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Development and validation of a model to preoperatively predict the risk of placenta accreta spectrum in women with placenta previa. 术前预测前置胎盘患者胎盘增生谱风险模型的建立与验证。
IF 2.1 4区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-12-13 DOI: 10.17219/acem/191828
Bohui Zhou, Junfang Lian, Yanping Wang, Yanling Yang, Hua Bai, Suhui Wu

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.

背景:前置胎盘是指胎盘在28周后覆盖宫颈口,可导致严重的产后出血,尤其是在合并胎盘早剥谱系(PAS)的情况下,具有器官损伤的风险,必须进行子宫切除术。对患有前置胎盘的产妇进行准确的术前诊断对减少不良后果至关重要:本研究旨在建立前置胎盘妇女 PAS 的风险预测模型:共纳入2012年1月至2018年12月期间分娩的437名前置胎盘患者。收集的数据包括临床记录、中性粒细胞与淋巴细胞比率(NLR)和超声波检查结果。通过单变量和多变量逻辑回归分析,研究确定了与前置胎盘准妈妈PAS相关的关键因素。通过接收器操作特征(ROC)分析,建立并评估了风险预测模型。研究还利用其他确诊为前置胎盘的患者进行了外部验证:前置胎盘PAS的独立风险因素包括NLR、剖宫产和流产的时间、前置胎盘类型、胎盘裂孔的存在以及子宫血管过多。预测模型是通过特定系数建立的。ROC 曲线显示曲线下面积(AUC)为 0.821,灵敏度为 80.6%,特异度为 68.9%。外部验证显示诊断吻合率为 75%,根据 Hosmer-Lemeshow 检验(P = 0.3742,>0.05),该模型显示出良好的校准性:结论:所开发的模型在预测前置胎盘妇女的 PAS 方面显示出有效的潜力。结论:所开发的模型在预测前置胎盘妇女的 PAS 方面显示出了有效的潜力,其应用将大大有助于 PAS 的早期发现和后续管理。
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引用次数: 0
Study on the role of postoperative rehabilitation based on the ERAS concept for patients undergoing pancreaticoduodenectomy: Protocol for a randomized controlled clinical trial. 基于ERAS概念的术后康复在胰十二指肠切除术患者中的作用研究:随机对照临床试验方案
IF 2.1 4区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-12-06 DOI: 10.17219/acem/189583
Bonuan Yao, Yunqiang Chen, Hongbo Chen, Xuxia Feng, Xiaojie Ma

Background: Pancreaticoduodenectomy (PD), an abdominal surgery, is known for its complexity, cost and inherent risks. Recently, there has been increasing interest in enhanced recovery after surgery (ERAS) as a therapeutic approach. However, the mechanisms underlying postoperative functional recovery remain uncertain, and there are limited data on the efficacy of ERAS in postoperative physiotherapy following complex PD.

Objectives: This study aims to examine the feasibility and effectiveness of conducting a large powered randomized controlled trial (RCT) to evaluate a 2-week postoperative rehabilitation program based on the ERAS concept for patients undergoing pancreaticoduodenectomy.

Material and methods: This study is a RCT with a single treatment group. From June 2022 to June 2024, 28 PD patients will participate in the trial. Patients will be randomly assigned to either a control group receiving standard clinical care or an intervention group undergoing a 2-week postoperative rehabilitation program. Cardiopulmonary function will be assessed using the 6-minute walk test (6MWT), and gastrointestinal (GI) recovery will be evaluated using the Intake, Feeling nausea, Emesis, physical Exam, and Duration of symptoms (I-FEED) scoring system.

Results: Secondary outcomes, including changes in recovery quality post-surgery, will be evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) and the Quality of Recovery Questionnaire (QOR-40). Additional recorded items will include time to first flatus and feces, daily volume of stomach fluid, time to gastric tube removal, length of hospital stay (LOS), and postoperative complications.

Conclusion: The study will utilize the I-FEED score, a novel tool for assessing GI function, to monitor the impact of a 2-week postoperative rehabilitation exercise program on patients. The primary outcome will focus on improvements in cardiopulmonary capacity following postoperative rehabilitation activities.

背景:胰十二指肠切除术(PD)是一种腹部手术,以其复杂性、成本和固有风险而闻名。最近,人们对手术后恢复(ERAS)作为一种治疗方法越来越感兴趣。然而,术后功能恢复的机制仍然不确定,并且关于ERAS在复杂PD术后物理治疗中的疗效的数据有限。目的:本研究旨在探讨开展一项大型随机对照试验(RCT)的可行性和有效性,以评估基于ERAS概念的胰十二指肠切除术患者术后2周康复计划。材料和方法:本研究为单治疗组的随机对照试验。从2022年6月到2024年6月,28名PD患者将参加试验。患者将被随机分配到接受标准临床护理的对照组或接受2周术后康复计划的干预组。使用6分钟步行测试(6MWT)评估心肺功能,使用摄入、感觉恶心、呕吐、体格检查和症状持续时间(I-FEED)评分系统评估胃肠(GI)恢复情况。次要结局,包括术后恢复质量的变化,将使用欧洲癌症研究和治疗组织生活质量问卷(EORTC-QLQ-C30)和恢复质量问卷(QOR-40)进行评估。其他记录项目包括首次放屁和排便的时间、每日胃液量、移除胃管的时间、住院时间(LOS)和术后并发症。结论:该研究将利用I-FEED评分(一种评估GI功能的新工具)来监测2周术后康复锻炼计划对患者的影响。主要结果将集中在术后康复活动后心肺功能的改善。
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引用次数: 0
PPARγ alleviates damage to chorionic trophoblast cells induced by high glucose and high lipids through regulation of IGF-1. PPARγ通过调节IGF-1减轻高糖、高脂诱导的绒毛膜滋养细胞损伤。
IF 2.1 4区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-12-06 DOI: 10.17219/acem/190812
Hua Li, Qiuling Chen, Weitao Yang, Yanxia Deng, Lijing Zhao, Zhihua Zeng

