Medical Science Monitor最新文献

BACKGROUND Transcatheter tricuspid edge-to-edge repair (T-TEER) has expanded treatment options for tricuspid regurgitation (TR). The procedure was initially performed using systems designed for mitral valve repair, which were replaced by tricuspid-dedicated devices. This retrospective study compared outcomes of tricuspid-dedicated devices (TriClip or PASCAL) with a non-dedicated device (MitraClip) used for TR treatment. MATERIAL AND METHODS We analyzed data from 44 consecutive patients (mean age 74.7±7.5 years) who underwent T-TEER (2018-2024): 22 with non-dedicated (MitraClip) and 22 with dedicated systems (TriClip or PASCAL). The primary endpoint was technical success. Secondary endpoints included post-procedural TR≤ moderate, ≥2-grade TR reduction, peri-procedural complications, and 6-month mortality. RESULTS Baseline characteristics were largely balanced, although the non-dedicated group showed greater left-ventricular dysfunction. Technical success was significantly higher with dedicated systems (100% vs 77.3%, risk ratio 1.29; 95% CI 1.03-1.63; P=0.048) Post-procedural moderate or less TR and a reduction of ≥2 grades was achieved in 68.2% of patients with dedicated devices vs 31.8% with non-dedicated devices (risk ratio 2.14, 95% CI 1.09-4.21; P=0.02). Mortality during a 6-month follow-up was comparable between both cohorts (0.0% vs 9.1%; risk ratio 1.10; 95% CI 0.96-1.26; P=0.23). CONCLUSIONS Tricuspid-dedicated systems (TriClip or PASCAL) were associated with higher procedural success rates and greater TR reduction. They improved early outcomes and enabled the application of T‑TEER in a broader population of patients with less-advanced heart failure. Given the limited sample size and retrospective design, these findings should be interpreted with caution and regarded as exploratory and hypothesis-generating.

BACKGROUND Sepsis-associated acute kidney injury (SA-AKI) exhibits distinct clinical outcomes across age groups, yet current prognostic methods seldom consider age-related pathophysiologic differences. This multicenter study explored age-specific prognostic models for patients with SA-AKI using real-world critical care data. MATERIAL AND METHODS We analyzed 3662 patients with SA-AKI from the MIMIC-IV and eICU databases, stratified into 3 age cohorts: under 65, 65-80, and over 80. For each cohort, we constructed clinical prediction models. Model performance was evaluated using receiver operating characteristic curve analysis, along with sensitivity and specificity at optimal thresholds. RESULTS Age-specific clinical models demonstrated superior predictive performance compared with conventional severity scores. For patients younger than 65 years, the optimal model - incorporating urinary infection, catheter-related infection, lactate, and norepinephrine use - achieved an area under the curve (AUC) of 0.753 (95% confidence intervals [CI], 0.721-0.785) with 67.0% sensitivity and 73.1% specificity. In the 65-80-year cohort, the optimal model - incorporating urinary infection, blood urea nitrogen, lactate, and vasopressor use - achieved an AUC of 0.769 (95% CI, 0.743-0.796) with 78.2% sensitivity. For patients older than 80 years, the optimal model - incorporating urinary infection, catheter-related infection, lactate, vasopressor use, and intensive care unit length of stay - achieved an AUC of 0.770 (95% CI, 0.737-0.803) with 79.7% sensitivity. Survival curves confirmed significant mortality risk stratification across all age groups. CONCLUSIONS Age-specific prognostic models incorporating clinically modifiable factors substantially improved mortality prediction in SA-AKI compared with conventional severity scores. These models facilitate personalized risk assessment and may guide age-tailored treatments for this high-risk population.

BACKGROUND The literature contains no standard management guideline for the treatment of frozen shoulder (FS). Our aim in this study was to increase the shoulder joint range of motion (ROM) by performing passive shoulder manipulation on the affected shoulder under local anesthesia in patients with FS. MATERIAL AND METHODS Thirty-two adult patients who applied to the orthopedics and traumatology clinic between 2019 and 2022 and were diagnosed with FS were included in the study. This was a retrospective study without a control group. Approximately 20 cc (19 cc 2% prilocaine +1 cc 40 mg methylprednisolone acetate) mixture was injected into the affected shoulder of the patients at 6 different points. After an average of 15 minutes, passive manipulation was applied to the affected shoulder in 4 different directions. After manipulation, the patients were kept under observation for a certain period of time to assess for complications. Patients were given home exercise programs. During the treatment process, the patients were called for control at regular intervals and were followed up for 3 months. In this time interval, visual analog scale (VAS), shoulder pain and disability index (SPADI), and ROM values were recorded before and after manipulation and at the last check (LC). RESULTS During the treatment follow-up, ROM (abduction, flexion, extension, external rotation) values increased (P<0.001). A significant improvement was observed in SPADI and VAS values (P<0.001). CONCLUSIONS The manipulation method under local anesthesia is a time-saving, cost-effective treatment that eliminates hospitalization, general analgesia, or sedoanalgesia in the treatment of FS patients.

