Journal of Clinical Medicine最新文献

{"title":"Preimplantation Genetic Testing for Aneuploidy Versus Morphological Selection in Women Aged 35-42: Results of a Pilot Randomized Controlled Trial.","authors":"Yusuf Beebeejaun, Daniela Bakalova, Anastasia Mania, Timothy Copeland, Ippokratis Sarris, Kypros Nicolaides, Antonio Capalbo, Sesh K Sunkara","doi":"10.3390/jcm14145166","DOIUrl":"10.3390/jcm14145166","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Embryo selection in IVF is traditionally based on morphology, yet many high-quality embryos fail to implant. Preimplantation genetic testing for aneuploidy (PGT-A) using next-generation sequencing (NGS) has been proposed to improve selection by identifying euploid embryos. However, its effectiveness in women of advanced maternal age remains unclear due to limited randomized data. This pilot trial assessed the feasibility of a full-scale RCT comparing PGT-A to morphology-based selection in women aged 35-42. <b>Methods</b>: This single-centre, two-arm parallel RCT (NCT05009745) enrolled women aged 35-42 undergoing IVF/ICSI with ≥3 good-quality day-3 embryos. Participants were randomized (1:1) to either embryo selection by morphology with fresh transfer or PGT-A with frozen transfer of a single euploid embryo. Allocation concealment was achieved via a secure web-based randomization platform; patients and clinicians were unblinded, but the biostatistician remained blinded. The primary outcome was feasibility of recruitment, randomization, and adherence. <b>Results</b>: Between June 2021 and January 2023, 138 women consented (recruitment rate: 55.8%, 95% CI: 49.7-62.0%) and 100 were randomized. Protocol adherence was 94%. Barriers to recruitment included preference for private PGT-A (19%) or fresh transfer (6%). Among biopsied embryos, 51.4% were euploid and 6.6% low-level mosaic. Intention-to-treat analysis showed no significant differences between PGT-A and control groups in clinical pregnancy rate (50% vs. 40%), live birth rate (50% vs. 38%), or miscarriage rate (12% vs. 8%). Cumulative live birth rate after up to three SETs was 72% vs. 52%, respectively (<i>p</i> > 0.05). No multiple pregnancies occurred. <b>Conclusions</b>: RCTs of PGT-A in older women are feasible. A multicentre design with broader inclusion criteria could improve recruitment and allow better assessment of clinical benefit.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731358","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":"Immunosuppressants/Immunomodulators and Malignancy.","authors":"Norishige Iizuka, Yoshihiko Hoshida, Atsuko Tsujii Miyamoto, Hotaka Shigyo, Akira Nishigaichi, Gensuke Okamura, Shiro Ohshima","doi":"10.3390/jcm14145160","DOIUrl":"10.3390/jcm14145160","url":null,"abstract":"<p><p>Individuals with immunosuppressive conditions are at a higher risk of developing malignancies than those in the general population. Immunosuppression weakens tumor immunity, hinders the detection of pro-oncogenic cells, and activates oncogenic viruses. Malignancies arising in immunosuppressed patients tend to be aggressive, have a high incidence of virus-associated cancers, and are reversible in some cases. Notably, immunosuppressive agents influence the frequency and type of malignancies, as well as their clinicopathological features. Organ transplant recipients receive long-term immunosuppressants to prevent acute rejection. Post-transplant malignancies vary depending on the type of drug administered before the onset of these diseases. Patients with rheumatoid arthritis (RA) are treated with long-term immunosuppressive medications, such as methotrexate (MTX). MTX is widely recognized as being associated with a specific type of lymphoproliferative disorder (LPD), known as MTX-associated LPD. Our recent report indicated that the clinicopathological features of rheumatoid arthritis-associated lymphoproliferative disorder (RA-LPD) also vary based on the other anti-RA agents used, such as tacrolimus and tumor necrosis factor inhibitors. Therefore, the clinicopathological characteristics of post-transplant LPD and RA-LPD evolve alongside the changes in the immunosuppressants/immunomodulators administered. Understanding the various characteristics and time trends of immunosuppressive neoplasms, particularly LPDs, in relation to different immunosuppressant/immunomodulator medications is highly valuable in clinical practice.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731370","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 Role of Echocardiographic Right Atrial Strain Parameters in Evaluating Atrial Fibrillation Recurrence in Patients Undergoing Atrial Fibrillation Ablation.","authors":"Hasan Can Konte, Emir Dervis, Idris Yakut, Dursun Aras","doi":"10.3390/jcm14145155","DOIUrl":"10.3390/jcm14145155","url":null,"abstract":"<p><p><b>Background:</b> Atrial fibrillation (AF) recurrence following catheter ablation remains a significant clinical challenge despite technological advancements, with recurrence rates in the range of 20-40%. While left atrial parameters have been extensively studied as predictors of recurrence, the contribution of right atrial mechanical function has received limited attention. The hypothesis that the combined assessment of right and left atrial strain parameters may provide superior predictive value represents an important clinical question with potential implications for post-ablation risk stratification and follow-up strategies. <b>Methods:</b> This single-center, retrospective cohort study included 100 consecutive adult patients who underwent AF ablation between May 2022 and June 2024 with at least one-year follow-up. Patients were divided into two groups: those with recurrence (<i>n</i> = 13) and those without recurrence (<i>n</i> = 87). A comprehensive echocardiographic assessment, including the speckle-tracking strain analysis of both atria, was performed. <b>Results:</b> The median follow-up was 365 days [range: 150-912 days] in patients with recurrence. In the multivariable analysis, right ventricular diameter (OR: 0.74; 95% CI: 0.61-0.90; <i>p</i> = 0.001), left ventricular end-diastolic volume (OR: 1.04; 95% CI: 1.00-1.08; <i>p</i> = 0.022), and left ventricular global longitudinal strain rate (OR: 1.22; 95% CI: 1.05-1.40; <i>p</i> = 0.007) emerged as independent predictors of recurrence. <b>Conclusions:</b> The significant association of right atrial longitudinal reservoir strain with recurrence in univariable analysis, although not retained as an independent predictor in the multivariable model, suggests the importance of comprehensive cardiac assessment including right heart parameters in predicting AF recurrence.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731493","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 Role of Probiotics in Preventing Gestational Diabetes: An Umbrella Review.","authors":"Simone Cosmai, Sara Morales Palomares, Cristina Chiari, Daniela Cattani, Stefano Mancin, Alberto Gibellato, Alessandra Valsecchi, Marco Sguanci, Fabio Petrelli, Giovanni Cangelosi, Diego Lopane, Beatrice Mazzoleni","doi":"10.3390/jcm14145168","DOIUrl":"10.3390/jcm14145168","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Gestational diabetes (GD), which affects approximately 15% of pregnancies worldwide, poses significant risks to both maternal and fetal health, underscoring the need for effective prevention and management strategies. This umbrella review aims to evaluate the role of probiotics in the prevention of GD. <b>Methods:</b> The review was conducted in accordance with the <i>Joanna Briggs Institute (JBI) Manual for Evidence Synthesis</i>. A comprehensive literature search was performed in November 2024 across four databases: PubMed/Medline, Cochrane Library, Embase, and CINAHL. A total of 307 articles were identified, of which 6 met the inclusion criteria and were included in the final synthesis. <b>Results:</b> Probiotic supplementation was associated with a significant reduction in the incidence of GD in selected populations, particularly in women with a body mass index (BMI) < 26, age < 30 years [Relative Risk (RR): 0.58], and <i>p</i> < 0.05 in the other studies included, alongside improvements in several metabolic parameters. However, consistent benefits on maternal or neonatal complications were not observed but a 33% reduction in GD was confirmed (RR 0.67). The combination of probiotics with healthy lifestyle behaviors appeared to exert a stronger protective effect against GD and its potential complications. <b>Conclusions:</b> This umbrella review suggests that probiotics-particularly multi-strain formulations-may have a potential role in reducing the risk of GD in certain populations. However, the findings across the included studies are inconsistent and sometimes conflicting. While probiotics are generally considered safe and have recognized benefits for metabolic health, their efficacy as an adjunct intervention for GD prevention remains not fully clear. Further well-designed research is needed to clarify which specific probiotic interventions may be effective and to better guide clinical practice.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731495","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":"Emergency Department Discharges Following Falls in Residential Aged Care Residents: A Scoping Review.","authors":"Gigi Guan, Kadison Michel, Charlie Corke, Geetha Ranmuthugala","doi":"10.3390/jcm14145169","DOIUrl":"10.3390/jcm14145169","url":null,"abstract":"<p><p><b>Background:</b> Falls in residential aged care facilities (RACFs) have a significant impact, often leading to costly and unnecessary emergency department (ED) transfers. This scoping review examined the ED discharge proportions and patient characteristics of RACF residents presenting to the ED following a fall, to identify factors that could reduce unnecessary ED transfers. <b>Methods:</b> The databases MEDLINE, CINAHL, Scopus, and Web of Science were searched, resulting in an initial 1385 articles. Nine of these articles met the inclusion criteria and were included in this review. <b>Results:</b> The median age of patients reported in the nine papers ranged from 80.8 to 88 years. Discharge proportions from ED back to RACF ranged from 36% to 91%, with an average of 63%. The studies that reported on computed tomography of the brain (CTB) showed that CTB findings did not significantly influence discharge decisions. <b>Conclusions:</b> Many RACF residents transferred to EDs following falls are discharged without hospital admission. The heterogeneity of study methods makes it challenging to draw definitive conclusions about factors that may help identify patient groups that do not require transfer to the ED following a fall. However, this scoping review highlights potential opportunities to reduce ED transfers from RCAFs. These findings highlight a need for geriatric-specific, person-centred protocols that reduce unnecessary ED transfers while safeguarding quality of care and respecting residents' advance care preferences.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12294946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731343","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":"Total Arch Replacement with Ascyrus Medical Dissection Stent Versus Frozen Elephant Trunk in Acute Type A Aortic Dissection: A Meta-Analysis.","authors":"Massimo Baudo, Fabrizio Rosati, Michele D'Alonzo, Antonio Fiore, Claudio Muneretto, Stefano Benussi, Lorenzo Di Bacco","doi":"10.3390/jcm14145170","DOIUrl":"10.3390/jcm14145170","url":null,"abstract":"<p><p><b>Background</b>: Acute Stanford Type A aortic dissection (ATAAD) often requires total arch replacement (TAR) with frozen elephant trunk (FET) to address entry tears and support aortic remodeling. In select cases, AMDS may provide a simpler option. The present meta-analysis aims to compare surgical outcomes between these two approaches. <b>Methods</b>: A comprehensive search in the Pubmed, ScienceDirect, SciELO, DOAJ, and Cochrane library databases was performed until February 2025. We included studies that reported the outcomes of patients with ATAAD undergoing TAR with AMDS or FET. To enable a meaningful comparison, we only included FET studies where patients met the same inclusion criteria as those with the AMDS. <b>Results</b>: Thirty-eight articles met our inclusion criteria, with a total of 319 patients in the AMDS group and 4129 in the FET group. Patients undergoing an AMDS procedure experienced significantly higher bleeding requiring surgery (21.2% vs. 6.4%, <i>p</i> < 0.001) and a higher hospital mortality (14.5% vs. 10.0%, <i>p</i> = 0.037) compared to FET. The individual patient data of 1411 patients were constructed. Overall survival at 1 and 3 years was 81.9% ± 3.3% vs. 88.8% ± 0.9% and 81.9% ± 3.3% vs. 85.2% ± 1.0% between AMDS and FET, respectively. A flexible parametric survival model demonstrated a significant mortality drawback for AMDS compared to FET up to 31 days, beyond which the difference was no longer evident. <b>Conclusions</b>: The comparison between AMDS and FET for ATAAD treatment remains debated, with FET favored for its lower mortality and stronger long-term evidence. AMDS, as a newer technique, shows promise but lacks sufficient data to confirm its safety and efficacy.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731511","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":"Ex Vivo Thrombocyte Function and Its Response to NO/Sildenafil in Patients Undergoing Hemodialysis.","authors":"Vera Bonell, Christoph Schmaderer, Georg Lorenz, Roman Günthner, Susanne Angermann, Quirin Bachmann, Claudius Küchle, Lutz Renders, Uwe Heemann, Thorsten Kessler, Stephan Kemmner","doi":"10.3390/jcm14145156","DOIUrl":"10.3390/jcm14145156","url":null,"abstract":"<p><p><b>Background:</b> Coagulation disorders, including both bleeding and thrombotic complications, are common in patients undergoing hemodialysis (HD). Here, we aimed to characterize platelet function in patients undergoing hemodialysis three times per week, compared to healthy controls. <b>Methods:</b> Platelet function was assessed using the Multiplate analyzer (Roche), which is based on multiple electrode impedance aggregometry. Platelet aggregation was induced using adenosine diphosphate (ADP), and the area under the curve (AUC) served as the primary endpoint. In addition, platelet counts and C-reactive protein (CRP) levels were measured. To further evaluate nitric oxide (NO)-mediated inhibition of platelet aggregation, blood samples were incubated with the NO donor, sodium nitroprusside (SNP), and the phosphodiesterase 5A (PDE5A) inhibitor, sildenafil. <b>Results:</b> A total of 60 patients undergoing HD and 67 healthy controls were included in the analysis. Patients receiving HD treatment had significantly lower platelet counts compared to healthy controls (226.9 ± 53.47 vs. 246.7 ± 47.21 G/L, <i>p</i> = 0.029). Platelet aggregation was markedly reduced in patients undergoing HD compared to controls (462.0 ± 266.54 vs. 644.5 ± 254.44 AU × min, <i>p</i> < 0.001) with a significant correlation for platelet count (r = 0.42, <i>p</i> = 0.001) and systemic inflammation as indicated by CRP levels (r = 0.28, <i>p</i> = 0.035). Following SNP and sildenafil administration, inhibition of platelet aggregation remained more pronounced in patients undergoing HD. However, the change in platelet aggregation after SNP/sildenafil treatment did not differ significantly between the groups. <b>Conclusions</b>: Patients undergoing HD exhibit altered platelet function, indicated by reduced aggregation and platelet counts, as well as an association with systemic inflammation. Multiple electrode impedance aggregometry appears to be a feasible method for detecting platelet function alterations in patients receiving HD treatment. Responsiveness to NO donors was preserved in patients undergoing HD. Further studies are needed to identify the underlying mechanisms, particularly the role of NO signaling in platelet dysfunction in patients undergoing HD.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731270","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":"Exploring the Perceived Value of Standing in Individuals with Lower Limb Impairments.","authors":"Yukiyo Shimizu, Hideki Kadone, Yosuke Eguchi, Kai Sasaki, Kenji Suzuki, Yasushi Hada","doi":"10.3390/jcm14145161","DOIUrl":"10.3390/jcm14145161","url":null,"abstract":"<p><p><b>Background:</b> Standing has medical and psychosocial benefits for people with lower limb impairments; however, systemic, logistical, and economic barriers often limit opportunities to stand in daily life. This study explored how users perceive standing and standing-assistive technologies. <b>Methods</b>: This study used a mixed-methods approach: in-person interviews (<i>n</i> = 18) and a nationwide web-based survey (<i>n</i> = 125; 74.4% male, mean age 52.2 ± 13.9 years, diagnoses: spinal cord injury 37.6%, cerebrovascular disease 27.2%, and cerebral palsy 16.8%). <b>Results</b>: Participants described the psychosocial values of standing, such as feeling more confident and being able to interact with others at eye level. The web survey revealed that most participants believed that standing was beneficial for health (76.8%) and task efficiency (76.0%), although only 49.6% showed an interest in standing wheelchairs. The multivariate analysis revealed that ongoing standing training was the strongest predictor of positive perceptions of health benefits, task efficiency, and interest in standing wheelchairs. Younger participants showed a greater interest in standing wheelchairs. The reported barriers include a lack of awareness, high costs, and difficulty in accessing training. <b>Conclusions:</b> These findings suggest the need for a user-centered design and improved support systems to integrate standing into the daily lives of people with mobility impairments.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731272","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":"Current Antithrombotic Prescribing Habits for Extended Secondary Prevention in Patients with Peripheral Artery Disease and Unprovoked Venous Thromboembolism: A Survey Among Specialists in Angiology and Vascular Surgery.","authors":"Elena Butera, Frederikus Albertus Klok, Jamilla Goedegebuur, Angelo Porfidia, Behnood Bikdeli, Walter Ageno, Roberto Pola","doi":"10.3390/jcm14145157","DOIUrl":"10.3390/jcm14145157","url":null,"abstract":"<p><p><b>Background:</b> Venous thromboembolism (VTE) is conventionally treated with anticoagulant therapy. In contrast, the core treatment for peripheral artery disease (PAD) is antiplatelet therapy. VTE and PAD share common risk factors and may occur in the same patient. Nonetheless, there is little evidence of the best antithrombotic regimen to use when the two conditions coexist, especially in terms of the extended prevention of major adverse cardiovascular events (MACE), major adverse limb events (MALE), and VTE recurrences. <b>Methods:</b> We conducted an online survey of members of the Italian Society of Angiology and Vascular Medicine (SIAPAV) to explore current prescribing habits for extended antithrombotic therapy in patients with PAD and unprovoked VTE. The survey included four clinical scenarios with variations in age, gender, bleeding risk, index VTE event, and severity of PAD. In all cases, patients had received anticoagulation for 6 months, and the key question was how to continue treatment beyond 6 months from the index VTE event. <b>Results:</b> A total of 174 clinicians participated to the survey. The most common choice was combining antiplatelet therapy with a direct oral anticoagulant (DOAC) at a low dose. Full-dose DOAC alone or antiplatelet therapy alone were less frequently chosen. Older age and high bleeding risk increased the preference for antiplatelet therapy alone. <b>Conclusions:</b> This survey highlights the marked variability in antithrombotic prescribing patterns among specialists in vascular medicine for patients with unprovoked VTE and concomitant PAD, reflecting the lack of evidence on optimal management in this specific setting. More research is needed to define the safest and most effective treatment strategies for patients with concurrent PAD and VTE.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731295","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":"Vitamin D Deficiency as an Independent Predictor for Plaque Vulnerability and All-Cause Mortality in Patients with High-Grade Carotid Disease.","authors":"Stephanie Kampf, Olesya Harkot, Rodrig Marculescu, Svitlana Demyanets, Markus Klinger, Wolf Eilenberg, Johann Wojta, Christoph Neumayer, Stefan Stojkovic","doi":"10.3390/jcm14145163","DOIUrl":"10.3390/jcm14145163","url":null,"abstract":"<p><p><b>Objectives:</b> The mechanisms linking vitamin D deficiency to carotid artery stenosis (CAS) remain unclear. Data on cardiovascular outcomes in CAS patients with vitamin D deficiency are limited. We investigated the association of vitamin D deficiency with carotid plaque morphology and patient outcomes in high-grade CAS. <b>Methods:</b> A total of 332 patients undergoing carotid endarterectomy for symptomatic (n = 113, 34%) or asymptomatic (n = 219, 66%) CAS were included. Preoperative vitamin D levels were measured, and duplex sonography was used to assess luminal narrowing. Associations of vitamin D with clinical presentation were analyzed using univariate and multivariate linear regression. For vitamin D deficiency and the prediction of major adverse cardiovascular events (MACE) and all-cause mortality, the Cox proportional hazard regression model was used. <b>Results:</b> The median age was 69 years (interquartile range (IQR) 64-74), and 94 (29.3%) patients were female. Vitamin D deficiency was present in 84 (25%) patients. Symptomatic patients had significantly lower vitamin D levels (41.2 nmol/L, IQR 25.1-63.5) than asymptomatic patients (51.6 nmol/L, IQR 30.5-74.3, <i>p</i> = 0.011). Patients with echolucent (44.9 nmol/L, IQR 27.4-73.7) or mixed plaques (39.2 nmol/L, IQR 22.9-63.5) had lower vitamin D levels than those with echogenic plaques (52.3 nmol/L, IQR 34.1-75.7). Vitamin D deficiency predicted MACE and all-cause mortality with an adjusted HR of 1.6, 95% CI of 1.1-2.6, and <i>p</i> = 0.030 and an HR of 2.2, 95% CI of 1.3-3.6, and <i>p</i> = 0.002, respectively, in a multivariable Cox proportional hazard regression model. <b>Conclusions:</b> A deficiency in vitamin D was correlated with unstable plaque characteristics and symptomatic CAS. Furthermore, vitamin D deficiency was associated with long-term adverse cardiovascular outcomes and mortality, suggesting its potential as a modifiable risk factor for improved risk stratification in patients undergoing carotid endarterectomy.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 14","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12295226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731533","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}