Journal of Clinical Medicine

32 pages, 1569 KB

Open AccessEditor’s ChoiceReview

Autoimmune Thyroid Disease and Pregnancy: The Interaction Between Genetics, Epigenetics and Environmental Factors

by Tatjana Bogović Crnčić, Božena Ćurko-Cofek, Lara Batičić, Neva Girotto, Maja Ilić Tomaš, Antea Kršek, Ines Krištofić, Tea Štimac, Ivona Perić, Vlatka Sotošek and Sanja Klobučar

J. Clin. Med. 2025, 14(1), 190; https://doi.org/10.3390/jcm14010190 - 31 Dec 2024

Cited by 10 | Viewed by 9640

Abstract

Autoimmune thyroid disease (AITD) is the leading cause of thyroid dysfunction globally, characterized primarily by two distinct clinical manifestations: Hashimoto’s thyroiditis (HT) and Graves’ disease (GD). The prevalence of AITD is approximately twice as high in women compared to men, with a particularly [...] Read more.

Autoimmune thyroid disease (AITD) is the leading cause of thyroid dysfunction globally, characterized primarily by two distinct clinical manifestations: Hashimoto’s thyroiditis (HT) and Graves’ disease (GD). The prevalence of AITD is approximately twice as high in women compared to men, with a particularly pronounced risk during the reproductive years. Pregnancy exerts profound effects on thyroid physiology and immune regulation due to hormonal fluctuations and immune adaptations aimed at fostering maternal–fetal tolerance, potentially triggering or exacerbating AITD. The impact of AITD on pregnancy outcomes is multifaceted. Both HT and GD have been associated with adverse obstetric and neonatal outcomes, including miscarriage, preterm delivery, preeclampsia and fetal growth restriction. Inadequately managed AITD can also affect fetal neurodevelopment due to disrupted maternal thyroid hormone availability during critical periods of brain maturation. This review explores the complex interplay between the genetic, epigenetic and environmental factors that drive AITD during pregnancy, highlighting their roles in disease development and impacts on pregnancy outcomes. Gaining a deeper understanding of these mechanisms is crucial for improving diagnostic tools, treatment options and preventive measures to enhance the health and well-being of both the mother and the newborn. Full article

(This article belongs to the Special Issue Thyroid Disease: Updates from Diagnosis to Treatment)

► Show Figures

Figure 1

22 pages, 2597 KB

Open AccessEditor’s ChoiceReview

A Comprehensive Review of Catheter-Related Thrombosis

by Marina López-Rubio, Marta-Olimpia Lago-Rodríguez, Lucía Ordieres-Ortega, Crhistian-Mario Oblitas, Sergio Moragón-Ledesma, Rubén Alonso-Beato, Luis-Antonio Alvarez-Sala-Walther and Francisco Galeano-Valle

J. Clin. Med. 2024, 13(24), 7818; https://doi.org/10.3390/jcm13247818 - 21 Dec 2024

Cited by 11 | Viewed by 17823

Abstract

Catheter-related thrombosis (CRT) is a frequent and potentially serious complication associated with the widespread use of intravascular devices such as central venous catheters, including peripherally inserted central catheters and implantable port systems, pacemakers or implantable cardioverter-defibrillators. Although CRT management has been informed by [...] Read more.

Catheter-related thrombosis (CRT) is a frequent and potentially serious complication associated with the widespread use of intravascular devices such as central venous catheters, including peripherally inserted central catheters and implantable port systems, pacemakers or implantable cardioverter-defibrillators. Although CRT management has been informed by guidelines extrapolated from lower extremity deep vein thrombosis (DVT), unique challenges remain due to the distinct anatomical, pathophysiological, and clinical characteristics of upper extremity DVT. Risk factors for CRT are multifactorial, encompassing patient-related characteristics such as cancer, prior venous thromboembolism, and infection, as well as catheter-specific factors like device type, lumens, and insertion site. The diagnosis of CRT relies primarily on ultrasonography; however, computed tomography angiography and magnetic resonance imaging play a complementary role, particularly in anatomically challenging cases or when complications such as pulmonary embolism or superior vena cava syndrome are suspected. Treatment strategies for CRT include anticoagulation, catheter removal when feasible, and, in select cases, local thrombolysis or catheter-directed interventions. Anticoagulation remains the cornerstone of therapy, with direct oral anticoagulants increasingly favored due to their safety profile and efficacy. This article provides a detailed review of CRT, focusing on clinical features, diagnostic methods, and treatment strategies while addressing specific challenges in managing pacemaker and hemodialysis catheter-related thrombosis. Full article

(This article belongs to the Special Issue Deep Vein Thrombosis and Pulmonary Embolism: Clinical Treatment and Management)

► Show Figures

Figure 1

17 pages, 727 KB

Open AccessEditor’s ChoiceArticle

Comparison of the Accuracy, Completeness, Reproducibility, and Consistency of Different AI Chatbots in Providing Nutritional Advice: An Exploratory Study

by Valentina Ponzo, Rosalba Rosato, Maria Carmine Scigliano, Martina Onida, Simona Cossai, Morena De Vecchi, Andrea Devecchi, Ilaria Goitre, Enrica Favaro, Fabio Dario Merlo, Domenico Sergi and Simona Bo

J. Clin. Med. 2024, 13(24), 7810; https://doi.org/10.3390/jcm13247810 - 20 Dec 2024

Cited by 18 | Viewed by 5212

Abstract

Background: The use of artificial intelligence (AI) chatbots for obtaining healthcare advice is greatly increased in the general population. This study assessed the performance of general-purpose AI chatbots in giving nutritional advice for patients with obesity with or without multiple comorbidities. Methods [...] Read more.

Background: The use of artificial intelligence (AI) chatbots for obtaining healthcare advice is greatly increased in the general population. This study assessed the performance of general-purpose AI chatbots in giving nutritional advice for patients with obesity with or without multiple comorbidities. Methods: The case of a 35-year-old male with obesity without comorbidities (Case 1), and the case of a 65-year-old female with obesity, type 2 diabetes mellitus, sarcopenia, and chronic kidney disease (Case 2) were submitted to 10 different AI chatbots on three consecutive days. Accuracy (the ability to provide advice aligned with guidelines), completeness, and reproducibility (replicability of the information over the three days) of the chatbots’ responses were evaluated by three registered dietitians. Nutritional consistency was evaluated by comparing the nutrient content provided by the chatbots with values calculated by dietitians. Results: Case 1: ChatGPT 3.5 demonstrated the highest accuracy rate (67.2%) and Copilot the lowest (21.1%). ChatGPT 3.5 and ChatGPT 4.0 achieved the highest completeness (both 87.3%), whereas Gemini and Copilot recorded the lowest scores (55.6%, 42.9%, respectively). Reproducibility was highest for Chatsonic (86.1%) and lowest for ChatGPT 4.0 (50%) and ChatGPT 3.5 (52.8%). Case 2: Overall accuracy was low, with no chatbot achieving 50% accuracy. Completeness was highest for ChatGPT 4.0 and Claude (both 77.8%), and lowest for Copilot (23.3%). ChatGPT 4.0 and Pi Ai showed the lowest reproducibility. Major inconsistencies regarded the amount of protein recommended by most chatbots, which suggested simultaneously to both reduce and increase protein intake. Conclusions: General-purpose AI chatbots exhibited limited accuracy, reproducibility, and consistency in giving dietary advice in complex clinical scenarios and cannot replace the work of an expert dietitian. Full article

(This article belongs to the Section Endocrinology & Metabolism)

► Show Figures

Figure 1

15 pages, 2532 KB

Open AccessEditor’s ChoiceReview

MicroRNA and Heart Failure: A Novel Promising Diagnostic and Therapeutic Tool

by Andrea D’Amato, Silvia Prosperi, Paolo Severino, Vincenzo Myftari, Michele Correale, Pasquale Perrone Filardi, Roberto Badagliacca, Francesco Fedele, Carmine Dario Vizza and Alberto Palazzuoli

J. Clin. Med. 2024, 13(24), 7560; https://doi.org/10.3390/jcm13247560 - 12 Dec 2024

Cited by 9 | Viewed by 3885

Abstract

Heart failure (HF) has a multifaceted and complex pathophysiology. Beyond neurohormonal, renin–angiotensin–aldosterone system, and adrenergic hyperactivation, a role for other pathophysiological determinants is emerging. Genetic and epigenetic factors are involved in this syndrome. In many maladaptive processes, the role of microRNAs (miRNAs) has [...] Read more.

Heart failure (HF) has a multifaceted and complex pathophysiology. Beyond neurohormonal, renin–angiotensin–aldosterone system, and adrenergic hyperactivation, a role for other pathophysiological determinants is emerging. Genetic and epigenetic factors are involved in this syndrome. In many maladaptive processes, the role of microRNAs (miRNAs) has been recently demonstrated. MiRNAs are small endogenous non-coding molecules of RNA involved in gene expression regulation, and they play a pivotal role in intercellular communication, being involved in different biological and pathophysiological processes. MiRNAs can modulate infarct area size, cardiomyocytes restoration, collagen deposition, and macrophage polarization. MiRNAs may be considered as specific biomarkers of hypertrophy and fibrosis. MiRNAs have been proposed as a therapeutical tool because their administration can contrast with myocardial pathophysiological remodeling leading to HF. Antimir and miRNA mimics are small oligonucleotides which may be administered in several manners and may be able to regulate the expression of specific and circulating miRNAs. Studies on animal models and on healthy humans demonstrate that these molecules are well tolerated and effective, opening the possibility of a therapeutic use of miRNAs in cases of HF. The application of miRNAs for diagnosis, prognostic stratification, and therapy fits in with the new concept of a personalized and tailored approach to HF. Full article

(This article belongs to the Section Cardiovascular Medicine)

► Show Figures

Figure 1

14 pages, 1754 KB

Open AccessEditor’s ChoiceReview

Efficacy of Dietary Interventions for Irritable Bowel Syndrome: A Systematic Review and Network Meta-Analysis

by Hossein Haghbin, Fariha Hasan, Manesh Kumar Gangwani, Nurruddinkhodja Zakirkhodjaev, Wade Lee-Smith, Azizullah Beran, Faisal Kamal, Benjamin Hart and Muhammad Aziz

J. Clin. Med. 2024, 13(24), 7531; https://doi.org/10.3390/jcm13247531 - 11 Dec 2024

Cited by 8 | Viewed by 7588

Abstract

Introduction: Irritable bowel syndrome (IBS) is a common condition that alters the quality of life of patients. A variety of dietary interventions have been introduced to address this debilitating condition. The low-FODMAP diet (LFD), gluten-free diet (GFD), and Mediterranean diet are examples showing [...] Read more.

Introduction: Irritable bowel syndrome (IBS) is a common condition that alters the quality of life of patients. A variety of dietary interventions have been introduced to address this debilitating condition. The low-FODMAP diet (LFD), gluten-free diet (GFD), and Mediterranean diet are examples showing efficacy. The aim of this network meta-analysis was to compare these interventions to find the best approach. Methods: We performed a systematic review of the available literature through 14 March 2024 in the following databases: Embase, PubMed, MEDLINE OVID, Web of Science, CINAHL Plus, and Cochrane Central. We only included randomized controlled trials (RCTs). We used a random effects model and conducted a direct meta-analysis based on the DerSimonian–Laird approach and a network meta-analysis based on the frequentist approach. Mean differences (MDs) with 95% confidence interval (CI) were calculated. The primary outcomes included IBS quality of life (IBS QOL) and IBS symptom severity scale (IBS-SSS). Results: We finalized 23 studies including 1689 IBS patients. In the direct meta-analysis, there was no statistically significant difference in any IBS score between GFD and either LFD or standard diet. Meanwhile, the LFD was statistically superior to the standard diet in the IBS-SSS (MD: −46.29, CI: −63.72–−28.86, p < 0.01) and IBS QOL (MD: 4.06, CI: 0.72–7.41, p = 0.02). On ranking, the Mediterranean diet showed the greatest improvement in IBS-SSS, IBS-QOL, distension, dissatisfaction, and general life interference, followed by the LFD alone or in combination with the GFD. Conclusions: We demonstrated the efficacy of dietary interventions such as the LFD and Mediterranean diet in improving IBS. There is a need for large RCTs with head-to-head comparisons, particularly for the Mediterranean diet. Full article

(This article belongs to the Special Issue Updates in Digestive Diseases and Endoscopy)

► Show Figures

Figure 1

16 pages, 2951 KB

Open AccessEditor’s ChoiceSystematic Review

Worldwide Prevalence and Demographic Predictors of Impacted Third Molars—Systematic Review with Meta-Analysis

by Ana Catarina Pinto, Helena Francisco, Duarte Marques, Jorge N. R. Martins and João Caramês

J. Clin. Med. 2024, 13(24), 7533; https://doi.org/10.3390/jcm13247533 - 11 Dec 2024

Cited by 16 | Viewed by 10801

Abstract

Background/Objectives: Impacted teeth are a common phenomenon, in both young and adult populations, as extensively documented in the literature. This study aims to systematically assess the global prevalence of impacted third molars and to analyze their demographic predictors. Methods: The present review adheres [...] Read more.

Background/Objectives: Impacted teeth are a common phenomenon, in both young and adult populations, as extensively documented in the literature. This study aims to systematically assess the global prevalence of impacted third molars and to analyze their demographic predictors. Methods: The present review adheres to PRISMA guidelines and includes studies published until December 2023. Three databases (MEDLINE, LILACS, Cochrane) were searched, and studies reporting prevalence rates and demographic predictors of impacted third molars were selected for analysis. A meta-analysis was conducted using a random-effects model to calculate pooled prevalence and assess demographic variations. Results: This review yielded 98 studies involving 183,828 subjects. The pooled prevalence of impacted third molars was 36.9% [95% CI: 33.1–40.7%] per subject and 46.4% [95% CI: 36.7–56.1%] per tooth, with the highest rates in Asia (43.1% [95% CI: 34.6–51.7%]) and the lowest in Europe (24.5% [95% CI: 16.1–33.9%]). An odds ratio of 1.173 [95% CI: 1.021–1.347%] indicated a slightly higher likelihood of third molar impaction among women compared to men, and mandibular third molar impaction was more frequent than maxillary impaction. The meta-regression indicated insufficient consistency for the geographic area to be considered a source of heterogeneity in the prevalence of impacted third molars. Conclusions: The present meta-analysis highlights the substantial prevalence of impacted third molars worldwide and underscores the influence of demographic predictors. These findings may inform region-specific clinical guidelines and preventive approaches for managing impacted third molars. Full article

(This article belongs to the Special Issue Clinical Challenges and Advances in Periodontology and Oral Surgery)

► Show Figures

Figure 1

10 pages, 228 KB

Open AccessEditor’s ChoiceReview

The Evolution of Implant-Based Breast Reconstruction: Innovations, Trends, and Future Directions

by Chris Amro, Thomas J. Sorenson, Carter J. Boyd, Kshipra Hemal, Nicholas A. Vernice, Jenn J. Park, Oriana D. Cohen, Mihye Choi and Nolan S. Karp

J. Clin. Med. 2024, 13(23), 7407; https://doi.org/10.3390/jcm13237407 - 5 Dec 2024

Cited by 13 | Viewed by 4530

Abstract

Background/Objectives: Implant-based breast reconstruction has been essential since the 1960s, offering a faster and less invasive alternative to autologous reconstruction. Recent innovations—including direct-to-implant (DTI) reconstruction, advancements in surgical planes, synthetic meshes, and nipple-areolar complex (NAC) neurotization—have improved patient outcomes. This review explores these [...] Read more.

Background/Objectives: Implant-based breast reconstruction has been essential since the 1960s, offering a faster and less invasive alternative to autologous reconstruction. Recent innovations—including direct-to-implant (DTI) reconstruction, advancements in surgical planes, synthetic meshes, and nipple-areolar complex (NAC) neurotization—have improved patient outcomes. This review explores these developments, analyzing their impact on breast reconstruction over the past two decades. Methods: A comprehensive literature review was conducted using PubMed, Google Scholar, and Cochrane Library databases, focusing on peer-reviewed studies published up to 2024. Articles were selected based on relevance, quality, and documentation of clinical outcomes and patient satisfaction. Results: Findings indicate that DTI reconstruction reduces the need for multiple surgeries, especially in cases with sufficient mastectomy flap quality. Prepectoral placement showed benefits in postoperative comfort and recovery speed compared to subpectoral placement, but had specific risks, such as implant rippling. Synthetic meshes improved implant support and reduced complication rates, while neurotization has shown potential in restoring sensation to the nipple-areolar complex (NAC), addressing quality-of-life concerns. Conclusions: Innovations like DTI, prepectoral techniques, and adjunctive mesh and neurotization strategies are advancing patient outcomes. Future research should refine these methods, aiming to expand applicability and further improve aesthetic and sensory outcomes for breast cancer survivors. Full article

(This article belongs to the Special Issue Trends in Plastic and Reconstructive Surgery)

11 pages, 1326 KB

Open AccessEditor’s ChoiceArticle

Correlation Between the Pitch and Loudness of Tinnitus, Hearing Levels, and Tinnitus Handicap Inventory Scores in Patients with Chronic Subjective Tinnitus

by Panayiota Mavrogeni, András Molnár, Viktória Molnár, László Tamás and Stefani Maihoub

J. Clin. Med. 2024, 13(23), 7261; https://doi.org/10.3390/jcm13237261 - 29 Nov 2024

Cited by 9 | Viewed by 2254

Abstract

Objectives: The aim of this study was to investigate the relationships between tinnitus pitch and loudness, the frequency of hearing loss, hearing level, and the Tinnitus Handicap Inventory (THI) scores reported by patients. Methods: In total, 139 patients (50 men and 89 women; [...] Read more.

Objectives: The aim of this study was to investigate the relationships between tinnitus pitch and loudness, the frequency of hearing loss, hearing level, and the Tinnitus Handicap Inventory (THI) scores reported by patients. Methods: In total, 139 patients (50 men and 89 women; mean age ± SD, 60.19 ± 11.47 years) who suffered from chronic primary tinnitus associated with sensorineural hearing loss were included in the study. Participants underwent pure-tone audiometry and tinnitus pitch matching assessments. Additionally, all participants completed the Hungarian version of the THI questionnaire. Correlations were assessed using simple linear, Spearman’s, and Pearson’s correlation tests, and a linear regression model was applied. The Mann–Whitney U test was also used. Results: This study identified a significant correlation between the pitch of tinnitus and the frequency of hearing loss (p = 0.000 *; rho = 0.549). There was also a significant correlation between tinnitus noise and hearing levels (p = 0.000 *; rho = 0.375). Age was shown to significantly affect tinnitus loudness (p = 0.016 *) and hearing levels (p = 0.000 *) as determined by a linear regression model. Tinnitus duration only significantly influenced tinnitus loudness (p = 0.022). There was no significant effect of sex on tinnitus or audiometry parameters. Total THI scores were influenced solely by tinnitus loudness (p = 0.021 *). Furthermore, sex did have an effect on total THI scores, with women reporting higher scores (p = 0.000 *). Conclusions: This study concluded that there is a significant correlation between the pitch and loudness of tinnitus and hearing levels, suggesting a connection in their underlying mechanisms. The intensity of tinnitus and hearing level are primarily affected by ageing processes. Furthermore, the severity of self-perceived tinnitus is mainly related to the loudness of tinnitus. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Surgical Strategies Update on Ear Disorders)

► Show Figures

Figure 1

21 pages, 1678 KB

Open AccessEditor’s ChoiceReview

Alpha-Synuclein and Microglia in Parkinson’s Disease: From Pathogenesis to Therapeutic Prospects

by Hyemi Eo, Sehwan Kim, Un Ju Jung and Sang Ryong Kim

J. Clin. Med. 2024, 13(23), 7243; https://doi.org/10.3390/jcm13237243 - 28 Nov 2024

Cited by 15 | Viewed by 7585

Abstract

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by both motor symptoms and non-motor features. A hallmark of PD is the misfolding and accumulation of alpha-synuclein (α-syn), which triggers neuroinflammation and drives neurodegeneration. Microglia, brain cells that play a central role in neuroinflammatory [...] Read more.

Parkinson’s disease (PD) is a neurodegenerative disorder characterized by both motor symptoms and non-motor features. A hallmark of PD is the misfolding and accumulation of alpha-synuclein (α-syn), which triggers neuroinflammation and drives neurodegeneration. Microglia, brain cells that play a central role in neuroinflammatory responses and help clear various unnecessary molecules within the brain, thus maintaining the brain’s internal environment, respond to α-syn through mechanisms involving inflammation, propagation, and clearance. This review delves into the complex interplay between α-syn and microglia, elucidating how these interactions drive PD pathogenesis. Furthermore, we discuss emerging therapeutic strategies targeting the α-syn–microglia axis, with a focus on modulating microglial functions to mitigate neuroinflammation, enhance clearance, and prevent α-syn propagation, emphasizing their potential to slow PD progression. Full article

(This article belongs to the Section Clinical Neurology)

► Show Figures

Figure 1

17 pages, 457 KB

Open AccessEditor’s ChoiceReview

A Review of Pharmacologic and Non-Pharmacologic Therapies in the Management of Irritable Bowel Syndrome: Current Recommendations and Evidence

by Anthony J. Papale, Robert Flattau, Nandan Vithlani, Deepti Mahajan and Sandeep Nadella

J. Clin. Med. 2024, 13(22), 6948; https://doi.org/10.3390/jcm13226948 - 18 Nov 2024

Cited by 7 | Viewed by 15257

Abstract

Irritable bowel syndrome (IBS) is a highly prevalent and debilitating disorder of gut–brain interaction (DGBI) affecting millions globally. It imposes a significant burden on healthcare systems and is a leading cause of workplace absenteeism. IBS is classified into several subtypes based on predominant [...] Read more.

Irritable bowel syndrome (IBS) is a highly prevalent and debilitating disorder of gut–brain interaction (DGBI) affecting millions globally. It imposes a significant burden on healthcare systems and is a leading cause of workplace absenteeism. IBS is classified into several subtypes based on predominant presenting symptoms, including IBS with constipation (IBS-C) and IBS with diarrhea (IBS-D), with each requiring targeted approaches to treatment. Some treatments, such as psychotherapy, dietary intervention, and medications like tricyclic antidepressants, are nonspecific and recommended for managing IBS symptoms across all subtypes. In contrast, therapies like secretagogues for IBS-C and eluxadoline or rifaximin for IBS-D are subtype-specific. However, many IBS treatments carry conditional recommendations and are based on low-certainty evidence, emphasizing the need for further research to expand the available treatment options. This review compares the latest IBS management guidelines from the American Gastroenterological Association (AGA), American College of Gastroenterology (ACG), British Society of Gastroenterology (BSG), and European Society for Neurogastroenterology and Motility (ESNM). Pharmacologic and non-pharmacologic therapies, including established and emerging interventions, will be explored to provide a comprehensive guide to management. Full article

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

► Show Figures

Figure 1

17 pages, 1085 KB

Open AccessEditor’s ChoiceReview

The Potential Health Risks and Benefits of Progesterone in the Transgender Woman Population—A Narrative Review

by Simone Szymczyk, Katarzyna Mączka, Lidia Mądrzak, Monika Grymowicz and Roman Smolarczyk

J. Clin. Med. 2024, 13(22), 6795; https://doi.org/10.3390/jcm13226795 - 12 Nov 2024

Cited by 2 | Viewed by 12933

Abstract

Introduction: Currently, progesterone is notably absent from conventional feminizing hormone therapies for transgender women. Anecdotal reports indicate the potential for health advantages following the incorporation of progesterone into treatment regimens. The primarily female hormone, progesterone naturally surges in women during the menstrual luteal [...] Read more.

Introduction: Currently, progesterone is notably absent from conventional feminizing hormone therapies for transgender women. Anecdotal reports indicate the potential for health advantages following the incorporation of progesterone into treatment regimens. The primarily female hormone, progesterone naturally surges in women during the menstrual luteal phase. When administered exogenously, it may expedite bodily changes that are pivotal for gender transition. Progesterone holds promise as a potential remedy for various health conditions prevalent in the transgender woman population. Methods: This narrative review synthesizes existing literature and presents a comprehensive account of the administration of exogenous progesterone in transgender women. A literature search was conducted using the PubMed, Embase, ScienceDirect, and ResearchGate databases. The following keywords were used in the search: progesterone, transgender, breast neoplasms, lactation, prostate, testicular neoplasms, and thrombosis. These terms were combined using Boolean operators. The results of the initial search were screened by three independent reviewers based on their relevance to the topic under study. Results: A total of 104 studies were initially identified as meeting the criteria for inclusion. Following an assessment based on the contents of the title, abstract, and full text, 39 studies were deemed eligible for inclusion. A critical examination of health outcomes was conducted across key sections, including breast development, mental health, lactation, cancer risk (breast and prostate), thrombosis, and nervous and other systems. Discussion: The use of progesterone in the transgender woman population is a topic that has yet to be sufficiently researched. The limited sample size, short follow-up periods, and lack of randomization restrict the potential for achieving a robust scientific evidence base. In order to gain a fuller understanding of this topic, findings from studies on contraception, hormone replacement therapy, and animal models were considered. Conclusions: Progesterone may have a beneficial effect on the bodies of transgender women without significant adverse health effects. Further investigation through well-designed studies is recommended. Randomized controlled trials that include various dosages, broad and long-term effects, and precise demographics are needed. There is an immediate need for more knowledge to create appropriate patent and clinical practice guidelines. Full article

(This article belongs to the Special Issue Gender Dysphoria: Current Approach to Clinical Care and Research)

► Show Figures

Figure 1

12 pages, 10217 KB

Open AccessEditor’s ChoiceReview

Corneal Artificial Endothelial Layer (EndoArt): Literature Review and Our Experience

by Davide Romano, Mariacarmela Ventura, Sabrina Vaccaro, Eliana Forbice, Scott Hau, Francesco Semeraro and Vito Romano

J. Clin. Med. 2024, 13(21), 6520; https://doi.org/10.3390/jcm13216520 - 30 Oct 2024

Cited by 15 | Viewed by 3028

Abstract

Background/Objectives: The objective of this study was to examine the morphological corneal changes and outcomes following the implantation of an artificial endothelial layer (EndoArt) in patients with chronic corneal oedema. Methods: A systematic review of the literature was conducted alongside a [...] Read more.

Background/Objectives: The objective of this study was to examine the morphological corneal changes and outcomes following the implantation of an artificial endothelial layer (EndoArt) in patients with chronic corneal oedema. Methods: A systematic review of the literature was conducted alongside a detailed analysis of two clinical cases with chronic corneal oedema that were treated using EndoArt. Our experience with these two cases is included to provide practical insights and real-world outcomes. Results: Across the 24 cases reported (including the two presented here), an analysis was possible in 23 cases. Notably, 82% of patients had undergone at least one previous corneal transplant, with 39% having undergone three or more transplants. Additionally, 78% of cases had ocular comorbidities, with glaucoma surgery being the most prevalent (83%), which could have impacted visual outcomes. The follow-up period ranged from 3 to 17 months with a median of 3 months. After EndoArt implantation, the average reduction in the central corneal thickness (CCT) was 29%, and the rebubbling rate was 47.8%, with some cases requiring no rebubbling, while others required it up to 100% of the time. Visual acuity significantly improved from a mean best-corrected visual acuity (BCVA) value of 1.61 ± 0.5 logMAR to 1.07 ± 0.59 logMAR (p < 0.001). The CCT decreased from 771 ± 146 µm to 580 ± 134 µm (p < 0.001). These findings are consistent with our experience. Conclusions: EndoArt shows promise as an alternative treatment for chronic corneal oedema in complex cases where conventional corneal transplantation has failed or carries a high risk of failure. The morphological changes observed using anterior segment optical coherence tomography (OCT) and in vivo confocal microscopy (IVCM) were similar to those reported after endothelial keratoplasty, with the notable exception of the absence of the hyper-reflective donor–host interface. Full article

(This article belongs to the Special Issue Advancements in Cornea Transplantation)

► Show Figures

Figure 1

11 pages, 510 KB

Open AccessFeature PaperEditor’s ChoiceReview

EGFR-Targeted Therapies: A Literature Review

by Calista Sha and Paul C. Lee

J. Clin. Med. 2024, 13(21), 6391; https://doi.org/10.3390/jcm13216391 - 25 Oct 2024

Cited by 9 | Viewed by 7436

Abstract

Lung cancer remains the leading cause of cancer death in the United States, underscoring the critical need to optimize treatment strategies. Compared to conventional treatments such as surgical resection, radiotherapy, chemotherapy, and immunotherapy, targeted therapy stands out for its higher selectivity and minimal [...] Read more.

Lung cancer remains the leading cause of cancer death in the United States, underscoring the critical need to optimize treatment strategies. Compared to conventional treatments such as surgical resection, radiotherapy, chemotherapy, and immunotherapy, targeted therapy stands out for its higher selectivity and minimal adverse effects. Among these, epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are the most widely used in targeted therapy for non-small-cell lung cancer (NSCLC). In our paper, we will conduct a comprehensive review of current literature on EGFR TKIs to contribute to advancements in molecular genomics and the treatment of lung cancer. Full article

(This article belongs to the Section Oncology)

► Show Figures

Figure 1

15 pages, 303 KB

Open AccessEditor’s ChoiceReview

The Current Role of Hydroxyurea in the Treatment of Sickle Cell Anemia

by Montserrat López Rubio and María Argüello Marina

J. Clin. Med. 2024, 13(21), 6404; https://doi.org/10.3390/jcm13216404 - 25 Oct 2024

Cited by 16 | Viewed by 18478

Abstract

Despite advancements in treatment of sickle cell disease (SCD), hydroxyurea, a ribonucleotide reductase inhibitor, remains the cornerstone of therapy. While its primary effect is the elevation of fetal hemoglobin (HbF), hydroxyurea’s mechanisms of action are multifaceted. Hydroxyurea (HU) reduces leukocyte and platelet counts, [...] Read more.

Despite advancements in treatment of sickle cell disease (SCD), hydroxyurea, a ribonucleotide reductase inhibitor, remains the cornerstone of therapy. While its primary effect is the elevation of fetal hemoglobin (HbF), hydroxyurea’s mechanisms of action are multifaceted. Hydroxyurea (HU) reduces leukocyte and platelet counts, decreases the expression of endothelial adhesion molecules CD36 and CD49d, and increases nitric oxide and cyclic nucleotide levels, which may facilitate vascular dilation and further HbF induction. Numerous studies have demonstrated that hydroxyurea therapy reduces the frequency of painful episodes, acute chest syndrome, and the need for erythrocyte transfusions and hospitalizations. Long-term use of hydroxyurea leads to reduced morbidity and mortality. Hydroxyurea should be initiated in children from 9 months of age, including asymptomatic individuals, and is recommended for adults experiencing pain crises that significantly interfere with daily activities or quality of life, as well as those with severe or recurrent vaso-occlusive crises, ACS, or severe symptomatic anemia. Hydroxyurea is not recommended during pregnancy or lactation due to potential teratogenic effects and transfer into breast milk. However, its use may be considered in high-risk patients, particularly during the second and third trimesters. Concerns about secondary tumor development have not been substantiated in long-term follow-up studies. Alternative therapies, including L-glutamine, crizanlizumab, and voxelotor, are not presently approved or available for clinical use in Europe. Full article

(This article belongs to the Special Issue Innovative Treatments for Anemias)

20 pages, 717 KB

Open AccessEditor’s ChoiceSystematic Review

Approaches to Deprescribing Proton Pump Inhibitors in Clinical Practice: A Systematic Review

by Andrea Rossi, Lara Perrella, Stefano Scotti, Elena Olmastroni, Federica Galimberti, Ilaria Ardoino, Valentina Orlando, Enrica Menditto, Carlotta Franchi and Manuela Casula

J. Clin. Med. 2024, 13(20), 6283; https://doi.org/10.3390/jcm13206283 - 21 Oct 2024

Cited by 11 | Viewed by 6960

Abstract

Background: Proton pump inhibitors (PPIs) are some of the most frequently prescribed medications, but they are often used inappropriately, either being prescribed without a clear indication or continued for longer than necessary. In such cases, deprescribing is recommended. However, despite its proven [...] Read more.

Background: Proton pump inhibitors (PPIs) are some of the most frequently prescribed medications, but they are often used inappropriately, either being prescribed without a clear indication or continued for longer than necessary. In such cases, deprescribing is recommended. However, despite its proven effectiveness, the implementation of deprescribing in clinical practice remains inconsistent and varied, making it challenging to identify the most effective strategies. The goal is to provide a comprehensive outline of deprescribing interventions for PPI therapy implemented across various settings and by different healthcare professionals. Methods: The study is designed to be a systematic review of the published literature. PubMed, Embase, and Web of Science databases were searched from 1 January 1989 (the first PPI on the market) to 30 September 2024 for articles assessing PPI deprescribing in adult patients, focusing on the implementation rate (primary outcome) or effects on symptoms (secondary outcome). Results: After screening, 66 studies were included, predominantly pragmatic trials (N = 32) or randomized controlled trials (N = 25). We found a variety of interventions promoting PPI deprescription. Collaborative efforts involving multiple healthcare professionals, the use of algorithms for clinical decision-making, and patient involvement have proven to be key elements in the most effective strategies. Discontinuing therapy may not be advisable in cases of recurrent symptoms, suggesting that on-demand therapy could be a recommended approach. Deprescribing is particularly relevant for individuals with mild illnesses and symptoms, where tapering can effectively mitigate the rebound symptoms often associated with abrupt discontinuation. Conclusions: Given the current prevalence of inappropriate PPI prescribing, it is imperative to raise awareness among both physicians and patients about the importance of the deprescribing process, which should be tailored to the specific needs of each patient, considering his/her medical history, current health status, and personal preferences. Full article

(This article belongs to the Section Pharmacology)

► Show Figures

Figure 1

13 pages, 1686 KB

Open AccessEditor’s ChoiceSystematic Review

Blood Flow Restriction Training and Its Use in Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

by Jamaal Butt and Zubair Ahmed

J. Clin. Med. 2024, 13(20), 6265; https://doi.org/10.3390/jcm13206265 - 20 Oct 2024

Cited by 8 | Viewed by 11479

Abstract

Background/Objectives: Anterior cruciate ligament (ACL) reconstruction (ACLR) is often followed by significant muscle atrophy and subsequent loss of strength. Blood flow restriction training (BFRT) has recently emerged as a potential mode of rehabilitation to mitigate these effects. The goal of this systematic [...] Read more.

Background/Objectives: Anterior cruciate ligament (ACL) reconstruction (ACLR) is often followed by significant muscle atrophy and subsequent loss of strength. Blood flow restriction training (BFRT) has recently emerged as a potential mode of rehabilitation to mitigate these effects. The goal of this systematic review was to evaluate the efficacy of BFRT in functional recovery when compared to traditional rehabilitation methods. Methods: A literature review was conducted across July and August 2024 using multiple databases that reported randomised controlled trials comparing BFRT to traditional rehabilitation methods. Primary outcomes were changes to thigh muscle mass and knee extensor/flexor strength with secondary outcomes consisting of patient-reported functional measures (IKDC and Lysholm scores). The RoB-2 tool was used to assess the risk of bias. Results: Eight studies met the inclusion criteria; however, substantial heterogeneity prevented a meta-analysis being conducted for the primary outcomes. Three out of the five studies measuring muscle mass reported significant (p < 0.05) findings favouring BFRT. There was variation amongst the strength improvements, but BFRT was generally favoured over the control. Meta analysis of the secondary outcomes showed significant improvements (p < 0.05) favouring BFRT despite moderate heterogeneity. Conclusions: BFRT shows promise for maintaining muscle mass and improving patient reported outcomes following ACL reconstruction. However, the high risk of bias limits the strength of these conclusions. Further high-quality research needs to be conducted to establish optimal BFRT protocols for this cohort and to determine if BFRT has a place in ACL rehabilitation. Full article

(This article belongs to the Section Clinical Rehabilitation)

► Show Figures

Figure 1

17 pages, 696 KB

Open AccessEditor’s ChoiceSystematic Review

Safety and Efficacy of Sodium-Glucose Transport Protein 2 Inhibitors and Glucagon-like Peptide-1 Receptor Agonists in Diabetic Kidney Transplant Recipients: Synthesis of Evidence

by Ioannis Bellos, Pagona Lagiou, Vassiliki Benetou and Smaragdi Marinaki

J. Clin. Med. 2024, 13(20), 6181; https://doi.org/10.3390/jcm13206181 - 17 Oct 2024

Cited by 10 | Viewed by 2609

Abstract

Background: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of novel antidiabetics, namely, sodium-glucose transport protein 2 inhibitors (SGLT2-i) and glucagon-like peptide-1 receptor agonists (GLP1-RA), in diabetic kidney transplant recipients. Methods: Medline, Scopus, Web of Science, CENTRAL, and Clinicaltrials.gov [...] Read more.

Background: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of novel antidiabetics, namely, sodium-glucose transport protein 2 inhibitors (SGLT2-i) and glucagon-like peptide-1 receptor agonists (GLP1-RA), in diabetic kidney transplant recipients. Methods: Medline, Scopus, Web of Science, CENTRAL, and Clinicaltrials.gov were systematically searched from inception until 25 August 2024. Pooled estimates were obtained by applying random-effects models. Results: Overall, 18 studies (17 observational studies and one randomized controlled trial) were included. GLP1-RA were administered to 270 and SGLT2-i to 1003 patients. After GLP1-RA therapy, patients presented significantly lower glycated hemoglobin [mean difference (MD): −0.61%; 95% confidence interval (CI): −0.99; −0.23] and body weight (MD: −3.32 kg; 95% CI: −5.04; −1.59) but a similar estimated glomerular filtration rate (eGFR) and systolic blood pressure. After SGLT2-i therapy, patients had significantly lower glycated hemoglobin (MD: −0.40%, 95% CI: −0.57; −0.23) and body weight (MD: −2.21 kg, 95% CI: −2.74; −1.67), while no difference was noted in eGFR or systolic blood pressure. Preliminary data have shown an association between SGLT2-i use and a reduced risk of cardiovascular events, graft loss, and mortality. Evidence regarding the association between GLP1-RA and SGLT2-i and proteinuria was mixed. No significant effects on calcineurin inhibitor levels were observed. The risk of urinary tract infections was similar among patients treated with SGLT2-i or placebo (odds ratio: 0.84, 95% CI: 0.43; 1.64). Conclusions: Observational data suggest that GLP1-RA and SGLT2-i administration in diabetic kidney transplant recipients may be associated with better glycemic control and reduced body weight, presenting an acceptable safety profile. Full article

(This article belongs to the Special Issue Recent Advances and Complications of Kidney Transplantation)

► Show Figures

Figure 1

17 pages, 672 KB

Open AccessEditor’s ChoiceReview

Intrasaccular Treatment of Intracranial Aneurysms: A Comprehensive Review

by Miriam M. Shao, Timothy G. White, Jared B. Bassett, Ehsan Dowlati, Shyle H. Mehta, Cassidy Werner, Danielle Golub, Kevin A. Shah, Amir R. Dehdashti, Ina Teron, Thomas Link, Athos Patsalides and Henry H. Woo

J. Clin. Med. 2024, 13(20), 6162; https://doi.org/10.3390/jcm13206162 - 16 Oct 2024

Cited by 11 | Viewed by 5424

Abstract

Background: The endovascular treatment of complex intracranial aneurysms, such as wide-neck aneurysms (WNAs), remains a challenge. More established endovascular techniques, which include balloon-assisted coiling, stent-assisted coiling, and flow diversion, all have their drawbacks. Intrasaccular flow disruptor devices have emerged as a useful [...] Read more.

Background: The endovascular treatment of complex intracranial aneurysms, such as wide-neck aneurysms (WNAs), remains a challenge. More established endovascular techniques, which include balloon-assisted coiling, stent-assisted coiling, and flow diversion, all have their drawbacks. Intrasaccular flow disruptor devices have emerged as a useful tool for the neurointerventionalist. Methods: Here, we discuss landmark studies and provide a comprehensive, narrative review of the Woven EndoBridge (WEB; Microvention, Alisa Viejo, CA, USA), Artisse (Medtronic, Irvine, CA, USA), Contour (Stryker, Kalamazoo, MI, USA), Saccular Endovascular Aneurysm Lattice Embolization System (SEAL; Galaxy Therapeutics Inc, Milpitas, CA, USA), Medina (Medtronic, Irvine, CA, USA), and Trenza (Stryker, Kalamazoo, MI, USA) devices. Results: Intrasaccular devices have proven to be effective in treating complex aneurysms like WNAs. Conclusions: Intrasaccular flow disruptors have emerged as a new class of effective endovascular therapy, and results of ongoing clinical studies for the newer devices (e.g., SEAL and Trenza) are much anticipated. Full article

(This article belongs to the Section Clinical Neurology)

► Show Figures

Graphical abstract

20 pages, 1054 KB

Open AccessFeature PaperEditor’s ChoiceReview

A 2024 Update on Growth Hormone Deficiency Syndrome in Adults: From Guidelines to Real Life

by Luigi Simone Aversa, Daniela Cuboni, Silvia Grottoli, Ezio Ghigo and Valentina Gasco

J. Clin. Med. 2024, 13(20), 6079; https://doi.org/10.3390/jcm13206079 - 12 Oct 2024

Cited by 11 | Viewed by 12800

Abstract

Background: Adult growth hormone deficiency (GHD) has been recognized since the late 1980s. The clinical manifestations of adult GHD are often nonspecific, and diagnosis relies on GH stimulation tests, which are intricate, costly, time-consuming, and may carry the risk of adverse effects. Diagnosis [...] Read more.

Background: Adult growth hormone deficiency (GHD) has been recognized since the late 1980s. The clinical manifestations of adult GHD are often nonspecific, and diagnosis relies on GH stimulation tests, which are intricate, costly, time-consuming, and may carry the risk of adverse effects. Diagnosis is further complicated by factors like age, sex, and BMI, which affect GH response during testing. Therefore, GH replacement therapy remains challenging, requiring careful individualized evaluation of risks and benefits. The aim of this review is to provide an update on diagnosing and treating adult GHD, addressing current limitations and challenges based on recent studies. Methods: We conducted a comprehensive review of the literature regarding the diagnosis and management of adult GHD by searching PubMed and EMBASE. Only articles in English were included, and searches were conducted up to August 2024. Results: A review of guidelines and literature up to 2024 highlights the significant heterogeneity in the data and reveals various protocols for managing GHD, covering both diagnostic and therapeutic approaches. Conclusions: Despite diagnostic and treatment advances, managing adult GHD remains challenging due to variable presentation and the need for personalized GH therapy. Future efforts should aim to improve and standardize diagnostic and treatment protocols. Full article

(This article belongs to the Section Endocrinology & Metabolism)

► Show Figures

Figure 1

14 pages, 6077 KB

Open AccessEditor’s ChoiceReview

Gender-Affirming Phalloplasty: A Comprehensive Review

by Brandon Alba, Ian T. Nolan, Brielle Weinstein, Elizabeth O’Neill, Annie Fritsch, Kristin M. Jacobs and Loren Schechter

J. Clin. Med. 2024, 13(19), 5972; https://doi.org/10.3390/jcm13195972 - 8 Oct 2024

Cited by 5 | Viewed by 31999

Abstract

The goals of gender-affirming phalloplasty typically include an aesthetic phallus and scrotum, standing micturition, and/or penetrative intercourse. Phalloplasty can be performed using both free and pedicled flaps. Complications include flap-related healing compromise and urethral issues, including stricture and fistula. Phalloplasty has high patient [...] Read more.

The goals of gender-affirming phalloplasty typically include an aesthetic phallus and scrotum, standing micturition, and/or penetrative intercourse. Phalloplasty can be performed using both free and pedicled flaps. Complications include flap-related healing compromise and urethral issues, including stricture and fistula. Phalloplasty has high patient satisfaction and has demonstrated improvement in quality of life. Full article

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

► Show Figures

Figure 1

13 pages, 1682 KB

Open AccessFeature PaperEditor’s ChoiceReview

Coronary Artery Disease, Family History, and Screening Perspectives: An Up-to-Date Review

by Francesca Di Lenarda, Angela Balestrucci, Riccardo Terzi, Pedro Lopes, Giuseppe Ciliberti, Davide Marchetti, Matteo Schillaci, Marco Doldi, Eleonora Melotti, Angelo Ratti, Andrea Provera, Pasquale Paolisso, Daniele Andreini and Edoardo Conte

J. Clin. Med. 2024, 13(19), 5833; https://doi.org/10.3390/jcm13195833 - 30 Sep 2024

Cited by 11 | Viewed by 8556

Abstract

Family history for CAD (coronary artery disease) is an established cardiovascular (CV) risk factor and it is progressively acquiring importance in patients’ CV risk stratification. Numerous studies have demonstrated that individuals with a first-degree relative affected by CAD have a significantly higher risk [...] Read more.

Family history for CAD (coronary artery disease) is an established cardiovascular (CV) risk factor and it is progressively acquiring importance in patients’ CV risk stratification. Numerous studies have demonstrated that individuals with a first-degree relative affected by CAD have a significantly higher risk of developing the condition themselves; in particular, when CAD occurs at an early age in relatives. Indeed, recently published CCS (chronic coronary syndrome) ESC (European Society of Cardiology) guidelines include family history (FH) as a risk factor to consider when calculating pre-test risk for CAD. ESC guidelines on preventive cardiology (2021) only suggested CV risk assessment in the presence of a positive FH for CV disease, not considering it in the actual risk scores. Evidence suggests that positive anamnesis for relatives affected by CAD correlates with ACS (acute coronary syndrome) and CAD, with slight differences in relative risk as far as the degree of kinship is concerned. Genetic factors contribute to this correlation by influencing key processes that affect heart health, such as cholesterol metabolism, blood pressure regulation, and inflammatory responses. New technologies in the genetics field are increasing the availability of genome sequencing, and new polymorphism panels are being tested as predictive for CAD, objectifying familiarity. Advances in imaging techniques allow the assessment of coronary atherosclerosis and its composition, and these are acquiring strength in evidence and recommendations in ESC guidelines as a way to define coronary disease in low and low-to-intermediate risk patients and to guide medical therapy and interventional procedures. Use of these emerging tools to guide screening is likely to be extended, beyond high CV risk patients, to individuals with FH for early CAD and/or specific genetic profiles, as recent evidence in the literature is suggesting. Full article

(This article belongs to the Special Issue Current Trends and Innovations in Coronary Artery Disease and Myocardial Ischemia)

► Show Figures

Figure 1

19 pages, 3136 KB

Open AccessEditor’s ChoiceReview

Advances in Adenomyosis Treatment: High-Intensity Focused Ultrasound, Percutaneous Microwave Therapy, and Radiofrequency Ablation

by Adamantios Athanasiou, Arrigo Fruscalzo, Ioannis Dedes, Michael D. Mueller, Ambrogio P. Londero, Carolin Marti, Benedetta Guani and Anis Feki

J. Clin. Med. 2024, 13(19), 5828; https://doi.org/10.3390/jcm13195828 - 29 Sep 2024

Cited by 7 | Viewed by 6722

Abstract

Background/Objectives: Adenomyosis is a debilitating gynecologic condition that affects both multiparous older women and nulliparous younger women, inducing a variety of symptoms such as dysmenorrhea, menorrhagia, and infertility. Thermal ablation techniques are new procedures that have been proposed for the treatment of [...] Read more.

Background/Objectives: Adenomyosis is a debilitating gynecologic condition that affects both multiparous older women and nulliparous younger women, inducing a variety of symptoms such as dysmenorrhea, menorrhagia, and infertility. Thermal ablation techniques are new procedures that have been proposed for the treatment of adenomyosis. They include high-intensity focused ultrasound (HIFU), percutaneous microwave ablation (PMWA), and radiofrequency ablation (RFA). Because thermal ablation techniques are minimally invasive or noninvasive, fertility is not impaired while symptoms improve. In addition, hospital stays and financial costs are generally reduced, increasing the interest in these alternative management options. Methods: In this narrative review, we conducted a thorough literature search of PubMed/Medline from the database inception to September 2022. In our search, we focused on noninvasive treatment methods such as HIFU ablation, RFA ablation, and PMWA as well as adenomyosis-specific terms and noninvasive techniques (ultrasonography, ultrasound, or magnetic resonance imaging). The queries were a combination of MeSH terms and keywords. The search was limited to the English language. Abstracts were screened according to their content, and relevant articles were selected. Results: Overall, the results showed that the above-mentioned ablation techniques are effective and safe in providing adenomyosis treatment. Lesion size and uterus volume are reduced, leading to considerable symptom alleviation with all three methods. Positive results concerning safety and fertility preservation have been described as well. Conclusions: Nonetheless, more research is required in this field to compare the efficacy and safety of different ablation techniques with traditional therapies. Such research will help improve these procedures and their associated decision-making processes. Full article

(This article belongs to the Section Obstetrics & Gynecology)

► Show Figures

Figure 1

16 pages, 327 KB

Open AccessEditor’s ChoiceReview

Barriers to Type 1 Diabetes Adherence in Adolescents

by Sarah Azar, Noa Maroun Abou Jaoude, Andrzej Kędzia and Elżbieta Niechciał

J. Clin. Med. 2024, 13(19), 5669; https://doi.org/10.3390/jcm13195669 - 24 Sep 2024

Cited by 12 | Viewed by 8299

Abstract

Background: Adolescence is a particularly crucial period of physical, emotional, and social development and adaptation, rendering these formative years rather challenging for individuals with chronic conditions like type 1 diabetes (T1D). Despite rapid improvement in diabetes therapies, adolescents with T1D are characterized by [...] Read more.

Background: Adolescence is a particularly crucial period of physical, emotional, and social development and adaptation, rendering these formative years rather challenging for individuals with chronic conditions like type 1 diabetes (T1D). Despite rapid improvement in diabetes therapies, adolescents with T1D are characterized by poorer adherence to treatment regimens compared with other pediatric age groups. Insufficient adherence is strongly related to low diabetes control, increasing morbidity, and risk for premature mortality. This study aimed to provide a comprehensive overview of adolescents’ most common barriers to T1D adherence, stressing the need for a deep and comprehensive understanding of these barriers. The complexity of these barriers is underscored by the diverse factors contributing to poor T1D adherence in adolescents. Methods: A narrative review was conducted, surveying four databases (PubMed, Scopus, EMBASE, and Web of Science) for full-text articles in the English language published up to June 2024. All studies related to barriers to T1D adherence in adolescents were considered. The literature was selected using selection and exclusion criteria and extracted and organized using Mendeley. Exclusion criteria included studies with insufficient data and non-peer-reviewed articles. This review revealed that adolescents face numerous obstacles to T1D adherence related to psychological factors, flux in family dynamics, perceived social pressures, therapy-related factors, transitioning responsibility, risk-taking behaviors, and pubertal changes. Conclusions: Navigating the adaptations to the different aspects of T1D, from treatment to complications and adolescents’ personal growth, effectively requires a thorough understanding of the barriers of a treatment regimen that patients at this critical age face. Full article

(This article belongs to the Section Clinical Pediatrics)

26 pages, 399 KB

Open AccessEditor’s ChoiceReview

Pharmacological Treatments of Negative Symptoms in Schizophrenia—An Update

by Evangelia Maria Tsapakis, Michael Treiber, Calypso Mitkani, Zoe Drakaki, Anastasios Cholevas, Cleanthe Spanaki and Konstantinos N. Fountoulakis

J. Clin. Med. 2024, 13(18), 5637; https://doi.org/10.3390/jcm13185637 - 23 Sep 2024

Cited by 6 | Viewed by 12461

Abstract

Schizophrenia is a chronic psychotic disorder comprising positive symptoms, negative symptoms, and cognitive deficits. Negative symptoms are associated with stigma, worse functional outcomes, and a significant deterioration in quality of life. Clinical diagnosis is challenging despite its significance, and current treatments offer little [...] Read more.

Schizophrenia is a chronic psychotic disorder comprising positive symptoms, negative symptoms, and cognitive deficits. Negative symptoms are associated with stigma, worse functional outcomes, and a significant deterioration in quality of life. Clinical diagnosis is challenging despite its significance, and current treatments offer little improvement in the burden of negative symptoms. This article reviews current pharmacological strategies for treating negative symptoms. Dopaminergic, glutamatergic, serotonergic, noradrenergic, cholinergic, anti-inflammatory compounds, hormones, and psychostimulants are explored. Finally, we review pharmacological global treatment guidelines for negative symptoms. In general, switching to a second-generation antipsychotic seems to be most often recommended for patients with schizophrenia on first-generation antipsychotics, and an add-on antidepressant is considered when depression is also present. However, the treatment of negative symptoms remains an unmet need. Future, larger clinical studies and meta-analyses are needed to establish effective pharmacological agents for the effective treatment of negative symptoms. Full article

(This article belongs to the Section Mental Health)

10 pages, 233 KB

Open AccessEditor’s ChoiceReview

Surgical Innovations to Protect Fertility from Oncologic Pelvic Radiation Therapy: Ovarian Transposition and Uterine Fixation

by Ariella Yazdani, Katherine Moran Sweterlitsch, Hanna Kim, Rebecca L. Flyckt and Mindy S. Christianson

J. Clin. Med. 2024, 13(18), 5577; https://doi.org/10.3390/jcm13185577 - 20 Sep 2024

Cited by 11 | Viewed by 3254

Abstract

As oncologic therapy continues to advance, survivorship care has widened the realm of possibilities for quality-of-life improvements, including fertility preservation and restoration. We aim to summarize the current and future directions of fertility preservation techniques for patients facing gonadotoxic medical therapies who desire [...] Read more.

As oncologic therapy continues to advance, survivorship care has widened the realm of possibilities for quality-of-life improvements, including fertility preservation and restoration. We aim to summarize the current and future directions of fertility preservation techniques for patients facing gonadotoxic medical therapies who desire pregnancy after their condition is treated. This review of both ovarian and uterine transposition highlights the present roles, techniques, and fertility outcomes of the two fertility preservation treatment modalities designed to protect reproductive organs from harmful pelvic radiation. Current evidence shows that ovarian transposition preserves ovarian function for patients with localized pelvic radiation demonstrating the most successful return of fertility. Uterine transposition holds great promise for patients desiring to conceive and carry a full-term pregnancy after radiation therapy. With ongoing advancements in oncologic treatments leading to increased survival rates, fertility is increasingly becoming a key survivorship issue. Patients can anticipate counseling about these fertility preservation surgical techniques that protect both the ovaries as well as the uterus from harmful pelvic radiation. Full article

(This article belongs to the Special Issue New Advances in Uterus and Ovarian Transplantation)

21 pages, 2192 KB

Open AccessEditor’s ChoiceReview

Challenges in Contemporary Spine Surgery: A Comprehensive Review of Surgical, Technological, and Patient-Specific Issues

by Emmanuel O. Mensah, Joshua I. Chalif, Jessica G. Baker, Eric Chalif, Jason Biundo and Michael W. Groff

J. Clin. Med. 2024, 13(18), 5460; https://doi.org/10.3390/jcm13185460 - 14 Sep 2024

Cited by 14 | Viewed by 5372

Abstract

Spine surgery has significantly progressed due to innovations in surgical techniques, technology, and a deeper understanding of spinal pathology. However, numerous challenges persist, complicating successful outcomes. Anatomical intricacies at transitional junctions demand precise surgical expertise to avoid complications. Technical challenges, such as underestimation [...] Read more.

Spine surgery has significantly progressed due to innovations in surgical techniques, technology, and a deeper understanding of spinal pathology. However, numerous challenges persist, complicating successful outcomes. Anatomical intricacies at transitional junctions demand precise surgical expertise to avoid complications. Technical challenges, such as underestimation of the density of fixed vertebrae, individual vertebral characteristics, and the angle of pedicle inclination, pose additional risks during surgery. Patient anatomical variability and prior surgeries add layers of difficulty, often necessitating thorough pre- and intraoperative planning. Technological challenges involve the integration of artificial intelligence (AI) and advanced visualization systems. AI offers predictive capabilities but is limited by the need for large, high-quality datasets and the “black box” nature of machine learning models, which complicates clinical decision making. Visualization technologies like augmented reality and robotic surgery enhance precision but come with operational and cost-related hurdles. Patient-specific challenges include managing postoperative complications such as adjacent segment disease, hardware failure, and neurological deficits. Effective patient outcome measurement is critical, yet existing metrics often fail to capture the full scope of patient experiences. Proper patient selection for procedures is essential to minimize risks and improve outcomes, but criteria can be inconsistent and complex. There is the need for continued technological innovation, improved patient-specific outcome measures, and enhanced surgical education through simulation-based training. Integrating AI in preoperative planning and developing comprehensive databases for spinal pathologies can aid in creating more accurate, generalizable models. A holistic approach that combines technological advancements with personalized patient care and ongoing education is essential for addressing these challenges and improving spine surgery outcomes. Full article

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

► Show Figures

Figure 1

28 pages, 2208 KB

Open AccessEditor’s ChoiceReview

Flap Monitoring Techniques: A Review

by Ignacy Rogoń, Agnieszka Rogoń, Mariusz Kaczmarek, Adam Bujnowski, Jerzy Wtorek, Filip Lachowski and Jerzy Jankau

J. Clin. Med. 2024, 13(18), 5467; https://doi.org/10.3390/jcm13185467 - 14 Sep 2024

Cited by 8 | Viewed by 13699

Abstract

Postoperative tissue flap vitality monitoring enables early detection of clinical complications, allowing for intervention. Timely re-operation can prevent the need for extensive correction procedures, thus reducing healthcare costs and hospitalization time. Statistics show that monitoring can increase the success rate of flap survival [...] Read more.

Postoperative tissue flap vitality monitoring enables early detection of clinical complications, allowing for intervention. Timely re-operation can prevent the need for extensive correction procedures, thus reducing healthcare costs and hospitalization time. Statistics show that monitoring can increase the success rate of flap survival to 95% or higher. However, despite the significant progress in monitoring techniques, major and minor complications, leading to the loss of the flap, still occur. This clinical application review aims to provide a comprehensive overview of the recent advancements and findings in flap surgery reconstructions, transplants, and systems for their postoperative assessment. The literature from the years 1925 to 2024 has been reviewed to capture previous and current solutions for monitoring flap vitality. Clinically acclaimed methods and experimental techniques were classified and reviewed from a technical and clinical standpoint. Physical examination, metabolism change, ultrasound method, and electromagnetic (EM) radiation-based measurement methods were carefully evaluated from the perspective of their considered applications. Guidelines aiding engineers in the future design and development process of monitoring systems were proposed. This paper provides a comprehensive overview of the monitoring techniques used in postoperative flap vitality monitoring. It also gives an overview of each approach and potential ways for future development. Full article

(This article belongs to the Special Issue Breast Reconstruction: Current Challenges and Future Perspectives)

► Show Figures

Graphical abstract

12 pages, 519 KB

Open AccessEditor’s ChoiceReview

Screening Strategies to Improve Early Diagnosis in Endometrial Cancer

by Silvia Cabrera, Irene de la Calle, Sonia Baulies, Antonio Gil-Moreno and Eva Colas

J. Clin. Med. 2024, 13(18), 5445; https://doi.org/10.3390/jcm13185445 - 13 Sep 2024

Cited by 8 | Viewed by 5642

Abstract

Endometrial cancer is the most common gynecological malignancy in high-income countries and the sixth most common cancer in women. Overall incidence has risen in the last few decades as a consequence of the increase in the prevalence of its risk factors, mainly obesity [...] Read more.

Endometrial cancer is the most common gynecological malignancy in high-income countries and the sixth most common cancer in women. Overall incidence has risen in the last few decades as a consequence of the increase in the prevalence of its risk factors, mainly obesity and the aging of the population, and although diagnoses have increased across all age groups, the incidence rates have doubled in women under the age of 40 years. The survival rates of endometrial cancer are highly dependent on its stage at diagnosis, bringing to the fore the importance of early diagnosis. The aim of a screening strategy in this type of tumor should be to detect the disease in the pre-invasive or early stage (before developing myometrial invasion), which would improve cure rates, reduce the morbidity associated with aggressive treatment and offer uterus-sparing management options for younger women. The ideal screening tool in this scenario would be a minimally invasive, inexpensive and easy-to-perform test or auto-test, which could be implemented in a routine gynecologic checkup of patients at-risk or in the general adult population. In this comprehensive review, we aim to define the populations at higher risk of developing endometrial cancer, to assess the performance of current diagnostic tools when used in a screening setting and to discuss the accuracy of new molecular screening strategies. Full article

(This article belongs to the Section Obstetrics & Gynecology)

► Show Figures

Figure 1

13 pages, 740 KB

Open AccessEditor’s ChoiceReview

Migraine and Stroke: A Scoping Review

by Neal Nathan, Angeline Ngo and Suzan Khoromi

J. Clin. Med. 2024, 13(18), 5380; https://doi.org/10.3390/jcm13185380 - 11 Sep 2024

Cited by 6 | Viewed by 6839

Abstract

An increased risk of ischemic stroke in migraine with aura (MA) has been consistently demonstrated. The pathophysiology of risk factors is not yet well understood. Several mechanisms have been proposed to explain the association between MA and ischemic stroke including decreased focal cerebral [...] Read more.

An increased risk of ischemic stroke in migraine with aura (MA) has been consistently demonstrated. The pathophysiology of risk factors is not yet well understood. Several mechanisms have been proposed to explain the association between MA and ischemic stroke including decreased focal cerebral blood flow and other phenomena linked with cortical spreading depression (CSD) as well as neurovascular pathology, which appear to play a key role in MA. In addition to genetic predisposition, other classic stroke risk factors such as atrial fibrillation, emboli, migraine-associated vasculopathy, endothelial dysfunction, platelet dysfunction, coagulation pathway abnormalities, and inflammatory factors have been examined and investigated. For further clarification, distinctions have been made between features of migrainous infarctions and non-migrainous infarctions among migraineurs. Furthermore, the association is less clear when considering the mixed results studying the risk of ischemic stroke in migraines without aura (MO) and the risk of hemorrhagic stroke in people with all types of migraine. Translational research is investigating the role of biomarkers which can help identify vascular links between stroke and migraine and lead to further treatment developments. We performed a scoping review of the PubMed database to further characterize and update the clinical connections between migraine and stroke. Full article

(This article belongs to the Section Clinical Neurology)

► Show Figures

Figure 1

18 pages, 868 KB

Open AccessEditor’s ChoiceSystematic Review

Cardiovascular Risk in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review

by Ana Sá-Sousa, Cidália Rodrigues, Cristina Jácome, João Cardoso, Inês Fortuna, Miguel Guimarães, Paula Pinto, Pedro Morais Sarmento and Rui Baptista

J. Clin. Med. 2024, 13(17), 5173; https://doi.org/10.3390/jcm13175173 - 31 Aug 2024

Cited by 14 | Viewed by 5981

Abstract

Background/Objectives: A comprehensive and up-to-date review on cardiovascular disease (CVD) risk in patients with COPD is needed. Therefore, we aimed to systematically review the risk of a range of CVD in patients with COPD. Methods: We searched three databases (Pubmed, Web [...] Read more.

Background/Objectives: A comprehensive and up-to-date review on cardiovascular disease (CVD) risk in patients with COPD is needed. Therefore, we aimed to systematically review the risk of a range of CVD in patients with COPD. Methods: We searched three databases (Pubmed, Web of Science, SCOPUS) from inception to September 2023 using terms related to COPD and CVD. Observational studies were included if they (1) were conducted in adults with a diagnosis of COPD based on the GOLD criteria, spirometry, physician diagnosis, or review of electronic health records; (2) reported the risk of CVD, namely of myocardial infarction (MI), ischaemic heart disease (IHD), atrial fibrillation (AF), heart failure, cerebrovascular disease, pulmonary hypertension, and peripheral vascular disease, compared with a control population using a measure of risk. A narrative synthesis was used. Results: Twenty-four studies from 2015 to 2023, mainly from Europe (n = 17), were included. A total of 3,485,392 patients with COPD (43.5–76.0% male; 63.9–73.5 yrs) and 31,480,333 (40.0–55.4% male, 49.3–70.0 yrs) controls were included. A higher risk of CVD in patients with COPD was evident regarding overall CVD, MI, IHD, heart failure, and angina. Higher risks of arrhythmia and AF, stroke, sudden cardiac death/arrest, pulmonary embolism, pulmonary hypertension, and peripheral vascular disease were also found, although based on a small amount of evidence. Conclusions: Patients with COPD have a higher risk of CVD than the general population or matched controls. This review underscores the need for vigilant and close monitoring of cardiovascular risk in individuals with COPD to inform more precise preventive strategies and targeted interventions to enhance their overall management. Full article

(This article belongs to the Special Issue Clinical Advances in Chronic Obstructive Pulmonary Disease and Its Complications: Part II)

► Show Figures

Figure 1

27 pages, 673 KB

Open AccessEditor’s ChoiceReview

Probiotics in the Management of Vulvovaginal Candidosis

by Karolina Akinosoglou, Georgios Schinas, Eleni Polyzou, Aristotelis Tsiakalos and Gilbert G. G. Donders

J. Clin. Med. 2024, 13(17), 5163; https://doi.org/10.3390/jcm13175163 - 30 Aug 2024

Cited by 10 | Viewed by 15060

Abstract

Vulvovaginal candidosis (VVC) represents a frequent and cumbersome vaginal infection. Recurrent and/or persistent infections remain common among a significant number of patients despite the use of antifungals. Probiotics offer a promising adjunctive or alternative therapeutic strategy to antifungals in the management of VVC. [...] Read more.

Vulvovaginal candidosis (VVC) represents a frequent and cumbersome vaginal infection. Recurrent and/or persistent infections remain common among a significant number of patients despite the use of antifungals. Probiotics offer a promising adjunctive or alternative therapeutic strategy to antifungals in the management of VVC. We aimed to explore and thoroughly examine the various roles and potential applications of probiotics in VVC. A comprehensive literature search was conducted to identify relevant clinical trials and systematic reviews that examine the effectiveness of probiotics in the treatment and prevention of VVC and recurrent VVC (rVVC). Following the initial screening of 4563 articles, a total of 25 clinical studies and seven systematic reviews were finally included in this analysis. The studies reviewed provide a generally positive yet inconsistent view of the efficacy of probiotics in managing VVC, including clinical, mycological response, and prevention perspectives. Nonetheless, fluconazole remains more effective than probiotics in treating VVC, while the combination of the two seems to reduce recurrence and improve symptoms significantly. For prevention, probiotics seem to improve vaginal health and reduce symptoms, while safety and tolerability are consistently reported across the studies, affirming that probiotics represent a low-risk intervention. However, clear conclusions are difficult to establish since relative studies explore different clinical endpoints and follow-up times, variable populations are included, different probiotics are used, and diverse schedules and regimens are administered. We propose that future studies should study the benefit of probiotics in well-defined categories such as (1) treatment with acute probiotics instead of antifungals, (2) adjuvant probiotic therapy together or after antifungals, and (3) VVC recurrence prevention using probiotics. Full article

(This article belongs to the Section Infectious Diseases)

► Show Figures

Figure 1

20 pages, 674 KB

Open AccessEditor’s ChoiceReview

Metabolic and Immune System Dysregulation: Unraveling the Connections between Alzheimer’s Disease, Diabetes, Inflammatory Bowel Diseases, and Rheumatoid Arthritis

by Julia Doroszkiewicz, Jan Mroczko, Izabela Winkel and Barbara Mroczko

J. Clin. Med. 2024, 13(17), 5057; https://doi.org/10.3390/jcm13175057 - 26 Aug 2024

Cited by 12 | Viewed by 4495

Abstract

Alzheimer’s disease (AD), diabetes mellitus (DM), inflammatory bowel diseases (IBD), and rheumatoid arthritis (RA) are chronic conditions affecting millions globally. Despite differing clinical symptoms, these diseases share pathophysiological mechanisms involving metabolic and immune system dysregulation. This paper examines the intricate connections between these [...] Read more.

Alzheimer’s disease (AD), diabetes mellitus (DM), inflammatory bowel diseases (IBD), and rheumatoid arthritis (RA) are chronic conditions affecting millions globally. Despite differing clinical symptoms, these diseases share pathophysiological mechanisms involving metabolic and immune system dysregulation. This paper examines the intricate connections between these disorders, focusing on shared pathways such as insulin resistance, lipid metabolism dysregulation, oxidative stress, and chronic inflammation. An important aspect is the role of amyloid-beta plaques and tau protein tangles, which are hallmark features of AD. These protein aggregates are influenced by metabolic dysfunction and inflammatory processes similar to those seen in DM, RA, and IBD. This manuscript explores how amyloid and tau pathologies may be exacerbated by shared metabolic and immune dysfunction. Additionally, this work discusses the gut–brain axis and the influence of gut microbiota in mediating disease interactions. Understanding these commonalities opens new avenues for multi-targeted therapeutic approaches that address the root causes rather than merely the symptoms of these conditions. This integrative perspective could lead to more effective interventions and improved patient outcomes, emphasizing the importance of a unified approach in managing these interconnected diseases. Full article

(This article belongs to the Special Issue Current Practice and Future Perspectives of Neurological Conditions Caused by Neurodegeneration)

► Show Figures

Figure 1

35 pages, 958 KB

Open AccessEditor’s ChoiceReview

Impact of Molecular Profiling on Therapy Management in Breast Cancer

by Flavia Ultimescu, Ariana Hudita, Daniela Elena Popa, Maria Olinca, Horatiu Alin Muresean, Mihail Ceausu, Diana Iuliana Stanciu, Octav Ginghina and Bianca Galateanu

J. Clin. Med. 2024, 13(17), 4995; https://doi.org/10.3390/jcm13174995 - 23 Aug 2024

Cited by 11 | Viewed by 4495

Abstract

Breast cancer (BC) remains the most prevalent cancer among women and the leading cause of cancer-related mortality worldwide. The heterogeneity of BC in terms of histopathological features, genetic polymorphisms, and response to therapies necessitates a personalized approach to treatment. This review focuses on [...] Read more.

Breast cancer (BC) remains the most prevalent cancer among women and the leading cause of cancer-related mortality worldwide. The heterogeneity of BC in terms of histopathological features, genetic polymorphisms, and response to therapies necessitates a personalized approach to treatment. This review focuses on the impact of molecular profiling on therapy management in breast cancer, emphasizing recent advancements in next-generation sequencing (NGS) and liquid biopsies. These technologies enable the identification of specific molecular subtypes and the detection of blood-based biomarkers such as circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), and tumor-educated platelets (TEPs). The integration of molecular profiling with traditional clinical and pathological data allows for more tailored and effective treatment strategies, improving patient outcomes. This review also discusses the current challenges and prospects of implementing personalized cancer therapy, highlighting the potential of molecular profiling to revolutionize BC management through more precise prognostic and therapeutic interventions. Full article

(This article belongs to the Topic From Basic Research to a Clinical Perspective in Oncology)

► Show Figures

Figure 1

13 pages, 282 KB

Open AccessEditor’s ChoiceReview

Innovations in Early Lung Cancer Detection: Tracing the Evolution and Advancements in Screening

by Lindsey B. Cotton, Peter B. Bach, Chris Cisar, Caitlin A. Schonewolf, Demetria Tennefoss, Anil Vachani, Lisa Carter-Bawa and Ali H. Zaidi

J. Clin. Med. 2024, 13(16), 4911; https://doi.org/10.3390/jcm13164911 - 20 Aug 2024

Cited by 8 | Viewed by 5870

Abstract

Lung cancer mortality rates, particularly non-small cell lung cancer (NSCLC), continue to present a significant global health challenge, and the adoption of lung cancer screening remains limited, often influenced by inequities in access to healthcare. Despite clinical evidence demonstrating the efficacy of annual [...] Read more.

Lung cancer mortality rates, particularly non-small cell lung cancer (NSCLC), continue to present a significant global health challenge, and the adoption of lung cancer screening remains limited, often influenced by inequities in access to healthcare. Despite clinical evidence demonstrating the efficacy of annual screening with low-dose computed tomography (LDCT) and recommendations from medical organizations including the U.S. Preventive Services Task Force (USPSTF), the national lung cancer screening uptake remains around 5% among eligible individuals. Advancements in the clinical management of NSCLC have recently become more personalized with the implementation of blood-based biomarker testing. Extensive research into tumor-derived cell-free DNA (cfDNA) through fragmentation offers a novel method for improving early lung cancer detection. This review assesses the screening landscape, explores obstacles to lung cancer screening, and discusses how a plasma whole genome fragmentome test (pWGFrag-Lung) can improve lung cancer screening participation and adherence. Full article

(This article belongs to the Special Issue Novel Strategies for Detection, Diagnosis and Management of Non-small Cell Lung Cancer)

21 pages, 700 KB

Open AccessEditor’s ChoiceReview

Omalizumab and Dupilumab for the Treatment of Bullous Pemphigoid: A Systematic Review

by Elena Granados-Betancort, Manuel Sánchez-Díaz, Daniel Muñoz-Barba and Salvador Arias-Santiago

J. Clin. Med. 2024, 13(16), 4844; https://doi.org/10.3390/jcm13164844 - 16 Aug 2024

Cited by 11 | Viewed by 5190

Abstract

Background: Bullous pemphigoid (BP) is an autoimmune disease characterized by the appearance of very pruritic subepidermal blisters. It appears mostly in the elderly and is associated with multiple comorbidities, which makes its management and treatment difficult. The purpose of this systematic review [...] Read more.

Background: Bullous pemphigoid (BP) is an autoimmune disease characterized by the appearance of very pruritic subepidermal blisters. It appears mostly in the elderly and is associated with multiple comorbidities, which makes its management and treatment difficult. The purpose of this systematic review is to compile current information on published cases of BP treated with omalizumab (omalizumab) and dupilumab (dupilumab) in order to obtain information on clinical efficacy and safety data available. Methods: A literature search of all cases of BP treated with omalizumab/dupilumab published in the literature up to January 2024 was performed using the Pubmed database. After an exhaustive search, a total of 61 studies encompassing 886 patients met the inclusion criteria and were included in the review. Results: The majority of patients with BP treated with omalizumab/dupilumab presented a significant improvement in symptomatology, being very safe drugs with minimal side effects. The main limitation of the presented review is the quality of the included studies, most of them being case series or individual cases. The development of studies with a higher level of scientific evidence in the near future would be of great interest. Conclusions: Both omalizumab and dupilumab appear to be effective options for treating BP in patients refractory to other pharmacological therapies. They are drugs with a good safety profile and the adverse reactions associated with their use are infrequent and generally mild. Full article

(This article belongs to the Special Issue Targeted Treatment of Skin Inflammation)

► Show Figures

Figure 1

14 pages, 1331 KB

Open AccessEditor’s ChoiceSystematic Review

Fistulizing Perianal Disease as a First Manifestation of Crohn’s Disease: A Systematic Review and Meta-Analysis

by Liesbeth Jozefien Munster, Giulia Louise Emilia Mönnink, Susan van Dieren, Marco William Mundt, Geert Renaat Alfons Maria D’Haens, Willem Adrianus Bemelman, Christianne Johanna Buskens and Jarmila Dagmara Wendelien van der Bilt

J. Clin. Med. 2024, 13(16), 4734; https://doi.org/10.3390/jcm13164734 - 12 Aug 2024

Cited by 9 | Viewed by 3674

Abstract

Background: Incidences of perianal fistulas (PAFs) as a first manifestation of Crohn’s disease (CD) vary widely in the literature. Aim: To analyse the percentage of patients with a PAF preceding CD diagnosis and assess the time to diagnosis. Methods: A systematic [...] Read more.

Background: Incidences of perianal fistulas (PAFs) as a first manifestation of Crohn’s disease (CD) vary widely in the literature. Aim: To analyse the percentage of patients with a PAF preceding CD diagnosis and assess the time to diagnosis. Methods: A systematic literature search was conducted. Studies reporting on patients with a PAF preceding CD diagnosis were identified. Primary outcomes were the (weighted) percentage of patients with CD with a PAF preceding CD and their time to CD diagnosis. Secondary outcomes were the (weighted) percentage of patients with CD with a PAF preceding CD diagnosis in predefined patient subgroups, including (1) sex (men vs. women), (2) ethnicity (Asian vs. non-Asian), and (3) age (paediatric (0–18 y) and patients with elderly onset CD (>60 y) vs. adult patients (18–60 y)). Results: Seventeen studies were included (34,030 patients with CD). In the overall CD population, a PAF preceded CD in 8.6% [95%CI; 5.72; 12.71] with a weighted mean time to CD diagnosis of 45.9 (31.3) months. No studies reported details on sex differences in patients with a PAF as a manifesting sign of CD. In Asian populations, a PAF preceded CD in 17.66% [95%CI; 11.45; 26.25], which was significantly higher when compared with non-Asians (4.99% [95%CI; 3.75; 6.60], OR:3.99, p < 0.0001). In adolescents, an incidence of 9.17% [95%CI; 5.92; 13.93] was found with significantly lower incidences in paediatric patients (6.38% [95%CI; 1.84; 19.85], OR:0.53, p < 0.0001), and elderly-onset patients (3.77% [95%CI; 1.68; 8.25], OR:0.44, p = 0.0035). Conclusions: This systematic review shows that in the literature, almost 10% of patients present with a PAF as a first manifestation of CD, with a mean time to diagnosis of almost four years. These results emphasise that increased clinical awareness is needed. Full article

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

► Show Figures

Figure 1

18 pages, 835 KB

Open AccessEditor’s ChoiceReview

Management of Heparin-Induced Thrombocytopenia: A Contemporary Review

by Jun Yen Ng, Melanie D’Souza, Felanita Hutani and Philip Choi

J. Clin. Med. 2024, 13(16), 4686; https://doi.org/10.3390/jcm13164686 - 9 Aug 2024

Cited by 7 | Viewed by 12049

Abstract

Heparin-induced thrombocytopenia (HIT) is a life- and limb-threatening immune-mediated emergency classically associated with heparin therapy. This review focuses on type II HIT, characterized by the development of antibodies against platelet-factor 4 (PF4) bound to heparin after exposure, causing life-threatening thrombocytopenia, arterial thrombosis, and/or [...] Read more.

Heparin-induced thrombocytopenia (HIT) is a life- and limb-threatening immune-mediated emergency classically associated with heparin therapy. This review focuses on type II HIT, characterized by the development of antibodies against platelet-factor 4 (PF4) bound to heparin after exposure, causing life-threatening thrombocytopenia, arterial thrombosis, and/or venous thrombosis. The high morbidity and mortality rates emphasize the need for early recognition and urgent intervention with discontinuation of heparin and initiation of non-heparin anticoagulation. We discuss the management of HIT with an emphasis on recent developments: (i) incorporating the phases of HIT (i.e., suspected, acute, subacute A and B, and remote) into its management, categorized according to platelet count, immunoassay, and functional assay results and (ii) direct-acting oral anticoagulants (DOACs), which are increasingly used in appropriate cases of acute HIT (off-label). In comparison to parenteral options (e.g., bivalirudin and danaparoid), they are easier to administer, are more cost-effective, and obviate the need for transition to an oral anticoagulant after platelet recovery. We also identify the knowledge gaps and suggest areas for future research. Full article

(This article belongs to the Special Issue Antibody-Mediated Thrombotic Diseases)

► Show Figures

Figure 1

15 pages, 1286 KB

Open AccessEditor’s ChoiceReview

Sedation for GI Endoscopy in the Morbidly Obese: Challenges and Possible Solutions

by Lalitha Sundararaman and Basavana Goudra

J. Clin. Med. 2024, 13(16), 4635; https://doi.org/10.3390/jcm13164635 - 8 Aug 2024

Cited by 9 | Viewed by 7904

Abstract

With the increasing prevalence of obesity and morbid obesity, this subgroup’s contribution to patients presenting for elective procedures requiring sedation is significant. Gastrointestinal (GI) procedures clearly form the largest group of such procedures. These procedures may be intended to treat obesity such as [...] Read more.

With the increasing prevalence of obesity and morbid obesity, this subgroup’s contribution to patients presenting for elective procedures requiring sedation is significant. Gastrointestinal (GI) procedures clearly form the largest group of such procedures. These procedures may be intended to treat obesity such as the insertion of an intragastric balloon or one or more unrelated procedures such as a screening colonoscopy and (or) diagnostic/therapeutic endoscopy. Regardless of the procedure, these patients pose significant challenges in terms of choice of sedatives, dosing, airway management, ventilation, and oxygenation. An understanding of dissimilarity in the handling of different groups of medications used by an anesthesia provider and alterations in airway anatomy is critical for providing safe sedation. Administration of sedative medications and conduct of anesthesia requires dose modifications and airway adjuncts. In this review, we discuss the above issues in detail, with a particular focus on GI endoscopy. Full article

(This article belongs to the Section Anesthesiology)

► Show Figures

Figure 1

14 pages, 834 KB

Open AccessEditor’s ChoiceReview

Mechanical Circulatory Support with Impella: Principles, Evidence, and Daily Practice

by Giulia Masiero, Federico Arturi, Andrea Panza and Giuseppe Tarantini

J. Clin. Med. 2024, 13(16), 4586; https://doi.org/10.3390/jcm13164586 - 6 Aug 2024

Cited by 9 | Viewed by 6498

Abstract

The Impella (Abiomed, Danvers, MA, USA) microaxial pump is a percutaneous mechanical circulatory support (MCS) that has been shown to increase coronary perfusion, reduce myocardial oxygen demand, and improve peripheral organ perfusion. Therefore, indications for the Impella device include emergency use for cardiogenic [...] Read more.

The Impella (Abiomed, Danvers, MA, USA) microaxial pump is a percutaneous mechanical circulatory support (MCS) that has been shown to increase coronary perfusion, reduce myocardial oxygen demand, and improve peripheral organ perfusion. Therefore, indications for the Impella device include emergency use for cardiogenic shock (CS) and pre-emptive implantation during high-risk percutaneous coronary intervention (HR-PCI). However, despite their exponential use in cardiovascular practice over the past decade, there is limited randomized evidence to support the benefits of this therapy and growing concern regarding complication rates. In this review, we summarize the principles, evidence, and practical considerations of the most widely used Impella CP percutaneous left ventricular support in both CS and HR-PCI settings, moving from the historical background to current issues and future expectations for this device. Full article

(This article belongs to the Special Issue Percutaneous Coronary Intervention (PCI): Past, Present and Future)

► Show Figures

Figure 1

18 pages, 2175 KB

Open AccessEditor’s ChoiceReview

Physical Treatments and Therapies for Androgenetic Alopecia

by Siddhi Bianca Camila Lama, Luis Alfonso Pérez-González, Mehmet A. Kosoglu, Robert Dennis and Daniel Ortega-Quijano

J. Clin. Med. 2024, 13(15), 4534; https://doi.org/10.3390/jcm13154534 - 2 Aug 2024

Cited by 8 | Viewed by 11668

Abstract

Androgenetic alopecia, the most common cause of hair loss affecting both men and women, is typically treated using pharmaceutical options, such as minoxidil and finasteride. While these medications work for many individuals, they are not suitable options for all. To date, the only [...] Read more.

Androgenetic alopecia, the most common cause of hair loss affecting both men and women, is typically treated using pharmaceutical options, such as minoxidil and finasteride. While these medications work for many individuals, they are not suitable options for all. To date, the only non-pharmaceutical option that the United States Food and Drug Administration has cleared as a treatment for androgenetic alopecia is low-level laser therapy (LLLT). Numerous clinical trials utilizing LLLT devices of various types are available. However, a myriad of other physical treatments for this form of hair loss have been reported in the literature. This review evaluated the effectiveness of microneedling, pulsed electromagnetic field (PEMF) therapy, low-level laser therapy (LLLT), fractional laser therapy, and nonablative laser therapy for the treatment of androgenetic alopecia (AGA). It also explores the potential of multimodal treatments combining these physical therapies. The majority of evidence in the literature supports LLLT as a physical therapy for androgenetic alopecia. However, other physical treatments, such as nonablative laser treatments, and multimodal approaches, such as PEMF-LLLT, seem to have the potential to be equally or more promising and merit further exploration. Full article

(This article belongs to the Special Issue Autoimmune-Induced Alopecia and Emerging Therapies in Hair Loss)

► Show Figures

Graphical abstract

10 pages, 546 KB

Open AccessEditor’s ChoiceReview

Harnessing Mirror Neurons: A New Frontier in Parkinson’s Disease Rehabilitation—A Scoping Review of the Literature

by Roberto Tedeschi, Daniela Platano, Danilo Donati and Federica Giorgi

J. Clin. Med. 2024, 13(15), 4539; https://doi.org/10.3390/jcm13154539 - 2 Aug 2024

Cited by 9 | Viewed by 3666

Abstract

Background: Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor symptoms such as tremors, rigidity, and bradykinesia. Rehabilitation utilizing mirror neurons leverages the brain’s capacity for action observation (AO) and motor imagery (MI) to enhance motor function. This approach involves patients [...] Read more.

Background: Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor symptoms such as tremors, rigidity, and bradykinesia. Rehabilitation utilizing mirror neurons leverages the brain’s capacity for action observation (AO) and motor imagery (MI) to enhance motor function. This approach involves patients imitating movements observed in therapists or videos, aiming to improve gait, coordination, and overall quality of life. Mirror neuron activation facilitates motor learning and may decelerate disease progression, thus enhancing patient mobility and independence. Methods: This scoping review aimed to map current evidence on PD therapies employing mirror neuron-based rehabilitation. Databases searched included PubMed, PEDro, and Cochrane. The review included randomized controlled trials (RCTs) and systematic reviews that examined the effects of AO and MI in PD rehabilitation. Results: Five studies met the inclusion criteria, encompassing various rehabilitation techniques focusing on AO and MI. These studies consistently demonstrated positive outcomes, such as reduced disease severity and improved quality of life, gait, and balance in PD patients. The activation of mirror neurons through AO and MI was shown to facilitate motor learning and contribute to improved functional mobility. Conclusions: Although the included studies support the beneficial impact of AO and MI techniques in PD rehabilitation, numerous questions remain unresolved. Further research is necessary to evaluate the potential integration of these techniques into standard physiotherapy routines for PD patients. This review highlights the promise of AO and MI in enhancing motor rehabilitation for PD, suggesting the need for more comprehensive studies to validate and refine these therapeutic approaches. Full article

(This article belongs to the Section Clinical Neurology)

► Show Figures

Figure 1

20 pages, 886 KB

Open AccessEditor’s ChoiceReview

Prevention of Pregnancy Complications Using a Multimodal Lifestyle, Screening, and Medical Model

by Jim Parker, Pierre Hofstee and Shaun Brennecke

J. Clin. Med. 2024, 13(15), 4344; https://doi.org/10.3390/jcm13154344 - 25 Jul 2024

Cited by 8 | Viewed by 6575

Abstract

Prevention of pregnancy complications related to the “great obstetrical syndromes” (preeclampsia, fetal growth restriction, spontaneous preterm labor, and stillbirth) is a global research and clinical management priority. These syndromes share many common pathophysiological mechanisms that may contribute to altered placental development and function. [...] Read more.

Prevention of pregnancy complications related to the “great obstetrical syndromes” (preeclampsia, fetal growth restriction, spontaneous preterm labor, and stillbirth) is a global research and clinical management priority. These syndromes share many common pathophysiological mechanisms that may contribute to altered placental development and function. The resulting adverse pregnancy outcomes are associated with increased maternal and perinatal morbidity and mortality and increased post-partum risk of cardiometabolic disease. Maternal nutritional and environmental factors are known to play a significant role in altering bidirectional communication between fetal-derived trophoblast cells and maternal decidual cells and contribute to abnormal placentation. As a result, lifestyle-based interventions have increasingly been recommended before, during, and after pregnancy, in order to reduce maternal and perinatal morbidity and mortality and decrease long-term risk. Antenatal screening strategies have been developed following extensive studies in diverse populations. Multivariate preeclampsia screening using a combination of maternal, biophysical, and serum biochemical markers is recommended at 11–14 weeks’ gestation and can be performed at the same time as the first-trimester ultrasound and blood tests. Women identified as high-risk can be offered prophylactic low dose aspirin and monitored with angiogenic factor assessment from 22 weeks’ gestation, in combination with clinical assessment, serum biochemistry, and ultrasound. Lifestyle factors can be reassessed during counseling related to antenatal screening interventions. The integration of lifestyle interventions, pregnancy screening, and medical management represents a conceptual advance in pregnancy care that has the potential to significantly reduce pregnancy complications and associated later life cardiometabolic adverse outcomes. Full article

(This article belongs to the Special Issue Management of Pregnancy Complications)

► Show Figures

Figure 1

12 pages, 244 KB

Open AccessEditor’s ChoiceReview

Remimazolam and Its Place in the Current Landscape of Procedural Sedation and General Anesthesia

by Matthew Brohan, Janette Brohan and Basavana Goudra

J. Clin. Med. 2024, 13(15), 4362; https://doi.org/10.3390/jcm13154362 - 25 Jul 2024

Cited by 14 | Viewed by 3956

Abstract

Remimazolam was derived from its parent compound by adding an ester linkage into its structure so that the drug becomes a substrate for ester metabolism. As a result, it undergoes organ-independent ester hydrolysis, although the clinical benefits in terms of shorter recovery are [...] Read more.

Remimazolam was derived from its parent compound by adding an ester linkage into its structure so that the drug becomes a substrate for ester metabolism. As a result, it undergoes organ-independent ester hydrolysis, although the clinical benefits in terms of shorter recovery are not uniformly observed in clinical practice. Remimazolam is mainly tested in procedural sedation. In comparison to propofol, the current gold standard for procedural sedation, its proposed attractiveness is shorter wake-up times and a clear-headed recovery. Its clear advantages over propofol are better hemodynamic stability, lack of pain on injection and availability of a reversal agent in the form of flumazenil. Data on patient and proceduralist satisfaction are lacking. Remimazolam is also used for induction and maintenance of general anesthesia in Japan (where it is approved for this purpose). In this scenario, it is not clear if it can achieve the same degree of lack of recall as propofol. The use of remimazolam in obstetrics, pediatrics and high-risk populations is an emerging area. Full article

(This article belongs to the Section Anesthesiology)

12 pages, 249 KB

Open AccessFeature PaperEditor’s ChoiceReview

Errors in Radiology: A Standard Review

by Filippo Pesapane, Giulia Gnocchi, Cettina Quarrella, Adriana Sorce, Luca Nicosia, Luciano Mariano, Anna Carla Bozzini, Irene Marinucci, Francesca Priolo, Francesca Abbate, Gianpaolo Carrafiello and Enrico Cassano

J. Clin. Med. 2024, 13(15), 4306; https://doi.org/10.3390/jcm13154306 - 23 Jul 2024

Cited by 10 | Viewed by 5764

Abstract

Radiological interpretations, while essential, are not infallible and are best understood as expert opinions formed through the evaluation of available evidence. Acknowledging the inherent possibility of error is crucial, as it frames the discussion on improving diagnostic accuracy and patient care. A comprehensive [...] Read more.

Radiological interpretations, while essential, are not infallible and are best understood as expert opinions formed through the evaluation of available evidence. Acknowledging the inherent possibility of error is crucial, as it frames the discussion on improving diagnostic accuracy and patient care. A comprehensive review of error classifications highlights the complexity of diagnostic errors, drawing on recent frameworks to categorize them into perceptual and cognitive errors, among others. This classification underpins an analysis of specific error types, their prevalence, and implications for clinical practice. Additionally, we address the psychological impact of radiological practice, including the effects of mental health and burnout on diagnostic accuracy. The potential of artificial intelligence (AI) in mitigating errors is discussed, alongside ethical and regulatory considerations in its application. This research contributes to the body of knowledge on radiological errors, offering insights into preventive strategies and the integration of AI to enhance diagnostic practices. It underscores the importance of a nuanced understanding of errors in radiology, aiming to foster improvements in patient care and radiological accuracy. Full article

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

27 pages, 2395 KB

Open AccessEditor’s ChoiceReview

Sex Differences in Aortic Stenosis: From the Pathophysiology to the Intervention, Current Challenges, and Future Perspectives

by Paolo Springhetti, Kathia Abdoun and Marie-Annick Clavel

J. Clin. Med. 2024, 13(14), 4237; https://doi.org/10.3390/jcm13144237 - 19 Jul 2024

Cited by 10 | Viewed by 4097

Abstract

Calcific aortic stenosis (AS) is a major cause of morbidity and mortality in high-income countries. AS presents sex-specific features impacting pathophysiology, outcomes, and management strategies. In women, AS often manifests with a high valvular fibrotic burden, small valvular annuli, concentric left ventricular (LV) [...] Read more.

Calcific aortic stenosis (AS) is a major cause of morbidity and mortality in high-income countries. AS presents sex-specific features impacting pathophysiology, outcomes, and management strategies. In women, AS often manifests with a high valvular fibrotic burden, small valvular annuli, concentric left ventricular (LV) remodeling/hypertrophy, and, frequently, supernormal LV ejection fraction coupled with diastolic dysfunction. Paradoxical low-flow low-gradient AS epitomizes these traits, posing significant challenges post-aortic valve replacement due to limited positive remodeling and significant risk of patient–prosthesis mismatch. Conversely, men present more commonly with LV dilatation and dysfunction, indicating the phenotype of classical low-flow low-gradient AS, i.e., with decreased LV ejection fraction. However, these distinctions have not been fully incorporated into guidelines for AS management. The only treatment for AS is aortic valve replacement; women are frequently referred late, leading to increased heart damage caused by AS. Therefore, it is important to reassess surgical planning and timing to minimize irreversible cardiac damage in women. The integrity and the consideration of sex differences in the management of AS is critical. Further research, including sufficient representation of women, is needed to investigate these differences and to develop individualized, sex-specific management strategies. Full article

(This article belongs to the Special Issue Diagnosis and Management of Aortic Diseases: Drafting from Theoretical Aspects to Clinical Practice)

► Show Figures

Graphical abstract

16 pages, 4275 KB

Open AccessEditor’s ChoiceArticle

Fully Automated Measurement of Cobb Angles in Coronal Plane Spine Radiographs

by Kenneth Chen, Christoph Stotter, Thomas Klestil, Jennyfer A. Mitterer, Christopher Lepenik and Stefan Nehrer

J. Clin. Med. 2024, 13(14), 4122; https://doi.org/10.3390/jcm13144122 - 15 Jul 2024

Cited by 8 | Viewed by 7052

Abstract

Background/Objectives: scoliosis is a three-dimensional structural deformity characterized by lateral and rotational curvature of the spine. The current gold-standard method to assess scoliosis is the measurement of lateral curvature of the spine using the Cobb angle in coronal plane radiographs. The interrater variability [...] Read more.

Background/Objectives: scoliosis is a three-dimensional structural deformity characterized by lateral and rotational curvature of the spine. The current gold-standard method to assess scoliosis is the measurement of lateral curvature of the spine using the Cobb angle in coronal plane radiographs. The interrater variability for Cobb angle measurements reaches up to 10°. The purpose of this study was to describe and assess the performance of a fully automated method for measuring Cobb angles using a commercially available artificial intelligence (AI) model trained on over 17,000 images, and investigate its interrater/intrarater agreement with a reference standard. Methods: in total, 196 AP/PA full-spine radiographs were included in this study. A reference standard was established by four radiologists, defined as the median of their Cobb angle measurements. Independently, an AI-based software, IB Lab SQUIRREL (version 1.0), also performed Cobb angle measurements on the same radiographs. Results: after comparing the readers’ Cobb angle end vertebrae selection to the AI’s outputs, 194 curvatures were considered valid for performance assessment, displaying an accuracy of 88.58% in end vertebrae selection. The AI’s performance showed very low absolute bias, with a mean difference and standard deviation of differences from the reference standard of 0.16° ± 0.35° in the Cobb angle measurements. The ICC comparing the reference standard and the AI’s measurements was 0.97. Conclusions: the AI model demonstrated good results in the determination of end vertebrae and excellent results in automated Cobb angle measurements compared to radiologists and could serve as a reliable tool in clinical practice and research. Full article

(This article belongs to the Special Issue Spinal Deformity: Diagnosis, Complication and Treatment in Adolescent Patients)

► Show Figures

Figure 1

26 pages, 1229 KB

Open AccessEditor’s ChoiceReview

The Brain–Gut Axis, an Important Player in Alzheimer and Parkinson Disease: A Narrative Review

by Eugenio Caradonna, Raffaello Nemni, Angelo Bifone, Patrizia Gandolfo, Lucy Costantino, Luca Giordano, Elisabetta Mormone, Anna Macula, Mariarosa Cuomo, Rossana Difruscolo, Camilla Vanoli, Emilio Vanoli and Fulvio Ferrara

J. Clin. Med. 2024, 13(14), 4130; https://doi.org/10.3390/jcm13144130 - 15 Jul 2024

Cited by 41 | Viewed by 9068

Abstract

Neurodegenerative diseases, such as Alzheimer’s disease (AD) and Parkinson’s disease (PD), are severe age-related disorders with complex and multifactorial causes. Recent research suggests a critical link between neurodegeneration and the gut microbiome, via the gut–brain communication pathway. This review examines the role of [...] Read more.

Neurodegenerative diseases, such as Alzheimer’s disease (AD) and Parkinson’s disease (PD), are severe age-related disorders with complex and multifactorial causes. Recent research suggests a critical link between neurodegeneration and the gut microbiome, via the gut–brain communication pathway. This review examines the role of trimethylamine N-oxide (TMAO), a gut microbiota-derived metabolite, in the development of AD and PD, and investigates its interaction with microRNAs (miRNAs) along this bidirectional pathway. TMAO, which is produced from dietary metabolites like choline and carnitine, has been linked to increased neuroinflammation, protein misfolding, and cognitive decline. In AD, elevated TMAO levels are associated with amyloid-beta and tau pathologies, blood–brain barrier disruption, and neuronal death. TMAO can cross the blood–brain barrier and promote the aggregation of amyloid and tau proteins. Similarly, TMAO affects alpha-synuclein conformation and aggregation, a hallmark of PD. TMAO also activates pro-inflammatory pathways such as NF-kB signaling, exacerbating neuroinflammation further. Moreover, TMAO modulates the expression of various miRNAs that are involved in neurodegenerative processes. Thus, the gut microbiome–miRNA–brain axis represents a newly discovered mechanistic link between gut dysbiosis and neurodegeneration. MiRNAs regulate the key pathways involved in neuroinflammation, oxidative stress, and neuronal death, contributing to disease progression. As a direct consequence, specific miRNA signatures may serve as potential biomarkers for the early detection and monitoring of AD and PD progression. This review aims to elucidate the complex interrelationships between the gut microbiota, trimethylamine-N-oxide (TMAO), microRNAs (miRNAs), and the central nervous system, and the implications of these connections in neurodegenerative diseases. In this context, an overview of the current neuroradiology techniques available for studying neuroinflammation and of the animal models used to investigate these intricate pathologies will also be provided. In summary, a bulk of evidence supports the concept that modulating the gut–brain communication pathway through dietary changes, the manipulation of the microbiome, and/or miRNA-based therapies may offer novel approaches for implementing the treatment of debilitating neurological disorders. Full article

(This article belongs to the Special Issue Advances in Longevity Medicine)

► Show Figures

Figure 1

16 pages, 1211 KB

Open AccessEditor’s ChoiceReview

Eosinophils, Eosinophilic Gastrointestinal Diseases, and Inflammatory Bowel Disease: A Critical Review

by Giulia Migliorisi, Elisabetta Mastrorocco, Arianna Dal Buono, Roberto Gabbiadini, Gaia Pellegatta, Paola Spaggiari, Francesca Racca, Enrico Heffler, Edoardo Vincenzo Savarino, Cristina Bezzio, Alessandro Repici and Alessandro Armuzzi

J. Clin. Med. 2024, 13(14), 4119; https://doi.org/10.3390/jcm13144119 - 14 Jul 2024

Cited by 12 | Viewed by 6434

Abstract

Background/Objectives: Inflammatory bowel disease (IBD) and eosinophilic gastrointestinal diseases (EGIDs) are complex, multifactorial chronic inflammatory disorders affecting the gastrointestinal tract. Their epidemiology, particularly for eosinophilic esophagitis (EoE), is increasing worldwide, with a rise in the co-diagnosis of IBD and EGIDs. Both disorders share [...] Read more.

Background/Objectives: Inflammatory bowel disease (IBD) and eosinophilic gastrointestinal diseases (EGIDs) are complex, multifactorial chronic inflammatory disorders affecting the gastrointestinal tract. Their epidemiology, particularly for eosinophilic esophagitis (EoE), is increasing worldwide, with a rise in the co-diagnosis of IBD and EGIDs. Both disorders share common risk factors, such as early exposure to antibiotics or specific dietary habits. Moreover, from a molecular perspective, eosinophilic infiltration is crucial in the diagnosis of eosinophilic disorders, and it also plays a pivotal role in IBD histological diagnosis. Indeed, recent evidence highlights the significant role of eosinophils in the health of the intestinal mucosal barrier and as mediators between innate and acquired immunity, even indicating a potential role in IBD pathogenesis. This narrative review aims to summarize the current evidence regarding the common clinical and molecular aspects of EGIDs and IBD and the current state of knowledge regarding overlap conditions and their pathogenesis. Methods: Pubmed was searched until May 2023 to assess relevant studies describing the epidemiology, pathophysiology, and therapy of EGIDs in IBD. Results: The immune pathways and mechanisms underlying both EGIDs and IBD remain partially known. An improved understanding of the role of eosinophils in overlapping conditions could lead to enhanced diagnostic precision, the development of more effective future therapeutic strategies, and a more accurate prediction of patient response. Consequently, the identification of red flags indicative of an eosinophilic disorder in IBD patients is of paramount importance and must be evaluated on a case-by-case basis. Full article

(This article belongs to the Special Issue Inflammatory Bowel Disease: From Diagnosis to Treatment)

► Show Figures

Figure 1

25 pages, 2408 KB

Open AccessEditor’s ChoiceReview

A Review of Myositis-Associated Interstitial Lung Disease

by Renuka Kannappan, Raagni Kumar, Kimberly Cichelli and Lawrence H. Brent

J. Clin. Med. 2024, 13(14), 4055; https://doi.org/10.3390/jcm13144055 - 11 Jul 2024

Cited by 6 | Viewed by 12406

Abstract

There is a well-established relationship between different subsets of idiopathic inflammatory myopathies (IIMs, myositis) and interstitial lung disease (ILD), with lung complications sometimes presenting prior to myopathic manifestations. The subtypes of myositis include those that are strongly associated with ILD, such as polymyositis [...] Read more.

There is a well-established relationship between different subsets of idiopathic inflammatory myopathies (IIMs, myositis) and interstitial lung disease (ILD), with lung complications sometimes presenting prior to myopathic manifestations. The subtypes of myositis include those that are strongly associated with ILD, such as polymyositis (PM) and dermatomyositis (DM). Research has shown that in certain patients, these can then be further divided into subtypes using myositis-specific antibodies (MSAs), which are specific for myositis, and myositis-associated antibodies (MAAs), which can be found in myositis in overlap syndromes with other connective tissue diseases (CTDs). Notably, certain MSAs and MAAs are associated with ILD in patients with myositis. The clinical presentations of ILD in patients with myositis can vary widely and can be insidious in onset and difficult to diagnose. As ILD can progress rapidly in some cases, it is essential that clinicians are able to identify and diagnose ILD in patients with myositis. For this reason, the aim of this review is to highlight the clinical features, diagnostic criteria, important histopathologic, laboratory, and radiographic features, and treatment modalities for those patients with myositis-associated ILD. Full article

(This article belongs to the Special Issue Clinical Advances in Interstitial Lung Diseases)

► Show Figures

Figure 1

13 pages, 1189 KB

Open AccessEditor’s ChoiceReview

Hepatitis C Virus (HCV) Infection: Pathogenesis, Oral Manifestations, and the Role of Direct-Acting Antiviral Therapy: A Narrative Review

by Dario Di Stasio, Agostino Guida, Antonio Romano, Massimo Petruzzi, Aldo Marrone, Fausto Fiori and Alberta Lucchese

J. Clin. Med. 2024, 13(14), 4012; https://doi.org/10.3390/jcm13144012 - 9 Jul 2024

Cited by 10 | Viewed by 5329

Abstract

Hepatitis C virus (HCV) infection is a global health concern with significant systemic implications, including a range of oral manifestations. This review aims to provide a comprehensive overview of the oral and dental pathologies related to HCV, the etiopathogenetic mechanisms linking such conditions [...] Read more.

Hepatitis C virus (HCV) infection is a global health concern with significant systemic implications, including a range of oral manifestations. This review aims to provide a comprehensive overview of the oral and dental pathologies related to HCV, the etiopathogenetic mechanisms linking such conditions to HCV and the impact of direct-acting antiviral (DAA) therapy. Common oral manifestations of HCV include oral lichen planus (OLP), periodontal disease, and xerostomia. The pathogenesis of these conditions involves both direct viral effects on oral tissues and indirect effects related to the immune response to HCV. Our literature analysis, using PubMed, Scopus, Web of Science, and Google Scholar, suggests that both the HCV infection and the immune response to HCV contribute to the increased prevalence of these oral diseases. The introduction of DAA therapy represents a significant advancement in HCV treatment, but its effects on oral manifestations, particularly OLP, are still under evaluation. Although a possible mechanism linking HCV to OSCC is yet to be determined, existing evidence encourages further investigation in this sense. Our findings highlight the need for established protocols for managing the oral health of patients with HCV, aiming to improve outcomes and quality of life. Full article

(This article belongs to the Special Issue Stomatognathic Diseases: State of the Art and Future Perspectives)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Editor’s Choice Articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI