Journal of Research in Medical Sciences最新文献

Background: Breast cancer is one of the most common cancers in women. General anesthesia is a commonly used anesthesia method for breast cancer surgery, and studies have confirmed that general anesthesia can induce immunosuppression in breast cancer patients and increase the metastasis rate of tumors. However, the difference between the effects of intravenous general anesthesia and inhalation anesthesia on the function of T-lymphocytes is still controversial, and it is necessary to explore reasonable anesthesia methods to reduce immunosuppression caused by surgery and anesthesia.

Materials and methods: Databases (Embase, PubMed, Cochrane Library, CBM, CNKI, and Wanfang) were searched (up to October 2022) for randomized controlled trials (RCTs) comparing intraoperative inhalation anesthesia and propofol intravenous anesthesia in breast cancer patients, with the outcome of T-lymphocyte subsets. The meta-analysis was performed by STATA 14.0.

Results: Six RCTs with 352 patients were included in the study. Compared with inhalation anesthesia, there was no difference in T-lymphocyte subsets between the two groups immediately after surgery, but the activities of CD4⁺ T cells in patients with propofol anesthesia were higher (standard mean difference [SMD] = 0.234, 95% confidence interval [CI]: 0.003-0.466, P = 0.047, I² = 44.1%) than those under inhalation anesthesia 1 day after surgery, and CD4⁺/CD8⁺ activities in patients with propofol anesthesia were higher (SMD = 304, 95% CI: 0.072-0.537, P = 0.010, I² = 48.0%) than those under inhalation anesthesia 1 day after surgery.

Conclusion: There were no differences in the effects of propofol and inhalation anesthetics on T-lymphocytes immediately after surgery, but the inhibitory effects of inhalation anesthetics on CD4⁺ and CD4⁺/CD8⁺ cells were stronger 1 day after surgery.

Background: Protein-1 (PD-1) and programmed cell death 1 ligand 1 (PD-L1) therapy have become an important treatment approach for patients with advanced nonsmall cell lung cancer (NSCLC), but primary or secondary resistance remains a challenge for some patients. PD-1/PD-L1 combined with anti-angiogenic drugs (AAs) in NSCLC patients have potential synergistic effects, and the survival benefit may vary based on a treatment order. To investigate the efficacy of PD-1/PD-L1 combined with AAs as the treatment for patients with advanced NSCLC.

Materials and methods: We comprehensively searched EMBASE, PubMed, Web of Science, CNKI, VIP, and Wanfang databases from January 2017 to September 2022. The Cochrane risk bias tool evaluated the quality of included randomized clinical trials. Newcastle-Ottawa-Scale score was used to evaluate the quality of retrospective studies. Publication bias was evaluated by funnel plot, Begg's test, and Egger's test.

Results: Seventeen articles were finally selected, involving 5182 patients. Meta-analysis results showed that PD1/PD-L1 combined with AAs therapy significantly improved progression-free survival (PFS) (hazard ratio [HR] = 0.61, 95% confidence interval [CI]: 0.50-0.75, P < 0.00001), overall survival (OS) (HR = 0.79, 95% CI: 0.71-0.88, P < 0.00001), and objective response rate (ORR) (risk ratio = 0.88, 95% CI: 0.81-0.96, P = 0.004), with the statistically significant difference. The sensitivity analysis demonstrated the robustness of the PFS, ORR, and OS.

Conclusion: The combination of PD-1/PD-L1 inhibitors with AAs in treating advanced patients has exhibited notable therapeutic advantages when contrasted with monotherapy. Specifically, the administration of PD-1/PD-L1 inhibitors in conjunction with AAs, or sequential treatment involving PD-1/PD-L1 followed by AAs, has shown enhanced therapeutic efficacy in this patient population.

Background: 10%-15% of the world's population suffers from kidney stones. Nearly 50% increase was observed in diagnosing and treating nephrolithiasis in the last decades. Effective medical treatment for the disease is not yet well established. Moreover, there is an increasing global demand to manage diseases using complementary and alternative medicine. This study aimed to formulate and assess the safety and efficacy of a multi-ingredient formulation from traditional Persian medicine (TPM) known as Mofatet powder in patients suffering from calcium kidney stones.

