Medical Principles and Practice最新文献

{"title":"Cannabis-Induced Gastrointestinal Tract Symptoms in the Adult Population: A Systematic Review.","authors":"Helen Senderovich, Christopher Meaney, Srishti Vashishtha","doi":"10.1159/000536161","DOIUrl":"10.1159/000536161","url":null,"abstract":"<p><strong>Objective: </strong>Cannabinoid usage is widespread in the self-management of various medical ailments. However, adverse effects have been reported with use, especially pertaining to the gastrointestinal system in adults and aged patients. These range from nausea, vomiting, bloating, or abdominal pain. This systematic review of previously reported cannabis-induced gastrointestinal symptoms in the adult population from the literature provides an analysis of relevant data to enhance knowledge and awareness of this topic.</p><p><strong>Methods: </strong>PubMed, Ovid MEDLINE, Cochrane Central, EMBASE, and Google Scholar databases were searched for relevant studies published from inception to March 2023.</p><p><strong>Results: </strong>The search yielded 598 results, of which 13 were deemed relevant and underwent further review. These included two systematic reviews, one retrospective cohort study, one retrospective chart review, two cross-sectional studies, one survey, and six case reports. The Cochrane Risk Tool for bias analysis was applied where relevant. The total number of people in the studies selected for analysis was 79, 779. Twelve out of the thirteen included studies reported some type of gastrointestinal tract symptoms experienced in medical and/or recreational cannabis users ranging from nausea, vomiting, diarrhoea, abdominal pain to adult intussusception.</p><p><strong>Conclusion: </strong>Potential limitations include small sample sizes, variation in research methodologies, varied studied designs, and limited availability of data on specific populations such as geriatric users. Further research is warranted to add to current evidence pertaining to this emerging topic of significance, fill the broad knowledge gaps and contribute to evidence-based guidelines for healthcare professionals, ensuring safe prescribing practices and provision of quality care.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"90-101"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11096793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139417384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prognostic Significance of Surgical Treatment for Excessive Elderly Soft Tissue Sarcoma Patients over 90 Years Old: A Clinicopathological Study of 16 Cases.","authors":"Hiroyuki Tsuchie, Makoto Emori, Hiroyuki Nagasawa, Yasutaka Murahashi, Emi Mizushima, Junya Shimizu, Toshihiko Yamashita, Naohisa Miyakoshi","doi":"10.1159/000539728","DOIUrl":"10.1159/000539728","url":null,"abstract":"<p><strong>Objectives: </strong>The incidence of soft tissue sarcomas (STSs) among older patients is increasing. Although surgical treatment of elderly patients with STS has been reported to improve their prognosis, most of these studies included patients with STS aged &lt;85 years. This study aimed to analyze the clinical features and prognostic factors of STS in elderly patients aged ≥90 years.</p><p><strong>Subject and methods: </strong>We retrospectively identified patients aged ≥90 years with STS who were treated at our two hospitals between 1994 and 2022. Data on clinical information and detailed assessments were collected. We evaluated the features and factors affecting the prognosis of patients with older-extremity STS. In addition, we compared the clinical courses and results of patients treated with surgery and radiotherapy for primary tumors.</p><p><strong>Results: </strong>Among 454 patients with STS, 16 were aged ≥90 years. Kaplan-Meier curves for overall survival showed a significantly poorer prognosis in patients who did not receive surgical treatment (p = 0.0348) and those who received radiotherapy (p = 0.0070). Moreover, we investigated the difference in prognosis between surgical treatment and radiotherapy, excluding two cases with distant metastasis at initial diagnosis and one case with no treatment. Kaplan-Meier curves for overall survival showed a significantly better prognosis in patients who underwent surgical treatment (p = 0.0161). Univariate analysis revealed that only primary tumor size was a significant predictor of poor prognosis (p = 0.0426).</p><p><strong>Conclusion: </strong>In patients with STS aged ≥90 years old, aggressive surgical treatment may improve the prognosis more than radiotherapy.