BioMed Research International最新文献

Background and purpose: Hip pain, a common complaint among adults that often causes functional disability, can be caused by femoroacetabular impingement, labral injuries, stress fractures of the femoral neck, avascular necrosis of the femoral head, osteoarthritis of the femoroacetabular joint, hip fractures, greater trochanteric pain syndrome, pathology of the lumbar spine and sacroiliac joint, and myofascial pain syndrome (MPS). MPS is characterized by the presence of hyperirritable nodules, known as myofascial trigger points (MTPs), within muscles and fascia. MTPs limit the range of motion of the joints. Moreover, they induce a local contraction response triggered by mechanical stimulation. The stimulation of MTPs induces pain and sensory changes that can be localized or referred. The MTPs present in the gluteus medius muscle play a role in inducing patellofemoral pain, pain in the lower limbs, anterior region of the knee and thigh, and lower back; however, the anatomy of MTPs remains to be elucidated. This study is aimed at relating the entry points of the superior gluteal nerve into the gluteus medius muscle with the MTPs described in the literature via anatomical dissection.

Method: Twenty gluteus medius muscles of 10 adult cadavers were divided into four areas: posterosuperior, posteroinferior, anterosuperior, and anteroinferior. The distribution of the nerve branches was classified according to these predetermined areas. Statistical analyses were performed using Poisson distribution and logarithmic link function, followed by Bonferroni multiple comparisons (p < 0.05).

Results: All areas of the gluteus medius were innervated by the branches of the superior gluteal nerve. A significantly greater number of nerve entry points was observed in Areas II and IV (posterosuperior and anteroinferior, respectively).

Conclusion: The areas of penetration of the superior gluteal nerve correspond to the clinically described MTPs.

Triple-negative breast cancer (TNBC) has an aggressive nature, a specific set of molecular characteristics, distinct patterns of metastasis, and a lack of targeted treatment. Many types of cancer have Notch pathway dysregulation, which leads to tumor initiation, spreading, and increased therapeutic resistance. In breast cancer, the overexpression of NOTCH1 and NOTCH4 in tumors suggests their role as oncogenes. The Notch signaling pathway is highly active in breast cancer tissues and thus can be considered a possible target. This project is aimed at developing a protein-based vaccine that targets NOTCH1 and NOTCH4 antigens associated with TNBC, using bioinformatic and in silico tools for increased precision, immunogenic potency, and faster therapeutic intervention development. The designed vaccine demonstrated coverage for 99.27%, indicating its potential effectiveness across diverse populations. Epitope-MHC docking simulations demonstrated strong binding affinities, with docking scores ranging from -135.96 to -285.59, suggesting effective immune system activation. The immune modeling analysis suggested that the vaccine can induce a consistent and accurate immune response alongside an increase in immunoglobulins, B cells, memory T cells, and cytotoxic T cells. Physicochemical evaluations confirmed the vaccine's stability, with an instability index of 39.70, indicating its robustness under physiological conditions. Furthermore, structural modeling of the vaccine indicated high stability and reliability under physiological conditions. Molecular docking demonstrated strong binding affinities with MHC I, MHC II, TLR4, and TLR7 molecules, with the highest docking score of -317.05 for TLR7 and the most favorable ΔG of -15.5 kcal/mol for TLR4. Molecular dynamics simulations (repeated three times) showed that the vaccine and its complexes with MHC I, MHC II, and TLR4 are stable, with the docked complexes exhibiting dynamic interaction. These findings collectively highlight a targeted approach to combating TNBC, demonstrating the vaccine's potential as a therapeutic candidate.

Acinetobacter baumannii is a troublesome bacterium that is highly prevalent in hospital settings, particularly in intensive care units (ICUs). Biofilm is one of the main virulence factors that makes A. baumannii a successful pathogen, enabling it to survive the harshest environments. This study aimed to corrolate the biofilm-forming capacity of clinical A. baumannii isolates with their antibiotic resistance phenotypes and isolation sources. A total of 327 clinical isolates originated from different hospitals, were recovered from diverse clinical specimens collected from patients admitted to the ICU and non-ICU wards. The isolates were characterized for their resistance phenotypes and biofilm formation capacities. Most A. baumannii isolates showed high resistance patterns against all examined antibiotics. Based on the resistance profiles, 81.2% and 12.3% of isolates were classified into extensively resistant (XDR) and multidrug-resistant (MDR), respectively. Moreover, the number of the ICU isolates exhibiting the XDR phenotype (86.7%) was higher than non-ICU XDR isolates (76.4%). The biofilm-forming capacity varied among the isolates, with most of the isolates forming either strong (44.3%) or weak biofilms (25.7%). Additionally, the fraction of ICU isolates with a strong capacity to form biofilms (60.7%, 91/150) was higher compared with the non-ICU isolates (30.5%, 54/177). We found a significantly higher tendency to form biofilms in isolates that are susceptible to 10 out of the 17 antibiotics (p = 0.014-0.002), including three carbapenems. In addition, a significant difference in the ability to form biofilms was revealed between the isolates originating from different hospitals and clinical specimens. Notably, a higher tendency to form biofilms was associated with susceptible strains isolated from blood (p = 0.024-0.04) and cerebrospinal fluid (p = 0.001-0.009). Our findings indicate that investigating the biofilm formation capacity of clinical A. baumannii strains could help identify patients requiring short or extended therapeutic treatments.

Background: Cervical cancer is one of the diseases that reflects global inequities. Vaccination against the human papillomavirus (HPV) is one of the main pillars of the World Health Organization (WHO) 2030 cervical cancer 90:70:90 elimination strategy. The role of healthcare practitioners in HPV vaccination acceptance cannot be overemphasized. This review investigated healthcare practitioners' knowledge, attitudes and barriers to promoting HPV vaccination in low- and middle-income countries (LMICs).

Methods: A comprehensive search for relevant literature from 2006 to 2024 was conducted in the following databases: Web of Science, Scopus, MEDLINE, EMBASE, PsycINFO (via Ovid), Cochrane Library and CINAHL PLUS (via EBSCOhost). The included studies were published in the English language. Screening of eligible studies, data extraction and quality assessment were conducted in duplicate. The data was synthesise using narrative synthesis.

Results: A total of 671 papers were identified from the database search, with seven studies meeting the criteria for inclusion. This review demonstrates varied levels of awareness, knowledge and attitudes of 136 healthcare practitioners in LMICs towards HPV vaccination. Although some studies demonstrated a positive attitude, others reported resistance towards the vaccine. The perceived barriers to HPV vaccination by healthcare practitioners identified were interpersonal, community-level and systemic in nature. Additionally, acceptance of HPV vaccination varied across the studies.

Conclusions: This review highlights the need for capacity building programmes for healthcare practitioners in the area of HPV vaccination to enhance their knowledge and attitudes and develop contextually relevant interventions to eliminate the many barriers they encounter.

Soil-transmitted helminths (STHs) and urinary tract infections (UTIs) pose major public health challenges, especially in regions with poor healthcare access, inadequate sanitation, and limited clean water supply. When these two conditions recur, they can cause stunted growth in children between 24 and 59 months of age, a vital phase for physical development. This study sought to assess the prevalence of STHs and asymptomatic bacteriuria among preschool children aged 1-5 years in the Bosomtwe District. A total of 344 children from 5 educational circuits were randomly selected for this study. Fecal specimens were obtained from each child and examined for STHs via the formol-ether concentration method, while urine samples were inoculated onto CLED agar to isolate and identify asymptomatic bacteriuria isolates. Antibiotic susceptibility was assessed using the Kirby-Bauer disk diffusion test. Participant demographics were obtained using a predesigned and structured survey questionnaire. The study found a prevalence of 19.8% (68/344) for STHs and 44.8% (154/344) for bacteriuria, with 6.1% (21/344) having both infections. Ascaris lumbricoides was the most common STH, accounting for 12.2% (42/344), followed by Trichuris trichiura 4.4% (15/344) and hookworm 3.2% (11/344). More males, 24.2% (40/165), than females, 15.6% (28/179), were affected by STHs. The Kuntenase circuit recorded the highest STH positivity with 26.1% (18/69). For bacteriuria, more females, 47.5% (85/179), than males, 41.8% (69/165) were affected, with age 5 being the most at-risk group, 46.6% (41/88). Escherichia coli was the most isolated Bacteriuria pathogen, 37.5% (129/344), followed by Klebsiella spp. 6.1% (21/344) and Proteus spp. 1.2% (4/344). Gentamicin was the most effective antibiotic against Bacteriuria isolates. Given the high prevalence of both STHs and bacteriuria, stakeholders should ensure better sanitation and health services, distribute anthelminthic drugs regularly, and raise awareness of bacteriuria in the district.

Background: Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory condition affecting the gastrointestinal tract. While significant progress has been made in managing IBD, the long-term outcomes remain heterogeneous, prompting this cohort study.

Methods: A retrospective analysis was performed on patients with IBD registered between 2000 and 2023. Clinical data, including demographics, disease activity, remission rates, therapeutic approaches, and complications, were collected.

Results: Among 600 enrolled patients, 72.8% were diagnosed with UC. Both patients with UC and those with CD showed improvements in endoscopic severity by the end of follow-up (p < 0.001). Clinical remission was achieved by 96.3% of patients with UC and 91.2% of those with CD during the last 6 months of follow-up (p = 0.046). Disease progression occurred in 22.1% of patients with CD and 18% of those with UC (p = 0.100). Gastrointestinal complications were more prevalent in patients with CD (25.6% vs. 1.6%, p < 0.001). Relapse remained high, with 86.7% of patients with UC and 92.6% of those with CD experiencing relapses at least once during follow-up, particularly those with severe baseline disease (p < 0.01). Biologic therapies were used more frequently (p < 0.01) and initiated earlier in patients with CD (p = 0.031).

Conclusion: The study showed significant clinical improvement, yet many patients, particularly those with severe initial disease, had incomplete remission and frequent relapses, necessitating more effective long-term management strategies. The distinction between CD and UC highlights the need for specialized treatments.

Background: Hypertension is a growing public health concern, particularly among white-collar workers exposed to sedentary lifestyles and occupational stress. This study examines the prevalence and determinants of hypertension among commercial bank employees in Sunsari, Nepal, with a focus on lifestyle risk factors and health literacy.

Methods: A cross-sectional study was conducted among 240 bank employees using stratified random sampling. Data were collected through a self-administered questionnaire adapted from the WHO STEPS survey and clinical measurements of blood pressure, BMI, and waist circumference. Hypertension was classified based on the JNC 8 guidelines. Descriptive statistics, chi-square tests, and independent t tests were used for preliminary analysis. Logistic regression was performed to identify independent predictors of hypertension, controlling for potential confounders.

Results: The prevalence of hypertension was 62.1% (95% CI 58.6-65.6), with 47.5% in Stage I and 14.6% in Stage II. Males had significantly higher odds of hypertension than females (aOR 2.237, 95% CI 1.170-4.276). Behavioral risk factors such as alcohol consumption (aOR 4.732, 95% CI 1.386-16.160) and frequent processed food intake (aOR 2.640, 95% CI 1.024-7.096) were significantly associated with hypertension. Overweight (aOR 1.819) and obesity (aOR 1.575) were also found to be the major risk factors. Lower health literacy scores, particularly in healthcare engagement and self-management, were associated with hypertension.

Conclusion: The high prevalence of hypertension among bank employees highlights the need for workplace interventions promoting healthy lifestyles, routine screenings, and health literacy programs to improve hypertension awareness and management.

This research introduces "XMP-Net," a modified Xception-based deep learning architecture constructed for the categorization of skin conditions, with a particular focus on identifying monkeypox. The study recognizes skin images of four categories: normal, chickenpox, measles, and monkeypox. To enhance interpretability and foster confidence in the model's predictions, Grad-CAM (gradient-weighted class activation mapping) and LIME (local interpretable model-agnostic explanations) were employed to illustrate the model's thinking manner. The model demonstrated impressive classification performance, attaining an accuracy of 98.33% for normal skin, 98.25% for monkeypox, 84.21% for measles, and 77.27% for chickenpox. Precision, recall, and F1-score values were also analyzed for each class, with monkeypox achieving a precision of 91.80%, a recall of 98.25%, and an F1-score of 94.92%. The visual explanations generated by Grad-CAM and LIME highlighted critical parts in the input images that affected the model's likelihoods, offering clinicians valuable insights into the diagnostic process. This research underscores the potential of explainable artificial intelligence (XAI) in augmenting traditional diagnostic methods, particularly for emerging communicable maladies like monkeypox, and provides a foundation for developing reliable, interpretable, and accessible diagnostic tools for resource-constrained settings.

Aims: Prediction of future deterioration in emergency department patients with infection is difficult, and existing prognostic tools are inaccurate. We evaluated the feasibility of deployment of a clinical decision support tool, Sepsis Advisor, which utilizes heart rate variability and laboratory values to predict future deterioration in emergency department patients with treated infection.

Methods: This study was an observational, prospective, Pilot Phase 1 feasibility implementation study involving two sites within a single academic health sciences centre. Then, 71 patients were enrolled, all with suspected/treated infection and systemic inflammatory response. Patients underwent 30 min of electrocardiograph recording. The generated predictive model and Sepsis Advisor report were shown to physicians observationally, > 48 h after clinical encounter, while assessing perceived usability, value, barriers and drivers with using the tool through interviews with nurses and physicians.

Results: Of the 71 patients enrolled, 65 (92%) had adequate duration of heart rate variability measurements to generate a predictive model (average recording: 25 ± 7 min); 100% had clinical data entry. Creatinine, lactate, and INR were drawn 97%, 56%, and 28% of the time and were incorporated into predictive models. Physician and nurse reported drivers for use included potential to facilitate communication, improve care, and ease of integration. Barriers included the need to understand and interpret results from the tool, time constraints, changing routines, and gaining buy-in. User-centered feedback informed four improved versions of the tool.

Conclusions: Observational deployment of a heart rate variability-based clinical decision support tool within the emergency department is feasible and perceived to have the potential to improve care.

The seminal Michaelis-Menten theorization for biological catalysis was based on "transition state" (TS), involving the formation of a topologically complementary substrate (S) and enzyme (E) complex (ES) at the "active site" of the latter. Rudolph Marcus put forth the theory of outer sphere electron transfer (ET) in a "donor-acceptor" TS complex, which was seen as a foundational framework for understanding ET reactions in chemical systems. Although these two theories are quite robust, the active site treatment of Michaelis-Menten may not be relevant in promiscuous/nonspecific xenobiotic-metabolizing redox enzymes, and Marcus theory's applicability to biological ET (BET) systems can be limited in interfacial protein-protein interactions. Herein, the "mathematical" necessity to venture beyond the "active site constraints" of interpreting redox enzyme kinetics and BETs is established first with fresh data. Also, (i) the classical explanation vouching for active site binding and protein-protein complexation-based BET in xenobiotic metabolism (mediated at the endoplasmic reticulum membranes of hepatocytes) and oxidative phosphorylation (multiprotein machinery at mitochondrial cristae) is demonstrated to be untenable, and (ii) tangible/viable murburn models were proposed in lieu. Therefore, toward the imperative goal of arriving at quantitative expressions correlating the parameters/variables involved, the foundational considerations of murburn ET and murzyme catalysis in simple heme systems are presented, with some assumptions/constraints. While some derivations are from ab initio considerations, others are heuristic/empirical, often needing experimental fitting. The linear time-course profiles of ET (substrate depletion) and the biphasic substrate-dependent (product formation) are well fit with the newly derived expressions. A mechanistic comparison of the murburn model vis-à-vis the longstanding P450cam explanation for drug/xenobiotic metabolism is also provided.