Medical Science Monitor最新文献

BACKGROUND Long-term clinical practice has suggested a possible association between ossification of cervical ligament (OCL) and primary osteoporosis (POP). However, there is a lack of relevant research data. This study aimed to clarify the potential relationship between OCL and POP, and propose new strategies for preventing the onset of POP. MATERIAL AND METHODS The study involved 107 patients. The patients' diagnosis included OCL (ossification of the posterior longitudinal ligament, ossification of the ligamentum flavum, and ossification of the nuchal ligament) and POP. Bone mineral density (BMD), types of OCL, types of ossification of posterior longitudinal ligament, age, sex, serum calcium, serum phosphorus, alkaline phosphatase, type I collagen amino-terminal extension peptide, type I collagen degradation products, osteocalcin N-terminal molecular fragments, 25-hydroxyvitamin D, and history of taking steroid drugs were collected. SPSS24.0 and GraphPad Prism 8 were used to obtain the risk factors for POP. RESULTS One-way analysis of variance found that OCL, ossification of posterior longitudinal ligament, alkaline phosphatase, and osteocalcin N-terminal molecular fragments had statistical significance on BMD of the femoral neck (P<0.05). The independent sample t test showed that patient sex had statistical significant effect on BMD (femoral neck) (P=0.036). Incorporating the above factors into multiple linear regression analysis, it was found that OCL, alkaline phosphatase, and osteocalcin N-terminal molecular fragments were risk factors affecting BMD of femoral neck (P<0.05). CONCLUSIONS OCL, osteocalcin N-terminal molecular fragments, and alkaline phosphatase are risk factors for POP.

BACKGROUND Gastric bezoars are a relatively rare condition. We aim to summarize the clinical characteristics and endoscopic features of patients with gastric bezoars, and analyze the treatment process. MATERIAL AND METHODS The medical records of 44 patients with gastric bezoars treated at Henan Provincial People's Hospital from September 2017 to December 2023 were retrospectively reviewed. RESULTS Among the 44 patients, there were 20 males and 24 females. The average age was 55.36±15.17 years. Abdominal pain was the primary symptom in patients with gastric bezoars. Single gastric bezoars were more common than multiple ones, accounting for 86.4% of all cases. Endoscopic examination revealed ulcers in 36 (81.8%) patients, mainly at the gastric angle and antrum. Single ulcers were more common than multiple ulcers, with most ulcer diameters being less than 2 cm. The occurrence of ulcers was not significantly related to patient age or the size of the bezoars. Endoscopic examination confirmed complete clearance of gastric bezoars in 30 patients. In the 26 patients treated successfully under endoscopy, the number of endoscopic treatments ranged from 1 to 4, with an average of 1.27 interventions per patient. The interval for the second endoscopic re-examination ranged from 2 to 6 days, with an average of 3.87±1.22 days. CONCLUSIONS The most common type of gastric bezoar is phytobezoars. There is a close association between ulcer formation and gastric bezoars. Endoscopic therapy combined with oral treatment can effectively treat gastric bezoars. Most patients require only 1 endoscopic treatment to be successful. The appropriate interval for a follow-up endoscopy after the first endoscopic treatment is around 4 days.

This comprehensive review explores the interaction between neuromuscular blocking agents, reversal agents, and renal function, focusing on various drugs commonly used in anesthesia and their effects on kidney health. Succinylcholine, commonly used for anesthesia induction, can trigger elevated potassium levels in patients with specific medical conditions, leading to serious cardiac complications. While studies suggest the use of succinylcholine in patients with renal failure is safe, cases of postoperative hyperkalemia warrant further investigation. Some agents, such as atracurium and mivacurium, are minimally affected by impaired kidney function, whereas others, such as cisatracurium and rocuronium, can have altered clearance, necessitating dose adjustments in patients with renal failure. The reversal agents neostigmine and sugammadex affect renal markers, while cystatin C levels remain relatively stable with sugammadex use, indicating its milder impact on glomerular function, compared with neostigmine. Notably, the combination of rocuronium and sugammadex in rat studies shows potential nephrotoxic effects, cautioning against the simultaneous use of these agents. In conclusion, understanding the interplay between neuromuscular blocking agents and renal function is crucial for optimizing patient care during anesthesia. While some agents can be used safely in patients with renal failure, others can require careful dosing and monitoring. Further research is needed to comprehensively assess the long-term impact of these agents on kidney health, especially in high-risk patient populations. This article aims to review the use of muscle relaxants and reversal for anesthesia in patients with impaired renal function.

