Advances in Clinical and Experimental Medicine最新文献

Only a few studies have examined the effects of coronavirus disease 2019 (COVID-19) and influenza on clinical outcomes in pediatric patients. Furthermore, no meta-analysis has assessed the impact of these diseases on adverse outcomes. This study aims to compare the clinical outcomes of COVID-19 and influenza in pediatric patients. Searches were conducted from December 2019 to February 2022 in databases including Embase, Scopus, PubMed Central (PMC), MEDLINE, Google Scholar, Cochrane Library, and ScienceDirect. Our meta-analysis used a random-effects model, reporting pooled odds ratios (ORs) or standardized mean differences with 95% confidence intervals (95% CIs). Thirteen studies meeting the inclusion criteria were analyzed. Most studies had poor quality. The pooled OR was 0.13 for oxygen requirement (95% CI: 0.04-0.45; I2 = 74%) and 0.03 for steroid requirement (95% CI: 0.01-0.19; I2 = 60.8%). No significant differences were found in outcomes such as intensive care unit (ICU) admission, duration of inpatient stay, invasive/non-invasive ventilation, death, acute respiratory distress syndrome (ARDS), and acute kidney injury (AKI). SARS-CoV-2 infection was comparable to influenza regarding mortality, pediatric intensive care unit (PICU) admissions, mechanical ventilation, and AKI incidence, but with notable differences in oxygen supplementation.

Background: Thyroid carcinoma (TC), the most prevalent endocrine cancer worldwide, has become progressively more common, especially in women. Most TCs are epithelial-derived differentiated TCs, specifically papillary thyroid cancer (PTC). Although there are many therapeutic drugs available, curing TC is a difficult task.

Objectives: A flavone called eupatorin (EUP) obtained from herbs can prevent the growth of many types of cancerous cells. Nonetheless, the mechanisms of EUP's actions against PTC are still unknown.

Material and methods: The goal of our work was to evaluate the mechanisms of EUP (20 and 30 μM/mL) and examine its antiproliferative and apoptotic effects on human PTC cells BCPAP. The MTT test; dual acridine orange/ethidium bromide (AO/EB), rhodamine-123 (Rh-123), and 4',6-diamidino-2-phenylindole (DAPI) staining; adherence assays; and western blot analyses were used to evaluate the antiproliferative and apoptotic properties of EUP on BCPAP cells.

Results: Our research showed that the quantity-dependent administration of EUP inhibited the proliferation of BCPAP cells, which in turn caused apoptosis through the increase in caspase-9 and p53 protein expression and the reduction of proliferating cell nuclear antigen (PCNA) levels. Additionally, when P13K/AKT signaling is inhibited by nuclear factor kappa B (NF-κB), EUP reduces inflammation and BCPAP proliferation.

Conclusions: By blocking the NF-κB and P13K/AKT pathways, EUP can reduce the growth of BCPAP cells and promote cell death.

Background: Dysphagia, prevalent in 90% of children with neurological disorders, poses risks of medical complications and is associated with cognitive and psychosocial challenges. The absence of the sucking-swallowing reflex and variations in the gag reflex contribute to feeding difficulties.

Objectives: This study focuses on examining the impact of the gag reflex on the masticatory system structure in children with cerebral palsy, aiming to assess its significance.

Material and methods: This observational study investigated the gag reflex and soft palate shape in 25 children with cerebral palsy (average age: 14 years). Inclusion criteria considered specific levels of the Eating and Drinking Ability Classification System (EDACS) and the Gross Motor Function Classification System (GMFCS). Exclusion criteria comprised hypotension, inflammation and tumors. The Castillo-Morales questionnaire assessed variables and statistical analysis (Spearman's rank correlation and non-parametric tests) utilizing PQStat v. 1.8.6.120 software.

Results: Findings did not reveal an association between the absence of the gag reflex and abnormal palate structure in children. Our results showed a correlation between higher tension of the buccinator muscles and mobility of the tongue on the structure of the palate.

Conclusions: Children with neurological disorders, such as cerebral palsy, are a diverse group requiring specialized orthodontic treatment and close interdisciplinary collaboration.

Alzheimer's disease (AD) is the leading cause of dementia in the aging population. Pathogenic processes related to the accumulation of amyloid plaques (Aβ) and intracellular neurofibrillary tangles (NFTs) begin during the asymptomatic stage long before the onset of deterioration in cognitive functions and neurodegeneration, which makes rapid diagnosis and treatment difficult. Although biochemical diagnostic markers isolated from the body fluids of AD patients are currently used, scientists are engaged in research into molecular biomarkers that will significantly accelerate the diagnosis long before the first clinical symptoms appear. The research presented here focused on microRNAs (miRNAs), small, non-coding RNA molecules that are involved in the regulation of the post-transcriptional expression of many genes. A review of the literature revealed that miRNAs play an important role in regulating the expression of genes involved in the pathophysiological mechanisms of AD. Changes in the levels of miRNAs in a patient's body fluids can be used for rapid diagnosis. Original scientific articles published between 2014 and 2023 describing clinical and experimental studies on the role and expression levels of various miRNAs were selected from scientific databases such as PubMed, NCBI, Science Direct, and Google Scholar. The selected miRNAs were divided into 2 groups based on their expression level in AD: those with increased expression and those with decreased expression. A review of the latest scientific reports confirms that miRNAs may be a promising source of non-invasive and widely available biomarkers. Additionally, their modulation may prove to be an effective therapeutic strategy in AD.

