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Keywords = airway severity score

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10 pages, 710 KiB  
Article
CPAP Use and Retinal Disease Risk in Obstructive Apnea: A Cohort Study
by Dillan Cunha Amaral, Pedro Lucas Machado Magalhães, Muhammad Alfatih, Bruna Gabriel Miranda, Hashem Abu Serhan, Raíza Jacometti, Bruno Fortaleza de Aquino Ferreira, Letícia Sant’Ana, Diogo Haddad Santos, Mário Luiz Ribeiro Monteiro and Ricardo Noguera Louzada
Vision 2025, 9(3), 65; https://doi.org/10.3390/vision9030065 - 1 Aug 2025
Viewed by 125
Abstract
Obstructive sleep apnea (OSA) is a common condition associated with intermittent hypoxia, systemic inflammation, and vascular dysfunction; mechanisms implicated in retinal disease pathogenesis. This real-world retrospective cohort study used data from the TriNetX Research Network to assess whether continuous positive airway pressure (CPAP) [...] Read more.
Obstructive sleep apnea (OSA) is a common condition associated with intermittent hypoxia, systemic inflammation, and vascular dysfunction; mechanisms implicated in retinal disease pathogenesis. This real-world retrospective cohort study used data from the TriNetX Research Network to assess whether continuous positive airway pressure (CPAP) therapy reduces retinal disease incidence among adults with OSA and BMI between 25.0 and 30.0 kg/m2. After 1:1 propensity score matching, 101,754 patients were included in the analysis. Retinal outcomes included diabetic retinopathy (DR), age-related macular degeneration (AMD), retinal vein occlusion (RVO), and central serous chorioretinopathy (CSC). CPAP use was associated with a modest but statistically significant reduction in DR (3.2% vs. 3.4%, RR: 0.922, p = 0.016) and AMD (2.1% vs. 2.3%, RR: 0.906, p = 0.018), while no significant differences were found for RVO or CSC. These findings support prior evidence linking CPAP to improved retinal microvascular health and suggest a protective effect against specific retinal complications. Limitations include a lack of data on CPAP adherence, OSA severity, and imaging confirmation. Still, this study highlights the importance of interdisciplinary care between sleep and eye health, and the need for further prospective studies to validate CPAP’s role in preventing retinal disease progression in OSA patients. Full article
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16 pages, 1446 KiB  
Systematic Review
Soft Palate and Pharyngeal Surgery for the Treatment of Snoring: A Systematic Review
by Giovanni Cammaroto, Giuseppe Caccamo, Tommaso Rodella, Diletta Angeletti, Francesca Boscolo Nata, Davide Topazio and Luca Cerritelli
J. Clin. Med. 2025, 14(14), 4964; https://doi.org/10.3390/jcm14144964 - 14 Jul 2025
Viewed by 568
Abstract
Background: Snoring is a common symptom within the spectrum of sleep-disordered breathing, often occurring independently or in association with obstructive sleep apnea syndrome (OSAS). Despite its prevalence, treatment strategies remain variable and lack standardization, particularly regarding surgical interventions. This review aims to [...] Read more.
Background: Snoring is a common symptom within the spectrum of sleep-disordered breathing, often occurring independently or in association with obstructive sleep apnea syndrome (OSAS). Despite its prevalence, treatment strategies remain variable and lack standardization, particularly regarding surgical interventions. This review aims to evaluate and summarize the outcomes of soft palate and pharyngeal surgeries for adult snoring based on recent literature. Methods: A systematic review was conducted using the PubMed database, identifying studies published between 2014 and 2024 that involved adult patients undergoing upper airway surgery for snoring. Inclusion criteria required pre- and postoperative snoring assessment using the Visual Analog Scale (VAS). Studies were categorized by surgical technique (anterior vs. lateral/circumferential), anesthesia type, presence of tonsillectomy, BMI, OSAS severity (based on AHI), and use of Drug-Induced Sleep Endoscopy (DISE). Descriptive analysis was performed on the changes in VAS scores. Results: A total of 43 studies involving 2713 patients were included, with 18 eligible for quantitative analysis (716 patients). Across all patients, mean VAS scores improved from 7.29 to 3.50 (ΔVAS 3.79). Both anterior and lateral/circumferential techniques yielded significant symptom reduction (ΔVAS 4.12 and 3.68, respectively). General anesthesia showed slightly better outcomes than local anesthesia. Notably, tonsillectomy was associated with greater symptom improvement (ΔVAS 5.17 vs. 4.49). Patients with lower BMI and milder OSAS showed higher baseline VAS but similar improvements. Limited objective measures and heterogeneity in surgical protocols were key limitations. Conclusions: Surgical interventions for snoring provide subjective symptom relief regardless of surgical approach or OSAS severity. Tonsillectomy may enhance outcomes. Future efforts should prioritize standardized, objective outcome measures and personalized treatment planning, potentially incorporating DISE and wearable acoustic technologies. Full article
(This article belongs to the Section Otolaryngology)
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31 pages, 3002 KiB  
Review
Difficult Airway Management in the Intensive Care Unit: A Narrative Review of Algorithms and Strategies
by Talha Liaqat, Mohammad Asim Amjad and Sujith V. Cherian
J. Clin. Med. 2025, 14(14), 4930; https://doi.org/10.3390/jcm14144930 - 11 Jul 2025
Viewed by 1655
Abstract
Background: The management of difficult airways is one of the most critical and challenging aspects of emergency and ICU care. Despite technological advances, unanticipated airway difficulty can result in serious complications, including hypoxia, brain injury, and death. This comprehensive narrative review aims to [...] Read more.
