Advances in Clinical and Experimental Medicine最新文献

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.

Hematological malignancies encompass a diverse group of cancers affecting the blood, bone marrow and lymph nodes. The p16 gene, encoding the P16INK4A protein, plays a pivotal role in cell cycle regulation and tumor suppression. Understanding the involvement of p16 in the development and progression of hematological malignancies is crucial for advancing therapeutic strategies. This systematic review aims to elucidate the multifaceted roles of the p16 gene and P16INK4A protein in hematological malignancies, focusing on their impact on disease pathogenesis, prognostic significance and therapeutic implications. A comprehensive search was conducted across electronic databases, including PubMed, Scopus and Google Scholar, using predefined search terms related to p16, P16INK4A, hematological malignancies, and therapy. Studies published up to 2023 were included, encompassing clinical trials, observational studies, meta-analyses, and preclinical research. The review synthesizes evidence highlighting the dysregulation of the p16 pathway in various hematological cancers. Alterations in p16 expression levels, genetic mutations and epigenetic modifications contribute to disease initiation and progression. Moreover, the prognostic significance of p16 status in predicting therapeutic outcomes and patient survival is explored. The p16 gene and P16INK4A protein emerge as promising biomarkers and therapeutic targets in hematological malignancies. Integrating knowledge of p16 dysregulation into clinical practice holds the potential to optimize treatment strategies, enhance patient outcomes and pave the way for personalized medicine approaches in the management of these challenging diseases.

Background: Sepsis is a life-threatening condition characterized by a dysregulated host immune response to infection. Currently, stress hyperglycemia is frequently associated with an unfavorable prognosis in cardiovascular and cerebrovascular disease. During sepsis, the progression of the immune response and inflammation often leads to aberrant metabolic indicators. However, the association between the stress-induced hyperglycemia ratio (SHR) and sepsis in patients admitted to the intensive care unit (ICU) remains uncertain.

Objectives: This study aimed to explore the potential correlation between SHR and sepsis.

Material and methods: In this retrospective cohort study, data were obtained from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Patients with recorded glucose and glycosylated HbA1c levels within 24-h ICU admission were identified. The endpoints of the follow-up period were the occurrence of sepsis during ICU stay or ICU discharge. After adjustment for factors including demographics, vital signs and biochemical indicators, the univariate and multivariate logistic regression model was employed to examine the relationship between SHR, baseline blood glucose levels and the risk of sepsis. The associations were further explored in subgroups based on age, gender and presence/absence of type 2 diabetes.

Results: Of the total 2,161 patients, with the average age of 64.96 ±16.84 years, 205 (9.49%) had sepsis. After adjustment or confounders, high SHR levels were associated with the risk of sepsis odds ratio (OR) = 1.53, 95% confidence interval (95% CI): 1.07-2.17). Similar results were found in patients aged ≥65 years (OR = 1.91, 95% CI: 1.16-3.17), in men (OR = 1.64, 95% CI: 1.02-2.63) and patients without type 2 diabetes history (OR = 1.58, 95% CI: 1.01-2.48). The baseline blood glucose level did not exhibit a significant association with the risk of sepsis.

Conclusions: Elevated SHR levels were correlated with sepsis. Bedside monitoring of SHR may be a valuable tool for clinicians to identify patients at high risk of sepsis, and be beneficial to promptly implement clinical interventions.

Background: Leukemia may form at any age, from newborns to the elderly, and accounts for considerable mortality worldwide.

Objectives: Nerolidol (NRD) is isolated from the aromatic florae oils and was found to have anticancer activities. However, the role of NRD in antiproliferative and apoptosis actions in acute lymphoblastic leukemia (ALL) is unclear.

Material and methods: Human ALL cell lines, MOLT-4, were used to examine the potential anticancer mechanisms of NRD on cellular proliferation, reactive oxygen species (ROS)-mediated apoptosis, oxidative stress markers, caspases, PI3K/AKT, nuclear factor kappa B (NF-κB), and STAT-3/VEGF/Bcl-2 signaling pathways.

Results: The MTT (3-(4, 5-dimethylthiazolyl-2)-2, 5-diphenyltetrazolium bromide) assay demonstrated that NRD inhibited MOLT-4 cell proliferation in a concentration-dependent manner, with an IC50 value of 30 μM. It was found that NRD (20 and 30 μM/mL) resulted in accumulated intracellular ROS, reduced oxidative stress and loss of mitochondrial membrane potential (MMP) in MOLT-4 cells in a concentration-related way. Nerolidol was able to induce apoptosis, as evidenced by dual acridine orange/ethidium bromide (AO/EB) staining. The levels of antioxidants, caspases-3, -8 and -9 were enhanced by NRD. This research proves that NRD instantaneously triggers ROS-mediated pro-apoptotic signaling and caspases and attenuates PI3K/Akt/NF-κB and STAT3/VEGF/Bcl-2 anti-apoptotic signaling.

Conclusions: Our results suggest that NRD treatment stimulates apoptosis in MOLT-4 cells by causing the accumulation of intracellular ROS through PI3K/AKT/STAT-3 signaling pathways.

The Enhanced Recovery After Surgery (ERAS) consensus offers a robust framework but must be tailored to the unique challenges of free-tissue transfer reconstructions in oral cancer. Factors such as clinical heterogeneity, institutional variability, inconsistent monitoring, and the absence of internal compliance audits can undermine postoperative recovery. By fostering multidisciplinary collaboration, ERAS can evolve from a theoretical guideline into a reproducible clinical pathway that enhances survival, functional outcomes and quality of life for oral cancer patients undergoing free-tissue reconstruction. Our proposed checklist merges evidence-based recommendations with practical adaptations to establish a more consistent, auditable and outcome-driven approach to perioperative care.

Introduction: Social prescribing (SP) is an innovative model that connects individuals to non-clinical community resources. However, its uptake and evaluation have been hindered by inconsistent role definitions for key stakeholders. Although recent studies have refined SP definitions, outside the UK, the responsibilities, educational backgrounds and training requirements of social prescribing link workers (SPLWs) remain poorly defined. Additionally, it is essential to identify which patient populations will benefit most from SP, establish specific methodologies, and standardize assessment tools and referral pathways.

Material and methods: We will employ a 3-round Delphi protocol with an international expert panel to establish consensus on SP definitions. Approximately 60 participants from diverse disciplines and regions will be recruited to complete multiple survey rounds, providing insights into the roles of SPLWs, beneficiary populations, methodologies, and assessment tools. Consensus will be defined as at least 80% agreement on a 5-point Likert scale. Data collection and analysis will follow rigorous protocols to ensure validity, reliability and transparency, in accordance with the Guidance on Conducting and REporting DElphi Studies (CREDES) guidelines.

Objectives: The aim of this research is to unify the fragmented understanding of SP and the role of SPLWs, thereby establishing a foundation for integrating SPLWs into healthcare systems where appropriate. The Delphi technique offers key strengths - namely, participant anonymity and structured iterative feedback - to enable robust consensus building. While we acknowledge limitations such as potential participant attrition and the resource-intensive nature of the methodology, these will be mitigated through targeted engagement strategies and strict adherence to established best practices.

Conclusion: This study addresses critical gaps in SP engagement, conceptual understanding and implementation. The anticipated outcomes will reinforce SP's role in community-based, integrated care to reduce health inequalities and foster social cohesion across Europe and beyond. Ultimately, this work aims to enhance the uptake and adoption of SP in primary care.

This editorial examines the relationship between nutrition, physical activity, and brain health, emphasizing their effects on cognitive function and mental well-being. Evidence supports a balanced diet - rich in antioxidants, omega-3 fatty acids, polyphenols, and patterned after the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet - as crucial for sustaining neural structure, function, and plasticity. Similarly, regular exercise has been shown to enhance mood, attention, memory, and overall cognitive performance. However, despite these demonstrated benefits, the precise neurobiological mechanisms through which diet and exercise influence brain health remain unclear. This article explores both the efficacy of these interventions and the challenges involved in optimizing them for long-term cognitive resilience.

