Journal of Clinical Medicine

11 pages, 1506 KiB

Open AccessArticle

Contemporary Outcomes of Infrainguinal Vein Bypass Surgery for Chronic Limb-Threatening Ischaemia: A Two-Centre Cross-Sectional Study

by Thomas Lovelock, Sharan Randhawa, Cameron Wells, Anastasia Dean and Manar Khashram

J. Clin. Med. 2024, 13(17), 5343; https://doi.org/10.3390/jcm13175343 - 9 Sep 2024

Abstract

Background/Objectives: Chronic limb-threatening ischaemia (CLTI) is a significant life and limb-threatening condition. Two recent seminal trials, BEST-CLI and BASIL-2, have provided seemingly conflicting results concerning the optimal treatment modality for patients with CLTI. We sought to investigate the outcomes of patient undergoing [...] Read more.

Background/Objectives: Chronic limb-threatening ischaemia (CLTI) is a significant life and limb-threatening condition. Two recent seminal trials, BEST-CLI and BASIL-2, have provided seemingly conflicting results concerning the optimal treatment modality for patients with CLTI. We sought to investigate the outcomes of patient undergoing infrainguinal bypass at two centres in Aotearoa New Zealand. Methods: A cross-sectional retrospective review of all patients who underwent infrainguinal bypass grafting for CLTI at Auckland City Hospital and Waikato Hospital between January 2020 and December 2021 was performed. The primary outcome was a composite of death, above-ankle amputation, and major limb reintervention. The secondary outcome was minor limb reintervention. Kaplan–Meier survival analysis was performed to determine time to the primary and secondary endpoints. Demographic factors were examined using the log-rank test to examine the effect on the outcome. Results: One hundred and nineteen patients who underwent infrainguinal bypass for CLTI in the study period were identified. Of these, 93 patients had a bypass with ipsilateral or contralateral GSV. The median follow-up time was 1.85 years. The most common indication for surgery was tissue loss (69%, n = 63), with the most common distal bypass target being the below-knee popliteal artery (45%, n = 41). The primary composite outcome occurred in 42.8% of the cohort (n = 39). Death was the most common component of the primary outcome (26%, n = 24). Male sex (HR 0.48, 95% CI 0.26–0.88, p = 0.018) and statin use (HR 0.49, 95% CI 0.24–0.98, p = 0.044) were independent predictors of protection from the composite outcome on multivariate analysis. Dialysis dependence (HR 3.32, 95% CI 1.23–8.99, p = 0.018) was an independent predictor for patients meeting the composite outcome. Conclusions: This study’s results are consistent with the published outcomes of BEST-CLI. The patient cohorts examined, anatomical disease patterns, and conduit use may explain some of the differences observed between this study, BEST-CLI and BASIL-2. Further work is required to define the specific patient populations who will benefit most from an open surgical or endovascular first approach to the management of CLTI. Full article

(This article belongs to the Special Issue Clinical Advances in Vascular and Endovascular Surgery)

► Show Figures

Figure 1

11 pages, 1202 KiB

Open AccessArticle

Impact of Accidental High or Low Implantation Depth on Peri-Procedural Outcomes after Implantation with the Self-Expanding ACURATE neo2

by Clemens Eckel, Won-Keun Kim, Judith Schlüter, Matthias Renker, Sophie Bargon, Christina Grothusen, Albrecht Elsässer, Guido Dohmen, Yeong-Hoon Choi, Efstratios I. Charitos, Christian W. Hamm, Samuel Sossalla, Helge Möllmann and Johannes Blumenstein

J. Clin. Med. 2024, 13(17), 5342; https://doi.org/10.3390/jcm13175342 - 9 Sep 2024

Abstract

Background: Precise implantation could play a crucial role in the technical success of transcatheter aortic valve replacement (TAVR) for some prostheses. The impact of an accidental implantation depth (ID) outside the recommended range has not been assessed for the ACURATE neo2 (NEO2). [...] Read more.

Background: Precise implantation could play a crucial role in the technical success of transcatheter aortic valve replacement (TAVR) for some prostheses. The impact of an accidental implantation depth (ID) outside the recommended range has not been assessed for the ACURATE neo2 (NEO2). Methods: Data from 1839 patients with severe native aortic stenosis treated with the NEO2 prosthesis were evaluated. We compared the results of prostheses implanted in an ID both inside and outside the recommendations. The outcome assessment followed the Valve Academic Research Consortium-3 criteria. Results: Patients were retrospectively divided into high (<3 mm; n = 412), optimal (3–7 mm; n = 1236), and low (>7 mm; n = 169) implantations. Technical success (94.7% vs. 94.7% vs. 91.7%, p = 0.296) and device success were high (90.1% vs. 89.3% vs. 84.6%, p = 0.112) without differences between groups. Rates of relevant paravalvular regurgitation (PVL; >mild or VinV due to PVL) were comparable (1.2% vs. 1.8% vs. 1.2%, p = 0.759). Even when hemodynamics were superior in the high-implantation group, with greater iEOA (1.01 cm²/m² vs. 0.95 cm²/m² vs. 0.92 cm²/m², p < 0.001), spontaneous embolization or after post-dilatation was more common. Low implantation was associated with a higher rate of associated pacemaker implantation (PPI) (6.1% vs. 8.8% vs. 14.8%, p = 0.001). Conclusions: Implantation with the ACURATE neo2 showed excellent hemodynamic results, including low gradients and a small number of relevant PVL, in line with a high technical success rate that was irrespective of the ID. A favorable outcome can also be achieved in accidental low or high positions. Low implantation was associated with a higher rate of associated pacemaker implantation. Deliberately high implantation should be avoided due to the risk of embolization. Full article

(This article belongs to the Special Issue Clinical Advances in Structural Heart Diseases)

► Show Figures

Figure 1

13 pages, 2530 KiB

Open AccessArticle

Anatomical Posterior Acetabular Plate Versus Conventional Reconstruction Plates for Acetabular Posterior Wall Fractures: A Comparative Study

by Chang-Han Chuang, Hao-Chun Chuang, Jou-Hua Wang, Jui-Ming Yang, Po-Ting Wu, Ming-Hsien Hu, Hong-Lin Su and Pei-Yuan Lee

J. Clin. Med. 2024, 13(17), 5341; https://doi.org/10.3390/jcm13175341 - 9 Sep 2024

Abstract

Background: Functional recovery following the surgical fixation of acetabular posterior wall fractures remains a challenge. This study compares outcomes of posterior wall fracture reconstruction using an anatomical posterior acetabular plate (APAP) versus conventional reconstruction plates. Methods: Forty patients with acetabular fractures involving the [...] Read more.

Background: Functional recovery following the surgical fixation of acetabular posterior wall fractures remains a challenge. This study compares outcomes of posterior wall fracture reconstruction using an anatomical posterior acetabular plate (APAP) versus conventional reconstruction plates. Methods: Forty patients with acetabular fractures involving the posterior wall or column underwent surgery, with 20 treated using APAPs (APAP group) and 20 with conventional pelvic reconstruction plates (control group). Baseline patient characteristics, intraoperative blood loss and time, reduction quality, postoperative function, and postoperative complications were compared using appropriate non-parametric statistical tests. A general linear model for repeated measures analysis of variance was employed to analyze trends in functional recovery. Results: No significant differences were observed in baseline characteristics. APAP significantly reduced surgical time by 40 min (186.5 ± 51.0 versus 225.0 ± 47.7, p =0.004) and blood loss (695 ± 393 versus 930 ± 609, p = 0.049) compared to conventional plates. At 3 and 6 months following surgery, the APAP group exhibited higher functional scores (modified Merle d’Aubigné scores 10 ± 1.8 versus 7.8 ± 1.4, p < 0.001; 13.4 ± 2.8 versus 10.1 ± 2.1, p = 0.001), converging with the control group by 12 months (modified Merle d’Aubigné scores 14.2 ± 2.6 versus 12.7 ± 2.6, p = 0.072; OHS 31.6 ± 12.3 versus 30.3 ± 10.1, p = 0.398). Radiologically, the APAP group demonstrated superior outcomes (p = 0.047). Complication and conversion rates to hip arthroplasty did not significantly differ between groups (10% versus 15%, p = 0.633). Conclusions: The use of an APAP in reconstructing the posterior acetabulum significantly reduces surgical time, decreases intraoperative blood loss, and leads to earlier functional recovery compared to conventional reconstruction plates. The APAP provides stable fixation of the posterior wall and ensures the durable maintenance of reduction, ultimately yielding favorable surgical outcomes. Full article

(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)

► Show Figures

Figure 1

15 pages, 2827 KiB

Open AccessArticle

Estimation of Lactate Thresholds, Aerobic Capacity and Recovery Rate from Muscle Oxygen Saturation in Highly Trained Speed Skaters and Healthy Untrained Individuals

by Kinga Rębiś, Andrzej Klusiewicz, Barbara Długołęcka, Paweł Różański, Karol Kowieski and Tomasz Kowalski

J. Clin. Med. 2024, 13(17), 5340; https://doi.org/10.3390/jcm13175340 - 9 Sep 2024

Abstract

Objective: The main objective of this study was to compare lactate thresholds and aerobic capacity from a graded-intensity exercise test (GXT) for near-infrared spectroscopy measurements in healthy, untrained individuals and highly trained athletes. Methods: This study included 29 untrained students (13 females) and [...] Read more.

Objective: The main objective of this study was to compare lactate thresholds and aerobic capacity from a graded-intensity exercise test (GXT) for near-infrared spectroscopy measurements in healthy, untrained individuals and highly trained athletes. Methods: This study included 29 untrained students (13 females) and 27 highly trained speed skaters (13 females). A maximal effort GXT was performed on a cycloergometer. The lactate-based aerobic and anaerobic thresholds, and the corresponding thresholds for muscle oxygen saturation (SmO₂), were determined. Results: The power values determined for all thresholds were significantly higher in female and male speed skaters compared to male and female college students. SmO₂ at anaerobic thresholds was significantly lower in female speed skaters than in female students. Both female and male skaters showed greater changes in SmO₂ after the GXT compared to students. The recovery did not significantly differ between groups within gender. There was a significant positive correlation in females between the rate of muscle reoxygenation and VO₂max power (r = 0.610). In speed skaters, the rate of muscle reoxygenation was not significantly higher than students and correlated positively with VO₂max (r = 0.449). Conclusions: The SmO₂ at the exercise thresholds, during and after maximal exercise, depends on the training status of the individual. The participants with a higher physical fitness level showed greater decreases in ΔSmO₂ at the AT level, as well as after maximal exercise. SmO₂ corresponding to the well-established exercise thresholds may be applied to guide training prescription. The rate of muscle reoxygenation after a GXT was also dependent on the aerobic capacity of the participants. Full article

(This article belongs to the Special Issue Physical Activity, Exercise, and Health: Bridging Research and Clinical Practice)

► Show Figures

Figure 1

21 pages, 506 KiB

Open AccessFeature PaperReview

The Effect of Conservative vs. Radical Treatment of Ameloblastoma on Recurrence Rate and Quality of Life: An Umbrella Review

by Roberta Gasparro, Francesco Giordano, Maria Domenica Campana, Angelo Aliberti, Elena Landolfo, Pasquale Dolce, Gilberto Sammartino and Alessandro E. di Lauro

J. Clin. Med. 2024, 13(17), 5339; https://doi.org/10.3390/jcm13175339 - 9 Sep 2024

Abstract

Ameloblastoma is a rare, benign, but locally aggressive odontogenic tumor that originates from the epithelial cells involved in tooth development. The surgical approach to treating an ameloblastoma depends on the type, size, location, and extent of the tumor, as well as the patient’s [...] Read more.

Ameloblastoma is a rare, benign, but locally aggressive odontogenic tumor that originates from the epithelial cells involved in tooth development. The surgical approach to treating an ameloblastoma depends on the type, size, location, and extent of the tumor, as well as the patient’s age and overall health. This umbrella review’s aim is to summarize the findings from systematic reviews (SRs) and meta-analyses on the effect of radical or conservative treatment of ameloblastoma on the recurrence rate and quality of life, to evaluate the methodological quality of the included SRs and discuss the clinical management. Three electronic databases (PubMed, Scopus, The Cochrane Library) were checked. The primary outcome was the recurrence rate after surgical treatment, while the secondary outcomes were the post-operative complications, quality of life, esthetic, and functional impairment. The methodological quality of the included SRs was assessed using the updated version of “A Measurement Tool to Assess Systematic Review” (AMSTAR-2). Eighteen SRs were included. The quality of the included reviews ranged from critically low (three studies) to high (eight studies). Four studies were included in meta-analysis, and they revealed that the recurrence rate is about three-times more likely in the conservative treatment group compared to the radical treatment group, and this result is statistically significant. Despite the high recurrence rate, the latter was more appropriate in the case of smaller lesions and younger patients, due to better post-operative quality of life and reduced functional and esthetic impairments. Based on the results of this overview, conservative treatment may be recommended as the first-line approach for intraosseous ameloblastoma not involving soft tissue. However, given the expectation of a higher recurrence rate, it is advisable to reduce the interval between follow-up visits. However, further prospective studies are needed to establish the best treatment choice and follow-up period. Full article

(This article belongs to the Special Issue Oral and Maxillofacial Surgery: Current Updates and Perspectives)

► Show Figures

Figure 1

14 pages, 1353 KiB

Open AccessArticle

C4d Is an Independent Predictor of the Kidney Failure in Primary IgA Nephropathy

by Nikola Zagorec, Ivica Horvatić, Dino Kasumović, Besa Osmani, Slavica Sović, Jagoda Nikić, Matija Horaček, Petar Šenjug, Krešimir Galešić and Danica Galešić Ljubanović

J. Clin. Med. 2024, 13(17), 5338; https://doi.org/10.3390/jcm13175338 - 9 Sep 2024

Abstract

Background: C4d deposits are present in a substantial proportion of patients with IgA nephropathy (IgAN), indicating the activation of the lectin pathway (LP) of the complement system. It seems that patients with activated LP have worse renal prognosis. The aim of this study [...] Read more.

Background: C4d deposits are present in a substantial proportion of patients with IgA nephropathy (IgAN), indicating the activation of the lectin pathway (LP) of the complement system. It seems that patients with activated LP have worse renal prognosis. The aim of this study was to investigate the prevalence and prognostic significance of C4d in our cohort of patients with primary IgA nephropathy (pIgAN). Methods: Patients with pIgAN were recruited from a hospital register of kidney biopsies of the Department of Nephrology and Dialysis, Dubrava University Hospital, Zagreb. Additional immunohistochemistry staining for C4d was performed on paraffin-embedded kidney tissue, and patients were stratified into being C4d positive or C4d negative. The clinical and histologic features of patients were analyzed and compared regarding C4d positivity. The primary outcome was defined as kidney failure (KF), and predictor variables of KF and renal survival were analyzed. Results: Of a total of 95 patients with pIgAN included in the study, C4d was present in 43 (45.3%). C4d-positive patients had a higher value of systolic (p = 0.039) and diastolic (p = 0.006) blood pressure at diagnosis as well as higher 24 h proteinuria (p = 0.018), serum urate (p = 0.033), and lower eGFR (p < 0.001). C4d-positive patients had worse renal survival (p < 0.001), higher rates of disease progression to KF (p < 0.001), and higher proteinuria (p < 0.001) and lower eGFR (p < 0.001) at the last follow-up. Glomerular C4d was an independent predictor of disease progression to KF (HR = 5.87 [0.95 CI 1.06–32.44], p = 0.032). Conclusions: C4d is an independent predictor of disease progression in patients with pIgAN. C4d may be used as an additional marker of progressive disease course in IgAN. The therapeutic implications of C4d status in IgAN, particularly in terms of complement inhibitors application, are not yet known. Full article

(This article belongs to the Special Issue Kidney Failure: Diagnosis and Treatment of Acute and Chronic Conditions)

► Show Figures

Figure 1

9 pages, 1345 KiB

Open AccessArticle

Prospective Analysis of the Effectiveness of Targeted Botulinum Toxin Type A Injection Using an Ultrasound-Guided Single-Point Injection Technique for Lower Face Contouring

by Hyun-Jung Ryoo, Ho Kwon, Jae-Seon Choi, Bo-Seong Sohn, Ja-Young Yoo and Hyung-Sup Shim

J. Clin. Med. 2024, 13(17), 5337; https://doi.org/10.3390/jcm13175337 - 9 Sep 2024

Abstract

Background: Botulinum toxin type A (BoNT-A) injection is widely used for masseter hypertrophy. Traditional BoNT-A injection methods often incorporate landmark-guided blind injections, which approximate the shape of the masseter muscle inject across various points. Conversely, ultrasound (US)-guided injection techniques offer real-time visualization [...] Read more.

Background: Botulinum toxin type A (BoNT-A) injection is widely used for masseter hypertrophy. Traditional BoNT-A injection methods often incorporate landmark-guided blind injections, which approximate the shape of the masseter muscle inject across various points. Conversely, ultrasound (US)-guided injection techniques offer real-time visualization and dynamic monitoring, enhancing accuracy. Patients and Methods: 50 patients who underwent BoNT-A injections were included in this trial. One on the face side received a landmark-guided injection, and the other side was treated with a US-guided injection. Initial and post-procedure measurements of muscle thickness at the upper, middle, and lower regions were collected using ultrasound. Results: Both methods led to a significant reduction in muscle thickness one month after injection. In the upper area, the absolute difference in muscle thickness between the two methods was observed as a mean ± standard deviation (SD) value of 0.37 ± 0.0314 (p < 0.0001), indicating a superior effect with US-guided injection. Similarly, in the middle area, the mean ± SD difference was 0.41 ± 0.0608 (p < 0.0001) and in the lower area, the mean ± SD difference was 0.24 ± 0.0134 (p = 0.0004). Conclusions: This study demonstrated that the US-guided single-point injection technique is a more effective and accurate method for BoNT-A injection compared to the conventional method. Full article

(This article belongs to the Section Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine)

► Show Figures

Figure 1

9 pages, 948 KiB

Open AccessArticle

Does the Change of Weather Influence Disease Activity in Rheumatoid Arthritis Patients: Patients’ Self-Assessment via WebApp

by Martin Poller, Martin M. P. Schulz, Hendrik Schulze-Koops, Diego Kyburz, Johannes von Kempis and Ruediger B. Mueller

J. Clin. Med. 2024, 13(17), 5336; https://doi.org/10.3390/jcm13175336 - 9 Sep 2024

Abstract

Objectives: The aim was to evaluate the influence of weather parameters on disease activity assessed by Routine Assessment of Patient Index Data (RAPID) scores via a Web-based smartphone application (WebApp). Methods: Correlation of changes of temperature (change of temperature, °C) and air pressure [...] Read more.

Objectives: The aim was to evaluate the influence of weather parameters on disease activity assessed by Routine Assessment of Patient Index Data (RAPID) scores via a Web-based smartphone application (WebApp). Methods: Correlation of changes of temperature (change of temperature, °C) and air pressure (change of air pressure, hPa) two days prior to and weekly self-assessment of disease activity by RAPID-3 scores over three months. To define background noise and quadrants of weather changes, we defined a central quadrant ± 2 hPa and ± 2° C, called E1. Based on this inner square, four quadrants were defined: A1 = sector left side above with increasing temperature and air pressure (improving weather); B1 = sector right side above; C1 = decreasing temperature and air pressure sector right side down (worsening weather); and D1 = sector left side down. Alterations of RAPID-3 scores analyzed changes in disease activity compared to RAPID-3 scores detected one week in advance. Results: Eighty patients were included in the analysis (median RA duration, 4.5 years; age, 57 years; 59% female). Median disease activity was 2.8 as assessed by DAS 28. In total, 210 time points were analyzed for quadrant A1, 164 for quadrant B1, 160 for quadrant C1, 196 for quadrant D1, and 145 for the inner square E1 were found during follow-up. The middle square E1 was balanced between increasing or decreasing values for RAPID scores. The odds for increasing RAPID scores were 1.33 (95% confidence interval CI: 1.0–1.78) for patients with ameliorating weather conditions which improve or alleviate unfavorable or adverse conditions (A1) compared to 0.98 (CI: 0.67–1.45) for worsening weather (C1) as defined by temperature and air pressure. Conclusions: On average, more patients developed a slight increase of disease activity if they were in the quadrant with increasing temperature and air pressure (improving weather). Thus, no correlation between the worsening of the weather and changing RAPID-3 scores was found. Full article

(This article belongs to the Special Issue Advances in Clinical Rheumatology)

► Show Figures

Figure 1

16 pages, 1965 KiB

Open AccessFeature PaperArticle

Proteinuria Assessment and Therapeutic Implementation in Chronic Kidney Disease Patients—A Clinical Audit on KDIGO (“Kidney Disease: Improving Global Outcomes”) Guidelines

by Gabriela Adelakun, Maria Boesing, Munachimso Kizito Mbata, Zahra Pasha, Giorgia Lüthi-Corridori, Fabienne Jaun, Felix Burkhalter and Jörg D. Leuppi

J. Clin. Med. 2024, 13(17), 5335; https://doi.org/10.3390/jcm13175335 - 9 Sep 2024

Abstract

Background/Objectives: Chronic kidney disease (CKD) is a major health problem with a rising prevalence due to comorbidities like diabetes and hypertension. The aim of this research was to audit the assessment and therapeutic management of proteinuria in CKD patients at the Cantonal [...] Read more.

Background/Objectives: Chronic kidney disease (CKD) is a major health problem with a rising prevalence due to comorbidities like diabetes and hypertension. The aim of this research was to audit the assessment and therapeutic management of proteinuria in CKD patients at the Cantonal Hospital Baselland (KSBL) in Switzerland and determine associations between patient comorbidities, rehospitalisation, death, and the quality of therapeutic management. Methods: We analysed data from 427 adults with CKD (eGFR < 45 mL/min/1.73 m²) hospitalised on the internal medicine ward in 2022. Results: The mean age was 85 years (range: 79–89), 45.9% were female, and the median eGFR was 32.8 mL/min/1.73 m² (range: 25–40). Proteinuria assessment was performed in 120 (28.1%) patients (the ProtU group), and a corresponding treatment was prescribed in 59%. The ProtU group had a higher quota of patients with diabetes (44.1% vs. 33%, p = 0.048) and obesity (21.2% vs. 12.5%, p = 0.039) when compared to the group without proteinuria assessment (the Ustix group). Twelve-month survival was not significantly different between the groups (HR: 0.75; 95% CI: 0.488–1.154; p-value = 0.191). However, survival was significantly better in patients who received an antiproteinuric treatment compared to those who did not (HR: 0.30; 95% CI: 0.121–0.0761; p = 0.011). Conclusions: Improvements need to be made in managing CKD at the KSBL in accordance with the guidelines. Full article

(This article belongs to the Section Nephrology & Urology)

► Show Figures

Figure 1

16 pages, 12097 KiB

Open AccessArticle

BD Vacutainer™ Urine Culture & Sensitivity Preservative PLUS Plastic Tubes Minimize the Harmful Impact of Stressors Dependent on Temperature and Time Storage in Uropathogenic Bacteria

by Samuel Treviño, Eduardo Ramírez-Flores, Steffany Cortezano-Esteban, Hugo Hernández-Fragoso and Eduardo Brambila

J. Clin. Med. 2024, 13(17), 5334; https://doi.org/10.3390/jcm13175334 - 9 Sep 2024

Abstract

Background: Urinary tract infection is a worldwide health problem. According to the Clinical Laboratory Improvement Amendments and the European Urinalysis Guideline, urine samples should be tested within 2 h of collection. Thus, using chemical preservatives that guarantee the pre-analytical conditions is a practical [...] Read more.

Background: Urinary tract infection is a worldwide health problem. According to the Clinical Laboratory Improvement Amendments and the European Urinalysis Guideline, urine samples should be tested within 2 h of collection. Thus, using chemical preservatives that guarantee the pre-analytical conditions is a practical tool. However, the effects of temperature and storage time as uropathogenic bacteria stressors are unclear. Methods: Gram-negative and -positive ATTC strains, E. coli, P. mirabilis, E. faecalis, and S. aureus, were used in this study. Strains in liquid media were stored at 4, 25, and 37 °C for 0, 2, 12, 24, and 48 h in tubes with and without preservatives. Then, reactive oxygen species (ROS) levels, viable but non-culturable bacteria (VBNC), and bacteria growth were analyzed. Results: A high ROS level was associated with the presence of VBNC and dead bacteria with low CFU counts, but a low ROS level increased the CFU number, depending on temperature and storage time in tubes without preservatives (boric acid, sodium borate, and formate). The BD Vacutainer™ Urine Culture & Sensitivity Preservative PLUS Plastic Tubes (C&S-PP) prevent this ROS increase, maintaining the CFU number for longer. Conclusions: C&S-PP tubes minimize the stressor effects (temperature and time storage) on uropathogenic bacteria when stored, improving the pre-analytical conditions of cultures realized by the clinical laboratory. Full article

(This article belongs to the Special Issue Clinical Advances in Specimen Collection and Laboratory Testing in Population Health)

► Show Figures

Figure 1

12 pages, 1853 KiB

Open AccessArticle

Visualization of the Postoperative Position of the Hydrus^® Microstent Using Automatic 360° Gonioscopy

by Julian Alexander Zimmermann, Sarah Kleemann, Jens Julian Storp, Cedric Weich, Ralph-Laurent Merté, Nicole Eter and Viktoria Constanze Brücher

J. Clin. Med. 2024, 13(17), 5333; https://doi.org/10.3390/jcm13175333 - 9 Sep 2024

Abstract

Introduction: Glaucoma, one leading cause of irreversible vision loss worldwide, is primarily caused by elevated intraocular pressure (IOP). Recently, minimally invasive glaucoma surgeries (MIGSs) have become popular due to their shorter surgical times, tissue-sparing nature, and faster recovery. One such MIGS, the [...] Read more.

Introduction: Glaucoma, one leading cause of irreversible vision loss worldwide, is primarily caused by elevated intraocular pressure (IOP). Recently, minimally invasive glaucoma surgeries (MIGSs) have become popular due to their shorter surgical times, tissue-sparing nature, and faster recovery. One such MIGS, the Hydrus^® nickel–titanium alloy Microstent, helps lower IOP by improving aqueous humor outflow. The NIDEK GS-1 automated 360° gonioscope provides advanced imaging of the chamber angle for evaluation and documentation. The aim of this study was to test automated 360° gonioscopy for the detection of postoperative positional variations after Hydrus^® Microstent implantation. This study is the largest to date to evaluate post-op positioning of the Hydrus^® Microstent using the NIDEK GS-1. Materials and Methods: This study analyzed postoperative outcomes and stent location in eyes diagnosed with mild to moderate glaucoma that underwent Hydrus^® Microstent implantation with or without phacoemulsification. Patients with prior IOP-lowering surgery or vitrectomy were excluded. Analyses of the postoperative Hydrus^® Microstent position were based on the evaluation of automated 360° gonioscopy images. Results: Twenty-three eyes were included in the study, and all showed a reduction in IOP and a decrease in antiglaucomatous drop use postoperatively. Postoperative gonoscopic images showed variations in implant position. In all cases, the proximal inlet was clearly visible in the anterior chamber. The degree of protrusion into the anterior chamber was variable. The distal tip of the stent was visible behind the trabecular meshwork in Schlemm’s canal in five cases, in the anterior chamber in one case, and not visible in seven cases. In no case did postoperative alterations in the position of the implant lead to explantation. Conclusions: This study demonstrated that the Hydrus^® Microstent can effectively lower IOP even in the presence of postoperative positional variations. Automated 360° gonioscopy was found to be a useful tool to verify and document the postoperative position of the implant. Positional changes did not require device explantation in any of the cases evaluated. Full article

(This article belongs to the Special Issue Clinical Debates in Minimally Invasive Glaucoma Surgery (MIGS))

► Show Figures

Figure 1

11 pages, 3309 KiB

Open AccessArticle

Risk Factors for Failure of Second-Trimester Termination with Misoprostol as a Single Agent

by Veera Wisanumahimachai, Saipin Pongsatha, Latchee Chatchawarat and Theera Tongsong

J. Clin. Med. 2024, 13(17), 5332; https://doi.org/10.3390/jcm13175332 - 9 Sep 2024

Abstract

Background: Understanding the potential risk factors for failure of pregnancy termination is crucial for informed clinical decision making. Such insights can assist clinicians in adjusting the dosage or route of various regimens, as well as in counseling patients and predicting the likelihood of [...] Read more.

Background: Understanding the potential risk factors for failure of pregnancy termination is crucial for informed clinical decision making. Such insights can assist clinicians in adjusting the dosage or route of various regimens, as well as in counseling patients and predicting the likelihood of successful outcomes. However, research on these risk factors has been limited, and existing studies have yielded inconsistent results. To address this gap, we conducted a study with a large sample size, focusing on identifying the potential risk factors for failure of second-trimester termination using misoprostol as a single agent, specifically between 14 and 28 weeks of gestation. Methods: A secondary analysis based on a database of second-trimester terminations was conducted. The inclusion criteria were a singleton pregnancy, gestational age between 14 and 28 weeks, an unfavorable cervix, no spontaneous labor pain, intact membranes, and termination with misoprostol alone. Potential risk factors for failure of termination, defined as no abortion within 48 h, were analyzed using univariate and multivariate analyses. Results: A total of 1094 cases were included in the analysis, consisting of 991 successful cases and 103 (9.4%) cases of failure. The significant risk factors for failure of termination included early gestational age, live fetuses, sublingual regimen of 400 mcg every 6 h, and high maternal pre-pregnancy BMI. Previous cesarean sections and lower Bishop scores tended to increase the risk but did not reach a significant level. Conclusions: Second-trimester termination with misoprostol as a single agent was highly effective, with a failure rate of 9.4%. The risk factors for failure included gestational age, fetal viability, misoprostol regimen, and maternal pre-pregnancy BMI, suggesting that these factors should be taken into consideration for second-trimester terminations with misoprostol. Full article

(This article belongs to the Special Issue Management of Pregnancy Complications)

► Show Figures

Figure 1

19 pages, 1234 KiB

Open AccessReview

Intrauterine Shaping of Fetal Microbiota

by Norbert Dera, Natalia Żeber-Lubecka, Michał Ciebiera, Katarzyna Kosińska-Kaczyńska, Iwona Szymusik, Diana Massalska, Kacper Dera and Katarzyna Bubień

J. Clin. Med. 2024, 13(17), 5331; https://doi.org/10.3390/jcm13175331 - 9 Sep 2024

Abstract

Mechanisms resulting from the physiological immaturity of the digestive system in children delivered before 32 weeks of gestation and, in particular, different interactions between the microbiome and the body have not been fully elucidated yet. Next-generation sequencing methods demonstrated the presence of bacterial [...] Read more.

Mechanisms resulting from the physiological immaturity of the digestive system in children delivered before 32 weeks of gestation and, in particular, different interactions between the microbiome and the body have not been fully elucidated yet. Next-generation sequencing methods demonstrated the presence of bacterial DNA in the placenta and amniotic fluid, which may reflect bacterial populations that initiate intestinal colonization in utero. Numerous studies confirmed the hypothesis stating that intestinal bacteria played an important role in the pathogenesis of necrotizing enterocolitis (NEC) early- and late-onset neonatal sepsis (EONS and LONS). The model and scale of disorders within the intestinal microbiome are the subject of active research in premature infants. Neonatal meconium was primarily used as an indicator defining the environment in utero, as it is formed before birth. Metagenomic results and previous data from microbiological bacterial cultures showed a correlation between the time from birth to sample collection and the detection of bacteria in the neonatal meconium. Therefore, it may be determined that the colonization of the newborn’s intestines is influenced by numerous factors, which may be divided into prenatal, perinatal, and postnatal, with particular emphasis put on the mode of delivery and contact with the parent immediately after birth. Background: The aim of this review was to collect available data on the intrauterine shaping of the fetal microbiota. Methods: On 13 March 2024, the available literature in the PubMed National Library of Medicine search engine was reviewed using the following selected keywords: “placental microbiome”, “intestinal bacteria in newborns and premature infants”, and “intrauterine microbiota”. Results: After reviewing the available articles and abstracts and an in-depth analysis of their content, over 100 articles were selected for detailed elaboration. We focused on the origin of microorganisms shaping the microbiota of newborns. We also described the types of bacteria that made up the intrauterine microbiota and the intestinal microbiota of newborns. Conclusions: The data presented in the review on the microbiome of both term newborns and those with a body weight below 1200 g indicate a possible intrauterine colonization of the fetus depending on the duration of pregnancy. The colonization occurs both via the vaginal and intestinal route (hematogenous route). However, there are differences in the demonstrated representatives of various types of bacteria, phyla Firmicutes and Actinobacteria in particular, taking account of the distribution in their abundance in the individual groups of pregnancy duration. Simultaneously, the distribution of the phyla Actinobacteria and Proteobacteria is consistent. Considering the duration of pregnancy, it may also be concluded that the bacterial flora of vaginal origin dominates in preterm newborns, while the flora of intestinal origin dominates in term newborns. This might explain the role of bacterial and infectious factors in inducing premature birth with the rupture of fetal membranes. Full article

(This article belongs to the Section Clinical Pediatrics)

► Show Figures

Figure 1

9 pages, 751 KiB

Open AccessArticle

Predictive Value of Neutrophil–Lymphocyte Ratio and Other Inflammation Indices in Febrile Seizures in Children

by Yakup Söğütlü and Uğur Altaş

J. Clin. Med. 2024, 13(17), 5330; https://doi.org/10.3390/jcm13175330 - 9 Sep 2024

Abstract

Objective: There is increasing evidence for the effect of inflammation on the etiology of febrile seizure (FS) patients. We aimed to investigate the role of easily accessible inflammatory markers such as the neutrophil–lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammation response index [...] Read more.

Objective: There is increasing evidence for the effect of inflammation on the etiology of febrile seizure (FS) patients. We aimed to investigate the role of easily accessible inflammatory markers such as the neutrophil–lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil–lymphocyte–platelet ratio (NLPR), and pan-immune-inflammation value (PIV) in febrile seizure. Methods: A total of 300 children, including 100 with febrile convulsions (FS), 100 febrile controls (FCs), and 100 healthy controls (HCs), were included in this retrospective study. The FS group was compared with the FC and HC groups in terms of these inflammatory indexes. Results: Between the FS group and the FC group, the neutrophil count was significantly higher in the FS group (p = 0.001) and the lymphocyte count was significantly lower (p < 0.001). The NLR (p < 0.001), SII (p < 0.001), SIRI (p < 0.001), NLPR (p < 0.001), and PIV (p < 0.001) were significantly higher in the FS group than in both the FC and healthy control groups. The optimal cut-off values for predicting FS in febrile conditions were 3.59> for NLR, >870.47 for SII, >1.96 for SIRI, 0.96> for NLPR, and >532.75 for PIV. Conclusions: The inflammatory indices are inexpensive, easily accessible hematological markers that can contribute to the diagnosis of FS. Full article

(This article belongs to the Special Issue The Future of Inflammatory Biomarkers: Challenges and Clinical Integration)

► Show Figures

Figure 1

9 pages, 243 KiB

Open AccessArticle

Relationship between the Presence of Human Papillomavirus in the Female Urethra and Recurrent Urinary Tract Infections

by Cristina Mena-Ruiz, Julius Jan Szczesnieski, Magaly Márquez-Sánchez, Bárbara-Yolanda Padilla-Fernández, Javier Flores-Fraile and María-Fernanda Lorenzo-Gómez

J. Clin. Med. 2024, 13(17), 5329; https://doi.org/10.3390/jcm13175329 - 9 Sep 2024

Abstract

Introduction: Recurrent urinary tract infections (rUTIs) are highly prevalent health issues among women, significantly impacting their quality of life. Urethral pain or urethritis can arise from infectious or non-infectious origins. The presence of Human Papillomavirus (HPV) in the urogenital tract has been associated [...] Read more.

Introduction: Recurrent urinary tract infections (rUTIs) are highly prevalent health issues among women, significantly impacting their quality of life. Urethral pain or urethritis can arise from infectious or non-infectious origins. The presence of Human Papillomavirus (HPV) in the urogenital tract has been associated with high-risk sexual behaviors, but its presence in the female urethra without such behaviors has not been thoroughly investigated. Objectives: The study aims to determine the presence of HPV in the urethra of women with recurrent urinary tract infections (rUTIs) and concomitant urethral syndrome and to compare the clinical and microbiological characteristics of women with and without urethral HPV, specifically focusing on those without high-risk sexual behaviors. Methods: This prospective multicenter study included 138 women over 18 years old with rUTIs and concomitant urethral pain syndrome. High-risk sexual behaviors, sexually transmitted infections, and vaginitis were set as exclusion criteria. Participants were divided into two groups: NHPV (n = 72) with no urethral HPV and HPV (n = 66) with urethral HPV presence. Variables analyzed included age, body mass index (BMI), follow-up duration, comorbidities, treatments, toxic habits, surgical history, main symptoms, urine sediment findings, and cultures from urine and vaginal exudate. HPV genotyping was also performed. Descriptive statistics were used, along with Student’s t-test, Chi-square, Fisher’s exact test, ANOVA, and multivariate cluster analysis. Results: The NHPV group was older on average (48.75 years) compared to the HPV group (39.09 years). The HPV group had a longer follow-up period (2634 days vs. 1975 days in NHPV). Urinary incontinence was significantly more common in NHPV (63.89%) compared to HPV (18.18%) (p = 0.001). HPV-positive women had a higher prevalence of verrucous lesions in the vaginal introitus (64% vs. 8% in NHPV). Additionally, the HPV group showed higher rates of pyuria (27.27%), vaginal Candida albicans (36.26%), and positive urine cultures for Escherichia coli (47.83%), Enterococcus faecalis (36.36%), and Klebsiella pneumoniae (21.74%). No significant differences were observed between the groups concerning BMI, smoking habits, diabetes, or the main symptom at consultation. The most common HPV genotypes identified were G35, G42, and G66 (each 27%). Multivariate analysis revealed that sensitivity to nitrofurantoin was the most significant variable in the HPV group (importance of 0.96), followed by fosfomycin (0.79), trimethoprim (0.79), and amoxicillin (0.71). Conclusions: HPV was present in the urethra of 47.8% of women with rUTIs and concomitant urethral syndrome who did not exhibit high-risk sexual behaviors. These women were younger and had a longer duration of symptoms compared to those without urethral HPV. The identification of Enterococcus faecalis, Escherichia coli, and Klebsiella pneumoniae was more common in the HPV group. The sensitivity of bacteria to nitrofurantoin and fosfomycin is crucial for the clinical management of these patients. The presence of urethral HPV should be considered in the evaluation and treatment of women with rUTIs and urethral syndrome. Full article

(This article belongs to the Section Nephrology & Urology)

10 pages, 380 KiB

Open AccessArticle

Prosigna Assay for Treatment Decisions in Early Breast Cancer: A Decision Impact Study

by Ece Esin, Hasan Cagri Yildirim, Berna Oksuzoglu, Fatma Markoc, Sezen Guntekin, Irem Bilgetekin, Fatih Yildiz, Fisun Yukruk, Umut Demirci and Rengul Cetin-Atalay

J. Clin. Med. 2024, 13(17), 5328; https://doi.org/10.3390/jcm13175328 - 9 Sep 2024

Cited by 1

Abstract

Introduction: Therapeutic decisions in early breast cancer are based on clinico-pathological features which are subject to intra- and inter-observer variability. This single-center decision impact study aimed to evaluate the effects of the Prosigna assay on physicians’ adjuvant treatment choices. Methods: Between 09/2017 and [...] Read more.

Introduction: Therapeutic decisions in early breast cancer are based on clinico-pathological features which are subject to intra- and inter-observer variability. This single-center decision impact study aimed to evaluate the effects of the Prosigna assay on physicians’ adjuvant treatment choices. Methods: Between 09/2017 and 02/2018, formalin-fixed tumor samples from 52 newly diagnosed, postmenopausal, hormone receptor-positive, HER2-negative breast cancer (T1–T2; pN0-N1a) patients were analyzed. Pre-test clinical judgements and Prosigna test results were compared. Results: The mean age was 59 (42–77). Invasive ductal carcinoma (79.2%), grade 2 (52.8%) and T1c-N0 tumors (43.4%) were represented. There was 40.4% discordance between the pre- and post-test risk of recurrences. No significant change was observed in the clinical intermediate risk category, while there was a net reclassification of low-risk patients into a high Prosigna recurrence risk group. In addition, clinically determined intrinsic subtypes were 34.6% discordant with the Prosigna results, which is largely driven by the reclassification of the luminal A tumors into the Prosigna-assessed luminal B group. Before the Prosigna test, endocrine treatment was the primary choice in 20 patients (39.2%), and chemotherapy was recommended to 31 patients (60.8%). Overall, the Prosigna assay led to a change in treatment choice for one patient. Conclusions: Although conventional risk assessment methods are relatively inexpensive with shorter turnaround times, their accuracy and value for risk reduction are suboptimal. According to our results, the Prosigna assay was found to be a relevant tool for the clinical decision making process. Long-term follow-up of these patients will elucidate the potential benefits of using multigene molecular tests as biomarkers for treatment. Full article

(This article belongs to the Section Oncology)

► Show Figures

Figure 1

12 pages, 666 KiB

Open AccessSystematic Review

Effectiveness of Laser Therapy in Treatment of Temporomandibular Joint and Muscle Pain

by Smaranda Buduru, Denisa Maria Oprea, Manuela-Maria Manziuc, Daniel-Corneliu Leucuța and Oana Almășan

J. Clin. Med. 2024, 13(17), 5327; https://doi.org/10.3390/jcm13175327 - 9 Sep 2024

Abstract

Background/Objectives: Temporomandibular joint disorders (TMDs) express a condition derived from a broad spectrum of etiological factors and clinical manifestations. Many treatment options have been developed for TMDs; nevertheless, conservative and non-invasive approaches ought to be prioritized. Laser therapy is an effective treatment for [...] Read more.

Background/Objectives: Temporomandibular joint disorders (TMDs) express a condition derived from a broad spectrum of etiological factors and clinical manifestations. Many treatment options have been developed for TMDs; nevertheless, conservative and non-invasive approaches ought to be prioritized. Laser therapy is an effective treatment for pain management due to its non-invasive nature and capacity for tissue regeneration. This review aimed at bringing an overview of the present evidence regarding the efficiency of laser therapy on myofascial or temporomandibular joint disorders pain. Methods: The search was conducted in four electronic databases: PubMed, Web of Science, Embase, and Scopus, of studies published between January 1997 and January 2023. The following terms have been extensively searched: “laser treatment”, pain management”, “temporomandibular joint disorders”, “masseter muscle pain”, “pterygoid muscle pain”, and “temporal muscle pain”. The inclusion criteria were original papers, available in full text, and written in English. Cohen’s Kappa coefficient was used to assess the inter-rater reliability for article selection. The methodological quality was assessed with the Cochrane Risk of Bias tool for randomized controlled trials and the National Heart, Lung, and Blood Institute’s quality assessment tool for before-after studies with no control group. Results: Out of 846 identified records, 7 studies were included, of which 5 were randomized controlled trials. The inter-rater reliability for article selection showed an almost perfect agreement (Cohen’s Kappa = 0.832, p < 0.001). The protocol of laser application was not standardized; the laser wavelength ranged from 633 to 940 nm, with a power output range from 25 to 1600 mW. The number of sessions varied from 3 to 12, with a frequency of application from 1 time per week to 3 times per week. All studies reported pain reduction after laser therapy. Conclusions: Laser therapy is an efficient method to treat TMDs related to muscle pain. To accomplish the desired results, a standard procedure must be followed; however, the protocol is still not fully designed. Full article

(This article belongs to the Special Issue Interdisciplinary Approach on the Oral Cavity Management Due to Musculoskeletal Conditions)

► Show Figures

Figure 1

13 pages, 583 KiB

Open AccessReview

Spinal Anesthesia for Awake Spine Surgery: A Paradigm Shift for Enhanced Recovery after Surgery

by John Preston Wilson, Bryce Bonin, Christian Quinones, Deepak Kumbhare, Bharat Guthikonda and Stanley Hoang

J. Clin. Med. 2024, 13(17), 5326; https://doi.org/10.3390/jcm13175326 - 9 Sep 2024

Abstract

Awake surgery has been applied for various surgical procedures with positive outcomes; however, in neurosurgery, the technique has traditionally been reserved for cranial surgery. Awake surgery for the spine (ASFS) is an alternative to general anesthesia (GA). As early studies report promising results, [...] Read more.

Awake surgery has been applied for various surgical procedures with positive outcomes; however, in neurosurgery, the technique has traditionally been reserved for cranial surgery. Awake surgery for the spine (ASFS) is an alternative to general anesthesia (GA). As early studies report promising results, ASFS is progressively gaining more interest from spine surgeons. The history defining the range of adverse events facing patients undergoing GA has been well described. Adverse reactions resulting from GA can include postoperative nausea and vomiting, hemodynamic instability and cardiac complications, acute kidney injury or renal insufficiency, atelectasis, pulmonary emboli, postoperative cognitive dysfunction, or malignant hyperthermia and other direct drug reactions. For this reason, many high-risk populations who have typically been poor candidates under classifications for GA could benefit from the many advantages of ASFS. This narrative review will discuss the significant historical components related to ASFS, pertinent mechanisms of action, protocol overview, and the current trajectory of spine surgery with ASFS. Full article

(This article belongs to the Special Issue Targeted Diagnosis and Treatment in Lumbar and Spine Surgeries)

► Show Figures

Figure 1

19 pages, 540 KiB

Open AccessSystematic Review

Frailty Detection in Older Adults with Diabetes: A Scoping Review of Assessment Tools and Their Link to Key Clinical Outcomes

by Ernesto Guevara, Andreu Simó-Servat, Verónica Perea, Carmen Quirós, Carlos Puig-Jové, Francesc Formiga and María-José Barahona

J. Clin. Med. 2024, 13(17), 5325; https://doi.org/10.3390/jcm13175325 - 9 Sep 2024

Abstract

Objectives: With the increasing prevalence of diabetes and frailty among older adults, there is an urgent need for precision medicine that incorporates comprehensive geriatric assessments, including frailty detection. This scoping review aims to map and synthesize the available evidence on validated tools for [...] Read more.

Objectives: With the increasing prevalence of diabetes and frailty among older adults, there is an urgent need for precision medicine that incorporates comprehensive geriatric assessments, including frailty detection. This scoping review aims to map and synthesize the available evidence on validated tools for detecting pre-frailty and frailty in community-dwelling elderly individuals with diabetes and outpatient diabetes patients. Specifically, it addresses: (1) What validated tools are available for detecting pre-frailty and frailty in this population? (2) How are these tools associated with outcomes such as glycemic control, hypoglycemia, and metabolic phenotypes? (3) What gaps exist in the literature regarding these tools? Methods: The review followed PRISMA-ScR guidelines, conducting a systematic search across PubMed, Cochrane Library, and Web of Science. The inclusion criteria focused on studies involving individuals aged 70 years and older with diabetes, emphasizing tools with predictive capacity for disability and mortality. Results: Eight instruments met the inclusion criteria, including the Frailty Index, Physical Frailty Phenotype, and Clinical Frailty Scale. These tools varied in domains such as physical, psychological, and social aspects of frailty and their association with glycemic control, hypoglycemia, and metabolic phenotypes. The review identified significant gaps in predicting diabetes-related complications and their clinical application. Conclusions: Routine management of older adults with diabetes should incorporate frailty detection, as it is crucial for their overall health. Although widely used, the reviewed tools require refinement to address the unique characteristics of this population. Developing tailored instruments will enhance precision medicine, leading to more effective, individualized interventions for elderly individuals with diabetes. Full article

(This article belongs to the Section Endocrinology & Metabolism)

► Show Figures

Figure 1

14 pages, 58424 KiB

Open AccessReview

Multi-Flap Microsurgical Autologous Breast Reconstruction

by Thomas N. Steele, Sumeet S. Teotia and Nicholas T. Haddock

J. Clin. Med. 2024, 13(17), 5324; https://doi.org/10.3390/jcm13175324 - 9 Sep 2024

Abstract

Microsurgical autologous breast reconstruction (MABR) remains the gold standard technique of breast reconstruction, providing a durable, natural, and aesthetically pleasing result. However, some patients may not be candidates for a traditional deep inferior epigastric perforator (DIEP) flap, either due to abdominal tissue paucity, [...] Read more.

Microsurgical autologous breast reconstruction (MABR) remains the gold standard technique of breast reconstruction, providing a durable, natural, and aesthetically pleasing result. However, some patients may not be candidates for a traditional deep inferior epigastric perforator (DIEP) flap, either due to abdominal tissue paucity, the need for higher-volume reconstruction, or prior surgical procedures. In these patients, alternative flaps must be considered to achieve the optimal result. Such configurations include the conjoined (or double pedicle) DIEP flap, and alternative flaps such as the lumbar artery perforator (LAP) and profunda artery perforator (PAP) flaps, which can be combined in a stacked fashion. By combining multiple flaps in a conjoined or stacked fashion, breast reconstruction can be optimized to fulfill the three critical components of breast reconstruction in restoring the skin envelope, breast footprint, and conus shape. When harvesting multiple flaps, the surgical sequence of events must be meticulously planned to ensure an efficient and successful operation. Preoperative imaging can aid the surgeon in identifying the ideal perforator, assess for side branches for possible intra-flap anastomoses, expedite the operative time, and decrease intraoperative complications. Reconstructive surgeons should be familiar with the variety of configurations with conjoined and/or stacked flaps to address patient-specific reconstructive needs. Full article

(This article belongs to the Special Issue Current Research Trends and Updates in Breast Reconstruction)

► Show Figures

Figure 1

12 pages, 451 KiB

Open AccessArticle

Vestibular Function and Postural Control in Children with Autism Spectrum Disorder

by Donella Chisari, Jessica Vitkovic, Ross Clark and Gary Rance

J. Clin. Med. 2024, 13(17), 5323; https://doi.org/10.3390/jcm13175323 - 9 Sep 2024

Abstract

Background: Postural control deficits have been documented in children with autism spectrum disorder (ASD), yet vestibular system contributions to postural control have not been widely considered. The purpose of this study is to explore the relationship between functional balance, postural sway, and vestibular [...] Read more.

Background: Postural control deficits have been documented in children with autism spectrum disorder (ASD), yet vestibular system contributions to postural control have not been widely considered. The purpose of this study is to explore the relationship between functional balance, postural sway, and vestibular function in children with ASD. Methods: Ten children with a confirmed diagnosis of ASD according to DSM-V guidelines along with ten children with no known neurodevelopmental or motor delays participated in the study. Bruininks–Oseretsky Test of Motor Proficiency and the Paediatric Balance Scale measured functional balance ability, and postural sway was measured using static posturography with modified sensory inputs. Peripheral vestibular function was measured using cervical vestibular evoked myogenic potentials and video head impulse testing. Correlations between measures were performed. Results: When visual cues were removed, children with ASD demonstrated larger path velocities indicative of reduced postural control, and different patterns of postural sway. Functional balance was correlated with path velocities for conditions where sensory information was modified. No differences in peripheral vestibular function were noted between groups, and functional balance was not correlated with vestibular function. Conclusions: Findings suggest that while peripheral vestibular function is similar between groups, postural control differences in children with ASD remain, particularly for conditions where sensory information is modified. Furthermore, demonstrated patterns of postural sway suggest sensory system integration is less developed in children with ASD. These findings highlight the importance of utilising a range of clinical tools to quantify balance ability and consideration of postural control measures to inform intervention. Full article

(This article belongs to the Special Issue Recent Advances in Audio-Vestibular Medicine)

► Show Figures

Graphical abstract

12 pages, 852 KiB

Open AccessArticle

Association between Mild Overweight and Survival: A Study of an Exceptionally Long-Lived Population in the Sardinian Blue Zone

by Giovanni Mario Pes, Alessandra Errigo and Maria Pina Dore

J. Clin. Med. 2024, 13(17), 5322; https://doi.org/10.3390/jcm13175322 - 9 Sep 2024

Abstract

Background/Objectives: Overweight and obesity are generally considered risk factors for premature mortality. However, scientific evidence suggests that among older populations, mild conditions of overweight might be associated with reduced comorbidity and longer survival. This study investigates the potential association between anthropometric parameters [...] Read more.

Background/Objectives: Overweight and obesity are generally considered risk factors for premature mortality. However, scientific evidence suggests that among older populations, mild conditions of overweight might be associated with reduced comorbidity and longer survival. This study investigates the potential association between anthropometric parameters and survival among a cohort of nonagenarians in Sardinia, Italy. Methods: This study included 200 subjects (50% females) aged 89 and older, enrolled in 2018 in the Sardinian Blue Zone—a population known for longevity—and followed for up to six years. Anthropometric variables such as body height, weight, age, sex, comorbidity, disability, and food group intake were collected using validated questionnaires and analyzed through multivariable analysis. Results: Out of 200 participants at baseline, 28 (14%) were still alive after six years of follow-up (females 10%, males 18%). Mean survival was 3.36 years (range 0.1–6.9 years) for males and 3.03 years (range 0.2–6.6 years) for females. Participants with a Body Mass Index (BMI) in the range of 25.0–27.0 kg/m² among males and 25.0–27.2 kg/m² among females had longer survival compared to those who were underweight (p = 0.002) or obese (p < 0.0001). The Cox proportional hazards regression model, adjusted for age, sex, and comorbidity, revealed a statistically significant association between the BMI and survival, demonstrating an inverted–U relationship. This indicates that mild overweight was associated with a survival advantage compared to both normal weight and obesity. Conclusions: Our study indicates that mild, but not severe, overweight in nonagenarians is associated with extended lifespan. Therefore, primary care physicians and geriatricians should exercise caution before recommending calorie-restricted diets for mildly overweight elderly patients. Full article

(This article belongs to the Special Issue Frailty in the Elderly: Risk Factors, Prevention and Clinical Management)

► Show Figures

Figure 1

14 pages, 909 KiB

Open AccessArticle

by Dong Kee Jang, Hyung Seok Nam, Jieun Kim and Yeo Hyung Kim

J. Clin. Med. 2024, 13(17), 5321; https://doi.org/10.3390/jcm13175321 - 8 Sep 2024

Abstract

Objective: With advancements in treatment, the increasing number of women with breast cancer has led to a growing focus on enhancing their well-being by understanding health-related quality of life (HRQoL). This study aimed to investigate the association between comorbidities and HRQoL in [...] Read more.

Objective: With advancements in treatment, the increasing number of women with breast cancer has led to a growing focus on enhancing their well-being by understanding health-related quality of life (HRQoL). This study aimed to investigate the association between comorbidities and HRQoL in middle-aged and older community-dwelling Korean women with breast cancer. Methods: Data from the Sixth, Seventh, and Eighth Korea National Health and Nutrition Examination Surveys between 2014 and 2020 were used to analyze 12,218 women aged ≥50 years (244 women with breast cancer vs. 11,974 women without breast cancer). HRQoL was assessed using the EQ-5D-3L tool and the EQ-5D index. Associations between comorbidities (arthritis, depression, hypertension, diabetes, and cardiovascular disease) and HRQoL were examined. Results: Among women with breast cancer, arthritis was associated with problems in mobility (OR, 3.24; 95% CI, 1.39–7.53) and pain/discomfort (OR, 7.30; 95% CI, 3.62–14.73). Depression was associated with problems in self-care (OR, 7.02; 95% CI, 1.97–25.01), usual activities (OR, 5.73; 95% CI, 1.52–21.59), pain/discomfort (OR, 5.58; 95% CI, 1.49–20.87), and anxiety/depression (OR, 3.81; 95% CI, 1.14–12.72). Arthritis and depression were also considerably associated with overall HRQoL, as measured by the EQ-5D index. Hypertension, diabetes, and cardiovascular disease were not independently associated with HRQoL. Conclusions: Arthritis and depression were markedly associated with HRQoL in middle-aged and older women in the community who suffer from breast cancer. Public health interventions that focus on managing these comorbidities can enhance the well-being of women with breast cancer. Full article

(This article belongs to the Special Issue Innovations and Advances in Breast Cancer Research and Treatment)

► Show Figures

Figure 1

14 pages, 211 KiB

Open AccessArticle

Effectiveness of Voice Therapy in Telepractice with Patients with Hyperfunctional Voice Disorder: A Pilot Study

by Nayeon Choi, Suna Park and Gil Joon Lee

J. Clin. Med. 2024, 13(17), 5320; https://doi.org/10.3390/jcm13175320 - 8 Sep 2024

Abstract

Background: The need for telepractice and digital treatment has increased due to issues this revision.regarding medical access and the COVID-19 pandemic. However, in many countries, telepractice is rarely performed. The purpose of this pilot study was to describe the detailed process of [...] Read more.

Background: The need for telepractice and digital treatment has increased due to issues this revision.regarding medical access and the COVID-19 pandemic. However, in many countries, telepractice is rarely performed. The purpose of this pilot study was to describe the detailed process of telepractice in patients with hyperfunctional voice disorder and investigate its effects. Methods: The three subjects who were enrolled in this pilot study had hyperfunctional voice disorders. The evaluation was performed face to face. Auditory perceptual evaluation, acoustic evaluation, aerodynamic evaluation, patient self-evaluation, and interviews were conducted. Treatment was delivered by telepractice using a smartphone application. Results: In quantitative analysis of auditory perceptual evaluation, acoustic evaluation, aerodynamic evaluation, and patient self-evaluation, all subjects showed improved voice after treatment. In-depth analysis of telepractice was performed through the interview. Conclusions: Telepractice was effective in patients with voice disorders, and the patients were satisfied with this approach. In addition to this pilot study, further large-scale studies are required, but telemedicine may improve treatment outcomes and patient satisfaction in cases where medical access is limited or during outbreaks of respiratory infections like COVID-19. Full article

(This article belongs to the Section Otolaryngology)

12 pages, 1723 KiB

Open AccessArticle

The Impact of Tumor Elongation on Facial Nerve Outcome after Surgery for Koos Grade 3 and 4 Vestibular Schwannomas in the Semi-Sitting Position via the Retrosigmoid Approach

by Franziska Glieme, Lisa Haddad, Felix Arlt, Martin Vychopen, Clemens Seidel, Alonso Barrantes-Freer, Erdem Güresir and Johannes Wach

J. Clin. Med. 2024, 13(17), 5319; https://doi.org/10.3390/jcm13175319 - 8 Sep 2024

Abstract

Background: Facial nerve paralysis is a severe dysfunction after vestibular schwannoma (VS) surgery. Methods: This monocentric study analyzed 61 patients who underwent sporadic VS surgery in a standardized manner. The primary endpoint was the facial nerve outcome (FNO) at 3 months after VS [...] Read more.

Background: Facial nerve paralysis is a severe dysfunction after vestibular schwannoma (VS) surgery. Methods: This monocentric study analyzed 61 patients who underwent sporadic VS surgery in a standardized manner. The primary endpoint was the facial nerve outcome (FNO) at 3 months after VS surgery. FNO was dichotomized into “good” (House–Brackmann (HB) score ≤ 2) and “poor” (HB > 2). Results: Poor FNO was observed in 11 patients (18.0%) at 3 months after VS surgery. Radiomic tumor shape features were analyzed, and the AUC of elongation in the prediction of a poor HB at 3 months was 0.70 (95% CI: 0.56–0.85, p = 0.03) and the optimum threshold value (≤/>0.35) yielded a sensitivity and specificity of 64.0% and 75.4%, respectively. Multivariable logistic regression analyses considering the extent of resection (</≥93.4%), preoperative tumor volume (</≥2.6 cm³), age (</≥55), sex (female/male), and elongation (≤/>0.35) revealed that more elongated VSs (≤0.35; OR: 5.8; 95%CI: 1.2–28.2; p = 0.03) and those with an increased EoR (≥93.4%; OR: 6.5; 95%CI: 1.0–42.5; p = 0.05) are independently associated with poorer FNO at 3 months after surgery. Conclusions: Highly elongated VS shape seems to be a risk factor for worsened facial nerve outcome at 3 months after surgery for Koos grade 3 and 4 tumors. Full article

(This article belongs to the Special Issue Current Trends in the Management of Vestibular Schwannoma)

► Show Figures

Figure 1

15 pages, 941 KiB

Open AccessArticle

Impact of Intra-Retinal Fluids on Changes in Retinal Ganglion Cell and Nerve Fiber Layers in Neovascular AMD under Anti-VEGF Therapy

by Yaser Abu Dail, Berthold Seitz, Haris Sideroudi and Alaa Din Abdin

J. Clin. Med. 2024, 13(17), 5318; https://doi.org/10.3390/jcm13175318 - 8 Sep 2024

Abstract

Purpose: To investigate the influence of intraretinal fluid (IRF) on change in retinal nerve fiber layer (RNFL) and retinal ganglion cell layer (RGCL) and thickness in patients with naive neovascular AMD under anti-VEGF treatment. Design: post hoc analysis. Methods: 97 [...] Read more.

Purpose: To investigate the influence of intraretinal fluid (IRF) on change in retinal nerve fiber layer (RNFL) and retinal ganglion cell layer (RGCL) and thickness in patients with naive neovascular AMD under anti-VEGF treatment. Design: post hoc analysis. Methods: 97 eyes of 83 patients on continuous therapy with intravitreal anti-vascular endothelial growth factors (anti-VEGF) and a follow-up of 24 months were included. RGCL and RNFL thickness in the perifoveal (-O), parafoveal (PF), and nasal areas and number of injections (IVI) were recorded before the first IVI as well as 1 and 2 years after initiating treatment and compared longitudinally and between groups with and without IRF. Results: The group with IRF at baseline had a higher RNFL thickness at baseline and showed a significant reduction in RNFL-PF between baseline and first and second follow-ups (p < 0.001) but not between first and second follow-ups. The group without IRF showed no significant reduction in RNFL over time. The presence of IRF was not associated with a reduction in RNFL-O or RNFL-nasal. RGCL thickness decreased significantly in both groups with and without IRF after 2 years. Number of IVIs showed no significant correlation to RNFL or RGCL after stratification for the presence of IRF. Conclusions: The presence of IRF has a significant influence on RNFL thickness at baseline as well as on its changes over time during anti-VEGF therapy. The preoperative presence of IRF should be considered when comparing changes in RNFL thickness after IVI. Full article

(This article belongs to the Section Ophthalmology)

► Show Figures

Figure 1

11 pages, 750 KiB

Open AccessArticle

Significant Preoperative Anxiety Associated with Perceived Risk and Gender in Cataract Surgery

by Georgios Floros, Stylianos Kandarakis, Nikolaos Glynatsis, Filaretos Glynatsis and Ioanna Mylona

J. Clin. Med. 2024, 13(17), 5317; https://doi.org/10.3390/jcm13175317 - 8 Sep 2024

Abstract

Background/Objectives: Cataract surgery is an often-sought solution to the universal problem of lens opacification. Studies of perioperative anxiety have yielded conflicting results, reporting a high prevalence but low clinical significance. The objective of this study was to ascertain anxiety levels immediately after [...] Read more.

Background/Objectives: Cataract surgery is an often-sought solution to the universal problem of lens opacification. Studies of perioperative anxiety have yielded conflicting results, reporting a high prevalence but low clinical significance. The objective of this study was to ascertain anxiety levels immediately after the scheduling of surgery, controlling for trait anxiety and other related factors. Methods: This is an observational comparative study of two patient populations assessed for receiving cataract surgery, with one group of seventy patients scheduled for operation and receiving an assessment of the potential perioperative risk and the other group of seventy patients deemed ineligible for operation since their opacification was not advanced. The patients were assessed for state and trait anxiety while controlling for cognitive status. Results: The findings indicate a clinically significant burden of state anxiety in the group of patients scheduled for operation, with 34 out of 70 meeting the threshold for clinically significant levels of state anxiety compared to 9 out of the 70 patients who were not assigned for surgery (p < 0.001). Those patients who were assigned for surgery were assessed for perioperative risk factors, and state anxiety differed statistically significantly between the preoperative risk factor groups, (p = 0.003) with those assessed as having at least low perioperative risk presenting with more anxiety than those without any risk factors. Male patients exhibited lower state anxiety compared to female patients in the group assigned to surgery (p = 0.028). Cognitive status did not affect the results. Conclusions: These findings point to the importance of prevention against perioperative anxiety early on, especially in patients with a higher perioperative risk and female gender. Full article

(This article belongs to the Section Mental Health)

► Show Figures

Figure 1

14 pages, 575 KiB

Open AccessArticle

The Concentration of Follistatin and Activin A in Serum and Selected Biochemical Parameters in Women with Polycystic Ovary Syndrome: Stratification by Tobacco Smoke Exposure, Insulin Resistance, and Overweight/Obesity

by Justyna Niepsuj, Agnieszka Piwowar, Grzegorz Franik and Anna Bizoń

J. Clin. Med. 2024, 13(17), 5316; https://doi.org/10.3390/jcm13175316 - 8 Sep 2024

Abstract

Background/Objectives: The aim of the study was to investigate the concentrations of follistatin and activin A in the serum of women with polycystic ovary syndrome (PCOS) and to assess their relationship with selected biochemical parameters, specifically stratifying the analysis based on tobacco [...] Read more.

Background/Objectives: The aim of the study was to investigate the concentrations of follistatin and activin A in the serum of women with polycystic ovary syndrome (PCOS) and to assess their relationship with selected biochemical parameters, specifically stratifying the analysis based on tobacco smoke, insulin resistance, and abnormal weight. Methods: The research was carried out within a cohort of 88 women (60 women with and 28 without PCOS). Results: We observed significant differences (p < 0.05) in follistatin concentrations between women with PCOS stratified by homeostatic model assessment for insulin resistance (HOMA-IR) values. These differences were consistent across both smoking and non-smoking subgroups with PCOS. Similar results were observed when comparing normal-weight women with PCOS to those with overweight or obesity. Additionally, activin A concentrations were significantly increased by higher body mass index (BMI) and HOMA-IR values in non-smoking women with PCOS. Moreover, we identified a negative correlation (r = −0.30; p < 0.023) between cotinine levels and Anti-Müllerian hormone. Among smoking women with PCOS, we noted decreased concentrations of sex hormone-binding globulin and high-density lipoproteins, alongside increased fasting glucose, insulin, HOMA-IR, and free androgen index values. Conclusions: Our findings suggest that activin A and follistatin concentrations are more strongly influenced by disruptions in glucose metabolism and BMI than by tobacco smoke exposure. The observed changes were more pronounced in follistatin than in activin A level. Full article

(This article belongs to the Special Issue Polycystic Ovary Syndrome (PCOS): State of the Art—Volume 2)

► Show Figures

Figure 1

9 pages, 722 KiB

Open AccessSystematic Review

The Use of Stem Cells in Bone Regeneration of Cleft Lip and Palate Patients: A Systematic Review

by Mohamed Jaber, Aalaa Majed Alshikh Ali, Roba Imad El Saleh and Prathibha Prasad

J. Clin. Med. 2024, 13(17), 5315; https://doi.org/10.3390/jcm13175315 - 8 Sep 2024

Abstract

Background and Objectives: Cleft lip alone or a combination of cleft lip and palate (CLP) is a common developmental abnormality in the craniofacial region. This umbrella review aims to identify promising avenues for treatment using stem cell therapy. Materials and Methods: Systematic reviews [...] Read more.

Background and Objectives: Cleft lip alone or a combination of cleft lip and palate (CLP) is a common developmental abnormality in the craniofacial region. This umbrella review aims to identify promising avenues for treatment using stem cell therapy. Materials and Methods: Systematic reviews from 2014 to 2024 were searched among databases like PubMed, Medline, and Google Scholar. PRISMA guidelines were employed to ensure the thoroughness of the search. A quality assessment (ROBIS) of the included reviews was conducted to ensure the reliability and validity of the synthesized evidence. Results: Five systematic reviews were selected for this umbrella review. Results show that stem cell therapy, specifically using mesenchymal stem cells (MSCs) and adipocyte stem cells (ADSCs), promotes bone regeneration in CLP deformities. Although multiple studies have established the effectiveness of diverse types of stem cells in treating CLP, important considerations including safety concerns, methodological variability, and the need for standardization have been identified. The fact that the number of relevant systematic reviews that matched our inclusion criteria was limited could affect this research’s robustness and may limit the breadth and depth of evidence synthesis. Definitive conclusions could not be reached due to variation among treatments and outcomes. Conclusions: The examined studies highlight the potential of stem cell therapy as a complementary approach to existing treatments for CLP. However, there are challenges that need to be addressed, including concerns regarding safety, variations in methodologies, and the need for standardization. Exploring the potential of other stem cell types may further enhance treatment outcomes for CLP patients. Full article

(This article belongs to the Special Issue Cleft Lip and Palate: Current Treatment and Future Options)

► Show Figures

Figure 1

10 pages, 486 KiB

Open AccessArticle

Androgen Deprivation Therapy and the Risk of Newly Developed Dry Eye Syndrome in Patients with Prostate Cancer: A Nationwide Nested Case–Control Study in the Republic of Korea

by Jinhyung Jeon, Jee Soo Ha, Hye Sun Lee, Soyoung Jeon, Ho Sik Hwang, Daeho Kim, June Seok Kim, Byeong Seon Kim, Min Kim and Kang Su Cho

J. Clin. Med. 2024, 13(17), 5314; https://doi.org/10.3390/jcm13175314 - 8 Sep 2024

Abstract

Background: We aimed to evaluate the association between androgen deprivation therapy (ADT) and newly developed dry eye syndrome (DES) in patients with prostate cancer. Methods: A nested case–control study was conducted. From the nationwide claims database of the Republic of Korea, 125,005 patients [...] Read more.

Background: We aimed to evaluate the association between androgen deprivation therapy (ADT) and newly developed dry eye syndrome (DES) in patients with prostate cancer. Methods: A nested case–control study was conducted. From the nationwide claims database of the Republic of Korea, 125,005 patients were included in the final analysis. Cases were defined as those newly diagnosed with DES during follow-up, and 12,654 patients were identified. The cases were matched with controls in a ratio of 1:4. Odds ratios (ORs) for newly developed DES associated with ADT were estimated using conditional logistic regression. Results: After matching, 7499 cases and 29,996 controls were selected. ADT was associated with a reduced risk of newly developed DES in patients with prostate cancer compared to no ADT (OR = 0.875; 95% confidence interval, 0.825–0.927; p < 0.0001). An accumulated dose of ADT < 1 year was associated with a reduced risk of incidental DES (OR = 0.811; 95% CI, 0.751–0.875; p < 0.0001), and a duration of 1–2 years was also associated with a reduced risk (OR = 0.890; 95% CI, 0.802–0.986; p = 0.026). No association was observed with an ADT duration of ≥2 years. Conclusions: The use of ADT, especially for shorter durations (<2 years), was associated with a reduced risk of newly developed DES in S. Korean patients with prostate cancer. Full article

(This article belongs to the Section Nephrology & Urology)

► Show Figures

Figure 1

Journal Menu

Journal Browser

J. Clin. Med., Volume 13, Issue 17 (September-1 2024) – 375 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI