J. Clin. Med., Volume 13, Issue 6 (March-2 2024) – 306 articles

Background/Objectives: We aimed to determine the trends over time and current status of early Helicobacter pylori-uninfected gastric cancer (HpUIGC) treatment in a region with an aging population. Methods: This retrospective, multi-center observational study was conducted at seven major general hospitals in Kagoshima Prefecture. From January 2009 to July 2022, 2091 patients who received endoscopic resection (ER) for early gastric cancer (EGC) were retrospectively enrolled, of which 35 were identified as early HpUIGC cases. Results: The number of ERs for EGC demonstrated a significant increasing trend from 2010 to 2021 (p = 0.01 for trend). Furthermore, the 12-year period from 2010 to 2021 was divided into an early and late phase every 6 years. In the early phase, there were 5 cases (0.7%) of early HpUIGC, while in the late phase, there were 25 cases (2.1%), indicating a significant increase in the proportion of ERs for early HpUIGC cases in the late phase (p = 0.02). Conclusions: The proportion of ERs for early HpUIGC, which are more common in relatively young patients, may be increasing as a proportion of all ERs for GC, even in areas of Japan with an aging population. Full article

(1) Background: Although the diagnostic criteria for massive hemorrhage with organ dysfunction, such as disseminated intravascular coagulation associated with delivery, have been empirically established based on clinical findings, strict logic has yet to be used to establish numerical criteria. (2) Methods: A dataset of 107 deliveries with >2000 mL of blood loss, among 13,368 deliveries, was obtained from nine national perinatal centers in Japan between 2020 and 2023. Twenty-three patients had fibrinogen levels <170 mg/dL, which is the initiation of coagulation system failure, according to our previous reports. Three of these patients had hematuria. We used six machine learning methods to identify the borderline criteria dividing the fibrinogen/fibrin/fibrinogen degradation product (FDP) planes, using 15 coagulation fibrinolytic factors. (3) Results: The boundaries of hematuria development on a two-dimensional plane of fibrinogen and FDP were obtained. A positive FDP–fibrinogen/3–60 (mg/dL) value indicates hematuria; otherwise, the case is nonhematuria, as demonstrated by the support vector machine method that seemed the most appropriate. (4) Conclusions: Using artificial intelligence, the borderline criterion was obtained, which divides the fibrinogen/FDP plane for patients with hematuria that could be considered organ dysfunction in massive hemorrhage during delivery; this method appears to be useful. Full article

Background: COVID-19 increases the risk of venous thromboembolism (VTE) through a complex interplay of mechanisms collectively referred to as immunothrombosis. Limited data exist on VTE challenges in the acute setting throughout a dynamic long-term follow-up of COVID-19 patients compared to non-COVID-19 patients. The aim of the study was to investigate acute and long-term management and complications in VTE patients with and without COVID-19. Methods: A prospective, observational, single-center cohort study on VTE patients followed from the acute care stage until 24 months post-diagnosis. Results: 157 patients, 30 with COVID-19-associated VTE and 127 unrelated to COVID-19, were enrolled. The mean follow-up was 10.8 (±8.9) months. COVID-19 patients had fewer comorbidities (1.3 ± 1.29 vs. 2.26 ± 1.68, p < 0.001), a higher proportion of pulmonary embolism at baseline (96.7% vs. 76.4%, p = 0.01), and had a lower probability of remaining on anticoagulant therapy after three months (p < 0.003). The most used initial therapy was low-molecular-weight heparin in 130/157 cases, followed by long-term treatment with direct oral anticoagulants in 123/157. Two (6.7%) COVID-19 vs. three (2.4%) non-COVID-19 patients (p = 0.243) had major hemorrhagic events, all of them within the first three months. Four (3.1%) non-COVID-19 patients had VTE recurrence after six months. Three (2.4%) non-COVID-19 patients developed chronic thromboembolic pulmonary hypertension. There were no fatalities among patients with COVID-19, compared to a mortality of 12/127 (9.4%) in the non-COVID-19 subgroup (p = 0.027). Discussion: Our study offers a comprehensive overview of the evolving nature of VTE management, emphasizing the importance of personalized risk-based approaches, including a limited course of anticoagulation for most COVID-19-associated VTE cases and reduced-dose extended therapy for high-risk subsets. Full article

(1) Background: The present review aims to identify risk factors with predictive value for differentiating between pseudoexfoliation patients at risk of developing intra- or postoperative complications and those without operative risk during cataract surgery. (2) Methods: The review protocol was registered at PROSPERO, registration no. CRD42023417721. The following databases were searched for studies between 2000 and 2023: PubMed/Medline, Scopus, Springer, Science Direct, Web of Science, Cochrane Database of Systematic Reviews, TRIP database, LILACS, Clinical Trials, and reference lists of articles. We included analytical studies of any design examining cataract surgery complications in pseudoexfoliation patients across two population groups, one who underwent uneventful cataract surgery and the other who experienced intra- or postoperative complications. The paper will follow PRISMA 2020 criteria for reporting. Effect measure was assessed using odds ratios (ORs) and corresponding 95% confidence interval (CI) for qualitative variables and means with their respective standard deviation (SD) for quantitative variables. The risk of bias was assessed using the method presented in the Cochrane Handbook for Systematic Reviews. The GRADE scale was used for quality of evidence and certainty. (3) Results: The initial search of published and gray literature databases retrieved 1435 articles, six of which were included in this report. A total of 156 intra- or postoperative incidents were reported in 999 eyes with pseudoexfoliation. The identified predictive factors were a shallow anterior chamber, cataract grade, neutrophil-to-lymphocyte ratio, preoperative intraocular pressure, and symmetry of the exfoliation material. Limitations include heterogeneity of data and limited number of studies identified in our search. (4) Conclusions: These findings suggest the potential to refine risk stratification protocols in clinical settings and assist surgeons in personalized decision-making among individuals with pseudoexfoliation syndrome. Full article

