Journal of Clinical Medicine最新文献

{"title":"Intraoperative Nerve Monitoring in Thyroid Surgery: A Comprehensive Review of Technical Principles, Anesthetic Considerations, and Clinical Applications.","authors":"Ji-Yoon Jung","doi":"10.3390/jcm14093259","DOIUrl":"10.3390/jcm14093259","url":null,"abstract":"<p><p><b>Background</b>: Intraoperative nerve monitoring (IONM) is increasingly recognized as an essential technique in thyroid surgery to preserve the integrity of the recurrent laryngeal nerve (RLN) and prevent postoperative complications. Although widely adopted, several technical and anesthetic factors can significantly affect the reliability and interpretation of electromyographic (EMG) signals. <b>Methods</b>: This narrative review summarizes the principles and methodologies of IONM in thyroid surgery, focusing on the mechanisms of RLN injury, the clinical benefits of IONM, and its limitations. Particular emphasis is placed on the anesthesiologic considerations, including the effects of neuromuscular blocking agents and anesthetic maintenance methods for EMG signal quality. Recent advances in alternative IONM techniques are also discussed. <b>Results</b>: IONM facilitates early detection of RLN injury and improves surgical outcomes. However, signal loss and technical errors occur in up to 23% of cases. Appropriate anesthetic management, such as the judicious use of neuromuscular blocking agents and the use of reversal agents like sugammadex, can significantly improve IONM accuracy. Alternative approaches, such as transcutaneous or thyroid cartilage electrode-based monitoring, show promise in overcoming current limitations. <b>Conclusions</b>: IONM is a valuable tool in modern thyroid surgery, aiding in the prevention of RLN injury. Anesthesiologists play a crucial role in optimizing IONM quality by managing factors that affect EMG signals. Ongoing research into novel monitoring techniques is expected to further enhance patient safety and surgical precision.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007841","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":"Risk Factors for Prenatal Anxiety in European Women: A Review.","authors":"Alba Val, Cristina M Posse, M Carmen Míguez","doi":"10.3390/jcm14093248","DOIUrl":"10.3390/jcm14093248","url":null,"abstract":"<p><p><b>Background:</b> Prenatal anxiety is a common problem affecting a large number of women. The presence of anxiety during pregnancy is associated with adverse consequences for both the mother and the baby. The main objective of this review was to determine the risk factors associated with anxiety during pregnancy in European women. Specifically, we wanted to know if these factors are the same as those found in other continents and if they are similar to those associated with depression during this stage. <b>Methods:</b> A literature review was carried out on studies that were published in the last 10 years in the PsycInfo, Medline, and SCOPUS databases. Thirteen studies were selected for the purposes of this review. <b>Results:</b> Sociodemographic risk factors associated with a higher level of anxiety during pregnancy included having a lower educational level and socioeconomic status. Obstetric and pregnancy-related risk factors included having had complications during pregnancy. Having a history of mental health problems, low social support, high levels of stress, and being exposed to adverse life events were the most relevant psychological factors for presenting prenatal anxiety. Furthermore, these factors are largely common to those associated with prenatal anxiety in other continents of the world and to those associated with prenatal depression. <b>Conclusions</b>: This review shows that there are multiple factors that contribute to women experiencing prenatal anxiety. Most can be identified at the beginning of pregnancy, and some factors, such as psychological ones, are potentially modifiable. This underlines the importance of carrying out a proper screening for anxiety during pregnancy in order to prevent its onset or treat it appropriately. Furthermore, the fact that risk factors are common for both prenatal anxiety and depression implies that the same intervention could reduce the probability of the onset of both pathologies and the possible consequences associated with them.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064039","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":"Postoperative Infection After Esophageal Injury in Anterior Cervical Spine Surgery: A Comprehensive Review of Diagnosis, Management, and Outcomes.","authors":"Chae-Gwan Kong, Jong-Beom Park","doi":"10.3390/jcm14093244","DOIUrl":"10.3390/jcm14093244","url":null,"abstract":"<p><p>Postoperative infection following anterior cervical spine surgery, particularly when complicated by esophageal injury, is a rare but serious condition associated with significant morbidity and mortality. This review elucidates the complex interplay between postoperative infection and esophageal injury. We systematically analyzed studies from 2000 to 2025 using PubMed, Scopus, and Web of Science, focusing on infection, esophageal injury, surgical outcomes, and management strategies, with emphasis on recent advances in diagnostics, surgical techniques, and postoperative care. Our findings highlight the multifactorial nature of these complications and the critical role of early recognition, accurate diagnosis, and timely management. Imaging modalities such as CT, MRI, and contrast esophagography, along with flexible esophagoscopy, are indispensable in assessing injury and infection extent. Effective management requires a multidisciplinary approach integrating broad-spectrum antibiotics, surgical debridement, vascularized flap reinforcement, negative pressure wound therapy, and antibiotic-loaded cement beads. Meticulous postoperative care with prolonged antibiotics, nutritional support, and imaging follow-up is vital for optimizing outcomes. Innovative approaches, including vascularized muscle flaps and hyperbaric oxygen therapy, show promise in enhancing healing and reducing infections. Our review underscores the need for future meta-analyses to strengthen evidence and refine protocols. As surgical techniques evolve, so too must our diagnostic, surgical, and postoperative strategies to minimize complications and improve patient outcomes.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994685","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":"Acute Suppurative and Subacute Thyroiditis: From Diagnosis to Management.","authors":"Tommaso Toschetti, Cecilia Parenti, Ilaria Ricci, Irene Addati, Sonia Diona, Susanna Esposito, Maria Elisabeth Street","doi":"10.3390/jcm14093233","DOIUrl":"10.3390/jcm14093233","url":null,"abstract":"<p><p><b>Background</b>: Acute suppurative thyroiditis (AST) and subacute thyroiditis (SAT) are two distinct inflammatory conditions of the thyroid gland with different clinical presentation and treatment and that recognize different causes. AST is a rare but serious bacterial infection, often associated with congenital anomalies in children, whereas SAT is a self-limiting, post-viral condition that causes temporary thyroid dysfunction. <b>Methods</b>: A comprehensive literature review was conducted using PubMed and UpToDate, including systematic reviews, meta-analyses, case series, and case reports. Studies focusing on epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment were selected, with special attention paid to pediatric cases. <b>Results</b>: AST accounts for fewer than 1% of thyroid diseases and is more common in children, with pyriform sinus fistulas being present in 21% of cases. It presents with fever, painful neck swelling, and complications such as abscess formation and airway obstruction. Early recognition and prompt management with broad-spectrum antibiotics, ultrasound-guided aspiration, or surgical drainage are crucial. In contrast, SAT can occur at any age but is most common in adult women and typically follows a viral infection. It presents with anterior neck pain and transient thyrotoxicosis and is generally managed with non-steroidal anti-inflammatory drugs or corticosteroids in severe cases. Accurate differential diagnosis is essential to prevent unnecessary interventions. <b>Conclusions</b>: Although rare, both AST and SAT require timely diagnosis and tailored treatment strategies to avoid complications. Advances in imaging and the early detection of congenital anomalies have improved AST outcomes, while SAT remains a self-limiting condition that primarily requires symptom management. Further research is needed to better understand risk factors, pathogenesis, and optimal treatment approaches, particularly in pediatric populations and resource-limited settings.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020861","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":"Characteristics and Outcomes of New-Onset Cardiomyopathy in Hospitalized COVID-19 Patients.","authors":"Sachin Kumar, Gautam Shah, Raunak Nair, Sarah Rikabi, Mohannad Seif, Bindesh Ghimire, Brian Griffin, Umesh N Khot","doi":"10.3390/jcm14093258","DOIUrl":"10.3390/jcm14093258","url":null,"abstract":"<p><p><b>Background:</b> The association between Coronavirus Disease-2019 (COVID-19) and new-onset cardiomyopathy (NOC) is unclear. <b>Objectives:</b> We aim to assess the incidence of NOC in hospitalized COVID-19 patients and its impact on short- and long-term survival. <b>Methods:</b> We retrospectively studied 2219 COVID-19 patients hospitalized between March 2020 and February 2022 who underwent an in-hospital echocardiogram. NOC was