Materials and methods: The aqueous extract of Mofatet powder was prepared, freeze-dried, and formulated as capsules. 26 patients in the drug group and 25 patients in the placebo group used 500 mg capsules of the drug/placebo twice daily for 5 weeks. Ultrasonography/kidney, ureter and bladder imaging, urine analysis, and biochemical parameters were evaluated before and after the intervention.

Results: The imaging results showed a 60.73% decrease (P < 0.001) in stone size in the drug group. Moreover, the urinary calcium decreased (P = 0.02) and the urinary magnesium increased (P < 0.001) in the drug group. No remarkable changes were observed in the placebo group in these parameters. No significant effect was observed in aspartate transaminase, alanine transaminase, serum creatinine, and blood urea nitrogen levels in none of the groups.

Conclusion: This study suggests that Mofatet powder was effective in reducing calcium kidney stones size with no potential nephro/hepatotoxicity. After confirming these results in larger clinical trials with longer duration, this formulation can be considered a treatment for nephrolithiasis.

Background: Human T-cell lymph tropic virus type 1 (HTLV-I)-related myelopathy/tropical spastic paraparesis (TSP) is a progressive inflammatory process affecting the spinal cord that occurs as a result of HTLV 1. The use of nonpharmacological approaches has always been one of the treatment strategies in these patients, but disagreement about these interventions and their results has led to their limited use. Therefore, this study aimed to identify nonpharmacological interventions and their consequences in these patients.

Materials and methods: We followed the Cochrane Handbook for systematic reviews of interventions. The present report is organized according to the preferred reporting items for systematic reviews and meta-analyses. This study was conducted at PubMed, Cochrane Library, Web of Science, and Scopus, among all published studies by December 30, 2021. Keywords were: HTLV-1, Human T-lymph tropic virus 1, HTLV-I-associated myelopathy, HAM/TSP, tropical spastic paraparesis, nonpharmacological intervention, nonpharmacological treatment, massage, physiotherapy, acupuncture, acupressure, and exercise. The quality of the studies was assessed using JADAD.

Results: Of 288 articles, 11 were eligible for data extraction published between 2014 and 2021. 90/9% of studies were randomized clinical trials. 81/8% of articles were of high quality. The total sample size was 253 people, of which 137 (54/15%) were women. Approaches such as exercise and motion therapy, electrotherapy, behavioral therapy, and virtual reality can be used for these patients. With these interventions, results such as improved mobility and balance, physical condition, pain, quality of life, muscle spasticity, maximum inspiratory pressure, and urinary symptoms can be achieved.

Conclusion: The most common physical therapy method used in studies was active and passive body movements, which are associated with positive results for patients. Due to the small sample size in this group of studies, it is necessary to conduct more clinical trials for more accurate conclusions. Furthermore, due to the limited number of studies that have used electrical stimulation or combined intervention packages, it is not possible to say with certainty what effect these methods have on patients. It is necessary to conduct more clinical trials.

Background: Myocardial infarction (MI) can lead to higher cellular damage, making cell-free DNA (cfDNA) a potential biomarker for assessing disease severity. The aim of this study is to evaluate survival predictions using cfDNA measurements and assess its correlation with MI.

Materials and methods: A direct fluorescence assay was employed to measure cfDNA content in the blood samples of participants. The inclusion criteria included patients who gave informed consent, suffering from ST-elevation myocardial infraction (STEMI) based on established diagnostic criteria (joint ESC/ACC guidelines), between the age of 18 and 80 years old, and had elevated troponin biomarker levels. The study included 150 patients diagnosed with STEMI and 50 healthy volunteers as controls. Serial monitoring of patients was conducted to track their postdisease status. The rate of change of cfDNA was calculated and daily measurements for 7 days were recorded.

Results: Mean levels of cfDNA were found to be 5.93 times higher in patients with STEMI compared to healthy controls, providing clear evidence of a clinical correlation between cfDNA and STEMI. Patients were further categorized based on their survival status within a 90-day period. The study observed a strong predictive relationship between the rate of change of cfDNA during daily measurements and survival outcomes. To assess its predictive capability, a receiver operating characteristics (ROC) curve analysis was performed. The ROC analysis identified an optimal cutoff value of 2.50 for cfDNA, with a sensitivity of 81.5% and specificity of 74.0% in predicting disease outcomes.

