Advances in Clinical and Experimental Medicine最新文献

Perinatal mental health has been increasingly recognized as one of the most prevalent and consequential complications of pregnancy and childbirth. Approximately 1 in 5 women experience depression during or after pregnancy, and up to 1 in 4 encounter difficulties in establishing an emotional bond with their infants - a condition known as mother-to-infant bonding difficulties (MIBD). Pooled global estimates from meta-analyses indicate that these conditions are more prevalent than major obstetric complications such as gestational diabetes and preeclampsia. They also represent the leading cause of maternal mortality, particularly in high-income countries. For example, suicidal ideation (SI) is approx. 16 times more common among women with postpartum depression (PPD) than among those without. Moreover, SI occurring alongside PPD is often associated with prior depressive episodes and a lack of social support, whereas SI in the absence of depression tends to be linked to first-time motherhood, infection during pregnancy, or loneliness. Postpartum depression and MIBD are also closely interconnected, exhibiting a bidirectional relationship and sharing major risk factors such as prenatal depression, limited family support, and adverse childhood experiences. When left untreated, perinatal depression and MIBD can impair maternal functioning and delay infants' emotional, cognitive and social development. Emerging integrative approaches that combine psychotherapy with bonding-focused, lifestyle and psychosocial components show promise in improving outcomes. Future research should focus on developing comprehensive, multimodal interventions that integrate psychotherapy with lifestyle and psychosocial elements within a preventive, family-centered framework, promoting sustained recovery beyond active treatment.

Background: Many studies reported positive effects of physical exercise on the condition of dialysis patients. The insufficient value of those changes makes it difficult to interpret their clinical relevance.

Objectives: This study aimed to assess the influence of selected training (endurance, resistance, tai chi) on cardiopulmonary fitness and muscle function, as well as to analyze the factors having the most significant effect on cardiopulmonary fitness in a group of dialysis patients.

Material and methods: Ninety-eight patients agreed to participate in the study. Selection of the type of training was done by cluster randomization. Group 1 were patients in a cluster with an endurance exercise program, and group 2 in a cluster with resistance exercises. Group 3 consisted of patients who took part in a tai chi program (non-cluster randomization). Exercise programs with each of the 3 groups were conducted for a period of 6 months, 3 times a week (groups 1 and 2) and twice a week (group 3), up to 60 min for 1 session.

Results: The full exercises was completed by 45 patients: group 1 - 16; group 2 - 15; group 3 - 14. The significance of the observed difference in the cardiopulmonary function was confirmed only in endurance group for absolute oxygen concumption (VO2) and heart rate (HR). Measurements of peak torque (PTQ) and total work (TW) performed at a speed of 60°/s showed a significant increase in the measured values only in the resistance training group. Measurements of PTQ and TW performed at 180°/s showed a significant increase in the measured values in the endurance and resistance group.

Conclusions: The 6 months of training resulted in a slight improvement in cardiopulmonary parameters only in the endurance group. The above results seem to confirm the observed limited potential for improving aerobic capacity in dialysis patients. The results of strength and speed parameters shows the specificity of each training, expressed by selective improvements in isometric and both isokinetic tests.

Background: Despite legal advances and the depathologization of transgender identities, transgender individuals still face significant barriers and discrimination within healthcare systems. A pervasive lack of training in gender diversity among healthcare professionals often results in uncomfortable, even hostile, clinical encounters, exacerbating physical and mental health vulnerabilities. Consequently, fear of stigma and discrimination leads many transgender people to avoid seeking care, placing their wellbeing at further risk due to delayed or foregone medical attention.

Objectives: To explore transgender individuals' perceptions of healthcare professionals' awareness and responsiveness to their care and support needs in the Valencian Community (Spain).

Material and methods: We conducted a descriptive qualitative study with a phenomenological approach in the Valencian Community. Using convenience sampling, we recruited 14 participants. Data were collected between April and June 2022 via in-depth, semi-structured, open-ended interviews. The study comprised 2 sequential phases: An initial focus group session, followed by individual interviews conducted using a snowball sampling technique.

Results: We identified 3 thematic domains: T1: Experiences of professional care among transgender individuals; T2: Impact of cisgender-centric regulations within the healthcare system; T3: Gender diversity education needs for healthcare professionals.

Conclusions: The transformation of the health system is urgent to ensure inclusive and equitable care for transgender people. According to the interviews, they consider that better training of professionals will improve their care. In addition, they highlight the need to reduce bureaucratic barriers, create specific protocols, and improve access to specialized treatment. Implementing inclusive public policies will contribute to a fairer and more accessible system.

Background: Stroke is a leading cause of disability and one of the primary causes of death worldwide. Stroke survivors often experience a range of symptoms, including impaired motor function, speech and language abnormalities, swallowing difficulties, cognitive deficits, visual disturbances, and sensory impairments.

Objectives: This meta-analysis was conducted to assess and compare the relative effectiveness of telerehabilitation compared to traditional in-person speech and language therapy for individuals with aphasia.

