Adv Clin Exp Med [JOURNAL]
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200 papers
Obesity: A call to action.
Dissen A, Uchmanowicz I, Czapla M
Adv Clin Exp Med · 2025 Apr · PMID 40195812 · Publisher ↗
Obesity has emerged as one of the most pressing public health challenges of the 21st century, impacting millions worldwide and contributing to serious health complications such as type 2 diabetes and cardiovascular disea...
Obesity has emerged as one of the most pressing public health challenges of the 21st century, impacting millions worldwide and contributing to serious health complications such as type 2 diabetes and cardiovascular diseases, as well as a diminished quality of life. This editorial explores the multifaceted nature of obesity, emphasizing the interplay between genetic predisposition, environmental constraints and behavioral drivers. Key contributors, such as the rising consumption of ultra-processed foods, increasingly sedentary lifestyles and psychosocial stressors, are explored in detail, along with their combined impact on the escalating global obesity rates. The editorial highlights the far-reaching consequences of obesity, including its economic burden, societal implications and the ripple effects on healthcare systems. Priority areas for action are proposed, including public health policies, education and the creation of environments that support active lifestyles. The importance of clinical interventions, such as early screening, personalized treatment strategies and the inclusion of dietitians within multidisciplinary care teams, is emphasized as vital for enhancing patient outcomes and managing obesity effectively. This editorial calls for a comprehensive, systemic response to address the global obesity epidemic, advocating for evidence-based interventions that are tailored to individual needs while addressing societal and environmental determinants. By fostering collaboration across sectors and prioritizing prevention and treatment, meaningful progress can be made in combating this escalating crisis.
Clearing the path: Hypertonic saline's impact on intracranial pressure in traumatic brain injury. A systematic review and meta-analysis.
Ren X, Liu S, Gao J … +2 more , Choudhury R, Rastogi S
Adv Clin Exp Med · 2025 Nov · PMID 40123354 · Publisher ↗
OBJECTIVES: To assess the effectiveness of HTS in lowering elevated ICP in TBI patients with TBI. MATERIAL AND METHODS: A systematic search was conducted using 4 electronic databases (PubMed, Embase, Scopus, and Cochrane...
OBJECTIVES: To assess the effectiveness of HTS in lowering elevated ICP in TBI patients with TBI. MATERIAL AND METHODS: A systematic search was conducted using 4 electronic databases (PubMed, Embase, Scopus, and Cochrane Library) to select relevant articles published in peer-reviewed journals. The risk ratio (RR) and mean difference (MD) were calculated, along with their 95% confidence intervals (95% CIs). Heterogeneity was assessed using Cochrane Q, I2 statistics and p-value. RevMan 5.4 was used. RESULTS: The current meta-analysis included 965 TBI patients from 15 randomized controlled trials (RCTs). We found that HTS was significantly more effective than other ICP-lowering agents with RR of 0.74 (95% CI: 0.58-0.94) for reduction of elevated ICP; RR = 0.57 (95% CI: 0.40-0.81) for all-cause mortality; RR = 0.68 (95% CI: 0.49-0.95) for rate of adverse hypernatremia; RR = 0.73 (95% CI: 0.60-0.88) for substantial change in the Glasgow Outcome Scale (GOS) score and shorter period of hospital stay with MD of -1.26 (95% CI: -2.30 to -0.21). CONCLUSION: We found that HTS is considerably effective in reducing elevated ICP with improvement in long-term neurological functions, all-cause mortality, rate of hypernatremia, and length of hospital stay in TBI patients.
Assessment of the physical fitness status of patients with hematological malignancies qualified for hematopoietic stem cell transplantation.
Chmielewski M, Szeremet A, Jabłonowska-Babij P … +5 more , Majcherek M, Czyż A, Bursiewicz N, Wróbel T, Malicka I
Adv Clin Exp Med · 2025 Aug · PMID 40099316 · Publisher ↗
BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is a procedure commonly used in the treatment of various hematological disorders with the aim of curing the patient or prolonging life. The vast majority of pati...
BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is a procedure commonly used in the treatment of various hematological disorders with the aim of curing the patient or prolonging life. The vast majority of patients must have antineoplastic therapy before HSCT, which can result in weight loss, sarcopenia or cachexia. Additionally, there is a high risk of malnutrition and physical deterioration during HSCT. By assessing physical fitness prior to HSCT, a physical therapist can individualize an exercise program, which in turn may speed up recovery after HSCT. OBJECTIVES: The aim of the study was to assess the physical fitness of patients with hematological malignancies qualified for HSCT as an indication for prehabilitation. MATERIAL AND METHODS: The study included 65 patients with hematological malignancies who were qualified for HSCT between September 1, 2022, and September 1, 2023. The reference group consisted of 219 healthy adults. The clinical study protocol involved participants performing 3 tests: the 6-minute walk test (6MWT), the timed-up and go test (TUG) and the 30-second chair-stand test (30CST). RESULTS: Patients with hematological malignancies were characterized by significantly lower endurance capacity (median (Me) = 420.50 (IQR 110.25) vs Me = 580.00 (IQR 133.00); p < 0.001) and significantly lower body strength (Me = 11.00 (IQR 6.00) vs Me = 15.00 (IQR 5.00); p < 0.001). There was also a statistically significant difference in the diagnosis and in the number of lines of systemic therapy. Additionally, a statistically significant difference was observed between the outcomes of the physical fitness level, particularly for TUG and 30CST, and the time from diagnosis to transplantation. CONCLUSIONS: The presented results suggest a negative consequence of hematological disease and its treatment on the functional status of patients qualified for HSCT and indicate the need for individualized rehabilitation management depending on the type of diagnosis, the number of lines of systemic therapy, and the time between diagnosis and transplantation.
