Medical sciences (Basel, Switzerland)最新文献

Background: Acute mastoiditis is the most frequent suppurative complication of acute otitis media in children. AM can lead to both extracranial complications and intracranial complications. Recent studies suggest an increase in cases after the COVID-19 pandemic. Objective: To compare the epidemiological and clinical characteristics of pediatric patients diagnosed with acute mastoiditis admitted to Santobono-Pausilipon Children's Hospital before and after COVID-19. Methods: We conducted a retrospective study including all patients aged 0-16 years with AM admitted to our hospital between January 2017 and December 2024. Patients were stratified into three groups: pre-COVID-19: 1 January 2017-28 February 2020; COVID-19: 1 March 2020-31 December 2021; and post-COVID-19: 1 January 2022-31 December 2024. Demographic data, clinical presentations, complications, laboratory findings, and treatment modalities were analyzed and compared between groups. Results: A total of 276 children (153 males and 123 females; median age: 49 months, age range: 1-177 months) were included. Hospital admissions for AM increased in the post-COVID-19 period, reaching more than a threefold increase in 2024 compared with the pre-COVID-19 years. Similar to the overall number of AM cases, the absolute number of complications, especially IC, such as thrombosis and empyema, increased. The rate of surgical procedures increased during the post-COVID-19 period, with an overall increase of 88.5%. Both the duration of antibiotic therapy and hospital stay were significantly longer in the post-COVID-19 period. Conclusions: The COVID-19 pandemic has been associated with epidemiological and clinical changes in pediatric AM patients. These findings highlight the need for effective preventive strategies, including enhanced vaccination coverage and the promotion of early diagnosis. Additionally, implementing standardized clinical protocols could support more efficient and consistent management, reducing hospital stays and recurrence rates.

Objective: This analysis compares new (G2) versus old (G1) generations of transcatheter heart valves (THVs) in transcatheter aortic valve replacement (TAVR) procedures, focusing on key outcomes: post-procedural conduction disturbance (CD) and permanent pacemaker implantation (PPMI). We aim to determine whether G2 valves reduce these specific complications and thereby improve patient outcomes compared with G1. Methods: From February 2015 to September 2022, 1468 patients underwent TAVR at the university clinic in Kiel. After applying exclusion criteria, a final cohort of 1182 patients were analysed. Among these, 782 patients underwent TAVR with G1, whereas 400 underwent TAVR with G2. The primary study endpoints were the occurrence of new CD and PPMI within 30 days post-procedure. The secondary endpoints included diverse post-TAVR events as defined by the safety criteria of Valve Academic Research Consortium 3 (VARC III). A statistical analysis compared outcomes between the G1 and G2 groups. Results: Out of 1182 patients, 12.1% required PPMI within 30 days. Rates showed no statistical difference between G2 and G1 for PPMI (10.3% vs. 13.0%, IPTW-weighted p = 0.31) or CD (15.3% vs. 21.48%, IPTW-weighted p = 0.08). Among G2, the Sapien 3 Ultra valve had the lowest PPMI rate (4.8%). Overall, G2 and G1 had similar post-procedural and 30-day mortality rates. Conclusion: G2 valves may reduce post-procedure CD, but the difference is not statistically significant. Differences between specific valve types-such as the Sapien 3 Ultra's lower rates-are notable, but overall, PPMI and safety profiles remain similar between G1 and G2. Patient and procedural factors still play a significant role. Careful valve and patient selection is essential, and ongoing research will guide further improvements.

Background: Primary cardiac tumors are exceedingly rare, with myxomas representing the most common benign type among these tumors, predominantly located in the left atrium. Biatrial involvement is an exceptional presentation, reported in less than 2.5% of cases. The terms bilateral and biatrial atrial myxoma are often confused and used interchangeably. We present a rare case of atrial myxoma involving both chambers, resected via a minimally invasive endoscopic approach, accompanied by a literature review.

Case presentation: A 52-year-old male with a three-month history of progressive fatigue and exertional dyspnea was found, on transthoracic echocardiography and cardiac MR, to have two intracardiac masses affecting both atria. Intraoperative transesophageal echocardiography confirmed the presence of mirror-image myxomas attached to the interatrial septum, in the absence of any septal defect. The tumors were excised en bloc, including the septal attachment, using a minimally invasive endoscopic approach. Histopathological examination confirmed the diagnosis of atrial myxoma, and the postoperative course was uneventful.

Conclusions: Bilateral and biatrial atrial myxomas are exceedingly rare forms of cardiac tumors. In many cases, the first clinical manifestations may arise from cerebral or peripheral embolic events or from pulmonary thromboembolism. For this reason, screening echocardiography may be useful, particularly in cases of familial myxoma. Transthoracic and transesophageal echocardiography, combined with careful inspection of all cardiac chambers, play a crucial role in preventing recurrence by detecting small or overlooked tumor fragments. The minimally invasive endoscopic approach offers a safe and effective surgical option for biatrial myxomas, providing excellent visualization and facilitating thorough exploration of the cardiac cavities.

This review aims to discuss the apparent reduction in pulmonary cancer incidence in the general population during and shortly after the COVID-19 pandemic from a biological and pathophysiological mechanistic point of view. While the epidemiological evidence points to a disruption in the early- and mid-stage diagnostic process, which causes a shift to late-stage lung cancer discovery with no impact on its actual prevalence, an alternative hypothesis based on the intersection of viral and cancer biology could have a real effect on lung carcinogenesis as an independent phenomenon. By weaving together population-level trends, mechanistic insights, and translational oncology, we discuss whether the pandemic-associated decline in lung cancer diagnoses reflects primarily a temporary diagnostic artifact or whether it also reveals biologically relevant intersections between SARS-CoV-2 and pulmonary oncogenesis. The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has exerted profound and multifaceted effects on global healthcare systems, altering patterns of disease detection, management, and outcomes across nearly all medical disciplines. These disruptions generated what has been termed a "diagnostic deficit", producing a backlog of undetected cancers that have only partially been recovered in subsequent years. This phenomenon, sometimes described as a "COVID-19 debt" in oncology, is thought to contribute to excess late-stage diagnoses and potentially worse medium-term survival outcomes. Beyond the disruption of medical systems, the pandemic also raised a more speculative but biologically intriguing question: could SARS-CoV-2 infection itself, through direct or indirect mechanisms, influence lung cancer biology? Our review aims to critically synthesize the evidence across seven domains to address this dual hypothesis. (1) We examine the observed effects of the pandemic on cancer incidence, highlighting global registry and health-system data; (2) we review SARS-CoV-2 infection biology, including viral entry, replication, protein functions, and treatment implications; (3) we summarize the pathogenesis of lung cancer; (4) we explore the role of immune checkpoints in tumor immune evasion, followed by (5) analyses of immune dysregulation in acute infection and (6) in long COVID; and (7) finally, we evaluate proposed oncogenic mechanisms of SARS-CoV-2, integrating molecular virology with cancer immunology. We conclude that the "diagnostic deficit" phenomenon was a reality during and immediately post-pandemic. However, a definitive answer to the questions related to the impact of the infection as an independent phenomenon would require advanced research information covering the biology of the viral infection and lung cancer oncogenesis: processes that are not currently implemented in routine clinical laboratory investigations.

Chronic exposure to low concentrations of ozone leads to oxidative stress, which disrupts immune regulation. The thymus gland plays a crucial role in the maturation and differentiation of T lymphocytes, cells essential for the body's defense and immune tolerance. In the early years of life, the thymus is highly active, but after adolescence, it undergoes a process known as thymic involution. This process involves a reduction in the size and functionality of the thymus, which is gradually replaced by adipose tissue. Ozone pollution exacerbates this involution and impairs the thymus's proper function. Consequently, thymic cells may alter their function, leading to a decreased production and diversity of T lymphocytes. This decrease contributes to the establishment of chronic inflammatory states, autoimmunity, and a reduced capacity to respond to infections. Immune dysfunction and chronic inflammation can further result in the development and progression of neurodegenerative diseases. Moreover, thymic involution, exacerbated by environmental factors and oxidative stress, negatively impacts overall immunity and accelerates the progression of degenerative diseases over time. This review aims to explore the relationship between oxidative stress and its impact on the thymus gland. We hypothesize that understanding the relationship between ozone pollution and disruption of the redox-immune axis is crucial for understanding the role of the thymus in senescence and neurodegenerative diseases. To explore this topic, we conducted a review from 2006 to 2025, utilizing several databases, including PubMed, Scopus, Google Scholar, EBSCO, and Web of Science.