Material and methods: A comprehensive literature search was conducted up to October 2024, reviewing 1,185 identified studies. Ultimately, 6 studies were selected that included a total of 168 participants with aphasia at baseline. The meta-analysis examined the relative effectiveness of telerehabilitation compared to traditional in-person speech and language therapy using continuous outcomes, with mean differences (MD) and 95% confidence intervals (95% CIs) calculated. Analyses were performed using either fixed-effect or random-effects models, depending on heterogeneity.

Results: In individuals with aphasia, telerehabilitation demonstrated significantly greater improvements in generalization post-intervention compared to face-to-face treatment (MD = 11.53; 95% CI: 3.64-19.43; p = 0.004). However, no significant differences were found between telerehabilitation and face-to-face treatment in naming accuracy post-intervention (MD = 3.09; 95% CI: 1.98-8.16; p = 0.23), Western Aphasia Battery (WAB) aphasia quotient (MD = -0.54; 95% CI: -9.96-8.88; p = 0.91), auditory comprehension post-intervention (MD = 0.66; 95% CI: -8.83-10.14; p = 0.89), or functional communication post-intervention (MD = -0.95; 95% CI: -10.19-8.29; p = 0.84).

Conclusion: In individuals with aphasia, telerehabilitation showed significantly greater improvements in generalization post-intervention compared to face-to-face treatment. However, no significant differences were observed between the 2 approaches in naming accuracy, WAB aphasia quotient, auditory comprehension, or functional communication post-intervention. To validate these findings, further research is needed, and caution should be exercised when interpreting the current results due to the limited number of included studies.

Minimally invasive techniques are progressively transforming colorectal (CRC) surgery. Given the high mortality and morbidity rates associated with conventional surgical treatments for CRC, the development of less invasive alternatives is crucial. The long-established use of transanal platforms for local excision of early-stage rectal cancers paved the way for the development of a transanal approach to total mesorectal excision (TME). Transanal total mesorectal excision (taTME) has emerged as a novel technique for treating low CRC, offering superior and more accurate visualization of the presacral mesorectal plane compared to the abdominal approach, and providing particular advantages in the narrow male pelvis. The current data on oncological and functional outcomes are promising. The transanal transection and single-stapled anastomosis (TTSS) approach represents the latest advancement in transanal techniques for treating low CRC. Evolving from taTME, it provides a more controlled and potentially safer anastomotic technique. However, the data are still preliminary, and larger studies are needed to validate its effectiveness. This review explores the evolution of minimally invasive and transanal surgical techniques for low CRC treatment, comparing outcomes across various approaches with a focus on patient selection criteria and oncological results.

Background: Despite the broad range of treatment options available for intestinal inflammation, the development of novel therapeutics remains essential due to the diminishing effectiveness of current therapies over time. Both the endocannabinoid system (ECS) and nociceptin/orphanin FQ peptide (NOP) receptors have been implicated in the pathogenesis of diseases associated with intestinal inflammation, highlighting their potential as therapeutic targets.

Objectives: We hypothesized that an interaction exists between cannabinoid receptors 1 and 2 (CB1 and CB2) and the NOP receptor, which may hold therapeutic relevance for the treatment of colitis.

Material and methods: In this study, we used 3 selective ligands: a CB1 antagonist (AM6545), a CB2 antagonist (AM630) and a NOP agonist (SCH221510) in a mouse model of colitis induced by 3% dextran sulfate sodium (DSS). Quantification of several secondary messengers was conducted using western blot analysis. Real-time quantitative polymerase chain reaction (qPCR) was employed to assess CB1 expression levels in colonic tissue, while liquid chromatography-mass spectrometry (LC-MS) was used to evaluate the concentrations of endocannabinoids and related lipid mediators.

Results: We observed a statistically significant increase in the macroscopic score and a nonsignificant increase in the microscopic score in inflamed mice treated with both AM6545 and SCH221510 compared to those treated with SCH221510 alone. Additionally, the combination-treated group exhibited significantly lower levels of extracellular signal-regulated kinases 1/2 (ERK1/2) and significantly higher levels of phosphorylated protein kinase B (p-AKT) and β-arrestin relative to the SCH221510-only group.

Conclusions: Our study offers novel insights into the interaction between the ECS and the NOP receptor, which may inform the development of new therapeutic strategies for inflammatory conditions such as colitis.

Electroencephalography has advanced from spectral analyses to integrate functional-connectivity and oscillatory metrics, offering mechanistic insights into network dysfunction across neurological and psychiatric disorders. Methodological advances, such as source reconstruction and brain modelling, enhance spatial precision and mitigate volume conduction. Empirical studies show that oscillatory brain activity and functional connectivity serve human cognition and their disruptions underlie symptoms in a variety of neuropsychiatric disorders. The study of the relation between brain oscillations and connectivity is pivotal for the advances in cognitive and clinical neuroscience. Crucially, integrating these biomarkers into machine-learning frameworks and closed-loop neuromodulation holds promise for personalized diagnostics and interventions.

