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J. Clin. Med., Volume 10, Issue 23 (December-1 2021) – 252 articles

Cover Story (view full-size image): The COVID-19 pandemic has adversely affected the provision of healthcare and disease management around the world. Heart failure (HF) patients are particularly at risk for severe COVID-19 disease and high mortality rates. This paper evaluated the clinical outcomes and management of HF patients during the COVID-19 pandemic in Israel. In a cohort of 6748 chronic HF patients, 12.5% were infected with COVID-19, and there was a very high (23%) mortality rate. During the pandemic, there was a marked decrease in the usage of medical services including hospitalizations. However, mortality rates in HF patients were very similar to the years prior to COVID-19. There was a decline in non-COVID-19 deaths, substituted with deaths due to COVID-19. This surprising 'protective' effect could be due to reduced exposure to respiratory infections and other insults, attributed to social distancing. View this paper.
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15 pages, 1232 KiB  
Article
The Effect of Periprocedural Clinical Factors Related to the Course of STEMI in Men and Women Based on the National Registry of Invasive Cardiology Procedures (ORPKI) between 2014 and 2019
by Janusz Sielski, Karol Kaziród-Wolski, Karolina Jurys, Paweł Wałek and Zbigniew Siudak
J. Clin. Med. 2021, 10(23), 5716; https://doi.org/10.3390/jcm10235716 - 6 Dec 2021
Cited by 5 | Viewed by 2156
Abstract
Background: There are several sex-related differences in the course, management, and outcomes of ST-elevation myocardial infarction (STEMI). This study aimed to identify the risk factors that may affect the odds of procedure-related death in patients with STEMI. Methods: The observational cohort study group [...] Read more.
Background: There are several sex-related differences in the course, management, and outcomes of ST-elevation myocardial infarction (STEMI). This study aimed to identify the risk factors that may affect the odds of procedure-related death in patients with STEMI. Methods: The observational cohort study group consisted of 118,601 participants recruited from the National Registry of Invasive Cardiology Procedures (ORPKI). Results: Procedure-related death occurred in 802 (1.0%) men and in 663 (1.7%) women. The odds of procedure-related death among women were significantly higher than among men (OR, 1.76; 95% CI, 1.59–1.95; p < 0.001). The probability of procedure-related mortality was highest in both men and women with cardiac arrest in the cath lab, critical stenosis of the left main coronary artery, and direct transfer to the cath lab. The factors that reduced the probability of procedure-related mortality in both men and women were thrombolysis in myocardial infarction (TIMI) flow grade and the use of P2Y12 inhibitors in the peri-infarct period. Psoriasis was associated with increased odds of procedure-related death among men, whereas cigarette smoking reduced the odds among women. Conclusions: Procedure-related deaths occurred more frequently in women than men with STEMI. Additional scrutiny needs to be undertaken to identify factors influencing survival regarding gender differences. Full article
(This article belongs to the Section Cardiology)
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13 pages, 1152 KiB  
Article
Stage 2: Who Are the Best Candidates for Robotic Gait Training Rehabilitation in Hemiparetic Stroke?
by Wonjun Oh, Chanhee Park, Seungjun Oh and Sung (Joshua) H. You
J. Clin. Med. 2021, 10(23), 5715; https://doi.org/10.3390/jcm10235715 - 6 Dec 2021
Cited by 6 | Viewed by 3125
Abstract
We aimed to compare the effects of robotic-assisted gait training (RAGT) in patients with FAC < 2 (low initial functional ambulation category [LFAC]) and FAC ≥ 2 (high initial functional ambulation category [HFAC]) on sensorimotor and spasticity, balance and trunk stability, the number [...] Read more.
We aimed to compare the effects of robotic-assisted gait training (RAGT) in patients with FAC < 2 (low initial functional ambulation category [LFAC]) and FAC ≥ 2 (high initial functional ambulation category [HFAC]) on sensorimotor and spasticity, balance and trunk stability, the number of steps and walking distance in subacute hemiparetic stroke. Fifty-seven patients with subacute hemiparetic stroke (mean age, 63.86 ± 12.72 years; 23 women) were assigned to two groups. All patients received a 30-min Walkbot-assisted gait training session, 3 times/week, for 6 weeks. Clinical outcomes included scores obtained on the Fugl–Meyer Assessment (FMA) scale, Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), trunk impairment scale (TIS), and the number of walking steps and walking distance. Analysis of covariance and analysis of variance were conducted at p < 0.05. Significant main effects of time in both groups on number of walking steps and distance (p < 0.05) were observed, but not in MAS (p> 0.05). Significant changes in FMA, BBS, and TIS scores between groups (p < 0.05) were observed. Significant main effects of time on BBS and TIS were demonstrated (p < 0.05). Our study shows that RAGT can maximize improvement in the functional score of FMA, BBS, TIS, steps, and distance during neurorehabilitation of subacute stroke patients regardless of their FAC level. Full article
(This article belongs to the Topic Age-Related Neurodegenerative Diseases and Stroke)
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28 pages, 529 KiB  
Review
Leptin—A Potential Bridge between Fat Metabolism and the Brain’s Vulnerability to Neuropsychiatric Disorders: A Systematic Review
by Gilmara Gomes de Assis and Eugenia Murawska-Ciałowicz
J. Clin. Med. 2021, 10(23), 5714; https://doi.org/10.3390/jcm10235714 - 6 Dec 2021
Cited by 7 | Viewed by 2762
Abstract
Background: Obesity and being overweight have been described as potential causes of neurological disorders. Leptin, a peptide expressed in fat tissue, importantly participates in energy homeostasis and storage and has recently been identified for its signaling receptors in neuronal circuits of the brain. [...] Read more.
Background: Obesity and being overweight have been described as potential causes of neurological disorders. Leptin, a peptide expressed in fat tissue, importantly participates in energy homeostasis and storage and has recently been identified for its signaling receptors in neuronal circuits of the brain. Aim: To elucidate whether the endogenous modulation of leptin can be a protection against neuropsychiatric disorders. Method: A systematic review was performed in accordance with the PRISMA-P method, and reports of studies containing data of leptin concentrations in healthy individuals with or without obesity were retrieved from the PubMed database, using the combinations of Mesh terms for “Leptin” and “Metabolism”. Results: Forty-seven randomized and non-randomized controlled trials, dating from 2000 to 2021, were included in the qualitative synthesis. Discussion and conclusions: Leptin secretion displays a stabilizing pattern that is more sensitive to a negative energy intake imbalance. Leptin levels influence body weight and fat mass as a pro-homeostasis factor. However, long-term exposure to elevated leptin levels may lead to mental/behavioral disorders related to the feeding and reward systems. Full article
(This article belongs to the Section Endocrinology & Metabolism)
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13 pages, 10112 KiB  
Article
Differences in Adiposity Profile and Body Fat Distribution between Forwards and Backs in Sub-Elite Spanish Female Rugby Union Players
by Dolores Escrivá, Jordi Caplliure-Llopis, Inmaculada Benet, Gonzalo Mariscal, Juan Vicente Mampel and Carlos Barrios
J. Clin. Med. 2021, 10(23), 5713; https://doi.org/10.3390/jcm10235713 - 6 Dec 2021
Cited by 8 | Viewed by 2810
Abstract
The purpose of this study was to analyze the adiposity profile and the body fat distribution in 56 sub-elite female rugby union players involved in the Spanish National Women’s Rugby Union Championships. The participants included in this study, which was the first to [...] Read more.
