Journal of Clinical Medicine最新文献

Background/Objectives: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a multifactorial condition often refractory to standard medical therapy. Low-intensity extracorporeal shock wave therapy (Li-ESWT) is a mechanism-oriented option; however, prior reviews reported substantial heterogeneity, potentially due to pooling different wave-generator modalities despite their distinct physical properties. This study synthesized randomized evidence on Li-ESWT for CP/CPPS and explored a wave-generator modality as a prespecified effect modifier. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched from January 2015 to 31 October 2025 (date of last search) for randomized controlled trials (INPLASY: 2025120064). Eligible studies compared Li-ESWT (focused, radial, or multifocal) with sham or standard medical therapy (SMT). The primary outcome was total NIH-CPSI at the follow-up closest to 12 weeks. Pooled effects were calculated as weighted mean differences (WMDs) with 95% confidence intervals (CIs). Prespecified subgroup analyses were performed by wave-generator modality and therapy strategy (monotherapy vs add-on to SMT). Results: Eight RCTs (n = 455) were included. Li-ESWT significantly improved total NIH-CPSI versus the control (WMD -8.46; 95% CI -12.12 to -4.79; I² = 94.8%). Benefits were observed in both monotherapy and the add-on to SMT trials. By modality, focused devices showed consistent effects (WMD -6.59; I² = 0.0%), whereas radial devices showed an imprecise estimate with extreme heterogeneity (WMD -10.38; 95% CI -21.33 to +0.57; I² = 98.2%). Multifocal devices showed a significant benefit (WMD -10.84; I² = 81.0%). Improvements were mainly driven by pain-domain reduction. Conclusions: Li-ESWT provides clinically meaningful symptom relief in CP/CPPS, predominantly through pain reduction. Modality- and strategy-based subgroup findings are exploratory given substantial heterogeneity, limited trials, and no head-to-head comparisons; focused devices showed consistent effects, whereas estimates for radial and multifocal devices warrant cautious interpretation.

Peripheral ulcerative keratitis (PUK) is a sight-threatening corneal disorder characterized by progressive peripheral stromal thinning and ulceration. It often reflects an underlying systemic autoimmune or vasculitic disease and may herald severe morbidity or even mortality. This review offers a comprehensive synthesis of current knowledge on the pathophysiology, clinical presentation, diagnostic approach, and management strategies for PUK, with a special focus on idiopathic forms such as Mooren's ulcer. We explore the immunological mechanisms driving peripheral corneal destruction, including the roles of complement activation, matrix metalloproteinases, and systemic immune dysregulation. A detailed classification of etiologies, including systemic autoimmune diseases, infectious causes, and iatrogenic forms, is presented, along with recommendations for diagnosis, laboratory workup, and differential diagnosis. Management strategies are reviewed in a stepladder approach, from local anti-collagenase and immunomodulatory therapy to systemic immunosuppressants and biologics, and, when necessary, surgical intervention.

Background: Maternal serum screening remains widely implemented for prenatal aneuploidy assessment despite increased uptake of cell-free DNA testing. Evidence suggests that fetal sex may influence placental endocrine function and maternal serum biomarker levels; however, available studies are inconsistent and often limited by sample size or incomplete adjustment for maternal factors. Objective: The aim of this study was to determine whether fetal sex independently modifies first- and second-trimester maternal serum marker Multiple of the Median (MoM) values and whether sex-related biochemical variation affects trisomy-21 screen-positive classification. Methods: A retrospective cohort was identified from institutional screening records (10,384 screened pregnancies), of which 5040 first-trimester and 1476 second-trimester cases had complete biochemical data. First-trimester PAPP-A and free β-hCG, as well as second-trimester AFP, uE3, and free β-hCG, were measured. Implausible MoM values (<0.10 or >5.00) were excluded. Multivariable linear and logistic regression models adjusted for maternal age, maternal weight, gestational age at sampling, and parity assessed independent associations. Results: Pregnancies with female fetuses showed significantly higher MoM values for first-trimester PAPP-A and free β-hCG as well as second-trimester AFP and uE3. The magnitude of these differences was small, and no significant differences were observed in trisomy-21 screen-positive rates between fetal sex groups. Conclusions: Fetal sex independently influences several maternal serum markers across both trimesters but does not result in clinically meaningful differences in trisomy-21 screening outcomes under current algorithms. Any potential relevance of fetal sex for risk interpretation should be regarded as hypothesis-generating and requires outcome-validated investigation before clinical application.

Background: To compare postoperative outcomes between partial resection and preservation of the middle turbinate (MT) in patients with chronic rhinosinusitis undergoing endoscopic sinus surgery (ESS). Methods: A comprehensive search was undertaken across multiple major bibliographic databases, including PubMed, Scopus, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). Our outcome assessment measures included postoperative complications such as bleeding, synechia formation, MT lateralization, crustations, CSF leak, orbital injury, middle meatal antrostomy obstruction, frontal recess obstruction, revision surgery rate, smell test scores, and patient-reported outcomes (PROMs). Data were pooled using STATA software as risk ratio, mean difference, or standardized mean difference. Results: Fifteen clinical trials involving 2037 patients were analyzed. Partial MT resection was significantly associated with reduced rates of postoperative synechiae, MT lateralization, middle meatal obstruction, and frontal recess obstruction. Rates of postoperative bleeding, crusting, CSF leak, orbital injury, and revision surgery were comparable between the partial resection and preservation groups. No significant differences were found in olfactory outcomes. While PROMs, nasal obstruction, and headaches improved with partial resection, SNOT scores and nasal discharge remained similar. Conclusions: Partial MT resection demonstrated a safe and effective technique during ESS. Further large-scale RCTs are warranted to confirm and extend these findings.

Objectives: Transperineal (TP) prostate biopsy is increasingly used because of its lower complication rates compared with the transrectal approach. However, prospective data regarding its effects on erectile and ejaculatory function remain limited. This study prospectively evaluated short-term sexual function outcomes after TP prostate biopsy in sexually active men. Methods: This single-center prospective observational cohort study included men undergoing TP prostate biopsy between 15 April 2025 and 1 September 2025. Indications for biopsy were prostate-specific antigen levels >4 ng/mL, abnormal digital rectal examination findings, or suspicious lesions (PI-RADS ≥ 3) on multiparametric prostate MRI. Sexual function was assessed at baseline and at 1 and 3 months after biopsy using the International Index of Erectile Function (IIEF-5), the Premature Ejaculation Diagnostic Tool (PEDT), and the Male Sexual Health Questionnaire-Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF). Results: Overall, 249 sexually active men were analyzed. No significant changes in erectile or ejaculatory function were observed in the overall cohort at either follow-up point. In contrast, among 132 men diagnosed with prostate cancer, significant declines were observed in IIEF-5, PEDT, and MSHQ-EjD-SF scores at both 1 and 3 months compared to baseline (all p < 0.001). Conclusions: Transperineal prostate biopsy minimally affects sexual function in the general population. However, prostate cancer patients experience notable deterioration in erectile and ejaculatory outcomes, which may be a transient decline, and long-term follow-up is necessary for this subgroup.

Background/Objectives: Patients with early-stage non-small cell lung cancer (NSCLC) or limited lung metastases and compromised lung function, such as those with interstitial lung disease (ILD) or chronic obstructive pulmonary disease (COPD), or other factors rendering them high-risk for surgery or medically inoperable, face increased risks of treatment-related toxicity from stereotactic ablative radiation therapy (SABR). This study evaluated a novel treatment approach to mitigate these risks. Methods: We investigated Personalized Ultra-Fractionated Stereotactic Adaptive Radiotherapy (PULSAR), delivered as pulsed radiation every three weeks, in patients with <5 cm lung tumors and ILD, COPD, or prior therapy. Treatment occurred between 2022 and 2024. Online adaptive radiotherapy (o-ART) was employed in 20 patients (80%) to modify treatment plans when anatomical changes warranted replanning. Primary outcomes included volumetric tumor response, changes in dose to organs at risk (OARs) and acute events, while secondary outcomes included local and tumor control, and overall survival. Results: Twenty-three patients received PULSAR treatment at doses between 40 Gy and 60 Gy in 5 fractions and one patient received 54 Gy in 3 fractions, with a median follow-up time of 16.2 months. Approximately half of treated patients demonstrated volumetric tumor response, with median residual volume of 70% (range 36-100%) at maximal response. Among the 20 patients (80%) who underwent online adaptive replanning, significant reductions in OAR dosimetry were observed for all organs assessed including the Dmax for heart (p = 0.0053), bronchus (p = 0.0003), esophagus (p = 0.0005), spinal cord (p = 0.025), and the lung V20 Gy and V12.5 Gy (p < 0.0001). Treatment-related toxicity included two grade 1-2 adverse events and six grade 3 events consisting of pneumonitis, dyspnea or lung infection, with no grade 4 or 5 events. Median progression-free survival was 21.1 months, with 1-year overall survival of 74% and 1-year local control of 100%. Conclusions: PULSAR shows promise as a feasible treatment option for high-risk patients with NSCLC or lung metastases, demonstrating no grade 5 events and complete tumor control. Additional research is needed to fully evaluate the safety profile of PULSAR in the high-risk subgroups and whether PULSAR's treatment intervals and adaptive planning advantages lead to improved long-term outcomes compared to conventional, uninterrupted SABR regimens.

Background/Objectives: Peripheral venous cannulation is one of the most frequently performed invasive procedures in adult patients and is often associated with procedural pain. Despite the availability of various pain-reduction strategies, analgesia during cannulation is not consistently implemented in routine clinical practice. The aim of this review was to identify local pharmacological interventions recommended for reducing procedural pain during peripheral venous cannulation, to assess their clinical effectiveness, and to determine which interventions may be feasibly incorporated into everyday clinical practice. Methods: A literature review was conducted including randomized controlled trials, prospective studies, and meta-analyses involving adult patients undergoing peripheral venous cannulation. Outcomes of interest included procedural pain intensity, clinical effectiveness of pharmacological interventions, and their impact on additional outcomes such as patient satisfaction, anxiety, and safety. Results: Peripheral venous cannulation was most commonly associated with moderate-intensity pain. The use of local pharmacological interventions-particularly vapocoolant sprays and topical local anesthetics in cream or patch form-resulted in a significant reduction in pain intensity compared with placebo or no intervention. Several studies also reported improved patient satisfaction and a favorable safety profile of the analyzed interventions. Conclusions: Current evidence indicates that local pharmacological interventions are effective and safe in reducing pain associated with peripheral venous cannulation and may represent a valuable component of patient-centered clinical care. In addition to summarizing clinical effectiveness, this review highlights practical and organizational factors influencing the implementation of pharmacological pain-reducing interventions in routine nursing practice.

Emerging evidence highlights the critical role of corneal nerves in the pathophysiology of dry eye disease (DED) and other related ocular surface disorders (OSDs). These conditions increasingly demonstrate neuropathic and neurotrophic components, wherein alterations in corneal nerve morphology and function contribute to symptomatology and disease progression. Recent advances in imaging and diagnostic modalities have enabled detailed, in vivo evaluation of corneal nerve architecture and sensory function, offering novel insights into underlying mechanisms and therapeutic responses. This review comprehensively examines current and emerging technologies for corneal nerve assessment, both structural and functional. The structural methods include in vivo confocal microscopy (IVCM), optical coherence tomography (OCT)-based nerve imaging (e.g., micro-OCT), and emerging technologies like multiphoton microscopy. The functional methods of corneal nerve assessment include advanced esthesiometers, quantitative sensory testing (QST), and functional magnetic resonance imaging (fMRI). The emerging technologies also include AI-driven analytical platforms that can be applied to both structural and functional methods. These various nerve assessment modalities can aid in delineating DED subtypes, selecting targeted treatments, monitoring nerve regeneration, and predicting treatment outcomes. By integrating structural and functional assessments, these technologies are reshaping the diagnosis, phenotyping, and management of DED and other related OSDs, paving the way for personalized therapeutic approaches.

Background: The widespread use of antithrombotic therapies increases bleeding risk, particularly in patients with a high bleeding risk (HBR). Although proton pump inhibitors are recommended for lowering the risk of upper gastrointestinal (UGI) bleeding, the optimal agent and dosage remain uncertain. This study evaluated the efficacy and safety of low-dose rabeprazole (LORA, 5 mg) in reducing the incidence of GI-related adverse events in HBR patients receiving chronic antithrombotic therapy. Methods: This was a prospective, multicenter, interventional study that enrolled 909 South Korean patients receiving long-term antithrombotic therapy with HBR features including age ≥70 years, dual antiplatelet therapy, combined antithrombotic regimens, and prior GI bleeding. The primary endpoint was the incidence of significant GI events, including overt/occult bleeding and symptomatic peptic ulcer disease (PUD). Secondary endpoints included study drug discontinuation owing to GI adverse events, composite cardiovascular events, and all-cause mortality. Results: No patients had significant UGI bleeding or symptomatic PUD. The median adherence rate was 92.0% (interquartile range [IQR], 87.0-95.0). Drug discontinuation owing to GI symptoms occurred in 32 patients (3.52%) at a median of 81 days (IQR, 36-119 days). GI-related adverse events were reported in 3.96%, with diarrhea, epigastric discomfort, and constipation being the most common. Non-GI bleeding and cardiovascular composite events occurred in 0.33% (n = 3) each, with all-cause mortality at 0.55% (n = 5). Conclusions: Low-dose rabeprazole was associated with reduced GI complications in patients receiving chronic antithrombotic therapy, with a favorable safety profile and high adherence. Further studies with larger and broader populations are required to confirm these findings.