OBJECTIVE:To evaluate the association of bedside spirometry, dyspnea severity, and inflammatory markers with noninvasive mechanical ventilation (NIMV) requirement in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). SUBJECTS AND METHODS:This prospective observational study included adults presenting to the emergency department (ED) with AECOPD. Bedside forced expiratory volume in one second (FEV₁% predicted) and peak expiratory flow (PEF% predicted) were measured before treatment. Dyspnea was assessed using the Visual Analog Scale (VAS). Neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, eosinophil-to-basophil ratio, arterial pH, and arterial partial pressure of carbon dioxide (PaCO₂) were obtained. Spirometry and VAS were repeated at three hours. The primary outcome was NIMV requirement during emergency department observation. Secondary outcomes included ICU admission. Mortality was analyzed descriptively because of limited events. RESULTS:Among 211 patients, 91 (43.1%) required NIMV. NIMV requirement was associated with lower baseline and third-hour FEV₁% and PEF% and higher VAS scores. Higher neutrophil-to-lymphocyte ratio and systemic immune-inflammation index were associated with ICU admission. Seven patients (3.3%) died within 30 days and had higher neutrophil-to-lymphocyte ratio and systemic immune-inflammation index values and lower eosinophil-to-basophil ratio. In multivariable analysis including arterial pH and PaCO₂, the PaCO₂ was found to be independently associated with NIMV requirement. CONCLUSIONS:Lower FEV₁% and PEF% values and greater dyspnea severity were associated with NIMV requirement, whereas inflammatory markers were associated with ICU admission and showed an association with 30-day mortality. Bedside spirometry may also provide complementary information alongside clinical assessment and arterial blood gas analysis in patients with AECOPD.
OBJECTIVE:The objectives of the study were to compare clinical efficacy, hemodynamic stability, and 90-day renal outcomes between Sustained low-efficiency dialysis (SLED) and Intermittent hemodialysis (IHD) in Medical intensive care unit (MICU) patients with severe Acute kidney injury (AKI). METHODS:This observational cohort study evaluated 300 patients with KDIGO Stage-2 or 3 AKI (SLED: n = 160; IHD: n = 140). Outcomes included MICU mortality, discharge renal recovery, stay duration, intradialytic complications, and 90-day renal preservation. RESULTS:Baseline characteristics were comparable. No significant differences emerged between SLED and IHD regarding MICU mortality (33% vs. 39%, p = 0.272) or renal recovery at discharge (61% vs. 54%, p = 0.223). However, SLED demonstrated superior safety, significantly lowering intradialytic hypotension (21% vs. 41%, p < 0.001) and the need for new vasopressors (11% vs. 22%, p = 0.011), while minimizing mean arterial pressure drops (12.12 ± 3.9 vs. 19 ± 6.36 mmHg, p < 0.001). SLED achieved shorter median MICU stays (14 vs. 16 days, p < 0.001). At 90-day, SLED survivors exhibited significantly lower Renal replacement therapy (RRT) dependence (11% vs. 24%, p = 0.014), reduced chronic kidney disease progression (26% vs. 34%, p = 0.044), and higher glomerular filtration rate (eGFR) (55.93 ± 7.69 vs. 45.86 ± 9.29 mL/min/1.73m2, p < 0.001). CONCLUSIONS:While short-term mortality is similar, SLED dramatically mitigates intradialytic hemodynamic instability compared to IHD. By minimizing circulatory insults, SLED significantly improves 90-day parenchymal renal recovery and minimizes long-term dialysis dependence among AKI survivors.
