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PMC11277452_p8
|
PMC11277452
|
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4. Chronic Inflammation, Endothelial Dysfunction and HF
| 3.691406 |
biomedical
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Moreover, infectious diseases, particularly those enhancing a pro-inflammatory and pro-thrombotic milieu, including coronavirus disease 2019 (COVID-19), recently emerged as further contributors to endothelial dysfunction and CMD .
|
[
"Giulia La Vecchia",
"Isabella Fumarulo",
"Andrea Caffè",
"Mario Chiatto",
"Rocco A. Montone",
"Nadia Aspromonte"
] |
https://doi.org/10.3390/ijms25147628
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
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en
| 0.999997 |
PMC11277452_p9
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PMC11277452
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4. Chronic Inflammation, Endothelial Dysfunction and HF
| 5.015625 |
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Therefore, cardiovascular risk factors and comorbidities of HF play a key pathogenetic role in determining CMD in this setting, particularly that of HFpEF. Elevated concentrations of inflammation biomarkers such as interleukin-6 (IL-6), TNF-α, pentraxin 3, and soluble suppression of tumorigenicity 2 (sST2) have been described in HFpEF patients, while an increase in inflammatory cells expressing CD3, CD11a, and CD45, together with the vascular cell adhesion molecule VCAM-1, and increased oxidative stress been recognized in HFpEF cardiac tissue samples . Interleukin-2 (IL-2) has been recently proposed as a predictor of HFpEF development, playing a hypothesized role in chronic microvascular inflammation, while neutrophilic myeloperoxidase (MPO)-related oxidative stress has been associated with endothelial dysfunction in HFpEF . In the setting of oxidative stress at the level of the coronary microvasculature, an ROS-mediated reduction in the endothelial NO bioavailability leads to decreased cyclic guanosine monophosphate (cGMP) levels and protein kinase G (PKG) activity, which favors structural cardiac changes such as left ventricular concentric remodeling and hypertrophy . Inflammation-driven PKG activity, such a deficiency also impairs cardiomyocyte relaxation due to titin hypophosphorylation . Simultaneously, impaired endothelial NO release gives rise to fibroblast and myofibroblast proliferation, while NO-mediated antifibrotic effects through the cGMP pathway are blunted . Moreover, the inflammation of the microvascular endothelium itself causes the migration of monocytes and secretion of transforming growth factor-β (TGF-β), favoring interstitial fibrosis . As previously mentioned, CMD induces diastolic dysfunction not only through fibrosis but also through structural microvascular rarefaction, and both processes may arise from a common mechanism involving a microvascular endothelial inflammatory state . Pro-oxidative conditions at the level of diseased coronary microvessels make them prone to microinfarcts during local ischemic events, further enhancing fibrosis and consequent reduced myocardial diastolic function and systolic reserve . Myofibroblasts and inflammatory cells migrating through the endothelium into cardiac interstitial tissue may then fuel inflammation, stimulate fibrosis via TGF-β, and downregulate matrix metalloproteinase (MMP-1), thus reducing extracellular matrix degradation . Consequently, the reciprocal biological signaling taking place between the endothelium, perivascular tissue, and myocardium is decisive in HFpEF pathogenesis and progression.
|
[
"Giulia La Vecchia",
"Isabella Fumarulo",
"Andrea Caffè",
"Mario Chiatto",
"Rocco A. Montone",
"Nadia Aspromonte"
] |
https://doi.org/10.3390/ijms25147628
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277452_p10
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PMC11277452
|
sec[3]/p[3]
|
4. Chronic Inflammation, Endothelial Dysfunction and HF
| 4.328125 |
biomedical
|
Study
|
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The role of comorbidity-driven systemic inflammation in the pathophysiology of HFrEF may be less significant than in HFpEF . Circulating markers such as IL-6, TNF-α, and CRP are known to be better predictors of HFpEF than of HFrEF, and their levels are related to the overall comorbidity burden of HFpEF patients . On the other hand, oxidative stress directly affects cardiomyocytes in HFrEF, causing apoptosis or necrosis and replacement fibrosis, a feature that is not observed in HFpEF . Of importance, an elevation in inflammatory biomarkers such as TNF-α, soluble TNF-receptor II, and IL-6 has been observed in the advanced stages of HFrEF, and endothelium-dependent vasodilatation impairment has also been demonstrated in HFrEF patients, probably related to oxidative stress . Thus, inflammation-related endothelial dysfunction may also be a marker of disease progression and adverse prognosis in patients with HFrEF.
|
[
"Giulia La Vecchia",
"Isabella Fumarulo",
"Andrea Caffè",
"Mario Chiatto",
"Rocco A. Montone",
"Nadia Aspromonte"
] |
https://doi.org/10.3390/ijms25147628
|
N/A
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https://creativecommons.org/licenses/by/4.0/
|
en
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PMC11277452
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|
5. Targeting CMD in Patients with HF
| 3.75 |
biomedical
|
Review
|
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To date, there are no specific pharmacologic strategies to treat CMD in patients with HF and randomized clinical trials addressing this field are lacking. An accurate understanding of the pathophysiological mechanisms underlying this condition is essential to provide comprehensive and effective therapeutic interventions (both pharmacological and addressing the lifestyle) aimed at targeting different pathophysiological aspects of the disease .
|
[
"Giulia La Vecchia",
"Isabella Fumarulo",
"Andrea Caffè",
"Mario Chiatto",
"Rocco A. Montone",
"Nadia Aspromonte"
] |
https://doi.org/10.3390/ijms25147628
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
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en
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|
5. Targeting CMD in Patients with HF
| 3.763672 |
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|
Review
|
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As mentioned above, patients affected by CMD and HFpEF typically suffer from numerous comorbidities and risk factors. Lifestyle modifications including regular exercise, weight management, and smoking cessation are fundamental to improving endothelial function and have been shown to ameliorate the coronary flow reserve, with beneficial effects on exercise capacity and cardiovascular outcomes .
|
[
"Giulia La Vecchia",
"Isabella Fumarulo",
"Andrea Caffè",
"Mario Chiatto",
"Rocco A. Montone",
"Nadia Aspromonte"
] |
https://doi.org/10.3390/ijms25147628
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277452_p13
|
PMC11277452
|
sec[4]/p[2]
|
5. Targeting CMD in Patients with HF
| 4.15625 |
biomedical
|
Study
|
[
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Nevertheless, risk factors and comorbidities contribute to the creation and perpetration of a pro-inflammatory status, which plays a key role in the development of CMD. Consequently, inflammation represents an important target in CMD management and can be approached with different drugs. In patients with high blood cholesterol, statins have been shown to exert anti-inflammatory properties and positive effects on endothelial homeostasis by restoring the downstream NO signaling and improving endothelium-dependent coronary relaxation . A meta-analysis and observational studies recently demonstrated that statin treatment may reduce mortality and HF hospitalizations among patients with HFpEF, with a beneficial effect that seems independent from cholesterol levels and HF severity and likely due to their off-target anti-inflammatory properties . In an interesting study by Eshtehardi et al., the imaging characteristics of coronary atheromas were analyzed at baseline and after 6 months of high-intensity statin treatment (atorvastatin 80 mg) among 20 patients with moderate CAD . The authors proved that patients on statin treatment showed not only a modification in atheroma composition and plaque phenotype but also a modest improvement in coronary microvascular function, assessed by coronary flow reserve (+0.26 [IQR, −0.37 to 0.76]; p = 0.23) and hyperemic microvascular resistance (−0.22 [IQR, −0.56 to 0.28]; p = 0.12) .
|
[
"Giulia La Vecchia",
"Isabella Fumarulo",
"Andrea Caffè",
"Mario Chiatto",
"Rocco A. Montone",
"Nadia Aspromonte"
] |
https://doi.org/10.3390/ijms25147628
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277452_p14
|
PMC11277452
|
sec[4]/p[3]
|
5. Targeting CMD in Patients with HF
| 4.070313 |
biomedical
|
Review
|
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Beta-blockers are a cornerstone of the pharmacological management of HFrEF, while there are no specific data on their potential beneficial effects in HFpEF. In patients with microvascular angina (MVA), beta-blockers, in particular third-generation beta-blockers such as nebivolol and carvedilol, have been shown to ameliorate effort-related symptoms and exercise tolerance by improving endothelial function, decreasing myocardial oxygen needs and extending diastolic perfusion time . Therefore, they are recommended as first-line therapy in this group of individuals . However, beta-blockers should not be used routinely in HFpEF since they ultimately reduce cyclic AMP, which is important for myocardial relaxation and diastolic function .
|
[
"Giulia La Vecchia",
"Isabella Fumarulo",
"Andrea Caffè",
"Mario Chiatto",
"Rocco A. Montone",
"Nadia Aspromonte"
] |
https://doi.org/10.3390/ijms25147628
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277452_p15
|
PMC11277452
|
sec[4]/p[4]
|
5. Targeting CMD in Patients with HF
| 4.175781 |
biomedical
|
Study
|
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Angiotensin-converting enzyme inhibitors (ACEis) are strongly recommended as the first-line therapy for patients with HFrEF, given their demonstrated efficacy in reducing cardiovascular mortality and hospitalization for HF on a large-scale basis . Data from the Trial on Reversing Endothelial Dysfunction (TREND) study further support the positive impact of ACE inhibitors, particularly quinapril, on endothelial function. This study, involving 101 patients without HF, hypertension, or dyslipidemia, underscored the beneficial effects of ACE inhibitors on endothelial function by evaluating the effect of quinapril (40 mg daily) vs. placebo on coronary artery responses to acetylcholine using quantitative coronary angiography. The authors proved that after 6 months of therapy, only the quinapril group showed a significant enhancement in the vasoactive response to incremental concentrations of acetylcholine ( p = 0.002) . These beneficial properties of ACE inhibitors on CMD were attributed to their ability to inhibit coronary vasoconstriction and superoxide generation while enhancing endothelial cell release of NO and further improving endothelial homeostasis.
