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Volume 12, January-2
 
 

J. Clin. Med., Volume 12, Issue 3 (February-1 2023) – 328 articles

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Article
Eruption Pattern of Third Molars in Orthodontic Patients Treated with First Permanent Molar Extraction: A Longitudinal Retrospective Evaluation
J. Clin. Med. 2023, 12(3), 1060; https://doi.org/10.3390/jcm12031060 (registering DOI) - 30 Jan 2023
Abstract
The aim of this study was to evaluate angular and positional changes in the second (M2) and third molars (M3) of orthodontically treated patients undergoing a first molar (M1) extraction. A retrospective longitudinal study with a sample of 152 pre- and post-treatment panoramic [...] Read more.
The aim of this study was to evaluate angular and positional changes in the second (M2) and third molars (M3) of orthodontically treated patients undergoing a first molar (M1) extraction. A retrospective longitudinal study with a sample of 152 pre- and post-treatment panoramic radiographs was conducted. Thirty-nine patients (51.3%) were orthodontically treated with M1 extraction and thirty-seven (48.7%) were treated without extraction. Angulations of M2 and M3 relative to the infraorbital (IOP) and the palatal planes (PP) were measured and compared between the groups before orthodontic treatment (T1) and after the completion of orthodontic space closure (T2). The prognosis of M3 eruptions was evaluated by assessing their horizontal and vertical position (inclination) using different classification systems. The angular (p < 0.001) and inclination improvement (p < 0.01) of the maxillary M3 was significant for the M1 extraction group. The mandibular M3 inclination significantly improved (p < 0.01), whereas the groups’ angulation and vertical position were not significantly different. These findings suggest that extraction therapy has a favorable effect on the maxillary M2 and M3 angulation, but not on the mandibular. M1 extraction showed a signi- ficant effect on the horizontal position of M3 and thus may improve the eruption space and prognosis. Full article
(This article belongs to the Special Issue Orthodontics: Current Clinical Status and Future Challenges)
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Opinion
The sFlt-1/PlGF Ratio in Pregnant Patients Affected by COVID-19
J. Clin. Med. 2023, 12(3), 1059; https://doi.org/10.3390/jcm12031059 (registering DOI) - 29 Jan 2023
Abstract
COVID-19 in pregnant women increases the risk of adverse pregnancy outcomes, including preeclampsia. This meta-analysis aimed to examine the effect of SARS-CoV-2 infection on sFlt-1/PIGF ratio during pregnancy. The study was designed as a systematic review and meta-analysis. PubMed, Web of Science, Embase [...] Read more.
COVID-19 in pregnant women increases the risk of adverse pregnancy outcomes, including preeclampsia. This meta-analysis aimed to examine the effect of SARS-CoV-2 infection on sFlt-1/PIGF ratio during pregnancy. The study was designed as a systematic review and meta-analysis. PubMed, Web of Science, Embase and Cochrane Library were searched for relevant studies reporting the sFlt-1/PlGF ratio in pregnant women with COVID-19. Results were compared using meta-analysis by the Mantel–Haenszel method. A total of 7 studies were included in the analysis. sFlt-1/PlGF ratios between COVID-19 positive vs. negative women were 45.8 ± 50.3 vs. 37.4 ± 22.5, respectively (SMD = 1.76; 95% CI: 0.43 to 3.09; p = 0.01). sFlt-1/PlGF ratios between asymptomatic vs. symptomatic patients were 49.3 ± 35.7 vs. 37.1 ± 25.6 (SMD = 0.30; 95% CI: −0.35 to 0.95; p = 0.36). sFlt-1/PlGF ratio in non-severe group was 30.7 ± 56.5, compared to 64.7 ± 53.5 for severe patients (SMD = −1.88; 95% CI: −3.77 to 0.01; p = 0.05). sFlt-1/PlGF ratios in COVID-19 patients, with and without hypertensive disease of pregnancy, were 187.0 ± 121.8 vs. 21.6 ± 8.6, respectively (SMD = 2.46; 95% CI: 0.99 to 3.93; p = 0.001). Conclusions: Patients with COVID-19, as compared to patients without COVID-19, were characterized by higher sFlt-1/PlGF ratio. Moreover, severe COVID-19 and SARS-CoV-2 infection in hypertensive pregnant women was related to significantly higher sFlt-1/PlGF ratio. Full article
(This article belongs to the Section Obstetrics & Gynecology)
Article
Quality of Life in COVID-Related ARDS Patients One Year after Intensive Care Discharge (Odissea Study): A Multicenter Observational Study
J. Clin. Med. 2023, 12(3), 1058; https://doi.org/10.3390/jcm12031058 (registering DOI) - 29 Jan 2023
Abstract
Background: Investigating the health-related quality of life (HRQoL) after intensive care unit (ICU) discharge is necessary to identify possible modifiable risk factors. The primary aim of this study was to investigate the HRQoL in COVID-19 critically ill patients one year after ICU discharge. [...] Read more.
Background: Investigating the health-related quality of life (HRQoL) after intensive care unit (ICU) discharge is necessary to identify possible modifiable risk factors. The primary aim of this study was to investigate the HRQoL in COVID-19 critically ill patients one year after ICU discharge. Methods: In this multicenter prospective observational study, COVID-19 patients admitted to nine ICUs from 1 March 2020 to 28 February 2021 in Italy were enrolled. One year after ICU discharge, patients were required to fill in short-form health survey 36 (SF-36) and impact of event-revised (IES-R) questionnaire. A multivariate linear or logistic regression analysis to search for factors associated with a lower HRQoL and post-traumatic stress disorded (PTSD) were carried out, respectively. Results: Among 1,003 patients screened, 343 (median age 63 years [57–70]) were enrolled. Mechanical ventilation lasted for a median of 10 days [2–20]. Physical functioning (PF 85 [60–95]), physical role (PR 75 [0–100]), emotional role (RE 100 [33–100]), bodily pain (BP 77.5 [45–100]), social functioning (SF 75 [50–100]), general health (GH 55 [35–72]), vitality (VT 55 [40–70]), mental health (MH 68 [52–84]) and health change (HC 50 [25–75]) describe the SF-36 items. A median physical component summary (PCS) and mental component summary (MCS) scores were 45.9 (36.5–53.5) and 51.7 (48.8–54.3), respectively, considering 50 as the normal value of the healthy general population. In all, 109 patients (31.8%) tested positive for post-traumatic stress disorder, also reporting a significantly worse HRQoL in all SF-36 domains. The female gender, history of cardiovascular disease, liver disease and length of hospital stay negatively affected the HRQoL. Weight at follow-up was a risk factor for PTSD (OR 1.02, p = 0.03). Conclusions: The HRQoL in COVID-19 ARDS ( C-ARDS ) patients was reduced regarding the PCS, while the median MCS value was slightly above normal. Some risk factors for a lower HRQoL have been identified, the presence of PTSD is one of them. Further research is warranted to better identify the possible factors affecting the HRQoL in C-ARDS. Full article
(This article belongs to the Section Intensive Care)
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Review
Ultrasound during the COVID-19 Pandemic: A Global Approach
J. Clin. Med. 2023, 12(3), 1057; https://doi.org/10.3390/jcm12031057 (registering DOI) - 29 Jan 2023
Viewed by 78
Abstract
SARS-COV-2 (severe acute respiratory syndrome Coronavirus-2) rapidly spread worldwide as COVID-19 (Coronavirus disease 2019), causing a costly and deadly pandemic. Different pulmonary manifestations represent this syndrome's most common clinical manifestations, together with the cardiovascular complications frequently observed in these patients. Ultrasound (US) evaluations [...] Read more.
