Journal of Clinical Medicine

22 pages, 4459 KiB

Open AccessArticle

The Anti-Inflammatory Effects of Fermented Herbal Roots of Asparagus cochinchinensis in an Ovalbumin-Induced Asthma Model

by Jun Young Choi¹, Ji Eun Kim¹, Jin Ju Park¹, Mi Rim Lee¹, Bo Ram Song¹, Ji Won Park¹, Mi Ju Kang¹, Hee Seob Lee², Hong Joo Son¹, Jin Tae Hong³

and Dae Youn Hwang^1,*,†

¹ College of Natural Resources and Life Science/Life and Industry Convergence Research Institute, Pusan National University, Miryang 627-706, Korea

² College of Human Ecology, Pusan National University, Busan 609-735, Korea

³ College of Pharmacy, Chungbuk National University, Chungju 361-763, Korea

^† Current Address: Department of Biomaterials Science, College of Natural Resources and Life Science, Pusan National University, 50 Cheonghak-ri, Samnangjin-eup Miryang-si, Gyeongsangnam-do 627-706, Korea.

J. Clin. Med. 2018, 7(10), 377; https://doi.org/10.3390/jcm7100377 - 22 Oct 2018

Cited by 17 | Viewed by 5225

Abstract

Introduction: Roots of Asparagus cochinchinensis, which have pharmacologically active ingredients, have received great attention because they show good therapeutic effects for various inflammatory diseases without specific toxicity. This study investigated the anti-asthmatic effects of a butanol extract of Asparagus cochinchinensis roots that [...] Read more.

Introduction: Roots of Asparagus cochinchinensis, which have pharmacologically active ingredients, have received great attention because they show good therapeutic effects for various inflammatory diseases without specific toxicity. This study investigated the anti-asthmatic effects of a butanol extract of Asparagus cochinchinensis roots that had been fermented with Weissella cibaria (BAW) and its possible underlying cholinergic regulation. Methods: Alterations of the anti-asthmatic markers and the molecular response factors were measured in an ovalbumin (OVA)-induced asthma model after treatment with BAW. Results: Treatment with BAW decreased the intracellular reactive oxygen species (ROS) production in lipopolysaccharides (LPS) activated RAW264.7 cells. The results of the animal experiments revealed lower infiltration of inflammatory cells and bronchial thickness, and a significant reduction in the number of macrophages and eosinophils, concentration of OVA-specific IgE, and expression of Th2 cytokines in the OVA + BAW treated group. In addition, a significant recovery of goblet cell hyperplasia, MMP-9 expression, and the VEGF signaling pathway was observed upon airway remodeling in the OVA + BAW treated group. Furthermore, these responses of BAW were linked to recovery of acetylcholine esterase (AChE) activity and muscarinic acetylcholine receptor (mAChR) M3 downstream signaling pathway in epithelial cells, smooth muscle cells, and afferent sensory nerves of OVA + BAW-treated mice. Conclusion: Overall, these findings are the first to provide evidence that the therapeutic effects of BAW can prevent airway inflammation and remodeling through the recovery of cholinergic regulation in structural cells and inflammatory cells of the chronic asthma model. Full article

(This article belongs to the Special Issue Lung Disease on COPD, Asthma, Bronchiectasis, Lung Cancer Screening, IPF)

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9 pages, 221 KiB

Open AccessArticle

Clinical Implications of the NICE 2015 Criteria for Gestational Diabetes Mellitus

by Meena Bhatia^1,*, Lucy H. Mackillop^1,2

, Katy Bartlett¹, Lise Loerup³, Yvonne Kenworthy², Jonathan C. Levy⁴, Andrew J. Farmer⁵, Carmelo Velardo³

, Lionel Tarassenko³ and Jane E. Hirst²

¹ Oxford University Hospitals NHS Foundation Trust, Headington OX3 9DU, UK

² Nuffield Department of Women’s Reproductive Health, University of Oxford, Oxford OX3 9DU, UK

³ Institute of Biomedical Engineering, University of Oxford, Oxford OX3 7DQ, UK

⁴ The Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Trust, Oxford OX3 7LE, UK

⁵ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK

J. Clin. Med. 2018, 7(10), 376; https://doi.org/10.3390/jcm7100376 - 22 Oct 2018

Cited by 17 | Viewed by 5252

Abstract

Background: In response to concerns that the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria labeled too many women with gestational diabetes mellitus (GDM) without evidence of clinical or economic benefit, NICE recommended a change in diagnostic criteria in 2015. Aim: [...] Read more.

Background: In response to concerns that the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria labeled too many women with gestational diabetes mellitus (GDM) without evidence of clinical or economic benefit, NICE recommended a change in diagnostic criteria in 2015. Aim: To compare diabetes associated maternal and neonatal complications in pregnancies complicated by GDM diagnosed using IADPSG criteria only, to those with GDM diagnosed using both IADPSG and NICE 2015 criteria. GDM screening was risk factor based. Methods: This was a secondary analysis of a trial of women with GDM diagnosed by the IADPSG criteria (fasting blood glucose (BG) ≥ 5.1 mmol/L, 1 h ≥ 10.0 mmol/L and 2 h ≥ 8.5 mmol/L). Outcomes were compared for two groups: NICE + IADPSG defined as those with GDM diagnosed by both the NICE 2015 and IADPSG criteria (fasting BG ≥ 5.6 mmol/L, 2 h ≥ 8.5 mmol/L); and IADPSG-ONLY (fasting BG 5.1 mmol/L to 5.5 mmol/L, and/or 1-hour ≥10.0 mmol/L, and 2 h ≥ 8.5 mmol/L). We were not able to obtain data for women with a 2-h value between BG 7.8–8.4 mmol/L (i.e., NICE-ONLY; NICE 2015 positive and IADPSG negative). All women were treated for GDM using targets of fasting BG < 5.3 mmol/L and 1-h post prandial BG < 7.8 mmol/L respectively. Results: Of 159 women, 65 (40.9%) were NICE + IADPSG and 94 (59.1%) IADPSG-ONLY. Hypoglycaemic medication use was similar in both groups: 52.3% NICE + IADPSG, 46.8% IADPSG-ONLY, OR 1.0 (0.5–1.9). The IADPSG-ONLY group delivered later than the NICE + IADPSG group; 39.0 weeks (sd 1.4) compared to 38.2 weeks (sd 2.5), p value 0.02. Fewer caesarean sections occurred in IADPSG-ONLY group 30.9% vs. 52.3%, OR 0.4 (0.2–0.9). Birthweight, large for gestational age, and other neonatal complications were not significantly different between groups. Conclusions: Gestational diabetes-associated perinatal complications were similar in both groups. The IADPSG criteria detect women with evidence of ongoing hyperglycaemia who may benefit from treatment during pregnancy. Full article

(This article belongs to the Special Issue Therapeutic Strategies for Diabetes in Pregnancy)

17 pages, 2325 KiB

Open AccessArticle

PG-Priming Enhances Doxorubicin Influx to Trigger Necrotic and Autophagic Cell Death in Oral Squamous Cell Carcinoma

by Shian-Ren Lin

and Ching-Feng Weng^*

Department of Life Science and Institute of Biotechnology, National Dong Hwa University, Hualien 97401, Taiwan

J. Clin. Med. 2018, 7(10), 375; https://doi.org/10.3390/jcm7100375 - 21 Oct 2018

Cited by 19 | Viewed by 4804

Abstract

Synergistic effects between natural compounds and chemotherapy drugs are believed to have fewer side effects with equivalent efficacy. However, the synergistic potential of prodigiosin (PG) with doxorubicin (Dox) chemotherapy is still unknown. This study explores the synergistic mechanism of PG and Dox against [...] Read more.

Synergistic effects between natural compounds and chemotherapy drugs are believed to have fewer side effects with equivalent efficacy. However, the synergistic potential of prodigiosin (PG) with doxorubicin (Dox) chemotherapy is still unknown. This study explores the synergistic mechanism of PG and Dox against oral squamous cell carcinoma (OSCC) cells. Three OSCC cell lines were treated with different PG/Dox combinatory schemes for cytotoxicity tests and were further investigated for cell death characteristics by cell cycle flow cytometry and autophagy/apoptosis marker labelling. When OSCC cells were pretreated with PG, the cytotoxicity of the subsequent Dox-treatment was 30% higher than Dox alone. The cytotoxic efficacy of PG-pretreated was found better than those of PG plus Dox co-treatment and Dox-pretreatment. Increase of Sub-G1 phase and caspase-3/LC-3 levels without poly (ADP-ribose) polymeras (PARP) elevation indicated both autophagy and necrosis occurred in OSCC cells. Dox flux after PG-priming was further evaluated by rhodamine-123 accumulation and Dox transporters analysis to elucidate the PG-priming effect. PG-priming autophagy enhanced Dox accumulation according to the increase of rhodamine-123 accumulation without the alterations of Dox transporters. Additionally, the cause of PG-triggered autophagy was determined by co-treatment with endoplasmic reticulum (ER) stress or AMP-activated protein kinase (AMPK) inhibitor. PG-induced autophagy was not related to nutrient deprivation and ER stress was proved by co-treatment with specific inhibitor. Taken together, PG-priming autophagy could sensitize OSCC cells by promoting Dox influx without regulation of Dox transporter. The PG-priming might be a promising adjuvant approach for the chemotherapy of OSCC. Full article

(This article belongs to the Special Issue Head and Neck Critical Illness: Basic and Clinical Research Implications)

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7 pages, 205 KiB

Open AccessArticle

Metabolic Profile of Patients with Premature Ovarian Insufficiency

by Agnieszka Podfigurna¹, Angelika Stellmach², Anna Szeliga¹, Adam Czyzyk¹ and Blazej Meczekalski^1,*

¹ Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Polna 33, Poznan 60-535, Poland

² Students Scientific Society of the Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Polna 33, Poznan 60-535, Poland

J. Clin. Med. 2018, 7(10), 374; https://doi.org/10.3390/jcm7100374 - 21 Oct 2018

Cited by 36 | Viewed by 4631

Abstract

Premature ovarian insufficiency (POI) is hypogonadism associated with amenorrhea, increased levels of gonadotropins, and hypoestrogenism. Deficiency of estrogens may contribute to higher risk of cardiovascular diseases and death. POI patients present several risk factors for the development of cardiovascular diseases (CVD): endothelial dysfunction, [...] Read more.

Premature ovarian insufficiency (POI) is hypogonadism associated with amenorrhea, increased levels of gonadotropins, and hypoestrogenism. Deficiency of estrogens may contribute to higher risk of cardiovascular diseases and death. POI patients present several risk factors for the development of cardiovascular diseases (CVD): endothelial dysfunction, abnormal lipid profile, insulin resistance, and insulin action disturbances. Therefore, patients present a higher risk of developing metabolic syndrome. Materials and methods: Follicle stimulating hormone (FSH), luteinizing hormone (LH), 17β-estradiol (E2), prolactin (PRL), testosterone (T), dehydroepiandrosterone sulfate (DHEA-S), thyroid stimulating hormone (TSH), thyroxine (fT4), fasting serum glucose and insulin concentrations, homeostatic model for insulin resistance (HOMA-IR), and lipid profiles were assessed in 56 women (mean age: 30.7 ± 6.9) suffering from POI diagnosed according to European Society of Human Reproduction and Embryology (ESHRE) criteria and 68 healthy age-and-weight matched women (mean age: 27.3 ± 4.5). Results: After regression analysis with BMI and age correction, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) serum concentrations were found to be significantly higher in the POI group, when compared to healthy subjects, whilst triglycerides, glucose, insulin serum concentrations, HOMA-IR, as well as systolic (SBP) and diastolic blood pressure (DBP) did not differ significantly between both groups. A significant positive correlation was identified between TC and LDL-C levels, regardless of BMI and age, whilst SBP correlated only with serum glucose concentration. Additionally, FSH correlated positively with fasting serum glucose concentration after BMI and age correction. Conclusions: Certain metabolic parameters appeared to correlate with POI and these correlations persisted after correction for BMI and age. More research is required to determine the influence of absent ovulatory function on metabolic profiles in POI women. This information may additionally help in early identification of CVD risk factors in those patients. Full article

(This article belongs to the Section Obstetrics & Gynecology)

10 pages, 566 KiB

Open AccessArticle

10-Year Renal Function Trajectories in Community-Dwelling Older Adults: Exploring the Risk Factors for Different Patterns

by Chia-Ter Chao^1,2

, Yung-Ming Chen^3,4

, Fu-Hui Ho⁴, Kun-Pei Lin⁴, Jen-Hau Chen⁴, Chung-Jen Yen^3,* and COGENT Study Group (COhort of GEriatric Nephrology in NTUH)⁵

¹ Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei 10617, Taiwan

² Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei 10617, Taiwan

³ Department of Internal Medicine; National Taiwan University, Taipei 10617, Taiwan

⁴ Department of Geriatrics and Gerontology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan

⁵ COohort of GEriatric Nephrology in National Taiwan University Hospital, Taipei 10617, Taiwan

J. Clin. Med. 2018, 7(10), 373; https://doi.org/10.3390/jcm7100373 - 20 Oct 2018

Cited by 4 | Viewed by 3381

Abstract

Longitudinal changes of renal function help inform patients’ clinical courses and improve risk stratification. Rare studies address risk factors predicting changes in estimated glomerular filtration rate (eGFR) over time in older adults, particularly of Chinese ethnicity. We identified prospectively enrolled community-dwelling older adults [...] Read more.

Longitudinal changes of renal function help inform patients’ clinical courses and improve risk stratification. Rare studies address risk factors predicting changes in estimated glomerular filtration rate (eGFR) over time in older adults, particularly of Chinese ethnicity. We identified prospectively enrolled community-dwelling older adults (≥65 years) receiving annual health examinations between 2005 and 2015 with serum creatinine available continuously in a single institute, and used linear regression to derive individual’s annual eGFR changes, followed by multivariate logistic regression analyses to identify features associated with different eGFR change patterns. Among 500 elderly (71.3 ± 4.2 years), their mean annual eGFR changes were 0.84 ± 1.67 mL/min/1.73 m²/year, with 136 (27.2%) and 238 (47.6%) classified as having downward (annual eGFR change <0 mL/min/1.73 m²/year) and upward eGFR (≥1 mL/min/1.73 m²/year) trajectories, respectively. Multivariate logistic regression showed that higher age (odds ratio (OR) 1.08), worse renal function (OR 13.2), and more severe proteinuria (OR 9.86) or hematuria (OR 3.39) were predictive of a declining eGFR while greater waist circumference (OR 1.06) and higher leukocyte counts (OR 1.21) were predictive of an uprising 10-year eGFR. These findings elucidate important features associated with geriatric renal function variations, which are expected to improve their renal care. Full article

(This article belongs to the Section Immunology)

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10 pages, 932 KiB

Open AccessArticle

Bone Metabolism Markers and Bone Mineral Density in Patients on Long-Term Acenocoumarol Treatment: A Cross-Sectional Study

by Jolanta Sawicka-Powierza^1,2,*, Ewa Jablonska³, Wioletta Ratajczak-Wrona³, Dorota Rogowska-Szadkowska¹

, Marzena Garley³

, Alicja M. Oltarzewska¹, Slawomir Chlabicz¹ and Jerzy Konstantynowicz⁴

¹ Department of Family Medicine, Medical University of Bialystok, Bialystok 15-054, Poland

² Department of Haematology, Medical University of Bialystok, Bialystok 15-276, Poland

³ Department of Immunology, Medical University of Bialystok, Bialystok 15-269, Poland

⁴ Department of Pediatric Rheumatology, Immunology, and Metabolic Bone Diseases, Medical University of Bialystok, Bialystok 15-274, Poland

J. Clin. Med. 2018, 7(10), 372; https://doi.org/10.3390/jcm7100372 - 20 Oct 2018

Cited by 5 | Viewed by 3308

Abstract

The aim of this study was to evaluate levels of osteocalcin (OC), osteoprotegerin (OPG) and total soluble receptor activator of nuclear factor-κB ligand (RANKL), and bone mineral density (BMD) in patients on long-term acenocoumarol (AC) treatment. The cross-sectional study was carried out in [...] Read more.

The aim of this study was to evaluate levels of osteocalcin (OC), osteoprotegerin (OPG) and total soluble receptor activator of nuclear factor-κB ligand (RANKL), and bone mineral density (BMD) in patients on long-term acenocoumarol (AC) treatment. The cross-sectional study was carried out in 42 patients treated long-term with AC and 28 control subjects. Serum concentrations of OC, OPG, and sRANKL were measured using enzyme linked immunosorbent assay (ELISA) kits, and BMD at the femoral neck and lumbar spine were assessed by dual energy X-ray absorptiometry. A significantly decreased concentration of OC was found in AC users compared to control subjects (4.94 ± 2.22 vs. 10.68 ± 4.5; p < 0.001). Levels of OPG, sRANKL logarithm (log), sRANKL/OPG log ratio, and BMD were comparable between. In female AC users, positive correlations between OC and RANKL log, and between OC and RANKL/OPG log ratio (p = 0.017; p = 0.005, respectively), and a negative correlation between OC and OPG (p = 0.027) were found. Long-term AC anticoagulation significantly decreases OC concentration, but does not affect other bone metabolism markers or BMD. Our results also suggest the possibility that long-term treatment with AC may alleviate bone resorption in postmenopausal women. Full article

(This article belongs to the Section Pharmacology)

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11 pages, 4057 KiB

Open AccessConcept Paper

The Vagus Nerve Can Predict and Possibly Modulate Non-Communicable Chronic Diseases: Introducing a Neuroimmunological Paradigm to Public Health

by Yori Gidron^1,*, Reginald Deschepper², Marijke De Couck^2,3

, Julian F. Thayer⁴ and Brigitte Velkeniers⁵

¹ SCALAB UMR CNRS 9193, Université Lille, BP 60149, Villeneuve d’Ascq CEDEX 59653, France

² Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel (VUB), Laerbeeklaan 103, 1090 Jette, Brussels, Belgium

³ Faculty of Health Care, University College Odisee, 9302 Aalst, Belgium

⁴ Department of Neuroscience and Psychology, College of Medicine, Ohio State University, 33 Psychology Building, 1835 Neil Ave. Columbus, OH 43210, USA

⁵ Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Laerbeeklaan 103, 1090 Jette, Brussels, Belgium

J. Clin. Med. 2018, 7(10), 371; https://doi.org/10.3390/jcm7100371 - 19 Oct 2018

Cited by 50 | Viewed by 12843

Abstract

Global burden of diseases (GBD) includes non-communicable conditions such as cardiovascular diseases, cancer and chronic obstructive pulmonary disease. These share important behavioral risk factors (e.g., smoking, diet) and pathophysiological contributing factors (oxidative stress, inflammation and excessive sympathetic activity). This article wishes to introduce [...] Read more.

Global burden of diseases (GBD) includes non-communicable conditions such as cardiovascular diseases, cancer and chronic obstructive pulmonary disease. These share important behavioral risk factors (e.g., smoking, diet) and pathophysiological contributing factors (oxidative stress, inflammation and excessive sympathetic activity). This article wishes to introduce to medicine and public health a new paradigm to predict, understand, prevent and possibly treat such diseases based on the science of neuro-immunology and specifically by focusing on vagal neuro-modulation. Vagal nerve activity is related to frontal brain activity which regulates unhealthy lifestyle behaviors. Epidemiologically, high vagal activity, indexed by greater heart rate variability (HRV), independently predicts reduced risk of GBD and better prognosis in GBD. Biologically, the vagus nerve inhibits oxidative stress, inflammation and sympathetic activity (and associated hypoxia). Finally, current non-invasive methods exist to activate this nerve for neuro-modulation, and have promising clinical effects. Indeed, preliminary evidence exists for the beneficial effects of vagal nerve activation in diabetes, stroke, myocardial infarction and possibly cancer. Thus, we propose to routinely implement measurement of HRV to predict such GBD in populations, and to test in randomized controlled trials effects of non-invasive vagal nerve activation on prevention and treatment of GBD, reflecting possible neuro-modulation of health. Full article

(This article belongs to the Section Epidemiology & Public Health)

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14 pages, 969 KiB

Open AccessArticle

Epidemiology and Prognostic Importance of Atrial Fibrillation in Kidney Transplant Recipients: A Meta-Analysis

by Charat Thongprayoon^1,†, Ronpichai Chokesuwattanaskul^2,†, Tarun Bathini³

, Nadeen J. Khoury⁴, Konika Sharma⁵, Patompong Ungprasert⁶

, Narut Prasitlumkum⁷, Narothama Reddy Aeddula⁸

, Kanramon Watthanasuntorn⁵, Sohail Abdul Salim⁹, Wisit Kaewput¹⁰

, Felicitas L. Koller¹¹ and Wisit Cheungpasitporn^11,*

¹ Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA

² Division of Cardiovascular Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand

³ Department of Internal Medicine, University of Arizona, Tucson, AZ 85721, USA

⁴ Division of Nephrology and Hypertension, Henry Ford Health System, Detroit, MI 48202, USA

⁵ Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY 13326, USA

⁶ Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

⁷ Department of Internal Medicine, University of Hawaii, Honolulu, HI 96822, USA

⁸ Division of Nephrology, Department of Medicine, Deaconess Health System, Evansville, IN 47747, USA

⁹ Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA

¹⁰ Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand

¹¹ Department of Transplant and Hepatobiliary Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA

^† Equally contributed to this article.

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J. Clin. Med. 2018, 7(10), 370; https://doi.org/10.3390/jcm7100370 - 19 Oct 2018

Cited by 18 | Viewed by 5031

Abstract

This meta-analysis was conducted with the aims to summarize all available evidence on (1) prevalence of pre-existing atrial fibrillation (AF) and/or incidence of AF following kidney transplantation; (2) the outcomes of kidney transplant recipients with AF; and (3) the trends of estimated incidence [...] Read more.

This meta-analysis was conducted with the aims to summarize all available evidence on (1) prevalence of pre-existing atrial fibrillation (AF) and/or incidence of AF following kidney transplantation; (2) the outcomes of kidney transplant recipients with AF; and (3) the trends of estimated incidence of AF following kidney transplantation over time. A literature search was conducted utilizing MEDLINE, EMBASE, and the Cochrane Database from inception through March 2018. We included studies that reported (1) prevalence of pre-existing AF or incidence of AF following kidney transplantation or (2) outcomes of kidney transplant recipients with AF. Effect estimates from the individual study were extracted and combined utilizing random-effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42018086192). Eight cohort studies with 137,709 kidney transplant recipients were enrolled. Overall, the pooled estimated prevalence of pre-existing AF in patients undergoing kidney transplantation was 7.0% (95% CI: 5.6–8.8%) and pooled estimated incidence of AF following kidney transplantation was 4.9% (95% CI: 1.7–13.0%). Meta-regression analyses were performed and showed no significant correlations between year of study and either prevalence of pre-existing AF (p = 0.93) or post-operative AF after kidney transplantation (p = 0.16). The pooled odds ratios (OR) of mortality among kidney transplant recipients with AF was 1.86 (3 studies; 95% CI: 1.03–3.35). In addition, AF is also associated with death-censored allograft loss (2 studies; OR: 1.55, 95% CI: 1.02–2.35) and stroke (3 studies; OR: 2.54, 95% CI: 1.11–5.78) among kidney transplant recipients. Despite advances in medicine, incidence of AF following kidney transplant does not seem to decrease over time. In addition, there is a significant association of AF with increased mortality, allograft loss, and stroke after kidney transplantation. Full article

(This article belongs to the Section Clinical Laboratory Medicine)

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8 pages, 1657 KiB

Open AccessArticle

Could Cardiovascular Health Metrics Account for Age and Sex Disparities in Self-Reported Ischemic Heart Disease Prevalence?

by Yang Peng^* and Zhiqiang Wang

Centre for Chronic Disease, School of Clinical Medicine, The University of Queensland, Herston, QLD 4006, Australia

J. Clin. Med. 2018, 7(10), 369; https://doi.org/10.3390/jcm7100369 - 19 Oct 2018

Cited by 3 | Viewed by 3341

Abstract

The American Heart Association has outlined seven modifiable cardiovascular health (CVH) metrics. However, the sex and age disparities in the association between those CVH metrics and ischemic heart disease (IHD) prevalence are unclear. Our study sought to examine the possible sex and age [...] Read more.

The American Heart Association has outlined seven modifiable cardiovascular health (CVH) metrics. However, the sex and age disparities in the association between those CVH metrics and ischemic heart disease (IHD) prevalence are unclear. Our study sought to examine the possible sex and age variations in the association between CVH metrics and IHD prevalence using an Australian nationally representative survey. We used the core sample of the 2011–2012 Australian Health Survey, and 7499 adults with fasting plasma glucose (FPG) and total cholesterol values were included. We used Poisson regression analysis to measure the associations between individual metrics and IHD prevalence. Our study used both stratification and interaction analyses to compare the magnitude of associations between sex and age groups. Then, we calculated the population attributable fractions to measure the contribution of each metric to IHD prevalence. In addition, we applied logistic regression analysis to examine the influences of ideal CVH metrics number on IHD prevalence and used stratification and interaction analyses. Body mass index, physical activity, blood pressure, and FPG have greater effects on IHD prevalence in young adults compared to older adults. We failed to detect the sex variations in CVH metrics and IHD prevalence. The ideal CVH metrics number was inversely correlated to IHD prevalence and it has similar effects in four subgroups. These CVH metrics do not explain the sex and age disparities in IHD prevalence and the topic need further explorations. Full article

(This article belongs to the Section Cardiology)

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13 pages, 1168 KiB

Open AccessArticle

Effects of Widespread Inotrope Use in Acute Heart Failure Patients

by Jeehoon Kang¹, Hyun-Jai Cho^1,*, Hae-Young Lee¹, Sangjun Lee²

, Sue K. Park², Sang Eun Lee³, Jae-Joong Kim³, Eun-Seok Jeon⁴, Shung Chull Chae⁵, Sang Hong Baek⁶, Seok-Min Kang⁷, Dong-Ju Choi⁸, Byung-Su Yoo⁹, Kye Hun Kim¹⁰, Myeong-Chan Cho¹¹ and Byung-Hee Oh¹

¹ Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea

² Department of Preventive Medicine and Department of Biomedical Science, Seoul National University College of Medicine, Seoul 03080, Korea

³ Department of Cardiology, Asian Medical Center, Seoul 05505, Korea

⁴ Department of Medicine, Sungkyunkwan University College of Medicine, Seoul 16419, Korea

⁵ Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu 37224, Korea

⁶ Department of Internal Medicine, The Catholic University of Korea, Seoul 06591, Korea

⁷ Yonsei University College of Medicine, Seoul 03722, Korea

⁸ Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea

⁹ Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea

¹⁰ Heart Research Center of Chonnam National University, Gwangju 61469, Korea

¹¹ Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju 28644, Korea

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J. Clin. Med. 2018, 7(10), 368; https://doi.org/10.3390/jcm7100368 - 18 Oct 2018

Cited by 8 | Viewed by 4566

Abstract

Current guidelines recommend that inotropes should not be used in patients with normal systolic blood pressure (SBP). However, this is not supported with concrete evidence. We aimed to evaluate the effect of inotropes in acute heart failure (HF) patients from a nationwide HF [...] Read more.

Current guidelines recommend that inotropes should not be used in patients with normal systolic blood pressure (SBP). However, this is not supported with concrete evidence. We aimed to evaluate the effect of inotropes in acute heart failure (HF) patients from a nationwide HF registry. A total of 5625 patients from the Korean Acute Heart Failure (KorAHF) registry were analyzed. The primary outcomes were in-hospital adverse events and 1-month mortality. Among the total population, 1703 (31.1%) received inotropes during admission. Inotrope users had a higher event rate than non-users (in-hospital adverse events: 13.3% vs. 1.4%, p < 0.001; 1-month mortality: 5.5% vs. 2.5%, p < 0.001), while inotrope use was an independent predictor for clinical outcomes (in-hospital adverse events: OR_adjusted 5.459, 95% CI 3.622–8.227, p < 0.001; 1-month mortality: HR_adjusted 1.839, 95% CI 1.227–2.757, p = 0.003). Subgroup analysis showed that inotrope use was an independent predictor for detrimental outcomes only in patients with normal initial SBP (≥90 mmHg) (in-hospital adverse events: OR_adjusted 5.931, 95% CI 3.864–9.104, p < 0.001; 1-month mortality: HR_adjusted 3.584, 95% CI 1.280–10.037, p = 0.015), and a propensity score-matched population showed consistent results. Clinicians should be cautious with the usage of inotropes in acute heart failure patients, especially in those with a normal SBP. Full article

(This article belongs to the Section Cardiology)

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16 pages, 2651 KiB

Open AccessArticle

Factors Influencing Variations in Hospitalization for Diabetes with Hypoglycemia

by Waleed Kattan¹

and Thomas T. H. Wan^2,*

¹ Department of Health Services and Hospitals Administration, College of Economics and Management, King Abdulaziz University, Jeddah 21589, Saudi Arabia

² Department of Health Management and Informatics, University of Central Florida, Orlando, FL 32816, USA

J. Clin. Med. 2018, 7(10), 367; https://doi.org/10.3390/jcm7100367 - 18 Oct 2018

Cited by 7 | Viewed by 4742

Abstract

Many studies have explored risk factors associated with Hypoglycemia (HG) and examined the variation in healthcare utilization among HG patients. However, most of these studies failed to integrate a comprehensive list of personal risk factors in their investigations. This empirical study employed the [...] Read more.

Many studies have explored risk factors associated with Hypoglycemia (HG) and examined the variation in healthcare utilization among HG patients. However, most of these studies failed to integrate a comprehensive list of personal risk factors in their investigations. This empirical study employed the Behavioral Model (BM) of health care utilization as a framework to investigate diabetes’ hospitalizations with HG. The national inpatient sample with all non-pregnant adult patients admitted to hospitals’ emergency departments and diagnosed with HG from 2012 to 2014 was used. Personal factors were grouped as predictors of the length of stay and the total charges incurred for hospitalization. High-risk profiles of hospitalized HG patients were identified. The analysis shows the need for care factors are the most influential predictors for lengthy hospitalization. The predisposing factors have a limited influence, while enabling factors influence the variation in hospital total charges. The presence of renal disease and diabetes mellitus (DM) complications played a key role in predicting hospital utilization. Furthermore, age, socio-economic status (SES), and the geographical location of the patients were also found to be vital factors in determining the variability in utilization among HG patients. Findings provide practical applications for targeting the high-risk HG patients for interventions. Full article

(This article belongs to the Special Issue Type 2 Diabetes: Update on Pathophysiology and Treatment)

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12 pages, 474 KiB

Open AccessArticle

Hysterectomies Are Associated with an Increased Risk of Depression: A Population-Based Cohort Study

by Tomor Harnod¹, Weishan Chen^2,3, Jen-Hung Wang⁴

, Shinn-Zong Lin¹ and Dah-Ching Ding^4,5,6,*

¹ Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 970, Taiwan

² Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan

³ College of Medicine, China Medical University, Taichung 404, Taiwan

⁴ Department of Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 970, Taiwan

⁵ Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien 970, Taiwan

⁶ Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan

J. Clin. Med. 2018, 7(10), 366; https://doi.org/10.3390/jcm7100366 - 18 Oct 2018

Cited by 18 | Viewed by 5367

Abstract

Using the National Health Insurance Research Database of Taiwan, we investigated whether undergoing a hysterectomy increases the risk of depression. A total of 7872 patients aged 30–49 years who underwent a hysterectomy from 2000 to 2013 were enrolled as the hysterectomy group. The [...] Read more.

Using the National Health Insurance Research Database of Taiwan, we investigated whether undergoing a hysterectomy increases the risk of depression. A total of 7872 patients aged 30–49 years who underwent a hysterectomy from 2000 to 2013 were enrolled as the hysterectomy group. The comparison group was randomly selected from women who had never undergone a hysterectomy and was four times the size of the hysterectomy group. We calculated adjusted hazard ratios and 95% confidence intervals (CIs) for depression [The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 296.2, 296.3, 300.4, 311] in these cohorts after adjusting for age, comorbidities, oophorectomy, and hormone therapy. The overall incidence of depression was 1.02 and 0.66 per 100 person-years in the hysterectomy and comparison cohorts, respectively, yielding an adjusted hazard ratio of 1.35 (95% CI = 1.22–1.50) for depression risk. When we stratified patients by age, comorbidities, oophorectomy, and hormone use, hysterectomy increased the risk of depression. Hysterectomy, oophorectomy, and post-surgery hormone use were associated with an increased risk of depression when they occurred alone, but conferred a greater risk if they were considered jointly. Hysterectomy would be a predisposing factor for increased risk of subsequent depression. Our findings provide vital information for patients, clinicians, and the government for improving the treatment strategy in the future. Full article

(This article belongs to the Section Mental Health)

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23 pages, 4012 KiB

Open AccessArticle

AST-120 Reduces Neuroinflammation Induced by Indoxyl Sulfate in Glial Cells

by Simona Adesso¹, Irene Paterniti², Salvatore Cuzzocrea²

, Masaki Fujioka³, Giuseppina Autore¹

, Tim Magnus^4,†, Aldo Pinto¹ and Stefania Marzocco^1,*,†

¹ Department of Pharmacy, University of Salerno, Via Giovanni Paolo II 132, Fisciano, I-84084 Salerno, Italy

² Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale Ferdinando Stagno D’Alcontres 31, 98166 Messina, Italy

³ Pharmaceuticals Division, Kureha Corporation, Tokyo 169-8503, Japan

⁴ Department of Neurology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany

^† These authors equally contributed as last author.

J. Clin. Med. 2018, 7(10), 365; https://doi.org/10.3390/jcm7100365 - 17 Oct 2018

Cited by 60 | Viewed by 5463

Abstract

Chronic kidney disease (CKD) involves multiple organ dysfunction, and the neurological complications that are often present in CKD patients support the idea of a crosstalk between the kidneys and the brain. Evidence suggests a possible role for products accumulating in these patients as [...] Read more.

Chronic kidney disease (CKD) involves multiple organ dysfunction, and the neurological complications that are often present in CKD patients support the idea of a crosstalk between the kidneys and the brain. Evidence suggests a possible role for products accumulating in these patients as uremic toxins in various CKD complications, including neurodegeneration. Indoxyl sulfate (IS), derived from tryptophan metabolism, is well-known as a uremic nephron-vascular toxin, and recent evidence suggests it also has a role in the immune response and in neurodegeneration. Inflammation has been associated with neurodegenerative diseases, as well as with CKD. In this study, we demonstrated that sera of CKD patients induced a significant inflammation in astrocyte cells which was proportional to IS sera concentrations, and that the IS adsorbent, AST-120, reduced this inflammatory response. These results indicated that, among the uremic toxins accumulating in serum of CKD patients, IS significantly contributed to astrocyte inflammation. Moreover, being also chronic inflammation associated with CKD, here we reported that IS further increased inflammation and oxidative stress in primary central nervous system (CNS) cells, via Nuclear Factor-κB (NF-κB) and Aryl hydrocarbon Receptor (AhR) activation, and induced neuron death. This study is a step towards elucidating IS as a potential pharmacological target in CKD patients. Full article

(This article belongs to the Special Issue Clinical Symptoms, Diagnostics and Treatments of Chronic Kidney Diseases (CKD))

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14 pages, 609 KiB

Open AccessArticle

Physician Empathy Interacts with Breaking Bad News in Predicting Lung Cancer and Pleural Mesothelioma Patient Survival: Timing May Be Crucial

by Sophie Lelorain^1,*

, Alexis Cortot², Véronique Christophe¹, Claire Pinçon³

and Yori Gidron¹

¹ University of Lille, CNRS, CHU Lille, UMR 9193—SCALab—Cognitive and Affective Sciences, F-59000 Lille, France

² University of Lille, Department of Thoracic Oncology, Albert Calmette University Hospital, F-59000 Lille, France

³ University of Lille, CHU Lille, EA 2694, Public Health: Epidemiology and Quality of Care, F-59000 Lille, France

J. Clin. Med. 2018, 7(10), 364; https://doi.org/10.3390/jcm7100364 - 17 Oct 2018

Cited by 13 | Viewed by 4427

Abstract

This study is the first to examine the prognostic role of physician empathy in interaction with the type of consultation (TC) (TC, bad news versus follow-up consultations) in cancer patient survival. Between January 2015 and March 2016, 179 outpatients with thoracic cancer and [...] Read more.

This study is the first to examine the prognostic role of physician empathy in interaction with the type of consultation (TC) (TC, bad news versus follow-up consultations) in cancer patient survival. Between January 2015 and March 2016, 179 outpatients with thoracic cancer and a Karnofsky performance status ≥60 assessed their oncologist’s empathy using the CARE questionnaire, which provides a general score and two sub-dimensions: listening/compassion and active/positive empathy. Survival was recorded until April 2018. Usual medical, social and psychological confounders were included in the Cox regression. The median follow-up time was 3.1 years. There was a statistical interaction between listening/compassion empathy and TC (p = 0.016) such that in bad news consultations, higher listening/compassion predicted a higher risk of death (hazard ratio (HR) = 1.13; 95% confidence interval (CI): 1.03–1.23; p = 0.008). In follow-up consultations, listening/compassion did not predict survival (HR = 0.94; 95% CI: 0.85–1.05; p = 0.30). The same results were found with the general score of empathy, but not with active/positive empathy. In bad news consultations, high patient-perceived physician compassion could worry patients by conveying the idea that there is no longer any hope, which could hasten death. Further studies are warranted to confirm these results and find out the determinants of patient perception of physician empathy. Full article

(This article belongs to the Section Epidemiology & Public Health)

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26 pages, 1488 KiB

Open AccessReview

Emotional Prosody Processing in Schizophrenic Patients: A Selective Review and Meta-Analysis

by Yi Lin¹, Hongwei Ding^1,* and Yang Zhang^2,*

¹ Institute of Cross-Linguistic Processing and Cognition, School of Foreign Languages, Shanghai Jiao Tong University, Shanghai 200240, China

² Department of Speech-Language-Hearing Sciences & Center for Neurobehavioral Development, University of Minnesota, Twin Cities, MN 55455, USA

J. Clin. Med. 2018, 7(10), 363; https://doi.org/10.3390/jcm7100363 - 17 Oct 2018

Cited by 40 | Viewed by 7025

Abstract

Emotional prosody (EP) has been increasingly recognized as an important area of schizophrenic patients’ dysfunctions in their language use and social communication. The present review aims to provide an updated synopsis on emotional prosody processing (EPP) in schizophrenic disorders, with a specific focus [...] Read more.

Emotional prosody (EP) has been increasingly recognized as an important area of schizophrenic patients’ dysfunctions in their language use and social communication. The present review aims to provide an updated synopsis on emotional prosody processing (EPP) in schizophrenic disorders, with a specific focus on performance characteristics, the influential factors and underlying neural mechanisms. A literature search up to 2018 was conducted with online databases, and final selections were limited to empirical studies which investigated the prosodic processing of at least one of the six basic emotions in patients with a clear diagnosis of schizophrenia without co-morbid diseases. A narrative synthesis was performed, covering the range of research topics, task paradigms, stimulus presentation, study populations and statistical power with a quantitative meta-analytic approach in Comprehensive Meta-Analysis Version 2.0. Study outcomes indicated that schizophrenic patients’ EPP deficits were consistently observed across studies (d = −0.92, 95% CI = −1.06 < δ < −0.78), with identification tasks (d = −0.95, 95% CI = −1.11 < δ < −0.80) being more difficult to process than discrimination tasks (d = −0.74, 95% CI = −1.03 < δ < −0.44) and emotional stimuli being more difficult than neutral stimuli. Patients’ performance was influenced by both participant- and experiment-related factors. Their social cognitive deficits in EP could be further explained by right-lateralized impairments and abnormalities in primary auditory cortex, medial prefrontal cortex and auditory-insula connectivity. The data pointed to impaired pre-attentive and attentive processes, both of which played important roles in the abnormal EPP in the schizophrenic population. The current selective review and meta-analysis support the clinical advocacy of including EP in early diagnosis and rehabilitation in the general framework of social cognition and neurocognition deficits in schizophrenic disorders. Future cross-sectional and longitudinal studies are further suggested to investigate schizophrenic patients’ perception and production of EP in different languages and cultures, modality forms and neuro-cognitive domains. Full article

(This article belongs to the Section Mental Health)

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12 pages, 579 KiB

Open AccessArticle

Impaired Executive Functioning of Sexual Assault Survivors with Acute Stress Disorder

by Su Mi Park^1,2,†

, Jung-Seok Choi^1,3,†

, Ji Sun Lee¹

, Jun-Young Lee^1,4

, Saerom Lee¹

and Hee Yeon Jung^1,2,3,*

¹ Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul 07061, Korea

² Department of Clinical Medical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea

³ Department of Psychiatry and Behavioral Science and Institute of Human Behavioral Medicine, National University College of Medicine, Seoul 03080, Korea

⁴ Department of Psychiatry and Neuroscience Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea

^† These authors contributed equally to this work.

J. Clin. Med. 2018, 7(10), 362; https://doi.org/10.3390/jcm7100362 - 16 Oct 2018

Cited by 3 | Viewed by 3941

Abstract

This study aimed to examine the executive functioning of survivors exposed to recent sexual assaults. Twenty-seven female rape survivors who met the criterion for acute stress disorder (ASD) were enrolled and completed the assessment within 4 weeks after the traumatic experience. Additionally, 25 [...] Read more.

This study aimed to examine the executive functioning of survivors exposed to recent sexual assaults. Twenty-seven female rape survivors who met the criterion for acute stress disorder (ASD) were enrolled and completed the assessment within 4 weeks after the traumatic experience. Additionally, 25 age-matched female health controls (HC) never exposed to such a traumatic event were enrolled. The assessments evaluated psychiatric symptoms including post-traumatic stress symptoms, depression, anxiety, and trait and state anger; general intelligence indexed by intellectual quotient (IQ); and executive functioning including set-shift/attention, planning, spatial working memory, and inhibition using the Cambridge Neuropsychological Test Automated Battery. The ASD group showed higher levels of depression, anxiety, and state anger, and lower IQ than the HC group. The ASD group also showed global impairment of executive functioning for set-shifting, attention, planning, and response inhibition compared to the HC group. Rather than being associated with low IQ and education levels, these results could be from trauma-related effects in survivors with ASD. Additionally, the state anger level was related to survivors’ deficient executive functioning. The findings indicate the importance of providing assessment and intervention efforts to sexual assault survivors soon after the trauma occurs. Full article

(This article belongs to the Section Mental Health)

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10 pages, 240 KiB

Open AccessArticle

Reduced Cardiorespiratory Capacity in Children with Autism Spectrum Disorders

by Véronique-Aurélie Bricout^1,2,3,*

, Marion Pace³, Léa Dumortier^1,3, Flavie Baillieul³, Anne Favre-Juvin^2,3 and Michel Guinot^2,3

¹ Université Grenoble Alpes, INSERM U1042, HP2, F-38000 Grenoble, France

² UM Sports et Pathologies, CHU Sud, CS 90338, Avenue de Kimberley, F-38434 Echirolles CEDEX, France

³ CHU de Grenoble, UF Recherche Exercice, UM Sports et Pathologies, F-38000 Grenoble, France

J. Clin. Med. 2018, 7(10), 361; https://doi.org/10.3390/jcm7100361 - 16 Oct 2018

Cited by 27 | Viewed by 4396

Abstract

Background—Children with autistic spectrum disorders (ASDs) are frequently hampered by motor impairment. It limits them from regularly practicing physical activities and results in a lower physical fitness even though low cardiorespiratory fitness is one of the most important predictors of all-cause mortality. [...] Read more.

Background—Children with autistic spectrum disorders (ASDs) are frequently hampered by motor impairment. It limits them from regularly practicing physical activities and results in a lower physical fitness even though low cardiorespiratory fitness is one of the most important predictors of all-cause mortality. This study aimed to investigate the cardiorespiratory fitness of boys with ASD compared to typically developed children. Methods—forty male children participated. Twenty were control children (CONT—10.0 ± 1.6 years) and 20 were ASD children (ASD—10.7 ± 1.2 years; intellectual quotient > 70). All participants completed an incremental exercise test on a treadmill. An evaluation of motor characteristics by three tests was conducted (muscular strength; explosive power; flexibility). Assessments of daily physical activity were obtained by questionnaires (PAQ-C) and by actigraphy. Results—in the ASD group, aerobic capacity values (VO_2peak), effort duration and maximal speed were significantly lower compared to CONT (p < 0.05). Flexibility, explosive power and muscular strength were significantly lower in ASD compared to CONT (p < 0.05). Similarities between all children were observed for physical activity evaluation by actigraphy and with the PAQ-C. Conclusions—children with ASD had lower cardiorespiratory fitness than CONT despite similar physical activity levels. Our results suggested that the difference may be due to motor discrepancies. Full article

(This article belongs to the Section Mental Health)

11 pages, 1185 KiB

Open AccessArticle

Higher Screening Aldosterone to Renin Ratio in Primary Aldosteronism Patients with Diabetes Mellitus

by Chia-Hui Chang^1,2

, Ya-Hui Hu¹, Kuo-How Huang³, Yen-Hung Lin⁴

, Yao-Chou Tsai⁵, Che-Hsiung Wu⁶, Shao-Yu Yang⁷, Chin-Chen Chang⁸, Ching-Chu Lu⁹, Kwan-Dun Wu⁷ and Vin-Cent Wu^7,10,*

¹ Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Taipei 23142, Taiwan

² Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 10002, Taiwan

³ Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan

⁴ Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan

⁵ Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Taipei 23142, Taiwan

⁶ Division of Nephrology, Department of Internal Medicine, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, Taipei 23142, Taiwan

⁷ Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei 10002, Taiwan

⁸ Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan

⁹ Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10002, Taiwan

¹⁰ TAIPAI, Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group, Taipei 10002, Taiwan

J. Clin. Med. 2018, 7(10), 360; https://doi.org/10.3390/jcm7100360 - 16 Oct 2018

Cited by 10 | Viewed by 4309

Abstract

Accumulated evidence has shown that low renin hypertension is common in patients with diabetic nephropathy. However, the performance of aldosterone to renin ratio (ARR) in primary aldosteronism (PA) patients with diabetes has not been well validated. Here, we report the performance of screening [...] Read more.

Accumulated evidence has shown that low renin hypertension is common in patients with diabetic nephropathy. However, the performance of aldosterone to renin ratio (ARR) in primary aldosteronism (PA) patients with diabetes has not been well validated. Here, we report the performance of screening ARR in PA patients with diabetes. The study enrolled consecutive patients and they underwent ARR testing at screening. Then the diagnosis of PA was confirmed from the Taiwan Primary Aldosteronism Investigation registration dataset. Generalized additive model smoothing plot was used to validate the performance of screening ARR in PA patients with or without diabetes. During this study period, 844 PA patients were confirmed and 136 (16.0%) among them had diabetes. Other 816 patients were diagnosed with essential hypertension and used as the control group and 89 (10.9%) among them had diabetes. PA patients with diabetes were older and had a longer duration of hypertensive latency, higher systolic blood pressure and lower glomerular filtration rate than those PA patients without diabetes. The cut-off value of ARR in the generalized additive model predicting PA was 65 ng/dL per ng/mL/h in diabetic patients, while 45 ng/dL per ng/mL/h in non-diabetic patients. There was a considerable prevalence of diabetes among PA patients, which might be capable of interfering with the conventional screening test. The best cut-off value of ARR, more than 65 ng/dL per ng/mL/h in PA patients with diabetes, was higher than those without diabetes. Full article

(This article belongs to the Special Issue Advanced Analytical Methods in Clinical Diagnosis and Therapy)

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9 pages, 1197 KiB

Open AccessArticle

Apparent Diffusion Coefficient Is a Novel Imaging Biomarker of Myopathic Changes in Liver Cirrhosis

by Alexey Surov^1,*

, Lisa Paul¹, Hans Jonas Meyer¹

, Stefan Schob¹, Cornelius Engelmann^2,3 and Andreas Wienke⁴

¹ Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany

² Section Hepatology, Department of Gastroenterology and Rheumatology, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany

³ Institute for Liver and Digestive Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK

⁴ Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther University, 06112 Halle-Wittenberg, Germany

J. Clin. Med. 2018, 7(10), 359; https://doi.org/10.3390/jcm7100359 - 15 Oct 2018

Cited by 12 | Viewed by 3731

Abstract

Diffusion weighted imaging can provide information regarding tissue composition and can quantitatively characterize different pathological changes by means of apparent diffusion coefficient (ADC). The study comprised of 114 patients with liver cirrhosis—22 women and 92 men with a mean age of 56.5 ± [...] Read more.

Diffusion weighted imaging can provide information regarding tissue composition and can quantitatively characterize different pathological changes by means of apparent diffusion coefficient (ADC). The study comprised of 114 patients with liver cirrhosis—22 women and 92 men with a mean age of 56.5 ± 9.0 years. In all patients, the Model for End Stage-Liver Disease (MELD) score was calculated. Furthermore, 12 healthy persons (5 women, 7 men), mean age, 42.1 ± 16.2 years, were investigated as a control group. In all cases, magnetic resonance imaging of the liver/trunk was performed using different 3T scanners and diffusion weighted images were obtained with a multi-shot SE-EPI sequence. In all cases, polygonal regions of interest were manually drawn on the ADC maps along the contours of the iliopsoas and paravertebral muscles. The comparison of ADC values in groups was performed by Mann-Whitney-U tests. The association between ADC and MELD score was calculated by Spearman’s rank correlation coefficient. ADC values of the skeletal musculature were statistically much higher in comparison to those in the control group: 1.85 ± 0.46 × 10⁻³ mm² s⁻¹ vs. 1.23 ± 0.12 × 10⁻³ mm² s⁻¹, p = 0.001. ADC values showed statistically significant correlation with the MELD score (r = 0.473, p = 0.0001). Furthermore, ADC values differed between the subgroups with different values of the MELD score. ADC values correlated slightly with lactate dehydrogenase (LDH) (r = 0.381, p = 0.0001) and tended to correlate with C-reactive protein (CRP) (r = 0.171, p = 0.07) and alanine aminotransferase (ALAT) (r = −0.167, p = 0.076). ADC can reflect muscle changes in liver cirrhosis and shows statistically significant correlation with the MELD score. Therefore, ADC can be used as an imaging biomarker of myopathic changes in liver cirrhosis. Full article

(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)

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10 pages, 467 KiB

Open AccessArticle

Patient- and Surgery-Related Factors that Affect Patient-Reported Outcomes after Total Hip Arthroplasty

by Toshiyuki Kawai^*

, Masanao Kataoka, Koji Goto, Yutaka Kuroda

, Kazutaka So and Shuichi Matsuda

Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan

J. Clin. Med. 2018, 7(10), 358; https://doi.org/10.3390/jcm7100358 - 15 Oct 2018

Cited by 17 | Viewed by 4084

Abstract

Patient-reported outcome measures (PROMs) are used to assess satisfaction after total hip arthroplasty (THA); however, the factors that determine these PROMs remain unclear. This study aimed to identify the patient- and surgery-related factors that affect patient satisfaction after THA as indicated by the [...] Read more.

Patient-reported outcome measures (PROMs) are used to assess satisfaction after total hip arthroplasty (THA); however, the factors that determine these PROMs remain unclear. This study aimed to identify the patient- and surgery-related factors that affect patient satisfaction after THA as indicated by the Oxford Hip Score (OHS). One-hundred-and-twenty patients who underwent primary THA were included. Various patient-related factors, including clinical scores, and surgery-related factors were examined for potential correlations with the OHS at 3, 6, and 12 months post-THA. Univariate regression analysis showed that higher preoperative University of California Los Angeles (UCLA) activity score (p = 0.027) and better preoperative OHS (p = 0.0037) were correlated with better OHS at 3 months post-THA. At 6 months post-THA, the factors associated with better OHS were higher preoperative UCLA activity score (p = 0.039), better preoperative OHS (p = 0.0006), and use of a cemented stem (p = 0.0071). At 12 months post-THA, the factors associated with better OHS were higher preoperative UCLA activity score (p = 0.0075) and better preoperative OHS (p < 0.0001). Multivariate regression analysis showed that the factors significantly correlated with better OHS were female sex (p = 0.011 at 3 months post-THA), osteoarthritis (p = 0.043 at 6 months), higher preoperative OHS (p < 0.001 at 3 and 12 months, p = 0.018 at 6 months), higher preoperative Harris Hip Score (p = 0.001 at 3 months), higher preoperative UCLA activity score (p = 0.0075 at 3 months), and the use of a cemented femoral component (p = 0.012 at 6 months). Patient- and surgery-related factors affecting post-THA PROMs were identified, although the effect of these factors decreased over time. Full article

(This article belongs to the Special Issue Complications in Total Joint Arthroplasties)

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19 pages, 925 KiB

Open AccessReview

NANOmetric BIO-Banked MSC-Derived Exosome (NANOBIOME) as a Novel Approach to Regenerative Medicine

by Bruna Codispoti¹

, Massimo Marrelli², Francesco Paduano¹

and Marco Tatullo^1,*

¹ Tecnologica Research Institute, 88900 Crotone, Italy

² Marrelli Health, 88900 Crotone, Italy

J. Clin. Med. 2018, 7(10), 357; https://doi.org/10.3390/jcm7100357 - 15 Oct 2018

Cited by 66 | Viewed by 6405

Abstract

Mesenchymal stem cells (MSCs) are well known for their great potential in clinical applications. In fact, MSCs can differentiate into several cell lineages and show paracrine behavior by releasing endogenous factors that stimulate tissue repair and modulate local immune response. Each MSC type [...] Read more.

Mesenchymal stem cells (MSCs) are well known for their great potential in clinical applications. In fact, MSCs can differentiate into several cell lineages and show paracrine behavior by releasing endogenous factors that stimulate tissue repair and modulate local immune response. Each MSC type is affected by specific biobanking issues—technical issues as well as regulatory and ethical concerns—thus making it quite tricky to safely and commonly use MSC banking for swift regenerative applications. Extracellular vesicles (EVs) include a group of 150–1000 nm vesicles that are released by budding from the plasma membrane into biological fluids and/or in the culture medium from varied and heterogenic cell types. EVs consist of various vesicle types that are defined with different nomenclature such as exosomes, shedding vesicles, nanoparticles, microvesicles and apoptotic bodies. Ectosomes, micro- and nanoparticles generally refer to the direct release of single vesicles from the plasma membrane. While many studies describe exosomes as deriving from multivesicular bodies, solid evidence about the origin of EVs is often lacking. Extracellular vesicles represent an important portion of the cell secretome. Their numerous properties can be used for diagnostic, prognostic, and therapeutic uses, so EVs are considered to be innovative and smart theranostic tools. The aim of this review is to investigate the usefulness of exosomes as carriers of the whole information panel characterizing the use of MSCs in regenerative medicine. Our purpose is to make a step forward in the development of the NANOmetric BIO-banked MSC-derived Exosome (NANOBIOME). Full article

(This article belongs to the Special Issue Biobanking and Regenerative Medicine)

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30 pages, 948 KiB

Open AccessReview

Drug-Induced Interstitial Lung Disease: A Systematic Review

by Sarah Skeoch^1,2, Nicholas Weatherley³, Andrew J. Swift³, Alexander Oldroyd¹, Christopher Johns³, Conal Hayton⁴, Alessandro Giollo^5,6

, James M. Wild³, John C. Waterton^7,8

, Maya Buch⁵, Kim Linton⁹

, Ian N. Bruce^1,10, Colm Leonard⁴, Stephen Bianchi¹¹ and Nazia Chaudhuri^4,*

¹ Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK

² Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath BA1 1RL, UK

³ Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK

⁴ North West Lung Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M6 8HD, UK

⁵ Leeds Institute of Rheumatic and Musculoskeletal Medicine, NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds LS2 9JT, UK

⁶ Rheumatology Unit, Department of Medicine, University of Verona, 37134 Verona, Italy

⁷ Bioxydyn Limited, Rutherford House, Manchester Science Park, Manchester M15 6SZ, UK

⁸ Centre for Imaging Sciences, Division of Informatics Imaging & Data Sciences, School of Health Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK

⁹ Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester M13 9PL, UK

¹⁰ The Kellgren Centre for Rheumatology, NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M6 8HD, UK

¹¹ Academic Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK

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J. Clin. Med. 2018, 7(10), 356; https://doi.org/10.3390/jcm7100356 - 15 Oct 2018

Cited by 290 | Viewed by 31153

Abstract

Background: Drug-induced interstitial lung disease (DIILD) occurs as a result of numerous agents, but the risk often only becomes apparent after the marketing authorisation of such agents. Methods: In this PRISMA-compliant systematic review, we aimed to evaluate and synthesise the current literature on [...] Read more.

Background: Drug-induced interstitial lung disease (DIILD) occurs as a result of numerous agents, but the risk often only becomes apparent after the marketing authorisation of such agents. Methods: In this PRISMA-compliant systematic review, we aimed to evaluate and synthesise the current literature on DIILD. Results: Following a quality assessment, 156 full-text papers describing more than 6000 DIILD cases were included in the review. However, the majority of the papers were of low or very low quality in relation to the review question (78%). Thus, it was not possible to perform a meta-analysis, and descriptive review was undertaken instead. DIILD incidence rates varied between 4.1 and 12.4 cases/million/year. DIILD accounted for 3–5% of prevalent ILD cases. Cancer drugs, followed by rheumatology drugs, amiodarone and antibiotics, were the most common causes of DIILD. The radiopathological phenotype of DIILD varied between and within agents, and no typical radiological pattern specific to DIILD was identified. Mortality rates of over 50% were reported in some studies. Severity at presentation was the most reliable predictor of mortality. Glucocorticoids (GCs) were commonly used to treat DIILD, but no prospective studies examined their effect on outcome. Conclusions: Overall high-quality evidence in DIILD is lacking, and the current review will inform larger prospective studies to investigate the diagnosis and management of DIILD. Full article

(This article belongs to the Special Issue Lung Disease on COPD, Asthma, Bronchiectasis, Lung Cancer Screening, IPF)

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21 pages, 1658 KiB

Open AccessReview

Clinical Application of Mesenchymal Stem Cell-Derived Extracellular Vesicle-Based Therapeutics for Inflammatory Lung Diseases

by Yu Fujita^1,2,*

, Tsukasa Kadota^1,2

, Jun Araya¹, Takahiro Ochiya² and Kazuyoshi Kuwano¹

¹ Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo 105-0003 Japan

² Division of Molecular and Cellular Medicine, National Cancer Center Research Institute, Tokyo 104-0045, Japan

J. Clin. Med. 2018, 7(10), 355; https://doi.org/10.3390/jcm7100355 - 14 Oct 2018

Cited by 142 | Viewed by 9527

Abstract

It is currently thought that extracellular vesicles (EVs), such as exosomes and microvesicles, play an important autocrine/paracrine role in intercellular communication. EVs package proteins, mRNA and microRNA (miRNA), which have the ability to transfer biological information to recipient cells in the lungs. Depending [...] Read more.

It is currently thought that extracellular vesicles (EVs), such as exosomes and microvesicles, play an important autocrine/paracrine role in intercellular communication. EVs package proteins, mRNA and microRNA (miRNA), which have the ability to transfer biological information to recipient cells in the lungs. Depending on their origin, EVs fulfil different functions. EVs derived from mesenchymal stem cells (MSCs) have been found to promote therapeutic activities that are comparable to MSCs themselves. Recent animal model-based studies suggest that MSC-derived EVs have significant potential as a novel alternative to whole-cell therapies. Compared to their parent cells, EVs may have a superior safety profile and can be stored without losing function. It has been observed that MSC-derived EVs suppress pro-inflammatory processes and reduce oxidative stress, pulmonary fibrosis and remodeling in a variety of in vivo inflammatory lung disease models by transferring their components. However, there remain significant challenges to translate this therapy to the clinic. From this view point, we will summarize recent studies on EVs produced by MSCs in preclinical experimental models of inflammatory lung diseases. We will also discuss the most relevant issues in bringing MSC-derived EV-based therapeutics to the clinic for the treatment of inflammatory lung diseases. Full article

(This article belongs to the Special Issue Lung Disease on COPD, Asthma, Bronchiectasis, Lung Cancer Screening, IPF)

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16 pages, 754 KiB

Open AccessArticle

Addressing Opioid-Related Chemical Coping in Long-Term Opioid Therapy for Chronic Noncancer Pain: A Multicenter, Observational, Cross-Sectional Study

by Anyela Marcela Castañeda¹, Chang-Soon Lee¹, Yong-Chul Kim¹, Dasom Lee²

and Jee Youn Moon^1,3,*

¹ Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, 101Daehak-ro, Jongno-gu, Seoul 03080, Korea

² Department of Psychiatry, Seoul National University Hospital College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea

³ Department of Integrated Cancer Care Center, Seoul National University Cancer Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea

J. Clin. Med. 2018, 7(10), 354; https://doi.org/10.3390/jcm7100354 - 14 Oct 2018

Cited by 22 | Viewed by 5279

Abstract

Opioid consumption has increased worldwide, which carries the risk of opioid use disorder (OUD). However, the literature on OUD and opioid-related chemical coping (OrCC) in chronic noncancer pain (CNCP) is heterogeneous, with most studies conducted in the United States. We performed a multicenter, [...] Read more.

Opioid consumption has increased worldwide, which carries the risk of opioid use disorder (OUD). However, the literature on OUD and opioid-related chemical coping (OrCC) in chronic noncancer pain (CNCP) is heterogeneous, with most studies conducted in the United States. We performed a multicenter, observational, cross-sectional study to address OrCC in long-term opioid therapy (LtOT) for CNCP in South Korea. The objectives were to determine the frequency and predictors of OrCC. We included 258 patients. Among them, fifty-five (21%) patients showed OrCC. The sample had high pain catastrophizing (≥30 points; 66%), moderate-severe insomnia (≥15 points; 63%), low resilience (68 points), and high suicidal ideation (67%). OrCC patients had greater pain interference (85.18% vs. 58.28%, p = 0.017) and lower satisfaction with the LtOT (56.4% vs. 78.3%, p = 0.002). In multivariable analysis, alcohol abuse (OR = 6.84, p = 0.001), prescription drugs abuse (OR = 19.32, p = 0.016), functional pain (OR = 12.96, p < 0.001), head and neck pain (OR = 2.48, p = 0.039), MEDD (morphine equivalent daily dose) ≥ 200 mg/day (OR = 3.48, p = 0.006), and ongoing litigation (OR = 2.33, p = 0.047) were significant predictors of OrCC. In conclusion, the break-out of OrCC in CNCP in South Korea was comparable to those in countries with high opioid consumption, such as the United States, regardless of the country’s opioid consumption rate. Full article

(This article belongs to the Section Anesthesiology)

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14 pages, 2753 KiB

Open AccessArticle

Deep vs. Awake Extubation and LMA Removal in Terms of Airway Complications in Pediatric Patients Undergoing Anesthesia: A Systemic Review and Meta-Analysis

by Chang-Hoon Koo^1,2

, Sun Young Lee², Seung Hyun Chung³ and Jung-Hee Ryu^1,3,*

¹ Department of Anesthesiology & Pain medicine, Seoul National University College of Medicine, Seoul 03080, Korea

² Department of Anesthesiology & Pain medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea

³ Department of Anesthesiology & Pain medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea

J. Clin. Med. 2018, 7(10), 353; https://doi.org/10.3390/jcm7100353 - 14 Oct 2018

Cited by 44 | Viewed by 9575

Abstract

The purpose of this study was to compare the incidence of airway complications between extubation under deep anesthesia (deep extubation) and extubation when fully awake (awake extubation) in pediatric patients after general anesthesia. A systematic review was performed in accordance with the Preferred [...] Read more.

The purpose of this study was to compare the incidence of airway complications between extubation under deep anesthesia (deep extubation) and extubation when fully awake (awake extubation) in pediatric patients after general anesthesia. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement standards. The review protocol was registered with the International Prospective Register of Systematic Reviews (registration number: CRD 42018090172). Electronic databases were searched, without discrimination of publication year and language, to identify all randomized controlled trials investigating airway complications following deep or awake extubation after general anesthesia. The Cochrane tool was used to assess the risk of bias of trials. Randomized trials investigating airway complications of deep extubation compared with awake extubation after general anesthesia with an endotracheal tube and laryngeal mask airway (LMA) were sought. Overall airway complications, airway obstruction, cough, desaturation, laryngospasm and breath holding were analyzed using random-effect modelling. The odds ratio was used for these incidence variables. Seventeen randomized trials were identified, and a total of 1881 pediatric patients were enrolled. The analyses indicated deep extubation reduces the risk of overall airway complications (odds ratio (OR) 0.56, 95% confidence interval (CI) 0.33–0.96, p = 0.04), cough (OR 0.30, 95% CI 0.12–0.72, p = 0.007) and desaturation (OR 0.49, 95% CI 0.25–0.95, p = 0.04) in children after general anesthesia. However, deep extubation increased the risk of airway obstruction compared with awake extubation (OR 3.38 CI 1.69–6.73, p = 0.0005). No difference was observed in the incidence of laryngospasm and breath-holding between the two groups regardless of airway device. The result of this analysis indicates that deep extubation may decrease the risk of overall airway complications including cough and desaturation but may increase airway obstruction compared with awake extubation in pediatric patients after general anesthesia. Therefore, deep extubation may be recommended in pediatric patients to minimize overall airway complications except airway obstruction and the clinicians may choose the method of extubation according to the risk of airway complications of pediatric patients. Full article

(This article belongs to the Section Anesthesiology)

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8 pages, 1135 KiB

Open AccessArticle

Functional and Endoscopic Indicators for Percutaneous Endoscopic Gastrostomy (PEG) in Amyotrophic Lateral Sclerosis Patients

by Bebiana Conde^1,2,3,*, Natália Martins^2,3

, Inês Rodrigues¹, Ana Cláudia Pimenta¹ and João Carlos Winck²

¹ Pulmonology Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Avenida da Noruega, Vila Real 5000-508, Portugal

² Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal

³ Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen, Porto 4200-135, Portugal

J. Clin. Med. 2018, 7(10), 352; https://doi.org/10.3390/jcm7100352 - 14 Oct 2018

Cited by 7 | Viewed by 3782

Abstract

(1) Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative condition, whose bulbar involvement compromises language, swallowing, and airway protection. When oral nutrition is no longer adequate, percutaneous endoscopic gastroscopy (PEG) may be indicated. However, as exact timing is still debatable, we tried [...] Read more.

(1) Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative condition, whose bulbar involvement compromises language, swallowing, and airway protection. When oral nutrition is no longer adequate, percutaneous endoscopic gastroscopy (PEG) may be indicated. However, as exact timing is still debatable, we tried to find it. (2) Methods: A prospective cohort study was performed using fiber-optic endoscopic evaluation of swallowing (FEES), functional evaluation scales (ALS Functional Rating Scale-Revised (ALSFRS-R) and bulbar sub-score (ALSFRS-R-B)), lung function tests (like Forced Vital Capacity (FVC), Cough Peak Flow (CPF)) and anthropometric data. (3) Results: Twenty-three patients were enrolled (mean 65.4 ± 9.1 years, 60.9% males), 12 with spinal-onset. During the study period, 58 FEES were performed (1–4/patients). Even before formal the PEG indication, suggestions were given to correct the alterations found. PEG was placed in 12 patients, on average 21.8 months after diagnosis (FVC = 69.9% ± 26.7%, ALSFRS-R-B = 7.7 ± 3.7, ALSFRS-R = 28.9 ± 12.3), and being 91.7% under ventilatory support. ALSFRS-R-B, CPF, FVC, and ALSFRS-R showed significant discriminant ability for PEG placement. Sensitivity and specificity were, respectively, ALSFRS-R-B ≤ 8 (100/90.9), CPF ≤ 205 (83.3), FVC ≤ 74 (83.3/74.2), and ALSFRS-R < 29 (83.3/65.1). (4) Conclusions: FEES provide additional information beyond formal PEG indication. ALSFRS-R-B score ≤ 8 was found as a best functional and noninvasive indicator for PEG performance in ALS patients. Full article

(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)

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16 pages, 996 KiB

Open AccessArticle

A Modified Two-Step Screening Strategy for Gestational Diabetes Mellitus Based on the 2013 WHO Criteria by Combining the Glucose Challenge Test and Clinical Risk Factors

by Katrien Benhalima^1,*

, Paul Van Crombrugge², Carolien Moyson¹, Johan Verhaeghe³, Sofie Vandeginste⁴, Hilde Verlaenen⁴, Chris Vercammen⁵, Toon Maes⁵, Els Dufraimont⁶, Christophe De Block⁷, Yves Jacquemyn⁸, Farah Mekahli⁹, Katrien De Clippel¹⁰, Annick Van Den Bruel¹¹, Anne Loccufier¹², Annouschka Laenen¹³, Caro Minschart¹

, Roland Devlieger³ and Chantal Mathieu¹

¹ Department of Endocrinology, University hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium

² Department of Endocrinology, OLV ziekenhuis Aalst-Asse-Ninove, 9300 Aalst, Belgium

³ Department of Obstetrics & Gynecology, University Hospital Gasthuisberg, KU Leuven, 3000 Leuven, Belgium

⁴ Department of Obstetrics & Gynecology, OLV Ziekenhuis Aalst-Asse-Ninove, 9300 Aalst, Belgium

⁵ Department of Endocrinology, Imelda ziekenhuis, 2820 Bonheiden, Belgium

⁶ Department of Obstetrics & Gynecology, Imelda Ziekenhuis, 2820 Bonheiden, Belgium

⁷ Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, 2560 Edegem, Belgium

⁸ Department of Obstetrics & Gynecology, Antwerp University Hospital, 2560 Edegem, Belgium

⁹ Department of Endocrinology, Kliniek St-Jan Brussel, 1000 Brussel, Belgium

¹⁰ Department of Obstetrics & Gynecology, Kliniek St-Jan Brussel, 1000 Brussel, Belgium

¹¹ Department of Endocrinology, AZ St Jan Brugge, 8000 Brugge, Belgium

¹² Department of Obstetrics & Gynecology, AZ St Jan Brugge, 8000 Brugge, Belgium

¹³ Center of Biostatics and Statistical bioinformatics, KU Leuven, 3000 Leuven, Belgium

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J. Clin. Med. 2018, 7(10), 351; https://doi.org/10.3390/jcm7100351 - 13 Oct 2018

Cited by 33 | Viewed by 5964

Abstract

This study determines if a modified two-step screening strategy with a glucose challenge test (GCT) ≥ 7.2 mmol/L and clinical risk factors improves the diagnostic accuracy for gestational diabetes mellitus (GDM), based on 2013 WHO criteria, while limiting the number of oral glucose [...] Read more.

This study determines if a modified two-step screening strategy with a glucose challenge test (GCT) ≥ 7.2 mmol/L and clinical risk factors improves the diagnostic accuracy for gestational diabetes mellitus (GDM), based on 2013 WHO criteria, while limiting the number of oral glucose tolerance tests (OGTT). This was a prospective multicentric cohort study with 1811 participants receiving both GCT and 75 g OGTT in pregnancy. Participants and health care providers were blinded for GCT. Characteristics were analyzed across four glucose tolerance groups: abnormal (≥7.2 mmol/L), GCT GDM (n = 165), normal GCT GDM (n = 63), abnormal GCT normal glucose tolerant (NGT) (n = 472); normal GCT NGT (n = 1113). Compared to normal GCT NGT women, normal GCT GDM women had increased rates of obesity (23.8% vs. 10.5%, p < 0.001), ethnic minority background (19.3% vs. 8.2%, p < 0.001) and a history of GDM (13.8% vs. 4.6%, p = 0.03). By combined screening of GCT ≥ 7.2 mmol/L with these risk factors, sensitivity increased to respectively, 74.1–78.1% using one risk factor, and to 82.9% using any of these risk factors with a specificity of 57.5%. By using a modified two-step screening strategy, the number of women needing both a GCT and OGTT would be reduced to 25.5%, and 52.6% of all OGTTs could be avoided, compared to a universal one-step approach. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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15 pages, 1773 KiB

Open AccessArticle

Identification of the Gene Expression Rules That Define the Subtypes in Glioma

by Yu-Dong Cai¹

, Shiqi Zhang^1,2, Yu-Hang Zhang³, Xiaoyong Pan⁴, KaiYan Feng⁵, Lei Chen^6,7

, Tao Huang³

and Xiangyin Kong^3,*

¹ School of Life Sciences, Shanghai University, Shanghai 200444, China

² Department of Biostatistics, University of Copenhagen, Copenhagen 2099, Denmark

³ Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China

⁴ Department of Medical Informatics, Erasmus Medical Centre, Rotterdam 3014ZK, The Netherlands

⁵ Department of Computer Science, Guangdong AIB Polytechnic, Guangzhou, 510507, China

⁶ College of Information Engineering, Shanghai Maritime University, Shanghai 201306, China

⁷ Shanghai Key Laboratory of Pure Mathematics and Mathematical Practice (PMMP), East China Normal University, Shanghai 200241, China

J. Clin. Med. 2018, 7(10), 350; https://doi.org/10.3390/jcm7100350 - 13 Oct 2018

Cited by 35 | Viewed by 5392

Abstract

As a common brain cancer derived from glial cells, gliomas have three subtypes: glioblastoma, diffuse astrocytoma, and anaplastic astrocytoma. The subtypes have distinctive clinical features but are closely related to each other. A glioblastoma can be derived from the early stage of diffuse [...] Read more.

As a common brain cancer derived from glial cells, gliomas have three subtypes: glioblastoma, diffuse astrocytoma, and anaplastic astrocytoma. The subtypes have distinctive clinical features but are closely related to each other. A glioblastoma can be derived from the early stage of diffuse astrocytoma, which can be transformed into anaplastic astrocytoma. Due to the complexity of these dynamic processes, single-cell gene expression profiles are extremely helpful to understand what defines these subtypes. We analyzed the single-cell gene expression profiles of 5057 cells of anaplastic astrocytoma tissues, 261 cells of diffuse astrocytoma tissues, and 1023 cells of glioblastoma tissues with advanced machine learning methods. In detail, a powerful feature selection method, Monte Carlo feature selection (MCFS) method, was adopted to analyze the gene expression profiles of cells, resulting in a feature list. Then, the incremental feature selection (IFS) method was applied to the obtained feature list, with the help of support vector machine (SVM), to extract key features (genes) and construct an optimal SVM classifier. Several key biomarker genes, such as IGFBP2, IGF2BP3, PRDX1, NOV, NEFL, HOXA10, GNG12, SPRY4, and BCL11A, were identified. In addition, the underlying rules of classifying the three subtypes were produced by Johnson reducer algorithm. We found that in diffuse astrocytoma, PRDX1 is highly expressed, and in glioblastoma, the expression level of PRDX1 is low. These rules revealed the difference among the three subtypes, and how they are formed and transformed. These genes are not only biomarkers for glioma subtypes, but also drug targets that may switch the clinical features or even reverse the tumor progression. Full article

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13 pages, 1016 KiB

Open AccessArticle

Impact of Hyperbaric Oxygen Therapy on Subsequent Neurological Sequelae Following Carbon Monoxide Poisoning

by Chien-Cheng Huang^1,2,3

, Chung-Han Ho^4,5

, Yi-Chen Chen⁴, Chien-Chin Hsu^1,6, Yi-Fong Wang⁷, Hung-Jung Lin^1,6,8, Jhi-Joung Wang⁴ and How-Ran Guo^2,9,10,*

¹ Department of Emergency Medicine, Chi-Mei Medical Center, Tainan 710, Taiwan

² Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan

³ Department of Senior Services, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan

⁴ Department of Medical Research, Chi Mei Medical Center, Tainan 710, Taiwan

⁵ Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan 71710, Taiwan

⁶ Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan

⁷ Department of Leisure, Recreation and Tourism Management, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan

⁸ Department of Emergency Medicine, Taipei Medical University, Taipei 110, Taiwan

⁹ Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan

¹⁰ Occupational Safety, Health, and Health Research Center, National Cheng Kung University Hospital, Tainan 704, Taiwan

J. Clin. Med. 2018, 7(10), 349; https://doi.org/10.3390/jcm7100349 - 13 Oct 2018

Cited by 28 | Viewed by 6144

Abstract

The purpose of this study was to evaluate the effects of hyperbaric oxygen therapy (HBOT) on reducing neurological sequelae (NS) in patients with carbon monoxide poisoning (COP). Using a nationwide database of insurance claims in Taiwan, we conducted a population-based cohort study to [...] Read more.

The purpose of this study was to evaluate the effects of hyperbaric oxygen therapy (HBOT) on reducing neurological sequelae (NS) in patients with carbon monoxide poisoning (COP). Using a nationwide database of insurance claims in Taiwan, we conducted a population-based cohort study to identify 24,046 patients with COP diagnosed between 1999 and 2012, including 6793 (28.2%) patients who received HBOT and 17,253 (71.8%) patients who did not. We followed the two cohorts of patients and compared the occurrence of NS. The two cohorts had similar sex ratios, but patients who received HBOT were younger (34.8 ± 14.8 vs. 36.1 ± 17.2 years, p < 0.001). Patients who received HBOT had a higher risk for NS (adjusted hazard ratio [AHR]: 1.4; 95% confidence interval [CI]: 1.4–1.5), after adjusting for age, sex, underlying comorbidities (hypertension, diabetes, chronic obstructive pulmonary disease, hyperlipidemia, malignancy, coronary artery disease, congestive heart failure, liver disease, renal disease, connective tissue disease, human immunodeficiency virus [HIV] infection, and alcoholism), monthly income, suicide, drug poisoning, and acute respiratory failure. We observed similar findings when we stratified the patients by age, sex, underlying comorbidities, and monthly income. The increased risk was most prominent in the first 2 weeks (AHR: 2.4; 95% CI: 2.1–2.7) and remained significant up to 6 months later (AHR: 1.6; 95% CI: 1.4–1.7). The risk for NS was higher in patients with COP who received HBOT than in those who did not, even after considering the possible impact of longer observation periods on survivors. Further studies that included the potential confounding factors we did not measure are needed to confirm findings in this study. Full article

(This article belongs to the Section Clinical Neurology)

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16 pages, 242 KiB

Open AccessArticle

Implications of an Autism Spectrum Disorder Diagnosis: An Interview Study of How Physicians Experience the Diagnosis in a Young Child

by Delphine Jacobs^1,*

, Jean Steyaert², Kris Dierickx¹ and Kristien Hens³

¹ Center for Biomedical Ethics and Law, KU Leuven, 3000 Leuven, Belgium

² Center for Autism Expertise, UPC-KU Leuven, 3000 Leuven, Belgium

³ Department of philosophy, University of Antwerp, 3000 Leuven, Belgium

J. Clin. Med. 2018, 7(10), 348; https://doi.org/10.3390/jcm7100348 - 12 Oct 2018

Cited by 23 | Viewed by 6259

Abstract

Clinicians are significant translators and interpreters towards parents of the abundant literature on autism spectrum disorder (ASD). However, how clinicians experience and view ASD and an ASD diagnosis is not well known. Sixteen physicians working with young children with a (presumed) diagnosis of [...] Read more.

Clinicians are significant translators and interpreters towards parents of the abundant literature on autism spectrum disorder (ASD). However, how clinicians experience and view ASD and an ASD diagnosis is not well known. Sixteen physicians working with young children with a (presumed) diagnosis of ASD participated in a semi-structured interview. They described their professional view on ASD and an ASD diagnosis, and how they experienced its use in their clinical practice. Interpretative phenomenological analysis of the data revealed two main topics about physicians’ experiences: how they view ASD and an ASD diagnosis, and how they experience the implications of an ASD diagnosis. The latter topic comprised three themes: (1) the ASD diagnosis leads to a particular treatment trajectory and services; (2) ambivalence about how the ASD diagnosis impacts parents and child; and (3) psycho-relational functions of the ASD diagnosis. Physicians feel that some doubts and questions are inevitable when dealing clinically with ASD and an ASD diagnosis. They also perceive that there are certain risks associated with assigning the categorical ASD diagnosis to a young child. Altogether however, ASD is perceived by physicians as a useful and valuable diagnosis both because of treatment related consequences and of several psycho-relational implications. Full article

(This article belongs to the Section Mental Health)

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J. Clin. Med., Volume 7, Issue 10 (October 2018) – 85 articles

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