Background: The coronavirus disease 2019 (COVID-19) pandemic has significantly accelerated the development and use of new healthcare technologies. While younger individuals may have been able to quickly embrace virtual advancements, older adults may still have different needs in terms of health communication.

Objectives: To identify areas of interest and preferred sources of information related to the COVID-19 pandemic among older adults and to verify their eHealth competencies.

Material and methods: The study was conducted between February 2022 and July 2022. It included listeners from the University of the Third Age (U3A) and younger students. Both groups received information about the HealthBuddy+ chatbot, a questionnaire that addressed respondents' interests about COVID-19, and the PL-eHEALS (eHealth Literacy Scale) questionnaire to measure their eHealth competencies.

Results: There were 573 participants in the study (U3A listeners - 303 participants, median age: 73 years (interquartile range (IQR): 69-77); young adult students - 270, median age: 24 years (IQR: 23-24). The primary source of information about COVID-19 for older adults was television (84.5%), and for younger adults, internet (84.4%). Among the older adults, only 17% ever interacted with a chatbot (younger adults - 78% respectively), and 19% considered it a trustworthy source of information on COVID-19 compared to 79% of younger respondents. Older adults and younger adults in our study were most interested in COVID-19 treatment methods (45.5% and 69.3%, respectively), symptoms of the disease (36.6% and 35.2%, respectively) and chronic diseases coexisting with COVID-19 (35.0% and 51.5%, respectively). However, their eHealth competencies were generally low (median (Me): 34; IQR: 30-39) compared to younger adults (Me: 42; IQR: 40-47).

Conclusions: Health education for older adults should be appropriately tailored to their current needs and differentiated. The level of eHealth competencies of older adults suggests that much work remains to narrow the gap between the eHealth competencies of the younger and older generations.

Background: Liquid biopsy, including miRNA profiling, is a promising approach to identify breast cancer (BC) resistance. However, the effect of long-term storage on the quality of miRNA assessment in archival serum has not been fully addressed.

Objectives: We aimed to determine whether miRNAs were recoverable from long-stored serum samples to subsequently evaluate prognostic and predictive miRNA value in the archival collection of samples from patients treated with neoadjuvant chemotherapy at Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland.

Material and methods: We have evaluated miRNA quantity in serum samples stored for up to 12 years. Additionally, we compared miRNA expression in archival samples to freshly collected samples derived from advanced BC patients.

Results: Forty BC patients were included in the study. Archival samples were derived from 20 BC patients treated with radical intent between 2011 and 2015. Freshly collected samples were collected from 20 advanced BC patients in 2022. miRNA was present in archived serum samples frozen at -80C° for at least 12 years. Additionally, we found significantly different expressions between the 2 analyzed groups. Expression of circulating miR-16, -17, -18a, -20a, -21, -27a, -30b, -222, and -326 were significantly higher in archival samples, whereas expression of circulating miR-19a, -29b, -29c, -128, -145, -146a, -193b, -195, -200b, -210, -221, -424, and -451a were lower than in freshly collected samples. In 14 miRs, we observed expression in both groups; however, differences were statistically insignificant (miR-1, -7a, -10b, -19b, -34a, -99a, -106b, -122, -125b, -155, -200a, -205, -223, -340).

Conclusions: MiRNA can be identified from long-stored samples, making large prospectively collected serum repositories with long follow-up time an invaluable source for miRNA biomarker discovery.

Background: The role of primary healthcare (PHC) during a pandemic varies across European countries. The coronavirus disease 2019 (COVID-19) pandemic has altered the working practices of family medicine doctors and impacted the resilience of healthcare systems.

Objectives: This study aimed to examine European healthcare system responses to the pandemic, focusing on rural and urban differences.

Material and methods: This cross-sectional, mixed-methods study used a semi-structured online questionnaire with 68 questions, including 21 free-text comments. Data were collected from May 2020 to January 2021. Key informants from 16 European Rural and Isolated Practitioners Association (EURIPA) member countries distributed questionnaires to 406 PHC doctors. Data were analyzed using descriptive statistics and nonparametric tests (χ2, Kruskal-Wallis, Mann-Whitney U) with a significance threshold of 0.05.

Results: A statistically significant difference was found between rural (36.4%, 55/151), semirural (19.4%, 24/124) and urban populations (29.8%, 39/131) regarding medicine shortages (χ2 = 9.91, degrees of freedom (df) = 4, p = 0.042). The semirural setting showed a statistically significant difference from the other settings (p = 0.004 in post hoc χ2 test). Significant differences were found between countries in resilience features including, effectiveness of triage, adapting to the rapidly changing requirements, government help, existence of a community resilience group, improved interprofessional collaboration, medicine shortage, and general practitioners (GPs) involvement in palliative care.

