Journal of Clinical Medicine最新文献

{"title":"Mission and One-Year Experience of a Kidney-Heart Outpatient Service: A Patient-Centered Management Model.","authors":"Caterina Carollo, Salvatore Evola, Alessandra Sorce, Emanuele Cirafici, Miriam Bennici, Giuseppe Mulè, Giulio Geraci","doi":"10.3390/jcm14062102","DOIUrl":"10.3390/jcm14062102","url":null,"abstract":"<p><p><b>Background</b>: Cardiorenal Syndrome (CRS) represents a growing global health challenge due to the increasing prevalence of coexisting kidney and heart disease. The complex pathophysiology of CRS demands an integrated, multidisciplinary approach involving both nephrology and cardiology. However, specialized care models remain limited, leading to fragmented management and suboptimal outcomes. <b>Methods</b>: A Kidney-Heart Outpatient Service was established at \"Paolo Giaccone\" University Hospital in Palermo in May 2023 to provide coordinated, multidisciplinary care for non-hospitalized patients with CRS. The service involves structured patient assessments, including medical history, physical examinations, laboratory tests, imaging, and a collaborative therapeutic plan formulated by nephrologists and cardiologists. Preliminary patient data were collected and analysed to assess demographic characteristics, comorbidities, and clinical outcomes. <b>Results</b>: Among the first 115 patients evaluated, most were male and over 70 years old. Hypertension (91%) and diabetes were the leading comorbidities, with CKD stage G3b being the most prevalent. Cardiovascular conditions such as atrial fibrillation (18%), prior myocardial infarction (17%), and heart failure (15%) were frequently observed. Three patient deaths occurred, and one progressed to hemodialysis. <b>Conclusions</b>: The Kidney-Heart Outpatient Service represents a novel, patient-centered model for CRS management, aiming to improve clinical outcomes and reduce hospital admissions through multidisciplinary collaboration. Longitudinal follow-up and expanded data collection are essential to validate the long-term efficacy of this approach and refine management strategies for CRS patients. Ongoing research efforts will focus on tracking patient outcomes over extended periods, optimizing therapeutic strategies, and further integrating nephrology and cardiology training. The goal is to establish a sustainable and scalable framework for CRS management that enhances patient care and reduces the healthcare burden.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11942838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719554","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":"Integrating Blinatumomab in the Frontline Treatment in B-Cell Acute Lymphoblastic Leukemia: A New Era in Therapeutic Management.","authors":"Martina Canichella, Laura De Fazio, Matteo Molica","doi":"10.3390/jcm14062055","DOIUrl":"10.3390/jcm14062055","url":null,"abstract":"<p><p>Blinatumomab, a bispecific T-cell engager (BiTE), has shown substantial efficacy in treating both relapsed/refractory (R/R) Philadelphia chromosome (Ph)-positive and Ph-negative acute lymphoblastic leukemia (ALL). With its targeted mechanism of action, favorable safety profile, and ability to induce deep molecular remissions, blinatumomab is increasingly incorporated into frontline treatment regimens for B-ALL. Recently, the Food and Drug Administration (FDA) has approved its use in the frontline setting for Ph-negative ALL. In Ph-negative ALL, combining blinatumomab with intensive chemotherapy has resulted in superior measurable residual disease (MRD) clearance and improved long-term outcomes. In Ph-positive ALL, combination therapies involving tyrosine kinase inhibitors (TKIs), particularly ponatinib and blinatumomab, are challenging the traditional approach of allogeneic hematopoietic stem cell transplantation (allo-SCT). This review explores the current evidence supporting the frontline use of blinatumomab in newly diagnosed adults with B-ALL, its impact on treatment paradigms, and potential future directions, including novel combination therapies and the role of emerging immunotherapeutic approaches.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11942861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719577","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":"Endogenous Causes of Obturator Nerve Entrapment: Literature Review and Proposal of a Treatment Algorithm.","authors":"Sandra Scharfetter, Florian Wimmer, Elisabeth Russe, Karl Schwaiger, Peter Pumberger, Laurenz Weitgasser, Gottfried Schaffler, Gottfried Wechselberger","doi":"10.3390/jcm14062068","DOIUrl":"10.3390/jcm14062068","url":null,"abstract":"<p><p><b>Background:</b> Obturator nerve entrapment can result from endogenous and exogenous causes. Due to its long course, which includes both endopelvic and exopelvic segments, the nerve is susceptible to irritation from multiple etiologies. However, as obturator nerve entrapment is relatively uncommon, a thorough understanding of endogenous factors contributing to nerve entrapment is lacking. Nevertheless, understanding the endogenous factors contributing to obturator nerve entrapment is crucial for an effective treatment approach. <b>Material and Methods</b>: We performed a systematic literature search on studies investigating the diagnostic and (surgical) therapeutic approaches to obturator neuropathy due to endogenous causes. Studies were grouped according to the etiology responsible for nerve irritation. Lastly, data were synthesized to create a clinical work-up flowchart for obturator nerve entrapment syndromes due to endogenous causes. <b>Results:</b> Data from 45 studies comprising 175 patients met our inclusion criteria. We were able to summarize these data into six broad etiologies (tumor, obturator hernia, endometriosis, cystic lesions, vascular, and idiopathic causes) responsible for nerve irritation and saw that the most important factors for therapy are the onset of the symptoms and the anatomical localization. MRI emerged as the most valuable diagnostic tool for chronic conditions, especially in identifying the precise etiology and location of nerve compression. <b>Conclusions:</b> This review offers a structured framework for diagnosing and managing obturator nerve entrapment due to endogenous causes. We propose a diagnostic and therapeutic algorithm based on the identified etiologies to facilitate clinical decision-making.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718865","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 Machine Learning-Based Prediction Model for Diabetic Kidney Disease in Korean Patients with Type 2 Diabetes Mellitus.","authors":"Kyung Ae Lee, Jong Seung Kim, Yu Ji Kim, In Sun Goak, Heung Yong Jin, Seungyong Park, Hyejin Kang, Tae Sun Park","doi":"10.3390/jcm14062065","DOIUrl":"10.3390/jcm14062065","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Diabetic kidney disease (DKD) is a major cause of end-stage kidney disease and a leading contributor to morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). However, predictive models for DKD onset in Korean patients with T2DM remain underexplored. This study aimed to develop and validate a machine learning (ML)-based DKD prediction model for this population. <b>Methods:</b> This retrospective study utilized electronic health records from six secondary or tertiary hospitals in Korea. The Jeonbuk National University Hospital cohort was used for model development (ratio training: test data, 8:2), whereas datasets from five other hospitals supported external validation. We employed multiple ML algorithms, including lasso, ridge, and elastic net regression; random forest; XGBoost; support vector machines; and neural networks. The model incorporated demographic variables, comorbidities, medications, and laboratory test results. <b>Results:</b> Among 5120 patients with T2DM, 1361 (26.6%) developed DKD. In the development cohort, XGBoost achieved the highest predictive performance (AUC: 0.8099), followed by random forest and logistic regression models (AUCs: 0.7977-0.8019). External validation confirmed the model's robustness with high AUCs (XGBoost: 0.8113, logistic regression models: 0.8228-0.8271). Key predictive factors included age; baseline estimated glomerular filtration rate; and creatinine, hemoglobin, and hemoglobin A1c levels. <b>Conclusions:</b> Our findings highlight the potential of ML-based approaches in predicting DKD in patients with T2DM. The superior performance of XGBoost and logistic regression models underscores their clinical utility. External validation supports the model's generalizability. This model is a valuable tool for the early DKD risk assessment of Korean patients with T2DM.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11942948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719433","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 Retrospective Review of the Deep Parasternal Intercostal Plane Block in Patients Undergoing Cardiac Surgery with Median Sternotomy.","authors":"Tzonghuei Chen, Leslie Annette Vargas Galvan, Kendra L Walsh, Andrew Winegarner, Patricia Apruzzese, Shyamal Asher, Andrew Maslow","doi":"10.3390/jcm14062074","DOIUrl":"10.3390/jcm14062074","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Regional anesthesia is an important part of Enhanced Recovery after Cardiac Surgery (ERACS) protocols designed to enhance analgesia, reduce opioid use, and improve postoperative outcomes. The deep parasternal intercostal plane (Deep-PIP) block is a fascial plane block in which local anesthetics are injected between the intercostal and transversus thoracis muscles to block neural transmission through the anterior cutaneous branches of the intercostal nerve. This study evaluates the impact of the Deep-PIP block in patients undergoing cardiac surgery via median sternotomy. <b>Methods</b>: In this retrospective cohort study, patients were divided into cohorts of 232 patients who had a block (BLOCK group) and 351 patients who did not receive a block (NOBlock group) using propensity score matching. Pain scores and opioid consumption over 24 h, extubation times, and ICU and hospital length of stay were compared for the two groups. Several subgroup analyses were also performed to evaluate the effects of block technique and block adjuvants. <b>Results</b>: While there was not a statistically significant difference in opioid consumption between the two groups, the BLOCK group had significantly lower pain scores, extubation times, and hospital length of stay. The subgroup analyses showed that modifications to block technique and use of block adjuvants were associated with reduced opioid consumption, but did not significantly affect pain scores, extubation time, or ICU or hospital length of stay. <b>Conclusions</b>: This study demonstrates the benefits of the deep parasternal intercostal plane block as part of an ERACS protocol. Routine implementation of the Deep-PIP block is reasonable given its potential benefits combined with its positive safety profile.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11942828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719476","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":"Cardiorespiratory Effects of Inverse Ratio Ventilation in Obese Patients During Laparoscopic Surgery: A Systematic Review and Meta-Analysis.","authors":"Michele Carron, Enrico Tamburini, Alessandra Maggiolo, Federico Linassi, Nicolò Sella, Paolo Navalesi","doi":"10.3390/jcm14062063","DOIUrl":"10.3390/jcm14062063","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Managing ventilatory strategies in patients with obesity under general anesthesia presents significant challenges due to obesity-related pathophysiological changes. Inverse ratio ventilation (IRV) has emerged as a potential strategy to optimize respiratory mechanics during laparoscopic surgery in this population. The primary outcomes were changes in respiratory mechanics, including peak inspiratory pressure (P_Peak), plateau pressure (P_Plat), mean airway pressure (P_Mean), and dynamic compliance (C_Dyn). Secondary outcomes included gas exchange parameters, hemodynamic measures, inflammatory cytokines, and postoperative complications. <b>Methods:</b> A systematic review and meta-analysis were conducted, searching PubMed, Scopus, EMBASE, and PMC Central. Only English-language randomized controlled trials (RCTs) evaluating the impact of IRV in adult surgical patients with obesity were included. The quality and certainty of evidence were assessed using the Risk of Bias 2 (RoB 2) tool and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework, respectively. <b>Results:</b> Three RCTs including 172 patients met the inclusion criteria. Compared to conventional ventilation without prolonged inspiratory time or IRV, IRV significantly reduced P_Peak (MD [95%CI]: -3.15 [-3.88; -2.42] cmH₂O, <i>p</i> < 0.001) and P_Plat (MD [95%CI]: -3.13 [-3.80; -2.47] cmH₂O, <i>p</i> < 0.001) while increasing P_Mean (MD [95%CI]: 4.17 [3.11; 5.24] cmH₂O, <i>p</i> < 0.001) and C_Dyn (MD [95%CI]: 2.64 [0.95; 4.22] mL/cmH₂O, <i>p</i> = 0.002) during laparoscopy, without significantly affecting gas exchange. IRV significantly reduced mean arterial pressure (MD [95%CI]: -2.93 [-3.95; -1.91] mmHg, <i>p</i> < 0.001) and TNF-α levels (MD [95%CI]: -9.65 [-17.89; -1.40] pg/mL, <i>p</i> = 0.021). <b>Conclusions:</b> IRV optimizes intraoperative respiratory mechanics but has no significant impact on postoperative outcomes, necessitating further research to determine its clinical role.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719481","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":"Induced Mesenchymal Stem Cells: An Emerging Source for Regenerative Medicine Applications.","authors":"Mahmood S Choudhery, Taqdees Arif, Ruhma Mahmood, Asad Mushtaq, Ahmad Niaz, Zaeema Hassan, Hamda Zahid, Pakeeza Nayab, Iqra Arshad, Mehak Arif, Mashaim Majid, David T Harris","doi":"10.3390/jcm14062053","DOIUrl":"10.3390/jcm14062053","url":null,"abstract":"<p><p>Regenerative medicine is gaining interest in the medical field due to the limitations of conventional treatments, which often fail to address the underlying cause of disease. In recent years, stem cell-based therapies have evolved as a promising alternative approach to treat those diseases that cannot be cured using conventional medicine. Adult stem cells, particularly the mesenchymal stem cells (MSCs), have attracted a lot of attention due to their ability to regenerate and repair human tissues and organs. MSCs isolated from adult tissues are well characterized and are currently the most common type of cells for use in regenerative medicine. However, their low number in adult donor tissues, donor-age and cell-source related heterogeneity, limited proliferative and differentiation potential, and early senescence in in vitro cultures, negatively affect MSC regenerative potential. These factors restrict MSC use for research as well as for clinical applications. To overcome these problems, MSCs with superior regenerative potential are required. Induced MSCs (iMSCs) are obtained from induced pluripotent stem cells (iPSCs). These cells are patient-specific, readily available, and have relatively superior regenerative potential and, therefore, can overcome the problems associated with the use of primary MSCs. In this review, the authors aim to discuss the characteristics, regenerative potential, and limitations of MSCs for regenerative medicine applications. The main methods to generate iMSCs from iPSCs have been discussed in detail. In addition, the proposed criteria for their molecular characterization, applications of iMSCs for disease modeling and drug discovery, as well as potential use in regenerative medicine have been explored in detail.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719563","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":"Short- and Long-Term Mortality in Severely Injured Older Trauma Patients: A Retrospective Analysis.","authors":"Silviya Ivanova, Elsa F Hilverdink, Johannes D Bastian, Dominik A Jakob, Aristomenis K Exadaktylos, Marius J B Keel, Joerg C Schefold, Helen Anwander, Thomas Lustenberger","doi":"10.3390/jcm14062064","DOIUrl":"10.3390/jcm14062064","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background/Objectives&lt;/b&gt;: Older trauma patients experience increased in-hospital mortality due to the physiological challenges associated with aging and injury severity. However, limited data exist on long-term mortality rates beyond hospital discharge, particularly among severely injured elderly trauma patients. Understanding these outcomes is essential for improving clinical management and rehabilitation strategies. The objective of this study was to evaluate cumulative mortality rates (in-hospital, 28-day, 1-year, 2-year, and 3-year) in older trauma patients with an Injury Severity Score (ISS) ≥ 16. Independent risk factors for 1-year mortality were also identified. &lt;b&gt;Methods&lt;/b&gt;: This retrospective cohort study included all trauma patients aged ≥ 65 years with ISS ≥ 16 admitted to the Emergency Department of our level 1 trauma center between January 2017 and December 2022. Demographic characteristics, injury patterns (Abbreviated Injury Scale (AIS) scores, ISS), and mortality rates were collected from electronic health records. Patients were stratified into two age groups: 65-80 years and &gt;80 years. Mortality rates were compared with those in the corresponding age groups in the general Swiss population. Statistical analysis included Kaplan-Meier survival curves and logistic regression for identifying risk factors associated with 1-year mortality. &lt;b&gt;Results&lt;/b&gt;: A total of 1189 older trauma patients with a mean ISS of 24.3 ± 7.9 were included. The most common injury was severe head trauma (AIS head ≥ 3: 70.6%), followed by chest trauma (AIS chest ≥ 3: 28.2%) and extremity injuries (AIS extremity ≥ 3: 17.4%). The overall in-hospital mortality rate was 10.3%. Mortality rates at 28 days, 1 year, 2 years, and 3 years were 15.8%, 26.5%, 31.5%, and 36.3%, respectively. Age-stratified analysis showed significantly higher mortality rates in patients aged &gt; 80 years compared to the 65- to 80-year group at all post-discharge time points (28-day: 22.6% vs. 11.9%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001; 1-year: 39.9% vs. 18.8%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001; 2-year: 46.5% vs. 22.8%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001; 3-year: 56.4% vs. 24.9%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Compared to the general Swiss population, we observed significantly higher mortality rates at all measured time points in elderly trauma patients, particularly in those aged over 80 years, with 1-year mortality rates of 39.9% vs. 10% in the general population and 3-year mortality rates of 56.4% vs. 30% in the general population. Independent risk factors for 1-year mortality included advanced age and severe head injury (AIS head ≥ 3, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). &lt;b&gt;Conclusions&lt;/b&gt;: Severely injured elderly trauma patients face high long-term mortality risks, with 1-year mortality rates reaching 26.5% overall and nearly 40% in patients aged &gt; 80 years. These findings highlight the need for research on tailored, holistic management strategies, including comprehensive in-hospital care, specialized neurorehabilitation, and post-discharge follow-up progr","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11942779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719739","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 Effect on Extubation of Early vs. Late Definitive Closure of the Patent Ductus Arteriosus in Premature Infants: A Target Trial Emulation Using Electronic Health Records.","authors":"Zhou Du, Craig R Wheeler, Michael Farias, Diego Porras, Philip T Levy, Arin L Madenci","doi":"10.3390/jcm14062072","DOIUrl":"10.3390/jcm14062072","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Premature infants are often referred for the definitive procedural closure of the patent ductus arteriosus (PDA) with the failure of, or contraindication to, pharmacotherapy and the inability to wean respiratory support. However, once this need is identified, the importance of expedited closure is unclear. The objective of this study was to compare the effect of the timing of definitive closure (i.e., surgical ligation or device occlusion) on early respiratory outcomes in premature infants. <b>Method</b>: We first specify a hypothetical randomized trial (the \"target trial\") that would estimate the effect on extubation of early (0-4 days from referral) vs. late (5-14 days from referral) definitive PDA closure. We then emulate this target trial using a single-institution registry of premature infants (born <30 weeks or with a birth weight < 1500 g) who underwent the definitive closure of PDA between January 2014 and October 2023. <b>Results</b>: We identify 131 eligible infants. At the end of the follow-up, 70 and 38 infants were adherent to early and late PDA closure strategies, respectively. The cumulative incidence of extubation in the early group was higher than that in the late group until day 40 (maximum risk difference: 22 percentage points at day 13; 95% CI: -11 to 56). Outcomes were similar at the end of the 45-day follow-up period (risk difference: -1 percentage point; 95% CI: -46 to 42). <b>Conclusions</b>: The need for mechanical ventilation was equivalent between early and late PDA closure strategies at the end of a 45-day follow-up period although infants in the early intervention group were extubated sooner.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11943036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719097","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":"Clinical Significance of Extracellular Volume of Myocardium (ECV) Assessed by Computed Tomography: A Systematic Review and Meta-Analysis.","authors":"Adrian Martuszewski, Patrycja Paluszkiewicz, Rafał Poręba, Paweł Gać","doi":"10.3390/jcm14062066","DOIUrl":"10.3390/jcm14062066","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Extracellular volume (ECV) of the myocardium, a biomarker of interstitial space and fibrosis, plays a critical role in cardiac disease diagnosis and prognosis. Although cardiac magnetic resonance imaging (MRI) is the gold standard for ECV assessment, computed tomography (CT) offers a viable alternative, particularly in patients with contraindications to MRI. This study aimed to assess whether CT-derived ECV is systematically elevated in cardiac diseases associated with myocardial fibrosis. <b>Methods</b>: A systematic search of PubMed and Web of Science up to January 2023 identified 364 studies, including 16 from registers and 4 from manual searches. After exclusions, 73 studies were included in the systematic review. Of these, 15 provided quantitative data on group sizes, mean ECV values, standard deviations, and imaging modalities (CTA, DECT, LIE-DECT) and were analyzed in the meta-analysis. Standardized mean differences (SMD) were calculated using <i>Cochrane Handbook</i> formulas. Statistical analyses employed random-effects models (R version 4.4.2). <b>Results</b>: The pooled analysis showed that ECV was significantly higher in pathological groups compared to controls (SMD 1.60; 95% CI: 1.23-1.96; I² = 84.6%). Elevated ECV correlated with worse clinical outcomes, including higher mortality in heart failure and advanced myocardial fibrosis in amyloidosis and cardiomyopathies. Subgroup analyses demonstrated that advanced CT techniques (DECT, LIE-DECT) and CTA provided comparable diagnostic accuracy. <b>Conclusions</b>: CT-derived ECV is a reliable, non-invasive marker of myocardial fibrosis, offering diagnostic and prognostic value similar to MRI. Standardizing CT protocols and conducting multicenter studies are essential to validate its broader clinical application.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 6","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11942809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719392","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}