Journal of Clinical Medicine

Review

16 pages, 324 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 11 | Viewed by 2439

Abstract

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

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

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

23 pages, 807 KiB

Open AccessFeature PaperEditor’s ChoiceReview

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

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

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

Cited by 13 | Viewed by 6085

Abstract

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

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

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

► Show Figures

Figure 1

13 pages, 601 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 13 | Viewed by 4886

Abstract

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

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

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

► Show Figures

Figure 1

39 pages, 947 KiB

Open AccessEditor’s ChoiceReview

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

by Kim Oren Gradel

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

Cited by 14 | Viewed by 2484

Abstract

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

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

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

► Show Figures

Figure 1

21 pages, 690 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 18 | Viewed by 7116

Abstract

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

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

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

► Show Figures

Figure 1

13 pages, 604 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 13 | Viewed by 3291

Abstract

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

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

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

► Show Figures

Figure 1

23 pages, 3402 KiB

Open AccessEditor’s ChoiceReview

The Latest Advancements in Diagnostic Role of Endosonography of Pancreatic Lesions

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

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

Cited by 11 | Viewed by 3048

Abstract

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

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

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

► Show Figures

Figure 1

18 pages, 657 KiB

Open AccessEditor’s ChoiceReview

Modifiable Pancreatic Ductal Adenocarcinoma (PDAC) Risk Factors

by Natalia Michalak and Ewa Małecka-Wojciesko

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

Cited by 13 | Viewed by 5287

Abstract

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

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

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

► Show Figures

Figure 1

20 pages, 612 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 11 | Viewed by 3677

Abstract

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

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

(This article belongs to the Section Cardiology)

► Show Figures

Figure 1

20 pages, 1038 KiB

Open AccessFeature PaperEditor’s ChoiceReview

Efficacy and Safety of Dry Powder Antibiotics: A Narrative Review

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

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

Cited by 11 | Viewed by 3500

Abstract

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

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

(This article belongs to the Section Respiratory Medicine)

► Show Figures

Figure 1

12 pages, 275 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 11 | Viewed by 3460

Abstract

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

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

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

16 pages, 1458 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 11 | Viewed by 4398

Abstract

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

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

(This article belongs to the Section Cardiology)

► Show Figures

Figure 1

19 pages, 1427 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 9 | Viewed by 4427

Abstract

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

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

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

► Show Figures

Figure 1

28 pages, 22618 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 9 | Viewed by 4767

Abstract

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

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

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

► Show Figures

Figure 1

20 pages, 1939 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 12 | Viewed by 3623

Abstract

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

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

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

► Show Figures

Figure 1

31 pages, 567 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 13 | Viewed by 6652

Abstract

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

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

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

► Show Figures

Graphical abstract

13 pages, 1202 KiB

Open AccessEditor’s ChoiceReview

A Review of Parental Vaccine Hesitancy for Human Papillomavirus in Japan

by Madoka Lelliott, Ethan Sahker and Hemant Poudyal

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

Cited by 13 | Viewed by 2997

Abstract

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

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

(This article belongs to the Section Immunology)

► Show Figures

Figure 1

15 pages, 360 KiB

Open AccessEditor’s ChoiceReview

The Symptomatic Outcomes of Cholecystectomy for Gallstones

by Daniel Mønsted Shabanzadeh

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

Cited by 10 | Viewed by 4533

Abstract

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

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

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

14 pages, 326 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 9 | Viewed by 4121

Abstract

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

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

(This article belongs to the Section Anesthesiology)

22 pages, 3547 KiB

Open AccessEditor’s ChoiceReview

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

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

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

Cited by 8 | Viewed by 1975

Abstract

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

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

(This article belongs to the Section Cardiology)

► Show Figures

Figure 1

14 pages, 987 KiB

Open AccessEditor’s ChoiceReview

Juvenile Psoriatic Arthritis: Myth or Reality? An Unending Debate

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

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

Cited by 9 | Viewed by 12745

Abstract

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

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

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

► Show Figures

Figure 1

Other

28 pages, 914 KiB

Open AccessEditor’s ChoiceSystematic Review

Prognostic Factors in Patients Undergoing Physiotherapy for Chronic Low Back Pain: A Level I Systematic Review

by Alice Baroncini, Nicola Maffulli, Marco Pilone, Gennaro Pipino, Michael Kurt Memminger, Gaetano Pappalardo and Filippo Migliorini

J. Clin. Med. 2024, 13(22), 6864; https://doi.org/10.3390/jcm13226864 - 14 Nov 2024

Cited by 6 | Viewed by 2237

Abstract

Background: Low back pain is common. For patients with mechanic or non-specific chronic LBP (cLBP), the current guidelines suggest conservative, nonpharmacologic treatment as a first-line treatment. Among the available strategies, physiotherapy represents a common option offered to patients presenting with cLBP. The [...] Read more.

