Medical Science Monitor最新文献

BACKGROUND Dilated cardiomyopathy (DCM) is characterized by chronic myocardial inflammation and remodeling. Polyunsaturated fatty acid-derived oxylipins are critical mediators of cardiac inflammation; their plasma profiles in DCM and diagnostic potential remain undefined. We aimed to comprehensively quantify plasma oxylipins in patients with DCM, identify dysregulated lipid pathways, and develop a noninvasive biomarker panel for disease classification. MATERIAL AND METHODS Seventy-three oxylipins were quantified by targeted ultra-high-performance liquid chromatography-tandem mass spectrometry in plasma samples from 30 patients with DCM and 30 age/sex-matched healthy controls. Differential metabolites were identified using Wilcoxon rank-sum tests, significance analysis of microarrays (SAM), and empirical Bayes analysis of microarrays (EBAM). Intersecting features defined a high-confidence signature. Ingenuity Pathway Analysis (IPA) detected enriched lipid mediator pathways. Diagnostic performance was evaluated with a support vector machine (SVM) model using hold-out validation. RESULTS Sixteen oxylipins significantly differed according to Wilcoxon testing. Overlap with SAM and EBAM identified 14 core metabolites dominated by lipoxygenase-derived hydroxyeicosatetraenoic acids, cyclooxygenase-derived prostaglandin E2, and cytochrome P450-derived hydroxyeicosapentaenoic acids, with concomitant suppression of pro-resolving mediators. IPA revealed activation of eicosanoid signaling, triggering receptor expressed on myeloid cells 1 signaling, and prostanoid biosynthesis. A 6-marker SVM panel (15-oxo-eicosatetraenoic acid, 9-hydroxyeicosatetraenoic acid, 6R-lipoxin A4, prostaglandin E2, 16-hydroxyeicosatetraenoic acid, and 18-hydroxyeicosapentaenoic acid) achieved an area under the curve of 0.876 (sensitivity 74.2%, specificity 75.9%). CONCLUSIONS DCM is associated with a dominant pro-inflammatory oxylipin milieu and impaired resolution signaling. The 6-oxylipin panel provides a noninvasive diagnostic tool and suggests lipid mediator pathways represent therapeutic targets in heart failure.

Six years ago, in December 2019, patients in Hubei Province, China, reported symptoms of atypical pneumonia that were unresponsive to treatment, and in Wuhan, an outbreak of similar cases was reported to the World Health Organization (WHO). On January 30, 2020, the WHO declared that COVID-19, caused by SARS-CoV-2, was a public health emergency of international concern (PHEIC). By November 2, 2025, the total number of COVID-19 cases reported to the WHO since 2020 was 778,900,250. On June 25, 2025, the WHO Technical Advisory Group on Virus Evolution (TAG-VE) reported a risk evaluation for two SARS-CoV-2 Omicron variants under monitoring (VUM), NB.1.8.1 (Nimbus) and XFG (Stratus). At the end of 2025, genomic analysis of the infecting SARS‑CoV‑2 virus identified them as the most common circulating viruses causing COVID-19. This editorial aims to highlight that, six years on from the initial reports of SARS-CoV-2 cases that led to the COVID-19 pandemic, complacency in infection control and surveillance has resulted in a concerning increase in infection from endemic Omicron variants, including NB.1.8.1 (Nimbus) and XFG (Stratus).

Neurotoxicity is one of the complications of treatment of acute lymphoblastic leukemia (ALL) with chemotherapeutic agents. Detecting any adverse changes early and effectively is important, as neurotoxicity may be reversible at certain stages. Imaging studies, such as computed tomography (CT) or magnetic resonance imaging (MRI), can be helpful in visualizing neurotoxicity. Neurotoxicity usually occurs during the first 2 months of treatment, roughly the induction phase, and includes leukoencephalopathy, encephalopathy, and posterior reversible encephalopathy syndrome. Changes mainly take the form of reduced restrictive diffusion and periventricular hyperintensity in the subcortical white matter because of cytotoxic swelling caused by ALL treatment. Some previous studies have not considered simultaneous CT and MRI, making it difficult to assess their simultaneous utility. Imaging studies are not usually included in ALL treatment protocols. However, it would be worthwhile to introduce them into clinical practice to prevent complications after chemotherapy in children with ALL, to confirm or rule out neurotoxic complications of the central nervous system more quickly. Furthermore, due to the limited number of studies, it would be advisable to develop predictive models using CT and MRI images to predict the risk of neurological complications, allowing for early prevention in at-risk patients. Considering the above, the present study aimed to evaluate the utility of MRI and CT for identifying lesions associated with neurotoxicity caused by vincristine, methotrexate, and asparaginase in pediatric patients with ALL.

BACKGROUND Acute cerebral infarction significantly impacts patients' physical, cognitive, and psychological health. Evidence-based nursing (EBN) interventions offer a patient-centered approach to address these multifaceted challenges. This study evaluated the effectiveness of EBN in improving psychological outcomes, cognitive function, independence in daily living, and quality of life in patients with acute cerebral infarction. MATERIAL AND METHODS A retrospective study was conducted on 256 patients with acute cerebral infarction between January 2022 and December 2023. Patients were assigned to either the control group (routine care, n=126) or the observation group (EBN care, n=130). Clinical outcomes, including Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Chinese version of the Mini-Mental State Assessment (CMMS), Activities of Daily Living (ADL), and World Health Organization Quality of Life Assessment (WHOQOL-BREF) scores, were compared before and after intervention. Statistical analyses were performed using SPSS version 27.0, with significance set at P<0.05. RESULTS The observation group demonstrated significantly greater improvements across all measured outcomes compared to the control group (P<0.05). Post-intervention HAMD and HAMA scores decreased substantially in the observation group, indicating reduced psychological distress. Similarly, CMMS and ADL scores improved markedly, reflecting enhanced cognitive function and greater independence. Quality-of-life scores across physical, social, psychological, and environmental domains were significantly higher in the observation group. CONCLUSIONS EBN interventions significantly improve psychological outcomes, cognitive function, daily living independence, and quality of life in patients with acute cerebral infarction. These findings support the integration of EBN into routine stroke care to optimize patient recovery and overall prognosis.

BACKGROUND Surface conditioning methods play a critical role in enhancing adhesion by creating micro-mechanical and chemical bonds between resin cement and ceramics. This study aimed to evaluate the effects of different surface treatments on micro-tensile bond strength (MTBS) between resin cement and glass-infiltrated zirconia (GLZR), as well as surface changes in topography, roughness, and elemental properties assessed by energy-dispersive X-ray analysis (EDAX). MATERIAL AND METHODS Thirty GLZR blocks were fabricated and divided into 3 groups (n=10) according to the applied surface treatment: laboratory grit-blasting (LGB), laboratory silica coating (LSC), and hydrofluoric acid etching (HFAE). After treatment, specimens were bonded to composite blocks with resin cement, and MTBS was tested using a universal testing machine. Surface roughness was measured; morphological and elemental changes were examined by scanning electron microscopy (SEM) and EDAX. RESULTS The LSC group exhibited the highest MTBS (28.23±1.53 MPa), followed by the LGB group (20.27±2.33 MPa) and the HFAE group (10.41±1.46 MPa). Surface roughness was highest in the LGB group (Ra=9.34±1.23 μm). SEM analysis revealed prominent crater formation in the LGB and LSC groups, whereas the HFAE group showed minimal topographic change. EDAX indicated increased silica content in the LSC group and reduced zirconia content in the LGB group; these findings were linked to enhanced chemical bonding. CONCLUSIONS Among the tested surface treatments, laboratory silica coating significantly improved both surface chemistry and MTBS, making it the most effective method for strengthening resin-zirconia adhesion.

BACKGROUND Postoperative delirium affects recovery. Dexmedetomidine shows promise in reducing it, but the ideal dose is unclear. MATERIAL AND METHODS We performed a systematic review of randomized controlled trials and meta-analyses. Studies from PubMed, Embase, Web of Science, and the Cochrane Library were retrieved. Only trials involving adults (≥18 years) were considered. The effectiveness of high (loading dose, >0.5 µg/kg) and low doses (loading dose, ≤0.5 µg/kg) of dexmedetomidine in preventing delirium was examined, along with the incidence of delirium and adverse events like hypotension and bradycardia. RESULTS High-dose dexmedetomidine was associated with a lower delirium incidence compared to low-dose. The incidence of bradycardia or hypotension did not differ significantly between the 2 groups. However, some included studies had small sample sizes, focused on intraoperative use, or had potential data bias and heterogeneity in the low-dose group. CONCLUSIONS High-dose dexmedetomidine may be more effective in reducing postoperative delirium without increasing the risk of bradycardia or hypotension. But due to study limitations, more randomized controlled trials are required to confirm these findings.

BACKGROUND Physical activity (PA) is essential for individuals with Parkinson's disease (PD) to maintain functional independence and quality of life. However, difficulties in accurately measuring PA complicate the identification of effective and beneficial interventions. Understanding the discrepancies between self-reported and objectively measured PA is critical for clinical practice. This study compared self-reported and objectively measured PA among people with PD, considering their participation in functional physical rehabilitation (FPR). MATERIAL AND METHODS The International Physical Activity Questionnaire and Actigraph GT3X+ were used to measure PA. Patients with PD (n=47) in stages II or III of the disease according to the Hoehn and Yahr scale, aged 64.37±7.12 years, with disease duration of 6.29±4.02 years were divided into 2 groups: participating (Group A) and not participating (Group B) in FPR. The FPR program combined motor symptom-targeted therapy with task-oriented training to improve functional independence and quality of life. RESULTS Comparing self-reported weekly PA with the objective showed statistically significant differences (P<0.05) in both groups - the self-reported PA was 8.61% higher in Group A and 56.70% higher in Group B. In Group A, declared PA was higher than the objective in all intensity zones: by 19.50% in high, by 10.52% in moderate, and by 7.35% in low. In Group B, declared PA was higher than the objective by 250% in high-intensity, by 90.66% in moderate-intensity, and by 48.32% in low-intensity. CONCLUSIONS We found significant differences between self-reported and objectively measured PA in people with PD, based on their participation in FPR. Participation in FPR seems to improve the accuracy of PA self-assessment, demonstrating the importance of objective PA measurement in clinical practice.

BACKGROUND The optimal antithrombotic regimen for patients with atrial fibrillation (AF) and multivessel disease undergoing complex percutaneous coronary intervention (PCI) remains controversial, particularly with high ischemic and complex coronary anatomy. MATERIAL AND METHODS We retrospectively recruited 56 AF patients with SYNTAX scores >22 who underwent PCI January 2018-December 2023. Patients were grouped by antithrombotic strategy 1 year after PCI, as follows: oral anticoagulant (OAC) alone (monotherapy group, n=32) or OAC plus antiplatelet therapy (APT; dual-therapy group, n=24). RESULTS Baseline demographics, comorbidities, and coronary disease severity were comparable. At 1-year follow-up, composite endpoint rates were significantly higher in the dual-therapy group (66.7%) than monotherapy group (28.1%, P=0.006). Revascularization rates were notably higher in the dual-therapy group (50.0% vs 12.5%, P=0.003), including target lesion (33.3% vs 9.4%, P=0.041) and target vessel revascularization (37.5% vs 9.4%, P=0.019). One year after index PCI, continued dual therapy was associated with a significantly increased risk of revascularization (HR: 4.003, 95% CI: 1.287-12.450, P=0.017) in univariate Cox regression analysis. CONCLUSIONS In AF patients with complex coronary artery disease, continuation of OAC plus APT beyond 1 year after PCI was associated with higher adverse clinical outcomes and greater need for repeat revascularization, compared with OAC alone, suggesting long-term OAC monotherapy represents a safer and equally effective alternative for selected high-risk patients. However, given the retrospective design and limited sample size of our study, OAC monotherapy warrants prospective validation in AF patients with complex PCI, as our retrospective results should be regarded as hypothesis-generating.

BACKGROUND Obstructive sleep apnea (OSA) is associated with increased risk of systemic comorbidities, leading to significant morbidity and mortality. This study investigates predictors of all-cause and OSA-related mortality, emphasizing the interplay of clinical symptoms, polysomnographic findings, and comorbidities. The aim of this study was to identify and compare predictors of all-cause and OSA-related mortality over 5, 10, and 15 years of follow-up. MATERIAL AND METHODS In this single-center study conducted at our Sleep Medicine Department between 2005 and 2019, 4025 patients with suspected OSA underwent polysomnography and were enrolled in this longitudinal study. Patients were categorized based on their mortality status, with a follow-up time of up to 15 years, and the cause of death if applicable. Based on the underlying cause of death, we identified 2 study groups: all-cause mortality (n=853) and OSA-related mortality (n=460). We performed Cox regression analyses to evaluate predictors of mortality. RESULTS Prevalence of OSA was high - 75.6% in the cohort: 929 patients with mild OSA (23.1%), 770 with moderate OSA (19.1%), and 1343 with severe OSA (33.4%). Survival rates were 89.7%, 81.9%, and 78.8% at 5, 10, and 15 years, respectively. Cardiovascular causes dominated mortality (33.3%), followed by cancer (26.5%). We compared the apnea-hypopnea index (AHI) a well-known, widely used metric for indicating the severity of OSA, in 0-5, 0-10, and 0-15 years of observation of all-cause mortality and OSA-related mortality. Comparing the AHI during rapid eye movement (REM) sleep, non-rapid eye movement (NREM) sleep, and total sleep time (TST), AHIREM was associated with a higher mortality risk than AHINREM and AHITST. Sleepiness (HR 1.17 95% CI: 1.09-1.26), episodes of stroke (HR 1.77 95% CI: 1.38-2.28), and use of new oral anticoagulants (HR 1.71 95% CI: 1.21-2.43) were associated with mortality at 15 years. CONCLUSIONS OSA management requires a holistic approach that extends beyond AHI, integrating clinical symptoms, comorbidities, and polysomnographic indices.

BACKGROUND Secondary hemophagocytic lymphohistiocytosis (sHLH) is a life-threatening hyperinflammatory syndrome. The immunopathology of cytotoxic lymphocytes in sHLH is complex and differs from primary HLH. This study aimed to characterize the distribution and perforin expression of key cytotoxic lymphocyte subsets in sHLH and assess their clinical and longitudinal significance. MATERIAL AND METHODS In this single-center observational study, peripheral blood from 19 patients with newly diagnosed sHLH and 10 healthy controls was analyzed using multi-color flow cytometry. Proportions of NK cells, CD8⁺ T cells, and CD56⁺ T cells, along with intracellular perforin expression, were quantified. Six patients were re-assessed after achieving complete response. RESULTS Compared with controls, sHLH patients showed a significantly lower proportion of NK cells, while the percentage of perforin-expressing CD56⁺ T cells was significantly increased. Among sHLH subtypes, NK-cell proportion was significantly lower in lymphoma-associated HLH than in non-lymphoma cases. Longitudinally, CD8⁺ T-cell proportion decreased significantly in patients in remission. NK-cell proportion correlated positively with fibrinogen, a key diagnostic and disease activity marker. Perforin expression in CD56⁺ T cells correlated negatively with alanine aminotransferase, while perforin in CD8⁺ T cells correlated positively with soluble interleukin-2 receptor. CONCLUSIONS sHLH exhibits a distinct immunological profile characterized by reduced NK-cell proportion and increased perforin expression in CD56⁺ T cells, diverging from the primary HLH model. These findings suggest that monitoring cytotoxic lymphocyte dynamics may be valuable for assessing disease activity and treatment response in sHLH, although further validation in larger cohorts is warranted.