Journal of Clinical Medicine最新文献

Background/Objectives: Obstructive Sleep Apnea Syndrome (OSAS) is a chronic disorder characterized by repeated upper airway obstruction during sleep, leading to intermittent hypoxia and elevated sympathetic activity. OSAS is strongly linked to cardiovascular comorbidities such as hypertension, arrhythmias, heart failure, and atherosclerosis, contributing to structural and functional cardiac alterations. Methods: This study enrolled 105 consecutive patients diagnosed with OSAS and a control group of 100 patients without the syndrome. All participants underwent a comprehensive echocardiographic evaluation using Doppler imaging to assess cardiac structure and function. Results: Hypertension was significantly more prevalent in the OSAS group (81%) compared to controls (74%). Left ventricular diastolic dysfunction occurred in 56.2% of OSAS patients versus 26% of controls. Left atrial enlargement and left ventricular hypertrophy were also more frequent in the OSAS group (21% and 51.4%, respectively) compared to controls (13% and 5%). Permanent atrial fibrillation was present in 17.1% of OSAS patients, significantly higher than the 7% observed in controls. These findings highlight the pronounced cardiac remodeling and arrhythmic burden associated with OSAS. Conclusions: The data confirm that OSAS is associated with increased cardiovascular abnormalities detectable by echocardiography, underscoring the need for routine cardiovascular screening in OSAS patients. Given the systemic implications of OSAS beyond sleep disturbances, a multidisciplinary approach is essential for early diagnosis and optimized management, aiming to mitigate cardiovascular risk and improve outcomes. OSAS is a significant cardiovascular risk factor requiring comprehensive clinical attention.

Human sexual development begins in the prenatal period and continues throughout life, shaped by both biological and psychosocial factors. Somatic development leads to reproductive maturity through several stages regulated by the hypothalamic-pituitary-gonadal axis. Psychosexual development, described in classical theories such as Freud's and in contemporary models, emphasizes the development of gender identity and sexual behaviors from infancy through early and middle childhood into adolescence, a period characterized by the integration of sexual and emotional components. This developmental trajectory evolves from a biologically driven process into a conscious, socially shaped phenomenon through concretization, mentalization, and socialization. To synthesize current knowledge, this paper is based on a literature review conducted across multiple databases, with studies selected and evaluated for relevance to both somatic and psychosexual development. Understanding the dynamics of these processes is essential for clinical practice, sexual education, and health prevention. It emphasizes integrated clinical practices that employ a multidisciplinary approach, incorporating both medical treatment and psychological support, particularly in the care of children and adolescents with disorders of sexual development. This article presents a comprehensive overview of human sexual development from the prenatal period through adolescence, considering its somatic and psychosexual aspects.

Difficulties in emotion regulation (ER) have been consistently associated with eating disorders (EDs). However, little is known about how this association operates during early adolescence, and the specific influence of sex. Objectives: This study aims to assess if maladaptive ER strategies predict greater ED symptomatology, while adaptive strategies predict lower levels of EDs symptoms among early adolescents. Additionally, the moderating effect of sex will also be assessed in these associations. Method: Ninety-eight Spanish-speaking adolescents aged 12-15 years (55 girls, 43 boys) participated in this study and completed a baseline assessment, including measures of EDs, adaptative (i.e., cognitive reappraisal) and maladaptive (i.e., expressive suppression and rumination) ER strategies. Independent sample t-tests were used to examine sex differences in age, ER, and ED symptoms. Hierarchical regression models assessed whether sex moderated the associations between ER strategies and ED symptoms. Results: Girls reported significantly higher levels of both brooding and reflective rumination compared to boys, but no sex differences were found in other measures. Regression analyses showed that expressive suppression and brooding rumination significantly predicted higher ED symptomatology, independent of sex. In contrast, cognitive reappraisal and reflective rumination were not associated with ED symptoms. No moderating effects of sex were observed in any model. Conclusions: Findings indicate that maladaptive ER strategies, particularly expressive suppression and ruminative brooding, predict greater ED symptom severity in early adolescence. However, sex did not moderate these relationships. These results underscore the importance of targeting maladaptive ER processes in adolescent prevention programs. Interventions focused on reducing maladaptive ER may be especially relevant at this developmental stage, when cognitive capacities for adaptive ER are still maturing.

Background/Objectives: Human papillomavirus (HPV) infection remains the principal etiologic factor for cervical intraepithelial neoplasia (CIN) and cervical cancer. This longitudinal cohort study aimed to characterize the dynamics of cytological and histopathological changes over a two-year follow-up, focusing on post-treatment reduction in lesion grade, persistence, and progression in relation to HPV genotype distribution and smoking status. Methods: A total of 351 women aged 20-76 years were included, with cervical samples collected at the "Elena Doamna" Clinical Hospital, Iași, Romania. Cytology was categorized according to the Bethesda System, while colposcopy and conization served as diagnostic confirmation methods. HPV genotyping identified both high-risk (HR) and low-risk (LR) viral subtypes. Longitudinal assessments were performed at baseline, one-year, and two-year intervals to evaluate temporal patterns of disease evolution. Results: At baseline, HSIL represented the predominant cytologic category (51.3%, n = 180), followed by ASC-US (19.1%), ASC-H (15.1%), and LSIL (14.5%). Negative cytology increased from 62.4% at one year to 71.8% at two years, indicating substantial post-treatment reduction in lesion grade. Downgrading of lesion severity after treatment occurred in 26.2%, persistence in 11.1%, and progression in 11.1% of cases. Concordance between colposcopy and conization was moderate but statistically significant (κ = 0.345), with the highest agreement observed for HSIL with equivocal features between CIN II and CIN III lesions. Smoking showed a significant association with lesion persistence at two years (OR = 3.07; 95% CI: 1.16-8.08) but no statistically significant association with HR-HPV persistence. HR-HPV genotypes 16, 18, 31, and 33 were most frequently linked to progression, whereas HPV 35, 59, and 68 were associated with persistence. Conclusions: Over two years, most cervical lesions regressed or normalized, demonstrating effective management and follow-up. Persistent infection with HR-HPV types and smoking were the primary determinants of unfavorable outcomes. These findings highlight the clinical relevance of sustained surveillance, HPV genotyping, and smoking cessation as integral components of evidence-based cervical disease prevention and management strategies.

Introduction: Minimally invasive pancreatoduodenectomy (MIPD), including laparoscopic (LPD) and robotic approaches (RPD), has gained increasing attention as an alternative to open pancreatoduodenectomy (OPD). Despite rapid technological progress, concerns persist regarding safety, reproducibility, and oncological adequacy. The publication of randomized controlled trials (RCTs) provides essential high-level evidence to reassess the true benefits and limitations of MIPD. Methods: This narrative review synthesizes all available RCTs comparing LPD and RPD with OPD. Major domains evaluated include mortality, major morbidity, intraoperative parameters, postoperative recovery, oncological outcomes, conversion, costs, and the influence of surgeon experience and institutional volume. The objective is to contextualize RCT findings rather than perform a quantitative meta-analysis. Discussion: Across studies, LPD demonstrates comparable mortality and complication rates to OPD in high-volume centers, with consistent reductions intraoperative blood loss (IBL) and shorter recovery or length of stay (LOS). RPD shows more heterogeneous results: one large trial reported improved postoperative recovery, whereas the EUROPA trial identified higher rates of pancreatic fistula (POPF) and delayed gastric emptying (DGE) alongside significantly increased costs. Both LPD and RPD achieve oncological outcomes equivalent to OPD, and 3-year survival data confirm the long-term non-inferiority of LPD. However, operative time remains longer for all minimally invasive approaches, and conversion persists as a marker of technical difficulty and incomplete learning curve. Conclusions: Current RCT evidence indicates that MIPD is safe, feasible, and oncologically sound only when performed by surgeons who have surpassed the demanding learning curve within specialized, high-volume centers. The benefits, mainly reduced IBL and faster recovery, must be weighed against longer operative times, conversion risks, and substantially higher costs for RPD. MIPD should therefore be considered an advanced option rather than a universal standard, and its broader implementation requires structured training pathways, appropriate patient selection, and institutional readiness.

Background: The European Society of Cardiology (ESC) published the first guidelines on cardio-oncology in 2022. Implementing the 272 proposed recommendations into everyday clinical practice has become a mandatory challenge for countries belonging to the ESC community. Methods: The study aimed to assess cardio-oncology knowledge and the degree of implementation of ESC guidelines among cardiologists registered with the Heart Failure Association of the Polish Cardiac Society and oncologists from the Polish Society of Clinical Oncology. Physicians were invited via email and voluntarily chose to participate by completing a 20-question questionnaire. Results: Among the 104 respondents, half (50%) were cardiologists, and the majority (80%) had more than ten years of clinical experience. A total of 38.8% of specialists practiced outpatient medicine, while 41.7% worked in academic centres. The majority (58.3%) consult fewer than ten cardio-oncology patients per week, with less than 8% of specialists having the greatest experience (>25 consultations per week). Most physicians were familiar with the ESC guidelines on cardio-oncology. Cardiologists more frequently indicated heart failure as the main problem in cancer patients (OR = 5.82; 95% CI: 2.08-16.22; p = 0.0007), ordered echocardiography and ECG together with cardiovascular risk factors control (OR = 4.01; 95% CI: 1.74-9.25; p = 0.001) during long-term follow-up, chose angiotensin converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) combined with calcium channel blocker (CCB) for treating hypertension (OR = 3.9; 95% CI: 1.56-9.75; p = 0.003), and rarely monitored lipid profile based on the type of cancer therapy (OR = 0.09; 95% CI: 0.03-0.26; p = 0.000009). Oncologists more often observed cardiovascular issues in lung cancer (OR = 3.78; 95% CI: 1.58-9.05; p = 0.002), recognized venous thromboembolism as the most common problem in cardio-oncology (OR = 6.52; 95% CI: 2.7-15.73; p = 0.00002), opted for ACEI/ARB monotherapy in the management of high blood pressure (OR = 11.76; 95% CI: 2.49-55.54; p = 0.002), and significantly more often chose low-molecular-weight heparin in the treatment of asymptomatic incidental pulmonary embolism (OR = 5.93; 95% CI: 2.47-14.24; p = 0.00006). Conclusions: The understanding of cardio-oncology varies significantly between cardiologists and oncologists. Although the survey was conducted only in one country (Poland), its results may serve as a reference point for structural reforms with building implementation strategies of ESC guidelines in daily practice in other countries.

Background: The sustentaculum screw plays a crucial role in achieving stable osteosynthesis for intra-articular calcaneal fractures, particularly when using minimally invasive or percutaneous techniques. Accurate placement of the screw within the sustentaculum tali is technically demanding due to the complex anatomy and the limited intraoperative visualization provided by standard fluoroscopic views. Methods: Patients were positioned in a standardized lateral decubitus position. Beginning with a standard lateral fluoroscopic view, the C-arm was tilted approximately 25° to align the central beam with the plane of the lower ankle joint. This adjustment enables clear visualization of the borders of the sustentaculum tali and allows precise definition of the target point for guide-wire insertion. To evaluate whether this technique improves screw positioning, two groups were compared: one using the described fluoroscopic view and a control group using conventional imaging alone. Results: Screw placement accuracy was significantly higher in the group using the dedicated fluoroscopic view compared with the control group. Conclusions: With meticulous preoperative planning, standardized positioning, and the use of a dedicated fluoroscopic setting-referred to as the "sustentaculum view"-accurate and safe screw placement can be achieved with significantly higher accuracy than with conventional imaging alone.

Background: Prepectoral breast reconstruction with an acellular dermal matrix (ADM) typically requires intraoperative manual tailoring, introducing structural variability and workflow delays. We developed the Polyhedral Matrix Configuration (PMC) technique-a geometric method for standardizing ADM shell creation-and compared it to our traditional "tear-drop" wrap to determine whether standardization improves structural integrity and operative efficiency. Methods: We reviewed all consecutive 227 patients undergoing immediate prepectoral reconstruction from January 2021 to December 2024 (tear-drop group: n = 155; PMC group: n = 72). PMC transforms planar ADM into a 3D dome using pre-designed wedge resections and butt-joint sutures, eliminating material overlap. Standardization permits back-table fabrication during mastectomy ("parallel two-team workflow"). We excluded bilateral cases for consistent operative time assessment and performed subgroup analysis to control for higher robotic mastectomy rates in the PMC cohort. Results: PMC reduced the plastic surgery time by a mean of 44.6 min (95% CI: 35.2-54.0) (p < 0.001), with subgroup analysis confirming efficiency gains across both conventional (32.8 min, 95% CI: 20.1-45.5, p < 0.001) and robotic mastectomies (60.8 min, 95% CI: 47.3-74.3, p < 0.001). Despite zero-overlap design, PMC showed no increase in major complications (p > 0.99) and lower rates of visible rippling (odds ratio 0.28, 95% CI: 0.08-0.97, p = 0.032). BREAST-Q "Satisfaction with Breasts" scores were higher in the PMC group (mean difference +7.3 points, 95% CI: 3.1-11.5, p = 0.001). Conclusions: Geometric standardization enables both design precision and operative efficiency. By separating reconstruction preparation from mastectomy through a reproducible protocol, PMC reduces the operative time while improving aesthetics through stable, single-layer construction.

Bladder cancer (BC) is a biologically heterogeneous tumor affected by genetic, metabolic, environmental, and lifestyle factors. Recent research indicates that nutrition can change the way urothelial cancer forms by affecting inflammation, oxidative stress, cellular energy, and the epigenome. It can also change the risk of BC and how well treatment works. Simultaneous progress in precision nutrition (PN) and nutriomic profiling-encompassing nutrigenomics, nutrigenetics, nutriepigenetics, metabolomics, and microbiome science-presents novel options to tailor dietary regimens beyond universal guidelines. In this review, we consolidate existing knowledge regarding the nutritional factors influencing BC, outline pertinent principles of PN for BC prevention and survival, and explore how urine proteomics and molecular subtyping facilitate the integration of PN into precision oncology. Our review examines the methodological, bioinformatic, biomarker, and clinical translation challenges that impede the implementation of PN in BC management; these challenges include the need for validated nutritional biomarkers with mechanistic endpoints, interoperable data platforms, and rigorously designed clinical trials. Finally, we emphasize future prospects for PN-guided medical nutrition therapy and dietary models during and after systemic treatment recovery. We propose research priorities that will facilitate the integration of PN-informed individualized dietary plans with medical and surgical approaches in BC treatment, aiming to decrease the costs associated with expensive or excessively aggressive treatment methods, thereby supporting long-term survival care. This review seeks to establish a conceptual framework for the integration of PN into BC management by delineating the opportunities and challenges, hence promoting hypothesis-driven research in a promising yet underexplored domain.

Background/Objectives: Gestational diabetes (GD) is a well known risk factor for future metabolic diseases. However, the long-term time-dependent risk of non-alcoholic fatty liver disease (NAFLD) remains unexplored. The aim of this meta-analysis was to quantify the long-term risk of NAFLD in women with previous GD and evaluate if the risk persists beyond the postpartum period. Methods: A systematic search was performed in PubMed using appropriate medical subject headings to identify trials evaluating the incidence of NAFLD among women with previous GD compared to those with normal glucose tolerance (NGT). Studies reporting adjusted risk estimates with a follow-up duration beyond pregnancy were included. Data were extracted and analyzed using relevant statistical methods, with the level of significance at p < 0.05. Results: A total of four studies (N = 2873) were included in the meta-analysis. Women with previous GD had a 2.46-fold higher odds of NAFLD compared to those with NGT (95% CI 1.88-3.23, p < 0.001). The slope for years since delivery was not significant (β = 0.001 per year, 95% CI -0.037 to 0.040, p = 0.901), indicating that the likelihood of NAFLD in women with prior GD did not change over time. Conclusions: GD is associated with a substantially increased and sustained risk of NAFLD, persisting decades beyond pregnancy. These findings identified GD as a potential early risk marker of future liver outcomes and highlight the need for long-term metabolic screening and preventive strategies for this high-risk population.