Background: Overweight and obesity are the most common high-risk conditions that increase the risk of adverse outcomes during pregnancy, childbirth, and the postpartum period. Dysfunctions in trophoblastic peroxisome proliferator-activated receptor gamma (PPARγ) contribute to a variety of related pregnancy disorders.

Objectives: This study investigated whether PPARγ influences chorionic trophoblast cell damage induced by high glucose (HG) and high lipid (HL) by regulating insulin-like growth factor-1 (IGF-1).

Material and methods: Human trophoblast HTR-8/SVneo cells were exposed to HG and HL conditions to simulate damaged trophoblasts during pregnancy in vitro. Cell Counting Kit-8 (CCK-8) was used to assess cell proliferation. The Scratch test was used to test cell migration. Cell invasion ability was assessed by Transwell assay. ELISA was used to assess the inflammatory factor levels. Glucose, lactic acid, and adenosine triphosphate (ATP) levels were measured using biochemical kits.

Results: High glucose/HL inhibited the proliferation, migration, and invasion of HTR-8/SVneo cells. High glucose and HL increased tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, and IL-6 expression while decreasing IL-10 expression. High glucose and HL decreased glucose uptake and ATP levels. High glucose and HL reduced the expressiofns of PPARγ, IGF-1, insulin receptor substrate (IRS) 1, IRS2, GLUT1, and GLUT4. High PPARγ expression promoted cell proliferation, migration, and invasion induced by HG and HL, increased glucose uptake and ATP levels and inhibited inflammation. Low IGF-1 expression inhibited cell proliferation, migration, and invasion under HG and HL conditions, reduced glucose uptake and ATP levels, and increased inflammation. Low IGF-1 expression reversed the effects of PPARγ on HTR-8/SVneo cells under HG and HL conditions.

Conclusions: Peroxisome proliferator-activated receptor gamma alleviated HTR-8/SVneo cell damage induced by HG and HL by regulating IGF-1, suggesting a potentially effective approach for treating gestational obesity.

背景:超重和肥胖是妊娠、分娩和产后期间最常见的高危状况,会增加不良后果的风险。滋养层过氧化物酶体增殖物激活受体γ (PPARγ)的功能障碍有助于多种相关的妊娠疾病。目的:研究PPARγ是否通过调节胰岛素样生长因子-1 (IGF-1)影响高糖、高脂诱导的绒毛膜滋养细胞损伤。材料和方法:将人滋养细胞HTR-8/SVneo细胞暴露于HG和HL条件下,模拟体外妊娠期间滋养细胞损伤。细胞计数试剂盒-8 (CCK-8)检测细胞增殖情况。Scratch测试用于测试细胞迁移。采用Transwell法测定细胞侵袭能力。ELISA法检测炎症因子水平。使用生化试剂盒检测葡萄糖、乳酸和三磷酸腺苷(ATP)水平。结果:高糖/HL抑制HTR-8/SVneo细胞的增殖、迁移和侵袭。高糖和HL升高肿瘤坏死因子-α (TNF-α)、白细胞介素(IL)-1β和IL-6的表达,降低IL-10的表达。高糖和HL降低葡萄糖摄取和ATP水平。高糖和HL降低了PPARγ、IGF-1、胰岛素受体底物(IRS) 1、IRS2、GLUT1和GLUT4的表达。PPARγ高表达促进HG和HL诱导的细胞增殖、迁移和侵袭,增加葡萄糖摄取和ATP水平,抑制炎症。在HG和HL条件下,低IGF-1表达抑制细胞增殖、迁移和侵袭,降低葡萄糖摄取和ATP水平,并增加炎症。在HG和HL条件下,低IGF-1表达逆转了PPARγ对HTR-8/SVneo细胞的作用。结论:过氧化物酶体增殖物激活受体γ通过调节IGF-1减轻HG和HL诱导的HTR-8/SVneo细胞损伤,可能是治疗妊娠期肥胖的有效途径。
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引用次数: 0
Association of oxygen saturation and mortality in patients with acute respiratory failure. 急性呼吸衰竭患者血氧饱和度与死亡率的关系。
IF 2.1 4区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-12-06 DOI: 10.17219/acem/189879
Li Ai, Ran Li, Xixian Teng, Jing Li, Bing Hai

Background: The variability and disparities in the recommended targets across different international guidelines suggest the optimal oxygen saturation (SpO2) target for acute respiratory failure (ARF) patients be further explored.

Objectives: To explore the association between SpO2 and in-hospital mortality of ARF patients, as well as to determine the optimum SpO2 for ARF patients.

Material and methods: In this cohort study, 3,225 ARF patients were included at the end of the follow-up; among them, and 1,249 patients survived and 1,976 died. The restricted cubic spline (RCS) was drawn to show the nonlinear association between the median SpO2 and the risk of in-hospital mortality of ARF patients and to identify the optimal range of SpO2. Cox regression was applied to identify the association between the median SpO2 and the risk of in-hospital mortality in ARF patients. Kaplan-Meier curves were plotted to identify the in-hospital mortality of ARF patients.

Results: The in-hospital mortality rate was 61.2% in all ARF patients at the end of the follow-up. The median SpO2 was associated with decreased risk of in-hospital mortality of ARF patients after adjusting for confounders (hazard ratio (HR) = 0.95, 95% confidence interval (95% CI): 0.93-0.97). The median SpO2 was non-linearly correlated with the in-hospital mortality of ARF patients. The overall survival (OS) was higher in the 96-98% group. A median SpO2 ≤ 96% was associated with an increased risk of in-hospital mortality in ARF patients accompanied by malignant cancer (HR = 1.55, 95% CI: 1.24-1.94), renal failure (HR = 1.45, 95% CI: 1.24-1.70), chronic obstructive pulmonary disease (COPD; HR = 1.70, 95% CI: 1.27-2.28) and atrial fibrillation (AF; HR = 1.25, 95% CI: 1.02-1.53). The median SpO2 > 98% was associated with an elevated risk of in-hospital mortality in ARF patients accompanied by AF (HR = 1.22, 95% CI: 1.04-1.44).

Conclusions: The median SpO2 was linked to a decreased risk of in-hospital mortality in ARF patients.

背景:不同国际指南推荐目标的可变性和差异表明急性呼吸衰竭(ARF)患者的最佳氧饱和度(SpO2)目标有待进一步探讨。目的:探讨动脉血氧饱和度与ARF患者住院死亡率的关系,确定ARF患者的最佳动脉血氧饱和度。材料和方法:在本队列研究中,随访结束时纳入3225例ARF患者;其中存活1249例,死亡1976例。绘制限制三次样条(restricted cubic spline, RCS)来显示SpO2中位数与ARF患者住院死亡风险之间的非线性关系,并确定SpO2的最佳范围。应用Cox回归分析确定急性肾功能衰竭患者SpO2中位数与住院死亡风险之间的关系。绘制Kaplan-Meier曲线以确定ARF患者的住院死亡率。结果:随访结束时,所有ARF患者住院死亡率为61.2%。校正混杂因素后,SpO2中位数与ARF患者住院死亡风险降低相关(风险比(HR) = 0.95, 95%可信区间(95% CI): 0.93-0.97)。中位SpO2与ARF患者住院死亡率呈非线性相关。96% ~ 98%组总生存率(OS)较高。中位SpO2≤96%与ARF患者合并恶性肿瘤(HR = 1.55, 95% CI: 1.24-1.94)、肾功能衰竭(HR = 1.45, 95% CI: 1.24-1.70)、慢性阻塞性肺疾病(COPD;HR = 1.70, 95% CI: 1.27-2.28)和心房颤动(AF;Hr = 1.25, 95% ci: 1.02-1.53)。中位SpO2 bb0 98%与伴有房颤的ARF患者住院死亡风险升高相关(HR = 1.22, 95% CI: 1.04-1.44)。结论:中位SpO2与ARF患者住院死亡风险降低有关。
{"title":"Association of oxygen saturation and mortality in patients with acute respiratory failure.","authors":"Li Ai, Ran Li, Xixian Teng, Jing Li, Bing Hai","doi":"10.17219/acem/189879","DOIUrl":"https://doi.org/10.17219/acem/189879","url":null,"abstract":"<p><strong>Background: </strong>The variability and disparities in the recommended targets across different international guidelines suggest the optimal oxygen saturation (SpO2) target for acute respiratory failure (ARF) patients be further explored.</p><p><strong>Objectives: </strong>To explore the association between SpO2 and in-hospital mortality of ARF patients, as well as to determine the optimum SpO2 for ARF patients.</p><p><strong>Material and methods: </strong>In this cohort study, 3,225 ARF patients were included at the end of the follow-up; among them, and 1,249 patients survived and 1,976 died. The restricted cubic spline (RCS) was drawn to show the nonlinear association between the median SpO2 and the risk of in-hospital mortality of ARF patients and to identify the optimal range of SpO2. Cox regression was applied to identify the association between the median SpO2 and the risk of in-hospital mortality in ARF patients. Kaplan-Meier curves were plotted to identify the in-hospital mortality of ARF patients.</p><p><strong>Results: </strong>The in-hospital mortality rate was 61.2% in all ARF patients at the end of the follow-up. The median SpO2 was associated with decreased risk of in-hospital mortality of ARF patients after adjusting for confounders (hazard ratio (HR) = 0.95, 95% confidence interval (95% CI): 0.93-0.97). The median SpO2 was non-linearly correlated with the in-hospital mortality of ARF patients. The overall survival (OS) was higher in the 96-98% group. A median SpO2 ≤ 96% was associated with an increased risk of in-hospital mortality in ARF patients accompanied by malignant cancer (HR = 1.55, 95% CI: 1.24-1.94), renal failure (HR = 1.45, 95% CI: 1.24-1.70), chronic obstructive pulmonary disease (COPD; HR = 1.70, 95% CI: 1.27-2.28) and atrial fibrillation (AF; HR = 1.25, 95% CI: 1.02-1.53). The median SpO2 > 98% was associated with an elevated risk of in-hospital mortality in ARF patients accompanied by AF (HR = 1.22, 95% CI: 1.04-1.44).</p><p><strong>Conclusions: </strong>The median SpO2 was linked to a decreased risk of in-hospital mortality in ARF patients.</p>","PeriodicalId":7306,"journal":{"name":"Advances in Clinical and Experimental Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Surgical approach to pulmonary metastases and its impact on prognosis. 肺转移瘤的手术入路及其对预后的影响。
IF 2.1 4区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-12-06 DOI: 10.17219/acem/191597
Turkan Dubus, Gokce Cangel, Fatih Kesmezacar, Aziz Ari

Background: Pulmonary metastasectomy (PM) is an important procedure for the treatment of metastatic nodules in the lung. The choice of surgical approach, whether thoracotomy or video-assisted thoracoscopic surgery (VATS), remains controversial in terms of the impact on patient prognosis.

Objectives: This study aimed to evaluate the outcomes and impact on survival of patients undergoing PM with VATS compared to thoracotomy.

Material and methods: A retrospective evaluation of 136 patients who underwent PM between September 2012 and July 2020 was performed. Data on the demographics, primary tumor histopathology, metastatic features, surgical approach, surgical outcomes, and survival status were analyzed. Statistical analyses included descriptive statistics, survival analysis and Cox regression models.

Results: Of the participants, 84 underwent thoracotomy and 52 underwent VATS. The median survival time of thoracotomized patients was 86.6 months, while it was 99.6 months for VATS patients. A gender-specific analysis revealed a significantly longer survival time for female VATS patients compared to thoracotomy. Multivariate analysis showed significant independent effects of specific tumor types and the number of nodes removed on survival. Overall, no significant difference in survival was found between the 2 surgical methods.

Conclusions: Both VATS and thoracotomy are effective and safe options for PM. Video-assisted thoracoscopic surgery may offer advantages, particularly in certain patient groups and tumor types, potentially prolonging survival. Gender-specific analyses suggest a survival benefit of VATS, particularly in women. Further studies are needed to validate these results and optimize surgical decision-making in PM.

背景:肺转移切除术(PM)是治疗肺转移性结节的重要手段。手术入路的选择,无论是开胸手术还是电视胸腔镜手术(VATS),对患者预后的影响仍然存在争议。目的:本研究旨在评估与开胸手术相比,VATS合并PM患者的预后和对生存的影响。材料和方法:对2012年9月至2020年7月期间接受PM治疗的136例患者进行回顾性评估。统计数据,原发肿瘤组织病理学,转移特征,手术入路,手术结果和生存状态进行分析。统计分析包括描述性统计、生存分析和Cox回归模型。结果:84例患者行开胸手术,52例行VATS手术。开胸患者中位生存时间为86.6个月,而VATS患者中位生存时间为99.6个月。一项针对性别的分析显示,与开胸手术相比,女性VATS患者的生存时间明显更长。多因素分析显示,特定肿瘤类型和切除淋巴结数量对生存率有显著的独立影响。总体而言,两种手术方式的生存率无显著差异。结论:VATS和开胸术是治疗PM的有效和安全的选择。视频辅助胸腔镜手术可能具有优势,特别是在某些患者群体和肿瘤类型中,可能延长生存期。针对不同性别的分析表明,VATS对生存有好处,尤其是对女性。需要进一步的研究来验证这些结果并优化PM的手术决策。
{"title":"Surgical approach to pulmonary metastases and its impact on prognosis.","authors":"Turkan Dubus, Gokce Cangel, Fatih Kesmezacar, Aziz Ari","doi":"10.17219/acem/191597","DOIUrl":"https://doi.org/10.17219/acem/191597","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary metastasectomy (PM) is an important procedure for the treatment of metastatic nodules in the lung. The choice of surgical approach, whether thoracotomy or video-assisted thoracoscopic surgery (VATS), remains controversial in terms of the impact on patient prognosis.</p><p><strong>Objectives: </strong>This study aimed to evaluate the outcomes and impact on survival of patients undergoing PM with VATS compared to thoracotomy.</p><p><strong>Material and methods: </strong>A retrospective evaluation of 136 patients who underwent PM between September 2012 and July 2020 was performed. Data on the demographics, primary tumor histopathology, metastatic features, surgical approach, surgical outcomes, and survival status were analyzed. Statistical analyses included descriptive statistics, survival analysis and Cox regression models.</p><p><strong>Results: </strong>Of the participants, 84 underwent thoracotomy and 52 underwent VATS. The median survival time of thoracotomized patients was 86.6 months, while it was 99.6 months for VATS patients. A gender-specific analysis revealed a significantly longer survival time for female VATS patients compared to thoracotomy. Multivariate analysis showed significant independent effects of specific tumor types and the number of nodes removed on survival. Overall, no significant difference in survival was found between the 2 surgical methods.</p><p><strong>Conclusions: </strong>Both VATS and thoracotomy are effective and safe options for PM. Video-assisted thoracoscopic surgery may offer advantages, particularly in certain patient groups and tumor types, potentially prolonging survival. Gender-specific analyses suggest a survival benefit of VATS, particularly in women. Further studies are needed to validate these results and optimize surgical decision-making in PM.</p>","PeriodicalId":7306,"journal":{"name":"Advances in Clinical and Experimental Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prognostic value of the systemic inflammation response index on 3-year outcomes of elderly patients with acute coronary syndrome after stent implantation. 全身炎症反应指数对老年急性冠脉综合征患者支架置入术后3年预后的预测价值。
IF 2.1 4区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-12-06 DOI: 10.17219/acem/190739
Yi Ma, Xuebin Geng

Background: Few studies have focused on the relationship between the systemic inflammation response index (SIRI) and the prognosis of elderly patients with acute coronary syndrome (ACS).

Objectives: This study aimed to evaluate the predictive value of the SIRI for predicting 3-year outcomes in patients >60 years old after stent implantation and to assess variables associated with SIRI.

Material and methods: A total of 1,758 patients with ACS who underwent percutaneous coronary intervention (PCI) were enrolled and divided into an older group (n = 960) and a younger group (n = 798) using a cutoff of >60 years. Major adverse cardiac events (MACEs) including all-cause death, nonfatal acute myocardial infarction (AMI) and nonfatal stroke were recorded.

Results: During follow-up, 165 patients experienced 1 or more MACEs. Patients in the older group had a greater incidence of recurrent MACEs and mortality than those in the younger group. The SIRIs were significantly greater in the older group. Multiple linear regression analysis revealed that the level of the SIRI was significantly associated with age, hypertension, diagnosis of AMI, number of diseased vessels, and platelet count. The SIRI was an independent predictive risk factor for MACEs in patients >60 years old. Similar relationships between the SIRI and MACEs were also observed in ACS patients with and without AMI.

Conclusions: The SIRI was an independent predictive risk factor for MACEs in patients aged >60 years with ACS and ACS with or without AMI after stent implantation during 3 years of follow-up. The SIRI can be used as an indicator for identifying high-risk patients for intensive therapy to further reduce MACEs in the PCI era.

背景:关于老年急性冠脉综合征(ACS)患者全身炎症反应指数(SIRI)与预后关系的研究较少。目的:本研究旨在评估SIRI对60岁至60岁患者支架植入术后3年预后的预测价值,并评估与SIRI相关的变量。材料和方法:共纳入1758例经皮冠状动脉介入治疗(PCI)的ACS患者,并以60岁为截止年龄分为老年组(n = 960)和年轻组(n = 798)。主要心脏不良事件(mace)包括全因死亡、非致死性急性心肌梗死(AMI)和非致死性卒中。结果:随访期间,165例患者出现1次及以上mace。老年组患者的mace复发率和死亡率高于年轻组。老年人的SIRIs明显更高。多元线性回归分析显示,SIRI水平与年龄、高血压、AMI诊断、病变血管数、血小板计数显著相关。SIRI是60 ~ 60岁患者mace的独立预测危险因素。在伴有和不伴有AMI的ACS患者中,SIRI和mace之间也观察到类似的关系。结论:在3年的随访中,SIRI是60 ~ 60岁ACS患者和ACS合并或不合并AMI患者支架置入术后mace的独立预测危险因素。在PCI时代,SIRI可作为识别高危患者进行强化治疗的指标,进一步降低mace。
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引用次数: 0
Pulp regeneration using a peptide nanofiber artificial scaffold on animal models: A preliminary study. 肽纳米纤维人工支架在动物模型上牙髓再生的初步研究。
IF 2.1 4区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-12-05 DOI: 10.17219/acem/189639
Ozlem Marti Akgun, Ayse Begum Tekinay, Gulistan Tansık, Ceren Yıldırım, Gunseli Guven Polat

Background: In regenerative endodontic procedures (REPs), it is crucial to find effective materials. This study introduces glycosaminoglycan (GAG) mimetic peptide amphiphile (PA, GAG-PA) and K-PA nanofibers, synthesized to emulate sulfated GAGs, aiming to enhance tissue repair within damaged pulp - an area where standardized protocols are currently lacking.

Objectives: The objective of this study was to investigate the regenerative potential of GAG-PA nanofibers in REP.

Material and methods: Heparan sulfate mimicking PAs was designed to develop a bioactive nanofibrous supramolecular system. The cavities on the mesial surfaces of the first upper molars of 8 rats (4 rats in the study group and 4 in the control group) were prepared, and the pulps were perforated. Then, the material was applied onto the dental pulp, and the cavities were closed with a self-curing glass ionomer cement filling material. Physiological saline was used in the control group. Thirty days after application, the teeth were extracted, and the formation of regenerative tissue sections in the pulp was evaluated using hematoxylin and eosin (H&E) staining and Masson's trichrome staining.

Results: After 30 days, H&E staining demonstrated robust tissue regeneration in the implanted region, with minimal neutrophil infiltration. Masson's trichrome staining confirmed reparative dentin formation. Quantitative analysis revealed a regeneration percentage of 85% in the study group, compared to 80% in the control group. Statistical analysis showed no significant difference in regeneration between the groups (p > 0.05).

Conclusions: Our comprehensive study, utilizing GAG-PA and K-PA nanofibers, demonstrated successful synthesis, characterization and formation of nanofiber networks. The in vivo experiment with rats exhibited substantial tissue regeneration with quantifiable results supporting the efficacy of the nanofiber approach. Statistical analysis confirmed the consistency between the study and control groups, emphasizing the potential of these nanofibers in endodontic tissue regeneration applications.

背景:在再生牙髓治疗中,寻找有效的材料是至关重要的。本研究引入了糖胺聚糖(GAG)仿生肽两亲体(PA, GAG-PA)和K-PA纳米纤维,合成来模拟硫酸化的GAGs,旨在增强受损牙髓内的组织修复-这是目前缺乏标准化方案的领域。目的:研究GAG-PA纳米纤维在体外再生中的再生潜能。材料与方法:设计硫酸肝素模拟pa纳米纤维超分子体系。8只大鼠(研究组4只,对照组4只)在第一上颌磨牙近中面制备空腔,穿孔牙髓。然后,将该材料涂在牙髓上,用自固化玻璃离子水门体填充材料封闭牙槽。对照组采用生理盐水治疗。应用30 d后拔牙,采用苏木精-伊红(H&E)染色和马松三色染色评价牙髓再生组织切片的形成情况。结果:30天后,H&E染色显示移植区组织再生强劲,中性粒细胞浸润较少。马氏三色染色证实修复性牙本质形成。定量分析显示,研究组的再生率为85%,而对照组为80%。统计学分析显示,两组间再生能力差异无统计学意义(p < 0.05)。结论:我们的综合研究,利用GAG-PA和K-PA纳米纤维,成功地合成、表征和形成了纳米纤维网络。大鼠体内实验显示出大量的组织再生,可量化的结果支持纳米纤维方法的有效性。统计分析证实了研究组和对照组之间的一致性,强调了这些纳米纤维在牙髓组织再生应用中的潜力。
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引用次数: 0
The translation into Polish, cultural adaptation, and initial validation of the Action Research Arm Test in subacute stroke patients. 亚急性脑卒中患者行动研究臂测试的波兰语翻译、文化适应和初步验证。
IF 2.1 4区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-12-04 DOI: 10.17219/acem/191775
Joanna Małecka, Magdalena Goliwąs, Katarzyna Adamczewska, Jacek Lewandowski, Dawid Łochyński

Background: In Poland, there are limited validated outcome measures to evaluate upper extremity function in stroke patients for clinical and research use. The Action Research Arm Test (ARAT) aims to assess functional performance of the upper extremities.

Objectives: To translate and culturally adapt the original version of ARAT into Polish, and to determine its reliability and validity.

Material and methods: A Polish version of ARAT (ARAT-PL) was developed using a forward-backward translation. The study then examined 60 patients with subacute stroke. Internal consistency (α), test-retest and inter-rater reliability (intra-class correlation (ICC), κ), standard error of measurement (SEM), minimal detectable change (MDC), and floor and ceiling effects were determined. The construct validity was evaluated using the method of hypothesis testing based on the results of correlations (rho) between subscale and total scores of the ARAT-PL and the upper and lower extremity section of the Fugl-Meyer Assessment (FMA-UE and FMA-LE).

Results: The internal consistency of the total scores and subscale was excellent (α = 0.97-0.99). Test-retest and inter-rater reliability scores were almost perfect (κ = 0.85-1.0) and excellent for the total and subscale scores (ICC = 0.99-1). The SEM and MDC for the test-retest and inter-rater reliability were 0.479, 1.327 points and 0.335, 0.930 points, respectively. The ceiling effect amounted to 48%. The validity levels with respect to FMA-UE and FMA-LE were found to be high (rho ranging from 0.70 to 0.83) and moderate (rho ranging from 0.53 to 0.68), respectively.

Conclusions: A Polish version of ARAT is a reliable and valid tool for assessing upper extremity function in subacute stroke patients in Poland. However, it appears to have a ceiling effect that limits differentiation of patients with mild upper limb impairment.

背景:在波兰,用于临床和研究的评估脑卒中患者上肢功能的有效结果指标有限。动作研究臂测试(ARAT)旨在评估上肢的功能表现。目的:将原版本的ARAT翻译成波兰语并进行文化改编,并确定其信度和效度。材料和方法:波兰语版本的ARAT (ARAT- pl)是使用向前向后翻译开发的。该研究随后检查了60名亚急性中风患者。测定了内部一致性(α)、重测信度和评分者间信度(类内相关性(ICC)、κ)、测量标准误差(SEM)、最小可检测变化(MDC)以及下限和上限效应。根据ARAT-PL子量表和总分与Fugl-Meyer评估(FMA-UE和FMA-LE)上肢和下肢部分的相关系数(rho),采用假设检验的方法评估结构效度。结果:总分与量表内部一致性极好(α = 0.97 ~ 0.99)。重测信度和量表间信度得分几乎为完美(κ = 0.85-1.0),总量表和分量量表的信度得分为优秀(ICC = 0.99-1)。重测信度的SEM和MDC分别为0.479、1.327点和0.335、0.930点。上限效应达到48%。FMA-UE和FMA-LE的效度水平分别为高效度(rho为0.70 ~ 0.83)和中等效度(rho为0.53 ~ 0.68)。结论:波兰版ARAT是评估波兰亚急性脑卒中患者上肢功能的可靠和有效的工具。然而,它似乎具有天花板效应,限制了轻度上肢损伤患者的分化。
{"title":"The translation into Polish, cultural adaptation, and initial validation of the Action Research Arm Test in subacute stroke patients.","authors":"Joanna Małecka, Magdalena Goliwąs, Katarzyna Adamczewska, Jacek Lewandowski, Dawid Łochyński","doi":"10.17219/acem/191775","DOIUrl":"https://doi.org/10.17219/acem/191775","url":null,"abstract":"<p><strong>Background: </strong>In Poland, there are limited validated outcome measures to evaluate upper extremity function in stroke patients for clinical and research use. The Action Research Arm Test (ARAT) aims to assess functional performance of the upper extremities.</p><p><strong>Objectives: </strong>To translate and culturally adapt the original version of ARAT into Polish, and to determine its reliability and validity.</p><p><strong>Material and methods: </strong>A Polish version of ARAT (ARAT-PL) was developed using a forward-backward translation. The study then examined 60 patients with subacute stroke. Internal consistency (α), test-retest and inter-rater reliability (intra-class correlation (ICC), κ), standard error of measurement (SEM), minimal detectable change (MDC), and floor and ceiling effects were determined. The construct validity was evaluated using the method of hypothesis testing based on the results of correlations (rho) between subscale and total scores of the ARAT-PL and the upper and lower extremity section of the Fugl-Meyer Assessment (FMA-UE and FMA-LE).</p><p><strong>Results: </strong>The internal consistency of the total scores and subscale was excellent (α = 0.97-0.99). Test-retest and inter-rater reliability scores were almost perfect (κ = 0.85-1.0) and excellent for the total and subscale scores (ICC = 0.99-1). The SEM and MDC for the test-retest and inter-rater reliability were 0.479, 1.327 points and 0.335, 0.930 points, respectively. The ceiling effect amounted to 48%. The validity levels with respect to FMA-UE and FMA-LE were found to be high (rho ranging from 0.70 to 0.83) and moderate (rho ranging from 0.53 to 0.68), respectively.</p><p><strong>Conclusions: </strong>A Polish version of ARAT is a reliable and valid tool for assessing upper extremity function in subacute stroke patients in Poland. However, it appears to have a ceiling effect that limits differentiation of patients with mild upper limb impairment.</p>","PeriodicalId":7306,"journal":{"name":"Advances in Clinical and Experimental Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142764993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Esomeprazole inhibits liver inflammation and carcinogenesis by suppressing farnesoid X receptors and NF-κB signaling. 埃索美拉唑通过抑制法内甾体X受体和NF-κB信号传导抑制肝脏炎症和癌变。
IF 2.1 4区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-12-04 DOI: 10.17219/acem/191596
Chia-Chia Lu, Yi-Chin Yang, Yi-Wen Hung, Yen-Chun Peng

Background: The activity of proton pump inhibitors (PPIs) hinders the function of proton pumps that generate stomach acid. Nuclear factor kappa B (NF-κB) is a transcriptional factor engaged in inflammation, immunity and the formation of cancer. The farnesoid X receptor (FXR) is a nuclear receptor that governs the metabolism of bile acids and the metabolic functioning of the liver. The impact of PPIs on the signaling of FXRs and NF-κB is not well understood.

Objectives: We aimed to study the effects of esomeprazole on FXRs and NF-κB signaling in liver cells.

Material and methods: For the liver cell model, we used the human liver cell line HepaG2. Cells were treated with lipopolysaccharides (LPS) and esomeprazole, and then we assessed the effects of esomeprazole on inflammatory and carcinogenic markers, NF-κB and FXR. We applied the techniques of western blotting, reverse-transcription polymerase chain reaction (RT-PCR), confocal microscopic imaging, and electrophoretic mobility shift assay (EMSA).

Results: Lipopolysaccharides-induced FXRs and NF-κB signaling upregulated the NF-κB-associated cytokines interleukin 6 (IL-6), cyclooxygenase-2 (COX-2) and tumor necrosis factor alpha (TNF-α). Esomeprazole inhibited the upregulation of all these cytokines. Additionally, esomeprazole inhibited LPS-induced FXR expression and NF-κB signaling in HepaG2 cells. The net effect on FXRs and NF-κB signaling was the lower levels of the associated inflammatory and carcinogenic cytokines.

Conclusions: Our study provides insight into the potential therapeutic effects of esomeprazole on hepatic inflammation and carcinogenesis by inhibiting LPS-induced NF-κB and FXR expression in HepG2 cells.

背景:质子泵抑制剂(PPIs)的活性阻碍了质子泵产生胃酸的功能。核因子κB (NF-κB)是参与炎症、免疫和肿瘤形成的转录因子。法内甾体X受体(FXR)是一种核受体,控制胆汁酸的代谢和肝脏的代谢功能。PPIs对FXRs和NF-κB信号传导的影响尚不清楚。目的:研究埃索美拉唑对肝细胞FXRs及NF-κB信号通路的影响。材料与方法:肝细胞模型选用人肝细胞系HepaG2。用脂多糖(LPS)和埃索美拉唑处理细胞,然后评估埃索美拉唑对炎症和致癌标志物NF-κB和FXR的影响。我们应用了western blotting,逆转录聚合酶链反应(RT-PCR),共聚焦显微镜成像和电泳迁移量转移测定(EMSA)技术。结果:脂多糖诱导的FXRs和NF-κB信号通路上调NF-κB相关细胞因子白介素6 (IL-6)、环氧化酶2 (COX-2)和肿瘤坏死因子α (TNF-α)。埃索美拉唑抑制所有这些细胞因子的上调。此外,埃索美拉唑抑制lps诱导的HepaG2细胞FXR表达和NF-κB信号传导。对FXRs和NF-κB信号的净影响是降低相关炎症和致癌细胞因子的水平。结论:我们的研究揭示了埃索美拉唑通过抑制lps诱导的HepG2细胞中NF-κB和FXR的表达,对肝脏炎症和癌变的潜在治疗作用。
{"title":"Esomeprazole inhibits liver inflammation and carcinogenesis by suppressing farnesoid X receptors and NF-κB signaling.","authors":"Chia-Chia Lu, Yi-Chin Yang, Yi-Wen Hung, Yen-Chun Peng","doi":"10.17219/acem/191596","DOIUrl":"https://doi.org/10.17219/acem/191596","url":null,"abstract":"<p><strong>Background: </strong>The activity of proton pump inhibitors (PPIs) hinders the function of proton pumps that generate stomach acid. Nuclear factor kappa B (NF-κB) is a transcriptional factor engaged in inflammation, immunity and the formation of cancer. The farnesoid X receptor (FXR) is a nuclear receptor that governs the metabolism of bile acids and the metabolic functioning of the liver. The impact of PPIs on the signaling of FXRs and NF-κB is not well understood.</p><p><strong>Objectives: </strong>We aimed to study the effects of esomeprazole on FXRs and NF-κB signaling in liver cells.</p><p><strong>Material and methods: </strong>For the liver cell model, we used the human liver cell line HepaG2. Cells were treated with lipopolysaccharides (LPS) and esomeprazole, and then we assessed the effects of esomeprazole on inflammatory and carcinogenic markers, NF-κB and FXR. We applied the techniques of western blotting, reverse-transcription polymerase chain reaction (RT-PCR), confocal microscopic imaging, and electrophoretic mobility shift assay (EMSA).</p><p><strong>Results: </strong>Lipopolysaccharides-induced FXRs and NF-κB signaling upregulated the NF-κB-associated cytokines interleukin 6 (IL-6), cyclooxygenase-2 (COX-2) and tumor necrosis factor alpha (TNF-α). Esomeprazole inhibited the upregulation of all these cytokines. Additionally, esomeprazole inhibited LPS-induced FXR expression and NF-κB signaling in HepaG2 cells. The net effect on FXRs and NF-κB signaling was the lower levels of the associated inflammatory and carcinogenic cytokines.</p><p><strong>Conclusions: </strong>Our study provides insight into the potential therapeutic effects of esomeprazole on hepatic inflammation and carcinogenesis by inhibiting LPS-induced NF-κB and FXR expression in HepG2 cells.</p>","PeriodicalId":7306,"journal":{"name":"Advances in Clinical and Experimental Medicine","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142764802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The role of p16 gene and P16INK4a protein in hematologic malignancies and therapeutic implications: A systematic review. p16基因和P16INK4a蛋白在血液恶性肿瘤中的作用及其治疗意义:系统综述。
IF 2.1 4区 医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2024-12-04 DOI: 10.17219/acem/192903
Paula Jabłonowska-Babij, Maciej Majcherek, Anna Kłopot, Agnieszka Szeremet, Tomasz Wróbel, Anna Czyż

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.

血液恶性肿瘤包括影响血液、骨髓和淋巴结的多种癌症。p16基因编码P16INK4A蛋白,在细胞周期调控和肿瘤抑制中起关键作用。了解p16在血液恶性肿瘤发生和发展中的作用对于推进治疗策略至关重要。本系统综述旨在阐明p16基因和P16INK4A蛋白在血液系统恶性肿瘤中的多方面作用,重点关注它们对疾病发病机制、预后意义和治疗意义的影响。在PubMed、Scopus和谷歌Scholar等电子数据库中进行了全面的搜索,使用与p16、P16INK4A、血液恶性肿瘤和治疗相关的预定义搜索词。纳入了截至2023年发表的研究,包括临床试验、观察性研究、荟萃分析和临床前研究。这篇综述综合了各种血液学癌症中p16通路失调的证据。p16表达水平的改变、基因突变和表观遗传修饰有助于疾病的发生和进展。此外,我们还探讨了p16状态在预测治疗结果和患者生存方面的预后意义。p16基因和P16INK4A蛋白在血液恶性肿瘤中成为有前途的生物标志物和治疗靶点。将p16失调的知识整合到临床实践中,有可能优化治疗策略,提高患者的治疗效果,并为这些具有挑战性的疾病的个性化治疗方法铺平道路。
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引用次数: 0
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