Background: The management of difficult airways is one of the most critical and challenging aspects of emergency and ICU care. Despite technological advances, unanticipated airway difficulty can result in serious complications, including hypoxia, brain injury, and death. This comprehensive narrative review aims to consolidate current algorithms and evidence-based strategies to guide clinicians in the assessment and management of difficult airways. Methods: A comprehensive literature review was conducted using PubMed, Embase, and Google Scholar to identify relevant studies, clinical guidelines, and expert consensus documents related to difficult airway management. The focus was placed on both pre-intubation assessment tools and intervention strategies used in various clinical contexts. Results: Airway difficulty is best anticipated through a combination of history, physical examination, and validated tools such as the Mallampati score. Several algorithms, including those from the American Society of Anesthesiologists (ASA) and the Difficult Airway Society (DAS), provide structured approaches that emphasize preoxygenation, preparedness for failed intubation, and the use of adjuncts such as video laryngoscopy, supraglottic airway devices, and awake intubation techniques. Crisis algorithms such as the Vortex approach help simplify decision-making during emergencies. It is important to have adjuncts available in cases of anticipated difficult airways, such as fiberoptic intubation, while surgical airway access is an important component of a stepwise airway management algorithm when critical scenarios are encountered. Conclusions: Effective difficult airway management requires anticipation, a structured plan, familiarity with advanced airway tools, and adherence to validated algorithms. Training in crisis resource management and multidisciplinary rehearsal of airway scenarios are essential to improving outcomes. Full article
(This article belongs to the Section Respiratory Medicine)
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10 pages, 187 KiB  
Article
Correlation of Airway POCUS Measures with Screening and Severity Evaluation Tools in Obstructive Sleep Apnea: An Exploratory Study
by Sapna Ravindranath, Yatish S. Ranganath, Ethan Lemke, Matthew B Behrens, Anil A. Marian, Hari Kalagara, Nada Sadek, Melinda S. Seering, Linder Wendt, Patrick Ten Eyck and Rakesh V. Sondekoppam
J. Clin. Med. 2025, 14(14), 4858; https://doi.org/10.3390/jcm14144858 - 9 Jul 2025
Viewed by 389
Abstract
Background: Obstructive Sleep Apnea (OSA) is a common occurrence in the perioperative patient population but is often undiagnosed. Point-of-Care Ultrasound (POCUS) has emerged as a promising tool for perioperative assessment; however, its effectiveness in detecting the presence or severity of OSA needs to [...] Read more.
Background: Obstructive Sleep Apnea (OSA) is a common occurrence in the perioperative patient population but is often undiagnosed. Point-of-Care Ultrasound (POCUS) has emerged as a promising tool for perioperative assessment; however, its effectiveness in detecting the presence or severity of OSA needs to be evaluated. Objective: We assessed the ability of airway POCUS as a screening and severity evaluation tool for OSA by examining its correlation with STOP-BANG scores and the Apnea–Hypopnea Index (AHI). Design: Cross-sectional observational study. Setting: A single-center study in a tertiary care hospital between June 2020 to May 2021. Patients: Adult patients aged 18–65 with prior Polysomnography (PSG) for OSA workup were screened. Interventions: The participants completed the STOP-BANG questionnaire and subsequently underwent POCUS examinations, either pre- or post-surgery. Ten different POCUS views previously used for evaluating OSA were acquired in a predefined sequence, with subsequent measurements of airway parameters. Outcome measures: Generalized linear modeling was used to explore and assess the relationships between the measured parameters, STOP-BANG, and AHI scores (modeled continuously and categorized into risk levels of STOP-BANG and AHI). Results: A total of 260 patients were screened, of which 142 were enrolled and 127 completed the scanning studies. The median AHI was 16.71, while the STOP-BANG scores were mostly between 5 and 6, indicating a moderate-to-high OSA risk in the study population. Notably, only neck circumference was significantly associated with AHI severity (p = 0.012), whereas none of the other POCUS measures were. Among the POCUS measures, significant associations with STOP-BANG scores were observed for the Tongue Cross-Sectional Area (T-CSA) (p = 0.002), Retro-Palatal Diameter (RPD) (p = 0.034), Distance Between Lingual Arteries (DLA) (p = 0.034), and Geniohyoid Muscle Thickness (GMT) (p = 0.040). Conclusions: Neck circumference is a more reliable predictor of OSA severity (AHI) compared to other POCUS measurements. Many of the POCUS measures had a good correlation with the STOP-BANG scores, highlighting the utility of POCUS as a screening tool for OSA rather than as a severity evaluation tool. Full article
(This article belongs to the Special Issue Innovations in Perioperative Anesthesia and Intensive Care)
16 pages, 246 KiB  
Article
Severe Traumatic Brain Injuries and Associated Outcomes at a Level 1 Trauma Center
by Bharti Sharma, Tirth Patel, Hasan Al-Ali, George Agriantonis, Navin D. Bhatia, Carrie Garcia, Praise Nesamony, Jasmine Dave, Juan Mestre, Shalini Arora, Saad Bhatti, Zahra Shafaee, Suganda Phalakornkul, Kate Twelker and Jennifer Whittington
Biomedicines 2025, 13(7), 1614; https://doi.org/10.3390/biomedicines13071614 - 1 Jul 2025
Viewed by 306
Abstract
Background: Severe traumatic brain injury (TBI) remains a leading cause of mortality and long-term morbidity, particularly in high-acuity trauma settings. We aim to evaluate the clinical, physiologic, and socioeconomic factors associated with outcomes in patients with severe traumatic brain injury (TBI) at a [...] Read more.
Background: Severe traumatic brain injury (TBI) remains a leading cause of mortality and long-term morbidity, particularly in high-acuity trauma settings. We aim to evaluate the clinical, physiologic, and socioeconomic factors associated with outcomes in patients with severe traumatic brain injury (TBI) at a single urban Level 1 trauma center. Method: This is a single-center, retrospective study of patients presenting with severe TBI between 1 January 2020 and 31 December 2023 at Elmhurst Hospital Center in Queens, New York. Patients were identified using ICD trauma codes and an Abbreviated Injury Severity (AIS) Head score of ≥3. Demographic data, injury characteristics, vital signs, airway interventions, alcohol level, and insurance status were analyzed. Result: A total of 1130 patients met the inclusion criteria. The cohort was predominantly male (76.1%) with a mean age of 52.7 years. Blunt trauma accounted for 97.8% of cases, with a mortality rate of 13.8%, while penetrating trauma comprised 2.2%, with a markedly higher mortality rate of 48%. Patients who died as full code had lower mean systolic blood pressure (82.5 mmHg), oxygen saturation (63%), and shorter emergency department stays (~3.7 h). The mean Glasgow Coma Scale (GCS) score was 12.6, dropping to 6.0 in patients who died. Moreover, higher AIS Head and Injury Severity Score (ISS) values were correlated with worse outcomes. Severely intoxicated patients had higher TBI incidence, with no clear difference observed when compared to normal BAC levels. Self-pay patients exhibited the highest mortality (40%). All associations were statistically significant (p < 0.0001). Conclusions: Severe TBI outcomes are significantly influenced by injury mechanisms, physiologic parameters, and socioeconomic status. These findings emphasize the need for targeted prognostic tools and improved trauma system preparedness for TBI patients at risk of poor outcomes. Full article
(This article belongs to the Section Molecular and Translational Medicine)
17 pages, 3070 KiB  
Article
Virtual Guided and Customized Orthognathic Surgery in Patients with Obstructive Sleep Apnea Syndrome: Accuracy and Clinical Outcomes
by Marta Benito Anguita, Saad Khayat, Soledad López Martín, Natalia Bravo Quelle, Ignacio Navarro Cuéllar, Ana López López, José Luis Cebrián Carretero, José Luis del Castillo Pardo de Vera, Pablo Montes Fernández-Micheltorena, Manuel Tousidonis Rial, Giovanni Dell’Aversana Orabona, Farzin Falahat, José Zamorano León and Carlos Navarro Cuéllar
J. Clin. Med. 2025, 14(11), 3780; https://doi.org/10.3390/jcm14113780 - 28 May 2025
Viewed by 744
Abstract
Background: This preliminary case series aimed to evaluate the clinical and morphometric outcomes of maxillomandibular advancement (MMA) surgery in patients with severe obstructive sleep apnea (OSA) using virtual surgical planning (VSP), patient-specific cutting guides, and customized titanium plates. Primary outcomes included changes in [...] Read more.
Background: This preliminary case series aimed to evaluate the clinical and morphometric outcomes of maxillomandibular advancement (MMA) surgery in patients with severe obstructive sleep apnea (OSA) using virtual surgical planning (VSP), patient-specific cutting guides, and customized titanium plates. Primary outcomes included changes in the Apnea–Hypopnea Index (AHI), airway dimensions, surgical accuracy, and quality of life. Methods: In this preliminary case series, six patients with severe OSA underwent MMA surgery planned using three-dimensional VSP, and executed with the aid of CAD-/CAM-generated surgical guides and patient-specific osteosynthesis. Clinical variables included AHI, Epworth Sleepiness Scale (ESS), and computed tomography-based airway morphometry. Surgical accuracy was assessed by comparing planned and achieved skeletal movements. Statistical analysis was performed using Wilcoxon signed-rank tests and Spearman’s correlation. Results: The mean preoperative AHI decreased significantly from 48.8 ± 23.6 to 12.4 ± 10.0 (p = 0.035), and ESS scores improved from 14.5 ± 4.6 to 7.8 ± 2.1 (p = 0.029). Mean airway area increased significantly from 51.8 ± 9.0 mm2 to 91.8 ± 26.6 mm2 (p = 0.035). A strong but non-significant correlation was observed between airway gain and ESS improvement (p = 0.754, p = 0.084). No patients required CPAP at 6-month follow-up, and all were asymptomatic. The anteroposterior accuracy of skeletal movements was high: 82.6% for the maxilla and 85.8% for the pogonion, with mean absolute errors of 1.25 mm and 1.95 mm, respectively. Vertical accuracy was lower, particularly in the chin region, where error analysis showed greater variability. No statistically significant differences were found between planned and achieved movements in any vector. Conclusions: MMA surgery performed with VSP, cutting guides, and customized titanium plates offers a highly effective, safe, and precise treatment modality for selected OSA patients. This approach leads to a significant reduction in AHI, expansion of the upper airway, and improvement in patient-reported daytime functioning. High accuracy in skeletal repositioning—particularly in anteroposterior vectors—supports the reliability and reproducibility of digitally guided orthognathic surgery. These findings reinforce the role of technologically assisted MMA as a definitive treatment for severe OSA. Full article
(This article belongs to the Special Issue Innovations in Maxillofacial Surgery)
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11 pages, 1609 KiB  
Article
Comparison of Modified Lund–Kennedy Endoscopic Score and Nasal Polyp Score in the Follow-Up of Patients with Severe Uncontrolled CRSwNP During Biological Therapy
by Giuseppe Roccuzzo, Tommaso Saccardo, Sonny Zampollo, Nicola Tessari, Alessandro Fontana, Paolo Manildo, Bruno Scarpa, Piero Nicolai and Giancarlo Ottaviano
Appl. Sci. 2025, 15(9), 4873; https://doi.org/10.3390/app15094873 - 27 Apr 2025
Viewed by 846
Abstract
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory disorder of the upper airways, severely impacting quality of life. Dupilumab, targeting type 2 inflammatory pathways, is effective in managing severe, uncontrolled CRSwNP. However, the comparative accuracy of endoscopic scoring systems in monitoring [...] Read more.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory disorder of the upper airways, severely impacting quality of life. Dupilumab, targeting type 2 inflammatory pathways, is effective in managing severe, uncontrolled CRSwNP. However, the comparative accuracy of endoscopic scoring systems in monitoring therapeutic response to dupilumab remains unclear. This study compared the accuracy of the nasal polyp score (NPS) and the modified Lund–Kennedy endoscopic score (M-LKS) in assessing dupilumab response. Methods: A retrospective cohort analysis included 66 severe CRSwNP patients treated with dupilumab at Padua University. Endoscopic scores (NPS and M-LKS), patient-reported outcome mesures (PROMs), and clinician-reported outcome measures (CROMs), including peak nasal inspiratory flow (PNIF) and the Sniffin’ Sticks test, were evaluated at baseline and over 24 months. Results: Both NPS and M-LKS showed significant reductions over time (p < 0.001), significantly correlating with PNIF (p < 0.001). Given time and patient, PNIF emerged to be the only covariate related to endoscopic scores. No significant differences were observed between NPS and M-LKS regarding clinical outcome associations, suggesting equivalent accuracy. PNIF was identified as a critical predictor of endoscopic improvement, highlighting its clinical utility. These findings reinforce the role of standardized endoscopic metrics in assessing the efficacy of biologic therapies for CRSwNP. Full article
(This article belongs to the Section Applied Biosciences and Bioengineering)
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13 pages, 1761 KiB  
Article
Evaluation of the Effectiveness of Animated Images in First Aid for Infants with Foreign Body Airway Obstruction: A Simulation Study
by Taekgeun Ohk, Junhwi Cho, Hyunseok Cho, Goeun Yang, Kicheol You and Taehun Lee
J. Clin. Med. 2025, 14(8), 2839; https://doi.org/10.3390/jcm14082839 - 20 Apr 2025
Viewed by 591
Abstract
Background: Foreign body airway obstruction is a sudden emergency that can occur unexpectedly in healthy people, leading to severe consequences if immediate first aid is not provided. Unlike the Heimlich maneuver for adults, the first aid for infant choking is less widely known [...] Read more.
