Journal of Clinical Medicine最新文献

Background: Acne vulgaris is a common inflammatory disorder with significant clinical and psychosocial impacts. Medium-depth chemical peels are increasingly used to manage both active acne lesions and atrophic acne scars. This study aimed to quantitatively assess the clinical effectiveness of a novel multimodal medium-depth chemical peel regimen, yellow peel, in improving acne severity and scar depth, as well as skin hydration and sebum production in patients with mild to moderate facial acne. Methods: Twenty patients (17 women and 3 men) aged 20-25 with mild to moderate acne vulgaris underwent two sessions of yellow peel treatment at four-week intervals. The peel protocol combined glycolic acid, salicylic acid, and a multi-acid mask containing retinol, azelaic, phytic, kojic, and salicylic acids. Clinical outcomes were evaluated at baseline, four weeks after the first peel, and two months after the second peel. Assessments included the Investigators Global Assessment (IGA), inflammatory lesion count, 3D scar depth analysis, skin hydration (corneometer), and sebum secretion (sebumeter). Results: Yellow peel treatment significantly reduced acne severity, with an 85% decrease in inflammatory lesion counts and over 20% reduction in scar depth. Skin hydration improved significantly across all facial regions, and sebum secretion decreased substantially, enhancing skin barrier function and seboregulation. Statistical analysis confirmed the treatment's efficacy with sustained improvements two months post-final peel. Conclusions: The yellow peel protocol is an effective and well-tolerated adjunct therapy for managing mild to moderate acne and atrophic acne scars. By combining exfoliative, anti-inflammatory, antibacterial, sebostatic, and depigmenting agents, this multimodal approach delivers comprehensive skin improvement. Further large-scale, controlled studies are recommended to confirm long-term safety and efficacy.

Background: Biomechanical disorders may result from joint deformities. The purpose of this prospective research was to assess total load distribution over the lower limbs and balance in individuals before and after an hemiepiphysiodesis procedure performed due to valgus or varus knee deformity. Methods: Thirty-five patients, mean age 12 years, who underwent hemiphysiodesis for valgus or varus deformity of the knee were evaluated in comparison to a healthy control group. In patients, the percentage distribution of weight-bearing capacity between the operated and unoperated limbs was analyzed before and after surgery. Balance was assessed based on CoG (center of gravity) sway area and the CoG path length. Results were collected using the FreeMED MAXI pedobarographic platform. Results: Before surgery, statistically significant lower load on the entire affected limb was noted compared to unaffected limb. The values of path of center of gravity improved statistically significantly after surgery, compared to the values before surgery. There were no differences in the load on the treated lower limb in the study group and the non-dominant limb in the control group. There were no differences between the load on the non-operated limb in the study group and the load on the dominant limb in the control group. In the hemiepiphysiodesis group there were no significant differences between the mean total load on the treated and untreated limb after surgery. The median CoG sway area and path length in the group of patients after hemiphysiodesis and in the healthy control group did not differ. Conclusions: After hemiphysiodesis, the percentage load distribution did not differ between the operated and non-operated lower limb. Hemiepiphysiodesis allows for achieving balance similar to the healthy control group. Performing hemiepiphysiodesis allows for the improvement of balance parameters and load distribution in the lower limbs.

Background: Accurately predicting difficult airways is essential to ensuring patient safety in anesthesiology and emergency medicine. However, traditional assessment tools often lack sufficient sensitivity and specificity, particularly in high-pressure or resource-limited settings. Artificial intelligence (AI) and machine learning (ML) have emerged as promising tools for enhancing airway assessment. Objective: This review evaluates the performance of AI- and ML-based models for predicting difficult airways and compares them with traditional clinical methods. The review also analyzes the models' methodological robustness, clinical applicability, and ethical considerations. Methods: A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus to identify studies published between 2020 and 2025 that employed AI/ML models to predict difficult airways. Both original research and review articles were included. Key metrics, such as the area under the curve (AUC), sensitivity, and specificity, were extracted and compared. A qualitative analysis was performed to focus on dataset characteristics, validation strategies, model interpretability, and clinical relevance. Results: AI models demonstrated superior performance compared to traditional assessment tools. The MixMatch semi-supervised deep learning (DL) model achieved the highest performance (area under the curve [AUC] of 0.9435, sensitivity of 89.58%, and specificity of 90.13%). Models that used facial imaging combined with deep learning consistently outperformed those that relied solely on clinical parameters. However, methodological heterogeneity, a lack of standardized evaluation metrics, and limited population diversity impeded cross-study comparability. Few studies incorporated interpretability frameworks or addressed ethical challenges related to data privacy and algorithmic bias. Conclusions: AI and ML models have the potential to transform the assessment of difficult airways by improving diagnostic accuracy and enabling real-time clinical decision support.

Background: Hip fractures in older adults are sentinel events linked to high mortality and functional decline. Few studies have quantified long-term survival probabilities, standardized mortality ratios (SMRs), and risks of new nursing home admission alongside patient-related predictors. Methods: We retrospectively analyzed 355 patients aged ≥ 60 years who underwent hip fracture surgery at a general hospital in Japan (2020-2024). Primary outcomes were mortality and new nursing home admission. Survival probabilities and remaining life expectancy were estimated, and SMRs were calculated using age- and sex-matched national data. Cox regression identified independent predictors. Results: Mean age was 84 years; 76% were female. Mortality probabilities at 1, 2, and 3 years were 23%, 41%, and 60%, respectively; SMRs consistently exceeded 9. Median remaining life expectancy was 260 days. New nursing home admissions occurred in 42%, with cumulative probabilities of 16%, 27%, and 35% at 1, 2, and 3 years, respectively, showing a rapid rise within 9 months. Independent predictors of mortality were delayed surgery, higher Charlson Comorbidity Index, and low Geriatric Nutritional Risk Index. Older age and failure to regain ambulatory ability at 3 months predicted institutionalization. Conclusions: Older adults with hip fractures face persistently high mortality and institutionalization risks, comparable to advanced malignancies or neurodegenerative diseases. Surgical timing, comorbidities, nutrition, and functional recovery critically influence prognosis and should guide perioperative care and discharge planning.

Background/Objectives: Posterior vitreous detachment (PVD) is an age-related physiological process, yet the clinical and biometric factors influencing its progression remain incompletely characterized in adults undergoing routine ophthalmic evaluation at a tertiary center. Characterizing expected vitreous patterns is essential for interpreting vitreoretinal interface changes in disease. This study aimed to identify independent clinical and biometric factors associated with more advanced PVD stages in adults without macular pathology. Methods: In this cross-sectional observational study, 340 eyes from 198 consecutive adults undergoing routine ophthalmological evaluation at a tertiary hospital (March 2022-April 2023) were analyzed. Eyes with current or past macular disease were excluded. Demographic variables, systemic comorbidities and ocular history were recorded. Axial length was measured using optical biometry IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany). Vitreous status was assessed with 10-MHz B-scan ultrasonography and classified as no PVD, partial PVD or complete PVD. Analyses were performed at the eye level. Given its cross-sectional design, this study evaluates associations and cannot establish causal relationships. Bivariate comparisons examined associations between clinical variables and PVD grade. Multivariable modeling was conducted using a clustered generalized estimating equations (GEE) ordinal logit model as the primary analysis, and a secondary independent-eye ordinal logistic regression model was used to evaluate the proportional-odds assumption and model robustness. Results: Mean age was 55.6 ± 18.3 years, and 68.5% of eyes were from female participants. No PVD, partial PVD and complete PVD were present in 30.9%, 43.5% and 25.6% of eyes, respectively. In the primary GEE model, axial length (OR 1.35; p < 0.001), systemic hypertension (OR 7.13; p < 0.001), and prior cataract surgery (OR 2.13; p = 0.020) were independently associated with more advanced PVD stages. Age showed a modest but significant association with increasing PVD severity (OR 1.03; p = 0.012). Sex and diabetes mellitus were not associated with PVD grade. The independent-eye ordinal model yielded consistent effect directions. Conclusions: In adults without macular disease, more advanced PVD stages are independently associated with axial elongation, systemic hypertension, and previous cataract surgery, while age shows a mild but significant association. These findings provide clinically useful contextual reference information for interpreting vitreoretinal interface changes in health and disease. These associations should not be interpreted as causal due to the cross-sectional nature of the study.