BACKGROUND Diabetes is increasingly prevalent among older adults; mild cognitive impairment (MCI) comorbidity in this group represents a major concern. Existing MCI prediction methods are often inaccurate, but machine learning (ML) offers improved potential. This study aimed to identify factors associated with MCI through ML analysis of retrospective data from hospitalized older patients with type 2 diabetes mellitus (T2DM). MATERIAL AND METHODS This retrospective study analyzed data from 503 inpatients older than 60 years with T2DM. Patients were classified into MCI (n=102) and normal (n=401) groups based on Mini-Mental State Examination scores. To minimize overfitting and maximize data utilization, 5-fold cross-validation was used for model training and evaluation. Least absolute shrinkage and selection operator regression identified 8 core predictors from clinical data. Logistic regression, eXtreme Gradient Boosting (XGBoost), and random forest algorithms were employed to construct predictive models. Receiver operating characteristic (ROC) curves were used to compare model performance. RESULTS Key predictors of early MCI included age, body mass index, glycated hemoglobin, C-reactive protein, waist-to-height ratio, presence of diabetic complications, diabetes duration exceeding 5 years, and low education level. The XGBoost model outperformed other algorithms in ROC analysis: area under the curve, 0.892±0.032; accuracy, 0.851±0.028; sensitivity, 0.843±0.031; specificity, 0.859±0.029; and F1 score, 0.834±0.033. CONCLUSIONS The XGBoost model, incorporating these identified factors, demonstrated optimal predictive performance for MCI in older patients with T2DM. It may aid clinical risk stratification and provide a quantitative foundation for early intervention.

BACKGROUND Lymphovascular invasion (LVI) and perineural invasion (PNI) are established markers of aggressive disease in primary gastric cancer, but their specific prognostic role in patients who develop recurrence after curative surgery is less clear. This study aimed to evaluate clinicopathological and treatment-related factors associated with overall survival (OS) and disease-free survival (DFS) in a cohort of gastric cancer patients who experienced recurrence. MATERIAL AND METHODS This retrospective study included 70 patients who underwent curative gastrectomy and subsequently developed confirmed recurrence. OS (from diagnosis) and DFS (from surgery to recurrence) were analyzed using Kaplan-Meier curves and Cox regression. Multivariate models were constructed with a limited number of variables to avoid overfitting. RESULTS The median OS was 38.9 months, and the median DFS was 22.4 months. In multivariate analysis, LVI positivity (HR=3.39; 95% CI: 1.59-7.19; P=0.001) and advanced clinical stage were independent predictors of worse OS, while adjuvant chemoradiotherapy (HR=0.44; P=0.017) and receiving first-line systemic therapy after recurrence (HR=0.22; P<0.001) were protective. For DFS, PNI positivity predicted shorter DFS (HR=1.91; P=0.033). HER2 positivity was associated with longer DFS (HR=0.78; P=0.015); notably, 42.9% of HER2-positive patients received trastuzumab upon recurrence. CONCLUSIONS In gastric cancer patients who develop recurrence, baseline biological markers (LVI, PNI, HER2) retain significant prognostic value for OS and DFS from the time of diagnosis and surgery, respectively. Integrating these markers with treatment parameters may improve risk stratification. This study did not evaluate pure post-recurrence survival (PRS); OS was calculated from diagnosis and therefore reflects pre- and post-recurrence periods combined.

Numerous abnormalities of the endometriosis eutopic endometrium contribute to the initiation and development of ectopic lesions. It is also believed that among the complex causes of the disease, systemic immunological disorders play a significant role. Therefore, this literature review aims to summarize the current knowledge on immunological alterations in the endometriosis eutopic endometrium and the impact of these changes on the progression of this disease. The reviewed studies mostly indicated a pro-inflammatory immunological profile within this tissue. This was evidenced by a predominance of M1 macrophages, which have a pro-inflammatory character and elevated levels of pro-inflammatory cytokines such as interleukin-1 (IL-1) or IL-6. Additionally, an increased number of cytotoxic T lymphocytes and a positive correlation between B lymphocyte levels and the presence of endometriosis have been observed. Some changes in T cells and natural killer (NK) cells receptors, which possibly determine endometriosis development, have been described. Several studies have also revealed that patients with endometriosis exhibit reduced presence of dendritic cells in the eutopic endometrium of affected individuals, which may impair uterine cavity clearance during menstruation and contribute to ectopic lesion formation. In summary, current data indicate a pivotal role of the endometrial immune environment in disease progression, but further research is needed to drive development of immunological treatment in endometriosis management.

