Journal of Clinical Medicine最新文献

{"title":"Glycocalyx Disintegration Is Associated with Mortality in Chronic Heart Failure.","authors":"Patricia P Wadowski, Martin Hülsmann, Irene M Lang, Christian Schörgenhofer, Joseph Pultar, Constantin Weikert, Thomas Gremmel, Sabine Steiner, Renate Koppensteiner, Christoph W Kopp, Bernd Jilma","doi":"10.3390/jcm14103571","DOIUrl":"https://doi.org/10.3390/jcm14103571","url":null,"abstract":"<p><p><b>Background:</b> Glycocalyx disintegration is associated with adverse outcomes in patients with trauma or sepsis. As microvascular dysfunction has an impact on disease progression in chronic heart failure (CHF) patients, we hypothesized that changes in microcirculation might be associated with mortality. <b>Methods:</b> Fifty patients with ischemic and non-ischemic cardiomyopathy and conservative treatment with baseline measurements of the sublingual microcirculation (via Sidestream Darkfield videomicroscopy) were followed up for two years. Glycocalyx thickness was assessed indirectly by calculation of the perfused boundary region (PBR). <b>Results:</b> Loss of glycocalyx was pronounced in non-survivors after one, n = 10, and two years, n = 16; PBR: 2.05 μm (1.88-2.15 μm) vs. 1.87 μm (1.66-2.03 μm) and 2.04 (1.93-2.11) vs. 1.84 (1.62-1.97); <i>p</i> = 0.042 and <i>p</i> = 0.003, respectively. Area under the ROC curve for the analysis of the predictive value of PBR on two-year mortality was 0.77 (<i>p</i> = 0.003; SE: 0.07, CI (95%): 0.63-0.91). ROC curve analysis determined a PBR of 1.9 μm as the best predictor for two-year mortality (sensitivity: 0.81; specificity: 0.59). Moreover, multivariate regression analysis revealed PBR and functional capillary density as significant predictors of two-year mortality, <i>p</i> = 0.036 and <i>p</i> = 0.048, respectively. <b>Conclusions:</b> Glycocalyx disintegration is related to poor overall survival in CHF patients.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159253","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":"Crystal Ball in a Blood's Drop: Unlocking Hidden Prognostic Power in the Neutrophil-to-Lymphocyte Ratio (NLR) and the Platelet-to-Lymphocyte Ratio (PLR) for Elderly Hip Fracture Patients.","authors":"Andrea Perna, Giuseppe Rovere, Marco Passiatore, Andrea Franchini, Luca Macchiarola, Francesco Maruccia, Raffaele Vitiello, Franco Lucio Gorgoglione","doi":"10.3390/jcm14103584","DOIUrl":"https://doi.org/10.3390/jcm14103584","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Hip fractures in elderly patients are associated with high morbidity and mortality, requiring early risk stratification to optimize management. Systemic inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have emerged as potential prognostic tools. This study aimed to evaluate the predictive value of the NLR and PLR measured at admission for adverse outcomes following hip fracture surgery in elderly patients. <b>Methods:</b> This retrospective, single-center cohort study included patients aged 65 years or older admitted for hip fractures between January 2019 and December 2023. Baseline demographic, clinical, surgical, and laboratory data were collected. Primary outcomes were 30-day, 90-day, and 1-year mortality; secondary outcomes included postoperative ICU admission and prolonged hospitalization (>15 days). Univariable and multivariable Cox regression analyses were performed. Receiver operating characteristic (ROC) curve analysis determined optimal cut-offs for the NLR and PLR. <b>Results:</b> Among 395 included patients (mean age 84 years, 56.4% female), the 30-day, 90-day, and 1-year mortality rates were 4.8%, 10.5%, and 13.9%, respectively. ROC analysis identified cut-offs of 7.2 for the NLR (AUC 0.78, sensitivity 69.7%, specificity 85.4%) and 189.4 for the PLR (AUC 0.73, sensitivity 65.1%, specificity 76.1%). Elevated NLR and PLR were independently associated with increased risk of mortality, ICU admission, and prolonged hospitalization. <b>Conclusions:</b> Elevated NLR and PLR at admission are independent, strong predictors of adverse outcomes in elderly patients with hip fractures. These inexpensive, readily available biomarkers could enhance early risk stratification and inform perioperative management strategies.