American journal of translational research最新文献

Objective: To develop and validate a prediction model for successful trial of labor after cesarean (TOLAC) in women with a scarred uterus using clinical data from a single center with an external temporal validation set.

Methods: This retrospective study developed a prediction model using data from a single center (Huai'an Maternal and Child Health Hospital) with scarred uterus planning TOLAC, collected from January 2016 to December 2023. Assessed variables included maternal characteristics, obstetric history, and prenatal examination findings. Univariate and multivariate logistic regression were used to identify predictors and develop the model. The model was temporally validated using an independent external dataset from two other tertiary hospitals. Its performance was evaluated by the area under the ROC curve (AUC), sensitivity, and specificity, and was compared with the Grobman model.

Results: Among 2,386 eligible women, 1,721 (72.1%) had a successful TOLAC. Univariate analysis identified 10 significant variables (P<0.05). Multivariate analysis retained six independent predictors: age, body mass index, history of vaginal delivery, cervical score, estimated fetal weight, and gestational age. The model expression was: Logit(P) = -3.82 + 0.04 × age - 0.12 × BMI + 1.56 × vaginal delivery history + 0.37 × cervical score - 0.02 × fetal weight + 0.18 × gestational age. Internal validation showed an AUC of 0.85 (95% CI: 0.82-0.88), sensitivity of 82.3%, and specificity of 78.5%. Temporal Validation (n=524) yielded an AUC of 0.83 (95% CI: 0.79-0.87), which was significantly higher than the Grobman model (AUC=0.79, P<0.05).

Conclusions: The developed prediction model demonstrates good performance and generalizability for predicting TOLAC success, potentially aiding clinical decision-making and improving maternal and neonatal outcomes.

In recent years, the WovenEndoBridge (WEB), as a representative of emerging intratumoral flow disturbance devices, has been increasingly used in clinical practice. However, there are few reports on how to utilize it correctly when the release position is unsatisfactory or the parent artery is affected during WEB embolization of cerebral aneurysms. We report the treatment process of two female patients who underwent intracranial aneurysm flow diversion therapy for saccular aneurysms at the bifurcation of the middle cerebral artery and benefited from the procedure. The aneurysm embolization was satisfactory during the operation, but the embolization system partially interfered with the parent artery. In order to protect the parent artery and prevent embolism of the Middle Cerebral Artery (MCA) branch, an Atlas stent was introduced to assist in embolization. The angiography was repeated: the parent artery was unobstructed. This article describes in detail the preoperative evaluation of the patient's condition, the surgical plan, and the postoperative treatment. The results of this case confirm the feasibility of stent-assisted WEB embolization of complex aneurysms at the bifurcation of the middle cerebral artery.

Objectives: This study explored how ultrasound features relate to tumor size and inflammatory markers in invasive ductal carcinoma (IDC) patients.

Methods: We retrospectively reviewed 218 female IDC patients. Based on the largest diameter of the tumor, patients were split into two groups: those with tumors ≤ 2 cm and those with tumors > 2 cm. We gathered data from conventional ultrasound (CUS), contrast-enhanced ultrasound (CEUS), and virtual touch tissue imaging quantification (VTIQ), along with blood-based inflammation indicators like neutrophil count and C-reactive protein (CRP) levels. Group comparisons were done using univariate analysis, and Spearman correlation was used to examine relationships between tumor size and other variables.

Results: Larger tumors were more frequently located in the upper outer quadrant (60.71% vs 41.03%, P = 0.035) and showed richer blood flow (73.57% vs 53.85%, P = 0.003). By CEUS, larger tumors were more likely to show high enhancement (90% vs 78.21%, P = 0.017) and expanded enhancement range (82.86% vs 70.51%, P = 0.034). VTIQ results showed that SWV max (P = 0.033), SWV peritumoral average (peri-avg) (P = 0.010), and SWVR max/min (P = 0.009) were significantly increased in the larger tumor group. Correlation analysis showed that tumor size was significantly correlated with the above elastic parameters (P < 0.05). For inflammation, CRP was significantly increased in the larger tumor group (P < 0.001) and positively correlated with tumor size (r = 0.249, P = 0.0002); neutrophils were also correlated with SWV peri-avg (r = 0.158, P = 0.019) (P < 0.05).

Conclusions: Tumor size in IDC patients is not only related to their ultrasonographic features but also reflects their inflammatory status.

Objective: To analyze the clinical effect of ulinastatin (UTI)-somatostatin (SS) combination on acute severe pancreatitis (SAP) patients, focusing on changes in efficacy and serum inflammatory markers (IMs).

Methods: This study retrospectively enrolled 104 SAP patients (July 2022-July 2025), with 51 patients (control group) treated with SS and 53 cases (observation group) receiving UTI+SS. Clinical efficacy, safety (rash, dizziness, diarrhea, nausea/vomiting, kidney injury, hyperglycemia), symptom relief time (vomiting, pyrexia, celialgia, defecation recovery, abdominal distension), disease-related indicators (blood amylase [AMS], Acute Physiology And Chronic Health Evaluation II [APACHE-II]), pancreatic function (insulin [INS], trypsinogen-2 [TPS2], glucose [Glu]), serum IMs (C-reactive protein [CRP], tumor necrosis factor [TNF]-α, interleukin [IL]-6), intestinal mucosal barrier function (diamine oxidase [DAO], D-lactic acid [D-Lac], endotoxin [ET]), laboratory-related indexes (total white blood cell count [WBC], platelet count [PLT], creatinine [Cr], total bilirubin [TBIL]), and humoral immunity (immunoglobulin [Ig] A/M/G) were comparatively assessed. Finally, determinants of patients' therapeutic effects were isolated by uni- and multivariate analyses.

Results: UTI+SS was markedly superior to sole SS in terms of overall effectiveness, INS, PLT, and IgA/M/G, along with faster symptom relief, lower AMS, APACHE-II scores, TPS2, Glu, CRP, TNF-α, IL-6, DAO, D-Lac, WBC, Cr, and TBIL. Total adverse reaction incidence showed no notable inter-group difference. CRP and Cr were independent risk factors for therapeutic efficacy among SAP patients, while treatment modality acted as an independent protective factor.

Conclusion: UTI+SS for SAP is effective in clinical efficacy enhancement and serum inflammation suppression.

Objective: This study investigated the potential of black ginseng extract (BGE) to prevent and treat gastric cancer by evaluating its effects on the proliferation of human gastric cancer cells and the growth of human gastric tumors implanted in mice.

Materials and methods: The antitumor effects of BGE on gastric cancer were evaluated by assessing its cytotoxicity and apoptotic activity in AGS and KATO III gastric cancer cells. Additionally, in a nude mouse model with AGS cell xenografts, tumor volume, weight, size, and body weight were analyzed following oral administration of BGE, red ginseng extract (RGE), or no treatment. Subsequently, the liver and spleen were weighed, and histopathological analysis was performed to assess the non-toxicity of BGE to non-cancerous cells.

Results: In vitro studies revealed that BGE had significant cytotoxic and apoptotic effects on AGS and KATO III gastric cancer cells. In vivo, oral administration of RGE and BGE to nude mice with AGS cell xenografts resulted in no increase in tumor volume or body weight, while both tumor weight and size were significantly reduced. Notably, the group treated with BGE had significantly smaller tumors and weight than the RGE-treated group. Furthermore, following oral BGE, no significant differences were observed in the weights of the liver and spleen, and no histopathological abnormalities were detected in the organs of the AGS cell xenograft mice.

Conclusions: BGE exhibited anticancer activity against gastric cancer cells in vitro and in vivo, with no toxicity observed in the major organs.

Objective: To assess the value of optical coherence tomography (OCT) and OCT angiography (OCTA) for the early diagnosis of dysthyroid optic neuropathy (DON) in patients with thyroid-associated orbitopathy (TAO).

Methods: This retrospective study (2022-2024) included 52 TAO eyes (22 DON, 30 non-DON) and 52 healthy controls. OCT/OCTA scans evaluated structural features (ganglion cell complex, peripapillary retinal nerve fiber layer, Bruch's membrane opening-minimum rim width [BMO-MRW]) and vascular features (superficial retinal capillary plexus [SRCP] density, choroidal capillary vascular density, foveal avascular zone [FAZ] area). Contrast sensitivity function (CSF), thyroid peroxidase antibody (TPOAb) status, and glutamate levels were also analyzed. Multivariate logistic regression identified risk factors, and receiver operating characteristic curves evaluated diagnostic performance.

Results: Most structural OCT features showed no significant differences, except CSF, which was significantly reduced in DON eyes (P < 0.001). Vascular features such as SRCP density and choroidal capillary density decreased progressively in DON, while FAZ area was significantly larger (all P < 0.001). TPOAb positivity and glutamate levels were highest in the DON group (P < 0.001). Multivariate analysis identified SRCP density, FAZ area, TPOAb positivity, and glutamate concentration as independent risk factors for DON. A combined model of BMO-MRW and subfoveal choroidal thickness achieved the highest diagnostic accuracy (AUC = 0.940, sensitivity = 88.0%, specificity = 90.0%).

Conclusions: Multimodal imaging combining OCT and OCTA features improves the sensitivity and specificity of early DON diagnosis, offering a reliable, noninvasive screening approach for clinical practice.

The trend of painless diagnostic and therapeutic procedures is on the increase among older patients as the global population is aging. The pathophysiological changes unique to the aging process are troublesome in terms of sedation management. The use of the traditional narcotic sedation guidelines like fentanyl and propofol is linked to respiratory and circulatory suppression in this at-risk group. Conversely, the new compound of alfentanil-ciprofol has shown potential pharmacological benefits that can maximize sedation in painless gastroscopy in the elderly. This is a systematic literature review discussing the physiological and pharmacological basis for sedation in older individuals, with a focus on the interactions and efficacy of alfentanil and ciprofol. By synthesizing the available evidence, we generalize upon the effectiveness, safety, quality of recovery and benefits of such a combination on the geriatric gastroscopy procedure. Furthermore, we address the challenges inherent to its use in this age group, such as dose individualization and respiratory management, and propose potential solutions. Lastly, we outline future research directions, emphasizing that individualized dosing strategies based on the principles of precision anesthesia will be central to optimizing outcomes for elderly patients.

Objectives: To explore the expression levels of oxidative stress indicators and carcinoembryonic antigen (CEA) in different pathologic types of pulmonary ground-glass nodules (GGN) and their predictive value for early lung adenocarcinoma.

Methods: This study was a retrospective analysis. General data were collected from 100 patients diagnosed in The Affiliated Taizhou People's Hospital of Nanjing Medical University from February 2022 to May 2024 with GGN in the lungs. According to pathologic types, they were divided into the glandular prodromal lesion group (n=39) and the lung adenocarcinoma group (n=61). The pretreatment levels of CEA, reactive oxygen species (ROS), superoxide dismutase (SOD), and malondialdehyde (MDA) were compared between the two groups. Risk factors for developing early-stage lung adenocarcinoma were screened by univariate versus multivariate logistic regression analysis. The receiver operator characteristic curve (ROC) was used to evaluate the predictive value of each index for early lung adenocarcinoma.

Results: Compared to the glandular prodromal lesion group, the levels of ROS, MDA and CEA in the lung adenocarcinoma group were significantly higher, while the level of SOD was significantly lower (P<0.05). Multifactorial logistic regression analysis showed that high MDA (OR=7.205, 95% CI: 1.587-32.704), high ROS (OR=3.553, 95% CI: 1.552-8.136), and high CEA (OR=3.241, 95% CI: 1.343-7.818) were risk factors for developing early-stage lung adenocarcinoma (all P<0.05) while elevated SOD levels were a protective factor (OR=0.513, 95% CI: 0.328-0.803, P<0.05). ROC curve analysis showed that the combined application of tests had the highest predictive efficacy, with an area under the curve (AUC) of 0.887, both higher than those of the single tests.

Conclusions: Oxidative stress indicators and CEA show regular changes in GGN. Combined detection can significantly improve the predictive ability for early lung adenocarcinoma.

Background: Elective supratentorial craniotomies may affect short-term prognoses. This study investigates the utility of the preoperative Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score for predicting patient outcomes following such procedures.

Methods: We retrospectively analyzed patients who underwent elective supratentorial craniotomy at a single center between January 2018 and August 2022. Outcomes were categorized as favorable or unfavorable according to survival and the occurrence of major complications. The HALP score was calculated from preoperative blood samples collected within 24 hours before surgery. Postoperative evaluation encompassed monitoring of complications, cognitive function using the Montreal Cognitive Assessment (MoCA), and neurological status assessed with the Glasgow Coma Scale (GCS).

Results: After propensity score matching, 150 patients were analyzed (75 per group). Preoperative HALP scores in the good prognosis group were significantly higher than those of the poor prognosis group (73.24 ± 8.45 vs. 61.67 ± 7.82, P < 0.001). Multivariate analysis confirmed that lower values of HALP components independently increased the risk of poor prognosis. The receiver operator characteristic (ROC) analysis showed that the HALP score (AUC = 0.841) was better as a predictor of poor prognosis than its component alone, with an optimal intersection value of 69.42 (sensitivity = 0.84, specificity = 0.747). Patients with a low HALP score also experienced less than ideal perioperative outcomes, including longer surgery times, more blood loss, longer hospital stays, and higher rates of neurological dysfunction, consciousness disorders, and infections.

Conclusions: Preoperative HALP score can predict the short-term outcome of patients undergoing elective supratentorial neurosurgery.

Objective: This review aims to examine the challenges of opportunistic viral infections in transplant recipients on long-term immunosuppression and to explore the potential of emerging immunotherapies to improve infection management.

Methods: We summarize the mechanisms and effects of current clinical immunosuppressants, outline the incidence of viral infections following various organ transplants, and discuss the limitations of existing antiviral pharmacotherapies. Furthermore, we systematically review recent advances in novel immunotherapies that harness the patient's immune system.

Results: While immunosuppressive regimens significantly improve graft survival, they increase susceptibility to viral infections. Emerging immunotherapies demonstrate promising potential in managing these infections, yet their application in transplant recipients remains underexplored.

Conclusion: Innovative immunotherapies represent a promising avenue for overcoming the limitations of conventional treatments. Their integration into transplantation practice may enhance long-term outcomes, although further clinical validation is needed.