Journal of Clinical Medicine

Review

17 pages, 606 KiB

Open AccessEditor’s ChoiceReview

Depression and Eye Disease—A Narrative Review of Common Underlying Pathophysiological Mechanisms and their Potential Applications

by Wymann Shao Wen Tang, Nicole Xer Min Lau, Muthuramalingam Naveen Krishnan, You Chuen Chin and Cyrus Su Hui Ho

J. Clin. Med. 2024, 13(11), 3081; https://doi.org/10.3390/jcm13113081 - 24 May 2024

Cited by 7 | Viewed by 2787

Abstract

Background: Depression has been shown to be associated with eye diseases, including dry eye disease (DED), cataracts, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR). This narrative review explores potential pathophysiological connections between depression and eye disease, as well as its potential [...] Read more.

Background: Depression has been shown to be associated with eye diseases, including dry eye disease (DED), cataracts, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR). This narrative review explores potential pathophysiological connections between depression and eye disease, as well as its potential correlations with ocular parameters. Methods: A literature search was conducted in August 2022 in PUBMED, EMBASE, and PsycINFO. Published articles related to the subject were consolidated and classified according to respective eye diseases and pathophysiological mechanisms. Results: The literature reviewed suggests that common pathophysiological states like inflammation and neurodegeneration may contribute to both depression and certain eye diseases, while somatic symptoms and altered physiology, such as disruptions in circadian rhythm due to eye diseases, can also influence patients’ mood states. Grounded in the shared embryological, anatomical, and physiological features between the eye and the brain, depression is also correlated to changes observed in non-invasive ophthalmological imaging modalities, such as changes in the retinal nerve fibre layer and retinal microvasculature. Conclusions: There is substantial evidence of a close association between depression and eye diseases. Understanding the underlying concepts can inform further research on treatment options and monitoring of depression based on ocular parameters. Full article

(This article belongs to the Section Mental Health)

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16 pages, 1329 KiB

Open AccessEditor’s ChoiceReview

Management of Cardiovascular Complications in Antiphospholipid Syndrome: A Narrative Review with a Focus on Older Adults

by Marco Bernardi, Luigi Spadafora, Silvia Andaloro, Alessandra Piscitelli, Giovanni Fornaci, Chiara Intonti, Alberto Emanuele Fratta, Chieh-En Hsu, Karol Kaziròd-Wolski, Theodora Metsovitis, Giuseppe Biondi-Zoccai, Pierre Sabouret, Emanuele Marzetti and Stefano Cacciatore

J. Clin. Med. 2024, 13(11), 3064; https://doi.org/10.3390/jcm13113064 - 23 May 2024

Cited by 5 | Viewed by 5653

Abstract

Antiphospholipid syndrome (APS), also known as Hughes syndrome, is an acquired autoimmune and procoagulant condition that predisposes individuals to recurrent thrombotic events and obstetric complications. Central is the role of three types of antiphospholipid antibodies that target phospholipid-binding proteins: lupus anticoagulant (LAC), anti-β2-glycoprotein [...] Read more.

Antiphospholipid syndrome (APS), also known as Hughes syndrome, is an acquired autoimmune and procoagulant condition that predisposes individuals to recurrent thrombotic events and obstetric complications. Central is the role of three types of antiphospholipid antibodies that target phospholipid-binding proteins: lupus anticoagulant (LAC), anti-β2-glycoprotein I (β2-GPI-Ab), and anti-cardiolipin (aCL). Together with clinical data, these antibodies are the diagnostic standard. However, the diagnosis of APS in older adults may be challenging and, in the diagnostic workup of thromboembolic complications, it is an underestimated etiology. The therapeutic management of APS requires distinguishing two groups with differential risks of thromboembolic complications. The standard therapy is based on low-dose aspirin in the low-risk group and vitamin K antagonists in the high-risk group. The value of direct oral anticoagulants is currently controversial. The potential role of monoclonal antibodies is investigated. For example, rituximab is currently recommended in catastrophic antiphospholipid antibody syndrome. Research is ongoing on other monoclonal antibodies, such as daratumumab and obinutuzumab. This narrative review illustrates the pathophysiological mechanisms of APS, with a particular emphasis on cardiovascular complications and their impact in older adults. This article also highlights advancements in the diagnosis, risk stratification, and management of APS. Full article

(This article belongs to the Section Immunology)

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15 pages, 795 KiB

Open AccessEditor’s ChoiceReview

How Will Artificial Intelligence Shape the Future of Decision-Making in Congenital Heart Disease?

by Alice Pozza, Luca Zanella, Biagio Castaldi and Giovanni Di Salvo

J. Clin. Med. 2024, 13(10), 2996; https://doi.org/10.3390/jcm13102996 - 20 May 2024

Cited by 10 | Viewed by 2745

Abstract

Improvements in medical technology have significantly changed the management of congenital heart disease (CHD), offering novel tools to predict outcomes and personalize follow-up care. By using sophisticated imaging modalities, computational models and machine learning algorithms, clinicians can experiment with unprecedented insights into the [...] Read more.

Improvements in medical technology have significantly changed the management of congenital heart disease (CHD), offering novel tools to predict outcomes and personalize follow-up care. By using sophisticated imaging modalities, computational models and machine learning algorithms, clinicians can experiment with unprecedented insights into the complex anatomy and physiology of CHD. These tools enable early identification of high-risk patients, thus allowing timely, tailored interventions and improved outcomes. Additionally, the integration of genetic testing offers valuable prognostic information, helping in risk stratification and treatment optimisation. The birth of telemedicine platforms and remote monitoring devices facilitates customised follow-up care, enhancing patient engagement and reducing healthcare disparities. Taking into consideration challenges and ethical issues, clinicians can make the most of the full potential of artificial intelligence (AI) to further refine prognostic models, personalize care and improve long-term outcomes for patients with CHD. This narrative review aims to provide a comprehensive illustration of how AI has been implemented as a new technological method for enhancing the management of CHD. Full article

(This article belongs to the Special Issue Clinical Applications of Novel Tools to Personalize the Follow-Up and Predict the Outcomes in Congenital Heart Disease)

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15 pages, 920 KiB

Open AccessEditor’s ChoiceReview

The Surgical Stress Response and Anesthesia: A Narrative Review

by Robert Ivascu, Ligia I. Torsin, Laura Hostiuc, Cornelia Nitipir, Dan Corneci and Madalina Dutu

J. Clin. Med. 2024, 13(10), 3017; https://doi.org/10.3390/jcm13103017 - 20 May 2024

Cited by 22 | Viewed by 12270

Abstract

The human physiological response “to stress” includes all metabolic and hormonal changes produced by a traumatic event at the micro or macro cellular levels. The main goal of the body’s first response to trauma is to keep physiological homeostasis. The perioperative non-specific adaptation [...] Read more.