SARS-COV-2 (severe acute respiratory syndrome Coronavirus-2) rapidly spread worldwide as COVID-19 (Coronavirus disease 2019), causing a costly and deadly pandemic. Different pulmonary manifestations represent this syndrome's most common clinical manifestations, together with the cardiovascular complications frequently observed in these patients. Ultrasound (US) evaluations of the lungs, heart, and lower limbs may be helpful in the diagnosis, follow-up, and prognosis of patients with COVID-19. Moreover, POCUS (point-of-care ultrasound) protocols are particularly useful for patients admitted to intensive care units. The present review aimed to highlight the clinical conditions during the SARS-COV-2 pandemic in which the US represents a crucial diagnostic tool. Full article
(This article belongs to the Section Cardiovascular Medicine)
Article
Differential Modulation of the Excitatory and Inhibitory Synaptic Circuits of Retinal Ganglion Cells via Asiatic Acid in a Chronic Glaucoma Rat Model
J. Clin. Med. 2023, 12(3), 1056; https://doi.org/10.3390/jcm12031056 (registering DOI) - 29 Jan 2023
Abstract
Purpose: To investigate whether asiatic acid (AA) can improve the quantity and function of retinal ganglion cells (RGCs), as well as how AA regulates synaptic pathways in rat models with chronic glaucoma. Methods: In our study, a rat model of chronic glaucoma was [...] Read more.
Purpose: To investigate whether asiatic acid (AA) can improve the quantity and function of retinal ganglion cells (RGCs), as well as how AA regulates synaptic pathways in rat models with chronic glaucoma. Methods: In our study, a rat model of chronic glaucoma was prepared via the electrocoagulation of the episcleral veins. The numbers of surviving RGCs were counted via retrograde Fluorogold labeling, and a whole-cell patch clamp was used to clamp RGCs in normal retinal sections and in retinal sections 4 weeks after glaucoma induction. Results: Retrograde-Fluorogold-labeled RGC loss caused by persistent glaucoma was decreased by AA. Additionally, AA reduced the postsynaptic current produced by N-methyl-D-aspartate (NMDA) and diminished miniature glutamatergic excitatory neurotransmission to RGCs. On the other hand, AA increased miniature gamma-aminobutyric acid (GABA)-ergic inhibitory neurotransmission to RGCs and enhanced the GABA-induced postsynaptic current. The excitability of the RGC itself was also decreased by AA. RGCs in glaucomatous slices were less excitable because AA decreased their spontaneous action potential frequency and membrane potential, which led to a hyperpolarized condition. Conclusions: AA directly protected RGCs in a chronic glaucoma rat model by lowering their hyperexcitability. To enhance RGCs’ survival and function in glaucoma, AA may be a viable therapeutic drug. Full article
(This article belongs to the Special Issue State-of-the-Art Research on Vitreoretinal Disorders)
Article
Long Pentraxin 3 as a New Biomarker for Diagnosis of Hip and Knee Periprosthetic Joint Infections
J. Clin. Med. 2023, 12(3), 1055; https://doi.org/10.3390/jcm12031055 (registering DOI) - 29 Jan 2023
Viewed by 75
Abstract
Background: Preoperative diagnosis of periprosthetic joint infections (PJIs) poses an unmet clinical challenge. The long pentraxin PTX3 is a component of the innate immune system involved in infection immunity. This study evaluated the potential of synovial and plasmatic PTX3 in the diagnosis of [...] Read more.
Background: Preoperative diagnosis of periprosthetic joint infections (PJIs) poses an unmet clinical challenge. The long pentraxin PTX3 is a component of the innate immune system involved in infection immunity. This study evaluated the potential of synovial and plasmatic PTX3 in the diagnosis of hip and knee PJIs. Methods: Consecutive total hip and knee arthroplasty (THA/TKA) revisions were prospectively included and classified as septic or aseptic according to the European Bone and Joint Infection Society (EBJIS) and Musculoskeletal Infection Society (MSIS) criteria. The concentration of PTX3 in plasma and synovial fluid samples was measured with ELISA. The AUC, threshold value, sensitivity, specificity, and positive and negative likelihood ratios were calculated using the ROC (receiver operating characteristic) curve method. Results: The study population included 128 patients (94 THAs; 34 TKAs). The AUC of the synovial PTX3 based on EBJIS criteria was 0.85 (p < 0.0001), with a sensitivity of 81.13% and a specificity of 93.33%. The AUC based on MSIS criteria was 0.95 (p < 0.001), with a sensitivity of 91.43% and a specificity of 89.25%. Plasmatic PTX3 failed to discriminate infected from non-infected patients. Conclusions: Synovial PTX3 demonstrated an excellent diagnostic potential in hip and knee PJIs, with a very high specificity irrespective of the diagnostic criteria for PJI. Full article
(This article belongs to the Section Orthopedics)
Review
Progress in Brain Magnetic Resonance Imaging of Individuals with Prader–Willi Syndrome
J. Clin. Med. 2023, 12(3), 1054; https://doi.org/10.3390/jcm12031054 (registering DOI) - 29 Jan 2023
Viewed by 70
Abstract
Prader–Willi syndrome (PWS), a rare epigenetic disease mapping the imprinted chromosomal domain of 15q11.2-q13.3, manifests a regular neurodevelopmental trajectory in different phases. The current multimodal magnetic resonance imaging (MRI) approach for PWS focues on morphological MRI (mMRI), diffusion MRI (dMRI) and functional MRI [...] Read more.
Prader–Willi syndrome (PWS), a rare epigenetic disease mapping the imprinted chromosomal domain of 15q11.2-q13.3, manifests a regular neurodevelopmental trajectory in different phases. The current multimodal magnetic resonance imaging (MRI) approach for PWS focues on morphological MRI (mMRI), diffusion MRI (dMRI) and functional MRI (fMRI) to uncover brain alterations. This technique offers another perspective to understand potential neurodevelopmental and neuropathological processes of PWS, in addition to specific molecular gene expression patterns, various clinical manifestations and metabolic phenotypes. Multimodal MRI studies of PWS patients demonstrated common brain changes in the volume of gray matter, the integrity of the fiber tracts and the activation and connectivity of some networks. These findings mainly showed that brain alterations in the frontal reward circuit and limbic system were related to molecular genetics and clinical manifestations (e.g., overwhelming eating, obsessive compulsive behaviors and skin picking). Further exploration using a large sample size and advanced MRI technologies, combined with artificial intelligence algorithms, will be the main research direction to study the structural and functional changes and potential pathogenesis of PWS. Full article
(This article belongs to the Special Issue Recent Advances in Clinical Neuroimaging)
Article
A Deep Learning Model for Evaluating Meibomian Glands Morphology from Meibography
J. Clin. Med. 2023, 12(3), 1053; https://doi.org/10.3390/jcm12031053 (registering DOI) - 29 Jan 2023
Viewed by 81
Abstract
To develop a deep learning model for automatically segmenting tarsus and meibomian gland areas on meibography, we included 1087 meibography images from dry eye patients. The contour of the tarsus and each meibomian gland was labeled manually by human experts. The dataset was [...] Read more.
