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J. Clin. Med., Volume 10, Issue 14 (July-2 2021) – 194 articles

Cover Story (view full-size image): Acute kidney injury (AKI) is a widely held concern related to a substantial burden of morbidity and mortality. Genetic factors have been suggested as being potentially responsible for its susceptibility and severity. As there is no effective treatment other than supportive measures and renal replacement therapy, updated knowledge on the genetic implications may serve as a strategic tool to counteract its dire consequences. Further understanding of the genetics that predispose AKI may shed light on novel approaches for the prevention and treatment of this condition. This review attempts to address the role of key genes in the appearance and development of AKI, providing a comprehensive update of the process and identifying markers that could serve as targets for further AKI therapies. View this paper
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11 pages, 1002 KiB  
Article
Importance of Lung Ultrasound Follow-Up in Patients Who Had Recovered from Coronavirus Disease 2019: Results from a Prospective Study
by Alba Hernández-Píriz, Yale Tung-Chen, David Jiménez-Virumbrales, Ibone Ayala-Larrañaga, Raquel Barba-Martín, Jesús Canora-Lebrato, Antonio Zapatero-Gaviria and Gonzalo García De Casasola-Sánchez
J. Clin. Med. 2021, 10(14), 3196; https://doi.org/10.3390/jcm10143196 - 20 Jul 2021
Cited by 19 | Viewed by 4728
Abstract
There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasounds, however, their role in predicting the prognosis has yet to be explored. Our objective was to assess the usefulness of lung ultrasound in the short-term follow-up (1 [...] Read more.
There is growing evidence regarding the imaging findings of coronavirus disease 2019 (COVID-19) in lung ultrasounds, however, their role in predicting the prognosis has yet to be explored. Our objective was to assess the usefulness of lung ultrasound in the short-term follow-up (1 and 3 months) of patients with SARS-CoV-2 pneumonia, and to describe the progression of the most relevant lung ultrasound findings. We conducted a prospective, longitudinal and observational study performed in patients with confirmed COVID-19 who underwent a lung ultrasound examination during hospitalization and repeated it 1 and 3 months after hospital discharge. A total of 96 patients were enrolled. In the initial ultrasound, bilateral involvement was present in 100% of the patients with mild, moderate or severe ARDS. The most affected lung area was the posteroinferior (93.8%) followed by the lateral (88.7%). Subpleural consolidations were present in 68% of the patients and consolidations larger than 1 cm in 24%. One month after the initial study, only 20.8% had complete resolution on lung ultrasound. This percentage rose to 68.7% at 3 months. Residual lesions were observed in a significant percentage of patients who recovered from moderate or severe ARDS (32.4% and 61.5%, respectively). In conclusion, lung injury associated with COVID-19 might take time to resolve. The findings in this report support the use of lung ultrasound in the short-term follow-up of patients recovered from COVID-19, as a radiation-sparing, easy to use, novel care path worth exploring. Full article
(This article belongs to the Special Issue Clinical Trends and Therapies of the COVID-19 Pandemic)
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8 pages, 227 KiB  
Article
Neonatal Lupus Erythematosus as a Rare Cause of Fever in Young Infants
by Ji Yeon Song, Su Eun Park, Joung-Hee Byun, Narae Lee, Young Mi Han, Shin Yun Byun and Seong Heon Kim
J. Clin. Med. 2021, 10(14), 3195; https://doi.org/10.3390/jcm10143195 - 20 Jul 2021
Cited by 5 | Viewed by 2155
Abstract
Neonatal lupus erythematosus (NLE) is a rare disease caused by passively transmitted autoantibodies from the mother. NLE is a multi-organ system disease characterized by cutaneous, cardiac, hematological, hepatobiliary, and neurological manifestations. This study aimed to review the various symptoms and clinical manifestations in [...] Read more.
Neonatal lupus erythematosus (NLE) is a rare disease caused by passively transmitted autoantibodies from the mother. NLE is a multi-organ system disease characterized by cutaneous, cardiac, hematological, hepatobiliary, and neurological manifestations. This study aimed to review the various symptoms and clinical manifestations in young infants with NLE and their mothers. We conducted a retrospective review of medical records of patients with NLE who were both examined and treated at Pusan National University Children’s Hospital between January 2009 and December 2020 and their mothers. Twenty-seven patients with NLE comprising 13 male patients (48.1%) and 14 female patients (51.9%) were included. The most common symptom was rash (40.7%), followed by fever (25.9%), arrhythmia (14.8%), splenomegaly (11.1%), and intrauterine growth retardation (7.4%). Seven patients with fever had various organ system manifestations, including cutaneous (100%), hematological (71.4%), hepatobiliary (57.1%), and central nervous system (CNS; 28.6%) manifestations. Two of the febrile patients had aseptic meningitis. Cutaneous, cardiac, hematological, hepatobiliary, and CNS involvement were noted in 44.4%, 18.5%, 51.9%, 40.7%, and 22.2% of the patients, respectively. Systemic lupus erythematosus (SLE) was the most common maternal disease (14/27, 51.9%). Ten mothers (37.0%) had not been diagnosed with any autoimmune disease until their babies were diagnosed. Among them, three were subsequently diagnosed with SLE, five were diagnosed with the Sjögren’s syndrome, and two of them still had no known diagnosis of any autoimmune disorder. Fever is a common symptom of NLE; thus, when there is no clear focus of fever in infants, NLE needs to be considered, especially in cases with skin rashes. Full article
(This article belongs to the Section Immunology)
19 pages, 1373 KiB  
Article
Comparison of Psoriatic Arthritis and Rheumatoid Arthritis Patients across Body Mass Index Categories in Switzerland
by Enriqueta Vallejo-Yagüe, Theresa Burkard, Burkhard Möller, Axel Finckh and Andrea M. Burden
J. Clin. Med. 2021, 10(14), 3194; https://doi.org/10.3390/jcm10143194 - 20 Jul 2021
Cited by 8 | Viewed by 3922
Abstract
Abnormal body mass index (BMI) was associated with worse rheumatic markers in psoriatic arthritis (PsA) and rheumatoid arthritis (RA). Aiming to describe PsA and RA patients stratified by BMI, we performed a descriptive study in PsA and RA patients (two distinct cohorts) in [...] Read more.
Abnormal body mass index (BMI) was associated with worse rheumatic markers in psoriatic arthritis (PsA) and rheumatoid arthritis (RA). Aiming to describe PsA and RA patients stratified by BMI, we performed a descriptive study in PsA and RA patients (two distinct cohorts) in the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) registry. New users of biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) were stratified by BMI at the start of their treatment (underweight, normal weight, overweight, obese). The PsA underweight and normal weight categories were merged. Age at disease onset and further characteristics at the start of the first b/tsDMARD treatment were compared across BMI categories vs. the corresponding normal weight group. The study included 819 PsA (36.5% overweight, 23.8% obese) and 3217 RA patients (4.4% underweight, 31.8% overweight, 17.0% obese). Compared to the corresponding normal weight group, PsA and RA obese patients had significantly (p < 0.05) higher C-reactive protein, worse disease activity, and lower quality of life (QoL). Obese PsA patients had significantly worse skin manifestation and pain, while obese RA patients had significantly higher erythrocyte sedimentation rate and tender joint counts, as well as lower seropositive prevalence. To conclude, obese PsA and RA patients presented worse disease activity and poorer QoL than those with normal weight. Full article
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10 pages, 625 KiB  
Article
Prenatal and Postnatal Anxiety and Depression in Mothers during the COVID-19 Pandemic
by Joanna Baran, Justyna Leszczak, Rafał Baran, Anna Biesiadecka, Aneta Weres, Ewelina Czenczek-Lewandowska and Katarzyna Kalandyk-Osinko
J. Clin. Med. 2021, 10(14), 3193; https://doi.org/10.3390/jcm10143193 - 20 Jul 2021
Cited by 21 | Viewed by 4539
Abstract
The aim of this study was to assess the changes in the occurrence of prenatal and postnatal anxiety and depression symptoms, and to assess what factors significantly affect the appearance of symptoms of depression and anxiety in young mothers. The study group consisted [...] Read more.