Non-pharmacological approaches for stress-related neuropsychiatric disorders: Focus on physical activity and natural compounds.
Moradikor N
Adv Clin Exp Med · 2025 Mar · PMID 40079541 · Publisher ↗
This editorial emphasizes on non-pharmacological approaches for stress-related neuropsychiatric disorders due to side effects of pharmacological approaches. It highlights various exercises, specific natural compounds and...
This editorial emphasizes on non-pharmacological approaches for stress-related neuropsychiatric disorders due to side effects of pharmacological approaches. It highlights various exercises, specific natural compounds and their mechanisms for stress reduction. A combination of both can be a good strategy for the stress management. There are some challenges for these approaches. One major limitation is the standardization of these interventions. Natural compounds often have different quality and potency depending on their source and preparation, which can impact their efficiency. Additionally, determining the optimal dosage for different compounds remains a significant challenge, as individual responses can vary considerably. Interdisciplinary collaboration between researchers, clinicians and policymakers must be established to address the challenges. By conducting large-scale, well-designed clinical trials researchers gain a deeper understanding of the mechanisms underlying these approaches and can prepare clear guidelines for their integration into mainstream healthcare, ultimately improving patient outcomes and reducing dependence on pharmacological treatments.
Mesoderm/mesenchyme homeobox l as a potential target that orchestrates hepatic stellate cell activation.
Ruan J, Xie Y, Zhou H … +4 more , Su L, Liu C, Zhang C, Dianxing S
Adv Clin Exp Med · 2025 Nov · PMID 40071791 · Publisher ↗
BACKGROUND: Hepatic stellate cell (HSC) activation is a critical factor in the development of liver fibrosis. Recent research indicates that mesoderm/mesenchyme homeobox 1 (Meox1) contributes to fibrosis in organs like t...
BACKGROUND: Hepatic stellate cell (HSC) activation is a critical factor in the development of liver fibrosis. Recent research indicates that mesoderm/mesenchyme homeobox 1 (Meox1) contributes to fibrosis in organs like the skin and heart. OBJECTIVES: To investigate the potential impact of Meox1 on HSC activation and provide an available target for hepatic fibrosis research. MATERIAL AND METHODS: The human HSC cell line LX-2 was utilized to investigate the role of Meox1 in HSC activation. Fibrotic gene expression was analyzed, and assays were conducted to assess cell proliferation, migration and the cell cycle. RESULTS: Meox1 was identified as a positive regulator of HSC activation. We found that transforming growth factor-β1 (TGF-β1) treatment significantly upregulated Meox1 expression in a dose-dependent manner in LX-2 cells, and the expression levels of α-smooth muscle actin (α-SMA), collagen type I (collagen-I) and matrix metalloproteinase-2 (MMP-2) also increased progressively with higher concentrations of TGF-β1. Knockdown of Meox1 via small interfering RNA (siRNA) inhibited TGF-β1-induced expression of HSC activation markers and fibrotic genes, including α-SMA, collagen-I and MMP-2. Conversely, Meox1 overexpression promoted HSC activation, evidenced by increased levels of α-SMA, collagen-I and MMP-2. Meanwhile, Meox1 overexpression accelerated cell proliferation and enhanced cell migration. Additionally, forced expression of Meox1 in LX-2 cells elevated Smad3 phosphorylation level, although TGF-β1 and total Smad3 protein levels remained unchanged. Furthermore, we observed that Meox1 could induce a redistribution of the cell population, extending the G1 phase, and that Meox1-upregulated p21CIP1/WAF1 expression in LX-2 cells was independent of p53. CONCLUSIONS: Our findings suggest that Meox1 plays a pivotal role in HSC activation and may be involved in the canonical TGF-β1/Smad pathway.
Comorbidity-related risk factors for acute respiratory distress syndrome in sepsis patients: A systematic review and meta-analysis.
Lin X, Liu Y, Kong L … +4 more , Ba T, Bao B, Zhang S, Liu W
Adv Clin Exp Med · 2025 Aug · PMID 40071790 · Publisher ↗
BACKGROUND: Acute respiratory distress syndrome (ARDS) presents a significant challenge in the management of sepsis, with various comorbidities potentially influencing its development. Understanding the impact of these c...
