Journal of Clinical Medicine最新文献

{"title":"The Triple Procedure in Patients with Congenital Aniridia.","authors":"Bogumił Henryk Wowra, Olga Łach-Wojnarowicz, Marzena Wysocka-Kosmulska, Dariusz Dobrowolski, Edward Wylęgała","doi":"10.3390/jcm13216619","DOIUrl":"10.3390/jcm13216619","url":null,"abstract":"<p><p><b>Background:</b> Aniridia is a rare panocular, bilateral, and congenital disease characterized by complete or partial iris hypoplasia and foveal hypoplasia, leading to decreased visual acuity and nystagmus. AAK, also referred to as aniridic keratopathy, manifests as corneal surface damage, epithelial thinning or loss, inflammation with immune cell infiltration, vascularization, and chronic progressive opacification. <b>Methods:</b> Twenty-one eyes in eighteen patients with aniridia underwent the triple procedure for visual rehabilitation. Subjects with stromal scarring with mild limbal deficiency were qualified for surgery. The majority of them developed stage II (15), and a few of them had third-degree (6) aniridic keratopathy. <b>Results:</b> The mean patient age was 38.4 ± 8.8. Visual acuity after one year of observation ranged from 0.4 in two eyes to 0.2 in nine eyes to below 0.1 in ten eyes. In the second year, VA remained at the same level in 13 patients (72.2%). In the third year, four patients (22.2%) experienced recurrence of AAK. <b>Conclusions:</b> A majority of the ARK cases (72.2%) had a graft providing useful vision for the patient 2 years after corneal transplantation, but the visual gain was modest at best. Longer follow-up time is required to evaluate functional graft outcomes.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11547142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142636075","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":"Hemodialysis Experience After Kahramanmaraş Earthquake.","authors":"Bulent Kaya, Mustafa Balal, Neslihan Seyrek, Burak Mete, Ibrahim Karayaylali","doi":"10.3390/jcm13216610","DOIUrl":"10.3390/jcm13216610","url":null,"abstract":"<p><p><b>Background</b>: Hemodialysis treatment for acute kidney injury associated with crush syndrome is very complex. In our study, we summarized the problems and complications experienced by our hemodialysis center after the Kahramanmaraş earthquake. <b>Methods</b>: After the earthquake, our hospital treated 1396 victims. We evaluated the initial indications for dialysis, hemodialysis complications and the mortality of patients undergoing hemodialysis, including crush-related acute kidney injury (<i>n</i> = 82), during the earthquake period. We also compared them with patients who were undergoing hemodialysis (<i>n</i> = 76) in the same period but had end-stage renal failure and acute kidney injury due to other causes (<i>n</i> = 15). <b>Results</b>: After the earthquake, 173 adult patients, 91 (52.6%) of whom were male, with a mean age of 49.5 + 19.7 years, underwent hemodialysis between 6 and 22 February 2023. Patients with crush-related acute kidney injury experienced more complications during hemodialysis, and the increase in creatine kinase activity increased the risk of hemodialysis complications. The most common complications were blood clots in the dialyzer membrane, intradialytic hypotension, and intradialytic insufficient flow. The most frequent indication for initial hemodialysis was hyperkalemia (61, 74.4%). The major problems in the hemodialysis center included inadequate equipment and an insufficient number of experienced health personnel. <b>Conclusions</b>: Hyperkalemia is the most important initial indication for hemodialysis in patients with crush-related acute kidney injury. Crush-related acute kidney injury patients require hemodialysis more frequently, and hemodialysis complications are higher in patients with crush-related AKI, so the hemodialysis treatment of these patients should be more cautious. In an earthquake, hemodialysis centers may face significant challenges, such as damage, transportation issues, power outages, and water outages, which can hinder hemodialysis treatment.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11547136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621644","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":"Applications of Near Infrared Spectroscopy and Mirror Therapy for Upper Limb Rehabilitation in Post-Stroke Patients: A Brain Plasticity Pilot Study.","authors":"Caterina Formica, Simona De Salvo, Nunzio Muscarà, Lilla Bonanno, Francesca Antonia Arcadi, Viviana Lo Buono, Giuseppe Acri, Angelo Quartarone, Silvia Marino","doi":"10.3390/jcm13216612","DOIUrl":"10.3390/jcm13216612","url":null,"abstract":"<p><p><b>Objectives:</b> The aim of this study was to identify the neural pattern activation during mirror therapy (MT) and explore any cortical reorganization and reducing asymmetry