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Surgical Treatment of Pectus Excavatum: The Boundary Between Pathologic and Aesthetic Need.
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-03 DOI: 10.3390/jcm14010231
Paola Ciriaco

Background: Pectus excavatum, also known as sunken chest or funnel chest, is a structural deformity of the anterior chest wall, characterized by an inward sternum. This condition can lead to respiratory and cardiovascular issues, although it is often addressed for aesthetic reasons. This perspective article reviews the experiences of multiple centers in treating pectus excavatum, to explore whether a clear boundary exists between pathological and aesthetic needs. Methods: The research was conducted on PubMed, using the following targeted search queries to identify relevant studies: "pectus excavatum and surgery", and "pectus excavatum and conservative treatment." Additional searches were performed for articles related to the psychological and emotional state of patients with pectus excavatum. Results: Over 2000 articles related to the topic were identified in the literature. Only primary studies from the past 20 years were included, with a focus on centers reporting a minimum of 30 to 50 cases annually. Nearly 60% of these centers perform the Nuss procedure, exclusively. Major complications occurred in 1-2% of cases, particularly when the procedure was performed without videothoracoscopy. Post-surgery, improvements in lung function and exercise capacity were reported, along with significant reductions in depression and anxiety. Conclusions: The decision to pursue surgical correction of pectus excavatum requires a thorough evaluation of both therapeutic and aesthetic factors. A patient-centered approach, considering both the physical and emotional aspects of the condition, is essential for achieving the best possible outcome.

{"title":"Surgical Treatment of Pectus Excavatum: The Boundary Between Pathologic and Aesthetic Need.","authors":"Paola Ciriaco","doi":"10.3390/jcm14010231","DOIUrl":"10.3390/jcm14010231","url":null,"abstract":"<p><p><b>Background:</b> Pectus excavatum, also known as sunken chest or funnel chest, is a structural deformity of the anterior chest wall, characterized by an inward sternum. This condition can lead to respiratory and cardiovascular issues, although it is often addressed for aesthetic reasons. This perspective article reviews the experiences of multiple centers in treating pectus excavatum, to explore whether a clear boundary exists between pathological and aesthetic needs. <b>Methods:</b> The research was conducted on PubMed, using the following targeted search queries to identify relevant studies: \"pectus excavatum and surgery\", and \"pectus excavatum and conservative treatment.\" Additional searches were performed for articles related to the psychological and emotional state of patients with pectus excavatum. <b>Results:</b> Over 2000 articles related to the topic were identified in the literature. Only primary studies from the past 20 years were included, with a focus on centers reporting a minimum of 30 to 50 cases annually. Nearly 60% of these centers perform the Nuss procedure, exclusively. Major complications occurred in 1-2% of cases, particularly when the procedure was performed without videothoracoscopy. Post-surgery, improvements in lung function and exercise capacity were reported, along with significant reductions in depression and anxiety. <b>Conclusions:</b> The decision to pursue surgical correction of pectus excavatum requires a thorough evaluation of both therapeutic and aesthetic factors. A patient-centered approach, considering both the physical and emotional aspects of the condition, is essential for achieving the best possible outcome.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pediatric Supracondylar Humerus Fracture: When Should We Surgically Treat? A Case-Series.
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-03 DOI: 10.3390/jcm14010237
Filippo Familiari, Andrea Zappia, Giorgio Gasparini, Michele Mercurio, Giuseppe Tedesco, Daria Anna Riccelli, Livio Perticone, Giovanni Carlisi, Gianluca Testa, Ludovico Lucenti, Vito Pavone, Andrea Vescio

Background/Objectives: Supracondylar humerus fractures (SCHFs) are the most common pediatric elbow injuries and often require surgical intervention. Despite guidelines, optimal timing for surgical management, particularly for cases without neurovascular compromise, remains unclear. This study evaluates the influence of surgical timing on short-term outcomes, focusing on fracture reduction quality and surgical parameters. Methods: In total, 62 pediatric patients who had been treated for Gartland type II and III SCHF between 2018 and 2023 were retrospectively assessed. Patients were grouped based on time of admission (morning, afternoon, early evening, and night shifts) and time to surgery (<12 h vs. >12 h). Primary outcomes included immediate radiological reduction, assessed via the Baumann's angle (BA) and shaft-condylar angle (SCA). Secondary outcomes encompassed surgery duration and radiation exposure. Statistical analyses used ANOVA and chi-square tests, with p < 0.05 considered significant. Results: No significant differences were observed in BA (p = 0.84) or SCA (p = 0.79) between early and delayed surgical groups. Similarly, surgical timing (shift or delay >12 h) did not significantly affect surgery duration (p = 0.92) or radiation exposure (p = 0.12). The complication rate was 6.45%. Conclusions: Surgical timing, including delays beyond 12 h, does not adversely affect short-term outcomes in SCHFs. However, after-hours procedures may pose practical challenges, emphasizing the importance of surgeon experience and institutional protocols. Larger prospective studies are warranted to validate these findings and examine them in the long term.

{"title":"Pediatric Supracondylar Humerus Fracture: When Should We Surgically Treat? A Case-Series.","authors":"Filippo Familiari, Andrea Zappia, Giorgio Gasparini, Michele Mercurio, Giuseppe Tedesco, Daria Anna Riccelli, Livio Perticone, Giovanni Carlisi, Gianluca Testa, Ludovico Lucenti, Vito Pavone, Andrea Vescio","doi":"10.3390/jcm14010237","DOIUrl":"10.3390/jcm14010237","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Supracondylar humerus fractures (SCHFs) are the most common pediatric elbow injuries and often require surgical intervention. Despite guidelines, optimal timing for surgical management, particularly for cases without neurovascular compromise, remains unclear. This study evaluates the influence of surgical timing on short-term outcomes, focusing on fracture reduction quality and surgical parameters. <b>Methods</b>: In total, 62 pediatric patients who had been treated for Gartland type II and III SCHF between 2018 and 2023 were retrospectively assessed. Patients were grouped based on time of admission (morning, afternoon, early evening, and night shifts) and time to surgery (<12 h vs. >12 h). Primary outcomes included immediate radiological reduction, assessed via the Baumann's angle (BA) and shaft-condylar angle (SCA). Secondary outcomes encompassed surgery duration and radiation exposure. Statistical analyses used ANOVA and chi-square tests, with <i>p</i> < 0.05 considered significant. <b>Results</b>: No significant differences were observed in BA (<i>p</i> = 0.84) or SCA (<i>p</i> = 0.79) between early and delayed surgical groups. Similarly, surgical timing (shift or delay >12 h) did not significantly affect surgery duration (<i>p</i> = 0.92) or radiation exposure (<i>p</i> = 0.12). The complication rate was 6.45%. <b>Conclusions</b>: Surgical timing, including delays beyond 12 h, does not adversely affect short-term outcomes in SCHFs. However, after-hours procedures may pose practical challenges, emphasizing the importance of surgeon experience and institutional protocols. Larger prospective studies are warranted to validate these findings and examine them in the long term.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Antegrade Ureteral Stenting in Pediatric Patients: Introducing a Novel Ureteral Morphological Classification and a New Perspective on Functional Success.
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-03 DOI: 10.3390/jcm14010246
Mustafa Mazıcan, Ismail Karluka, Abdulkerim Temiz, Cagatay Andic

Background/Objectives: The objective of the current research is to assess the benefits that come with antegrade ureteral stenting coupled with imaging techniques in children and also provide a new classification based on the ureter's morphological elements. Methods: Between 2011 and 2024, 107 antegrade stent placement procedures performed in 71 pediatric patients aged 0-12 years who could not undergo retrograde double-J stent placement were retrospectively analyzed. According to the morphologic structure of the ureter, four categories were classified as normal, straight/slightly angled, S-shaped, and spiral-shaped. Functional success was evaluated by comparing the results of ultrasonography and Tc-99m MAG3 scintigraphy before and after the procedure. Results: Technical success rate was 99.1% and functional success rate was 84.1%. Intra-procedural complication rate was 5.6% and post-procedural complication rate was 39.3%. According to morphologic classification, the functional success rate was lowest in spiral-shaped ureters with 79.5%, but this difference was not statistically significant (p = 0.775). There was no significant correlation between stent diameter, balloon dilatation, and degree of hydronephrosis and functional success. Conclusions: Antegrade ureteral stent placement is a safe method with high technical success and acceptable complication rates in pediatric patients. The developed ureteral morphologic classification may guide clinical practice.

{"title":"Antegrade Ureteral Stenting in Pediatric Patients: Introducing a Novel Ureteral Morphological Classification and a New Perspective on Functional Success.","authors":"Mustafa Mazıcan, Ismail Karluka, Abdulkerim Temiz, Cagatay Andic","doi":"10.3390/jcm14010246","DOIUrl":"10.3390/jcm14010246","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The objective of the current research is to assess the benefits that come with antegrade ureteral stenting coupled with imaging techniques in children and also provide a new classification based on the ureter's morphological elements. <b>Methods</b>: Between 2011 and 2024, 107 antegrade stent placement procedures performed in 71 pediatric patients aged 0-12 years who could not undergo retrograde double-J stent placement were retrospectively analyzed. According to the morphologic structure of the ureter, four categories were classified as normal, straight/slightly angled, S-shaped, and spiral-shaped. Functional success was evaluated by comparing the results of ultrasonography and Tc-99m MAG3 scintigraphy before and after the procedure. <b>Results</b>: Technical success rate was 99.1% and functional success rate was 84.1%. Intra-procedural complication rate was 5.6% and post-procedural complication rate was 39.3%. According to morphologic classification, the functional success rate was lowest in spiral-shaped ureters with 79.5%, but this difference was not statistically significant (<i>p</i> = 0.775). There was no significant correlation between stent diameter, balloon dilatation, and degree of hydronephrosis and functional success. <b>Conclusions</b>: Antegrade ureteral stent placement is a safe method with high technical success and acceptable complication rates in pediatric patients. The developed ureteral morphologic classification may guide clinical practice.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Evidence-Based Medicine Management of Endometriosis Should Be Updated for the Limitations of Trial Evidence, the Multivariability of Decisions, Collective Experience, Heuristics, and Bayesian Thinking.
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-03 DOI: 10.3390/jcm14010248
Philippe R Koninckx, Anastasia Ussia, Assia Stepanian, Ertan Saridogan, Mario Malzoni, Charles E Miller, Jörg Keckstein, Arnaud Wattiez, Geert Page, Jan Bosteels, Emmanuel Lesaffre, Leila Adamyan

Background/Objectives: The diagnosis and treatment of endometriosis should be based on the best available evidence. Emphasising the risk of bias, the pyramid of evidence has the double-blind, randomised controlled trial and its meta-analyses on top. After the grading of all evidence by a group of experts, clinical guidelines are formulated using well-defined rules. Unfortunately, the impact of evidence-based medicine (EBM) on the management of endometriosis has been limited and, possibly, occasionally harmful. Methods: For this research, the inherent problems of diagnosis and treatment were discussed by a working group of endometriosis and EBM specialists, and the relevant literature was reviewed. Results: Most clinical decisions are multivariable, but randomized controlled trials (RCTs) cannot handle multivariability because adopting a factorial design would require prohibitively large cohorts and create randomization problems. Single-factor RCTs represent a simplification of the clinical reality. Heuristics and intuition are both important for training and decision-making in surgery; experience, Bayesian thinking, and learning from the past are seldom considered. Black swan events or severe complications and accidents are marginally discussed in EBM since trial evidence is limited for rare medical events. Conclusions: The limitations of EBM for managing endometriosis and the complementarity of multivariability, heuristics, Bayesian thinking, and experience should be recognized. Especially in surgery, the value of training and heuristics, as well as the importance of documenting the collective experience and of the prevention of complications, are fundamental. These additions to EBM and guidelines will be useful in changing the Wild West mentality of surgery resulting from the limited scope of EBM data because of the inherent multivariability, combined with the low number of similar interventions.

{"title":"The Evidence-Based Medicine Management of Endometriosis Should Be Updated for the Limitations of Trial Evidence, the Multivariability of Decisions, Collective Experience, Heuristics, and Bayesian Thinking.","authors":"Philippe R Koninckx, Anastasia Ussia, Assia Stepanian, Ertan Saridogan, Mario Malzoni, Charles E Miller, Jörg Keckstein, Arnaud Wattiez, Geert Page, Jan Bosteels, Emmanuel Lesaffre, Leila Adamyan","doi":"10.3390/jcm14010248","DOIUrl":"10.3390/jcm14010248","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The diagnosis and treatment of endometriosis should be based on the best available evidence. Emphasising the risk of bias, the pyramid of evidence has the double-blind, randomised controlled trial and its meta-analyses on top. After the grading of all evidence by a group of experts, clinical guidelines are formulated using well-defined rules. Unfortunately, the impact of evidence-based medicine (EBM) on the management of endometriosis has been limited and, possibly, occasionally harmful. <b>Methods</b>: For this research, the inherent problems of diagnosis and treatment were discussed by a working group of endometriosis and EBM specialists, and the relevant literature was reviewed. <b>Results</b>: Most clinical decisions are multivariable, but randomized controlled trials (RCTs) cannot handle multivariability because adopting a factorial design would require prohibitively large cohorts and create randomization problems. Single-factor RCTs represent a simplification of the clinical reality. Heuristics and intuition are both important for training and decision-making in surgery; experience, Bayesian thinking, and learning from the past are seldom considered. Black swan events or severe complications and accidents are marginally discussed in EBM since trial evidence is limited for rare medical events. <b>Conclusions</b>: The limitations of EBM for managing endometriosis and the complementarity of multivariability, heuristics, Bayesian thinking, and experience should be recognized. Especially in surgery, the value of training and heuristics, as well as the importance of documenting the collective experience and of the prevention of complications, are fundamental. These additions to EBM and guidelines will be useful in changing the Wild West mentality of surgery resulting from the limited scope of EBM data because of the inherent multivariability, combined with the low number of similar interventions.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11720984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effects of Combined Periodontal, Endodontic, and Dentoalveolar Surgical Treatments on Laboratory Parameters in Patients with Hyperlipidemia-A Clinical Interventional Study.
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-03 DOI: 10.3390/jcm14010241
Renáta Martos, Mariann Harangi, Judit Szabó, Anett Földvári, János Sándor, Éva Katona, Ildikó Tar, György Paragh, Csongor Kiss, Ildikó Márton

Background: Patients with hyperlipidemia are of interest because of the possible interplay between chronic local dental infections and hyperlipidemia. This interventional clinical study aimed to evaluate the oral health status of hyperlipidemic patients receiving lipid-lowering therapy for at least 6 months and the effects of non-surgical and surgical dental treatments on serum C-reactive protein (CRP) levels and lipid markers. Methods: Twenty-eight patients with controlled hyperlipidemia and 18 healthy controls were enrolled in the study. All participants underwent dental examinations (clinical evaluation, X-ray imaging, and microbial analysis of subgingival and supragingival plaque samples) at baseline. Hyperlipidemic patients received periodontal, endodontic, and dentoalveolar surgical treatments. Serum CRP and lipid parameters were assessed at baseline, 1 week, and 3 months, while subgingival and supragingival plaque samples were analyzed at baseline and 3 months after completing dental treatments. Results: At the 3-month follow-up, clinical periodontal characteristics, including the plaque index, gingival index, and periodontal probing depth, improved significantly (p < 0.05). A significant shift in microflora was observed in both subgingival and supragingival plaque samples (p < 0.05), alongside improvements in periodontal values and a significant reduction in serum CRP levels (p < 0.05). Serum cholesterol levels decreased significantly, while moderate improvements in serum triglycerides, low-density lipoprotein, and high-density lipoprotein levels were observed but were not statistically significant (p > 0.05). Conclusions: Treating local dental inflammation is associated with a significant decrease in CRP and cholesterol levels and may serve as beneficial adjunct therapy alongside lipid-lowering therapy in patients with hyperlipidemia.

{"title":"Effects of Combined Periodontal, Endodontic, and Dentoalveolar Surgical Treatments on Laboratory Parameters in Patients with Hyperlipidemia-A Clinical Interventional Study.","authors":"Renáta Martos, Mariann Harangi, Judit Szabó, Anett Földvári, János Sándor, Éva Katona, Ildikó Tar, György Paragh, Csongor Kiss, Ildikó Márton","doi":"10.3390/jcm14010241","DOIUrl":"10.3390/jcm14010241","url":null,"abstract":"<p><p><b>Background:</b> Patients with hyperlipidemia are of interest because of the possible interplay between chronic local dental infections and hyperlipidemia. This interventional clinical study aimed to evaluate the oral health status of hyperlipidemic patients receiving lipid-lowering therapy for at least 6 months and the effects of non-surgical and surgical dental treatments on serum C-reactive protein (CRP) levels and lipid markers. <b>Methods:</b> Twenty-eight patients with controlled hyperlipidemia and 18 healthy controls were enrolled in the study. All participants underwent dental examinations (clinical evaluation, X-ray imaging, and microbial analysis of subgingival and supragingival plaque samples) at baseline. Hyperlipidemic patients received periodontal, endodontic, and dentoalveolar surgical treatments. Serum CRP and lipid parameters were assessed at baseline, 1 week, and 3 months, while subgingival and supragingival plaque samples were analyzed at baseline and 3 months after completing dental treatments. <b>Results:</b> At the 3-month follow-up, clinical periodontal characteristics, including the plaque index, gingival index, and periodontal probing depth, improved significantly (<i>p</i> < 0.05). A significant shift in microflora was observed in both subgingival and supragingival plaque samples (<i>p</i> < 0.05), alongside improvements in periodontal values and a significant reduction in serum CRP levels (<i>p</i> < 0.05). Serum cholesterol levels decreased significantly, while moderate improvements in serum triglycerides, low-density lipoprotein, and high-density lipoprotein levels were observed but were not statistically significant (<i>p</i> > 0.05). <b>Conclusions:</b> Treating local dental inflammation is associated with a significant decrease in CRP and cholesterol levels and may serve as beneficial adjunct therapy alongside lipid-lowering therapy in patients with hyperlipidemia.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
An Observational Study of the First 100 Patients Undergoing Nocturnal Every-Other-Day Online Hemodiafiltration: Clinical Outcomes and Patient and Technique Survival.
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-03 DOI: 10.3390/jcm14010251
Francisco Maduell, Víctor Joaquín Escudero-Saiz, Lida Maria Rodas, Elena Cuadrado, Laura Morantes, Marta Arias-Guillen, Néstor Fontseré, Nayra Rico, José Jesús Broseta

Background: High-volume online hemodiafiltration (OL-HDF) has proven to be the most efficient dialysis modality and to offer better clinical outcomes in patients on hemodialysis. Longer and more frequent dialysis sessions have demonstrated clinical and survival benefits. Methods: A single-center observational study of the first one hundred patients on nocturnal every-other-day OL-HDF was conducted with the aim of reporting the experience with this treatment schedule and evaluating analytical and clinical outcomes as well as the patient and technique survival. Results: Nocturnal OL-HDF on alternate days was highly accepted, with no adverse symptoms, good clinical tolerance, and maintained active work in 62%. Kt, and the convective volume increased from 67.6 ± 12 L to 105.4 ± 11.7 L, and from 27.1 ± 4.6 L to 48.1 ± 6.4 L, respectively, from the baseline to 24 months. An improved calcium-phosphate balance and blood pressure control were observed, as the use of phosphate binders and antihypertensive medications decreased from 76.7% to 3.3% and from 56.7% to 28.3%, respectively. Furthermore, 58.3% of patients required phosphate supplementation in the dialysis fluid to prevent intradialytic hypophosphatemia. Additionally, doses of iron and erythropoiesis-stimulating agents were reduced. The global patient survival was 94% at the end of the follow-up. It was higher in those on the transplant waiting list, with 98.1% survival compared to 84.6% in non-wait-listed patients at 24 months. The main reason for treatment discontinuation was kidney transplantation, accounting for 78.4% of the 88 withdrawals, while death was the leading cause of discontinuation in non-listed patients (41.6%). Conclusions: Nocturnal every-other-day OL-HDF is a well-tolerated dialysis regimen that offers significant clinical benefits, which may positively impact morbidity and mortality. Additionally, it allows patients to integrate the treatment into their social and occupational lives.

{"title":"An Observational Study of the First 100 Patients Undergoing Nocturnal Every-Other-Day Online Hemodiafiltration: Clinical Outcomes and Patient and Technique Survival.","authors":"Francisco Maduell, Víctor Joaquín Escudero-Saiz, Lida Maria Rodas, Elena Cuadrado, Laura Morantes, Marta Arias-Guillen, Néstor Fontseré, Nayra Rico, José Jesús Broseta","doi":"10.3390/jcm14010251","DOIUrl":"10.3390/jcm14010251","url":null,"abstract":"<p><p><b>Background</b>: High-volume online hemodiafiltration (OL-HDF) has proven to be the most efficient dialysis modality and to offer better clinical outcomes in patients on hemodialysis. Longer and more frequent dialysis sessions have demonstrated clinical and survival benefits. <b>Methods</b>: A single-center observational study of the first one hundred patients on nocturnal every-other-day OL-HDF was conducted with the aim of reporting the experience with this treatment schedule and evaluating analytical and clinical outcomes as well as the patient and technique survival. <b>Results</b>: Nocturnal OL-HDF on alternate days was highly accepted, with no adverse symptoms, good clinical tolerance, and maintained active work in 62%. Kt, and the convective volume increased from 67.6 ± 12 L to 105.4 ± 11.7 L, and from 27.1 ± 4.6 L to 48.1 ± 6.4 L, respectively, from the baseline to 24 months. An improved calcium-phosphate balance and blood pressure control were observed, as the use of phosphate binders and antihypertensive medications decreased from 76.7% to 3.3% and from 56.7% to 28.3%, respectively. Furthermore, 58.3% of patients required phosphate supplementation in the dialysis fluid to prevent intradialytic hypophosphatemia. Additionally, doses of iron and erythropoiesis-stimulating agents were reduced. The global patient survival was 94% at the end of the follow-up. It was higher in those on the transplant waiting list, with 98.1% survival compared to 84.6% in non-wait-listed patients at 24 months. The main reason for treatment discontinuation was kidney transplantation, accounting for 78.4% of the 88 withdrawals, while death was the leading cause of discontinuation in non-listed patients (41.6%). <b>Conclusions</b>: Nocturnal every-other-day OL-HDF is a well-tolerated dialysis regimen that offers significant clinical benefits, which may positively impact morbidity and mortality. Additionally, it allows patients to integrate the treatment into their social and occupational lives.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of a Scheimpflug Camera and Optical Coherence Tomography in Evaluating Keratoconic Eyes Post Keratoplasty.
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-03 DOI: 10.3390/jcm14010238
Anna Maria Gadamer, Piotr Miklaszewski, Dominika Janiszewska-Bil, Anita Lyssek-Boroń, Dariusz Dobrowolski, Edward Wylęgała, Beniamin Oskar Grabarek, Katarzyna Krysik

Background/Objective: The aim of this retrospective study was to compare corneal parameters and compliance using a Pentacam HR-Scheimpflug (Pentacam HR) and a swept-source OCT Casia (Casia) in keratoconus (KC) patients post penetrating keratoplasty (PKP) and KC patients without PKP, as well as a control group. Pachymetry measurements were also analyzed using a spectral domain OCT Solix (OCT Solix), Pentacam HR, and Casia. Methods: The study included 71 patients (136 keratoconic eyes; group A), 86 eyes with KC post-PKP (group B), 50 eyes with KC without PKP (group C), and 52 control participants (104 eyes). All participants were adults, Polish Caucasian, and met specific inclusion criteria. Patients with ophthalmological or systemic diseases, cognitive impairment, or pregnancy were excluded. Corneal parameters were measured using two devices (Casia and Pentacam HR), while pachymetry was assessed with three devices (Casia, Pentacam HR, and OCT Solix), with the inter-device agreement and group differences analyzed. Results: Significant differences (p < 0.05) were found across all groups. The post-PKP KC eyes showed significant differences in all front parameters and K2 and Astig. back, while the non-PKP KC eyes showed differences in the K1 back (p = 0.025). The controls displayed differences in all parameters except front astigmatism (p = 0.61). The Pentacam HR overestimated the thinnest corneal thickness (TCT) compared to the OCT Casia across groups. The inter-device agreement was excellent for the anterior parameters (ICC > 0.9) but good for the posterior parameters and TCT. Conclusions: This study highlights significant variability in corneal and pachymetry measurements across devices, with OCT Casia providing more consistent and clinically reliable results than Pentacam HR. Clinicians should exercise caution when using these devices interchangeably, particularly for posterior parameters and TCT.

{"title":"Comparison of a Scheimpflug Camera and Optical Coherence Tomography in Evaluating Keratoconic Eyes Post Keratoplasty.","authors":"Anna Maria Gadamer, Piotr Miklaszewski, Dominika Janiszewska-Bil, Anita Lyssek-Boroń, Dariusz Dobrowolski, Edward Wylęgała, Beniamin Oskar Grabarek, Katarzyna Krysik","doi":"10.3390/jcm14010238","DOIUrl":"10.3390/jcm14010238","url":null,"abstract":"<p><p><b>Background/Objective:</b> The aim of this retrospective study was to compare corneal parameters and compliance using a Pentacam HR-Scheimpflug (Pentacam HR) and a swept-source OCT Casia (Casia) in keratoconus (KC) patients post penetrating keratoplasty (PKP) and KC patients without PKP, as well as a control group. Pachymetry measurements were also analyzed using a spectral domain OCT Solix (OCT Solix), Pentacam HR, and Casia. <b>Methods:</b> The study included 71 patients (136 keratoconic eyes; group A), 86 eyes with KC post-PKP (group B), 50 eyes with KC without PKP (group C), and 52 control participants (104 eyes). All participants were adults, Polish Caucasian, and met specific inclusion criteria. Patients with ophthalmological or systemic diseases, cognitive impairment, or pregnancy were excluded. Corneal parameters were measured using two devices (Casia and Pentacam HR), while pachymetry was assessed with three devices (Casia, Pentacam HR, and OCT Solix), with the inter-device agreement and group differences analyzed. <b>Results:</b> Significant differences (<i>p</i> < 0.05) were found across all groups. The post-PKP KC eyes showed significant differences in all front parameters and K2 and Astig. back, while the non-PKP KC eyes showed differences in the K1 back (<i>p</i> = 0.025). The controls displayed differences in all parameters except front astigmatism (<i>p</i> = 0.61). The Pentacam HR overestimated the thinnest corneal thickness (TCT) compared to the OCT Casia across groups. The inter-device agreement was excellent for the anterior parameters (ICC > 0.9) but good for the posterior parameters and TCT. <b>Conclusions:</b> This study highlights significant variability in corneal and pachymetry measurements across devices, with OCT Casia providing more consistent and clinically reliable results than Pentacam HR. Clinicians should exercise caution when using these devices interchangeably, particularly for posterior parameters and TCT.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Enhancing Corneal Sensitivity in Diabetic Patients Through an Innovative Ophthalmic Solution: In Vivo and Vitro Results.
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-03 DOI: 10.3390/jcm14010245
Fabio Scarinci, Giovanna De Simone, Chiara Ciancimino, Claudio Caggiano, Giulio Pocobelli, Alessandra Di Masi

Background/Objectives: Diabetes is a well-recognised factor inducing a plethora of corneal alterations ranging from dry eye to reduced corneal sensibility, epithelial defects, and reduced cicatrisation. This cohort study aimed to assess the efficacy of a novel ophthalmic solution combining cross-linked hyaluronic acid (CHA), chondroitin sulfate (CS), and inositol (INS) in managing diabetes-induced corneal alterations. Specifically, it evaluated the solution's impact on the tear breakup time (TBUT), the ocular surface disease index (OSDI), and corneal sensitivity after three months of treatment. Additionally, the solution's potential to promote wound healing was examined. Methods: Two different populations were retrieved from the database; the first one was composed of 20 diabetic subjects treated for three months with the ophthalmic CAH-CS (OPHTAGON srl, Rome, Italy), while the second group was composed of 20 diabetic subjects who did not want to use any eye lubricant or other treatment. The outcome measures were the TBUT, the OSDI score, and the corneal sensitivity measured using a Cochet-Bonnet aesthesiometer. To investigate the wound-healing properties, in vitro tests were conducted using two cell lines, comparing the results of scratch tests with and without the solution. Results: The results indicate that CHA-CS significantly improved the tear film stability, as evidenced by an increased TBUT and a reduction in dry eye symptoms reflected by lower OSDI scores. Moreover, the solution was associated with an enhanced corneal sensitivity in treated patients. In wound-healing assays, CHA-CS promoted cell motility, suggesting a supportive role in tissue repair compared to untreated cells. Conclusions: Collectively, the results suggest that CHA-CS could serve as an innovative tool for the treatment of diabetic patients with corneal alterations and delayed corneal sensitivity. Clinical trial registration number: Clinical Trial.gov NCT06573606.

{"title":"Enhancing Corneal Sensitivity in Diabetic Patients Through an Innovative Ophthalmic Solution: In Vivo and Vitro Results.","authors":"Fabio Scarinci, Giovanna De Simone, Chiara Ciancimino, Claudio Caggiano, Giulio Pocobelli, Alessandra Di Masi","doi":"10.3390/jcm14010245","DOIUrl":"10.3390/jcm14010245","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Diabetes is a well-recognised factor inducing a plethora of corneal alterations ranging from dry eye to reduced corneal sensibility, epithelial defects, and reduced cicatrisation. This cohort study aimed to assess the efficacy of a novel ophthalmic solution combining cross-linked hyaluronic acid (CHA), chondroitin sulfate (CS), and inositol (INS) in managing diabetes-induced corneal alterations. Specifically, it evaluated the solution's impact on the tear breakup time (TBUT), the ocular surface disease index (OSDI), and corneal sensitivity after three months of treatment. Additionally, the solution's potential to promote wound healing was examined. <b>Methods</b>: Two different populations were retrieved from the database; the first one was composed of 20 diabetic subjects treated for three months with the ophthalmic CAH-CS (OPHTAGON srl, Rome, Italy), while the second group was composed of 20 diabetic subjects who did not want to use any eye lubricant or other treatment. The outcome measures were the TBUT, the OSDI score, and the corneal sensitivity measured using a Cochet-Bonnet aesthesiometer. To investigate the wound-healing properties, in vitro tests were conducted using two cell lines, comparing the results of scratch tests with and without the solution. <b>Results</b>: The results indicate that CHA-CS significantly improved the tear film stability, as evidenced by an increased TBUT and a reduction in dry eye symptoms reflected by lower OSDI scores. Moreover, the solution was associated with an enhanced corneal sensitivity in treated patients. In wound-healing assays, CHA-CS promoted cell motility, suggesting a supportive role in tissue repair compared to untreated cells. <b>Conclusions</b>: Collectively, the results suggest that CHA-CS could serve as an innovative tool for the treatment of diabetic patients with corneal alterations and delayed corneal sensitivity. Clinical trial registration number: Clinical Trial.gov NCT06573606.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Non-Male Factor Only-ICSI Can Overcome Oocyte Factor in PCOS Patients.
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-03 DOI: 10.3390/jcm14010244
Yasmin Shibli Abu Raya, Nardin Aslih, Yuval Atzmon, Moamina Sharqawi, Maya Shavit, Asaf Bilgory, Einat Shalom-Paz

Background: In this research, we retrospectively studied the influence of the IVF vs. the ICSI technique on embryo morphokinetics by means of a time-lapse incubator in fresh cycles. Methods: A total of 2645 treatment cycles resulting in ovum pick-up of 11,471 fertilized oocytes were included in the research from 2018 to 2022. The embryos were grouped according to IVF or ICSI. Embryonic development was monitored using a time-lapse incubator, and they were transferred on day 3 or 5. Results: The embryos in the ICSI group developed faster and had less fragmentation. However, fewer 2PNs were achieved and more embryos were discarded compared to IVF. When sibling oocytes treated with either IVF or ICSI were analyzed, we found that ICSI resulted in quicker development and higher KIDScores. Discussion: The anovulation and PCOS subgroups were the primary contributors to the high KIDScores in sibling oocytes, indicating that ICSI might have beneficial effects on oocyte factors, similar to the positive results it provides when male factors are involved. Conclusions: Women with PCOS undergoing IVF had better results when ICSI was used compared to spontaneous IVF. This study reveals that ICSI is superior to IVF in female factor infertility.

{"title":"Non-Male Factor Only-ICSI Can Overcome Oocyte Factor in PCOS Patients.","authors":"Yasmin Shibli Abu Raya, Nardin Aslih, Yuval Atzmon, Moamina Sharqawi, Maya Shavit, Asaf Bilgory, Einat Shalom-Paz","doi":"10.3390/jcm14010244","DOIUrl":"10.3390/jcm14010244","url":null,"abstract":"<p><p><b>Background:</b> In this research, we retrospectively studied the influence of the IVF vs. the ICSI technique on embryo morphokinetics by means of a time-lapse incubator in fresh cycles. <b>Methods:</b> A total of 2645 treatment cycles resulting in ovum pick-up of 11,471 fertilized oocytes were included in the research from 2018 to 2022. The embryos were grouped according to IVF or ICSI. Embryonic development was monitored using a time-lapse incubator, and they were transferred on day 3 or 5. <b>Results:</b> The embryos in the ICSI group developed faster and had less fragmentation. However, fewer 2PNs were achieved and more embryos were discarded compared to IVF. When sibling oocytes treated with either IVF or ICSI were analyzed, we found that ICSI resulted in quicker development and higher KIDScores. Discussion: The anovulation and PCOS subgroups were the primary contributors to the high KIDScores in sibling oocytes, indicating that ICSI might have beneficial effects on oocyte factors, similar to the positive results it provides when male factors are involved. <b>Conclusions:</b> Women with PCOS undergoing IVF had better results when ICSI was used compared to spontaneous IVF. This study reveals that ICSI is superior to IVF in female factor infertility.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical Profiles, Survival, and Lung Function Outcomes in ANCA-Associated Interstitial Lung Disease: An Observational Study.
IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-03 DOI: 10.3390/jcm14010229
Cristina Valero-Martínez, Claudia Valenzuela, Juan Pablo Baldivieso Achá, Elisa Martínez-Besteiro, Patricia Quiroga-Colina, Arantzazu Alfranca, Esther F Vicente-Rabaneda, Susana Hernández Muñiz, Santos Castañeda, Rosario García-Vicuña

Background/Objectives: Anti-neutrophil cytoplasmic antibodies (ANCAs) have been found in interstitial lung disease (ILD) in recent years, although its impact on ILD prognosis is less known. To date, ANCAs are not included in the interstitial pneumonia with autoimmune features (IPAF) definition criteria. Therefore, ANCA-ILD, in the absence of known ANCA-associated vasculitis (AAV), could be underdiagnosed. Our aim was to analyze the clinical profile and prognosis of ANCA-ILD patients. Methods: Patients diagnosed with ILD and positive ANCA were enrolled in a retrospective, monocentric cohort study. Lung function outcomes and mortality were assessed according to clinical, serological, radiological, and treatment characteristics. Survival was analyzed using Kaplan-Meier curves and Cox regression models. Results: A total of 23 patients were included, mostly women, with a median time from ILD diagnosis of 36 (24-68) months and a predominant anti-MPO pattern (56.5%). Nearly half of the patients had AAV, mostly microscopic polyangiitis (MPA). The presence of AAV was significantly associated with anti-MPO antibodies and an NSIP radiographic pattern. Overall, the fibrotic pattern (either UIP or fibrotic NSIP) was the most common (73.9%), mainly UIP (51.2%). However, it appeared less frequently in the AAV-ILD group. During follow-up, lung function impairment or radiological progression was observed in 65.2% of patients. Cumulative mortality incidence was high (43.4%), largely due to ILD itself (80%). A UIP pattern was associated with a higher and earlier mortality (HR 34.4 [1.36-132]), while the use of immunosuppressants showed a trend towards lower ILD-related death. Conclusions: In our cohort, ANCA-ILD patients mostly presented with fibrotic patterns, with AAV in almost half of the cases and a high and early mortality rate, which suggests the need to assess ANCA in all ILD patients.

{"title":"Clinical Profiles, Survival, and Lung Function Outcomes in ANCA-Associated Interstitial Lung Disease: An Observational Study.","authors":"Cristina Valero-Martínez, Claudia Valenzuela, Juan Pablo Baldivieso Achá, Elisa Martínez-Besteiro, Patricia Quiroga-Colina, Arantzazu Alfranca, Esther F Vicente-Rabaneda, Susana Hernández Muñiz, Santos Castañeda, Rosario García-Vicuña","doi":"10.3390/jcm14010229","DOIUrl":"10.3390/jcm14010229","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Anti-neutrophil cytoplasmic antibodies (ANCAs) have been found in interstitial lung disease (ILD) in recent years, although its impact on ILD prognosis is less known. To date, ANCAs are not included in the interstitial pneumonia with autoimmune features (IPAF) definition criteria. Therefore, ANCA-ILD, in the absence of known ANCA-associated vasculitis (AAV), could be underdiagnosed. Our aim was to analyze the clinical profile and prognosis of ANCA-ILD patients. <b>Methods</b>: Patients diagnosed with ILD and positive ANCA were enrolled in a retrospective, monocentric cohort study. Lung function outcomes and mortality were assessed according to clinical, serological, radiological, and treatment characteristics. Survival was analyzed using Kaplan-Meier curves and Cox regression models. <b>Results</b>: A total of 23 patients were included, mostly women, with a median time from ILD diagnosis of 36 (24-68) months and a predominant anti-MPO pattern (56.5%). Nearly half of the patients had AAV, mostly microscopic polyangiitis (MPA). The presence of AAV was significantly associated with anti-MPO antibodies and an NSIP radiographic pattern. Overall, the fibrotic pattern (either UIP or fibrotic NSIP) was the most common (73.9%), mainly UIP (51.2%). However, it appeared less frequently in the AAV-ILD group. During follow-up, lung function impairment or radiological progression was observed in 65.2% of patients. Cumulative mortality incidence was high (43.4%), largely due to ILD itself (80%). A UIP pattern was associated with a higher and earlier mortality (HR 34.4 [1.36-132]), while the use of immunosuppressants showed a trend towards lower ILD-related death. <b>Conclusions</b>: In our cohort, ANCA-ILD patients mostly presented with fibrotic patterns, with AAV in almost half of the cases and a high and early mortality rate, which suggests the need to assess ANCA in all ILD patients.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of Clinical Medicine
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