Journal of Clinical Medicine最新文献

{"title":"The Interaction Among Effector, Regulatory, and Tγδ Cells Determines the Development of Allergy or Tolerance to Chromium.","authors":"Magdalena Zemelka-Wiacek","doi":"10.3390/jcm14041370","DOIUrl":"https://doi.org/10.3390/jcm14041370","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Chromium, a common environmental and occupational sensitizer, frequently induces allergic contact dermatitis (ACD). This study investigates the role of CD4⁺ (T helper), CD8⁺ (T cytotoxic), regulatory (Tregs: CD4⁺CD25⁺ and CD8⁺CD25⁺), and gamma delta (Tγδ) T cells in chromium tolerance versus hypersensitivity. <b>Methods</b>: Six chromium-allergic patients and six healthy controls were recruited, confirmed via patch testing. Peripheral blood mononuclear cells (PBMCs) were isolated and cultured, with chromium exposure and proliferation assays conducted. Specific T cell subtypes were isolated and analyzed for chromium-specific proliferative responses, cytokine production, and metabolic activity. <b>Results</b>: Chromium-allergic individuals exhibited broad proliferation across PBMC and T cell subsets, contrasting with restricted responses in controls. Treg cells in healthy subjects effectively suppressed T cell proliferation in response to chromium, while allergic individuals showed unmodulated T cell activity, indicative of impaired regulatory function. Cytokine analysis revealed elevated IL-2 and TNF-α but absent IL-10 in allergic patients. Metabolic assessments showed higher glycolytic activity in Tregs of healthy controls, suggesting enhanced regulatory potential. <b>Conclusions</b>: These findings highlight the importance of balanced effector and regulatory T cell interactions for chromium tolerance. Dysregulated Treg and Tγδ cell functions in allergic individuals may contribute to hypersensitivity, with implications for targeted therapeutic strategies to restore immune balance and reduce allergic responses in chromium-sensitive patients.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501744","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":"Aortopexy for Tracheomalacia in Children: A Systematic Review and Meta-Analysis.","authors":"Andrea Zanini, Stefano Mazzoleni, Luigi Arcieri, Raffaele Giordano, Stefano Marianeschi, Francesco Macchini","doi":"10.3390/jcm14041367","DOIUrl":"https://doi.org/10.3390/jcm14041367","url":null,"abstract":"<p><p><b>Introduction:</b> Aortopexy is the most common surgical option for the treatment of severe tracheomalacia (TM) in children. Despite being described over 75 years ago, several aspects of the procedure remain controversial. <b>Materials and Methods:</b> A systematic review of aortopexy was conducted following the PRISMA guidelines. All original articles describing at least one case of aortopexy performed in children for the treatment of TM were included. Patients' characteristics, surgical indications, approaches and details were collected. Outcomes were reviewed, and potential factors associated with procedural success were investigated. <b>Results:</b> Of 243 papers, 17 were included in this review, encompassing a total of 473 patients who underwent aortopexy. Of these, 65.3% were male, with a mean age at surgery of 12.2 months (5 days-18 years). Primary TM accounted for 7.9% of cases, while 92.1% were secondary to other anomalies, including esophageal atresia (54.1%), aberrant innominate artery (16.1%) and vascular rings (8.3%). There is a general consensus on the surgical indication for TM with severe symptoms, although the definition of severity is not well established. Overall success was 84%, but 40.8% of patients experienced some persistent symptoms. Sternotomy and thoracotomy were the most successful approaches (92.6% and 84.2%, respectively). Thoracoscopy had a similar success rate to sternotomy when pericardiotomy, thymectomy and pledgeted suture were performed (86.4% vs. 92.6% <i>p</i> = 0.41). <b>Conclusions:</b> Aortopexy is associated with good outcomes, but no evidence-based guidelines are currently available. Success appears to be associated with specific surgical steps rather than the surgical approach. Prospective studies are desirable for establishing precise guidelines.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501431","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":"Potential MRI Biomarkers for Predicting Kidney Function and Histological Damage in Transplanted Deceased Donor Kidney Recipients.","authors":"Andrejus Bura, Gintare Stonciute-Balniene, Audra Banisauskaite, Laura Velickiene, Inga Arune Bumblyte, Antanas Jankauskas, Ruta Vaiciuniene","doi":"10.3390/jcm14041349","DOIUrl":"https://doi.org/10.3390/jcm14041349","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Kidney transplantation (kTx) is the preferred treatment for end-stage kidney disease. Limited evaluation of structural changes in transplanted kidneys hinders the timely prediction of disease progression and the implementation of treatment modifications. Protocol biopsies provide valuable insights but are invasive and carry risks of biopsy-related complications. This study investigates whether multiparametric magnetic resonance imaging (MRI), including T1 and T2 mapping and diffusion-weighted imaging (DWI), can predict kidney function and the progression of interstitial fibrosis and tubular atrophy (IF/TA) in the early post-transplant period. <b>Methods</b>: A prospective study was conducted at The Hospital of Lithuanian University of Health Sciences Kauno Klinikos from May 2022 to March 2024. Thirty-four patients receiving kidney transplants from deceased donors underwent baseline biopsies and post-transplant MRI scans. Follow-up assessments included kidney function evaluation, biopsies, and MRI scans at three months post-transplant. <b>Results</b>: Significant correlations were observed between MRI parameters and kidney function: T1 and apparent diffusion coefficient (ADC) corticomedullary differentiation (CMD) correlated with eGFR at discharge (r = -0.338, <i>p</i> = 0.05; r = 0.392, <i>p</i> = 0.022, respectively). Linear and logistic regression models demonstrated that post-transplant T1 and ADC CMD values significantly predicted kidney function at discharge. Furthermore, T1 CMD values measured 10-15 days post-transplant predicted IF/TA progression at three months post-kTx, with an area under the curve of 0.802 (95% CI: 0.616-0.987, <i>p</i> = 0.001) and an optimal cut-off value of -149.71 ms. The sensitivity and specificity were 0.818 and 0.273, respectively (Youden's index = 0.545). T2 mapping was not predictive. <b>Conclusions</b>: This study highlights the potential immediate clinical utility of MRI-derived biomarkers, particularly ADC and T1 CMD, in centers equipped with advanced imaging capabilities as tools for assessing kidney function in the early post-transplant period. With an AUROC of 0.802, T1 CMD demonstrates strong discriminatory power for predicting IF/TA progression early in the post-transplant period.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501774","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":"Virtual Reality and Relaxation for the Treatment of Generalized Anxiety Disorder: A Randomized Comparative Study with Standard Intervention.","authors":"Eric Malbos, Nadège Chichery, Baptiste Borwell, Gabriel Weindel, Jordan Molitor, Mélodie Einig-Iscain, Julien Seimandi, Christophe Lançon","doi":"10.3390/jcm14041351","DOIUrl":"https://doi.org/10.3390/jcm14041351","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Modern therapeutic strategies incorporating virtual reality (VR) have emerged as potential treatments for generalized anxiety disorder (GAD), a prevalent and debilitating condition that is challenging to cure. This study aimed to evaluate the efficacy of VR combined with relaxation techniques in patients with GAD by comparing VR-based relaxation with standard mental imagery (MI) relaxation. <b>Methods:</b> Fifty-eight patients with GAD participated in a randomized comparative trial. Specific virtual environments were created using an inexpensive game engine/level editor (GLE). Psychometric scales and physiological instruments were employed to assess the effects of relaxation therapy on anxiety, depression, quality of life, presence within virtual environments and cybersickness. <b>Results:</b> Both the VR and MI groups demonstrated statistically significant improvements in anxiety, worry and mental quality of life scores. However, no significant differences were observed between the two groups in pre-post comparisons of psychometric scores. The VR group exhibited a noticeably higher protocol completion rate and a significant increase in heart rate variability during the therapy. The level of presence in the VR group was satisfactory and significantly correlated with physiological improvements and anxiety reduction, while cybersickness remained low. Participants' preferences for specific virtual environments for relaxation are also discussed. <b>Conclusions:</b> These findings suggest that teaching and practicing relaxation in VR holds therapeutic potential for the treatment of GAD. Further research leveraging advanced VR sensory equipment and artificial intelligence agents is warranted to enhance therapeutic outcomes and explore additional applications.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501764","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":"Efficacy of Transcranial Direct Current Stimulation (tDCS) on Neuropsychiatric Symptoms in Substance Use Disorder (SUD)-A Review and Insights into Possible Mechanisms of Action.","authors":"James Chmiel, Marta Stępień-Słodkowska, Irena Ramik-Mażewska","doi":"10.3390/jcm14041337","DOIUrl":"https://doi.org/10.3390/jcm14041337","url":null,"abstract":"<p><p><b>Introduction:</b> Substance use disorder (SUD) is a significant global clinical issue marked by the excessive consumption of alcohol, nicotine, and various psychoactive substances, leading to impaired social, cognitive, and occupational functioning. Individuals with SUD frequently experience depression and anxiety disorders, which exacerbate their prognosis and contribute to substantial health and social burdens. The pathophysiology of SUD and its associated conditions is multifaceted, involving multiple dysfunctions in the brain. This complexity underscores an urgent need for the development of noninvasive treatments that can directly target the brain. One of them is transcranial direct current stimulation (tDCS), an intensively studied technique for safely modulating cortical excitability. The aim of this study is to investigate the effectiveness of tDCS in treating symptoms of depression and anxiety in SUD. <b>Methods:</b> With an emphasis on the underlying mechanisms of action, this mechanistic review investigates the effectiveness of tDCS in treating anxiety and depression in SUD patients. Literature searches were conducted using the PubMed/Medline, ResearchGate, Cochrane, and Google Scholar databases. <b>Results:</b> The review identified 12 relevant studies. The results showed that left dorsolateral prefrontal cortex (DLPFC) stimulation is an effective treatment option for depression in SUD. In anxiety disorders, left and right DLPFC stimulation is effective, with better results observed with right DLPFC stimulation. However, the included studies differed in their methodology, sample characteristics, and measurement methods, which could have influenced the final results of the analysis. The central focus of this mechanistic review is to discuss the potential mechanisms of action of tDCS in treating depression and anxiety in SUD. These mechanisms include the modulation of brain networks, a reduction in neuroinflammation, an enhancement in neuroplasticity, and an increase in P300 amplitude. We also discuss the limitations of the included studies and propose ways to address them in future research. <b>Conclusions:</b> This review provides evidence that tDCS is an effective treatment option for anxiety and depression in SUD. Stimulation of the left DLPFC reduces symptoms of depression, while stimulation of the right DLPFC reduces symptoms of anxiety. However, future research is required to confirm these findings and to deepen our understanding of the mechanisms through which tDCS exerts its effects in this context. Neuroimaging methods (fMRI and EEG) and blood tests could be particularly useful.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501525","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":"Chat Generative Pre-Trained Transformer (ChatGPT) in Oral and Maxillofacial Surgery: A Narrative Review on Its Research Applications and Limitations.","authors":"Sung-Woon On, Seoung-Won Cho, Sang-Yoon Park, Ji-Won Ha, Sang-Min Yi, In-Young Park, Soo-Hwan Byun, Byoung-Eun Yang","doi":"10.3390/jcm14041363","DOIUrl":"https://doi.org/10.3390/jcm14041363","url":null,"abstract":"<p><p><b>Objectives:</b> This review aimed to evaluate the role of ChatGPT in original research articles within the field of oral and maxillofacial surgery (OMS), focusing on its applications, limitations, and future directions. <b>Methods</b>: A literature search was conducted in PubMed using predefined search terms and Boolean operators to identify original research articles utilizing ChatGPT published up to October 2024. The selection process involved screening studies based on their relevance to OMS and ChatGPT applications, with 26 articles meeting the final inclusion criteria. <b>Results</b>: ChatGPT has been applied in various OMS-related domains, including clinical decision support in real and virtual scenarios, patient and practitioner education, scientific writing and referencing, and its ability to answer licensing exam questions. As a clinical decision support tool, ChatGPT demonstrated moderate accuracy (approximately 70-80%). It showed moderate to high accuracy (up to 90%) in providing patient guidance and information. However, its reliability remains inconsistent across different applications, necessitating further evaluation. <b>Conclusions</b>: While ChatGPT presents potential benefits in OMS, particularly in supporting clinical decisions and improving access to medical information, it should not be regarded as a substitute for clinicians and must be used as an adjunct tool. Further validation studies and technological refinements are required to enhance its reliability and effectiveness in clinical and research settings.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501559","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":"Early Intervention Including an Active Motor Component in Preterms with Varying Risks for Neuromotor Delay: A Systematic Review and Narrative Synthesis.","authors":"Nele De Bruyn, Britta Hanssen, Lisa Mailleux, Christine Van den Broeck, Bieke Samijn","doi":"10.3390/jcm14041364","DOIUrl":"https://doi.org/10.3390/jcm14041364","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Previous reviews demonstrated stronger benefits of early interventions on cognition compared to motor outcome in preterm-born infants. Potentially, motor development needs more targeted interventions, including at least an active motor component. However, there is no overview focusing on such interventions in preterm-born infants, despite the increased risk for neuromotor delays. <b>Methods:</b> PubMed, Embase and Web of Science were systematically searched for (quasi-)randomized controlled trials regarding early interventions in preterm-born infants, with varying risks for neuromotor delay, and trials comprising an active motor component started within the first year were included. Study data and participant characteristics were extracted. The risk of bias was assessed with the Risk of Bias 2 tool. <b>Results:</b> Twenty-five reports, including twenty-one unique (quasi-)RCTs, were included and categorized as either pure motor-based interventions (<i>n</i> = 6) or family-centered interventions (<i>n</i> = 19). Of the motor-based interventions, four improved motor outcomes immediately after the intervention, and one of these also did so at follow-up, compared to five and one for family-centered approaches, respectively. Only five family-centered studies assessed long-term effects beyond age five, finding no greater efficacy than standard care. Overall, large variations were present for intervention intensity, type and outcomes between the included studies. <b>Conclusions:</b> Although methodological heterogeneity compromised conclusions, limited effects on motor outcome, in particular long-term outcome, were identified. Including a stronger motor-focused component embedded within a family-centered approach could potentially increase the impact on motor outcome, which would be of particular interest for infants showing early signs of neuromotor delay.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501670","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":"Intracranial Hemorrhage During Pregnancy: An Interdisciplinary Literature Review and a Rare Case Report of Early-Onset Eclampsia with Intracranial Hemorrhage and HELLP Syndrome.","authors":"Natalia Katarzyna Mazur, Justyna Małgorzata Fercho, Maria Kałas, Karolina Szaruta-Raflesz, Magdalena Emilia Grzybowska, Mariusz Siemiński, Dariusz Grzegorz Wydra","doi":"10.3390/jcm14041361","DOIUrl":"https://doi.org/10.3390/jcm14041361","url":null,"abstract":"<p><p>Intracranial hemorrhage is a rare yet potentially devastating event during pregnancy with a significant risk of maternal and fetal mortality and morbidity. The risk of intracranial hemorrhage increases during the third trimester of pregnancy and is greatest during labor and the postpartum period. Interdisciplinary diagnosis and treatment of the pregnant population often begins in the emergency department setting and is key to increasing patient survival rates through immediate and adequate treatment, including emergency medicine, neurosurgical and obstetrical procedures. A unique case report with a diagnostic pathway for intracranial hemorrhage due to eclampsia in a primipara at 24 weeks of gestation is presented, illustrating potential diagnostic dilemmas as the patient rapidly progresses into hemolysis, elevated liver enzymes and low platelets syndrome. A literature review was conducted to uncover the etiology of intracranial hemorrhage during pregnancy, as well as its diagnostic challenges and treatment. Pregnancy should not be viewed as a barrier to performing angiography or endovascular treatment for vascular causes of intracranial hemorrhage. Patient transport to a tertiary reference center and the interdisciplinary cooperation of specialists are key to achieving correct and rapid treatment. Continuous prevention of preeclampsia and patient education are necessary to decrease the incidence of eclampsia and its complications. Key message: Intracranial hemorrhage and eclampsia in pregnant patients are rare yet may result in high rates of maternal and fetal morbidity and mortality. The diagnostic process is difficult and requires interdisciplinary cooperation to start the correct treatment immediately.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501773","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":"Artificial Intelligence-Assisted Virtual Reality for Reducing Anxiety in Pediatric Endoscopy.","authors":"Mehmet Bulduk, Veysel Can, Emre Aktaş, Belkıs İpekçi, Bahattin Bulduk, İbrahim Nas","doi":"10.3390/jcm14041344","DOIUrl":"https://doi.org/10.3390/jcm14041344","url":null,"abstract":"<p><p><b>Background/Objectives:</b> This study aimed to evaluate the effects of artificial intelligence (AI)-assisted virtual reality (VR) applications on preoperative anxiety levels and vital signs in children undergoing endoscopy. <b>Methods:</b> A randomized controlled trial design was employed, including a total of 80 children aged 8-17 years (40 in the intervention group and 40 in the control group). Children in the intervention group were exposed to VR applications featuring space and underwater themes, while the control group received standard procedures. Anxiety levels were assessed using the \"State-Trait Anxiety Inventory for Children (STAIC)\", and vital signs were evaluated through measurements of systolic and diastolic blood pressure, heart rate, temperature, and SpO₂. <b>Results:</b> VR applications significantly reduced anxiety scores in the intervention group (36.3 ± 1.9), while no significant changes were observed in the control group (45.4 ± 2.74) (<i>p</i> < 0.001). Regarding vital signs, more favorable outcomes were observed in the intervention group. Systolic blood pressure was measured as 89 ± 6.7 mmHg in the intervention group and 96.5 ± 10.5 mmHg in the control group (<i>p</i> < 0.001). Diastolic blood pressure was 60.8 ± 4.7 mmHg in the intervention group and 63.8 ± 6 mmHg in the control group (<i>p</i> < 0.05). Heart rate was recorded as 88.7 ± 10.1 bpm in the intervention group and 94.5 ± 14.8 bpm in the control group (<i>p</i> < 0.05). SpO₂ levels were 98 ± 1 in the intervention group and 96.2 ± 1.3 in the control group (<i>p</i> < 0.001). <b>Conclusions:</b> AI-assisted VR applications emerge as an effective non-pharmacological method for reducing preoperative anxiety and promoting physiological stability in children. This approach holds the potential to enhance pediatric experiences during invasive procedures such as endoscopy.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501501","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":"BRM: From Skin-Reducing Mastectomy to the New Concept of Breast Reshaping Mastectomy.","authors":"Valerio Lorenzano, Andrea Vittorio Emanuele Lisa, Valeriano Vinci, Benedetta Agnelli, Alessia Lozito, Marco Klinger, Alessandro Mela, Martina Caruso, Francesco Klinger","doi":"10.3390/jcm14041350","DOIUrl":"https://doi.org/10.3390/jcm14041350","url":null,"abstract":"<p><p><b>Background:</b> Macromastia is a well-known issue in breast reconstruction. Skin-reducing mastectomy (SRM) was introduced as a skin-sparing mastectomy that utilizes a skin reduction pattern similar to breast reduction or breast lift surgery, specifically to manage hypertrophic and pendulous breasts. Over time, numerous authors have contributed to refining the SRM technique, leading to the development of various technical variants. However, the diversity of approaches inspired by SRM has created confusion, and clear surgical indications are lacking. <b>Methods:</b> We propose a unifying concept called breast reshaping mastectomy (BRM), which encompasses all techniques based on SRM principles. The BRM aims not only to preserve and reduce the breast skin envelope but also to immediately reshape it for a more aesthetic outcome. This approach is applicable to all mastectomies where skin envelope preservation (with or without the nipple-areola complex) is oncologically safe, a modification of breast skin coverage is needed for better aesthetic results, and an implant-based reconstruction is planned. <b>Results:</b> To define the BRM concept, we reviewed the existing literature on SRM and its related techniques. Our analysis focused on four key elements: skin incision pattern, implant coverage strategy, nipple-areola complex (NAC) management, and the choice between two-stage and direct-to-implant reconstruction. <b>Conclusions:</b> By integrating these four components into a single surgical framework, BRM provides a structured approach to breast reconstruction that enhances both oncologic safety and aesthetic outcomes. Standardizing these techniques could help clarify surgical indications and improve reconstructive planning for patients undergoing skin-sparing mastectomy.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 4","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501509","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}