OBJECTIVE:Tonsilloliths are calcified concretions within tonsillar crypts whose relationship with smoking remains poorly understood. This study investigated the association between smoking and tonsillolith characteristics using cone-beam computed tomography (CBCT). SUBJECT AND METHODS:This retrospective cross-sectional study evaluated 416 dental CBCT scans obtained between 2021 and 2023. Scans were evaluated for the presence, size, number, laterality, and anatomical localization of tonsilloliths by a single oral and maxillofacial radiologist, with a second radiologist consulted in cases of diagnostic uncertainty. Demographic characteristics and smoking status were obtained from medical records. Statistical analyses included the chi-square or Fisher's exact test, independent-samples t-test or Mann-Whitney U test, and one-way ANOVA with Bonferroni post hoc correction (α = 0.05). RESULTS:Tonsilloliths were detected in 29.6% of participants (123/416). Smoking was not significantly associated with tonsillolith prevalence, size, or number (p > 0.05). Among patients with tonsilloliths, smokers showed significantly higher frequencies of unilateral (p = 0.041) and lingual (p = 0.036) tonsilloliths than non-smokers. Age was significantly associated with both prevalence and size (p < 0.001 and p = 0.037, respectively), with higher prevalence in older groups. No significant sex differences were found. CONCLUSIONS:Smoking was not associated with the overall prevalence, size, or number of tonsilloliths, but unilateral and lingual tonsilloliths were more frequent among smokers. Age was the strongest factor associated with tonsillolith formation, exerting a greater influence than smoking. Further prospective, multicenter studies with detailed smoking exposure data are needed to validate these findings.
OBJECTIVES:This study aimed to identify key hepatic genes involved in Metabolic dysfunction-associated steatotic liver disease (MASLD) pathogenesis and determine whether Sleeve gastrectomy (SG) attenuates cafeteria diet-induced hepatic steatosis in a rat model. METHODS:Thirty-two male Sprague-Dawley rats were divided into four groups: Control (lean), diet induced obesity (DIO)-Obese control, DIO-Sham, and DIO-SG. Hepatic expression profiling of MASLD-associated genes was performed using RT² Profiler polymerase chain reaction (PCR) arrays. Circulating adipokines (leptin and adiponectin) and hepatic triglyceride (TG) content were also quantified. RESULTS:SG significantly reversed obesity-induced upregulation of key lipogenic (Fasn, Srebf1, Dgat2), gluconeogenic (G6pc, Gck), and inflammatory (Nfkb1, Il1b) genes, while enhancing fatty acid oxidation and mitochondrial pathways (Cpt2, Ppargc1a, Acadl) please give in full and then abbreviations in parentheses when a term appears for the first time. Pathway analysis demonstrated significant modulation of peroxisome proliferator-activated receptor (PPAR) and adenosine monophosphate-activated protein kinase (AMPK) signaling, fatty acid oxidation, and insulin sensitivity networks. Circulating leptin and hepatic TG content, were significantly reduced following SG, consistent with systemic metabolic improvement. The normalization of Srebf1 and Dgat2 highlights restoration of hepatic lipid homeostasis and improved insulin sensitivity. CONCLUSION:SG reduced hepatic fat accumulation and mitigated MASLD through broad transcriptional and metabolic reprogramming of lipid, oxidative, and inflammatory pathways. The identification of shared hepatic-whole blood signatures together with improvements in circulating biomarkers, underscores the systemic impact of SG and suggests potential translational targets for non-invasive monitoring and therapeutic intervention.
OBJECTIVE:This study aimed to evaluate the remineralization potential and antibacterial activity of 5 commercially available pediatric toothpastes with different active ingredients. SUBJECT AND METHODS:The evaluated toothpastes were Kids Ozon, Oral-B Pro-Kids, Dentiste Junior Postbiotics, Curasept Biosmalto and Zubio. To assess remineralization efficacy, 48 specimens from extracted third molars were subjected to baseline microhardness testing. The samples were divided into six groups: five experimental and one negative control (n = 8). After 4 days in a demineralizing solution, microhardness was remeasured, followed by a 14-day pH-cycling protocol at 37 °C with twice-daily toothpaste applications. Final microhardness values were recorded and statistically analyzed. For antibacterial assessment, the agar diffusion method was applied using Streptococcus mutans, Lactobacillus acidophilus, Enterococcus faecalis and Candida albicans. RESULTS:All the tested toothpastes produced statistically significant remineralization of initial enamel carious lesions (p < 0.05). The microhardness ranking after pH-cycling was: Kids Ozon > Dentiste Junior Postbiotics > Curasept Biosmalto > Zubio > Oral-B Pro-Kids > negative control. However, intergroup differences weren't statistically significant (p > 0.05). All formulations showed antibacterial activity against the tested microorganisms. For S. mutans, Curasept Biosmalto had a significantly larger inhibition zone than Kids Ozon (p < 0.05). Although Curasept Biosmalto showed relatively higher antibacterial activity, differences among the other formulations were not significant (p > 0.05). CONCLUSION:Fluoridated and hydroxyapatite-based toothpastes exhibited comparable remineralization potential and antibacterial activity under in vitro conditions. The addition of other agents (ozone, propolis, and postbiotics) showed statistically non-significant improvements under the present experimental conditions.
