Medical Science Monitor最新文献

BACKGROUND Cartilage injuries are challenging to treat due to limited self-healing. Standard treatments often lead to the formation of less durable fibrocartilage. Caffeic acid phenethyl ester (CAPE), a polyphenolic compound, can improve cartilage repair. This animal study aimed to evaluate the histological effects of intra-articular injection of CAPE on cartilage repair in a rat model of microfracture of the knee joint. MATERIAL AND METHODS Twenty-four male Sprague-Dawley rats were divided into 4 groups. A cartilage defect was created in all groups, but Group A received no further intervention. Group B underwent a microfracture. Group C received intra-articular CAPE in the presence of a defect, without microfracture. Group D underwent both microfracture and CAPE treatment. Also, each rat underwent bilateral surgery, with one knee receiving CAPE (150 µg/kg) and the other receiving a control solution. After 28 days, histological analysis was performed on the cartilage tissue samples obtained from the defect sites by using the International Cartilage Research Society (ICRS-I and -II) visual assessment scale. Statistical analysis was performed using appropriate tests to compare histological scores between groups, with significance set at P<0.05. RESULTS Intra-articular CAPE significantly improved histopathological outcomes across several parameters, including reduced inflammation (P<0.05), enhanced tissue morphology (P<0.05), and improved cartilage matrix staining (P<0.05). No significant difference was observed in chondrocyte clustering or surface architecture among the groups. CONCLUSIONS Intra-articular CAPE enhances cartilage healing by improving tissue morphology and cartilage matrix quality.

BACKGROUND We aimed to investigate the implementation of outpatient comprehensive preoperative assessments in gynecological ambulatory surgery management in a hospital in China. MATERIAL AND METHODS Patients undergoing gynecologic minimally invasive surgery who received outpatient comprehensive preoperative assessment and ambulatory surgical procedures during November 2021 to December 2021 were classified into the intervention group (n=330). Those who received routine medical procedures during the same period were classified into the control group (n=336). A retrospective analysis was conducted with the medical records of the 2 groups of patients. RESULTS The scores for information transmission and patient education and for level of mastery of preoperative health knowledge in the intervention group were higher than that of the control group (P<0.05). Patient experience was positively correlated with level of mastery of preoperative health knowledge (r=0.525; P<0.01). No statistically significant differences were identified in the incidences of surgical complications and anesthetic complications among the 2 groups (P>0.05). The number of delayed surgery cases in the intervention group was higher than that of the control group (P<0.05). A statistically significant difference of P<0.05 was identified in the average length of hospital stay between the 2 groups, but no statistically significant differences were identified in patient satisfaction during hospitalization between the 2 groups (P>0.05). CONCLUSIONS The establishment of an outpatient comprehensive preoperative assessment unit for gynecological ambulatory surgery can improve patient experience and level of mastery of preoperative health knowledge.

BACKGROUND Blood products are an expensive resource. The study aimed to assess the cost spent on red blood cell (RBC) transfusions before and after implementing a 2-factorial RBC transfusion decision protocol and the current cost of an RBC transfusion procedure in the local healthcare system. MATERIAL AND METHODS Six-month periods before and after the implementation of the decision protocol were compared. The cost components considered included RBCs, laboratory tests, labor of healthcare workers involved in the procedure, and management of transfusion reactions. RESULTS Following the implementation of the decision protocol, there was a decrease in transfusion costs by €51,411 (56.4%) in our low transfusion rate setting. Inappropriate RBC transfusions amounted to €25,0146 (62.9% of all transfusions costs). The cost of a leucodepleted RBC transfusion increased in the periods being compared, from approximately €109 to €126 in the local healthcare system. CONCLUSIONS Implementing an RBC transfusion decision protocol based on a 2-factorial approach can lead to a more than 2-fold reduction in cost spent on RBC transfusions in a low transfusion rate setting. Even after the implementation of the protocol, further education of clinicians is required, as there may still be potential to reduce costs associated with inappropriate transfusions. The non-RBC acquisition cost of an RBC transfusion procedure approximates the cost of a blood component itself in the local healthcare system.

