Journal of Clinical Medicine最新文献

Background/Objectives: Following lumbar fusion procedures, adjacent segment degeneration (ASD) at cranial levels presents as a well-documented long-term complication, manifesting through recurrent pain, neurological deficits, and progressive functional decline. The prone single-position technique for lateral lumbar interbody fusion (PSP-LLIF) streamlines surgical workflow by eliminating the need for intraoperative patient repositioning; however, comprehensive evidence supporting its clinical and radiological effectiveness in managing cranial ASD remains insufficient. Material and Methods: This retrospective cohort study examined 30 consecutive patients presenting with symptomatic cranial adjacent segment disease who were treated with PSP-LLIF at a single institution. Patient-reported outcome measures included visual analog scale (VAS) assessments for axial and radicular pain, alongside the Oswestry Disability Index (ODI) for functional status evaluation. Radiological parameters included overall and segmental lumbar lordotic measurements, anterior and posterior disk height, fusion status, and instrumentation-related complications. Results: At 12-month postoperative evaluation, substantial clinical improvements were demonstrated. Mean VAS reductions measured 4.7 points for axial pain and 6.5 points for radicular pain, while ODI decreased by 28.5 points (p < 0.05). Radiological assessment demonstrated mean increases of 6.3° in lumbar lordosis and 5.1° in segmental lordosis, along with significant gains in both anterior and posterior disk height (p < 0.05). Solid fusion was radiographically confirmed at all instrumented levels. Temporary postoperative neurological symptoms developed in several patients but resolved spontaneously without requiring revision surgery. Conclusions: PSP-LLIF yields substantial clinical benefit and reliable radiological correction in patients with symptomatic cranial ASD. Optimal outcomes necessitate rigorous adherence to position-specific technical modifications, particularly maintenance of perpendicular fluoroscopic trajectories and implementation of continuous neural monitoring to account for prone-induced anatomical shifts. This approach represents a viable treatment strategy for patients with symptomatic cranial ASD.

Background/Objectives: Isolated cleft lips and/or palates often require orthognathic treatment. Traditional planning based on 2D images and plaster models limits precision; therefore, virtual surgical planning (VSP) and Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) technologies are increasingly being used. The aim of this scoping review was to analyze the techniques, outcomes, and gaps in research on VSP in orthognathics for patients with isolated (non-syndromic) clefts. Methods: Searches were conducted in July 2025 in seven databases (including PubMed, Scopus, and Cochrane) without language restrictions, in accordance with the PRISMA guidelines for scoping reviews. Of the 2836 records, 36 publications were eligible after deduplication and full-text screening, and their Level of Evidence (LoE) was assessed using the Oxford CEBM scale. A risk of bias assessment was also conducted according to JBI tools. Results: The identified studies primarily comprised LoE III and IV; there were no systematic reviews or randomized controlled trials (LoE I). Descriptions of bimaxillary procedures and LeFort I osteotomies dominated. The most commonly used software was ProPlan CMF, Dolphin 3D, and Rhinoceros, although other tools have emerged in recent years. The available studies suggest that VSP increases translational and rotational accuracy and facilitates individualized treatment, and bimaxillary procedures bring better functional and aesthetic outcomes in patients with severe maxillary hypoplasia. Conclusions: Despite the growing interest in VSP in orthognathics, the scientific evidence is limited and mostly of lower quality. Well-designed prospective studies are needed to assess the long-term stability, quality of life, and cost-effectiveness of modern technologies.

Background: Perforator flaps improved the reconstruction paradigm in the lower extremity, increasing coverage possibilities. This study aims to quantify how added perforators could enhance standard geometrical patterns (compared to random flaps). Methods: A total of 29 cases of lower limb soft tissue reconstruction (STR)-52% trauma, 21% osteomyelitis with skin fistulas, 21% healing disorders with unstable scarring and 6% cancer-related surgery-were performed in our institution between 2012 to 2023 with geometric random (GR) local flaps (34%), geometric perforator-enhanced (GP) flaps (32%) or pure propeller perforator (PP) flaps (34%), were retrospectively analysed. Patients with proximal thigh defects, a follow up of less than 3 months and those who received an axial, muscle or free flap were excluded. Geometric patterns (as length:width ratio (L:W)) were compared among groups, analysing healing outcomes and complications. Results: Leg defects were categorized into 62% distal, 14% middle, 14% proximal third and 10% distal thigh. No significant difference in defect size was detected among groups. Mean flap size was significantly larger for GP (70.5 cm², (p < 0.05)) and PP (74.4 cm², (p < 0.01)) than GR (53.7 cm²). The L:W ratio was significantly higher in GP (L:W 2.2:1, (p < 0.05)) and PP (L:W 2.8:1, (p < 0.01)) than in GR (1.5:1), but no significant difference was found between GP and PP. A reduced complications rate (partial flap loss, infection, healing, revision surgery, etc.) was observed in the GP group, when compared to GR. Conclusions: Flap geometric design can be significantly improved by the inclusion of perforators, maintaining spatial advantages with larger ductility and improved vascular solidity.

Background: Anterior cervical discectomy and fusion (ACDF) is widely performed and has a low incidence of postoperative infection. Anterior cervical abscess is a rare but potentially life-threatening complication, typically caused by skin or oral flora. Identification of atypical pathogens has important implications for diagnostic vigilance and antimicrobial management. Case Presentation: We report a 56-year-old man with degenerative cervical myelopathy and significant respiratory comorbidity who underwent single-level ACDF and developed progressive dysphagia and neck pain in the early postoperative period. Imaging demonstrated a prevertebral abscess requiring urgent surgical drainage. Intraoperative cultures identified Moraxella catarrhalis, a respiratory tract commensal rarely implicated in postoperative spinal infections. No evidence of esophageal perforation or superficial wound contamination was identified. The patient was treated with surgical washout and prolonged culture-directed antibiotic therapy, with full clinical recovery. To contextualize novelty, we performed a focused review of the available literature on M. catarrhalis spinal infections. Conclusions: This case expands the spectrum of pathogens implicated in postoperative cervical spine infections and highlights the need to consider respiratory tract organisms in high-risk patients, particularly those with chronic pulmonary disease or immunosuppression. Early imaging in the presence of dysphagia, prompt source control, and culture-directed antimicrobial therapy are essential to optimizing outcomes.

Background/Objectives: Under general anesthesia, maintaining patients' blood pressure (BP) is important to prevent organ ischemia. When bleeding occurs, it is sometimes difficult to increase BP with boluses of fluids or transfusions, and vasoconstrictors must be administered. This study investigated circulatory dynamic changes in patients who bled during surgery and were administered phenylephrine, particularly left ventricular end-diastolic volume (EDV), effective arterial elastance (Ea), and left ventricular end-systolic elastance (Ees), calculating each value from the left ventricular-arterial coupling (Ees/Ea). Methods: We calculated Ees/Ea using electrocardiograms, arterial pressure waveforms, and phonocardiograms using an esophageal stethoscope. We investigated the changes in patients' EDV, Ea, and Ees during two periods: phenylephrine administration and after BP elevation. Results: The seven participants comprised three men and four women. Between the two periods, linear mixed-model analysis revealed that mean arterial pressure (MAP), Ea, and Ees significantly increased over time (MAP; β = 8.7, p < 0.01, Ea; β = 0.22, p < 0.05, Ees; β = 0.73, p < 0.05), while no significant changes were observed in other parameters such as heart rate and EDV. Conventional parameters demonstrated that stroke volume variation significantly decreased (β = -2.0, p = 0.01), systemic vascular resistance index significantly increased (β = 200, p < 0.01), while no significant change was observed in cardiac index (β = -0.03, p = 0.7). In patients administered phenylephrine due to BP decrease from bleeding, significant changes in afterload and cardiac contractility occurred without changes in preload. Conclusions: Our noninvasive method for calculating EDV, Ea, and Ees can be valuable for monitoring hemodynamics under anesthesia.

Background/Objectives: Respiratory dysfunction in Parkinson's disease (PD) is frequently underrecognized, particularly when resting oxygen saturation is preserved. Dynamic stress testing, however, may reveal exercise-induced oxygen desaturation, reflecting a latent functional respiratory impairment. The relationship between exertional oxygen desaturation and cognitive performance in PD remains insufficiently explored. Objective: To investigate the association between exercise-induced oxygen desaturation and global cognitive performance in patients with PD, and to explore the contribution of pulmonary gas exchange impairment assessed by diffusing capacity of the lung for carbon monoxide (DLCO). Methods: This prospective, cross-sectional, single-center observational study with consecutive enrollment included 50 patients with idiopathic Parkinson's disease undergoing multidisciplinary respiratory evaluation following neurological assessment. Participants underwent cognitive evaluation using the Romanian version of the Montreal Cognitive Assessment (MoCA), pulmonary function testing including DLCO and total lung capacity (TLC), and a supervised 6-min walk test (6MWT) with continuous pulse oximetry. Exercise-induced oxygen desaturation was defined as a decrease in SpO₂ of ≥4% from baseline. Correlation analyses and multivariable regression models were applied. Results: Exercise-induced oxygen desaturation was frequent, with 60% of patients exhibiting a ≥4% decrease in SpO₂ during the 6MWT. Greater desaturation was significantly associated with lower MoCA scores (Spearman's r = -0.383, p = 0.006). No significant associations were found between exertional desaturation and resting pulmonary function parameters, including DLCO and TLC. In multivariable analysis, lower MoCA score and levodopa-carbidopa intestinal gel treatment independently predicted greater oxygen desaturation during exercise. Conclusions: Exercise-induced oxygen desaturation is common in patients with PD despite preserved resting oxygenation and is associated with poorer cognitive performance. These findings suggest that exertional desaturation may reflect a dynamic functional impairment and may be associated with increased physiological vulnerability. Functional exercise testing with oxygen saturation monitoring may provide complementary information beyond resting pulmonary assessments.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder frequently associated with impairments in executive functions (EF). These deficits have been linked to difficulties across various cognitive domains, including metaphonological skills (MS), essential for phonological awareness and processing abilities. Background/Objectives: This pilot study examines the correlations between EF and MS in ADHD children. Methods: A total of 84 children aged 6-14 years, diagnosed with ADHD and an IQ ≥ 70, were assessed using the NEPSY-II test to evaluate executive functions and the Assessment of Metaphonological Skills Test to assess phonological processing abilities. Results: Correlational analyses and multiple regression models were employed to explore the relationships between EF and MS, focusing on attention, cognitive flexibility, and response inhibition. Rhyme was positively correlated with processing speed and negatively correlated with response inhibition. Phonemic segmentation was significantly related to auditory attention and response inhibition. Age emerged as a significant predictor of phonemic synthesis and final syllable deletion, consistent with the developmental maturation of executive and phonological abilities. Conclusions: The findings suggest that deficits in executive functioning in ADHD children are closely linked to metaphonological abilities, which play a crucial role in the acquisition of reading and writing skills. Integrating EF training into phonological interventions can help reduce learning difficulties and improve cognitive and language outcomes.

Objectives: We aimed to assess sex differences in benefits from cardiac rehabilitation and the impact of comorbidities. Methods: We analyzed 3239 individuals with cardiovascular diseases (81.2% males) who participated in a three-week cardiac rehabilitation program at Bad Schallerbach center (Upper Austria). Training success was measured by maximal oxygen consumption (VO₂ max). Sex-specific differences in baseline characteristics were assessed using t-tests/chi² tests. Associations between covariates and the outcome were evaluated with baseline-adjusted univariate analysis of variance/linear regression models. Covariates significant at α = 0.05 were included in a multivariable linear regression model, which was refined by backward selection based on the best Akaike information criterion. The final model was used to test the relationship between sex and the outcome. Results: The mean age and BMI were 63.9 years and 27.5 kg/m² for males and 67.2 years and 27.4 kg/m² for females. Males had higher baseline VO₂ max compared to females (26.18 mL/min/kg vs. 23.55 mL/min/kg, p < 0.001), and a greater change in VO₂ max after rehabilitation was seen in males compared to females (3.64 mL/min/kg vs. 2.77 mL/min/kg, p < 0.001). Female sex was associated with a 1.4-point-lower change in VO₂ max after adjustment for comorbidities, sex, and training intensity (β coefficients = -1.409; CI 95% -0.410, -0.104; p < 0.001). Heart valve surgery (β coefficients = -0.90; CI 95% -1.444, -0.366; p < 0.001) and diabetes mellitus (β coefficients = -1.207; CI 95% -1.926, -0.488; p < 0.0001) were associated with lower changes in VO₂ max in both sexes. Conclusions: Our findings suggest that females and individuals with specific comorbidities benefit less from cardiac rehabilitation and support the creation of personalized rehabilitation programs.

Background/Objectives: Craniopharyngiomas (CPs) are rare, generally benign tumors predominantly located in the sellar and suprasellar regions, associated with significant morbidity and complex surgical management. Despite high overall survival rates, patients frequently experience complications including visual impairment, pituitary dysfunction, diabetes insipidus (DI), and hypothalamic syndrome. Among these, hypothalamic obesity (HO) represents one of the most clinically challenging sequelae, often occurring early, lacking standardized medical treatment, and leading to substantial comorbidity and reduced quality of life. This study reports a single-center experience focusing on the relationship between skull base anatomy, surgical approach selection, and endocrinological outcomes. Methods: A retrospective analysis was conducted on patients diagnosed with CPs who underwent surgery by a dedicated team at our Department from January 2014 to January 2024. The approaches used were endoscopic (ER) and transcranial (TR). Preoperative imaging (volumetric MRI and CT scans) was analyzed using 3DSlicer (open-source software) for anatomical modeling of the tumor and skull base. Clinical outcomes were evaluated through follow-up assessments by a team of neuroendocrinologists. Data on BMI changes, DI onset, and hypopituitarism were collected. Statistical analyses consisted of descriptive comparisons and exploratory regression models. Results: Of 18 patients reviewed, 14 met the inclusion criteria. Larger sphenoid sinus volumes were associated with selection of an endoscopic endonasal approach (p = 0.0351; AUC = 0.875). In ER cases, the osteotomy area was directly related to tumor volume, independent of other anatomical parameters. Postoperatively, a significant increase in BMI (22.39 vs. 26.65 kg/m²; p = 0.0049) and in the incidence of DI (three vs. nine cases; p-value 0.0272) was observed. No clear differential association between surgical approach and endocrinological outcomes emerged in this cohort. Conclusions: Quantitative assessment of skull base anatomy using 3D modeling may support surgical approach selection in patients with craniopharyngiomas, particularly in identifying anatomical settings favorable to endoscopic endonasal surgery. Endocrinological outcomes appeared more closely related to tumor characteristics and hypothalamic involvement than to the surgical route itself. These findings support the role of individualized, anatomy-informed surgical planning within a multidisciplinary framework.

Background: T2 low asthma in children is an emerging yet underexplored endotype that challenges traditional views of type 2 inflammation. Recent data suggest that it is more prevalent than previously thought and is defined by low type 2 biomarkers, non-allergic clinical profiles, and strong associations with modifiable comorbidities such as obesity, passive smoke exposure, and recurrent respiratory infections. This phenotype often shows a poor response to standard inhaled corticosteroid therapy and T2-targeted biologics, underscoring the urgent need for improved diagnostic and therapeutic approaches.

Methods: This narrative review conducted a literature search from PubMed and WoS databases (2020-2025), focusing on T2-low asthma defined by low blood eosinophils (<150-300/µL), FeNO (<20-25 ppb), and absent atopy in children under 18.

Results: This review highlights the heterogeneity of T2-low asthma, including subtypes from neutrophilic/Th 17-high to paucigranulocytic airway remodeling and metabolic driven forms, as well as diagnostic challenges from biomarker supresssion by high-dose therapies. Pragmatic phenotyping algorithms using routine tests enable identification, directing comorbidity management over ineffective biologics.

Conclusions: Systematic T2-low phenotyping in pediatric practice, alongside prospective studies and non-T2 therapy trials, promises precision medicine to enhance outcomes for these children, moving beyond eosinophil-centric care.