|
[
"Giulia La Vecchia",
"Isabella Fumarulo",
"Andrea Caffè",
"Mario Chiatto",
"Rocco A. Montone",
"Nadia Aspromonte"
] |
https://doi.org/10.3390/ijms25147628
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277452_p16
|
PMC11277452
|
sec[4]/p[5]
|
5. Targeting CMD in Patients with HF
| 4.199219 |
biomedical
|
Study
|
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Sacubitril/valsartan is a first-class recommendation in patients with HFrEF as it has been shown to reduce all-cause mortality and HF hospitalization compared to enalapril . In patients with HFpEF, the PARAMOUNT-HF Phase II trial has demonstrated a significant reduction in NT-proBNP levels after 12 weeks of therapy with sacubitril-valsartan in comparison with valsartan . Conversely, in the PARAGON-HF trial, which included 4822 patients with HF and an ejection fraction of 45% or higher, sacubitril/valsartan failed to meet the primary endpoint of a reduction in the total hospitalizations for HF (690 vs. 797 total hospitalizations for heart failure, respectively [rate ratio, 0.85; 95% CI, 0.72 to 1.00]) and death from cardiovascular causes (8.5% in the sacubitril–valsartan group vs. 8.9% in the valsartan group [hazard ratio, 0.95; 95% CI, 0.79 to 1.16]) compared to valsartan . Notably, the impact of angiotensin receptor-neprilysin inhibitor (ARNI) therapy on the emerging pathophysiological mechanisms underlying HFpEF, such as myocardial interstitial fibrosis and CMD, remains largely unexplored. Addressing this gap, ongoing research like the PRISTINE-HF Study (Study of Sacubitril/ValsarTan on MyocardIal OxygenatioN and Fibrosis in Heart Failure with Preserved Ejection Fraction) will evaluate the potential effects of sacubitril-valsartan on CMD and microvascular ischemia using stress perfusion oxygen-sensitive CMR in HFpEF patients .
|
[
"Giulia La Vecchia",
"Isabella Fumarulo",
"Andrea Caffè",
"Mario Chiatto",
"Rocco A. Montone",
"Nadia Aspromonte"
] |
https://doi.org/10.3390/ijms25147628
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277452_p17
|
PMC11277452
|
sec[4]/p[6]
|
5. Targeting CMD in Patients with HF
| 4.382813 |
biomedical
|
Review
|
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Recently, sodium glucose co-transport-2 inhibitors (SGLTis), a class of antidiabetic drugs, have been introduced as first-line therapy in patients with HFrEF as they have been shown to reduce the all-cause mortality and HF hospitalization rate in this group of patients . Preclinical studies utilizing a pre-diabetic murine model have also suggested potential positive effects of SGLT2is on coronary microvascular function, revealing a significant improvement in the coronary flow reserve in the animals treated . More recently, the Effect of Empagliflozin on Worsening Heart Failure Events in Patients With Heart Failure and Preserved Ejection Fraction trial (EMPEROR-Preserved trial) and the Efficacy and Safety of Dapagliflozin in Heart Failure With Mildly Reduced or Preserved Ejection Fraction According to Age trial (The DELIVER Trial) have corroborated these findings, reporting significant reductions in cardiovascular mortality and the rates of heart failure hospitalization in HFpEF patients receiving SGLT2i therapy . Consequently, the most recent 2023 updated guidelines on heart failure management from the ESC integrated this class of drugs as a first-line therapy for HFpEF . The pleiotropic effects of SGLT2is are still largely unknown. Nevertheless, emerging data suggest that the inhibition of pro-inflammatory cytokines and ROS production can contribute to off-target anti-inflammatory properties having additional beneficial effects on endothelial homeostasis . Indeed, in animal models, SGLT2is have been proven to reduce the circulating levels of pro-inflammatory biomarkers, such as IL-6 TNF and C-reactive protein, with well-known detrimental effects on endothelial function .
|
[
"Giulia La Vecchia",
"Isabella Fumarulo",
"Andrea Caffè",
"Mario Chiatto",
"Rocco A. Montone",
"Nadia Aspromonte"
] |
https://doi.org/10.3390/ijms25147628
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277452_p18
|
PMC11277452
|
sec[4]/p[7]
|
5. Targeting CMD in Patients with HF
| 4.070313 |
biomedical
|
Review
|
[
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[
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In addition to SGLT2is, another class of antidiabetic drugs, Glucagon-Like Peptide Receptor Agonists (GLP-1 RAs), seem to have promising cardiovascular effects. Encouraging data on cardiovascular outcomes have emerged in several trials on diabetic patients . The pathophysiological rationale is to be found in the endothelial expression of GLP-1 RAs. They are able to decrease ROS production, leading to reduced oxidative stress, with a positive effect on the atherosclerotic process . GLP-1 RAs also modulate inflammation with a direct action on inflammatory cells . Furthermore, the use of Liraglutide seems to improve diastolic function , typically impaired in HFpEF patients. However, to date, randomized studies with GLP-1 RA in HFpEF patients are still lacking.
|
[
"Giulia La Vecchia",
"Isabella Fumarulo",
"Andrea Caffè",
"Mario Chiatto",
"Rocco A. Montone",
"Nadia Aspromonte"
] |
https://doi.org/10.3390/ijms25147628
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11277452_p19
|
PMC11277452
|
sec[4]/p[8]
|
5. Targeting CMD in Patients with HF
| 4.464844 |
biomedical
|
Study
|
[
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Several other anti-anginal drugs, such as ivabradine, ranolazine, nicorandil, and trimetazidine, have been investigated in patients with CMD with spare data to date in the setting of HF pathology . Ivabradine is a selective inhibitor of the hyperpolarization-activated cyclic-nucleotide gated funny current (If) in the sinoatrial node, with the known property of heart rate reduction. According to the ESC guidelines on HF management, it is indicated with a class II level of recommendation A in patients with HFrEF when beta-blockers are contraindicated or as additional anti-anginal therapy in patients with sinus rhythm to reduce the heart rate and oxygen consumption . However, ivabradine has also been shown to have beneficial effects on MVA . In a randomized controlled trial evaluating the effects of ranolazine and ivabradine vs. placebo among 46 patients with stable MVA (effort angina, positive exercise stress test [EST], normal coronary angiography, coronary flow reserve < 2.5) and anginal symptoms despite standard anti-ischemic medical therapy, ivabradine was proven to effectively reduce angina symptoms and quality of life assessed by the Seattle Angina Questionnaire (SAQ) and EuroQoL scale ( p < 0.05) . According to the ESC guidelines on HF management, it is indicated with a class II level of recommendation A in patients with HFrEF when beta-blockers are contraindicated or as additional anti-anginal therapy in patients with sinus rhythm . Ranolazine has been tested in several small randomized controlled trials, with controversial results in terms of coronary flow reserve and symptom improvement . Nitrates have demonstrated inconclusive results in CMD but their use in the short-acting form can be considered to treat angina attacks, especially among patients with an impaired vasodilator reserve . Fasudil is an inhibitor of the Rho-kinase pathway, a molecular pathway with a pivotal role in the pathogenesis and development of MVA that modulates the calcium sensitivity of the myosin light chain in smooth muscle cells . In a study by Mohri et al. evaluating the effect of the Rho-kinase inhibitor in 18 patients with angiographically proven MVA, the pretreatment with Fasudil was proven to be highly effective in preventing acetylcholine-induced coronary vasospasm compared to placebo (saline solution) ( p < 0.01) and it can be considered in patients with MVA . These results were further strengthened by other studies with a larger sample size, corroborating the promising therapeutic role of this class of drugs in patients with CMD on top of the standard anti-ischemic medical therapy .
|
[
"Giulia La Vecchia",
"Isabella Fumarulo",
"Andrea Caffè",
"Mario Chiatto",
"Rocco A. Montone",
"Nadia Aspromonte"
] |
https://doi.org/10.3390/ijms25147628
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277452_p20
|
PMC11277452
|
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|
6. Conclusions and Future Perspectives
| 4.414063 |
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|
Review
|
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In conclusion, CMD is an emerging clinical condition due to structural and/or function alterations at the coronary microcirculatory level which represents a significant and often-overlooked component of HF pathophysiology, contributing to myocardial ischemia and fibrosis, impaired cardiac function, and adverse clinical outcomes. The precise mechanisms linking CMD to heart failure development and progression are still not well known and randomized clinical trials evaluating the efficacy of specific treatments targeting these molecular mechanisms are lacking to date. However, comorbidities promoting systemic and coronary inflammation (such as diabetes, chronic kidney disease, and infections) seem to play a pivotal role as predisposing factors in the pathogenesis of endothelial dysfunction leading to CMD and finally HF, especially HFpEF. This is likely the HFpEF phenotype in which a systematic assessment may be worthwhile. Ongoing clinical trials assessing the efficacy of emerging pharmacological therapies for HF, such as SGLT2is and ARNIs, in preserving microvascular integrity and function hold promise for advancing our understanding and management of CMD in this particular clinical setting. Overall, continued efforts to unravel the complexities of CMD in HF are crucial for improving patient outcomes and reducing the burden of this debilitating condition.
|
[
"Giulia La Vecchia",
"Isabella Fumarulo",
"Andrea Caffè",
"Mario Chiatto",
"Rocco A. Montone",
"Nadia Aspromonte"
] |
https://doi.org/10.3390/ijms25147628
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277464_p0
|
PMC11277464
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1. Introduction
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biomedical
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Other
|
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[
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Kidney stones, or nephrolithiasis, constitute crystalline aggregates within the urinary system . The prevalence of urinary lithiasis in developed countries is about 5%, and its symptomatic onset (renal colic) serves as the main reason for emergency room visits due to urological issues .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
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PMC11277464_p1
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1. Introduction
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There are various mechanisms leading to the formation of lithiasis, among them : Saturation: characterized by an increase in the urine concentration of a substance, potentially leading to the formation of stones; Alteration in urinary pH: for instance, a high pH promotes the formation of calcium phosphate stones, while a decrease in pH favors uric acid lithiasis ; Modification of crystallization inhibitors; An increase in lithogenic substances.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
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1. Introduction
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There are several types of lithiasis ( Table 1 ), such as calcium lithiasis, which is the most common form, accounting for about 70% . There are two types of calcium-based stones: calcium oxalate (more common) and calcium phosphate .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277464_p3
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sec[0]/p[3]
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1. Introduction
| 2.115234 |
biomedical
|
Other
|
[
0.9951171875,
0.002349853515625,
0.002506256103515625
] |
[
0.01904296875,
0.9755859375,
0.002979278564453125,
0.0024471282958984375
] |
Uric acid stones rank second in frequency, comprising about 10–15% of cases. Their unique composition renders them radiotransparent in X-ray evaluations .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277464_p4
|
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|
sec[0]/p[4]
|
1. Introduction
| 2.03125 |
biomedical
|
Other
|
[
0.990234375,
0.00588226318359375,
0.0037078857421875
] |
[
0.0102691650390625,
0.98388671875,
0.0032978057861328125,
0.0027866363525390625
] |
Less frequent types of stones include infectious and cystine lithiasis.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.85714 |
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sec[0]/p[5]
|
1. Introduction
| 3.933594 |
biomedical
|
Other
|
[
0.99853515625,
0.0009303092956542969,
0.0002906322479248047
] |
[
0.2021484375,
0.78662109375,
0.0082550048828125,
0.00304412841796875
] |
Infectious lithiasis, responsible for about 10% of cases, occurs due to colonization of the urinary tract by urease-positive germs (e.g., Proteus, Pseudomonas, Klebsiella, Serratia or Enterobacter) that convert urea into ammonia and carbon dioxide. Ammonia is then hydrolyzed, resulting in an increase in pH and subsequent formation of struvite stones .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11277464_p6
|
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|
sec[0]/p[6]
|
1. Introduction
| 2.671875 |
biomedical
|
Other
|
[
0.9970703125,
0.001636505126953125,
0.0014247894287109375
] |
[
0.016082763671875,
0.97900390625,
0.0021877288818359375,
0.0028591156005859375
] |
Cystine stones, making up 1% of cases, are typically associated with cystinuria, an autosomal recessive disease .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
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|
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sec[0]/p[7]
|
1. Introduction
| 3.730469 |
biomedical
|
Other
|
[
0.984375,
0.0148162841796875,
0.000873565673828125
] |
[
0.0101776123046875,
0.947265625,
0.033935546875,
0.00848388671875
] |
Renal colic typically manifests as a low back pain of a colic nature, which may radiate to the genital region. It can be accompanied by additional symptoms, such as nausea, vomiting, dysuria, pollakiuria, tenesmus and hematuria . The diagnosis is facilitated by abdominal ultrasound, which assesses potential dilation in the calico-pyelic cavities or the possible presence of lithiasis in the upper urinary tract or in the bladder. However, non-contrast computed tomography (CT) remains the diagnostic gold standard .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277464_p8
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sec[0]/p[8]
|
1. Introduction
| 2.917969 |
biomedical
|
Other
|
[
0.79931640625,
0.195556640625,
0.005229949951171875
] |
[
0.001373291015625,
0.9853515625,
0.0042724609375,
0.00881195068359375
] |
In non-complicated cases, treatment is generally conservative, involving hydration, analgesics (excluding spasmolytics) and non-steroidal anti-inflammatory drugs to reduce local edema. For distal lithiasis, alpha-blockers may also be considered .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
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|
1. Introduction
| 2.814453 |
biomedical
|
Other
|
[
0.62353515625,
0.37060546875,
0.005786895751953125
] |
[
0.0036163330078125,
0.97216796875,
0.0012722015380859375,
0.0230560302734375
] |
In more complex cases, such as in cases of infection or severe hydroureteronephrosis, careful monitoring along with antibiotics may be necessary . Interventions such as a double-J catheter or percutaneous nephrostomy could also be required .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
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https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277464_p10
|
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sec[0]/p[10]
|
1. Introduction
| 3.601563 |
biomedical
|
Other
|
[
0.94140625,
0.0562744140625,
0.002445220947265625
] |
[
0.0089111328125,
0.98486328125,
0.0015363693237304688,
0.004619598388671875
] |
For stones of significant size (peri-centimetric), spontaneous expulsion is unlikely; hence, extracorporeal shock wave lithotripsy (ESWL) may be necessary. Stones greater than 2 cm could even necessitate open or percutaneous surgery to reduce the lithiasic mass associated with ESWL for lithiasic remains .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
PMC11277464_p11
|
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|
1. Introduction
| 3.767578 |
biomedical
|
Review
|
[
0.998046875,
0.0017366409301757812,
0.00043487548828125
] |
[
0.046478271484375,
0.07733154296875,
0.8740234375,
0.0019969940185546875
] |
The significant increase in renal colic cases presenting in emergency settings, combined with the high cost associated with hospitalization and treatment, underlines the importance of prevention . Several risk factors contributing to kidney stone formation have been identified, including genetic predisposition, eating habits and regular intake of certain medications or supplements (such as diuretics and calcium-based antacids), but also conditions such as gout, chronic kidney disease and obesity .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277464_p12
|
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|
sec[0]/p[12]
|
1. Introduction
| 3.794922 |
biomedical
|
Study
|
[
0.99951171875,
0.0001970529556274414,
0.0004582405090332031
] |
[
0.6396484375,
0.072509765625,
0.287109375,
0.0007386207580566406
] |
Recent research studies have directed their focus towards visceral fat (VF) as a key factor in stone formation. VF is deemed a more accurate indicator than general obesity or body mass index (BMI) since it is more closely related to metabolic and inflammatory disorders that can alter urine composition and thus affect stone formation .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
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|
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|
1. Introduction
| 3.046875 |
biomedical
|
Other
|
[
0.99853515625,
0.0007548332214355469,
0.0008568763732910156
] |
[
0.092041015625,
0.499267578125,
0.406494140625,
0.0022029876708984375
] |
Moreover, VF is also associated with several metabolic disorders, including insulin resistance, diabetes mellitus type 2 and dyslipidemia .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
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https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
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|
1. Introduction
| 4.023438 |
biomedical
|
Other
|
[
0.99853515625,
0.0006175041198730469,
0.000640869140625
] |
[
0.2783203125,
0.66455078125,
0.05560302734375,
0.0014429092407226562
] |
The Visceral adiposity Index (VAI) is a mathematical model that incorporates waist circumference, BMI, triglyceride levels and high-density lipoprotein (HDL) cholesterol levels to estimate VF distribution and its associated metabolic risk . It is derived from a combination of anthropometric and metabolic parameters, including waist-to-hip ratio, BMI, plasma triglycerides and HDL cholesterol level .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
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1. Introduction
| 3.431641 |
biomedical
|
Other
|
[
0.9970703125,
0.0013513565063476562,
0.0015707015991210938
] |
[
0.028350830078125,
0.9697265625,
0.0012845993041992188,
0.0005598068237304688
] |
The measurement units are the following: Waist circumference is measured in centimeters (cm); BMI is a unitless measurement, as it is calculated as weight in kilograms (kg) divided by the square of height in meters (m 2 ); Triglycerides are measured in millimoles per liter (mmol/L); HDL (is also measured in millimoles per liter (mmol/L).
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
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https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
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sec[0]/p[16]
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1. Introduction
| 3.005859 |
biomedical
|
Other
|
[
0.9970703125,
0.0006756782531738281,
0.0023860931396484375
] |
[
0.34033203125,
0.6484375,
0.010223388671875,
0.0012540817260742188
] |
This formula has been developed to better reflect the metabolic risk posed by VF accumulation, overcoming the limitations of individual indicators and also accounting for gender-specific variations.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
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https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
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1. Introduction
| 2.498047 |
biomedical
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Other
|
[
0.98388671875,
0.0015230178833007812,
0.0147857666015625
] |
[
0.352783203125,
0.64501953125,
0.0016117095947265625,
0.0005893707275390625
] |
To determine which factor affects the VAI value the most, sensitivity analysis must be performed. This involves changing each factor individually and observing the effect on the VAI value. In general terms:
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
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1. Introduction
| 2.669922 |
biomedical
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Other
|
[
0.99560546875,
0.0007648468017578125,
0.0034160614013671875
] |
[
0.08831787109375,
0.90771484375,
0.0034236907958984375,
0.0005764961242675781
] |
Waist circumference and BMI: since both are components related to adiposity, changes in these values can significantly impact the VAI, particularly waist circumference as it is directly related to VF.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
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https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
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1. Introduction
| 2.589844 |
biomedical
|
Other
|
[
0.99609375,
0.0013294219970703125,
0.0026493072509765625
] |
[
0.0167236328125,
0.98046875,
0.0021991729736328125,
0.0007982254028320312
] |
Triglycerides and HDL: these are lipid parameters. High levels of triglycerides or low levels of HDL cholesterol can increase the VAI.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
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https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
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1. Introduction
| 2.248047 |
biomedical
|
Study
|
[
0.98974609375,
0.0006275177001953125,
0.00963592529296875
] |
[
0.50830078125,
0.487060546875,
0.0037689208984375,
0.0008344650268554688
] |
Given the formula, it is likely that waist circumference might have the most direct and significant impact on the VAI due to its direct relationship with VF. However, the exact factor with the most impact can vary depending on individual variations and initial values of the factors.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
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https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
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|
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1. Introduction
| 3.976563 |
biomedical
|
Review
|
[
0.9873046875,
0.00881195068359375,
0.004016876220703125
] |
[
0.00276947021484375,
0.0033245086669921875,
0.9931640625,
0.0008592605590820312
] |
This review aims to gather and analyze the available scientific literature to consolidate the evidence on the association between visceral obesity and nephrolithiasis, highlighting new biomarkers and mechanistic findings.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
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sec[1]/p[0]
|
2. Methods
| 3.376953 |
biomedical
|
Study
|
[
0.99951171875,
0.00023865699768066406,
0.00047087669372558594
] |
[
0.994140625,
0.0026874542236328125,
0.003185272216796875,
0.0001703500747680664
] |
The literature research was performed on April 2024 using MEDLINE PubMed Central and Google Scholar, taking into account only articles written in English and without limits of time span. Keywords used for the search included “kidney stones”, “nephrolithiasis”, “visceral fat”, “visceral adiposity index” and “computed tomography”. Relevant articles related to VF and kidney stones were selected and included.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
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https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
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|
3. Discussion
| 3.417969 |
biomedical
|
Review
|
[
0.9921875,
0.0036144256591796875,
0.004024505615234375
] |
[
0.0114288330078125,
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0.984375,
0.0006814002990722656
] |
Seven studies have been selected for this review ( Table 2 ). All are retrospective studies aimed at evaluating a correlation between VF and the development of kidney stones.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
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https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
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|
3. Discussion
| 3.601563 |
biomedical
|
Study
|
[
0.99951171875,
0.00019252300262451172,
0.00033402442932128906
] |
[
0.998046875,
0.0008287429809570312,
0.0010585784912109375,
0.00007861852645874023
] |
The VAI has been identified as an indicator with higher sensitivity and specificity compared to commonly used metrics for assessing metabolic disorders, such as waist circumference, BMI and blood lipids ( Table 3 ).
