Journal of Research in Medical Sciences最新文献

Background: Obstructive sleep apnea (OSA) commonly coexists with lung disease. However, the association between OSA components and lung function remains unclear. This study estimated STOP-BANG scores according to lung function using nationwide Korean data.

Materials and methods: Three thousand and two hundred eighty adults with available STOP-BANG scores and spirometry data were analyzed. Multivariate regression models were applied to estimate STOP-BANG scores according to lung function.

Results: Approximately 28% of participants had abnormal lung function, and the characteristics were diverse. The significant factors associated with abnormal lung function included the STOP-BANG score. In multivariate regression analyses, individuals with abnormal lung function had significantly higher STOP-BANG scores than those with normal lung function (odds ratio: 1.19; 95% confidence interval: 1.10- 1.29; P < 0.001), and this difference was remarkable in men.

Conclusion: Our results suggest that screening and management of OSA components are warranted to prevent impaired lung function.

Background: One of the most appropriate methods for analyzing longitudinal data is multistate model. This study has aimed to evaluate the risk factors of transfer to local recurrence (LR), distant metastasis (DM), and death in rectal cancer patients through multistate survival analysis.

Materials and methods: This is a retrospective cohort of rectal cancer patients in Mashhad, Iran. Multistate models were applied to show the difference between the significant risk factors affecting death and recurrence in different defined transitions. Risk factors include age, sex, primary surgical technique, tumor location, postoperative tumor stage, circumferential or distal resection involvement, surgery time, and surgical complications.

Results: A total of 280 eligible patients with a median (interquartile range) survival time of 60 (42-76.2) months were investigated. Based on Cox proportional multistate model, the hazard ratio (HR) of DM increases by 3%/1-year increase in age (P = 0.018). The HR of DM and the HR of LR in patients with postoperative disease Stage II/III were 3.06 and 2.53 times higher than patients with cancer Stage 0/I (P < 0.05). When the resection margins of distal or circumferential were involved, the HR of DM was 3.58 times higher than those patients without involvement. In the extended multistate model, time of DM was a significant predictor of death (P = 0.006).

Conclusion: Age and margin involvement in DM path and stage in LR and DM path had a significant effect; however, no effective variable was seen on the death of patients with recurrence. The time of metastasis also had an effect on the path of death.

The implementation of human research involving children and adolescents necessitates a nuanced understanding of the distinct ethical complexities and sensitivities that arise. This study aimed to conduct a comprehensive review of ethical guidelines for research with these populations by extensively examining existing standards and applied studies. The review revealed a myriad of challenges inherent in the involvement of children and adolescents as research subjects. The most important ethical challenges relate to the principles of bioethics and their compliance with human studies involving children/adolescents, informed consent, and risk assessment in studies on children/adolescents. To facilitate appropriate participation of youth in research endeavors, meticulous planning is required, in conjunction with a re-examination of the definitions of ethical principles in pediatric research, close monitoring of potential risks and benefits, and the utilization of a combination of innovative and traditional approaches to obtain informed consent that adheres to ethical standards. Performing research with children and adolescents requires special considerations to address the unique ethical issues that can emerge. By adhering to ethical guidelines tailored specifically to these vulnerable populations, researchers can help ensure that studies are conducted in an appropriate and responsible manner.

Background: Apnea testing is mandatory to confirm brain death; however, it is unsafe for patients who have substantial hypoxemia without ventilator support. We used a new modified apnea test without the need to disconnect the patient from the ventilator in the present study and compared the outcomes and complications of the new method to the widely used old method.

Materials and methods: The current study was conducted on people suspected of having brain death. Both the old and new apnea tests were carried out on the same individual. In the new modified method, instead of hyperventilating and then separating the brain death from the ventilator, the induced hypercapnia method was used, and instead of performing repeated arterial blood gas (ABG), the target ETCO₂ was obtained, and at the time of the target ETCO₂, ABG was also checked followed by comparing ETCO₂ with PaCO₂.

Results: Thirty patients, including 25 (83.3%) males and 5 (16.75%) females, were included in the study. The results showed significant improvement in terms of O₂ saturation and heart rate (HR) using the new modified apnea test compared to the common test. Systolic blood pressure, diastolic blood pressure, and the frequency of complications were improved in the new modified test.

Conclusion: The modified apnea test produced better results in terms of O₂ saturation, HR, and other clinical factors, while it does not require disconnection from the ventilator and repeated ABG assessment. Therefore, it can be used to successfully diagnose brain death in high-risk individuals suffering from severe hypoxia.