To develop a deep learning model for automatically segmenting tarsus and meibomian gland areas on meibography, we included 1087 meibography images from dry eye patients. The contour of the tarsus and each meibomian gland was labeled manually by human experts. The dataset was divided into training, validation, and test sets. We built a convolutional neural network-based U-net and trained the model to segment the tarsus and meibomian gland area. Accuracy, sensitivity, specificity, and receiver operating characteristic curve (ROC) were calculated to evaluate the model. The area under the curve (AUC) values for models segmenting the tarsus and meibomian gland area were 0.985 and 0.938, respectively. The deep learning model achieved a sensitivity and specificity of 0.975 and 0.99, respectively, with an accuracy of 0.985 for segmenting the tarsus area. For meibomian gland area segmentation, the model obtained a high specificity of 0.96, with high accuracy of 0.937 and a moderate sensitivity of 0.751. The present research trained a deep learning model to automatically segment tarsus and the meibomian gland area from infrared meibography, and the model demonstrated outstanding accuracy in segmentation. With further improvement, the model could potentially be applied to assess the meibomian gland that facilitates dry eye evaluation in various clinical and research scenarios. Full article
(This article belongs to the Section Ophthalmology)
Commentary
Bowel Perforation after Extracorporeal Wave Lithotripsy: A Review of the Literature
J. Clin. Med. 2023, 12(3), 1052; https://doi.org/10.3390/jcm12031052 (registering DOI) - 29 Jan 2023
Viewed by 84
Abstract
Introduction: Extracorporeal wave lithotripsy (ESWL) is considered a first-line treatment for renal and ureteral stones up to 10–20 mm in diameter. Complications are uncommon, with a reported rate of 0–6% in the literature. Bowel perforation has only been described in a few case [...] Read more.
Introduction: Extracorporeal wave lithotripsy (ESWL) is considered a first-line treatment for renal and ureteral stones up to 10–20 mm in diameter. Complications are uncommon, with a reported rate of 0–6% in the literature. Bowel perforation has only been described in a few case reports but requires rapid diagnosis and treatment. Methods: A review of the literature from PubMed/Medline, Embase, Cochrane, and Web of Science databases was performed including studies reporting bowel perforation secondary to ESWL between January 1990 and June 2022. Results: We found 16 case reports of intestinal perforation in the literature. Although some patients had previously undergone abdominal surgery or had inflammatory intestinal disease, others were without comorbidities that could lead to complications. Abdominal pain was the main symptom and imaging was required to confirm the diagnosis, which usually necessitated a surgical intervention. As regards the ESWL technique, it appears that the combination of a high energy level and the prone position constitutes a risk factor for these rare complications. At the authors’ centre, only one case has been reported among 24,000 ESWL procedures over 20 years: A 59-year-old female who underwent ESWL for a distal right ureteral stone presented acute abdominal pain and free intraperitoneal pelvic fluid on ultrasound. A CT scan revealed a small bowel perforation requiring open laparotomy with primary closure. Conclusions: In conclusion, although bowel perforation after ESWL is rare, progressive abdominal pain with tenderness at physical examination requires proper imaging evaluation to exclude bowel perforation and prompt intervention if required. Full article
(This article belongs to the Special Issue Medical and Surgical Management of Urinary Tract Diseases)
Article
Investigation of the Relationship between Right Coronary Artery–Aorta Angle and Coronary Artery Disease and Associated Risk Factors
J. Clin. Med. 2023, 12(3), 1051; https://doi.org/10.3390/jcm12031051 (registering DOI) - 29 Jan 2023
Viewed by 123
Abstract
At the level of the left coronary artery tree, there is evidence showing an association between bifurcation angle and coronary artery disease (CAD), and this motivated us to explore similar associations at the level of the right coronary artery (RCA). The purpose of [...] Read more.
At the level of the left coronary artery tree, there is evidence showing an association between bifurcation angle and coronary artery disease (CAD), and this motivated us to explore similar associations at the level of the right coronary artery (RCA). The purpose of this study was to determine whether there is a relationship between RCA–aorta angle and CAD and age, sex, body mass index, smoking status, hypertension, and high blood cholesterol. The coronary computed tomography angiography datasets and CAD risk factor checklists of 250 patients were retrospectively reviewed, with RCA–aorta angles measured via multiplanar reformation images. Independent t-tests were used to compare mean RCA–aorta angle measurements between groups, correlations between continuous variables were assessed using Pearson and Spearman correlations, and a general linear model was used to adjust for potentially confounding variables. Coronary angle measurements were conducted by two independent assessors with very strong intraclass correlation (r=0.999, p<0.001). A significantly smaller mean RCA–aorta angle was observed in the CAD group (79.07 ± 24.88°) compared to the normal group (92.08 ± 19.51°, p=0.001), in smokers (76.63  ± 22.94°) compared to non-smokers (85.25  ± 23.84°, p=0.016), and a narrow RCA–aorta angle was negatively correlated with BMI (r=0.174, p=0.007). This study suggests a relationship between narrow RCA–aorta angles and CAD, smoking, and increasing BMI. Full article
(This article belongs to the Special Issue Recent Advances in Cardiovascular Imaging 2.0 Edition)
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Article
Initial In-Hospital Visit-to-Visit Heart Rate Variability Is Associated with Higher Risk of Atrial Fibrillation in Patients with Acute Ischemic Stroke
J. Clin. Med. 2023, 12(3), 1050; https://doi.org/10.3390/jcm12031050 (registering DOI) - 29 Jan 2023
Viewed by 105
Abstract
Background: To evaluate the association between the visit-to-visit heart rate variability and the risk of atrial fibrillation (AF) in acute ischemic stroke (AIS). Methods: We analyzed the data of 8179 patients with AIS. Patients without AF on 12-lead electrocardiography underwent further 24 h [...] Read more.
Background: To evaluate the association between the visit-to-visit heart rate variability and the risk of atrial fibrillation (AF) in acute ischemic stroke (AIS). Methods: We analyzed the data of 8179 patients with AIS. Patients without AF on 12-lead electrocardiography underwent further 24 h Holter monitoring. They were categorized into four subgroups according to the visit-to-visit heart rate variability expressed as the coefficient of variation in heart rate (HR-CV). Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using the HR-CV < 0.08 subgroup as a reference. Results: The adjusted OR of paroxysmal AF was 1.866 (95% CI = 1.205–2.889) for the HR-CV ≥ 0.08 and <0.10 subgroup, 1.889 (95% CI = 1.174–3.038) for the HR-CV ≥ 0.10 and <0.12 subgroup, and 5.564 (95% CI = 3.847–8.047) for the HR-CV ≥ 0.12 subgroup. The adjusted OR of persistent AF was 2.425 (95% CI = 1.921–3.062) for the HR-CV ≥ 0.08 and <0.10 subgroup, 4.312 (95% CI = 3.415–5.446) for the HR-CV ≥ 0.10 and <0.12 subgroup, and 5.651 (95% CI = 4.586–6.964) for the HR-CV ≥ 0.12 subgroup. Conclusions: HR-CV can facilitate the identification of patients with AIS at a high risk of paroxysmal AF. Full article
(This article belongs to the Special Issue Biomarkers for Cardiovascular Risk)
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Article
Pleural Effusion in COVID-19 Pneumonia: Clinical and Prognostic Implications—An Observational, Retrospective Study
J. Clin. Med. 2023, 12(3), 1049; https://doi.org/10.3390/jcm12031049 (registering DOI) - 29 Jan 2023
Viewed by 177
Abstract
Background: COVID-19 presents with a wide spectrum of clinical and radiological manifestations, including pleural effusion. The prevalence and prognostic impact of pleural effusion are still not entirely clear. Patients and methods: This is a retrospective, single-center study including a population of consecutive patients [...] Read more.
