Adv Clin Exp Med [JOURNAL]
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200 papers
Honey-based dressing vs gelatin sponge for palatal wound healing after free gingival graft harvest: A randomized clinical trial.
Molga-Chlipała N, Górski B
Adv Clin Exp Med · 2026 May · PMID 42087593 · Publisher ↗
BACKGROUND: Subepithelial connective tissue graft (SCTG) is commonly used in dental procedures and is associated with postoperative discomfort at the palatal donor site. The question is whether the use of a honey-based d...
BACKGROUND: Subepithelial connective tissue graft (SCTG) is commonly used in dental procedures and is associated with postoperative discomfort at the palatal donor site. The question is whether the use of a honey-based dressing may improve patients' postoperative experience and promote wound healing. OBJECTIVES: The aim of this study was to compare the effects of a non-adherent viscose net dressing coated with 99% Manuka honey and 1% Manuka oil (Actilite; Advancis Medical, Kirkby-in-Ashfield, UK) and an absorbable hemostatic porcine gelatin sponge (Aegis Lifesciences, Sanand, India) on the healing of the palatal donor site and patient morbidity after free gingival graft (FGG) preparation. MATERIAL AND METHODS: A total of 21 patients (16 females and 5 males) with multiple gingival recessions (GR) were treated using the modified coronally advanced tunnel technique (MCAT) and subepithelial connective tissue graft (SCTG) following FGG de-epithelialization. Two grafts were harvested from both sides of the palate in each patient. Using a split-mouth design, donor sites were randomly assigned to the test group (honey dressing) or the control group (gelatin sponge). The palatal donor sites were evaluated at 1, 2, 4, 7, and 14 days postoperatively for pain, patient discomfort, changes in dietary habits, and burning sensation. Wound healing and delayed bleeding were assessed 2 weeks after surgery. RESULTS: In both the honey group and the gelatin sponge group, no significant differences were observed in postoperative pain, patient discomfort, burning sensation, or changes in dietary habits at 14 days postoperatively (p > 0.05). No prolonged bleeding was observed during the 2-week follow-up, and wound healing was assessed as "very good" after 14 days. CONCLUSIONS: Both dressing materials can be successfully used at the palatal donor site after periodontal surgery and result in comparable outcomes in wound healing. Honey dressing may be considered an alternative to traditional dressing methods.
The role of static and dynamic evaluation of sarcopenia in liver transplant candidates.
Miarka M, Smyk W, Bodys-Pełka A … +4 more , Gibiński K, Główczyńska R, Figiel W, Raszeja-Wyszomirska J
Adv Clin Exp Med · 2026 Jun · PMID 42083488 · Publisher ↗
BACKGROUND: Sarcopenia, characterized by the loss of skeletal muscle mass, strength, and function, is a prevalent and severe complication of liver cirrhosis, irrespective of its etiology. Despite its early onset in cirrh...
BACKGROUND: Sarcopenia, characterized by the loss of skeletal muscle mass, strength, and function, is a prevalent and severe complication of liver cirrhosis, irrespective of its etiology. Despite its early onset in cirrhosis, the impact of sarcopenia on liver transplantation (LT) outcomes is often underestimated. OBJECTIVES: This study evaluates the role of both static and dynamic assessments of sarcopenia in LT recipients, focusing on cardiopulmonary performance and the likelihood of prolonged ICU stays. MATERIAL AND METHODS: We studied 54 LT recipients (median age: 53.5 years, 59% female patients) at a single center. The L3 skeletal muscle index (L3SMI) was measured using computed tomography (CT) scans, while exercise tolerance was evaluated with the 6-minute walk test (6MWT). Cardiac output (CO) was recorded in liters per minute. RESULTS: The median Model for End-Stage Liver Disease (MELD) score was 14.4, with 37% of patients classified as Child-Pugh class C. Major LT indications included autoimmune liver diseases (46.3%) and alcohol-related liver disease (ALD; 31.5%). Sarcopenia was present in 60.4% of patients. No significant differences in L3SMI were found related to underlying liver disease, gender, body mass index (BMI), or ammonia levels. However, patients with ALD covered significantly shorter distances in the 6MWT (p = 0.02). Sarcopenic patients had significantly higher CO than non-sarcopenic patients (p < 0.01). Intensive care unit (ICU) stay ≥3 days was observed in 77.8% of recipients, with no clear risk factors identified. CONCLUSIONS: Sarcopenia linked to end-stage liver disease (ESLD) correlates with cirrhotic cardiomyopathy, as evidenced by increased CO. Further studies are required to clarify the role of 6MWT and CO in post-LT risk stratification.
TRPC3 induces intervertebral disc degeneration by mediating the Ca2+/NF-κB pathway to inhibit autophagy.
Gao Y, Zhang N, Zhang JF … +1 more , Fei Z
Adv Clin Exp Med · 2026 May · PMID 42083487 · Publisher ↗
BACKGROUND: Intervertebral disc degeneration (IDD) is the primary cause of lower back pain. Transient receptor potential canonical 3 (TRPC3) is a nonselective cation channel permeable to Ca2+. OBJECTIVES: This study expl...
BACKGROUND: Intervertebral disc degeneration (IDD) is the primary cause of lower back pain. Transient receptor potential canonical 3 (TRPC3) is a nonselective cation channel permeable to Ca2+. OBJECTIVES: This study explores the mechanisms by which the TRPC3-mediated Ca2+/nuclear factor kappa B (NF-κB) pathway regulates autophagy in IDD. MATERIAL AND METHODS: An IDD rat model was established using the annulus fibrosus puncture method and was treated with local intraspinal injection of adeno-associated virus (AAV)-shRNA targeting TRPC3. Primary human nucleus pulposus cells (NPCs) were transfected with TRPC3 siRNA and subsequently treated with pyrrolidine dithiocarbamate (PDTC; an NF-κB inhibitor), rapamycin (RAPA), or 3-methyladenine (3-MA), respectively. Micro-computed tomography (micro-CT), hematoxylin and eosin (H&E) staining, immunohistochemistry, western blotting, transmission electron microscopy (TEM), and flow cytometry were performed. RESULTS: TRPC3 expression was significantly increased in IDD rats (p < 0.05). TRPC3 shRNA ameliorated histopathological damage in IDD rats and promoted the expression of autophagy-related protein 5 (ATG5), Beclin-1, and LC3-II (all p < 0.05). In vitro, interleukin-1 beta (IL-1β) increased Ca2+ levels, siRNA TRPC3 reduced them, and PDTC further decreased them (p < 0.05). In addition, siRNA TRPC3 increased the expression of ATG5, Beclin-1, and the LC3-II/LC3-I ratio and inhibited phosphorylation of p-NF-κB p65 in NPCs (p < 0.05). Transmission electron microscopy and flow cytometry showed that siRNA TRPC3-induced autophagy promoted apoptosis in NPCs (p < 0.05). Furthermore, siRNA TRPC3 increased the levels of aggrecan and collagen II and decreased matrix metalloproteinase-13 (MMP-13) expression (p < 0.05). CONCLUSIONS: TRPC3 exacerbates IDD by inhibiting protective autophagy via activation of the Ca2+/NF-κB signaling pathway. Knockdown of TRPC3 promotes autophagy, which in turn influences NPC apoptosis and extracellular matrix (ECM) metabolism. This study offers potential novel strategies for IDD prevention and treatment.
Reducing ageism in healthcare: A systematic review of educational interventions and methodological insights.
Caballero-Bonafé A, Valera-Lloris R, Fernández-Puerta L … +3 more , De-Moya-Romero JR, Chover-Sierra E, Martínez-Sabater A
Adv Clin Exp Med · 2026 Apr · PMID 42046328 · Publisher ↗
Ageism, defined as stereotypes, prejudice, and discrimination toward older adults, represents a global challenge with negative consequences for health, wellbeing, and quality of care. This review aimed to analyze the cha...
Ageism, defined as stereotypes, prejudice, and discrimination toward older adults, represents a global challenge with negative consequences for health, wellbeing, and quality of care. This review aimed to analyze the characteristics and effectiveness of educational interventions designed to reduce ageism in healthcare settings. A systematic review was conducted using PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus. Eleven primary studies met the inclusion criteria: 1) educational or training interventions targeting healthcare professionals or students; 2) primary studies; 3) quantitative or mixed-methods designs with extractable quantitative outcomes; 4) published between 2020 and 2025; and 5) articles in English or Spanish. Three main types of interventions were identified. First, gerontological education has shown promising effects, particularly when explicitly addressing ageism, although the evidence remains limited. Second, clinical simulation-based interventions yielded mixed results, especially when not supported by structured educational components. Third, empathy-focused interventions were insufficient to reduce ageist attitudes. Only 1 randomized trial was conducted among healthcare professionals. Educational multicomponent interventions, particularly those incorporating gerontological content, may help reduce ageism in healthcare settings. However, the available evidence is limited and heterogeneous, and remains largely restricted to student populations. Further methodologically robust studies, particularly among practicing healthcare professionals and in real clinical settings, are needed to determine whether improvements in attitudes translate into sustained changes in clinical practice.
Autoimmune mechanisms in drug-resistant focal epilepsy: Pathophysiology, biomarkers, and therapeutic implications.
Kunecki KA, Dziadkowiak E
Adv Clin Exp Med · 2026 Apr · PMID 42046327 · Publisher ↗
This review explores the role of autoimmune mechanisms in drug-resistant epilepsy (DRE), with emphasis on etiology, mechanisms of drug resistance, and potential immunomodulatory interventions. A structured review of clin...
This review explores the role of autoimmune mechanisms in drug-resistant epilepsy (DRE), with emphasis on etiology, mechanisms of drug resistance, and potential immunomodulatory interventions. A structured review of clinical and experimental studies was conducted to assess current knowledge on the interplay between molecular mechanisms and immune responses in DRE. Particular attention was given to the involvement of the mTOR pathway, blood-brain barrier (BBB) dysfunction, astrocyte activation, and overexpression of efflux transporters, as well as the presence of neuronal autoantibodies such as N-methyl-D-aspartate receptor (NMDAR) and GluR3. The available evidence suggests that, although conventional pharmacologic approaches fail in a subset of patients, immunologic diagnostics and targeted therapies - including intravenous immunoglobulin, corticosteroids, rituximab, and plasmapheresis - may provide clinical benefit. Seizure reduction has been reported in selected patients; however, therapeutic response remains heterogeneous and is limited by small study populations. In conclusion, early identification of autoimmune mechanisms in DRE may help optimize treatment strategies, improve patient outcomes, and reduce the long-term clinical and societal burden of the disease.
Statin therapy improves long-term survival in patients with myocardial infarction and non-obstructive coronary arteries (MINOCA).