Conclusion: This study demonstrates a robust association between cfDNA and STEMI, indicating that cfDNA levels can be a valuable early prognostic factor for patients. Serial measurements of cfDNA during early disease onset hold promise as an effective approach for predicting survival outcomes in MI patients.

Background: To compare perioperative adverse events between general anesthesia with endotracheal tube (ETT) and general anesthesia with laryngeal mask airway (LMA) in patients undergoing laparoscopic hysterectomy.

Materials and methods: This was a large sample retrospective, propensity score-matched (PSM) study. We collected the data of 6739 female patients who underwent laparoscopic hysterectomy between January 2016 and June 2021 in our hospital, China. Patients were divided into two groups (ETT group and LMA group) according to different airway management modes. Data on all perioperative adverse events were collected. PSM analysis was performed to control confounding factors and differences in baseline values between the two groups. Finally, 4150 female patients were recruited after PSM.

Results: The total number of patients taking intraoperative vasoactive drugs during surgery was higher in the ETT group than in the LMA group (P = 0.04). The LMA group had a higher incidence of vomiting (51 [2.46%]) and somnolence (165 [7.95]) in the postanesthesia care unit (PACU) than the ETT group (71 [3.42%] and 102 [4.92%], respectively) (P = 0.02 and P < 0.001). Hypothermia was significantly higher in the LMA group (183 [10.36%]) than in the ETT group (173 [8.34%]) in the PACU (P = 0.03). The number of patients with sore throat was significantly higher in the ETT group (434 [20.02%]) than in the LMA group (299 [14.41%]) in the ward (P < 0.001). Other variables such as hypoxemia, moderate to severe pain, abdominal distension, diarrhea, sleep disorders, wound bleeding, and skin itch were not significantly different between the two groups (P > 0.05).

Conclusion: The ETT group had more incidences of vomiting, sore throat, and cough complications and needed more drug treatment than the LMA group. LMA is a better airway management mode and LMA general anesthesia can be safely used in patients undergoing laparoscopic nonemergency hysterectomy.

Background: This retrospective cohort study aimed to evaluate the effect of lifestyle factors (e.g., smoking, drinking, physical exercise, and sleep duration) on the long-term survival of gastric cancer (GC) patients after radical resection.

Materials and methods: GC patients after radical resection were enrolled from January 2016 to December 2017. Their baseline clinical data, lifestyle factors, and prognosis were collected. The primary endpoint was all-cause death. The relationship between the variables and survival was examined using the Cox proportional hazards model.

Results: A total of 309 patients were enrolled and 296 patients were followed up for a median of 54.0 months, with 130 confirmed deaths. Older age (>60 years) (hazard ratio [HR]: 1.307, 95% confidence interval [CI]: 1.056-2.161, P = 0.006), advanced tumor, node, and metastasis stage (P < 0.05), poorly pathological differentiation (HR: 1.765, 95% CI: 1.080-2.884, P = 0.023), history of smoking (P < 0.001), never physical exercise (HR: 2.057, 95% CI: 1.170-3.617, P = 0.012), long sleep duration (≥8 h) (HR: 4.160, 95% CI: 1.501-11.533, P = 0.006), and short sleep duration (<6 h) (HR: 3.417, 95% CI: 1.312-8.900, P = 0.012) were independent indicators of a poor overall survival in GC patients after radical resection.

Conclusion: Smoking cessation, proper sleep duration, and regular physical exercise habits can improve the long-term survival of GC patients after radical resection.

Background: There is a lack of evidence on the link between mitral annular calcification (MAC) and coronary atherosclerotic diseases. The present investigation was undertaken to detect the clinical and prognostic value of MAC in coronary atherosclerotic diseases in patients who underwent coronary computed tomographic (CT) angiography.

Materials and methods: Two hundred and five individuals with MAC and without it (n = 85 and 120, respectively) were included in the present cross-sectional study. Coronary artery disease-reporting and data system (CAD-RADS) at coronary CT angiography was used to define the severity of coronary atherosclerotic diseases. Patients were classified into no or non-significant CAD (CAD-RADS 0-2) and significant CAD (CAD-RADS 3-5) according to the severity of coronary atherosclerotic diseases. The association of MAC with two mentioned groups (no or non-significant CAD and significant CAD) was assessed using the Chi-squared test and logistic regression in crude and adjusted models.

Results: Patients with MAC were significantly older (69.34 ± 8.20 vs. 60.64 ± 11.42, P < 0.001), had lower glomerular infiltration rate (69.67 ± 20.92 vs. 78.00 ± 20.23, P = 0.005), and higher coronary artery calcification score (352.87 ± 495.85 vs. 200.55 ± 426.13, P = 0.05) in comparison to those without MAC. However, the significant difference between the two groups regarding coronary artery calcification score disappeared after adjustment for confounders (P = 0.14). In addition, a statistically significant positive link between MAC and significant CAD was observed (odds ratio [OR] [95% confidence interval (CI)]: 1.96 [1.04-3.71], P = 0.04). Nevertheless, the association became statistically insignificant after adjustment for confounders (OR [95% CI]: 1.60 [0.78-3.28], P = 0.2).

Conclusion: The findings of the study revealed that MAC has no independent prognostic value in coronary atherosclerotic diseases evaluated by coronary CT angiography.

Background: Autism spectrum disorder is a neurodevelopmental condition in which impaired connectivity of the brain network. The functional magnetic resonance imaging (fMRI) technique can provide information on the early diagnosis of autism by evaluating communication patterns in the brain. The present study aimed to assess functional connectivity (FC) variations in autism patients.

Materials and methods: Resting-state fMRI data were obtained from the "ABIDE" website. These data include 294 autism patients with a mean (standard deviation) age of 16.49 (7.63) and 312 healthy individuals with a mean (standard deviation) age of 15.98 (6.31). In this study, changes in communication patterns across different brain regions in autism patients were investigated using graph-based models.

Results: The FC cluster of 17 regions in the brain, such as the hippocampus, cuneus, and inferior temporal, was different between the patient and healthy groups. Based on connectivity analysis of pair regions, 36 of the 136 correlations in the cluster were significantly different between the two groups. The middle temporal gyrus had more communication than the other regions. The largest difference between groups was - 0.112, which corresponding to the right middle temporal and right thalamus regions.

Conclusion: The findings of this study revealed functional relationship alterations in patients with autism compared to healthy individuals, indicating the disease's effects on the brain connectivity network.

Background: Sleep as a biological phenomenon is effective in the performance and recovery of athletes. Questionnaires can be used as a cost-effective initial assessment tool for sleep. The Athlete Sleep Screening Questionnaire (ASSQ) demonstrated a clinically valid instrument for screening relevant sleep issues in athletic populations. Due to the lack of validated tools for adequate screening for sleep difficulties in the Iranian athlete population, the present study was conducted to evaluate the validity and reliability of the Persian version of the ASSQ.

Materials and methods: The translation process was performed using instructions by Beaton et al. Content validity was assessed by a panel of experts. Exploratory and confirmatory factor analysis was performed for two 5-item sleep difficulty scores (SDS) and a 4-item chronotype score. Internal consistency based on Cronbach's alpha and McDonald's omega and stability reliability were used to evaluate reliability.

Results: The ASSQ achieved conceptual and semantic equivalence with the original scale. The item-level content validity index (I-CVI) of each item ranged from 0.87 to 1, and the averaging scale-level CVI/average was 0.95. In factor analysis, one factor for SDS and one factor for chronotype score were identified and confirmed. The internal consistency of the SDS scale (α =0.77, Ω =0.83) and chronotype (α =0.74, Ω =0.77) was acceptable. Stability reliability was confirmed for SDS scale (intra-class correlation [ICC] =0.87) and for chronotype (ICC = 0.83).

Conclusion: Persian ASSQ has acceptable psychometric measurement properties as a screening tool to assess sleep in Iranian athletes.