The purpose of this study was to analyze the adiposity profile and the body fat distribution in 56 sub-elite female rugby union players involved in the Spanish National Women’s Rugby Union Championships. The participants included in this study, which was the first to analyze sub-elite players, show thinner skinfolds, lower fat mass, and lesser fat percentage than previously reported for elite female rugby union players. Forwards were heavier and had higher body mass index (BMI) and fat mass, thicker skinfolds, and higher fat percentage than back players. Forwards also possessed significantly greater total fat-free mass than backs. All these differences were applicable only to players under 25 years of age. A negative correlation between age and both abdominal and lower extremity fat was found in forward players but not in the backs. Both Yuhasz and Faulkner equations tended to underestimate fat percentage in comparison to Reilly equation. Although Yuhasz equation provided higher systematic error, random error was lower in comparison to Faulkner equation. This study shows the relevance of analyzing and monitoring adiposity in female rugby union players to optimize adaptation to the sports requirements of different playing positions and age. Full article
(This article belongs to the Special Issue Health, Quality of Life and Sport Rehabilitation)
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17 pages, 867 KiB  
Review
Diagnostic, Prognostic, and Therapeutic Value of Droplet Digital PCR (ddPCR) in COVID-19 Patients: A Systematic Review
by Angela Ishak, Mousa M. AlRawashdeh, Stepan M. Esagian and Ilias P. Nikas
J. Clin. Med. 2021, 10(23), 5712; https://doi.org/10.3390/jcm10235712 - 6 Dec 2021
Cited by 19 | Viewed by 4007
Abstract
Accurate detection of SARS-CoV-2, the pathogen causing the global pandemic of COVID-19, is essential for disease surveillance and control. Quantitative reverse transcription PCR (RT-qPCR) is considered the reference standard test for the diagnosis of SARS-CoV-2 by the World Health Organization and Centers for [...] Read more.
Accurate detection of SARS-CoV-2, the pathogen causing the global pandemic of COVID-19, is essential for disease surveillance and control. Quantitative reverse transcription PCR (RT-qPCR) is considered the reference standard test for the diagnosis of SARS-CoV-2 by the World Health Organization and Centers for Disease Control and Prevention. However, its limitations are a prompt for a more accurate assay to detect SARS-CoV-2, quantify its levels, and assess the prognosis. This article aimed to systematically review the literature and assess the diagnostic performance of droplet digital PCR (ddPCR), also to evaluate its potential role in prognosis and management of COVID-19 patients. PubMed and Scopus databases were searched to identify relevant articles published until 13 July 2021. An additional PubMed search was performed on 21 October 2021. Data from the 39 eligible studies were extracted and an overall 3651 samples from 2825 patients and 145 controls were used for our qualitative analysis. Most studies reported ddPCR was more accurate than RT-qPCR in detecting and quantifying SARS-CoV-2 levels, especially in patients with low viral loads. ddPCR was also found highly effective in quantifying SARS-CoV-2 RNAemia levels in hospitalized patients, monitoring their disease course, and predicting their response to therapy. These findings suggest ddPCR could serve as a complement or alternative SARS-CoV-2 tool with emerging diagnostic, prognostic, and therapeutic value, especially in hospital settings. Additional research is still needed to standardize its laboratory protocols, also to accurately assess its role in monitoring COVID-19 therapy response and in identifying SARS-CoV-2 emerging variants. Full article
(This article belongs to the Special Issue New Diagnostic Assays for COVID-19)
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16 pages, 2928 KiB  
Article
Membrane of Plasma Rich in Growth Factors in Primary Pterygium Surgery Compared to Amniotic Membrane Transplantation and Conjunctival Autograft
by Miriam Idoipe, Borja de la Sen-Corcuera, Ronald M. Sánchez-Ávila, Carmen Sánchez-Pérez, María Satué, Antonio Sánchez-Pérez, Gorka Orive, Francisco Muruzabal, Eduardo Anitua and Luis Pablo
J. Clin. Med. 2021, 10(23), 5711; https://doi.org/10.3390/jcm10235711 - 6 Dec 2021
Cited by 5 | Viewed by 2086
Abstract
This prospective and comparative study aimed to compare the use of a conjunctival autograft (CAG), plasma rich in growth factors fibrin membrane (mPRGF) or amniotic membrane transplantation (AMT) in primary pterygium surgery. Patients were assigned for surgery with CAG (group A), mPRGF (group [...] Read more.
This prospective and comparative study aimed to compare the use of a conjunctival autograft (CAG), plasma rich in growth factors fibrin membrane (mPRGF) or amniotic membrane transplantation (AMT) in primary pterygium surgery. Patients were assigned for surgery with CAG (group A), mPRGF (group B), or AMT (group C). Pterygium recurrence, Best Corrected Visual Acuity (BCVA), graft size (measured with anterior segment optical coherence tomography (AS-OCT)), and ocular surface symptoms (visual analogue scale (VAS) and ocular surface disease index (OSDI)) were evaluated. Thirteen eyes in group A, 26 in group B, and 10 in group C were evaluated. No changes in BCVA (p > 0.05) were found. Recurrence cases for groups A, B, and C were none, two, and two, respectively, and three cases of pyogenic granulomas in group A. The horizontal/vertical graft size was lower in group B vs group A (p < 0.05) from months 1 to 12. The improvement in VAS frequency for groups A, B, and C was: 35.5%, 86.2%, and 39.1%, respectively. The OSDI scale reduction for groups A, B, and C was: 12.7%, 39.0%, and 84.1%. The use of the three surgical techniques as a graft for primary pterygium surgery was safe and effective, showing similar results. The mPRGF graft represents an autologous novel approach for pterygium surgery. Full article
(This article belongs to the Special Issue Treatment of Cornea and Ocular Surface Diseases)
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37 pages, 6682 KiB  
Review
Artificial Intelligence: A Shifting Paradigm in Cardio-Cerebrovascular Medicine
by Vida Abedi, Seyed-Mostafa Razavi, Ayesha Khan, Venkatesh Avula, Aparna Tompe, Asma Poursoroush, Alireza Vafaei Sadr, Jiang Li and Ramin Zand
J. Clin. Med. 2021, 10(23), 5710; https://doi.org/10.3390/jcm10235710 - 6 Dec 2021
Cited by 6 | Viewed by 4354
Abstract
The future of healthcare is an organic blend of technology, innovation, and human connection. As artificial intelligence (AI) is gradually becoming a go-to technology in healthcare to improve efficiency and outcomes, we must understand our limitations. We should realize that our goal is [...] Read more.
The future of healthcare is an organic blend of technology, innovation, and human connection. As artificial intelligence (AI) is gradually becoming a go-to technology in healthcare to improve efficiency and outcomes, we must understand our limitations. We should realize that our goal is not only to provide faster and more efficient care, but also to deliver an integrated solution to ensure that the care is fair and not biased to a group of sub-population. In this context, the field of cardio-cerebrovascular diseases, which encompasses a wide range of conditions—from heart failure to stroke—has made some advances to provide assistive tools to care providers. This article aimed to provide an overall thematic review of recent development focusing on various AI applications in cardio-cerebrovascular diseases to identify gaps and potential areas of improvement. If well designed, technological engines have the potential to improve healthcare access and equitability while reducing overall costs, diagnostic errors, and disparity in a system that affects patients and providers and strives for efficiency. Full article
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12 pages, 1500 KiB  
Article
Anti-Xa Activity of Enoxaparin for Prevention of Venous Thromboembolism in Severe Nephrotic Syndrome—A Single Center Prospective Study
by Anna Matyjek, Aleksandra Rymarz, Zuzanna Nowicka, Slawomir Literacki, Tomasz Rozmyslowicz and Stanislaw Niemczyk
J. Clin. Med. 2021, 10(23), 5709; https://doi.org/10.3390/jcm10235709 - 6 Dec 2021
Cited by 3 | Viewed by 2736
Abstract
Severe nephrotic syndrome (NS) is associated with high risk of venous thromboembolic events (VTE), as well as presumably altered heparin pharmacokinetics and pharmacodynamics. Although prophylactic anticoagulation is recommended, the optimal dose is not established. The aim of the study was to test two [...] Read more.
