Journal of Clinical Medicine最新文献

Background/Objectives: Rhegmatogenous retinal detachment (RRD) is a potentially blinding retinal disorder. RRD in the first eye is a well-recognized risk factor for bilateral RRD since risk factors that predispose to RRD affect both eyes. In this study, we assess the presenting factors that predispose individuals to bilateral RRD and evaluate the role of prophylactic retinopexy in preventing fellow-eye RRD. Methods: Retrospectively, all patients who underwent RRD repair through pars plana vitrectomy were included. A medical database was utilized to extract the data. The primary outcome was to report the development of RRD in the fellow eyes according to the presenting risk factors. Secondary outcomes included the prophylactic effect of laser retinopexy for the fellow eye. Results: In this study, 348 patients were included. The mean age of the patients was 46.3 years. Bilateral RRD was developed in 13.7% of the patients. It was found that total RRD in the first eye (p-value = 0.045), the presence of lattice degeneration in the first eye (p-value = 0.036), the presence of high-risk breaks (p-value = 0.0001) or lattice degeneration (p-value = 0.0004) in the fellow eye, the involvement of the inferior-nasal quadrant in the first eye (p-value = 0.043), and the presence of connective tissue diseases (p-value = 0.008) were significantly associated with the development of fellow-eye RRD. Performing prophylactic retinopexy was associated with a reduction in the incidence of fellow-eye RRD (with or without high-risk breaks) (p-value = 0.0001). It was not associated with a reduction in the risk of fellow-eye RRD in cases of lattice degeneration alone. Conclusions: Recognition of certain perioperative risk factors (such as high-risk retinal tears) during the presentation of first-eye RRD is crucial. Prophylactic laser retinopexy may have a critical role in preventing fellow-eye RRD. Patients' awareness should be raised about the symptoms of RRD.

Background: Few studies have compared the efficacy and safety of Janus kinase (JAK) inhibitors in patients with ulcerative colitis (UC). We compared the real-world effectiveness and safety of tofacitinib (TOF) and filgotinib (FIL) as induction therapy for UC by propensity score-matching analysis. Methods: We enrolled 230 patients with active UC who received either TOF (n = 197) or FIL (n = 33) as induction therapy. The primary outcome was the clinical response at week 8, and the secondary outcomes were the clinical response/remission rates from weeks 2-8, including the course of patients without a clinical response/remission at week 4. Results: Propensity score-matching analysis revealed that the clinical response rate gradually increased to 72.2% at 8 weeks in the TOF group, whereas it tended to decrease to 48.5% in the FIL group. Clinical remission rates increased from 2 (36.7% vs. 36.7%) to 8 weeks (63.6% vs. 48.5%) after treatment in the TOF and FIL groups, respectively. The clinical response rate was higher in the TOF group than in the FIL group at week 8 in patients without a clinical response at week 4 (38.5% vs. 0%; p = 0.011). The clinical remission rate was also higher in the TOF group than in the FIL group at week 8 in patients without clinical remission at week 4 (50.0% vs. 16.7%; p = 0.046). The incident rates of infection and anemia were higher in the TOF group than in the FIL group. Conclusions: TOF may be more effective than FIL at 8 weeks for patients with UC who do not respond to treatment within the first 4 weeks.

Management of melanoma in 2024 requires at times complex decision making and a multidisciplinary approach. An article by Dixon and collaborators published in this Journal contained broad-reaching recommendations, some of which are in contradiction of accepted National and International Guidelines. This article seeks to highlight these points of contention and outline widely accepted standards of care that are considered best practice.

Background: The study investigates sex-related differences and outcomes in unselected patients undergoing invasive coronary angiography (CA). Sex-based differences with regard to baseline characteristics and management of patients with cardiovascular disease have yet been demonstrated. However, their impact on long-term outcomes in unselected patients undergoing CA remains unknown. Methods: Consecutive patients undergoing invasive CA from 2016 to 2022 were included at one institution. Prognosis of male and female patients undergoing CA was investigated with regard to the primary endpoint of rehospitalization for heart failure (HF) at 36 months. Secondary endpoints comprised the risk of acute myocardial infarction (AMI) and coronary revascularization at 36 months, as well as in-hospital all-cause mortality. Statistical analyses included Kaplan-Meier analyses, as well as uni- and multivariable Cox proportional regression analyses. Results: From 2016 to 2022, 7691 patients undergoing CA were included (males: 65.1%; females: 34.9%). Males had a higher prevalence of coronary artery disease (CAD) (76.2% vs. 57.4%; p = 0.001), alongside a higher prevalence of 3-vessel CAD compared to females (33.9% vs. 20.3%; p = 0.001). The risk of rehospitalization for HF at 36 months was higher in males compared to females (22.4% vs. 20.3%; p = 0.036; HR = 1.127; 95% CI: 1.014-1.254; p = 0.027), which was no longer observed after multivariable adjustment. Male sex was associated with a higher risk of coronary revascularization (9.6% vs. 5.9%; p = 0.001; HR = 1.659; 95% CI: 1.379-1.997; p = 0.001), which was still evident after multivariable adjustment (HR = 1.650; 95% CI 1.341-2.029; p = 0.001). However, neither the risk of AMI at 36 months (8.1% vs. 6.9%; p = 0.077), nor the risk of in-hospital all-cause mortality (6.9% vs. 6.5%; p = 0.689) differed significantly between the two sexes. Conclusions: In consecutive patients undergoing coronary angiography, male sex was independently associated with an increased risk of coronary revascularization, but not HF-related rehospitalization.

Objectives: To compare the long-term efficacy and safety of intense pulsed light (IPL) treatments using a 590-nm and an acne filter. Methods: In this prospective, randomized, paired-eye trial study, 30 patients with moderate and severe meibomian gland dysfunction (MGD) were followed up for at least one month after their last treatment. Group A received IPL treatment with an acne filter, a type of notch filter that blocks wavelengths between 600 and 800 nm, allowing IPL to emit wavelengths between 400-600 nm and 800-1200 nm. Group B received treatment with a 590 nm filter, a type of cut-off filter that blocks wavelengths below 590 nm. Clinical parameters, including tear osmolarity, matrix metalloproteinase (MMP)-9 expression, tear break-up time, ocular surface staining scores, Schirmer's test I, lid margin telangiectasia scores, MG expressibility/secretion scores, and Ocular Surface Disease Index scores, were measured at baseline, 1, 6, and 12 months after their last treatment. Results: In the linear mixed model, significant time effects on all clinical parameters, except for MMP-9 grades and Schirmer's test I results, were observed within each group. However, interactions between time points (baseline, 6 months, 12 months) and groups (Group A, B) were not significant. The generalized estimating equation model showed no significant interaction between time points and groups for MMP-9 positivity; however, a significant time effect on MMP-9 positivity was observed in Group A, with a decrease at 12 months after their last treatment when compared to baseline and 6 months. Conclusions: The IPL treatment modality for moderate to severe MGD demonstrated a significant therapeutic effect for one year under strictly controlled self-administration of other treatments. IPL treatment using acne filter is a promising treatment option for reducing MMP-9 positivity in MGD patients.

New international recommendations on the diagnosis and treatment of polycystic ovary syndrome (PCOS) were published in autumn 2023 [...].

The management of cerebrovascular diseases has significantly evolved over the last decade or so [...].

Background: The objective of this study was to assess the course of rehabilitation of patients hospitalized in the cardiac rehabilitation unit after surgery for acute Stanford type A aortic dissection, extending beyond the ascending aorta, and comparing these findings with those for patients who, after the same type of surgery, had no remaining dissection. The aim was to develop an optimal cardiac rehabilitation model for this patient population, given the lack of clear guidelines. Additionally, the study aimed to evaluate their one-year survival. Methods: The study included patients referred to the cardiac rehabilitation unit after surgery for acute Stanford type A aortic dissection extending beyond the ascending aorta (a total of 25 patients). The study group was compared with a cohort of patients (a total of 58) who underwent similar cardiac surgery. The main difference was the absence of residual aortic dissection. All patients were assessed on admission to the cardiac rehabilitation unit and at discharge using the 6-min walk test and the Tinetti test. All patients underwent 2-3 weeks of rehabilitation following the same protocol; however, the study group had significantly reduced exercise loads. Results: Patients in the study group were admitted to the cardiac rehabilitation unit in a significantly worse functional status compared to the comparison group, but the final assessment showed comparable results for the Tinetti test and the 6-min walk test. There were no differences in one-year survival between the two groups. Conclusions: Early postoperative cardiac rehabilitation in patients after acute aortic dissection significantly improves the functional status of this patient group, and is safe.

Background/Objectives: Male infertility is influenced by physiological factors like age, as well as lifestyle factors, including physical activity. However, the specific impact of sport activity on semen parameters, and thus on male fertility, remains unclear. Specifically, the aim of this systematic review is to evaluate how an intense regime of training may affect sperm parameters in professional and non-profession athletes. Methods: Studies reporting sperm parameters associated with high training load were included. In April 2024, three electronic databases and literature sources (PubMed, Scopus, and Web of Science) were searched. Quality appraisal was performed independently by three authors using the National Heart, Lung, and Blood Institute Quality Assessment Tools (NHLBI-QAT). Results: Four studies met the inclusion criteria, reporting a total of 156 participants. Sixteen weeks of intensive cycling training produced a significant decrease in seminal volume, sperm concentration, sperm motility, and morphology, with a return to their initial levels, except for sperm morphology and sperm concentration, after at least one week of rest. In addition, in athletes with varicocele, a 6-month stop from sports activity went a long way toward improving sperm concentration and sperm motility. However, DNA fragmentation, a greater presence of round cells, and high numbers of active macrophages were described. At least 30 days improve semen parameters in professional and non-professional athletes. Conclusions: Intensive training could worsen seminal parameters and, consequently, male fertility. However, certainty of evidence is very low, and the results should be interpreted with caution.

As our understanding of ophthalmic optics and visual function advances, the intersection between clinical practice and technological innovation becomes increasingly significant in enhancing patient outcomes [...].