BACKGROUND The role of post-reduction radiography in patients with shoulder dislocation remains controversial. Therefore, this retrospective study of 1076 cases of shoulder dislocation at a single center in Türkiye aimed to evaluate the role of post-reduction radiography in the detection of clinically significant fractures. MATERIAL AND METHODS Patients with radiographically confirmed anterior shoulder dislocation were included in the study, and their demographic data, mechanism of injury, pre- and post-reduction radiograph readings, reduction method, and patient outcome were recorded. The study analyzed patients who had pre- and post-reduction anterior-posterior and axillary shoulder radiographs. RESULTS During the 44-month study period, a total of 1076 patients were examined, and their pre- and post-reduction radiographs were reviewed by an independent radiologist. Of these patients, 27 (2.6%) had a fracture on their pre-reduction radiographs, while 32 (3.1%) had a fracture on their post-reduction radiographs. The difference between the 2 groups was not statistically significant (P=0.142). The study found that patients who did not undergo a post-reduction radiograph spent an average of 106 min in the emergency department, while patients who had the radiograph and were discharged spent an average of 237 min. The hospital stay of patients who had the radiograph was also significantly longer (P<0.01). CONCLUSIONS Our study supports that routine use of post-reduction radiographs in all cases of anterior shoulder dislocation may not be necessary and could potentially expose patients to unnecessary radiation exposure and healthcare costs. Shortening the examination time in the emergency department by not taking a follow-up radiograph will help prevent overcrowding.

BACKGROUND Reverse shoulder arthroplasty (RSA) is an accepted treatment that provides reproducible results in the treatment of rotator cuff deficiency and proximal humerus fractures. This single-center study aimed to evaluate the outcomes from reverse shoulder arthroplasty for rotator cuff ınsufficiency and proximal humerus fractures in 22 patients from a single center. MATERIAL AND METHODS Twenty-two patients were included in the study. The median age of the patients was 66 years (Range: 58-95). Proximal humerus fractures were diagnosed using X-ray and CT, while rotator cuff tears were diagnosed using MRI. For the assessment of joint function, the Constant-Murley score, the American Shoulder and Elbow Surgeons (ASES), and the Disabilities of Arm, Shoulder, and Hand (DASH) scores were used as patient-reported outcome measures. Kaplan-Meier analysis was conducted to evaluate implant survival. RESULTS The mean follow-up duration was 4.05±1.2 years. Significant improvements were observed: ASES Score: Increased from 35.8±2.8 to 81.3±5.4 (p<0.001). VAS Pain Score: Decreased from 7.3±1 to 2.9±0.9 (p<0.001). DASH Score: Improved from 66.3±4.3 to 32.5±3.6 (p<0.001). Constant-Murley Score: Increased from 48.3±3.5 to 74.6±7.7 (p<0.001). Kaplan-Meier analysis estimated implant survival at 6.7 years (95% CI, 6.3-7.2). CONCLUSIONS When performed with appropriate indications, RSA yields positive results, as seen in the literature and our study. Interscalene block anesthesia, advancements in implant technology, and adherence to surgical procedures can reduce RSA complications and ensure its safe application.

BACKGROUND The study was aimed to determine level of stress and using of coping strategies and frequency of type D personality in women with androgenetic alopecia with polycystic ovary syndrome (PCOS), to correlate personality type with level of stress and coping strategies, and to correlate severity of alopecia with personality type, level of stress, and coping strategies. MATERIAL AND METHODS The study was conducted in 2023 and included 146 Polish women aged 18 to 45 years with androgenetic alopecia and PCOS. A questionnaire containing social-demographic data, gynecological and obstetric history, health history, history of diagnosis, and treatment of PCOS in the past and present. Three standardized questionnaires were used: the Type-D Scale (DS)-14, Perceived Stress Scale (PSS)-10, and Coping Orientation to Problems Experienced (COPE) inventory. RESULTS Type D personality was found in 45% of patients. Most patients perceived high levels of stress (44%) and most frequently used active and supportive strategies, with avoidance strategies being less frequent. Women with type D personality experienced significantly higher levels of stress, used active strategies less often, and used avoidant strategies more often. Stages of androgenetic alopecia did not correlate with type D personality or levels of perceived stress. CONCLUSIONS In women with androgenetic alopecia, type D personality is determinative of a high level of perceived stress and more frequent use of dysfunctional coping strategies. The severity of the condition did not correlate with personality type and level of stress, while it was related to certain coping strategies.

BACKGROUND The spring-and-loop with clip (S-O clip) consists of a spring and a nylon loop located on one side of the claws of the clip, and is used in gastric endoscopic submucosal dissection (ESD) to allow countertraction. This retrospective study included 290 patients with early gastric neoplasms (eGNs) and aimed to compare postoperative outcomes of ESD with and without the use of the S-O clip. MATERIAL AND METHODS We retrospectively reviewed the data of 347 patients with eGN who underwent ESD, with or without an S-O clip, at our institution between April 1, 2017 and March 31, 2023. Overall, 290 patients were analyzed after excluding ineligible participants. The control group (n=149; adenoma: 1, carcinoma: 148) underwent ESD without an S-O clip between April 2017 and March 2020, while the S-O group (n=141; adenoma: 4, carcinoma: 137) used the clip between April 2020 and March 2023. Primary outcomes included procedure time, en bloc resection rate, and complete resection rate. Subgroup analysis for examined procedure time concerning endoscopist expertise, submucosal fibrosis, and neoplasm locations. RESULTS The S-O group had a shorter procedure time (44.4±23.9 vs 61.1±40.9 min, P<0.001) and a higher complete resection rate (97.9% vs 92.6%, P<0.05) than the control group. Subgroup analysis revealed that the S-O clip significantly reduced procedure time for trainees compared to the control group (40.8±18.3 vs 61.1±35.6 min, P<0.05). CONCLUSIONS The scheduled use of S-O clips in gastric ESD is effective in improving procedural time and complete resection rates, benefiting endoscopists across all experience levels.