Background/Objectives: Takayasu's arteritis (TAK) is an inflammatory vascular disease, but atherosclerotic mechanisms may also contribute to vascular injury in TAK. This study aimed to evaluate the clinical and imaging characteristics of TAK patients with and without iliofemoral artery involvement on FDG-PET/CT, focusing on the association with classical atherosclerotic risk factors. Methods: Patients fulfilling the 1990 ACR classification criteria for TAK who underwent FDG-PET/CT imaging during follow-up were retrospectively analyzed. Demographic, clinical, and laboratory data were recorded, including traditional cardiovascular risk factors: diabetes, hypertension, hyperlipidemia, smoking, obesity (BMI ≥ 30 kg/m²), and family history of cardiovascular disease. PET vascular activity score (PETVAS) and visual analysis were used to assess vascular inflammation. Results: PET/CT scans of 77 TAK patients (F/M = 63/14) were evaluated. The mean age was 43.0 ± 12.9 years, and the mean disease duration was 120.1 ± 88.8 months. Iliofemoral artery involvement was observed in nine (12%) patients. Compared to those without such involvement, these patients were older (52.5 ± 17.4 vs. 41.3 ± 12.1 years, p = 0.098), more frequently male (44% vs. 6%, p = 0.015), and had higher CRP levels (38.5 mg/L vs. 10.7 mg/L, p = 0.026). Smoking (77% vs. 40%, p = 0.045) and chronic kidney disease (22% vs. 4%, p = 0.046) were also more prevalent. PET activity according to visual analysis was higher among those with iliofemoral involvement (67% vs. 27%, p = 0.015). In multivariate analysis, older age (OR = 1.07, p = 0.044) and male sex (OR = 6.68, p = 0.039) were independently associated with iliofemoral artery involvement. Conclusions: Iliofemoral artery involvement on PET/CT in TAK patients was associated with traditional atherosclerotic risk factors-particularly older age, male sex and smoking. These findings suggest that atherosclerotic mechanisms may coexist with or amplify vascular inflammation in TAK. Aggressive management of cardiovascular risk factors should therefore be emphasized in this subgroup of TAK patients.

Background/Objectives: Data on the long-term outcomes of hypoplastic left heart syndrome (HLHS) patients compared to other single-ventricle patients reaching adolescence after Fontan surgery is limited. This study analyzes the outcomes of HLHS patients compared to non-HLHS patients following total cavopulmonary connection (TCPC) from the same era at a large single center. Methods: This study included patients aged ≥ 12 years at the last follow-up who underwent TCPC surgery between 05/2001 and 12/2009, with follow-up data available from 05/2012 to 01/2024. The primary endpoint (Fontan-specific major adverse cardiovascular events, MACEs) included all-cause death, cardiac transplantation or listing, heart failure hospitalizations, ventricular arrhythmias, third-degree AV block, or resuscitation. Results: A total of 130 patients were included, with 39 (30.0%) having HLHS. Among non-HLHS patients, 18 (13.8%) had a systemic right ventricle, and 73 (56.2%) had a systemic left ventricle. The mean age at the last follow-up was 18.6 ± 3.2 years, with no significant age difference between groups (p = 0.195). HLHS patients experienced significantly more MACEs (p = 0.019), had reduced ventricular function (p = 0.009), and exhibited higher NT-proBNP levels (p = 0.004) compared to non-HLHS patients. Conclusions: While long-term outcomes for adolescents with TCPC are generally encouraging, HLHS patients are at higher risk of adverse cardiovascular events. These findings highlight the need for targeted follow-up and interventions to improve long-term prognosis in this high-risk group.

