Journal of Clinical Medicine

14 pages, 3558 KiB

Open AccessEditor’s ChoiceReview

Non-Invasive Imaging Assessment in Patients with Aortic Coarctation: A Contemporary Review

by Isabella Leo, Jolanda Sabatino, Martina Avesani, Sara Moscatelli, Francesco Bianco, Nunzia Borrelli, Rosalba De Sarro, Benedetta Leonardi, Giuseppe Calcaterra, Elena Surkova, Giovanni Di Salvo and on behalf of the Working Group on Congenital Heart Disease, Cardiovascular Prevention in Paediatric Age of the Italian Society of Cardiology (SIC)

J. Clin. Med. 2024, 13(1), 28; https://doi.org/10.3390/jcm13010028 - 20 Dec 2023

Cited by 10 | Viewed by 3751

Abstract

Coarctation of the aorta (CoA) is a congenital abnormality characterized by a narrowing of the aortic lumen, which can lead to significant morbidity and mortality if left untreated. Even after repair and despite significant advances in therapeutic management, these patients have overall reduced [...] Read more.

Coarctation of the aorta (CoA) is a congenital abnormality characterized by a narrowing of the aortic lumen, which can lead to significant morbidity and mortality if left untreated. Even after repair and despite significant advances in therapeutic management, these patients have overall reduced long-term survival due to the consequences of chronic afterload increase. Cardiovascular imaging is key from the first diagnosis to serial follow-up. In recent years, novel imaging techniques have emerged, increasing accessibility to advanced imaging modalities and enabling early and non-invasive identification of complications after repair. The aim of this paper is to provide a comprehensive review of the role of different imaging techniques in the evaluation and management of patients with native or repaired CoA, highlighting their unique strengths and limitations. Full article

(This article belongs to the Special Issue Hypertension in Childhood and Adolescence)

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14 pages, 1476 KiB

Open AccessEditor’s ChoiceArticle

LECOM (Lead Extraction COMplexity): A New Scoring System for Predicting a Difficult Procedure

by Wojciech Jacheć, Dorota Nowosielecka, Bettina Ziaja, Anna Polewczyk and Andrzej Kutarski

J. Clin. Med. 2023, 12(24), 7568; https://doi.org/10.3390/jcm12247568 - 8 Dec 2023

Cited by 10 | Viewed by 1403

Abstract

(1) Background: Transvenous lead extraction (TLE) can become far more complex when unanticipated difficulties arise. The aim was to develop a simple scoring system that allows for the prediction of the difficulty and complexity of this significant procedure. (2) Methods: Based on analysis [...] Read more.

(1) Background: Transvenous lead extraction (TLE) can become far more complex when unanticipated difficulties arise. The aim was to develop a simple scoring system that allows for the prediction of the difficulty and complexity of this significant procedure. (2) Methods: Based on analysis of 3741 TLE procedures with and without complicating factors (extended fluoroscopy time, need for second-line instruments, and advanced techniques and instruments), a five-point Complex Indicator of Difficulty of (TLE) Procedure (CID-TLEP) scale was developed. Two or more points on the CID-TLEP scale indicate a higher level of procedure complexity. (3) Results: Patient age below 51 years at first CIED implantation, number of abandoned leads, number of previous procedures, passive fixation and multiple leads to be extracted, and a ratio of dwell time of oldest lead to patient age during TLE of >0.13 are significant predictors of higher levels of lead extraction complexity. The ROC analysis demonstrates that a point total (being the sum of the odds ratios of the above variables) of >9.697 indicates a 21.83% higher probability of complex TLE (sensitivity 74.08%, specificity 74.46%). Finally, a logistic function was calculated, and we constructed a simple equation for lead extraction complexity that can predict the probability of a difficult procedure. The risk of complex extraction (as a percentage) is calculated as [1/(1 + 55.34 · 0.754^X)] · 100 (p < 0.001). (4) Conclusion: The LECOM score can effectively predict the risk of a difficult transvenous lead extraction procedure, and predicting the probability of a more complex procedure may help clinicians in planning lead removal and improving patient management. Full article

(This article belongs to the Special Issue Transvenous Lead Extraction - Progress in Lead Management)

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16 pages, 3125 KiB

Open AccessEditor’s ChoiceReview

Evolution of More Aggressive LDL-Cholesterol Targets and Therapies for Cardiovascular Disease Prevention

by Jeffrey E. Jones, Kevin S. Tang, Ailin Barseghian and Nathan D. Wong

J. Clin. Med. 2023, 12(23), 7432; https://doi.org/10.3390/jcm12237432 - 30 Nov 2023

Cited by 15 | Viewed by 7982

Abstract

Over the last half-century, discussions on the exact targets for low-density lipoprotein cholesterol (LDL-C) reduction have evolved towards a more aggressive approach with lower LDL-C targets, particularly for high-risk patients with pre-existing atherosclerotic cardiovascular disease (ASCVD). A wealth of cardiovascular outcome trials have [...] Read more.

Over the last half-century, discussions on the exact targets for low-density lipoprotein cholesterol (LDL-C) reduction have evolved towards a more aggressive approach with lower LDL-C targets, particularly for high-risk patients with pre-existing atherosclerotic cardiovascular disease (ASCVD). A wealth of cardiovascular outcome trials have shown the efficacy of statin therapy in general, as well as the incremental impact of high-intensity statin therapy in particular. More recent trials have further demonstrated the impact of non-statin therapies, including ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, and, most recently, bempedoic acid, on reducing ASCVD outcomes. The availability of these and other newer therapies has prompted clinicians to strive for lower LDL-C targets to address residual ASCVD risk after statin therapy. This paper will provide an overview of the historical trends in lipid management and therapeutics and review the current state of evidence for lower LDL-C targets in clinical guidelines and recommendations. Full article

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

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22 pages, 1836 KiB

Open AccessEditor’s ChoiceReview

Trabecular Bone Score (TBS) in Individuals with Type 2 Diabetes Mellitus: An Updated Review

by Alexandra-Ioana Trandafir, Oana-Claudia Sima, Ana-Maria Gheorghe, Adrian Ciuche, Anca-Pati Cucu, Claudiu Nistor and Mara Carsote

J. Clin. Med. 2023, 12(23), 7399; https://doi.org/10.3390/jcm12237399 - 29 Nov 2023

Cited by 21 | Viewed by 2966

Abstract

Bone fragility is a complication of type 2 diabetes mellitus (T2DM) that has been identified in recent decades. Trabecular bone score (TBS) appears to be more accurate than bone mineral density (BMD) in diabetic bone disease, particularly in menopausal women with T2DM, to [...] Read more.

Bone fragility is a complication of type 2 diabetes mellitus (T2DM) that has been identified in recent decades. Trabecular bone score (TBS) appears to be more accurate than bone mineral density (BMD) in diabetic bone disease, particularly in menopausal women with T2DM, to independently capture the fracture risk. Our purpose was to provide the most recent overview on TBS-associated clinical data in T2DM. The core of this narrative review is based on original studies (PubMed-indexed journals, full-length, English articles). The sample-based analysis (n = 11, N = 4653) confirmed the use of TBS in T2DM particularly in females (females/males ratio of 1.9), with ages varying between 35 and 91 (mean 65.34) years. With concern to the study design, apart from the transversal studies, two others were prospective, while another two were case-control. These early-post-pandemic data included studies of various sample sizes, such as: males and females (N of 245, 361, 511, and 2294), only women (N of 80, 96, 104, 243, 493, and 887), and only men (N = 169). Overall, this 21-month study on published data confirmed the prior profile of BMD-TBS in T2DM, while the issue of whether checking the fracture risk is mandatory in adults with uncontrolled T2DM remains to be proven or whether, on the other hand, a reduced TBS might function as a surrogate marker of complicated/uncontrolled T2DM. The interventional approach with bisphosphonates for treating T2DM-associated osteoporosis remains a standard one (n = 2). One control study on 4 mg zoledronic acid showed after 1 year a statistically significant increase of lumbar BMD in both diabetic and non-diabetic groups (+3.6%, p = 0.01 and +6.2%, p = 0.01, respectively). Further studies will pinpoint additive benefits on glucose status of anti-osteoporotic drugs or will confirm if certain glucose-lowering regimes are supplementarily beneficial for fracture risk reduction. The novelty of this literature research: these insights showed once again that the patients with T2DM often have a lower TBS than those without diabetes or with normal glucose levels. Therefore, the decline in TBS may reflect an early stage of bone health impairment in T2DM. The novelty of the TBS as a handy, non-invasive method that proved to be an index of bone microarchitecture confirms its practicality as an easily applicable tool for assessing bone fragility in T2DM. Full article

(This article belongs to the Special Issue Update in Osteoporosis and Related Bone Metabolic Disease)

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12 pages, 1111 KiB

Open AccessEditor’s ChoiceArticle

Pulmonary Lobectomy for Early-Stage Lung Cancer with Uniportal versus Three-Portal Video-Assisted Thoracic Surgery: Results from a Single-Centre Randomized Clinical Trial

by Davide Tosi, Alessandra Mazzucco, Valeria Musso, Gianluca Bonitta, Lorenzo Rosso, Paolo Mendogni, Ilaria Righi, Rosaria Carrinola, Francesco Damarco and Alessandro Palleschi

J. Clin. Med. 2023, 12(22), 7167; https://doi.org/10.3390/jcm12227167 - 18 Nov 2023

Cited by 9 | Viewed by 1797

Abstract

Video-assisted thoracic surgery (VATS) is a consolidated approach; however, there is no consensus on the number of ports leading to less postoperative pain. We compared early postoperative pain after uniportal and three-portal VATS lobectomy for early-stage NSCLC. In this randomized clinical trial, patients [...] Read more.

Video-assisted thoracic surgery (VATS) is a consolidated approach; however, there is no consensus on the number of ports leading to less postoperative pain. We compared early postoperative pain after uniportal and three-portal VATS lobectomy for early-stage NSCLC. In this randomized clinical trial, patients undergoing VATS lobectomy were randomly assigned to receive uniportal (U-VATS Group) or three-portal (T-VATS Group) VATS. The inclusion criteria were age ≤ 80 years and ASA < 4. The exclusion criteria were clinical T3, previous thoracic surgery, induction therapy, chest radiotherapy, connective tissue or vascular diseases, major organ failure, and analgesics or corticosteroids use. The postoperative analgesia protocol was based on NRS. Pain was measured as analgesic consumption; the secondary endpoints were intra- and postoperative complications, conversion rate, surgical time, dissected lymph nodes, hospital stay, and respiratory function. Out of 302 eligible patients, 120 were included; demographics were distributed homogeneously. The mean cumulative morphine consumption (CMC) in the U-VATS Group after 7 days was lower than in the T-VATS Group (77.4 mg vs. 90.1 mg, p = 0.003). Intraoperative variables and postoperative complications were comparable. The 30-day intercostal neuralgia rate was lower in the U-VATS Group, without reaching statistical significance. Patients undergoing U-VATS showed a lower analgesic consumption compared with the T-VATS Group; analgesic consumption was moderate in both groups. Full article

(This article belongs to the Special Issue Thoracic Surgery: Current and Future Strategies)

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16 pages, 324 KiB

Open AccessEditor’s ChoiceReview

Perioperative Right Ventricular Dysfunction and Abnormalities of the Tricuspid Valve Apparatus in Patients Undergoing Cardiac Surgery

by Alessia Mattei, Alessandro Strumia, Maria Benedetto, Antonio Nenna, Lorenzo Schiavoni, Raffaele Barbato, Ciro Mastroianni, Omar Giacinto, Mario Lusini, Massimo Chello and Massimiliano Carassiti

J. Clin. Med. 2023, 12(22), 7152; https://doi.org/10.3390/jcm12227152 - 17 Nov 2023

Cited by 11 | Viewed by 2550

Abstract

Right ventricular (RV) dysfunction frequently occurs after cardiac surgery and is linked to adverse postoperative outcomes, including mortality, reintubation, stroke, and prolonged ICU stays. While various criteria using echocardiography and hemodynamic parameters have been proposed, a consensus remains elusive. Distinctive RV anatomical features [...] Read more.