Background: A correlation between thyroid function and cognitive impairment has been well established; however, the impact of thyroid dysfunction on structural changes in the brain cortex remains largely unexplored.

Objectives: The study describes a 2-sample Mendelian randomization (MR) analysis to elucidate the relationship between thyroid malfunction and brain structure and function.

Material and methods: Eight phenotypes of thyroid function were extracted from THYROIDOMICS consortium by determining free thyroxine (FT4) and thyroid-stimulating hormone (TSH) levels in both men and women separately and together, as well as in individuals with increased or decreased TSH levels. The results were assessed in terms of overall brain cortical thickness and the surface area (SA) of grey matter, along with 34 specific measurements for various regions. The primary method employed for the analysis was the inverse-variance weighted (IVW) approach.

Results: The data were subjected to MR Egger regression, Cochrane's Q statistic and leave-one-out analysis to determine the correlation between the variables. The FT4 in men, women and overall was statistically associated with cortical thickness of entorhinal cortex (EC). Overall TSH and TSH in men were associated with cortical thickness of caudal anterior cingulate. Additionally, in men, TSH levels showed an association with cortical thickness in the cuneus gyrus. Increased TSH was associated with decreased SA of lateral occipital (LO) and increased SA of lateral orbitofrontal, medial orbitofrontal and superior frontal cortex. Decreased TSH was negatively associated with the SA of pars opercularis (PO) and the cortical thickness of posterior cingulate cortex. No pleiotropy was detected.

Conclusions: Our findings indicate a possible causal link between thyroid function and the cortical architecture of particular functional areas associated with neurodegenerative and psychiatric conditions.

Background: Age and gender have been identified as significant factors contributing to the global rise in thyroid cancer (TC), with this disease predominantly affecting women. It is crucial to thoroughly investigate the trends of the disease over time to better understand its progression and potential risk factors.

Objectives: This study analyzed the global incidence of TC using data from the Global Burden of Disease (GBD) database from 1990 to 2021. Additionally, we aimed to develop a high-performance diagnostic model using machine-learning algorithms and to explore the tumor microenvironment through single-cell sequencing.

Material and methods: To analyze trends in incidence, age-period cohort models were applied, with a particular focus on birth cohort and period effects. Machine learning algorithms, including least absolute shrinkage and selection operator (LASSO) and Ridge regression, were used for gene feature selection. Subsequently, cross-validation was conducted to validate the diagnostic model. For deeper insights, single-cell RNA sequencing was conducted to analyze myeloid cell subpopulations within the tumor microenvironment.

Results: Age and period effects emerged as the primary drivers in our analysis of TC trends, particularly among women. Machine learning models, specifically LASSO and Ridge regression, demonstrated high predictive accuracy in diagnosing the disease. Additionally, single-cell RNA sequencing unveiled crucial interactions between myeloid cells and the tumor microenvironment.

Conclusions: This study provides a comprehensive analysis of TC trends and introduces a machine-learning-based diagnostic tool. Additionally, single-cell RNA sequencing offers novel insights into the tumor microenvironment, which may help shape future treatment strategies for TC.

Background: Optic nerve head drusen (ONHD) are benign calcified deposits that can compress local capillaries, disrupt blood flow and potentially lead to visual loss.

Objectives: The aim of the study was to present the correlations between optical coherence tomography (OCT), OCT angiography (OCTA) results and fundus autofluorescence (FAF) findings in patients with ONHD, and to highlight the importance of multimodal imaging in the diagnosis and management of this pathology.

Material and methods: This retrospective study included 21 patients (36 eyes) with ONHD, with a mean age of 45.75 years (range: 19-71 years), who had no other ocular pathologies. All participants underwent a full ophthalmic examination and multimodal imaging using the DRI Triton OCT (Topcon). Drusen presence was divided into quadrants based on FAF and correlated with OCT and OCTA results.

Results: Optic nerve head drusen were unilateral in 6 patients (28.57%) and bilateral in 15 (71.43%). Drusen were most common in the nasal and superior quadrants (NQ and SQ) but were significantly more frequent in the inferior (IQ) and temporal (TQ) quadrants in patients with bilateral ONHD. Eyes with drusen located in the IQ and TQ showed a significantly decreased radial peripapillary capillary (RPCP) vessel density (VD). Retinal nerve fibre layer (RNFL) measurements showed the strongest positive correlations with RPCP, especially in the IQ (r = 0.78, p < 0.001). Ganglion cell layer and nerve fiber layer (GCL++) thickness showed significant correlations with RPCP VD, particularly in the IQ and TQ (p < 0.001 for both).

Conclusions: Fundus autofluorescence is a valuable tool for identifying superficial drusen. Optical coherence tomography and OCTA are effective in assessing optic nerve fiber integrity and microvascular changes. Microcirculation assessment using OCTA should focus not only on the radial peripapillary capillaries (RPCP), but also on the macular region. Multimodal imaging plays a crucial role in the accurate diagnosis and comprehensive evaluation of patients with ONHD. Further longitudinal studies are needed to investigate how these correlations evolve over time, particularly in the context of ONHD progression.