Clinics and Practice最新文献

Background/Objectives: Phrenic nerve conduction (PNC) studies are essential for evaluating respiratory dysfunction and neuromuscular disorders. Despite international reference data, no normative values exist for the Mexican population. This study aimed to establish reference values for PNC latency and amplitude in healthy Mexican adults. Methods: We conducted a cross-sectional study between June 2022 and February 2023 including healthy adults (>18 years). Bilateral PNC studies were performed using surface electrodes and a 4-channel stimulation device. Latency and amplitude were recorded, and demographic and anthropometric data were collected. Results: Fifty subjects (22 women, 44%; 28 men, 56%) were enrolled. Mean latency was 6.10 ms (SD ± 1.48), and mean amplitude was 0.60 mV (SD ± 0.20). Significant differences were observed in left phrenic nerve latency between women and men (median 5.83 vs. 6.37 ms, p = 0.0348) and in amplitude between left and right phrenic nerves (0.55 vs. 0.65 mV, p = 0.0036). No significant correlations were found between latency and age or between amplitude and thoracic perimeter; however, the correlation coefficient suggests a positive relationship for both that should be confirmed in future studies with a larger sample size. Conclusions: This is the first report of PNC normative values in Mexican adults. Findings are consistent with international data and provide locally relevant reference values. Larger multicenter studies are warranted to validate and expand these results.

Background/Objectives: Written discharge explanations are crucial for patient understanding and safety in emergency eye care, yet their tone and clarity vary. Large language models (LLMs, artificial intelligence systems trained to generate human-like text) can produce patient-friendly materials, but direct, blinded comparisons with clinician-written texts remain scarce. This study compared patient perceptions of a routine clinician-written discharge text and a GPT-5-generated explanation, where GPT-5 (OpenAI) is a state-of-the-art LLM, based on the same clinical facts in emergency ophthalmology. The primary objective was empathy; secondary outcomes included clarity, detail, usefulness, trust, satisfaction, and intention to follow advice. Methods: We conducted a prospective, single-blind, within-subject study in the Emergency Ophthalmology Unit of the University Hospital Centre Split, Croatia. Adults (n = 129) read two standardized texts (clinician-written vs. GPT-5-generated), presented in identical format and in randomized order under masking. Each participant rated both on Likert scales with 1-5 points. Paired comparisons used Wilcoxon signed-rank tests with effect sizes, and secondary outcomes were adjusted using the Benjamini-Hochberg false discovery rate. Results: Empathy ratings were lower for the GPT-5-generated text than for the clinician-written text (means 3.97 vs. 4.30; mean difference -0.33; 95% CI -0.44 to -0.22; p < 0.001). After correcting for multiple comparisons, no secondary outcome differed significantly between sources. Preferences were evenly split (47.8% preferred GPT-5 among those expressing a preference). Conclusions: In emergency ophthalmology, GPT-5-generated explanations approached clinician-written materials on most perceived attributes but were rated less empathic. A structured, human-in-the-loop workflow-in which LLM-generated drafts are reviewed and tailored by clinicians-appears prudent for safe, patient-centered deployment.

Background: Pulmonary embolism (PE) is a time-sensitive condition with variable clinical presentations and outcomes. Rapid risk stratification and appropriate triage are essential for optimizing treatment and patient outcomes. Artificial intelligence (AI) offers an opportunity to enhance clinical decision-making, yet its real-world applications remain limited.

Objective: The objective of this study was to describe a single healthcare system's implementation and early experience with an AI-enabled triage tool for pulmonary embolism patients across a multi-hospital network.

Methods: This retrospective observational study evaluated the deployment of an AI-based clinical decision support system within a healthcare network. The AI tool detected PE and right ventricular (RV) strain and alerted the PE response team (PERT) to facilitate timely transfer and intervention. Three cohorts were evaluated: pre-AI, Year 1 post-AI, and Year 2 post-AI. Outcomes included transfer volumes, advanced therapy rates, and hospital length of stay (LOS).

Results: A total of 183 PE transfer patients were analyzed: 36 pre-AI, 72 in Year 1 post-AI, and 75 in Year 2 post-AI. Transfers increased by 100% in Year 1 (p = 0.0005) and 108% in Year 2 (p = 0.011) compared to pre-AI. Catheter-based thrombectomy increased from 10 pre-AI to 18 in Year 1 (+80%, p < 0.0001) and 28 in Year 2 (+180%, p = 0.0006). After-hours diagnosis rose from 69.4% pre-AI to 70.8% in Year 1 (p = 0.027) and 77.3% in Year 2 (p = 0.088). Surgical embolectomy showed a borderline increase in Year 2 (p = 0.04), though case numbers were small.

Conclusions: Implementation of an AI-assisted triage platform for PE was associated with sustained increases in interhospital transfers and advanced interventions, and a reduction in hospital length of stay. These findings support the potential for AI to standardize and expedite acute PE care in a multi-hospital health system.

The oral microbiome may be an indicator of oral pathologies and hormonal fluctuations. Consequently, the proper identification of methods for studying microbial factors is essential. Because more than half of the components of the oral microbiome belong to species that are very difficult or even impossible to cultivate in the laboratory, the assessment of the oral microbiome nowadays is based on genetic sequencing, using techniques such as DNA hybridization, 16S rRNA sequencing, and metagenomics, mainly analyzing saliva and subgingival plaque. Variations in results may be caused by differences in sample type, analysis methods, accuracy in determining cycle phases, and biases introduced by DNA extraction techniques and technical variations. Choosing the right primers for the 16S rRNA gene and reference databases (like HOMD, Greengenes2) is essential for accurately identifying microorganisms. Metagenomic sequencing offers greater taxonomic and functional detail, but it is costlier and presents bioinformatics challenges, including contamination with human DNA. When the patients under study are women, we have to take into consideration the cyclical changes in the menstrual cycle. Studies suggest that estrogen influences local immune and inflammatory responses and can worsen existing gingival inflammation. Certain oral bacteria can even utilize estradiol and progesterone as growth factors. The composition of the oral microbiome is also affected by hormonal contraceptives, carbohydrate intake, smoking, age, body mass index, genetics, and oral hygiene-all factors that need to be controlled for in future studies. Interpreting the biological significance of the reported cyclic changes requires careful examination of the specific methods used in each study.

Background/objectives: Salivary stones, also known as sialoliths, are calcified structures that develop within the salivary glands and/or their ducts. They occur in approximately 1 per 10,000 to 30,000 individuals per year, primarily affecting adults between 30 and 50 years of age. Although several hypotheses have been proposed, the exact mechanisms of formation and their predisposing factors are yet to be confirmed. The submandibular gland is the most commonly affected site, accounting for nearly 80% of cases, while giant and asymptomatic sialoliths are rare clinical findings in dental practice. This study is divided into two components: first, a case report of a giant, asymptomatic sialolith located in Wharton's duct; second, a systematic review of the literature to explore the clinical procedures, diagnoses, outcomes, and other relevant aspects of this pathology.

Methods: The case involved a 42-year-old woman who sought dental care due to the presence of a painless sublingual swelling. Intraoral examination and imaging revealed a calcified mass consistent with sialolithiasis in Wharton's duct. The stone was successfully removed via sialolithotomy. For the systematic review, an extensive search was conducted in PubMed, Embase, and Cochrane Library up to June 2025, using specific keywords. Initially, 262 studies were identified. After applying inclusion and exclusion criteria, six case reports were included in the final analysis.

Results: All selected studies described giant salivary stones located in Wharton's duct and/or the parenchyma of the submandibular gland, notably without associated pain. Computed tomography and ultrasonography were the most commonly used imaging modalities for diagnosis. In all cases, the primary treatment was sialolithotomy.

Conclusions: This study explored a rare case report of an asymptomatic giant sialolith in Wharton's duct, and it includes a systematic review focused exclusively on asymptomatic giant sialoliths. It specifically addresses key characteristics, preferred imaging modalities, treatment strategies, and clinical considerations for managing this uncommon condition.

Registration number: Prospero registration nº CRD420251076737.

Introduction: Oral health in children is essential for their overall well-being, influencing nutrition, language development, and self-esteem. Dental caries represent one of the most prevalent chronic diseases in childhood. Objective: The objective of this study is to evaluate the association between parents' self-perceived knowledge of oral health and the presence of dental caries in their children. Materials and Methods: A cross-sectional observational study was conducted with 1052 children aged 4 to 14 years and their parents in Quito, Ecuador. Parents completed validated questionnaires (OHIP-14, OIDP, CPQ, and OHQoL-UK) to assess their self-perceived oral health knowledge. Clinical examinations were performed to detect cavitated carious lesions. Statistical analysis included Chi-square tests and odds ratio (OR) calculations. Results: A significant association was found between lower parental knowledge and higher prevalence of dental caries in children (Chi-square = 16.245, p = 0.0062; OR = 18.18, 95% CI [1.80-183.75]). Most caries cases were found in children whose parents rated their knowledge as "good" or "very good," suggesting a gap between perceived and actual knowledge. Conclusions: The findings highlight the need for targeted educational strategies that address both knowledge and behavioral practices in oral health, especially among parents with low self-perceived knowledge.

Background: Vascular access is a very important element for patients on chronic hemodialysis treatment, but it is also a major source of complications, often compromising patients' quality of life. Arteriovenous fistulas (AVFs) are preferred for their durability, but complications such as edema, bruising, cannulation pain, and hygiene concerns can affect patient satisfaction. Aim: We aimed to evaluate patient satisfaction with vascular access and to identify the clinical and sociodemographic factors influencing this satisfaction. Methods: We conducted a multicenter cross-sectional study on 235 hemodialysis patients in Italy. Satisfaction was assessed using the Short Form Vascular Access Questionnaire (SF-VAQ). Clinical and sociodemographic data were collected and analyzed with descriptive statistics, correlations, and multivariate regression models. Results: Satisfaction was significantly influenced by local complications, perceived hygiene, and access duration. Lower satisfaction was reported by patients with swelling, bruising, or negative hygiene perceptions. Longer use of the access was also associated with declining satisfaction. Conclusions: Patient satisfaction involves both clinical outcomes and patient perceptions. The integration of patient-reported outcomes (PROs) into vascular access management can help clinicians identify early dissatisfaction and implement interventions that can improve treatment adherence and quality of life.

Aims: The purpose of this study was to evaluate survival outcomes and recurrence patterns following curative-intent resection of pancreatic neuroendocrine tumours (PNETs) at a UK tertiary centre. The secondary aims included identifying prognostic clinicopathological factors that influenced survival.

Methods: Patients undergoing curative-intent surgical resection for PNETs between August 2010 and March 2024 were retrospectively reviewed. The data collated included demographics, histopathology, recurrence, and survival outcomes.

Results: Eighty-six patients were included, with a median age of 61.5 years (IQR: 50-71) and an equal sex distribution. Most tumours were solitary (88.4%) and located in the pancreatic tail (57%), with distal pancreatectomy performed in 75% of cases. The median tumour size was 25 mm (IQR: 13-40). Lymph node metastases were observed in 23.3% of patients, and R0 resection was achieved in 67%. Most of the PNETs resected were WHO grade 1 tumours (65.1%), followed by grade 2 tumours (26.7%). Postoperative morbidity occurred in 37.2% of cases, while the 30-day postoperative mortality rate was 1.5%. Recurrence was observed in 13.95% of patients, with a median time to recurrence of 36.3 months. The 5-year overall survival (OS) was 83.0%, with a median OS and disease-free survival (DFS) of 143.3 months and 147.0 months, respectively. Multivariable analysis revealed that poorer DFS was associated with larger tumours (p = 0.009), higher tumour grade (p = 0.006), male sex (p = 0.039), vascular invasion (p = 0.003), perineural invasion (p = 0.042) and lymph node metastases (p = 0.015). OS was significantly influenced by the Charlson Comorbidity Index (p < 0.001) and tumour grade (p = 0.025).

Conclusions: PNETs are associated with excellent long-term survival following curative-intent resection. However, adverse pathological features are linked to an increased risk of recurrence and a poorer prognosis.

Background/Objectives: Sleep disturbances are among the most prevalent and persistent comorbidities in children and adolescents with autism spectrum disorder (ASD), affecting up to 83% of this population. These disturbances not only impact the quality of life but are increasingly recognized as significant contributors to behavioral dysregulation. Methods: This systematic review synthesizes evidence from 26 studies published between 2010 and 2024, examining the association between sleep problems and behavioral outcomes in individuals with ASD aged 2 to 18 years. Results: The findings reveal consistent associations between sleep-onset insomnia, night walking, bedtime resistance, and various behavioral difficulties, including aggression, hyperactivity, and emotional dysregulation. Internalizing symptoms and exacerbation of core ASD features were also linked to chronic sleep problems. Studies employing objective sleep measures, such as actigraphy and polysomnography, further supported these associations by identifying disruptions in sleep architecture correlated with behavioral severity. While most included studies were of moderate to high methodological quality, the limited number of randomized controlled trials and heterogeneity of sleep and behavior assessment tools highlight the need for standardization. Conclusions: Overall, the review emphasizes the importance of routine sleep evaluation in ASD clinical care and supports targeted sleep interventions as a potential strategy to reduce behavioral problems and improve developmental outcomes.

Background: Burnout among healthcare professionals is increasingly recognized as a syndrome with biological correlations. Beyond psychosocial factors, circadian misalignment, sleep disturbances, and hormonal dysregulation-particularly involving melatonin and cortisol-are emerging as relevant mechanisms. Methods: We systematically reviewed studies published between 2015 and 2025 examining associations between burnout, melatonin, circadian disruption, sleep quality, and related biomarkers in healthcare workers. Results: Across 14 included studies, burnout was associated with suppressed melatonin secretion, cortisol dysregulation, and circadian misalignment, including social jet lag and poor sleep quality. Night-shift nurses consistently displayed greater circadian disruption and higher burnout scores than day-shift colleagues. Evidence also suggests that environmental and interventional approaches-such as optimizing daylight exposure and melatonin supplementation to improve sleep quality and cognitive performance-may mitigate circadian disruption and occupational fatigue. Conclusions: Burnout should be recognized as a biopsychosocial syndrome with measurable chronobiological correlates. Future research should integrate circadian biomarkers into occupational health assessments and evaluate preventive strategies aimed at preserving circadian health in healthcare professionals.