Right ventricular (RV) dysfunction frequently occurs after cardiac surgery and is linked to adverse postoperative outcomes, including mortality, reintubation, stroke, and prolonged ICU stays. While various criteria using echocardiography and hemodynamic parameters have been proposed, a consensus remains elusive. Distinctive RV anatomical features include its thin wall, which presents a triangular shape in a lateral view and a crescent shape in a cross-sectional view. Principal causes of RV dysfunction after cardiac surgery encompass ischemic reperfusion injury, prolonged ischemic time, choice of cardioplegia and its administration, cardiopulmonary bypass weaning characteristics, and preoperative risk factors. Post-left ventricular assist device (LVAD) implantation RV dysfunction is common but often transient, with a favorable prognosis upon resolution. There is an ongoing debate regarding the benefits of concomitant surgical repair of the RV in the presence of regurgitation. According to the literature, the gold standard techniques for assessing RV function are cardiac magnetic resonance imaging and hemodynamic assessment using thermodilution. Echocardiography is widely favored for perioperative RV function evaluation due to its accessibility, reproducibility, non-invasiveness, and cost-effectiveness. Although other techniques exist for RV function assessment, they are less common in clinical practice. Clinical management strategies focus on early detection and include intravenous drugs (inotropes and vasodilators), inhalation drugs (pulmonary vasodilators), ventilator strategies, volume management, and mechanical support. Bridging research gaps in this field is crucial to improving clinical outcomes associated with RV dysfunction in the near future. Full article

(This article belongs to the Special Issue Mitral and Tricuspid Valve Disease and Imaging Techniques)

23 pages, 807 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Drug–Drug Interactions Involving Dexamethasone in Clinical Practice: Myth or Reality?

by Venceslas Bourdin, William Bigot, Anthony Vanjak, Ruxandra Burlacu, Amanda Lopes, Karine Champion, Audrey Depond, Blanca Amador-Borrero, Damien Sene, Chloe Comarmond and Stéphane Mouly

J. Clin. Med. 2023, 12(22), 7120; https://doi.org/10.3390/jcm12227120 - 15 Nov 2023

Cited by 13 | Viewed by 6547

Abstract

Concomitant administration of multiple drugs frequently causes severe pharmacokinetic or pharmacodynamic drug–drug interactions (DDIs) resulting in the possibility of enhanced toxicity and/or treatment failure. The activity of cytochrome P450 (CYP) 3A4 and P-glycoprotein (P-gp), a drug efflux pump sharing localization and substrate affinities [...] Read more.

Concomitant administration of multiple drugs frequently causes severe pharmacokinetic or pharmacodynamic drug–drug interactions (DDIs) resulting in the possibility of enhanced toxicity and/or treatment failure. The activity of cytochrome P450 (CYP) 3A4 and P-glycoprotein (P-gp), a drug efflux pump sharing localization and substrate affinities with CYP3A4, is a critical determinant of drug clearance, interindividual variability in drug disposition and clinical efficacy, and appears to be involved in the mechanism of numerous clinically relevant DDIs, including those involving dexamethasone. The recent increase in the use of high doses of dexamethasone during the COVID-19 pandemic have emphasized the need for better knowledge of the clinical significance of drug–drug interactions involving dexamethasone in the clinical setting. We therefore aimed to review the already published evidence for various DDIs involving dexamethasone in vitro in cell culture systems and in vivo in animal models and humans. Full article

(This article belongs to the Collection Practice and Research in Clinical Pharmacology)

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13 pages, 601 KiB

Open AccessEditor’s ChoiceReview

The First-Line Approach in Children with Obstructive Sleep Apnea Syndrome (OSA)

by Nicole Mussi, Roberta Forestiero, Giulia Zambelli, Letizia Rossi, Maria Rosaria Caramia, Valentina Fainardi and Susanna Esposito

J. Clin. Med. 2023, 12(22), 7092; https://doi.org/10.3390/jcm12227092 - 14 Nov 2023

Cited by 15 | Viewed by 5172

Abstract

Obstructive sleep apnea syndrome (OSA) is the main manifestation of sleep-disordered breathing in children. Untreated OSA can lead to a variety of complications and adverse consequences mainly due to intermittent hypoxemia. The pathogenesis of OSA is multifactorial. In children aged 2 years or [...] Read more.

Obstructive sleep apnea syndrome (OSA) is the main manifestation of sleep-disordered breathing in children. Untreated OSA can lead to a variety of complications and adverse consequences mainly due to intermittent hypoxemia. The pathogenesis of OSA is multifactorial. In children aged 2 years or older, adenoid and/or tonsil hypertrophy are the most common causes of upper airway lumen reduction; obesity becomes a major risk factor in older children and adolescents since the presence of fat in the pharyngeal soft tissue reduces the caliber of the lumen. Treatment includes surgical and non-surgical options. This narrative review summarizes the evidence available on the first-line approach in children with OSA, including clinical indications for medical therapy, its effectiveness, and possible adverse effects. Literature analysis showed that AT is the first-line treatment in most patients with adenotonsillar hypertrophy associated with OSA but medical therapy in children over 2 years old with mild OSA is a valid option. In mild OSA, a 1- to 6-month trial with intranasal steroids (INS) alone or in combination with montelukast with an appropriate follow-up can be considered. Further studies are needed to develop an algorithm that permits the selection of children with OSA who would benefit from alternatives to surgery, to define the optimal bridge therapy before surgery, to evaluate the long-term effects of INS +/− montelukast, and to compare the impact of standardized approaches for weight loss. Full article

(This article belongs to the Special Issue Obstructive Sleep Apnea (OSA): What Can We Do Now?)

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20 pages, 3319 KiB

Open AccessEditor’s ChoiceSystematic Review

Hyperthermic Intraperitoneal Chemotherapy (HIPEC): New Approaches and Controversies on the Treatment of Advanced Epithelial Ovarian Cancer—Systematic Review and Meta-Analysis

by Luigi Della Corte, Carmine Conte, Mario Palumbo, Serena Guerra, Dario Colacurci, Gaetano Riemma, Pasquale De Franciscis, Pierluigi Giampaolino, Anna Fagotti, Giuseppe Bifulco and Giovanni Scambia

J. Clin. Med. 2023, 12(22), 7012; https://doi.org/10.3390/jcm12227012 - 9 Nov 2023

Cited by 11 | Viewed by 3539

Abstract

Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery has been extensively studied in patients with peritoneal carcinomatosis, and it holds promise as a therapeutic strategy, but its role remains elusive. The aim of this study was to assess the existing evidence for the [...] Read more.

Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery has been extensively studied in patients with peritoneal carcinomatosis, and it holds promise as a therapeutic strategy, but its role remains elusive. The aim of this study was to assess the existing evidence for the use or not of HIPEC in primary debulking surgery (PDS), interval debulking surgery (IDS), and recurrent ovarian cancer (ROC), evaluated in terms of survival rates and post-surgical morbidity. Methods: Medline, Pubmed, Cochrane, and Medscape were systematically searched for any article comparing the use of HIPEC treatment with any other therapy in patients with ovarian cancer in PDS, IDS, and ROC. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were followed. We only considered English-language published studies. Results: We included 14 studies, including two RCTs with a total of 1813 women, published between 2003 and 2023 with a recruitment period between 1998 and 2020. In PDS, there were no differences in progression-free survival (PFS) between HIPEC and controls [MD −5.53 months [95% CI −19.91 to 8.84 months]; I² = 96%]. Conversely, in patients treated with NACT, pooled results showed a significant survival advantage in terms of progression-free survival (PFS) and overall survival (OS) in the combined HIPEC plus IDS group rather than surgery alone [PFS: MD 4.68 months (95% CI 3.49 to 5.86 months, I² = 95%); OS: MD 11.81 months (95% CI 9.34 to 14.27 months); I² = 97%]. Concerning ROC patients, pooled MD did not show either a significant PFS difference between intervention and controls [MD 2.68 months (95% CI 433 to 9.70 months); I² = 95%], and OS significant difference (MD 6.69 months [95% CI −9.09 to 22.47 months]; I² = 98%). Severe post-operative complications (≥grade 3) were available in 10 studies, accounting for 1108 women. Overall, there was a slightly but significantly increased risk with the combined approach compared to controls [RR 1.26 (95% CI 1.02 to 1.55); I² = 0%]. Conclusions: The combination of HIPEC with cytoreductive surgery prolongs OS and PFS in advanced epithelial ovarian cancer after NACT with acceptable morbidity. However, additional trials are still needed to determine the effectiveness of HIPEC in primary and recurrence settings. In the era of personalized medicine, the correlation between the efficacy of HIPEC and biological and molecular findings represents a challenge for the future of ovarian cancer. Full article

(This article belongs to the Special Issue Ovarian Cancer: Clinical Advances and Challenges)

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39 pages, 947 KiB

Open AccessEditor’s ChoiceReview

Interpretations of the Role of Plasma Albumin in Prognostic Indices: A Literature Review

by Kim Oren Gradel

J. Clin. Med. 2023, 12(19), 6132; https://doi.org/10.3390/jcm12196132 - 22 Sep 2023

Cited by 15 | Viewed by 2572

Abstract

This review assesses how publications interpret factors that influence the serum or plasma albumin (PA) level in prognostic indices, focusing on inflammation and nutrition. On PubMed, a search for “albumin AND prognosis” yielded 23,919 results. From these records, prognostic indices were retrieved, and [...] Read more.

This review assesses how publications interpret factors that influence the serum or plasma albumin (PA) level in prognostic indices, focusing on inflammation and nutrition. On PubMed, a search for “albumin AND prognosis” yielded 23,919 results. From these records, prognostic indices were retrieved, and their names were used as search strings on PubMed. Indices found in 10 or more original research articles were included. The same search strings, restricted to “Review” or “Systematic review”, retrieved yielded on the indices. The data comprised the 10 latest original research articles and up to 10 of the latest reviews. Thirty indices had 294 original research articles (6 covering two indices) and 131 reviews, most of which were from recent years. A total of 106 articles related the PA level to inflammation, and 136 related the PA level to nutrition. For the reviews, the equivalent numbers were 54 and 65. In conclusion, more publications mention the PA level as a marker of nutrition rather than inflammation. This is in contrast to several general reviews on albumin and nutritional guidelines, which state that the PA level is a marker of inflammation but not nutrition. Hypoalbuminemia should prompt clinicians to focus on the inflammatory aspects in their patients. Full article

(This article belongs to the Topic Biomarker Development and Application)

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33 pages, 1796 KiB

Open AccessEditor’s ChoiceSystematic Review

Association between Obstructive Sleep Apnea and Heart Failure in Adults—A Systematic Review

by Agnieszka Polecka, Natalia Olszewska, Łukasz Danielski and Ewa Olszewska

J. Clin. Med. 2023, 12(19), 6139; https://doi.org/10.3390/jcm12196139 - 22 Sep 2023

Cited by 17 | Viewed by 3684

Abstract

Background: Heart failure (HF) patients commonly experience obstructive sleep apnea (OSA), which may worsen their condition. We reviewed a diverse range of studies to investigate the prevalence of OSA in HF patients, the effects of positive airway pressure (PAP) treatment, and the potential [...] Read more.

Background: Heart failure (HF) patients commonly experience obstructive sleep apnea (OSA), which may worsen their condition. We reviewed a diverse range of studies to investigate the prevalence of OSA in HF patients, the effects of positive airway pressure (PAP) treatment, and the potential impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and sacubitril/valsartan on OSA outcomes. Methods: We analyzed case-control, observational studies, and randomized controlled trials. Prevalence rates, PAP treatment, and HF pharmacotherapy were assessed. Results: Numerous studies revealed a high prevalence of OSA in HF patients, particularly with preserved ejection fraction. PAP treatment consistently improved an apnea-hypopnea index, left ventricular ejection fraction, oxygen saturation, and overall quality of life. Emerging evidence suggests that SGLT2i and sacubitril/valsartan might influence OSA outcomes through weight loss, improved metabolic profiles, and potential direct effects on upper airway muscles. Conclusions: The complex interplay between OSA and HF necessitates a multifaceted approach. PAP treatment has shown promising results in improving OSA symptoms and HF parameters. Additionally, recent investigations into the effects of HF pharmacotherapy on OSA suggest their potential as adjunctive therapy. This review provides insights for clinicians and researchers, highlighting the importance of addressing OSA and HF in patient management strategies. Full article

(This article belongs to the Special Issue Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II)

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21 pages, 690 KiB

Open AccessEditor’s ChoiceReview

Epidemiology of Injuries in Men’s Professional and Amateur Football (Part I)

by Tudor Vladimir Gurau, Gabriela Gurau, Doina Carina Voinescu, Lucretia Anghel, Gelu Onose, Daniel Andrei Iordan, Constantin Munteanu, Ilie Onu and Carmina Liana Musat

J. Clin. Med. 2023, 12(17), 5569; https://doi.org/10.3390/jcm12175569 - 26 Aug 2023

Cited by 19 | Viewed by 7336

Abstract

Background (1): Football is the most popular sport among men, associated with a certain risk of injury, which leads to short- and long-term health consequences. While the injury profile of professional footballers is known, little is known about the injury profile of amateur [...] Read more.

Background (1): Football is the most popular sport among men, associated with a certain risk of injury, which leads to short- and long-term health consequences. While the injury profile of professional footballers is known, little is known about the injury profile of amateur footballers; amateur football is a major and diverse area, the development of which should be a priority for football associations around the world and UEFA. The aim of this study was to perform a systematic review of epidemiological literature data on injuries in professional and amateur football players belonging to certain leagues. Methods (2): A systematic review according to the PRISMA guidelines was performed until June 2023 in the databases PubMed, Web of Science, Google Academic, Google Scholar, and Diva portal. Forty-six studies reporting injury incidence in professional and amateur men’s football were selected and analyzed. Two reviewers independently extracted data and assessed study quality using an adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale (NOS) to assess risk of bias for the quality of external validity. Results (3): The overall incidence of injuries in professional male football players was 7.75 ± 2.28, 95% confidence interval, injuries/1000 h of exposure and that of amateur football players was 7.98 ± 2.95, 95% confidence interval, injuries/1000 h of exposure. The incidence of match injuries (30.64 ± 10.28, 95% confidence interval, injuries/1000 exposure hours) was 7.71 times higher than the training injury incidence rate (3.97 ± 1.35, 95% confidence interval, injuries/1000 h) in professional football players and 5.45 times higher in amateurs (17.56 ± 6.15 vs. 3.22 ± 1.4, 95% confidence interval, injuries/1000 h). Aggregate lower extremity injuries had the highest prevalence in both categories of footballers, being 83.32 ± 4.85% in professional footballers and 80.4 ± 7.04% in amateur footballers: thigh, ankle, and knee injuries predominated. Conclusions (4): Professional and amateur football players are at substantial risk of injury, especially during matches that require the highest level of performance. Injury rates have implications for players, coaches, and sports medicine practitioners. Therefore, information on football injuries can help develop personalized injury risk mitigation strategies that could make football safer for both categories of football players. The current findings have implications for the management, monitoring, and design of training, competition, injury prevention, especially severe injury, and education programs for amateur football players. Full article

(This article belongs to the Special Issue Clinical Advances in Rehabilitation and Prevention)

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15 pages, 1958 KiB

Open AccessEditor’s ChoiceSystematic Review

Sarcopenia Adversely Affects Outcomes following Cardiac Surgery: A Systematic Review and Meta-Analysis

by Ali Ansaripour, Arian Arjomandi Rad, Marinos Koulouroudias, Dimitrios Angouras, Thanos Athanasiou and Antonios Kourliouros

J. Clin. Med. 2023, 12(17), 5573; https://doi.org/10.3390/jcm12175573 - 26 Aug 2023

Cited by 15 | Viewed by 2314

Abstract

Background: Sarcopenia is a degenerative condition characterised by the loss of skeletal muscle mass and strength. Its impact on cardiac surgery outcomes remains poorly investigated. This meta-analysis aims to provide a comprehensive synthesis of the available evidence to determine the effect of sarcopenia [...] Read more.

Background: Sarcopenia is a degenerative condition characterised by the loss of skeletal muscle mass and strength. Its impact on cardiac surgery outcomes remains poorly investigated. This meta-analysis aims to provide a comprehensive synthesis of the available evidence to determine the effect of sarcopenia on cardiac surgery outcomes. Methods: A systematic review and meta-analysis followed PRISMA guidelines from inception to April 2023 in EMBASE, MEDLINE, Cochrane database, and Google Scholar. Twelve studies involving 2717 patients undergoing cardiac surgery were included. Primary outcomes were early and late mortality; secondary outcomes included surgical time, infection rates, and functional outcomes. Statistical analyses were performed using appropriate methods. Results: Sarcopenic patients (906 patients) had a significantly higher risk of early mortality (OR: 2.40, 95% CI: 1.44 to 3.99, p = 0.0007) and late mortality (OR: 2.65, 95% CI: 1.57 to 4.48, p = 0.0003) compared to non-sarcopenic patients (1811 patients). There were no significant differences in overall surgical time or infection rates. However, sarcopenic patients had longer ICU stays, higher rates of renal dialysis, care home discharge, and longer intubation times. Conclusion: Sarcopenia significantly increases the risk of early and late mortality following cardiac surgery, and sarcopenic patients also experience poorer functional outcomes. Full article

(This article belongs to the Special Issue New Perspectives in Cardiothoracic Surgery)

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16 pages, 556 KiB

Open AccessEditor’s ChoiceSystematic Review

Radiomics and Artificial Intelligence for the Diagnosis and Monitoring of Alzheimer’s Disease: A Systematic Review of Studies in the Field

by Roberta Bevilacqua, Federico Barbarossa, Lorenzo Fantechi, Daniela Fornarelli, Enrico Paci, Silvia Bolognini, Cinzia Giammarchi, Fabrizia Lattanzio, Lucia Paciaroni, Giovanni Renato Riccardi, Giuseppe Pelliccioni, Leonardo Biscetti and Elvira Maranesi

J. Clin. Med. 2023, 12(16), 5432; https://doi.org/10.3390/jcm12165432 - 21 Aug 2023

Cited by 15 | Viewed by 3166

Abstract

The use of radiomics and artificial intelligence applied for the diagnosis and monitoring of Alzheimer’s disease has developed in recent years. However, this approach is not yet completely applicable in clinical practice. The aim of this paper is to provide a systematic analysis [...] Read more.

The use of radiomics and artificial intelligence applied for the diagnosis and monitoring of Alzheimer’s disease has developed in recent years. However, this approach is not yet completely applicable in clinical practice. The aim of this paper is to provide a systematic analysis of the studies that have included the use of radiomics from different imaging techniques and artificial intelligence for the diagnosis and monitoring of Alzheimer’s disease in order to improve the clinical outcomes and quality of life of older patients. A systematic review of the literature was conducted in February 2023, analyzing manuscripts and articles of the last 5 years from the PubMed, Scopus and Embase databases. All studies concerning discrimination among Alzheimer’s disease, Mild Cognitive Impairment and healthy older people performing radiomics analysis through machine and deep learning were included. A total of 15 papers were included. The results showed a very good performance of this approach in the differentiating Alzheimer’s disease patients—both at the dementia and pre-dementia phases of the disease—from healthy older people. In summary, radiomics and AI can be valuable tools for diagnosing and monitoring the progression of Alzheimer’s disease, potentially leading to earlier and more accurate diagnosis and treatment. However, the results reported by this review should be read with great caution, keeping in mind that imaging alone is not enough to identify dementia due to Alzheimer’s. Full article

(This article belongs to the Special Issue Advances in Alzheimer’s Disease: Prevention, Diagnosis and Treatment)

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10 pages, 260 KiB

Open AccessEditor’s ChoiceArticle

Impact of Dental Anxiety on Dental Care Routine and Oral-Health-Related Quality of Life in a German Adult Population—A Cross-Sectional Study

by Christian H. Winkler, Monika Bjelopavlovic, Karl M. Lehmann, Katja Petrowski, Lisa Irmscher and Hendrik Berth

J. Clin. Med. 2023, 12(16), 5291; https://doi.org/10.3390/jcm12165291 - 14 Aug 2023

Cited by 22 | Viewed by 3291

Abstract

The interaction between dental anxiety and the establishment of a consistent dental care routine has been an ongoing challenge. Unfortunately, there is limited available data concerning the detailed dental care practices of individuals with dental anxiety. Therefore, this study aims to explore how [...] Read more.

The interaction between dental anxiety and the establishment of a consistent dental care routine has been an ongoing challenge. Unfortunately, there is limited available data concerning the detailed dental care practices of individuals with dental anxiety. Therefore, this study aims to explore how dental anxiety influences dental care habits and oral-health-related quality of life within an adult population. By utilizing the Dental Anxiety Scale (DAS) and the German Oral Health Impact Profile (OHIP-G5), we assessed their extent. To evaluate the differences, we performed analyses of variance (Anova), an independent t-test and rank correlation. The findings of this study unveil a significant correlation between elevated DAS scores and reduced frequency of tooth brushing; calculus removal and appointments for professional teeth cleaning. Interestingly; the use of dental floss and mouthwash solution as well as toothbrush hardness appeared to be not significantly affected by dental fear. Moreover, individuals with dental anxiety demonstrated a preference for manual toothbrushes over electric ones. In addition, higher DAS scores were found to be strongly associated with greater OHIP-G5 scores, thus leading to a substantial decline in overall oral health-related quality of life. Full article

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

13 pages, 604 KiB

Open AccessEditor’s ChoiceReview

Assessment Methods for Marginal and Internal Fit of Partial Crown Restorations: A Systematic Review

by Adolfo Di Fiore, Andrea Zuccon, Filippo Carraro, Michele Basilicata, Patrizio Bollero, Giovanni Bruno and Edoardo Stellini

J. Clin. Med. 2023, 12(15), 5048; https://doi.org/10.3390/jcm12155048 - 31 Jul 2023

Cited by 14 | Viewed by 3390

Abstract

Background: Different methods are used for the analysis of marginal and internal fit of partial crowns, but not all of them are applicable for in vivo studies. The aim of this review is to search the available methods, described in the current literature, [...] Read more.

Background: Different methods are used for the analysis of marginal and internal fit of partial crowns, but not all of them are applicable for in vivo studies. The aim of this review is to search the available methods, described in the current literature, to assess marginal and internal fit in partial crowns. Methods: an electronic search was performed on Pubmed and Web of Science databases to find studies published from 1 January 2017 up to 2 March 2023, following PRISMA guidelines and Cochrane handbook for systematic reviews. The search strategy applied was: “(marginal) AND (fit OR gap OR adaptation OR discrepancy) AND (inlay OR onlay OR partial crown)”. In vitro studies which evaluated marginal and internal fit on CAD CAM or 3D printed partial crowns were included in this review. Quality of the studies was assessed by using Quality Assessment Tool For In Vitro Studies (QUIN tool). Results: 22 studies were included. Among conventional methods, direct view with microscope, indirect view on resin replicas, and silicone replica technique (SRT) were used. Considering new digital methods, micro-CT, SRT 3D and triple scan technique (TST) were applied. Conclusions: Among 2D methods, direct view technique is the most used marginal fit analysis. For a more comprehensive evaluation, a 3D digital analysis is suggested. SRT and indirect view are the only 2D methods available for in vivo analysis. A protocol for the application of TST for assessment in vivo is now available, but no studies are reported in literature yet. Full article

(This article belongs to the Special Issue Current Trends and Future Directions in Prosthetic and Implant Dentistry in the Digital Era, 2nd Edition)

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11 pages, 587 KiB

Open AccessEditor’s ChoiceArticle

Differential Association of Sex Hormones with Metabolic Parameters and Body Composition in Men and Women from the United States

by Stefano Ciardullo, Francesca Zerbini, Rosa Cannistraci, Emanuele Muraca, Silvia Perra, Alice Oltolini and Gianluca Perseghin

J. Clin. Med. 2023, 12(14), 4783; https://doi.org/10.3390/jcm12144783 - 19 Jul 2023

Cited by 11 | Viewed by 2944

Abstract

Sex hormones impact body composition. Data on the specific impact of each hormone on different body depots in men and women are scarce. The aim of this study is to evaluate the association between testosterone, estradiol and body fat distribution in the general [...] Read more.

Sex hormones impact body composition. Data on the specific impact of each hormone on different body depots in men and women are scarce. The aim of this study is to evaluate the association between testosterone, estradiol and body fat distribution in the general population. This is a population-based cross-sectional study based on data from the 2013–2016 cycles of the National Health and Nutrition Examination Survey. Dual energy X-ray absorptiometry (DXA) and liquid chromatography tandem mass spectrometry were performed on participants aged 18–59 years to evaluate body composition and sex hormone levels, respectively. Weighted multivariable linear regression analyses were performed to evaluate the association between these parameters after adjustment for potential confounders. A total of 6655 participants (3309 males and 3346 females) was included in the analysis. Men with lower testosterone levels were older, had a higher body mass index (BMI) and had a generally unfavorable metabolic profile, while no specific trends were found in women. Among men, testosterone was positively associated with lean body mass and was negatively associated with fat mass and the android/gynoid (A/G) ratio, while an opposite trend was found for estradiol. Among women, testosterone did not impact body composition, while estradiol levels were positively associated with lean mass and were negatively associated with fat mass. Our results support the notion that the impact of different sex hormones on specific fat depots varies substantially between men and women. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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23 pages, 3402 KiB

Open AccessEditor’s ChoiceReview

The Latest Advancements in Diagnostic Role of Endosonography of Pancreatic Lesions

by Jagoda Oliwia Rogowska, Łukasz Durko and Ewa Malecka-Wojciesko

J. Clin. Med. 2023, 12(14), 4630; https://doi.org/10.3390/jcm12144630 - 12 Jul 2023

Cited by 12 | Viewed by 3132

Abstract

Endosonography, a minimally invasive imaging technique, has revolutionized the diagnosis and management of pancreatic diseases. This comprehensive review highlights the latest advancements in endosonography of the pancreas, focusing on key technological developments, procedural techniques, clinical applications and additional techniques, which include real-time elastography [...] Read more.

Endosonography, a minimally invasive imaging technique, has revolutionized the diagnosis and management of pancreatic diseases. This comprehensive review highlights the latest advancements in endosonography of the pancreas, focusing on key technological developments, procedural techniques, clinical applications and additional techniques, which include real-time elastography endoscopic ultrasound, contrast-enhanced-EUS, EUS-guided fine-needle aspiration or EUS-guided fine-needle biopsy. EUS is well established for T-staging and N-staging of pancreaticobiliary malignancies, for pancreatic cyst discovery, for identifying subepithelial lesions (SEL), for differentiation of benign pancreaticobiliary disorders or for acquisition of tissue by EUS-guided fine-needle aspiration or EUS-guided fine-needle biopsy. This review briefly describes principles and application of EUS and its related techniques. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases)

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14 pages, 6036 KiB

Open AccessEditor’s ChoiceArticle

Long-Term Outcomes of the PRESERFLO MicroShunt Implant in a Heterogeneous Glaucoma Cohort

by Jens Julian Storp, Friederike Elisabeth Vietmeier, Ralph-Laurent Merté, Raphael Koch, Julian Alexander Zimmermann, Nicole Eter and Viktoria Constanze Brücher

J. Clin. Med. 2023, 12(13), 4474; https://doi.org/10.3390/jcm12134474 - 4 Jul 2023

Cited by 13 | Viewed by 4364

Abstract

The Preserflo MicroShunt represents a novel glaucoma treatment device, necessitating long-term follow-up data to accurately assess its efficacy. The aim of this study is to report real-world data of a heterogenous glaucoma cohort who received Preserflo implantation at a specialized glaucoma clinic. A [...] Read more.