BACKGROUND Acromioclavicular (AC) joint dislocation is a common shoulder injury, with a range of suture button techniques available for treatment. This study aimed to evaluate the clinical outcomes of a novel suture button technique - the FengChao button technique. MATERIAL AND METHODS Between December 2019 and December 2021, 25 patients with AC joint dislocation were treated using the arthroscopic triple FengChao button technique. Clinical outcomes measured included UCLA and CMS scores, operative time, and the incidence of complications. Radiological assessment focused on the coracoclavicular (CC) distance. RESULTS The follow-up period ranged from 6 to 19 months, with an average of 13.3 months. One patient required an open revision due to postoperative trauma. The mean operative time was 52.34±13.76 minutes. The UCLA score improved significantly from a preoperative average of 19.32±2.45 to 31.67±2.38 at the final follow-up (P<0.05). Similarly, the CMS score increased from 75.23±2.34 preoperatively to 92.73±2.96 at the final follow-up (P<0.05). The CC distance narrowed from a preoperative measurement of 21.34±1.32 mm to 9.23±1.13 mm 2 to 4 days postoperatively (P<0.05), and further to 11.93±1.03 mm at the final follow-up (P<0.05). CONCLUSIONS The arthroscopic triple FengChao button technique for AC joint dislocation offers satisfactory short-term functional outcomes.

Kidney transplantation is a well-established treatment for patients with end-stage renal disease; however, graft availability is limited. To expand the donor pool, organs from expanded criteria donors and donors after circulatory determination of death (DCDD) are increasingly used. Normothermic in-situ regional perfusion (NRP) delivered using an extracorporeal membrane oxygenation device (ECMO) may be used, mitigating warm ischemia time and improving outcomes of DCDD grafts. NRP using ECMO (nECMO) during DCDD kidney transplantation achieves delayed graft function rates of 5.3% to 43.0%, primary non-function of 0.0% to 6.0%, and a 1-year mortality of 0.0% to 1.3%, closely mirroring DNDD outcomes. The survival rates of nECMO are comparable to DNDD or DCDD with the rapid recovery technique. Kidney discard rates are similar between nECMO and DNDD. Using nECMO in controlled and uncontrolled DCDD leads to better graft function and higher survival rates compared with standard DCDD transplantation. Outcomes are generally comparable to DNDD transplants. Early ECMO cannulation, even before death is declared, may minimize warm ischemia time and enhance graft function, although ethical concerns and strict protocols may hinder its routine use. This article aims to review available literature on ECMO implementation in DCDD kidney transplantation.

BACKGROUND Spondylolisthesis, characterized by anterior displacement of a vertebra, often leads to pain and impaired sleep quality, negatively affecting overall quality of life. While postoperative outcomes in degenerative spinal conditions such as disc herniation and spinal stenosis have been widely studied, evidence focusing on sleep quality in homogeneous cohorts of patients with low-grade lumbar spondylolisthesis remains scarce. This study evaluated changes in sleep quality, pain, quality of life, and functional capacity before and after surgery in this patient population. MATERIAL AND METHODS This prospective observational study included 55 patients who underwent posterior decompression and instrumented fusion surgery for low-grade lumbar spondylolisthesis. The Visual Analog Scale (VAS), Pittsburgh Sleep Quality Index (PSQI), EuroQol-5 Dimensions-3 Levels (EQ-5D-3L), and Oswestry Disability Index (ODI) were administered preoperatively and on the 90th postoperative day. RESULTS All evaluated parameters showed significant postoperative improvements. VAS, PSQI, and ODI scores decreased markedly, indicating effective pain relief, better sleep quality, and improved functional capacity (all P<0.001). EQ-5D-3L scores increased significantly (P<0.001), reflecting enhanced overall quality of life. Subgroup analyses demonstrated consistent benefits across spondylolisthesis types and grades, with male patients exhibiting greater improvements in quality-of-life measures. CONCLUSIONS Surgery for low-grade lumbar spondylolisthesis yields substantial benefits, extending beyond pain control to improvements in sleep quality, functional capacity, and overall quality of life. These findings underscore the role of surgical treatment as a reliable option for patients unresponsive to conservative management and highlight its positive impact on both physical recovery and psychosocial well-being.

BACKGROUND Although atrial fibrillation (AF) is a well-established risk factor for thromboembolic events, patients with a low CHA₂DS₂-VASc score are generally considered at low risk. However, permanent AF may independently worsen outcomes via non-embolic mechanisms such as myocardial remodeling and progression of heart failure (HF). MATERIAL AND METHODS This retrospective observational sub-study used data from the CRAFT study (NCT02987062), a multicenter registry of AF patients hospitalized between 2011 and 2016. We included 418 patients with CHA₂DS₂-VASc ≤2 for women and with ≤1 for men, of whom 63 had permanent AF as defined by ESC guidelines. The primary endpoint was all-cause mortality; secondary endpoints included ischemic events and bleeding during a mean follow-up of 4 years. RESULTS Patients with permanent AF had significantly higher all-cause mortality (39.7% vs 8.7%; P<0.0001) and a comparable rate of ischemic events (12.7% vs 8.5%; P=0.12) despite similarly low thromboembolic risk profiles. They were older (64 vs 60 years; P<0.0001), more frequently had heart failure (48.4% vs 15.5%; P<0.0001) and, lower left ventricular ejection fraction (LVEF) (43.5% vs 55%; P=0.0005), and more often had cardiac devices. CONCLUSIONS Our findings suggest that permanent AF is associated with worse long-term outcomes, even in patients with low thromboembolic risk score. These results show the importance of early rhythm control in preventing AF progression and irreversible structural remodeling.