Narra J最新文献

Alzheimer's disease is a leading neurodegenerative disorder characterized by progressive cognitive decline. Early prediction is crucial for enabling timely interventions. Plasma amyloid β-peptides (Aβ), particularly the Aβ-42/Aβ-40 ratio, have been proposed as potential non-invasive biomarkers for cognitive decline and Alzheimer's disease risk. However, conflicting findings and methodological variability have hindered consensus regarding their clinical utility. The aim of this study was to evaluate whether the plasma Aβ levels predict dementia, Alzheimer's disease, and cognitive decline. Studies were eligible for inclusion if they measured at least one plasma Aβ species (Aβ-40, Aβ-42, or the Aβ-42/Aβ-40 ratio) and reported outcomes related to dementia, Alzheimer's disease, or cognitive change. Only human studies published in peer-reviewed journals were included. A comprehensive search of six databases (PubMed, PMC, SSRN, Scopus, BioRxiv, and MedRxiv) was conducted up to December 1, 2024. Risk of bias was assessed using the ROBINS-E tool, and pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis. A total of 25 studies were included in the systematic review, with four contributing to the meta-analysis. Lower plasma Aβ-42/Aβ-40 ratio was not significantly associated with Alzheimer's disease risk (pooled HR=0.8; 95%CI: 0.62-1.04), and substantial heterogeneity was observed (I2=70%, p=0.02). Individual studies varied in their findings: while some reported that lower Aβ-42/Aβ-40 ratio predicted increased Alzheimer's disease risk, others found no association or even opposing trends. Methodological heterogeneity-including differences in sample handling, measurement techniques, and study designs-likely contributed to these inconsistencies. Overall, this review suggests that plasma Aβ-42/Aβ-40 ratio is not reliable predictors for the onset of Alzheimer's disease or dementia. However, the substantial heterogeneity observed underscores the need for further research to clarify the potential of plasma Aβ as a preclinical biomarker.

Iron deficiency is the leading cause of anemia during pregnancy, a major public health concern in many developing countries. To mitigate anemia, iron supplementation for at least 90 days is recommended for pregnant women. The aim of this study was to evaluate adherence to iron supplementation during pregnancy and to identify its key determinants in Cambodia. A cross-sectional study was conducted using secondary data from the 2021- 2022 Cambodia National Demographic and Health Survey. Key variables assessed included maternal age, education level, ethnicity, wealth index, number of pregnancies, age at first pregnancy, prenatal care provider, timing of the first antenatal care (ANC) visit, and frequency of ANC visits. Multivariate logistic regression was employed to evaluate associations between adherence and independent variables. A total of 4,475 women aged 15-49 years who had been pregnant in the past five years were included in the analysis, with 91.2% adhering to iron supplementation for at least 90 days. Multivariate logistic regression showed that those with primary and higher education had greater odds of adherence (odds ratio (OR)=1.38; 95%CI: 1.00-1.90; OR=3.07; 95%CI: 1.39-6.79, respectively) compared to women with no education. There was a positive relationship between education level and adherence. Women who attended four or more ANC visits were more likely to adhere (OR=2.93; 95%CI: 2.27-3.77), and those who initiated ANC in the first trimester had higher adherence compared to those who started later (OR=1.78; 95%CI: 1.35-2.36). This study highlights that education level, frequency, and timing of ANC visits significantly influenced adherence to iron supplementation. Strengthening maternal education and promoting early and regular ANC follow-up should be prioritized to improve adherence and prevent anemia during pregnancy.

Interprofessional collaboration plays a crucial role in the preparation for elective surgeries to enhance the quality, safety, and efficiency of patient care. However, its implementation continues to encounter substantial obstacles, which require the creation of a customized maturity model to effectively resolve these concerns. The aim of this study was to develop an interprofessional collaboration maturity model that is specifically designed for the context of elective surgery preparation. This qualitative study employed a case study approach, conducted in 2024. This maturity model was developed through four stages: a literature study to identify key interprofessional collaboration indicators in surgery; in-depth interviews with ten healthcare professionals at Universitas Muhammadiyah General Hospital, Malang, Indonesia; (3) adaptation of existing maturity models (Fleming, Hudson, collaboration maturity model, and quality management system) as a framework for synthesizing data from the findings of stage 2 (in-depth interviews); and (4) expert panel review to evaluate the maturity model. We successfully developed an interprofessional collaboration maturity model specifically applied to elective surgery preparation, Preoperative Interprofessional Collaboration Maturity Model (P-ICMM), consisting of five maturity levels: emerging, developing, coordinated, integrated, and optimized. Each level's assessment criteria are based on indicators of interprofessional collaboration. This maturity model has been evaluated by the experts in elective surgery preparation to ensure its validity and applicability. This maturity model is expected to help hospitals identify the level of interprofessional collaboration, design strategies to enhance collaboration, and ultimately improve the quality of healthcare services and patient safety in the preparation for elective surgeries.