of hemispheric activity for upper limb rehabilitation in post-stroke patients. <b>Methods:</b> A box containing a mirror was placed between the arms of the patients to create the illusion of normal motion in the affected limb by reflecting the image of the unaffected limb in motion. We measured the cerebral hemodynamic response using near-infrared spectroscopy (NIRS). We enrolled ten right-handed stroke patients. They observed healthy hand movements in the mirror (MT condition) while performing various tasks (MT condition), and then repeated the same tasks with the mirror covered (N-MT condition). <b>Results:</b> Significant activation of some brain areas was observed in the right and left hemiparesis groups for the MT condition, while lower levels of activation were observed for the N-MT condition. The results showed significant differences in hemodynamic response based on oxygenated (HbO) concentrations between MT and N-MT conditions across all tasks in sensorimotor areas. These neural circuits were activated despite the motor areas being affected by the brain injury, indicating that the reflection of movement in the mirror helped to activate them. <b>Conclusions:</b> These results suggest that MT promotes cortical activations of sensory motor areas in affected and non-affected brain sides in subacute post-stroke patients, and it encourages the use of these tools in clinical practice.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11547098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621297","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":"Effective Treatment of Basal Cell Carcinoma with a Topical Enzymatic Mixture Enriched in Bromelain: Summary of Proof-Of Concept Clinical Studies on the First 22 Tumors.","authors":"Lior Rosenberg, Yaron Shoham, Brian Berman, Stephen K Tyring, Michael D Tharp, Adam J Singer","doi":"10.3390/jcm13216624","DOIUrl":"10.3390/jcm13216624","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Basal cell carcinoma (BCC), the most prevalent form of human cancer, is traditionally treated by surgical and alternative destructive or topical chemical means, each with its advantages, challenges, and drawbacks. We describe our experience treating BCCs with a topical concentrate of proteolytic enzymes enriched in bromelain (CPEEB) sourced from pineapple stems. CPEEB has strong proteolytic, antitumor-proapoptotic, and inflammation modulation activities, and is approved for debridement of deep burns and starting phase 3 trials for chronic wounds. <b>Methods:</b> In the first proof-of-concept (POC) study, six BCCs on three individuals were treated with five to six daily CPEEB 10% topical applications under a zinc oxide-based occlusive dressing for 9-12 h each during a period of up to 10 days. These patients were followed for up to 4 years. In an additional two POC studies, 16 patients with one BCC each were treated every other day for a total of seven applications of topical CPEEB 5% under a variety of occlusive dressings. The wounds were followed for up to 2 months before undergoing diagnostic excisional biopsy. <b>Results:</b> In the first study, clinical assessment of the BCCs and two excisional biopsies after 6 months suggested that all lesions were eradicated with spontaneous healing within ~2 weeks without clinical or histological recurrence for over 4 years. In the two subsequent studies, 16 histologically diagnosed superficial and nodular BCCs were treated using four application techniques. Excisional histology after 2 months confirmed BCC eradication in seven of the patients. In nine patients, with compromised occlusive dressings, histological eradication was incomplete. Treatment was well tolerated by all patients with the expected local skin reactions, which completely healed within 2-3 weeks. <b>Conclusions:</b> These are POC preliminary studies aimed at indicating the potential efficacy and feasibility of topical CPEEB in eradicating BCC. In these studies, topical CPEEB 10% and 5% resulted in complete eradication of the BCC when appropriately applied. CPEEB was well tolerated in all patients, and all treated sites' erosions healed without scars in <3 weeks. Further research is necessary to corroborate the results, refine the application technique, and complete the regulatory process.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621557","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":"Molecular Diagnostics for Group A Streptococcal Pharyngitis: Clinical and Economic Benefits in the Belgian Healthcare Context.","authors":"Mohammad Hossein Panahandeh, Reza Soleimani, Yasmine Nezzar, Hector Rodriguez-Villalobos, Benoît Kabamba-Mukadi, Alexandre Grimmelprez, Patricia Schatt","doi":"10.3390/jcm13216627","DOIUrl":"10.3390/jcm13216627","url":null,"abstract":"<p><p>(1) Background: Group A Streptococcal (GAS) pharyngitis is common, resulting in numerous ambulatory visits. Accurate diagnosis is challenging. This study evaluated the clinical utility, cost, and performance of a nucleic acid amplification test (NAAT) for GAS detection, comparing it to a rapid antigen detection test (RADT) and throat culture. Additionally, we assessed the diagnostic stewardship related to these testing methods to ensure appropriate antibiotic use in clinical practice.</p><p><strong>Methods: </strong>Between November 2022 and February 2023, 82 throat swabs were analyzed, with McIsaac clinical scores calculated for each. The Abbott ID NOW STREP A 2 NAAT and Sekisui Diagnostics' OSOM^® STREP A RADT were performed, followed by bacterial culture. Diagnostic performance was compared using culture as the gold standard.</p><p><strong>Results: </strong>Of the 82 samples, 28 (34.14%) tested positive for pathogenic germs, primarily <i>Streptococcus</i> pyogenes (92.85%). RADTs showed a sensitivity of 80.76% and a specificity of 100%, while NAATs demonstrated a sensitivity of 100% and specificity of 96.42%. Cost analysis indicated the need for reimbursement adjustments to optimize NAAT's economic benefits. Clinical data indicated that symptoms alone were insufficient for reliable diagnosis.</p><p><strong>Conclusions: </strong>This study confirmed the superior sensitivity of Abbott's Strep A2 NAAT over RADT. Given the Belgian guidelines against routine antibiotic treatment for pharyngitis and considering local treatment recommendations and cost, implementing NAAT for GAS detection in Belgian laboratories is less beneficial. However, the role of NAAT in supporting antimicrobial stewardship by ensuring appropriate antibiotic use remains significant.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621649","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 the Effectiveness of Body Surface Area Estimation Formulas in Predicting the Risk of Death in Patients with Heart Failure.","authors":"Małgorzata Piecuch, Maciej Chylak, Michał Górski, Jagoda Garbicz-Kata, Anna Szczyrba, Marta Buczkowska, Jolanta Malinowska-Borowska, Jolanta Urszula Nowak, Jacek T Niedziela, Mariusz Gąsior, Piotr Rozentryt","doi":"10.3390/jcm13216625","DOIUrl":"10.3390/jcm13216625","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Body surface area is one of the most important anthropometric parameters in medicine. The study's primary objective is to compare the consistency of the BSA estimation results through applying available formulas. Other objectives include determining the ability of these formulas to discriminate between death and survival in patients, comparing the formulas' diagnostic features, and investigating whether the risk associated with a low BSA is independent of BMI. <b>Methods</b>: This study included 1029 patients (median age, 54 years; female, 13.7%; NYHA I/II/III/IV, 6.3%/36.5%/47.7%/9.5%) diagnosed with heart failure. For each patient, BSA was calculated using 25 formulas. Over the 3-year observation period, 31.2% of the patients died. <b>Results</b>: The average BSA value of the optimal discrimination thresholds was 1.79 m² ± 0.084 m² and the BSA difference between the estimators with the lowest (BSA_Meeh1879) and the highest (BSA_Nwoye1989) optimal discrimination thresholds was 0.42 m². The lowest mortality rate was 35.2% and occurred in the subgroup of individuals with BSA values below the optimal discrimination threshold using the BSA_Schlich2010 estimator. The highest mortality was predicted when the estimator BSA_Meeh1879 or BSA_{Livingston&Lee2001} was used. <b>Conclusions</b>: Our study showed a relatively good concordance of 25 BSA estimators in BSA assessment in patients, without extremes of weight or height being known to disrupt it. All BSA estimators presented a significant, although weak, ability to discriminate death from survival at 3-year follow-up; however, BSA is not a very good predictor of HF mortality at 3 years. The higher risk of death in smaller patients, as shown by BSA, was independent of BMI in all but two BSA estimators.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620392","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":"Assessment of Professional Practices in the Care Pathway of Patients with Upper Aerodigestive Tract Cancer in a University Hospital.","authors":"Dounia Chbihi, Morgane Corda, Thomas Thibault, Jérémy Baude, Caroline Guigou, Mireille Folia","doi":"10.3390/jcm13216623","DOIUrl":"10.3390/jcm13216623","url":null,"abstract":"<p><strong>Objectives: </strong>The main objective of this study was to evaluate the alignment between treatment decisions made during multidisciplinary team meetings (MTMs) and the treatments received by patients with upper aerodigestive tract cancers. The secondary objective was to identify factors influencing potential discrepancies.</p><p><strong>Methods: </strong>This retrospective, single-center study was conducted at a tertiary referral center and included 147 patients diagnosed with squamous cell carcinoma of the upper aerodigestive tract. Patients were divided into two groups based on the match between MTM-decided and actual treatments. Multivariate analysis was performed to assess factors independently associated with discrepancies.</p><p><strong>Results: </strong>Out of 147 patients, 28 (19%) received treatment that did not align with MTM decisions. Among these, eight died before treatment, one patient refused care, five received supportive care, five patients underwent surgery, three received radiotherapy alone, one patient underwent surgery and adjuvant radiochemotherapy, one patient underwent surgery and adjuvant radiotherapy alone, three patients received radiochemotherapy, and one patient received palliative chemotherapy. Independent significant factors associated with non-concordance included poor performance status (PS) and treatment not received at a tertiary reference center. Treatment shifts mainly involved downgrading from curative to palliative care.</p><p><strong>Conclusions: </strong>This study highlights the importance of patient health status in determining deviations from MTM decisions. Further efforts should focus on improving the integration of patient comorbidities and health status into MTM decision-making to optimize care delivery.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621468","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":"IgA Vasculitis (Henoch-Schönlein Purpura): An Update on Treatment.","authors":"Santos Castañeda, Patricia Quiroga-Colina, Paz Floranes, Miren Uriarte-Ecenarro, Cristina Valero-Martínez, Esther F Vicente-Rabaneda, Miguel A González-Gay","doi":"10.3390/jcm13216621","DOIUrl":"10.3390/jcm13216621","url":null,"abstract":"<p><p><b>Objective:</b> IgA vasculitis (IgAV), previously named as Henoch-Schönlein purpura, is the most frequent systemic vasculitis in children. In adults, IgAV is less common although it is associated with more severe disease. In fact, the frequency of glomerulonephritis (referred to as IgAV nephritis) in adults is higher than in children and tends to present more severely, with around 10-30% of those affected eventually progressing to end-stage renal disease. In this review, we describe the pathophysiology, main clinical features, diagnosis of the disease, and latest clinical data regarding IgAV therapy. <b>Methods:</b> A narrative literature review, primarily based on articles published in PubMed, was conducted. In addition to discussing the main aspects of glucocorticoids and conventional disease-modifying drugs used in the management of IgAV, this review focuses on the latest information reported regarding biologics and potential future therapies. <b>Results:</b> Glucocorticoids are the first-line therapy for IgAV, especially in adults with severe manifestations. Colchicine, dapsone, and methotrexate can be useful for controlling minor manifestations. Several immunomodulatory agents, such as cyclosporine A, tacrolimus, and mycophenolate mofetil, have shown favorable results as glucocorticoid-sparing agents. Leflunomide has shown promising results but requires further study. The use of rituximab has demonstrated efficacy in reducing relapse frequency, lowering the cumulative glucocorticoid burden, and achieving long-term remission of the disease in children and adults with IgAV. Immunoglobulins and plasma exchange therapy can also be useful in difficult and life-threatening situations. Other potential therapies with encouraging results include TRF-budesonide, B-cell-directed therapy, B-cell-depleting agents, sodium-glucose cotransporter-2 inhibitors, endothelin receptor antagonists, and complement pathway inhibitors. <b>Conclusions:</b> Glucocorticoids are the first-line therapy for IgAV, especially in adults with severe manifestations. The role of various immunomodulatory therapies, such as calcineurin inhibitors and mycophenolate mofetil, remains promising, while rituximab reduces the long-term side effects of glucocorticoids and can help achieve disease remission. Other potential therapies with encouraging results require further research.