Diagnosis, Management, and Prognostic Assessment of Chronic Disease

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Journal of Clinical Medicine jcm	3.0	5.7	2012	16 Days	CHF 2600	Submit
Journal of Personalized Medicine jpm	-	4.1	2011	17.4 Days	CHF 2600	Submit
Journal of Vascular Diseases jvd	-	-	2022	23.3 Days	CHF 1000	Submit
Diagnostics diagnostics	3.0	4.7	2011	20.3 Days	CHF 2600	Submit
Cancers cancers	4.5	8.0	2009	17.4 Days	CHF 2900	Submit

22 pages, 2137 KiB

Open AccessArticle

Tuberous Sclerosis Complex: A Case Series from a Romanian Genetics Center and a Review of the Literature

by Aurora Alexandra Jurca, Ramona Hodisan, Alexandru Daniel Jurca, Emilia Severin, Sanziana Jurca, Ana Trandafir, Tiberia Ilias, Cosmin Vesa and Claudia Maria Jurca

J. Clin. Med. 2025, 14(9), 2974; https://doi.org/10.3390/jcm14092974 - 25 Apr 2025

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Abstract

Introduction: Tuberous sclerosis complex (TSC) is a rare multisystemic genetic disorder characterized by the formation of benign tumors in various organs, including the central nervous system, skin, kidneys, and heart. The diagnosis is based on well-defined clinical criteria, such as those from [...] Read more.

Introduction: Tuberous sclerosis complex (TSC) is a rare multisystemic genetic disorder characterized by the formation of benign tumors in various organs, including the central nervous system, skin, kidneys, and heart. The diagnosis is based on well-defined clinical criteria, such as those from Schwartz (2007) updated in 2012 by the International Tuberous Sclerosis Complex Consensus Group. The study aims to investigate the clinical, imaging, and molecular characteristics of patients diagnosed with tuberous sclerosis and to explore the correlation between specific genetic mutations (TSC1 and TSC2 genes) and the severity of clinical manifestations. Material and Methods: This is a retrospective longitudinal study of 13 patients diagnosed with tuberous sclerosis, identified in the records of the Bihor Regional Center for Medical Genetics (BRCMG) within the Bihor County Emergency Clinical Hospital from 1984 to 2024. Clinical, imaging, and molecular features were assessed. Patients were evaluated by a multidisciplinary team, including a geneticist, pediatrician, neurologist, psychiatrist, and psychologist. Clinical and imaging data were retrospectively collected from the congenital malformations and genetic disease records of BRCMG Bihor and statistically analyzed. Results: All patients showed clinical and imaging signs consistent with the diagnosis of tuberous sclerosis. Neurological manifestations were present in 83% of patients, including epilepsy and cognitive delays. Renal lesions were detected in 46% of cases, and dermatological lesions, such as facial angiofibromas, were observed in 69% of patients. Mutational variants identified in the TSC2 gene correlated with a more severe clinical presentation, including severe intellectual disability and treatment-resistant seizures, compared to variants in the TSC1 gene. Conclusions: Our study, although involving a small number of patients, highlights the clinical heterogeneity of tuberous sclerosis and the importance of a multidisciplinary approach in patient management. Early diagnosis and ongoing monitoring are essential to improving the quality of life for patients. Further studies are needed to assess the impact of therapeutic interventions and genetic correlations within the studied population. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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9 pages, 485 KiB

Open AccessArticle

Intestinal Failure in Pediatric Vascular Ehlers–Danlos Syndrome: A Case Series and Literature Review

by Carolina Percul, Veronica Busoni, Carina Izquierdo and Pablo A. Lobos

J. Vasc. Dis. 2025, 4(2), 17; https://doi.org/10.3390/jvd4020017 - 24 Apr 2025

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Abstract

Background: Vascular Ehlers–Danlos syndrome (vEDS) is a rare connective tissue disorder characterized by collagen type III deficiency, predisposing to spontaneous arterial, uterine, and intestinal ruptures. While intestinal complications are recognized in vEDS, intestinal failure (IF) secondary to these complications is a rare and [...] Read more.

Background: Vascular Ehlers–Danlos syndrome (vEDS) is a rare connective tissue disorder characterized by collagen type III deficiency, predisposing to spontaneous arterial, uterine, and intestinal ruptures. While intestinal complications are recognized in vEDS, intestinal failure (IF) secondary to these complications is a rare and potentially life-threatening occurrence. This study aimed to describe the clinical presentation, surgical management, and outcomes of pediatric patients with IF secondary to vEDS and to provide a comprehensive review of the limited existing literature on this challenging clinical scenario. Methods: This study comprises a case series of pediatric patients with IF due to vEDS complications and a comprehensive literature review. Clinical data were collected from medical records, including age at diagnosis, surgical history, complications, nutritional status, and long-term outcomes. A literature review was performed to identify studies reporting gastrointestinal complications, surgical outcomes in pediatric vEDS patients, and cases of intestinal failure. Results: Two pediatric patients with vEDS and IF were included. Both patients experienced intestinal perforations and surgical complications and required long-term parenteral nutrition (PN). One patient required PN for 18 months before achieving enteral autonomy, while the other remains dependent. The literature review included four articles and revealed a high risk of complications, including anastomotic leaks, fistulae, and recurrent perforations, in patients with vEDS undergoing intestinal surgery. Delayed diagnosis of vEDS was common. Conclusions: Intestinal complications in pediatric patients with vEDS can lead to severe short bowel syndrome and long-term PN dependence. Early diagnosis and a multidisciplinary approach are crucial for optimizing patient care and minimizing complications. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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10 pages, 356 KiB

Open AccessArticle

Mid-Term Outcomes of the Double-Barrel Technique for Patients Who Are Unfit for Standard Endovascular Aortic Aneurysm Repair

by Jinmo Kang, Daisik Ko and Juhun Lee

J. Vasc. Dis. 2025, 4(2), 13; https://doi.org/10.3390/jvd4020013 - 24 Mar 2025

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Abstract

Background: Endovascular aortic aneurysm repair (EVAR) is a commonly used treatment for abdominal aortic aneurysms (AAAs), but anatomical complexities limit its application in certain cases. Objective: This study evaluates the mid-term outcomes, referring to a follow-up period with a mean of 29.9 ± [...] Read more.

Background: Endovascular aortic aneurysm repair (EVAR) is a commonly used treatment for abdominal aortic aneurysms (AAAs), but anatomical complexities limit its application in certain cases. Objective: This study evaluates the mid-term outcomes, referring to a follow-up period with a mean of 29.9 ± 24.1 months (approximately 1–5 years), of a novel double-barrel technique that employs overlapping tubular stent grafts to address these challenges. Methods: A retrospective analysis was conducted on seven patients treated with this technique from May 2014 to February 2023. Patients had narrow and short proximal necks, inadequate landing zones, or required re-do procedures. Results: The double-barrel technique achieved technical success in 85.7% of cases with zero mortality. Patients had an average hospital stay of 11.9 ± 10.0 days and attended follow-up for a mean of 29.9 ± 24.1 months. Minimal complications and no significant adverse events were reported. Conclusions: These findings suggest that the double-barrel technique is a cost-effective and viable alternative for anatomically complex cases where standard EVAR is unsuitable. While promising mid-term outcomes were observed, further studies with larger cohorts are necessary to confirm its long-term effectiveness and broader applicability. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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14 pages, 539 KiB

Open AccessArticle

Velopharyngeal Insufficiency and Impaired Tongue Movement Indicate Neuromuscular Disorders: A 10-Year Statistical Study in a Single Tertiary Institution

by Aiko Fujisaki, Rumi Ueha, Carmel Cotaoco, Misaki Koyama, Taku Sato, Takao Goto, Kenji Kondo and Tatsuya Yamasoba

J. Clin. Med. 2025, 14(2), 477; https://doi.org/10.3390/jcm14020477 - 13 Jan 2025

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Abstract

Objectives: This study aimed to determine the positive predictive value of our NMD Suspicion Criteria in the diagnosis of NMDs. Other clinical factors routinely examined in our voice and swallowing examinations were also investigated to see if they had a significant association [...] Read more.

Objectives: This study aimed to determine the positive predictive value of our NMD Suspicion Criteria in the diagnosis of NMDs. Other clinical factors routinely examined in our voice and swallowing examinations were also investigated to see if they had a significant association with the diagnosis of NMDs. Methods: This study retrospectively investigated the medical charts of patients who visited our Voice and Swallowing outpatient clinic between 2013 and 2022. Patients with previously diagnosed NMDs were excluded from the analysis. Among the remaining patients, we included those that were referred to neurologists for further evaluation due to suspicion of having an NMD based on the NMD Suspicion Criteria. The patients were then divided into groups according to the status of their diagnosis within 2 years of referral as “diagnosed”, “denied”, or “observed”. These three groups of patients were then compared according to the following clinical findings; velopharyngeal insufficiency (VPI), tongue atrophy, impaired tongue movement, dysarthria, vocal fold mobility impairment, dysphagia, involuntary movement, gait disturbances, weight loss, and a sense of fatigue in order to see if they were significantly associated with the diagnosis of NMDs. Results: Of 3769 outpatients without a confirmed diagnosis of NMDs, 37 were referred to neurologists for suspected NMDs, and 19 (51%) were diagnosed with NMDs. VPI and impaired tongue movement were significant diagnostic factors for NMDs (p = 0.014, 0.033). VPI during speech (p = 0.045) was more strongly associated with the diagnosis of NMDs than VPI during swallowing (p = 0.076). Fatigue was a significant related factor for other diseases (non-NMDs) causing Voice and Swallowing problems (p = 0.049). Conclusions: In the outpatient clinic setting, suspicion of NMD should be raised, particularly when VPI and impaired tongue movement are observed, prompting a thorough assessment of velopharyngeal closure during both speech and swallowing. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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9 pages, 623 KiB

Open AccessReview

Advancements and Challenges in Endovascular Revascularization for the Total Occlusion of the Femoropopliteal Artery: A Comprehensive Review

by Jen-Kuang Lee, Mu-Yang Hsieh, Hung-Chi Su, Po-Chao Hsu, Chung-Ho Hsu and Hsin-Fu Lee

J. Vasc. Dis. 2025, 4(1), 2; https://doi.org/10.3390/jvd4010002 - 2 Jan 2025

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Abstract

Endovascular revascularization is a critical strategy in managing total occlusions of the femoropopliteal artery, a significant challenge in patients with peripheral artery disease (PAD). This review provides a comprehensive analysis of procedural strategies, highlighting the role of drug-coated balloons, atherectomy devices, and advanced [...] Read more.

Endovascular revascularization is a critical strategy in managing total occlusions of the femoropopliteal artery, a significant challenge in patients with peripheral artery disease (PAD). This review provides a comprehensive analysis of procedural strategies, highlighting the role of drug-coated balloons, atherectomy devices, and advanced crossing techniques like subintimal recanalization and re-entry methods. It discusses the importance of lesion-specific considerations, such as the use of atherectomy devices for un-crossable or un-dilatable lesions and the effectiveness of drug-coated balloons in reducing restenosis. Emerging techniques, including the PIERCE needle-cracking method and intravascular lithotripsy, offer novel approaches for treating heavily calcified plaques. Moreover, the review compares endovascular interventions with surgical bypass, noting that while minimally invasive techniques are preferred for high-risk patients, a hybrid approach may be optimal for selected cases. Despite advances, challenges remain regarding long-term outcomes and the management of complex calcified lesions, emphasizing the need for ongoing research and innovation in this field. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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14 pages, 631 KiB

Open AccessArticle

On-Target Low-Density Lipoprotein Cholesterol in Adults with Diabetes Not at High Cardiovascular Disease Risk Predicts Greater Mortality, Independent of Early Deaths or Frailty

by Bruna C. Chwal, Rodrigo C. P. dos Reis, Maria I. Schmidt, Antonio L. P. Ribeiro, Sandhi M. Barreto, Rosane H. Griep, Paulo A. Lotufo and Bruce B. Duncan

J. Clin. Med. 2024, 13(24), 7667; https://doi.org/10.3390/jcm13247667 - 16 Dec 2024

Cited by 1 | Viewed by 1262

Abstract

Background/Objectives: Lowering low-density lipoprotein cholesterol (LDL-C) to <70 mg/dL is recommended for most patients with diabetes. However, clinical trials investigating subjects with diabetes who are not at high cardiovascular risk are inconclusive regarding the all-cause mortality benefit of the current target, and real-world [...] Read more.

Background/Objectives: Lowering low-density lipoprotein cholesterol (LDL-C) to <70 mg/dL is recommended for most patients with diabetes. However, clinical trials investigating subjects with diabetes who are not at high cardiovascular risk are inconclusive regarding the all-cause mortality benefit of the current target, and real-world studies suggest greater mortality. We aimed to assess the all-cause mortality at different LDL-C levels among subjects with diabetes not at high risk and to examine the potential roles of early deaths and frailty for this greater mortality. Methods: We followed 2098 such participants of the ELSA-Brasil cohort between 2008 and 2019. Results: Over 10.3 (1.4) years of follow-up, 204 (9.7%) individuals died. In the proportional hazards models, participants with LDL-C values < 100 mg/dL and <70 mg/dL had greater adjusted mortality compared to those with LDL-C 100–129 mg/dL (HR = 1.67; 95%CI 1.21–2.30 and HR = 2.27; 95%CI 1.51–3.41, respectively). Increased risk when LDL-C was <100 mg/dL was higher in those >60 years (HR = 2.12; 95%CI 1.35–3.34) and greatest for deaths due to cancer (HR = 2.55; 95%CI 1.10–5.91). Further analyses for those with LDL-C < 100 mg/dL that excluded early deaths and adjusted for the frailty phenotype (HR = 2.01; 1.19–3.41) or frailty index (HR = 1.92; 1.17–3.16) did not materially alter the results. The risk of death across the spectrum of LDL-C was U-shaped, with a nadir at 112.2 mg/dL. Conclusions: The higher risk of all-cause mortality in these subjects with LDL-C within currently recommended levels was not explained by early deaths or frailty. Given the recent decline in cardiovascular mortality and the increased risk of cancer and infections in persons with diabetes, the clinical significance of low LDL-C in diabetes requires reconsideration and the definition of LDL-C treatment targets in diabetes warrants further trial evaluation. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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13 pages, 2442 KiB

Open AccessArticle

Screening for Hypophosphatasia in Adult Patients at a Maximum Care Provider—Retrospective Analyses over Fifteen Years

by Robert Hennings, Diana Le Duc, Linnaeus Bundalian, Anke Tönjes, Johannes R. Lemke, Joachim Thiery, Jürgen Kratzsch and Andreas Roth

J. Clin. Med. 2024, 13(23), 7313; https://doi.org/10.3390/jcm13237313 - 2 Dec 2024

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Abstract

Background/Objectives: Hypophosphatasemia (HPE) may be temporary (tHPE) in the context of severe diseases, such as sepsis or trauma, or it may persist (pHPE), indicating an adult form of hypophosphatasia (HPP; OMIM 171760), a rare metabolic bone disorder caused by pathogenic nucleotide variants (PNVs) [...] Read more.

Background/Objectives: Hypophosphatasemia (HPE) may be temporary (tHPE) in the context of severe diseases, such as sepsis or trauma, or it may persist (pHPE), indicating an adult form of hypophosphatasia (HPP; OMIM 171760), a rare metabolic bone disorder caused by pathogenic nucleotide variants (PNVs) in the ALPL gene. The aim of this study was to analyze the role of auxiliary general biomarkers in verifying low alkaline phosphatase (ALP) serum activity level as an alert parameter for PNVs in the ALPL gene, which are indicative of HPP. In this retrospective analysis, we examined adult patients with an ALP serum activity level below 21 U/L. The cohort comprised 88 patients with temporary HPE (tHPE group) and 20 patients with persistent HPE who underwent re-examination. Genetic analysis performed on 12 pHPE patients identified PNV in the ALPL gene in 11 cases (ALPL group). Hemoglobin [HB], aspartate aminotransferase [AST], gamma-glutamyl transferase [GGT], calcium, phosphate, thyrotropin [TSH], albumin, total protein, and C-reactive protein [CRP] levels represented basic biomarkers. A comparative analysis between groups employed a Student’s t-test, and a Student’s t-test with bootstrap sampling (n = 10.000) was performed. Results: The mean HB, ALP, calcium, albumin, and total protein levels were lower in the tHPE group compared with the ALPL group (p < 0.01). AST and CRP were increased in the tHPE group (p < 0.01). The model showed an accuracy of 90% and an AUC of 0.94, which means that it can discern the two groups ~94% of the time. Conclusions: Basic biomarker evaluation effectively supports the interpretation of a decreased ALP serum activity level in the context of suspected HPP. In patients with laboratory HPE and biomarkers within reference, a PNV in the ALPL gene is highly suspected. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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11 pages, 920 KiB

Open AccessArticle

Exploring Biomarkers for Excess Extracellular Fluid in the Context of Physical Function in Chronic Kidney Disease Patients

by Hyae Min Lee, Jihyun Baek, So-Young Lee, Yu Ho Lee, Sang Hyun Jung and Hye Yun Jeong

J. Pers. Med. 2024, 14(12), 1124; https://doi.org/10.3390/jpm14121124 - 27 Nov 2024

Viewed by 761

Abstract

Background/Objectives: Fluid overload is an important risk factor for protein-energy wasting, which could lead to poor outcomes, such as higher morbidity and mortality, in patients with chronic kidney disease (CKD). This study aimed to validate the possible myokine as a biomarker of [...] Read more.

Background/Objectives: Fluid overload is an important risk factor for protein-energy wasting, which could lead to poor outcomes, such as higher morbidity and mortality, in patients with chronic kidney disease (CKD). This study aimed to validate the possible myokine as a biomarker of volume status in patients with non-dialysis CKD. Methods: In total, 151 patients with CKD were enrolled from a single medical center. Demographic data were collected via medical record review. Bioimpedance analysis was performed to measure body composition, and physical performance was assessed by measuring hand grip strength. Results: The physical performance of hand grip strength (21.9 ± 8.7 vs. 19.0 ± 10.1 kg, p = 0.233) and walking speed (1.05 ± 0.29 vs. 0.86 ± 0.52 m/s, p = 0.192) was higher in the low extracellular water/total body water (ECW/TBW) ratio group. Although higher, the median value of the brain-derived neurotrophic factor (BDNF) was not significant in the low ECW/TBW ratio group. Despite that, it had significant negative correlations with the ECW/TBW ratio in Pearson’s correlation analyses (r = −0.329, p < 0.001; r = −0.287, p < 0.001; and r = −0.238, p = 0.003). Linear regression analysis showed that the BDNF level had a significant negative relationship with the ECW/TBW ratio and significant associations even after multivariate analysis. Conclusions: Among myokines, BDNF had a significant negative relationship with the ECW/TBW ratio, suggesting that BDNF could be a possible biomarker for volume status in patients with non-dialysis CKD. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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9 pages, 475 KiB

Open AccessArticle

Evaluating the Efficacy and Safety of Transbrachial Access in Iliac Endovascular Interventions: A Comprehensive Analysis

by Nur Dikmen and Evren Ozcinar

J. Vasc. Dis. 2024, 3(4), 471-479; https://doi.org/10.3390/jvd3040035 - 20 Nov 2024

Viewed by 596

Abstract

Background: This study evaluates the use of transbrachial artery access for endovascular treatment of iliac artery lesions, with a focus on its efficacy and safety outcomes. Methods: Between January 2020 and May 2023, 94 patients with iliac artery disease underwent endovascular procedures via [...] Read more.

Background: This study evaluates the use of transbrachial artery access for endovascular treatment of iliac artery lesions, with a focus on its efficacy and safety outcomes. Methods: Between January 2020 and May 2023, 94 patients with iliac artery disease underwent endovascular procedures via a transbrachial access approach. The majority of patients (n = 68; 72%) presented with lifestyle-limiting claudication (Rutherford category 3). Diagnostic angiography identified Transatlantic Inter-Society Consensus II (TASC) C/D lesions in 54 patients (57%). The primary outcome was achieving technical success with transbrachial access, while secondary outcomes included secondary technical success (necessitating additional transfemoral access), access site complications, and cerebrovascular events. Results: The primary and secondary technical success rates were 82% and 92%, respectively. Access site-related adverse events occurred in 12 patients (12%), primarily hematomas (seven events, 7.4%; two requiring transfusion) and pseudoaneurysms (four events, 4.2%). Thrombotic occlusion was observed in one patient (1%), and brachial arterial bleeding requiring urgent surgical intervention occurred in three patients (3.2%). Neurological complications included two cerebrovascular events (2.1%), although no permanent or transient median nerve injuries were observed. Conclusions: The transbrachial approach represents a potential alternative to the femoral artery route in patients with iliac artery lesions. However, the relatively higher incidence of access site complications may limit its broader application in clinical practice. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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15 pages, 643 KiB

Open AccessArticle

Elevated Calprotectin Levels Reveal Loss of Vascular Pattern and Atrophy of Villi in Ileum by Digital Chromoendoscopy and Magnification Colonoscopy in Patients with Spondyloarthritis Without Having Inflammatory Bowel Disease

by Juliette De Avila, Cristian Flórez-Sarmiento, Viviana Parra-Izquierdo, Wilson Bautista-Molano, Magaly Chamorro-Melo, Adriana Beltrán-Ostos, Diego Alejandro Jaimes, Valery Khoury, Lorena Chila-Moreno, Alejandro Ramos-Casallas, Juan Manuel Bello-Gualtero, Jaiber Gutiérrez, Cesar Pacheco-Tena, Philippe Selim Chalem Choueka and Consuelo Romero-Sánchez

Diagnostics 2024, 14(22), 2591; https://doi.org/10.3390/diagnostics14222591 - 18 Nov 2024

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Abstract

Objective: This study aimed to establish a correlation between fecal calprotectin levels (FC) and intestinal inflammation in patients with spondyloarthritis without inflammatory bowel disease. Methods: A total of 180 SpA patients were included in the study of them 20.6% required Digital chromoendoscopy (DCE). [...] Read more.

Objective: This study aimed to establish a correlation between fecal calprotectin levels (FC) and intestinal inflammation in patients with spondyloarthritis without inflammatory bowel disease. Methods: A total of 180 SpA patients were included in the study of them 20.6% required Digital chromoendoscopy (DCE). FC, C-reactive protein (CRP), HLA-B*27 and clinical indices were assessed. Results: Positive fecal calprotectin (PFC) and high fecal calprotectin (HFC) levels were observed in 27.0% and 16.0% of patients, respectively. HFC correlated with a Bath Ankylosing Spondylitis Functional Index (BASFI) score > 4.0 (p = 0.036) and a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score > 4.0 (p = 0.047). Loss of vascular pattern in the ileum (LVPI) was observed in approximately 70.0% of patients (p = 0.005), which was associated with PFC and abdominal bloating (p = 0.020). LVPI was also linked to microscopic inflammation (p = 0.012) and PFC with abdominal pain (p = 0.007). HFC was significantly associated with alterations in the ileal mucosa (p = 0.009) and LVPI (p = 0.001). Additionally, HFC and diarrhea were associated with LVPI in 27.3% of patients (p = 0.037) and with erosions in the ileum (p = 0.031). Chronic ileal inflammation correlated with HFC (p = 0.015), ASDAS-CRP > 2.1 (p = 0.09), LVPI (p = 0.001), and villous atrophy (p = 0.014). Factorial analysis of mixed data (FAMD) identified significant associations between micro/macroscopic changes in chronic inflammation and HFC (CC = 0.837); increased levels of CRP and microscopic acute inflammation (CC = 0.792); and clinical activity scores of ASDAS-CRP and BASDAI (CC = 0.914). Conlusions: FC levels were significantly elevated in patients with SpA, particularly those with LVPI, suggesting their potential as a valuable biomarker for managing SpA when joint manifestations coincide with ileal villous atrophy. This indicates a shared immune pathway linked to chronic gut damage. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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15 pages, 2180 KiB

Open AccessReview

Time to Rethink Bronchiolitis Obliterans Syndrome Following Lung or Hematopoietic Cell Transplantation in Pediatric Patients

by Tang-Her Jaing, Yi-Lun Wang and Chia-Chi Chiu

Cancers 2024, 16(21), 3715; https://doi.org/10.3390/cancers16213715 - 4 Nov 2024

Cited by 2 | Viewed by 1820

Abstract

Background: Similar in histological characteristics and clinical manifestations, bronchiolitis obliterans syndrome (BOS) can develop following lung transplantation (LTx) or hematopoietic cell transplantation (HCT). In contrast to lung transplantation, where BOS is restricted to the lung allograft, HCT-related systemic graft-versus-host disease (GVHD) is the [...] Read more.

Background: Similar in histological characteristics and clinical manifestations, bronchiolitis obliterans syndrome (BOS) can develop following lung transplantation (LTx) or hematopoietic cell transplantation (HCT). In contrast to lung transplantation, where BOS is restricted to the lung allograft, HCT-related systemic graft-versus-host disease (GVHD) is the root cause of BOS. Because lung function declines following HCT, diagnosis becomes more difficult. Given the lack of proven effective medicines, treatment is based on empirical evidence. Methods: Cross-disciplinary learning is crucial, and novel therapies are under investigation to improve survival and avoid LTx. Recent advances have focused on updating the understanding of the etiology, clinical features, and pathobiology of BOS. It emphasizes the significance of learning from experts in other transplant modalities, promoting cross-disciplinary knowledge. Results: Our treatment algorithms are derived from extensive research and expert clinical input. It is important to ensure that immunosuppression is optimized and that any other conditions or contributing factors are addressed, if possible. Clear treatment algorithms are provided for each condition, drawing from the published literature and consensus clinical opinion. There are several novel therapies currently being investigated, such as aerosolized liposomal cyclosporine, Janus kinase inhibitors, antifibrotic therapies, and B-cell-directed therapies. Conclusions: We urgently need innovative treatments that can greatly increase survival rates and eliminate the need for LTx or re-transplantation. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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12 pages, 2784 KiB

Open AccessArticle

Apelin from Perivascular Adipose Tissue Is Involved in the Regulation of Vasorelaxation and Renal Function in Metabolic Syndrome

by Satomi Kagota, Kana Maruyama-Fumoto, Risa Futokoro and Kazumasa Shinozuka

J. Vasc. Dis. 2024, 3(4), 385-396; https://doi.org/10.3390/jvd3040030 - 25 Oct 2024

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Abstract

The perivascular adipose tissue (PVAT) regulates the arterial tone by releasing vasoactive molecules. PVAT dysfunction favoring the vasorelaxation response could contribute to the development of kidney disease in metabolic syndrome (MetS). Previously, we demonstrated that overactivation of angiotensin II signaling in the PVAT [...] Read more.

The perivascular adipose tissue (PVAT) regulates the arterial tone by releasing vasoactive molecules. PVAT dysfunction favoring the vasorelaxation response could contribute to the development of kidney disease in metabolic syndrome (MetS). Previously, we demonstrated that overactivation of angiotensin II signaling in the PVAT deteriorates the compensatory PVAT effects in rats with MetS (SHRSP.Z-Lepr^fa/IzmDmcr (SPZF) and SHR/NDmcr-cp (CP) rats). Apelin is an endogenous regulator of angiotensin II. Therefore, we investigated whether changes in apelin levels in the PVAT alter PVAT function and impair kidney function in MetS. Twenty-three-week-old male and female SPZF and CP rats were used. In the female CP rats, apelin mRNA levels in renal arterial PVAT, enhancing effects of the PVAT on acetylcholine-induced relaxation in renal arteries, and estimated glomerular filtration rate (eGFR) were the highest, and urine protein levels and homeostasis model assessment of insulin resistance (HOMA-IR) were the lowest. Apelin mRNA levels were positively correlated with the enhancing effects of the PVAT on vasorelaxation and eGFR but negatively correlated with urine protein levels and HOMA-IR. Moreover, apelin levels positively correlated with mRNA levels of angiotensin-converting enzyme 2 and angiotensin II type 1 receptor-associated protein, which are negative regulators of angiotensin II. This study suggests that a decline in apelin levels in the PVAT, probably owing to angiotensin II, is associated with PVAT dysfunction on vascular tone, resulting in impaired kidney function in MetS. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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13 pages, 1532 KiB

Open AccessArticle

Comparative Value of CRP and FCP for Endoscopic and Histologic Remissions in Ulcerative Colitis

by Oguz Kagan Bakkaloglu, Gozde Sen, Nuray Kepil, Tugce Eskazan, Enes Ali Kurt, Ugur Onal, Selcuk Candan, Melek Balamir, Ibrahim Hatemi, Yusuf Erzin and Aykut Ferhat Celik

Diagnostics 2024, 14(20), 2283; https://doi.org/10.3390/diagnostics14202283 - 14 Oct 2024

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Abstract

Aim: We have previously shown that CRP < 2.9 mg/L is a better predictor of endoscopic remission (ER) than CRP < 5 mg/L in ulcerative colitis (UC). Here, we prospectively evaluate CRP and FCP cut-offs and compare them in predicting ER and histological [...] Read more.

Aim: We have previously shown that CRP < 2.9 mg/L is a better predictor of endoscopic remission (ER) than CRP < 5 mg/L in ulcerative colitis (UC). Here, we prospectively evaluate CRP and FCP cut-offs and compare them in predicting ER and histological remission (HR) in UC. Method: One hundred thirty-five steroid-free UC patients were evaluated prospectively. ER was defined as Mayo endoscopic sub-score 0–1. In colonoscopy, the colon was evaluated as seven segments: rectum, sigmoid, descending, proximal-transverse, distal-transverse, ascending colon, and cecum. Two biopsies of each segment were evaluated for histological inflammation and graded using the Nancy and Geboes scores. All segment biopsies with Nancy < 1 and Geboes < 2 were defined as HR. Results: The optimum cut-off values for FCP and CRP were 120 μg/g and 2.75 mg/L for ER, respectively. AUC values of FCP and CRP were similar for ER and Mayo-0 disease in ROC analysis. CRP and FCP also had similar performances with these cut-offs regarding ER. While CRP was a predictor to assess the extensiveness of active UC, FCP was not. ROC analysis showed no difference between CRP and FCP regarding HR. Cut-off values for HR were 2.1 mg/L and 55 μg/g for CRP and FCP, respectively. CRP and FCP, in combination with the mentioned cut-off values, detected ER and HR in nearly 2/3 and ½ of the patients, respectively, with high specificity. Conclusions: Reappraised CRP (ER: 2.75 mg/L, HR: 2.1 mg/L) has as much diagnostic contribution as relevant FCP in predicting ER and HR and contributes more to revealing the proximal extension in active colitis compared to FCP. Relevant CRP and FCP combinations may improve the prediction rates. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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27 pages, 2130 KiB

Open AccessArticle

The Usability and Feasibility of a Dietary Intake Self-Monitoring Application in a Population with Varying Literacy Levels

by Beenish Moalla Chaudhry, Katie A. Siek and Kay Connelly

J. Pers. Med. 2024, 14(9), 1001; https://doi.org/10.3390/jpm14091001 - 20 Sep 2024

Cited by 1 | Viewed by 1223

Abstract

Objectives: Our aim was to study how hemodialysis patients with varying levels of literacy would use a diet and fluid intake monitoring mobile application (DIMA-P) and what would be its impact on their dietary behaviors. Materials and Methods: We developed a mobile application [...] Read more.

Objectives: Our aim was to study how hemodialysis patients with varying levels of literacy would use a diet and fluid intake monitoring mobile application (DIMA-P) and what would be its impact on their dietary behaviors. Materials and Methods: We developed a mobile application using user-centered methods and informed by the Integrated Theory of Health Behavior Change (ITHBC). Eight hemodialysis patients were recruited to use the application to record and monitor their diet and fluid intakes for a 6-week study. Overall, the participants had low literacy, numeracy, and technical skills. We collected the data on application usage and administered usability and context-of-use questionnaires to gain insights into the participants’ interaction with the application. The participants’ portion estimation skills and dietary self-regulation self-efficacy were assessed using various tests. In addition, interdialytic weight gain data were collected to assess the impact of app usage on the participants’ health outcomes. Results: The application usage patterns varied, with a general trend towards frequent use (n = 5) correlating with engagement in self-monitoring. The participants gave high comprehensibility, user-friendliness, satisfaction, and usefulness ratings, suggesting that the app was well designed and the target users could easily navigate and interact with the features. While the participants improved in estimating portion sizes, the impact on measuring skills was variable. There was also an improvement in the participants’ dietary self-regulation self-efficacy post-study. The interdialytic weight gain trends indicated a slight improvement in fluid and diet management. Conclusion: People with different literacy skills can effectively use icon-based interfaces for portion size estimation and develop personalized usage patterns to self-regulate their fluid and dietary intakes. Moreover, they can experience an enhancement in their dietary self-efficacy skills by using a mobile application aimed at providing nutritional feedback. Furthermore, this research shows that the constructs of the ITHBC are effective in promoting dietary behavior change in a population with varying literacy skills. The target users can benefit from explicitly visualizing the relationship between their health outcomes and the factors influencing those outcomes. These user ambitions could be supported by developing machine learning models. Future research should also focus on enhancing the mechanisms by which technology can further enhance each component of the ITHBC framework. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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9 pages, 204 KiB

Open AccessArticle

by Mohamad Adam Bujang, Yoon Khee Hon, Wei Hong Lai, Eileen Pin Pin Yap, Xun Ting Tiong, Selvasingam Ratnasingam, Alex Ren Jye Kim, Masliyana Husin, Yvonne Yih Huan Jee, Nurul Fatma Diyana Ahmad, Cheng Hoon Chew, Clare Hui Hong Tan, Sing Yee Khoo, Fazalena Johari and Alan Yean Yip Fong

J. Clin. Med. 2024, 13(18), 5398; https://doi.org/10.3390/jcm13185398 - 12 Sep 2024

Cited by 2 | Viewed by 1222

Abstract

Background/Objectives: This study aims to compare the health-related quality of life (HRQOL) between healthcare providers without chronic diseases and participants with chronic diseases presenting with one of the four different primary diagnoses on the health-related quality of life with six domains (HRQ-6D) scale. [...] Read more.

Background/Objectives: This study aims to compare the health-related quality of life (HRQOL) between healthcare providers without chronic diseases and participants with chronic diseases presenting with one of the four different primary diagnoses on the health-related quality of life with six domains (HRQ-6D) scale. Methods: This is a cross-sectional study to compare the HRQOL between healthcare providers without chronic diseases and participants with chronic diseases. Data collection was performed from May 2022 to May 2023. Data for the comparison group were taken from healthcare providers without chronic diseases, and for the participant group with chronic diseases, the data were collected from actual patients with one of four types of primary diagnoses who were recruited from specialist cardiology, oncology, psychiatry, and nephrology clinics. All the participants of this study filled in the HRQ-6D. Results: There were 238 (58.6%) healthcare providers without chronic diseases who participated in this study, as well as 41 (10.1%) patients with end-stage renal disease (ESRD), 48 (11.8%) patients with cancer, and 40 (9.9%) patients who were depressed, and the remaining patients had heart disease. The means (SD) of HRQ-6D scores among healthcare providers without chronic diseases for pain, physical strength, emotion, mobility, self-care, perception of future health, and overall HRQ-6D score were 75.3% (19.8), 74.5% (21.1), 85.6% (18.4%), 93.0% (12.3), 91.6% (13.9), 74.2% (23.3), and 82.4% (13.6), respectively. In comparisons between healthcare providers without chronic diseases and participants with chronic diseases, all mean differences of the overall HRQ-6D score and its domains and dimensions were statistically significant (p < 0.001). Conclusions: The overall score of the HRQ-6D, as well as its domains and dimensions are sensitive in detecting the study participants with chronic diseases from among those without chronic diseases. Therefore, the HRQ-6D is a reliable and valid scale to measure HRQOL. Future studies may use this scale for interventional, observational, and cost-effectiveness studies. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

15 pages, 1325 KiB

Open AccessArticle

Sarcoidosis and Cancer: The Role of the Granulomatous Reaction as a Double-Edged Sword

by Angela Maria Di Francesco, Giuliana Pasciuto, Elena Verrecchia, Ludovico Luca Sicignano, Laura Gerardino, Maria Grazia Massaro, Andrea Urbani and Raffaele Manna

J. Clin. Med. 2024, 13(17), 5232; https://doi.org/10.3390/jcm13175232 - 4 Sep 2024

Cited by 2 | Viewed by 1586

Abstract

Background/Objectives: The relationship between sarcoidosis and the occurrence of neoplasia deserves to be investigated, but this relation has been observed in different and heterogeneous populations, leading to conflicting data. To clarify the causal relationship between these two diseases, different risk factors (e.g., smoking), [...] Read more.

Background/Objectives: The relationship between sarcoidosis and the occurrence of neoplasia deserves to be investigated, but this relation has been observed in different and heterogeneous populations, leading to conflicting data. To clarify the causal relationship between these two diseases, different risk factors (e.g., smoking), concurrent comorbidities, corticosteroid therapy, and metastasis development—as an expression of cancer aggressiveness—were investigated. Methods: In a retrospective study on 287 sarcoidosis outpatients at the Pneumological Department of the Gemelli Foundation (Rome, Italy) between 2000 and 2024, the diagnosis of cancer was recorded in 36 subjects (12.5%). Results: The reciprocal timeline of the diseases showed three different scenarios: (1) cancer preceding sarcoidosis or sarcoid-like reactions (63.8%); (2) cancer arising after sarcoidosis diagnosis (8.3%); and (3) sarcoidosis accompanying the onset of malignancy (27.8%). Only two subjects with sarcoidosis and cancer showed metastasis, and one of them was affected by lymphoma. Conclusions: These data suggest that granulomatous inflammation due to sarcoidosis may assume an ambivalent role as a “double-edged sword”, according to the M1/M2 macrophage polarization model: it represents a protective shield, preventing the formation of metastasis through the induction of immune surveillance against cancer while, on the other hand, it can be a risk factor for carcinogenesis due to the persistence of a chronic active inflammatory status. Low-dose steroid treatment was administered in only 31.6% of the cancer–sarcoidosis subjects for less than six months to control inflammation activity, with no promotive effect on carcinogenesis observed. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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11 pages, 2699 KiB

Open AccessSystematic Review

Efficacy and Safety of Hyperbaric Oxygen Therapy for Radiation-Induced Hemorrhagic Cystitis: A Systematic Review and Meta-Analysis

by Teng-Kai Yang, Yu-Jen Wang, Hsing-Ju Li, Ya-Fang Yu, Kai-Wen Huang and Jason Chia-Hsien Cheng

J. Clin. Med. 2024, 13(16), 4724; https://doi.org/10.3390/jcm13164724 - 12 Aug 2024

Cited by 2 | Viewed by 1965

Abstract

Background: Radiation-induced hemorrhagic cystitis (RHC) is a chronic inflammatory disease in patients undergoing radiation therapy that causes a cluster of symptoms which may have a latent period of months to years. The current non-invasive treatments include drug treatment and hyperbaric oxygen therapy (HBOT), [...] Read more.

Background: Radiation-induced hemorrhagic cystitis (RHC) is a chronic inflammatory disease in patients undergoing radiation therapy that causes a cluster of symptoms which may have a latent period of months to years. The current non-invasive treatments include drug treatment and hyperbaric oxygen therapy (HBOT), which has been widely applied for RHC so far but with limited evidence. Thus, we conducted a systematic review and meta-analysis to clarify the effects and safety of HBOT for RHC. Methods: A systematic review and meta-analysis were utilized, searching in the databases of Embase, Pubmed, and Web of Science. The primary endpoint of the present study was complete remission of hematuria. The meta-analysis was conducted using a random effects model, and a pooled odds ratio with 95% CI was calculated. Results: A total of 317 studies were searched and fourteen articles with 556 patients were collected. The results showed that a total of 500 patients (89.9%) had symptom improvement, and the pooled results demonstrated that 55% of patients with HBOT had complete remission of hematuria (95% CI 51–59%). Conclusions: A significant improvement of symptoms when treated with HBOT was shown in this meta-analysis for patients with RHC. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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21 pages, 619 KiB

Open AccessArticle

Assessing Functional Capacity in Myalgic Encephalopathy/Chronic Fatigue Syndrome: A Patient-Informed Questionnaire

by Kristian Sommerfelt, Trude Schei, Katharine A. Seton and Simon R. Carding

J. Clin. Med. 2024, 13(12), 3486; https://doi.org/10.3390/jcm13123486 - 14 Jun 2024

Cited by 5 | Viewed by 10304

Abstract

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an acquired disease with significant morbidity that affects both children and adults. Post-exertional malaise is a cardinal symptom of ME/CFS and impacts a patient’s functional capacity (FC). The absence of effective tools to assess FC has [...] Read more.

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is an acquired disease with significant morbidity that affects both children and adults. Post-exertional malaise is a cardinal symptom of ME/CFS and impacts a patient’s functional capacity (FC). The absence of effective tools to assess FC has significant consequences for timely diagnosis, clinical follow-up, assessments for patient disability benefits, and research studies. In interventional studies, the inability to assess FC can result in an incomplete assessment of the potential benefit of the intervention, leading to beneficial treatment outcomes being missed. Methods: Using extensive, repeated patient feedback, we have developed a new questionnaire, FUNCAP, to accurately assess FC in ME/CFS patients. The questionnaire consists of eight domains divided by activity types: A. personal hygiene/basic functions, B. walking/movement, C. being upright, D. activities in the home, E. communication, F. activities outside the home, G. reactions to light and sound, and H. concentration. Results: Through five rounds of anonymous web-based surveys and a further test–retest validation round, two versions of the questionnaire were developed: a longer version comprising 55 questions (FUNCAP55), developed for improved diagnostic and disability benefit/insurance FC assessments; and a shorter version (FUNCAP27) for clinical patient follow-up and potential use in research. Good reliability and validity and negligible floor and ceiling effects were found, with comparable findings in all aspects in both a large Norwegian (n = 1263) and a separate English-language international sample (n = 1387) demonstrating the validity and reliability of FUNCAP. Conclusions: Our findings support the utility of FUNCAP as an effective, reliable and valid tool for assessing FC in ME/CFS patients. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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11 pages, 1716 KiB

Open AccessArticle

Perivascular Adipose Tissue Density and Stenosis Plaque Degree in Lower Limb Peripheral Arteries in CT

by Alice Fortunati, Chiara Perazzo, Maria chiara Basile, Maurizio Ce’, Alexis Elias Malavazos, Sergio Papa, Deborah Fazzini, Francesco Secchi and Marco Alì

J. Vasc. Dis. 2024, 3(2), 224-234; https://doi.org/10.3390/jvd3020018 - 11 Jun 2024

Viewed by 1310

Abstract

Background: Perivascular adipose tissue (PVAT) attenuation has emerged as a novel biomarker for identifying high-risk arterial plaques due to its association with inflammation. Recognizing the systemic nature of atherosclerosis and its link with major cardiovascular events in coronary disease, this study evaluated PVAT [...] Read more.

Background: Perivascular adipose tissue (PVAT) attenuation has emerged as a novel biomarker for identifying high-risk arterial plaques due to its association with inflammation. Recognizing the systemic nature of atherosclerosis and its link with major cardiovascular events in coronary disease, this study evaluated PVAT attenuation in the peripheral arteries using CT imaging to expand the understanding of its diagnostic and prognostic potential. Methods: a retrospective analysis of 53 consecutive patients who underwent CT angiography, examining PVAT density across five primary peripheral arterial segments. A 5 mm region of interest adjacent to the vascular wall was analyzed by two blinded readers, with reproducibility coefficients calculated to determine the reliability of the measurements. For the statistical analyses, mean values were derived from these measurements. The patients were stratified into four groups based on the degree of arterial stenosis: <25%, 25–50%, 50–70%, and >70%. PVAT density comparisons between these groups were performed using the Kruskal–Wallis test and the pairwise Mann–Whitney U test with Holm–Bonferroni correction for multiple comparisons. Results: the Kruskal–Wallis test revealed statistically significant disparities in PVAT density across the categorically differentiated stenosis groups (p < 0.001), indicating an association between PVAT density and arterial stenosis severity. This association was especially pronounced in the external iliac, common femoral, superficial femoral, and popliteal arteries, where the p-values were consistently below 0.05. Subsequent pairwise analyses utilizing the Mann–Whitney U test with Holm–Bonferroni correction affirmed these findings, in particular for the external iliac, common femoral, superficial femoral and popliteal arteries (p < 0.05). Conclusions: our findings reinforce the correlation between increased PVAT density and the degree of arterial stenosis, supporting the clinical value of PVAT as a non-invasive biomarker for cardiovascular risk stratification and potentially guiding therapeutic interventions. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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12 pages, 2310 KiB

Open AccessArticle

Role of Autologous Micro-Fragmented Adipose Tissue in Osteoarthritis Treatment

by Paolo Trentani, Elena Meredi, Paola Zarantonello and Alessandro Gennai

J. Pers. Med. 2024, 14(6), 604; https://doi.org/10.3390/jpm14060604 - 6 Jun 2024

Viewed by 1549

Abstract

Osteoarthritis (OA) is the most common complex musculoskeletal disorder, resulting from the degeneration of the articular cartilage and characterized by joint pain and dysfunction that culminate in progressive articular cartilage loss. We present our experience in the management of hip and knee OA [...] Read more.

Osteoarthritis (OA) is the most common complex musculoskeletal disorder, resulting from the degeneration of the articular cartilage and characterized by joint pain and dysfunction that culminate in progressive articular cartilage loss. We present our experience in the management of hip and knee OA by means of the intra-articular injection of fat micrograft, describing our approach, which was developed from the belief in the powerful reparative effect of autologous fat graft on damaged tissue, as well as its natural lubricating effect on the joints. Inclusion criteria were as follows: men and women, aged 20 to 80 years, that referred articular pain of the hips and/or knees, showing initial-stage degenerative OA. From October 2018 to July 2023, a total of 250 patients underwent treatment with the Sefficare^® device (SEFFILINE srl, Bologna, Italy). The Superficial Enhanced Fluid Fat Injection device was used to perform autologous regenerative treatments in a safe, standardized, easy, and effective way on 160 women, 64%, and 90 men, 36%. A total of 190 procedures (76%) involved the knees, with 20 patients who were bilaterally treated, while 60 procedures, all unilateral, involved the hips (24%). The mean age at treatment was 52.4 years. Before treatment, each patient had undergone X-rays and Magnetic Resonance Imaging (MRI) of the painful hip/knee to evaluate and grade the articular OA. Postoperatively, each patient was assessed after one, three, six, and twelve months. The donor site postoperative course was uneventful other than minimal discomfort. Clinically, the ROM (range of motion) of the treated knee/hip increased an average of 10 degrees 3 months after treatment, but the stiffness was reduced, as reported by the patients. The VAS (Visual Analog Scale) was submitted at 3, 6, and 12 months, demonstrating a progressive reduction of pain, with the best score obtained at six months postoperatively. In total, 85% of patients were satisfied one year after treatment, with a considerable improvement in pain and quality of life. The satisfactory outcome of this minimally invasive procedure indicates that the intra-articular injection of fat micrograft can replace or considerably delay the need for the classical major joint replacement surgery, thanks to its impact on the quality of life of patients and financial cost. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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14 pages, 431 KiB

Open AccessArticle

Ending an Odyssey? The Psychosocial Experiences of Parents after the Genetic Diagnosis of a Mitochondrial Disease in Children

by Oliver Heath, Emma Hammerl, Anna Spitzinger and Saskia B. Wortmann

J. Pers. Med. 2024, 14(5), 523; https://doi.org/10.3390/jpm14050523 - 14 May 2024

Cited by 1 | Viewed by 1889

Abstract

Obtaining a genetic diagnosis of a primary mitochondrial disease (PMD) is often framed as a diagnostic odyssey. Yet, even after receiving a diagnosis, parents of affected children experience ongoing therapeutic and prognostic uncertainty and considerable psychosocial challenges. Semi-structured interviews (N = 24) were [...] Read more.

Obtaining a genetic diagnosis of a primary mitochondrial disease (PMD) is often framed as a diagnostic odyssey. Yet, even after receiving a diagnosis, parents of affected children experience ongoing therapeutic and prognostic uncertainty and considerable psychosocial challenges. Semi-structured interviews (N = 24) were conducted with parents of 13 children (aged 2–19 years) with a genetically confirmed PMD. Paternal (N = 11) and maternal (N = 13) perspectives were obtained, and thematic analysis was performed on all interviews. A genetic diagnosis was valuable and empowering for parents, despite eliciting varied emotional responses. While the diagnosis helped focus management decisions, families often felt overwhelmed and unsupported in navigating the healthcare system. Most parents reported a serious impact on their romantic relationship. The sources of social support varied, with a preference for established friendship and family support networks over disease-specific community support groups. Most parents favored prenatal genetic testing in the event of a future pregnancy. This study provides insight into the lived experiences of parents after a genetic diagnosis of PMD in their children. The findings draw awareness to supportive care needs and highlight important gaps that should be addressed to ensure that parents feel supported within a holistic framework of management for PMDs. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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11 pages, 635 KiB

Open AccessArticle

Impact of Controlling Nutritional Status Score on Mortality in Elderly Patients with Idiopathic Pulmonary Fibrosis

by Yuji Iwanami, Kento Ebihara, Keiko Nakao, Ryuki Kubo, Midori Miyagi, Yasuhiko Nakamura, Susumu Sakamoto, Kazuma Kishi, Ikuko Okuni and Satoru Ebihara

J. Clin. Med. 2024, 13(10), 2825; https://doi.org/10.3390/jcm13102825 - 10 May 2024

Cited by 2 | Viewed by 1216

Abstract

Background: There are only a few reports on the nutritional status and mortality of patients with idiopathic pulmonary fibrosis (IPF). As such, this study aims to investigate the relationship between controlling nutritional status (CONUT) and the mortality of elderly patients with IPF. [...] Read more.

Background: There are only a few reports on the nutritional status and mortality of patients with idiopathic pulmonary fibrosis (IPF). As such, this study aims to investigate the relationship between controlling nutritional status (CONUT) and the mortality of elderly patients with IPF. Methods: A total of 170 IPF patients aged ≥65 years old who visited the rehabilitation department of our hospital between July 2014 and July 2021 (mean age: 75.7 ± 6.3 years, sex (male/female): 138/32, %FVC: 78.3 ± 18.3%) were retrospectively analyzed. The Kaplan–Meier method and log-rank test were applied. Furthermore, using a Cox proportional hazards model with multivariate analysis, we analyzed the relationship between all-cause mortality and baseline characteristics including CONUT. Results: Based on the CONUT score, the normal group included 101 cases, the mild group included 58 cases, the moderate group included 11 cases, and the severe group had 0 cases. There were 49 cases of all-cause mortality events, suggesting that the mortality of the moderate group was significantly poorer than that of the normal and mild groups (p < 0.05). Furthermore, multivariate analysis identified GAP stage (HR: 5.972, 95%CI: 2.901~12.291, p < 0.0001), mMRC scale (HR: 0.615, 95%CI: 0.389~0.971, p = 0.009), and CONUT (HR: 2.012, 95%CI: 1.192~3.395, p = 0.037) as factors significantly influencing mortality. Conclusions: Severe malnutrition was not observed in elderly patients with IPF. Moderate malnutrition was associated with a significantly higher risk of all-cause mortality, suggesting that CONUT is an important indicator for predicting mortality. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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16 pages, 595 KiB

Open AccessSystematic Review

Prognostic Significance of Lung Ultrasound for Heart Failure Patient Management in Primary Care: A Systematic Review

by Anna Panisello-Tafalla, Marcos Haro-Montoya, Rosa Caballol-Angelats, Maylin Montelongo-Sol, Yoenia Rodriguez-Carralero, Jorgina Lucas-Noll and Josep Lluis Clua-Espuny

J. Clin. Med. 2024, 13(9), 2460; https://doi.org/10.3390/jcm13092460 - 23 Apr 2024

Cited by 1 | Viewed by 2608

Abstract

Background: Heart failure (HF) affects around 60 million individuals worldwide. The primary aim of this study was to evaluate the efficacy of lung ultrasound (LUS) in managing HF with the goal of reducing hospital readmission rates. Methods: A systematic search was conducted on [...] Read more.

Background: Heart failure (HF) affects around 60 million individuals worldwide. The primary aim of this study was to evaluate the efficacy of lung ultrasound (LUS) in managing HF with the goal of reducing hospital readmission rates. Methods: A systematic search was conducted on PubMed, Embase, Google Scholar, Web of Science, and Scopus, covering clinical trials, meta-analyses, systematic reviews, and original articles published between 1 January 2019 and 31 December 2023, focusing on LUS for HF assessment in out-patient settings. There is a potential for bias as the effectiveness of interventions may vary depending on the individuals administering them. Results: The PRISMA method synthesized the findings. Out of 873 articles identified, 33 were selected: 19 articles focused on prognostic assessment of HF, 11 centred on multimodal diagnostic assessments, and two addressed therapeutic guidance for HF diagnosis. LUS demonstrates advantages in detecting subclinical congestion, which holds prognostic significance for readmission and mortality during out-patient follow-up post-hospital-discharge, especially in complex scenarios, but there is a lack of standardization. Conclusions: there are considerable uncertainties in their interpretation and monitoring changes. The need for an updated international consensus on the use of LUS seems obvious. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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14 pages, 1726 KiB

Open AccessArticle

Using Machine Learning with Impulse Oscillometry Data to Develop a Predictive Model for Chronic Obstructive Pulmonary Disease and Asthma

by Chien-Hua Huang, Kun-Ta Chou, Diahn-Warng Perng, Yi-Han Hsiao and Chien-Wen Huang

J. Pers. Med. 2024, 14(4), 398; https://doi.org/10.3390/jpm14040398 - 9 Apr 2024

Cited by 1 | Viewed by 3110

Abstract

We aimed to develop and validate a machine learning model using impulse oscillometry system (IOS) profiles for accurately classifying patients into three assessment-based categories: no airflow obstruction, asthma, and chronic obstructive pulmonary disease (COPD). Our research questions were as follows: (1) Can machine [...] Read more.

We aimed to develop and validate a machine learning model using impulse oscillometry system (IOS) profiles for accurately classifying patients into three assessment-based categories: no airflow obstruction, asthma, and chronic obstructive pulmonary disease (COPD). Our research questions were as follows: (1) Can machine learning methods accurately classify obstructive disease states based solely on multidimensional IOS data? (2) Which IOS parameters and modeling algorithms provide the best discrimination? We used data for 480 patients (240 with COPD and 240 with asthma) and 84 healthy individuals for training. Physiological and IOS parameters were combined into six feature combinations. The classification algorithms tested were logistic regression, random forest, neural network, k-nearest neighbor, and support vector machine. The optimal feature combination for identifying individuals without pulmonary obstruction, with asthma, or with COPD included 15 IOS and physiological features. The neural network classifier achieved the highest accuracy (0.786). For discriminating between healthy and unhealthy individuals, two combinations of twenty-three features performed best in the neural network algorithm (accuracy of 0.929). When distinguishing COPD from asthma, the best combination included 15 features and the neural network algorithm achieved an accuracy of 0.854. This study provides compelling technical evidence and clinical justifications for advancing IOS data-driven models to aid in COPD and asthma management. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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11 pages, 652 KiB

Open AccessArticle

CARDS, a Novel Prognostic Index for Risk Stratification and In-Hospital Monitoring

by Siyu Liang, Qing Chang, Yuelun Zhang, Hanze Du, Huijuan Zhu, Shi Chen and Hui Pan

J. Clin. Med. 2024, 13(7), 1961; https://doi.org/10.3390/jcm13071961 - 28 Mar 2024

Viewed by 1075

Abstract

Background: Sodium fluctuation is independently associated with clinical deterioration. We developed and validated a prognostic index based on sodium fluctuation for risk stratification and in-hospital monitoring. Methods: This study included 33,323 adult patients hospitalized at a tertiary care hospital in 2014. [...] Read more.

Background: Sodium fluctuation is independently associated with clinical deterioration. We developed and validated a prognostic index based on sodium fluctuation for risk stratification and in-hospital monitoring. Methods: This study included 33,323 adult patients hospitalized at a tertiary care hospital in 2014. The first 28,279 hospitalizations were analyzed to develop the model and then the validity of the model was tested using data from 5044 subsequent hospitalizations. We predict in-hospital mortality using age, comorbidity, range of sodium fluctuation, and duration of sodium fluctuation, abbreviated as CARDS. Results: In-hospital mortality was similar in the derivation (0.6%) and validation (0.4%) cohorts. In the derivation cohort, four independent risk factors for mortality were identified using logistic regression: age (66–75, 2 points; >75, 3 points); Charlson comorbidity index (>2, 5 points); range of sodium fluctuation (7–10, 4 points; >10, 10 points); and duration of fluctuation (≤3, 3 points). The AUC was 0.907 (95% CI: 0.885–0.928) in the derivation cohort and 0.932 (95% CI: 0.895–0.970) in the validation cohort. In the derivation cohort, in-hospital mortality was 0.106% in the low-risk group (0–7 points), 1.076% in the intermediate-risk group (8–14 points), and 8.463% in the high-risk group (15–21 points). In the validation cohort, in-hospital mortality was 0.049% in the low-risk group, 1.064% in the intermediate-risk group, and 8.403% in the high-risk group. Conclusions: These results suggest that patients at low, intermediate, and high risk for in-hospital mortality may be identified by CARDS mainly based on sodium fluctuation. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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23 pages, 6644 KiB

Open AccessArticle

Concatenated Modified LeNet Approach for Classifying Pneumonia Images

by Dhayanithi Jaganathan, Sathiyabhama Balsubramaniam, Vidhushavarshini Sureshkumar and Seshathiri Dhanasekaran

J. Pers. Med. 2024, 14(3), 328; https://doi.org/10.3390/jpm14030328 - 21 Mar 2024

Cited by 7 | Viewed by 1909

Abstract

Pneumonia remains a critical health concern worldwide, necessitating efficient diagnostic tools to enhance patient care. This research proposes a concatenated modified LeNet classifier to classify pneumonia images accurately. The model leverages deep learning techniques to improve the diagnosis of Pneumonia, leading to more [...] Read more.

Pneumonia remains a critical health concern worldwide, necessitating efficient diagnostic tools to enhance patient care. This research proposes a concatenated modified LeNet classifier to classify pneumonia images accurately. The model leverages deep learning techniques to improve the diagnosis of Pneumonia, leading to more effective and timely treatment. Our modified LeNet architecture incorporates a revised Rectified Linear Unit (ReLU) activation function. This enhancement aims to boost the discriminative capacity of the features learned by the model. Furthermore, we integrate batch normalization to stabilize the training process and enhance performance within smaller, less complex, CNN architectures like LeNet. Batch normalization addresses internal covariate shift, a phenomenon where the distribution of activations within a network alter during training. These modifications help to prevent overfitting and decrease computational time. A comprehensive dataset is used to evaluate the model’s performance, and the model is benchmarked against relevant deep-learning models. The results demonstrate a high recognition rate, with an accuracy of 96% in pneumonia image recognition. This research suggests that the Concatenated Modified LeNet classifier has the potential to be a highly useful tool for medical professionals in the diagnosis of pneumonia. By offering accurate and efficient image classification, our model could contribute to improved treatment decisions and patient outcomes. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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13 pages, 1194 KiB

Open AccessArticle

Association between Chronic Kidney Disease and Chronic Rhinosinusitis: A Longitudinal Follow-Up Study Using a National Health Screening Cohort

by Heejin Kim, Tae Jun Kim, Mi Jung Kwon, Jee Hye Wee, Sung Kwang Hong, Hyo Geun Choi and Joong Seob Lee

J. Pers. Med. 2024, 14(3), 268; https://doi.org/10.3390/jpm14030268 - 29 Feb 2024

Cited by 2 | Viewed by 1587

Abstract

Chronic kidney disease (CKD) is a leading cause of global mortality. While recent reports suggest potential connections between CKD and chronic rhinosinusitis (CRS), further research is needed to elucidate the direct association between CKD and CRS. This study investigated the association between CKD [...] Read more.

Chronic kidney disease (CKD) is a leading cause of global mortality. While recent reports suggest potential connections between CKD and chronic rhinosinusitis (CRS), further research is needed to elucidate the direct association between CKD and CRS. This study investigated the association between CKD and CRS using data from the Korean National Health Insurance Service Health Screening Cohort. Participants were recruited according to medical claim codes, and individuals with CKD were matched in a 1:4 ratio with the control group. Covariates, such as demographics, health-related data, and medical history were used. The incidence rates and hazard ratio of CRS were analyzed. A further analysis was performed based on the presence of nasal polyps. Among the 514,866 participants, 16,644 patients with CKD and 66,576 matched controls were included in the analysis. The CKD group demonstrated a higher incidence of CRS than the controls: 18.30 versus 13.10 per 10,000 person-years. The CKD group demonstrated a higher risk of CRS than the control group (1.28 adjusted hazard ratio). In additional analyses, the CKD group did not exhibit a statistically significant correlation for the development of CRS with nasal polyps. This study suggests that CKD is associated with an increased risk for CRS. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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9 pages, 263 KiB

Open AccessBrief Report

Perceived Parental Style Is Better in Adults with Congenital Heart Disease than Healthy Controls—But There Is Work Left to Do in Specific Subgroups

by Leon Brudy, Julia Hock, Laura Willinger, Renate Oberhoffer-Fritz, Alfred Hager, Peter Ewert and Jan Müller

J. Vasc. Dis. 2024, 3(1), 58-66; https://doi.org/10.3390/jvd3010005 - 1 Feb 2024

Viewed by 1151

Abstract

Objective: To compare perceived parental style in a large cohort of adults with congenital heart disease (ACHD) to healthy reference (RCs). Furthermore, factors associated with perceived parental style were determined in ACHD. Patients and Methods: From September 2016 to April 2019, 912 ACHD [...] Read more.

Objective: To compare perceived parental style in a large cohort of adults with congenital heart disease (ACHD) to healthy reference (RCs). Furthermore, factors associated with perceived parental style were determined in ACHD. Patients and Methods: From September 2016 to April 2019, 912 ACHD (34.9 ± 10.4 years, 45% female) and 175 RCs (35.8 ± 12.2 years, 53% female) completed the Measure of Parental Style (MOPS) questionnaire. Results: After adjusting for age and sex, ACHD recalled the parental style of both their parents to be significantly less indifferent (mother: ACHD: 1.2 ± 0.01 vs. RC: 1.3 ± 0.03, p < 0.001; father: ACHD: 1.3 ± 0.02 vs. RC: 1.7 ± 0.05, p < 0.001), overcontrolling (mother: ACHD: 1.6 ± 0.63 vs. RC: 1.9 ± 0.62, p < 0.001; father: ACHD: 1.4 ± 0.52 vs. RC: 1.5 ± 0.50, p < 0.001), and abusive (mother: ACHD: 1.2 ± 0.47 vs. RC: 1.4 ± 0.46, p < 0.001; father: ACHD: 1.3 ± 0.59 vs. RC: 1.5 ± 0.57, p < 0.001) than healthy controls did. In ACHD, female sex (β = 0.068, p = 0.017), higher age (β = 0.005, p = 0.003), Ebstein anomaly (β = 0.170, p = 0.005), and cyanotic CHD (β = 0.336, p = 0.004) contribute to perceiving the parental style of at least one of the parents negatively. Conclusions: While ACHD appear to recall the parental style to be less negative, subgroup analysis revealed specific patients at risk. These findings point to the need for interventions in specific subgroups susceptible to psychological distress. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

14 pages, 2534 KiB

Open AccessArticle

Ultrasound and Sialendoscopy Findings in Radioactive Iodine–Induced Sialadenitis: Comparative Analysis and Possible Impact on Management

by Michael Koch, Sarina Müller, Konstantinos Mantsopoulos, Heinrich Iro and Matti Sievert

J. Clin. Med. 2024, 13(3), 657; https://doi.org/10.3390/jcm13030657 - 23 Jan 2024

Cited by 1 | Viewed by 1382

Abstract

Background: To assess the correlation/association between ultrasound and sialendoscopy findings in radioactive iodine therapy–induced sialadenitis (RAIS). Methods: Patients presenting with RAIS were investigated with ultrasound and sialendoscopy. Four pathologic ultrasound parameters and seven pathologic sialendoscopy parameters were retrospectively assessed. Correlations/associations between ultrasound and [...] Read more.

Background: To assess the correlation/association between ultrasound and sialendoscopy findings in radioactive iodine therapy–induced sialadenitis (RAIS). Methods: Patients presenting with RAIS were investigated with ultrasound and sialendoscopy. Four pathologic ultrasound parameters and seven pathologic sialendoscopy parameters were retrospectively assessed. Correlations/associations between ultrasound and sialendoscopy findings and associations between the changes between the first and last ultrasound and sialendoscopy findings were assessed separately for the parotid (PG) and submandibular glands (SMG). Results: Sixty-seven patients were included. In the first examination, 107 glands were investigated (PGs 88.8%, SMGs 11.21%), and in the last examination, 64 glands were investigated (90.6% PGs, 9.4% SMGs). Highly significant positive associations were observed between the severity or category of ultrasound and sialendoscopy findings for first and last examinations for PGs (both p = 0.0001) and SMGs (p = 0.002; p = 0.037). Duct dilation had a significant negative association with the sialendoscopy findings for PGs in the first and last examinations (both p = 0.0001), but not for SMGs. Comparison of changes in the ultrasound and sialendoscopy findings between the first and last examinations showed a significant positive association for PGs (p = 0.0001) but not for SMGs. Conclusions: Ultrasound and sialendoscopy findings for the parenchyma and duct system in RAIS showed significant associations/correlations and can be useful for effective management in RAIS. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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31 pages, 3727 KiB

Open AccessReview

Prediction of Subclinical and Clinical Multiple Organ Failure Dysfunction in Breast Cancer Patients—A Review Using AI Tools

by Andreea-Iuliana Ionescu (Miron), Dimitrie-Ionut Atasiei, Radu-Tudor Ionescu, Flavia Ultimescu, Andrei-Alexandru Barnonschi, Alexandra-Valentina Anghel, Cătălin-Alexandru Anghel, Ionuț-Lucian Antone-Iordache, Ruxandra Mitre, Alexandra Maria Bobolocu, Andreea Zamfir, Horia-Dan Lișcu, Simona Coniac and Florica Șandru

Cancers 2024, 16(2), 381; https://doi.org/10.3390/cancers16020381 - 16 Jan 2024

Cited by 9 | Viewed by 5147

Abstract

This review explores the interconnection between precursor lesions of breast cancer (typical ductal hyperplasia, atypical ductal/lobular hyperplasia) and the subclinical of multiple organ failure syndrome, both representing early stages marked by alterations preceding clinical symptoms, undetectable through conventional diagnostic methods. Addressing the question [...] Read more.

This review explores the interconnection between precursor lesions of breast cancer (typical ductal hyperplasia, atypical ductal/lobular hyperplasia) and the subclinical of multiple organ failure syndrome, both representing early stages marked by alterations preceding clinical symptoms, undetectable through conventional diagnostic methods. Addressing the question “Why patients with breast cancer exhibit a tendency to deteriorate”, this study investigates the biological progression from a subclinical multiple organ failure syndrome, characterized by insidious but indisputable lesions, to an acute (clinical) state resembling a cascade akin to a waterfall or domino effect, often culminating in the patient’s demise. A comprehensive literature search was conducted using PubMed, Google Scholar, and Scopus databases in October 2023, employing keywords such as “MODS”, “SIRS”, “sepsis”, “pathophysiology of MODS”, “MODS in cancer patients”, “multiple organ failure”, “risk factors”, “cancer”, “ICU”, “quality of life”, and “breast cancer”. Supplementary references were extracted from the retrieved articles. This study emphasizes the importance of early identification and prevention of the multiple organ failure cascade at the inception of the malignant state, aiming to enhance the quality of life and extend survival. This pursuit contributes to a deeper understanding of risk factors and viable therapeutic options. Despite the existence of the subclinical multiple organ failure syndrome, current diagnostic methodologies remain inadequate, prompting consideration of AI as an increasingly crucial tool for early identification in the diagnostic process. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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14 pages, 1969 KiB

Open AccessArticle

Comorbidity Patterns and Management in Inpatients with Endocrine Diseases by Age Groups in South Korea: Nationwide Data

by Sung-Soo Kim and Hun-Sung Kim

J. Pers. Med. 2024, 14(1), 42; https://doi.org/10.3390/jpm14010042 - 28 Dec 2023

Viewed by 1746

Abstract

This study aimed to examine comorbidity associations across age groups of inpatients with endocrine diseases as the primary diagnosis throughout the life cycle to develop an effective management strategy. Data were obtained from the Korean National Hospital Discharge In-depth Injury Survey (KNHDS) from [...] Read more.

This study aimed to examine comorbidity associations across age groups of inpatients with endocrine diseases as the primary diagnosis throughout the life cycle to develop an effective management strategy. Data were obtained from the Korean National Hospital Discharge In-depth Injury Survey (KNHDS) from 2006 to 2021, involving 68,515 discharged patients aged ≥ 19 years with a principal diagnosis of endocrine disease. A database was constructed for analysis, extracting general characteristics and comorbidities. Employing R version 4.2.3, the Chi-squared test and the Apriori algorithm of ARM (association rule mining) were used for analyzing general characteristics and comorbidity associations. There were more women (53.1%) than men (46.9%) (p < 0.001, with women (61.2 ± 17.2) having a higher average age than men (58.6 ± 58.6) (p < 0.001). Common comorbidities include unspecified diabetes mellitus; essential (primary) hypertension; unspecified diabetes mellitus; and other disorders of fluid, electrolyte, and acid-base balance. Notably, type 2 diabetes mellitus, disorders of lipoprotein metabolism and other lipidemia, polyneuropathy in diseases classified elsewhere, retinal disorders in diseases classified elsewhere, and essential (primary) hypertension prevail across all age groups. Association rules further highlight specific comorbidities appearing selectively in certain age groups. In conclusion, establishing a management strategy for comorbidities in patients with a primary diagnosis of an endocrine disorder is necessary. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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11 pages, 262 KiB

Open AccessArticle

Circadian Rhythms and Depression in Adolescents: A Comparative Analysis of First Episode and Recurrent-Episode Groups

by Young-Soo Jang, Hye-Mi Cho, Young-Eun Mok, Su-Hyuk Chi, Chang-Su Han and Moon-Soo Lee

J. Pers. Med. 2023, 13(12), 1665; https://doi.org/10.3390/jpm13121665 - 28 Nov 2023

Cited by 2 | Viewed by 1818

Abstract

Circadian rhythm disruptions are a hallmark feature of mood disorders. Patients experiencing acute depressive episodes report noticeable changes in their sleep–wake cycles. This research explains the association between depression and various circadian rhythm metrics, explicitly focusing on adolescents diagnosed with depressive disorders. Adolescence [...] Read more.

Circadian rhythm disruptions are a hallmark feature of mood disorders. Patients experiencing acute depressive episodes report noticeable changes in their sleep–wake cycles. This research explains the association between depression and various circadian rhythm metrics, explicitly focusing on adolescents diagnosed with depressive disorders. Adolescence is a critical period marked by significant physiological and psychological changes, making it imperative to understand how mood disorders manifest during this phase. However, there have been minimal specific studies in pediatric populations to determine whether circadian rhythm changes differ between adolescents with first and multiple-recurrent depressive episodes. Our study involved a group of 61 adolescents aged between 13 and 18. We performed a cross-sectional study of a clinical population of patients presenting to a child and adolescent psychiatry clinic diagnosed with depression. Participants were asked to complete self-report evaluations using several tools: the Korean version of the Biological Rhythms Interview of Assessment in Neuropsychiatry (K-BRIAN), the Korean Translation of Composite Scale to Measure Morningness-Eveningness (KtCS), and the Seasonal Pattern Assessment Questionnaire (SPAQ). Tools such as the Children’s Depression Inventory (CDI), State-Trait Anxiety Inventory (STAI), and K-Mood Disorder Questionnaire (K-MDQ) were employed for the assessment of clinical characteristics of depression. Based on the frequency of their depressive episodes, participants were bifurcated into two distinct groups: those experiencing their first episode (n = 22, mean age: 15.09 ± 1.44 years) and those with recurrent episodes (n = 39, mean age: 15.95 ± 1.26 years). At first, the two groups’ data revealed no significant differences regarding mood or circadian rhythm metrics (CDI: first episode 26.18 ± 10.54 and recurrent episode 25.90 ± 10.59, STAI-S: first episode 56.91 ± 12.12 and recurrent episode 57.49 ± 11.93, STAI-T: first episode 60.36 ± 11.63 and recurrent episode 59.09 ± 12.10, SPAQ-total: first episode 6.59 ± 4.86 and recurrent episode 6.77 ± 5.23, KtCS: first episode 30.32 ± 5.83 and recurrent episode 28.13 ± 7.36). However, we observed significant correlations between circadian rhythm disruptions and depression scales (CDI with SPAQ-weight (r = 0.26), KtCS (r = −0.48), K-BRIAN-sleep (r = 0.58), K-BRIAN-activity (r = 0.64), K-BRIAN-social (r = 0.71), and K-BRIAN-eating (r = 0.40)). These correlations were especially pronounced in the recurrent episode group, suggesting that with the progression and chronicity of depression, the relationship between circadian rhythms and depression becomes more intertwined and evident. In conclusion, especially in adolescents, as the severity and chronicity of depression increase, the interplay between circadian rhythms and mood disorders becomes more pronounced, warranting further research and clinical attention. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

11 pages, 289 KiB

Open AccessArticle

Preventing Dementia—A Cross-Sectional Study of Outpatients in a Tertiary Internal Medicine Department

by Ioana-Alexandra Sandu, Ramona Ștefăniu, Teodora Alexa-Stratulat, Adina-Carmen Ilie, Sabinne-Marie Albișteanu, Ana-Maria Turcu, Călina-Anda Sandu, Anisia-Iuliana Alexa, Anca-Iuliana Pîslaru, Gabriela Grigoraș, Cristinel Ștefănescu and Ioana-Dana Alexa

J. Pers. Med. 2023, 13(12), 1630; https://doi.org/10.3390/jpm13121630 - 22 Nov 2023

Viewed by 1510

Abstract

Dementia is a significant health problem worldwide, being the seventh leading cause of death (2,382,000 deaths worldwide in 2016). Recent data suggest there are several modifiable risk factors that, if addressed, can decrease dementia risk. Several national dementia screening programs exist; however, limited-income [...] Read more.

Dementia is a significant health problem worldwide, being the seventh leading cause of death (2,382,000 deaths worldwide in 2016). Recent data suggest there are several modifiable risk factors that, if addressed, can decrease dementia risk. Several national dementia screening programs exist; however, limited-income countries do not have the means to implement such measures. We performed a prospective cross-sectional study in an outpatient department to identify individuals at risk for dementia. Patients with no known cognitive dysfunction seeking a medical consult were screened for dementia risk by means of the cardiovascular risk factors, ageing, and dementia (CAIDE) and modified CAIDE tests. Additionally, we collected demographic and clinical data and assessed each participant for depression, mental state, and ability to perform daily activities. Of the 169 patients enrolled, 63.3% were identified as being in the intermediate-risk or high-risk group, scoring more than seven points on the mCAIDE test. Over 40% of the elderly individuals in the study were assessed as “somewhat depressed” or “depressed” on the geriatric depression scale. Almost 10% of the study population was diagnosed de novo with cognitive dysfunction. In conclusion, using a simple questionnaire such as the mCAIDE in a predefined high-risk population is easy and does not represent a major financial burden. At-risk individuals can subsequently benefit from personalized interventions that are more likely to be successful. Limited-resource countries can implement such screening tools in outpatient clinics. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

7 pages, 1272 KiB

Open AccessInteresting Images

Obstructed Hemi-Vagina with Ipsilateral Renal Agenesis Syndrome in Adulthood: A Diagnostic Challenge

by Alexandros Loukas Grammatis, Femi Ajibade, Dinuke Warakaulle and Tunde Dada

Diagnostics 2023, 13(21), 3377; https://doi.org/10.3390/diagnostics13213377 - 3 Nov 2023

Cited by 1 | Viewed by 1556

Abstract

A patient in her early 20s presented with constant and progressive lower abdominal and back pain, mainly on the right side of the abdomen, purulent vaginal discharge and pyrexia. A radiological assessment revealed a possible tubo-ovarian abscess and the incidental diagnosis of ipsilateral [...] Read more.

A patient in her early 20s presented with constant and progressive lower abdominal and back pain, mainly on the right side of the abdomen, purulent vaginal discharge and pyrexia. A radiological assessment revealed a possible tubo-ovarian abscess and the incidental diagnosis of ipsilateral renal agenesis. The patient was treated for pelvic inflammatory disease (PID); however, after antibiotic administration and since the symptoms did not resolve, an abdominal MRI was requested, which revealed uterus didelphys with two cervices, an obstructed haemivagina and evidence of haematocolpos. The diagnosis of Obstructed Hemi-Vagina with Ipsilateral Renal Agenesis (OHVIRA) syndrome was confirmed, and the patient underwent the excision of the vaginal septum, the drainage of the haematopyocolpos and the laparoscopic drainage of the tubo-ovarian abscess. She achieved a good recovery. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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6 pages, 642 KiB

Open AccessOpinion

New Paradigms for Thoracic Outlet Compression and Thoracic Outlet Syndrome, with or without Complications or Sequelae: A Trans-Continental and Trans-Disciplinary Opinion Paper

by Pierre Abraham, Paul W. Wennberg, Pascal Bauer, Yongquan Gu, Nafi Ouedraogo, Lianrui Guo, Garry Tew, Lucia Mazzolai, Romeo Martini and Samir Henni

J. Vasc. Dis. 2023, 2(4), 413-418; https://doi.org/10.3390/jvd2040032 - 2 Nov 2023

Cited by 4 | Viewed by 1510

Abstract

The anatomy of the human shoulder predisposes the neurovascular bundle to compression at different levels of the thoracic outlet during abduction of the arm. There are four possible levels of compression at the thoracic outlet pathway: at the costo-clavicular angle, the inter-scalenic angle, [...] Read more.

The anatomy of the human shoulder predisposes the neurovascular bundle to compression at different levels of the thoracic outlet during abduction of the arm. There are four possible levels of compression at the thoracic outlet pathway: at the costo-clavicular angle, the inter-scalenic angle, under the pectoralis minor muscle or at the level of the humeral head. The positional thoracic outlet compression (TOC) often remains completely asymptomatic. When symptomatic, compressions are collectively referred to as thoracic outlet syndrome (TOS) and may require surgery if physical therapy fails to improve symptoms. The “thoracic outlet compression with complications or sequelae” (the acronym of which is “TOC-CS”, which can be simplified as “TOX”) will almost invariably lead to surgery to release the compression, and other possible treatment targeting the complications as required. There is a continuum between TOC, TOS and TOX, which are simply different clinical stages of the same mechanical issue, just like the Rutherford grades represent different stages of lower extremity arterial disease. We believe that discriminating between TOC, TOS and TOX clarifies clinical definitions and their respective treatment options. TOC is to be considered as a physiological positional phenomenon, TOS requires medical or surgical treatment and surgery should be considered as a primary option in TOX. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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13 pages, 1753 KiB

Open AccessArticle

Urinary Liver-Type Fatty Acid Binding Protein, a Biomarker for Disease Progression, Dialysis and Overall Mortality in Chronic Kidney Disease

by Nicos Mitsides, Vikram Mitra, Ananya Saha, Shelly Harris, Philip A. Kalra and Sandip Mitra

J. Pers. Med. 2023, 13(10), 1481; https://doi.org/10.3390/jpm13101481 - 11 Oct 2023

Cited by 2 | Viewed by 2245

Abstract

Chronic kidney disease (CKD) is a major public health concern with an increasing proportion of sufferers progressing to renal replacement therapy (RRT). Early identification of those at risk of disease progression could be key in improving outcomes. We hypothesise that urinary liver-type fatty [...] Read more.

Chronic kidney disease (CKD) is a major public health concern with an increasing proportion of sufferers progressing to renal replacement therapy (RRT). Early identification of those at risk of disease progression could be key in improving outcomes. We hypothesise that urinary liver-type fatty acid binding protein (uL-FABP) may be a suitable biomarker for CKD progression and can add value to currently established biomarkers such as the urinary protein-to-creatinine ratio (uPCR). A total of 583 participants with CKD 1–5 (not receiving renal replacement therapy) entered a 2 yr prospective longitudinal study. UPCR and uL-FABP were measured at baseline and CKD progression was defined as either (i) a decline in eGFR of >5 mL/min/1.73 m² or an increase in serum creatinine by 10% at 1 yr; (ii) a decline in eGFR of >6 mL/min/1.73 m² or an increase in serum creatinine by 20% at 2 yrs; or (iii) the initiation of RRT. A combined outcome of initiating RRT or death was also included. Approximately 40% of participants showed CKD progression. uL-FABP predicted CKD progression at both years 1 and 2 (OR 1.01, p < 0.01). Sensitivity and specificity were comparable to those of uPCR (AUC 0.623 v 0.706) and heat map analysis suggested that uL-FABP in the absence of significant proteinuria can predict an increase in serum creatinine of 10% at 1 yr and 20% at 2 yrs. The risk of the combined outcome of initiating RRT or death was 23% higher in those with high uL-FABP (p < 0.01) independent of uPCR. uL-FABP appears to be a highly sensitive and specific biomarker of CKD progression. The use of this biomarker could enhance the risk stratification of CKD and its progression and should be assessed further. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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14 pages, 910 KiB

Open AccessArticle

The Worsening of Heart Failure with Reduced Ejection Fraction: The Impact of the Number of Hospital Admissions in a Cohort of Patients

by Jorge Perea-Armijo, José López-Aguilera, Rafael González-Manzanares, Cristina Pericet-Rodriguez, Juan Carlos Castillo-Domínguez, Gloria Heredia-Campos, Álvaro Roldán-Guerra, Cristina Urbano-Sánchez, Lucas Barreiro-Mesa, Nerea Aguayo-Caño, Mónica Delgado-Ortega, Manuel Crespín-Crespín, Martín Ruiz-Ortiz, Dolores Mesa-Rubio, Manuel Pan-Álvarez Osorio and Manuel Anguita-Sánchez

J. Clin. Med. 2023, 12(18), 6082; https://doi.org/10.3390/jcm12186082 - 20 Sep 2023

Cited by 2 | Viewed by 1625

Abstract

Background: Worsening heart failure (WFH) includes heart failure (HF) hospitalisation, representing a strong predictor of mortality in patients with heart failure with reduced ejection fraction (HFrEF). However, there is little evidence analysing the impact of the number of previous HF admissions. Our main [...] Read more.

Background: Worsening heart failure (WFH) includes heart failure (HF) hospitalisation, representing a strong predictor of mortality in patients with heart failure with reduced ejection fraction (HFrEF). However, there is little evidence analysing the impact of the number of previous HF admissions. Our main objective was to analyse the clinical profile according to the number of previous admissions for HF and its prognostic impact in the medium and long term. Methods: A retrospective study of a cohort of patients with HFrEF, classified according to previous admissions: cohort-1 (0–1 previous admission) and cohort-2 (≥2 previous admissions). Clinical, echocardiographic and therapeutic variables were analysed, and the medium- and long-term impacts in terms of hospital readmissions and cardiovascular mortality were assessed. A total of 406 patients were analysed. Results: The mean age was 67.3 ± 12.6 years, with male predominance (73.9%). Some 88.9% (361 patients) were included in cohort-1, and 45 patients (11.1%) were included in cohort-2. Cohort-2 had a higher proportion of atrial fibrillation (49.9% vs. 73.3%; p = 0.003), chronic kidney disease (36.3% vs. 82.2%; p < 0.001), and anaemia (28.8% vs. 53.3%; p = 0.001). Despite having similar baseline ventricular structural parameters, cohort-1 showed better reverse remodelling. With a median follow-up of 60 months, cohort-1 had longer survival free of hospital readmissions for HF (37.5% vs. 92%; p < 0.001) and cardiovascular mortality (26.2% vs. 71.9%; p < 0.001), with differences from the first month. Conclusions: Patients with HFrEF and ≥2 previous admissions for HF have a higher proportion of comorbidities. These patients are associated with worse reverse remodelling and worse medium- and long-term prognoses from the early stages, wherein early identification is essential for close follow-up and optimal intensive treatment. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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19 pages, 1379 KiB

Open AccessSystematic Review

The Influence of Electroconvulsive Therapy (ECT) on Brain-Derived Neurotrophic Factor (BDNF) Plasma Level in Patients with Schizophrenia—A Systematic Review and Meta-Analysis

by Anna Maria Szota, Beata Kowalewska, Małgorzata Ćwiklińska-Jurkowska and Wiktor Dróżdż

J. Clin. Med. 2023, 12(17), 5728; https://doi.org/10.3390/jcm12175728 - 2 Sep 2023

Cited by 5 | Viewed by 2350

Abstract

The main aim of this systematic review and meta-analysis is to establish whether there is a correlation between the brain-derived neurotrophic factor (BDNF) level and electroconvulsive therapy (ECT) treatment and the reduction in psychotic symptoms in patients diagnosed with schizophrenia. A systematic search [...] Read more.

The main aim of this systematic review and meta-analysis is to establish whether there is a correlation between the brain-derived neurotrophic factor (BDNF) level and electroconvulsive therapy (ECT) treatment and the reduction in psychotic symptoms in patients diagnosed with schizophrenia. A systematic search of PubMed/Medline, Cochrane Library, Web of Science, Scopus and Embase was conducted up to March 2023. Inclusion criteria: studies in which adult patients with schizophrenia treated with antipsychotic medication received ECT therapy and had the BDNF level measured before and after ECT treatment. Exclusion criteria: animal and in vitro studies or studies not involving complete information about the treatment and concentration of BDNF in plasma. The risk of bias was assessed using Egger’s regression-based test for meta-analysis with continuous outcomes. Six studies comprising 248 individuals with schizophrenia were included. A statistically significant increase in BDNF levels after ECT treatment was observed only in two studies (p < 0.001 and p < 0.027, respectively), whereas in four other studies, an upward trend without statistical significance was noticed. The estimated overall size effect revealed that ECT therapy caused a slight change in the BDNF level but without statistical significance (ES = −0.328). Different numbers of ECT procedures (4-10), final measurement of the BDNF level made at a different time point, using bilateral or unilateral electrode positioning during ECT and treatment with different combinations of typical or atypical antipsychotic medications may be potential reasons for the lack of statistical significance in the changes in BDNF levels after treatment. Data regarding the measurement of BDNF levels pre and post ECT therapy in patients with schizophrenia are very limited without an extended follow-up period and evaluation of mental health change. Our meta-analysis showed that treatment with ECT therapy and antipsychotic medication increases serum BDNF levels in patients with drug-resistant schizophrenia compared to patients treated with medication only; however, this effect is not statistically significant. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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13 pages, 2434 KiB

Open AccessArticle

High Frequency of Osteophytes Detected by High-Resolution Ultrasound at the Finger Joints of Asymptomatic Factory Workers

by Mario Giulini, Ralph Brinks, Stefan Vordenbäumen, Hasan Acar, Jutta G. Richter, Xenofon Baraliakos, Benedikt Ostendorf, Matthias Schneider, Oliver Sander and Philipp Sewerin

J. Pers. Med. 2023, 13(9), 1343; https://doi.org/10.3390/jpm13091343 - 30 Aug 2023

Cited by 1 | Viewed by 1726

Abstract

Hand Osteoarthritis (HOA) is a frequently occurring musculoskeletal disease that impacts health. Diagnostic criteria often incorporate osteophytes documented through imaging procedures. Radiographic imaging is considered the gold standard; however, more sensitive and safer methods like ultrasound imaging are becoming increasingly important. We conducted [...] Read more.

Hand Osteoarthritis (HOA) is a frequently occurring musculoskeletal disease that impacts health. Diagnostic criteria often incorporate osteophytes documented through imaging procedures. Radiographic imaging is considered the gold standard; however, more sensitive and safer methods like ultrasound imaging are becoming increasingly important. We conducted a population-based cross-sectional study to examine the prevalence, grade, and pattern of osteophytes using high-resolution ultrasound investigation. Factory workers were recruited on-site for the study. Each participant had 26 finger joints examined using ultrasonography to grade the occurrence of osteophytes on a semi-quantitative scale ranging from 0–3, where higher scores indicate larger osteophytes. A total of 427 participants (mean age 53.5 years, range 20–79 years) were included, resulting in 11,000 joints scored. At least one osteophyte was found in 4546 out of 11,000 (41.3%) joints or in 426 out of 427 (99.8%) participants, but only 5.0% (553) of the joints showed grade 2 or 3 osteophytes. The total osteophyte sum score increased by 0.18 per year as age increased (p < 0.001). The distal interphalangeal joints were the most commonly affected, with 61%, followed by the proximal interphalangeal joints with 48%, carpometacarpal joint 1 with 39%, and metacarpophalangeal joints with 16%. There was no observed impact of gender or workload. In conclusion, ultrasound imaging proves to be a practical screening tool for osteophytes and HOA. Grade 1 osteophytes are often detected in the working population through ultrasound assessments and their incidence increases with age. The occurrence of grade 2 or 3 osteophytes is less frequent and indicates the clinical presence of HOA. Subsequent evaluations are imperative to ascertain the predictive significance of early osteophytes. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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13 pages, 1138 KiB

Open AccessArticle

Cancer and Pregnancy: Estimates in Italy from Record-Linkage Procedures between Cancer Registries and the Hospital Discharge Database

by Daniela Pierannunzio, Alice Maraschini, Tania Lopez, Serena Donati, Rosalba Amodio, Fortunato Bianconi, Rossella Bruni, Marine Castaing, Claudia Cirilli, Giovanna Fantaci, Linda Guarda, Silvia Iacovacci, Lucia Mangone, Guido Mazzoleni, Walter Mazzucco, Anna Melcarne, Elisabetta Merlo, Fabio Parazzini, Fedro Alessandro Peccatori, Massimo Rugge, Giuseppe Sampietro, Giovanni Scambia, Giovanna Scarfone, Ausilia Sferrazza, Fabrizio Stracci, Antonina Torrisi, Maria Francesca Vitale and Silvia Francisci Show full author list Hide full author list

Cancers 2023, 15(17), 4305; https://doi.org/10.3390/cancers15174305 - 28 Aug 2023

Cited by 5 | Viewed by 1665

Abstract

The aim of this study is to describe the frequency and trend of pregnancy-associated cancer (PAC) in Italy, an increasingly relevant phenomenon due to postponing age at childbirth. To this purpose, a population-based retrospective longitudinal study design based on cohorts of women aged [...] Read more.

The aim of this study is to describe the frequency and trend of pregnancy-associated cancer (PAC) in Italy, an increasingly relevant phenomenon due to postponing age at childbirth. To this purpose, a population-based retrospective longitudinal study design based on cohorts of women aged 15–49 diagnosed with cancer and concomitant pregnancy is proposed. The study uses 19 population-based Cancer Registries, covering about 22% of Italy, and linked at an individual level with Hospital Discharge Records. A total of 2,861,437 pregnancies and 3559 PAC are identified from 74,165 women of the cohort with a rate of 1.24 PAC per 1000 pregnancies. The most frequent cancer site is breast (24.3%), followed by thyroid (23.9%) and melanoma (14.3%). The most frequent outcome is delivery (53.1%), followed by voluntary termination of pregnancy and spontaneous abortion (both 12.0%). The trend of PAC increased from 2003 to 2015, especially when the outcome is delivery, thus confirming a new attitude of clinicians to manage cancer throughout pregnancy. This represents the first attempt in Italy to describe PAC from Cancer Registries data; the methodology is applicable to other areas with the same data availability. Evidence from this study is addressed to clinicians for improving clinical management of women with PAC. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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12 pages, 470 KiB

Open AccessReview

Fibrotic Diseases of the Human Urinary and Genital Tract: Current Understanding and Potential Strategies for Treatment

by Harrina E. Rahardjo, Viktoria Märker, Dimitrios Tsikas, Markus A. Kuczyk, Stefan Ückert and Andreas Bannowsky

J. Clin. Med. 2023, 12(14), 4770; https://doi.org/10.3390/jcm12144770 - 19 Jul 2023

Cited by 3 | Viewed by 2808

Abstract

Fibrosis is a disease condition characterized by abnormalities of the extracellular matrix, such as accumulation of the transforming growth factor β, infiltration by myofibroblasts, deposition of collagen, and a generalized dysregulation of collagen maturation. It can severely impair the function of organs by [...] Read more.

Fibrosis is a disease condition characterized by abnormalities of the extracellular matrix, such as accumulation of the transforming growth factor β, infiltration by myofibroblasts, deposition of collagen, and a generalized dysregulation of collagen maturation. It can severely impair the function of organs by replacing normal tissue with a highly collagenized matrix, thereby reducing the elasticity and compliance of tissues. Fibrotic diseases of the genitourinary tract present relevant problems in healthcare, and their principles of pathophysiology remain unclarified; hence, the armamentarium for prevention and treatment is limited. These diseases include renal fibrosis, Peyronie’s disease and ureteral and urethral strictures due to perturbations in the process of wound healing in response to injuries. Such deteriorations may contribute to obstructive uropathies or sexual dysfunction. This review provides a brief overview of the most frequent fibrotic diseases of the genitourinary system and of how the pathophysiology is related to symptoms, and also highlights potential therapeutic strategies to address the abnormal deposition of collagen. Although the understanding of factors associated with fibrotic conditions of the urinary and genital tract is still limited, some beneficial advances have been made. Further research will serve to provide a more comprehensive insight into factors responsible for the development of fibrotic tissue deposition. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)
(This article belongs to the Section Nephrology & Urology)

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12 pages, 1609 KiB

Open AccessArticle

Previous Lumbar Spine Surgery Decreases the Therapeutic Efficacy of Dorsal Root Ganglion Pulsed Radiofrequency in Patients with Chronic Lumbosacral Radicular Pain

by Jiri Jandura, Milan Vajda, Roman Kostysyn, Jiri Vanasek, Eva Cermakova, Jan Zizka and Pavel Ryska

J. Pers. Med. 2023, 13(7), 1054; https://doi.org/10.3390/jpm13071054 - 27 Jun 2023

Cited by 2 | Viewed by 1635

Abstract

Chronic lumbosacral radicular pain (CLRP) as a possible adverse consequence of lumbar spine surgery represents a serious medical challenge. Pulsed radiofrequency of dorsal root ganglion (PRF–DRG) treatment is known to be effective in alleviating CLRP. This retrospective study compares the efficacy of a [...] Read more.

Chronic lumbosacral radicular pain (CLRP) as a possible adverse consequence of lumbar spine surgery represents a serious medical challenge. Pulsed radiofrequency of dorsal root ganglion (PRF–DRG) treatment is known to be effective in alleviating CLRP. This retrospective study compares the efficacy of a single CT-guided PRF–DRG procedure in the treatment of unilateral CLRP between patients without (non-PSS) and with (PSS) previous lumbar spine surgery. Non-PSS and PSS groups included 30 and 20 patients, respectively. Outcomes (pain intensity and disability) were evaluated by means of the visual analog scale (VAS) and Oswestry disability index (ODI) immediately after the procedure (VAS), as well as three and six months after the procedure, respectively. Non-PSS group showed a significant (p ˂ 0.001) decrease of VAS (median) at all follow-up intervals (from 6 to 4; 4; 4.5 points, respectively). The PSS group showed a significant yet transient VAS (median) decrease (from 6 to 5 points) immediately after the procedure only (p < 0.001). The decrease of VAS was more pronounced in the non-PSS group after three and six months (p = 0.0054 and 0.011, respectively) in intergroup comparison. A relative decrease of VAS ≥ 50% during follow-up was achieved in 40%; 43.3%; 26.7% (non-PSS), and 25%; 5%; 0% (PSS) of patients. ODI (median) significantly decreased in the non-PSS group (from 21.5 to 18 points) at three and six months (p = 0.014 and 0.021, respectively). In conclusion, previous lumbar spine surgery decreases the therapeutic efficacy of PRF–DRG procedure in CLRP patients. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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15 pages, 481 KiB

Open AccessArticle

Association between Psychological, Biochemical and Personal Factors with the Inflammatory Marker High-Sensitive C Reactive Protein (Hs-CRP) in Mexican Healthy Population

by Aniel Jessica Leticia Brambila-Tapia, Ana Lilia Jacquez-Castañeda, Laura Arely Carrillo-Delgadillo, Jessica Natalia Dávila-Flores, Fabiola Macías-Espinoza, Saúl Ramírez-De Los Santos and Itzae Adonai Gutiérrez-Hurtado

J. Pers. Med. 2023, 13(5), 876; https://doi.org/10.3390/jpm13050876 - 22 May 2023

Cited by 2 | Viewed by 2202

Abstract

In the last decades, it has been shown that inflammatory processes play a role in the development of mental and physical problems; although some studies have researched the relationship between inflammation and psychological variables, the inclusion of biochemical variables as possible confounders has [...] Read more.

In the last decades, it has been shown that inflammatory processes play a role in the development of mental and physical problems; although some studies have researched the relationship between inflammation and psychological variables, the inclusion of biochemical variables as possible confounders has been limited. Therefore, the aim of this study was to determine whether psychological variables are associated with the inflammatory marker, highly sensitive CRP (hs-CRP), after controlling for personal and biochemical variables in the Mexican population. The study was performed at the University of Guadalajara facilities, during the second half of 2022. Healthy subjects were invited to participate in the study, which consisted of the measurement of personal, psychological, and biochemical variables. We included 172 participants, 92 (52.9%) of which were women; the median (range) of age of the whole sample was 22 (18–69) years old. In the bivariate analysis, significant positive correlations were observed between hs-CRP and body mass index (BMI) and waist/hip ratio (WHR) in both sexes, together with leukocytes, uric acid, low-density lipoprotein (LDL), triglycerides, and the liver enzymes gamma glutamyl transferase (GGT) and alkaline phosphatase (ALP). In the multivariate regression analysis of the global and men’s samples, anxiety was positively associated with hs-CRP, while depression and positive relations with others were negatively associated with hs-CRP. In conclusion, psychological variables influence inflammation mainly in men, and anxiety was the main contributor; in addition, positive relation with others is a variable that should be further explored as a psychological protector of inflammation in both sexes. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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9 pages, 1371 KiB

Open AccessBrief Report

Increased Red Blood Cell Distribution Predicts Severity of Chronic Obstructive Pulmonary Disease Exacerbation

by Elias Saad, Basheer Maamoun and Assy Nimer

J. Pers. Med. 2023, 13(5), 843; https://doi.org/10.3390/jpm13050843 - 17 May 2023

Cited by 3 | Viewed by 3272

Abstract

Introduction: Increased red blood cell distribution width (RDW) has been reported to be related to underlying chronic inflammation. Our aim is to investigate the relationship of different complete blood count (CBC) parameters such as hemoglobin level, mean corpuscular volume (MCV), mean platelet volume [...] Read more.

Introduction: Increased red blood cell distribution width (RDW) has been reported to be related to underlying chronic inflammation. Our aim is to investigate the relationship of different complete blood count (CBC) parameters such as hemoglobin level, mean corpuscular volume (MCV), mean platelet volume (MPV) or RDW with COPD exacerbation severity. Methods: In the present retrospective analysis, consecutive patients admitted with the diagnosis of “COPD Exacerbation” between 1 January 2012 and 31 December 2015 were evaluated. Results: The study population included 804 patients with COPD exacerbation. The maximal partial pressure of carbon dioxide in the arterial blood (PaCO₂) during hospital stay was significantly higher in patients with high MCV (p < 0.001), and in patients with a high RDW (p < 0.001). The hospitalization duration was significantly longer in patients with high RDW (p < 0.001) and in patients with elevated C-reactive protein (CRP) levels (p < 0.001). CRP levels strongly correlated to RDW (p = 0.001). Conclusions: Our study demonstrated that different CBC parameters, such as MCV and RDW, are in correlation with the severity of acute exacerbation of COPD reflected by the PaCO₂ level and the duration of hospitalization. Furthermore, we also found a positive correlation between RDW and CRP levels. This finding supports the hypothesis that RDW is a good biomarker of acute inflammation. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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11 pages, 315 KiB

Open AccessArticle

Hemophilic Arthropathy of the Knee and Its Association with Reduced Muscle Strength and Activation and the Pressure Pain Threshold: A Case-Control Study

by Mar Villalón-González, Íñigo Fernández de Luco-Santamaría, Rubén Cuesta-Barriuso, José Antonio López-Pina and Raúl Pérez-Llanes

J. Clin. Med. 2023, 12(9), 3275; https://doi.org/10.3390/jcm12093275 - 4 May 2023

Cited by 6 | Viewed by 1803

Abstract

(1) Background: Hemophilia is characterized by recurrent hemarthrosis leading to degenerative arthropathy. The aim was to evaluate the differences in muscle strength and activity and the pressure pain threshold between patients with knee arthropathy and their healthy peers; (2) Methods: A case-control study [...] Read more.

(1) Background: Hemophilia is characterized by recurrent hemarthrosis leading to degenerative arthropathy. The aim was to evaluate the differences in muscle strength and activity and the pressure pain threshold between patients with knee arthropathy and their healthy peers; (2) Methods: A case-control study in which 23 adult patients with knee arthropathy and 24 healthy peers matched in terms of characteristics were recruited. The study variables were quadriceps muscle strength, muscle activation and the pressure pain threshold; (3) Results: There were significant differences between the two groups in quadriceps strength on the dominant (CI95%: 64.69, 129.2) and non-dominant (CI95%: 29.95, 93.55) sides and in the pressure pain threshold on the dominant (CI95%: 3.30, 43.54) and non-dominant (CI95%: 3.09, 45.25) sides. There were differences in neuromuscular fatigue on the non-dominant side in the vastus medialis (CI95%: 8.72, 21.51), vastus lateralis (CI95%: 4.84, 21.66) and rectus femoris (CI95%: 6.48, 24.95) muscles; (4) Conclusions: Muscle strength and the pressure pain threshold are lower in patients with hemophilia. Quadriceps muscle activation in patients with hemophilic knee arthropathy does not in any way differ from activation in healthy subjects. However, muscle fatigue is greater in patients with knee arthropathy. Strength training in patients with hemophilia should focus on the activation of the vastus medialis and lateralis muscles. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

14 pages, 469 KiB

Open AccessArticle

Development of a Predictive Model of Cardiovascular Risk in a Male Population from the Peruvian Amazon

by Jose M. Alcaide-Leyva, Manuel Romero-Saldaña, María García-Rodríguez, Rafael Molina-Luque, Rocío Jiménez-Mérida and Guillermo Molina-Recio

J. Clin. Med. 2023, 12(9), 3199; https://doi.org/10.3390/jcm12093199 - 29 Apr 2023

Cited by 1 | Viewed by 1478

Abstract

Background: The coexistence of malnutrition due to over- and under-nutrition in the Peruvian Amazon increases chronic diseases and cardiovascular risk. Methods: A cross-sectional study of a male population where anthropometric, clinical, and demographic variables were obtained to create a binary logistic regression predictive [...] Read more.

Background: The coexistence of malnutrition due to over- and under-nutrition in the Peruvian Amazon increases chronic diseases and cardiovascular risk. Methods: A cross-sectional study of a male population where anthropometric, clinical, and demographic variables were obtained to create a binary logistic regression predictive model of cardiovascular risk. Results: We compared two methods with good predictive results, finally choosing Model 4 (r² = 0.57, sensitivity 73.68%, specificity 95.35%, Youden index 0.69, and validity index 94.21), with non-invasive variables such as blood pressure (p < 0.001), hip circumference (p < 0.001), and FINDRISC test result (p < 0.05); Conclusions: We developed a cheap, fast, and non-invasive tool to determine cardiovascular risk in the population of this endemic area. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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8 pages, 246 KiB

Open AccessBrief Report

Eosinopenia as a Prognostic Biomarker for Noninvasive Ventilation Use in COPD Exacerbations

by Konstantinos Bartziokas, Evgenia Papathanasiou, Andriana I. Papaioannou, Ilias Papanikolaou, Emmanouil Antonakis, Ioanna Makou, Georgios Hillas, Theodoros Karampitsakos, Ourania Papaioannou, Katerina Dimakou, Vasiliki Apollonatou, Galateia Verykokou, Spyros Papiris, Petros Bakakos, Stelios Loukides and Konstantinos Kostikas

J. Pers. Med. 2023, 13(4), 686; https://doi.org/10.3390/jpm13040686 - 19 Apr 2023

Cited by 3 | Viewed by 1808

Abstract

Background: In recent years, blood eosinophils have been evaluated as a surrogate biomarker for eosinophilic airway inflammation and as a prognostic indicator of the outcomes of hospitalized COPD subjects. During an exacerbation of COPD, eosinopenia has been proposed as a prognostic marker of [...] Read more.

