Journal of Research in Medical Sciences最新文献

Background: Sepsis remains a leading cause of morbidity and mortality among critically ill patients. Fluid resuscitation is essential, but conventional protocols often lack individualized assessment of tissue perfusion, risking underresuscitation or fluid overload. The peripheral perfusion index (PPI), derived from pulse oximetry, offers a practical, noninvasive way to dynamically guide fluid therapy and may improve outcomes. The objective of the study was to evaluate whether PPI-guided targeted fluid therapy improves clinical and microvascular outcomes in septic intensive care unit patients compared with conventional fluid therapy.

Materials and methods: In a prospective, randomized trial, 60 septic adults were assigned to standard fluid therapy or PPI-guided resuscitation. The primary outcome was microvascular perfusion improvement within 72 h. The secondary outcomes included 7-day mortality, acute kidney injury (AKI), fluid balance, lactate clearance, and renal biomarkers (including cystatin C).

Results: PPI-guided therapy significantly improved microvascular perfusion (P = 0.001) and reduced cystatin C levels by day 7 (P = 0.0001), suggesting renal protection. Although there were fewer deaths at 7 days and less AKI in the intervention group, these differences did not reach statistical significance. Trends favored lactate clearance and more favorable fluid balance with PPI guidance.

Conclusion: PPI-guided fluid therapy is a feasible, low-cost approach to individualized resuscitation in septic patients, associated with short-term improvements in microvascular perfusion and renal biomarkers. The observed physiological benefits warrant confirmation in larger multicenter trials to determine any impact on long-term clinical outcomes.

Background: Transurethral resection of the prostate (TURP) is the standard treatment for benign prostatic hyperplasia (BPH). The incidence of postoperative urethral stricture (US) and urinary incontinence remains clinically important, and their predictors are not fully established. This study aimed to determine the incidence of these complications and identify associated risk factors.

Materials and methods: This retrospective cohort study was conducted at Al-Zahra Hospital, Isfahan, Iran, between 2020 and 2023. A total of 110 male patients with BPH who underwent TURP and completed 6 months of postoperative follow-up were included. Baseline variables (age, prostate volume, and operative duration) were extracted from medical records. Complications were assessed at 6 months, specifically the occurrence of US, urinary incontinence, and the composite outcome defined as either stricture or incontinence. An independent samples t-test compared mean values between groups, and logistic regression was used to identify predictors.

Results: The mean age of patients was 68.2 ± 11.6 years, the mean prostate volume was 38.9 ± 10.3 mL, and the mean operative duration was 96.8 ± 17.4 min. The incidence of US was 9.1% (18.2 cases per 100 person-years), urinary incontinence 6.4% (12.7 cases per 100 person-years), and the composite outcome 15.5% (30.9 cases per 100 person-years). Patients with US had slightly lower age and smaller prostate volume but longer operative duration; none of these differences were statistically significant. Patients with urinary incontinence were significantly older (78.1 ± 9.4 vs. 67.5 ± 11.4 years, P = 0.018). Logistic regression confirmed age as an independent predictor of incontinence (odds ratio = 1.095, 95% confidence interval: 1.011-1.186, P = 0.025). No significant predictors were identified for stricture or the composite outcome.

Conclusion: The incidence of US and urinary incontinence after TURP was modest, with age emerging as a significant predictor of incontinence. Elderly patients undergoing TURP should be counseled about the increased risk of postoperative incontinence, and perioperative strategies may be needed to mitigate this risk.

Background: Numerous epidemiological studies have identified a positive correlation between increased physical activity and raised levels of serum 25-hydroxyvitamin D (25(OH)D). However, it remains uncertain whether this correlation implies a cause-and-effect relationship. The aim of this systematic review and meta-analysis was to analyze the effects of physical activity on serum 25(OH)D concentrations in humans.

Materials and methods: Interventional studies examining the effect of physical activity on serum 25(OH)D and published before July 2025 were detected by searching online databases, including PubMed, Embase, Scopus, and Web of Sciences, using a combination of suitable keywords. The heterogeneity among the included trials was evaluated using I2 statistics. Data were pooled using a random-effects model, and the weighted mean difference (WMD) was considered as the overall effect size.

Results: Thirty eligible studies were included in the final analysis. Pooling effect sizes from studies demonstrated a significant increase in serum 25(OH)D levels following physical activity (WMD = 4.08 nmol/L; 95% confidence interval [CI]: 2.05, 6.11). Moreover, in subgroup analysis, the outdoor setting of the intervention resulted in a large and statistically significant difference in the serum Vitamin D levels, compared to the control groups (WMD: 17.23 nmol/L, 95% CI: 14.54, 19.92). However, the indoor setting of the physical activity intervention had a negligible effect on the serum Vitamin D levels (WMD: 0.37 nmol/L, 95% CI: -0.38, 1.14), compared to the control groups.