Snakebite envenomation remains a significant medical concern, particularly in tropical regions where venomous snakes such as Calloselasma rhodostoma and Trimeresurus insularis are prevalent. Both venoms are known for their potent hemotoxic, myotoxic, and inflammatory effects, yet their differential impacts on systemic physiological pathways remain unclear. The aim of this study was to characterize the hematological, myotoxic, and inflammatory effects of C. rhodostoma and T. insularis venoms in a murine model and to explore their influence on systemic factors such as insulin-like growth factor 1 (IGF-1), which is critical for muscle repair and inflammation regulation. Mice were exposed to varying doses (20-100 µg) of C. rhodostoma and T. insularis venoms. Hematological parameters, muscle degeneration, inflammatory cell infiltration, and plasma IGF-1 levels were assessed to evaluate the venoms' systemic and local effects. Our data indicated that C. rhodostoma venom induced significant changes in blood coagulation, muscle edema, and inflammatory infiltration, with pronounced effects even at lower doses. Conversely, T. insularis venom showed a dose-dependent suppression of IGF-1 levels, highlighting its unique systemic impact. Both venoms caused severe muscle damage, characterized by structural disintegration and increased leukocyte infiltration, with C. rhodostoma eliciting a stronger inflammatory response at lower doses.

Colorectal cancer (CRC) is one of the leading causes of cancer-related mortality worldwide, necessitating the need for an effective therapeutic strategy. Beta vulgaris (beetroot) possesses active compounds that exert anti-cancer properties. The aim of this study was to evaluate the potential of beetroot as a preventative agent against the progression of CRC using differentially expressed gene (DEG) analysis and network pharmacology approaches. The protein-protein interaction network and molecular docking analyses were employed to assess the key interactions of beetroot active compounds with CRC-related target protein. Cytotoxicity of beetroot extract was experimentally evaluated using 3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyl tetrazolium bromide (MTT) assay on the HT29 cell line. The result of this study showed that protein in the cell cycle was significantly enriched in CRC, with cyclin-dependent kinase 4 (CDK4) gene as one of the specific genes. Quercetin, galangin, hesperidin, farrerol, and betanin were the most typical compounds of beetroot based on the Comparative Toxicogenomics Database (CTD). Molecular docking studies revealed the strong binding affinity between quercetin (-7.04 kcal/mol) and bentanin (-8.11 kcal/mol) with CDK4. Beetroot demonstrated anticancer properties against the HT29 cell line with IC₅₀ value of 39.03±1.4 µg/mL. In conclusion, the beetroot extract has inhibitory activity against HT29 cell line proliferation, highlighting its potential in preventing the development of CRC through the substantial suppression of gene expression within the cell cycle pathway.

Teloschistes flavicans (Sw.) Norman is a lichen known as the golden-haired lichen. This lichen has been recognized and used in herbal medicine mixtures as an antimicrobial and bioindicator of air pollution that plays a role in ecological systems. The aim of this study was to explore the potential of its secondary metabolites as antibacterial and anticancer agents, particularly against bacterial pneumonia. Two main compounds (vicacinin and parietin) were isolated with chromatography and identified by spectrometry and single- crystal X-ray diffraction. The crystallographic data of vicanicin are reported for the first time. Chromatography and recrystallization methods were used to obtain both compounds with orange (parietin) and white (vicanicin) crystals. Furthermore, these compounds were evaluated for cytotoxicity on keratinocytes (HaCaT) cells and antibacterial activity against pneumonia pathogens (Klebsiella pneumoniae ATCC 1706, Streptococcus pneumoniae ATCC 49619, Moraxella catarhalis ATCC 25240, and Staphylococcus pyogenes ATCC 19615). The cytotoxic activity of these compounds was moderate at the concentration of 50-100 µM. The antibacterial pneumonia activity was relatively weak compared to chloramphenicol. Between the two compounds, vicanicin showed stronger activity than parietin against all strains. Vicanicin was more active against Klebsiella pneumoniae and Staphylococcus pyogenes with minimum inhibitory concentrations of 156±0.77 µM and 156±0.91 µM, respectively. In this study, comprehensive molecular structures of parietin and vicanicin have been successfully elucidated, and their antibacterial and cytotoxic activities have been provided.

Rising life expectancy and changes in disease patterns have led to an increase in retiree medical costs. Understanding these trends is essential for ensuring the financial sustainability of retiree healthcare programs. The aim of this study was to analyze medical cost inflation and its drivers in Indonesia's employer-sponsored retiree health insurance program from 2020 to 2023. A retrospective cohort study using total sampling included 29,695 retirees, analyzing medical records and insurance claims to examine demographic transition, cost analysis and relative risk of cost drivers. The study found that the retiree population is aging, characterized by longer life expectancy and a growing proportion of individuals aged above 71 years. Medical cost inflation among retirees is higher compared to the general population, driven by aging, high-cost diseases, increased healthcare utilization, and rising treatment costs. Cardiovascular diseases, diabetes, and chronic kidney disease are major drivers of high medical costs. Inpatient care is the most significant cost component, with a cost risk 14.39 times higher than clinic visits. Medicine and medical treatment are leading cost contributors in the retired population. The rising cost of retiree healthcare necessitates sustainable financing strategies. The study highlights that medical cost inflation in retirees was higher than in the general population, driven by aging, high-cost diseases, increased utilization, and rising treatment costs. Strengthening preventive care, optimizing primary care, and diversifying funding sources are recommended to ensure long-term financial stability.

