Journal of Clinical Medicine最新文献

Background: Diagnosis is the fundamental basis for understanding biomechanics in orthodontic treatment and for accurately designing the treatment plan. Traditionally, the sagittal plane has been the primary focus of assessment; however, it is essential to consider the patient in all three spatial planes. Therefore, it is necessary to explore the transverse plane, which is equally as crucial as the sagittal and vertical planes. With current technological advances, it is now possible to obtain three-dimensional images of the patient using cone-beam computed tomography (CBCT), allowing evaluation of all planes in a single diagnostic test. This study aimed to assess the diagnostic methods used for transverse analysis and the usefulness of CBCT for this purpose. Material and Methods: To select the studies for this review, we searched the PubMed, Scopus, and Cochrane databases for publications between 1965 and 2021. Our inclusion criteria targeted studies that evaluated the transverse plane using CBCT or CT. We assessed the level of evidence according to the OCEBM classification and evaluated the risk of bias using the QUADAS-2 scale. Results: After reviewing 535 articles, we selected 16 that met the established criteria. These studies compared various diagnostic methods for transverse analysis and their reproducibility indices. We identified the absence of a gold standard for measuring transverse discrepancies and high variability among diagnostic methods as the main limitations. Conclusions: Based on the available evidence, it can be concluded that dental and skeletal transverse discrepancies can be reliably differentiated using the diagnostic techniques evaluated in this study, particularly through CBCT-based assessment. Therefore, the diagnosis of transverse discrepancies should not be considered unclear, as it can be established using objective and measurable criteria. These findings reinforce the clinical value of current diagnostic tools and highlight the importance of accurate three-dimensional interpretation for informed and effective treatment decision-making.

Background/Objectives: Familial Mediterranean fever (FMF) is a chronic autoinflammatory disorder that can affect cardiac structure and function. However, the impact of different Mediterranean fever (MEFV) gene subtypes on clinical features and subclinical cardiac changes remains unclear. This study aimed to evaluate the association between MEFV gene subtypes, clinical features, and cardiac function in patients with FMF. Methods: A total of 98 patients with FMF were prospectively included. Twelve mutations in the MEFV gene were screened, and the M694V homozygous (Gene-1), M694V heterozygous (Gene-2), and M680I heterozygous (Gene-3) subtypes were analyzed. All patients underwent transthoracic echocardiography and speckle-tracking strain analysis. Results: The age of disease onset was earlier in patients carrying the gene-1 mutation compared to mutation-negative patients (11.4 ± 8.0 and 17.6 ± 11.4 years, respectively; p = 0.025). Disease duration was longer in patients with gene-1 mutation (23.3 ± 12.8 and 12.5 ± 9.3 years, respectively; p < 0.001), and disease activity score was higher (6.41 ± 1.9 and 5.15 ± 1.6, respectively; p = 0.007). Furthermore, left atrial contractile strain was significantly lower in this group (-10.6 ± 3.5% and -14.5 ± 6.1%, respectively; p = 0.012). Arthralgia was more frequent in patients with gene-2 mutation (p = 0.026), while left atrial contractile strain was better preserved compared to mutation-negative patients (p = 0.002). No significant association was found between gene-3 mutation and clinical or cardiac parameters. Conclusions: MEFV gene subtypes have different effects on clinical phenotype and cardiac function in FMF. These findings support the importance of genotype-based cardiac monitoring and risk stratification in FMF patients.

Background/Objectives: Chronic Kidney Disease (CKD) is a global public health burden with a rising prevalence driven by population aging. Existing prediction models, such as the Kidney Failure Risk Equation (KFRE), often lack generalizability across ethnicities and comprehensive systemic indicators. This study aimed to develop and validate a machine learning model for predicting CKD progression by integrating traditional risk factors with novel composite indicators reflecting systemic health. Methods: Data from the China Health and Retirement Longitudinal Study (CHARLS, n = 2500) was used for model training. External validation was performed using independent cohorts from the English Longitudinal Study of Ageing (ELSA, n = 1200) and the Health and Retirement Study (HRS, n = 1500). Multiple machine learning algorithms, including XGBoost, were employed. Feature engineering incorporated composite indicators such as the frailty index (FI), triglyceride-glucose (TyG) index, and aggregate index of systemic inflammation (AISI). Results: The XGBoost model achieved an area under the curve (AUC) of 0.892 in the training set and maintained robust performance in external validation (AUC 0.867 in ELSA, 0.871 in HRS), outperforming the KFRE (AUC 0.745). SHAP analysis identified the FI as the most influential predictor. Decision curve analysis confirmed the model's clinical utility. Conclusions: This machine learning model demonstrates high accuracy and cross-ethnicity validity, offering a practical tool for early intervention and personalized CKD management. Future work should address limitations such as the retrospective design and expand validation to underrepresented regions.

Cardiac magnetic resonance (CMR) imaging has been considered crucial in non-ischemic cardiomyopathy (NICM). This study aims to evaluate the role of CMR in identifying risk factors for life-threatening events in patients with NICM and reduced left ventricular ejection fraction (LVEF). Methods: We analysed 57 (mean age 62.5 ± 11.4 years, 68.4% male) first-diagnosed NICM patients with reduced LVEF (mean 42 ± 9%). CMR assessments evaluated LVEF, right ventricular ejection fraction (RVEF), cardiac T1 mapping, extracellular volume (ECV), and the presence/extension of late gadolinium enhancement (LGE). Patients were monitored for a composite endpoint including sudden cardiac death (SCD), major ventricular arrhythmic events, and hospitalization for heart failure (HHF). Results: During a median follow-up lasting 543 days, 18 patients (31%) experienced cardiovascular events. A higher native T1 mapping value (1076 (1025-1120) ms vs. 999 (990-1037) ms, p < 0.001), a higher ECV (34 ± 6% vs. 28 ± 4,% p < 0.001) and a reduced RVEF (52 ± 13% vs. 60 ± 9%, p < 0.03) proved to be significantly correlated to an increased HHF, arrhythmic and SCD risk. Additionally, a native T1 mapping value exceeding 1018 ms demonstrated an increased risk (HR: 6.285; 95% CI: 2.044-19.326, p = 0.001) as well as an ECV greater than 28% (HR: 19.752; 95% CI: 2.622-148.817, p = 0.004) for composite endpoint. Conclusion: In NICM patients, elevated native T1 mapping and ECV values identified a high-risk subgroup for arrhythmic events while LVEF, and RVEF provide further risk stratification for the composite endpoint. CMR assessment may optimize risk stratification in NICM patients.

Background/Objectives: Preoperative differentiation between oral squamous cell carcinoma (SCC) and minor salivary gland carcinoma (SGC) remains clinically challenging due to overlapping imaging characteristics. This study aimed to develop a diagnostic model based on quantitative dynamic contrast-enhanced MRI (qDCE-MRI) parameters to distinguish SCC from SGC prior to surgery. Methods: Patients with histopathologic confirmed SCC or minor SGC who underwent preoperative 3.0T qDCE-MRI were recruited. Clinical characteristics and pharmacokinetic parameters, including volume transfer constant (K^trans), reverse reflux rate constant (K_ep), volume fraction of extravascular extracellular space (V_e), plasma volume fraction (V_p), time to peak (TTP), maximum concentration (MAXConc), maximal slope (MAXSlope), and area under the concentration-time curve (AUCt), along with the apparent diffusion coefficient (ADC), were extracted. Univariate and multivariable logistic regression analyses were performed to identify independent discriminators. Diagnostic performance was assessed using receiver operating characteristic analysis, and model comparisons were conducted with the DeLong test. Interobserver agreement was evaluated using intraclass correlation coefficients (ICC). Results: All qDCE-MRI parameters demonstrated excellent interobserver agreement (ICC range, 0.82-0.94). Multivariable analysis identified K_ep (OR = 2620.172, p = 0.001), maximal slope (OR = 1.715, p = 0.024), and tumor location (OR = 5.561, p = 0.027) as independent predictors. The qDCE-MRI model achieved superior diagnostic performance compared with the clinical model (AUC: 0.945 vs. 0.747; p = 0.012). Conclusions: A qDCE-MRI-based model incorporating K_ep and MAXSlope was shown to provide excellent accuracy for preoperative differentiation between oral SCC and minor SGC.

Background/Objectives: Although the outcomes of endoluminal lacrimal duct recanalization (ELDR) for nasolacrimal duct (NLD) obstruction are associated with the obstruction length, NLD obstruction has not been quantified. In this study, we aimed to quantify the obstruction length using a calibrated dacryoendoscope and investigate its relationship with surgical outcomes following endoscopic recanalization of the lacrimal passage. Methods: We retrospectively analyzed the eyes of patients who underwent ELDR using a calibrated dacryoendoscope at our institution between January 2023 and February 2025. Patients with dacryocystitis detected during preoperative irrigation testing were excluded. A lacrimal tube was placed for 2 months after recanalization, and we used the calibrated dacryoendoscope to measure the obstruction length. The 3-month postoperative outcomes were determined using irrigation testing, subjective symptoms, and cotton thread testing. Results: A total of 31 eyes of 26 patients (6 eyes of 5 males; 25 eyes of 21 females; mean age, 68.8 ± 10.5 years) were included in this study. The mean obstruction length was 10.8 mm (range: 1-30 mm). The nasolacrimal duct was patent, showed reflux, and was obstructed in 12, 16, and 3 eyes, respectively, at 3 months. The symptoms resolved, improved, and remained unchanged in 18, 11, and 2 eyes, respectively. Trend analysis revealed a significant relationship between the obstruction length and irrigation outcomes. However, no significant association was observed with the symptoms. The obstruction length was significantly correlated with the 3-month postoperative cotton thread test results. Conclusions: The NLD obstruction length was associated with the 3-month postoperative irrigation test results, and longer obstruction was associated with poorer postoperative outcomes.

Objectives: The HOSTILE score was developed to assess femoral access challenges in transcatheter valve therapy. Similar vascular issues arise in femoral cannulation for minimally invasive valve surgery, making CT-based planning essential. We adapted the score for surgical use (MOD-HOSTILE) and evaluated its association with neurological and adverse outcomes. Methods: In this single-center retrospective study, the MOD-HOSTILE score (0-11 points) was calculated for 364 patients undergoing minimally invasive heart valve surgery from 2019 to 2023. Patients were stratified into low (0-2), mild (>2-5), and high (>5-11) score categories. Outcomes included 30-day stroke, other neurological events, and perioperative complications. Results: High MOD-HOSTILE patients were significantly older (70 [64.7-73.0] vs. 61 [60.0-63.0] years; p < 0.01) and had higher surgical risk (EuroSCORE II 1.79 [1.26-2.16] vs. 0.83 [0.75-0.94]; p < 0.01). Neurological complications were more frequent in the high MOD-HOSTILE group, including stroke (8.7% vs. 0.9%; p = 0.02) and hemiplegia (13.0% vs. 0.9%; p < 0.01). Axillary cannulated patients had higher MOD-HOSTILE scores than femoral cannulated patients. Stroke risk was highest in patients with high MOD-HOSTILE score undergoing axillary cannulation (high vs. low MOD-HOSTILE, 18.2% vs. 0%; p = 0.04). Thirty-day mortality was comparable between groups (p = 0.09). MOD-HOSTILE predicted stroke with an AUC of 0.78 (95% CI 0.73-0.82) and OR 1.4 per point (95% CI 1.1-2.0). Conclusions: The MOD-HOSTILE score identifies vascular and neurological risk in minimally invasive valve surgery, with scores ≥5 indicating elevated risk of stroke and delirium. Patients with high scores may benefit from alternative surgical strategies.

Background/Objectives: The Rapid Access Chest Pain Assessment Clinic (RACPAC) streamlines the evaluation of low-to-intermediate risk chest pain and helps avoid unnecessary hospitalisation. Biomarkers {low-density lipoprotein cholesterol (LDL-c) and high-sensitivity C-reactive protein (hsCRP)} are established cardiovascular risk markers. Yet, their diagnostic value for stable coronary artery disease (CAD) in RACPAC remains uncertain. Therefore, we aimed to determine the utility of biomarkers in predicting the presence of CAD in the RACPAC setting. Methods: A retrospective cohort study of consecutive adults attending RACPAC between 2012 and 2021. Multivariable logistic regression and receiver operating characteristic analyses, including prespecified subgroup and sensitivity analyses, were used to evaluate the predictive value of hsCRP and LDL-c for the presence of CAD detected on CT Coronary Angiogram (CTCA) or Treadmill Stress Echocardiography (TSE) as the primary outcome. Results: 3569 patients were included in this study, the mean age was 55.4 ± 11.3 years, and 48.8% were female; 37.4% had hypertension, while 39.5% had dyslipidemia. The mean LDL-c was 3.1 ± 0.9 mmol/L, and the median hsCRP was 1.9 mg/L (IQR 0.9 to 3.8). The regression analysis for the primary outcome showed that neither hsCRP nor LDL-c predicted CAD on CTCA (hsCRP OR 1.00, 95% CI 0.99 to 1.02, p = 0.70; LDL-c OR 1.16, 95% CI 0.97 to 1.39, p = 0.11). On TSE, hsCRP was not associated with CAD, while LDL-c showed an inverse association with CAD (hsCRP OR 0.98, 95% CI 0.83 to 1.00, p = 0.78; LDL-c OR 0.44, 95% CI 0.21 to 0.87, p = 0.02). ROC analysis showed AUC 0.553 for log hsCRP (95% CI 0.501 to 0.606) and 0.508 for LDL-c (95% CI 0.450 to 0.566), with p = 0.2756. Conclusions: In a large real-world RACPAC cohort, neither elevated hsCRP nor LDL-c predicted the presence of coronary artery disease in the rapid access chest pain clinic (RACPAC) cohort. In contrast, CT coronary angiography (CTCA) demonstrated superior diagnostic accuracy compared with treadmill stress echocardiography (TSE) in this setting.

Background: Pediatric inflammatory bowel disease (pIBD), including Crohn's disease (CD) and ulcerative colitis (UC), is characterized by chronic intestinal inflammation and fibrosis. Identifying molecular mediators involved in inflammation and tissue repair is critical for improving disease management. Objective: To examine the expression of periostin, TGF-β, and SLUG in pIBD and assess their potential roles in intestinal inflammation, fibrosis, and mucosal healing. Methods: Intestinal biopsies from 33 pediatric patients (11 CD, 22 UC) and 10 healthy controls were analyzed immunohistochemically. Quantitative PCR evaluated POSTN, TGF-β1, and SNAI2 expression in 22 patients and 6 controls. Correlations with fecal calprotectin, the Pediatric Crohn's Disease Activity Index (PCDAI), and the Pediatric Ulcerative Colitis Activity Index (PUCAI) were determined. Results: Periostin, TGF-β, and SLUG expression were significantly increased in pIBD compared with controls. Periostin levels were higher in CD than in UC. All markers correlated positively at mRNA and protein levels. Notably, periostin showed an inverse correlation with fecal calprotectin and PCDAI scores. Conclusions: Periostin, TGF-β, and SLUG may represent biomarkers of pIBD activity. Periostin appears to mediate inflammation and promote mucosal fibrosis or repair, and its inverse association with disease activity suggests a potential therapeutic role in pIBD.

Background: Adverse Drug Reactions (ADRs) are a significant public concern because of their impact on healthcare systems. Spontaneous reporting of ADRs is crucial for monitoring drug safety and recognizing possible risk factors. The objective of this study was to characterize ADR reports from the Allergy and Clinical Immunology Unit of the G. Martino University Hospital, Messina, Italy. Methods: A retrospective analysis was conducted, including all ADRs spontaneously reported from patients attending the clinic because of at least one previous ADR, from June 2022 to June 2024. Results: A total of 388 reports were collected, mainly from females (71.1%) and adult patients (84.3%). ADRs were mostly immediate, from antibiotics and anti-inflammatory drugs (61.5%), with a high prevalence of cutaneous and respiratory disorders. Delayed reactions were mostly from endocrine therapies, vaccines, and antiepileptics. Anaphylactic shock was present only in 13 ADR reports (3.35%). A higher risk of developing serious ADRs was found in elderly patients aged ≥65 years (p = 0.012). An original finding was that a positive history of allergies (p = 0.023) and past medical history of ADRs (p = 0.045) were negatively correlated to the occurrence of a serious ADR, probably because patients had been previously followed in an allergy setting and alerted about ADRs. Conclusions: This study underlines the role of ADR follow-up in allergy settings to identify preventable traits and related risk factors; appropriate ADR reporting and collaboration between allergists and pharmacovigilance centers can be a winning strategy for ADR prevention.