Archives of Medical Science最新文献

Introduction: The aim of this study is to assess the effects of various exercise interventions of differing types and intensities (high-intensity aerobic training, moderate-intensity aerobic training, low-intensity aerobic training, high-intensity aerobic training combined with anaerobic training, high-intensity aerobic training combined with resistance training, moderate-intensity aerobic training combined with resistance training, mind-body exercises, and resistance training) on metabolic and cardiorespiratory function in children and adolescents with type 1 diabetes mellitus (T1DM).

Material and methods: Through systematic searches of databases such as PubMed, Embase, Cochrane, and Web of Science, randomized controlled trials (RCTs) were gathered to examine the effects of eight different types and intensities of exercise interventions on the metabolic and cardiorespiratory functions of children and adolescents with T1DM.

Results: A total of 19 RCTs involving 738 children and adolescents with T1DM were included. The network meta-analysis (NMA) results showed that high-intensity aerobic training combined with anaerobic training and high-intensity aerobic training significantly reduced the patients' lipid profile, including total cholesterol (TC) (MD = -1.92, 95% CI = (-2.36, -1.48)), low-density lipoprotein cholesterol (LDL-C) (MD = -1.18, 95% CI = (-1.94, -0.42)), and increased high-density lipoprotein cholesterol (HDL-C) (MD = 1.63, 95% CI = (1.21, 2.05)).

Conclusions: Based on NMA and surface under the cumulative ranking curve (SUCRA) rankings, it was concluded that high-intensity aerobic training combined with anaerobic training and high-intensity aerobic training can improve the metabolic and cardiorespiratory functions of children and adolescents with T1DM, although they did not show significant effects on hemoglobin A1c (HbA1c), blood glucose (BG), peak oxygen consumption (VO₂ peak), or triglycerides (TG).

Introduction: Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer characterized by the absence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Ferroptosis, a regulated form of cell death driven by lipid peroxidation, has emerged as a potential therapeutic target. This study aimed to evaluate the expression levels of ferroptosis-associated genes GPX4, ACSL4, and BCAT2 in TNBC tissues and to investigate their potential as diagnostic or therapeutic biomarkers.

Material and methods: A total of 100 formalin-fixed paraffin-embedded (FFPE) breast tissue samples were analyzed, including 60 TNBC patient samples and 40 healthy controls. Gene expression levels of GPX4, ACSL4, and BCAT2 were determined using RT-qPCR. Statistical comparisons were conducted using the Mann-Whitney U test, and correlation analyses were performed using Spearman's test.

Results: The expression levels of GPX4, ACSL4, and BCAT2 were significantly lower in the TNBC group compared to controls (p = 0.0001 for all genes). Strong positive correlations were observed among the three genes, with BCAT2 showing the highest correlation with both GPX4 (R = 0.636) and ACSL4 (R = 0.683). Additionally, BCAT2 expression negatively correlated with tumor diameter and Ki-67 index.

Conclusions: The significant downregulation and strong positive correlation of GPX4, ACSL4, and BCAT2 in TNBC tissues suggest coordinated suppression of ferroptosis. These findings highlight the potential of targeting ferroptosis as a novel therapeutic strategy in TNBC and propose these genes as candidate biomarkers for diagnosis and treatment response.

Introduction: The chronic gynecological condition endometriosis affects about 10 percent of reproductive aged women and imposes a heavy physical and psychological burden. The impact of pain and infertility is well documented, but the link between endometriosis and mental health (depressive and anxiety), in particular, is not well studied. In this systematic review and meta-analysis, we synthesize evidence on the association between endometriosis and mental health outcomes, specifically anxiety and depression.Methods: PubMed, Cochrane Library and Google Scholar were searched comprehensively to identify studies that have reported the association of endometriosis and mental health outcomes. Nine studies were included after applying predefined inclusion and exclusion criteria from 1,632 articles screened. The Newcastle-Ottawa Scale (NOS) was used to assess study quality and random effects meta-analyses were performed using R. Relative risk (RR) values for anxiety and depression among women with endometriosis were pooled as the primary outcomes.

Results: The meta-analysis revealed a significant association between endometriosis and anxiety (pooled RR = 2.82; 95% CI: 1.69-4.68, p < 0.001) and depression (pooled RR = 2.93; 95% CI: 1.63-5.25, p < 0.001). Substantial heterogeneity was observed in both analyses (I ² = 100%), reflecting variability in study designs and populations. Funnel plots showed moderate asymmetry, suggesting potential publication bias. Statistical heterogeneity was further quantified with τ² values of 0.6032 for anxiety and 0.794 for depression, indicating considerable between-study variability. These findings underscore the heightened mental health burden in women with endometriosis.

Conclusions: Endometriosis patients are more likely to develop anxiety and depressive symptoms due to pain and diagnostic evaluation and related psychosocial factors. This study stresses the importance of integrated care, which involves screening and treatment for mental health problems in addition to conventional medical care. Future work should aim to reduce heterogeneity and examine potential pathways through which these relationships exist in order to develop specific prevention strategies.

Introduction: Diabetes mellitus (DM) is associated with increased mortality in hospitalized adults. However, data regarding the impact of DM on long-term mortality after discharge in very old patients are scarce. This prospective study assessed 3-year post-discharge mortality and its predictive factors in older patients, focusing on possible differences between patients with and without DM.

Material and methods: Medical history, chronic medication use, clinical and laboratory characteristics, Charlson Comorbidity Index (CCI), 5-item Fried Frailty Score (FFS), Clinical Frailty Scale (CFS), Barthel Index (BI), and Katz Index were recorded on admission.

Results: A total of 815 older adults (46.0% males) with a median age of 83.0 years (IQR: 77.0-88.0) were included in the study. The 3-year mortality rate was 54.9% in patients with DM (n = 368) and 60.2% in patients without DM (n = 447, p = 0.13 between groups). In multivariate logistic analysis, nursing home residency, higher CCI, higher CFS, higher FFS, lower BI, the total number of days of hospitalization in the past year, and hospital-acquired infections were independently associated with the 3-year mortality in both groups. In individuals with DM, lower body mass index (BMI) and elevated urine albumin-to-creatinine ratio (UACR) were identified as additional independent predictors of 3-year mortality.

Conclusions: A high post-discharge mortality rate was observed in very old patients. DM was not identified as an independent factor of post-discharge mortality. Assessment of frailty and disability in very old patients is important for predicting long-term post-discharge mortality. Additionally, in patients with DM, evaluating BMI and UACR may aid in better prediction of 3-year mortality.

Introduction: Lipoprotein (a) (Lp(a)) is a largely genetically determined (70-90%) independent risk factor for cardiovascular disease (CVD). However, clinicians often encounter adults/elder adults with elevated Lp(a), who are otherwise healthy and asymptomatic for atherosclerosis. We aimed to identify additional risk factors and conditions, apart from elevated Lp(a), which lead to atherosclerosis progression and CVD, and whether any protective factors mitigate Lp(a)-related risk.

Material and methods: In the STAR (Specialist Care Patients) Lp(a) study, we prospectively enrolled 2,594 consecutive patients aged over 50 years, who had elevated Lp(a), referred to two outpatient cardiology clinics. These patients were either healthy, or had established CVD or three or more cardiovascular risk factors. Lp(a) concentration was measured by enzyme-linked immunosorbent assay.

Results: Among adults > 50 years with Lp(a) ≥ 30 mg/dl (75 nmol/l) (mean Lp(a), 65.4 vs. 72.7 mg/dl, p = 0.118), healthy individuals and patients differed significantly in mean age (62.8 vs. 69.6 years, p < 0.001), body mass index (BMI) and prevalence of overweight/ obesity (16.0% vs. 32.7%, p = 0.001), mean hsCRP (2.12 vs. 2.35 mg/l, p = 0.007), dyslipidemia, mean glucose and HbA_1c levels (5.44% vs. 5.86%, p < 0.001), and coronary artery calcium (CAC) scores (43.1 vs. 339.9, p < 0.001). In multivariable analysis, the independent predictors of increased CAC in healthy individuals were gender and non-HDL-C, while in patients, the independent predictors were non-HDL-C and age. Correlation analysis showed that in healthy individuals, CAC correlated with gender and non-HDL-C, while in patients, CAC correlated with age, gender, non-HDL-C, HbA_1c, and Lp(a). Comparing sub-groups with Lp(a) > 50 mg/dl (125 nmol/l) (mean age: 62.3 vs. 69.2 years, p < 0.001; female: 77.8% vs. 68.5%, p = 0.021; mean Lp(a) : 87.8 vs. 88.8 mg/dl, p = 0.838), the independent predictors of CAC in healthy individuals were elevated hsCRP and gender, whereas in patients, they were age and Lp(a). Correlation analysis confirmed that Lp(a) was significantly associated with CAC in patients only, and LDL-C and hsCRP correlated with CAC in patients only.

Conclusions: In adults > 50 years with elevated Lp(a), Lp(a) - related risk of atherosclerosis progression can be substantially mitigated by addressing modifiable CVD risk factors, such as obesity, diabetes, inflammation, and dyslipidemia, preferably by early preventive measures. In our study cohort, Lp(a) was independently associated with atherosclerosis progression in the patient group only.