Pub Date : 2024-09-14DOI: 10.3390/medicina60091502
Mehmet Göktuğ Efgan, Ejder Saylav Bora, Ahmet Kayalı, Umut Payza, Tutku Duman Şahan, Zeynep Karakaya
Background and Objectives: Acute cardiorespiratory failure disrupts the delicate balance of energy supply, demand, and consumption, with elevated lactate levels and decreased blood pH serving as crucial indicators. Acute cardiogenic pulmonary edema (ACPO), a common cause of acute respiratory failure, poses a substantial mortality risk. Lactate, a byproduct of pyruvate reduction, is a pertinent marker in perfusion assessment. Lactate clearance (LC) has proven prognostic efficacy in various conditions but lacks consensus on its predictive power in acute cardiogenic pulmonary edema. Materials and Methods: This prospective observational study, conducted in a metropolitan area’s third-level emergency department, involved patients with cardiogenic pulmonary edema from May 2021 to August 2023. The inclusion criteria specified acute cardiogenic pulmonary edema, excluding patients with incomplete data or other respiratory conditions. Lactate clearance, calculated at presentation and after 6 h, served as the primary outcome predictor. Our data analysis employed logistic regression, the ROC curve, and statistical tests. Results: The cohort of 106 patients revealed that a lactate clearance below 14.29% was significantly associated with mortality. While 51.6% of survivors were discharged, LC’s predictive success for discharge was inconclusive. Logistic regression underscored the significance of lactate clearance, with a one-unit increase yielding a 5.55-fold probability of survival. The AUC for LC was 0.759. Conclusions: This study pioneers the exploration of lactate clearance in patients with acute cardiogenic pulmonary edema. LC below 14.29% signifies a poor prognosis, emphasizing its potential as an early treatment initiation marker. While acknowledging this study’s limitations, we advocate for further multicenter research to refine the understanding of lactate clearance in this context.
{"title":"Prognostic Significance of Lactate Clearance in Cardiogenic Pulmonary Edema in the Emergency Department","authors":"Mehmet Göktuğ Efgan, Ejder Saylav Bora, Ahmet Kayalı, Umut Payza, Tutku Duman Şahan, Zeynep Karakaya","doi":"10.3390/medicina60091502","DOIUrl":"https://doi.org/10.3390/medicina60091502","url":null,"abstract":"Background and Objectives: Acute cardiorespiratory failure disrupts the delicate balance of energy supply, demand, and consumption, with elevated lactate levels and decreased blood pH serving as crucial indicators. Acute cardiogenic pulmonary edema (ACPO), a common cause of acute respiratory failure, poses a substantial mortality risk. Lactate, a byproduct of pyruvate reduction, is a pertinent marker in perfusion assessment. Lactate clearance (LC) has proven prognostic efficacy in various conditions but lacks consensus on its predictive power in acute cardiogenic pulmonary edema. Materials and Methods: This prospective observational study, conducted in a metropolitan area’s third-level emergency department, involved patients with cardiogenic pulmonary edema from May 2021 to August 2023. The inclusion criteria specified acute cardiogenic pulmonary edema, excluding patients with incomplete data or other respiratory conditions. Lactate clearance, calculated at presentation and after 6 h, served as the primary outcome predictor. Our data analysis employed logistic regression, the ROC curve, and statistical tests. Results: The cohort of 106 patients revealed that a lactate clearance below 14.29% was significantly associated with mortality. While 51.6% of survivors were discharged, LC’s predictive success for discharge was inconclusive. Logistic regression underscored the significance of lactate clearance, with a one-unit increase yielding a 5.55-fold probability of survival. The AUC for LC was 0.759. Conclusions: This study pioneers the exploration of lactate clearance in patients with acute cardiogenic pulmonary edema. LC below 14.29% signifies a poor prognosis, emphasizing its potential as an early treatment initiation marker. While acknowledging this study’s limitations, we advocate for further multicenter research to refine the understanding of lactate clearance in this context.","PeriodicalId":18512,"journal":{"name":"Medicina","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-14DOI: 10.3390/medicina60091500
Ishith Seth, Bryan Lim, Robert Phan, Yi Xie, Peter Sinkjær Kenney, William E. Bukret, Jørn Bo Thomsen, Roberto Cuomo, Richard J. Ross, Sally Kiu-Huen Ng, Warren M. Rozen
Background and Objectives: Despite CTAs being critical for preoperative planning in autologous breast reconstruction, experienced plastic surgeons may have differing preferences for which side of the abdomen to use for unilateral breast reconstruction. Large language models (LLMs) have the potential to assist medical imaging interpretation. This study compares the perforator selection preferences of experienced plastic surgeons with four popular LLMs based on CTA images for breast reconstruction. Materials and Methods: Six experienced plastic surgeons from Australia, the US, Italy, Denmark, and Argentina reviewed ten CTA images, indicated their preferred side of the abdomen for unilateral breast reconstruction and recommended the type of autologous reconstruction. The LLMs were prompted to do the same. The average decisions were calculated, recorded in suitable tables, and compared. Results: The six consultants predominantly recommend the DIEP procedure (83%). This suggests experienced surgeons feel more comfortable raising DIEP than TRAM flaps, which they recommended only 3% of the time. They also favoured MS TRAM and SIEA less frequently (11% and 2%, respectively). Three LLMs—ChatGPT-4o, ChatGPT-4, and Bing CoPilot—exclusively recommended DIEP (100%), while Claude suggested DIEP 90% and MS TRAM 10%. Despite minor variations in side recommendations, consultants and AI models clearly preferred DIEP. Conclusions: Consultants and LLMs consistently preferred DIEP procedures, indicating strong confidence among experienced surgeons, though LLMs occasionally deviated in recommendations, highlighting limitations in their image interpretation capabilities. This emphasises the need for ongoing refinement of AI-assisted decision support systems to ensure they align more closely with expert clinical judgment and enhance their reliability in clinical practice.
{"title":"Perforator Selection with Computed Tomography Angiography for Unilateral Breast Reconstruction: A Clinical Multicentre Analysis","authors":"Ishith Seth, Bryan Lim, Robert Phan, Yi Xie, Peter Sinkjær Kenney, William E. Bukret, Jørn Bo Thomsen, Roberto Cuomo, Richard J. Ross, Sally Kiu-Huen Ng, Warren M. Rozen","doi":"10.3390/medicina60091500","DOIUrl":"https://doi.org/10.3390/medicina60091500","url":null,"abstract":"Background and Objectives: Despite CTAs being critical for preoperative planning in autologous breast reconstruction, experienced plastic surgeons may have differing preferences for which side of the abdomen to use for unilateral breast reconstruction. Large language models (LLMs) have the potential to assist medical imaging interpretation. This study compares the perforator selection preferences of experienced plastic surgeons with four popular LLMs based on CTA images for breast reconstruction. Materials and Methods: Six experienced plastic surgeons from Australia, the US, Italy, Denmark, and Argentina reviewed ten CTA images, indicated their preferred side of the abdomen for unilateral breast reconstruction and recommended the type of autologous reconstruction. The LLMs were prompted to do the same. The average decisions were calculated, recorded in suitable tables, and compared. Results: The six consultants predominantly recommend the DIEP procedure (83%). This suggests experienced surgeons feel more comfortable raising DIEP than TRAM flaps, which they recommended only 3% of the time. They also favoured MS TRAM and SIEA less frequently (11% and 2%, respectively). Three LLMs—ChatGPT-4o, ChatGPT-4, and Bing CoPilot—exclusively recommended DIEP (100%), while Claude suggested DIEP 90% and MS TRAM 10%. Despite minor variations in side recommendations, consultants and AI models clearly preferred DIEP. Conclusions: Consultants and LLMs consistently preferred DIEP procedures, indicating strong confidence among experienced surgeons, though LLMs occasionally deviated in recommendations, highlighting limitations in their image interpretation capabilities. This emphasises the need for ongoing refinement of AI-assisted decision support systems to ensure they align more closely with expert clinical judgment and enhance their reliability in clinical practice.","PeriodicalId":18512,"journal":{"name":"Medicina","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-14DOI: 10.3390/medicina60091501
Vulcan Talida, Suciu Sergiu Tudor, Iancu Mihaela, Mitrea Daniela-Rodica, Filip Gabriela A., Procopciuc Lucia Maria
Background and Objectives: Polycystic ovary syndrome (PCOS) is a frequent and complex multidisciplinary disorder. Data regarding the role of genes involved in vitamin D metabolism in PCOS are as-yet elusive but suggest an association of VDR (vitamin D receptor) and vitamin D levels with metabolic, endocrine and cutaneous manifestations. The aim of this study was to evaluate the association between VDR gene polymorphisms and cutaneous manifestations, to find a correlation between hormonal parameters, oxidative stress and skin manifestations in women with PCOS, and to determine the impact of VDR gene polymorphisms on these parameters. Materials and Methods: This case–control study included 39 controls and 46 women with PCOS, matched by age and BMI distribution. Acne, hirsutism, seborrhea, androgenetic alopecia, oxidative stress and androgen hormones were recorded. VDR gene polymorphisms ApaI, FokI and TaqI were examined by polymerase chain reaction restriction fragment length polymorphism, and the androgen hormone (total testosterone, DHEAS), SHBG and malondialdehyde levels were assessed. Results: The most frequent skin manifestations in PCOS cases were acne followed by seborrhea, hirsutism and androgenic alopecia. The VDR-FokI polymorphism CC genotype had a significant protective role in the odds of acne (OR = 0.11, 95% CI: [0.02, 0.70], p = 0.015, p-corrected = 0.040) and seborrhea (OR = 0.15, 95% CI: [0.03, 0.75], p = 0.019, p-corrected = 0.039). The results demonstrated a significant protective effect of the C allele on the odds of acne and seborrhea in PCOS cases. Moreover, the dominant genotype of VDR-TaqI could have a protective role against oxidative stress (lower MDA levels) compared to patients carrying the TT genotype. Conclusions: In summary, this is the first study to demonstrate that the FokI CC genotype may have a protective role against both acne and seborrhea in women with PCOS, while the VDR-TaqI dominant genotype is associated with diminished oxidative stress in PCOS patients.
{"title":"The Impact of Vitamin D Receptor Gene Polymorphisms (FokI, ApaI, TaqI) in Correlation with Oxidative Stress and Hormonal and Dermatologic Manifestations in Polycystic Ovary Syndrome","authors":"Vulcan Talida, Suciu Sergiu Tudor, Iancu Mihaela, Mitrea Daniela-Rodica, Filip Gabriela A., Procopciuc Lucia Maria","doi":"10.3390/medicina60091501","DOIUrl":"https://doi.org/10.3390/medicina60091501","url":null,"abstract":"Background and Objectives: Polycystic ovary syndrome (PCOS) is a frequent and complex multidisciplinary disorder. Data regarding the role of genes involved in vitamin D metabolism in PCOS are as-yet elusive but suggest an association of VDR (vitamin D receptor) and vitamin D levels with metabolic, endocrine and cutaneous manifestations. The aim of this study was to evaluate the association between VDR gene polymorphisms and cutaneous manifestations, to find a correlation between hormonal parameters, oxidative stress and skin manifestations in women with PCOS, and to determine the impact of VDR gene polymorphisms on these parameters. Materials and Methods: This case–control study included 39 controls and 46 women with PCOS, matched by age and BMI distribution. Acne, hirsutism, seborrhea, androgenetic alopecia, oxidative stress and androgen hormones were recorded. VDR gene polymorphisms ApaI, FokI and TaqI were examined by polymerase chain reaction restriction fragment length polymorphism, and the androgen hormone (total testosterone, DHEAS), SHBG and malondialdehyde levels were assessed. Results: The most frequent skin manifestations in PCOS cases were acne followed by seborrhea, hirsutism and androgenic alopecia. The VDR-FokI polymorphism CC genotype had a significant protective role in the odds of acne (OR = 0.11, 95% CI: [0.02, 0.70], p = 0.015, p-corrected = 0.040) and seborrhea (OR = 0.15, 95% CI: [0.03, 0.75], p = 0.019, p-corrected = 0.039). The results demonstrated a significant protective effect of the C allele on the odds of acne and seborrhea in PCOS cases. Moreover, the dominant genotype of VDR-TaqI could have a protective role against oxidative stress (lower MDA levels) compared to patients carrying the TT genotype. Conclusions: In summary, this is the first study to demonstrate that the FokI CC genotype may have a protective role against both acne and seborrhea in women with PCOS, while the VDR-TaqI dominant genotype is associated with diminished oxidative stress in PCOS patients.","PeriodicalId":18512,"journal":{"name":"Medicina","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-14DOI: 10.3390/medicina60091503
Marko Cubrilo, Marko Banovic, Milos Matkovic, Ilija Bilbija, Nemanja Aleksic, Dragan Ivanisevic, Vladimir Tutus, Vladimir Milicevic, Vladimir Cvetic, Natasa Jankovic, Svetozar Putnik
Background and Objectives: The aim of this study was to estimate the prevalence of silent coronary artery disease (CAD) in asymptomatic patients with severe aortic stenosis (AS) and assess long-term prognosis in terms of major adverse cardiovascular event (MACE)-free survival. Materials and Methods: This was a prospective study conducted at the Clinic for Cardiac Surgery, University Clinical Center of Serbia, in asymptomatic patients with severe AS, normal LVEF and stress test without signs of myocardial ischemia. Adverse cardiovascular events (cardiac death, myocardial infarction and any hospitalization due to heart disease) was monitored during one year of follow up. Results: A total of 116 asymptomatic patients with severe AS were included in the study. The average age was 67.3 ± 9.6 years, and 56.9% of patients were men. The most common cause of AS was degenerative valvular disease (83.5%). The incidence of significant CAD was 30 out of 116 patients (25.9%). The median Society for Thoracic Surgeons (STS) predicted risk of mortality score was 1.62% (25th to 75th percentile: 1.15–2.76%). The overall mean gradient across aortic valve (Pmean) was 52.30 mmHg ± 12.16, and the mean indexed AVA (AVAi) was 0.37 ± 0.09 cm2/m2. The mean LVEF was 68.40% ± 8.01%. Early surgery for aortic valve replacement was performed in 55 patients (55.2%), while 52 (44.8%) patients received conservative treatment. Twenty-two patients (42.3%) in the conservative treatment group underwent surgery during follow up. There were a total of 44 (37.9%) patients with MACE during one year of follow up. Univariate Cox regression analyses identified the following significant risk factors for MACE-free survival: presence of CAD and early conservative treatment (p = 0.004), age (p = 0.003), diabetes mellitus (p = 0.016) and STS score (p = 0.039). According to multivariate analysis, the presence of CAD with early conservative treatment was the most important predictor of MACE-free survival in asymptomatic patients with severe aortic stenosis (p ≤ 0.001). Conclusions: Early surgery for aortic valve replacement in asymptomatic patients with severe AS and concomitant CAD is beneficial for long-term survival.
{"title":"Incidence and Prognostic Significance of Silent Coronary Disease in Asymptomatic Patients with Severe Aortic Stenosis","authors":"Marko Cubrilo, Marko Banovic, Milos Matkovic, Ilija Bilbija, Nemanja Aleksic, Dragan Ivanisevic, Vladimir Tutus, Vladimir Milicevic, Vladimir Cvetic, Natasa Jankovic, Svetozar Putnik","doi":"10.3390/medicina60091503","DOIUrl":"https://doi.org/10.3390/medicina60091503","url":null,"abstract":"Background and Objectives: The aim of this study was to estimate the prevalence of silent coronary artery disease (CAD) in asymptomatic patients with severe aortic stenosis (AS) and assess long-term prognosis in terms of major adverse cardiovascular event (MACE)-free survival. Materials and Methods: This was a prospective study conducted at the Clinic for Cardiac Surgery, University Clinical Center of Serbia, in asymptomatic patients with severe AS, normal LVEF and stress test without signs of myocardial ischemia. Adverse cardiovascular events (cardiac death, myocardial infarction and any hospitalization due to heart disease) was monitored during one year of follow up. Results: A total of 116 asymptomatic patients with severe AS were included in the study. The average age was 67.3 ± 9.6 years, and 56.9% of patients were men. The most common cause of AS was degenerative valvular disease (83.5%). The incidence of significant CAD was 30 out of 116 patients (25.9%). The median Society for Thoracic Surgeons (STS) predicted risk of mortality score was 1.62% (25th to 75th percentile: 1.15–2.76%). The overall mean gradient across aortic valve (Pmean) was 52.30 mmHg ± 12.16, and the mean indexed AVA (AVAi) was 0.37 ± 0.09 cm2/m2. The mean LVEF was 68.40% ± 8.01%. Early surgery for aortic valve replacement was performed in 55 patients (55.2%), while 52 (44.8%) patients received conservative treatment. Twenty-two patients (42.3%) in the conservative treatment group underwent surgery during follow up. There were a total of 44 (37.9%) patients with MACE during one year of follow up. Univariate Cox regression analyses identified the following significant risk factors for MACE-free survival: presence of CAD and early conservative treatment (p = 0.004), age (p = 0.003), diabetes mellitus (p = 0.016) and STS score (p = 0.039). According to multivariate analysis, the presence of CAD with early conservative treatment was the most important predictor of MACE-free survival in asymptomatic patients with severe aortic stenosis (p ≤ 0.001). Conclusions: Early surgery for aortic valve replacement in asymptomatic patients with severe AS and concomitant CAD is beneficial for long-term survival.","PeriodicalId":18512,"journal":{"name":"Medicina","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-14DOI: 10.3390/medicina60091499
Pavel Ryška, Miroslav Lojík, Jiřina Habalová, Carmen Kajzrová, Tomáš Česák, Eva Vítková, Michael Bartoš, Zdeněk Bělobrádek, Antonín Krajina
Background: Using two case reports of adult women with moyamoya disease presenting with intracranial hemorrhage from ruptured aneurysms on moyamoya collateral vessels, we aim to demonstrate the potential for effective endovascular treatment navigated by CT angiography, digital subtraction angiography, and flat panel CT. Case 1 Presentation: A 45-year-old female patient with sudden onset of headache, followed by somnolency. CT scan showed a four-ventricle hematocephalus caused by a 27 × 31 × 17 mm hematoma located in the left basal ganglia. Angiography revealed a 3 mm aneurysm on hypertrophic lenticulostriate artery bridging the M1 occlusion. Selective catheterization and distal embolisation with acrylic glue was done. Case 2 Presentation: A 47-year-old woman was admitted for a sudden onset of severe headache, CT scan showed four-ventricle hematocephalus. A 4 mm aneurysm on the collateral vessel–anterior chorioidal artery bridging the closure of the terminal segment of the internal carotid artery was diagnosed as the source of bleeding. Selective catheterization and distal embolisation with acrylic glue was done. Conclusions: Selective embolisation of ruptured aneurysms on moya moya collaterals is a simple, effective, and safe procedure when relevant microcatheters are used with imaging software navigation such as 3D DSA, 3D road map and flat-panel CT.
{"title":"Endovascular Therapy of Ruptured Aneurysms on Moyamoya Collateral Vessels: Two Cases","authors":"Pavel Ryška, Miroslav Lojík, Jiřina Habalová, Carmen Kajzrová, Tomáš Česák, Eva Vítková, Michael Bartoš, Zdeněk Bělobrádek, Antonín Krajina","doi":"10.3390/medicina60091499","DOIUrl":"https://doi.org/10.3390/medicina60091499","url":null,"abstract":"Background: Using two case reports of adult women with moyamoya disease presenting with intracranial hemorrhage from ruptured aneurysms on moyamoya collateral vessels, we aim to demonstrate the potential for effective endovascular treatment navigated by CT angiography, digital subtraction angiography, and flat panel CT. Case 1 Presentation: A 45-year-old female patient with sudden onset of headache, followed by somnolency. CT scan showed a four-ventricle hematocephalus caused by a 27 × 31 × 17 mm hematoma located in the left basal ganglia. Angiography revealed a 3 mm aneurysm on hypertrophic lenticulostriate artery bridging the M1 occlusion. Selective catheterization and distal embolisation with acrylic glue was done. Case 2 Presentation: A 47-year-old woman was admitted for a sudden onset of severe headache, CT scan showed four-ventricle hematocephalus. A 4 mm aneurysm on the collateral vessel–anterior chorioidal artery bridging the closure of the terminal segment of the internal carotid artery was diagnosed as the source of bleeding. Selective catheterization and distal embolisation with acrylic glue was done. Conclusions: Selective embolisation of ruptured aneurysms on moya moya collaterals is a simple, effective, and safe procedure when relevant microcatheters are used with imaging software navigation such as 3D DSA, 3D road map and flat-panel CT.","PeriodicalId":18512,"journal":{"name":"Medicina","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142250491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.3390/medicina60091496
Dong-Ho Lee, Hyung Rae Lee, Sang Yun Seok, Ji Uk Choi, Jae Min Park, Jae-Hyuk Yang
Background and Objectives: Posterior cervical foraminotomy (PCF) aims to resolve cervical radiculopathy while preserving range of motion (ROM). However, its effectiveness in maintaining ROM is uncertain. This study investigates the changes in ROM after PCF and identifies preoperative factors that influence ROM reduction post surgery. Materials and Methods: This retrospective cohort study included patients treated at our hospital from August 2016 to September 2021. Clinical outcomes were assessed using the visual analog scale (VAS) for neck and arm pain and the neck disability index (NDI). Radiological outcomes included the segmental angle (SA), cervical angle (CA), C2–C7 SVA, Pfirrmann grade, extent of facetectomy, foraminal stenosis, and ROM. Patients were categorized into two groups based on segmental ROM changes: decreased (Group D) and maintained (Group M). Radiological and clinical outcomes were compared between the groups. Univariate and multivariate regression analyses were performed to identify risk factors for ROM loss after PCF. Results: 76 patients were included: 34 in Group D and 42 in Group M, with no demographic differences. Preoperatively, Group D had significantly larger flexion segmental and cervical angles than Group M (segmental, p < 0.001; cervical, p = 0.001). Group D also had a higher Pfirrmann grade (p = 0.014) and more bony bridge formations (p = 0.004). While no significant differences were observed in arm pain VAS and NDI scores, Group D exhibited worse neck pain VAS at the last follow-up (p = 0.03). Univariate linear regression indicated that preoperative segmental ROM (p < 0.001, B = 0.82) and bony bridge formation (p = 0.046, B = 5.33) were significant predictors of ROM loss post PCF. Conclusions: Patients with higher preoperative flexion angles and Pfirrmann grades at the operative level are at an increased risk for ROM loss and neck pain and often exhibit bony bridge formation. Accounting for these factors can improve surgical planning and patient outcomes.
背景和目的：颈椎后路椎板切除术（PCF）旨在解决颈椎病，同时保持颈椎的活动范围（ROM）。然而，其在保持 ROM 方面的有效性尚不确定。本研究调查了 PCF 术后 ROM 的变化，并确定了影响术后 ROM 减少的术前因素。材料与方法：这项回顾性队列研究纳入了2016年8月至2021年9月在我院接受治疗的患者。临床结果采用颈部和手臂疼痛视觉模拟量表（VAS）和颈部残疾指数（NDI）进行评估。放射学结果包括节段角度（SA）、颈椎角度（CA）、C2-C7 SVA、Pfirrmann分级、面神经切除范围、椎孔狭窄和ROM。根据节段 ROM 的变化将患者分为两组：减少组（D 组）和保持组（M 组）。两组患者的放射学和临床结果进行了比较。进行了单变量和多变量回归分析，以确定 PCF 后 ROM 损失的风险因素。结果共纳入 76 名患者：D组34人，M组42人，两组在人口统计学上无差异。术前，D组的屈曲节段角和颈椎角明显大于M组（节段角，p < 0.001；颈椎角，p = 0.001）。D 组的 Pfirrmann 分级更高（p = 0.014），骨桥形成更多（p = 0.004）。虽然在手臂疼痛 VAS 和 NDI 评分方面没有观察到明显差异，但 D 组在最后一次随访时颈部疼痛 VAS 更严重（p = 0.03）。单变量线性回归表明，术前节段 ROM（p < 0.001，B = 0.82）和骨桥形成（p = 0.046，B = 5.33）是 PCF 术后 ROM 损失的重要预测因素。结论：术前屈曲角度和手术水平的Pfirrmann分级较高的患者发生ROM丧失和颈部疼痛的风险较高，而且通常会出现骨桥形成。考虑这些因素可以改善手术规划和患者预后。
{"title":"Preoperative Factors on Loss of Range of Motion after Posterior Cervical Foraminotomy","authors":"Dong-Ho Lee, Hyung Rae Lee, Sang Yun Seok, Ji Uk Choi, Jae Min Park, Jae-Hyuk Yang","doi":"10.3390/medicina60091496","DOIUrl":"https://doi.org/10.3390/medicina60091496","url":null,"abstract":"Background and Objectives: Posterior cervical foraminotomy (PCF) aims to resolve cervical radiculopathy while preserving range of motion (ROM). However, its effectiveness in maintaining ROM is uncertain. This study investigates the changes in ROM after PCF and identifies preoperative factors that influence ROM reduction post surgery. Materials and Methods: This retrospective cohort study included patients treated at our hospital from August 2016 to September 2021. Clinical outcomes were assessed using the visual analog scale (VAS) for neck and arm pain and the neck disability index (NDI). Radiological outcomes included the segmental angle (SA), cervical angle (CA), C2–C7 SVA, Pfirrmann grade, extent of facetectomy, foraminal stenosis, and ROM. Patients were categorized into two groups based on segmental ROM changes: decreased (Group D) and maintained (Group M). Radiological and clinical outcomes were compared between the groups. Univariate and multivariate regression analyses were performed to identify risk factors for ROM loss after PCF. Results: 76 patients were included: 34 in Group D and 42 in Group M, with no demographic differences. Preoperatively, Group D had significantly larger flexion segmental and cervical angles than Group M (segmental, p < 0.001; cervical, p = 0.001). Group D also had a higher Pfirrmann grade (p = 0.014) and more bony bridge formations (p = 0.004). While no significant differences were observed in arm pain VAS and NDI scores, Group D exhibited worse neck pain VAS at the last follow-up (p = 0.03). Univariate linear regression indicated that preoperative segmental ROM (p < 0.001, B = 0.82) and bony bridge formation (p = 0.046, B = 5.33) were significant predictors of ROM loss post PCF. Conclusions: Patients with higher preoperative flexion angles and Pfirrmann grades at the operative level are at an increased risk for ROM loss and neck pain and often exhibit bony bridge formation. Accounting for these factors can improve surgical planning and patient outcomes.","PeriodicalId":18512,"journal":{"name":"Medicina","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142190233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.3390/medicina60091493
Stefan Lucian Popa, Teodora Surdea-Blaga, Dan Lucian Dumitrascu, Andrei Vasile Pop, Abdulrahman Ismaiel, Liliana David, Vlad Dumitru Brata, Daria Claudia Turtoi, Giuseppe Chiarioni, Edoardo Vincenzo Savarino, Imre Zsigmond, Zoltan Czako, Daniel Corneliu Leucuta
Background/Objectives: To develop a deep learning model for esophageal motility disorder diagnosis using high-resolution manometry images with the aid of Gemini. Methods: Gemini assisted in developing this model by aiding in code writing, preprocessing, model optimization, and troubleshooting. Results: The model demonstrated an overall precision of 0.89 on the testing set, with an accuracy of 0.88, a recall of 0.88, and an F1-score of 0.885. It presented better results for multiple categories, particularly in the panesophageal pressurization category, with precision = 0.99 and recall = 0.99, yielding a balanced F1-score of 0.99. Conclusions: This study demonstrates the potential of artificial intelligence, particularly Gemini, in aiding the creation of robust deep learning models for medical image analysis, solving not just simple binary classification problems but more complex, multi-class image classification tasks.
{"title":"Gemini-Assisted Deep Learning Classification Model for Automated Diagnosis of High-Resolution Esophageal Manometry Images","authors":"Stefan Lucian Popa, Teodora Surdea-Blaga, Dan Lucian Dumitrascu, Andrei Vasile Pop, Abdulrahman Ismaiel, Liliana David, Vlad Dumitru Brata, Daria Claudia Turtoi, Giuseppe Chiarioni, Edoardo Vincenzo Savarino, Imre Zsigmond, Zoltan Czako, Daniel Corneliu Leucuta","doi":"10.3390/medicina60091493","DOIUrl":"https://doi.org/10.3390/medicina60091493","url":null,"abstract":"Background/Objectives: To develop a deep learning model for esophageal motility disorder diagnosis using high-resolution manometry images with the aid of Gemini. Methods: Gemini assisted in developing this model by aiding in code writing, preprocessing, model optimization, and troubleshooting. Results: The model demonstrated an overall precision of 0.89 on the testing set, with an accuracy of 0.88, a recall of 0.88, and an F1-score of 0.885. It presented better results for multiple categories, particularly in the panesophageal pressurization category, with precision = 0.99 and recall = 0.99, yielding a balanced F1-score of 0.99. Conclusions: This study demonstrates the potential of artificial intelligence, particularly Gemini, in aiding the creation of robust deep learning models for medical image analysis, solving not just simple binary classification problems but more complex, multi-class image classification tasks.","PeriodicalId":18512,"journal":{"name":"Medicina","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142190230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and Objectives: Hypermobility of the lateral meniscus is typically associated with the posterior part of this structure, with occurrences in the anterior part rarely reported. However, a hypermobile anterior horn of the lateral meniscus can manifest clinical symptoms. This study aimed to increase awareness regarding hypermobility in the anterior horn of the lateral meniscus by presenting its clinical presentations, magnetic resonance imaging (MRI) findings, arthroscopic findings, treatment approaches, postoperative protocols, and clinical outcomes. Materials and Methods: A retrospective case-series involving patients diagnosed as having hypermobile anterior horn of the lateral meniscus through arthroscopy. The clinical presentations, preoperative image findings, arthroscopic findings, treatments, postoperative protocols, and clinical outcomes following meniscal stabilization were all reviewed. Results: A total of 17 patients (17 knees) with a mean age of 45.9 ± 18.4 years were analyzed. The mean follow-up period was 18.2 ± 7.6 months (range, 6–24 months). Primary symptoms included anterior lateral knee pain, tenderness in the lateral joint lines, and a locking sensation in six of the knees. MRI revealed hypodense lesions anterior to the meniscus, fluid accumulation, degenerative changes, and anterior horn deformities. Following meniscal stabilization, the Lysholm Knee Scoring Scale score increased from 65.8 ± 12.7 before surgery to 91.1 ± 9.6 at the final follow-up (p < 0.001). All the analyzed knees achieved a full range of motion by the final follow-up, with no patient experiencing any complication or requiring reoperation. Conclusions: There is no specific sign or test that can be used to detect a hypermobile anterior horn of the lateral meniscus. A thorough arthroscopic examination is essential for diagnosing hypermobility in the anterior horn of the lateral meniscus. Arthroscopic meniscal stabilization yields favorable outcomes.
{"title":"Hypermobile Anterior Horn of the Lateral Meniscus: A Retrospective Case-Series Study of Presentation, Imaging, Treatment, and Outcomes","authors":"Chang-Hao Lin, Chen-Hao Chiang, Wei-Chen Hung, Wei-Hsing Chih","doi":"10.3390/medicina60091497","DOIUrl":"https://doi.org/10.3390/medicina60091497","url":null,"abstract":"Background and Objectives: Hypermobility of the lateral meniscus is typically associated with the posterior part of this structure, with occurrences in the anterior part rarely reported. However, a hypermobile anterior horn of the lateral meniscus can manifest clinical symptoms. This study aimed to increase awareness regarding hypermobility in the anterior horn of the lateral meniscus by presenting its clinical presentations, magnetic resonance imaging (MRI) findings, arthroscopic findings, treatment approaches, postoperative protocols, and clinical outcomes. Materials and Methods: A retrospective case-series involving patients diagnosed as having hypermobile anterior horn of the lateral meniscus through arthroscopy. The clinical presentations, preoperative image findings, arthroscopic findings, treatments, postoperative protocols, and clinical outcomes following meniscal stabilization were all reviewed. Results: A total of 17 patients (17 knees) with a mean age of 45.9 ± 18.4 years were analyzed. The mean follow-up period was 18.2 ± 7.6 months (range, 6–24 months). Primary symptoms included anterior lateral knee pain, tenderness in the lateral joint lines, and a locking sensation in six of the knees. MRI revealed hypodense lesions anterior to the meniscus, fluid accumulation, degenerative changes, and anterior horn deformities. Following meniscal stabilization, the Lysholm Knee Scoring Scale score increased from 65.8 ± 12.7 before surgery to 91.1 ± 9.6 at the final follow-up (p < 0.001). All the analyzed knees achieved a full range of motion by the final follow-up, with no patient experiencing any complication or requiring reoperation. Conclusions: There is no specific sign or test that can be used to detect a hypermobile anterior horn of the lateral meniscus. A thorough arthroscopic examination is essential for diagnosing hypermobility in the anterior horn of the lateral meniscus. Arthroscopic meniscal stabilization yields favorable outcomes.","PeriodicalId":18512,"journal":{"name":"Medicina","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142190232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.3390/medicina60091498
Sevcan Avcı Işık, Elif Budak Ertürk, Hakkı Tankut Akay, Azize Karahan, Denizhan Akpınar, Arif Okay Karslıoğlu
Background and Objectives: Chronic venous insufficiency negatively affects the quality of life and reduces the job performance of nurses, who are important components of the healthcare system. The aim of this study was to assess the risk factors of venous insufficiency according to demographic characteristics among nurses working at a foundation university hospital. Materials and Methods: This study used an analytical cross-sectional approach. The sample consisted of 100 nurses working at a foundation university hospital in a metropolitan city of Turkey. Data were collected using a demographic characteristics form, VEINESQOL/Sym, and a CEAP classification form. The condition of varicose veins among the nurses was diagnosed by a cardiovascular surgeon using Doppler ultrasonography. Results: The prevalence of chronic venous insufficiency (CVI) among nurses was 65%, with 48% at a C1 level according to the CEAP classification. CVI was higher among those with chronic diseases (p = 0.027) and those who had pregnancy (p = 0.021). In addition, the risk of CVI (+) was 7.68 times higher among those aged older than 26.5 years and 36.14 times higher for women (p < 0.001). A 0.9-fold increase in the risk of CVI (+) among nurses produced a one-unit decrease in venous-insufficiency-related quality of life (p = 0.006, OR = 0.94, 95% CI:(0.896–0.982)). Conclusions: The prevalence of CVI among nurses was found to be high, especially among women, those with chronic diseases, and pregnant individuals. In this context, it is recommended to implement risk screening and prevention education programs for CVI among nurses.
{"title":"Analysis of Venous Insufficiency Risk Factors and Demographic Characteristics among Nurses: An Analytical Cross-Sectional Study","authors":"Sevcan Avcı Işık, Elif Budak Ertürk, Hakkı Tankut Akay, Azize Karahan, Denizhan Akpınar, Arif Okay Karslıoğlu","doi":"10.3390/medicina60091498","DOIUrl":"https://doi.org/10.3390/medicina60091498","url":null,"abstract":"Background and Objectives: Chronic venous insufficiency negatively affects the quality of life and reduces the job performance of nurses, who are important components of the healthcare system. The aim of this study was to assess the risk factors of venous insufficiency according to demographic characteristics among nurses working at a foundation university hospital. Materials and Methods: This study used an analytical cross-sectional approach. The sample consisted of 100 nurses working at a foundation university hospital in a metropolitan city of Turkey. Data were collected using a demographic characteristics form, VEINESQOL/Sym, and a CEAP classification form. The condition of varicose veins among the nurses was diagnosed by a cardiovascular surgeon using Doppler ultrasonography. Results: The prevalence of chronic venous insufficiency (CVI) among nurses was 65%, with 48% at a C1 level according to the CEAP classification. CVI was higher among those with chronic diseases (p = 0.027) and those who had pregnancy (p = 0.021). In addition, the risk of CVI (+) was 7.68 times higher among those aged older than 26.5 years and 36.14 times higher for women (p < 0.001). A 0.9-fold increase in the risk of CVI (+) among nurses produced a one-unit decrease in venous-insufficiency-related quality of life (p = 0.006, OR = 0.94, 95% CI:(0.896–0.982)). Conclusions: The prevalence of CVI among nurses was found to be high, especially among women, those with chronic diseases, and pregnant individuals. In this context, it is recommended to implement risk screening and prevention education programs for CVI among nurses.","PeriodicalId":18512,"journal":{"name":"Medicina","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142190236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-13DOI: 10.3390/medicina60091492
Sung Eun Kim, Seong Hwan Kim, Jung-In Lee, Hyuk-Soo Han, Myung Chul Lee, Du Hyun Ro
Background and Objectives: Neglected patellar dislocation in the presence of end-stage osteoarthritis (OA) is a rare condition characterized by the patella remaining laterally dislocated without reduction. Due to the scarcity of reported cases, the optimal management approach is still uncertain. However, primary total knee arthroplasty (TKA) can serve as an effective treatment option. This study aimed to present the clinical and radiological outcomes achieved using our surgical technique. Materials and Methods: A retrospective review of 12 knees in 8 patients with neglected patellar dislocation and end-stage OA who underwent primary TKA was conducted. The surgical procedure involved conventional TKA techniques (e.g., medial parapatellar arthrotomy) and additional procedures specific to the individual pathologies of neglected patellar dislocation (e.g., lateral release, medial plication, and quadriceps lengthening). Clinical outcomes, including patient-reported outcome measures (PROMs) (Knee Society Scores and the Western Ontario and McMaster Universities Osteoarthritis Index) and knee range of motion (ROM), were assessed preoperatively and two years postoperatively. Radiological measures including mechanical femorotibial angle and patellar tilt angle were assessed preoperatively and until the last follow-up examinations. Any complications were also reviewed. Results: There were significant improvements in all PROMs, knee ROM, and radiological outcomes, including mechanical femorotibial angle and patellar tilt angle (all p < 0.05). At a mean follow-up of 68 months, no major complications requiring revision surgery, including patellar dislocation, were reported. Conclusions: Primary TKA is an effective procedure for correcting various pathologies associated with neglected patellar dislocation in end-stage OA without necessitating additional bony procedures. Satisfactory clinical and radiological outcomes can be expected using pathology-specific procedures.
背景和目的：存在终末期骨关节炎（OA）的被忽视的髌骨脱位是一种罕见病症，其特点是髌骨仍然侧向脱位而未复位。由于报道的病例很少，最佳治疗方法仍不确定。不过，初级全膝关节置换术（TKA）是一种有效的治疗方法。本研究旨在介绍采用我们的手术技术所取得的临床和放射学效果。材料和方法：对8名髌骨脱位和终末期OA患者的12个膝关节进行了回顾性研究，这些患者均接受了初级TKA手术。手术方法包括传统的 TKA 技术（如内侧髌骨旁关节切开术）和针对被忽视的髌骨脱位的不同病理特征的附加手术（如外侧松解术、内侧夹板术和股四头肌延长术）。临床结果包括患者报告的结果测量（PROMs）（膝关节协会评分和西安大略和麦克马斯特大学骨关节炎指数）和膝关节活动范围（ROM），分别在术前和术后两年进行评估。在术前和最后一次随访检查前，对包括机械股胫骨角和髌骨倾斜角在内的放射学指标进行了评估。此外，还对任何并发症进行了复查。结果：所有 PROMs、膝关节 ROM 和放射学结果（包括机械股胫骨角和髌骨倾斜角）均有明显改善（所有 P < 0.05）。在平均 68 个月的随访中，没有发现需要进行翻修手术的重大并发症，包括髌骨脱位。结论：原位 TKA 是一种有效的手术方法，可纠正终末期 OA 中与被忽视的髌骨脱位相关的各种病变，而无需进行额外的骨性手术。采用病理特异性手术可获得令人满意的临床和放射学效果。
{"title":"Primary Total Knee Arthroplasty for Treating Osteoarthritic Knees with Neglected Patellar Dislocation","authors":"Sung Eun Kim, Seong Hwan Kim, Jung-In Lee, Hyuk-Soo Han, Myung Chul Lee, Du Hyun Ro","doi":"10.3390/medicina60091492","DOIUrl":"https://doi.org/10.3390/medicina60091492","url":null,"abstract":"Background and Objectives: Neglected patellar dislocation in the presence of end-stage osteoarthritis (OA) is a rare condition characterized by the patella remaining laterally dislocated without reduction. Due to the scarcity of reported cases, the optimal management approach is still uncertain. However, primary total knee arthroplasty (TKA) can serve as an effective treatment option. This study aimed to present the clinical and radiological outcomes achieved using our surgical technique. Materials and Methods: A retrospective review of 12 knees in 8 patients with neglected patellar dislocation and end-stage OA who underwent primary TKA was conducted. The surgical procedure involved conventional TKA techniques (e.g., medial parapatellar arthrotomy) and additional procedures specific to the individual pathologies of neglected patellar dislocation (e.g., lateral release, medial plication, and quadriceps lengthening). Clinical outcomes, including patient-reported outcome measures (PROMs) (Knee Society Scores and the Western Ontario and McMaster Universities Osteoarthritis Index) and knee range of motion (ROM), were assessed preoperatively and two years postoperatively. Radiological measures including mechanical femorotibial angle and patellar tilt angle were assessed preoperatively and until the last follow-up examinations. Any complications were also reviewed. Results: There were significant improvements in all PROMs, knee ROM, and radiological outcomes, including mechanical femorotibial angle and patellar tilt angle (all p < 0.05). At a mean follow-up of 68 months, no major complications requiring revision surgery, including patellar dislocation, were reported. Conclusions: Primary TKA is an effective procedure for correcting various pathologies associated with neglected patellar dislocation in end-stage OA without necessitating additional bony procedures. Satisfactory clinical and radiological outcomes can be expected using pathology-specific procedures.","PeriodicalId":18512,"journal":{"name":"Medicina","volume":"68 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142190229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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