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Medicina, Volume 58, Issue 9 (September 2022) – 174 articles

Cover Story (view full-size image): Endoscopic retrograde cholangiopancreatography (ERCP) is the primary therapeutic approach for disorders of the pancreatobiliary tree. It carries the highest risk of complications and mortality, with post-ERCP pancreatitis (PEP) being the most frequent complication. PEP can be mitigated through a combination of pharmacological and intraprocedural measures, prompt diagnosis and early management. This review covers the definition, epidemiology and risk factors for PEP, with a focus on the latest evidence-based medical and endoscopic strategies to prevent and manage PEP. View this paper
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10 pages, 1107 KiB  
Article
A Comparative Evaluation of Dentogingival Tissue Using Transgingival Probing and Cone-Beam Computed Tomography
by Gotam Das, Abdul Razzaq Ahmed, Ghazala Suleman, Abhishek Lal, Muhammad Haseeb Rana, Naseer Ahmed and Suraj Arora
Medicina 2022, 58(9), 1312; https://doi.org/10.3390/medicina58091312 - 19 Sep 2022
Cited by 1 | Viewed by 2775
Abstract
Background and Objective: Gingival biotype can be assessed using a variety of invasive and non-invasive procedures, such as direct probing, transgingival probing, ultrasound-guided approaches, and, for the more sophisticated, cone-beam computed tomography. The aim of this study was to evaluate gingival biotype [...] Read more.
Background and Objective: Gingival biotype can be assessed using a variety of invasive and non-invasive procedures, such as direct probing, transgingival probing, ultrasound-guided approaches, and, for the more sophisticated, cone-beam computed tomography. The aim of this study was to evaluate gingival biotype in relation to transgingival probing and cone-beam computed tomography (CBCT). Materials and Methods: This study included a total of two hundred healthy individuals. Gingival thickness was assessed and measured from the right and left maxillary central incisor teeth using CBCT and transgingival probing of the attached gingiva. The measurements were analyzed with regard to tooth type (central incisor). Linear measurements for gingival biotype were measured using both methods. Correlations and differences between measurement methods were assessed. Results: The mean age of study participants was 32.49 ± 8.61 years. The radiographic measurements on CBCT were 1.34 ± 0.17 mm for the right central and 1.28 ± 0.21mm for the left central. The transgingival probing measurements were 1.31 ± 0.18 for the right central and 1.22 ± 0.21mm for the left central. Conclusion: As per the results of this study, there is a significant positive correlation between transgingival probing and CBCT measurements of gingival biotypes. Full article
(This article belongs to the Collection New Concepts for Dental Treatments and Evaluations)
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28 pages, 1668 KiB  
Review
Molecular Pathogenesis of Endotheliopathy and Endotheliopathic Syndromes, Leading to Inflammation and Microthrombosis, and Various Hemostatic Clinical Phenotypes Based on “Two-Activation Theory of the Endothelium” and “Two-Path Unifying Theory” of Hemostasis
by Jae C. Chang
Medicina 2022, 58(9), 1311; https://doi.org/10.3390/medicina58091311 - 19 Sep 2022
Cited by 5 | Viewed by 2721
Abstract
Endotheliopathy, according to the “two-activation theory of the endothelium”, can be triggered by the activated complement system in critical illnesses, such as sepsis and polytrauma, leading to two distinctly different molecular dysfunctions: (1) the activation of the inflammatory pathway due to the release [...] Read more.
Endotheliopathy, according to the “two-activation theory of the endothelium”, can be triggered by the activated complement system in critical illnesses, such as sepsis and polytrauma, leading to two distinctly different molecular dysfunctions: (1) the activation of the inflammatory pathway due to the release of inflammatory cytokines, such as interleukin 6 and tumor necrosis factor-α, and (2) the activation of the microthrombotic pathway due to the exocytosis of hemostatic factors, such as ultra-large von Willebrand factor (ULVWF) multimers and FVIII. The former promotes inflammation, including inflammatory organ syndrome (e.g., myocarditis and encephalitis) and multisystem inflammatory syndrome (e.g., cytokine storm), and the latter provokes endotheliopathy-associated vascular microthrombotic disease (VMTD), orchestrating thrombotic thrombocytopenic purpura (TTP)-like syndrome in arterial endotheliopathy, and immune thrombocytopenic purpura (ITP)-like syndrome in venous endotheliopathy, as well as multiorgan dysfunction syndrome (MODS). Because the endothelium is widely distributed in the entire vascular system, the phenotype manifestations of endotheliopathy are variable depending on the extent and location of the endothelial injury, the cause of the underlying pathology, as well as the genetic factor of the individual. To date, because the terms of many human diseases have been defined based on pathological changes in the organ and/or physiological dysfunction, endotheliopathy has not been denoted as a disease entity. In addition to inflammation, endotheliopathy is characterized by the increased activity of FVIII, overexpressed ULVWF/VWF antigen, and insufficient ADAMTS13 activity, which activates the ULVWF path of hemostasis, leading to consumptive thrombocytopenia and microthrombosis. Endothelial molecular pathogenesis produces the complex syndromes of inflammation, VMTD, and autoimmunity, provoking various endotheliopathic syndromes. The novel conceptual discovery of in vivo hemostasis has opened the door to the understanding of the pathogeneses of many endotheliopathy-associated human diseases. Reviewed are the hemostatic mechanisms, pathogenesis, and diagnostic criteria of endotheliopathy, and identified are some of the endotheliopathic syndromes that are encountered in clinical medicine. Full article
(This article belongs to the Special Issue Endotheliopathy: Its Pathogenesis and Dysfunction Syndromes)
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12 pages, 7457 KiB  
Article
Therapeutic Efficacy of Weissella cibaria CMU and CMS1 on Allergic Inflammation Exacerbated by Diesel Exhaust Particulate Matter in a Murine Asthma Model
by Kyung-Hyo Do, Kwangwon Seo, Sanggu Kim, Soochong Kim, Geun-Yeong Park, Mi-Sun Kang and Wan-Kyu Lee
Medicina 2022, 58(9), 1310; https://doi.org/10.3390/medicina58091310 - 19 Sep 2022
Cited by 2 | Viewed by 1794
Abstract
Background and Objectives: Diesel exhaust particulate matter (DEPM) is an air pollutant that is associated with asthma. In this study, the therapeutic efficacy of Weissella cibaria strains CMU (Chonnam Medical University) and CMS (Chonnam Medical School) 1, together with the drug Synatura, [...] Read more.
Background and Objectives: Diesel exhaust particulate matter (DEPM) is an air pollutant that is associated with asthma. In this study, the therapeutic efficacy of Weissella cibaria strains CMU (Chonnam Medical University) and CMS (Chonnam Medical School) 1, together with the drug Synatura, an anti-tussive expectorant, was investigated in a murine asthma model exacerbated by DEPM. Materials and Methods: BALB/c mice were sensitized with ovalbumin (OVA) before intranasal challenge with OVA and DEPM. W. cibaria CMU, CMS1, and Synatura were administered orally for 21 days. Results: Neither Synatura nor W. cibaria strains affected spleen, liver, or lung weights. W. cibaria strains CMU and CMS1 significantly reduced the levels of interleukin (IL)-4, OVA-specific immunoglobulin E (IgE), and total lung collagen in bronchoalveolar lavage fluid (BALF), similar to those with Synatura, regardless of the oral dose concentration (p < 0.05). In addition, the W. cibaria CMU strain significantly alleviated IL-1β, IL-6, IL-12, monocyte chemotactic protein-1, and tumor necrosis factor-α in BALF, whereas the CMS1 strain significantly alleviated IL-10 and IL-12 in BALF (p < 0.05); however, Synatura did not show any statistical efficacy against them (p > 0.05). All concentrations of W. cibaria CMU and low concentrations of W. cibaria CMS1 significantly reduced lung bronchiolar changes and inflammatory cell infiltration. Conclusions: In conclusion, W. cibaria CMU in asthmatic mice showed better efficacy than W. cibaria CMS1 in improving asthma exacerbated by DEPM exposure, as well as better results than pharmaceuticals. Full article
(This article belongs to the Section Pulmonary)
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16 pages, 868 KiB  
Review
Midwives in Health Sciences as a Sociocultural Phenomenon: Legislation, Training and Health (XV–XVIII Centuries)
by Blanca Espina-Jerez, Laura Romera-Álvarez, Maylene Cotto-Andino, Mercedes de Dios Aguado, José Siles-Gonzalez and Sagrario Gómez-Cantarino
Medicina 2022, 58(9), 1309; https://doi.org/10.3390/medicina58091309 - 19 Sep 2022
Cited by 2 | Viewed by 1684
Abstract
Background and Objectives: The first inquisitorial processes were developed against Muslims and Jews. Then, they focused on women, especially those dedicated to care. Progressively, they were linked to witchcraft and sorcery due to their great assistance, generational and empirical knowledge. The health historiography [...] Read more.
