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J. Clin. Med., Volume 13, Issue 21 (November-1 2024) – 337 articles

Cover Story (view full-size image): Thoracostomy and chest tube placement are essential for treating fluid or air buildup in the pleural cavity. Key historical advancements include closed drainage systems to prevent air entry into the pleural space, the use of plastic materials, and the Heimlich valve. Modern technology offers various chest tube designs (straight, angled, pig-tail) and advanced drainage systems, such as PVC or silicone tubes with radiopaque stripes for improved imaging. Current chest drainage units can incorporate digital systems that monitor and graph pleural pressure and fluid/air removal. Intrapleural therapies, suction, pleurodesis, and long-term indwelling catheters are among the latest applications of chest drain in pleural disease management. View this paper
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10 pages, 225 KiB  
Article
Molecular Diagnostics for Group A Streptococcal Pharyngitis: Clinical and Economic Benefits in the Belgian Healthcare Context
by Mohammad Hossein Panahandeh, Reza Soleimani, Yasmine Nezzar, Hector Rodriguez-Villalobos, Benoît Kabamba-Mukadi, Alexandre Grimmelprez and Patricia Schatt
J. Clin. Med. 2024, 13(21), 6627; https://doi.org/10.3390/jcm13216627 - 4 Nov 2024
Viewed by 821
Abstract
(1) Background: Group A Streptococcal (GAS) pharyngitis is common, resulting in numerous ambulatory visits. Accurate diagnosis is challenging. This study evaluated the clinical utility, cost, and performance of a nucleic acid amplification test (NAAT) for GAS detection, comparing it to a rapid antigen [...] Read more.
(1) Background: Group A Streptococcal (GAS) pharyngitis is common, resulting in numerous ambulatory visits. Accurate diagnosis is challenging. This study evaluated the clinical utility, cost, and performance of a nucleic acid amplification test (NAAT) for GAS detection, comparing it to a rapid antigen detection test (RADT) and throat culture. Additionally, we assessed the diagnostic stewardship related to these testing methods to ensure appropriate antibiotic use in clinical practice. Methods: Between November 2022 and February 2023, 82 throat swabs were analyzed, with McIsaac clinical scores calculated for each. The Abbott ID NOW STREP A 2 NAAT and Sekisui Diagnostics’ OSOM® STREP A RADT were performed, followed by bacterial culture. Diagnostic performance was compared using culture as the gold standard. Results: Of the 82 samples, 28 (34.14%) tested positive for pathogenic germs, primarily Streptococcus pyogenes (92.85%). RADTs showed a sensitivity of 80.76% and a specificity of 100%, while NAATs demonstrated a sensitivity of 100% and specificity of 96.42%. Cost analysis indicated the need for reimbursement adjustments to optimize NAAT’s economic benefits. Clinical data indicated that symptoms alone were insufficient for reliable diagnosis. Conclusions: This study confirmed the superior sensitivity of Abbott’s Strep A2 NAAT over RADT. Given the Belgian guidelines against routine antibiotic treatment for pharyngitis and considering local treatment recommendations and cost, implementing NAAT for GAS detection in Belgian laboratories is less beneficial. However, the role of NAAT in supporting antimicrobial stewardship by ensuring appropriate antibiotic use remains significant. Full article
10 pages, 680 KiB  
Article
The Tinetti Balance Test Is an Effective Predictor of Functional Decline in Non-Hospitalized Post-COVID-19 Individuals: A Cross-Sectional Study
by Janice R. M. Bastos, Arthur S. Ferreira, Agnaldo J. Lopes, Talita P. Pinto, Erika Rodrigues and Fabio V. dos Anjos
J. Clin. Med. 2024, 13(21), 6626; https://doi.org/10.3390/jcm13216626 - 4 Nov 2024
Viewed by 527
Abstract
Background/Objectives: Individuals with post-COVID-19 conditions risk developing short- and/or long-term neuromuscular impairments, including postural imbalance. However, there is limited evidence showing whether balance deficits are associated with declines in the functional status in post-COVID-19 individuals. This study examined postural balance in non-hospitalized post-COVID-19 [...] Read more.
Background/Objectives: Individuals with post-COVID-19 conditions risk developing short- and/or long-term neuromuscular impairments, including postural imbalance. However, there is limited evidence showing whether balance deficits are associated with declines in the functional status in post-COVID-19 individuals. This study examined postural balance in non-hospitalized post-COVID-19 individuals using different assessment tools and tested the most relevant balance tools in predicting functional status. Methods: This cross-sectional study enrolled 60 adults split into control (n = 30) and post-COVID-19 (n = 30) groups. Postural balance was assessed in both groups using the Functional Reach Test (FRT), Berg Balance Scale (BBS), Timed Up and Go (TUG), Tinetti Balance Test (Tinetti), and Mini-BESTest (MBT). Functional status in the post-COVID-19 group was assessed using post-COVID-19 functional status (PCFS). Results: Significant differences in postural stability between groups were found only for the FRT. All balance tests showed a statistically significant correlation with PCFS in the post-COVID-19 group, with better performance in all tests being associated with better functional status: Tinetti (r = −0.584), FRT (r = −0.542), MBT (r = −0.530), BBS (r = −0.415) and TUG (r = 0.368). Tinetti was the independent variable that significantly played an important role in determining PCFS (adjusted R2 = 0.318, p < 0.001). Conclusions: Post-COVID-19 functional status is best determined by the Tinetti Balance Test, making it an effective tool for assessing postural balance deficits in this population, with potential implications for postural control assessment and rehabilitation. Full article
(This article belongs to the Special Issue Novel Insights into COVID-19-Associated Complications and Sequelae)
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14 pages, 3779 KiB  
Article
Comparison of the Effectiveness of Body Surface Area Estimation Formulas in Predicting the Risk of Death in Patients with Heart Failure
by Małgorzata Piecuch, Maciej Chylak, Michał Górski, Jagoda Garbicz-Kata, Anna Szczyrba, Marta Buczkowska, Jolanta Malinowska-Borowska, Jolanta Urszula Nowak, Jacek T. Niedziela, Mariusz Gąsior and Piotr Rozentryt
J. Clin. Med. 2024, 13(21), 6625; https://doi.org/10.3390/jcm13216625 - 4 Nov 2024
Viewed by 703
Abstract
Background/Objectives: Body surface area is one of the most important anthropometric parameters in medicine. The study’s primary objective is to compare the consistency of the BSA estimation results through applying available formulas. Other objectives include determining the ability of these formulas to [...] Read more.
Background/Objectives: Body surface area is one of the most important anthropometric parameters in medicine. The study’s primary objective is to compare the consistency of the BSA estimation results through applying available formulas. Other objectives include determining the ability of these formulas to discriminate between death and survival in patients, comparing the formulas’ diagnostic features, and investigating whether the risk associated with a low BSA is independent of BMI. Methods: This study included 1029 patients (median age, 54 years; female, 13.7%; NYHA I/II/III/IV, 6.3%/36.5%/47.7%/9.5%) diagnosed with heart failure. For each patient, BSA was calculated using 25 formulas. Over the 3-year observation period, 31.2% of the patients died. Results: The average BSA value of the optimal discrimination thresholds was 1.79 m2 ± 0.084 m2 and the BSA difference between the estimators with the lowest (BSAMeeh1879) and the highest (BSANwoye1989) optimal discrimination thresholds was 0.42 m2. The lowest mortality rate was 35.2% and occurred in the subgroup of individuals with BSA values below the optimal discrimination threshold using the BSASchlich2010 estimator. The highest mortality was predicted when the estimator BSAMeeh1879 or BSALivingston&Lee2001 was used. Conclusions: Our study showed a relatively good concordance of 25 BSA estimators in BSA assessment in patients, without extremes of weight or height being known to disrupt it. All BSA estimators presented a significant, although weak, ability to discriminate death from survival at 3-year follow-up; however, BSA is not a very good predictor of HF mortality at 3 years. The higher risk of death in smaller patients, as shown by BSA, was independent of BMI in all but two BSA estimators. Full article
(This article belongs to the Section Cardiology)
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14 pages, 4579 KiB  
Article
Effective Treatment of Basal Cell Carcinoma with a Topical Enzymatic Mixture Enriched in Bromelain: Summary of Proof-Of Concept Clinical Studies on the First 22 Tumors
by Lior Rosenberg, Yaron Shoham, Brian Berman, Stephen K. Tyring, Michael D. Tharp and Adam J. Singer
J. Clin. Med. 2024, 13(21), 6624; https://doi.org/10.3390/jcm13216624 - 4 Nov 2024
Viewed by 994
Abstract
Background/Objectives: Basal cell carcinoma (BCC), the most prevalent form of human cancer, is traditionally treated by surgical and alternative destructive or topical chemical means, each with its advantages, challenges, and drawbacks. We describe our experience treating BCCs with a topical concentrate of proteolytic [...] Read more.
Background/Objectives: Basal cell carcinoma (BCC), the most prevalent form of human cancer, is traditionally treated by surgical and alternative destructive or topical chemical means, each with its advantages, challenges, and drawbacks. We describe our experience treating BCCs with a topical concentrate of proteolytic enzymes enriched in bromelain (CPEEB) sourced from pineapple stems. CPEEB has strong proteolytic, antitumor–proapoptotic, and inflammation modulation activities, and is approved for debridement of deep burns and starting phase 3 trials for chronic wounds. Methods: In the first proof-of-concept (POC) study, six BCCs on three individuals were treated with five to six daily CPEEB 10% topical applications under a zinc oxide-based occlusive dressing for 9–12 h each during a period of up to 10 days. These patients were followed for up to 4 years. In an additional two POC studies, 16 patients with one BCC each were treated every other day for a total of seven applications of topical CPEEB 5% under a variety of occlusive dressings. The wounds were followed for up to 2 months before undergoing diagnostic excisional biopsy. Results: In the first study, clinical assessment of the BCCs and two excisional biopsies after 6 months suggested that all lesions were eradicated with spontaneous healing within ~2 weeks without clinical or histological recurrence for over 4 years. In the two subsequent studies, 16 histologically diagnosed superficial and nodular BCCs were treated using four application techniques. Excisional histology after 2 months confirmed BCC eradication in seven of the patients. In nine patients, with compromised occlusive dressings, histological eradication was incomplete. Treatment was well tolerated by all patients with the expected local skin reactions, which completely healed within 2–3 weeks. Conclusions: These are POC preliminary studies aimed at indicating the potential efficacy and feasibility of topical CPEEB in eradicating BCC. In these studies, topical CPEEB 10% and 5% resulted in complete eradication of the BCC when appropriately applied. CPEEB was well tolerated in all patients, and all treated sites’ erosions healed without scars in <3 weeks. Further research is necessary to corroborate the results, refine the application technique, and complete the regulatory process. Full article
(This article belongs to the Section Oncology)
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11 pages, 367 KiB  
Article
Assessment of Professional Practices in the Care Pathway of Patients with Upper Aerodigestive Tract Cancer in a University Hospital
by Dounia Chbihi, Morgane Corda, Thomas Thibault, Jérémy Baude, Caroline Guigou and Mireille Folia
J. Clin. Med. 2024, 13(21), 6623; https://doi.org/10.3390/jcm13216623 - 4 Nov 2024
Viewed by 632
Abstract
Objectives: The main objective of this study was to evaluate the alignment between treatment decisions made during multidisciplinary team meetings (MTMs) and the treatments received by patients with upper aerodigestive tract cancers. The secondary objective was to identify factors influencing potential discrepancies. Methods: [...] Read more.
Objectives: The main objective of this study was to evaluate the alignment between treatment decisions made during multidisciplinary team meetings (MTMs) and the treatments received by patients with upper aerodigestive tract cancers. The secondary objective was to identify factors influencing potential discrepancies. Methods: This retrospective, single-center study was conducted at a tertiary referral center and included 147 patients diagnosed with squamous cell carcinoma of the upper aerodigestive tract. Patients were divided into two groups based on the match between MTM-decided and actual treatments. Multivariate analysis was performed to assess factors independently associated with discrepancies. Results: Out of 147 patients, 28 (19%) received treatment that did not align with MTM decisions. Among these, eight died before treatment, one patient refused care, five received supportive care, five patients underwent surgery, three received radiotherapy alone, one patient underwent surgery and adjuvant radiochemotherapy, one patient underwent surgery and adjuvant radiotherapy alone, three patients received radiochemotherapy, and one patient received palliative chemotherapy. Independent significant factors associated with non-concordance included poor performance status (PS) and treatment not received at a tertiary reference center. Treatment shifts mainly involved downgrading from curative to palliative care. Conclusions: This study highlights the importance of patient health status in determining deviations from MTM decisions. Further efforts should focus on improving the integration of patient comorbidities and health status into MTM decision-making to optimize care delivery. Full article
(This article belongs to the Section Otolaryngology)
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12 pages, 1743 KiB  
Review
Outcome Through the Years of Left-Ventricular Assist Devices Therapy for End-Stage Heart Failure: A Review
by Ilaria Tropea, Giovanni Domenico Cresce, Valerio Sanesi, Loris Salvador and Daniele Zoni
J. Clin. Med. 2024, 13(21), 6622; https://doi.org/10.3390/jcm13216622 - 4 Nov 2024
Viewed by 1063
Abstract
Heart transplantation remains the gold standard surgical treatment for advanced heart failure. Over time, medical therapies have achieved remarkable outcomes in terms of survival and quality of life, yet their results may be insufficient, even when maximized. The limited availability of organ donors [...] Read more.
Heart transplantation remains the gold standard surgical treatment for advanced heart failure. Over time, medical therapies have achieved remarkable outcomes in terms of survival and quality of life, yet their results may be insufficient, even when maximized. The limited availability of organ donors and the selective criteria for heart transplant eligibility have led to a significant rise in the utilization of long-term mechanical circulatory support, including left ventricular assist devices. Patients receiving LVADs often present with multiple comorbidities, constituting a highly vulnerable population. Individuals living with LVADs may experience various long-term complications, such as bleeding, driveline infections, neurological events, and right ventricular dysfunction. Fortunately, the development of increasingly biocompatible LVAD devices in recent years has resulted in a notable reduction in these complications. This review aims to summarize the principal complications encountered by patients with LVADs throughout their treatment and the associated daily management strategies. Full article
(This article belongs to the Special Issue Current and Emerging Treatment Perspectives in Heart Failure)
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21 pages, 390 KiB  
Review
IgA Vasculitis (Henoch–Schönlein Purpura): An Update on Treatment
by Santos Castañeda, Patricia Quiroga-Colina, Paz Floranes, Miren Uriarte-Ecenarro, Cristina Valero-Martínez, Esther F. Vicente-Rabaneda and Miguel A. González-Gay
J. Clin. Med. 2024, 13(21), 6621; https://doi.org/10.3390/jcm13216621 - 4 Nov 2024
Viewed by 2825
Abstract
Objective: IgA vasculitis (IgAV), previously named as Henoch–Schönlein purpura, is the most frequent systemic vasculitis in children. In adults, IgAV is less common although it is associated with more severe disease. In fact, the frequency of glomerulonephritis (referred to as IgAV nephritis) in [...] Read more.
Objective: IgA vasculitis (IgAV), previously named as Henoch–Schönlein purpura, is the most frequent systemic vasculitis in children. In adults, IgAV is less common although it is associated with more severe disease. In fact, the frequency of glomerulonephritis (referred to as IgAV nephritis) in adults is higher than in children and tends to present more severely, with around 10–30% of those affected eventually progressing to end-stage renal disease. In this review, we describe the pathophysiology, main clinical features, diagnosis of the disease, and latest clinical data regarding IgAV therapy. Methods: A narrative literature review, primarily based on articles published in PubMed, was conducted. In addition to discussing the main aspects of glucocorticoids and conventional disease-modifying drugs used in the management of IgAV, this review focuses on the latest information reported regarding biologics and potential future therapies. Results: Glucocorticoids are the first-line therapy for IgAV, especially in adults with severe manifestations. Colchicine, dapsone, and methotrexate can be useful for controlling minor manifestations. Several immunomodulatory agents, such as cyclosporine A, tacrolimus, and mycophenolate mofetil, have shown favorable results as glucocorticoid-sparing agents. Leflunomide has shown promising results but requires further study. The use of rituximab has demonstrated efficacy in reducing relapse frequency, lowering the cumulative glucocorticoid burden, and achieving long-term remission of the disease in children and adults with IgAV. Immunoglobulins and plasma exchange therapy can also be useful in difficult and life-threatening situations. Other potential therapies with encouraging results include TRF-budesonide, B-cell-directed therapy, B-cell-depleting agents, sodium–glucose cotransporter-2 inhibitors, endothelin receptor antagonists, and complement pathway inhibitors. Conclusions: Glucocorticoids are the first-line therapy for IgAV, especially in adults with severe manifestations. The role of various immunomodulatory therapies, such as calcineurin inhibitors and mycophenolate mofetil, remains promising, while rituximab reduces the long-term side effects of glucocorticoids and can help achieve disease remission. Other potential therapies with encouraging results require further research. Full article
(This article belongs to the Special Issue Vasculitis: Current Treatment and Future Options)
3 pages, 156 KiB  
Editorial
Complex Thoracic Aortic Diseases and Surgery: A Quest for the Golden Fleece
by Dimitrios E. Magouliotis and Thanos Athanasiou
J. Clin. Med. 2024, 13(21), 6620; https://doi.org/10.3390/jcm13216620 - 4 Nov 2024
Viewed by 628
Abstract
In Greek mythology, the Golden Fleece, a golden-wooled fleece of a winged ram called Chrysomallos, stood as an eternal symbol of authority and power [...] Full article
(This article belongs to the Special Issue Surgical Approaches for Complex Thoracic Aortic Diseases)
10 pages, 584 KiB  
Article
The Triple Procedure in Patients with Congenital Aniridia
by Bogumił Henryk Wowra, Olga Łach-Wojnarowicz, Marzena Wysocka-Kosmulska, Dariusz Dobrowolski and Edward Wylęgała
J. Clin. Med. 2024, 13(21), 6619; https://doi.org/10.3390/jcm13216619 - 4 Nov 2024
Viewed by 627
Abstract
Background: Aniridia is a rare panocular, bilateral, and congenital disease characterized by complete or partial iris hypoplasia and foveal hypoplasia, leading to decreased visual acuity and nystagmus. AAK, also referred to as aniridic keratopathy, manifests as corneal surface damage, epithelial thinning or loss, [...] Read more.
Background: Aniridia is a rare panocular, bilateral, and congenital disease characterized by complete or partial iris hypoplasia and foveal hypoplasia, leading to decreased visual acuity and nystagmus. AAK, also referred to as aniridic keratopathy, manifests as corneal surface damage, epithelial thinning or loss, inflammation with immune cell infiltration, vascularization, and chronic progressive opacification. Methods: Twenty-one eyes in eighteen patients with aniridia underwent the triple procedure for visual rehabilitation. Subjects with stromal scarring with mild limbal deficiency were qualified for surgery. The majority of them developed stage II (15), and a few of them had third-degree (6) aniridic keratopathy. Results: The mean patient age was 38.4 ± 8.8. Visual acuity after one year of observation ranged from 0.4 in two eyes to 0.2 in nine eyes to below 0.1 in ten eyes. In the second year, VA remained at the same level in 13 patients (72.2%). In the third year, four patients (22.2%) experienced recurrence of AAK. Conclusions: A majority of the ARK cases (72.2%) had a graft providing useful vision for the patient 2 years after corneal transplantation, but the visual gain was modest at best. Longer follow-up time is required to evaluate functional graft outcomes. Full article
(This article belongs to the Section Ophthalmology)
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12 pages, 971 KiB  
Article
The Time Course of Catecholamine Dose Reduction in Septic Shock as a Predictor of Bacterial Susceptibility to Empiric Antimicrobial Therapy: A Retrospective Observational Study
by Tsukasa Kuwana, Kosaku Kinoshita, Yurina Yamaya, Ken Takahashi, Junko Yamaguchi, Atsushi Sakurai and Toru Imai
J. Clin. Med. 2024, 13(21), 6618; https://doi.org/10.3390/jcm13216618 - 4 Nov 2024
Viewed by 694
Abstract
Background/Objectives: The 28-day mortality rate for septic shock is high, necessitating rapid and effective empiric antimicrobial therapy. In this study, we investigate whether the rate of catecholamine dose reduction in septic shock can indicate bacterial susceptibility to initial antimicrobial therapy or not. [...] Read more.
Background/Objectives: The 28-day mortality rate for septic shock is high, necessitating rapid and effective empiric antimicrobial therapy. In this study, we investigate whether the rate of catecholamine dose reduction in septic shock can indicate bacterial susceptibility to initial antimicrobial therapy or not. Methods: This retrospective observational study involved 108 adult patients with bacteraemia and septic shock admitted to the intensive care unit of Nihon University Itabashi Hospital between January 2017 and December 2023. They were classified into the Susceptible or Resistant groups based on the bacteria’s susceptibility to the initial empiric antimicrobial therapy. Catecholamine dosages were converted to norepinephrine equivalent (NEE) scores, with the time course from the peak to the end of administration measured at NEE reductions. Results: Of the 108 patients, 94 were in the Susceptible group and 14 in the Resistant group. The Susceptible group showed faster reductions in catecholamine doses: the time to reduce the dose from the maximum NEE to 25% was 19 vs. 49.5 h (p = 0.0057), and to 0%, it was 29 vs. 54 h (p = 0.0475). The time to reduce the dose from the maximum NEE to 75% was 8 vs. 12.5 h (p = 0.0733), and to 50% it was 13 vs. 21.5 h (p = 0.1081). Conclusions: In septic shock with bacteraemia, a faster catecholamine dose reduction indicates bacterial susceptibility to the initial empiric antibiotics. This reduction rate can serve as an early clinical indicator of the appropriate initial empiric therapy. Full article
(This article belongs to the Section Intensive Care)
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35 pages, 61213 KiB  
Systematic Review
Hip Flexor Muscle Activation During Common Rehabilitation and Strength Exercises
by Jessica Juan, Gretchen Leff, Kate Kevorken and Michael Jeanfavre
J. Clin. Med. 2024, 13(21), 6617; https://doi.org/10.3390/jcm13216617 - 4 Nov 2024
Viewed by 1998
Abstract
Background/Objectives: The iliopsoas muscle plays an essential role in lumbopelvic and hip anterior stability, which is particularly important in the presence of limited osseous acetabular coverage anteriorly as in hip dysplasia and/or hip micro-instability. The purpose of this systematic review is to (1) [...] Read more.
Background/Objectives: The iliopsoas muscle plays an essential role in lumbopelvic and hip anterior stability, which is particularly important in the presence of limited osseous acetabular coverage anteriorly as in hip dysplasia and/or hip micro-instability. The purpose of this systematic review is to (1) describe iliopsoas activation levels during common rehabilitation exercises and (2) provide an evidence-based exercise progression for strengthening the iliopsoas based on electromyography (EMG) studies. Methods: In total, 109 healthy adult participants ranging from ages 20 to 40 were included in nine studies. PubMed, CINAHL, and Embase databases were systematically searched for EMG studies of the psoas, iliacus, or combined iliopsoas during specific exercise. The Modified Downs and Black Checklist was used to perform a risk of bias assessment. PROSPERO guidelines were followed. Results: Nine studies were included. Findings suggest that the iliopsoas is increasingly activated in ranges of hip flexion of 30–60°, particularly with leg lowering/raising exercises. Briefly, >60% MVIC activity of the iliopsoas was reported in the active straight leg raise (ASLR) in ranges around 60° of hip flexion, as well as with supine hip flexion and leg lifts. In total, 40–60% MVIC was found in exercises including the mid-range of the ASLR around 45° of hip flexion and lifting a straight trunk while in a hip flexed position. Conclusions: The findings suggest that exercises in increased hip flexion provide greater activation of the iliopsoas compared to exercises where the trunk is moving on the lower extremity. Iliopsoas activation can be incrementally progressed from closed to open kinetic chain exercises, and eventually to the addition of external loads. The proposed exercise program interprets the results and offers immediate translation into clinical practice. Full article
(This article belongs to the Special Issue Musculoskeletal Disorders: Clinical Rehabilitation and Physiotherapy)
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28 pages, 1717 KiB  
Systematic Review
Effectiveness of Robotic Devices for Medical Rehabilitation: An Umbrella Review
by Kei Kiyono, Shigeo Tanabe, Satoshi Hirano, Takuma Ii, Yuki Nakagawa, Koki Tan, Eiichi Saitoh and Yohei Otaka
J. Clin. Med. 2024, 13(21), 6616; https://doi.org/10.3390/jcm13216616 - 4 Nov 2024
Viewed by 1683
Abstract
Background/Objectives: Clinical trials have investigated the efficacy of rehabilitation robotics for various pathological conditions, but the overall impact on rehabilitation practice remains unclear. We comprehensively examined and analyzed systematic reviews (SRs) of randomized controlled trials (RCTs) investigating rehabilitative interventions with robotic devices. Methods: [...] Read more.
Background/Objectives: Clinical trials have investigated the efficacy of rehabilitation robotics for various pathological conditions, but the overall impact on rehabilitation practice remains unclear. We comprehensively examined and analyzed systematic reviews (SRs) of randomized controlled trials (RCTs) investigating rehabilitative interventions with robotic devices. Methods: Four databases were searched using term combinations of keywords related to robotic devices, rehabilitation, and SRs. The SR meta-analyses were categorized into “convincing”, “highly suggestive”, “suggestive”, “weak”, or “non-significant” depending on evidence strength and validity. Results: Overall, 62 SRs of 341 RCTs involving 14,522 participants were identified. Stroke was most frequently reported (40 SRs), followed by spinal cord injury (eight SRs), multiple sclerosis (four SRs), cerebral palsy (four SRs), Parkinson’s disease (three SRs), and neurological disease (any disease causing limited upper- and lower-limb functioning; three SRs). Furthermore, 38, 21, and 3 SRs focused on lower-limb devices, upper-limb devices, and both upper- and lower-limb devices, respectively. Quantitative synthesis of robotic intervention effects was performed by 51 of 62 SRs. Robot-assisted training was effective for various outcome measures per disease. Meta-analyses offering suggestive evidence were limited to studies on stroke. Upper-limb devices were effective for motor control and activities of daily living, and lower-limb devices for walking independence in stroke. Conclusions: Robotic devices are useful for improving impairments and disabilities in several diseases. Further high-quality SRs including RCTs with large sample sizes and meta-analyses of these RCTs, particularly on non-stroke-related diseases, are required. Further research should also ascertain which type of robotic device is the most effective for improving each specific impairment or disability. Full article
(This article belongs to the Special Issue Innovations in Neurorehabilitation)
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25 pages, 4946 KiB  
Article
A Multifaceted Exploration of Status Asthmaticus: A Retrospective Analysis in a Romanian Hospital
by Adriana Ana Trusculescu, Versavia Maria Ancusa, Camelia Corina Pescaru, Norbert Wellmann, Corneluta Fira-Mladinescu, Cristian Iulian Oancea and Ovidiu Fira-Mladinescu
J. Clin. Med. 2024, 13(21), 6615; https://doi.org/10.3390/jcm13216615 - 4 Nov 2024
Viewed by 664
Abstract
Background: Status asthmaticus is a severe, life-threatening asthma exacerbation requiring urgent medical intervention. This study aims to examine its epidemiology in Timis County, Romania, over 11 years. Methods: A retrospective analysis was conducted using hospital records from 2013 to 2023, focusing [...] Read more.
Background: Status asthmaticus is a severe, life-threatening asthma exacerbation requiring urgent medical intervention. This study aims to examine its epidemiology in Timis County, Romania, over 11 years. Methods: A retrospective analysis was conducted using hospital records from 2013 to 2023, focusing on demographic, geospatial, and temporal distributions. Network analysis of the recorded comorbidities was used to identify phenotypic clusters among patients. Results: Females and older adults were disproportionately affected. Several triggers and geospatial patterns were identified. Five phenotypic clusters were determined: two in the T2-high endotype, two in T2-low, and a mixed one. Conclusions: The findings highlight the need for personalized asthma management strategies and public healthcare interventions in Timiș County, addressing specific demographic and geospatial factors. This study also provides a valuable reference for similar regions. Full article
(This article belongs to the Section Pulmonology)
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12 pages, 1163 KiB  
Article
Cirrhosis Progression Is Not Associated with Clinically Significant Alterations in Global Hemostasis Assessed by Thromboelastography
by Rareș Crăciun, Alina Buliarcă, Daniela Matei, Cristiana Grapă, Iuliana Nenu, Horia Ștefănescu, Tudor Mocan, Bogdan Procopeț and Zeno Spârchez
J. Clin. Med. 2024, 13(21), 6614; https://doi.org/10.3390/jcm13216614 - 4 Nov 2024
Cited by 1 | Viewed by 609
Abstract
(1) Background: Cirrhosis is associated with frequent alterations in standard coagulation tests that do not adequately reflect hemostasis. Thromboelastography provides a global assessment of coagulation and evaluates the functional status of clotting factors, fibrinogen, platelets, and fibrinolysis. The study aimed to assess whether [...] Read more.
(1) Background: Cirrhosis is associated with frequent alterations in standard coagulation tests that do not adequately reflect hemostasis. Thromboelastography provides a global assessment of coagulation and evaluates the functional status of clotting factors, fibrinogen, platelets, and fibrinolysis. The study aimed to assess whether liver disease severity leads to progressive alterations in the thromboelastography-based assessment of coagulation. (2) Methods: Consecutive patients with cirrhosis and abnormal standard coagulation tests (at least one of International Normalized Ratio > 2, platelet count < 50 × 103/µL, fibrinogen < 200 mg/dL) were analyzed using native thromboelastography. (3) Results: A total of 106 patients were included, of whom 69 (65.1%) had a normal thromboelastography. While the standard coagulation tests were significantly worse in patients in the Child C group (n = 62, 58.5%) than in patients staged in Child A and B, no significant differences existed between any of the thromboelastography variables. Of the 50 patients (47.1%) with an International Normalized Ratio > 2, only two patients (4%) had features of hypocoagulation, while 26% had features of hypercoagulability on thromboelastography. Patients with a platelet count < 50 × 103/µL had significantly lower platelet function as assessed by thromboelastography, yet only eight patients (20%) met the criteria for platelet transfusion. A thromboelastography-based transfusion protocol might lead to a 94.6% reduction in blood product transfusion indications in a simulation where the included patients would require interventional procedures. (4) Conclusion: Standard coagulation tests showed a poor correlation with thromboelastography. Based on thromboelastography, patients with severe, decompensated liver disease have a preserved hemostasis balance despite abnormal standard coagulation tests. Therefore, standard coagulation tests should not be used to guide the administration of blood products in patients with cirrhosis. Full article
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
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14 pages, 1594 KiB  
Hypothesis
Intra-Articular Physiological Saline in Temporomandibular Disorders May Be a Treatment, Not a Placebo: A Hypothesis, Systematic Review, and Meta-Analysis
by Maciej Chęciński, Kamila Chęcińska, Katarzyna Cholewa-Kowalska, Kalina Romańczyk, Dariusz Chlubek and Maciej Sikora
J. Clin. Med. 2024, 13(21), 6613; https://doi.org/10.3390/jcm13216613 - 4 Nov 2024
Viewed by 686
Abstract
Background: Intra-articular injections reduce pain in patients with temporomandibular joint (TMJ) disorders who are unresponsive to conservative treatment. Hyaluronic acid, blood products, and medications provide rapid relief when administered this way, although their mechanisms of action remain unclear. In control groups, which are [...] Read more.
Background: Intra-articular injections reduce pain in patients with temporomandibular joint (TMJ) disorders who are unresponsive to conservative treatment. Hyaluronic acid, blood products, and medications provide rapid relief when administered this way, although their mechanisms of action remain unclear. In control groups, which are intended to be untreated, 0.9% NaCl is typically delivered. The hypothesis that “normal saline injections in TMJ cavities produce a therapeutic effect” is proposed, with an exploration of its potential verification, alongside a systematic review and meta-analysis of studies on intra-TMJ 0.9% NaCl. Methods: Randomized controlled trials (RCTs) on patients with TMJ internal derangement, arthritis, or degeneration were selected under PRISMA 2020 and assessed with RoB2. Results: Seven RCTs with 359 patients were included. Weekly follow-ups revealed a decrease in articular pain by 23.72% (SE: 0.84%; 95% CI: 24.38–21.06%; p < 0.01), and monthly follow-ups indicated a decrease of 34.01% (SE: 1.09%; 95% CI: 36.16–31.86%; p < 0.01) compared to the baseline values. These findings were grounded in low-risk-of-bias evidence on 267 patients in five RCTs and 222 patients in four RCTs, respectively. Conclusions: The hypothesis warrants further testing to determine whether, in addition to the known biological activity of typical injectables, the mechanical action also contributes to pain relief. Full article
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13 pages, 2278 KiB  
Article
Applications of Near Infrared Spectroscopy and Mirror Therapy for Upper Limb Rehabilitation in Post-Stroke Patients: A Brain Plasticity Pilot Study
by Caterina Formica, Simona De Salvo, Nunzio Muscarà, Lilla Bonanno, Francesca Antonia Arcadi, Viviana Lo Buono, Giuseppe Acri, Angelo Quartarone and Silvia Marino
J. Clin. Med. 2024, 13(21), 6612; https://doi.org/10.3390/jcm13216612 - 4 Nov 2024
Viewed by 663
Abstract
Objectives: The aim of this study was to identify the neural pattern activation during mirror therapy (MT) and explore any cortical reorganization and reducing asymmetry of hemispheric activity for upper limb rehabilitation in post-stroke patients. Methods: A box containing a mirror was placed [...] Read more.
