Medical Science Monitor最新文献

BACKGROUND The choice of prosthetic valve for surgical mitral valve replacement (SMVR) remains a clinical challenge, particularly in balancing long-term survival with anticoagulation risk and prosthesis durability. In Taiwan, newer-generation tissue valves were introduced in recent years, providing additional options for patients and clinicians. MATERIAL AND METHODS We conducted a nationwide, retrospective cohort study using Taiwan's National Health Insurance Research Database from 2000 to 2017. Adult patients who underwent SMVR were categorized based on the prosthesis type: mechanical valve (MV), porcine bioprosthetic valve (PV), or newer-generation durable-tissue valve (DV). Propensity-score matching (PSM) was applied to minimize baseline differences. Outcomes analyzed included all-cause mortality, index hospitalization cost, length of hospital stay, and re-operation rates within 3 years. RESULTS Among 10 406 patients (5301 MV, 4300 PV, 805 DV), the DV group was older than in the MV group but younger and healthier than in the PV group. After PSM, DV was associated with significantly lower all-cause mortality compared to PV (HR: 0.61; 95% CI: 0.50-0.74; P<0.001) and MV (HR: 0.72; 95% CI: 0.60-0.88; P=0.002). Hospitalization costs and length of stay were highest for PV, moderate for DV, and lowest for MV. Within 3 years, DV showed the lowest re-operation rate (0.75%) compared to MV (1.96%; OR: 2.66, 95% CI: 1.17-6.09) and PV (3.21%; OR: 4.42, 95% CI: 1.94-10.03). CONCLUSIONS In this retrospective cohort, newer durable-tissue valves were associated with favorable early survival, lower short-term re-operation rates, and moderate hospitalization costs compared to older prostheses. However, the limited follow-up, potential confounding, heterogeneity of valve models, and era-related improvements in care preclude definitive conclusions about long-term durability or superiority. These real-world findings highlight the need for individualized prosthesis selection and longer-term prospective studies to confirm these observations.

Arthropod-borne viruses (arboviruses) are RNA viruses that depend on transmission to humans and other vertebrates through the bites of infected mosquitoes, ticks, and sand flies. On March 31, 2022, the World Health Organization (WHO) Global Arbovirus Initiative identified the need for risk mapping as a crucial source of evidence for arbovirus disease surveillance and provided updated recommendations to improve current management. On May 20, 2025, the 78th World Health Assembly of the WHO adopted the Pandemic Agreement to highlight the importance of pandemic preparedness. The arbovirus diseases dengue, chikungunya, Zika, and yellow fever have been identified as an escalating global threat in urbanized areas, as indicated by new global risk maps for Aedes-borne arboviruses. On July 4, 2025, the WHO published its first global guidelines for managing infections by the four most significant arboviruses: dengue virus, chikungunya virus, Zika virus, and yellow fever virus. This article aims to review the changing global distribution of arbovirus transmission, the increased risk to human health from arbovirus diseases, and the potential for both epidemics and future pandemics, which have led to recent WHO recommendations and warrant the inclusion of arbovirus diseases as candidates for Disease X.

BACKGROUND Percutaneous kyphoplasty and vertebroplasty are the most commonly used minimally invasive procedures for Kümmell disease. However, they are not always effective in treating Kümmell disease with segmental instability. This study aimed to evaluate the efficacy of short-segment bone cement-augmented pedicle screw fixation combined with bone grafting in the treatment of Kümmell disease with segmental instability. MATERIAL AND METHODS The study included 23 patients treated with short-segment bone cement-augmented pedicle screw fixation combined with bone grafting between January 2021 and January 2024. The Oswestry Disability Index (ODI), visual analog scale (VAS) score, vertebral anterior height, and kyphotic Cobb angle were evaluated. The operation time, hospital stay, intraoperative blood loss, and complications were recorded. RESULTS The VAS scores, ODI scores, vertebral anterior height, and kyphotic Cobb angles showed statistically significant differences between before and 1 week after surgery and between before surgery and at final follow-up (P<0.05). VAS and ODI at the final follow-up were lower than those measured 1 week postoperatively (P<0.05), but no significant difference was found in the vertebral anterior height and kyphotic Cobb angle (P>0.05). Twenty-one patients (91.3%) had achieved solid fusion at final follow-up. No serious complications were observed in any of the cases. CONCLUSIONS Short-segment bone cement-augmented pedicle screw fixation combined with bone grafting is a safe and effective treatment for Kümmell disease with segmental instability. This approach can achieve significant pain relief and functional improvement, provide satisfactory correction of kyphosis and vertebral height restoration, and result in a low complication rate.

BACKGROUND Non-ST-segment elevation myocardial infarction (NSTEMI) has a with high incidence rate and a high mortality rate in elderly patients, and inflammation plays an important role. As a useful inflammatory marker, the relationship between the inflammatory burden index (IBI) and in-hospital death of elderly patients with NSTEMI remains unclear. The aim of this study was to investigate the predictive value of IBI for in-hospital death in elderly patients with NSTEMI. MATERIAL AND METHODS This single-center study retrospectively enrolled patients diagnosed with NSTEMI between February 2021 and February 2025. All patients were ≥75 years old and did not receive percutaneous coronary intervention (PCI) treatment during hospitalization. Patients were divided into 2 groups according to whether cardiogenic death occurred during hospitalization. IBI was calculated as the product of C-reactive protein and the neutrophil-to-lymphocyte ratio. RESULTS This study enrolled a total of 418 patients, with a mean age of 79.60±3.67 years. During the hospitalization period, cardiogenic death occurred in 43 (10.3%) patients. After adjusting for possible confounding factors, multivariate logistic regression analysis showed that IBI (OR=2.22, 95% CI: 1.64-3.00) was an independent risk factor for in-hospital death in elderly patients with NSTEMI. Restricted cubic spline suggested a non-linear dose-response relationship between IBI and in-hospital death. The results of ROC showed that the area under the curve of IBI was 0.760. CONCLUSIONS In elderly patients with NSTEMI, IBI demonstrated an independent association with in-hospital mortality, with modest discriminatory performance. There is a non-linear dose-response relationship between IBI and in-hospital death in elderly patients with NSTEMI.

BACKGROUND Hyperuricemia in patients undergoing maintenance hemodialysis (MHD) has been associated with an increased risk of cardiovascular disease, although its role remains controversial. This study aims to evaluate the prevalence of hyperuricemia and its association with cardiovascular disease risk factors among patients undergoing MHD in Southwest China. MATERIAL AND METHODS This study included 99 patients who underwent MHD at the Blood Purification Center of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University. We statistically analyzed the general characteristics, physical indicators, biochemical markers, and cardiac ultrasound parameters. We examined the correlation between serum uric acid levels and cardiovascular risk factors. RESULTS Logistic regression analysis revealed that heavy smoking and higher abdominal fat thickness, waist circumference, and systolic blood pressure were significantly associated with elevated serum uric acid levels. Multivariate linear regression analysis revealed that, compared with patients with normal uric acid levels, those with elevated levels showed gradual increases in triglycerides, C-reactive protein, parathyroid hormone, homocysteine, left ventricular posterior wall thickness, interventricular septum thickness, and left ventricular end-diastolic diameter. In contrast, high-density lipoprotein cholesterol levels and left ventricular ejection fraction progressively decreased. CONCLUSIONS In patients undergoing maintenance hemodialysis, hyperuricemia is closely associated with heavy smoking and abdominal obesity. These associations may increase cardiovascular risk through multiple pathways, including changes in biochemical markers (eg, triglycerides, C-reactive protein) and alterations in cardiac structure. Moreover, this risk increased proportionally with higher serum uric acid levels.

Chronic diseases such as asthma, which affect many children, require ongoing monitoring to identify agents that worsen morbidity and cause molecular changes. Asthma is a health condition with genetic and environmental influences. While the molecular mechanisms are still under investigation, the environmental component remains a pivotal part of understanding and managing the disease. The environment largely influences the development of asthma. Therefore, to obtain essential data regarding the effect of environmental exposure, it is vital to use omics science, such as exposomics. Accordingly, the purpose of this review was to collect the most essential information on asthma, with emphasis on early childhood asthma, and to provide an introduction to the role of environmental exposure in relation to asthma, with a background of exposomics. The exposome has recently become a vital interdisciplinary concept, focusing on identifying how environmental agents influence health and disease throughout a person's life. Consequently, exposomics is the study of the exposome, encompassing measurements of environmental exposure and the associated biological reactions. In addition, attention has been focused on examples of potential environmental pollutants to which children may be exposed in their immediate surroundings, including phthalates, polycyclic aromatic hydrocarbons, per- and polyfluoroalkyl substances, and secondhand smoke. Finally, this review highlights the role of exposomics studies in pediatric asthma in 3 areas: clinical, analytical, and environmental. In summary, in this article, we aim to review the potential effects of the exposome, or multiple environmental factors, on childhood asthma.

Myocardial infarction (MI) is a leading cause of myocardial fibrosis, contributing significantly to heart disease morbidity and mortality. Recent advancements have elucidated various signaling pathways and therapeutic strategies targeting myocardial fibrosis following MI. This review summarizes key pathways, including TGF-ß1, PI3K/AKT, STAT3, AMPK, Nrf2, NF-kappaB, NLRP3 inflammasome, Wnt/b-catenin, MAPK, and P53, highlighting their potential in therapeutic interventions in recent years. Drug therapy, protein therapy, gene therapy, physical therapy, cell therapy, and exercise training have all shown promise in mitigating fibrosis through these pathways. Notably, multi-pathway therapeutic strategies offer a comprehensive approach to managing myocardial fibrosis, with the TGF-ß1 pathway acting as a central hub in the regulatory network. This review underscores the need for further clinical studies to optimize therapeutic strategies and improve outcomes for patients with myocardial fibrosis following MI.

BACKGROUND Parents of children with central coordination disorders (CCD) undergoing Vojta therapy are at increased risk of mental health issues. The study aimed to assess the emotional state of 103 parents of children rehabilitated using the Vojta method and to identify factors determining stress levels at the beginning and after 2 months of therapy. MATERIAL AND METHODS A total of 103 parents of 61 children with CCD were enrolled; 51 completed the 2-month follow-up. Participants completed a sociodemographic questionnaire and standardized scales at baseline (T1) and after 2 months (T2). The following scales were used: the Perceived Stress Scale (PSS-10) to assess level of stress, Patient Health Questionnaire (PHQ) to assess depression, State-Trait Anxiety Inventory (STAI) to assess anxiety, and Satisfaction With Life Scale (SWLS) to assess life satisfaction. RESULTS At T1 parents exhibited moderate stress, average anxiety, mild depressive symptoms, and high life satisfaction. Nearly 70% of participants reported experiencing moderate or high levels of stress. More than 60% of participants presented symptoms of depression. After 2 months, depressive symptoms significantly decreased (P=0.009). Regression analyses identified female sex (P=0.0220), physical activity 3 times a week (P=0.0044), trait anxiety (P=0.0097), and life satisfaction (P=0.0006) as significant determinants of stress levels at T1 and T2. CONCLUSIONS The emotional state of parents of children with CCD is influenced by psychological traits and lifestyle factors. This highlights the need to provide parents with appropriate psychological support.

BACKGROUND The quality of life of patients with multiple myeloma is an important parameter in the assessment of patient condition. The aim of this study was to determine the quality of life among Polish patients with multiple myeloma. MATERIAL AND METHODS The study was conducted in 4 Polish centers from August 2020 to December 2021 using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) in paper and electronic versions. The patients were divided into groups based on their treatment method (chemotherapy, autologous hematopoietic stem cell transplantation [autoHSCT], or supportive therapy), age, and sex. RESULTS Responses were obtained from the patients during chemotherapy (n=98), after autoHSCT (n=87), and during supportive therapy following completion of treatment to maintain disease remission (n=61). For the entire study population, the highest scores were recorded for social functioning (M=65.718, SD=23.886) and emotional functioning (M=60.467, SD=22.353). Fatigue was the most burdensome symptom reported by patients (M=59.937, SD=22.546). Older patients reported lower quality of life and more severe disease-related symptoms. Patient sex did not have a statistically significant effect on most of the analyzed parameters. Patients receiving supportive therapy had the highest level of quality of life (P<0.001) and the lowest severity of most symptoms (P<0.001). CONCLUSIONS In this study, the quality of life of patients with multiple myeloma was found to be linked to treatment method and patient age.

BACKGROUND Obesity-induced insulin resistance significantly contributes to the global increase in type 2 diabetes, with gut microbiota alterations playing a critical role. Traditional herbal formulations, such as Xiehuang San (XHS), have been used for centuries in Chinese medicine. However, their mechanisms - particularly via the gut-liver-metabolism axis - remain to be fully elucidated. This study aimed to evaluate the efficacy of XHS in improving insulin resistance through metabolic and microbial modulation. MATERIAL AND METHODS A high-fat diet-induced obese insulin-resistant rat model (n=30) was established using male rats. Rats were randomized into 6 groups and treated with low, medium, or high doses of XHS, metformin, or vehicle control via daily gavage for 8 weeks. Metabolic parameters, including fasting blood glucose (FBG), fasting insulin (FINS), the homeostatic model assessment for insulin resistance (HOMA-IR), oral glucose tolerance (OGTT), and insulin tolerance tests (ITT) were assessed. Liver histology and lipid profiles were analyzed, and 16S rRNA sequencing was used to examine gut microbiota composition. RESULTS XHS treatment significantly reduced FBG (~25%), FINS (~30%), and HOMA-IR scores compared with the model group (P<0.05), with effects comparable to metformin. OGTT and ITT improvements were dose-dependent. XHS also ameliorated hepatic steatosis and improved lipid profiles (eg, lowered triglycerides and low-density lipoprotein cholesterol, and elevated high-density lipoprotein cholesterol). Gut microbiota analysis revealed that XHS decreased the Firmicutes/Bacteroidetes ratio and selectively increased Bacteroides while reducing Escherichia-Shigella, suggesting a reshaping of microbial diversity and abundance. CONCLUSIONS These findings suggest that XHS may enhance insulin sensitivity and improve metabolic outcomes in obese rats, partly via gut microbiota modulation. Further studies are needed to isolate its active components, clarify molecular pathways, and evaluate translational relevance in human subjects.