Medicina

10 pages, 3241 KiB

Open AccessArticle

Engineering a New Polymeric Heart Valve Using 3D Printing—TRISKELION

by Philip Tschorn, Filip Schröter, Martin Hartrumpf, Ralf-Uwe Kühnel, Roya Ostovar and Johannes M. Albes

Medicina 2022, 58(11), 1695; https://doi.org/10.3390/medicina58111695 - 21 Nov 2022

Cited by 3 | Viewed by 3020

Abstract

Background and Objectives: Developing a prosthetic heart valve that combines the advantageous hemodynamic properties of its biological counterpart with the longevity of mechanical prostheses has been a major challenge for heart valve development. Anatomically inspired artificial polymeric heart valves have the potential to [...] Read more.

Background and Objectives: Developing a prosthetic heart valve that combines the advantageous hemodynamic properties of its biological counterpart with the longevity of mechanical prostheses has been a major challenge for heart valve development. Anatomically inspired artificial polymeric heart valves have the potential to combine these beneficial properties, and innovations in 3D printing have given us the opportunity to rapidly test silicone prototypes of new designs to further the understanding of biophysical properties of artificial heart valves. TRISKELION is a promising prototype that we have developed, tested, and further improved in our institution. Materials and Methods: STL files of our prototypes were designed with FreeCad 0.19.2 and 3D printed with an Agilista 3200W (Keyence, Osaka, Japan) using silicones of Shore hardness 35 or 65. Depending on the valve type, the support structures were printed in AR-M2 plastics. The prototypes were then tested using a hemodynamic pulse duplicator (HKP 2.0) simulating an aortic valve cycle at 70 bpm with 70 mL stroke volume (cardiac output 4.9 L/min). Valve opening cycles were visualized with a high-speed camera (Phantom Miro C320). The resulting values led to further improvements of the prototype (TRISKELION) and were compared to a standard bioprosthesis (Edwards Perimount 23 mm) and a mechanical valve (Bileaflet valve, St. Jude Medical). Results: We improved the silicone prototype with currently used biological and mechanical valves measured in our setup as benchmarks. The regurgitation fractions were 22.26% ± 4.34% (TRISKELION) compared to 8.55% ± 0.22% (biological) and 13.23% ± 0.79% (mechanical). The mean systolic pressure gradient was 9.93 ± 3.22 mmHg (TRISKELION), 8.18 ± 0.65 mmHg (biological), and 10.15 ± 0.16 mmHg (mechanical). The cardiac output per minute was at 3.80 ± 0.21 L/min (TRISKELION), 4.46 ± 0.01 L/min (biological), and 4.21 ± 0.05 L/min (mechanical). Conclusions: The development of a heart valve with a central structure proves to be a promising concept. It offers another principle to address the problem of longevity in currently used heart valves. Using 3D printing to develop new prototypes provides a fast, effective, and accurate way to deepen understanding of its physical properties and requirements. This opens the door for translating and combining results into modern prototypes using highly biocompatible polymers, internal structures, and advanced valve layouts. Full article

(This article belongs to the Special Issue Aortic Valve Stenosis and Aortic Regurgitation: Recent Insights, Current Challenges, and Future Prospects)

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Graphical abstract

7 pages, 289 KiB

Open AccessReview

Long QT Syndrome Management during and after Pregnancy

by Agne Marcinkeviciene, Diana Rinkuniene and Aras Puodziukynas

Medicina 2022, 58(11), 1694; https://doi.org/10.3390/medicina58111694 - 21 Nov 2022

Cited by 3 | Viewed by 2459

Abstract

Long QT syndrome (LQTS) is majorly an autosomal dominantly inherited electrical dysfunction, but there are exceptions (Jervell and Lange-Nielsen syndrome is inherited in an autosomal recessive pattern). This disorder prolongs ventricular repolarization and increases the risk of ventricular arrhythmias, syncope, and even sudden [...] Read more.

Long QT syndrome (LQTS) is majorly an autosomal dominantly inherited electrical dysfunction, but there are exceptions (Jervell and Lange-Nielsen syndrome is inherited in an autosomal recessive pattern). This disorder prolongs ventricular repolarization and increases the risk of ventricular arrhythmias, syncope, and even sudden cardiac death. The risk of fatal events is reduced during pregnancy, but dramatically increases during the 9 months after delivery, especially in patients with LQT2. In women with LQTS, treatment with β-blockers at appropriate doses is recommended throughout pregnancy and the high-risk postnatal period. In this review, we summarize the management of LQTS during pregnancy and beyond. Full article

(This article belongs to the Special Issue Diagnosis, Evaluation, and Management of Diseases during Pregnancy)

12 pages, 1361 KiB

Open AccessArticle

Assessment of Therapeutic Responses Using a Deep Neural Network Based on ¹⁸F-FDG PET and Blood Inflammatory Markers in Pyogenic Vertebral Osteomyelitis

by Hyunkwang Shin, Eunjung Kong, Dongwoo Yu, Gyu Sang Choi and Ikchan Jeon

Medicina 2022, 58(11), 1693; https://doi.org/10.3390/medicina58111693 - 21 Nov 2022

Cited by 2 | Viewed by 1810

Abstract

Background and Objectives: This study investigated the usefulness of deep neural network (DNN) models based on ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) and blood inflammatory markers to assess the therapeutic response in pyogenic vertebral osteomyelitis (PVO). Materials and Methods: This was a retrospective [...] Read more.

Background and Objectives: This study investigated the usefulness of deep neural network (DNN) models based on ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) and blood inflammatory markers to assess the therapeutic response in pyogenic vertebral osteomyelitis (PVO). Materials and Methods: This was a retrospective study with prospectively collected data. Seventy-four patients diagnosed with PVO underwent clinical assessment for therapeutic responses based on clinical features during antibiotic therapy. The decisions of the clinical assessment were confirmed as ‘Cured’ or ‘Non-cured’. FDG-PETs were conducted concomitantly regardless of the decision at each clinical assessment. We developed DNN models depending on the use of attributes, including C-reactive protein (CRP), erythrocyte sedimentation ratio (ESR), and maximum standardized FDG uptake values of PVO lesions (SUV_max), and we compared their performances to predict PVO remission. Results: The 126 decisions (80 ‘Cured’ and 46 ‘Non-cured’ patients) were randomly assigned with training and test sets (7:3). We trained DNN models using a training set and evaluated their performances for a test set. DNN model 1 had an accuracy of 76.3% and an area under the receiver operating characteristic curve (AUC) of 0.768 [95% confidence interval, 0.625–0.910] using CRP and ESR, and these values were 79% and 0.804 [0.674–0.933] for DNN model 2 using ESR and SUV_max, 86.8% and 0.851 [0.726–0.976] for DNN model 3 using CRP and SUV_max, and 89.5% and 0.902 [0.804–0.999] for DNN model 4 using ESR, CRP, and SUV_max, respectively. Conclusions: The DNN models using SUV_max showed better performances when predicting the remission of PVO compared to CRP and ESR. The best performance was obtained in the DNN model using all attributes, including CRP, ESR, and SUV_max, which may be helpful for predicting the accurate remission of PVO. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnostics, and Therapeutics of Infectious Diseases)

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11 pages, 2148 KiB

Open AccessArticle

Adipose Autologous Micrograft and Its Derived Mesenchymal Stem Cells in a Bio Cross-Linked Hyaluronic Acid Scaffold for Correction Deep Wrinkles, Facial Depressions, Scars, Face Dermis and Its Regenerations: A Pilot Study and Cases Report

by Lorenzo Svolacchia, Claudia Prisco, Federica Giuzio and Fabiano Svolacchia

Medicina 2022, 58(11), 1692; https://doi.org/10.3390/medicina58111692 - 21 Nov 2022

Cited by 3 | Viewed by 2069

Abstract

The aim of this clinical study was to demonstrate that through a micrograft of viable adipose tissue cells microfiltered at 50 microns to exclude fibrous shoots and cell debris in a suspension of cross-linked hyaluronic acid, we were able to improve visible imperfections [...] Read more.

