Journal of Clinical Medicine

20 pages, 1121 KB

Open AccessFeature PaperEditor’s ChoiceArticle

Treatment of Refractory Cardiac Arrest by Controlled Reperfusion of the Whole Body: A Multicenter, Prospective Observational Study

by Georg Trummer, Christoph Benk, Jan-Steffen Pooth, Tobias Wengenmayer, Alexander Supady, Dawid L. Staudacher, Domagoj Damjanovic, Dirk Lunz, Clemens Wiest, Hug Aubin, Artur Lichtenberg, Martin W. Dünser, Johannes Szasz, Dinis Dos Reis Miranda, Robert J. van Thiel, Jan Gummert, Thomas Kirschning, Eike Tigges, Stephan Willems, Friedhelm Beyersdorf and on behalf of the Extracorporeal Multi-Organ Repair Study Group Show full author list Hide full author list

J. Clin. Med. 2024, 13(1), 56; https://doi.org/10.3390/jcm13010056 - 21 Dec 2023

Cited by 13 | Viewed by 8706

Abstract

Background: Survival following cardiac arrest (CA) remains poor after conventional cardiopulmonary resuscitation (CCPR) (6–26%), and the outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) are often inconsistent. Poor survival is a consequence of CA, low-flow states during CCPR, multi-organ injury, insufficient monitoring, and delayed treatment [...] Read more.

Background: Survival following cardiac arrest (CA) remains poor after conventional cardiopulmonary resuscitation (CCPR) (6–26%), and the outcomes after extracorporeal cardiopulmonary resuscitation (ECPR) are often inconsistent. Poor survival is a consequence of CA, low-flow states during CCPR, multi-organ injury, insufficient monitoring, and delayed treatment of the causative condition. We developed a new strategy to address these issues. Methods: This all-comers, multicenter, prospective observational study (69 patients with in- and out-of-hospital CA (IHCA and OHCA) after prolonged refractory CCPR) focused on extracorporeal cardiopulmonary support, comprehensive monitoring, multi-organ repair, and the potential for out-of-hospital cannulation and treatment. Result: The overall survival rate at hospital discharge was 42.0%, and a favorable neurological outcome (CPC 1+2) at 90 days was achieved for 79.3% of survivors (CPC 1+2 survival 33%). IHCA survival was very favorable (51.7%), as was CPC 1+2 survival at 90 days (41%). Survival of OHCA patients was 35% and CPC 1+2 survival at 90 days was 28%. The subgroup of OHCA patients with pre-hospital cannulation showed a superior survival rate of 57.1%. Conclusions: This new strategy focusing on repairing damage to multiple organs appears to improve outcomes after CA, and these findings should provide a sound basis for further research in this area. Full article

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

► Show Figures

Graphical abstract

10 pages, 1598 KB

Open AccessEditor’s ChoiceSystematic Review

Reproductive Safety Issues of Novel Small Molecules for the Treatment of Inflammatory Bowel Disease: A Systematic Review

by Niloufar Monfared, Matthew Gold, Isabel Carbery, Robyn Laube and Christian P. Selinger

J. Clin. Med. 2024, 13(1), 34; https://doi.org/10.3390/jcm13010034 - 20 Dec 2023

Cited by 17 | Viewed by 2592

Abstract

Maintenance of remission during pregnancy is vital for women with inflammatory bowel disease (IBD). The antenatal safety of novel small molecules for IBD is yet to be ascertained. We aimed to describe the current evidence on reproductive data regarding small-molecule drugs. We performed [...] Read more.

Maintenance of remission during pregnancy is vital for women with inflammatory bowel disease (IBD). The antenatal safety of novel small molecules for IBD is yet to be ascertained. We aimed to describe the current evidence on reproductive data regarding small-molecule drugs. We performed a systematic review searching Embase Classic + Embase and Ovid MEDLINE for reproductive outcomes for tofacitinib, filgotinib, upadacitininb, and ozanimod. Additionally, we asked the manufacturers for available data on file regarding reproduction. We analysed data from 10 sources; six studies and four manufacturer reports were identified from our search. Significant malformation risks were reported for tofacitinib, filgotinib, upadacitininb, and ozanimod in animal studies. In 126 tofacitinib-exposed pregnancies, there were 55 live births with 2 congenital malformations and 1 serious infant infection, 14 terminations, 15 miscarriages, and 42 outcomes unknown. In 50 filgotinib-exposed pregnancies, there were 20 healthy babies, 1 congenital malformation, 9 terminations, 10 miscarriages, and 10 outcomes unknown. In 78 upadacitinib-exposed pregnancies, there were 30 healthy babies, 15 terminations, 15 miscarriages, and 18 outcomes unknown. In 60 ozanimod-exposed pregnancies, there were 31 live births with 1 congenital malformation, 1 case of intra-uterine growth restriction, 1 case of neonatal icterus, 13 terminations, 9 miscarriages, and 8 unknown outcomes. Animal data suggest significant risks of malformations for tofacitinib, filgotinib, upadacitininb, and ozanimod. Human data from clinical trials and real-world observations do not show concerning data so far, but these are very limited. Currently, alternative treatments should be used for IBD during pregnancy. Full article

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

► Show Figures

Figure 1

15 pages, 281 KB

Open AccessEditor’s ChoiceArticle

Barriers to Adherence to Healthy Diet and Recommended Physical Activity Perceived by the Polish Population

by Katarzyna Domosławska-Żylińska, Magdalena Łopatek, Magdalena Krysińska-Pisarek and Larysa Sugay

J. Clin. Med. 2024, 13(1), 22; https://doi.org/10.3390/jcm13010022 - 19 Dec 2023

Cited by 17 | Viewed by 4176

Abstract

Background: According to the World Health Organization, an unhealthy diet and lack of physical activity constitute the primary global health risks. The purpose of this study was to as-certain the barriers to a healthy diet (HD) and physical activity (PA) as perceived by [...] Read more.

Background: According to the World Health Organization, an unhealthy diet and lack of physical activity constitute the primary global health risks. The purpose of this study was to as-certain the barriers to a healthy diet (HD) and physical activity (PA) as perceived by the Polish population in order to implement public health interventions. Methods: A quantitative survey was conducted using the computer-assisted telephone interview technique on a randomly selected representative sample of 2000 Polish citizens aged 18–88 years. The research tool was a questionnaire consisting of two parts: sociodemographic characteristics and examining barriers to an HD (Cronbach’s alpha = 0.899) and regular PA (Cronbach’s alpha = 0.923). Results: Women constituted more than half of the sample (53.4%), and most of the respondents lived in urban areas (60.5%), considered their financial situation as average (56.9%), and their health as satisfactory (42.3%). Barriers to an HD include the cost of healthy food (43%), lack of motivation (26.7%), and lack of time (25.4%). Barriers to taking up PA include competing priorities (29%), a lack of motivation to exercise (27.3%), feeling of constant fatigue, and lack of energy (24.4%). Limiting factors in the adoption of both an HD and PA are gender (women > men; HD p < 0.01; PA p < 0.001), financial situation (unsatisfactory; HD and PA p < 0.001), health condition (unsatisfactory; HD and PA p < 0.001), type of work (blue-collar workers; HD p < 0.001; PA p < 0.05), and employment status (people running household; HD and PA p < 0.001). Conclusions: The results of this study provide important information about barriers to adopting healthy lifestyle principles. The practical implications of our work can be used by policymakers responsible for intervention strategies and programmes to increase the number of people adhering to recommendations for an HD and PA by removing barriers. Full article

(This article belongs to the Special Issue Reducing Modifiable Risk Factors to Prevent and Control Non-communicable Diseases)

10 pages, 274 KB

Open AccessEditor’s ChoiceReview

Neisseria gonorrhoeae Antimicrobial Resistance: The Future of Antibiotic Therapy

by Angelo Roberto Raccagni, Martina Ranzenigo, Elena Bruzzesi, Chiara Maci, Antonella Castagna and Silvia Nozza

J. Clin. Med. 2023, 12(24), 7767; https://doi.org/10.3390/jcm12247767 - 18 Dec 2023

Cited by 15 | Viewed by 6313

Abstract

The growing threat of antibiotic-resistant Neisseria gonorrhoeae, which causes gonorrhea, presents a current public health challenge. Over the years, the pathogen has developed resistance to different antibiotics, leaving few effective treatment options. High-level resistance to key drugs, including ceftriaxone, has become a [...] Read more.

The growing threat of antibiotic-resistant Neisseria gonorrhoeae, which causes gonorrhea, presents a current public health challenge. Over the years, the pathogen has developed resistance to different antibiotics, leaving few effective treatment options. High-level resistance to key drugs, including ceftriaxone, has become a concerning reality. This article primarily focuses on the treatment of gonorrhea and the current clinical trials aimed at providing new antibiotic treatment options. We explore ongoing efforts to assess new antibiotics, including zoliflodacin, and gepotidacin. These drugs offer new effective treatment options, but their rapid availability remains uncertain. We delve into two ongoing clinical trials: one evaluating the efficacy and safety of gepotidacin compared to the standard ceftriaxone–azithromycin combination and the other assessing the non-inferiority of zoliflodacin versus the combination therapy of ceftriaxone–azithromycin. These trials represent crucial steps in the search for alternative treatments for uncomplicated gonorrhea. Notably, gonorrhea has been included in the “WHO Priority Pathogens List for Research and Development of New Antibiotics”. In conclusion, the urgent need for innovative treatment strategies is underscored by the rising threat of antibiotic resistance in N. gonorrhoeae; collaboration among researchers, industries, and healthcare authorities is therefore essential. Full article

(This article belongs to the Section Infectious Diseases)

16 pages, 673 KB

Open AccessFeature PaperEditor’s ChoiceArticle

Maternal Stress, Anxiety, Well-Being, and Sleep Quality in Pregnant Women throughout Gestation

by Rosalia Pascal, Irene Casas, Mariona Genero, Ayako Nakaki, Lina Youssef, Marta Larroya, Leticia Benitez, Yvan Gomez, Anabel Martinez-Aran, Ivette Morilla, Teresa M. Oller-Guzmán, Andrés Martín-Asuero, Eduard Vieta, Fàtima Crispi, Eduard Gratacos, María Dolores Gomez-Roig and Francesca Crovetto

J. Clin. Med. 2023, 12(23), 7333; https://doi.org/10.3390/jcm12237333 - 26 Nov 2023

Cited by 15 | Viewed by 5918

Abstract

Background: Maternal stress, anxiety, well-being, and sleep quality during pregnancy have been described as influencing factors during pregnancy. Aim: We aimed to describe maternal stress, anxiety, well-being, and sleep quality in pregnant women throughout gestation and their related factors. Methods: A prospective study [...] Read more.

Background: Maternal stress, anxiety, well-being, and sleep quality during pregnancy have been described as influencing factors during pregnancy. Aim: We aimed to describe maternal stress, anxiety, well-being, and sleep quality in pregnant women throughout gestation and their related factors. Methods: A prospective study including pregnant women attending BCNatal, in Barcelona, Spain (n = 630). Maternal stress and anxiety were assessed by the Perceived Stress Scale (PSS) and State-Trait Anxiety Inventory (STAI)-validated questionnaires. Maternal well-being was assessed using the World Health Organization Well-Being Index Questionnaire (WHO-5), and sleep quality was assessed using the Pittsburgh Sleep Quality Index Questionnaire (PSQI). All questionnaires were obtained twice during the second and third trimester of pregnancy. A multivariate analysis was conducted to assess factors related to higher maternal stress and anxiety and worse well-being and sleep quality. Results: High levels of maternal stress were reported in 23.1% of participants at the end of pregnancy, with maternal age <40 years (OR 2.02; 95% CI 1.08–3.81, p = 0.03), non-white ethnicity (OR 2.09; 95% CI 1.19–4.02, p = 0.01), and non-university studies (OR 1.86; 95% CI 1.08–3.19, p = 0.02) being the parameters mostly associated with it. A total of 20.7% of women had high levels of anxiety in the third trimester and the presence of psychiatric disorders (OR 3.62; 95% CI 1.34–9.78, p = 0.01) and non-university studies (OR 1.70; 95% CI 1.11–2.59, p = 0.01) provided a significant contribution to high anxiety at multivariate analysis. Poor maternal well-being was observed in 26.5% of women and a significant contribution was provided by the presence of psychiatric disorders (OR 2.96; 95% CI 1.07–8.25, p = 0.04) and non-university studies (OR 1.74; 95% CI 1.10–2.74, p = 0.02). Finally, less sleep quality was observed at the end of pregnancy (p < 0.001), with 81.1% of women reporting poor sleep quality. Conclusion: Maternal stress and anxiety, compromised maternal well-being, and sleep quality disturbances are prevalent throughout pregnancy. Anxiety and compromised sleep quality may increase over gestation. The screening of these conditions at different stages of pregnancy and awareness of the associated risk factors can help to identify women at potential risk. Full article

(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth)

► Show Figures

Graphical abstract

22 pages, 386 KB

Open AccessEditor’s ChoiceReview

Beyond Conventional Operations: Embracing the Era of Contemporary Minimally Invasive Cardiac Surgery

by Lilly Ilcheva, Petar Risteski, Igor Tudorache, Achim Häussler, Nestoras Papadopoulos, Dragan Odavic, Hector Rodriguez Cetina Biefer and Omer Dzemali

J. Clin. Med. 2023, 12(23), 7210; https://doi.org/10.3390/jcm12237210 - 21 Nov 2023

Cited by 16 | Viewed by 3186

Abstract

Over the past two decades, minimally invasive cardiac surgery (MICS) has gained a significant place due to the emergence of innovative tools and improvements in surgical techniques, offering comparable efficacy and safety to traditional surgical methods. This review provides an overview of the [...] Read more.