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621695","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":"Cirrhosis Progression Is Not Associated with Clinically Significant Alterations in Global Hemostasis Assessed by Thromboelastography.","authors":"Rareș Crăciun, Alina Buliarcă, Daniela Matei, Cristiana Grapă, Iuliana Nenu, Horia Ștefănescu, Tudor Mocan, Bogdan Procopeț, Zeno Spârchez","doi":"10.3390/jcm13216614","DOIUrl":"10.3390/jcm13216614","url":null,"abstract":"<p><p>(1) Background: Cirrhosis is associated with frequent alterations in standard coagulation tests that do not adequately reflect hemostasis. Thromboelastography provides a global assessment of coagulation and evaluates the functional status of clotting factors, fibrinogen, platelets, and fibrinolysis. The study aimed to assess whether liver disease severity leads to progressive alterations in the thromboelastography-based assessment of coagulation. (2) Methods: Consecutive patients with cirrhosis and abnormal standard coagulation tests (at least one of International Normalized Ratio > 2, platelet count < 50 × 10³/µL, fibrinogen < 200 mg/dL) were analyzed using native thromboelastography. (3) Results: A total of 106 patients were included, of whom 69 (65.1%) had a normal thromboelastography. While the standard coagulation tests were significantly worse in patients in the Child C group (<i>n</i> = 62, 58.5%) than in patients staged in Child A and B, no significant differences existed between any of the thromboelastography variables. Of the 50 patients (47.1%) with an International Normalized Ratio > 2, only two patients (4%) had features of hypocoagulation, while 26% had features of hypercoagulability on thromboelastography. Patients with a platelet count < 50 × 10³/µL had significantly lower platelet function as assessed by thromboelastography, yet only eight patients (20%) met the criteria for platelet transfusion. A thromboelastography-based transfusion protocol might lead to a 94.6% reduction in blood product transfusion indications in a simulation where the included patients would require interventional procedures. (4) Conclusion: Standard coagulation tests showed a poor correlation with thromboelastography. Based on thromboelastography, patients with severe, decompensated liver disease have a preserved hemostasis balance despite abnormal standard coagulation tests. Therefore, standard coagulation tests should not be used to guide the administration of blood products in patients with cirrhosis.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621611","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":"Cerebral Overperfusion Despite Reduced Cortical Metabolism Is Associated with Postoperative Delirium in Cardiac Surgery Patients: A Prospective Observational Study.","authors":"Marcus Thudium, Lara Braun, Annika Stroemer, Andreas Mayr, Jan Menzenbach, Thomas Saller, Martin Soehle, Evgeniya Kornilov, Tobias Hilbert","doi":"10.3390/jcm13216605","DOIUrl":"10.3390/jcm13216605","url":null,"abstract":"<p><p><b>Background</b>: Decreased cerebral oximetry (rSO₂) in cardiac surgery is associated with postoperative delirium (POD). However, interventions optimizing intraoperative rSO₂ are inconclusive. <b>Methods</b>: In this prospective observational cohort study, the relationship between rSO₂, middle cerebral artery blood flow velocity (MCAV), and processed EEG was assessed in cardiac surgery patients with and without POD. MCAV was continuously recorded by transcranial Doppler sonography (TCD), together with continuous rSO₂ and bispectral index (BIS) monitoring. Cardiopulmonary bypass (CPB) flow rate was adjusted according to body surface area. The cohort was divided into the POD and control groups, according to the postoperative results of the confusion assessment method (CAM/CAM-ICU), the 4A's test (4AT), and the Delirium Observation Scale (DOS). A mixed model analysis was performed for intraoperative raw data. The cerebral autoregulation index was calculated from TCD, rSO₂, and arterial pressure values. Differences in impaired autoregulation were compared using the Mann-Whitney U test. <b>Results</b>: A total of 41 patients were included in this study. A total of 13 patients (36.11%) developed postoperative delirium. There were no significant differences in the baseline characteristics of patients with or without POD. Patients with POD had lower BIS values during CPB (adjusted mean difference -4.449 (95% CI [-7.978, -0.925])). RSO₂ was not significantly reduced in POD, (adjusted mean difference: -5.320, 95% CI [-11.508, 0.874]). In contrast, MCAV was significantly increased in POD (10.655, 95% CI [0.491, 20.819]). The duration of cerebral autoregulation impairment did not differ significantly for TCD and cerebral oximetry-derived indices (<i>p</i> = 0.4528, <i>p</i> = 0.2715, respectively). <b>Conclusions</b>: Our results suggest that disturbed cerebral metabolism reflects a vulnerable brain which may be more susceptible to overperfusion during CPB, which can be seen in increased MCAV values. These phenomena occur irrespectively of cerebral autoregulation.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"13 21","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11545882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621570","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}