Medical Science Monitor最新文献

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 Rather than relying on outdated categorical subtypes, current research emphasizes dimensional approaches.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.

BACKGROUND Patient monitoring systems are widely used in intensive care units (ICUs) to monitor patient's conditions. A high false alarm rate can lead to alarm fatigue among nurses, increasing workload and stress. This study aimed to improve the accuracy of arrhythmia detection by enhancing the noise detection algorithm in patient monitoring systems and to determine whether false alarm rate and workload decreased through clinical trials. MATERIAL AND METHODS Trials were conducted on adult patients in the ICU at Yongin Severance Hospital who required continuous electrocardiogram (ECG) monitoring for at least 2 days. After the first trial, the noise detection algorithm of the M50 (investigational device) was improved, and a second trial was conducted to evaluate its performance. Both trials followed the same study design. During the study period, M50 and MX700 (comparator device) were applied simultaneously for 3 days. Arrhythmia alarms were reviewed by an independent evaluator who assessed false alarms by comparing them with the ECG signals. False alarm rates were compared between trials using the chi-square (χ²) test. RESULTS The clinical trial was conducted through 2 separate trials, with 17 and 11 participants, respectively. A comparative analysis of false alarm rates of the investigational device demonstrated a reduction from 71.75% to 27.61%. Statistical analysis using the chi-square test indicated a P value of 0.000 (<0.001), confirming a statistically significant difference. CONCLUSIONS The results of 2 trials demonstrated reductions in false alarm rate and NASA-TLX score. These findings suggest that enhancing the noise detection algorithm in the patient monitoring system improved arrhythmia detection accuracy and helped reduce nurses' workload.

BACKGROUND Gestational diabetes mellitus (GDM) is a pregnancy complication associated with increased risks of metabolic disorders in mothers and their children. Interleukins (ILs) such as IL-10 and IL-37 play key roles in modulating inflammation during pregnancy. Exploration of their postpartum concentrations may help characterize the immunometabolic profile of women with a history of GDM. MATERIAL AND METHODS This study compared serum concentrations of IL-10 and IL-37 between postpartum women with GDM (n=30) and healthy controls (n=50) within the first few days after delivery. Correlation analyses were performed between IL levels and clinical variables, including gestational weight gain, physical activity, smoking, alcohol use, hydration status, body composition (assessed via bioimpedance), and family history of obesity or diabetes. RESULTS IL-37 concentrations were significantly lower in the GDM group than in controls. No significant differences in IL-10 levels were observed. In women with GDM, IL-10 showed key negative correlations with pre-pregnancy body mass index, total body weight, and extracellular-to-intracellular water ratio; IL-37 was negatively correlated with reported water intake and positively correlated with gestational age at delivery. CONCLUSIONS The altered IL profile observed in postpartum women with GDM, particularly reduced IL-37 levels, may reflect persistent low-grade inflammation. These findings support further investigation of IL-37 as a potential biomarker of immune dysregulation in the early postpartum period after GDM.

BACKGROUND This study examines the efficacy of biologically guided dose painting in Gamma Knife stereotactic radiosurgery (GKSRS) to improve radiographic response in patients with recurrent high-grade gliomas by increasing radiation dosage in functionally active tumor subregions identified through magnetic resonance spectroscopy (MRS) and T1-weighted perfusion magnetic resonance imaging (T1-PMRI). MATERIAL AND METHODS In this single-arm cohort of patients (n=23) with recurrent high-grade glioma, all patients previously treated with surgery, chemotherapy, and fractionated radiotherapy underwent GKSRS. Functional imaging (MRS and T1-weighted PMRI) delineated metabolically active ("aggressive") and less active ("passive") tumor regions. A modified radiosurgery plan prescribed 18 Gy to aggressive and 15 Gy to passive zones. For intra-patient comparison, a uniform-dose plan (plan 1, 16 Gy) was generated but not delivered. All statistical analyses were performed in Python 3.11 (SciPy-v1.11, statsmodels-v0.14, lifelines-v0.28) executed in Visual Studio Code 1.88 (Microsoft). RESULTS Across 23 patients, plan 2 vs plan 1 showed no significant change in whole-brain mean dose (P=0.716), integral dose (P=0.792), or V12 (P=0.583). Among 11 patients with follow-up imaging, K-trans decreased significantly (median, -18%; P=0.028; Wilcoxon) with a trend for initial area under the gadolinium concentration-time curve (IAUC; median, -22%; P=0.031 for table; overall P=0.08 for initial under curve analysis). Higher baseline K-trans correlated with greater K-trans reduction (r=-0.84, P=0.0012). CONCLUSIONS Using advanced MRI techniques (accounting for K-trans and IAUC on T1-PMRI, and MRS) to determine aggressive zones in salvage treatment for recurrent high-grade gliomas, and then focusing radiotherapy on these zones, can increase Gamma Knife efficiency without increasing the morbidity rate.

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.