Conclusion: These results propose that prescribing outdoor physical activity may be an effective clinical strategy for improving Vitamin D levels, primarily mediated through sunlight exposure.

Background: Systemic sclerosis (SSc) is a relatively uncommon connective tissue disorder, commonly manifesting as interstitial lung disease (ILD) and affecting both the lung parenchyma and the modification of the space between endothelium and epithelium. Imaging modalities like computed tomography (CT) scans are essential for diagnosing and revealing specific abnormal findings (ILD patterns) in SSc, such as reticulation and Ground-glass opacity (GGO). To enhance diagnostic precision and minimize human error, we leverage deep learning (DL) techniques.

Materials and methods: In our study, we collected and annotated a new public dataset from 22 individuals, encompassing 2190 lung CT scan slices. After preprocessing and exclusion of slices without abnormalities, 1777 slices from 17 patients were used for model training and validation, and 413 slices from five patients were reserved for independent testing. We use a specialized U-net model to segment these patterns, categorizing them into reticulation or GGO, and employ an automated algorithm to outline lung areas in each CT slice. The model's objective is to quantify the patient's lung involvement in SSc by calculating the total identified GGO and reticulation areas across all slices and normalizing this by the total lung surface area.

Results: The U-net model shows promising results in segmenting both reticulation and a combination of GGO and reticulation, as indicated by Dice coefficients of 87.22% and 86.20%, respectively. Furthermore, the automated algorithm effectively outlines the lung region in each slice, enabling accurate measurement of lung involvement in SSc patients.

Conclusion: In conclusion, using DL using the U-Net model and an automated algorithm has shown promising results in accurately segmenting and quantifying lung involvement in Scleroderma patients using CT scans.

Linear psoriasis (LP) is an unusual form of psoriasis with an unidentified prevalence and is characterized by psoriatic papules and plaques in a Blaschko linear distribution. Based on clinical features, this disorder is divided into two types: isolated LP and superimposed LP. Previous studies have suggested that LP presenting linear appearances is closely related to the Kobner phenomenon (KP) caused by external provocation, including trauma, skin incision, drugs, infections, and striae distensae. Pathogenesis of LP is mainly attributed to the concept of genetic mosaicism but not completely illustrated until now. In this review, we summarize its epidemiological characteristics, clinicopathological features, diagnosis/differential diagnosis, corresponding therapies, focus on the possible pathogenesis of LP, and explore the relationship between LP and KP.

Diabetic kidney disease (DKD) affects 30%-40% of patients with diabetes mellitus (DM). Dyslipidemia is a key modifiable risk factor for the development and progression of DKD. Statins remain the mainstay of lipid management in DM, but concerns exist about their renal effects and limited impact on high-density lipoprotein (HDL) and triglycerides. Fibrates, which primarily target HDL elevation and triglyceride reduction, have shown promise in addressing the lipid profile most relevant to DKD; however, they initially raise serum creatinine levels. This review aims to compare the effects of statins and fibrates on the development and progression of DKD, examining their mechanisms of action, clinical evidence, and limitations of current research. A comprehensive search of PubMed, Scopus, and Web of Science identified clinical studies published from 2000 onward, evaluating the renal effects of statins and/or fibrates in patients with DM, focusing on kidney function, damage markers, and disease progression. According to our findings, statins offer modest, short-term kidney protection; however, their long-term renal effects, and their limited impact on the specific dyslipidemia pattern associated with DKD, are a concern. Fibrates, which more effectively target triglycerides and HDL, show promise in preserving kidney function, though their use may be limited in advanced kidney disease. While some evidence suggests fibrates may be superior, especially in patients with low HDL and high triglycerides, more long-term studies are needed to confirm their definitive advantage over statins. Future research should focus on long-term studies with comprehensive assessments of kidney function.

Fractures pose a significant public health challenge due to their association with poor health outcomes and increased healthcare costs. While bone mineral density (BMD) remains a fundamental element of fracture risk assessment, it fails to fully capture bone quality, including strength and microstructural integrity. Advanced glycation end products, particularly pentosidine, have emerged as critical determinants of bone fragility by altering collagen cross-linking and mechanical properties. This manuscript reviews current evidence on pentosidine as a biomarker for bone quality and fracture risk. Pentosidine, a stable advanced glycation end product, accumulates in bone collagen through nonenzymatic cross-linking, impairing bone toughness and increasing fracture susceptibility. Elevated pentosidine levels correlate with age, diabetes, and chronic kidney disease, conditions strongly linked to increased fracture risk. Clinical studies demonstrate that serum, plasma, and urinary pentosidine levels independently predict fracture risk, even in the absence of significant BMD changes. Advances in detection technologies, including liquid chromatography and enzyme-linked immunosorbent assay, have improved pentosidine quantification, though challenges remain in establishing bone-specific biomarkers. Future research should focus on refining detection strategies and validating pentosidine as a clinical tool for fracture risk assessment, particularly in high-risk populations.

