Journal of Clinical Medicine最新文献

Background/Objectives: Thyroid eye disease (TED) can lead to structural and microvascular changes in the orbit and retina. This study aimed to investigate the associations between Clinical Activity Score (CAS), orbital magnetic resonance imaging (MRI) measurements, and retinal microvascular changes in TED patients. Methods: This cross-sectional study included 38 patients (76 eyes) with TED. Each patient underwent a comprehensive ophthalmological evaluation, CAS assessment, and a detailed medical history. Optical coherence tomography angiography (OCTA) was performed to quantify vessel density (VD) in the superficial and deep capillary plexus (SCP and DCP). Exophthalmos, extraocular muscle thickness and orbital fat thickness were measured on MRI scans to evaluate structural changes. Laboratory analyses included thyroid hormone levels, thyrotropin receptor antibodies (TRAb), anti-thyroid peroxidase antibodies (anti-TPO), and lipid profile. Results: Active TED patients (CAS ≥ 3) had significantly higher TRAb levels (p < 0.001), while anti-TPO did not differ between groups. Active eyes showed significantly higher DCP VD in the whole image (p = 0.013), parafovea (p = 0.012), and perifovea (p = 0.009) across all quadrants, with no difference in SCP or the foveal avascular zone (FAZ). In linear mixed model regression analyses, after adjusting for previous glucocorticosteroid therapy, higher triglycerides, greater medial rectus thickness, and whole-image DCP VD independently predicted higher CAS values (R² = 42, p < 0.001). After adjusting for age and sex, CAS remained significantly positive predictor of DCP VD in the parafovea (R² = 0.22, p < 0.001). Conclusions: Changes in DCP VD reflect TED activity and structural orbital involvement.

Background/Objectives: Accurate knowledge of tracheobronchial anatomy is essential for safe airway management, particularly during one-lung ventilation using double-lumen tubes (DLTs). However, population-specific morphometric data in Asian adults remain limited. We aimed to establish a comprehensive morphometric profile of the tracheobronchial tree in Korean adults using 2D and 3D computed tomography (CT), and evaluate the clinical implications for DLT sizing and right upper lobe (RUL) alignment. Methods: This retrospective observational study included 398 adults who underwent preoperative chest CT. Measurements included tracheal dimensions, bronchial lengths, bronchial diameters, and anteroposterior angle of the RUL orifice. Height tertiles and sex-stratified linear regression analyses were performed to evaluate height-bronchial diameter relationships. Results: Bronchial dimensions were larger in men; however, height was more closely related to bronchial diameter in women. In women, each 1 cm increase in height corresponded to a 0.071 mm increase in left and a 0.077 mm increase in right bronchial transverse diameter (p < 0.001 for both). The RUL orifice showed posterior deviation of 15.5 ± 12.2° in men and 9.9 ± 11.4° in women, with height and weight being independent but weak predictors (R² = 0.05). Bronchial diameter measurements showed consistent differences between 2D and 3D CT, with 2D images generally overestimating transverse diameters. Conclusions: The present analysis provides population-specific reference values for Korean adults. Our findings support the use of 2D CT as a practical tool for estimating bronchial dimensions and guiding DLT selection, and may serve as foundation for future airway devices tailored to Asian populations.

Background/Objectives: Minimally invasive coronary artery bypass grafting (MICS-CABG) offers reduced access trauma compared with conventional off-pump coronary artery bypass (OPCAB) but requires more demanding surgical and anesthetic conditions, including single-lung ventilation. Enhanced Recovery After Cardiac Surgery (ERACS) pathways-particularly those incorporating early extubation in a post-anesthesia care unit (PACU) and routine ICU bypass-may harmonize postoperative recovery across different surgical approaches. This study evaluated whether a standardized early-extubation ERACS protocol could achieve comparable short-term recovery outcomes between MICS-CABG and OPCAB. Methods: This single-center retrospective study included all adult patients who underwent off-pump MICS-CABG via mini-thoracotomy or OPCAB via sternotomy between January 2020 and December 2024 within an ERACS pathway. Propensity score matching (1:1) was applied using key demographic and clinical variables. Primary outcomes were hospital length of stay (LOS), ventilation time, and unplanned ICU transfer. Secondary outcomes included postoperative complications, transfusion requirements, pain scores, and in-hospital mortality. Results: Of 144 MICS-CABG patients, 131 met inclusion criteria and 116 were propensity-matched to 116 OPCAB patients. Operative duration was longer in MICS-CABG (238.9 ± 65 vs. 175.0 ± 48 min; p < 0.001). However, ventilation time (112.2 ± 56.9 vs. 116.9 ± 64.7 min; p = 0.59), hospital LOS (8.7 ± 4.0 vs. 8.6 ± 4.1 days; p = 0.78), and unplanned ICU transfer (0.9% vs. 2.6%; p = 0.37) were comparable. Postoperative complications, transfusion rates, pain scores, and in-hospital mortality also did not differ significantly. Conclusions: Within a structured ERACS pathway incorporating early extubation and ICU bypass, MICS-CABG and OPCAB achieved similar short-term recovery outcomes despite differences in operative complexity. These findings suggest that ERACS can provide a consistent postoperative recovery framework across both revascularization strategies.

