Journal of Clinical Medicine最新文献

Background/Objectives: Endometriosis affects up to 10% of women of reproductive age and about 47% of adolescents with pelvic pain. Symptoms include dysmenorrhea, dyspareunia, and chronic pelvic pain (CPP). Adolescents often present atypical symptoms that can make endometriosis more difficult to diagnose. This study aimed to compare characteristics of pain, atypical symptoms, and the effects of hormonal treatments between adolescents and adults with endometriosis. Methods: A total of 238 women with endometriosis were included: 92 aged 12-18 (group A) and 146 over 18 (group B). Data on menarches, cycle length, comorbidities, dysmenorrhea, dyspareunia, CPP, analgesic use, pain characteristics, atypical symptoms, and endometrioma size were recorded. The efficacy, compliance, and side effects of hormonal treatments were also assessed. Quality of life (QoL) was measured using the SF-12 questionnaire at baseline and after six months of therapy. Results: Adolescents had earlier menarche (p < 0.001), longer menstrual periods (p < 0.001), and higher analgesic use (p = 0.001) compared to adults. Dysmenorrhea was more frequent (p = 0.01), lasted longer (p < 0.001), and was associated with higher pain scores (p < 0.001) in adolescents. CPP was more common in adolescents (p < 0.001), often described as "confined" (p = 0.04) and "oppressive" (p = 0.038), while adults reported it as "widespread" (p = 0.007). Headaches (p < 0.001) and nausea (p = 0.001) were also more frequent in adolescents. Both groups showed significant improvement in QoL with hormonal treatment (p < 0.001) and reported minimal side effects. Conclusions: Adolescents with endometriosis often present with earlier menarche, longer menstrual periods, more severe dysmenorrhea, and atypical symptoms. Hormonal contraceptives and dienogest are effective and safe treatments that improve pain and QoL.

Objective: The aim of this study was to determine mortality and predictive factors for death in patients with rheumatoid arthritis (RA) diagnosed with and without interstitial lung disease (ILD). Methods: We retrospectively performed a long-term follow-up study of patients diagnosed with RA at our medical center between April 2001 and June 2023. The diagnosis and classification of ILD were made based on pulmonary high-resolution computed tomography (HRCT), taken at RA diagnosis and during follow-up. Results: Among 781 patients with RA, 78 were diagnosed with ILD; all cases except one were subclinical. The most common HRCT pattern was definite usual interstitial pneumonia (UIP) followed by nonspecific interstitial pneumonia (NSIP)/UIP, probable UIP, NSIP, and early UIP. During follow-up (mean of 10.0 years), the crude incidence rate of death (95% confidence interval [CI]) was 7.1 (5.2-10.0) and 1.5 (1.0-1.9) per 100 person-years in RA patients with and without ILD. Poor control of RA activity was associated with increased incidence rates of death. The standardized mortality ratio (95% CI) compared with the general population was 1.32 (1.11-1.53) for all RA patients, 2.09 (1.45-2.73) for RA-ILD patients, and 1.16 (0.95-1.38) for non-ILD RA patients. Lung cancer and respiratory failure were the most common causes of death in RA-ILD patients. The Multivariable Fine-Gray regression analysis revealed that ILD (adjusted hazard ratio [HR] 2.97 [95% CI 1.95-4.53]), advanced age (1.08 per additional year [1.05-1.10]), and low body mass index (3.07 [2.10-4.49]) were strong predictive factors for mortality in RA patients. HRCT patterns did not affect the risk of death in RA-ILD patients. Conclusions: Regardless of HRCT pattern, RA-ILD contributes to the increased mortality risk in patients with RA.