Stępień K, Horosin G, Kachnic N … +7 more , Yika ADC, Karcińska A, Walczak P, Nowak K, Podolec M, Nessler J, Zalewski J
Adv Clin Exp Med · 2026 Apr · PMID 42046326 · Publisher ↗
BACKGROUND: Current guidelines suggest that statins may be beneficial in patients with myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA). However, the available data are ambiguous. OBJECTIVES: We...
BACKGROUND: Current guidelines suggest that statins may be beneficial in patients with myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA). However, the available data are ambiguous. OBJECTIVES: We sought to investigate the effect of statin therapy on long-term mortality among MINOCA patients. MATERIAL AND METHODS: Between 2012 and 2019, coronary angiography was performed in 1,011 patients hospitalized with a diagnosis of MI. Patients with lesions narrowing coronary arteries by less than 50% were classified as MINOCA. Baseline clinical characteristics, laboratory and echocardiographic parameters, statin type prescribed at discharge, as well as long-term all-cause mortality were collected in the MINOCA group. RESULTS: MINOCA was diagnosed in 77 (7.6%) patients, while statins were prescribed in 57 (74%) of them at discharge. Subjects treated with statins had a higher prevalence of hypertension (94.7 vs 70%, p = 0.008) and dyslipidemia (77.2 vs 45%, p = 0.008), had a higher body mass index (BMI; p = 0.028), and were less likely to suffer from active cancer (17.5 vs 55.0%, p = 0.001). In multivariable logistic regression, active cancer independently reduced (odds ratio (OR) = 0.143, 95% confidence interval (95% CI): 0.027-0.748), whereas higher baseline low-density lipoorotein cholesterol (LDL-C) (OR = 3.216, 95% CI: 1.192-8.686) independently increased the likelihood of statin prescription at discharge. In the median follow-up of 69.2 [interquartile range (IQR): 37.8-79.9] months, all-cause mortality was significantly higher in MINOCA patients not treated with statins (p = 0.025). CONCLUSIONS: Roughly 75% of MINOCA patients were treated with statins at discharge. This decision was independently influenced by clinical characteristics and lipid profile. Statin prescription was associated with lower long-term all-cause mortality.
Author guidelines in the AI era: Writing for readers, search engines, and reproducibility. Insights from editorial practice.
Misiak M, Kurpas D
Adv Clin Exp Med · 2026 May · PMID 42046325 · Publisher ↗
Scientific journals establish author guidelines to ensure manuscript consistency, enhance readability, and maintain editorial standards. However, the rationale behind specific requirements is not always apparent to submi...
Scientific journals establish author guidelines to ensure manuscript consistency, enhance readability, and maintain editorial standards. However, the rationale behind specific requirements is not always apparent to submitting authors, leading to misunderstandings and noncompliance. This editorial examines the instructions for authors currently applied at Advances in Clinical and Experimental Medicine, explaining the purpose behind selected regulations that may initially seem arbitrary or overly prescriptive. We analyze requirements concerning manuscript titles (sentence case, study design specification, avoidance of nonstandard abbreviations), author affiliations (institutional hierarchy, geographic formatting), ORCID (Open Researcher and Contributor ID) usage, highlights preparation, taxonomic nomenclature (italicization of genus and species, distinction between genes and proteins), laboratory equipment reporting (manufacturer details, catalog numbers, software versions), abbreviation protocols, and supplementary file management. We demonstrate that these requirements serve essential practical functions: improving search engine optimization and discoverability, ensuring experimental reproducibility, preventing taxonomic and nomenclatural confusion, facilitating rigorous peer review, and enhancing reader comprehension across different formats and access points. The editorial also addresses the evolving nature of author guidelines in the era of artificial intelligence (AI) and digital publishing, emphasizing that editorial policies should function as adaptable documents that respond to technological advances and changing scholarly communication practices. By fostering open dialogue between editors and authors regarding the rationale behind publication requirements, journals can maintain high standards while remaining responsive to the legitimate concerns of the research community. We conclude that transparent communication about editorial policies not only improves compliance but also strengthens the collaborative relationship between journals and the researchers they serve.
Clinical competence of Polish paramedics in caring for LGBT patients: A national cross-sectional study.
Czapla M, Karniej P, Juárez-Vela R … +8 more , Kędzierski K, Dissen A, Griesmann K, Wojciechowski J, Mickiewicz A, Smereka J, Świtała J, Lewandowski Ł
Adv Clin Exp Med · 2026 Apr · PMID 42012480 · Publisher ↗
BACKGROUND: Systemic preparation for the care of lesbian, gay, bisexual, and transgender (LGBT) patients in Poland remains limited, despite the increasing visibility of sexual and gender minorities in clinical settings....
