Journal of Clinical Medicine

27 pages, 3473 KB

Open AccessEditor’s ChoiceSystematic Review

Artificial Intelligence in Surgery: A Systematic Review of Use and Validation

by Nitzan Kenig, Javier Monton Echeverria and Aina Muntaner Vives

J. Clin. Med. 2024, 13(23), 7108; https://doi.org/10.3390/jcm13237108 - 24 Nov 2024

Cited by 10 | Viewed by 6565

Background: Artificial Intelligence (AI) holds promise for transforming healthcare, with AI models gaining increasing clinical use in surgery. However, new AI models are developed without established standards for their validation and use. Before AI can be widely adopted, it is crucial to [...] Read more.

Background: Artificial Intelligence (AI) holds promise for transforming healthcare, with AI models gaining increasing clinical use in surgery. However, new AI models are developed without established standards for their validation and use. Before AI can be widely adopted, it is crucial to ensure these models are both accurate and safe for patients. Without proper validation, there is a risk of integrating AI models into practice without sufficient evidence of their safety and accuracy, potentially leading to suboptimal patient outcomes. In this work, we review the current use and validation methods of AI models in clinical surgical settings and propose a novel classification system. Methods: A systematic review was conducted in PubMed and Cochrane using the keywords “validation”, “artificial intelligence”, and “surgery”, following PRISMA guidelines. Results: The search yielded a total of 7627 articles, of which 102 were included for data extraction, encompassing 2,837,211 patients. A validation classification system named Surgical Validation Score (SURVAS) was developed. The primary applications of models were risk assessment and decision-making in the preoperative setting. Validation methods were ranked as high evidence in only 45% of studies, and only 14% of the studies provided publicly available datasets. Conclusions: AI has significant applications in surgery, but validation quality remains suboptimal, and public data availability is limited. Current AI applications are mainly focused on preoperative risk assessment and are suggested to improve decision-making. Classification systems such as SURVAS can help clinicians confirm the degree of validity of AI models before their application in practice. Full article

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

► Show Figures

Figure 1

18 pages, 755 KB

Open AccessEditor’s ChoiceReview

Psychiatric Disorders in Patients with Chronic Obstructive Pulmonary Disease: Clinical Significance and Treatment Strategies

by Pasquale Moretta, Nicola Davide Cavallo, Claudio Candia, Anna Lanzillo, Giuseppina Marcuccio, Gabriella Santangelo, Laura Marcuccio, Pasquale Ambrosino and Mauro Maniscalco

J. Clin. Med. 2024, 13(21), 6418; https://doi.org/10.3390/jcm13216418 - 26 Oct 2024

Cited by 7 | Viewed by 2902

Abstract

Chronic obstructive pulmonary disease (COPD) is a debilitating lung disease characterized by chronic airflow limitation and persistent respiratory symptoms. It is a major cause of morbidity and mortality worldwide, significantly impacting healthcare systems with considerable socioeconomic consequences. The main risk factors include exposure [...] Read more.

Chronic obstructive pulmonary disease (COPD) is a debilitating lung disease characterized by chronic airflow limitation and persistent respiratory symptoms. It is a major cause of morbidity and mortality worldwide, significantly impacting healthcare systems with considerable socioeconomic consequences. The main risk factors include exposure to tobacco smoke, environmental pollutants, occupational dust, and genetic factors such as alpha-1 antitrypsin deficiency. COPD is often associated with extrapulmonary comorbidities, particularly psychiatric disorders like depression and anxiety, which worsen patients’ quality of life and prognosis. The prevalence of these disorders in patients with COPD varies significantly but is always higher than in healthy controls. Psychiatric disorders can negatively influence COPD management and vice versa, creating a complex bidirectional interaction. Depression and anxiety are the most common psychiatric comorbidities in patients with COPD, influenced by factors such as social isolation, physical limitations, and fear of exacerbations. Diagnosis of these psychiatric disorders is complicated by the overlap of symptoms with those of COPD. However, some screening tools can facilitate early detection. The treatment of psychiatric disorders in patients with COPD in a rehabilitation setting requires a multidisciplinary approach involving pulmonologists, neurologists and psychologists. Pharmacological therapy with antidepressants shows mixed results in terms of efficacy and safety, with some studies reporting benefits on quality of life and others suggesting an increased risk of exacerbations and pneumonia. An integrated approach that includes the assessment and intervention of mental disorders is essential to improve the overall management of COPD and the quality of life of patients. This narrative review provides an overview of the main psychiatric comorbidities in COPD patients, aiming to fill gaps in the literature and suggest areas for future research. Full article

(This article belongs to the Special Issue Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD))

► Show Figures

Figure 1

12 pages, 250 KB

Open AccessEditor’s ChoiceReview

Prenatal mTOR Inhibitors in Tuberous Sclerosis Complex: Current Insights and Future Directions

by Giacomo Racioppi, Martina Proietti Checchi, Giorgia Sforza, Alessandra Voci, Luigi Mazzone, Massimiliano Valeriani and Romina Moavero

J. Clin. Med. 2024, 13(21), 6335; https://doi.org/10.3390/jcm13216335 - 23 Oct 2024

Cited by 7 | Viewed by 2070

Abstract

Background: Tuberous sclerosis complex (TSC) can present prenatally, often with cardiac rhabdomyomas, which, if large, may cause complications such as hydrops fetalis and reduced cardiac output. Prenatal treatment of these lesions with mTOR inhibitors, approved for other TSC manifestations, is under investigation. [...] Read more.

Background: Tuberous sclerosis complex (TSC) can present prenatally, often with cardiac rhabdomyomas, which, if large, may cause complications such as hydrops fetalis and reduced cardiac output. Prenatal treatment of these lesions with mTOR inhibitors, approved for other TSC manifestations, is under investigation. We hypothesize that mTOR inhibitors could help manage or prevent other TSC-related conditions, particularly neurological issues like epilepsy and CNS lesions, potentially improving neurodevelopmental outcomes. However, the safety of prenatal mTOR treatment remains a concern, especially for foetal development, and limited data are available on neurological outcomes. Methods: We conducted a literature review using PubMed, EMBASE, and Cochrane CENTRAL, focusing on studies involving mTOR inhibitors for prenatal TSC management. The search included case reports and series involving pregnant women diagnosed with TSC or early manifestations like cardiac rhabdomyomas. Keywords included “mTOR Inhibitor”, “Rapamycin”, “tuberous sclerosis complex”, “prenatal”, and “rhabdomyoma”. Results: Three prenatal mouse studies and eight papers reporting on ten pregnant women treated with mTOR inhibitors were identified. Conclusions: The literature confirms that prenatal mTOR inhibitors may reduce cardiac rhabdomyomas. However, further studies are needed to explore their broader potential, particularly in preventing neurological complications, while carefully considering their impact on intrauterine growth and neurodevelopment. Full article

(This article belongs to the Section Clinical Neurology)

13 pages, 563 KB

Open AccessEditor’s ChoiceSystematic Review

A Systematic Review of Ureteral Reimplantation Techniques in Endometriosis: Laparoscopic Versus Robotic-Assisted Approach

by Stefano Di Michele, Silvia Bramante and Maurizio Rosati

J. Clin. Med. 2024, 13(19), 5677; https://doi.org/10.3390/jcm13195677 - 24 Sep 2024

Cited by 7 | Viewed by 2409

Abstract

Introduction: Endometriosis, characterized by the presence of endometrial tissue outside the uterus, includes deep endometriosis (DE), which can affect the urinary tract. Ureteral endometriosis (UE) is a rare but significant manifestation that can lead to ureteral obstruction, hydronephrosis, and potential kidney loss. This [...] Read more.

Introduction: Endometriosis, characterized by the presence of endometrial tissue outside the uterus, includes deep endometriosis (DE), which can affect the urinary tract. Ureteral endometriosis (UE) is a rare but significant manifestation that can lead to ureteral obstruction, hydronephrosis, and potential kidney loss. This systematic review evaluates the effectiveness and outcomes of laparoscopic versus robotic-assisted ureteral reimplantation techniques in patients with UE. Materials and Methods: A systematic literature search was conducted following PRISMA guidelines across PubMed, MEDLINE, Embase, Web of Science, and the Cochrane Library, from inception to July 2024. Studies included patients with UE who underwent ureteral reimplantation using laparoscopic or robotic-assisted techniques. Data on patient demographics, surgical technique, duration of surgery, complications, follow-up duration, and clinical outcomes were extracted and analyzed. Results: Twelve studies met the inclusion criteria, comprising 225 patients in the laparoscopic group and 24 in the robotic-assisted group. Lich–Gregoir ureteral reimplantation, with or without a psoas hitch, was the predominant technique used. The average surgery duration was 271.1 min for the laparoscopic group and 310.4 min for the robotic-assisted group. Recurrence rates for UE were 2.95% for laparoscopic and 5.9% for robotic-assisted procedures. The robotic-assisted group had a significantly shorter hospital stay (6.7 days vs. 9.1 days, p < 0.01). Postoperative complication rates were comparable between the two techniques (p = 0.422). Conclusions: Both laparoscopic and robotic-assisted techniques for ureteral reimplantation in UE are safe and effective, with the choice of technique guided by surgeon expertise and specific clinical scenarios. However, the limited number of robotic cases introduces a bias, despite statistical significance. Full article

(This article belongs to the Section Obstetrics & Gynecology)

► Show Figures

Figure 1

14 pages, 4271 KB

Open AccessEditor’s ChoiceReview

Advances in Modern Microsurgery

by Oliver C. Thamm, Johannes Eschborn, Ruth C. Schäfer and Jeremias Schmidt

J. Clin. Med. 2024, 13(17), 5284; https://doi.org/10.3390/jcm13175284 - 6 Sep 2024

Cited by 8 | Viewed by 2981

Abstract

Background/Objectives: Microsurgery employs techniques requiring optical magnification and specialized instruments to operate on small anatomical structures, including small vessels. These methods are integral to plastic surgery, enabling procedures such as free tissue transfer, nerve reconstruction, replantation, and lymphatic surgery. This paper explores [...] Read more.

Background/Objectives: Microsurgery employs techniques requiring optical magnification and specialized instruments to operate on small anatomical structures, including small vessels. These methods are integral to plastic surgery, enabling procedures such as free tissue transfer, nerve reconstruction, replantation, and lymphatic surgery. This paper explores the historical development, advancements, and current applications of microsurgery in plastic surgery. Methods: The databases MEDLINE (via PubMed) and Web of Science were selectively searched with the term “(((microsurgery) OR (advances)) OR (robotic)) OR (AI)) AND (((lymphatic surgery) OR (peripheral nerve surgery)) OR (allotransplantation))” and manually checked for relevance. Additionally, a supplementary search among the references of all publications included was performed. Articles were included that were published in English or German up to June 2024. Results: Modern microsurgical techniques have revolutionized plastic surgery, enabling precise tissue transfers, improved nerve reconstruction, and effective lymphedema treatments. The evolution of robotic-assisted surgery, with systems like da Vinci and MUSA, has enhanced precision and reduced operative times. Innovations in imaging, such as magnetic resonance (MR) lymphography and near-infrared fluorescence, have significantly improved surgical planning and outcomes. Conclusions: The continuous advancements in microsurgery, including supermicrosurgical techniques and robotic assistance, have significantly enhanced the capabilities and outcomes of plastic surgery. Future developments in AI and robotics promise further improvements in precision and efficiency, while new imaging modalities and surgical techniques expand the scope and success of microsurgical interventions. Full article

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

► Show Figures

Figure 1

11 pages, 4030 KB

Open AccessEditor’s ChoiceReview

Mitral Annular Plane Systolic Excursion (MAPSE): A Review of a Simple and Forgotten Parameter for Assessing Left Ventricle Function

by Liviu Cirin, Simina Crișan, Constantin-Tudor Luca, Roxana Buzaș, Daniel Florin Lighezan, Cristina Văcărescu, Andreea Cozgarea, Cristina Tudoran and Dragoș Cozma

J. Clin. Med. 2024, 13(17), 5265; https://doi.org/10.3390/jcm13175265 - 5 Sep 2024

Cited by 7 | Viewed by 6000

Abstract

Mitral annular plane systolic excursion (MAPSE) was a widely used and simple M-mode echocardiographic parameter for determining the left ventricle (LV) longitudinal systolic function. The purpose of this review is to analyze the use of MAPSE as a simple LV systolic function marker [...] Read more.

Mitral annular plane systolic excursion (MAPSE) was a widely used and simple M-mode echocardiographic parameter for determining the left ventricle (LV) longitudinal systolic function. The purpose of this review is to analyze the use of MAPSE as a simple LV systolic function marker in different clinical scenarios, especially given the recent paradox of choices in ultrasound markers assessing cardiac performance. Recent data on the use of MAPSE in the assessment of LV function in different settings seem to be relatively scarce, given the wide variety of possible causes of cardiovascular pathology. There remain significant possible clinical applications of MAPSE utilization. This review included all major articles on the topic of mitral annular plane systolic excursion published and indexed in the PubMed, Google Scholar, and Scopus databases. We analyzed the potential implications of using simpler ultrasonographical tools in heart failure diagnosis, prediction, and treatment. MAPSE is a dependable, robust, and easy-to-use parameter compared to ejection fraction (EF) or global longitudinal strain (GLS) for the quick assessment of LV systolic function in various clinical settings. However, there may be a gap of evidence in certain scenarios such as conventional cardiac pacing. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)

► Show Figures

Figure 1

20 pages, 1785 KB

Open AccessEditor’s ChoiceReview

Pulsed Field Ablation: A Comprehensive Update

by Fatima M. Ezzeddine, Samuel J. Asirvatham and Duy T. Nguyen

J. Clin. Med. 2024, 13(17), 5191; https://doi.org/10.3390/jcm13175191 - 1 Sep 2024

Cited by 10 | Viewed by 8332

Abstract

One of the recent advancements in the field of cardiac electrophysiology is pulsed field ablation (PFA). PFA is a novel energy modality that does not rely on thermal processes to achieve ablation which, in turn, results in limited collateral damage to surrounding structures. [...] Read more.

One of the recent advancements in the field of cardiac electrophysiology is pulsed field ablation (PFA). PFA is a novel energy modality that does not rely on thermal processes to achieve ablation which, in turn, results in limited collateral damage to surrounding structures. In this review, we discuss the mechanisms, safety, efficacy, and clinical applications of PFA for the management of atrial and ventricular arrhythmias. We also summarize the published pre-clinical and clinical studies regarding this new technology. Full article

(This article belongs to the Special Issue Clinical Updates in Cardiac Electrophysiology)

► Show Figures

Figure 1

17 pages, 1038 KB

Open AccessEditor’s ChoiceReview

The Latest Data Concerning the Etiology and Pathogenesis of Irritable Bowel Syndrome

by Vlad Alexandru Ionescu, Gina Gheorghe, Teodor Florin Georgescu, Nicolae Bacalbasa, Florentina Gheorghe and Camelia Cristina Diaconu

J. Clin. Med. 2024, 13(17), 5124; https://doi.org/10.3390/jcm13175124 - 29 Aug 2024

Cited by 8 | Viewed by 5636

Abstract

Globally, irritable bowel syndrome (IBS) is present in approximately 10% of the population. While this condition does not pose a risk of complications, it has a substantial impact on the patient’s quality of life. Moreover, this disease has a significant financial impact on [...] Read more.

Globally, irritable bowel syndrome (IBS) is present in approximately 10% of the population. While this condition does not pose a risk of complications, it has a substantial impact on the patient’s quality of life. Moreover, this disease has a significant financial impact on healthcare systems. This includes the direct costs associated with the diagnosis and treatment of these patients, as well as the indirect costs that arise from work absenteeism and reduced productivity. In light of these data, recent research has focused on elucidating the pathophysiological basis of this condition in order to improve the quality of life for affected individuals. Despite extensive research to date, we still do not fully understand the precise mechanisms underlying IBS. Numerous studies have demonstrated the involvement of the gut–brain axis, visceral hypersensitivity, gastrointestinal dysmotility, gut microbiota dysbiosis, food allergies and intolerances, low-grade mucosal inflammation, genetic factors, and psychosocial factors. The acquisition of new data is crucial for the advancement of optimal therapeutic approaches aimed at enhancing the general health of these patients while simultaneously reducing the financial burden associated with this ailment. Full article

(This article belongs to the Special Issue New Insights into Irritable Bowel Syndrome)

► Show Figures

Figure 1

14 pages, 971 KB

Open AccessEditor’s ChoiceArticle

Early Clinical Experience of Finerenone in People with Chronic Kidney Disease and Type 2 Diabetes in Japan—A Multi-Cohort Study from the FOUNTAIN (FinerenOne mUltidatabase NeTwork for Evidence generAtIoN) Platform

by Atsuhisa Sato, Daloha Rodriguez-Molina, Kanae Yoshikawa-Ryan, Satoshi Yamashita, Suguru Okami, Fangfang Liu, Alfredo Farjat, Nikolaus G. Oberprieler, Csaba P. Kovesdy, Keizo Kanasaki and David Vizcaya

J. Clin. Med. 2024, 13(17), 5107; https://doi.org/10.3390/jcm13175107 - 28 Aug 2024

Cited by 7 | Viewed by 4299

Abstract

Background: In the phase 3 clinical trials FIGARO-DKD and FIDELIO-DKD, finerenone reduced the risk of cardiovascular and kidney events among people with chronic kidney disease (CKD) and type 2 diabetes (T2D). Evidence regarding finerenone use in real-world settings is limited. Methods: A retrospective [...] Read more.

Background: In the phase 3 clinical trials FIGARO-DKD and FIDELIO-DKD, finerenone reduced the risk of cardiovascular and kidney events among people with chronic kidney disease (CKD) and type 2 diabetes (T2D). Evidence regarding finerenone use in real-world settings is limited. Methods: A retrospective cohort study (NCT06278207) using two Japanese nationwide hospital-based databases provided by Medical Data Vision (MDV) and Real World Data Co., Ltd. (RWD Co., Kyoto Japan), converted to the OMOP common data model, was conducted. Persons with CKD and T2D initiating finerenone from 1 July 2021, to 30 August 2023, were included. Baseline characteristics were described. The occurrence of hyperkalemia after finerenone initiation was assessed. Results: 1029 new users of finerenone were included (967 from MDV and 62 from RWD Co.). Mean age was 69.5 and 72.4 years with 27.3% and 27.4% being female in the MDV and RWD Co. databases, respectively. Hypertension (92 and 95%), hyperlipidemia (59 and 71%), and congestive heart failure (60 and 66%) were commonly observed comorbidities. At baseline, 80% of persons were prescribed angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers. Sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists were prescribed in 72% and 30% of the study population, respectively. The incidence proportions of hyperkalemia were 2.16 and 2.70 per 100 persons in the MDV and RWD Co. databases, respectively. There were no hospitalizations associated with hyperkalemia observed in either of the two datasets. Conclusions: For the first time, we report the largest current evidence on the clinical use of finerenone in real-world settings early after the drug authorization in Japan. This early evidence from clinical practice suggests that finerenone is used across comorbidities and comedications. Full article

(This article belongs to the Special Issue Type 2 Diabetes: Epidemiology and Clinical Advances)

► Show Figures

Figure 1

14 pages, 2304 KB

Open AccessEditor’s ChoiceReview

Patch Augmentation in Arthroscopic Rotator Cuff Surgery—Review of Current Evidence and Newest Trends

by Maximilian Russo, Gert Karl Dirkx and Claudio Rosso

J. Clin. Med. 2024, 13(17), 5066; https://doi.org/10.3390/jcm13175066 - 27 Aug 2024

Cited by 8 | Viewed by 5112

Abstract

Background: Rotator cuff tears are a common and debilitating condition requiring surgical intervention. Arthroscopic rotator cuff repair is essential for restoring shoulder function and alleviating pain. Tear classification by size and tendon retraction, along with the grade for fatty infiltration, influence postoperative outcomes, [...] Read more.

Background: Rotator cuff tears are a common and debilitating condition requiring surgical intervention. Arthroscopic rotator cuff repair is essential for restoring shoulder function and alleviating pain. Tear classification by size and tendon retraction, along with the grade for fatty infiltration, influence postoperative outcomes, with large tears and higher fatty infiltration grades linked to higher retear rates. Managing complex tears is challenging, with failure rates ranging from 20 to 94%. Patch augmentation has emerged as a promising strategy, using biological or synthetic materials to reinforce tendon repairs, enhancing structural integrity and reducing retear risk. Methods: A review of the recent literature from January 2018 to March 2024 was conducted using PubMed/MEDLINE, Embase, and Web of Science. Keywords included “rotator cuff tear”, “rotator cuff augmentation”, “rotator cuff patch”, “tendon augmentation”, “massive rotator cuff tear”, “patch augmentation”, and “grafts”. Relevant articles were selected based on their abstracts for a comprehensive review. Results: Initial methods used autograft tissues, but advances in biomaterials have led to standardized, biocompatible synthetic patches. Studies show reduced retear rates with patch augmentation, ranging from 17 to 45%. Conclusions: Patch augmentation reduces the retear rates and improves tendon repair, but complications like immune responses and infections persist. Cost-effectiveness analyses indicate that while initial costs are higher, long-term savings from reduced rehabilitation, revision surgeries, and increased productivity can make patch augmentation economically beneficial. Full article

(This article belongs to the Special Issue Current Trends and Innovations in Arthroscopic Shoulder Surgery)

► Show Figures

Figure 1

21 pages, 826 KB

Open AccessEditor’s ChoiceReview

Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors in Patients Following Acute Coronary Syndromes: From Lipid Lowering and Plaque Stabilization to Improved Outcomes

by Kyriakos Dimitriadis, Nikolaos Pyrpyris, Panagiotis Iliakis, Eirini Beneki, Eleni Adamopoulou, Aggelos Papanikolaou, Dimitrios Konstantinidis, Christos Fragkoulis, Anastasios Kollias, Konstantinos Aznaouridis and Konstantinos Tsioufis

J. Clin. Med. 2024, 13(17), 5040; https://doi.org/10.3390/jcm13175040 - 25 Aug 2024

Cited by 9 | Viewed by 3604

Abstract

Lipid lowering, with the use of statins after an acute coronary syndrome (ACS), is a cornerstone, well-established strategy for the secondary prevention of ischemic events in this high-risk cohort. In addition to the positive effect on lipid levels, statins have also been linked [...] Read more.

Lipid lowering, with the use of statins after an acute coronary syndrome (ACS), is a cornerstone, well-established strategy for the secondary prevention of ischemic events in this high-risk cohort. In addition to the positive effect on lipid levels, statins have also been linked to improved atherosclerotic plaque characteristics, such as plaque regression and inflammation reduction, associated with the extent of reduction in LDL-C. The recent emergence of PCSK9 inhibitors for the management of dyslipidemia and the more extensive lipid lowering provided by these agents may provide better prevention for ACS patients when initiated after the ACS event. Several trials have evaluated the immediate post-ACS initiation of PCSK9 inhibitors, which has shown, to date, beneficial results. Furthermore, PCSK9 inhibitors have been linked with positive plaque remodeling and associated mortality benefits, which makes their use in the initial management strategy of such patients appealing. Therefore, in this review, we will analyze the rationale behind immediate lipid lowering after an ACS, report the evidence of PCSK9 inhibition immediately after the ACS event and the available data on plaque stabilization, and discuss treatment algorithms and clinical perspectives for the use of these agents in this clinical setting. Full article

(This article belongs to the Special Issue Personalized Medicine and Treatment of Acute Coronary Syndrome)

► Show Figures

Figure 1

16 pages, 1449 KB

Open AccessEditor’s ChoiceArticle

Eosinophilic Bronchiectasis: Prevalence, Severity, and Associated Features—A Cohort Study

by Raffaele Campisi, Santi Nolasco, Manuel Mancuso, Miriam Spinella, Fabio Vignera, Nunzio Crimi, Carlo Vancheri and Claudia Crimi

J. Clin. Med. 2024, 13(16), 4932; https://doi.org/10.3390/jcm13164932 - 21 Aug 2024

Cited by 6 | Viewed by 1944

Abstract

Background: Bronchiectasis (BE) has been traditionally associated with neutrophilic inflammation, but eosinophilic bronchiectasis (EB) has recently emerged. Data about prevalence, clinical features, and disease severity are lacking. This study aimed to assess the EB prevalence, compare EB with non-EB, evaluate the Type-2 (T2) [...] Read more.

Background: Bronchiectasis (BE) has been traditionally associated with neutrophilic inflammation, but eosinophilic bronchiectasis (EB) has recently emerged. Data about prevalence, clinical features, and disease severity are lacking. This study aimed to assess the EB prevalence, compare EB with non-EB, evaluate the Type-2 (T2) high endotype in BE (T2-high EB) versus non-T2-high EB, and identify EB predictors. Methods: We conducted a prospective study involving 153 BE patients. The data collected included clinical, radiological, and microbiological findings. BE severity was assessed using the bronchiectasis severity index (BSI), FACED and E-FACED scores, and the bronchiectasis etiology and comorbidity index (BACI). EB was defined as a blood eosinophil count (BEC) ≥ 300 cells/μL, and T2-high EB as BEC ≥ 300 cells/μL with fractional exhaled nitric oxide (FeNO) ≥ 25 ppb. Results: Prevalence was 27% for EB and 20% for T2-high EB. EB patients exhibited poorer lung function and more severe radiologic features, with significantly higher severity scores [BSI, FACED, E-FACED, BACI (p < 0.05)], and a higher median exacerbation rate [4 (2–5) in EB vs. 2 (1–4) in non-EB, p = 0.0002], compared with non-EB patients. T2-high EB patients showed higher severity scores [BSI, FACED, E-FACED (p < 0.05)], as well as worse lung function parameters [FEV₁%, FVC%, FEF _25–75% (p < 0.05)] compared with non-T2-high EB patients. In our study, patients with EB exhibited notably worsened lung function and higher BE severity scores compared with their non-EB counterparts, with exacerbations playing a major role in these differences. We found statistically significant positive correlations between BEC and disease severity scores, such as BSI, FACED, and mMRC, as well as an inverse relationship with pulmonary function. The likelihood of EB being present was significantly higher in association with mMRC ≥ 1 (OR = 2.53; 95% CI, 1.26–5.64), exacerbations/year ≥ 1 (OR = 1.27; 95% CI, 1.0–1.63), and chronic PA colonization (OR = 3.9; 95% CI, 1.08–15.8). Conclusions: EB is a distinct endotype. Dyspnea, exacerbations, and PA colonization may be predictive of EB, emphasizing the importance of early detection for improved outcomes. BEC could serve as a useful biomarker of disease severity to consider when diagnosing EB. Full article

(This article belongs to the Special Issue Biomarkers and Diagnostics in Respiratory Diseases)

► Show Figures

Figure 1

18 pages, 811 KB

Open AccessEditor’s ChoiceReview

Role of Cytokines and Chemokines in Vitiligo and Their Therapeutic Implications

by Marcelina Kądziela, Magdalena Kutwin, Paulina Karp and Anna Woźniacka

J. Clin. Med. 2024, 13(16), 4919; https://doi.org/10.3390/jcm13164919 - 20 Aug 2024

Cited by 9 | Viewed by 4990

Abstract

Vitiligo is a persistent autoimmune disease characterized by progressive depigmentation of the skin caused by the selective destruction of melanocytes. Although its etiopathogenesis remains unclear, multiple factors are involved in the development of this disease, from genetic and metabolic factors to cellular oxidative [...] Read more.

Vitiligo is a persistent autoimmune disease characterized by progressive depigmentation of the skin caused by the selective destruction of melanocytes. Although its etiopathogenesis remains unclear, multiple factors are involved in the development of this disease, from genetic and metabolic factors to cellular oxidative stress, melanocyte adhesion defects, and innate and adaptive immunity. This review presents a comprehensive summary of the existing knowledge on the role of different cellular mechanisms, including cytokines and chemokines interactions, in the pathogenesis of vitiligo. Although there is no definitive cure for vitiligo, notable progress has been made, and several treatments have shown favorable results. A thorough understanding of the basis of the disease uncovers promising drug targets for future research, providing clinical researchers with valuable insights for developing improved treatment options. Full article

(This article belongs to the Section Dermatology)

► Show Figures

Figure 1

17 pages, 1622 KB

Open AccessEditor’s ChoiceReview

Breast Reconstruction: The Oncoplastic Approach

by Vincenzo Vindigni, Francesco Marena, Chiara Zanettin and Franco Bassetto

J. Clin. Med. 2024, 13(16), 4718; https://doi.org/10.3390/jcm13164718 - 12 Aug 2024

Cited by 8 | Viewed by 2781

Abstract

Breast reconstruction surgery is continualladvancing, significantly enhancing patient well-being. Current surgical techniques prioritize minimizing donor site morbidity while achieving a more natural breast appearance. Increasing patient preferences for avoiding prosthetic materials in reconstruction, along with advancements in oncological safety and heightened aesthetic expectations, [...] Read more.

Breast reconstruction surgery is continualladvancing, significantly enhancing patient well-being. Current surgical techniques prioritize minimizing donor site morbidity while achieving a more natural breast appearance. Increasing patient preferences for avoiding prosthetic materials in reconstruction, along with advancements in oncological safety and heightened aesthetic expectations, are driving the exploration and development of innovative approaches. Today’s reconstructive options range from straightforward oncoplastic glandular remodeling to intricate microsurgical procedures. This narrative review, titled “Breast reconstruction: the oncoplastic approach,” provides a comprehensive overview of contemporary trends in breast-conserving treatment. It evaluates the indications for these techniques and offers guidance to plastic surgeons in crafting personalized treatment plans. This approach presents a valuable single-stage alternative or adjunct to traditional prosthetic or microsurgical reconstruction methods. Full article

(This article belongs to the Special Issue Breast Reconstruction: Clinical Updates and Perspectives)

► Show Figures

Figure 1

14 pages, 936 KB

Open AccessEditor’s ChoiceArticle

Use of Neutrophil-to-Lymphocyte Ratio to Predict In-Hospital Mortality in Patients Admitted with Acute Decompensation of Atrial Fibrillation

by Nilima Rajpal Kundnani, Abhinav Sharma, Daniel Florin Lighezan, Doina Georgescu, Stelian I. Morariu, Daniel Dumitru Nisulescu, Romina Georgiana Bita and Ciprian Ilie Rosca

J. Clin. Med. 2024, 13(16), 4719; https://doi.org/10.3390/jcm13164719 - 12 Aug 2024

Cited by 7 | Viewed by 2165

Abstract

Background/Objectives: The prevalence of atrial fibrillation (AF) has been on the rise over the last 20 years. It is considered to be the most common cardiac arrhythmia and is associated with significant morbidity and mortality. The need for in-hospital management of patients having [...] Read more.

Background/Objectives: The prevalence of atrial fibrillation (AF) has been on the rise over the last 20 years. It is considered to be the most common cardiac arrhythmia and is associated with significant morbidity and mortality. The need for in-hospital management of patients having AF is increasing. Acute decompensation of cardiac rhythm is an indication for hospital admission. In the existing literature, several studies on different pathologies have observed that the risk of death was greater for patients with an increased neutrophil-to-lymphocyte ratio (NLR) and suggested that the NLR can be a useful biomarker to predict in-hospital mortality. This study aims to evaluate the link between the neutrophil-to-lymphocyte ratio at admission and death among the patients admitted to the medical ward for the acute manifestation of AF, and to gain a better understanding of how we can predict in-hospital all-cause death based on the NLR for these patients. Methods: A single-center retrospective study in an academic medical clinic was conducted. We analyzed if the NLR at in-hospital admission can be related to in-hospital mortality among the patients admitted for AF at the Medical Ward of Municipal Emergency University Hospital Timisoara between 2015 and 2016. After identifying a total of 1111 patients, we divided them into two groups: in-hospital death patients and surviving patients. We analyzed the NLR in both groups to determine if it is related to in-hospital mortality or not. One patient was excluded because of missing data. Results: Our analysis showed that patients who died during in-hospital admission had a significantly higher NLR compared to those who survived (p < 0.0001, 95% CI (1.54 to 3.48)). The NLR was found to be an independent predictor of in-hospital death among patients with AF, even for the patients with no raised level of blood leukocytes (p < 0.0001, 95% CI (0.6174 to 3.0440)). Additionally, there was a significant correlation between the NLR and the risk of in-hospital death for patients admitted with decompensated AF (p < 0.0001), with an area under the ROC curve of 0.745. Other factors can increase the risk of death for these patients (such as the personal history of stroke, HAS-BLED score, and age). Conclusions: The NLR is a useful biomarker to predict in-hospital mortality in patients with AF and can predict the risk of death with a sensitivity of 72.8% and a specificity of 70.4%. Further studies are needed to determine the clinical utility of the NLR in risk stratification and management of patients with AF. Full article

(This article belongs to the Special Issue Clinical Perspectives on Cardiac Electrophysiology and Arrhythmias)

► Show Figures

Figure 1

18 pages, 1468 KB

Open AccessEditor’s ChoiceReview

The Microbiome in Inflammatory Bowel Disease

by Aranzazu Jauregui-Amezaga and Annemieke Smet

J. Clin. Med. 2024, 13(16), 4622; https://doi.org/10.3390/jcm13164622 - 7 Aug 2024

Cited by 12 | Viewed by 3992

Abstract

The management of patients with inflammatory bowel disease (IBD) aims to control inflammation through the use of immunosuppressive treatments that target various points in the inflammatory cascade. However, the efficacy of these therapies in the long term is limited, and they often are [...] Read more.

The management of patients with inflammatory bowel disease (IBD) aims to control inflammation through the use of immunosuppressive treatments that target various points in the inflammatory cascade. However, the efficacy of these therapies in the long term is limited, and they often are associated with severe side effects. Although the pathophysiology of the disease is not completely understood, IBD is regarded as a multifactorial disease that occurs due to an inappropriate immune response in genetically susceptible individuals. The gut microbiome is considered one of the main actors in the development of IBD. Gut dysbiosis, characterised by significant changes in the composition and functionality of the gut microbiota, often leads to a reduction in bacterial diversity and anti-inflammatory anaerobic bacteria. At the same time, bacteria with pro-inflammatory potential increase. Although changes in microbiome composition upon biological agent usage have been observed, their role as biomarkers is still unclear. While most studies on IBD focus on the intestinal bacterial population, recent studies have highlighted the importance of other microbial populations, such as viruses and fungi, in gut dysbiosis. In order to modulate the aberrant immune response in patients with IBD, researchers have developed therapies that target different players in the gut microbiome. These innovative approaches hold promise for the future of IBD treatment, although safety concerns are the main limitations, as their effects on humans remain unknown. Full article

(This article belongs to the Special Issue Editorial Board Members’ Collection Series: Inflammatory Bowel Disease)

► Show Figures

Figure 1

11 pages, 540 KB

Open AccessEditor’s ChoiceArticle

Short-Term Clinical Outcomes of Patients with Diabetic Macular Edema Following a Therapy Switch to Faricimab

by Peter Wolfrum, Elsa Wilma Böhm, Katrin Lorenz, Bernhard Stoffelns, Norbert Pfeiffer and Christina A. Korb

J. Clin. Med. 2024, 13(15), 4508; https://doi.org/10.3390/jcm13154508 - 1 Aug 2024

Cited by 7 | Viewed by 2008

Abstract

Background: With this study, we investigate the short-term clinical outcomes of patients affected by diabetic macular edema (DME) after switching to intravitreal Faricimab (IVF) in a real-world setting. Methods: We conducted a retrospective chart review on all patients treated for DME with IVF [...] Read more.

Background: With this study, we investigate the short-term clinical outcomes of patients affected by diabetic macular edema (DME) after switching to intravitreal Faricimab (IVF) in a real-world setting. Methods: We conducted a retrospective chart review on all patients treated for DME with IVF who showed insufficient responses to prior anti-VEGF therapy. Data collected included baseline patient demographics, medical history, best-corrected visual acuity (BCVA), central retinal thickness (CRT) and central retinal volume (CRV). We analyzed functional and structural measures before and after IVF, compared baseline demographics and treatment factors between Faricimab-responders and reduced-responders and assessed influencing factors of the follow-up BCVA and CRT. Results: This study included 25 eyes from 16 patients. After switching to IVF, the mean BCVA showed no significant improvement, changing from 59.4 ± 13.4 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters at baseline to 61.4 ± 12.8 ETDRS letters at follow-up (p = 0.26). CRT significantly reduced from 414.4 ± 126.3 µm to 353.3 ± 131.1 µm (p < 0.011), and the 3 mm CRV significantly decreased from 2.8 ± 0.5 mm³ to 2.6 ± 0.6 mm³ (p < 0.012). Seven patients met the responder criteria, exhibiting an improvement of at least 5 ETDRS letters and a simultaneous CRT reduction of at least 30 µm. Further analysis showed that higher BCVA at baseline (p < 0.001) was associated with better BCVA following IVF, while higher baseline CRT (p < 0.003), a higher number of prior anti-VEGF agents (p < 0.034) and prior corticosteroid injections (p < 0.019) were associated with greater CRT at follow-up. Conclusions: Following the initial IVF injection series, we observed a clear improvement of anatomical measures. No functional improvement was observed, although visual acuity remained stable. Higher baseline BCVA was associated with better post-IVF BCVA, while higher baseline CRT, a greater number of prior anti-VEGF agents and prior corticosteroid injections were linked to higher CRT post-IVF. Full article

(This article belongs to the Section Ophthalmology)

► Show Figures

Figure 1

21 pages, 1985 KB

Open AccessEditor’s ChoiceReview

Calcipotriol/Betamethasone Dipropionate for the Treatment of Psoriasis: Mechanism of Action and Evidence of Efficacy and Safety versus Topical Corticosteroids

by Paolo Gisondi, Tamara Gracia-Cazaña, Hjalmar Kurzen and Jordi Galván

J. Clin. Med. 2024, 13(15), 4484; https://doi.org/10.3390/jcm13154484 - 31 Jul 2024

Cited by 11 | Viewed by 7850

Abstract

The combined treatment with calcipotriol (Cal) and betamethasone dipropionate (BDP) has emerged as the leading anti-psoriatic topical treatment. Fixed-dose Cal/BDP is available in different formulations, including ointment, gel, foam, and cream. This review examines the mechanism of action of Cal/BDP underlying its therapeutic [...] Read more.

The combined treatment with calcipotriol (Cal) and betamethasone dipropionate (BDP) has emerged as the leading anti-psoriatic topical treatment. Fixed-dose Cal/BDP is available in different formulations, including ointment, gel, foam, and cream. This review examines the mechanism of action of Cal/BDP underlying its therapeutic effect and compiles the evidence regarding its efficacy and safety compared to monotherapy with topical corticosteroids. The dual-action of Cal/BDP targets the inflammatory pathways and abnormal keratinocyte proliferation, both of them fundamental mechanisms of psoriasis pathogenesis. A large number of randomized, double-blind studies support Cal/BDP superiority over topical corticosteroids, demonstrating its broad efficacy across several degrees of psoriasis severity and its capability to provide early significant clinical improvements. This increased efficacy is achieved without negative effects on the safety profile, since the incidence of adverse effects reported with Cal/BDP is usually similar to that of BDP and even lower than that of Cal alone. The combination therapy rapid onset of action, coupled with a simplified dosing regimen, has been identified as crucial for improving long-term adherence and patient outcomes. In conclusion, Cal/BDP is confirmed as a versatile, effective, and convenient option for the patient in psoriasis management. Full article

(This article belongs to the Section Dermatology)

► Show Figures

Figure 1

19 pages, 298 KB

Open AccessEditor’s ChoiceReview

New Frontiers in Locally Advanced Cervical Cancer Treatment

by Roberta Massobrio, Lavinia Bianco, Beatrice Campigotto, Daniela Attianese, Elisa Maisto, Maria Pascotto, Maria Grazia Ruo Redda and Annamaria Ferrero

J. Clin. Med. 2024, 13(15), 4458; https://doi.org/10.3390/jcm13154458 - 30 Jul 2024

Cited by 12 | Viewed by 5257

Abstract

Despite the introduction of targeted vaccines and screening protocols, locally advanced cervical cancer represents a median proportion of 37% among all cervical carcinomas. Compared to early stages, it presents significantly lower cure rates, with a 5-year disease-free survival rate of 68% and a [...] Read more.

Despite the introduction of targeted vaccines and screening protocols, locally advanced cervical cancer represents a median proportion of 37% among all cervical carcinomas. Compared to early stages, it presents significantly lower cure rates, with a 5-year disease-free survival rate of 68% and a 5-year overall survival rate of 74%. According to current guidelines, definitive radiotherapy with concomitant chemotherapy represents the gold standard for locally advanced cervical cancer treatment. However, a significant number of patients relapse and die from metastatic disease. The aim of this narrative review is to examine the recent advancements in treating locally advanced cervical cancer, exploring new frontiers in therapeutic approaches. The PubMed database and clinical trial registries were searched to identify relevant articles published on locally advanced cervical cancer treatment up to March 2024, mainly focusing on papers published in the last decade. Abstracts presented at major international congresses that bring relevant evidence were included. Progress achieved in refining radiotherapy techniques, recent evidence regarding neoadjuvant treatment preceding surgery or concurrent chemoradiotherapy, and key findings concerning adjuvant treatment are thoroughly explored. Furthermore, a comprehensive review of prominent phase II and phase III trials examining the integration of immune checkpoint inhibitors is conducted, analyzing the various contexts in which they are applied. In light of the new evidence that has emerged in recent years and is discussed in this article, the appropriate selection of the most suitable therapeutic approach for each patient remains a complex but crucial issue. Full article

(This article belongs to the Section Oncology)

20 pages, 3215 KB

Open AccessEditor’s ChoiceArticle

Epidemiologic Trends in Maxillofacial Trauma Surgery in Germany—Insights from the National DRG Database 2005–2022

by Axel Meisgeier, Simon Pienkohs, Florian Dürrschnabel, Laura Moosdorf and Andreas Neff

J. Clin. Med. 2024, 13(15), 4438; https://doi.org/10.3390/jcm13154438 - 29 Jul 2024

Cited by 8 | Viewed by 1573

Abstract

Background: Maxillofacial trauma (MFT) caused by falls, interpersonal violence or traffic accidents leading to fractures of different facial regions, including the midface and the mandible, are common clinical conditions requiring open reduction and internal fixation. The aim of this study was to analyze [...] Read more.

Background: Maxillofacial trauma (MFT) caused by falls, interpersonal violence or traffic accidents leading to fractures of different facial regions, including the midface and the mandible, are common clinical conditions requiring open reduction and internal fixation. The aim of this study was to analyze the incidence and time trends in MFT-associated surgeries regarding different facial regions in the German healthcare system over time. Materials and methods: Nationwide data regarding the national diagnosis-related group (DRG) inpatient billing system was received from the German Federal Statistical Office for the years 2005–2022. We estimated the age–gender standardized incidence of MFT-associated procedures classified by the Operation and Procedure Classification System (OPS) and evaluated age- and gender-adjusted time trends using Poisson regression analysis. Results: The total standardized incidence rate of MFT-associated procedures in the observational period 2005–2022 was 25.1 (♀13.3; ♂37.5) per 100,000 person-years within a slight significant annual decrease of 0.5%. A significant increase in the incidence of MFT-related procedures within the observational period was found in older adults from 60 to 79 years (+55.1%; ♀+54.8%; ♂+56.3%) and elderly patients over 80 years (+66.7%; ♀+59.1%; ♂+85.1%). Other significant trends are decreases in MFT-related procedures performed in children from 0–14 years (−28.1%; ♀−30.3%; ♂−27.3%) and young adults between 15 and 35 years (−20.4%; ♀−7.3%; ♂−22.5%). Conclusions: MFT-associated surgery is a persisting challenge in the German healthcare system. There is an ongoing transition in MFT-associated surgeries from younger to older patients beyond the scope of demographic change, highlighting the increasing importance of interdisciplinary treatment of patients with pre-existing conditions in maxillofacial surgery. Implementation of injury prevention measures might be beneficial in this population. Full article

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

► Show Figures

Figure 1

19 pages, 4253 KB

Open AccessEditor’s ChoiceReview

Is Conduction System Pacing Going to Be the New Gold Standard for Cardiac Resynchronization Therapy?

by Michael Derndorfer, Georgios Kollias, Martin Martinek and Helmut Pürerfellner

J. Clin. Med. 2024, 13(15), 4320; https://doi.org/10.3390/jcm13154320 - 24 Jul 2024

Cited by 6 | Viewed by 6503

Abstract

The current gold standard in device therapy for advanced heart failure (HF), which has been firmly established in HF management for more than 25 years, is classical biventricular pacing (BiV-CRT). In the last decade, a new pacing modality called conduction system pacing (CSP) [...] Read more.

The current gold standard in device therapy for advanced heart failure (HF), which has been firmly established in HF management for more than 25 years, is classical biventricular pacing (BiV-CRT). In the last decade, a new pacing modality called conduction system pacing (CSP) has emerged as a variant for advanced cardiac device therapy. It provides pacing with preserved intrinsic cardiac activation by direct stimulation of the specific cardiac conduction system. The term CSP integrates the modalities of HIS bundle pacing (HBP) and left bundle branch area pacing (LBBAP), both of which have provided convincing data in smaller randomized and big non-randomized studies for the prevention of pacemaker-induced cardiomyopathy and for providing effective cardiac resynchronization therapy in patients with classical CRT-indication (primary approach or after failed CRT). Recent American guidelines proposed the term “cardiac physiological pacing” (CPP), which summarizes CSP including left ventricular septal pacing (LVSP), a technical variant of LBBAP together with classical BiV-CRT. The terms HOT-CRT (HIS-optimized CRT) and LOT-CRT (LBBP-optimized CRT) describe hybrid technologies that combine CSP with an additional coronary-sinus electrode, which is sometimes useful in patients with advanced HF and diffuse interventricular conduction delay. If CSP continues providing promising data that can be confirmed in big, randomized trials, it is likely to become the new gold standard for patients with an expected high percentage of pacing (>20%), possibly also for cardiac resynchronization therapy. CSP is a sophisticated new treatment option that has the potential to raise the term “cardiac resynchronization therapy” to a new level. The aim of this review is to provide basic technical, anatomical, and functional knowledge of these new pacemaker techniques in order to facilitate the understanding of the different modalities, as well as to provide an up-to-date overview of the existing randomized and non-randomized evidence, particularly in direct comparison to right ventricular and classical biventricular pacing. Full article

(This article belongs to the Special Issue Advances in Cardiac Electrophysiology and Pacing: Part II)

► Show Figures

Figure 1

13 pages, 783 KB

Open AccessEditor’s ChoiceReview

Current Evidence and Future Perspectives in the Medical Management of Vascular Ehlers–Danlos Syndrome: Focus on Vascular Prevention

by Giacomo Buso, Federica Corvini, Elena Maria Fusco, Massimiliano Messina, Fabio Cherubini, Nicola Laera, Anna Paini, Massimo Salvetti, Carolina De Ciuceis, Marco Ritelli, Marina Venturini, Nicola Chiarelli, Marina Colombi and Maria Lorenza Muiesan

J. Clin. Med. 2024, 13(14), 4255; https://doi.org/10.3390/jcm13144255 - 21 Jul 2024

Cited by 7 | Viewed by 4227

Abstract

Vascular Ehlers–Danlos syndrome (vEDS) is a rare autosomal dominant connective tissue disease resulting from pathogenic variants in the collagen type III alpha 1 chain (COL3A1) gene, encoding type III procollagen. Patients with vEDS present with severe tissue fragility that can result [...] Read more.

Vascular Ehlers–Danlos syndrome (vEDS) is a rare autosomal dominant connective tissue disease resulting from pathogenic variants in the collagen type III alpha 1 chain (COL3A1) gene, encoding type III procollagen. Patients with vEDS present with severe tissue fragility that can result in arterial aneurysm, dissection, or rupture, especially of medium-caliber vessels. Although early reports have indicated a very high mortality rate in affected patients, with an estimated median survival of around 50 years, recent times have seen a remarkable improvement in outcomes in this population. This shift could be related to greater awareness of the disease among patients and physicians, with improved management both in terms of follow-up and treatment of complications. Increasing use of drugs acting on the cardiovascular system may also have contributed to this improvement. In particular, celiprolol, a β1 cardio-selective blocker with a β2-agonist vasodilator effect, has been shown to reduce rates of vascular events in patients with vEDS. However, the evidence on the true benefits and possible mechanisms responsible for the protective effect of celiprolol in this specific setting remains limited. Drugs targeting the extracellular matrix organization and autophagy–lysosome pathways are currently under investigation and could play a role in the future. This narrative review aims to summarize current evidence and future perspectives on vEDS medical treatment, with a specific focus on vascular prevention. Full article

(This article belongs to the Section Vascular Medicine)

► Show Figures

Figure 1

12 pages, 3395 KB

Open AccessEditor’s ChoiceArticle

Radiological Assessment of Coronal Plane Alignment of the Knee Phenotypes in the Romanian Population

by Serban Dragosloveanu, Bogdan-Sorin Capitanu, Radu Josanu, Diana Vulpe, Romica Cergan and Cristian Scheau

J. Clin. Med. 2024, 13(14), 4223; https://doi.org/10.3390/jcm13144223 - 19 Jul 2024

Cited by 7 | Viewed by 2185

Abstract

Background: The Coronal Plane Alignment of the Knee (CPAK) classification system has been developed as a comprehensive framework delineating nine coronal plane phenotypes, based on arithmetic hip–knee angle (aHKA) and joint line obliquity (JLO). Our study aimed to assess the prevalence of [...] Read more.

Background: The Coronal Plane Alignment of the Knee (CPAK) classification system has been developed as a comprehensive framework delineating nine coronal plane phenotypes, based on arithmetic hip–knee angle (aHKA) and joint line obliquity (JLO). Our study aimed to assess the prevalence of knee phenotypes in the Romanian population using the CPAK classification, encompassing both osteoarthritic and healthy cohorts. Methods: We conducted an observational cross-sectional study, analyzing data from 500 knees with osteoarthritis and 500 healthy knees that met the inclusion criteria. Demographic data were collected, and radiological parameters including lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), aHKA, and JLO were measured. Knee phenotypes were categorized using the CPAK classification. Results: In the osteoarthritic cohort, the most prevalent CPAK phenotype was type I (42.4%), characterized by varus alignment and an apex distal joint. Conversely, in the healthy population, CPAK type II, indicating neutral alignment and an apex distal joint, was the most prevalent phenotype (39.0%). CPAK types VII, VIII, and IX were rare. Conclusions: Our findings demonstrate similarities in knee phenotypes compared to other populations, with some minor differences and particularities. The CPAK classification proves to be a valuable tool in assessing knee tyalignment. Full article

(This article belongs to the Special Issue Latest Advances in Clinical Diagnosis and Treatment of Hip and Knee Osteoarthritis)

► Show Figures

Figure 1

20 pages, 1578 KB

Open AccessEditor’s ChoiceReview

A Comprehensive Geriatric Workup and Frailty Assessment in Older Patients with Severe Aortic Stenosis

by Enrico Brunetti, Fabiana Lucà, Roberto Presta, Niccolò Marchionni, Alessandro Boccanelli, Andrea Ungar, Carmelo Massimiliano Rao, Nadia Ingianni, Maddalena Lettino, Donatella Del Sindaco, Adriano Murrone, Carmine Riccio, Furio Colivicchi, Massimo Grimaldi, Michele Massimo Gulizia, Fabrizio Oliva, Mario Bo and Iris Parrini

J. Clin. Med. 2024, 13(14), 4169; https://doi.org/10.3390/jcm13144169 - 16 Jul 2024

Cited by 8 | Viewed by 3682

Abstract

Aortic stenosis (AS) represents a notable paradigm for cardiovascular (CV) and geriatric disorders owing to comorbidity. Transcatheter aortic valve replacement (TAVR) was initially considered a therapeutic strategy in elderly individuals deemed unsuitable for or at high risk of surgical valve replacement. The progressive [...] Read more.

Aortic stenosis (AS) represents a notable paradigm for cardiovascular (CV) and geriatric disorders owing to comorbidity. Transcatheter aortic valve replacement (TAVR) was initially considered a therapeutic strategy in elderly individuals deemed unsuitable for or at high risk of surgical valve replacement. The progressive improvement in TAVR technology has led to the need to refine older patients’ stratification, progressively incorporating the concept of frailty and other geriatric vulnerabilities. Recognizing the intricate nature of the aging process, reliance exclusively on chronological age for stratification resulted in an initial but inadequate tool to assess both CV and non-CV risks effectively. A comprehensive geriatric evaluation should be performed before TAVR procedures, taking into account both physical and cognitive capabilities and post-procedural outcomes through a multidisciplinary framework. This review adopts a multidisciplinary perspective to delve into the diagnosis and holistic management of AS in elderly populations in order to facilitate decision-making, thereby optimizing outcomes centered around patient well-being. Full article

(This article belongs to the Section Cardiology)

► Show Figures

Figure 1

24 pages, 379 KB

Open AccessEditor’s ChoiceReview

Flow Diversion for Endovascular Treatment of Intracranial Aneurysms: Past, Present, and Future Directions

by Michael Gaub, Greg Murtha, Molly Lafuente, Matthew Webb, Anqi Luo, Lee A. Birnbaum, Justin R. Mascitelli and Fadi Al Saiegh

J. Clin. Med. 2024, 13(14), 4167; https://doi.org/10.3390/jcm13144167 - 16 Jul 2024

Cited by 13 | Viewed by 5443

Abstract

Flow diversion for intracranial aneurysms emerged as an efficacious and durable treatment option over the last two decades. In a paradigm shift from intrasaccular aneurysm embolization to parent vessel remodeling as the mechanism of action, the proliferation of flow-diverting devices has enabled the [...] Read more.

Flow diversion for intracranial aneurysms emerged as an efficacious and durable treatment option over the last two decades. In a paradigm shift from intrasaccular aneurysm embolization to parent vessel remodeling as the mechanism of action, the proliferation of flow-diverting devices has enabled the treatment of many aneurysms previously considered untreatable. In this review, we review the history and development of flow diverters, highlight the pivotal clinical trials leading to their regulatory approval, review current devices including endoluminal and intrasaccular flow diverters, and discuss current and expanding indications for their use. Areas of clinical equipoise, including ruptured aneurysms and wide-neck bifurcation aneurysms, are summarized with a focus on flow diverters for these pathologies. Finally, we discuss future directions in flow diversion technology including bioresorbable flow diverters, transcriptomics and radiogenomics, and machine learning and artificial intelligence. Full article

(This article belongs to the Special Issue Clinical Advances in Diagnosis and Treatment of Cerebrovascular Diseases)

27 pages, 1291 KB

Open AccessEditor’s ChoiceReview

Charting Alzheimer’s Disease and Dementia: Epidemiological Insights, Risk Factors and Prevention Pathways

by Israel Contador, Bárbara Buch-Vicente, Teodoro del Ser, Sara Llamas-Velasco, Alberto Villarejo-Galende, Julián Benito-León and Félix Bermejo-Pareja

J. Clin. Med. 2024, 13(14), 4100; https://doi.org/10.3390/jcm13144100 - 13 Jul 2024

Cited by 10 | Viewed by 5405

Abstract

Alzheimer’s disease (AD), the most common cause of dementia, is a complex and multifactorial condition without cure at present. The latest treatments, based on anti-amyloid monoclonal antibodies, have only a modest effect in reducing the progression of cognitive decline in AD, whereas the [...] Read more.

Alzheimer’s disease (AD), the most common cause of dementia, is a complex and multifactorial condition without cure at present. The latest treatments, based on anti-amyloid monoclonal antibodies, have only a modest effect in reducing the progression of cognitive decline in AD, whereas the possibility of preventing AD has become a crucial area of research. In fact, recent studies have observed a decrease in dementia incidence in developed regions such as the US and Europe. However, these trends have not been mirrored in non-Western countries (Japan or China), and the contributing factors of this reduction remain unclear. The Lancet Commission has delineated a constrained classification of 12 risk factors across different life stages. Nevertheless, the scientific literature has pointed to over 200 factors—including sociodemographic, medical, psychological, and sociocultural conditions—related to the development of dementia/AD. This narrative review aims to synthesize the risk/protective factors of dementia/AD. Essentially, we found that risk/protective factors vary between individuals and populations, complicating the creation of a unified prevention strategy. Moreover, dementia/AD explanatory mechanisms involve a diverse array of genetic and environmental factors that interact from the early stages of life. In the future, studies across different population-based cohorts are essential to validate risk/protective factors of dementia. This evidence would help develop public health policies to decrease the incidence of dementia. Full article

(This article belongs to the Section Clinical Neurology)

► Show Figures

Figure 1

26 pages, 4291 KB

Open AccessEditor’s ChoiceReview

Innovations in Intracoronary Imaging: Present Clinical Practices and Future Outlooks

by Andreas Mitsis, Christos Eftychiou, Nikolaos P. E. Kadoglou, Konstantinos C. Theodoropoulos, Efstratios Karagiannidis, Athina Nasoufidou, Antonios Ziakas, Stergios Tzikas and George Kassimis

J. Clin. Med. 2024, 13(14), 4086; https://doi.org/10.3390/jcm13144086 - 12 Jul 2024

Cited by 6 | Viewed by 3572

Abstract

Engaging intracoronary imaging (IC) techniques such as intravascular ultrasound or optical coherence tomography enables the precise description of vessel architecture. These imaging modalities have well-established roles in providing guidance and optimizing percutaneous coronary intervention (PCI) outcomes. Furthermore, IC is increasingly recognized for its [...] Read more.

Engaging intracoronary imaging (IC) techniques such as intravascular ultrasound or optical coherence tomography enables the precise description of vessel architecture. These imaging modalities have well-established roles in providing guidance and optimizing percutaneous coronary intervention (PCI) outcomes. Furthermore, IC is increasingly recognized for its diagnostic capabilities, as it has the unique capacity to reveal vessel wall characteristics that may not be apparent through angiography alone. This manuscript thoroughly reviews the contemporary landscape of IC in clinical practice. Focused on current methodologies, the review explores the utility and advancements in IC techniques. Emphasizing their role in clarifying coronary pathophysiology, guiding PCI, and optimizing patient outcomes, the manuscript critically evaluates the strengths and limitations of each modality. Additionally, the integration of IC into routine clinical workflows and its impact on decision-making processes are discussed. By synthesizing the latest evidence, this review provides valuable insights for clinicians, researchers, and healthcare professionals involved in the dynamic field of interventional cardiology. Full article

(This article belongs to the Special Issue State-of-the-Art Developments in Percutaneous Coronary Intervention (PCI))

► Show Figures

Figure 1

10 pages, 233 KB

Open AccessEditor’s ChoiceArticle

Gender-Specific Medicine in the European Society of Cardiology Guidelines from 2018 to 2023: Where Are We Going?

by Federica Piani, Laura Baffoni, Enrico Strocchi and Claudio Borghi

J. Clin. Med. 2024, 13(14), 4026; https://doi.org/10.3390/jcm13144026 - 10 Jul 2024

Cited by 7 | Viewed by 2826

Abstract

Background/Objectives: Evidence-based medicine (EBM) shapes most clinical guidelines. Although the advent of EBM marked a significant advancement, failure to include sex differences in the study design and analysis of most trials leads to an under-representation of gender-specific medicine (GM) in EBM-directed guidelines. [...] Read more.

Background/Objectives: Evidence-based medicine (EBM) shapes most clinical guidelines. Although the advent of EBM marked a significant advancement, failure to include sex differences in the study design and analysis of most trials leads to an under-representation of gender-specific medicine (GM) in EBM-directed guidelines. In this review, we evaluated how the topic of GM was developed in the guidelines produced by the European Society of Cardiology (ESC) from 2018 to 2023. Methods: Two independent reviewers evaluated 24 ESC guidelines. Significant mentions of GM were counted and divided between epidemiology, diagnosis, and therapeutics. The qualitative and semi-quantitative analysis of information relating to GM was performed. Data on the number of citations of papers with a title concerning GM and the prevalence and role of women in guidelines’ authorship were also analyzed. Results: Less than 50% of guidelines had a section dedicated to GM. Only nine guidelines were led by a woman, and 144/567 authors were female. In the most recent guidelines and in those with at least 30% of female authors, there was an increased mention of GM. On average, guidelines had four significant mentions of GM regarding epidemiology, two regarding diagnosis, and one regarding therapy. Articles with titles concerning GM made up, on average, 1.5% of the total number of citations. Conclusions: Although sex differences play a significant role in most clinical scenarios, ESC guidelines still do not sufficiently account for this. The problem does not seem to solely lie in the guidelines, but in the lack of attention to GM in research needed for their preparation. Full article

(This article belongs to the Section Clinical Guidelines)

23 pages, 1745 KB

Open AccessEditor’s ChoiceReview

A Comprehensive Review of Biologics in Phase III and IV Clinical Trials for Atopic Dermatitis

by Katarzyna Waligóra-Dziwak, Aleksandra Dańczak-Pazdrowska and Dorota Jenerowicz

J. Clin. Med. 2024, 13(14), 4001; https://doi.org/10.3390/jcm13144001 - 9 Jul 2024

Cited by 12 | Viewed by 7818

Abstract

Atopic dermatitis (AD) is a skin condition characterized by significant challenges and a substantial deterioration in the life quality for affected patients. The therapeutic landscape for AD has witnessed a transformative shift with the emergence of biologic therapies. Our focus centers on biologics [...] Read more.

Atopic dermatitis (AD) is a skin condition characterized by significant challenges and a substantial deterioration in the life quality for affected patients. The therapeutic landscape for AD has witnessed a transformative shift with the emergence of biologic therapies. Our focus centers on biologics currently undergoing phase III and IV clinical trials, deeming them to hold the highest potential for significant clinical relevance. To identify biologic drugs under development in phase III and IV clinical trials, we searched ClinicalTrials.gov. Additional relevant trials were identified through JapicCTI/ Japan Registry of Clinical Trials (jRCT) with a citation search. A search in MEDLINE and EMBASE was performed. There have been 76 clinical trials identified concerning biologic drugs: dupilumab (34 trials), lebrikizumab (14 trials), tralokinumab (10 trials), rocatinlimab (7 trials), amlitelimab (2 trials), nemolizumab (6 trials), MG-K10 (1 trial), CM310 (1 trial), 611 (1 trial). A search in MEDLINE revealed 132 articles concerning phase III and IV clinical trials for AD treatment. A total of 39 articles concerned biologic drugs covering 23 clinical trials. A search in EMBASE revealed 268 relevant articles, allowing us to identify results of an additional six clinical trials. The safety and efficacy of these biologics are comprehensively addressed in this review. This comprehensive review aims to explore the current landscape of biologic therapies for AD, delving into the latest research findings, clinical trial outcomes, and the diverse mechanisms of action employed by these novel interventions. Full article

(This article belongs to the Special Issue Treatment of Atopic Dermatitis)

► Show Figures

Figure 1

16 pages, 3255 KB

Open AccessEditor’s ChoiceArticle

Machine Learning Prediction of Treatment Response to Biological Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis

by Fatemeh Salehi, Luis I. Lopera Gonzalez, Sara Bayat, Arnd Kleyer, Dario Zanca, Alexander Brost, Georg Schett and Bjoern M. Eskofier

J. Clin. Med. 2024, 13(13), 3890; https://doi.org/10.3390/jcm13133890 - 2 Jul 2024

Cited by 13 | Viewed by 2492

Abstract

Background: Disease-modifying antirheumatic drugs (bDMARDs) have shown efficacy in treating Rheumatoid Arthritis (RA). Predicting treatment outcomes for RA is crucial as approximately 30% of patients do not respond to bDMARDs and only half achieve a sustained response. This study aims to leverage machine [...] Read more.

Background: Disease-modifying antirheumatic drugs (bDMARDs) have shown efficacy in treating Rheumatoid Arthritis (RA). Predicting treatment outcomes for RA is crucial as approximately 30% of patients do not respond to bDMARDs and only half achieve a sustained response. This study aims to leverage machine learning to predict both initial response at 6 months and sustained response at 12 months using baseline clinical data. Methods: Baseline clinical data were collected from 154 RA patients treated at the University Hospital in Erlangen, Germany. Five machine learning models were compared: Extreme Gradient Boosting (XGBoost), Adaptive Boosting (AdaBoost), K-nearest neighbors (KNN), Support Vector Machines (SVM), and Random Forest. Nested cross-validation was employed to ensure robustness and avoid overfitting, integrating hyperparameter tuning within its process. Results: XGBoost achieved the highest accuracy for predicting initial response (AUC-ROC of 0.91), while AdaBoost was the most effective for sustained response (AUC-ROC of 0.84). Key predictors included the Disease Activity Score-28 using erythrocyte sedimentation rate (DAS28-ESR), with higher scores at baseline associated with lower response chances at 6 and 12 months. Shapley additive explanations (SHAP) identified the most important baseline features and visualized their directional effects on treatment response and sustained response. Conclusions: These findings can enhance RA treatment plans and support clinical decision-making, ultimately improving patient outcomes by predicting response before starting medication. Full article

(This article belongs to the Section Immunology & Rheumatology)

► Show Figures

Figure 1

11 pages, 2206 KB

Open AccessEditor’s ChoiceReview

Pyoderma Gangrenosum Post-Breast Surgery: A Case Report and Comprehensive Review of Management Strategies

by Ioan Constantin Pop, Radu Alexandru Ilies, Corina Baican, Stefan Strilciuc, Valentin Muntean and Maximilian Muntean

J. Clin. Med. 2024, 13(13), 3800; https://doi.org/10.3390/jcm13133800 - 28 Jun 2024

Cited by 7 | Viewed by 2613

Abstract

Background/Objectives: Pyoderma gangrenosum (PG) is a rare, autoimmune skin condition characterized by painful, rapidly progressing ulcers, often associated with autoimmune dysregulation. Managing PG following breast surgery presents unique challenges due to its pathergy phenomenon, which complicates surgical interventions. This article outlines the [...] Read more.

Background/Objectives: Pyoderma gangrenosum (PG) is a rare, autoimmune skin condition characterized by painful, rapidly progressing ulcers, often associated with autoimmune dysregulation. Managing PG following breast surgery presents unique challenges due to its pathergy phenomenon, which complicates surgical interventions. This article outlines the case of PG in a 48-year-old female post-breast surgery and reviews management strategies through a systematic analysis of the literature. Methods: A systematic literature review from 2018 to 2023 identified 24 relevant articles on PG management post-breast surgery. The studies were analyzed to compare the efficacy and complications of conservative versus combined (conservative and surgical) treatment strategies. Results: Results indicate that while conservative management, primarily with corticosteroids, remains preferred, combined strategies, including systemic therapies, vacuum-assisted closure, and surgery, offer significant benefits in select cases. Conclusions: Our findings suggest that a personalized, multifaceted treatment plan is crucial for managing PG effectively, emphasizing the need for early detection, meticulous planning, and comprehensive care to optimize patient outcomes. Full article

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

► Show Figures

Figure 1

12 pages, 1994 KB

Open AccessEditor’s ChoiceSystematic Review

Influence of Schneiderian Membrane Perforation on Implant Survival Rate: Systematic Review and Meta-Analysis

by Verónica Schiavo-Di Flaviano, Sonia Egido-Moreno, Beatriz González-Navarro, Eugenio Velasco-Ortega, José López-López and Loreto Monsalve-Guil

J. Clin. Med. 2024, 13(13), 3751; https://doi.org/10.3390/jcm13133751 - 27 Jun 2024

Cited by 10 | Viewed by 4940

Abstract

Background: Maxillary sinus lift is a well-documented and accepted technique in the rehabilitation of the posterior maxilla. Schneiderian membrane perforation is the most common complication and may occur in between 7% and 56% of cases. Different materials and techniques have been described [...] Read more.

Background: Maxillary sinus lift is a well-documented and accepted technique in the rehabilitation of the posterior maxilla. Schneiderian membrane perforation is the most common complication and may occur in between 7% and 56% of cases. Different materials and techniques have been described to achieve reparation of the perforation. The aim of this study was to establish whether the perforation of the Schneiderian membrane and its repair during maxillary sinus lift surgery results in a lower implant survival rate compared to those cases where the membrane has not been perforated. Materials and methods: A systematic review and meta-analysis of studies assessing the survival rate of implants placed in regenerated sinus using the lateral window approach, where the perforation of the Schneiderian membrane occur, was carried out. Statistical analysis was performed with Open Meta-Analyst, calculating the odds ratio of implants placed in perforated sinuses and non-perforated sinuses. Results: Ten articles were included in the qualitative analysis and seven articles in the quantitative analysis or meta-analysis. A total of 1224 maxillary sinus augmentation surgeries were performed without perforation of the Schneiderian membrane and 2725 implants were placed; 62 implants failed during the follow-up period with an overall survival rate of 97.7%. In 480 perforated sinuses, 1044 implants were placed, of which 30 failed; the overall survival rate was 97.1%. There were no significant differences between the implant survival rate of the implants in the two groups (OR = 0.78; CI = 0.49–2.23; p = 0.28 and I² heterogeneity: 0%, p = 0.44). Conclusions: Schneiderian membrane perforation, as long as it is repaired, does not appear to negatively influence implant survival rate. Membrane perforation should not be considered a reason to abort the procedure or an absolute contraindication to implant placement. Full article

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

► Show Figures

Graphical abstract

35 pages, 2611 KB

Open AccessEditor’s ChoiceReview

Novel Treatment Strategies for Hormone Receptor (HR)-Positive, HER2-Negative Metastatic Breast Cancer

by Antonella Ferro, Michela Campora, Alessia Caldara, Delia De Lisi, Martina Lorenzi, Sara Monteverdi, Raluca Mihai, Alessandra Bisio, Mariachiara Dipasquale, Orazio Caffo and Yari Ciribilli

J. Clin. Med. 2024, 13(12), 3611; https://doi.org/10.3390/jcm13123611 - 20 Jun 2024

Cited by 11 | Viewed by 8028

Abstract

Estrogen receptor (ER)-positive breast cancer (BC) is the most common BC subtype. Endocrine therapy (ET) targeting ER signaling still remains the mainstay treatment option for hormone receptor (HR)-positive BC either in the early or in advanced setting, including different strategies, such as the [...] Read more.

Estrogen receptor (ER)-positive breast cancer (BC) is the most common BC subtype. Endocrine therapy (ET) targeting ER signaling still remains the mainstay treatment option for hormone receptor (HR)-positive BC either in the early or in advanced setting, including different strategies, such as the suppression of estrogen production or directly blocking the ER pathway through SERMs—selective estrogen receptor modulators—or SERDs—selective estrogen receptor degraders. Nevertheless, the development of de novo or acquired endocrine resistance still remains challenging for oncologists. The use of novel ET combined with targeted drugs, such as cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors, has significantly improved long-term outcome rates, thus changing the therapeutic algorithm for metastatic BC (MBC) and recently the therapeutic strategy in the adjuvant setting for early high-risk BC. Eluding the resistance to CDK4/6 inhibitors combined with ET is currently an unmet medical need, and there is disagreement concerning the best course of action for patients who continue to progress after this combination approach. Genetic changes in the tumor along its growth uncovered by genomic profiling of recurrent and/or metastatic lesions through tumor and/or liquid biopsies may predict the response or resistance to specific agents, suggesting the best therapeutic strategy for each patient by targeting the altered ER-dependent pathway (novel oral SERDs and a new generation of anti-estrogen agents) or alternative ER-independent signaling pathways such as PI3K/AKT/mTOR or tyrosine kinase receptors (HER2 mutations or HER2 low status) or by inhibiting pathways weakened through germline BRCA1/2 mutations. These agents are being investigated as single molecules and in combination with other target therapies, offering promising weapons to overcome or avoid treatment failure and propose increasingly more personalized treatment approaches. This review presents novel insights into ET and other targeted therapies for managing metastatic HR⁺/HER2⁻ BC by exploring potential strategies based on clinical evidence and genomic profiling following the failure of the CDK4/6i and ET combination. Full article

(This article belongs to the Special Issue Breast Cancer: Novel Insights into Hormone Therapy)

► Show Figures

Graphical abstract

10 pages, 901 KB

Open AccessEditor’s ChoiceArticle

Kinematic Alignment Achieves a More Balanced Total Knee Arthroplasty Than Mechanical Alignment among CPAK Type I Patients: A Simulation Study

by Noriaki Arai, Seikai Toyooka, Hironari Masuda, Hirotaka Kawano and Takumi Nakagawa

J. Clin. Med. 2024, 13(12), 3596; https://doi.org/10.3390/jcm13123596 - 19 Jun 2024

Cited by 6 | Viewed by 2304

Abstract

Background: There is no consensus on whether mechanical alignment (MA) or kinematic alignment (KA) should be chosen for total knee arthroplasty (TKA) for coronal plane alignment of the knee (CPAK) Type I with a varus arithmetic HKA (aHKA) and apex distal joint [...] Read more.

Background: There is no consensus on whether mechanical alignment (MA) or kinematic alignment (KA) should be chosen for total knee arthroplasty (TKA) for coronal plane alignment of the knee (CPAK) Type I with a varus arithmetic HKA (aHKA) and apex distal joint line obliquity (JLO). The aim of this study was to investigate whether MA or KA is preferable for soft tissue balancing in TKA for this phenotype. Method: This prospective cohort study included 64 knees with CPAK Type I osteoarthritis that had undergone cruciate-retaining TKA. Using optical tracking software, we simulated implant placement in the Mako system before making the actual bone cut and compared the results between MA and KA. Extension balance (the difference between medial and lateral gaps in extension) and medial balance (the difference in medial gaps in flexion and extension) were examined. These gap differences within 2 mm were defined as good balance. Achievement of overall balance was defined as an attainment of good extension and medial balance. The incidence of balance in each patient was compared with an independent sample ratio test. Results: Compared with the MA group, the KA group achieved better soft tissue balance in extension balance (p < 0.001). A total of 75% of the patients in the KA group achieved overall balance, which was greater than the 38% achieved in the MA group (p < 0.001). Conclusions: In robot-assisted TKA for CPAK Type I osteoarthritis, KA achieved knee balance during extension without soft tissue release in a greater percentage of patients than MA. Full article

(This article belongs to the Special Issue Total Joint Arthroplasty: Management and Future Opportunities)

► Show Figures

Figure 1

12 pages, 269 KB

Open AccessEditor’s ChoiceReview

Spinal Muscular Atrophy Scoliosis in the Era of Background Therapies—A Review of the Literature

by Fred Ruythooren and Pierre Moens

J. Clin. Med. 2024, 13(12), 3467; https://doi.org/10.3390/jcm13123467 - 14 Jun 2024

Cited by 7 | Viewed by 2766

Abstract

Spinal deformities are considered an important complication of neuromuscular disorders such as spinal muscular atrophy (SMA). SMA patients typically develop progressive early-onset scoliosis, which is associated with increased functional decline, discomfort, and respiratory dysfunction. Over the second decade of the twenty-first century, a [...] Read more.

Spinal deformities are considered an important complication of neuromuscular disorders such as spinal muscular atrophy (SMA). SMA patients typically develop progressive early-onset scoliosis, which is associated with increased functional decline, discomfort, and respiratory dysfunction. Over the second decade of the twenty-first century, a lot has changed in terms of the therapeutic options available to people with SMA. Specifically, the use of pharmaceutical agents such as nusinersen (Spinraza), onasemnogene abeparvovec (Zolgensma), and risdiplam (Evrysdi) has dramatically changed the landscape for SMA patients. These medications significantly alter motor- and respiratory functioning, as well as the natural progression of spinal deformities. When evaluating these agents and their impact on the development of scoliosis and motor functioning, it is important to consider the timing of treatment initiation. In patients treated after they had already developed symptoms, a shift of phenotype to a less severe subtype has been observed. This results in a delay in the onset of scoliosis for the less severe SMA types and an increase in early-onset scoliosis for the severe types in patients who would typically not live to develop scoliosis. Patients who receive treatment before they develop symptoms achieve almost normal motor functioning and will likely have a significant decrease in scoliosis prevalence or at least delay its onset. Full article

(This article belongs to the Special Issue Scoliosis and Spinal Deformity: Current Diagnosis, Treatment and Clinical Management)

14 pages, 309 KB

Open AccessEditor’s ChoiceReview

Acute Kidney Injury in Neonatal Intensive Care Unit: Epidemiology, Diagnosis and Risk Factors

by Valeria Chirico, Antonio Lacquaniti, Filippo Tripodi, Giovanni Conti, Lucia Marseglia, Paolo Monardo, Eloisa Gitto and Roberto Chimenz

J. Clin. Med. 2024, 13(12), 3446; https://doi.org/10.3390/jcm13123446 - 13 Jun 2024

Cited by 11 | Viewed by 4618

Abstract

Acute kidney injury (AKI) is associated with long-term consequences and poor outcomes in the neonatal intensive care unit. Its precocious diagnosis represents one of the hardest challenges in clinical practice due to the lack of sensitive and specific biomarkers. Currently, neonatal AKI is [...] Read more.

Acute kidney injury (AKI) is associated with long-term consequences and poor outcomes in the neonatal intensive care unit. Its precocious diagnosis represents one of the hardest challenges in clinical practice due to the lack of sensitive and specific biomarkers. Currently, neonatal AKI is defined with urinary markers and serum creatinine (sCr), with limitations in early detection and individual treatment. Biomarkers and risk factor scores were studied to predict neonatal AKI, to early identify the stage of injury and not the damage and to anticipate late increases in sCr levels, which occurred when the renal function already began to decline. Sepsis is the leading cause of AKI, and sepsis-related AKI is one of the main causes of high mortality. Moreover, preterm neonates, as well as patients with post-neonatal asphyxia or after cardiac surgery, are at a high risk for AKI. Critical patients are frequently exposed to nephrotoxic medications, representing a potentially preventable cause of AKI. This review highlights the definition of neonatal AKI, its diagnosis and new biomarkers available in clinical practice and in the near future. We analyze the risk factors involving patients with AKI, their outcomes and the risk for the transition from acute damage to chronic kidney disease. Full article

(This article belongs to the Special Issue Research Progress in Pediatric Critical Care Medicine)

20 pages, 1588 KB

Open AccessEditor’s ChoiceReview

PET Molecular Imaging in Breast Cancer: Current Applications and Future Perspectives

by Sanaz Katal, Michael J. McKay and Kim Taubman

J. Clin. Med. 2024, 13(12), 3459; https://doi.org/10.3390/jcm13123459 - 13 Jun 2024

Cited by 7 | Viewed by 4990

Abstract

Positron emission tomography (PET) plays a crucial role in breast cancer management. This review addresses the role of PET imaging in breast cancer care. We focus primarily on the utility of 18F-fluorodeoxyglucose (FDG) PET in staging, recurrence detection, and treatment response evaluation. Furthermore, [...] Read more.

Positron emission tomography (PET) plays a crucial role in breast cancer management. This review addresses the role of PET imaging in breast cancer care. We focus primarily on the utility of 18F-fluorodeoxyglucose (FDG) PET in staging, recurrence detection, and treatment response evaluation. Furthermore, we delve into the growing interest in precision therapy and the development of novel radiopharmaceuticals targeting tumor biology. This includes discussing the potential of PET/MRI and artificial intelligence in breast cancer imaging, offering insights into improved diagnostic accuracy and personalized treatment approaches. Full article

(This article belongs to the Special Issue Advances in Breast Cancer Radiotherapy: Implications for Current and Future Practice)

► Show Figures

Figure 1

16 pages, 3068 KB

Open AccessEditor’s ChoiceReview

Fibroblast Yap/Taz Signaling in Extracellular Matrix Homeostasis and Tissue Fibrosis

by Cong-Qiu Chu and Taihao Quan

J. Clin. Med. 2024, 13(12), 3358; https://doi.org/10.3390/jcm13123358 - 7 Jun 2024

Cited by 7 | Viewed by 4825

Abstract

Tissue fibrosis represents a complex pathological condition characterized by the excessive accumulation of collagenous extracellular matrix (ECM) components, resulting in impaired organ function. Fibroblasts are central to the fibrotic process and crucially involved in producing and depositing collagen-rich ECM. Apart from their primary [...] Read more.

Tissue fibrosis represents a complex pathological condition characterized by the excessive accumulation of collagenous extracellular matrix (ECM) components, resulting in impaired organ function. Fibroblasts are central to the fibrotic process and crucially involved in producing and depositing collagen-rich ECM. Apart from their primary function in ECM synthesis, fibroblasts engage in diverse activities such as inflammation and shaping the tissue microenvironment, which significantly influence cellular and tissue functions. This review explores the role of Yes-associated protein (Yap) and Transcriptional co-activator with PDZ-binding motif (Taz) in fibroblast signaling and their impact on tissue fibrosis. Gaining a comprehensive understanding of the intricate molecular mechanisms of Yap/Taz signaling in fibroblasts may reveal novel therapeutic targets for fibrotic diseases. Full article

(This article belongs to the Special Issue Tissue Scarring, Fibrosis and Regeneration)

► Show Figures

Figure 1

15 pages, 5917 KB

Open AccessEditor’s ChoiceReview

Alopecia Areata of the Nails: Diagnosis and Management

by Christin Pelzer and Matilde Iorizzo

J. Clin. Med. 2024, 13(11), 3292; https://doi.org/10.3390/jcm13113292 - 3 Jun 2024

Cited by 6 | Viewed by 7087

Abstract

Background: Alopecia areata (AA) is a common form of non-scarring alopecia characterized by acute hair loss. Nail involvement, though not always present, can occur in AA patients. Nail changes are more frequent in severe forms of AA and in children. Methods: Literature related [...] Read more.

Background: Alopecia areata (AA) is a common form of non-scarring alopecia characterized by acute hair loss. Nail involvement, though not always present, can occur in AA patients. Nail changes are more frequent in severe forms of AA and in children. Methods: Literature related to nail changes in AA was comprehensively reviewed after a search on the PubMed database without time restrictions in order to identify common clinical presentations and associated factors to aid clinicians with the correct evaluation and management of these dystrophies. Results: Nail changes in AA include pitting, trachyonychia, leukonychia, red lunula, and miscellaneous alterations such as longitudinal ridging and brittle nails. Nail changes are usually asymptomatic but, nevertheless, sometimes cosmetically disfiguring and can be associated with a reduced quality of life and impaired daily activities. Conclusions: Nail changes in AA may precede or follow hair loss and can occur as an isolated finding. Diagnosis may require a biopsy for definitive identification. Spontaneous improvement is possible, particularly in children, and treatment is not always necessary. Further research is, however, needed to establish a consensus on treatment approaches according to age and severity. Full article

(This article belongs to the Special Issue Alopecia Areata: From Diagnosis to Treatment)

► Show Figures

Figure 1

9 pages, 780 KB

Open AccessEditor’s ChoiceArticle

Benefits of Biosimilars in the Management of Patients with Inflammatory Bowel Disease: An International Survey

by Ferdinando D’Amico, Laurent Peyrin-Biroulet and Silvio Danese

J. Clin. Med. 2024, 13(11), 3069; https://doi.org/10.3390/jcm13113069 - 24 May 2024

Cited by 10 | Viewed by 2148

Abstract

Background/Objectives: The development of biosimilar drugs has revolutionized the management of patients with inflammatory bowel diseases (IBD), significantly reducing healthcare costs. However, the impact of biosimilar availability on patient care is unknown. We conducted a survey to investigate the benefits of using [...] Read more.

Background/Objectives: The development of biosimilar drugs has revolutionized the management of patients with inflammatory bowel diseases (IBD), significantly reducing healthcare costs. However, the impact of biosimilar availability on patient care is unknown. We conducted a survey to investigate the benefits of using biosimilars in patients with IBD. Methods: Physicians involved in the IBD care were invited to participate in an anonymous online survey. The questionnaire consisted of 42 questions addressing availability, cost, recommendations, and positioning regarding the use of biosimilars. Results: A total of 233 physicians (88.4% gastroenterologists) from 63 countries worldwide participated in the survey. Most respondents had >10 years of practice (202/233, 85.9%). Biosimilars were available in almost all cases (221, 94.8%), and over two-thirds of respondents had more than one biosimilar of adalimumab or infliximab on hospital formulary. In most cases, adalimumab and infliximab biosimilars had a reduced cost of at least 30% compared to the originators. The savings resulting from the use of biosimilars allowed physicians to improve patient care (3/233, 1.3%) or to improve research (2/233, 0.8%) in only a few cases. Interestingly, for about 50% of respondents, the cost of biologics was a limitation for patient access to therapy. For the majority of participants, the availability of biosimilars did not influence treatment decisions in Crohn’s disease (70/165, 42.4%) and ulcerative colitis (83/165, 50.3%). Conclusions: The reduced cost of biosimilars compared to reference products is the main driver of choice in IBD. The impact of biosimilars of ustekinumab and vedolizumab in improving access to therapies and changing the treatment algorithm remains to be defined. Full article

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

► Show Figures

Figure 1

22 pages, 330 KB

Open AccessFeature PaperEditor’s ChoiceReview

Pulsed Field Energy in Atrial Fibrillation Ablation: From Physical Principles to Clinical Applications

by Nicola Pierucci, Marco Valerio Mariani, Domenico Laviola, Giacomo Silvetti, Pietro Cipollone, Antonio Vernile, Sara Trivigno, Vincenzo Mirco La Fazia, Agostino Piro, Fabio Miraldi, Carmine Dario Vizza and Carlo Lavalle

J. Clin. Med. 2024, 13(10), 2980; https://doi.org/10.3390/jcm13102980 - 18 May 2024

Cited by 11 | Viewed by 6077

Abstract

Atrial fibrillation, representing the most prevalent sustained cardiac arrhythmia, significantly impacts stroke risk and cardiovascular mortality. Historically managed with antiarrhythmic drugs with limited efficacy, and more recently, catheter ablation, the interventional approach field is still evolving with technological advances. This review highlights pulsed [...] Read more.

Atrial fibrillation, representing the most prevalent sustained cardiac arrhythmia, significantly impacts stroke risk and cardiovascular mortality. Historically managed with antiarrhythmic drugs with limited efficacy, and more recently, catheter ablation, the interventional approach field is still evolving with technological advances. This review highlights pulsed field ablation (PFA), a revolutionary technique gaining prominence in interventional electrophysiology because of its efficacy and safety. PFA employs non-thermal electric fields to create irreversible electroporation, disrupting cell membranes selectively within myocardial tissue, thus preventing the non-selective damage associated with traditional thermal ablation methods like radiofrequency or cryoablation. Clinical studies have consistently shown PFA’s ability to achieve pulmonary vein isolation—a cornerstone of AF treatment—rapidly and with minimal complications. Notably, PFA reduces procedure times and has shown a lower incidence of esophageal and phrenic nerve damage, two common concerns with thermal techniques. Emerging from oncological applications, the principles of electroporation provide a unique tissue-selective ablation method that minimizes collateral damage. This review synthesizes findings from foundational animal studies through to recent clinical trials, such as the MANIFEST-PF and ADVENT trials, demonstrating PFA’s effectiveness and safety. Future perspectives point towards expanding indications and refinement of techniques that promise to improve AF management outcomes further. PFA represents a paradigm shift in AF ablation, offering a safer, faster, and equally effective alternative to conventional methods. This synthesis of its development and clinical application outlines its potential to become the new standard in AF treatment protocols. Full article

(This article belongs to the Special Issue Advances in Cardiac Electrophysiology and Pacing: Part II)

22 pages, 966 KB

Open AccessEditor’s ChoiceReview

NGF, EPO, and IGF-1 in the Male Reproductive System

by Chryssa Metallinou, Chrysovalanto Staneloudi, Konstantinos Nikolettos and Byron Asimakopoulos

J. Clin. Med. 2024, 13(10), 2918; https://doi.org/10.3390/jcm13102918 - 15 May 2024

Cited by 6 | Viewed by 3630

Abstract

Several studies have demonstrated interesting results considering the implication of three growth factors (GFs), namely nerve growth factor (NGF), erythropoietin (EPO), and the insulin-like growth factor-I (IGF-1) in the physiology of male reproductive functions. This review provides insights into the effects of NGF, [...] Read more.

Several studies have demonstrated interesting results considering the implication of three growth factors (GFs), namely nerve growth factor (NGF), erythropoietin (EPO), and the insulin-like growth factor-I (IGF-1) in the physiology of male reproductive functions. This review provides insights into the effects of NGF, EPO, and IGF-1 on the male reproductive system, emphasizing mainly their effects on sperm motility and vitality. In the male reproductive system, the expression pattern of the NGF system varies according to the species and testicular development, playing a crucial role in morphogenesis and spermatogenesis. In humans, it seems that NGF positively affects sperm motility parameters and NGF supplementation in cryopreservation media improves post-thaw sperm motility. In animals, EPO is found in various male reproductive tissues, and in humans, the protein is present in seminal plasma and testicular germ cells. EPO receptors have been discovered in the plasma membrane of human spermatozoa, suggesting potential roles in sperm motility and vitality. In humans, IGF-1 is expressed mainly in Sertoli cells and is present in seminal plasma, contributing to cell development and the maturation of spermatozoa. IGF-1 seems to modulate sperm motility, and treatment with IGF-1 has a positive effect on sperm motility and vitality. Furthermore, lower levels of NGF or IGF-1 in seminal plasma are associated with infertility. Understanding the mechanisms of actions of these GFs in the male reproductive system may improve the outcome of sperm processing techniques. Full article

(This article belongs to the Special Issue Assisted Reproductive Technology and Infertility Treatment: Current Updates and Perspectives)

► Show Figures

Figure 1

12 pages, 6352 KB

Open AccessEditor’s ChoiceReview

Advances in Dynamization of Plate Fixation to Promote Natural Bone Healing

by Michael Bottlang, Sunil S. Shetty, Connor Blankenau, Jennifer Wilk, Stanley Tsai, Daniel C. Fitzpatrick, Lawrence J. Marsh and Steven M. Madey

J. Clin. Med. 2024, 13(10), 2905; https://doi.org/10.3390/jcm13102905 - 14 May 2024

Cited by 7 | Viewed by 3196

Abstract

The controlled dynamization of fractures can promote natural fracture healing by callus formation, while overly rigid fixation can suppress healing. The advent of locked plating technology enabled new strategies for the controlled dynamization of fractures, such as far cortical locking (FCL) screws or [...] Read more.

The controlled dynamization of fractures can promote natural fracture healing by callus formation, while overly rigid fixation can suppress healing. The advent of locked plating technology enabled new strategies for the controlled dynamization of fractures, such as far cortical locking (FCL) screws or active plates with elastically suspended screw holes. However, these strategies did not allow for the use of non-locking screws, which are typically used to reduce bone fragments to the plate. This study documents the first in vivo study on the healing of ovine tibia osteotomies stabilized with an advanced active plate (AAP). This AAP allowed plate application using any combination of locking and non-locking screws to support a wide range of plate application techniques. At week 9 post-surgery, tibiae were harvested and tested in torsion to failure to assess the healing strength. The five tibiae stabilized with an AAP regained 54% of their native strength and failed by spiral fracture through a screw hole, which did not involve the healed osteotomy. In comparison, tibiae stabilized with a standard locking plate recovered 17% of their strength and sustained failure through the osteotomy. These results further support the stimulatory effect of controlled motion on fracture healing. As such, the controlled dynamization of locked plating constructs may hold the potential to reduce healing complications and may shorten the time to return to function. Integrating controlled dynamization into fracture plates that support a standard fixation technique may facilitate the clinical adoption of dynamic plating. Full article

(This article belongs to the Special Issue Clinical Advances in Orthopedic Trauma Surgery)

► Show Figures

Figure 1

13 pages, 1182 KB

Open AccessEditor’s ChoiceArticle

Cenobamate Plasma Levels in Patients with Epilepsy: Correlation with Efficacy and Tolerability?

by Bernhard J. Steinhoff, Dimitra Georgiou, Daniel Dietmann and Tassanai Intravooth

J. Clin. Med. 2024, 13(10), 2757; https://doi.org/10.3390/jcm13102757 - 8 May 2024

Cited by 8 | Viewed by 2338

Abstract

Objective: Cenobamate is approved by the European Medicine Agency for the treatment of adult patients with epilepsy (PWEs) with ongoing focal-onset seizures despite appropriate treatment with at least two established antiseizure medications. Pivotal trials and post-marketing real-world observational studies suggest high efficacy with [...] Read more.

Objective: Cenobamate is approved by the European Medicine Agency for the treatment of adult patients with epilepsy (PWEs) with ongoing focal-onset seizures despite appropriate treatment with at least two established antiseizure medications. Pivotal trials and post-marketing real-world observational studies suggest high efficacy with unusually high seizure-free rates. The authors sought to investigate the plasma levels of cenobamate under steady-state conditions in seizure-free versus non-responding PWEs, and in PWEs who experienced adverse events versus those who did not. Methods: Blood samples were collected from adult PWEs who were treated with adjunct cenobamate under steady-state conditions. Daily doses, concomitant medications, efficacy, and tolerability were assessed. The plasma cenobamate levels of seizure-free versus non-responding PWEs and between PWEs with and those without clinical adverse events were compared. Results: Samples from 101 PWEs were included. Thirty-six PWEs were seizure-free and 65 were non-responders. In 31 PWEs, adverse events were apparent, whereas in the remaining 70, no tolerability issues were reported. A linear correlation was found between the daily doses (range: 100 mg–400 mg) and the plasma levels (3.8 mg/L–54.6 mg/L). Neither the daily doses nor the plasma levels differed significantly between the investigated subgroups. The main reason for this result was that the individual therapeutic ranges varied widely: seizure freedom and adverse effects were observed alongside low doses and plasma levels in some PWEs. Conversely, there were examples of PWEs who did not respond or who reported no tolerability issues at high doses or plasma levels. Conclusions: To evaluate the individual therapeutic range and to better understand the influence of other drugs in cases where concomitant medications are used, the therapeutic drug monitoring of cenobamate may be useful. A general therapeutic range cannot be defined. Full article

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

► Show Figures

Figure 1

19 pages, 8452 KB

Open AccessFeature PaperEditor’s ChoiceReview

Waves of Precision: A Practical Guide for Reviewing New Tools to Evaluate Mechanical In-Exsufflation Efficacy in Neuromuscular Disorders

by Michelle Chatwin, Jesus Sancho, Manel Lujan, Tiina Andersen and Joao-Carlos Winck

J. Clin. Med. 2024, 13(9), 2643; https://doi.org/10.3390/jcm13092643 - 30 Apr 2024

Cited by 8 | Viewed by 3919

Abstract

Mechanical insufflation-exsufflation (MI-E) is essential for secretion clearance, especially in neuromuscular disorders. For the best outcomes, initiation of MI-E should be started at the correct time with regular evaluation to the response to treatment. Typically, cough peak flow has been used to evaluate [...] Read more.

Mechanical insufflation-exsufflation (MI-E) is essential for secretion clearance, especially in neuromuscular disorders. For the best outcomes, initiation of MI-E should be started at the correct time with regular evaluation to the response to treatment. Typically, cough peak flow has been used to evaluate cough effectiveness with and without MI-E. This review highlights the limitations of this and discussed other tools to evaluate MI-E efficacy in this rapidly developing field. Such tools include the interpretation of parameters (like pressure, flow and volumes) that derive from the MI-E device and external methods to evaluate upper airway closure. In this review we pinpoint the differences between different devices in the market and discuss new tools to better titrate MI-E and detect pathological responses of the upper airway. We discuss the importance of point of care ultrasound (POCUS), transnasal fiberoptic laryngoscopy and wave form analysis in this setting. To improve clinical practice newer generation MI-E devices should allow real-time evaluation of waveforms and standardize some of the derived parameters. Full article

(This article belongs to the Special Issue Non-invasive Respiratory Support: How to Get It Right in Clinical Medicine—Volume II)

► Show Figures

Figure 1

16 pages, 1193 KB

Open AccessEditor’s ChoiceReview

Obstructive Sleep Apnea and Risk of Postoperative Complications after Non-Cardiac Surgery

by Rabail Arif Chaudhry, Lori Zarmer, Kelly West and Frances Chung

J. Clin. Med. 2024, 13(9), 2538; https://doi.org/10.3390/jcm13092538 - 26 Apr 2024

Cited by 12 | Viewed by 6068

Abstract

Obstructive sleep apnea (OSA), a common sleep disorder, poses significant challenges in perioperative management due to its complexity and multifactorial nature. With a global prevalence of approximately 22.6%, OSA often remains undiagnosed, and increases the risk of cardiac and respiratory postoperative complications. Preoperative [...] Read more.

Obstructive sleep apnea (OSA), a common sleep disorder, poses significant challenges in perioperative management due to its complexity and multifactorial nature. With a global prevalence of approximately 22.6%, OSA often remains undiagnosed, and increases the risk of cardiac and respiratory postoperative complications. Preoperative screening has become essential in many institutions to identify patients at increased risk, and experts recommend proceeding with surgery in the absence of severe symptoms, albeit with heightened postoperative monitoring. Anesthetic and sedative agents exacerbate upper airway collapsibility and depress central respiratory activity, complicating intraoperative management, especially with neuromuscular blockade use. Additionally, OSA patients are particularly prone to opioid-induced respiratory depression, given their increased sensitivity to opioids and heightened pain perception. Thus, regional anesthesia and multimodal analgesia are strongly advocated to reduce perioperative complication risks. Postoperative care for OSA patients necessitates vigilant monitoring and tailored management strategies, such as supplemental oxygen and Positive Airway Pressure therapy, to minimize cardiorespiratory complications. Health care institutions are increasingly focusing on enhanced monitoring and resource allocation for patient safety. However, the rising prevalence of OSA, heterogeneity in disease severity, and lack of evidence for the efficacy of costly perioperative measures pose challenges. The development of effective screening and monitoring algorithms, alongside reliable risk predictors, is crucial for identifying OSA patients needing extended postoperative care. This review emphasizes a multidimensional approach in managing OSA patients throughout the perioperative period, aiming to optimize patient outcomes and minimize adverse outcomes. Full article

(This article belongs to the Special Issue Perioperative Pulmonary Evaluation and Management after Non-cardiac Surgery)

► Show Figures

Figure 1

11 pages, 269 KB

Open AccessEditor’s ChoiceReview

Clinical Genetic and Genomic Testing in Congenital Heart Disease and Cardiomyopathy

by Mahati Pidaparti, Gabrielle C. Geddes and Matthew D. Durbin

J. Clin. Med. 2024, 13(9), 2544; https://doi.org/10.3390/jcm13092544 - 26 Apr 2024

Cited by 6 | Viewed by 3617

Abstract

Congenital heart disease (CHD) and cardiomyopathies are the leading cause of morbidity and mortality worldwide. These conditions are often caused by genetic factors, and recent research has shown that genetic and genomic testing can provide valuable information for patient care. By identifying genetic [...] Read more.

Congenital heart disease (CHD) and cardiomyopathies are the leading cause of morbidity and mortality worldwide. These conditions are often caused by genetic factors, and recent research has shown that genetic and genomic testing can provide valuable information for patient care. By identifying genetic causes, healthcare providers can screen for other related health conditions, offer early interventions, estimate prognosis, select appropriate treatments, and assess the risk for family members. Genetic and genomic testing is now the standard of care in patients with CHD and cardiomyopathy. However, rapid advances in technology and greater availability of testing options have led to changes in recommendations for the most appropriate testing method. Several recent studies have investigated the utility of genetic testing in this changing landscape. This review summarizes the literature surrounding the clinical utility of genetic evaluation in patients with CHD and cardiomyopathy. Full article

(This article belongs to the Section Cardiology)

22 pages, 778 KB

Open AccessEditor’s ChoiceReview

Endothelial Function in Pulmonary Arterial Hypertension: From Bench to Bedside

by Michele Correale, Francesco Chirivì, Ester Maria Lucia Bevere, Lucia Tricarico, Michele D’Alto, Roberto Badagliacca, Natale D. Brunetti, Carmine Dario Vizza and Stefano Ghio

J. Clin. Med. 2024, 13(8), 2444; https://doi.org/10.3390/jcm13082444 - 22 Apr 2024

Cited by 9 | Viewed by 4544

Abstract

Pulmonary arterial hypertension is a complex pathology whose etiology is still not completely well clarified. The pathogenesis of pulmonary arterial hypertension involves different molecular mechanisms, with endothelial dysfunction playing a central role in disease progression. Both individual genetic predispositions and environmental factors seem [...] Read more.

Pulmonary arterial hypertension is a complex pathology whose etiology is still not completely well clarified. The pathogenesis of pulmonary arterial hypertension involves different molecular mechanisms, with endothelial dysfunction playing a central role in disease progression. Both individual genetic predispositions and environmental factors seem to contribute to its onset. To further understand the complex relationship between endothelial and pulmonary hypertension and try to contribute to the development of future therapies, we report a comprehensive and updated review on endothelial function in pulmonary arterial hypertension. Full article

(This article belongs to the Special Issue Clinical Advances in Pulmonary Heart Disease)

► Show Figures

Figure 1

20 pages, 3059 KB

Open AccessEditor’s ChoiceReview

Pushing the Limits of Minimally Invasive Spine Surgery—From Preoperative to Intraoperative to Postoperative Management

by Peter N. Drossopoulos, Arnav Sharma, Favour C. Ononogbu-Uche, Troy Q. Tabarestani, Alyssa M. Bartlett, Timothy Y. Wang, David Huie, Oren Gottfried, Jeanna Blitz, Melissa Erickson, Shivanand P. Lad, W. Michael Bullock, Christopher I. Shaffrey and Muhammad M. Abd-El-Barr

J. Clin. Med. 2024, 13(8), 2410; https://doi.org/10.3390/jcm13082410 - 20 Apr 2024

Cited by 8 | Viewed by 4749

Abstract

The introduction of minimally invasive surgery ushered in a new era of spine surgery by minimizing the undue iatrogenic injury, recovery time, and blood loss, among other complications, of traditional open procedures. Over time, technological advancements have further refined the care of the [...] Read more.

The introduction of minimally invasive surgery ushered in a new era of spine surgery by minimizing the undue iatrogenic injury, recovery time, and blood loss, among other complications, of traditional open procedures. Over time, technological advancements have further refined the care of the operative minimally invasive spine patient. Moreover, pre-, and postoperative care have also undergone significant change by way of artificial intelligence risk stratification, advanced imaging for surgical planning and patient selection, postoperative recovery pathways, and digital health solutions. Despite these advancements, challenges persist necessitating ongoing research and collaboration to further optimize patient care in minimally invasive spine surgery. Full article

(This article belongs to the Special Issue Advances and Challenges in Spine Surgery)

► Show Figures

Figure 1

16 pages, 1951 KB

Open AccessEditor’s ChoiceArticle

A Multidisciplinary Approach to End-Stage Limb Salvage in the Highly Comorbid Atraumatic Population: An Observational Study

by Karen R. Li, Christian X. Lava, Monique B. Neughebauer, Rachel N. Rohrich, Jayson Atves, John Steinberg, Cameron M. Akbari, Richard C. Youn, Christopher E. Attinger and Karen K. Evans

J. Clin. Med. 2024, 13(8), 2406; https://doi.org/10.3390/jcm13082406 - 20 Apr 2024

Cited by 9 | Viewed by 2696

Abstract

Background: The use of free tissue transfer (FTT) is efficacious for chronic, non-healing lower extremity (LE) wounds. The four pillars of managing patient comorbidities, infection control, blood flow status, and biomechanical function are critical in achieving successful limb salvage. The authors present their [...] Read more.

Background: The use of free tissue transfer (FTT) is efficacious for chronic, non-healing lower extremity (LE) wounds. The four pillars of managing patient comorbidities, infection control, blood flow status, and biomechanical function are critical in achieving successful limb salvage. The authors present their multidisciplinary institutional experience with a review of 300 FTTs performed for the complex LE limb salvage of chronic LE wounds. Methods: A single-institution, retrospective review of atraumatic LE FTTs performed by a single surgeon from July 2011 to January 2023 was reviewed. Data on patient demographics, comorbidities, preoperative management, intraoperative details, flap outcomes, postoperative complications, and long-term outcomes were collected. Results: A total of 300 patients who underwent LE FTT were included in our retrospective review. Patients were on average 55.9 ± 13.6 years old with a median Charlson Comorbidity Index of 4 (IQR: 3). The majority of patients were male (70.7%). The overall hospital length of stay (LOS) was 27 days (IQR: 16), with a postoperative LOS of 14 days (IQR: 9.5). The most prevalent comorbidities were diabetes (54.7%), followed by peripheral vascular disease (PVD: 35%) and chronic kidney disease (CKD: 15.7%). The average operative LE FTT time was 416 ± 115 min. The majority of flaps were anterolateral thigh (ALT) flaps (52.7%), followed by vastus lateralis (VL) flaps (25.3%). The immediate flap success rate was 96.3%. The postoperative ipsilateral amputation rate was 12.7%. Conclusions: Successful limb salvage is possible in a highly comorbid patient population with a high prevalence of diabetes mellitus, peripheral vascular disease, and end-stage renal disease. In order to optimize patients prior to their LE FTT, extensive laboratory, arterial, and venous preoperative testing and diabetes management are needed preoperatively. Postoperative monitoring and long-term follow-up with a multidisciplinary team are also crucial for long-term limb salvage success. Full article

(This article belongs to the Special Issue State-of-the-Art in Plastic Surgery)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Editor’s Choice Articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI