Panminerva medica最新文献

Introduction: Limitations in mobility caused by pain, injury, or external immobilization can lead to adverse neuroplastic changes affecting the brain, the nervous system, and sensorimotor function. Mental imagery (MI) has been proposed as a non-invasive, low-cost intervention that may help mitigate these negative effects during periods of immobilization following surgery or trauma. This systematic review and meta-analysis aims to analyse the effects of MI applied during post-surgical or post-traumatic immobilization.

Evidence acquisition: A systematic literature search was performed in the databases PubMed, CINAHL, Web of Science, Medline, and PEDro. The methodological quality of the included studies was assessed using the PEDro scale, and the risk of bias was evaluated with the Cochrane RoB 2 tool. Only randomized controlled trials were included.

Evidence synthesis: A total of 11 studies met the inclusion criteria. Overall, the studies showed moderate methodological quality and a high risk of bias. The meta-analysis revealed a statistically significant effect on pain reduction in favour of mental imagery, with a Hedges' g of 1.187 (95% CI: 0.492 to 1.882; P=0.001). Additionally, several studies reported improvements in secondary outcomes such as range of motion, muscle strength, mental health, and quality of life.

Conclusions: MI appears to be a beneficial intervention to reduce pain in patients undergoing immobilization after surgery or trauma. Moreover, promising effects have been observed on range of motion, strength, mental health, and quality of life, supporting its inclusion as a complementary strategy in rehabilitation settings.

Background: This prospective observational study aimed to evaluate the efficacy and safety of a new multicomponent medical device containing Gingigel Pro^®, sodium alginate, Tamarindus indica, hyaluronic acid, and vegetal extracts in patients with laryngopharyngeal reflux disease (LPRD).

Methods: Twenty-two adult patients (13 females, 9 males; mean age: 49.9 years) with a clinical diagnosis of LPRD (R-RSI ≥18 and RSA >14) were enrolled. All patients were treated with the device (one stick twice daily for 2 months) and received standardized behavioral and dietary counseling. Assessments were performed at baseline and after treatment using the Revised Reflux Symptom Index (R-RSI), Voice Handicap Index-10 (VHI-10), and Reflux Sign Assessment (RSA). Patients were stratified into three subgroups based on symptom duration: 0-4 months, 5-8 months, and ≥9 months. Statistical analyses evaluated changes in total and item-specific scores across the overall population and subgroups. Tolerability and adverse events were also recorded.

Results: All outcome scores improved significantly after treatment (P<0.0001 for R-RSI, VHI-10, and RSA). The proportion of patients with pathological R-RSI scores decreased from 100% to 9.1%, and with pathological RSA scores from 100% to 59.1%. Most R-RSI items improved significantly. Specific RSA signs related to acute inflammation (e.g., erythema and edema of the uvula, epiglottis, and vocal folds) also showed significant improvement. No adverse events were reported. Subgroup analysis showed that both symptoms and objective signs improved in all subgroups, with the greatest reductions observed in patients with symptom onset within 0-4 months.

Conclusions: This study provides the first clinical evidence that the tested multicomponent device is effective and safe in improving both subjective symptoms and objective signs of LPRD. The observed greater benefit in patients with recent symptom onset supports early intervention. These findings are consistent with current recommendations that prioritize non-acid-suppressive agents in LPRD management. Further randomized controlled trials are warranted.

Background: Malnutrition is associated with poor outcomes. Exocrine pancreatic insufficiency (EPI) may be an overlooked factor contributing to malnutrition. Early nutritional support improves the prognosis of critically ill patients. The effect of pancreatic enzyme preparations on nutritional status and prognosis in critically ill patients requires further study.

Methods: An exploratory, single-center, randomized controlled trial was conducted in critically ill adult patients. A total of 768 patients admitted to the Department of Critical Care Medicine between November 2021 and August 2022 were screened, and 317 patients who met the inclusion criteria were randomized into the pancreatic enzyme replacement therapy (PERT) group or the non-pancreatic enzyme replacement therapy (NOT PERT) group. Neither group received a specific enteral nutrition formula. The formula was selected according to the patient's condition to provide the required calories and protein. The primary outcome was the change in the cross-sectional area of the rectus femoris muscle (RFCSA). Secondary outcomes included changes in rectus femoris muscle echogenicity, retinol-binding protein, and prealbumin levels; duration of mechanical ventilation; APACHE II scores; and 14-day and 28-day mortality. This trial was registered in ChiCTR under identifier 2100052385.

Results: RFCSA decreased over time. PERT combined with enteral nutrition appeared to slow the decline in RFCSA but had no significant effect on rectus femoris muscle echogenicity. PERT had no significant effect on retinol-binding protein, prealbumin, or the duration of mechanical ventilation. No significant differences were observed in APACHE II scores, 14-day mortality, or 28-day mortality.

Conclusions: PERT may serve as an effective adjunct to nutritional support in critically ill patients.

Cardiac rehabilitation (CR) is a cornerstone in the management of patients recovering from myocardial infarction (MI), significantly improving survival, functional capacity, and quality of life. Recent evidence highlights the critical importance of early initiation of rehabilitation, ideally within days to weeks following the acute event. Early cardiac rehabilitation facilitates prompt recovery of cardiovascular function, reduces complications, and enhances patient motivation and adherence to therapeutic regimens. The multidimensional nature of modern CR programs addresses not only physical reconditioning but also psychological, nutritional, and social factors, recognizing the complex interplay affecting patient outcomes. Physical exercise training, tailored to individual risk profiles and functional status, promotes myocardial perfusion, endothelial function, and autonomic balance. Concurrently, psychosocial support targets anxiety, depression, and stress, common sequelae post-MI, which are known to influence prognosis negatively. Nutritional counseling ensures optimal dietary patterns that support cardiovascular health, while smoking cessation and risk factor management are integral components. The multidisciplinary team - comprising cardiologists, physiotherapists, dietitians, psychologists, and nurses - collaborates to develop personalized care plans that maximize patient engagement and long-term adherence. Early, multidimensional cardiac rehabilitation ultimately reduces rehospitalization rates and mortality, improving comprehensive health outcomes. This review underscores the value of initiating rehabilitation promptly after MI and implementing a holistic approach to enhance recovery, prevent recurrent events, and promote sustained lifestyle changes.

Obesity is a chronic disease associated with multiple health risks. Multimodal treatments including lifestyle interventions, pharmacotherapies and bariatric surgery should be the standard of care for obesity management. Bariatric surgery remains the most effective treatment yielding to sustainable weight loss (WL) of about 20-30%. Having understood better the role of the gut-brain axis on appetite, the field of obesity pharmacotherapy has been advancing rapidly. The recent approvals for glucagon-like peptide-1 (GLP-1) receptor agonist (RA) semaglutide 2.4 mg and the dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) agonist tirzepatide as treatments for obesity have raised the bar for WL efficacy for the emerging obesity pharmacotherapies. Combining GLP-1 RA and other entero-pancreatic hormones including GIP, glucagon or amylin receptor agonists (RAs) as well as GIP receptor antagonists have shown promising data in early phases of clinical trials, with some progressing to phase III clinical trials. Notably, the combinations of GLP-1 RA, GIP and glucagon RA (retatrutide) have shown WL efficacy closing on to that observed in bariatric surgery. While entero-pancreatic hormone-based therapies have been the centre of attention for obesity pharmacotherapies, non- entero-pancreatic hormone treatments also hold promise. In this review, we present the future pharmacotherapies for weight management in people with obesity, focusing on entero-pancreatic hormone-based molecules.

Hepatitis D is considered the most severe form of viral hepatitis in humans, and chronic HDV hepatitis patients typically show a more rapid progression to cirrhosis and a higher mortality. While awareness of the disease has increased, it still remains underdiagnosed and of challenging treatment. Besides the physical toll that an HDV infection takes, the psychological impact needs to be considered when treating the infected patients. The aim of this work is to assess the psychological course of the disease from the patient's point of view and the clinicians tasked with the treatment of this specific class of patients. Two surveys covering emotional perspectives about the suspect of the disease, the diagnosis, the therapy, and the relationship between physicians and patients were administered to the clinicians and the patients. The patients reported their journey starting from sentiments of discouragement and fear upon diagnosis, the challenges associated with the disease's symptoms and the therapies, which evolved into a story of endurance, coexistence with the disease, and hope for future scientific advancements. The clinicians reported their challenges in caring for HDV-positive patients, which span from the sub-optimal referral rate, and the lack of therapeutic options to the occasional absence of patient compliance. Although, at the same time they describe elements of satisfaction that come from the efficacy of some treatments and the possibility of the development of novel drugs. In conclusion, the psychological toll that hepatitis D has on patients should be one of the factors driving communication with the physicians.

Introduction: Peripheral nerve injuries (PNIs) are challenging to manage due to complex anatomy and variable presentations. Artificial intelligence (AI) techniques are increasingly applied in medicine, and their role in PNI care is emerging. This systematic review aimed to summarize the current applications of AI in the diagnosis, prognosis, and treatment of PNIs.

Evidence acquisition: A comprehensive literature search of PubMed, Embase, and Web of Science was conducted (October 2024) for studies applying AI to human PNI diagnosis, prognostication, or treatment. After screening 1000 records, 42 studies met inclusion criteria. Data were extracted by two independent reviewers. Due to heterogeneity of outcomes, a narrative synthesis was performed complying with PRISMA guidelines.

Evidence synthesis: Included studies covered diverse AI applications: 20 on carpal tunnel syndrome, 10 on traumatic nerve injuries, 4 on brachial plexus injuries, 3 on nerve sheath tumors, 2 on regional anesthesia nerve blocks, and 1 each on peroneal nerve palsy, thermography-based diagnosis, and hand trauma. AI showed the greatest utility in diagnostics - for example, automating ultrasound and MRI image analysis with accuracy often comparable to experts. Notably, AI models accurately diagnosed carpal tunnel syndrome from ultrasound images and segmented nerves in medical images with high precision. Prognostic uses and intraoperative applications are promising but currently in early stages. Overall, AI tools demonstrated feasibility and improved speed or consistency in many PNI-related tasks, though most are still in validation phases.

Conclusions: AI is rapidly emerging as a valuable adjunct in PNI management. Diagnostic applications have progressed the most, while predictive modelling and surgical assistance remain nascent. The current evidence, although encouraging, is limited by small sample sizes, heterogeneity and lack of multicenter validation. With further development and proper integration, AI has the potential to enhance diagnostic precision, guide treatment decisions, and ultimately improve outcomes for patients with peripheral nerve injuries.