Journal of clinical medicine research最新文献

Background: Breast cancer is a leading malignancy among women globally, with chemotherapy as a cornerstone of treatment. However, the side effects and toxicity associated with chemotherapy necessitate the exploration of adjunctive therapies to improve efficacy and reduce adverse effects. Thymoquinone (TQ) has shown potential anti-cancer properties. This systematic review aimed to evaluate the effectiveness of TQ in combination with chemotherapeutic agents in treating breast cancer.

Methods: This study thoroughly reviewed and synthesized existing research following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The selected databases, including PubMed, ProQuest, ScienceDirect, Epistemonikos, and Google Scholar, were searched over the past 10 years. Eligibility criteria were based on the PICOS framework, focusing on experimental studies involving TQ-chemotherapy combinations. Data extraction and quality assessment were performed using SYRCLE and SCIRAP tools. This review included 18 in vitro and six in vivo studies.

Results: Findings revealed that TQ enhances the efficacy of chemotherapeutic agents by inducing apoptosis, enhancing autophagy, inhibiting tumor growth, and regulating cancer cell signaling pathways as well as multiple phases of the cell cycle. Additionally, TQ reduced chemotherapy-related toxicity, such as heart, blood, liver, and kidney damage, and also improved patient tolerance. Nanoparticle-based delivery systems further amplified these synergistic effects.

Conclusions: The TQ-chemotherapy combination shows significant potential as a therapy for breast cancer, enhancing treatment efficacy while mitigating side effects. Future clinical studies are needed to establish its safety and therapeutic applicability.

[This corrects the article DOI: 10.14740/jocmr6126.].

Background: The aim of this study was to evaluate the levels of kinesiophobia and its relationship with functional status, quality of life, pulmonary involvement, depression, and other clinical parameters of the disease in patients with systemic sclerosis (SSc).

Methods: A total of 100 individuals (40 patients with SSc and 60 healthy controls) were included in the study. The Tampa scale was used to assess kinesiophobia. Beck Depression Inventory (BDI) was used to assess depression. Scleroderma Health Assessment Questionnaire (SSc-HAQ) was used to assess functional status. Modified Rodnan skin score was used to assess skin thickness, and high-resolution computed tomography was used to assess lung fibrosis.

Results: The mean Tampa kinesiophobia score was significantly higher in patients with SSc compared to healthy controls. Depressive symptoms were present in 57.5% of patients with SSc. Disease duration, pain, fatigue, disease activity, functional status, pulmonary fibrosis, and depressive symptoms were correlated with kinesiophobia in patients with SSc.

Conclusion: There is an increased prevalence of kinesiophobia in patients with SSc, which seems to be more closely associated with disease duration, pain levels, and depressive symptoms.

Background: When performing clinical trials on lifestyle-related diseases at our hospital, we have sometimes experienced patients who fulfilled the inclusion criteria at the time of receiving an explanation of the trial but who no longer met the criteria when they arrived to provide their consent to participate 1 month later. In some of these cases, we noticed that the patient's lifestyle subsequently improved. Therefore, we hypothesized that receiving information on clinical trials may affect lifestyle-related diseases.

Methods: We enrolled patients aged 85 years or younger who received information on a double-blind randomized clinical trial on treatment-resistant hypertension (R-HT) or one on diabetic nephropathy. In these patients, we evaluated whether the trial information affected a range of variables. In addition, we compared the rate of change in variables between two groups, i.e., patients who became ineligible to participate and were not randomized (early dropouts) and patients who decided to participate and were randomized (patients randomized to treatment). We also conducted a questionnaire on changes in patients' motivation level, health awareness and behavior, and expectations and concerns and evaluated changes from before to after receiving an explanation of the trial.

Results: Seven patients who received an explanation of the R-HT trial and 14 who received an explanation of the diabetic nephropathy trial participated in the present study. The only significant change in any variable was in the R-HT clinical trial, where systolic and diastolic blood pressure significantly decreased in the early dropout group. There were no significant differences between the two groups in the rate of change in variables. After receiving information about one of the studies, patients who became more proactive or involved in changing their health-related behavior, such as their exercise, eating, and drinking habits, increased in both groups.

Conclusions: Receiving information on a clinical trial on hypertension can significantly affect blood pressure. Future research should examine whether providing information on clinical trials on other lifestyle-related diseases motivates patients to improve their lifestyles.

Background: Diabetes mellitus places a significant burden on society in terms of healthcare expenditures and poor health outcomes and complications. Heart failure is one of its complications which increases morbidity and mortality for patients with diabetes. The purpose of this study was to assess the prevalence of left ventricular diastolic dysfunction (LVDD) and its predictors among Saudi patients with type 2 diabetes mellitus (T2DM).