Background: We aimed to analyze the clinical outcomes and effectiveness of cervical biportal endoscopic spine surgery (C-BESS) and anterior cervical discectomy and fusion (ACDF) in patients with symptomatic cervical disc herniation. Methods: This study was a retrospective chart review of four-year clinical data involving 318 cases of symptomatic cervical disc herniation, with 156 patients undergoing the ACDF and 162 patients receiving the C-BESS. Preoperative and postoperative one-year data were collected. Results: The numeric rating scale and neck disability index showed statistically significant improvement for both ACDF and C-BESS groups. While showing a longer operation time and more blood loss during surgery compared to the ACDF group, the C-BESS group demonstrated a learning effect as the surgeon’s proficiency increased with more cases. There was no significant difference in the postoperative length of hospitalization between the two methods. The subgroup with predominant arm pain revealed the statistical difference in arm pain intensity changes between the two groups (p < 0.001). The rates of complication were 2.6% for the ACDF group and 1.9% for the C-BESS group. Conclusions: C-BESS and ACDF are effective surgical treatments for patients with symptomatic single-level cervical disc herniation in relieving relevant pain intensities and pain-related disabilities. Full article

Background: Preterm birth is a risk factor for a variety of detrimental health outcomes. Previous studies have identified recalled (or remembered) parental rearing behaviour as a potential modifier of preterm individuals’ mental health in adulthood. However, no investigations to date have contrasted the parents’ and children’s views, explored whether their congruence is associated with preterm individuals’ mental health, or tested associations with maternal self-reported first skin-on-skin contact. Methods: This cohort study involved 199 participants of the Gutenberg Prematurity Eye Study (GPES), with prospective clinical examination and psychological assessment data available for individuals born preterm and term and their mothers’ perspective on recalled parental rearing behaviour. Participants also completed the Patient Health Questionnaire-9 (PHQ-9). Results: There were substantial similarities between reported recalled maternal rearing behaviour of individuals born preterm and at term and their mothers, with individuals born preterm with lower gestational age (age of the pregnancy from the woman’s last menstrual period) recalling mothers as comparatively more controlling and overprotective. Incongruence in recalled rejection/punishment was associated with more depressive symptoms. Late first skin-to-skin contact was related to more recalled maternal rejection/punishment, less emotional warmth, and more control/overprotection. Conclusions: this study expands the knowledge about the interrelations of preterm birth, maternal rearing behaviour, and mental health, underscoring the relevance of first relationship experiences, including close intimate contact. Full article

Background: Real-world evidence of the efficacy and adverse events of JAK inhibitor treatment (Tofacitinib, Baricitinib, Upadacitinib, and Filgotinib) in rheumatoid arthritis is still limited. Methods: We studied 115 patients from the Rheumatology Unit of S. Giovanni di Dio Hospital affected by D2T-RA, according to the 2010 EULAR criteria. Out of the 115 patients, 17 had been treated with Baricitinib 8 mg/daily, 32 with Filgotinib 200 mg/daily, 21 with Tofacitinib 10 mg/daily, and 45 with Upadacitinib 15 mg/daily. We evaluated the clinical response after 3, 6, and 12 months of treatment and the follow-up from September 2022 to September 2023. All patients were evaluated according to the number of tender joints (NTJs), number of swollen joints (NSJs), visual analog scale (VAS), global assessment (GA), health assessment questionnaire (HAQ), Disease Activity Score (DAS28), and CDAI. Furthermore, laboratory parameters of efficacy and tolerability were evaluated. Results: All treatments demonstrated a statistically significant decrease in the DAS28 and CDAI scores, tender and swollen joint counts, VAS, HAQ, and patient global assessment (PGA) after 3, 6, and 12 months of treatment. All treatments showed similar behavior, and statistically significant decreases in circulating calprotectin, TNFα, and IL-6 were observed for all drugs after 12 months of treatment. In addition, soluble urokinase plasminogen activator receptor (suPAR) values showed significant differences at baseline and after 12 months of treatment for Filgotinib: 4.87 ± 4.53 vs. 3.61 ± 0.9 (0.009) and Upadacitinib: 6.64 ± 7.12 vs. 4.06 ± 3.61 (0.0003), while no statistically significant differences were found for Baricitinib: 3.4 ± 0.1 vs. 3.78 ± 0.1 and Tofacitinib: 3.95 ± 1.77 vs. 2.58 ± 0.1. The TC/HDL-C ratio (atherogenic index) showed significant differences when comparing Baricitinib vs. Filgotinib (0.0012), Filgotinib vs. Tofacitinib (0.0095), and Filgotinib vs. Upadacitinib (0.0001); furthermore, the LDL-C/HDL-C ratio in the Filgotinib group did not change (2.37 ± 0.45 vs. 2.35 ± 2.13 (NS)) after 12 months of treatment. Venous Thrombotic Events (VTEs) and major adverse cardiovascular events (MACEs) accounted for 1% of adverse events after treatment with Baricitinib. Herpes zoster reactivation accounted for 1% of adverse events after treatment with Filgotinib and Tofacitinib, while non-melanoma skin cancer (NMSC) accounted for 1% of adverse events after Upadacitinib treatment. Conclusions: Our real-world data from patients with RA show differences in some laboratory parameters and in the impact of lipid metabolism in JAK inhibitor treatment. Full article