BACKGROUND: Acute respiratory distress syndrome (ARDS) presents a significant challenge in the management of sepsis, with various comorbidities potentially influencing its development. Understanding the impact of these comorbidities is crucial for improving patient outcomes. OBJECTIVES: This meta-analysis was conducted to investigate the relationship between various comorbidities and the development of ARDS in patients with sepsis, with the aim of improving understanding and management of this condition. MATERIAL AND METHODS: The study included adult sepsis patients from 8 studies, totaling 16,964 participants. Risk of bias was assessed using the Newcastle-Ottawa scale (NOS), and the data analysis was performed and reported as pooled odds ratios (ORs) computed using a random-effects model. Heterogeneity and publication bias were assessed using the I2 statistic and Doi plots with the Luis Furuya-Kanamori (LFK) index, respectively. RESULTS: Chronic obstructive pulmonary disease was significantly associated with an increased risk of ARDS (OR: 1.43, 95% confidence interval (95% CI): 1.02-2.01). Other comorbidities showed no significant associations: diabetes mellitus (DM) (OR: 0.88, 95% CI: 0.69-1.11), hypertension (HTN) (OR: 0.86, 95% CI: 0.56 to 1.34), coronary artery disease (CAD) (OR: 0.95, 95% CI: 0.86-1.06), congestive heart failure (CHF) (OR: 1.08, 95% CI: 0.61 to 1.90), chronic kidney disease (CKD) (OR: 0.89, 95% CI: 0.65-1.22), chronic liver disease (CLD) (OR: 1.13, 95% CI: 0.61-2.09), and cancer (OR: 0.90, 95% CI: 0.59-1.35). Additional analyses indicated moderate-to-high heterogeneity and some evidence of publication bias. CONCLUSION: Chronic obstructive pulmonary disease is a notable risk factor for ARDS in sepsis patients, suggesting the need for enhanced surveillance and management in this group. Further research is necessary to understand the mechanisms and explore other potential ARDS risk factors in sepsis.
Preoperative hemoglobin A1c as a predictor of lymph node metastasis in diabetic women with endometrial cancer.
Korpe B, Kose C, Erdogan K … +2 more , Engin-Ustun Y, Korkmaz V
Adv Clin Exp Med · 2025 Sep · PMID 40067169 · Publisher ↗
BACKGROUND: Glycated hemoglobin A1c (HbA1c) is a well-established marker for glycemic control; recent studies suggest its potential role in cancer prognosis. Understanding the relationship between preoperative HbA1c leve...
BACKGROUND: Glycated hemoglobin A1c (HbA1c) is a well-established marker for glycemic control; recent studies suggest its potential role in cancer prognosis. Understanding the relationship between preoperative HbA1c levels and lymph node metastasis (LNM) in diabetic women with endometrial cancer (EC) can enhance prognostic assessments and treatment strategies. OBJECTIVES: This study aimed to evaluate the predictive value of preoperative HbA1c levels for LNM in diabetic women with EC. MATERIAL AND METHODS: A retrospective analysis was conducted on 233 diabetic women who underwent surgery for endometrioid-type EC at a tertiary referral hospital between 2010 and 2021. Data collected included demographic information, fasting plasma glucose, HbA1c levels, ultrasound findings, and tumor characteristics. Receiver operating characteristic (ROC) analysis was used to assess the predictive power of HbA1c levels for LNM. Univariate and multivariate regression analyses were performed to identify independent risk factors for LNM. RESULTS: The mean preoperative HbA1c level was 7.03 ±1.37%. A cutoff HbA1c level ≥7.26% demonstrated a sensitivity of 73.7%, a specificity of 72.3% and an area under the curve (AUC) of 0.781 for predicting LNM (p < 0.001). Significant correlations were found between HbA1c levels and endometrial thickness (r = 0.231, p < 0.001), primary tumor diameter (PTD) (r = 0.173, p = 0.008) and duration of diabetes (r = 0.203, p = 0.002). Multivariate analysis identified HbA1c level (odds ratio (OR) = 2.621, 95% confidence interval (95% CI): 1.722-3.987, p < 0.001), lymphovascular space involvement (LVSI) (OR = 19.193, 95% CI: 5.805-63.458, p < 0.001), body mass index (BMI) (OR = 1.095, 95% CI: 1.010-1.188, p = 0.029), and duration of diabetes (OR = 1.019, 95% CI: 1.001-1.301, p = 0.039) as independent risk factors for LNM. CONCLUSIONS: Preoperative HbA1c levels serve as a significant predictor for LNM in diabetic women with EC. A cutoff HbA1c level ≥7.26% indicates higher risk of LNM. These findings underscore the importance of glycemic control in reducing cancer progression risks and improving the prognosis of diabetic patients with EC. Integrating HbA1c monitoring into preoperative assessments can help tailor personalized treatment strategies for better outcomes.
Patient's characteristic included for treatment with individualized allogenic 3D bone block before or during/after orthodontic treatment: A 6-year observational study.
Dominiak S, Dominiak M, Kubasiewicz-Ross P … +1 more , Gedrange T
Adv Clin Exp Med · 2025 Sep · PMID 40067168 · Publisher ↗
BACKGROUND: The most important part of orthodontic treatment (OT) is the pre-orthodontic examination (PE). Only a precise evaluation of clinical and radiological features can reduce the risk of complications. OBJECTIVES:...