Conclusions: Medicine shortage was more prevalent in rural and urban areas compared to semirural areas. Differences were observed between countries in their responses to the pandemic, particularly in adapting to the rapidly changing requirements, effectiveness of triage, government help, and the existence of a community resilience group. These differences were confirmed with qualitative analysis. The results emphasize the need for tailored approaches considering diverse contexts in shaping effective healthcare system resilience.

Background: Oral squamous cell carcinoma (OSCC) is one of the most common cancers in humans. The role of neoadjuvant chemotherapy (NAC) in OSCC remains controversial.

Objectives: The study aimed to investigate the effect of NAC on locally advanced OSCC and identify prognostic factors varying is different therapies to ultimately guide the optimal selection of future treatment.

Material and methods: A total of 156 patients with locally advanced OSCC were enrolled. The clinical characteristics and survival outcomes of patients with and without NAC were compared. The primary endpoint was overall survival (OS), and the secondary endpoint was disease-free survival (DFS).

Results: Among the 156 patients enrolled in this study, 81 patients received NAC followed by surgery and 75 patients received surgery alone. No significant difference in OS at 3 years was detected (78.3% vs 79.8%, p = 0.76). However, a significantly worse DFS was observed in the NAC group (42.4% vs 59.2%, p = 0.048). Within the NAC group, 50 patients (61.7%) had a favorable clinical response, and 12 patients (14.8%) had a complete pathological response. Better survival outcomes were observed in patients with favorable clinical responses. In stratified analysis, patients of pT3/4 OSCC after NAC showed worse DFS than those of the same stage who underwent surgery alone (40.2% vs 58%, p = 0.033). In Cox regression, clinical response and pathological stage were predictors of survival in the NAC group, while pathological stage was the only predictor of OS in the surgery group.

Conclusions: Patients with advanced pathological stages after NAC may be at a higher risk of treatment failure, and upfront surgery is recommended for locally advanced OSCC patients in current clinical practice.

Background: The spread of antibiotic-resistance genes among healthcare-associated infections (HAIs) poses serious problems in the treatment of these infections. Recently, these resistance genes have also been shown to be present in integrons.

Objectives: By focusing on integron-mediated mechanisms of antibiotic resistance, we sought to elucidate the genetic determinants underpinning the development of multidrug resistance in clinical isolates of Acinetobacter baumannii.

Material and methods: In this study, 27 TMP-SXT-resistant A. baumannii isolates were obtained from various clinical samples. Class I and class II integrons were determined using polymerase chain reaction (PCR). Samples were sent for DNA sequence analysis of the integron to a private firm (BMLabosis, Ankara, Turkey). The similarities of the DNA sequences with the associated integron were determined using National Center for Biotechnology Information (NCBI) GenBank.

Results: While all isolates were resistant to TMT-SXT and gentamicin, amikacin and tobramycin resistance rates were detected as 70% and 26%, respectively. Class I and class II integrons were found in 1 strain and 2 isolates, respectively. It was also determined that the dfrA12 gene and the aadA2 gene were found in the class I integrons. It was determined that 2 isolates carrying class II integron had dfrA1 and sat2 genes. Both class I and class II integrons were detected in 1 of these isolates.

Conclusions: Despite the low integron detection in the resistant isolates, with the detection of class I and class II integrons among A. baumannii isolates, it was determined that HAIs could spread very rapidly within the hospital and cause multidrug resistance. This study reveals the need for comprehensive surveillance and molecular characterization of integron-mediated resistance mechanisms to inform effective strategies to combat infections caused by multidrug-resistant (MDR) A. baumannii.

Background: Placenta previa, occurring when the placenta covers the cervical opening after 28 weeks, can lead to severe postpartum bleeding, especially when coupled with placenta accreta spectrum (PAS), posing risks of organ damage and necessitating hysterectomy. Accurate preoperative diagnosis of PAS in women with placenta previa is crucial to reduce adverse outcomes.

Objectives: This study aimed to develop a risk prediction model for PAS in women with placenta previa.

Material and methods: A total of 437 patients with placenta previa, delivering babies between January 2012 and December 2018, were included. Data collected encompassed clinical records, neutrophil-to-lymphocyte ratio (NLR) and sonographic findings. Utilizing univariate and multivariate logistic regression analyses, the study identified key factors correlated with PAS in expectant mothers with placenta previa. A risk prediction model was formulated and evaluated through receiver operating characteristic (ROC) analysis. External validation was performed using additional patients diagnosed with placenta previa.

Results: Independent risk factors for PAS in placenta previa included NLR, timing of cesarean section and miscarriage, placenta previa type, presence of placental lacunae, and uterovesical hypervascularity. The predictive model was established using specific coefficients. The ROC curve indicated an area under the curve (AUC) of 0.821, with a sensitivity of 80.6% and specificity of 68.9%. External validation demonstrated a diagnosis coincidence rate of 75%, and the model exhibited good calibration according to the Hosmer-Lemeshow test (p = 0.3742, >0.05).

Conclusions: The developed model showed effective potential in predicting PAS among women with placenta previa. Its application could significantly contribute to the early detection and subsequent management of PAS.