Journal of Clinical Medicine最新文献

{"title":"Laparoendoscopic Rendezvous: An Effective and Safe Approach in the Management of Cholecysto-Choledocholithiasis in Selected Patients.","authors":"Rossana Percario, Paolo Panaccio, Maria Pia Caldarella, Marco Trappoliere, Maria Marino, Maira Farrukh, Carla Di Giacomo, Giuseppe Di Martino, Giovanni De Nobili, Raffaella Marina di Renzo, Tommaso Grottola, Pierluigi Di Sebastiano, Fabio Francesco di Mola","doi":"10.3390/jcm14041310","DOIUrl":"https://doi.org/10.3390/jcm14041310","url":null,"abstract":"<p><p><b>Background:</b> Different techniques have been proposed to manage Cholecysto-choledocholithiasis (CCL) advantageously in one stage. Among these, Laparoendoscopic Rendezvous (LERV) addresses the CCL issue with a laparoscopic cholecystectomy, with insertion of a guide wire into the common bile duct through an incision of the cystic duct, followed by the clearance of the bile duct carried out by the endoscopists. The aim of this study was to evaluate the safety and the efficacy of the one-stage vs. a two-stage approach (pre-operative ERCP followed by cholecystectomy), and to compare our results with data from the current literature. <b>Methods:</b> All patients that underwent LERV in our facilities between January 2018 and December 2023 were evaluated. As a control group, we included patients that underwent a two-stage technique called the \"sequential approach\". The primary outcome was to evaluate the efficacy in obtaining complete clearance of the common bile duct (CBD). The secondary outcomes included morbidity, mortality, operative time, conversion rate, hospital stay and CDB stone recurrence. <b>Results:</b> 120 patients in the LERV group were included; meanwhile, 70 patients underwent pre-operative ERCP plus cholecystectomy. A 97% bile duct clearance success rate in the LERV group and 93% in the ERCP group was observed, respectively. The median intraoperative time for the one-stage technique was 122 min (<i>p</i> < 0.001) and the median hospital stay was 4 days (<i>p</i> < 0.001). In the LERV group, an overall morbidity of 15% was reported (18/120): 15 Clavien-Dindo type 1, one type 3a and two type 3b (<i>p</i> < 0.001). At a median follow-up of 14 months, five patients experienced stone recurrence. In the ERCP group, we had a 93% success rate; meanwhile, we had longer hospitalization (<i>p</i> < 0.001), 27% post-ERCP pancreatitis (<i>p</i> < 0.001) and a cumulative morbidity of 30%. <b>Conclusions:</b> LERV offers the advantages of a being single-stage procedure and shorter hospitalization, with a lower risk of clinically relevant post-ERCP pancreatitis and failed CBD cannulation.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Hemoglobin, Albumin, Lymphocyte Count, and Platelet (HALP) Score on Survival of Patients with Metastatic Thyroid Cancer Treated with Tyrosine Kinase Inhibitors.","authors":"Hikmet Öztop, Fazıl Çağrı Hunutlu, Selin İldemir Ekizoğlu, Özen Öz Gül, Soner Cander, Ahmet Bilgehan Şahin","doi":"10.3390/jcm14041306","DOIUrl":"https://doi.org/10.3390/jcm14041306","url":null,"abstract":"<p><p>Tyrosine kinase inhibitors (TKIs) are crucial for improving the survival rates of individuals with metastatic thyroid cancer. Moreover, systemic inflammation and malnutrition are known to negatively affect metastatic thyroid cancer prognosis. Evaluating nutritional status at the start of treatment can improve survival rates. <b>Purpose:</b> This study investigated the correlation between the hemoglobin, albumin, lymphocyte count, and platelet (HALP) score and prognosis of patients with metastatic thyroid cancer undergoing first-line TKI therapy. <b>Methods:</b> We retrospectively analyzed data from 44 patients between January 2010 and June 2024. The primary outcomes evaluated in the study were time to treatment failure (TTF) and overall survival (OS); HALP scores were categorized as low (≤29.21) and high (>29.21) based on receiver operating characteristic analysis. <b>Results:</b> The 1-year survival rate was significantly lower in the low HALP score group compared to the high HALP score group (50% vs. 96.3%). Multivariate Cox regression analysis revealed that low HALP scores, elevated leukocyte counts, and lymphopenia were independent predictors of shorter TTF (HR = 0.272, <i>p</i> = 0.011) and OS (HR = 0.208, <i>p</i> = 0.028). <b>Conclusions:</b> The results obtained in the present study demonstrate that the HALP score has prognostic significance for patients with metastatic thyroid cancer who are undergoing first-line TKI treatment. In metastatic thyroid cancer patients, interventions focused on improving nutritional status at the start, during initiation, and throughout the TKI treatment may enhance treatment effectiveness. However, further prospective studies involving larger patient cohorts are necessary to validate our results.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Planning to Practice: Impact of Achieved Proximal Sealing Zone in Endovascular Aneurysm Repair (EVAR).","authors":"Giulio Accarino, Angelo Silverio, Michele Bellino, Sergio Furgiuele, Mario Fimiani, Mattia Sica, Francesco De Vuono, Giovanni Fornino, Davide Turchino, Giancarlo Accarino, Raffaele Serra, Gennaro Galasso, Carmine Vecchione, Umberto Marcello Bracale","doi":"10.3390/jcm14041309","DOIUrl":"https://doi.org/10.3390/jcm14041309","url":null,"abstract":"<p><p><b>Background:</b> Endovascular aneurysm repair (EVAR) is the preferred treatment for abdominal aortic aneurysms (AAAs). This study evaluated the differences between the anticipated and actual achieved proximal sealing zones for standard EVAR endografts and their potential implications in a real-world AAA population. <b>Methods:</b> Data from 275 consecutive EVAR patients treated with the Endurant endograft (Medtronic, Minneapolis, MN, USA) between 2009 and 2022 were retrospectively analyzed. The proximal sealing zone was calculated preoperatively (target anticipated sealing zone, TASZ) and postoperatively (real achieved sealing zone, RASZ) from computed tomography angiography (CTA) images. These metrics were evaluated by assuming that they had a truncated cone shape, calculating the cone's lateral surface by measuring the proximal and distal centerline areas and the distance between the planes. The primary outcome was the occurrence of type 1A endoleak at the longest available follow-up. <b>Results:</b> RASZ was significantly smaller and shorter than TASZ (<i>p</i> = 0.001), with an average area reduction of 24.5 mm² and a median length reduction of 3 mm. Area and cranial length loss were present even when correcting for graft positioning imperfections. In the Cox proportional hazard regression model, TASZ and RASZ lengths were both independently associated with a lower risk of type 1A endoleak (HR: 0.88, 95% CI 0.80-0.96 and HR: 0.92, 95% CI 0.86-0.99, respectively). A Kaplan-Meier analysis confirmed that patients with RASZ > 5.5 mm had a survival free from endoleak higher than patients with RASZ ≤ 5.5 mm. <b>Conclusions</b>: In this real-world AAA population, the achieved proximal sealing zone was significantly shorter and smaller than planned, regardless of optimal endograft placement. The early calculation of RASZ, i.e., the PSZ achieved via CTA, is critical for risk stratification and follow-up.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comorbidities, Endocrine Medications, and Mortality in Prader-Willi Syndrome-A Swedish Register Study.","authors":"Julia Giesecke, Anna Oskarsson, Maria Petersson, Anna Skarin Nordenvall, Giorgio Tettamanti, Ann Nordgren, Charlotte Höybye","doi":"10.3390/jcm14041307","DOIUrl":"https://doi.org/10.3390/jcm14041307","url":null,"abstract":"<p><p><b>Background:</b> Prader-Willi Syndrome (PWS) is a rare, genetic, multi-systemic disorder. Its main characteristics are muscular hypotonia, behavioral problems, intellectual disability, endocrine deficiencies, hyperphagia, and a high risk of morbid obesity and related comorbidities. This study aimed to investigate the rate of comorbidity, prescription of endocrine medications, and mortality in individuals with PWS compared to the general population. <b>Methods:</b> The association between PWS and outcomes were investigated in a matched cohort study of individuals born in