Background and Objectives: The first inquisitorial processes were developed against Muslims and Jews. Then, they focused on women, especially those dedicated to care. Progressively, they were linked to witchcraft and sorcery due to their great assistance, generational and empirical knowledge. The health historiography of the 15th–18th centuries still has important bibliographic and interpretive gaps in the care provided by women. The main objective was to analyse the care provided by midwives in the legislative and socio-sanitary context of New Castile, in the inquisitorial Spain of the 15th–18th centuries. Materials and Methods: A historical review was conducted, following the Dialectical Structural Model of Care. Historical manuals, articles and databases were analysed. Results: The Catholic Monarchs established health profession regulations in 1477, including midwives. However, all legislations were annulled by Felipe II in 1576. These were not resumed until 1750. Midwives assumed a huge range of functions in their care commitment (teaching, care and religion) and were valued in opposing ways. However, many of them were persecuted and condemned by the Inquisition. They used to accompany therapeutic action with prayers and charms. Midwives were usually women in a social vulnerability situation, who did not comply with social stereotypes. Conclusions: Midwives, forerunners of current nursing and health sciences, overcame sociocultural difficulties, although they were condemned for it. Midwives achieved an accredited title, which was taken from them for two centuries. They acted as health agents in a society that demanded them while participating in a “witch hunt”. Full article
(This article belongs to the Special Issue Work Culture in Medicine: Ethical, Legal and Social Challenges)
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12 pages, 2791 KiB  
Article
Synergistic Sequential Emission of Fractional 10.600 and 1540 nm Lasers for Skin Resurfacing: An Ex Vivo Histological Evaluation
by Steven Paul Nisticò, Luigi Bennardo, Tiziano Zingoni, Laura Pieri, Irene Fusco, Francesca Rossi, Giada Magni and Giovanni Cannarozzo
Medicina 2022, 58(9), 1308; https://doi.org/10.3390/medicina58091308 - 19 Sep 2022
Cited by 11 | Viewed by 2025
Abstract
Background: Fractional ablative and non-ablative lasers are useful treatments for skin rejuvenation. A procedure that provides the sequential application of fractional ablative followed by non-ablative laser treatment may reduce patients’ downtime and deliver better cosmetic results than with either laser alone. Objective: The [...] Read more.
Background: Fractional ablative and non-ablative lasers are useful treatments for skin rejuvenation. A procedure that provides the sequential application of fractional ablative followed by non-ablative laser treatment may reduce patients’ downtime and deliver better cosmetic results than with either laser alone. Objective: The purpose of the current study was to demonstrate the ameliorative and therapeutic effects in skin remodeling of the synergistic use of the two laser wavelengths (fractional ablative CO2 and non-ablative 1540 nm) with three different types of pulse shapes, S-Pulse (SP), D-Pulse (DP) and H-Pulse (HP), through which the CO2 laser can emit, performing an ex vivo histological evaluation. Methods: In this prospective study, ex vivo sheep inner thigh skin was chosen due to its similarity to human skin tissue, and a histological evaluation was performed. Three irradiation conditions, using all of the three CO2 pulse shapes (alone or averaged), were investigated: (1) 10.600 nm alone, the sequential irradiation of the two wavelengths in the same perfectly controlled energy pulses (DOT) for the entire scan area; ((2) 10.600 nm followed immediately by 1540 nm; and (3) 1540 nm followed immediately by 10.600 nm). Results: When comparing ablative to sequential irradiations, the synergy of the two wavelengths did not alter the typical ablative pulse shape of the 10.600 nm laser alone. With the same CO2 pulse shape, the lesion depth did not vary with the synergy of the two wavelengths, while thermal lesion width increased compared to CO2 alone. The ablation rate was achieved, while the total thermal lesion coverage in the scanning area of CO2 − 1540 lasers was greater than when using CO2 alone and then the other sequential irradiation. Conclusions: This study provides important preclinical data for new and early uses of the novel 10.600/1540 nm dual-wavelength non-ablative fractional laser. The synergy of the two wavelengths enhanced all the benefits already available when using CO2 laser systems both in terms of tone strengthening, thanks to a greater shrinking effect, and in terms of stimulation and collagen remodeling thanks to a greater volumetric thermal effect. Full article
(This article belongs to the Special Issue Lasers, Lights and New Technologies in Medicine and Surgery)
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10 pages, 2994 KiB  
Article
Imaging Characterization of Non-Rheumatoid Retro-Odontoid Pseudotumors: Comparison with Atlantoaxial Manifestation of Rheumatoid Arthritis
by You-Seon Song, In-Sook Lee, Kyoung-Hyup Nam, Dong-Hwan Kim, In-Ho Han, Hwangbo Lee, Yeon-Joo Jeong and Jeong-A Yeom
Medicina 2022, 58(9), 1307; https://doi.org/10.3390/medicina58091307 - 19 Sep 2022
Cited by 2 | Viewed by 4829
Abstract
Backgroundand Objectives: To date, imaging characterization of non-rheumatic retro-odontoid pseudotumors (NRROPs) has been lacking; therefore, NRROPs have been confused with atlantoaxial joint involvement of rheumatoid arthritis (RA). It is important to differentiate these two disease because the treatment strategies may differ. [...] Read more.
Backgroundand Objectives: To date, imaging characterization of non-rheumatic retro-odontoid pseudotumors (NRROPs) has been lacking; therefore, NRROPs have been confused with atlantoaxial joint involvement of rheumatoid arthritis (RA). It is important to differentiate these two disease because the treatment strategies may differ. The purpose of this study is to characterize imaging findings of NRROPs and compare them with those of RA. Material and Methods: From January 2015 to December 2019, 27 patients (14 women and 13 men) with NRROPs and 19 patients (15 women and 4 men) with RA were enrolled in this study. We evaluated various imaging findings, including atlantoaxial instability (AAI), and measured the maximum diameter of preodontoid and retro-odontoid spaces with magnetic resonance imaging (MRI) and computed tomography (CT). Results: Statistical significance was considered for p < 0.05. AAI was detected in eight patients with NRROPs and in all patients with RA (p < 0.0001). Seventeen patients with NRROPs and six patients with RA showed spinal cord compression (p = 0.047). Compressive myelopathy was observed in 14 patients with NRROPs and in 4 patients with RA (p = 0.048). Subaxial degeneration was observed in 25 patients with NRROPs and in 9 patients with RA (p = 0.001). Moreover, C2-3 disc abnormalities were observed in 11 patients with NRROPs and in 2 patients with RA (p = 0.02). Axial and longitudinal diameter of retro-odontoid soft tissue and preodontoid and retro-odontoid spaces showed significant differences between NRROP and RA patients (p < 0.0001). Furthermore, CT AAI measurements were differed significantly between NRROP and RA patients (p < 0.05). Conclusions: NRROPs showed prominent retro-odontoid soft tissue thickening, causing compressive myelopathy and a high frequency of subaxial and C2-3 degeneration without AAI. Full article
(This article belongs to the Section Hematology and Immunology)
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2 pages, 243 KiB  
Comment
Comment on Ivanov et al. Ultra-Hypofractionated vs. Moderate Fractionated Whole Breast Three Dimensional Conformal Radiotherapy during the COVID-19 Pandemic. Medicina 2022, 58, 745
by Gianluca Ferini
Medicina 2022, 58(9), 1306; https://doi.org/10.3390/medicina58091306 - 19 Sep 2022
Cited by 1 | Viewed by 1178
Abstract
I read the paper by Ivanov et al. [...] Full article
(This article belongs to the Topic Cancer Biology and Radiation Therapy)
11 pages, 6465 KiB  
Article
Comparison of Anatomic and Non-Anatomic Liver Resection for Hepatocellular Carcinoma: A Retrospective Cohort Study
by Elvan Onur Kirimker, Alp Togan Kirac, Suleyman Utku Celik, Can Yahya Boztug, Muharrem Berat Kaya, Deniz Balci and Mehmet Kaan Karayalcin
Medicina 2022, 58(9), 1305; https://doi.org/10.3390/medicina58091305 - 19 Sep 2022
Cited by 2 | Viewed by 1870
Abstract
Background and Objectives: The survival benefit of anatomical liver resection for hepatocellular carcinoma has not been elucidated yet. In this study, we aimed to investigate the effects of anatomic and non-anatomic liver resection on surgical outcomes in patients with hepatocellular carcinoma. Materials [...] Read more.
