Journal of Clinical Medicine

15 pages, 1468 KiB

Open AccessEditor’s ChoiceSystematic Review

The Therapeutic Potential of Different Surgical Approaches in the Management of Cardiac Myxoma: A Systematic Review

by Dominik Mendyka, Tomasz Płonek, Tomasz Jędrasek, Adrian Korman, Aleksandra Złotowska, Aleksandra Jędrasek, Robert Skalik and Wojciech Kustrzycki

J. Clin. Med. 2025, 14(1), 121; https://doi.org/10.3390/jcm14010121 - 28 Dec 2024

Viewed by 1266

Abstract

Background: Cardiac myxomas are benign tumors of the heart. They occur mostly in the left atrium. The preferred treatment is surgical resection, which can be performed via conventional median sternotomy, minimally invasive, or robotic-assisted approaches. This study aimed to evaluate the outcomes, advantages, [...] Read more.

Background: Cardiac myxomas are benign tumors of the heart. They occur mostly in the left atrium. The preferred treatment is surgical resection, which can be performed via conventional median sternotomy, minimally invasive, or robotic-assisted approaches. This study aimed to evaluate the outcomes, advantages, and limitations of these surgical methods, with a focus on their safety, efficacy, and impact on patient recovery. Methods: This systemic review was conducted according to PRISMA guidelines. The chosen databases were systematically searched using the keywords “cardiac myxoma”, “resection”, “approach”, “minimally invasive”, and “robotic surgery”. The comparison between the surgical strategies was based on thirteen articles, which met the inclusion criteria. Results: Median sternotomy remains the standard technique, providing excellent surgical access but is associated with longer hospital stays, higher blood loss, and increased risk of complications such as stroke. Minimally invasive approaches demonstrated comparable safety with shorter ICU stays, reduced blood loss, and lower postoperative pain but presented challenges, including limited exposure and longer procedure times. Robotic-assisted surgery showed potential as a safe alternative but was limited by high costs and technical demands. However, the data on minimally invasive and robotic methods are limited due to the rarity of cardiac myxomas. Conclusions: The choice of surgical technique should be individualised by considering the tumour size, location, patient condition, and surgeon expertise. Routine postoperative echocardiographic monitoring is essential to detect residual or recurrent tumours. Further studies are needed to validate the long-term efficacy of minimally invasive and robotic approaches. Full article

(This article belongs to the Section Cardiovascular Medicine)

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19 pages, 455 KiB

Open AccessEditor’s ChoiceReview

Nursing Interventions to Prevent Complications in Patients with Peripherally Inserted Central Catheters: A Scoping Review

by Andreia Vilão, Cidália Castro and Júlio Belo Fernandes

J. Clin. Med. 2025, 14(1), 89; https://doi.org/10.3390/jcm14010089 - 27 Dec 2024

Viewed by 2219

Abstract

Background: A Peripherally Inserted Central Catheter (PICC) is a safe and effective Central Vascular Access Device when properly used. Therefore, it has become an increasingly frequent procedure. Nurses are often the professionals responsible for its insertion, maintenance, and removal. Despite the advantages [...] Read more.

Background: A Peripherally Inserted Central Catheter (PICC) is a safe and effective Central Vascular Access Device when properly used. Therefore, it has become an increasingly frequent procedure. Nurses are often the professionals responsible for its insertion, maintenance, and removal. Despite the advantages of this device, it presents risks and possible associated complications. This scoping review aims to identify and analyze nursing interventions to prevent complications in adults with PICC. Methods: The review was conducted according to Joanna Briggs Institute’s scoping review proposal. The electronic databases Pubmed, CINAHL Complete, MEDLINE Complete, Cochrane Central Register of Controlled Trials, Nursing & Allied Health Collection: Comprehensive, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Library, Information Science & Technology Abstracts, and MedicLatina were consulted in October 2023. Additionally, we searched the websites of the Registered Nurses Association of Ontario and the Canadian Vascular Access Association. We included articles published in English and Portuguese between 2018 and 2023. Results: A total of 170 articles were initially identified. After selecting and analyzing the articles, 13 studies were included. This review identified nursing interventions in adults to prevent PICC-related complications, categorized into five main groups: pre-procedure, during the procedure, post-procedure, maintenance, and team management interventions. Nurses are pivotal in averting PICC complications by employing evidence-based nursing interventions at each process stage. Conclusions: The importance of nursing interventions in enhancing patient safety, improving health outcomes, and informing clinical practice highlights the need for standardized protocols, specialized training, and consistent patient education for PICC care. Full article

(This article belongs to the Section Vascular Medicine)

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19 pages, 2447 KiB

Open AccessEditor’s ChoiceReview

Echocardiography in the Ventilated Patient: What the Clinician Has to Know

by Fiorella Chiara Delle Femine, Diego D’Arienzo, Biagio Liccardo, Maria Concetta Pastore, Federica Ilardi, Giulia Elena Mandoli, Simona Sperlongano, Alessandro Malagoli, Matteo Lisi, Giovanni Benfari, Vincenzo Russo, Matteo Cameli and Antonello D’Andrea

J. Clin. Med. 2025, 14(1), 77; https://doi.org/10.3390/jcm14010077 - 27 Dec 2024

Viewed by 4036

Abstract

Heart and lung sharing the same anatomical space are influenced by each other. Spontaneous breathing induces dynamic changes in intrathoracic pressure, impacting cardiac function, particularly the right ventricle. In intensive care units (ICU), mechanical ventilation (MV) and therefore positive end-expiratory pressure (PEEP) are [...] Read more.

Heart and lung sharing the same anatomical space are influenced by each other. Spontaneous breathing induces dynamic changes in intrathoracic pressure, impacting cardiac function, particularly the right ventricle. In intensive care units (ICU), mechanical ventilation (MV) and therefore positive end-expiratory pressure (PEEP) are often applied, and this inevitably influences cardiac function. In ventilated patients, the use of positive pressures leads to an increase in intrathoracic pressure and, consequently, to a reduction in the right ventricular preload and thus cardiac output. The clinician working in the intensive care unit must be able to assess the effects MV has on the heart in order to set it up appropriately and to manage any complications. The echocardiographic evaluation of the ventilated patient has the main purpose of studying the right ventricle; in fact, they are the ones most affected by PEEP. It is therefore necessary to assess the size, thickness, and systolic function of the right ventricle. In the mechanically ventilated patient, it may be difficult to assess the volemic status and fluid responsiveness, in fact, the study of the inferior vena cava (IVC) is not always reliable in these patients. In patients with MV, it is preferable to assess fluid responsiveness with dynamic methods such as the end-expiration occlusion (EEO) test, passive leg raise (PLR), and fluid challenge (FC). The study of the diaphragm is also essential to identify possible complications, manage weaning, and provide important prognostic information. This review describes the basis for echocardiographic evaluation of the mechanically ventilated patient with the aim of supporting the clinician in managing the consequences of MV for heart–lung interaction. Full article

(This article belongs to the Section Cardiology)

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10 pages, 1372 KiB

Open AccessEditor’s ChoiceArticle

Evolving Trends and Future Demands in ENT Procedures: A Nationwide 10-Year Analysis

by Akash Jangan, Satvir Minhas, Emmanuel Diakos, Mark Simmons and Zahir Mughal

J. Clin. Med. 2024, 13(24), 7850; https://doi.org/10.3390/jcm13247850 - 23 Dec 2024

Viewed by 1455

Abstract

Objective: This study aims to investigate the trends in otology, rhinology, and head and neck (H&N) operations over the past decade in England. These trends will allow for predictive modelling to forecast the demand over the coming years to aid workforce and [...] Read more.

Objective: This study aims to investigate the trends in otology, rhinology, and head and neck (H&N) operations over the past decade in England. These trends will allow for predictive modelling to forecast the demand over the coming years to aid workforce and resource planning in ENT. Methods: Hospital Episode Statistics data were extracted between April 2012 and April 2023. A total of 121 otology, 114 rhinology, and 122 H&N procedure codes were included. Correlation and linear regression analyses were conducted to examine trends and produce a forecast model for the volume of operations. Results: A gradual upward trend in the volume of operations was observed in rhinology, with a positive correlation coefficient (R = 0.74). In contrast, otology (R = −0.67) and H&N (R= −0.75) showed negative trends, indicating a moderate decline in operational volumes over time. The COVID-19 pandemic significantly disrupted operating activity in rhinology and otology. To address the backlog and reach the pre-pandemic forecasted levels within the next five years, surgical capacity must increase by an additional 33,807 rhinology 25,486 otology, and 10,300 head procedures per year in England. Conclusions: This analysis highlights a need for prioritization and expansion of the ENT workforce and resources to manage the current backlog and anticipated increase in demand over the next five years. Full article

(This article belongs to the Special Issue Current and Future Trends in Otorhinolaryngology–Head and Neck Surgery)

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21 pages, 841 KiB

Open AccessEditor’s ChoiceReview

Advances in Atrial Fibrillation Management: A Guide for General Internists

by Hoang Nhat Pham, Ramzi Ibrahim, Hong Hieu Truong, Enkhtsogt Sainbayar, Viet Nghi Tran, Mahmoud Abdelnabi, Christopher Kanaan and Aadhavi Sridharan

J. Clin. Med. 2024, 13(24), 7846; https://doi.org/10.3390/jcm13247846 - 23 Dec 2024

Viewed by 2926

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, impacting approximately 6.1 million adults in the United States, with projections to increase two-fold by 2030. AF significantly increases the risk of stroke and other adverse cardiovascular events, leading to increased morbidity and [...] Read more.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, impacting approximately 6.1 million adults in the United States, with projections to increase two-fold by 2030. AF significantly increases the risk of stroke and other adverse cardiovascular events, leading to increased morbidity and mortality. The 2023 ACC/AHA/ACCP/HRS guidelines present a paradigm shift in AF management, moving from a duration-based classification to a more comprehensive, patient-centered approach. This includes a novel AF classification system that emphasizes early detection and intervention, including risk factors and lifestyle modification tailored to each patient’s risk profile. Moreover, the recommendations advocate for a multidisciplinary care model, ensuring coordinated management involving primary care providers and specialists. Primary care providers play a crucial role in initiating risk factor management and lifestyle interventions, even before the development of AF. This review aims to thoroughly examine the guidelines for the diagnosis and management of AF and equip general internists with the necessary insights to navigate the evolving landscape of AF care effectively. Full article

(This article belongs to the Section Cardiovascular Medicine)

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17 pages, 7534 KiB

Open AccessEditor’s ChoiceArticle

First Diagnostic Questionnaire for Assessing Patients’ Social Functioning: Comprehensive DDX3X Syndrome Patient Profile

by Urszula Stefaniak-Preis, Ada Kaczmarek, Mirosław Andrusiewicz, Magdalena Roszak, Natalia Trzeszczyńska, Włodzimierz Samborski, Ewa Mojs and Roksana Malak

J. Clin. Med. 2024, 13(24), 7842; https://doi.org/10.3390/jcm13247842 - 22 Dec 2024

Viewed by 2020

Abstract

Background/Objectives: DDX3X syndrome is often misdiagnosed as autism spectrum disorder (ASD, Rett Syndrome, and Dandy–Walker Syndrome). Precise phenotyping is needed with reference to neurodevelopmental diagnosis. Observation of behavior and communication in parents with DDX3X syndrome in the USA, France, and Poland; conversations with [...] Read more.

Background/Objectives: DDX3X syndrome is often misdiagnosed as autism spectrum disorder (ASD, Rett Syndrome, and Dandy–Walker Syndrome). Precise phenotyping is needed with reference to neurodevelopmental diagnosis. Observation of behavior and communication in parents with DDX3X syndrome in the USA, France, and Poland; conversations with the parents of patients; and rudimentary information in evidence-based medical articles prompted us to identify differences in communication, play, and social interaction between children with ASD only, those with both ASD and DDX3X, and those with DDX3X only. Methods: As diagnostic tool for DDX3X patients, we created a questionnaire divided into four sections: medical, social, play, and communication. Results: The results showed inconsistent diagnoses in different countries where children could have been diagnosed with DDX3X. In a comparative analysis, individuals with DDX3X exhibited greater social skills than individuals with ASD. Furthermore, those with DDX3X demonstrated higher levels of social functioning compared to children with ASD. Therefore, parents of children recently diagnosed with ASD or similar conditions are encouraged to complete a survey to determine if their child is likely to have features of DDX3X syndrome. Conclusion: Identification of early behavioral markers that differentiate children with ASD and those with DDX3X could lead to the earliest opportunity for identification and intervention, and can significantly impact developmental trajectories, leading to better long-term outcomes. Full article

(This article belongs to the Section Mental Health)

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Graphical abstract

18 pages, 1944 KiB

Open AccessEditor’s ChoiceArticle

Body Positions and Physical Activity Levels Modulate the Ratio of Abdominal to Thoracic Breathing and Respiratory Rate in Young Individuals

by Szonja Decker, Tamás Horváth, Johanna Takács and Akos Koller

J. Clin. Med. 2024, 13(24), 7825; https://doi.org/10.3390/jcm13247825 - 21 Dec 2024

Viewed by 1303

Abstract

Background/Objectives: The COVID-19 pandemic highlighted that body positions substantially affected the mortality rate. We hypothesized that body position modulates the contribution of abdominal (AB) and thoracic breathing (TB) to the breathing cycle (BC), as well as respiratory rate (RR). In addition, we [...] Read more.

Background/Objectives: The COVID-19 pandemic highlighted that body positions substantially affected the mortality rate. We hypothesized that body position modulates the contribution of abdominal (AB) and thoracic breathing (TB) to the breathing cycle (BC), as well as respiratory rate (RR). In addition, we hypothesized that physical activity level can increase the contribution of abdominal breathing. Methods: Thus, we used plethysmography respiratory belts to measure changes in abdominal (AB) and thoracic (TB) circumferences, their ratio (AB/TB), and respiratory rate (RR) under resting conditions. Measurements were taken in four body positions—standing (St), sitting (Si), supine (Su), and prone (Pr)—for two groups of young adults (aged 21 ± 2 years) with different physical activity levels (low and high PA). Results: The AB/TB ratios significantly differed between the body positions (Si: 45.5/54.5%, St: 40.5/59.5%, Su: 56.8/43.2%, Pr: 52.2/47.8% (p < 0.001)). AB was significantly the highest in Su and lowest in Si and St (p < 0.001). There was a significant difference in respiratory rate (RR) between the four body positions (p = 0.005). RR in the four body positions was the following: Si: 15.1, St: 15.0, Su: 13.7, and Pr: 14.4. RR was the lowest in Su (13.7), where AB was the highest (56.8%), and RR was the highest in Si (15.1) and St (15.0), where TB was higher compared to Su (p < 0.001). PA significantly affected the various body positions’ AB/TB ratio and RR. The high PA group showed a significant difference in the AB/TB ratio between the body positions (p < 0.001). The low PA group showed a significant difference in RR between the body positions (p = 0.025). Conclusions: In young, healthy adults, we found that body position significantly influenced the abdominal/thoracic breathing ratio during the breathing cycle. The supine position showed the highest contribution of abdominal breathing, which correlated with the lowest respiratory rate. Additionally, a higher level of physical activity increased the contribution of abdominal breathing in the Si, Su, and St positions, suggesting a more energy-efficient breathing pattern. These findings suggest the potentials for breathing pattern monitoring and position-based interventions to improve healthcare outcomes and enhance sports performance and recovery. Full article

(This article belongs to the Special Issue Sports Exercise: How It Benefits Health and Disease)

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12 pages, 1585 KiB

Open AccessEditor’s ChoiceReview

Advancing LVAD Technology: Overcoming Challenges and Shaping the Future of Mechanical Circulatory Support

by Kostiantyn Kozakov, Zdenek Provaznik, Christof Schmid and Daniele Camboni

J. Clin. Med. 2024, 13(24), 7813; https://doi.org/10.3390/jcm13247813 - 20 Dec 2024

Viewed by 1664

Abstract

Ventricular assist devices (VADs) invigorated the management of patients with advanced heart failure, providing a lifeline for patients awaiting transplantation or requiring long-term circulatory support. This article reviews recent advances in VAD technologies, focusing on key areas of progress to overcome existing challenges [...] Read more.

Ventricular assist devices (VADs) invigorated the management of patients with advanced heart failure, providing a lifeline for patients awaiting transplantation or requiring long-term circulatory support. This article reviews recent advances in VAD technologies, focusing on key areas of progress to overcome existing challenges and the potential for future applications. The reduction or possible elimination of infection-prone components and the evolution to transcutaneous energy transfer systems are two main research fields to reach a new quality of life category for VADs patients. Miniaturization and enhanced biocompatibility have resulted in smaller, less invasive devices with a significantly reduced risk of complications and mortality. Advances in percutaneous ventricular assist devices have emerged, contributing to the creation of less invasive options with or without intracardiac pumps, and facilitating their use for both left and right ventricles. These devices have gained more and more features, including the use of artificial intelligence. Moreover, the possibility of long-term use of intracardiac pumps offers a potential bridge to transplantation, allowing ambulation and probably also long-term circulatory support. Despite considerable advances, challenges remain, particularly in terms of improving durability, reducing the risk of ischemic events, further refining materials, and more sophisticated control and synchronization between systems that adapt to changing physiological demands. Full article

(This article belongs to the Section Cardiovascular Medicine)

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39 pages, 9029 KiB

Open AccessEditor’s ChoiceReview

Olfactory Receptors and Aortic Aneurysm: Review of Disease Pathways

by Theodora M. Stougiannou, Konstantinos C. Christodoulou and Dimos Karangelis

J. Clin. Med. 2024, 13(24), 7778; https://doi.org/10.3390/jcm13247778 - 19 Dec 2024

Viewed by 1310

Abstract

Aortic aneurysm, the pathological dilatation of the aorta at distinct locations, can be attributed to many different genetic and environmental factors. The resulting pathobiological disturbances generate a complex interplay of processes affecting cells and extracellular molecules of the tunica interna, media and externa. [...] Read more.

Aortic aneurysm, the pathological dilatation of the aorta at distinct locations, can be attributed to many different genetic and environmental factors. The resulting pathobiological disturbances generate a complex interplay of processes affecting cells and extracellular molecules of the tunica interna, media and externa. In short, aortic aneurysm can affect processes involving the extracellular matrix, lipid trafficking/atherosclerosis, vascular smooth muscle cells, inflammation, platelets and intraluminal thrombus formation, as well as various endothelial functions. Many of these processes are interconnected, potentiating one another. Newer discoveries, including the involvement of odorant olfactory receptors in these processes, have further shed light on disease initiation and pathology. Olfactory receptors are a varied group of G protein coupled-receptors responsible for the recognition of chemosensory information. Although they comprise many different subgroups, some of which are not well-characterized or identified in humans, odorant olfactory receptors, in particular, are most commonly associated with recognition of olfactory information. They can also be ectopically localized and thus carry out additional functions relevant to the tissue in which they are identified. It is thus the purpose of this narrative review to summarize and present pathobiological processes relevant to the initiation and propagation of aortic aneurysm, while also incorporating evidence associating these ectopically functioning odorant olfactory receptors with the overall pathology. Full article

(This article belongs to the Section General Surgery)

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21 pages, 1015 KiB

Open AccessEditor’s ChoiceReview

Chronobiology in Paediatric Neurological and Neuropsychiatric Disorders: Harmonizing Care with Biological Clocks

by Gabriele Giannotta, Marta Ruggiero and Antonio Trabacca

J. Clin. Med. 2024, 13(24), 7737; https://doi.org/10.3390/jcm13247737 - 18 Dec 2024

Viewed by 1530

Abstract

Background: Chronobiology has gained attention in the context of paediatric neurological and neuropsychiatric disorders, including migraine, epilepsy, autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD). Disruptions in circadian rhythms are associated with key symptoms such as sleep disturbances, [...] Read more.

Background: Chronobiology has gained attention in the context of paediatric neurological and neuropsychiatric disorders, including migraine, epilepsy, autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD). Disruptions in circadian rhythms are associated with key symptoms such as sleep disturbances, mood dysregulation, and cognitive impairments, suggesting a potential for chronobiology-based therapeutic approaches. Methods: This narrative review employs a systematic approach to identify relevant studies through searches of three major scientific databases, NCBI/PubMed, ScienceDirect, and Scopus, up to July 2024. We used a combination of broad and condition-specific keywords, such as “chronobiology”, “biorhythm”, “pediatric”, “epilepsy”, “ADHD”, and “ASD”, among others. Articles in English that focused on clinical features, treatments, or outcomes related to circadian rhythms in paediatric populations were included, while non-peer-reviewed articles and studies lacking original data were excluded. Rayyan software was used for article screening, removing duplicates, and facilitating consensus among independent reviewers. Results: A total of 87 studies were included in the analysis. Findings reveal a consistent pattern of circadian rhythm disruptions across the disorders examined. Specifically, dysregulation of melatonin and cortisol secretion is observed in children with ASD, ADHD, and PTSD, with altered circadian timing contributing to sleep disturbances and mood swings. Alterations in core clock genes (CLOCK, BMAL1, PER, and CRY) were also noted in children with epilepsy, which was linked to seizure frequency and timing. Chronotherapy approaches showed promise in managing these disruptions: melatonin supplementation improved sleep quality and reduced ADHD symptoms in some children, while light therapy proved effective in stabilizing sleep–wake cycles in ASD and ADHD patients. Additionally, behaviour-based interventions, such as the Early Start Denver Model, showed success in improving circadian alignment in children with ASD. Conclusions: This review highlights the significant role of circadian rhythm disruptions in paediatric neurological and neuropsychiatric disorders, with direct implications for treatment. Chronobiology-based interventions, such as melatonin therapy, light exposure, and individualized behavioural therapies, offer potential for improving symptomatology and overall functioning. The integration of chronotherapy into clinical practice could provide a paradigm shift from symptom management to more targeted, rhythm-based treatments. Future research should focus on understanding the molecular mechanisms behind circadian disruptions in these disorders and exploring personalized chronotherapeutic approaches tailored to individual circadian patterns. Full article

(This article belongs to the Section Clinical Pediatrics)

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16 pages, 503 KiB

Open AccessEditor’s ChoiceReview

Future of Acute Severe Ulcerative Colitis—A Narrative Review

by Leshni Pillay, Janakan Selvarajah, Bridgette Andrew, Britt Christensen, Finlay Macrae and Jonathan P. Segal

J. Clin. Med. 2024, 13(24), 7723; https://doi.org/10.3390/jcm13247723 - 18 Dec 2024

Cited by 1 | Viewed by 2147

Abstract

While corticosteroids have led to significant reduction in ASUC mortality over the last few decades, they are associated with significant side effects and up to 30% of patients have steroid refractory ASUC, which means we require safer and better therapies for patients with [...] Read more.

While corticosteroids have led to significant reduction in ASUC mortality over the last few decades, they are associated with significant side effects and up to 30% of patients have steroid refractory ASUC, which means we require safer and better therapies for patients with ASUC. Several salvage therapies have been proposed in guidelines; however, we lack high quality head-to-head randomised controlled trials to assess effectiveness and safety of these agents. Furthermore, the role of newer novel agents in ASUC management is unclear. We aim to present an up to date review and envisage future treatment of ASUC without steroids based on current trials and data. In summary, we conclude that ASUC treatment still heavily relies on corticosteroids despite the side effect profile. While infliximab and cyclosporine have extensive data, there are no prospective studies comparing them with corticosteroids as initial therapy. Novel therapies open up the possibility of oral options but require prospective data before any conclusion can be made. Full article

(This article belongs to the Special Issue Inflammatory Bowel Disease: Clinical Advances and Therapeutic Prospects)

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19 pages, 980 KiB

Open AccessEditor’s ChoiceArticle

Two Different Hemodynamic Responses in ME/CFS Patients with Postural Orthostatic Tachycardia Syndrome During Head-Up Tilt Testing

by C. (Linda) M. C. van Campen, Peter C. Rowe and Frans C. Visser

J. Clin. Med. 2024, 13(24), 7726; https://doi.org/10.3390/jcm13247726 - 18 Dec 2024

Viewed by 2236

Abstract

Introduction: While the diagnosis of postural orthostatic tachycardia syndrome (POTS) is based on heart rate (HR) and blood pressure (BP) criteria, the pathophysiology of POTS is not fully understood as multiple pathophysiological mechanisms have been recognized. Also, cardiac function, being dependent on [...] Read more.

Introduction: While the diagnosis of postural orthostatic tachycardia syndrome (POTS) is based on heart rate (HR) and blood pressure (BP) criteria, the pathophysiology of POTS is not fully understood as multiple pathophysiological mechanisms have been recognized. Also, cardiac function, being dependent on preload, afterload, contractility, and HR, has not been properly studied. Preload and contractility changes can be inferred from stroke volume index (SVI) changes during a tilt test. Afterload plays a minor role in POTS as a normal BP response is a prerequisite for POTS. Therefore, we analyzed the HR-SVI relation during a tilt test in myalgic encephalomyelitis (ME/CFS) patients with POTS and compared the data with ME/CFS patients with a normal HR-BP response and with that of healthy controls (HC). Material and Methods: In ME/CFS patients with either POTS (n = 233) or a normal HR-BP response (n = 507) and healthy controls (n = 48), we measured SVI (by suprasternal echo), HR, and BP during the tilt. Results: In all ME/CFS patients, the decrease in SVI was larger compared to HC. In patients with a normal HR-BP response and in POTS patients with a HR increase between 30–39 bpm, there was an inverse relationship between the HR increase and SVI decrease during the tilt, compatible with increased venous pooling. In POTS patients with a HR increase ≥40 bpm, this inverse relation was lost, and SVI changes were significantly less compared to POTS patients with a HR increase between 30–39 bpm, suggestive of a hyperadrenergic response. Conclusions: In ME/CFS patients with POTS, two different hemodynamic profiles can be observed: in patients with a limited HR increase, mainly increased venous pooling is observed, while in patients with a large (≥ 40 bpm) HR increase the data are suggestive of a hyperadrenergic response. These two different profiles may have different therapeutic implications. Full article

(This article belongs to the Special Issue Advances in Postural Orthostatic Tachycardia Syndrome (POTS))

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14 pages, 735 KiB

Open AccessEditor’s ChoiceArticle

Project Initiate: A Clinical Feasibility Trial of Equitable Access to Early Neurodevelopmental Therapy

by Jessica Trenkle, Alison Liddle, Lynn Boswell, Dawn Drumm, Denise Barnes, Aneta M. Jedraszko, Bree Andrews, Shannon Murphy, Michael E. Msall, Deborah Gaebler-Spira and Raye-Ann deRegnier

J. Clin. Med. 2024, 13(24), 7681; https://doi.org/10.3390/jcm13247681 - 17 Dec 2024

Viewed by 1734

Abstract

Background/Objectives: Despite evidence of the effectiveness of early intervention (EI) programs, eligible infants often experience delays in initiation of services or fail to receive services entirely. Disparities have been documented, including lower enrollment rates for infants with public insurance. The objective of this [...] Read more.

Background/Objectives: Despite evidence of the effectiveness of early intervention (EI) programs, eligible infants often experience delays in initiation of services or fail to receive services entirely. Disparities have been documented, including lower enrollment rates for infants with public insurance. The objective of this pilot study was to evaluate the feasibility of initiating home physical therapy (PT) services promptly after neonatal or cardiac intensive care unit (NICU/CICU) discharge for infants with public insurance and to assess early motor outcomes for children who received study therapy compared with a standard of care group. Methods: Infants were recruited if discharged from a study NICU/CICU, had public insurance, and were eligible for Illinois EI services. Infants living in Chicago (n = 46) received weekly home-based PT from a study therapist until 3–4 months corrected age (CA). Infants living outside Chicago received standard of care services and served as a control group (n = 14). At discharge, infants were referred to EI and underwent the Test of Infant Motor Performance (TIMP). Outcomes at 3–4 months CA included initiation rates for study PT and EI and follow-up TIMP testing. Results: By 3–4 months CA, 78% of the intervention group had received ≥1 PT session. In contrast, just 13% of the entire cohort had received any EI therapy. Infants who had 8–10 PT sessions in the first 3–4 months after discharge were more likely to have a change in the TIMP Z-score of >0.5 SD. Conclusions: Prompt transition to home therapy was feasible for infants with public insurance in an urban setting who may benefit most due to the potential for neuroplastic change. Addressing barriers identified in this study may assist in improving access to EI for young infants. Full article

(This article belongs to the Section Clinical Neurology)

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13 pages, 610 KiB

Open AccessEditor’s ChoiceReview

Transdermal Fentanyl Patch Effectiveness in Postoperative Pain Management in Orthopedic Patients: Literature Review

by Andrei Niculae, Ionel Alexandru Checherita, Ileana Peride, Mirela Tiglis, Razvan Ene, Tiberiu Paul Neagu and Dragos Ene

J. Clin. Med. 2024, 13(24), 7646; https://doi.org/10.3390/jcm13247646 - 16 Dec 2024

Viewed by 1780

Abstract

Controlling pain after major orthopedic surgery may be challenging, and it is related to delayed recovery, the development of chronic pain, and analgesic dependence. It is well known that effective postoperative pain control can reduce hospital stays by ensuring a more rapid rehabilitation,
[...] Read more.

Controlling pain after major orthopedic surgery may be challenging, and it is related to delayed recovery, the development of chronic pain, and analgesic dependence. It is well known that effective postoperative pain control can reduce hospital stays by ensuring a more rapid rehabilitation,
thereby decreasing the overall costs. Despite the development of analgesics, the use of opioids and their derivates remains the cornerstone of treatment for patients with acute moderate-to-severe pain in association with general or regional anesthesia. To reduce the risk of side effects and opioid addiction, considering the alarming epidemiological reports in relation to opioid abuse, combined analgesic methods are used, in addition to lower dosages or different forms of administration, such as transdermal administration. Fentanyl transdermal patches appear to be effective in controlling postoperative pain as part of multimodal analgesic regimens in knee and hip surgery, shoulder arthroplasty, traumatic fractures, and one-day surgery; this treatment has fewer associated side effects and can be safely used even in patients with renal impairment. It is also recommended for postoperative pain management in combination with a femoral–sciatic nerve block during foot and ankle surgery. Full article

(This article belongs to the Section Orthopedics)

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10 pages, 229 KiB

Open AccessEditor’s ChoiceArticle

Objective Voice Analysis in Partial Deafness: Comparison of Multi-Dimensional Voice Program (MDVP) and VOXplot Results

by Karol Myszel

J. Clin. Med. 2024, 13(24), 7631; https://doi.org/10.3390/jcm13247631 - 14 Dec 2024

Viewed by 975

Abstract

Acoustic analysis of voice enables objective assessment of voice to diagnose changes in voice characteristics, and track the progress of therapy. In contrast to subjective assessment, objective measurements provide mathematical results referring to specific parameters and can be analyzed statistically. Changes in the [...] Read more.

Acoustic analysis of voice enables objective assessment of voice to diagnose changes in voice characteristics, and track the progress of therapy. In contrast to subjective assessment, objective measurements provide mathematical results referring to specific parameters and can be analyzed statistically. Changes in the voice of patients with partial deafness (PD) were not widely described in the literature, and recent studies referred to the voice parameters measured in this group of patients only using the multi-dimensional voice program (MDVP) by Kay Pentax. This paper describes the results of acoustic analysis of voice in patients with PD using VOXplot, and compares the results with those achieved with MDVP. Background/Objectives: The purpose of this study was a VOXplot objective analysis of voice in individuals with PD and to assess consistency with results obtained using MDVP and with perceptual assessment. Methods: Voice samples from 22 post-lingual PD individuals were recorded. They included continuous speech (cs) and sustained vowels (sv). The control group consisted of 22 healthy individuals with no history of voice or hearing dysfunction. The samples were analyzed with MDVP followed by VOXplot version 2.0.0 Beta. Statistical analysis was performed using a t-test paired with two samples for means. All individuals were also subjected to a perceptual voice assessment using the GRBAS by Hirano. Results: Differences were observed in 13 VOXplot parameters measured in voice samples of adults with PD compared with those in the control group. Both multiparametric indices, AVQI and ABI, showed a statistical increase. When it comes to MDVP parameters correlating with breathiness, all of them (shim dB, APQ, NHR, SPI, and NSH) increased in patients with partial deafness, reflecting a breathy voice. Only one increase in the SPI was not statistically significant. Seven MDVP parameters correlating with hoarseness were elevated, and five (Jitt%, vF0, Shim dB, APQ, and NHR) showed a statistically significant increase. Correlations were found of VOXplot and MDVP parameters with perceptual voice assessment. Conclusions: Both programs for objective assessment showed voice abnormalities in patients with PD compared with the control groups. There was a poor to moderate level of consistency in the results achieved using both systems. Correlations were also found with GRBAS assessment results. Full article

(This article belongs to the Section Otolaryngology)

12 pages, 684 KiB

Open AccessEditor’s ChoiceArticle

Effect of Transcutaneous Auricular Vagus Nerve Stimulation in Chronic Low Back Pain: A Pilot Study

by Isabelle Tavares-Figueiredo, Yves-Marie Pers, Claire Duflos, Fanchon Herman, Benjamin Sztajnzalc, Hugo Lecoq, Isabelle Laffont, Arnaud F. Dupeyron and Alexis F. Homs

J. Clin. Med. 2024, 13(24), 7601; https://doi.org/10.3390/jcm13247601 - 13 Dec 2024

Viewed by 1805

Abstract

Background/Objectives: Chronic low back pain (CLBP) is a common condition with limited long-term treatment options. Vagus nerve stimulation (VNS) has shown potential for pain improvement, but its use in CLBP remains underexplored. Our aim was to evaluate the efficacy, feasibility and tolerability [...] Read more.

Background/Objectives: Chronic low back pain (CLBP) is a common condition with limited long-term treatment options. Vagus nerve stimulation (VNS) has shown potential for pain improvement, but its use in CLBP remains underexplored. Our aim was to evaluate the efficacy, feasibility and tolerability of transcutaneous auricular vagus nerve stimulation (taVNS) in reducing pain and improving functional outcomes in CLBP patients. Methods: Thirty adults with CLBP (VAS ≥ 40/100) participated in this open-label pilot study (NCT05639270). Patients were treated with a taVNS device on the left ear for 30 min daily over a period of 3 months. The primary outcome was a reduction in pain intensity (VAS) at 1 month. Secondary outcomes included pain intensity at 3 months, disability (Oswestry Disability Index, ODI), quality of life (EQ-5D-5L), catastrophizing and psychological distress. In addition, compliance and adverse events were monitored. Results: After 1 month, 27 patients were evaluated. VAS scores decreased significantly by 16.1 (SD = 17.9) mm (p < 0.001) and by 22.5 (25) mm (p < 0.001) after 3 months (24 patients were analyzed). Functional disability improved with an average reduction in ODI of 11.9 (11.1) points (p < 0.001) after 3 months. Other patient-reported outcomes also improved significantly over the 3-month period. Overall, 51.9% of the patients achieved clinically meaningful pain reduction (≥20 mm), and no serious adverse events were reported. Treatment adherence was good, with half of the patients achieving 80% adherence. Conclusions: This pilot study suggests that taVNS is a feasible, safe and potentially effective treatment for CLBP that warrants further investigation in a randomized controlled trial compared to sham stimulation. Full article

(This article belongs to the Section Clinical Rehabilitation)

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25 pages, 373 KiB

Open AccessEditor’s ChoiceReview

Emergencies in Hematology: Why, When and How I Treat?

by Andrea Duminuco, Vittorio Del Fabro, Paola De Luca, Dario Leotta, Miriana Carmela Limoli, Ermelinda Longo, Antonella Nardo, Gabriella Santuccio, Alessandro Petronaci, Gaia Stanzione, Francesco Di Raimondo and Giuseppe Alberto Palumbo

J. Clin. Med. 2024, 13(24), 7572; https://doi.org/10.3390/jcm13247572 - 12 Dec 2024

Cited by 3 | Viewed by 8378

Abstract

Hematological emergencies are critical medical conditions that require immediate attention due to their rapid progression and life-threatening nature. As various examples, hypercalcemia, often associated with cancers such as multiple myeloma, can lead to severe neurological and cardiac dysfunction. Hyperleukocytosis, common in acute myeloid [...] Read more.

Hematological emergencies are critical medical conditions that require immediate attention due to their rapid progression and life-threatening nature. As various examples, hypercalcemia, often associated with cancers such as multiple myeloma, can lead to severe neurological and cardiac dysfunction. Hyperleukocytosis, common in acute myeloid leukemias, increases the risk of leukostasis and multiorgan failure. Sickle cell crisis, a common complication in sickle cell disease, results from vaso-occlusion, leading to acute pain and tissue ischemia. Tumor lysis syndrome, reported in cases of rapid destruction of cancer cells, causes electrolyte imbalances and acute kidney injury. Acute transfusion reactions, fundamental in hematological conditions, can range from mild allergic responses to severe hemolysis and shock, requiring prompt management. Disseminated intravascular coagulation, involving excessive coagulation and bleeding, is commonly triggered by hematological malignancies, common in the first phases of acute promyelocytic leukemia. Recently, in the era of bispecific antibodies and chimeric antigen receptor T cells, cytokine release syndrome is a manifestation that must be recognized and promptly treated. Understanding the pathophysiology, recognizing the clinical manifestations, and ensuring adequate diagnostic strategies and management approaches for each condition are central to early intervention in improving patient outcomes and reducing mortality. Full article

(This article belongs to the Section Hematology)

11 pages, 1058 KiB

Open AccessEditor’s ChoiceArticle

Orthokeratology Lens Decentration with Two Designs of Corneal Refractive Therapy™ Lenses: A One-Year Prospective Study

by Laura Batres, Cristina Arroyo-del Arroyo, Julia Bodas-Romero and Gonzalo Carracedo

J. Clin. Med. 2024, 13(24), 7567; https://doi.org/10.3390/jcm13247567 - 12 Dec 2024

Viewed by 1382

Abstract

Background/Objectives: The objective of this study was to examine the trend of treatment zone (TZ) decentration over 12 months of orthokeratology (OK) wear using two Corneal Refractive Therapy (CRT) lens designs: standard (STD) and dual axis (DA). Methods: A prospective, randomized, [...] Read more.

Background/Objectives: The objective of this study was to examine the trend of treatment zone (TZ) decentration over 12 months of orthokeratology (OK) wear using two Corneal Refractive Therapy (CRT) lens designs: standard (STD) and dual axis (DA). Methods: A prospective, randomized, longitudinal study was conducted at the Optometry Clinic of the Complutense University of Madrid. Subjects were randomly fitted with an STD design or DA design in one of the eyes. Refraction, uncorrected visual acuity (VA), and corneal topography were performed at baseline and after 1 night, 1 week, and 1, 3, 6, and 12 months of lens wear. Subjects requiring lens parameter adjustments or replacements after 3 months were excluded. Decentration was measured by subtracting pre-OK from post-OK tangential curvature maps at each visit, with decentration distance and corneal optical TZ being measured using MATLAB. Correlations between decentration and visual acuity (VA) were also analyzed. Results: A total of 30 healthy children (17 females and 13 males) with a mean age of 12.83 ± 2.42 years (range: 8–17 years) completed all the visits. No statistically significant differences (p > 0.05) were found between lens designs in horizontal, vertical, nor total decentration through the visits. However, for the STD design, horizontal and total decentration increased significantly at the last visit (p < 0.05). For the DA design, no significant differences were found over time (p > 0.05). No correlation was found between decentration and VA. Conclusions: Total decentration in both lens designs was similar throughout one year of follow-up. The standard design tended to decenter horizontally during the last 6 months, while the dual-axis design maintained consistent decentration throughout the year. Full article

(This article belongs to the Special Issue Multifactorial Causation and Therapies of Myopia)

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10 pages, 449 KiB

Open AccessEditor’s ChoiceReview

Metabolic Consequences of Thyroidectomy and Patient-Centered Management

by Karina Wang and Seza A. Gulec

J. Clin. Med. 2024, 13(23), 7465; https://doi.org/10.3390/jcm13237465 - 8 Dec 2024

Viewed by 1567

Abstract

Thyroidectomy has been post-operatively managed by hormone replacement therapy in order to satisfy the reference ranges of thyroid stimulating hormone (TSH) and thyroxine (T4) levels. While medication and standardized reference ranges have proven to be effective, many patients continue to report unintentional weight [...] Read more.

Thyroidectomy has been post-operatively managed by hormone replacement therapy in order to satisfy the reference ranges of thyroid stimulating hormone (TSH) and thyroxine (T4) levels. While medication and standardized reference ranges have proven to be effective, many patients continue to report unintentional weight gain despite adequate amounts of treatment and levels of TSH and T4. Physicians, over the years, have become complacent to these “normal” ranges, and have ignored the metabolic consequences that are affecting thyroidectomy patients. This paper aims to redefine the approach to post-thyroidectomy clinical care by challenging the current standardized hormonal range values, exploring the gaps in thyroid hormone conversion, investigating the metabolic pathways of T3, considering the influence of inflammatory markers, and proposing the future for patient-centered management. Full article

(This article belongs to the Special Issue New Strategies in the Treatment of Thyroid Carcinoma)

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23 pages, 2410 KiB

Open AccessEditor’s ChoiceReview

Bedside Assessment of the Respiratory System During Invasive Mechanical Ventilation

by Lorenzo Giosa, Patrick D. Collins, Sridevi Shetty, Marta Lubian, Riccardo Del Signore, Mara Chioccola, Francesca Pugliese and Luigi Camporota

J. Clin. Med. 2024, 13(23), 7456; https://doi.org/10.3390/jcm13237456 - 7 Dec 2024

Viewed by 2943

Abstract

Assessing the respiratory system of a patient receiving mechanical ventilation is complex. We provide an overview of an approach at the bedside underpinned by physiology. We discuss the importance of distinguishing between extensive and intensive ventilatory variables. We outline methods to evaluate both [...] Read more.

Assessing the respiratory system of a patient receiving mechanical ventilation is complex. We provide an overview of an approach at the bedside underpinned by physiology. We discuss the importance of distinguishing between extensive and intensive ventilatory variables. We outline methods to evaluate both passive patients and those making spontaneous respiratory efforts during assisted ventilation. We believe a comprehensive assessment can influence setting mechanical ventilatory support to achieve lung and diaphragm protective ventilation. Full article

(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS): Causes, Management, and Treatment)

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22 pages, 2291 KiB

Open AccessEditor’s ChoiceArticle

Analysing Digital Engagement Patterns: A Machine Learning Investigation into Social Anxiety Among Adolescents with ADHD

by Roxana Șipoș, Tudor Văidean, Andreea-Marlena Răpciuc, Costina-Ruxandra Poetar and Elena Predescu

J. Clin. Med. 2024, 13(23), 7461; https://doi.org/10.3390/jcm13237461 - 7 Dec 2024

Cited by 1 | Viewed by 1871

Abstract

Background: The relationship between screen time and mental health among adolescents, particularly those identified as “digital natives”, has become increasingly pertinent, especially in the context of heightened digital engagement during the COVID-19 pandemic. This study aims to examine the associations between digital engagement [...] Read more.

Background: The relationship between screen time and mental health among adolescents, particularly those identified as “digital natives”, has become increasingly pertinent, especially in the context of heightened digital engagement during the COVID-19 pandemic. This study aims to examine the associations between digital engagement patterns, ADHD severity, and anxiety symptoms in adolescents aged 11–18. Methods: A cross-sectional observational study was conducted with a sample of 97 adolescents diagnosed with ADHD. Participants completed validated questionnaires assessing daily digital activities and anxiety symptoms while caregivers provided additional contextual information. Data were analyzed using Random Forest regression to identify relationships between screen time, ADHD severity, and anxiety symptoms. Results: The findings indicate an average screen time of 6.6 h on weekdays and 8.1 h on weekends, with social media emerging as the primary activity, particularly among female participants. Notable gender differences were identified, with family dynamics influencing digital engagement; family disputes had a more significant impact on girls than boys. Furthermore, specific anxiety traits, i.e., physical symptoms and harm avoidance, significantly predicted time spent on social media across all genders considered in the study, while others, namely social anxiety and separation anxiety, were less valuable. Conclusions: This study highlights the complex interplay between screen time, ADHD, and anxiety symptoms in adolescents. These findings underscore the importance of tailored interventions that address the nuanced relationships between digital engagement and mental health in this population, warranting further research to develop effective management strategies. Full article

(This article belongs to the Special Issue Substance and Behavioral Addictions: Prevention and Diagnosis)

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22 pages, 6664 KiB

Open AccessEditor’s ChoiceArticle

Development and Initial Outcomes of the Interdisciplinary ‘Early Identification and Intervention for Infants Network’ (Ei3) in Los Angeles

by Christiana D. Butera, Amy Yeh, Manoj Biniwale, Edward Bloch, Debi Craddock, Mary Doyle, Sai N. Iyer, Kari S. Kretch, Nora Liu, Christine B. Mirzaian, Barbara Sargent, Priscilla Solano, Margaret Swaine and Stacey C. Dusing

J. Clin. Med. 2024, 13(23), 7442; https://doi.org/10.3390/jcm13237442 - 6 Dec 2024

Viewed by 1487

Abstract

Background/Objectives: The Early Identification and Intervention for Infants (Ei3) Network is an interdisciplinary team dedicated to improving early detection and intervention of cerebral palsy (CP) in California. This paper describes the key (1) awareness-building and (2) capacity-building strategies utilized by the Ei3 [...] Read more.

Background/Objectives: The Early Identification and Intervention for Infants (Ei3) Network is an interdisciplinary team dedicated to improving early detection and intervention of cerebral palsy (CP) in California. This paper describes the key (1) awareness-building and (2) capacity-building strategies utilized by the Ei3 Network in the first two years. Methods: Awareness-building methods included interactive conference discussions, resource deliverable creation, and the creation of a framework for dissemination. Capacity-building methods were hosting assessment training, gathering stakeholder feedback, and implementation training. All deliverables were created with a minimum of 3 review and revision cycles. We planned, hosted, and provided scholarships for training, including the Hammersmith Infant Neurological Examination (HINE), Prechtl’s GMA, and an implementation conference. Preliminary descriptive statistics and paired samples t-tests were performed on HINE training surveys. Results: Seven resource deliverables were created and distributed. A professional website, @steps2home.org, was launched. Online channels gained followers (146, Instagram; 198, X; 298, Mailchimp). Providers participated in various trainings: the Sykes Symposium on early detection and intervention (70), HINE (211), GMA Basic or Advanced (46), and Implementation Conference (six facilities from April 2023 to June 2024). HINE training participants reported increased ability to identify CP (p = 0.001), knowledge of (p = 0.004) early detection, ability to implement early detection guidelines (p < 0.001), and confidence in performing the HINE on the post-test (79.87%). Conclusions: The first two years of Ei3 resulted in increased awareness of the early detection guidelines through resources to help providers and families navigate complex care systems and dissemination through online and in-person strategies. We built capacity by training an increased number of providers to identify infants at risk of CP and implement the early detection guidelines. Engagement of stakeholders in focus groups, reviewing documents, and including a parent panel throughout the process increased the value of this work and should support the expansion of the network in the next year. Full article

(This article belongs to the Section Clinical Neurology)

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16 pages, 9000 KiB

Open AccessEditor’s ChoiceSystematic Review

Comparative Efficacy of Glucosamine-Based Combination Therapies in Alleviating Knee Osteoarthritis Pain: A Systematic Review and Network Meta-Analysis

by Dewan Md. Sumsuzzman, Zeeshan Ahmad Khan, Jin Ho Jung, Yunkyung Hong, Won Jong Yang, Kanghui Park, Hong Jin Choi, Ok Chan Jeong, Sang Jin Kim and Yonggeun Hong

J. Clin. Med. 2024, 13(23), 7444; https://doi.org/10.3390/jcm13237444 - 6 Dec 2024

Viewed by 3774

Abstract

Background: The lack of definitive scientific evidence sustains uncertainty about the efficacy of glucosamine and its combination therapies for knee osteoarthritis (KOA), contributing to an ongoing debate among clinical practice guidelines and healthcare practitioners. This systematic review and network meta-analysis (NMA) aimed to [...] Read more.

Background: The lack of definitive scientific evidence sustains uncertainty about the efficacy of glucosamine and its combination therapies for knee osteoarthritis (KOA), contributing to an ongoing debate among clinical practice guidelines and healthcare practitioners. This systematic review and network meta-analysis (NMA) aimed to identify the most effective glucosamine combination therapy for KOA patients. Methods: Frequentist random-effects models were employed for this NMA, with standardized mean differences (SMDs) and 95% confidence intervals (CIs) calculated for primary outcomes. We incorporated an SMD value of 0.40 as a minimum clinically important difference (MCID) to interpret the pain outcome. Confidence in evidence was evaluated using CINeMA. Results: Thirty randomized controlled trials (RCTs) covering 5265 patients were included. Glucosamine with omega-3 (G + omega-3, SMD –2.59 [95% CI –4.42 to –0.75], moderate quality) and glucosamine with ibuprofen (G + ibuprofen, SMD –2.27 [95% CI –3.73 to –0.82], moderate quality) significantly reduced overall pain compared to placebo. Similarly, glucosamine + chondroitin sulfate + methylsulfonylmethane showed effectiveness in pain reduction (SMD –2.25 [95% CI –3.84 to –0.67], low-quality). None of the other interventions met the MCID threshold for overall pain reduction. Moreover, clustered ranking results showed that glucosamine with omega-3 interventions was more effective than others in reducing overall pain and adverse events. Conclusions: For KOA, combining glucosamine with omega-3 and ibuprofen effectively reduces pain and may lower NSAID side effects, improving treatment guidelines and decision-making for better patient care. Full article

(This article belongs to the Section Orthopedics)

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12 pages, 523 KiB

Open AccessEditor’s ChoiceArticle

Gla-Rich Protein Is Associated with Vascular Calcification, Inflammation, and Mineral Markers in Peritoneal Dialysis Patients

by Catarina Marreiros, Carla Viegas, Anabela Malho Guedes, Ana Paula Silva, Ana Catarina Águas, Marília Faísca, Leon Schurgers and Dina Costa Simes

J. Clin. Med. 2024, 13(23), 7429; https://doi.org/10.3390/jcm13237429 - 6 Dec 2024

Viewed by 1330

Abstract

Background/Objectives: Vascular calcification (VC) is a crucial risk factor for cardiovascular diseases (CVD), particularly in chronic kidney disease (CKD) populations. However, the specific relationship between VC and end-stage renal disease (ESRD) patients undergoing peritoneal dialysis (PD) remains to be fully understood. The [...] Read more.

Background/Objectives: Vascular calcification (VC) is a crucial risk factor for cardiovascular diseases (CVD), particularly in chronic kidney disease (CKD) populations. However, the specific relationship between VC and end-stage renal disease (ESRD) patients undergoing peritoneal dialysis (PD) remains to be fully understood. The identification of new biomarkers to improve VC diagnosis and monitoring would significantly impact cardiovascular risk management in these high-risk patients. Gla-rich protein (GRP) is a VC inhibitor and an anti-inflammatory agent and thus is a potential VC marker in CKD. Here we explored the potential role of GRP as a marker for CVD and investigated the impact of VC in 101 PD patients. Methods: Circulating total Gla-rich protein (tGRP) was quantified in serum and in 24 h dialysate samples. VC score (VCS) was determined using the Adragão method. Results: Serum tGRP was negatively associated with VCS, serum calcium (Ca), phosphate (P), and high-sensitivity C-reactive protein (hsCRP), while it was positively associated with magnesium (Mg). A total of 35.6% of PD patients presented with extensive calcifications (VCS ≥ 3), and the lowest tGRP serum levels were present in this group (419.4 ± 198.5 pg/mL). tGRP in the 24 h dialysate was also negatively associated with VCS and with serum Ca and P. Moreover, serum Ca, P, and VCS were identified as independent determinants of serum tGRP levels. Conclusions: The association of serum tGRP with VC, mineral, and inflammation markers reinforces its potential use as a novel VC biomarker in CKD patients undergoing PD. Full article

(This article belongs to the Section Vascular Medicine)

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13 pages, 1692 KiB

Open AccessEditor’s ChoiceArticle

The Prevalence of Comorbidities in Individuals with Periodontitis in a Private Periodontal Referral Practice

by Nicky G. F. M. Beukers, Bruno G. Loos, Geert J. M. G. van der Heijden, Elena Stamatelou, Athanasios Angelakis and Naichuan Su

J. Clin. Med. 2024, 13(23), 7410; https://doi.org/10.3390/jcm13237410 - 5 Dec 2024

Viewed by 1332

Abstract

Objectives: Periodontitis (PD) patients frequently suffer from comorbidities, necessitating increased attention to disease management and monitoring. The aim of this study is to describe the prevalence and patterns of comorbidities among patients with PD in a private periodontal referral practice. Methods: This study [...] Read more.

Objectives: Periodontitis (PD) patients frequently suffer from comorbidities, necessitating increased attention to disease management and monitoring. The aim of this study is to describe the prevalence and patterns of comorbidities among patients with PD in a private periodontal referral practice. Methods: This study involved 3171 adults with PD. Data on demographics, lifestyle, number of teeth, pockets of size ≥ 6 mm, bleeding on probing, periodontal inflammatory surface area, and comorbidities were extracted from electronic patient records. Descriptive and statistical analyses, including t-tests, chi-square tests, cluster analysis, binomial logistic regression analysis, and hypergraph network analysis, were performed. Results: Among this PD population, 47% had a comorbidity, and 20% had multimorbidity (≥2 diseases). Based on the disease patterns, two distinct clusters emerged: Cluster 1 was dominated by respiratory tract conditions (asthma, lung disease, and allergic rhinitis), allergies, and hypothyroidism, while Cluster 2 primarily included cardiometabolic diseases (angina pectoris, hypertension, diabetes mellitus (DM), and hyperthyroidism). The hypergraph network analysis for those with multimorbidity identified two main groups: (i) pulmonary conditions (lung disease, asthma, allergic rhinitis, and allergies) and (ii) cardiometabolic disorders (hypertension, myocardial infarction, cerebrovascular disease, and DM). Hypertension, allergies, and allergic rhinitis showed high centrality, serving as central nodes frequently co-occurring with other diseases. Conclusions: Nearly half of the PD patients in a private periodontal referral practice were found to have comorbidities, primarily clustering into cardiometabolic and respiratory tract diseases. These findings, based on real-world data, should encourage dental professionals to integrate systemic conditions into their care strategies. They could also guide policymakers and practitioners in developing evidence-based approaches to mitigate the reciprocal negative effects of PD and comorbidities. Full article

(This article belongs to the Special Issue Periodontal Diseases: Clinical Diagnosis and Treatment)

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18 pages, 1530 KiB

Open AccessEditor’s ChoiceReview

Challenges in AAV-Based Retinal Gene Therapies and the Role of Magnetic Nanoparticle Platforms

by Oliver Siontas and Seungkuk Ahn

J. Clin. Med. 2024, 13(23), 7385; https://doi.org/10.3390/jcm13237385 - 4 Dec 2024

Viewed by 1674

Abstract

Retinal diseases, leading to various visual impairments and blindness, are on the rise. However, the advancement of retinal gene therapies offers new hope for treatment of such diseases. Among different vector systems for conferring therapeutic genetic load to retinal cells, adeno-associated viruses (AAVs) [...] Read more.

Retinal diseases, leading to various visual impairments and blindness, are on the rise. However, the advancement of retinal gene therapies offers new hope for treatment of such diseases. Among different vector systems for conferring therapeutic genetic load to retinal cells, adeno-associated viruses (AAVs) have been most intensively explored and have already successfully gained multiple clinical approvals. AAV-based retinal gene therapies have shown great promise in treating retinal disorders, but usually rely on the heavily disruptive administration methods such as subretinal injection. This is because the clinically well-established, minimally invasive alternative of intravitreal injection (IVI) necessitates AAVs to traverse the retinal inner limiting membrane (ILM), which is hard to penetrate in higher eye models, like human or porcine eyes. Additionally, AAVs’ natural transduction preference, known as tropism, is commonly not specific to cells of only one target retinal layer, which is another ongoing challenge in retinal gene therapy. This review examines strategies to overcome these obstacles with a focus on the potential of magnetic nanoparticles (MNPs) for improved retinal AAV delivery. Full article

(This article belongs to the Section Ophthalmology)

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10 pages, 647 KiB

Open AccessEditor’s ChoiceReview

Vasopressor Therapy

by Jean-Louis Vincent and Filippo Annoni

J. Clin. Med. 2024, 13(23), 7372; https://doi.org/10.3390/jcm13237372 - 3 Dec 2024

Cited by 2 | Viewed by 4048

Abstract

Vasopressor therapy represents a key part of intensive care patient management, used to increase and maintain vascular tone and thus adequate tissue perfusion in patients with shock. Norepinephrine is the preferred first-line agent because of its reliable vasoconstrictor effects, with minimal impact on [...] Read more.

Vasopressor therapy represents a key part of intensive care patient management, used to increase and maintain vascular tone and thus adequate tissue perfusion in patients with shock. Norepinephrine is the preferred first-line agent because of its reliable vasoconstrictor effects, with minimal impact on heart rate, and its mild inotropic effects, helping to maintain cardiac output. Whichever vasopressor is used, its effects on blood flow must be considered and excessive vasoconstriction avoided. Other vasoactive agents include vasopressin, which may be considered in vasodilatory states, and angiotensin II, which may be beneficial in patients with high renin levels, although more data are required to confirm this. Dobutamine should be considered, along with continued fluid administration, to help maintain adequate tissue perfusion in patients with reduced oxygen delivery. In this narrative review, we consider the different vasopressor agents, focusing on the importance of tailoring therapy to the individual patient and their hemodynamic response. Full article

(This article belongs to the Section Emergency Medicine)

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14 pages, 3237 KiB

Open AccessEditor’s ChoiceArticle

Oral Lichen Planus: Clinical Presentation, Demographic Characteristics, and Risk Factors in a Retrospective Study of 186 Polish Patients

by Zuzanna Ślebioda, Julia Drożdżyńska, Aleksandra Karpińska, Aleksandra Krzyżaniak, Marianna Kasperczak, Natalia Tomoń, Paulina Wiśniewska and Marzena Liliana Wyganowska

J. Clin. Med. 2024, 13(23), 7363; https://doi.org/10.3390/jcm13237363 - 3 Dec 2024

Viewed by 1827

Abstract

Background/Objectives: Lichen planus (LP) is a chronic, recurrent mucocutaneous inflammatory disease that develops due to a disturbed immunological response triggered by endogenous and exogenous factors. To evaluate clinical presentation, demographic characteristics, and risk factors in a cohort of Polish patients with oral lichen [...] Read more.

Background/Objectives: Lichen planus (LP) is a chronic, recurrent mucocutaneous inflammatory disease that develops due to a disturbed immunological response triggered by endogenous and exogenous factors. To evaluate clinical presentation, demographic characteristics, and risk factors in a cohort of Polish patients with oral lichen planus (OLP). Methods: Medical records of 186 patients with OLP referred to the student outpatient clinic in Poznań University of Medical Sciences from 2013 to 2023 were analyzed in order to establish clinical presentation, patient’s demographic characteristics, and risk factors for OLP. We considered data regarding age, sex, medical history, habits, subjective complaints, clinical type, localization, histology, and treatment. Results: Patients with OLP constituted 20.1% of 887 admitted patients. Of the 186 patients with OLP, 130 (69.9%) were females and 56 (30.1%) were males. The average age at the diagnosis was 60.7 years (range 15–95 years). Only 24.2% of patients reported smoking. The most common intraoral presentation of OLP was reticular form (61.8%), followed by mixed erosive-bullous type (15%), and atrophic (6.4%). Pathologic lesions were most commonly located on buccal mucosa (89.2%) and tongue (58.6%). Subjective complaints included pain (48.4%), burning sensation (46.2%), xerostomia (25.3%), bleeding (10.2%), taste disturbance (4.8%), and excessive saliva production (3.8%), while 22.6% of OLP patients were asymptomatic. Conclusions: The most common type of OLP in Polish patients was reticular, developing mostly on the buccal mucosa and tongue. It was found most often in non-smoking middle-aged women. Subjective complaints were reported by over 77% of patients. Full article

(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)

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19 pages, 357 KiB

Open AccessEditor’s ChoiceReview

Low-Intensity Resistance Exercise in Cardiac Rehabilitation: A Narrative Review of Mechanistic Evidence and Clinical Implications

by Jemima Jansen, Paul W. Marshall, Jocelyne R. Benatar, Rebecca Cross, Tia K. Lindbom and Michael Kingsley

J. Clin. Med. 2024, 13(23), 7338; https://doi.org/10.3390/jcm13237338 - 2 Dec 2024

Cited by 2 | Viewed by 1939

Abstract

Cardiac rehabilitation, a multi-component intervention designed to mitigate the impact of cardiovascular disease, often underutilises low-intensity resistance exercise despite its potential benefits. This narrative review critically examines the mechanistic and clinical evidence supporting the incorporation of low-intensity resistance exercise into cardiac rehabilitation programmes. [...] Read more.

Cardiac rehabilitation, a multi-component intervention designed to mitigate the impact of cardiovascular disease, often underutilises low-intensity resistance exercise despite its potential benefits. This narrative review critically examines the mechanistic and clinical evidence supporting the incorporation of low-intensity resistance exercise into cardiac rehabilitation programmes. Research indicates that low-intensity resistance exercise induces hypertrophic adaptations by maximising muscle fibre activation through the size principle, effectively recruiting larger motor units as it approaches maximal effort. This activation promotes adaptation in both type I and II muscle fibres, resulting in comparable increases in myofibrillar protein synthesis and phosphorylation of key signalling proteins when compared to high-intensity resistance exercise. Low-intensity resistance exercise provides equivalent improvements in muscular strength and hypertrophy compared to high-intensity protocols while addressing barriers to participation, such as concerns about safety and logistical challenges. By facilitating engagement through a more accessible exercise modality, low-intensity resistance exercise might improve adherence rates and patient outcomes in cardiac rehabilitation. Additionally, the ability of low-intensity resistance exercise to address sarcopenia and frailty syndrome, significant determinants of cardiovascular disease progression, can enhance the recovery and overall quality of life for patients. This review establishes evidence-based recommendations for the inclusion of low-intensity resistance exercise in cardiac rehabilitation, offering a promising pathway to enhance the effectiveness of these programmes. Full article

(This article belongs to the Section Clinical Rehabilitation)

16 pages, 1928 KiB

Open AccessEditor’s ChoiceReview

Combine Surgery and In Vitro Fertilization (IVF) in Endometriosis-Related Infertility: When and Why

by Irene Colombi, Alessandro Ginetti, Alberto Cannoni, Giulia Cimino, Claudia d’Abate, Giorgia Schettini, Matteo Giorgi, Diego Raimondo, Francesco Giuseppe Martire, Lucia Lazzeri, Errico Zupi and Gabriele Centini

J. Clin. Med. 2024, 13(23), 7349; https://doi.org/10.3390/jcm13237349 - 2 Dec 2024

Cited by 1 | Viewed by 1628

Abstract

Endometriosis is a chronic, estrogen-dependent inflammatory disease characterized by the presence of endometrial tissue outside the uterus, causing pelvic pain and infertility. Infertility arises mainly due to inflammatory mediators in the peritoneal fluid, contributing to local hypoestrogenism, which appears to exacerbate chronic inflammation [...] Read more.

Endometriosis is a chronic, estrogen-dependent inflammatory disease characterized by the presence of endometrial tissue outside the uterus, causing pelvic pain and infertility. Infertility arises mainly due to inflammatory mediators in the peritoneal fluid, contributing to local hypoestrogenism, which appears to exacerbate chronic inflammation and sensitize pelvic nerves. Local hypoestrogenism within endometriotic lesions contrasts with the systemic estrogen-dependent nature of the disease. This localized reduction in estrogen levels, resulting from an altered hormonal response, can contribute to the altered immune response and inflammation characteristic of endometriosis, potentially exacerbating tissue damage, promoting fibrosis, adhesions, and endometrioma formation that distort pelvic anatomy, and affecting fertility. Chronic pelvic pain and dyspareunia further complicate conception in affected women. In vitro fertilization (IVF) and laparoscopic surgical excision of endometriotic lesions are the two primary management options for endometriosis-related infertility, although current data provide limited guidance on when to prefer one approach over the other. It is generally accepted that treatment strategies must be individualized according to the patient’s wishes, symptomatology, age and the preferences of the woman and the couple. Timely intervention and structured follow-up for symptomatic women wishing to conceive may maximize conception rates within two years post-surgery, while minimizing the need for repeated interventions, which should be avoided. On the other hand, first-line IVF is particularly viable in cases of unoperated deep infiltrating endometriosis in asymptomatic women, or for those ineligible for or opposed to surgery. This review aims to evaluate the most recent data on endometriosis-related infertility to identify evidence-based key points that can enhance tailored management in clinical practice. Full article

(This article belongs to the Special Issue Clinical Aspects of Diagnosis and Treatment of Endometriosis)

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16 pages, 1286 KiB

Open AccessEditor’s ChoiceReview

Resuscitation and Initial Management After Moderate-to-Severe Traumatic Brain Injury: Questions for the On-Call Shift

by Jesús Abelardo Barea-Mendoza, Mario Chico-Fernández, Maria Angeles Ballesteros, Alejandro Caballo Manuel, Ana M. Castaño-Leon, J. J. Egea-Guerrero, Alfonso Lagares, Guillermo Morales-Varas, Jon Pérez-Bárcena, Luis Serviá Goixart and Juan Antonio Llompart-Pou

J. Clin. Med. 2024, 13(23), 7325; https://doi.org/10.3390/jcm13237325 - 2 Dec 2024

Viewed by 2009

Abstract

Traumatic brain injury (TBI) is a leading cause of disability and mortality globally, stemming from both primary mechanical injuries and subsequent secondary responses. Effective early management of moderate-to-severe TBI is essential to prevent secondary damage and improve patient outcomes. This review provides a [...] Read more.

Traumatic brain injury (TBI) is a leading cause of disability and mortality globally, stemming from both primary mechanical injuries and subsequent secondary responses. Effective early management of moderate-to-severe TBI is essential to prevent secondary damage and improve patient outcomes. This review provides a comprehensive guide for the resuscitation and stabilization of TBI patients, combining clinical experience with current evidence-based guidelines. Key areas addressed in this study include the identification and classification of severe TBI, intubation strategies, and optimized resuscitation targets to maintain cerebral perfusion. The management of coagulopathy and special considerations for patients with concomitant hemorrhagic shock are discussed in depth, along with recommendations for neurosurgical interventions. This article further explores the role of multimodal neuromonitoring and targeted temperature management to mitigate secondary brain injury. Finally, it discusses end-of-life care in cases of devastating brain injury (DBI). This practical review integrates foundational and recent advances in TBI management to aid in reducing secondary injuries and enhancing long-term recovery, presenting a multidisciplinary approach to support acute care decisions in TBI patients. Full article

(This article belongs to the Special Issue Neurocritical Care: New Insights and Challenges)

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12 pages, 5893 KiB

Open AccessEditor’s ChoiceArticle

Glue and Ethanol Mixture for Aneurysm Endovascular Treatment: Animal Lab Study, Imaging, and Histopathological Findings

by Massimo Muto, Giuseppe Leone, Flavio Giordano, Gianluigi Guarnieri, Antonio Di Donna, Vincenzo Andreone, Eva Di Maro, Alessandro Poli, Niccolò Fonti, Ferdinando Caranci and Mario Muto

J. Clin. Med. 2024, 13(23), 7222; https://doi.org/10.3390/jcm13237222 - 28 Nov 2024

Viewed by 3507

Abstract

Background: This study aims to investigate the degree of penetration, permanence of occlusion, and vascular changes induced by a newly modified mixture of n-butyl cyanoacrylate (Glubran 2^®), ethanol, and Lipidol^® (GEL) in the endovascular treatment of experimental aneurysms induced in [...] Read more.

Background: This study aims to investigate the degree of penetration, permanence of occlusion, and vascular changes induced by a newly modified mixture of n-butyl cyanoacrylate (Glubran 2^®), ethanol, and Lipidol^® (GEL) in the endovascular treatment of experimental aneurysms induced in swine. Methods: Bilateral pouch aneurysms were created in the wall of the internal carotid artery in eighteen pigs. The sixteen aneurysms were treated with a new mixture of GEL with different component proportions. Angiograms were obtained at the time of treatment and at 1, 4, and 16 weeks after treatment. According to the scheduled experimental design, subjects were sacrificed at the time of treatment and 7, 30, and 90 days after the embolization of experimentally induced aneurysms. The internal carotid artery and aneurysms were removed en bloc and sampled for histopathologic study. Results: The mixture induced complete and stable occlusion without recanalization in all experimentally induced aneurysms throughout the study period. Histopathological studies showed focal angionecrosis and acute inflammatory reactions from 7 dpi, followed by chronic inflammation and vessel wall thickening. Conclusions: The GEL mixture may be useful in future clinical applications for the embolization of arteriovenous malformations, the control of acute bleeding, and the isolation of aneurysms due to its very short polymerization time and minimal adhesion to the microcatheter. Full article

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

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35 pages, 3758 KiB

Open AccessEditor’s ChoiceReview

Role of Proteins in Oncology: Advances in Cancer Diagnosis, Prognosis, and Targeted Therapy—A Narrative Review

by Magdalena Kędzierska and Magdalena Bańkosz

J. Clin. Med. 2024, 13(23), 7131; https://doi.org/10.3390/jcm13237131 - 25 Nov 2024

Cited by 1 | Viewed by 3121

Abstract

Modern oncology increasingly relies on the role of proteins as key components in cancer diagnosis, prognosis, and targeted therapy. This review examines advancements in protein biomarkers across several cancer types, including breast cancer, lung cancer, ovarian cancer, and hepatocellular carcinoma. These biomarkers have [...] Read more.

Modern oncology increasingly relies on the role of proteins as key components in cancer diagnosis, prognosis, and targeted therapy. This review examines advancements in protein biomarkers across several cancer types, including breast cancer, lung cancer, ovarian cancer, and hepatocellular carcinoma. These biomarkers have proven critical for early detection, treatment response monitoring, and tailoring personalized therapeutic strategies. The article highlights the utility of targeted therapies, such as tyrosine kinase inhibitors and monoclonal antibodies, in improving treatment efficacy while minimizing systemic toxicity. Despite these advancements, challenges like tumor resistance, variability in protein expression, and diagnostic heterogeneity persist, complicating universal application. The review underscores future directions, including the integration of artificial intelligence, advanced protein analysis technologies, and the development of combination therapies to overcome these barriers and refine personalized cancer treatment. Full article

(This article belongs to the Section Oncology)

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17 pages, 320 KiB

Open AccessEditor’s ChoiceReview

Challenges and Considerations in Diagnosing and Managing p16+-Related Oropharyngeal Squamous Cell Carcinoma (OPSCC) with Neck Metastasis: Implications of p16 Positivity, Tobacco Exposure, and De-Escalation Strategies

by Giovanni Motta, Benedetta Brandolini, Tonia Di Meglio, Salvatore Allosso, Massimo Mesolella, Filippo Ricciardiello, Marco Bocchetti, Domenico Testa and Gaetano Motta

J. Clin. Med. 2024, 13(22), 6773; https://doi.org/10.3390/jcm13226773 - 11 Nov 2024

Viewed by 1938

Abstract

Background: The incidence of patients showing neck metastasis and no obvious primary tumor at the initial diagnostic evaluation or neck cancer of unknown primary (NCUP) is rising. It is estimated that a relevant part of these tumors arises in the tonsillar crypts or [...] Read more.

Background: The incidence of patients showing neck metastasis and no obvious primary tumor at the initial diagnostic evaluation or neck cancer of unknown primary (NCUP) is rising. It is estimated that a relevant part of these tumors arises in the tonsillar crypts or base of the tongue and are p16+-related. However, today, the detection rate of the primary tumor is suboptimal. Identifying the primary tumor and its biomolecular characterization is essential since it influences the treatment administered, possibly reducing radiation fields and providing de-escalation to primary surgical management. However, p16 IHC (immunohistochemistry) might not be sufficient to diagnose HPV-related OPSCC. The other subset of patients discussed are the HPV-positive patients who have a history of tobacco exposure and/or p53 mutations. Possible factors that could negatively influence the outcomes of these patients are investigated and discussed below. So, this paper aims to analyze the diagnostic, bio-molecular, clinico-radiological, morphological, prognostic and therapeutical aspects of p16-positive OPSCC, highlighting the possible bias that can occur during the diagnostic and prognostic process. Methods: A narrative review was conducted to investigate the biases in the diagnostic and therapeutic process of two groups of patients: those who are p16-positive but HPV-negative patients, and those who are p16-positive and HPV-positive with exposure to traditional risk factors and/or p53 mutations. The keywords used for the literature research included the following: NCUP, OPSCC, p16IHC, HPV testing, p16 positive HPV negative OPSCC, p16 positive HPV positive OPSCC, tonsillectomy, tobacco exposure, p53 mutations, cystic neck metastasis, extranodal extension (ENE), radiotherapy, de-escalation and neck neck dissection. Results: HPV-positive OPSCC has specific clinico-radiological features. Bilateral tonsillectomy should be considered for the identification of the primary tumor. P16 IHC alone is not sufficient for diagnosing HPV-related OPSCC; additional detection methods are required. The role of tobacco exposure and p53 mutations should be investigated especially in cases of HPV-positive tumors. Extranodal extension (ENE) must be taken into consideration in the prognostic staging of HPV-positive tumors. Surgical primary treatment involving neck dissection (ND) and bilateral tonsillectomy followed by adjuvant radiation may represent the most appropriate approach for N3 cases. Diagnosis, prognosis and therapeutical implications must be addressed considering clinical, biomolecular and morphological aspects. At least today, the numerous biases that are still present influencing the diagnostic and prognostic process do not permit considering de-escalation protocols. Conclusions: A precise and accurate diagnosis is required in order to adequately stage and manage p16+ OPSCC, particularly with neck metastasis. The role of tobacco exposure and/or p53 mutations must be considered not only in p16+ OPSCC but especially in HPV-positive OPSCC. Until a more accurate diagnosis is possible, ENE should be considered even in p16+HPV+ OPSCC. Primary surgery with unilateral ND and bilateral tonsillectomy might be the treatment of choice given the numerous diagnostic and prognostic pitfalls. Therefore, it is inappropriate and risky to propose de-escalation protocols in routine clinical practice due to the risk of undertreatment. Full article

(This article belongs to the Special Issue New Advances in Nasopharyngeal and Oropharyngeal Cancer Treatment)

21 pages, 312 KiB

Open AccessEditor’s ChoiceReview

Mandibular Advancement Devices in Obstructive Sleep Apnea and Its Effects on the Cardiovascular System: A Comprehensive Literature Review

by Agnieszka Polecka, Jakub Nawrocki, Maria Alejandra Pulido and Ewa Olszewska

J. Clin. Med. 2024, 13(22), 6757; https://doi.org/10.3390/jcm13226757 - 10 Nov 2024

Viewed by 2938

Abstract

Background: Obstructive sleep apnea syndrome (OSA) is a chronic inflammatory disease characterized by endothelial dysfunction and cardiovascular complications. Continuous positive airway pressure (CPAP) is the standard treatment, hence poor adherence has prompted interest in mandibular advancement devices (MAD) as an alternative. This comprehensive [...] Read more.

Background: Obstructive sleep apnea syndrome (OSA) is a chronic inflammatory disease characterized by endothelial dysfunction and cardiovascular complications. Continuous positive airway pressure (CPAP) is the standard treatment, hence poor adherence has prompted interest in mandibular advancement devices (MAD) as an alternative. This comprehensive review aimed to explore the effects of MAD therapy on oxidative stress, inflammation, endothelial function, and its impact on the cardiovascular risk in OSA patients. Results: MAD therapy significantly reduces the apnea-hypopnea index (AHI), improves serum nitric oxide (NOx) concentrations, reduces oxidative stress markers, and enhances endothelial function. Animal studies indicated that MAD reduces myocardial fibrosis and attenuates inflammatory markers. While both CPAP and MADs improve endothelial function and heart rate variability, CPAP is more effective in reducing OSA severity. Nevertheless, MAD has higher compliance, contributing to its positive impact on cardiovascular function. Moreover, CPAP and MADs have similar effectiveness in reducing cardiovascular risk. Conclusions: MAD therapy is an effective alternative to CPAP, particularly for patients with mild to moderate OSA as well as those intolerant to CPAP. It offers significant improvements in endothelial function and oxidative stress. Further studies are needed to assess MAD therapy in comprehensive OSA management. Full article

(This article belongs to the Topic Biomarkers in Cardiovascular Disease—Chances and Risks, 2nd Volume)

23 pages, 1450 KiB

Open AccessEditor’s ChoiceSystematic Review

A Systematic Review of Dietary Lifestyle Interventions for Neuropathic Pain

by Michael Klowak, Rachel Lau, Mariyam N. Mohammed, Afia Birago, Bethel Samson, Layla Ahmed, Camille Renee, Milca Meconnen, Mahmud Sam and Andrea K. Boggild

J. Clin. Med. 2024, 13(22), 6766; https://doi.org/10.3390/jcm13226766 - 10 Nov 2024

Viewed by 1598

Abstract

Background/Objectives: Chronic severe neuropathic pain (NP) affects one in 10 individuals over the age of 30 in North America. Standard pharmacological interventions are associated with significant side effects and have limited effectiveness. Diets seeking to improve physiological health, support gut barrier integrity, and [...] Read more.

Background/Objectives: Chronic severe neuropathic pain (NP) affects one in 10 individuals over the age of 30 in North America. Standard pharmacological interventions are associated with significant side effects and have limited effectiveness. Diets seeking to improve physiological health, support gut barrier integrity, and decrease systemic inflammation have recently emerged as powerful tools conferring neuroprotective and anti-inflammatory effects, potentially reducing the overall morbidity and mortality of multiple neurological and metabolic diseases. This systematic review aimed to synthesize the literature around NP outcomes following dietary interventions compared to routine standard of care. Methods: Following PRISMA guidelines, an initial search yielded 15,387 records after deduplication. Six interventional trials specifically assessing dietary interventions for neuropathic pain were included and analyzed. The dietary lifestyle interventions included low-fat plant-based, plant-based fasting-mimicking, low-calorie, potassium-reduced, gluten-free, and intermittent high-protein/Mediterranean diets. Results: The included studies described some statistically significant improvements in pain severity on objective quantitative sensory testing, electrophysiology, imaging, and subjective questionnaires. The overall risk of bias was moderate, with only one trial demonstrating a low risk of bias across all assessed domains. No serious adverse events were identified, and dietary interventions were generally well tolerated. Conclusions: The data collected and synthesized in this systematic review indicate that dietary lifestyle interventions may offer a low-risk, low-cost, low-tech option for chronic neuropathic pain management, potentially improving quality of life and reducing overall morbidity. However, given substantial variability across studies and a moderate risk of bias, further research is warranted to substantiate these findings. Full article

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

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12 pages, 1393 KiB

Open AccessEditor’s ChoiceReview

Role of Avacopan on Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis

by Justo Sandino and Enrique Morales

J. Clin. Med. 2024, 13(22), 6676; https://doi.org/10.3390/jcm13226676 - 7 Nov 2024

Cited by 1 | Viewed by 3100

Abstract

Antineutrophil cytoplasmic antibody-associated (ANCA) vasculitis are a group of autoimmune diseases characterized by inflammation of the microvasculature, leading to life-threatening complications, including kidney disease. These diseases are associated with a high morbidity and mortality rate. Conventional treatment modalities have evolved towards personalized therapies [...] Read more.

Antineutrophil cytoplasmic antibody-associated (ANCA) vasculitis are a group of autoimmune diseases characterized by inflammation of the microvasculature, leading to life-threatening complications, including kidney disease. These diseases are associated with a high morbidity and mortality rate. Conventional treatment modalities have evolved towards personalized therapies intending to mitigate inflammation and minimize the adverse effects of traditional immunosuppressive agents. Avacopan, a novel C5a receptor inhibitor, represents a promising therapeutic option for vasculitis with renal involvement. This article provides a comprehensive review of the role of complement in the pathogenesis of vasculitis with renal involvement and the role of avacopan for its treatment, taking into account recent updates to both the EULAR and KDIGO guidelines and published experience of avacopan use in real clinical settings. Full article

(This article belongs to the Special Issue Glomerulonephritis: Current Diagnosis, Treatment and Future Options)

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17 pages, 6623 KiB

Open AccessEditor’s ChoiceReview

The Management of Interstitial Lung Disease in the ICU: A Comprehensive Review

by Zehra Dhanani and Rohit Gupta

J. Clin. Med. 2024, 13(22), 6657; https://doi.org/10.3390/jcm13226657 - 6 Nov 2024

Viewed by 4766

Abstract

Interstitial lung disease (ILD) encompasses a diverse group of parenchymal lung diseases characterized by varying degrees of inflammation and/or fibrosis. Patients with ILD frequently require hospitalization, with many needing intensive care unit (ICU) admission, most often due to respiratory failure. The diagnosis and [...] Read more.

Interstitial lung disease (ILD) encompasses a diverse group of parenchymal lung diseases characterized by varying degrees of inflammation and/or fibrosis. Patients with ILD frequently require hospitalization, with many needing intensive care unit (ICU) admission, most often due to respiratory failure. The diagnosis and management of ILD in the ICU present unique challenges. Diagnosis primarily relies on chest CT imaging to identify fibrosis and inflammation. Acute exacerbations, whether in idiopathic pulmonary fibrosis (IPF) or non-IPF ILD, require careful evaluation of potential triggers and differential diagnoses. Bronchoalveolar lavage may provide valuable information, such as the identification of infections, but carries risks of complications. Biopsies, whether transbronchial or surgical, can also be informative but pose significant procedural risks. Corticosteroids are the cornerstone of treatment for acute exacerbations of IPF, with higher doses potentially benefiting non-IPF ILD. Additional immunosuppressive agents may be used in cases with evidence of inflammation. Oxygen supplementation, particularly with high-flow nasal cannula, is often employed to manage severe hypoxemia, while noninvasive ventilation can be useful for worsening hypoxemia and/or hypercapnia. When mechanical ventilation is used, it is recommended to target low tidal volumes to minimize lung injury; high PEEP may be less effective and even associated with increased mortality. Prone positioning can improve oxygenation in severely hypoxemic patients. In addition to ventilatory strategies, careful fluid management and addressing concomitant pulmonary hypertension are essential components of care. Extracorporeal membrane oxygenation is a high-risk intervention reserved for the most severe cases. Lung transplantation may be considered for end-stage ILD patients in the ICU, with outcomes dependent on the urgency of transplantation and the patient’s overall condition. Managing ILD in the ICU requires a multidisciplinary approach, and despite recent advances, mortality remains high, emphasizing the need for continued research and individualized treatment strategies. Full article

(This article belongs to the Special Issue Updates on Interstitial Lung Disease)

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21 pages, 390 KiB

Open AccessFeature PaperEditor’s ChoiceReview

IgA Vasculitis (Henoch–Schönlein Purpura): An Update on Treatment

by Santos Castañeda, Patricia Quiroga-Colina, Paz Floranes, Miren Uriarte-Ecenarro, Cristina Valero-Martínez, Esther F. Vicente-Rabaneda and Miguel A. González-Gay

J. Clin. Med. 2024, 13(21), 6621; https://doi.org/10.3390/jcm13216621 - 4 Nov 2024

Cited by 1 | Viewed by 7911

Abstract

Objective: IgA vasculitis (IgAV), previously named as Henoch–Schönlein purpura, is the most frequent systemic vasculitis in children. In adults, IgAV is less common although it is associated with more severe disease. In fact, the frequency of glomerulonephritis (referred to as IgAV nephritis) in [...] Read more.

Objective: IgA vasculitis (IgAV), previously named as Henoch–Schönlein purpura, is the most frequent systemic vasculitis in children. In adults, IgAV is less common although it is associated with more severe disease. In fact, the frequency of glomerulonephritis (referred to as IgAV nephritis) in adults is higher than in children and tends to present more severely, with around 10–30% of those affected eventually progressing to end-stage renal disease. In this review, we describe the pathophysiology, main clinical features, diagnosis of the disease, and latest clinical data regarding IgAV therapy. Methods: A narrative literature review, primarily based on articles published in PubMed, was conducted. In addition to discussing the main aspects of glucocorticoids and conventional disease-modifying drugs used in the management of IgAV, this review focuses on the latest information reported regarding biologics and potential future therapies. Results: Glucocorticoids are the first-line therapy for IgAV, especially in adults with severe manifestations. Colchicine, dapsone, and methotrexate can be useful for controlling minor manifestations. Several immunomodulatory agents, such as cyclosporine A, tacrolimus, and mycophenolate mofetil, have shown favorable results as glucocorticoid-sparing agents. Leflunomide has shown promising results but requires further study. The use of rituximab has demonstrated efficacy in reducing relapse frequency, lowering the cumulative glucocorticoid burden, and achieving long-term remission of the disease in children and adults with IgAV. Immunoglobulins and plasma exchange therapy can also be useful in difficult and life-threatening situations. Other potential therapies with encouraging results include TRF-budesonide, B-cell-directed therapy, B-cell-depleting agents, sodium–glucose cotransporter-2 inhibitors, endothelin receptor antagonists, and complement pathway inhibitors. Conclusions: Glucocorticoids are the first-line therapy for IgAV, especially in adults with severe manifestations. The role of various immunomodulatory therapies, such as calcineurin inhibitors and mycophenolate mofetil, remains promising, while rituximab reduces the long-term side effects of glucocorticoids and can help achieve disease remission. Other potential therapies with encouraging results require further research. Full article

(This article belongs to the Special Issue Vasculitis: Current Treatment and Future Options)

35 pages, 61213 KiB

Open AccessEditor’s ChoiceSystematic Review

Hip Flexor Muscle Activation During Common Rehabilitation and Strength Exercises

by Jessica Juan, Gretchen Leff, Kate Kevorken and Michael Jeanfavre

J. Clin. Med. 2024, 13(21), 6617; https://doi.org/10.3390/jcm13216617 - 4 Nov 2024

Cited by 2 | Viewed by 4021

Abstract

Background/Objectives: The iliopsoas muscle plays an essential role in lumbopelvic and hip anterior stability, which is particularly important in the presence of limited osseous acetabular coverage anteriorly as in hip dysplasia and/or hip micro-instability. The purpose of this systematic review is to (1) [...] Read more.

Background/Objectives: The iliopsoas muscle plays an essential role in lumbopelvic and hip anterior stability, which is particularly important in the presence of limited osseous acetabular coverage anteriorly as in hip dysplasia and/or hip micro-instability. The purpose of this systematic review is to (1) describe iliopsoas activation levels during common rehabilitation exercises and (2) provide an evidence-based exercise progression for strengthening the iliopsoas based on electromyography (EMG) studies. Methods: In total, 109 healthy adult participants ranging from ages 20 to 40 were included in nine studies. PubMed, CINAHL, and Embase databases were systematically searched for EMG studies of the psoas, iliacus, or combined iliopsoas during specific exercise. The Modified Downs and Black Checklist was used to perform a risk of bias assessment. PROSPERO guidelines were followed. Results: Nine studies were included. Findings suggest that the iliopsoas is increasingly activated in ranges of hip flexion of 30–60°, particularly with leg lowering/raising exercises. Briefly, >60% MVIC activity of the iliopsoas was reported in the active straight leg raise (ASLR) in ranges around 60° of hip flexion, as well as with supine hip flexion and leg lifts. In total, 40–60% MVIC was found in exercises including the mid-range of the ASLR around 45° of hip flexion and lifting a straight trunk while in a hip flexed position. Conclusions: The findings suggest that exercises in increased hip flexion provide greater activation of the iliopsoas compared to exercises where the trunk is moving on the lower extremity. Iliopsoas activation can be incrementally progressed from closed to open kinetic chain exercises, and eventually to the addition of external loads. The proposed exercise program interprets the results and offers immediate translation into clinical practice. Full article

(This article belongs to the Special Issue Musculoskeletal Disorders: Clinical Rehabilitation and Physiotherapy)

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28 pages, 1717 KiB

Open AccessEditor’s ChoiceSystematic Review

Effectiveness of Robotic Devices for Medical Rehabilitation: An Umbrella Review

by Kei Kiyono, Shigeo Tanabe, Satoshi Hirano, Takuma Ii, Yuki Nakagawa, Koki Tan, Eiichi Saitoh and Yohei Otaka

J. Clin. Med. 2024, 13(21), 6616; https://doi.org/10.3390/jcm13216616 - 4 Nov 2024

Cited by 1 | Viewed by 3387

Abstract

Background/Objectives: Clinical trials have investigated the efficacy of rehabilitation robotics for various pathological conditions, but the overall impact on rehabilitation practice remains unclear. We comprehensively examined and analyzed systematic reviews (SRs) of randomized controlled trials (RCTs) investigating rehabilitative interventions with robotic devices. Methods: [...] Read more.

Background/Objectives: Clinical trials have investigated the efficacy of rehabilitation robotics for various pathological conditions, but the overall impact on rehabilitation practice remains unclear. We comprehensively examined and analyzed systematic reviews (SRs) of randomized controlled trials (RCTs) investigating rehabilitative interventions with robotic devices. Methods: Four databases were searched using term combinations of keywords related to robotic devices, rehabilitation, and SRs. The SR meta-analyses were categorized into “convincing”, “highly suggestive”, “suggestive”, “weak”, or “non-significant” depending on evidence strength and validity. Results: Overall, 62 SRs of 341 RCTs involving 14,522 participants were identified. Stroke was most frequently reported (40 SRs), followed by spinal cord injury (eight SRs), multiple sclerosis (four SRs), cerebral palsy (four SRs), Parkinson’s disease (three SRs), and neurological disease (any disease causing limited upper- and lower-limb functioning; three SRs). Furthermore, 38, 21, and 3 SRs focused on lower-limb devices, upper-limb devices, and both upper- and lower-limb devices, respectively. Quantitative synthesis of robotic intervention effects was performed by 51 of 62 SRs. Robot-assisted training was effective for various outcome measures per disease. Meta-analyses offering suggestive evidence were limited to studies on stroke. Upper-limb devices were effective for motor control and activities of daily living, and lower-limb devices for walking independence in stroke. Conclusions: Robotic devices are useful for improving impairments and disabilities in several diseases. Further high-quality SRs including RCTs with large sample sizes and meta-analyses of these RCTs, particularly on non-stroke-related diseases, are required. Further research should also ascertain which type of robotic device is the most effective for improving each specific impairment or disability. Full article

(This article belongs to the Special Issue Innovations in Neurorehabilitation)

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28 pages, 2371 KiB

Open AccessEditor’s ChoiceReview

Clinical Recommendations for Managing Genitourinary Adverse Effects in Patients Treated with SGLT-2 Inhibitors: A Multidisciplinary Expert Consensus

by Juan J. Gorgojo-Martínez, José L. Górriz, Ana Cebrián-Cuenca, Almudena Castro Conde and María Velasco Arribas

J. Clin. Med. 2024, 13(21), 6509; https://doi.org/10.3390/jcm13216509 - 30 Oct 2024

Cited by 1 | Viewed by 8792

Abstract

Background: SGLT-2 inhibitors (SGLT-2is) are considered to be a first-line treatment for common conditions like type 2 diabetes, chronic kidney disease, and heart failure due to their proven ability to reduce cardiovascular and renal morbidity and mortality. Despite these benefits, SGLT-2is are associated [...] Read more.

Background: SGLT-2 inhibitors (SGLT-2is) are considered to be a first-line treatment for common conditions like type 2 diabetes, chronic kidney disease, and heart failure due to their proven ability to reduce cardiovascular and renal morbidity and mortality. Despite these benefits, SGLT-2is are associated with certain adverse effects (AEs), particularly genitourinary (GU) events, which can lead to treatment discontinuation in some patients. Preventing these AEs is essential for maintaining the cardiorenal benefits of SGLT-2is. Methods: A multidisciplinary panel of experts from various medical specialties reviewed the best available evidence on GU AEs associated with SGLT-2i therapy. The panel focused on the prevention and management of genital mycotic infections, urinary tract infections, and lower urinary tract symptoms in both the general population and high-risk groups, such as renal and cardiac transplant recipients. Results: The panel found that permanent discontinuation of SGLT-2is results in a rapid loss of cardiorenal benefits. Preventive strategies, including identifying high-risk patients before initiating therapy, are critical for minimizing GU AEs. Clinical trials show that most GU infections linked to SGLT-2i therapy are mild to moderate in severity and typically respond to standard antimicrobial treatment, without the need for discontinuation. Conclusions: Routine discontinuation of SGLT-2is due to GU AEs is not recommended. Therapy should be resumed as soon as possible, unless severe or persistent conditions contraindicate their use, in order to preserve the significant benefits of SGLT-2is in reducing cardiovascular and renal events Full article

(This article belongs to the Section Endocrinology & Metabolism)

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19 pages, 9467 KiB

Open AccessEditor’s ChoiceArticle

Biomimetic Curcumin-Loaded Liposomes for the Treatment of Dry Eyes and Meibomian Gland Dysfunction: An In Vivo Study

by Vytautas Baranauskas, Ruta Jaruseviciene, Mantas Grigalavicius, Saulius Galgauskas, Vitalijus Karabanovas and Simona Steponkiene

J. Clin. Med. 2024, 13(21), 6436; https://doi.org/10.3390/jcm13216436 - 27 Oct 2024

Cited by 3 | Viewed by 6323

Abstract

Background/Objectives: Meibomian gland dysfunction (MGD) and dry eye syndrome (DES) are common eye diseases characterized by altered tear film stability and inflammation of the ocular surface, causing significant discomfort and possible visual impairment. This study aimed to investigate the efficacy of curcumin-loaded liposomes [...] Read more.

Background/Objectives: Meibomian gland dysfunction (MGD) and dry eye syndrome (DES) are common eye diseases characterized by altered tear film stability and inflammation of the ocular surface, causing significant discomfort and possible visual impairment. This study aimed to investigate the efficacy of curcumin-loaded liposomes (Lipo@Cur) compared to cyclosporine A-loaded liposomes (Lipo@CycA) in experimental rabbit models of MGD and DES, with a focus on their ability to improve tear film stability and reduce ocular surface inflammation. Methods: MGD and DES were induced using complete Freund’s adjuvant (CFA) and treated to evaluate the effect of liposomal formulations on tear break-up time (TBUT), clinical signs of inflammation (telangiectasia, conjunctival hyperemia, meibomian foramen occlusion), and corneal as well as conjunctival histological cells. Results: Lipo@Cur increased TBUT and reduced the signs of ocular surface inflammation, potentially approaching the effectiveness of clinically approved cyclosporine A encapsulated in liposomes (Lipo@CycA). Histological analysis suggested improvements in corneal epithelial thickness and goblet cell density in the treated groups, which may indicate a reversal of DES-induced damage to the ocular surface. Conclusions: Plant-originated curcumin encapsulated in liposomes offers a promising therapeutic strategy for the management of MGD and DES that may improve patient outcomes by addressing the underlying inflammatory mechanisms of these conditions. Full article

(This article belongs to the Special Issue New Insights into Ocular Surface, Cornea, Cataract, and Refractive Surgery)

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14 pages, 1214 KiB

Open AccessEditor’s ChoiceReview

Finerenone: A Third-Generation MRA and Its Impact on Cardiovascular Health—Insights from Randomized Controlled Trials

by Michael Sabina, Jennifer Trube, Shrinand Shah, Andrew Lurie, Mason Grimm and Anas Bizanti

J. Clin. Med. 2024, 13(21), 6398; https://doi.org/10.3390/jcm13216398 - 25 Oct 2024

Viewed by 4315

Abstract

Introduction: Finerenone, a third-generation non-steroidal mineralocorticoid receptor antagonist (MRA), offers a targeted approach to managing cardiovascular outcomes, particularly in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). Unlike traditional MRAs such as spironolactone and eplerenone, which can cause off-target hormonal [...] Read more.

Introduction: Finerenone, a third-generation non-steroidal mineralocorticoid receptor antagonist (MRA), offers a targeted approach to managing cardiovascular outcomes, particularly in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). Unlike traditional MRAs such as spironolactone and eplerenone, which can cause off-target hormonal side effects and hyperkalemia, Finerenone selectively binds to mineralocorticoid receptors, reducing these risks. Recent randomized controlled trials have demonstrated Finerenone’s potential to improve cardiovascular outcomes, making it a promising alternative in the management of heart failure and other cardiovascular conditions associated with CKD and T2D. Methods: We conducted a scoping review using PRISMA guidelines. A search for “Finerenone” in the PubMed, Embase, and Cochrane Library databases included randomized controlled trials (RCTs), post hoc analyses, and relevant meta-analyses on cardiovascular outcomes. Data were synthesized narratively, assessing study quality through strengths and limitations. Discussion: Finerenone has shown significant benefits and a superior safety profile compared with traditional MRAs like spironolactone and eplerenone in managing CKD, T2D, and heart failure. It effectively reduces cardiovascular and renal events while minimizing risks such as hyperkalemia and hormonal side effects associated with steroidal MRAs. Future studies, including the REDEFINE-HF, FINALITY-HF, and CONFIRMATION-HF trials, will further explore Finerenone’s potential across diverse heart failure phenotypes, including its role in heart failure with mildly reduced and preserved ejection fractions, potentially establishing it as a cornerstone therapy in heart failure management. Conclusions: Finerenone represents a significant advancement in MRA therapy, offering enhanced safety and efficacy in managing cardiovascular outcomes in CKD and T2D patients. The current evidence supports its use as a promising alternative to traditional MRAs, particularly in patients intolerant to steroidal MRAs. Further trials are needed to fully establish its potential across diverse patient populations, including those with varying heart failure phenotypes. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Cardiovascular Medicine, 2nd Edition)

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11 pages, 888 KiB

Open AccessEditor’s ChoiceArticle

The Validity of a Smartphone-Based Method for Acquiring 3D Images of the Face

by Alexandra K. Papadopoulou, Francesca Di Santo, Gregory S. Antonarakis and Luis Huanca Ghislanzoni

J. Clin. Med. 2024, 13(21), 6362; https://doi.org/10.3390/jcm13216362 - 24 Oct 2024

Viewed by 6538

Abstract

Objectives. To evaluate the accuracy and reproducibility of measurements obtained using the Bellus3D Face Application on a mobile smartphone by comparing them to direct measurements on pre-marked and blank face scans. Materials and Methods. Twenty-five healthy young adults (six males and nineteen females; [...] Read more.

Objectives. To evaluate the accuracy and reproducibility of measurements obtained using the Bellus3D Face Application on a mobile smartphone by comparing them to direct measurements on pre-marked and blank face scans. Materials and Methods. Twenty-five healthy young adults (six males and nineteen females; age range 20–30 years) were included in this prospective cross-sectional study, with the only exclusion criterion being the presence of significant facial hair interfering with the placement and visualization of landmarks. Image acquisitions were performed using an iPhone XR with the Bellus3D FaceApp face scanning application, an iOS application for smartphones. Ten single midfacial and five paired bilateral landmarks were defined and marked. Two face scans were performed on each patient, both on blank and marked faces, and distances were measured directly with calipers and digitally. Results. The random error values were 1.0 mm and 0.4 mm for the manual point placement and measurements and virtual point placement on blank faces, respectively. The two methods used (the direct method and acquisition on faces with landmarks) demonstrate relatively similar reliability (ICC > 0.8); however, a paired t-test showed that the differences between several measurements were statistically significant (p < 0.05). Regardless of the method used, there was a systematic error for various values that included the nose and mouth (p < 0.05). The measurements demonstrating the most significant differences between the methods were those that included the tip of the nose, with the mean differences being −4.4–3.3 mm. The measurements of the distances that estimate face “depth” showed the greatest consistency irrespective of the tested method (p > 0.05 and ICC > 0.8). Conclusions. The use of the Bellus3D FaceApp is precise and reproducible for certain areas of the face, but digital reconstruction errors prohibit, for the time being, the use of this technology in everyday clinical practice. The noted discrepancies were consistent and more prevalent for specific areas such as the tip of the nose. Further investigations are required to determine other sources of error and for other smartphone-based applications released for 3D face image acquisitions. Full article

(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)

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12 pages, 1345 KiB

Open AccessEditor’s ChoiceArticle

Comparison Between Total Hip and Knee Arthroplasty on Short-Term Performance-Based Outcomes and Factors Associated with the Improvement of Gait Function During Post-Acute Inpatient Rehabilitation

by Kenichi Kawaguchi, So Kuwakado, Hiroshi Otsuka, Akemi Sakugawa, Masanori Takahashi, Taiji Oda, Goro Motomura, Satoshi Hamai and Yasuharu Nakashima

J. Clin. Med. 2024, 13(21), 6381; https://doi.org/10.3390/jcm13216381 - 24 Oct 2024

Viewed by 5370

Abstract

Background: Data on the differences in functional recovery between inpatient rehabilitation for total hip arthroplasty (THA) and total knee arthroplasty (TKA) are lacking, and the factors influencing the improvement of short-term functional mobility remain unknown. In this study, we compared the short-term [...] Read more.

Background: Data on the differences in functional recovery between inpatient rehabilitation for total hip arthroplasty (THA) and total knee arthroplasty (TKA) are lacking, and the factors influencing the improvement of short-term functional mobility remain unknown. In this study, we compared the short-term functional outcomes of both procedures and identified early postoperative predictors of physical function gain during post-acute rehabilitation. Methods: A total of 435 patients who underwent THA and TKA were included. The main outcomes were knee extension strength, the motor component of the Functional Independence Measure, Numerical Rating Scale, 10 Meter Walk Test, Timed Up and Go (TUG) test, and the Berg Balance Scale. The recovery process and rehabilitation outcomes were compared between patients with THA and TKA. Additionally, predictors related to physical performance improvement were examined for each procedure. Results: Patients with THA and TKA achieved significant short-term functional recovery after multidisciplinary rehabilitation (time; p < 0.001). However, the pain score was higher at discharge in patients with TKA (p < 0.001). Age (β: −0.264, p = 0.009) and TUG test (β: −0.884, p < 0.001) in THA, and non-operated knee extension strength (β: 0.234, p = 0.016) and TUG test (β: −0.783, p < 0.001) in TKA were significant early postoperative predictors of functional mobility. Conclusions: Multidisciplinary rehabilitation was beneficial for functional improvement in patients with THA and TKA despite persistent pain at discharge after TKA. Baseline functional levels in both groups and non-operated knee extension strength in TKA can be useful performance-based predictors of short-term gait function improvement. Full article

(This article belongs to the Section Orthopedics)

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33 pages, 1401 KiB

Open AccessEditor’s ChoiceReview

An Update on Advances in Hypopituitarism: Etiology, Diagnosis, and Current Management

by Pedro Iglesias

J. Clin. Med. 2024, 13(20), 6161; https://doi.org/10.3390/jcm13206161 - 16 Oct 2024

Cited by 2 | Viewed by 4392

Abstract

This article provides an updated review of hypopituitarism (HP), an endocrine disorder characterized by a deficiency of one or more pituitary hormones. The various etiologies are reviewed, including pituitary neuroendocrine tumors (PitNETs), hypothalamic lesions, genetic mutations, and acquired factors such as head trauma, [...] Read more.

This article provides an updated review of hypopituitarism (HP), an endocrine disorder characterized by a deficiency of one or more pituitary hormones. The various etiologies are reviewed, including pituitary neuroendocrine tumors (PitNETs), hypothalamic lesions, genetic mutations, and acquired factors such as head trauma, medications, neoplasms, and infiltrative diseases. It is noted that PitNETs are responsible for approximately half of the cases in adults, whereas in children the causes are predominantly congenital. Diagnosis is based on clinical evaluation and hormonal testing, with identification of the specific hormonal deficiencies essential for effective treatment. Laboratory tests present challenges and limitations that must be understood and addressed. Hormone replacement therapy is the mainstay of treatment, significantly improving patients’ quality of life. It is important to know the possible interactions between hormone replacement therapies in HP. Recent advances in understanding the pathophysiology of HP and the importance of a multidisciplinary approach to the management of associated complications are discussed. This article emphasizes the need for comprehensive evaluation and continuous follow-up to optimize outcomes in patients with HP and highlights the importance of ongoing research to improve diagnostic and treatment strategies. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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11 pages, 424 KiB

Open AccessEditor’s ChoiceArticle

Kidney Stones of Type I vs. Type II Diabetic Patients: Are There Any Differences?

by Cătălin Pricop, Marius Ivănuță, Mihaela Nikolic and Dragoş Puia

J. Clin. Med. 2024, 13(20), 6110; https://doi.org/10.3390/jcm13206110 - 14 Oct 2024

Cited by 5 | Viewed by 1665

Abstract

Background: This study highlighted the differences between the biochemical compositions of urinary stones from patients with type 1 diabetes versus those with type 2 diabetes. Materials and Methods: This study included patients diagnosed with kidney stones and diabetes who were referred [...] Read more.

Background: This study highlighted the differences between the biochemical compositions of urinary stones from patients with type 1 diabetes versus those with type 2 diabetes. Materials and Methods: This study included patients diagnosed with kidney stones and diabetes who were referred to the Urological Clinic of the Dr. C. I. Parhon Hospital in Iasi from April 2017 to April 2024. We analyzed the spectroscopic stone composition from 128 lithiasis patients treated in our Clinic. In the current study, the distribution of the biochemical composition of stones varied significantly between diabetic patients with type 2 diabetes, who formed primarily mixed uric acid stones, and diabetic patients with type 1 diabetes, who mainly developed pure uric acid stones (p < 0.001). Patients with uric acid stones had significantly higher mean creatinine values than the other stone types (p < 0.001). Urinary pH levels were abnormal for all biochemical subtypes of stones, indicating acidic urine. However, patients with uric acid stones had lower pH values than the group average. From the Kaplan–Mayer analysis, patients with pure uric acid stones had a shorter time to stone recurrence compared to patients with other biochemical types identified. Conclusions: These findings, which highlight the prevalence of pure uric acid stones in patients with type 1 diabetes and the impact of this on the strategy for dissolving pure stones, represent a significant advancement in understanding urinary lithiasis in diabetic patients. Full article

(This article belongs to the Section Nephrology & Urology)

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13 pages, 999 KiB

Open AccessEditor’s ChoiceArticle

Advanced Lung Cancer Inflammation Index as Predictor of All-Cause Mortality in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

by Giancarlo Trimarchi, Fausto Pizzino, Alessio Lilli, Alberto Ranieri De Caterina, Augusto Esposito, Stefano Dalmiani, Annamaria Mazzone, Gianluca Di Bella, Sergio Berti and Umberto Paradossi

J. Clin. Med. 2024, 13(20), 6059; https://doi.org/10.3390/jcm13206059 - 11 Oct 2024

Cited by 12 | Viewed by 1979

Abstract

Background: The advanced lung cancer inflammation index (ALI) is an independent prognostic biomarker used to assess inflammation and nutritional status in various cancers, heart failure, and acute coronary syndromes. This study investigates the prognostic significance of ALI in patients experiencing ST-elevation myocardial infarction [...] Read more.

Background: The advanced lung cancer inflammation index (ALI) is an independent prognostic biomarker used to assess inflammation and nutritional status in various cancers, heart failure, and acute coronary syndromes. This study investigates the prognostic significance of ALI in patients experiencing ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), comparing its predictive abilities with the established Neutrophil-Lymphocyte Ratio (NLR). Methods: We conducted a retrospective analysis of 1171 patients from the Matrix Registry, encompassing demographic and clinical data for STEMI cases treated with pPCI, and ALI was determined using the formula [serum albumin (g/dL) × body mass index (kg/m²)]/NLR at the time of hospital admission. The primary outcome was all-cause mortality. Results: Of the 1171 patients, 86 died during the follow-up period. Univariate analysis identified age, female gender, smoking, hypertension, diabetes, prior myocardial infarction (PMI), lower left ventricular ejection fraction (LVEF), and reduced ALI as factors associated with mortality. Multivariate analysis confirmed age (HR: 1.1, 95% CI: 1.05–1.11, p < 0.001) and PMI (HR: 2.4, 95% CI: 1.4–4.3, p = 0.001) as prominent independent predictors, alongside ALI (HR: 0.95, 95% CI: 0.92–0.97, p < 0.001) and LVEF (HR: 0.98, 95% CI: 0.97–0.99, p = 0.04). An ALI cut-off of ≤10 indicated a higher mortality risk (HR: 2.3, 95% CI: 1.5–3.7, p < 0.001). The area under the curve for ALI (0.732) surpassed that for NLR (0.685), demonstrating ALI’s superior predictive capability. Conclusions: ALI is an independent prognostic factor for all-cause mortality in STEMI patients undergoing pPCI, showing greater discriminatory power than NLR, particularly in patients with ALI values ≤ 10, who face a 2.3-fold higher mortality risk. Full article

(This article belongs to the Special Issue Advancements in Myocardial Infarction Care: Strategies and Outcomes)

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12 pages, 764 KiB

Open AccessEditor’s ChoiceReview

Acute Ischemic Stroke during Extracorporeal Membrane Oxygenation (ECMO): A Narrative Review of the Literature

by Konstantinos Themas, Marios Zisis, Christos Kourek, Giorgos Konstantinou, Lucio D’Anna, Panagiotis Papanagiotou, George Ntaios, Stavros Dimopoulos and Eleni Korompoki

J. Clin. Med. 2024, 13(19), 6014; https://doi.org/10.3390/jcm13196014 - 9 Oct 2024

Cited by 2 | Viewed by 3602

Abstract

Ischemic stroke (IS) is a severe complication and leading cause of mortality in patients under extracorporeal membrane oxygenation (ECMO). The aim of our narrative review is to summarize the existing evidence and provide a deep examination of the diagnosis and treatment of acute [...] Read more.

Ischemic stroke (IS) is a severe complication and leading cause of mortality in patients under extracorporeal membrane oxygenation (ECMO). The aim of our narrative review is to summarize the existing evidence and provide a deep examination of the diagnosis and treatment of acute ischemic stroke patients undergoing ECMO support. The incidence rate of ISs is estimated to be between 1 and 8%, while the mortality rate ranges from 44 to 76%, depending on several factors, including ECMO type, duration of support and patient characteristics. Several mechanisms leading to ISs during ECMO have been identified, with thromboembolic events and cerebral hypoperfusion being the most common causes. However, considering that most of the ECMO patients are severely ill or under sedation, stroke symptoms are often underdiagnosed. Multimodal monitoring and daily clinical assessment could be useful preventive techniques. Early recognition of neurological deficits is of paramount importance for prompt therapeutic interventions. All ECMO patients with suspected strokes should immediately receive brain computed tomography (CT) and CT angiography (CTA) for the identification of large vessel occlusion (LVO) and assessment of collateral blood flow. CT perfusion (CTP) can further assist in the detection of viable tissue (penumbra), especially in cases of strokes of unknown onset. Catheter angiography is required to confirm LVO detected on CTA. Intravenous thrombolytic therapy is usually contraindicated in ECMO as most patients are on active anticoagulation treatment. Therefore, mechanical thrombectomy is the preferred treatment option in cases where there is evidence of LVO. The choice of the arterial vascular access used to perform mechanical thrombectomy should be discussed between interventional radiologists and an ECMO team. Anticoagulation management during the acute phase of IS should be individualized after the thromboembolic risk has been carefully balanced against hemorrhagic risk. A multidisciplinary approach is essential for the optimal management of ISs in patients treated with ECMO. Full article

(This article belongs to the Section Clinical Neurology)

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