the period of 1930-2018 with data from Swedish national health and welfare registers. Each individual was matched with 50 non-PWS comparisons. The associations between PWS, outcomes and prescribed endocrine medications were estimated through Cox proportional hazard models, presented as Hazard Ratios (HR) with 95% Confidence Intervals (CIs). <b>Results:</b> Among 360 individuals (53% men) with PWS, 16% had diabetes mellitus, 6% heart failure, 4% vein thrombosis, 2% atrial fibrillation, 2% coronary heart disease, and 1% pulmonary embolism. Individuals with PWS had an increased rate of heart failure (HR: 23.85; 95% CI: 14.09-40.38), diabetes mellitus (HR: 17.49; 95% CI: 12.87-23.74), vein thrombosis (HR: 10.44; 95% CI: 5.69-19.13), pulmonary embolism (HR: 5.77; 95% CI: 2.27-14.67), atrial fibrillation (HR: 5.19; 95% CI: 2.48-10.86), and coronary heart disease (HR: 3.46; 95% CI: 1.50-7.97) compared to non-PWS individuals. Somatotropin was prescribed in 63%, antidiabetics in 18%, and thyroid hormones in 16% of the PWS individuals (<1%, 2%, and 3%, respectively, in non-PWS individuals). The rate of mortality was fifteen times higher in PWS than in non-PWS, with a mean age at death of 42 years. <b>Conclusions:</b> The rates of diabetes mellitus and cardiovascular comorbidities were higher in individuals with PWS. As expected, the prescription of somatotropin was high, but the endocrine prescription pattern also reflected the high prevalence of diabetes mellitus and thyroid illness. Although the mean age at death was older than previously reported, a higher awareness and intensified efforts to avoid obesity, as well as the prevention and early treatment of cardiovascular and endocrine comorbidity, are crucial aims in the care of people with PWS.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic Advancements in Psoriasis and Psoriatic Arthritis.","authors":"Robin C Yi, Maya Akbik, Logan R Smith, Yael Klionsky, Steven R Feldman","doi":"10.3390/jcm14041312","DOIUrl":"https://doi.org/10.3390/jcm14041312","url":null,"abstract":"<p><p><b>Background:</b> Within the past few years, many new therapies have emerged for psoriasis and psoriatic arthritis (PsA). Current topical therapies-including corticosteroids, vitamin D analogs, tapinarof, and roflumilast-remain the mainstay for mild disease, while oral systemic and biologic options are for moderate to severe cases. Biologics-such as Tumor necrosis factor-alpha (TNF-alpha), Interleukin 12/23 (IL-12/23), Interleukin-17 (IL-17), and Interleukin-23 (IL-23)-have revolutionized care by providing highly effective and safer alternatives. Oral small molecules, including Janus kinase (JAK) and tyrosine kinase 2 (TYK2) inhibitors, further expand the therapeutic options. <b>Objectives</b>: The goal for this review article was to examine current and latest treatments for psoriasis and PsA and discuss whether these emerging therapeutic options address the unmet needs of current treatments. <b>Methods</b>: The search for this review article included PubMed, Google Scholar, and ClinicalTrials.gov for relevant articles and current clinical trials using keywords. <b>Results:</b> A wide range of novel psoriatic and PsA therapies are currently undergoing clinical trials. These include selective JAK inhibitors, TYK2 inhibitors, retinoic acid-related orphan receptor (RORγT) inhibitors, oral IL-23 receptor inhibitors, oral IL-17A inhibitors, nanobody products, sphingosine-1-phosphate (S1P1R) antagonists, A3 adenosine receptor (A3AR) agonists, heat shock protein (HSP) 90 inhibitors, and rho-associated protein kinases (ROCK-2) inhibitors. <b>Conclusions:</b> These different mechanisms of action not only expand treatment options but may offer potential solutions for patients who do not achieve adequate response with existing therapies. However, the safety and contraindications of these newer agents remain an important consideration to ensure appropriate patient selection and minimize potential risks. Certain mechanisms may pose increased risks for infection, cardiovascular manifestations, malignancy, or other immune-related adverse events, necessitating careful