channels. These findings support a dimensional approach to schizophrenia heterogeneity and suggest that fNIRS-derived neurobiological markers can inform symptom-specific interventions.