The aim of this clinical study was to demonstrate that through a micrograft of viable adipose tissue cells microfiltered at 50 microns to exclude fibrous shoots and cell debris in a suspension of cross-linked hyaluronic acid, we were able to improve visible imperfections of the dermis and to improve clinically observable wrinkles, with a beneficial effect also in the extracellular matrix (ECM). Background and Objectives: With the passage of time, the aging process begins, resulting in a progressive impairment of tissue homeostasis. The main reason for the formation of wrinkles is the involution of the papillary dermis, as well as the loss of stem cell niches with compromise of the extra-cytoplasmic matrix (ECM), and the loss of hyaluronic acid, which helps to maintain the shape and resistance and that is contained in the connective tissue. Materials and Methods: This study involved 14 female patients who underwent dermal wrinkle correction and bio-regeneration over the entire facial area through a suspension containing 1.0 mL of viable micrografts from adipose tissue in a 1.0 mL cross-linked hyaluronic acid. To verify the improvement of the anatomical area concerned over time, the various degrees of correction obtained for wrinkles, and in general for texture, were objectively evaluated by using a Numeric Rating scale (NRS) 10–0, a modified Vancouver scale and a Berardesca scale. Results: The Berardesca, NRS and Modified Vancouver scales showed that with this technique it was possible to obtain excellent results both when the suspension was injected into wrinkles with the linear retrograde technique, and when it was injected with the micropomphs technique to correct furrows, with the intent to revitalize the tissue through progenitors with adult stemness markers. Conclusions: The combination of microfragmented and microfiltered adipose tissue and cross-linked hyaluronic acid at 50 microns is safe new method to treat soft tissue defects such as deep wrinkles. Full article

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17 pages, 10968 KiB

Open AccessArticle

Supernumerary Extraocular Muscle: A Rare Cause of Atypical Restrictive Strabismus

by Xiangjun Wang, Tao Shen, Mengya Han and Jianhua Yan

Medicina 2022, 58(11), 1691; https://doi.org/10.3390/medicina58111691 - 21 Nov 2022

Cited by 2 | Viewed by 2717

Abstract

Background and objectives: Supernumerary extraocular muscle (SEOM) is extremely rare. The purpose of this paper was to review the clinical characteristics and surgical outcomes of SEOM patients with atypical restrictive strabismus. Materials and Methods: A retrospective review was conducted on the [...] Read more.

Background and objectives: Supernumerary extraocular muscle (SEOM) is extremely rare. The purpose of this paper was to review the clinical characteristics and surgical outcomes of SEOM patients with atypical restrictive strabismus. Materials and Methods: A retrospective review was conducted on the data from 12 SEOM cases. Pre- and post-operative measurements consisted of visual acuity, cycloplegic refraction, ocular alignment, ocular motility, binocular vision, and imaging. Management strategies included either conservative or surgical treatments. Results: Of the 12 cases reviewed (seven females, five males), the mean ± SD age was 14.3 ± 10.6 years (range: 4–38 years). The right eye was affected in six cases, the left in five, and both eyes in one case. The major clinical manifestations included restrictive ocular motility (12 cases), with seven cases in no less than three directions; varying degrees of horizontal or vertical strabismus; ipsilateral amblyopia (10 cases); and unequal palpebral aperture (10 cases). Imaging results revealed muscular bands originating from the annulus of Zinn and insertion into the globe or other recti, as well as anomalous muscular bands connecting two or more recti, sometimes with optic nerve involvement. Three patients received conservative treatment, while rectus recession with or without resection (seven patients) or rectus disinsertion plus globe fixation (two patients) were performed in those receiving surgical treatments. A surgical success was achieved in four cases. Conclusions: For restrictive strabismus, imaging plays an important role in the diagnosis of SEOM. When the SEOM is difficult to resect, a personalized surgical strategy may be required to achieve a good ocular alignment. Full article

(This article belongs to the Section Ophthalmology)

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11 pages, 1749 KiB

Open AccessArticle

Organic Bone Matrix Component Type I and V Collagen Are Not Destructed in Bisphosphonate-Associated Osteonecrosis of the Jaws

by Yahya Acil, Jan-Tobias Weitkamp, Henning Wieker, Christian Flörke, Jörg Wiltfang and Aydin Gülses

Medicina 2022, 58(11), 1690; https://doi.org/10.3390/medicina58111690 - 21 Nov 2022

Cited by 2 | Viewed by 1911

Abstract

Background and objectives: The investigation of the pathophysiology behind medication-related osteonecrosis (MRONJ) of the jaw mostly focuses on alterations in osteoclast and osteoblast cell activity, but changes in the organic and inorganic bone matrix have rarely been studied. The aim of this [...] Read more.

Background and objectives: The investigation of the pathophysiology behind medication-related osteonecrosis (MRONJ) of the jaw mostly focuses on alterations in osteoclast and osteoblast cell activity, but changes in the organic and inorganic bone matrix have rarely been studied. The aim of this study was to investigate whether collagen, the main organic component of extracellular bone matrix, is destructed in osteonecrosis of the jaw secondary to antiresorptive medication. Material and methods: Bone samples of patients with MRONJ (n = 15, control group n = 3) were demineralized, and collagen fragments were separated from intact collagen pellets by ultrafiltration. The quantification of mature collagen cross-links hydroxylysylpyridinoline (HP) and lysylpyridinoline (LP) in pellets and ultrafiltrates was performed by high-performance liquid chromatography (HPLC). The detection of hydroxyproline (Hyp) was carried out using a spectrophotometric assay. In addition, collagen chains were analyzed by sodium dodecylsulfate-polyacrylamide gel (SDS-PAGE). Results: The results revealed significantly higher concentrations of HP, LP and Hyp in pellet samples. In addition, there were no significant differences between samples from MRONJ patients and those of the control group. These results were paralleled by SDS- PAGE. Conclusion: These findings suggest that MRONJ does not involve the destruction of type I and V collagen molecules, in contrast to previously reported destruction by osteoradionecrosis. Full article

(This article belongs to the Special Issue Advances in Interdisciplinary Research in Medicine and Dentistry)

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11 pages, 1252 KiB

Open AccessArticle

Development and Preliminary Characterization of Polyester-Urethane Microparticles Used in Curcumin Drug Delivery System for Oropharyngeal Cancer

by Alexandru Chioreanu, Ion Cristian Mot, Delia Ioana Horhat, Nicolae Constantin Balica, Cristian Andrei Sarau, Raluca Morar, Eugenia Maria Domuta, Catalin Dumitru, Rodica Anamaria Negrean, Bogdan Andrei Bumbu, Madhavi Ravulapalli, Satish Alambaram, Raja Akshay and Marius Pricop

Medicina 2022, 58(11), 1689; https://doi.org/10.3390/medicina58111689 - 21 Nov 2022

Cited by 5 | Viewed by 2649

Abstract

Background and Objectives: Curcumin (Cc) as an active substance is known for its anti-inflammatory, anticoagulant, antioxidant, and anti-carcinogenic effects, together with its role in cholesterol regulation, and its use in different gastrointestinal derangements. On the other hand, curcumin can be used for [...] Read more.

Background and Objectives: Curcumin (Cc) as an active substance is known for its anti-inflammatory, anticoagulant, antioxidant, and anti-carcinogenic effects, together with its role in cholesterol regulation, and its use in different gastrointestinal derangements. On the other hand, curcumin can be used for its properties as an inactive substance, with Cc particles being more often tested in pharmaceutical formulations for drug delivery, with promising safety records and kinetics. The aim of this research was to obtain and characterize polyurethane microparticles that can be used as a carrier with a controlled Cc release. Materials and Methods: The in vitro samples were characterized by the Zetasizer procedure, and UV–Vis spectroscopy, while the in-vivo measurements on human subjects were performed by non-invasive skin assays (trans-epidermal water loss, erythema, and skin hydration). A total of 16 patients with oropharyngeal cancer stages II and III in equal proportions were recruited for participation. Results: The experimental values of sample characteristics using the Zetasizer identified a mean structural size of 215 nm in the polyester-urethane preparate (PU), compared to 271 nm in the curcumin-based PU. Although the size was statistically significantly different, the IPDI and Zeta potential did not differ significantly (22.91 mV vs. 23.74 mV). The average age during the study period was 57.6 years for patients in the PU group, respectively, and 55.1 years in those who received the curcumin preparations. The majority of oropharyngeal cancers were of HPV-related etiology. There were no significant side effects; 75.0% of patients in the PU group reporting no side effects, compared to 87.5% in the Cc group. The 48 h TEWL measurement at the end of the experiment found a statistically significant difference between the PU and the Cc group (2.2 g/h/m² vs. 2.6 g/h/m²). The erythema assessment showed a starting measurement point for both research groups with a 5.1-unit difference. After 48 h, the difference between PU and PU_Cc was just 1.7 units (p-value = 0.576). The overall difference compared to the reference group with sodium lauryl sulfate (SLS) was statistically significant at a 95% significance level. Conclusions: Our findings indicate the obtaining of almost homogeneous particles with a medium tendency to form agglomerations, with a good capacity of encapsulation (around 60%), a medium release rate, and a non-irritative potential. Therefore, this polyester-urethane with Cc microparticles can be tested in other clinical evaluations. Full article

(This article belongs to the Special Issue Advances in Cancer Therapy from Research to Clinical Practice—Surgical, Molecular or Systemic Management of Cancer)

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9 pages, 563 KiB

Open AccessSystematic Review

Hysteroscopic Removal of Intrauterine Device in Pregnancy: A Scoping Review to Guide Personalized Care

by Guglielmo Stabile, Francesco Cracco, Luigi Nappi, Felice Sorrentino, Salvatore Giovanni Vitale, Stefano Angioni, Stefania Carlucci and Giuseppe Ricci

Medicina 2022, 58(11), 1688; https://doi.org/10.3390/medicina58111688 - 21 Nov 2022

Cited by 2 | Viewed by 2779

Abstract

Background and objectives: Pregnancies that occur with an intrauterine device (IUD) in situ are at increased risk for developing severe conditions which may affect the fetus and the mother. The incidence of such adverse consequences significantly drops after device removal. A scoping [...] Read more.

Background and objectives: Pregnancies that occur with an intrauterine device (IUD) in situ are at increased risk for developing severe conditions which may affect the fetus and the mother. The incidence of such adverse consequences significantly drops after device removal. A scoping review of the literature was performed to highlight the risks, benefits, and outcomes of hysteroscopic removal of intrauterine devices in early pregnancy. Materials and Methods: PubMed, Scopus, and Web of Science were searched. The review included all reports from 1990 to October 2022. The research strategy adopted included different combinations of the following terms: (“hysteroscopy”) AND (“pregnancy”) AND (“intrauterine device” or “IUD”) AND (“intrauterine system” or “IUS”). A scoping review of the hysteroscopic removal of IUDs during pregnancy was performed. All studies identified were listed by citation, title, authors, and abstract. Duplicates were identified by an independent manual screening performed by two researchers and then removed. For the eligibility process, two authors independently screened the titles and abstracts of all non-duplicated papers and excluded those not pertinent to the topic. Results: PRISMA guidelines were followed. Nine manuscripts were detected, accounting for 153 patients. Most IUD removals occurred during the first trimester of pregnancy. Most of the time, the procedure was safe and without consequences. Conclusions: This review highlights the safety and efficacy of operative hysteroscopy as a method of IUD removal in early pregnancy. We recommend using a 3 to 5 mm hysteroscope, avoiding cervical dilation, and maintaining low infusion pressure during the procedure to avoid potential damage to the gestational sac and IUD fragment displacement. Heating the distension media to 30 °C should be considered. Full article

(This article belongs to the Special Issue New Insights and Perspectives in Minimally Invasive Gynecology)

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14 pages, 4201 KiB

Open AccessArticle

Heritability of Subcortical Grey Matter Structures

by David Strelnikov, Amirreza Alijanpourotaghsara, Marton Piroska, Laszlo Szalontai, Bianka Forgo, Zsofia Jokkel, Alíz Persely, Anita Hernyes, Lajos Rudolf Kozak, Adam Szabo, Pal Maurovich-Horvat, David Laszlo Tarnoki and Adam Domonkos Tarnoki

Medicina 2022, 58(11), 1687; https://doi.org/10.3390/medicina58111687 - 21 Nov 2022

Cited by 3 | Viewed by 3640

Abstract

Background and Objectives: Subcortical grey matter structures play essential roles in cognitive, affective, social, and motoric functions in humans. Their volume changes with age, and decreased volumes have been linked with many neuropsychiatric disorders. The aim of our study was to examine [...] Read more.

Background and Objectives: Subcortical grey matter structures play essential roles in cognitive, affective, social, and motoric functions in humans. Their volume changes with age, and decreased volumes have been linked with many neuropsychiatric disorders. The aim of our study was to examine the heritability of six subcortical brain volumes (the amygdala, caudate nucleus, pallidum, putamen, thalamus, and nucleus accumbens) and four general brain volumes (the total intra-cranial volume and the grey matter, white matter, and cerebrospinal fluid (CSF) volume) in twins. Materials and Methods: A total of 118 healthy adult twins from the Hungarian Twin Registry (86 monozygotic and 32 dizygotic; median age 50 ± 27 years) underwent brain magnetic resonance imaging. Two automated volumetry pipelines, Computational Anatomy Toolbox 12 (CAT12) and volBrain, were used to calculate the subcortical and general brain volumes from three-dimensional T1-weighted images. Age- and sex-adjusted monozygotic and dizygotic intra-pair correlations were calculated, and the univariate ACE model was applied. Pearson’s correlation test was used to compare the results obtained by the two pipelines. Results: The age- and sex-adjusted heritability estimates, using CAT12 for the amygdala, caudate nucleus, pallidum, putamen, and nucleus accumbens, were between 0.75 and 0.95. The thalamus volume was more strongly influenced by common environmental factors (C = 0.45−0.73). The heritability estimates, using volBrain, were between 0.69 and 0.92 for the nucleus accumbens, pallidum, putamen, right amygdala, and caudate nucleus. The left amygdala and thalamus were more strongly influenced by common environmental factors (C = 0.72−0.85). A strong correlation between CAT12 and volBrain (r = 0.74−0.94) was obtained for all volumes. Conclusions: The majority of examined subcortical volumes appeared to be strongly heritable. The thalamus was more strongly influenced by common environmental factors when investigated with both segmentation methods. Our results underline the importance of identifying the relevant genes responsible for variations in the subcortical structure volume and associated diseases. Full article

(This article belongs to the Special Issue Twin Studies and Imaging)

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16 pages, 395 KiB

Open AccessReview

Behavioral and Dietary Habits That Could Influence Both COVID-19 and Non-Communicable Civilization Disease Prevention—What Have We Learned Up to Now?

by Milica Veljković, Dragana R. Pavlović, Nikola M. Stojanović, Tanja Džopalić and Lidija Popović Dragonjić

Medicina 2022, 58(11), 1686; https://doi.org/10.3390/medicina58111686 - 21 Nov 2022

Cited by 7 | Viewed by 2708

Abstract

The massive expansion of the new coronavirus SARS-CoV-2 has urged countries to introduce lockdowns and set restrictive actions worldwide. The focus of the studies was to determine how COVID-19 induces damage to the lungs in order to find an alternative or adjuvant therapy [...] Read more.

The massive expansion of the new coronavirus SARS-CoV-2 has urged countries to introduce lockdowns and set restrictive actions worldwide. The focus of the studies was to determine how COVID-19 induces damage to the lungs in order to find an alternative or adjuvant therapy that could lead to preventing COVID-19 or at least ameliorating it. This paper aims to survey the literature and provide new insights into behavioral and dietary habits that could influence the prevention of COVID-19. Maintaining an adequate mental health status, sleep, and taking moderate exercise are often disrupted in the conditions of lockdown and are followed by weakened immunity. Mediterranean and vegetarian diets are superior to other eating patterns in terms of immunity boosting and fighting COVID-19. Our study showed how adequate hydration, green tea intake, and supplementation with vitamins D, C, and E can increase our chances of avoiding the infection and even help us sleep better. Another focus of the research was on determining what level of hygiene really increases one’s chances of not contracting SARS-CoV-2, but this seems a little counter-intuitive at first. Since an immunocompromised state is a familiar predisposing factor for all contagious diseases, maintaining healthy behavioral and dietary habits could be a crucial step in boosting immunity and preventing COVID-19. Full article

10 pages, 1165 KiB

Open AccessArticle

Atrial Fibrillation and Transvenous Lead Extraction—A Comprehensive Subgroup Analysis of the GermAn Laser Lead Extraction RegistrY (GALLERY)

by Da-Un Chung, Simon Pecha, Heiko Burger, Omar Anwar, Christian Eickholt, Herbert Nägele, Hermann Reichenspurner, Nele Gessler, Stephan Willems, Christian Butter and Samer Hakmi

Medicina 2022, 58(11), 1685; https://doi.org/10.3390/medicina58111685 - 21 Nov 2022

Cited by 1 | Viewed by 1873

Abstract

Background: Atrial fibrillation is the most common arrhythmia and has been described as driver of cardiovascular morbidity and risk factor for cardiac device-related complications, as well as in transvenous lead extraction (TLE). Objectives: Aim of this study was to characterize the [...] Read more.

Background: Atrial fibrillation is the most common arrhythmia and has been described as driver of cardiovascular morbidity and risk factor for cardiac device-related complications, as well as in transvenous lead extraction (TLE). Objectives: Aim of this study was to characterize the procedural outcome and risk-factors of patients with atrial fibrillation (AF) undergoing TLE. Methods: We performed a subgroup analysis of all AF patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) database. Predictors for all-cause mortality were assessed. Results: A total number of 510 patients with AF were identified with a mean age of 74.0 ± 10.3 years. Systemic infection (38.4%) was the leading cause for TLE, followed by local infection (37.5%) and lead dysfunction (20.4%). Most of the patients (45.9%) presented with pacemaker systems to be extracted. The total number of leads was 1181 with a 2.3 ± 0.96 leads/patient. Clinical procedural success was achieved in 97.1%. Occurrence of major complications was 1.8% with a procedure-related mortality of 1.0%. All-cause mortality was high with 5.9% and septic shock being the most common cause. Systemic device infection (OR: 49.73; 95% CI: 6.56–377.09, p < 0.001), chronic kidney disease (CKD; OR: 2.67; 95% CI: 1.01–7.03, p = 0.048) and a body mass index < 21 kg/m² (OR: 6.6; 95% CI: 1.68–25.87, p = 0.007) were identified as independent predictors for all-cause mortality. Conclusions: TLE in AF patients is effective and safe, but in patients with systemic infection the mortality due to septic shock is high. Systemic infection, CKD and body mass index <21 kg/m² are risk factors for death in patient with AF undergoing TLE. Full article

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

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15 pages, 1895 KiB

Open AccessReview

Migraine, Tension-Type Headache and Parkinson’s Disease: A Systematic Review and Meta-Analysis

by Efthalia Angelopoulou, Andreas Nikolaos Papadopoulos, Nikolaos Spantideas and Anastasia Bougea

Medicina 2022, 58(11), 1684; https://doi.org/10.3390/medicina58111684 - 20 Nov 2022

Cited by 3 | Viewed by 3188

Abstract

Background and Objectives: The relationship between migraine and tension-type headache (TTH) with Parkinson’s disease (PD) is controversial, while a common pathophysiological link remains obscure. The aim of this systematic review is to investigate the association between PD, migraine and TTH. Materials and [...] Read more.

Background and Objectives: The relationship between migraine and tension-type headache (TTH) with Parkinson’s disease (PD) is controversial, while a common pathophysiological link remains obscure. The aim of this systematic review is to investigate the association between PD, migraine and TTH. Materials and Methods: Following PRISMA, we searched MEDLINE, WebofScience, Scopus, CINAHL, Cochrane Library and ClinicalTrials.gov up to 1 July 2022 for observational studies examining the prevalence and/or associations of PD with migraine and TTH. We pooled proportions, standardized mean differences (SMD) and odds ratios (OR) with random effects models. The risk of bias was assessed with the Newcastle-Ottawa scale (PROSPERO CRD42021273238). Results: Out of 1031 screened studies, 12 were finally included in our review (median quality score 6/9). The prevalence of any headache among PD patients was estimated at 49.1% (760 PD patients; 95% CI 24.8–73.6), migraine prevalence at 17.2% (1242 PD patients; 95% CI 9.9–25.9), while 61.5% (316 PD patients; 95% CI 52.6–70.1) of PD patients with migraine reported headache improvement after PD onset. Overall, migraine was not associated with PD (302,165 individuals; OR_pooled = 1.11; 95% CI 0.72–1.72).However, cohort studies demonstrated a positive association of PD among lifetime migraineurs (143,583 individuals; OR_pooled = 1.54, 95% CI 1.28–1.84), while studies on 12-month migraine prevalence yielded an inverse association (5195 individuals; OR_pooled = 0.64, 95% CI 0.43–0.97). Similar findings were reported by 3 studies with data on the TTH-PD relationship (high prevalence, positive association when examined prospectively and an inverse relationship on 12-month prevalence). These data were not quantitatively synthesized due to methodological differences among the studies. Finally, PD patients suffering from any headache had a lower motor unified Parkinson’s disease rating scale (UPDRS) score (503 PD patients; SMD −0.39; 95% CI −0.57 to −0.21) compared to PD patients not reporting headache. There is an unclear association of headaches in genetic PD cohorts. Conclusions: Observational data suggest that migraine and TTH could be linked to PD, but the current literature is conflicting. Full article

(This article belongs to the Special Issue Non-motor Disorders in Parkinson Disease and Other Parkinsonian Syndromes)

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11 pages, 914 KiB

Open AccessArticle

The Impact of Individualized Hemodynamic Management on Intraoperative Fluid Balance and Hemodynamic Interventions during Spine Surgery in the Prone Position: A Prospective Randomized Trial

by Lucie Kukralova, Vlasta Dostalova, Miroslav Cihlo, Jaroslav Kraus and Pavel Dostal

Medicina 2022, 58(11), 1683; https://doi.org/10.3390/medicina58111683 - 20 Nov 2022

Cited by 1 | Viewed by 2952

Abstract

Background and Objectives: The effect of individualized hemodynamic management on the intraoperative use of fluids and other hemodynamic interventions in patients undergoing spinal surgery in the prone position is controversial. This study aimed to evaluate how the use of individualized hemodynamic management [...] Read more.

Background and Objectives: The effect of individualized hemodynamic management on the intraoperative use of fluids and other hemodynamic interventions in patients undergoing spinal surgery in the prone position is controversial. This study aimed to evaluate how the use of individualized hemodynamic management based on extended continuous non-invasive hemodynamic monitoring modifies intraoperative hemodynamic interventions compared to conventional hemodynamic monitoring with intermittent non-invasive blood pressure measurements. Methods: Fifty adult patients (American Society of Anesthesiologists physical status I–III) who underwent spinal procedures in the prone position and were then managed with a restrictive fluid strategy were prospectively randomized into intervention and control groups. In the intervention group, individualized hemodynamic management followed a goal-directed protocol based on continuously non-invasively measured blood pressure, heart rate, cardiac output, systemic vascular resistance, and stroke volume variation. In the control group, patients were monitored using intermittent non-invasive blood pressure monitoring, and the choice of hemodynamic intervention was left to the discretion of the attending anesthesiologist. Results: In the intervention group, more hypotensive episodes (3 (2–4) vs. 1 (0–2), p = 0.0001), higher intraoperative dose of ephedrine (0 (0–10) vs. 0 (0–0) mg, p = 0.0008), and more positive fluid balance (680 (510–937) vs. 270 (196–377) ml, p < 0.0001) were recorded. Intraoperative norepinephrine dose and postoperative outcomes did not differ between the groups. Conclusions: Individualized hemodynamic management based on data from extended non-invasive hemodynamic monitoring significantly modified intraoperative hemodynamic management and was associated with a higher number of hemodynamic interventions and a more positive fluid balance. Full article

(This article belongs to the Section Surgery)

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9 pages, 463 KiB

Open AccessArticle

Concurrent Aerobic Plus Resistance Training Elicits Different Effects on Short-Term Blood Pressure Variability of Hypertensive Patients in Relation to Their Nocturnal Blood Pressure Pattern

by Giuseppe Caminiti, Ferdinando Iellamo, Marco Alfonso Perrone, Giuseppe Marazzi, Alessandro Gismondi, Anna Cerrito, Alessio Franchini and Maurizio Volterrani

Medicina 2022, 58(11), 1682; https://doi.org/10.3390/medicina58111682 - 20 Nov 2022

Cited by 1 | Viewed by 2122

Abstract

Background and Objectives: The purpose of this study was to investigate the effects of a 12-week concurrent training (CT) (i.e., aerobic plus resistance exercise) on short–term blood pressure variability (BPV) and BP values in hypertensive patients with non-dippper BP nocturnal pattern and [...] Read more.

Background and Objectives: The purpose of this study was to investigate the effects of a 12-week concurrent training (CT) (i.e., aerobic plus resistance exercise) on short–term blood pressure variability (BPV) and BP values in hypertensive patients with non-dippper BP nocturnal pattern and underlying coronary artery disease. Material and Methods: The study included 72 consecutive patients who were divided into two groups according to the nocturnal BP pattern: dipping pattern (33 pts) and non-dipping (39 pts). Before starting CT and at 12 weeks, patients underwent the six minute walk test, ergometric test, assessment of 1-repetiton maximum (1 RM), and 24/h BP monitoring (24-h ABPM). Results: After CT, exercise capacity increased in both groups in a similar fashion. Twenty-four/h systolic BPV and daytime systolic BPV decreased significantly in the dipping group while they were unchanged in the non-dipping group (between groups changes: −1.0 ± 0.4 mmHg and −1.3 ± 0.9 mmHg; p = 0.02 and p = 0.006, respectively). Twenty-four/h systolic BP and daytime systolic BP decreased significantly in the dipping group while they were unchanged in the non-dipping group (between groups changes: −7.1 ± 2.6 mmHg and −7.8 ± 2.4 mmHg; p = 0.004 and p = 0.002, respectively). Nighttime systolic BP and BPV was unchanged in both groups. Twenty-four/h diastolic BP presented small but not significant changes in both groups. Conclusions: The effects of CT on BPV and BP were blunted in hypertensive subjects with a non-dipping BP pattern. Full article

(This article belongs to the Section Sports Medicine and Sports Traumatology)

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7 pages, 1810 KiB

Open AccessArticle

Automatic Diagnosis of Diabetic Retinopathy Stage Focusing Exclusively on Retinal Hemorrhage

by Yoshihiro Tokuda, Hitoshi Tabuchi, Toshihiko Nagasawa, Mao Tanabe, Hodaka Deguchi, Yuki Yoshizumi, Zaigen Ohara and Hiroshi Takahashi

Medicina 2022, 58(11), 1681; https://doi.org/10.3390/medicina58111681 - 20 Nov 2022

Cited by 2 | Viewed by 2434

Abstract

Background and Objectives: The present study evaluated the detection of diabetic retinopathy (DR) using an automated fundus camera focusing exclusively on retinal hemorrhage (RH) using a deep convolutional neural network, which is a machine-learning technology. Materials and Methods: This investigation was [...] Read more.

Background and Objectives: The present study evaluated the detection of diabetic retinopathy (DR) using an automated fundus camera focusing exclusively on retinal hemorrhage (RH) using a deep convolutional neural network, which is a machine-learning technology. Materials and Methods: This investigation was conducted via a prospective and observational study. The study included 89 fundus ophthalmoscopy images. Seventy images passed an image quality review and were graded as showing no apparent DR (n = 51), mild nonproliferative DR (NPDR; n = 16), moderate NPDR (n = 1), severe NPDR (n = 1), and proliferative DR (n = 1) by three retinal experts according to the International Clinical Diabetic Retinopathy Severity scale. The RH numbers and areas were automatically detected and the results of two tests—the detection of mild-or-worse NPDR and the detection of moderate-or-worse NPDR—were examined. Results: The detection of mild-or-worse DR showed a sensitivity of 0.812 (95% confidence interval: 0.680–0.945), specificity of 0.888, and area under the curve (AUC) of 0.884, whereas the detection of moderate-or-worse DR showed a sensitivity of 1.0, specificity of 1.0, and AUC of 1.0. Conclusions: Automated diagnosis using artificial intelligence focusing exclusively on RH could be used to diagnose DR requiring ophthalmologist intervention. Full article

(This article belongs to the Special Issue Multidisciplinary Approaches for Managing Ophthalmic Complications of Diabetes)

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7 pages, 268 KiB

Open AccessCase Report

Assessing the Safety of Total Intravenous Anesthesia with Remimazolam in General Anesthesia for Transcatheter Aortic Valve Implantation of Severe Aortic Valve Stenosis: A Case Series

by Yu-Yil Kim, Hyun-Joo Heo, Ji-Hye Lee, Hyung-Gu Cho and Geonbo Kim

Medicina 2022, 58(11), 1680; https://doi.org/10.3390/medicina58111680 - 19 Nov 2022

Cited by 9 | Viewed by 2120

Abstract

Background and Objectives: In patients with severe aortic stenosis (sAS), it is crucial to maintain hemodynamic stability during the induction and maintenance of general anesthesia for transcatheter aortic valve implantation (TAVI). In this study, we assessed the efficacy and safety of remimazolam [...] Read more.

Background and Objectives: In patients with severe aortic stenosis (sAS), it is crucial to maintain hemodynamic stability during the induction and maintenance of general anesthesia for transcatheter aortic valve implantation (TAVI). In this study, we assessed the efficacy and safety of remimazolam in maintaining hemodynamic stability during anesthetic induction and maintenance. Cases: TAVI was performed on seven patients with sAS, and remimazolam was administered for total intravenous anesthesia (TIVA) of general anesthesia with induction (3.0 mg/kg/h) and maintenance (1.0 mg/kg/h). All patients underwent TAVI without major hemodynamic concerns and later recovered. Conclusions: Remimazolam can be safely used for induction and maintenance of general anesthesia in patients with sAS when performing TAVI. Full article

(This article belongs to the Section Intensive Care/ Anesthesiology)

8 pages, 1444 KiB

Open AccessArticle

Transosseous Suturing for the Correction of Juvenile Hallux Valgus: A Preliminary Case Series Study

by Wei-Chen Hung, Shu-Hsin Yao, Ting-Ming Wang and Chun-Ho Chen

Medicina 2022, 58(11), 1679; https://doi.org/10.3390/medicina58111679 - 19 Nov 2022

Viewed by 1925

Abstract

Background and Objectives: Many treatment modalities are available for juvenile hallux valgus. However, all of them have some disadvantages. Therefore, we developed a transosseous suturing procedure. Materials and Methods: Six patients (seven feet) with juvenile hallux valgus received transosseous suturing procedure. [...] Read more.

Background and Objectives: Many treatment modalities are available for juvenile hallux valgus. However, all of them have some disadvantages. Therefore, we developed a transosseous suturing procedure. Materials and Methods: Six patients (seven feet) with juvenile hallux valgus received transosseous suturing procedure. Clinical and radiological examinations were performed preoperatively and postoperatively. All patients underwent the soft tissue release procedure, followed by transosseous suturing with Fiberwire (in which sutures are anchored with mini plates). Results: The mean IMA and HVA decreased from 15.6° ± 2.6° to 7.3° ± 1.1° and 39.2° ± 3.3° to 12.5° ± 3.1°, respectively. Corrections achieved in the IMA and HVA of all patients were maintained through the last follow-up. The mean American Orthopedic Foot & Ankle Society score improved from 53.3 ± 3.5 to 86.9 ± 4.7 points. Conclusions: Based on these preliminary data, the transosseous suturing technique demonstrated satisfactory results and apparent improvements in the IMA and HVA without early complications. Full article

(This article belongs to the Section Surgery)

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15 pages, 379 KiB

Open AccessArticle

A Cross-Sectional Analysis of Self-Medication Patterns during the COVID-19 Pandemic in Ecuador

by Fabián Arias, Juan S. Izquierdo-Condoy, Patricio Naranjo-Lara, Verónica Alarcón, Paulina Bonilla, Elizabeth Erazo, Sarah J. Carrington and Esteban Ortiz-Prado

Medicina 2022, 58(11), 1678; https://doi.org/10.3390/medicina58111678 - 19 Nov 2022

Cited by 6 | Viewed by 3062

Abstract

Background and Objectives: Drug consumption is a widely developed practice around the world. However, sometimes medicines are acquired with or without prescription, a practice termed self-medication, which can have negative impacts on the health of the population. It has been observed that [...] Read more.

Background and Objectives: Drug consumption is a widely developed practice around the world. However, sometimes medicines are acquired with or without prescription, a practice termed self-medication, which can have negative impacts on the health of the population. It has been observed that with the arrival of the coronavirus disease 2019 (COVID-19) pandemic, self-medicated drug consumption figures increased in several countries. To describe the patterns of medication, use and the prevalence of self-medication during the COVID-19 pandemic in inhabitants of the capital province of Pichincha, Ecuador. Materials and Methods: A descriptive, cross-sectional study was conducted based on a self-administered online questionnaire from April to June 2022, among residents of the province of Pichincha, Ecuador. Participants were invited through social networks (WhatsApp and Facebook). A total of 401 surveys were included in this study. Consumption patterns (prescription of and treatment with) of medicines during the pandemic were evaluated, as well as the prevalence of self-medication and variables that characterize the way of acquiring medicines. The Chi-square test was used to look for relationships between consumption patterns, self-medication, and the characteristics of the participants. Results: Most participants were female (53.4%), and 59.4% reported having had COVID-19. A total of 244 (60.9%) consumed medications during the pandemic, mostly for the purpose of treating the infection. About half (48.4%) self-medicated. The most used medications were paracetamol (87.3%) and ibuprofen (47.5%). Drugs consumption as a treatment and informal sources of information (TV, social networks, advice) were associated with the practice of self-medication (p < 0.05). Conclusions: A significant percentage of over-the-counter (OTC) and legal drug use was found to persist after the COVID-19 pandemic. Our findings highlight the effects that alternative forms of information sources other than medical personnel can have on drug consumption and self-medication practices. Full article

(This article belongs to the Section Epidemiology & Public Health)

12 pages, 3083 KiB

Open AccessArticle

Automated Detection of Surgical Implants on Plain Knee Radiographs Using a Deep Learning Algorithm

by Back Kim, Do Weon Lee, Sanggyu Lee, Sunho Ko, Changwung Jo, Jaeseok Park, Byung Sun Choi, Aaron John Krych, Ayoosh Pareek, Hyuk-Soo Han and Du Hyun Ro

Medicina 2022, 58(11), 1677; https://doi.org/10.3390/medicina58111677 - 19 Nov 2022

Cited by 5 | Viewed by 2486

Abstract

Background and Objectives: The number of patients who undergo multiple operations on a knee is increasing. The objective of this study was to develop a deep learning algorithm that could detect 17 different surgical implants on plain knee radiographs. Materials and Methods [...] Read more.

Background and Objectives: The number of patients who undergo multiple operations on a knee is increasing. The objective of this study was to develop a deep learning algorithm that could detect 17 different surgical implants on plain knee radiographs. Materials and Methods: An internal dataset consisted of 5206 plain knee antero-posterior X-rays from a single, tertiary institute for model development. An external set contained 238 X-rays from another tertiary institute. A total of 17 different types of implants including total knee arthroplasty, unicompartmental knee arthroplasty, plate, and screw were labeled. The internal dataset was approximately split into a train set, a validation set, and an internal test set at a ratio of 7:1:2. You Only look Once (YOLO) was selected as the detection network. Model performances with the validation set, internal test set, and external test set were compared. Results: Total accuracy, total sensitivity, total specificity value of the validation set, internal test set, and external test set were (0.978, 0.768, 0.999), (0.953, 0.810, 0.990), and (0.956, 0.493, 0.975), respectively. Means ± standard deviations (SDs) of diagonal components of confusion matrix for these three subsets were 0.858 ± 0.242, 0.852 ± 0.182, and 0.576 ± 0.312, respectively. True positive rate of total knee arthroplasty, the most dominant class of the dataset, was higher than 0.99 with internal subsets and 0.96 with an external test set. Conclusion: Implant identification on plain knee radiographs could be automated using a deep learning technique. The detection algorithm dealt with overlapping cases while maintaining high accuracy on total knee arthroplasty. This could be applied in future research that analyzes X-ray images with deep learning, which would help prompt decision-making in clinics. Full article

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

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14 pages, 1479 KiB

Open AccessArticle

Diastolic versus Systolic Left Ventricular Dysfunction as Independent Predictors for Unfavorable Postoperative Evolution in Patients with Aortic Regurgitation Undergoing Aortic Valve Replacement

by Luminita Iliuta, Andreea Gabriella Andronesi, Camelia Cristina Diaconu, Horatiu Moldovan, Marius Rac-Albu and Madalina-Elena Rac-Albu

Medicina 2022, 58(11), 1676; https://doi.org/10.3390/medicina58111676 - 19 Nov 2022

Cited by 12 | Viewed by 2212

Abstract

Background and Objectives: Chronic severe aortic valve disease is associated with important changes in left ventricle (LV) performance associated with eccentric or concentric LV hypertrophy. We aimed to assess the immediate prognostic implications of the type of the LV diastolic filling pattern [...] Read more.

Background and Objectives: Chronic severe aortic valve disease is associated with important changes in left ventricle (LV) performance associated with eccentric or concentric LV hypertrophy. We aimed to assess the immediate prognostic implications of the type of the LV diastolic filling pattern (LVDFP) compared with LV systolic performance in patients with severe aortic regurgitation (AR) undergoing aortic valve replacement (AVR) and to define the independent echographic predictors for the immediate and long-term prognoses. Materials and Methods: We performed a prospective study enrolling 332 AR patients undergoing AVR, divided into two groups: Group A—201 pts with normal LV systolic function, divided into two subgroups (A1: 129 pts with a nonrestrictive LVDFP and A2: 72 pts with restrictive LVDFP), and Group B—131 pts with LV systolic dysfunction (LV ejection fraction LVEF < 50%), divided into two subgroups (B1: 83 pts with a nonrestrictive LVDFP and B2: 48 pts with restrictive LVDFP). Results: The early postoperative mortality rate was higher in patients with a restrictive LVDFP (11.12% in A2 and 12.5% in B2) compared with normal LV filling (2.32% in A1 and 7.63% in B1, p < 0.0001), regardless of the LVEF. The restrictive LVDFP—defined by at least one of the following echographic parameters: an E/A > 2 with an E wave deceleration time (EDt) < 100 ms; an isovolumetric relaxation time (IVRT) < 60 ms; or an S/D ratio < 1 in the pulmonary vein flow—was an independent predictor for early postoperative mortality, increasing the relative risk by 8.2-fold. Other independent factors associated with early poor prognosis were an LV end-systolic diameter (LVESD) > 58 mm, an age > 75 years, and the presence of comorbidities (chronic obstructive pulmonary disease-COPD or diabetes mellitus). On a medium-term, an unfavorable evolution was associated with: an age > 75 years (RR = 8.1), an LV end-systolic volume (LVESV) > 95 cm³ (RR = 6.7), a restrictive LVDFP (RR = 9.8, p < 0.0002), and pulmonary hypertension (RR = 8.2). Conclusions: The presence of a restrictive LVDFP in patients with AR undergoing AVR is associated with both increased early and medium-term mortality rates. The LV diastolic function is a more reliable parameter for prognosis than LV systolic performance (RR 9.2 versus 2.1). Other independent predictors for increased early postoperative mortality rate were: an age > 75 years, an LVESD > 58 mm, and comorbidities (diabetes mellitus, COPD), and for unfavorable evolution at 2 years postoperatively: an age > 75 years, an LVESV > 95 cm³, and severe pulmonary hypertension. Full article

(This article belongs to the Special Issue Mitral and Aortic Valve Repair and Replacement: Yesterday, Today, and Tomorrow)

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19 pages, 1845 KiB

Open AccessReview

An Overview on Phenotypic and Genotypic Characterisation of Carbapenem-Resistant Enterobacterales

by Ali A. Rabaan, Khalid Eljaaly, Saad Alhumaid, Hawra Albayat, Wasl Al-Adsani, Amal A. Sabour, Maha A. Alshiekheid, Jumana M. Al-Jishi, Faryal Khamis, Sara Alwarthan, Mashael Alhajri, Amal H. Alfaraj, Huseyin Tombuloglu, Mohammed Garout, Duaa M. Alabdullah, Elmoeiz Ali Elnagi Mohammed, Fatimah S. Al Yami, Haifa A. Almuhtaresh, Kovy Arteaga Livias, Abbas Al Mutair, Shawqi A. Almushrif, Mai Abdel Haleem A. Abusalah and Naveed Ahmed Show full author list Hide full author list

Medicina 2022, 58(11), 1675; https://doi.org/10.3390/medicina58111675 - 19 Nov 2022

Cited by 22 | Viewed by 7405

Abstract

Improper use of antimicrobials has resulted in the emergence of antimicrobial resistance (AMR), including multi-drug resistance (MDR) among bacteria. Recently, a sudden increase in Carbapenem-resistant Enterobacterales (CRE) has been observed. This presents a substantial challenge in the treatment of CRE-infected individuals. Bacterial plasmids [...] Read more.

Improper use of antimicrobials has resulted in the emergence of antimicrobial resistance (AMR), including multi-drug resistance (MDR) among bacteria. Recently, a sudden increase in Carbapenem-resistant Enterobacterales (CRE) has been observed. This presents a substantial challenge in the treatment of CRE-infected individuals. Bacterial plasmids include the genes for carbapenem resistance, which can also spread to other bacteria to make them resistant. The incidence of CRE is rising significantly despite the efforts of health authorities, clinicians, and scientists. Many genotypic and phenotypic techniques are available to identify CRE. However, effective identification requires the integration of two or more methods. Whole genome sequencing (WGS), an advanced molecular approach, helps identify new strains of CRE and screening of the patient population; however, WGS is challenging to apply in clinical settings due to the complexity and high expense involved with this technique. The current review highlights the molecular mechanism of development of Carbapenem resistance, the epidemiology of CRE infections, spread of CRE, treatment options, and the phenotypic/genotypic characterisation of CRE. The potential of microorganisms to acquire resistance against Carbapenems remains high, which can lead to even more susceptible drugs such as colistin and polymyxins. Hence, the current study recommends running the antibiotic stewardship programs at an institutional level to control the use of antibiotics and to reduce the spread of CRE worldwide. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnostics, and Therapeutics of Infectious Diseases)

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10 pages, 1335 KiB

Open AccessArticle

Assessing Whether Morphological Changes in Axillary Lymph Node Have Already Occurred Prior to Metastasis in Breast Cancer Patients by Ultrasound

by Qiang Guo, Zhiwu Dong, Lixin Jiang, Lei Zhang, Ziyao Li and Dongmo Wang

Medicina 2022, 58(11), 1674; https://doi.org/10.3390/medicina58111674 - 18 Nov 2022

Cited by 6 | Viewed by 2358

Abstract

Background and Objectives: Whether the morphological changes in axillary lymph node (ALN) have occurred prior to metastasis remains unclear in breast cancer (BC) patients. The aim of this study is to investigate the influence of BC for the morphology of non-metastasis ALN (N−) [...] Read more.

Background and Objectives: Whether the morphological changes in axillary lymph node (ALN) have occurred prior to metastasis remains unclear in breast cancer (BC) patients. The aim of this study is to investigate the influence of BC for the morphology of non-metastasis ALN (N−) and, further, to improve the performance of ultrasound (US) examination for metastasis ALN (N+). Materials and Methods: In this retrospective study, 653 patients with breast mass were enrolled and divided into normal group of 202 patients with benign breast tumor, N− group of 233 BC patients with negative ALN and N+ group of 218 BC patients with positive ALN. US features of ALN were evaluated and analyzed according to long (L) and short (S) diameter, the (L/S) axis ratio, cortical thickness, lymph node edge, replaced hilum and color Doppler flow imaging (CDFI). Results: ALN US features of short diameter, replaced hilum, cortical thickness and CDFI have significant statistical differences in N− group comparing with normal group and N+ group, respectively (p < 0.05). Conclusions: Therefore, BC can affect ALN and lead to US morphological changes whether lymph node metastasis is present, which reduces the sensitivity of axillary US. The combination of US and other examination methods should be applied to improve the diagnostic performance of N+. Full article

(This article belongs to the Section Obstetrics and Gynecology)

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11 pages, 302 KiB

Open AccessArticle

Clinical Features of Infectious Uveitis in Children Referred to a Hospital-Based Eye Clinic in Italy

by Maria Pia Paroli, Lucia Restivo, Eleonora Ottaviani, Chiara Nardella, Irene Abicca, Luca Spadea and Marino Paroli

Medicina 2022, 58(11), 1673; https://doi.org/10.3390/medicina58111673 - 18 Nov 2022

Cited by 5 | Viewed by 1904

Abstract

Background and Objectives: To investigate the etiology, clinical features, ocular complications, and visual outcomes in children with infectious uveitis referred to a tertiary uveitis hospital-based service. Materials and Methods: Children with infectious uveitis were included in a retrospective cohort study. The [...] Read more.

Background and Objectives: To investigate the etiology, clinical features, ocular complications, and visual outcomes in children with infectious uveitis referred to a tertiary uveitis hospital-based service. Materials and Methods: Children with infectious uveitis were included in a retrospective cohort study. The data set was obtained after reviewing the medical records of pediatric patients with uveitis of different causes referred to our center during the period from 2009 to 2019. Clinical evaluations were performed at the time of diagnosis and the end of follow-up. Results: Uveitis of infectious origin was present in 57 (72 eyes) of 314 (18.1%) patients examined. The median age at presentation was 10.9 years (6.1–15.8), 52.6% of patients were female, and 47.4% were male. The main cause of infectious uveitis was viral (56.1% of cases), followed by Toxoplasma gondii infection (24.5%). The anatomical location of uveitis was posterior in 40.3%, anterior in 36.8%, panuveitis in 15.7%, and intermediate in 7% of cases. Ocular involvement was unilateral in 42 children (73.7%) and bilateral in 15 (26.3%) cases. The main causes of reduced visual acuity were cataract and maculopathy in 57.1% and 28.5% of cases, respectively. During the follow-up period, 75% of patients showed significant improvements in visual acuity. Conclusions: Specialist management in a tertiary referral eye care center facilitates early diagnosis and effective treatment of this serious cause of morbidity and vision loss in children. Full article

(This article belongs to the Section Ophthalmology)

7 pages, 1893 KiB

Open AccessCase Report

Patient with Aberrant Internal Carotid Artery in the Middle Ear Presenting with Rare Symptoms of Mixed Hearing Loss and Postauricular Pain: A Case Report

by Bo-Nien Chen

Medicina 2022, 58(11), 1672; https://doi.org/10.3390/medicina58111672 - 18 Nov 2022

Viewed by 3930

Abstract

Aberrant internal carotid artery in the middle ear (aICA) is a rare congenital malformation in which the internal carotid artery passes through the tympanic cavity without being separated by bone. A pulsatile vascular mass can be observed in the tympanic cavity of patients [...] Read more.

Aberrant internal carotid artery in the middle ear (aICA) is a rare congenital malformation in which the internal carotid artery passes through the tympanic cavity without being separated by bone. A pulsatile vascular mass can be observed in the tympanic cavity of patients with aICA. The diagnosis of aICA may be challenging because improper surgery or treatment can lead to iatrogenic injury, including massive hemorrhage. The aim of this case report was to describe a 39-year-old woman with aICA presenting with mixed hearing loss and postauricular pain. We provided detailed clinical images of the patient to illustrate how aICA can be diagnosed. Because this patient’s aICA had no risk of bleeding, close observation, pharmacological therapy, and regular follow-up were applied. The patient’s postauricular pain was significantly improved after treatment with oxcarbazepine. At the time of this manuscript’s preparation, the patient had been monitored for 10 years and had stable mixed hearing loss with no other complications. Based on the management of this patient, oxcarbazepine can improve aICA-associated postauricular pain, and conservative treatment should be prioritized in cases of aICA without a risk of bleeding. Further studies in a large cohort are required to confirm our findings and recommendations. Full article

(This article belongs to the Special Issue Current Advances in Diagnosis and Surgical Treatment of the Head and Neck Disorders)

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11 pages, 1096 KiB

Open AccessReview

Insulin Pump Therapy Efficacy and Key Factors Influencing Adherence in Pediatric Population—A Narrative Review

by Laura Mihaela Trandafir, Stefana Maria Moisa, Mihaela Victoria Vlaiculescu, Lacramioara Ionela Butnariu, Laura Otilia Boca, Maria Magdalena Leon Constantin, Paula Madalina Lupu, Crischentian Brinza, Oana Raluca Temneanu and Alexandru Burlacu

Medicina 2022, 58(11), 1671; https://doi.org/10.3390/medicina58111671 - 18 Nov 2022

Cited by 3 | Viewed by 3433

Abstract

Objective: we aimed to highlight the state of the art in terms of pediatric population adherence to insulin pumps. This study intends to underline the significance of identifying and minimizing, to the greatest extent feasible, the factors that adversely affect the juvenile [...] Read more.

Objective: we aimed to highlight the state of the art in terms of pediatric population adherence to insulin pumps. This study intends to underline the significance of identifying and minimizing, to the greatest extent feasible, the factors that adversely affect the juvenile population’s adherence to insulin pump therapy. Materials and methods: articles from PubMed, Embase, and Science Direct databases were evaluated using the following search terms: adherence, pump insulin therapy, children, pediatric population, and type 1 diabetes, in combination with several synonyms such as compliance, treatment adherence, pump adherence, patient dropouts, and treatment refusal. Results: A better glycemic control is connected to a better adherence to diabetes management. We identify, enumerate, and discuss a number of variables which make it difficult to follow an insulin pump therapy regimen. Several key factors might improve adherence to insulin pump therapy: efficient communication between care provider and patients (including home-based video-visits), continuous diabetes education, family support and parental involvement, as well as informational, practical assistance, and emotional support from the society. Conclusions: every cause and obstacle that prevents young patients from adhering to insulin pumps optimally is an opportunity for intervention to improve glycemic control and, as a result, their quality of life. Full article

(This article belongs to the Special Issue Modern Management and Treatment of Diabetes—Celebrating the 100th Anniversary of the First Diabetic Patient Who Received Insulin)

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9 pages, 326 KiB

Open AccessArticle

Effects of Alcohol Consumption on Oxidative Stress in a Sample of Patients Recruited in a Dietary Center in a Southern University Hospital: A Retrospective Study

by Daniela Metro, Francesco Corallo, Francesco Fedele, Martina Buda, Luigi Manasseri, Viviana Lo Buono, Angelo Quartarone and Lilla Bonanno

Medicina 2022, 58(11), 1670; https://doi.org/10.3390/medicina58111670 - 18 Nov 2022

Cited by 2 | Viewed by 2458

Abstract

Background and objectives: The aim of this retrospective study was to evaluate the effects of alcohol consumption on oxidative stress. Materials and Methods: The study was conducted by analyzing the increase in lipid peroxidation, the reduction of antioxidant defenses and the [...] Read more.

Background and objectives: The aim of this retrospective study was to evaluate the effects of alcohol consumption on oxidative stress. Materials and Methods: The study was conducted by analyzing the increase in lipid peroxidation, the reduction of antioxidant defenses and the alteration of the oxidation/antioxidant balance after the administration of ethanol in 25% aqueous solution (v/v) at a concentration of 0.76 g/kg of body weight daily in two doses for 3 days. The changes in oxidative stress indices were investigated by standard methods previously described. Results: Ethanol administration has determined a significant increase in plasma levels of lipid hydroperoxide (LOOH), malonilaldehyde (MDA) and oxidized glutathione (GSSH), and a decrease in total antioxidant capacity (TAC), reduced glutathione (GSH) and GSH/GSSH ratio. Conclusions: In the proposed experimental condition, the excessive and repeated consumption of ethanol causes oxidative damage, as shown by the increase in lipid peroxidation, the reduction of antioxidant defenses and the alteration of the oxidation/antioxidant balance, which, at least in part, are responsible for the harmful effects of excess ethanol. Full article

13 pages, 1116 KiB

Open AccessArticle

Neurodevelopmental Outcomes among Brazilian Children with Cyanotic Congenital Heart Disease and Its Associated Factors

by Flávia Saraçol Vignol, Priscila Aikawa, Tatiane Britto da Silveira, Ronan Adler Tavella, Vinita Mahtani-Chugani, Emílio J. Sanz and Flavio Manoel Rodrigues da Silva Júnior

Medicina 2022, 58(11), 1669; https://doi.org/10.3390/medicina58111669 - 18 Nov 2022

Viewed by 1981

Abstract

Objectives: The aim of this study was to evaluate neurodevelopmental outcomes (motor development, nonverbal intelligence, and attention) in children with cyanotic congenital heart disease (CHD) compared with healthy children from a public hospital in southern Brazil. Materials and Methods: This was a cross-sectional [...] Read more.

Objectives: The aim of this study was to evaluate neurodevelopmental outcomes (motor development, nonverbal intelligence, and attention) in children with cyanotic congenital heart disease (CHD) compared with healthy children from a public hospital in southern Brazil. Materials and Methods: This was a cross-sectional study with pediatric patients of both sexes: 37 children with cyanotic CHD and a control group with 38 healthy children. Parents/guardians undertook a questionnaire and the SNAP IV scale (to evaluate attention) was applied. Two instruments were applied to each child: the R-2 Non-Verbal Intelligence test and the motor development scale. To assess the factors associated with insufficient performance in the three fields of neurodevelopment, a Poisson regression analysis was performed with a robust estimate. Results: There were no significant differences between children with cyanotic CHD and the control group for any of the neurodevelopmental outcomes studied. Low socioeconomic class was a factor associated with worse performance on the intelligence test and inattention. Furthermore, age was a factor for performance on the intelligence test, while a greater number of siblings was a factor associated with worse performance on the attention test. Conclusions: Public policies regarding child health must involve prioritizing the improvement of families’ social conditions. Full article

(This article belongs to the Section Cardiology)

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4 pages, 742 KiB

Open AccessBrief Report

Carbon Peeling Laser Treatment to Improve Skin Texture, Pores and Acne Lesions: A Retrospective Study

by Claudio Conforti, Stefania Guida, Caterina Dianzani, Piergiorgio Turco, Vito Cazzato, Iris Zalaudek and Domenico Piccolo

Medicina 2022, 58(11), 1668; https://doi.org/10.3390/medicina58111668 - 18 Nov 2022

Cited by 6 | Viewed by 7390

Abstract

Carbon peel laser treatment has been described for the improvement of skin texture, with pore reduction and acne lesion treatment. The technique consists of applying a carbon mask to the face for about ten minutes followed by laser irradiation with a Q-switched 1064 [...] Read more.

Carbon peel laser treatment has been described for the improvement of skin texture, with pore reduction and acne lesion treatment. The technique consists of applying a carbon mask to the face for about ten minutes followed by laser irradiation with a Q-switched 1064 nm laser. This mechanism of action seems to be related to small carbon molecules binding both the corneocytes and serum within the hair follicles; the effect of the laser eliminates carbon bound to skin particles and the high temperature generated reduces sebum production by sebaceous glands and inhibits Cutibacterium acnes replication. Although this method was described 20 years ago, scientific data supporting its efficacy and safety have only recently been reported in small case series. For this reason, we performed a retrospective study including patients treated from January to May 2022 in the context of a private practice. Even if this study is limited by the low number of patients and its retrospective nature, this is the first research to show that carbon peel laser, performed with a standardized technique, is an effective and safe treatment for patients with acne lesions, showing pores and wrinkles, and is able to improve the overall skin aspect. Full article

(This article belongs to the Special Issue Advances in Laser Treatment for Skin Diseases)

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13 pages, 1198 KiB

Open AccessFeature PaperArticle

Pseudophakic Cystoid Macular Oedema (PCME) Prevention in Patients with Non-Proliferative Diabetic Retinopathy (NPDR)—Randomized Controlled Trial

by Anđela Jukić, Rajka Kasalica Žužul, Josip Pavan, Mila Lovrić, Ana Kozmar, Davor Plavec, Tomislav Kuzman, Miro Kalauz and Tomislav Jukić

Medicina 2022, 58(11), 1667; https://doi.org/10.3390/medicina58111667 - 17 Nov 2022

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Abstract

Background and Objectives: The purpose of this study was to compare the effect of topical bromfenac and dexamethasone on the intraocular concentration of interleukin 6 (IL-6) and incidence of pseudophakic cystoid macular oedema (PCME) after cataract surgery in patients with non-proliferative diabetic retinopathy [...] Read more.

Background and Objectives: The purpose of this study was to compare the effect of topical bromfenac and dexamethasone on the intraocular concentration of interleukin 6 (IL-6) and incidence of pseudophakic cystoid macular oedema (PCME) after cataract surgery in patients with non-proliferative diabetic retinopathy (NPDR). Materials and Methods: Ninety eyes of patients with mild-to-moderate NPDR that underwent phacoemulsification cataract surgery were divided into three groups. A detailed description of the clinical study protocol is described later in paper. In short, Group 1 received topical bromfenac (0.9 mg/mL), Group 2 dexamethasone (1 mg/mL), and Group 3 placebo, both preoperatively and postoperatively. Additionally, all patients received combined topical steroid and antibiotic drops (dexamethasone, neomycin and polymyxin B) 3 weeks postoperatively. On the day of the surgery, aqueous humour samples (0.1–0.2 mL) were obtained and IL-6 concentrations were analysed. Central foveal subfield thickness (CFT) measured using spectral-domain optical coherence tomography (SD-OCT) was analysed preoperatively and postoperatively. Results: There was no significant difference in IL-6 concentrations between groups. Postoperative CFT was significantly lower in the dexamethasone group compared to the placebo group. In addition, the correlation between IL-6 and CFT was statistically significant in the dexamethasone group. No patient developed PCME in any of the three groups. No adverse events were reported during the study. Conclusion: Topical bromfenac and dexamethasone have no significant effect on intraocular IL-6 concentration in patients with NPDR. Topical bromfenac is not more effective than topical dexamethasone in reducing postoperative CFT in patients with NPDR. Full article

(This article belongs to the Section Ophthalmology)

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10 pages, 1557 KiB

Open AccessArticle

To Angulate or Not to Angulate the Ulna during the Progressive Distraction Period Performed with a Monolateral External Fixator in Paediatric Patients with a Chronic Monteggia Fracture?

by Yanhan Liu, Hai Zhao, Hongwen Xu, Weizhe Shi, Jingchun Li, Yiqiang Li and Federico Canavese

Medicina 2022, 58(11), 1666; https://doi.org/10.3390/medicina58111666 - 17 Nov 2022

Cited by 4 | Viewed by 2144

Abstract

Background and Objectives: The purpose of this study was to compare the clinical and radiographic evolution of chronic Monteggia fractures (CMFs) treated by ulnar osteotomy and monolateral external fixators (MEFs) with or without angulation of the ulna during the distraction period. Materials and [...] Read more.

Background and Objectives: The purpose of this study was to compare the clinical and radiographic evolution of chronic Monteggia fractures (CMFs) treated by ulnar osteotomy and monolateral external fixators (MEFs) with or without angulation of the ulna during the distraction period. Materials and Methods: This retrospective study evaluated 20 children (14 boys and 6 girls) with CMFs. According to the strategy of ulnar lengthening, two groups of patients were identified: patients undergoing gradual lengthening with (Group A, n = 11) or without ulna angulation (Group B, n = 9). The mean age at the time of surgery was 7.7 years old (range, 5.4–12.9). The mean time from initial trauma to surgery was 26.3 months (range, 1–96), and the mean follow-up was 24.6 months (range, 5.5–45.4). Clinical outcomes were evaluated by Kim et al.’s Elbow Performance Score, while radiographic outcomes were assessed on plain radiographs. Results: Age at surgery, sex, laterality, time between trauma and surgery, and time of follow up in the two groups of patients showed no significant differences. The radial head was successfully reduced in 9 of 9 and 10 of 11 patients in Groups B and A, respectively (p = 1.00). The mean time to achieve radial head reduction was shorter in Group B (18.1 ± 5.3 days) than in Group A (39.2 ± 18.7 days; p = 0.004). The mean angulation of the ulna at the end of treatment was significantly lower in Group B (0.6° ± 1.1°) than in Group A (25.9° ± 6.3°; p < 0.0001). The average ulnar lengthening at the end of treatment in Group B (14.1 ± 5.8 mm) was, on average, 7.7 mm less than that in Group A (21.8 ± 9.7 mm; p = 0.05). The Kim et al. Elbow Performance Score at the last follow-up visit was comparable between the two groups of patients (p = 1.00). Conclusions: A shorter time to achieve radial head reduction and less deformity of the ulna can be expected in paediatric patients with CMFs undergoing intraoperative restoration of ulnar alignment and gradual lengthening without angulation postoperatively. Full article

(This article belongs to the Special Issue Advanced Trauma Operative Management (ATOM) in Children)

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Medicina, Volume 58, Issue 11 (November 2022) – 193 articles

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