BACKGROUND: Systemic preparation for the care of lesbian, gay, bisexual, and transgender (LGBT) patients in Poland remains limited, despite the increasing visibility of sexual and gender minorities in clinical settings. Emergency medical services, often the first and sometimes the only point of contact with healthcare, operate without structured guidance on inclusive practice. For paramedics, this gap translates into uncertainty at the bedside and inconsistent quality of care. However, the clinical competence of Polish paramedics in responding to the needs of LGBT patients has never been empirically examined. OBJECTIVES: This study aimed to assess the clinical preparedness, attitudinal awareness, and basic knowledge of Polish paramedics regarding LGBT patients. MATERIAL AND METHODS: In a national cross-sectional survey (n = 465), 289 participants completed the LGBT-Development of Clinical Skills Scale (LGBT-DOCSS) scale. Data were analyzed using beta-inflated generalized additive model for location, scale, and shape (GAMLSS) regression with least absolute shrinkage and selection operator (LASSO)-based predictor selection. RESULTS: Clinical preparedness was low (predicted μ = 2.32/7), particularly among those without prior LGBT-specific training or exposure. Attitudinal awareness was high (μ = 5.82), while basic knowledge scores were moderate (μ = 4.06). Recent LGBT-related training was associated with higher clinical preparedness (β = 0.779, p < 0.001), and prior informal experience also showed a positive association (β = 0.553, p < 0.001). Male sex (β = 0.369, p < 0.001) was associated with higher clinical preparedness, while homosexual orientation (β = 0.349, p = 0.001) was associated with higher overall clinical competence. Lower attitudinal awareness was observed among men (β = -0.545, p < 0.001) and those without LGBT contact (β = -0.688, p < 0.001). Recent training had no significant effect on basic knowledge (β = 0.280, p = 0.295). CONCLUSIONS: Polish paramedics express attitudinal awareness but lack clinical readiness, with a low baseline clinical preparedness score (μ = 2.32/7). Given the frontline role of emergency medical services, these findings highlight an urgent need for structured, practice-oriented LGBT training within paramedic education and continuing professional development.
Benefits and adverse effects of ketogenic diet treatment in pediatric patients with inborn errors of metabolism.
Wesół-Kucharska D, Kaczor MA, Emczyńska-Seliga EEV
Adv Clin Exp Med · 2026 Apr · PMID 42012479 · Publisher ↗
BACKGROUND: The ketogenic diet (KD) is an established therapeutic option for epilepsy and selected inborn errors of metabolism (IEMs), particularly glucose transporter type 1 deficiency (GLUT1D) and pyruvate dehydrogenas...
BACKGROUND: The ketogenic diet (KD) is an established therapeutic option for epilepsy and selected inborn errors of metabolism (IEMs), particularly glucose transporter type 1 deficiency (GLUT1D) and pyruvate dehydrogenase complex deficiency (PDCD). Increasing evidence suggests broader applications of KD in pediatric metabolic disorders; however, data on its safety and efficacy in heterogeneous IEM populations remain limited. OBJECTIVES: To evaluate the efficacy, clinical benefits, and adverse effects (AEs) of KD in pediatric patients with various IEMs. MATERIAL AND METHODS: A retrospective analysis was conducted in pediatric patients with IEMs receiving KD treatment. Patients were categorized into 3 groups: 1) other IEMs (n = 7), 2) mitochondrial diseases (MD) (n = 17), and 3) GLUT1D and PDCD (n = 20). The median age at initiation of KD was 37, 53, and 53 months, respectively, and the median duration of KD treatment was 5, 11, and 55 months in groups 1, 2, and 3. RESULTS: The KD was associated with clinical benefits in 84% of patients. Among children with epilepsy (n = 23), a seizure reduction of >50% was observed in 73.9% of patients, including complete seizure freedom in 4 individuals. Improvements were also noted in muscle tone (27.6%), exercise tolerance (51.2%), ataxia (83.3%), and involuntary movements (60%). Lactate levels decreased in 84.6% of patients with mitochondrial disease and in all patients with PDCD. The KD was discontinued in 12 patients due to insufficient efficacy (n = 5) or AEs (AEs; n = 7). The most common AEs included gastrointestinal (GI) symptoms, dyslipidemia, hyperuricemia, metabolic acidosis, and decreased free carnitine; most were transient. No significant association was found between median β-hydroxybutyrate (BHB) levels and clinical outcomes. CONCLUSIONS: The KD is an effective and generally well-tolerated therapeutic option in pediatric IEMs, with benefits extending beyond seizure control. Adverse effects are typically manageable, although GI intolerance may limit long-term use. Ketogenic diet should be considered not only for refractory epilepsy but also for selected metabolic indications.
Academic mediator-driven research translation: The concept for making possible implementation.
Sattayut S, Srisilapanan P, Patcharanuchat P
Adv Clin Exp Med · 2026 Jun · PMID 42012478 · Publisher ↗
Translation research into practice remains one of the critical yet underdeveloped aspects of scientific progress. This editorial explores how academic mediation can transform fragmented research activities into sustainab...
Translation research into practice remains one of the critical yet underdeveloped aspects of scientific progress. This editorial explores how academic mediation can transform fragmented research activities into sustainable translational ecosystems. Drawing from Thailand's experience in laser dentistry, the paper illustrates a progression from individual projects to collective research networks and the institutionalization of the Hub of Knowledge in Orofacial Laserology (HKOL). The model demonstrates how innovation can move beyond diffusion and normalization to achieve implementation grounded in education and community relevance through structured collaboration, standardized protocols, and academic stewardship. By addressing theoretical gaps and aligning practice with governance, the academic mediator-driven model offers an adaptable framework for integrating research, clinical service, and policy. It underscores that effective translation is not a spontaneous outcome of evidence but the result of deliberate structure, shared accountability, and long-term academic continuity.
The PassTrue® technique for evaluating the needle/tissue mechanical interaction in a medicolegal simulation setting.
Boscolo-Berto R, Contran M, Cassai A … +3 more , Caro R, Macchi V, Porzionato A
Adv Clin Exp Med · 2026 Apr · PMID 42012477 · Publisher ↗
BACKGROUND: The increasing availability of body donations and the expansion of reference centers provide forensic clinical anatomy with the opportunity to experimentally reproduce, in ex vivo settings, the effects of spe...