The aim of this study was to assess the changes in the occurrence of prenatal and postnatal anxiety and depression symptoms, and to assess what factors significantly affect the appearance of symptoms of depression and anxiety in young mothers. The study group consisted of 130 women after childbirth. Due to the ongoing restrictions caused by the COVID-19 pandemic, the survey was prepared online. The questionnaire was fully anonymous, and it contained the authors’ own questions and two standardized questionnaires: the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorders GAD-7. The conducted analysis clearly indicated that the level of postpartum depression, in as many as 52 of the mothers, had increased significantly compared to the time before delivery, when symptoms of depression were shown by 22 women (p = 0.009). However, there was no statistically significant change between prenatal and postnatal anxiety. There are many factors associated with postnatal depression. The strongest predictors turned out to be average socioeconomic status, history of anxiety disorders, past neurosis or depression, lack of or inadequate level of assistance from healthcare professionals, as well as lactation problems and postpartum pain. Full article
(This article belongs to the Special Issue Women’s Health and Perinatal Mood and Anxiety Disorders)
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13 pages, 293 KiB  
Review
Impact of Obesity on Anti-Mullerian Hormone (AMH) Levels in Women of Reproductive Age
by Alexis L. Oldfield, Maryam Kazemi and Marla E. Lujan
J. Clin. Med. 2021, 10(14), 3192; https://doi.org/10.3390/jcm10143192 - 20 Jul 2021
Cited by 20 | Viewed by 5266
Abstract
Obesity negatively impacts reproductive health, including ovarian function. Obesity has been posited to alter Anti-Müllerian hormone (AMH) production. Understanding biological factors that could impact AMH levels is necessary given the increasing use of AMH for predicting reproductive health outcomes in response to controlled [...] Read more.
Obesity negatively impacts reproductive health, including ovarian function. Obesity has been posited to alter Anti-Müllerian hormone (AMH) production. Understanding biological factors that could impact AMH levels is necessary given the increasing use of AMH for predicting reproductive health outcomes in response to controlled ovarian stimulation, diagnosing ovulatory disorders, onset of menopause, and natural conception. In this narrative review, we evaluated the impact of obesity on AMH levels in healthy, regularly cycling reproductive-age women (18–48 years). Thirteen studies (n = 1214 women; (811, non-obese (body mass index; BMI < 30 kg/m2); 403, obese (BMI > 30 kg/m2))) were included, of which five reported decreased AMH levels with obesity, whereas eight showed comparable AMH levels between groups. Inclusion of women with higher obesity classes (Class 3 versus Class 1) may have been a factor in studies reporting lower AMH levels. Together, studies reporting AMH levels in otherwise healthy women remain limited by small sample sizes, cross-sectional designs, and lack of representation across the entire adiposity spectrum. Ultimately, the degree to which obesity may negatively impact AMH levels, and possibly ovarian reserve, in otherwise healthy women with regular menstrual cycles should be deemed uncertain at this time. This conclusion is prudent considering that the biological basis for an impact of obesity on AMH production is unknown. Full article
(This article belongs to the Section Reproductive Medicine & Andrology)
16 pages, 1089 KiB  
Article
Mental Health and Psychological Wellbeing during the COVID-19 Lockdown: A Longitudinal Study in the Balearic Islands (Spain)
by Joana Ripoll, Sara Contreras-Martos, Magdalena Esteva, Aina Soler and Maria Jesús Serrano-Ripoll
J. Clin. Med. 2021, 10(14), 3191; https://doi.org/10.3390/jcm10143191 - 20 Jul 2021
Cited by 21 | Viewed by 3762
Abstract
Confining the entire population to a lockdown after the outbreak of SARS-CoV-2 was an unprecedented measure designed to protect the health of those living in Spain. The objective of the present study is to assess the evolution of mental health and psychological wellbeing [...] Read more.
Confining the entire population to a lockdown after the outbreak of SARS-CoV-2 was an unprecedented measure designed to protect the health of those living in Spain. The objective of the present study is to assess the evolution of mental health and psychological wellbeing during lockdown. To do this, we carried out a longitudinal study, via an online survey over the eight weeks of lockdown (weekly assessments). Sociodemographic variables were recorded, along with data related to COVID-19, psychological wellbeing (anxiety, depression, psychotropic drugs, consultations made to improve mood or anxiety), life satisfaction, and self-perceived health. A total of 681 individuals participated in the study, 76.8% were women; the mean age was 43 years old (SD = 12.7). Initially, high scores were reported for anxiety, depression, and the number of consultations to improve mood, but these decreased significantly over the study period. The reverse seems to be true for life satisfaction, perceived good health, and intake of psychotropic drugs. We also identified groups whose psychological wellbeing was more susceptible to the effects of lockdown. Women, those worried about their jobs after the pandemic, and those afraid of being infected were the most affected individuals. More generally, after the initial negative effect on psychological wellbeing, various indicators improved over the lockdown period. Full article
(This article belongs to the Special Issue Psychological Distress and Panic during Global Pandemic)
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18 pages, 712 KiB  
Article
Short-Term Outcome of Inpatient Treatment for Adolescents with Anorexia Nervosa Using DSM-5 Remission Criteria
by Dunja Mairhofer, Michael Zeiler, Julia Philipp, Stefanie Truttmann, Tanja Wittek, Katrin Skala, Michaela Mitterer, Gabriele Schöfbeck, Clarissa Laczkovics, Julia Schwarzenberg, Gudrun Wagner and Andreas Karwautz
J. Clin. Med. 2021, 10(14), 3190; https://doi.org/10.3390/jcm10143190 - 20 Jul 2021
Cited by 10 | Viewed by 3424
Abstract
This study evaluated the short-term outcome of a multimodal inpatient treatment concept for adolescents with anorexia nervosa (AN). In this prospective observational study, a cohort of 126 female adolescents with AN (age range: 11–17, mean age: 14.83) was longitudinally followed from admission to [...] Read more.
This study evaluated the short-term outcome of a multimodal inpatient treatment concept for adolescents with anorexia nervosa (AN). In this prospective observational study, a cohort of 126 female adolescents with AN (age range: 11–17, mean age: 14.83) was longitudinally followed from admission to discharge (average duration of stay: 77 days). We used gold-standard clinical interviews and self-report data, as well as DSM-5 remission criteria, to evaluate the treatment outcome. From admission to discharge, body-mass-index (BMI) significantly improved by 2.6 kg/m2. Data from clinical interviews and self-reports yielded similar improvements in restraint eating and eating concerns (large effects). Lower effects were observed for variables assessing weight/shape concerns and drive for thinness. At discharge, 23.2% of patients showed full remission of AN, 31.3% partial remission, and 45.5% no remission according to DSM-5 criteria. Differences in remission groups were found regarding AN severity, age at admission, and use of antidepressant medication. Living with both parents, longer duration of inpatient treatment and the use of antipsychotic medication were significantly associated with higher BMI change. The findings provide evidence for the short-term effectiveness of our inpatient treatment concept. We recommend using DSM-5 based remission criteria to evaluate the treatment outcome to improve the comparability of studies. Full article
(This article belongs to the Special Issue Special Updated Research on Eating Disorders: Medical Perspectives)
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10 pages, 3491 KiB  
Article
Concomitant Acute Ischemic Stroke and Upper Extremity Arterial Occlusion: Feasibility of Mechanical Thrombectomy of the Upper Limb Using Neurointerventional Devices and Techniques
by Dominik F. Vollherbst, Christian Ulfert, Volker Maus, Timan Boujan, Hans Henkes, Martin Bendszus and Markus A. Möhlenbruch
J. Clin. Med. 2021, 10(14), 3189; https://doi.org/10.3390/jcm10143189 - 20 Jul 2021
Cited by 2 | Viewed by 2320
Abstract
Background: Concomitant acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), and acute upper extremity arterial occlusion causing upper limb ischemia (ULI) is a rarely observed coincidence. The first-line treatment for AIS is mechanical thrombectomy (MT), with or without additional intravenous thrombolysis, [...] Read more.
Background: Concomitant acute ischemic stroke (AIS) caused by large vessel occlusion (LVO), and acute upper extremity arterial occlusion causing upper limb ischemia (ULI) is a rarely observed coincidence. The first-line treatment for AIS is mechanical thrombectomy (MT), with or without additional intravenous thrombolysis, while there are different pharmacological, surgical and endovascular treatment options for an acute occlusion of the UL arteries. Here, we describe the practicability, efficacy and safety of neurointerventional devices and techniques for MT of upper extremity arterial occlusions. Materials and Methods: A retrospective analysis of prospectively collected patient databases from four neurovascular centers was performed. Clinical and imaging data, as well as procedural parameters, were assessed. Results: Seven out of 6138 patients (incidence: 0.11%) presenting with an AIS due to the occlusion of craniocervical arteries requiring MT and a concomitant occlusion of the brachial (4/7), axillary (2/7), or ulnar (1/7) artery causing acute ULI were identified. Craniocervical MT was technically successful in all cases. Subsequent MT of the upper limb was performed using neurointerventional thrombectomy techniques, most frequently stent retriever thrombectomy (in 4/7 cases) and direct aspiration (in 7/7 cases). MT achieved successful recanalization in 6/7 cases, and the UL completely recovered in all six cases. In one case, recanalization was not successful, and the patient still had a marginally threatened extremity after the procedure, which improved after pharmacological therapy. Conclusion: In the rare case of AIS requiring MT and concomitant acute upper extremity arterial occlusion, MT of the UL arteries using neurointerventional devices and techniques is practical, effective, and safe. Full article
(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)
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9 pages, 1049 KiB  
Article
Value of Transnasal Esophagoscopy in the Workup of Laryngo-Pharyngeal Reflux
by Lukas Horvath, Karolos Fostiropoulos, Emanuel Burri and Marcel Kraft
J. Clin. Med. 2021, 10(14), 3188; https://doi.org/10.3390/jcm10143188 - 20 Jul 2021
Cited by 4 | Viewed by 2643
Abstract
Background: Laryngopharyngeal reflux (LPR) can display a variety of symptoms, and upper endoscopy is occasionally used for its investigation. The aim of the present study was to determine the value of transnasal esophagoscopy (TNE) in the workup of LPR. Methods: In 200 consecutive [...] Read more.
Background: Laryngopharyngeal reflux (LPR) can display a variety of symptoms, and upper endoscopy is occasionally used for its investigation. The aim of the present study was to determine the value of transnasal esophagoscopy (TNE) in the workup of LPR. Methods: In 200 consecutive patients with suspected LPR, reflux symptom index (RSI), reflux finding score (RFS), oropharyngeal pH-monitoring (PHM) and transnasal esophagoscopy (TNE) were carried out and rated according to the Horvath Score. Results: In the investigation of LPR, TNE showed a sensitivity, specificity and accuracy of 96%, 85% and 95%, respectively. The most common pathologic TNE findings in LPR patients were an insufficient cardia, hiatal hernia, lymphoid follicles and visible reflux. Conclusions: TNE is a supportive method in the workup of LPR, which can display the underlying pathology and directly affect therapeutic decisions. Full article
(This article belongs to the Special Issue Laryngopharyngeal Reflux: The Last Decade)
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18 pages, 1085 KiB  
Article
Albuminuria Is Associated with Hepatic Iron Load in Patients with Non-Alcoholic Fatty Liver Disease and Metabolic Syndrome
by Manuela Abbate, Sofía Montemayor, Catalina M. Mascaró, Miguel Casares, Cristina Gómez, Lucía Ugarriza, Silvia Tejada, Itziar Abete, M. Ángeles Zulet, Antoni Sureda, J. Alfredo Martínez and Josep A. Tur
J. Clin. Med. 2021, 10(14), 3187; https://doi.org/10.3390/jcm10143187 - 20 Jul 2021
Cited by 7 | Viewed by 3016
Abstract
Background: Increased albuminuria is associated with increased serum ferritin, insulin resistance, and non-alcoholic fatty liver disease (NAFLD). Liver iron accumulation is also related to hyperferritinemia, insulin resistance, and NAFLD; however, there is no evidence on its relationship with albuminuria. Aims: To assess the [...] Read more.
Background: Increased albuminuria is associated with increased serum ferritin, insulin resistance, and non-alcoholic fatty liver disease (NAFLD). Liver iron accumulation is also related to hyperferritinemia, insulin resistance, and NAFLD; however, there is no evidence on its relationship with albuminuria. Aims: To assess the relationship between hepatic iron load and urine albumin-to-creatinine ratio (UACR) in patients with metabolic syndrome (MetS) and NAFLD. Methods: In total, 75 MetS and NAFLD patients (aged 40–60 years, BMI 27–40 kg/m2) were selected from a cohort according to available data on hepatic iron load (HepFe) by magnetic resonance imaging (MRI). Subjects underwent anthropometric measurements, biochemistry testing, and liver MRI. Increased albuminuria was defined by UACR. Results: UACR correlated with NAFLD, HepFe, triglycerides, serum ferritin, fasting insulin, insulin resistance (calculated using the homeostatic model assessment for insulin resistance—HOMA-IR- formula), and platelets (p < 0.05). Multiple regression analysis adjusted for gender, age, eGFR, HbA1c, T2DM, and stages of NAFLD, found that HepFe (p = 0.02), serum ferritin (p = 0.04), fasting insulin (p = 0.049), and platelets (p = 0.009) were associated with UACR (R2 = 0.370; p = 0.007). UACR, liver fat accumulation, serum ferritin, and HOMA-IR increased across stages of HepFe (p < 0.05). Patients with severe NAFLD presented higher HepFe, fasting insulin, HOMA-IR, and systolic blood pressure as compared to patients in NAFLD stage 1 (p < 0.05). Conclusion: Hepatic iron load, serum ferritin, fasting insulin, and platelets were independently associated with albuminuria. In the context of MetS, increased stages of NAFLD presented higher levels of HepFe. Higher levels of HepFe were accompanied by increased serum ferritin, insulin resistance, and UACR. The association between iron accumulation, MetS, and NAFLD may represent a risk factor for the development of increased albuminuria. Full article
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
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14 pages, 539 KiB  
Article
Nonalcoholic Fatty Liver Disease-Related Hepatocellular Carcinoma: Clinical Patterns, Outcomes, and Prognostic Factors for Overall Survival—A Retrospective Analysis of a Slovak Cohort
by Dominik Safcak, Sylvia Drazilova, Jakub Gazda, Igor Andrasina, Svetlana Adamcova-Selcanova, Radovan Barila, Michal Mego, Marek Rac, Lubomir Skladany, Miroslav Zigrai, Martin Janicko and Peter Jarcuska
J. Clin. Med. 2021, 10(14), 3186; https://doi.org/10.3390/jcm10143186 - 20 Jul 2021
Cited by 4 | Viewed by 2621
Abstract
Objective: To compare NAFLD-related HCC and other etiology-related HCC and to describe predictive factors for survival in patients with NAFLD-related HCC independent of the BCLC staging system. Methods: We performed a multicenter longitudinal retrospective observational study of patients diagnosed with HCC during the [...] Read more.
Objective: To compare NAFLD-related HCC and other etiology-related HCC and to describe predictive factors for survival in patients with NAFLD-related HCC independent of the BCLC staging system. Methods: We performed a multicenter longitudinal retrospective observational study of patients diagnosed with HCC during the period from 2010 through 2016. Results: 12.59% of patients had NAFLD-related HCC, and 21.91% had either NAFLD or cryptogenic etiology. NAFLD-related HCC patients were younger (p = 0.0007), with a higher proportion of women (p < 0.001) compared to other etiology-related HCC patients. The NAFLD group had a significantly lower proportion of patients with liver cirrhosis at the time of HCC diagnosis (p < 0.0001), and they were more frequently diagnosed with both diabetes and metabolic syndrome when compared to other etiology-related HCC (p < 0.0001). We did not find any difference in the overall survival or in the progression-free survival between NAFLD-related and other etiology-related HCC patients staged as BCLC B and BCLC C. NAFLD-related HCC patients with three or more liver lesions had a shorter overall survival when compared to patients with one or two liver lesions (p = 0.0097), while patients with baseline CRP values of ≥5 mg/L or with PLR ≥ 150 had worse overall survival (p = 0.012 and p = 0.0028, respectively). ALBI Grade 3 predicted worse overall survival compared to ALBI Grade 1 or 2 (p = 0.00021). In NAFLD-related HCC patients, PLR and ALBI remained significant predictors of overall survival even after adjusting for BCLC. Conclusion: NAFLD-related HCC patients have a similar prognosis when compared to other etiology-related HCC. In NAFLD-related HCC patients, ALBI and PLR are significant predictors of the overall survival independent of the BCLC staging system. Full article
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15 pages, 1210 KiB  
Review
Immunomodulatory Nanomedicine for the Treatment of Atherosclerosis
by Linsey J. F. Peters, Alexander Jans, Matthias Bartneck and Emiel P. C. van der Vorst
J. Clin. Med. 2021, 10(14), 3185; https://doi.org/10.3390/jcm10143185 - 20 Jul 2021
Cited by 6 | Viewed by 3397
Abstract
Atherosclerosis is the main underlying cause of cardiovascular diseases (CVDs), which remain the number one contributor to mortality worldwide. Although current therapies can slow down disease progression, no treatment is available that can fully cure or reverse atherosclerosis. Nanomedicine, which is the application [...] Read more.