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
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3. Discussion
| 2.726563 |
biomedical
|
Other
|
[
0.99853515625,
0.000713348388671875,
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] |
[
0.1766357421875,
0.72607421875,
0.0948486328125,
0.0022487640380859375
] |
Although obesity remains an important factor involved in the high prevalence of urolithiasis , existing obesity indicators lack the precision needed to accurately predict the risk of kidney stone development within the population.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
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https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
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3. Discussion
| 2.705078 |
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|
Study
|
[
0.994140625,
0.003139495849609375,
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] |
[
0.96826171875,
0.0281219482421875,
0.00254058837890625,
0.0009417533874511719
] |
A high VAI significantly correlates with an increased risk of kidney stones, outperforming other risk factors statistically.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277464_p27
|
PMC11277464
|
sec[2]/p[4]
|
3. Discussion
| 4.136719 |
biomedical
|
Study
|
[
0.99951171875,
0.00018203258514404297,
0.00013518333435058594
] |
[
0.97998046875,
0.00600433349609375,
0.0139007568359375,
0.00028061866760253906
] |
VF, being metabolically active, secretes various substances, including proinflammatory cytokines, adipokines and hormones . These substances influence urinary metabolism and pH, potentially altering urine composition, by increasing the concentration of calcium, oxalate and uric acid, which are the main constituents of kidney stones . Furthermore, VF is linked with insulin resistance, which may enhance renal calcium reabsorption and reduce urinary citrate levels, a crucial inhibitor of stone formation .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277464_p28
|
PMC11277464
|
sec[2]/p[5]
|
3. Discussion
| 3.585938 |
biomedical
|
Review
|
[
0.9990234375,
0.0005068778991699219,
0.0004138946533203125
] |
[
0.112060546875,
0.2159423828125,
0.67041015625,
0.0017681121826171875
] |
Epidemiological studies support the higher risk of kidney stone development in individuals with elevated VF, highlighting the need to consider VF not only as a risk factor for metabolic and cardiovascular diseases but also for nephrolithiasis .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11277464_p29
|
PMC11277464
|
sec[2]/p[6]
|
3. Discussion
| 2.054688 |
biomedical
|
Study
|
[
0.98779296875,
0.0004467964172363281,
0.01178741455078125
] |
[
0.79150390625,
0.1966552734375,
0.01092529296875,
0.000797271728515625
] |
Limited major studies exist on this subject; among them, three utilized the National Health and Nutrition Examination Survey (NHANES) datasets, an American research initiative aiming to compile health and nutrition data of the U.S. population through interviews and physical examinations.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999995 |
PMC11277464_p30
|
PMC11277464
|
sec[2]/p[7]
|
3. Discussion
| 4.085938 |
biomedical
|
Study
|
[
0.99951171875,
0.0003399848937988281,
0.0001742839813232422
] |
[
0.9990234375,
0.00018405914306640625,
0.0005450248718261719,
0.00007641315460205078
] |
For instance, Wang et al. conducted a retrospective analysis using cross-sectional data collected from 2007 to 2018, encompassing a total of 13,871 American adults over 20 years old with nephrolithiasis. The study divided patients into four groups according to VAI quartiles: Q1 (11.96–42.89), Q2 (42.90–74.45), Q3 (74.45–131.43) and Q4 (131.45–611.34). The mean standard deviations of the VAI in the four groups are Q1 (29.07 ± 8.22), Q2 (57.53 ± 8.81), Q3 (99.52 ± 16.25) and Q4 (225.92 ± 95.83). The association between the VAI and nephrolithiasis was evaluated using logistic regression models, both unadjusted and adjusted for various potential confounders. Model 1 was unadjusted. Model 2 was adjusted for age, gender and race. Model 3 included adjustments for gender, age, race, education, marital status, poverty–income ratio, smoking, alcohol consumption, high blood pressure, diabetes, congestive hearth failure, cancer, HEI2015 total score, energy intake, vigorous activity and moderate activity.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277464_p31
|
PMC11277464
|
sec[2]/p[8]
|
3. Discussion
| 4.316406 |
biomedical
|
Study
|
[
0.99951171875,
0.00052642822265625,
0.00018584728240966797
] |
[
0.998046875,
0.0004532337188720703,
0.0011701583862304688,
0.00016379356384277344
] |
The multivariate regression analyses, adjusted for different confounders, demonstrated a positive correlation between the VAI and kidney stones. In model 1, the odds ratio (OR) was 1.002 (95% CI: 1.001–1.003); in model 2, it was 1.002 (95% CI: 1.001–1.002); and in model 3, it was 1.001 (95% CI: 1.000–1.001). Additionally, participants in the highest quartile (Q4: 131.45–611.34) had a significantly increased risk of developing kidney stones compared to those in the lowest quartile (Q1). The ORs were 1.879 (95% CI: 1.589–2.222) in model 1, 1.644 (95% CI: 1.384–1.953) in model 2 and 1.329 (95% CI: 1.104–1.600) in model 3. The p -value for the trend across all three models was less than 0.05. After adjusting for other variables, no significant interactions were observed. Moreover, the association between the VAI and kidney stones was examined using generalized additive models, smooth curve fitting, and piecewise linear regression. The results of the fully adjusted model revealed a curved relationship between the VAI and kidney stone incidence. As the VAI increased, the risk of developing nephrolithiasis rose parabolically and then gradually leveled off after the VAI reached a certain value. The piecewise linear regression used to identify the inflection point showed that when the VAI was below 75.130, each unit increase in the VAI raised the risk of developing kidney stones [OR: 1.005 (95% CI: 1.001–1.009)], and when the VAI was above 75.130, the risk remained steady [OR: 1.000 (95% CI: 1.000–1.001)]. The p -value for the likelihood ratio test was less than 0.05, indicating a nonlinear association between the VAI and kidney stones. According to the piecewise linear regression analysis, when the VAI was <75.130, there was a positive and approximately linear correlation between the VAI and the risk of kidney stones . The results reveal a clear relationship between the VAI and the prevalence of kidney stones, theoretically supporting the use of the VAI to assess the potential risk of developing kidney stones .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277464_p32
|
PMC11277464
|
sec[2]/p[9]
|
3. Discussion
| 4.167969 |
biomedical
|
Study
|
[
0.99951171875,
0.00026535987854003906,
0.00020182132720947266
] |
[
0.9990234375,
0.00021517276763916016,
0.0006146430969238281,
0.00007319450378417969
] |
The study with the largest cohort was conducted by Hou et al. , which gathered a total of 29,384 participants over 20 years old from 2007 to 2018, using NHANES data and using the same covariants of a previous study. The results reported 2781 participants with kidney stones, with logistic regression analysis demonstrating a higher average VAI among patients with a history of kidney stones compared to the control group. In particular, the VAI was 0.74 (0.70, 0.78) in the kidney stones group and 0.55 (0.52, 0.57) in the control group. After adjusting for confounders, the prevalence of kidney stones increased by 13% for each unit increase in the VAI (OR = 1.13, 95% CI: 1.08, 1.19). Additionally, a linear relationship was observed between the VAI and kidney stone prevalence. Subgroup analysis revealed a positive correlation between the VAI and kidney stone risk in both males (OR = 1.14, 95% CI: 1.07, 1.22) and females (OR = 1.14, 95% CI: 1.05, 1.24), whites (OR = 1.20, 95% CI: 1.11, 1.28) and other races, all age subgroups and non-hypertensive (OR = 1.06, 95% CI: 1.08, 1.25), and non-diabetic subgroups (OR = 1.14, 95% CI: 1.07, 1.21). An incremental increase in the VAI was associated with a 13% rise in kidney stone prevalence. This positive correlation was consistent across several subgroups, suggesting an increased risk of kidney stones with higher VAI levels .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277464_p33
|
PMC11277464
|
sec[2]/p[10]
|
3. Discussion
| 3.011719 |
biomedical
|
Study
|
[
0.9990234375,
0.00028443336486816406,
0.0006275177001953125
] |
[
0.99462890625,
0.0034885406494140625,
0.0016107559204101562,
0.0001747608184814453
] |
The most recent study utilizing NHANES data was performed by Liang et al. , spanning from 2007 to 2014, and included 9886 participants who suffered at least once in their lives from nephrolithiasis.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277464_p34
|
PMC11277464
|
sec[2]/p[11]
|
3. Discussion
| 4.046875 |
biomedical
|
Study
|
[
0.99951171875,
0.000377655029296875,
0.0001735687255859375
] |
[
0.99951171875,
0.00029754638671875,
0.0003094673156738281,
0.00006943941116333008
] |
Continuous variables were reported as means with standard errors, while categorical variables were reported as proportions. Differences between subjects grouped by VAI quartiles were assessed using a weighted Student’s t -test for continuous variables and a weighted Chi-Square test for categorical variables. To explore the association between the VAI and the risk of kidney stones and their recurrence, three models of multivariable logistic regression were used. Model 1 had no covariate adjustments. Model 2 adjusted for gender, age, race, educational level and BMI (as a continuous variable). Model 3 further adjusted for gender, age, race, educational level, BMI (as a continuous variable), physical activity, diabetes and hypertension. Subgroup analysis was performed to examine the correlation between the VAI and the risk of kidney stones and their recurrence across different stratification factors.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
PMC11277464_p35
|
PMC11277464
|
sec[2]/p[12]
|
3. Discussion
| 4.09375 |
biomedical
|
Study
|
[
0.9990234375,
0.0005230903625488281,
0.0002560615539550781
] |
[
0.99951171875,
0.00019478797912597656,
0.00033783912658691406,
0.00007027387619018555
] |
The average VAI index was 2.09 ± 0.04. The overall incidence of kidney stones was 9.24%, increasing with higher VAI quartiles (Quartile 1: 6.08%, Quartile 2: 8.57%, Quartile 3: 9.95%, Quartile 4: 12.40%). The recurrence rate of kidney stones among all subjects was 2.97%, with higher VAI quartiles associated with a greater risk of recurrence (Quartile 1: 1.78%, Quartile 2: 1.86%, Quartile 3: 3.78%, Quartile 4: 4.51%). Statistically significant differences were observed among the four VAI quartiles in terms of age, total cholesterol, HDL cholesterol, triglycerides, waist circumference, race, poverty–income ratio, education, physical activity, BMI, alcohol use, smoking status, hypertension and diabetes mellitus ( p < 0.05). Compared to the lowest VAI quartile, individuals in higher VAI quartiles had higher levels of total cholesterol, triglycerides, waist circumference, BMI, lower levels of HDL cholesterol, and a higher likelihood of developing hypertension and diabetes. Additionally, participants in higher VAI quartiles were more often Mexican-American and Non-Hispanic white, and were less physically active.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11277464_p36
|
PMC11277464
|
sec[2]/p[13]
|
3. Discussion
| 2.998047 |
biomedical
|
Study
|
[
0.99853515625,
0.0004940032958984375,
0.0009036064147949219
] |
[
0.91015625,
0.06903076171875,
0.0200347900390625,
0.0008187294006347656
] |
Once again, statistical analysis underscored a significant correlation between an increased VAI and the incidence of kidney stones and recurrences in the American population, irrespective of personal factors such as gender, age or health status .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277464_p37
|
PMC11277464
|
sec[2]/p[14]
|
3. Discussion
| 1.929688 |
biomedical
|
Study
|
[
0.98974609375,
0.0012407302856445312,
0.009124755859375
] |
[
0.9326171875,
0.06060791015625,
0.005779266357421875,
0.0009360313415527344
] |
The three studies mentioned above used the NHANES datasets and the specific value of the VAI to catalog and compare their patients.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11277464_p38
|
PMC11277464
|
sec[2]/p[15]
|
3. Discussion
| 3.080078 |
biomedical
|
Study
|
[
0.9990234375,
0.000186920166015625,
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] |
[
0.9921875,
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0.0001926422119140625
] |
Other studies have employed different methodologies to quantify peri-visceral fat, such as CT scans. For instance, Zhou et al. found that individuals with uric acid stones had higher rates of hypertension and greater VF area.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277464_p39
|
PMC11277464
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sec[2]/p[16]
|
3. Discussion
| 4.128906 |
biomedical
|
Study
|
[
0.99853515625,
0.001239776611328125,
0.0002319812774658203
] |
[
0.9990234375,
0.00033974647521972656,
0.0003666877746582031,
0.00016689300537109375
] |
This study included 269 patients undergoing percutaneous nephrolithotomy. VF area was measured from a single 5 mm axial slice at the umbilical level using the Aquarius iNtuition computerized fat analysis tool, version 4.4.6.100.2862. VF was identified using a fixed attenuation range of −190 to −30 HUs, consistent with previous studies . Out of the 269 patients included in the final analysis, 220 (81.8%) had non-uremic acid (UA) stones and 49 (18.2%) had UA stones as part or all of the stone composition. In univariate analysis, patients with UA stones exhibited significantly higher rates of hypertension (67.4% vs. 47.3%, p = 0.011) and coronary artery disease (14.3% vs. 4.6%, p = 0.011) compared to those with non-UA stones. Moreover, a significantly higher mean VF area was seen in patients with UA stones . A significantly greater percentage of patients with UA stones had a high VF area compared to non-UA stone patients (59.2% vs. 34.1%, p = 0.003). Logistic regression analysis was conducted to examine the association between UA stones and the three VF area categories (low, medium and high), as well as hypertension and coronary artery disease, which were individually associated with UA stones in univariate analysis. In this model, only a high VF area was significantly associated with UA stones (OR 3.12, 95% CI 1.25–7.76, p = 0.015), while medium VF area, hypertension and coronary artery disease were not.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277464_p40
|
PMC11277464
|
sec[2]/p[17]
|
3. Discussion
| 4.0625 |
biomedical
|
Study
|
[
0.99951171875,
0.00045299530029296875,
0.00021851062774658203
] |
[
0.99951171875,
0.0002224445343017578,
0.0002715587615966797,
0.00007480382919311523
] |
In the logistic regression analysis, including patient characteristics (age, gender and BMI) to determine potential confounding by these variables, the VF area was divided into tertiles: low (less than 124 cm 2 ), medium (124 cm 2 to 186.9 cm 2 ) and high (187 cm 2 or greater). Compared to the low VF area group, hypertension (OR 2.16, 95% CI 1.05–4.45, p = 0.04) and high VF area (OR 3.64, 95% CI 1.22–10.85, p = 0.02) emerged as independent predictors of UA nephrolithiasis, while medium VF area and coronary artery disease were not significant predictors.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277464_p41
|
PMC11277464
|
sec[2]/p[18]
|
3. Discussion
| 2.947266 |
biomedical
|
Study
|
[
0.998046875,
0.0010595321655273438,
0.001041412353515625
] |
[
0.9970703125,
0.002025604248046875,
0.0007977485656738281,
0.00021719932556152344
] |
When multivariate analysis was repeated in the subset of patients with available serum UA, hypertension and high VF area were no longer significant.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11277464_p42
|
PMC11277464
|
sec[2]/p[19]
|
3. Discussion
| 3.814453 |
biomedical
|
Study
|
[
0.9990234375,
0.000583648681640625,
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] |
[
0.99853515625,
0.0008578300476074219,
0.0003311634063720703,
0.00011968612670898438
] |
Patients with UA stones exhibited a significantly larger mean VF area, with a high VF area (greater than 187 cm 2 ) as an independent risk factor for UA nephrolithiasis .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277464_p43
|
PMC11277464
|
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|
3. Discussion
| 4.066406 |
biomedical
|
Study
|
[
0.99951171875,
0.00041556358337402344,
0.00018727779388427734
] |
[
0.99951171875,
0.00023496150970458984,
0.0003142356872558594,
0.00007349252700805664
] |
Akarken et al. involved 149 kidney stone patients identified through CT scans from August 2012 to April 2013, while the control group comprised 139 individuals who reported flank pain but had no CT evidence of nephrolithiasis. Patients were categorized by age, sex, BMI, VF and subcutaneous fat areas and serum level of low-density lipoproteins and triglycerides. VF area and subcutaneous fat area were measured on a single CT axial image located at the level of the umbilicus, by determining the values between −190 and −30 HUs as fixed attenuation range, using the Aquarius iNtuition computerized fat analysis tool, version 4.4.6.100.2862 .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277464_p44
|
PMC11277464
|
sec[2]/p[21]
|
3. Discussion
| 4.0625 |
biomedical
|
Study
|
[
0.99951171875,
0.00042057037353515625,
0.00019860267639160156
] |
[
0.99951171875,
0.00020694732666015625,
0.0003070831298828125,
0.00007641315460205078
] |
The respective measurements for the stone and control groups were as follows: BMI (29.1 vs. 27.6 kg/m 2 ), VF area (186.0 vs. 120.2 cm 2 ) and subcutaneous fat area (275.9 vs. 261.9 cm 2 ), with p -values of 0.01, 0.01 and 0.36, respectively. Multivariate analysis identified hyperlipidemia ( p = 0.003), hypertension ( p = 0.001) and the VF area % ( p = 0.01) as factors increasing the risk of kidney stone formation .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277464_p45
|
PMC11277464
|
sec[2]/p[22]
|
3. Discussion
| 3.693359 |
biomedical
|
Study
|
[
0.99951171875,
0.0003528594970703125,
0.0002033710479736328
] |
[
0.99853515625,
0.0006833076477050781,
0.0005688667297363281,
0.00011557340621948242
] |
Sönmez et al. investigated the variation in VAI between individuals with nephrolithiasis (103 patients) and a control group (45 patients), aiming to also assess the association between the VAI, stone characteristics and surgical outcomes.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277464_p46
|
PMC11277464
|
sec[2]/p[23]
|
3. Discussion
| 3.675781 |
biomedical
|
Study
|
[
0.9892578125,
0.01050567626953125,
0.00045180320739746094
] |
[
0.9970703125,
0.0020580291748046875,
0.0002677440643310547,
0.0006847381591796875
] |
Their prospective study encompassed patients undergoing percutaneous nephrolithotomy (PCNL) (45.6%) and intrarenal retrograde surgery (RIRS) (54.4%) for kidney stones in the same urology department between January 2017 and December 2019.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277464_p47
|
PMC11277464
|
sec[2]/p[24]
|
3. Discussion
| 2.683594 |
biomedical
|
Study
|
[
0.994140625,
0.005268096923828125,
0.0004603862762451172
] |
[
0.9892578125,
0.009490966796875,
0.0005512237548828125,
0.0009341239929199219
] |
The control group consisted of healthy individuals without documented lithiasis on a CT scan, residing in the same geographical area with similar nutritional habits as the patient group. Exclusion criteria were individuals under 18 years old, smokers, cancer patients or those with urinary tract diseases other than stones (including kidney failure).
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277464_p48
|
PMC11277464
|
sec[2]/p[25]
|
3. Discussion
| 2.164063 |
biomedical
|
Study
|
[
0.98876953125,
0.009552001953125,
0.0018215179443359375
] |
[
0.962890625,
0.03216552734375,
0.002185821533203125,
0.0029354095458984375
] |
Various data were taken into consideration, such as demographic and metabolic information, stone type and location, as well as surgical details and post-operative outcomes.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277464_p49
|
PMC11277464
|
sec[2]/p[26]
|
3. Discussion
| 3.771484 |
biomedical
|
Study
|
[
0.9990234375,
0.00043964385986328125,
0.00036025047302246094
] |
[
0.99951171875,
0.0003783702850341797,
0.00027632713317871094,
0.00007015466690063477
] |
VAI, waist circumference and BMI values showed significantly higher values in the nephrolithiasis group compared to the control group ( p = 0.02, p = 0.04, p < 0.001, respectively).
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277464_p50
|
PMC11277464
|
sec[2]/p[27]
|
3. Discussion
| 3.994141 |
biomedical
|
Study
|
[
0.99951171875,
0.00032806396484375,
0.0003437995910644531
] |
[
0.99951171875,
0.00023221969604492188,
0.0002429485321044922,
0.00005644559860229492
] |
In the multivariate analysis, among the various metabolic parameters, only the VAI was statistically significant {1.52 OR [(95% CI 1.21–1.9)], p < 0.001}; however, no significant relationship was found between the VAI and surgical parameters .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277464_p51
|
PMC11277464
|
sec[2]/p[28]
|
3. Discussion
| 4.019531 |
biomedical
|
Study
|
[
0.99951171875,
0.0001933574676513672,
0.00020575523376464844
] |
[
0.9990234375,
0.0001989603042602539,
0.0007128715515136719,
0.00005710124969482422
] |
Bartani et al. , in 2017, broadened their research to include not only VAT but also SAT, proposing that the VAT/SAT ratio might influence kidney stone development. Their study included 103 obese individuals, equally divided into a group with a history of kidney stones and a control group without such history or other pathologies. Using bioimpedance analysis to assess body composition, researchers discovered that the VF/subcutaneous fat ratio was significantly higher in the kidney stone group ( p = 0.012) .
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277464_p52
|
PMC11277464
|
sec[2]/p[29]
|
3. Discussion
| 3.957031 |
biomedical
|
Review
|
[
0.9970703125,
0.001552581787109375,
0.0012922286987304688
] |
[
0.03472900390625,
0.0012369155883789062,
0.9638671875,
0.0004086494445800781
] |
The studies reviewed provide several advantages in understanding the correlation between VF and nephrolithiasis. They collectively demonstrate that the VAI is a more sensitive and specific indicator of metabolic disorders compared to traditional metrics like BMI and waist circumference. Retrospective analyses, particularly those using large datasets like NHANES, offer robust evidence supporting the positive correlation between the VAI and kidney stones, highlighting a nonlinear relationship where risk increases significantly up to a certain VAI threshold.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277464_p53
|
PMC11277464
|
sec[2]/p[30]
|
3. Discussion
| 4.09375 |
biomedical
|
Study
|
[
0.99951171875,
0.0003066062927246094,
0.0001347064971923828
] |
[
0.86669921875,
0.0088043212890625,
0.12396240234375,
0.0007123947143554688
] |
Visceral adiposity contributes to nephrolithiasis through multiple mechanisms. Adipokines secreted by VF induce systemic inflammation, which in turn affects renal function and promotes stone formation. Furthermore, insulin resistance, commonly associated with VF, leads to increased renal calcium reabsorption and decreased urinary citrate excretion, both of which are critical factors in stone pathogenesis.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277464_p54
|
PMC11277464
|
sec[2]/p[31]
|
3. Discussion
| 3.947266 |
biomedical
|
Study
|
[
0.99951171875,
0.0002703666687011719,
0.0001933574676513672
] |
[
0.92138671875,
0.0017719268798828125,
0.0765380859375,
0.00032401084899902344
] |
Studies employing various methodologies, such as CT scans and bioimpedance analysis, further validate the association by demonstrating higher VF in patients with kidney stones compared to controls. These comprehensive analyses underscore the importance of considering VF in the risk assessment and management of nephrolithiasis, offering a potential for improved predictive accuracy over traditional obesity metrics.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277464_p55
|
PMC11277464
|
sec[3]/p[0]
|
4. Conclusions
| 4.03125 |
biomedical
|
Review
|
[
0.9892578125,
0.00901031494140625,
0.0019283294677734375
] |
[
0.0220947265625,
0.1746826171875,
0.80078125,
0.0026607513427734375
] |
The assessment of VF emerges as a potent risk indicator, poised to transform preventive strategies. This proactive approach facilitates early detection, enabling more effective management. Identifying individuals at high risk before symptom onset can substantially reduce the incidence of kidney colic and the subsequent need for emergency room interventions. Moreover, prioritizing early intervention could significantly decrease the necessity for surgical procedures and the associated risk of complications. This comprehensive approach underscores the importance of integrating perivisceral fat evaluation into health assessments, aiming to improve the prevention and management of kidney stones, ultimately enhancing patient outcomes and reducing healthcare costs tied to advanced urolithiasis treatments.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277464_p56
|
PMC11277464
|
sec[3]/p[1]
|
4. Conclusions
| 2.417969 |
biomedical
|
Other
|
[
0.9921875,
0.0012054443359375,
0.006519317626953125
] |
[
0.1798095703125,
0.78466796875,
0.0333251953125,
0.0021076202392578125
] |
Undoubtedly, more prospective studies are essential to validate these findings.
|
[
"Carlo Augusto Mallio",
"Laura Cea",
"Valerio D’Andrea",
"Andrea Buoso",
"Caterina Bernetti",
"Bruno Beomonte Zobel",
"Federico Greco"
] |
https://doi.org/10.3390/jcm13144065
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277479_p0
|
PMC11277479
|
sec[0]/p[0]
|
1. Introduction
| 4.230469 |
biomedical
|
Review
|
[
0.990234375,
0.00885009765625,
0.0008993148803710938
] |
[
0.276123046875,
0.01080322265625,
0.70947265625,
0.0038166046142578125
] |
Hip fractures and strokes are prevalent and escalating issues in geriatric healthcare. With the global aging population, approximately 1.5 million hip fractures and 14 million strokes occur annually. The projections indicate that these numbers will rise, with proximal femur fractures expected to reach 2.5 million by 2025 and 4.5 million by 2050 . Stroke is a significant risk factor that increases the risk of femur fractures in the paretic limb due to sensory disorders, weakened muscle strength, increased muscle tension, impaired balance, and cognitive dysfunction. The literature reports that 7.3–15.3% of stroke patients experience femoral fractures, with their risk of hip fractures being 2–4 times higher than that of healthy individuals . Proximal femur fractures significantly impair patients’ quality of life by limiting locomotion and mobility. Prolonged immobility in stroke patients leads to permanent joint stiffness, muscle atrophy, and systemic issues such as cardiorespiratory disorders, significantly increasing their mortality risk . These patients require continuous care and medical supervision, which impose substantial economic and social burdens, emphasizing the necessity for effective management strategies . In this article, we will explore the challenges and management strategies associated with hip arthroplasty in patients who have experienced a stroke and subsequent failure of fixation treatment for proximal femur fractures. The multi-morbidity of elderly patients and the dependence resulting from a stroke, combined with a proximal femur fracture, present significant challenges for the entire treatment team, including doctors, physiotherapists, nurses, and family members. These challenges are compounded by the patient’s spastic muscle paresis, limited joint mobility, and sensory disturbances. The postoperative complications in stroke patients undergoing hip arthroplasty are exacerbated by factors such as prolonged immobilization, pain, urinary catheter insertion, and postoperative disorientation. These factors significantly reduce the likelihood of regaining independence and increase the risk of further complications, including additional strokes, heart attacks, and even death . Timely and safe surgical intervention, followed by early postoperative rehabilitation, are crucial for stroke patients with hip fractures. These measures significantly enhance the chances of regaining independence and improving the overall outcomes . Furthermore, addressing the unique challenges posed by spastic muscle paresis and limited joint mobility in post-stroke patients requires a multidisciplinary approach. This includes comprehensive preoperative planning, effective pain management, and a structured rehabilitation program to mitigate the risks of long-term complications and enhance patient recovery.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277479_p1
|
PMC11277479
|
sec[1]/sec[0]/p[0]
|
2.1. The Patient
| 3.263672 |
clinical
|
Clinical case
|
[
0.1796875,
0.8115234375,
0.00875091552734375
] |
[
0.00275421142578125,
0.00484466552734375,
0.0030307769775390625,
0.9892578125
] |
This case study describes a 64-year-old man with left-sided hemiparesis and a failed surgical treatment of a pertrochanteric fracture of the proximal femur in the spastic limb. He was admitted to the Department of Rehabilitation and Orthopedics in December 2022 for diagnostic evaluation and treatment planning after five months of non-ambulatory status.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277479_p2
|
PMC11277479
|
sec[1]/sec[1]/p[0]
|
2.2. Patient Medical History
| 2.6875 |
clinical
|
Clinical case
|
[
0.1280517578125,
0.86181640625,
0.01016998291015625
] |
[
0.0022125244140625,
0.005985260009765625,
0.0020580291748046875,
0.98974609375
] |
The patient’s medical history includes second-degree aortic valve regurgitation, ischemic heart disease, and multiple myocardial infarctions in 2004 and 2007. He also underwent stent implantation in 2004 and suffered a left orbital fracture and left frontal lobe contusion. In 2005, a subdural hemorrhage due to an aneurysm rupture led to left-sided hemiparesis.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277479_p3
|
PMC11277479
|
sec[1]/sec[2]/p[0]
|
2.3. Initial Treatment
| 3.701172 |
clinical
|
Clinical case
|
[
0.2186279296875,
0.7783203125,