BACKGROUND: The most important part of orthodontic treatment (OT) is the pre-orthodontic examination (PE). Only a precise evaluation of clinical and radiological features can reduce the risk of complications. OBJECTIVES: To develop practical guidelines for advanced clinical-radiological pre-orthodontic examinations and for qualifying patients for alveolar bone reconstructions. MATERIAL AND METHODS: A retrospective assessment was performed on 49 out of 145 patients (aged 22-55) referred for alveolar bone reconstructions over a 6-year observation period, with 77.6% of the patients being women. Patient examinations were conducted using the following parameters: clinical (e.g., gingival recession (GR), Miller and Angle classifications), radiological (using cone beam computed tomography (CBCT) to evaluate bone dehiscence, occlusal plane (OccP), atlanto-occipital joint position (O-C1), width of mentalis muscle (B:D), bone marrow steatosis (BMS), and various cephalometric parameters such as the position of the alveolar ridge (AR) relative to the mandible, labial width angle, and volumetry of AR, as well as vitamin D level. Statistical analyses were performed using Student's t-test, Shapiro-Wilk test and Pearson's χ2 test. RESULTS: In the group of patients before orthodontic treatment (OT), the average bone marrow steatosis (BMS) was significantly lower compared to that in patients after treatment (-12 HU vs -137 Hounsfield units (HU)). In patients with class C dehiscence, the B:D measurement was significantly greater than in those with class A dehiscence (15.0 mm vs 12.5 mm). Additionally, a lateral shift of the atlanto-occipital joint (Oc-1) had a significant negative impact on the angles describing lower teeth inclination. Overall, the odds of gingival recession (GR) were 6.5 times higher in women (OR = 6.55); GR odds increased by more than 3.5 times when B:D exceeded 14.1 mm, by 4 times when the occlusal plane (OccP) was flat, and by 8 times when bone density was 24.9 ng/mL. CONCLUSIONS: Insufficient bone volume was observed in a similar proportion both before and during/after orthodontic treatment. The described pre-orthodontic examination allows for an accurate assessment of soft tissue and bone condition, thereby reducing the risk of further complications. CBCT should become a standard component of the pre-orthodontic examination.
Clinical analysis of 338 cases of dacryolithiasis.
Zhang T, Zhuo W, Wang WN … +1 more , Zhao L
Adv Clin Exp Med · 2025 Aug · PMID 40067167 · Publisher ↗
BACKGROUND: Dacryolithiasis can occur anywhere in the lacrimal drainage system and is frequently associated with microbial infections. The presence of dacryolithiasis is difficult to determine based on its clinical manif...
BACKGROUND: Dacryolithiasis can occur anywhere in the lacrimal drainage system and is frequently associated with microbial infections. The presence of dacryolithiasis is difficult to determine based on its clinical manifestations, which complicates clinical treatment. OBJECTIVES: To analyze the clinical diagnosis, treatment and characteristics of dacryolithiasis, as well as surgical methods used to treat it and treatment effects over the past 5 years. MATERIAL AND METHODS: A retrospective analysis was performed on the clinical data of 338 patients who were diagnosed with dacryolithiasis at our hospital from January 2017 to December 2021. Patients diagnosed with canaliculitis were treated with canaliculotomy. Dacryocystitis complicated by canaliculitis was treated with endoscopic dacryocystorhinostomy (En-DCR) combined with canaliculotomy. Dacryocystitis accompanied by dacryoliths was treated with En-DCR. Nasolacrimal duct stones were treated with lacrimal intubation. All patients were followed up for 6-12 months. RESULTS: All patients underwent successful surgery. Of 302 cases (89.35%) with canaliculitis, 297 (98.34%) were cured with canaliculotomy; 5 cases (1.66%) recurred within 1 year after surgery and were cured with canaliculotomy again. Four cases (1.18%) of dacryocystitis complicated by canaliculitis were treated with En-DCR combined with canaliculotomy. In addition, 30 patients (8.88%) had dacryolithiasis; 28 (93.33%) of them were cured, and 2 (6.67%) with common canalicular atresia were cured after lacrimal intubation. Furthermore, 2 patients (0.59%) with nasolacrimal duct stones underwent lacrimal intubation. In addition, 62 cases (20.53%) with canaliculitis tested positive for bacteria, and the top 2 common bacteria were Staphylococcus epidermidis and Streptococcus mitis. CONCLUSIONS: Secretions are the main clinical characteristic of patients with dacryolithiasis, and surgery is the primary treatment method. In addition, different surgical methods correspond to different locations of stones.
Long-term exposure of indoxyl sulfate induces mesothelial-to-mesenchymal transition of peritoneal mesothelial cells via β-catenin-involved signaling pathway.
Liu R, Wen W, Wang Q … +2 more , Weng X, Yu G
Adv Clin Exp Med · 2025 Oct · PMID 40047191 · Publisher ↗
BACKGROUND: Long-term peritoneal dialysis (PD) leads to peritoneal injury, with mesothelial-to-mesenchymal transition (MMT) potentially serving as an initial and reversible stage of this process. Indoxyl sulfate (IS), a...
BACKGROUND: Long-term peritoneal dialysis (PD) leads to peritoneal injury, with mesothelial-to-mesenchymal transition (MMT) potentially serving as an initial and reversible stage of this process. Indoxyl sulfate (IS), a protein-bound uremic toxin that accumulates in patients with declining renal function, is known to be associated with epithelial-mesenchymal transition (EMT) in proximal renal tubular cells. However, its effects on peritoneal mesothelial cells, which serve as the first-line barrier during PD, have not yet been investigated. OBJECTIVES: This study aimed to evaluate whether IS induces MMT in human peritoneal mesothelial cells during PD through the β-catenin signaling pathway. MATERIAL AND METHODS: A human peritoneal mesothelial cell line (HMrSV5) was used for this in vitro study. Cells were treated with IS or combined with β-catenin inhibitor ICG-001, and high glucose PD fluid (PDF) served as a positive control. Morphology, proliferation and adhesion were assessed, while the expression of β-catenin and α-smooth muscle actin (α-SMA) as mesenchymal markers, along with E-cadherin as a mesothelial marker, were analyzed at both RNA and protein levels using real-time polymerase chain reaction (PCR) and western blot, respectively. RESULTS: The number of viable and adherent cells was significantly increased in the IS and PDF groups compared to the control (p < 0.05). Treatment with ICG-001 significantly reduced both viable and adherent cell numbers compared to cells treated with IS or PDF alone (p < 0.05). At the RNA level, IS treatment significantly decreased E-cadherin expression (p = 0.002) while significantly increasing β-catenin (p = 0.001) and α-SMA (p = 0.002) expression compared to the control group. These changes were reversed by ICG-001 treatment. Protein expression showed similar trends. CONCLUSIONS: Indoxyl sulfate induces MMT in human peritoneal mesothelial cells, and these changes can be reversed by the specific β-catenin inhibitor ICG-001. This suggests that IS may be considered as another inducer of MMT during PD through the β-catenin signaling pathway.
