Journal of Clinical Medicine最新文献

Background: The pathophysiology of HFpEF is complex and characterized by systemic inflammation, metabolic dysregulation, and endothelial dysfunction. Trace element involvement in redox balance, mitochondrial function, and calcium signaling is postulated. This cross-sectional analysis aimed to investigate possible differences in hair scalp trace element concentrations in patients with HFpEF and controls. Material and methods: Fifty-eight consecutive patients were enrolled (HFpEF n = 37; controls n = 21). HFpEF diagnosis was established using the HFA-PEFF diagnostic algorithm by two independent cardiologists blinded to hair analysis results. Scalp hair samples were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). Results: HFpEF patients demonstrated higher hair concentrations of magnesium (17.8 (7.3-47.5) vs. 14.0 (6.7-29.0) µg/g, p = 0.037), copper (57.24 (33.87-84.76) vs. 12.96 (9.85-26.02) µg/g, p < 0.001), calcium (322 (106-1330) vs. 145 (74-672) µg/g, p = 0.006), and lead (0.257 (0.164-0.563) vs. 0.159 (0.079-0.283) µg/g, p = 0.03). Conclusions: In this exploratory analysis, HFpEF was associated with differences in selected scalp hair trace element concentrations. The interaction between magnesium, calcium, copper, and lead were noted, with higher concentrations in HFpEF phenotypes. These findings are hypothesis-generating and warrant confirmation in larger cohorts incorporating serum/urine measurements and exposure assessment.

Objectives: The objective of this study was to investigate choroidal structural alterations and evaluate the outcomes of switching to faricimab in patients with neovascular age-related macular degeneration (nAMD) previously treated with other anti-vascular endothelial growth factor (anti-VEGF) therapies after 12 months of follow-up. Methods: We performed a retrospective study of 30 eyes from 30 patients with nAMD who were switched to faricimab. The choroidal vascularity index (CVI), best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (CST), and the presence of subretinal fluid, intraretinal fluid, and wet macula were assessed at baseline and after 6 and 12 months. Results: CVI remained stable during follow-up (p > 0.05). BCVA improved significantly after 6 months (p = 0.041), but not at 12 months (p = 0.075). A significant reduction in CMT was observed (p < 0.05). Additionally, wet macula improved after 12 months (p < 0.05). Moreover, treatment intervals increased from 7.53 ± 2.39 to 12.47 ± 4.51 weeks. Conclusions: Switching to faricimab in patients with nAMD previously treated with other anti-VEGF therapies was associated with anatomical improvement, extended treatment intervals, and short-term visual gains, while choroidal vascular structure was maintained. Nonetheless, additional studies are warranted to more comprehensively evaluate the effectiveness of switching to faricimab, as well as the associated changes in choroidal vascular structure.

Objectives: This study investigated the effects of trunk extension-based inspiratory muscle strengthening on respiratory function, balance, and gait in patients with stroke. Methods: Thirty stroke patients were randomly assigned to the study group (n = 15) or control group (n = 15). The study group performed inspiratory muscle strengthening exercises in a trunk extension posture, while the control group received conventional inspiratory muscle training. Both groups trained five times per week for six weeks. Outcome measures included maximal inspiratory pressure (MIP), maximal inspiratory flow rate (MIFR), maximal inspiratory volume (MIV), peak expiratory flow (PEF), forced expiratory volume in 1 s (FEV₁), Berg Balance Scale (BBS), weight distribution ratio (WDR), limits of stability (LOSs), Timed Up and Go (TUG), gait velocity, cadence, and stride length. Results: The study group showed significantly greater improvements in respiratory parameters (MIP, MIFR, MIV, PEF, FEV₁) and functional outcomes (WDR, LOS, BBS, TUG, gait velocity, cadence, stride length) compared to the control group. Conclusions: Trunk extension-based inspiratory muscle strengthening effectively improves respiratory function, balance, and gait in stroke patients, and may serve as a valuable addition to stroke rehabilitation programs.

Background/Objectives: As an escalating global health challenge, food allergies impose substantial burdens on the physical and psychological well-being of pediatric populations, profoundly compromising their quality of life. Given the marked geographical heterogeneity in allergen distribution patterns, this epidemiological investigation systematically characterizes prevalent pediatric food allergens sensitization patterns in Southwest China, yielding critical region-specific data to inform targeted prevention strategies and clinical management protocols. Methods: A cohort of 36,399 pediatric participants (age <18 years) underwent hospital-based testing for allergen-specific immunoglobulin E (sIgE) reactivity against 10 regionally prevalent food allergens, utilizing a semi-quantitative, immunocapture-based, and enzyme-linked immunosorbent assay. Results: Of the 36,399 children whose food allergen sensitization profiles were analyzed, 48.12% (n = 17,514) demonstrated elevated sIgE reactivity in response to at least one tested allergen, with milk and eggs emerging as the predominant allergenic triggers. Age-stratified analyses identified preschool age (≤6 years) as the critical window for food sensitization, demonstrating peak IgE reactivity to major allergens, including milk, peanuts, soybeans, shrimp, eggs, wheat, and beef. Male subjects exhibited significantly higher sensitization rates to peanuts, soybeans, crustaceans and wheat compared to females (p < 0.05), underscoring the importance of sex-based considerations in allergy prevention strategies. Conclusions: Milk and eggs emerge as the dominant food allergens that cause sensitization in Chengdu's pediatric population. Age- and sex-dependent vulnerabilities were identified, with younger children and male participants demonstrating higher sensitization rates than their counterparts. These age-stratified and male-predominant sensitization patterns provide a scientific foundation for public health initiatives.

Background/Objectives: Rigid interfragmentary compression is essential for primary bone healing following fractures, osteotomies, and arthrodeses of the foot and ankle. Evidence on the clinical performance of the MAX Variable Pitch Compression (VPC) Screw System (Zimmer Biomet, Warsaw, IN, USA) remains limited. This post-market, retrospective cohort study evaluated its safety, performance, and patient-reported outcomes. Methods: A single-center, consecutive series of patients treated with the MAX VPC Screw System for foot or ankle fractures, osteotomies, or arthrodeses between March 2018 and October 2023 was analyzed. The primary endpoint was radiographic and clinical bone union or joint fusion at 6-8 weeks and ≥18 months. Secondary endpoints included adverse events and functional outcomes using the Foot and Ankle Ability Measure (FAAM). Results: A total of 214 procedures were included (27 fractures, 80 osteotomies, 107 arthrodeses). Union was assessed in 209 procedures (97.7%) at 6-8 weeks and in 82 procedures (38.3%) at ≥18 months. Union rates were 86.1% at 6-8 weeks and 98.8% at ≥18 months. Early union was higher in arthrodeses (91.5%) than in fractures/osteotomies (80.6%). Adverse events occurred in 13.1% of procedures, 67.9% of which were device-related; no recurrent mechanical failures were observed. Mean FAAM scores were 92.3 (ADL) and 78.8 (Sports) for arthrodeses and 94.3 and 85.8, respectively, for fractures/osteotomies, at a mean FAAM follow-up of 2.9 years. Conclusions: The MAX VPC Screw System demonstrated high bone-union rates, favorable functional outcomes, and a moderate number of device-related complications. These results support its clinical use in foot and ankle surgery. However, the retrospective, single-center design limits generalizability, and prospective multicenter trials are warranted to confirm these findings.

Background/Objectives: Breast morphology is commonly described using volume, projection, and ptosis, whereas proportional relationships within the breast footprint are less frequently quantified. Routine clinical measurements describe the apparent or clinically measured breast footprint rather than the fixed anatomical footprint. This exploratory study examines how body mass index and thoracic width are associated with the clinically measured horizontal and vertical dimensions of the breast footprint and introduces the height-to-base-width (H/B) ratio as a simple descriptive index. Methods: Anthropometric measurements from 50 women undergoing aesthetic breast surgery were retrospectively analyzed. Breast base width and breast height were obtained using standardized upright clinical measurements. BMI was used as a surrogate of adiposity, while thoracic circumference measured at the inframammary fold (band size) served as a proxy for thoracic frame size. Associations were examined using Spearman correlation and multivariable regression. Results: BMI showed a strong positive association with clinically measured breast base width (ρ = 0.691, p < 0.001) but only a weak association with breast height (ρ = 0.327, p = 0.0777). Thoracic width was inversely associated with the H/B ratio (ρ = -0.549, p = 0.002). Multivariable analysis identified BMI as the principal determinant of measured base width, whereas vertical footprint dimensions showed limited responsiveness to BMI variation. Conclusions: Higher BMI was associated with horizontal expansion of the measured breast footprint, while vertical dimensions remained comparatively stable. These findings reflect soft-tissue redistribution and measurement-dependent footprint appearance rather than alteration of the underlying anatomical footprint. The H/B ratio emerges as a potential descriptive index for apparent footprint proportions, meriting further investigation and prospective validation.

Background: Chronic pain following thoracotomy remains a common and clinically significant complication that adversely affects functional recovery and quality of life. Despite advances in perioperative analgesic techniques, chronic post-thoracotomy pain continues to be under-recognized and insufficiently managed in routine clinical practice. In this study, we aimed to determine the incidence of chronic pain after thoracotomy and evaluate its impact on daily activities and postoperative pain management behaviors. Methods: This retrospective observational study was conducted after institutional ethics committee approval was received (approval no. 2023/61). Patients aged ≥15 years who underwent thoracotomy between 15 June 2022 and 15 June 2023 and had undergone an operation at least three months prior to the study were included. Patients who underwent video-assisted thoracoscopic surgery were excluded. Demographic, surgical, anesthetic, and postoperative analgesia data were obtained from medical records. Patients were contacted by telephone to assess pain intensity using a Numeric Rating Scale (NRS), functional impact on daily activities, and analgesic medication use. The primary outcome was the incidence of chronic post-thoracotomy pain, defined as pain persisting beyond three months and reported at the time of the interview. Results: A total of 56 patients were included in the analysis. Chronic pain was reported by 55.4% of the patients. Pain that interfered with daily activities and required medication use was reported by 51.5% of the patients. Thirty-three patients (57.9%) reported an NRS score > 3 during movement. Among patients with chronic pain, 64.7% reported self-medication without physician consultation, whereas only 11.8% sought medical advice for pain management. Conclusions: Chronic pain remains highly prevalent after thoracotomy and substantially interferes with daily functioning. A considerable proportion of patients self-manage their pain without medical supervision, underscoring the need for structured postoperative follow-up, early identification of high-risk patients, and individualized multimodal analgesic strategies to reduce the burden of chronic post-thoracotomy pain.

Introduction: Pelvic floor disorders (PFDs) are a very widespread clinical phenomenon and are known to affect millions of women worldwide, significantly impairing their quality of life. New technologies and innovations such as electrotherapy and photobiostimulation are currently revolutionizing what concerns conservative treatment, allowing clinicians to tailor therapy to every woman. The aim of this study was to evaluate the feasibility of use of electrotherapy and photobiostimulation in PFD management and the initial results of treatment in clinical practice. Methods: This prospective study (IRB code: GSM-RF 2025) aimed to analyze the impact of the innovative DAFNE system to treat PFDs through electrotherapy and photobiostimulation. We enrolled patients with mild pelvic organ prolapse and stress urinary incontinence who desired a conservative treatment for their conditions. The following validated scales were used for assessing baseline quality of life before and after treatment: Urinary Distress Inventory-6 (UDI-6), Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), Female Sexual Function Index-6 (FSFI-6), 0-100 VAS Scale, and Vaginal Health Index. Electrotherapy was delivered through 4 gold rings, providing Functional Electrical Stimulation (FES), Transcutaneous Electrical Nerve Stimulation (TENS) and/or Microcurrent Electrical Neuromuscular Stimulation (MENS). The photobiostimulation system consisted of 24 LEDs per wavelength (420 nm UVA; 630 nm RED; 870 nm NIR/INFRARED) positioned at 360° along the entire length of the handpiece for antimicrobial purposes, microcirculation improvement, and anti-inflammatory action. The cycle of treatment consisted of 3-5 sessions, according to necessity. Overall improvement was measured through the Patient Global Impression of Improvement (PGI-I). Statistical analysis was performed using Student's t-Test. A value of p < 0.05 was considered as significant. Results: In the period of interest, 32 women were treated with the DAFNE system. The mean age was 57.0 ± 16.6 years. Indications for treatment were stress urinary incontinence (16/32), mild pelvic organ prolapse (14/32), or both (2/32). The mean number of treatments per patient was 4. Quality of life improved as a consequence of the treatment according to the considered scales. Specifically, 87.5% of patients considered themselves improved. Conclusions: The DAFNE system has been successful in managing mild pelvic organ prolapse and stress urinary incontinence, improving quality of life scores. Embracing new technologies such as electrotherapy and photobiostimulation appears to be successful in conservatively managing a variety of PFDs.

Background/Objectives: Lower extremity peripheral artery disease (PAD) is recognized as a significant public health issue, particularly due to its strong association with adverse cardiovascular events. Despite this, little attention has been given to its influence on left ventricular (LV) and left atrial (LA) function in patients with chronic heart failure (CHF). This study aims to examine the relationship between femoral plaque burden and structural and functional properties of the LV and LA in patients with CHF. Methods: Study design: cross-sectional observational single-center study. A total of 89 patients with CHF underwent comprehensive assessments, including duplex ultrasonography of lower extremity arteries and two-dimensional echocardiography. Analysis focused on evaluating femoral plaque burden, left ventricular deformation, and ventricular-arterial coupling. Results: Findings indicated that increased femoral plaque burden was associated with reductions in LA deformation and increases in LA stiffness. Similarly, there was evidence of impaired LV mechanics and elevated arterial loading, suggesting impaired ventricular-arterial coupling in patients with CHF and significant lower extremity atherosclerosis. Conclusions: Femoral plaque burden is closely linked to detrimental changes in LA and LV function, as well as disturbances in ventricular-arterial coupling, underscoring the importance of addressing lower extremity atherosclerosis in managing CHF patients.