monitoring and individualized treatment decisions. Ongoing clinical research aims to address unmet needs for patients who do not respond to previous agents to achieve sustained remission, monitor long-term safety outcomes, and assess patient preferences for delivery, including a preference for oral delivery. Oral IL-23 inhibitors hold potential due to their robust safety profiles. In contrast, oral IL-17 inhibitors and TYK-2 inhibitors are effective but may present side effects that could impact their acceptability. It is essential to balance efficacy, safety, and patient preferences to guide the selection of appropriate therapies.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The BG Study Part 1 (Bergisch Gladbach): Development of a Prototype Coronary Artery Disease Risk Score Incorporating Peripheral Vascular Parameters-Preliminary Insights for Future CAD Risk Prediction Models in Vascular Patients.","authors":"Tuna Aras, Mahmoud Tayeh, Adel Aswad, Mohamed Sharkawy, Zaki Almuzakki, Bernhard Dorweiler, Payman Majd","doi":"10.3390/jcm14041297","DOIUrl":"https://doi.org/10.3390/jcm14041297","url":null,"abstract":"<p><p><b>Background:</b> Peripheral vascular parameters may provide valuable insights into coronary artery disease (CAD) risk stratification. This study aimed to develop a CAD risk score by integrating carotid duplex velocities, ankle-brachial index (ABI), and clinical history into a point-based model. <b>Methods:</b> We analyzed data from 902 cardiology patients, of whom 592 (65.6%) had confirmed CAD based on coronary angiography. Peripheral vascular assessments included carotid duplex ultrasonography and ABI measurements. Predictors were identified through multivariate logistic regression, addressing multicollinearity and interaction effects. A point-based scoring system was developed using statistically significant variables and evaluated via receiver operating characteristic (ROC) analysis. <b>Results:</b> Key predictors included external carotid artery velocities, ABI, carotid stenosis, chronic kidney disease (CKD) stage, smoking history, diabetes, hypertension, and age. The scoring system demonstrated moderate discriminative ability (AUC: 0.683) and high sensitivity (97%) for detecting CAD-positive cases but lower specificity (11%) for CAD-negative cases. Patients were stratified into risk categories, with an optimal threshold of ≥7 points maximizing the F1 score. <b>Conclusions:</b> This novel scoring system highlights the clinical relevance of integrating peripheral vascular assessments into CAD risk models. While its high sensitivity ensures robust detection of CAD-positive patients, future multicenter studies are needed to improve specificity and validate its broader clinical utility.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Injective Therapies for Managing Sacroiliac Joint Pain in Spondyloarthropathy: A Systematic Review and Meta-Analysis.","authors":"Tosca Cerasoli, Giuseppe Filardo, Antongiulio Favero, Vito Gaetano Rinaldi, Laura Di Maio, Giulio Maria Marcheggiani Muccioli, Stefano Zaffagnini","doi":"10.3390/jcm14041294","DOIUrl":"https://doi.org/10.3390/jcm14041294","url":null,"abstract":"<p><p><b>Background</b>: The most effective treatment approach for sacroiliac joint (SIJ) pain in spondyloarthropathy (SpA) patients remains unclear. This systematic review and meta-analysis aimed to assess the safety and effectiveness of different injective therapies for SIJ pain in SpA patients. <b>Methods</b>: A comprehensive literature search was conducted up to January 2024. The inclusion criteria encompassed studies in English, including comparative and non-comparative studies, and case series. A meta-analysis was performed on the available data. The \"Checklist for Measuring Quality\" by Downs and Black was used to evaluate the quality of included papers. <b>Results</b>: A total of 17 studies involving 494 patients were included: 12 prospective case series, 1 retrospective comparative study, 2 prospective comparative studies, and 2 randomized controlled trials. Steroid injections were analyzed in 15 studies, etanercept in 1, and infliximab in 1. A meta-analysis of 375 patients receiving steroid injections showed a significant reduction in visual analog scale (VAS) scores from 8.2 pre-treatment to 3.2 (<i>p</i> < 0.001) at short-term follow-up, with stability at mid-term follow-up (VAS 3.3, <i>p</i> < 0.001) and worsening at the last follow-up (VAS 5.1, <i>p</i> < 0.001). The failure rate was 13% (<i>p</i> = 0.019), and one study reported a 12.5% complication rate. Biologic therapies showed no complications or failures, with improvements in both VAS and BASDAI scores. <b>Conclusions</b>: Intra-articular steroid injections are effective and safe for SIJ pain in SpA patients, although their efficacy diminishes over time, and not all patients respond to treatment. Biologic therapies have shown promising results, but further research is needed to confirm their long-term efficacy.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of Digital Measurements: Analysis of Orthopantomography Versus Lateral Cephalograms for Evaluation of Facial Asymmetry.","authors":"Andra-Alexandra Stăncioiu, Alexandru Cătălin Motofelea, Anca Adriana Hușanu, Lorena Vasica, Riham Nagib, Adelina Popa, Camelia Szuhanek","doi":"10.3390/jcm14041296","DOIUrl":"https://doi.org/10.3390/jcm14041296","url":null,"abstract":"<p><p><b>Background/Objectives</b>: This study aimed to compare the associations of digital measurements obtained from orthopantomographies (OPGs) or panoramic radiographs and lateral cephalograms in evaluating facial asymmetry in patients with different skeletal classes. The sample consisted of 128 Romanian patients (67 females, 61 males) who sought orthodontic treatment. These measurements are an essential diagnostic tool for evaluating facial asymmetry in order to treat them. <b>Methods</b>: Lateral cephalograms and OPGs were obtained for each patient, and digital tracing was performed using the WebCeph program. Angular measurements (ANB, FMA, gonial angles) and linear measurements (ramus height, mandibular body length) were assessed on both imaging modalities. <b>Results</b>: Strong positive correlations were found between the gonial angle and ramus height measurements obtained from lateral cephalograms and OPGs (rs range: 0.800-0.946; <i>p</i> < 0.001). However, the mandibular body length showed weaker correlations between the two methods. Significant sex differences were observed, with males exhibiting larger craniofacial measurements compared to females (<i>p</i> < 0.05). The study population was quite young, as seen by the cohort's median age of 21 years and interquartile range (IQR) of 16 to 29 years. Lateral Ceph: the FMA angle median value of 22° (IQR: 17-25), gonial angle median of 121° (IQR: 116-127), mandibular ramus height median value of 44 mm (IQR: 41-48 mm), and mandibular body length median value of 70 mm (IQR of 65 to 76 mm). OPG: gonial angles on the right and left sides yield medians of 121° (IQR: 116-127) and 122° (IQR: 117-127); the mandibular ramus height on the right and left sides shows medians of 44.0 mm (IQR: 40.0-47.0 mm) and 43 mm (IQR: 40-48 mm); and the mandibular body on the right side presents a median of 71 mm (IQR: 67-76 mm) and the left side has a median of 71 mm (IQR: 67-75 mm). <b>Conclusions</b>: The findings suggest that OPGs can be reliably used to measure the gonial angle and ramus height, providing results comparable to lateral cephalograms. However, caution should be exercised when predicting horizontal measurements from OPGs. The standardization of the OPG recording process and further research with larger sample sizes are required to establish standard panoramic norms for OPG parameters in the assessment of facial asymmetry.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the Crossmatch Test in Kidney Transplantation Up to the Virtual Level.","authors":"Nataša Katalinić, Tajana Crnić Marčetić, Zlatko Trobonjača, Franco Barin-Turica, Sanja Balen","doi":"10.3390/jcm14041288","DOIUrl":"https://doi.org/10.3390/jcm14041288","url":null,"abstract":"<p><p>The Human Leukocyte Antigen (HLA) system forms the central part of the immune system and is crucial in the recognition and elimination of \"non-self\" antigens. While this role of the HLA system is essential in the effective defense of the organism against pathogens, it is undesirable in organ and tissue transplantation because it enables the recognition of mismatched HLA molecules of the donor as being foreign and stimulates the graft rejection reaction. Organ transplantation involves the introduction of antigens that are more or less mismatched to the recipient; therefore, in order to achieve the best possible match in the HLA system between the recipient and the donor, a whole series of immunogenetic tests is performed, including crossmatching (XM). If performed before kidney transplantation, it represents the final in vitro test to rule out the presence of donor-specific antibodies, which may cause graft rejection and which may not have been detected by earlier serum screening. The beginning of XM was marked by the complement-dependent cytotoxicity (CDC) method developed by Terasaki and colleagues in 1964. Later, as a result of advances in technology and the need for methods that overcome the limitations of CDC, flow cytometry and Luminex XM assays were developed. The introduction of solid-phase technology brought a new dimension to the detection of low-level HLA antibodies and the determination of their specificities, which enabled the development and implementation of the virtual XM test (vXM). It is an <i>in silico</i> test that assesses the immunological match between the recipient and the organ donor based on the analysis of the specificity of the antibodies present in the recipient's serum and the HLA typing of the organ donor. Each method has its own advantages and limitations, which are described below and need to be taken into account, considering their significant impact on clinical application in kidney transplantation.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Admission Ward on Long-Term Outcomes in Patients with Non-ST Elevation Myocardial Infarction.","authors":"Carmi Bartal, Ranin Hilu, Hadel Alsana, Ido Peles, Gal Tsaban, Miri Merkin, Gabriel Rosenstein, Aref El-Nasasra, Hezzy Shmueli, Yigal Abramowitz, Carlos Cafri, Doron Zagher, Edward Koifman","doi":"10.3390/jcm14041284","DOIUrl":"https://doi.org/10.3390/jcm14041284","url":null,"abstract":"<p><p><b>Background</b>: Patients presenting with non-ST elevation myocardial infarction (NSTEMI) are often admitted to medical wards. We aimed to evaluate the impact of the admitting department on long-term outcomes. <b>Methods</b>: Patients admitted to a large tertiary center were categorized according to the admission ward, either the intensive cardiac care unit (ICCU) or internal medicine department (IMD). We compared major adverse cardiovascular events (MACEs), a composite of all-cause death, recurrent myocardial infarction (MI), and revascularization, along with the individual components of MACE, between the two groups during a long-term follow-up. <b>Results</b>: A total of 11,779 NSTEMI patients were included, with 4522 admitted to the ICCU and 7257 to the department of internal medicine. Patients admitted to the ICCU had lower systolic blood pressure, higher troponin levels and lower left ventricular ejection fraction (LVEF) compared to those in the IMD group, indicating greater initial clinical severity. Although patients admitted to the ICCU experienced a significantly higher rate of in-hospital complications, there were no significant differences in the incidence of in-hospital deaths between the two groups. During 5-year follow-up, NSTEMI patients initially admitted to the ICCU had significantly lower rates of mortality and MACEs. The estimated hazard ratio for 5-year MACE and 5-year mortality rates for NSTEMI patients admitted to the IMD vs. those admitted to the ICCU were 2.03 (95% CI, 1.04-3.34) and 2.5 (95% CI, 1.10-4.38), respectively. <b>Conclusions</b>: NSTEMI patients admitted to the ICCU experienced lower long-term mortality and MACE rates. These findings support the management of NSTEMI patients in cardiac wards and warrant further research into the reasons for the improved outcome.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}