Background: COVID-19 presents with a wide spectrum of clinical and radiological manifestations, including pleural effusion. The prevalence and prognostic impact of pleural effusion are still not entirely clear. Patients and methods: This is a retrospective, single-center study including a population of consecutive patients admitted to the University Hospital of Cisanello (Pisa) from March 2020 to January 2021 with a positive SARS-CoV-2 nasopharyngeal swab and SARS-CoV-2-related pneumonia. The patients were divided into two populations based on the presence (n = 150) or absence (n = 515) of pleural effusion on chest CT scan, excluding patients with pre-existing pleural effusion. We collected laboratory data (hemoglobin, leukocytes, platelets, C-reactive protein, procalcitonin), worst PaO2/FiO2 ratio as an index of respiratory gas exchange impairment, the extent of interstitial involvement related to SARS-CoV-2 pneumonia and data on intensity of care, length of stay and outcome (discharge or death). Results: The prevalence of pleural effusion was 23%. Patients with pleural effusion showed worse gas exchange (p < 0.001), longer average hospital stay (p < 0.001), need for more health care resources (p < 0.001) and higher mortality (p < 0.001) compared to patients without pleural effusion. By multivariate analysis, pleural effusion was found to be an independent negative prognostic factor compared with other variables such as increased C-reactive protein, greater extent of pneumonia and older age. Pleural effusion was present at the first CT scan in most patients (68%). Conclusions: Pleural effusion associated with SARS-CoV-2 pneumonia is a relatively frequent finding that is confirmed to be a negative prognostic factor. Identifying early prognostic factors in an endemic-prone disease such as COVID-19 is necessary to optimize its clinical management. Further clinical studies aimed at better characterizing pleural effusion in these patients will be appropriate in order to clarify its pathogenetic role. Full article
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Article
Global, Regional, and National Incidence and Disability-Adjusted Life-Years for Urolithiasis in 195 Countries and Territories, 1990–2019: Results from the Global Burden of Disease Study 2019
J. Clin. Med. 2023, 12(3), 1048; https://doi.org/10.3390/jcm12031048 (registering DOI) - 29 Jan 2023
Viewed by 101
Abstract
Purpose: Urolithiasis is highly prevalent worldwide. The aim of this study was to report the results of the Global Burden of Disease 2019 study on urolithiasis burden estimates grouped by gender, regions, countries or territories, and sociodemographic index (SDI) from 1990 to 2019 [...] Read more.
Purpose: Urolithiasis is highly prevalent worldwide. The aim of this study was to report the results of the Global Burden of Disease 2019 study on urolithiasis burden estimates grouped by gender, regions, countries or territories, and sociodemographic index (SDI) from 1990 to 2019 globally. Methods: We reported detailed estimates and temporal trends of the burden estimates of urolithiasis from 1990 to 2019 in 195 countries and territories and further evaluated the relationship between these estimates and SDI, a composite indicator of income per person, years of education, and fertility as a measurement of country/region socio-economic level. Urolithiasis incidence and disability-adjusted life years by gender, regions, countries or territories, and SDI were reported. The percentage change and estimated annual percentage change of these burden estimates were calculated to quantify temporal trends. Results: From 1990 to 2019, the age-standardized incidence rate (ASIR) and disability-adjusted life years (DALYs) of urolithiasis decreased globally by 0.459% and 1.898% per year, respectively. Such a trend of ASIR was prominently due to the decline in the middle, high-middle, and high SDI countries, including Eastern Asia, high-income Eastern Europe, and high-income North America. During this period, these estimates increased in low and low-middle SDI countries, particularly in South Asia, Andean Latin America, and Western Europe. A decline in DALYs was observed in all SDI countries. An approximate positive linear association existed between the burden estimate’s decreased APC and SDI level, except at the high SDI level. Both males and females showed the same trend. Conclusions: This study provides comprehensive knowledge of the burden estimate of urolithiasis. Although the burden estimates of urolithiasis showed a global decrease during the past 29 years, this progress has yet to be universal; the increasing trends were observed in countries with low and low-middle SDI countries. Research in these countries is needed and helps with the appropriate allocation of health resources for prevention, screening, and treatment strategies. Full article
(This article belongs to the Special Issue Clinical Epidemiology of Kidney Disease)
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Article
Plasma Level of Pyrophosphate Is Low in Pseudoxanthoma Elasticum Owing to Mutations in the ABCC6 Gene, but It Does Not Correlate with ABCC6 Genotype
J. Clin. Med. 2023, 12(3), 1047; https://doi.org/10.3390/jcm12031047 (registering DOI) - 29 Jan 2023
Viewed by 87
Abstract
Background: Pseudoxanthoma elasticum (PXE), a monogenic disorder resulting in calcification affecting the skin, eyes and peripheral arteries, is caused by mutations in the ABCC6 gene, and is associated with low plasma inorganic pyrophosphate (PPi). It is unknown how ABCC6 genotype affects [...] Read more.
Background: Pseudoxanthoma elasticum (PXE), a monogenic disorder resulting in calcification affecting the skin, eyes and peripheral arteries, is caused by mutations in the ABCC6 gene, and is associated with low plasma inorganic pyrophosphate (PPi). It is unknown how ABCC6 genotype affects plasma PPi. Methods: We studied the association of ABCC6 genotype (192 patients with biallelic pathogenic ABCC6 mutations) and PPi levels, and its association with the severity of arterial and ophthalmological phenotypes. ABCC6 variants were classified as truncating or non-truncating, and three groups of the 192 patients were formed: those with truncating mutations on both chromosomes (n = 121), those with two non-truncating mutations (n = 10), and a group who had one truncating and one non-truncating ABCC6 mutation (n = 61). The hypothesis formulated before this study was that there was a negative association between PPi level and disease severity. Results: Our findings confirm low PPi in PXE compared with healthy controls (0.53 ± 0.15 vs. 1.13 ± 0.29 µM, p < 0.01). The PPi of patients correlated with increasing age (β: 0.05 µM, 95% CI: 0.03–0.06 per 10 years) and was higher in females (0.55 ± 0.17 vs. 0.51 ± 0.13 µM in males, p = 0.03). However, no association between PPi and PXE phenotypes was found. When adjusted for age and sex, no association between PPi and ABCC6 genotype was found. Conclusions: Our data suggest that the relationship between ABCC6 mutations and reduced plasma PPi may not be as direct as previously thought. PPi levels varied widely, even in patients with the same ABCC6 mutations, further suggesting a lack of direct correlation between them, even though the ABCC6 protein-mediated pathway is responsible for ~60% of this metabolite in the circulation. We discuss potential factors that may perturb the expected associations between ABCC6 genotype and PPi and between PPi and disease severity. Our findings support the argument that predictions of pathogenicity made on the basis of mutations (or on the structure of the mutated protein) could be misleading. Full article
(This article belongs to the Section Vascular Medicine)
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Review
Towards the Clinical Application of Gene Therapy for Genetic Inner Ear Diseases
J. Clin. Med. 2023, 12(3), 1046; https://doi.org/10.3390/jcm12031046 (registering DOI) - 29 Jan 2023
Viewed by 96
Abstract
Hearing loss, the most common human sensory defect worldwide, is a major public health problem. About 70% of congenital forms and 25% of adult-onset forms of deafness are of genetic origin. In total, 136 deafness genes have already been identified and there are [...] Read more.
Hearing loss, the most common human sensory defect worldwide, is a major public health problem. About 70% of congenital forms and 25% of adult-onset forms of deafness are of genetic origin. In total, 136 deafness genes have already been identified and there are thought to be several hundred more awaiting identification. However, there is currently no cure for sensorineural deafness. In recent years, translational research studies have shown gene therapy to be effective against inherited inner ear diseases, and the application of this technology to humans is now within reach. We provide here a comprehensive and practical overview of current advances in gene therapy for inherited deafness, with and without an associated vestibular defect. We focus on the different gene therapy approaches, considering their prospects, including the viral vector used, and the delivery route. We also discuss the clinical application of the various strategies, their strengths, weaknesses, and the challenges to be overcome. Full article
(This article belongs to the Special Issue Clinical and Translational Research in Auditory Processing Disorder)
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Article
Being Underweight Is Associated with Increased Risk of Sudden Cardiac Death in People with Diabetes Mellitus
J. Clin. Med. 2023, 12(3), 1045; https://doi.org/10.3390/jcm12031045 (registering DOI) - 29 Jan 2023
Viewed by 109
Abstract
Background: Diabetes mellitus (DM) can cause various atherosclerotic cardiovascular disease including sudden cardiac death (SCD). The impact of being underweight on the risk of SCD in people with DM remains to be revealed. We aimed to evaluate the risk of SCD according to [...] Read more.
Background: Diabetes mellitus (DM) can cause various atherosclerotic cardiovascular disease including sudden cardiac death (SCD). The impact of being underweight on the risk of SCD in people with DM remains to be revealed. We aimed to evaluate the risk of SCD according to body-mass index (BMI; kg/m2) level in DM population. Methods: We used a nationwide healthcare insurance database to conduct this study. We identified people with DM among those who underwent nationwide health screening during 2009 to 2012. Medical follow-up data was available until December 2018. Results: A total of 2,602,577 people with DM with a 17,851,797 person*year follow-up were analyzed. The underweight group (BMI < 18.5) showed 2.4-fold increased risk of SCD during follow-up (adjusted-hazard ratio [HR] = 2.40; 95% confidence interval [CI] = 2.26–2.56; p < 0.001). When normal-BMI group (18.5 ≤ BMI < 23) was set as a reference, underweight group (adjusted-HR = 2.01; 95% CI = 1.88–2.14) showed even higher risk of SCD compared with the obesity group (BMI ≥ 30; adjusted-HR = 0.89; 95% CI = 0.84–0.94). When BMI was stratified by one unit, BMI and SCD risk showed a U-curve association with the highest risk observed at low BMI levels. The lowest risk was observed in 27 ≤ BMI < 28 group. The association between being underweight and increased SCD risk in DM people was maintained throughout various subgroups. Conclusions: Being underweight is significantly associated with an increased risk of SCD in the DM population. A steep rise in the risk of SCD was observed as the BMI level decreased below 23. The lowest risk of SCD was observed in 27 ≤ BMI < 28 group. Full article
(This article belongs to the Special Issue Sudden Cardiac Death: Clinical Updates and Perspectives)
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Article
High Incidence of Obstetric Anal Sphincter Injuries among Immigrant Women of Asian Ethnicity
J. Clin. Med. 2023, 12(3), 1044; https://doi.org/10.3390/jcm12031044 (registering DOI) - 29 Jan 2023
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Abstract
(1) Background: Obstetric anal sphincter injuries (OASI) may complicate vaginal deliveries. The aim of the present study was to explore the incidence and clinical characteristics of OASI among Asian women living in a Western country compared to local Caucasian women. (2) Methods: A [...] Read more.
(1) Background: Obstetric anal sphincter injuries (OASI) may complicate vaginal deliveries. The aim of the present study was to explore the incidence and clinical characteristics of OASI among Asian women living in a Western country compared to local Caucasian women. (2) Methods: A retrospective cohort study of 380 women diagnosed with OASI, following singleton vaginal deliveries, during a 10-year period (January 2011 to December 2020). Exclusion criteria: age < 18 years, stillbirth, and breech presentation. Demographic, clinical, and obstetrical data were obtained, and a comparison between Asian and Caucasian women was performed. (3) Results: There were 35 cases of OASI among 997 women of Asian ethnicity compared to 345 cases of OASI among 86,250 Caucasian women (3.5% vs. 0.4%, respectively, p < 0.001). Asian women endured a significantly higher rate of fourth-degree OASI (17.1%) even though they bore smaller newborns (3318 g vs. 3501 g, p = 0.004), and birth weights rarely exceeded 3800 g (2.8% vs. 25.8%, p < 0.001). Asian ethnicity was also associated with a significantly higher risk for blood transfusion following OASI and a lower tendency for postpartum follow up. (4) Conclusions: Immigrant women of Asian ethnicity had a nine-fold higher rate of OASI, much higher than previously reported. Furthermore, Asian women had higher rates of fourth-degree OASI. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Urinary and Fecal Incontinence in Women)
Perspective
Newly Proposed Diagnostic Criteria for Acute Respiratory Distress Syndrome: Does Inclusion of High Flow Nasal Cannula Solve the Problem?
J. Clin. Med. 2023, 12(3), 1043; https://doi.org/10.3390/jcm12031043 (registering DOI) - 29 Jan 2023
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Abstract
Acute respiratory distress syndrome (ARDS) is a common life-threatening clinical syndrome which accounts for 10% of intensive care unit admissions. Since the Berlin definition was developed, the clinical diagnosis and therapy have changed dramatically by adding a minimum positive end-expiratory pressure (PEEP) to [...] Read more.
Acute respiratory distress syndrome (ARDS) is a common life-threatening clinical syndrome which accounts for 10% of intensive care unit admissions. Since the Berlin definition was developed, the clinical diagnosis and therapy have changed dramatically by adding a minimum positive end-expiratory pressure (PEEP) to the assessment of hypoxemia compared to the American-European Consensus Conference (AECC) definition in 1994. High-flow nasal cannulas (HFNC) have become widely used as an effective respiratory support for hypoxemia to the extent that their use was proposed in the expansion of the ARDS criteria. However, there would be problems if the diagnosis of a specific disease or clinical syndrome occurred, based on therapeutic strategies. Full article
(This article belongs to the Special Issue New Insights into Acute Respiratory Distress Syndrome)
Article
Epidemiology and Outcomes of Hypernatraemia in Patients with COVID-19—A Territory-Wide Study in Hong Kong
J. Clin. Med. 2023, 12(3), 1042; https://doi.org/10.3390/jcm12031042 (registering DOI) - 29 Jan 2023
Viewed by 127
Abstract
Background: Dysnatraemias are commonly reported in COVID-19. However, the clinical epidemiology of hypernatraemia and its impact on clinical outcomes in relation to different variants of SARS-CoV-2, especially the prevailing Omicron variant, remain unclear. Methods: This was a territory-wide retrospective study to investigate the [...] Read more.
Background: Dysnatraemias are commonly reported in COVID-19. However, the clinical epidemiology of hypernatraemia and its impact on clinical outcomes in relation to different variants of SARS-CoV-2, especially the prevailing Omicron variant, remain unclear. Methods: This was a territory-wide retrospective study to investigate the clinical epidemiology and outcomes of COVID-19 patients with hypernatraemia at presentation during the period from 1 January 2020 to 31 March 2022. The primary outcome was 30-day mortality. Key secondary outcomes included rates of hospitalization and ICU admission, and costs of hospitalization. Results: In this study, 53,415 adult COVID-19 patients were included for analysis. Hypernatraemia was observed in 2688 (5.0%) patients at presentation, of which most cases (99.2%) occurred during the local “5th wave” dominated by the Omicron BA.2 variant. Risk factors for hypernatraemia at presentation included age, institutionalization, congestive heart failure, dementia, higher SARS-CoV-2 Ct value, white cell count, C-reactive protein and lower eGFR and albumin levels (p < 0.001 for all). Patients with hypernatraemia showed significantly higher 30-day mortality (32.0% vs. 5.7%, p < 0.001) and longer lengths of stay (12.9 ± 10.9 vs. 11.5 ± 12.1 days, p < 0.001) compared with those with normonatraemia. Multivariate analysis revealed hypernatraemia at presentation as an independent predictor for 30-day mortality (aHR 1.32, 95% CI 1.14–1.53, p < 0.001) and prolonged hospital stays (OR 1.55, 95% CI 1.17–2.05, p = 0.002). Conclusions: Hypernatraemia is common among COVID-19 patients, especially among institutionalized older adults with cognitive impairment and other comorbidities during large-scale outbreaks during the Omicron era. Hypernatraemia is associated with unfavourable outcomes and increased healthcare utilization. Full article
(This article belongs to the Special Issue Clinical Features of COVID-19 in Elderly Patients)
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Article
The Correlation between the Results of the Sniffin’ Sticks Test, Demographic Data, and Questionnaire of Olfactory Disorders in a Hungarian Population after a SARS-CoV-2 Infection
J. Clin. Med. 2023, 12(3), 1041; https://doi.org/10.3390/jcm12031041 (registering DOI) - 29 Jan 2023
Viewed by 128
Abstract
Background: After a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, smell disorders frequently occur, significantly affecting patients’ quality of life (QoL). Methods: 110 patients with persistent olfactory disorder after coronavirus infection were enrolled. These patients underwent chemosensory testing using the Sniffin’ Sticks test, [...] Read more.
Background: After a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, smell disorders frequently occur, significantly affecting patients’ quality of life (QoL). Methods: 110 patients with persistent olfactory disorder after coronavirus infection were enrolled. These patients underwent chemosensory testing using the Sniffin’ Sticks test, and completed the Questionnaire of Olfactory Disorders (QOD). Results: 30% of the patients reported anosmia, and 70% reported hyposmia. Upon comparing subjective and chemosensory testing categories, good category matching was observed in 75.3% (i.e., anosmia based on both methods in 10 and hyposmia in 48 cases). Statistical analysis using the Chi-square test revealed a significant result (p = 0.001 *). Between the TDI (i.e., Threshold, Discrimination, Identification) results of the three subjective report groups (i.e., hyposmia, anosmia, and parosmia), no significant differences were observed. When the TDI and QOD results were compared, no consistent significant correlations were found in most TDI and QOD outcomes. Between the TDI and Scale 2 results, a significant, although slight correlation was observed by the Spearman’s (rho = 0.213, p = 0.027 *) and Pearson’s (rho = 0.201, p = 0.037 *) tests. Conclusions: The nonsignificant correlation between objective and subjective methods suggests that these results should be interpreted independently. Moreover, adequate management is essential even in mild cases. Full article
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Article
Microcirculation Improvement in Diabetic Foot Patients after Treatment with Sucrose Octasulfate-Impregnated Dressings
J. Clin. Med. 2023, 12(3), 1040; https://doi.org/10.3390/jcm12031040 (registering DOI) - 29 Jan 2023
Viewed by 147
Abstract
To assess the patients’ microcirculation evolution during the treatment with a sucrose octasulfate-impregnated dressing, fifty patients with neuroischaemic DFU treated with TLC-NOSF dressing were included in a prospective study between November 2020 and February 2022. TcpO2 values were measured on the dorsalis [...] Read more.
To assess the patients’ microcirculation evolution during the treatment with a sucrose octasulfate-impregnated dressing, fifty patients with neuroischaemic DFU treated with TLC-NOSF dressing were included in a prospective study between November 2020 and February 2022. TcpO2 values were measured on the dorsalis pedis or tibial posterior arteries’ angiosome according to the ulcer location. TcpO2 values were assessed at day 0 and every 4 weeks during 20 weeks of the follow-up or until the wound healed. A cut-off point of tcpO2 < 30 mmHg was defined for patients with impaired microcirculation. The TcpO2 values showed an increase between day 0 and the end of the study, 33.04 ± 12.27 mmHg and 40.89 ± 13.06 mmHg, respectively, p < 0.001. Patients with impaired microcirculation showed an increase in the tcpO2 values from day 0 to the end of the study (p = 0.023). Furthermore, we observed a significant increase in the TcpO2 values in the forefoot DFU (p = 0.002) and in the rearfoot DFU (p = 0.071), with no difference between the ulcer locations (p = 0.694). The local treatment with TLC-NOSF dressing improved the microcirculation in patients with neuroischaemic DFU, regardless of microcirculation status at the baseline, and in the forefoot, regardless of the location. Full article
Review
Diagnostics of Sacroiliac Joint Differentials to Axial Spondyloarthritis Changes by Magnetic Resonance Imaging
J. Clin. Med. 2023, 12(3), 1039; https://doi.org/10.3390/jcm12031039 (registering DOI) - 29 Jan 2023
Viewed by 108
Abstract
The diagnosis of axial spondyloarthritis (axSpA) is usually based on a pattern of imaging and clinical findings due to the lack of diagnostic criteria. The increasing use of magnetic resonance imaging (MRI) of the sacroiliac joints (SIJ) to establish the diagnosis early in [...] Read more.
The diagnosis of axial spondyloarthritis (axSpA) is usually based on a pattern of imaging and clinical findings due to the lack of diagnostic criteria. The increasing use of magnetic resonance imaging (MRI) of the sacroiliac joints (SIJ) to establish the diagnosis early in the pre-radiographic phase has resulted in a shift in the paradigm with an increasing frequency of axSpA diagnoses and a changed sex distribution. Non-radiographic axSpA affects males and females nearly equally, whereas ankylosing spondylitis predominantly occurs in males. The MRI-based increasing frequency of axSpA in women is mainly due to the presence of subchondral bone marrow edema (BME) on fluid-sensitive MR sequences, which may be a non-specific finding in both women and men. Due to the somewhat different pelvic tilt and SIJ anatomy, women are more prone than men to develop strain-related MRI changes and may have pregnancy-related changes. Awareness of non-specific subchondral BME at the SIJ is important as it can imply a risk for an incorrect SpA diagnosis, especially as the clinical manifestations of axSpA may also be non-specific. Knowledge of relevant MRI and clinical features of differential diagnoses is needed in the diagnostic workout of patients with suspected axSpA considering that non-SpA-related SIJ conditions are more common in patients with low back or buttock pain than axSpA sacroiliitis. The purpose of this review was to present current knowledge of the most frequent differential diagnoses to axSpA sacroiliitis by MRI taking the clinical characteristics into account. Full article
(This article belongs to the Special Issue Imaging of Arthropathies and Tendinopathies)
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Review
Bilateral Atypical Femoral Fractures after Bisphosphonate Treatment for Osteoporosis: A Literature Review
J. Clin. Med. 2023, 12(3), 1038; https://doi.org/10.3390/jcm12031038 (registering DOI) - 29 Jan 2023
Viewed by 113
Abstract
Introduction: This literature review aimed to investigate the incidence, anatomical concerns, etiology, symptoms, diagnostic tools, management, and prognosis of bisphosphonate (BP)—associated bilateral atypical femoral fractures (AFFs). Methods: The PubMed, Cochrane Library, Web of Sciences, and CINAHL databases were searched up to 20 March [...] Read more.
Introduction: This literature review aimed to investigate the incidence, anatomical concerns, etiology, symptoms, diagnostic tools, management, and prognosis of bisphosphonate (BP)—associated bilateral atypical femoral fractures (AFFs). Methods: The PubMed, Cochrane Library, Web of Sciences, and CINAHL databases were searched up to 20 March 2022. All cases of bilateral AFFs were included, excluding those without any bisphosphonate treatment information and those in which the femoral fracture did not precisely fit into the diagnostic criteria for AFF. Results: We identified 43 patients with bilateral AFFs associated with BP use and conducted a comprehensive analysis. Among 43 patients, 29 (67%) had prodromal symptoms. Regarding the simultaneity of fracture, 21 cases (49%) occurred simultaneously, and 22 cases (51%) occurred sequentially. Alendronate was the most commonly used BP treatment (59%). Regardless of the medication type, BP intake duration was more than 5 years in 77%. The initial diagnosis was performed using X-rays in all cases. A total of 53% of patients had complete fractures, and all patients underwent surgical treatment. Among the remaining patients with incomplete fractures, 18% and 29% received surgical and medical treatments, respectively. After BP discontinuation, teriparatide was most commonly used (63%). Conclusions: The careful evaluation of relevant imaging findings in patients with thigh/groin pain allows the identification of early incomplete fractures and timely management. Since the rate of contralateral side fractures is also high, imaging studies should be performed on the asymptomatic contralateral side. Full article
(This article belongs to the Section Orthopedics)
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Article
Reduction of Lams-Related Adverse Events with Accumulating Experience in a Large-Volume Tertiary Referral Center
J. Clin. Med. 2023, 12(3), 1037; https://doi.org/10.3390/jcm12031037 (registering DOI) - 29 Jan 2023
Viewed by 141
Abstract
Background and aims: Lumen-apposing metal stents (LAMSs) are increasingly used both for on- and off-label indications. We continuously adapt our step-by-step protocol to optimize the safe deployment of LAMSs for the different indications. The aim of this study was to evaluate the impact [...] Read more.
Background and aims: Lumen-apposing metal stents (LAMSs) are increasingly used both for on- and off-label indications. We continuously adapt our step-by-step protocol to optimize the safe deployment of LAMSs for the different indications. The aim of this study was to evaluate the impact of this approach over time. Methods: We conducted a single-center study on consecutive patients who underwent LAMS placement for on- and off-label indications between June 2020 and June 2022. Endpoints included technical success, clinical success and adverse event rates. We compared the results with our previously published early experience with LAMSs (N = 61), between March 2018 and May 2020. Results: This cohort consisted of 168 LAMSs in 153 patients. Almost half of them (47.6%) were placed for off-label indications (gastro-enterostomy, temporary access to the excluded stomach in patients with previous gastric bypass, drainage of postsurgical collections, stenting of short refractory gastrointestinal strictures). While the technical and clinical success rates were similar to those in our previously published cohort (97% and 93.5% versus 93.4% and 88.5%, respectively), the adverse event rate dropped from 21.3% to 8.9%. Conclusions: Our results demonstrate the impact of a learning curve in LAMS placement, with a clinically relevant drop in LAMS-related adverse events over time. Full article
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Article
3D-Printed Biomaterial Testing in Response to Cryoablation: Implications for Surgical Ventricular Tachycardia Ablation
J. Clin. Med. 2023, 12(3), 1036; https://doi.org/10.3390/jcm12031036 (registering DOI) - 29 Jan 2023
Viewed by 156
Abstract
Background: The lack of thermally and mechanically performant biomaterials represents the major limit for 3D-printed surgical guides, aimed at facilitating complex surgery and ablations. Methods: Cryosurgery is a treatment for cardiac arrhythmias. It consists of obtaining cryolesions, by freezing the target tissue, resulting [...] Read more.
Background: The lack of thermally and mechanically performant biomaterials represents the major limit for 3D-printed surgical guides, aimed at facilitating complex surgery and ablations. Methods: Cryosurgery is a treatment for cardiac arrhythmias. It consists of obtaining cryolesions, by freezing the target tissue, resulting in selective and irreversible damage. MED625FLX and TPU95A are two biocompatible materials for surgical guides; however, there are no data on their response to cryoenergy delivery. The study purpose is to evaluate the biomaterials’ thermal properties, examining the temperature changes on the porcine muscle samples (PMS) when the biomaterials are in place during the cryoablation. Two biomaterials were selected, MED625FLX and TPU95A, with two thicknesses (1.0 and 2.5 mm). To analyze the biomaterials’ behavior, the PMS temperatures were measured during cryoablation, firstly without biomaterials (control) and after with the biomaterials in place. To verify the biomaterials’ suitability, the temperatures under the biomaterial samples should not exceed a limit of −30.0 °C. Furthermore, the biomaterials’ geometry after cryoablation was evaluated using the grid paper test. Results: TPU95A (1.0 and 2.5 mm) successfully passed all tests, making this material suitable for cryoablation treatment. MED625FLX of 1.0 mm did not retain its shape, losing its function according to the grid paper test. Further, MED625FLX of 2.5 mm is also suitable for use with a cryoenergy source. Conclusions: TPU95A (1.0 and 2.5 mm) and MED625FLX of 2.5 mm could be used in the design of surgical guides for cryoablation treatment, because of their mechanical, geometrical, and thermal properties. The positive results from the thermal tests on these materials and their thickness prompt further clinical investigation. Full article
(This article belongs to the Special Issue Management of Complex Arrhythmias)
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Article
Efficacy Evaluation of Tissue Plasminogen Activator with Anti-Vascular Endothelial Growth Factor Drugs for Submacular Hemorrhage Treatment: A Meta-Analysis
J. Clin. Med. 2023, 12(3), 1035; https://doi.org/10.3390/jcm12031035 (registering DOI) - 29 Jan 2023
Viewed by 171
Abstract
Submacular hemorrhage (SMH) is the accumulation of blood in the macular area that can severely damage the macular structure and visual function. Recently, the intraocular administration of tissue plasminogen activator (TPA) with anti-vascular endothelial growth factor (anti-VEGF) drugs was reported to have a [...] Read more.
Submacular hemorrhage (SMH) is the accumulation of blood in the macular area that can severely damage the macular structure and visual function. Recently, the intraocular administration of tissue plasminogen activator (TPA) with anti-vascular endothelial growth factor (anti-VEGF) drugs was reported to have a positive effect on SMH. This meta-analysis aimed to explore the efficacy and safety of the drug combination. We systematically searched the Web of Science, MEDLINE, EMBASE, and Cochrane Library databases and screened relevant full-length literature reports. The quality of the reports was assessed by two independent reviewers. The best-corrected visual acuity (BCVA) and foveal thickness (FT) were considered the main indicators of efficacy. RevMan 5.4 software was used for this meta-analysis. Twelve studies were analyzed, and the results showed that BCVA at 1 month (p < 0.001), 3 months (p < 0.001), 6 months (p < 0.001), and the last follow-up (p < 0.001) was improved relative to the preoperative value. The postoperative FT was lower than the preoperative FT (p < 0.001). No significant difference in efficacy was observed between subretinal and intravitreal TPA injections (p = 0.37). TPA with anti-VEGF drugs is safe for SMH treatment and can significantly improve BCVA and reduce FT. Full article
(This article belongs to the Special Issue Retinal Disorders: Clinical Updates and Perspectives)
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Article
Urinary Dickkopf-3 (DKK3) Is Associated with Greater eGFR Loss in Patients with Resistant Hypertension
J. Clin. Med. 2023, 12(3), 1034; https://doi.org/10.3390/jcm12031034 (registering DOI) - 29 Jan 2023
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Abstract
Patients with resistant hypertension (HTN) demonstrate an increased risk of chronic kidney disease and progression to end-stage renal disease; however, the individual course of progression is hard to predict. Assessing the stress-induced, urinary glycoprotein Dickkopf-3 (uDKK3) may indicate ongoing renal damage and consecutive [...] Read more.
Patients with resistant hypertension (HTN) demonstrate an increased risk of chronic kidney disease and progression to end-stage renal disease; however, the individual course of progression is hard to predict. Assessing the stress-induced, urinary glycoprotein Dickkopf-3 (uDKK3) may indicate ongoing renal damage and consecutive estimated glomerular filtration rate (eGFR) decline. The present study aimed to determine the association between uDKK3 levels and further eGFR changes in patients with resistant HTN. In total, 31 patients with resistant HTN were included. Blood pressure and renal function were measured at baseline and up to 24 months after (at months 12 and 24). uDKK3 levels were determined exclusively from the first available spot urine sample at baseline or up to a period of 6 months after, using a commercial ELISA kit. Distinctions between different patient groups were analyzed using the unpaired t-test or Mann–Whitney test. Correlation analysis was performed using Spearman’s correlation. The median uDKK3 level was 303 (interquartile range (IQR) 150–865) pg/mg creatinine. Patients were divided into those with high and low eGFR loss (≥3 vs. <3 mL/min/1.73 m²/year). Patients with high eGFR loss showed a significantly higher median baseline uDKK3 level (646 (IQR 249–2555) (n = 13) vs. 180 (IQR 123–365) pg/mg creatinine (n = 18), p = 0.0412 (Mann–Whitney U)). Alternatively, patients could be classified into those with high and low uDKK3 levels (≥400 vs. <400 pg/mg creatinine). Patients with high uDKK3 levels showed significantly higher eGFR loss (−6.4 ± 4.7 (n = 11) vs. 0.0 ± 7.6 mL/min/1.73 m2/year (n = 20), p = 0.0172 (2-sided, independent t-test)). Within the entire cohort, there was a significant correlation between the uDKK3 levels and change in eGFR at the latest follow-up (Spearman’s r = −0.3714, p = 0.0397). In patients with resistant HTN, high levels of uDKK3 are associated with higher eGFR loss up to 24 months later. Full article
(This article belongs to the Section Nephrology & Urology)
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Article
A Comparative Analysis of Bi-Portal Endoscopic Spine Surgery and Unilateral Laminotomy for Bilateral Decompression in Multilevel Lumbar Stenosis Patients
J. Clin. Med. 2023, 12(3), 1033; https://doi.org/10.3390/jcm12031033 (registering DOI) - 29 Jan 2023
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Abstract
The clinical and radiological results before and after surgery were compared and analyzed for patients with multilevel lumbar stenosis who underwent bi-portal endoscopic spine surgery (BESS) and microscopic unilateral laminotomy for bilateral decompression (ULBD). We retrospectively identified 47 and 49 patients who underwent [...] Read more.
The clinical and radiological results before and after surgery were compared and analyzed for patients with multilevel lumbar stenosis who underwent bi-portal endoscopic spine surgery (BESS) and microscopic unilateral laminotomy for bilateral decompression (ULBD). We retrospectively identified 47 and 49 patients who underwent BESS and microscopic ULBD, respectively, who were diagnosed with multi-level lumbar stenosis. Clinical outcomes were evaluated using the visual analog scale score for both back and leg pain, and medication (pregabalin) use and Oswestry Disability Index (ODI) scores for overall treatment outcomes were used pre-operatively and at the final follow-up. Radiological outcomes were evaluated as the percentage of dura expansion volume, and percentage preservation of both facets and both lateral recess angles. The follow-up period of patients was about 17.04 months in the BESS group and about 16.90 months in the microscopic ULBD group. The back and leg visual analog scale (VAS) scores and average pregabalin use decreased more significantly in the BESS group than in the microscopic ULBD group (each p-value 0.0443, <0.001, 0.0378). All radiological outcomes were significantly higher in the BESS group than in the ULBD group. The change in ODI in two-level spinal stenosis showed a significantly higher value in the BESS group compared to the microscopic ULBD group (p-value 0.0335). Multilevel decompression with the BESS technique in multiple spinal stenosis is an adequate technique as it shows better clinical and radiological results than microscopic ULBD during a short-term follow-up period. Full article
(This article belongs to the Special Issue Lumbar Spine Surgery: Causes, Complications and Management)
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Article
Rectal Cancer following Local Excision of Rectal Adenomas with Low-Grade Dysplasia—A Multicenter Study
J. Clin. Med. 2023, 12(3), 1032; https://doi.org/10.3390/jcm12031032 (registering DOI) - 29 Jan 2023
Viewed by 115
Abstract
Purpose: Rectal polyps with low-grade dysplasia (LGD) can be removed by local excision surgery (LE). It is unclear whether these lesions pose a higher risk for recurrence and cancer development and might warrant an early repeat rectal endoscopy. This study aims to [...] Read more.
Purpose: Rectal polyps with low-grade dysplasia (LGD) can be removed by local excision surgery (LE). It is unclear whether these lesions pose a higher risk for recurrence and cancer development and might warrant an early repeat rectal endoscopy. This study aims to assess the rectal cancer rate following local excision of LGD rectal lesions. Methods: A retrospective multicenter study including all patients that underwent LE for rectal polyps over a period of 11 years was conducted. Demographic, clinical, and surgical data of patients with LGD werecollected and analyzed. Results: Out of 274 patients that underwent LE of rectal lesions, 81 (30%) had a pathology of LGD. The mean patient age was 65 ± 11 years, and 52 (64%) were male. The mean distance from the anal verge was 7.2 ± 4.3 cm, and the average lesion was 3.2 ± 1.8 cm. Full thickness resection was achieved in 68 patients (84%), and four (5%) had involved margins for LGD. Nine patients (11%) had local recurrence and developed rectal cancer in an average time interval of 19.3 ± 14.5 months, with seven of them (78%) diagnosed less than two years after the initial LE. Seven of the nine patients were treated with another local excision, whilst one had a low anterior resection, and one was treated with radiation. The mean follow-up time was 25.3 ± 22.4 months. Conclusions: Locally resected rectal polyps with LGD may carry a significant risk of recurring and developing cancer within two years. This data suggests patients should have a closer surveillance protocol in place. Full article
(This article belongs to the Special Issue Advances in Proctology and Colorectal Surgery)
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Editorial
Precision Medicine in Vascular and Endovascular Surgery
J. Clin. Med. 2023, 12(3), 1031; https://doi.org/10.3390/jcm12031031 (registering DOI) - 29 Jan 2023
Viewed by 172
Abstract
Personalized medicine and precision medicine are terms often used to refer to treatment strategies tailored specifically to individual characteristics of patients, as opposed to a one-size fits all approach [...] Full article
(This article belongs to the Special Issue Advances in Vascular and Endovascular Surgery)
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