Journal of Clinical Medicine

12 pages, 557 KiB

Open AccessEditor’s ChoiceArticle

Effects of an Early Exercise Program with Cryotherapy on Range of Motion, Pain, Swelling, and Gait in Patients with Total Knee Arthroplasty: A Randomized Controlled Trial

by Bomi Lee, Doyoo Yoon and Jongeun Yim

J. Clin. Med. 2024, 13(5), 1420; https://doi.org/10.3390/jcm13051420 - 29 Feb 2024

Cited by 6 | Viewed by 4181

Abstract

Background: This study aimed to investigate the effects of cryotherapy on range of motion, pain, swelling, and gait in patients who underwent total knee arthroplasty. Methods: Forty-three patients who underwent TKA (total knee arthroplasty) and met the inclusion criteria were randomly [...] Read more.

Background: This study aimed to investigate the effects of cryotherapy on range of motion, pain, swelling, and gait in patients who underwent total knee arthroplasty. Methods: Forty-three patients who underwent TKA (total knee arthroplasty) and met the inclusion criteria were randomly divided into two groups. The experimental (n = 21) and control (n = 22) groups underwent cryotherapy and non-cryotherapy treatments, respectively, six times a week for two weeks, and once each before and after exercise for 3 min. Both groups followed a similar initial rehabilitation exercise program using a continuous passive motion device. Results: The results showed a significant difference in knee flexion range of motion, pain, edema, and 10 MWT comparisons from pre- to post-test (p < 0.001). The above values were also significantly different in the comparison between the two groups (p < 0.05). Conclusions: Therefore, this study confirmed that an initial rehabilitation exercise program accompanied by cryotherapy could be an effective intervention method for range of motion, pain, edema, and walking in patients undergoing total knee arthroplasty. Full article

(This article belongs to the Section Clinical Rehabilitation)

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12 pages, 1750 KiB

Open AccessEditor’s ChoiceReview

Evolution in the Management of Patella Fractures

by Mahak Baid, Sid Narula, Jonathan R. Manara and William Blakeney

J. Clin. Med. 2024, 13(5), 1426; https://doi.org/10.3390/jcm13051426 - 29 Feb 2024

Cited by 6 | Viewed by 5310

Abstract

Patella fractures usually occur as a result of direct trauma to the anterior knee joint, indirect injury as a result of eccentric muscle contraction, or rapid knee flexion against a contracted quadriceps muscle. The patella functions as part of the extensor mechanism of [...] Read more.

Patella fractures usually occur as a result of direct trauma to the anterior knee joint, indirect injury as a result of eccentric muscle contraction, or rapid knee flexion against a contracted quadriceps muscle. The patella functions as part of the extensor mechanism of the knee, where large forces are transmitted, and its subcutaneous nature has made treatment of patella fractures a challenge. In this review article, we evaluate how the management of these fractures has evolved over time and the advantages associated with the various treatment techniques. There are few comparative studies looking at the different treatment types for fractures of the patella, with the goal of achieving a functional extensor mechanism with low rates of post-traumatic arthritis and metal-work irritation. Full article

(This article belongs to the Special Issue Orthopaedic Trauma Surgery: Diagnosis, Treatment and Outcome)

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14 pages, 3884 KiB

Open AccessEditor’s ChoiceSystematic Review

Mesh Rectopexy or Resection Rectopexy for Rectal Prolapse; Is There a Gold Standard Method: A Systematic Review, Meta-Analysis and Trial Sequential Analysis

by Georgios Koimtzis, Leandros Stefanopoulos, Georgios Geropoulos, Christopher G. Chalklin, Ioannis Karniadakis, Awad A. Alawad, Vyron Alexandrou, Nikos Tteralli, Eliot Carrington-Windo, Andreas Papacharalampous and Kyriakos Psarras

J. Clin. Med. 2024, 13(5), 1363; https://doi.org/10.3390/jcm13051363 - 28 Feb 2024

Cited by 5 | Viewed by 2409

Abstract

(1) Background: Rectal prolapse is a benign condition that mainly affects females and the elderly. The most common symptoms are constipation and incontinence. The treatment of choice is surgical, but so far, there has been no gold standard method. The aim of this [...] Read more.

(1) Background: Rectal prolapse is a benign condition that mainly affects females and the elderly. The most common symptoms are constipation and incontinence. The treatment of choice is surgical, but so far, there has been no gold standard method. The aim of this study is to compare the two most common intrabdominal procedures utilized for treating rectal prolapse: the resection rectopexy and the mesh rectopexy. (2) Methods: In this study, we conducted a thorough systematic review and meta-analysis of the available literature and compared the two different approaches regarding their complication rate, recurrence rate, and improvement of symptoms rate. (3) Results: No statistically significant difference between the two methods was found regarding the operating time, the length of stay, the overall complication rate, the surgical site infection rate, the cardiopulmonary complication rate, the improvement in constipation and incontinence rates, and the recurrence rate. (4) Conclusions: Our study revealed that mesh rectopexy and resection rectopexy for rectal prolapse have similar short- and long-term outcomes. As a result, the decision for the procedure used should be individualized and based on the surgeon’s preference and expertise. Full article

(This article belongs to the Special Issue Preventive, Diagnostic and Therapeutic Strategies for Abdominal Surgery Complications)

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13 pages, 2314 KiB

Open AccessEditor’s ChoiceSystematic Review

A Meta-Analysis of the Global Prevalence of Temporomandibular Disorders

by Grzegorz Zieliński, Beata Pająk-Zielińska and Michał Ginszt

J. Clin. Med. 2024, 13(5), 1365; https://doi.org/10.3390/jcm13051365 - 28 Feb 2024

Cited by 94 | Viewed by 11759

Abstract

Background: This meta-analysis aims to evaluate the proportion of people with TMDs in different studies, considering factors such as geographical region, patient age, and sample size. Methods: The search yielded 6984 articles on the incidence of TMDs. Finally, 74 studies with [...] Read more.

Background: This meta-analysis aims to evaluate the proportion of people with TMDs in different studies, considering factors such as geographical region, patient age, and sample size. Methods: The search yielded 6984 articles on the incidence of TMDs. Finally, 74 studies with 172,239 subjects and 35,259 with TMDs were selected for final analysis. Analyses were performed using the R statistical language. Results: The incidence of TMDs in the world population was 34%. The age group 18–60 years is the most exposed to TMDs. From the data presented, we observed that for each continent, the female group was 9% to 56% larger than the male group. The highest female-to-male ratio (F:M) was reported in South America (1.56), whereas the lowest F:M ratio was reported in Europe (1.09), suggesting an almost equal distribution of males and females. Conclusions: This suggests that geographical location may play a role in the results of the studies. The prevalence of TMDs was significantly higher in South America (47%) compared to Asia (33%) and Europe (29%). Larger epidemiological studies of TMDs in African and Australian populations are recommended. In conclusion, both visual and statistical assessments suggest that the results of our meta-analysis are robust and unlikely to be significantly affected by publication bias. This suggests that geographical location may play a role in the prevalence of TMDs. Full article

(This article belongs to the Special Issue Multidisciplinary Approach to Diagnosing and Treatment of Temporomandibular Disorders—Patient Care Challenges)

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Graphical abstract

21 pages, 2985 KiB

Open AccessEditor’s ChoiceSystematic Review

Celiac Disease-Related Enamel Defects: A Systematic Review

by Alessio Danilo Inchingolo, Gianna Dipalma, Fabio Viapiano, Anna Netti, Irene Ferrara, Anna Maria Ciocia, Antonio Mancini, Daniela Di Venere, Andrea Palermo, Angelo Michele Inchingolo and Francesco Inchingolo

J. Clin. Med. 2024, 13(5), 1382; https://doi.org/10.3390/jcm13051382 - 28 Feb 2024

Cited by 6 | Viewed by 4355

Abstract

Introduction: This systematic review aims to elucidate the intricate correlation between celiac disease (CD) and dental enamel defects (DED), exploring pathophysiological mechanisms, oral health implications, and a dentist’s role in early diagnosis. Materials and methods: Following PRISMA guidelines, a comprehensive search from 1 [...] Read more.

Introduction: This systematic review aims to elucidate the intricate correlation between celiac disease (CD) and dental enamel defects (DED), exploring pathophysiological mechanisms, oral health implications, and a dentist’s role in early diagnosis. Materials and methods: Following PRISMA guidelines, a comprehensive search from 1 January 2013 to 1 January 2024 across PubMed, Cochrane Library, Scopus, and Web of Science identified 153 publications. After exclusions, 18 studies met the inclusion criteria for qualitative analysis. Inclusion criteria involved study types (RCTs, RCCTs, case series), human participants, English language, and full-text available. Results: The search yielded 153 publications, with 18 studies meeting the inclusion criteria for qualitative analysis. Notable findings include a high prevalence of DED in CD patients, ranging from 50 to 94.1%. Symmetrical and chronological defects, according to Aine’s classification, were predominant, and significant associations were observed between CD severity and enamel defect extent. Conclusions: The early recognition of oral lesions, particularly through Aine’s classification, may signal potential CD even in the absence of gastrointestinal symptoms. Correlations between CD and dental health conditions like molar incisor hypomineralization (MIH) emphasize the dentist’s crucial role in early diagnosis. Collaboration between dentists and gastroenterologists is essential for effective monitoring and management. This review consolidates current knowledge, laying the groundwork for future research and promoting interdisciplinary collaboration for improved CD-related oral health outcomes. Further large-scale prospective research is recommended to deepen our understanding of these issues. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics—2nd Edition)

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15 pages, 2173 KiB

Open AccessEditor’s ChoiceArticle

Complete Blood Count (CBC)-Derived Inflammation Indexes Are Useful in Predicting Metabolic Syndrome in Adults with Severe Obesity

by Alice Marra, Adele Bondesan, Diana Caroli and Alessandro Sartorio

J. Clin. Med. 2024, 13(5), 1353; https://doi.org/10.3390/jcm13051353 - 27 Feb 2024

Cited by 17 | Viewed by 3417

Abstract

Background: Metabolic syndrome (MetS) is a globally increasing pathological condition. Recent research highlighted the utility of complete blood count-derived (CBC) inflammation indexes to predict MetS in adults with obesity. Methods: This study examined CBC-derived inflammation indexes (NHR, LHR, MHR, PHR, SIRI, AISI, and [...] Read more.

Background: Metabolic syndrome (MetS) is a globally increasing pathological condition. Recent research highlighted the utility of complete blood count-derived (CBC) inflammation indexes to predict MetS in adults with obesity. Methods: This study examined CBC-derived inflammation indexes (NHR, LHR, MHR, PHR, SIRI, AISI, and SII) in 231 adults with severe obesity (88 males, 143 females; age: 52.3 [36.4–63.3] years), divided based on the presence (MetS+) or absence (MetS-) of MetS. The relationships between the indexes and the cardiometabolic risk biomarkers HOMA-IR, TG/HDL-C, and non-HDL-C were also evaluated. Results: Individuals with metabolic syndrome (MetS+) had significantly higher values of MHR, LHR, NHR, PHR, and SIRI than those without (MetS-) (MHR and NHR: p < 0.0001; LHR: p = 0.001; PHR: p = 0.011; SIRI: p = 0.021). These values were positively correlated with the degree of MetS severity. Logistic regression (MHR and NHR: p = 0.000; LHR: p = 0.002; PHR: p = 0.022; SIRI: p = 0.040) and ROC analysis (MHR: AUC = 0.6604; LHR: AUC = 0.6343; NHR: AUC = 0.6741; PHR: AUC = 0.6054; SIRI: AUC = 0.5955) confirmed the predictive potential of CBC-derived inflammation indexes for MetS in individuals with severe obesity. CBC-derived inflammation indexes also correlated with HOMA-IR (MHR, LHR, and NHR: p < 0.0001; PHR: p < 0.001; SIRI: p = 0.000) and TG/HDL-C (MHR, LHR, NHR and PHR: p < 0.0001; SIRI: p = 0.006). Conclusions: In conclusion, this study validates CBC-derived inflammation indexes for predicting MetS in individuals with severe obesity. The relationships between these indexes and cardiometabolic risk factors can enable clinicians to better grade MetS associated with obesity. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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18 pages, 829 KiB

Open AccessEditor’s ChoiceReview

Novel and Emerging LDL-C Lowering Strategies: A New Era of Dyslipidemia Management

by Federica Agnello, Salvatore Ingala, Giulia Laterra, Lorenzo Scalia and Marco Barbanti

J. Clin. Med. 2024, 13(5), 1251; https://doi.org/10.3390/jcm13051251 - 22 Feb 2024

Cited by 8 | Viewed by 10640

Abstract

Atherosclerotic cardiovascular disease (ASCVD) represents a major global health challenge, significantly contributing to mortality rates. This chronic inflammatory condition affecting blood vessels is intricately linked to hypercholesterolemia, with elevated levels of low-density lipoprotein cholesterol (LDL-C) recognized as a central and modifiable risk factor. [...] Read more.

Atherosclerotic cardiovascular disease (ASCVD) represents a major global health challenge, significantly contributing to mortality rates. This chronic inflammatory condition affecting blood vessels is intricately linked to hypercholesterolemia, with elevated levels of low-density lipoprotein cholesterol (LDL-C) recognized as a central and modifiable risk factor. The effectiveness of lipid-lowering therapy (LLT) in mitigating ASCVD risk is well established, with studies revealing a substantial reduction in major ischemic events correlating with LDL-C reduction. While statins, often combined with ezetimibe, remain fundamental in dyslipidemia management, a significant proportion of patients on statin therapy continue to experience cardiovascular events. Recent pharmacological advancements, driven by a deeper understanding of atherogenesis, have unveiled novel therapeutic targets and potent drugs. Notably, agents like bempedoic acid and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (evolocumab, alirocumab, inclisiran) have emerged as effective options to intensify LLT and achieve LDL-C goals, addressing limitations associated with statins, such as myopathy. Molecular insights into alternative pathways have spurred the investigation of emerging agents, offering promising perspectives for novel medications with efficacy comparable to established treatments, associated with advantages in cost and administration. This review provides a comprehensive overview of the evolving landscape of lipid-lowering strategies, highlighting the progress made in addressing ASCVD risk and the potential of upcoming therapies to further optimize cardiovascular prevention. Full article

(This article belongs to the Section Cardiovascular Medicine)

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12 pages, 2481 KiB

Open AccessEditor’s ChoiceSystematic Review

Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients with Acute Decompensated Heart Failure: A Meta-Analysis

by Song Peng Ang, Jia Ee Chia, Vikash Jaiswal, Muhammad Hanif and Jose Iglesias

J. Clin. Med. 2024, 13(5), 1212; https://doi.org/10.3390/jcm13051212 - 21 Feb 2024

Cited by 10 | Viewed by 1891

Abstract

Background: Inflammation plays a pivotal role in the pathogenesis of both acute and chronic heart failure. Recent studies showed that the neutrophil-to-lymphocyte ratio (NLR) could be related to adverse outcomes in patients with cardiovascular diseases. We sought to evaluate whether NLR could predict [...] Read more.

Background: Inflammation plays a pivotal role in the pathogenesis of both acute and chronic heart failure. Recent studies showed that the neutrophil-to-lymphocyte ratio (NLR) could be related to adverse outcomes in patients with cardiovascular diseases. We sought to evaluate whether NLR could predict mortality in patients with acute heart failure by means of a meta-analysis. Methods: A comprehensive literature search was performed in PubMed, Embase, and Cochrane databases through January 2023 for studies evaluating the association of NLR with mortality in patients with acute heart failure. Primary outcomes were in-hospital mortality and long-term all-cause mortality. Endpoints were pooled using a random-effects DerSimonian-and-Laird model and were expressed as a hazard ratio (HR) or mean difference (MD) with their corresponding 95% confidence intervals. Results: A total of 15 studies with 15,995 patients with acute heart failure were included in the final study. Stratifying patients based on a cut-off NLR, we found that high NLR was associated with a significantly higher in-hospital mortality [HR 1.54, 95% CI (1.18–2.00), p < 0.001] and long-term all-cause mortality [HR 1.61, 95% CI (1.40–1.86), p < 0.001] compared to the low-NLR group. Comparing the highest against the lowest NLR quartile, it was shown that patients in the highest NLR quartile has a significantly heightened risk of long-term all-cause mortality [HR 1.77, 95% CI (1.38–2.26), p < 0.001] compared to that of lowest NLR quartile. However, the risks of in-hospital mortality were compared between both quartiles of patients [HR 1.78, 95% CI (0.91–3.47), p = 0.09]. Lastly, NLR values were significantly elevated among non-survivors compared to survivors during index hospitalization [MD 5.07, 95% CI (3.34–6.80), p < 0.001] and during the follow-up period [MD 1.06, 95% CI (0.54–1.57), p < 0.001]. Conclusions: Elevated NLR was associated with an increased risk of short- and long-term mortality and could be a useful tool or incorporated in the risk stratification in patients with acute heart failure. Full article

(This article belongs to the Special Issue Key Advances in the Treatment of the Critically Ill: 2nd Edition)

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11 pages, 250 KiB

Open AccessEditor’s ChoiceReview

Interactions between the Exocrine and the Endocrine Pancreas

by Roberto Valente, Alessandro Coppola, Chiara Maria Scandavini, Asif Halimi, Annelie Magnusson, Augusto Lauro, Ira Sotirova, Urban Arnelo and Oskar Franklin

J. Clin. Med. 2024, 13(4), 1179; https://doi.org/10.3390/jcm13041179 - 19 Feb 2024

Cited by 8 | Viewed by 6069

Abstract

The pancreas has two main functions: to produce and secrete digestive enzymes (exocrine function) and to produce hormones that regulate blood glucose and splanchnic secretion (endocrine function). The endocrine and exocrine portions of the pancreas are central regulators in digestion and metabolism, with [...] Read more.

The pancreas has two main functions: to produce and secrete digestive enzymes (exocrine function) and to produce hormones that regulate blood glucose and splanchnic secretion (endocrine function). The endocrine and exocrine portions of the pancreas are central regulators in digestion and metabolism, with continuous crosstalk between their deeply interconnected components, which plays a role in disease. Pancreatic neoplasms, inflammation, trauma, and surgery can lead to the development of type 3c diabetes when an insult simultaneously damages both acini and islets, leading to exocrine and endocrine dysfunction. In diabetes mellitus patients, pancreatic exocrine insufficiency is highly prevalent, yet little is known about the associations between diabetes mellitus and pancreatic exocrine function. This review aims to provide an overview of the physiology of the pancreas, summarize the pathophysiology and diagnostic work-up of pancreatic exocrine insufficiency, and explore the relationships between exocrine pancreatic insufficiency and diabetes mellitus. Full article

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

32 pages, 2659 KiB

Open AccessEditor’s ChoiceSystematic Review

Nonsteroidal Anti-Inflammatory Drug Injections versus Steroid Injections in the Management of Upper and Lower Extremity Orthopedic Conditions: A Systematic Review with Meta-Analysis

by Hye Chang Rhim, Joseph Ruiz, Atta Taseh, Wilma Afunugo, Zack Crockett, Jason Schon, Xiaoyu Pan, Jaehyung Shin, Sean Schowalter, Ki-Mo Jang and David M Robinson

J. Clin. Med. 2024, 13(4), 1132; https://doi.org/10.3390/jcm13041132 - 17 Feb 2024

Cited by 4 | Viewed by 4372

Abstract

Background: Although corticosteroid injections are an effective treatment for musculoskeletal pathologies, they may not be suitable for all patients. The purpose of this systematic review was to compare clinical outcomes between patients who received NSAID and corticosteroid injections for various orthopedic conditions. Methods: [...] Read more.

Background: Although corticosteroid injections are an effective treatment for musculoskeletal pathologies, they may not be suitable for all patients. The purpose of this systematic review was to compare clinical outcomes between patients who received NSAID and corticosteroid injections for various orthopedic conditions. Methods: Medline, Embase, Web of Science, and Cochrane Central Register of Controlled Trials were searched, and meta-analyses were performed using a random-effects model for outcomes presented in three or more studies. Other studies were qualitatively analyzed. Results: A total of 28 articles with 2113 patients were included. A meta-analysis of five studies in patients with shoulder impingement syndrome demonstrated that there was no significant difference in the pain visual analogue scale (VAS) between subacromial NSAID injections and corticosteroid injections at 1 month [weighted mean difference (WMD) −0.244; 95% CI, −1.232 to 0.745; I², 94.5%]. For patients with knee osteoarthritis, a meta-analysis of three studies demonstrated that there was no significant difference between intraarticular NSAID injections and corticosteroid injections in pain VAS at 1 month (WMD 0.754; 95% CI, −0.413 to 1.921; I², 90.2%) and 3 months (WMD−0.089; 95% CI, −0.345 to 0.166; I², 0%). A review of the studies assessing pain outcomes for hip osteoarthritis, adhesive capsulitis, and plantar fasciitis showed no significant differences between the NSAID and corticosteroid groups. Conclusion: NSAID injections may be safe and effective alternatives to steroid injections, especially in shoulder impingement syndrome and knee osteoarthritis. Full article

(This article belongs to the Section Orthopedics)

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12 pages, 1654 KiB

Open AccessFeature PaperEditor’s ChoiceArticle

Early-Onset Colorectal Cancer: Are Neuroendocrine Tumors or Adenocarcinomas the Culprit? Analysis of the Largest U.S. Cancer Incidence Database, 2001–2020

by Yazan Abboud, Madison Fraser, Imran Qureshi and Kaveh Hajifathalian

J. Clin. Med. 2024, 13(4), 1098; https://doi.org/10.3390/jcm13041098 - 15 Feb 2024

Cited by 6 | Viewed by 2812

Abstract

(1) Background: While prior data showed an increasing incidence of colorectal cancer (CRC) in young adults, the contribution of adenocarcinoma (ADC) and neuroendocrine tumors (NETs) to this trend is not well studied. Therefore, we conducted a comparative analysis of the incidence rates and [...] Read more.

(1) Background: While prior data showed an increasing incidence of colorectal cancer (CRC) in young adults, the contribution of adenocarcinoma (ADC) and neuroendocrine tumors (NETs) to this trend is not well studied. Therefore, we conducted a comparative analysis of the incidence rates and time trends of colorectal ADC and NETs in young adults (aged 24–54) using the United States Cancer Statistics (USCS) database. (2) Methods: Age-adjusted CRC incidence rates between 2001 and 2020 were calculated and categorized by sex, histopathology, and stage at diagnosis. Annual percentage change (APC) and average APC (AAPC) were computed via joinpoint regression utilizing weighted Bayesian information criteria to generate the simplest trend. Pairwise comparative analysis of ADC and NETs was conducted using tests of identicalness and parallelism. (3) Results: In this study, 514,875 patients were diagnosed with early-onset-CRC between 2001 and 2020 (54.8% men). While CRC incidence was significantly increased, including both ADC (448,670 patients) and NETs (36,205 patients), a significantly greater increase was seen for NETs (AAPC = 2.65) compared to ADC (AAPC = 0.91), with AAPC difference = 1.73 (p = 0.01) and non-identical non-parallel trends (p-values < 0.001). This was most notable in males (AAPC difference = 1.81, p = 0.03) and for early-stage tumors (AAPC difference = 3.56, p < 0.001). (4) Conclusions: Our study, covering ~98% of the U.S. population provides the first comparative analysis of early-onset CRC histopathological subtypes, showing that the rate of increase of NETs in young adults is much greater than that of ADC. Given that patients with NETs with malignant behavior can experience significant mortality, our findings are importance, highlighting the rapidly increasing NET incidence in young adults and encouraging early screening that can improve outcomes. Full article

(This article belongs to the Special Issue From Endocrine Tumors Requiring Surgery to Endocrine Issues of Different Surgical Conditions)

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11 pages, 626 KiB

Open AccessEditor’s ChoiceArticle

Clinical Impact of Switching or Continuation of Apixaban or Rivaroxaban among Patients with Non-Valvular Atrial Fibrillation

by Steven Deitelzweig, Amiee Kang, Jenny Jiang, Chuan Gao, Xuemei Luo, Nipun Atreja, Stella Han, Dong Cheng, Saarusri R Loganathan and Gregory Y. H. Lip

J. Clin. Med. 2024, 13(4), 1073; https://doi.org/10.3390/jcm13041073 - 14 Feb 2024

Cited by 6 | Viewed by 11496

Abstract

Background: Real-world evidence on direct oral anticoagulant outcomes among Non-Valvular Atrial Fibrillation (NVAF) patients is limited. We aimed to evaluate stroke/systemic embolism (SE) and major bleeding (MB) risks among NVAF patients continuing or switching to different oral anticoagulants. Methods: Using Optum’s de-identified Clinformatics® [...] Read more.

Background: Real-world evidence on direct oral anticoagulant outcomes among Non-Valvular Atrial Fibrillation (NVAF) patients is limited. We aimed to evaluate stroke/systemic embolism (SE) and major bleeding (MB) risks among NVAF patients continuing or switching to different oral anticoagulants. Methods: Using Optum’s de-identified Clinformatics® Data Mart Database, we identified NVAF patients initiating apixaban or rivaroxaban between 1 January 2013 and 31 December 2021. Patients switching therapies within 30 days before or 90 days after discontinuing their initial DOAC and those who continued initial therapy were included. The index date was the switch date for switchers, while continuers were assigned a hypothetic index date. Switchers and continuers were propensity score matched based on pre-index characteristics. Results: Among 167,868 apixaban and 65,888 rivaroxaban initiators, 2900 apixaban-to-rivaroxaban switchers were matched with 14,500 apixaban continuers, and 2873 rivaroxaban-to-apixaban switchers were matched with 14,365 rivaroxaban continuers. Apixaban-to-rivaroxaban switching was associated with higher stroke/SE risk (HR: 1.99, 95% CI: 1.38–2.88) and MB risk (HR:1.80, 95% CI: 1.46–2.23) than continuing apixaban. Rivaroxaban-to-apixaban switching had similar stroke/SE risk (HR: 0.74, 95% CI: 0.45–1.22) but lower MB risk (HR: 0.49, 95% CI: 0.38–0.65) than continuing rivaroxaban. Conclusions: These findings may aid physicians and patients in making informed decisions when considering a switch between apixaban and rivaroxaban. Full article

(This article belongs to the Special Issue Cardiovascular Medicine and Cardiac Surgery)

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35 pages, 1283 KiB

Open AccessEditor’s ChoiceSystematic Review

Epidural Spinal Cord Stimulation for Spinal Cord Injury in Humans: A Systematic Review

by J. I. Chalif, V. S. Chavarro, E. Mensah, B. Johnston, D. P. Fields, E. J. Chalif, M. Chiang, O. Sutton, R. Yong, R. Trumbower and Y. Lu

J. Clin. Med. 2024, 13(4), 1090; https://doi.org/10.3390/jcm13041090 - 14 Feb 2024

Cited by 12 | Viewed by 7707

Abstract

(1) Background: Spinal cord injury (SCI) represents a major health challenge, often leading to significant and permanent sensorimotor and autonomic dysfunctions. This study reviews the evolving role of epidural spinal cord stimulation (eSCS) in treating chronic SCI, focusing on its efficacy and safety. [...] Read more.

(1) Background: Spinal cord injury (SCI) represents a major health challenge, often leading to significant and permanent sensorimotor and autonomic dysfunctions. This study reviews the evolving role of epidural spinal cord stimulation (eSCS) in treating chronic SCI, focusing on its efficacy and safety. The objective was to analyze how eSCS contributes to the recovery of neurological functions in SCI patients. (2) Methods: We utilized the PRISMA guidelines and performed a comprehensive search across MEDLINE/PubMed, Embase, Web of Science, and IEEE Xplore databases up until September 2023. We identified studies relevant to eSCS in SCI and extracted assessments of locomotor, cardiovascular, pulmonary, and genitourinary functions. (3) Results: A total of 64 studies encompassing 306 patients were identified. Studies investigated various stimulation devices, parameters, and rehabilitation methods. Results indicated significant improvements in motor function: 44% of patients achieved assisted or independent stepping or standing; 87% showed enhanced muscle activity; 65% experienced faster walking speeds; and 80% improved in overground walking. Additionally, eSCS led to better autonomic function, evidenced by improvements in bladder and sexual functions, airway pressures, and bowel movements. Notable adverse effects included device migration, infections, and post-implant autonomic dysreflexia, although these were infrequent. (4) Conclusion: Epidural spinal cord stimulation is emerging as an effective and generally safe treatment for chronic SCI, particularly when combined with intensive physical rehabilitation. Future research on standardized stimulation parameters and well-defined therapy regimens will optimize benefits for specific patient populations. Full article

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

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16 pages, 1998 KiB

Open AccessEditor’s ChoiceArticle

Assessment of Behavioral Risk Factors in Chronic Obstructive Airway Diseases of the Lung Associated with Metabolic Syndrome

by Andreea Mihai, Magdalena Mititelu, Marius Matei, Elena Carmen Lupu, Liliana Streba, Ionela Mihaela Vladu, Maria Livia Iovănescu, Ramona Cioboată, Cristina Călărașu, Ștefan Sebastian Busnatu and Costin Teodor Streba

J. Clin. Med. 2024, 13(4), 1037; https://doi.org/10.3390/jcm13041037 - 11 Feb 2024

Cited by 7 | Viewed by 2118

Abstract

Background: Diet and lifestyle play important roles in preventing and improving chronic diseases, and evaluating behavioral risk factors in these pathologies allows for efficient management. Methods: A clinical study by screening biochemical parameters and pulmonary function was carried out to evaluate behavioral risk [...] Read more.

Background: Diet and lifestyle play important roles in preventing and improving chronic diseases, and evaluating behavioral risk factors in these pathologies allows for efficient management. Methods: A clinical study by screening biochemical parameters and pulmonary function was carried out to evaluate behavioral risk factors in obstructive pulmonary disease associated with metabolic syndrome. Results: Of the total of 70 patients included in the clinical study, 46 were men and 24 were women (χ² = 3.9, p = 0.168). Forty-eight patients presented at least three met risk criteria associated with the metabolic syndrome (19 women and 29 men). Regarding the assessment of lung function, only 7 of the patients presented normal spirometry values (χ² = 75.28, p < 0.001), and the other 63 patients presented with ventilatory dysfunction; most (over 80%) declared that they were smokers or had smoked in the past (χ² = 5.185, p = 0.075). In terms of body weight, 45 of the patients are overweight or obese, most of them declaring that they do not consume enough vegetable products, they consume large amounts of foods of animal origin (meat, milk, eggs) but also super processed foods (food products type of junk food), do not hydrate properly, and are predominantly sedentary people (54 of the patients do no physical activity at all; χ² = 2.12, p = 0.713). Conclusion: From the statistical processing of the data, it is noted that insufficient hydration, low consumption of vegetables, increased consumption of hyper-caloric food products rich in additives, sedentary lifestyle, and smoking are the main disruptive behavioral factors that worsen the health status in lung disease associated with the metabolic syndrome. An important conclusion emerging from the study is that the imbalances that aggravate obstructive lung diseases are generated by unhealthy food and an unbalanced lifestyle. Full article

(This article belongs to the Section Respiratory Medicine)

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13 pages, 624 KiB

Open AccessEditor’s ChoiceReview

Current Approaches for Monitoring of Patients with Inflammatory Bowel Diseases: A Narrative Review

by Alessandro Vitello, Marcello Maida, Endrit Shahini, Fabio Salvatore Macaluso, Ambrogio Orlando, Mauro Grova, Daryl Ramai, Gaetano Serviddio and Antonio Facciorusso

J. Clin. Med. 2024, 13(4), 1008; https://doi.org/10.3390/jcm13041008 - 9 Feb 2024

Cited by 6 | Viewed by 3425

Abstract

Background: Patients with inflammatory bowel diseases (IBD) require proactive monitoring both during the active phase to evaluate therapeutic response and during the remission phase to evaluate relapse or colorectal cancer surveillance. However, monitoring may vary between patients with ulcerative colitis (UC) and Crohn’s [...] Read more.

Background: Patients with inflammatory bowel diseases (IBD) require proactive monitoring both during the active phase to evaluate therapeutic response and during the remission phase to evaluate relapse or colorectal cancer surveillance. However, monitoring may vary between patients with ulcerative colitis (UC) and Crohn’s disease (CD), with distinct tools and intervals. Methods: This narrative review aims to focus on modern approaches to IBD monitoring, considering international guidelines and expert consensus. Results: The most recent European diagnostic guidelines advocate a combination of clinical, laboratory, endoscopic, and radiological parameters to evaluate the disease course of patients with IBD. Unfortunately, the conventional symptom-based therapeutic approach does not improve long-term outcomes and there is no single ideal biomarker available. Endoscopy plays a key role in evaluating response to therapy as well as monitoring disease activity. Recently, bedside intestinal ultrasound (IUS) has gained increasing interest and diffusion as it appears to offer several advantages including the monitoring of therapeutic response. Conclusion: In light of growing clinical advances, we present a schematic evidence-based monitoring algorithm that can be easily applied in clinical practice which combines all major monitoring modalities, including noninvasive tools such as IUS and video-capsule endoscopy. Full article

(This article belongs to the Special Issue Optimizing Present and Future Therapeutic Choices for Treatment and Management of Chronic Inflammatory Bowel Diseases)

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14 pages, 673 KiB

Open AccessEditor’s ChoiceReview

Metabolic Disorders in Liver Transplant Recipients: The State of the Art

by Filippo Gabrielli, Lucia Golfieri, Fabio Nascimbeni, Pietro Andreone and Stefano Gitto

J. Clin. Med. 2024, 13(4), 1014; https://doi.org/10.3390/jcm13041014 - 9 Feb 2024

Cited by 8 | Viewed by 2597

Abstract

Liver transplantation represents a chief therapeutic approach for acute liver failure, end-stage liver disease and hepatocellular carcinoma. Despite witnessing advancements in short- and medium-term survival over recent decades, attributed to refinements in surgical techniques and immunosuppressive protocols, long-term mortality remains impervious to modification. [...] Read more.

Liver transplantation represents a chief therapeutic approach for acute liver failure, end-stage liver disease and hepatocellular carcinoma. Despite witnessing advancements in short- and medium-term survival over recent decades, attributed to refinements in surgical techniques and immunosuppressive protocols, long-term mortality remains impervious to modification. Notably, cardiovascular disease emerges as a predominant cause of mortality among liver transplant recipients. This trend is accentuated by the increasing prominence of non-alcoholic steatohepatitis-related cirrhosis as an indication for liver transplantation. Moreover, the administration of immunosuppressive agents is intricately linked to the degradation of the metabolic profile in liver transplant recipients, thereby contributing to the initiation or exacerbation of cardiovascular risk factors, such as hypertension, diabetes, and dyslipidaemia. In addition, the post-liver transplantation period is marked by a decline in lifestyle quality and a failure to acknowledge the psychological distress experienced by patients throughout the transplant process. These factors can precipitate a deterioration in the patient’s metabolic profile, exacerbated by suboptimal therapeutic compliance. This narrative review aims to comprehensively address the principal metabolic disorders intricately associated with liver transplantation. Full article

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

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12 pages, 4335 KiB

Open AccessEditor’s ChoiceArticle

Outcomes of Boston Keratoprosthesis Type I Implantation in Poland: A Retrospective Study on 118 Patients

by Ewa Wróblewska-Czajka, Dariusz Dobrowolski, Adam Wylęgała, Ula V. Jurkunas and Edward Wylęgała

J. Clin. Med. 2024, 13(4), 975; https://doi.org/10.3390/jcm13040975 - 8 Feb 2024

Cited by 4 | Viewed by 1434

Abstract

Background: Boston Keratoprosthesis Type I (BI-KPro I) is a synthetic cornea that can be used to restore vision in patients with corneal blindness. This retrospective study evaluated the outcomes of BI-KPro implantation in 118 patients. Material: The mean age of the patients was [...] Read more.

Background: Boston Keratoprosthesis Type I (BI-KPro I) is a synthetic cornea that can be used to restore vision in patients with corneal blindness. This retrospective study evaluated the outcomes of BI-KPro implantation in 118 patients. Material: The mean age of the patients was 56.76 ± 14.24 years. Indications for keratoprosthesis implantation were as follows: graft failure, 47 (39.83%); ocular burn, 38 (32.20%); neurotrophic keratopathy, 11 (9.32%), mucous membrane pemphigoid 9 (7.67%); autoimmune, 6 (5.08%); Stevens–Johnson syndrome, 4 (3.39%); and aniridia (2.54%). Methods: The surgeries were performed between March 2019 and June 2022 at a single clinical center in two locations. The postoperative visual acuity, complications, and need for additional surgical procedures were analyzed. Results: The Best Corrected Visual Acuity before surgery was 0.01 ± 0.006. After one year (V1), it was 0.30 ± 0.27; at two years (V2), it was 0.27 ± 0.26; and at three years (V3), it was 0.21 ± 0.23. The percentage of patients with visual acuity better than 0.1 on the Snellen chart was 37.29% after 1 year, 49.35% after 2 years, and 46.81% after 3 years of follow up. The most common complications were glaucoma (78 patients; 66.1%), corneal melting (22 patients; 18.6%), and retroprosthetic membranes (20 patients; 17.0%). Conclusions: The BI-KPro can significantly improve visual acuity. The worst long-term results were obtained in the group of patients with autoimmune diseases; therefore, careful consideration should be given to implanting BI-KPro in this group. The high incidence of de novo glaucoma or the progression of pre-existing glaucoma suggests the need for careful monitoring. Full article

(This article belongs to the Section Ophthalmology)

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10 pages, 904 KiB

Open AccessEditor’s ChoiceArticle

Fracture Severity and Triangular Fibrocartilage Complex Injury in Distal Radius Fractures with or without Osteoporosis

by Ho-Won Lee, Ki-Tae Kim, Sanghyeon Lee, Joon-Hyeok Yoon and Jung-Youn Kim

J. Clin. Med. 2024, 13(4), 992; https://doi.org/10.3390/jcm13040992 - 8 Feb 2024

Cited by 4 | Viewed by 2402

Abstract

The purpose of this study was to investigate the fracture morphology of distal radius fractures (DRFs) with the status of triangular fibrocartilage complex (TFCC) foveal insertion in patients with or without osteoporosis and to identify the relationship between osteoporosis and foveal tear. Seventy-five [...] Read more.

The purpose of this study was to investigate the fracture morphology of distal radius fractures (DRFs) with the status of triangular fibrocartilage complex (TFCC) foveal insertion in patients with or without osteoporosis and to identify the relationship between osteoporosis and foveal tear. Seventy-five patients who underwent surgery for DRF from January 2021 to September 2023 were included. All patients were evaluated by standard radiography and dual-energy X-ray absorptiometry and underwent a 3.0 T magnetic-resonance imaging examination of the involved wrist to identify TFCC foveal tear. Patients were allocated into two groups according to the presence of osteoporosis: patients with osteoporosis (group I) and those without osteoporosis (group II). Group I showed a significantly larger displacement of fractures compared to group II (radial inclination; 13.7 ± 5.4 vs. 17.9 ± 4.2; p < 0.001, dorsal angulation; 22.2 ± 12.1 vs. 16.5 ± 9.4; p = 0.024, ulnar variance; 4.15 ± 2.1 vs. 2.2 ± 1.9; p < 0.001). Dorsal angulation and ulnar variance were found to be independent prognostic factors for TFCC foveal tear in logistic regression analysis. Displacement of fractures was related to osteoporosis, and dorsal angulation and ulnar variance were independent prognostic factors for TFCC foveal tear. However, osteoporosis was not identified as a factor associated with TFCC foveal tears. Full article

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

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10 pages, 1376 KiB

Open AccessEditor’s ChoiceArticle

Reduction of Post-Surgical Facial Edema Following Bromelain and Coumarin Intake in Traumatology: A Prospective Study with 100 Patients

by Giuseppe Consorti, Gabriele Monarchi, Mariagrazia Paglianiti, Enrico Betti and Paolo Balercia

J. Clin. Med. 2024, 13(4), 922; https://doi.org/10.3390/jcm13040922 - 6 Feb 2024

Cited by 7 | Viewed by 2133

Abstract

Background: Bromelain and coumarins are recognized as safe and effective therapeutic agents, used by individuals to treat ailments such as postoperative edema, inflammation and other diseases. Bromelain has been proven to be well absorbed by the body after oral administration, and it has [...] Read more.

Background: Bromelain and coumarins are recognized as safe and effective therapeutic agents, used by individuals to treat ailments such as postoperative edema, inflammation and other diseases. Bromelain has been proven to be well absorbed by the body after oral administration, and it has no major side effects even after prolonged use. The purpose of this study is to evaluate the effectiveness of bromelain and other nutraceuticals in reducing post-surgical swelling, pain and the need of anti-inflammatory drugs in maxillofacial post-traumatic surgery. Methods: This prospective open-label study was conducted on patients undergoing surgery for trauma of the maxillofacial area. One hundred patients were selected and divided into two groups: one group who underwent therapy with bromelain, Aesculus hippocastanum and Melilotus officinalis and a control group that was not given the drug in postoperative therapy. Results: Patients in the experimental group showed a reduction of edema in the first and second postoperative weeks, a faster complete reduction of facial edema and a lower reduction in maximum mouth opening and needed less anti-inflammatory therapy to control pain. Conclusions: These findings seem to provide evidence that Brovas^® may be effective in improving postoperative edema outcomes in patients undergoing surgical treatment of facial fractures. Full article

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

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11 pages, 1922 KiB

Open AccessEditor’s ChoiceArticle

Occlusal Caries Detection with Intraoral Scanners in Pediatric Dentistry: A Comparative Clinical Study

by Nelly Schulz-Weidner, Marina Gruber, Bernd Wöstmann, Constanze Friederike Uebereck, Norbert Krämer and Maximiliane Amelie Schlenz

J. Clin. Med. 2024, 13(4), 925; https://doi.org/10.3390/jcm13040925 - 6 Feb 2024

Cited by 5 | Viewed by 2913

Abstract

Background: The aim of this clinical study was to compare the occlusal caries detection (OCD) performance of the intraoral scanners (IOSs) Trios 4 (TIO, 3Shape) and Emerald S (EME, Planmeca) and the Diagnocam (DIA, KaVo) with the established visual (WHO) examination (VIS, reference [...] Read more.

Background: The aim of this clinical study was to compare the occlusal caries detection (OCD) performance of the intraoral scanners (IOSs) Trios 4 (TIO, 3Shape) and Emerald S (EME, Planmeca) and the Diagnocam (DIA, KaVo) with the established visual (WHO) examination (VIS, reference method). Methods: Between 08/2022 and 02/2023, 60 children (mean age 9.6 ± 2.5 years) were examined as part of their regular dental checkups. OCD was performed at the tooth level, separately for primary and permanent unrestored teeth. Furthermore, two thresholds were analyzed: sound versus overall caries (pooled data of enamel and dentin caries, TH1) and pooled data of sound and enamel caries versus dentin caries (TH2). Results: The best agreement with the reference method (reliability) in both dentitions was obtained for DIA (ĸ = 0.829/ĸ = 0.846; primary/permanent teeth), followed by EME (ĸ = 0.827/ĸ = 0.837) and TIO (ĸ = 0.714/ĸ = 0.680). Similar results were shown for the diagnostic quality (sensitivity, specificity and area under the curve of the receiver operating characteristic curve), with higher values for TH1 than for TH2. Both IOSs and the DIA showed worse results than the reference method VIS. Conclusions: Currently, IOS should be used as an additional caries detection tool, especially for visualization, and cannot be recommended as a basic tool for diagnosis or invasive/noninvasive therapy decisions in OCD. Full article

(This article belongs to the Special Issue Novel Research in Pediatric Dentistry)

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12 pages, 573 KiB

Open AccessEditor’s ChoiceArticle

Association between Preoperative Glucose Dysregulation and Delirium after Non-Cardiac Surgery

by Ah Ran Oh, Dong Yun Lee, Seunghwa Lee, Jong-Hwan Lee, Kwangmo Yang, Byungjin Choi and Jungchan Park

J. Clin. Med. 2024, 13(4), 932; https://doi.org/10.3390/jcm13040932 - 6 Feb 2024

Cited by 6 | Viewed by 1813

Abstract

This study aimed to investigate the association between glucose dysregulation and delirium after non-cardiac surgery. Among a total of 203,787 patients who underwent non-cardiac surgery between January 2011 and June 2019 at our institution, we selected 61,805 with available preoperative blood glucose levels [...] Read more.

This study aimed to investigate the association between glucose dysregulation and delirium after non-cardiac surgery. Among a total of 203,787 patients who underwent non-cardiac surgery between January 2011 and June 2019 at our institution, we selected 61,805 with available preoperative blood glucose levels within 24 h before surgery. Patients experiencing glucose dysregulation were divided into three groups: hyperglycemia, hypoglycemia, and both. We compared the incidence of postoperative delirium within 30 days after surgery between exposed and unexposed patients according to the type of glucose dysregulation. The overall incidence of hyperglycemia, hypoglycemia, and both was 5851 (9.5%), 1452 (2.3%), and 145 (0.2%), respectively. The rate of delirium per 100 person-months of the exposed group was higher than that of the unexposed group in all types of glucose dysregulation. After adjustment, the hazard ratios of glucose dysregulation in the development of delirium were 1.35 (95% CI, 1.18–1.56) in hyperglycemia, 1.36 (95% CI, 1.06–1.75) in hypoglycemia, and 3.14 (95% CI, 1.27–7.77) in both. The subgroup analysis showed that exposure to hypoglycemia or both to hypo- and hyperglycemia was not associated with delirium in diabetic patients, but hyperglycemia was consistently associated with postoperative delirium regardless of the presence of diabetes. Preoperative glucose dysregulation was associated with increased risk of delirium after non-cardiac surgery. Our findings may be helpful for preventing postoperative delirium, and further investigations are required to verify the association and mechanisms for the effect we observed. Full article

(This article belongs to the Section General Surgery)

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13 pages, 275 KiB

Open AccessEditor’s ChoiceReview

Tele-Monitoring Applications in Respiratory Allergy

by Xenofon Aggelidis, Maria Kritikou, Michael Makris, Michael Miligkos, Niki Papapostolou, Nikolaos G. Papadopoulos and Paraskevi Xepapadaki

J. Clin. Med. 2024, 13(3), 898; https://doi.org/10.3390/jcm13030898 - 4 Feb 2024

Cited by 8 | Viewed by 3721

Abstract

Respiratory allergic diseases affect over 500 million people globally and pose a substantial burden in terms of morbidity, mortality, and healthcare costs. Restrictive factors such as geographical disparities, infectious pandemics, limitations in resources, and shortages of allergy specialists in underserved areas impede effective [...] Read more.

Respiratory allergic diseases affect over 500 million people globally and pose a substantial burden in terms of morbidity, mortality, and healthcare costs. Restrictive factors such as geographical disparities, infectious pandemics, limitations in resources, and shortages of allergy specialists in underserved areas impede effective management. Telemedicine encompasses real-time visits, store-and-forward option triage, and computer-based technologies for establishing efficient doctor-patient communication. Recent advances in digital technology, including designated applications, informative materials, digital examination devices, wearables, digital inhalers, and integrated platforms, facilitate personalized and evidence-based care delivery. The integration of telemonitoring in respiratory allergy care has shown beneficial effects on disease control, adherence, and quality of life. While the COVID-19 pandemic accelerated the adoption of telemedicine, certain concerns regarding technical requirements, platform quality, safety, reimbursement, and regulatory considerations remain unresolved. The integration of artificial intelligence (AI) in telemonitoring applications holds promise for data analysis, pattern recognition, and personalized treatment plans. Striking the balance between AI-enabled insights and human expertise is crucial for optimizing the benefits of telemonitoring. While telemonitoring exhibits potential for enhancing patient care and healthcare delivery, critical considerations have to be addressed in order to ensure the successful integration of telemonitoring into the healthcare landscape. Full article

(This article belongs to the Special Issue Allergic Asthma: Causes, Diagnosis and Treatment)

15 pages, 301 KiB

Open AccessEditor’s ChoiceReview

Altered Autonomic Function in Metabolic Syndrome: Interactive Effects of Multiple Components

by Joseph Mannozzi, Louis Massoud, Jon Stavres, Mohamed-Hussein Al-Hassan and Donal S. O’Leary

J. Clin. Med. 2024, 13(3), 895; https://doi.org/10.3390/jcm13030895 - 3 Feb 2024

Cited by 5 | Viewed by 2044

Abstract

Metabolic syndrome (MetS) describes a set of disorders that collectively influence cardiovascular health, and includes hypertension, obesity, insulin resistance, diabetes, and dyslipidemia. All these components (hypertension, obesity, dyslipidemia, and prediabetes/diabetes) have been shown to modify autonomic function. The major autonomic dysfunction that has [...] Read more.

Metabolic syndrome (MetS) describes a set of disorders that collectively influence cardiovascular health, and includes hypertension, obesity, insulin resistance, diabetes, and dyslipidemia. All these components (hypertension, obesity, dyslipidemia, and prediabetes/diabetes) have been shown to modify autonomic function. The major autonomic dysfunction that has been documented with each of these components is in the control of sympathetic outflow to the heart and periphery at rest and during exercise through modulation of the arterial baroreflex and the muscle metaboreflex. Many studies have described MetS components in singularity or in combination with the other major components of metabolic syndrome. However, many studies lack the capability to study all the factors of metabolic syndrome in one model or have not focused on studying the effects of how each component as it arises influences overall autonomic function. The goal of this review is to describe the current understanding of major aspects of metabolic syndrome that most likely contribute to the consequent/associated autonomic alterations during exercise and discuss their effects, as well as bring light to alternative mechanisms of study. Full article

(This article belongs to the Special Issue New Advances in Cardiorenal Syndrome)

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13 pages, 1969 KiB

Open AccessEditor’s ChoiceArticle

Method Comparison of Erythrocyte Sedimentation Rate Automated Systems, the VES-MATIC 5 (DIESSE) and Test 1 (ALIFAX), with the Reference Method in Routine Practice

by Michele Cennamo, Loredana Giuliano, Gloria Arrigoni, Valentina Fardone, Roberta Russo, Luca Maria De Tomasi, Fabio Bertani, Gaetano Cammarota, Giovanni Brunetti, Lucia Del Vecchio and Michelarcangelo Partenope

J. Clin. Med. 2024, 13(3), 847; https://doi.org/10.3390/jcm13030847 - 1 Feb 2024

Cited by 6 | Viewed by 2507

Abstract

Background: The erythrocyte sedimentation rate (ESR) is a routine and aspecific test that is still widely used. The reference-manual method for ESR determination is the Westergren method. The VES-MATIC 5 is a novel, fully automated, and closed system based on a modified [...] Read more.

Background: The erythrocyte sedimentation rate (ESR) is a routine and aspecific test that is still widely used. The reference-manual method for ESR determination is the Westergren method. The VES-MATIC 5 is a novel, fully automated, and closed system based on a modified Westergren method. This study conceived the aim of comparing two ESR analytical analysers, Test 1 and the VES-MATIC 5, with the reference method in routine practice. Methods: This study included 264 randomly analysed samples. A comparison between the two methods and Westergren was performed, and they were evaluated for inter-run and intra-run precision. In addition, we investigated possible interferences and different sensitivities to conventional analytes. Results: The comparison of methods by Passing–Bablok analysis provided a good agreement for both systems, with a better correlation for VES-MATIC 5 (p = 0.96) than Test 1 (p = 0.93), and sensitivity studies did not show any significant influence. Conclusions: The VES-MATIC 5 analyser demonstrated excellent comparability with the reference method, and it had better performance than Test 1. It can be employed in routine practice, bringing advantages such as a reduction in the probability of human error compared to the manual method, as well as an increase in operator safety and environmental protection. Full article

(This article belongs to the Section Clinical Laboratory Medicine)

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12 pages, 1165 KiB

Open AccessEditor’s ChoiceArticle

Predictive Factors of Cardiac Mortality Following TEER in Patients with Secondary Mitral Regurgitation

by Teruhiko Imamura, Shuhei Tanaka, Ryuichi Ushijima, Nobuyuki Fukuda, Hiroshi Ueno, Koichiro Kinugawa, Shunsuke Kubo, Masanori Yamamoto, Mike Saji, Masahiko Asami, Yusuke Enta, Masaki Nakashima, Shinichi Shirai, Masaki Izumo, Shingo Mizuno, Yusuke Watanabe, Makoto Amaki, Kazuhisa Kodama, Junichi Yamaguchi, Yoshifumi Nakajima, Toru Naganuma, Hiroki Bota, Yohei Ohno, Masahiro Yamawaki, Kazuki Mizutani, Toshiaki Otsuka, Kentaro Hayashida and on behalf of the OCEAN-Mitral Investigators Show full author list Hide full author list

J. Clin. Med. 2024, 13(3), 851; https://doi.org/10.3390/jcm13030851 - 1 Feb 2024

Viewed by 1900

Abstract

Background: Transcatheter edge-to-edge mitral valve repair (TEER) has emerged as a viable approach to addressing substantial secondary mitral regurgitation. In the contemporary landscape where ultimate heart failure-specific therapies, such as cardiac replacement modalities, are available, prognosticating a high-risk cohort susceptible to early cardiac [...] Read more.

Background: Transcatheter edge-to-edge mitral valve repair (TEER) has emerged as a viable approach to addressing substantial secondary mitral regurgitation. In the contemporary landscape where ultimate heart failure-specific therapies, such as cardiac replacement modalities, are available, prognosticating a high-risk cohort susceptible to early cardiac mortality post-TEER is pivotal for formulating an effective therapeutic regimen. Methods: Our study encompassed individuals with secondary mitral regurgitation and chronic heart failure enlisted in the multi-center (Optimized CathEter vAlvular iNtervention (OCEAN)-Mitral registry. We conducted an assessment of baseline variables associated with cardiac death within one year following TEER. Results: Amongst the 1517 patients (median age: 78 years, 899 males), 101 experienced cardiac mortality during the 1-year observation period after undergoing TEER. Notably, a history of heart failure-related admissions within the preceding year, utilization of intravenous inotropes, and elevated plasma B-type natriuretic peptide levels emerged as independent prognosticators for the primary outcome (p < 0.05 for all). Subsequently, we devised a novel risk-scoring system encompassing these variables, which significantly stratified the cumulative incidence of the 1-year primary outcome (16%, 8%, and 4%, p < 0.001). Conclusions: Our study culminated in the development of a new risk-scoring system aimed at predicting 1-year cardiac mortality post-TEER. Full article

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

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15 pages, 1295 KiB

Open AccessEditor’s ChoiceArticle

Long-Term Clinical Outcomes in Patients with Chronic Rhinosinusitis with Nasal Polyps Associated with Expanded Types of Endoscopic Sinus Surgery

by Daniel Martin-Jimenez, Ramon Moreno-Luna, Amparo Callejon-Leblic, Alfonso del Cuvillo, Charles S. Ebert, Jr., Juan Maza-Solano, Jaime Gonzalez-Garcia, Pedro Infante-Cossio and Serafin Sanchez-Gomez

J. Clin. Med. 2024, 13(3), 866; https://doi.org/10.3390/jcm13030866 - 1 Feb 2024

Cited by 9 | Viewed by 3101

Abstract

(1) Background: Surgical criteria for chronic rhinosinusitis with nasal polyps (CRSwNP) remain unresolved. This study addresses these discrepancies by comparing the clinical outcomes of expanded–functional endoscopic sinus surgeries (E–FESS) with more-limited FESS (L-FESS). (2) Methods: A database was analyzed retrospectively to compare surgical [...] Read more.

(1) Background: Surgical criteria for chronic rhinosinusitis with nasal polyps (CRSwNP) remain unresolved. This study addresses these discrepancies by comparing the clinical outcomes of expanded–functional endoscopic sinus surgeries (E–FESS) with more-limited FESS (L-FESS). (2) Methods: A database was analyzed retrospectively to compare surgical outcomes in CRSwNP patients who underwent E-FESS versus those subjected to L-FESS. Quality of life, endoscopic and radiological outcomes were compared at the baseline and two years after surgery. The clinical status of the responder was defined when a minimal clinically important difference of 12 points in SNOT-22 change was achieved. (3) Results: A total of 274 patients met the inclusion criteria and were analyzed; 111 underwent E-FESS and 163 were subjected to L-FESS. Both groups exhibited significant clinical improvements, although a greater magnitude of change in SNOT-22 (14.8 ± 4.8, p = 0.002) was shown after E-FESS. Higher significant improvements for endoscopic and radiological scores and lower surgical revision rates were also noted in the E-FESS group. (4) Conclusions: E-FESS provides better clinical outcomes and reduced revision surgery rates when compared to L-FESS in CRSwNP patients two years after surgery, irrespective of any comorbidity. Further randomized prospective studies are needed to comprehensively contrast these results. Full article

(This article belongs to the Special Issue Advances in Treatment and Management of Chronic Rhinosinusitis)

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25 pages, 4780 KiB

Open AccessEditor’s ChoiceArticle

Methylphenidate Ameliorates Behavioural and Neurobiological Deficits in Executive Function for Patients with Chronic Traumatic Brain Injury

by Alexander R. D. Peattie, Anne E. Manktelow, Barbara J. Sahakian, David K. Menon and Emmanuel A. Stamatakis

J. Clin. Med. 2024, 13(3), 771; https://doi.org/10.3390/jcm13030771 - 29 Jan 2024

Cited by 4 | Viewed by 3672

Abstract

(1) Background: Traumatic brain injury (TBI) often results in cognitive impairments, including in visuospatial planning and executive function. Methylphenidate (MPh) demonstrates potential improvements in several cognitive domains in patients with TBI. The Tower of London (TOL) is a visuospatial planning task used [...] Read more.

(1) Background: Traumatic brain injury (TBI) often results in cognitive impairments, including in visuospatial planning and executive function. Methylphenidate (MPh) demonstrates potential improvements in several cognitive domains in patients with TBI. The Tower of London (TOL) is a visuospatial planning task used to assess executive function. (2) Methods: Volunteers with a history of TBI (n = 16) participated in a randomised, double-blinded, placebo-controlled, fMRI study to investigate the neurobiological correlates of visuospatial planning and executive function, on and off MPh. (3) Results: Healthy controls (HCs) (n = 18) and patients on placebo (TBI-placebo) differed significantly in reaction time (p < 0.0005) and accuracy (p < 0.0001) when considering all task loads, but especially for high cognitive loads for reaction time (p < 0.001) and accuracy (p < 0.005). Across all task loads, TBI-MPh were more accurate than TBI-placebo (p < 0.05) but remained less accurate than HCs (p < 0.005). TBI-placebo substantially improved in accuracy with MPh administration (TBI-MPh) to a level statistically comparable to HCs at low (p = 0.443) and high (p = 0.175) cognitive loads. Further, individual patients that performed slower on placebo at low cognitive loads were faster with MPh (p < 0.05), while individual patients that performed less accurately on placebo were more accurate with MPh at both high and low cognitive loads (p < 0.005). TBI-placebo showed reduced activity in the bilateral inferior frontal gyri (IFG) and insulae versus HCs. MPh normalised these regional differences. MPh enhanced within-network connectivity (between parietal, striatal, insula, and cerebellar regions) and enhanced beyond-network connectivity (between parietal, thalamic, and cerebellar regions). Finally, individual changes in cerebellar-thalamic (p < 0.005) and cerebellar-parietal (p < 0.05) connectivity with MPh related to individual changes in accuracy with MPh. (4) Conclusions: This work highlights behavioural and neurofunctional differences between HCs and patients with chronic TBI, and that adverse differences may benefit from MPh treatment. Full article

(This article belongs to the Special Issue Targeted Diagnosis and Management of Traumatic Brain Injury)

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17 pages, 1006 KiB

Open AccessEditor’s ChoiceReview

Heart Rate Variability as a Tool for Seizure Prediction: A Scoping Review

by Federico Mason, Anna Scarabello, Lisa Taruffi, Elena Pasini, Giovanna Calandra-Buonaura, Luca Vignatelli and Francesca Bisulli

J. Clin. Med. 2024, 13(3), 747; https://doi.org/10.3390/jcm13030747 - 27 Jan 2024

Cited by 6 | Viewed by 3790

Abstract

The most critical burden for People with Epilepsy (PwE) is represented by seizures, the unpredictability of which severely impacts quality of life. The design of real-time warning systems that can detect or even predict ictal events would enhance seizure management, leading to high [...] Read more.

The most critical burden for People with Epilepsy (PwE) is represented by seizures, the unpredictability of which severely impacts quality of life. The design of real-time warning systems that can detect or even predict ictal events would enhance seizure management, leading to high benefits for PwE and their caregivers. In the past, various research works highlighted that seizure onset is anticipated by significant changes in autonomic cardiac control, which can be assessed through heart rate variability (HRV). This manuscript conducted a scoping review of the literature analyzing HRV-based methods for detecting or predicting ictal events. An initial search on the PubMed database returned 402 papers, 72 of which met the inclusion criteria and were included in the review. These results suggest that seizure detection is more accurate in neonatal and pediatric patients due to more significant autonomic modifications during the ictal transitions. In addition, conventional metrics are often incapable of capturing cardiac autonomic variations and should be replaced with more advanced methodologies, considering non-linear HRV features and machine learning tools for processing them. Finally, studies investigating wearable systems for heart monitoring denoted how HRV constitutes an efficient biomarker for seizure detection in patients presenting significant alterations in autonomic cardiac control during ictal events. Full article

(This article belongs to the Section Clinical Neurology)

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23 pages, 3282 KiB

Open AccessEditor’s ChoiceReview

Recent Advances and Future Directions in Syncope Management: A Comprehensive Narrative Review

by Anna Maria Martone, Iris Parrini, Francesca Ciciarello, Vincenzo Galluzzo, Stefano Cacciatore, Claudia Massaro, Rossella Giordano, Tommaso Giani, Giovanni Landi, Michele Massimo Gulizia, Furio Colivicchi, Domenico Gabrielli, Fabrizio Oliva and Giuseppe Zuccalà

J. Clin. Med. 2024, 13(3), 727; https://doi.org/10.3390/jcm13030727 - 26 Jan 2024

Cited by 10 | Viewed by 19307

Abstract

Syncope is a highly prevalent clinical condition characterized by a rapid, complete, and brief loss of consciousness, followed by full recovery caused by cerebral hypoperfusion. This symptom carries significance, as its potential underlying causes may involve the heart, blood pressure, or brain, leading [...] Read more.

Syncope is a highly prevalent clinical condition characterized by a rapid, complete, and brief loss of consciousness, followed by full recovery caused by cerebral hypoperfusion. This symptom carries significance, as its potential underlying causes may involve the heart, blood pressure, or brain, leading to a spectrum of consequences, from sudden death to compromised quality of life. Various factors contribute to syncope, and adhering to a precise diagnostic pathway can enhance diagnostic accuracy and treatment effectiveness. A standardized initial assessment, risk stratification, and appropriate test identification facilitate determining the underlying cause in the majority of cases. New technologies, including artificial intelligence and smart devices, may have the potential to reshape syncope management into a proactive, personalized, and data-centric model, ultimately enhancing patient outcomes and quality of life. This review addresses key aspects of syncope management, including pathogenesis, current diagnostic testing options, treatments, and considerations in the geriatric population. Full article

(This article belongs to the Section Cardiology)

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15 pages, 558 KiB

Open AccessEditor’s ChoiceReview

Possible Effect of Polycystic Ovary Syndrome (PCOS) on Cardiovascular Disease (CVD): An Update

by Nicia I. Profili, Roberto Castelli, Antonio Gidaro, Roberto Manetti, Margherita Maioli, Marco Petrillo, Giampiero Capobianco and Alessandro P. Delitala

J. Clin. Med. 2024, 13(3), 698; https://doi.org/10.3390/jcm13030698 - 25 Jan 2024

Cited by 8 | Viewed by 4243

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women during the fertile period. Women with PCOS have an increased risk of developing major cardiovascular risk factors during the fertile period: obesity, impaired glucose tolerance, diabetes mellitus, dyslipidemia, and metabolic syndrome. [...] Read more.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women during the fertile period. Women with PCOS have an increased risk of developing major cardiovascular risk factors during the fertile period: obesity, impaired glucose tolerance, diabetes mellitus, dyslipidemia, and metabolic syndrome. The possible effect of PCOS on cardiovascular disease (CVD) has been reported in different studies, but the results are not clear for several reasons. Indeed, most of the studies analyzed a cohort of fertile women who, given their relatively young age, have a low frequency of cardiovascular diseases. In addition, longitudinal studies have a short follow-up period, insufficient to draw firm conclusions on this topic. Finally, pharmacological treatment is limited by the lack of specific drugs available to specifically treat PCOS. In this review, we report on studies that analyzed the possible effect of PCOS on the most common CVD (hypertension, arterial stiffness, atherosclerosis, and cardiovascular event) and available drugs used to reduce CVD in PCOS women. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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13 pages, 1055 KiB

Open AccessEditor’s ChoiceArticle

Evaluating Computer Vision, Large Language, and Genome-Wide Association Models in a Limited Sized Patient Cohort for Pre-Operative Risk Stratification in Adult Spinal Deformity Surgery

by Ethan Schonfeld, Aaradhya Pant, Aaryan Shah, Sina Sadeghzadeh, Dhiraj Pangal, Adrian Rodrigues, Kelly Yoo, Neelan Marianayagam, Ghani Haider and Anand Veeravagu

J. Clin. Med. 2024, 13(3), 656; https://doi.org/10.3390/jcm13030656 - 23 Jan 2024

Cited by 7 | Viewed by 2600

Abstract

Background: Adult spinal deformities (ASD) are varied spinal abnormalities, often necessitating surgical intervention when associated with pain, worsening deformity, or worsening function. Predicting post-operative complications and revision surgery is critical for surgical planning and patient counseling. Due to the relatively small number [...] Read more.

Background: Adult spinal deformities (ASD) are varied spinal abnormalities, often necessitating surgical intervention when associated with pain, worsening deformity, or worsening function. Predicting post-operative complications and revision surgery is critical for surgical planning and patient counseling. Due to the relatively small number of cases of ASD surgery, machine learning applications have been limited to traditional models (e.g., logistic regression or standard neural networks) and coarse clinical variables. We present the novel application of advanced models (CNN, LLM, GWAS) using complex data types (radiographs, clinical notes, genomics) for ASD outcome prediction. Methods: We developed a CNN trained on 209 ASD patients (1549 radiographs) from the Stanford Research Repository, a CNN pre-trained on VinDr-SpineXR (10,468 spine radiographs), and an LLM using free-text clinical notes from the same 209 patients, trained via Gatortron. Additionally, we conducted a GWAS using the UK Biobank, contrasting 540 surgical ASD patients with 7355 non-surgical ASD patients. Results: The LLM notably outperformed the CNN in predicting pulmonary complications (F1: 0.545 vs. 0.2881), neurological complications (F1: 0.250 vs. 0.224), and sepsis (F1: 0.382 vs. 0.132). The pre-trained CNN showed improved sepsis prediction (AUC: 0.638 vs. 0.534) but reduced performance for neurological complication prediction (AUC: 0.545 vs. 0.619). The LLM demonstrated high specificity (0.946) and positive predictive value (0.467) for neurological complications. The GWAS identified 21 significant (p < 10⁻⁵) SNPs associated with ASD surgery risk (OR: mean: 3.17, SD: 1.92, median: 2.78), with the highest odds ratio (8.06) for the LDB2 gene, which is implicated in ectoderm differentiation. Conclusions: This study exemplifies the innovative application of cutting-edge models to forecast outcomes in ASD, underscoring the utility of complex data in outcome prediction for neurosurgical conditions. It demonstrates the promise of genetic models when identifying surgical risks and supports the integration of complex machine learning tools for informed surgical decision-making in ASD. Full article

(This article belongs to the Special Issue Advances in Scoliosis, Spinal Deformity and Other Spinal Disorders)

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12 pages, 638 KiB

Open AccessEditor’s ChoiceArticle

Recurrence-Free Survival after Synovectomy and Subsequent Radiosynoviorthesis in Patients with Synovitis of the Knee—A Retrospective Data Analysis

by Melanie Schindler, Stephan Puchner, Jan Reinhard, Franziska Leiss, Reinhard Windhager and Richard Lass

J. Clin. Med. 2024, 13(2), 601; https://doi.org/10.3390/jcm13020601 - 21 Jan 2024

Cited by 6 | Viewed by 2367

Abstract

Background: Persistent knee synovitis leads to joint discomfort, incapacitating inflammation, and functional limitations. The conventional approach has involved surgical procedures to eliminate the actively inflamed synovial membrane. This study aims to investigate the recurrence-free survival and functional outcome after synovectomy and subsequent radiosynoviorthesis [...] Read more.

Background: Persistent knee synovitis leads to joint discomfort, incapacitating inflammation, and functional limitations. The conventional approach has involved surgical procedures to eliminate the actively inflamed synovial membrane. This study aims to investigate the recurrence-free survival and functional outcome after synovectomy and subsequent radiosynoviorthesis (RSO) in patients with knee synovitis. Methods: Thirty-seven knees diagnosed with pigmented villonodular synovitis (PVNS), rheumatoid arthritis (RA), and peripheral spondyloarthritis underwent synovectomy and subsequent RSO between May 2005 and October 2016. The mean age was 34.9 ± 15.1 years, and the mean follow-up period was 84 ± 36.4 months. Clinical outcomes were assessed using the Oxford Knee Score and the presence of swelling and pain at the last follow-up. Recurrence-free survival denotes the duration from synovectomy to surgical re-synovectomy. Results: In general, twelve knees underwent re-synovectomy after a mean follow-up of 34.8 ± 24.9 months. The recurrence-free survival was 83.8% at two years, 71.3% at five years, and 61.7% at ten years. The subgroup analysis revealed recurrence-free survival at two years in 63.6% of patients with PVNS, 86.7% of those with RA, and 100% of individuals with peripheral spondyloarthritis. Conclusions: This study demonstrates that combined therapy for synovitis is an effective approach, significantly improving clinical outcomes. Full article

(This article belongs to the Special Issue Pain and Rheumatology)

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13 pages, 904 KiB

Open AccessEditor’s ChoiceSystematic Review

The Kynurenine Pathway in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Blood Concentrations of Tryptophan and Its Catabolites

by Daniele Cavaleri, Cristina Crocamo, Pietro Morello, Francesco Bartoli and Giuseppe Carrà

J. Clin. Med. 2024, 13(2), 583; https://doi.org/10.3390/jcm13020583 - 19 Jan 2024

Cited by 6 | Viewed by 1955

Abstract

Preliminary evidence shows that the kynurenine pathway (KP) may be altered in attention-deficit/hyperactivity disorder (ADHD). We thus conducted a systematic review and meta-analysis exploring the peripheral blood concentrations of tryptophan catabolites (TRYCATs) in people with ADHD. We searched the main electronic databases up [...] Read more.

Preliminary evidence shows that the kynurenine pathway (KP) may be altered in attention-deficit/hyperactivity disorder (ADHD). We thus conducted a systematic review and meta-analysis exploring the peripheral blood concentrations of tryptophan catabolites (TRYCATs) in people with ADHD. We searched the main electronic databases up to 7th December 2023. Standardised mean differences (SMDs) with 95% confidence intervals (95%CIs) were used to compare TRYCAT concentrations between participants with ADHD and healthy controls (HCs). We included eight studies. Random-effects meta-analyses found higher kynurenine (SMD = 0.56; 95%CI: 0.04 to 1.08; p = 0.033; I² = 90.3%) and lower kynurenic acid (SMD = −0.33; 95%CI: −0.49 to −0.17; p < 0.001; I² = 0%) concentrations in people with ADHD compared to HCs. Additional analyses on drug-free children with ADHD showed higher tryptophan (SMD = 0.31; 95%CI: 0.11 to 0.50; p = 0.002; I² = 0%) and kynurenine (SMD = 0.74; 95%CI: 0.30 to 1.17; p < 0.001; I² = 76.5%), as well as lower kynurenic acid (SMD = −0.37; 95%CI: −0.59 to −0.15; p < 0.001; I² = 0%) blood levels, as compared to HCs. Despite some limitations, our work provides preliminary evidence on KP alterations in ADHD that may suggest decreased neuroprotection. Further research is needed to clarify the role of the KP in ADHD. Full article

(This article belongs to the Special Issue Research Status of Attention Deficit Hyperactivity Disorder)

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14 pages, 625 KiB

Open AccessEditor’s ChoiceArticle

Association between Asthma and Lower Levels of Physical Activity: Results of a Population-Based Case–Control Study in Spain

by Javier De-Miguel-Diez, Carlos Llamas-Saez, Teresa Saez Vaquero, Rodrigo Jiménez-García, Ana López-de-Andrés, David Carabantes-Alarcón, Francisco Carricondo, Barbara Romero-Gómez and Napoleón Pérez-Farinos

J. Clin. Med. 2024, 13(2), 591; https://doi.org/10.3390/jcm13020591 - 19 Jan 2024

Cited by 5 | Viewed by 1769

Abstract

(1) Background: Our aim was to determine changes in the prevalence of physical activity (PA) in adults with asthma between 2014 and 2020 in Spain, investigate sex differences and the effect of other variables on adherence to PA, and compare the prevalence of [...] Read more.

(1) Background: Our aim was to determine changes in the prevalence of physical activity (PA) in adults with asthma between 2014 and 2020 in Spain, investigate sex differences and the effect of other variables on adherence to PA, and compare the prevalence of PA between individuals with and without asthma. (2) Methods: This study was a cross-sectional, population-based, matched, case–control study using European Health Interview Surveys for Spain (EHISS) for 2014 and 2020. (3) Results: We identified 1262 and 1103 patients with asthma in the 2014 and 2020 EHISS, respectively. The prevalence of PA remained stable (57.2% vs. 55.7%, respectively), while the percentage of persons who reported walking continuously for at least 2 days a week increased from 73.9% to 82.2% (p < 0.001). Male sex, younger age, better self-rated health, and lower body mass index (BMI) were significantly associated with greater PA. From 2014 to 2020, the number of walking days ≥2 increased by 64% (OR1.64 95%CI 1.34–2.00). Asthma was associated with less PA (OR0.87 95%CI 0.47–0.72) and a lower number of walking days ≥2 (OR0.84 95%0.72–0.97). (4) Conclusions: Walking frequency improved over time among people with asthma. Differences in PA were detected by age, sex, self-rated health status, and BMI. Asthma was associated with less LTPA and a lower number of walking days ≥2. Full article

(This article belongs to the Section Respiratory Medicine)

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14 pages, 1528 KiB

Open AccessEditor’s ChoiceReview

Current Approach to Complications and Difficulties during Transrectal Ultrasound-Guided Prostate Biopsies

by Salloum Osama, Crenguta Serboiu, Iulian-Alexandru Taciuc, Emil Angelescu, Costin Petcu, Tiberiu Alexandru Priporeanu, Andreea Marinescu and Adrian Costache

J. Clin. Med. 2024, 13(2), 487; https://doi.org/10.3390/jcm13020487 - 16 Jan 2024

Cited by 6 | Viewed by 2576

Abstract

Prostate cancer is one of the most common male malignancies worldwide. It affects middle-aged men (45–60 years) and is the leading cause of cancer-related mortality in Western countries. The TRUS (trans rectal ultrasound)-guided prostate biopsy has been a standard procedure in prostate cancer [...] Read more.

Prostate cancer is one of the most common male malignancies worldwide. It affects middle-aged men (45–60 years) and is the leading cause of cancer-related mortality in Western countries. The TRUS (trans rectal ultrasound)-guided prostate biopsy has been a standard procedure in prostate cancer detection for more than thirty years, and it is recommended in male patients with an abnormal PSA (prostate-specific antigens) or abnormalities found during digital rectal examinations. During this procedure, urologists might encounter difficulties which may cause subsequent complications. This manuscript aims to present both the complications and the technical difficulties that may occur during TRUS-guided prostate biopsy, along with resolutions and solutions found in the specialized literature. The conclusions of this manuscript will note that the TRUS-guided prostate biopsy remains a solid, cost-efficient, and safe procedure with which to diagnose prostate cancer. The complications are usually self-limiting and do not require additional medical assistance. The difficulties posed by the procedure can be safely overcome if there are no other available alternatives. Open communication with the patients improves both pre- and post-procedure compliance. Full article

(This article belongs to the Section Nephrology & Urology)

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13 pages, 1611 KiB

Open AccessEditor’s ChoiceArticle

Is the Ventilatory Efficiency in Endurance Athletes Different?—Findings from the NOODLE Study

by Przemysław Kasiak, Tomasz Kowalski, Kinga Rębiś, Andrzej Klusiewicz, Maria Ładyga, Dorota Sadowska, Adrian Wilk, Szczepan Wiecha, Marcin Barylski, Adam Rafał Poliwczak, Piotr Wierzbiński, Artur Mamcarz and Daniel Śliż

J. Clin. Med. 2024, 13(2), 490; https://doi.org/10.3390/jcm13020490 - 16 Jan 2024

Cited by 9 | Viewed by 2196

Abstract

Background: Ventilatory efficiency (VE/VCO₂) is a strong predictor of cardiovascular diseases and defines individuals’ responses to exercise. Its characteristics among endurance athletes (EA) remain understudied. In a cohort of EA, we aimed to (1) investigate the relationship between different methods of [...] Read more.

Background: Ventilatory efficiency (VE/VCO₂) is a strong predictor of cardiovascular diseases and defines individuals’ responses to exercise. Its characteristics among endurance athletes (EA) remain understudied. In a cohort of EA, we aimed to (1) investigate the relationship between different methods of calculation of VE/VCO₂ and (2) externally validate prediction equations for VE/VCO₂. Methods: In total, 140 EA (55% males; age = 22.7 ± 4.6 yrs; BMI = 22.6 ± 1.7 kg·m⁻²; peak oxygen uptake = 3.86 ± 0.82 L·min⁻¹) underwent an effort-limited cycling cardiopulmonary exercise test. VE/VCO₂ was first calculated to ventilatory threshold (VE/VCO₂-slope), as the lowest 30-s average (VE/VCO₂-Nadir) and from whole exercises (VE/VCO₂-Total). Twelve prediction equations for VE/VCO₂-slope were externally validated. Results: VE/VCO₂-slope was higher in females than males (27.7 ± 2.6 vs. 26.1 ± 2.0, p < 0.001). Measuring methods for VE/VCO₂ differed significantly in males and females. VE/VCO₂ increased in EA with age independently from its type or sex (β = 0.066–0.127). Eleven equations underestimated VE/VCO₂-slope (from −0.5 to −3.6). One equation overestimated VE/VCO₂-slope (+0.2). Predicted and observed measurements differed significantly in nine models. Models explained a low amount of variance in the VE/VCO₂-slope (R² = 0.003–0.031). Conclusions: VE/VCO₂-slope, VE/VCO₂-Nadir, and VE/VCO₂-Total were significantly different in EA. Prediction equations for the VE/VCO₂-slope were inaccurate in EA. Physicians should be acknowledged to properly assess cardiorespiratory fitness in EA. Full article

(This article belongs to the Section Sports Medicine)

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10 pages, 1001 KiB

Open AccessEditor’s ChoiceArticle

Improved Extracorporeal Cardiopulmonary Resuscitation (ECPR) Outcomes are Associated with a Restrictive Patient Selection Algorithm

by Benjamin Assouline, Nathalie Mentha, Hannah Wozniak, Viviane Donner, Carole Looyens, Laurent Suppan, Robert Larribau, Carlo Banfi, Karim Bendjelid and Raphaël Giraud

J. Clin. Med. 2024, 13(2), 497; https://doi.org/10.3390/jcm13020497 - 16 Jan 2024

Cited by 4 | Viewed by 2540

Abstract

Introduction: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality. Despite decades of intensive research and several technological advancements, survival rates remain low. The integration of extracorporeal cardiopulmonary resuscitation (ECPR) has been recognized as a promising approach in refractory OHCA. However, evidence [...] Read more.

Introduction: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality. Despite decades of intensive research and several technological advancements, survival rates remain low. The integration of extracorporeal cardiopulmonary resuscitation (ECPR) has been recognized as a promising approach in refractory OHCA. However, evidence from recent randomized controlled trials yielded contradictory results, and the criteria for selecting eligible patients are still a subject of debate. Methods: This study is a retrospective analysis of refractory OHCA patients treated with ECPR. All adult patients who received ECPR, according to the hospital algorithm, from 2013 to 2021 were included. Two different algorithms were used during this period. A “permissive” algorithm was used from 2013 to mid-2016. Subsequently, a revised algorithm, more “restrictive”, based on international guidelines, was implemented from mid-2016 to 2021. Key differences between the two algorithms included reducing the no-flow time from less than three minutes to zero minutes (implying that the cardiac arrests must occur in the presence of a witness with immediate CPR initiation), reducing low-flow duration from 100 to 60 min, and lowering the age limit from 65 to 55 years. The aim of this study is to compare these two algorithms (permissive (1) and restrictive (2)) to determine if the use of a restrictive algorithm was associated with higher survival rates. Results: A total of 48 patients were included in this study, with 23 treated under Algorithm 1 and 25 under Algorithm 2. A significant difference in survival rate was observed in favor of the restrictive algorithm (9% vs. 68%, p < 0.05). Moreover, significant differences emerged between algorithms regarding the no-flow time (0 (0–5) vs. 0 (0–0) minutes, p < 0.05). Survivors had a significantly shorter no-flow and low-flow time (0 (0–0) vs. 0 (0–3) minutes, p < 0.01 and 40 (31–53) vs. 60 (45–80) minutes, p < 0.05), respectively. Conclusion: The present study emphasizes that a stricter selection of OHCA patients improves survival rates in ECPR. Full article

(This article belongs to the Special Issue Clinical Advances in Cardiac Arrest and Cardiopulmonary Resuscitation)

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12 pages, 1107 KiB

Open AccessEditor’s ChoiceSystematic Review

Using Three-Dimensional Printing Technology to Solve Complex Primary Total Hip Arthroplasty Cases: Do We Really Need Custom-Made Guides and Templates? A Critical Systematic Review on the Available Evidence

by Giuseppe Anzillotti, Edoardo Guazzoni, Pietro Conte, Vincenzo Di Matteo, Elizaveta Kon, Guido Grappiolo and Mattia Loppini

J. Clin. Med. 2024, 13(2), 474; https://doi.org/10.3390/jcm13020474 - 15 Jan 2024

Cited by 4 | Viewed by 1602

Abstract

The burden of osteoarthritis (OA) is around 300 million people affected worldwide, with the hip representing a commonly affected joint. Total hip arthroplasty (THA) has been used with notable success as a definitive treatment to improve pain and function in hip OA patients. [...] Read more.

The burden of osteoarthritis (OA) is around 300 million people affected worldwide, with the hip representing a commonly affected joint. Total hip arthroplasty (THA) has been used with notable success as a definitive treatment to improve pain and function in hip OA patients. The recent advent of new technologies, such as 3D printing, has pushed the application of these new concepts toward applications for the well-known THA. Currently, the evidence on the use of 3D printing to aid complex primary THA cases is still scarce. Methods: An extensive literature review was conducted to retrieve all articles centered on the use of 3D printing in the setting of primary THA. Results: A total of seven studies were included in the present systematic review. Four studies investigated the use of 3D-printed surgical guides to be used during surgery. The remaining three studies investigated the benefit of the use of 3D-printed templates of the pelvis to simulate the surgery. Conclusions: The use of 3D printing could be a promising aid to solve difficult primary total hip arthroplasty cases. However, the general enthusiasm in the field is not supported by high-quality studies, hence preventing us from currently recommending its application in everyday practice. Full article

(This article belongs to the Section Orthopedics)

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13 pages, 5650 KiB

Open AccessEditor’s ChoiceReview

Fat Matters: Exploring Cancer Risk through the Lens of Computed Tomography and Visceral Adiposity

by Federico Greco, Claudia Lucia Piccolo, Valerio D’Andrea, Arnaldo Scardapane, Bruno Beomonte Zobel and Carlo Augusto Mallio

J. Clin. Med. 2024, 13(2), 453; https://doi.org/10.3390/jcm13020453 - 14 Jan 2024

Cited by 6 | Viewed by 2435

Abstract

Obesity is an established risk factor for cancer. However, conventional measures like body mass index lack precision in assessing specific tissue quantities, particularly of the two primary abdominal fat compartments, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Computed tomography (CT) stands [...] Read more.

Obesity is an established risk factor for cancer. However, conventional measures like body mass index lack precision in assessing specific tissue quantities, particularly of the two primary abdominal fat compartments, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). Computed tomography (CT) stands as the gold standard for precisely quantifying diverse tissue types. VAT, distinguished by heightened hormonal and metabolic activity, plays a pivotal role in obesity-related tumor development. Excessive VAT is linked to aberrant secretion of adipokines, proinflammatory cytokines, and growth factors, fostering the carcinogenesis of obesity-related tumors. Accurate quantification of abdominal fat compartments is crucial for understanding VAT as an oncological risk factor. The purpose of the present research is to elucidate the role of CT, performed for staging purposes, in assessing VAT (quantity and distribution) as a critical factor in the oncogenesis of obesity-related tumors. In the field of precision medicine, this work takes on considerable importance, as quantifying VAT in oncological patients becomes fundamental in understanding the influence of VAT on cancer development–the potential “phenotypic expression” of excessive VAT accumulation. Previous studies analyzed in this research showed that VAT is a risk factor for clear cell renal cell carcinoma, non-clear cell renal cell carcinoma, prostate cancer, and hepatocarcinoma recurrence. Further studies will need to quantify VAT in other oncological diseases with specific mutations or gene expressions, in order to investigate the relationship of VAT with tumor genomics. Full article

(This article belongs to the Section Nuclear Medicine & Radiology)

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12 pages, 612 KiB

Open AccessEditor’s ChoiceReview

Arrhythmogenic Cardiomyopathy: Definition, Classification and Arrhythmic Risk Stratification

by Marisa Varrenti, Alberto Preda, Antonio Frontera, Matteo Baroni, Lorenzo Gigli, Sara Vargiu, Giulia Colombo, Marco Carbonaro, Marco Paolucci, Federica Giordano, Fabrizio Guarracini and Patrizio Mazzone

J. Clin. Med. 2024, 13(2), 456; https://doi.org/10.3390/jcm13020456 - 14 Jan 2024

Cited by 6 | Viewed by 2240

Abstract

Arrhythmogenic cardiomyopathy (ACM) is a heart disease characterized by a fibrotic replacement of myocardial tissue and a consequent predisposition to ventricular arrhythmic events, especially in the young. Post-mortem studies and the subsequent diffusion of cardiac MRI have shown that left ventricular involvement in [...] Read more.

Arrhythmogenic cardiomyopathy (ACM) is a heart disease characterized by a fibrotic replacement of myocardial tissue and a consequent predisposition to ventricular arrhythmic events, especially in the young. Post-mortem studies and the subsequent diffusion of cardiac MRI have shown that left ventricular involvement in arrhythmogenic cardiomyopathy is common and often develops early. Regarding the arrhythmic risk stratification, the current scores underestimate the arrhythmic risk of patients with arrhythmogenic cardiomyopathy with left involvement. Indeed, the data on arrhythmic risk stratification in this group of patients are contradictory and not exhaustive, with the consequence of not correctly identifying patients at a high arrhythmic risk who deserve protection from arrhythmic death. We propose a literature review on arrhythmic risk stratification in patients with ACM and left involvement to identify the main features associated with an increased arrhythmic risk in this group of patients. Full article

(This article belongs to the Section Cardiology)

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30 pages, 2462 KiB

Open AccessEditor’s ChoiceSystematic Review

Systematic Review of Auditory Training Outcomes in Adult Cochlear Implant Recipients and Meta-Analysis of Outcomes

by James R. Dornhoffer, Shreya Chidarala, Terral Patel, Karl R. Khandalavala, Shaun A. Nguyen, Kara C. Schvartz-Leyzac, Judy R. Dubno, Matthew L. Carlson, Aaron C. Moberly and Theodore R. McRackan

J. Clin. Med. 2024, 13(2), 400; https://doi.org/10.3390/jcm13020400 - 11 Jan 2024

Cited by 5 | Viewed by 2635

Abstract

Objective: to review evidence on the efficacy of auditory training in adult cochlear implant recipients. Data Sources: PRISMA guidelines for a systematic review of the literature were followed. PubMed, Scopus, and CINAHL databases were queried on 29 June 2023 for terms involving cochlear [...] Read more.

Objective: to review evidence on the efficacy of auditory training in adult cochlear implant recipients. Data Sources: PRISMA guidelines for a systematic review of the literature were followed. PubMed, Scopus, and CINAHL databases were queried on 29 June 2023 for terms involving cochlear implantation and auditory training. Studies were limited to the English language and adult patient populations. Study Selection: Three authors independently reviewed publications for inclusion in the review based on a priori inclusion and exclusion criteria. Inclusion criteria encompassed adult cochlear implant populations, an analysis of clinician- or patient-directed auditory training, and an analysis of one or more measures of speech recognition and/or patient-reported outcome. Exclusion criteria included studies with only pediatric implant populations, music or localization training in isolation, and single-sample case studies. Data Extraction: The data were collected regarding study design, patient population, auditory training modality, auditory training timing, speech outcomes, and data on the durability of outcomes. A quality assessment of the literature was performed using a quality metric adapted from the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group guidelines. Data Synthesis and Meta-Analysis: Data were qualitatively summarized for 23 studies. All but four studies demonstrated significant improvement in at least one measured or patient-reported outcome measure with training. For 11 studies with sufficient data reporting, pre-intervention and post-intervention pooled means of different outcome measures were compared for 132 patients using meta-analysis. Patient-direct training was associated with significant improvement in vowel-phoneme recognition and speech recognition in noise (p < 0.05 and p < 0.001, respectively), and clinician-directed training showed significant improvement in sentence recognition in noise (p < 0.001). Conclusions: The literature on auditory training for adult cochlear implant recipients is limited and heterogeneous, including a small number of studies with limited levels of evidence and external validity. However, the current evidence suggests that auditory training can improve speech recognition in adult cochlear implant recipients. Full article

(This article belongs to the Special Issue Current Advances in Assessment and Intervention for Hearing Loss and Cochlear Implantation)

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12 pages, 969 KiB

Open AccessEditor’s ChoiceReview

Therapeutic Strategies in Children with Epilepsy: A Quality-of-Life-Related Perspective

by Hideaki Kanemura

J. Clin. Med. 2024, 13(2), 405; https://doi.org/10.3390/jcm13020405 - 11 Jan 2024

Cited by 6 | Viewed by 2986

Abstract

Back ground: Children with epilepsy are affected by several factors, including clinical and social variables. Among these variables, cognitive decline and behavioral disturbances, perceptions of stigma, and fatigue can lead to reductions in quality of life (QOL). Epileptic activities, including seizure severity, frequent [...] Read more.

Back ground: Children with epilepsy are affected by several factors, including clinical and social variables. Among these variables, cognitive decline and behavioral disturbances, perceptions of stigma, and fatigue can lead to reductions in quality of life (QOL). Epileptic activities, including seizure severity, frequent seizures, and status epilepticus (SE), have been identified as important predictors of QOL. In addition, the frequency of interictal epileptiform discharges (IEDs) on electroencephalogram (EEG) may also be an important predictor of QOL, because IEDs can lead to cognitive decline and behavioral disturbances. Moreover, frequent seizures and/or IEDs may play a role in emotional mediators, such as stigma and fatigue, in childhood epilepsy. Seizure severity and/or IEDs are, therefore, important QOL-related factors in childhood epilepsy. Seizure severity as a QOL-related factor: Frontal lobe dysfunctions, such as cognitive decline and behavioral disturbances, can result in reduced QOL for both the child and their family. Frontal and prefrontal lobe growth disturbances can be present during active-phase epilepsy in some children with neuropsychological impairments. Recovery from prefrontal lobe growth disturbances may depend on the active seizure period. Children with a shorter active seizure period can recover from disturbances in prefrontal lobe growth more rapidly. In contrast, recovery may be delayed in children with a longer active seizure period. Moreover, frequent seizures can lead to seizure-associated headaches, perceptions of self-stigma and parental stigma, and fatigue. Accordingly, severe seizures can lead to neuropsychological impairments in association with prefrontal lobe growth disturbances in children with epilepsy. EEG abnormalities as QOL-related factors: IEDs on EEG, representing persistent pathological neuronal discharges, may be associated with several pathological aspects. Frontal IEDs can be a risk factor for recurrent seizures, cognitive decline, and behavioral disturbances, and they may also play a role as emotional mediators similar to stigma. In addition, behavioral disturbances may result in the presence of secondary bilateral synchrony (SBS) on EEG. Behavioral disturbances can be improved in association with a reduction in IEDs in children with frontal IEDs and SBS. Therefore, EEG abnormalities, such as frontal IEDs and SBS, can also lead to neuropsychological impairments in children with epilepsy. Therapeutic strategies in children with epilepsy: Seizure severity and IEDs on EEG may be associated with neuropsychological impairments, leading to QOL reduction. Therapeutic management may be desirable to reduce seizures and EEG abnormalities, such as frontal IEDs and SBS, as early as possible to improve QOL in children with epilepsy. During antiseizure medication (ASM) selection and adjustment, physicians should strategize the therapeutic approach to controlling seizures and suppressing EEG abnormalities in children with epilepsy. Among various ASMs, novel ASMs, such as levetiracetam and perampanel, may suppress both clinical seizures and IEDs on EEG; thus, these novel ASMs may represent an important addition to the treatments available for epileptic children presenting with frontal IEDs and SBS. Full article

(This article belongs to the Special Issue Clinical Therapeutic and Management Strategies for Epilepsy)

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12 pages, 1090 KiB

Open AccessEditor’s ChoiceArticle

The Extent and Nature of Functional Limitations According to the Health Assessment Questionnaire Disability Index in Patients with Rheumatoid Arthritis and Severe Functional Disability

by Max M. H. Teuwen, Maria A. T. van Wissen, Wilfred F. Peter, Dirkjan van Schaardenburg, Cornelia H. M. van den Ende, Maaike G. J. Gademan and Salima F. E. van Weely

J. Clin. Med. 2024, 13(2), 379; https://doi.org/10.3390/jcm13020379 - 10 Jan 2024

Cited by 4 | Viewed by 1805

Abstract

Background: For a subgroup of people with rheumatoid arthritis (RA) and severe disability, insight into their limitations is crucial for adequate treatment. Aim: To describe the extent and nature of functional limitations in people with RA and severe disability and to explore the [...] Read more.

Background: For a subgroup of people with rheumatoid arthritis (RA) and severe disability, insight into their limitations is crucial for adequate treatment. Aim: To describe the extent and nature of functional limitations in people with RA and severe disability and to explore the associations of the extent of the functional limitations with patient characteristics, disease characteristics, and outcome measures. Methods: Baseline data of 215 participants in an RCT on the (cost-)effectiveness of longstanding physiotherapy were used. Functional limitations were assessed with the Health Assessment Questionnaire Disability Index (HAQ-DI). The total HAQ-DI including eight domain scores were calculated. Associations between high HAQ-DI scores (≥2, yes/no) and other variables were examined using the Student’s t-test or Chi-squared test where appropriate. Results: The participants (90% women, age 58.8 ± 12.8 years) had a mean HAQ-DI score of 1.7 ± 0.5. The majority (56%) showed a moderate-to-severe disability in all domains. Higher HAQ-DI scores seemed to be associated with advanced age, longer disease duration, unemployment, joint replacements, and outcomes for daily functioning and physical quality of life, but not with measures of disease activity. Conclusions: Our findings indicate that a comprehensive assessment of all areas of daily activities in this subgroup is necessary in order to provide appropriate (non-)pharmacological care. Full article

(This article belongs to the Special Issue Physiotherapy and Rehabilitation for People with Rheumatic and Musculoskeletal Diseases)

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13 pages, 393 KiB

Open AccessEditor’s ChoiceReview

Investigating the Association of Assisted Reproduction Techniques and Adverse Perinatal Outcomes

by Anastasios Potiris, Paraskevas Perros, Eirini Drakaki, Despoina Mavrogianni, Nikolaos Machairiotis, Antonios Sfakianakis, Theodoros Karampitsakos, Dionysios Vrachnis, Nikolaos Antonakopoulos, Periklis Panagopoulos, Peter Drakakis and Sofoklis Stavros

J. Clin. Med. 2024, 13(2), 328; https://doi.org/10.3390/jcm13020328 - 6 Jan 2024

Cited by 12 | Viewed by 2977

Abstract

Background: Infertility affects about 80 million individuals worldwide and 10–15% of couples at reproductive age will seek medical assistance. There is increasing evidence that pregnancies after Assisted Reproduction Techniques (ART) are associated with pre-term birth, low birthweight, congenital defects, and increased mortality rates. [...] Read more.

Background: Infertility affects about 80 million individuals worldwide and 10–15% of couples at reproductive age will seek medical assistance. There is increasing evidence that pregnancies after Assisted Reproduction Techniques (ART) are associated with pre-term birth, low birthweight, congenital defects, and increased mortality rates. The aim of this review is to assess all the published literature and provide an updated review on the effect of assisted conception and perinatal and neonatal outcomes. Methods: Comprehensive research on Pubmed/Medline, Scopus, and Google scholar electronic databases was conducted from July 2023 up to September 2023, using the terms assisted reproductive techniques, ART, in vitro fertilization, IVF, intracytoplasmic sperm injection, ICSI, preterm birth, PTB, low birth weight, LBW, chromosomal defects, congenital defects, and hypospadias. In total, 87 full text articles were retrieved and after a careful evaluation, 31 studies were selected for data extraction. Results: Our review demonstrated a higher risk of congenital and chromosomal defects, and a higher incidence of male genital tract defects and heart defects in ART pregnancies. Regarding pre-term birth, our results were contradictory. Conclusions: Although assisted reproduction techniques are associated with increased risks, they are safe regarding perinatal outcomes and couples should not be discouraged from utilizing them. Our results aim to alert clinicians to these specific outcomes and offer more personalized care and counseling to infertile couples and their children. Full article

(This article belongs to the Special Issue Gynecologic and Obstetric Pathologies: From Birth to Menopause)

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12 pages, 628 KiB

Open AccessEditor’s ChoiceArticle

The Value of Next-Generation Sequencing in Diagnosis and Therapy of Critically Ill Patients with Suspected Bloodstream Infections: A Retrospective Cohort Study

by Remco Overbeek, Christoph J. Leitl, Sandra E. Stoll, Wolfgang A. Wetsch, Tobias Kammerer, Alexander Mathes, Bernd W. Böttiger, Harald Seifert, Dominique Hart and Fabian Dusse

J. Clin. Med. 2024, 13(2), 306; https://doi.org/10.3390/jcm13020306 - 5 Jan 2024

Cited by 7 | Viewed by 3061

Abstract

Bloodstream infection (BSI), a frequent cause of severe sepsis, is a life-threatening complication in critically ill patients and still associated with a high mortality rate. Rapid pathogen identification from blood is crucial for an early diagnosis and the treatment of patients with suspected [...] Read more.

Bloodstream infection (BSI), a frequent cause of severe sepsis, is a life-threatening complication in critically ill patients and still associated with a high mortality rate. Rapid pathogen identification from blood is crucial for an early diagnosis and the treatment of patients with suspected BSI. For this purpose, novel diagnostic tools on the base of genetic analysis have emerged for clinical application. The aim of this study was to assess the diagnostic value of additional next-generation sequencing (NGS) pathogen test for patients with suspected BSI in a surgical ICU and its potential impact on antimicrobial therapy. In this retrospective single-centre study, clinical data and results from blood culture (BC) and NGS pathogen diagnostics were analysed for ICU patients with suspected BSI. Consecutive changes in antimicrobial therapy and diagnostic procedures were evaluated. Results: 41 cases with simultaneous NGS and BC sampling were assessed. NGS showed a statistically non-significant higher positivity rate than BC (NGS: 58.5% (24/41 samples) vs. BC: 21.9% (9/41); p = 0.056). NGS detected eight different potentially relevant bacterial species, one fungus and six different viruses, whereas BC detected four different bacterial species and one fungus. NGS results affected antimicrobial treatment in 7.3% of cases. Conclusions: NGS-based diagnostics have the potential to offer a higher positivity rate than conventional culture-based methods in patients with suspected BSI. Regarding the high cost, their impact on anti-infective therapy is currently limited. Larger randomized prospective clinical multicentre studies are required to assess the clinical benefit of this novel diagnostic technology. Full article

(This article belongs to the Section Intensive Care)

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13 pages, 2107 KiB

Open AccessEditor’s ChoiceArticle

Multiparametric Monitoring of Disease Progression in Contemporary Patients with Wild-Type Transthyretin Amyloid Cardiomyopathy Initiating Tafamidis Treatment

by Svenja Ney, Roman Johannes Gertz, Lenhard Pennig, Richard J. Nies, Udo Holtick, Linus A. Völker, Gilbert Wunderlich, Katharina Seuthe, Christopher Hohmann, Clemens Metze, Claas Philip Nähle, Jennifer von Stein, Monique Brüwer, Henrik ten Freyhaus and Roman Pfister

J. Clin. Med. 2024, 13(1), 284; https://doi.org/10.3390/jcm13010284 - 4 Jan 2024

Cited by 7 | Viewed by 2674

Abstract

Background: Recently, a disease modifying therapy has become available for transthyretin amyloid cardiomyopathy (ATTR-CM). A validated monitoring concept of treatment is lacking, but a current expert consensus recommends three clinical domains (clinical, biomarker and ECG/imaging) assessed by several measurable features to define disease [...] Read more.

Background: Recently, a disease modifying therapy has become available for transthyretin amyloid cardiomyopathy (ATTR-CM). A validated monitoring concept of treatment is lacking, but a current expert consensus recommends three clinical domains (clinical, biomarker and ECG/imaging) assessed by several measurable features to define disease progression. Methods: We retrospectively analyzed data of wild-type ATTR-CM patients initiating tafamidis therapy assessed within our local routine protocol at baseline and 6-months follow-up with respect to the frequency of values beyond the proposed thresholds defining disease progression. Additionally, associations of cardiac magnetic resonance (CMR) tomography with clinical domains were examined within a subgroup. Results: Sixty-two ATTR-CM patients were included (88.7% male, mean age 79 years). In total, 16.1% of patients had progress in the clinical and functional domain, 33.9% in the biomarker domain and 43.5% in the imaging/electrocardiography (ECG) domain, with the latter driven by deterioration of the diastolic dysfunction grade and global longitudinal strain. In total, 35.5% of patients showed progress in none, 35.5% in one, 29.0% in two and no patient in three domains, the latter indicating overall disease progression. A subgroup analysis of twenty-two patients with available baseline and follow-up CMR data revealed an increase in CMR-based extracellular volume by more than 5% in 18.2% of patients, with no significant correlation with progress in one of the clinical domains. Conclusions: We provide first frequency estimates of the markers of disease progression according to a recent expert consensus statement, which might help refine the multiparametric monitoring concept in patients with ATTR-CM. Full article

(This article belongs to the Special Issue New Insights in Cardiac Amyloidosis and Its Complications)

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13 pages, 4139 KiB

Open AccessFeature PaperEditor’s ChoiceReview

From Clinical Suspicion to Diagnosis: A Review of Diagnostic Approaches and Challenges in Fungal Keratitis

by Panagiotis Toumasis, Andreas G. Tsantes, Anastasia Tsiogka, George Samonis and Georgia Vrioni

J. Clin. Med. 2024, 13(1), 286; https://doi.org/10.3390/jcm13010286 - 4 Jan 2024

Cited by 5 | Viewed by 3939

Abstract

Fungal keratitis is a relatively rare yet severe ocular infection that can lead to profound vision impairment and even permanent vision loss. Rapid and accurate diagnosis plays a crucial role in the effective management of the disease. A patient’s history establishes the initial [...] Read more.

Fungal keratitis is a relatively rare yet severe ocular infection that can lead to profound vision impairment and even permanent vision loss. Rapid and accurate diagnosis plays a crucial role in the effective management of the disease. A patient’s history establishes the initial clinical suspicion since it can provide valuable clues to potential predisposing factors and sources of fungal exposure. Regarding the evaluation of the observed symptoms, they are not exclusive to fungal keratitis, but their timeline can aid in distinguishing fungal keratitis from other conditions. Thorough clinical examination of the affected eye with a slit-lamp microscope guides diagnosis because some clinical features are valuable predictors of fungal keratitis. Definitive diagnosis is established through appropriate microbiological investigations. Direct microscopic examination of corneal scrapings or biopsy specimens can assist in the presumptive diagnosis of fungal keratitis, but culture remains the gold standard for diagnosing fungal keratitis. Advanced molecular techniques such as PCR and MALDI-ToF MS are explored for their rapid and sensitive diagnostic capabilities. Non-invasive techniques like in vivo confocal microscopy (IVCM) and optical coherence tomography (OCT) are useful for real-time imaging. Every diagnostic technique has both advantages and drawbacks. Also, the selection of a diagnostic approach can depend on various factors, including the specific clinical context, the availability of resources, and the proficiency of healthcare personnel. Full article

(This article belongs to the Special Issue Keratitis and Keratopathy: New Insights into Diagnosis and Treatment)

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10 pages, 235 KiB

Open AccessEditor’s ChoiceReview

Considering Histologic Remission in Ulcerative Colitis as a Long-Term Target

by Christopher Pavel, Mircea Mihai Diculescu, Alex-Emilian Stepan, Gabriel Constantinescu, Vasile Sandru, Cristian George Ţieranu, Luiza Tomescu, Alexandru Constantinescu, Cristina Patoni, Oana-Mihaela Plotogea and Madalina Ilie

J. Clin. Med. 2024, 13(1), 289; https://doi.org/10.3390/jcm13010289 - 4 Jan 2024

Cited by 5 | Viewed by 2379

Abstract

Monitoring disease activity in inflammatory bowel disease (IBD) is challenging since clinical manifestations do not represent reliable surrogates for an accurate reflection of the inflammatory burden. Endoscopic remission had been the most significant endpoint target in the last years; nevertheless, a remarkable proportion [...] Read more.

Monitoring disease activity in inflammatory bowel disease (IBD) is challenging since clinical manifestations do not represent reliable surrogates for an accurate reflection of the inflammatory burden. Endoscopic remission had been the most significant endpoint target in the last years; nevertheless, a remarkable proportion of patients continue to relapse despite a normal-appearing mucosa, highlighting that endoscopy may underestimate the true extent of the disease. A subtle hint of the importance that histology plays in the long-term course of the disease has been endorsed by the STRIDE-II consensus, which recommends considering histologic healing for ulcerative colitis (UC), even though it is not stated to be a compulsory formal target. It is a continuum-changing paradigm, and it is almost a certainty that in the near future, histologic healing may become the new formal target for ulcerative colitis. It must be emphasized that there is great heterogeneity in defining histological remission, and the main criteria or cut-off values for inflammatory markers are still in an ill-defined area. The complexity of some histologic scores is a source of confusion among clinicians and pathologists, leading to low adherence in clinical practice when it comes to a homogenous histopathological report. Therefore, a standardized and more practical approach is urgently needed. Full article

(This article belongs to the Special Issue Clinical Advances in Inflammatory Bowel Disease)

29 pages, 1355 KiB

Open AccessEditor’s ChoiceReview

Children with Autism Spectrum Disorder and Abnormalities of Clinical EEG: A Qualitative Review

by Chiara Bosetti, Luca Ferrini, Anna Rita Ferrari, Emanuele Bartolini and Sara Calderoni

J. Clin. Med. 2024, 13(1), 279; https://doi.org/10.3390/jcm13010279 - 3 Jan 2024

Cited by 5 | Viewed by 6343

Abstract

Over the last decade, the comorbidity between Autism Spectrum Disorder (ASD) and epilepsy has been widely demonstrated, and many hypotheses regarding the common neurobiological bases of these disorders have been put forward. A variable, but significant, prevalence of abnormalities on electroencephalogram (EEG) has [...] Read more.

Over the last decade, the comorbidity between Autism Spectrum Disorder (ASD) and epilepsy has been widely demonstrated, and many hypotheses regarding the common neurobiological bases of these disorders have been put forward. A variable, but significant, prevalence of abnormalities on electroencephalogram (EEG) has been documented in non-epileptic children with ASD; therefore, several scientific studies have recently tried to demonstrate the role of these abnormalities as a possible biomarker of altered neural connectivity in ASD individuals. This narrative review intends to summarize the main findings of the recent scientific literature regarding abnormalities detected with standard EEG in children/adolescents with idiopathic ASD. Research using three different databases (PubMed, Scopus and Google Scholar) was conducted, resulting in the selection of 10 original articles. Despite an important lack of studies on preschoolers and a deep heterogeneity in results, some authors speculated on a possible association between EEG abnormalities and ASD characteristics, in particular, the severity of symptoms. Although this correlation needs to be more strongly elucidated, these findings may encourage future studies aimed at demonstrating the role of electrical brain abnormalities as an early biomarker of neural circuit alterations in ASD, highlighting the potential diagnostic, prognostic and therapeutic value of EEG in this field. Full article

(This article belongs to the Special Issue Advances in Autism Spectrum Disorder: Etiopathogenesis, Clinical Phenotypes, Diagnosis and Treatment)

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24 pages, 4700 KiB

Open AccessEditor’s ChoiceReview

Myocarditis and Chronic Inflammatory Cardiomyopathy, from Acute Inflammation to Chronic Inflammatory Damage: An Update on Pathophysiology and Diagnosis

by Giuseppe Uccello, Giacomo Bonacchi, Valentina Alice Rossi, Giulia Montrasio and Matteo Beltrami

J. Clin. Med. 2024, 13(1), 150; https://doi.org/10.3390/jcm13010150 - 27 Dec 2023

Cited by 7 | Viewed by 4495

Abstract

Acute myocarditis covers a wide spectrum of clinical presentations, from uncomplicated myocarditis to severe forms complicated by hemodynamic instability and ventricular arrhythmias; however, all these forms are characterized by acute myocardial inflammation. The term “chronic inflammatory cardiomyopathy” describes a persistent/chronic inflammatory condition with [...] Read more.

Acute myocarditis covers a wide spectrum of clinical presentations, from uncomplicated myocarditis to severe forms complicated by hemodynamic instability and ventricular arrhythmias; however, all these forms are characterized by acute myocardial inflammation. The term “chronic inflammatory cardiomyopathy” describes a persistent/chronic inflammatory condition with a clinical phenotype of dilated and/or hypokinetic cardiomyopathy associated with symptoms of heart failure and increased risk for arrhythmias. A continuum can be identified between these two conditions. The importance of early diagnosis has grown markedly in the contemporary era with various diagnostic tools available. While cardiac magnetic resonance (CMR) is valid for diagnosis and follow-up, endomyocardial biopsy (EMB) should be considered as a first-line diagnostic modality in all unexplained acute cardiomyopathies complicated by hemodynamic instability and ventricular arrhythmias, considering the local expertise. Genetic counseling should be recommended in those cases where a genotype–phenotype association is suspected, as this has significant implications for patients’ and their family members’ prognoses. Recognition of the pathophysiological pathway and clinical “red flags” and an early diagnosis may help us understand mechanisms of progression, tailor long-term preventive and therapeutic strategies for this complex disease, and ultimately improve clinical outcomes. Full article

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

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