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"424-430"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply: The Emerging Role of AI in Patient Education: A Comparative Analysis of the Accuracy of Large Language Models for Pelvic Organ Prolapse.","authors":"Sakine Rahimli Ocakoglu, Burhan Coskun","doi":"10.1159/000540160","DOIUrl":"10.1159/000540160","url":null,"abstract":"","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"503-504"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141759678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Potential of Bacteriophage Therapy as an Alternative Treatment Approach for Antibiotic-Resistant Infections.","authors":"Nike Walter, Mohammadali Mirzaei, Li Deng, Christian Willy, Volker Alt, Markus Rupp","doi":"10.1159/000534717","DOIUrl":"10.1159/000534717","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to provide a comprehensive overview of the current state of the literature on the therapeutical application of bacteriophages.</p><p><strong>Methods: </strong>First, a bibliometric analysis was performed using the database Web of Science to determine annual number of publications and citations. Second, a systematic literature review was conducted on randomized-controlled trials (RCTs) of phage therapy in PubMed.</p><p><strong>Results: </strong>Over the past decade, the number of publications on bacteriophage therapy increased more than fourfold with 212 articles in 2011 and 739 in 2022. The systematic search in PubMed yielded 7 RCTs eligible for inclusion, reporting on a total of 418 participants. Identified indications in this study included bacterial diarrhea, urinary tract infections, infected burn wounds, chronic otitis, chronic venous leg ulcers, and chronic rhinosinusitis. In three studies, mild to moderate adverse events were reported in 10/195 participants (5.1%). Three of the studies reported a statistically significant difference in outcomes comparing phage therapy with standard of care or placebo.</p><p><strong>Conclusion: </strong>Phage therapy has gained increasing interest over the years. RCTs on different indications suggest the safety of phage therapy; however, reasons why phage therapy is not yet well accepted are limitations in the study designs. For a successful translation into clinical practice researchers and clinicians should learn from the earlier experiences and consider issues such as the quality of phage preparation, sensitivity testing, titer and dosages, as well as access to the infection site and stability for standardized protocols and future trials.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10896615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50162133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of Point-of-Care Testing of C-Reactive Protein, Interleukin-6, and Procalcitonin in Neonates with Clinically Suspected Sepsis: A Prospective Observational Study.","authors":"Medha Goyal, Dwayne Mascarenhas, Prashanth Rr, Anitha Haribalakrishna","doi":"10.1159/000536678","DOIUrl":"10.1159/000536678","url":null,"abstract":"<p><strong>Objective: </strong>Sepsis often prompts clinicians to start empirical antibiotics in suspected neonates while awaiting diagnosis. The next-generation testing with point-of-care (POC) techniques offers a lead-time advantage that could bridge the gap by providing a timely diagnosis.</p><p><strong>Materials and methods: </strong>We conducted a prospective diagnostic study in 82 neonates enrolled between May and October 2022 in a level III neonatal intensive care unit. All neonates with a new episode of clinically suspected sepsis were included. Diagnostic accuracy of POC testing of C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT) with standard laboratory methods was performed.</p><p><strong>Results: </strong>The mean gestation age and birth weight of the neonates were 33.17 ± 4.25 weeks and 1,695.4 ± 700.74 grams, respectively. Most neonates were preterm (75%) with nearly equal proportions of early (51.22%) and late-onset (48.78%) sepsis. The POC CRP correlated well with standard CRP (r = 0.8001, 95% CI: 0.706-0.867, p &lt; 0.0001). Among the three biomarkers, CRP had the maximum diagnostic accuracy (area under the curve [AUC] - 0.73) followed by PCT (AUC - 0.65) and IL-6 (0.55). There was no significant difference in the diagnostic accuracy of CRP (p = 0.46), PCT (p = 0.29), and IL-6 (p = 0.60) in early- and late-onset sepsis. The mean time for POC estimation of IL-6, PCT, and CRP was 12 ± 3 min which was significantly less compared to 366 ± 61 min for standard techniques (p &lt; 0.001).</p><p><strong>Conclusion: </strong>POC CRP correlates well with standard techniques of estimation, and CRP alone and in combination with PCT has good diagnostic accuracy in neonatal sepsis.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"291-298"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11175603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139697831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Cancer Side Population Stem Cells in Ovarian Cancer Angiogenesis.","authors":"Yue Pan, XueFen Yang, Miaojuan Chen, Kun Shi, Yuan Lyu, Annette P Meeson, Gendie E Lash","doi":"10.1159/000539642","DOIUrl":"10.1159/000539642","url":null,"abstract":"<p><p>Ovarian cancer is one of the most common gynecologic malignancies. Recurrence and metastasis often occur after treatment, and it has the highest mortality rate of all gynecological tumors. Cancer stem cells (CSCs) are a small population of cells with the ability of self-renewal, multidirectional differentiation, and infinite proliferation. They have been shown to play an important role in tumor growth, metastasis, drug resistance, and angiogenesis. Ovarian cancer side population (SP) cells, a type of CSC, have been shown to play roles in tumor formation, colony formation, xenograft tumor formation, ascites formation, and tumor metastasis. The rapid progression of tumor angiogenesis is necessary for tumor growth; however, many of the mechanisms driving this process are unclear as is the contribution of CSCs. The aim of this review was to document the current state of knowledge of the molecular mechanism of ovarian cancer stem cells (OCSCs) in regulating tumor angiogenesis.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"403-413"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periconceptional Supplementation with Folic Acid or Multiple Micronutrients Containing Folic Acid and the Risk for Hypertensive Disorders in Pregnancy.","authors":"Huang Wantong, Wenying Meng, Jie Zhang, Lei Jin, Lei Jin","doi":"10.1159/000540322","DOIUrl":"10.1159/000540322","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate the association between supplementation containing folic acid only (FAO) or multiple micronutrients containing folic acid and the risk for hypertensive disorders in pregnancy (HDP).</p><p><strong>Subjects and methods: </strong>The retrospective cohort study was based on data from women who gave birth from 2016 to 2018 at Tongzhou Maternal and Child Health Care Hospital of Beijing, China. The outcomes were HDP diagnosed after the 20th week of pregnancy, including gestational hypertension (GH), preeclampsia, and eclampsia. Associations between supplementation patterns and HDP were estimated by Poisson loglinear regression models. Sensitivity analyses were based on prepregnancy body mass index (BMI) and maternal age.</p><p><strong>Results: </strong>Among the 25,866 women included in the study, periconceptional use of FA supplementation marginally reduced the risk for HDP (adjusted risk ratio [aRR] = 0.87, 95% confidence interval [CI] 0.73-1.04). Women who began FAO supplementation before conception had a lower risk for GH compared to those who began after conception (aRR = 0.59, 95% CI: 0.45-0.78). The risk for HDP also reduced among FAO users who began supplementation before conception with a normal prepregnancy BMI (aRR = 0.64, 95% CI: 0.49-0.84) and users ≥30 years old (aRR = 0.75, 95% CI: 0.58-0.98).</p><p><strong>Conclusions: </strong>Periconceptional FAO supplementation may reduce the risk for HDP, especially GH. The protective effects are greater among women with a normal prepregnancy BMI and those ≥30 years old.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"578-586"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum Levels of Plasminogen Activator Inhibitor-1 in Patients with Parkinson's Disease.","authors":"Azra Meryem Tanrikulu, Betul Ozdilek, Mehmet Agirbasli","doi":"10.1159/000540854","DOIUrl":"10.1159/000540854","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to investigate serum plasminogen activator inhibitor-1 (PAI-1) levels of patients with Parkinson's disease (PD) and their relationship with clinical findings and treatment of disease.</p><p><strong>Methods: </strong>The study included 125 PD patients and 48 healthy controls. Patients have been taking effective dopaminergic treatment regularly. The clinical severity of parkinsonism was assessed using the Hoehn and Yahr (HY) staging scale and the Unified PD Rating Scale (UPDRS). PAI-1 level analysis was performed by enzyme-linked immunosorbent assay.</p><p><strong>Results: </strong>Patients with PD had significantly lower serum PAI-1 levels than healthy controls (p < 0.001). Correlations with clinical findings showed only a marginally positive correlation between serum PAI-1 and HY score (r = 0.170, p = 0.05). In contrast, no significant correlation was demonstrated with the UPDRS score or other clinical parameters.</p><p><strong>Conclusion: </strong>This is the first comprehensive analysis of serum PAI-1 levels in patients with PD. The distribution of PAI-1 in PD appears to be complex. The study results implicate that the paradoxical effects of tissue plasminogen activator on the brain parenchyma can be important in the pathophysiology of PD. Future studies are needed to elucidate the role of fibrinolytic system components in PD.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"562-568"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Real-World Retrospective Study to Evaluate the Reliability of Cetuximab plus Capecitabine versus Capecitabine as Maintenance Therapy in Patients with RAS and BRAF Wild-Type Metastatic Colorectal Cancer.","authors":"Jun Li, Hang Zhang, Xuli Guo, Shaoting Dong, Yi Li, Weizhen Huang, Xia Yuan","doi":"10.1159/000533528","DOIUrl":"10.1159/000533528","url":null,"abstract":"<p><strong>Background: </strong>The optimal maintenance therapy for rat sarcoma (RAS) and v-raf murine sarcoma viral oncogene homolog B (BRAF) metastatic colorectal cancers (mCRCs) remains unclear. It is critical to evaluate the reliability of cetuximab-capecitabine (the observation group) relative to capecitabine alone (control group).</p><p><strong>Patients and methods: </strong>In this retrospective analysis, patients with RAS and BRAF mCRC admitted to Huizhou Municipal Central Hospital, between January 2016 and October 2020 were enrolled and treated with cetuximab plus 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI) as an initial therapy. Patients whose disease was controlled after at least six cycles of treatment were administered a maintenance therapy until disease progression. We also analyzed the prognosis of patients according to clinicopathological features. Altogether, 39 RAS and BRAF mCRC patients were recruited from January 2016 to October 2020, with 18 cases in the treatment group and 21 cases in the control group. The difference in baseline clinicopathological features between the two treatments is not obvious.</p><p><strong>Results: </strong>The median progression-free survival after maintenance treatment in observation group (9.5 months [95% confidence interval (CI) = 6.4-12.6]), was significantly better than the control group (7.3 months [95% CI = 5.8-8.8]). During maintenance treatment, there were no deaths caused by treatment-related adverse events, and the overall incidence of rash acne was different between the observation and control groups (p &lt; 0.05). Most adverse events were mild and easily controlled. Primary tumor site, baseline carcinoembryonic antigen levels, and microsatellite instability status were independent prognostic factors.</p><p><strong>Conclusion: </strong>Maintenance therapy using cetuximab plus capecitabine improved survival in patients with mCRC and was well tolerated by patients.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"31-40"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10896611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41135581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inconsistency in the Application of Glasgow Coma Scale in Pediatric Patients.","authors":"Maria Caruana, Sophie Noelle Hackenbruch, Victor Grech, Ruth Farrugia","doi":"10.1159/000534797","DOIUrl":"10.1159/000534797","url":null,"abstract":"<p><strong>Objective: </strong>The Glasgow Coma Scale (GCS) is widely used to objectively describe the extent of patients' impaired consciousness. However, there are known variations in scoring GCS both in adults and children which may impact patient management. The aim of this audit was to assess the application of GCS by medical and nursing staff in pediatric medical patients.</p><p><strong>Subject and methods: </strong>An online questionnaire was distributed amongst doctors and nurses working in the Department of Child and Adolescent Health at Mater Dei Hospital in Malta. The participants assigned GCS for 8 case scenarios involving children of different ages with varying levels of consciousness. Results were analyzed by calculating percentage agreement and by Cronbach's alpha.</p><p><strong>Results: </strong>Sixty-six participants were studied, with a response rate of 52%. Performance was poor overall, with Cronbach alpha 0.53. Correlation was better at the upper and lower ends of the scale and the worst performance was for verbal response. Only respondents with 5-10 years of experience achieved acceptable consistency in the application of the GCS (Cronbach alpha 0.78).</p><p><strong>Conclusion: </strong>There is considerable variation in application of GCS in pediatric patients, highlighting the need for education and training to improve consistency for this commonly used neurological assessment tool.</p>","PeriodicalId":18455,"journal":{"name":"Medical Principles and Practice","volume":" ","pages":"41-46"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10896613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71412908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}