The human physiological response “to stress” includes all metabolic and hormonal changes produced by a traumatic event at the micro or macro cellular levels. The main goal of the body’s first response to trauma is to keep physiological homeostasis. The perioperative non-specific adaptation response can sometimes be detrimental and can produce systemic inflammatory response syndrome (SIRS), characterized by hypermetabolism and hyper catabolism. We performed a narrative review consisting of a description of the surgical stress response’s categories of changes (neurohormonal and immunological response) followed by reviewing methods found in published studies to modulate the surgical stress response perioperatively. We described various preoperative measures cited in the literature as lowering the burden of surgical trauma. This article revises the anesthetic drugs and techniques that have an impact on the surgical stress response and proven immune-modulatory effects. We also tried to name present knowledge gaps requiring future research. Our review concludes that proper preoperative measures, adequate general anesthetics, multimodal analgesia, early postoperative mobilization, and early enteral nutrition can decrease the stress response to surgery and ease patient recovery. Anesthetics and analgesics used during the perioperative period may modulate the innate and adaptive immune system and inflammatory system, with a consecutive impact on cancer recurrence and long-term outcomes. Full article

(This article belongs to the Section Anesthesiology)

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24 pages, 914 KiB

Open AccessEditor’s ChoiceReview

Ultraviolet Filters: Dissecting Current Facts and Myths

by Thomas Breakell, Isabel Kowalski, Yannick Foerster, Rafaela Kramer, Michael Erdmann, Carola Berking and Markus V. Heppt

J. Clin. Med. 2024, 13(10), 2986; https://doi.org/10.3390/jcm13102986 - 19 May 2024

Cited by 9 | Viewed by 7641

Abstract

Skin cancer is a global and increasingly prevalent issue, causing significant individual and economic damage. UV filters in sunscreens play a major role in mitigating the risks that solar ultraviolet ra-diation poses to the human organism. While empirically effective, multiple adverse effects of [...] Read more.

Skin cancer is a global and increasingly prevalent issue, causing significant individual and economic damage. UV filters in sunscreens play a major role in mitigating the risks that solar ultraviolet ra-diation poses to the human organism. While empirically effective, multiple adverse effects of these compounds are discussed in the media and in scientific research. UV filters are blamed for the dis-ruption of endocrine processes and vitamin D synthesis, damaging effects on the environment, induction of acne and neurotoxic and carcinogenic effects. Some of these allegations are based on scientific facts while others are simply arbitrary. This is especially dangerous considering the risks of exposing unprotected skin to the sun. In summary, UV filters approved by the respective governing bodies are safe for human use and their proven skin cancer-preventing properties make them in-dispensable for sensible sun protection habits. Nonetheless, compounds like octocrylene and ben-zophenone-3 that are linked to the harming of marine ecosystems could be omitted from skin care regimens in favor of the myriad of non-toxic UV filters. Full article

(This article belongs to the Section Dermatology)

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10 pages, 896 KiB

Open AccessEditor’s ChoiceReview

Expandable Cages for Lumbar Interbody Fusion: A Narrative Review

by Soo-Bin Lee, Jonghun Yoon, Sung-Jun Park and Dong-Sik Chae

J. Clin. Med. 2024, 13(10), 2889; https://doi.org/10.3390/jcm13102889 - 14 May 2024

Cited by 6 | Viewed by 3533

Abstract

Lumbar fusion surgery for treating degenerative spinal diseases has undergone significant advancements in recent years. In addition to posterior instrumentation, anterior interbody fusion techniques have been developed along with various cages for interbody fusion. Recently, expandable cages capable of altering height, lordotic angle, [...] Read more.

Lumbar fusion surgery for treating degenerative spinal diseases has undergone significant advancements in recent years. In addition to posterior instrumentation, anterior interbody fusion techniques have been developed along with various cages for interbody fusion. Recently, expandable cages capable of altering height, lordotic angle, and footprint within the disc space have garnered significant attention. In this manuscript, we review the current status, clinical outcomes, and future prospects of expandable cages for lumbar interbody fusion based on the existing literature. Expandable cages are suitable for minimally invasive spinal surgeries. Small-sized cages can be inserted and subsequently expanded to a larger size within the disc space. While expandable cages generally demonstrate superior clinical outcomes compared to static cages, some studies have suggested comparable or even poorer outcomes with expandable cages than static cages. Careful interpretation through additional long-term follow-ups is required to assess the utility of expandable cages. If these shortcomings are addressed and the advantages are further developed, expandable cages could become suitable surgical instruments for minimally invasive spinal surgeries. Full article

(This article belongs to the Section Orthopedics)

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13 pages, 1640 KiB

Open AccessEditor’s ChoiceReview

Drusen in AMD from the Perspective of Cholesterol Metabolism and Hypoxic Response

by Norimitsu Ban, Ari Shinojima, Kazuno Negishi and Toshihide Kurihara

J. Clin. Med. 2024, 13(9), 2608; https://doi.org/10.3390/jcm13092608 - 29 Apr 2024

Cited by 4 | Viewed by 2854

Abstract

Drusen are one of the most characteristic pathologies of precursor lesion of age-related macular degeneration (AMD). Drusen comprise a yellowish white substance that accumulates typically under the retinal pigment epithelium (RPE), and their constituents are lipids, complement, amyloid, crystallin, and others. In the [...] Read more.

Drusen are one of the most characteristic pathologies of precursor lesion of age-related macular degeneration (AMD). Drusen comprise a yellowish white substance that accumulates typically under the retinal pigment epithelium (RPE), and their constituents are lipids, complement, amyloid, crystallin, and others. In the past, many researchers have focused on drusen and tried to elucidate the pathophysiology of AMD because they believed that disease progression from early AMD to advanced AMD might be based on drusen or drusen might cause AMD. In fact, it is well established that drusen are the hallmark of precursor lesion of AMD and a major risk factor for AMD progression mainly based on their size and number. However, the existence of advanced AMD without drusen has long been recognized. For example, polypoidal choroidal vasculopathy (PCV), which comprises the majority of AMD cases in Asians, often lacks drusen. Thus, there is the possibility that drusen might be no more than a biomarker of AMD and not a cause of AMD. Now is the time to reconsider the relationship between AMD and drusen. In this review, we focus on early AMD pathogenesis based on basic research from the perspective of cholesterol metabolism and hypoxic response in the retina, and we discuss the role of drusen. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Management of Age-Related Macular Degeneration)

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21 pages, 696 KiB

Open AccessEditor’s ChoiceReview

Heart Failure Management through Telehealth: Expanding Care and Connecting Hearts

by Andrea Tedeschi, Matteo Palazzini, Giancarlo Trimarchi, Nicolina Conti, Francesco Di Spigno, Piero Gentile, Luciana D’Angelo, Andrea Garascia, Enrico Ammirati, Nuccia Morici and Daniela Aschieri

J. Clin. Med. 2024, 13(9), 2592; https://doi.org/10.3390/jcm13092592 - 28 Apr 2024

Cited by 20 | Viewed by 5906

Abstract

Heart failure (HF) is a leading cause of morbidity worldwide, imposing a significant burden on deaths, hospitalizations, and health costs. Anticipating patients’ deterioration is a cornerstone of HF treatment: preventing congestion and end organ damage while titrating HF therapies is the aim of [...] Read more.

