American journal of translational research最新文献

Objective: To elucidate the underlying mechanism of iron deficiency augmented Angiotensin II-induced aortic medial degeneration.

Methods: ApoE^-/- mice were randomly divided into four groups: normal control group (NC group), Angiotensin II (Ang II) subcutaneous pumped alone Group (Ang II group), iron deficiency (ID) group (ID group) and ID+Ang II group. The survival time, systolic blood pressure (SBP), and aortic medial degeneration (AMD) formation were monitored. Iron deposition in the aortas was assessed using Prussian blue iron staining. The expression of iron metabolism indicators, aortopathies and the cytoskeleton of vascular smooth muscle cells (VSMCs) were analyzed. In an in vitro setting, deferoxamine (DFO) was employed to mimic ID to examine the effects of Ang II on the cytoskeletal and contractile function of VSMCs during ID. Ras-related C3 botulinum toxin substrate 1 (Rac-1) expression was inhibited with EHT1864 to verify the role of Cdc42/Rac1 pathway in this pathological process. Blood samples were collected from 150 patients with aortic dissection (AD) and 60 patients with hypertension who were admitted to the Department of Cardiovascular Surgery at Renmin Hospital of Wuhan University between June 2018 and September 2019. The aortic tissues were obtained during the surgical treatment of Stanford type A AD patients and the heart donor. The iron metabolism status in plasma and aortic tissue was analyzed.

Results: In vivo experiments revealed that, in comparison to the NC and ID groups, mice in the Ang II and ID+Ang II groups exhibited increased SBP, significantly reduced survival time, and an expanded range of aortic dissection (P < 0.05). ID feeding augmented the Ang II-induced aortopathies. Both in vitro and in vivo results indicated that ID led to diminished expression of phosphorylated myosin light chain (p-MLC) and recombinant Cell Division Cycle Protein 42 (Cdc42) in VSMCs, while Rac-1 expression increased. The clinical sample testing data further confirmed the discovery that individuals diagnosed with AD display ID in both the plasma and the diseased aortas.

Conclusions: The Cdc42/Rac1 pathway plays a crucial role in disrupting the cytoskeleton of vascular smooth muscle cells during iron deficiency, which leads to aortic medial degeneration both in vivo and in vitro.

Double Primary Hepatic Cancer (DPHC) which refers to synchronous hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) coexisting in the same liver, has rarely been reported. Here we discussed the clinical characteristics, diagnosis, treatment, and prognosis of DPHC based on an analysis of 12 DPHC cases. Meanwhile, data of 60 HCC cases and 60 ICC cases were collected at a ratio of 5:1 and with matched age and gender to DPHC in the same period. A total of 4,626 cases of primary liver cancer were screened, and the proportion of DPHC was approximately 0.26%. Hepatitis B Virus prevalence in the DPHC group (83.3%) was higher than that in the ICC group (38.3%). Lymph node metastasis was more common in the DPHC group (16.7%) compared to the HCC group (1.7%). The median disease-free survival (DFS) and overall survival (OS) for DPHC were 6.0±2.6 months and 15.0±1.7 months, respectively. Pathological diagnosis indicated a significant effect of preoperative adjuvant transarterial chemoembolization (TACE) on HCC, but limited efficacy on ICC. Both alpha fetoprotein and carbohydrate antigen 19-9 levels were elevated in the DPHC group. In conclusion, the preferred treatment for DPHC is radical resection and regional lymphadenectomy. Preoperative TACE is effective for DPHC with large HCC components. The prognosis for DPHC is marked by high recurrence and high mortality.

Background: To investigate the clinical relevance of cytokine levels in assessment of the severity of mycoplasma pneumoniae pneumonia (MPP) in children.

Methods: A retrospective study was conducted on 150 pediatric cases of MPP admitted to a local hospital in China from November 1, 2022 to October 31, 2023. These MPP cases were divided into mild (n=100) and severe (n=50) groups according to the severity of the disease. Cytokine levels, including Interferon-γ (IFN-γ), Tumor Necrosis Factor-α (TNF-α), C-reactive protein (CRP), Interleukin-6 (IL-6), Interleukin-2 (IL-2), and D-Dimer (D-D), were compared between the two groups. The diagnostic efficacy of each cytokine in assessing the severity of MPP was analyzed through Receiver Operating Characteristic (ROC) curves, and correlation between cytokine levels and disease severity was assessed using Pearson's correlation coefficient.

Results: The IL-2 level was significantly lower, while TNF-α, IL-6, and IFN-γ levels were significantly higher in the severe group compared to the mild group (all P<0.05). TNF-α, IFN-γ, IL-2, IL-6, CRP, and D-D were identified as factors influencing the severity of MPP (all P<0.05). The ROC curve analysis showed that the areas under the curve (AUCs) of TNF-α, IL-2, IL-6, IFN-γ, CRP, and D-D were 0.864, 0.692, 0.874, 0.949, 0.814, and 0.691, respectively (all P<0.001), indicating their diagnostic value in assessing the severity of MPP. There exists a positive correlation between IL-2 and the percentage of normal lung density on Computed Tomography (CT) scan (P<0.05), while TNF-α, IL-6, IFN-γ, CRP, and D-D showed negative correlations with the percentage of normal lung density (P<0.05).

Conclusion: Cytokines such as TNF-α, IL-2, IL-6, IFN-γ, CRP, and D-D are aberrantly expressed in children with MPP and are associated with the severity of the disease. These cytokines have high diagnostic value and can serve as reference indicators for clinical, especially prognostic assessment of the severity of (pediatric) MPP.

Objective: To develop a comprehensive and evidence-based early rehabilitation framework for critically ill patients, aiming to establish a systematic and scientifically grounded rehabilitation system.

Methods: A Delphi survey study was conducted, involving two rounds of consultations with 24 experts from critical care medicine, nursing, respiratory therapy, and rehabilitation medicine. Based on evidence from the literature, a draft rehabilitation system was created and evaluated using a Likert 5-point scale. Entries were refined based on expert feedback, with criteria for inclusion being a mean score ≥4, a coefficient of variation <0.25, and agreement (percentage of ratings as "very important" or "important" and "very operative" or "strong operability") ≥75%. Entries were modified or deleted according to expert suggestions.

Results: The survey achieved recall rates of 95.8% (23/24) and 86.9% (20/23) in the first and second rounds, respectively. The experts' judgment basis, familiarity, and authority coefficients were 0.96, 0.94, and 0.95, respectively. Following the initial round, 20 questionnaire entries were amended, 14 new entries were added, and 1 was deleted. The second round of Delphi consultations resulted in an early rehabilitation system consisting of 5 primary indicators, 21 secondary indicators, and 56 tertiary indicators, totaling 82 entries.

Conclusions: This study established the first Chinese early rehabilitation system for critically ill patients based on the scientific Delphi method. It provides a structured framework that can serve as a reference for early rehabilitation practices in settings for critically ill patients.

Medical device research and development are characterized by high costs, extended timelines, inherent risks, and the necessity for interdisciplinary knowledge and skills. It is significantly influenced by policies, making the understanding of medical device innovation both important and challenging. This paper takes a dual approach to analyze medical device innovation. We reviewed representative clinical product of bougie and stylet and summarized the common characteristics and trend of these product. Innovations in these products often involve adding depth markings, replacing material and design structure, enhancing visualization, deciding between reusable or disposable designs, and integrating multi-functional features. This underscores the delicate balance between technological advancements and medical costs for widespread clinical applicability. We explored the guiding role of policy in medical device innovation, emphasizing its impact through an analysis of medical device regulations and policies in China. By offering insights from the perspectives of medical device companies and regulators, this paper aims to elucidate the critical aspects of medical device innovation, assisting researchers in mitigating risks during product development.

Objective: To evaluate the effect of dental operative microscopes on precision in minimally invasive dental restoration procedures.

Methods: This retrospective analysis included patients who underwent minimally invasive dental restoration procedure at Nanjing Stomatological Hospital from March 2018 to December 2019. Patients were categorized into two groups, an observation group treated with microscope-guided provisional restorations, and a control group treated using conventional methods. Clinical indices, including implant survival rates over five years, were compared between the groups. Multivariate analysis was employed to identify independent risk factors for implant failure.

Results: After treatment the observation group exhibited significantly lower labial vertical marginal discrepancies and absolute marginal discrepancies, as well as improved labial gingival indices and periodontal probing depths compared to the control group (all P<0.001). Additionally, the observation group scored significantly higher in efficiency, accuracy, and overall quality of tooth preparation (all P<0.001). Clinicians using microscopes demonstrated significantly lower mean Rapid Upper Limb Assessment scores, indicating reduced ergonomic strain (P<0.001). Higher age, worn tooth defects, poor oral hygiene, and non-use of a microscope were identified as independent risk factors for implant failure at the five-year mark.

Conclusion: Dental operative microscopes significantly enhance the precision, efficiency, and ergonomic comfort in minimally invasive dental restorations for both clinicians and patients. Widespread adoption of this technology is strongly recommended.

Background: Patients with hemodialysis (HD) frequently encounter stigma, which impacts their social network and adherence to treatment, increasing their risk of depression and lowering their quality of life. The factors associated with stigma among patients with HD remain poorly understood due to insufficient evidence. To fill this gap, this meta-analysis was conducted.

Methods: We carried out a thorough literature review in both Chinese and English databases like China National Knowledge Infrastructure (CNKI), Wan Fang Knowledge Data Service Platform, PubMed, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Web of Science. We included literature up to May 25, 2024, focusing on the levels and factors related to stigma in HD patients. Data extraction and quality assessment of the included literature were separately carried out by two researchers, who also independently did the literature screening. Data analysis was carried out using Stata 15.1 software. The possible sources of heterogeneity were explored by sensitivity analysis and subgroup analysis, and the robustness of the results was evaluated.

Results: A total of 12 papers were included, and the quality of these papers was evaluated as moderate or above. The findings of the meta-analysis demonstrated that the pooled stigma mean score was 59.30 [95% (Confidence interval) CI: 55.62 to 62.97]. Per capita monthly family income [MD (Mean Deviation) =4.95, 95% CI (1.55 to 8.35), P=0.004], residence [MD=-4.66, 95% CI (-6.96 to -2.36), P<0.001], complications [MD=4.76, 95% CI (0.92 to 8.61), P=0.015], family function [Z=-0.29, 95% CI (-0.38 to -0.21), P<0.001], self-efficacy [Z=-0.37, 95% CI (-0.48 to -0.26), P<0.001], levels of social support [Z=-0.35, 95% CI (-0.45 to -0.25), P<0.001], and levels of psychological distress [Z=0.59, 95% CI (0.26 to 0.91), P<0.001] were all significant factors contributing to stigma in patients undergoing HD.

Conclusion: Healthcare professionals should pay attention to the early assessment of stigma in patients with HD, implement personalized interventions targeting related factors, and promote effective coping strategies for managing the disease.

Objective: To evaluate the validity of comprehensive airway management intervention on ventilator-associated pneumonia (VAP) in ICU patients requiring mechanical ventilation.

Methods: In this retrospective observational study, the clinical data from 120 patients undergoing mechanical ventilation in the ICU of Hebei Chest Hospital from May 2020 to July 2022 were surveyed. Finally, 50 cases of VAP were identified and placed into an observation (n=25) and a control group (n=25) according to the nursing model they received. The control group was treated with routine nursing intervention, and the observation group was given comprehensive airway management intervention based on the control group. After 3 weeks of intervention, the clinical symptom recovery time, treatment-related indexes, nursing quality and nursing satisfaction score, and blood gas indexes and vital signs of the patients in the two groups were examined. The multivariate Logistic regression analysis was performed to identify the risk factors related to the death of critically ill patients.

Results: The observation group showed a significant reduction in the recovery time of heart failure, wheezing cough, and lung rales compared with that in the control group. The duration of mechanical ventilation, hospitalization, and antibiotic use in the observation group were appreciably shorter compared with those in the control group (all P<0.05). Additionally, nursing satisfaction and nursing quality scores were higher in the observation group compared to the control group (P<0.05). The contrast of blood gas indexes and vital signs between the two groups before ventilation and 1 hour after evacuation ventilation showed that a statistical significance existed in the interaction between groups (P<0.05). The risk factors related to the death of critically ill patients included D-dimer (OR=1.051, 95% CI: 1.006-1.08, P<0.05) and lactic acid (OR=0.894, 95% CI: 0.923-1.031, P<0.05).

Conclusion: Comprehensive airway management mode can reduce the occurrence of VAP in ICU patients requiring mechanical ventilation.

Objective: To analyze the efficacy of phloroglucinol versus ritodrine hydrochloride in preventing miscarriage and adverse reactions (ARs).

Methods: A retrospective analysis was conducted on 211 patients with threatened abortion or premature birth who were admitted to the Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine between July 2019 and July 2021. The control group (n=57) received ritodrine hydrochloride, while the observation group (n=154) was treated with phloroglucinol. We compared the overall therapeutic efficacy, time to symptom resolution, cessation of uterine contractions, success rate of miscarriage prevention, and full-term pregnancy rate between the two groups. Estrogen levels, including serum progesterone (P), estradiol (E2), and human chorionic gonadotropin (hCG), were measured and compared before and after treatment using ELISA. Additionally, neonatal outcomes, such as birth weight, Apgar scores, and umbilical arterial blood gas parameters [pH value, partial pressure of oxygen (PaO₂), and partial pressure of carbon dioxide (PaCO₂)], were evaluated and compared between the groups. Finally, the incidence of ARs during treatment was assessed and compared.

Results: Compared to the control group, the observation group had higher effective rate of treatment, success rate of miscarriage prevention, and a full-term pregnancy rate (all P<0.05). The times to symptom resolution and cessation of uterine contractions were markedly shorter in the observation group than those in the control group (both P<0.05). After treatment, levels of serum P, E₂, and hCG in the observation group were significantly higher than those of the control group (all P<0.05). Additionally, the body weight, Apgar scores, pH value, and PaO₂ of the neonates in the observation group were higher, while PaCO₂ and the incidence of ARs were lower compared to the control group (all P<0.05).

Conclusion: For threatened abortion or threatened premature labor, phloroglucinol is more effective than ritodrine hydrochloride for clinical intervention and treatment.

Objective: The combinative effects of neuromuscular electrical stimulation and ibuprofen on pain in patients with femoral head necrosis were discussed and analyzed.

Method: This retrospective study analyzed data of 60 patients with femoral head necrosis hospitalized during Oct. 2020 to Oct. 2021. According to different treatment methods, the patients were divided into an observation group and a control group (30 cases in each group). The control group took oral ibuprofen sustained-release capsules, and the observation group was treated with neuromuscular electrical stimulation in addition to ibuprofen. Both groups received a 4-week treatment course. The therapeutic efficacy, Harris scale scores, Visual Analogue Scale (VAS) score, MRI hip imaging stage, SF-36 scale score, serum plasminogen activator inhibitor 1 (PAI-1), leptin and osteopontin levels before and after treatment were compared between the two groups.

Results: After treatment, the overall response rate in the observation group was higher than that in control group (P<0.05). The post-treatment scores of Harris scale were higher in both groups than those pre-treatment (P<0.05), and were higher in the observation group than in the control group (P<0.05). The VAS scores were decreased in both groups (P<0.05), and the decrease was more significant in the observation group than in the control group (P<0.05). After treatment, there were more patients with 0-I MRI hip imaging stage in the two groups than before treatment (P<0.05), and more in the observation group than in the control group (P<0.05). The SF-36 scores in both groups were increased (P<0.05), and the increase was more significant in the observation group than in the control group (P<0.05). The serum levels of PAI-1, leptin and osteopontin were decreased in both groups (P<0.05), and the decreases were more significant in the observation group than in the control group (P<0.05).

Conclusion: The combinative treatment of neuromuscular electrical stimulation and ibuprofen has a significant effect on patients with femoral head necrosis. The treatment can remarkably reduce patients' pain, improve their hip function and quality of life, and decrease the PAI-1, leptin and osteopontin levels.