The ANB angle, the cephalometric parameter of choice for assessing the anteroposterior relationship between the maxilla and mandible, is subject to several limitations, prompting the investigation of alternative parameters. Objective: This study aimed to investigate the ABwise measurement as an alternative to the ANB angle for evaluating maxillomandibular relationships in orthodontics, particularly addressing the impact of skeletal discrepancies on conventional methods. Methods: A retrospective analysis was performed on a CBCT dataset of patients attending the University of Milan's Department of Orthodontics and Maxillofacial Surgery, selected based on high-quality imaging, a full-cranium field of view, and a slice thickness between 150 and 300 μm. Eight craniofacial landmarks were annotated using the 3D Slicer software to calculate the ANB values and the new ABwise measurement. Statistical analyses included Spearman's correlation (ρ), linear regression, and inter-rater agreement (Cohen's κ score), with data classified into skeletal Classes I, II, and III based on defined thresholds. Results: 354 CBCT were selected and analyzed (mean age: 18.6 years). ABwise showed a strong correlation with the ANB angle (ρ = 0.805) and new normative ranges for ABwise were established: Class I (-1.4 ± 2.3 mm), Class II (>0.9 mm), and Class III (<-3.7 mm). Moderate agreement was observed between the ABwise and ANB classifications (κ = 0.527). ABwise effectively addressed limitations associated with divergence and vertical discrepancies, providing a more reliable assessment of skeletal sagittal relationships. Conclusions: ABwise presents a viable alternative to the ANB angle for three-dimensional cephalometric analysis, offering improved accuracy and alignment with radioprotection principles by reducing the CBCT field of view needed for its measurement. Further research is required in order to validate these findings across diverse populations and clinical scenarios.

Background: Musculoskeletal disorders associated with excessive smartphone use represent a significant health issue. Text neck syndrome is one such disorder within that group, increasingly affecting individuals worldwide across various age groups. The phenomenon of text neck may occur in individuals who frequently and for prolonged periods adopt a forward-flexed neck and head position while looking at the screens of mobile electronic devices. Various therapeutic methods are used in the treatment of text neck syndrome. However, there is no consensus on text neck rehabilitation, which poses a challenge for physiotherapists. Objective: The aim of this study is to analyze the phenomenon of text neck, with a particular emphasis on current scientific reports regarding the rehabilitation of text neck syndrome. The scoping review was conducted to determine the physiotherapy methods currently used in the treatment of individuals with text neck, assess their impact on symptom reduction, and identify existing knowledge gaps and limitations in the current literature on the rehabilitation of text neck syndrome. Design: A scoping review was conducted on the treatment of text neck syndrome based on electronic databases: PubMed, ResearchGate, Physiotherapy Evidence Database (PEDro), and the Cochrane Library. The databases were searched up to 1 December 2024. The inclusion criteria comprised studies investigating physiotherapy interventions for individuals with text neck, published between 2018 and 2024 and written in English. Results: A total of fifteen papers were reviewed, focusing on various methods used in text neck rehabilitation, including postural correction exercises, stabilization exercises, strengthening and stretching exercises, Pilates, PNF (Proprioceptive Neuromuscular Facilitation), kinesiology taping, Bowen therapy, and manual therapy. Nearly all studies were conducted in the adult population (93%), with the majority of studies taking place in India (60%). Conclusions: In summary, all studies suggest that appropriate physiotherapeutic interventions can provide significant benefits, including pain reduction, posture correction, and improved range of motion in the cervical spine. The best outcomes appear to be achieved by combining various therapeutic techniques. However, further high-quality research is needed to strengthen the evidence and offer reliable recommendations for clinical practice. Additionally, there is limited research on physiotherapy for text neck in the pediatric population, presenting a potential area for future studies.

Background: Intra-articular calcaneal fracture (CF) treatment is associated with a high risk of complications, but closed reduction and internal fixation (CRIF) is a minimally invasive alternative for treatment. Methods: Forty-eight patients treated with CRIF and CALCAnail^® due to intra-articular CF between 2016 and 2021 were analyzed to check union time, complication rate, and functionality after the intervention. Functional and pain outcomes were assessed, including the Maryland Foot Score (MFS), American Orthopedic Foot & Ankle Society (AOFAS) scale questionnaires, and the numerical pain scale (NRS) at mid-term follow-ups 2-5 years after the intervention. Results: Intervention increased median Böhler's angle from 21.5° to 32° (p < 0.01). The median bone union time was 12 weeks. The risk of malunion was higher in patients with Sanders type 4 (RR = 2.28; 95% CI 1.11-4.72) and those operated on later than the 2nd day after injury (RR = 2.1; 95% CI 1.08-4.09). Patients with at least one of the comorbidities (nicotinism, diabetes, obesity) had a higher risk of intensive pain (NRS > 3) 2-5 years after surgery (RR = 1.69; 95% CI 1.06-2.68), and 84% were satisfied with their treatment. Other complications included complex regional pain syndrome in two patients (4%), malunion in three (6%), and surgical site infection in two (4%). The MFS had a median score of 85 points, while that of the AOFAS was 82 points. Conclusions: CRIF, with the use of the CALCAnail^® implant, allows doctors to restore anatomical relationships around the subtalar joint, resulting in good clinical and functional results.

Background/Objectives: Pulp stones (PSs) are calcified masses, with rounded or oval shapes, ranging from small particles to masses larger than the chamber and/or canals. There are limited data regarding the prevalence of pulp stones in the Iberian population. Our aim was to determine the prevalence of PSs, using CBCT, in an Iberian population, and its association with gender, age, tooth location (arch and hemiarch), dental group, the presence of caries, restorations, alveolar bone loss, and a history of orthodontic treatment. Methods: In total, 300 CBCTs were analyzed, selected from the database of the Dental Clinic of the University of Valencia. A total of 5485 teeth were included. The images were obtained by NewTom equipment and visualized using NNT software 11 by a single calibrated examiner in the axial, sagittal, and coronal planes. The Chi-square test, ANOVA, and t-test were used to analyze the study variables for a significance level of p < 0.05. Results: The prevalence of PSs was 88.3% from the total number of patients assessed and 61.2% from the total number of teeth assessed. No differences were found by gender or age. A significant association was found within tooth groups between arches and hemiarches. The proportion of PSs was 3.7 times higher in teeth with caries, 4.7 times higher in teeth with fillings, and 2.3 times higher in teeth with alveolar bone loss. Conclusions: PSs were more prevalent in molars. The presence of caries, fillings, and bone loss increased the chance of presenting PSs. Maxillary teeth had a higher prevalence of PSs than mandibular teeth.

Background/Objectives: The diagnostic guidelines for pediatric patellofemoral instability (PFI) remain incomplete. PFI remains a challenging issue as it affects the biomechanics of the knee joint, triggers anterior knee pain, and is linked to the development of early-onset osteoarthritis. The diagnostic process is complicated by numerous anatomical factors that must be considered. This review aims to consolidate current knowledge presented in the literature on radiological diagnostics for PFI in pediatric populations, with the application of all imaging techniques-including ultrasonography (US), magnetic resonance imaging (MRI), computed tomography (CT), and radiography (RTG)-which enable the evaluation of anatomical risk factors critical for the diagnosis, prevention, and treatment of PFI. Methods: A search of the PubMed/MEDLINE database was conducted to identify relevant studies from 1975 to 2024. The search terms were as follows: (patellar or patella) and (instability or displacement or dislocation) and (diagnostic or diagnosis or imaging or radiographic). A total of 2743 articles were retrieved, which were screened to yield 29 studies for further review. These studies were then divided into seven categories regarding the diagnostic methods: risk factors, tibial tubercle trochlear groove (TT-TG)/tibial tubercle posterior cruciate ligament (TT-PCL), MPFL injury and cartilage damage, patella and trochlear dysplasia, torsional abnormalities, coronal plane alignment, and genetics. Results: The methods presented statistically significant differences, with those most commonly used for the diagnosis of patella dislocation being TT-TG index, MPFL rapture, and trochlear dysplasia. Conclusions: In summary, multiple diagnostic tools, including MRI, CT, X-ray, and physical examination, are available for the assessment of PFI, each contributing to treatment decisions. Although MRI remains the primary diagnostic tool, further research is needed to establish more precise diagnostic criteria.

Background: Patients with peripheral artery disease (PAD) and diabetes face high risks of comorbidities, tissue loss, and cardiovascular events. As global type 2 diabetes (T2DM) prevalence rises, so does its incidence in symptomatic patients with PAD, though this population is under-studied in Australia. This cross-sectional analysis sought to characterize PAD patients with diabetes regarding prevalence, major complications, medication use, and prescribing patterns, comparing them to non-diabetic PAD patients. We also examined PAD complications in relation to diabetic control. Methods: This cross-sectional study looked at the baseline data from 105 PAD participants in the TEAM-PAD randomized controlled trial that were analyzed using descriptive statistics, prevalence odds ratios and regression analysis. Participants were recruited between June 2023 and August 2024 from public clinics, private surgeons, and Concord Repatriation General Hospital, Sydney. Results: Diabetes prevalence was 52.83% (n = 56) with 29.5% (n = 31) of participants with T2DM having uncontrolled hyperglycemia (HbA1c ≥ 7%), which was weakly negatively correlated with age (r = -0.372, p = 0.039). Participants with T2DM were twice as likely to have a history of coronary artery disease (POR 2.43; 95% with a 95% confidence interval (CI) between 1.09-5.43, and over three times as likely to have tissue loss (POR 3.39; 95% CI 1.22-9.43). The odds of polypharmacy (≥5 medications) were 10 times greater in participants with T2DM (POR 10.8; 95% CI 2.31-50.4), affecting 96.4% of this group. Conclusions: Diabetes prevalence and associated complications were higher than previous estimates, underscoring the challenges in managing diabetes and polypharmacy in participants with PAD. A multidisciplinary approach may improve outcomes.

Background/Objectives: The aim was to develop a Japanese version of the Obstetric Quality of Recovery-11 questionnaire (ObsQoR-11J), assess its feasibility, reliability, and validity, and investigate its association with postpartum depression and functionality. The need for this study is underscored by the limited availability of the ObsQoR-11 in different languages and the lack of documentation on its associations with early postpartum recovery and mid-term postpartum patient-reported outcomes. Methods: After translating the ObsQoR-11J into Japanese, 138 patients who underwent non-emergent cesarean delivery were enrolled in this study. ObsQoR-11J scores were evaluated at 24 h, 3 days, and 5 days post-surgery. The associations between ObsQoR-11J scores and postpartum depression and functionality, which were assessed using the Edinburgh Postnatal Depression Scale (EPDS) at 1 and 3 months and the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0, respectively, at three months after cesarean delivery, were evaluated. Results: The questionnaire completion rate at 24 h was 97.1% (134/138), and the mean ObsQoR-11 scores at 24 h and 3 and 5 days post-surgery were 67.2, 89.0, and 96.3, respectively. Cronbach's alpha was 0.77, and the Spearman correlation coefficient between ObsQoR-11J scores and global health visual analog scale scores was 0.43 (p = 0.03) at 24 h. The ObsQoR-11 score at any measurement point was significantly associated with the EPDS and 12-item WHODAS2.0 after adjusting for clinically relevant factors (all p < 0.05). Conclusions: The ObsQoR-11J is a valid assessment tool, and its scores are associated with patient-reported outcome measures.

Background. Despite the achievement of therapeutic goals regarding low-density lipoprotein cholesterol (LDL-C) levels with statins, high residual risk of events was reported in patients with coronary artery disease (CAD). Widespread attention has recently been focused on low plasmatic levels of high-density lipoproteins (HDLs) and high levels of triglycerides as risk factors for cardiovascular disease and as potential pharmacological targets, with particular attention paid to their ratio. Therefore, the aim of the current study was to investigate the association between triglycerides and HDLs and the TG/HDL ratio and their association with the prevalence and extent of CAD. Methods. We included patients undergoing non-urgent coronary angiography at Azienda Ospedaliera-Universitaria "Maggiore della Carità", Novara, Italy, from 2007 to 2018. Patients chronically treated with triglyceride-lowering therapies (PUFA and Fibrates) were excluded from this analysis. Fasting samples were collected at the moment of angiography. CAD was defined as at least one vessel stenosis >50%. Results. Our study population of 5997 patients was divided according to TG/HDL ratio quartiles. The TG/HDL ratio was significantly associated with age, gender, smoking status, hypercholesterolemia, diabetes, and the chronic use of ACE inhibitors, statins, beta-blockers, aspirin, ADP antagonists, and diuretics. The TG/HDL ratio was additionally associated with several laboratory parameters. In multiple logistic regression analysis, HDLs but not the TG/HDL ratio were independently associated with the prevalence and extent of CAD. Conclusions. Our study showed that HDLs but not the TG/HDL ratio are independently associated with the extent and prevalence of CAD. Therefore, this ratio does not provide additional prognostic information to HDLs in the prediction of the prevalence and extent of this disease.