Heart failure (HF) is a leading cause of morbidity worldwide, imposing a significant burden on deaths, hospitalizations, and health costs. Anticipating patients’ deterioration is a cornerstone of HF treatment: preventing congestion and end organ damage while titrating HF therapies is the aim of the majority of clinical trials. Anyway, real-life medicine struggles with resource optimization, often reducing the chances of providing a patient-tailored follow-up. Telehealth holds the potential to drive substantial qualitative improvement in clinical practice through the development of patient-centered care, facilitating resource optimization, leading to decreased outpatient visits, hospitalizations, and lengths of hospital stays. Different technologies are rising to offer the best possible care to many subsets of patients, facing any stage of HF, and challenging extreme scenarios such as heart transplantation and ventricular assist devices. This article aims to thoroughly examine the potential advantages and obstacles presented by both existing and emerging telehealth technologies, including artificial intelligence. Full article

(This article belongs to the Section Cardiovascular Medicine)

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11 pages, 2088 KiB

Open AccessEditor’s ChoiceReview

The Ascyrus Medical Dissection Stent: A One-Fits-All Strategy for the Treatment of Acute Type A Aortic Dissection?

by Leonard Pitts, Michael C. Moon, Maximilian Luehr, Markus Kofler, Matteo Montagner, Simon Sündermann, Semih Buz, Christoph Starck, Volkmar Falk and Jörg Kempfert

J. Clin. Med. 2024, 13(9), 2593; https://doi.org/10.3390/jcm13092593 - 28 Apr 2024

Cited by 6 | Viewed by 2117

Abstract

The treatment of DeBakey type I aortic dissection remains a major challenge in the field of aortic surgery. To upgrade the standard of care hemiarch replacement, a novel device called an “Ascyrus Medical Dissection Stent” (AMDS) is now available. This hybrid device composed [...] Read more.

The treatment of DeBakey type I aortic dissection remains a major challenge in the field of aortic surgery. To upgrade the standard of care hemiarch replacement, a novel device called an “Ascyrus Medical Dissection Stent” (AMDS) is now available. This hybrid device composed of a proximal polytetrafluoroethylene cuff and a distal non-covered nitinol stent is inserted into the aortic arch and the descending thoracic aorta during hypothermic circulatory arrest in addition to hemiarch replacement. Due to its specific design, it may result in a reduced risk for distal anastomotic new entries, the effective restoration of branch vessel malperfusion and positive aortic remodeling. In this narrative review, we provide an overview about the indications and the technical use of the AMDS. Additionally, we summarize the current available literature and discuss potential pitfalls in the application of the AMDS regarding device failure and aortic re-intervention. Full article

(This article belongs to the Special Issue Clinical Updates on the Aortic Aneurysm and Aortic Dissection)

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16 pages, 839 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Bioactive Dressing: A New Algorithm in Wound Healing

by Gianmarco Polverino, Francesca Russo and Francesco D’Andrea

J. Clin. Med. 2024, 13(9), 2488; https://doi.org/10.3390/jcm13092488 - 24 Apr 2024

Cited by 5 | Viewed by 4070

Abstract

Wound management presents a significant global challenge, necessitating a comprehensive understanding of wound care products and clinical expertise in selecting dressings. Bioactive dressings (BD) represent a diverse category of dressings, capable of influencing wound healing through various mechanisms. These dressings, including honey, hyaluronic [...] Read more.

Wound management presents a significant global challenge, necessitating a comprehensive understanding of wound care products and clinical expertise in selecting dressings. Bioactive dressings (BD) represent a diverse category of dressings, capable of influencing wound healing through various mechanisms. These dressings, including honey, hyaluronic acid, collagen, alginates, and polymers enriched with polyhexamethylene biguanide, chitin, and chitosan derivatives, create a conducive environment for healing, promoting moisture balance, pH regulation, oxygen permeability, and fluid management. Interactive dressings further enhance targeted action by serving as substrates for bioactive agents. The continuous evolution of BDs, with new products introduced annually, underscores the need for updated knowledge in wound care. To facilitate dressing selection, a practical algorithm considers wound exudate, infection probability, and bleeding, guiding clinicians through the process. This algorithm aims to optimize wound care by ensuring the appropriate selection of BDs tailored to individual patient needs, ultimately improving outcomes in wound management. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine)

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16 pages, 323 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Diagnostic, Theranostic and Prognostic Value of Thyroglobulin in Thyroid Cancer

by Luca Giovanella, Federica D’Aurizio, Petra Petranović Ovčariček and Rainer Görges

J. Clin. Med. 2024, 13(9), 2463; https://doi.org/10.3390/jcm13092463 - 23 Apr 2024

Cited by 5 | Viewed by 3330

Abstract

Thyroglobulin (Tg) is an iodinated glycoprotein, which is normally stored in the follicular colloid of the thyroid, being a substrate for thyroid hormone production. Since it is produced by well-differentiated thyroid cells, it is considered a reliable tumor marker for patients with differentiated [...] Read more.

Thyroglobulin (Tg) is an iodinated glycoprotein, which is normally stored in the follicular colloid of the thyroid, being a substrate for thyroid hormone production. Since it is produced by well-differentiated thyroid cells, it is considered a reliable tumor marker for patients with differentiated thyroid carcinoma (DTC) during their follow-up after total thyroidectomy and radioiodine ablation. It is used to monitor residual disease and to detect recurrent disease. After total thyroid ablation, unstimulated highly sensitive Tg measurements are sufficiently accurate to avoid exogenous or endogenous thyrotropin (TSH) stimulation and provide accurate diagnostic and prognostic information in the great majority of DTC patients. Adopting sophisticated statistical analysis, i.e., decision tree models, the use of Tg before radioiodine theranostic administration was demonstrated to be useful in refining conventional, pathology-based risk stratification and providing personalized adjuvant or therapeutic radioiodine administrations. The follow-up of DTC patients aims to promptly identify patients with residual or recurrent disease following primary treatment. Our review paper covers the diagnostic, theranostic and prognostic value of thyroglobulin in DTC patients. Full article

(This article belongs to the Special Issue New Strategies in the Treatment of Thyroid Carcinoma)

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22 pages, 5904 KiB

Open AccessEditor’s ChoiceReview

Current Management of In-Stent Restenosis

by Daniele Giacoppo, Placido Maria Mazzone and Davide Capodanno

J. Clin. Med. 2024, 13(8), 2377; https://doi.org/10.3390/jcm13082377 - 19 Apr 2024

Cited by 7 | Viewed by 4314

Abstract

In-stent restenosis (ISR) remains the primary cause of target lesion failure following percutaneous coronary intervention (PCI), resulting in 10-year incidences of target lesion revascularization at a rate of approximately 20%. The treatment of ISR is challenging due to its inherent propensity for recurrence [...] Read more.

In-stent restenosis (ISR) remains the primary cause of target lesion failure following percutaneous coronary intervention (PCI), resulting in 10-year incidences of target lesion revascularization at a rate of approximately 20%. The treatment of ISR is challenging due to its inherent propensity for recurrence and varying susceptibility to available strategies, influenced by a complex interplay between clinical and lesion-specific conditions. Given the multiple mechanisms contributing to the development of ISR, proper identification of the underlying substrate, especially by using intravascular imaging, becomes pivotal as it can indicate distinct therapeutic requirements. Among standalone treatments, drug-coated balloon (DCB) angioplasty and drug-eluting stent (DES) implantation have been the most effective. The main advantage of a DCB-based approach is the avoidance of an additional metallic layer, which may otherwise enhance neointimal hyperplasia, provide the substratum for developing neoatherosclerosis, and expose the patient to a persistently higher risk of coronary ischemic events. On the other hand, target vessel scaffolding by DES implantation confers relevant mechanical advantages over DCB angioplasty, generally resulting in larger luminal gain, while drug elution from the stent surface ensures the inhibition of neointimal hyperplasia. Nevertheless, repeat stenting with DES also implies an additional permanent metallic layer that may reiterate and promote the mechanisms leading to ISR. Against this background, the selection of either DCB or DES on a patient- and lesion-specific basis as well as the implementation of adjuvant treatments, including cutting/scoring balloons, intravascular lithotripsy, and rotational atherectomy, hold the potential to improve the effectiveness of ISR treatment over time. In this review, we comprehensively assessed the available evidence from randomized trials to define contemporary interventional treatment of ISR and provide insights for future directions. Full article

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

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23 pages, 1614 KiB

Open AccessEditor’s ChoiceReview

Trace Elements in Alzheimer’s Disease and Dementia: The Current State of Knowledge

by Magdalena Tyczyńska, Marta Gędek, Adam Brachet, Wojciech Stręk, Jolanta Flieger, Grzegorz Teresiński and Jacek Baj

J. Clin. Med. 2024, 13(8), 2381; https://doi.org/10.3390/jcm13082381 - 19 Apr 2024

Cited by 19 | Viewed by 3782

Abstract

Changes in trace element concentrations are being wildly considered when it comes to neurodegenerative disorders, such as Alzheimer’s disease and Parkinson’s disease. This study aims to present the role that trace elements play in the central nervous system. Moreover, we reviewed the mechanisms [...] Read more.

Changes in trace element concentrations are being wildly considered when it comes to neurodegenerative disorders, such as Alzheimer’s disease and Parkinson’s disease. This study aims to present the role that trace elements play in the central nervous system. Moreover, we reviewed the mechanisms involved in their neurotoxicity. Low zinc concentrations, as well as high levels of copper, manganese, and iron, activate the signalling pathways of the inflammatory, oxidative and nitrosative stress response. Neurodegeneration occurs due to the association between metals and proteins, which is then followed by aggregate formation, mitochondrial disorder, and, ultimately, cell death. In Alzheimer’s disease, low Zn levels suppress the neurotoxicity induced by β-amyloid through the selective precipitation of aggregation intermediates. High concentrations of copper, iron and manganese cause the aggregation of intracellular α-synuclein, which results in synaptic dysfunction and axonal transport disruption. Parkinson’s disease is caused by the accumulation of Fe in the midbrain dopaminergic nucleus, and the pathogenesis of multiple sclerosis derives from Zn deficiency, leading to an imbalance between T cell functions. Aluminium disturbs the homeostasis of other metals through a rise in the production of oxygen reactive forms, which then leads to cellular death. Selenium, in association with iron, plays a distinct role in the process of ferroptosis. Outlining the influence that metals have on oxidoreduction processes is crucial to recognising the pathophysiology of neurodegenerative diseases and may provide possible new methods for both their avoidance and therapy. Full article

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

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15 pages, 1209 KiB

Open AccessEditor’s ChoiceReview

Early Rectal Cancer and Local Excision: A Narrative Review

by Cecilia Binda, Matteo Secco, Luigi Tuccillo, Chiara Coluccio, Elisa Liverani, Carlo Felix Maria Jung, Carlo Fabbri and Giulia Gibiino

J. Clin. Med. 2024, 13(8), 2292; https://doi.org/10.3390/jcm13082292 - 16 Apr 2024

Cited by 6 | Viewed by 3866

Abstract

A rise in the incidence of early rectal cancer consequent to bowel-screening programs around the world and an increase in the incidence in young adults has led to a growing interest in organ-sparing treatment options. The rectum, being the most distal portion of [...] Read more.

A rise in the incidence of early rectal cancer consequent to bowel-screening programs around the world and an increase in the incidence in young adults has led to a growing interest in organ-sparing treatment options. The rectum, being the most distal portion of the large intestine, is a fertile ground for local excision techniques performed with endoscopic or surgical techniques. Moreover, the advancement in endoscopic optical evaluation and the better definition of imaging techniques allow for a more precise local staging of early rectal cancer. Although the local treatment of early rectal cancer seems promising, in clinical practice, a significant number of patients who could benefit from local excision techniques undergo total mesorectal excision (TME) as the first approach. All relevant prospective clinical trials were identified through a computer-assisted search of the PubMed, EMBASE, and Medline databases until January 2024. This review is dedicated to endoscopic and surgical local excision in the treatment of early rectal cancer and highlights its possible role in current and future clinical practice, taking into account surgical completion techniques and chemoradiotherapy. Full article

(This article belongs to the Special Issue The Rising Concern of Rectal Cancer: Causes, Diagnosis and Treatment Options)

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11 pages, 236 KiB

Open AccessEditor’s ChoiceReview

Effect of Physical Activity during Pregnancy on the Risk of Hypertension Disorders and Gestational Diabetes: Evidence Generated by New RCTs and Systematic Reviews

by Cristina Taliento, Irene Piccolotti, Arianna Sabattini, Mara Tormen, Rosaria Cappadona, Pantaleo Greco and Gennaro Scutiero

J. Clin. Med. 2024, 13(8), 2198; https://doi.org/10.3390/jcm13082198 - 11 Apr 2024

Cited by 8 | Viewed by 6026

Abstract

Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are the most common medical complications in pregnancy. Physical exercise is considered to be safe and beneficial during pregnancy. Moreover, pregnancy could be considered as an opportunity for healthcare providers to promote positive [...] Read more.

Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are the most common medical complications in pregnancy. Physical exercise is considered to be safe and beneficial during pregnancy. Moreover, pregnancy could be considered as an opportunity for healthcare providers to promote positive lifestyle behavior and optimize the well-being of pregnant women. Since there are few up-to-date reviews evaluating the role of exercise and the risks of developing obstetrical complications, we performed a review to investigate the effects of physical activity and exercise during pregnancy compared to a control group, focusing on the risk of development of HDP and GDM. We searched Medline and Web of Science, including only randomized controlled trials (RCTs) and systematic reviews. This review supports a beneficial effect of exercise and provides evidence that it significantly decreases the risk of HDP and GDM. Full article

(This article belongs to the Special Issue Challenges in High-Risk Pregnancy and Delivery)

23 pages, 852 KiB

Open AccessEditor’s ChoiceReview

Isthmocele and Infertility

by Giorgio Maria Baldini, Dario Lot, Antonio Malvasi, Doriana Di Nanni, Antonio Simone Laganà, Cecilia Angelucci, Andrea Tinelli, Domenico Baldini and Giuseppe Trojano

J. Clin. Med. 2024, 13(8), 2192; https://doi.org/10.3390/jcm13082192 - 10 Apr 2024

Cited by 14 | Viewed by 6625

Abstract

Isthmocele is a gynecological condition characterized by a disruption in the uterine scar, often associated with prior cesarean sections. This anatomical anomaly can be attributed to inadequate or insufficient healing of the uterine wall following a cesarean incision. It appears that isthmocele may [...] Read more.

Isthmocele is a gynecological condition characterized by a disruption in the uterine scar, often associated with prior cesarean sections. This anatomical anomaly can be attributed to inadequate or insufficient healing of the uterine wall following a cesarean incision. It appears that isthmocele may impact a woman’s quality of life as well as her reproductive capacity. The incidence of isthmocele can range from 20% to 70% in women who have undergone a cesarean section. This review aims to sum up the current knowledge about the effect of isthmocele on fertility and the possible therapeutic strategies to achieve pregnancy. However, currently, there is not sufficiently robust evidence to indicate the need for surgical correction in all asymptomatic patients seeking fertility. In cases where surgical correction of isthmocele is deemed necessary, it is advisable to evaluate residual myometrial thickness (RMT). For patients with RMT >2.5–3 mm, hysteroscopy appears to be the technique of choice. In cases where the residual tissue is lower, recourse to laparotomic, laparoscopic, or vaginal approaches is warranted. Full article

(This article belongs to the Special Issue Assisted Reproductive Technology: Clinical Perspectives on Enhancing Fertility Outcomes)

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15 pages, 1664 KiB

Open AccessEditor’s ChoiceReview

Evolution of Cervical Endoscopic Spine Surgery: Current Progress and Future Directions—A Narrative Review

by Chuan-Ching Huang, Jamal Fitts, David Huie, Deb A. Bhowmick and Muhammad M. Abd-El-Barr

J. Clin. Med. 2024, 13(7), 2122; https://doi.org/10.3390/jcm13072122 - 6 Apr 2024

Cited by 7 | Viewed by 2902

Abstract

Cervical endoscopic spine surgery is rapidly evolving and gaining popularity for the treatment of cervical radiculopathy and myelopathy. This approach significantly reduces muscular damage and blood loss by minimizing soft tissue stripping, leading to less postoperative pain and a faster postoperative recovery. As [...] Read more.

Cervical endoscopic spine surgery is rapidly evolving and gaining popularity for the treatment of cervical radiculopathy and myelopathy. This approach significantly reduces muscular damage and blood loss by minimizing soft tissue stripping, leading to less postoperative pain and a faster postoperative recovery. As scientific evidence accumulates, the efficacy and safety of cervical endoscopic spine surgery are continually affirmed. Both anterior and posterior endoscopic approaches have surfaced as viable alternative treatments for various cervical spine pathologies. Newer techniques, such as endoscopic-assisted fusion, the anterior transcorporeal approach, and unilateral laminotomy for bilateral decompression, have been developed to enhance clinical outcomes and broaden surgical indications. Despite its advantages, this approach faces challenges, including a steep learning curve, increased radiation exposure for both surgeons and patients, and a relative limitation in addressing multi-level pathologies. However, the future of cervical endoscopic spine surgery is promising, with potential enhancements in clinical outcomes and safety on the horizon. This progress is fueled by integrating advanced imaging and navigation technologies, applying regional anesthesia for improved and facilitated postoperative recovery, and incorporating cutting-edge technologies, such as augmented reality. With these advancements, cervical endoscopic spine surgery is poised to broaden its scope in treating cervical spine pathologies while maintaining the benefits of minimized tissue damage and rapid recovery. Full article

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

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24 pages, 1126 KiB

Open AccessEditor’s ChoiceReview

Venetoclax Combination Treatment of Acute Myeloid Leukemia in Adolescents and Young Adult Patients

by Elena Chatzikalil, Kleoniki Roka, Panagiotis T. Diamantopoulos, Efthymia Rigatou, Georgia Avgerinou, Antonis Kattamis and Elena E. Solomou

J. Clin. Med. 2024, 13(7), 2046; https://doi.org/10.3390/jcm13072046 - 1 Apr 2024

Cited by 5 | Viewed by 3913

Abstract

Over the past two decades, the prognosis in adolescents and young adults (AYAs) diagnosed with acute myeloid leukemia (AML) has significantly improved. The standard intensive cytotoxic treatment approach for AYAs with AML, consisting of induction chemotherapy with anthracycline/cytarabine combination followed by consolidation chemotherapy [...] Read more.

Over the past two decades, the prognosis in adolescents and young adults (AYAs) diagnosed with acute myeloid leukemia (AML) has significantly improved. The standard intensive cytotoxic treatment approach for AYAs with AML, consisting of induction chemotherapy with anthracycline/cytarabine combination followed by consolidation chemotherapy or stem cell transplantation, has lately been shifting toward novel targeted therapies, mostly in the fields of clinical trials. One of the most recent advances in treating AML is the combination of the B-cell lymphoma 2 (Bcl-2) inhibitor venetoclax with hypomethylating agents, which has been studied in elderly populations and was approved by the Food and Drug Administration (FDA) for patients over 75 years of age or patients excluded from intensive chemotherapy induction schemas due to comorbidities. Regarding the AYA population, venetoclax combination therapy could be a therapeutic option for patients with refractory/relapsed (R/R) AML, although data from real-world studies are currently limited. Venetoclax is frequently used by AYAs diagnosed with advanced hematologic malignancies, mainly acute lymphoblastic leukemia and myelodysplastic syndromes, as a salvage therapeutic option with considerable efficacy and safety. Herein, we aim to summarize the evidence obtained from clinical trials and observational studies on venetoclax use in AYAs with AML. Based on the available evidence, venetoclax is a safe and effective therapeutic option for R/R AML AYA patients. However, further research in larger cohorts is needed to confirm these data, establishing the benefits of a venetoclax-based regimen for this special population. Full article

(This article belongs to the Special Issue Acute Myeloid Leukemia: Latest Advances in the Diagnostics, Therapeutic Strategies and Clinical Management)

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20 pages, 8482 KiB

Open AccessEditor’s ChoiceReview

Endoscopic Management of Post-Sleeve Gastrectomy Complications

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

J. Clin. Med. 2024, 13(7), 2011; https://doi.org/10.3390/jcm13072011 - 29 Mar 2024

Cited by 4 | Viewed by 2917

Abstract

Obesity is associated with several chronic conditions including diabetes, cardiovascular disease, and metabolic dysfunction-associated steatotic liver disease and malignancy. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, is an effective treatment modality for obesity and can improve associated comorbidities. Over the [...] Read more.

Obesity is associated with several chronic conditions including diabetes, cardiovascular disease, and metabolic dysfunction-associated steatotic liver disease and malignancy. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, is an effective treatment modality for obesity and can improve associated comorbidities. Over the last 20 years, there has been an increase in the rate of bariatric surgeries associated with the growing obesity epidemic. Sleeve gastrectomy is the most widely performed bariatric surgery currently, and while it serves as a durable option for some patients, it is important to note that several complications, including sleeve leak, stenosis, chronic fistula, gastrointestinal hemorrhage, and gastroesophageal reflux disease, may occur. Endoscopic methods to manage post-sleeve gastrectomy complications are often considered due to the risks associated with a reoperation, and endoscopy plays a significant role in the diagnosis and management of post-sleeve gastrectomy complications. We perform a detailed review of the current endoscopic management of post-sleeve gastrectomy complications. Full article

(This article belongs to the Special Issue Sleeve Gastrectomy: Risks, Outcomes, and Complications)

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14 pages, 2370 KiB

Open AccessEditor’s ChoiceReview

The Art of Sleeve Gastrectomy

by Shahed Tish and Ricard Corcelles

J. Clin. Med. 2024, 13(7), 1954; https://doi.org/10.3390/jcm13071954 - 28 Mar 2024

Cited by 5 | Viewed by 3595

Abstract

Sleeve gastrectomy (SG) has historically evolved from gastroplasty and anti-reflux procedures into one of the most commonly performed primary metabolic surgeries in the United States and worldwide. Initially initiated in the 1980s as part of the duodenal switch procedure, its standalone effectiveness and [...] Read more.

Sleeve gastrectomy (SG) has historically evolved from gastroplasty and anti-reflux procedures into one of the most commonly performed primary metabolic surgeries in the United States and worldwide. Initially initiated in the 1980s as part of the duodenal switch procedure, its standalone effectiveness and simplicity have led to increasing popularity globally. The rise in obesity rates transcends age boundaries, alarmingly affecting not only adults but also the younger demographic. This escalating trend is concerning, as it predisposes these populations to numerous future health complications, as well as highlighting the critical necessity for a safe and potent weight loss strategy. Although sleeve gastrectomy carries a higher risk for gastroesophageal reflux disease (GERD) compared to other bariatric procedures, it stands out as a reliable, safe and effective surgical solution for obesity. It is particularly beneficial for adolescents and patients with complex medical comorbidities, including, but not limited to, heart failure and immunocompromisation. It has also served as a bridge for transplants in morbidly obese patients with end-stage heart, liver and kidney disease due to its favorable safety profile. Full article

(This article belongs to the Special Issue Sleeve Gastrectomy: Risks, Outcomes, and Complications)

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17 pages, 1327 KiB

Open AccessEditor’s ChoiceReview

New-Onset Diabetes Mellitus after Kidney Transplantation

by Salah Alajous and Pooja Budhiraja

J. Clin. Med. 2024, 13(7), 1928; https://doi.org/10.3390/jcm13071928 - 27 Mar 2024

Cited by 6 | Viewed by 4735

Abstract

New-Onset Diabetes Mellitus after Transplantation (NODAT) emerges as a prevalent complication post-kidney transplantation, with its incidence influenced by variations in NODAT definitions and follow-up periods. The condition’s pathophysiology is marked by impaired insulin sensitivity and β-cell dysfunction. Significant risk factors encompass age, gender, [...] Read more.

New-Onset Diabetes Mellitus after Transplantation (NODAT) emerges as a prevalent complication post-kidney transplantation, with its incidence influenced by variations in NODAT definitions and follow-up periods. The condition’s pathophysiology is marked by impaired insulin sensitivity and β-cell dysfunction. Significant risk factors encompass age, gender, obesity, and genetics, among others, with the use of post-transplant immunosuppressants intensifying the condition. NODAT’s significant impact on patient survival and graft durability underscores the need for its prevention, early detection, and treatment. This review addresses the complexities of managing NODAT, including the challenges posed by various immunosuppressive regimens crucial for transplant success yet harmful to glucose metabolism. It discusses management strategies involving adjustments in immunosuppressive protocols, lifestyle modifications, and pharmacological interventions to minimize diabetes risk while maintaining transplant longevity. The importance of early detection and proactive, personalized intervention strategies to modify NODAT’s trajectory is also emphasized, advocating for a shift towards more anticipatory post-transplant care. Full article

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

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17 pages, 1380 KiB

Open AccessEditor’s ChoiceReview

Endometriosis-Related Ovarian Cancer: Where Are We Now? A Narrative Review towards a Pragmatic Approach

by Gabriele Centini, Giorgia Schettini, Emilio Pieri, Matteo Giorgi, Lucia Lazzeri, Francesco Giuseppe Martire, Virginia Mancini, Diego Raimondo, Renato Seracchioli, Nassir Habib, Francesco Fedele and Errico Zupi

J. Clin. Med. 2024, 13(7), 1933; https://doi.org/10.3390/jcm13071933 - 27 Mar 2024

Cited by 17 | Viewed by 4218

Abstract

Background: Endometriosis affects more than 10% of reproductive-aged women, causing pelvic pain and infertility. Despite the benign nature of endometriosis, ovarian endometriomas carry a higher risk of developing endometrioid carcinomas (EnOCs) and clear cell ovarian carcinomas (CCCs). Atypical endometriosis, defined as cytological atypia [...] Read more.

Background: Endometriosis affects more than 10% of reproductive-aged women, causing pelvic pain and infertility. Despite the benign nature of endometriosis, ovarian endometriomas carry a higher risk of developing endometrioid carcinomas (EnOCs) and clear cell ovarian carcinomas (CCCs). Atypical endometriosis, defined as cytological atypia resembling intraepithelial cancer, is considered the precursor of endometriosis-associated ovarian cancer (EAOC). This narrative review aims to provide an overview of EAOC, proposing a practical approach to clinical and therapeutic decision making. Methods: An electronic literature search was conducted from inception up to January 2023, using the MEDLINE database via PubMed to evaluate the existing literature on EAOC, including its pathogenesis, the diagnostic process, and the therapeutic possibilities, with articles not relevant to the topic or lacking scientific merit being excluded. Results: Eighty-one articles were included in the review to present the current state of the art regarding EAOC. A pragmatic clinical flowchart is proposed to guide therapeutic decisions and improve patient outcomes. Conclusions: Endometriosis patients may have an increased risk of developing EAOC (either EnOC or CCC). Despite not being fully accepted, the concept of AE may reshape the endometriosis–ovarian cancer relationship. Further research is needed to understand the unaddressed issues. Full article

(This article belongs to the Special Issue Update on Laparoscopic Management of Gynecologic Malignancies)

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13 pages, 891 KiB

Open AccessEditor’s ChoiceReview

Revascularization Strategy in Myocardial Infarction with Multivessel Disease

by Alexander Jobs, Steffen Desch, Anne Freund, Hans-Josef Feistritzer and Holger Thiele

J. Clin. Med. 2024, 13(7), 1918; https://doi.org/10.3390/jcm13071918 - 26 Mar 2024

Cited by 5 | Viewed by 3157

Abstract

The proportion of patients with multivessel coronary artery disease in individuals experiencing acute coronary syndrome (ACS) varies based on age and ACS subtype. In patients with ST-segment elevation myocardial infarction (STEMI) without cardiogenic shock, the prognostic benefit of complete revascularization has been demonstrated [...] Read more.

The proportion of patients with multivessel coronary artery disease in individuals experiencing acute coronary syndrome (ACS) varies based on age and ACS subtype. In patients with ST-segment elevation myocardial infarction (STEMI) without cardiogenic shock, the prognostic benefit of complete revascularization has been demonstrated by several randomized trials and meta-analyses, leading to a strong guideline recommendation. However, similar data are lacking for ACS without ST-segment elevation (NSTE-ACS). Non-randomized data suggesting a benefit from complete revascularization in non-ST-segment elevation myocardial infarction (NSTEMI) are prone to selection bias and should be interpreted with caution. A series of large randomized controlled trials have been initiated recently to address these open questions. Full article

(This article belongs to the Special Issue Acute Coronary Syndrome: Current State of Diagnosis and Treatment)

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31 pages, 1670 KiB

Open AccessEditor’s ChoiceReview

Reducing the Risk of Pre-Eclampsia in Women with Polycystic Ovary Syndrome Using a Combination of Pregnancy Screening, Lifestyle, and Medical Management Strategies

by Jim Parker, Claire Louise O’Brien, Christabelle Yeoh, Felice L. Gersh and Shaun Brennecke

J. Clin. Med. 2024, 13(6), 1774; https://doi.org/10.3390/jcm13061774 - 20 Mar 2024

Cited by 6 | Viewed by 5524

Abstract

Polycystic ovary syndrome (PCOS) is a multisystem disorder that presents with a variety of phenotypes involving metabolic, endocrine, reproductive, and psychological symptoms and signs. Women with PCOS are at increased risk of pregnancy complications including implantation failure, miscarriage, gestational diabetes, fetal growth restriction, [...] Read more.

Polycystic ovary syndrome (PCOS) is a multisystem disorder that presents with a variety of phenotypes involving metabolic, endocrine, reproductive, and psychological symptoms and signs. Women with PCOS are at increased risk of pregnancy complications including implantation failure, miscarriage, gestational diabetes, fetal growth restriction, preterm labor, and pre-eclampsia (PE). This may be attributed to the presence of specific susceptibility features associated with PCOS before and during pregnancy, such as chronic systemic inflammation, insulin resistance (IR), and hyperandrogenism, all of which have been associated with an increased risk of pregnancy complications. Many of the features of PCOS are reversible following lifestyle interventions such as diet and exercise, and pregnant women following a healthy lifestyle have been found to have a lower risk of complications, including PE. This narrative synthesis summarizes the evidence investigating the risk of PE and the role of nutritional factors in women with PCOS. The findings suggest that the beneficial aspects of lifestyle management of PCOS, as recommended in the evidence-based international guidelines, extend to improved pregnancy outcomes. Identifying high-risk women with PCOS will allow targeted interventions, early-pregnancy screening, and increased surveillance for PE. Women with PCOS should be included in risk assessment algorithms for PE. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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10 pages, 406 KiB

Open AccessEditor’s ChoiceReview

Fresh Frozen Homologous Rib Cartilage: A Narrative Review of a New Trend in Rhinoplasty

by Giovanni Salzano, Giovanni Audino, Giovanni Dell’Aversana Orabona, Umberto Committeri, Stefania Troise, Antonio Arena, Luigi Angelo Vaira, Pietro De Luca, Alfonso Scarpa, Andrea Elefante, Antonio Romano, Luigi Califano and Pasquale Piombino

J. Clin. Med. 2024, 13(6), 1715; https://doi.org/10.3390/jcm13061715 - 16 Mar 2024

Cited by 6 | Viewed by 2814

Abstract

Background: Revision rhinoplasty is a technically demanding surgical procedure that can put every surgeon in trouble. The main issue of these cases is often an altered osteocartilaginous framework following over-resection during the first intervention. Moreover, the available septal or auricular cartilage for [...] Read more.

Background: Revision rhinoplasty is a technically demanding surgical procedure that can put every surgeon in trouble. The main issue of these cases is often an altered osteocartilaginous framework following over-resection during the first intervention. Moreover, the available septal or auricular cartilage for grafting is usually not enough. This review aims to examine contemporary advances in applications of fresh frozen cartilage in rhinoplasty. Methods: A structured review of the current literature (up to December 2023) was performed on four bibliographic databases: PubMed, EMBASE, Cochrane and Medline. The search terms were combinations of “Rhinoplasty” and “Cartilage Graft”, “Allograft” or “Fresh Frozen Cartilage”. The citations of selected studies and review articles were also evaluated if present. Results: The research resulted in 152 articles, and only ten met the inclusion criteria: nine clinical articles and one in vitro study. One of the ten eligible articles was excluded. Conclusions: Fresh frozen rib cartilage proved to be a viable alternative to autologous rib grafts and irradiated homologous rib graft. Despite the higher costs, FFRG can provide a sufficient amount of tissue for grafting avoiding donor site complications and reducing the operative time and proved to have more chondrocytes and to be less prone to resorption compared to irradiated rib. Full article

(This article belongs to the Topic Current Challenges and Advances in Skin Repair and Regeneration)

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23 pages, 320 KiB

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Coping Strategies and Inflammatory Bowel Disease: A Narrative Review

by Stefan L. Popa, Mihaela Fadgyas Stanculete, Simona Grad, Vlad Dumitru Brata, Traian-Adrian Duse, Andrei-Vlad Badulescu, Raquel-Vanessa Dragan, Paolo Bottalico, Cristina Pop, Abdulrahman Ismaiel, Daria-Claudia Turtoi, Dinu Iuliu Dumitrascu, Cristina Pojoga, Claudia Gherman and Liliana David

J. Clin. Med. 2024, 13(6), 1630; https://doi.org/10.3390/jcm13061630 - 12 Mar 2024

Cited by 5 | Viewed by 3897

Abstract

Background: Coping strategies play a crucial role in managing inflammatory bowel disease (IBD), influencing both health-related quality of life (HRQoL) and psychological well-being. This study systematically reviews the available literature to analyze coping mechanisms in IBD populations and their impact. Methods: [...] Read more.

Background: Coping strategies play a crucial role in managing inflammatory bowel disease (IBD), influencing both health-related quality of life (HRQoL) and psychological well-being. This study systematically reviews the available literature to analyze coping mechanisms in IBD populations and their impact. Methods: Relevant English-language studies published until 2023 were identified through a comprehensive search of PubMed, EMBASE, EBSCOhost, and Cochrane Library. After applying inclusion and exclusion criteria, 57 articles underwent full analysis. Results: The findings highlight the diversity of coping strategies used by individuals with IBD and emphasize the need for a nuanced approach considering factors like disease severity, duration, and individual characteristics. This review underlines the influence of coping mechanisms on QoL and indicates their potential to aid IBD management and rehabilitation. Conclusions: This study underscores the value of investigating coping strategies to promote better outcomes for individuals with IBD. Future research should explore personalized interventions that address the heterogeneity of the IBD population. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches to Inflammatory Bowel Disease Management)

12 pages, 550 KiB

Open AccessEditor’s ChoiceReview

Right Ventricular Dysfunction before and after Cardiac Surgery: Prognostic Implications

by Anna Merlo, Camilla Cirelli, Enrico Vizzardi, Laura Fiorendi, Federica Roncali, Marco Marino, Maurizio Merlo, Michele Senni and Edoardo Sciatti

J. Clin. Med. 2024, 13(6), 1609; https://doi.org/10.3390/jcm13061609 - 11 Mar 2024

Cited by 7 | Viewed by 4406

Abstract

Right ventricular dysfunction is a prognostic factor for morbidity and mortality across a broad spectrum of cardiovascular diseases. While the role of the right ventricle in surgical patients has emerged, the prognostic impact of right ventricular dysfunction remains unclear in a large cardiac [...] Read more.

Right ventricular dysfunction is a prognostic factor for morbidity and mortality across a broad spectrum of cardiovascular diseases. While the role of the right ventricle in surgical patients has emerged, the prognostic impact of right ventricular dysfunction remains unclear in a large cardiac surgery population. We reviewed the existing literature about the role of right ventricular dysfunction in adults undergoing different kinds of cardiac surgery either present before or developed after surgery itself. Pre- and post-operative right ventricular dysfunction has demonstrated substantial prognostic implications. However, there remains a lack of consensus regarding its definition and diagnostic criteria. The available literature is limited to small-sized studies, underscoring the need for studies with larger populations. Full article

(This article belongs to the Special Issue Targeted Diagnosis and Treatment of Right Ventricular Function and Failure)

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16 pages, 1273 KiB

Open AccessEditor’s ChoiceReview

Displacing the Burden: A Review of Protein-Bound Uremic Toxin Clearance Strategies in Chronic Kidney Disease

by Didier Sánchez-Ospina, Sebastián Mas-Fontao, Carolina Gracia-Iguacel, Alejandro Avello, Marina González de Rivera, Maddalen Mujika-Marticorena and Emilio Gonzalez-Parra

J. Clin. Med. 2024, 13(5), 1428; https://doi.org/10.3390/jcm13051428 - 1 Mar 2024

Cited by 6 | Viewed by 3488

Abstract

Uremic toxins (UTs), particularly protein-bound uremic toxins (PBUTs), accumulate in chronic kidney disease (CKD) patients, causing significant health complications like uremic syndrome, cardiovascular disease, and immune dysfunction. The binding of PBUTs to plasma proteins such as albumin presents a formidable challenge for clearance, [...] Read more.

Uremic toxins (UTs), particularly protein-bound uremic toxins (PBUTs), accumulate in chronic kidney disease (CKD) patients, causing significant health complications like uremic syndrome, cardiovascular disease, and immune dysfunction. The binding of PBUTs to plasma proteins such as albumin presents a formidable challenge for clearance, as conventional dialysis is often insufficient. With advancements in the classification and understanding of UTs, spearheaded by the European Uremic Toxins (EUTox) working group, over 120 molecules have been identified, prompting the development of alternative therapeutic strategies. Innovations such as online hemodiafiltration aim to enhance the removal process, while novel adsorptive therapies offer a means to address the high affinity of PBUTs to plasma proteins. Furthermore, the exploration of molecular displacers, designed to increase the free fraction of PBUTs, represents a cutting-edge approach to facilitate their dialytic clearance. Despite these advancements, the clinical application of displacers requires more research to confirm their efficacy and safety. The pursuit of such innovative treatments is crucial for improving the management of uremic toxicity and the overall prognosis of CKD patients, emphasizing the need for ongoing research and clinical trials. Full article

(This article belongs to the Special Issue Clinical Application of Hemodialysis and Its Adverse Effects)

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12 pages, 1750 KiB

Open AccessEditor’s ChoiceReview

Evolution in the Management of Patella Fractures

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

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

Cited by 7 | Viewed by 5707

Abstract

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

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

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

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18 pages, 829 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 10 | Viewed by 11017

Abstract

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

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

(This article belongs to the Section Cardiovascular Medicine)

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11 pages, 250 KiB

Open AccessEditor’s ChoiceReview

Interactions between the Exocrine and the Endocrine Pancreas

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

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

Cited by 8 | Viewed by 6355

Abstract

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

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

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

13 pages, 624 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 6 | Viewed by 3635

Abstract

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

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

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

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14 pages, 673 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 9 | Viewed by 2688

Abstract

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

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

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

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13 pages, 275 KiB

Open AccessEditor’s ChoiceReview

Tele-Monitoring Applications in Respiratory Allergy

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

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

Cited by 8 | Viewed by 3813

Abstract

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

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

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

15 pages, 301 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 5 | Viewed by 2126

Abstract

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

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

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

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17 pages, 1006 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 6 | Viewed by 3939

Abstract

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

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

(This article belongs to the Section Clinical Neurology)

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23 pages, 3282 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 10 | Viewed by 20106

Abstract

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

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

(This article belongs to the Section Cardiology)

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15 pages, 558 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 8 | Viewed by 4378

Abstract

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

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

(This article belongs to the Section Obstetrics & Gynecology)

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14 pages, 1528 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 8 | Viewed by 2720

Abstract

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

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

(This article belongs to the Section Nephrology & Urology)

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13 pages, 5650 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 6 | Viewed by 2539

Abstract

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

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

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

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12 pages, 612 KiB

Open AccessEditor’s ChoiceReview

Arrhythmogenic Cardiomyopathy: Definition, Classification and Arrhythmic Risk Stratification

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

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

Cited by 7 | Viewed by 2310

Abstract

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

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

(This article belongs to the Section Cardiology)

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12 pages, 969 KiB

Open AccessEditor’s ChoiceReview

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

by Hideaki Kanemura

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

Cited by 6 | Viewed by 3153

Abstract

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

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

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

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13 pages, 393 KiB

Open AccessEditor’s ChoiceReview

Investigating the Association of Assisted Reproduction Techniques and Adverse Perinatal Outcomes

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

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

Cited by 12 | Viewed by 3034

Abstract

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

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

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

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13 pages, 4139 KiB

Open AccessFeature PaperEditor’s ChoiceReview

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

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

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

Cited by 7 | Viewed by 4154

Abstract

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

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

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

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10 pages, 235 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 6 | Viewed by 2451

Abstract

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

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

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

29 pages, 1355 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 6 | Viewed by 6655

Abstract

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

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

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

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24 pages, 4700 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 9 | Viewed by 4668

Abstract

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

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

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

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14 pages, 3558 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 9 | Viewed by 3551

Abstract

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

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

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

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16 pages, 3125 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 13 | Viewed by 7461

Abstract

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

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

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

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22 pages, 1836 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 17 | Viewed by 2843

Abstract

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

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

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

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