Background: We still know little about the effective pharmacological treatment of heart failure (HF) associated with the Fontan circulation. One of the new options may be sodium glucose cotransporter-2 inhibitors (SGLT2i), which have been proven effective in classic forms of left ventricular HF.

Objectives: To evaluate the effect and safety of SGLT2i inclusion in adults with Fontan circulation. To this end, we conducted observation and complex diagnostics of adult Fontan patients in whom we started treatment with flozins.

Material and methods: The study population consisted of 17 adult Fontan patients with average age 30.5 (9.7) years, 59% in II New York Heart Association (NYHA) class, among whom 53% received dapagliflozin and rest empagliflozin.

Results: The average observation time was 11.0 (3.7) months. None of the patients have reported side effects or complications related to treatment. We observed a significant increase (20.1 mL/kg/min vs 24.2 mL/kg/min, p = 0.008) in the median of maximum oxygen uptake (VO2 max) among participants (9) who completed at least 2 reliable cardiopulmonary exercise tests. We did not notice any significant differences in N-terminal prohormone of brain natriuretic peptide concentration (641.35 (923.7) vs 741.47 (1,139.02), p = 0.12) after the inclusion. Interestingly, we observed a significant increase in erythrocytes (+6%, p = 0.003), hemoglobin (+7%, p = 0.03) and hematocrit (+7%, p = 0.02).

Conclusions: To the best of our knowledge, this is the first study to demonstrate that the implementation of SGLT2i may have a positive effect on exercise capacity among adults with Fontan circulation. Our experience confirms the high safety of using these drugs in Fontan adults.

Background: Pyroptosis has been implicated in the progression of chronic prostatitis (CP)/chronic pelvic pain syndrome (CPPS).

Objectives: The present study was performed to explore the diagnostic value of the levels of the pyroptosis-related protein nucleotide-binding oligomerization domain, leucine-rich repeat and pyrin domain-containing 3 (NLRP3) inflammasome in the expressed prostatic secretions (EPS) of patients with CP.

Material and methods: A total of 167 CP patients, including 85 National Institutes of Health (NIH)-IIIA CP patients and 82 NIH-IIIB CP patients, as well as 80 benign prostatic hyperplasia (BPH) patients and 80 healthy controls, were enrolled. The levels of NLRP3, interleukin 1 beta (IL-1β), and interleukin 18 (IL-18) in EPS were detected using an enzyme-linked immunosorbent assay (ELISA). Disease severity was assessed using the Bergman CP scale. Differences in EPS NLRP3 inflammasome levels between the groups were analyzed, and receiver operating characteristic (ROC) curves were used to investigate the clinical value of the NLRP3 inflammasome in the diagnosis of CP. The numerical rating scale (NRS), the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and the Danish Prostatic Symptom Score (DAN-PSS-1) were applied to evaluate symptom severity. The cutoff value of NLRP3 expression was calculated using R language.

Results: NLRP3 inflammasome levels in EPS were significantly higher in CP patients of NIH-IIIA and NIH-IIIB compared to the BPH patients and controls. NLRP3 levels in EPS were positively associated with Bergman grade. In addition, NRS levels were in a positive relationship with NIH-CPSI and DAN-PSS-1. The ROC curve analysis demonstrated that NLRP3 in EPS may act as a decent indicator for the diagnosis of CP/CPPS. The cutoff value of EPS NLRP3 expression was ≥55.25 ng/mL.

Conclusions: NLRP3 levels in EPS were significantly higher in NIH-IIIA and NIH-IIIB patients compared to BPH patients and healthy controls. NLRP3 inflammasome levels in EPS may be valuable as diagnostic indicators, and targeting chemokines may present a promising approach to treatment for those suffering from CPPS.