RNA binding protein ELAVL1 is associated with severity and prognosis of hepatocellular carcinoma patients: A retrospective study.
Ji G, Guo Q, Chen L … +2 more , Chen J, Li Z
Adv Clin Exp Med · 2025 Oct · PMID 39961001 · Publisher ↗
BACKGROUND: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, which is characterized by a lack of sensitive and specific biomarkers. OBJECTIVES: This study investigates the association betwe...
BACKGROUND: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, which is characterized by a lack of sensitive and specific biomarkers. OBJECTIVES: This study investigates the association between ELAV-like RNA binding protein 1 (ELAVL1) and HCC patient outcomes. MATERIAL AND METHODS: This retrospective study encompassed 108 HCC patients who reported to Wuhan Fourth Hospital and Tongji Hospital, China, from January 2016 to August 2020. Clinical data collected included age, sex, body mass index (BMI), comorbidities, tumor-node-metastasis (TNM) stage, Barcelona Clinic Liver Cancer (BCLC) stage, and lymphatic metastasis. All patients received routine follow-up for survival and recurrence status ranged from 36 to 60 months. The serum levels of ELAVL1 were tested using enzyme-linked immuno-sorbent assay (ELISA). Levels of total bilirubin, alanine aminotransferase (ALT), aspartate transaminase (AST), HCC-related biomarkers of alpha fetoprotein (AFP), α-L-fucosidase (AFU), and carcinoembryonic antigen (CEA) were recorded. RESULTS: Our findings revealed a significantly higher expression of ELAVL1 in patients presenting with TNM stages III-IV, BCLC stages C-D, lymphatic metastasis, as well as deceased and recurrent patients. Receiver operating characteristic (ROC) curves showed that the areas under the curve (AUCs) for ELAVL1 in predicting mortality, recurrence and poor prognosis (defined as mortality or recurrence) in HCC patients were 0.818, 0.732 and 0.827, respectively. Patients with higher expression of ELAVL1 showed significantly higher frequencies of TNM III-IV stages, BCLC D stage, lymphatic metastasis, higher mortality, and recurrence ratio, as well as higher AFP and CEA levels. ELAVL1 was positively correlated with levels of AFP and CEA. Higher BCLC stage, lymphatic metastasis, age, AFP, and ELAVL1 were independent risk factors for poor prognosis of HCC patients. CONCLUSIONS: Higher serum levels of ELAVL1 are associated with worse clinical outcomes and poorer prognosis in ‑HCC patients.
Chronic pain in the elderly: A constant challenge.
Sobieszczańska MI
Adv Clin Exp Med · 2025 Feb · PMID 39945562 · Publisher ↗
Chronic pain is a common, long-standing and bitter experience affecting a huge percentage of the still increasing elderly population. Owing to the multifactorial etiopathology and complex clinical presentation with a lot...
Chronic pain is a common, long-standing and bitter experience affecting a huge percentage of the still increasing elderly population. Owing to the multifactorial etiopathology and complex clinical presentation with a lot of severe consequences, management of the permanent pain should be varied and tailored to the particular patient. This approach comprises multimodal pharmacotherapy, including all analgesics and adjuvants, likewise selected interventions, physical therapy and rehabilitation, as well psychological counselling.
Evidence-based healthcare: Bridging the gap between research and practice.
Królikowska A, Prill R, Klugar M
Adv Clin Exp Med · 2025 Feb · PMID 39945561 · Publisher ↗
The establishment of the first JBI Affiliated group in Poland at Wroclaw Medical University marks a significant advancement in evidence-based healthcare (EBHC) nationally. This editorial explores the evolution of EBHC an...
The establishment of the first JBI Affiliated group in Poland at Wroclaw Medical University marks a significant advancement in evidence-based healthcare (EBHC) nationally. This editorial explores the evolution of EBHC and the critical role of JBI in driving its progress. Founded in 1996 as a research institute at the Royal Adelaide Hospital in South Australia and now based at the University of Adelaide, JBI has emerged as an international leader in evidence synthesis, transfer and implementation. Its Feasibility, Appropriateness, Meaningfulness, and Effectiveness (FAME) framework highlights the feasibility, appropriateness, meaningfulness, and effectiveness of healthcare practices, ensuring that decisions are patient-centered and contextually relevant. JBI's global collaboration network encompasses over 85 entities, with 23 located in Europe, emphasizing the importance of cultural inclusivity and international partnerships. Recent initiatives include translating the JBI Model of into Polish, German and Czech, linking global knowledge to local contexts, and enhancing understanding for professionals and students alike. This editorial also underscores the collaborative achievements of JBI entities in Wroclaw, Brandenburg an der Havel, Prague, and Olomouc. These partnerships have propelled regional implementation, research and education, fostering a shared vision for elevating healthcare quality. Launching a new EBHC section in the Advances in Clinical and Experimental Medicine journal is a significant step forward, inviting global contributions and stimulating innovation and knowledge sharing in EBHC. The presence of a JBI Affiliated group at Wroclaw Medical University symbolizes a transformative commitment to excellence and collaboration. It sets new benchmarks for healthcare in Poland and beyond while reinforcing the global mission of evidence-based practice.
The causal role of metabolic syndrome components in insomnia: A bidirectional two-sample Mendelian randomization.
Liao L, Zhou J, Zhang X … +1 more , Zhu Y
Adv Clin Exp Med · 2025 Oct · PMID 39945560 · Publisher ↗
BACKGROUND: The neuroendocrine system's role in maintaining bodily homeostasis implicates it in insomnia, suggesting both causal relationships and therapeutic targets. Yet, studies examining the link between metabolic sy...
BACKGROUND: The neuroendocrine system's role in maintaining bodily homeostasis implicates it in insomnia, suggesting both causal relationships and therapeutic targets. Yet, studies examining the link between metabolic syndrome (MetS) components such as hypertension, elevated blood glucose levels and abnormal cholesterol and insomnia have been inconsistent. Some research suggests a correlation, proposing that metabolic dysfunctions might contribute to sleep disturbances. However, other studies found little to no significant connection, indicating the complexity of this relationship and the potential influence of genetic, lifestyle and environmental factors. These contradictory findings underscore the challenges in fully understanding the intricate interplay between metabolic health and sleep quality. OBJECTIVES: To explore the relationship between MetS and insomnia. MATERIAL AND METHODS: This study used bidirectional two-sample Mendelian randomization (MR) analysis to determine the causal relationship between the characteristics of MetS components and insomnia. Based on Genome-Wide Association Studies (GWAS) public databases, we explored the causal relationship between waist circumference (WC), hypertension, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), and the risk of insomnia. Sensitivity analysis was conducted to evaluate the stability, heterogeneity and potential presence of horizontal pleiotropy in the results. RESULTS: Waist circumference and hypertension were associated with an increased risk of insomnia (WC, odds ratio (OR) = 1.05, 95% confidence interval (95% CI): 1.03-1.06, p = 9.15e-07; hypertension, OR = 1.06, 95% CI: 1.02-1.10, p = 0.005). In the reverse MR analysis, there was no significant causal relationship between insomnia and WC, TG, HDL-C, and FBG. CONCLUSIONS: Our study has demonstrated the close connection between MetS components and insomnia by genetic means, thereby guiding the future research direction of insomnia prevention and treatment.
An artificial intelligence model for Lhermitte's sign in patients with pediatric-onset multiple sclerosis: A follow-up study.
Uysal HA, Poyraz T, Gulluoglu H … +2 more , Idiman F, Idiman E
Adv Clin Exp Med · 2025 Feb · PMID 39945559 · Publisher ↗
BACKGROUND: Lhermitte's sign (LS) is an important clinical marker for patients with multiple sclerosis (MS). Research on pediatric-onset MS (POMS) and LS is limited. To date, there has been no research conducted on the c...
BACKGROUND: Lhermitte's sign (LS) is an important clinical marker for patients with multiple sclerosis (MS). Research on pediatric-onset MS (POMS) and LS is limited. To date, there has been no research conducted on the clinical and artificial intelligence (AI)-based radiological correlation of LS. OBJECTIVES: This follow-up study aims to investigate the relationship between LS and clinical findings according to AI-based radiological characteristics of patients with POMS. MATERIAL AND METHODS: Basic descriptive statistics of patients with POMS according to sociodemographic, clinical and radiological findings were collected. Variables were evaluated at a 95% confidence level (95% CI), and a value of p < 0.05 was accepted as statistically significant. The LS in patients with MS was classified according to its presence in the past and at the time of the study screening: group A: absent; group B: positive in the past but absent at screening; group C: present both in the past and at the screening; group D: absent in the past but present at the screening. In addition, patients were grouped according to the duration of their MS, with the following classifications: <10 years and at least 10 years. RESULTS: A total of 1,298 records were identified in the database search. Ninety-two patients who met the inclusion criteria were included in the study. The frequency of upper cervical lesions (C1-4 vertebral segmental levels) was higher in group B and C than in group A (p = 0.017). Among patients with an MS duration of 10-years, C1-4 lesions were least frequent in group A. CONCLUSIONS: Spinal imaging with AI-based programs can be used at least as much as brain magnetic resonance imaging (MRI) for early diagnosis, prognosis and treatment response. We have for the first time investigated LS in a large sample of patients with POMS. It is, however, recommended to conduct further multicenter studies to more specifically identify LS in patients with POMS.
Improving sepsis mortality prediction with machine learning: A comparative study of advanced classifiers and performance metrics.
Zhou P, Duan J, Li J
Adv Clin Exp Med · 2025 Aug · PMID 39932470 · Publisher ↗
BACKGROUND: High sepsis mortality rates pose a serious global health problem. Machine learning is a promising technique with the potential to improve mortality prediction for this disease in an accurate and timely manner...
BACKGROUND: High sepsis mortality rates pose a serious global health problem. Machine learning is a promising technique with the potential to improve mortality prediction for this disease in an accurate and timely manner. OBJECTIVES: This study aimed to develop a model capable of rapidly and accurately predicting sepsis mortality using data that can be quickly obtained in an ambulance, with a focus on practical application during ambulance transport. MATERIAL AND METHODS: Data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) dataset were used to compare the performance of 11 machine learning algorithms against the widely utilized quick Sequential Organ Failure Assessment (qSOFA) score. A dynamic updating model was implemented. Performance was evaluated using area under the curve (AUC) and precision-recall area under the curve (PRAUC) scores, and feature importance was assessed with SHapley Additive exPlanations (SHAP) values. RESULTS: The light gradient boosting machine (LightGBM) model achieved the highest AUC (0.79) and PRAUC (0.44) scores, outperforming the qSOFA score (AUC = 0.76, PRAUC = 0.40). The LightGBM also achieved the highest PRAUC (0.44), followed by Optuna_LightGBM (0.43) and random forest (0.42). The dynamically updated and tuned model further improved performance metrics (AUC = 0.79, PRAUC = 0.44) compared to the base model (AUC = 0.76, PRAUC = 0.39). Feature importance analysis offers clinicians insights for prioritizing patient assessments and interventions. CONCLUSIONS: The LightGBM-based model demonstrated superior performance in predicting sepsis-related mortality in an ambulance setting. This study underscores the practical applicability of machine learning models, addressing the limitations of previous research, and highlights the importance of real-time updates and hyperparameter tuning in optimizing model performance.
Examination of 6 and 12 month follow-up of calcium hydroxide and calcium silicate materials used in direct and indirect pulp capping.
Yavuz Y, Kotanli S, Dogan MS … +1 more , Almak Z
Adv Clin Exp Med · 2025 Aug · PMID 39932469 · Publisher ↗
BACKGROUND: Pulpal vitality is important for the tooth to maintain its physiological function and preserve its structure. OBJECTIVES: The aim of this study was to evaluate the clinical and radiographic 6- and 12-month tr...
BACKGROUND: Pulpal vitality is important for the tooth to maintain its physiological function and preserve its structure. OBJECTIVES: The aim of this study was to evaluate the clinical and radiographic 6- and 12-month treatment success of calcium hydroxide (CH) and calcium silicate materials in indirect pulp treatment (IPT) and direct pulp capping (DPC) in teeth with deep dentin decay. MATERIAL AND METHODS: The study included 143 teeth of patients aged 17-69 years with no systemic disease. The study is grouped under 3 main groups (Dycal, Biodentine, TheraCal PT). Direct pulp capping was applied to 65 teeth and IPT to 66 teeth. All teeth were restored with Universal adhesive system and Universal composite (G-Premio Bond; GC Corp., Tokyo, Japan). RESULTS: In the statistical evaluations of the data obtained, 0.05 was accepted as the level of statistical significance. The general success rate in the IPT group was found to be 95.2% for Biodentine (Septodont, SaintMaur-des-Fossés, France), 91.7% for Dycal (Dentsply/Caulk, International Inc. Milford, USA) and 90.1% for TheraCal PT (Bisco Inc., Schaumburg, USA) at both 6 and 12 months. When the clinical and radiographic success was compared at 6 months and 12 months, no statistically significant difference was determined between the materials (p > 0.05). In the clinical and radiographic evaluations at the end of 6-month follow-up in the DPC group, the success rates were determined to be 96.0% for Biodentine, 81.8% for Dycal and 63.2% for TheraCal PT. At 12 months, these rates were 96.0% for Biodentine, 68.2% for Dycal and 63.2% for TheraCal PT. DPC Biodentine was found to be the most successful material (96.0%). CONCLUSIONS: At the end of the 12-month follow-up period, it was considered that the 3 materials (Biodentine, Dycal, TheraCal) can be selected for IPT. In DPC, Biodentine was found to be more successful than both calcium silicate containing resin and CH.
Squamous and basal skin cancers in 17,207 solid organ transplant recipients: Real-world data from national health insurance database in Poland.
Wysocki WM, Kulbat A, Richter K … +3 more , Krzysztofik M, Kołodziej-Rzepa M, Wojewoda T
Adv Clin Exp Med · 2025 Jun · PMID 39912318 · Publisher ↗
BACKGROUND: Immunosuppressive therapy in organ transplant ensures proper graft function for many years, but it is burdened with a negative impact on the development of skin cancer in them. OBJECTIVES: To characterize the...
BACKGROUND: Immunosuppressive therapy in organ transplant ensures proper graft function for many years, but it is burdened with a negative impact on the development of skin cancer in them. OBJECTIVES: To characterize the impact of immunosuppressive therapy in transplant recipients on the development of non-melanoma skin cancers (NMSC). MATERIAL AND METHODS: A total of 17,207 Polish patients who underwent liver, heart or kidney transplants between 2010 and 2022 and were on immunosuppression were included in the study. Immunosuppression was most commonly achieved using a regimen of tacrolimus (TAC) or cyclosporine A (CsA) combined with mycophenolic acid (MPA) and glucocorticosteroids (GS). Data on NMSC incidence from the National Health Fund in this population were analyzed and compared against incidence of NMSC in general Polish population in the same period. RESULTS: Renal transplant recipients demonstrated a significantly elevated risk of NMSC compared to the general population, with a 1-year cumulative incidence of 0.09% vs 0.04% (p < 0.001), a 5-year incidence of 1.21% vs 0.18% (p < 0.001) and a 10-year incidence of 4.18% vs 0.36% (p < 0.001). Liver transplant recipients exhibited an elevated risk for the development of NMSC, which persisted and increased over time (incidence of 0.09% vs 0.04% at 1 year (p < 0.001), 0.83% vs 0.18% at 5 years (p < 0.001) and 2.65% vs 0.36% at 10 years (p < 0.001)). Heart transplant recipients also showed a significantly higher cumulative incidence of NMSC at 1 year (0.09% vs 0.04%, p < 0.001), 5 years (0.89% vs 0.18%, p < 0.001) and 10 years (4.06% vs. 0.36%, p < 0.001) post-transplantation. CONCLUSIONS: Organ transplant recipients have an 2 times at 1 year, 4,5 times after 5 years and 9 times after 10 years increased risk of NMSC on average as opposed to general Polish population in the same period.
Effectiveness of gua sha with Masanggoubang oil in rats with chronic soft tissue injury.
Zhu M, Zhao D, Lu C … +1 more , Cui J
Adv Clin Exp Med · 2025 Mar · PMID 39868741 · Publisher ↗
BACKGROUND: Chronic soft tissue injury is characterized by sterile inflammation and pain. Gua sha with Masanggoubang oil (GSMO) treatment has been found to possess anti-inflammatory and analgesic effects. OBJECTIVES: To...
BACKGROUND: Chronic soft tissue injury is characterized by sterile inflammation and pain. Gua sha with Masanggoubang oil (GSMO) treatment has been found to possess anti-inflammatory and analgesic effects. OBJECTIVES: To explore the mechanism of GSMO in chronic soft tissue injuries. MATERIAL AND METHODS: Fifty male rats were randomly divided into 5 groups (n = 10): 1) control group; 2) chronic soft tissue injury model group; 3) GSMO group; 4) inunction with Masanggoubang oil (IMO) group; and 5) ua sha with tea oil (GSTO) group. The control group and model group received no treatment, while the GSTO group and GSMO group received gua sha therapy with tea oil or Masanggoubang oil on the injured sites. The rats in the IMO group were treated with Masanggoubang oil inunction on the injured sites once every other day, 4 times in total. All animals were sacrificed 48 h after the last treatment. Muscle tissue sections from the injured sites of the rats were stained with hematoxylin & eosin (H&E) staining to observe pathological changes. The protein levels of tumor necrosis factor alpha (TNF-α), interleukin 1β (IL-1β), interleukin 6 (IL-6), inducible nitric oxide synthase (iNOS), and β-endorphin (β-EP) in the rats' skin, serum, and muscle were determined using enzyme-linked immunosorbent assay (ELISA). RESULTS: Gua sha with Masanggoubang oil treatment alleviated necrosis and the denaturation of muscle fibers at the injured sites, reduced connective tissue proliferation and scar tissue generation, downregulated the levels of TNF-α, IL-6 and iNOS in the skin and TNF-α, IL-1β, IL-6, and iNOS in the muscle and serum, and upregulated β-EP levels in the muscle. CONCLUSIONS: Gua sha with Masanggoubang oil treatment significantly improved the inflammatory response in rats with chronic soft tissue injury, which may be associated with a reduction of M1 macrophage polarization in the peripheral blood and local tissues. Additionally, the combination of gua sha therapy and Masanggoubang oil may have a synergistic effect in treating chronic soft tissue injuries.
Electrical impedance tomography confirmed the impact of the method of delivery of term neonates on early lung aeration.
Janulionis A, Sutova V, Langiene V … +4 more , Virsilas E, Drejeriene V, Liubsys A, Valiulis A
Adv Clin Exp Med · 2025 Jul · PMID 39868740 · Publisher ↗
BACKGROUND: The number of infants born via cesarean section (CS) is increasing globally due to medical and cultural reasons. OBJECTIVES: This study aimed to determine the effect of the mode of delivery on early lung aera...
BACKGROUND: The number of infants born via cesarean section (CS) is increasing globally due to medical and cultural reasons. OBJECTIVES: This study aimed to determine the effect of the mode of delivery on early lung aeration in newborns using electrical impedance tomography (EIT). MATERIAL AND METHODS: The case-control study was conducted from December 2020 to April 2021. It included 32 term neonates delivered by CS and 20 term neonates delivered by normal vaginal delivery (NVD) as controls. Electrical impedance tomography examinations were performed with a Swisstom BB2 device with NEO SensorBelt and 32 integrated electrodes at 47.68 Hz. Three data recordings were conducted within 30, 60 and 90 min (mean times: 13, 62 and 93 min, respectively) after the birth. RESULTS: Cesarean section neonates, compared to those delivered by NVD, had greater non-aerated areas in gravity-dependent lung regions at the 2nd recording (p = 0.04). The CS group showed lower changes in lung stretch at the 2nd and 3rd recording compared to the NVD group (p = 0.022 and p = 0.032, respectively). In the study group, lung regions with the lowest stretch (10-20%, 20-30% and 30-40%) corresponded with increased total lung capacities 1 h after birth compared to the control group (p = 0.024, p = 0.004 and p = 0.044, respectively). Measurements from the 1st and 3rd EIT recording showed a greater distribution of tidal volume (TV) in the right lung toward the central regions among CS neonates compared to NVD neonates, whereas NVD neonates showed increased distribution of TV toward the central-ventral regions of the right lung immediately after birth. CONCLUSIONS: The mode of delivery significantly affects early postnatal lung aeration in term neonates assessed using EIT. Caesarean section neonates were characterized by poorer aeration in gravity-dependent lung regions, whereas NVD neonates demonstrated greater changes in lung stretch and more intense tissue expansion, potentially leading to better postnatal adaptation.
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