The Preserflo MicroShunt represents a novel glaucoma treatment device, necessitating long-term follow-up data to accurately assess its efficacy. The aim of this study is to report real-world data of a heterogenous glaucoma cohort who received Preserflo implantation at a specialized glaucoma clinic. A total of 160 eyes of 160 patients who underwent Preserflo MicroShunt implantation were retrospectively enrolled in this study. Patient characteristics, as well as success and failure rates, were assessed. The numbers of adverse events and revision procedures were recorded, along with any reduction in supplementary medication. The progression of intraocular pressure (IOP) was assessed over the course of 12 months, and fluctuations were analyzed. The overall success rate was 61.9% (complete success: 51.3%, qualified success: 10.6%). Revision surgery was performed in 25% of cases. Excessive hypotony occurred postoperatively in 54.4% of patients and regressed after 7 days in 88.8% of all cases. Median IOP decreased from 22 (interquartile range (IQR): 17–27) mmHg preoperatively to 14 (IQR 12–16) mmHg at 12 months postoperatively (p < 0.01). The median number of antiglaucomatous agents decreased from three to zero at latest follow-up. The Preserflo MicroShunt achieved a noticeable reduction in IOP over the course of 12 months in glaucoma patients, irrespective of disease severity or disease subtype. The frequency of postoperative adverse events and number for revision surgeries over the course of the follow-up period were low. Full article

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

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18 pages, 657 KiB

Open AccessEditor’s ChoiceReview

Modifiable Pancreatic Ductal Adenocarcinoma (PDAC) Risk Factors

by Natalia Michalak and Ewa Małecka-Wojciesko

J. Clin. Med. 2023, 12(13), 4318; https://doi.org/10.3390/jcm12134318 - 27 Jun 2023

Cited by 13 | Viewed by 5456

Abstract

This study aims to summarize the modifiable risk factors for pancreatic ductal adenocarcinoma (PDAC) that have been known for a long time, as well as information from the most recent reports. As a cancer with a late diagnosis and poor prognosis, accurate analysis [...] Read more.

This study aims to summarize the modifiable risk factors for pancreatic ductal adenocarcinoma (PDAC) that have been known for a long time, as well as information from the most recent reports. As a cancer with a late diagnosis and poor prognosis, accurate analysis of PDAC risk factors is warranted. The incidence of this cancer continues to rise, and the five-year survival rate is the lowest with respect to other tumors. The influence of cigarette smoking, alcohol consumption, and chronic pancreatitis in increasing the risk of pancreatic ductal adenocarcinoma is continually being confirmed. There are also newly emerging reports relating to the impact of lifestyle, including physical activity, the gut and oral microbiome, and hepatotropic viruses. A precise understanding of PDAC risk factors can help to identify groups of high-risk patients, and this may contribute to population awareness and education as well as earlier diagnoses with possible better treatment outcomes. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Pancreatic Cancer)

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19 pages, 4677 KiB

Open AccessEditor’s ChoiceSystematic Review

Multi-Port Robotic-Assisted Laparoscopic Myomectomy: A Systematic Review and Meta-Analysis of Comparative Clinical and Fertility Outcomes

by Elias Tsakos, Emmanouil M. Xydias, Apostolos C. Ziogas, Felice Sorrentino, Luigi Nappi, Nikolaos Vlachos and Angelos Daniilidis

J. Clin. Med. 2023, 12(12), 4134; https://doi.org/10.3390/jcm12124134 - 19 Jun 2023

Cited by 12 | Viewed by 2291

Abstract

Background: Uterine fibroids are the most frequently diagnosed gynaecological tumours, and they often require surgical treatment (conventional laparoscopic myomectomy—CLM). The introduction and evolution of robotic-assisted laparoscopic myomectomy (RALM) in the early 2000s has expanded the range of minimally invasive options for the majority [...] Read more.

Background: Uterine fibroids are the most frequently diagnosed gynaecological tumours, and they often require surgical treatment (conventional laparoscopic myomectomy—CLM). The introduction and evolution of robotic-assisted laparoscopic myomectomy (RALM) in the early 2000s has expanded the range of minimally invasive options for the majority of cases. This study aims to compare RALM with CLM and abdominal myomectomy (AM). Methods and materials: Fifty-three eligible studies adhered to the pre-established inclusion criteria and were subsequently evaluated for risk of bias and statistical heterogeneity. Results: The available comparative studies were compared using surgical outcomes, namely blood loss, complication rate, transfusion rate, operation duration, conversion to laparotomy, and length of hospitalisation. RALM was significantly superior to AM in all assessed parameters other than operation duration. RALM and CLM performed similarly in most parameters; however, RALM was associated with reduced intra-operative bleeding in patients with small fibroids and had lower rates of conversion to laparotomy, proving RALM as a safer overall approach. Conclusion: The robotic approach for surgical treatment of uterine fibroids is a safe, effective, and viable approach, which is constantly being improved and may soon acquire widespread adoption and prove to be superior to CLM in certain patient subgroups. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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14 pages, 1766 KiB

Open AccessEditor’s ChoiceSystematic Review

A Systematic Review on Combined [¹⁸F]FDG and ⁶⁸Ga-SSA PET/CT in Pulmonary Carcinoid

by Daniela Prosperi, Luciano Carideo, Vincenzo Marcello Russo, Rosaria Meucci, Giuseppe Campagna, Secondo Lastoria and Alberto Signore

J. Clin. Med. 2023, 12(11), 3719; https://doi.org/10.3390/jcm12113719 - 28 May 2023

Cited by 14 | Viewed by 3393

Abstract

Pulmonary carcinoids (PCs) are part of a spectrum of well-differentiated neuroendocrine neoplasms (NENs) and are classified as typical carcinoid (TC) and atypical carcinoid (AC). TC differ from AC not only for its histopathological features but also for its “functional imaging pattern” and prognosis. [...] Read more.

Pulmonary carcinoids (PCs) are part of a spectrum of well-differentiated neuroendocrine neoplasms (NENs) and are classified as typical carcinoid (TC) and atypical carcinoid (AC). TC differ from AC not only for its histopathological features but also for its “functional imaging pattern” and prognosis. ACs are more undifferentiated and characterized by higher aggressiveness. Positron emission tomography/computed tomography (PET/CT) with somatostatin analogs (SSA) labeled with Gallium-68 (⁶⁸Ga-DOTA-TOC, ⁶⁸Ga-DOTA-NOC, ⁶⁸Ga-DOTA-TATE) has widely replaced conventional imaging with gamma camera using ¹¹¹In- or ^99mTc-labelled compounds and represents now the gold standard for diagnosis and management of NENs. In this setting, as already described for gastro-entero-pancreatic NENs, ¹⁸F-Fluorodeoxiglucose ([¹⁸F]FDG) in addition to ⁶⁸Ga-SSA can play an important role in clinical practice, particularly for ACs that show a more aggressive behavior compared to TCs. The aim of this systematic review is to analyze all original studies collected from the PubMed and Scopus databases regarding PCs in which both ⁶⁸Ga-SSA PET/CT and [¹⁸F]FDG PET/CT were performed in order to evaluate the clinical impact of each imaging modality. The following keywords were used for the research: “¹⁸F, ⁶⁸Ga and (bronchial carcinoid or carcinoid lung)”. A total of 57 papers were found, of which 17 were duplicates, 8 were reviews, 10 were case reports, and 1 was an editorial. Of the remaining 21 papers, 12 were ineligible because they did not focus on PC or did not compare ⁶⁸Ga-SSA and [¹⁸F]FDG. We finally retrieved and analyzed nine papers (245 patients with TCs and 110 patients with ACs), and the results highlight the importance of the combined use of ⁶⁸Ga-SSA and [¹⁸F]FDG PET/CT for the correct management of these neoplasms. Full article

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

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20 pages, 612 KiB

Open AccessEditor’s ChoiceReview

Drug Coated Balloon in the Treatment of De Novo Coronary Artery Disease: A Narrative Review

by Filippo Zilio, Monica Verdoia, Maria Carmen De Angelis, Federico Zucchelli, Marco Borghesi, Andrea Rognoni and Roberto Bonmassari

J. Clin. Med. 2023, 12(11), 3662; https://doi.org/10.3390/jcm12113662 - 25 May 2023

Cited by 12 | Viewed by 3765

Abstract

Drug coated balloons (DCBs) are currently indicated in guidelines as a first choice option in the management of instant restenosis, whereas their use in de novo lesions is still debated. The concerns raised after the contrasting results of the initial trials with DCBs [...] Read more.

Drug coated balloons (DCBs) are currently indicated in guidelines as a first choice option in the management of instant restenosis, whereas their use in de novo lesions is still debated. The concerns raised after the contrasting results of the initial trials with DCBs in de novo lesions have been more recently overcome by a larger amount of data confirming their safety and effectiveness as compared to drug-eluting stents (DES), with potentially greater benefits being achieved, especially in particular anatomical settings, as in very small or large vessels and bifurcations, but also in selected subsets of higher-risk patients, where a ‘leave nothing behind’ strategy could offer a reduction of the inflammatory stimulus and thrombotic risk. The present review aims at providing an overview of current available DCB devices and their indications of use based on the results of data achieved so far. Full article

(This article belongs to the Section Cardiology)

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20 pages, 1038 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Efficacy and Safety of Dry Powder Antibiotics: A Narrative Review

by David de la Rosa-Carrillo, Guillermo Suárez-Cuartín, Oriol Sibila, Rafael Golpe, Rosa-María Girón and Miguel-Ángel Martínez-García

J. Clin. Med. 2023, 12(10), 3577; https://doi.org/10.3390/jcm12103577 - 20 May 2023

Cited by 11 | Viewed by 3651

Abstract

The use of inhaled antibiotics was initially almost exclusively confined to patients with cystic fibrosis (CF). However, it has been extended in recent decades to patients with non-CF bronchiectasis or chronic obstructive pulmonary disease who present with chronic bronchial infection by potentially pathogenic [...] Read more.

The use of inhaled antibiotics was initially almost exclusively confined to patients with cystic fibrosis (CF). However, it has been extended in recent decades to patients with non-CF bronchiectasis or chronic obstructive pulmonary disease who present with chronic bronchial infection by potentially pathogenic microorganisms. Inhaled antibiotics reach high concentrations in the area of infection, which enhances their effect and enables their long-term administration to defeat the most resistant infections, while minimizing possible adverse effects. New formulations of inhaled dry powder antibiotics have been developed, providing, among other advantages, faster preparation and administration of the drug, as well as avoiding the requirement to clean nebulization equipment. In this review, we analyze the advantages and disadvantages of the different types of devices that allow the inhalation of antibiotics, especially dry powder inhalers. We describe their general characteristics, the different inhalers on the market and the proper way to use them. We analyze the factors that influence the way in which the dry powder drug reaches the lower airways, as well as aspects of microbiological effectiveness and risks of resistance development. We review the scientific evidence on the use of colistin and tobramycin with this type of device, both in patients with CF and with non-CF bronchiectasis. Finally, we discuss the literature on the development of new dry powder antibiotics. Full article

(This article belongs to the Section Respiratory Medicine)

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12 pages, 275 KiB

Open AccessEditor’s ChoiceReview

Treat-to-Target in Systemic Lupus Erythematosus: Reality or Pipe Dream

by Dina Zucchi, Chiara Cardelli, Elena Elefante, Chiara Tani and Marta Mosca

J. Clin. Med. 2023, 12(9), 3348; https://doi.org/10.3390/jcm12093348 - 8 May 2023

Cited by 12 | Viewed by 3603

Abstract

Treat-to-target is a therapeutic approach based on adjustments to treatment at set intervals in order to achieve well-defined, clinically relevant targets. This approach has been successfully applied to many chronic conditions, and in rheumatology promising results have emerged for rheumatoid arthritis. For systemic [...] Read more.

Treat-to-target is a therapeutic approach based on adjustments to treatment at set intervals in order to achieve well-defined, clinically relevant targets. This approach has been successfully applied to many chronic conditions, and in rheumatology promising results have emerged for rheumatoid arthritis. For systemic lupus erythematosus (SLE), defining the most meaningful treatment targets has been challenging, due to disease complexity and heterogeneity. Control of disease activity, the reduction of damage accrual and the patient’s quality of life should be considered as the main targets in SLE, and several new drugs are emerging to achieve these targets. This review is focused on describing the target to achieve in SLE and the methods to do so, and it is also aimed at discussing if treat-to-target could be a promising approach also for this complex disease. Full article

(This article belongs to the Special Issue Lupus and Scleroderma: New Aspects and Considerations)

17 pages, 2180 KiB

Open AccessEditor’s ChoiceArticle

Evaluation of Adjuvant Antibiotic Loaded Injectable Bio-Composite Material in Diabetic Foot Osteomyelitis and Charcot Foot Reconstruction

by Venu Kavarthapu, Jasdeep Giddie, Varun Kommalapati, Joanne Casey, Maureen Bates and Prashanth Vas

J. Clin. Med. 2023, 12(9), 3239; https://doi.org/10.3390/jcm12093239 - 1 May 2023

Cited by 11 | Viewed by 3199

Abstract

The management of diabetic foot osteomyelitis (DFO) is extremely challenging with high amputation rates reported alongside a five-year mortality risk of more than fifty percent. We describe our experience in using adjuvant antibiotic-loaded bio-composite material (Cerament) in the surgical management of DFO and [...] Read more.