Background: Low back pain is common. For patients with mechanic or non-specific chronic LBP (cLBP), the current guidelines suggest conservative, nonpharmacologic treatment as a first-line treatment. Among the available strategies, physiotherapy represents a common option offered to patients presenting with cLBP. The present systematic review investigates the prognostic factors of patients with mechanic or non-specific cLBP undergoing physiotherapy. Methods: In September 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which evaluated the efficacy of a physiotherapy programme in patients with LBP were accessed. All studies evaluating non-specific or mechanical LBP were included. Data concerning the following PROMs were collected: the pain scale, Roland Morris Disability Questionnaire (RMQ), and Oswestry Disability Index (ODI). A multiple linear model regression analysis was conducted using the Pearson Product–Moment Correlation Coefficient. Results: Data from 2773 patients were retrieved. The mean length of symptoms before the treatment was 61.2 months. Conclusions: Age and BMI might exert a limited influence on the outcomes of the physiotherapeutic management of cLBP. Pain and disability at baseline might represent important predictors of health-related quality of life at the six-month follow-up. Further studies on a larger population with a longer follow-up are required to validate these results. Full article

(This article belongs to the Special Issue Clinical Advances in Spine Disorders)

► Show Figures

Figure 1

14 pages, 478 KiB

Open AccessEditor’s ChoiceSystematic Review

The Effect of Corticotomy-Assisted Orthodontic Therapy (CAOT) or Periodontally Accelerated Osteogenic Orthodontics (PAOO) on Bone Remodeling and the Health of Periodontium: A Systematic Review of Systematic Reviews

by Anna Ewa Kuc, Maria Kulgawczyk, Magdalena Ewa Sulewska, Natalia Kuc, Beata Kawala, Joanna Lis, Michał Sarul and Jacek Kotuła

J. Clin. Med. 2024, 13(19), 5726; https://doi.org/10.3390/jcm13195726 - 26 Sep 2024

Cited by 5 | Viewed by 2587

Abstract

Background: Orthodontic treatment involves moving teeth within the alveolar ridge. Bone remodeling is associated with the activity of osteoblasts and osteoclasts. Procedures such as corticotomy-assisted orthodontic therapy (CAOT) or periodontally accelerated osteogenic orthodontics (PAOO) are intended to reduce bone density and negative stress [...] Read more.

Background: Orthodontic treatment involves moving teeth within the alveolar ridge. Bone remodeling is associated with the activity of osteoblasts and osteoclasts. Procedures such as corticotomy-assisted orthodontic therapy (CAOT) or periodontally accelerated osteogenic orthodontics (PAOO) are intended to reduce bone density and negative stress on the grip side and therefore limit bone resorption during orthodontic movement or add bone substitute material so that the tooth does not cross the vestibular plate. Methods: The study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The study design was defined in the PICO format—Population (P): patients with full permanent dentition, both adolescents and adults; Intervention (I): orthodontic treatment with fixed appliances using additional supportive treatments such as CAOT or PAOO; Comparison (C): assessment of the impact of additional treatments during orthodontic treatment on the remodeling of the alveolar bone and the condition of the periodontium; Result (O): statistically significant/non-significant differences in the condition of the alveolar bone before and after orthodontic treatment. Search filters include the time of publication of the article, systematic reviews from the last five years, and publications that appeared in English. The information provided in the abstracts of systematic reviews that describe the effects of additional procedures during orthodontic treatment such as CAOT or PAOO on the health of periodontium was analyzed. Articles unrelated to the subject of the planned study and those in which tooth movement acceleration was analyzed were excluded. Results: Eight articles were selected in which a total number of 835 subjects took part. The changes in bone density and effects on periodontium were different after CAOT and PAOO. Conclusions: The validity of CAOT and PAOO procedures remains controversial. Better results are obtained when combined with tissue augmentation or thickening of the gingival phenotype rather than as stand-alone procedures, as their uses to protect periodontal tissues are limited. Full article

(This article belongs to the Special Issue Orthodontics: Current Advances and Future Options)

► Show Figures

Figure 1

14 pages, 582 KiB

Open AccessEditor’s ChoiceSystematic Review

The Impact of Night Work on the Sleep and Health of Medical Staff—A Review of the Latest Scientific Reports

by Katarzyna Czyż-Szypenbejl and Wioletta Mędrzycka-Dąbrowska

J. Clin. Med. 2024, 13(15), 4505; https://doi.org/10.3390/jcm13154505 - 1 Aug 2024

Cited by 5 | Viewed by 7978

Abstract

Introduction: Employees working in shifts are exposed to many threats affecting their health, quality of life and safety at work. Those who perform their work only at night are particularly vulnerable. The purpose of the review is to identify risks to the health, [...] Read more.