Background: Foreign body airway obstruction is a sudden emergency that can occur unexpectedly in healthy people, leading to severe consequences if immediate first aid is not provided. Unlike the Heimlich maneuver for adults, the first aid for infant choking is less widely known and more complex, making it difficult to explain verbally. This study aimed to assess the efficiency of using an animated graphics interchange format (GIF) to teach first aid for infant choking due to foreign bodies. Methods: Eighty adults who had not received recent training in choking first aid within the last two years were randomly assigned to either the auditory (n = 40) or audiovisual (n = 40) groups. The participants were asked to perform first aid on an infant manikin under the guidance of a researcher using a smartphone in a separate room. The auditory group received verbal instructions only, while the audiovisual group received animated GIFs on their smartphones along with verbal instructions simultaneously. The entire process was recorded with two cameras, and two emergency physicians reviewed the videos to assess the adequacy of the first aid administered. Results: The “infant position”, “supporting arm posture”, and “head tilt” were more adequate in the audiovisual group. The Instruction Performance scores were higher in the audiovisual group. There was no significant difference in the time required to administer first aid between the two groups. Conclusions: Audiovisual guidance using animated GIFs has been shown to effectively enhance the adequacy of first-aid performance for infant airway obstruction caused by foreign bodies. Full article
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14 pages, 258 KiB  
Article
The Validation of the Italian Version of the Munich Swallowing Score (IT-MUCSS) Against the Fiberoptic Endoscopic Evaluation of Swallowing and Food Intake Modalities in Patients with Neurogenic Dysphagia: A Cross-Sectional Study
by Giorgia Gottardo, Maria Zampieri, Maria Luisa Costanza, Marta Scamardella, Elena Castagnetti, Isabella Koch, Lorenza Maistrello and Sara Nordio
J. Clin. Med. 2025, 14(6), 1942; https://doi.org/10.3390/jcm14061942 - 13 Mar 2025
Viewed by 1853
Abstract
Background/Objectives: Oral intake and secretions need to be assessed separately, especially in patients with tracheal tubes, as they are vital for dysphagia treatment and may require different management strategies. This study aims to validate the Italian version of the Munich Swallowing Score [...] Read more.
Background/Objectives: Oral intake and secretions need to be assessed separately, especially in patients with tracheal tubes, as they are vital for dysphagia treatment and may require different management strategies. This study aims to validate the Italian version of the Munich Swallowing Score (IT-MUCSS) by examining its content and construct validity in relation to the fiberoptic endoscopic evaluation of swallowing (FEES) and oral intake in adults with neurogenic dysphagia, as well as assessing intra- and inter-rater reliability. This tool is clinically and scientifically useful as it includes two subscales: IT-MUCSS-Saliva, which assesses saliva/secretion management and the presence of a tracheal tube, and IT-MUCSS-Alimentazione, which evaluates feeding methods. Methods: In this prospective cross-sectional study, a total of 50 dysphagic patients with a neurological diagnosis were recruited from a neuro-rehabilitation hospital and underwent both clinical and instrumental assessments. The main outcome measures included evaluating food and liquid intake using the Italian versions of the Functional Oral Intake Scale (FOIS-It) and the IT-MUCSS. Pharyngeal residues were assessed using the Yale Pharyngeal Residue Severity Rating Scale (IT-YPRSRS), and airway penetration/aspiration were evaluated using the Penetration–Aspiration Scale (PAS) during FEES. Results: The IT-MUCSS demonstrated excellent reproducibility (K = 0.91) and internal consistency (Cronbach’s alpha = 0.72). Strong correlations were found between IT-MUCSS and the FOIS-It scale, indicating the effective assessment of dysphagia. Test–retest reliability was high (ICC = 0.96 for total score). Construct validity was confirmed through significant correlations with instrumental measures during FEES. Conclusions: The IT-MUCSS is a valid tool for assessing functional oral intake and the management of saliva/secretions, specifically in relation to the level of saliva/secretions management compared to FEES measures of swallowing safety and efficiency in patients with neurogenic dysphagia. Full article
(This article belongs to the Section Otolaryngology)
21 pages, 1854 KiB  
Article
Therapeutic Impact of Gardasil® in Recurrent Respiratory Papillomatosis: A Retrospective Study on RRP Patients
by Jennifer Sieg, Asita Fazel, Elgar Susanne Quabius, Astrid Dempfle, Susanne Wiegand and Markus Hoffmann
Viruses 2025, 17(3), 321; https://doi.org/10.3390/v17030321 - 26 Feb 2025
Cited by 1 | Viewed by 1262
Abstract
Background: Recurrent respiratory papillomatosis (RRP) is a rare, non-malignant disease caused by human papillomavirus (HPV) types 6 and 11. The condition primarily affects the larynx, potentially leading to life-threatening airway obstruction. It is more aggressive in younger patients, necessitating frequent surgical interventions. This [...] Read more.
