Minerva medica最新文献

Diabetic foot syndrome (DFS) is a severe complication of diabetes mellitus, representing a significant burden on healthcare systems and patient quality of life. This syndrome encompasses a spectrum of pathologies, including neuropathy, peripheral arterial disease (PAD), infection and foot deformities, culminating in ulceration and potential amputation. Notably, individuals with DFS often present with multiple comorbidities, which significantly influence management and outcomes. This article provides a comprehensive overview of the internal medicine management of DFS, focusing on risk factor identification, preventive strategies, diagnostic approaches, therapeutic interventions and thecritical consideration of comorbidities. The four pillars of management of diabetic foot syndrome are: 1) metabolic management; 2) DFU management; 3) comorbidities management 4) Prevention. A multidisciplinary approach, involving diabetologists, internists, vascular surgeons, infectious disease specialists, podiatrists, and specialized nursing staff, is crucial for optimal patient outcomes.

Background: Patent foramen ovale (PFO) is a common congenital heart defect associated with cryptogenic stroke, transient ischemic attacks (TIAs), and migraines. The Multifenestrated MemoPart device is specifically designed to address complex anatomical variations of PFO. This study evaluates the feasibility, safety, and effectiveness of MemoPart for PFO closure in a real-world setting.

Methods: Consecutive patients undergoing PFO closure with the MemoPart device were included. Diagnosis was based on transthoracic echocardiography with bubble contrast and quantification of Valsalva maneuver intensity with a Valsalva assist device. Procedural success, adverse events, residual shunts, and clinical outcomes were assessed at baseline and up to 3 months.

Results: A total of 60 patients were included in the overall analysis, with age 51.6±12.6 years, and 30 (50%) women. Most participants (46 [77%]) reported a history of stroke, and a Reduce PFO morphology was the most common (34 [57%]). Acutely complete closure was achieved in 59 (98% [91%-100%]) cases, whereas 3-month echocardiographic follow-up showed complete closure in all 60 (100% [94%-100%]). No major or other serious adverse events were reported, and bubble testing showed 0 MES in 49 (82% [70%-91%]) cases. Exploratory ordinal logistic regression suggested that MES were higher in those with complicated (natural logarithm of the odds ratio [LnOR]=1.54 [0.04-3.04], P=0.044) and Tunnel morphologies (LnOR=1.23 [0.01-2.45], P=0.048), as well as with atrial septal aneurysm (LnOR=2.22 [0.54-3.91], P=0.010).

Conclusions: MemoPart is a safe and effective option for PFO closure, in routine as well as anatomically complex cases. These findings support its routine use and encourage further long-term studies to confirm its clinical benefits.

Background: Fibromyalgia is characterized by widespread musculoskeletal pain, fatigue, disturbances in cognitive and emotional functioning. Cognitive impairment (so-called "fibrofog") is increasingly recognized as a central feature of fibromyalgia. However, its relationship with psychological traits and personality dimensions remains insufficiently explored. This study aimed to examine the interaction between cognitive performance, emotional states, and personality traits in individuals diagnosed with fibromyalgia.

Methods: This descriptive pilot study involved 10 female outpatients diagnosed with fibromyalgia according to the criteria of the American College of Rheumatology. Participants underwent a comprehensive assessment including neuropsychological, psychological, personality, and motor evaluations. Instruments used included the Young Schema Questionnaire, the State-Trait Anxiety Inventory, the Beck Depression Inventory, the Brief COPE questionnaire, and a battery of cognitive and motor tests. Statistical analyses were conducted using Spearman's rank correlation coefficient.

Results: The most frequently observed maladaptive personality schemas were self-sacrifice (80%) and unrelenting standards (70%). Trait anxiety was present in 80% of participants, and depressive symptoms were reported by 90%. While short-term and long-term memory were generally preserved, 80% of participants showed deficits in divided attention, and 40% demonstrated impaired mobility under dual-task conditions. Significant correlations were found between anxiety and cognitive flexibility, as well as between coping strategies and working memory performance.

Conclusions: Patients with fibromyalgia exhibit a complex cognitive-emotional profile characterized by attentional deficits, maladaptive personality traits, and elevated psychological distress. These findings emphasize the importance of multidimensional assessment and suggest that interventions targeting personality schemas and coping mechanisms may improve cognitive and functional outcomes in this population.

Introduction: Acute ischemic stroke (AIS) requires prompt thrombolytic therapy to restore cerebral perfusion. Recombinant human prourokinase (rhPro-UK) has emerged as a potential alternative to standard agents, but the optimal dosage remains unclear.

Evidence acquisition: A systematic review and network meta-analysis was conducted using PubMed and Embase up to January 27, 2025. Eligible studies were randomized controlled trials (RCTs) comparing intravenous rhPro-UK dosages in adults with AIS. Outcomes included changes in NIHSS scores (24 hours and 7 days), mRS scores (0-1 and 0-2), all-cause mortality, serious adverse events (SAEs), and symptomatic intracranial hemorrhage (SIH). Data were analyzed using a Bayesian random-effects model in R (v4.4.2), with results reported as mean differences (MDs), odds ratios (ORs), and risk differences (RDs) with 95% confidence intervals (CIs).

Evidence synthesis: Eight RCTs (N.=4309; mean age 64.7 years; 33.1% female) were included. Both 35 mg and 50 mg rhPro-UK improved NIHSS scores at 24 hours (MD: -1.03 and -0.44) and 7 days (MD: -1.19 and -0.86) versus standard care. The combination of 40 mg rhPro-UK + alteplase (ALT) showed the highest probability of achieving mRS 0-2 (OR: 1.59). The 50 mg dose was associated with increased mortality (OR: 2.34), while the 35 mg dose had the highest estimated SIH risk (OR: 4.73).

Conclusions: Both 35 mg and 50 mg rhPro-UK improve early neurological outcomes. However, 40 mg rhPro-UK + ALT may offer the most favorable efficacy-safety profile. Further trials are warranted to optimize dosing strategies.

Background: Tension-type headache is the most prevalent neurological disorder worldwide and is frequently associated with neck pain. Musculoskeletal dysfunctions of the cervical spine are commonly reported in patients with tension-type headache, suggesting a potential therapeutic role for physical rehabilitation. Short-wave diathermy is a deep-heating modality known to increase pain thresholds, reduce muscle spasm, and enhance soft tissue extensibility. The aim of this study was preliminary to assess the effectiveness of short-wave diathermy as an adjunct to conventional rehabilitation for adults with tension-type headache associated with neck pain.

Methods: This single-center case-control observational study retrospectively analyzed data of 42 adult patients with persistent tension-type headache and neck pain were included. Cases received short-wave diathermy (20 minutes) combined with myofascial release (pompage technique, 20 minutes), while controls underwent pompage and therapeutic neck exercises (20 minutes each). All participants completed ten 45-minute sessions over five weeks. Primary outcome was pain intensity (Numerical Pain Rating Scale). Secondary outcomes included disability (Neck Disability Index) and pressure pain threshold. Assessments were conducted before and one week after treatment completion.

Results: After treatment, the Case group showed significantly greater improvements compared to controls in neck pain (P=0.03) and disability (P=0.04). No significant between-group differences were observed in pressure pain threshold measurements at cervical sites.

Conclusions: Preliminary findings suggest that short-wave diathermy may serve as a useful adjunct in the rehabilitation of adults with tension-type headache associated with neck pain. Larger randomized controlled studies are needed to confirm these results.