Background and Objectives: Spinal Cord Injury (SCI) develops when the spinal cord is damaged and leads to partial or complete loss of motor and/or sensory function, usually below the level of injury. Medical advances in the last few decades have enabled SCI patients to survive after their initial injury and extend their life expectancy. As a result, the need for outcome measures to assess health and Quality of Life (QoL) after rehabilitation is increasing. All QoL assessment measures include implicit or explicit reactions and evaluations of a person’s life characteristics. This review aims to investigate QoL and its assessment in patients with SCI and how the instruments that are used may influence rehabilitation. Materials and Methods: Studies were identified from an online search of PubMed, Cochrane Library, and Scopus databases. Studies published between 2013 and 2023 were selected. This review has been registered on OSF (n) 892NY. Results: We found that different psychological and physical aspects can positively or negatively influence the QoL of SCI patients, and the measurement of this aspect, despite the number of tools, is limited due to the lack of a universal definition of this theme and the greater prevalence of quantitative rather than qualitative tools. Conclusions: This review has demonstrated that clinicians and psychologists involved in SCI rehabilitation should consider tools that use high-quality standardized outcome measures to detect and compare potential differences and outcomes of interventions related to HRQoL and their relationship with the personality and functional status of the patient. Full article

Background: To report on the outcome of intravitreal brolucizumab compared to aflibercept in patients with diabetic macular edema (DME). Methods: Prospective, observational, study in 35 eyes of 24 patients with a loading dose of five injections of 6 mg brolucizumab every 6 weeks (q6w, treatment-naïve eyes) or a minimum of two injections of brolucizumab q6w after the switch (recalcitrant DME eyes), followed by a treat and extend (T&E) regimen. The results were compared with 40 eyes of 31 DME patients who were treated with aflibercept. The data were obtained from the Berlin Macula Registry. The primary outcome measure was the change in best-corrected visual acuity (BCVA) at week 36. Secondary outcome measures were the change in central retinal thickness (CRT) and the treatment intervals until week 36. Results: BCVA increased significantly in treatment-naïve DME eyes treated with either brolucizumab (+0.12 logMAR, +6.4 letters, p = 0.03) or aflibercept (+0.19 logMAR, +9.5 letters, p = 0.001). In recalcitrant DME eyes, BCVA also increased significantly after switching to brolucizumab (+0.1 logMAR, +5 letters, p = 0.006) or aflibercept (+0.11 logMAR, +5.5 letters, p = 0.02). All treatment-naïve and recalcitrant DME eyes had a significant decrease in CRT after treatment with brolucizumab (p = 0.001 and p < 0.001) or aflibercept (p = 0.0002 and p = 0.03). At week 36, the mean treatment interval for brolucizumab was 11.3 weeks, while for aflibercept, it was 6.5 weeks for treatment-naïve eyes and 9.3 weeks vs. 5.3 weeks for pretreated eyes. Conclusions: In routine clinical practice, patients with treatment-naïve and recalcitrant DME showed a favorable response to brolucizumab and aflibercept therapy, with a reduced injection frequency after brolucizumab treatment. Full article

Background: Women are typically diagnosed with estrogen receptor-positive breast cancer around the postmenopausal period when declining estrogen levels initiate changes in lipid profiles. Aromatase inhibitors (AI) are used to prevent the progression of cancer; however, a further reduction in estrogen levels may have detrimental effects on lipid levels, which was our working hypothesis. Methods: Our meta-analysis was conducted on the lipid profiles of postmenopausal breast cancer patients at baseline and at different treatment time points. Results: We identified 15 studies, including 1708 patients. Studies using anastrozole (ANA), exemestane (EXE), letrozole (LET), and tamoxifen (TMX) were involved. Subgroup analyses revealed that 3- and 12-month administrations of LET and EXE lead to negative changes in lipid profiles that tend to alter the lipid profile undesirably, unlike ANA and TMX. Conclusions: Our results suggest that, despite statistically significant results, EXE and LET may not be sufficient to cause severe dyslipidemia in patients without cardiovascular comorbidities according to the AHA/ACC Guideline on the Management of Blood Cholesterol. However, the results may raise the question of monitoring the effects of AIs in patients, especially those with pre-existing cardiovascular risk factors such as dyslipidemia. Full article

