Advances in Clinical and Experimental Medicine最新文献

The establishment of the first JBI Affiliated group in Poland at Wroclaw Medical University marks a significant advancement in evidence-based healthcare (EBHC) nationally. This editorial explores the evolution of EBHC and the critical role of JBI in driving its progress. Founded in 1996 as a research institute at the Royal Adelaide Hospital in South Australia and now based at the University of Adelaide, JBI has emerged as an international leader in evidence synthesis, transfer and implementation. Its Feasibility, Appropriateness, Meaningfulness, and Effectiveness (FAME) framework highlights the feasibility, appropriateness, meaningfulness, and effectiveness of healthcare practices, ensuring that decisions are patient-centered and contextually relevant. JBI's global collaboration network encompasses over 85 entities, with 23 located in Europe, emphasizing the importance of cultural inclusivity and international partnerships. Recent initiatives include translating the JBI Model of into Polish, German and Czech, linking global knowledge to local contexts, and enhancing understanding for professionals and students alike. This editorial also underscores the collaborative achievements of JBI entities in Wroclaw, Brandenburg an der Havel, Prague, and Olomouc. These partnerships have propelled regional implementation, research and education, fostering a shared vision for elevating healthcare quality. Launching a new EBHC section in the Advances in Clinical and Experimental Medicine journal is a significant step forward, inviting global contributions and stimulating innovation and knowledge sharing in EBHC. The presence of a JBI Affiliated group at Wroclaw Medical University symbolizes a transformative commitment to excellence and collaboration. It sets new benchmarks for healthcare in Poland and beyond while reinforcing the global mission of evidence-based practice.

Chronic pain is a common, long-standing and bitter experience affecting a huge percentage of the still increasing elderly population. Owing to the multifactorial etiopathology and complex clinical presentation with a lot of severe consequences, management of the permanent pain should be varied and tailored to the particular patient. This approach comprises multimodal pharmacotherapy, including all analgesics and adjuvants, likewise selected interventions, physical therapy and rehabilitation, as well psychological counselling.

Background: Lhermitte's sign (LS) is an important clinical marker for patients with multiple sclerosis (MS). Research on pediatric-onset MS (POMS) and LS is limited. To date, there has been no research conducted on the clinical and artificial intelligence (AI)-based radiological correlation of LS.

Objectives: This follow-up study aims to investigate the relationship between LS and clinical findings according to AI-based radiological characteristics of patients with POMS.

Material and methods: Basic descriptive statistics of patients with POMS according to sociodemographic, clinical and radiological findings were collected. Variables were evaluated at a 95% confidence level (95% CI), and a value of p < 0.05 was accepted as statistically significant. The LS in patients with MS was classified according to its presence in the past and at the time of the study screening: group A: absent; group B: positive in the past but absent at screening; group C: present both in the past and at the screening; group D: absent in the past but present at the screening. In addition, patients were grouped according to the duration of their MS, with the following classifications: <10 years and at least 10 years.

Results: A total of 1,298 records were identified in the database search. Ninety-two patients who met the inclusion criteria were included in the study. The frequency of upper cervical lesions (C1-4 vertebral segmental levels) was higher in group B and C than in group A (p = 0.017). Among patients with an MS duration of 10-years, C1-4 lesions were least frequent in group A.

Conclusions: Spinal imaging with AI-based programs can be used at least as much as brain magnetic resonance imaging (MRI) for early diagnosis, prognosis and treatment response. We have for the first time investigated LS in a large sample of patients with POMS. It is, however, recommended to conduct further multicenter studies to more specifically identify LS in patients with POMS.

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.

Background: High sepsis mortality rates pose a serious global health problem. Machine learning is a promising technique with the potential to improve mortality prediction for this disease in an accurate and timely manner.

Objectives: This study aimed to develop a model capable of rapidly and accurately predicting sepsis mortality using data that can be quickly obtained in an ambulance, with a focus on practical application during ambulance transport.

Material and methods: Data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) dataset were used to compare the performance of 11 machine learning algorithms against the widely utilized quick Sequential Organ Failure Assessment (qSOFA) score. A dynamic updating model was implemented. Performance was evaluated using area under the curve (AUC) and precision-recall area under the curve (PRAUC) scores, and feature importance was assessed with SHapley Additive exPlanations (SHAP) values.

Results: The light gradient boosting machine (LightGBM) model achieved the highest AUC (0.79) and PRAUC (0.44) scores, outperforming the qSOFA score (AUC = 0.76, PRAUC = 0.40). The LightGBM also achieved the highest PRAUC (0.44), followed by Optuna_LightGBM (0.43) and random forest (0.42). The dynamically updated and tuned model further improved performance metrics (AUC = 0.79, PRAUC = 0.44) compared to the base model (AUC = 0.76, PRAUC = 0.39). Feature importance analysis offers clinicians insights for prioritizing patient assessments and interventions.

Conclusions: The LightGBM-based model demonstrated superior performance in predicting sepsis-related mortality in an ambulance setting. This study underscores the practical applicability of machine learning models, addressing the limitations of previous research, and highlights the importance of real-time updates and hyperparameter tuning in optimizing model performance.

Background: Pulpal vitality is important for the tooth to maintain its physiological function and preserve its structure.

Objectives: The aim of this study was to evaluate the clinical and radiographic 6- and 12-month treatment success of calcium hydroxide (CH) and calcium silicate materials in indirect pulp treatment (IPT) and direct pulp capping (DPC) in teeth with deep dentin decay.

Material and methods: The study included 143 teeth of patients aged 17-69 years with no systemic disease. The study is grouped under 3 main groups (Dycal, Biodentine, TheraCal PT). Direct pulp capping was applied to 65 teeth and IPT to 66 teeth. All teeth were restored with Universal adhesive system and Universal composite (G-Premio Bond; GC Corp., Tokyo, Japan).

Results: In the statistical evaluations of the data obtained, 0.05 was accepted as the level of statistical significance. The general success rate in the IPT group was found to be 95.2% for Biodentine (Septodont, SaintMaur-des-Fossés, France), 91.7% for Dycal (Dentsply/Caulk, International Inc. Milford, USA) and 90.1% for TheraCal PT (Bisco Inc., Schaumburg, USA) at both 6 and 12 months. When the clinical and radiographic success was compared at 6 months and 12 months, no statistically significant difference was determined between the materials (p > 0.05). In the clinical and radiographic evaluations at the end of 6-month follow-up in the DPC group, the success rates were determined to be 96.0% for Biodentine, 81.8% for Dycal and 63.2% for TheraCal PT. At 12 months, these rates were 96.0% for Biodentine, 68.2% for Dycal and 63.2% for TheraCal PT. DPC Biodentine was found to be the most successful material (96.0%).

Conclusions: At the end of the 12-month follow-up period, it was considered that the 3 materials (Biodentine, Dycal, TheraCal) can be selected for IPT. In DPC, Biodentine was found to be more successful than both calcium silicate containing resin and CH.

Background: Immunosuppressive therapy in organ transplant ensures proper graft function for many years, but it is burdened with a negative impact on the development of skin cancer in them.

Objectives: To characterize the impact of immunosuppressive therapy in transplant recipients on the development of non-melanoma skin cancers (NMSC).

Material and methods: A total of 17,207 Polish patients who underwent liver, heart or kidney transplants between 2010 and 2022 and were on immunosuppression were included in the study. Immunosuppression was most commonly achieved using a regimen of tacrolimus (TAC) or cyclosporine A (CsA) combined with mycophenolic acid (MPA) and glucocorticosteroids (GS). Data on NMSC incidence from the National Health Fund in this population were analyzed and compared against incidence of NMSC in general Polish population in the same period.

Results: Renal transplant recipients demonstrated a significantly elevated risk of NMSC compared to the general population, with a 1-year cumulative incidence of 0.09% vs 0.04% (p < 0.001), a 5-year incidence of 1.21% vs 0.18% (p < 0.001) and a 10-year incidence of 4.18% vs 0.36% (p < 0.001). Liver transplant recipients exhibited an elevated risk for the development of NMSC, which persisted and increased over time (incidence of 0.09% vs 0.04% at 1 year (p < 0.001), 0.83% vs 0.18% at 5 years (p < 0.001) and 2.65% vs 0.36% at 10 years (p < 0.001)). Heart transplant recipients also showed a significantly higher cumulative incidence of NMSC at 1 year (0.09% vs 0.04%, p < 0.001), 5 years (0.89% vs 0.18%, p < 0.001) and 10 years (4.06% vs. 0.36%, p < 0.001) post-transplantation.

Conclusions: Organ transplant recipients have an 2 times at 1 year, 4,5 times after 5 years and 9 times after 10 years increased risk of NMSC on average as opposed to general Polish population in the same period.

Background: Chronic soft tissue injury is characterized by sterile inflammation and pain. Gua sha with Masanggoubang oil (GSMO) treatment has been found to possess anti-inflammatory and analgesic effects.

Objectives: To explore the mechanism of GSMO in chronic soft tissue injuries.

Material and methods: Fifty male rats were randomly divided into 5 groups (n = 10): 1) control group; 2) chronic soft tissue injury model group; 3) GSMO group; 4) inunction with Masanggoubang oil (IMO) group; and 5) ua sha with tea oil (GSTO) group. The control group and model group received no treatment, while the GSTO group and GSMO group received gua sha therapy with tea oil or Masanggoubang oil on the injured sites. The rats in the IMO group were treated with Masanggoubang oil inunction on the injured sites once every other day, 4 times in total. All animals were sacrificed 48 h after the last treatment. Muscle tissue sections from the injured sites of the rats were stained with hematoxylin & eosin (H&E) staining to observe pathological changes. The protein levels of tumor necrosis factor alpha (TNF-α), interleukin 1β (IL-1β), interleukin 6 (IL-6), inducible nitric oxide synthase (iNOS), and β-endorphin (β-EP) in the rats' skin, serum, and muscle were determined using enzyme-linked immunosorbent assay (ELISA).

Results: Gua sha with Masanggoubang oil treatment alleviated necrosis and the denaturation of muscle fibers at the injured sites, reduced connective tissue proliferation and scar tissue generation, downregulated the levels of TNF-α, IL-6 and iNOS in the skin and TNF-α, IL-1β, IL-6, and iNOS in the muscle and serum, and upregulated β-EP levels in the muscle.

Conclusions: Gua sha with Masanggoubang oil treatment significantly improved the inflammatory response in rats with chronic soft tissue injury, which may be associated with a reduction of M1 macrophage polarization in the peripheral blood and local tissues. Additionally, the combination of gua sha therapy and Masanggoubang oil may have a synergistic effect in treating chronic soft tissue injuries.

Background: The number of infants born via cesarean section (CS) is increasing globally due to medical and cultural reasons.

Objectives: This study aimed to determine the effect of the mode of delivery on early lung aeration in newborns using electrical impedance tomography (EIT).

Material and methods: The case-control study was conducted from December 2020 to April 2021. It included 32 term neonates delivered by CS and 20 term neonates delivered by normal vaginal delivery (NVD) as controls. Electrical impedance tomography examinations were performed with a Swisstom BB2 device with NEO SensorBelt and 32 integrated electrodes at 47.68 Hz. Three data recordings were conducted within 30, 60 and 90 min (mean times: 13, 62 and 93 min, respectively) after the birth.

Results: Cesarean section neonates, compared to those delivered by NVD, had greater non-aerated areas in gravity-dependent lung regions at the 2nd recording (p = 0.04). The CS group showed lower changes in lung stretch at the 2nd and 3rd recording compared to the NVD group (p = 0.022 and p = 0.032, respectively). In the study group, lung regions with the lowest stretch (10-20%, 20-30% and 30-40%) corresponded with increased total lung capacities 1 h after birth compared to the control group (p = 0.024, p = 0.004 and p = 0.044, respectively). Measurements from the 1st and 3rd EIT recording showed a greater distribution of tidal volume (TV) in the right lung toward the central regions among CS neonates compared to NVD neonates, whereas NVD neonates showed increased distribution of TV toward the central-ventral regions of the right lung immediately after birth.

Conclusions: The mode of delivery significantly affects early postnatal lung aeration in term neonates assessed using EIT. Caesarean section neonates were characterized by poorer aeration in gravity-dependent lung regions, whereas NVD neonates demonstrated greater changes in lung stretch and more intense tissue expansion, potentially leading to better postnatal adaptation.

Background: Vitamin D supplementation could offer irritable bowel syndrome (IBS) patients significant improvements in terms of symptom severity and overall quality of life (QoL). Yet, the potential benefits and risks associated with vitamin D supplementation still require additional investigation.

Objectives: We aimed to evaluate the impact of vitamin D supplementation on IBS using a systematic review and meta-analysis.

Material and methods: A comprehensive search was carried out utilizing 4 electronic databases (PubMed, Embase, Scopus, and Cochrane Library) to identify articles published in English-language peer-reviewed journals. The odds ratios (ORs), risk ratios (RRs) and mean differences (MDs), along with their respective 95% confidence intervals (95% CIs), were computed. Heterogeneity was evaluated using the appropriate p-value and Cochrane Q and I2 statistics. For the analysis, RevMan 5.3 was utilized.

Results: Nine randomized controlled trials involving a total of 780 participants were included in this study. Vitamin D supplementation, in adolescents and young adults with IBS, improves the IBS symptoms severity score, QoL and serum 25(OH)D levels compared to controls. We obtained an OR of 2.34 (95% CI: 1.56-3.50) for change in the IBS severity scoring system (IBS-SSS), OR = 2.51 (95% CI: 1.71-3.70) for change in QoL, low risk of any adverse events (RR 0.49 (95% CI: 0.35-0.69)), and substantial changes in serum 25(OH)D level (MD = 11.29 (95% CI: 7.13-15.45)). Results were statistically significant (p < 0.05).

Conclusion: Vitamin D supplementation could lead to better IBS management with a low risk of adverse events.