Methods: This retrospective cross-sectional study was conducted between May 2021 and May 2022 at King Saud University Medical City in Riyadh, Saudi Arabia. Medical records of adult patients with T2DM without prior cardiovascular disease who underwent echocardiographic examination were reviewed, and data were extracted. Echocardiographic findings were reviewed for the diagnosis of LVDD.

Results: A total of 251 participants were included in the study. LVDD was diagnosed in 66.9% of the participants. The majority (89.9%) had grade I. The mean age was 59 ± 9.1 years and the mean diabetes duration was 20 ± 8.5 years. Of the patients, 76.9% had hypertension and 81.2% had dyslipidemia. The mean body mass index was 32.9 ± 6.6 kg/m² and the mean glycated hemoglobin level was 7.7±2.3%. LVDD correlated with older age, longer duration of diabetes, obesity, poor glycemic control, higher systolic blood pressure, the presence of hypertension, and the usage of antihypertensive and lipid-lowering medications. In logistic regression analysis, older age and higher body mass index were the only independent risk factors of LVDD.

Conclusion: The prevalence of LVDD among Saudi patients with T2DM was high. It was associated significantly with age and obesity. These findings highlight the need for early monitoring, and treatment to prevent its progression and reduce morbidity and mortality.

Background: The aim of the study was to compare the effectiveness of tirzepatide versus semaglutide in producing weight loss.

Methods: A systematic search was conducted in databases PubMed, Scopus, and Web of Science on January 22, 2025, using search terms ("tirzepatide," "semaglutide," and "weight loss") and their alternatives, which yielded 751 studies in total. After deduplication, title/abstract and full text screening was conducted, and studies were assessed based on the eligibility criteria. After extracting the data, a meta-analysis (MA) was performed through RStudio. Heterogeneity among studies was evaluated with Cochran's Q and I² tests. A random-effect model was used to calculate pooled "mean differences" (MDs). Study quality was estimated by Newcastle-Ottawa Quality Assessment Scale (NOS) and Cochrane risk of bias (RoB) version 2 tool, and publication bias was estimated through forest plots and the Egger's test.

Results: A total of two randomized controlled trials (RCTs) and five retrospective cohorts were included in this MA. MA results showed that compared with the semaglutide, tirzepatide could produce significantly greater weight loss (MD = 4.23; 95% confidence interval (CI): 3.22 - 5.25; P < 0.01). Subgroup analysis showed a dose- and duration-dependent significantly superior therapeutic effect of tirzepatide (> 10 mg dose: MD = 6.50, 95% CI: 5.93 - 7.08, P < 0.01 vs. ≤ 10 mg: MD = 3.89, 95% CI: 2.12 - 5.65, P < 0.01) (> 6 months duration: MD = 5.00, 95% CI: 3.48 - 6.52, P < 0.01 vs. ≤ 6 months: MD = 3.50, 95% CI: 2.24 - 4.75, P < 0.01). The supremacy of tirzepatide was maintained in both types of studies: RCTs and retrospective cohorts. No publication bias was found through forest plots visually or Egger's test (Egger's regression asymmetry test P value 0.94). Study quality estimated by NOS revealed the quality of each study as "good" (≥ 7 points) and that estimated by the Cochrane RoB tool revealed "low" RoB.

Conclusion: The pooled analysis provides evidence that tirzepatide is better than semaglutide in reducing body weight, regardless of study design. A dose-response relationship exists, and the weight loss magnitude increases with the dose or duration of tirzepatide. The studies that provide this evidence are of high quality and have a low RoB.

Lipoprotein(a) (Lp(a)) is a type of lipoprotein consisting of low-density lipoprotein with apoprotein(a) (apo(a)) and is a risk factor for cardiovascular disease (CVD). Lowering Lp(a) levels may improve CVD outcomes, but this has been challenging owing to the unique structure and metabolic pathway of Lp(a). Recently, several new treatments using apo(a)-targeting drugs have been developed to reduce Lp(a) levels. Here, we briefly summarize the treatments, including earlier attempts at reducing Lp(a). Some lipid-lowering drugs can reduce Lp(a) levels in a non-targeted manner; while the effect of statins varies, niacin and proprotein convertase subtilisin/kexin type 9 inhibitors exhibit a reduction of over 20% in Lp(a) levels. Estrogen-related drugs and certain supplements can reduce Lp(a) levels, which may promote a deeper understanding of the modulation of Lp(a) levels. An apo(a) antisense oligonucleotide, small interfering RNAs, and a small molecule Lp(a)-formation inhibitor have recently been developed as promising drugs that specifically reduce Lp(a) levels by approximately 80%. The treatment strategies for Lp(a) are set to be updated, although we are awaiting clinical evidence on the reduction of CVD events by new treatments and the effective threshold for Lp(a) levels for the prevention of CVD.

Background: Assessment of center of mass (COM) changes during static stance control has practical implications in clinical settings, notably among older adults. Recently portable and wearable devices, including accelerometers and gyroscopes, have emerged as a promising alternative to traditional clinical and laboratory assessments. The objectives of the study were to evaluate COM postural sway parameters derived from accelerometer and gyroscope data during static balance tasks with varying bases of support in healthy elderly individuals, and to examine the correlation and agreement between accelerometer-based and gyroscope-based parameters in postural sway assessment.

Methods: One hundred and fourteen healthy elderly individuals who had not experienced falls within the preceding 6 months and were confirmed to have no risk of falling as determined by the timed up and go test, were included in this study. They were evaluated for postural sway while standing, using the sensor securely with a belt attached to the L5 vertebra. The four-stage balance test, including standing in a double stance (SO), semi-tandem stance (STO), tandem stance (TO), and single-leg stance (SL), was employed to assess each participant's ability to maintain balance under increasingly challenging standing positions on a stable surface.

Results: The study demonstrated that COM posture sway increased with a demanding position and a decreasing base of support. Spearman's rho correlation coefficients from the anteroposterior and mediolateral planes exhibited strong correlation (0.75 - 0.9). Moderate reliability was observed for both the accelerometer and gyroscope parameters in both planes (intraclass correlation coefficient: 0.5 and 0.75).

Conclusions: Accelerometry and gyroscopes provide objective quantification of balance that have the potential to be utilized in conjunction with clinical tests to effectively evaluate the risk of falling.

Background: Our goal in this manuscript was to perform a survival analysis and understand the causes of death (CODs) in patients with glioblastoma using the Surveillance, Epidemiology, and End Results (SEER) database.

Methods: A retrospective cohort study was conducted using version 8.3.9.2 of SEER*Stat software to extract data from the SEER 17 Plus database. Patients with World Health Organization (WHO) grade IV glioblastoma diagnosed between 2000 and 2019 were included to calculate overall survival (OS), relative survival (RS), and conditional survival. R software was used to calculate univariate and multivariate Cox regression models for age, sex, and race to identify their effect on survival.

Results: We included 45,071 patients with grade IV glioblastoma according to WHO 2016 classification. The observed 1-year, 3-year, and 5-year survival rates showed a decline to 40.1%, 9.8%, and 5.2%, respectively. Similarly, the relative 1-year, 3-year, and 5-year survival rates were 40.7%, 10.2%, and 5.4%, respectively. The conditional 3-year survival rates improved up to 16.9%, 42.9%, and 60.2% after 1, 3, and 5 years of survival, correspondingly, with females showing better estimates. The most common cancer CODs were the brain and other central nervous system (CNS) cancers. Among non-glioblastoma cancer CODs, breast cancer was the most common cause. Additionally, cardiovascular diseases, cerebrovascular diseases, and septicemia were the most common non-cancer CODs.

Conclusion: In this study, patients with glioblastoma showed a sharp decline in OS and RS over time after diagnosis. However, there was a notable improvement in conditional 3-year survival over time. Cardiovascular diseases emerged as the most common non-cancer COD, with lower survival rates in males and advanced age.

Background: Acute interstitial pneumonia (AIP), also known as Hamman-Rich syndrome, is a rapidly progressive interstitial lung disease. In addition to being challenging to diagnose, AIP is also difficult to treat. The mortality rate of AIP is greater than 70% due to the disease's rapid progression. Furthermore, survivors are likely to develop chronic interstitial lung disease as a sequela. Treatment primarily focuses on supportive care, which consists of oxygenation through mechanical ventilation, administration of broad-spectrum antibiotics, and the use of corticosteroids. Although the use of steroids as empiric treatment is controversial and results on its mortality benefit are variable, some studies have shown high-dose pulse steroid therapy to be associated with better health outcomes. This review aimed to evaluate cases of AIP to better understand the role of corticosteroids in the management plan of these cases.

Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. Outcomes of interest included patient age, sex, autoimmune condition, corticosteroid use, survival or expiration of patients, and time from hospitalization to expiration.

Results: Initial querying of the five databases yielded 376 articles. Following a thorough review, only 30 articles remained, comprising 42 patient cases. Of these cases, 62% of the patients survived, 36% expired, and 2% were unknown. The average stay from hospitalization to death was 20.2 days, and corticosteroid pulse doses were used as a first- or second-line treatment in 31% of patients.

Conclusion: The limitations of the evidence used in this study highlight the need for a greater output of higher-level evidence in the form of controlled trials and retrospective studies to help further elucidate the proper role and dosage of corticosteroids in the management plan of AIP with the ultimate goal of enhancing clinical decision-making and patient care. The findings of this systematic review, primarily based on observational data from case reports, highlight the critical need for treatment guidelines for this condition. The compilations of these cases also illustrated the diverse strategies employed by clinicians globally to save patients afflicted by this condition. While specific recommendations cannot be made based solely on these results, we anticipate that this comprehensive overview of varied clinical approaches from around the world will serve as a valuable resource for healthcare providers navigating the complexities of managing this condition.