Background: Previous studies indicated that metabolic and bariatric surgery (MBS) is a well-known procedure for considerable and sustainable weight loss. While the studies showed that MBS may unfavorably influence and stimulate hepatic dysfunction by raising the aspartate aminotransferase (AST) and alanine aminotransferase (ALT). It is not yet clear whether the ALT and AST alterations following MBS are transient or it is permanently dangerous for liver function. Thus, we aimed to compare the metabolic effect of three MBS methods on liver function status.

Materials and methods: In this retrospective cohort study, we focused on adults who underwent MBS without a history of liver disorders. The trends of liver function enzymes and albumin levels from the baseline to 3, 6, and 12 months postsurgery were explored for all patients with complete data using multiple binary logistic regressions.

Results: The study involved 1378 participants who completed all of the measurements, with 366 (26.56%) undergoing sleeve gastrectomy (SG), 772 (56.02%) undergoing one-anastomosis gastric bypass (OAGB), and 240 (17.41%) undergoing Roux-en-Y gastric bypass (RYGB). While there were no significant differences in the levels of AST, ALT, and albumin between the three surgical methods at baseline, the effect of bariatric procedures on the AST and ALT levels went through completely differed across time. Furthermore, each bariatric technique had a different trend of the levels of AST and ALT. The trend of the levels of AST and ALT of RYGB and OAGB reached a stable level after 12 months of surgery. On the other hand, the stability time of the AST and ALT levels for SG was observed at 6 months, and the reduction was significantly higher than other methods.

Conclusion: Our findings suggest that the increasing trend of the AST and ALT levels and the stimulation of the liver function postoperatively were transient. The changes in the AST and ALT trend also reached a stable level after 12 months postoperative.

Background: Due to the anti-inflammatory and antioxidant effects of riboflavin, this vitamin can be effective in improving migraine. However, due to conflicting results in previous studies, the present study aimed to determine the effectiveness of riboflavin in improving migraine in a systematic review and dose-response meta-analysis.

Methods: Scopus, ISI Web of Science, and PubMed databases, as well as Google Scholar, were searched up to March 15, 2025 to find trials, published in the English language, that investigated the effect of riboflavin on migraine. Quality assessment of trial studies was done using the Cochrane Collaboration tool. STATA software was used to analyze the data.

Results: The present study included 12 trials with a total sample size 749. The dose-response meta-analysis revealed a significant linear relationship, showing that increasing riboflavin intake up to 400 mg/day was associated with greater reductions in migraine frequency and duration, without evidence of a threshold effect (P < 0.001). Riboflavin had a significant effect on frequency (weighted mean difference [WMD]: -1.39, 95%CI: -2.52 to -0.25; I ² = 91.7%, P < 0.001) and duration of migraine (WMD: -1.36, 95% CI: -2.69 to -0.03; I ² = 90.4%, P < 0.001) in comparison to the control. In terms of methodological approach, eight trials had a good and four had a fair quality.

Conclusion: Riboflavin exhibits promising effects in reducing the frequency and duration of migraine. The limitations of the present study include the absence of a control group and the small sample size in some included studies.

Background: Acute coronary syndrome (ACS) is one of the leading causes of death, but there is no attention paid to the risk stratification of patients with ACS.

Aims: We evaluated the utility of the triglyceride-glucose (TyG) index in predicting the hospital and intensive care unit (ICU) mortality of critically ill patients with ACS.

Materials and methods: The study patients were collected from the eICU Collaborative Research Database. TyG index was calculated as the ln (fasting glucose level [mg/dL] × triglyceride level [mg/dL]/2). The endpoints were hospital and ICU mortality. The univariate and multivariate logistic regressions and subgroup analysis were used to determine the relationship between the TyG index and two endpoints. The scatter plots, bar graphs and smoothing curves further proved it.

Results: 5237 critically ill patients with ACS were enrolled. The TyG index was obviously higher in nonsurvivors groups than survivors groups. TyG index was significantly associated with hospital mortality in univariate analysis (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.15-1.53, P < 0.001), adjusted model I (OR 1.59, 95% CI 1.36-1.85, P < 0.001) and adjusted model II (OR 2.23, 95% CI 1.50-3.31, P < 0.001). The ICU mortality showed the same trends (OR 1.50, 95% CI 1.26-1.78, OR 1.73, 95% CI 1.45-2.06, OR 2.53, 95% CI 1.59-4.03, P < 0.001). The same trends were observed after stratified by tertiles and quartiles. There were continuous linear relations between the TyG index and hospital and ICU mortality.

Conclusion: TyG index is an independent predictor of ICU and hospital mortality in critically ill patients with ACS.