Background: Systemic inflammation plays a pivotal role in heart failure (HF) progression, yet no meta-analysis has synthesized prospective cohort data on interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), and neutrophil-to-lymphocyte ratio (NLR) as prognostic biomarkers. Objectives: To quantify the independent prognostic value of IL-6, hs-CRP, and NLR for mortality and HF-related outcomes across HF phenotypes. Methods: Following PRISMA and MOOSE guidelines, we searched PubMed, Embase, Scopus, Web of Science, and CENTRAL from January 2014 to October 2025 for prospective cohorts reporting adjusted hazard ratios (HRs). Random-effects meta-analysis pooled HRs; heterogeneity was assessed via I² statistic, with subgroup and sensitivity analyses for robustness. Quality was evaluated using Newcastle-Ottawa Scale (NOS) and GRADE. Results: Thirteen cohorts (n ≈ 19,000) were included. Elevated IL-6 (five studies) was associated with increased all-cause mortality and composite outcomes (low-moderate heterogeneity, I² < 35%). hs-CRP (five studies) showed similar prognostic strength, with trajectories amplifying risk. NLR (three studies) independently predicted adverse events with negligible heterogeneity. Associations persisted across HFrEF and HFpEF, acute/chronic settings, and geographic regions, independent of natriuretic peptides and comorbidities (NOS median 8/9; GRADE moderate-to-high). Conclusions: IL-6, hs-CRP, and NLR are robust, independent prognostic biomarkers in HF, supporting their integration into clinical risk stratification and inflammation-targeted therapies. PROSPERO: CRD420251207035.

As surgeries using multifocal intraocular lenses (IOLs) to correct both cataracts and presbyopia have become common, it has become essential for clinicians to understand their basic optical characteristics to select the optimal lens for their patients. However, there are relatively few review articles on optics that are directly useful to clinicians who perform surgery on patients. In this paper, we systematically review fundamental concepts, from the basic properties of light, geometric optics, and Gaussian approximation to lens performance metrics like the point spread function and modulation transfer function (MTF), and the clinical implications of spherical and chromatic aberrations. Based on these principles, the mechanisms of major multifocal technologies are explained. We also explore the refractive extended depth of focus lenses, which expand the range of focus by precisely controlling higher-order spherical aberrations. In contrast, diffractive lenses use diffractive kinoforms to split light into multiple foci, and they may also leverage higher diffraction orders to correct chromatic aberration. However, this multifocality involves an optical compromise, often resulting in a reduced overall MTF compared to monofocal IOLs and photic phenomena such as glare and halo. In conclusion, while multifocal IOLs are groundbreaking technology that significantly enhances quality of life by reducing spectacle dependence, this comes at the cost of sacrificing optimal image quality. Therefore, a thorough understanding of these optical principles by ophthalmologists is crucial for selecting the optimal lens according to each patient's ocular condition and for managing postoperative outcomes.

Background/Objectives: With the increasing use of immune checkpoint inhibitors (ICIs), their administration in pregnant patients is expected to become more frequent. Although immunotherapy has transformed melanoma treatment, its use during pregnancy remains complex and controversial. Methods: We present the case of a young female patient diagnosed with advanced melanoma in whom combination ICI therapy was initiated. Results: During maintenance nivolumab treatment, a routine staging CT scan revealed an incidental pregnancy. Immunotherapy was discontinued upon pregnancy detection. The pregnancy proceeded without significant complications related to melanoma or the immunotherapy. During follow-up, the patient remained in remission and delivered a healthy male infant at 38 weeks of gestation. Conclusions: The most frequently reported side effects of ICIs during in utero exposure include fetal growth restriction, premature delivery, fetal distress syndrome, and occasional congenital abnormalities such as hypothyroidism and hand malformations. While existing evidence highlights potential risks, isolated case reports-including the present case-demonstrate that favorable pregnancy and neonatal outcomes are possible with careful monitoring and multidisciplinary care. Given the limited literature on ICI use during pregnancy, our case adds meaningful clinical insights to the field and underscores the need for further research and data collection to establish definitive guidelines, with an emphasis on individualized risk assessment and multidisciplinary care.