Journal of Clinical Medicine最新文献

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the growing spine, frequently associated with functional impairment, altered trunk biomechanics, compromised respiratory performance, and psychosocial burden. The risk of curve progression increases during periods of rapid growth, highlighting the need for effective conservative interventions targeting both structural and neuromuscular components of the deformity. This review synthesizes evidence published between 2005 and 2025 on the effects of Schroth-based physiotherapeutic scoliosis-specific exercises in adolescents aged 10-18 years with idiopathic scoliosis and Risser stages 0-5. Studies applying Schroth therapy exclusively or predominantly, either as a stand-alone intervention or combined with bracing, were included, while non-idiopathic scoliosis and mixed PSSE protocols were excluded. A total of 17 studies meeting predefined eligibility criteria were included. Across randomized controlled trials, controlled cohort studies, and longitudinal case series, Schroth interventions were associated with attenuation of Cobb angle progression, improvements in three-dimensional trunk symmetry, postural control, respiratory mechanics, and health-related quality of life. Combined Schroth and brace therapy generally demonstrated superior outcomes compared with bracing alone. Despite these findings, heterogeneity in intervention protocols and outcome measures limits direct comparability across studies. Overall, current evidence supports the Schroth Method as a relevant conservative strategy for AIS, particularly when initiated early and delivered through individualized three-dimensional correction. Further high-quality multicenter studies with standardized protocols are required to strengthen the long-term evidence base.

Background/Objectives: Oxidative stress and extracellular redox alterations are involved in the pathophysiology of essential hypertension, but their clinical assessment is limited by the invasiveness and preanalytical complexity of blood-based measurements. Urine represents an attractive non-invasive biological matrix; however, the relationship between urinary and plasma DTNB-reactive reduced thiols in hypertensive patients remains insufficiently characterized. This study aimed to evaluate the association between plasma and urinary reduced thiols in essential hypertension. Methods: In this paired observational study, plasma and urine samples were obtained from 40 patients with treated essential hypertension. Reduced thiols were quantified using a DTNB-based colorimetric assay under identical analytical conditions. Plasma thiols were normalized to total plasma protein concentration, and urinary thiols were normalized to creatinine. Associations between plasma and urinary thiols were assessed using non-parametric correlation analyses. Results: Protein-normalized plasma thiols and creatinine-normalized urinary thiols showed a significant positive correlation (Spearman's ρ ≈ 0.7, p < 0.001). Conclusions: In patients with essential hypertension, creatinine-normalized urinary reduced thiols are strongly associated with protein-normalized plasma reduced thiols, as measured by the DTNB reaction method. These findings provide hypothesis-generating evidence that urinary thiols may reflect extracellular thiol-related redox alterations, warranting further validation in independent and more diverse cohorts.

Background/Objectives: Lupus Nephritis (LN) is a major complication of Systemic Lupus Erythematosus (SLE) leading to significant morbidity. While biopsy is the gold standard, non-invasive tools are needed for longitudinal monitoring. This study aims to evaluate the diagnostic utility of Shear Wave Elastography (SWE) in detecting subclinical renal damage (fibrosis) in SLE patients with a history of LN who are currently in clinical remission (inactive disease), and to compare its efficacy with Doppler ultrasonography (DUS). Methods: This cross-sectional study included 80 SLE patients and 41 age- and sex-matched healthy controls. Crucially, all SLE patients were in the clinically inactive disease (SLEDAI-2K < 6) at the time of evaluation. Patients were stratified into two groups: those with a history of LN (LN Group, n = 37) and those without (Non-LN SLE Group, n = 43). Strict exclusion criteria were applied to eliminate non-SLE renal comorbidities. Renal parenchymal stiffness (kPa) was measured using SWE, and the renal resistive index (RI) was assessed using DUS. SWE findings were correlated with renal function tests and disease activity scores. Results: Despite being in clinical remission, the LN group exhibited significantly higher renal stiffness values (Median: 1.60 kPa) compared to the non-LN SLE group (1.40 kPa, p < 0.001) and healthy controls (1.32 kPa, p < 0.001). No significant difference was observed between the non-LN SLE group and controls. Unlike SWE, renal RI values showed no statistically significant difference among the groups (p > 0.05). Correlation analysis revealed that renal stiffness was positively associated with prior serum creatinine and disease activity (SLEDAI-2K), and negatively associated with eGFR. Conclusions: SWE is superior to DUS (RI) in detecting renal parenchymal changes in LN patients. The persistence of elevated stiffness during the inactive disease suggests that SWE captures cumulative chronic damage (remodeling and fibrosis) rather than just acute inflammation. Consequently, SWE holds promise as a non-invasive surrogate for monitoring disease chronicity in SLE patients.

Background/Objectives: Knee osteoarthritis (KOA) is associated with pain, functional decline, and altered biomechanics. The Step-Up and Down-Forwards (StUD-F) task provides an ecologically relevant assessment of challenging movements. This study investigated neuromuscular activation and lower-limb kinematics of leading and trailing-limbs during the StUD-F in individuals with KOA. Methods: Forty participants with KOA (65.3 ± 7.68 years; 21M/19F; BMI 28.9 ± 4.52 kg/m²) completed a 25 cm box StUD-F task. Surface electromyograph recorded bilateral activation of the vastus medialis (VM), vastus lateralis (VL), bicep femoris (BF), and semitendinosus (ST). Triplanar hip, knee, and ankle joint angles were estimated using inertial measurement units. StUD-F events (initial stance; step contact; ascent completion; descent preparation; step-down touchdown; and descent completion) were identified using custom algorithms. Pain was assessed using visual analogue scales and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Limb differences were analysed for leading or trailing roles using paired samples t-tests or non-parametric equivalents; waveforms were visually inspected. Results: Distinct neuromuscular and kinematic asymmetries were observed when affected and contralateral limbs were compared within each role (leading/trailing). During step-up, the affected leading limb demonstrated higher quadriceps activation at initial stance (VM: p = 0.035; VL: p = 0.027) and reduced trailing-limb activation at step contact (VM: p = 0.015; VL: p = 0.018), with sagittal-plane ankle differences (p = 0.004). During step-down, when the affected limb initiated ascent, trailing limb activation was higher at descent completion (VL: p < 0.001; VM: p = 0.003; BF: p = 0.009), with coronal-plane hip deviations (p < 0.001). When the contralateral limb-initiated ascent, trailing-limb muscles activation differences (VM: p < 0.001; VL: p = 0.015; BF: p = 0.007) and ankle/coronal-plane asymmetries (p ≤ 0.049) persisted. Conclusions: The StUD-F task elicits altered strategies in KOA, including elevated quadriceps-hamstring co-activation and altered sagittal/coronal alignment, and habitual limb choice across ascent and descent. These adaptations may enhance stability and joint protection but could increase medial compartment loading. The findings support rehabilitation focused on dynamic control, alignment, and shock absorption.

Background/Objective: The optimal strategy for hospital transport of patients with out-of-hospital cardiac arrest is unclear. A transport protocol based on the shortest travel route was implemented in a metropolitan area in the Republic of Korea to minimize prehospital transport time; however, the protocol is frequently violated. This study evaluated whether protocol violations influenced the clinical outcomes of patients who experienced intra-arrest. Methods: This retrospective observational study included patients who experienced out-of-hospital cardiac arrest and were transported by emergency medical services between September 2021 and December 2022. We analyzed run sheets, the cardiac arrest registry, and Out-of-Hospital Cardiac Arrest Surveillance data, which contain patient demographics, time variables, Utstein factors, posthospital arrival treatments, and clinical outcomes. The primary outcome was emergency department mortality. The secondary outcome was poor neurological outcome (cerebral performance category scores 3-5). Logistic regression and mediation analyses assessed associations between protocol violations, transport times, and clinical outcomes. Results: Among the 3474 cardiac arrest cases, 1534 (44.2%) had transport protocol violations. Violations were associated with longer scene and transfer times. The emergency department survival rates for the protocol-violation and -nonviolation groups were 15.4% and 16.4%, respectively. Protocol violations were not associated with mortality (odds ratio [OR]: 1.04; 95% confidence interval [CI] 0.85-1.27, p = 0.70) or poor neurological outcomes (OR: 1.00; 95% CI 0.45-2.18, p = 0.99). Mediation analysis revealed that increased transfer time did not affect clinical outcomes. Conclusions: These results suggest that transport strategies should consider real-time availability of emergency resources and adopt an evidence-based approach.

Background/Objectives: The study aims to provide a comprehensive understanding of personalized treatment for patients with inguinal hernias at our hospital, focusing on complications, recurrence rates, and hospitalization duration to optimize treatment outcomes. Methods: Our center performs inguinal hernia surgery using an algorithm tailored to individual clinical conditions, developed in collaboration with the anesthesiology department. We retrospectively reviewed outcomes of open, totally extraperitoneal (TEP), and transabdominal preperitoneal (TAPP) approaches, with all procedures performed by a single surgeon. Results: A total of 229 patients (213 males; age range, 24-92 years; median age, 69 years) underwent inguinal hernia repair at Busan National University Hospital between January 2018 and April 2024. Patients in the open group had higher age and comorbidity burden (age/ASA American Society of Anesthesiologists physical status classification: open 74/3.5 vs. TAPP 70/2.0 vs. TEP 68/2.0; p = 0.036/< 0.001). There were no statistically significant differences in intraoperative complications (p = 1.000); however, the conversion rate was slightly higher in the TEP group (TEP 2 vs. TAPP 1). Length of hospital stay was longest in the TAPP group (open 3.77 days vs. TAPP 3.98 days vs. TEP 3.27 days; p = 0.817), while postoperative complication rates did not differ significantly among groups (overall complications: open 15.4% vs. TAPP 6.2% vs. TEP 4.3%; p = 0.100). Conclusions: Laparoscopic surgery is recommended when general anesthesia is feasible, with TEP preferred for patients without previous surgeries and TAPP for those with preperitoneal space (PPS) access challenges due to previous surgeries or radiation therapy. Open surgery is suitable for patients unable to undergo general anesthesia. Anesthesia and surgical approaches should be based on patient preferences and individual clinical conditions.

Bicuspid Aortic Valve (BAV) disease is recognized as the most common congenital heart condition and is frequently associated with complex valvular and aortic disorders. Cardiovascular computed tomography (CT) has become essential for diagnosing BAV, planning procedures, and evaluating patients after treatment. This is largely due to CT's high spatial resolution and its ability to perform volume imaging effectively. This review provides an up-to-date overview of the increasing role of cardiovascular CT in the management of bicuspid aortic valve (BAV). It covers various aspects, including BAV morphology, optimal sizing for transcatheter aortic valve replacement (TAVR), and post-procedural monitoring. We highlight significant innovations, such as supra-annular sizing techniques and artificial intelligence (AI)-guided analysis, that position CT at the nexus of anatomy, function, and targeted treatment. Additionally, we address controversies concerning inconsistencies in sizing algorithms, recent classification challenges, and radiation exposure. Future development areas include AI predictive tools, radiomic phenotyping, and CT-guided precision medicine. This synthesis aims to provide clinicians and researchers with a high-level guide to the clinical integration of cardiovascular CT and its future in the BAV population. This review provides the most current, comprehensive synthesis on the pivotal role of cardiovascular CT in BAV management, offering a roadmap for integrating advanced imaging into clinical practice and guiding future research priorities.

Background/Objectives: Autologous fat grafting (AFG) is widely used in breast reconstruction; however, graft retention remains unpredictable due to recipient-bed variability. Photoacoustic imaging (PAI) is a contrast-free, noninvasive modality enabling visualization of vascular structures in detail. This study used PAI to visualize and quantitatively assess neovascularization and vascular structure in breasts reconstructed with AFG. Methods: In this retrospective, cross-sectional study, data from eight patients who underwent PAI of both reconstructed and contralateral breasts at least three months after their final AFG procedure for total breast reconstruction were used. Excluding the nipple-areola complex and skin markings, four 3 × 3 cm regions of interest (one per quadrant) were selected in the periareolar region. Vascular density in terms of depth from the skin surface was analyzed in five cases with adequate contact between the device and the skin. Visible vessel diameters within the regions of interest were manually measured and categorized as small, medium, or large to assess distribution patterns. Results: PAI successfully enabled visualization of vascular structures on the reconstructed side in all cases, even at depths greater than 10 mm. In five cases, vascular density in the superficial layer (0-2.5 mm) was higher on the reconstructed side than on the contralateral side. A longer postoperative interval was associated with a higher proportion of small vessels and fewer large vessels. Conclusions: PAI enabled noninvasive visualization of vascular structures consistent with neovascularization on the reconstructed side after AFG. Temporal changes in vessel diameter distribution suggest ongoing vascular remodeling, supporting the potential utility of PAI in assessing vascular structural changes in grafted tissue over time.

Background/Objectives: Penile prosthesis implantation is a safe and effective treatment for erectile dysfunction, with low complication rates. Glans ischemia is a rare but serious postoperative complication that can lead to irreversible tissue loss. However, not all postoperative glans color changes reflect true ischemia, and distinguishing reversible from irreversible perfusion compromise remains challenging. The objective was to describe the clinical course, management, and outcomes of four patients who developed glans color changes following penile prosthesis implantation, emphasizing the role of glans sensibility in guiding treatment. Methods: We conducted a retrospective case series supplemented with a narrative literature review. Clinical data were obtained from medical records, operative reports, and follow-up visits. Literature searches were performed using PubMed, Scopus, and Google Scholar. Results: Four patients developed postoperative glans discoloration. Two patients, with preserved glans sensibility and no evidence of tissue necrosis, were managed conservatively with cylinder deflation and removal of compressive dressings, resulting in full recovery without tissue loss. Two patients, who exhibited impaired glans sensitivity, developed progressive ischemia. One had prior pelvic radiation, and the other underwent combined grafting and glanspexia. Both required surgical debridement and reconstruction, with permanent tissue loss. Conclusions: Glans color changes after penile prosthesis implantation do not always indicate irreversible ischemia. Preserved glans sensibility is a useful clinical marker of potentially reversible perfusion compromise and may support a conservative management strategy with close monitoring. Conversely, loss of sensation and necrosis should prompt urgent consideration of prosthesis explantation to prevent further tissue loss.

Background: The protracted Syrian conflict has severely disrupted healthcare services, compromising the continuity and quality of care for individuals with type 2 diabetes mellitus (T2DM). This study evaluated diabetes-related quality of life, treatment satisfaction, and perceived stress among adults with T2DM receiving care in selected clinics within conflict-affected Syrian regions and examined predictors of these outcomes. Methods: A cross-sectional survey was conducted in July 2024 among 200 adults with T2DM recruited from outpatient clinics, primary healthcare centers, and diagnostic laboratories in Homs and Damascus. Participants completed validated Arabic versions of the Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Treatment Satisfaction Questionnaire (DTSQs), and Perceived Stress Scale (PSS-10), alongside the collection of sociodemographic and clinical data. Descriptive statistics, univariate analyses, and multivariable linear regression models were applied. As this study used a facility-based purposive sample, its findings may not be generalizable to all individuals with diabetes in Syria. Results: Participants had a mean age of 57.6 ± 11.8 years, and 59.5% were male. Hypertension (70.5%) and obesity (35.5%) were the most common comorbidities, while retinopathy (21.5%), nephropathy (23.5%), and neuropathy (19.5%) were the most frequent complications. The mean ADDQoL Average Weighted Impact score was -3.1 ± 1.3, indicating substantial quality-of-life impairment. The mean DTSQs total score was 30.4 ± 5.6, suggesting moderate satisfaction with treatment despite frequent perceived hyperglycemia. The mean PSS-10 score was 18.8 ± 3.4, with 92.5% of respondents experiencing moderate stress. In multivariable models, poorer quality of life was predicted by older age, rural residence, higher BMI, and depression. Lower treatment satisfaction was associated with rural residence and retinopathy, while higher perceived stress was linked to lower education, obesity, and obstructive sleep apnea. Conclusions: Adults with T2DM attending selected healthcare facilities in conflict-affected Syria experience marked reductions in quality of life, moderate treatment satisfaction, and elevated psychosocial stress. These findings highlight the need for strengthened medication supply chains, improved rural service coverage, and integration of psychosocial support within diabetes care in fragile health systems.