Advances in Clinical and Experimental Medicine最新文献

Background: Hematopoietic stem cell transplantation (HSCT) is a procedure commonly used in the treatment of various hematological disorders with the aim of curing the patient or prolonging life. The vast majority of patients must have antineoplastic therapy before HSCT, which can result in weight loss, sarcopenia or cachexia. Additionally, there is a high risk of malnutrition and physical deterioration during HSCT. By assessing physical fitness prior to HSCT, a physical therapist can individualize an exercise program, which in turn may speed up recovery after HSCT.

Objectives: The aim of the study was to assess the physical fitness of patients with hematological malignancies qualified for HSCT as an indication for prehabilitation.

Material and methods: The study included 65 patients with hematological malignancies who were qualified for HSCT between September 1, 2022, and September 1, 2023. The reference group consisted of 219 healthy adults. The clinical study protocol involved participants performing 3 tests: the 6-minute walk test (6MWT), the timed-up and go test (TUG) and the 30-second chair-stand test (30CST).

Results: Patients with hematological malignancies were characterized by significantly lower endurance capacity (median (Me) = 420.50 (IQR 110.25) vs Me = 580.00 (IQR 133.00); p < 0.001) and significantly lower body strength (Me = 11.00 (IQR 6.00) vs Me = 15.00 (IQR 5.00); p < 0.001). There was also a statistically significant difference in the diagnosis and in the number of lines of systemic therapy. Additionally, a statistically significant difference was observed between the outcomes of the physical fitness level, particularly for TUG and 30CST, and the time from diagnosis to transplantation.

Conclusions: The presented results suggest a negative consequence of hematological disease and its treatment on the functional status of patients qualified for HSCT and indicate the need for individualized rehabilitation management depending on the type of diagnosis, the number of lines of systemic therapy, and the time between diagnosis and transplantation.

This editorial emphasizes on non-pharmacological approaches for stress-related neuropsychiatric disorders due to side effects of pharmacological approaches. It highlights various exercises, specific natural compounds and their mechanisms for stress reduction. A combination of both can be a good strategy for the stress management. There are some challenges for these approaches. One major limitation is the standardization of these interventions. Natural compounds often have different quality and potency depending on their source and preparation, which can impact their efficiency. Additionally, determining the optimal dosage for different compounds remains a significant challenge, as individual responses can vary considerably. Interdisciplinary collaboration between researchers, clinicians and policymakers must be established to address the challenges. By conducting large-scale, well-designed clinical trials researchers gain a deeper understanding of the mechanisms underlying these approaches and can prepare clear guidelines for their integration into mainstream healthcare, ultimately improving patient outcomes and reducing dependence on pharmacological treatments.

Background: Acute respiratory distress syndrome (ARDS) presents a significant challenge in the management of sepsis, with various comorbidities potentially influencing its development. Understanding the impact of these comorbidities is crucial for improving patient outcomes.

Objectives: This meta-analysis was conducted to investigate the relationship between various comorbidities and the development of ARDS in patients with sepsis, with the aim of improving understanding and management of this condition.

Material and methods: The study included adult sepsis patients from 8 studies, totaling 16,964 participants. Risk of bias was assessed using the Newcastle-Ottawa scale (NOS), and the data analysis was performed and reported as pooled odds ratios (ORs) computed using a random-effects model. Heterogeneity and publication bias were assessed using the I2 statistic and Doi plots with the Luis Furuya-Kanamori (LFK) index, respectively.

Results: Chronic obstructive pulmonary disease was significantly associated with an increased risk of ARDS (OR: 1.43, 95% confidence interval (95% CI): 1.02-2.01). Other comorbidities showed no significant associations: diabetes mellitus (DM) (OR: 0.88, 95% CI: 0.69-1.11), hypertension (HTN) (OR: 0.86, 95% CI: 0.56 to 1.34), coronary artery disease (CAD) (OR: 0.95, 95% CI: 0.86-1.06), congestive heart failure (CHF) (OR: 1.08, 95% CI: 0.61 to 1.90), chronic kidney disease (CKD) (OR: 0.89, 95% CI: 0.65-1.22), chronic liver disease (CLD) (OR: 1.13, 95% CI: 0.61-2.09), and cancer (OR: 0.90, 95% CI: 0.59-1.35). Additional analyses indicated moderate-to-high heterogeneity and some evidence of publication bias.

Conclusion: Chronic obstructive pulmonary disease is a notable risk factor for ARDS in sepsis patients, suggesting the need for enhanced surveillance and management in this group. Further research is necessary to understand the mechanisms and explore other potential ARDS risk factors in sepsis.