Severe nephrotic syndrome (NS) is associated with high risk of venous thromboembolic events (VTE), as well as presumably altered heparin pharmacokinetics and pharmacodynamics. Although prophylactic anticoagulation is recommended, the optimal dose is not established. The aim of the study was to test two co-primary hypotheses: of reduced enoxaparin effectiveness and of the need for dose-adjustment in NS. Forty two nephrotic patients with serum albumin ≤2.5 g/dL were alternately assigned to a standard fixed-dose of enoxaparin (NS-FD: 40 mg/day) or ideal body weight (IBW)-based adjusted-dose (NS-AD: 1 mg/kg/day). Twenty one matched non-proteinuric individuals (C-FD) also received fixed-dose. Co-primary outcomes were: the achievement of low- and high-VTE risk threshold of antifactor-Xa activity (anti-FXa) defined as 0.2 IU/mL and 0.3 IU/mL, respectively. Low-VTE-risk threshold was achieved less often in NS-FD than C-FD group (91 vs. 62%, p = 0.024), while the high-VTE-risk threshold more often in NS-AD than in NS-FD group (90 vs. 38%, p < 0.001). Two VTE were observed in NS during 12 months of follow-up (incidence: 5.88%/year). In both cases anti-FXa were 0.3 IU/mL implying the use of anti-FXa >0.3 IU/mL as a target for dose-adjustment logistic regression models. We determined the optimal dose/IBW cut-off value at 0.8 mg/kg and further developed bivariate model (termed the DoAT model) including dose/IBW and antithrombin activity that improved the diagnostic accuracy (AUC 0.85 ± 0.06 vs. AUC 0.75 ± 0.08). Enoxaparin efficacy is reduced in severe NS and the dose should be adjusted to ideal body weight to achieve target anti-FXa activity. Full article
(This article belongs to the Section Nephrology & Urology)
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11 pages, 2064 KiB  
Article
PEACE: Perception and Expectations toward Artificial Intelligence in Capsule Endoscopy
by Romain Leenhardt, Ignacio Fernandez-Urien Sainz, Emanuele Rondonotti, Ervin Toth, Cedric Van de Bruaene, Peter Baltes, Bruno Joel Rosa, Konstantinos Triantafyllou, Aymeric Histace, Anastasios Koulaouzidis, Xavier Dray and on behalf of the I-CARE Group
J. Clin. Med. 2021, 10(23), 5708; https://doi.org/10.3390/jcm10235708 - 6 Dec 2021
Cited by 13 | Viewed by 2615
Abstract
Artificial intelligence (AI) has shown promising results in digestive endoscopy, especially in capsule endoscopy (CE). However, some physicians still have some difficulties and fear the advent of this technology. We aimed to evaluate the perceptions and current sentiments toward the use of AI [...] Read more.
Artificial intelligence (AI) has shown promising results in digestive endoscopy, especially in capsule endoscopy (CE). However, some physicians still have some difficulties and fear the advent of this technology. We aimed to evaluate the perceptions and current sentiments toward the use of AI in CE. An online survey questionnaire was sent to an audience of gastroenterologists. In addition, several European national leaders of the International CApsule endoscopy REsearch (I CARE) Group were asked to disseminate an online survey among their national communities of CE readers (CER). The survey included 32 questions regarding general information, perceptions of AI, and its use in daily life, medicine, endoscopy, and CE. Among 380 European gastroenterologists who answered this survey, 333 (88%) were CERs. The mean average time length of experience in CE reading was 9.9 years (0.5–22). A majority of CERs agreed that AI would positively impact CE, shorten CE reading time, and help standardize reporting in CE and characterize lesions seen in CE. Nevertheless, in the foreseeable future, a majority of CERs disagreed with the complete replacement all CE reading by AI. Most CERs believed in the high potential of AI for becoming a valuable tool for automated diagnosis and for shortening the reading time. Currently, the perception is that AI will not replace CE reading. Full article
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8 pages, 503 KiB  
Article
Preventing Breast Cancer-Related Lymphedema: Feasibility of Axillary Reverse Mapping Technique
by Alexandra Caziuc, Diana Schlanger, Giorgiana Amarinei, Vlad Fagarasan, David Andras and George Calin Dindelegan
J. Clin. Med. 2021, 10(23), 5707; https://doi.org/10.3390/jcm10235707 - 6 Dec 2021
Cited by 1 | Viewed by 1580
Abstract
Introduction. Our study aimed to determine the feasibility of axillary reverse mapping (ARM) technique, the identification rate of ARM nodes and their metastatic involvement, as well as to identify the factors that influence the identification and metastatic involvement. Material and methods. In total, [...] Read more.
Introduction. Our study aimed to determine the feasibility of axillary reverse mapping (ARM) technique, the identification rate of ARM nodes and their metastatic involvement, as well as to identify the factors that influence the identification and metastatic involvement. Material and methods. In total, 30 breast cancer patients scheduled for axillary lymph node dissection were enrolled in our study. The lymphatic nodes that drain the arm were identified by injecting 1 mL of blue dye in the ipsilateral upper arm; then, the ARM nodes were resected along with the other lymph nodes and sent for histological evaluation. Results. Identification of ARM node was successful in 18 patients (60%) and 22.22% of the identified ARM lymph nodes had metastatic involvement. Patients with identified ARM nodes had a significant lower BMI and a statistically significant relationship between axillary lymph node status and ARM node metastases was proven. Most of ARM lymph nodes (96.3%) were found above the intercostobrachial nerve, under the axillary vein and lateral to the thoracodorsal bundle. Conclusions. The ARM procedure is easy to reproduce but might not be appropriate for patients with a high BMI. The rate of metastatic involvement of ARM nodes is significant and no factor can predict it, showing that the preservation of these nodes cannot be considered. Full article
(This article belongs to the Section Oncology)
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11 pages, 606 KiB  
Article
Reaching 80 Years of Age: Clinical, Behavioral, and Psychosocial Related Risk Factors in a Large Cohort of Israeli Working Men
by Shahar Lev-Ari, Anne Marie Novak, Adva Zemer, Yariv Gerber and Uri Goldbourt
J. Clin. Med. 2021, 10(23), 5706; https://doi.org/10.3390/jcm10235706 - 5 Dec 2021
Cited by 1 | Viewed by 1588
Abstract
The objective of this study was to estimate the probability of long-term overall survival based on total number of risk factors (RF). We also sought to examine the role of midlife clinical, behavioral, and psychosocial predictors of longevity in a large cohort of [...] Read more.
The objective of this study was to estimate the probability of long-term overall survival based on total number of risk factors (RF). We also sought to examine the role of midlife clinical, behavioral, and psychosocial predictors of longevity in a large cohort of Israeli men. This study was based on the Israeli Ischemic Heart Disease (IIHD) cohort that included over 10,000 men who were followed up for mortality over more than four decades. During the 43 years of follow-up, 4634 (46.1%) men survived to 80 years of age or older. We considered cigarette smoking, diabetes mellitus, high systolic blood pressure, hypercholesterolemia, low socioeconomic status, and serious family problems as RF at ages 40–65. Cox proportional hazards regression models, with age as the time scale, were constructed to estimate the hazard ratios (HRs) for failure to survive 80 years of age. Compared with men free of all the above RF, those with one identified RF (HR = 1.58, 95% CI: 1.42–1.75) and counterparts with two identified RF (HR = 2.18, 95% CI: 1.96–2.43) were at a significantly greater risk of death before 80. Additional RF further increased the risk of early mortality (HR = 3.62, 95% CI: 1.50–8.73 for men with 5 RF). The results suggest a role of physiological, behavioral, and psychological risk factors at midlife in predicting longevity. Full article
(This article belongs to the Section Epidemiology & Public Health)
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13 pages, 1273 KiB  
Article
Retinal Hemorrhage after SARS-CoV-2 Vaccination
by Hyo Song Park, Yeojue Byun, Suk Ho Byeon, Sung Soo Kim, Yong Joon Kim and Christopher Seungkyu Lee
J. Clin. Med. 2021, 10(23), 5705; https://doi.org/10.3390/jcm10235705 - 5 Dec 2021
Cited by 21 | Viewed by 5274
Abstract
To report retinal vein occlusion (RVO) and age-related macular degeneration (AMD)-related submacular hemorrhage developing after administration of SARS-CoV-2 vaccines, a single-center, retrospective observational case series was conducted. Clinical data including fundus photographs and optical coherence tomography (OCT) scans were reviewed. Twenty-three eyes of [...] Read more.
To report retinal vein occlusion (RVO) and age-related macular degeneration (AMD)-related submacular hemorrhage developing after administration of SARS-CoV-2 vaccines, a single-center, retrospective observational case series was conducted. Clinical data including fundus photographs and optical coherence tomography (OCT) scans were reviewed. Twenty-three eyes of 21 patients were included with the median age at symptom presentation being 77 years (range: 51–85 years). Twelve eyes (52.2%) had submacular hemorrhage and 11 (47.8%) had RVO. Twelve patients (60.9%) had been vaccinated with the Pfizer vaccine (BNT162b2) and 8 with the AstraZeneca (ChAdOx1) vaccine. Sixteen patients (76.2%) experienced ocular disease exacerbation after the first vaccination and 4 (19.0%) after the second vaccination. The median visual acuity (logarithm of the minimal angle of resolution; logMAR) before symptom development was 0.76 (interquartile range: 0.27–1.23); the median logMAR at symptom presentation was 1.40 (interquartile range 0.52–1.70). The median time between vaccination and symptom exacerbation was 2.0 days (interquartile range: 1.0–3.0 days). Five patients (23.8%) underwent tests for hematological abnormalities, including the presence of anti-PF4 antibodies; all were negative. Further studies with larger patient group for evaluation of effect of SARS-CoV-2 vaccination on retinal hemorrhage are necessary. Full article
(This article belongs to the Section Ophthalmology)
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9 pages, 1083 KiB  
Article
Gastric Xanthoma Is Related to the Rapid Growth of Gastric Cancer
by Ko Miura, Tadayuki Oshima, Akio Tamura, Ken Hara, Takuya Okugawa, Masashi Fukushima, Toshihiko Tomita, Hirokazu Fukui and Hiroto Miwa
J. Clin. Med. 2021, 10(23), 5704; https://doi.org/10.3390/jcm10235704 - 5 Dec 2021
Cited by 4 | Viewed by 2196
Abstract
Early detection of gastric cancer is important. However, rapid growth of gastric cancers that cannot be resected endoscopically occurs even with periodic check-ups. Accordingly, we assessed factors associated with the speed of gastric cancer growth by examining historical endoscopic images. A total of [...] Read more.
Early detection of gastric cancer is important. However, rapid growth of gastric cancers that cannot be resected endoscopically occurs even with periodic check-ups. Accordingly, we assessed factors associated with the speed of gastric cancer growth by examining historical endoscopic images. A total of 1996 gastric cancer cases were screened, and characteristics of lesions with slow and rapid growth were assessed. A total of 114 lesions from 114 patients were included in the assessment. Sixty slow-growing and fifty-four rapidly growing gastric cancers were compared. Female sex and incidence of lesions in the lower part of the stomach were significantly less frequent in the rapid-growth group than in the slow-growth group. History of endoscopic treatment tended to be more frequent in the rapid-growth group. Age, body mass index, histology, Helicobacter pylori status, and medications did not differ significantly between groups. Xanthoma was significantly related to rapid growth of gastric cancer, and map-like redness tended to be more frequent in the rapid-growth group in univariate analysis. Xanthoma was significantly related to rapid growth of gastric cancer on multivariate analysis. Further studies are warranted to clarify the pathophysiological mechanisms involved in the speed of gastric cancer growth. Full article
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15 pages, 1584 KiB  
Article
Radiological Cardiothoracic Ratio as a Potential Predictor of Right Ventricular Enlargement in Patients with Suspected Pulmonary Embolism Due to COVID-19
by Krystian Truszkiewicz, Małgorzata Poręba, Rafał Poręba and Paweł Gać
J. Clin. Med. 2021, 10(23), 5703; https://doi.org/10.3390/jcm10235703 - 4 Dec 2021
Cited by 4 | Viewed by 2818
Abstract
The aim of the study was to determine the usefulness of the radiological cardiothoracic ratio (CTR) as a predictor of right ventricular enlargement in patients with suspected pulmonary embolism during COVID-19. The study group consisted of 61 patients with confirmed COVID-19, suspected of [...] Read more.
The aim of the study was to determine the usefulness of the radiological cardiothoracic ratio (CTR) as a predictor of right ventricular enlargement in patients with suspected pulmonary embolism during COVID-19. The study group consisted of 61 patients with confirmed COVID-19, suspected of pulmonary embolism based on physical examination and laboratory tests (age: 67.18 ± 12.47 years). Computed tomography angiography (CTA) of pulmonary arteries and chest radiograph in AP projection with cardiothoracic ratio assessment were performed in all patients. Right ventricular enlargement was diagnosed by the ratio of right ventricular to left ventricular (RV/LV) dimensions in pulmonary CTA with two cut-off points: ≥0.9 and ≥1.0. Heart silhouette enlargement was found when CTR on the chest radiograph in the projection AP > 0.55. The mean values of RV/LV and CTR in the studied group were 0.96 ± 0.23 and 0.57 ± 0.05, respectively. Pulmonary embolism was diagnosed in 45.9%. Right ventricular enlargement was documented in 44.3% or 29.5% depending on the adopted criterion RV/LV ≥ 0.9 or RV/LV ≥ 1.0. Heart silhouette enlargement was found in 60.6%. Patients with confirmed pulmonary embolism (PE+) had a significantly higher RV/LV ratio and CTR than patients with excluded pulmonary embolism (PE−) (RV/LV: PE+ 1.08 ± 0.24, PE− 0.82 ± 0.12; CTR: PE+ 0.60 ± 0.05, PE− 0.54 ± 0.04; p < 0.05). The correlation analysis showed a statistically significant positive correlation between the RV/LV ratio and CTR (r = 0.59, p < 0.05). Based on the ROC curves, CTR values were determined as the optimal cut-off points for the prediction of right ventricular enlargement (RV/LV ≥ 0.9 or RV/LV ≥ 1.0), being 0.54 and 0.55, respectively. The sensitivity, specificity, and accuracy of the CTR criterion >0.54 as a predictor of RV/LV ratio ≥0.9 were 0.412, 0.963, and 0.656, respectively, while those of the CTR criterion >0.55 as a predictor of RV/LV ratio ≥1.0 were 0.488, 0.833, and 0.590, respectively. In summary, in patients with suspected pulmonary embolism during COVID-19, the radiographic cardiothoracic ratio can be considered as a prognostic factor for right ventricular enlargement, especially as a negative predictor of right ventricular enlargement in the case of lower CTR values. Full article
(This article belongs to the Special Issue The Roles of Cardiac Imaging in Medical Diagnosis and Management)
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10 pages, 265 KiB  
Article
Focus on Key Issues in Immune Thrombotic Thrombocytopenic Purpura: Italian Experience of Six Centers
by Giovanni Tiscia, Maria Teresa Sartori, Gaetano Giuffrida, Angelo Ostuni, Nicola Cascavilla, Daniela Nicolosi, Cosima Battista, Teresa Maria Santeramo, Lorella Melillo, Giulio Giordano, Filomena Cappucci, Lucia Fischetti, Elena Chinni, Giuseppe Tarantini, Anna Cerbo, Antonella Bertomoro, Fabrizio Fabris and Elvira Grandone
J. Clin. Med. 2021, 10(23), 5702; https://doi.org/10.3390/jcm10235702 - 4 Dec 2021
Viewed by 2314
Abstract
Immune-mediated thrombotic thrombocytopenic purpura is a rare and challenging hematological disease caused by the antibody anti-ADAMTS13. Though the mortality rate has decreased considerably in recent years, fatalities still remain unacceptable. This study aimed at further adding to the existing knowledge of this medical [...] Read more.
