Bosnian Journal of Basic Medical Sciences
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Clinical profile and risk factors for respiratory failure in children with Mycoplasma pneumoniae infection
Full text linkMycoplasma pneumoniae (MP) is a common cause of community-acquired pneumonia (CAP) in children and can lead to severe complications, including respiratory failure. A retrospective analysis of 2084 children diagnosed with CAP and treated in our hospital from January 2022 to January 2023 was conducted. A comprehensive dataset of patient demographics, clinical symptoms, and laboratory findings was initially assembled. Subsequent statistical analyses were carried out to elucidate the clinical characteristics of MP pneumonia (MPP) in children. Additionally, the study identified high-risk factors for respiratory failure in the context of MPP. Among the hospitalized MPP cases, 15.8% progressed to respiratory failure. Statistical analysis identified D-dimer level as a significant risk factor for respiratory failure in children with MPP. A predictive model was developed using D-dimer levels, yielding an area under the curve (AUC) of 0.818 with a cutoff value of 1.015 mg/L. The model demonstrated a sensitivity of 62.4% and a specificity of 91.3%, proving effective in predicting respiratory failure caused by MPP. Respiratory failure remains a critical complication in children with MPP, and D-dimer levels serve as a key predictive risk factor. Vigilant monitoring of coagulation function, particularly D-dimer levels, is essential for the early identification of patients at risk of developing respiratory failure in MPP cases
DPP4 rs17574 polymorphism and elevated DPP4 levels linked to fatty liver in subclinical atherosclerosis: GEA study findings
Full text linkDipeptidyl peptidase-4 (DPP4) concentrations are known to correlate with nonalcoholic fatty liver (FL), which is also associated with subclinical atherosclerosis (SA). This study aimed to determine whether DPP4 concentrations and the DPP4 rs17574 polymorphism are associated with FL in individuals with SA. The study included 378 participants with SA, of whom 143 had FL and 235 did not. DPP4 serum concentrations were measured using a Bioplex system, and DPP4 rs17574 genotypes were determined using TaqMan assays. Logistic regression was used to assess the relationships between FL, DPP4 concentrations, and rs17574 genotypes. Overall, DPP4 concentrations did not differ significantly between individuals with and without FL. No significant differences in DPP4 levels were observed among DPP4 genotypes in the total sample. However, within the FL group, significant differences in DPP4 concentration were observed across genotypes: AA genotype (134 [106–175] ng/mL), AG genotype (128 [114–149] ng/mL), and GG genotype (80 [71–117] ng/mL); P = 0.019. The DPP4 rs17574 polymorphism was associated with FL under a recessive model (P = 0.037). DPP4 concentration was also significantly associated with FL: the likelihood of presenting with FL increased by 6.2% for every 10 ng/mL increase in DPP4 levels (P = 0.009). These findings suggest that DPP4 concentration may serve as a biochemical risk marker for FL in individuals with SA. Moreover, the rs17574 polymorphism may influence DPP4 protein levels, particularly in those with FL. To our knowledge, this is the first study to describe an association between DPP4 concentration, the rs17574 polymorphism, and FL. Assessing DPP4 levels may offer a novel and effective strategy for risk stratification of FL in SA populations
Profiling of sesquiterpenoid fractions from Artemisia annua L. and testing their in vitro anti-SARS-CoV-2 activity
Full text linkThe current state of research on the anti‑SARS‑CoV‑2 potential of artemisinin‑related compounds has identified arteannuin B as a potent inhibitor of the nCoV‑2019BetaCov/Wuhan/WiV04/2019 and BetaCov/Italy/CDG1/2020 strains of the virus. The aim of this work was to fractionate the targeted sesquiterpenoid compounds, arteannuin B and artemisinin, from the complex matrix of the crude ethanolic leaf extract of Artemisia annua L. using high‑speed countercurrent chromatography (HSCCC) and to test the simplified or purified fractions against the genomically characterized Alpha SARS‑CoV‑2 variant in vitro. This is the first detailed in vitro anti‑SARS‑CoV‑2 study using an analytically characterized supercritical fluid extract of A. annua L. The preparative HSCCC method enabled the isolation of purified arteannuin B in a single chromatographic step, which was confirmed by LC‑ESI‑QTOF‑MS/MS. The MS data confirmed the selectivity of the HSCCC method for the targeted fractionation of artemisinin from the complex matrix, as it was successfully separated from the EtOH crude extract without co‑elution with arteannuin B. Antiviral activity determined by quantitative real‑time PCR (qRT‑PCR) yielded half‑maximal effective concentrations (EC₅₀) of 93.7 µg/mL (SC‑CO₂ extract), 173.5 µg/mL (EtOH extract), 187.3 µg/mL (artemisinin knockout fraction), 38.1 µg/mL (arteannuin B fraction), and >100 µg/mL (artemisinin). The arteannuin B fraction was highly active at 50 µg/mL (p < 0.0001) and 100 µg/mL (p < 0.0001), and inhibited the amplification of the SARS‑CoV‑2 N and RdRp genes by 84% and 100%, respectively. An important contribution of this study is the demonstration of the antiviral activity of arteannuin B against the Alpha variant of SARS‑CoV‑2, which is known to have increased infectivity and transmissibility
PJ34 prevents cisplatin-induced hair cell loss via inhibition of PARP-1–AIF parthanatos
Full text linkThe poly (ADP-ribose) polymerase-1 (PARP-1) inhibitor PJ34 acts as an anti-inflammatory and neuroprotective agent by modulating parthanatos. This study aimed to explore the protective effects of PJ34 against cisplatin-induced injury in auditory cells and to elucidate its underlying mechanism of action. Flow cytometry and immunofluorescence were employed to detect apoptosis in HEI-OC1 and ovarian cancer cell lines. Additionally, immunofluorescence and Western blotting were used to assess changes in the expression of related proteins, including cleaved Caspase-3, PARP-1, and cytosolic apoptosis-inducing factor (AIF), across the groups. Mitochondrial membrane potential (MMP) levels were measured using the MMP assays, and reactive oxygen species (ROS) levels were assessed by MitoSox red staining. Our results indicate that treatment with 30 μM cisplatin activates cleaved Caspase-3, promotes PARP-1 overexpression, and facilitates AIF nuclear translocation, leading to decreased MMP and increased ROS accumulation, which ultimately triggers auditory cell death. Treatment with 2.5 μM PJ34 mitigated PARP-1 overexpression and AIF nuclear translocation following cisplatin exposure, reduced the decline in MMP, and decreased ROS accumulation, thereby alleviating damage to auditory cells. Conversely, PJ34 enhanced the damaging effects of cisplatin on ovarian cancer cell lines. In conclusion, our findings suggest that PJ34 may reduce cisplatin-induced hair cell death by regulating PARP-1-mediated parthanatos. Notably, PJ34 shows promise as a potential novel therapeutic agent for the prevention and/or treatment of cisplatin-induced ototoxicity
Letter regarding "Association between triglyceride-glucose (TyG) index and risk of depression in middle-aged and elderly Chinese adults: Evidence from a large national cohort study."
Full text linkThis correspondence addresses the recent study by Xu et al. examining the relationship between the triglyceride-glucose (TyG) index and depression in older Chinese adults. The study\u27s identification of a J-shaped association between TyG levels and depressive symptoms adds meaningful insight into the connection between metabolic health and mental well-being. However, when considered alongside other findings, including those using combined indices such as TyG-BMI and TyG-WHtR, the results suggest that a broader, multidimensional approach may offer greater predictive value. Supporting studies have linked these composite measures not only to depression but also to wider metabolic and cardiovascular risks. Additionally, other reviews highlight the potential link between TyG and more severe psychiatric conditions. The letter emphasizes the need for further research, especially longitudinal and interventional studies, to clarify causal relationships and explore whether improving metabolic health can help prevent or reduce depressive symptoms. The authors encourage continued exploration of metabolic indicators not just as risk markers but as possible targets for intervention.
Response to the Letter regarding "Association between triglyceride-glucose (TyG) index and risk of depression in middle-aged and elderly Chinese adults: Evidence from a large national cohort study."
Full text linkThis response addresses constructive feedback on our CHARLS cohort study linking the triglyceride-glucose (TyG) index to depressive symptoms. As noted by the letter\u27s author, a substantial body of research on TyG-related composite indices and mental disorders has emerged, with inconsistencies in cutoff values and the shape of dose-response curves observed among different indices. Our decision to focus solely on the single TyG index in this study was primarily motivated by the following two considerations. Firstly, the study population consisted of elderly individuals, among whom BMI levels cannot effectively reflect metabolic status. Secondly, this study represents a continuation of our group\u27s preliminary preclinical research, thus specifically focusing on the factor of insulin resistance. Different findings derived from different indices necessitate consideration of various factors, including different application contexts, variations in the study populations, and differences in data processing methods. Finally, we believe more large randomized controlled trials and related pharmacological intervention studies are essential to validate the use of TyG and its related indices in the diagnosis and treatment of psychiatric disorders.
This is the response to Letter to the Editor which you can read here: https://www.bjbms.org/ojs/index.php/bjbms/article/view/12739
Beyond BMI: An opinion on the clinical value of AI-powered CT body composition analysis
Full text linkBody Mass Index (BMI) has long been used as a standard measure for assessing population-level health risks, but its clinical adequacy has increasingly been called into question. This opinion paper challenges the clinical adequacy of BMI and presents AI-enhanced CT body composition analysis as a superior alternative for individualized risk assessment. While BMI serves population-level screening, its inability to differentiate between tissue types leads to critical misclassifications, particularly for sarcopenic obesity. AI-powered analysis of CT imaging at the L3 vertebra level provides precise quantification of skeletal muscle index, visceral, and subcutaneous adipose tissues -metrics that consistently outperform BMI in predicting outcomes across oncology, cardiology, and critical care. Recent technological advances have transformed this approach: the "opportunistic" use of existing clinical CT scans eliminates radiation concerns, while AI automation has reduced analysis time from 15-20 minutes to mere seconds. These innovations effectively address previous implementation barriers and enable practical clinical application with minimal resource demands, creating opportunities for targeted interventions and personalized care pathways
Effect of topical nitroglycerin on neoangiogenesis and pedicle-independent viability in a rat dorsal skin flap model
Full text linkInterpolated flaps are frequently used in reconstructive surgery when free tissue transfer is not feasible, but they require staged procedures due to pedicle dependence. Flap autonomization, the process by which transferred tissue develops new vascular connections and survives independently of its pedicle, is essential before division. Although methods such as delay techniques, hyperbaric oxygen (HBO), vascular endothelial growth factor (VEGF), and stem cell therapies have been tested to enhance angiogenesis, the effect of topical nitroglycerin (NTG), a nitric oxide (NO) donor with vasodilatory, anti-inflammatory, and angiogenic properties, has not been investigated. This study aimed to evaluate the effect of topical NTG on neoangiogenesis and flap autonomization in a rat dorsal skin flap model. Sixty Wistar-Albino rats were divided into five groups (n = 12). A 3×3 cm dorsal flap with a caudal pedicle was elevated in all animals. In Groups 1–3, pedicles were transected on day 5: Group 1 received vaseline, Group 2 received NTG for 5 days then vaseline, and Group 3 received NTG continuously. Groups 4 and 5 were sacrificed on day 5 to assess early angiogenesis after vaseline or NTG. Flap survival was analyzed with ImageJ, angiogenesis with VEGF, CD34, and CD105 staining, and histology with Hematoxylin and Eosin (H&E) and Masson’s Trichrome. Flap survival was significantly greater in Groups 2 (485.5 mm²) and 3 (757.3 mm²) than in Group 1 (273.5 mm²), with Group 3 highest (p < 0.01). NTG-treated groups showed increased VEGF, CD34, and CD105 expression, with the strongest angiogenesis in Group 3. Group 5 also had higher vascular proliferation than Group 4 (p < 0.001). Histology showed that NTG reduced epithelial disruption, hemorrhage, collagen degradation, and leukocytic infiltration while enhancing vascular proliferation. In conclusion, continuous topical NTG enhanced angiogenesis and accelerated flap autonomization, leading to greater viability after pedicle division. NTG may help shorten pedicle division intervals and improve outcomes in reconstructive surgery, but further molecular and clinical studies are needed
First-trimester prediction of early-onset preeclampsia using PAPP-A and mean arterial pressure
Full text linkPredicting early-onset preeclampsia (EOP) during the initial stages of pregnancy is essential for effective clinical management and enhancing maternal-fetal outcomes. Current methodologies, which include clinical and demographic risk factors, biophysical parameters, and serum biomarkers, exhibit limited efficacy in predicting EOP. This study aimed to evaluate whether the incorporation of pregnancy-associated plasma protein-A (PAPP-A) and mean arterial pressure (MAP) significantly enhances EOP detection. We conducted a retrospective case-control study involving 518 gravidas, of whom 202 developed EOP and 316 experienced normal pregnancies. Logistic regression models were employed to assess EOP predictions, and the predictive accuracy of these statistical models was evaluated using receiver-operating characteristic curve analysis. Our findings indicate that lower PAPP-A levels, higher MAP, and increased body mass index (BMI) are associated with EOP. Notably, in pregnant women between 11+0 and 13+6 weeks of gestation, a 1-point decrease in PAPP-A corresponds to an 84% increase in the likelihood of developing EOP. The predictive performance of PAPP-A improves significantly when combined with other factors such as BMI, MAP, and a history of diabetes mellitus (DM). The risk of EOP is substantially heightened (20.410 times, 95% CI: 11.104-37.515) in patients exhibiting low PAPP-A levels (<0.88) and high BMI (≥35 kg/m²). Additionally, low PAPP-A combined with elevated MAP levels significantly increases EOP risk (adjusted odds ratio [OR]: 114.83). However, after adjustment, the association between low PAPP-A and a history of DM was not statistically significant (adjusted OR: 2.30, p = 0.202). In conclusion, employing a combination of multiple variables for predicting EOP yields a significant improvement over traditional methods that rely solely on individual factors
Presepsin as a diagnostic biomarker for sepsis across neonates, children, and adults: A meta-analysis
Full text linkSepsis remains a leading global health challenge, with delayed recognition and limited diagnostic accuracy of current tools contributing to high morbidity and mortality. Conventional clinical scores (SOFA/qSOFA), standard biomarkers (CRP, PCT), and blood cultures suffer from delayed responsiveness, insufficient specificity, or slow turnaround, underscoring the urgent need for more reliable early diagnostic strategies. Presepsin, a soluble CD14 subtype generated during pathogen recognition by innate immune cells, has emerged as a promising biomarker with potential to reflect infection status earlier and more specifically than traditional markers. This systematic review and meta-analysis quantitatively evaluated the diagnostic accuracy of presepsin across diverse populations. PubMed, EMBASE, Web of Science, and Cochrane Library were searched for studies published between 2015 and 2025. Forty-seven studies involving 7,087 participants were included. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), area under the curve (AUC), and likelihood ratios (PLR/NLR) with 95% confidence intervals (CI) were calculated using random-effects models. Heterogeneity was assessed with I² statistics, meta-regression, and subgroup analyses. Study quality was evaluated using QUADAS-2. Presepsin demonstrated excellent overall diagnostic performance: pooled sensitivity 0.84 (95% CI: 0.81–0.88), specificity 0.86 (95% CI: 0.80–0.90), DOR 32.23 (95% CI: 20.11–51.66), and AUC 0.91 (95% CI: 0.88–0.93). Subgroup analyses confirmed robust performance across settings and populations, with particularly high accuracy in neonates (sensitivity 0.90, specificity 0.92, AUC 0.96), followed by children (sensitivity 0.84, specificity 0.81, AUC 0.88, NLR 0.20) and adults (sensitivity 0.81, specificity 0.82, AUC 0.87). Meta-regression identified year of publication, geographic region, specimen type, population, and diagnostic criteria as key contributors to heterogeneity, but sensitivity analyses confirmed result stability. No significant publication bias was observed (p = 0.33). In conclusion, presepsin is a valuable and highly promising biomarker for sepsis diagnosis, showing favorable diagnostic accuracy across populations, with strongest utility in neonates. Its application in pediatric and adult patients warrants further validation through large, prospective, multi-center studies