Medical sciences (Basel, Switzerland)最新文献

Background: Temporomandibular disorders (TMDs) are associated with altered masticatory muscle function and pain. Although electromyographic parameters have been extensively studied, the rate of force development (RFD) remains an underexplored biomarker in this context. Objective: Analyze the RFD differences in women diagnosed with and without TMD. As a secondary outcome, the masseter and temporalis muscle pre-activation values were compared between groups based on the biting force onset. Additionally, neuromuscular efficiency analysis was also performed. Methods: A retrospective analysis of 62 medical records (41 with TMD, 21 controls) was conducted. Electromyographic activity and bite force were measured during three 5-s maximal biting tasks using synchronized surface electromyography (sEMG) and a laboratory-grade load cell. RFD was computed from force-time curves. Muscle pre-activation was assessed based on sEMG activity immediately preceding contraction onset. Results: The TMD group showed a significantly smaller RFD (mean = 85.5 N/s) compared to controls (mean = 109.0 N/s; p = 0.03; Cohen's d = 0.5). No significant differences were found in neuromuscular efficiency and pre-activation or post-activation levels of the masseter and temporalis muscles between groups. Conclusions: RFD distinguishes women with TMD from healthy controls and may represent a sensitive biomechanical marker of neuromuscular adaptation in TMD, although confirmatory studies are needed. The absence of neuromuscular efficiency and pre-activation differences suggests compensatory neuromuscular mechanisms. Further prospective studies are needed to validate these findings and explore clinical applications.

Introduction: The incidence of NSCLC increases with age, with a median of approximately 70 years at diagnosis. Historically, treatment strategies for locally advanced cancers have been developed predominantly in younger populations, often excluding elderly patients who may present with multiple comorbidities, severely impaired lung function, or decreased performance status, leading to a lack of age-relevant clinical data. Therefore, we performed a subanalysis of real-world data from the ALLSTAR study to investigate the impact of durvalumab and the radiation regimen (sequential versus concurrent) on clinical outcome in elderly patients with unresectable stage III NSCLC.

Methods: We included a total of 171 patients in this subanalysis. All patients were diagnosed with unresectable stage III NSCLC. Patients were divided into two age groups, ≥70 (41%) and <70 years (59%). All of them received curative chemoradiotherapy with (66%) or without (34%) durvalumab.

Results: Patients were followed up for a median time of 25.1 months (range: 3.3-52.1). In the elderly group, patients who did not receive durvalumab consolidation had a median PFS of 17 months (95%-CI: 12.4-not reached) and a higher risk of progression (HR = 2.2; 95%-CI: 1-4.6) than those treated with durvalumab, which had a median PFS of 37 months (95%-CI: 24.5-not reached). This difference was statistically significant (log rank p = 0.026). Moreover, the Cox model yielded a hazard ratio suggesting a higher risk of locoregional (HR = 3.8; 95%-CI: 1.28-11.48; log rank p-value =0.01) as well as local recurrence (HR = 5.5: 95%-CI: 1.67-18.1: p-value =0.002) in patients who received sequential chemoradiotherapy compared to those with concomitant chemoradiotherapy in the same age group. In an exploratory analysis based on a Mann-Whitney U test, we did not find significant difference in toxicity between the two age groups.

Conclusions: Durvalumab was associated with prolonged progression-free survival, while concomitant radiotherapy showed a trend towards improvement in locoregional and local control in patients aged ≥70. There was no significant difference in treatment toxicity found in the exploratory Mann-Whitney U analysis between the two age groups.

A multifaceted clinical disease, heart failure (HF) is typified by decreased cardiac function and systemic symptoms caused by anatomical or functional abnormalities in the heart. Although traditional studies have concentrated on hemodynamic and neurohormonal processes, new data highlight the vital role that the gut microbiota and its byproducts play in the pathogenesis of HF. An imbalance in the microbial structure known as gut dysbiosis is common in HF patients and is linked to increased gut permeability, systemic inflammation, and changed bioactive metabolite synthesis. Prominent metabolites generated by the microbiota, including phenylacetylglutamine, short-chain fatty acids (SCFAs), secondary bile acids, and trimethylamine N-oxide (TMAO), have a major impact on endothelial function, cardiac remodeling, and inflammation. Together with gut-derived lipopolysaccharides, these metabolites interact with host systems to exacerbate the course of HF. Further impacting HF outcomes are comorbidities such as diabetes, obesity, and chronic renal disease, which intensify gut dysbiosis. The importance of metabolites originating from the microbiota in the progression of HF is highlighted in this review, which summarizes recent findings regarding the gut-heart axis. Additionally, it investigates how dietary changes, probiotics, prebiotics, and multi-omics techniques can all be used to improve the management of HF. This thorough analysis emphasizes the necessity of integrative therapy approaches and longitudinal research to better address the complex link between HF and the gut microbiota.

