Advances in medical sciences最新文献

Purpose

Acute exacerbations (AE) are severe complications of chronic obstructive pulmonary disease (COPD); however, the need for biomarkers which predict them is still unmet. High platelet count (PLC) and platelet-to-lymphocyte ratio (PLR) are associated with higher mortality in patients with COPD. We investigated if PLC and PLR at the onset of a severe AE could predict the time of the next relapse.

Methods

In a prospective observational cohort study, data of 152 patients hospitalized with AECOPD were collected, and patients were divided into PLC-low (<239 ​× ​10⁹/L, n ​= ​51), PLC-medium (239-297 ​× ​10⁹/L, n ​= ​51) and PLC-high (>297 ​× ​10⁹/L, n ​= ​50) or PLR-low (<147, N ​= ​51), PLR-medium (147–295, n ​= ​51) and PLR high (>295, n ​= ​50) groups based on PLC and PLR tertiles using admission laboratory results. Clinical characteristics and the time to the next severe or moderate AE within 52 weeks were compared among subgroups using log-rank test.

Results

PLC and PLR tertiles did not differ in clinical characteristics or the time till the next AE (p ​> ​0.05). PLC and PLR showed a direct weak correlation to neutrophil count (Pearson r ​= ​0.26, p ​< ​0.01 and r ​= ​0.20, p ​= ​0.01) and PLC also demonstrated a weak relationship to white blood cell counts (Pearson r ​= ​0.29, p ​< ​0.001). However, PLR presented an inverse relationship to monocyte and eosinophil counts (r ​= ​−0.32, p ​< ​0.001 and r ​= ​−0.17, p ​= ​0.03).

Conclusion

PLC and PLR do not predict the time till the next relapse; however, they may reflect on neutrophilic inflammatory response during an exacerbation of COPD.

Purpose

Mitral valve surgery in children involves correcting congenital and acquired pathologies, with a reported mortality rate of 0.9%. Low cardiac output syndrome (LCOS) is a serious complication with the incidence of 20–25%. The aim of the study was to estimate possible prognostic factors of LCOS in children undergoing mitral valve procedure.

Material and method

This single-center retrospective analysis enrolled children aged <18 years who underwent mitral valve surgery during 24 year period. Preoperative clinical and laboratory parameters, and operative factors were analyzed.

Results

Thirty consecutive pediatric patients (11 (37%) males and 19 (63%) females) in median (Q₁ – Q₃) age of 57 (25–115) months, who underwent mitral valve replacement, were included. The 30-day mortality was 7% (2 patients) and was related to postoperative multiorgan failure. LCOS occurred in 8 (27%) children. The receiver operator curve (ROC) analysis established parameters that have predictive value for LCOS occurrence: cardiopulmonary bypass (CPB) time, with 89 ​min as optimal cut-off point (AUC ​= ​0.744, p ​= ​0.011) yielding sensitivity of 100% and specificity of 42.9%; left ventricular ejection fraction (LVEF) ​< ​60 % (AUC ​= ​0.824, okp ​= ​0.001) with sensitivity of 62.5% and specificity of 93.75%; and red blood cell distribution width (RDW) above 14.5 % (AUC ​= ​0.840, p ​< ​0.001; sensitivity of 87.5% and specificity of 75%).

Conclusions

In mitral valve replacement in pediatric patients, CPBtime above 89 ​min, preoperative LVEF below 60% and preoperative RDW above 14.5% can be regarded as the potential predictors of LCOS.

Obesity continues to be a significant global health concern, giving rise to various complications. This review article explores the current standards and emerging innovations in diagnosing and treating obesity, including recent disease name change, staging system or therapeutic goals. This narrative review has been based on recent scientific articles from PubMed database, limiting the scope of topics to current standards and upcoming developments and breakthroughs in the diagnosis and treatment of obesity. The educational and informative nature of the review has been maintained in order to make the information presented accessible to both researchers and clinical practitioners. The recognition of diverse obesity phenotypes has prompted a paradigm shift towards a complex and patient-centered approach to diagnosis and therapy. Pharmacotherapy for obesity is evolving rapidly, with ongoing research focusing on novel molecular targets and metabolic pathways. Promising developments include dual or triple incretin analogs, oral incretin drugs, neurotransmitter-based therapies, muscle mass-increasing treatments, and therapies targeting visceral adipose tissue browning. Despite current evidence-based international standards, the field of obesity diagnosis and treatment continues to expand, with new diagnostic tools and pharmacotherapies potentially replacing current practices. Therapeutic management should be tailored to individual patients, considering obesity phenotype, health status, lifestyle, and preferences. Looking ahead, the future holds promising opportunities for obesity management, but further research is required to assess the efficacy and safety of emerging therapies. A multifactorial and personalized approach will be pivotal in addressing the diverse challenges posed by obesity.

Purpose

The aim of this study was to compare High Carbohydrates Low Fat (HCLF) and Low Carbohydrate High Fat (LCHF) diets in terms of changes in body composition and maximal strength.

Patients/methods

The study involved 48 men aged 25 ​± ​2.5, divided into two groups, one of which (n ​= ​23) was following the LCHF diet and the other (n ​= ​25) the HCLF diet. Both groups performed the same resistance training protocol for 15 weeks. Maximal strength in squat, bench press and deadlift was assessed pre- and post-intervention. Measurements of selected body circumferences and tissue parameters were made using the multifunctional, multi-frequency, direct bioelectric impedance InBody 770 analyzer from InBody Co., Ltd (Cerritos, California, USA). The team with the necessary qualifications and experience in research performed all the measurements and maintained participants’ oversight throughout the entire length of the study.

Results

Both nutritional approaches were effective in terms of reducing body fat mass. The HCLF group achieved greater skeletal muscle hypertrophy. Significant decreases in body circumferences, especially in the abdominal area, were observed for both dietary approaches. Maximal strength significantly increased in the HCLF group and decreased in the LCHF group.

Conclusion

Holistic analysis of the results led to the conclusion that both dietary approaches may elicit positive adaptations in body composition. The two approaches constitute useful alternatives for both recreational exercisers and physique athletes with body composition goals.

Purpose

Breast cancer is the most common malignancy with high recurrence and mortality rates in women. There are still insufficient biomarkers to predict disease prognosis. Therefore, the present study aimed to investigate the clinical significance of postoperative hematologic parameters and their derivatives in patients with breast cancer who underwent tumor resection.

Patients and methods

The clinicopathological and laboratory data of 90 female breast cancer patients who underwent surgical treatment in the Greater Poland Cancer Center in Poznan from December 2015 to November 2017 were retrospectively analyzed. Postoperative hematologic parameters, including neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), monocyte-to-red blood cell ratio (MRR), lymphocyte-to-red blood cell ratio (LRR), platelet-to-red blood cell ratio (PRR) were evaluated in recurrence and non-recurrence group. Receiver-operating characteristic (ROC) curve analysis was used to assess the optimal cutoff value of postoperative hematologic parameters for tumor recurrence. The association of postoperative hematologic parameters with disease-free survival (DFS) was investigated by the Kaplan-Meier method and Cox regression analysis.

Results

Patients with local, regional, or distant metastases accounted for 14% of the total. The postoperative monocyte count and MRR were significantly elevated, whereas postoperative LMR was statistically decreased in the recurrence group. Univariate and multivariate Cox analysis revealed that postoperative LMR ≤3.044 and postoperative MRR >0.1398 were associated with significantly shorter DFS.

Conclusion

Our results revealed that both postoperative LMR and MRR are independent predictors of DFS in breast cancer patients. Large-scale prospective investigations are needed to validate our findings.

Purpose

Metformin (MET), a first-line treatment for type 2 diabetes mellitus, restores ovarian function in women with polycystic ovary syndrome. MET has been shown to increase the rate of success for in vitro fertilization when utilized in assisted reproductive technologies. This study was designed to examine the impact of MET on ovarian function and fertility in a mouse model of galactose-induced premature ovarian insufficiency (POI). We further investigated the underlying mechanisms.

Materials and methods

Female mice were divided into 4 groups: saline, d-galactose, d-galactose ​+ ​MET, and MET. Body weight, ovarian index, and fertility were assessed. The hormonal profile was done. Advanced glycation end products (AGEPs), receptor for advanced glycation end products (RAGE), phosphoinositide 3-kinase (PI3K), protein kinase B (Akt), forkhead box O3a (FOXO3a) expression were measured. Ovarian follicle counting and morphology were analyzed. Immunohistochemistry of cleaved caspase-3 expression was performed.

Results

Our findings demonstrated that MET reversed irregularities in the estrus cycle, enhanced the ovarian index, and improved the abnormal levels of hormones and AGEs induced by d-galactose. Furthermore, the expression levels of PI3K, Akt, FOXO3a, and RAGE were upregulated with d-galactose. However, MET attenuated their expression levels. The primordial follicles ratio was improved, whereas atretic follicles and apoptotic-related cleaved caspase-3 expression were decreased in the d-galactose ​+ ​MET group compared to the d-galactose group.

Conclusion

This study demonstrates that MET partially rescued ovarian dysfunction and apoptosis induced by d-galactose via a mechanism involving PI3K-Akt-FOXO3a pathway. Our finding proposed that MET may be a promising alternative treatment for POI.

Purpose

Acute heart failure (AHF) is a serious condition that requires prompt diagnosis and management. To optimize patient care, clinicians need a reliable, non-invasive method to assess hemodynamic parameters and total body congestion. Currently, no standardized technology is widely used for this purpose. However, NICaS technology, which measures hemodynamic parameters based on regional bioimpedance, has shown promise in monitoring AHF patients in a non-invasive and reliable manner. In this study, researchers aimed to evaluate the usefulness of NICaS technology in predicting patients' outcome in Caucasian and Asian AHF patients presenting to the emergency department (ED).

Patients and methods

The study included 40 Caucasian patients from Italy (group A) and 71 Asian patients from Indonesia and Singapore (group B) with a diagnosis of AHF in the ED. The study compared data from NICaS parameters, clinical findings, laboratory, and radiological results with short-term events.

Results

In group A, NICaS data at ED arrival significantly predicted 30-day cardiovascular mortality and rehospitalization. At discharge, a value of cardiac output obtained using NICaS was a significant predictor for 30-day rehospitalization. In group B, NICaS variables, total peripheral resistance index on admission and during 48–72 ​h had prominent AUC compared to clinical congestion score and NT-proBNP in predicting mortality and rehospitalization.

Conclusions

The results indicate that NICaS technology offers a simple, non-invasive, and reliable method of assessing cardiac hemodynamics and congestion in AHF patients. These measurements may enhance diagnosis, tailor management plans, stratify risk, and predict outcomes in both Caucasian and Asian patients.

Purpose

Plasminogen activator inhibitor-1 (PAI-1) is the main inhibitor of fibrinolytic systems. The effect of PAI-1 on inflammatory response is still inconsistent. Our study was conducted to investigate its effects on inflammation to clarify the role of PAI-1 in acute lung injury (ALI) induced by lipopolysaccharide (LPS).

Material and methods

ALI models were established in wild-type (WT) and PAI-1 knockout (KO) mice by LPS intervention for 48 ​h. Lung histopathology, wet-dry ratio, total cell count and TNF-α concentration in bronchoalveolar lavage fluid (BALF), and inflammation related proteins were detected. Flow cytometry was used to sort neutrophils, macrophages, regulatory T cells (Treg) and T helper cell 17 (Th17). RNA sequencing was performed to find differentially expressed genes. Masson staining and immunohistochemistry were used to analyze pulmonary fiber deposition and proliferation.

Results

Compared with ALI (WT) group, the wet-dry ratio, the total number of BALF cells, the concentration of TNF-α in BALF, and the expression of pp65 in the lung tissue was increased in ALI (PAI-1 KO) group, with increased proportion of neutrophils, decreased proportion of macrophages and decreased proportion of Treg/Th17 in the lung tissue. Collagen fiber deposition and PCNA expression were lighter in ALI (PAI-1 KO) group than ALI (WT) group. PPI analysis showed that PAI-1 was closely related to TNF, IL-6, IL-1β, Smad2/3 and mainly concentrated in the complement and coagulation system, TNF-α and IL-17 signaling pathways.

Conclusions

PAI-1 KO could aggravate ALI induced by LPS at 48 ​h. PAI-1 may be an important target to improve the prognosis of ALI.

Purpose

Bipolar affective disorder (BP) causes major functional impairment and reduced quality of life not only for patients, but also for many close relatives. We aimed to investigate mRNA levels in BP patients to find differentially expressed genes linked to specific clinical course variants; assuming that several gene expression alterations might indicate vulnerability pathways for specific course and severity of the disease.

Materials

We searched for up- and down-regulated genes comparing patients with diagnosis of BP type I (BPI) vs type II (BPII), history of suicide attempts, psychotic symptoms, predominance of manic/hypomanic episodes, and history of numerous episodes and comorbidity of substance use disorders or anxiety disorders. RNA was extracted from peripheral blood mononuclear cells and analyzed with use of microarray slides.

Results

Differentially expressed genes (DEGs) were found in all disease characteristics compared. The lowest number of DEGs were revealed when comparing BPI and BPII patients (18 genes), and the highest number when comparing patients with and without psychotic symptoms (3223 genes). Down-regulated genes identified here with the use of the DAVID database were among others linked to cell migration, defense response, and inflammatory response.

Conclusions

The most specific transcriptome profile was revealed in BP with psychotic symptoms. Differentially expressed genes in this variant include, among others, genes involved in inflammatory and immune processes. It might suggest the overlap of biological background between BP with a history of psychotic features and schizophrenia.

Purpose

Growth differentiation factor 15 (GDF-15) is a member of the transforming growth factor beta superfamily and is faintly expressed under healthy conditions. GDF-15 is markedly elevated in a variety of diseases, including coronary artery disease (CAD), atrial fibrillation and heart failure. Here, we aimed to investigate the association of GDF-15 with the extent and severity of CAD in patients with stable CAD.

Methods

We enrolled 129 patients undergoing coronary angiography for the evaluation of stable CAD in the study. SYNTAX and SYNTAX II PCI/CABG scores were calculated. The CAD (+) study group was also stratified into two groups (high and low GDF-15) with respect to the mean GDF-15 value. Correlation and regression analyses were performed for further evaluation.

Results

Of the 129 patients, 75 had CAD. GDF-15 values were higher in the CAD (+) group (p ​< ​0.001). The two groups were compared according to a cut-off value of 2451.77. SYNTAX and SYNTAX II PCI/CABG scores were significantly associated with the high GDF-15 group (p ​< ​0.001). Additionally, correlation analysis showed a strong positive correlation between GDF-15 and SYNTAX (r: 0.859, p ​< ​0.001), SYNTAX II PCI (r: 0.921, p ​< ​0.001) and SYNTAX II CABG (r: 0.874, p ​< ​0.001) scores. Multivariate analysis identified GDF-15 as an independent predictor of CAD.

Conclusion

GDF-15 is an independent predictor of CAD and is associated with CAD severity in terms of SYNTAX, SYNTAX II PCI and SYNTAX II CABG scores.