Background: In recent years, blood eosinophils have been evaluated as a surrogate biomarker for eosinophilic airway inflammation and as a prognostic indicator of the outcomes of hospitalized COPD subjects. During an exacerbation of COPD, eosinopenia has been proposed as a prognostic marker of adverse outcomes. Objectives: The aim of the present post hoc analysis was to elucidate the effectiveness of blood eosinophils for predicting the need of NIV in subjects with COPD exacerbation. Methods: Consecutive subjects admitted to a hospital for COPD exacerbation were included in the analysis. The eosinophil count from the first complete blood count was used to designate the eosinophil groups. The relationship between the clinical characteristics and blood eosinophil counts, as dichotomized using 150 cells/μL, was evaluated. Results Subjects with blood eosinophil number < 150 k/μL had a more severe disease on admission compared to subjects with ≥150 k/μL, regarding pH 7.400 (7.36, 7.44) vs. 7.42 (7.38, 7.45), p = 0.008, PO₂/FiO₂ levels 238.1 (189.8, 278.6) vs. 276.2 (238.2, 305.6), p < 0.001, CRP (mg/L) levels 7.3 (3.1, 19.9) vs. 3.5 (0.7, 7.8), p < 0.001 and required a longer hospital stay (days) 10.0 (8.0, 14.0) vs. 5.0 (3.0, 7.0) p < 0.001 respectively. The number of blood eosinophils correlated with the levels of CRP upon admission (p < 0.001, r = −0.334), with arterial pH upon admission (p < 0.030, r = 0.121), with PO₂/FiO₂ (p < 0.001, r = −0.248), and with duration of hospital stay (p < 0.001, r = −0.589). In the multinomial logistic regression analysis, blood eosinophil count < 150 k/μL was an independent predictor of the use of NIV during hospital stay. Conclusion: During COPD exacerbation, low blood eosinophil levels upon admission are related to more severe disease and can be used as a predictor of the need of NIV. Further prospective studies are needed to identify the use of blood eosinophil levels as a predictor of unfavorable outcomes. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

13 pages, 2231 KiB

Open AccessArticle

Myocardial Strain during Surveillance Screening Is Associated with Future Cardiac Dysfunction among Survivors of Childhood, Adolescent and Young Adult-Onset Cancer

by Wendy J. Bottinor, Xiaoyan Deng, Dipankar Bandyopadhyay, Gary Coburn, Corey Havens, Melissa Carr, Daniel Saurers, Chantelle Judkins, Wu Gong, Chang Yu, Debra L. Friedman, Scott C. Borinstein and Jonathan H. Soslow

Cancers 2023, 15(8), 2349; https://doi.org/10.3390/cancers15082349 - 18 Apr 2023

Cited by 1 | Viewed by 2102

Abstract

Cardiovascular disease is a leading contributor to mortality among childhood, adolescent and young adult (C-AYA) cancer survivors. While serial cardiovascular screening is recommended in this population, optimal screening strategies, including the use of echocardiography-based myocardial strain, are not fully defined. Our objective was [...] Read more.

Cardiovascular disease is a leading contributor to mortality among childhood, adolescent and young adult (C-AYA) cancer survivors. While serial cardiovascular screening is recommended in this population, optimal screening strategies, including the use of echocardiography-based myocardial strain, are not fully defined. Our objective was to determine the relationship between longitudinal and circumferential strain (LS, CS) and fractional shortening (FS) among survivors. This single-center cohort study retrospectively measured LS and CS among C-AYAs treated with anthracycline/anthracenedione chemotherapy. The trajectory of LS and CS values over time were examined among two groups of survivors: those who experienced a reduction of >5 fractional shortening (FS) units from pre-treatment to the most recent echocardiogram, and those who did not. Using mixed modeling, LS and CS were used to estimate FS longitudinally. A receiver operator characteristic curve was generated to determine the ability of our model to correctly predict an FS ≤ 27%. A total of 189 survivors with a median age of 14 years at diagnosis were included. Among the two survivor groups, the trajectory of LS and CS differed approximately five years from cancer diagnosis. A statistically significant inverse relationship was demonstrated between FS and LS −0.129, p = 0.039, as well as FS and CS −0.413, p < 0.001. The area under the curve for an FS ≤ 27% was 91%. Among C-AYAs, myocardial strain measurements may improve the identification of individuals with cardiotoxicity, thereby allowing earlier intervention. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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20 pages, 2849 KiB

Open AccessArticle

The Survival Outcomes, Prognostic Factors and Adverse Events following Systemic Chemotherapy Treatment in Bone Sarcomas: A Retrospective Observational Study from the Experience of the Cancer Referral Center in Northern Thailand

by Wachiranun Sirikul, Nida Buawangpong, Dumnoensun Pruksakorn, Chaiyut Charoentum, Pimpisa Teeyakasem and Nut Koonrungsesomboon

Cancers 2023, 15(7), 1979; https://doi.org/10.3390/cancers15071979 - 26 Mar 2023

Cited by 8 | Viewed by 2419

Abstract

This study aimed to assess survival outcomes, prognostic factors, and adverse events following chemotherapy treatment for osteosarcoma and Ewing’s sarcoma. This retrospective observational study was conducted to collect the data of the patients with osteosarcoma or Ewing’s sarcoma who received chemotherapy treatment between [...] Read more.

This study aimed to assess survival outcomes, prognostic factors, and adverse events following chemotherapy treatment for osteosarcoma and Ewing’s sarcoma. This retrospective observational study was conducted to collect the data of the patients with osteosarcoma or Ewing’s sarcoma who received chemotherapy treatment between 2008 and 2019. The flexible parametric survival model was performed to explore the adjusted survival probability and the prognostic factors. A total of 102 patients (79 with osteosarcoma and 23 with Ewing’s sarcoma) were included. The estimated 5-year disease-free survival (DFS) and 5-year overall survival (OS) probabilities in patients with resectable disease were 60.9% and 63.3% for osteosarcoma, and 54.4% and 88.3% for Ewing’s sarcoma, respectively, whereas the 5-year DFS and 5-year OS for those with unresectable/metastatic disease remained below 25%. Two prognostic factors for osteosarcoma included a response to neoadjuvant chemotherapy and female gender. Ewing’s sarcoma patients aged 25 years and older were significantly associated with poorer survival outcomes. Of 181 chemotherapy treatment cycles, common self-reported adverse symptoms included tumor pain (n = 32, 17.7%), fever (n = 21, 11.6%), and fatigue (n = 16, 8.8%), while common grade III adverse events included febrile neutropenia (n = 13, 7.3%) and neutropenia (n = 9, 5.1%). There was no chemotherapy-related mortality (grade V) or anaphylaxis events. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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19 pages, 1546 KiB

Open AccessArticle

Association of Alternative Markers of Carbohydrate Metabolism (Fructosamine and 1,5-Anhydroglucitol) with Perioperative Characteristics and In-Hospital Complications of Coronary Artery Bypass Grafting in Patients with Type 2 Diabetes Mellitus, Prediabetes, and Normoglycemia

by Alexey N. Sumin, Natalia A. Bezdenezhnykh, Andrey V. Bezdenezhnykh, Anastasiya A. Kuzmina, Yuliya A. Dyleva and Olga L. Barbarash

Diagnostics 2023, 13(5), 969; https://doi.org/10.3390/diagnostics13050969 - 3 Mar 2023

Cited by 1 | Viewed by 2027

Abstract

Patients with type 2 diabetes make up 25 to 40% of those referred for coronary bypass surgery, and the impact of diabetes on the results of the operation is studied in various aspects. To assess the state of carbohydrate metabolism before any surgical [...] Read more.

Patients with type 2 diabetes make up 25 to 40% of those referred for coronary bypass surgery, and the impact of diabetes on the results of the operation is studied in various aspects. To assess the state of carbohydrate metabolism before any surgical interventions, including CABG, daily glycemic control, and the determination of glycated hemoglobin (HbA1c) is recommended. Glycated hemoglobin reflects the glucose concentration for the 3 months prior to the measurement, but alternative markers that reflect glycemic fluctuations over a shorter period of time may be useful in preoperative preparation. The aim of this study was to study the relationship between the concentration of alternative markers of carbohydrate metabolism (fructosamine and 1,5-anhydroglucitol) with patients’ clinical characteristics and the rate of hospital complications after coronary artery bypass grafting (CABG). Method. In the cohort of 383 patients, besides the routine examination, additional markers of carbohydrate metabolism were determined before and on days 7–8 after CABG: glycated hemoglobin (HbA1c), fructosamine, and 1,5-anhydroglucitol. We evaluated the dynamics of these parameters in groups of patients with diabetes mellitus, prediabetes, and normoglycemia, as well as the association of these parameters with clinical parameters. Additionally, we assessed the incidence of postoperative complications and factors associated with their development. Results. In all groups of patients (diabetes mellitus, prediabetes, normoglycemia), there was a significant decrease in the level of fructosamine on the 7th day after CABG compared with baseline (p1st–2nd point 0.030, 0.001, and 0.038 in groups 1, 2, and 3, respectively), whereas the level of 1,5-anhydroglucitol did not change significantly. The preoperative level of fructosamine was associated with the risk of surgery according to the EuroSCORE II scale (p = 0.002), as were the number of bypasses (p = 0.012), body mass index and overweightness (p < 0.001 in both cases), triglyceride (p < 0.001) and fibrinogen levels (p = 0.002), preoperative and postoperative glucose and HbA1c levels (p < 0.001 in all cases), left atrium size (p = 0.028), multiplicity of cardioplegia, cardiopulmonary bypass duration and aortic clamp time (p < 0.001 in all cases). The preoperative level of 1,5-anhydroglucitol showed an inverse correlation with fasting glucose and fructosamine levels before surgery (p < 0.001 in all cases), intima media thickness (p = 0.016), and a direct correlation with LV end-diastolic volume (p = 0.020). The combined endpoint (presence of significant perioperative complications + extended hospital stay after surgery >10 days) was identified in 291 patients. In binary logistic regression analysis patient age (p = 0.005) and fructosamine level (p = 0.022) were independently associated with the development of this composite endpoint (presence of significant perioperative complications + extended hospital stay after surgery >10 days). Conclusions: This study demonstrated that in patients after CABG there was the significant decrease in the level of fructosamine compared with baseline, whereas the level of 1,5-anhydroglucitol did not change. Preoperative fructosamine levels were one of the independent predictors of the combined endpoint. The prognostic value of preoperative assessment of alternative markers of carbohydrate metabolism in cardiac surgery deserves further study. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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24 pages, 3348 KiB

Open AccessArticle

Data Analysis of Impaired Renal and Cardiac Function Using a Combination of Standard Classifiers

by Danijela Tasic, Drasko Furundzic, Katarina Djordjevic, Slobodanka Galovic, Zorica Dimitrijevic and Sonja Radenkovic

J. Pers. Med. 2023, 13(3), 437; https://doi.org/10.3390/jpm13030437 - 28 Feb 2023

Cited by 1 | Viewed by 2190

Abstract

We examine the significance of the predictive potential of EPI cystatin C (EPI CysC) in combination with NTproBNP, sodium, and potassium in the evaluation of renal function in patients with cardiorenal syndrome using standard mathematical classification models from the domain of artificial intelligence. [...] Read more.

We examine the significance of the predictive potential of EPI cystatin C (EPI CysC) in combination with NTproBNP, sodium, and potassium in the evaluation of renal function in patients with cardiorenal syndrome using standard mathematical classification models from the domain of artificial intelligence. The criterion for the inclusion of subjects with combined impairment of heart and kidney function in the study was the presence of newly discovered or previously diagnosed clinically manifest cardiovascular disease and acute or chronic kidney disease in different stages of evolution. In this paper, five standard classifiers from the field of machine learning were used for the analysis of the obtained data: ensemble of neural networks (MLP), ensemble of k-nearest neighbors (k-NN) and naive Bayes classifier, decision tree, and a classifier based on logistic regression. The results showed that in MLP, k-NN, and naive Bayes, EPI CysC had the highest predictive potential. Thus, our approach with utility classifiers recognizes the essence of the disorder in patients with cardiorenal syndrome and facilitates the planning of further treatment. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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13 pages, 2756 KiB

Open AccessArticle

Association between Metabolic Obesity Phenotypes and the Burden of Hospitalized Postmenopausal Patients Concomitant with Osteoporosis: A Retrospective Cohort Study Based on the National Readmission Database

by Jie Jiang, Chao Xu, Zinuo Yuan, Junming Han, Zhixiang Wang, Yang Tian, Yingchun Dong, Weibo Xia, Xiude Fan and Jiajun Zhao

J. Clin. Med. 2023, 12(4), 1623; https://doi.org/10.3390/jcm12041623 - 17 Feb 2023

Viewed by 2157

Abstract

Background: The present definition of obesity based on body mass index (BMI) is not accurate and effective enough to identify hospitalized patients with a heavier burden, especially for postmenopausal hospitalized patients concomitant with osteoporosis. The link between common concomitant disorders of major chronic [...] Read more.

Background: The present definition of obesity based on body mass index (BMI) is not accurate and effective enough to identify hospitalized patients with a heavier burden, especially for postmenopausal hospitalized patients concomitant with osteoporosis. The link between common concomitant disorders of major chronic diseases such as osteoporosis, obesity, and metabolic syndrome (MS) remains unclear. Here, we aim to evaluate the impact of different metabolic obesity phenotypes on the burden of postmenopausal hospitalized patients concomitant with osteoporosis in view of unplanned readmissions. Methods: Data was acquired from the National Readmission Database 2018. The study population was classified into metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO) patients. We estimated the associations between metabolic obesity phenotypes and 30- and 90-day unplanned readmissions. A multivariate Cox Proportional Hazards (PH) model was used to assess the effect of factors on endpoints, with results expressed as HR and 95% CI. Results: The 30-day and 90-day readmission rates for the MUNO and MUO phenotypes were higher than that of the MHNO group (all p < 0.05), whereas no significant difference was found between the MHNO and MHO groups. For 30-day readmissions, MUNO raised the risk mildly (hazard ratio [HR] = 1.110, p < 0.001), MHO had a higher risk (HR = 1.145, p = 0.002), and MUO further elevated this risk (HR = 1.238, p < 0.001). As for 90-day readmissions, both MUNO and MHO raised the risk slightly (HR = 1.134, p < 0.001; HR = 1.093, p = 0.014, respectively), and MUO had the highest risk (HR = 1.263, p < 0.001). Conclusions: Metabolic abnormalities were associated with elevated rates and risks of 30- or 90-day readmission among postmenopausal hospitalized women complicated with osteoporosis, whereas obesity did not seem to be innocent, and the combination of these factors led to an additional burden on healthcare systems and individuals. These findings indicate that clinicians and researchers should focus not only on weight management but also metabolism intervention among patients with postmenopausal osteoporosis. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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12 pages, 1469 KiB

Open AccessArticle

Arterial Stiffness in Patients with Sarcoidosis and Obstructive Sleep Apnea

by Maurice Roeder, Noriane A. Sievi, Stefan Malesevic, Thomas Gaisl, Daniel Franzen and Malcolm Kohler

J. Vasc. Dis. 2023, 2(1), 165-176; https://doi.org/10.3390/jvd2010011 - 16 Feb 2023

Viewed by 2294

Abstract

Background: Obstructive sleep apnea (OSA) and sarcoidosis have both been implied to be risk factors for increased arterial stiffness. However, it is unclear whether an elevated apnea–hypopnea index (AHI) in sarcoidosis patients increases arterial stiffness and thus the cardiovascular risk. Methods: We performed [...] Read more.

Background: Obstructive sleep apnea (OSA) and sarcoidosis have both been implied to be risk factors for increased arterial stiffness. However, it is unclear whether an elevated apnea–hypopnea index (AHI) in sarcoidosis patients increases arterial stiffness and thus the cardiovascular risk. Methods: We performed non-invasive applanation tonometry in 57 adults with sarcoidosis. The participants underwent SphygmoCor to assess arterial stiffness using an aortic augmentation index with a heart rate of 75/min (AIx) and level-3 respiratory polygraphy. An AHI of ≥5/h, ≥15/h, and ≥30/h defined mild, moderate, and severe OSA, respectively. Multivariate regression analysis was used to investigate the association between AIx and AHI, adjusted for prespecified risk factors for AIx. Results: 23 (40%) sarcoidosis patients had at least mild OSA (AHI ≥ 5), while 7 (12%) patients showed AHI ≥ 15/h. AHI was significantly associated with AIx (coef. (95%CI) of 0.31 (0.09/0.52), p = 0.006) even after adjustment for known risk factors of arterial stiffness. While severe OSA was positively associated with increased AIx, mild and moderate OSA were not associated with increased AIx after adjusting for known risk factors. Conclusions: Increased AHI is independently associated with increased arterial stiffness in sarcoidosis patients. Further investigations are needed to underline the association between OSA severity and the magnitude of arterial stiffness. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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15 pages, 2133 KiB

Open AccessArticle

Establishing a Prediction Model for the Efficacy of Platinum—Based Chemotherapy in NSCLC Based on a Two Cohorts GWAS Study

by Qi Xiao, Chenxue Mao, Ying Gao, Hanxue Huang, Bing Yu, Lulu Yu, Xi Li, Xiaoyuan Mao, Wei Zhang, Jiye Yin and Zhaoqian Liu

J. Clin. Med. 2023, 12(4), 1318; https://doi.org/10.3390/jcm12041318 - 7 Feb 2023

Viewed by 2259

Abstract

Platinum drugs combined with other agents have been the first-line treatment for non-small cell lung cancer (NSCLC) in the past decades. To better evaluate the efficacy of platinum–based chemotherapy in NSCLC, we establish a platinum chemotherapy response prediction model. Here, a total of [...] Read more.

Platinum drugs combined with other agents have been the first-line treatment for non-small cell lung cancer (NSCLC) in the past decades. To better evaluate the efficacy of platinum–based chemotherapy in NSCLC, we establish a platinum chemotherapy response prediction model. Here, a total of 217 samples from Xiangya Hospital of Central South University were selected as the discovery cohort for a genome-wide association analysis (GWAS) to select SNPs. Another 216 samples were genotyped as a validation cohort. In the discovery cohort, using linkage disequilibrium (LD) pruning, we extract a subset that does not contain correlated SNPs. The SNPs with p < 10⁻³ and p < 10⁻⁴ are selected for modeling. Subsequently, we validate our model in the validation cohort. Finally, clinical factors are incorporated into the model. The final model includes four SNPs (rs7463048, rs17176196, rs527646, and rs11134542) as well as two clinical factors that contributed to the efficacy of platinum chemotherapy in NSCLC, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.726. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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21 pages, 7294 KiB

Open AccessArticle

A Multi-Omics Analysis of NASH-Related Prognostic Biomarkers Associated with Drug Sensitivity and Immune Infiltration in Hepatocellular Carcinoma

by Yongting Liu, Zhaohui Jiang, Xin Zhou, Yin Li, Ping Liu, Yihong Chen, Jun Tan, Changjing Cai, Ying Han, Shan Zeng, Hong Shen and Ziyang Feng

J. Clin. Med. 2023, 12(4), 1286; https://doi.org/10.3390/jcm12041286 - 6 Feb 2023

Cited by 6 | Viewed by 3072

Abstract

Background: Nonalcoholic steatohepatitis (NASH)-driven hepatocellular carcinoma (HCC) is becoming a major health-related problem. The exploration of NASH-related prognostic biomarkers and therapeutic targets is necessary. Methods: Data were downloaded from the GEO database. The “glmnet” package was used to identify differentially expressed [...] Read more.

Background: Nonalcoholic steatohepatitis (NASH)-driven hepatocellular carcinoma (HCC) is becoming a major health-related problem. The exploration of NASH-related prognostic biomarkers and therapeutic targets is necessary. Methods: Data were downloaded from the GEO database. The “glmnet” package was used to identify differentially expressed genes (DEGs). The prognostic model was constructed by the univariate Cox and LASSO regression analyses. Validation of the expression and prognosis by immunohistochemistry (IHC) in vitro. Drug sensitivity and immune cell infiltration were analyzed by CTR-DB and ImmuCellAI. Results: We constructed a prognostic model that identified the NASH-related gene set (DLAT, IDH3B, and MAP3K4), which was validated in a real-world cohort. Next, seven prognostic transcription factors (TFs) were identified. The prognostic ceRNA network included three mRNAs, four miRNAs, and seven lncRNAs. Finally, we found that the gene set was associated with drug response which was validated in six clinical trial cohorts. Moreover, the expression level of the gene set was inversely correlated with CD8 T cell infiltration in HCC. Conclusions: We established a NASH-related prognostic model. Upstream transcriptome analysis and the ceRNA network provided clues for mechanism exploration. The mutant profile, drug sensitivity, and immune infiltration analysis further guided precise diagnosis and treatment strategies. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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12 pages, 1200 KiB

Open AccessArticle

Changes in Clinical Manifestations Due to AFLD Retyping Based on the New MAFLD Criteria: An Observational Study Based on the National Inpatient Sample Database

by Xiaoshan Feng, Ruirui Xuan, Yingchun Dong, Xiaoqin Wu, Yiping Cheng, Zinuo Yuan, Hang Dong, Junming Han, Fang Zhong, Jiajun Zhao and Xiude Fan

Diagnostics 2023, 13(3), 488; https://doi.org/10.3390/diagnostics13030488 - 29 Jan 2023

Cited by 2 | Viewed by 2823

Abstract

(1) Background: As the introduction of “positive” diagnostic criteria for metabolic dysfunction-associated fatty liver disease (MAFLD) does not exclude alcohol consumption, some patients originally diagnosed with alcoholic fatty liver disease (AFLD) may be diagnosed with dual- etiology fatty liver disease (AFLD&MAFLD), which requires [...] Read more.

(1) Background: As the introduction of “positive” diagnostic criteria for metabolic dysfunction-associated fatty liver disease (MAFLD) does not exclude alcohol consumption, some patients originally diagnosed with alcoholic fatty liver disease (AFLD) may be diagnosed with dual- etiology fatty liver disease (AFLD&MAFLD), which requires us to urgently explore the impact of the changes in this classification of AFLD on clinical manifestations. (2) Methods: Utilizing data from the Nationwide Inpatient Sample database 2016–2018, a total of 9269 participants with AFLD were selected. With the definition of MAFLD, these patients were further categorized into two groups: single AFLD and AFLD&MAFLD. The primary outcome was the risk of comorbidities and organ failures. The secondary outcomes were the length of stay, total charges, and in-hospital all-cause mortality. (3) Results: The patients with AFLD&MAFLD were older, were predominantly male, and had more comorbidities and organ failures compared to the patients with AFLD. These comorbidities included coronary atherosclerosis, myocardial infarction, cerebrovascular disease, arrhythmia, asthma, chronic obstructive pulmonary disease, and chronic kidney disease (all p values < 0.05). The patients with AFLD&MAFLD were more likely to develop acute and chronic heart and/or kidney failures than those with single AFLD (all p < 0.05). The length of stay and total charges of the patients in the AFLD&MAFLD group were greater than the single AFLD group (p = 0.029 and p < 0.001, respectively). No significant difference in all-cause mortality was observed. (4) Conclusions: The patients with AFLD&MAFLD have more comorbidities and organ failures, longer hospital stays, and higher hospitalization costs than the patients with single AFLD. Hence, patients with dual-etiology fatty liver disease deserve more attention from clinical staff during treatment. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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11 pages, 1314 KiB

Open AccessArticle

Development and Validation of a Nomogram for Predicting Blood Pressure Change Failure in Patients with Pheochromocytoma and Concomitant Hypertension after Adrenalectomy

by Yuntian Ge, Yunhong Zhan, Chunyu Pan, Jia Li, Zhenhua Li, Song Bai and Lina Liu

J. Clin. Med. 2023, 12(3), 874; https://doi.org/10.3390/jcm12030874 - 22 Jan 2023

Cited by 1 | Viewed by 1727

Abstract

(1) Background: Pheochromocytoma is a common cause of secondary hypertension, which is considered curable; nevertheless, some patients still suffer from hypertension after adrenalectomy. Therefore, we developed and validated a nomogram for predicting blood pressure change failure in patients with pheochromocytoma and concomitant hypertension [...] Read more.

(1) Background: Pheochromocytoma is a common cause of secondary hypertension, which is considered curable; nevertheless, some patients still suffer from hypertension after adrenalectomy. Therefore, we developed and validated a nomogram for predicting blood pressure change failure in patients with pheochromocytoma and concomitant hypertension after adrenalectomy. (2) Methods: The development cohort of this study consisted of 259 patients with pheochromocytoma who underwent adrenalectomy at our center between 1 January 2007 and 31 December 2018. Each patient’s clinicopathologic data were recorded. LASSO (the least absolute shrinkage and selection operator) regression was used to reduce and select the features of the data. Furthermore, we used multivariate logistic regression analysis to develop the prediction model. An independent cohort of 110 consecutive patients from 1 January 2019 to 31 December 2021 was used for validation. The performance of this nomogram was assessed with regard to discrimination, calibration, and clinical usefulness. (3) Results: 40.9% and 46.4% of patients experienced blood pressure change failure in the development and validation cohorts of this study, respectively. We found that older patients with a longer duration of hypertension and concomitant cardiovascular events were more likely to suffer from blood pressure change failure. In the validation cohort, the model manifested great discrimination with an AUROC (area under the receiver operating characteristic) of 0.996 (p < 0.001) and good calibration (unreliability test, p = 0.359). Decision curve analysis demonstrated that the model was clinically useful. (4) Conclusions: This study presented a reliable nomogram that facilitated individualized preoperative prediction of blood pressure change failure after adrenalectomy in patients with pheochromocytoma, which may help decision-making in perioperative treatment and follow-up strategies. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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10 pages, 2332 KiB

Open AccessFeature PaperArticle

Clinical Relevance of a Vancomycin 24 h Area under the Concentration—Time Curve Values Using Different Renal Function Equations in Bayesian Dosing Software

by Hyun-Ki Kim and Tae-Dong Jeong

J. Pers. Med. 2023, 13(1), 120; https://doi.org/10.3390/jpm13010120 - 5 Jan 2023

Cited by 2 | Viewed by 2121

Abstract

With the updated 2020 vancomycin therapeutic drug monitoring (TDM) guidelines suggesting a ratio of area under the curve over 24 h to a minimum inhibitory concentration (AUC₂₄/MIC) as a target from the Infectious Diseases Society of America, an accurate estimation of [...] Read more.

With the updated 2020 vancomycin therapeutic drug monitoring (TDM) guidelines suggesting a ratio of area under the curve over 24 h to a minimum inhibitory concentration (AUC₂₄/MIC) as a target from the Infectious Diseases Society of America, an accurate estimation of AUC₂₄ has become more critical. We aim to compare the AUC₂₄ using Bayesian dosing software according to various estimated glomerular filtration rate (eGFR) equations in order to analyze the clinical impact of eGFR in vancomycin TDM. We reviewed the TDM dataset of 214 adult patients and analyzed the AUC₂₄ values from various renal function equations, including the Cockcroft-Gault (C-G), the modification of diet in renal disease (MDRD), the chronic kidney disease epidemiology collaboration (CKD-EPI), and the revised Lund–Malmö. The AUC₂₄/MIC results (assuming a MIC of 1 mg/L) were divided into three groups as follows: <400, 400–600, and >600. Additionally, we compared the group agreement between the C-G and the three eGFR formulas. Although there was a statistically significant difference in the AUC24 of the MDRD and the CKD-EPI formulas compared to the C-G, the group concordance rate of the eGFR formula was 95.2–100%, which indicates no clinical significance. The clinical impact of the eGFR formula type on drug dosing recommendations in vancomycin TDM using Bayesian software was insignificant in clinical practice. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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14 pages, 2283 KiB

Open AccessArticle

Immunodeficiencies Push Readmissions in Malignant Tumor Patients: A Retrospective Cohort Study Based on the Nationwide Readmission Database

by Wenchen Wang, Qingyu Meng, Yiping Cheng, Yalin Han, Yonggan Xue, Yanshen Kuang, Xuning Wang, Bobin Ning, Mu Ke, Zhipeng Teng, Sen Li, Peng Li, Hongyi Liu, Xiude Fan and Baoqing Jia

Cancers 2023, 15(1), 88; https://doi.org/10.3390/cancers15010088 - 23 Dec 2022

Cited by 4 | Viewed by 1689

Abstract

Background: Immunodeficiency diseases (IDDs) are associated with an increased proportion of cancer-related morbidity. However, the relationship between IDDs and malignancy readmissions has not been well described. Understanding this relationship could help us to develop a more reasonable discharge plan in the special tumor [...] Read more.

Background: Immunodeficiency diseases (IDDs) are associated with an increased proportion of cancer-related morbidity. However, the relationship between IDDs and malignancy readmissions has not been well described. Understanding this relationship could help us to develop a more reasonable discharge plan in the special tumor population. Methods: Using the Nationwide Readmissions Database, we established a retrospective cohort study that included patients with the 16 most common malignancies, and we defined two groups: non-immunodeficiency diseases (NOIDDs) and IDDs. Results: To identify whether the presence or absence of IDDs was associated with readmission, we identified 603,831 patients with malignancies at their time of readmission in which 0.8% had IDDs and in which readmission occurred in 47.3%. Compared with NOIDDs, patients with IDDs had a higher risk of 30-day (hazard ratio (HR) of 1.32; 95% CI of 1.25–1.40), 90-day (HR of 1.27; 95% CI of 1.21–1.34) and 180-day readmission (HR of 1.28; 95% CI of 1.22–1.35). More than one third (37.9%) of patients with IDDs had readmissions that occurred within 30 days and most (82.4%) of them were UPRs. An IDD was an independent risk factor for readmission in patients with colorectal cancer (HR of 1.32; 95% CI of 1.01–1.72), lung cancer (HR of 1.23; 95% CI of 1.02–1.48), non-Hodgkin’s lymphoma (NHL) (HR of 1.16; 95% CI of 1.04–1.28), prostate cancer (HR of 1.45; 95% CI of 1.07–1.96) or stomach cancer (HR of 2.34; 95% CI of 1.33–4.14). Anemia (44.2%), bacterial infections (28.6%) and pneumonia (13.9%) were the 30-day UPR causes in these populations. (4) Conclusions: IDDs were independently associated with higher readmission risks for some malignant tumors. Strategies should be considered to prevent the causes of readmission as a post discharge plan. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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10 pages, 1044 KiB

Open AccessArticle

Pulse Pressure Independent of Mean Arterial Pressure Is Associated with Cardiovascular and All-Cause Mortality in Normotensive Elders: Findings from National Health and Nutrition Examination Survey III 1999–2014

by Yuqi Jiang, Huanrui Zhang, Yu Yang, Yujiao Sun and Wen Tian

J. Vasc. Dis. 2022, 1(2), 113-122; https://doi.org/10.3390/jvd1020013 - 8 Dec 2022

Viewed by 2136

Abstract

Background: Pulse pressure (PP), a marker of arterial stiffening, is closely related to adverse outcomes in hypertensive patients. Correspondingly, less attention has been paid to the value of PP in the population with normal blood pressure. Methods: The study included normotensive elders aged [...] Read more.

Background: Pulse pressure (PP), a marker of arterial stiffening, is closely related to adverse outcomes in hypertensive patients. Correspondingly, less attention has been paid to the value of PP in the population with normal blood pressure. Methods: The study included normotensive elders aged over 60 years from the 1999–2014 National Health and Nutrition Examination Survey (NHANES). All included participants were followed up until the date of death or 31 December 2015. Restricted cubic spline analyses were used to explore the associations of PP with cardiovascular mortality and all-cause mortality. The population was categorized into two groups according to the optimal cut-off of PP for all-cause mortality by X-tile software. Propensity matching score analysis was further performed to reduce confounding bias. The Kaplan–Meier curves and Cox proportional hazard models were applied to estimate the associations of widening PP cardiovascular mortality and all-cause mortality. Subgroup analyses were also conducted. Results: A total of 6309 participants were included (52.9% men and median age 69 (63, 75) years). The median follow-up duration was 74 (42, 114) months. The restricted cubic spline analyses revealed that continuous PP was linearly related to cardiovascular mortality (p for linearity < 0.001; p for nonlinearity = 0.284) and nonlinearly related to all-cause mortality (p for nonlinearity = 0.001). After propensity score matching, 1855 subjects with widening PP and 1855 matched counterparts were included (50.2% men and average age 72 (66, 78) years, 50.9% men and average age 72 (66, 78) years, respectively), of which 966 (26.0%) died during a median follow-up duration of 71 (39, 105) months. In the Cox proportional hazards model, widening PP was associated with increased cardiovascular mortality Hazard Ratio (HR) 1.47; 95% Confidence Interval (CI) 1.07–2.00, p < 0.05] and all-cause mortality (HR 1.15; 95% CI 1.01–1.31, p < 0.05). After adjusting for other traditional risk factors, the association of widening PP with cardiovascular mortality (HR 1.44; 95%CI 1.05–1.98, p < 0.05) remained, and the association of widening PP with all-cause mortality was not statistically significant (p > 0.05). Conclusion: In the normotensive elder population, a low-risk population without traditional coronary risk factors, PP is an independent risk factor for cardiovascular mortality. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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7 pages, 592 KiB

Open AccessArticle

Measuring the Quality of Life in Patients with Chronic Venous Disease before and Short Term after Surgical Treatment—A Comparison between Different Open Surgical Procedures

by Sergiu-Ciprian Matei, Cristina Ștefania Dumitru and Daniela Radu

J. Clin. Med. 2022, 11(23), 7171; https://doi.org/10.3390/jcm11237171 - 2 Dec 2022

Cited by 10 | Viewed by 2028

Abstract

Chronic venous disease (CVD) is a common pathology that significantly affects the quality of life (QoL) of patients. Methods: QoL was assessed in 317 patients diagnosed with CVD who underwent surgeries, including cryostripping (n = 113), high ligation and stripping (HL&S, n [...] Read more.

Chronic venous disease (CVD) is a common pathology that significantly affects the quality of life (QoL) of patients. Methods: QoL was assessed in 317 patients diagnosed with CVD who underwent surgeries, including cryostripping (n = 113), high ligation and stripping (HL&S, n = 96), and phlebectomies (n = 108). CVD symptoms and QoL were assessed before surgery and 2 weeks after surgery using the following questionnaires: CIVIQ-20, VAS, Eq-5D, PHQ-9 and GAD-9. Results. The results reveal a significant correlation (p < 0.05) between CEAP score and QoL questionnaires performed preoperatively and postoperatively in all three surgical technique groups, with a statistical improvement postoperatively. Phlebectomy had the best postoperative QoL score (r = 0.495) compared to the other two types of procedures. Conclusions: Analyzing patients’ subjective perception following conventional surgery for CVD treatment, an improved QoL is observed both in functional and psychosocial aspects, even early postoperatively. Classical surgical procedures remain an effective and feasible option in CVD treatment. Full article

(This article belongs to the Topic Diagnosis, Management, and Prognostic Assessment of Chronic Disease)

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