Advances in medical sciences最新文献

Purpose: Graves' disease (GD) is an autoimmune thyroid disorder that may be complicated by Graves' orbitopathy (GO). This study evaluated salivary cytokine alterations in GD and the influence of orbitopathy activity and treatment, aiming to identify potential non-invasive biomarkers differentiating GD patients with and without orbitopathy from healthy controls.

Patients and methods: This exploratory observational cross-sectional study included consecutively enrolled adult patients with confirmed GD, with or without orbitopathy (n=32 and n=18, respectively), and age- and gender-matched healthy controls (n=50). Selected salivary inflammatory cytokines were analysed.

Results: Salivary IL-10 and CCL2 concentrations were lower in GD patients without orbitopathy than in GD patients with orbitopathy and controls, although differences were attenuated after adjustment for demographic and clinical covariates. ROC analysis showed significant discrimination of GD without orbitopathy from controls for IL-10 (AUC=0.741), CCL2 (AUC=0.717), and IL-33 (AUC=0.678), and from GD with orbitopathy for IL-10 (AUC=0.755), CCL2 (AUC=0.740), and IL-33 (AUC=0.695). Higher IL-6 was observed in GD patients with orbitopathy receiving antithyroid drugs and higher IL-15 in patients with active GO, but these differences did not remain significant after multiple-comparison correction.

Conclusions: Salivary cytokine patterns differed across the GD spectrum, with lower IL-10 and CCL2 concentrations in GD without clinically evident orbitopathy. IL-10, CCL2, and IL-33 showed apparent discriminatory ability in distinguishing GD from patients with orbitopathy and controls, warranting validation in independent cohorts. Subgroup findings for IL-6 and IL-15 provide insufficient evidence for treatment-related effects or GO activity markers.

Purpose: A multidisciplinary team-based approach became one of the main paradigms in health care. Current evidence regarding the efficacy of Shock Teams and related advanced shock care models in cardiogenic shock (CS) comes from observational studies, with limited synthetic data available. We aimed to assess the association between advanced shock care models and short- and mid-term outcomes of CS patients.

Materials and methods: This systematic review and meta-analysis (PROSPERO registration: CRD42024581904) were conducted according to the PRISMA 2020 Statement. We included observational studies of at least 25 adult CS patients managed with or without a Shock Team or related advanced shock care models. We searched Embase, Medline Ultimate, PubMed, Scopus, and Web of Science from 01.01.2016 to 13.08.2024. Risk of bias was assessed with the Newcastle-Ottawa Scale. Meta-analyses were performed with a random-effects model. The primary outcome was in-hospital mortality.

Results: Nine studies with a total of 658,708 patients met the inclusion criteria. For medium-term mortality, follow-up ranged from 60 to 365 days. Treatment of patients within the included models was associated with lower in-hospital mortality (OR: 0.81, 95%CI: [0.74, 0.90], p<0.0001, I²=58%), lower intensive care unit mortality (OR: 0.58, 95%CI: [0.43, 0.78], p=0.0004, I²=45%), and lower medium-term mortality (HR: 0.59, 95%CI: [0.48, 0.72], p<0.00001, I²=0%). These associations remained significant in sensitivity analyses, although clinical and methodological heterogeneity persisted.

Conclusions: Advanced shock care models may be associated with improved short- and mid-term outcomes in CS patients including lower in-hospital and medium-term mortality. Prospective studies are needed to confirm these results.

Purpose: Right ventricular-pulmonary artery (RV-PA) coupling is a major determinant of cardiovascular outcomes in hemodialysis patients, yet simple and accessible biomarkers capable of identifying early RV-PA impairment remain limited. The Systemic Inflammation Response Index (SIRI) has recently emerged as a promising inflammatory marker, but its relationship with RV-PA coupling has not been previously explored. This study aimed to evaluate the association between SIRI and the TAPSE/sPAP ratio in hemodialysis patients.