defined as a left-ventricular ejection fraction (LVEF) reduction of >10%, resulting in an LVEF of <54% for females and <52% for males. The 30-day and 1-year survival outcomes in patients without and with NOC were studied. <b>Results:</b> Among 25,943 hospitalized COVID-19 patients, 2219 met our inclusion criteria, with 209 (9.4%) having NOC. NOC patients were more likely to be male (56.1% vs. 68.4%, <i>p</i> = 0.001) and have chronic kidney disease (51.4% vs. 60.3%, <i>p</i> = 0.018). They had a higher 30-day mortality rate (29.1% vs. 32%, <i>p</i> = 0.033), but the 1-year survival rate was similar between the patients without and with NOC (36.9% vs. 41.6%, <i>p</i> = 0.12). Multivariable regression revealed that advanced age, admission to intensive care unit, mechanical ventilation, treatment with glucocorticoids, and treatment with vasopressors were associated with higher odds of 30-day mortality in NOC patients. Only 74 (35.4%) NOC patients had follow-up echocardiograms after discharge, of which 47 showed persistent cardiomyopathy. <b>Conclusions:</b> NOC can affect around 1 out of 10 hospitalized COVID-19 patients undergoing echocardiography. While NOC was associated with worse short-term survival, it did not impact the long-term mortality of these patients. Persistent LVEF deficits in some patients emphasize the need for improved outpatient follow-up to identify at-risk individuals and optimize treatment.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021270","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":"Utility of Deceased Expanded-Criteria Donors in Kidney Transplantation: A Single-Center Experience.","authors":"Yavuz Ayar, Alparslan Ersoy, Emel Isiktas Sayilar, Abdülmecit Yildiz, Fatma Ezgi Can, Aysegul Oruc","doi":"10.3390/jcm14093232","DOIUrl":"10.3390/jcm14093232","url":null,"abstract":"<p><p><b>Purpose</b>: The success of solid organ transplantation and the consequent increase in the patients on the waiting list has led to an increased utilization of donor kidneys with a high kidney donor profile index (KDPI)/expanded criteria. In our study, patients who underwent transplantation based on the standard and expanded donor criteria were compared in terms of factors affecting graft survival. Data of patients who underwent transplantation from cadavers with standard and extended criteria (SCD, ECD) between 01 July 2011 and 30 June 2016 were evaluated retrospectively. Donor characteristics, treatment type, response and graft characteristics, 1st-, 3rd-, and 5th-year graft survival, and acute rejection rates were analyzed retrospectively. <b>Recent findings</b>: In terms of the causes of death, cerebrovascular accidents were more common in the ECD group (<i>p</i> < 0.001). Hypertension and diabetes were more common in both donor groups and were detected more frequently in recipients in the ECD group (<i>p</i> < 0.001). The absence of mycophenolate mofetil (MMF) use and the presence of an acute rejection attack adversely affected graft survival at the end of the 1st, 3rd, and 5th years. <b>Summary</b>: The utilization of expanded criteria donors is widespread. Appropriate monitoring of patients undergoing immunosuppressive therapy, especially using mycophenolate mofetil (MMF) and the presence of acute rejection, affect graft survival.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021832","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":"Comparison of Dimensional Accuracy of Diagnostic Trial Restoration Transfer with Four Different Methods: A Randomized Clinical Trial.","authors":"Lucas Queiroz Caponi, Pilar Fenoy-Illacer, Oscar Figueras-Álvarez, Eduardo de Lima Flor, Carla Vidal-Ponsoda, Miguel Roig","doi":"10.3390/jcm14093240","DOIUrl":"10.3390/jcm14093240","url":null,"abstract":"<p><p><b>Background/Objective:</b> Diagnostic trial restorations play a crucial role in restorative dentistry by allowing clinicians to evaluate aesthetics, function, and phonetics before finalizing definitive restorations. These restorations facilitate communication between patients, clinicians, and dental technicians, ensuring treatment alignment and predictable outcomes. The accuracy of transferring diagnostic trial restorations to the oral cavity is essential to maintain the integrity of the planned design. Various fabrication techniques, including conventional silicone matrices and computer-aided design/computer-aided manufacturing (CAD-CAM)-based methods, have been developed to improve transfer precision. However, there is limited evidence directly comparing their dimensional accuracy. This randomized in vivo study aimed to evaluate and compare the accuracy of four commonly used techniques-condensation silicone, addition PVS silicone, transparent PVS silicone, and CAD-CAM combination matrices-by assessing their linear and volumetric discrepancies. <b>Methods</b>: Twenty patients requiring aesthetic rehabilitation of their anterior maxillary teeth participated. The sequence of matrix usage was determined through randomization. Four techniques for transferring diagnostic trial restorations were evaluated: (1) condensation silicone matrix, (2) addition polyvinyl siloxane (PVS) silicone matrix, (3) transparent PVS silicone matrix, and (4) CAD-CAM combination matrix. Dimensional accuracy was assessed by comparing intraoral scans (IOSs) of the transferred restorations to the original diagnostic wax-up. Linear discrepancies were measured at four buccal landmarks (cervical, medial, lower medial, and incisal), and volumetric deviation was evaluated using reverse engineering alignment software. <b>Results:</b> Significant differences were observed among the groups in both linear and volumetric discrepancies (<i>p</i> < 0.05). The CAD-CAM combination matrix showed superior volumetric accuracy, with minimal deviations from the diagnostic wax-up. The addition PVS silicone matrix demonstrated consistent linear accuracy, particularly at the cervical and medial landmarks. The condensation silicone matrix exhibited moderate performance across both linear and volumetric accuracy. The transparent PVS silicone matrix showed the highest variability, with greater volumetric deviations. <b>Conclusions:</b> The study highlights that the choice of matrix material and technique significantly impacts the dimensional accuracy of diagnostic trial restoration transfers. The CAD-CAM combination matrix and the addition PVS silicone matrix demonstrated superior advantages compared to the other techniques. Clinicians should consider the specific requirements of each case, including accuracy and ease of use, when selecting a transfer technique for aesthetic rehabilitations.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018403","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":"A Multicenter Study by the DENO Research Group on the Use of Denosumab in Giant-Cell Tumors of the Bone.","authors":"Deno Research Group, Carolina de la Calva, Manuel Angulo, Paula González-Rojo, Ana Peiró, Pau Machado, Juan Luis Cebrián, Roberto García-Maroto, Antonio Valcárcel, Pablo Puertas, Gregorio Valero-Cifuentes, Óscar Pablos, Miriam Maireles, María Luisa Fontalva, Iván Chaves, Aida Orce, Luis Coll-Mesa, Israel Pérez, Fausto González, María Del Carmen Sanz, Isidro Gracia","doi":"10.3390/jcm14093242","DOIUrl":"10.3390/jcm14093242","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Despite the therapeutic potential of denosumab for the treatment of giant-cell tumors of the bone (GCTBs), there is a lack of standardization in treatment protocols. <b>Methods</b>: We present a multicenter, retrospective, descriptive study conducted across the seven hospitals in Spain affiliated with the DENO Research Group. Seventy-three patients diagnosed with GCTB and treated with denosumab were included and stratified according to treatment strategy-neoadjuvant (<i>n</i> = 38), adjuvant (<i>n</i> = 8), and single treatment (<i>n</i> = 27). <b>Results</b>: Patients in the neoadjuvant group received denosumab for a median of 6.1 months, with reintroduction after surgery in 25.8% of all cases. Among the neoadjuvant patients treated with curettage, recurrence was 35.5%, with no association with denosumab treatment duration (<i>p</i> = 0.274) nor with denosumab reintroduction after surgery (<i>p</i> = 0.405). In the adjuvant group, those who completed treatment received denosumab for 15.3 months, while those still undergoing therapy received it for a median of 12.8 months; only one case (12.5%) recurred. Recurrence rates in neoadjuvant and adjuvant treatment strategies were not different (<i>p</i> = 0.394). Patients treated only with denosumab and no longer on treatment had received it for 34.2 months, with 31.3% recurrence; those still on treatment had received it for 51.8 months, with 25.0% recurrence. Across all strategies, more than 85% of patients reported favorable clinical outcomes, and only 43.8% presented adverse events. No deaths occurred during this study. <b>Conclusions</b>: Although patients who experienced recurrence during neoadjuvant treatment had longer durations of denosumab administration, the difference was not statistically significant. Similarly, recurrence rates did not differ significantly, whether denosumab was reintroduced after surgery or not. Among the patients treated with curettage, recurrence rates were comparable between neoadjuvant and adjuvant strategies. Discontinuation of the single treatment did not necessarily result in disease progression.