Background and Objectives: The survival benefit of anatomical liver resection for hepatocellular carcinoma has not been elucidated yet. In this study, we aimed to investigate the effects of anatomic and non-anatomic liver resection on surgical outcomes in patients with hepatocellular carcinoma. Materials and Methods: A retrospective analysis of patients undergoing anatomic or non-anatomic resections due to hepatocellular carcinoma between March 2006 and October 2019 was conducted. Demographics, preoperative laboratory assessments, treatment strategies, and postoperative outcomes were analyzed. Results: The total cohort consisted of 94 patients, with a mean age of 63.1 ± 8.9 years, and 74.5% were male. A total of 41 patients underwent anatomic liver resection, and 53 patients underwent non-anatomic resection. The overall survival rates were found to be similar (5-year overall survival was 49.3% for anatomic resection and 44.5% for non-anatomic resection). Estimated median overall survival times were 58.5 months and 57.3 months, respectively (p = 0.777). Recurrence-free 1-, 3-, and 5-year survival rates were found to be 73.6%, 39.1%, and 32.8% in the non-anatomic resection group and 48.8%, 22.7%, and 22.7% in the anatomic resection group, respectively. Grade three or higher complication rates were found to be similar among the groups. Conclusions: This study did not find a difference between two surgical methods, in terms of survival. A tailored selection of the resection method should be made, with the aim of complete removal of tumoral lesions and leaving a suitable functional liver reserve, according to the parenchymal quality and volume of the liver remnant. Full article
(This article belongs to the Section Surgery)
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7 pages, 453 KiB  
Article
Clinical Outcomes of Stereotactic Ablative Radiotherapy for All Stages of Non-Small Cell Lung Cancer; Definitive versus Consolidative
by Hakyoung Kim, Sun Myung Kim, Dae Sik Yang, Kyung Hwa Lee and Young Bum Kim
Medicina 2022, 58(9), 1304; https://doi.org/10.3390/medicina58091304 - 18 Sep 2022
Viewed by 1607
Abstract
Background and Objectives: Stereotactic ablative radiotherapy (SABR) is not confined to early stage non-small cell lung cancer (NSCLC) and has a potential role in stage IV disease. We aimed to evaluate the effect of SABR on local control rates and survival outcomes in [...] Read more.
Background and Objectives: Stereotactic ablative radiotherapy (SABR) is not confined to early stage non-small cell lung cancer (NSCLC) and has a potential role in stage IV disease. We aimed to evaluate the effect of SABR on local control rates and survival outcomes in patients with all stages of NSCLC according to the treatment aim. Materials and Methods: We retrospectively reviewed the medical records of 88 patients with NSCLC who received SABR at the Korea University Guro Hospital between January 2015 and March 2021. Among these, 64 patients with stage I–II NSCLC ineligible for surgery were treated with a definitive aim. Twenty-four patients with stage IV limited metastatic NSCLC showing a favorable response to prior systemic therapy were treated with a consolidative aim. Results: The median follow-up time was 34 (range: 5–88) months. Thirty-one patients developed recurrence (35.2%), with distant metastasis being the most common (25/31, 80.6%). In-field local recurrence occurred in four patients (4/88 patients, 4.5%). For patients treated with definitive SABR, the 3-year overall survival (OS) and disease-free survival (DFS) rates were 91.8% and 58.6%, respectively. In patients treated with consolidative SABR, the 3-year OS and DFS rates were 86.7% and 53.8%, respectively. With respect to treatment-related pulmonary toxicity, grade 3 radiation pneumonitis incidence requiring hospitalization was 2.3% (2/88). Conclusions: Definitive SABR is appropriate for medically inoperable or high surgical risk patients with early stage NSCLC with acceptable treatment-related toxicities. Consolidative SABR improves local control rates and helps achieve long-term survival in patients with limited metastatic NSCLC. Full article
(This article belongs to the Special Issue Emerging Therapies for Non-small Cell Lung Cancer Ⅱ)
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14 pages, 7502 KiB  
Article
Influence of the Text Neck Posture on the Static Dental Occlusion
by Eniko Tunde Stoica, Corina Marcauteanu, Anca Tudor, Virgil-Florin Duma, Elena Constanta Amaricai, Roxana Onofrei, Oana Suciu, Meda Lavinia Negrutiu and Cosmin Sinescu
Medicina 2022, 58(9), 1303; https://doi.org/10.3390/medicina58091303 - 18 Sep 2022
Cited by 3 | Viewed by 2598
Abstract
Background and Objectives: The excessive use of smartphones for various tasks led to a new adverse postural phenomenon called text neck. The aim of this study was to investigate the effect of the text neck posture (TNP) on static occlusion by using the [...] Read more.
Background and Objectives: The excessive use of smartphones for various tasks led to a new adverse postural phenomenon called text neck. The aim of this study was to investigate the effect of the text neck posture (TNP) on static occlusion by using the T-Scan III occlusal diagnostic system. Materials and Methods: Nineteen subjects (aged 20 to 24 years) were considered for this research. They had normal values for anterior overbite and overjet, Angle Class I occlusion, no posterior crossbite, and no signs or symptoms of cervical or temporo-mandibular disorders. Occlusal registrations were performed with the T-Scan III system in a normal, neutral head posture (NHP), as well as in the TNP. The investigated parameters were: occlusion time (OT), asymmetry index of the occlusal force (AOF), percent of the maximum movie force (%MMF), and the time elapsed from the last occlusal contact until the maximum intercuspation (MAT-OTB). The last three parameters were analyzed in the maximum area frame (MA) of the registrations. For the statistical analysis of the recorded data, the Wilcoxon Signed Ranks test and the Spearman’s correlation coefficient were used. Results: The following values were obtained in NHP and in TNP: for AOF, 14.88 ± 10.39% and 18.04 ± 12.83%, respectively; for OT, 1.34 ± 1.84 s and 1.32 ± 1.8 s, respectively; for the %MMF, 97.5 ± 2.83% and 96.31 ± 3.17%, respectively; for MAT-OTB, 2.08 ± 1.82 s and 1.45 ± 2.3 s, respectively. There were no statistically significant differences between the static occlusal parameters measured in NHP and those in TNP. However, the high values of the AOF and OT in NHP revealed an imbalance of the occlusal force distribution between the right and left side in maximum intercuspation (MI), as well as a lack of simultaneity of static occlusal contacts. Furthermore, there was a significant, direct, and strong correlation between OT and AOF in NHP. Conclusions: The NHP should not be used as the starting position in TNP simulations in T-Scan studies, so as to avoid statistically insignificant differences between static occlusion in NHP and TNP. The healthy standing subjects, with normal occlusal relationships from the clinical point of view, revealed an occlusal instability in NHP when examined with the T-Scan. Full article
(This article belongs to the Collection New Concepts for Dental Treatments and Evaluations)
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12 pages, 847 KiB  
Article
Healing of Unilateral Maxillary Sinusitis by Endodontic and Periodontal Treatment of Maxillary Teeth
by Klaudia Migas, Remigiusz Kozłowski, Aleksandra Sierocka and Michał Marczak
Medicina 2022, 58(9), 1302; https://doi.org/10.3390/medicina58091302 - 18 Sep 2022
Cited by 3 | Viewed by 2623
Abstract
Inflammatory conditions of dental origin may spread to the bone tissue, causing its destruction, and to anatomical structures located in the vicinity of the tooth affected with inflammation. Maxillary premolars and molars may develop inflammatory lesions of the Schneiderian membrane and lead to [...] Read more.
Inflammatory conditions of dental origin may spread to the bone tissue, causing its destruction, and to anatomical structures located in the vicinity of the tooth affected with inflammation. Maxillary premolars and molars may develop inflammatory lesions of the Schneiderian membrane and lead to tooth-borne lesions in the maxillary sinuses. Unilateral inflammation of the maxillary sinuses should be diagnosed and treated. The aim of this study was to determine whether and after what time from the applied endodontic or nonsurgical periodontal treatment the inflammation in the maxillary sinus was diminished (assessed by the decrease in the Schneiderian membrane hypertrophy). A retrospective study was performed to analyze the records of endodontically, periodontally, or endodontically-periodontally treated patients with unilateral inflammation of the maxillary sinuses along with diagnostic Cone Beam Computed Tomography. The method for determination of the inflammation was measurements registered in millimeters in Carestream software. The analysis included the situation before treatment and 3 months, 6 months, and 12 months after completion of the treatment. Regardless of the origin of the maxillary sinus lesion, healing of inflammation of the sinus has been reported after the implementation of causative treatment of the maxillary tooth. Dental treatment reduces the need to implement conservative or surgical ENT treatment. Full article
(This article belongs to the Section Dentistry)
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11 pages, 1434 KiB  
Article
Synergistic Beneficial Effects of Resveratrol and Diet on High-Fat Diet-Induced Obesity
by Osama Abo Alrob, Ramzi A. Al-Horani, Zaid Altaany and Mohammad B. Nusair
Medicina 2022, 58(9), 1301; https://doi.org/10.3390/medicina58091301 - 18 Sep 2022
Cited by 6 | Viewed by 1945
Abstract
Introduction: Despite decades of research, obesity and its related medical complications remain a major health concern globally. Therefore, novel therapeutic strategies are needed to combat obesity and its numerous debilitating complications. Resveratrol (RES) has a potential therapeutic effect in obesity and diabetes [...] Read more.
Introduction: Despite decades of research, obesity and its related medical complications remain a major health concern globally. Therefore, novel therapeutic strategies are needed to combat obesity and its numerous debilitating complications. Resveratrol (RES) has a potential therapeutic effect in obesity and diabetes by improving oxidative metabolism and insulin signaling. Background and Objectives: The aim of this study was to investigate the effect of RES treatment on weight loss and glucose and fatty acid metabolism. Methods: Obesity was induced in 24 mice by exposure to a high-fat diet (HFD) for 8 weeks. Mice were randomly assigned to one group of either: group 1: control, non-treated low-fat diet (LFD) for 12 weeks (n = 8), group 2: non-treated high-fat diet (HFD) for 12 weeks (n = 8), group 3: RES-treated HFD (HFD + RES) (n = 8), or group 4: RES-treated and switched to LFD (HFD-LFD + RES) (n = 8). HFD + RES mice were first fed an HFD for 8 weeks followed by 4 weeks of RES. The HFD-LFD + RES group was first fed an HFD for 8 weeks and then treated with RES and switched to an LFD for 4 weeks. Results: After 12 weeks, group 2 mice had significantly higher body weights compared to group 1 (23.71 ± 1.95 vs. 47.83 ± 2.27; p < 0.05). Group 4 had a significant decrease in body weight and improvement in glucose tolerance compared to mice in group 2 (71.3 ± 1.17 vs. 46.1 ± 1.82 and 40.9 ± 1.75, respectively; p < 0.05). Skeletal muscles expression of SIRT1, SIRT3, and PGC1α were induced in group 3 and 4 mice compared to group 2 (p < 0.01), with no changes in AMP-activated protein kinase expression levels. Furthermore, combination of RES and diet ameliorated skeletal muscle intermediate lipid accumulation and significantly improved insulin sensitivity and secretion. Conclusions: The results of this study suggest a synergistic beneficial effect of LFD and RES to lower body weight and enhance glucose and fatty acid metabolism. Full article
(This article belongs to the Section Pharmacology)
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15 pages, 7338 KiB  
Case Report
Large Grafting Void Resembling a Surgical Ciliated Cyst following Maxillary Sinus Augmentation. Four Case Reports with Histological Observation
by Won-Bae Park, Meghan Pandya, Ji-Young Han and Philip Kang
Medicina 2022, 58(9), 1300; https://doi.org/10.3390/medicina58091300 - 18 Sep 2022
Viewed by 1732
Abstract
The cause and pathogenicity of grafting voids following lateral maxillary sinus augmentation (MSA) have not yet been elucidated. The first purpose of this case series is to introduce an unusually large grafting void that radiologically resembles a surgical ciliated cyst (SCC) at the [...] Read more.
The cause and pathogenicity of grafting voids following lateral maxillary sinus augmentation (MSA) have not yet been elucidated. The first purpose of this case series is to introduce an unusually large grafting void that radiologically resembles a surgical ciliated cyst (SCC) at the sinus augmented site; the second is to observe the histological findings of these grafting voids. In four patients, MSA was performed using the lateral window technique. An unusually large grafting void appeared on cone-beam-computed tomography (CBCT) taken one week after surgery and except for one patient, there were no clinical symptoms. On CBCT taken six months after surgery, the grafting voids were slightly smaller in size but showed radiographic findings similar to those of SCC. During uncovering, grafting voids were removed through the lateral window site. Histologically, the grafting void was empty or filled with dense connective tissue, and no ciliated columnar epithelium or inflammatory cells were observed. Within the limitations of this case series, the large grafting voids generated after MSA was not converted to SCCs. Rather, they remained scar tissue, which could infringe the sinus bone graft and affect the apical bone support of the implant. Full article
(This article belongs to the Special Issue Recent Advances in Periodontics and Dental Implantology)
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11 pages, 580 KiB  
Article
Long-Term Outcomes of Laparoscopic Greater Curvature Plication and Laparoscopic Sleeve Gastrectomy: Critical Appraisal of the Role of Gastric Plication in Bariatric Surgery
by Lien-Cheng Tsao, Joseph Lin, Bing-Yen Wang, Yu-Jun Chang, Cheng-Yen Huang, Shu-Fen Yu, Wan-Yu Hung, Chi-Chien Lin and Chien-Pin Chan
Medicina 2022, 58(9), 1299; https://doi.org/10.3390/medicina58091299 - 17 Sep 2022
Cited by 2 | Viewed by 1669
Abstract
Background and Objectives: This single-center study aimed to assess the role of laparoscopic greater curvature plication (LGCP) in bariatric surgery. Materials and Methods: Using data from our institution’s prospectively maintained database, we identified adult patients with obesity who underwent either laparoscopic [...] Read more.
Background and Objectives: This single-center study aimed to assess the role of laparoscopic greater curvature plication (LGCP) in bariatric surgery. Materials and Methods: Using data from our institution’s prospectively maintained database, we identified adult patients with obesity who underwent either laparoscopic sleeve gastrectomy (LSG) or LGCP between January 2012 and July 2017. In total, 280 patients were enrolled in this study. Results: The body mass index was higher in the LSG group than in the LGCP group (39.3 vs. 33.3, p < 0.001). Both groups achieved significant weight loss during the 3-year follow-up (p < 0.001). The weight-reduction rate was higher in the LSG group than in the LGCP group 6, 12, and 24 months postoperatively (p = 0.001, 0.001, and 0.012, respectively). The reoperation rate of the LGCP group was higher than that of the LSG group (p = 0.001). No deaths were recorded in either group. Conclusions: Although both the LGCP and LSG groups achieved significant weight loss over three years, the LGCP group demonstrated a lower weight-reduction rate and a higher reoperation rate than the LSG group. Thus, it is necessary to reassess the role of LGCP in bariatric surgery, particularly when LSG is a feasible alternative. Full article
(This article belongs to the Section Surgery)
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19 pages, 742 KiB  
Review
Management of Advanced Pancreatic Cancer through Stromal Depletion and Immune Modulation
by Tiantong Liu, Sihang Cheng, Qiang Xu and Zhiwei Wang
Medicina 2022, 58(9), 1298; https://doi.org/10.3390/medicina58091298 - 17 Sep 2022
Viewed by 2465
Abstract
Pancreatic cancer is one of the leading causes of cancer-related deaths worldwide. Unfortunately, therapeutic gains in the treatment of other cancers have not successfully translated to pancreatic cancer treatments. Management of pancreatic cancer is difficult due to the lack of effective therapies and [...] Read more.
Pancreatic cancer is one of the leading causes of cancer-related deaths worldwide. Unfortunately, therapeutic gains in the treatment of other cancers have not successfully translated to pancreatic cancer treatments. Management of pancreatic cancer is difficult due to the lack of effective therapies and the rapid development of drug resistance. The cytotoxic agent gemcitabine has historically been the first-line treatment, but combinations of other immunomodulating and stroma-depleting drugs are currently undergoing clinical testing. Moreover, the treatment of pancreatic cancer is complicated by its heterogeneity: analysis of genomic alterations and expression patterns has led to the definition of multiple subtypes, but their usefulness in the clinical setting is limited by inter-tumoral and inter-personal variability. In addition, various cell types in the tumor microenvironment exert immunosuppressive effects that worsen prognosis. In this review, we discuss current perceptions of molecular features and the tumor microenvironment in pancreatic cancer, and we summarize emerging drug options that can complement traditional chemotherapies. Full article
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11 pages, 2477 KiB  
Article
Evaluation of Pharmacy Inquiries in Physician Order Reviews for Medication Safety: A Cross-Sectional Study
by Jungwon Cho, Koenhee Kim, Young Mi Jeong and Euni Lee
Medicina 2022, 58(9), 1297; https://doi.org/10.3390/medicina58091297 - 16 Sep 2022
Cited by 1 | Viewed by 1360
Abstract
Background and Objectives: Despite the effort to prevent drug-related problems (DRPs) in healthcare settings, prescribing errors are common in the medication use process. In a Korean teaching hospital, pharmacists verify prescription orders during their routine order review process and document the details in [...] Read more.
Background and Objectives: Despite the effort to prevent drug-related problems (DRPs) in healthcare settings, prescribing errors are common in the medication use process. In a Korean teaching hospital, pharmacists verify prescription orders during their routine order review process and document the details in a homegrown health information system (HIS). The objectives of this study were to identify the annual trends in pharmacy inquiries and to evaluate the prevalence of the inquiries by drug ingredients, including a description of the “pharmacy inquiry” screen in the HIS. Materials and Methods: A retrospective cross-sectional study was conducted to describe pharmacy inquiries related to preventing potential DRPs during order reviews and to evaluate the associated factors for discontinuation of prescription orders on medication among inquiries using data from January 2008 to December 2021. A descriptive analysis was performed using 128,188 inquiries, documented by 245 pharmacists for 14 years. Results: The frequency of inquiry steadily increased annually. The most frequent cause was “inappropriate dose or regimen” (49.1%) and “piperacillin and beta-lactamase inhibitor” was the most mentioned drug ingredient in the inquiries (3.4%). The overall acceptance rate of the pharmacists’ recommendation was 82.4%, and the cause of the highest acceptance was “inappropriate mix solution” (96.5%). Hospitalization and certain inquiry topics were significantly associated with discontinuation of prescription orders on inquired medications by clinicians. Conclusions: The findings indicate that pharmacy inquiries with integrated HIS could resolve inaccuracy during physicians’ order reviews and ensure safe patient care. As a tool for preventing prescribing errors, the pharmacy inquiry data can help maximize consistent improvement and optimize the medication use process in healthcare settings. Full article
(This article belongs to the Section Pharmacology)
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11 pages, 662 KiB  
Article
Comparing Preoperative Anxiety Effects of Brachial Plexus Block and General Anesthesia for Orthopedic Upper-Extremity Surgery: A Randomized, Controlled Trial
by Gokhan Sertcakacilar, Gunes Ozlem Yildiz, Berhan Bayram, Yaser Pektas, Zafer Cukurova and Gulsum Oya Hergunsel
Medicina 2022, 58(9), 1296; https://doi.org/10.3390/medicina58091296 - 16 Sep 2022
Cited by 2 | Viewed by 1530
Abstract
Background and objectives: Preoperative anxiety is an enormous feeling of fear that is seen in all patients undergoing surgery. The severity of anxiety may vary depending on the type of surgery and anesthesia to be performed. The aim of this study is to [...] Read more.
Background and objectives: Preoperative anxiety is an enormous feeling of fear that is seen in all patients undergoing surgery. The severity of anxiety may vary depending on the type of surgery and anesthesia to be performed. The aim of this study is to compare the effects of brachial plexus blocks and general anesthesia methods on preoperative anxiety levels in patients who will undergo orthopedic upper-extremity surgery and to determine the factors affecting anxiety. Materials and Methods: After randomization, the Amsterdam Preoperative Anxiety and Knowledge Scale (APAIS) questionnaire was applied to the patients to determine the preoperative anxiety level, and then anesthesia was applied according to the anesthesia type determined. Pain scores (1, 8, 16, and 24 h) and total opioid consumption of the patients were recorded postoperatively. Results: The APAIS score of the patients in the general anesthesia (GA) group was significantly higher (p = 0.021). VAS score medians at 1, 4, and 8 h postoperatively were found to be significantly higher in the GA group (p < 0.001, p < 0.001 and p = 0.044, respectively). Conclusions: USG-guided BPB may cause less anxiety than GA in patients who will undergo elective upper-extremity surgery. However, these patients have moderate anxiety, although it is more associated with advanced age, female gender, and education level. Full article
(This article belongs to the Section Intensive Care/ Anesthesiology)
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10 pages, 317 KiB  
Article
Incidence and Risk Factors for Glucose Disturbances in Premature Infants
by Ivona Butorac Ahel, Kristina Lah Tomulić, Inge Vlašić Cicvarić, Marta Žuvić, Kristina Baraba Dekanić, Silvije Šegulja and Iva Bilić Čače
Medicina 2022, 58(9), 1295; https://doi.org/10.3390/medicina58091295 - 16 Sep 2022
Cited by 4 | Viewed by 1638
Abstract
Background and Objectives: There are limited data regarding the incidence and risk factors for hypoglycemia, hyperglycemia, and unstable glycemia in preterm infants. The aim of the present study was to determine the incidence and risk factors associated with neonatal hypoglycemia, hyperglycemia, and unstable [...] Read more.
Background and Objectives: There are limited data regarding the incidence and risk factors for hypoglycemia, hyperglycemia, and unstable glycemia in preterm infants. The aim of the present study was to determine the incidence and risk factors associated with neonatal hypoglycemia, hyperglycemia, and unstable glycemia in preterm infants during the first seven days of life. Materials and Methods: This prospective study included preterm infants <37 weeks of gestation, admitted to the Neonatal Intensive Care Unit between January 2018 and December 2020. Based on blood glucose levels in the first week of life, infants were divided into the following four groups: normoglycemic, hypoglycemic, hyperglycemic, and unstable. Blood glucose levels were measured from capillary blood at the 1st, 3rd, 6th, and 12th hour of life during the first 24 h, and at least once a day from days 2 to 7, prefeed. Results: Of 445 enrolled infants, 20.7% (92/445) were categorized as hypoglycemic, 9.9% (44/445) as hyperglycemic, and 2.9% (13/445) as unstable, respectively. Hypoglycemia was most commonly observed among infants ≥34 weeks (27.9%), and hyperglycemia was most common among preterm infants <28 weeks (50%). Female gender increased the chances of developing hypoglycemia by three times. The decrease in gestational age by one week increased the chance of developing hyperglycemia by 1.9 times. Sepsis increased the chance of developing hyperglycemia seven times, respiratory distress syndrome five times, and mechanical ventilation three times, respectively. Conclusions: Glucose disturbances in the early neonatal period in preterm infants are common and mostly asymptomatic. Therefore, careful blood glucose level monitoring is required in those infants, especially in late preterm infants, in order to prevent possible neurological complications. Full article
(This article belongs to the Section Pediatrics)
10 pages, 568 KiB  
Article
Influence of DNA-Polymorphisms in Selected Circadian Clock Genes on Clock Gene Expression in Subjects from the General Population and Their Association with Sleep Duration
by Rocío Barragán, José V. Sorlí, Oscar Coltell, Inmaculada Gonzalez-Monje, Rebeca Fernández-Carrión, Laura V. Villamil, Olga Portolés, Dolores Corella, Carolina Ortega-Azorín and Eva M. Asensio
Medicina 2022, 58(9), 1294; https://doi.org/10.3390/medicina58091294 - 16 Sep 2022
Cited by 1 | Viewed by 1670
Abstract
Background and Objectives: Circadian rhythms have an important implication in numerous physiological and metabolic processes, including the sleep/wake cycle. Inter-individual differences in factors associated with circadian system may be due to gene differences in gene expression. Although several studies have analyzed the [...] Read more.
Background and Objectives: Circadian rhythms have an important implication in numerous physiological and metabolic processes, including the sleep/wake cycle. Inter-individual differences in factors associated with circadian system may be due to gene differences in gene expression. Although several studies have analyzed the association between DNA polymorphisms and circadian variables, the influence on gene expression has been poorly analyzed. Our goal was to analyze the association of genetic variations in the clock genes and the gene expression level. Materials and Methods: We carried out a cross-sectional study of 102 adults (50.9% women). RNA and DNA were isolated from blood and single-nucleotide polymorphisms (SNPs), and the main circadian clock genes were determined. Gene expression of CLOCK, PER1, and VRK2 genes was measured by Reverse-transcription polymerase chain reaction (RT-PCR). The association between the DNA-SNPs and gene expression was analyzed at the gene level. In addition, a polygenic risk score (PRS), including all the significant SNPs related to gene expression, was created for each gene. Multivariable model analysis was performed. Results: Sex-specific differences were detected in PER1 expression, with these being higher in women (p = 0.034). No significant differences were detected in clock genes expression and lifestyle variables. We observed a significant association between the ARNTL-rs7924734, ARNTL-rs10832027, VRK2- rs2678902 SNPs, and CLOCK gene expression; the PER3-rs228642 and PER3-rs10127838 were related to PER1 expression, and the ARNTL-rs10832027, ARNTL-rs11022778, and MNTR1B-rs10830963 were associated with VRK2 gene expression (p < 0.05). The specific PRS created was significantly associated with each of the gene expressions analyzed (p < 0.001). Finally, sleep duration was associated with PER3-rs238666 (p = 0.008) and CLOCK-rs4580704 (p = 0.023). Conclusion: We detected significant associations between DNA-SNPs in the clock genes and their gene expression level in leukocytes and observed some differences in gene expression per sex. Moreover, we reported for the first time an association between clock gene polymorphisms and CLOCK, PER1, and VRK2 gene expression. These findings need further investigation. Full article
(This article belongs to the Special Issue Diabetes, Lifestyle and Genetics)
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12 pages, 1595 KiB  
Article
Algorithm of Femoropopliteal Endovascular Treatment
by Maxime Dubosq, Maxime Raux, Bahaa Nasr and Yann Gouëffic
Medicina 2022, 58(9), 1293; https://doi.org/10.3390/medicina58091293 - 16 Sep 2022
Viewed by 2065
Abstract
Background and Objectives: Indications for the endovascular treatment of femoropopliteal lesions have steadily increased over the past decade. Accordingly, the number of devices has also increased, but the choice of the best endovascular treatment remains to be defined. Many devices are now [...] Read more.
Background and Objectives: Indications for the endovascular treatment of femoropopliteal lesions have steadily increased over the past decade. Accordingly, the number of devices has also increased, but the choice of the best endovascular treatment remains to be defined. Many devices are now available for physicians. However, in order to obtain a high success rate, it is necessary to respect an algorithm whose choice of device is only one step in the treatment. Materials and Methods: The first step is, therefore, to define the approach according to the lesion to be treated. Anterograde approaches (femoral, radial, or humeral) are distinguished from retrograde approaches depending on the patient’s anatomy and surgical history. Secondarily, the lesion will be crossed intraluminally or subintimally using a catheter or an angioplasty balloon. The third step corresponds to the preparation of the artery, which is essential before the implantation of the device. It has a crucial role in reducing the rate of restenosis. Several tools are available and are chosen according to the lesion requiring treatment (stenosis, occlusion). Among them, we find the angioplasty balloon, the atherectomy probes, or intravascular lithotripsy. Finally, the last step corresponds to the choice of the device to be implanted. This is also based on the nature of the lesion, which is considered short, up to 15 cm and complex beyond that. The choice of device will be between bare stents, covered stents, drug-coated balloons, and drug-eluting stents. Currently, drug-eluting stents appear to be the treatment of choice for short lesions, and active devices seem to be the preferred treatment for more complex lesions, although there is a lack of data. Results: In case of failure to cross the lesion, the retrograde approach is a safe and effective alternative. Balloon angioplasty currently remains the reference method for the preparation of the artery, the aim of which is to ensure the intraoperative technical success of the treatment (residual stenosis < 30%), to limit the risk of dissection and, finally, to limit the occurrence of restenosis. Concerning the treatment, the drug-eluting devices seem to present the best results, whether for simple or complex lesions. Conclusions: Endovascular treatment for femoropopliteal lesions needs to be considered upstream of the intervention in order to anticipate the treatment and the choice of devices for each stage. Full article
(This article belongs to the Special Issue Modern Endovascular Therapy for Peripheral Arterial Disease)
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7 pages, 1090 KiB  
Brief Report
Remote Dielectric Sensing to Assess Residual Pulmonary Congestion Following Percutaneous Mitral Valve Repair
by Teruhiko Imamura, Shuhei Tanaka, Hiroshi Ueno and Koichiro Kinugawa
Medicina 2022, 58(9), 1292; https://doi.org/10.3390/medicina58091292 - 16 Sep 2022
Cited by 1 | Viewed by 1448
Abstract
Background and Objectives: Percutaneous mitral valve repair using a MitraClip system is an established therapeutic strategy to treat severe mitral regurgitation, which is recommended by guidelines in Europe and in the United States, whereas residual mitral regurgitation is associated with mortality and [...] Read more.
Background and Objectives: Percutaneous mitral valve repair using a MitraClip system is an established therapeutic strategy to treat severe mitral regurgitation, which is recommended by guidelines in Europe and in the United States, whereas residual mitral regurgitation is associated with mortality and morbidity. Accurate assessment of residual mitral regurgitation is crucial for risk stratification and further adequate intervention, whereas its quantification has technical limitations due to “double” regurgitation that is often encountered following valve clipping. Remote dielectric sensing (ReDSTM) is a non-invasive electromagnetic-based technology to quantify lung fluid levels and might be a promising tool to assess the impact of residual mitral regurgitation following MitraClip. Materials and Methods: Following MitraClip, ReDS values measurements and right heart catheterization were performed and correlated. Results: We had 13 patients (median 74 years, 7 men) who underwent successful MitraClip. According to the visual estimation, eight patients had none or mild regurgitation, and five patients had moderate regurgitation. ReDS values were distributed widely between 16% and 33%, irrespective of the severity of regurgitation. ReDS values had a moderate correlation with invasively measured pulmonary artery wedge pressure (r = 0.73, p = 0.004). Conclusions: ReDS value might be a promising tool to assess residual pulmonary congestion following MitraClip, irrespective of the visually estimated severity of residual mitral regurgitation. Full article
(This article belongs to the Section Cardiology)
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13 pages, 2019 KiB  
Article
Effect of C-Clamp Application on Hemodynamic Instability in Polytrauma Victims with Pelvic Fracture
by Jan Gewiess, Markus Martin Luedi, Beat Schnüriger, Theodoros Hercules Tosounidis, Marius Johann Baptist Keel and Johannes Dominik Bastian
Medicina 2022, 58(9), 1291; https://doi.org/10.3390/medicina58091291 - 16 Sep 2022
Cited by 3 | Viewed by 2156
Abstract
Background and Objectives: C-clamp application may reduce mortality in patients with unstable pelvic fractures and hemodynamic instability. Decreasing C-clamp use over the past decades may have resulted from concerns about its effectiveness and safety. The purpose of this study was to document effective [...] Read more.
Background and Objectives: C-clamp application may reduce mortality in patients with unstable pelvic fractures and hemodynamic instability. Decreasing C-clamp use over the past decades may have resulted from concerns about its effectiveness and safety. The purpose of this study was to document effective hemodynamic stabilization after C-clamp application by means of vital parameters (primary outcome parameter), and the subsequent effect on metabolic indices and volume management (secondary outcome parameters). Materials and Methods: C-clamp application was performed between 2014 and 2021 for n = 13 patients (50 ± 18 years) with unstable pelvic fractures and hemodynamic instability. Vital parameters, metabolic indices, volume management, and the correlation of factors and potential changes were analyzed. Results: After C-clamp application, increases were measured in systolic blood pressure (+15 mmHg; p = 0.0284) and mean arterial pressure (+12 mmHg; p = 0.0157), and a reduction of volume requirements (p = 0.0266) and bolus vasoactive medication needs (p = 0.0081) were observed. The earlier C-clamp application was performed, the greater the effect (p < 0.05; r > 0.6). Heart rate, shock index, and end-tidal CO2 were not significantly altered. The extent of base deficit, hemoglobin, and lactate did not correlate with changes in vital parameters. Conclusions: In the majority of hemodynamically unstable trauma patients not responding to initial fluid resuscitation and severe pelvic fracture, early C-clamp application had an additive effect on hemodynamic stabilization and reduction in volume substitution. Based on these findings, there is still a rationale for considering early C-clamp stabilization in this group of severely injured patients. Full article
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14 pages, 657 KiB  
Systematic Review
Obesity as a Risk Factor for Venous Thromboembolism Recurrence: A Systematic Review
by Pinelopi Ntinopoulou, Erato Ntinopoulou, Ioanna V. Papathanasiou, Evangelos C. Fradelos, Ourania Kotsiou, Nikolaos Roussas, Dimitrios G. Raptis, Konstantinos I. Gourgoulianis and Foteini Malli
Medicina 2022, 58(9), 1290; https://doi.org/10.3390/medicina58091290 - 16 Sep 2022
Cited by 2 | Viewed by 2167
Abstract
Background and Objectives: Venous thromboembolism (VTE) encompasses Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE). The duration of anticoagulant therapy following a VTE event partly relies on the risk of recurrent VTE which depends on the clinical setting where VTE occurred and the [...] Read more.
