Journal of clinical medicine research最新文献

Radiation and chemical-induced cancer are of increasing concern as the various activities of humans continuously elevate the levels of radiation and toxic chemicals in the environment. The prevention of this incidence using alternative medicines-phytopreparations, therefore, becomes pertinent as conventional approaches tend to produce various unwanted side effects. To achieve this, there is a need to understand the various mechanisms of action through which phytopreparations exhibit their protective effects. This systematic review, therefore, aims to explore the mechanism of action of various phytopreparations in the prevention of induced radiation and chemical (chromium) cancer. A systematic review approach following the stipulated guidelines by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to identify research papers published between 2015 and 2025. Four databases, namely Europe PubMed Central (PMC), PubMed, Springer Open, and Wiley Online Library were used to search for related open access papers. A total of 621 research papers were reviewed for suitability to the review objective; however, only five papers met the inclusion criteria, and an additional two papers were sourced from ResearchGate. Thus, a total of seven papers were finally included in the analysis. This review highlights the mechanisms of action of various phytopreparations in the prevention of radiation and chromium-induced cancer. The major mechanisms of phytopreparations' action in the prevention of induced radiation and chromium oncogenesis majorly involve regulating pro and anti-inflammatory cytokines, improving cell-to-cell communication, and preventing damage to DNA structure.

Background: Molnupiravir (MOV) is recommended for the treatment of patients with coronavirus disease 2019 (COVID-19) who are ineligible for remdesivir treatment. However, data regarding laboratory-based adverse events (AEs) associated with MOV use in hospitalized patients are limited. In this study, we evaluated MOV-associated laboratory abnormalities, including increased creatine phosphokinase (CPK) and decreased hemoglobin (Hb) levels (e.g., anemia), and evaluated related risk factors in hospitalized COVID-19 patients.

Methods: We reviewed retrospective data for 78 adult inpatients with COVID-19 who received MOV upon admission at Fukuoka University Chikushi Hospital. Individuals with MOV treatment history, early discontinuation, or premature discharge were excluded. Data were collected on demographics, Charlson Comorbidity Index, bacterial coinfection, concomitant medications, COVID-19 severity, oxygen therapy, and length of hospital stay. The AEs were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 Japanese Clinical Oncology Group. Multivariate analyses were conducted to identify risk factors for elevated CPK levels and anemia.

Results: The median age of the study population was 82 years (interquartile range: 74 - 89 years; men: 56.4%), and 17.9% had bacterial coinfection. Twenty-seven patients (34.6%) experienced ≥ 1 AE, and MOV was discontinued in two patients because of a mild rash and CPK elevation. Elevated CPK levels and anemia each occurred in 11 patients (14.1%). Severe AEs (grade ≥ 3) were observed in one patient with grade 4 CPK elevation and in another with grade 3 anemia. Multivariate analysis showed that bacterial coinfection tended to increase CPK levels (adjusted odds ratio (aOR): 3.30, 95% confidence interval (CI): 0.75 - 13.32, P = 0.10) and was significantly associated with anemia (aOR: 5.40, 95% CI: 1.27 - 23.69, P = 0.022).

Conclusions: MOV exhibits a generally favorable safety profile in hospitalized COVID-19 patients, with low treatment discontinuation rates and mild laboratory abnormalities. Elevated CPK levels and anemia may reflect the complications of bacterial coinfection rather than direct MOV toxicity; however, these results should be interpreted with caution because of the small sample size and single-center, non-controlled study design. Further multicenter prospective studies are warranted to determine the relationship between CPK elevation, anemia, and MOV treatment in COVID-19 patients.

Background: Previous studies have reported inconsistent findings on the relationship between telomere length and metabolic syndrome (MS). The aim of the work was to study leukocyte telomere length in young patients without cardiovascular diseases and its relationship with MS and its components.

Methods: This study included 450 Caucasian patients with a median age of 30 (21 - 42) years. Glycemic parameters and lipid profile components were determined using the CardioChek PA (USA, 2017). Integral metabolic indices were calculated in all patients. To investigate leukocyte telomere length, 45 were randomly selected from the total cohort of 450 participants.

Results: The selected patients were divided into two groups according to the presence of MS. The median telomere length in MS patients (7.36 (6.96 - 8.67) pn) was significantly lower than in the comparison group (8.72 (8.37 - 8.96) pn) (P = 0.016). Correlation analysis was performed to assess the relationship between telomere length and various traditional cardiovascular risk factors (sex, age, smoking, and blood pressure levels), MS components, and integral metabolic indices. Several linear regression analysis models were constructed to assess the independent associations between various factors and telomere length. Age, smoking, neck circumference, triglycerides, high-density lipoprotein levels, LAP index, and the presence of dyslipidemia were significantly associated with telomere length.

Conclusion: Our results are consistent with the notion of shorter leukocyte telomere length in individuals with MS and support an association with dyslipidemia in premature shortening of telomere length. The causal relationship between these changes requires further study.

Background: This systematic review aimed to evaluate the efficacy of medical-grade honey (MGH) in eliminating and inhibiting Pseudomonas aeruginosa (P. aeruginosa) biofilms, which are known for their resistance to conventional antibiotics and significant role in chronic infections.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered in PROSPERO (CRD42024614542), a systematic search was conducted across PubMed, ProQuest, Scopus, and EBSCO using terms related to P. aeruginosa, biofilm, and MGH. Inclusion criteria encompassed in vitro studies assessing MGH's effect on P. aeruginosa biofilms, with reported outcomes including biofilm inhibition and eradication. Data extraction and risk-of-bias assessment were performed independently by two reviewers using the Quality Assessment Tool for In Vitro Studies (QUIN) tool. Publication bias was estimated through forest plot.

Results: A total of 1,934 records were identified from four databases. After screening and full-text review, six in vitro studies met the inclusion criteria for qualitative synthesis, and five were eligible for meta-analysis. All studies evaluated the effect of MGH, including Manuka and Surgihoney, on P. aeruginosa biofilms using crystal violet staining and spectrophotometric analysis. Pooled results showed that MGH significantly reduced biofilm formation (standardized mean difference (SMD) = -4.98; 95% confidence interval (CI): -6.72 to -3.25) and effectively disrupted established biofilms (SMD = -4.44; 95% CI: -6.62 to -2.26). Subgroup analysis revealed stronger effects on American Type Culture Collection (ATCC) strains than clinical isolates, with low within-subgroup heterogeneity. MGH also demonstrated significant superiority compared to active biofilm controls, although sterility control comparisons showed high variability. Mechanistic analysis found that Medihoney outperformed sugar solutions and methylglyoxal (MGO) alone, suggesting that its antibiofilm activity results from synergistic bioactive compounds. Overall, these findings support MGH as a potent antibiofilm agent, warranting further research for clinical application against P. aeruginosa biofilm infections.

Conclusion: MGH exhibits consistent and substantial anti-biofilm activity against P. aeruginosa in vitro, affecting both biofilm formation and established biofilms. These findings support its potential application as a topical therapeutic agent in managing biofilm-related infections, particularly in chronic wounds. Future research should prioritize standardized application protocols and investigate synergistic effects with conventional antimicrobials through clinical trials.

Middle ear surgery is a daily routine procedure in otolaryngology. Pain control, along with a bloodless and non-moving operative field during the surgery, is crucial for achieving better surgical outcomes and can be achieved easily under general anesthesia (GA). Nevertheless, local anesthesia (LA), especially if done as office-based surgery, is an ideal alternative to GA in certain scenarios. Despite the well-established nature of LA for middle ear surgery, only a small percentage of otolaryngologists choose to use it, and few publications in the literature address this topic. This article reviews the literature for the feasibility of performing middle ear surgeries in an office base setting. A scoping review of the literature was conducted on middle ear surgery under LA in an office-based setting, focusing on feasibility, advantages, surgical techniques, limitations, and outcomes, to provide a concise guide for its implementation. LA will avoid the rare but serious complications of GA, and there are cost savings of approximately 50% in LA, which is crucial for the sustainability of healthcare systems. It is an ideal alternative to GA in certain scenarios, including decreased access to operative rooms, staff shortage or contraindications for GA. Also, surgeons can appreciate hearing improvement and the need for prosthesis adjustment with instant feedback during the surgery or prevent significant complications such as a dead ear under LA. Office-based surgery for middle ear under LA is feasible and the present work offers a brief guide for beginners with some tips and tricks to ensure optimal patient care and outcomes.

The ABO and Rhesus blood systems have been studied extensively in relation to various diseases, including cancers. Recent evidence suggests that ABO blood group may influence susceptibility to oral potentially malignant disorders (OPMDs) and oral cancers, particularly oral squamous cell carcinoma (OSCC). The current review explores the association of ABO and Rhesus blood groups with oral cancers, summarizing epidemiological, molecular, and immunological studies to elucidate potential mechanisms underlying this relationship.

Background: A previous study developed a predictive model for identifying positive findings on computed tomography (CT) brain imaging in patients with non-traumatic seizures. One key predictor was the Glasgow Coma Scale (GCS), categorized into three groups (≤ 8, 9 - 13, >13). However, in real-world practice, some bedridden patients have low baseline GCS, which may lead to overprediction and unnecessary CT imaging. The original model yielded a false positive of 16.6%, exceeding the predefined threshold of less than 15%. This study aimed to improve the model by replacing categorized GCS with GCS change from baseline to reduce false positives below 15%, while maintaining false negatives below 5%.

Methods: This diagnostic predictive study included patients with non-traumatic seizures who underwent CT brain imaging at the emergency department between November 2019 and November 2023. The original predictors were retained, with GCS change from baseline replacing the categorized GCS. Multivariable logistic regression analysis was used to estimate multivariable odds ratios. Discriminative performance was assessed using the area under the receiver operating characteristic (AuROC) curve. A trade-off between sensitivity and specificity was applied to identify a probability cut-off that met the target for false positives and false negatives. The revised model was named the "SeizCT optimized model".

Results: Of the 625 patients included, 18.9% had positive CT findings. The majority were male (74.9%) with a mean age of 55 years. The SeizCT optimized model incorporated six predictors: prior stroke (> 3 months), current cancer, GCS change from baseline, alcohol withdrawal symptoms, epilepsy, and focal neurological deficit. The model demonstrated an AuROC of 0.8221 (95% confidence interval (CI): 0.7813, 0.8629). Using a threshold probability of 22.57%, it outperformed the original model (AuROC of 0.8156; 95% CI: 0.7586, 0.8727) with narrower confidence intervals. It achieved a false negative of 4.8% and a false positive of 14.4%.

Conclusions: The SeizCT optimized model showed improved performance over the original tool, reducing both false positives and false negatives within the predefined thresholds. External validation is recommended.

Background: The main study aims are to determine the incidence of congenital ear abnormalities in children in Kazakhstan and their risk factors. This research examined the medical treatment given to children with congenital malformations and the medical and social aspects impacting them and their parents. It also evaluated congenital ear deformity children's quality of life.

Methods: This retrospective, cross-sectional study was conducted in two public health maternity hospitals in Kazakhstan and aimed to investigate 975 consecutive children delivered therein. The study utilized hospital records to assess various factors related to neonatal health and outcomes in the sampled population.

Results: The study revealed significant associations between congenital ear malformation and various factors: parental consanguinity (P = 0.001), maternal alcohol consumption (P = 0.020), cesarean section (P = 0.000), stillbirth/prenatal mortality (P = 0.005), and maternal medication use (P = 0.002). Surgical interventions comprised 68% of treatments, with non-surgical methods covering all cases, emphasizing a comprehensive approach. Maternal alcohol consumption (P = 0.005) and drug use (P = 0.002) showed notable associations with congenital malformations. Cesarean section (P = 0.048) and lower gestational age (P = 0.001) were linked to prenatal complications. Maternal behaviors like smoking (P = 0.010) and vitamin intake (P = 0.009) also impacted neonatal health.

Conclusions: These findings stress the importance of targeted interventions to mitigate risks in at-risk populations. Congenital ear malformations, influenced by genetics and environment, require targeted interventions. Surgical and non-surgical treatments address physical challenges, emphasizing holistic care for improved quality of life and well-being.

Chronic kidney disease (CKD) affects an estimated 15% of all adults in Central Europe. Those affected are at high risk of cardiovascular disease and death. Inflammatory rheumatic systemic diseases manifest themselves extra-articularly with varying frequency. This article summarized the prevalence and pathogenetic mechanisms of CKD in rheumatic systemic diseases. The following databases were searched for references: PubMed, Web of Science, Cochrane Library, Scopus. The search period spanned from 1975 to 2025. Kidney involvement is almost always present in systemic lupus erythematosus and certain types of systemic vasculitis. In the context of rheumatic diseases, there are additional mechanisms that can contribute to enhancing the functional and structural integrity of the kidneys. These mechanisms include inflammation and an increase in cardiovascular risk. The prevalence of CKD is disproportionately high in certain entities of the rheumatic form. Given the disproportionately high prevalence of CKD in relevant entities of the inflammatory rheumatic group and the associated increase in the risk of cardiovascular disease and death, CKD screening should be an integral part of the care of affected patients.

Background: The aim of this study was to compare cancer-specific survival (CSS) and overall survival (OS) after partial cystectomy (PC) versus radical cystectomy (RC) in patients with stage T2N0M0 non-urothelial carcinoma of the bladder (NUCB).

Methods: Data on patients with stage T2N0M0 NUCB treated with PC or RC were retrospectively retrieved from the Surveillance, Epidemiology, and End Results (SEER) database from 2007 to 2015. Propensity score matching (PSM) was used to create matched cohorts, which were used to calculate OS and CSS.

Results: Among 999 histologically confirmed NUCB patients (752 in PC group and 247 in RC group), significant differences were found in age, marital status, tumor-related features, and treatment modalities. After 1:1 PSM, 169 pairs were obtained. In the matched cohort, the RC group had significantly higher 1-year, 3-year, and 5-year OS and CSS rates than the PC group (OS: P = 0.002; CSS: P = 0.004). Cox regression analysis showed that older age, unmarried status, and PC were independent risk factors for poor prognosis, while RC was associated with improved survival (OS: hazard ratio (HR) = 0.34, 95% confidence interval (CI): 0.26 - 0.44, P < 0.001; CSS: HR = 0.47, 95% CI: 0.31 - 0.72, P < 0.001). T2b-stage patients had lower cancer-specific mortality than T2a-stage patients (P = 0.01). Subgroup analysis indicated that RC generally led to better survival, except in the neuroendocrine carcinoma subgroup for OS (P = 0.085) and the other carcinoma subgroup for CSS (P = 0.132).

Conclusions: This study reveals that RC is associated with superior CSS and OS compared to PC in patients with NUCB. Patient-related factors (age and marital status) and histological subtype significantly influence prognosis, highlighting the need for personalized treatment strategies.