Advances in Clinical and Experimental Medicine最新文献

Anterior cruciate ligament (ACL) injury is one of the most frequent injuries in sports medicine. Despite advancements in surgical techniques, suboptimal results in terms of delayed graft incorporation into bone tunnels and ligamentization, as well as inferior clinical outcomes, still present significant challenges in treating these injuries. Orthobiological modalities such as platelet-rich plasma (PRP) and stem cells have emerged as a potential adjunct to ACL treatment, with a theoretical advantage in enhancing local biological processes and subsequent improvements in clinical outcomes. Embase, Cochrane, and PubMed databases were searched for relevant literature. The aim of this narrative review was to summarize the currently available evidence on the efficacy of orthobiologics, or the lack thereof, in ACL repair and reconstruction (ACLR), with emphasis on graft incorporation into bone tunnels, ligamentization, and overall clinical outcomes. These modalities exert their theoretical effect by delivering growth factors, anti-inflammatory cytokines, and regenerative cells to the target site, which enhance local biological processes. Although some research has shown positive effects of orthobiologics in ACLR, clinical outcomes remain inconsistent, without consensus on preparation methods and administration protocols. The lack of homogeneous, high-quality methodology in existing studies limits the possibility of drawing definitive conclusions on the efficacy of orthobiologics in ACLR. Although orthobiological modalities provide theoretical benefits in improving outcomes, until more robust evidence is available regarding their efficacy and optimal application methods, their routine use warrants caution and cannot yet be recommended. Future research should focus on improving and standardizing clinical and research protocols before drawing any definitive conclusions on this matter.

Background: Gestational diabetes mellitus (GDM) is characterized by a higher degree of insulin resistance (IR) than in a normal pregnancy. Several surrogate measures have been proposed to assess insulin sensitivity, including glycated hemoglobin, the Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), and the Quantitative Insulin Sensitivity Check Index (QUICKI).

Objectives: The aim of the study was to determine whether markers of IR in the 1st week postpartum differ between mothers with GDM and healthy controls, and whether mothers with GDM treated with insulin have significantly different levels of IR markers compared with those treated with diet and physical activity. The association between IR markers, pregnancy outcomes, and maternal glucose profiles based on the oral glucose tolerance test (OGTT) was also investigated.

Material and methods: Among the 70 participants, 50 mothers were diagnosed with GDM; 21 were treated with diet and physical activity (GDM G1), while 29 received insulin therapy (GDM G2). The remaining 20 participants constituted a control group with no history of glucose intolerance before or during pregnancy (non-GDM). A range of statistical methods (e.g., analysis of variance (ANOVA), Kruskal-Wallis test, χ2 test, regression analysis, and cluster analysis) were used to compare data between study groups, with a significance level of α = 0.05.

Results: The results showed that selected markers of IR in the 1st week after delivery differed significantly between mothers. Mothers with GDM exhibited considerably higher levels of HOMA-IR and HbA1c (p < 0.05), yet no substantially divergent QUICKI (p > 0.05) in the 1st week postpartum. Additionally, they demonstrated elevated glucose levels at 3 OGTT time points in comparison with non-GDM mothers. The GDM G2 group exhibited higher values than the GDM G1 group, except for the 1 h OGTT. Identification of maternal glucose phenotypes confirmed variability in the degree of glucose metabolism disorders among mothers.

Conclusions: Cluster analysis and glucose phenotype stratification in mothers with GDM help identify high-risk groups and support targeted counseling and monitoring to improve pregnancy outcomes.

Background: Sleep quality often decreases in patients after surgery and may affect postoperative outcomes.

Objectives: The aim of this study was to compare the effects of peribulbar block and incisionless sub-Tenon's block on postoperative sleep quality.

Material and methods: Patients who underwent cataract surgery under peribulbar block (n = 36) or incisionless sub-Tenon's block (n = 31) were included in the study. The 2 blocks were compared with each other in terms of eyelid and globe movements, corneal sensation, complications, pain, and postoperative sleep quality (evaluated using the Richard-Campbell Sleep Questionnaire (RCSQ) score).

Results: Sixty-seven patients with a mean age of 67 years were included in the study. At the 15th minute after the block (p = 0.066) and at the end of surgery (p = 0.098), akinesia was better in the incisionless sub-Tenon's group, with p-values close to the level of statistical significance. Chemosis was found to be significantly lower in the peribulbar block group than in the incisionless sub-Tenon's block group (p = 0.033) 3 h after surgery. All minor complications, including chemosis, subconjunctival petechiae, and subconjunctival hemorrhage, were observed less frequently in the peribulbar block group, although the differences were not statistically significant (p > 0.05). Pain scores were comparable between the groups (p > 0.05). The total RCSQ score (p = 0.396) and overall sleep perception (p = 0.355) were also comparable between the groups.

Conclusions: The incisionless sub-Tenon's block was superior to the peribulbar block in terms of providing akinesia and reducing the need for maintenance anesthetic medications such as sedatives or analgesics. Although chemosis and subconjunctival hemorrhage occurred more frequently in the incisionless sub-Tenon's group, all events were transient and had no serious clinical significance. The 2 regional techniques were similar in terms of postoperative sleep quality and patient satisfaction.

Background: Reliable toxicological analysis is crucial for accurate forensic and clinical interpretation; however, pre-analytical factors such as handling and storage can significantly alter drug concentrations in postmortem (PM) samples, potentially leading to misinterpretation. Postmortem degradation, influenced by enzymatic and microbial activity, can change drug levels, making it essential to understand drug stability in biological matrices.

Objectives: This preliminary study investigates the long-term stability of drugs of abuse and psychoactive substances in PM blood samples from drug-related deaths stored at -20°C for 29 months.

Material and methods: Postmortem blood samples were analyzed using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) following the routine methodology currently in use in the forensic toxicology laboratory. Stability was assessed by measuring concentration changes between analyses performed shortly after sample collection and reanalyses conducted after 6-29 months. Regression analyses were used to relate percentage variation in concentration to elapsed time.

Results: A strong correlation was found between the percentage reduction in drug concentration and storage time for all tested molecules, including morphine, cocaine, methadone, ketamine, benzodiazepines, antidepressants, antipsychotics, and lidocaine. Regression curve analysis revealed a reduction in concentration beginning within the initial months, with high variability.

Conclusions: The study highlights the significant impact of long-term storage on drug concentrations in PM blood, emphasizing the need for careful consideration of storage intervals when reanalysis of samples is requested for forensic purposes. The findings underscore the importance of understanding degradation patterns for the accurate interpretation of toxicological results in medicolegal investigations.

The triglyceride-glucose (TyG) index, a simple surrogate marker integrating insulin resistance and atherogenic dyslipidemia, has attracted growing attention as a potential tool for addressing residual risk in cardiovascular disease (CVD) prediction. Robust observational evidence consistently links the TyG index to hard cardiovascular endpoints and subclinical atherosclerosis, positioning it as a strong candidate for clinical translation. However, its adoption in mainstream guidelines is constrained by a critical limitation: the current evidence is exclusively observational and lacks interventional data demonstrating that lowering the TyG index improves clinical outcomes. This editorial argues that, although the TyG index represents a practical and readily available risk-stratification adjunct, it has not yet evolved into a validated therapeutic target. We propose a dual-pathway strategy: provisional recognition within guidelines as a risk-enhancing factor, accompanied by a clear call for dedicated cardiovascular outcome trials. Such an approach would capitalize on its present utility while upholding the evidentiary standards required to inform clinical practice.

Background: Malnutrition is common among patients with heart failure (HF), yet accurate assessment of nutritional status in this population remains challenging. The phase angle (PhA) derived from bioelectrical impedance analysis (BIA) has been proposed as a marker of nutritional status at the cellular level; however, concerns persist regarding its dependence on hydration status.

Objectives: This study aimed to assess the association between HF and nutritional status, with particular emphasis on phase angle (PhA) measured at 50 kHz, and to evaluate its diagnostic value in comparison with other indices, including the Nutritional Risk Screening 2002 (NRS 2002), body mass index (BMI), and selected laboratory parameters.

Material and methods: In this cross-sectional study, 270 patients with chronic coronary syndrome were evaluated using laboratory tests, anthropometric measurements, the NRS 2002, and BIA. Patients were stratified according to HF status. Statistical analyses included parametric and non-parametric tests, correlation analyses, multivariable logistic regression models, and receiver operating characteristic (ROC) curve analysis. Adjustments were made for age, sex, BMI, estimated glomerular filtration rate (eGFR), hemoglobin, and extracellular fluid percentage (ECF%).

Results: Heart failure was present in 91 of 270 patients (33.7%). Patients with HF had significantly lower PhA (median 4.79 vs 5.22; p < 0.001), higher NRS 2002 scores (p = 0.010), and lower eGFR and hemoglobin levels. In multivariable logistic regression analysis, PhA remained independently associated with HF (odds ratio (OR) = 0.62; p = 0.016), whereas NRS 2002 and ECF% were not significant. Inclusion of ECF% did not improve model performance. In ROC analysis, PhA showed modestly higher discriminative ability for HF (area under the curve (AUC) = 0.636) compared with NRS 2002 (AUC = 0.594) and BMI (AUC = 0.598).

Conclusions: Heart failure is associated with impaired nutritional status. Phase angle appears to be a clinically relevant marker that remains independently associated with HF after adjustment for hydration status and may be considered as a complementary tool for routine nutritional screening in this high-risk population.

Background: Gastric cancer (GC) remains highly lethal, with limited available biomarkers. The Pathway Mutation Accumulation Perturbation Score (PMAPscore), which leverages pathway-level mutations, provides a novel approach to predicting immunotherapy response and survival outcomes.

Objectives: To evaluate the prognostic and predictive value of the PMAPscore in patients with advanced GC undergoing immunotherapy.

Material and methods: Three cohorts of patients with GC treated with immunotherapy were analyzed: PUCH (Peking University Cancer Hospital; n = 39, training cohort), MSK (Memorial Sloan Kettering; n = 19, validation cohort) and SMC (Samsung Medical Center; n = 43, validation cohort). A PMAPscore-based risk model was developed and validated for survival outcomes. Immune mechanisms in highand low-risk groups were explored using The Cancer Genome Atlas (TCGA) GC data (n = 431).

Results: Low-risk patients identified by the PMAPscore model exhibited significantly better progression-free survival (PFS), overall survival (OS) and durable clinical benefit (DCB). In the PUCH cohort, low-risk patients had higher DCB rates (85.7% vs 44.0%, p = 0.02), longer PFS (p < 0.001), and longer OS (p < 0.001). Similar trends were observed in the MSK and SMC cohorts. Multivariate analysis confirmed low-risk status as an independent predictor of improved PFS and OS, outperforming tumor mutation burden (TMB), programmed death-ligand 1 (PD-L1) expression, microsatellite instability (MSI) status, and the gastrointestinal immune prognostic signature (GIPS). The TCGA data indicated enhanced antitumor immune activity in low-risk tumors, with increased human leukocyte antigen (HLA)-related gene expression and greater B-cell and natural killer (NK) cell infiltration.

Conclusions: The PMAPscore-based risk model is a robust tool for predicting survival and immunotherapy responses in patients with advanced GC, supporting its clinical application for treatment stratification.

Background: The prevalence of fetal alcohol spectrum disorders (FASD) in Poland is about 2%, but the prevalence of prenatal alcohol exposure (PAE) is much higher than previously reported. In the absence of a single biomarker or imaging test that can confirm the diagnosis, the identification of FASD relies on clinical diagnostic criteria; therefore, the first Polish diagnostic standards were developed in 2020.

Objectives: To present the process of updating the national diagnostic guidelines for FASD in Poland and discuss the key revisions made based on clinical implementation feedback.