Background: Hepatic stellate cell (HSC) activation is a critical factor in the development of liver fibrosis. Recent research indicates that mesoderm/mesenchyme homeobox 1 (Meox1) contributes to fibrosis in organs like the skin and heart.

Objectives: To investigate the potential impact of Meox1 on HSC activation and provide an available target for hepatic fibrosis research.

Material and methods: The human HSC cell line LX-2 was utilized to investigate the role of Meox1 in HSC activation. Fibrotic gene expression was analyzed, and assays were conducted to assess cell proliferation, migration and the cell cycle.

Results: Meox1 was identified as a positive regulator of HSC activation. We found that transforming growth factor-β1 (TGF-β1) treatment significantly upregulated Meox1 expression in a dose-dependent manner in LX-2 cells, and the expression levels of α-smooth muscle actin (α-SMA), collagen type I (collagen-I) and matrix metalloproteinase-2 (MMP-2) also increased progressively with higher concentrations of TGF-β1. Knockdown of Meox1 via small interfering RNA (siRNA) inhibited TGF-β1-induced expression of HSC activation markers and fibrotic genes, including α-SMA, collagen-I and MMP-2. Conversely, Meox1 overexpression promoted HSC activation, evidenced by increased levels of α-SMA, collagen-I and MMP-2. Meanwhile, Meox1 overexpression accelerated cell proliferation and enhanced cell migration. Additionally, forced expression of Meox1 in LX-2 cells elevated Smad3 phosphorylation level, although TGF-β1 and total Smad3 protein levels remained unchanged. Furthermore, we observed that Meox1 could induce a redistribution of the cell population, extending the G1 phase, and that Meox1-upregulated p21CIP1/WAF1 expression in LX-2 cells was independent of p53.

Conclusions: Our findings suggest that Meox1 plays a pivotal role in HSC activation and may be involved in the canonical TGF-β1/Smad pathway.

Background: The most important part of orthodontic treatment (OT) is the pre-orthodontic examination (PE). Only a precise evaluation of clinical and radiological features can reduce the risk of complications.

Objectives: To develop practical guidelines for advanced clinical-radiological pre-orthodontic examinations and for qualifying patients for alveolar bone reconstructions.

Material and methods: A retrospective assessment was performed on 49 out of 145 patients (aged 22-55) referred for alveolar bone reconstructions over a 6-year observation period, with 77.6% of the patients being women. Patient examinations were conducted using the following parameters: clinical (e.g., gingival recession (GR), Miller and Angle classifications), radiological (using cone beam computed tomography (CBCT) to evaluate bone dehiscence, occlusal plane (OccP), atlanto-occipital joint position (O-C1), width of mentalis muscle (B:D), bone marrow steatosis (BMS), and various cephalometric parameters such as the position of the alveolar ridge (AR) relative to the mandible, labial width angle, and volumetry of AR, as well as vitamin D level. Statistical analyses were performed using Student's t-test, Shapiro-Wilk test and Pearson's χ2 test.

Results: In the group of patients before orthodontic treatment (OT), the average bone marrow steatosis (BMS) was significantly lower compared to that in patients after treatment (-12 HU vs -137 Hounsfield units (HU)). In patients with class C dehiscence, the B:D measurement was significantly greater than in those with class A dehiscence (15.0 mm vs 12.5 mm). Additionally, a lateral shift of the atlanto-occipital joint (Oc-1) had a significant negative impact on the angles describing lower teeth inclination. Overall, the odds of gingival recession (GR) were 6.5 times higher in women (OR = 6.55); GR odds increased by more than 3.5 times when B:D exceeded 14.1 mm, by 4 times when the occlusal plane (OccP) was flat, and by 8 times when bone density was 24.9 ng/mL.

Conclusions: Insufficient bone volume was observed in a similar proportion both before and during/after orthodontic treatment. The described pre-orthodontic examination allows for an accurate assessment of soft tissue and bone condition, thereby reducing the risk of further complications. CBCT should become a standard component of the pre-orthodontic examination.

Background: Glycated hemoglobin A1c (HbA1c) is a well-established marker for glycemic control; recent studies suggest its potential role in cancer prognosis. Understanding the relationship between preoperative HbA1c levels and lymph node metastasis (LNM) in diabetic women with endometrial cancer (EC) can enhance prognostic assessments and treatment strategies.

Objectives: This study aimed to evaluate the predictive value of preoperative HbA1c levels for LNM in diabetic women with EC.