Background: Recurrent respiratory papillomatosis (RRP) is a rare, non-malignant disease caused by human papillomavirus (HPV) types 6 and 11. The condition primarily affects the larynx, potentially leading to life-threatening airway obstruction. It is more aggressive in younger patients, necessitating frequent surgical interventions. This study investigates the therapeutic potential of the prophylactic HPV vaccine Gardasil® in RRP patients, focusing on its impact on lesion size and the frequency of surgical interventions. Furthermore, a literature review was conducted to analyze the factors influencing the decision to vaccinate. Methods: A retrospective analysis was conducted on 63 RRP patients treated from 2008 to 2021. Disease burden was assessed using the Derkay score and the annual frequency of laser-surgical ablations. Comparisons were made between pre- and post-vaccination periods in vaccinated patients (n = 18), and between first and second halves of the disease’s course in unvaccinated patients (n = 14). Results: A reduction in the frequency of surgical interventions post-vaccination (p < 0.05) could be seen. The cumulated Derkay score per year decreased after second and third vaccination (p < 0.05). The decision to be vaccinated is influenced by multiple factors (e.g., potential side-effects, sociocultural factors, impact of social media, pre-existing conditions and the wider context of the recent pandemic). Conclusions: Gardasil® appears to reduce the frequency of surgery and lessen disease severity in RRP patients, supporting the potential role of HPV vaccination as a therapeutic option for RRP. Moreover, it is crucial to overcome skepticism towards vaccinations to prevent the development of HPV-associated diseases in the first place. Full article
(This article belongs to the Special Issue Human and Animal Papillomavirus: Infections, Genetics, and Vaccines)
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12 pages, 1145 KiB  
Review
The Potential Role of Nasal Cytology in Respiratory Diseases: Clinical Research and Future Perspectives
by Giuseppina Marcuccio, Giuseppina Raffio, Pasquale Ambrosino, Claudio Candia, Elena Cantone, Aikaterini Detoraki and Mauro Maniscalco
J. Clin. Med. 2025, 14(3), 884; https://doi.org/10.3390/jcm14030884 - 29 Jan 2025
Viewed by 1602
Abstract
Nasal cytology is a non-invasive, affordable, and easily executable technique commonly used in research to study rhinitis and, to a lesser extent, chronic rhinosinusitis. It is particularly useful for the differential diagnosis of non-allergic rhinitis and for phenotyping chronic rhinosinusitis. Allergic rhinitis, asthma, [...] Read more.
Nasal cytology is a non-invasive, affordable, and easily executable technique commonly used in research to study rhinitis and, to a lesser extent, chronic rhinosinusitis. It is particularly useful for the differential diagnosis of non-allergic rhinitis and for phenotyping chronic rhinosinusitis. Allergic rhinitis, asthma, and aspirin intolerance are frequent comorbidities of chronic rhinosinusitis. A diagnostic system has been proposed to assess the severity of chronic rhinosinusitis (clinical-cytological grading), incorporating nasal cytology and comorbidity observation. This score correlates with the recurrence risk of chronic rhinosinusitis with nasal polyposis. Specifically, a higher grade is often linked to asthma, aspirin intolerance, a recurrent disease requiring surgery, and a mixed cell phenotype (eosinophilic and mast cell). Although nasal cytology has been shown to be able to replace bronchial analysis with acceptable precision due to its technical characteristics, its use in diseases affecting both upper and lower airways remains limited. The main limitation of this technique is its lack of standardization, which currently hinders its widespread clinical adoption despite its increasing familiarity among allergists and otolaryngologists. In the context of the unitary airways hypothesis, nasal cytology could also provide valuable insights for managing lower airway diseases like chronic obstructive pulmonary disease and obstructive sleep apnea syndrome, which significantly impact quality of life and healthcare costs. This review aims to provide an overview of nasal cytology, highlighting its limitations and potential applications in chronic respiratory diseases. Full article
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15 pages, 2843 KiB  
Systematic Review
Systematic Review and Meta-Analysis of the Application of T-PEP in the Therapeutic Management of COPD Patients
by Arianna Sepiacci, Nadia Starc, Rossella Laitano, Franco Pasqua, Paola Rogliani and Josuel Ora
J. Clin. Med. 2025, 14(2), 320; https://doi.org/10.3390/jcm14020320 - 7 Jan 2025
Viewed by 2254
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, characterized by chronic mucus hypersecretion (CMH) that exacerbates airway obstruction and accelerates disease progression. Effective airway clearance techniques are essential to improve respiratory function and reduce exacerbations. Temporary [...] Read more.
Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide, characterized by chronic mucus hypersecretion (CMH) that exacerbates airway obstruction and accelerates disease progression. Effective airway clearance techniques are essential to improve respiratory function and reduce exacerbations. Temporary Positive Expiratory Pressure (T-PEP) is a novel airway clearance device that has shown promise in managing COPD. Objectives: This meta-analysis aimed to evaluate the efficacy of T-PEP in a standard pulmonary rehabilitation program. Methods: Following PRISMA guidelines, a comprehensive search of randomized controlled trials (RCTs) was conducted in the MEDLINE and PEDro databases. Data from 162 subjects, including those with severe COPD and bronchiectasis, were analyzed. Key outcomes assessed were changes in lung function (FVC, FEV1, TLC), inspiratory and expiratory pressures (MIP, MEP), gas exchange (PaO2, PaCO2), exercise capacity (6MWT), symptom severity (mMRC, CAT, BCSS), and exacerbation rates. Results: T-PEP significantly improved FVC, FEV1, TLC, MIP, MEP, and DLCO compared to baseline, with heterogeneity noted across studies. Improvements in gas exchange and physical capacity were observed, with PaO2 increasing and PaCO2 decreasing. T-PEP also reduced symptoms of cough and dyspnea, improving quality-of-life scores. Additionally, a notable reduction in acute exacerbations of COPD was seen after one month and three months of treatment. Conclusions: T-PEP therapy shows substantial benefits in improving lung function, exercise capacity, and quality of life while reducing exacerbation rates in COPD patients. Although promising, these findings require further confirmation through randomized clinical trials to establish the optimal application of T-PEP in various clinical settings and patient phenotypes. Full article
(This article belongs to the Section Respiratory Medicine)
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11 pages, 691 KiB  
Article
Sub-Tenon’s Block in Patients with Previous Encircling Band Surgery—A Feasibility Study
by Johannes Harte, Gesar Ugen, Joana Berger-Estilita, Andreas Ebneter and Friedrich Lersch
J. Clin. Med. 2024, 13(24), 7735; https://doi.org/10.3390/jcm13247735 - 18 Dec 2024
Viewed by 957
Abstract
Introduction: During the COVID-19 pandemic, reducing aerosol-generating procedures became fundamental, particularly in ophthalmic surgeries traditionally performed under general anesthesia (GA). Regional anesthesia, such as sub-Tenon’s block (STB), is widely used in vitreoretinal surgeries, offering a safer alternative by avoiding airway manipulation. However, the [...] Read more.
Introduction: During the COVID-19 pandemic, reducing aerosol-generating procedures became fundamental, particularly in ophthalmic surgeries traditionally performed under general anesthesia (GA). Regional anesthesia, such as sub-Tenon’s block (STB), is widely used in vitreoretinal surgeries, offering a safer alternative by avoiding airway manipulation. However, the altered orbital anatomy in patients with previous scleral explant surgery creates unique challenges to STB application. This study aims to evaluate the effectiveness, safety, and feasibility of STB in patients after encircling band surgery. Methods: This retrospective analysis included 46 patients with a history of scleral explant surgery, undergoing vitreoretinal procedures at the Bern University Hospital. All procedures were conducted under STB with either analgosedation or GA for additional support when required. An ophthalmic surgeon or an experienced anesthesiologist performed the STBs. Data collected included block success rate, procedural difficulty, incidence of chemosis, and patient satisfaction. The Institutional Ethics Committee approved this study, and all participants provided informed consent. Results: STB was successfully administered in 93.5% of cases, with only three unsuccessful blocks. Block placement was rated as easy in 55% of cases, moderately difficult in 28%, and difficult in 17%. Chemosis was observed in 24% of patients, with severe cases in only 4%. Patient satisfaction scores were high, with most patients expressing satisfaction with the STB procedure. Conversion to GA was required in only one case due to alcohol withdrawal-related agitation. Discussion: The high success rate and minimal complications suggest that STB is a feasible and safe alternative to GA in patients with prior scleral buckling surgery. The altered orbital anatomy presents potential challenges, including scar tissue and compartmentalization, which may lead to patchy anesthesia. However, the use of STB avoids the risks associated with GA and may be especially beneficial for elderly or frail patients. Future studies should further investigate the hemodynamic implications of STB in these cases and the potential for ultrasound-guided techniques to improve accuracy and safety. Full article
(This article belongs to the Special Issue Advances in Regional Anaesthesia and Acute Pain Management)
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19 pages, 3692 KiB  
Article
Predicting Severe Respiratory Failure in Patients with COVID-19: A Machine Learning Approach
by Bahadır Ceylan, Oktay Olmuşçelik, Banu Karaalioğlu, Şule Ceylan, Meyha Şahin, Selda Aydın, Ezgi Yılmaz, Rıdvan Dumlu, Mahir Kapmaz, Yeliz Çiçek, Abdullah Kansu, Mustafa Duger and Ali Mert
J. Clin. Med. 2024, 13(23), 7386; https://doi.org/10.3390/jcm13237386 - 4 Dec 2024
Cited by 1 | Viewed by 1176
Abstract
Background/Objectives: Studies attempting to predict the development of severe respiratory failure in patients with a COVID-19 infection using machine learning algorithms have yielded different results due to differences in variable selection. We aimed to predict the development of severe respiratory failure, defined as [...] Read more.
Background/Objectives: Studies attempting to predict the development of severe respiratory failure in patients with a COVID-19 infection using machine learning algorithms have yielded different results due to differences in variable selection. We aimed to predict the development of severe respiratory failure, defined as the need for high-flow oxygen support, continuous positive airway pressure, or mechanical ventilation, in patients with COVID-19, using machine learning algorithms to identify the most important variables in achieving this prediction. Methods: This retrospective, cross-sectional study included COVID-19 patients with mild respiratory failure (mostly receiving oxygen through a mask or nasal cannula). We used XGBoost, support vector machines, multi-layer perceptron, k-nearest neighbor, random forests, decision trees, logistic regression, and naïve Bayes methods to accurately predict severe respiratory failure in these patients. Results: A total of 320 patients (62.1% male; average age, 54.67 ± 15.82 years) were included in this study. During the follow-ups of these cases, 114 patients (35.6%) required high-level oxygen support, 67 (20.9%) required intensive care unit admission, and 43 (13.4%) died. The machine learning algorithms with the highest accuracy values were XGBoost, support vector machines, k-nearest neighbor, logistic regression, and multi-layer perceptron (0.7395, 0.7395, 0.7291, 0.7187, and 0.75, respectively). The method that obtained the highest ROC-AUC value was logistic regression (ROC-AUC = 0.7274). The best predictors of severe respiratory failure were a low lymphocyte count, a high computed tomography score in the right and left upper lung zones, an elevated neutrophil count, a small decrease in CRP levels on the third day of admission, a high Charlson comorbidity index score, and a high serum procalcitonin level. Conclusions: The development of severe respiratory failure in patients with COVID-19 could be successfully predicted using machine learning methods, especially logistic regression, and the best predictors of severe respiratory failure were the lymphocyte count and the degree of upper lung zone involvement. Full article
(This article belongs to the Section Infectious Diseases)
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8 pages, 225 KiB  
Article
Transition from Transbronchial Forceps to Cryobiopsy After Lung Transplantation: A Single-Centre Experience
by Davide Tosi, Margherita Brivio, Sara Franzi, Alessandro Palleschi, Gianluca Bonitta, Gianluca Lopez, Ilaria Righi, Paolo Mendogni, Margherita Cattaneo, Francesco Damarco, Letizia Morlacchi, Valeria Rossetti and Lorenzo Rosso
Life 2024, 14(11), 1474; https://doi.org/10.3390/life14111474 - 13 Nov 2024
Viewed by 1009
Abstract
The gold standard for histological acute cellular rejection diagnosis is transbronchial forceps biopsy (FB), but in recent years, transbronchial cryobiopsy (CB) has been increasingly used. This study aims to compare the diagnostic rate and safety of FBs and CBs performed in two different [...] Read more.
The gold standard for histological acute cellular rejection diagnosis is transbronchial forceps biopsy (FB), but in recent years, transbronchial cryobiopsy (CB) has been increasingly used. This study aims to compare the diagnostic rate and safety of FBs and CBs performed in two different periods. We retrospectively reviewed our case history for the two biopsy procedures: 251 FBs (223 for surveillance purposes and 28 for clinical indication) and 218 consecutive CBs (159 for surveillance purposes and 59 for clinical indication). All biopsies were scored according to the ISHLT criteria. Diagnostic yield was higher in the CB group for all the parameters considered: a grade of acute rejection (AR) was detected in 95.0% vs. 84.5% in the CB vs. FB groups (p < 0.001). The diagnostic rate of airway inflammation was 65.1% vs. 51.8% (p = 0.005), and 89.0% vs. 64.9% (p < 0.001) for chronic rejection. Pneumothorax requiring chest drainage occurred in 4% of the CB group and 3% of the FB group. Moderate and severe bleeding complicated CB and FB procedures in seven (3%) and three cases (1%), respectively. Transbronchial cryobiopsies improved the diagnostic yield in the monitoring of the lung allograft. The complication rate did not increase significantly in CBs vs. FBs. Full article
(This article belongs to the Section Medical Research)
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