BACKGROUND Predicting 24-hour intraocular pressure (IOP) fluctuations is crucial for enhancing glaucoma management. Traditional methods of measuring 24-hour IOP fluctuations are complex and present certain limitations. The present study leverages machine learning techniques to forecast 24-hour IOP fluctuations based on daytime IOP measurements. MATERIAL AND METHODS A binary method was used to classify 24-hour IOP fluctuations as either >8 mmHg or £8 mmHg. Data were collected from 24-hour IOP monitoring, including 22 different features. Feature selection involved the chi-square test and point-biserial correlation, leading to the establishment of 4 subsets with significance levels of P<1, P<0.1, P<0.05, and P<0.025. Five binary classification machine learning algorithms were used to construct the model. Model performance was assessed by comparing accuracy, specificity, 10-fold cross-validation, precision, sensitivity, F1 score, area under the curve (AUC), and Area Under the Precision-Recall Curve (AUCPR). The model with the highest performance was selected, and feature importance was assessed using Shapley additive explanations.   RESULTS In the subset of features where P<0.05, all models performed better than those in the other subsets, with XGBoost standing out the most. The XGBoost algorithm achieved an accuracy of 0.886, a specificity of 0.972, a 10-fold cross-validation of 0.872, a precision of 0.857, a sensitivity of 0.585, and an F1 score of 0.696. Additionally, it obtained an AUC of 0.890 and an AUCPR of 0.794. CONCLUSIONS Our study illustrates the predictive capabilities of machine learning algorithms in forecasting 24-hour IOP fluctuations. The exceptional performance of the XGBoost algorithm in predicting IOP fluctuations underscores its significance for future research and clinical applications.

Anesthesia management in neuromuscular diseases (NMDs) is a complex challenge, requiring careful preoperative evaluation, tailored treatment strategies, and vigilant perioperative monitoring. This review examines the nuances of anesthesia in patients with NMD, addressing potential complications such as intubation difficulties, respiratory failure, and adverse effects of anesthetics and neuromuscular conduction blocking agents (NMBAs). Nondepolarizing NMBAs, including steroidal agents and benzylisoquinolines, are analyzed for their role, risks, and optimal use based on procedural requirements and patient characteristics. Challenges with depolarizing agents such as succinylcholine are highlighted, emphasizing the need for careful evaluation and monitoring to reduce the risk of adverse events such as malignant hyperthermia and hyperkalemia. The review highlights the role of reversal agents, particularly sugammadex, as a safer and more effective alternative to traditional acetylcholinesterase inhibitors such as neostigmine. Sugammadex reduces the risk of complications such as prolonged paralysis and respiratory failure in patients with NMD. In addition, anesthesia considerations tailored to specific NMDs, including Guillain-Barre syndrome, myasthenia gravis, Duchenne muscular dystrophy, Charcot-Marie-Tooth disease, and inflammatory myopathies are presented, including monitoring techniques and individualized approaches. Based on the available literature and the authors' clinical experience, this review aims to discuss the role of muscle relaxants in anesthesia in patients with the aforementioned neuromuscular disorders. This document uses the latest possible articles, covering items from 1992 to 2024.

BACKGROUND Rituximab (RTX) is a chimeric therapeutic monoclonal antibody that targets the CD20 molecule on B lymphocytes. RTX is approved for the treatment of rheumatoid arthritis (RA) in patients who do not respond to disease-modifying anti-rheumatic drugs (DMARDs) or other biologics. The purpose of this retrospective study was to report our experience with RTX treatment at a single center in Saudi Arabia between 2015 and 2022 in 52 patients with RA. MATERIAL AND METHODS This retrospective cohort study at King Khalid University Hospital in Riyadh examined 52 patients with RA who received RTX from April 2015 to October 2022. Data were collected from electronic health records, including patient demographics, disease activity, and treatment details. The primary outcome was prednisolone tapering, with secondary outcomes including adverse reactions and disease activity. Statistical analysis was conducted using SPSS. RESULTS Out of 678 screened patients, 52 (7.7%) were recruited. Of these, 44 (84.6%) were female, with a mean disease duration of 28±7 years and a mean age of 57.1±11 years. Prednisolone was used by 22 patients (42.31%) at RTX initiation, with a mean dose of 10.45±10.25 mg. After RTX, the dose significantly dropped to 3.41±5.54 mg (P<0.001). Older patients, those from outside Riyadh, and those with fewer prior DMARDs were more likely to taper off without full dose reinstatement. CONCLUSIONS This retrospective study supports the findings from other studies and current clinical guidelines that recommend rituximab in patients with rheumatoid arthritis, highlighting the importance of patient monitoring during treatment. Multicenter studies are required to determine the economic impact of tapering biological drugs.

This year, 2024, marks the 60th anniversary of the Declaration of Helsinki, with the latest revision adopted by the World Medical Association (WMA) in October 2024. The 2024 Declaration of Helsinki is a statement document of ethical principles for research involving humans, human data, and human cells and tissues. Revising the 2013 Declaration of Helsinki document was undertaken over more than two years with international collaboration to enhance the inclusivity of medical research, protect the rights of research study participants, and address contemporary research challenges such as global health emergencies and data privacy. The revised Declaration document does not replace the roles of the Institutional Review Board and the local Ethics Committee in reviewing and approving all research study protocols but continues to provide ethical guidance for the individuals who support, review, and conduct medical research. This editorial highlights the timely revisions in the 2024 Declaration of Helsinki and the importance of updating and maintaining an international consensus for a code of ethics that guides medical research.

Depression affects about 280 million people globally and is marked by persistent sadness and impaired daily functioning. Sleep disturbances are prevalent in major depressive disorder, affecting roughly 90% of patients, and are linked to the severity and progression of depression. This review emphasizes the critical role of sleep in depressive disorders and evaluates the alternative treatments bright light therapy and sleep deprivation. Sleep disturbances are not only symptoms but also mediators in the relationship between depression and other conditions, such as anxiety, chronic inflammation, emotional dysregulation, and cognitive decline. Effective management of depressive disorders must address these sleep issues. Bright light therapy, which uses artificial light to mimic natural sunlight, is effective for treating seasonal affective disorder and non-seasonal major depressive disorder. It is well tolerated, can be used alone or with antidepressants, and often improves both mood and sleep quality. In contrast, sleep deprivation, which involves enforced wakefulness, can provide rapid symptom relief. However, its effects are generally short-lived, and there is a risk of inducing mania in patients with bipolar disorder. In conclusion, sleep significantly impacts the severity and progression of depressive disorders. Bright light therapy and sleep deprivation offer promising alternatives to conventional treatments. The aim of this review is to underscore the importance of sleep in depression and advocate for the consideration of these alternative treatment methods to improve patient outcomes.

BACKGROUND During the COVID-19 pandemic, strict feeding restrictions were implemented in many dialysis centers to minimize transmission between patients. This study aims to evaluate the effects of these feeding restrictions on dry weight, intradialytic hypotension (IDH), and dialysis adequacy in hemodialysis patients. MATERIAL AND METHODS In this retrospective single-center study involving 76 hemodialysis patients, data from 2 consecutive 6-month periods were analyzed: the first before the COVID-19 pandemic when intradialytic nutrition was supported, and the second during the pandemic when intradialytic nutrition was restricted. Data from the patients' monthly visits during both periods were evaluated, averages were recorded, and a comparison was made between the 2 periods. RESULTS The frequency of IDH was significantly higher during the feeding period compared with the no-feeding period (1.4±1.2/month vs 0.81±0.86/month, P=0.01). Conversely, the urea reduction ratio was greater in the no-feeding period [72.5% (69-76) vs 71% (68-75), P=0.01], as were the single-pool Kt/V values (1.59±0.23 vs 1.52±0.26, P=0.004) and ultrafiltration rates (mL/h/kg) (11.4±3.0 vs 10.4±3.2, P=0.01). However, the dry weight of the patients was similar in the 2 periods (65.4±13.7 kg vs 65.7±14.2 kg, P=0.62). CONCLUSIONS During the COVID-19 pandemic, mandatory feeding restrictions for hemodialysis patients, aimed at reducing transmission, were linked to a decrease in IDH frequency and improved dialysis adequacy. However, no significant reduction in patients' dry weights was observed.

Contrast-enhanced ultrasonography (CEUS) is a novel technology in ultrasound medicine that has gained widespread application in clinical practice. While CEUS offers various quantitative and qualitative parameters, it is limited by factors such as the single-color transient coverage of the contrast agent and its dependence on the operator, rendering it less suitable for detecting blood in organ lesions. Additionally, fluid dynamic perfusion remains unsatisfactory. Recently, arrival-time parametric imaging (At-PI) has emerged as a promising alternative; this technology not only uses color overlay to statically represent the dynamic perfusion of blood flow within lesions but also enhances visualization, minimizes operator variability, and provides insights into the vascular patterns of both benign and malignant lesions. At-PI has demonstrated numerous advantages and has been successfully applied to the liver, adrenal gland, breast, lymph nodes, prostate, and gastrointestinal tract, yielding encouraging preliminary results. This review synthesizes existing research findings, highlights significant parameters, examines the current global research landscape regarding this technology, and outlines the research directions pursued by scholars in the field. Furthermore, we offer a critical analysis and discussion of the limitations of these findings. The ultimate aim is to elucidate the role of At-PI in clinical diagnosis and treatment.