0.0030956268310546875
] |
[
0.01419830322265625,
0.0117950439453125,
0.002902984619140625,
0.97119140625
] |
Following a hemorrhagic stroke in 2005, the patient underwent extensive rehabilitation, focusing on locomotion and upper limb manipulation. Following recovery, he was able to walk independently using a hand cane. His Barthel scale score was 85, indicating slight disability and independence in daily activities, although his Tinetti scale score was 10 out of 28, indicating a high fall risk . Table 1 shows the Barthel scale scores, indicating the patient’s functional status before and after treatment. Table 2 displays the Tinetti scale scores, assessing balance and fall risk.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277479_p4
|
PMC11277479
|
sec[1]/sec[3]/p[0]
|
2.4. Fracture and Initial Surgery
| 3.076172 |
clinical
|
Clinical case
|
[
0.05926513671875,
0.935546875,
0.005046844482421875
] |
[
0.0021724700927734375,
0.005908966064453125,
0.0018148422241210938,
0.990234375
] |
In July 2022, the patient came to the emergency room due to severe pain in the left hemiparetic limb and the inability to bear weight on it after a fall from his own height. During the examination, an X-ray revealed a pertrochanteric fracture of the left lower limb. The second day after the fracture, surgery was performed to stabilize the fracture with a Gamma nail. Figure 1 shows the X-ray taken after the initial surgery, illustrating the successful fusion of the fracture.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277479_p5
|
PMC11277479
|
sec[1]/sec[3]/p[1]
|
2.4. Fracture and Initial Surgery
| 2.884766 |
clinical
|
Clinical case
|
[
0.11370849609375,
0.88232421875,
0.004062652587890625
] |
[
0.006389617919921875,
0.00982666015625,
0.0021209716796875,
0.9814453125
] |
Following the initial surgery, the patient experienced a significant decline in mobility, relying entirely on a wheelchair. His Barthel scale score dropped to 40, indicating substantial dependence on others for daily activities. Table 1 and Table 2 illustrate the patient’s functional status and fall risk assessment over time, highlighting the significant decline in independence following the surgery.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277479_p6
|
PMC11277479
|
sec[1]/sec[3]/p[2]
|
2.4. Fracture and Initial Surgery
| 1.545898 |
clinical
|
Clinical case
|
[
0.10711669921875,
0.8759765625,
0.0168914794921875
] |
[
0.0028839111328125,
0.034423828125,
0.0016498565673828125,
0.9609375
] |
In December 2022, 5 months after the first surgery, the patient consulted a doctor due to pain, a snapping sensation in the area of the operated joint, and a fistula that appeared below the postoperative scar.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277479_p7
|
PMC11277479
|
sec[1]/sec[4]/p[0]
|
2.5. Treatment
| 1.208984 |
clinical
|
Clinical case
|
[
0.050018310546875,
0.9326171875,
0.0174102783203125
] |
[
0.00440216064453125,
0.158935546875,
0.00341796875,
0.83349609375
] |
After admission to the Department of Rehabilitation and Orthopedics, the patient was assessed by a multidisciplinary team of orthopedics, medical rehabilitation, and physiotherapist specialists. The team decided to treat the patient in three stages, preparing him for hip arthroplasty.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277479_p8
|
PMC11277479
|
sec[1]/sec[4]/p[1]
|
2.5. Treatment
| 3.160156 |
clinical
|
Clinical case
|
[
0.240478515625,
0.7578125,
0.0019378662109375
] |
[
0.031707763671875,
0.06658935546875,
0.0028839111328125,
0.89892578125
] |
The first stage of treatment, performed in January 2023, involved the removal of the failed fixation and the use of an absorbable calcium sulfate antibiotic carrier with Gentamicin to fill bone defects. This was followed by comprehensive perioperative care, including antibiotic therapy, antithrombotic prophylaxis, and anti-edema management. Figure 2 shows the X-ray taken after the first stage of treatment, illustrating the successful removal of the failed fixation and filling of the bone defects.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277479_p9
|
PMC11277479
|
sec[1]/sec[4]/p[2]
|
2.5. Treatment
| 1.936523 |
clinical
|
Clinical case
|
[
0.040008544921875,
0.95458984375,
0.005489349365234375
] |
[
0.0020122528076171875,
0.0138397216796875,
0.0015287399291992188,
0.982421875
] |
Following the surgery, the patient underwent a 6-week intensive rehabilitation program to enhance his general fitness and relearn walking using orthopedic equipment. The patient was discharged from the hospital in good general condition, walking with support for short distances using handrails and a brace limiting the flexion of the left knee joint. Table 3 shows the detailed rehabilitation program for each stage of treatment.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277479_p10
|
PMC11277479
|
sec[1]/sec[4]/p[3]
|
2.5. Treatment
| 2.251953 |
biomedical
|
Other
|
[
0.97119140625,
0.0258636474609375,
0.003047943115234375
] |
[
0.0138702392578125,
0.9755859375,
0.0017452239990234375,
0.0086669921875
] |
The second stage of treatment, implemented in September 2023, included botulinum toxin (BnT) injections to the spastic muscles and further rehabilitation to improve muscle function and joint mobility.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277479_p11
|
PMC11277479
|
sec[1]/sec[4]/p[4]
|
2.5. Treatment
| 3.894531 |
clinical
|
Clinical case
|
[
0.440185546875,
0.55810546875,
0.0019550323486328125
] |
[
0.04150390625,
0.03680419921875,
0.0038242340087890625,
0.91796875
] |
Before the botulinum treatment, the muscle tension of the paretic limb was assessed as 3 according to the Ashworth scale (mm. gastrocnemius, soleus, posterior tibialis, and adductors). There was also a significant limitation of mobility in the hip joint (flexion–adduction contracture 20 degrees), knee joint (flexion contracture 30 degrees), and a fixed equinus foot position. In the upper limb, the muscle tension of the elbow and wrist flexors was 4 on the Ashworth scale. The left upper limb was assessed as unusable due to severe spasticity and the persistent limitation of mobility of the wrist and finger joints.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277479_p12
|
PMC11277479
|
sec[1]/sec[4]/p[5]
|
2.5. Treatment
| 2.048828 |
clinical
|
Clinical case
|
[
0.2490234375,
0.74658203125,
0.004619598388671875
] |
[
0.014495849609375,
0.1373291015625,
0.0018768310546875,
0.84619140625
] |
The patient’s gait could not be assessed due to pain and fear of falling. After the assessment, the gastrocnemius, tibialis posterior, and adductors were chosen as the injection sites. The BnT treatment was performed with ultrasound guidance to secure an accurate needle position.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277479_p13
|
PMC11277479
|
sec[1]/sec[4]/p[6]
|
2.5. Treatment
| 3.150391 |
biomedical
|
Other
|
[
0.9677734375,
0.031280517578125,
0.001171112060546875
] |
[
0.100830078125,
0.79443359375,
0.00334930419921875,
0.10125732421875
] |
As a result of the drug administration, the spastic muscle tension was reduced to 2 in all the treated muscles. Consequently, the flexion contracture was reduced, and the range of motion in the hip and knee joints was increased, which, combined with the exercises, improved the supporting function of the limb.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277479_p14
|
PMC11277479
|
sec[1]/sec[4]/p[7]
|
2.5. Treatment
| 2.707031 |
clinical
|
Clinical case
|
[
0.122314453125,
0.87255859375,
0.005096435546875
] |
[
0.004119873046875,
0.01947021484375,
0.0013036727905273438,
0.97509765625
] |
After finishing a 6-week period of rehabilitation, the patient was qualified for the third and final stage of treatment—the insertion of a complete bipolar snap-on prosthesis with simultaneous tenotomy of the adductor muscles. Figure 3 displays the X-ray after the final surgery, confirming the correct placement of the total snap-on endoprosthesis.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277479_p15
|
PMC11277479
|
sec[1]/sec[4]/p[8]
|
2.5. Treatment
| 2.533203 |
clinical
|
Clinical case
|
[
0.042388916015625,
0.95361328125,
0.00386810302734375
] |
[
0.00208282470703125,
0.0118560791015625,
0.0018129348754882812,
0.984375
] |
The surgery went without complications, and the patient was able to stand up with the aid of the therapist with a standing walker the first day after the surgery. After two weeks, the initial postoperative rehabilitation treatment was intensified to further improve locomotion. During this time, the patient rehabilitation included Proprioceptive Neuromuscular Facilitation (PNF), passive exercises with a Continuous Passive Motion machine (CPM), and improvement of ambulation with handrails and a hand cane.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999999 |
PMC11277479_p16
|
PMC11277479
|
sec[1]/sec[4]/p[9]
|
2.5. Treatment
| 3.492188 |
clinical
|
Clinical case
|
[
0.050445556640625,
0.9462890625,
0.0033016204833984375
] |
[
0.003719329833984375,
0.009490966796875,
0.0028018951416015625,
0.98388671875
] |
After the final stage of the treatment, which involved the insertion of a complete bipolar snap-on prosthesis and adductor muscle tenotomy, the patient was able to walk short distances (about 30 m) and climb the stairs with support . His Barthel scale score improved to 60, although his Tinetti scale score remained low at 6, indicating ongoing balance and mobility challenges. The patient was discharged home after five weeks of rehabilitation with recommendations to continue the exercises at home (balance and mobility training to decrease the risk of further falls) and to continue the botulinum therapy every 3 months. Figure 6 displays a detailed timeline of the patient’s treatment.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277479_p17
|
PMC11277479
|
sec[2]/p[0]
|
3. Discussion
| 3.875 |
biomedical
|
Review
|
[
0.9990234375,
0.00046443939208984375,
0.0003325939178466797
] |
[
0.423828125,
0.0040435791015625,
0.5712890625,
0.0007276535034179688
] |
There is a scarcity of literature addressing the complexities of arthroplasty for proximal femur fractures in patients with spastic hemiparesis. Despite the scarcity of literature, this issue is well-recognized in modern medicine. The absence of standardized surgical protocols for patients with spastic hemiparesis and multiple comorbidities presents a significant medical challenge. The studies indicate that patients with hemiplegia have higher risks of fractures due to factors such as sensory disorders, weakened muscle strength, and spasticity, which impair balance . Fisher et al. reported that a significant proportion of these patients have vitamin D deficiency and increased bone resorption, predisposing them to osteoporosis and falls .
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277479_p18
|
PMC11277479
|
sec[2]/p[1]
|
3. Discussion
| 3.335938 |
clinical
|
Clinical case
|
[
0.392822265625,
0.603515625,
0.003620147705078125
] |
[
0.01403045654296875,
0.04107666015625,
0.0022735595703125,
0.94287109375
] |
Our patient scored 10 on the Tinetti scale following a stroke, indicating a high fall risk and underscoring the need for targeted rehabilitation to improve balance and coordination . The Barthel scale, used to assess patient independence in daily activities, showed a score of 60, indicating moderate disability and partial assistance needs .
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277479_p19
|
PMC11277479
|
sec[2]/p[2]
|
3. Discussion
| 3.478516 |
biomedical
|
Other
|
[
0.99169921875,
0.007518768310546875,
0.001018524169921875
] |
[
0.06512451171875,
0.671875,
0.259765625,
0.0035076141357421875
] |
Pre- and postoperative rehabilitation for hip prosthesis surgery in paralyzed patients is vital for achieving successful treatment outcomes and enhancing their quality of life. The necessity for early and comprehensive physiotherapy following total hip arthroplasty has been demonstrated. The patient evaluations consistently indicate that their quality of life improved following the insertion of an artificial hip and subsequent rehabilitation .
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277479_p20
|
PMC11277479
|
sec[2]/p[3]
|
3. Discussion
| 3.708984 |
biomedical
|
Study
|
[
0.994140625,
0.00508880615234375,
0.0009665489196777344
] |
[
0.83154296875,
0.1539306640625,
0.012359619140625,
0.0022068023681640625
] |
Although research has been conducted to establish effective rehabilitation strategies for patients following hip fracture surgery, currently, there are no clear and evidence-based guidelines for managing patients with both stroke and hip fractures . Developing such standards is essential for improving patient outcomes and reducing complications. Choosing a proper strategy for managing a patient who has experienced both a stroke and a hip fracture presents significant challenges for the whole treatment team. Consequently, our work addresses this issue by proposing pre- and postoperative procedure programs.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277479_p21
|
PMC11277479
|
sec[2]/p[4]
|
3. Discussion
| 2.402344 |
biomedical
|
Other
|
[
0.96435546875,
0.0321044921875,
0.003326416015625
] |
[
0.0142059326171875,
0.9365234375,
0.04376220703125,
0.005535125732421875
] |
In the existing literature, clear guidelines are lacking for hemiparetic patient hip fracture surgeries, including eligibility criteria, surgery timing, and the approach . The surgical decisions are often influenced by the patient’s functional status, comorbidities, type, and stroke severity .
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277479_p22
|
PMC11277479
|
sec[2]/p[5]
|
3. Discussion
| 2.660156 |
biomedical
|
Study
|
[
0.9970703125,
0.001819610595703125,
0.0009217262268066406
] |
[
0.74658203125,
0.1905517578125,
0.05963134765625,
0.003093719482421875
] |
Studies indicate that patients with hemiplegia stayed in the hospital longer and developed postoperative complications more often than patients without hemiplegia, as well as those related to the use of bone cement and bone substitutes .
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277479_p23
|
PMC11277479
|
sec[2]/p[6]
|
3. Discussion
| 4.023438 |
biomedical
|
Study
|
[
0.96240234375,
0.037261962890625,
0.00046062469482421875
] |
[
0.74609375,
0.2069091796875,
0.0070343017578125,
0.03985595703125
] |
Additionally, the choice of surgical approach and the type of artificial hip joint used can impact the success of postoperative rehabilitation. The research indicates that the direct anterior approach in hip surgery, as used in our case, results in fewer postoperative complications and faster recovery compared to the posterolateral approach, although it involves longer operation times and more intraoperative bleeding . The bipolar snap-on prosthesis, as used in our patient, facilitated early mobilization and reduced the postoperative dislocations, crucial for patients with spastic paresis and limited joint mobility .
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277479_p24
|
PMC11277479
|
sec[2]/p[7]
|
3. Discussion
| 4.011719 |
biomedical
|
Review
|
[
0.99462890625,
0.00412750244140625,
0.0011577606201171875
] |
[
0.0137786865234375,
0.028106689453125,
0.95654296875,
0.0017786026000976562
] |
Spasticity is a pathological condition whose main feature is involuntary and prolonged muscle contraction . Several treatments can help to reduce the tone of spastic muscles, including physiotherapy, pharmacotherapy, and the increasingly popular method of botulinum toxin injections. To achieve optimal results, it is essential to combine multiple approaches. Emerging evidence suggests that combining electrical stimulation to the muscles following botulinum toxin injections with gait training is particularly effective . Over the last decade, the intrathecal baclofen (ITB) pump has been increasingly used to treat generalized or regional spasticity refractory to oral medications or injection therapy .
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277479_p25
|
PMC11277479
|
sec[2]/p[8]
|
3. Discussion
| 2.753906 |
biomedical
|
Other
|
[
0.8896484375,
0.10797119140625,
0.0024700164794921875
] |
[
0.00746917724609375,
0.93896484375,
0.0016279220581054688,
0.0517578125
] |
To manage spasticity, botulinum toxin injections were administered to the patient’s lower limb muscles, significantly reducing the muscle tone and improving the joint mobility, thereby enhancing the limb’s supportive function.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999996 |
PMC11277479_p26
|
PMC11277479
|
sec[2]/p[9]
|
3. Discussion
| 3.619141 |
biomedical
|
Other
|
[
0.90673828125,
0.09051513671875,
0.0028514862060546875
] |
[
0.002918243408203125,
0.98779296875,
0.003971099853515625,
0.0054779052734375
] |
A prompt and comprehensive management strategy for patients with both stroke and hip fracture should include timely surgical intervention, appropriate prosthesis selection, and an intensive rehabilitation program incorporating botulinum toxin therapy and physiotherapy for optimal recovery and preparing the musculoskeletal system for gait training.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277479_p27
|
PMC11277479
|
sec[3]/p[0]
|
4. Conclusions: Challenges and Management Strategies for Hip Fractures in Spastic Paralysis Patients
| 2.994141 |
biomedical
|
Other
|
[
0.99755859375,
0.0013103485107421875,
0.0011882781982421875
] |
[
0.0848388671875,
0.74169921875,
0.1707763671875,
0.002803802490234375
] |
Treating hip fractures in patients with spastic paralysis is understudied. This complex issue is recognized in modern medicine, yet the absence of standardized protocols for managing surgical treatment in these patients complicates the situation. The research indicates a higher fracture risk in stroke patients due to sensory disorders, reduced muscle strength with spasticity, and balance issues.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999997 |
PMC11277479_p28
|
PMC11277479
|
sec[3]/p[1]
|
4. Conclusions: Challenges and Management Strategies for Hip Fractures in Spastic Paralysis Patients
| 4.195313 |
biomedical
|
Clinical case
|
[
0.744140625,
0.254638671875,
0.0011529922485351562
] |
[
0.096923828125,
0.317138671875,
0.06219482421875,
0.52392578125
] |
The research also indicates that patients with hemiplegia experience longer hospital stays and more frequent postoperative complications, highlighting the need for specialized care protocols. Choosing the appropriate surgical approach, such as the direct anterior approach, and selecting the optimal type of artificial hip joint are critical for successful rehabilitation and reduced postoperative complications. Effective spasticity management requires a multimodal approach, including botulinum toxin injections combined with electrical stimulation and gait training. The use of intrathecal baclofen pumps is also beneficial for patients with refractory spasticity. A staged treatment program, starting with botulinum toxin injections to reduce muscle spasticity, followed by continuous therapeutic rehabilitation, and culminating in hip arthroplasty, significantly enhances the patient outcomes by promoting independent movement and greater autonomy. In conclusion, the management of hip fractures in patients with spastic paralysis requires a multidisciplinary approach and the development of standardized treatment protocols. This case underscores the importance of comprehensive pre- and postoperative rehabilitation to improve patient outcomes.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999998 |
PMC11277479_p29
|
PMC11277479
|
sec[3]/p[2]
|
4. Conclusions: Challenges and Management Strategies for Hip Fractures in Spastic Paralysis Patients
| 3.164063 |
biomedical
|
Other
|
[
0.9970703125,
0.0015230178833007812,
0.0013866424560546875
] |
[
0.05377197265625,
0.92626953125,
0.0186309814453125,
0.0011167526245117188
] |
Further research is needed to establish standardized rehabilitation protocols for spastic patients undergoing hip arthroplasty. Randomized controlled trials could provide valuable insights into the efficacy of various interventions.
|
[
"Izabela Dąbkowska",
"Lena Sobiech",
"Michał Merkisz",
"Karolina Turżańska",
"Tomasz Blicharski",
"Katarzyna Jankiewicz"
] |
https://doi.org/10.3390/jcm13144023
|
N/A
|
https://creativecommons.org/licenses/by/4.0/
|
en
| 0.999994 |
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