OBJECTIVES:Concerns regarding the higher incidence of postoperative complications in Crohn's disease patients may delay surgical resection. Calibrating postoperative risks specific to Crohn's disease, with the more common indication of colon cancer, is valuable for making informed surgical decisions. The primary objective of this study was to report a disease-specific postoperative complication profile. The secondary objective was to identify factors associated with significant complications (Clavien-Dindo classification grade ≥ 2). SUBJECTS AND METHODS:This retrospective study was conducted at a tertiary center from January 2010 to December 2025 on adult patients who underwent right-sided segmental colectomy for Crohn's disease or colon cancer. The data analyzed included demographics, comorbidities, laboratory findings, and perioperative clinical variables, and 30-day postoperative complications. RESULTS:A total of 230 patients met the inclusion criteria (86 with Crohn's disease and 144 with colon cancer). Patients with Crohn's disease were significantly younger and had fewer associated comorbidities. No differences were observed in the overall postoperative complications. However, among patients who developed complications, the rate of infectious complications was higher in patients with Crohn's disease compared to patients with colon cancer (72.4% vs. 46.4%, p = 0.022 ). Respiratory complications occurred only in patients with colon cancer. Chronic kidney disease and conversion to open surgery were found to be independently associated with significant complications on multivariate regression analysis. CONCLUSION:Overall postoperative complications rates were comparable between Crohn's disease and colon cancer patients undergoing right-sided segmental colectomy. However, a disease-specific complication profile was noted, with a higher rate of infectious complications in Crohn's disease.
OBJECTIVES:This retrospective cohort study evaluated the real-world clinical effects of four dual-combination antihypertensive regimens on 24-hour ambulatory blood pressure variability (BPV) and circadian rhythm modifications over a 24-week period. METHODS:A total of 302 adults with primary hypertension were evaluated across parallel cohorts: an angiotensin-converting enzyme inhibitor plus calcium channel blocker group (ACEi+CCB, n = 76), an angiotensin II receptor blocker plus thiazide diuretic group (ARB+Thiazide, n = 75), a beta-blocker plus thiazide group (BB+Thiazide, n = 74), and a calcium channel blocker plus beta-blocker group (CCB+BB, n = 77). 24-hour systolic blood pressure (SBP) standard deviation (SD), Coefficient of Variation (CV), and night-to-day SBP ratios were analyzed to assess hemodynamic variations independent of absolute blood pressure lowering. RESULTS:While all regimens significantly reduced mean office and 24-hour ambulatory blood pressure, the ACEi+CCB combination demonstrated a significantly greater reduction in the 24-hour systolic CV from baseline to week 24 (from 10.35% ± 1.25% to 7.45% ± 0.92%, a relative drop of -28.0%) compared to the ARB+Thiazide (-15.1%), CCB+BB (-14.4%), and BB+Thiazide (-4.8%) cohorts (p < 0.001 after adjusting for absolute BP reduction). Additionally, the ACEi+CCB group achieved a significant downward shift in the continuous night-to-day SBP ratio from 0.96±0.04 to 0.91 ± 0.03 (p < 0.001), outperforming the ARB+Thiazide and BB+Thiazide arms. Treatment compliance (92%-95%) and overall adverse event rates (7.1%-9.7%) remained comparable across all groups. CONCLUSIONS:Dual therapies show class-dependent effects on BPV and circadian rhythm; ACEi+CCB most effectively reduces 24-hour systolic fluctuations.odifications, with the ACEi+CCB combination yielding the most pronounced reductions in 24-hour systolic fluctuations.
BACKGROUND:Fetal vascular malperfusion (FVM) represents a significant cause of adverse perinatal outcomes, yet population-specific patterns remain understudied in Middle Eastern populations. This study characterizes FVM patterns and clinical correlates in Kuwait over a 10-year period. METHODS:Retrospective analysis of 180 histologically confirmed FVM cases from the Maternity Hospital, Kuwait (2014-2024). Cases were classified by FVM grade, associated pathology, and clinical parameters. RESULTS:High-grade FVM predominated (80.0%, 144/180). Distinct trimester-specific patterns emerged: the second trimester showed the highest inflammatory pathology (18.6%), while maternal vascular malperfusion occurred exclusively in third trimester pregnancies (10.7%). Maternal age analysis revealed an unexpected peak risk in the 30-34 years group (88.3% high-grade FVM). Twin pregnancies demonstrated significantly higher pathological burden (88.9% vs. 79.5% in singletons, p = 0.041). CONCLUSIONS:This study reveals distinct FVM patterns in Middle Eastern populations, including unique age-related risks and trimester-specific pathological profiles. These findings support population-specific approaches to FVM assessment and management.
OBJECTIVE:We evaluated the clinicopathological correlations of maternal serum free beta human chorionic gonadotropin (FBHCG)/ pregnancy-associated plasma protein A (PAPP-A) multiples of the median (MoM) ratio measured between 11+0 and 13+6 weeks of gestation, pregnancy characteristics and placental histopathology in pregnancies affected by fetal growth restriction (FGR). SUBJECT AND METHODS:We investigated 69 pregnancies complicated with FGR. Different indicators of FGR, placental villous capillarization, placental weight to birth weight ratio and placental histopathological entities were correlated with FBHCG/PAPP-A ratio. RESULTS:Complication of FGR with preeclampsia (p < 0.001) and birth weight below the 2nd percentile (p < 0.001) were significantly more common when the FBHCG/PAPP-A ratio was higher. Placental weight to birth weight ratio was significantly lower (<1:8) in cases of higher FBHCG/PAPP-A ratio. Distal villous hypoplasia, avascular villi and chorangiosis were more prevalent in cases with a higher FBHCG/PAPP-A ratio, however villous capillarization, onset of FGR, oligohydramnios, and preterm birth did not have an association with it. CONCLUSION:In FGR, higher FBHCG/PAPP-A ratio could be an early indicator of placental villous underdevelopment, which is further supported by the fact that higher prevalence of distal villous hypoplasia and avascular villi was described in cases with higher FBHCG/PAPP-A ratio. We conclude that this ratio could be an early marker of potential placental dysfunction (and consecutive FGR later in pregnancy), rendering a helpful marker as early as the end of the first trimester for identifying pregnancies that warrant close monitoring throughout gestation.
OBJECTIVE:Breast cancer remains a leading cause of global mortality in women, with therapy resistance posing a major challenge to successful treatment. Chemotherapy-induced oxidative stress can trigger adaptive survival mechanisms through the antioxidative transcription factor NRF2 and membrane pores known as peroxiporins. Peroxiporins regulate cellular redox homeostasis by controlling the flux of H2O2, potentially driving the development of chemoresistance in aggressive subtypes. This study investigated the expression of peroxiporins, AQP3 and AQP5, and the antioxidative transcription factor NRF2, before and after chemotherapy to determine their role in chemotherapy resistance in HER2-positive and triple negative breast cancer. SUBJECTS AND METHODS:In this retrospective study, we analyzed the expressions of AQP3, AQP5, and NRF2 by immunohistochemical staining in paired clinical biopsy samples of HER2-positive (N = 75) and triple-negative (N = 56) breast cancer patients. We evaluated target protein expression across both tumor and surrounding stroma within these tissue samples. RESULTS:Chemotherapy significantly increased AQP5 and NRF2 expression in both tumor cells and stroma across both subtypes. However, when stratified by therapy response, significant upregulation of AQP5 and nuclear NRF2 was observed only in the pathological incomplete response group. In contrast, patients achieving a complete response showed no significant changes in protein expression post-therapy. CONCLUSION:Chemotherapy is associated with increased AQP5 expression and NRF2 nuclear translocation within both tumor cells and stroma. These post-therapy molecular changes are significantly associated with a lack of pathological complete response, suggesting that AQP5 and NRF2 may be involved in resistance to chemotherapy in HER2-positive and TNBC.
Carbohydrate restriction has been proposed as an adjunctive strategy in cancer, largely because many tumours show high glucose uptake. Clinical evidence for benefit remains limited, mixed, and often overstated. Lactate is now recognised as more than a metabolic by-product: it influences redox balance, tumour-stromal signalling, immune suppression, angiogenesis, epigenetic regulation, and metastatic behaviour. This review considers carbohydrate-restrictive diets from a lactate-centred perspective. The stronger mechanistic argument is not simple glucose deprivation, but the possibility that lower carbohydrate availability may reduce glucose-to-lactate flux and disrupt lactate-dependent tumour ecosystems in selected contexts. It discusses where this idea is biologically plausible, where claims run beyond the data, and how dietary approaches compare with direct lactate-targeted strategies. To ground the clinical discussion, registered interventional trials of caloric and/or carbohydrate manipulation in cancer were reviewed; they show an active but early-stage field dominated by small, heterogeneous studies and few direct lactate-related endpoints. Future trials should use biomarker-guided tumour selection, direct measures of tumour lactate flux, immune and microenvironmental endpoints, and explicit safeguards for weight, muscle mass, treatment tolerance, and quality of life. At present, carbohydrate restriction should remain investigational and be tested only in well-designed clinical studies with clear nutritional safeguards.
Objective: This study aimed to investigate the relationship between vitamin D receptor gene polymorphism and vitamin D levels with asthma severity, control level and exacerbation status in asthmatic patients. Subjects and Methods: Over a six-month period, 162 patients diagnosed with asthma and 85 healthy volunteers were prospectively evaluated. Blood samples were analyzed for Vitamin D receptor gene polymorphism by PCR and periostin by ELISA. Results: Among the study participants, 163 were females and 84 were males. The median value of Vitamin D in the patient group was significantly lower at 13.95 (3.5-33) compared to 17 (6.1-39.9) in the control group (p = 0.003). A significant positive correlation was found between Vitamin D and Asthma Control Test (ACT), eosinophil count, Peak Expiratory Flow (PEF, %) (r:0.18 to 0.25 p < 0.05). When VDR gene polymorphism Fok1 and Apa1 alleles in the patient and control groups were examined, they were found to be similar (p > 0.05). However, when VDR gene polymorphism genotypes were analyzed in terms of vitamin D levels, no significant difference was found between Apa1 genotypes (CC, CT, TT). Regression analysis of variables which are considered to influence Vitamin D levels showed that gender and PEF are independent determinants. Conclusions: In our study, a significant relationship was found between Vitamin D levels and asthma severity, asthma control level, and respiratory functions. However, no significant effect of VDR gene polymorphism was detected on the vitamin D levels and asthma.
Objectives: The risk of myocardial infarction (MI) evolves beyond the acute phase, and in-hospital tools, such as the Global Registry of Acute Coronary Events (GRACE) score, may not fully capture long-term vulnerability. We evaluated whether simple longitudinal clinical and patient-reported measures improved the prediction of major adverse cardiovascular events (MACEs). Subjects and Methods: In this prospective cohort study, 351 patients with first MI were enrolled at a rural tertiary center in South India, of whom 319 formed the analytic cohort. MACE was defined as cardiovascular death, non-fatal MI, stroke, heart failure hospitalization, or urgent coronary revascularization, as ascertained through hospital records and structured follow-up. Baseline clinical, biochemical, echocardiographic, and interviewer-administered Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and sleep variables were collected during hospitalization and follow-up (1, 6, and 12 months). Cox models were developed in stages, with the GRACE score as a baseline anchor and follow-up variables incorporated using the last available observations. Model performance was assessed using Harrell’s concordance index (C-index), time-dependent area under the curve, and bootstrap validation methods. Results: Over a median follow-up of 5.8 years, 94 patients (29.5%) experienced MACE. The baseline model modestly improved discrimination over GRACE alone (C-index, 0.622 vs. 0.556). The extended model showed higher discrimination (apparent C-index 0.684; optimism corrected 0.660). Follow-up sleep quality, psychosocial symptoms, glycemic measures, and global longitudinal strain contributed to the model, although the estimates were imprecise. Conclusion: Longitudinal follow-up measures provided modest incremental prognostic information beyond a GRACE-based benchmark. Findings are exploratory and require external validation before clinical application.
Postpartum thyroiditis (PPT) is a common autoimmune sequela of pregnancy, affecting 5-10% of women, a considerable percentage of whom ultimately develop lifelong hypothyroidism. The disorder's characteristic symptoms, such as debilitating tiredness and cognitive impairment, are frequently misattributed to the routine challenges of new parenthood, leading to delayed diagnosis and adverse effects on maternal quality of life and newborn development. Evidence suggests that the currently utilized reactive, clinic-based model of care may be insufficient to address this significant and often overlooked public health concern.The fundamental paradigm change toward a proactive, community-based treatment strategy to secure long-term maternal thyroid health. We synthesize available evidence on PPT pathophysiology, including the post-delivery immunological rebound, and examine the potential role of diet and micronutrient supervision in both primary and secondary prevention. We detail the function of essential micronutrients, including the delicate balance of iodine, the antioxidant protection provided by selenium, and the necessity of iron for thyroid hormone production. Available data suggest that while high iodine consumption is a modifiable risk factor, dietary shortages in these and other key nutrients may significantly exacerbate thyroid dysfunction.This review outlines a comprehensive Community-Based Care (CBC) framework that transcends conventional clinical settings, advocating for the integration of telehealth with trained community health professionals to provide systematic screening, education, and professional dietary oversight. By prioritizing the identification of at-risk women and implementing consistent, personalized nutritional management, this methodology offers a robust approach to proactive prevention, thereby reducing the significant long-term burden of PPT and improving maternal health outcomes.
OBJECTIVES:This study characterized cytokine profiles in peripheral blood mononuclear cells (PBMC) and neutrophils following SARS-CoV-2 vaccination with Pfizer-BioNTech (mRNA-based) and AstraZeneca (adenoviral vector-based) vaccines in Kuwait. SUBJECTS AND METHODS:The study included 200 adult participants: 100 unvaccinated healthy controls; 18 recipients of two Pfizer-BioNTech doses; 32 recipients of two AstraZeneca doses; and 50 recipients of a third Pfizer-BioNTech dose. Blood samples were collected at 0-2 months and 3-6 months after vaccination, and cytokines were measured in mitogen-stimulated PBMC and neutrophil culture supernatants. RESULTS:Both vaccine platforms induced measurable cytokine responses, but the cytokine patterns differed according to vaccine type, cell population, and time after vaccination. Pfizer-BioNTech vaccination was associated with an early Th2-skewed profile in PBMC, while AstraZeneca vaccination showed broader activation of Th1/Th2/Th17-associated cytokines. IL-6 and IL-10 decreased over time in several comparisons; however, these findings should be interpreted with caution because cytokine concentrations are dynamic and may vary with sampling time, cell type, and stimulation conditions. Overall, vaccine-induced cytokine profiles waned by 3-6 months after primary vaccination, whereas the third Pfizer-BioNTech dose enhanced several PBMC cytokine responses. CONCLUSIONS:These findings support the immunomodulatory effects of SARS-CoV-2 vaccines and highlight the value of booster vaccination for sustaining cellular immune responsiveness.
OBJECTIVES:The objectives of the study were to evaluate the efficacy of the Problem-Based Learning (PBL) with the Bridge-in, Objective, Pre-assessment, Participatory learning, Post-assessment, and Summary (BOPPPS) PBL-BOPPPS model compared to conventional instruction in endocrinology clinical education, focusing on academic outcomes and learner satisfaction. METHODS:This is a quasi-experimental study and was conducted at the Affiliated Guangdong Second Provincial General Hospital (January 2022-September 2025). A total of 285 students were enrolled (BS Cohort: PBL-BOPPPS, n = 105; TT Cohort: Conventional, n = 180). RESULTS:The BS cohort achieved significantly higher median scores across all evaluation components, including written exam (52 vs. 47.5, p < 0.001) and total score (68 vs. 58, p < 0.001). Student satisfaction was also higher in the BS cohort (median 14 vs. 13, p < 0.001). Granular analysis revealed consistently higher satisfaction across all 10 items, with the largest differences in creativity, clinical thinking, interest, and communication skills. Correlation analyses demonstrated significant positive associations between academic performance and satisfaction (rs = 0.433, p < 0.001), attendance and exam performance (rs = 0.7449, p < 0.001), case-based video learning and exam performance (rs = 0.5125, p < 0.001), and clinical thinking with creativity (rs = 0.8604, p < 0.001). CONCLUSION:The PBL-BOPPPS model significantly improved academic performance and student satisfaction compared to conventional instruction in endocrinology clinical education. Its structured, interactive design enhanced both cognitive and affective learning outcomes, supporting its adoption in competency-based medical education.
Radiomics makes it possible to extract quantitative data from medical images, revealing details about tissue heterogeneity that are not apparent from visual evaluation alone. Conventional evaluation of temporomandibular joint (TMJ) imaging still primarily relies on qualitative morphological criteria that primarily detect late-stage structural alterations. This narrative review summarizes current evidence on quantitative imaging of the mandibular condyle and subchondral bone within the TMJ, with emphasis on radiomics applications using computed tomography (CT), cone-beam CT (CBCT), and magnetic resonance imaging (MRI). Studies have shown that texture and morphometric features derived from CT and CBCT can reflect trabecular organization and subchondral remodeling, with some parameters validated against micro-CT in experimental settings. MRI-based approaches are particularly sensitive to changes in subchondral bone marrow, especially in inflammatory and degenerative conditions, even when morphological alterations are subtle or absent. Radiomic features can detect patterns associated with joint degeneration and adaptation across imaging modalities. However, variability in acquisition protocols, segmentation methods, and limited longitudinal data still restrict their clinical application. At present, quantitative imaging should be considered a research tool that may support the development of imaging biomarkers and contribute to a better understanding of TMJ disease.
Different degrees of chronic metabolic inflammation and adiponectin resistance significantly contribute to the development of cardiovascular diseases and metabolic syndrome. Adiponectin is a unique pleiotropic adipokine with anti-inflammatory, antiatherogenic, and antidiabetic effects. In early metabolic dysfunction, adiponectin levels increase as a compensatory response, whereas in advanced coronary disease, hypoadiponectinemia develops due to adiponectin resistance. The aim of this review was to highlight how contemporary cardiovascular therapies alter adiponectin levels and why this is clinically important for reducing low-grade systemic and vascular inflammation in chronic coronary syndromes. Evidence suggests that drug classes such as peroxisome proliferator-activated receptor agonists, sodium-glucose transport proteins inhibitors, glucagon-like peptide-1 receptor agonists, renin-angiotensin-aldosterone system blockers, metformin, certain statins, and fibrates may increase adiponectin levels, although effects vary by drug class and disease stage. Although adiponectin represents a promising therapeutic target for the treatment of coronary syndromes, further experimental and pharmacological research is necessary to develop drugs based on its mechanism of action.
