Journal of Clinical Medicine最新文献

{"title":"Intracranial Metastases from Uterine Leiomyosarcoma: A Systematic Review and Case Illustration.","authors":"Ahmad Pour-Rashidi, Sara Zandpazandi, Laetitia Perronne, Virginia B Hill, Chase Krumpelman, Kamal Subedi, Linda Kelahan, Amir A Borhani, Hatice Savas, Ryan Avery, Tugce Agirlar Trabzonlu, Ulas Bagci, Sean Sachdev, Karan Dixit, Rimas V Lukas, Priya Kumthekar, Yuri S Velichko","doi":"10.3390/jcm14186631","DOIUrl":"10.3390/jcm14186631","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Brain metastasis from uterine leiomyosarcoma (ULMS) is an exceptionally rare complication of an aggressive malignancy. With fewer than 40 cases previously documented, a significant knowledge gap exists regarding its clinical course, management, and outcomes. This study provides the largest analysis of ULMS brain metastases to date, integrating a systematic literature review with a novel case report illustrating the disease's uniquely rapid progression. <b>Methods</b>: Following PRISMA guidelines, we systematically reviewed four major databases to identify all reported cases of intracranial metastasis from ULMS. Data on patient demographics, clinico-radiological features, treatments, and survival were extracted and analyzed. Methodological quality was assessed using a modified Joanna Briggs Institute (JBI) tool. <b>Results</b>: We analyzed 34 studies with 39 individual cases. Additionally, this review was supplemented by one new illustrative case from our institution. The median patient age was 51.5 years, and most presented with focal neurological symptoms. Common imaging findings included hyperdense lesions on CT and homogeneously enhancing, dural-based masses on MRI, which mimic other intracranial pathologies. Though surgery was the most frequent intervention (76.9%), median survival after a brain metastasis diagnosis was a grim 5 months, with no significant difference observed between treatment modalities. Our illustrative case was remarkable for an extremely rapid volumetric doubling time averaging just 7.3 days. <b>Conclusions</b>: Brain metastasis from ULMS is a lethal event with an extremely poor prognosis. Nonspecific imaging features create diagnostic challenges, necessitating histopathological confirmation. Current therapies, including surgery and radiotherapy, offer palliative benefit but do not significantly alter survival. The aggressive biological behavior demonstrated here underscores the urgent need for increased clinical awareness and collaborative research to develop more effective management strategies and improve outcomes for this devastating diagnosis.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175940","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":"Action Observation Training for Upper Limb Stroke Rehabilitation: A Pilot Study on the Role of Attention.","authors":"Giada Milani, Andrea Baroni, Martina Galluccio, Giulia Fregna, Annibale Antonioni, Sofia Straudi, Thierry Pozzo, Luciano Fadiga","doi":"10.3390/jcm14186618","DOIUrl":"10.3390/jcm14186618","url":null,"abstract":"<p><p><b>Background</b>: Restoring motor function is crucial for daily life after a stroke. Although patients' engagement and attention influence motor recovery, these factors are frequently overlooked in rehabilitation interventions. <b>Methods</b>: This prospective open-label pilot trial (NCT04622189) investigated the impact of attentional deficits on engagement and motor recovery in 10 subacute stroke patients undergoing a 4-week action observation training program. At baseline, they were divided into two subgroups based on attentional performance, as determined by scores on the Test of Attentional Performance (subtests of divided attention and Go/No-Go): those with attention deficits (AD, i.e., deficits in one or both tasks, n = 6) and those without (No_AD, no deficits in either task, n = 4). <b>Results</b>: Both groups exhibited similar motor profiles at baseline; however, the AD group presented significantly lower cognitive reserve (AD mean (SD) 92.2 ± 4.09, No_AD 120 ± 14.9, <i>p</i> = 0.005) and greater anxiety and depressive symptoms (AD 66.7%, No_AD 0%, <i>p</i> = 0.035). While all patients showed improvements in motor outcomes, the No_AD group demonstrated significantly greater gains in upper limb function, as assessed by the Fugl-Meyer Assessment (AD 3.33 ± 1.21, No_AD 10.8 ± 5.7, <i>p</i> = 0.013). Engagement and accuracy of interactive questions, used as proxies for concentration during training, were also higher in the No_AD group and positively correlated (rho = 0.9075, <i>p</i> ≤ 0.001). Moreover, patients with attention deficits reported lower levels of engagement during training. <b>Conclusions</b>: These findings indicate that attentional status may affect both adherence to and responsiveness to rehabilitation. This highlights a potentially relevant factor to consider when improving post-stroke interventions.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12471024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175725","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":"Extracorporeal Membrane Oxygenation for Severe Hypoxemia in Burn Patients: Analysis from Taiwan National Health Insurance Research Database.","authors":"Jiun-Yu Lin, Yi-Ting Tsai, Chih-Yuan Lin, Hung-Yen Ke, Yi-Chang Lin, Jia-Lin Chen, Hsiang-Yu Yang, Chien-Ting Liu, Wu-Chien Chien, Chien-Sung Tsai, Po-Shun Hsu, Shih-Ying Sung","doi":"10.3390/jcm14186623","DOIUrl":"10.3390/jcm14186623","url":null,"abstract":"<p><p><b>Background</b>: Burn patients with severe inhalation injury and refractory hypoxemia are at high risk for cardiorespiratory failure and mortality. Extracorporeal membrane oxygenation (ECMO) has emerged as a potential rescue therapy, but its survival benefits in this population remain uncertain. This study aimed to evaluate the impact of ECMO on mortality in burn patients with severe lung injury, to identify risk factors associated with death, and to analyze causes of rehospitalization among survivors. <b>Methods</b>: We conducted a population-based, retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD). Burn patients with severe hypoxia requiring mechanical ventilation between 2000 and 2015 were identified. A 0.25-fold propensity score matching was applied based on age, gender, and burn severity. Mortality rates, survival risk factors, and rehospitalization causes were analyzed between ECMO and non-ECMO groups. <b>Results</b>: Among 6493 eligible patients, ECMO-treated patients had a hospital mortality rate of 47.09%, compared to 38.71% in the non-ECMO group. Early-phase mortality was higher among ECMO patients (adjusted 1-year mortality HR: 3.19), but survivors demonstrated stable long-term outcomes. Pulmonary complications, cardiac dysfunction, and sepsis were the leading causes of death. Kidney failure and infections were the most common reasons for rehospitalization among survivors. <b>Conclusions</b>: This research offers a comprehensive real-world analysis of the effectiveness of ECMO in burn patients. While ECMO does not eliminate early mortality risk, it may provide critical support during acute phase in carefully selected burn patients with severe hypoxemia. Multidisciplinary care and early rehabilitation planning are essential to improve long-term outcomes. Further research is needed to refine patient selection and optimize ECMO strategies in this high-risk population.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175808","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":"Evaluation of a Theoretical and Experiential Training Programme for Allied Healthcare Providers to Prescribe Exercise Among Persons with Multiple Sclerosis: A Co-Designed Effectiveness-Implementation Study.","authors":"Yvonne C Learmonth, Georgios Mavropalias, Kym Wansbrough","doi":"10.3390/jcm14186625","DOIUrl":"10.3390/jcm14186625","url":null,"abstract":"<p><p><b>Background:</b> Multiple sclerosis (MS) is the most prevalent neurological disorder in young adults, characterised by physical, psychological and cognitive dysfunction. Exercise training is a safe management strategy. Healthcare providers (HCPs) acknowledge deficiencies in awareness, counselling strategies, and resources that prevent them from promoting and prescribing this effective treatment. We implemented an online evidence-based educational programme and evaluated the effect, acceptability, appropriateness, and feasibility of the programme in improving HCP confidence, knowledge, and attitudes towards remote exercise prescription to persons with MS. <b>Methods</b>: Physiotherapists and exercise physiologists were recruited and received the educational programme (online theory and 16-week experience of prescribing to persons with MS). Participants' confidence, knowledge and attitudes towards exercise prescription, as well as their professional quality of life, were our primary outcomes-baseline (T1), immediately post-online theoretical learning (T2), post-application with clients (T3; approximately 16 weeks after T2), and at 12-month follow-up (T4). We gathered participants' acceptability, appropriateness, and feasibility evaluation at T2, T3 and T4. We analysed the effect on primary outcomes using generalised linear mixed models, with secondary and evaluative outcomes analysed as counts and qualitative themes. <b>Results</b>: Of 40 participants who provided baseline data, 24 completed the theoretical programme, and 16 completed the experiential programme. Self-confidence improved significantly (|βs| ≥ 1.27, SEs ≤ 0.31, |zs| ≥ 5.28, ps < 0.001), with large effect sizes (percentage change: 256.8-479.4%). Some theoretical domains framework-based domains have improved, such as beliefs about skills to prescribe evidence-based principles. Participants expressed high satisfaction with the programme and showed increased delivery of implementation behaviour change strategies. <b>Conclusions</b>: An online evidence-based education programme for MS care improved HCPs' self-confidence, perceived skills and delivery of evidence-based exercise behaviour-based prescription.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175872","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":"Vascular Dementia: From Pathophysiology to Therapeutic Frontiers.","authors":"Han-Mo Yang","doi":"10.3390/jcm14186611","DOIUrl":"10.3390/jcm14186611","url":null,"abstract":"<p><p>Vascular dementia (VaD) represents the second-most common dementia type after Alzheimer's disease since it results from complications of cerebrovascular disease. Mixed pathologies combining vascular and neurodegenerative processes are the rule rather than exception in elderly dementia patients. The condition known as VaD includes various types of vascular damage that affect both large and small blood vessels in the brain which results in cerebral hypoperfusion, blood-brain barrier disruption, glymphatic dysfunction, and molecular cascades causing neuronal damage. The mechanisms of VaD include endothelial dysfunction, oxidative stress, chronic neuroinflammation, impaired glymphatic clearance, white matter demyelination, and synaptic failure. The disease susceptibility of individuals depends on genetic factors which include NOTCH3 mutations and vascular risk polymorphisms. The diagnostic field uses neuroimaging tools and fluid biomarkers such as neurofilament light chain, inflammatory markers, and Aβ/tau ratios for mixed pathology. The current practice of vascular risk management combines with new therapeutic approaches that use phosphodiesterase inhibitors for cerebral perfusion and NLRP3 inflammasome inhibitors for neuroinflammation, senolytics for cellular senescence, and remyelination agents for white matter repair. However, the majority of new treatment methods remain investigational with limited Phase III data. Future medical treatment development will depend on precision medicine approaches which use biomarker-guided treatment selection and combination strategies targeting multiple pathological mechanisms.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175976","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":"Medication-Induced Xerostomia: Cross-Sectional Analysis of Salivary Flow, Intraoral Aching, and Anxiety.","authors":"Olga A Korczeniewska, Eli Eliav, Szilvia Arany","doi":"10.3390/jcm14186624","DOIUrl":"10.3390/jcm14186624","url":null,"abstract":"<p><p><b>Background:</b> This cross-sectional study investigated the associations between medication-induced xerostomia (perceived oral dryness) and intraoral painful aching in 141 middle-aged adults (45-64 years) with self-reported xerostomia resulting from anticholinergic medications. <b>Methods:</b> Xerostomia severity, anxiety, and intraoral painful aching were evaluated using questionnaires, including the semiquantitative Xerostomia Inventory survey. Reduction in saliva secretion (hyposalivation) was objectively assessed by the measurement of unstimulated whole saliva (UWS) flow. <b>Results:</b> Multivariate stepwise linear regression was used to identify factors associated with XI scores, adjusting for potential confounders including age, sex, diabetes, smoking status, and race. The final model identified UWS flow (<i>p</i> = 0.0023), intraoral painful aching (<i>p</i> = 0.0030), and diabetes (<i>p</i> = 0.0097) as significant predictors of xerostomia severity. Anxiety demonstrated a marginal association (<i>p</i> = 0.0643) and accounted for a smaller proportion of model variance. Relative importance analysis revealed that UWS flow contributed 33.16% to the overall model fit, followed by intraoral pain (31.30%), diabetes (23.60%), and anxiety (11.93%). <b>Conclusions:</b> The findings indicate that reduced salivary flow, intraoral discomfort, and the presence of diabetes are significant contributors to xerostomia severity in individuals taking anticholinergic medications. These results highlight the importance of individualized evaluation in xerostomia care and inform targeted clinical strategies for managing xerostomia symptoms in patients with intraoral painful aching, anxiety, or comorbid diabetes.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175683","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":"At-Home Urea Breath Testing Demonstrates Increased Patient Uptake, High Satisfaction Rates, and Reduction in Carbon Emission Due to Eliminated Hospital Attendances, While Maintaining Diagnostic Accuracy for <i>H. pylori</i>.","authors":"Conor Costigan, Edric Leung, Sandeep Sihag, Emmanuel Omallao, Deirdre McNamara","doi":"10.3390/jcm14186598","DOIUrl":"10.3390/jcm14186598","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Healthcare accounts for approximately 4.4% of global carbon emissions. Gastroenterology is a particularly heavy producer, with professional organisations outlining targets to move towards carbon neutrality. Missed hospital appointments, associated with poor medical outcomes, also represent physical and economic waste to the sector. COVID-19 expedited the shift toward virtual clinics, but tele-diagnostics have not expanded similarly. We aimed to assess the feasibility of a virtual C13 urea breath test clinic for <i>H. pylori</i> in Ireland. <b>Methods</b>: C13 urea breath test kits were provided to patients in the community, who were subsequently invited to book an online video appointment with a GI lab technician to assist them in performing the test at home. Completed tests were returned to the hospital via local GP, by post, or a specified hospital drop-off point, and analysed using our standard protocol. <b>Results</b>: 423 virtual appointments were reviewed. 135 (32%) were male, and the mean age was 42 years. The test positivity rate was 22%, similar to a matched in-person testing cohort (21%). In all, there were no non-attenders, and two cancellations. Virtual patients were more likely to attend their appointments (OR = 153.9, <i>p</i> = 0.0004) than in-person patients. Virtual UBT appointments saved 9943.5 Km of road journeys, equivalent to 254 person-hours of travel time and 1.24 metric tonnes of CO₂. Additionally, 300 (71%) patients returned a feedback questionnaire, of which 276 (92%) rated the overall home breath test experience as 'good' or 'excellent'. <b>Conclusions</b>: Home testing for <i>H. pylori</i> is effective, acceptable, and reduces both reliance on invasive procedures such as endoscopy and carbon emissions.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175444","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":"Effect of Dry Carbonic Acid Baths on Blood Rheological Parameters in Patients with Venous Leg Ulcers.","authors":"Patrycja Dolibog, Paweł Tomasz Dolibog, Mikołaj Łanocha, Marcelina Paruzel, Tomasz Pryzwan, Aleksandra Frątczak, Wiesław Pilis, Daria Chmielewska, Sławomir Grzegorczyn, Beata Bergler-Czop","doi":"10.3390/jcm14186614","DOIUrl":"10.3390/jcm14186614","url":null,"abstract":"<p><p><b>Background</b>: Chronic venous insufficiency (CVI) is one of the main causes of venous leg ulcers. Rheological disorders of the blood, such as changes in viscosity, hematocrit, and erythrocyte aggregation and deformability, can impair microcirculation and impede healing. Carbonic acid (CO₂) dry baths are a non-invasive physical method that can affect microcirculation and blood parameters, and this study aimed to assess their effectiveness in ulcer healing and in modifying selected blood rheological parameters in patients with CVI. <b>Methods</b>: This prospective, controlled study enrolled 23 participants (11 patients with active venous leg ulcers and 12 healthy controls). The intervention group underwent ten sessions of dry CO₂ baths, performed twice weekly for 5 weeks. No randomization was applied. Ulcer healing was assessed planimetrically, and blood rheological parameters (hematocrit, blood and plasma viscosity, erythrocyte deformability index [EI], aggregation index [AI], aggregation amplitude [AMP], and half-time of aggregation [T_1/2]) were measured before and after therapy. <b>Results</b>: Following the intervention, the ulcer area decreased significantly (median 3.35 cm² to 1.74 cm²; <i>p</i> < 0.01), as did ulcer circumference (7.33 cm to 5.87 cm; <i>p</i> < 0.01). Hematocrit increased (median 40.25% to 41.50%; <i>p</i> < 0.05), and blood viscosity values at low shear rates approached those of the control group. In contrast, erythrocyte deformability (EI) and aggregation indices (AI, AMP, T_1/2) showed no statistically significant intragroup changes, although intergroup differences persisted. Pain intensity decreased significantly (VAS 6.0 to 3.5 cm; <i>p</i> < 0.05). <b>Conclusions</b>: CO₂ dry baths support the treatment of venous ulcers by improving microcirculation and reducing pain. Their impact on blood rheology may have clinical significance, especially as an adjunct to therapy in chronic venous insufficiency. However, the relatively small sample size (<i>n</i> = 23) should be considered a limitation when interpreting these findings.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12471036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175851","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":"Immune Checkpoint Inhibitor-Induced Diabetes Mellitus-A Brief Review and Three Case Reports.","authors":"Marius-Lucian Mitrache, Aura-Diana Reghina, Iulia-Simona Stoian, Simona Fica","doi":"10.3390/jcm14186620","DOIUrl":"10.3390/jcm14186620","url":null,"abstract":"<p><p>Immune checkpoint inhibitors (ICIs) have emerged as the cornerstone of treatment in a broad range of neoplasms, but at the cost of several types of immune-related adverse events (irAEs), some of which can also involve the endocrine system. Among those, ICI-induced diabetes mellitus (ICI-DM), while generally considered rare, has been growing in incidence in the past years. While this growth mostly reflects the expanding indications for the use of ICI, several other risk factors have also been described, but they have not been fully characterized. As with the majority of endocrine irAEs, once an endocrine loss of function occurs, it is usually irreversible and requires lifelong substitution therapy. However, the uniqueness of ICI-DM among those stems from the fact that its clinical presentation is usually acute, often life-threatening, and sometimes requires at least brief cessation of immunotherapy. In this paper, we report three cases of ICI-DM and provide a review of the literature regarding this topic, while presenting the real-world clinical lessons we learned from managing these cases, which can prove valuable for both oncologists and endocrinologists.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175956","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":"Evaluation of Automated Vasopressor Administration Algorithms Using Lower-Limit Control for Intraoperative Hypotension: A Simulation Study.","authors":"Emi Morinushi, Osamu Nagata, Fumiyo Yasuma, Aya Kuroyanagi, Kanji Uchida","doi":"10.3390/jcm14186615","DOIUrl":"10.3390/jcm14186615","url":null,"abstract":"<p><p><b>Background/Objectives:</b> The aim of this study was to develop evaluation metrics for lower-limit vasopressor control, a strategy intended to prevent prolonged intraoperative hypotension under noninvasive blood pressure monitoring. <b>Methods:</b> Using general-purpose simulation software, we developed a blood pressure generation model with one-minute intervals and an automated vasopressor administration model with five-minute intervals. The latter delivered drugs according to predefined rules when systolic blood pressure (sBP) fell below a threshold. Four dosing strategies were constructed by combining bolus, repeated low-dose bolus, and continuous infusion approaches. Simulations were performed, and the following evaluation metrics were calculated: (1) proportion of time below threshold (PTBT), (2) mean value below threshold (MVBT), (3) average sBP, and (4) median performance error (MDPE) and median absolute performance error (MDAPE). <b>Results</b>: PTBT and MVBT analyses showed that incorporating continuous infusion reduced both the duration and severity of hypotension. Moreover, adding MVBT to the average sBP after subtracting the threshold quantified the extent to which sBP exceeded the threshold on average. In contrast, MDPE and MDAPE varied substantially with the assumed target pressure, highlighting their limitations in evaluating lower-limit control without a fixed target. <b>Conclusions</b>: For lower-limit control, metrics such as PTBT, MVBT, and average sBP offer useful insights into control stability and hypotension avoidance, whereas MDPE and MDAPE may be unsuitable for quantitative assessment when the primary goal is to exceed a threshold rather than achieve a fixed target pressure.</p>","PeriodicalId":15533,"journal":{"name":"Journal of Clinical Medicine","volume":"14 18","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175965","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}