BACKGROUND The Vibro-Swing system consists of 2 spiraled tubes containing 4 steel balls that move to generate a vibrational musculoskeletal and nervous system stimulus. This study included 45 older adults and aimed to compare balance, muscle strength, and proprioception with and without a 6-week program of Pilates training using the Vibro-Swing system. MATERIAL AND METHODS The present study included 45 older adults (mean age: 78.31±4.50). The experimental group (n=24) underwent a Pilates with Vibro-Swing exercise. The control group (n=21) participated in regular Pilates exercise. Both groups engaged in exercise for 40-50 minutes per session, twice a week, for 6 weeks, resulting in a total of 12 intervention sessions. Assessments were conducted before and after the intervention. The pre-post test evaluated balance (gait analysis, 10-meter walk test [10 MWT], functional reach test [FRT]), muscle strength (Five Times Sit-to-Stand Test [FTSS], grip strength), and proprioception (wrist joint position sense [WRT_30°]). RESULTS The experimental group exhibited statistically significant differences in velocity, cadence, 10MWT, FRT, FTSS, right grip, left grip, and wrist joint position sense (extension 30°) between the pre- and post-test (P>0.05). The experimental group exhibited statistically significant differences in gait velocity, cadence, 10 MWT, FTSS, right grip strength, FRT, and [WRT_30°] results compared with the control group (P>0.05). CONCLUSIONS The Pilates with Vibro-Swing exercise resulted in greater improvements in balance, muscle strength, and wrist joint proprioception.

Mesenchymal stem cells (MSCs) are a promising tool that may be used in regenerative medicine. Thanks to their ability to differentiate and paracrine signaling, they can be used in the treatment of many diseases. Undifferentiated MSCs can support the regeneration of surrounding tissues through secreted substances and exosomes. This is possible thanks to the production of growth factors. These factors stimulate the growth of neighboring cells, have an anti-apoptotic effect, and support angiogenesis, and MSCs also have an immunomodulatory effect. The level of secreted factors may vary depending on many factors. Apart from the donor's health condition, it is also influenced by the source of MSCs, methods of harvesting, and even the banking of cells. This work is a review of research on how the patient's health condition affects the properties of obtained MSCs. The review discusses the impact of the patient's diabetes, obesity, autoimmune diseases, and inflammation, as well as the impact of the source of MSCs and methods of harvesting and banking cells on the phenotype, differentiation capacity, anti-inflammatory, angiogenic effects, and proliferation potential of MSCs. Knowledge about specific clinical factors allows for better use of the potential of stem cells and more appropriate targeting of procedures for collecting, multiplying, and banking these cells, as well as for their subsequent use. This article aims to review the characteristics, harvesting, banking, and paracrine signaling of MSCs and their role in diabetes, obesity, autoimmune and inflammatory diseases, and potential role in regenerative medicine.

BACKGROUND Crush injury can result in crush syndrome (CS) when the pressure is released from the limb, resulting in ischemia-reperfusion injury and rhabdomyolysis. This retrospective study aimed to evaluate the demographics, clinical findings, management, and outcomes of 377 patients admitted as an emergency with a diagnosis of crush syndrome between February 6 and 16, 2023, following the Türkiye-Syria earthquakes. MATERIAL AND METHODS This observational study retrospectively analyzed CS patients admitted to the emergency service from February 6 to 16, 2023. We collected data on demographics, vital signs, time under debris, blood parameters, hemodialysis needs, outcomes, hospital stay duration, 7-day mortality, diagnoses, and treatments. RESULTS During the study period, 1682 earthquake victims were admitted, with 377 diagnosed with CS included in the study. The mean age was 33.51±0.89 years, with 51.7% male. The mean time under debris was 24.92±1.62 h, and the mean hospital stay was 34.39±1.20 days. Hemodialysis was required for 91 patients (24.1%), and 20 patients (5.3%) died. AKI developed in 23.1% (n=87) of the patients, with 30.5% (n=115) under debris for more than 24 h. Mortality, hospital stay, and AKI rates were higher in those requiring hemodialysis (P<0.001, P=0.003, and P<0.001, respectively). CONCLUSIONS The study highlights a high incidence of AKI, increased hemodialysis needs, and higher mortality in earthquake-related crush syndrome cases. Longer debris entrapment (over 24 h) was common. Early and aggressive fluid resuscitation, beginning in the field and continuing through hospital care, is crucial. Prioritizing this in disaster planning for field personnel is recommended.