Immune-mediated thrombotic thrombocytopenic purpura is a rare and challenging hematological disease caused by the antibody anti-ADAMTS13. Though the mortality rate has decreased considerably in recent years, fatalities still remain unacceptable. This study aimed at further adding to the existing knowledge of this medical challenge. We enrolled 89 consecutive patients observed in six Italian centers (from 8 August 2013 to 28 May 2021) with a diagnosis of immune-mediated thrombotic thrombocytopenic purpura. Clinical information and blood parameters were collected for all patients. We describe clinical manifestations and laboratory data, possible risk factors and the therapeutic management of first episodes or relapses. A total of 74 first episodes and 19 relapses (median 3 years (interquartile range (IQR): 2–7)) were recorded. Seventy percent of patients enrolled at the first episode showed neurological signs and/or symptoms. All the patients enrolled at the first episode were treated with plasma exchange (median = 12; IQR: 8–19.5) and methylprednisolone (1 mg/kg/day). Rituximab (375 mg/m2 weekly for four weeks) and caplacizumab were given to 15 (20.2%) and 2 patients (2.6%), respectively. We observed an overall mortality of 5.4% in the follow-up (median 60 months; IQR: 36.0–103.5). All fatalities occurred after a diagnostic delay. Present data point to the importance of the early detection of factors mostly associated with poor outcomes. It is likely that use of caplacizumab could improve the prognosis in those patients. Full article
(This article belongs to the Section Hematology)
2 pages, 166 KiB  
Editorial
Special Issue “Pathogenesis, Epidemiology and Treatment of Atopic Dermatitis and Psoriasis”
by Masutaka Furue
J. Clin. Med. 2021, 10(23), 5701; https://doi.org/10.3390/jcm10235701 - 4 Dec 2021
Viewed by 1431
Abstract
Atopic dermatitis and psoriasis are common inflammatory skin diseases that enormously deteriorate the psycho-physical and socio-economic condition of the patients who are afflicted with these conditions [...] Full article
11 pages, 1408 KiB  
Article
Measuring Patient Value after Total Shoulder Arthroplasty
by Alexandre Lädermann, Rodolphe Eurin, Axelle Alibert, Mehdi Bensouda and Hugo Bothorel
J. Clin. Med. 2021, 10(23), 5700; https://doi.org/10.3390/jcm10235700 - 4 Dec 2021
Cited by 4 | Viewed by 1652
Abstract
Evaluating the value of health care is of paramount importance to keep improving patients’ quality of life and optimizing associated costs. Our objective was to present a calculation method based on Michael Porter’s formula and standard references to estimate patient value delivered by [...] Read more.
Evaluating the value of health care is of paramount importance to keep improving patients’ quality of life and optimizing associated costs. Our objective was to present a calculation method based on Michael Porter’s formula and standard references to estimate patient value delivered by total shoulder arthroplasty (TSA). We retrospectively reviewed the records of 116 consecutive TSAs performed between June 2015 and June 2019. Patient value was defined as quality of care divided by direct costs of surgery. Quality metrics included intra- and postoperative complications as well as weighted improvements in three different patient-reported outcome measures at a minimum of one-year follow-up. Direct costs of surgery were retrieved from the management accounting analyses. Substantial clinical benefit (SCB) thresholds and the standard reimbursement system were used as references for quality and cost dimensions. A multivariable linear regression was performed to identify factors associated with patient delivered value. Compared to a reference of 1.0, the quality of care delivered to patients was 1.3 ± 0.3 (range, 0.6–2.0) and the associated direct cost was 1.0 ± 0.2 (range, 0.7–1.6). Ninety patients (78%) had a quality of care ≥1.0 and 61 patients (53%) had direct costs related to surgery ≤1.0. The average value delivered to patients was 1.3 ± 0.4 (range, 0.5–2.5) with 91 patients (78%) ≥ 1.0, was higher for non-smokers (beta, 0.12; p = 0.044), anatomic TSA (beta, 0.53; p < 0.001), increased with higher pre-operative pain (beta, 0.08; p < 0.001) and lower pre-operative Constant score (beta, −0.06; p = 0.001). Our results revealed that almost 80% of TSAs provided substantial patient value. Patient pre-operative pain/function, tobacco use, and procedure type are important factors associated with delivered patient value. Full article
(This article belongs to the Special Issue Shoulder Arthroplasty: State of the Art and Future Perspectives)
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22 pages, 835 KiB  
Review
The Role of Rehabilitative Ultrasound Imaging Technique in the Lumbopelvic Region as a Diagnosis and Treatment Tool in Physiotherapy: Systematic Review, Meta-Analysis and Meta-Regression
by Samuel Fernández-Carnero, Carlos Martin-Saborido, Alexander Achalandabaso Ochoa-Ruiz de Mendoza, Alejandro Ferragut-Garcias, Juan Nicolás Cuenca-Zaldivar, Alejandro Leal-Quiñones, Cesar Calvo-Lobo and Tomas Gallego-Izquierdo
J. Clin. Med. 2021, 10(23), 5699; https://doi.org/10.3390/jcm10235699 - 3 Dec 2021
Cited by 8 | Viewed by 3790
Abstract
Rehabilitative ultrasound imaging (RUSI) technique seems to be a valid and reliable tool for diagnosis and treatment in physiotherapy and has been widely studied in the lumbopelvic region the last three decades. The aims for this utility in clinical settings must be review [...] Read more.
Rehabilitative ultrasound imaging (RUSI) technique seems to be a valid and reliable tool for diagnosis and treatment in physiotherapy and has been widely studied in the lumbopelvic region the last three decades. The aims for this utility in clinical settings must be review through a systematic review, meta-analysis and meta-regression. A systematic review was designed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with PROSPERO registration and per review in all phases of the process using COVIDENCE, analysis of risk of bias and meta-analysis using REVMAN, and meta-regression calculation using STATA. Database screening provided 6544 references, out of which 321 reported narrative synthesis, and 21 reported quantitative synthesis, while only 7 of them provided comparable data to meta-analyze the variables pain and muscle thickness. In most cases, the forest plots showed considerable I2 heterogeneity indexes for multifidus muscle thickness (I2 = 95%), low back pain (I2 = 92%) and abdominal pain (I2 = 95%), not important for transversus abdominis muscle thickness (I2 = 22%), significant heterogenity (I2 = 69%) depending on the subgroup and not important internal oblique muscle thickness (I2 = 0%) and external oblique muscle thickness (I2 = 0%). Meta-regression did not provide significant data for the correlations between the variables analyzed and the intervention, age, and BMI (Body Mass Index). This review reveals that RUSI could contribute to a high reliability of the measurements in the lumbopelvic region with validity and reliability for the assessments, as well as showing promising results for diagnosis and intervention assessment in physiotherapy compared to the traditional model, allowing for future lines of research in this area. Full article
(This article belongs to the Special Issue Recent Advances in Musculoskeletal Pain and Its Management)
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16 pages, 2221 KiB  
Article
Differences in the Composition of Gut Microbiota between Patients with Parkinson’s Disease and Healthy Controls: A Cohort Study
by Barbara Zapała, Tomasz Stefura, Magdalena Wójcik-Pędziwiatr, Radosław Kabut, Marta Bałajewicz-Nowak, Tomasz Milewicz, Alicja Dudek, Anastazja Stój and Monika Rudzińska-Bar
J. Clin. Med. 2021, 10(23), 5698; https://doi.org/10.3390/jcm10235698 - 3 Dec 2021
Cited by 16 | Viewed by 3001
Abstract
Gut microbiome and colonic inflammation can be associated with the predisposition and progression of Parkinson’s disease (PD). The presented study aimed to compare gastrointestinal microbiota composition between patients diagnosed with PD and treated only with Levodopa to healthy controls. In this prospective study, [...] Read more.
Gut microbiome and colonic inflammation can be associated with the predisposition and progression of Parkinson’s disease (PD). The presented study aimed to compare gastrointestinal microbiota composition between patients diagnosed with PD and treated only with Levodopa to healthy controls. In this prospective study, patients were recruited in 1 academic hospital from July 2019 to July 2020. The detailed demographic data and medical history were collected using a set of questionnaires. Fecal samples were obtained from all participants. Next-Generation Sequencing was used to assess the microbiota composition. The endpoint was the difference in composition of the gut microbiota. In this study, we enrolled 27 hospitalized PD patients with well-controlled symptoms. The control group included 44 healthy subjects matched for age. Among PD patients, our results presented a higher abundance of Bacteroides phylum, class Corynebacteria among phylum Actinobacteria, class Deltaproteobacteria among phylum Proteobacteria, and genera such as Butyricimonas, Robinsoniella, and Flavonifractor. The species Akkermansia muciniphila, Eubacterium biforme, and Parabacteroides merdae were identified as more common in the gut microbiota of PD patients. In conclusion, the patients diagnosed with PD have significantly different gut microbiota profiles in comparison with healthy controls. Full article
(This article belongs to the Topic Age-Related Neurodegenerative Diseases and Stroke)
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11 pages, 1880 KiB  
Article
Intracranial Pressure Patterns and Neurological Outcomes in Out-of-Hospital Cardiac Arrest Survivors after Targeted Temperature Management: A Retrospective Observational Study
by Hogul Song, Changshin Kang, Jungsoo Park, Yeonho You, Yongnam In, Jinhong Min, Wonjoon Jeong, Yongchul Cho, Hongjoon Ahn and Dongil Kim
J. Clin. Med. 2021, 10(23), 5697; https://doi.org/10.3390/jcm10235697 - 3 Dec 2021
Cited by 9 | Viewed by 1731
Abstract
We aimed to investigate intracranial pressure (ICP) changes over time and the neurologic prognosis for out-of-hospital cardiac arrest (OHCA) survivors who received targeted temperature management (TTM). ICP was measured immediately after return of spontaneous circulation (ROSC) (day 1), then at 24 h (day [...] Read more.
We aimed to investigate intracranial pressure (ICP) changes over time and the neurologic prognosis for out-of-hospital cardiac arrest (OHCA) survivors who received targeted temperature management (TTM). ICP was measured immediately after return of spontaneous circulation (ROSC) (day 1), then at 24 h (day 2), 48 h (day 3), and 72 h (day 4), through connecting a lumbar drain catheter to a manometer or a LiquoGuard machine. Neurological outcomes were determined at 3 months after ROSC, and a poor neurological outcome was defined as Cerebral Performance Category 3–5. Of the 91 patients in this study (males, n = 67, 74%), 51 (56%) had poor neurological outcomes. ICP was significantly higher in the poor outcome group at each time point except day 4. ICP elevation was highest between days 2 and 3 in the good outcome group, and between days 1 and 2 in the poor outcome group. However, there was no difference in total ICP elevation between the poor and good outcome groups (3.0 vs. 3.1; p = 0.476). All OHCA survivors who had received TTM had elevated ICP, regardless of neurologic prognosis. However, the changing pattern of ICP levels differed depending on the neurological outcome. Full article
(This article belongs to the Section Emergency Medicine)
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10 pages, 283 KiB  
Article
Beta-Endorphin and Oxytocin in Patients with Alcohol Use Disorder and Comorbid Depression
by Olga V. Roschina, Lyudmila A. Levchuk, Anastasiia S. Boiko, Ekaterina V. Michalitskaya, Elena V. Epimakhova, Innokentiy S. Losenkov, German G. Simutkin, Anton J. M. Loonen, Nikolay A. Bokhan and Svetlana A. Ivanova
J. Clin. Med. 2021, 10(23), 5696; https://doi.org/10.3390/jcm10235696 - 3 Dec 2021
Cited by 6 | Viewed by 2085
Abstract
Background: The neuropeptides β-endorphin and oxytocin are released into the bloodstream as hormones from the pituitary gland but also have an important function as neuroregulators in the forebrain. The blood levels of both polypeptides have been shown to reflect depressive symptoms. β-Endorphin, in [...] Read more.
Background: The neuropeptides β-endorphin and oxytocin are released into the bloodstream as hormones from the pituitary gland but also have an important function as neuroregulators in the forebrain. The blood levels of both polypeptides have been shown to reflect depressive symptoms. β-Endorphin, in particular, is also involved in abstinence from alcohol. Methods: The serum levels of β-endorphin and oxytocin were measured during the early withdrawal phase in patients with alcohol use disorder (AUD) with (N = 35) or without (N = 45) depressive comorbidity and compared with those in healthy volunteers (N = 23). In addition to comparing the groups, the study examined whether serum levels correlated with various psychometric measures of dependence, depression and aggression, as well as with clinical characteristics of dependence. Results: Both serum levels of beta-endorphin and oxytocin were significantly lower in patients than those in healthy controls (p = 0.011 for β-endorphin and p = 0.005 for oxytocin, Kruskal–Wallis test). In patients with depressive comorbidity, the significance was greatest (p = 0.005 for β-endorphin and p = 0.004 for oxytocin, U-test). There was no correlation with clinical or psychometric parameters (p > 0.05, Spearman test), but beta-endorphin levels did correlate significantly with physical aggression (p = 0.026, Spearman test). Conclusions: Serum levels of β-endorphin and oxytocin are lower in patients with AUD, particularly in those with depressive comorbidity. β-Endorphin levels correlated with physical aggression according to the Buss–Durkee (BDHI) estimates. Full article
(This article belongs to the Special Issue Addictive Disorders and Clinical Psychiatry – Part I)
12 pages, 748 KiB  
Article
Epilepsy Due to Mild TBI in Children: An Experience at a Tertiary Referral Center
by Jun T. Park, Sarah J. DeLozier and Harry T. Chugani
J. Clin. Med. 2021, 10(23), 5695; https://doi.org/10.3390/jcm10235695 - 3 Dec 2021
Cited by 4 | Viewed by 2065
Abstract
Rationale: Posttraumatic epilepsy (PTE) is a common cause of morbidity in children after a traumatic brain injury (TBI), occurring in 10–20% of children following severe TBI. PTE is diagnosed after two or more unprovoked seizures occurring 1-week post TBI. More often, studies have [...] Read more.
Rationale: Posttraumatic epilepsy (PTE) is a common cause of morbidity in children after a traumatic brain injury (TBI), occurring in 10–20% of children following severe TBI. PTE is diagnosed after two or more unprovoked seizures occurring 1-week post TBI. More often, studies have focused on children with epilepsy due to severe TBI. We aim to understand the utility of head computed tomography (HCT), EEG, and the risk of developing drug-resistant epilepsy in children after mild TBI. Method: We retrospectively studied 321 children with TBI at a tertiary pediatric referral center during a 10-year period. Mild TBI was defined as loss of consciousness (LOC) or amnesia < 30 min, moderate TBI as LOC or amnesia between 30 min and 1 day, and severe TBI as LOC or amnesia > 1 day, subdural hemorrhage, or contusion. Multiple clinical variables were reviewed, including past and present antiepileptic drug(s), seizure control, and mode of injury. First and subsequent post-TBI EEGs/prolonged video-EEGs were obtained acutely, subacutely, and/or chronically (range, day 1–3 years, median 1 month). Descriptive analyses were conducted using medians and ranges for continuous data. Categorical data were reported using frequencies and percentages, while comparisons between groups were made using Fisher’s exact test for small sample sizes. Results: Forty-seven children were diagnosed with posttraumatic epilepsy: eight children (17%) due to mild TBI, 39 children (83%) due to severe TBI. For the eight children with mild TBI whom all had an accidental trauma (non-inflicted), the median follow-up time was 25 months (range 1.5 months–84 months). The median age was 10 years (range 4–18 years), and the median age at the time of injury was seven years (range: 23 months–13 years). No relevant previous medical history was present for six patients (80%), and two patients’ (20%) relevant previous medical histories were unknown. Seven patients (88%) had no history of seizures, and patient #6 (12%) had unknown seizure history. Six patients (75%) had normal routine EEG(s). Patient #6 (13%) had an abnormal VEEG 3 months after the initial normal routine EEG, while patient #1 (13%) had an initial prolonged EEG 8 months after TBI. Compared to the 39 patients with severe TBI, 31 (79%) of whom had abnormal EEGs (routine and/or prolonged with video), mild TBI patients were more likely to have normal EEGs, p = 0.005. Head CT scans were obtained acutely for seven patients (90%), all of which were normal. One patient only had brain magnetic resonance imaging (MRI) 8 months after the injury. Compared to the 39 patients with severe TBI, all of whom had abnormal HCTs, mild TBI patients were less likely to have abnormal HCTs, p < 0.0001. In patients with mild TBI, no patient had both abnormal EEG/VEEG and HCT, and no one was on more than one Antiepileptic drug (AED), p < 0.005. Six patients (75%) had MRIs, of which five (63%) were normal. Two patients (#1, 7) did not have MRIs, while one patient’s (#4) MRI was unavailable. Five patients (63%) had a seizure <24 h post TBI, while the rest had seizures after the first week of injury. Conclusion: Children with epilepsy due to mild TBI, loss of consciousness, or amnesia < 30 min are more likely to have normal HCT and EEG and to be on 0–1 AED. Limitations of our study include the small sample size and retrospective design. The current findings add to the paucity of data in children who suffer from epilepsy due to mild TBI. Full article
(This article belongs to the Special Issue Evaluation and Treatment of Drug-Resistant Epilepsy)
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13 pages, 890 KiB  
Article
Association between Rheumatoid Arthritis and Meniere’s Disease: A Longitudinal Follow-Up Study Using a National Health Screening Cohort
by So Young Kim, Dae Myoung Yoo, Ji Hee Kim, Mi Jung Kwon, Joo-Hee Kim and Hyo Geun Choi
J. Clin. Med. 2021, 10(23), 5694; https://doi.org/10.3390/jcm10235694 - 3 Dec 2021
Cited by 2 | Viewed by 1702
Abstract
This study aimed to evaluate the impact of pre-existing rheumatoid arthritis (RA) on the occurrence of Meniere’s disease (MD). The 2002–2015 Korean National Health Insurance Service—Health Screening Cohort data were retrospectively analyzed. A total of 3038 participants with RA were matched with 12,152 [...] Read more.
This study aimed to evaluate the impact of pre-existing rheumatoid arthritis (RA) on the occurrence of Meniere’s disease (MD). The 2002–2015 Korean National Health Insurance Service—Health Screening Cohort data were retrospectively analyzed. A total of 3038 participants with RA were matched with 12,152 control participants for demographic factors. The occurrence of MD was evaluated in both the RA and control groups. The hazard ratios (HRs) of RA for participants with MD were calculated using a stratified Cox proportional hazard model. Additionally, subgroup analyses were conducted. The rate of MD was not different between the RA and control groups (1.5% vs. 1.3%, standardized difference = 0.01). The HR was not higher in the RA group than in the MD group (adjusted HR = 1.03, 95% confidence interval = 0.73–1.44, p = 0.885). A higher HR of RA for participants with MD was found in the ≥60-year-old subgroup in the crude model but not in the adjusted model. An association between RA and MD was not found in any of the other subgroups. A previous history of RA was not related to an increased risk of MD. Full article
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10 pages, 523 KiB  
Article
Impact of Co-Existing Placental Pathologies in Pregnancies Complicated by Placental Abruption and Acute Neonatal Outcomes
by Dorsa Mavedatnia, Jason Tran, Irina Oltean, Vid Bijelić, Felipe Moretti, Sarah Lawrence and Dina El Demellawy
J. Clin. Med. 2021, 10(23), 5693; https://doi.org/10.3390/jcm10235693 - 3 Dec 2021
Cited by 5 | Viewed by 2014
Abstract
Placental abruption (PA) is a concern for maternal and neonatal morbidity. Adverse neonatal outcomes in the setting of PA include higher risk of prematurity. Placental pathologies include maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), acute chorioamnionitis, and villitis of unknown etiology (VUE). [...] Read more.
Placental abruption (PA) is a concern for maternal and neonatal morbidity. Adverse neonatal outcomes in the setting of PA include higher risk of prematurity. Placental pathologies include maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), acute chorioamnionitis, and villitis of unknown etiology (VUE). We aimed to investigate how placental pathology contributes to acute neonatal outcome in PA. A retrospective cohort study of all placentas with PA were identified. Exposures were MVM, FVM, acute chorioamnionitis and VUE. The primary outcome was NICU admission and the secondary outcomes included adverse base deficit and Apgar scores, need for resuscitation, and small-for-gestational age. A total of 287 placentas were identified. There were 160 (59.9%) of placentas with PA alone vs 107 (40.1%) with PA and additional placental pathologies. Odds of NICU admission were more than two times higher in pregnancies with placental pathologies (OR = 2.37, 95% CI 1.28–4.52). These estimates were in large part mediated by prematurity and birthweight, indirect effect acting through prematurity was OR 1.79 (95% CI 1.12–2.75) and through birthweight OR 2.12 (95% CI 1.40–3.18). Odds of Apgar score ≤ 5 was more than four times higher among pregnancies with placental pathologies (OR = 4.56, 95% CI 1.28–21.26). Coexisting placental pathology may impact Apgar scores in pregnancies complicated by PA. This knowledge could be used by neonatal teams to mobilize resources in anticipation of the need for neonatal resuscitation. Full article
(This article belongs to the Special Issue Diagnostic or Therapeutic Strategies for Pregnancy Complications)
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15 pages, 5322 KiB  
Article
Fatigue Analysis of NiTi Rotary Endodontic Files through Finite Element Simulation: Effect of Root Canal Geometry on Fatigue Life
by Victor Roda-Casanova, Antonio Pérez-González, Álvaro Zubizarreta-Macho and Vicente Faus-Matoses
J. Clin. Med. 2021, 10(23), 5692; https://doi.org/10.3390/jcm10235692 - 3 Dec 2021
Cited by 7 | Viewed by 2835
Abstract
This article describes a numerical procedure for estimating the fatigue life of NiTi endodontic rotary files. An enhanced finite element model reproducing the interaction of the endodontic file rotating inside the root canal was developed, which includes important phenomena that allowed increasing the [...] Read more.
This article describes a numerical procedure for estimating the fatigue life of NiTi endodontic rotary files. An enhanced finite element model reproducing the interaction of the endodontic file rotating inside the root canal was developed, which includes important phenomena that allowed increasing the degree of realism of the simulation. A method based on the critical plane approach was proposed for extracting significant strain results from finite element analysis, which were used in combination with the Coffin–Manson relation to predict the fatigue life of the NiTi rotary files. The proposed procedure is illustrated with several numerical examples in which different combinations of endodontic rotary files and root canal geometries were investigated. By using these analyses, the effect of the radius of curvature and the angle of curvature of the root canal on the fatigue life of the rotary files was analysed. The results confirm the significant influence of the root canal geometry on the fatigue life of the NiTi rotary files and reveal the higher importance of the radius of curvature with respect to the angle of curvature of the root canal. Full article
(This article belongs to the Special Issue The State of the Art in Endodontics)
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15 pages, 753 KiB  
Article
The Relationship between Alcohol Hangover Severity, Sleep and Cognitive Performance; a Naturalistic Study
by Elizabeth Ayre, Andrew Scholey, David White, Grant J. Devilly, Jordy Kaufman, Joris C. Verster, Corey Allen and Sarah Benson
J. Clin. Med. 2021, 10(23), 5691; https://doi.org/10.3390/jcm10235691 - 3 Dec 2021
Cited by 3 | Viewed by 2532
Abstract
Alcohol hangover (AH) has been associated with poor sleep due to the negative effects of alcohol intoxication on sleep quantity and sleep quality. The aim of the current study was to further explore the relationship between AH severity and sleep using a naturalistic [...] Read more.
Alcohol hangover (AH) has been associated with poor sleep due to the negative effects of alcohol intoxication on sleep quantity and sleep quality. The aim of the current study was to further explore the relationship between AH severity and sleep using a naturalistic study design. A further aim was to determine whether quantitative aspects of sleep were a mediating influence on the relationship between AH severity and cognitive performance. As part of the naturalistic study design, 99 drinkers were recruited following a night of drinking in an Australian state capital, with breath alcohol concentration (BrAC) measured as participants were leaving the entertainment district. The following morning at home, participants answered online questions regarding their drinking behaviour on the previous evening, current AH symptoms and sleep quality. Participants also completed an online version of the Trail-Making Test B (TMT-B) to assess cognitive performance. The findings reveal the duration of nightly awakenings to be negatively related to six individual AH symptoms as well as overall AH severity. The number of nightly awakenings, sleep quality and total sleep time correlated with four AH symptoms including overall AH severity. Total AH severity accounted for a moderate amount of variance (11%) in the time to complete the TMT-B. These findings confirm that alcohol consumption negatively affects sleep, which is related to higher next-day hangover severity ratings and poorer cognitive performance. Full article
(This article belongs to the Section Mental Health)
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23 pages, 727 KiB  
Review
Female Oncofertility: Current Understandings, Therapeutic Approaches, Controversies, and Future Perspectives
by Kim Cat Tuyen Vo and Kazuhiro Kawamura
J. Clin. Med. 2021, 10(23), 5690; https://doi.org/10.3390/jcm10235690 - 3 Dec 2021
Cited by 9 | Viewed by 3187
Abstract
Recent advances in early detection and oncological therapies have ameliorated the survival rate of young cancer patients. Yet, ovarian impairment induced by chemotherapy and radiotherapy is still a challenging issue. This review, based on clinical and lab-based studies, summarizes the evidence of gonadotoxicity [...] Read more.
Recent advances in early detection and oncological therapies have ameliorated the survival rate of young cancer patients. Yet, ovarian impairment induced by chemotherapy and radiotherapy is still a challenging issue. This review, based on clinical and lab-based studies, summarizes the evidence of gonadotoxicity of chemoradiotherapy, the recent approaches, ongoing controversies, and future perspectives of fertility preservation (FP) in female patients who have experienced chemo- or radio-therapy. Existing data indicate that chemotherapeutic agents induce DNA alterations and massive follicle activation via the phosphoinositide 3-kinase (PI3K)/Akt signaling pathway. Meanwhile, the radiation causes ionizing damage, leading to germ cell loss. In addition to the well-established methods, numerous therapeutic approaches have been suggested, including minimizing the follicle loss in cryopreserved ovarian grafts after transplantation, in vitro activation or in vitro growing of follicles, artificial ovarian development, or fertoprotective adjuvant to prevent ovarian damage from chemotherapy. Some reports have revealed positive outcomes from these therapies, whereas others have demonstrated conflictions. Future perspectives are improving the live birth rate of FP, especially in patients with adverse ovarian reserve, eliminating the risk of malignancy reintroducing, and increasing society’s awareness of FP importance. Full article
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8 pages, 487 KiB  
Article
Portal Vein Thrombosis Is Associated with an Increased Incidence of Depression and Anxiety Disorders
by Simon Johannes Gairing, Peter Robert Galle, Jörn M. Schattenberg, Karel Kostev and Christian Labenz
J. Clin. Med. 2021, 10(23), 5689; https://doi.org/10.3390/jcm10235689 - 2 Dec 2021
Cited by 1 | Viewed by 1747
Abstract
Portal vein thrombosis (PVT) is a severe disease that adversely affects patients’ well-being. Data on the influence of PVT on the occurrence of depression or anxiety disorders are lacking. This study aimed to explore the impact of PVT on the incidence of depression [...] Read more.
Portal vein thrombosis (PVT) is a severe disease that adversely affects patients’ well-being. Data on the influence of PVT on the occurrence of depression or anxiety disorders are lacking. This study aimed to explore the impact of PVT on the incidence of depression and anxiety disorders diagnoses in a large German primary care cohort over a ten-year period. Patients with PVT were matched to non-PVT individuals by age, sex, yearly consultation frequency, index year and comorbidities in a 1:5 ratio. The primary outcome of the study was the incidence of depression and anxiety disorders. The relationship between PVT and both depression and anxiety disorders was investigated using Cox regression models. We compared 547 patients with PVT with 2735 matched individuals without PVT. Within 5 years of the index date, 17.4% of patients with PVT and 9.3% of non-PVT individuals were diagnosed with depression (p < 0.001). Anxiety disorders were diagnosed in 5.5% and 3.0% of patients with PVT and non-PVT individuals, respectively (p = 0.002). On regression analyses, PVT was positively associated with incident depression (HR 2.01, 95% CI 1.53–2.64, p < 0.001) as well as anxiety disorders (HR 2.16, 95% CI 1.35–3.46, p = 0.001). Regarding depression, this association remained significant in women as well as in men. There was no association between PVT and the incidence of anxiety disorders in women. In conclusion, PVT is associated with the development of depression and anxiety disorders. However, further prospective studies are needed to confirm our findings before definitive recommendations can be made. Full article
(This article belongs to the Special Issue Portal Vein Thrombosis)
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14 pages, 1620 KiB  
Article
Early Identification of Resuscitated Patients with a Significant Coronary Disease in Out-of-Hospital Cardiac Arrest Survivors without ST-Segment Elevation
by Chun-Song Youn, Hahn Yi, Youn-Jung Kim, Hwan Song, Namkug Kim and Won-Young Kim
J. Clin. Med. 2021, 10(23), 5688; https://doi.org/10.3390/jcm10235688 - 2 Dec 2021
Cited by 1 | Viewed by 1587
Abstract
This study aimed to develop a machine learning (ML)-based model for identifying patients who had a significant coronary artery disease among out-of-hospital cardiac arrest (OHCA) survivors without ST-segment elevation (STE). This multicenter observational study used data from the Korean Hypothermia Network prospective registry [...] Read more.
This study aimed to develop a machine learning (ML)-based model for identifying patients who had a significant coronary artery disease among out-of-hospital cardiac arrest (OHCA) survivors without ST-segment elevation (STE). This multicenter observational study used data from the Korean Hypothermia Network prospective registry (KORHN-PRO) gathered between October 2015 and December 2018. We used information available before targeted temperature management (TTM) as predictor variables, and the primary outcome was a significant coronary artery lesion in coronary angiography (CAG). Among 1373 OHCA patients treated with TTM, 331 patients without STE who underwent CAG were enrolled. Among them, 127 patients (38.4%) had a significant coronary artery lesion. Four ML algorithms, namely regularized logistic regression (RLR), random forest classifier (RF), CatBoost classifier (CBC), and voting classifier (VC), were used with data collected before CAG. The VC model showed the highest accuracy for predicting significant lesions (area under the curve of 0.751). Eight variables (older age, male, initial shockable rhythm, shorter total collapse duration, higher glucose and creatinine, and lower pH and lactate) were significant to ML models. These results showed that ML models may be useful in developing early predictive tools for identifying high-risk patients with a significant stenosis in CAG. Full article
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8 pages, 777 KiB  
Article
Early Postoperative Pneumothorax Might Not Be ‘True’ Recurrence
by Wongi Woo, Chong Hoon Kim, Bong Jun Kim, Seung Hwan Song, Duk Hwan Moon, Du-Young Kang and Sungsoo Lee
J. Clin. Med. 2021, 10(23), 5687; https://doi.org/10.3390/jcm10235687 - 2 Dec 2021
Cited by 3 | Viewed by 1583
Abstract
Objectives: To date, there is no consensual definition of what constitutes a postoperative recurrence of primary spontaneous pneumothorax (PSP), despite there being many studies reporting a high incidence of recurrence. This study aims to describe the long-term recurrence rates of pneumothorax and to [...] Read more.
Objectives: To date, there is no consensual definition of what constitutes a postoperative recurrence of primary spontaneous pneumothorax (PSP), despite there being many studies reporting a high incidence of recurrence. This study aims to describe the long-term recurrence rates of pneumothorax and to suggest a possible way to differentiate recurrence events based on temporal patterns. Methods: This single-center study retrospectively evaluated all postoperative recurrence of PSP from January 2007 to May 2019. Patients’ demographics, history of pneumothorax, radiologic data, surgical technique, and the time between operation and recurrence were analyzed. Univariate and multivariable analyses were conducted to find potential risk factors related to long-term recurrence. Results: Of the 77 postoperative recurrent cases of pneumothorax, 21 (27.2%) occurred within 30 days after surgery and, thus, were classified as early recurrences (ER), while the remaining cases were classified as late recurrences (LR). There was no difference in preoperative variables between the two groups. However, the rate of incidence of second recurrence (SR), which represented a long-term prognosis, was significantly higher in the LR group (28.6% vs. 4.8%, p = 0.030). On univariate and multivariable analyses, late recurrence was the only significant factor predicting later recurrence events. Conclusion: Postoperative recurrence (PoR) within 30 days had a lower SR rate. Therefore, it might not be a ‘true’ postoperative recurrence with a favorable prognosis. Further studies investigating postoperative recurrence based on temporal patterns would be warranted to improve the classification of PoR. Full article
(This article belongs to the Special Issue Clinical Research of Spontaneous Pneumothorax)
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