Journal of Clinical Medicine最新文献

{"title":"A Multifaceted Exploration of Status Asthmaticus: A Retrospective Analysis in a Romanian Hospital.","authors":"Adriana Ana Trusculescu, Versavia Maria Ancusa, Camelia Corina Pescaru, Norbert Wellmann, Corneluta Fira-Mladinescu, Cristian Iulian Oancea, Ovidiu Fira-Mladinescu","doi":"10.3390/jcm13216615","DOIUrl":"10.3390/jcm13216615","url":null,"abstract":"<p><p><b>Background</b>: Status asthmaticus is a severe, life-threatening asthma exacerbation requiring urgent medical intervention. This study aims to examine its epidemiology in Timis County, Romania, over 11 years. <b>Methods</b>: A retrospective analysis was conducted using hospital records from 2013 to 2023, focusing on demographic, geospatial, and temporal distributions. Network analysis of the recorded comorbidities was used to identify phenotypic clusters among patients. <b>Results</b>: Females and older adults were disproportionately affected. Several triggers and geospatial patterns were identified. Five phenotypic clusters were determined: two in the T2-high endotype, two in T2-low, and a mixed one. <b>Conclusions</b>: The findings highlight the need for personalized asthma management strategies and public healthcare interventions in Timiș County, addressing specific demographic and geospatial factors. This study also provides a valuable reference for similar regions.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142636101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Tinetti Balance Test Is an Effective Predictor of Functional Decline in Non-Hospitalized Post-COVID-19 Individuals: A Cross-Sectional Study.","authors":"Janice R M Bastos, Arthur S Ferreira, Agnaldo J Lopes, Talita P Pinto, Erika Rodrigues, Fabio V Dos Anjos","doi":"10.3390/jcm13216626","DOIUrl":"10.3390/jcm13216626","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Individuals with post-COVID-19 conditions risk developing short- and/or long-term neuromuscular impairments, including postural imbalance. However, there is limited evidence showing whether balance deficits are associated with declines in the functional status in post-COVID-19 individuals. This study examined postural balance in non-hospitalized post-COVID-19 individuals using different assessment tools and tested the most relevant balance tools in predicting functional status. <b>Methods:</b> This cross-sectional study enrolled 60 adults split into control (n = 30) and post-COVID-19 (n = 30) groups. Postural balance was assessed in both groups using the Functional Reach Test (FRT), Berg Balance Scale (BBS), Timed Up and Go (TUG), Tinetti Balance Test (Tinetti), and Mini-BESTest (MBT). Functional status in the post-COVID-19 group was assessed using post-COVID-19 functional status (PCFS). <b>Results:</b> Significant differences in postural stability between groups were found only for the FRT. All balance tests showed a statistically significant correlation with PCFS in the post-COVID-19 group, with better performance in all tests being associated with better functional status: Tinetti (r = -0.584), FRT (r = -0.542), MBT (r = -0.530), BBS (r = -0.415) and TUG (r = 0.368). Tinetti was the independent variable that significantly played an important role in determining PCFS (adjusted <i>R</i>² = 0.318, <i>p</i> < 0.001). <b>Conclusions:</b> Post-COVID-19 functional status is best determined by the Tinetti Balance Test, making it an effective tool for assessing postural balance deficits in this population, with potential implications for postural control assessment and rehabilitation.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11547088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome Through the Years of Left-Ventricular Assist Devices Therapy for End-Stage Heart Failure: A Review.","authors":"Ilaria Tropea, Giovanni Domenico Cresce, Valerio Sanesi, Loris Salvador, Daniele Zoni","doi":"10.3390/jcm13216622","DOIUrl":"10.3390/jcm13216622","url":null,"abstract":"<p><p>Heart transplantation remains the gold standard surgical treatment for advanced heart failure. Over time, medical therapies have achieved remarkable outcomes in terms of survival and quality of life, yet their results may be insufficient, even when maximized. The limited availability of organ donors and the selective criteria for heart transplant eligibility have led to a significant rise in the utilization of long-term mechanical circulatory support, including left ventricular assist devices. Patients receiving LVADs often present with multiple comorbidities, constituting a highly vulnerable population. Individuals living with LVADs may experience various long-term complications, such as bleeding, driveline infections, neurological events, and right ventricular dysfunction. Fortunately, the development of increasingly biocompatible LVAD devices in recent years has resulted in a notable reduction in these complications. This review aims to summarize the principal complications encountered by patients with LVADs throughout their treatment and the associated daily management strategies.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Time Course of Catecholamine Dose Reduction in Septic Shock as a Predictor of Bacterial Susceptibility to Empiric Antimicrobial Therapy: A Retrospective Observational Study.","authors":"Tsukasa Kuwana, Kosaku Kinoshita, Yurina Yamaya, Ken Takahashi, Junko Yamaguchi, Atsushi Sakurai, Toru Imai","doi":"10.3390/jcm13216618","DOIUrl":"10.3390/jcm13216618","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The 28-day mortality rate for septic shock is high, necessitating rapid and effective empiric antimicrobial therapy. In this study, we investigate whether the rate of catecholamine dose reduction in septic shock can indicate bacterial susceptibility to initial antimicrobial therapy or not. <b>Methods:</b> This retrospective observational study involved 108 adult patients with bacteraemia and septic shock admitted to the intensive care unit of Nihon University Itabashi Hospital between January 2017 and December 2023. They were classified into the Susceptible or Resistant groups based on the bacteria's susceptibility to the initial empiric antimicrobial therapy. Catecholamine dosages were converted to norepinephrine equivalent (NEE) scores, with the time course from the peak to the end of administration measured at NEE reductions. <b>Results:</b> Of the 108 patients, 94 were in the Susceptible group and 14 in the Resistant group. The Susceptible group showed faster reductions in catecholamine doses: the time to reduce the dose from the maximum NEE to 25% was 19 vs. 49.5 h (<i>p</i> = 0.0057), and to 0%, it was 29 vs. 54 h (<i>p</i> = 0.0475). The time to reduce the dose from the maximum NEE to 75% was 8 vs. 12.5 h (<i>p</i> = 0.0733), and to 50% it was 13 vs. 21.5 h (<i>p</i> = 0.1081). <b>Conclusions:</b> In septic shock with bacteraemia, a faster catecholamine dose reduction indicates bacterial susceptibility to the initial empiric antibiotics. This reduction rate can serve as an early clinical indicator of the appropriate initial empiric therapy.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Robotic Devices for Medical Rehabilitation: An Umbrella Review.","authors":"Kei Kiyono, Shigeo Tanabe, Satoshi Hirano, Takuma Ii, Yuki Nakagawa, Koki Tan, Eiichi Saitoh, Yohei Otaka","doi":"10.3390/jcm13216616","DOIUrl":"10.3390/jcm13216616","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Clinical trials have investigated the efficacy of rehabilitation robotics for various pathological conditions, but the overall impact on rehabilitation practice remains unclear. We comprehensively examined and analyzed systematic reviews (SRs) of randomized controlled trials (RCTs) investigating rehabilitative interventions with robotic devices. <b>Methods:</b> Four databases were searched using term combinations of keywords related to robotic devices, rehabilitation, and SRs. The SR meta-analyses were categorized into \"convincing\", \"highly suggestive\", \"suggestive\", \"weak\", or \"non-significant\" depending on evidence strength and validity. <b>Results:</b> Overall, 62 SRs of 341 RCTs involving 14,522 participants were identified. Stroke was most frequently reported (40 SRs), followed by spinal cord injury (eight SRs), multiple sclerosis (four SRs), cerebral palsy (four SRs), Parkinson's disease (three SRs), and neurological disease (any disease causing limited upper- and lower-limb functioning; three SRs). Furthermore, 38, 21, and 3 SRs focused on lower-limb devices, upper-limb devices, and both upper- and lower-limb devices, respectively. Quantitative synthesis of robotic intervention effects was performed by 51 of 62 SRs. Robot-assisted training was effective for various outcome measures per disease. Meta-analyses offering suggestive evidence were limited to studies on stroke. Upper-limb devices were effective for motor control and activities of daily living, and lower-limb devices for walking independence in stroke. <b>Conclusions:</b> Robotic devices are useful for improving impairments and disabilities in several diseases. Further high-quality SRs including RCTs with large sample sizes and meta-analyses of these RCTs, particularly on non-stroke-related diseases, are required. Further research should also ascertain which type of robotic device is the most effective for improving each specific impairment or disability.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complex Thoracic Aortic Diseases and Surgery: A Quest for the Golden Fleece.","authors":"Dimitrios E Magouliotis, Thanos Athanasiou","doi":"10.3390/jcm13216620","DOIUrl":"10.3390/jcm13216620","url":null,"abstract":"<p><p>In Greek mythology, the Golden Fleece, a golden-wooled fleece of a winged ram called Chrysomallos, stood as an eternal symbol of authority and power [...].</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11545950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flow-Adjusted Trabeculectomy.","authors":"Assaf Kratz, Ivan Goldberg, Tal Koren, Aviel Hadad, Boris Knyazer, Ridia Lim","doi":"10.3390/jcm13216609","DOIUrl":"10.3390/jcm13216609","url":null,"abstract":"<p><p><b>Background/Objectives:</b> As one of the most efficacious glaucoma surgical techniques, trabeculectomy is considered by many surgeons to be the \"gold standard\" intra-ocular pressure (IOP)-reducing intervention. The purpose of this study is to present our intra-operative flow-adjusted surgical method, which aims to provide safety and efficacy more simply than previous methods. <b>Methods:</b> Retrospectively, we evaluated outcomes for trabeculectomy or phacotrabeculectomy in surgery-naïve eyes over three years for patients with glaucoma not associated with other ocular co-morbidities. We defined complete success as an IOP between 5 and 18 mmHg plus at least a 20% reduction from baseline, without concomitant medications. Relative success was the same result, with glaucoma medication(s). Failure was regarded as an IOP less than 5 or higher than 18 mmHg, or by the need for a subsequent glaucoma operation. <b>Results:</b> We assessed the results from 186 eyes of 186 patients. After exclusion, a group of 45 trabeculectomies and 35 phacotrabeculectomies were analyzed. In eyes undergoing a trabeculectomy, over a mean follow-up of 16.0 months, IOP fell from 28.1 ± 8.0 mmHg with 3.6 ± 1.1 medications to 9.7 ± 3.6 mmHg (66% reduction) with 0.4 ± 1.0 medications (each <i>p</i> < 0.00001). The success rate was 88.9% (75.6% complete success). In eyes undergoing a phacotrabeculectomy, over a mean of 19.1 months, IOP fell from 26.1 ± 10.2 mmHg with 3.5 ± 1.3 medications to 10.0 ± 3.6 mmHg (62% reduction) on 0.9 ± 1.4 medications (each <i>p</i> < 0.00001). The success rate was 91.4% (57.1% complete success). Complication rates were low, with no major complications in either group. <b>Conclusion:</b> To lower IOP, our intra-operative flow-adjusted trabeculectomy and phacotrabeculectomy techniques appear to be safe and effective.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip Flexor Muscle Activation During Common Rehabilitation and Strength Exercises.","authors":"Jessica Juan, Gretchen Leff, Kate Kevorken, Michael Jeanfavre","doi":"10.3390/jcm13216617","DOIUrl":"10.3390/jcm13216617","url":null,"abstract":"<p><p><b>Background/Objectives:</b> The iliopsoas muscle plays an essential role in lumbopelvic and hip anterior stability, which is particularly important in the presence of limited osseous acetabular coverage anteriorly as in hip dysplasia and/or hip micro-instability. The purpose of this systematic review is to (1) describe iliopsoas activation levels during common rehabilitation exercises and (2) provide an evidence-based exercise progression for strengthening the iliopsoas based on electromyography (EMG) studies. <b>Methods:</b> In total, 109 healthy adult participants ranging from ages 20 to 40 were included in nine studies. PubMed, CINAHL, and Embase databases were systematically searched for EMG studies of the psoas, iliacus, or combined iliopsoas during specific exercise. The Modified Downs and Black Checklist was used to perform a risk of bias assessment. PROSPERO guidelines were followed. <b>Results:</b> Nine studies were included. Findings suggest that the iliopsoas is increasingly activated in ranges of hip flexion of 30-60°, particularly with leg lowering/raising exercises. Briefly, >60% MVIC activity of the iliopsoas was