Journal of Clinical Medicine最新文献

{"title":"Nutritional Support for Necrotizing Soft Tissue Infection Patients: From ICU to Outpatient Care.","authors":"Eftikhar A Akam, Stacy L Pelekhaty, Caitlin P Knisley, Michael G Ley, Noah V Loran, Eric J Ley","doi":"10.3390/jcm14093167","DOIUrl":"10.3390/jcm14093167","url":null,"abstract":"<p><p>Although nutrition recommendations for patients with necrotizing soft tissue infections (NSTIs) often parallel those for patients with burn injuries, differences in the metabolic response to stress indicate that NSTIs require a unique approach. The sepsis and wound management associated with NSTIs trigger a metabolic response, driven by inflammatory and neuroendocrine changes, that leads to high circulating levels of cortisol, catecholamines, insulin, and pro-inflammatory cytokines. This metabolic response follows four phases of recovery (Early Acute; Late Acute; Persistent Inflammation, Immunosuppression, and Catabolism Syndrome; Recovery) that require a thoughtful approach to nutrition by risk screening, malnutrition assessment, and micronutrient deficiency assessment. Close monitoring of energy expenditure and protein needs is required for appropriate nutrition management. Nutrition intake after transfer from the intensive care unit and hospital discharge is often inadequate. Ongoing monitoring of nutrition intake at all outpatient follow-up appointments is necessary, regardless of the route of delivery, until the nutrition status stabilizes and any nutritional decline experienced during hospitalization has been corrected.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994285","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":"Outcomes of Post-Keratoplasty Microbial Keratitis: A 16-Year Analysis.","authors":"Joanna Przybek-Skrzypecka, Małgorzata Ryk-Adamska, Janusz Skrzypecki, Justyna Izdebska, Monika Udziela, Joanna Major, Jacek P Szaflik","doi":"10.3390/jcm14093165","DOIUrl":"10.3390/jcm14093165","url":null,"abstract":"<p><p><b>Purpose:</b> To determine the incidence, risk factors (including systemic immunosuppression), and outcomes of microbial keratitis in corneal transplants over a 16-year observation period at a tertiary referral hospital in Poland. <b>Methods:</b> This retrospective cohort study included 125 episodes of infectious keratitis in 117 patients who underwent corneal transplantation between 2008 and 2023 at the Department of Ophthalmology, Medical University of Warsaw, Poland. The data collected included demographics, indications for transplantation, infection rates, risk factors, best-corrected visual acuity (BCVA) at presentation and discharge, changes in visual acuity, and treatments received prior to hospital admission. Clinical signs, symptoms, diagnostic tests, and management strategies were also reviewed. Additionally, the outcomes of surgical interventions, such as therapeutic corneal transplantation and evisceration, were examined. <b>Results</b>: Among the 2869 corneal transplants performed over the 16-year period, the incidence of post-keratoplasty microbial keratitis (PKMK) was 4.35%. The most common indication for transplantation in affected patients was an active infection unresponsive to medical therapy (n = 62, 52%). One-third of PKMK cases occurred in patients with repeat transplants. Median visual acuity prior to infection was 1.6 logMAR, worsening to 2.3 logMAR at presentation. Following treatment, visual acuity improved to a median of 1.9 logMAR at discharge, with no significant improvement by the one-year follow-up. At that time, 75.1% of patients remained legally blind (BCVA ≤ 20/200); 21% recovered to pre-infection visual levels, while 46% experienced additional visual loss due to PKMK. Multivariate regression identified corneal perforation and systemic immunosuppression as independent predictors of poorer visual outcomes (<i>p</i> < 0.001 and <i>p</i> = 0.03, respectively. <b>Conclusions</b>: Microbial keratitis in corneal grafts is associated with poor long-term visual outcomes. At one year post-infection, the median BCVA was 1.9 logMAR, with 75.1% of patients remaining legally blind. Nearly half of the cohort experienced additional visual loss compared to their pre-infection status, underscoring the severity of PKMK and the need for vigilant postoperative care.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12073063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010001","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":"Pelvic and Perineal Reconstruction After Bowel, Gynecological or Sacral Tumor Resection: A Case Series.","authors":"Aikaterini Bini, Spyridon Stavrianos","doi":"10.3390/jcm14093172","DOIUrl":"10.3390/jcm14093172","url":null,"abstract":"<p><p><b>Background/Aim:</b> Perineal, pelvic and urogenital reconstruction presents a challenge, not only due to defect size but also due to high morbidity resulting from surgery and post-operative complications. The purpose of this study is to review the surgical approach and evaluate the results regarding pelvic/perineal reconstruction after advanced tumor resection. <b>Patients and Methods:</b> The total number of patients was 34 (11 males, 23 females). The histology varied, including sixteen rectal-anal squamous cell carcinomas, five Buschke-Lowenstein tumors, four vulvar-vaginal carcinomas, four sacral chordomas, two cutaneous squamous cell carcinomas, two soft tissue sarcomas and a case of Paget's disease. Most patients had previously been treated with colectomies and/or gynecological resections and received a full dose of radiotherapy. Reconstruction was performed with the following flaps: oblique/vertical rectus abdominis myocutaneous flap (ORAM/VRAM), gracilis myocutaneous flap, inferior gluteal artery perforator flap (IGAP), internal pudendal artery perforator flap (IPAP) and lotus petal flaps. <b>Results:</b> Most patients had a relatively uncomplicated post-operative course. Surgical site infection and wound dehiscence occurred more commonly with the thigh flaps rather than the abdominal flaps. However, the aggression and the frequent recurrences of these tumors had as a result, only 15 out of 34 patients achieved a five-year disease-free survival. <b>Conclusions:</b> Pelvic and perineal defects are usually massive and the use of myocutaneous flaps to eliminate the dead space is of paramount importance. Although these are mainly salvage operations with a low survival rate, they promote patients' quality of life. A frequent challenge is the simultaneous achievement of tumor radical resection and pelvis functionality.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027653","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":"High-Volume Hemodiafiltration: Expanding the Evidence Beyond Randomized Trials-A Critical Perspective on the 2025 EuDial Consensus.","authors":"Stefano Stuard, Franklin W Maddux","doi":"10.3390/jcm14093174","DOIUrl":"10.3390/jcm14093174","url":null,"abstract":"<p><p>The 2025 EuDial Consensus systematically compared hemodiafiltration (HDF) to high-flux hemodialysis (HD), highlighting HDF's superior removal of middle-molecular-weight uremic toxins, potential survival advantages, and immunomodulatory properties. High-Volume HDF (HVHDF), defined by a substitution volume exceeding 23 L per session, was associated with improved cardiovascular outcomes, reduced infection-related mortality, and decreased systemic inflammation. <b>Background/Objectives:</b> Nevertheless, the consensus refrains from endorsing HDF as the standard of care, citing insufficient evidence to prevent sudden cardiac death, reduce intradialytic hypotension, or significantly lower hospitalization rates compared to HD. <b>Methods:</b> This review critically evaluates the EuDial Consensus, highlighting its methodological strengths while noting potential limitations stemming from an exclusive reliance on randomized controlled trials (RCTs). The exclusion of real-world evidence (RWE) and mechanistic studies may have led to an underestimation of HDF's broader clinical benefits, particularly in cardiovascular stability, inflammation control, and anemia management. <b>Results:</b> Multiple studies have demonstrated HDF's capacity to enhance immune function, improve erythropoiesis, and increase the clearance of beta-2 microglobulin (β2M) and other pro-inflammatory toxins. Furthermore, the CONVINCE trial's economic analysis supports HDF's cost-effectiveness, especially when considering improved survival and reduced dependency on erythropoiesis-stimulating agents. <b>Conclusions:</b> Future research should integrate RWE and mechanistic insights to better define HDF's therapeutic potential, particularly concerning anemia control, infection mitigation, and hemodynamic stability. While the EuDial Consensus provides valuable clinical guidance, its conclusions should be contextualized within a broader and evolving evidence base. Given its multidimensional benefits, post-dilution HVHDF is increasingly viewed as a preferred renal replacement therapy modality, warranting wider adoption in clinical practice.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011976","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":"Post-Marketing Safety of Spinal Muscular Atrophy Therapies: Analysis of Spontaneous Adverse Drug Reactions from EudraVigilance.","authors":"Andrej Belančić, Petar Mas, Lara Miletić, Barbara Kovačić Bytyqi, Dinko Vitezić","doi":"10.3390/jcm14093173","DOIUrl":"10.3390/jcm14093173","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Spinal muscular atrophy (SMA) treatment has evolved with the approval of nusinersen, onasemnogene abeparvovec, and risdiplam. This study aims to assess the post-marketing safety profile of these therapies through the spontaneous adverse drug reaction (ADR) reports available in EudraVigilance (EV). <b>Methods</b>: Data from EV were retrieved via adrreports.eu for the suspected ADRs associated with nusinersen, onasemnogene abeparvovec, and risdiplam from their approval in the European Economic Area (EEA) to 31 December 2024. The ADR reports were exported and analysed using descriptive statistics in Microsoft Excel. Reporting odds ratios (RORs) with 95% confidence intervals (CIs) were calculated for suspected ADRs, focusing on reactions with a lower limit of the 95% CI exceeding 1. <b>Results</b>: A total of 3196, 806, and 956 individual case safety reports (ICSRs) were identified for nusinersen, onasemnogene abeparvovec, and risdiplam, respectively. The most frequently reported ADRs with significantly increased RORs included post-lumbar puncture syndrome (nusinersen: 11%), pyrexia (onasemnogene abeparvovec: 23%), and pneumonia (risdiplam: 9%). While some ADRs were therapy-specific, others were consistent with SMA disease progression and complications. Onasemnogene abeparvovec showed a notable prevalence of hepatotoxicity, while risdiplam was associated with gastrointestinal and respiratory events. <b>Conclusions</b>: To conclude, the analysis reinforces the known safety profiles of these SMA treatments while highlighting potential areas for further investigation. ADRs related to SMA complications require careful differentiation from true drug-related effects. Future pharmacovigilance efforts should focus on long-term safety assessments and real-world evidence to optimize treatment strategies.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994682","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":"Innovating Pelvic Fracture Surgery: Development and Evaluation of a New Surgical Table for Enhanced C-Arm Imaging and Operational Efficiency.","authors":"Yong-Cheol Yoon, Min Jun Kim, Ji Sub Lim, Hyung Keun Song","doi":"10.3390/jcm14093169","DOIUrl":"10.3390/jcm14093169","url":null,"abstract":"<p><p><b>Background:</b> Pelvic fractures require precise reduction and stabilization, necessitating high-quality C-arm imaging and accurate patient positioning. Standard operating tables often obstruct optimal C-arm maneuverability. To address this, we developed a new auxiliary surgical table that integrates with existing tables and evaluated its clinical utility compared to a specialized carbon surgical table. <b>Methods:</b> Between March 2018 and June 2023, we conducted a retrospective study involving 162 patients (97 men and 65 women; average age 45.7 years) who underwent percutaneous sacroiliac screw fixation for pelvic fractures. Ninety patients were treated using the newly developed table, and seventy-two patients were treated using the carbon table. The new table, measuring 200 cm in length, 50 cm in width, and 2 cm in thickness, was constructed from waterproof plywood and designed to be securely attached to existing operating tables. We compared surgical preparation times, economic costs, and intraoperative imaging feasibility between the two groups. <b>Results:</b> Use of the new table significantly reduced the surgical preparation time by an average of 21 min and saved approximately $43,000 in cost compared to the carbon table. Subjective assessments indicated no notable difference in intraoperative C-arm image quality between the two groups. The new table allowed free C-arm rotation by overcoming the mechanical limitations of conventional tables. <b>Conclusions:</b> The new auxiliary table demonstrated clinical feasibility and economic advantages without compromising intraoperative imaging quality, offering a practical and cost-effective alternative for pelvic fracture surgeries.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021999","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":"An Assessment of Clinician Knowledge of Hidradenitis Suppurativa: Insights from a Multidisciplinary Survey Study.","authors":"Klaudia Knecht-Gurwin, Adam Gurwin, Magdalena Łyko, Tomasz Drewa, Wojciech Kielan, Agnieszka Mastalerz-Migas, Rafał Stojko, Jacek C Szepietowski, Lukasz Matusiak","doi":"10.3390/jcm14093171","DOIUrl":"10.3390/jcm14093171","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Hidradenitis suppurativa (HS) is a chronic, debilitating skin disease primarily diagnosed through clinical examination. Despite its characteristic clinical features, HS remains under-recognized and frequently misclassified, especially by non-dermatologist clinicians. This study aims to evaluate the diagnostic accuracy of HS across various specialties, identify knowledge gaps, and inform targeted educational strategies to reduce diagnostic delays. <b>Methods:</b> A cross-sectional survey was conducted during multidisciplinary scientific conferences, enrolling 655 clinicians including dermatologists, gynecologists, urologists, general surgeons, and general practitioners. Participants were presented with clinical images representing HS lesions at Hurley stages I-III and responded to open-ended and closed-ended diagnostic questions. Data were analyzed to assess diagnostic accuracy and compare recognition patterns across specialties. <b>Results:</b> The recognition of HS varied significantly by specialty and disease stage. For Hurley stage III axillary disease, correct identification was highest among dermatologists (96.56%) compared to general practitioners (48.91%), gynecologists (31.25%), urologists (40%), and general surgeons (63.64%). In a Hurley II genital case in a male patient, only 34.5% diagnosed HS, while 25.65% suggested furunculosis and 16.18% venereal granuloma. For a Hurley I genital case in a female patient, 29.92% diagnosed HS, with furunculosis (23.36%) and steatocystoma multiplex (14.35%) as common misdiagnoses. A Hurley III buttock case was correctly identified by only 29.77% of participants. <b>Conclusions:</b> This large, first-of-its-kind global survey highlights substantial gaps in HS recognition, particularly among non-dermatologist clinicians. The findings underscore the urgent need for targeted, multidisciplinary educational interventions to improve diagnostic accuracy, reduce delays, and ultimately enhance patient outcomes in HS.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028574","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":"Juvenile Spondyloarthropathies: Diagnostic and Therapeutic Advances-A Narrative Review.","authors":"Călin Lazăr, Mirela Crișan, Oana-Iulia Man, Lucia Maria Sur, Gabriel Samașca, Alexandru Cristian Bolunduț","doi":"10.3390/jcm14093166","DOIUrl":"10.3390/jcm14093166","url":null,"abstract":"<p><p>Spondyloarthropathies (SpAs) represent a diverse group of seronegative immune-mediated inflammatory diseases characterized by a genetic predisposition and an association with human leukocyte antigen-B27. This narrative review aims to explore juvenile spondyloarthropathies (JSpAs), their classification, clinical manifestations, diagnostic challenges, and contemporary treatment strategies. According to the International League of Associations for Rheumatology criteria, JSpAs include several specific forms: enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis. Despite established classifications, the terms and definitions surrounding these conditions can often lead to confusion among healthcare professionals. This ambiguity underscores the need for a standardized approach to nosological classification. The clinical presentation of JSpAs can be multifaceted, encompassing both articular and extra-articular manifestations. Articular symptoms may include enthesitis and varying forms of arthritis, while extra-articular involvement can range from uveitis to gastrointestinal, cardiovascular, pulmonary, neurological, and renal complications. These diverse manifestations highlight the systemic nature of the disease and the importance of a holistic approach to diagnosis and treatment. While laboratory tests for SpAs are often non-specific, imaging modalities such as musculoskeletal ultrasound and magnetic resonance imaging play a crucial role in the early detection of inflammatory lesions. These imaging techniques can provide valuable insights into disease progression and aid in the formulation of appropriate treatment plans. Current treatment guidelines advocate for a \"stepwise\" approach to therapy, beginning with nonsteroidal anti-inflammatory drugs and progressing to glucocorticoids, disease-modifying antirheumatic drugs, and biological agents, particularly anti-tumor necrosis factor alpha agents. The primary objective of treatment is to achieve clinical remission or, at a minimum, to attain low disease activity. Regular monitoring of disease activity is imperative; however, the lack of validated assessment tools for the pediatric population remains a significant challenge. JSpAs pose unique challenges in terms of diagnosis and management due to their diverse manifestations and the complexities of their classification. Ongoing research and clinical efforts are essential to refine our understanding of these conditions, improve treatment outcomes, and enhance quality of life for affected children and their families. Effective management hinges on early detection, individualized treatment plans, and continuous monitoring, ensuring that patients receive the most appropriate care tailored to their specific needs.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966580","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":"Effect of Electroconvulsive Therapy (ECT) on IL-1β, IP-10, IL-17, TNFα, IL-10 and Soluble IL-2 Receptor in Treatment-Resistant Schizophrenia (TRS) Patients-A Preliminary Study.","authors":"Anna Maria Szota, Małgorzata Ćwiklińska-Jurkowska, Izabela Radajewska, Kinga Lis, Przemysław Grudzka, Wiktor Dróżdż","doi":"10.3390/jcm14093170","DOIUrl":"10.3390/jcm14093170","url":null,"abstract":"<p><p><b>Background</b>: Resistance to antipsychotic treatment in patients suffering from schizophrenia is linked to immune system disequilibrium. One effective therapeutic option for treatment-resistant schizophrenia is electroconvulsive therapy (ECT); however, its impact on cytokines remains poorly understood. The aim of this study is to evaluate the impact of ECT on cytokines (IL-1β, IP-10, IL-17, TNFα, IL-10, and soluble receptor for IL-2 (sIL-2R)) in TRS patients. Additionally, correlations between cytokine concentrations and schizophrenia symptoms severity are explored. <b>Methods</b>: Cytokine and receptor concentrations were measured in eight TRS patients before and after ECT and in 13 healthy participants from control group. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate the severity of the symptoms. <b>Results</b>: Before ECT, TRS patients exhibited significantly higher concentrations of IL-1ß, IL-10, IL-17, and IP-10 compared to the control group, whereas no significant differences were observed in sIL-2R and TNF-α. In the TRS patients, ECT induced a significant reduction in IL-10, IL-17 and IP-10 levels, while IL-1β, TNF-α, and sIL-2R remained unchanged compared to pre-ECT. ECT also led to clinical improvement in schizophrenia symptoms, as measured by PANSS. Furthermore, correlations between cytokine levels and PANSS results were found. <b>Conclusions</b>: The above results suggest that clinical improvement in TRS patients following ECT is associated with immune modulation, especially with the steadiness between pro- and anti-inflammatory systems. However, further research is required to elucidate these mechanisms in greater detail.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010690","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":"Role of Respiratory Viruses in Severe Acute Respiratory Failure.","authors":"David Mokrani, Jean-François Timsit","doi":"10.3390/jcm14093175","DOIUrl":"10.3390/jcm14093175","url":null,"abstract":"<p><p>Respiratory viruses are widespread in the community, affecting both the upper and lower respiratory tract. This review provides an updated synthesis of the epidemiology, pathophysiology, clinical impact, and management of severe respiratory viral infections in critically ill patients, with a focus on immunocompetent adults. The clinical presentation is typically nonspecific, making etiological diagnosis challenging. This limitation has been mitigated by the advent of molecular diagnostics-particularly multiplex PCR (mPCR)-which has not only improved pathogen identification at the bedside but also significantly reshaped our understanding of the epidemiology of respiratory viral infections. Routine mPCR testing has revealed that respiratory viruses are implicated in 30-40% of community-acquired pneumonia hospitalizations and are a frequent trigger of acute decompensations in patients with chronic comorbidities. While some viruses follow seasonal patterns, others circulate year-round. Influenza viruses and Pneumoviridae, including respiratory syncytial virus and human metapneumovirus, remain the principal viral pathogens associated with severe outcomes, particularly acute respiratory failure and mortality. Bacterial co-infections are also common and substantially increase both morbidity and mortality. Despite the growing contribution of respiratory viruses to the burden of critical illness, effective antiviral therapies remain limited. Neuraminidase inhibitors remain the cornerstone of treatment for severe influenza, whereas therapeutic options for other respiratory viruses are largely lacking. Optimizing early diagnosis, refining antiviral strategies, and systematically addressing bacterial co-infections are critical to improving outcomes in patients with severe viral pneumonia.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995555","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}