Introduction: Employees working in shifts are exposed to many threats affecting their health, quality of life and safety at work. Those who perform their work only at night are particularly vulnerable. The purpose of the review is to identify risks to the health, quality of life and sleep of shift health workers. Method: A systematic review (SR) was used in the analysis. Electronic databases were searched. The search was limited to the latest studies published in the last five years: 2019–2023. Results: Finally, 36 articles were included in the review. Most authors have shown a link between sleep disturbance or its quality and shift work/night work. Moreover, a three-shift schedule was the most significant factor for poorer subjective sleep quality when compared to other work schedules. Furthermore, many authors have shown a link between shift/night work and health problems, which include cardiometabolic risk, glucose intolerance, breast cancer and immune vulnerability. Conclusions: The research results clearly show a significant impact of night work on the increased risk of sleep disorders and health disturbance. Healthcare workers should be aware of the risks associated with night work in order to take measures preventing sleep/health problems. Shift/night workers should have the opportunity to be screened for disorders linked with their work. Full article

(This article belongs to the Special Issue Association Between Sleep Disorders and Diabetes)

► Show Figures

Graphical abstract

30 pages, 2326 KiB

Open AccessEditor’s ChoiceSystematic Review

Global Prevalence of Sleep Bruxism and Awake Bruxism in Pediatric and Adult Populations: A Systematic Review and Meta-Analysis

by Grzegorz Zieliński, Agnieszka Pająk and Marcin Wójcicki

J. Clin. Med. 2024, 13(14), 4259; https://doi.org/10.3390/jcm13144259 - 22 Jul 2024

Cited by 43 | Viewed by 10132

Abstract

Background/Objectives: The purpose of this systematic review was to assess the global prevalence of sleep bruxism and awake bruxism in pediatric and adult populations. Methods: This systematic review was conducted by analyzing studies published from 2003 to 2023. The following keyword [...] Read more.

Background/Objectives: The purpose of this systematic review was to assess the global prevalence of sleep bruxism and awake bruxism in pediatric and adult populations. Methods: This systematic review was conducted by analyzing studies published from 2003 to 2023. The following keyword combination was utilized: prevalence, epidemiology, population, and bruxism. The PubMed database was analyzed, supplemented by manual searches using the Google search. Additionally, the snowballing procedure method was applied. A double assessment of the quality of publications was carried out to preserve the highest possible quality of evidence (e.g., Joanna Briggs Institute critical appraisal checklist). Analyses were conducted using the R statistical language. Results: The global bruxism (sleep and awake) prevalence is 22.22%. The global sleep bruxism prevalence is 21% and awake prevalence is 23%. The occurrence of sleep bruxism, based on polysomnography, was estimated at 43%. The highest prevalence of sleep bruxism was observed in North America at 31%, followed by South America at 23%, Europe at 21%, and Asia at 19%. The prevalence of awake bruxism was highest in South America at 30%, followed by Asia at 25% and Europe at 18%. Conclusions: One in four individuals may experience awake bruxism. Bruxism is a significant factor among women. It was observed that age is a significant factor for the occurrence of sleep bruxism in women. Among the limitations of the study is the lack of analysis of the prevalence of bruxism in Africa and Australia due to not collecting an adequate sample for analysis. The study was registered in the Open Science Framework (10.17605/OSF.IO/ZE786). Full article

(This article belongs to the Special Issue The Current Trend in the Management of Bruxism and Temporomandibular Disorders)

► Show Figures

Graphical abstract

18 pages, 804 KiB

Open AccessEditor’s ChoiceSystematic Review

Work-Related Musculoskeletal Disorders: A Systematic Review and Meta-Analysis

by Chiara Greggi, Virginia Veronica Visconti, Marco Albanese, Beatrice Gasperini, Angela Chiavoghilefu, Caterina Prezioso, Benedetta Persechino, Sergio Iavicoli, Elena Gasbarra, Riccardo Iundusi and Umberto Tarantino

J. Clin. Med. 2024, 13(13), 3964; https://doi.org/10.3390/jcm13133964 - 6 Jul 2024

Cited by 15 | Viewed by 14345

Abstract

Background: Musculoskeletal disorders (MSDs) involve muscles, nerves, tendons, joints, cartilage, and spinal discs. These conditions can be triggered by both the work environment and the type of work performed, factors that, in some cases, can also exacerbate pre-existing conditions. This systematic review aims [...] Read more.

Background: Musculoskeletal disorders (MSDs) involve muscles, nerves, tendons, joints, cartilage, and spinal discs. These conditions can be triggered by both the work environment and the type of work performed, factors that, in some cases, can also exacerbate pre-existing conditions. This systematic review aims to provide an overview of the impact that different work-related activities have on the musculoskeletal system. Methods: A global search of publications was conducted using the following international bibliographic web databases: PubMed and Web of Science. The search strategies combined terms for musculoskeletal disorders and workers. In addition, a meta-analysis was conducted to estimate the prevalence of MSDs within the healthcare sector. Results: A total of 10,805 non-duplicated articles were identified, and finally, 32 studies were reviewed in this article. Once the literature search was completed, occupational figures were categorized into healthcare, farming, industrial, and computer sectors. In the healthcare sector, the prevalence estimate for degenerative diseases of the lumbar spine was 21% (497 out of 2547 physicians and dentists) (95% CI, 17–26%), while for osteoarthritis of the hand, it was 37% (382 out of 1013 dentists) (95% CI, 23–51%). Conclusions: Musculoskeletal disorders significantly impair workers’ quality of life, especially in healthcare sector. These conditions are also associated with high costs for employers, such as absenteeism, lost productivity, and increased costs for healthcare, disability, and workers’ compensation. Full article

(This article belongs to the Section Orthopedics)

► Show Figures

Figure 1

16 pages, 4495 KiB

Open AccessEditor’s ChoiceSystematic Review

Clinical Outcomes in Scleral Fixation Secondary Intraocular Lens with Yamane versus Suture Techniques: A Systematic Review and Meta-Analysis

by Charles Zhang, Charles Palka, Daniel Zhu, Daniel Lai, Jules Winokur, Treefa Shwani, Margaret M. DeAngelis and Andrew L. Reynolds

J. Clin. Med. 2024, 13(11), 3071; https://doi.org/10.3390/jcm13113071 - 24 May 2024

Cited by 5 | Viewed by 2213

Abstract

Background: The purpose of the study is to compare the visual outcomes and complications of sutured scleral fixation (SSF), a traditional and conservative surgical approach, and the newer and faster Yamane technique for secondary intraocular lens placement. Methods: A literature search was performed [...] Read more.

Background: The purpose of the study is to compare the visual outcomes and complications of sutured scleral fixation (SSF), a traditional and conservative surgical approach, and the newer and faster Yamane technique for secondary intraocular lens placement. Methods: A literature search was performed on PubMed, Embase, and Scopus on studies published between 1 July 2017 to 29 September 2023. Outcomes analyzed included the final best corrected visual acuity (BCVA) between 3 and 12 months to assess the effectiveness of the procedure, post-operative month (POM) 1 BCVA to assess the speed of visual recovery, endothelial cell count (ECC), absolute refractive error, surgical duration, and complication rates. Additional subgroup analyses were performed based on surgeon experience with the technique. Single-surgeon studies had an average of 26 procedures performed, whereas multiple-surgeon studies averaged only 9 procedures performed; these were then used to delineate surgeon experience. A sample-size weighted mean difference (MD) meta-analysis was performed across all variables using RevMan 5.4.1; p < 0.05 was considered statistically significant. Results: Thirteen studies with 737 eyes were included: 406 eyes were included in the SSF group, and 331 eyes were included in the Yamane group. There was no significant difference in the final BCVA between groups in both the single-surgeon versus multiple-surgeon studies (MD = −0.01, 95% CI: [−0.06, 0.04], p = 0.73). In the single-surgeon studies, the BCVA at POM1 was significantly improved in the Yamane group compared to SSF (MD = −0.10, 95% CI: [−0.16, −0.04], p = 0.002). In the multiple-surgeon studies, there was no significant difference in BCVA at POM1 (MD = −0.06, 95% CI: [−0.16, 0.04], p = 0.23). The Yamane group had a shorter surgical duration than SSF in both single-surgeon and multiple-surgeon studies (MD = −24.68, 95% CI: [−35.90, −13.46], p < 0.0001). The ECC, refractive error, and complication rates did not significantly differ amongst all groups. Conclusions: The Yamane technique demonstrated similar long-term visual outcomes and complication rates to the traditional SSF. Visual recovery was significantly faster in the Yamane group in the single-surgeon studies. The operative times were shorter across all Yamane groups. Based on these findings, it is advisable to consider the Yamane technique as a viable, and perhaps preferable, option for patients requiring secondary IOL placement, alongside traditional SSF methods. Full article

(This article belongs to the Section Ophthalmology)

► Show Figures

Figure 1

16 pages, 838 KiB

Open AccessEditor’s ChoiceSystematic Review

Landiolol for Treatment of New-Onset Atrial Fibrillation in Critical Care: A Systematic Review

by Bruno Levy, Michel Slama, Ines Lakbar, Julien Maizel, Hiromi Kato, Marc Leone and Motoi Okada

J. Clin. Med. 2024, 13(10), 2951; https://doi.org/10.3390/jcm13102951 - 17 May 2024

Cited by 8 | Viewed by 3805

Abstract

Background: new-onset atrial fibrillation remains a common complication in critical care settings, often necessitating treatment when the correction of triggers is insufficient to restore hemodynamics. The treatment strategy includes electric cardioversion in cases of hemodynamic instability and either rhythm control or rate [...] Read more.

Background: new-onset atrial fibrillation remains a common complication in critical care settings, often necessitating treatment when the correction of triggers is insufficient to restore hemodynamics. The treatment strategy includes electric cardioversion in cases of hemodynamic instability and either rhythm control or rate control in the absence of instability. Landiolol, an ultrashort beta-blocker, effectively controls heart rate with the potential to regulate rhythm. Objectives This review aims to compare the efficacy of landiolol in controlling heart rate and converting to sinus rhythm in the critical care setting. Methods: We conducted a comprehensive review of the published literature from 2000 to 2022 describing the use of landiolol to treat atrial fibrillation in critical care settings, excluding both cardiac surgery and medical cardiac care settings. The primary outcome assessed was sinus conversion following landiolol treatment. Results: Our analysis identified 17 publications detailing the use of landiolol for the treatment of 324 critical care patients. While the quality of the data was generally low, primarily comprising non-comparative studies, landiolol consistently demonstrated similar efficacy in controlling heart rate and facilitating conversion to sinus rhythm in both non-surgical (75.7%) and surgical (70.1%) settings. The incidence of hypotension associated with landiolol use was 13%. Conclusions: The use of landiolol in critical care patients with new-onset atrial fibrillation exhibited comparable efficacy and tolerance in both non-surgical and surgical settings. Despite these promising results, further validation through randomized controlled trials is necessary. Full article

(This article belongs to the Section Intensive Care)

► Show Figures

Figure 1

24 pages, 1684 KiB

Open AccessEditor’s ChoiceSystematic Review

The Enhanced Recovery after Surgery Approach in Heart Valve Surgery: A Systematic Review of Clinical Studies

by Pietro Giorgio Malvindi, Olimpia Bifulco, Paolo Berretta, Michele Galeazzi, Jacopo Alfonsi, Mariano Cefarelli, Carlo Zingaro, Hossein M. Zahedi, Christopher Munch and Marco Di Eusanio

J. Clin. Med. 2024, 13(10), 2903; https://doi.org/10.3390/jcm13102903 - 14 May 2024

Cited by 9 | Viewed by 2184

Abstract

Background: Enhanced recovery after surgery (ERAS) protocols aim to reduce postoperative complications and promote earlier recovery. Although it is well established in noncardiac surgery fields, the ERAS approach has only recently been adopted in cardiac surgery. The aim of this review is to [...] Read more.

Background: Enhanced recovery after surgery (ERAS) protocols aim to reduce postoperative complications and promote earlier recovery. Although it is well established in noncardiac surgery fields, the ERAS approach has only recently been adopted in cardiac surgery. The aim of this review is to evaluate the status and implementation of ERAS protocols in patients undergoing heart valve surgery and to summarise associated clinical results. Methods: A literature search for the period January 2015 and January 2024 was performed through online databases. Clinical studies (randomised controlled trials and cohort studies) on patients undergoing heart valve surgical procedures and comparing ERAS and conventional approaches were included. The data extracted covered studies and populations characteristics, early outcomes and the features of each ERAS protocol. Results: There were 14 studies that fulfilled the final search criteria and were ultimately included in the review. Overall, 5142 patients were identified in the 14 studies, with 2501 in ERAS groups and 2641 patients who were representative of control groups. Seven experiences exclusively included patients who underwent heart valve surgery. Twelve out of fourteen protocols involved multiple interventions from the preoperative to postoperative phase, while two studies reported actions limited to intraoperative and postoperative care. We found high heterogeneity among the included protocols regarding key actions targeted for improvement and measured outcomes. All the studies showed that ERAS pathways can be safely adopted in cardiac surgery and in most of the experiences were associated with shorter mechanical ventilation time, reduced postoperative opioid use and reduced ICU and hospital stays. Conclusions: As demonstrated in noncardiac surgery, the adoption of structured ERAS protocols has the potential to improve results in patients undergoing heart valve surgery. Further evidence based on larger populations is needed, including more homogenous pathways and reporting further outcomes in terms of patient satisfaction, recovery and quality of life after surgery. Full article

(This article belongs to the Section Cardiovascular Medicine)

► Show Figures

Figure 1

14 pages, 1862 KiB

Open AccessEditor’s ChoiceSystematic Review

Does Thoracic Duct Ligation at the Time of Esophagectomy Impact Long-Term Survival? An Individual Patient Data Meta-Analysis

by Alberto Aiolfi, Davide Bona, Matteo Calì, Michele Manara, Emanuele Rausa, Gianluca Bonitta, Moustafa Elshafei, Sheraz R. Markar and Luigi Bonavina

J. Clin. Med. 2024, 13(10), 2849; https://doi.org/10.3390/jcm13102849 - 12 May 2024

Cited by 5 | Viewed by 1806

Abstract

Background: Thoracic duct ligation (TDL) during esophagectomy has been proposed to reduce the risk of postoperative chylothorax. Because of its role in immunoregulation, some authors argued that it had an unfavorable TDL effect on survival. The aim of this study was to [...] Read more.

Background: Thoracic duct ligation (TDL) during esophagectomy has been proposed to reduce the risk of postoperative chylothorax. Because of its role in immunoregulation, some authors argued that it had an unfavorable TDL effect on survival. The aim of this study was to analyze the effect of TDL on overall survival (OS). Methods: PubMed, MEDLINE, Scopus, and Web of Science were searched through December 2023. The primary outcome was 5-year OS. The restricted mean survival time difference (RMSTD), hazard ratios (HRs), and 95% confidence intervals (CI) were used as pooled effect size measures. The GRADE methodology was used to summarize the certainty of the evidence. Results: Five studies (3291 patients) were included. TDL was reported in 54% patients. The patients’ age ranged from 49 to 69, 76% were males, and BMI ranged from 18 to 26. At the 5-year follow-up, the combined effect from the multivariate meta-analysis is -3.5 months (95% CI −6.1, −0.8) indicating that patients undergoing TDL lived 3.5 months less compared to those without TDL. TDL was associated with a significantly higher hazard for mortality at 12 months (HR 1.54, 95% CI 1.38–1.73), 24 months (HR 1.21, 95% CI 1.12–1.35), and 28 months (HR 1.14, 95% CI 1.02–1.28). TDL and noTDL seem comparable in terms of the postoperative risk for chylothorax (RR = 0.66; p = 0.35). Conclusions: In this study, concurrent TDL was associated with reduced 5-year OS after esophagectomy. This may suggest the need of a rigorous follow-up within the first two years of follow-up. Full article

(This article belongs to the Special Issue Clinical Updates on the Diagnosis and Treatment of Esophageal Cancer)

► Show Figures

Figure 1

15 pages, 878 KiB

Open AccessEditor’s ChoiceSystematic Review

Association between Bone Turnover Markers and Fracture Healing in Long Bone Non-Union: A Systematic Review

by Francesca Perut, Laura Roncuzzi, Enrique Gómez-Barrena and Nicola Baldini

J. Clin. Med. 2024, 13(8), 2333; https://doi.org/10.3390/jcm13082333 - 17 Apr 2024

Cited by 6 | Viewed by 2203

Abstract

Background: Fracture healing is a very complex and well-orchestrated regenerative process involving many cell types and molecular pathways. Despite the high efficiency of this process, unsatisfying healing outcomes, such as non-union, occur for approximately 5–10% of long bone fractures. Although there is [...] Read more.

Background: Fracture healing is a very complex and well-orchestrated regenerative process involving many cell types and molecular pathways. Despite the high efficiency of this process, unsatisfying healing outcomes, such as non-union, occur for approximately 5–10% of long bone fractures. Although there is an obvious need to identify markers to monitor the healing process and to predict a potential failure in callus formation to heal the fracture, circulating bone turnover markers’ (BTMs) utility as biomarkers in association with radiographic and clinical examination still lacks evidence so far. Methods: A systematic review on the association between BTMs changes and fracture healing in long bone non-union was performed following PRISMA guidelines. The research papers were identified via the PubMed, Cochrane, Cinahl, Web of Science, Scopus, and Embase databases. Studies in which the failure of fracture healing was associated with osteoporosis or genetic disorders were not included. Results: A total of 172 studies were collected and, given the inclusion criteria, 14 manuscripts were included in this review. Changes in circulating BTMs levels were detected during the healing process and across groups (healed vs. non-union patients and healthy vs. patients with non-union). However, we found high heterogeneity in patients’ characteristics (fracture site, gender, and age) and in sample scheduling, which made it impossible to perform a meta-analysis. Conclusions: Clinical findings and radiographic features remain the two important components of non-union diagnosis so far. We suggest improving blood sample standardization and clinical data collection in future research to lay the foundations for the effective use of BTMs as tools for diagnosing non-union. Full article

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

► Show Figures

Figure 1

18 pages, 2513 KiB

Open AccessEditor’s ChoiceSystematic Review

Influence of High-Intensity Interval Training on Neuroplasticity Markers in Post-Stroke Patients: Systematic Review

by Gines Montero-Almagro, Carlos Bernal-Utrera, Noelia Geribaldi-Doldán, Pedro Nunez-Abades, Carmen Castro and Cleofas Rodriguez-Blanco

J. Clin. Med. 2024, 13(7), 1985; https://doi.org/10.3390/jcm13071985 - 29 Mar 2024

Cited by 5 | Viewed by 3736

Abstract

Background: Exercise has shown beneficial effects on neuronal neuroplasticity; therefore, we want to analyze the influence of high-intensity interval training (HIIT) on neuroplasticity markers in post-stroke patients. Methods: A systematic review of RCTs including studies with stroke participants was conducted using the following [...] Read more.

Background: Exercise has shown beneficial effects on neuronal neuroplasticity; therefore, we want to analyze the influence of high-intensity interval training (HIIT) on neuroplasticity markers in post-stroke patients. Methods: A systematic review of RCTs including studies with stroke participants was conducted using the following databases (PubMed, LILACS, ProQuest, PEDro, Web of Science). Searches lasted till (20/11/2023). Studies that used a HIIT protocol as the main treatment or as a coadjutant treatment whose outcomes were neural plasticity markers were used and compared with other exercise protocols, controls or other kinds of treatment. Studies that included other neurological illnesses, comorbidities that interfere with stroke or patients unable to complete a HIIT protocol were excluded. HIIT protocol, methods to assess intensity, neuroplasticity markers (plasmatic and neurophysiological) and other types of assessments such as cognitive scales were extracted to make a narrative synthesis. Jadad and PEDro scales were used to assess bias. Results: Eight articles were included, one included lacunar stroke (less than 3 weeks) and the rest had chronic stroke. The results found here indicate that HIIT facilitates neuronal recovery in response to an ischemic injury. This type of training increases the plasma concentrations of lactate, BDNF and VEGF, which are neurotrophic and growth factors involved in neuroplasticity. HIIT also positively regulates other neurophysiological measurements that are directly associated with a better outcome in motor learning tasks. Conclusions: We conclude that HIIT improves post-stroke recovery by increasing neuroplasticity markers. However, a limited number of studies have been found indicating that future studies are needed that assess this effect and include the analysis of the number of intervals and their duration in order to maximize this effect. Full article

(This article belongs to the Topic Advances in Exercise-Induced Neurogenesis, Neuronal and Functional Adaptations in Neurorehabilitation)

► Show Figures

Graphical abstract

12 pages, 1924 KiB

Open AccessEditor’s ChoiceSystematic Review

A Long-Term Comparative Analysis of Endovascular Coiling and Clipping for Ruptured Cerebral Aneurysms: An Individual Patient-Level Meta-Analysis Assessing Rerupture Rates

by Johannes Wach, Martin Vychopen, Agi Güresir, Alexandru Guranda, Ulf Nestler and Erdem Güresir

J. Clin. Med. 2024, 13(6), 1778; https://doi.org/10.3390/jcm13061778 - 20 Mar 2024

Cited by 6 | Viewed by 2913

Abstract

Background: Although the initial functional outcome findings of the International Subarachnoid Aneurysm Trial (ISAT) study favored coiling at one year after aneurysmal subarachnoid hemorrhage (aSAH), concerns arose regarding limited long-term rerupture data. This meta-analysis is the first to analyze longitudinal individual patient data [...] Read more.

Background: Although the initial functional outcome findings of the International Subarachnoid Aneurysm Trial (ISAT) study favored coiling at one year after aneurysmal subarachnoid hemorrhage (aSAH), concerns arose regarding limited long-term rerupture data. This meta-analysis is the first to analyze longitudinal individual patient data (IPD) of target aneurysm rerupture in terms of treatment modality. Methods: The present meta-analysis included studies that compared clipping with coiling of ruptured aneurysms regarding long-term rerupture. Rerupture rates’ individual patient data (IPD) were extracted from published Kaplan–Meier curves utilizing the R package IPDfromKM in R Version 4.3.1. Results: A total of 3153 patients from two studies were included. The clipping arm included 1755 patients, whereas the coiling arm included 1398 patients. Median reconstructed follow-up was 6.1 years (IQR = 0.5–11.7). The rerupture rates in the clipping arm and the coiling arm were 0.5% and 1.5%, respectively (p = 0.002). Kaplan–Meier chart analysis of the 3153 patients revealed a shortened time to rerupture in the coiling arm (log-rank test: p = 0.01). The hazard ratio (HR) for coiling compared with clipping regarding rerupture was 3.62 (95% CI:1.21–10.86, p = 0.02). Conclusion: Target aneurysm rerupture was rare beyond the initial year. Pooled long-term IPD from the 3153 patients revealed that reruptures of target aneurysms are more common after coiling and might be considered in the pretherapeutic decision-making process for aSAH. Full article

(This article belongs to the Special Issue Subarachnoid Hemorrhage: Clinical Advances and Challenges)

► Show Figures

Graphical abstract

19 pages, 1336 KiB

Open AccessEditor’s ChoiceSystematic Review

Candida auris Infection, a Rapidly Emerging Threat in the Neonatal Intensive Care Units: A Systematic Review

by Rozeta Sokou, Alexia Eleftheria Palioura, Paschalia Kopanou Taliaka, Aikaterini Konstantinidi, Andreas G. Tsantes, Daniele Piovani, Konstantina A. Tsante, Eleni A. Gounari, Zoi Iliodromiti, Theodora Boutsikou, Argirios E. Tsantes, Stefanos Bonovas and Nicoletta Iacovidou

J. Clin. Med. 2024, 13(6), 1586; https://doi.org/10.3390/jcm13061586 - 10 Mar 2024

Cited by 16 | Viewed by 4132

Abstract

(1) Background: In recent years, a global epidemiological shift in candidemia has been observed, marked by the emergence of resistant non-albicans Candida species. Candida auris, in particular, has become a significant global concern, causing infections in both pediatric and adult populations within [...] Read more.

(1) Background: In recent years, a global epidemiological shift in candidemia has been observed, marked by the emergence of resistant non-albicans Candida species. Candida auris, in particular, has become a significant global concern, causing infections in both pediatric and adult populations within healthcare settings. Despite its widespread impact, there is a limited understanding of the clinical course and transmission dynamics of neonatal systemic Candida auris infections, hindering effective prevention and management. This study focused on the epidemiologic data, the clinical presentation, risk factors, and outcome of C. auris infection in neonatal population. (2) Methods: A systematic review of the literature using PubMed and Scopus databases until December 2023 was conducted. (3) Results: A total of 24 relevant studies were identified, encompassing 476 documented cases of Candida auris infection in neonates. Prematurity emerged as a primary risk factor, alongside total parenteral nutrition, central line insertion, mechanical ventilation, and prior broad-spectrum antibiotic use. The mortality rate reached approximately 42%, with therapeutic details sparingly reported in 12% of cases. Treatment strategies varied, with amphotericin B predominantly used as monotherapy, while combination antifungal agents were used in 44% of cases. Notably, 97.4% of cases exhibited fluconazole resistance, and 67.1% showed resistance to amphotericin B. Limited data were available on resistance to other antifungal agents. (4) Conclusions: Despite the rarity of neonatal Candida auris infections, their global occurrence necessitates comprehensive preparedness in patient care. A deeper understanding of Candida auris pathogenesis is crucial for developing effective strategies to control and prevent neonatal infections caused by this pathogen. Full article

(This article belongs to the Section Clinical Pediatrics)

► Show Figures

Figure 1

14 pages, 3884 KiB

Open AccessEditor’s ChoiceSystematic Review

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

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

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

Cited by 5 | Viewed by 2543

Abstract

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

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

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

► Show Figures

Figure 1

13 pages, 2314 KiB

Open AccessEditor’s ChoiceSystematic Review

A Meta-Analysis of the Global Prevalence of Temporomandibular Disorders

by Grzegorz Zieliński, Beata Pająk-Zielińska and Michał Ginszt

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

Cited by 115 | Viewed by 12699

Abstract

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

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

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

► Show Figures

Graphical abstract

21 pages, 2985 KiB

Open AccessEditor’s ChoiceSystematic Review

Celiac Disease-Related Enamel Defects: A Systematic Review

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

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

Cited by 6 | Viewed by 4591

Abstract

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

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

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

► Show Figures

Figure 1

12 pages, 2481 KiB

Open AccessEditor’s ChoiceSystematic Review

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

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

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

Cited by 10 | Viewed by 1967

Abstract

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

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

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

► Show Figures

Figure 1

32 pages, 2659 KiB

Open AccessEditor’s ChoiceSystematic Review

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

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

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

Cited by 6 | Viewed by 4630

Abstract

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

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

(This article belongs to the Section Orthopedics)

► Show Figures

Figure 1

35 pages, 1283 KiB

Open AccessEditor’s ChoiceSystematic Review

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

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

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

Cited by 14 | Viewed by 8139

Abstract

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

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

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

► Show Figures

Figure 1

13 pages, 904 KiB

Open AccessEditor’s ChoiceSystematic Review

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

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

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

Cited by 6 | Viewed by 2053

Abstract

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

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

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

► Show Figures

Figure 1

12 pages, 1107 KiB

Open AccessEditor’s ChoiceSystematic Review

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

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

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

Cited by 4 | Viewed by 1668

Abstract

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

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

(This article belongs to the Section Orthopedics)

► Show Figures

Figure 1

30 pages, 2462 KiB

Open AccessEditor’s ChoiceSystematic Review

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

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

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

Cited by 5 | Viewed by 2827

Abstract

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

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

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

► Show Figures

Figure 1

20 pages, 3319 KiB

Open AccessEditor’s ChoiceSystematic Review

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

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

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

Cited by 11 | Viewed by 3438

Abstract

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

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

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

► Show Figures

Figure 1

33 pages, 1796 KiB

Open AccessEditor’s ChoiceSystematic Review

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

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

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

Cited by 17 | Viewed by 3554

Abstract

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

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

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

► Show Figures

Figure 1

15 pages, 1958 KiB

Open AccessEditor’s ChoiceSystematic Review

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

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

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

Cited by 14 | Viewed by 2260

Abstract

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

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

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

► Show Figures

Figure 1

16 pages, 556 KiB

Open AccessEditor’s ChoiceSystematic Review

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

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

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

Cited by 15 | Viewed by 3077

Abstract

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

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

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

► Show Figures

Figure 1

19 pages, 4677 KiB

Open AccessEditor’s ChoiceSystematic Review

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

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

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

Cited by 11 | Viewed by 2200

Abstract

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

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

(This article belongs to the Section Obstetrics & Gynecology)

► Show Figures

Figure 1

14 pages, 1766 KiB

Open AccessEditor’s ChoiceSystematic Review

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

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

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

Cited by 13 | Viewed by 3287

Abstract

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

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

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

► Show Figures

Figure 1

24 pages, 869 KiB

Open AccessEditor’s ChoiceSystematic Review

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

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

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

Cited by 9 | Viewed by 3316

Abstract

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

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

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

► Show Figures

Figure 1

Journal Menu

Journal Browser

Editor’s Choice Articles

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI