Achievements and Challenges of Medicine and Medical Science Vol. 3
This book covers key areas of medicine and medical science. The contributions by the authors include behavioral attitudes, HPV infection, low-risk and high-risk HPVs, school-based HPV interventions, maxillary and mandibular morphology, mandibular growth, craniofacial development, vertical development of the facial skeleton, tissue engineered vascular grafts, cardiovascular disease, 3D print vascular grafts, protein phosphatase 2A, Dulbecco’s modified Eagle’s medium, human pancreatic normal cells, stability of PR55\(\alpha\) protein, schizophrenia, randomized controlled trials, electroconvulsive therapy, transcranial direct current stimulation, repetitive transcranial magnetic stimulation, adrenomedullin, anti-vascular endothelial growth factor therapy, angiogenesis, metastasis, adjunctive periodontal therapy, periodontal waterlase, root surface biomodification, periowave TM, personal protective equipment. This book contains various materials suitable for students, researchers, and academicians in the fields of medicine and medical science.
Varying Behavioral Attitudes and Correlates of HPV Infection among Young Adolescents in Benue State, Nigeria: A Cross-Sectional Study
Aim: This study aims to assess the knowledge of HPV infection and the practice of primary prevention, the willingness of HPV uptake, and attitudinal differences and correlates among randomly sampled secondary school students across the three senatorial districts of Benue State, Nigeria. Background: Human Papillomavirus (HPV) infection is a significant public health concern globally, especially in low- and middle-income countries. It is one of the most prevalent sexually transmitted infections (STIs). In Africa, including Nigeria, HPV prevalence is high, contributing to a substantial burden of cervical cancer. Despite challenges, massive HPV vaccination campaigns in Africa show promise for preventing cervical cancer cases. In Benue State, Nigeria, limited research exists on several aspects of HPV knowledge and attitudes towards HPV among secondary school students. Methods: The cross-sectional study was conducted among adolescents aged 10–19 years in six secondary schools in three local government areas (LGAs) in Benue State, Nigeria. Two-stage sampling was used to select the LGAs and schools, with a final sample size of 591 students. Within these schools, students were recruited using simple random sampling, which gives every student an equal chance of being selected, ensuring fair representation. The selected schools represent both junior and senior secondary school levels and span across the three senatorial districts of the state. Data were collected using a self-administered questionnaire covering sociodemographic characteristics, HPV knowledge, prevention practices, and willingness for HPV vaccination. Statistical analyses included univariate analyses and tests of association, with significance set at p < 0.05 or 0.001 depending on the level of the stringency of the evidence required. Data were analysed using SPSS version 25. Results: This study found a statistically significant median difference in the perceived knowledge that HPV infection is a sexually transmitted infection (STI) based on age. Only 35.4% of the participants were males, and 86.8% were between the ages of 10 and 16. Only 24.7% acknowledged that HPV can be transmitted during sexual intercourse, and 36.2% recognized that HPV can be transmitted via skin-to-skin contact. In the survey, 48.1% noted that HPV can cause cervical cancer. Around half (50.9%) acknowledged that early sexual debut increases the risk of acquiring HPV, while only 28.1% recognized vaccination as a preventive strategy against HPV infection. Only 35% correctly stated the best time for the HPV vaccine. In assessing the practice of HPV prevention, 14.9% are in a sexual relationship and 10.3% admitted to not using condoms during sexual intercourse. Also, 11.8% have had STIs, and 27.2% have previously undergone HIV screening. Various bivariate analyses showed some varying behavioural differences and correlates of HPV infection among young adolescents in Benue State, Nigeria. Conclusions: This study provides valuable insights into HPV knowledge, prevention practices, and willingness to uptake HPV vaccination among secondary school students in Benue State, Nigeria. The significance of the differences and correlates was discussed using themes. The research has unpacked complex relationships that could have public health implications for researchers and policymakers. Moreover, ten actionable policy recommendations were prescribed. Several interventions and areas for further study were proposed. The study also recommended that public health campaigns can leverage existing infrastructure, and healthcare providers can play a key role in raising HPV awareness.
Copyright (c) 2024 Author(s). The licensee is the publisher (BP International).