Background: The establishment of pneumoperitoneum has impacts on patient's cardiovascular function. In this study, the respiratory variation of inferior vena cava (IVC), stroke volume (SV) index, and other parameters was monitored to determine how the pneumoperitoneum affects the patient's hemodynamic and acknowledge how to resolve it.

Materials and methods: Fifty-five patients were randomly divided into Group A (8 mmHg), Group B (10 mmHg), Group C (12 mmHg), Group D (14 mmHg), and Group E (12 mmHg, infusion with 7 mL/kg crystalloid solution). The parameters including IVC variability, SV index, mean artery pressure (MAP), heart rate (HR), cardiac output index (CI), and airway pressure were measured, to compare the changes before and after pneumoperitoneum.

Results: Among Group A, Group B, Group C, and Group D, there were no significant differences in patients' prepneumoperitoneum information. Compare with prepneumoperitoneum, the difference in IVC variability, SV index, MAP, HR, CI, and airway pressure was statistically significant (P < 0.05). After the establishment of pneumoperitoneum, the difference in IVC variability, SV index, and airway pressure among Group A, Group B, Group C, and Group D was statistically significant (P < 0.05). Compare with Group C, the change rates of IVC variability, SV index, MAP, HR, and CI were smaller in Group E (P < 0.05).

Conclusion: The establishment of pneumoperitoneum could increase the patient's IVC variability and reduce SV index, and with the increase of pressure, IVC variability had an increasing trend, SV index had a decreasing trend. Fluid transfusion could reduce the relative influence of the pneumoperitoneum.

Background: The research explores the predictive efficacy of the neutrophil-to-lymphocyte ratio (NLR) in conjunction with the Global Registry of Acute Coronary Events (GRACEs) score for inhospital major adverse cardiovascular events (MACEs) among acute ST-segment elevation myocardial infarction (STEMI) subjects with primary percutaneous coronary intervention (PCI) history.

Materials and methods: Patients were categorized into MACE (n = 58) and non-MACE cohorts (n = 184) based on MACE occurrence events during hospitalization. The predictive value of the NLR, GRACE score, and their combination for inhospital MACE events in STEMI subjects was assessed by the receiver operating characteristic curve (ROC).

Results: NLR (8.99 [5.06, 12.01] vs. 5.15 [3.13, 7.66]) and GRACE scores (159.62 ± 43.39 vs. 116.96 ± 28.15) within MACE group notably surpassed the non-MACE group (P < 0.05). ROC curve analysis demonstrated that the area under the curve (AUC) for NLR in forecasting inhospital MACE events was 0. 72 (95% confidence interval [CI]: 0.645-0.795), with 0.655 sensitivity and 0.723 specificity, and optimal cutoff value as 7.01. The AUC for the GRACE score was 0.791 (95% CI: 0.717-0.865), with 0.862 sensitivity and 0.598 specificity, and the optimal cutoff value was 121.5. The combined AUC of NLR and GRACE score was 0.814 (95% CI: 0.745-0.884), with 0.707 sensitivity and 0.837 specificity.

Conclusion: Both NLR and GRACE score independently predict inhospital MACE events in STEMI patients post-PCI. Integration of the NLR and GRACE score enhances accuracy in forecasting inhospital MACE event occurrences.

There are different types of treatment for eye diseases. Although the majority of eye diseases are curable with primary treatments and surgery, some of degenerative eye damages need regeneration that is not gained by conventional procedures. Stem cells, such as mesenchymal stem cells, human embryonic stem cell-derived retinal pigmented epithelium, and inducible pluripotent stem cells, are now considered one of the most important and safe methods for regeneration of various damaged tissues or organs. However, how will stem cell therapy contribute to regeneration and overcome degenerative eye diseases? This review discusses the regenerative mechanisms, clinical applications, and advantages of different types of stem cells for restoring degenerative eye diseases.

Background: The importance of diffusion in prostate cancer (PCa) diagnosis has been widely proven. Several studies investigated diffusion models in PCa diagnosis.

Materials and methods: This systematic review and meta-analysis study was performed to evaluate the ability of three diffusion models to diagnose PCa from the scientific electronic databases Embase, PubMed, Scopus, and Web of Science (ISI) for the period up to March 2022 to identify all relevant articles.

Results: Eighteen studies were included in the systematic review section (7 diffusion kurtosis imaging [DKI] studies, 4 diffusion tensor imaging [DTI] studies, 4 intravoxel incoherent motion [IVIM] studies, and 3 IVIM-DKI studies). Pooled sensitivity, specificity, accuracy, and summary area under each diffusion model's curve (AUC) and 95% confidence intervals (CIs) were calculated. The pooled accuracy and 95% CI on detection (differentiation of tumor from normal tissue and benign prostatic hyperplasia/prostatitis) were obtained for apparent diffusion coefficient (ADC) at 87.97% (84.56%-91.38%) for DKI parameters (Gaussian diffusion [DK] 87.94% [78.71%-97.16%] and deviation from Gaussian diffusion [K] 86.84% [81.83%-91.85%]) and IVIM parameters (true molecular diffusion [DIVIM] 81.73% [72.54%-90.91%], perfusion-related diffusion [D*] 65% [48.47%-81.53%] and perfusion fraction [f] 80.36% [64.23%-96.48%]). The AUC values and 95% CI in the detection of PCa were obtained for ADC at 0.95 (0.92-0.97), for DKI parameters (DK 0.94 [0.89-0.99] and K 0.93 [0.90-0.96]) and for IVIM parameters (DIVIM 0.85 [0.80-0.91], D* 0.60 [0.43-0.77] and f 0.73 [0.63-0.84]). Two studies showed that the DTI accuracy values were 97.34% and 85%. For IVIM-kurtosis model in PCa detection, two studies stated that the DIVIM-K and KIVIM-K accuracy values were 85% and 84.44% (the pooled accuracy; 84.64% with 95% CI 75.78%-93.50%), and 72.50% and 71.11% (the pooled accuracy, 72.10% with 95% CI 64.73%-79.48%), respectively.

Conclusion: Our findings showed that among the DKI, IVIM, and ADC parameters, it seems that ADC, Dk, DIVIM, and K are the most important, which can be used as an indicator to distinguish PCa from normal tissue. The DKI model probably has a higher ability to detect PCa from normal tissue than the IVIM model. DKI probably has the same diagnostic performance in PCa detection and grading compared to diffusion-weighted imaging and ADC.

Background: Perioperative neurocognitive disorders (PNDs) were the most common complication in elderly patients undergoing surgery. Early identification of risk factors for PNDs and implementation of preventive measures were critical to improve prognosis. We performed this systematic review and meta-analysis to explore the impact of preoperative frailty on PNDs in elderly surgical patients.

Materials and methods: Systematic searches were performed in PubMed, Embase, and Web of Science. A fixed-effect model in RevMan5.3 software was conducted due to the low heterogeneity. The potential risk bias was assessed through Funnel plot and Egger's test. Sensitivity analysis was used to examine the robustness of the outcomes.

Results: Sixteen cohort studies enrolling 4805 elderly patients were qualified for meta-analysis. Pooled results showed that preoperative frailty was linked to the development of PNDs (pooled odds ratio [OR]: 2.40, 95% confidence interval [CI]: 2.05-2.80, P < 0.001) without obvious heterogeneity (P = 0.19, I ² = 22%). Subgroup analyses revealed that the correlation between preoperative frailty and PNDs was more remarkable in prospective cohort studies (OR: 3.11, 95% CI: 2.47-3.91, P < 0.001) compared to retrospective cohort studies (OR: 1.94, 95% CI: 1.57-2.39, P < 0.001; test for subgroup difference, P = 0.003). In addition, the correlation in patients with cardiac surgery (OR: 3.38, 95% CI: 2.44-4.68, P < 0.001) was more noticeable than noncardiac surgery (OR: 2.17, 95% CI: 1.82-2.59, P < 0.001; test for subgroup difference P = 0.02).

Conclusion: Our results demonstrated that preoperative frailty was independently associated with PNDs in geriatric patients undergoing elective surgery.

Background: In this study, we decided to investigate the state of depression, anxiety, and quality of life and its relationship with some demographic characteristics of lung neoplasm patients who were candidates for surgery.

Materials and methods: In a cross-sectional study, all patients with lung neoplasm who were referred to medical centers affiliated to Isfahan University of Medical Sciences and were candidate for lung surgery in 2020-2021. Based on the inclusion and exclusion criteria, 52 people were assigned to the study consecutively. Then, the patients completed the demographic information questionnaire, the Hospital Anxiety and Depression Scale, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) (EORTC QLQ-C30).

Results: The score of depression and anxiety was normal (range 7-0) and the score of quality of life was in the relatively good range (50-175). As the patient's age increases (P = 0.014) and the duration of the disease increases (P = 0.041), the level of depression increases significantly. People with higher education had lower depression (P = 0.001) and anxiety (P = 0.003). People living in the city had a significantly better quality of life (P = 0.039). The higher the depression (P < 0.0001) and anxiety (P = 0.037) of the people, the lower the quality of life of the patients.

Conclusion: As anxiety and depression increase, the quality of life of lung neoplasm patients decreases. Some demographic characteristics such as old age, insufficient education, rurality, and increased duration of the disease can be the risk factors for depression, anxiety, and reduced quality of life of patients with lung neoplasm.