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159294","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":"Disproportionality Analysis of Renal Adverse Events Associated with a Combination of Immune Checkpoint Inhibitors and Acid-Suppressing Agents-A Pharmacovigilance Study Based on the FAERS Database.","authors":"Jinmei Liu, Xu Chen, Cong Zhang, Huiping Hu, Shijun Li, Zhiwen Fu, Ruxu You","doi":"10.3390/jcm14103581","DOIUrl":"https://doi.org/10.3390/jcm14103581","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The nephrotoxicity of immune checkpoint inhibitors (ICIs) combined with proton pump inhibitors (PPIs) has been recognized but lacks a comprehensive analysis. We conducted an in-depth investigation of renal adverse events (rAEs) associated with ICIs and different acid-suppressing agents (ASAs)-including PPIs, histamine-2 receptor antagonists (H₂RAs), and potassium-competitive acid blockers (P-CABs)-using real-world data from the FDA's Adverse Event Reporting System (FAERS). <b>Methods</b>: We analyzed rAE reports from the FAERS database covering Q1 2004 to Q1 2023. Disproportionality analysis was conducted to identify rAEs associated with ICI or ASA monotherapy or combination therapy. Univariate logistic regression was employed to explore influencing factors. <b>Results</b>: No eligible rAE reports were retrieved for H₂RAs and P-CABs. However, 6,775 reports in the ICI group, 54,055 reports in the PPI group, and 210 reports in the ICI-PPI combination therapy group were included in the final analysis. In PPI-ICI combination settings, tubulointerstitial nephritis had the highest reporting frequency and signal intensity; the overall risk of rAEs was significantly elevated compared to ICI or PPI monotherapy, with reporting odds ratios of 14. 65 (95% confidence interval [CI] 12.93-16.58) and 3.24 (95% CI 2.87-3.66), respectively; the median onset time was shortest at 21 days (interquartile range 5.5-135); and PD-1 monotherapy, omeprazole, and rabeprazole were associated with higher rAE risks. <b>Conclusions</b>: Our findings confirm that the combination of PPIs (but not other ASAs) with ICIs further increases the risk of various acute and chronic rAEs. Healthcare providers should exercise caution when managing patients on these therapies.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159358","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":"Long-Term Outcomes Associated with the Use of a Soft, Partially Absorbable Transobturator Mid-Urethral Tape for the Treatment of Stress Urinary Incontinence.","authors":"Ronen S Gold, Jonatan Neuman, Menahem Neuman, Asnat Groutz","doi":"10.3390/jcm14103572","DOIUrl":"https://doi.org/10.3390/jcm14103572","url":null,"abstract":"<p><p><b>Objectives:</b> To assess the long-term safety and efficacy of the Serasis^® inside-out transobturator midurethral sling (MUS), a partially absorbable soft tape for stress urinary incontinence (SUI). <b>Methods:</b> A cohort study of 146 consecutive women who underwent the Serasis^® MUS procedure from January 2013 to January 2014 was investigated. All patients had SUI as the main complaint. Patients with predominant urgency urinary incontinence (UUI) and stage III-IV pelvic organ prolapse were excluded. Clinical, intraoperative, and postoperative data were retrospectively retrieved from a computerized database. At 10 years postoperatively, a follow-up telephone survey was conducted. The patients were interviewed regarding tape-related complications, repeated SUI surgery, and decision regret or satisfaction. <b>Results:</b> All patients underwent the Serasis^® MUS procedure, most of whom also had concomitant colporrhaphies. The mean duration of surgery was 26.03 min, and the mean blood loss was 32.4 cc. All patients were discharged within a few hours after surgery or on the following day. No significant intraoperative or early postoperative complications were reported. Overall, 107 (73.3%) patients were available for the 10-year follow-up, 17 (15.9%) of whom reported symptoms of SUI, but only half of them underwent a repeated MUS. The rate of tape erosion was 1.9%, and no symptoms of tape-related pain were reported. Additionally, 10.3% of the patients were categorized as a subjective failure, most of whom considered persistent UUI as the main reason for dissatisfaction. <b>Conclusions:</b> The long-term outcomes of the transobturator Serasis^® MUS, a partially absorbable soft tape, are favorable and are associated with significantly fewer tape-related complications.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159200","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":"Heart Rate Variability Prediction of Stimulant-Induced Creativity Gains in Attention-Deficit/Hyperactivity Disorder.","authors":"Carrina Appling, Nanan Nuraini, Eric Hart, David Wang, Aneesh Tosh, David Beversdorf, Bradley Ferguson","doi":"10.3390/jcm14103570","DOIUrl":"https://doi.org/10.3390/jcm14103570","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent condition etiologically related to suboptimal levels of dopamine (DA) and norepinephrine (NE) that is typically treated with psychostimulant medication. In individuals with ADHD, divergent thinking abilities have been shown to improve with the use of psychostimulants. Furthermore, psychostimulants affect autonomic nervous system (ANS) functioning, which can impact creative cognition. However, it is not known how DA and NE affect creative cognition in this setting and how this effect is related to autonomic activity in ADHD. Therefore, our objective was to elucidate ANS function and its relationship with divergent creativity gains related to psychostimulant treatment in ADHD. <b>Method:</b> Seventeen individuals diagnosed with ADHD (age 27.9 ± 6.7 sd) participated in two counterbalanced sessions-one while on their prescribed stimulant medication and another after abstaining for at least 24 h. During each session, participants completed convergent (anagrams) and divergent (Torrance Test of Creative Thinking) thinking tasks. An 8 min electrocardiogram prior to cognitive testing was taken to measure heart rate variability (HRV), which is an index of ANS functioning. <b>Results:</b> The hypothesized baseline pNN50 HRV measure was not predictive of enhanced creativity gains on convergent anagrams or divergent creativity on the Torrance when taking stimulants. <b>Conclusions:</b> In this pilot study, the relationship between baseline HRV and the impact of stimulants on anagram performance suggests the noradrenergic system may not play a role in the effect of stimulants on convergent or divergent creativity. The lack of a relationship between baseline HRV and stimulant-related changes in TTCT and anagram scores lends some support to the hypothesis that dopaminergic effects may be the predominant factor in the effect of stimulants on creativity in ADHD. Future research should further investigate the interaction between hypoactive neurotransmitter systems, particularly dopamine in divergent and norepinephrine in convergent creativity, using neuroimaging techniques to assess neurotransmitter dynamics during creativity-based tasks.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159276","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":"Cognitive Impairment in ANCA-Associated Vasculitis: A Cross-Sectional Pilot Study.","authors":"Marion Camard, Ana Moises, Katia Bourdic, Laura Venditti, Christian Denier, Julien Henry, Raluca Sterpu, Perla David, Mathilde De Menthon, Olivier Lambotte, Anne-Cécile Petit, Matthias Babin, Nicolas Noel, Fanny Urbain","doi":"10.3390/jcm14103582","DOIUrl":"https://doi.org/10.3390/jcm14103582","url":null,"abstract":"<p><p><b>Objectives:</b> Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) comprises rare systemic vasculitides that can present with cognitive dysfunction. However, data on the screening and characterization of cognitive dysfunction in AAV remain limited. <b>Methods:</b> Cognitive complaints in AAV patients were screened using self-report questionnaires. Objective cognitive impairment was assessed with a standardized neurocognitive test battery. Results were compared with clinical evaluations, brain MRI findings, treatment history, and neuropsychiatric symptoms. All test results were standardized for the overall population. <b>Results:</b> Twelve patients (five women, seven men) with a median [IQR] age of 68 [59-71] and a median [IQR] disease duration of 92 months [55-127] were included. None of the patients showed evidence of vasculitis activity on brain MRI. Cognition was assessed using a standardized neurocognitive test battery in all patients except one. Four patients (36%) were found to have cognitive impairment, defined as three or more altered tests. The most affected functions were attentional and executive, with the d2-R (4/4), Rey-Osterrieth Complex Figure Delayed Recall (3/4), and Trail Making Test Part B (3/4) showing the most frequent deficiencies. Objective cognitive disorders were not associated with self-reported cognitive complaints. No significant association was found between cognitive impairment and vasculitis activity or sequelae, corticosteroid and immunosuppressive treatments, or neuropsychiatric symptoms. <b>Conclusions:</b> This study highlights the presence of cognitive impairments in AAV, predominantly affecting attentional and executive functions, which may reflect vascular involvement. Early and tailored approaches to cognitive screening and management are essential to improve patient care and quality of life.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158190","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":"Postoperative Refractory Diarrhea After Margin Accentuation of the Superior Mesenteric Artery with Irreversible Electroporation in Pancreaticoduodenectomy.","authors":"Eline-Alice Brys, Filip Gryspeerdt, Nikdokht Rashidian, An Verena Lerut, Pieter Dries, Luís Abreu de Carvalho, Frederik Berrevoet","doi":"10.3390/jcm14103568","DOIUrl":"https://doi.org/10.3390/jcm14103568","url":null,"abstract":"<p><p><b>Background</b>: Pancreatic ductal adenocarcinoma (PDAC) presents a challenge due to its poor prognosis. Irreversible electroporation (IRE) shows promise in improving margin clearance and increasing R0 and R1 indirect resection rates. Although IRE is believed to preserve surrounding tissues, this study aimed to assess postoperative refractory diarrhea as a severe complication and challenge the assumption of consistent tissue preservation. <b>Methods</b>: Patients undergoing pancreaticoduodenectomy (PD) with IRE for superior mesenteric artery (SMA) margin accentuation between May 2022 and April 2024 were included. Primary endpoints were diarrhea-related morbidity and mortality; secondary endpoints included R-status, recurrence, and metastases. IRE electrodes were initially positioned circumferentially around the SMA, but this approach was modified to hemi-circumferential placement and applied in six additional patients. <b>Results</b>: All five patients (median age 70, 80% female) in the initial cohort developed secretory diarrhea lasting a median of 6 months (IQR 5-6.5), with a median frequency of 5 stools/day (IQR 5-6.5). Two patients (40%) died due to diarrhea-associated cachexia. In contrast, among the six patients treated with the modified technique, patients' diarrhea resolved within a median of 8 days (IQR 6-10) without need for opioid or advanced antidiarrheal therapy. <b>Conclusions</b>: Circumferential IRE for SMA margin accentuation may damage the superior mesenteric plexus and induce severe, prolonged diarrhea. Hemi-circumferential application may mitigate this risk. Larger studies are required to validate these findings and optimize the use of IRE in PD.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159412","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 Neonatal Fosdenopterin Treatment for Molybdenum Cofactor Deficiency Type A: New Insights into Its Natural History and Potential Role for Fetal Therapy.","authors":"Adolfo Etchegaray, Darrah Haffner, Stephanie M Cruz, Oluseyi Ogunleye, Jason Xia, Amy Schlegel, Oluyinka O Olutoye, Bimal P Chaudhari","doi":"10.3390/jcm14103561","DOIUrl":"https://doi.org/10.3390/jcm14103561","url":null,"abstract":"<p><p><b>Introduction:</b> Molybdenum cofactor deficiency (MoCD) is a rare, lethal disorder characterized by early-onset encephalopathy and seizures. In 2021, fosdenopterin (Nulibry^TM) became the first FDA-approved treatment for MoCD type A (MoCD-A). <b>Case Presentation:</b> A G3P2 woman with a prior affected child underwent prenatal diagnosis of MoCD-A at 16 weeks via amniocentesis. Fetal Magnetic Resonance Imaging (MRI) at 22 weeks was normal but showed a mega cisterna magna by 28 weeks. Concerns of ongoing brain damage led to a cesarean section at 32 weeks 6 days estimated gestational age (EGA). Intravenous fosdenopterin was administered within 10 min of birth. Seizures started around 12 h and escalated to status epilepticus by 24 h but resolved by 60 h with treatment. Early MRI demonstrated acute injury without chronic changes. The infant was discharged on day 37 and diagnosed with spastic quadriplegic cerebral palsy at 6 months, with cognition relatively spared. At 24 months, the child remains seizure-free with moderate motor impairment. <b>Conclusions:</b> This case highlights that brain injury in MoCD-A may commence in utero during the second trimester. Early delivery combined with immediate neonatal fosdenopterin treatment controlled seizures and halted progression, but residual injury suggests that prenatal interventions are necessary to optimize outcomes.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158191","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":"Ramadanov-Zabler Safe Zone for Sacroiliac Screw Placement: A CT-Based Computational Pilot Study.","authors":"Nikolai Ramadanov, Simon Zabler","doi":"10.3390/jcm14103567","DOIUrl":"https://doi.org/10.3390/jcm14103567","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Posterior pelvic ring fractures are severe injuries requiring surgical stabilization, often through sacroiliac (SI) screw fixation. However, improper screw placement poses risks of neurovascular injury and implant failure. Defining a precise safe zone for screw placement is crucial to improving surgical accuracy and reducing complications. <b>Methods</b>: A computational study was conducted using a CT scan of a 75-year-old male patient to establish a safe zone for SI screw placement. Manual segmentation and 3D modeling techniques were used to analyze bone density distribution. A 2D lateral projection of the sacrum was generated to identify high-density regions optimal for screw placement. While the general principle of targeting areas of higher bone density for screw insertion is well established, this study introduces a novel computational method to define and visualize such a safe zone. The resulting region, termed the Ramadanov-Zabler Safe Zone, was delineated based on this analysis to ensure maximal intraosseous fixation with minimal risk of cortical breaches. <b>Results</b>: A high-resolution 3D model of the sacral region was successfully generated. Standard thresholding methods for segmentation proved ineffective due to low bone density, necessitating a freehand approach. The derived 2D projection revealed regions of higher bone density, which were defined as the Ramadanov-Zabler Safe Zone for screw insertion. This zone correlates with areas providing the best structural integrity, thereby reducing risks associated with screw misplacement. Additionally, intraoperative and postoperative imaging from a representative case is included to illustrate the translational feasibility of the proposed technique. <b>Conclusions</b>: The Ramadanov-Zabler Safe Zone offers a reproducible, CT-based computational approach to guide for SI screw placement, enhancing surgical precision and patient safety. This CT-based computational approach provides a standardized reference for preoperative planning, minimizing neurovascular complications and improving surgical outcomes. This pilot technique is supported by preliminary clinical imaging that demonstrates feasibility for intraoperative application. Further validation across diverse patient populations is recommended to confirm its clinical applicability.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159018","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":"An Investigation of the Effect of Combining Tolterodine and Duloxetine in the Treatment of Mixed-Type Urinary Incontinence and the Factors Affecting Success.","authors":"Resul Sobay, Eyüp Veli Küçük","doi":"10.3390/jcm14103575","DOIUrl":"https://doi.org/10.3390/jcm14103575","url":null,"abstract":"<p><p><b>Background</b>: Mixed urinary incontinence (MUI), particularly the urge-predominant subtype, involves both stress urinary incontinence (SUI) and urge urinary incontinence (UUI), posing a therapeutic challenge. Duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI), enhances urethral tone, while tolterodine, an antimuscarinic agent, reduces detrusor overactivity. Their combination may offer synergistic benefits. <b>Aim</b>: The aim of this study was to evaluate the efficacy of duloxetine and tolterodine combination therapy in urge-predominant MUI and identify factors influencing treatment success. <b>Method</b>: A retrospective study was conducted on 106 patients (mean age: 56.45 years) with urge-predominant MUI treated with duloxetine (40 mg twice daily) and tolterodine (4 mg once daily) for 12 weeks. Treatment outcomes were evaluated using the overactive bladder symptom score (OABSS), International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), 24 h pad test, and Clinical Global Impression Scale (CGI). Univariate and multivariate regression analyses were performed to determine predictors of success. <b>Results</b>: Significant improvements were observed: OABSS decreased from 11.08 to 6.95, ICIQ-SF decreased from 15.69 to 8.84, and pad use decreased from 3.58 to 0.73/day (all <i>p</i> 0.0001). Bladder capacity increased from 315.09 mL to 436.32 mL. Baseline ICIQ-SF scores were independent predictors of success (odds ratio [OR] = 2.919, <i>p</i> = 0.001). Patient satisfaction reached 77.4%, with mild side effects (constipation and dizziness) in 14 patients. <b>Conclusions</b>: Duloxetine and tolterodine combination therapy significantly improved symptoms and quality of life in urge-predominant MUI. Baseline ICIQ-SF scores may predict treatment success. Further prospective studies are needed.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 10","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159363","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}