Atherosclerosis is the main underlying cause of cardiovascular diseases (CVDs), which remain the number one contributor to mortality worldwide. Although current therapies can slow down disease progression, no treatment is available that can fully cure or reverse atherosclerosis. Nanomedicine, which is the application of nanotechnology in medicine, is an emerging field in the treatment of many pathologies, including CVDs. It enables the production of drugs that interact with cellular receptors, and allows for controlling cellular processes after entering these cells. Nanomedicine aims to repair, control and monitor biological and physiological systems via nanoparticles (NPs), which have been shown to be efficient drug carriers. In this review we will, after a general introduction, highlight the advantages and limitations of the use of such nano-based medicine, the potential applications and targeting strategies via NPs. For example, we will provide a detailed discussion on NPs that can target relevant cellular receptors, such as integrins, or cellular processes related to atherogenesis, such as vascular smooth muscle cell proliferation. Furthermore, we will underline the (ongoing) clinical trials focusing on NPs in CVDs, which might bring new insights into this research field. Full article
(This article belongs to the Section Cardiovascular Medicine)
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20 pages, 1768 KiB  
Review
Strength Training to Prevent Falls in Older Adults: A Systematic Review with Meta-Analysis of Randomized Controlled Trials
by João Gustavo Claudino, José Afonso, Javad Sarvestan, Marcel Bahia Lanza, Juliana Pennone, Carlos Alberto Cardoso Filho, Julio Cerca Serrão, João Espregueira-Mendes, Ana Luiza Vilefort Vasconcelos, Monique Paula de Andrade, Sílvia Rocha-Rodrigues, Renato Andrade and Rodrigo Ramirez-Campillo
J. Clin. Med. 2021, 10(14), 3184; https://doi.org/10.3390/jcm10143184 - 20 Jul 2021
Cited by 17 | Viewed by 9181
Abstract
We performed a systematic review with meta-analysis of randomized controlled trials (RCTs) to assess the effects of strength training (ST), as compared to alternative multimodal or unimodal exercise programs, on the number of falls in older adults (≥60 years). Ten databases were consulted [...] Read more.
We performed a systematic review with meta-analysis of randomized controlled trials (RCTs) to assess the effects of strength training (ST), as compared to alternative multimodal or unimodal exercise programs, on the number of falls in older adults (≥60 years). Ten databases were consulted (CINAHL, Cochrane Library, EBSCO, EMBASE, PEDro, PubMed, Scielo, Scopus, SPORTDiscus and Web of Science), without limitations on language or publication date. Eligibility criteria were as follows: RCTs with humans ≥60 years of age of any gender with one group performing supervised ST and a group performing another type of exercise training, reporting data pertaining falls. Certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Meta-analysis used a random effects model to calculate the risk ratio (RR) for number of falls. Five RCTs with six trials were included (n = 543, 76% women). There was no difference between ST and alternative exercise interventions for falls (RR = 1.00, 95% CI 0.77–1.30, p = 0.99). The certainty of evidence was very low. No dose–response relationship could be established. In sum, ST showed comparable RR based on number of falls in older adults when compared to other multimodal or unimodal exercise modalities, but evidence is scarce and heterogeneous, and additional research is required for more robust conclusions. Registration: PROSPERO CRD42020222908. Full article
(This article belongs to the Special Issue Improving Physical Function, Bone and Muscle Health in Older Adults)
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11 pages, 259 KiB  
Review
Review of Rhinitis: Classification, Types, Pathophysiology
by Georgia A. Liva, Alexander D. Karatzanis and Emmanuel P. Prokopakis
J. Clin. Med. 2021, 10(14), 3183; https://doi.org/10.3390/jcm10143183 - 19 Jul 2021
Cited by 51 | Viewed by 13286
Abstract
Rhinitis describes a pattern of symptoms as a result of nasal inflammation and/or dysfunction of the nasal mucosa. It is an umbrella entity that includes many different subtypes, several of which escape of complete characterization. Rhinitis is considered as a pathologic condition with [...] Read more.
Rhinitis describes a pattern of symptoms as a result of nasal inflammation and/or dysfunction of the nasal mucosa. It is an umbrella entity that includes many different subtypes, several of which escape of complete characterization. Rhinitis is considered as a pathologic condition with considerable morbidity and financial burden on health care systems worldwide. Its economic impact is further emphasized by the fact that it represents a risk factor for other conditions such as sinusitis, asthma, learning disabilities, behavioral changes, and psychological impairment. Rhinitis may be associated with many etiologic triggers such as infections, immediate-type allergic responses, inhaled irritants, medications, hormonal disturbances, and neural system dysfunction. It is basically classified into three major clinical phenotypes: allergic rhinitis (AR), infectious rhinitis, and non-allergic, non-infectious rhinitis (NAR). However, this subdivision may be considered as an oversimplification because a combined (mixed) phenotype exists in many individuals and different endotypes of rhinitis subgroups are overlapping. Due to the variety of pathophysiologic mechanisms (endotypes) and clinical symptoms (phenotypes), it is difficult to develop clear guidelines for diagnosis and treatment. This study aims to review the types of allergic and non-allergic rhinitis, providing a thorough analysis of the pathophysiological background, diagnostic approach, and main treatment options. Full article
(This article belongs to the Section Otolaryngology)
6 pages, 225 KiB  
Article
The Level of Conus Medullaris in 629 Healthy Japanese Individuals
by Hiroaki Nakashima, Keigo Ito, Yoshito Katayama, Mikito Tsushima, Kei Ando, Kazuyoshi Kobayashi, Masaaki Machino, Sadayuki Ito, Hiroyuki Koshimizu, Naoki Segi, Hiroyuki Tomita and Shiro Imagama
J. Clin. Med. 2021, 10(14), 3182; https://doi.org/10.3390/jcm10143182 - 19 Jul 2021
Cited by 6 | Viewed by 2623
Abstract
The conus medullaris typically terminates at the L1 level; however, variations in its level and the factors associated with the conus medullaris level are unclear. We investigated the level of conus medullaris on magnetic resonance imaging in healthy volunteers. In total, 629 healthy [...] Read more.
The conus medullaris typically terminates at the L1 level; however, variations in its level and the factors associated with the conus medullaris level are unclear. We investigated the level of conus medullaris on magnetic resonance imaging in healthy volunteers. In total, 629 healthy adult volunteers (≥50 individuals of each sex and in each decade of age from 20 to 70) were enrolled. The level of the conus medullaris was assessed based on the T2-weighted sagittal magnetic resonance images, and factors affecting its level were investigated employing multivariate regression analysis including the participants’ background and radiographical parameters. L1 was the most common conus medullaris level. Participant height was significantly shorter in the caudally placed conus medullaris (p = 0.013). With respect to the radiographical parameters, pelvic incidence (p = 0.003), and pelvic tilt (p = 0.03) were significantly smaller in participants with a caudally placed conus medullaris. Multiple regression analysis showed that the pelvic incidence (p < 0.0001) and height (p < 0.0001) were significant factors affecting the conus medullaris level. These results indicated that the length of the spinal cord varies little among individuals and that skeletal differences affect the level of the conus medullaris. Full article
(This article belongs to the Special Issue Current Advances in Spinal Diseases of Elderly Patients)
7 pages, 1134 KiB  
Article
Comparison of Efficacy between 120° and 180° Schlemm’s Canal Incision Microhook Ab Interno Trabeculotomy
by Naoki Okada, Kazuyuki Hirooka, Hiromitsu Onoe, Yumiko Murakami, Hideaki Okumichi and Yoshiaki Kiuchi
J. Clin. Med. 2021, 10(14), 3181; https://doi.org/10.3390/jcm10143181 - 19 Jul 2021
Cited by 17 | Viewed by 2008
Abstract
We compared surgical outcomes in patients with either primary open-angle glaucoma or exfoliation glaucoma after undergoing combined phacoemulsification with either a 120° or 180° incision during a Schlemm’s canal microhook ab interno trabeculotomy (μLOT-Phaco). This retrospective comparative case series examined 52 μLOT-Phaco eyes [...] Read more.
