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J. Clin. Med., Volume 13, Issue 22 (November-2 2024) – 373 articles

Cover Story (view full-size image): Patients with neck metastasis and no obvious primary tumor (NCUP) pose a diagnostic challenge. Many of these cases are p16-positive oropharyngeal squamous cell carcinomas (OPSCCs), often originating in the tonsils or base of the tongue. Early neck metastasis is likely due to the unique anatomy of the oropharynx. Identifying the primary tumor is crucial for treatment planning. However, imaging studies may not always be definitive. HPV testing can help localize the primary tumor, particularly in the oropharynx. Careful consideration of clinical, biomolecular, and morphological factors is essential for accurate prognosis and treatment, especially in HPV-positive patients with tobacco exposure or p53 mutations. View this paper
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8 pages, 502 KiB  
Article
Epidemiology and Mortality of Surgical Amputations in Severely Injured Patients with Extremity Injuries—A Retrospective Analysis of 32,572 Patients from the TraumaRegister DGU®
by Julian Scherer, Jakob Hax, Michel Paul Johan Teuben, Hans-Christoph Pape, Rolf Lefering and Kai Sprengel
J. Clin. Med. 2024, 13(22), 7000; https://doi.org/10.3390/jcm13227000 - 20 Nov 2024
Viewed by 350
Abstract
Background: Extremity fractures are common injuries in polytraumatized patients. Concomitant injuries to the soft tissue, vessels and nerves in these fractures are defined as mangled extremities. The decision for or against limb salvage is dependent on the patient’s physiology and the limb status. [...] Read more.
Background: Extremity fractures are common injuries in polytraumatized patients. Concomitant injuries to the soft tissue, vessels and nerves in these fractures are defined as mangled extremities. The decision for or against limb salvage is dependent on the patient’s physiology and the limb status. In severely injured patients with critical physiological status, limb salvage may be contraindicated. International data on the epidemiology and management of mangled limbs in severely injured patients are lacking. Thus, the aim of this study was to assess the incidence of polytraumatized patients with severe injuries to either upper (UL) or lower limb (LL) as well as their management. Methods: A retrospective cohort analysis was conducted of patients aged 16 years and above with an Injury Severity Score (ISS) ≥ 16 who sustained fractures to the limbs and were admitted to a certified trauma center of the TraumaRegister DGU® (TR-DGU) between 2009 and 2019. Results: In total, we assessed 32,572 patients (UL: 14,567, mean age 48.3 years, 70% male and LL: 18,005, mean age 47.0 years, 70.5% male) The mean ISS in UL was 28.8 (LL 29.3). Fractures to the humerus (n = 4969) and radius (n = 7008) were predominantly assessed in UL, and fractures to the femur (n = 9502) and tibia (n = 8076) were most common in LL. In both groups, the most frequent injury mechanism was motor vehicle accidents, and more than half (UL: 9416 and LL: 11,689) of the patients had additional severe Abbreviated Injury Scale (AIS) ≥ 3 chest trauma. 915 patients in UL and 1481 in LL died within 24 h of the index admission. Surgical amputation occurred in 242 (UL) and 422 (LL) cases with a peak ratio in patients with an ISS above 50 in both groups. In both groups, patients with severe concomitant chest trauma were more often surgically amputated. In both groups, fewer patients with surgical amputations died within 24 h of admission (3.3% vs. 6.3% UL; 6.4% vs. 8.3% LL) compared to patients without amputation, but more patients with surgical amputations died within the overall hospital admissions (15.7% vs. 11.9% UL; 19.2% vs. 14.2%). In both groups, hemodynamical shock as well as the administration of Packed Red Blood Cells (PRBCs) were associated with a higher amputation rate. Conclusions: Surgical amputations after major trauma seem to be rare. Hemodynamical instability seems to play a key role in the management of mangled limbs. Patients with life-saving surgical amputation still have an increased overall in-hospital mortality. Full article
(This article belongs to the Special Issue Acute Care for Traumatic Injuries and Surgical Outcomes)
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15 pages, 2193 KiB  
Article
Two-Year Outcomes Using Fast-Acting, Sub-Perception Therapy for Spinal Cord Stimulation: A European, Real-World, Multicenter Experience
by Simon Bayerl, Jose Paz-Solis, Georgios Matis, Philippe Rigoard, Jan Willem Kallewaard, M. Angeles Canos-Verdecho, Jan Vesper, Jose Emilio Llopis, Georgios Kyriakopoulos, Ashish Gulve, Sylvie Raoul, Alfonso Papa, Sarah Love-Jones and Adam Williams
J. Clin. Med. 2024, 13(22), 6999; https://doi.org/10.3390/jcm13226999 - 20 Nov 2024
Viewed by 683
Abstract
Background/Objectives: Over the last 20 years, spinal cord stimulation (SCS) has seen the development of various paresthesia-free paradigms. Recently, a novel modality has emerged (Fast-Acting Sub-perception Therapy, FAST) that engages the surrounding inhibition mechanism of action. We evaluated long-term, real-world outcomes of preferential [...] Read more.
Background/Objectives: Over the last 20 years, spinal cord stimulation (SCS) has seen the development of various paresthesia-free paradigms. Recently, a novel modality has emerged (Fast-Acting Sub-perception Therapy, FAST) that engages the surrounding inhibition mechanism of action. We evaluated long-term, real-world outcomes of preferential FAST-SCS use in patients with chronic pain. Methods: In this multi-center, observational, consecutive case series, medical chart data from chronic pain patients preferentially using FAST-SCS (no exclusions) were retrospectively reviewed. Results: Data from 167 patients in 13 European centers were analyzed; 74% of patients suffered from persistent spine pain syndrome type 2 and 87% presented with low back and/or leg pain. At the last follow-up (mean 1.6 years), the numerical rating scale (NRS) overall pain score decreased by 5.1 ± 2.5 points versus baseline, from 8.0 ± 1.2 to 2.9 ± 2.2 (n = 167, p < 0.0001). 87% of patients reported ≥50% pain relief, and 55% were “high responders” with overall NRS pain scores ≤2/10. At the last follow-up, functional disability improved significantly (the Oswestry Disability Index reduced by 29.2 ± 21.5 points, n = 65, p < 0.0001) and patients had a significant gain in quality of life (EQ-5D-5L visual analog scale increased by 52.0 ± 26.9 points, n = 86, p < 0.0001). Results at the 2-year follow-up showed a sustained, substantial reduction in pain; 67% of patients were high responders and the NRS overall pain score decreased by 5.6 ± 2.4 versus baseline (n = 52, p < 0.0001). Conclusions: Our real-world outcomes suggest that in patients with chronic low back and/or leg pain, FAST-SCS therapy provided durable and profound pain relief and led to significant improvements in disability and quality of life. Full article
(This article belongs to the Section Clinical Neurology)
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11 pages, 2341 KiB  
Article
Comparative Effect of Insulin Resistance Reduction and Hormonal Alterations on Type 2 Diabetes Remission After Bariatric Surgery
by Ekaterina Shestakova, Iurii Stafeev, Yury Yashkov, Anatoly Yurasov, Alina Tomilova, Yelena Parfyonova, Marina Shestakova and Ivan Dedov
J. Clin. Med. 2024, 13(22), 6998; https://doi.org/10.3390/jcm13226998 - 20 Nov 2024
Viewed by 406
Abstract
Background: Bariatric surgery is known to induce weight loss and diabetes remission in patients with type 2 diabetes (T2D), but the exact mechanism of glycemic normalization needs to be defined. Methods: The study included patients with BMI ≥ 35 kg/m2, obesity [...] Read more.
Background: Bariatric surgery is known to induce weight loss and diabetes remission in patients with type 2 diabetes (T2D), but the exact mechanism of glycemic normalization needs to be defined. Methods: The study included patients with BMI ≥ 35 kg/m2, obesity history ≥ 10 years, and planned bariatric surgery. At baseline and 3 and 6 months after surgery, all patients underwent anthropometric measurements, body composition and blood tests (including insulin, glucagon, and incretins during oral glucose tolerance test (OGTT)), and hyperinsulinemic euglycemic clamp tests. Diabetes remission was defined if the person reached HbA1c < 6.5% after surgery and glucose-lowering therapy withdrawal. Results: The study included 86 patients, divided into groups with no diabetes (control group, n = 44) and T2D (n = 42). Most patients with T2D reached normoglycemia at 6 months. BMI and insulin resistance (according to M-index) decreased in T2D group comparably to people without diabetes. At 6 months, people with T2D at baseline had less insulin and GLP-1 secretion and higher glucagon level during OGTT when compared to the control group. Conclusions: We conclude that weight and insulin resistance reduction is sufficient for T2D remission. The absence of insulin, glucagon, and incretin restoration is not crucial for the glucose metabolism in the short-term, but it may explain the relapse of T2D years after bariatric surgery. Full article
(This article belongs to the Section Endocrinology & Metabolism)
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15 pages, 312 KiB  
Review
Physical Activity Measurement in People with Spinal Cord Injury: A Comparative Review of Different Questionnaires
by Joan Úbeda-Colomer and Alex Castan
J. Clin. Med. 2024, 13(22), 6997; https://doi.org/10.3390/jcm13226997 - 20 Nov 2024
Viewed by 385
Abstract
Physical activity (PA) provides great health benefits for people with spinal cord injury (SCI). Consequently, the design and implementation of PA interventions addressed to this population is needed. To rigorously evaluate these interventions, the use of valid and comprehensive PA measures is crucial. [...] Read more.
Physical activity (PA) provides great health benefits for people with spinal cord injury (SCI). Consequently, the design and implementation of PA interventions addressed to this population is needed. To rigorously evaluate these interventions, the use of valid and comprehensive PA measures is crucial. Since the suitability of PA assessment tools might differ among different populations, and considering that questionnaires are one of the most frequently used tools to quantify PA, the purpose of this comparative review was to examine nine questionnaires that have been used to assess PA in people with SCI. All the questionnaires were analyzed in depth in regard to three main dimensions: (1) SCI-specific development; (2) PA domains measured and PA intensity classification; and (3) reliability and validity. After careful consideration of the evidence available on all these aspects, it is suggested that the most suitable questionnaires to be used in PA research in the SCI population are the PARA-SCI and the LTPAQ-SCI[R]. To conclude, the strengths and limitations of these two questionnaires are discussed, and specific recommendations to SCI researchers and practitioners regarding the suitability, according to the context and characteristics, of the research/intervention are provided. Full article
(This article belongs to the Section Sports Medicine)
11 pages, 661 KiB  
Systematic Review
Effect of Cochlear Implantation on Air Conduction and Bone Conduction Elicited Vestibular Evoked Myogenic Potentials—A Scoping Review
by Muhammed Ayas, Jameel Muzaffar, Veronica Phillips, Mathew E. Smith, Daniele Borsetto and Manohar L. Bance
J. Clin. Med. 2024, 13(22), 6996; https://doi.org/10.3390/jcm13226996 - 20 Nov 2024
Viewed by 421
Abstract
Background/Objectives: Cochlear implantation (CI) is an effective intervention for individuals with severe to profound hearing loss; however, it may impact vestibular function due to its proximity to related anatomical structures. Vestibular evoked myogenic potentials (VEMPs) assess the function of the saccule and utricle, [...] Read more.
Background/Objectives: Cochlear implantation (CI) is an effective intervention for individuals with severe to profound hearing loss; however, it may impact vestibular function due to its proximity to related anatomical structures. Vestibular evoked myogenic potentials (VEMPs) assess the function of the saccule and utricle, critical components of the vestibular system. This review examines CI’s impact on air conduction (AC) and bone conduction (BC) VEMP responses. Methods: A scoping review was conducted following PRISMA guidelines, using databases such as Medline, Embase, Cochrane Library, Scopus, and ProQuest Dissertations. Studies reporting on AC and/or BC-VEMP in CI recipients were included. Data extraction focused on VEMP response rates, amplitudes, and latencies pre- and post-CI. Risk of bias/quality assessment was performed using the Newcastle–Ottawa Scale. Results: Out of 961 studies identified, 4 met the inclusion criteria, encompassing a total of 245 CI-implanted ears. Results indicated that AC-VEMP responses were often reduced or absent post-CI, reflecting the influence of surgical changes in the middle ear mechanics rather than otolith dysfunction. In contrast, BC-VEMP responses were more consistently preserved, suggesting that BC stimuli bypass the middle ear and more accurately delineate otolith function. Variations in VEMP outcomes were noted depending on the surgical approach and individual patient factors. Conclusions: CI impacts vestibular function as measured by VEMP, with AC-VEMP showing greater susceptibility to postoperative changes compared to BC-VEMP. The presence of preserved BC-VEMP alongside absent AC-VEMP underscores the need to differentiate between these measures in assessing vestibular function. Full article
(This article belongs to the Section Otolaryngology)
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13 pages, 15111 KiB  
Review
Highlights of Transesophageal Echocardiography During Interventions for Adult Congenital Heart Disease
by Eihab Ghantous and Gentian Lluri
J. Clin. Med. 2024, 13(22), 6995; https://doi.org/10.3390/jcm13226995 - 20 Nov 2024
Viewed by 567
Abstract
Significant advances in the diagnosis and treatment of congenital heart disease have transformed patient outcomes, leading to an expanding adult congenital heart disease population. Many of these adults require lifelong procedural interventions, frequently performed in catheterization labs under the guidance of echocardiography. This [...] Read more.
Significant advances in the diagnosis and treatment of congenital heart disease have transformed patient outcomes, leading to an expanding adult congenital heart disease population. Many of these adults require lifelong procedural interventions, frequently performed in catheterization labs under the guidance of echocardiography. This review explores the transesophageal echocardiographic aspect in key catheterization-based procedures. Full article
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20 pages, 3485 KiB  
Article
Evaluating a New Short Self-Management Tool in Heart Failure Against the Traditional Flinders Program
by Pupalan Iyngkaran, David Smith, Craig McLachlan, Malcolm Battersby, Maximilian de Courten and Fahad Hanna
J. Clin. Med. 2024, 13(22), 6994; https://doi.org/10.3390/jcm13226994 - 20 Nov 2024
Viewed by 445
Abstract
Background/Objective: Heart failure (HF) is a complex syndrome, with multiple causes. Numerous pathophysiological pathways are activated. Comprehensive and guideline-derived care is complex. A multidisciplinary approach is required. The current guidelines report little evidence for chronic disease self-management (CDSM) programs for reducing readmission and [...] Read more.
Background/Objective: Heart failure (HF) is a complex syndrome, with multiple causes. Numerous pathophysiological pathways are activated. Comprehensive and guideline-derived care is complex. A multidisciplinary approach is required. The current guidelines report little evidence for chronic disease self-management (CDSM) programs for reducing readmission and major adverse cardiovascular events (MACE). CDSM programs can be complex and are not user-friendly in clinical settings, particularly for vulnerable patients. The aim of this study was to investigate whether a simplified one-page CDSM tool, the SCReening in Heart Failure (SCRinHF), is comparable to a comprehensive Flinders Program of Chronic Disease Management, specifically in triaging self-management capabilities and in predicting readmission and MACE. Methods:SELFMAN-HF is a prospective, observational study based on community cardiology. Eligible patients, consecutively recruited, had HF with left ventricular ejection fraction <40% and were placed on sodium–glucose co-transporter-2 inhibitors (SGLT2-i) within 3 months of recruitment. SGLT2-i is the newest of the four HF treatment pillars; self-management skills are assessed at this juncture. CDSM was assessed and scored independently via the long-form (LF) and short-form (SF) tools, and concordance between forms was estimated. The primary endpoint is the 80% concordance across the two CDSM scales for predicting hospital readmission and MACE. Results: Of the 117 patients, aged 66.8 years (±SD 13.5), 88 (75%) were male. The direct comparisons for SF versus LF patient scores are as follows: “good self-managers”, 13 vs. 30 patients (11.1% vs. 25.6%); “average”, 46 vs. 21 patients (39.3% vs. 17.9%), “borderline”, 20 vs. 31 patients (17.1% vs. 26.5%), and “poor self-managers” (vulnerable), 38 vs. 35 patients (32.5% vs. 29.9%). These findings underscore the possibility of SF tools in picking up patients whose scores infer poor self-management capabilities. This concordance of the SF with the LF scores for patients who have poor self-management capabilities (38 vs. 35 patients p = 0.01), alongside readmission (31/38 vs. 31/35 p = 0.01) or readmission risk for poor self-managers versus good self-managers (31/38 vs. 5/13 p = 0.01), validates the simplification of the CDSM tools for the vulnerable population with HF. Similarly, when concurrent and predictive validity was tested on 52 patients, the results were 39 (75%) for poor self-managers and 14 (27%) for good self-managers in both groups, who demonstrated significant correlations between SF and LF scores. Conclusions: Simplifying self-management scoring with an SF tool to improve clinical translation is justifiable, particularly for vulnerable populations. Poor self-management capabilities and readmission risk for poor self-managers can be significantly predicted, and trends for good self-managers are observed. However, correlations of SF to LF scores across an HF cohort for self-management abilities and MACE are more complex. Translation to patients of all skill levels requires further research. Full article
(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)
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20 pages, 842 KiB  
Review
Non-Pharmacological Therapy in Heart Failure and Management of Heart Failure in Special Populations—A Review
by Jasmine K. Dugal, Arpinder S. Malhi, Noyan Ramazani, Brianna Yee, Michael V. DiCaro and KaChon Lei
J. Clin. Med. 2024, 13(22), 6993; https://doi.org/10.3390/jcm13226993 - 20 Nov 2024
Viewed by 610
Abstract
Non-pharmacological therapies play an essential role in the management of heart failure, complementing pharmacological treatments to mitigate disease progression and improve patient outcomes. This review provides an updated perspective on non-pharmacological interventions with a focus on lifestyle modifications, device therapies, and the management [...] Read more.
Non-pharmacological therapies play an essential role in the management of heart failure, complementing pharmacological treatments to mitigate disease progression and improve patient outcomes. This review provides an updated perspective on non-pharmacological interventions with a focus on lifestyle modifications, device therapies, and the management of heart failure in special populations, such as the elderly, women, and patients with comorbid conditions like renal dysfunction and diabetes. Key lifestyle interventions, including sodium and fluid restriction, dietary changes, and physical activity, are explored for their impact on symptom reduction, hospital readmissions, and quality of life. Device therapies like cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICD) are also evaluated for their effectiveness in reducing mortality in patients with advanced HF. Special attention is given to vulnerable populations, emphasizing the need for individualized approaches tailored to specific pathophysiological mechanisms and socioeconomic factors. By integrating these strategies, healthcare providers can optimize care and enhance patient adherence, reducing the overall burden of heart failure. Full article
(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)
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8 pages, 1335 KiB  
Article
Late-Onset Femoroacetabular Impingement Syndrome Following Knee Arthroscopy in a Retrospective Cohort
by Nicole D. Rynecki, Matthew T. Kingery, Rachel Roller, Emily Berzolla, Christopher A. Colasanti and Thomas Youm
J. Clin. Med. 2024, 13(22), 6992; https://doi.org/10.3390/jcm13226992 - 20 Nov 2024
Viewed by 322
Abstract
Background/Objectives: Hip–knee coupling is a well-documented phenomenon, and interventions to one joint can alter biomechanics at the other. The purpose of this study was to investigate if knee surgery is associated with later onset of femoroacetabular impingement syndrome (FAIS). Methods: A retrospective chart [...] Read more.
Background/Objectives: Hip–knee coupling is a well-documented phenomenon, and interventions to one joint can alter biomechanics at the other. The purpose of this study was to investigate if knee surgery is associated with later onset of femoroacetabular impingement syndrome (FAIS). Methods: A retrospective chart review was conducted regarding patients at a single academic institution who underwent hip arthroscopy for FAIS between January 2011–October 2021. Patient charts were queried for past surgical history of knee arthroscopy before hip arthroscopy. Patients who previously underwent hip arthroscopy with no history of knee arthroscopy served as controls. Details about demographics and the onset of hip symptoms were abstracted from patient charts. Statistical analysis was conducted using Mann–Whitney testing and binary logistic regression. Results: Of the 1569 patients identified, 127 had a history of knee arthroscopy and reported no hip symptoms at or prior to the time of surgery. Patients who had undergone prior knee arthroscopy were significantly older at onset of initial hip symptoms (42.15 ± 11.80 years versus 34.62 ± 12.49 years, p < 0.001) and at the time of hip arthroscopy (44.12 ± 11.85 years versus 36.90 ± 12.14 years, p < 0.001) when controlling for age, sex, and BMI. These patients first developed hip symptoms at a mean of 8.57 ± 8.53 years following knee arthroscopy (median 6.10 years) and underwent operative treatment 1.76 ± 1.96 years later. Conclusions: Patients with a history of prior knee arthroscopy are older at the time of hip symptom onset and subsequent hip arthroscopy for the treatment of FAIS. Full article
(This article belongs to the Section Orthopedics)
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12 pages, 1223 KiB  
Systematic Review
Co-Occurrence of Psoriasis and Asthma in the Pediatric Population: A Systematic Review and Meta-Analysis
by Mateusz Mleczko, Agnieszka Gerkowicz and Dorota Krasowska
J. Clin. Med. 2024, 13(22), 6991; https://doi.org/10.3390/jcm13226991 - 20 Nov 2024
Viewed by 388
Abstract
Introduction: The risk of asthma in patients with psoriasis and that of psoriasis in patients with asthma have increased, but relevant data for the pediatric population are lacking. Therefore, we performed a meta-analysis to assess the pooled association between psoriasis and asthma [...] Read more.
Introduction: The risk of asthma in patients with psoriasis and that of psoriasis in patients with asthma have increased, but relevant data for the pediatric population are lacking. Therefore, we performed a meta-analysis to assess the pooled association between psoriasis and asthma in children and adolescents. Methods: We conducted an extensive search of the medical literature databases through to July 2024. The estimated risk ratios (RRs) and corresponding 95% confidence intervals (CIs) were computed. Results: Three studies, involving 5310 children with psoriasis and 1,539,029 control participants, were included to evaluate the incidence of asthma in children with psoriasis. The meta-analysis indicated a significantly increased risk of asthma in children with psoriasis [RR 1.38 (95% CI, 1.28–1.49)]. Additionally, two studies involving 104,369 asthmatic children and 1,539,029 controls were included to evaluate the incidence of psoriasis in children with asthma. The meta-analysis indicated a significant increase in the risk of psoriasis in children with asthma [RR 1.17 (95% CI, 0.70–1.95)]. Conclusions: This meta-analysis offers evidence supporting the association between psoriasis and asthma in pediatric populations. Therefore, physicians should make patients aware of the connection between these two chronic diseases. Full article
(This article belongs to the Section Clinical Pediatrics)
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11 pages, 248 KiB  
Article
Echocardiographic Screening of Liver Transplant Candidates—Prevalence of Features of Portopulmonary Hypertension
by Olga Dzikowska-Diduch, Tomasz Cader, Krzysztof Jankowski, Aisha Ou-Pokrzewińska, Monika Sznajder, Jan Siwiec, Szymon Pucyło, Aleksandra Sikora, Marek Pacholczyk, Wojciech Lisik, Piotr Pruszczyk and Katarzyna Kurnicka
J. Clin. Med. 2024, 13(22), 6990; https://doi.org/10.3390/jcm13226990 - 20 Nov 2024
Viewed by 431
Abstract
Background: The prevalence of portopulmonary hypertension (PoPH) is relatively low; however, its presence significantly worsens patients’ prognosis. When diagnosed, PoPH can be effectively treated, and specific therapies can lead to a substantial reduction in pulmonary circulation pressure, facilitating the safe performance of [...] Read more.
Background: The prevalence of portopulmonary hypertension (PoPH) is relatively low; however, its presence significantly worsens patients’ prognosis. When diagnosed, PoPH can be effectively treated, and specific therapies can lead to a substantial reduction in pulmonary circulation pressure, facilitating the safe performance of liver transplantation. Echocardiography is recommended as a first-line method for the non-invasive diagnosis of pulmonary hypertension and serves as a valuable screening tool for patients being evaluated for liver transplantation (LT). The objective of this study was to thoroughly assess the occurrence of echocardiographic signs indicative of pulmonary hypertension and hepatopulmonary syndrome (HPS) in candidates for LT. We assumed that our analysis also made it possible to assess how frequently these candidates require further invasive diagnostics for pulmonary hypertension at specialized centers and how often they may need targeted treatment for pulmonary arterioles as a bridge to transplantation, which could improve patient outcomes. Additionally, this study included a comprehensive review of the current literature. Methods: All LT candidates underwent standardized transthoracic echocardiography and contrast evaluation to identify intrapulmonary vascular shunts. Results: A total of 152 liver transplantation candidates (67 women, mean age 50.6 years) were included in the analysis. The estimated echocardiographic probability of pulmonary hypertension was classified as high in only one patient. However, 63 patients exhibited the visualization of microbubbles in the left heart chambers after an average of six cardiac cycles (ranging from three to nine cycles) following their appearance in the right heart. Conclusions: Our analysis shows that the features of PoPH and a high probability of PH were very rare in the LT candidates, and echocardiographic signs suggestive of hepatopulmonary syndrome were more prevalent. Liver transplant candidates need screening for PoPH and HPS, as both PoPH and HPS significantly worsen their prognosis, but specific PH treatment as a bridge to transplantation improves PoPH patients’ survival. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Pulmonary Hypertension)
16 pages, 1246 KiB  
Article
Resection of Early Colorectal Neoplasms Using Endoscopic Submucosal Dissection: A Retrospective Multicenter Cohort Study
by Katarzyna Winter, Przemysław Kasprzyk, Zuzanna Nowicka, Suzuki Noriko, Alberto Herreros-de-Tejada and Michał Spychalski
J. Clin. Med. 2024, 13(22), 6989; https://doi.org/10.3390/jcm13226989 - 20 Nov 2024
Viewed by 641
Abstract
Background: Endoscopic submucosal dissection (ESD) is a reliable method that can replace surgery in the treatment of early colorectal cancer under certain conditions. Aim: The aim of the study was to analyze factors influencing the ESD procedure in early colorectal cancer, with the [...] Read more.
Background: Endoscopic submucosal dissection (ESD) is a reliable method that can replace surgery in the treatment of early colorectal cancer under certain conditions. Aim: The aim of the study was to analyze factors influencing the ESD procedure in early colorectal cancer, with the intention of improving its effectiveness. Patients and Methods: We conducted a multicenter, retrospective cohort study on 214 patients who underwent ESD procedures for early colorectal cancer from January 2016 to October 2023. Results:En bloc resection was achieved in 197 (92.1%) of ESD procedures, R0 resection in 149 (69.6%), and curative resection in 54 (40.9%). The submucosal invasion was classified as level 1 (SM1) in 96 cases (45.3%), level 2 (SM2) in 61 cases (28.8%), and level 3 (SM3) in 36 cases (17%). R0 resection was achieved more often in the rectum—92 (81.4%), compared to the right—24 (64.9%) and left colon—33 (61.1%), p = 0.009. In rectal tumors, R0 resection was achieved in 51 (98.1%) SM1 invasion, 27 (73%) SM2 invasion, and 13 (65%) SM3 invasion (p < 0.001). Lateral and vertical resection margins were positive in 12 (7.7%) and 52 (25.2%) cases, respectively. Vertical resection margins were statistically more often positive in lesions located in the right colon—11 cases (28.9%) and left colon—21 cases (38.9%), than in rectum—20 cases (17.5%); p = 0.010. Complications were found in 32 (15%) cases of ESD procedure—perforation in 12 cases (5.6%) and delayed bleeding in four cases (1.9%). Procedures performed in the right colon were associated with a significantly higher risk of any complications (30%) and perforations (15%) than those performed in the rectum (10.3% and 2.6%) or the left colon (13.8% and 5.2%; p = 0.016; p = 0.015), respectively. Conclusions: ESD for early colon cancer is a viable strategy due to its effectiveness and low complication rate. The ESD technique performed in the rectum yields the best results; however, in the right colon, it still requires careful attention. Full article
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25 pages, 725 KiB  
Systematic Review
Evaluating Surgical Approaches for Hemimandibular Hyperplasia Associated with Osteochondroma: A Systematic Literature Review
by Luis Eduardo Almeida, Samuel Zammuto and Diego Fernando Lopez
J. Clin. Med. 2024, 13(22), 6988; https://doi.org/10.3390/jcm13226988 - 20 Nov 2024
Viewed by 380
Abstract
Background/Objectives: Hemimandibular hyperplasia (HH) associated with osteochondroma presents complex challenges in maxillofacial surgery, including facial asymmetry, occlusal instability, and temporomandibular joint (TMJ) dysfunction. Surgical interventions vary widely in approach and outcomes, underscoring the need for a systematic evaluation of effectiveness. This systematic [...] Read more.
Background/Objectives: Hemimandibular hyperplasia (HH) associated with osteochondroma presents complex challenges in maxillofacial surgery, including facial asymmetry, occlusal instability, and temporomandibular joint (TMJ) dysfunction. Surgical interventions vary widely in approach and outcomes, underscoring the need for a systematic evaluation of effectiveness. This systematic review assesses the effectiveness of surgical approaches for managing HH associated with osteochondroma, focusing on techniques including condylectomy, orthognathic surgery, distraction osteogenesis, total joint replacement (TJR), and genioplasty. Methods: Following PRISMA 2020 guidelines, a comprehensive search was conducted in PubMed, Scopus, and Web of Science for studies published from 2000 to 2023. Eligibility criteria were based on the PICO framework, with primary outcomes evaluated for facial symmetry, occlusal correction, mandibular function, and recurrence rates. The Cochrane Risk of Bias Tool assessed study quality, while the GRADE framework evaluated the certainty of evidence. This review was not registered due to exclusion criteria for certain dental topics in PROSPERO. Results: Of 145 studies identified, 18 met inclusion criteria, totaling 214 patients. High and low condylectomy both effectively corrected asymmetry, with high condylectomy reducing recurrence risk but often requiring reconstruction. Orthognathic surgery, combined with condylectomy, significantly enhanced facial symmetry and occlusal function. Distraction osteogenesis proved valuable for mandibular lengthening in cases of severe deformities, while TJR offered definitive solutions for extensive joint involvement. Genioplasty corrected chin asymmetry, contributing to improved facial balance. Limitations included small sample sizes and variable follow-up durations. Conclusions: Surgical approaches tailored to individual patient needs show effectiveness in treating HH associated with osteochondroma, achieving functional and esthetic outcomes. Future studies should prioritize larger cohorts and standardized follow-up protocols to better assess long-term efficacy. Advances in 3D surgical planning and individualized treatment strategies show promise for optimized patient-specific care. Full article
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15 pages, 1389 KiB  
Article
Automated EEG-Based Brainwave Analysis for the Detection of Postoperative Delirium Does Not Result in a Shorter Length of Stay in Geriatric Hip Fracture Patients: A Multicentre Randomized Controlled Trial
by Emma J. de Fraiture, Henk Jan Schuijt, Maryse Menninga, Iris A. I. Koevoets, Tessa F. M. Verheul, Corine W. van Goor, Thomas M. P. Nijdam, Dieuwke. van Dartel, Johannes H. Hegeman and Detlef van der Velde
J. Clin. Med. 2024, 13(22), 6987; https://doi.org/10.3390/jcm13226987 - 20 Nov 2024
Viewed by 527
Abstract
Introduction: Delirium in postoperative geriatric hip fracture patients is a serious and often preventable condition. If detected in time, it can be treated, but a delay in the diagnosis and initiation of treatment impairs outcomes. A novel approach to detect delirium is [...] Read more.
Introduction: Delirium in postoperative geriatric hip fracture patients is a serious and often preventable condition. If detected in time, it can be treated, but a delay in the diagnosis and initiation of treatment impairs outcomes. A novel approach to detect delirium is to use point-of-care electro-encephalogram (EEG) recording with automated analysis. In this study, the authors investigated whether screening for delirium with EEG recording and automated analysis resulted in reduced length of stay after surgery and superior screening performance in comparison to the Delirium Observation Screening Scale (DOS). Methods: This randomized control trial was conducted at two geriatric trauma centres in the Netherlands. Patients were eligible for inclusion if they were aged 70 years or above, were admitted to the geriatric trauma unit and undergoing surgery for a hip fracture. Patients were randomized to either the intervention (EEG-based brainwave analysis) or control group (DOSS screening tool). Participants were screened for delirium twice a day during three consecutive days starting at day 0 of the surgery, with the first measurement before the surgery. The primary outcome was length of stay. In addition, the screening performance for both automated EEG-based brainwave analysis and DOS was determined. Results: A total of 388 patients were included (189 per arm). There were no differences between groups in terms of median hospital length of stay (DOS 7 days (IQR 5.75–9) vs. EEG-based brainwave analysis 7 days (IQR 5–9); p = 0.867). The performance of EEG-based brainwave analysis was considerably lower than that of the DOSS in terms of discrimination between patients with and without postoperative delirium. Conclusions: Screening for postoperative delirium in geriatric hip fracture patients using automated EEG-based brainwave analysis did not result in a shorter length of stay. Additionally, the results of this study show no clear advantage in terms of the screening performance of EEG-based brainwave analysis over the current standard of care for geriatric patients with a hip fracture. Full article
(This article belongs to the Section Orthopedics)
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9 pages, 555 KiB  
Article
Association Between Anaesthesiologists’ Sex and Anaesthesiology Quality Metrics and Postoperative Outcomes: A Retrospective Analysis
by Sebastian Zeiner, Mathias Maleczek, Daniel Laxar, Razvan Bologheanu, Eva Schaden and Oliver Kimberger
J. Clin. Med. 2024, 13(22), 6986; https://doi.org/10.3390/jcm13226986 - 20 Nov 2024
Viewed by 377
Abstract
Background: Evidence suggests differences in medical practice and patient outcomes between male and female physicians and surgeons. To date, no such relationships were investigated in anaesthesiologists. This study aimed to investigate an association between anaesthesiologists’ sex and anaesthesia quality metrics as well as [...] Read more.
Background: Evidence suggests differences in medical practice and patient outcomes between male and female physicians and surgeons. To date, no such relationships were investigated in anaesthesiologists. This study aimed to investigate an association between anaesthesiologists’ sex and anaesthesia quality metrics as well as outcomes. Methods: We performed a population-based, single-centre, retrospective cohort study. Data were gathered from all patients undergoing anaesthesia between 1 January 2014 and 31 March 2022 at a large tertiary centre in Vienna, Austria. We examined 30-day mortality in relation to the sex of the anaesthesiologist after adjusting for various patient, physician, and hospital factors. Additionally, we assessed anaesthesiologists’ sex and several anaesthesia quality benchmarks. Results: The final dataset included 94,254 cases. The study showed a very small but statistically significant correlation between male anaesthesia providers and an elevated risk for all-cause mortality within 30 days (adjusted odds ratio [aOR]: 1.0026; 95% confidence interval [CI], 1.0003–1.0048). Both male and female anaesthesiologists demonstrated similar proficiency in managing hemodynamic stability, blood glucose levels, preventing postoperative acute kidney injury (AKI) and lung-protective ventilation. However, male anaesthesiologists showed slightly higher adherence to guidelines for PONV prophylaxis. Conclusions: In a dataset of nearly 95,000 cases, there was a clinically marginal but statistically significant association between male provider sex and 30-day mortality. Full article
(This article belongs to the Section Anesthesiology)
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9 pages, 550 KiB  
Article
Severity of Acute Kawasaki Disease Can Be Predicted by Evaluating the Body Temperature at the Completion of an Initial Immunoglobulin Treatment
by Shintaro Kishimoto, Tamotsu Fujimoto and Kenji Ihara
J. Clin. Med. 2024, 13(22), 6985; https://doi.org/10.3390/jcm13226985 - 20 Nov 2024
Viewed by 365
Abstract
Objective: We aimed to determine whether the severity of acute Kawasaki disease (KD) can be predicted based on whether a patient remains febrile or becomes afebrile immediately after the completion of initial immunoglobulin treatment (IVIG). Methods: This retrospective cohort study at [...] Read more.
Objective: We aimed to determine whether the severity of acute Kawasaki disease (KD) can be predicted based on whether a patient remains febrile or becomes afebrile immediately after the completion of initial immunoglobulin treatment (IVIG). Methods: This retrospective cohort study at a single institution involved 306 patients with KD. They were categorized into four groups according to their fever status at two specific time points (end of the initial IVIG treatment and 24–36 h later): Group F-F, patients who remained febrile at both time points; Group F-AF, patients who were febrile at the end of the initial IVIG treatment but became afebrile 24–36 h later; Group AF-F, patients who were afebrile at the end of the initial IVIG treatment but became febrile 24–36 h later; and Group AF-AF, patients who remained afebrile at both time points. The clinical characteristics of the groups were compared. Results: Group F-F (n = 38) showed a significantly higher incidence of CAAs compared to Group AF-F (n = 37), 55.3% vs. 0.0% (p < 0.0001), although both groups were classified as resistant to the initial IVIG. Conclusions: In Japanese patients with acute KD, the presence or absence of fever at the completion of initial IVIG treatment may serve as an early predictor of the occurrence of CAAs. An earlier secondary treatment may be warranted for patients who are in a febrile state immediately after the completion of the initial IVIG treatment. Future research should include a prospective cohort study with a larger number of KD cases across multiple institutions to analyze the effects of other contributing factors related to CAL formation. Full article
(This article belongs to the Section Clinical Pediatrics)
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14 pages, 2284 KiB  
Article
Anticoagulation Management for Veno-Venous ECMO in COVID-19 Patients: Argatroban as Rescue Therapy in Heparin-Associated Thrombocytopenia
by Lorenzo Schiavoni, Alessia Mattei, Martina Cuccarelli, Alessandro Strumia, Carmelo Dominici, Antonio Nenna, Jessica Aceto, Gloria Palazzo, Giuseppe Pascarella, Fabio Costa, Rita Cataldo, Felice Eugenio Agrò and Massimiliano Carassiti
J. Clin. Med. 2024, 13(22), 6984; https://doi.org/10.3390/jcm13226984 - 20 Nov 2024
Viewed by 322
Abstract
Background/Objectives: Extracorporeal membrane oxygenation (ECMO) has been widely used as a life support technique in COVID-19 acute respiratory distress syndrome (ARDS). The use of anticoagulation during ECMO support remains a topic of debate. The primary aim of this study is to demonstrate the [...] Read more.
Background/Objectives: Extracorporeal membrane oxygenation (ECMO) has been widely used as a life support technique in COVID-19 acute respiratory distress syndrome (ARDS). The use of anticoagulation during ECMO support remains a topic of debate. The primary aim of this study is to demonstrate the safety and efficacy of using argatroban as an anticoagulant instead of heparin in patients with heparin-associated thrombocytopenia. Methods: 40 patients were enrolled and initially treated with unfractionated heparin for anticoagulation during ECMO, composing the UFH group. Twenty-one of these patients experienced a drop in platelet count to below 100,000 cells/mm3 and, after testing negative for IgG anti-PF4/heparin, the anticoagulation was switched to argatroban, composing the ARG group. Hemorrhagic events were recorded along with blood chemistry parameters. Results: Bleedings were significantly more frequent in the UFH group than in ARG group (58/579 days vs. 21/357 days, p = 0.041). No significant differences were observed in hemorrhagic episodes for each bleeding site, except for tracheal stoma (14 vs. 1, p = 0.011). No differences in activated partial thromboplastin time (aPTT) values were found between the two groups (aPTT 42.65 s vs. 44.70 s, p = 0.443). Linear regression analysis revealed that the platelet count on day 5 was correlated with the initial platelet count but not with the type of anticoagulant used (p = 0.001, CI 0.55, 0.69 and p = 0.078). Linear regression analysis in both groups showed a correlation between the duration of ECMO support and intensive care unit stay for the median aPTT and median platelet count. Furthermore, no major systemic thrombotic events or circuit clotting were observed in this patient cohort. Conclusions: Argatroban seems to be safe in patients with persistent heparin-associated thrombocytopenia undergoing ECMO. Full article
(This article belongs to the Section Pulmonology)
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11 pages, 252 KiB  
Article
A Therapeutic Proposal for Mini-Puberty in Male Infants with Hypogonadotropic Hypogonadism: A Retrospective Case Series
by María Aurora Mesas-Aróstegui, Fidel Hita-Contreras and Juan Pedro López-Siguero
J. Clin. Med. 2024, 13(22), 6983; https://doi.org/10.3390/jcm13226983 - 20 Nov 2024
Viewed by 353
Abstract
Background: Male patients with congenital hypogonadotropic hypogonadism (CHH) have impaired postnatal activation of the hypothalamic–pituitary–gonadal axis that occurs during mini-puberty. The aim of this study was to report our experience using gonadotropin replacement therapy for mini-puberty in male infants with CHH and to [...] Read more.
Background: Male patients with congenital hypogonadotropic hypogonadism (CHH) have impaired postnatal activation of the hypothalamic–pituitary–gonadal axis that occurs during mini-puberty. The aim of this study was to report our experience using gonadotropin replacement therapy for mini-puberty in male infants with CHH and to establish treatment recommendations. Methods: The patients included in this retrospective case series (n = 9) were diagnosed in the postnatal period due to micropenis, with two being accompanied by cryptorchidism and four with other associated hormonal deficits. All patients started treatment with gonadotropins early after diagnosis, between 2 weeks and 5 months of age, with a schedule of discontinuous injections with subcutaneous human chorionic gonadotropin (62.5–500 IU) two times per week and recombinant follicle-stimulating hormone-alpha (37.5–75 IU) three times per week. Results: The data from our study show an early response, ranging from almost undetectable levels of testosterone at diagnosis to elevated levels after starting treatment, as well as a positive clinical response with increases in testicular volume and penis size in all cases without requiring complementary treatment with testosterone esters and without adverse effects. Conclusions: Our results show that gonadotropin replacement therapy is a well-tolerated and effective treatment for testicular and penile problems in male patients with CHH. Full article
(This article belongs to the Special Issue Current Trends in Pediatric Endocrinology)
22 pages, 1578 KiB  
Systematic Review
Light Therapy for Older People with Depressive Symptoms: Systematic Review and Meta-Analysis
by Ji-Woo Seok and Jung-Dae Kim
J. Clin. Med. 2024, 13(22), 6982; https://doi.org/10.3390/jcm13226982 - 20 Nov 2024
Viewed by 479
Abstract
Background/Objectives: Light therapy has emerged as a promising non-pharmacological treatment for depressive symptoms. This meta-analysis aims to evaluate the effectiveness of light therapy specifically for depressive symptoms in elderly populations, with a focus on how different light intensities and spectra influence treatment outcomes. [...] Read more.
Background/Objectives: Light therapy has emerged as a promising non-pharmacological treatment for depressive symptoms. This meta-analysis aims to evaluate the effectiveness of light therapy specifically for depressive symptoms in elderly populations, with a focus on how different light intensities and spectra influence treatment outcomes. Methods: A systematic search targeting studies on light therapy for depressive symptoms in older adults was performed across multiple databases, including PubMed, Google Scholar, PsycINFO, and EMBASE, covering studies from database inception until July 2024. A total of 565 records were identified, with 461 studies remaining after removing duplicates. Following the screening of titles and abstracts, 54 studies underwent full-text review, resulting in the inclusion of 22 studies with a total of 1290 participants (687 in the intervention group and 603 in the control group). Results: The overall effect size for light therapy on depressive symptoms was moderate (Hedges’ g = 0.525, p < 0.001). Higher light intensities (10,000 lux and above) demonstrated significantly greater effectiveness compared to lower intensities. White light had the most substantial effect, while bluish light showed moderate efficacy. Significant heterogeneity was observed across studies (I2 = 80.459%), indicating variability in treatment outcomes based on study design, intensity, and light spectrum. Conclusions: This meta-analysis confirms that light therapy is an effective treatment for reducing depressive symptoms in older adults, particularly at higher intensities and with specific light spectra such as white light. Given the heterogeneity in results, future research should focus on optimizing treatment parameters to enhance clinical outcomes within this population. Full article
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10 pages, 645 KiB  
Article
The Unmet Needs of Lysosomal Storage Disorders from Early Diagnosis to Caregiving Pathways: An Italian Perspective
by Giancarlo Castaman, Silvia Linari, Antonio Barbato, Niko Costantino, Carlo Dionisi-Vici, Francesca Menni, Elena Procopio, Silvia Ramat, Fernanda Torquati, Elena Verrecchia and Maurizio Scarpa
J. Clin. Med. 2024, 13(22), 6981; https://doi.org/10.3390/jcm13226981 - 20 Nov 2024
Viewed by 521
Abstract
Background/Objective: Lysosomal storage diseases (LSDs) are a group of rare, inborn, metabolic errors characterized by deficiencies in normal lysosomal function and by the intralysosomal accumulation of undegraded substrates, resulting in the damage of multiple organ systems. The spectrum of clinical manifestations is extremely [...] Read more.
Background/Objective: Lysosomal storage diseases (LSDs) are a group of rare, inborn, metabolic errors characterized by deficiencies in normal lysosomal function and by the intralysosomal accumulation of undegraded substrates, resulting in the damage of multiple organ systems. The spectrum of clinical manifestations is extremely heterogeneous. LSD diagnosis and management still present many issues. Methods: A group of Italian experts and patients’ representatives met to discuss some critical aspects, and among the most impactful are early diagnosis, the transition of the patient from pediatric to adult age, territorial management, and the multidisciplinary approach. Results: Possible solutions to diagnostic delays may be a widespread newborn screening and screening programs on selected populations. The lack of a structured transition process could be helped by the drafting of shared diagnostic and therapeutic care pathways beyond the availability of databases accessible to the different levels that manage a patient. Territorial management could benefit from telemedicine, but a homogeneous diffusion of home therapy, not yet everywhere possible, is essential. A fundamental role is played by the patient associations, which should be increasingly involved in the political choices. It is also crucial to create structured multidisciplinary teams of experts for disease management and comorbidities. A transversal need appears to be greater training on LSDs. In Italy, the “Statement of Udine” was developed to guide further steps towards improvements in inherited metabolic medicine in adults, referencing the experience from the United Kingdom. Conclusions: Much can be done for the early diagnosis and management of LSDs with an effective treatment, but many aspects need improvement for the overall management of the patient. An investment in dedicated resources, formal recognition, and training is needed to address these unmet needs. Full article
(This article belongs to the Section Endocrinology & Metabolism)
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17 pages, 3327 KiB  
Review
Evaluation of Mesh Closure of Laparotomy and Extraction Incisions in Open and Laparoscopic Colorectal Surgery: A Systematic Review and Meta-Analysis
by Mohamed Albendary, Ali Yasen Mohamedahmed, Marwa Yassin Mohamedahmed, Ugochukwu Ihedioha, Shantanu Rout and Anouk Van Der Avoirt
J. Clin. Med. 2024, 13(22), 6980; https://doi.org/10.3390/jcm13226980 - 20 Nov 2024
Viewed by 542
Abstract
Background and Objectives: Evisceration and incisional hernia (IH) represent a significant morbidity following open or laparoscopic colorectal surgery where midline laparotomy or extraction incision (EI) are performed. We executed a systematic review to evaluate primary mesh closure of laparotomy or EI in [...] Read more.
Background and Objectives: Evisceration and incisional hernia (IH) represent a significant morbidity following open or laparoscopic colorectal surgery where midline laparotomy or extraction incision (EI) are performed. We executed a systematic review to evaluate primary mesh closure of laparotomy or EI in colorectal resections of benign or malignant conditions. Methods: A comprehensive literature search was performed using PubMed, Science Direct, Cochrane, and Google Scholar databases for studies comparing prophylactic mesh to traditional suture techniques in closing laparotomy in open approach or EI when minimally invasive surgery was adopted in colorectal procedures, regardless of the diagnosis. Both IH and evisceration were identified as primary outcomes. Secondary outcomes included surgical site infections (SSI), postoperative seroma, and length of hospital stay (LOS). Results: Six studies were included in our analysis with a total population of 1398 patients, of whom 411 patients had prophylactic mesh augmentation when closing laparotomy or EI, and 987 underwent suture closure. The mesh closure group had a significantly lower risk of developing IH compared to the conventional closure group (OR 0.23, p = 0.00001). This result was significantly consistent in subgroup analysis of open laparotomy or EI of laparoscopic surgery subgroups. There was no statistically notable difference in evisceration incidence (OR 0.51, p = 0.25). Secondary endpoints did not significantly differ between both groups in terms of SSI (OR 1.20, p = 0.54), postoperative seroma (OR 1.80, p = 0.13), and LOS (MD −0.54, p = 0.63). Conclusions: primary mesh reinforcement of laparotomy or EI closure in colorectal resections lessens IH occurrence. No safety concerns were identified; however, further high-quality research may provide more solid conclusions. Full article
(This article belongs to the Section General Surgery)
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9 pages, 388 KiB  
Article
Comparison of Oxidative Stress Markers with Clinical Data in Patients Requiring Anesthesia in an Intensive Care Unit
by Fatih Segmen, Semih Aydemir, Onur Küçük, Cihangir Doğu and Recep Dokuyucu
J. Clin. Med. 2024, 13(22), 6979; https://doi.org/10.3390/jcm13226979 - 20 Nov 2024
Viewed by 385
Abstract
Objectives: The aim of this study is to assess the oxidative stress status in patients requiring intensive care unit (ICU) admission before initiating ICU treatment, by measuring the total oxidant level (TOS) and total antioxidant level (TAS) and oxidative stress index (OSI) levels. [...] Read more.
Objectives: The aim of this study is to assess the oxidative stress status in patients requiring intensive care unit (ICU) admission before initiating ICU treatment, by measuring the total oxidant level (TOS) and total antioxidant level (TAS) and oxidative stress index (OSI) levels. Additionally, we aim to explore the correlation between these oxidative stress markers and biochemical and hematological parameters. Materials and Methods: A total of 153 patients treated in intensive care units were included in the study. Patients who met the patient admission criteria of the ethics committee of the intensive care medicine association were included in the study. Blood samples were taken at the first moment the patients were admitted to the intensive care unit (before starting treatment). In total, 60 healthy volunteers who were compatible with the patient group in terms of age and gender were included in the study as a control group. Patients who had previously received antioxidant treatment and cancer patients were excluded from the study. Results: The TOS was significantly higher in the patient group (13.4 ± 7.5) compared to controls (1.8 ± 4.4) (p = 0.021). TOS > 12.00 means a “very high oxidant level”. OSI was significantly higher in the patient group (689.8 ± 693.9) compared to the control group (521.7 ± 546.6) (p = 0.035). Ferritin levels were significantly higher in the patient group (546.5 ± 440.8 ng/mL) compared to controls (45.5 ± 46.5 ng/mL) (p < 0.001). Patients had significantly higher levels of C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBCs), immature granulocytes (IGs), zinc, and copper compared to the control group, indicating elevated inflammation and oxidative stress. CRP levels were 76.6 ± 85.9 mg/L in patients versus 5.6 ± 15.1 mg/L in controls (p < 0.001). PCT levels were 15.8 ± 8.6 ng/L in patients versus 2.3 ± 7.2 ng/L in controls (p = 0.012). Zinc and copper were also significantly elevated (p = 0.012 and p = 0.002, respectively). Conclusions: Our study provides valuable insights into the relationship between oxidative stress, inflammation, and trace elements, contributing to the growing understanding of oxidative stress as a prognostic tool in critical care. This could help to tailor therapeutic strategies aimed at reducing oxidative damage in ICU patients, enhancing patient outcomes. Full article
(This article belongs to the Section Intensive Care)
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12 pages, 785 KiB  
Article
Self-Rated Health and Mortality Among Older Adults in Israel: A Comparison Between Jewish and Arab Populations
by Itamar Shafran, Yael Benyamini, Lital Keinan-Boker and Yariv Gerber
J. Clin. Med. 2024, 13(22), 6978; https://doi.org/10.3390/jcm13226978 - 20 Nov 2024
Viewed by 408
Abstract
Background: Self-rated health (SRH) has been shown to predict mortality across a lifespan. However, its predictive value might differ between populations. We compared the association between SRH and mortality in Israeli Jewish and Arab older adults (65+). Methods: A prospective cohort [...] Read more.
Background: Self-rated health (SRH) has been shown to predict mortality across a lifespan. However, its predictive value might differ between populations. We compared the association between SRH and mortality in Israeli Jewish and Arab older adults (65+). Methods: A prospective cohort study was conducted among Jewish (n = 1463) and Arab (n = 298) participants in the first National Health and Nutrition Survey of Older Adults (2005–2006). SRH was measured on a four-point scale. Mortality data were available from baseline (2005–2006) through 2019. A survival analysis was performed using Cox models. Results: Mean baseline age (SD) was 75 (6) years among Jewish participants (54% women) and 72 (5) years among Arab participants (50% women). Jewish participants were more likely to rate their health as not good (35% vs. 29%) or poor (11% vs. 8%) than Arab participants (p = 0.01). During a median follow-up of 13.3 years, 896 deaths occurred; 744 in the Jewish group (mean age [SD] 77.8 [6.6] years) and 152 in the Arab group (mean age [SD] 74.0 [5.2] years). The age- and sex-adjusted hazard ratio (HR) for mortality in the Arab vs. Jewish participants was 1.33 (95% CI: 1.12–1.60). Mortality risk increased with declining SRH, with multivariable-adjusted HRs in the lowest vs. most-favorable SRH categories of 2.46 (95% CI: 1.66–3.63) in the Jewish sample and 2.60 (95% CI: 0.98–6.93) in the Arab sample. Conclusions: Although Jewish participants reported poorer SRH, their survival rate was better than Arab participants. Lower SRH was consistently and strongly associated with higher mortality in both groups in a dose–response manner. Full article
(This article belongs to the Special Issue Epidemiology of Aging: Unmet Needs)
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17 pages, 6657 KiB  
Systematic Review
Optimizing Myocardial Protection in Minimally Invasive Cardiac Surgeries: A Network Comparison of Del Nido, Histidine-Tryptophan-Ketoglutarate, and Blood Cardioplegia
by Sadeq Al-Hasan-Al-Saegh, Sho Takemoto, Stefano Benenati, Saeed Shafiei, Senol Yavuz, Mattia Galli, Florian Helms, Lukman Amanov, Nunzio Davide De Manna, Saeed Torabi, Jan Karsten, Jan Dieter Schmitto, Fabio Ius, Tim Kaufeld, Jawad Salman, Aron-Frederik Popov, Bastian Schmack, Arjang Ruhparwar, Alina Zubarevich and Alexander Weymann
J. Clin. Med. 2024, 13(22), 6977; https://doi.org/10.3390/jcm13226977 - 19 Nov 2024
Viewed by 472
Abstract
Background/Objectives: The optimal choice of cardioplegia solution in minimally invasive cardiac surgeries (MICS) remains debated, as prolonged myocardial protection is essential to avoid interruptions to the surgical flow, which can prolong aortic cross-clamp time and cardiopulmonary bypass time, especially in the constrained [...] Read more.
Background/Objectives: The optimal choice of cardioplegia solution in minimally invasive cardiac surgeries (MICS) remains debated, as prolonged myocardial protection is essential to avoid interruptions to the surgical flow, which can prolong aortic cross-clamp time and cardiopulmonary bypass time, especially in the constrained surgical field. We conducted a network meta-analysis to evaluate the safety and efficacy of the del Nido (DN), histidine-tryptophan-ketoglutarate (HTK), blood cardioplegia (BC), and St. Thomas’ (STH) solutions in MICS. Methods: Medical electronic databases were thoroughly searched without time restrictions, including all types of studies except for study protocols and animal research. The final search was completed in June 2024. Subsequently, a network meta-regression was performed on both primary and secondary endpoints, utilizing R (The R Foundation for Statistical Computing, version 3.6.2) for the analysis. Meta-analyses were carried out using Review Manager software. Results: A total of 15 studies, enrolling 2282 patients, were included in the analysis. None of the comparisons showed statistically significant differences in in-hospital mortality between the four cardioplegia solutions (BC vs. HTK, OR: 3.21, 95% CI: 0.13–80.84; DN vs. HTK, OR: 1.42, 95% CI: 0.28–7.23; STH vs. HTK, OR: 1.25, 95% CI: 0.19–8.20). Conclusions: In this network meta-analysis of cardioplegia solutions in MICS, no significant differences were observed in major clinical outcomes across the solutions. Cardioplegia solutions that provide long-lasting myocardial protection with a single dose, such as DN and HTK, were found to be safely applied in MICS. DN was associated with shorter CPB times and HTK was associated with shorter hospital stays, though these differences may not have clinical implications. Full article
(This article belongs to the Special Issue Cardiac Surgery: State of the Art and Future Perspectives)
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22 pages, 1139 KiB  
Article
Blood Pressure Patterns and Hepatosteatosis: Cardiometabolic Risk Assessment in Dipper and Non-Dipper Phenotypes
by Ramazan Astan, Dimitrios Patoulias, Ana Ninić, Ramazan Dayanan, Paschalis Karakasis, Tolga Mercantepe, Filiz Mercantepe and Aleksandra Klisic
J. Clin. Med. 2024, 13(22), 6976; https://doi.org/10.3390/jcm13226976 - 19 Nov 2024
Viewed by 409
Abstract
Background/Objectives: Non-dipper hypertension (HT), a condition in which blood pressure does not drop sufficiently at night compared to daytime, is considered a serious condition that increases the risk of cardiovascular disease, stroke, and organ damage. This study aimed to examine the relationship [...] Read more.
Background/Objectives: Non-dipper hypertension (HT), a condition in which blood pressure does not drop sufficiently at night compared to daytime, is considered a serious condition that increases the risk of cardiovascular disease, stroke, and organ damage. This study aimed to examine the relationship between dipper and non-dipper blood pressure patterns, hepatosteatosis, and biochemical markers in hypertensive and normotensive individuals. Methods: Demographic, biochemical, and hepatic ultrasonography data from 142 patients who underwent 24 h ambulatory blood pressure measurement (ABPM) were evaluated retrospectively and cross-sectionally in this study. Patients were categorized into four groups based on ABPM results: non-dipper normotensive (NDN), dipper normotensive (DN), non-dipper hypertensive (NDH), and dipper hypertensive (DH). Results: The study results indicate that NDH individuals had markedly elevated levels of hepatosteatosis and uric acid compared with DH and normotensive persons (p < 0.001). The grade of hepatosteatosis showed significant discriminatory capacity in differentiating between dipper and non-dipper hypertensive patients, with an AUC of 0.861, specificity of 94%, and sensitivity of 66%. Individuals with hypertension exhibiting a non-dipper pattern demonstrate a greater prevalence of hepatosteatosis and elevated uric acid levels. Conclusions: The study findings show non-dipper patterns have a higher risk for cardiometabolic diseases. This indicates that not only blood pressure, but also metabolic disorders should be closely monitored and treated in the management of non-dipper HT. Full article
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10 pages, 5073 KiB  
Review
Radiological Approach to Assessment of Lower-Limb Alignment—Coronal and Transverse Plane Analysis
by Anna Michalska-Foryszewska, Piotr Modzelewski, Katarzyna Sklinda, Bartosz Mruk and Jerzy Walecki
J. Clin. Med. 2024, 13(22), 6975; https://doi.org/10.3390/jcm13226975 - 19 Nov 2024
Viewed by 424
Abstract
Lower-limb alignment deformities constitute a significant clinical concern, as they can lead to serious complications, including progressive degenerative diseases and disabilities. Rotational deformities may give rise to conditions such as joint arthrosis, patellar instability, and the degeneration of the patellofemoral cartilage. Therefore, a [...] Read more.
Lower-limb alignment deformities constitute a significant clinical concern, as they can lead to serious complications, including progressive degenerative diseases and disabilities. Rotational deformities may give rise to conditions such as joint arthrosis, patellar instability, and the degeneration of the patellofemoral cartilage. Therefore, a comprehensive evaluation of lower-limb alignment is essential for the effective patient management, preoperative planning, and successful correction of these deformities. The primary assessment method employs full-length standing radiographs in the anteroposterior (AP) projection, which facilitates accurate measurements of the anatomical and mechanical axes of the lower limb, including angles and deviations. The outcomes of this analysis are vital for the meticulous planning of osteotomy and total knee arthroplasty (TKA). In addition, computed tomography (CT) provides a specialized approach for the precise evaluation of femoral and tibial rotation. In this area, there are potential opportunities for the implementation of AI-based automated measurement systems. Full article
(This article belongs to the Section Nuclear Medicine & Radiology)
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27 pages, 1340 KiB  
Review
Chronic Sarcoidosis: Diagnostic Difficulties and Search for New Criteria of Inflammatory Activity (A Case Report and Literature Review)
by Anna Starshinova, Elizaveta Berg, Artem Rubinstein, Anastasia Kulpina, Igor Kudryavtsev and Dmitry Kudlay
J. Clin. Med. 2024, 13(22), 6974; https://doi.org/10.3390/jcm13226974 - 19 Nov 2024
Viewed by 602
Abstract
Sarcoidosis is a systemic inflammatory disease with an unknown etiology and a wide range of clinical manifestations. The incidence of sarcoidosis ranges from approximately 1 to 15 cases per 100,000 individuals per year worldwide. The significant variability in clinical presentations and target organs, [...] Read more.
Sarcoidosis is a systemic inflammatory disease with an unknown etiology and a wide range of clinical manifestations. The incidence of sarcoidosis ranges from approximately 1 to 15 cases per 100,000 individuals per year worldwide. The significant variability in clinical presentations and target organs, as well as concomitant diseases, greatly complicates diagnosis. We analyzed articles in PubMed, Scopus, Cochrane Library, and Embase, where databases were searched using the keywords “chronic sarcoidosis”, “diagnosis of sarcoidosis”, “course of sarcoidosis”, “pulmonary sarcoidosis”, “cardiac sarcoidosis”, “skin sarcoidosis”, “neurosarcoidosis”, “ocular sarcoidosis”, and “autoimmune inflammation”. Studies on the course and diagnosis of sarcoidosis with a deep search of ten years were included. In this review, we present an analysis of publications on the course and diagnosis of chronic sarcoidosis, as well as a clinical case. We have noted that the diagnosis of chronic sarcoidosis is particularly difficult due to the lack of specific biomarkers or their combination. The development and introduction of new diagnostic criteria for this disease will contribute to increasing the level of efficiency, not only of the diagnostic complex, but also the prognosis of the development and course of the pathological process. Conclusion: For the most accurate diagnosis and determination of prognosis, the existence of a single immunological or imaging marker with sufficient sensitivity and specificity is necessary. Full article
(This article belongs to the Special Issue Adult Lung Disease: Clinical Symptoms, Diagnosis, and Treatment)
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16 pages, 2403 KiB  
Article
Dry Eye Treatment with Intense Pulsed Light for Improving Visual Outcomes After Cataract Surgery with Diffractive Trifocal Intraocular Lens Implantation
by Takeshi Teshigawara, Miki Akaishi, Yuki Mizuki, Masaki Takeuchi, Kazuro Yabuki, Seiichiro Hata, Akira Meguro and Nobuhisa Mizuki
J. Clin. Med. 2024, 13(22), 6973; https://doi.org/10.3390/jcm13226973 - 19 Nov 2024
Viewed by 515
Abstract
Background/Objectives: Meibomian gland dysfunction (MGD)-related dry eye aggravates postoperative visual outcomes in cataracts. Diffractive trifocal intraocular lenses (IOLs) decrease contrast sensitivity (CS). Intense pulsed light (IPL) improves tear film stability and ocular surface conditions in MGD-related dry eyes. We investigated the effect of [...] Read more.
Background/Objectives: Meibomian gland dysfunction (MGD)-related dry eye aggravates postoperative visual outcomes in cataracts. Diffractive trifocal intraocular lenses (IOLs) decrease contrast sensitivity (CS). Intense pulsed light (IPL) improves tear film stability and ocular surface conditions in MGD-related dry eyes. We investigated the effect of preoperative MGD-related dry eye treatment combining manual meibomian gland expression (MGX) with IPL (IPL-MGX) on visual outcomes post-cataract surgery with diffractive trifocal IOL implantation. Methods: In this single-center, prospective, and open-label study, we enrolled 67 patients (134 eyes) with MGD-related dry eye undergoing cataract surgery on both eyes. Preoperatively, IPL-MGX was performed on one eye (IPL-MGX group) but not the contralateral eye (control group). Tear break-up time, high-order aberrations, and central superficial punctate keratopathy (C-SPK) were assessed. CS and corrected distance visual acuity were analyzed. Differences between groups were analyzed at 1 week, 1 month, and 3 months postoperatively. Results: The IPL-MGX group showed greater mean tear break-up time and lower mean high-order aberration and C-SPK values after preoperative IPL treatment and postoperatively (all p < 0.01). Postoperative CS was higher in the IPL-MGX group at 1 week (all spatial frequencies) (p < 0.01 [cpd = 2.9, 4.5, 7.1, and 10.2] and p < 0.05 [cpd = 1.1 and 1.8]); 1 month [2.9–10.2 cpd] (p < 0.01); and 3 months [4.5–10.2 cpd] (p < 0.01 [cpd = 10.2] and p < 0.05 [cpd = 4.5 and 7.1]) postoperatively. Mean corrected distance visual acuity was higher in the IPL-MGX group only postoperatively (p < 0.01). Conclusions: Preoperative MGD-related dry eye treatment using IPL-MGX enhances tear film stability, ocular surface conditions, and visual outcomes, potentially improving postoperative vision quality and patient satisfaction. Full article
(This article belongs to the Section Ophthalmology)
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14 pages, 869 KiB  
Article
Skin Markers of Premature Ageing in Patients with COPD: Results Form COSYCONET
by Thomas Melzer, Veronika Graf, Angelika Kronseder, Stefan Karrasch, Martina Kerschner, Claus F. Vogelmeier, Robert Bals, Peter Alter, Henrik Watz, Sebastian Fähndrich, Jürgen Behr, Benjamin Waschki, Franziska Christina Trudzinski, Rudolf A. Jörres and Kathrin Kahnert
J. Clin. Med. 2024, 13(22), 6972; https://doi.org/10.3390/jcm13226972 - 19 Nov 2024
Viewed by 450
Abstract
Background: Chronic obstructive pulmonary disease (COPD) is commonly associated with ageing, with the prevalence and severity increasing by age. Smoking-induced premature ageing is thought to contribute to COPD, particularly lung emphysema. This study aimed to explore the relationship between lung function impairment and [...] Read more.
Background: Chronic obstructive pulmonary disease (COPD) is commonly associated with ageing, with the prevalence and severity increasing by age. Smoking-induced premature ageing is thought to contribute to COPD, particularly lung emphysema. This study aimed to explore the relationship between lung function impairment and skin texture, as a marker of biological or premature ageing, in COPD patients. Methods: A subcohort from the COSYCONET COPD-study was analyzed, where skin-relief replicas of the eye’s outer corner and mid-lower inner arm were collected, along with semi-quantitative facial photographs. We examined the correlation between skin parameters and lung function, particularly the diffusing capacity (TLCO) as an indicator of emphysema. Results: Among 46 COPD patients (69 ± 8 years, 52% female), skin texture from the inner forearm, but not from the eye corner, was significantly associated with TLCO% predicted, with a higher skin roughness correlating with a lower TLCO (p = 0.015). This relationship persisted after adjusting for age, BMI, sex, pack years, and smoking status. No significant associations were found with facial photographs. Conclusions: These findings suggest that systemic ageing, reflected in inner arm skin texture, is linked to lung emphysema. Skin ageing markers may be valuable in future interventional studies involving anti-ageing treatments. Full article
(This article belongs to the Section Pulmonology)
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9 pages, 218 KiB  
Article
Functional Mitral Regurgitation Post-Isolated Aortic Valve Replacement
by Petar Dabic, Bojan Vucurevic, Milorad Sevkovic, Dusan Andric, Slobodan Pesic, Mihailo Neskovic, Sasa Borovic and Jovan Petrovic
J. Clin. Med. 2024, 13(22), 6971; https://doi.org/10.3390/jcm13226971 - 19 Nov 2024
Viewed by 440
Abstract
Background: The management of mitral regurgitation during aortic valve replacement remains a complex question. Secondary mitral regurgitation often improves post-aortic valve replacement without mitral valve surgery, but residual mitral regurgitation can significantly affect long-term outcomes. This study investigates the natural history of [...] Read more.
Background: The management of mitral regurgitation during aortic valve replacement remains a complex question. Secondary mitral regurgitation often improves post-aortic valve replacement without mitral valve surgery, but residual mitral regurgitation can significantly affect long-term outcomes. This study investigates the natural history of mitral regurgitation following isolated aortic valve replacement and identifies prognostic factors for persistent mitral regurgitation. Methods: A retrospective study was conducted on 108 patients who underwent isolated aortic valve replacement. Patients were categorized based on mitral regurgitation improvement. Additionally, patients were divided into patient-prosthesis mismatch and non-patient-prosthesis mismatch groups based on the aortic prosthesis. Preoperative and postoperative echocardiographic data were analyzed. Results: In total, 63% of patients showed mitral regurgitation improvement. The improved functional MR group showed significant reductions in peak and mean transvalvular pressure gradients. In contrast, the patient-prosthesis mismatch group had persistent mitral regurgitation improvement in 59.2% of patients. The non-patient-prosthesis mismatch group exhibited significant structural improvements and a reduction in mitral regurgitation severity in 68.6% of patients. Conclusions: The study shows that aortic valve replacement could significantly improve MR when patient-prosthesis mismatch is avoided. This approach maximizes hemodynamic outcomes, mitigates the risk of residual or worsening mitral regurgitation, and potentially reduces the need for additional mitral valve interventions. Full article
(This article belongs to the Special Issue Valvular Heart Disease: From Basic to Clinical Advances)
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