Journal of Clinical Medicine最新文献

Background: Antibodies against Ku have been described in patients with various connective tissue diseases. The objective of this study was to describe the clinical, functional, and imaging characteristics of interstitial lung disease in patients with anti-Ku antibodies. Methods: This single-center, retrospective observational study was conducted at a tertiary referral institution. Patients with positive anti-Ku antibodies and interstitial lung disease identified between 2007 and 2022 were included. Clinical, immunological, functional, and imaging data were systematically reviewed. Results: Nineteen patients (ten females) with a mean age of 59 ± 12.6 years were included. The most frequent associated diagnosis was systemic sclerosis (42%), followed by rheumatoid arthritis (26%), Sjögren syndrome, undifferentiated connective tissue disease, and overlap between systemic sclerosis and idiopathic inflammatory myopathy (scleromyositis). Imaging revealed frequent septal and intralobular reticulations and ground-glass opacities, with nonspecific interstitial pneumonia as the predominant pattern (53%). The mean forced vital capacity was 82% ± 26 of the predicted value, and the mean diffusing capacity for carbon monoxide was 55% ± 21. Over the first year of follow-up, the mean annual forced vital capacity decline was 140 mL/year (range: 0-1610 mL/year). The overall survival rate was 82% at 5 years and 67% at 10 years. Conclusions: Most patients with interstitial lung disease and anti-Ku antibodies presented with dyspnea, a mild-to-moderate restrictive ventilatory pattern, and reduced diffusing capacity for carbon monoxide. The CT pattern was heterogeneous but was consistent with nonspecific interstitial pneumonia in half of the patients.

Background/Objectives: Acetabular fractures are rare fractures of the pelvis which usually result from trauma. Whilst data are reported on sexual and genitourinary function in those with pelvic fractures, less is known about those with isolated acetabulum fractures. This systematic review aimed to determine, first, the frequency of sexual and genitourinary dysfunction following isolated acetabulum fractures and, second, the nature of these complications. Methods: A PRISMA strategy was used. Medline, Cochrane Central Register of Controlled Trials, Scopus, and EMBASE library databases were interrogated using pre-defined MeSH terms and Boolean operators. Quality of evidence was evaluated based on OCEBM and GRADE systems. Results: Seven studies based on 648 individuals were identified with a mean follow-up time of 33.6 ± 22.4 months. Five papers described sexual functional outcomes, and two reported genitourinary function. Acetabulum fractures were noted to have an impact on sexual function ranging from 20.0% to 39.8% within the groups analysed. With respect to genitourinary outcomes, incidence of lower urinary tract injury and spontaneous voiding failure was quite low, but due to the existence of little data, firm conclusions cannot be made. Conclusions: This review has highlighted a paucity of data related to outcomes of sexual and genitourinary function in patients who are post-acetabulum fracture. The limited available data suggests that acetabular fractures have an impact on sexual function, but the impact on genitourinary function is less clear. Further prospective work is required to better understand the relationship between baseline demographics, injury characteristics, injury mechanism and concurrent injuries, and surgical fixation and acetabular-fracture outcomes.

Background/Objectives: Patient-reported outcome measures (PROMs) assess the severity and impact of both pain and dyspnea in those with acute exacerbations of chronic obstructive pulmonary disease (COPD), but their frequency of use in clinical practice is unknown. This study aimed to determine the point prevalence of pain and dyspnea assessment in patients hospitalized with an acute exacerbation of COPD and the measurement tools applied for this purpose in clinical practice. Methods: Clinical notes and observation charts of patients admitted with acute exacerbations of COPD to a metropolitan hospital in 2019 and 2020 were retrospectively audited to identify the point prevalence of pain and dyspnea assessment, the PROMs applied, and their associated focal periods. Results: Pain and dyspnea were assessed using a PROM in 99% and 8% of cases of acute exacerbation of COPD, respectively. All PROMs used measured symptom intensity. Focal periods were rarely reported in the assessment of pain; in the dyspnea assessment, timeframes predominantly reflected the impact of exertion. Conclusions: At this single health service site, in people hospitalized with an acute exacerbation of COPD, pain was more frequently assessed using a PROM than dyspnea. Understanding factors influencing clinicians' choice of assessment tools may inform future recommendations for the assessment of these symptoms in people hospitalized with exacerbations of COPD.

Background: Idiopathic nephrotic syndrome (INS) is the most common cause of nephrotic syndrome in children. A hallmark of the disease is the rapid remission of proteinuria following a high dose of steroids. Recurrent disease or steroid dependence are common, leading to a high steroid burden and the introduction of steroid sparing therapy. Anti-CD20 antibodies have been increasingly used with excellent results in complicated INS. Nevertheless, their use can be limited by the occurrence of infusion-related reactions (IRRs). Methods: This report discusses further treatment options for children who are intolerant to RTX and presents the first report of a successful switch to obinutuzumab (OBI) for a child with difficult-to-treat steroid-dependent nephrotic syndrome (SDNS) and RTX intolerance who was unresponsive to a desensitization protocol. Results: A 12-year-old boy with SDNS since the age of 2, was treated with steroids, cyclophosphamide and cyclosporine A (CsA). Because of the prolonged use of calcineurin inhibitors, a course of rituximab (RTX) was planned. Unfortunately, during first infusion, the boy presented with IRR. A desensitization protocol following the first unsuccessful infusion also failed. Facing the risks of long-term cyclosporine therapy, a decision was made to switch to another type of anti-CD20 antibody. Obinutuzumab infusion with a modified premedication scheme was uneventful. Conclusions: Switching therapy to obinutuzumab may be considered an option in nephrotic children who are intolerant to RTX when alternative therapies have been exhausted. The addition of montelukast to premedication and employment of desensitization protocols may decrease the risk of infusion-related reactions to anti-CD20 agents.

Background/Objectives: Injuries involving the Atlas (C1) and Axis (C2) vertebrae of the cervical spine present significant clinical challenges due to their complex anatomy and potential for severe neurological impairment. Traditional imaging methods often lack the detailed visualization required for precise surgical planning. This study aimed to develop high-resolution 3D models of the C1 and C2 vertebrae to perform a comprehensive morphometric analysis, identify gender differences, and assess bilateral symmetry to enhance surgical accuracy. Methods: A retrospective analysis was conducted using CT scans from 500 patients aged 18 and older from a single-center hospital. Three-dimensional models were generated using InVesalius 3.1 and visualized with Meshmixer. Morphometric measurements included screw placement angles, lamina length and height, bicortical diameters, and pedicle widths. Statistical analyses were conducted using SPSS, with the Student's t-test applied for gender and bilateral comparisons. Results: Significant gender differences were found in certain measurements, such as pedicle width (4.85 ± 0.90 mm in males vs. 4.60 ± 0.85 mm in females, p = 0.048) and C2 lamina height (12.90 ± 1.40 mm in males vs. 12.40 ± 1.25 mm in females, p = 0.033). Most measurements exhibited bilateral symmetry, supporting their applicability across genders. These results align with previous studies and highlight the importance of tailored surgical approaches. Conclusions: Three-dimensional models of the C1 and C2 provide comprehensive morphometric data that enhance preoperative planning and surgical precision. Integrating these models into clinical practice can reduce intraoperative risks and improve patient outcomes in cervical spine surgeries.

Background: Childhood nutrition plays an important role in the promotion of long-term health. Introducing solid foods in alignment with the Mediterranean Diet during weaning fosters a preference for healthy foods early in life. However, access to nutritious diets remains a challenge in underserved communities. Scampia, a socioeconomically disadvantaged district in Naples, Italy, exemplifies a community where barriers to healthy eating persist. This research reports a trial protocol that plans for a study to evaluate the impact of the Mediterranean Diet on child health and to establish preventive strategies for chronic diseases. Methods: The PEMED (PrEventive effect of MEditerranean Diet in Children) trial is a Bayesian Sequential Pragmatic Cluster Randomized Clinical Trial. Family Pediatricians (FPs) are randomized to deliver either Mediterranean Diet-based dietary guidance starting at weaning or standard dietary practices using typical baby foods. Children will be followed up for six years, with regular assessments of growth, microbiome composition, and adherence to the Mediterranean Diet, using validated tools. Interim analyses will be conducted at three-year intervals to evaluate the efficacy and monitor adverse events. Saliva and stool samples will be collected for genetic and microbiome analyses, and adherence will be monitored through quarterly dietary recalls and biomarkers. Results: This trial will consider Italy's established FP network for implementing innovative dietary intervention in a real-world setting. Conclusions: This study will address nutritional disparities in the underserved Scampia community and provide a scalable model for early dietary interventions. The results will shed light on the role of the Mediterranean Diet in improving childhood health and informing public health strategies globally.

Background/Objectives: Antiseizure drugs (ASDs) are the primary therapy for epilepsy, and the choice varies according to seizure type. Epilepsy patients experience chronic mitochondrial oxidative stress and increased levels of pro-inflammatory mediators, recognizable hallmarks of biological aging; however, few studies have explored aging markers in epilepsy. Herein, we addressed for the first time the impact of ASDs on molecular aging by measuring the telomere length (TL) and mtDNA copy number (mtDNA-CN). Methods: We used real-time quantitative PCR (QPCR) in epilepsy patients compared to matched healthy controls (CTs) and assessed the association with plasma levels of ASDs and other clinical variables. The sample comprised 64 epilepsy patients and 64 CTs. Patients were grouped based on monotherapy with lamotrigine (LTG) or valproic acid (VPA), and those treated with a combination therapy (LTG + VPA). Multivariable logistic regression was applied to analyze the obtained data. Results: mtDNA-CN was similar between patients and controls, and none of the comparisons were significant for this marker. TL was shorter in not seizure-free patients than in CTs (1.50 ± 0.35 vs. 1.68 ± 0.34; p < 0.05), regardless of the ASD therapy. These patients exhibited the highest proportion of adverse drug reactions. TL was longer in patients on VPA monotherapy, followed by patients on LTG monotherapy and patients on an LTG + VPA combined scheme (1.77 ± 0.24; 1.50 ± 0.32; 1.36 ± 0.37, respectively; p < 0.05), suggesting that ASD treatment differentially modulates TL. Conclusions: Our findings suggest that clinicians could consider TL measurements to decide the best ASD treatment option (VPA and/or LTG) to help predict ASD responses in epilepsy patients.

Background/Objectives: Objective: To discuss therapeutic outcomes in patients with symptomatic near-narrow internal auditory canal (NNIAC). Methods: We retrospectively analyzed the records of 26 symptomatic patients diagnosed with NNIAC, who had been treated with anti-epileptic drugs. In addition to clinical and radiological data, we recorded I-III latencies of auditory brainstem responses prior to and after medical therapy. Results: Among a total of 48 patients with NNIAC, 26 patients were included. Oxcarbazepine, Gabapentin, and Lamotrigine were prescribed among 19 (73%) patients, 6 (23%) patients, and 1 patient (4%), respectively. After treatment, 24 (92.3%) patients described improvement of vestibular symptoms, and 16 (76.2%) reported improvement of auditory symptoms. After treatment with antiepileptic drugs, ipsilateral IPL I-III latencies decreased (less than 2.3 ms) in 16 (84.2%) patients (23 ears out of 42). Conclusions: A low dose of anti-epileptic monotherapy for NNIAC could be effective over the long term and is generally well-tolerated. Further studies are needed to provide more solid evidence of the efficacy and safety of anti-epileptic drugs on a larger number of patients with NNIAC.

Background/objectives: This retrospective longitudinal outcome study comparing orthodontic extraction modalities, including extraction of maxillary first or second molars, aimed to compare the three-dimensional tooth movement of maxillary canines (C), premolars (P1, P2), and molars (M1, M2) in Class II division 1 malocclusion treatment with fixed appliances. Methods: A sample of 98 patients (mean age 13.20 ± 1.46 years) was selected for the M1 group, and 64 patients (mean age 13.20 ± 1.36 years) were chosen for the M2 group. Tooth movement was analyzed three-dimensionally on pre-treatment (T0) and post-treatment (T1) digital dental casts. Regression analyses compared the tooth movements (in mm) between the M1 and M2 groups. Results: The mean treatment duration for the M1 group was 2.51 ± 0.55 year, while, for the M2 group, it was 1.53 ± 0.37 year. The data showed limited distal movements of the C, P1, and P2 of approximately 2 mm in the M1 group and 1 mm in the M2 group during orthodontic treatment, but the M1 group exhibited significantly more distal movements than the M2 group (mean difference 1.11 to 1.24 mm). Vertical movements of the C, P1, and P2 in both groups were also minor (0.16 to 1.26 mm). The differences between groups did not exceed 0.2 mm and were not significant. Both treatment modalities resulted in a significant degree of anchorage loss with a distinct mesialization (8.40 ± 1.66 mm) of M2 in the M1 group and limited distalization (0.83 ± 0.98 mm) of M1 in the M2 group. Conclusions: The findings highlight the importance of thorough case evaluation when choosing between extraction modalities in Class II treatment. If a large distal movement of canines and premolars is required, additional anchorage mechanics should be considered.

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