We compared surgical outcomes in patients with either primary open-angle glaucoma or exfoliation glaucoma after undergoing combined phacoemulsification with either a 120° or 180° incision during a Schlemm’s canal microhook ab interno trabeculotomy (μLOT-Phaco). This retrospective comparative case series examined 52 μLOT-Phaco eyes that underwent surgery between September 2017 and December 2020. Surgical qualified success was defined as an intraocular pressure (IOP) of ≤20 mmHg, ≥20% IOP reduction with IOP-lowering medications, and no additional glaucoma surgery. Success rates were evaluated by Kaplan-Meier survival analysis. The number of postoperative IOP-lowering medications and occurrence of complications were also assessed. Mean preoperative IOP in the 120° group was 16.9 ± 7.6 mmHg, which significantly decreased to 10.9 ± 2.7 mmHg (p < 0.01) and 11.1 ± 3.1 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.8 ± 1.4 to 1.4 ± 1.4 (p < 0.01) at 24 months. Mean preoperative IOP in the 180° group was 17.1 ± 7.0 mmHg, which significantly decreased to 12.1 ± 3.2 mmHg (p = 0.02) and 12.9 ± 1.4 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.9 ± 1.2 to 1.4 ± 1.5 (p < 0.01) at 24 months. The probability of qualified success at 24 months in the 120° and 180° groups was 50.4% and 54.6%, respectively (p = 0.58). There was no difference observed for hyphema formation or IOP spikes. Surgical outcomes were not significantly different between the 120° and 180° incisions in Schlemm’s canal. Full article
(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)
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10 pages, 265 KiB  
Article
Antiphospholipid Antibodies and Heart Failure with Preserved Ejection Fraction. The Multicenter ATHERO-APS Study
by Daniele Pastori, Paul R. J. Ames, Massimo Triggiani, Antonio Ciampa, Vittoria Cammisotto, Roberto Carnevale, Pasquale Pignatelli, Tommaso Bucci and on behalf of the ATHERO-APS Study Group
J. Clin. Med. 2021, 10(14), 3180; https://doi.org/10.3390/jcm10143180 - 19 Jul 2021
Cited by 8 | Viewed by 2510
Abstract
Background. The prevalence of heart failure with preserved ejection fraction (HFpEF) in patients with antiphospholipid syndrome (APS) is unknown. Methods. A prospective multicenter cohort study including 125 patients was conducted: 91 primary APS (PAPS), 18 APS-SLE, and 16 carriers. HFpEF was diagnosed according [...] Read more.
Background. The prevalence of heart failure with preserved ejection fraction (HFpEF) in patients with antiphospholipid syndrome (APS) is unknown. Methods. A prospective multicenter cohort study including 125 patients was conducted: 91 primary APS (PAPS), 18 APS-SLE, and 16 carriers. HFpEF was diagnosed according to the 2019 European Society of Cardiology criteria: patients with ≥5 points among major and minor functional and morphological criteria including NT-ProBNP > 220 pg/mL, left atrial (LA) enlargement, increased left ventricular filling pressure. Results. Overall, 18 (14.4%) patients were diagnosed with HFpEF; this prevalence increased from 6.3% in carriers to 13.2% in PAPS and 27.8% in APS-SLE. Patients with HFpEF were older and with a higher prevalence of hypertension and previous arterial events. At logistic regression analysis, age, arterial hypertension, anticardiolipin antibodies IgG > 40 GPL (odds ratio (OR) 3.43, 95% confidence interval (CI) 1.09–10.77, p = 0.035), anti β-2-glycoprotein-I IgG > 40 GPL (OR 5.28, 1.53–18.27, p = 0.009), lupus anticoagulants DRVVT > 1.25 (OR 5.20, 95% CI 1.10–24.68, p = 0.038), and triple positivity (OR 3.56, 95% CI 1.11–11.47, p = 0.033) were associated with HFpEF after adjustment for age and sex. By multivariate analysis, hypertension (OR 19.49, 95% CI 2.21–171.94, p = 0.008), age (OR 1.07, 95% CI 1.00–1.14, p = 0.044), and aβ2GPI IgG > 40 GPL (OR 8.62, 95% CI 1.23–60.44, p = 0.030) were associated with HFpEF. Conclusion. HFpEF is detectable in a relevant proportion of APS patients. The role of aPL in the pathogenesis and prognosis of HFpEF needs further investigation. Full article
(This article belongs to the Section Cardiology)
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15 pages, 619 KiB  
Article
Retrospective Study of Nosocomial Infections in the Orthopaedic and Rehabilitation Clinic of the Medical University of Lublin in the Years 2018–2020
by Agnieszka Tomczyk-Warunek, Tomasz Blicharski, Rudolf Blicharski, Ryszard Pluta, Piotr Dobrowolski, Siemowit Muszyński, Ewa Tomaszewska and Mirosław Jabłoński
J. Clin. Med. 2021, 10(14), 3179; https://doi.org/10.3390/jcm10143179 - 19 Jul 2021
Cited by 4 | Viewed by 3317
Abstract
Nosocomial infections appear in patients treated in hospital, which are not the initial cause of admission. A retrospective study concerning nosocomial infections was conducted to provide data about the amount, frequency and types of nosocomial infections in the rehabilitation ward in the Orthopaedics [...] Read more.
Nosocomial infections appear in patients treated in hospital, which are not the initial cause of admission. A retrospective study concerning nosocomial infections was conducted to provide data about the amount, frequency and types of nosocomial infections in the rehabilitation ward in the Orthopaedics and Rehabilitation Clinic of Lublin. The study was conducted on a group of 49 patients that were admitted or transferred to the ward over a period of 20 months in the years 2018–2020. The patients and therefore the infections were divided by age, sex, time of hospitalization and the underlying disease. The study also provided data about the most frequent infection types in these patients, as well as the most commonly used drugs to treat those infections. The results showed that in fact all of the examined factors have an impact on the frequency of nosocomial infections appearance rates. Furthermore, results in the study showed that factors examined by the study also have an impact on what type of infection was present in these groups of patients. Full article
(This article belongs to the Section Orthopedics)
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29 pages, 1954 KiB  
Review
Gender and Sex Are Key Determinants in Osteoarthritis Not Only Confounding Variables. A Systematic Review of Clinical Data
by Matilde Tschon, Deyanira Contartese, Stefania Pagani, Veronica Borsari and Milena Fini
J. Clin. Med. 2021, 10(14), 3178; https://doi.org/10.3390/jcm10143178 - 19 Jul 2021
Cited by 98 | Viewed by 6989
Abstract
Many risk factors for osteoarthritis (OA) have been noted, while gender/sex differences have been understated. The work aimed to systematically review literature investigating as primary aim the relationship between gender/sex related discriminants and OA. The search was performed in PubMed, Science Direct and [...] Read more.
Many risk factors for osteoarthritis (OA) have been noted, while gender/sex differences have been understated. The work aimed to systematically review literature investigating as primary aim the relationship between gender/sex related discriminants and OA. The search was performed in PubMed, Science Direct and Web of Knowledge in the last 10 years. Inclusion criteria were limited to clinical studies of patients affected by OA in any joints, analyzing as primary aim gender/sex differences. Exclusion criteria were review articles, in vitro, in vivo and ex vivo studies, case series studies and papers in which gender/sex differences were adjusted as confounding variable. Of the 120 records screened, 42 studies were included. Different clinical outcomes were analyzed: morphometric differences, followed by kinematics, pain, functional outcomes after arthroplasty and health care needs of patients. Women appear to use more health care, have higher OA prevalence, clinical pain and inflammation, decreased cartilage volume, physical difficulty, and smaller joint parameters and dimensions, as compared to men. No in-depth studies or mechanistic studies analyzing biomarker differential expressions, molecular pathways and omic profiles were found that might drive preclinical and clinical research towards sex-/gender-oriented protocols. Full article
(This article belongs to the Special Issue Gender Medicine: Pharmacometabolomics and Personalized Medicine)
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6 pages, 349 KiB  
Article
Premedication Does Not Influence the Incidence of Infliximab Infusion Reactions in Pediatric Patients with Inflammatory Bowel Disease—A Single Center Case–Control Study
by Edyta Szymanska, Maciej Dadalski, Joanna Sieczkowska-Golub, Dorota Jarzebicka, Monika Meglicka, Marcin Osiecki, Anna Wiernicka, Dariusz M. Lebensztejn, Bartosz Korczowski and Jaroslaw Kierkus
J. Clin. Med. 2021, 10(14), 3177; https://doi.org/10.3390/jcm10143177 - 19 Jul 2021
Cited by 4 | Viewed by 2052
Abstract
Background: Infusion reactions (IRs) are the most common adverse events (AEs) of infliximab (IFX) treatment in patients with inflammatory bowel disease (IBD). Prophylactic premedication (PM) with corticosteroids or antihistamines prior to IFX infusions has been used in clinical practice, but its efficacy is [...] Read more.
Background: Infusion reactions (IRs) are the most common adverse events (AEs) of infliximab (IFX) treatment in patients with inflammatory bowel disease (IBD). Prophylactic premedication (PM) with corticosteroids or antihistamines prior to IFX infusions has been used in clinical practice, but its efficacy is not known. The aim of this study was to assess the influence of steroid PM on IR incidence in pediatric patients with IBD receiving IFX. Methods: We performed a case–control study that included pediatric patients with IBD receiving IFX. Patients were divided into four subgroups according to the agent and PM they received: Remicade (original drug) + PM, and two biosimilars—Reshma +/− PM, and Flixabi—PM. At our site, until 2018, PM with steroids was used as a part of standard IFX infusion (PM+); however, since then, this method has no longer been administered (PM−). IRs were divided into mild/severe reactions. Differences between subgroups were assessed with the appropriate chi-square test. Multivariate logistic regression was used to assess associations between PM and IR incidence, correcting for co-medication usage. Results: There were 105 children (55 PM+, 44 male, mean age 15 years) included in the study who received 1276 infusions. There was no difference between the PM+ and PM− subgroups, either in incidence of IR (18.2% vs. 16.0% of patients, p > 0.05) or in percentage of infusions followed by IR (2.02% vs. 1.02% of infusions, p > 0.5). The OR of developing IR when using PM was 0.34, and the difference in IRs ratio in PM+ and PM− patients was not statistically significant (95% CI, 0.034–1.9). There were 11/18 (61.1%) severe IRs (anaphylactic shock) reported in all patients (both PM+ and PM−). Conclusion: At our site, the incidence of IR was low, and PM did not decrease the incidence of IR in pediatric patients with IBD receiving IFX. These results indicate that PM with steroids should not be a standard part of IFX infusion to prevent IR. Full article
(This article belongs to the Section Clinical Pediatrics)
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19 pages, 1745 KiB  
Article
Effects of Recombinant Human Growth Hormone Treatment, Depending on the Therapy Start in Different Nutritional Phases in Paediatric Patients with Prader–Willi Syndrome: A Polish Multicentre Study
by Agnieszka Lecka-Ambroziak, Marta Wysocka-Mincewicz, Katarzyna Doleżal-Ołtarzewska, Agata Zygmunt-Górska, Anna Wędrychowicz, Teresa Żak, Anna Noczyńska, Dorota Birkholz-Walerzak, Renata Stawerska, Maciej Hilczer, Monika Obara-Moszyńska, Barbara Rabska-Pietrzak, Elżbieta Gołębiowska, Adam Dudek, Elżbieta Petriczko, Mieczysław Szalecki and on behalf of the Polish Coordination Group for rhGH Treatment
J. Clin. Med. 2021, 10(14), 3176; https://doi.org/10.3390/jcm10143176 - 19 Jul 2021
Cited by 13 | Viewed by 2976
Abstract
Recombinant human growth hormone (rhGH) treatment is an established management in patients with Prader–Willi syndrome (PWS), with growth promotion and improvement in body composition and possibly the metabolic state. We compared anthropometric characteristics, insulin-like growth factor 1 (IGF1) levels, metabolic parameters and the [...] Read more.
Recombinant human growth hormone (rhGH) treatment is an established management in patients with Prader–Willi syndrome (PWS), with growth promotion and improvement in body composition and possibly the metabolic state. We compared anthropometric characteristics, insulin-like growth factor 1 (IGF1) levels, metabolic parameters and the bone age/chronological age index (BA/CA) in 147 children with PWS, divided according to age of rhGH start into four groups, corresponding to nutritional phases in PWS. We analysed four time points: baseline, rhGH1 (1.21 ± 0.81 years), rhGH2 (3.77 ± 2.17 years) and rhGH3 (6.50 ± 2.92 years). There were no major differences regarding height SDS between the groups, with a higher growth velocity (GV) (p = 0.00) and lower body mass index (BMI) SDS (p < 0.05) between the first and older groups during almost the whole follow-up. IGF1 SDS values were lower in group 1 vs. other groups at rhGH1 and vs. groups 2 and 3 at rhGH2 (p < 0.05). Glucose metabolism parameters were favourable in groups 1 and 2, and the lipid profile was comparable in all groups. BA/CA was similar between the older groups. rhGH therapy was most effective in the youngest patients, before the nutritional phase of increased appetite. We did not observe worsening of metabolic parameters or BA/CA advancement in older patients during a comparable time of rhGH therapy. Full article
(This article belongs to the Special Issue Endocrinology and Metabolic Diseases: Prader-Willi Syndrome)
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22 pages, 2315 KiB  
Review
Associates of Insomnia in People with Chronic Spinal Pain: A Systematic Review and Meta-Analysis
by Thomas Bilterys, Carolie Siffain, Ina De Maeyer, Eveline Van Looveren, Olivier Mairesse, Jo Nijs, Mira Meeus, Kelly Ickmans, Barbara Cagnie, Dorien Goubert, Lieven Danneels, Maarten Moens and Anneleen Malfliet
J. Clin. Med. 2021, 10(14), 3175; https://doi.org/10.3390/jcm10143175 - 19 Jul 2021
Cited by 21 | Viewed by 4418
Abstract
Insomnia is a major problem in the chronic spinal pain (CSP) population and has a negative impact on health and well-being. While insomnia is commonly reported, underlying mechanisms explaining the relation between sleep and pain are still not fully understood. Additionally, no reviews [...] Read more.
Insomnia is a major problem in the chronic spinal pain (CSP) population and has a negative impact on health and well-being. While insomnia is commonly reported, underlying mechanisms explaining the relation between sleep and pain are still not fully understood. Additionally, no reviews regarding the prevention of insomnia and/or associated factors in people with CSP are currently available. To gain a better understanding of the occurrence of insomnia and associated factors in this population, we conducted a systematic review of the literature exploring associates for insomnia in people with CSP in PubMed, Web of Science and Embase. Three independent reviewers extracted the data and performed the quality assessment. A meta-analysis was conducted for every potential associate presented in at least two studies. A total of 13 studies were found eligible, which together identified 25 different potential associates of insomnia in 24,817 people with CSP. Twelve studies had a cross-sectional design. Moderate-quality evidence showed a significantly higher rate for insomnia when one of the following factors was present: high pain intensity, anxiety and depression. Low-quality evidence showed increased odds for insomnia when one of the following factors was present: female sex, performing no professional activities and physical/musculoskeletal comorbidities. Higher healthcare use was also significantly related to the presence of insomnia. One study showed a strong association between high levels of pain catastrophizing and insomnia in people with chronic neck pain. Last, reduced odds for insomnia were found in physically active people with chronic low back pain compared to inactive people with chronic low back pain. This review provides an overview of the available literature regarding potential associates of insomnia in people with CSP. Several significant associates of insomnia were identified. These findings can be helpful to gain a better understanding of the characteristics and potential origin of insomnia in people witch CSP, to identify people with CSP who are (less) likely to have insomnia and to determine directions of future research in this area. Full article
(This article belongs to the Special Issue Lifestyle and Chronic Pain)
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10 pages, 1530 KiB  
Article
Disproportionate Vertebral Bodies and Their Impact on Lumbar Disc Herniation
by Ralph Läubli, Robin Brugger, Tatiana Pirvu, Sven Hoppe, Dominik Sieroń, Karol Szyluk, Christoph E. Albers and Andreas Christe
J. Clin. Med. 2021, 10(14), 3174; https://doi.org/10.3390/jcm10143174 - 19 Jul 2021
Cited by 3 | Viewed by 2827
Abstract
Background: The aim of this study was to determine whether the presence of disproportionate vertebral bodies is a risk factor for disc herniation (DH). Methods: Sixty-seven consecutive patients (m: 31 f: 36) who underwent lumbar discectomy for symptomatic DH at one level between [...] Read more.
Background: The aim of this study was to determine whether the presence of disproportionate vertebral bodies is a risk factor for disc herniation (DH). Methods: Sixty-seven consecutive patients (m: 31 f: 36) who underwent lumbar discectomy for symptomatic DH at one level between L3 and S1 were retrospectively included. The last three motion segments (3 × 67 = 201) were assessed on sagittal MRI scans. A disproportionate motion segment was defined as the difference of more than 10% of the antero-posterior diameter of two adjacent endplates. Results: DH was present in 6/67 (9%), 26/67 (38.8%), and 35/67 (52.2%) patients at L3/4, L4/5, and L5/S1, respectively. A total of 14 of 67 patients demonstrated a disproportionate motion segment at the discectomy level (20.9%). A total of 23 of the 201 (11.4%) investigated motion segments met our criteria for a disproportionate motion segment. In our study population, when one of the 201 segments was disproportionate, the positive predictive value (PPV) for DH increased toward the lower segments: the PPV at the L5/S1 level was 83.0%. The odds ratio of disproportion for DH was the highest at the L5/S1 level, with 6.0 ± 0.82 (p = 0.017). Conclusions: The presence of a disproportionate motion segment in the lower spine may lead to a significant higher risk for DH in patients undergoing discectomy. Full article
(This article belongs to the Section Orthopedics)
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13 pages, 1595 KiB  
Article
Relationship between Prognostic Stage in Breast Cancer and Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography
by Mio Mori, Tomoyuki Fujioka, Kazunori Kubota, Leona Katsuta, Yuka Yashima, Kyoko Nomura, Emi Yamaga, Junichi Tsuchiya, Tokuko Hosoya, Goshi Oda, Tsuyoshi Nakagawa, Iichiroh Onishi and Ukihide Tateishi
J. Clin. Med. 2021, 10(14), 3173; https://doi.org/10.3390/jcm10143173 - 19 Jul 2021
Cited by 8 | Viewed by 1917
Abstract
This retrospective study examined the relationship between the standardized uptake value max (SUVmax) of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and the prognostic stage of breast cancer. We examined 358 breast cancers in 334 patients who underwent 18F-FDG [...] Read more.
This retrospective study examined the relationship between the standardized uptake value max (SUVmax) of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and the prognostic stage of breast cancer. We examined 358 breast cancers in 334 patients who underwent 18F-FDG PET/CT for initial staging between January 2016 and December 2019. We extracted data including SUVmax of 18F-FDG PET and pathological biomarkers, including estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and nuclear grade. Anatomical and prognostic stages were determined per the American Joint Committee on Cancer (eighth edition). We examined whether there were statistical differences in SUVmax between each prognostic stage. The mean SUVmax values for clinical prognostic stages were as follow: stage 0, 2.2 ± 1.4; stage IA, 2.6 ± 2.1; stage IB, 4.2 ± 3.5; stage IIA, 5.2 ± 2.8; stage IIB, 7.7 ± 6.7; and stage III + IV, 7.0 ± 4.5. The SUVmax values for pathological prognostic stages were as follows: stage 0, 2.2 ± 1.4; stage IA, 2.8 ± 2.2; stage IB, 5.4 ± 3.6; stage IIA, 6.3 ± 3.1; stage IIB, 9.2 ± 7.5, and stage III + IV, 6.2 ± 5.2. There were significant differences in mean SUVmax between clinical prognostic stage 0 and ≥II (p < 0.001) and I and ≥II (p < 0.001). There were also significant differences in mean SUVmax between pathological prognostic stage 0 and ≥II (p < 0.001) and I and ≥II (p < 0.001). In conclusion, mean SUVmax increased with all stages up to prognostic stage IIB, and there were significant differences between several stages. The SUVmax of 18F-FDG PET/CT may contribute to prognostic stage stratification, particularly in early cases of breast cancers. Full article
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7 pages, 359 KiB  
Article
The Incidence of Radial Artery Occlusion in Critically Ill Patients after Cannulation with a Long Catheter
by Magdalena Wujtewicz, Bartosz Regent, Rozalia Marszałek-Ratnicka, Aneta Smugała, Edyta Szurowska and Radosław Owczuk
J. Clin. Med. 2021, 10(14), 3172; https://doi.org/10.3390/jcm10143172 - 19 Jul 2021
Cited by 1 | Viewed by 1911
Abstract
Cardiac output monitoring is a common practice in critically ill patients. The PiCCO (pulse index continuous cardiac output) method requires artery cannulation. According to the manufacturer, the cannula in the radial artery should be removed after three days. However, longer monitoring is sometimes [...] Read more.
Cardiac output monitoring is a common practice in critically ill patients. The PiCCO (pulse index continuous cardiac output) method requires artery cannulation. According to the manufacturer, the cannula in the radial artery should be removed after three days. However, longer monitoring is sometimes necessary. The aim of this study was to assess the incidence of radial artery occlusion (RAO) after three days of cannulation and to check whether five-day cannulation is related to a higher occlusion rate. An additional assessment was made to verify the presence of occlusion three, fourteen and thirty days after decannulation. The PiCCO cannula was inserted into the radial artery after the Barbeau test and Doppler assessment of blood flow. It was left for three or five days. Doppler was performed immediately after its removal and at three, fourteen and thirty days following decannulation. Thirty-seven patients were randomly assigned for three or five days of cannulation, and twenty-three of them were eligible for further analysis. RAO was found in thirteen (56.5%) patients. No statistical difference was found between the RAO rate for three and five day cannulations (p = 0.402). The incidence of RAO was lower when the right radial artery was cannulated (p = 0.022; OR 0.129). Radial artery cannulation with a PiCCO catheter poses a risk of RAO. However, the incidence of prolonged cannulation appeared to not increase the risk of artery occlusion. ClinicalTrials.gov ID NCT02695407. Full article
(This article belongs to the Section Intensive Care)
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10 pages, 551 KiB  
Article
Risk Factors for Non-Contact Lower-Limb Injury: A Retrospective Survey in Pediatric-Age Athletes
by Yanfei Guan, Shannon S. D. Bredin, Jack Taunton, Qinxian Jiang, Nana Wu, Yongfeng Li and Darren E. R. Warburton
J. Clin. Med. 2021, 10(14), 3171; https://doi.org/10.3390/jcm10143171 - 19 Jul 2021
Cited by 7 | Viewed by 3057
Abstract
Background: Risk factors for non-contact lower-limb injury in pediatric-age athletes and the effects of lateral dominance in sport (laterally vs. non-laterally dominant sports) on injury have not been investigated. Purpose: To identify risk factors for non-contact lower-limb injury in pediatric-age athletes. Methods: Parents [...] Read more.
Background: Risk factors for non-contact lower-limb injury in pediatric-age athletes and the effects of lateral dominance in sport (laterally vs. non-laterally dominant sports) on injury have not been investigated. Purpose: To identify risk factors for non-contact lower-limb injury in pediatric-age athletes. Methods: Parents and/or legal guardians of 2269 athletes aged between 6–17 years were recruited. Each participant completed an online questionnaire that contained 10 questions about the athlete’s training and non-contact lower-limb injury in the preceding 12 months. Results: The multivariate logistic regression model determined that lateral dominance in sport (adjusted OR (laterally vs. non-laterally dominant sports), 1.38; 95% CI, 1.10–1.75; p = 0.006), leg preference (adjusted OR (right vs. left-leg preference), 0.71; 95% CI, 0.53–0.95; p = 0.023), increased age (adjusted OR, 1.21; 95% CI, 1.16–1.26; p = 0.000), training intensity (adjusted OR, 1.77; 95% CI, 1.43–2.19; p = 0.000), and training frequency (adjusted OR, 1.36; 95% CI, 1.25–1.48; p = 0.000) were significantly associated with non-contact lower-limb injury in pediatric-age athletes. Length of training (p = 0.396) and sex (p = 0.310) were not associated with a non-contact lower-limb injury. Conclusions: Specializing in laterally dominant sports, left-leg preference, increase in age, training intensity, and training frequency indicated an increased risk of non-contact lower-limb injury in pediatric-age athletes. Future research should take into account exposure time and previous injury. Full article
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12 pages, 2856 KiB  
Article
Localized Atrial Tachycardia and Dispersion Regions in Atrial Fibrillation: Evidence of Spatial Concordance
by Edouard Gitenay, Clément Bars, Michel Bremondy, Anis Ayari, Nicolas Maillot, Florian Baptiste, Antonio Taormina, Aicha Fofana, Sabrina Siame, Jérôme Kalifa and Julien Seitz
J. Clin. Med. 2021, 10(14), 3170; https://doi.org/10.3390/jcm10143170 - 18 Jul 2021
Cited by 2 | Viewed by 2445
Abstract
Introduction: During atrial fibrillation (AF) ablation, it is generally considered that atrial tachycardia (AT) episodes are a consequence of ablation. Objective: To investigate the spatial relationship between localized AT episodes and dispersion/ablation regions during persistent AF ablation procedures. Methods: We analyzed 72 consecutive patients who [...] Read more.
Introduction: During atrial fibrillation (AF) ablation, it is generally considered that atrial tachycardia (AT) episodes are a consequence of ablation. Objective: To investigate the spatial relationship between localized AT episodes and dispersion/ablation regions during persistent AF ablation procedures. Methods: We analyzed 72 consecutive patients who presented for an index persistent AF ablation procedure guided by the presence of spatiotemporal dispersion of multipolar electrograms. We characterized spontaneous or post-ablation ATs’ mechanism and location in regard to dispersion regions and ablation lesions. Results: In 72 consecutive patients admitted for persistent AF ablation, 128 ATs occurred in 62 patients (1.9 ± 1.1/patient). Seventeen ATs were recorded before any ablation. In a total of 100 ATs with elucidated mechanism, there were 58 localized sources and 42 macro-reentries. A large number of localized ATs arose from regions exhibiting dispersion during AF (n = 49, 84%). Importantly, these ATs’ locations were generally remote from the closest ablation lesion (n = 42, 72%). Conclusions: In patients undergoing a persistent AF ablation procedure guided by the presence of spatiotemporal dispersion of multipolar electrograms, localized ATs originate within dispersion regions but remotely from the closest ablation lesion. These results suggest that ATs represent a stabilized manifestation of co-existing AF drivers rather than ablation-induced arrhythmias. Full article
(This article belongs to the Special Issue New Perspective in Atrial Fibrillation)
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12 pages, 1110 KiB  
Article
Combined Transoral Robotic Tongue Base Surgery and Palate Surgery in Obstructive Sleep Apnea Syndrome: Modified Uvulopalatopharyngoplasty versus Barbed Reposition Pharyngoplasty
by Yung-An Tsou, Chun-Chieh Hsu, Liang-Chun Shih, Tze-Chieh Lin, Chien-Jen Chiu, Vincent Hui-Chi Tien, Ming-Hsui Tsai and Wen-Dien Chang
J. Clin. Med. 2021, 10(14), 3169; https://doi.org/10.3390/jcm10143169 - 18 Jul 2021
Cited by 9 | Viewed by 4403
Abstract
Background: Successful surgery outcomes are limited to moderate to severe obstructive sleep apnea (OSA) syndrome. Multilevel collapse at retropalatal and retroglossal areas is often found during the drug-induced sleep endoscopy (DISE). Therefore, multilevel surgery is considered for these patients. The aim of our [...] Read more.
Background: Successful surgery outcomes are limited to moderate to severe obstructive sleep apnea (OSA) syndrome. Multilevel collapse at retropalatal and retroglossal areas is often found during the drug-induced sleep endoscopy (DISE). Therefore, multilevel surgery is considered for these patients. The aim of our study was to survey surgical outcomes by modified uvulopalatoplasty (UPPP) plus transoral robotic surgery tongue base reduction (TORSTBR) versus barbed repositioning pharyngoplasty (BRP) plus TORSTBR. Methods: The retrospective cohort study was performed at a tertiary referral center. We collected moderate to severe OSA patients who were not tolerant to positive pressure assistant PAP from September 2016 to September 2019; pre-operative–operative Muller tests all showed retropalatal and retroglossal collapse; pre-operative Friedman Tongue Position (FTP) > III, with the tonsils grade at grade II minimum, with simultaneous velum (V > 1) and tongue base (T > 1), collapsed by drug-induced sleep endoscopy (DISE) under the VOTE grading system. The UPPP plus TORSTBR (n = 31) and BRP plus TORSTBR (n = 31) techniques were offered. We compare the outcomes using an Epworth sleepiness scale (ESS) questionnaire, and measure the patients’ apnea–hypopnea index (AHI), lowest O2 saturation, cumulative time spent below 90% (CT90), and arousal index (AI) by polysomnography six months after surgery; we also measure their length of hospital stay and complications between these two groups. Results: Comparing BRP plus TORSTBR with UPPP plus TORSTBR, the surgical success rate is 67.74% and 38.71%, respectively. The significantly higher surgical success rate in the BRP plus TORSTBR group was noted. The surgical time is shorter in the BRP plus TORSTBR group. The complication rate is not significant in pain, bleeding, dysgeusia, dysphagia, globus sensation, and prolonged suture stay, even though the BRP plus TORSTBR rendered a higher percentage of globus sensation during swallowing and a more prevalent requirement of suture removal one month after surgery. The length of hospital stay is not significantly different between the two groups. Conclusion: In conclusion, BRP plus TORSTBR is a considerable therapy for moderate to severe OSA patients with DISE showing a multi-level collapse in velum and tongue base area. The BRP technique might offer a better anterior–posterior suspension vector for palate level obstruction. Full article
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12 pages, 1071 KiB  
Article
Improvement of the Quality of Life in Aging by Stimulating Autobiographical Memory
by Alba Villasán Rueda, Antonio Sánchez Cabaco, Manuel Mejía-Ramírez, Susana I. Justo-Henriques and Janessa O. Carvalho
J. Clin. Med. 2021, 10(14), 3168; https://doi.org/10.3390/jcm10143168 - 18 Jul 2021
Cited by 8 | Viewed by 4005
Abstract
With notable increases in older adult populations, as well as with the associated cognitive impairments that can accompany aging, there is significant importance in identifying strategies to promote cognitive health. The current study explored the implementation of a positive reminiscence program (REMPOS), a [...] Read more.
With notable increases in older adult populations, as well as with the associated cognitive impairments that can accompany aging, there is significant importance in identifying strategies to promote cognitive health. The current study explored the implementation of a positive reminiscence program (REMPOS), a non-pharmacological cognitive therapy that has been previously structured, defined, and tested in a Spanish sample. We sought to improve the quality of life of institutionalized older adults with healthy aging, mild cognitive impairment, and Alzheimer’s disease by utilizing this protocol in these samples. A randomized design with a pre-post measure was conducted over a three-month period. Two types of interventions were used: the experimental groups received REMPOS, and the control groups underwent their regular daily institutional programming with cognitive stimulation techniques. After the intervention, the three experimental groups showed higher cognitive functioning, decreased depressive symptomatology (except for the MCI group) and higher evocation of specific positive memories (except for the MCI group). This study supports the effectiveness of REMPOS and reminiscence therapy, with regard to both cognitive and mood factors in cognitively impaired older adults. Full article
(This article belongs to the Special Issue Psychological Treatment for Older Adults and Their Caregivers)
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10 pages, 612 KiB  
Article
Serum Biomarkers in Differential Diagnosis of Idiopathic Pulmonary Fibrosis and Connective Tissue Disease-Associated Interstitial Lung Disease
by Eva Cabrera Cesar, Lidia Lopez-Lopez, Estrella Lara, M. Victoria Hidalgo-San Juan, Concepcion Parrado Romero, Jose Luis Royo Sánchez Palencia, Elisa Martín-Montañez and Maria Garcia-Fernandez
J. Clin. Med. 2021, 10(14), 3167; https://doi.org/10.3390/jcm10143167 - 18 Jul 2021
Cited by 9 | Viewed by 2981
Abstract
Introduction: The goal of this study is to determine whether Advanced glycosylated end-products (AGE), Advanced oxidation protein products (AOPP) and Matrix metalloproteinase 7 (MMP7) could be used as differential biomarkers for idiopathic pulmonary fibrosis (IPF) and connective tissue disease-associated interstitial lung disease (CTD-ILD). [...] Read more.
Introduction: The goal of this study is to determine whether Advanced glycosylated end-products (AGE), Advanced oxidation protein products (AOPP) and Matrix metalloproteinase 7 (MMP7) could be used as differential biomarkers for idiopathic pulmonary fibrosis (IPF) and connective tissue disease-associated interstitial lung disease (CTD-ILD). Method: Seventy-three patients were enrolled: 29 with IPF, 14 with CTD-ILD, and 30 healthy controls. The study included a single visit by participants. A blood sample was drawn and serum was analysed for AGE using spectrofluorimetry, AOPP by spectrophotometry, and MMP7 using sandwich-type enzyme-linked immunosorbent assay. Results: AGE, AOPP and MMP7 serum levels were significantly higher in both IPF and CTD-ILD patients versus healthy controls; and AGE was also significantly elevated in CTD-ILD compared to the IPF group. AGE plasma levels clearly distinguished CTD-ILD patients from healthy participants (AUC = 0.95; 95% IC 0.86–1), whereas in IPF patients, the distinction was moderate (AUC = 0.78; 95% IC 0.60–0.97). Conclusion: In summary, our results provide support for the potential value of serum AGE, AOPP and MMP7 concentrations as diagnostic biomarkers in IPF and CTD-ILD to differentiate between ILD patients and healthy controls. Furthermore, this study provides evidence, for the first time, for the possible use of AGE as a differential diagnostic biomarker to distinguish between IPF and CTD-ILD. The value of these biomarkers as additional tools in a multidisciplinary approach to IPF and CTD-ILD diagnosis needs to be considered and further explored. Multicentre studies are necessary to understand the role of AGE in differential diagnosis. Full article
(This article belongs to the Section Pulmonology)
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