A Review on the Clinical Application for Tissue Engineered Vascular Grafts
Cardiovascular-related medical conditions remain a significant cause of death worldwide despite the advent of tissue engineering research more than half a century ago. There is a continued and growing demand for vascular conduits for reconstructing or bypassing vascular occlusion and aneurysms. Although autologous tissue is still the preferred treatment, donor tissue is limited, and there remains a need for tissue engineered vascular grafts (TEVGs). The production of particularly large vascular tissue (> 1 cm3) in vitro meets the clinical needs of tissue grafts and biological research applications. The use of TEVGs in human patients remains limited due to issues related to thrombogenesis and stenosis. In addition to the advancement of simple manufacturing methods, the shift of attention to the combination of synthetic polymers and bio-derived materials and cell sources has enabled synergistic combinations of vascular tissue development. The aim of the study was to propose potential solutions and prospects in this highly dynamic field of research. This review detailed the selection of biomaterials and cell sources and related clinical trials in developing large diameter vascular grafts that can be applied clinically. Finally, the remaining challenges in the tissue engineering field which can be seen from complex requirements by covering both basic and clinical research from the perspective of material design, have been discussed. The study concludes that while autologous tissue has been successfully used to treat many cardiovascular diseases (e.g., atherosclerosis), autologous vascular tissue for transplantation is often insufficient. Therefore, the development of TEVGs offers a promising alternative. Advances in TEVG manufacturing technologies could potentially address these limitations in the near future. Additionally, the ability to 3D print vascular grafts with satisfactory properties is now a reality, offering new possibilities for treatment.
A Review of Treatment of Schizophrenia in Children and Adolescents
Objective: The primary objective of the study is to understand the current research status of treatments for schizophrenia in children and adolescents, and to clarify their effectiveness and shortcomings. Methods: We searched CNKI, Embase, Medline, and PsycInfo databases for systematic reviews, or randomized controlled trials (RCTs) of pharmaceutical and non-pharmaceutical interventions implemented in patients with childhood or adolescent onset schizophrenia. Results: Forty-eight articles were suitable for this review. The safety of antipsychotic drugs has not been fully determined though pharmacological therapy is generally considered to have a fast onset and significant therapeutic effect. Electroconvulsive therapy (ECT) has good efficacy and few adverse reactions, especially for symptoms of tension and stiffness, but it has strict indications and operational requirements. Repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and music therapy can increase cortical excitability, and improve the morphology of brainwaves and cognitive function, but clinical studies are limited. Clinical practice has shown that psychotherapies can reduce positive and negative symptoms, alleviate emotional disorders, correct cognition and personality, and promote social rehabilitation, their effectiveness needs to be confirmed by evidence-based medicine. Conclusion: Each therapy has its own advantages and disadvantages, and comprehensive treatments should be adopted according to the condition.
Evaluation of Maxillary and Mandibular Morphology in Different Vertical Facial Types: A Cephalometric Analysis
Background: The direction and amount of mandibular growth are important factors in orthodontic diagnosis and treatment planning as normal maxillary and mandibular growth is essential for well-balanced craniofacial development. Vertical development of the facial skeleton has been related to many skeletal units, like the nasomaxillary complex, the alveolar processes, and the mandible. These are all associated with normal and abnormal vertical growth patterns. Aims and Objectives: The aim of the study is to evaluate the maxillary and mandibular morphology in different vertical facial types and to implicate the achieved results into the diagnosis and treatment planning of patients requiring orthodontic treatment. Materials and Methods: The present study is conducted on a sample of 120 subjects comprising 60 males and 60 females in the age range of 18 to 25 years. The lateral head cephalograms of the subjects were divided into three groups, i.e. group I (hypodivergent), group II (normodivergent) and group III (hyperdivergent) with regard to vertical facial type by using the following three parameters, i.e. SN-MP (facial divergence angle), overbite depth indicator (ODI) and Jarabak ratio or facial height ratio (FHR). Differences among the groups and between genders were assessed by means of variance analysis and the Newman-Keuls post hoc test. The cephalometric tracing for area measurement was scanned using a scanner (HP 2400). A scanned version of the tracing was then digitized and area measurements were made twice by the same operator using AutoCAD® 2006. Results: Maxillary and mandibular anterior alveolar and maxillary postalveolar height was found to be greater for the hyperdivergent group in comparison to others. Hyperdivergent facial types possess long and narrow symphysis along with greater antegonial notch depth whereas hypodivergent showed an opposite tendency. Hyperdivergent facial types generally have a smaller maxillary area as compared to other facial types. However, the total mandibular area does not vary among different vertical facial types. Sexual dichotomy was found with maxillary anterior alveolar and basal height, mandibular posterior alveolar and basal height, mandibular length, symphyseal depth, depth of the antegonial notch, symphyseal area and external to total (ext/total) symphyseal area ratio. Conclusion: Vertical facial type may be related to the morphological and dentoalveolar pattern of both maxilla and mandible. Determination of this relationship may be of great help from diagnostic as well as therapeutic aspects of many vertical malocclusion problems. Additionally, hyperdivergent facial types possess greater antegonial notch depth as compared to hypodivergent facial types.
