Advances in Clinical and Experimental Medicine最新文献

Obesity has emerged as one of the most pressing public health challenges of the 21st century, impacting millions worldwide and contributing to serious health complications such as type 2 diabetes and cardiovascular diseases, as well as a diminished quality of life. This editorial explores the multifaceted nature of obesity, emphasizing the interplay between genetic predisposition, environmental constraints and behavioral drivers. Key contributors, such as the rising consumption of ultra-processed foods, increasingly sedentary lifestyles and psychosocial stressors, are explored in detail, along with their combined impact on the escalating global obesity rates. The editorial highlights the far-reaching consequences of obesity, including its economic burden, societal implications and the ripple effects on healthcare systems. Priority areas for action are proposed, including public health policies, education and the creation of environments that support active lifestyles. The importance of clinical interventions, such as early screening, personalized treatment strategies and the inclusion of dietitians within multidisciplinary care teams, is emphasized as vital for enhancing patient outcomes and managing obesity effectively. This editorial calls for a comprehensive, systemic response to address the global obesity epidemic, advocating for evidence-based interventions that are tailored to individual needs while addressing societal and environmental determinants. By fostering collaboration across sectors and prioritizing prevention and treatment, meaningful progress can be made in combating this escalating crisis.

Background: Heart failure (HF) is a chronic condition affecting tens of millions of people worldwide. Despite advances in treatment, its impact on mental health, cognitive function and self-care behaviors remains underexplored, particularly across ejection fraction phenotypes, underscoring the need for comprehensive investigations into these interconnected domains.

Objectives: This prospective cohort study investigated changes in affective symptoms, cognitive functioning and self-care behaviors in patients with HF stratified with ejection fraction (EF) phenotypes over 6 months.

Material and methods: The study included 162 patients aged over 60 years with a diagnosis of HF. Participants were examined at enrollment and after 6 months. The Mini-Mental State Examination (MMSE), the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9) and the European Heart Failure Self-care Behaviour Scale (EHFScB-9) were used to assess cognitive function, affective symptoms and self-care behaviors.

Results: Cognitive impairment indicated with the MMSE was less severe in patients with mildly-reduced HF (HFmrEF) compared to preserved EF (HFpEF) (MMSE median scores: 28 [interquartile range (IQR): 27-29] vs 27 [IQR: 25-28]; p = 0.008). The HADS showed that severity of depression worsened over 6 months, particularly in the HFpEF group (median scores increased from 1 [IQR: 0-4] to 3 [IQR: 0-6]; p = 0.006). Self-care ability declined in all groups as indicated in the increased EHFSc-9 (poorer self-care) median scores, which changed from 28 [IQR: 21-33] at baseline to 29 [IQR: 23-34] at 6 months (p = 0.035). Additionally, NT-proBNP parameters were higher in the HFrEF group (3437.7 pg/mL [IQR: 1336.33-6226.43) compared to both HFmrEF and HFpEF (2171.2 pg/mL [IQR: 806.65-4033.15] and 977.1 pg/mL [IQR: 576.9-3708.95, respectively, p = 0.001).

Conclusions: Patients with HF showed significant cognitive decline, increased depressive symptoms and reduced self-care over 6 months, with HFpEF patients exhibiting the most pronounced impairments. Differences in outcomes across HF phenotypes highlight the need for tailored diagnostic and therapeutic strategies to address cognitive and emotional challenges in this population.

Background: Recurrent miscarriage (RM) affects 1-2% of couples. Maternally expressed gene 3 (MEG3) is aberrantly expressed in RM patients.

Objectives: To investigate a novel regulatory mechanism, we examined the miR-204-5p/Specificity protein 1 (SP1)/DNA methyltransferase 1 (DNMT1)/MEG3 axis in the trophoblast cell line HTR-8/SVneo.

Material and methods: Human trophoblast cell line HTR-8/SVneo was used and cells were transfected with siRNA targeting SP1, miR-204-5p mimics, pcDNA3.1-DNMT1, or their negative controls (NCs). The methylation inhibitor, 5-azadC, was used to treat the cells transfected with pcDNA3.1-SP1. The reverse transcription quantitative polymerase chain reaction (RT-qPCR) method was used to examine the relative RNA levels of SP1, DNMT1 and MEG3. Western blot assay was performed to measure the protein levels of SP1 and DNMT1. The dual-luciferase reporter gene assay was used to validate the miR-204-5p bindings to SP1. Functional assays were utilized to assess cell apoptosis, colony formation, migration, and invasion.

Results: SP1 knockdown inhibited DNMT1 and increased MEG3 expression. The expression of MEG3 was enhanced by methylation inhibition through 5-azadC, but SP1 upregulation reversed this effect. SP1 knockdown increased apoptosis and decreased migration and invasion, which was reversed by DNMT1 overexpression. SP1 was targeted and inhibited by miR-204-5p. miR-204-5p also inhibited DNMT1, and enhanced the expression of MEG3. miR-204-5p inhibited cell proliferation, migration and invasion, and promoted apoptosis. Overexpression of SP1 partially reversed these effects by activating DNMT1 and inhibiting MEG3.

Conclusions: miR-204-5p promoted MEG3 expression in trophoblast cells via SP1-mediated DNMT1 inhibition, leading to reduced cell migration, proliferation and invasion, as well as increased apoptosis. This study reveals a novel regulatory axis in trophoblast cells, providing insights into potential regulatory mechanisms in RM.

Objectives: To assess the effectiveness of HTS in lowering elevated ICP in TBI patients with TBI.

Material and methods: A systematic search was conducted using 4 electronic databases (PubMed, Embase, Scopus, and Cochrane Library) to select relevant articles published in peer-reviewed journals. The risk ratio (RR) and mean difference (MD) were calculated, along with their 95% confidence intervals (95% CIs). Heterogeneity was assessed using Cochrane Q, I2 statistics and p-value. RevMan 5.4 was used.

Results: The current meta-analysis included 965 TBI patients from 15 randomized controlled trials (RCTs). We found that HTS was significantly more effective than other ICP-lowering agents with RR of 0.74 (95% CI: 0.58-0.94) for reduction of elevated ICP; RR = 0.57 (95% CI: 0.40-0.81) for all-cause mortality; RR = 0.68 (95% CI: 0.49-0.95) for rate of adverse hypernatremia; RR = 0.73 (95% CI: 0.60-0.88) for substantial change in the Glasgow Outcome Scale (GOS) score and shorter period of hospital stay with MD of -1.26 (95% CI: -2.30 to -0.21).

Conclusion: We found that HTS is considerably effective in reducing elevated ICP with improvement in long-term neurological functions, all-cause mortality, rate of hypernatremia, and length of hospital stay in TBI patients.

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.

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.