Tuberculosis (TB) remains a global and national public health concern, with mortality posing a significant challenge in treatment programs. The aim of this study was to develop a simple risk-scoring system to predict mortality among TB patients and assess its applicability in resource-limited settings. Data from TB patient registries in Phichit Province, Thailand, covering from January 1, 2017, to December 31, 2020, were used. Eligible participants were aged ≥18 years, having completed treatment or death. A risk score was developed and internally validated using logistic regression. Coefficients were used to assign weighted points to predictors and applied to a validation cohort to assess diagnostic performance. The performance was evaluated by generating a receiver operating characteristic (ROC) curve. The study included 2,196 participants, randomly allocated into derivation (n=1,600) and validation (n=596) cohorts. The risk score included Charlson Comorbidity Index scores (1-2 points and ≥3 points) and TB meningitis. It showed an area under ROC curve (AuROC) of 74.34% (95%CI: 70.80-77.88%) with good calibration (Hosmer-Lemeshow χ²: 0.53; p= 0.97). Positive likelihood ratios for low (≤3) and high (≥6) risk were 1.06 (95%CI: 1.03-1.09) and 31.62 (95%CI: 7.23-138.37), respectively. In the validation cohort, AuROC was 79.50% (95%CI: 74.40-84.60%), with 75% and 100% certainty in low- and high-risk groups. In conclusion, this simple risk score, using routine data and two predictors, can predict mortality in TB patients. It may aid clinicians in planning appropriate care strategies. Nevertheless, the tool should undergo external validation before being implemented in clinical practice.

Skin cancer is one of the most prevalent cancers worldwide, with early diagnosis being critical for improving survival rates. Dermoscopy, a non-invasive imaging tool, is widely used for identifying pigmented skin lesions. However, its accuracy is heavily dependent on expert interpretation, which introduces variability and limits accessibility in resource-constrained settings. This highlighted the need for automated solutions to enhance diagnostic consistency and aid in early detection. The aim of this study was to develop a refined machine-learning framework for classifying pigmented skin lesions using dermoscopy images. We employed an enhanced Inception-V3 model, a state-of-the-art convolutional neural network, integrated with a simplified soft-attention mechanism, advanced data augmentation techniques, and Bayesian hyperparameter tuning. These innovations improved the model's ability to accurately focus on and identify relevant lesion features, marking a significant advancement in the field. Using the ISIC-2019 dataset, a publicly available resource containing dermoscopy images classified into eight diagnostic categories, we implemented preprocessing steps such as resizing, cleaning, and data balancing. Additionally, ImageNet transfer learning and Bayesian optimization were applied to refine the model. The inclusion of a soft-attention mechanism further enhanced the model's capacity to identify patterns within lesion images. Our model exhibited outstanding performance on the ISIC-2019 dataset, achieving a sensitivity of 98.5%, specificity of 99.62%, precision of 97.42%, accuracy of 97.38%, an F1 score of 97.34%, and an area under the curve (AUC) of 0.99. These metrics underscored the model's superior capability in accurate and reliable classification of pigmented skin lesions, surpassing current benchmarks and demonstrating significant advancements over existing methodologies.

Oral mucositis is a common complication of chemotherapy that significantly impacts quality of life and may reduce treatment efficacy. While oral cryotherapy has been widely studied as a preventive intervention due to its cost-effectiveness, safety, and ease of use, most research focused on clinical outcomes without incorporating objective cytological assessments of mucosal changes. The aim of this study was to evaluate the effectiveness of oral cryotherapy in managing chemotherapy-induced mucositis using exfoliative cytology to monitor oral mucosal changes. A single-blinded, randomized controlled trial was conducted involving 50 cancer patients undergoing chemotherapy, who were randomly assigned to either the intervention or control group. The control group (n=25) received standard oral hygiene care, while the intervention group (n=25) received oral cryotherapy in addition to routine oral hygiene. A 20-minute oral cryotherapy was administered twice daily after breakfast (09:00 A.M.) and lunch (01:00 P.M.) for 14 days. This study found a significant reduction in mucositis scores was observed in both groups (p<0.05). However, post-hoc analysis indicated that mucositis severity declined earlier in the cryotherapy group, whereas improvement in the control group was noted only after 14 days. Serial oral mucosal smears analyzed via exfoliative cytology revealed a reduction in inflammatory cells and the absence of coccus microorganisms by days 7 and 14 in the intervention group. In conclusion, this study demonstrated that oral cryotherapy effectively reduces the severity and duration of mucositis and accelerates recovery in cancer patients undergoing chemotherapy. Oral cryotherapy can be applied as a viable alternative to mitigate the severity of oral mucositis in this patient population.