BACKGROUND: The increasing availability of body donations and the expansion of reference centers provide forensic clinical anatomy with the opportunity to experimentally reproduce, in ex vivo settings, the effects of specific interactions on the human body, such as needle-tissue interaction in medical procedures. OBJECTIVES: The primary objective of this study was to develop a reproducible, standardized benchtop methodology that enables the identification of the trajectory traveled by the needle when piercing soft tissue, causing detectable iatrogenic tissue damage. MATERIAL AND METHODS: Skeletal muscle tissue samples were harvested from a fresh-frozen 78-year-old male body housed at our Reference Center, Center for Body Donation. Needle transfixions were then tested using a novel technique designed for this purpose (PassTrue® methodology): full-thickness tissue transfixion by a needle, insertion into the needle of a coaxial thread, grasping the thread with forceps, and needle withdrawal, so that the in-place thread indicates the route of transfixion. This procedure was tested against the control procedure without a thread. RESULTS: Microscopic analysis revealed a pattern consistent with the needle's course during transfixion in all cases with the PassTrue® technique (10/10), but not in controls (0/10). CONCLUSION: Our novel methodology improves the efficiency of assessing needle-tissue interactions, enabling identification of the needle's trajectory within biological tissues.
Mendelian randomization analysis of risk factors for nasopharyngeal carcinoma: Examining causal links to EBV susceptibility and dietary influences.
Li G
Adv Clin Exp Med · 2026 Apr · PMID 42012476 · Publisher ↗
BACKGROUND: Nasopharyngeal carcinoma (NPC) is a rare but aggressive malignancy that originates in the epithelial cells of the nasopharynx. OBJECTIVES: This study aimed to investigate the causal relationship between Epste...
BACKGROUND: Nasopharyngeal carcinoma (NPC) is a rare but aggressive malignancy that originates in the epithelial cells of the nasopharynx. OBJECTIVES: This study aimed to investigate the causal relationship between Epstein-Barr virus (EBV) susceptibility, dietary factors (specifically preserved food intake), and NPC risk using Mendelian randomization (MR). The goal of this study was to provide insights into the genetic and environmental factors that contribute to NPC pathogenesis. MATERIAL AND METHODS: We performed MR analyses using genome-wide association study (GWAS) data to identify genetic variants associated with EBV susceptibility and preserved food consumption. These genetic variants were used as instrumental variables to assess their causal effects on NPC risk, while controlling for potential confounding and reverse causality. Subgroup and sensitivity analyses, including the MR-Egger, weighted median, and leave-one-out methods, were conducted to evaluate the robustness of the findings. RESULTS: Our MR analysis identified a significant causal effect of EBV genetic susceptibility on NPC risk (β = 1.47, 95% confidence interval (95% CI): 1.12-1.83, p = 0.001). Additionally, genetic predispositions related to higher preserved food intake were associated with an increased risk of NPC (β = 0.75, 95% CI: 0.45-1.05, p = 0.001). Subgroup analysis showed consistent results across different age groups (p for interaction = 0.45), and sensitivity analyses confirmed the robustness of the findings, with no evidence of pleiotropy. CONCLUSIONS: This study provides strong evidence that genetic susceptibility to EBV and preserved food intake are causal risk factors for NPC. These findings offer valuable insights into NPC prevention strategies, particularly in high-risk populations, and highlight the need for further research on gene-environment interactions in NPC pathogenesis.
Measurement of platelet reactivity in thrombocytopenic patients on dual antiplatelet therapy after percutaneous coronary intervention.
Wilczewska D, Błaziak M, Gajek K … +10 more , Karolko B, Cielecka M, Florek K, Wietrzyk W, Stefaniak W, Sokołowski J, Woźniak U, Mendyka D, Mysiak A, Kuliczkowski W
Adv Clin Exp Med · 2026 Apr · PMID 42012475 · Publisher ↗
BACKGROUND: Thrombocytopenia remains a significant problem in patients with cardiovascular disease (CVD) due to the indispensable use of antiplatelet therapy. OBJECTIVES: The aim of this study was to establish a novel fl...
BACKGROUND: Thrombocytopenia remains a significant problem in patients with cardiovascular disease (CVD) due to the indispensable use of antiplatelet therapy. OBJECTIVES: The aim of this study was to establish a novel flow cytometry (FC)-based method for measuring platelet reactivity during dual antiplatelet therapy (DAPT) and to compare it with impedance aggregometry (IA) in thrombocytopenic patients undergoing percutaneous coronary intervention (PCI). MATERIAL AND METHODS: This prospective cross-sectional study included 30 patients with thrombocytopenia. Platelet aggregation was assessed using IA and FC. RESULTS: A similar response to arachidonic acid (AA), reflecting the effect of acetylsalicylic acid (ASA), was observed in both groups. Responses to thrombin receptor agonist peptide (TRAP) and adenosine diphosphate (ADP), measured with aggregometry, were significantly higher in thrombocytopenic patients than in patients with normal platelet counts. When the FC method was used, the response to AA was significantly higher in thrombocytopenic patients. The optimal cut-off value for the FC method to define adequate platelet reactivity inhibition with clopidogrel in thrombocytopenic patients was <25.7%. CONCLUSIONS: In patients with thrombocytopenia, IA is useful for assessing ASA response, whereas the presented FC method may be more accurate for evaluating response to clopidogrel.
Lateral nail entry increases valgus risk, but coronal plane deformity does not affect knee function after femoral locked nailing.
Suer O, Kirmic YT, Eyceyurt RS … +4 more , Uzakgider M, Tahta M, Kayali C, Aktuglu K
Adv Clin Exp Med · 2026 Apr · PMID 41981882 · Publisher ↗
BACKGROUND: Closed locked intramedullary nailing (IMN) of femoral diaphyseal fractures (FDF) is the gold standard treatment. Postoperative frontal plane deformities can still occur following locked IMN. OBJECTIVES: The p...
BACKGROUND: Closed locked intramedullary nailing (IMN) of femoral diaphyseal fractures (FDF) is the gold standard treatment. Postoperative frontal plane deformities can still occur following locked IMN. OBJECTIVES: The primary aim of this study was to evaluate the effect of coronal plane deformities on knee joint function and overall functional outcomes in adults with FDF treated using static locked IMN. MATERIAL AND METHODS: One hundred and twenty patients treated with locked IMN for FDF were divided into 2 groups based on coronal plane angulation measured on long-leg radiographs: group A (<5° deformity, n = 100) and group B (≥5° deformity, n = 20). Factors potentially influencing coronal plane deformity were compared between the groups. Radiographic parameters, including the mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and postoperative lower extremity mechanical axis angle (MA), as well as intraoperative factors and complications, were analyzed. Functional outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee score, the Lower Extremity Functional Scale, and the Kujala patellofemoral scoring system. RESULTS: There were no significant differences between the groups in terms of age, gender, AO classification, or mechanism of injury. Coronal plane deformity was found to be independent of fracture localization, fracture type, and use of a traction table. However, nails implanted laterally to the greater trochanter were associated with significantly more valgus deformity (p < 0.001). No significant differences were observed in postoperative mLDFA, mMPTA, or MA between the groups at the final follow-up. Functional scores also showed no significant differences. CONCLUSIONS: After a minimum follow-up of 5 years, no adverse effects on knee or patellofemoral joint function were observed in patients with coronal plane deformities. Coronal plane deformity following locked IMN for FDF was independent of fracture location, classification, and traction table use. However, lateral entry to the greater trochanter was associated with increased valgus deformity.
Electromyographic activity of the orbicularis oris muscle in children with and without lip competence: A cross-sectional study.
Szyszka-Sommerfeld L, Machoy ME, Świtała J … +5 more , Sycińska-Dziarnowska M, Woźniak K, Spagnuolo G, Esposito L, Rengo C
Adv Clin Exp Med · 2026 May · PMID 41981875 · Publisher ↗
BACKGROUND: The "equilibrium theory" posits that the tongue and perioral muscles, including the orbicularis oris (OO) muscle, function synergistically to maintain balanced tooth positioning. Surface electromyography (sEM...
BACKGROUND: The "equilibrium theory" posits that the tongue and perioral muscles, including the orbicularis oris (OO) muscle, function synergistically to maintain balanced tooth positioning. Surface electromyography (sEMG) is a valuable, nonivasive method for assessing muscle activity. However, previous electromyographic (EMG) studies comparing lip muscle activity in children with and without lip competence (LC) have yielded inconsistent results. Therefore, further research is needed to clarify OO muscle activity patterns in this population. OBJECTIVES: The aim of the study was to evaluate the EMG activity of the superior (SOO) and inferior orbicularis oris (IOO) muscles in children with and without LC. MATERIAL AND METHODS: The sample comprised 30 children with lip incompetence (LI) (mean age 9.46 ± 1.76 years) and 30 children with LC (mean age 8.85 ± 1.52 years). Electromyographic recordings of the SOO and IOO muscles were obtained using a DAB Bluetooth Instrument (Zebris Medical GmbH, Isny im Allgäu, Germany) at clinical rest, during saliva swallowing, lip protrusion ("kissing" position), lip compression, and while articulating the syllables /pa/, /ba/, and /ma/. Statistical analyses were performed using Stata v. 11.0 (StataCorp, College Station, USA). The level of significance was set at p < 0.05. RESULTS: Electromyographic activity of the SOO and IOO muscles during saliva swallowing (p < 0.001, adjusted p (padj) = 0.002) and lip compression (p = 0.001, padj = 0.013 for SOO; p < 0.001, padj = 0.005 for IOO) was significantly greater in children with LI compared to those with LC. Similar EMG activity at rest and during speech production was observed in children with and without LC. CONCLUSIONS: Children with LI demonstrate increased SOO and IOO muscle activity during saliva swallowing and lip compression, suggesting greater muscular effort is required to achieve lip seal. This increased activity may disturb the muscular force balance essential for proper maxillofacial growth and could contribute to the development of malocclusion.
A new peer reviewer? Comparing AI with human performance in randomized controlled trial risk-of-bias assessment.
Lettner J, Ostojic M, Królikowska A … +3 more , Kayaalp ME, Ramadanov N, Prill R
Adv Clin Exp Med · 2026 Apr · PMID 41953984 · Publisher ↗
BACKGROUND: Risk-of-bias (RoB) assessment is essential for evidence synthesis but remains time-consuming and inherently subjective. Artificial intelligence (AI) may improve the efficiency of systematic reviews; however,...
