Medical Science Monitor最新文献

BACKGROUND Solitary thyroid nodules present a challenge in differentiating between benign and malignant conditions using ultrasound (US). Arrival time parameter imaging (At-PI) following contrast-enhanced ultrasound (CEUS) can effectively visualize the vascular architectural patterns of the nodules, providing valuable diagnostic information. This study aimed to explore the application value of At-PI in differentiating thyroid nodules, specifically focusing on a sample of 127 cases. MATERIAL AND METHODS From October 2020 to December 2023, 127 thyroid nodules from 108 patients who underwent ultrasound and CEUS examinations at the General Hospital of Northern Theater Command were reviewed. Pathological outcomes served as the criterion standard, categorizing the nodules into a benign group (44 cases) and a malignant group (83 cases). At-PI was employed to analyze the CEUS videos, allowing for a comparison of parameters between the 2 groups. Additionally, the diagnostic performance of 2 quantitative parameters was assessed using receiver operating characteristic (ROC) curves. RESULTS After conducting the chi-square test, the differences between the 2 groups regarding enhancement time, perfusion pattern, and perfusion defect were found to be statistically significant (P<0.05). There was a significant difference between the 2 groups over the time span (ΔT) (P<0.05). The areas under the curve (AUCs) for ΔT₄₋₃ and ΔT₆₋₅ were 0.715 (95% CI: 0.624-0.805) and 0.763 (95% CI: 0.676-0.851). CONCLUSIONS At-PI can offer more effective parameters for differentiating thyroid nodules. Additionally, some of these parameters exhibit notable diagnostic performance in the detection of thyroid cancer.

BACKGROUND Effective assessment and diagnosis using simple nutritional screening tools are crucial for identifying malnutrition in older adults. The aim of the study was to evaluate how effectively different anthropometric parameters, indices, and body composition metrics can assess nutrition-related risks, using the Geriatric Nutritional Risk Index (GNRI) in a cohort of 185 patients >60 years. MATERIAL AND METHODS This study included 185 patients over 60 years old. Anthropometric measurements, indices, and body composition were examined. Nutritional status based on GNRI was categorized as major risk (1.1%), moderate risk (9.7%), low risk (15.1%), and no risk (74.1%). RESULTS The strongest correlations with the GNRI were observed for body mass index (BMI) (ρ=0.8628) and body fat in kilograms (ρ=0.8269), P<0.001. A unit increase in BMI decreased the odds of being in the risk group by 52.1% (OR 0.479; 95% CI 0.377-0.609; P<0.001). ROC analysis showed BMI ≤25.0 had the highest predictive value (AUC 0.93, 95% CI 0.89-0.97) in assessing nutrition-related risk in the elderly. Body fat (AUC 0.89, 95% CI 0.85-0.94), abdominal volume index (AUC 0.86, 95% CI 0.80-0.91), hip circumference (AUC 0.85, 95% CI 0.79-0.91), and waist circumference (AUC 0.85, 95% CI 0.80-0.91) also demonstrated significant predictive power (P<0.001). CONCLUSIONS Our study underscores the importance of using BMI and other related anthropometric measures and indices as part of routine assessments to identify and manage nutrition-related risks among elderly individuals in hospitals, care facilities, and dietetic clinics, particularly in situations where standardized tools for assessing malnutrition are not available or are impossible to use.

BACKGROUND High-energy injuries, like car accidents, can cause thoracolumbar burst fractures, leading to spinal instability and cord compression. Anterior decompression with stabilization provides strong support, kyphosis correction, and bone fusion. This study evaluated long-term outcomes of using a nano-hydroxyapatite/polyamide 66 strut in 38 thoracolumbar fracture cases. MATERIAL AND METHODS Between December 2005 and December 2006, 38 patients underwent the introduced surgery of anterior-oblique approach, decompression, and interbody fusion, using n-HA/PA66 struts. The patients were followed up (FU) for at least 5 years. The neurological function was assessed by American Spinal Injury Association (ASIA) grades, the pain was evaluated by Visual Analogue Scale (VAS) score, the life quality was assessed by Oswestry Disability Index (ODI), and the radiographic results were assessed by X-ray and 3-dimensional computed tomography. RESULTS Twenty patients reached the final FU with a mean of 12.50±1.19 years. The mean surgical bleeding, surgical time, and hospitalization time were 633.50±169.0 mL, 183.30±25.41 min, and 18.35±3.05 days, respectively. VAS and ODI of preoperation had a significant difference between 1-year FU and final FU (P<0.05). At the final FU, the patients of ASIA B, C, and D recovered to E. All patients fused with a mean of 4.10±1.21months. Cobb angle and percentage of vertebral body height loss of preoperation had a significant difference between before surgery, at 1-year FU, and at final FU (P<0.05). CONCLUSIONS Long-term results of clinical and radiographic assessment of the n-HA/PA66 strut in treating thoracolumbar burst fractures could achieve satisfactory solid anterior support, effective restoration of intervertebral height, and good maintenance of thoracolumbar alignment.

BACKGROUND Patient monitoring systems (PMSs) are essential for monitoring and managing the condition of critically ill patients. In low-resource settings, limited access to technology, low-level digital literacy, and power outage challenges are usability concerns. The main aim of this study was to evaluate the usability of the IMPALA (Innovative Monitoring in Paediatrics in Low-resource settings: an Aid to save lives) PMS optimized for use in low-resource settings by assessing the opinions and experiences of 24 healthcare professionals. MATERIAL AND METHODS The study used a mixed-method design, combining quantitative and qualitative approaches. Quantitatively, 24 participants (nurses and clinicians) completed the Usefulness, Satisfaction, and Ease of Use questionnaire to assess the PMS usability. Qualitatively, contextual inquiry and co-design sessions provided insights into users' experiences and identified usability issues. Data were analyzed using descriptive statistics and thematic analysis. RESULTS The PMS was rated 9.13 for usefulness, 8.49 for user satisfaction, 7.83 for ease of use, and 7.60 for ease of learning. Reported challenges included lack of knowledge/skills due to limited previous exposure (70.8%), frequent sensor detachment (58.3%), inaccurate SpO₂ readings (37.5%), and frequent/false alarms (33.3%). Contextual inquiry revealed that patient movement and poorly fitting sensors often caused inaccurate readings, leading to false alarms and potential patient safety risks. CONCLUSIONS Successful implementation of PMSs in a low-resource setting requires specific contextual user-centered design and training. Applying this, the IMPALA system yielded high usability scores. Further improvement should focus on expanded battery life, robust and durable SpO₂ sensors, and tailored training methods.

Polycystic ovary syndrome (PCOS) is associated with several mild metabolic disorders, including insulin resistance (IR), obesity, and dyslipidemia, as well as with some more severe ones, including type 2 diabetes mellitus, non-alcoholic fatty liver disease (NAFLD), and cardiovascular disease. Clinically, mild metabolic complications of PCOS such as IR or lipid metabolism disorders are the predictors of these more severe ones. So far, there is no reliable single marker that enables defining metabolic risk in patients with PCOS. Therefore, novel independent markers of metabolic disturbances are needed. Most reports have focused on microRNA (miRNA, miR) assessment in blood serum or granulosa cells, suggesting the high potential clinical utility of such management. The greatest number of studies focused on the association between miRNAs and IR, obesity, or lipid disorders, and some miRNAs were characteristics of all these processes concomitantly. The altered expression of miR-222, miR-223, miR-320, and miR-122 has been most commonly mentioned as the regulator of these metabolic distortions and seems to result from common regulation pathways of metabolic disturbances. In turn, the current literature lacked the miRNA which could be identified as a reliable marker of type 2 diabetes mellitus or NAFLD accompanying PCOS. Therefore, the main objective of future studies should be determining miRNA markers of these most serious metabolic complications. This article aims to review the role of microRNAs as biomarkers for metabolic disorders in PCOS.

BACKGROUND Subchorionic hematoma (SCH) can lead to blood accumulation and potentially affect pregnancy outcomes. Despite being a relatively common finding in early pregnancy, the effects of SCH on pregnancy outcomes such as miscarriage, stillbirth, and preterm birth remain debated. This study aims to address these gaps by systematically evaluating the influence of SCH-related clinical factors on pregnancy outcomes using robust analytical techniques. MATERIAL AND METHODS Data from SCH and non-SCH pregnant women were collected and split into training and test datasets. Machine learning classifiers and regression models were used to assess the impact of clinical indices on outcomes such as delivery type, NICU transfer, gestational age, and birth weight. Results were evaluated using ROC and calibration plots. RESULTS (1) SCH women had a significantly higher risk of stillbirth or miscarriage than non-SCH women (P<0.001). Logistic regression and XGB models showed AUCs of 0.858 and 0.916, respectively. Key factors affecting delivery outcomes included the first positive HCG level, hematoma duration, CA125 level, gestational sac diameter, fibrinogen level, and spouse age. (2) 12.7% of successfully delivered SCH newborns required NICU transfer, but clinical indices did not predict NICU need (AUC 0.589 and 0.629). (3) Successfully delivered SCH women had longer gestational ages than those with miscarriage/stillbirth (38.8 vs 10.1 weeks), but indices did not predict preterm/full-term birth (AUCs 0.449 and 0.503). (4) Birth weight was significantly affected by live birth times and gestational age (P<0.05), though the adjusted R-square was 0.226. CONCLUSIONS (1) SCH increases miscarriage or stillbirth risk. (2) the first positive HCG level, the hematoma duration, serum CA125 level, the gestational sac maximum diameter, fibrinogen, and the spouse age highly impacted the delivery outcome. (3) SCH indices do not affect NICU transfer or birth weight. (4) Miscarriage/stillbirth mainly occurs in the first trimester; passing this stage often leads to successful delivery. (5) The birth weight of full-term newborns is significantly higher than that of preterm infants. The clinical indices of SCH pregnant women have no impact on the birth weight of the newborn.

This study included 107 patients with peripheral arterial disease (PAD) undergoing revascularization and aimed to evaluate the effects of body mass index (BMI) on outcomes of quality of life (intermittent claudication questionnaire - ICQ), pain-free walking distance (PFWD), and maximum claudication distance (MCD). The study included 107 patients aged 18-80 years with PAD undergoing revascularization (average age 66±6.7 years; 82% men and 18% women, average BMI 28.02±4.35). The diagnosis of PAD was made based on medical opinion and an ankle-brachial index (ABI) value of <0.9. Methods used were BMI assessment, PFWD and MCD distances assessment (treadmill test using the Gardner-Skinner protocol), and quality of life assessment (ICQ). The examination was performed twice - at 1-5 days before the planned revascularization (classical surgery, angioplasty, or hybrid) and 3 months after the procedure. A statistically significant correlation was demonstrated between the improvement of PFWD, MCD, ICQ, and patients' BMI (P<0.01). The worst results were achieved by patients with II-degree obesity (PFWD improvement by an average 10.33±0.87, MCD of 21.67±3.25, ICQ of 14.01±0.60), while the best results were obtained by those with normal body weight (PFWD improvement by an average of 52.57±2.42, MCD of 137.20±22.30, ICQ of 21.18±0.54). Patients with a higher BMI have worse PFWD and MCD distances and quality of life 3 months after revascularization, which indicates the need to consider obesity when planning therapy. Further studies are needed to better understand the impact of BMI on the effectiveness of treatment and rehabilitation of patients with PAD.

BACKGROUND Dual antiplatelet therapy is the main treatment for cardiovascular diseases (CADs). In this study, we evaluated the efficacy and safety of aspirin combined with low-dose rivaroxaban in the secondary prevention of high-risk ischemic cardiovascular diseases. MATERIAL AND METHODS In total, 168 patients who were diagnosed with acute myocardial infarction or multiple vessel disease 1 year after percutaneous coronary intervention were divided into 2 groups: the aspirin group (aspirin as acetylsalicylic acid: 100 mg once daily) and the aspirin + rivaroxaban group (aspirin: 100 mg once daily, rivaroxaban: 2.5 mg twice daily). The patients were followed up for 2 years to assess the clinical efficacy and safety of a new dual-channel antithrombotic treatment strategy. RESULTS The occurrence of MACE (recurrent myocardial infarction, in-stent restenosis, coronary target vessel revascularization, stent thrombosis, heart failure, rehospitalization, and all-cause mortality) in the rivaroxaban + aspirin group was lower than that in the aspirin group (3.57% of patients received aspirin + rivaroxaban treatment vs 13.10% of patients received aspirin treatment). There were not more adverse events in the rivaroxaban + aspirin group than in the aspirin group. Compared with patients administered aspirin, the coagulation function of patients taking aspirin + rivaroxaban was significantly changed. No heart failure occurred in either group of patients with CADs. CONCLUSIONS Aspirin + rivaroxaban had better primary outcome and secondary outcomes in patients with a high risk of ischemia. Our results provide a basis for evaluating the efficacy and safety of drugs used in secondary prevention among patients with high risk of ischemia.

BACKGROUND This retrospective study from a single center included 289 patients diagnosed with advanced non-small cell lung cancer (NSCLC) between 2010 to 2017 and aimed to evaluate the effects of body mass index (BMI) on overall survival. MATERIAL AND METHODS This retrospective study involved 289 patients diagnosed with metastatic-stage NSCLC at a single institution between January 2010 and December 2017. Patients were categorized into 2 groups based on their BMI at diagnosis: those with a BMI <25 kg/m² and those with a BMI ≥25 kg/m². Univariate and multivariate Cox regression analyses were conducted to identify factors associated with overall survival. RESULTS A total of 289 patients (241 men, 48 women) were included in the study, with a mean age of 60.1±11.1 years. Among them, 175 patients (60.6%) had a BMI less than 25 kg/m². Multivariate analysis revealed that BMI, pathological diagnosis, and complete response after first-line treatment were independently associated with survival in patients with lung cancer. Predicted survival time was significantly shorter in the BMI <25 group than in the BMI ≥25 group (9.3 months vs 13.0 months, P<0.05). CONCLUSIONS The study demonstrated that a higher BMI at the time of diagnosis is associated with improved overall survival in patients with de novo metastatic NSCLC. BMI may serve as an important prognostic factor in this patient population. Future prospective, multi-center studies are necessary to further validate the role of BMI in predicting survival outcomes in NSCLC patients across different treatment modalities.

BACKGROUND Stress-induced health disorders are related to an unhealthy lifestyle. This study aimed to investigate the prevalence of perceived stress among medical students and to correlate their respective stress levels with the caries index: decayed, missing, filled surfaces (DMFS). MATERIAL AND METHODS This study included 290 undergraduate medical students (140 men, 150 women) from 4 different grades. Demographic characteristics and perceived stress scale (PSS) were measured using a pre-validated scaled questionnaire. The DMFS for each individual was measured intraorally. Continuous variables were expressed as means, and categorical variables as frequencies. Using Pearson correlation, the types and strengths of the relationships between stress levels and DMFS scores were determined (positive, negative, linear, nonlinear). All differences were considered significant at a P value of less than 0.01 (P<0.01). RESULTS A higher percentage of participants had moderate stress (73.8%), with higher PSS scores among female participants (m=21.52) than male participants (m=20.43). Participants with higher stress scores (27 to 40) had very high DMFS scores (4.5 to 6.5). Age had a negative association with stress (r=-0.072, P=0.219) and DMFS (r=-0.023, P=0.695) scores. No significant differences in scores indicated no significant linear link between the variables. A significantly positive linear correlation was observed between stress and DMFS scores (r=0.41, P=0.000), although the correlation was weak. CONCLUSIONS Undergraduate medical students perceive stress during their training. Level of stress was associated with severity of dental caries.