Material and methods: A retrospective analysis was conducted on 233 diabetic women who underwent surgery for endometrioid-type EC at a tertiary referral hospital between 2010 and 2021. Data collected included demographic information, fasting plasma glucose, HbA1c levels, ultrasound findings, and tumor characteristics. Receiver operating characteristic (ROC) analysis was used to assess the predictive power of HbA1c levels for LNM. Univariate and multivariate regression analyses were performed to identify independent risk factors for LNM.

Results: The mean preoperative HbA1c level was 7.03 ±1.37%. A cutoff HbA1c level ≥7.26% demonstrated a sensitivity of 73.7%, a specificity of 72.3% and an area under the curve (AUC) of 0.781 for predicting LNM (p < 0.001). Significant correlations were found between HbA1c levels and endometrial thickness (r = 0.231, p < 0.001), primary tumor diameter (PTD) (r = 0.173, p = 0.008) and duration of diabetes (r = 0.203, p = 0.002). Multivariate analysis identified HbA1c level (odds ratio (OR) = 2.621, 95% confidence interval (95% CI): 1.722-3.987, p < 0.001), lymphovascular space involvement (LVSI) (OR = 19.193, 95% CI: 5.805-63.458, p < 0.001), body mass index (BMI) (OR = 1.095, 95% CI: 1.010-1.188, p = 0.029), and duration of diabetes (OR = 1.019, 95% CI: 1.001-1.301, p = 0.039) as independent risk factors for LNM.

Conclusions: Preoperative HbA1c levels serve as a significant predictor for LNM in diabetic women with EC. A cutoff HbA1c level ≥7.26% indicates higher risk of LNM. These findings underscore the importance of glycemic control in reducing cancer progression risks and improving the prognosis of diabetic patients with EC. Integrating HbA1c monitoring into preoperative assessments can help tailor personalized treatment strategies for better outcomes.

Background: Dacryolithiasis can occur anywhere in the lacrimal drainage system and is frequently associated with microbial infections. The presence of dacryolithiasis is difficult to determine based on its clinical manifestations, which complicates clinical treatment.

Objectives: To analyze the clinical diagnosis, treatment and characteristics of dacryolithiasis, as well as surgical methods used to treat it and treatment effects over the past 5 years.

Material and methods: A retrospective analysis was performed on the clinical data of 338 patients who were diagnosed with dacryolithiasis at our hospital from January 2017 to December 2021. Patients diagnosed with canaliculitis were treated with canaliculotomy. Dacryocystitis complicated by canaliculitis was treated with endoscopic dacryocystorhinostomy (En-DCR) combined with canaliculotomy. Dacryocystitis accompanied by dacryoliths was treated with En-DCR. Nasolacrimal duct stones were treated with lacrimal intubation. All patients were followed up for 6-12 months.

Results: All patients underwent successful surgery. Of 302 cases (89.35%) with canaliculitis, 297 (98.34%) were cured with canaliculotomy; 5 cases (1.66%) recurred within 1 year after surgery and were cured with canaliculotomy again. Four cases (1.18%) of dacryocystitis complicated by canaliculitis were treated with En-DCR combined with canaliculotomy. In addition, 30 patients (8.88%) had dacryolithiasis; 28 (93.33%) of them were cured, and 2 (6.67%) with common canalicular atresia were cured after lacrimal intubation. Furthermore, 2 patients (0.59%) with nasolacrimal duct stones underwent lacrimal intubation. In addition, 62 cases (20.53%) with canaliculitis tested positive for bacteria, and the top 2 common bacteria were Staphylococcus epidermidis and Streptococcus mitis.

Conclusions: Secretions are the main clinical characteristic of patients with dacryolithiasis, and surgery is the primary treatment method. In addition, different surgical methods correspond to different locations of stones.

Background: Long-term peritoneal dialysis (PD) leads to peritoneal injury, with mesothelial-to-mesenchymal transition (MMT) potentially serving as an initial and reversible stage of this process. Indoxyl sulfate (IS), a protein-bound uremic toxin that accumulates in patients with declining renal function, is known to be associated with epithelial-mesenchymal transition (EMT) in proximal renal tubular cells. However, its effects on peritoneal mesothelial cells, which serve as the first-line barrier during PD, have not yet been investigated.

Objectives: This study aimed to evaluate whether IS induces MMT in human peritoneal mesothelial cells during PD through the β-catenin signaling pathway.

Material and methods: A human peritoneal mesothelial cell line (HMrSV5) was used for this in vitro study. Cells were treated with IS or combined with β-catenin inhibitor ICG-001, and high glucose PD fluid (PDF) served as a positive control. Morphology, proliferation and adhesion were assessed, while the expression of β-catenin and α-smooth muscle actin (α-SMA) as mesenchymal markers, along with E-cadherin as a mesothelial marker, were analyzed at both RNA and protein levels using real-time polymerase chain reaction (PCR) and western blot, respectively.

Results: The number of viable and adherent cells was significantly increased in the IS and PDF groups compared to the control (p < 0.05). Treatment with ICG-001 significantly reduced both viable and adherent cell numbers compared to cells treated with IS or PDF alone (p < 0.05). At the RNA level, IS treatment significantly decreased E-cadherin expression (p = 0.002) while significantly increasing β-catenin (p = 0.001) and α-SMA (p = 0.002) expression compared to the control group. These changes were reversed by ICG-001 treatment. Protein expression showed similar trends.

Conclusions: Indoxyl sulfate induces MMT in human peritoneal mesothelial cells, and these changes can be reversed by the specific β-catenin inhibitor ICG-001. This suggests that IS may be considered as another inducer of MMT during PD through the β-catenin signaling pathway.

Background: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, which is characterized by a lack of sensitive and specific biomarkers.

Objectives: This study investigates the association between ELAV-like RNA binding protein 1 (ELAVL1) and HCC patient outcomes.

Material and methods: This retrospective study encompassed 108 HCC patients who reported to Wuhan Fourth Hospital and Tongji Hospital, China, from January 2016 to August 2020. Clinical data collected included age, sex, body mass index (BMI), comorbidities, tumor-node-metastasis (TNM) stage, Barcelona Clinic Liver Cancer (BCLC) stage, and lymphatic metastasis. All patients received routine follow-up for survival and recurrence status ranged from 36 to 60 months. The serum levels of ELAVL1 were tested using enzyme-linked immuno-sorbent assay (ELISA). Levels of total bilirubin, alanine aminotransferase (ALT), aspartate transaminase (AST), HCC-related biomarkers of alpha fetoprotein (AFP), α-L-fucosidase (AFU), and carcinoembryonic antigen (CEA) were recorded.

Results: Our findings revealed a significantly higher expression of ELAVL1 in patients presenting with TNM stages III-IV, BCLC stages C-D, lymphatic metastasis, as well as deceased and recurrent patients. Receiver operating characteristic (ROC) curves showed that the areas under the curve (AUCs) for ELAVL1 in predicting mortality, recurrence and poor prognosis (defined as mortality or recurrence) in HCC patients were 0.818, 0.732 and 0.827, respectively. Patients with higher expression of ELAVL1 showed significantly higher frequencies of TNM III-IV stages, BCLC D stage, lymphatic metastasis, higher mortality, and recurrence ratio, as well as higher AFP and CEA levels. ELAVL1 was positively correlated with levels of AFP and CEA. Higher BCLC stage, lymphatic metastasis, age, AFP, and ELAVL1 were independent risk factors for poor prognosis of HCC patients.

Conclusions: Higher serum levels of ELAVL1 are associated with worse clinical outcomes and poorer prognosis in ‑HCC patients.

Background: The neuroendocrine system's role in maintaining bodily homeostasis implicates it in insomnia, suggesting both causal relationships and therapeutic targets. Yet, studies examining the link between metabolic syndrome (MetS) components such as hypertension, elevated blood glucose levels and abnormal cholesterol and insomnia have been inconsistent. Some research suggests a correlation, proposing that metabolic dysfunctions might contribute to sleep disturbances. However, other studies found little to no significant connection, indicating the complexity of this relationship and the potential influence of genetic, lifestyle and environmental factors. These contradictory findings underscore the challenges in fully understanding the intricate interplay between metabolic health and sleep quality.

Objectives: To explore the relationship between MetS and insomnia.

Material and methods: This study used bidirectional two-sample Mendelian randomization (MR) analysis to determine the causal relationship between the characteristics of MetS components and insomnia. Based on Genome-Wide Association Studies (GWAS) public databases, we explored the causal relationship between waist circumference (WC), hypertension, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), and the risk of insomnia. Sensitivity analysis was conducted to evaluate the stability, heterogeneity and potential presence of horizontal pleiotropy in the results.

Results: Waist circumference and hypertension were associated with an increased risk of insomnia (WC, odds ratio (OR) = 1.05, 95% confidence interval (95% CI): 1.03-1.06, p = 9.15e-07; hypertension, OR = 1.06, 95% CI: 1.02-1.10, p = 0.005). In the reverse MR analysis, there was no significant causal relationship between insomnia and WC, TG, HDL-C, and FBG.

Conclusions: Our study has demonstrated the close connection between MetS components and insomnia by genetic means, thereby guiding the future research direction of insomnia prevention and treatment.