Background/Objectives: Mortality among patients receiving maintenance hemodialysis remains high, and biomarkers that allow early risk stratification are needed. Serum albumin reflects nutritional status and systemic inflammation and has been associated with adverse outcomes; however, its long-term prognostic significance remains incompletely defined. This study examined the association between baseline serum albumin and long-term (up to 10-year) all-cause mortality in a large hemodialysis cohort. Methods: This retrospective cohort study included adult patients undergoing maintenance hemodialysis between 2015 and 2025 at a tertiary nephrology center. Individuals with at least three months of stable dialysis and available baseline serum albumin measurements were included. Patients were categorized into two groups according to baseline serum albumin levels (<3.5 g/dL and ≥3.5 g/dL). The primary outcome was long-term (up to 10-year) all-cause mortality, while secondary outcomes included emergency department visits, hospital admissions, cardiovascular events, and infection-related hospitalizations. Survival was assessed using Kaplan-Meier analysis, and predictors of mortality were evaluated using Cox proportional hazards regression. The median follow-up duration was 54 months (interquartile range: 28-92), with a maximum follow-up of 10 years. Results: A total of 412 patients were analyzed, of whom 40.8% had serum albumin levels < 3.5 g/dL. During follow-up, 233 deaths occurred. Lower albumin levels were associated with significantly higher mortality (76.2% vs. 43.4%, p < 0.001), increased healthcare utilization, and a greater incidence of cardiovascular and infectious complications. In multivariate analysis, albumin < 3.5 g/dL remained an independent predictor of mortality (hazard ratio 1.84, 95% confidence interval 1.42-2.38; p < 0.001). Receiver operating characteristic analysis identified 3.4 g/dL as the optimal cutoff for mortality prediction (area under the curve 0.72). Conclusions: Baseline serum albumin is an independent predictor of long-term (up to 10-year) mortality and adverse clinical outcomes in patients receiving maintenance hemodialysis. Although albumin is not a causal determinant, its association with survival likely reflects underlying nutritional and inflammatory burden. Prospective multicenter studies are warranted to validate albumin-based risk stratification and to evaluate the prognostic value of longitudinal changes in serum albumin over time.

Objective: Idiopathic nephrotic syndrome (INS) is a rare, relapsing kidney disease. Trigger for relapses, among others, may be exposure to gluten in patients with INS and celiac disease (CD). CD is a gluten-sensitive disorder. The prevalence of CD ranges from 1% in the general population to 8% in patients with autoimmune diseases. The aim of the study was to assess the incidence of CD in patients with INS and the influence of a gluten-free diet on the course of INS. Material and Methods: A retrospective cohort study was conducted on 147 patients hospitalized between February 2020 and September 2024 in a single medical center. Patients were categorized into two groups: 98 patients with INS and 49 from the control group. The analysis included age, gender, total dose of glucocorticoids (GCs), duration of INS, serum levels of immunoglobulin class A (IgA) and G (IgG), the presence of antibodies against tissue transglutaminase (tTG) and endomysium (EMA), and urine analysis. A medical questionnaire regarding pathological symptoms during infancy and allergic diseases of patients and family members was conducted. Results: CD was diagnosed in 8% of patients with INS. A total of 66% of patients with INS and CD who followed a gluten-free diet had no or less frequent relapses. Conclusions: CD is more common in patients with INS than in the general population. A gluten-free diet in patients with INS and CD may decrease the frequency of nephrotic proteinuria relapses. CD may be oligosymptomatic, and it is important to search for it in all patients with INS. Owing to the small number of patients with CD among INS in the study, this issue requires further research.

Background/Objectives: Fingernail onychomycosis differs etiologically and epidemiologically from toenail infections and is frequently complicated by colonization and mixed growth. Reliable interpretation of microscopy-culture correlations is essential for avoiding overdiagnosis and guiding therapy. This study aimed to characterize the diagnostic structure, species distribution, and antifungal susceptibility patterns of fingernail onychomycosis in a large routine-laboratory cohort, and to evaluate the performance of a five-tier operational classification integrating microscopy and semi-quantitative culture. Methods: Laboratory records from 1075 patients with clinically suspected fingernail onychomycosis (including nail and periungual samples) were analyzed retrospectively (2017-2024). Direct microscopy with calcofluor white, semi-quantitative culture, and MALDI-TOF MS identification were performed. Cases were categorized based on predefined criteria combining microscopic elements with colony quantity and purity. Species distribution, age-sex patterns, diagnostic concordance between microscopy and culture, and results of EUCAST broth microdilution testing for selected yeasts were assessed. Results: The overall proportion of mycologically positive cases was similar in women and men, although age-dependent patterns differed. Microscopic findings correlated with culture outcomes, with hyphae predicting dermatophytes, yeast cells predicting ascomycetous yeasts, and negative slides aligning with the absence of growth. Yeasts predominated (Candida parapsilosis 30.9%, C. albicans 18.5%), dermatophytes were mainly Trichophyton rubrum, and molds were uncommon. Periungual swabs showed species distributions closely matching those from nail samples and demonstrated high analytical concordance. EUCAST MICs revealed species-dependent variation, including elevated amorolfine MICs in C. parapsilosis and reduced fluconazole activity in Wickerhamomyces pararugosa. Conclusions: Fingernail onychomycosis in this cohort was predominantly yeast-associated, with predictable microscopy-culture relationships and distinct age-sex patterns. The five-tier operational framework improved classification of infection versus colonization, and is proposed as a preliminary tool requiring clinical validation, while contemporary MIC data highlighted clinically relevant interspecies differences. The absence of clinical correlation data (symptoms, severity, treatment history) remains the primary limitation, preventing definitive distinction between infection and colonization in all cases.

Background/Objectives: The skin is an important indicator of overall health, and its relationship with insulin resistance (IR) and metabolic syndrome (MetS) has garnered increasing attention. This review explores the connection between glucose dysregulation and various dermatological conditions, aiming to highlight integrative approaches for management. Methods: A comprehensive literature search was conducted in June and July 2024 across PubMed, Google Scholar, and Embase. Peer-reviewed studies on glucose dysregulation in dermatology were identified using terms such as "insulin," "metabolic syndrome," and "dermatological manifestations." Relevant studies were selected based on their contributions to understanding these relationships. Results: The review identified significant associations between glucose dysregulation, MetS, and conditions such as psoriasis, acne, acanthosis nigricans, seborrheic dermatitis, and hidradenitis suppurativa. Key findings indicated that elevated insulin levels and inflammatory markers correlate with the severity of these skin disorders. Notably, dietary interventions and probiotics show potential in modulating inflammation and improving metabolic health. Conclusions: There is a clear link between glucose dysregulation and several dermatological conditions, underscoring the importance of a holistic treatment approach. By addressing glucose control and incorporating lifestyle modifications, clinicians can improve patient outcomes and mitigate the complications associated with IR and MetS. Further research is essential to refine these integrative strategies and assess their effectiveness in clinical practice.

Background/Objectives: To evaluate risk factors for postoperative neurological deficits following cervical endoscopic unilateral laminotomy for bilateral decompression (CE-ULBD) and to determine whether intraoperative neurophysiological monitoring (IONM) can predict neurological compromise. Methods: A multicenter retrospective review was performed on 42 CE-ULBD procedures conducted between 2016 and 2024; 33 cases met the inclusion criteria with available imaging and electromyography data. Demographic, operative, and neurophysiological variables were analyzed. Preoperative stenosis severity was graded using the Kang MRI system. Intraoperative IONM data, including electromyography firing and motor evoked potential (MEP) changes, were correlated with new postoperative weakness. Results: The cohort (69.1% male, mean age 70.2 ± 1.7 years, mean BMI 29.6 ± 1.1) included 56 decompressed levels. The most common operative levels were C3-4 (37%) and C4-5 (24%). Postoperative weakness occurred in four patients (12.1%), all of whom had severe (Grade 3) preoperative stenosis. Among these, 50% exhibited preoperative weakness. Neuromonitoring changes correlated significantly with postoperative weakness (Fisher's Exact, p < 0.001); 100% of patients with new post-operative weakness had sustained MEP decrease at the time of closure. Conclusions: Patients with severe cervical stenosis and preoperative weakness are at heightened risk of postoperative neurological deficits following CE-ULBD. Elevated epidural pressure from continuous irrigation in a constricted canal may exacerbate cord compression, particularly in those with preexisting myelopathy. IONM changes strongly correlate with new deficits and may exacerbate cord compression, particularly in those with preexisting myelopathy, and may serve as an early warning system for impending neurological injury. Surgeons should exercise caution and maintain low irrigation pressures in patients with severe stenosis undergoing endoscopic cervical decompression.

Background/Objectives: Sexual health is shaped by lifestyle factors alongside biomedical determinants. This review synthesises evidence on physiotherapy, balneology/peloidotherapy, and diet therapy as preventive and therapeutic adjuncts for female sexual dysfunctions and related gynaecological conditions. Methods: A structured narrative review of PubMed and Google Scholar (June-July 2025) was conducted by three independent reviewers using predefined keywords in English and Polish. Case reports, preprints, and studies before 2015 were excluded. From 7322 records, 47 studies met the inclusion criteria for qualitative synthesis. Results: Physiotherapy-particularly pelvic floor muscle training, multimodal manual therapy, neuromuscular electrical stimulation (including PTNS), magnetostimulation, short-wave diathermy, and capacitive-resistive monopolar radiofrequency-was consistently associated with reductions in dyspareunia, chronic pelvic pain, and urinary symptoms, with parallel improvements in sexual function and quality of life. Balneological procedures (brine baths/irrigations, crenotherapy, selected radon/sulphide/iodine-bromine applications) and peloidotherapy demonstrated analgesic, anti-inflammatory, and perfusion-enhancing effects, with signals of benefit in vulvodynia, endometriosis, and infertility support. Dietary measures-higher fruit intake (notably citrus), adequate vitamin D, targeted omega-3 use in PCOS, a Mediterranean dietary pattern, and prudent red-meat limitation-were associated with favourable endocrine-metabolic profiles and, in selected contexts, reduced disease risk. Conclusions: Integrating lifestyle-medicine modalities with standard care may meaningfully prevent and manage female sexual dysfunctions by addressing pain, perfusion, neuromuscular control, and endocrine-metabolic drivers. Implementation frameworks and high-quality trials are warranted to refine indications, dosing, and long-term effectiveness.

Background: Heart failure (HF) patients with a 'reduced' ejection fraction (HFrEF) have several proven treatment options, but for those with a 'preserved' ejection fraction (HFpEF) there are very few. However, recent trials such as the EMPEROR-Preserved and DELIVER have shown that sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce HF hospitalization in HFpEF patients, and these are now supported by both Australian and international guidelines. Methods: We undertook a narrative review using a structured multi-database search (MEDLINE, Embase, CINAHL, Scopus) and key Australian sources (AIHW, ABS, Department of Health and Aged Care) without geographic or publication-year restrictions. Results: In Australia there were approximately 179,000 hospitalizations in 2020-2021 due to HF equating to a rate of 697 per 100,000 population. The age-standardized hospitalization rate for HF in remote and very remote areas was 1.8 times higher than in major cities. Likewise, since 2000 the prevalence of diabetes has nearly tripled, from 460,000 to 1.3 million. In remote areas, there were 47,600 diabetes hospitalizations in 2021-2022, with residents being 2.5 times more likely to be hospitalized for diabetes compared to those in major cities. Conclusions: In rural Australia, reducing preventable hospitalizations and premature mortality from heart failure and type 2 diabetes requires a stronger rural generalist and general practitioner workforce, improved access to essential medicines and telehealth, and equity-focused evaluation.