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971220","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 Periarticular Knee Muscle Torques in Ensuring the Body Balance of Older Adults with Balance Disturbances.","authors":"Piotr Prochor, Łukasz Magnuszewski, Paulina Zalewska, Michał Świętek, Zyta Beata Wojszel, Szczepan Piszczatowski","doi":"10.3390/jcm14093251","DOIUrl":"10.3390/jcm14093251","url":null,"abstract":"<p><p><b>Background</b>: The role of the periarticular muscles of the knee joint in ensuring body balance is still ambiguous. Therefore, we conducted clinical and biomechanical assessments on 52 older adults (36 women and 16 men, age of 67.58 ± 7.30 years, body weight of 75.10 ± 13.42 kg, and height of 163.92 ± 8.80 cm) to determine the role of the knee muscles in balance maintenance. <b>Methods</b>: The clinical examination included the Dizziness Handicap Inventory (DHI), the Geriatric Depression Scale (GDS), the Performance-Oriented Mobility Assessment (POMA), the Functional Reach Test (FRT), the Falls Efficacy Scale-International (FES-I), and bioimpedance parameters (skeletal muscle mass-SMM-and its derived parameter-Diff SMM). The biomechanical assessment involved parameters that characterize muscle torques of knee joint extensors and flexors in isokinetic and isometric conditions, as well as changes in the centre of pressure (COP) position while standing with eyes open and closed. <b>Results</b>: Based on treatment history and DHI results (>10 points), 26 participants were identified as having balance disorders, while the remaining participants formed the control group. Statistical analysis was performed to determine differences between the groups. The groups significantly differed in terms of the results obtained from the DHI (<i>p</i> < 0.001) and GDS (<i>p</i> = 0.04) questionnaires as well as FES-I (<i>p</i> < 0.001) and POMA (<i>p</i> = 0.002) tests. While SMM (<i>p</i> = 0.012) was similar in the groups, Diff SMM (<i>p</i> = 0.04) significantly differed. The multiple regression analysis confirmed the knee joint extensor parameters' significant role in predicting the COP path (<i>p</i> = 0.03 and <i>p</i> = 0.04 for two assumed models). <b>Conclusions</b>: The obtained results proved that the muscle torques of knee extensors can be used in the diagnostic process of older patients with balance disorders, indicating possible rehabilitation directions.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982907","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":"Functional Status Enhances the FRAX^® Prediction of Fractures in Myasthenia Gravis: A 10-Year Cohort Study.","authors":"Shingo Konno, Takafumi Uchi, Hideo Kihara, Hideki Sugimoto","doi":"10.3390/jcm14093260","DOIUrl":"10.3390/jcm14093260","url":null,"abstract":"<p><p><b>Background</b>: Patients with myasthenia gravis (MG) are susceptible to fractures due to glucocorticoid (GC) use and disease-related functional impairment affecting activities of daily living (ADL). The Fracture Risk Assessment Tool (FRAX^®) estimates fracture probability but does not incorporate disease-specific functional status. We investigated whether combining FRAX^® with the Myasthenia Gravis Activities of Daily Living (MG-ADL) scale improves fracture risk stratification in MG patients. <b>Methods</b>: This single-center prospective cohort study followed 53 MG patients for 10 years (2012-2022) at Toho University Ohashi Medical Center, Japan. Patients were categorized into four groups based on baseline FRAX^® probability (calculated with bone mineral density [BMD]) and MG-ADL scores using median splits: high FRAX^®/high MG-ADL (HH), high FRAX^®/low MG-ADL (HL), low FRAX^®/high MG-ADL (LH), and low FRAX^®/low MG-ADL (LL). The primary outcome was incident major osteoporotic fracture (MOF). <b>Results</b>: Over 10 years, nine MOFs occurred: seven in the HH group (43.8%), two in the HL group (16.7%), and none in the LH or LL groups. Fracture-free survival differed significantly among the groups (log-rank <i>p</i> < 0.001), with the HH group exhibiting the lowest survival rate. Baseline characteristics, including age, disease duration, MG severity scores, BMD, and FRAX^® scores, differed significantly among groups. Specific MG-ADL items reflecting greater impairment (impairment of ability to arise from a chair, double vision, and ptosis) were significantly more pronounced in the HH group at baseline. <b>Conclusions</b>: Combining baseline FRAX^® scores with the MG-ADL assessment effectively stratifies long-term MOF risk in patients with MG. Individuals with both high FRAX^® and high MG-ADL represent a particularly high-risk subgroup. This dual-assessment approach may improve the identification of patients requiring targeted preventive interventions.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 9","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12072394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028578","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}