Material and methods: The work was carried out by the members of the Council for FASD Prevention and Treatment at the National Centre for Addiction Prevention in 4 steps: 1) a pilot implementation study; 2) a structured literature review supporting the update; 3) a formalized expert consensus process; and 4) stakeholder consultation.

Results: The updated guidelines include the following sections: Introduction, Methodology, Diagnostic categories, Diagnostic scheme, Ethical considerations, Evaluation of PAE, Evaluation of facial dysmorphism, Evaluation of growth impairment, and Evaluation of the central nervous system (CNS). Appendices containing practical tools useful in the diagnostic procedure are an important element of the recommendations. Key amendments include the introduction of the partial fetal alcohol syndrome (pFAS) diagnostic category; the addition of biomarker analysis as a tool to confirm PAE; simplification of the assessment of facial dysmorphologies; clarification of CNS evaluation; and discussion of the ethical concerns associated with FASD diagnosis.

Conclusions: The updated national guidelines may improve the quality and standardization of FASD diagnosis not only in Poland, but also worldwide. The practical utility of each recommendation should be continuously monitored, validated, and updated.

Social prescribing (SP) has gained increasing attention as an approach to addressing non-medical determinants of health by linking individuals to community-based resources. While SP is frequently discussed in the context of health inequalities, its relevance to lesbian, gay, bisexual, transgender, and other sexual and gender minority (LGBT+) populations has not been systematically examined. LGBT+ populations experience multidimensional health challenges shaped by social, structural, and institutional factors, including unmet social needs and barriers within healthcare systems, which may render SP conceptually relevant but empirically uncertain. This narrative review synthesizes and critically examines the international literature on SP with a particular focus on its conceptualization, application, and limitations in the context of LGBT+ health. A structured narrative search of major biomedical databases was conducted, complemented by title-based screening and review of relevant policy and practice sources. Findings were synthesized thematically. The available evidence directly addressing SP in LGBT+ populations is sparse and limited. Existing studies are predominantly descriptive or qualitative, often embedding LGBT+ individuals within broader vulnerable groups without disaggregated analysis. While inclusive SP models and services exist in practice, particularly within the UK, their effectiveness has not been rigorously evaluated. Overall, the literature reveals a substantial gap between the theoretical relevance of SP for LGBT+ health and the availability of robust empirical evidence to inform its implementation.

Background: Glaucoma is a chronic, progressive optic neuropathy that can lead to irreversible blindness if left untreated. It is the leading cause of irreversible blindness globally. Effective management relies heavily on the control of intraocular pressure (IOP), typically through lifelong pharmacological treatment, but adherence to therapy is often a challenge due to the asymptomatic nature of the disease.

Objectives: The primary aim of this study was to evaluate the predictive influence of the doctor-patient relationship, the quality of communication between doctor and patient, patient knowledge about glaucoma, and quality of life when adhering to therapeutic recommendations among a group of Polish glaucoma patients.

Material and methods: This study was conducted at the Ophthalmology Outpatient Clinic of the University Clinical Hospital in Wrocław, Poland. A total of 190 patients were enrolled, and adherence to treatment was assessed using the Adherence to Refills and Medications Scale (ARMS). Additional variables included patient-physician communication (CAT-14), relationship quality (PDRQ-9), visual function (NEI VFQ-25), and glaucoma knowledge (GKQ-10).

Results: The results indicated that 58.9% of patients showed low adherence to their prescribed treatment. Satisfaction with doctor-patient communication, higher levels of knowledge about glaucoma, and better visual function were significantly associated with better adherence. The quality of the patient-physician relationship, while not statistically significant, also showed potential positive effects on adherence.

Conclusions: Improving patient education and enhancing the quality of communication between healthcare providers and patients are critical to increasing adherence to glaucoma treatment. Importantly, the study provides a valuable evidence base for developing adherence-enhancing strategies within the Polish healthcare system. Given the scarcity of such data in Central and Eastern Europe, our results may also inform similar efforts in the region. Designing culturally sensitive and system-specific interventions, such as brief communication training for ophthalmologists or structured patient education programs, could help address persistent adherence challenges in chronic ophthalmic care.