Background/objectives: Dual-energy X-ray absorptiometry (DEXA), the gold standard for assessing bone mineral density (BMD), may yield inaccurate results in certain populations. This has prompted interest in alternative imaging methods, including the MRI-based cervical and lumbar vertebral bone quality (CVBQ and LVBQ) scores. The lumbar VBQ score is a validated MRI-based metric with excellent inter- and intra-rater reliability and established clinical utility in preoperative spine assessment, whereas the newer cervical VBQ (CVBQ) score has shown mixed results in early studies. This study investigates associations between a novel CVBQ score derived from MRI and established BMD metrics (Hounsfield unit (HU) measurements and DEXA values) to evaluate the comparative utility of these methods.

Methods: A retrospective review was performed on patients who underwent cervical CT, DEXA, and non-contrast MRI of the cervical and lumbar spine between 2016 and 2022. BMD was assessed using DEXA T-scores, cervical HU measurements, and CVBQ and LVBQ scores derived from T1-weighted MRI sequences. Statistical comparisons between patients with and without osteoporosis were conducted using t-tests and Pearson correlation coefficients.

Results: A total of 133 patients were included for CVBQ scoring and 127 for LVBQ. The CVBQ score showed poor correlation with both DEXA (r = -0.09, p < 0.001) and HU measurements (r = -0.34, p < 0.001), whereas a moderate correlation was found between LVBQ and DEXA scores (r = -0.34, p < 0.001).

Conclusions: The LVBQ score demonstrates moderate correlation with DEXA and may serve as a reliable tool for preoperative BMD assessment. However, the CVBQ score showed weak correlation with both DEXA and HU, limiting its clinical utility in its current form. Further refinement of the CVBQ methodology is needed to enhance its accuracy and relevance for surgical risk assessment and postoperative outcome prediction.

Background: The relationship between glycaemia and the variables of haematocrit, serum total protein and lipids possibly plays a role in pathological processes and hence is a subject of interest. Estimated blood viscosity causes impaired blood flow and is a factor in other vascular diseases. Blood viscosity is correlated with glycated haemoglobin, but the mechanism of this association has not been extensively investigated. Objective: To assess if changes in glycated haemoglobin translate into changes in blood viscosity through impact on haematocrit, serum protein or dyslipidaemia. Method: This was a clinical laboratory-based retrospective data analysis of patients attending a diabetic clinic. Analysis involved seven variables comprising serum total protein level, high-density lipoprotein cholesterol, total cholesterol, triglyceride, age and glycated haemoglobin. The statistical evaluations were descriptive, comparative and correlational. Results: A total of 12,986 sets of data represented the participants in this study. After excluding three with incomplete data of interest, the groups that were created for comparison comprised the following: good glycaemic control (2694), moderate glycaemic control (4075) and poorly controlled (6194). Serum levels of high-density lipoprotein cholesterol, total cholesterol, haematocrit and proteinaemia gradually decreased with worsening glycaemic control, while serum triglyceride and age increased. In the correlation analysis, serum triglyceride level was positively correlated with glycated haemoglobin r = 0.177, while haematocrit and proteinaemia were negatively related, at -0.045 and -0.103, respectively. Conclusions: Increase in glycated haemoglobin was inversely related to haematocrit and proteinaemia; therefore, this did not always increase with the determinants of estimated whole blood viscosity. The implication of this is that further studies are required to substantiate the observation of higher whole blood viscosity levels in patients with poorly controlled diabetes.

Background/Objectives: The quality of trial data reporting within the field of anesthesiology has, to date, been insufficiently examined. This study aims to investigate the consistency of reporting for WHO Data Set Items, trial outcomes, and adverse events between the data reported in ClinicalTrials.gov and the corresponding peer-reviewed publications in a cohort of anesthetic-related randomized controlled trials (RCTs) subject to the FDAAA. Methods: In a cross-sectional study, we investigated RCTs performed on 29 drugs in anesthesiology. We examined data reporting for eight categories, including the results and outcome probability measures, adverse events, all-cause mortality, study size, study outcome, study arm, selection criteria, and date of enrollment. We also examined compliance with the ClinicalTrials.gov registration deadline. Using descriptive statistics, we described the reporting reliability in both trial registration and corresponding publication data. Differences in the frequencies of discrepant or inadequate data reporting between selected subgroups were analyzed. Results: We identified 258 trials from 2009 to 2022 from ClinicalTrials.gov with corresponding publications. Of these, 28.7% were retrospectively registered. Discrepancies in reporting results occurred in 33.3% of the trials, with serious adverse events in 62.4% and other adverse events in 67.4% of the trials. Primary outcomes were reported much more consistently than secondary ones (77.5% vs. 27.9%). The selection criteria (24%) and enrollment date (29.5%) were the least consistently reported data categories. The only data item with improved reporting over time was all-cause mortality. Conclusions: Trial data in anesthesiology clinical trials continue to be misreported. Responsible parties involved in the peer-review process should consider using trial data registration forms as valuable sources for validating the integrity of trial data. Additionally, discrepancies along manuscript progression from submission to publication raise the question about the reliability of both registered and published data as sources for clinical decisions and meta-research.

Acute promyelocytic leukemia (APL) evolved from the most lethal to the most curable subtype of acute leukemia today, owing to targeted therapy with all-trans retinoic acid (ATRA) and arsenic trioxide. Despite cure rates exceeding 90% and the rarity of relapse or refractoriness, early death (ED)-occurring within 30 days of diagnosis-remains unacceptably high, reaching up to 30% in population-based studies. ED is the major barrier to universal cure, with fatal hemorrhage as the predominant cause, followed by infection, differentiation syndrome, and thrombosis. Patients who survive the initial month generally achieve excellent long-term outcomes. This review synthesizes data from clinical trials and large real-world cohorts to provide a comprehensive overview of the incidence, causes, and predictors of ED in APL. Higher white blood cell count and older age emerge as the most consistently validated predictors, followed by increased IRB/BICcreatinine, low albumin, thrombocytopenia, and coagulopathy, although their predictive value is not uniform across studies. Risk scores such as the Sanz classification, the Österroos ED model, and dynamic disseminated intravascular coagulation (DIC) assessments represent practical tools for identifying patients at high risk of ED. Importantly, ED rates remain significantly higher in real-world populations than in clinical trials, highlighting the impact of age and comorbidities, delayed diagnosis, and barriers to immediate ATRA initiation and supportive care. Addressing ED in APL requires intensified early supportive strategies, physician awareness and education, and rapid treatment initiation. Refinement and validation of predictive models may guide tailored interventions and inform strategies to finally overcome this persistent unmet need.

Delirium is one of the most common yet most elusive syndromes in the ICU, marked by fluctuating disturbances in awareness and attention arising from complex, multifactorial pathophysiological processes. Despite decades of research and the identification of numerous risk factors, delirium continues to evade full understanding and remains a major therapeutic challenge. Its consequences are profound: higher morbidity and mortality, prolonged ICU and hospital length of stay, and a substantial economic burden of thousands of dollars in excess costs. Beyond being a clinical complication, delirium has become a silent disruptor of modern critical care. This raises an urgent and challenging question: rather than endlessly treating the aftermath of delirium, could the key breakthrough lie in reimagining the ICU itself? Transformative investments in architecture, infrastructure, and human-centered design-together with elevating nonpharmacological strategies alongside pharmacological therapies-may hold the potential to prevent delirium at its roots. In this narrative review, we synthesize current knowledge on the epidemiology, etiology, pathophysiology, diagnosis, prevention, and management of ICU delirium. We highlight how innovative ICU redesign, holistic care approaches, and integrated evidence-based strategies may reshape the fight against delirium, turning the ICU into not just a site of survival but a therapeutic tool in its own right.

Background: Hepatitis C (HC) remains a major public health concern, affecting approximately 50 million people globally. In addition to hepatic damage, HC induces extrahepatic manifestations (EHMs), including oral conditions such as oral lichen planus (OLP), xerostomia, and Sjögren syndrome-like (SS-like), which impair quality of life. The aim of this study was to investigate the possible association between certain extrahepatic manifestations of HC and the presence of risk factors. Methods: A cross-sectional study was conducted on 38 adults (22 males and 16 females; mean age 56.5 ± 8.6 years) with inactive HC. For each patient, demographic and clinical data were collected, including the following: frequency of dental brushing, frequency of professional dental hygiene visits, smoking, alcohol consumption, the presence of xerostomia, OLP, and SS-like. Logistic regression analyses and ROC curves were performed using R software to identify independent predictors for each condition. Results: OLP was present in 39.5%, xerostomia in 47.4%, and SS-like in 15.8% of patients. Female gender significantly predicted OLP and showed a borderline association with xerostomia. Smoking was weakly associated with xerostomia. No predictors were significant for SS-like. Conclusions: Oral hygiene and smoking are risk factors for oral EHM, their good control being important for the quality of life of these patients. Gender has also been shown to be a risk factor for these manifestations.

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.