BACKGROUND: Risk-of-bias (RoB) assessment is essential for evidence synthesis but remains time-consuming and inherently subjective. Artificial intelligence (AI) may improve the efficiency of systematic reviews; however, its reliability in reproducing expert RoB judgements remains uncertain. OBJECTIVES: To compare the performance of AI models and human raters in RoB assessment of randomized controlled trials (RCTs) using the revised JBI critical appraisal tool. MATERIAL AND METHODS: Thirteen RCTs published between 2023 and 2025 in orthopedic journals were independently assessed by 2 human raters (an expert (R1) and a novice (R2)) and 2 AI models (ChatGPT-4.0 (CGPT) and DeepSeek-R1 (DS)) using the 13-domain JBI checklist. Deep-reasoning functionalities (e.g., chain-of-thought prompting) were applied. Inter-rater agreement, deviations from the expert assessment (reference standard), and binary disagreements (e.g., Yes vs No) were analyzed to evaluate consistency. RESULTS: The AI models demonstrated high inter-model agreement (91%), exceeding human-AI agreement (CGPT vs R1: 64%; DS vs R1: 68%). However, both AI systems showed substantial divergence from expert judgements in interpretive domains, including allocation concealment (Q2), blinding (Q7), and overall trial design (Q13), with deviation rates ranging from 30% to 38.5%. Binary decision reversals were more frequent in AI assessments (CGPT: 8.9%; DS: 7.7%) than in the human comparison (R2 vs R1: 2.4%). Human raters showed stronger agreement in contextual interpretation (R1-R2: 89.3%), whereas AI models performed better in rule-based domains (Q8/Q9: 100% agreement). CONCLUSIONS: AI can reliably support the automation of objective components of RoB assessment but remains limited in handling interpretive, context-dependent judgements. A hybrid approach combining AI-assisted pre-screening with expert evaluation may enhance the scalability of systematic reviews without compromising methodological rigor.
Association of EBV infection with increased cancer aggressiveness in prostate cancer patients: A systematic review and meta-analysis.
Abidi SH, Fabiyi OT, Omarova Z … +3 more , Sheikh A, Ahmed K, Bajpai R
Adv Clin Exp Med · 2026 Apr · PMID 41953983 · Publisher ↗
BACKGROUND: Several studies have reported the presence of Epstein-Barr virus (EBV) in prostate carcinoma tissues and have investigated how EBV might contribute to prostate cancer (PCa) development. To the best of our kno...
BACKGROUND: Several studies have reported the presence of Epstein-Barr virus (EBV) in prostate carcinoma tissues and have investigated how EBV might contribute to prostate cancer (PCa) development. To the best of our knowledge, no comprehensive systematic review and meta-analysis have been performed to: 1) estimate the pooled prevalence of EBV in PCa, particularly in samples with high and low Gleason scores; and 2) examine the association between EBV and PCa aggressiveness, measured using high-grade and/or Gleason scores. OBJECTIVES: This study aimed to achieve 2 primary objectives: 1) to estimate the pooled prevalence of EBV in PCa; and 2) to determine the association between EBV infection and cancer aggressiveness, specifically in relation to moderate-to-high Gleason scores (7 and above). MATERIAL AND METHODS: PubMed, Embase, and Google Scholar were systematically searched for relevant observational studies on EBV and PCa from database inception through December 31, 2024. The quality of the studies was assessed using the JBI criteria based on study design. A meta-analysis was conducted using 9 and 4 studies, respectively, to estimate the pooled EBV prevalence and the association between EBV infection and Gleason scores, along with 95% confidence and prediction intervals. RESULTS: A total of 9 studies were included in the analysis. The pooled EBV prevalence among 927 PCa samples was estimated at 33% (95% confidence interval (95% CI): 16-52%; I2 = 94.17%), while EBV prevalence in PCa samples with moderate-to-high (≥7) and low (6) Gleason scores was 59% (95% CI: 21-92%; I2 = 90.86%) and 34% (95% CI: 15-56%; I2 = 0.00%), respectively. Similarly, EBV presence in PCa samples was associated with increased odds of moderate-to-high Gleason scores (odds ratio (OR) = 2.38, 95% CI: 1.82-3.13, I2 = 0.00%, p = 0.002). CONCLUSION: This study highlights EBV as a possible risk factor for aggressive prostate cancer (PCa). Additional research is necessary to explore how EBV proteins contribute to PCa development.
The clock out of sync: Insights into circadian disruption in wake-up vs non-wake-up stroke.
Zhang X, Chen Z, Gu S … +6 more , Zhu YL, Yu L, Cai X, Zhao H, Wang H, Fang Q
Adv Clin Exp Med · 2026 Apr · PMID 41945262 · Publisher ↗
BACKGROUND: Wake-up stroke (WUS), an ischemic stroke occurring during sleep, accounts for 15-25% of acute ischemic strokes (AIS) cases and poses unique therapeutic challenges due to an unknown onset time. Circadian rhyth...
BACKGROUND: Wake-up stroke (WUS), an ischemic stroke occurring during sleep, accounts for 15-25% of acute ischemic strokes (AIS) cases and poses unique therapeutic challenges due to an unknown onset time. Circadian rhythms, regulated by the suprachiasmatic nucleus (SCN), influence various cardiovascular and metabolic processes, and disruptions of these rhythms have been implicated in stroke pathogenesis. OBJECTIVES: This study explored whether WUS patients exhibit distinct circadian abnormalities compared with non-WUS patients, focusing on markers such as melatonin, cortisol, circadian clock gene expression, blood pressure (BP), and heart rate (HR). MATERIAL AND METHODS: This exploratory, cross-sectional study included 28 participants (WUS: 8; non-WUS; 9, controls: 11). Blood samples were collected every 6 h over 24-h period, with melatonin and cortisol levels assessed via ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) and chemiluminescence, respectively. Circadian gene expression (CLOCK, CRY1, CRY2, PER1, PER2, and BMAL1) was analyzed using quantitative real-time reverse transcription polymerase chain reaction (RT-qPCR). Blood pressure and HR were recorded at 2-h intervals, and circadian rhythmicity was determined using MetaCycle analysis. RESULTS: The results revealed significant circadian rhythms in melatonin and cortisol in the non-WUS and control groups, with WUS patients showing a complete loss of melatonin rhythm and a 3-h phase delay in cortisol. Blood pressure and HR circadian variations were absent in both stroke groups, and none of the 6 clock genes exhibited rhythmicity in either the WUS or non-WUS group. CONCLUSIONS: This study highlights the potential role of disrupted circadian rhythms in WUS pathogenesis, providing insights into targeted interventions such as light therapy. Future studies with larger cohorts are essential to confirm these findings and assess their clinical implications for stroke prevention and recovery.
GPR149 (G protein-coupled receptor 149): Structure, signaling, and emerging roles in reproduction, metabolism, and neural function.
Esmaeilzadeh M, Ahmed A, Vasconcelos C … +2 more , Fereidouni A, Moradikor N
Adv Clin Exp Med · 2026 Apr · PMID 41945261 · Publisher ↗
G protein-coupled receptors (GPCRs) constitute one of the largest and most versatile families of membrane proteins, mediating a wide range of physiological functions through intracellular signaling pathways. Among them,...
G protein-coupled receptors (GPCRs) constitute one of the largest and most versatile families of membrane proteins, mediating a wide range of physiological functions through intracellular signaling pathways. Among them, G protein-coupled receptor 149 (GPR149) is an orphan receptor that has recently attracted increasing attention due to its distinctive structure and emerging biological roles. Although initially identified as an "antifertility" gene with high ovarian expression, accumulating evidence suggests a broader physiological relevance, including roles in metabolic and neurological regulation. This narrative review summarizes and integrates current evidence on the structure, expression patterns, and functional roles of GPR149 across multiple biological systems, including reproduction, metabolism, and the central nervous system (CNS), while highlighting existing knowledge gaps and future research directions. GPR149 appears to act as a negative regulator of fertility and ovulation, influencing oocyte maturation and granulosa cell signaling. In metabolic regulation, GPR149 deficiency is associated with resistance to diet-induced obesity and improved insulin sensitivity. In the nervous system, GPR149 expression in glial and neuronal populations has been linked to myelination and neuroendocrine signaling, primarily through modulation of the MAPK/ERK pathway. Altered expression of GPR149 under diabetic and neurological conditions further supports its multifunctional role. Collectively, current evidence positions GPR149 as a multifunctional orphan GPCR involved in the regulation of reproductive, metabolic, and neural processes. Elucidating its ligand interactions and signaling mechanisms may open new therapeutic avenues for reproductive disorders, metabolic syndromes, and neurodegenerative diseases.
Arthroscopic vs open surgery for shoulder dislocation and instability: A network meta-analysis of treatment outcomes.
Wen C, Hua Q, Qian W … +2 more , Su J, Lei M
Adv Clin Exp Med · 2026 May · PMID 41945260 · Publisher ↗
BACKGROUND: No comprehensive comparative research has been conducted to evaluate open Bankart (OB), arthroscopic Bankart (AB), open Latarjet (OL), and arthroscopic Latarjet (AL) simultaneously across all relevant clinica...
BACKGROUND: No comprehensive comparative research has been conducted to evaluate open Bankart (OB), arthroscopic Bankart (AB), open Latarjet (OL), and arthroscopic Latarjet (AL) simultaneously across all relevant clinical outcomes and parameters. OBJECTIVES: To compare the efficacy of OB, AB, OL, and AL procedures in the treatment of shoulder dislocation. MATERIAL AND METHODS: The databases PubMed, Embase, the Cochrane Library, and Web of Science were utilized for the literature search. The study evaluated recurrent instability, re-dislocation, apprehension, functional outcomes, and postoperative pain. The results were visually represented through network diagrams, forest plots, league tables, and rank probability plots to provide a comprehensive understanding of each outcome. RESULTS: Overall, 37 studies were included in the analysis. Individuals who underwent OL experienced a notably reduced risk of recurrent instability compared with those who underwent AB (random-effects model pooled relative risk (RR) = 0.34, 95% credible interval (95% CrI): 0.24-0.48) and OB (random-effects model pooled RR = 0.51, 95% CrI: 0.31-0.85). The risk of re-dislocation was also significantly lower for patients treated with OL compared with AB (pooled RR = 0.15, 95% CrI: 0.04-0.45). While not statistically significant, the OL procedure tended to have the lowest risk of apprehension and the highest Subjective Shoulder Value (SSV) score. Regarding postoperative pain, patients who underwent OB had the highest likelihood of attaining the lowest scores on the visual analogue scale (VAS). In addition, OL was associated with the highest probability of complications. CONCLUSION: The open Latarjet procedure appears to offer superior shoulder stability; however, while functional outcomes for patients undergoing OL are likely to be non-inferior, the procedure is not significantly associated with reduced postoperative pain as measured with the VAS score. Additionally, the OL procedure is associated with an increased likelihood of complications. Consequently, it is essential to implement preventive measures to manage postoperative pain and address potential complications following OL procedure.
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