Background/Objectives: Although hypertension is linked to oxidative stress, it remains unclear whether this pro-oxidant state persists after achieving recommended blood pressure (BP) control. This pilot study aimed to explore the presence of residual oxidative stress in patients with well-controlled hypertension compared to normotensive individuals. Methods: In this cross-sectional pilot study, 34 adults were enrolled: 20 normotensive controls and 14 patients with well-controlled hypertension (office BP < 140/90 mmHg). Macrovascular status was assessed by ankle-brachial index (ABI), and plasma concentrations of malondialdehyde (MDA), superoxide dismutase (SOD), catalase, tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were measured. Hypertensive patients were further stratified by median MDA levels for subgroup analysis. Results: Baseline characteristics, including BP, were similar between groups. However, patients with well-controlled hypertension exhibited significantly higher plasma MDA concentrations compared to normotensive controls (9.91 ± 6.07 vs. 4.73 ± 2.34 µmol/L, p = 0.008). In subgroup analysis, hypertensive patients with high MDA were significantly older (p = 0.03) and showed a trend towards higher systolic BP (p = 0.05) compared to those with low MDA. No significant differences were observed in SOD or catalase activity, ABI, or inflammatory markers (all p > 0.05). Conclusions: Residual oxidative stress-as reflected by increased plasma MDA-persists in patients with well-controlled hypertension. While this oxidative state appears broadly independent of BP when viewed as a whole, it is notably more pronounced in older patients and in those with systolic BP approaching the upper limit of the controlled range. These findings support the need for comprehensive, biomarker-based risk assessment and further investigation into targeted strategies for mitigating persistent redox imbalance in hypertension.

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive disease with a major impact on respiratory function, but also with possible underestimated effects on cognitive function. Although interest in cognitive impairment in chronic respiratory diseases, such as COPD, has increased, data on IPF remain limited and heterogeneous.

Objective: This systematic review aimed to synthesize current evidence on cognitive impairment in IPF, identify the most affected domains, and evaluate the certainty of evidence using standardized methodological tools.

Methods: A systematic review was conducted according to PRISMA 2020, with a registered PROSPERO protocol (CRD420251041866). Four databases (PubMed, Scopus, Web of Science, Cochrane Library) were searched for studies from 2014 to 2025. Methodological quality and certainty of evidence were appraised with the Joanna Briggs Institute (JBI) and GRADE frameworks.

Results: Four studies met the inclusion criteria (two cross-sectional, one descriptive, one case-control). Across investigations, working and verbal memory emerged as the most consistently impaired domains, followed by processing speed and executive function, whereas visuospatial and language abilities were less frequently affected. Cognitive impairment was present even in mild IPF and became more pronounced with lower DLCO, shorter 6 min walk distance, greater desaturation, and obstructive sleep apnea. Certainty of evidence ranged from low to moderate due to small samples and heterogeneous testing.

Conclusions: Cognitive dysfunction, particularly in memory, attention, and executive domains, is a frequent but under-recognized feature of IPF. Routine screening with brief, validated tools such as the MoCA may facilitate early detection and guide individualized rehabilitation.

Background and Objectives: Graves' orbitopathy (GO) is an autoimmune disease that can cause severe visual dysfunction and cosmetic impairment. Pure endoscopic orbital decompression reduces proptosis with minimal external morbidity. However, studies integrating both objective outcomes and patient-reported quality of life remain limited. This study aimed to analyze objective and subjective outcomes of pure endoscopic orbital decompression in inactive GO. Materials and Methods: We retrospectively reviewed 20 consecutive patients with severe inactive GO who underwent pure endoscopic transnasal orbital decompression between 2020 and 2023. Proptosis was measured using Hertel exophthalmometry, and quality of life was assessed with the disease-specific GO-QoL (Graves' Ophthalmopathy Quality of Life) questionnaire (functional and appearance subscales). Minimum follow-up was 12 months. Pre- and postoperative changes were compared using paired t tests. Results: A total of 26 orbits were operated on. Mean proptosis decreased by 3.85 mm (p < 0.001). GO-QoL improved in the functional (+3.27, p < 0.001) and appearance (+5.77, p < 0.001) subscales. No complications or new/worsened diplopia were observed. Conclusions: Pure endoscopic orbital decompression is a safe and effective technique to reduce proptosis in inactive GO. Although quality-of-life scores improved significantly, the clinical relevance may vary, highlighting the need to integrate objective outcomes and patient perception when evaluating surgical results.

Background and objectives: Pain neuroscience education (PNE) is a therapeutic strategy aimed at reconceptualizing pain in patients with chronic low back pain (CLBP). This systematic review with a meta-analysis (SRMA) aimed to assess the effectiveness of PNE in reducing pain, disability, kinesiophobia, and catastrophizing in patients with CLBP at the end of the intervention, and at 1 and 3 months of follow-up. Materials and Methods: Following PRISMA guidelines, an SRMA was conducted after searching in PubMed Medline, Scopus, Web of Science, and PEDro databases from inception up to June 2025. The inclusion criteria agreed with the PICOS tool: population (patients with CLBP), intervention (PNE), comparator (physiotherapy or non-intervention), outcomes (pain, disability, kinesiophobia, and catastrophizing), and study design (randomized controlled trials (RCTs) and pilot RCTs). The PEDro scale was used to assess the methodological quality and risk of bias of the RCTs included. The pooled effect was assessed using the Cohen standardized mean difference (SMD) and its 95% confidence interval (95% CI) in a random-effects model. Results: Fifteen RCTs, including data from 810 patients (43.7 ± 5.2 years; 61% female) with CLBP were included. The mean methodological quality of the RCTs included was good (6.8 ± 1.1 on the PEDro scale). Selection, performance, and detection were the most important biases identified. Our meta-analysis demonstrated, at the end of the intervention, and at 1 and 3 months of follow-up, respectively, that PNE is effective in reducing pain intensity (SMD = -0.65, p = 0.005; SMD = -1.1, p < 0.001; SMD = -1; p < 0.001), disability (SMD = -0.6, p = 0.009; SMD = -0.78, p = 0.002; SMD = -0.84; p = 0.004), and kinesiophobia (SMD = -1.12, p < 0.001; SMD = -1.51, p < 0.001; SMD = -1.57; p = 0.001). In reducing catastrophizing, PNE was largely effective at the end of intervention (SMD = -0.9, p = 0.016) and at 1 month of follow-up (SMD = -1.36, p = 0.007). Conclusions: Our findings demonstrate that PNE is an effective therapeutic approach for the management of CLBP, reducing pain, disability, kinesiophobia, and catastrophizing in patients with CLBP.

Background/objectives: Venous thromboembolism (VTE) is the third most common cardiovascular condition, with higher rates among hospitalized patients. The limited efficacy of universal prophylaxis strategies has led to individual VTE risk assessments approaches. The main objective of this study was to assess outcomes in high-risk patients for VTE who receive prophylactic vs. intermediate, weight-adjusted doses of tinzaparin for thromboprophylaxis.

Methods: This was a retrospective study assessing adult patients hospitalized with acute medical disease in a tertiary university hospital from January 2022-2024. Patients were included if found to be at high risk for VTE-as this reflected in Padua Prediction Score (PPS) ≥ 4-and received prophylactic versus intermediate dosage of tinzaparin. Data were collected from patients' files and analyzed using appropriate statistical methods.

Results: In total, 286 patients were included, of whom 160 received prophylactic and 126 intermediate tinzaparin dosage. The groups were comparable, except for arterial thrombosis history, central venous catheter presence, and median PPS. Patients receiving prophylactic doses exhibited significantly higher mortality rates (20.62 vs. 7.14, p = 0.002), increased length of stay (LOS) (6 vs. 4, p < 0.001), and prolonged treatment durations (5 vs. 3, p = 0.003) compared to patients receiving intermediate dosages. Univariate analysis revealed significant associations between mortality and tinzaparin dose (OR = 3.38, p = 0.002), age (OR = 1.03, p = 0.017), LOS (OR = 1.07, p = 0.001), PPS (OR = 1.62, p < 0.001), Charlson Comorbidity Index (CCI) (OR = 1.27, p < 0.001), and prior thrombotic events (OR = 2.27, p = 0.028). In multivariate analysis, tinzaparin dose (OR = 2.58, p = 0.035), age (OR = 1.04, p = 0.033), LOS (OR = 1.10, p < 0.001), and PPS (OR = 1.33, p = 0.038) remained independent predictors of mortality.

Conclusions: These findings reveal that intermediate tinzaparin dosing is a more effective and safe approach in high-risk for VTE hospitalized patients, emphasizing the need for personalized VTE management.