p53 Negatively Regulates the PR55\(\alpha\) Subunit of PP2A Ser/Thr Phosphatase Via FBXL20-mediated Proteasomal Degradation
Protein Phosphatase 2A (PP2A) is a family of holoenzyme complexes, which constitute the major Ser/Thr phosphatase activities in human cells. Each PP2A complex consists of one catalytic subunit, one scaffold subunit, and a regulatory subunit. The latter determines the substrate specificity of the PP2A complex. PR55\(\alpha\) is one of PP2A’s 27 possible regulatory subunits. Previous studies by us and others have defined an important role for PR55\(\alpha\) in the support of critical oncogenic pathways required for tumorigenesis and the malignant phenotype of pancreatic cancer. Our studies subsequently reveal a novel function of the p53 tumor suppressor in inhibiting the protein stability of PR55\(\alpha\) via FBXL20, a p53-target gene that serves as a substrate recognition subunit for the SCF (Skp1_Cullin1_F-box) E3 ubiquitin ligase complex. HPNE-E6, HPNE-E7, and HPNE-E6/E7 cell lines were established by transducing HPNE cells with retroviral vectors expressing the E6 and/or E7 proteins of the HPV 16 virus. All antibodies were purchased from Cell Signaling Technology (Danvers, MA) unless otherwise indicated. Immunoblotting (IB) and immunoprecipitation (IP) were performed. Immunofluorescence and microscopy were also performed. For statistical analysis, Student’s t-test and one-way ANOVA methods were used for the comparison of experimental groups using SigmaPlot software. The results show that inactivation of p53 by siRNA-knockdown, gene-deletion, HPV/E6-mediated degradation, or expression of the loss-of-function mutant p53R175H results in increased PR55\(\alpha\) protein stability, accompanied by reduced protein expression of FBXL20 and decreased ubiquitination of PR55\(\alpha\). Likewise, knockdown of FBXL20 by siRNA mimics p53 deficiency, reducing PR55\(\alpha\) ubiquitination and increasing PR55\(\alpha\) protein stability. Functional tests indicate that p53R175H or PR55\(\alpha\) overexpression results in an increase of c-Myc protein stability with concomitant dephosphorylation of c-Myc-T58, which is a PR55\(\alpha\) substrate, whose phosphorylation otherwise promotes c-Myc degradation. A significant increase in anchorage-independent proliferation is also observed in normal human pancreatic cells expressing p53R175H or, to a greater extent, overexpressing PR55\(\alpha\). Consistent with the frequent loss of p53 function in pancreatic cancer, FBXL20 mRNA expression is significantly lower in pancreatic cancer tissues compared to pancreatic normal tissues and low FBXL20 levels correlate with poor patient survival. In summary, this chapter delineates an important new mechanism by which the p53/FBXL20 axis negatively regulates PR55\(\alpha\) protein stability as a part of p53’s tumor suppression function.
Exploring the Role of Adrenomedullin in Overcoming Resistance to Anti-VEGF Therapy in Oncology
This study reviews the physiological and pathological processes mediated by AM, analyzing the advantages that the employment of anti-AM therapy may offer in oncology. The development, maintenance and metastasis of solid tumors are highly dependent on the formation of blood and lymphatic vessels from pre-existing ones through a series of processes that are respectively known as angiogenesis and lymphangiogenesis. Both are mediated by specific growth-stimulating molecules, such as the vascular endothelial growth factor (VEGF) and adrenomedullin (AM), secreted by diverse cell types that involve not only the cancerogenic ones, but also those constituting the tumor stroma (i.e., macrophages, pericytes, fibroblasts, and endothelial cells). In this sense, anti-angiogenic therapy represents a clinically-validated strategy in oncology. Current therapeutic approaches are mainly based on VEGF-targeting agents, which, unfortunately, are usually limited by toxicity and/or tumor-acquired resistance. AM is a ubiquitous peptide hormone mainly secreted in the endothelium with an important involvement in blood vessel development and cardiovascular homeostasis. In this review, we will introduce the state-of-the-art in terms of AM physiology, while putting a special focus on its pro-tumorigenic role, and discuss its potential as a therapeutic target in oncology. A large amount of research has evidenced AM overexpression in a vast majority of solid tumors and a correlation between AM levels and disease stage, progression and/or vascular density has been observed. In general, AM expression is upregulated by hypoxia, and the excessive production of this peptide is associated with poorer prognosis in cancer patients. Moreover, recent reports indicate that AM could be a master regulator upstream of the VEGF pathway and even induce HIF-1a expression, therefore attracting much interest as a therapeutic strategy. The analysis presented here indicates that the involvement of AM in the pathogenesis of cancer arises from: 1) direct promotion of cell proliferation and survival; 2) increased vascularization and the subsequent supply of nutrients and oxygen to the tumor; 3) and/or alteration of the cell phenotype into a more aggressive one. Furthermore, we have performed deep scrutiny of the pathophysiological prominence of each of the AM receptors (AM1 and AM2) in different cancers, highlighting their differential locations and functions, as well as regulatory mechanisms. From the therapeutic point of view, we summarize here an exhaustive series of preclinical studies showing a reduction of tumor angiogenesis, metastasis and growth following treatment with AM-neutralizing antibodies, AM receptor antagonists, or AM receptor interference. The study stated that current clinical trials with adrecizumab will be more than interesting in addressing the feasibility of this strategy in oncology. Nevertheless, the blockade of AM receptors might represent a more suitable alternative. Moreover, the recent FDA approval of the CGRP receptor-targeting erenumab/Aimovig® antibody encourages the application of the anti-AM receptors strategy in oncology. Anti-AM therapy is a promising strategy to be explored in oncology, not only as an anti-angiogenic alternative in the context of acquired resistance to VEGF treatment but also as a potential anti-metastatic approach.
Tumor Budding and Its Clinicopathological Correlations in Invasive Breast Carcinoma: A Cross-sectional Study
Introduction: Breast carcinoma is the leading cause of cancer-related mortality among women in India. Tumor budding is usually defined as isolated single cancer cells or clusters of up to four cancer cells located at the invasive tumor front. Tumor budding is associated with poor clinicopathological characteristics, such as Tumor size, tumor differentiation, lymph node invasion, lymphatic or vascular invasion, etc. One of the poor prognostic factors in breast carcinoma is an association between tumor budding and positive lymph node metastasis. Henceforth, tumor budding could be a reliable parameter that predicts the aggressive behaviour of tumor, overall survival, risk of recurrence, hormonal therapy response, distant metastasis along with the response to chemotherapy and targeted therapy. Tumor buds which are predominantly located at the invasive tumor front are associated with epithelial-mesenchymal transition (EMT) and are an essential part of the tumor microenvironment. Aims: The aim of the study is to study tumor budding, predominantly located at the invasive tumor front representing EMT and its association with known clinicopathological parameters like age, tumor size, grade, laterality, LVI, lymph node metastases, treatment status and hormone receptor status in invasive breast carcinoma. Materials and Methods: The index study is a cross sectional study of 50 mastectomy and lumpectomy specimens. It was conducted after approval from the ethics committee. Before conducting the study, informed consent was taken from all the participants whose biopsies were considered for the study. The duration of the study was 1.5 years from January 2022 to June 2023. The number of tumor buds was counted in 10 low-power fields (10x) of hematoxylin and eosin-stained sections. Tumor buds were further classified into low grade(<10/10 HPF) and high grade (\(\ge\)10/10 HPF) in most infiltrative areas at higher magnification (400x). Chi-square tests were used to know the association between tumor budding and the included variables of the study, pvalue<0.05 was considered statistically significant. Results: A total of fifty cases of invasive breast carcinomas were included in this study. Here, 70%(35 cases) were >50 years of age, and 65% (33 cases) were in T2 (tumor size) category. Also, 82%(41 cases) of Invasive duct carcinoma, No specific type, 12% (6 cases) of mixed carcinomas followed by three cases, one is invasive lobular carcinoma (6%), others are invasive papillary carcinoma (6%) and mucinous carcinoma (6%). Moreover, 76% (38 cases) showed presence of lymphovascular invasion, 74% (37 cases) showed absence of necrosis, 54%(27 cases) were categorized as grade 2. High-grade tumor budding was seen in 54% (27 cases). Conclusion: The following variables had a significant association with the tumor budding in the present study - Tumor size, TNM staging, treatment status, and lymphovascular invasion showing a p-value of <0.05. ER-positive tumors are also associated with high-grade tumor budding.
Recent Advances in Laser as an Adjunctive Periodontal Therapy
Since laser applications have been used in practically all dental specialties for more than 20 years their use in dentistry is not a novel approach. They can be used as a diagnostic tool to detect caries and subgingival calculus, as a cutting tool for hard dental tissues and as a disinfectant for root canals. Lasers can treat both soft and hard tissues, Calculus removal (erbium yttrium scandium gallium garnet and erbium yttrium aluminum garnet lasers), bio-stimulating root and implant surfaces, incision and ablation, osseous surgery, soft tissue excision, and bacterial reduction, are the various applications used in periodontology. Moreover their high sources of light, or more specifically non-ionizing, electromagnetic radiation, include lasers. The wavelengths of laser radiation are well-defined and predictable, and indeed the radiation seems to be more powerful at these wavelengths than can be produced by traditional light sources. Sutures are rarely indicated, there is very little possibility of mechanical trauma, and there is little scarring caused by lasers. The high proportion of patient acceptance of laser dentistry is one of its great advantages. Today’s patients are aware of lasers' benefits and today's dental lasers are portable, lightweight, compact, and becoming ever more accessible. Considering lasers used in dentistry, the prognosis seems optimistic. Practitioners can benefit from this new technology by knowing further about lasers and this form of light's attributes.