Background and Objectives: Venous thromboembolism (VTE) encompasses Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE). The duration of anticoagulant therapy following a VTE event partly relies on the risk of recurrent VTE which depends on the clinical setting where VTE occurred and the VTE risk factors present. Obesity is considered a minor risk factor and studies in the literature have provided conflicting results on whether obesity influences the development of recurrences. The aim of the present study is to assess the effect of obesity on VTE recurrence in patients that suffered from a previous VTE event. Materials and Methods: We conducted systematic research for English language studies in Medline, Scopus and ProQuest databases in order to identify publications that assess the risk of VTE recurrence in obesity. Inclusion criteria were: 1. Diagnosis of VTE, 2. Definition of obesity as a body mass index ≥30 kg/m2, 3. Report of the risk of obesity on VTE recurrence, 4. Adult human population. We did not include case reports, review studies or studies that assessed other forms of thrombosis and/or used other definitions of obesity. We used the Newcastle-Ottawa scale to address the quality of the studies. Results: Twenty studies were included in the analysis, of which 11 where prospective cohort studies, 6 were retrospective cohort studies, 1 was a cross-sectional study, and 2 were post-hoc analysis of randomized clinical trials. Obesity was significantly associated with recurrences in 9 studies and in 3 of them the association was significant only in females. Conclusions: There is heterogeneity between the studies both in their design and results, therefore the effect of obesity on VTE recurrence cannot be adequately estimated. Future randomized clinical studies with appropriately selected population are needed in order to streamline the effect of obesity on VTE recurrence. Full article
(This article belongs to the Special Issue Evidence Based Practice in Venous Thromboembolism)
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16 pages, 30799 KiB  
Article
Assessment of the In Vitro Cytotoxic Profile of Two Broad-Spectrum Antibiotics—Tetracycline and Ampicillin—On Pharyngeal Carcinoma Cells
by Daniel Florin Pancu, Robert Cosmin Racea, Ioana Macasoi, Cristian Andrei Sarau, Iulia Pinzaru, Marioara Poenaru, Laura-Cristina Rusu, Cristina Adriana Dehelean and Stefania Dinu
Medicina 2022, 58(9), 1289; https://doi.org/10.3390/medicina58091289 - 16 Sep 2022
Cited by 4 | Viewed by 1776
Abstract
Background and Objectives: In spite of the fact that antibiotics are considered to be the cornerstone of modern medicine, their use in the treatment of cancer remains controversial. In the present study, the main objective was to examine the effects of two antibiotics—tetracycline [...] Read more.
Background and Objectives: In spite of the fact that antibiotics are considered to be the cornerstone of modern medicine, their use in the treatment of cancer remains controversial. In the present study, the main objective was to examine the effects of two antibiotics—tetracycline and ampicillin—on the viability, morphology, migration, and organization and structure of the nuclei and the actin fiber network of pharyngeal carcinoma cells—Detroit-562. Materials and Methods: In order to determine the viability of the cells, the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) method was applied after the cells were stimulated with five concentrations of tetracycline and ampicillin (10, 25, 50, 75, and 100 μM) for 72 h. A scratch assay was used to assess the migration ability of the cells. For the visualization of the nuclei and actin fibers, 4,6-diamidino-2-phenylindole (Dapi) and Rhodamine-Phalloidin were used. Results: There are different effects of tetracycline and ampicillin. Thus, tetracycline: (i) exhibited a concentration-dependent cytotoxic effect, decreasing cell viability to approximately 46%; (ii) inhibits cellular migration up to 16% compared to 60% for control cells; and (iii) induces changes in cell morphology as well as apoptotic changes in the nucleus and F-actin fibers. In contrast, in the case of ampicillin, an increase in viability up to 113% was observed at 10 μM, while a decrease in viability up to approximately 94% was observed at the highest concentration tested (100 μM). Conclusions: The results indicated a different effect regarding the impact on pharyngeal carcinoma cells. Thus, tetracycline has a concentration-dependent cytotoxic effect, while in the case of ampicillin a slight stimulation of cell viability was observed. Full article
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18 pages, 4339 KiB  
Article
Enhancing Imagistic Interstitial Lung Disease Diagnosis by Using Complex Networks
by Ana Adriana Trușculescu, Diana Luminița Manolescu, Laura Broască, Versavia Maria Ancușa, Horia Ciocârlie, Camelia Corina Pescaru, Emanuela Vaștag and Cristian Iulian Oancea
Medicina 2022, 58(9), 1288; https://doi.org/10.3390/medicina58091288 - 16 Sep 2022
Cited by 1 | Viewed by 1564
Abstract
Background and Objectives: Diffuse interstitial lung diseases (DILD) are a heterogeneous group of over 200 entities, some with dramatical evolution and poor prognostic. Because of their overlapping clinical, physiopathological and imagistic nature, successful management requires early detection and proper progression evaluation. This [...] Read more.
Background and Objectives: Diffuse interstitial lung diseases (DILD) are a heterogeneous group of over 200 entities, some with dramatical evolution and poor prognostic. Because of their overlapping clinical, physiopathological and imagistic nature, successful management requires early detection and proper progression evaluation. This paper tests a complex networks (CN) algorithm for imagistic aided diagnosis fitness for the possibility of achieving relevant and novel DILD management data. Materials and Methods: 65 DILD and 31 normal high resolution computer tomography (HRCT) scans were selected and analyzed with the CN model. Results: The algorithm is showcased in two case reports and then statistical analysis on the entire lot shows that a CN algorithm quantifies progression evaluation with a very fine accuracy, surpassing functional parameters’ variations. The CN algorithm can also be successfully used for early detection, mainly on the ground glass opacity Hounsfield Units band of the scan. Conclusions: A CN based computer aided diagnosis could provide the much-required data needed to successfully manage DILDs. Full article
(This article belongs to the Section Pulmonary)
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13 pages, 1976 KiB  
Article
Hydroxychloroquine Effects on THP-1 Macrophage Cholesterol Handling: Cell Culture Studies Corresponding to the TARGET Cardiovascular Trial
by Saba Ahmed, Justin Konig, Lora J. Kasselman, Heather A. Renna, Joshua De Leon, Steven E. Carsons and Allison B. Reiss
Medicina 2022, 58(9), 1287; https://doi.org/10.3390/medicina58091287 - 16 Sep 2022
Viewed by 2116
Abstract
Background and Objectives: Cardiovascular (CV) risk is elevated in rheumatoid arthritis (RA). RA patient plasma causes pro-atherogenic derangements in cholesterol transport leading to macrophage foam cell formation (FCF). The TARGET randomized clinical trial compares CV benefits of 2 RA drug regimens. Hydoxychloroquine [...] Read more.
Background and Objectives: Cardiovascular (CV) risk is elevated in rheumatoid arthritis (RA). RA patient plasma causes pro-atherogenic derangements in cholesterol transport leading to macrophage foam cell formation (FCF). The TARGET randomized clinical trial compares CV benefits of 2 RA drug regimens. Hydoxychloroquine (HCQ) is a key medication used in TARGET. This study examines effects of HCQ on lipid transport to elucidate mechanisms underlying TARGET outcomes and as an indicator of likely HCQ effects on atherosclerosis in RA. Materials and Methods: THP1 human macrophages were exposed to media alone, IFNγ (atherogenic cytokine), HCQ, or HCQ + IFNγ. Cholesterol efflux protein and scavenger receptor mRNA levels were quantified by qRT-PCR and corresponding protein levels were assessed by Western blot. FCF was evaluated via Oil-Red-O and fluorescent-oxidized LDL. Intracellular cholesterol and efflux were quantified with Amplex Red assay. Results: With the exception of a decrease in the efflux protein cholesterol 27-hydroxylase in the presence IFNγ at all HCQ concentrations, no significant effect on gene or protein expression was observed upon macrophage exposure to HCQ and this was reflected in the lack of change in FCF and oxidized LDL uptake. Conclusions: HCQ did not significantly affect THP1 macrophage cholesterol transport. This is consistent with TARGET, which postulates superior effects of anti-TNF agents over sulfasalazine + HCQ. Full article
(This article belongs to the Section Cardiology)
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9 pages, 263 KiB  
Perspective
Reflections from a Psychologist Working with Sickle Cell and Thalassaemia Patients during the COVID-19 Pandemic
by Dede-Kossi Osakonor and Dimitris A. Tsitsikas
Medicina 2022, 58(9), 1286; https://doi.org/10.3390/medicina58091286 - 15 Sep 2022
Viewed by 1584
Abstract
Sickle cell disease and thalassaemia are life-long haematological diseases that can impact the quality of life of patients. This impact on quality of life can require intermittent psychological input throughout the lifespan for management. Managing everyday life during the COVID-19 pandemic could be [...] Read more.
Sickle cell disease and thalassaemia are life-long haematological diseases that can impact the quality of life of patients. This impact on quality of life can require intermittent psychological input throughout the lifespan for management. Managing everyday life during the COVID-19 pandemic could be challenging for people with these health conditions, which could impact their health, their mood and anxiety, their perception of control, and their engagement with their regular healthcare services. This report describes the characteristics of these health conditions and discusses reflections, from a specialist psychology service working with this clinical population, about the impact of COVID-19 on patient engagement with the service. The main aim of this report is to highlight the relevance and usefulness of videoconferencing as a therapy format, suggest implications for further service development and suggest alternate ways of working therapeutically with clients. Full article
(This article belongs to the Special Issue Sickle Cell Disease and the COVID-19 Pandemic)
9 pages, 680 KiB  
Article
Adding Low-Dose Propofol to Limit Anxiety during Target-Controlled Infusion of Remifentanil for Gastrointestinal Endoscopy: Respiratory Issues and Safety Recommendations
by Cyrus Motamed, Frederique Servin and Valerie Billard
Medicina 2022, 58(9), 1285; https://doi.org/10.3390/medicina58091285 - 15 Sep 2022
Viewed by 1501
Abstract
Backgroundand Objectives: Remifentanil-based sedation is one of many protocols proposed for endoscopy procedures in spontaneous ventilation, alone or in combination with propofol. However, the effect of these small doses of propofol on the efficacy and safety of remifentanil target-controlled infusion (TCI) [...] Read more.
Backgroundand Objectives: Remifentanil-based sedation is one of many protocols proposed for endoscopy procedures in spontaneous ventilation, alone or in combination with propofol. However, the effect of these small doses of propofol on the efficacy and safety of remifentanil target-controlled infusion (TCI) deserves to be examined in this context. The objective of this study was to assess the adverse respiratory and cardiovascular effects of small boluses of propofol combined with remifentanil, in comparison with remifentanil alone, and balanced with the quality of sedation and recovery. Materials andMethods: This was an observational bicenter study, representing a subgroup of a larger study describing remifentanil-based procedural sedation. In center 1, patients scheduled for gastrointestinal (GI) endoscopy had remifentanil TCI alone. In center 2, patients had a 10 mg propofol bolus before TCI and other boluses were allowed during the procedure. Remifentanil TCI was started at a target of 2 ng/mL then adapted by 0.5 ng/mL steps according to patient response to endoscopy stimulations. Results: Center 1 included 29 patients, while center 2 included 60 patients. No difference was found in the patients’ characteristics, incidence of success, average remifentanil consumption, or cardiovascular variables. Light sedation was achieved when propofol was added. The incidence of respiratory events, such as bradypnea, desaturation < 90%, and apnea requiring rescue maneuvers, were significantly higher with propofol. Conclusions: Adding propofol boluses to a remifentanil TCI for GI endoscopy ensures light sedation that may be necessary for anxiolysis but increases respiratory events, even after administration of small-dose boluses. Its safety is acceptable if the procedure is performed in an equipped environment with sedation providers trained to manage respiratory events and drugs titrated to minimal doses. Full article
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14 pages, 59565 KiB  
Article
Multicenter Retrospective Analysis of Intradiscal Condoliase Injection Therapy for Lumbar Disc Herniation
by Yusuke Oshita, Daisuke Matsuyama, Daisuke Sakai, Jordy Schol, Eiki Shirasawa, Haruka Emori, Kazuyuki Segami, Shu Takahashi, Kazumichi Yagura, Masayuki Miyagi, Wataru Saito, Takayuki Imura, Toshiyuki Nakazawa, Gen Inoue, Akihiko Hiyama, Hiroyuki Katoh, Tsutomu Akazawa, Koji Kanzaki, Masato Sato, Masashi Takaso and Masahiko Watanabeadd Show full author list remove Hide full author list
Medicina 2022, 58(9), 1284; https://doi.org/10.3390/medicina58091284 - 15 Sep 2022
Cited by 4 | Viewed by 2688
Abstract
Background and Objectives: Intradiscal injection of Condoliase (chondroitin sulfate ABC endolyase), a glycosaminoglycan-degrading enzyme, is employed as a minimally invasive treatment for lumbar disc herniation (LDH) and represents a promising option between conservative treatment and surgical intervention. Since its 2018 approval in [...] Read more.
Background and Objectives: Intradiscal injection of Condoliase (chondroitin sulfate ABC endolyase), a glycosaminoglycan-degrading enzyme, is employed as a minimally invasive treatment for lumbar disc herniation (LDH) and represents a promising option between conservative treatment and surgical intervention. Since its 2018 approval in Japan, multiple single-site trails have highlighted its effectiveness, however, the effect of LDH types, and influences of patient age, sex, etc., on treatment success remains unclear. Moreover, data on teenagers and elderly patients has not been reported. In this retrospective multi-center study, we sought to classify prognostic factors for successful condoliase treatment for LDH and assess its effect on patients < 20 and ≥70 years old. Materials and Methods: We reviewed the records of 137 LDH patients treated through condoliase at four Japanese institutions and assessed its effectiveness among different age categories on alleviation of visual analog scale (VAS) of leg pain, low back pain and numbness, as well as ODI and JOA scores. Moreover, we divided them into either a “group-A” category if a ≥50% improvement in baseline leg pain VAS was observed or “group-N” if VAS leg pain improved <50%. Next, we assessed the differences in clinical and demographic distribution between group-A and group-N. Results: Fifty-five patients were classified as group-A (77.5%) and 16 patients were allocated to group-N (22.5%). A significant difference in Pfirrmann classification was found between both cohorts, with grade IV suggested to be most receptive. A posterior disc angle > 5° was also found to approach statical significance. In all age groups, average VAS scores showed improvement. However, 75% of adolescent patients showed deterioration in Pfirrmann classification following treatment. Conclusions: Intradiscal condoliase injection is an effective treatment for LDH, even in patients with large vertebral translation and posterior disc angles, regardless of age. However, since condoliase imposes a risk of progressing disc degeneration, its indication for younger patients remains controversial. Full article
(This article belongs to the Special Issue New Advances in Intervertebral Disc Degeneration)
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11 pages, 989 KiB  
Article
Atrial Pacing Affects Left Atrial Morphological and Functional Parameters Early after Pacemaker Implantation
by Mindaugas Viezelis, Gintare Neverauskaite-Piliponiene, Agne Marcinkeviciene, Eligija Teleisyte, Tomas Kazakevicius, Vytautas Zabiela, Vilius Kviesulaitis, Renaldas Jurkevicius and Aras Puodziukynas
Medicina 2022, 58(9), 1283; https://doi.org/10.3390/medicina58091283 - 15 Sep 2022
Cited by 1 | Viewed by 1490
Abstract
Background and Objectives: Chronic atrial stimulation might impair left atrial (LA) function. We aimed to assess the impact of atrial pacing burden on LA volumetric and functional parameters after implantation of a dual-chamber pacemaker. Materials and Methods: The prospective study included [...] Read more.
Background and Objectives: Chronic atrial stimulation might impair left atrial (LA) function. We aimed to assess the impact of atrial pacing burden on LA volumetric and functional parameters after implantation of a dual-chamber pacemaker. Materials and Methods: The prospective study included 121 subjects with sinus node disease (SND) or atrioventricular block (AVB) that received a dual-chamber pacemaker. After device implantation, the subjects were divided into three groups: (1) SND with a lower rate (LR) set to 60 bpm and rate response enabled; (2) AVB with an LR set to 60 bpm and no rate response; and (3) AVB with an LR set to 40 bpm and no rate response. Subjects were followed at one and three months. Two subsets of patients with high and low atrial pacing burdens accompanied by low ventricular pacing percentage were analyzed. LA function was evaluated with volumetric and strain parameters from transthoracic echocardiography. Results: The high atrial low ventricular pacing group consisted of 38 subjects, and the low atrial low ventricular group consisted of 22 subjects. When looking at the change in volumetric parameters, we observed a tendency for volumes to increase in both groups; however, only minimal LA volume reached statistical significance at three months in the high atrial pacing group. A trend towards the lowering of an active emptying fraction at one month (p = 0.076) became significant at three months (p = 0.043), and was also only observed in the same group. Moreover, a decrease in the tendency to reach statistical significance at three months for reservoir and contractile strain parameters and stiffness index was only observed in the high atrial pacing group. Meanwhile, in the low atrial pacing burden group, all parameters remained significantly unchanged. Conclusions: The burden of right atrial pacing in patients with preserved left ventricular function negatively influences functional and morphologic LA parameters. Moreover, negative effects take place soon after pacemaker implantation and appear to be sustained. Full article
(This article belongs to the Section Cardiology)
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