reported in the active straight leg raise (ASLR) in ranges around 60° of hip flexion, as well as with supine hip flexion and leg lifts. In total, 40-60% MVIC was found in exercises including the mid-range of the ASLR around 45° of hip flexion and lifting a straight trunk while in a hip flexed position. <b>Conclusions:</b> The findings suggest that exercises in increased hip flexion provide greater activation of the iliopsoas compared to exercises where the trunk is moving on the lower extremity. Iliopsoas activation can be incrementally progressed from closed to open kinetic chain exercises, and eventually to the addition of external loads. The proposed exercise program interprets the results and offers immediate translation into clinical practice.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-Articular Physiological Saline in Temporomandibular Disorders May Be a Treatment, Not a Placebo: A Hypothesis, Systematic Review, and Meta-Analysis.","authors":"Maciej Chęciński, Kamila Chęcińska, Katarzyna Cholewa-Kowalska, Kalina Romańczyk, Dariusz Chlubek, Maciej Sikora","doi":"10.3390/jcm13216613","DOIUrl":"10.3390/jcm13216613","url":null,"abstract":"<p><p><b>Background:</b> Intra-articular injections reduce pain in patients with temporomandibular joint (TMJ) disorders who are unresponsive to conservative treatment. Hyaluronic acid, blood products, and medications provide rapid relief when administered this way, although their mechanisms of action remain unclear. In control groups, which are intended to be untreated, 0.9% NaCl is typically delivered. The hypothesis that \"normal saline injections in TMJ cavities produce a therapeutic effect\" is proposed, with an exploration of its potential verification, alongside a systematic review and meta-analysis of studies on intra-TMJ 0.9% NaCl. <b>Methods:</b> Randomized controlled trials (RCTs) on patients with TMJ internal derangement, arthritis, or degeneration were selected under PRISMA 2020 and assessed with RoB2. <b>Results:</b> Seven RCTs with 359 patients were included. Weekly follow-ups revealed a decrease in articular pain by 23.72% (SE: 0.84%; 95% CI: 24.38-21.06%; <i>p</i> < 0.01), and monthly follow-ups indicated a decrease of 34.01% (SE: 1.09%; 95% CI: 36.16-31.86%; <i>p</i> < 0.01) compared to the baseline values. These findings were grounded in low-risk-of-bias evidence on 267 patients in five RCTs and 222 patients in four RCTs, respectively. <b>Conclusions:</b> The hypothesis warrants further testing to determine whether, in addition to the known biological activity of typical injectables, the mechanical action also contributes to pain relief.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11547119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Activation of Irrigants in Root Canals with Open Apices: A Narrative Review.","authors":"Dina Abdellatif, Massimo Pisano, Luigi Cecere, Valentino Natoli, Davide Mancino, Eduard Euvrard, Alfredo Iandolo","doi":"10.3390/jcm13216611","DOIUrl":"10.3390/jcm13216611","url":null,"abstract":"<p><p>Performing endodontic treatment on a tooth with an immature apex can be challenging due to the risk of irrigant extrusion beyond the apex. This narrative review investigates the over-apex extrusion of activated irrigants in teeth with open and immature apices and aims to provide crucial insights for practice and research. Two hundred fifty-two results were found from the electronic search. Sixteen duplicates were removed before selection, and 24 were excluded. Of the 212 remaining results, the full text was evaluated for eligibility. One hundred ninety-four results were excluded: in one hundred sixty-five, irrigant activation was not performed; twenty-nine were animal studies; in seven, irrigant activation was not performed to disinfect the canal. Finally, 13 studies were included. They cover a range of topics, from the types of irrigants used to the techniques of activation, and their findings contribute to our understanding of the risks and consequences of irrigant extrusion. All the activation techniques investigated can, to varying degrees, cause the irrigant to extrude beyond the apex. Extrusion may not always be clinically relevant; however, the consequences of excessive irrigant leakage from the apex are dangerous, so try to assess all the variables that may cause it and adopt techniques to reduce it.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11547172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}