Objectives: The aim of this study was to identify the neural pattern activation during mirror therapy (MT) and explore any cortical reorganization and reducing asymmetry of hemispheric activity for upper limb rehabilitation in post-stroke patients. Methods: A box containing a mirror was placed between the arms of the patients to create the illusion of normal motion in the affected limb by reflecting the image of the unaffected limb in motion. We measured the cerebral hemodynamic response using near-infrared spectroscopy (NIRS). We enrolled ten right-handed stroke patients. They observed healthy hand movements in the mirror (MT condition) while performing various tasks (MT condition), and then repeated the same tasks with the mirror covered (N-MT condition). Results: Significant activation of some brain areas was observed in the right and left hemiparesis groups for the MT condition, while lower levels of activation were observed for the N-MT condition. The results showed significant differences in hemodynamic response based on oxygenated (HbO) concentrations between MT and N-MT conditions across all tasks in sensorimotor areas. These neural circuits were activated despite the motor areas being affected by the brain injury, indicating that the reflection of movement in the mirror helped to activate them. Conclusions: These results suggest that MT promotes cortical activations of sensory motor areas in affected and non-affected brain sides in subacute post-stroke patients, and it encourages the use of these tools in clinical practice. Full article
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16 pages, 510 KiB  
Review
Activation of Irrigants in Root Canals with Open Apices: A Narrative Review
by Dina Abdellatif, Massimo Pisano, Luigi Cecere, Valentino Natoli, Davide Mancino, Eduard Euvrard and Alfredo Iandolo
J. Clin. Med. 2024, 13(21), 6611; https://doi.org/10.3390/jcm13216611 - 4 Nov 2024
Viewed by 1524
Abstract
Performing endodontic treatment on a tooth with an immature apex can be challenging due to the risk of irrigant extrusion beyond the apex. This narrative review investigates the over-apex extrusion of activated irrigants in teeth with open and immature apices and aims to [...] Read more.
Performing endodontic treatment on a tooth with an immature apex can be challenging due to the risk of irrigant extrusion beyond the apex. This narrative review investigates the over-apex extrusion of activated irrigants in teeth with open and immature apices and aims to provide crucial insights for practice and research. Two hundred fifty-two results were found from the electronic search. Sixteen duplicates were removed before selection, and 24 were excluded. Of the 212 remaining results, the full text was evaluated for eligibility. One hundred ninety-four results were excluded: in one hundred sixty-five, irrigant activation was not performed; twenty-nine were animal studies; in seven, irrigant activation was not performed to disinfect the canal. Finally, 13 studies were included. They cover a range of topics, from the types of irrigants used to the techniques of activation, and their findings contribute to our understanding of the risks and consequences of irrigant extrusion. All the activation techniques investigated can, to varying degrees, cause the irrigant to extrude beyond the apex. Extrusion may not always be clinically relevant; however, the consequences of excessive irrigant leakage from the apex are dangerous, so try to assess all the variables that may cause it and adopt techniques to reduce it. Full article
(This article belongs to the Special Issue New Trends in Endodontics)
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13 pages, 1380 KiB  
Article
Hemodialysis Experience After Kahramanmaraş Earthquake
by Bulent Kaya, Mustafa Balal, Neslihan Seyrek, Burak Mete and Ibrahim Karayaylali
J. Clin. Med. 2024, 13(21), 6610; https://doi.org/10.3390/jcm13216610 - 4 Nov 2024
Viewed by 676
Abstract
Background: Hemodialysis treatment for acute kidney injury associated with crush syndrome is very complex. In our study, we summarized the problems and complications experienced by our hemodialysis center after the Kahramanmaraş earthquake. Methods: After the earthquake, our hospital treated 1396 victims. [...] Read more.
Background: Hemodialysis treatment for acute kidney injury associated with crush syndrome is very complex. In our study, we summarized the problems and complications experienced by our hemodialysis center after the Kahramanmaraş earthquake. Methods: After the earthquake, our hospital treated 1396 victims. We evaluated the initial indications for dialysis, hemodialysis complications and the mortality of patients undergoing hemodialysis, including crush-related acute kidney injury (n = 82), during the earthquake period. We also compared them with patients who were undergoing hemodialysis (n = 76) in the same period but had end-stage renal failure and acute kidney injury due to other causes (n = 15). Results: After the earthquake, 173 adult patients, 91 (52.6%) of whom were male, with a mean age of 49.5 + 19.7 years, underwent hemodialysis between 6 and 22 February 2023. Patients with crush-related acute kidney injury experienced more complications during hemodialysis, and the increase in creatine kinase activity increased the risk of hemodialysis complications. The most common complications were blood clots in the dialyzer membrane, intradialytic hypotension, and intradialytic insufficient flow. The most frequent indication for initial hemodialysis was hyperkalemia (61, 74.4%). The major problems in the hemodialysis center included inadequate equipment and an insufficient number of experienced health personnel. Conclusions: Hyperkalemia is the most important initial indication for hemodialysis in patients with crush-related acute kidney injury. Crush-related acute kidney injury patients require hemodialysis more frequently, and hemodialysis complications are higher in patients with crush-related AKI, so the hemodialysis treatment of these patients should be more cautious. In an earthquake, hemodialysis centers may face significant challenges, such as damage, transportation issues, power outages, and water outages, which can hinder hemodialysis treatment. Full article
(This article belongs to the Special Issue New Insights into Peritoneal Dialysis and Hemodialysis)
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9 pages, 670 KiB  
Article
Flow-Adjusted Trabeculectomy
by Assaf Kratz, Ivan Goldberg, Tal Koren, Aviel Hadad, Boris Knyazer and Ridia Lim
J. Clin. Med. 2024, 13(21), 6609; https://doi.org/10.3390/jcm13216609 - 4 Nov 2024
Viewed by 559
Abstract
Background/Objectives: As one of the most efficacious glaucoma surgical techniques, trabeculectomy is considered by many surgeons to be the “gold standard” intra-ocular pressure (IOP)-reducing intervention. The purpose of this study is to present our intra-operative flow-adjusted surgical method, which aims to provide safety [...] Read more.
Background/Objectives: As one of the most efficacious glaucoma surgical techniques, trabeculectomy is considered by many surgeons to be the “gold standard” intra-ocular pressure (IOP)-reducing intervention. The purpose of this study is to present our intra-operative flow-adjusted surgical method, which aims to provide safety and efficacy more simply than previous methods. Methods: Retrospectively, we evaluated outcomes for trabeculectomy or phacotrabeculectomy in surgery-naïve eyes over three years for patients with glaucoma not associated with other ocular co-morbidities. We defined complete success as an IOP between 5 and 18 mmHg plus at least a 20% reduction from baseline, without concomitant medications. Relative success was the same result, with glaucoma medication(s). Failure was regarded as an IOP less than 5 or higher than 18 mmHg, or by the need for a subsequent glaucoma operation. Results: We assessed the results from 186 eyes of 186 patients. After exclusion, a group of 45 trabeculectomies and 35 phacotrabeculectomies were analyzed. In eyes undergoing a trabeculectomy, over a mean follow-up of 16.0 months, IOP fell from 28.1 ± 8.0 mmHg with 3.6 ± 1.1 medications to 9.7 ± 3.6 mmHg (66% reduction) with 0.4 ± 1.0 medications (each p < 0.00001). The success rate was 88.9% (75.6% complete success). In eyes undergoing a phacotrabeculectomy, over a mean of 19.1 months, IOP fell from 26.1 ± 10.2 mmHg with 3.5 ± 1.3 medications to 10.0 ± 3.6 mmHg (62% reduction) on 0.9 ± 1.4 medications (each p < 0.00001). The success rate was 91.4% (57.1% complete success). Complication rates were low, with no major complications in either group. Conclusion: To lower IOP, our intra-operative flow-adjusted trabeculectomy and phacotrabeculectomy techniques appear to be safe and effective. Full article
(This article belongs to the Special Issue Advances in Glaucoma Surgery: 2nd Edition)
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9 pages, 2004 KiB  
Article
Dual-Fluoroscopy vs. Single-Fluoroscopy in Balloon Kyphoplasty: A Study of Efficiency and Safety
by Roy Romem, Itzhak Engel, David Segal, Refael Behrbalk, David Schleifer, Jonathan EJ Koch, Nissim Ohana and Yuval Baruch
J. Clin. Med. 2024, 13(21), 6608; https://doi.org/10.3390/jcm13216608 - 3 Nov 2024
Viewed by 630
Abstract
Background: Vertebral compression fractures (VCFs) are the most prevalent type of osteoporotic fractures, often causing significant pain, morbidity, and mortality. Vertebral augmentation procedures like balloon kyphoplasty (BK) are effective in treating VCFs. These procedures are typically performed using a single fluoroscopy machine (SF) [...] Read more.
Background: Vertebral compression fractures (VCFs) are the most prevalent type of osteoporotic fractures, often causing significant pain, morbidity, and mortality. Vertebral augmentation procedures like balloon kyphoplasty (BK) are effective in treating VCFs. These procedures are typically performed using a single fluoroscopy machine (SF) for anteroposterior (AP) and lateral views. We have implemented a dual-fluoroscopy (DF) technique to reduce procedure time and radiation exposure. The goal of this study was to determine whether dual-fluoroscopy could optimize surgical efficiency without compromising safety, offering a more effective alternative to traditional single-fluoroscopy methods. Methods: This retrospective study included 126 patients who underwent BK with either SF (n = 74, 58.7%) or DF (n = 52, 41.3%) between 2020 and 2024. We collected data on procedure duration per pedicle (PDPP), radiation exposure (reference air kerma and dose-area product [DAP]), and radiation duration. A sub-analysis of post-learning phase cases was performed. Results: A learning curve was identified for the first 24 cases and 15 cases using the SF technique and DF technique, respectively, which was followed by a stabilization in procedure duration per pedicle (Levene’s statistic = 10.623, p = 0.002 for SD difference, p < 0.001 for mean PDPP difference). After the completion of the learning phase for both techniques, the DF group demonstrated a significantly shorter PDPP (11.83 ± 4.3 vs. 14.03 ± 5.57 min, p = 0.049). No significant differences were found in radiation exposure, including radiation duration (p = 0.577), reference air kerma, or DAP. Conclusions: Dual-fluoroscopy significantly reduces procedure time after the learning curve is overcome, improving efficiency without increasing radiation exposure. This technique holds promise for optimizing kyphoplasty workflow and safety, supporting broader clinical adoption. Full article
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19 pages, 705 KiB  
Review
Role of Peripheral and Central Insulin Resistance in Neuropsychiatric Disorders
by Kannayiram Alagiakrishnan and Tyler Halverson
J. Clin. Med. 2024, 13(21), 6607; https://doi.org/10.3390/jcm13216607 - 3 Nov 2024
Viewed by 1481
Abstract
Insulin acts on different organs, including the brain, which helps it regulate energy metabolism. Insulin signaling plays an important role in the function of different cell types. In this review, we have summarized the key roles of insulin and insulin receptors in healthy [...] Read more.
Insulin acts on different organs, including the brain, which helps it regulate energy metabolism. Insulin signaling plays an important role in the function of different cell types. In this review, we have summarized the key roles of insulin and insulin receptors in healthy brains and in different brain disorders. Insulin signaling, as well as insulin resistance (IR), is a major contributor in the regulation of mood, behavior, and cognition. Recent evidence showed that both peripheral and central insulin resistance play a role in the pathophysiology, clinical presentation, and management of neuropsychiatric disorders like Cognitive Impairment/Dementia, Depression, and Schizophrenia. Many human studies point out Insulin Resistance/Metabolic Syndrome can increase the risk of dementia especially Alzheimer’s dementia (AD). IR has been shown to play a role in AD development but also in its progression. This review article discusses the pathophysiological pathways and mechanisms of insulin resistance in major neuropsychiatric disorders. The extent of insulin resistance can be quantified using IR biomarkers like insulin levels, HOMA-IR index, and Triglyceride glucose–body mass index (TyG–BMI) levels. IR has been shown to precede neurodegeneration. Human trials showed current treatment with certain antidiabetic drugs, as well as life style management, like weight loss and exercise for IR, have shown promise in the management of cognitive/neuropsychiatric disorders. This may pave the pathway to the development of new therapeutic approaches to these challenging disorders of dementia and psychiatric diseases. Recent clinical trials are showing some encouraging evidence for these pharmacological and nonpharmacological approaches for IR in psychiatric and cognitive disorders, even though more research is needed to apply this evidence into clinical practice. Early identification and management of IR may help as a strategy to potentially alter neuropsychiatric disorders onset as well as its progression Full article
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17 pages, 538 KiB  
Systematic Review
Prothrombotic Rebound After Discontinuation of Direct Oral Anticoagulants Therapy: A Systematic Review
by Marta Frydrych, Maciej Janeczek, Agata Małyszek, Kamil Nelke, Maciej Dobrzyński and Marceli Lukaszewski
J. Clin. Med. 2024, 13(21), 6606; https://doi.org/10.3390/jcm13216606 - 3 Nov 2024
Viewed by 1062
Abstract
Background/Objectives: The practice of holding anticoagulation is a relatively common approach, with the aim of either preventing excessive bleeding in preparation for surgical procedures or managing acute bleeding episodes. Methods: To assess the relationship between the discontinuation of direct oral anticoagulants [...] Read more.
Background/Objectives: The practice of holding anticoagulation is a relatively common approach, with the aim of either preventing excessive bleeding in preparation for surgical procedures or managing acute bleeding episodes. Methods: To assess the relationship between the discontinuation of direct oral anticoagulants (DOACs) therapy and the condition of hypercoagulability, a systematic review of the literature was conducted, following PRISMA guidelines, in PubMed/MEDLINE, Cochrane, and Google Scholar. These databases were searched for all publications that described a rebound phenomenon or hypercoagulability state after DOACs discontinuation. Results: A total of 1494 articles were selected from searched databases, and 29 were eligible. A final total of 16 case reports and 14 original research articles were subjected to analysis. Conclusions: The results of this study indicate that the cessation of DOAC therapy may be associated with an increased risk of thrombotic events. More studies are required to ascertain whether DOACs treatment cessation can be linked to rebound phenomena associated with thromboembolic events. This will provide the data needed to determine the incidence and risk of this phenomenon. Full article
(This article belongs to the Special Issue Advances in Thrombotic Disorders and Antithrombotic Treatments)
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9 pages, 1047 KiB  
Article
Cerebral Overperfusion Despite Reduced Cortical Metabolism Is Associated with Postoperative Delirium in Cardiac Surgery Patients: A Prospective Observational Study
by Marcus Thudium, Lara Braun, Annika Stroemer, Andreas Mayr, Jan Menzenbach, Thomas Saller, Martin Soehle, Evgeniya Kornilov and Tobias Hilbert
J. Clin. Med. 2024, 13(21), 6605; https://doi.org/10.3390/jcm13216605 - 3 Nov 2024
Viewed by 690
Abstract
Background: Decreased cerebral oximetry (rSO2) in cardiac surgery is associated with postoperative delirium (POD). However, interventions optimizing intraoperative rSO2 are inconclusive. Methods: In this prospective observational cohort study, the relationship between rSO2, middle cerebral artery blood [...] Read more.
Background: Decreased cerebral oximetry (rSO2) in cardiac surgery is associated with postoperative delirium (POD). However, interventions optimizing intraoperative rSO2 are inconclusive. Methods: In this prospective observational cohort study, the relationship between rSO2, middle cerebral artery blood flow velocity (MCAV), and processed EEG was assessed in cardiac surgery patients with and without POD. MCAV was continuously recorded by transcranial Doppler sonography (TCD), together with continuous rSO2 and bispectral index (BIS) monitoring. Cardiopulmonary bypass (CPB) flow rate was adjusted according to body surface area. The cohort was divided into the POD and control groups, according to the postoperative results of the confusion assessment method (CAM/CAM-ICU), the 4A’s test (4AT), and the Delirium Observation Scale (DOS). A mixed model analysis was performed for intraoperative raw data. The cerebral autoregulation index was calculated from TCD, rSO2, and arterial pressure values. Differences in impaired autoregulation were compared using the Mann–Whitney U test. Results: A total of 41 patients were included in this study. A total of 13 patients (36.11%) developed postoperative delirium. There were no significant differences in the baseline characteristics of patients with or without POD. Patients with POD had lower BIS values during CPB (adjusted mean difference −4.449 (95% CI [−7.978, −0.925])). RSO2 was not significantly reduced in POD, (adjusted mean difference: −5.320, 95% CI [−11.508, 0.874]). In contrast, MCAV was significantly increased in POD (10.655, 95% CI [0.491, 20.819]). The duration of cerebral autoregulation impairment did not differ significantly for TCD and cerebral oximetry-derived indices (p = 0.4528, p = 0.2715, respectively). Conclusions: Our results suggest that disturbed cerebral metabolism reflects a vulnerable brain which may be more susceptible to overperfusion during CPB, which can be seen in increased MCAV values. These phenomena occur irrespectively of cerebral autoregulation. Full article
(This article belongs to the Section Anesthesiology)
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10 pages, 657 KiB  
Article
Association Between Laboratory Coagulation Parameters and Postpartum Hemorrhage in Preterm and Term Caesarean Section: A Retrospective Analysis
by Christoph Dibiasi, Emilia Jecel, Veronica Falcone, Eva Schaden and Johannes Gratz
J. Clin. Med. 2024, 13(21), 6604; https://doi.org/10.3390/jcm13216604 - 3 Nov 2024
Viewed by 778
Abstract
Background: Deranged antepartum laboratory parameters may be risk factors for postpartum hemorrhage (PPH). However, whether this is also valid in women who give birth prematurely is currently unknown. Methods: We performed a retrospective single-center study to assess the role of antepartum hemoglobin, platelet [...] Read more.
Background: Deranged antepartum laboratory parameters may be risk factors for postpartum hemorrhage (PPH). However, whether this is also valid in women who give birth prematurely is currently unknown. Methods: We performed a retrospective single-center study to assess the role of antepartum hemoglobin, platelet count, fibrinogen, activated partial thromboplastin time, and prothrombin time as risk factors for PPH following caesarean section. We defined PPH as documented blood loss of at least 1 L and/or transfusion of red blood cell concentrates. We stratified the included patients according to gestational age: extremely preterm (gestational age < 28 weeks), very preterm (gestational age between 28 and 32 weeks), late and moderate preterm (gestational age between 32 and 37 weeks), and term (gestational age ≥ 37 weeks). Results: We included 1734 patients, 112 (6%) of whom had PPH. In total, 19 patients (10%) were in the extremely preterm group, 13 patients (10%) were in the very preterm group, 44 patients (9%) were in the late and moderate preterm group, and 36 patients (4%) were in the term group. Hemoglobin predicted PPH in all gestational age groups. Platelet count was associated with PPH in term, but not in preterm patients. Fibrinogen was associated with PPH in late prematurity but not in term patients and not in patients with early or extreme prematurity. Conclusions: Antepartum hemoglobin was the only factor predicting PPH in preterm and term caesarean sections. Platelet count and fibrinogen concentration were associated with PPH in term and late prematurity, respectively, but not in earlier stages of prematurity. Full article
(This article belongs to the Section Obstetrics & Gynecology)
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15 pages, 883 KiB  
Article
The Effects of an 8-Month Multicomponent Training Program in Body Composition, Functional Fitness, and Sleep Quality in Aged People: A Randomized Controlled Trial
by Pedro Forte, Samuel G. Encarnação, Luís Branquinho, Tiago M. Barbosa, António M. Monteiro and Daniel Pecos-Martín
J. Clin. Med. 2024, 13(21), 6603; https://doi.org/10.3390/jcm13216603 - 3 Nov 2024
Viewed by 982
Abstract
Background/Objectives: This study examined the effects of an intervention on anthropometrics, body composition, physical fitness, and sleep quality in aged individuals, comparing a control group (N = 11) and an experimental group (N = 13) across two measurement points. Methods: A [...] Read more.
Background/Objectives: This study examined the effects of an intervention on anthropometrics, body composition, physical fitness, and sleep quality in aged individuals, comparing a control group (N = 11) and an experimental group (N = 13) across two measurement points. Methods: A multicomponent training program of 8 months was adopted as the intervention group. A bioimpedance balance, functional fitness test, and Pittsburgh Sleep Quality Index measured body composition, functional fitness, and sleep quality. Results: Both groups showed minimal changes in body mass and hand grip strength. However, the experimental group experienced significant improvements in physical fitness, including a 26% increase in arm curl repetitions, an 18% reduction in 5 times sit-to-stand (5TSTS) completion time, and a 29% rise in 2-min step test (2MST) steps, indicating enhanced muscle endurance and cardiovascular fitness. Flexibility decreased significantly in the experimental group, while body fat percentage was reduced by 10%. Sleep quality improved by 47% in the experimental group but declined by 14% in the control group. Correlational analysis revealed that better sleep quality was linked to improved fitness performance and reduced body fat in the experimental group, with post-intervention results further confirming the connection between sleep and fat reduction. In the control group, improved sleep quality was associated with higher metabolic rates after 8 months. Conclusions: These findings suggest that the intervention positively impacted physical fitness and sleep quality, with potential benefits for overall health. Full article
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11 pages, 2056 KiB  
Article
Diagnosis of Enlarged Vestibular Aqueduct Using Wideband Tympanometry
by Akira Ganaha, Nao Nojiri, Takeshi Nakamura, Teruyuki Higa, Shunsuke Kondo and Tetsuya Tono
J. Clin. Med. 2024, 13(21), 6602; https://doi.org/10.3390/jcm13216602 - 3 Nov 2024
Viewed by 463
Abstract
Background: Wideband tympanometry (WBT) has the potential to distinguish various mechanical middle ear and inner ear pathologies noninvasively. This study investigated the diagnostic value of WBT in the diagnosis of enlarged vestibular aqueduct (EVA). Methods: The absorbance and resonance frequency (RF) of patients [...] Read more.
Background: Wideband tympanometry (WBT) has the potential to distinguish various mechanical middle ear and inner ear pathologies noninvasively. This study investigated the diagnostic value of WBT in the diagnosis of enlarged vestibular aqueduct (EVA). Methods: The absorbance and resonance frequency (RF) of patients with EVA (40 ears, 25 patients) and matched population controls (39 ears, 28 subjects) were compared, alongside receiver operating characteristic (ROC) analysis. Correlations between VA width and RF were also examined. Results: Patients with EVA had higher absorbance at low frequencies (226–917 Hz) and lower absorbance at high frequencies (2520–4896 Hz) compared to controls. The RF of the EVA group was significantly lower versus controls (751 [391–1165] vs. 933 [628–1346] Hz). The ROC analysis revealed area under the curve values of 0.771 and 0.801, respectively, for absorbance and RF. RF had a sensitivity, specificity, positive predictive value, and negative predictive value of 74.4%, 82.5%, 76.7%, and 80.6%, respectively, for diagnosing EVA. In the EVA group, the VA midpoint width (r = −0.334) and VA petrous width (r = −0.402) both significantly correlated with RF. Conclusions: Our findings support the utility of WBT for diagnosing EVA, with RF as the optimal index used. Full article
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10 pages, 3176 KiB  
Article
An MRI-Based Method for the Morphologic Assessment of the Anterior Tibial Tuberosity
by Emi Marinela Preda, Nicolae Constantin, Serban Dragosloveanu, Romica Cergan and Cristian Scheau
J. Clin. Med. 2024, 13(21), 6601; https://doi.org/10.3390/jcm13216601 - 3 Nov 2024
Viewed by 643
Abstract
Background: A prominent anterior tibial tuberosity (or tibial tubercle) can be seen in ongoing Osgood–Schlatter disease (OSD) in teenagers or as a sequela of OSD in adults. Current radiological methods do not provide a true anatomical assessment of the tibial tuberosity; therefore, [...] Read more.
Background: A prominent anterior tibial tuberosity (or tibial tubercle) can be seen in ongoing Osgood–Schlatter disease (OSD) in teenagers or as a sequela of OSD in adults. Current radiological methods do not provide a true anatomical assessment of the tibial tuberosity; therefore, we proposed and developed a Magnetic Resonance Imaging (MRI)-based method for measuring the anterior tibial tuberosity index, aiming to deal with the current lack of effective techniques for accurately assessing these particular morphologic features. Methods: A retrospective study included 47 knees with tibial tuberosity measurements on both true sagittal MPR images of 3D proton density (PD)-weighted MRI sequences and lateral knee radiographs. The same landmarks were followed and the anterior tibial tuberosity index (ATTI) was measured. Results: The comparison of the results obtained by the two methods demonstrates that our method is reliable and reproducible with substantial inter- and intra-observer agreement. The intraclass correlation coefficient was 0.9250 (95% CI: 0.8654 to 0.9582), indicating excellent reliability between the two methods. A strong positive correlation was also identified, with a correlation coefficient of r = 0.8746 (95% CI: 0.7845 to 0.9286, p < 0.0001) between the two methods. No significant deviation from linearity was observed by analyzing the linear model validity using the cusum test (p = 0.62). Conclusions: Based on these results, we encourage the use of 3D PD-weighted MRI sequences for the measurement of the anterior tibial tuberosity on MRI in order to avoid unnecessary exposure to ionizing radiation and potentially obtain a more accurate measurement. Future larger studies should also explore the benefit of utilizing 3D sequences over 2D lateral projections to minimize measuring bias. Full article
(This article belongs to the Section Nuclear Medicine & Radiology)
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10 pages, 501 KiB  
Article
Enhancing ICU Outcomes Through Intelligent Monitoring Systems: A Comparative Study on Ventilator-Associated Events
by Jui-Fang Liu, Mei-Ying Kang, Hui-Ling Lin and Shih-Feng Liu
J. Clin. Med. 2024, 13(21), 6600; https://doi.org/10.3390/jcm13216600 - 3 Nov 2024
Viewed by 1005
Abstract
Background: Using intelligent monitoring systems can potentially improve the identification and management of ventilator-associated events (VAEs). This single-center retrospective observational study evaluated the impact of implementing intelligent monitoring systems on the clinical outcomes of patients with VAEs in an ICU setting. Method: An [...] Read more.
Background: Using intelligent monitoring systems can potentially improve the identification and management of ventilator-associated events (VAEs). This single-center retrospective observational study evaluated the impact of implementing intelligent monitoring systems on the clinical outcomes of patients with VAEs in an ICU setting. Method: An intelligent VAE monitoring system was integrated into electronic medical records to continuously collect patient data and alert attending physicians when a ventilated patient met the criteria for a ventilator-associated condition, which was defined as an increase of at least three cm H2O in positive end expiratory pressure (PEEP), an increase of at least 0.20 in the fraction of inspired oxygen (FiO2), or the FiO2 being over baseline for at least two consecutive days. This study covered two phases, consisting of before using the intelligent monitoring system (2021–2022) and during its use (2023–2024). Results: The results showed that patients monitored with the intelligent system experienced earlier VAE detection (4.96 ± 1.86 vs. 7.77 ± 3.35 days, p < 0.001), fewer ventilator-associated condition (VAC) occurrences, and a shorter total duration of VACs. Additionally, the system significantly reduced ventilator days, antibiotic use, and 14-day mortality. Conclusions: Intelligent monitoring systems enhance VAE management, improve clinical outcomes, and provide valuable insights into the future of critical care medicine. Full article
(This article belongs to the Special Issue Clinical Advances in Critical Care Medicine)
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13 pages, 1484 KiB  
Article
A Proton Pump Inhibitor Independently Elevates Gastrin Levels as a Marker for Metachronous Gastric Cancer After Endoscopic Submucosal Dissection
by Hajime Teshima, Hidehiko Takigawa, Takahiro Kotachi, Akiyoshi Tsuboi, Hidenori Tanaka, Ken Yamashita, Yoshihiro Kishida, Yuji Urabe, Toshio Kuwai, Akira Ishikawa and Shiro Oka
J. Clin. Med. 2024, 13(21), 6599; https://doi.org/10.3390/jcm13216599 - 3 Nov 2024
Viewed by 756
Abstract
Background and Objective: Serum markers such as gastrin and pepsinogen are useful for stratifying gastric cancer risk. However, their utility in predicting metachronous gastric cancer after endoscopic submucosal dissection (ESD) in patients with gastric cancer after Helicobacter pylori eradication (GCAE) is unclear. This [...] Read more.
Background and Objective: Serum markers such as gastrin and pepsinogen are useful for stratifying gastric cancer risk. However, their utility in predicting metachronous gastric cancer after endoscopic submucosal dissection (ESD) in patients with gastric cancer after Helicobacter pylori eradication (GCAE) is unclear. This study aimed to clarify predictive factors for metachronous gastric cancer after ESD with a focus on serum markers. Methods: A retrospective analysis was conducted on 197 patients with 224 GCAE lesions who underwent ESD at Hiroshima University Hospital between April 2010 and December 2019. In total, 63 patients with 74 differentiated-type lesions were classified into metachronous gastric cancer (MG) and non-metachronous gastric cancer (NMG) groups, excluding proton pump inhibitor (PPI) users, female patients, and undifferentiated-type cases. The predictive value of serum markers was assessed using ROC curve analysis, and their association with carcinogenesis was evaluated using multiple logistic regression. Furthermore, the incidence of MG was compared between long-term PPI users and non-users. Results: ROC analysis revealed that serum gastrin had the highest discriminative ability for MG (AUC 0.77, cut-off 99 pg/mL, sensitivity 61.6%, and specificity 80.0%). Severe mucosal atrophy and high gastrin levels were significantly more common in the MG group and were independent predictors (p < 0.01). Although serum gastrin levels were significantly elevated in PPI users, no increased risk of MG was observed. Conclusions: In addition to severe mucosal atrophy, PPI-independent elevated serum gastrin levels may be associated with an increased risk of MG after ESD. Serum gastrin may serve as a valuable marker for post-ESD cancer surveillance in GCAE patients. Full article
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
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Article
Cholecystectomy Increases the Risk of Chronic Kidney Disease: A Nationwide Longitudinal Cohort Study
by Ji Hye Heo, Eun Ji Kim, Han Na Jung, Kyung-Do Han, Jun Goo Kang, Seong Jin Lee, Sung-Hee Ihm and Eun Roh
J. Clin. Med. 2024, 13(21), 6598; https://doi.org/10.3390/jcm13216598 - 2 Nov 2024
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Abstract
Background/Objectives: Growing evidence suggests that cholecystectomy is associated with adverse health outcomes, including the development of metabolic diseases. However, data on the association between cholecystectomy and kidney disease are limited. The present study aimed to investigate the association between cholecystectomy and chronic kidney [...] Read more.
Background/Objectives: Growing evidence suggests that cholecystectomy is associated with adverse health outcomes, including the development of metabolic diseases. However, data on the association between cholecystectomy and kidney disease are limited. The present study aimed to investigate the association between cholecystectomy and chronic kidney disease (CKD) using a nationwide longitudinal cohort. Methods: Participants aged ≥20 years with cholecystectomy between 2010 and 2014 (n = 116,748) and age- and sex-matched control participants without cholecystectomy (n = 116,748) were analyzed using the Korea National Health Insurance Service data. The adjusted hazard ratios (aHRs) were calculated for incident CKD in the cholecystectomy group compared with the nonoperative controls. Results: A total of 233,496 participants were included (mean age, 54.7 ± 12.7 years; 52.6% men). During the mean follow-up period of 4.8 ± 1.7 years, 6450 patients (5.5%) were newly diagnosed with CKD in the cholecystectomy group. Cholecystectomy was an independent risk factor for the development of CKD after adjustment for confounders, including age, sex, income, health behaviors, and comorbidities. The risk of CKD was 21% higher in the cholecystectomy group compared to the non-cholecystectomy group (aHR, 1.21; 95% CI, 1.17–1.26). The increased risk of CKD in the cholecystectomy group was consistently significant when a stratified analysis by age, sex, and presence or absence of comorbidities was conducted. Conclusions: Cholecystectomy was independently associated with an increased risk of developing CKD in a nationwide population-based study. Therefore, careful and long-term monitoring of the risk of CKD after cholecystectomy is necessary. Full article
(This article belongs to the Section Nephrology & Urology)
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