Journal of Clinical Medicine

17 pages, 4364 KB

Open AccessEditor’s ChoiceReview

Evolution of the Transforaminal Lumbar Interbody Fusion (TLIF): From Open to Percutaneous to Patient-Specific

by Peter N. Drossopoulos, Favour C. Ononogbu-uche, Troy Q. Tabarestani, Chuan-Ching Huang, Mounica Paturu, Anas Bardeesi, Wilson Z. Ray, Christopher I. Shaffrey, C. Rory Goodwin, Melissa Erickson, John H. Chi and Muhammad M. Abd-El-Barr

J. Clin. Med. 2024, 13(8), 2271; https://doi.org/10.3390/jcm13082271 - 14 Apr 2024

Cited by 11 | Viewed by 3540

Abstract

The transforaminal lumbar interbody fusion (TLIF) has seen significant evolution since its early inception, reflecting advancements in surgical techniques, patient safety, and outcomes. Originally described as an improvement over the posterior lumbar interbody fusion (PLIF), the TLIF began as an open surgical procedure, [...] Read more.

The transforaminal lumbar interbody fusion (TLIF) has seen significant evolution since its early inception, reflecting advancements in surgical techniques, patient safety, and outcomes. Originally described as an improvement over the posterior lumbar interbody fusion (PLIF), the TLIF began as an open surgical procedure, that notably reduced the need for the extensive neural retractation that hindered the PLIF. In line with the broader practice of surgery, trending toward minimally invasive access, the TLIF was followed by the development of the minimally invasive TLIF (MIS-TLIF), a technique that further decreased tissue trauma and postoperative complications. Subsequent advancements, including Trans-Kambin’s Triangle TLIF (percLIF) and transfacet LIF, have continued to refine surgical access, minimize surgical footprint, and reduce the risk of injury to the patient. The latest evolution, as we will describe it, the patient-specific TLIF, is a culmination of the aforementioned adaptations and incorporates advanced imaging and segmentation technologies into perioperative planning, allowing surgeons to tailor approaches based on individual patient anatomy and pathology. These developments signify a shift towards more precise methods in spine surgery. The ongoing evolution of the TLIF technique illustrates the dynamic nature of surgery and emphasizes the need for continued adaptation and refinement. Full article

(This article belongs to the Special Issue Latest Developments in Minimally Invasive Spinal Treatment—2nd Edition)

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10 pages, 207 KB

Open AccessEditor’s ChoiceReview

Neuropsychiatric Aspects of Sotos Syndrome: Explorative Review Building Multidisciplinary Bridges in Clinical Practice

by Sigita Lesinskiene, Reda Montvilaite, Kamile Pociute, Ausra Matuleviciene and Algirdas Utkus

J. Clin. Med. 2024, 13(8), 2204; https://doi.org/10.3390/jcm13082204 - 11 Apr 2024

Cited by 6 | Viewed by 3537

Abstract

Background: Sotos syndrome is a genetic disorder caused by NSD1 gene (nuclear receptor binding SET domain containing protein 1) variants and characterized by overgrowth, macrocephaly, learning disabilities, and co-occurring neuropsychiatric symptoms. Methods: Literature sources published in 2002–2023 were selected and analyzed from PubMed [...] Read more.

Background: Sotos syndrome is a genetic disorder caused by NSD1 gene (nuclear receptor binding SET domain containing protein 1) variants and characterized by overgrowth, macrocephaly, learning disabilities, and co-occurring neuropsychiatric symptoms. Methods: Literature sources published in 2002–2023 were selected and analyzed from PubMed and Google Scholar databases. Results: Neuropsychiatric symptoms are observed among children and adolescents with Sotos syndrome. The majority have intellectual disabilities or borderline intellect. Verbal IQ is higher than performance IQ. Individuals display difficulties in expressing language. Aggression is reported by parents. Children express autistic behavior, ADHD, anxiety based on phobias, and early bedtime-wake times. Conclusions: Sotos syndrome is associated with neuropsychiatric disorders in children. Slow intellectual and language development, aggressive outbursts, anxiety, autism spectrum disorder, and hyperactivity are present in the newest studies. Comprehensive assistance is needed for Sotos syndrome patients in responding to areas of difficulty. There is still a lack of research on the developmental characteristics of these children and the possibilities of improving psychosocial adaptation by providing multidisciplinary long-term medical, educational, and social care. Full article

(This article belongs to the Special Issue Clinical Updates on Psychology in Children and Adolescents)

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15 pages, 4795 KB

Open AccessEditor’s ChoiceArticle

The Influence of Increased Pedicle Screw Diameter and Thicker Rods on Surgical Results in Adolescents Undergoing Posterior Spinal Fusion for Idiopathic Scoliosis

by Pawel Grabala, Piotr Kowalski and Michal Grabala

J. Clin. Med. 2024, 13(8), 2174; https://doi.org/10.3390/jcm13082174 - 10 Apr 2024

Cited by 9 | Viewed by 2704

Abstract

Background: Modern surgical techniques allow for the correction of spinal deformity, stopping its progression and improving pain relief and social and physical functioning. These instruments have different implant designs, screws, and rod diameters and can be composed of different metal alloys with different [...] Read more.

Background: Modern surgical techniques allow for the correction of spinal deformity, stopping its progression and improving pain relief and social and physical functioning. These instruments have different implant designs, screws, and rod diameters and can be composed of different metal alloys with different hardnesses, which can have a significant impact on the effect of correcting spinal deformities. We designed a retrospective cohort study based on the same surgical technique and spine system using different implant sizes, and compared the results across them. Methods: This is a retrospective review of adolescent idiopathic scoliosis (AIS) patients who underwent posterior spinal fusion (PSF) between 2016 and 2022 with a minimum two-year follow-up (FU) using two spinal implant systems: 5.5 and 6.0 mm diameter screws with double 5.5 mm titanium rods (Group 1 (G1)), and 6.0 and 6.5 mm diameter pedicle screws with double 6.0 mm cobalt–chromium rods (Group 2 (G2)). The evaluated data were as follows: preoperative personal data, radiographic outcomes, complications, and health-related quality of life questionnaire (HRQoL). The parameters were reviewed preoperatively, after the final fusion, and during the FU. Results: The mean age of all 260 patients at surgery was 14.8 years. The average BMI was also similar in both groups and was noted as 21. The mean levels of fusion and screw density were similar in both groups. The mean preoperative major curves (MCs) were 57.6° and 62.5° in G1 and G2, respectively. The mean flexibility of the curves was noted as 35% in G1 and 33% in G2. After definitive surgery, the mean percentage correction of the MC was better in G2 vs. G1, with 74.5% vs. 69.8%, respectively (p < 0.001). At the final FU, the average loss of correction was 5.9° for G1 and 3.2° for G2 (p < 0.001). The mean preoperative (TK) thoracic kyphosis (T2–T5) was 12.2° in G1 and 10.8° in G2. It was corrected to 15.2° in G1 and to 13° in G2. At the FFU, we noted a significant difference in the TK (T2–T5) between the groups, with 16.7° vs. 9.6° for G1 vs. G2, respectively (p < 0.001). Statistical significance was observed between the preoperative sagittal balance and the final follow-up for both groups (p < 0.001). Conclusions: AIS patients surgically treated with screws with a larger diameter and thicker and stiffer rods showed greater correction and postoperative thoracic kyphosis without implant failure. The complication rates, implant density, and clinical outcomes remained similar. The radiographic benefits reported in this cohort study suggest that large-sized screws and stiffer rods for the correction of pediatric spinal deformities are safe and very effective. Full article

(This article belongs to the Special Issue State of the Art in Management of Idiopathic Scoliosis)

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24 pages, 13384 KB

Open AccessFeature PaperEditor’s ChoiceReview

Safe and Informed Use of Gadolinium-Based Contrast Agent in Body Magnetic Resonance Imaging: Where We Were and Where We Are

by Francesca Iacobellis, Marco Di Serafino, Camilla Russo, Roberto Ronza, Martina Caruso, Giuseppina Dell’Aversano Orabona, Costanza Camillo, Vittorio Sabatino, Dario Grimaldi, Chiara Rinaldo, Luigi Barbuto, Francesco Verde, Giuliana Giacobbe, Maria Laura Schillirò, Enrico Scarano and Luigia Romano

J. Clin. Med. 2024, 13(8), 2193; https://doi.org/10.3390/jcm13082193 - 10 Apr 2024

Cited by 8 | Viewed by 8227

Abstract

Gadolinium-based contrast agents (GBCAs) have helped to improve the role of magnetic resonance imaging (MRI) for the diagnosis and treatment of diseases. There are currently nine different commercially available gadolinium-based contrast agents (GBCAs) that can be used for body MRI cases, and which [...] Read more.

Gadolinium-based contrast agents (GBCAs) have helped to improve the role of magnetic resonance imaging (MRI) for the diagnosis and treatment of diseases. There are currently nine different commercially available gadolinium-based contrast agents (GBCAs) that can be used for body MRI cases, and which are classifiable according to their structures (cyclic or linear) or biodistribution (extracellular-space agents, target/specific-agents, and blood-pool agents). The aim of this review is to illustrate the commercially available MRI contrast agents, their effect on imaging, and adverse reaction on the body, with the goal to lead to their proper selection in different clinical contexts. When we have to choose between the different GBCAs, we have to consider several factors: (1) safety and clinical impact; (2) biodistribution and diagnostic application; (3) higher relaxivity and better lesion detection; (4) higher stability and lower tissue deposit; (5) gadolinium dose/concentration and lower volume injection; (6) pulse sequences and protocol optimization; (7) higher contrast-to-noise ratio at 3.0 T than at 1.5 T. Knowing the patient’s clinical information, the relevant GBCAs properties and their effect on body MRI sequences are the key features to perform efficient and high-quality MRI examination. Full article

(This article belongs to the Special Issue Challenges and Opportunities in the Application of Abdominal Imaging)

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16 pages, 264 KB

Open AccessEditor’s ChoiceReview

The Contribution of Proteomics in Understanding Endometrial Protein Expression in Women with Recurrent Implantation Failure

by Anastasios Potiris, Eleni Alyfanti, Eirini Drakaki, Despoina Mavrogianni, Theodoros Karampitsakos, Pavlos Machairoudias, Spyridon Topis, Athanasios Zikopoulos, Chara Skentou, Periklis Panagopoulos, Peter Drakakis and Sofoklis Stavros

J. Clin. Med. 2024, 13(7), 2145; https://doi.org/10.3390/jcm13072145 - 8 Apr 2024

Cited by 9 | Viewed by 3009

Abstract

Recurrent implantation failure (RIF) poses a significant challenge in assisted reproductive technology (ART) outcomes. The endometrium plays a crucial role in embryo implantation, and its protein expression profile is integral in determining receptivity. Proteomics has emerged as a valuable tool in unraveling the [...] Read more.

Recurrent implantation failure (RIF) poses a significant challenge in assisted reproductive technology (ART) outcomes. The endometrium plays a crucial role in embryo implantation, and its protein expression profile is integral in determining receptivity. Proteomics has emerged as a valuable tool in unraveling the molecular intricacies underlying endometrial receptivity and RIF. The aim of the present review is to analyze the contribution of proteomics to the understanding of endometrial protein expression in women with RIF, based on the results of significant proteomic studies. Medline/Pubmed databases were searched using keywords pertaining to proteomics combined with terms related to RIF. 15 studies were included in the present review. Several proteins have been found to exbibit differential expression in endometrial biopsies and fluid samples between fertile women and women with RIF during the receptive endometrial phase. The profile of endometrial proteins varied significantly among the studies. Nevertheless, similar changes in the expression levels of annexin-6, progesterone receptor, MMP-2, and MMP-9 in the endometrium of women with RIF, were found in more than one study indicating that certain proteins could potentially be effective biomarkers of endometrial receptivity. Proteomics contributes significantly to the understanding of protein expression in the endometrium of women with RIF and the analysis of proteins in endometrial fluid are promising for improving the clinical management of RIF. Full article

(This article belongs to the Special Issue Challenges in Diagnosis and Treatment of Infertility)

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12 pages, 11814 KB

Open AccessEditor’s ChoiceArticle

A Novel Intraoperative CT Navigation System for Spinal Fusion Surgery in Lumbar Degenerative Disease: Accuracy and Safety of Pedicle Screw Placement

by Haruo Kanno, Kyoichi Handa, Motoki Murotani and Hiroshi Ozawa

J. Clin. Med. 2024, 13(7), 2105; https://doi.org/10.3390/jcm13072105 - 4 Apr 2024

Cited by 7 | Viewed by 3486

Abstract

Background: In recent years, intraoperative computed tomography (CT) navigation has become widely used for the insertion of pedicle screws in spinal fusion surgery. However, conventional intraoperative CT navigation may be impaired by infrared interference between the infrared camera and surgical instruments, which can [...] Read more.

Background: In recent years, intraoperative computed tomography (CT) navigation has become widely used for the insertion of pedicle screws in spinal fusion surgery. However, conventional intraoperative CT navigation may be impaired by infrared interference between the infrared camera and surgical instruments, which can lead to the misplacement of pedicle screws. Recently, a novel intraoperative CT navigation system, NextAR, has been developed. It uses a small infrared camera mounted on surgical instruments within the surgical field. NextAR navigation can minimize the problem of infrared interference and be expected to improve the accuracy of pedicle screw placement. Methods: This study investigated the accuracy of pedicle screw insertion under NextAR navigation in spinal fusion surgery for lumbar degenerative diseases. The accuracy of pedicle screw placement was evaluated in 15 consecutive patients using a CT grading scale. Results: Screw perforation occurred in only 1 of the total 70 screws (1.4%). Specifically, there was one grade 1 perforation within 2 mm, but no perforations larger than 2 mm. There were no reoperations or neurological complications due to screw misplacement. Conclusions: NextAR navigation can provide high accuracy for pedicle screw insertion and help ensure safe spinal fusion surgery for lumbar degenerative diseases. Full article

(This article belongs to the Special Issue Clinical Advances in Minimally Invasive Spinal Treatment)

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14 pages, 2776 KB

Open AccessEditor’s ChoiceArticle

Prediction of Intracranial Pressure in Patients with an Aneurysmal Subarachnoid Hemorrhage Using Optic Nerve Sheath Diameter via Explainable Predictive Modeling

by Kwang Hyeon Kim, Hyung Koo Kang and Hae-Won Koo

J. Clin. Med. 2024, 13(7), 2107; https://doi.org/10.3390/jcm13072107 - 4 Apr 2024

Cited by 7 | Viewed by 1714

Abstract

Background: The objective of this investigation was to formulate a model for predicting intracranial pressure (ICP) by utilizing optic nerve sheath diameter (ONSD) during endovascular treatment for an aneurysmal subarachnoid hemorrhage (aSAH), incorporating explainable predictive modeling. Methods: ONSD measurements were conducted using a [...] Read more.

Background: The objective of this investigation was to formulate a model for predicting intracranial pressure (ICP) by utilizing optic nerve sheath diameter (ONSD) during endovascular treatment for an aneurysmal subarachnoid hemorrhage (aSAH), incorporating explainable predictive modeling. Methods: ONSD measurements were conducted using a handheld ultrasonography device during the course of endovascular treatment (n = 126, mean age 58.82 ± 14.86 years, and female ratio 67.46%). The optimal ONSD threshold associated with an increased ICP was determined. Additionally, the association between ONSD and ICP was validated through the application of a linear regression machine learning model. The correlation between ICP and various factors was explored through the modeling. Results: With an ICP threshold set at 20 cmH₂O, 82 patients manifested an increased ICP, with a corresponding ONSD of 0.545 ± 0.08 cm. Similarly, with an ICP threshold set at 25 cmH₂O, 44 patients demonstrated an increased ICP, with a cutoff ONSD of 0.553 cm. Conclusions: We revealed a robust correlation between ICP and ONSD. ONSD exhibited a significant association and demonstrated potential as a predictor of ICP in patients with an ICP ≥ 25 cmH₂O. The findings suggest its potential as a valuable index in clinical practice, proposing a reference value of ONSD for increased ICP in the institution. Full article

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22 pages, 645 KB

Open AccessFeature PaperEditor’s ChoiceReview

Blood Pressure Variability in Acute Stroke: A Narrative Review

by Christina Zompola, Lina Palaiodimou, Konstantinos Voumvourakis, Leonidas Stefanis, Aristeidis H. Katsanos, Else C. Sandset, Estathios Boviatsis and Georgios Tsivgoulis

J. Clin. Med. 2024, 13(7), 1981; https://doi.org/10.3390/jcm13071981 - 29 Mar 2024

Cited by 8 | Viewed by 4504

Abstract

The management of blood pressure variability (BPV) in acute stroke presents a complex challenge with profound implications for patient outcomes. This narrative review examines the role of BPV across various stages of acute stroke care, highlighting its impact on treatment strategies and prognostic [...] Read more.

The management of blood pressure variability (BPV) in acute stroke presents a complex challenge with profound implications for patient outcomes. This narrative review examines the role of BPV across various stages of acute stroke care, highlighting its impact on treatment strategies and prognostic considerations. In the prehospital setting, while guidelines lack specific recommendations for BP management, emerging evidence suggests a potential link between BPV and outcomes. Among ischaemic stroke patients who are ineligible for reperfusion therapies, BPV independently influences functional outcomes, emphasising the need for individualised approaches to BP control. During intravenous thrombolysis and endovascular therapy, the intricate interplay between BP levels, recanalisation status, and BPV is evident. Striking a balance between aggressive BP lowering and avoiding hypoperfusion-related complications is essential. Intracerebral haemorrhage management is further complicated by BPV, which emerges as a predictor of mortality and disability, necessitating nuanced BP management strategies. Finally, among patients with acute subarachnoid haemorrhage, increased BPV may be correlated with a rebleeding risk and worse outcomes, emphasizing the need for BPV monitoring in this population. Integration of BPV assessment into clinical practice and research protocols is crucial for refining treatment strategies that are tailored to individual patient needs. Future studies should explore novel interventions targeting BPV modulation to optimise stroke care outcomes. Full article

(This article belongs to the Section Clinical Neurology)

11 pages, 1911 KB

Open AccessEditor’s ChoiceArticle

Clinical Application of an Augmented Reality Navigation System for Transforaminal Epidural Injection: A Randomized Controlled Trial

by Yookyung Jang, Sunghwan Lim, Sunhee Lee, Lee Gyeong Je, Taesan Kim, Subin Joo, Joonho Seo, Deukhee Lee and Jae Chul Koh

J. Clin. Med. 2024, 13(7), 1992; https://doi.org/10.3390/jcm13071992 - 29 Mar 2024

Cited by 6 | Viewed by 2095

Abstract

Objectives: Augmented reality (AR) navigation systems are emerging to simplify and enhance the precision of medical procedures. Lumbosacral transforaminal epidural injection is a commonly performed procedure for the treatment and diagnosis of radiculopathy. Accurate needle placement while avoiding critical structures remains a challenge. [...] Read more.

Objectives: Augmented reality (AR) navigation systems are emerging to simplify and enhance the precision of medical procedures. Lumbosacral transforaminal epidural injection is a commonly performed procedure for the treatment and diagnosis of radiculopathy. Accurate needle placement while avoiding critical structures remains a challenge. For this purpose, we conducted a randomized controlled trial for our augmented reality navigation system. Methods: This randomized controlled study involved 28 patients, split between a traditional C-arm guided group (control) and an AR navigation guided group (AR-NAVI), to compare procedure efficiency and radiation exposure. The AR-NAVI group used a real-time tracking system displaying spinal structure and needle position on an AR head-mounted display. The procedural time and C-arm usage (radiation exposure) were measured. Results: All patients underwent successful procedures without complications. The AR-NAVI group demonstrated significantly reduced times and C-arm usage for needle entry to the target point (58.57 ± 33.31 vs. 124.91 ± 41.14, p < 0.001 and 3.79 ± 1.97 vs. 8.86 ± 3.94, p < 0.001). Conclusions: The use of the AR navigation system significantly improved procedure efficiency and safety by reducing time and radiation exposure, suggesting a promising direction for future enhancements and validation. Full article

(This article belongs to the Topic The Use of New Technologies for Health and Clinical Practice)

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13 pages, 270 KB

Open AccessEditor’s ChoiceReview

New Insights into First-Line Therapy in Diffuse Large B-Cell Lymphoma: Are We Improving Outcomes?

by Pau Abrisqueta

J. Clin. Med. 2024, 13(7), 1929; https://doi.org/10.3390/jcm13071929 - 27 Mar 2024

Cited by 6 | Viewed by 3703

Abstract

Diffuse large B-cell lymphoma (DLBCL) is the most prevalent subtype of lymphoma, comprising heterogeneous patient subgroups with distinctive biological and clinical characteristics. The R-CHOP combination (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) has been the standard initial treatment, yielding prolonged remissions in over 60% [...] Read more.

Diffuse large B-cell lymphoma (DLBCL) is the most prevalent subtype of lymphoma, comprising heterogeneous patient subgroups with distinctive biological and clinical characteristics. The R-CHOP combination (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) has been the standard initial treatment, yielding prolonged remissions in over 60% of patients with advanced-stage disease. Several attempts to enhance the outcomes of this regimen over the last two decades have shown limited success. Various novel therapeutic approaches have recently emerged in lymphoma, demonstrating promising results. These include small molecules, novel monoclonal antibodies, antibody–drug conjugates (ADC), bispecific antibodies (BsAbs), and chimeric antigen receptor (CAR) T-cell therapy. This review explores recent advancements in therapeutic strategies for DLBCL and their potential impact on the initial management of DLBCL patients. Full article

(This article belongs to the Special Issue Large Cell Lymphoma: Novel Therapeutic Approaches)

20 pages, 1325 KB

Open AccessEditor’s ChoiceReview

Hormone Receptor-Positive/HER2-Positive Breast Cancer: Hormone Therapy and Anti-HER2 Treatment: An Update on Treatment Strategies

by Chiara Tommasi, Giulia Airò, Fabiana Pratticò, Irene Testi, Matilde Corianò, Benedetta Pellegrino, Nerina Denaro, Laura Demurtas, Mariele Dessì, Sara Murgia, Giovanni Mura, Demi Wekking, Mario Scartozzi, Antonino Musolino and Cinzia Solinas

J. Clin. Med. 2024, 13(7), 1873; https://doi.org/10.3390/jcm13071873 - 24 Mar 2024

Cited by 10 | Viewed by 7212

Abstract

Hormone receptor (HR)-positive/HER2-positive breast cancer represents a distinct subtype expressing estrogen and progesterone receptors with an overexpression of HER2. Approximately 14% of female breast cancer cases are HER2-positive, with the majority being HR-positive. These tumors show a cross-talk between the hormonal and HER2 [...] Read more.

Hormone receptor (HR)-positive/HER2-positive breast cancer represents a distinct subtype expressing estrogen and progesterone receptors with an overexpression of HER2. Approximately 14% of female breast cancer cases are HER2-positive, with the majority being HR-positive. These tumors show a cross-talk between the hormonal and HER2 pathways; the interaction has implications for the treatment options for the disease. In this review, we analyze the biology of HR-positive/HER2-positive breast cancer and summarize the evidence concerning the standard of care options both in neoadjuvant/adjuvant settings and in advanced disease. Additionally, we focus on new trials and drugs for HR-positive/HER2-positive breast cancer and the new entity: HER2-low breast cancer. Full article

(This article belongs to the Special Issue Current Updates and Advances in Breast Cancer)

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12 pages, 1239 KB

Open AccessEditor’s ChoiceArticle

Prevalence and Estimation of the Evolution of Myopia in Spanish Children

by Miguel Ángel Sánchez-Tena, Clara Martinez-Perez, Cesar Villa-Collar, Mariano González-Pérez, Ana González-Abad, Grupo de Investigación Alain Afflelou and Cristina Alvarez-Peregrina

J. Clin. Med. 2024, 13(6), 1800; https://doi.org/10.3390/jcm13061800 - 21 Mar 2024

Cited by 7 | Viewed by 3229

Abstract

Background: In recent decades, myopia has turned into a public health issue across the world. Between 1993 and 2016, the percentage of myopes increased from 10.4% to 34.2%. This study aims to analyze the myopia prevalence in Spanish children from five to [...] Read more.

Background: In recent decades, myopia has turned into a public health issue across the world. Between 1993 and 2016, the percentage of myopes increased from 10.4% to 34.2%. This study aims to analyze the myopia prevalence in Spanish children from five to seven years old over the last five years and to predict the rate of myopia in Spain by 2030. Methods: The sample consisted of children aged between 5 and 7, who underwent an optometric examination consisting of the measurement of visual acuity (VA) and determination of objective and subjective refraction. The cut-off points to define refractive error are established by the spherical equivalent (SE) value: hyperopia for an SE over or equal to +0.50 D; myopia for an SE under or equal to −0.50 D; and emmetropia when the SE is between −0.50 D and +0.50 D. Results: The myopia rate in Spanish children aged between five and seven was 19%. Myopia prevalence progressively increased as children grew up (p ≤ 0.001). It is estimated that, in the year 2030, the rate of myopia will be 30.2% [CI: 25.3–35.0], of which 81.9% [CI: 78.3–85.3] will have low myopia, 10.0% [CI: 7.2–12.8] moderate myopia, and 7.3% [CI: 4.9–9.7] high myopia. Conclusions: Nineteen percent of Spanish children between five and seven are myopes. In 2030, is expected that 30.2% of Spanish children between 5 and 7 years of age will be myopes. These estimations will support eye care professionals in recommending that children spend more time outdoors to prevent the onset of myopia and the use of methods to control myopia to avoid reaching these figures of high myopia. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

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10 pages, 1286 KB

Open AccessEditor’s ChoiceSystematic Review

Sexualized Drug Use and Chemsex among Men Who Have Sex with Men in Europe: A Systematic Review and Meta-Analysis

by Marina Coronado-Muñoz, Emilio García-Cabrera, Angélica Quintero-Flórez, Encarnación Román and Ángel Vilches-Arenas

J. Clin. Med. 2024, 13(6), 1812; https://doi.org/10.3390/jcm13061812 - 21 Mar 2024

Cited by 23 | Viewed by 4147

Abstract

Background: In recent years, in Europe, there has been a growing concern about the use of sexualized drugs among men who have sex with men (MSM), due to its possible link to an increase in sexually transmitted infections. The aim of this review [...] Read more.

Background: In recent years, in Europe, there has been a growing concern about the use of sexualized drugs among men who have sex with men (MSM), due to its possible link to an increase in sexually transmitted infections. The aim of this review is to study the prevalence of chemsex, and the sexualized drug used in Europe, describing both different consumption patterns and other sexual behaviors considered risky and their possible relationship with positivity in diagnoses of sexually transmitted infections, including human immunodeficiency virus. Methods: We conducted a literature review in the main scientific databases (PubMed, Embase, Scopus, Cochrane Library, Web of Science), filtering for articles published between January 2018 and April 2023 that collect information on sexualized drug use and sexual practices conducted in European countries among men who have sex with men, including whether these behaviors can lead to diagnoses of sexually transmitted infections. Results: The definition of drugs included in chemsex is not clearly defined and shows heterogeneity between study publications; the three drugs presented in all manuscripts are mephedrone, GHB/GBL, and crystal methamphetamine. The prevalence of chemsex in Europe is 16% [11–21%] among MSM. The most frequent risky sexual behavior associated with chemsex practice was unprotected sex with a high number of partners. The log risk ratio of STIs was 0.86 (95% CI: 0.49 to 1.23). Conclusions: Adherence to definitions, stringent research methodologies, and focused interventions are needed to tackle the intricate relationship between substance use, sexual behavior, and the risk of HIV/STI transmission in MSM. Full article

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

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20 pages, 2933 KB

Open AccessEditor’s ChoiceSystematic Review

Aromatase Inhibitors and Plasma Lipid Changes in Postmenopausal Women with Breast Cancer: A Systematic Review and Meta-Analysis

by Bálint Bérczi, Nelli Farkas, Péter Hegyi, Barbara Tóth, Dezső Csupor, Balázs Németh, Anita Lukács, László Márk Czumbel, Beáta Kerémi, István Kiss, Andrea Szabó, Gábor Varga, Gábor Gerber and Zoltán Gyöngyi

J. Clin. Med. 2024, 13(6), 1818; https://doi.org/10.3390/jcm13061818 - 21 Mar 2024

Cited by 9 | Viewed by 3515

Abstract

Background: Women are typically diagnosed with estrogen receptor-positive breast cancer around the postmenopausal period when declining estrogen levels initiate changes in lipid profiles. Aromatase inhibitors (AI) are used to prevent the progression of cancer; however, a further reduction in estrogen levels may have [...] Read more.

Background: Women are typically diagnosed with estrogen receptor-positive breast cancer around the postmenopausal period when declining estrogen levels initiate changes in lipid profiles. Aromatase inhibitors (AI) are used to prevent the progression of cancer; however, a further reduction in estrogen levels may have detrimental effects on lipid levels, which was our working hypothesis. Methods: Our meta-analysis was conducted on the lipid profiles of postmenopausal breast cancer patients at baseline and at different treatment time points. Results: We identified 15 studies, including 1708 patients. Studies using anastrozole (ANA), exemestane (EXE), letrozole (LET), and tamoxifen (TMX) were involved. Subgroup analyses revealed that 3- and 12-month administrations of LET and EXE lead to negative changes in lipid profiles that tend to alter the lipid profile undesirably, unlike ANA and TMX. Conclusions: Our results suggest that, despite statistically significant results, EXE and LET may not be sufficient to cause severe dyslipidemia in patients without cardiovascular comorbidities according to the AHA/ACC Guideline on the Management of Blood Cholesterol. However, the results may raise the question of monitoring the effects of AIs in patients, especially those with pre-existing cardiovascular risk factors such as dyslipidemia. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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13 pages, 261 KB

Open AccessEditor’s ChoiceArticle

Real-Life Comparison of Four JAK Inhibitors in Rheumatoid Arthritis (ELECTRA-i Study)

by Maurizio Benucci, Francesca Li Gobbi, Arianna Damiani, Edda Russo, Serena Guiducci, Mariangela Manfredi, Barbara Lari, Valentina Grossi and Maria Infantino

J. Clin. Med. 2024, 13(6), 1821; https://doi.org/10.3390/jcm13061821 - 21 Mar 2024

Cited by 7 | Viewed by 6362

Abstract

Background: Real-world evidence of the efficacy and adverse events of JAK inhibitor treatment (Tofacitinib, Baricitinib, Upadacitinib, and Filgotinib) in rheumatoid arthritis is still limited. Methods: We studied 115 patients from the Rheumatology Unit of S. Giovanni di Dio Hospital affected by D2T-RA, according [...] Read more.

Background: Real-world evidence of the efficacy and adverse events of JAK inhibitor treatment (Tofacitinib, Baricitinib, Upadacitinib, and Filgotinib) in rheumatoid arthritis is still limited. Methods: We studied 115 patients from the Rheumatology Unit of S. Giovanni di Dio Hospital affected by D2T-RA, according to the 2010 EULAR criteria. Out of the 115 patients, 17 had been treated with Baricitinib 8 mg/daily, 32 with Filgotinib 200 mg/daily, 21 with Tofacitinib 10 mg/daily, and 45 with Upadacitinib 15 mg/daily. We evaluated the clinical response after 3, 6, and 12 months of treatment and the follow-up from September 2022 to September 2023. All patients were evaluated according to the number of tender joints (NTJs), number of swollen joints (NSJs), visual analog scale (VAS), global assessment (GA), health assessment questionnaire (HAQ), Disease Activity Score (DAS28), and CDAI. Furthermore, laboratory parameters of efficacy and tolerability were evaluated. Results: All treatments demonstrated a statistically significant decrease in the DAS28 and CDAI scores, tender and swollen joint counts, VAS, HAQ, and patient global assessment (PGA) after 3, 6, and 12 months of treatment. All treatments showed similar behavior, and statistically significant decreases in circulating calprotectin, TNFα, and IL-6 were observed for all drugs after 12 months of treatment. In addition, soluble urokinase plasminogen activator receptor (suPAR) values showed significant differences at baseline and after 12 months of treatment for Filgotinib: 4.87 ± 4.53 vs. 3.61 ± 0.9 (0.009) and Upadacitinib: 6.64 ± 7.12 vs. 4.06 ± 3.61 (0.0003), while no statistically significant differences were found for Baricitinib: 3.4 ± 0.1 vs. 3.78 ± 0.1 and Tofacitinib: 3.95 ± 1.77 vs. 2.58 ± 0.1. The TC/HDL-C ratio (atherogenic index) showed significant differences when comparing Baricitinib vs. Filgotinib (0.0012), Filgotinib vs. Tofacitinib (0.0095), and Filgotinib vs. Upadacitinib (0.0001); furthermore, the LDL-C/HDL-C ratio in the Filgotinib group did not change (2.37 ± 0.45 vs. 2.35 ± 2.13 (NS)) after 12 months of treatment. Venous Thrombotic Events (VTEs) and major adverse cardiovascular events (MACEs) accounted for 1% of adverse events after treatment with Baricitinib. Herpes zoster reactivation accounted for 1% of adverse events after treatment with Filgotinib and Tofacitinib, while non-melanoma skin cancer (NMSC) accounted for 1% of adverse events after Upadacitinib treatment. Conclusions: Our real-world data from patients with RA show differences in some laboratory parameters and in the impact of lipid metabolism in JAK inhibitor treatment. Full article

(This article belongs to the Special Issue Autoimmune Diseases and Cardiovascular System: Physiopathology, Epidemiology, Clinical Characteristics and Therapeutic Strategies)

20 pages, 4116 KB

Open AccessEditor’s ChoiceReview

Comprehensive Review of In Vitro Human Follicle Development for Fertility Restoration: Recent Achievements, Current Challenges, and Future Optimization Strategies

by Francisco Vitale and Marie-Madeleine Dolmans

J. Clin. Med. 2024, 13(6), 1791; https://doi.org/10.3390/jcm13061791 - 20 Mar 2024

Cited by 8 | Viewed by 4232

Abstract

Ovarian tissue cryopreservation (OTC) and subsequent transplantation (OTT) is a fertility preservation technique widely offered to prepubertal girls and young fertile women who need to undergo oncological treatment but are at a high risk of infertility. However, OTT is not considered safe in [...] Read more.

Ovarian tissue cryopreservation (OTC) and subsequent transplantation (OTT) is a fertility preservation technique widely offered to prepubertal girls and young fertile women who need to undergo oncological treatment but are at a high risk of infertility. However, OTT is not considered safe in patients with certain diseases like leukemia, Burkitt’s lymphoma, and ovarian cancer because of the associated risk of malignant cell reintroduction. In vitro follicle development has therefore emerged as a promising means of obtaining mature metaphase II (MII) oocytes from the primordial follicle (PMF) pool contained within cryopreserved ovarian tissue, without the need for transplantation. Despite its significant potential, this novel approach remains highly challenging, as it requires replication of the intricate process of intraovarian folliculogenesis. Recent advances in multi-step in vitro culture (IVC) systems, tailored to the specific needs of each follicle stage, have demonstrated the feasibility of generating mature oocytes (MII) from early-stage human follicles. While significant progress has been made, there is still room for improvement in terms of efficiency and productivity, and a long way to go before this IVC approach can be implemented in a clinical setting. This comprehensive review outlines the most significant improvements in recent years, current limitations, and future optimization strategies. Full article

(This article belongs to the Special Issue Challenges in Diagnosis and Treatment of Infertility)

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13 pages, 252 KB

Open AccessEditor’s ChoiceReview

Inferior Vena Cava Filters: A Clinical Review and Future Perspectives

by Raffaella Benedetti, Simone Marino, Flavio Tangianu and Davide Imberti

J. Clin. Med. 2024, 13(6), 1761; https://doi.org/10.3390/jcm13061761 - 19 Mar 2024

Cited by 9 | Viewed by 5191

Abstract

Anticoagulation represents the first line treatment for venous thromboembolism (VTE). However, inferior vena cava (IVC) filter insertion can be considered as a possible therapeutic strategy when anticoagulant therapy is contraindicated, to avoid embolization from the lower limbs to pulmonary circulation. Other possible indications [...] Read more.

Anticoagulation represents the first line treatment for venous thromboembolism (VTE). However, inferior vena cava (IVC) filter insertion can be considered as a possible therapeutic strategy when anticoagulant therapy is contraindicated, to avoid embolization from the lower limbs to pulmonary circulation. Other possible indications are debated among experts. Both permanent and retrievable caval filters are available in clinical practice. Retrievable filters can be removed when no longer necessary, as their use may be indicated only for a limited amount of time. Moreover, caval filter insertion is not devoid of possible complications, particularly in cases of permanent or long-dwelling filters. A multidisciplinary approach is recommended to review the appropriateness of caval filter use and to define the best timing for retrieval. Full article

(This article belongs to the Special Issue Advances in Thrombotic Disorders and Antithrombotic Treatments)

15 pages, 561 KB

Open AccessEditor’s ChoiceSystematic Review

Early HbA1c Levels as a Predictor of Adverse Obstetric Outcomes: A Systematic Review and Meta-Analysis

by Laura Mañé, Humberto Navarro, Juan Pedro-Botet, Juan José Chillarón, Silvia Ballesta, Antonio Payà, Verónica Amador, Juana Antonia Flores-Le Roux and David Benaiges

J. Clin. Med. 2024, 13(6), 1732; https://doi.org/10.3390/jcm13061732 - 17 Mar 2024

Cited by 8 | Viewed by 3518

Abstract

Background: The objective was to assess the association between early HbA1c levels and pregnancy complications and whether this relationship is affected when HbA1c thresholds are greater than or less than 39 mmol/mol (5.7%). Methods: Electronic searches of the MEDLINE and EMBASE [...] Read more.

Background: The objective was to assess the association between early HbA1c levels and pregnancy complications and whether this relationship is affected when HbA1c thresholds are greater than or less than 39 mmol/mol (5.7%). Methods: Electronic searches of the MEDLINE and EMBASE databases up to October 2022 were conducted. We included retrospective and prospective observational studies. The inclusion criteria were as follows: HbA1c measurements taken at <20 weeks’ gestation, singleton pregnancy, and no pre-existing diabetes mellitus. Results: We assessed the certainty of the evidence with the GRADE system. We determined the proportion of patients in each group who met the criteria for obstetrical outcomes and pooled data into two subgroups according to the HbA1c threshold: <39 mmol/mol or >39 mmol/mol (5.7%). Sixteen studies with a total of 43,627 women were included. An association between elevated early HbA1c levels and pre-eclampsia, large for gestational age (LGA), macrosomia, and preterm delivery (RR 2.02, 95% CI 1.53–2.66; RR 1.38, 95% CI 1.15–1.66; RR 1.40, 95% CI 1.07–1.83; and RR 1.67, 95% CI 1.39–2.0, respectively) was shown, with a moderate–high grade of certainty. According to the subgroup analysis of all studies, LGA, pre-eclampsia, and labour induction were associated with elevated HbA1c levels only in studies using an HbA1c threshold >39 mmol/mol (5.7%). The association between HbA1c levels and premature birth was statistically significant in studies using both higher and lower HbA1c thresholds. Conclusions: Women with high early HbA1c levels below the range of diabetes presented an increased risk of pregnancy complications such as macrosomia, LGA, and pre-eclampsia. An early HbA1c threshold of >39 mmol/mol (5.7%) showed the strongest association with pregnancy complications. Full article

(This article belongs to the Special Issue Gestational Diabetes: Current Knowledge and Therapeutic Prospects)

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14 pages, 1077 KB

Open AccessEditor’s ChoiceSystematic Review

Calcium Hydroxylapatite (CaHA) and Aesthetic Outcomes: A Systematic Review of Controlled Clinical Trials

by Mojgan Amiri, Renald Meçani, Erand Llanaj, Christa D. Niehot, Terri L. Phillips, Katherine Goldie, Janina Kolb, Taulant Muka and Hua Daughtry

J. Clin. Med. 2024, 13(6), 1686; https://doi.org/10.3390/jcm13061686 - 14 Mar 2024

Cited by 7 | Viewed by 8947

Abstract

Background: This study aimed to systematically review and summarize the available controlled clinical trials on the effectiveness of calcium hydroxylapatite (CaHA) in terms of aesthetic outcomes, skin-aging-related outcomes, and patient/investigator satisfaction. Methods: We included controlled clinical trials involving at least 10 [...] Read more.

Background: This study aimed to systematically review and summarize the available controlled clinical trials on the effectiveness of calcium hydroxylapatite (CaHA) in terms of aesthetic outcomes, skin-aging-related outcomes, and patient/investigator satisfaction. Methods: We included controlled clinical trials involving at least 10 human adults that examined the effects of CaHA on aesthetic and skin-aging-related outcomes and satisfaction. Due to the high heterogeneity among the included studies, only a qualitative analysis is provided. Results: Out of 2935 relevant references, 13 studies were included, of which 8 studies focused on facial areas and 5 on dorsum of hand. CaHA injection was associated with enhancements in global aesthetic improvement scale, whether applied in facial regions or on the dorsum of hands. The findings suggested high patients’ satisfaction following CaHA when applied to facial areas. Studies highlighted improvements in hand grading scales and a reduction in facial wrinkles. Conclusions: Current evidence suggests that CaHA injections improve aesthetic results, including facial areas, such as nasolabial folds and jawline, and hands, with high levels of satisfaction. Considering the methodological limitations and heterogeneous comparisons groups, additional controlled clinical trials would contribute to a better understanding of the applications and advantages offered by CaHA. Full article

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

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9 pages, 220 KB

Open AccessEditor’s ChoiceReview

Recurrent Kounis Syndrome: A Case Report and Literature Review

by Raffaele Brancaccio, Laura Bonzano, Alessia Cocconcelli, Rostyslav Boyko, Giuseppe Ienopoli and Alberico Motolese

J. Clin. Med. 2024, 13(6), 1647; https://doi.org/10.3390/jcm13061647 - 13 Mar 2024

Cited by 7 | Viewed by 2960

Abstract

Kounis syndrome is a condition where inflammatory cells (mostly mast cells with the contribution of macrophages and T-lymphocytes) cause an acute coronary syndrome. Kounis syndrome comes in four variants: type I in patients with normal coronary arteries; type II in patients with inactive [...] Read more.

Kounis syndrome is a condition where inflammatory cells (mostly mast cells with the contribution of macrophages and T-lymphocytes) cause an acute coronary syndrome. Kounis syndrome comes in four variants: type I in patients with normal coronary arteries; type II in patients with inactive pre-existing atheromatous disease; type III in patients with pre-existing coronary artery stenting; type IV in patients with a pre-existing coronary artery bypass. Recently, we came across a case of recurrent type I Kounis syndrome in our clinical practice. The purpose of the paper is to present our case and conduct a review using the Pubmed scientific database about the most relevant cases of recurrent Kounis syndrome. This review shows that recurrent Kounis syndrome is a rare condition and is mostly associated with Kounis syndrome type III. Recurrent Kounis syndrome may be also triggered by vaccination and it could be associated with chronic spontaneous urticaria. In the last condition, therapy is represented by second-generation anti-histamines and corticosteroids, but also by an anti-IgE monoclonal antibody (omalizumab) in the recalcitrant cases. Full article

(This article belongs to the Special Issue Allergic and Eosinophilic Diseases: Diagnosis, Treatment, and Management)

24 pages, 734 KB

Open AccessEditor’s ChoiceReview

Neurodevelopmental Disorders and Suicide: A Narrative Review

by Antonella Gagliano, Carola Costanza, Irene Di Modica, Sara Carucci, Federica Donno, Eva Germanò, Costanza Scaffidi Abbate, Michele Roccella and Luigi Vetri

J. Clin. Med. 2024, 13(6), 1627; https://doi.org/10.3390/jcm13061627 - 12 Mar 2024

Cited by 8 | Viewed by 3947

Abstract

Specific risk factors for self-harm and suicide in children and adolescents with neurodevelopmental disorders (NDD) may differ from those in the general population within this age range. In the present review paper, we conducted a narrative analysis of the literature, aiming to establish [...] Read more.

Specific risk factors for self-harm and suicide in children and adolescents with neurodevelopmental disorders (NDD) may differ from those in the general population within this age range. In the present review paper, we conducted a narrative analysis of the literature, aiming to establish a connection between suicide and affective disorders in children and adolescents with NDD. Emotion dysregulation (ED) as an individual factor and adverse childhood experiences (ACE) as environmental factors are discussed as risk factors for suicidality in all individuals with NDD. We propose a theoretical model in which ED and ACE can directly lead to self-harm or suicide, directly or indirectly by interacting with depressive spectrum disorders. Additionally, we suggest that specific risk factors are more frequently associated with each of the neurodevelopmental disorders listed in the DSM-V. This review underlines the key points useful to improve the knowledge of the trajectory leading to suicide risk in NDDs with the purpose to facilitate the early identification of the suicide risk. Full article

(This article belongs to the Special Issue Review Special Issue Series: Current Advances in Clinical Neurology)

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14 pages, 1447 KB

Open AccessEditor’s ChoiceArticle

Multicomponent Exercise Intervention for Preventing Falls and Improving Physical Functioning in Older Nursing Home Residents: A Single-Blinded Pilot Randomised Controlled Trial

by Munseef Sadaqa, Wesam A. Debes, Zsanett Németh, Zsófia Bera-Baka, Marianna Vachtler-Szepesi, Loretta Nácziné Földes, Viktória Prémusz and Márta Hock

J. Clin. Med. 2024, 13(6), 1577; https://doi.org/10.3390/jcm13061577 - 10 Mar 2024

Cited by 8 | Viewed by 5072

Abstract

Background: Older nursing home residents are at a greater risk of falling due to frailty. Exercise is effective at hampering frailty and related adverse events, including falls. Objectives: Our purpose was to evaluate the effect of a 12-week moderate-intensity multicomponent exercise programme on [...] Read more.

Background: Older nursing home residents are at a greater risk of falling due to frailty. Exercise is effective at hampering frailty and related adverse events, including falls. Objectives: Our purpose was to evaluate the effect of a 12-week moderate-intensity multicomponent exercise programme on the number of falls and physical functioning among older nursing home residents. Also, we examined the association between the number of falls and demographics as well as physical and cognitive baseline data. Methods: The study protocol was registered on clinicaltrials.gov with the following identifier: NCT05835297. Older adults aged 65 years and over were recruited from a nursing home, and eligible and consenting residents were randomly allocated to two parallel groups: the intervention group, which performed a multicomponent exercise programme composed of strength, balance, and aerobic training (n = 12), and the control group, which received usual care (n = 12). Outcomes included falls, and measures of strength, balance, and mobility. Results: We had high adherence to exercise sessions, and no adverse events were recorded. We observed a non-significant reduction in falls (p = 0.34) and a significant improvement in Short Physical Performance Battery (p = 0.003) after the exercise programme. Falls were associated with being female and having diminished physical or cognitive function. Conclusions: Multicomponent exercise programmes should be implemented regularly in nursing homes for their effectiveness. Future studies with bigger samples, including participants with worse physical and cognitive impairments, as well as follow-up periods are required. Full article

(This article belongs to the Special Issue One Size Does Not Fit All: New Strategies to Improve Overall Health and Physical Activity Behavior in Vulnerable Populations)

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16 pages, 3841 KB

Open AccessEditor’s ChoiceReview

Ustekinumab in the Treatment of Inflammatory Bowel Diseases: Evolving Paradigms

by Giammarco Mocci, Antonio Tursi, Francesca Maria Onidi, Paolo Usai-Satta, Giovanni Mario Pes and Maria Pina Dore

J. Clin. Med. 2024, 13(5), 1519; https://doi.org/10.3390/jcm13051519 - 6 Mar 2024

Cited by 6 | Viewed by 5228

Abstract

Inflammatory bowel diseases, comprising Crohn’s disease (CD) and ulcerative colitis (UC), are chronic, relapsing, and remitting immune-mediated inflammatory diseases affecting the gastrointestinal tract. Ustekinumab (UST) is a monoclonal antibody that blocks the p40 subunit of the anti-interleukin (IL) 12/23. Pivotal trials (CERTIFI and [...] Read more.

Inflammatory bowel diseases, comprising Crohn’s disease (CD) and ulcerative colitis (UC), are chronic, relapsing, and remitting immune-mediated inflammatory diseases affecting the gastrointestinal tract. Ustekinumab (UST) is a monoclonal antibody that blocks the p40 subunit of the anti-interleukin (IL) 12/23. Pivotal trials (CERTIFI and UNITI-IM for CD, UNIFI for UC) established the efficacy of UST for the induction and maintenance of remission in both CD and UC, with the most favorable results in naïve patients to biologics. In recent years, a wealth of ‘real-world’ data has emerged supporting positive clinical, endoscopic, and histological outcomes in patients treated with UST, as well as reassuring safety data. More recently, the results of the first head-to-head trials of UST and tumor necrosis factor (TNF) antagonists were reported. Moreover, a number of studies exploring the role of UST in specific clinical settings, such as perianal CD, postoperative complications and recurrence, extraintestinal manifestations, chronic antibiotic-refractory pouchitis, and pregnancy, were reported. This review explores the results reported to date on UST, including those from pivotal trials, real-world data, and emerging studies regarding therapeutic drug monitoring and immunogenicity. The safety profile of UST was also reviewed. Full article

(This article belongs to the Special Issue Targeted Treatment in Inflammatory Bowel Diseases (IBD))

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12 pages, 2315 KB

Open AccessEditor’s ChoiceArticle

Gaucher Disease or Acid Sphingomyelinase Deficiency? The Importance of Differential Diagnosis

by Miriam Giacomarra, Paolo Colomba, Daniele Francofonte, Marcomaria Zora, Giovanni Caocci, Daniela Diomede, Gaetano Giuffrida, Laura Fiori, Chiara Montanari, Annamaria Sapuppo, Anna Rita Scortechini, Nicola Vitturi, Giovanni Duro and Carmela Zizzo

J. Clin. Med. 2024, 13(5), 1487; https://doi.org/10.3390/jcm13051487 - 5 Mar 2024

Cited by 6 | Viewed by 2710

Abstract

Background: Gaucher disease is a lysosomal storage disorder caused by functional glucocerebrosidase enzyme deficiency. Hepatosplenomegaly and hematological complications are found in both Gaucher disease and Acid Sphingomyelinase Deficiency, which is caused by acid sphingomyelinase dysfunction. The possible overlap in clinical presentation can cause [...] Read more.

Background: Gaucher disease is a lysosomal storage disorder caused by functional glucocerebrosidase enzyme deficiency. Hepatosplenomegaly and hematological complications are found in both Gaucher disease and Acid Sphingomyelinase Deficiency, which is caused by acid sphingomyelinase dysfunction. The possible overlap in clinical presentation can cause diagnostic errors in differential diagnosis. For this reason, in patients with an initial clinical suspicion of Gaucher disease, we aimed to carry out a parallel screening of acid sphingomyelinase and glucocerebrosidase. Methods: Peripheral blood samples of 627 patients were collected, and enzymatic activity analysis was performed on both glucocerebrosidase and acid sphingomyelinase. The specific gene was studied in samples with null or reduced enzymatic activity. Specific molecular biomarkers helped to achieve the correct diagnosis. Results: In 98.7% of patients, normal values of glucocerebrosidase activity excluded Gaucher disease. In 8 of 627 patients (1.3%), the glucocerebrosidase enzymatic activity assay was below the normal range, so genetic GBA1 analysis confirmed the enzymatic defect. Three patients (0.5%) had normal glucocerebrosidase activity, so they were not affected by Gaucher disease, and showed decreased acid sphingomyelinase activity. SMPD1 gene mutations responsible for Acid Sphingomyelinase Deficiency were found. The levels of specific biomarkers found in these patients further strengthened the genetic data. Conclusions: Our results suggest that in the presence of typical signs and symptoms of Gaucher disease, Acid Sphingomyelinase Deficiency should be considered. For this reason, the presence of hepatosplenomegaly, thrombocytopenia, leukocytopenia, and anemia should alert clinicians to analyze both enzymes by a combined screening. Today, enzyme replacement therapy is available for the treatment of both pathologies; therefore, prompt diagnosis is essential for patients to start accurate treatment and to avoid diagnostic delay. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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12 pages, 3851 KB

Open AccessEditor’s ChoiceArticle

Efficacy and Complication Rates of Percutaneous Vertebroplasty and Kyphoplasty in the Treatment of Vertebral Compression Fractures: A Retrospective Analysis of 280 Patients

by Jan Cerny, Jan Soukup, Kadzhik Petrosian, Lucie Loukotova and Tomas Novotny

J. Clin. Med. 2024, 13(5), 1495; https://doi.org/10.3390/jcm13051495 - 5 Mar 2024

Cited by 5 | Viewed by 2965

Abstract

Background: Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are established methods in the treatment of vertebral compression fractures (VCFs). In our manuscript, the target was to evaluate the efficacy of PVPs/PKPs and to determine the implications of potential periprocedural complications. Methods: 280 [...] Read more.

Background: Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are established methods in the treatment of vertebral compression fractures (VCFs). In our manuscript, the target was to evaluate the efficacy of PVPs/PKPs and to determine the implications of potential periprocedural complications. Methods: 280 patients, specifically 194 women (69.3%) and 86 men (30.7%), were enrolled. We used the AO spine fractures classification and the Yeom classification to determine the subtype of cement leakage. Only single-level VCFs of the thoracic or lumbar spine were included. Visual analogue scale (VAS) was assessed preoperatively and regularly after the surgery. Vertebral compression ratio (VBCR) was used to determine postoperative vertebral body collapse. Results: We recorded 54 cases (19.3%) of cement leakage. There was a significant decrease in mean VAS scores (6.82–0.76 in PVPs, 7.15–0.81 in PKPs). The decrease in VBCR was greater in the VP group (4.39%; 84.21–79.82) compared to the KP group (1.95%; 74.36–72.41). Conclusions: No significant difference in the risk of cement leakage when comparing KPs and VPs was found. VPs and KPs provide rapid and significant pain relief in patients with VCFs. Clinically relevant complications of VPs and KPs are rare. Kyphoplasties prevent further vertebral body collapse more effectively compared to vertebroplasties. Full article

(This article belongs to the Special Issue Clinical Advances in Orthopaedic Treatment of Lumbar and Spine Diseases)

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14 pages, 950 KB

Open AccessEditor’s ChoiceSystematic Review

Cardiovascular Risks of Simultaneous Use of Alcohol and Cocaine—A Systematic Review

by Jan van Amsterdam, Femke Gresnigt and Wim van den Brink

J. Clin. Med. 2024, 13(5), 1475; https://doi.org/10.3390/jcm13051475 - 4 Mar 2024

Cited by 8 | Viewed by 6773

Abstract

Background: The simultaneous use of cocaine and alcohol is highly prevalent and is associated with high numbers of emergency department admissions, primarily due to cardiovascular complications. Aims: To answer the question of whether the co-use of cocaine and alcohol increases the cardiovascular [...] Read more.

Background: The simultaneous use of cocaine and alcohol is highly prevalent and is associated with high numbers of emergency department admissions, primarily due to cardiovascular complications. Aims: To answer the question of whether the co-use of cocaine and alcohol increases the cardiovascular risk compared to the use of cocaine alone. Method: A systematic review of human studies comparing the cardiovascular risk of co-used cocaine and alcohol with the use of cocaine alone. Results: Despite a higher myocardial workload induced by the co-use of cocaine and alcohol and the potentiation of cocaine’s cardiovascular effects by alcohol, the findings on the risk and severity of cardiovascular symptoms due to combined use are inconsistent. However, the co-use of cocaine and alcohol clearly leads to higher mortality. Interestingly, the presence of cocaethylene, a unique metabolite generated only via a pharmacokinetic interaction between alcohol and cocaine, carries an 18- to 25-fold increase over the absence of cocaethylene (cocaine-alone users) in the risk of sudden death and is associated with myocardial injury and cardiac arrest, probably due to the inhibition of cardiac ion channels by cocaethylene. Conclusion: Despite the inconsistency in some of the results, it is concluded that the co-use of cocaine and alcohol poses an additional risk of cardiovascular fatalities compared to the use of cocaine alone. Full article

(This article belongs to the Special Issue Current Challenges and Management of Substance Use Disorders and Other Mental Health Problems)

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17 pages, 1513 KB

Open AccessFeature PaperEditor’s ChoiceReview

Cognitive Impairment and Brain Atrophy in Patients with Chronic Kidney Disease

by Kazuhiko Tsuruya and Hisako Yoshida

J. Clin. Med. 2024, 13(5), 1401; https://doi.org/10.3390/jcm13051401 - 28 Feb 2024

Cited by 8 | Viewed by 3215

Abstract

In Japan, the aging of the population is rapidly accelerating, with an increase in patients with chronic kidney disease (CKD) and those undergoing dialysis. As a result, the number of individuals with cognitive impairment (CI) is rising, and addressing this issue has become [...] Read more.

In Japan, the aging of the population is rapidly accelerating, with an increase in patients with chronic kidney disease (CKD) and those undergoing dialysis. As a result, the number of individuals with cognitive impairment (CI) is rising, and addressing this issue has become an urgent problem. A notable feature of dementia in CKD patients is the high frequency of vascular dementia, making its prevention through the management of classical risk factors such as hypertension, diabetes mellitus, dyslipidemia, smoking, etc., associated with atherosclerosis and arteriosclerosis. Other effective measures, including the use of renin–angiotensin system inhibitors, addressing anemia, exercise therapy, and lifestyle improvements, have been reported. The incidence and progression of CI may also be influenced by the type of kidney replacement therapy, with reports suggesting that long-duration dialysis, low-temperature hemodialysis, peritoneal dialysis, and kidney transplantation can have a preferable effect on the preservation of cognitive function. In conclusion, patients with CKD are at a higher risk of developing CI, with brain atrophy being a contributing factor. Despite the identification of various preventive measures, the evidence substantiating their efficacy remains limited across all studies. Future expectations lie in large-scale randomized controlled trials. Full article

(This article belongs to the Section Brain Injury)

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11 pages, 402 KB

Open AccessEditor’s ChoiceReview

Why Kinematic Alignment Makes Little Sense in Valgus Osteoarthritis of the Knee: A Narrative Review

by Christian Manuel Sterneder, Martin Faschingbauer, Lyubomir Haralambiev, Maximilian F. Kasparek and Friedrich Boettner

J. Clin. Med. 2024, 13(5), 1302; https://doi.org/10.3390/jcm13051302 - 25 Feb 2024

Cited by 6 | Viewed by 3484

Abstract

There is a debate about the best alignment strategies in total knee arthroplasty (TKA). Mechanical alignment (MA) targets in combination with necessary soft tissue releases are the gold standard for TKA in end-stage valgus osteoarthritis. Some authors propagate kinematic alignment (KA) with the [...] Read more.

There is a debate about the best alignment strategies in total knee arthroplasty (TKA). Mechanical alignment (MA) targets in combination with necessary soft tissue releases are the gold standard for TKA in end-stage valgus osteoarthritis. Some authors propagate kinematic alignment (KA) with the aim of restoring the patient’s native alignment and minimizing the need for soft tissue releases. Our previous studies showed that MA with standardized soft tissue release produces reproducible results, and that the preoperative phenotype does not influence the results of patients with valgus osteoarthritis. These data suggest that there is no functional advantage to preserving valgus alignment in patients with valgus osteoarthritis. Many patients with valgus osteoarthritis present with a compromised medial collateral ligament and leaving the knee in valgus could increase the risk of secondary instability. The current literature supports MA TKA with soft tissue release as the gold standard. While using more sophisticated enabling technologies like robotic surgery might allow for aiming for very slight (1–2°) valgus alignment on the femoral side, any valgus alignment outside this range should be avoided. This review paper summarizes our current knowledge on the surgical techniques of TKA in patients with valgus osteoarthritis. Full article

(This article belongs to the Special Issue Knee Arthroplasty Surgery: Management and Future Opportunities)

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10 pages, 1728 KB

Open AccessEditor’s ChoiceArticle

Cardioprotective Effects of PARP Inhibitors: A Re-Analysis of a Meta-Analysis and a Real-Word Data Analysis Using the FAERS Database

by Ja-Young Han, Young-Eun Seo, Jae-Hee Kwon, Jae Hyun Kim and Myeong Gyu Kim

J. Clin. Med. 2024, 13(5), 1218; https://doi.org/10.3390/jcm13051218 - 21 Feb 2024

Cited by 8 | Viewed by 2237

Abstract

Objective: This study aimed to assess the potential of PARP inhibitors to prevent cardiotoxicity. Methods: First, a re-analysis and update of a previously published study was conducted. Additional searches were conducted of the PubMed and Cochrane Central Register of Controlled Trials databases on [...] Read more.

Objective: This study aimed to assess the potential of PARP inhibitors to prevent cardiotoxicity. Methods: First, a re-analysis and update of a previously published study was conducted. Additional searches were conducted of the PubMed and Cochrane Central Register of Controlled Trials databases on 2 June 2023. After the selection process, the pooled odds ratio (OR) for cardiac adverse events (AEs) was calculated. Second, the FAERS database was examined for 10 frequently co-administered anticancer agents. The reporting odds ratio (ROR) was calculated based on the occurrence of cardiac AEs depending on the co-administration of PARP inhibitors. Results: Seven studies were selected for the meta-analysis. Although not statistically significant, co-administration of PARP inhibitors with chemotherapy/bevacizumab decreased the risk of cardiac AEs (Peto OR = 0.61; p = 0.36), while co-administration with antiandrogens increased the risk of cardiac AEs (Peto OR = 1.83; p = 0.18). A total of 19 cases of cardiac AEs were reported with co-administration of PARP inhibitors in the FAERS database. Co-administration of PARP inhibitors with chemotherapy/bevacizumab significantly decreased the risk of cardiac AEs (ROR = 0.352; 95% confidence interval (CI), 0.194–0.637). On the other hand, for antiandrogens co-administered with PARP inhibitors, the ROR was 3.496 (95% CI, 1.539–7.942). The ROR for immune checkpoint inhibitors co-administered with PARP inhibitors was 0.606 (95% CI, 0.151–2.432), indicating a non-significant effect on cardiac AEs. Conclusion: This study reports that PARP inhibitors show cardioprotective effects when used with conventional anticancer agents. Full article

(This article belongs to the Section Oncology)

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16 pages, 650 KB

Open AccessEditor’s ChoiceReview

One Soul and Several Faces of Evaporative Dry Eye Disease

by Antonio Di Zazzo, Stefano Barabino, Romina Fasciani, Pasquale Aragona, Giuseppe Giannaccare, Edoardo Villani and Maurizio Rolando

J. Clin. Med. 2024, 13(5), 1220; https://doi.org/10.3390/jcm13051220 - 21 Feb 2024

Cited by 5 | Viewed by 2324

Abstract

The ocular surface system interacts with, reacts with, and adapts to the daily continuous insults, trauma, and stimuli caused by direct exposure to the atmosphere and environment. Several tissue and para-inflammatory mechanisms interact to guarantee such an ultimate function, hence maintaining its healthy [...] Read more.

The ocular surface system interacts with, reacts with, and adapts to the daily continuous insults, trauma, and stimuli caused by direct exposure to the atmosphere and environment. Several tissue and para-inflammatory mechanisms interact to guarantee such an ultimate function, hence maintaining its healthy homeostatic equilibrium. Evaporation seriously affects the homeostasis of the system, thereby becoming a critical trigger in the pathogenesis of the vicious cycle of dry eye disease (DED). Tear film lipid composition, distribution, spreading, and efficiency are crucial factors in controlling water evaporation, and are involved in the onset of the hyperosmolar and inflammatory cascades of DED. The structure of tear film lipids, and subsequently the tear film, have a considerable impact on tears’ properties and main functions, leading to a peculiar clinical picture and specific management. Full article

(This article belongs to the Section Ophthalmology)

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17 pages, 3494 KB

Open AccessEditor’s ChoiceArticle

TGF-β1, pSmad-2/3, Smad-7, and β-Catenin Are Augmented in the Pulmonary Arteries from Patients with Idiopathic Pulmonary Fibrosis (IPF): Role in Driving Endothelial-to-Mesenchymal Transition (EndMT)

by Archana Vijay Gaikwad, Mathew Suji Eapen, Surajit Dey, Prem Bhattarai, Affan Mahmood Shahzad, Collin Chia, Jade Jaffar, Glen Westall, Darren Sutherland, Gurpreet Kaur Singhera, Tillie-Louise Hackett, Wenying Lu and Sukhwinder Singh Sohal

J. Clin. Med. 2024, 13(4), 1160; https://doi.org/10.3390/jcm13041160 - 19 Feb 2024

Cited by 9 | Viewed by 2809

Abstract

Background: We have previously reported that endothelial-to-mesenchymal transition (EndMT) is an active process in patients with idiopathic pulmonary fibrosis (IPF) contributing to arterial remodelling. Here, we aim to quantify drivers of EndMT in IPF patients compared to normal controls (NCs). Methods: Lung resections [...] Read more.

Background: We have previously reported that endothelial-to-mesenchymal transition (EndMT) is an active process in patients with idiopathic pulmonary fibrosis (IPF) contributing to arterial remodelling. Here, we aim to quantify drivers of EndMT in IPF patients compared to normal controls (NCs). Methods: Lung resections from thirteen IPF patients and eleven NCs were immunohistochemically stained for EndMT drivers, including TGF-β1, pSmad-2/3, Smad-7, and β-catenin. Intima, media, and adventitia were analysed for expression of each EndMT driver in pulmonary arteries. Computer- and microscope-assisted Image ProPlus7.0 image analysis software was used for quantifications. Results: Significant TGF-β1, pSmad-2/3, Smad-7, and β-catenin expression was apparent across all arterial sizes in IPF (p < 0.05). Intimal TGF-β1, pSmad-2/3, Smad-7, and β-catenin were augmented in the arterial range of 100–1000 μm (p < 0.001) compared to NC. Intimal TGF-β1 and β-catenin percentage expression showed a strong correlation with the percentage expression of intimal vimentin (r′ = 0.54, p = 0.05 and r′ = 0.61, p = 0.02, respectively) and intimal N-cadherin (r′ = 0.62, p = 0.03 and r′ = 0.70, p = 0.001, respectively). Intimal TGF-β1 and β-catenin expression were significantly correlated with increased intimal thickness as well (r′ = 0.52, p = 0.04; r′ = 0.052, p = 0.04, respectively). Moreover, intimal TGF-β1 expression was also significantly associated with increased intimal elastin deposition (r′ = 0.79, p = 0.002). Furthermore, total TGF-β1 expression significantly impacted the percentage of DLCO (r′ = −0.61, p = 0.03). Conclusions: This is the first study to illustrate the involvement of active TGF-β/Smad-2/3-dependent and β-catenin-dependent Wnt signalling pathways in driving EndMT and resultant pulmonary arterial remodelling in patients with IPF. EndMT is a potential therapeutic target for vascular remodelling and fibrosis in general in patients with IPF. Full article

(This article belongs to the Section Respiratory Medicine)

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11 pages, 1199 KB

Open AccessEditor’s ChoiceReview

Deciphering Childhood Rosacea: A Comprehensive Review

by Yu Ri Woo and Hei Sung Kim

J. Clin. Med. 2024, 13(4), 1126; https://doi.org/10.3390/jcm13041126 - 16 Feb 2024

Cited by 5 | Viewed by 3827

Abstract

Childhood rosacea is a lesser known, yet significant, skin condition presenting diagnostic and treatment challenges. Although often underdiagnosed due to unclear diagnostic criteria, it manifests similarly to adult rosacea, with features such as papulopustular, telangiectasia, granulomatous, idiopathic facial aseptic granuloma, and ocular rosacea. [...] Read more.

Childhood rosacea is a lesser known, yet significant, skin condition presenting diagnostic and treatment challenges. Although often underdiagnosed due to unclear diagnostic criteria, it manifests similarly to adult rosacea, with features such as papulopustular, telangiectasia, granulomatous, idiopathic facial aseptic granuloma, and ocular rosacea. The complex pathophysiology involves genetic, immunological, and environmental factors. Distinguishing childhood rosacea from conditions like acne, steroid rosacea, sarcoidosis, and lupus vulgaris is crucial but complicated by the lack of established criteria. Treatment strategies, mainly extrapolated from adult management protocols, include topical therapies, systemic medications, and laser treatments, adapted for pediatric patients. Special attention is given to ocular rosacea, often preceding skin manifestations, necessitating multidisciplinary care. The review underscores the urgent need for clear diagnostic guidelines, increased awareness, and tailored pediatric treatment protocols to improve patient outcomes and mitigate the condition’s evolution into adulthood. Full article

(This article belongs to the Special Issue Recent Advances in Acne, Rosacea and Hidradenitis Suppurativa)

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10 pages, 1450 KB

Open AccessEditor’s ChoiceArticle

Outcome Prediction of Speech Perception in Quiet and in Noise for Cochlear Implant Candidates Based on Pre-Operative Measures

by Tobias Weissgerber, Marcel Löschner, Timo Stöver and Uwe Baumann

J. Clin. Med. 2024, 13(4), 994; https://doi.org/10.3390/jcm13040994 - 8 Feb 2024

Cited by 5 | Viewed by 1615

Abstract

(1) Background: The fitting of cochlear implants (CI) is an established treatment, even in cases with considerable residual hearing but insufficient speech perception. The aim of this study was to evaluate a prediction model for speech in quiet and to provide reference data [...] Read more.

(1) Background: The fitting of cochlear implants (CI) is an established treatment, even in cases with considerable residual hearing but insufficient speech perception. The aim of this study was to evaluate a prediction model for speech in quiet and to provide reference data and a predictive model for postoperative speech perception in noise (SPiN) after CI provision. (2) Methods: CI candidates with substantial residual hearing (either in hearing threshold or in word recognition scores) were included in a retrospective analysis (n = 87). Speech perception scores in quiet 12 months post-surgery were compared with the predicted scores. A generalized linear model was fitted to speech reception thresholds (SRTs) after CI fitting to identify predictive variables for SPiN. (3) Results: About two-thirds of the recipients achieved the expected outcome in quiet or were better than expected. The mean absolute error of the prediction was 13.5 percentage points. Age at implantation was the only predictive factor for SPiN showing a significant correlation (r = 0.354; p = 0.007). (4) Conclusions: Outcome prediction accuracy for speech in quiet was comparable to previous studies. For CI recipients in the included study population, the SPiN outcome could be predicted only based on the factor age. Full article

(This article belongs to the Special Issue Clinical Management of Audiological Disorders: Outcome Measure in Demanding Listening Situation after CI Provision)

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12 pages, 290 KB

Open AccessFeature PaperEditor’s ChoiceArticle

Malondialdehyde Serum Levels in a Full Characterized Series of 430 Rheumatoid Arthritis Patients

by Nayra Merino de Paz, Juan Carlos Quevedo-Abeledo, Fuensanta Gómez-Bernal, Antonia de Vera-González, Pedro Abreu-González, Candelaria Martín-González, Miguel Ángel González-Gay and Iván Ferraz-Amaro

J. Clin. Med. 2024, 13(3), 901; https://doi.org/10.3390/jcm13030901 - 4 Feb 2024

Cited by 9 | Viewed by 2354

Abstract

Background. Oxidative stress has been involved in the pathogenesis of rheumatoid arthritis (RA). The serum malondialdehyde (MDA) level is a reliable biomarker of oxidative stress status. In the present work, we aimed to analyze how a comprehensive characterization of the disease characteristics [...] Read more.

Background. Oxidative stress has been involved in the pathogenesis of rheumatoid arthritis (RA). The serum malondialdehyde (MDA) level is a reliable biomarker of oxidative stress status. In the present work, we aimed to analyze how a comprehensive characterization of the disease characteristics in RA, including a lipid profile, insulin resistance, and subclinical atherosclerosis, relates to serum MDA levels. Methods. In a cross-sectional study that included 430 RA patients, serum MDA levels were evaluated. Multivariable analysis was performed to examine the relationship of MDA with disease activity scores and disease characteristics, including subclinical carotid atherosclerosis, a comprehensive lipid molecule profile, and indices of insulin resistance and beta cell function indices. Results. The erythrocyte sedimentation rate (ESR) showed a significant and positive relationship with MDA. However, this did not occur for other acute phase reactants such as C-reactive protein or interleukin-6. Although the DAS28-ESR score (Disease Activity Score in 28 joints) had a positive and significant association with MDA serum levels, other disease activity scores that do not use the erythrocyte sedimentation rate in their formula did not show a significant relationship with MDA. Other disease characteristics, such as disease duration and the existence of rheumatoid factor and antibodies against citrullinated protein, were not related to serum MDA levels. This also occurred for lipid profiles, insulin resistance indices, and subclinical carotid atherosclerosis, for which no associations with circulating MDA were found. Conclusions. The disease characteristics are not related to circulating MDA levels in patients with RA. Full article

(This article belongs to the Special Issue Targeted Treatment in Rheumatoid Arthritis)

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10 pages, 246 KB

Open AccessEditor’s ChoiceReview

Dipeptidyl-Peptidase-4 and Glucagon-like-Peptide-1, a Link in the Connection between Periodontitis and Diabetes Mellitus—What Do We Know So Far?—A Scoping Review

by Theodora Claudia Gheonea, Petra Șurlin, Flavia Mirela Nicolae, Dorin Nicolae Gheorghe, Dora Maria Popescu and Ion Rogoveanu

J. Clin. Med. 2024, 13(3), 903; https://doi.org/10.3390/jcm13030903 - 4 Feb 2024

Cited by 8 | Viewed by 2914

Abstract

Periodontitis is a common condition affecting the tissues surrounding and supporting teeth. In addition to oral health concerns, periodontal disease increases the chance of developing systemic illnesses including type 2 diabetes mellitus. Porphyromonas gingivalis, a key-stone pathogen that has been linked to the [...] Read more.

Periodontitis is a common condition affecting the tissues surrounding and supporting teeth. In addition to oral health concerns, periodontal disease increases the chance of developing systemic illnesses including type 2 diabetes mellitus. Porphyromonas gingivalis, a key-stone pathogen that has been linked to the pathophysiology of periodontal disease, can generate a series of dipeptide producing exopeptidases, dipeptidyl peptidases (DPP). DPP-4 levels in gingival crevicular fluid have been shown to increase during active periodontal disease, which may lead to their association with the disease’s progression. Following oral glucose administration, mice injected with DPP-4 had higher blood glucose than the control group. DPP-4 inhibitors are used to treat patients with type 2 diabetes mellitus in order to extend the half-life of incretins. Elevated glucagon-like peptide-1 (GLP-1) levels following periodontal therapy could be considered new and applicable real-world evidence confirming the experimental findings of a beneficial interaction between oral microbiota and incretin axis. GLP-1 receptor agonist exendin-4 enhanced the osteoblast proliferation and development of these stem cells and inhibited the effects of glucose on the cells. In addition to lowering blood sugar, liraglutide, a GLP-1 receptor agonist, also possesses anti-inflammatory and bone-protective properties. These findings support the use of GLP-1 in the management and prevention of diabetic periodontitis. Full article

(This article belongs to the Special Issue Periodontal and Other Associated Oral Diseases: Diagnosis and Management in the Context of Systemic Pathology)

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15 pages, 464 KB

Open AccessEditor’s ChoiceArticle

Biliary Anatomy Visualization and Surgeon Satisfaction Using Standard Cholangiography versus Indocyanine Green Fluorescent Cholangiography during Elective Laparoscopic Cholecystectomy: A Randomized Controlled Trial

by Savvas Symeonidis, Ioannis Mantzoros, Elissavet Anestiadou, Orestis Ioannidis, Panagiotis Christidis, Stefanos Bitsianis, Konstantinos Zapsalis, Trigona Karastergiou, Dimitra Athanasiou, Stylianos Apostolidis and Stamatios Angelopoulos

J. Clin. Med. 2024, 13(3), 864; https://doi.org/10.3390/jcm13030864 - 1 Feb 2024

Cited by 8 | Viewed by 3089

Abstract

Background: Intraoperative biliary anatomy recognition is crucial for safety during laparoscopic cholecystectomy, since iatrogenic bile duct injuries represent a fatal complication, occurring in up to 0.9% of patients. Indocyanine green fluorescence cholangiography (ICG-FC) is a safe and cost-effective procedure for achieving a [...] Read more.

Background: Intraoperative biliary anatomy recognition is crucial for safety during laparoscopic cholecystectomy, since iatrogenic bile duct injuries represent a fatal complication, occurring in up to 0.9% of patients. Indocyanine green fluorescence cholangiography (ICG-FC) is a safe and cost-effective procedure for achieving a critical view of safety and recognizing early biliary injuries. The aim of this study is to compare the perioperative outcomes, usefulness and safety of standard intraoperative cholangiography (IOC) with ICG-FC with intravenous ICG. Methods: Between 1 June 2021 and 31 December 2022, 160 patients undergoing elective LC were randomized into two equal groups: Group A (standard IOC) and group B (ICG-FC with intravenous ICG). Results: No significant difference was found between the two groups regarding demographics, surgery indication or surgery duration. No significant difference was found regarding the visualization of critical biliary structures. However, the surgeon satisfaction and cholangiography duration presented significant differences in favor of ICG-FC. Regarding the inflammatory response, a significant difference between the two groups was found only in postoperative WBC levels. Hepatic and renal function test results were not significantly different between the two groups on the first postoperative day, except for direct bilirubin. No statistically significant difference was noted regarding 30-day postoperative complications, while none of the complications noted included bile duct injury events. Conclusions: ICG-FC presents equivalent results to IOC regarding extrahepatic biliary visualization and postoperative complications. However, more studies need to be performed in order to standardize the optimal dose, timing and mode of administration. Full article

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

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13 pages, 652 KB

Open AccessEditor’s ChoiceArticle

Steatotic Liver Disease and Sepsis Outcomes—A Prospective Cohort Study (SepsisFAT)

by Juraj Krznaric, Neven Papic, Nina Vrsaljko, Branimir Gjurasin, Marko Kutlesa and Adriana Vince

J. Clin. Med. 2024, 13(3), 798; https://doi.org/10.3390/jcm13030798 - 30 Jan 2024

Cited by 6 | Viewed by 2304

Abstract

Background: While it has been shown that steatotic liver disease (SLD) is associated with systemic changes in immune response, the impact of SLD on sepsis outcomes has not yet been established. The aim of this study was to investigate the association between [...] Read more.

Background: While it has been shown that steatotic liver disease (SLD) is associated with systemic changes in immune response, the impact of SLD on sepsis outcomes has not yet been established. The aim of this study was to investigate the association between SLD and sepsis severity and outcomes. Methods: A prospective observational study included consecutively hospitalized adult patients with community-acquired sepsis during a 16-month period. Results: Of the 378 included patients (49.5% male, median age of 69, IQR 57–78 years), 174 (46%) were diagnosed with SLD. Patients with SLD were older and more frequently fulfilled the criteria for metabolic syndrome. There were no differences in the source and etiology of sepsis between the groups. Patients with SLD exhibited a higher incidence of acute kidney injury (29.3% vs. 17.6%), the need for renal replacement therapy (16.1% vs. 8.8%), and more frequent use of invasive mechanical ventilation (29.3% vs. 18.1%). In-hospital mortality was significantly higher in the SLD group (18.39% vs. 9.8%). The multivariable analysis indicated that SLD was associated with mortality (HR 2.82, 95% CI 1.40–5.71) irrespective of the other elements within metabolic syndrome. Conclusions: SLD might be associated with higher sepsis in-hospital mortality, and more frequent development of acute kidney and respiratory insufficiency requiring more critical care support. Full article

(This article belongs to the Special Issue (Expert Views) Nonalcoholic Fatty Liver Disease: Pathogenesis, Clinical Diagnosis, and Treatment)

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10 pages, 1886 KB

Open AccessEditor’s ChoiceArticle

Comparison of Ultrasound and MRI with Intraoperative Findings in the Diagnosis of Peroneal Tendinopathy, Tears, and Subluxation

by David M. Melville, Mihra S. Taljanovic, Lana H. Gimber, Matthew Miller, Aamir Ahmad, Dustin Sepich and L. Daniel Latt

J. Clin. Med. 2024, 13(3), 740; https://doi.org/10.3390/jcm13030740 - 27 Jan 2024

Cited by 7 | Viewed by 4160

Abstract

Suspected peroneal tendinopathy, tears, and subluxation are often confirmed preoperatively using magnetic resonance imaging (MRI) or diagnostic ultrasound (US). No study has directly compared the accuracy of these tests for the diagnosis of peroneal tendon pathology. The purpose of this study is to [...] Read more.

Suspected peroneal tendinopathy, tears, and subluxation are often confirmed preoperatively using magnetic resonance imaging (MRI) or diagnostic ultrasound (US). No study has directly compared the accuracy of these tests for the diagnosis of peroneal tendon pathology. The purpose of this study is to directly compare MRI and US to intraoperative findings in patients who underwent surgery for suspected peroneal pathology to determine the imaging diagnostic accuracy. Operative records and diagnostic images for 21 consecutive patients who had both MRI and US prior to surgery for suspected peroneal tendinopathy, tears, or subluxation were retrospectively reviewed. The results of this review are compared with the intraoperative findings to yield the sensitivity and specificity for each imaging modality. For the diagnosis of peroneal tendon tears, US was found to have a sensitivity of 88% and specificity of 100%, compared to 100% sensitivity and specificity for MRI. In the diagnosis of peroneal tendinopathy, both US and MRI had a sensitivity and specificity of 100%. In diagnosing peroneal subluxation, US was 100% sensitive compared to 66% for MRI, and both were 100% specific. In conclusion, US was found to be more effective in diagnosing peroneal subluxation and MRI was slightly more accurate in the diagnosis of peroneal tendon tears. Full article

(This article belongs to the Section Orthopedics)

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16 pages, 756 KB

Open AccessEditor’s ChoiceReview

Effect of Transcranial Direct Current Stimulation (tDCS) on Depression in Parkinson’s Disease—A Narrative Review

by James Chmiel, Filip Rybakowski and Jerzy Leszek

J. Clin. Med. 2024, 13(3), 699; https://doi.org/10.3390/jcm13030699 - 25 Jan 2024

Cited by 7 | Viewed by 3705

Abstract

Introduction: Depression is the most prevalent comorbid neuropsychiatric condition in individuals with Parkinson’s disease (PD), and its underlying mechanisms are not yet fully understood. Current treatment methods are characterised by moderate effectiveness and possible side effects, prompting the search for new non-invasive and [...] Read more.

Introduction: Depression is the most prevalent comorbid neuropsychiatric condition in individuals with Parkinson’s disease (PD), and its underlying mechanisms are not yet fully understood. Current treatment methods are characterised by moderate effectiveness and possible side effects, prompting the search for new non-invasive and safe treatment methods. Methods: This narrative review explores the use of transcranial direct current stimulation (tDCS) in the treatment of depression in PD, based on neuropsychological measures. Searches were conducted in the PubMed/Medline, Research Gate, and Cochrane databases. Results: Nine relevant studies were identified, where depression scores served as either primary or secondary outcomes. Stimulation protocols displayed heterogeneity, especially concerning choice of stimulation site. Patient samples were also heterogeneous. The majority of the studies incorporated anodal stimulation targeting the left dorsolateral prefrontal cortex (DLPFC). The results revealed a reduction in depression scores among PD patients following tDCS. Potential mechanisms through which tDCS may alleviate depression in PD were discussed and recommendations for future research were made. Conclusions: Preliminary evidence suggests that tDCS applied anodally to the left DLPFC reduces depression scores in people with PD; however, due to the heterogeneity of the studies analysed, the use of tDCS in this field should be approached with caution and warrants further validation and confirmation. Full article

(This article belongs to the Special Issue Clinical Management of Parkinson's Symptoms)

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12 pages, 472 KB

Open AccessEditor’s ChoiceArticle

A Comprehensive Study on Tear Meniscus Height Inter-Eye Differences in Aqueous Deficient Dry Eye Diagnosis

by Hugo Pena-Verdeal, Jacobo Garcia-Queiruga, Belen Sabucedo-Villamarin, Carlos Garcia-Resua, Maria J. Giraldez and Eva Yebra-Pimentel

J. Clin. Med. 2024, 13(3), 659; https://doi.org/10.3390/jcm13030659 - 23 Jan 2024

Cited by 7 | Viewed by 2924

Abstract

(1) Background: Dry eye disease (DED) is a chronic ocular surface condition that requires precise diagnostic tools. The present study aimed to investigate the diagnostic potential of the absolute inter-eye difference (|OD-OS|) in tear meniscus height (TMH) for the detection of the presence [...] Read more.

(1) Background: Dry eye disease (DED) is a chronic ocular surface condition that requires precise diagnostic tools. The present study aimed to investigate the diagnostic potential of the absolute inter-eye difference (|OD-OS|) in tear meniscus height (TMH) for the detection of the presence of aqueous deficient dry eye (ADDE). (2) Methods: A sample of 260 participants with dry eye complaints underwent ocular surface examinations thorough diagnostic assessments based on the Tear Film and Ocular Surface Society guidelines (TFOS DEWS II). Participants were subsequently categorized as No ADDE and ADDE based on TMH. Statistical analyses to determine the optimal TMH|OD-OS| cut-off value in a randomly selected study group (200 participants) were performed, while a separate validation analysis of the cut-off value obtained in a random cross-validation group (60 participants) was also performed. (3) Results: The significant diagnostic capability of TMH|OD-OS| (area under the curve = 0.719 ± 0.036, p < 0.001) was found. The identified cut-off value of 0.033 mm demonstrated reliable specificity (77.6%) and moderate sensitivity (59.1%). Cross-validation confirmed the cut-off value’s association with the TFOS DEWS II diagnostic criterion (Cramer’s V = 0.354, p = 0.006). (4) Conclusions: The present study provides evidence for the diagnostic potential of TMH|OD-OS| in identifying ADDE. The identified cut-off value enhances the specificity and offers moderate sensitivity, providing an objective tool for clinical decision making. Full article

(This article belongs to the Special Issue Dry Eye Disease: Risk Factors, Diagnosis, Treatment and Prevention Measures)

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10 pages, 376 KB

Open AccessEditor’s ChoiceSystematic Review

Predicting Functional Outcomes of Total Hip Arthroplasty Using Machine Learning: A Systematic Review

by Nick D. Clement, Rosie Clement and Abigail Clement

J. Clin. Med. 2024, 13(2), 603; https://doi.org/10.3390/jcm13020603 - 21 Jan 2024

Cited by 6 | Viewed by 2321

Abstract

The aim of this review was to assess the reliability of machine learning (ML) techniques to predict the functional outcome of total hip arthroplasty. The literature search was performed up to October 2023, using MEDLINE/PubMed, Embase, Web of Science, and NIH Clinical Trials. [...] Read more.

The aim of this review was to assess the reliability of machine learning (ML) techniques to predict the functional outcome of total hip arthroplasty. The literature search was performed up to October 2023, using MEDLINE/PubMed, Embase, Web of Science, and NIH Clinical Trials. Level I to IV evidence was included. Seven studies were identified that included 44,121 patients. The time to follow-up varied from 3 months to more than 2 years. Each study employed one to six ML techniques. The best-performing models were for health-related quality of life (HRQoL) outcomes, with an area under the curve (AUC) of more than 84%. In contrast, predicting the outcome of hip-specific measures was less reliable, with an AUC of between 71% to 87%. Random forest and neural networks were generally the best-performing models. Three studies compared the reliability of ML with traditional regression analysis: one found in favour of ML, one was not clear and stated regression closely followed the best-performing ML model, and one showed a similar AUC for HRQoL outcomes but did show a greater reliability for ML to predict a clinically significant change in the hip-specific function. ML offers acceptable-to-excellent discrimination of predicting functional outcomes and may have a marginal advantage over traditional regression analysis, especially in relation to hip-specific hip functional outcomes. Full article

(This article belongs to the Special Issue Clinical Updates in Hip Arthroplasty)

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15 pages, 625 KB

Open AccessFeature PaperEditor’s ChoiceArticle

A Cohort of 469 Mayer–Rokitansky–Küster–Hauser Syndrome Patients—Associated Malformations, Syndromes, and Heterogeneity of the Phenotype

by Martin Pietzsch, Birgitt Schönfisch, Alice Höller, André Koch, Annette Staebler, Katharina Dreser, Kristina Bettecken, Lisa Schaak, Sara Yvonne Brucker and Katharina Rall

J. Clin. Med. 2024, 13(2), 607; https://doi.org/10.3390/jcm13020607 - 21 Jan 2024

Cited by 6 | Viewed by 3028

Abstract

The Mayer–Rokitansky–Küster–Hauser syndrome is characterized by aplasia of the uterus and upper two-thirds of the vagina. While it can appear as an isolated genital malformation, it is often associated with extragenital abnormalities, with little still known about the pathogenetic background. To provide an [...] Read more.

The Mayer–Rokitansky–Küster–Hauser syndrome is characterized by aplasia of the uterus and upper two-thirds of the vagina. While it can appear as an isolated genital malformation, it is often associated with extragenital abnormalities, with little still known about the pathogenetic background. To provide an overview of associated malformations and syndromes as well as to examine possible ties between the rudimentary tissue and patient characteristics, we analyzed a cohort of 469 patients with MRKHS as well as 298 uterine rudiments removed during surgery. A total of 165 of our patients (35.2%) had associated malformations (MRKHS type II). Renal defects were the most common associated malformation followed by skeletal abnormalities. Several patients had atypical associated malformations or combined syndromes. Uterine rudiments were rarer in patients with associated malformations than in patients without them. Rudiment size ranged from 0.3 cm³ to 184.3 cm³ with a mean value of 7.9 cm³. Importantly, MRKHS subtype or concomitant malformations were associated with a different frequency of uterine tissue as well as a different rudiment size and incidence of endometrial tissue, thereby indicating a clear heterogeneity of the phenotype. Further research into the associated molecular pathways and potential differences between MRKHS subtypes is needed. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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18 pages, 1499 KB

Open AccessEditor’s ChoiceReview

Heart Transplantation

by Nikolaos Chrysakis, Dimitrios E. Magouliotis, Kyriakos Spiliopoulos, Thanos Athanasiou, Alexandros Briasoulis, Filippos Triposkiadis, John Skoularigis and Andrew Xanthopoulos

J. Clin. Med. 2024, 13(2), 558; https://doi.org/10.3390/jcm13020558 - 18 Jan 2024

Cited by 10 | Viewed by 8132

Abstract

Heart transplantation (HTx) remains the last therapeutic resort for patients with advanced heart failure. The present work is a clinically focused review discussing current issues in heart transplantation. Several factors have been associated with the outcome of HTx, such as ABO and HLA [...] Read more.

Heart transplantation (HTx) remains the last therapeutic resort for patients with advanced heart failure. The present work is a clinically focused review discussing current issues in heart transplantation. Several factors have been associated with the outcome of HTx, such as ABO and HLA compatibility, graft size, ischemic time, age, infections, and the cause of death, as well as imaging and laboratory tests. In 2018, UNOS changed the organ allocation policy for HTx. The aim of this change was to prioritize patients with a more severe clinical condition resulting in a reduction in mortality of people on the waiting list. Advanced heart failure and resistant angina are among the main indications of HTx, whereas active infection, peripheral vascular disease, malignancies, and increased body mass index (BMI) are important contraindications. The main complications of HTx include graft rejection, graft angiopathy, primary graft failure, infection, neoplasms, and retransplantation. Recent advances in the field of HTx include the first two porcine-to-human xenotransplantations, the inclusion of hepatitis C donors, donation after circulatory death, novel monitoring for acute cellular rejection and antibody-mediated rejection, and advances in donor heart preservation and transportation. Lastly, novel immunosuppression therapies such as daratumumab, belatacept, IL 6 directed therapy, and IgG endopeptidase have shown promising results. Full article

(This article belongs to the Special Issue Mechanical Circulatory Support in Patients with Heart Failure)

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10 pages, 1330 KB

Open AccessEditor’s ChoiceSystematic Review

Transcaval versus Supra-Aortic Vascular Accesses for Transcatheter Aortic Valve Replacement: A Systematic Review with Meta-Analysis

by Panagiotis Antiochos, Matthias Kirsch, Pierre Monney, Georgios Tzimas, David Meier, Stephane Fournier, Clémence Ferlay, Anna Nowacka, Valentina Rancati, Christophe Abellan, Ioannis Skalidis, Olivier Muller and Henri Lu

J. Clin. Med. 2024, 13(2), 455; https://doi.org/10.3390/jcm13020455 - 14 Jan 2024

Cited by 6 | Viewed by 1735

Abstract

A growing body of evidence suggests that extrathoracic vascular accesses for transcatheter aortic valve replacement (TAVR) yield favorable outcomes and can be considered as primary alternatives when the gold-standard transfemoral access is contraindicated. Data comparing the transcaval (TCv) to supra-aortic (SAo) approaches (transcarotid, [...] Read more.

A growing body of evidence suggests that extrathoracic vascular accesses for transcatheter aortic valve replacement (TAVR) yield favorable outcomes and can be considered as primary alternatives when the gold-standard transfemoral access is contraindicated. Data comparing the transcaval (TCv) to supra-aortic (SAo) approaches (transcarotid, transsubclavian, and transaxillary) for TAVR are lacking. We aimed to compare the outcomes and safety of TCv and SAo accesses for TAVR as alternatives to transfemoral TAVR. A systematic review with meta-analysis was performed by searching PubMed/MEDLINE and EMBASE databases for all articles comparing TCv-TAVR against SAo-TAVR published until September 2023. Outcomes included in-hospital or 30-day all-cause mortality (ACM) and postoperative complications. A total of three studies with 318 TCv-TAVR and 179 SAo-TAVR patients were included. No statistically significant difference was found regarding in-hospital or 30-day ACM (relative risk [RR] 1.04, 95% confidence interval [CI] 0.47–2.34, p = 0.91), major bleeding, the need for blood transfusions, major vascular complications, and acute kidney injury. TCv-TAVR was associated with a non-statistically significant lower rate of neurovascular complications (RR 0.39, 95%CI 0.14–1.09, p = 0.07). These results suggest that both approaches may be considered as first-line alternatives to transfemoral TAVR, depending on local expertise and patients’ anatomy. Additional data from long-term cohort studies are needed. Full article

(This article belongs to the Special Issue New Developments in Transcatheter Aortic Valve Replacement)

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11 pages, 847 KB

Open AccessEditor’s ChoiceArticle

Patient Involvement in the Rehabilitation Process Is Associated with Improvement in Function and Goal Attainment: Results from an Explorative Longitudinal Study

by Joachim Støren Sagen, Ingvild Kjeken, Andreas Habberstad, Anita Dyb Linge, Ann Elisabeth Simonsen, Anne Dorte Lyken, Eirik Lind Irgens, Heidi Framstad, Peter Solvoll Lyby, Mari Klokkerud, Hanne Dagfinrud and Rikke Helene Moe

J. Clin. Med. 2024, 13(2), 320; https://doi.org/10.3390/jcm13020320 - 6 Jan 2024

Cited by 8 | Viewed by 3192

Abstract

The objective was to explore the associations between patient involvement in the rehabilitation process and improvements in function and goal attainment in the first year after rehabilitation. The longitudinal multicenter study RehabNytte provided data from participants who had been referred to rehabilitation ( [...] Read more.

The objective was to explore the associations between patient involvement in the rehabilitation process and improvements in function and goal attainment in the first year after rehabilitation. The longitudinal multicenter study RehabNytte provided data from participants who had been referred to rehabilitation (n = 2113). Quality indicator (QI) pass rates (% yes) were used to assess patient involvement in the rehabilitation process. The Patient-Specific Functional Scale (PSFS) (10 = best possible) was used to assess function. The outcome QI on goal achievement (response options of yes/no) was used to assess goal attainment. Logistic regression and paired sample t-tests were used to examine associations and mean changes in function from rehabilitation admission up to 3, 6, and 12 months. Most participants (95%) were involved in goal-setting, which was positively associated with younger age (OR 0.97, 95% CI 0.95–0.99) and female sex (OR 1.87, 95% CI 1.15–3.02). Function improved over the follow-up period, with greater improvements in the active goal-setting group. Being involved in goal planning almost tripled the odds of goal attainment (OR 2.78, 95% CI 1.60–4.83) and involvement in the rehabilitation plan almost doubled it (OR 1.99, 95% CI 1.41–2.81). Most participants were involved in rehabilitation goal-setting/planning and being involved was associated with beneficial functional outcomes and greater goal attainment. Full article

(This article belongs to the Section Clinical Rehabilitation)

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20 pages, 2278 KB

Open AccessEditor’s ChoiceReview

Lung Imaging and Artificial Intelligence in ARDS

by Davide Chiumello, Silvia Coppola, Giulia Catozzi, Fiammetta Danzo, Pierachille Santus and Dejan Radovanovic

J. Clin. Med. 2024, 13(2), 305; https://doi.org/10.3390/jcm13020305 - 5 Jan 2024

Cited by 8 | Viewed by 3851

Abstract

Artificial intelligence (AI) can make intelligent decisions in a manner akin to that of the human mind. AI has the potential to improve clinical workflow, diagnosis, and prognosis, especially in radiology. Acute respiratory distress syndrome (ARDS) is a very diverse illness that is [...] Read more.

Artificial intelligence (AI) can make intelligent decisions in a manner akin to that of the human mind. AI has the potential to improve clinical workflow, diagnosis, and prognosis, especially in radiology. Acute respiratory distress syndrome (ARDS) is a very diverse illness that is characterized by interstitial opacities, mostly in the dependent areas, decreased lung aeration with alveolar collapse, and inflammatory lung edema resulting in elevated lung weight. As a result, lung imaging is a crucial tool for evaluating the mechanical and morphological traits of ARDS patients. Compared to traditional chest radiography, sensitivity and specificity of lung computed tomography (CT) and ultrasound are higher. The state of the art in the application of AI is summarized in this narrative review which focuses on CT and ultrasound techniques in patients with ARDS. A total of eighteen items were retrieved. The primary goals of using AI for lung imaging were to evaluate the risk of developing ARDS, the measurement of alveolar recruitment, potential alternative diagnoses, and outcome. While the physician must still be present to guarantee a high standard of examination, AI could help the clinical team provide the best care possible. Full article

(This article belongs to the Topic Acute Respiratory Distress Syndrome (ARDS): Personalized Therapies and Beyond)

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16 pages, 2939 KB

Open AccessEditor’s ChoiceReview

Decongestion in Acute Heart Failure—Time to Rethink and Standardize Current Clinical Practice?

by Valentin Bilgeri, Philipp Spitaler, Christian Puelacher, Moritz Messner, Agne Adukauskaite, Fabian Barbieri, Axel Bauer, Thomas Senoner and Wolfgang Dichtl

J. Clin. Med. 2024, 13(2), 311; https://doi.org/10.3390/jcm13020311 - 5 Jan 2024

Cited by 6 | Viewed by 6155

Abstract

Most episodes of acute heart failure (AHF) are characterized by increasing signs and symptoms of congestion, manifested by edema, pleura effusion and/or ascites. Immediately and repeatedly administered intravenous (IV) loop diuretics currently represent the mainstay of initial therapy aiming to achieve adequate diuresis/natriuresis [...] Read more.

Most episodes of acute heart failure (AHF) are characterized by increasing signs and symptoms of congestion, manifested by edema, pleura effusion and/or ascites. Immediately and repeatedly administered intravenous (IV) loop diuretics currently represent the mainstay of initial therapy aiming to achieve adequate diuresis/natriuresis and euvolemia. Despite these efforts, a significant proportion of patients have residual congestion at discharge, which is associated with a poor prognosis. Therefore, a standardized approach is needed. The door to diuretic time should not exceed 60 min. As a general rule, the starting IV dose is 20–40 mg furosemide equivalents in loop diuretic naïve patients or double the preexisting oral home dose to be administered via IV. Monitoring responses within the following first hours are key issues. (1) After 2 h, spot urinary sodium should be ≥50–70 mmol/L. (2) After 6 h, the urine output should be ≥100–150 mL/hour. If these target measures are not reached, the guidelines currently recommend a doubling of the original dose to a maximum of 400–600 mg furosemide per day and in patients with severely impaired kidney function up to 1000 mg per day. Continuous infusion of loop diuretics offers no benefit over intermittent boluses (DOSE trial). Emerging evidence by recent randomized trials (ADVOR, CLOROTIC) supports the concept of an early combination diuretic therapy, by adding either acetazolamide (500 mg IV once daily) or hydrochlorothiazide. Acetazolamide is particularly useful in the presence of a baseline bicarbonate level of ≥27 mmol/L and remains effective in the presence of preexisting/worsening renal dysfunction but should be used only in the first three days to prevent severe metabolic disturbances. Patients should not leave the hospital when they are still congested and/or before optimized long-term guideline-directed medical therapy has been initiated. Special attention should be paid to AHF patients during the vulnerable post-discharge period, with an early follow-up visit focusing on up-titrate treatments of recommended doses within 2 weeks (STRONG-HF). Full article

(This article belongs to the Special Issue Acute Heart Failure: Risk Prediction, Diagnosis, and Clinical Management)

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30 pages, 871 KB

Open AccessEditor’s ChoiceSystematic Review

Heart Rate Variability and Cognition: A Narrative Systematic Review of Longitudinal Studies

by Paola Nicolini, Gabriella Malfatto and Tiziano Lucchi

J. Clin. Med. 2024, 13(1), 280; https://doi.org/10.3390/jcm13010280 - 4 Jan 2024

Cited by 12 | Viewed by 9211

Abstract

Background: Heart rate variability (HRV) is a reliable and convenient method to assess autonomic function. Cross-sectional studies have established a link between HRV and cognition. Longitudinal studies are an emerging area of research with important clinical implications in terms of the predictive value [...] Read more.

Background: Heart rate variability (HRV) is a reliable and convenient method to assess autonomic function. Cross-sectional studies have established a link between HRV and cognition. Longitudinal studies are an emerging area of research with important clinical implications in terms of the predictive value of HRV for future cognition and in terms of the potential causal relationship between HRV and cognition. However, they have not yet been the objective of a systematic review. Therefore, the aim of this systematic review was to investigate the association between HRV and cognition in longitudinal studies. Methods: The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Embase, PsycINFO and PubMed databases were searched from the earliest available date to 26 June 2023. Studies were included if they involved adult human subjects and evaluated the longitudinal association between HRV and cognition. The risk of bias was assessed with the Newcastle–Ottawa Scale for Cohort Studies. The results were presented narratively. Results: Of 14,359 records screened, 12 studies were included in this systematic review, with a total of 24,390 participants. Two thirds of the studies were published from 2020 onwards. All studies found a longitudinal relationship between HRV and cognition. There was a consistent association between higher parasympathetic nervous system (PNS) activity and better cognition, and some association between higher sympathetic nervous system activity and worse cognition. Also, higher PNS activity persistently predicted better executive functioning, while data on episodic memory and language were more scant and/or controversial. Conclusions: Our results support the role of HRV as a biomarker of future cognition and, potentially, as a therapeutic target to improve cognition. They will need confirmation by further, more comprehensive studies also including unequivocal non-HRV sympathetic measures and meta-analyses. Full article

(This article belongs to the Special Issue Cardiovascular Time Series in the Preclinical and Clinical Settings)

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14 pages, 2550 KB

Open AccessEditor’s ChoiceReview

Functional Near-Infrared Spectrometry as a Useful Diagnostic Tool for Understanding the Visual System: A Review

by Kelly Acuña, Rishav Sapahia, Irene Newman Jiménez, Michael Antonietti, Ignacio Anzola, Marvin Cruz, Michael T. García, Varun Krishnan, Lynn A. Leveille, Miklós D. Resch, Anat Galor, Ranya Habash and Delia Cabrera DeBuc

J. Clin. Med. 2024, 13(1), 282; https://doi.org/10.3390/jcm13010282 - 4 Jan 2024

Cited by 5 | Viewed by 4373

Abstract

This comprehensive review explores the role of Functional Near-Infrared Spectroscopy (fNIRS) in advancing our understanding of the visual system. Beginning with an introduction to fNIRS, we delve into its historical development, highlighting how this technology has evolved over time. The core of the [...] Read more.

This comprehensive review explores the role of Functional Near-Infrared Spectroscopy (fNIRS) in advancing our understanding of the visual system. Beginning with an introduction to fNIRS, we delve into its historical development, highlighting how this technology has evolved over time. The core of the review critically examines the advantages and disadvantages of fNIRS, offering a balanced view of its capabilities and limitations in research and clinical settings. We extend our discussion to the diverse applications of fNIRS beyond its traditional use, emphasizing its versatility across various fields. In the context of the visual system, this review provides an in-depth analysis of how fNIRS contributes to our understanding of eye function, including eye diseases. We discuss the intricacies of the visual cortex, how it responds to visual stimuli and the implications of these findings in both health and disease. A unique aspect of this review is the exploration of the intersection between fNIRS, virtual reality (VR), augmented reality (AR) and artificial intelligence (AI). We discuss how these cutting-edge technologies are synergizing with fNIRS to open new frontiers in visual system research. The review concludes with a forward-looking perspective, envisioning the future of fNIRS in a rapidly evolving technological landscape and its potential to revolutionize our approach to studying and understanding the visual system. Full article

(This article belongs to the Section Ophthalmology)

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11 pages, 1425 KB

Open AccessEditor’s ChoiceArticle

Laryngopharyngeal Mucosal Injury Due to Nasogastric Tube Insertion during Cardiopulmonary Resuscitation: A Retrospective Cohort Study

by Kazuyuki Miyamoto, Hiromi Takayasu, Shino Katsuki, Atsuo Maeda, Keisuke Suzuki, Motoyasu Nakamura, Noriko Hida, Takehiko Sambe, Masaharu Yagi, Jun Sasaki, Munetaka Hayashi and Kenji Dohi

J. Clin. Med. 2024, 13(1), 261; https://doi.org/10.3390/jcm13010261 - 2 Jan 2024

Cited by 5 | Viewed by 2451

Abstract

Background: Patients under cardiopulmonary resuscitation (CPR) are at high risk of aspirating gastric contents. Nasogastric tube insertion (NGTI) after tracheal intubation is usually performed blindly. This sometimes causes laryngopharyngeal mucosal injury (LPMI), leading to severe bleeding. This study clarified the incidence of LPMI [...] Read more.

Background: Patients under cardiopulmonary resuscitation (CPR) are at high risk of aspirating gastric contents. Nasogastric tube insertion (NGTI) after tracheal intubation is usually performed blindly. This sometimes causes laryngopharyngeal mucosal injury (LPMI), leading to severe bleeding. This study clarified the incidence of LPMI due to blind NGTI during CPR. Methods: We retrospectively analyzed 84 patients presenting with cardiopulmonary arrest on arrival, categorized them into a Smooth group (Smooth; blind NGTI was possible within 2 min), and Difficult group (blind NGTI was not possible), and consequently performed video laryngoscope-assisted NGTI. The laryngopharyngeal mucosal condition was recorded using video laryngoscope. Success rates and insertion time for the Smooth group were calculated. Insertion number and LPMI scores were compared between the groups. Each regression line of outcome measurements was obtained using simple regression analysis. We also analyzed the causes of the Difficult group, using recorded video laryngoscope-assisted videos. Results: The success rate was 78.6% (66/84). NGTI time was 48.8 ± 4.0 s in the Smooth group. Insertion number and injury scores in the Smooth group were significantly lower than those in the Difficult group. The severity of LPMI increased with NGT insertion time and insertion number. Conclusions: Whenever blind NGTI is difficult, switching to other methods is essential to prevent unnecessary persistence. Full article

(This article belongs to the Section Emergency Medicine)

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