Background: Tumour-induced osteomalacia (TIO) is a rare paraneoplastic syndrome. Detecting the primary tumour in TIO is challenging using conventional imaging methods. This study assesses the efficacy of [⁶⁸Ga]Ga-DOTATATE PET/CT in identifying the primary tumour. Methods: Six patients with suspected TIO underwent [⁶⁸Ga]Ga-DOTATATE PET/CT. The patients’ clinical history and biochemical parameters were analysed. Results: [⁶⁸Ga]Ga-DOTATATE PET/CT successfully identified primary tumours in four patients (femoral bones for two, iliac bone for one, subcutaneous tissue of pubic region for one). Tumour removal led to clinical and laboratory improvement. In one patient, PET/CT showed rib uptake, but the biopsy was negative. One patient showed no tumour lesions on PET/CT despite clinical evidence. Two patients had focal recurrence at the primary tumour site, detected by follow-up PET/CT. Conclusions: [⁶⁸Ga]Ga-DOTATATE PET/CT is a valuable tool for detecting primary tumours in TIO, aiding in accurate diagnosis and guiding surgery, leading to improved outcomes. Further research is needed to validate these findings and explore [⁶⁸Ga]Ga-DOTATATE PET/CT in other paraneoplastic syndromes. Full article

Background: The occurrence of myeloproliferative neoplasms (MPNs) that evolve into each other is well-described, as is this occurrence of lymphoproliferative neoplasms (LPNs). However, less is known about rare MPN/LPN coexistence, and the aim of our study was to analyze charachteristics of these patients after long term follow-up. Methods: Fourteen patients with MPN/LPN coexistence were diagnosed and treated according to guidelines at a single university center across two decades. Results: The overall median age was 53 years (22–69). MPNs patients with subsequent LPNs had a shorter period of second malignancy development and a more aggressive course of LPN, which can cause fatal outcomes. Polycythemia vera and chronic lymphocytic leukemia were most commonly associated (36%). The JAK2V617F mutation had 2/3 and cytogenetic abnormalities occurred in 1/3 of patients. MPN/LPN coexistence cases had significantly higher thrombotic potential (42.8%) and a higher third malignancy accruement frequency (21.4%) versus those without such malignancies. Conclusions: Considering the younger ages at MPN diagnosis, it is recommended to check regularly for blood lymphocytosis or lymphadenopathy occurrences and organomegaly progression faster than expected for MPN, with the aim of timely LPN diagnoses. The presence of molecular-cytogenetic abnormalities in a majority of patients indicate possible genetic instability and increased risk of development of multiple neoplasms, thus elevating thrombotic risk. Full article

Background: Olecranon fractures are common injuries of the upper limb in adults. Simple displaced trasverse fractures are generally surgically treated with tension-band wiring (TBW) or plate fixation (PF). The purpose of this retrospective study is to compare the clinical-functional outcome, complications and reoperation rates between TBW and PF for Mayo IIA fractures. Methods: 72 patients treated with PF or TBW at our institution, completed our survey and clinical evaluation and their demographic and clinical data were recorded and analysed. The clinical-functional outcomes were evaluated assessing ROMs and three validated scoring systems: the Disabilities of the Arm, Shoulder, and Hand (DASH), the Mayo Elbow Performance Score (MEPS) and the Patient American Shoulder and Elbow Surgeons Standardized Elbow Assessment score (pASES-e). Results: 38 patients (53%) underwent TBW and 34 (47%) PF. The mean DASH, MEPS and pASES-e scores were respectively 14.5 ± 17.2, 80.5 ± 14.7 and 83.6 ± 12.4 in the TBW group and 21 ± 21.7, 75.6 ± 15.3 and 75.1 ± 19.2 in the PF group (p = 0.16, p = 0.17 and p = 0.03). The mean duration of surgery and hospitalisation period were longer in the PF group (p = 0.002, p = 0.37) whereas the complication and reoperation rates were higher after TBW (p = 0.15, p = 0.24). Conclusions: According to the literature, both TBW and PF resulted comparable valid surgical options for the treatment of simple isolated displaced olecranon fractures. Our results corroborate previous findings, showing good/excellent outcomes without significant differences. Full article

Background: Clinimetrics and network analysis are two methodological approaches that, despite different origins, share the goal of improving mental health clinical assessment beyond the limitations of classical psychometrics. Despite their common goal and comparable conceptualization of clinical assessment, the potential connection and integration between these approaches has not been explored. The aim of this review is to identify meeting points for the potential integration of clinimetrics and network theory. Methods: A literature review was conducted by examining key works in clinimetrics and network theory and comparing similar concepts from the two approaches. Results: Two main areas of theoretical and methodological convergence and complementarity between clinimetrics and network theory were identified, as follows: the characteristics of clinical indexes and the strategies to assess and organize complex clinical data. These topics encompassed sub-topics related to the influence of individual symptoms on clinical presentation, longitudinal assessment of conditions, influence of comorbidities, and standardized procedures for case formulation. Conclusions: Results provide an indication of the potential for integration for these approaches in a single, clinically oriented methodology for psychological and psychiatric illness conceptualization and assessment. Despite the literature search strategy limitations, the results provide a basis for further exploring the potential for developing an integrated methodology for clinical assessment and treatment planning. Full article

Background: Multiple sclerosis (MS) is a prevalent chronic inflammatory and neurodegenerative disease of the central nervous system. The main evolving forms, relapsing–remitting MS (RRMS) and secondary progressive MS (SPMS), lack clear delineation. Methods: We conducted an observational study on 523 Caucasian RRMS patients receiving first-line disease-modifying therapies (DMTs), analyzing demographic, clinical, and geographical data. Results: RRMS patients experienced a statistically significant reduction in relapse rates post-DMT initiation. Significant differences in time to reach an Expanded Disability Status Score (EDSS) of 3.0 and 6.0 were observed based on demographics and onset topography. Kaplan–Meier analysis revealed that the onset with optic or supratentorial symptoms is linked to a longer time until EDSS = 3.0 is reached. Urban origin correlated with a prolonged time until EDSS = 3.0. Gender and environment showed no significant associations with the hazard of reaching an EDSS = 6.0. Cox regression analysis revealed no significant impact of relapses on the time to reach EDSS scores of 3.0 and 6.0 in our study cohort. Conclusions: Multivariate analysis identified several predictive factors for disability progression, including environment, age at onset, and disability level at DMT initiation. Full article

Background: In recent years, in Europe, there has been a growing concern about the use of sexualized drugs among men who have sex with men (MSM), due to its possible link to an increase in sexually transmitted infections. The aim of this review is to study the prevalence of chemsex, and the sexualized drug used in Europe, describing both different consumption patterns and other sexual behaviors considered risky and their possible relationship with positivity in diagnoses of sexually transmitted infections, including human immunodeficiency virus. Methods: We conducted a literature review in the main scientific databases (PubMed, Embase, Scopus, Cochrane Library, Web of Science), filtering for articles published between January 2018 and April 2023 that collect information on sexualized drug use and sexual practices conducted in European countries among men who have sex with men, including whether these behaviors can lead to diagnoses of sexually transmitted infections. Results: The definition of drugs included in chemsex is not clearly defined and shows heterogeneity between study publications; the three drugs presented in all manuscripts are mephedrone, GHB/GBL, and crystal methamphetamine. The prevalence of chemsex in Europe is 16% [11–21%] among MSM. The most frequent risky sexual behavior associated with chemsex practice was unprotected sex with a high number of partners. The log risk ratio of STIs was 0.86 (95% CI: 0.49 to 1.23). Conclusions: Adherence to definitions, stringent research methodologies, and focused interventions are needed to tackle the intricate relationship between substance use, sexual behavior, and the risk of HIV/STI transmission in MSM. Full article

Background: The ability to predict a long duration of mechanical ventilation (MV) by clinicians is very limited. We assessed the value of machine learning (ML) for early prediction of the duration of MV > 14 days in patients with moderate-to-severe acute respiratory distress syndrome (ARDS). Methods: This is a development, testing, and external validation study using data from 1173 patients on MV ≥ 3 days with moderate-to-severe ARDS. We first developed and tested prediction models in 920 ARDS patients using relevant features captured at the time of moderate/severe ARDS diagnosis, at 24 h and 72 h after diagnosis with logistic regression, and Multilayer Perceptron, Support Vector Machine, and Random Forest ML techniques. For external validation, we used an independent cohort of 253 patients on MV ≥ 3 days with moderate/severe ARDS. Results: A total of 441 patients (48%) from the derivation cohort (n = 920) and 100 patients (40%) from the validation cohort (n = 253) were mechanically ventilated for >14 days [median 14 days (IQR 8–25) vs. 13 days (IQR 7–21), respectively]. The best early prediction model was obtained with data collected at 72 h after moderate/severe ARDS diagnosis. Multilayer Perceptron risk modeling identified major prognostic factors for the duration of MV > 14 days, including PaO₂/FiO₂, PaCO₂, pH, and positive end-expiratory pressure. Predictions of the duration of MV > 14 days showed modest discrimination [AUC 0.71 (95%CI 0.65–0.76)]. Conclusions: Prolonged MV duration in moderate/severe ARDS patients remains difficult to predict early even with ML techniques such as Multilayer Perceptron and using data at 72 h of diagnosis. More research is needed to identify markers for predicting the length of MV. This study was registered on 14 August 2023 at ClinicalTrials.gov (NCT NCT05993377). Full article

Background: There has been an increase in people with disabilities who require continuous care, which often falls to informal carers (ICs). Stroke is one of the conditions where ICs are most needed. Therefore, it is necessary for ICs to improve their caregiving skills and self-care capacity. Telehealth (TH) can facilitate them. The aim of this systematic review is to summarize the evidence of the effects of interventions on ICs of stroke patients. Methods: The search was conducted in Pubmed, Scopus, Web of Science, CINALH, Psychology and Behavioral Sciences Collection, and APA PsycInfo. Key search terms included “stroke”, “informal caregiver” and “telemedicine”. Only randomised clinical trials were included. Results: A total of 2031 articles were found in the databases, 476 were screened and 19 clinical trials met the eligibility criteria. Different TH programmes have evaluated many outcomes related to physical and emotional health. The TH tools included phone, videophone, web-based interventions, and social media. The most investigated outcome was depression; although contradictory results were found, the TH may have helped to prevent an increase in depressive symptoms. There were inconsistent results on the caregiving burden and the preparedness of the IC. However, TH has positive effects on the health of the ICs, reducing the number of unhealthy days, anxiety, task difficulty perception, and improving psychological health. Conclusions: TH may be a useful tool to improve the abilities and health of ICs of SS. No adverse effects have been reported. More quality studies evaluating the effects of telemedicine on the ICs of stroke survivors, as well as the most appropriate doses, are needed. Full article

Background: Endovascular techniques have gained preference over peripheral arterial bypass surgery due to their minimally invasive nature; however, endovascular treatments often show limited efficacy in arterial segments with a high atherosclerotic load. The use of atherectomy devices enables the removal of calcified plaque material and may promote arterial wall remodeling. This study assessed the technical success, safety, and feasibility of the BYCROSS^® atherectomy device in femoropopliteal lesions. Methods: This single-center, retrospective cohort study analyzed elective patients undergoing BYCROSS^® atherectomy for chronic peripheral arterial disease from March 2022 to May 2023. Patient data, procedural details, and outcomes were retrospectively collected from electronic patient records. The primary performance endpoints of this study were technical success, complications, and patency rates. Primary safety endpoints included 30-day and short-term major adverse limb events (MALEs), major adverse cardiovascular events (MACEs), and mortality rate. Results: The study included 19 patients (median age, 71 years; 63% male) with Fontaine class IIb (26%), III (21%), or IV (53%). The BYCROSS^® atherectomy device was used to treat 22 limbs in the femoropopliteal tract, of which 11 lesions (50%) were occlusions and 11 were stenoses, with a median length of 24 cm (interquartile range: 17–38). Technical success was achieved in all cases: 4.5% required atherectomy only, 50% required additional balloon angioplasties, 41% required balloon angioplasties and stenting, and 4.5% required segments only stenting. Additional treatment of below-the-knee arteries was performed in 12 patients. Procedurally related complications (not limited to the use of the BYCROSS^® device) occurred in 23% of limbs, including distal embolization and laceration. At 30 days, mortality was 5%, the MACE rate was 11%, and the MALE rate was 0%. The observed mortality rate was not directly related to the procedure. Patency (<50% restenosis at duplex ultrasound) was 83% at 30 days. Conclusions: The use of the BYCROSS^® atherectomy device for the treatment of femoropopliteal lesions appears to be safe and feasible, with high technical success and low MALE and MACE rates in a challenging population with long-segment femoropopliteal lesions. Long-term follow-up in larger patient series is needed to confirm these findings and to determine the durability of this technique. Full article

This narrative review discusses the importance of rehabilitation in rheumatic and musculoskeletal diseases (RMDs), ultimately aiming to reduce their impact on individuals and society. It specifically emphasizes the need for rehabilitation in inflammatory arthritis (IA), particularly in cases where medical management is insufficient. It acknowledges that the complexity of rehabilitation demands a flexible approach. Thereby, it touches on the various models of rehabilitation, which may include multidisciplinary team care, extended practice models, shared care, remote care, and work rehabilitation. It discusses the challenges in research, practice, and policy implementation. In research, the need for innovative research designs is highlighted, whereas regarding clinical practice the importance of early detection of disability and patient engagement is underlined, as well as the role of telehealth and AI in reshaping the rehabilitation landscape. Financial barriers and work force shortages are identified as challenges that hinder the effective delivery of rehabilitative care. On the policy level, this paper suggests that the allocation of healthcare resources often prioritizes acute conditions over chronic diseases, leading to disparities in care. This paper concludes by emphasizing the critical role of evidence-based rehabilitation in improving the quality of life for people with RMDs, in particular for those with IA, and promoting their healthy aging. It also calls for tailored rehabilitation models and the early identification of persons with rehabilitation needs as future challenges in this field. Full article

Background: Reduced-port robotic myomectomy (RPRM) using Da Vinci^® Xi™ is a good fertility-saving surgical option, but the surgical and fertility outcomes are unknown. Methods: This was a retrospective cohort study evaluating the feasibility of RPRM in an academic tertiary hospital setting. A total of 401 patients who underwent RPRM by a single operator between October 2017 and October 2021 were included. For RPRM, three ports are required: a 1.5 cm umbilical incision and two 0.8 cm incisions 8 cm lateral to the umbilicus. A single-port system was applied through the umbilicus, which also functioned as a working port. Unlike conventional robotic surgery, only three robot arms were utilized for the entire surgical procedure. Results: Surgical and fertility outcomes were assessed through medical records review and follow-up telephone contact. The mean age of patients at the time of surgery was 39.7 ± 6.0 years. The most common indication for surgery was menorrhagia (n = 128, 31.9%). The average number of myomas removed was 4.7 ± 4.1 (1–22), and the size was 7.8 ± 2.5 cm (2.5–16.0). The mean operation time was 103.7 ± 45.6 min. Postoperative complications were found in 9.7% (n = 39) of patients; the most common complication was transfusion (7.7%, n = 31). After surgery, 70 patients tried to conceive, and 56 became pregnant naturally or by assisted reproduction (56/70, 80.0%). The mean interval time from operation to conception was 13.5 ± 10.1 months. Among 56 who conceived, 44 gave birth (62.9%), five were still ongoing (7.1%), and seven had miscarriages (10.0%). Cesarean section was performed for most cases (43/44, 97.7%). Eight patients had obstetric complications (16.3%), but no uterine rupture was reported. Conclusions: RPRM, which provides the benefits of conventional robotic surgery along with favorable obstetric and cosmetic results, is a feasible option for patients with symptomatic uterine myomas who wish to conceive in the future. Full article

Background: Numerous cardiovascular risk prediction models (RPM) have been developed, however, agreement studies between these models are scarce. We aimed to assess the inter-model agreement between eight RPMs: assessing cardiovascular risk using SIGN, the Australian CVD risk score (AusCVDRisk), the Framingham Risk Score for Hard Coronary Heart Disease, the Multi-Ethnic Study of Atherosclerosis risk score, the Pooled Cohort Equation (PCE), the QRISK3 cardiovascular risk calculator, the Reynolds Risk Score, and Systematic Coronary Risk Evaluation-2 (SCORE2). Methods: A cross-sectional study was conducted on 11,174 40–65-year-old individuals with diagnosed metabolic syndrome from a single tertiary university hospital in Lithuania. Cardiovascular risk was calculated using the eight RPMs, and the results were categorized into high, intermediate, and low-risk groups. Inter-model agreement was quantified using Cohen’s Kappa coefficients. Results: The study revealed significant heterogeneity in risk categorizations with only 1.49% of cases where all models agree on the risk category. SCORE2 predominantly categorized participants as high-risk (67.39%), while the PCE identified the majority as low-risk (62.03%). Cohen’s Kappa coefficients ranged from −0.09 to 0.64, indicating varying degrees of inter-model agreement. Conclusions: The choice of RPM can substantially influence clinical decision-making and patient management. The PCE and AusCVDRisk models exhibited the highest degree of agreement while the SCORE2 model consistently exhibited low agreement with other models. Full article

Background: The high volume of the fasciomyocutaneous anterolateral thigh flaps (ALT) is suitable for the reconstruction of pronounced soft tissue defects. At the same time, harvesting ALT results in a drastic change in thigh shape. Here, we present an optical three-dimensional imaging method for thigh comparison, which can be an objective and reproducible method for evaluating donor sites after ALT harvesting. Methods: In total, 128 thighs were scanned with an optical three-dimensional scanner, Vectra XT ^®. Sixty-eight non-operated right and left thighs were compared and served as a control. Sixty thighs were scanned in the ALT group. The average surface area deviations, thigh volume, thigh circumference, and flap ratio to thigh circumference were calculated. The results were correlated with Δthigh circumference and Δvolume of the unoperated thighs of the control group. Results: No significant difference between the thigh volumes of the right and left thighs was found in the control group. Removal of an ALT flap showed a significant (p < 0.007) volume reduction compared to unoperated thighs (2.7 ± 0.8 L and 3.3 ± 0.9 L, respectively). Flap area correlated strongly with the Δthigh circumference (r = 0.66, p < 0.001) and Δvolume (r = 0.68, p < 0.001). Strong correlations were observed between flap ratio and thigh circumference with Δhigh circumference (r = 0.57, p < 0.001) and Δvolume (r = 0.46, p < 0.05). Conclusions: Optical three-dimensional imaging provides an objective and reproducible tool for detecting changes in thigh morphology volume differences after ALT harvesting. Full article

Cholangiopathies include a group of chronic progressive disorders, affecting the cholangiocytes, the epithelial cells that line the biliary tree, leading to liver parenchymal fibrosis and eventually end-stage liver disease necessitating transplantation. Experimental modeling of these multifactorial cholestatic diseases faces challenges due to the lack of adequate experimental in vitro and in vivo models. A novel approach employs three-dimensional organoid systems that offer several advantages for modeling disease and testing drug response in vitro. Organoids mimic intercellular communication, replicate the architecture of organs, and maintain the cell’s original phenotype. Cholangiocyte organoids provide an in vitro model to study the pathogenesis and pharmacotherapeutic treatment of cholangiopathies and show great promise for regenerative therapies. In particular, patient-derived organoids allow personalized medicine approaches and the study of individual disease characteristics. This review highlights the significance of cholangiocyte organoid models in advancing our understanding of cholangiopathies and driving advancements in regenerative medicine strategies. Full article

Purpose: Myocarditis is frequently a sporadic disease, but may also occur in the context of genetic disorders which may increase susceptibility to cardiac inflammation. Cardiac involvement in Wolfram syndrome type 1 (WS1) has been scarcely characterized. To our knowledge, no cases of virus-negative myocarditis have been reported in the WS1 pediatric population. Methods: We report the description of a pediatric case of acute myocarditis in the context of WS1, followed by a literature review of cardiovascular involvement associated with wolframin variants, and discuss potential pathophysiological mechanisms and therapeutic options. Results: A young patient with WS1, treated with insulin and liraglutide, was admitted for acute chest pain. Cardiac magnetic resonance and endomyocardial biopsy were performed to confirm the clinical suspicion of myocarditis. While congenital heart diseases and arrhythmias have been described previously in patients with WS1, this is the first description of virus-negative myocarditis. Conclusions: Myocarditis may represent a possible manifestation of cardiovascular involvement in WS1. Cardiovascular screening may be considered in patients with WS1. Full article

Introduction: His bundle pacing (HBP) is suitable for 80% of patients with any indication for permanent pacemaker implantation, with a clinical benefit compared to right ventricular pacing (RVP). Although complications and mortality related to RVP are widely reported in the literature, data on HBP are limited. This study aimed to analyze HBP complications and outcomes in the short-term (up to 30 days) and long-term (up to the following 24 months) follow-up (F/U). Materials and Methods: The study includes 373 patients aged ≥ 18, enrolled from October 2015 to May 2019 in a single-center HBP prospective registry conducted in the Department of Electrocardiology, Upper Silesian Medical Centre of the Medical University of Silesia in Katowice, Poland. Mortality and HBP complications were used as end-points: during hospitalization and up to 30 days (short-term F/U), and for each F/U point—six months, 12 months, and 24 months after the procedure (long-term F/U). Results: Successful HBP was achieved in 252 patients (68%), with an increasing success rate during consecutive years: 57% in 2015–2016 and 73% in 2017–2019. Complications were found in 8.4% of patients (21/252) in short-term F/U and 5.8% (13/224), 5.5% (11/201), and 6.9% (12/174) at six months, 12 months, and 24 months, respectively. There were no deaths during the first 30 days. However, 26 patients (10.3%) died within 24 months. A left ventricular ejection fraction (LVEF) ≤ 34% was the only independent predictor of all-cause mortality or any major complication in the 24-month F/U. Conclusions: This single-center study reported a low risk of mortality and complications associated with HBP at the short-term F/U. However, during the long-term F/U, we observed a higher but acceptable risk of major complications, with a lower LVEF being an independent predictor of the composite end-point of all-cause mortality or any major complication. Full article

Objectives: With the ongoing epidemiological transition in sub-Saharan Africa (SSA), conditions that require invasive treatment (surgery, cancer, and anaesthesia, etc.) will become increasingly common. Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic process aimed at identifying older people at risk of negative outcomes. It is important to know whether this approach integrates care management strategies for older people in a context where health services for older people are scarce, and staff members have little training in geriatrics. The current work is a situational analysis on the use of CGA on invasive care (cancer, surgery, etc.) among older people in SSA. Methods: We searched PubMed-MEDLINE and other sources for studies reporting on CGA and conditions requiring invasive treatment in older patients in SSA. Results/Conclusions: We found no study that had comprehensively examined CGA and invasive care in SSA. There is, however, evidence that the offer of invasive care to older people has improved in SSA. Further research is needed to explore the applicability of CGA in SSA. Similarly, more investigations are needed on the role of CGA in the care trajectories of older people in SSA, in terms of outcomes and affordability. Full article

Background: In recent decades, myopia has turned into a public health issue across the world. Between 1993 and 2016, the percentage of myopes increased from 10.4% to 34.2%. This study aims to analyze the myopia prevalence in Spanish children from five to seven years old over the last five years and to predict the rate of myopia in Spain by 2030. Methods: The sample consisted of children aged between 5 and 7, who underwent an optometric examination consisting of the measurement of visual acuity (VA) and determination of objective and subjective refraction. The cut-off points to define refractive error are established by the spherical equivalent (SE) value: hyperopia for an SE over or equal to +0.50 D; myopia for an SE under or equal to −0.50 D; and emmetropia when the SE is between −0.50 D and +0.50 D. Results: The myopia rate in Spanish children aged between five and seven was 19%. Myopia prevalence progressively increased as children grew up (p ≤ 0.001). It is estimated that, in the year 2030, the rate of myopia will be 30.2% [CI: 25.3–35.0], of which 81.9% [CI: 78.3–85.3] will have low myopia, 10.0% [CI: 7.2–12.8] moderate myopia, and 7.3% [CI: 4.9–9.7] high myopia. Conclusions: Nineteen percent of Spanish children between five and seven are myopes. In 2030, is expected that 30.2% of Spanish children between 5 and 7 years of age will be myopes. These estimations will support eye care professionals in recommending that children spend more time outdoors to prevent the onset of myopia and the use of methods to control myopia to avoid reaching these figures of high myopia. Full article

Mitral valve transcatheter edge-to-edge repair (M-TEER) and replacement (TMVR) have evolved as guideline-recommended treatment approaches for mitral regurgitation (MR). Even though they are supported by a growing body of evidence from either randomized trials or large registries, there are still several unsolved challenges in the field of interventional MR treatment. In the present review, we discuss the ten most important open questions regarding M-TEER and TMVR. Full article

Background: Dermatofibrosarcoma protuberans (DFSP) is a superficial soft tissue sarcoma, and surgical excision is the first-line treatment. The aim of this systematic review is to provide an update about the current indications and clinical results regarding the use of postoperative radiotherapy in DSFP, considering both adjuvant and salvage setting. Methods: We conducted a systematic literature review using the main scientific database, including Cochrane library, Scopus, and PubMed, for any relevant article about the topic, and we considered all available papers without any time restriction. Results: Twenty-two papers, published between 1989 and 2023, were retrieved and considered eligible for inclusion in this review. Regarding the fractionation schedules, most authors reported using standard fractionation (2 Gy/die) with a wide total dose ranging from 50 to 70 Gy. The local control after postoperative radiotherapy was excellent (75–100%), with a median follow-up time of 69 months. Conclusions: After the primary surgical management of DFSP, postoperative radiotherapy may either be considered as adjuvant treatment (presence of risk factors, i.e., close margins, recurrent tumours, aggressive histological subtypes) or as salvage treatment (positive margins) and should be assessed within the frame of multidisciplinary evaluation. Full article