Methods: A total of 111 patients undergoing maintenance hemodialysis were enrolled. Transthoracic echocardiography was performed after the midweek dialysis session to assess TAPSE and sPAP. Patients were categorized into two groups according to the TAPSE/sPAP ratio (<0.55 vs. ≥0.55). Laboratory parameters, including SIRI and SII, were recorded. Group comparisons, multivariable logistic regression, and ROC analyses were conducted.

Results: Patients with a TAPSE/sPAP ratio <0.55 exhibited significantly higher sPAP and lower TAPSE values, indicating impaired RV-PA coupling. SIRI levels were also significantly elevated in this group (median 1.50 vs. 1.15). Although SIRI did not remain an independent predictor in multivariable analysis, it demonstrated a modest discriminatory ability in ROC analysis (AUC 0.630), with an optimal cut-off value of 1.50.

Conclusion: Elevated SIRI levels are associated with increased pulmonary artery pressure, reduced right ventricular systolic function, and a lower TAPSE/sPAP ratio in hemodialysis patients. As a low-cost and easily obtainable biomarker derived from routine laboratory tests, SIRI may provide supportive information regarding RV-PA coupling impairment. Larger prospective studies are warranted to clarify its clinical utility.

The increasing popularity of electronic cigarettes (e-cigarettes) has become a significant public health concern. Recent data show not only a growing number of users, especially among young adults, but also a notable expansion of the global e-cigarette market. E-cigarettes are often perceived as a less harmful alternative to traditional smoking, and although they do contain fewer toxic substances, their long-term health effects are still not fully understood. At the same time, obesity rates are rising worldwide and have become one of the leading preventable causes of chronic diseases. Nicotine, the main active substance in both conventional cigarettes and e-cigarettes, may play a role in body weight regulation. Its known effects include appetite suppression and an increase in the resting metabolic rate. Consequently, some individuals may use e-cigarettes as a tool to manage weight, particularly after quitting smoking. However, combustible cigarettes, nicotine itself, and e-cigarettes are not recommended for the treatment or prevention of obesity, and they should not be used as a strategy for intentional weight reduction. This review aims to summarise the current state of knowledge on the relationship between e-cigarette use and body mass. We discuss both physiological mechanisms related to nicotine as well as behavioral aspects that might influence food intake and weight control. Given the increasing prevalence of both vaping and obesity, understanding the potential links between the two is important from both a clinical and public health perspective.

Purpose: Traumatic spinal cord injury (TSCI) is a severe condition that profoundly affects individuals and places a substantial burden on healthcare systems. This study assesses functional recovery in TSCI under three conditions: a sham group without transplants, neural progenitor cells (NPCs) transplants, and NPCs differentiated into a Schwann-like phenotype (dNPCs) using an olfactory ensheathing cells-conditioned medium.

Materials/methods: An experimental model of TSCI was used, using complete transection in rats. Transplants were performed in the acute phase of TSCI using NPCs exposed to a conditioned medium.

Results: The NPCs formed neurospheres and acquired a Schwann-like morphology, confirmed via GFAP and p75 immunolabeling. NPCs-transplanted rats exhibited superior motor recovery compared to dNPCs and sham groups based on the Basso, Beattie, and Bresnahan (BBB) functional test. NPCs transplants promoted axonal regeneration and reduced lesion size. Both NPCs and dNPCs transplants reduced edema and inflammatory cell infiltration compared with the sham group. Immunohistochemistry revealed enhanced sensory neuron fiber regeneration (CGRP) and neuronal presence (NeuN) near the injury site in transplanted rats, with greater expression of p75 in NPCs-treated groups. Thus, the NPCs contributed to reduced lesion expansion, probably by releasing neurotrophic factors and forming a protective barrier.

Conclusions: These findings suggest that NPCs transplants may favorably modify the pathophysiological response to TSCI in the acute phase and improve functional outcomes, offering a potential therapeutic strategy for further investigation in chronic TSCI or its application in combined treatments.