Journal of Clinical Medicine最新文献

Background: Despite advancements in limb-sparing surgery (LSS), adjuvant therapies, and imaging techniques, amputations remain necessary in certain cases, including locally advanced tumors, inadequate resections, or palliative scenarios. This study aims to provide an overview of tumor-related amputations, comparing primary and secondary amputations in terms of survival, recurrence, and surgical outcomes. Methods: A retrospective cohort study of 132 patients undergoing tumor-related amputations between 2004 and 2023 at a tertiary care center was conducted. Patients were stratified by amputation level (major vs. hand/foot) and timing (primary vs. secondary). Kaplan-Meier survival and multivariate regression analysis identified prognostic factors. Results: Major amputations accounted for 77% of cases, while 23% involved the hands or feet. Primary amputations constituted 55% of procedures, and 45% were secondary interventions. Overall survival was 123 months (95% CI, 105-142), with a 5-year survival rate of 66% and a 10-year survival rate of 53%, respectively. Hand/foot amputations showed superior survival compared to major amputations (p = 0.032). Local recurrence emerged as the only significant predictor of overall survival (p = 0.033). Conclusions: Tumor-related amputations remain crucial in musculoskeletal oncology. Survival outcomes are comparable between primary and secondary amputations, but hand/foot amputations are associated with improved survival. Achieving local control is critical, underscoring the need for precise surgical planning.

Background/Objectives: Spinal excitability may undergo adaptive modulation in response to training load, sport-specific demands, and fatigue. While high-impact sports are known to influence reflex responsiveness, the extent to which these changes differ from athletes in lower-impact disciplines remains unclear. This study aimed to investigate post-exercise changes in Hmax/Mmax ratio among trained runners with varied sport backgrounds, and to identify emergent physiological profiles that may reflect differential spinal adaptation to fatigue. Methods: Twenty-two trained athletes underwent unilateral H-reflex testing before and after treadmill running performed to voluntary exhaustion. Amplitudes of the H-reflex and M-wave were recorded, and Hmax/Mmax ratios were analyzed. Based on a physiologically relevant threshold commonly used to distinguish normal from suppressed reflex amplitudes, participants were post hoc classified into three groups: Group A (pre- and post-test ratios above threshold), Group B (pre above, post below), and Group C (both below). A two-way repeated-measures ANOVA was used to assess between-group effects. Results: Significant differences were found across groups and conditions (p < 0.001). Group A maintained reflex ratios above the threshold, indicating stable excitability. Group B showed the greatest suppression (approximately 66%), transitioning from normal to subthreshold values. Group C remained consistently below-threshold. A significant interaction (p < 0.0001) confirmed that reflex modulation varied by physiological profile. A small but statistically significant reduction in H-reflex latency was also observed; however, this change remained within normal physiological variability. Conclusions: Postexercise H-reflex modulation revealed heterogeneous neuromuscular responses among athletes. These findings may contribute to understanding how sport-specific demands and fatigue shape spinal excitability and may help identify individuals with adaptive or potentially pathological profiles relevant to sports diagnostics.

Background/Objectives: Although O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation is a key predictive biomarker in glioblastoma, its association with clinical and lifestyle characteristics remains poorly understood. Methods: We retrospectively analyzed 105 patients who underwent surgical treatment for glioblastoma at Kyungpook National University Hospital between August 2012 and April 2022 to evaluate the relationship between MGMT promoter methylation status and clinical and lifestyle factors. Collected variables included age, sex, body weight, body height, smoking history, and comorbidities such as hypertension, diabetes mellitus, and hyperlipidemia. Results: Current smoking was significantly associated with MGMT promoter methylation in both univariate and multivariate analyses (adjusted odds ratio [OR], 4.6; p = 0.03). Additionally, a history of hypertension was associated with MGMT promoter methylation after multivariate adjustment (adjusted OR, 3.6; p = 0.03). Conclusions: MGMT promoter methylation in glioblastoma was associated with current smoking and a history of hypertension, suggesting lifestyle-related factors may influence epigenetic mechanisms underlying MGMT promoter methylation in glioblastoma.

Background: The coronary slow flow phenomenon (CSFP) is an angiographic entity increasingly recognized in patients with angina and/or ischemia but non-obstructive coronary arteries (ANOCA/INOCA), associated with systemic inflammation, endothelial dysfunction, and microvascular abnormalities. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a novel immunonutritional index that may reflect this multifactorial risk profile. Methods: This retrospective single-center case-control study included 122 patients with CSFP and 126 age- and sex-matched controls with normal coronary flow, all presenting with symptoms of chronic coronary syndrome. CSFP was diagnosed via corrected TIMI frame count. HALP and other inflammatory indices (NLR, PLR, SII, SIRI) were calculated from baseline laboratory values. Associations were evaluated using multivariable logistic regression, ROC analysis, and restricted cubic spline (RCS) modeling. Results: The HALP score was significantly lower in CSFP patients (mean 56.2 vs. 65.9, p < 0.001). In multivariable analysis, HALP was independently associated with CSFP (adjusted OR: 0.951; 95% CI: 0.930-0.972; p < 0.001), whereas NLR lost significance. PLR, SII, and SIRI remained independently associated. HALP showed the highest diagnostic performance (AUC: 0.698), significantly outperforming all other indices (DeLong p < 0.001). A HALP cutoff ≤ 56.4 provided 58.2% sensitivity and 77.0% specificity. RCS analysis demonstrated a significant non-linear inverse relationship (p for non-linearity = 0.034). Subgroup analyses confirmed consistent associations across age, sex, hypertension, and diabetes strata. Conclusions: The HALP score is independently associated with CSFP and outperforms traditional inflammatory indices. Its low cost and accessibility make it a promising tool for clinical risk stratification in ANOCA/INOCA patients, pending validation in multicenter prospective studies.

Background: Type 1 diabetes mellitus (T1DM) is associated with an increased risk of fragility fractures that cannot be fully explained by reduced bone mineral density (BMD), highlighting a potential role for bone quality impairment. The purpose of this study was to evaluate the prevalence of altered bone density and microarchitecture and to identify their main clinical correlates in adults with T1DM and seemingly adequate glycemic control at the time of assessment. Methods: Sixty-eight adults aged 18-69 years with T1DM attending a diabetes technology outpatient clinic were enrolled in this single-center, cross-sectional study. BMD at the lumbar spine, femoral neck, and total hip was assessed by dual-energy X-ray absorptiometry (DXA) and classified as reduced based on age and sex: Z-score < -2.0 SD for premenopausal women and men < 50 years, and T-score ≤ -2.5 SD for postmenopausal women and men ≥ 50 years. Bone microarchitecture was evaluated using trabecular bone score (TBS). Clinical, metabolic, and lifestyle variables were collected, including glycated hemoglobin (HbA1c; good control ≈ 7.0%/53 mmol/mol), diabetes duration, microvascular complications, and physical activity (PA) assessed by the International PA Questionnaire (IPAQ; moderate-high PA defined according to combined high and moderate IPAQ categories). Results: Reduced BMD was observed in 35.3% of patients and was associated with older age (p < 0.001), longer disease duration (p = 0.044), lower body mass index (p = 0.031), poorer glycemic control (p = 0.03), microvascular complications such as diabetic peripheral neuropathy (p = 0.028) and retinopathy (p = 0.045), and low PA (p = 0.012). Altered TBS was present in 45.6% of patients and was associated with older age (p < 0.001), longer diabetes duration (p = 0.011), higher HbA1c levels (p < 0.001), diabetic peripheral neuropathy (p = 0.002), retinopathy (p = 0.007), cardiovascular risk factors (dyslipidemia p = 0.002, hypertension p = 0.002), and low PA (p < 0.001). In multivariable analyses, older age and higher HbA1c were independently associated with reduced TBS, whereas moderate-high PA was associated with a lower likelihood of impaired bone microarchitecture. Conclusions: Impaired bone density and bone quality are highly prevalent in adults with T1DM and are frequently associated with longer disease duration, poorer metabolic control, and chronic complications. Our findings support the potential value of a combined assessment of BMD and TBS in fracture risk evaluation, together with strategies aimed at preventing diabetes-related complications and promoting healthy lifestyle behaviors.

Background/Objectives: Proton pump inhibitors (PPIs) are widely used, yet questions persist about kidney-related adverse events. We evaluated disproportional reporting of acute kidney injury (AKI) and tubulointerstitial nephritis (TIN) with PPIs in the FDA Adverse Event Reporting System (FAERS) from 2020 to 2025. Methods: FAERS reports were screened using MedDRA Preferred Terms. Report characteristics and annual counts of AKI and TIN reports were summarized. Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), Empirical Bayes Geometric Mean (EBGM), and Information Content (IC) were used to assess disproportionality. Results: We identified 13,654 PPI-associated AKI reports and 2409 TIN reports in FAERS (2020-2025). Reports were predominantly from the United States, and missing age/sex information was common. Hospitalization was reported in 12.3% of AKI and 22.7% of TIN reports, and death in 9.1% and 5.0%, respectively. Across all years, disproportionality analyses using ROR, PRR, EBGM, and IC consistently met signal thresholds for both outcomes, with stronger signals in 2020-2022 and attenuation thereafter alongside declining report counts. Conclusions: FAERS data show persistent disproportional reporting of AKI and TIN with PPI use. Causality cannot be inferred, but the findings support cautious, indication-based PPI prescribing and highlight the need for robust studies to clarify renal safety.

Acute and Chronic Coronary Syndromes represent two major medical challenges and are the leading cause of cardiovascular mortality and morbidity. While Chronic Coronary Syndrome (CCS) can be defined as the whole group of structural and/or functional abnormalities involving coronary arteries before and after an acute event, Acute Coronary Syndrome (ACS) encompasses the condition of acute myocardial ischemia (with or without consequent myocardial injury and troponin release) due to dynamic mechanisms such as athero-thrombosis or vasospasm. Because of this complex interplay between structural and functional mechanisms arising from both the epicardial and microvascular compartments, a comprehensive approach to fully investigate the whole spectrum of coronary disease is therefore essential. To address this issue, the invasive functional assessment has evolved through the years, from a way to guide revascularization to a meticulous protocol for characterizing ischemia-leading mechanisms and stratifying prognosis both in ACS and CCS. However, coronary physiology remains underused in clinical practice, and multiple gaps in knowledge still exist; on top of this, there is increasing heterogeneity regarding how to perform functional assessment, with different protocols proposed by various centers. The aim of this review is to summarize the evidence in the field of coronary physiology, and to discuss how and when to use it at its best.

Background/Objectives: Photobiomodulation (PBM) therapy has shown potential in managing orofacial neuropathic pain (ONP); however, inconsistent PBM dosimetry and methodological variability limit its clinical application. This World Association for Photobiomodulation Therapy (WALT) Position Paper aims to critically appraise current evidence and provide recommendations for Clinical Practice Guidelines (CPG) and Expert Consensus Opinion (ECO) where appropriate. Methods: Evidence evaluation was guided by the HANNA (Holistic Analysis & Novel Normative Actions) Framework, a structured multi-step methodology integrating systematic review, quality appraisal, and expert consensus. A systematic review was conducted in accordance with PRISMA 2020 guidelines. Methodological quality was assessed using validated tools: AMSTAR 2 for systematic reviews, RoB2 for randomized controlled trials (RCTs), and ROBINS-I for non-randomized studies (NRCTs). The AGREE II Reporting Checklist was applied to ensure transparency and rigor in the development of WALT recommendations. The Somerfield Criteria were used to rate the level of evidence (LoE) for each included ONP condition, where deemed appropriate. Results: WALT CPG were established for primary burning mouth syndrome (BMS), supported by robust evidence (LoE I) from 204 patients across six "Low RoB" RCTs and NRCTs, and 557 patients included in a "High-Confidence" systematic review and meta-analysis of "low RoB" RCTs. WALT ECO were developed for idiopathic trigeminal neuralgia (TN) and post-herpetic neuralgia (PHN), both supported by LoE II. Insufficient evidence precluded formal recommendations for post-traumatic trigeminal neuralgia, glossopharyngeal neuralgia, and occipital neuralgia. Conclusions: This Position Paper introduces the HANNA Framework, for the first time, as a robust and transparent methodology for developing WALT recommendations by delivering evidence-based CPG for PBM in the management of neuropathic pain associated with primary BMS, along with ECO for both TN and PHN. These recommendations support PBM as a safe and effective therapeutic approach, and provide a structured roadmap for future research and periodic guidelines updates.

Background: University students are increasingly vulnerable to both depressive symptoms and hazardous alcohol use, particularly in the aftermath of the COVID-19 pandemic. Disruptions in circadian rhythms, hormonal dysregulation, and changing social dynamics may heighten susceptibility to maladaptive coping behaviors such as alcohol consumption. While this relationship has been widely studied in Western populations, limited data exist for Eastern European contexts. This study investigated the association between alcohol consumption and depressive symptoms among Romanian university students and explored potential gender differences in this post-pandemic cohort. Methods: A cross-sectional study was conducted among 103 Romanian university students at the University of Medicine and Pharmacy of Craiova, Romania. Participants anonymously completed a combined survey integrating the Alcohol Use Disorders Identification Test (AUDIT) and the Depression subscale of the Depression, Anxiety and Stress Scale (DASS-21). Statistical analyses included Pearson correlation, linear regression, and subgroup comparisons to evaluate associations between alcohol use and depression severity. Results: The mean AUDIT score was 5.4 ± 5.8, while the mean DASS-21 Depression score was 13.8 ± 9.5. A strong positive correlation was observed between AUDIT and depression scores (r = 0.72, 95% CI [0.62, 0.80], p < 1 × 10^-17). Linear regression revealed that AUDIT scores significantly predicted depression severity (R² = 0.496, p < 0.001), with each one-point increase in AUDIT score associated with a 1.31-point rise in depression score. Male students reported significantly higher alcohol use than females (p = 0.005), while depression scores did not differ significantly by gender (p = 0.110). The alcohol-depression association was similarly strong across genders. Conclusions: Hazardous alcohol use was highly prevalent and strongly associated with increased depressive symptoms among university students. These findings highlight the need for integrated mental health and substance use screening programs in university settings to support early identification and intervention.