The management of diabetic foot osteomyelitis (DFO) is extremely challenging with high amputation rates reported alongside a five-year mortality risk of more than fifty percent. We describe our experience in using adjuvant antibiotic-loaded bio-composite material (Cerament) in the surgical management of DFO and infected Charcot foot reconstruction. We undertook a retrospective evaluation of 53 consecutive patients (54 feet) who underwent Gentamicin or Vancomycin-loaded Cerament application during surgery. The feet were categorised into two groups: Group 1, with infected ulcer and DFO, managed with radical debridement only (n = 17), and Group 2, requiring reconstruction surgery for infected and deformed Charcot foot. Group 2 was further subdivided into 2a, with feet previously cleared of infection and undergoing a single-stage reconstruction (n = 19), and 2b, with feet having an active infection managed with a two-stage reconstruction (n = 18). The mean age was 56 years (27–83) and 59% (31/53) were males. The mean BMI was 30.2 kg/m² (20.8–45.5). Foot ulcers were present in 69% (37/54) feet. At a mean follow-up of 30 months (12–98), there were two patients lost to follow up and the mortality rate was 11% (n = 5). The mean duration of post-operative systemic antibiotic administration was 20 days (4–42). Thirteen out of fifteen feet (87%) in group 1 achieved complete eradication of infection. There was a 100% primary ulcer resolution, 100% limb salvage and 76% bony union rate within Group 2. However, five patients, all in group 2, required reoperations due to problems with bone union. The use of antibiotic-loaded Cerament resulted in a high proportion of patients achieving infection clearance, functional limb salvage and decrease in the duration of postoperative antibiotic therapy. Larger, preferably randomised, studies are required to further validate these observations. Full article

(This article belongs to the Special Issue Diabetic Foot Complications: Current Challenges and Future Prospects—Part II)

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10 pages, 1250 KiB

Open AccessEditor’s ChoiceArticle

The Clinical Value of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio for Predicting Hematoma Expansion and Poor Outcomes in Patients with Acute Intracerebral Hemorrhage

by Yejin Kim, Jong-Hee Sohn, Chulho Kim, So Young Park and Sang-Hwa Lee

J. Clin. Med. 2023, 12(8), 3004; https://doi.org/10.3390/jcm12083004 - 20 Apr 2023

Cited by 13 | Viewed by 2154

Abstract

There is little knowledge of the effect of inflammatory markers on the prognoses of hematoma expansion (HE) in patients with intracranial hemorrhage (ICH). We evaluated the impact of neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) on HE and worse outcomes after acute ICH. [...] Read more.

There is little knowledge of the effect of inflammatory markers on the prognoses of hematoma expansion (HE) in patients with intracranial hemorrhage (ICH). We evaluated the impact of neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) on HE and worse outcomes after acute ICH. This study included 520 consecutive patients with ICH from the registry database enrolled over 80 months. Patients’ whole blood samples were collected upon arrival in the emergency department. Brain computed tomography scans were performed during hospitalization and repeated at 24 h and 72 h. The primary outcome measure was HE, defined as relative growth >33% or absolute growth <6 mL. A total of 520 patients were enrolled in this study. Multivariate analysis showed that NLR and PLR were associated with HE (NLR: odds ratio [OR], [95% CI] = 1.19 [1.12–1.27], p < 0.001; PLR: OR, [95% CI] = 1.01 [1.00–1.02], p = 0.04). Receiver operating characteristic curve analysis revealed that NLR and PLR could predict HE (AUC of NLR: 0.84, 95% CI [0.80–0.88], p < 0.001; AUC of PLR: 0.75 95% CI [0.70–0.80], p < 0.001). The cut-off value of NLR for predicting HE was 5.63, and that of PLR was 23.4. Higher NLR and PLR values increase HE risk in patients with ICH. NLR and PLR were reliable for predicting HE after ICH. Full article

(This article belongs to the Section Clinical Neurology)

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16 pages, 1458 KiB

Open AccessEditor’s ChoiceReview

Atrial Fibrillation and Diabetes Mellitus: Dangerous Liaisons or Innocent Bystanders?

by Ana Lorenzo-Almorós, Jesús Casado Cerrada, Luis-Antonio Álvarez-Sala Walther, Manuel Méndez Bailón and Óscar Lorenzo González

J. Clin. Med. 2023, 12(8), 2868; https://doi.org/10.3390/jcm12082868 - 14 Apr 2023

Cited by 12 | Viewed by 4502

Abstract

Atrial fibrillation (AF) is the most common arrhythmia in adults and diabetes mellitus (DM) is a major risk factor for cardiovascular diseases. However, the relationship between both pathologies has not been fully documented and new evidence supports the existence of direct and independent [...] Read more.

Atrial fibrillation (AF) is the most common arrhythmia in adults and diabetes mellitus (DM) is a major risk factor for cardiovascular diseases. However, the relationship between both pathologies has not been fully documented and new evidence supports the existence of direct and independent links. In the myocardium, a combination of structural, electrical, and autonomic remodeling may lead to AF. Importantly, patients with AF and DM showed more dramatic alterations than those with AF or DM alone, particularly in mitochondrial respiration and atrial remodeling, which alters conductivity, thrombogenesis, and contractile function. In AF and DM, elevations of cytosolic Ca²⁺ and accumulation of extra cellular matrix (ECM) proteins at the interstitium can promote delayed afterdepolarizations. The DM-associated low-grade inflammation and deposition/infiltration of epicardial adipose tissue (EAT) enforce abnormalities in Ca²⁺ handling and in excitation-contraction coupling, leading to atrial myopathy. This atrial enlargement and the reduction in passive emptying volume and fraction can be key for AF maintenance and re-entry. Moreover, the stored EAT can prolong action of potential durations and progression from paroxysmal to persistent AF. In this way, DM may increase the risk of thrombogenesis as a consequence of increased glycation and oxidation of fibrinogen and plasminogen, impairing plasmin conversion and resistance to fibrinolysis. Additionally, the DM-associated autonomic remodeling may also initiate AF and its re-entry. Finally, further evidence of DM influence on AF development and maintenance are based on the anti-arrhythmogenic effects of certain anti-diabetic drugs like SGLT2 inhibitors. Therefore, AF and DM may share molecular alterations related to Ca²⁺ mobility, mitochondrial function and ECM composition that induce atrial remodeling and defects in autonomic stimulation and conductivity. Likely, some specific therapies could work against the associated cardiac damage to AF and/or DM. Full article

(This article belongs to the Section Cardiology)

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19 pages, 1427 KiB

Open AccessEditor’s ChoiceReview

Challenges of the Effectiveness of Traumatic Brain Injuries Biomarkers in the Sports-Related Context

by Rossella Tomaiuolo, Martina Zibetti, Chiara Di Resta and Giuseppe Banfi

J. Clin. Med. 2023, 12(7), 2563; https://doi.org/10.3390/jcm12072563 - 29 Mar 2023

Cited by 9 | Viewed by 4530

Abstract

Traumatic brain injury affects 69 million people every year. One of the main limitations in managing TBI patients is the lack of univocal diagnostic criteria, including the absence of standardized assessment methods and guidelines. Computerized axial tomography is the first-choice examination, despite the [...] Read more.

Traumatic brain injury affects 69 million people every year. One of the main limitations in managing TBI patients is the lack of univocal diagnostic criteria, including the absence of standardized assessment methods and guidelines. Computerized axial tomography is the first-choice examination, despite the limited prevalence of positivity; moreover, its performance is undesirable due to the risk of radiological exposure, prolonged stay in emergency departments, inefficient use of resources, high cost, and complexity. Furthermore, immediacy and accuracy in diagnosis and management of TBIs are critically unmet medical needs. Especially in the context of sports-associated TBI, there is a strong need for prognostic indicators to help diagnose and identify at-risk subjects to avoid their returning to play while the brain is still highly vulnerable. Fluid biomarkers may emerge as new prognostic indicators to develop more accurate prediction models, improving risk stratification and clinical decision making. This review describes the current understanding of the cellular sources, temporal profile, and potential utility of leading and emerging blood-based protein biomarkers of TBI; its focus is on biomarkers that could improve the management of mild TBI cases and can be measured readily and directly in the field, as in the case of sports-related contexts. Full article

(This article belongs to the Special Issue Traumatic Brain Injury (TBI): Recent Trends and Future Perspectives)

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11 pages, 748 KiB

Open AccessEditor’s ChoiceArticle

Virtual Art Therapy: Application of Michelangelo Effect to Neurorehabilitation of Patients with Stroke

by Roberto De Giorgi, Antonio Fortini, Federica Aghilarre, Federico Gentili, Giovanni Morone, Gabriella Antonucci, Mario Vetrano, Gaetano Tieri and Marco Iosa

J. Clin. Med. 2023, 12(7), 2590; https://doi.org/10.3390/jcm12072590 - 29 Mar 2023

Cited by 13 | Viewed by 4550

Abstract

In neurorehabilitation, some studies reported the effective use of art therapy for reducing psychological disorders and for enhancing physical functions and cognitive abilities. Neuroaesthetical studies showed that seeing an art masterpiece can spontaneously elicit a widespread brain arousal, also involving motor networks. To [...] Read more.

In neurorehabilitation, some studies reported the effective use of art therapy for reducing psychological disorders and for enhancing physical functions and cognitive abilities. Neuroaesthetical studies showed that seeing an art masterpiece can spontaneously elicit a widespread brain arousal, also involving motor networks. To combine contemplative and performative benefits of art therapy protocols, we have developed an immersive virtual reality system, giving subjects the illusion that they are able to paint a copy of famous artistic paintings. We previously observed that during this virtual task, subjects perceived less fatigue and performed more accurate movements than when they were asked to color the virtual canvas. We named this upshot the Michelangelo effect. The aim of this study was to test the rehabilitative efficacy of our system. Ten patients with stroke in the subacute phase were enrolled and trained for one month with virtual art therapy (VAT) and physiotherapy. Their data were compared with those of ten patients matched for pathology, age and clinical parameters, trained only with conventional therapy for the same amount of time. The VAT group showed a significantly higher improvements in the Barthel Index score, a measure of independency in activities of daily living (66 ± 33% vs. 31 ± 28%, p = 0.021), and in pinching strength (66 ± 39% vs. 18 ± 33%, p = 0.008), with respect to the group treated with conventional rehabilitation. Full article

(This article belongs to the Special Issue Clinical Applications of Immersive and Nonimmersive Virtual Reality)

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28 pages, 22618 KiB

Open AccessEditor’s ChoiceReview

Clinical Utility of Three-Dimensional Echocardiography in the Evaluation of Mitral Valve Disease: Tips and Tricks

by Paolo G. Pino, Andrea Madeo, Fabiana Lucà, Roberto Ceravolo, Stefania Angela di Fusco, Francesco Antonio Benedetto, Giovanni Bisignani, Fabrizio Oliva, Furio Colivicchi, Michele Massimo Gulizia and Sandro Gelsomino

J. Clin. Med. 2023, 12(7), 2522; https://doi.org/10.3390/jcm12072522 - 27 Mar 2023

Cited by 9 | Viewed by 4887

Abstract

Although real-time 3D echocardiography (RT3DE) has only been introduced in the last decades, its use still needs to be improved since it is a time-consuming and operator-dependent technique and acquiring a good quality data can be difficult. Moreover, the additive value of this [...] Read more.

Although real-time 3D echocardiography (RT3DE) has only been introduced in the last decades, its use still needs to be improved since it is a time-consuming and operator-dependent technique and acquiring a good quality data can be difficult. Moreover, the additive value of this important diagnostic tool still needs to be wholly appreciated in clinical practice. This review aims at explaining how, why, and when performing RT3DE is useful in clinical practice. Full article

(This article belongs to the Special Issue Cardiovascular Heart Disease from the Myocyte to the Pathology: The Cutting Edge)

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24 pages, 869 KiB

Open AccessEditor’s ChoiceSystematic Review

Optimizing Adjuvant Therapy after Surgery for Colorectal Cancer Liver Metastases: A Systematic Review

by Emmanouil Georgilis, Maria Gavriatopoulou, Diamantis I. Tsilimigras, Panagiotis Malandrakis, Theodosios Theodosopoulos and Ioannis Ntanasis-Stathopoulos

J. Clin. Med. 2023, 12(6), 2401; https://doi.org/10.3390/jcm12062401 - 20 Mar 2023

Cited by 9 | Viewed by 3431

Abstract

The liver is the most common site of colorectal cancer metastatic spread. Although metastasectomy is the gold standard for fit patients with resectable colorectal cancer liver metastases (CRLMs), their management after surgical treatment remains controversial. The objective of this systematic review was to [...] Read more.

The liver is the most common site of colorectal cancer metastatic spread. Although metastasectomy is the gold standard for fit patients with resectable colorectal cancer liver metastases (CRLMs), their management after surgical treatment remains controversial. The objective of this systematic review was to collate the currently available data of the agents used in the adjuvant setting in order to define the most optimal therapeutic strategy. A systematic review of the literature was conducted by searching PubMed/Medline and Cochrane library databases. We included studies that evaluated the efficacy, the tolerability and the safety profile of various chemotherapeutic agents that are used as adjuvant treatment after surgical resection of CRLMs. The outcomes of interest were regression-free survival (RFS), disease-free survival (DFS), overall survival (OS) and severe toxicities. From 543 initial articles, 29 publications with 7028 patients were finally included. In general, the results of the eligible studies indicated that adjuvant therapy after resection of CRLMs led to improved RFS/DFS rates, but this benefit did not contribute to a statistically significant prolongation of OS. Moreover, the choice of the therapeutic strategy, namely systematic or regional chemotherapy or the combination of both, did not seem to have a differential impact on patient outcomes. However, these results should be interpreted with caution since the majority of the chosen studies are of low or moderate quality. In this context, further high-quality clinical trials conducted on patient sub-populations with modern therapies are required in order to reduce in-study and between-study heterogeneity and determine which patients are expected to derive the maximum benefit from adjuvant therapy after surgery for CRLMs. Full article

(This article belongs to the Topic Metastatic Colorectal Cancer: From Laboratory to Clinical Studies)

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20 pages, 1939 KiB

Open AccessEditor’s ChoiceReview

Vesicoureteral Reflux and Innate Immune System: Physiology, Physiopathology, and Clinical Aspects

by Marius-Cosmin Colceriu, Paul Luchian Aldea, Andreea-Liana Răchișan, Simona Clichici, Alexandra Sevastre-Berghian and Teodora Mocan

J. Clin. Med. 2023, 12(6), 2380; https://doi.org/10.3390/jcm12062380 - 19 Mar 2023

Cited by 12 | Viewed by 3709

Abstract

Vesicoureteral reflux represents one of the most concerning topics in pediatric nephrology due to its frequency, clinical expression with the potential to evolve into chronic kidney disease, and last but not least, its socio-economic implications. The presence of vesicoureteral reflux, the occurrence of [...] Read more.

Vesicoureteral reflux represents one of the most concerning topics in pediatric nephrology due to its frequency, clinical expression with the potential to evolve into chronic kidney disease, and last but not least, its socio-economic implications. The presence of vesicoureteral reflux, the occurrence of urinary tract infections, and the development of reflux nephropathy, hypertension, chronic kidney disease, and finally, end-stage renal disease represent a progressive spectrum of a single physiopathological condition. For the proper management of these patients with the best clinical outcomes, and in an attempt to prevent the spread of uropathogens’ resistance to antibacterial therapy, we must better understand the physiopathology of urinary tract infections in patients with vesicoureteral reflux, and at the same time, we should acknowledge the implication and response of the innate immune system in this progressive pathological condition. The present paper focuses on theoretical aspects regarding the physiopathology of vesicoureteral reflux and the interconditionality between urinary tract infections and the innate immune system. In addition, we detailed aspects regarding cytokines, interleukins, antimicrobial peptides, and proteins involved in the innate immune response as well as their implications in the physiopathology of reflux nephropathy. New directions of study should focus on using these innate immune system effectors as diagnostic and therapeutic tools in renal pathology. Full article

(This article belongs to the Special Issue Urinary Tract Infection: Prevention, Diagnosis, and Treatment)

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31 pages, 567 KiB

Open AccessEditor’s ChoiceReview

Multi-Mechanistic Approaches to the Treatment of Traumatic Brain Injury: A Review

by Daniel G. Lynch, Raj K. Narayan and Chunyan Li

J. Clin. Med. 2023, 12(6), 2179; https://doi.org/10.3390/jcm12062179 - 11 Mar 2023

Cited by 14 | Viewed by 6759

Abstract

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Despite extensive research efforts, the majority of trialed monotherapies to date have failed to demonstrate significant benefit. It has been suggested that this is due to the complex pathophysiology of [...] Read more.

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Despite extensive research efforts, the majority of trialed monotherapies to date have failed to demonstrate significant benefit. It has been suggested that this is due to the complex pathophysiology of TBI, which may possibly be addressed by a combination of therapeutic interventions. In this article, we have reviewed combinations of different pharmacologic treatments, combinations of non-pharmacologic interventions, and combined pharmacologic and non-pharmacologic interventions for TBI. Both preclinical and clinical studies have been included. While promising results have been found in animal models, clinical trials of combination therapies have not yet shown clear benefit. This may possibly be due to their application without consideration of the evolving pathophysiology of TBI. Improvements of this paradigm may come from novel interventions guided by multimodal neuromonitoring and multimodal imaging techniques, as well as the application of multi-targeted non-pharmacologic and endogenous therapies. There also needs to be a greater representation of female subjects in preclinical and clinical studies. Full article

(This article belongs to the Special Issue Traumatic Brain Injury (TBI): Recent Trends and Future Perspectives)

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13 pages, 1202 KiB

Open AccessEditor’s ChoiceReview

A Review of Parental Vaccine Hesitancy for Human Papillomavirus in Japan

by Madoka Lelliott, Ethan Sahker and Hemant Poudyal

J. Clin. Med. 2023, 12(5), 2004; https://doi.org/10.3390/jcm12052004 - 2 Mar 2023

Cited by 14 | Viewed by 3056

Abstract

Globally, Japan has the lowest rate of vaccine confidence. The persistent parental vaccine hesitancy has been attributed to safety and efficacy concerns and is primarily driven by the negative experience with human papillomavirus (HPV) vaccines. This literature review aimed to identify factors associated [...] Read more.

Globally, Japan has the lowest rate of vaccine confidence. The persistent parental vaccine hesitancy has been attributed to safety and efficacy concerns and is primarily driven by the negative experience with human papillomavirus (HPV) vaccines. This literature review aimed to identify factors associated with HPV vaccine uptake and potential strategies to reduce vaccine hesitancy among Japanese parents. Articles published in English or Japanese between January 1998 and October 2022 that examined Japanese parental factors for HPV vaccine uptake were identified from PubMed, Web of Science, and Ichushi-Web. In total, 17 articles met the inclusion criteria. Four key themes which affected HPV vaccine hesitancy and acceptance were identified: perceptions of risk and benefits, trust and recommendation, information and knowledge, and sociodemographic characteristics. While governmental and healthcare provider recommendations are important factors, efforts to improve parental confidence in the HPV vaccine are required. Future interventions to counteract HPV vaccine hesitancy should actively disseminate information on vaccine safety and effectiveness, along with information on the severity and susceptibility of HPV infection. Full article

(This article belongs to the Section Immunology)

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15 pages, 360 KiB

Open AccessEditor’s ChoiceReview

The Symptomatic Outcomes of Cholecystectomy for Gallstones

by Daniel Mønsted Shabanzadeh

J. Clin. Med. 2023, 12(5), 1897; https://doi.org/10.3390/jcm12051897 - 28 Feb 2023

Cited by 11 | Viewed by 4674

Abstract

Cholecystectomy is the definite treatment for symptomatic gallstones, and rates are rapidly rising. Symptomatic complicated gallstones are generally treated with cholecystectomy, but there is no consensus on the clinical selection of patients with symptomatic uncomplicated gallstones for cholecystectomy. The aim of this review [...] Read more.

Cholecystectomy is the definite treatment for symptomatic gallstones, and rates are rapidly rising. Symptomatic complicated gallstones are generally treated with cholecystectomy, but there is no consensus on the clinical selection of patients with symptomatic uncomplicated gallstones for cholecystectomy. The aim of this review is to describe symptomatic outcomes before versus after cholecystectomy in patients with symptomatic gallstones as reported in prospective clinical studies and to discuss patient selection for cholecystectomy. Following cholecystectomy, resolution of biliary pain is high and reported for 66–100%. Dyspepsia has an intermediate resolution of 41–91% and may co-exist with biliary pain but may also develop following cholecystectomy with an increase of 150%. Diarrhea has a high increase and debuts in 14–17%. Persisting symptoms are mainly determined by preoperative dyspepsia, functional disorders, atypical pain locations, longer duration of symptoms, and poor psychological or physical health. Patient satisfaction following cholecystectomy is high and may reflect symptom alleviation or a change in symptoms. Comparison of symptomatic outcomes in available prospective clinical studies is limited by variations in preoperative symptoms, clinical presentations, and clinical management of post-cholecystectomy symptoms. When selecting patients with biliary pain only in a randomized controlled trial, 30–40% still have persisting pain. Strategies for the selection of patients with symptomatic uncomplicated gallstones based on symptoms alone are exhausted. For the development of a selection strategy, future studies should explore the impact of objective determinants for symptomatic gallstones on pain relief following cholecystectomy. Full article

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

10 pages, 1064 KiB

Open AccessEditor’s ChoiceArticle

An Adequate Infusion Rate of Remimazolam for Induction of General Anesthesia in Adult Patients: A Prospective Up-and-Down Dose-Finding Study

by Heejoon Jeong, Hara Kim and Hyun Joo Ahn

J. Clin. Med. 2023, 12(5), 1763; https://doi.org/10.3390/jcm12051763 - 22 Feb 2023

Cited by 9 | Viewed by 2913

Abstract

Remimazolam is a recently developed anesthetic agent for general anesthesia and sedation. Currently, the optimal infusion rate for the induction of general anesthesia within two minutes remains unclear. We estimated the 50% and 90% effective doses (ED₅₀ and ED₉₀) of [...] Read more.

Remimazolam is a recently developed anesthetic agent for general anesthesia and sedation. Currently, the optimal infusion rate for the induction of general anesthesia within two minutes remains unclear. We estimated the 50% and 90% effective doses (ED₅₀ and ED₉₀) of remimazolam required for loss of responsiveness within two minutes in adult patients using the up-and-down method. The starting infusion rate of remimazolam was 0.1 mg/kg/min and was increased or decreased by 0.02 mg/kg/min intervals in the following patient according to the success or failure of the previous patient. Success was defined as a loss of responsiveness within two minutes. Patient enrollment continued until six crossover pairs were observed. The ED₅₀ and ED₉₀ were estimated by centered isotonic regression and the pooled adjacent violators algorithm with bootstrapping, respectively. Twenty patients were included in the analysis. The ED₅₀ and ED₉₀ of remimazolam for loss of responsiveness within two minutes were 0.07 mg/kg/min (90% CI: 0.05, 0.09 mg/kg/min) and 0.10 mg/kg/min (90% CI: 0.10, 0.15 mg/kg/min), respectively. Vital signs were stable with an infusion rate of 0.10 mg/kg/min, and no patients required inotrope/vasopressor. Intravenous infusion of remimazolam at a rate of 0.10 mg/kg/min can be an effective approach to inducing general anesthesia in adult patients. Full article

(This article belongs to the Section Anesthesiology)

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12 pages, 659 KiB

Open AccessEditor’s ChoiceArticle

Effect of Cadmium on Oxidative Stress Indices and Vitamin D Concentrations in Children

by Artur Chwalba, Joanna Orłowska, Michał Słota, Marta Jeziorska, Kinga Filipecka, Francesco Bellanti, Michał Dobrakowski, Aleksandra Kasperczyk, Jolanta Zalejska-Fiolka and Sławomir Kasperczyk

J. Clin. Med. 2023, 12(4), 1572; https://doi.org/10.3390/jcm12041572 - 16 Feb 2023

Cited by 10 | Viewed by 3705

Abstract

Heavy metal poisoning can have serious health consequences, including damage to the brain, kidneys, and other organs. Cadmium is a toxic heavy metal that can accumulate in the body over time and the exposure to this element has been linked to a variety [...] Read more.

Heavy metal poisoning can have serious health consequences, including damage to the brain, kidneys, and other organs. Cadmium is a toxic heavy metal that can accumulate in the body over time and the exposure to this element has been linked to a variety of adverse health effects. Cadmium toxicity can lead to an imbalance in the cellular redox state and be a source of oxidative stress. On the molecular level, cadmium ions negatively affect cellular metabolism, including the disruption of energy production, protein synthesis, and DNA damage. The study has been carried out on a group of 140 school-age children (8 to 14 years old) inhabiting the industrialized areas of Upper Silesia. The study population was divided into two sub-groups based on the median concentration of cadmium in blood (0.27 µg/L): Low-CdB and High-CdB. Measured traits comprised blood cadmium levels (CdB) as well as a blood count and selected oxidative stress markers. This research study aimed to demonstrate a correlation between the impact of exposure to elevated cadmium concentrations in a population of children and certain markers of oxidative stress, and 25-OH vitamin D3 concentration. A negative correlation has been found between cadmium concentration and 25-OH vitamin D3 level, protein sulfhydryl groups content in blood serum, glutathione reductase activity, and lipofuscin and malondialdehyde levels in erythrocytes. The concentration of 25-OH vitamin D₃ in the High-CdB group was decreased by 23%. The oxidative stress indices can be considered a valuable indicator of early Cd-toxicity effects to be included in the routinely-applied cadmium exposure monitoring parameters, allowing the evaluation of stress intensity to the cell metabolism. Full article

(This article belongs to the Special Issue Biomarkers for Diagnosis, Complications and Therapy Effects in the Management of Endocrine and Metabolic Disorders)

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12 pages, 826 KiB

Open AccessEditor’s ChoiceArticle

Improvement of Left Ventricular Global Longitudinal Strain after 6-Month Therapy with GLP-1RAs Semaglutide and Dulaglutide in Type 2 Diabetes Mellitus: A Pilot Study

by Paolo Basile, Andrea Igoren Guaricci, Giuseppina Piazzolla, Sara Volpe, Alfredo Vozza, Marina Benedetto, Maria Cristina Carella, Daniela Santoro, Francesco Monitillo, Andrea Baggiano, Saima Mushtaq, Laura Fusini, Fabio Fazzari, Cinzia Forleo, Nunziata Ribecco, Gianluca Pontone, Carlo Sabbà and Marco Matteo Ciccone

J. Clin. Med. 2023, 12(4), 1586; https://doi.org/10.3390/jcm12041586 - 16 Feb 2023

Cited by 11 | Viewed by 3955

Abstract

(1) Background: Glucagone-Like Peptide-1 Receptor Agonists (GLP-1 RAs) (GLP-1 RAs) are incretine-based medications recommended in the treatment of type 2 Diabetes Mellitus (DM2) with atherosclerotic cardiovascular disease (ASCVD) or high or very high cardiovascular (CV) risk. However, knowledge of the direct mechanism of [...] Read more.

(1) Background: Glucagone-Like Peptide-1 Receptor Agonists (GLP-1 RAs) (GLP-1 RAs) are incretine-based medications recommended in the treatment of type 2 Diabetes Mellitus (DM2) with atherosclerotic cardiovascular disease (ASCVD) or high or very high cardiovascular (CV) risk. However, knowledge of the direct mechanism of GLP-1 RAs on cardiac function is modest and not yet fully elucidated. Left ventricular (LV) Global Longitudinal Strain (GLS) with Speckle Tracking Echocardiography (STE) represents an innovative technique for the evaluation of myocardial contractility. (2) Methods: an observational, perspective, monocentric study was conducted in a cohort of 22 consecutive patients with DM2 and ASCVD or high/very high CV risk, enrolled between December 2019 and March 2020 and treated with GLP-1 RAs dulaglutide or semaglutide. The echocardiographic parameters of diastolic and systolic function were recorded at baseline and after six months of treatment. (3) Results: the mean age of the sample was 65 ± 10 years with a prevalence of the male sex (64%). A significant improvement in the LV GLS (mean difference: −1.4 ± 1.1%; p value < 0.001) was observed after six months of treatment with GLP-1 RAs dulaglutide or semaglutide. No relevant changes were seen in the other echocardiographic parameters. (4) Conclusions: six months of treatment with GLP-1 RAs dulaglutide or semaglutide leads to an improvement in the LV GLS in subjects with DM2 with and high/very high risk for ASCVD or with ASCVD. Further studies on larger populations and with a longer follow-up are warranted to confirm these preliminary results. Full article

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

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14 pages, 326 KiB

Open AccessEditor’s ChoiceReview

Peripheral Regional Anesthesia Using Local Anesthetics: Old Wine in New Bottles?

by Lukas Gasteiger, Lukas Kirchmair, Elisabeth Hoerner, Ottokar Stundner and Markus W. Hollmann

J. Clin. Med. 2023, 12(4), 1541; https://doi.org/10.3390/jcm12041541 - 15 Feb 2023

Cited by 9 | Viewed by 4236

Abstract

During the past decade, numerous efforts were undertaken aiming at prolonging the analgesic effect of regional anesthesia. With the development of extended-release formulations and enhanced selectivity for nociceptive sensory neurons, a very promising contribution to the development of pain medications has been achieved. [...] Read more.

During the past decade, numerous efforts were undertaken aiming at prolonging the analgesic effect of regional anesthesia. With the development of extended-release formulations and enhanced selectivity for nociceptive sensory neurons, a very promising contribution to the development of pain medications has been achieved. At present, liposomal bupivacaine is the most popular, non-opioid, controlled drug delivery system, but its duration of action, which is still controversially discussed, and its expensiveness have decreased initial enthusiasm. Continuous techniques can be seen as an elegant alternative for providing a prolonged duration of analgesia, but for logistic or anatomical reasons, they are not always the best choice. Therefore, focus has been directed towards the perineural and/or intravenous addition of old and established substances. As for perineural application, most of these so-called ‘adjuvants’ are used outside their indication, and their pharmacological efficacy is often not or only poorly understood. This review aims to summarize the recent developments for prolonging the duration of regional anesthesia. It will also discuss the potential harmful interactions and side effects of frequently used analgesic mixtures. Full article

(This article belongs to the Section Anesthesiology)

10 pages, 4293 KiB

Open AccessEditor’s ChoiceArticle

Graphene-Doped Polymethyl Methacrylate (PMMA) as a New Restorative Material in Implant-Prosthetics: In Vitro Analysis of Resistance to Mechanical Fatigue

by Eduardo J. Selva-Otaolaurruchi, Lucía Fernández-Estevan, María Fernanda Solá-Ruiz, Fernando García-Sala-Bonmati, Inmaculada Selva-Ribera and Rubén Agustín-Panadero

J. Clin. Med. 2023, 12(4), 1269; https://doi.org/10.3390/jcm12041269 - 6 Feb 2023

Cited by 13 | Viewed by 2918

Abstract

Background and Purpose: Provisional prostheses in restorations over several implants with immediate loading in completely edentulous patients increase the risk of frequent structural fractures. An analysis was performed of the resistance to fracture of prosthetic structures with cantilevers using graphene-doped polymethyl methacrylate (PMMA) [...] Read more.

Background and Purpose: Provisional prostheses in restorations over several implants with immediate loading in completely edentulous patients increase the risk of frequent structural fractures. An analysis was performed of the resistance to fracture of prosthetic structures with cantilevers using graphene-doped polymethyl methacrylate (PMMA) resins and CAD-CAM technology. Methods: A master model was produced with four implants measuring 4 mm in diameter and spaced 3 mm apart, over which 44 specimens representing three-unit fixed partial prostheses with a cantilever measuring 11 mm were placed. These structures were cemented over titanium abutments using dual cure resin cement. Twenty-two of the 44 units were manufactured from machined PMMA discs, and 22 were manufactured from PMMA doped with graphene oxide nanoparticles (PMMA-G). All of the samples were tested in a chewing simulator with a load of 80 N until fracture or 240,000 load applications. Results: The mean number of load applications required for temporary restoration until the fracture was 155,455 in the PMMA-G group versus 51,136 in the PMMA group. Conclusions: Resistance to fracture under cyclic loading was three times greater in the PMMA-G group than in the PMMA group. Full article

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

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15 pages, 1273 KiB

Open AccessEditor’s ChoiceArticle

Use of Direct Acting Oral Anticoagulants in Elderly Patients with Atrial Fibrillation: A Multicenter, Cross-Sectional Study in Spain

by Pablo Díez-Villanueva, Juan Cosín-Sales, Vanesa Roldán-Schilling, Vivencio Barrios, Diana Riba-Artés and Olga Gavín-Sebastián

J. Clin. Med. 2023, 12(3), 1224; https://doi.org/10.3390/jcm12031224 - 3 Feb 2023

Cited by 8 | Viewed by 4073

Abstract

Non-vitamin K antagonist oral anticoagulants (NOACs) have substantially improved anticoagulation. However, data on NOAC use among elderly patients are scarce. We sought to describe NOAC use among elderly AF patients in Spain. We performed a non-interventional, multicenter, multispecialty, cross-sectional study in elderly (≥75 [...] Read more.

Non-vitamin K antagonist oral anticoagulants (NOACs) have substantially improved anticoagulation. However, data on NOAC use among elderly patients are scarce. We sought to describe NOAC use among elderly AF patients in Spain. We performed a non-interventional, multicenter, multispecialty, cross-sectional study in elderly (≥75 years) AF patients treated with NOACs for stroke prevention. Patients’ characteristics by NOAC treatment were compared using standardized differences (SDD). NOAC dosing was classified according to the Spanish summary of products characteristics (SmPC) into appropriate (recommended dose) and inappropriate (under and overdosed). Multivariate logistic regression analyses were used to explore factors associated with inappropriate dosing. 500 patients were included. Mean (SD) age was 81.5 (4.7) years, and 50% were women. Mean (SD) creatinine clearance was 57.4 mL/min (18.8), and 23.6% were frail. Dabigatran treatment totaled 38.4%, rivaroxaban 15.2%, apixaban 33.2%, and edoxaban 13.2%. Almost one-fourth of elderly patients treated with NOACs in Spain were inappropriately dosed (underdosing 14.4% and overdosing 9.6%). Underdosing was significantly associated with weight (OR = 1.03, 95%CI = 1.0–1.1), while higher a EHRA score decreased the risk of underdosing (OR = 0.47, 95%CI = 0.2–1.0). Overdosing was significantly associated with a history of ischemic stroke (OR = 2.95, 95%CI = 1.1–7.7). Addressing incorrect dosing among elderly AF patients is relevant to improve patient outcomes. Full article

(This article belongs to the Section Cardiology)

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22 pages, 3547 KiB

Open AccessEditor’s ChoiceReview

A Longer T_peak-T_end Interval Is Associated with a Higher Risk of Death: A Meta-Analysis

by Cathrin Caroline Braun, Matthias Daniel Zink, Sophie Gozdowsky, Julie Martha Hoffmann, Nadine Hochhausen, Anna Bettina Röhl, Stefan Kurt Beckers and Felix Kork

J. Clin. Med. 2023, 12(3), 992; https://doi.org/10.3390/jcm12030992 - 28 Jan 2023

Cited by 8 | Viewed by 2013

Abstract

A noninvasive tool for cardiovascular risk stratification has not yet been established in the clinical routine analysis. Previous studies suggest a prolonged T_peak-T_end interval (the interval from the peak to the end of the T-wave) to be predictive of death. [...] Read more.

A noninvasive tool for cardiovascular risk stratification has not yet been established in the clinical routine analysis. Previous studies suggest a prolonged T_peak-T_end interval (the interval from the peak to the end of the T-wave) to be predictive of death. This meta-analysis was designed to systematically evaluate the association of the T_peak-T_end interval with mortality outcomes. Medline (via PubMed), Embase and the Cochrane Library were searched from 1 January 2008 to 21 July 2020 for articles reporting the ascertainment of the T_peak-T_end interval and observation of all-cause-mortality. The search yielded 1920 citations, of which 133 full-texts were retrieved and 29 observational studies involving 23,114 patients met the final criteria. All-cause deaths had longer T_peak-T_end intervals compared to survivors by a standardized mean difference of 0.41 (95% CI 0.23–0.58) and patients with a long T_peak-T_end interval had a higher risk of all-cause death compared to patients with a short T_peak-T_end interval by an overall odds ratio of 2.33 (95% CI 1.57–3.45). Heart rate correction, electrocardiographic (ECG) measurement methods and the selection of ECG leads were major sources of heterogeneity. Subgroup analyses revealed that heart rate correction did not affect the association of the T_peak-T_end interval with mortality outcomes, whereas this finding was not evident in all measurement methods. The T_peak-T_end interval was found to be significantly associated with all-cause mortality. Further studies are warranted to confirm the prognostic value of the T_peak-T_end interval. Full article

(This article belongs to the Section Cardiology)

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10 pages, 917 KiB

Open AccessEditor’s ChoiceArticle

Are YouTube Videos a Useful and Reliable Source of Information for Patients with Temporomandibular Joint Disorders?

by Luigi Angelo Vaira, Silvia Sergnese, Giovanni Salzano, Fabio Maglitto, Antonio Arena, Emanuele Carraturo, Vincenzo Abbate, Umberto Committeri, Valentino Vellone, Andrea Biglio, Jérome R. Lechien and Giacomo De Riu

J. Clin. Med. 2023, 12(3), 817; https://doi.org/10.3390/jcm12030817 - 19 Jan 2023

Cited by 10 | Viewed by 2585

Abstract

Counseling is considered a first-line conservative therapy with respect to temporomandibular joint disorders (TMJD). Nowadays, 50 to 80% of patients acquire health information from the internet before turning to professionals. The purpose of this study has been to investigate the quality of information [...] Read more.

Counseling is considered a first-line conservative therapy with respect to temporomandibular joint disorders (TMJD). Nowadays, 50 to 80% of patients acquire health information from the internet before turning to professionals. The purpose of this study has been to investigate the quality of information about TMJD that patients can obtain from YouTube. A YouTube.com search was conducted using the terms “temporomandibular joint disorder”; “limited movement of the mandible”; and “mandibular joint pain”. The videos identified were assessed independently by two panels of three professional and lay reviewers with HONcode, modified DISCERN (MD) and the global quality scale (GQS). A total of 106 videos were included. The professional reviewers reported a mean HONcode score of 4.148 ± 1.314 and a mean MD score of 2.519 ± 1.267, testifying to a modest general quality of the videos. The mean GQS score was 2.987 ± 1.012 for the professional and 3.469 ± 0.891 for the lay reviewers (p < 0.001). The correlations between the ratings were significant between the reviewers within the same group but not between the two groups. The presence of animations significantly influenced the GQS score expressed by the lay reviewers (p = 0.011) but not that of the professionals (p = 0.640). The quality of the information on TMJD on YouTube is generally of poor quality. Healthcare systems and professionals should be prepared to correct misinformation and build trusting relationships with patients which are based on quality counseling. Similarly, academic institutions should produce quality content that leads patients with TMJD toward a correct diagnostic-therapeutic process. Full article

(This article belongs to the Special Issue "Temporomandibular Disorders": Functional and Conservative Treatment)

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13 pages, 1499 KiB

Open AccessEditor’s ChoiceArticle

Comprehensive Assessment of Corvis ST Biomechanical Indices in Normal and Keratoconus Corneas with Reference to Corneal Enantiomorphism

by Vincent Borderie, Juliette Beauruel, Roxane Cuyaubère, Cristina Georgeon, Benjamin Memmi and Otman Sandali

J. Clin. Med. 2023, 12(2), 690; https://doi.org/10.3390/jcm12020690 - 15 Jan 2023

Cited by 10 | Viewed by 2868

Abstract

The aim of this study was to assess Corvis ST biomechanical indices in reference to corneal enantiomorphism. In a prospective observational cohort study, 117 eyes from 63 patients with normal or keratoconus corneas were assessed by three independent observers. In the control group [...] Read more.

The aim of this study was to assess Corvis ST biomechanical indices in reference to corneal enantiomorphism. In a prospective observational cohort study, 117 eyes from 63 patients with normal or keratoconus corneas were assessed by three independent observers. In the control group (n = 62), no significant differences were observed between the three observers for all indices. The best reproducibility was obtained with pachymetry and the weakest with CBI. All indices but CBI and arc length featured COV < 10%. All indices except the PD and SSI correlated with pachymetry; all but Rad correlated with IOP. The comparison of the thinnest with the thickest corneas showed no significant differences for any index except pachymetry. In the keratoconus group (n = 55), loss of corneal enantiomorphism was confirmed for all indices except the arc length, velocity, and PD. Significant differences between both groups were found for all indices, even after adjustment for pachymetry and intraocular pressure. The CBI featured the best accuracy (92%), sensitivity (91%), and graphical relevance for keratoconus diagnosis. However, its reproducibility was weak in normal corneas and was strongly dependent on corneal thickness. The SSI was independent of corneal thickness, highly reproducible, and provided the expected enantiomorphism characteristics in both groups, making it a relevant biomarker of biomechanical corneal behavior. Full article

(This article belongs to the Section Ophthalmology)

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11 pages, 1800 KiB

Open AccessEditor’s ChoiceArticle

A Novel Hair Restoration Technology Counteracts Androgenic Hair Loss and Promotes Hair Growth in A Blinded Clinical Trial

by Dominik Thor, Andrea Pagani, Julia Bukowiecki, Khosrow S. Houschyar, Stig-Frederik T. Kølle, Saranya P. Wyles and Dominik Duscher

J. Clin. Med. 2023, 12(2), 470; https://doi.org/10.3390/jcm12020470 - 6 Jan 2023

Cited by 10 | Viewed by 10275

Abstract

Androgenic alopecia (AGA) is a genetically predetermined condition that occurs as a result of stepwise miniaturization of the dermal papilla. During this process, the hair follicle suffers from increasing malnutrition and eventually dies, causing progressive hair loss. We recently highlighted that HIF-1α modulation [...] Read more.

Androgenic alopecia (AGA) is a genetically predetermined condition that occurs as a result of stepwise miniaturization of the dermal papilla. During this process, the hair follicle suffers from increasing malnutrition and eventually dies, causing progressive hair loss. We recently highlighted that HIF-1α modulation may counteract hair loss. Here, we aim to demonstrate the positive influence of Tomorrowlabs HIF strengthening factor [HSF] hair restoration technology on hair biology in a monocentric blinded clinical trial over a total period of 9 months. A trial with 20 subjects (4 female and 16 male) and once-daily application of [HSF] hair restoration technology to the scalp was conducted. To assess the tolerability and efficacy of [HSF], testing included dermatological assessment, determination of hair loss by counting after combing, macro images of the head and TrichoScan evaluation of hair density as well as the proportion of anagen hair versus telogen hair. The clinical data show Tomorrowlabs [HSF] hair restoration to be safe and effective to counteract AGA. The use of Tomorrowlabs [HSF] hair restoration resulted in improvements in the clinical parameters of hair quality such as thickness (+7.2%), hair density (+14.3%) and shine and elasticity (+20.3%) during the test period. The effectiveness of the test product was further determined by a significant reduction in hair loss of an average of 66.8% in treatment-responsive subjects after 6 months and an increase in hair growth reaching up to 32.5%, with an average percentage change of 8.4% in all participants and 10.8% in the responsive patients (85% of the study cohort) after 9 months on TrichoScan evaluation. The hair growth cycle was harmonized with the result of an average anagen hair percentage increase of +8.0% and telogen hair percentage reduction of −14.0% shown in the test area. Applicable for both sexes in an alcohol-free formulation, beneficial to scalp health and free of complications or side effects, this novel product provides objectively measurable results counteracting hair loss paired with an improved look and feel of the hair. Full article

(This article belongs to the Special Issue Regenerative Medicine for Longevity and Aesthetics)

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11 pages, 1643 KiB

Open AccessEditor’s ChoiceArticle

The Impact of Recirculation on Extracorporeal Gas Exchange and Patient Oxygenation during Veno-Venous Extracorporeal Membrane Oxygenation—Results of an Observational Clinical Trial

by Johannes Gehron, Dirk Bandorski, Konstantin Mayer and Andreas Böning

J. Clin. Med. 2023, 12(2), 416; https://doi.org/10.3390/jcm12020416 - 4 Jan 2023

Cited by 10 | Viewed by 2010

Abstract

Background: Recirculation during veno-venous extracorporeal membrane oxygenation reduces extracorporeal oxygen exchange and patient oxygenation. To minimize recirculation and maximize oxygen delivery (DO₂) the interaction of cannulation, ECMO flow and cardiac output requires careful consideration. We investigated this interaction in an observational [...] Read more.

Background: Recirculation during veno-venous extracorporeal membrane oxygenation reduces extracorporeal oxygen exchange and patient oxygenation. To minimize recirculation and maximize oxygen delivery (DO₂) the interaction of cannulation, ECMO flow and cardiac output requires careful consideration. We investigated this interaction in an observational trial. Methods: In 19 patients with acute respiratory distress syndrome and ECMO, we measured recirculation with the ultrasound dilution technique and calculated extracorporeal oxygen transfer (VO₂), extracorporeal oxygen delivery (DO₂) and patient oxygenation. To assess the impact of cardiac output (CO), we included CO measurement through pulse contour analysis. Results: In all patients, there was a median recirculation rate of approximately 14–16%, with a maximum rate of 58%. Recirculation rates >35% occurred in 13–14% of all cases. In contrast to decreasing extracorporeal gas exchange with increasing ECMO flow and recirculation, patient oxygenation increased with greater ECMO flows. High CO diminished recirculation by between 5–20%. Conclusions: Extracorporeal gas exchange masks the importance of DO₂ and its effects on patients. We assume that increasing DO₂ is more important than reduced VO₂. A negative correlation of recirculation to CO adds to the complexity of this phenomenon. Patient oxygenation may be optimized with the direct measurement of recirculation. Full article

(This article belongs to the Special Issue Extracorporeal Membrane Oxygenation (ECMO): Current Progress and Clinical Challenges)

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13 pages, 1133 KiB

Open AccessEditor’s ChoiceArticle

Safety of Sirolimus in Patients with Tuberous Sclerosis Complex under Two Years of Age—A Bicenter Retrospective Study

by Dominika Śmiałek, Sergiusz Jóźwiak and Katarzyna Kotulska

J. Clin. Med. 2023, 12(1), 365; https://doi.org/10.3390/jcm12010365 - 3 Jan 2023

Cited by 10 | Viewed by 3128

Abstract

Background: mTOR inhibitors are a novel pharmacotherapy recommended for subependymal giant astrocytomas, refractory epilepsy, and the treatment of the other clinical manifestations of tuberous sclerosis complex (TSC). Clinical trials on everolimus proved it to be effective and safe in children. Despite its common [...] Read more.

Background: mTOR inhibitors are a novel pharmacotherapy recommended for subependymal giant astrocytomas, refractory epilepsy, and the treatment of the other clinical manifestations of tuberous sclerosis complex (TSC). Clinical trials on everolimus proved it to be effective and safe in children. Despite its common use in clinical practice, the research on sirolimus is limited. This study is the first to determine and assess the severity of the adverse effects (AEs) of sirolimus administered to children with TSC under two years of age. Methods: We performed a bicenter retrospective data analysis of medical records of individuals with TSC who initiated therapy with sirolimus under the age of two. Results: Twenty-one patients were included in the study. At least one AE was reported in all participants. The most prevalent AEs were anemia, thrombocytosis, and hyperlipidemia. Infections and mouth ulcerations, often reported in the studies on older patients, were infrequent and of mild or moderate grade. Conclusions: Adverse effects associated with sirolimus use in infants and young children with TSC are frequent yet not life- or health-threatening. Further multicenter prospective clinical trials should determine the long-term safety of sirolimus. Full article

(This article belongs to the Section Clinical Neurology)

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14 pages, 987 KiB

Open AccessEditor’s ChoiceReview

Juvenile Psoriatic Arthritis: Myth or Reality? An Unending Debate

by Roberta Naddei, Ana Rebollo-Giménez, Marco Burrone, Valentina Natoli, Silvia Rosina, Alessandro Consolaro and Angelo Ravelli

J. Clin. Med. 2023, 12(1), 367; https://doi.org/10.3390/jcm12010367 - 3 Jan 2023

Cited by 10 | Viewed by 12819

Abstract

Juvenile psoriatic arthritis (JPsA) accounts for 1–7% of all cases of juvenile idiopathic arthritis (JIA) and its definition has been a matter of controversy among pediatric rheumatologists for many years. The traditional attribution of JPsA to the spondyloarthropathy group was challenged in the [...] Read more.

Juvenile psoriatic arthritis (JPsA) accounts for 1–7% of all cases of juvenile idiopathic arthritis (JIA) and its definition has been a matter of controversy among pediatric rheumatologists for many years. The traditional attribution of JPsA to the spondyloarthropathy group was challenged in the early 1990s, whereas the recent demonstrations of its heterogenous nature have led to questions about its identification as a distinct category in JIA classification. It has been shown that children with the phenotype of JPsA can be divided in two subgroups, one presenting with the features of early-onset ANA-positive JIA, and another that belongs to the spectrum of spondyloarthropathies. The few studies that have compared the clinical characteristics and genetic determinants of JPsA with those of the other JIA categories have obtained contrasting findings. The debate on the categorization of JPsA as a distinct entity within JIA classification is still ongoing and has prompted the revision of its current classification. Full article

(This article belongs to the Special Issue New Advances in Juvenile Idiopathic Arthritis (JIA))

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10 pages, 1273 KiB

Open AccessEditor’s ChoiceArticle

Association between Optic Nerve Sheath Diameter and Lamina Cribrosa Morphology in Normal-Tension Glaucoma

by Seung Hyen Lee, Tae-Woo Kim, Eun Ji Lee and Hyunkyung Kil

J. Clin. Med. 2023, 12(1), 360; https://doi.org/10.3390/jcm12010360 - 2 Jan 2023

Cited by 10 | Viewed by 2608

Abstract

(1) Background: To compare optic nerve sheath diameter (ONSD) in normal-tension glaucoma (NTG) and healthy eyes and to investigate the association between ONSD and lamina cribrosa (LC) morphology. (2) Methods: This cross-sectional study included 69 NTG eyes and 69 healthy eyes matched for [...] Read more.

(1) Background: To compare optic nerve sheath diameter (ONSD) in normal-tension glaucoma (NTG) and healthy eyes and to investigate the association between ONSD and lamina cribrosa (LC) morphology. (2) Methods: This cross-sectional study included 69 NTG eyes and 69 healthy eyes matched for age, axial length, and intraocular pressure. The LC curvature index (LCCI) was measured from horizontal Cirrus HD-OCT B-scan images from five uniformly divided positions vertically of the optic nerve. The average LCCI was defined as the mean of the measurements at these five locations. ONSD was measured as the width of the optic nerve sheath at the site perpendicular 3 mm behind the posterior globe. LCCI and ONSD were compared in eyes with NTG and healthy eyes. The clinical factors that could affect LCCI were analyzed. (3) Results: NTG eyes had significantly smaller mean ONSD (4.55 ± 0.69 mm vs. 4.97 ± 0.58 mm, p < 0.001) and larger average LCCI (11.61 ± 1.43 vs. 7.58 ± 0.90, p < 0.001) than matched healthy control eyes. LCCI was significantly correlated with smaller ONSD, higher intraocular pressure, thinner global retinal nerve fiber thickness, and worse visual field loss in all subjects (all Ps ≤ 0.022). (4) Conclusions: NTG eyes had smaller ONSD and greater LCCI than healthy control eyes. In addition, a negative correlation was observed between ONSD and LCCI. These findings suggest that cerebrospinal fluid pressure, which ONSD indirectly predicts, may affect LC configuration. Changes in the retrolaminar compartment may play a role in glaucoma pathogenesis. Full article

(This article belongs to the Special Issue Advances in Glaucoma Management and Intraocular Pressure Physiology)

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