Over the past two decades, minimally invasive cardiac surgery (MICS) has gained a significant place due to the emergence of innovative tools and improvements in surgical techniques, offering comparable efficacy and safety to traditional surgical methods. This review provides an overview of the history of MICS, its current state, and its prospects and highlights its advantages and limitations. Additionally, we highlight the growing trends and potential pathways for the expansion of MICS, underscoring the crucial role of technological advancements in shaping the future of this field. Recognizing the challenges, we strive to pave the way for further breakthroughs in minimally invasive cardiac procedures. Full article

(This article belongs to the Section Cardiovascular Medicine)

26 pages, 4148 KB

Open AccessFeature PaperEditor’s ChoiceReview

Biomarkers in Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Updated Review of the Literature

by Giulia Crisci, Emanuele Bobbio, Piero Gentile, Daniel I. Bromage, Entela Bollano, Emma Ferone, Muhammad Zubair Israr, Liam M. Heaney, Christian L. Polte, Antonio Cannatà and Andrea Salzano

J. Clin. Med. 2023, 12(23), 7214; https://doi.org/10.3390/jcm12237214 - 21 Nov 2023

Cited by 15 | Viewed by 4630

Abstract

Myocarditis is a disease caused by cardiac inflammation that can progress to dilated cardiomyopathy, heart failure, and eventually death. Several etiologies, including autoimmune, drug-induced, and infectious, lead to inflammation, which causes damage to the myocardium, followed by remodeling and fibrosis. Although there has [...] Read more.

Myocarditis is a disease caused by cardiac inflammation that can progress to dilated cardiomyopathy, heart failure, and eventually death. Several etiologies, including autoimmune, drug-induced, and infectious, lead to inflammation, which causes damage to the myocardium, followed by remodeling and fibrosis. Although there has been an increasing understanding of pathophysiology, early and accurate diagnosis, and effective treatment remain challenging due to the high heterogeneity. As a result, many patients have poor prognosis, with those surviving at risk of long-term sequelae. Current diagnostic methods, including imaging and endomyocardial biopsy, are, at times, expensive, invasive, and not always performed early enough to affect disease progression. Therefore, the identification of accurate, cost-effective, and prognostically informative biomarkers is critical for screening and treatment. The review then focuses on the biomarkers currently associated with these conditions, which have been extensively studied via blood tests and imaging techniques. The information within this review was retrieved through extensive literature research conducted on major publicly accessible databases and has been collated and revised by an international panel of experts. The biomarkers discussed in the article have shown great promise in clinical research studies and provide clinicians with essential tools for early diagnosis and improved outcomes. Full article

(This article belongs to the Section Cardiovascular Medicine)

► Show Figures

Figure 1

20 pages, 1425 KB

Open AccessEditor’s ChoiceReview

A Manifesto in Defense of Pain Complexity: A Critical Review of Essential Insights in Pain Neuroscience

by Javier Picañol Párraga and Aida Castellanos

J. Clin. Med. 2023, 12(22), 7080; https://doi.org/10.3390/jcm12227080 - 14 Nov 2023

Cited by 24 | Viewed by 12468

Abstract

Chronic pain has increasingly become a significant health challenge, not just as a symptomatic manifestation but also as a pathological condition with profound socioeconomic implications. Despite the expansion of medical interventions, the prevalence of chronic pain remains remarkably persistent, prompting a turn towards [...] Read more.

Chronic pain has increasingly become a significant health challenge, not just as a symptomatic manifestation but also as a pathological condition with profound socioeconomic implications. Despite the expansion of medical interventions, the prevalence of chronic pain remains remarkably persistent, prompting a turn towards non-pharmacological treatments, such as therapeutic education, exercise, and cognitive-behavioral therapy. With the advent of cognitive neuroscience, pain is often presented as a primary output derived from the brain, aligning with Engel’s Biopsychosocial Model that views disease not solely from a biological perspective but also considering psychological and social factors. This paradigm shift brings forward potential misconceptions and over-simplifications. The current review delves into the intricacies of nociception and pain perception. It questions long-standing beliefs like the cerebral-centric view of pain, the forgotten role of the peripheral nervous system in pain chronification, misconceptions around central sensitization syndromes, the controversy about the existence of a dedicated pain neuromatrix, the consciousness of the pain experience, and the possible oversight of factors beyond the nervous system. In re-evaluating these aspects, the review emphasizes the critical need for understanding the complexity of pain, urging the scientific and clinical community to move beyond reductionist perspectives and consider the multifaceted nature of this phenomenon. Full article

(This article belongs to the Special Issue Clinical Management of Chronic Pain)

► Show Figures

Figure 1

10 pages, 259 KB

Open AccessEditor’s ChoiceArticle

Reasons for Discontinuing Treatment with Sodium-Glucose Cotransporter 2 Inhibitors in Patients with Diabetes in Real-World Settings: The KAMOGAWA-A Study

by Yuto Saijo, Hiroshi Okada, Shinnosuke Hata, Hanako Nakajima, Nobuko Kitagawa, Takuro Okamura, Takafumi Osaka, Noriyuki Kitagawa, Saori Majima, Takafumi Senmaru, Emi Ushigome, Naoko Nakanishi, Masahide Hamaguchi and Michiaki Fukui

J. Clin. Med. 2023, 12(22), 6993; https://doi.org/10.3390/jcm12226993 - 9 Nov 2023

Cited by 15 | Viewed by 5798

Abstract

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a class of antidiabetic agents known to exert cardioprotective, renoprotective, and hypoglycemic effects. However, these agents have been associated with adverse effects, such as genital infection, volume depletion, hypoglycemia, and diabetic ketoacidosis, resulting in drug discontinuation. Herein, [...] Read more.

Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are a class of antidiabetic agents known to exert cardioprotective, renoprotective, and hypoglycemic effects. However, these agents have been associated with adverse effects, such as genital infection, volume depletion, hypoglycemia, and diabetic ketoacidosis, resulting in drug discontinuation. Herein, we aimed to determine the reasons for discontinuing treatment with SGLT2is among Japanese patients with diabetes. This retrospective cohort study enrolled 766 patients with diabetes who had initiated SGLT2is between January 2014 and September 2021. The follow-up period was 2 years from the initiation of the SGLT2is. Overall, 97 patients (12.7%) discontinued the SGLT2is during the follow-up period. The most common reasons for discontinuing the SGLT2is were frequent urination (19.6%), followed by genital infection (11.3%), improved glycemic control (10.6%), and renal dysfunction (8.2%). A comparison of the characteristics between the continuation and the discontinuation group was conducted, excluding those who discontinued the SGLT2is because of improved glycemic control. The patients in the discontinuation group (68 [55–75] years) were older than those in the continuation group (64 [53–71] years; p = 0.003). Importantly, we found no significant association between diabetes duration, diabetic control, renal function, or complications of diabetes in both groups. This real-world study revealed that frequent urination was the most common reason underlying SGLT2i discontinuation among Japanese patients with diabetes. To avoid discontinuation, precautions against various factors that may cause frequent urination must be implemented. Full article

(This article belongs to the Section Endocrinology & Metabolism)

21 pages, 691 KB

Open AccessEditor’s ChoiceReview

Pleural Mesothelioma: Advances in Blood and Pleural Biomarkers

by Claudio Sorino, Michele Mondoni, Giampietro Marchetti, Sergio Agati, Riccardo Inchingolo, Federico Mei, Sara Flamini, Filippo Lococo and David Feller-Kopman

J. Clin. Med. 2023, 12(22), 7006; https://doi.org/10.3390/jcm12227006 - 9 Nov 2023

Cited by 12 | Viewed by 5327

Abstract

Pleural mesothelioma (PM) is a type of cancer that is highly related to exposure to asbestos fibers. It shows aggressive behavior, and the current therapeutic approaches are usually insufficient to change the poor prognosis. Moreover, apart from staging and histological classification, there are [...] Read more.

Pleural mesothelioma (PM) is a type of cancer that is highly related to exposure to asbestos fibers. It shows aggressive behavior, and the current therapeutic approaches are usually insufficient to change the poor prognosis. Moreover, apart from staging and histological classification, there are no validated predictors of its response to treatment or its long-term outcomes. Numerous studies have investigated minimally invasive biomarkers in pleural fluid or blood to aid in earlier diagnosis and prognostic assessment of PM. The most studied marker in pleural effusion is mesothelin, which exhibits good specificity but low sensitivity, especially for non-epithelioid PM. Other biomarkers found in pleural fluid include fibulin-3, hyaluronan, microRNAs, and CYFRA-21.1, which have lower diagnostic capabilities but provide prognostic information and have potential roles as therapeutic targets. Serum is the most investigated matrix for biomarkers of PM. Several serum biomarkers in PM have been studied, with mesothelin, osteopontin, and fibulin-3 being the most often tested. A soluble mesothelin-related peptide (SMRP) is the only FDA-approved biomarker in patients with suspected mesothelioma. With different serum and pleural fluid cut-offs, it provides useful information on the diagnosis, prognosis, follow-up, and response to therapy in epithelioid PM. Panels combining different markers and proteomics technologies show promise in terms of improving clinical performance in the diagnosis and monitoring of mesothelioma patients. However, there is still no evidence that early detection can improve the treatment outcomes of PM patients. Full article

(This article belongs to the Section Respiratory Medicine)

► Show Figures

Figure 1

12 pages, 299 KB

Open AccessEditor’s ChoiceReview

Mirabegron, a Selective β3-Adrenergic Receptor Agonist, as a Potential Anti-Obesity Drug

by Anna Maria Dąbrowska and Jarosław Dudka

J. Clin. Med. 2023, 12(21), 6897; https://doi.org/10.3390/jcm12216897 - 2 Nov 2023

Cited by 17 | Viewed by 7576

Abstract

Obesity is becoming a global health epidemic. Brown and “beige” adipose tissue may produce heat, leading to energy expenditure enhancement and weight loss. Mirabegron, a selective β3-adrenergic receptor agonist, has been found to be effective as a brown adipose tissue activator, a “beige” [...] Read more.

Obesity is becoming a global health epidemic. Brown and “beige” adipose tissue may produce heat, leading to energy expenditure enhancement and weight loss. Mirabegron, a selective β3-adrenergic receptor agonist, has been found to be effective as a brown adipose tissue activator, a “beige” cells stimulator and a metabolic homeostasis controller in animal and human studies. Although in animal studies, administration of mirabegron led to obesity improvement, significant weight loss in obese patients after mirabegron treatment has not been demonstrated so far, which may be associated with the too-short duration of the trials and the small number of participants in the studies. In humans, the most effective treatment for adipose tissue stimulation was high doses of mirabegron; however, cardiovascular side effects may limit the use of such doses, so the long-term safety must be evaluated. In cases of tachycardia or blood pressure elevation, the co-administration of a β1-adrenergic receptor blocker may be useful. It should be checked whether smaller doses of mirabegron, taken for a longer time, will be sufficient to stimulate brown and “beige” adipose tissue, leading to weight loss. The introduction of mirabegron into obesity treatment in the future will require long-term trials with larger numbers of subjects, to assess mirabegron efficacy, tolerability, and safety. Full article

(This article belongs to the Collection Obesity: From Diagnosis to Treatment)

13 pages, 1150 KB

Open AccessEditor’s ChoiceArticle

Enhanced Physical Capacity and Gastrointestinal Symptom Improvement in Southern Italian IBS Patients following Three Months of Moderate Aerobic Exercise

by Antonella Bianco, Francesco Russo, Isabella Franco, Giuseppe Riezzo, Rossella Donghia, Ritanna Curci, Caterina Bonfiglio, Laura Prospero, Benedetta D’Attoma, Antonia Ignazzi, Angelo Campanella and Alberto Ruben Osella

J. Clin. Med. 2023, 12(21), 6786; https://doi.org/10.3390/jcm12216786 - 26 Oct 2023

Cited by 9 | Viewed by 2654

Abstract

Moderate-intensity aerobic exercise improves gastrointestinal (GI) health and alleviates irritable bowel syndrome (IBS) symptoms. This study explored its effects on physical capacity (PC) and IBS symptoms in 40 patients from Southern Italy (11 males, 29 females; 52.10 ± 7.72 years). The exercise program [...] Read more.

Moderate-intensity aerobic exercise improves gastrointestinal (GI) health and alleviates irritable bowel syndrome (IBS) symptoms. This study explored its effects on physical capacity (PC) and IBS symptoms in 40 patients from Southern Italy (11 males, 29 females; 52.10 ± 7.72 years). The exercise program involved moderate-intensity aerobic exercise (60/75% of HRmax) for at least 180 min per week. Before and after the intervention, participants completed the IBS-SSS questionnaire to assess IBS symptoms, reported their physical activity levels, and underwent field tests to evaluate PC. PC was quantified as the Global Physical Capacity Score (GPCS). A total of 38 subjects (21 males, 17 females; 53.71 ± 7.27 years) without lower GI symptoms served as a No IBS group. No significant differences were found between IBS patients and No IBS subjects, except for the symptom score, as expected. After the exercise, all participants experienced significant improvements in both IBS symptoms and PC. Higher PC levels correlated with greater benefits in IBS symptomatology, especially with GPCS reaching above-average values. Engaging in moderate-intensity aerobic exercise for at least 180 min per week positively impacts IBS symptoms and PC. Monitoring GPCS in IBS patients provides insights into the connection between physical activity and symptom severity, aiding healthcare professionals in tailoring effective treatment plans. Full article

(This article belongs to the Special Issue Effects of Physical Activity on Chronic Disease)

► Show Figures

Figure 1

12 pages, 1158 KB

Open AccessEditor’s ChoiceArticle

Anesthesia Management via an Automated Control System for Propofol, Remifentanil, and Rocuronium Compared to Management by Anesthesiologists: An Investigator-Initiated Study

by Osamu Nagata, Yuka Matsuki, Shuko Matsuda, Keita Hazama, Saiko Fukunaga, Hideki Nakatsuka, Fumiyo Yasuma, Yasuhiro Maehara, Shoko Fujioka, Karin Tajima, Ichiro Kondo, Itaru Ginoza, Misuzu Hayashi, Manabu Kakinohana and Kenji Shigemi

J. Clin. Med. 2023, 12(20), 6611; https://doi.org/10.3390/jcm12206611 - 19 Oct 2023

Cited by 11 | Viewed by 2685

Abstract

Background: We previously developed an automated total intravenous anesthesia control system that uses new closed-loop system algorithms to administer propofol, remifentanil, and rocuronium based on the bispectral index and train-of-four data. We recently improved this automated control system by adding a safety mechanism [...] Read more.

Background: We previously developed an automated total intravenous anesthesia control system that uses new closed-loop system algorithms to administer propofol, remifentanil, and rocuronium based on the bispectral index and train-of-four data. We recently improved this automated control system by adding a safety mechanism and using a modified monitoring device. Methods: Patients scheduled for elective surgery were randomly assigned to closed-loop feedback control (automatic group) or the manual administration of propofol, remifentanil, and rocuronium (manual group). The proportion of time during which the proper management of three-agent anesthesia was maintained during surgery was determined as the primary endpoint. Results: The proportion of time during which the three components of sedation, analgesia, and muscle relaxation were adequately controlled was 87.21 ± 12.79% in the automatic group, which was non-inferior to the proportion of 65.19 ± 20.16% in the manual group (p < 0.001). Adverse events during the operative or postoperative observation periods were significantly less frequent in the automatic group (54 patients, 90.0%) than in the manual group (60 patients, 100.0%; p = 0.027). Conclusion: Our three-agent automated control system, which features an improved muscle relaxation monitor and safety mechanism added to the basic control algorithms, maintained sedation, analgesia, and muscle relaxation appropriately in a manner non-inferior to anesthesiologists without compromising safety. Full article

(This article belongs to the Special Issue Anesthesia in General Surgery: Clinical Management and Challenges)

► Show Figures

Figure 1

12 pages, 2771 KB

Open AccessEditor’s ChoiceArticle

The Expression of Activation Markers CD25 and CD69 Increases during Biologic Treatment of Psoriasis

by Michał Adamczyk, Joanna Bartosińska, Dorota Raczkiewicz, Małgorzata Kowal, Agata Surdacka, Danuta Krasowska, Anna Michalak-Stoma and Dorota Krasowska

J. Clin. Med. 2023, 12(20), 6573; https://doi.org/10.3390/jcm12206573 - 17 Oct 2023

Cited by 13 | Viewed by 4708

Abstract

CD (cluster of differentiation) 69 and CD25 are considered early and late markers of the activation of lymphocytes, respectively. CD25 is a part of the IL-2 receptor and is present on the surface of immune and non-immune cells, with high amounts on activated [...] Read more.

CD (cluster of differentiation) 69 and CD25 are considered early and late markers of the activation of lymphocytes, respectively. CD25 is a part of the IL-2 receptor and is present on the surface of immune and non-immune cells, with high amounts on activated lymphocytes and regulatory T cells. CD69 is expressed on various types of white blood cells, including newly activated lymphocytes, lymphocytes infiltrating tissues isolated from subjects with chronic auto-inflammatory diseases, several subtypes of memory T cells and regulatory T cells. Primarily, CD69 was considered to be an early marker of the activation of lymphocytes, but, right now, data derived from in vitro and in vivo studies have revealed the immunomodulatory role of this surface antigen. In 84 patients with psoriasis, of whom 28 were treated with different biologic drugs, as well as in 29 healthy control subjects, the expression of CD25 and CD69 on different subtypes of peripheral blood mononuclear cells (PBMCs) was studied with the use of flow cytometry. Significantly higher levels of CD3/CD69-, CD8/CD69- and CD19/CD69-positive PBMCs as well as within CD3+ cells were present in subjects suffering from psoriasis when compared to healthy controls. In patients with psoriasis who were treated with biologic drugs, the levels of CD3/CD69-, CD4/CD69- and CD19/CD69-positive PBMCs, and CD3/CD69 within CD3+ cells, CD4/CD69 within CD4+ cells, CD4/CD25 within CD4+ cells and CD19/CD69 within CD19+ cells were significantly higher than before therapy. Our results support a role for activation markers, especially CD69, in psoriasis. Further research is warranted to fully clarify their significance in this common dermatosis, especially during biologic treatment. Full article

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

► Show Figures

Figure 1

18 pages, 725 KB

Open AccessEditor’s ChoiceReview

Revisiting Asthma Obstructive Sleep Apnea Overlap: Current Knowledge and Future Needs

by Damini Saxena, Ikuyo Imayama and Muhammad Adrish

J. Clin. Med. 2023, 12(20), 6552; https://doi.org/10.3390/jcm12206552 - 16 Oct 2023

Cited by 13 | Viewed by 3684

Abstract

Asthma and obstructive sleep apnea are highly prevalent conditions with a high cost burden. In addition to shared risk factors, existing data suggest a bidirectional relationship between asthma and OSA, where each condition can impact the other. Patients with asthma often complain of [...] Read more.

Asthma and obstructive sleep apnea are highly prevalent conditions with a high cost burden. In addition to shared risk factors, existing data suggest a bidirectional relationship between asthma and OSA, where each condition can impact the other. Patients with asthma often complain of sleep fragmentation, nocturnal asthma symptoms, daytime sleepiness, and snoring. The prevalence of OSA increases with asthma severity, as evidenced by multiple large studies. Asthma may lower the threshold for arousal in OSA, resulting in the hypopnea with arousal phenotype. Epidemiologic studies in adults have shown that OSA is associated with worse asthma severity, increased frequency of exacerbation, and poor quality of life. The current literature assessing the relationship among OSA, asthma, and CPAP therapy is heavily dependent on observational studies. There is a need for randomized controlled trials to minimize the interference of confounding shared risk factors. Full article

(This article belongs to the Special Issue Advances in Obstructive Sleep Apnea Syndrome)

► Show Figures

Figure 1

34 pages, 2611 KB

Open AccessEditor’s ChoiceReview

Biomarkers of Postpartum Depression: A Narrative Review

by Stefan Modzelewski, Aleksandra Oracz, Kamila Iłendo, Aleksandra Sokół and Napoleon Waszkiewicz

J. Clin. Med. 2023, 12(20), 6519; https://doi.org/10.3390/jcm12206519 - 14 Oct 2023

Cited by 13 | Viewed by 6778

Abstract

Postpartum depression (PPD) is a disorder that impairs the formation of the relationship between mother and child, and reduces the quality of life for affected women to a functionally significant degree. Studying markers associated with PPD can help in early detection, prevention, or [...] Read more.

Postpartum depression (PPD) is a disorder that impairs the formation of the relationship between mother and child, and reduces the quality of life for affected women to a functionally significant degree. Studying markers associated with PPD can help in early detection, prevention, or monitoring treatment. The purpose of this paper is to review biomarkers linked to PPD and to present selected theories on the pathogenesis of the disease based on data from biomarker studies. The complex etiology of the disorder reduces the specificity and sensitivity of markers, but they remain a valuable source of information to help clinicians. The biggest challenge of the future will be to translate high-tech methods for detecting markers associated with postpartum depression into more readily available and less costly ones. Population-based studies are needed to test the utility of potential PPD markers. Full article

(This article belongs to the Section Mental Health)

► Show Figures

Figure 1

15 pages, 1841 KB

Open AccessEditor’s ChoiceReview

The Sympathetic Nervous System in Hypertensive Heart Failure with Preserved LVEF

by Filippos Triposkiadis, Alexandros Briasoulis, Pantelis Sarafidis, Dimitrios Magouliotis, Thanos Athanasiou, Ioannis Paraskevaidis, John Skoularigis and Andrew Xanthopoulos

J. Clin. Med. 2023, 12(20), 6486; https://doi.org/10.3390/jcm12206486 - 12 Oct 2023

Cited by 11 | Viewed by 5328

Abstract

The neurohormonal model of heart failure (HF) pathogenesis states that a reduction in cardiac output caused by cardiac injury results in sympathetic nervous system (SNS) activation, that is adaptive in the short-term and maladaptive in the long-term. This model has proved extremely valid [...] Read more.

The neurohormonal model of heart failure (HF) pathogenesis states that a reduction in cardiac output caused by cardiac injury results in sympathetic nervous system (SNS) activation, that is adaptive in the short-term and maladaptive in the long-term. This model has proved extremely valid and has been applied in HF with a reduced left ventricular (LV) ejection fraction (LVEF). In contrast, it has been undermined in HF with preserved LVEF (HFpEF), which is due to hypertension (HTN) in the vast majority of the cases. Erroneously, HTN, which is the leading cause of cardiovascular disease and premature death worldwide and is present in more than 90% of HF patients, is tightly linked with SNS overactivity. In this paper we provide a contemporary overview of the contribution of SNS overactivity to the development and progression of hypertensive HF (HHF) as well as the clinical implications resulting from therapeutic interventions modifying SNS activity. Throughout the manuscript the terms HHF with preserved LVEF and HfpEF will be used interchangeably, considering that the findings in most HFpEF studies are driven by HTN. Full article

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

► Show Figures

Figure 1

11 pages, 488 KB

Open AccessEditor’s ChoiceReview

Factors Associated with Periodontitis in Younger Individuals: A Scoping Review

by Man Hung, Roah Kelly, Amir Mohajeri, Logan Reese, Sarah Badawi, Cole Frost, Taroniar Sevathas and Martin S. Lipsky

J. Clin. Med. 2023, 12(20), 6442; https://doi.org/10.3390/jcm12206442 - 10 Oct 2023

Cited by 14 | Viewed by 4426

Abstract

Periodontitis is a disease that affects many young adults, and if left untreated, it can have lasting and permanent effects on an individual’s oral health. The purpose of this scoping review was to review the recent literature to identify factors that place young [...] Read more.

Periodontitis is a disease that affects many young adults, and if left untreated, it can have lasting and permanent effects on an individual’s oral health. The purpose of this scoping review was to review the recent literature to identify factors that place young individuals at risk of stage II or III periodontitis. Using the PRISMA guidelines for scoping reviews, three databases were systematically searched for peer-reviewed human studies published in English that investigated risk factors associated with stage II and/or III periodontitis in individuals less than 40 years of age. This review excluded abstracts, literature reviews, including narrative, scoping, and systematic reviews and meta-analyses, conference proceedings, letters to the editor, and editorials. The authors then extracted data from the relevant studies using a predefined form to summarize the aims, design, results, risk factors examined, and the type and severity of periodontitis. Among a total of 2676 articles screened, only three articles met the review’s inclusion criteria. Of these articles, one was a longitudinal case-control study and two were cross-sectional studies. Identified risk factors associated with stage II or III periodontitis included self-reported bleeding when brushing, low bone mineral density, being overweight, and smoking in young adults. Of note, only three studies met the inclusion criteria, suggesting a gap in the research literature. Full article

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

► Show Figures

Figure 1

16 pages, 528 KB

Open AccessEditor’s ChoiceReview

Endometriosis as an Uncommon Cause of Intestinal Obstruction—A Comprehensive Literature Review

by Florentina Mușat, Dan Nicolae Păduraru, Alexandra Bolocan, Alexandru Constantinescu, Daniel Ion and Octavian Andronic

J. Clin. Med. 2023, 12(19), 6376; https://doi.org/10.3390/jcm12196376 - 6 Oct 2023

Cited by 12 | Viewed by 3962

Abstract

The prevalence of intestinal endometriosis has been estimated to be between 3% and 37% of all endometriosis cases. Cases of intestinal occlusion due to endometriosis foci on the small bowel and on the large bowel are even rarer, with a reported prevalence of [...] Read more.

The prevalence of intestinal endometriosis has been estimated to be between 3% and 37% of all endometriosis cases. Cases of intestinal occlusion due to endometriosis foci on the small bowel and on the large bowel are even rarer, with a reported prevalence of 0.1–0.7%. The aim of this literature review was to summarize the available published evidence on the diagnosis, characteristics, and management of intestinal occlusion due to endometriosis. The search on PubMed retrieved 295 records, of which 158 were rejected following a review of the title and abstract. After reviewing the full text, 97 studies met the Population, Intervention, Comparator, Outcomes, and Study (PICOS) criteria and were included in the analysis. The total number of patients with bowel occlusion due to endometriosis included in the studies was 107. The occlusive endometrial foci were localized on the ileum in 38.3% of the cases, on the rectosigmoid in 34.5% of the cases, at the ileocecal junction and the appendix in 14.9% of the cases, and at the rectum in 10.2% of the cases. Only one case reported large bowel obstruction by endometriosis of the hepatic flexure of the colon extending to the transverse colon (0.9%), and in one case the obstruction was caused by an omental giant endometrioid cyst compressing the intestines. We identified six cases of postmenopausal females with acute bowel obstruction due to endometriosis. Malignant degeneration of endometriosis was also identified as a cause of intestinal occlusion. The mechanisms of obstruction include the presence of a mass in the lumen of the intestine or in the wall of the intestine, extrinsic compression, adhesions, or intussusception. Full article

(This article belongs to the Special Issue Endometriosis: Clinical Diagnosis and Treatments)

► Show Figures

Figure 1

13 pages, 800 KB

Open AccessEditor’s ChoiceReview

The Role of Sclerostin in Rheumatic Diseases: A Review

by Łukasz Jaśkiewicz, Grzegorz Chmielewski, Jakub Kuna, Tomasz Stompór and Magdalena Krajewska-Włodarczyk

J. Clin. Med. 2023, 12(19), 6248; https://doi.org/10.3390/jcm12196248 - 28 Sep 2023

Cited by 9 | Viewed by 2638

Abstract

Systemic connective tissue disorders constitute a heterogenous group of autoimmune diseases with the potential to affect a range of organs. Rheumatoid arthritis (RA) is a chronic, progressive, autoimmune inflammatory disease affecting the joints. Systemic lupus erythematosus (SLE) may manifest with multiple system involvement [...] Read more.

Systemic connective tissue disorders constitute a heterogenous group of autoimmune diseases with the potential to affect a range of organs. Rheumatoid arthritis (RA) is a chronic, progressive, autoimmune inflammatory disease affecting the joints. Systemic lupus erythematosus (SLE) may manifest with multiple system involvement as a result of inflammatory response to autoantibodies. Spondyloarthropathies (SpAs) such as ankylosing spondylitis (AS) or psoriatic arthritis (PsA) are diseases characterised by the inflammation of spinal joints, paraspinal tissues, peripheral joints and enthesitis as well as inflammatory changes in many other systems and organs. Physiologically, sclerostin helps to maintain balance in bone tissue metabolism through the Wnt/β-catenin pathway, which represents a major intracellular signalling pathway. This review article aims to present the current knowledge on the role of sclerostin in the Wnt/β-catenin pathway and its correlation with clinical data from RA, SLE, AS and PsA patients. Full article

(This article belongs to the Special Issue Systemic Autoinflammatory Diseases—Clinical Rheumatic Challenges Series 2)

► Show Figures

Figure 1

11 pages, 1563 KB

Open AccessFeature PaperEditor’s ChoiceArticle

Evolving a Model for Cochlear Implant Outcome

by Ulrich Hoppe, Anne Hast, Joachim Hornung and Thomas Hocke

J. Clin. Med. 2023, 12(19), 6215; https://doi.org/10.3390/jcm12196215 - 26 Sep 2023

Cited by 13 | Viewed by 2114

Abstract

Background: Cochlear implantation is an efficient treatment for postlingually deafened adults who do not benefit sufficiently from acoustic amplification. Implantation is indicated when it can be foreseen that speech recognition with a cochlear implant (CI) is superior to that with a hearing aid. [...] Read more.

Background: Cochlear implantation is an efficient treatment for postlingually deafened adults who do not benefit sufficiently from acoustic amplification. Implantation is indicated when it can be foreseen that speech recognition with a cochlear implant (CI) is superior to that with a hearing aid. Especially for subjects with residual speech recognition, it is desirable to predict CI outcome on the basis of preoperative audiological tests. Purpose: The purpose of the study was to extend and refine a previously developed model for CI outcome prediction for subjects with preoperative word recognition to include subjects with no residual hearing by incorporating additional results of routine examinations. Results: By introducing the duration of unaided hearing loss (DuHL), the median absolute error (MAE) of the prediction was reduced. While for subjects with preoperative speech recognition, the model modification did not change the MAE, for subjects with no residual speech recognition before surgery, the MAE decreased from 23.7% with the previous model to 17.2% with the extended model. Conclusions: Prediction of word recognition with CI is possible within clinically relevant limits. Outcome prediction is particularly important for preoperative counseling and in CI aftercare to support systematic monitoring of CI fitting. Full article

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

► Show Figures

Figure 1

19 pages, 721 KB

Open AccessEditor’s ChoiceReview

Neuropsychiatric and Neuropsychological Aspects of Alcohol-Related Cognitive Disorders: An In-Depth Review of Wernicke’s Encephalopathy and Korsakoff’s Syndrome

by Lucian Eva, Felix-Mircea Brehar, Ioan-Alexandru Florian, Razvan-Adrian Covache-Busuioc, Horia Petre Costin, David-Ioan Dumitrascu, Bogdan-Gabriel Bratu, Luca-Andrei Glavan and Alexandru Vlad Ciurea

J. Clin. Med. 2023, 12(18), 6101; https://doi.org/10.3390/jcm12186101 - 21 Sep 2023

Cited by 12 | Viewed by 7881

Abstract

Alcohol-related cognitive disorders have long been an area of study, yet they continue to pose challenges in the diagnosis, treatment, and understanding of underlying neuropsychiatric mechanisms. The present article offers a comprehensive review of Wernicke’s Encephalopathy and Korsakoff’s Syndrome, two conditions often seen [...] Read more.

Alcohol-related cognitive disorders have long been an area of study, yet they continue to pose challenges in the diagnosis, treatment, and understanding of underlying neuropsychiatric mechanisms. The present article offers a comprehensive review of Wernicke’s Encephalopathy and Korsakoff’s Syndrome, two conditions often seen on a continuum of alcohol-related brain damage. Drawing on current medical literature, neuroimaging studies, and clinical case reports, we explore the neuropsychiatric and neuropsychological profiles, symptomatology, and differential diagnoses of these disorders. We delve into the biochemical pathways implicated in the development of WE and KS, notably thiamine deficiency and its impact on neurotransmitter systems and neural networks. The article also addresses the challenges in early diagnosis, often complicated by non-specific symptoms and co-occurring psychiatric conditions. Furthermore, we review the current state of treatment protocols, including pharmacological and non-pharmacological interventions. Finally, the article highlights gaps in current knowledge and suggests directions for future research to improve diagnosis, treatment, and patient outcomes. Understanding the nuanced interplay between the neuropsychiatric and neuropsychological aspects of WE and KS is crucial for both clinicians and researchers alike, in order to provide effective treatment and to advance our understanding of these complex conditions. Full article

(This article belongs to the Special Issue Wernicke's Encephalopathy and Korsakoff's Syndrome)

► Show Figures

Figure 1

12 pages, 12972 KB

Open AccessEditor’s ChoiceReview

The Use of Intact Fish Skin Grafts in the Treatment of Necrotizing Fasciitis of the Leg: Early Clinical Experience and Literature Review on Indications for Intact Fish Skin Grafts

by Philip Dueppers, Roland Bozalka, Reinhard Kopp, Anna-Leonie Menges, Benedikt Reutersberg, Claudia Schrimpf, Francisco Jose Moreno Rivero and Alexander Zimmermann

J. Clin. Med. 2023, 12(18), 6001; https://doi.org/10.3390/jcm12186001 - 16 Sep 2023

Cited by 12 | Viewed by 7679

Abstract

Background: Necrotizing fasciitis (NF) is a serious infectious disease that can initially place the patient’s life in danger and, after successful surgical and antibiotic treatment, leaves extensive wounds with sometimes even exposed bones and tendons. Autologous skin grafts are not always possible or [...] Read more.

Background: Necrotizing fasciitis (NF) is a serious infectious disease that can initially place the patient’s life in danger and, after successful surgical and antibiotic treatment, leaves extensive wounds with sometimes even exposed bones and tendons. Autologous skin grafts are not always possible or require adequate wound bed preparation. Novel intact fish skin grafts (iFSGs; Kerecis^® Omega3 Wound, Kerecis hf, Isafjördur, Iceland) have already shown their potential to promote granulation in many other wound situations. Faster wound healing rates and better functional and cosmetic outcomes were observed due to their additionally postulated anti-inflammatory and analgesic properties. Therefore, iFSGs may also be essential in treating NF. We present our initial experience with iFSGs in treating leg wounds after NF and review the literature for the current spectrum of clinical use of iFSGs. Case Presentations: We present two male patients (aged 60 and 69 years) with chronic or acute postsurgical extensive leg ulcers six weeks and six days after necrotizing fasciitis, respectively. Both suffered from diabetes mellitus without vascular pathologies of the lower limbs. A single application of one pre-meshed (Kerecis^® Graftguide) and one self-meshed 300 cm² iFSG (Kerecis^® Surgiclose) was performed in our operation room after extensive surgical debridement and single circles of negative wound pressure therapy. Application and handling were easy. An excellent wound granulation was observed, even in uncovered tibia bone and tendons, accompanied by pain relief in both patients. Neither complications nor allergic reactions occurred. The patients received autologous skin grafting with excellent functional and cosmetic outcomes. Conclusions: iFSGs have the potential to play a significant role in the future treatment of NF due to the fast promotion of wound granulation and pain relief. Our experience may encourage surgeons to use iFSGs in NF patients, although high-quality, large-sized studies are still required to confirm these results. The observed effects of iFSGs on wounds associated with NF may be transferred to other wound etiologies as well. Full article

(This article belongs to the Special Issue Experimental and Clinical Advances in Skin Grafting)

► Show Figures

Graphical abstract

12 pages, 599 KB

Open AccessFeature PaperEditor’s ChoiceReview

Portrait of Dysferlinopathy: Diagnosis and Development of Therapy

by Camille Bouchard and Jacques P. Tremblay

J. Clin. Med. 2023, 12(18), 6011; https://doi.org/10.3390/jcm12186011 - 16 Sep 2023

Cited by 14 | Viewed by 4351

Abstract

Dysferlinopathy is a disease caused by a dysferlin deficiency due to mutations in the DYSF gene. Dysferlin is a membrane protein in the sarcolemma and is involved in different functions, such as membrane repair and vesicle fusion, T-tubule development and maintenance, Ca²⁺ [...] Read more.

Dysferlinopathy is a disease caused by a dysferlin deficiency due to mutations in the DYSF gene. Dysferlin is a membrane protein in the sarcolemma and is involved in different functions, such as membrane repair and vesicle fusion, T-tubule development and maintenance, Ca²⁺ signalling, and the regulation of various molecules. Miyoshi Myopathy type 1 (MMD1) and Limb–Girdle Muscular Dystrophy 2B/R2 (LGMD2B/LGMDR2) are two possible clinical presentations, yet the same mutations can cause both presentations in the same family. They are therefore grouped under the name dysferlinopathy. Onset is typically during the teenage years or young adulthood and is characterized by a loss of Achilles tendon reflexes and difficulty in standing on tiptoes or climbing stairs, followed by a slow progressive loss of strength in limb muscles. The MRI pattern of patient muscles and their biopsies show various fibre sizes, necrotic and regenerative fibres, and fat and connective tissue accumulation. Recent tools were developed for diagnosis and research, especially to evaluate the evolution of the patient condition and to prevent misdiagnosis caused by similarities with polymyositis and Charcot–Marie–Tooth disease. The specific characteristic of dysferlinopathy is dysferlin deficiency. Recently, mouse models with patient mutations were developed to study genetic approaches to treat dysferlinopathy. The research fields for dysferlinopathy therapy include symptomatic treatments, as well as antisense-mediated exon skipping, myoblast transplantation, and gene editing. Full article

(This article belongs to the Section Clinical Neurology)

► Show Figures

Figure 1

20 pages, 1323 KB

Open AccessEditor’s ChoiceReview

REM-OSA as a Tool to Understand Both the Architecture of Sleep and Pathogenesis of Sleep Apnea—Literature Review

by Filip Franciszek Karuga, Piotr Kaczmarski, Piotr Białasiewicz, Bartosz Szmyd, Julia Jaromirska, Filip Grzybowski, Piotr Gebuza, Marcin Sochal and Agata Gabryelska

J. Clin. Med. 2023, 12(18), 5907; https://doi.org/10.3390/jcm12185907 - 12 Sep 2023

Cited by 13 | Viewed by 7081

Abstract

Sleep is a complex physiological state, which can be divided into the non-rapid eye movement (NREM) phase and the REM phase. Both have some unique features and functions. This difference is best visible in electroencephalography recordings, respiratory system activity, arousals, autonomic nervous system [...] Read more.

Sleep is a complex physiological state, which can be divided into the non-rapid eye movement (NREM) phase and the REM phase. Both have some unique features and functions. This difference is best visible in electroencephalography recordings, respiratory system activity, arousals, autonomic nervous system activity, or metabolism. Obstructive sleep apnea (OSA) is a common condition characterized by recurrent episodes of pauses in breathing during sleep caused by blockage of the upper airways. This common condition has multifactorial ethiopathogenesis (e.g., anatomical predisposition, sex, obesity, and age). Within this heterogenous syndrome, some distinctive phenotypes sharing similar clinical features can be recognized, one of them being REM sleep predominant OSA (REM-OSA). The aim of this review was to describe the pathomechanism of REM-OSA phenotype, its specific clinical presentation, and its consequences. Available data suggest that in this group of patients, the severity of specific cardiovascular and metabolic complications is increased. Due to the impact of apneas and hypopneas predominance during REM sleep, patients are more prone to develop hypertension or glucose metabolism impairment. Additionally, due to the specific function of REM sleep, which is predominantly fragmented in the REM-OSA, this group presents with decreased neurocognitive performance, reflected in memory deterioration, and mood changes including depression. REM-OSA clinical diagnosis and treatment can alleviate these outcomes, surpassing the traditional treatment and focusing on a more personalized approach, such as using longer therapy of continuous positive airway pressure or oral appliance use. Full article

(This article belongs to the Section Respiratory Medicine)

► Show Figures

Figure 1

22 pages, 2334 KB

Open AccessEditor’s ChoiceArticle

The Effects of Combined Motor Control and Isolated Extensor Strengthening versus General Exercise on Paraspinal Muscle Morphology, Composition, and Function in Patients with Chronic Low Back Pain: A Randomized Controlled Trial

by Maryse Fortin, Meaghan Rye, Alexa Roussac, Chanelle Montpetit, Jessica Burdick, Neda Naghdi, Brent Rosenstein, Cleo Bertrand, Luciana G. Macedo, James M. Elliott, Geoffrey Dover, Richard DeMont, Michael H. Weber and Véronique Pepin

J. Clin. Med. 2023, 12(18), 5920; https://doi.org/10.3390/jcm12185920 - 12 Sep 2023

Cited by 15 | Viewed by 4626

Abstract

Low back pain (LBP), a globally widespread and persistent musculoskeletal disorder, benefits from exercise therapy. However, it remains unclear which type leads to greater changes in paraspinal muscle health. This study aimed to (1) compare the effects of a combined motor control and [...] Read more.

Low back pain (LBP), a globally widespread and persistent musculoskeletal disorder, benefits from exercise therapy. However, it remains unclear which type leads to greater changes in paraspinal muscle health. This study aimed to (1) compare the effects of a combined motor control and isolated lumbar extension exercise (MC+ILEX) versus a general exercise (GE) intervention on paraspinal muscle morphology, composition, and function, and (2) examine whether alterations in paraspinal muscle health were correlated with improvements in pain, function, and quality of life. Fifty participants with chronic LBP were randomly assigned to each group and underwent a 12-week supervised intervention program. Magnetic resonance imaging and ultrasound assessments were acquired at baseline, 6 and 12 weeks to examine the impact of each intervention on erector spinae (ES) and multifidus (MF) muscle size (cross-sectional area, CSA), composition, and function at L4-L5 and L5-S1. Self-reported questionnaires were also acquired to assess participant-oriented outcomes. Our findings indicated that the MC+ILEX group demonstrated greater improvements in MF and ES CSA, along with MF thickness at both levels (all p < 0.01). Both groups significantly improved in pain, function, and quality of life. This study provided preliminary results suggesting that an MC+ILEX intervention may improve paraspinal morphology while decreasing pain and disability. Full article

(This article belongs to the Special Issue Low Back Pain Management: Clinical Advances and Perspectives)

► Show Figures

Figure 1

12 pages, 1553 KB

Open AccessEditor’s ChoiceArticle

Attentional Bias Modification Training Based on Virtual Reality and Eye Tracking in Anorexia Nervosa Patients

by Mariarca Ascione, Marta Carulla-Roig, Helena Miquel-Nabau, Bruno Porras-Garcia, Franck-Alexandre Meschberger-Annweiler, Eduardo Serrano-Troncoso, Marta Ferrer-Garcia, Manuel Moreno-Sánchez and Jose Gutierrez-Maldonado

J. Clin. Med. 2023, 12(18), 5932; https://doi.org/10.3390/jcm12185932 - 12 Sep 2023

Cited by 13 | Viewed by 2283

Abstract

Anorexia nervosa (AN) patients exhibit attentional bias (AB) related to the body, which is the tendency to pay greater attention to weight-related body areas compared to non-weight-related ones. This phenomenon has been linked to elevated levels of body dissatisfaction (BD) and may potentially [...] Read more.

Anorexia nervosa (AN) patients exhibit attentional bias (AB) related to the body, which is the tendency to pay greater attention to weight-related body areas compared to non-weight-related ones. This phenomenon has been linked to elevated levels of body dissatisfaction (BD) and may potentially reduce the effectiveness of body exposure therapy. The purpose of this pilot study is to assess the efficacy of a single session of a new body-related AB modification task (ABMT) that combines virtual reality with eye tracking in patients with AN. The goals of the ABMT are to reduce body-related AB by balancing attention between weight and non-weight-related body areas and to reduce BD levels. Twenty-three adolescent patients with AN were embodied in a virtual avatar and immersed in a virtual environment where they completed the ABMT. Body-related AB measures and BD levels were assessed before and after the training. A paired samples t-test showed statistically significant differences between pre-assessment and post-assessment; the complete fixation time on weight-related body parts was reduced and BD levels decreased. The initial evidence of the efficacy of this ABMT has important clinical implications, since AB and BD are considered risk factors for developing and maintaining eating disorder symptomatology among patients with AN. Full article

(This article belongs to the Section Mental Health)

► Show Figures

Figure 1

13 pages, 653 KB

Open AccessEditor’s ChoiceReview

Utility of Cone-Beam Computed Tomography in the Detection of Low Bone Mass—A Systematic Review

by Ioana Ruxandra Poiana, Ramona Dobre, Razvan-Ionut Popescu, Silviu-Mirel Pituru and Alexandru Bucur

J. Clin. Med. 2023, 12(18), 5890; https://doi.org/10.3390/jcm12185890 - 11 Sep 2023

Cited by 10 | Viewed by 2467

Abstract

Introduction: Cone-beam computed tomography (CBCT) is widely used in the preoperative qualitative and quantitative assessment of dental implant sites, offering dimensional accuracy, spatial resolution, gray density, and contrast comparable to those of classical CT scan, yet with disputable ability to determine bone mass [...] Read more.

Introduction: Cone-beam computed tomography (CBCT) is widely used in the preoperative qualitative and quantitative assessment of dental implant sites, offering dimensional accuracy, spatial resolution, gray density, and contrast comparable to those of classical CT scan, yet with disputable ability to determine bone mass density. Materials and methods: A systematic review of the literature was performed using the PubMed and SCOPUS databases, with terms referring to low bone mass and cone-beam computed tomography (CBCT). Results: Sixteen studies were included in the review. The results show different perspectives, but the evidence favors the use of CBCT, combined with dual-energy X-ray absorptiometry bone density scan (DXA) evaluation, for the assessment of the osteoporosis status of the aging population and, more specifically, in postmenopausal women. Radiographic density (RD) values of the dens and the left part of the first cervical vertebra show the strongest correlation coefficients and the highest sensitivity, specificity, and accuracy for predicting osteoporosis (OP) in the lumbar vertebrae and the femoral neck. Conclusions: Our review suggests the potential of CBCT as a screening tool for patients with low bone mass using different radiomorphometric indices. Linear measurements of the inferior mandibular cortex were lower in osteoporotic individuals, indicating the perspective of CBCT also as a diagnostic tool for this disease. Full article

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

► Show Figures

Figure 1

15 pages, 3953 KB

Open AccessEditor’s ChoiceSystematic Review

Dynamic Navigation System vs. Free-Hand Approach in Microsurgical and Non-Surgical Endodontics: A Systematic Review and Meta-Analysis of Experimental Studies

by Elina Mekhdieva, Massimo Del Fabbro, Mario Alovisi, Nicola Scotti, Allegra Comba, Elio Berutti and Damiano Pasqualini

J. Clin. Med. 2023, 12(18), 5845; https://doi.org/10.3390/jcm12185845 - 8 Sep 2023

Cited by 10 | Viewed by 1957

Abstract

(1) Background: A Dynamic Navigation System (DNS) is an innovative tool that facilitates the management of complex endodontic cases. Despite the number of advantages and limitations of this approach, there is no evidence-based information about its efficiency in comparison with that of the [...] Read more.

(1) Background: A Dynamic Navigation System (DNS) is an innovative tool that facilitates the management of complex endodontic cases. Despite the number of advantages and limitations of this approach, there is no evidence-based information about its efficiency in comparison with that of the traditional method in endodontics. (2) Objectives: We aimed to explore any beneficial effects of the DNS and compare the outcomes of DNS vs. free-hand (FH) approaches for non-surgical and microsurgical endodontics. (3) Methods: A literature search was conducted in August 2023 to identify randomized, experimental, non-surgical, and microsurgical endodontic studies that compared the DNS with FH approaches. The procedural time (ΔT, s), substance loss (ΔV, mm³), angular deviation (ΔAD, °), coronal/platform linear deviation (ΔLD_C, mm), and apical linear deviation (ΔLD_A, mm) were recorded and analyzed. Quality and risk of bias assessments were conducted according to the Quality Assessment Tool For In Vitro Studies. A meta-analysis was performed using mean difference and standard deviation for each outcome, and heterogeneity (I²) was estimated. p < 0.05 was considered significant. (4) Results: One-hundred and forty-six studies were identified following duplicate removal, and nine were included in the systematic review and meta-analysis. The overall risk of bias was classified as low. The DNS was found to be more accurate and efficient than the FH approach was, resulting in a significantly shorter operation time (p < 0.00001) and less angular (p ≤ 0.0001) and linear deviation (p ≤ 0.01). For substance loss, the advantage of the DNS was significant only for microsurgery (p = 0.65, and p < 0.005, for non-surgical and microsurgical procedures, respectively). A reduced risk of iatrogenic failure using the DNS was observed for both expert and novice operators. (5) Conclusions: The DNS appears beneficial for non-surgical and microsurgical endodontics, regardless of the operator’s experience. However, appropriate training and experience are necessary to access the full advantages offered by the DNS. Full article

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

► Show Figures

Figure 1

13 pages, 431 KB

Open AccessEditor’s ChoiceSystematic Review

Image-Based Artificial Intelligence Technology for Diagnosing Middle Ear Diseases: A Systematic Review

by Dahye Song, Taewan Kim, Yeonjoon Lee and Jaeyoung Kim

J. Clin. Med. 2023, 12(18), 5831; https://doi.org/10.3390/jcm12185831 - 7 Sep 2023

Cited by 11 | Viewed by 5209

Abstract

Otolaryngological diagnoses, such as otitis media, are traditionally performed using endoscopy, wherein diagnostic accuracy can be subjective and vary among clinicians. The integration of objective tools, like artificial intelligence (AI), could potentially improve the diagnostic process by minimizing the influence of subjective biases [...] Read more.

Otolaryngological diagnoses, such as otitis media, are traditionally performed using endoscopy, wherein diagnostic accuracy can be subjective and vary among clinicians. The integration of objective tools, like artificial intelligence (AI), could potentially improve the diagnostic process by minimizing the influence of subjective biases and variability. We systematically reviewed the AI techniques using medical imaging in otolaryngology. Relevant studies related to AI-assisted otitis media diagnosis were extracted from five databases: Google Scholar, PubMed, Medline, Embase, and IEEE Xplore, without date restrictions. Publications that did not relate to AI and otitis media diagnosis or did not utilize medical imaging were excluded. Of the 32identified studies, 26 used tympanic membrane images for classification, achieving an average diagnosis accuracy of 86% (range: 48.7–99.16%). Another three studies employed both segmentation and classification techniques, reporting an average diagnosis accuracy of 90.8% (range: 88.06–93.9%). These findings suggest that AI technologies hold promise for improving otitis media diagnosis, offering benefits for telemedicine and primary care settings due to their high diagnostic accuracy. However, to ensure patient safety and optimal outcomes, further improvements in diagnostic performance are necessary. Full article

(This article belongs to the Section Otolaryngology)

► Show Figures

Figure 1

24 pages, 758 KB

Open AccessEditor’s ChoiceSystematic Review

Bidirectional Association between Lichen Planus and Hepatitis C—An Update Systematic Review and Meta-Analysis

by María García-Pola, Lucia Rodríguez-Fonseca, Carlota Suárez-Fernández, Raquel Sanjuán-Pardavila, Juan Seoane-Romero and Samuel Rodríguez-López

J. Clin. Med. 2023, 12(18), 5777; https://doi.org/10.3390/jcm12185777 - 5 Sep 2023

Cited by 13 | Viewed by 3003

Abstract

Lichen planus (LP) is a chronic, inflammatory mucocutaneous disorder associated with systemic diseases such as hepatitis C (HCV). The objective of this study is to evaluate the association between LP and HCV bidirectionally through a systematic review and meta-analysis. A comprehensive search of [...] Read more.

Lichen planus (LP) is a chronic, inflammatory mucocutaneous disorder associated with systemic diseases such as hepatitis C (HCV). The objective of this study is to evaluate the association between LP and HCV bidirectionally through a systematic review and meta-analysis. A comprehensive search of studies published was performed in the databases of PubMed, Embase, and Web of Science. Out of 18,491 articles, 192 studies were included. The global prevalence of HCV positive (HCV+) in LP patients registered from 143 studies was 9.42% [95% confidence interval (CI), 7.27–11.58%], and from these, 84 studies showed HCV+ 4-fold more frequent in LP than a control group (OR, 4.48; 95% CI, 3.48–5.77). The global prevalence of LP in patients HCV+ recorded from 49 studies was 7.05% (95% CI, 4.85–9.26%), and from these, 15 registered a 3-fold more LP in HCV (OR, 3.65; 95% CI, 2.14–6.24). HCV+ in LP patients showed great geographic variability (OR, 2.7 to 8.57), and the predominantly cutaneous location was higher (OR, 5.95) than the oral location (OR, 3.49). LP in HCV+ patients was more frequent in the Eastern Mediterranean (OR, 5.51; 95% CI, 1.40–15.57). There is a higher prevalence of HCV+ in LP and vice versa than in the control group, especially in certain geographical areas that should be taken into consideration when doing screening in countries with an upper prevalence of HCV among the general population. Full article

(This article belongs to the Special Issue Clinical Epidemiology of Skin Diseases—Part II)

► Show Figures

Figure 1

15 pages, 675 KB

Open AccessEditor’s ChoiceArticle

Predictors of Length of Stay, Rehospitalization and Mortality in Community-Acquired Pneumonia Patients: A Retrospective Cohort Study

by Giorgia Lüthi-Corridori, Maria Boesing, Andrea Roth, Stéphanie Giezendanner, Anne Barbara Leuppi-Taegtmeyer, Philipp Schuetz and Joerg D. Leuppi

J. Clin. Med. 2023, 12(17), 5601; https://doi.org/10.3390/jcm12175601 - 28 Aug 2023

Cited by 10 | Viewed by 2682

Abstract

Background: Community-acquired pneumonia (CAP) represents one of the leading causes of hospitalization and has a substantial impact on the financial burden of healthcare. The aim of this study was to identify factors associated with the length of hospital stay (LOHS), rehospitalization and mortality [...] Read more.

Background: Community-acquired pneumonia (CAP) represents one of the leading causes of hospitalization and has a substantial impact on the financial burden of healthcare. The aim of this study was to identify factors associated with the length of hospital stay (LOHS), rehospitalization and mortality of patients admitted for CAP. Methods: A retrospective cohort study was conducted with patients presenting to a Swiss public hospital between January 2019 and December 2019. Zero-truncated negative binomial and multivariable logistic regression analyses were performed to assess risk factors. Results: A total of 300 patients were analyzed (median 78 years, IQR [67.56, 85.50] and 53% males) with an average LOHS of 7 days (IQR [5.00, 9.00]). Of the 300 patients, 31.6% (97/300) were re-hospitalized within 6 months, 2.7% (8/300) died within 30 days and 11.7% (35/300) died within 1 year. The results showed that sex (IRR = 0.877, 95% CI = 0.776–0.992, p-value = 0.036), age (IRR = 1.007, 95% CI = 1.002–1.012, p-value = 0.003), qSOFA score (IRR = 1.143, 95% CI = 1.049–1.246, p-value = 0.002) and atypical pneumonia (IRR = 1.357, 95% CI = 1.012–1.819, p-value = 0.04) were predictive of LOHS. Diabetes (OR = 2.149, 95% CI = 1.104–4.172, p-value = 0.024), a higher qSOFA score (OR = 1.958, 95% CI = 1.295–3.002, p-value = 0.002) and rehabilitation after discharge (OR = 2.222, 95% CI = 1.017–4.855, p-value = 0.044) were associated with a higher chance of being re-hospitalized within 6 months, whereas mortality within 30 days and within one year were both associated with older age (OR = 1.248, 95% CI = 1.056–1.562, p-value = 0.026 and OR = 1.073, 95% CI = 1.025–1.132, p-value = 0.005, respectively) and the presence of a cancer diagnosis (OR = 32.671, 95% CI = 4.787–369.1, p-value = 0.001 and OR = 4.408, 95% CI = 1.680–11.43, p-value = 0.002, respectively). Conclusion: This study identified routinely available predictors for LOHS, rehospitalization and mortality in patients with CAP, which may further advance our understanding of CAP and thereby improve patient management, discharge planning and hospital costs. Full article

(This article belongs to the Special Issue Update on Acute Severe Respiratory Infections)

► Show Figures

Figure 1

21 pages, 2290 KB

Open AccessEditor’s ChoiceReview

Unmet Challenges in Patients with Crohn’s Disease

by Katharina M Scheurlen, Mary A Parks, Anne Macleod and Susan Galandiuk

J. Clin. Med. 2023, 12(17), 5595; https://doi.org/10.3390/jcm12175595 - 27 Aug 2023

Cited by 11 | Viewed by 4953

Abstract

Patients with Crohn’s disease can present with a variety of clinical manifestations; treatment strategies should focus on long-term remission and improvement of quality of life. There is no standardized process of diagnosing, predicting prognosis, and treating the disease. This narrative review was based [...] Read more.

Patients with Crohn’s disease can present with a variety of clinical manifestations; treatment strategies should focus on long-term remission and improvement of quality of life. There is no standardized process of diagnosing, predicting prognosis, and treating the disease. This narrative review was based on a literature search using PubMed, Embase, and Science Direct. Data on unmet challenges in patients with Crohn’s disease were extracted from identified manuscripts. The aim was to discuss present research on standardized processes in the management of patients with Crohn’s disease and to identify the unmet needs in clinical evaluation and treatment approaches. There is no consensus on standardized diagnostic, treatment, and surveillance algorithms, particularly in assessing complications of Crohn’s, such as stricturing disease, intestinal cancer risk, and cutaneous manifestations. Complications and treatment failure rates of conventional, interventional, and surgical therapy place emphasis on the need for standardized treatment algorithms, particularly in the case of acute complications of the disease. Research on standardized clinical approaches, reliable biomarkers for disease diagnosis and therapy monitoring, and new treatment agents is necessary to improve therapy and reduce complications in patients with Crohn’s disease. Full article

(This article belongs to the Special Issue Current Status, Challenges and Future Directions in Crohn's Disease)

► Show Figures

Figure 1

12 pages, 2611 KB

Open AccessEditor’s ChoiceArticle

Vertebral Rotation in Functional Scoliosis Caused by Limb-Length Inequality: Correlation between Rotation, Limb Length Inequality, and Obliquity of the Sacral Shelf

by Martina Marsiolo, Silvia Careri, Diletta Bandinelli, Renato Maria Toniolo and Angelo Gabriele Aulisa

J. Clin. Med. 2023, 12(17), 5571; https://doi.org/10.3390/jcm12175571 - 26 Aug 2023

Cited by 10 | Viewed by 5475

Abstract

Background: Scoliosis is a structured rotatory deformity of the spine defined as >10° Cobb. Functional scoliosis (FS) is a curve < 10° Cobb, which is non-rotational and correctable. FS is often secondary to leg length inequality (LLI). To observe vertebral rotation (VR) in [...] Read more.

Background: Scoliosis is a structured rotatory deformity of the spine defined as >10° Cobb. Functional scoliosis (FS) is a curve < 10° Cobb, which is non-rotational and correctable. FS is often secondary to leg length inequality (LLI). To observe vertebral rotation (VR) in functional scoliosis due to LLI, one must demonstrate a correlation between LLI, sacral shelf inclination (SSI), and VR and discover a predictive value of LLI capable of inducing rotation. Methods: We studied 89 patients with dorso-lumbar or lumbar curves < 15° Cobb and radiographs of the spine and pelvis. We measured LLI, SSI, and VR. The patients were divided into VR and without rotation (WVR) groups. Statistical analysis was performed. Results: The mean LLI value was 6.5 ± 4.59 mm, and the mean SSI was 2.8 ± 2.53 mm. The mean value of LLI was 5.2 ± 4.87 mm in the WVR group and 7.4 ± 4.18 mm in the VR group. The mean SSI value for WVR was 1.4 ± 2.00 and that for VR was 3.9 ± 2.39. For each mm of LLI, it was possible to predict 0.12° of rotation. LLI ±5 mm increased the probability of rotation (R2.08 p < 0.0016), while this was ±2 mm for SSI (R2 0.22 p < 0.01). Each mm of LLI corresponded to 0.3 mm of SSI (R2 0.29, p < 0.01). Conclusions: FS secondary to LLI can cause VR, and 5 mm of LLI can cause SSI and rotation. Full article

(This article belongs to the Special Issue Spine Rehabilitation in 2022 and Beyond)

► Show Figures

Figure 1

18 pages, 1962 KB

Open AccessEditor’s ChoiceReview

The Management of Ruptured Abdominal Aortic Aneurysms: An Ongoing Challenge

by Nicola Troisi, Giulia Bertagna, Lorenzo Torri, Francesco Canovaro, Mario D’Oria, Daniele Adami and Raffaella Berchiolli

J. Clin. Med. 2023, 12(17), 5530; https://doi.org/10.3390/jcm12175530 - 25 Aug 2023

Cited by 10 | Viewed by 2980

Abstract

Background: despite improvements in the diagnosis and treatment of elective AAAs, ruptured abdominal aortic aneurysms (RAAAs) continue to cause a substantial number of deaths. The choice between an open or endovascular approach remains a challenge, as does postoperative complications in survivors. The aim [...] Read more.

Background: despite improvements in the diagnosis and treatment of elective AAAs, ruptured abdominal aortic aneurysms (RAAAs) continue to cause a substantial number of deaths. The choice between an open or endovascular approach remains a challenge, as does postoperative complications in survivors. The aim of this manuscript is to offer an overview of the contemporary management of RAAA patients, with a focus on preoperative and intraoperative factors that could help surgeons provide more appropriate treatment. Methods: we performed a search on MEDLINE, Embase, and Scopus from 1 January 1985 to 1 May 2023 and reviewed SVS and ESVS guidelines. A total of 278 articles were screened, but only those with data available on ruptured aneurysms’ incidence and prevalence, preoperative scores, and mortality rates after emergency endovascular or open repair for ruptured AAA were included in the narrative synthesis. Articles were not restricted due to the designs of the studies. Results: the centralization of RAAAs has improved outcomes after both surgical and endovascular repair. Preoperative mortality risk scores and knowledge of intraoperative factors influencing mortality could help surgeons with decision-making, although there is still no consensus about the best treatment. Complications continue to be an issue in patients surviving intervention. Conclusions: RAAA still represents a life-threatening condition, with high mortality rates. Effective screening and centralization matched with adequate preoperative risk–benefit assessment may improve outcomes. Full article

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

► Show Figures

Figure 1

23 pages, 2845 KB

Open AccessFeature PaperEditor’s ChoiceReview

Gastroesophageal Reflux Disease in Obesity: Bariatric Surgery as Both the Cause and the Cure in the Morbidly Obese Population

by Muaaz Masood, Donald Low, Shanley B. Deal and Richard A. Kozarek

J. Clin. Med. 2023, 12(17), 5543; https://doi.org/10.3390/jcm12175543 - 25 Aug 2023

Cited by 10 | Viewed by 5263

Abstract

Gastrointestinal reflux disease (GERD) is a chronic, highly prevalent condition in the United States. GERD can significantly impact quality of life and lead to complications including aspiration pneumonia, esophageal stricture, Barrett’s esophagus (BE) and esophageal cancer. Obesity is a risk factor for GERD, [...] Read more.

Gastrointestinal reflux disease (GERD) is a chronic, highly prevalent condition in the United States. GERD can significantly impact quality of life and lead to complications including aspiration pneumonia, esophageal stricture, Barrett’s esophagus (BE) and esophageal cancer. Obesity is a risk factor for GERD, which often improves with weight loss and bariatric surgery. Though the incidence of bariatric surgery, in particular, minimally invasive sleeve gastrectomy, has risen in recent years, emerging data has revealed that the severity or new onset of GERD may follow bariatric surgery. We performed a literature review to provide a detailed analysis of GERD with an emphasis on bariatric surgery as both the cure and the cause for GERD in the morbidly obese population. We also describe the pathophysiological mechanisms, management approach and treatment strategies of GERD following bariatric surgery. Full article

(This article belongs to the Special Issue Management of Recurrent Gastroesophageal Reflux Disease (GERD))

► Show Figures

Graphical abstract

13 pages, 479 KB

Open AccessEditor’s ChoiceArticle

The Usefulness of Cellular Immune Inflammation Markers and Ultrasound Evaluation in the Assessment of Disease Activity in Patients with Spondyloarthritis

by Bożena Targońska-Stępniak and Krzysztof Grzechnik

J. Clin. Med. 2023, 12(17), 5463; https://doi.org/10.3390/jcm12175463 - 23 Aug 2023

Cited by 14 | Viewed by 1671

Abstract

Background: The systemic inflammation response index (SIRI) and systemic immune-inflammation index (SII) have been introduced as inflammatory markers and predictors of poor prognosis in cancer and cardiovascular diseases. An appropriate evaluation of disease activity in spondyloarthritis (SpA) might be challenging. The purpose of [...] Read more.

Background: The systemic inflammation response index (SIRI) and systemic immune-inflammation index (SII) have been introduced as inflammatory markers and predictors of poor prognosis in cancer and cardiovascular diseases. An appropriate evaluation of disease activity in spondyloarthritis (SpA) might be challenging. The purpose of this study was to evaluate the usefulness of cellular immune inflammation markers and ultrasound (US) evaluation of entheses and joints in the assessment of disease activity in SpA patients. Methods: This cross-sectional study involved patients with SpA (62 axial SpA, 38 peripheral SpA, pSpA). The clinical data of both tender, swollen joint counts, erythrocyte sedimentation rate, C-reactive protein, white blood cell counts, and disease activity using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Disease Activity Index for Psoriatic Arthritis (DAPSA), were recorded. The SIRI, SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were calculated. US examination was performed (22 small joints, Achilles tendon, and plantar aponeurosis for enthesitis). Results: The SII, SIRI, NLR, and PLR were higher, and LMR was lower in patients with high disease activity (BASDAI > 4). Higher SII was observed in pSpA patients with moderate/high disease activity (DAPSA > 14). The SIRI was correlated with clinical and laboratory parameters of disease activity. The SII was correlated with US parameters in pSpA. Higher SII and NLR values were found in patients with signs of activity compared with no activity in the US of peripheral joints. There were no associations with US changes in entheses. Conclusions: The results of this study point to the value of SIRI and SII as biomarkers of disease activity in patients with SpA. The SII was associated with synovitis in the US of the peripheral joints. Full article

(This article belongs to the Section Immunology & Rheumatology)

► Show Figures

Figure 1

13 pages, 1127 KB

Open AccessFeature PaperEditor’s ChoiceArticle

The Impact of a Twelve-Week Moderate Aerobic Exercise Program on Gastrointestinal Symptom Profile and Psychological Well-Being of Irritable Bowel Syndrome Patients: Preliminary Data from a Southern Italy Cohort

by Giuseppe Riezzo, Laura Prospero, Benedetta D’Attoma, Antonia Ignazzi, Antonella Bianco, Isabella Franco, Ritanna Curci, Angelo Campanella, Caterina Bonfiglio, Alberto Ruben Osella and Francesco Russo

J. Clin. Med. 2023, 12(16), 5359; https://doi.org/10.3390/jcm12165359 - 17 Aug 2023

Cited by 11 | Viewed by 4656

Abstract

Walking is popular moderate-intensity aerobic exercise that improves mental and gastrointestinal (GI) health. It can relieve symptoms associated with irritable bowel syndrome (IBS), e.g., intestinal gas, abdominal distension, and bowel disturbances. This study examined the impact of a moderate-intensity aerobic exercise program on [...] Read more.

Walking is popular moderate-intensity aerobic exercise that improves mental and gastrointestinal (GI) health. It can relieve symptoms associated with irritable bowel syndrome (IBS), e.g., intestinal gas, abdominal distension, and bowel disturbances. This study examined the impact of a moderate-intensity aerobic exercise program on the clinical and psychological parameters of IBS patients. In total, 40 IBS patients (11 males and 29 females; mean age 51.9 ± 7.8 years) participated in a 12-week aerobic exercise program. Participants completed questionnaires assessing GI symptoms, psychological profiles, and quality of life (QoL) before and after the intervention. Field tests, anthropometric measurements, and bioimpedance assessments were also conducted. The present findings confirmed a significant improvement in IBS symptoms after the aerobic exercise program. Bloating was the most common symptom and, together with abdominal pain, was significantly reduced after treatment. Psychological and QoL questionnaires indicated decreased anxiety, depression, somatization, and stress levels. Correlations were found between anxiety/depression and the severity of abdominal pain as well as between stress and the severity of abdominal distension. Moderate-intensity aerobic exercise positively impacted GI symptoms and psychological well-being, complementing dietary and psychological support as a non-pharmacological therapy for the management of IBS. These findings emphasize the importance of alternative approaches for IBS treatment. Full article

(This article belongs to the Collection Latest Research in Irritable Bowel Syndrome)

► Show Figures

Figure 1

13 pages, 2106 KB

Open AccessEditor’s ChoiceArticle

Changes in Iron Status Biomarkers with Advancing Age According to Sex and Menopause: A Population-Based Study

by Francesco Merlo, Dion Groothof, Farnaz Khatami, Noushin Sadat Ahanchi, Faina Wehrli, Stephan J. L. Bakker, Michele F. Eisenga and Taulant Muka

J. Clin. Med. 2023, 12(16), 5338; https://doi.org/10.3390/jcm12165338 - 16 Aug 2023

Cited by 11 | Viewed by 3059

Abstract

Background: The risk of chronic diseases increases markedly with age and after menopause. An increase in bodily iron following menopause could contribute to this phenomenon of increased risk of chronic diseases. We aimed to investigate how various iron biomarkers change with advancing age, [...] Read more.

Background: The risk of chronic diseases increases markedly with age and after menopause. An increase in bodily iron following menopause could contribute to this phenomenon of increased risk of chronic diseases. We aimed to investigate how various iron biomarkers change with advancing age, according to sex and menopausal status. Methods: We enrolled community-dwelling individuals with available information on ferritin, transferrin, iron, hepcidin, and soluble transferrin receptor levels from the Prevention of Renal and Vascular Endstage Disease study. The association of the iron biomarkers with age, sex, and menopausal status was investigated with linear regression models. Results: Mean (SD) age of the 5222 individuals (2680 women [51.3%], among whom 907 [33.8%] were premenopausal, 529 [19.7%] perimenopausal, and 785 [29.3%] postmenopausal), was 53.4 (12.0) years. Iron biomarkers showed a constant increase in women throughout their life course, in some cases at older ages surpassing values in men who, in turn, showed consistently higher levels of iron status compared to women in most age categories. Ferritin, hepcidin, and transferrin saturation levels were 3.03, 2.92, and 1.08-fold (all p < 0.001) higher in postmenopausal women compared to premenopausal. Conclusions: We found that iron accumulates differently depending on sex, age, and menopausal status. An increased iron status was identified in women, especially during and after menopause. Full article

(This article belongs to the Section Nephrology & Urology)

► Show Figures

Figure 1

12 pages, 2283 KB

Open AccessEditor’s ChoiceArticle

Hemoglobin–Albumin–Lymphocyte–Platelet (HALP) Score as a Predictive Model for the Success of Reconstruction of Head and Neck Defects with Free Microvascular Flaps

by Marko Tarle, Igor Čvrljević, Marina Raguž and Ivica Lukšić

J. Clin. Med. 2023, 12(16), 5314; https://doi.org/10.3390/jcm12165314 - 15 Aug 2023

Cited by 10 | Viewed by 1969

Abstract

Significant advances in reconstructive head and neck surgery with free microvascular flaps have had a positive impact on esthetic outcomes and quality of life. However, complications still occur in some patients. This study investigated the influence of the Hemoglobin, Albumin, Lymphocyte, and Platelet [...] Read more.

Significant advances in reconstructive head and neck surgery with free microvascular flaps have had a positive impact on esthetic outcomes and quality of life. However, complications still occur in some patients. This study investigated the influence of the Hemoglobin, Albumin, Lymphocyte, and Platelet Score (HALP score), an immunonutritive marker, on complications and flap success. The retrospective analysis included 194 patients who underwent reconstruction of head and neck defects with free microvascular flaps. The HALP score correlated strongly with overall complications, including flap necrosis, infection, fistula, and hematoma. Hemoglobin, albumin, lymphocytes, and platelets individually showed associations with specific complications. HALP score was an extremely strong predictor of complications (AUC = 0.85). HALP score may be valuable for assessing patient status and predicting complications in microvascular free-flap reconstruction to allow timely interventions and improve outcomes. Further research is needed to investigate additional predictors and improve postoperative care. Full article

(This article belongs to the Special Issue Clinical Advances in Head and Neck Cancer Surgery)

► Show Figures

Graphical abstract

12 pages, 1353 KB

Open AccessEditor’s ChoiceArticle

Switching to Dupilumab from Other Biologics without a Treatment Interval in Patients with Severe Asthma: A Multi-Center Retrospective Study

by Hisao Higo, Hirohisa Ichikawa, Yukako Arakawa, Yoshihiro Mori, Junko Itano, Akihiko Taniguchi, Satoru Senoo, Goro Kimura, Yasushi Tanimoto, Kohei Miyake, Tomoya Katsuta, Mikio Kataoka, Yoshinobu Maeda, Katsuyuki Kiura, Nobuaki Miyahara and Okayama Respiratory Disease Study Group (ORDSG)

J. Clin. Med. 2023, 12(16), 5174; https://doi.org/10.3390/jcm12165174 - 9 Aug 2023

Cited by 11 | Viewed by 5324

Abstract

Background: Dupilumab is a fully humanized monoclonal antibody that blocks interleukin-4 and interleukin-13 signals. Several large clinical trials have demonstrated the efficacy of dupilumab in patients with severe asthma. However, few studies have examined a switch to dupilumab from other biologics. Methods: This [...] Read more.

Background: Dupilumab is a fully humanized monoclonal antibody that blocks interleukin-4 and interleukin-13 signals. Several large clinical trials have demonstrated the efficacy of dupilumab in patients with severe asthma. However, few studies have examined a switch to dupilumab from other biologics. Methods: This retrospective, multi-center observational study was conducted by the Okayama Respiratory Disease Study Group. Consecutive patients with severe asthma who were switched to dupilumab from other biologics without a treatment interval between May 2019 and September 2021 were enrolled. Patients with a treatment interval of more than twice the standard dosing interval for the previous biologic prior to dupilumab administration were excluded. Results: The median patient age of the 27 patients enrolled in this study was 57 years (IQR, 45–68 years). Eosinophilic chronic rhinosinusitis (ECRS)/chronic rhinosinusitis with nasal polyp (CRSwNP) was confirmed in 23 patients. Previous biologics consisted of omalizumab (n = 3), mepolizumab (n = 3), and benralizumab (n = 21). Dupilumab significantly improved FEV₁ (median improvement: +145 mL) and the asthma control test score (median improvement: +2). The overall response rate in patients receiving dupilumab for asthma as determined using the Global Evaluations of Treatment Effectiveness (GETE) was 77.8%. There were no significant differences in the baseline characteristics of the GETE-improved group vs. the non-GETE-improved group. ECRS/CRSwNP improved in 20 of the 23 patients (87.0%). Overall, 8 of the 27 patients (29.6%) developed transient hypereosinophilia (>1500/μL), but all were asymptomatic and able to continue dupilumab therapy. Conclusions: Dupilumab was highly effective for the treatment of severe asthma and ECRS/CRSwNP, even in patients switched from other biologics without a treatment interval. Full article

(This article belongs to the Special Issue Clinical Advances in Allergy and Asthma: Issues, Strategies, and Future Directions)

► Show Figures

Graphical abstract

17 pages, 1610 KB

Open AccessEditor’s ChoiceArticle

The Influence of Age, Gender and Education on Neuropsychological Test Scores: Updated Clinical Norms for Five Widely Used Cognitive Assessments

by Jannik F. Scheffels, Isabell Ballasch, Nadine Scheichel, Martin Voracek, Elke Kalbe and Josef Kessler

J. Clin. Med. 2023, 12(16), 5170; https://doi.org/10.3390/jcm12165170 - 8 Aug 2023

Cited by 16 | Viewed by 4567

Abstract

Background: Sociodemographic effects (i.e., age, gender, education) have been shown to influence neuropsychological test scores. The current retrospective, quasi-epidemiological work provides age-, gender- and education-corrected clinical norms for five common cognitive assessments. Methods: In total, test scores of 4968 patients from the University [...] Read more.

Background: Sociodemographic effects (i.e., age, gender, education) have been shown to influence neuropsychological test scores. The current retrospective, quasi-epidemiological work provides age-, gender- and education-corrected clinical norms for five common cognitive assessments. Methods: In total, test scores of 4968 patients from the University Hospital of Cologne (Department of Neurology), recruited between 2009 and 2020, were analyzed retrospectively. Conducted tests were the Mini-Mental State Examination (MMSE), F-A-S Test (FAS), Rey–Osterrieth Complex Figure Test (ROCFT) and Trail Making Test, Part A and B (TMT-A/-B). Using multiple linear regression analyses, test scores were analyzed for sociodemographic influences (age, gender, education). Based on these analyses, norms were generated by first separating patients into different age groups stratified by educational level and (if necessary) gender. Subsequently, percentile ranks and z-scores for a subsample including only individuals without dementia were calculated. Results: Lower age and higher educational level predicted better test scores (MMSE, FAS, ROCFT) and completion times (TMT-A/-B). Additionally, produced words on the FAS and remembered drawings from the ROCFT were influenced by gender, with females having better FAS but lower ROCFT (delayed recall) scores than males. Considering these effects, clinical norms were provided for the five cognitive assessments. Conclusions: We found influences of age, gender and education on test scores, although they are frequently not or only partially considered for test score interpretation. With the provided norms, neuropsychologists can make more profound evaluations of cognitive performance. A user-friendly Microsoft Excel file is offered to assist this process. Full article

(This article belongs to the Section Clinical Neurology)

► Show Figures

Figure 1

10 pages, 1687 KB

Open AccessEditor’s ChoiceArticle

Relationship between Laser Intensity at the Peripheral Nerve and Inhibitory Effect of Percutaneous Photobiomodulation on Neuronal Firing in a Rat Spinal Dorsal Horn

by Daisuke Uta, Naoya Ishibashi, Yuki Kawase, Shinichi Tao, Masahito Sawahata and Toshiaki Kume

J. Clin. Med. 2023, 12(15), 5126; https://doi.org/10.3390/jcm12155126 - 4 Aug 2023

Cited by 10 | Viewed by 2938

Abstract

Photobiomodulation is an effective treatment for pain. We previously reported that the direct laser irradiation of the exposed sciatic nerve inhibited firing in the rat spinal dorsal horn evoked by mechanical stimulation, corresponding to the noxious stimulus. However, percutaneous laser irradiation is used [...] Read more.

Photobiomodulation is an effective treatment for pain. We previously reported that the direct laser irradiation of the exposed sciatic nerve inhibited firing in the rat spinal dorsal horn evoked by mechanical stimulation, corresponding to the noxious stimulus. However, percutaneous laser irradiation is used in clinical practice, and it is unclear whether it can inhibit the firing of the dorsal horn. In this study, we investigated whether the percutaneous laser irradiation of the sciatic nerve inhibits firing. Electrodes were inserted into the lamina II of the dorsal horn, and mechanical stimulation was applied using von Frey filaments (vFFs) with both pre and post laser irradiation. Our findings show that percutaneous laser irradiation inhibited 26.0 g vFF-evoked firing, which corresponded to the noxious stimulus, but did not inhibit 0.6 g and 8.0 g vFF-evoked firing. The post- (15 min after) and pre-irradiation firing ratios were almost the same as those for direct and percutaneous irradiation. A photodiode sensor implanted in the sciatic nerve showed that the power density reaching the sciatic nerve percutaneously was attenuated to approximately 10% of that on the skin. The relationship between the laser intensity reaching the nerve and its effect could be potentially useful for a more appropriate setting of laser conditions in clinical practice. Full article

(This article belongs to the Topic Medical and Dental Care, Photobiomodulation and Photomedicine)

► Show Figures

Graphical abstract

12 pages, 298 KB

Open AccessEditor’s ChoiceReview

Nutritional Status and Metabolism in Celiac Disease: Narrative Review

by Aleksandra Mędza and Agnieszka Szlagatys-Sidorkiewicz

J. Clin. Med. 2023, 12(15), 5107; https://doi.org/10.3390/jcm12155107 - 3 Aug 2023

Cited by 15 | Viewed by 4012

Abstract

This review summarizes findings from studies assessing the nutritional status of patients with celiac disease (CD). Malnutrition, including over- and undernutrition, may be present in CD, both at diagnosis and while under treatment. Underweight and growth retardation in children, which mostly reflect malabsorption [...] Read more.

This review summarizes findings from studies assessing the nutritional status of patients with celiac disease (CD). Malnutrition, including over- and undernutrition, may be present in CD, both at diagnosis and while under treatment. Underweight and growth retardation in children, which mostly reflect malabsorption as a consequence of intestinal inflammation, are not a rule. Clinical presentations of CD can vary widely, and each manifestation has its own characteristics. Evaluating various nutritional parameters can be beneficial for CD patients and may improve health outcomes by facilitating an accurate definition of dietary needs and the development of a balanced diet that not only focuses on eliminating gluten but also provides adequate nutrients, alters metabolism, and reduces the risk of other disorders developing. The cornerstone of CD therapy is a gluten-free diet (GFD), which improves nutritional status, but even on a GFD, features of malnutrition may be present. Additionally, overweight and obesity may occur in patients on a GFD, with typical metabolic consequences. Full article

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

11 pages, 769 KB

Open AccessEditor’s ChoiceSystematic Review

Debridement, Antibiotics and Implant Retention: A Systematic Review of Strategies for Treatment of Early Infections after Revision Total Knee Arthroplasty

by Caspar W. J. Hulleman, Tommy S. de Windt, Karin Veerman, Jon H. M. Goosen, Frank-Christiaan B. M. Wagenaar and Gijs G. van Hellemondt

J. Clin. Med. 2023, 12(15), 5026; https://doi.org/10.3390/jcm12155026 - 31 Jul 2023

Cited by 11 | Viewed by 3161

Abstract

Goal: The purpose of this review is to provide a systematic and comprehensive overview of the available literature on the treatment of an early prosthetic joint infection (PJI) after revision total knee arthroplasty (TKA) and provide treatment guidelines. Methods: This systematic review was [...] Read more.

Goal: The purpose of this review is to provide a systematic and comprehensive overview of the available literature on the treatment of an early prosthetic joint infection (PJI) after revision total knee arthroplasty (TKA) and provide treatment guidelines. Methods: This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted using the electronic databases of PubMed, Trip, Cochrane, Embase, LILACS and SciElo. After the inclusion of the relevant articles, we extracted the data and results to compose a treatment algorithm for early and acute PJI after revision TKA. Results: After applying the in- and exclusion criteria, seven articles were included in this systematic review focusing on debridement, antibiotics and implant retention (DAIR) for PJI following revision TKA, of which one was prospective and six were retrospective. All studies were qualified as level IV evidence. Conclusions: The current literature suggests that DAIR is a valid treatment option for early infections after revision TKA with success rates of 50–70%. Repeat DAIR shows success rates of around 50%. Further research should be aimed at predicting successful (repeat/two-stage) DAIRs in larger study populations, antibiotic regimes and the cost effectiveness of a second DAIR after revision TKA. Full article

(This article belongs to the Special Issue Knee Arthroplasty: Therapeutic and Management Strategies)

► Show Figures

Figure 1

11 pages, 5110 KB

Open AccessEditor’s ChoiceSystematic Review

Clinical and Procedural Outcomes of IVUS-Guided vs. Angiography-Guided CTO-PCI: A Systematic Review and Meta-Analysis

by Giuseppe Panuccio, Youssef S. Abdelwahed, Nicole Carabetta, Nadia Salerno, David Manuel Leistner, Ulf Landmesser, Salvatore De Rosa, Daniele Torella and Gerald S. Werner

J. Clin. Med. 2023, 12(15), 4947; https://doi.org/10.3390/jcm12154947 - 27 Jul 2023

Cited by 12 | Viewed by 3076

Abstract

Chronic total occlusions (CTO) in coronary angiographies present a significant challenge nowadays. Intravascular ultrasound (IVUS) is a valuable tool during CTO-PCI, aiding in planning and achieving procedural success. However, the impact of IVUS on clinical and procedural outcomes in CTO-PCI remains uncertain. This [...] Read more.

Chronic total occlusions (CTO) in coronary angiographies present a significant challenge nowadays. Intravascular ultrasound (IVUS) is a valuable tool during CTO-PCI, aiding in planning and achieving procedural success. However, the impact of IVUS on clinical and procedural outcomes in CTO-PCI remains uncertain. This meta-analysis aimed to compare IVUS-guided and angiography-guided approaches in CTO-PCI. The study included five studies and 2320 patients with stable coronary artery disease (CAD) and CTO. The primary outcome of major adverse cardiac events (MACE) did not significantly differ between the groups (p = 0.40). Stent thrombosis was the only secondary clinical outcome that showed a significant difference, favoring the IVUS-guided approach (p = 0.01). Procedural outcomes revealed that IVUS-guided procedures had longer stents, larger diameters, and longer procedure and fluoroscopy times (p = 0.007, p < 0.001, p = 0.03, p = 0.002, respectively). Stent number and contrast volume did not significantly differ between the approaches (p = 0.88 and p = 0.33, respectively). In summary, routine IVUS use did not significantly improve clinical outcomes, except for reducing stent thrombosis. Decisions in CTO-PCI should be individualized based on patient characteristics and supported by a multi-parametric approach. Full article

(This article belongs to the Special Issue Interventional Cardiology: Current Challenges in Clinical Practice)

► Show Figures

Graphical abstract

23 pages, 1486 KB

Open AccessEditor’s ChoiceReview

Non-Hormonal Contraception

by Sarah Anne Howard and Soumya Rahima Benhabbour

J. Clin. Med. 2023, 12(14), 4791; https://doi.org/10.3390/jcm12144791 - 20 Jul 2023

Cited by 15 | Viewed by 11145

Abstract

While hormonal contraceptives are efficacious and available in several forms for women, perception of safety and concern over side effects are a deterrent for many. Existing non-hormonal contraceptives include permanent sterilization, copper intrauterine devices (IUDs), chemical/physical barriers such as spermicides and condoms, as [...] Read more.

While hormonal contraceptives are efficacious and available in several forms for women, perception of safety and concern over side effects are a deterrent for many. Existing non-hormonal contraceptives include permanent sterilization, copper intrauterine devices (IUDs), chemical/physical barriers such as spermicides and condoms, as well as traditional family planning methods including withdrawal and the rhythm method. Individuals who wish to retain their fertility in the future can achieve highest adherence and efficacy with long-acting, reversible contraceptives (LARCs), though there is only one, the copper IUD, that is non-hormonal. As rates of unintended pregnancies remain high with existing contraceptive options, it is becoming increasingly attractive to develop novel pregnancy prevention methods for both women and men. Non-hormonal contraceptives can target a variety of critical reproductive processes discussed here. This review focuses on identified non-hormonal contraceptive targets and subsequent drug candidates in development. Full article

(This article belongs to the Section Pharmacology)

► Show Figures

Graphical abstract

12 pages, 5082 KB

Open AccessEditor’s ChoiceArticle

Virtual Non-Contrast Spectral CT in Renal Masses: Is It Time to Discard Conventional Unenhanced Phase?

by Giuseppe M. Bucolo, Velio Ascenti, Simone Barbera, Federico Fontana, Francesco M. Aricò, Filippo Piacentino, Andrea Coppola, Giuseppe Cicero, Maria Adele Marino, Christian Booz, Thomas J. Vogl, Tommaso D’Angelo, Massimo Venturini and Giorgio Ascenti

J. Clin. Med. 2023, 12(14), 4718; https://doi.org/10.3390/jcm12144718 - 17 Jul 2023

Cited by 10 | Viewed by 2165

Abstract

Dual-layer Dual-Energy CT (dl-DECT) allows one to create virtual non-contrast (VNC) reconstructions from contrast-enhanced CT scans, with a consequent decrease of the radiation dose. This study aims to assess the reliability of VNC for the diagnostic evaluation of renal masses in comparison with [...] Read more.

Dual-layer Dual-Energy CT (dl-DECT) allows one to create virtual non-contrast (VNC) reconstructions from contrast-enhanced CT scans, with a consequent decrease of the radiation dose. This study aims to assess the reliability of VNC for the diagnostic evaluation of renal masses in comparison with true non-contrast (TNC) images. The study cohort included 100 renal masses in 40 patients who underwent dl-DECT between June and December 2021. Attenuation values and standard deviations were assessed through the drawing of regions of interest on TNC and VNC images reconstructed from corticomedullary and nephrographic phases. A Wilcoxon signed-rank test was performed in order to assess equivalence of data and Spearman’s Rho correlation coefficient to evaluate correlations between each parameter. The diagnostic accuracy of VNC was estimated through the performance of receiver operating characteristic (ROC) curve analysis. Differences between attenuation values were, respectively, 74%, 18%, 5% and 3% (TNC-VNC_cort), and 74%, 15%, 9% and 2% (TNC-VNC_neph). The Wilcoxon signed-rank test demonstrated the equivalence of attenuation values between the TNC and VNC images. The diagnostic performance of VNC images in the depiction of kidney simple cysts remains high compared to TNC (VNC_cort-AUC: 0.896; VNC_neph-AUC: 0.901, TNC-AUC: 0.903). In conclusion, quantitative analysis of attenuation values showed a strong agreement between VNC and TNC images in the evaluation of renal masses. Full article

(This article belongs to the Special Issue Technological Advancements and Clinical Innovations in Diagnostic and Interventional Radiology)

► Show Figures

Figure 1

17 pages, 1366 KB

Open AccessEditor’s ChoiceReview

Early Management of Severe Biliary Infection in the Era of the Tokyo Guidelines

by Esther Nve, Josep M. Badia, Mireia Amillo-Zaragüeta, Montserrat Juvany, Mónica Mourelo-Fariña and Rosa Jorba

J. Clin. Med. 2023, 12(14), 4711; https://doi.org/10.3390/jcm12144711 - 16 Jul 2023

Cited by 12 | Viewed by 19423

Abstract

Sepsis of biliary origin is increasing worldwide and has become one of the leading causes of emergency department admissions. The presence of multi-resistant bacteria (MRB) is increasing, and mortality rates may reach 20%. This review focuses on the changes induced by the Tokyo [...] Read more.

Sepsis of biliary origin is increasing worldwide and has become one of the leading causes of emergency department admissions. The presence of multi-resistant bacteria (MRB) is increasing, and mortality rates may reach 20%. This review focuses on the changes induced by the Tokyo guidelines and new concepts related to the early treatment of severe biliary disease. If cholecystitis or cholangitis is suspected, ultrasound is the imaging test of choice. Appropriate empirical antibiotic treatment should be initiated promptly, and selection should be performed while bearing in mind the severity and risk factors for MRB. In acute cholecystitis, laparoscopic cholecystectomy is the main therapeutic intervention. In patients not suitable for surgery, percutaneous cholecystostomy is a valid alternative for controlling the infection. Treatment of severe acute cholangitis is based on endoscopic or transhepatic bile duct drainage and antibiotic therapy. Endoscopic ultrasound and other new endoscopic techniques have been added to the arsenal as novel alternatives in high-risk patients. However, biliary infections remain serious conditions that can lead to sepsis and death. The introduction of internationally accepted guidelines, based on clinical presentation, laboratory tests, and imaging, provides a framework for their rapid diagnosis and treatment. Prompt assessment of patient severity, timely initiation of antimicrobials, and early control of the source of infection are essential to reduce morbidity and mortality rates. Full article

(This article belongs to the Special Issue Clinical Advances in the Gallbladder and Biliary Tract Diseases)

► Show Figures

Figure 1

10 pages, 1230 KB

Open AccessEditor’s ChoiceArticle

Effects of Fremanezumab on Psychiatric Comorbidities in Difficult-to-Treat Patients with Chronic Migraine: Post Hoc Analysis of a Prospective, Multicenter, Real-World Greek Registry

by Michail Vikelis, Emmanouil V. Dermitzakis, Georgia Xiromerisiou, Dimitrios Rallis, Panagiotis Soldatos, Pantelis Litsardopoulos, Dimitrios Rikos and Andreas A. Argyriou

J. Clin. Med. 2023, 12(13), 4526; https://doi.org/10.3390/jcm12134526 - 6 Jul 2023

Cited by 11 | Viewed by 2626

Abstract

Objective: this post hoc analysis aimed to evaluate the efficacy of fremanezumab in difficult-to-treat chronic migraine (CM) patients with and without psychiatric comorbidities (PCs), mainly anxiety and/or depression. Methods: We assessed data from CM patients with and without PCs who failed at least [...] Read more.

Objective: this post hoc analysis aimed to evaluate the efficacy of fremanezumab in difficult-to-treat chronic migraine (CM) patients with and without psychiatric comorbidities (PCs), mainly anxiety and/or depression. Methods: We assessed data from CM patients with and without PCs who failed at least 3 preventives and eventually received at least 3 consecutive monthly doses of fremanezumab 225 mg. Outcomes included the crude response (≥50% reduction in monthly headache days (MHDs)) rates to fremanezumab from the baseline to the last clinical follow-up. The changes in MHDs; MHDs of moderate/greater severity; monthly days with intake of abortive medication; and the proportion of patients’ changing status from with PCs to decreased/without PCs were also compared. Disability and quality of life (QOL) outcomes were also assessed. Results: Of 107 patients enrolled, 65 (60.7%) had baseline PCs. The percentage of patients with (n = 38/65; 58.5%) and without (n = 28/42; 66.6%) PCs that achieved a ≥50% reduction in MHDs with fremanezumab was comparable (p = 0.41), whereas MHDs were significantly reduced (difference vs. baseline) in both patients with PCs (mean −8.9 (standard error: 6.8); p < 0.001) and without PCs (−9.8 (7.5); p < 0.001). Both groups experienced significant improvements in all other efficacy, disability, and QOL outcomes at comparable rates, including in MHD reduction. A significant proportion of fremanezumab-treated patients with baseline PCs de-escalated in corresponding severities or even reverted to no PCs (28/65; 43.1%) post-fremanezumab. Conclusions: fremanezumab appears to be effective as a preventive treatment in difficult-to-treat CM patients with and without PCs while also being beneficial in reducing the severity of comorbid anxiety and/or depression. Full article

(This article belongs to the Special Issue Headache Disorders: New Advances in Management and Treatment Strategies)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Editor’s Choice Articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI