Journal of Clinical Medicine

21 pages, 2784 KiB

Open AccessArticle

Extracellular Vesicles Derived from Early and Late Stage Plasmodium falciparum-Infected Red Blood Cells Contain Invasion-Associated Proteins

by Sinmanus Vimonpatranon, Sittiruk Roytrakul, Narumon Phaonakrop, Kittima Lekmanee, Anyapat Atipimonpat, Narinee Srimark, Kasama Sukapirom, Kesinee Chotivanich, Ladawan Khowawisetsut and Kovit Pattanapanyasat

J. Clin. Med. 2022, 11(14), 4250; https://doi.org/10.3390/jcm11144250 - 21 Jul 2022

Cited by 14 | Viewed by 3161

Abstract

In infectious diseases, extracellular vesicles (EVs) released from a pathogen or pathogen-infected cells can transfer pathogen-derived biomolecules, especially proteins, to target cells and consequently regulate these target cells. For example, malaria is an important tropical infectious disease caused by Plasmodium spp. Previous studies [...] Read more.

In infectious diseases, extracellular vesicles (EVs) released from a pathogen or pathogen-infected cells can transfer pathogen-derived biomolecules, especially proteins, to target cells and consequently regulate these target cells. For example, malaria is an important tropical infectious disease caused by Plasmodium spp. Previous studies have identified the roles of Plasmodium falciparum-infected red blood cell-derived EVs (Pf-EVs) in the pathogenesis, activation, and modulation of host immune responses. This study investigated the proteomic profiles of Pf-EVs isolated from four P. falciparum strains. We also compared the proteomes of EVs from (i) different EV types (microvesicles and exosomes) and (ii) different parasite growth stages (early- and late-stage). The proteomic analyses revealed that the human proteins carried in the Pf-EVs were specific to the type of Pf-EVs. By contrast, most of the P. falciparum proteins carried in Pf-EVs were common across all types of Pf-EVs. As the proteomics results revealed that Pf-EVs contained invasion-associated proteins, the effect of Pf-EVs on parasite invasion was also investigated. Surprisingly, the attenuation of parasite invasion efficiency was found with the addition of Pf-MVs. Moreover, this effect was markedly increased in culture-adapted isolates compared with laboratory reference strains. Our evidence supports the concept that Pf-EVs play a role in quorum sensing, which leads to parasite growth-density regulation. Full article

(This article belongs to the Special Issue New Approaches to the Diagnosis and Management of Anemia and Malaria)

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4 pages, 523 KiB

Open AccessEditorial

Acute Liver Failure and Acute-on-Chronic Liver Failure in COVID-19 Era

by Tatsuo Kanda, Reina Sasaki-Tanaka, Tomotaka Ishii, Hayato Abe, Masahiro Ogawa and Hirayuki Enomoto

J. Clin. Med. 2022, 11(14), 4249; https://doi.org/10.3390/jcm11144249 - 21 Jul 2022

Cited by 5 | Viewed by 2213

Abstract

Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF), respectively, occur in patients with normal liver and patients with chronic liver diseases, including cirrhosis [...] Full article

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

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13 pages, 511 KiB

Open AccessArticle

Disparities in Survival Outcomes of Out-of-Hospital Cardiac Arrest Patients between Urban and Rural Areas and the Identification of Modifiable Factors in an Area of South Korea

by Song Yi Park, Daesung Lim, Seong Chun Kim, Ji Ho Ryu, Yong Hwan Kim, Byungho Choi and Sun Hyu Kim

J. Clin. Med. 2022, 11(14), 4248; https://doi.org/10.3390/jcm11144248 - 21 Jul 2022

Cited by 1 | Viewed by 1565

Abstract

This retrospective study aimed to compare the survival outcomes of adult out-of-hospital cardiac arrest (OHCA) patients between urban (Busan, Ulsan, Changwon) and rural (Gyeongnam) areas in South Korea and identify modifiable factors in the chain of survival. The primary and secondary outcomes were [...] Read more.

This retrospective study aimed to compare the survival outcomes of adult out-of-hospital cardiac arrest (OHCA) patients between urban (Busan, Ulsan, Changwon) and rural (Gyeongnam) areas in South Korea and identify modifiable factors in the chain of survival. The primary and secondary outcomes were survival to discharge and modifiable factors in the chain of survival were identified using logistic regression analysis. In total, 1954 patients were analyzed. The survival to discharge rates in the whole region and in urban and rural areas were 6.9%, 8.7% (Busan 8.7%, Ulsan 10.3%, Changwon 7.2%), and 3.4%, respectively. In the urban group, modifiable factors associated with survival to discharge were no advanced airway management (adjusted odds ratio (aOR) 2.065, 95% confidence interval (CI): 1.138–3.747), no mechanical chest compression (aOR 3.932, 95% CI: 2.015–7.674), and an emergency medical service (EMS) transport time of more than 8 min (aOR 3.521, 95% CI: 2.075–5.975). In the rural group, modifiable factors included an EMS scene time of more than 15 min (aOR 0.076, 95% CI: 0.006–0.883) and an EMS transport time of more than 8 min (aOR 4.741, 95% CI: 1.035–21.706). To improve survival outcomes, dedicated resources and attention to EMS practices and transport time in urban areas and EMS scene and transport times in rural areas are needed. Full article

(This article belongs to the Section Intensive Care)

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15 pages, 925 KiB

Open AccessReview

The Effects of Physiotherapy in the Treatment of Cubital Tunnel Syndrome: A Systematic Review

by Tomasz Wolny, César Fernández-de-las Peñas, Tomasz Buczek, Magdalena Domin, Arkadiusz Granek and Paweł Linek

J. Clin. Med. 2022, 11(14), 4247; https://doi.org/10.3390/jcm11144247 - 21 Jul 2022

Cited by 4 | Viewed by 4419

Abstract

Background: To date, various forms of physiotherapy are used in the treatment of cubital tunnel syndrome (CuTS). The effectiveness of physiotherapy for CuTS is inconclusive. The aim of this systematic review was to evaluate the effects of physiotherapy in the conservative treatment of [...] Read more.

Background: To date, various forms of physiotherapy are used in the treatment of cubital tunnel syndrome (CuTS). The effectiveness of physiotherapy for CuTS is inconclusive. The aim of this systematic review was to evaluate the effects of physiotherapy in the conservative treatment of CuTS. Methods: The six databases were searched from December 2020 to March 2022. The inclusion criteria were randomised controlled trials, case series, and case reports that evaluate the effects of physiotherapy in the treatment of adult participants with diagnosis CuTS. A total of 11 studies met the eligibility criteria, capturing a total of 187 participants. Results: In three types of papers, pain, muscle strength, and limitation of upper limb function were the most frequently assessed characteristics. Physiotherapy was most often based on manual therapy, neurodynamic techniques, and electrical modalities. One clinical trial rated the risk of bias “high” and the other two “some concerns”. In case-series designs, five studies rated the risk of bias as “serious” and three as “moderate”. Most of the studies showed a significant improvement in the clinical condition, also in the follow-up study. Only one clinical trial showed no therapeutic effect. Conclusion: There is no possibility of recommending the best method of physiotherapy in clinical practice for people with CuTS based on the results of this systematic review. More high-quality studies are required. Full article

(This article belongs to the Special Issue Recent Progress in Rehabilitation Medicine)

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10 pages, 2035 KiB

Open AccessArticle

Esophageal Mucosal Permeability as a Surrogate Measure of Cure in Eosinophilic Esophagitis

by Junji Chen, Tadayuki Oshima, Xinyi Huang, Toshihiko Tomita, Hirokazu Fukui and Hiroto Miwa

J. Clin. Med. 2022, 11(14), 4246; https://doi.org/10.3390/jcm11144246 - 21 Jul 2022

Cited by 6 | Viewed by 1911

Abstract

This study aimed to evaluate the relationship of esophageal epithelial permeability with mast cell infiltration and IgG4 deposits as well as chemokine levels in eosinophilic esophagitis (EoE) patients before and after treatment. Biopsies from controls and EoE patients before and after treatment were [...] Read more.

This study aimed to evaluate the relationship of esophageal epithelial permeability with mast cell infiltration and IgG4 deposits as well as chemokine levels in eosinophilic esophagitis (EoE) patients before and after treatment. Biopsies from controls and EoE patients before and after treatment were analyzed. Hematoxylin and eosin staining was used to show eosinophil infiltration. Paracellular permeability of the esophageal epithelium was assessed using surface biotinylation. Immunohistochemical staining was performed to examine mast cell infiltration and IgG4 deposits. Gene expression of chemokines was evaluated by qRT-PCR. Esophageal epithelial infiltration of mast cells, IgG4 deposits, and permeability were significantly increased in EoE patients. Levels of interleukin-13, calpain-14, and eotaxin-3 mRNAs were significantly upregulated, while filaggrin, serine peptidase inhibitor Kazal type 7 (SPINK7), and involucrin mRNAs were significantly downregulated in EoE patients. In patients achieving histologic remission diagnosed by eosinophil counts, a subset of EoE patients with unchanged permeability after treatment showed increases in mast cell infiltration, IgG4 deposits, and interleukin-13, calpain-14, filaggrin, and SPINK7 expression, with decreased eotaxin-3 and involucrin. Other EoE patients with decreased permeability displayed decreased eotaxin-3, involucrin, and mast cell infiltration, no IgG4 deposits, and increased IL-13, calpain-14, filaggrin, and SPINK7. Increased permeability of the esophagus in EoE patients without eosinophil infiltration after treatment was associated with mast cell infiltration and IgG4 deposits. Full article

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

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14 pages, 3097 KiB

Open AccessSystematic Review

Risk Factors for Periprosthetic Joint Infection after Shoulder Arthroplasty: Systematic Review and Meta-Analysis

by Hyun-Gyu Seok, Jeong-Jin Park and Sam-guk Park

J. Clin. Med. 2022, 11(14), 4245; https://doi.org/10.3390/jcm11144245 - 21 Jul 2022

Cited by 21 | Viewed by 2403

Abstract

Periprosthetic joint infection (PJI) after shoulder arthroplasty is a devastating complication that requires several additional surgeries. The purpose of this study was to assess the evidence regarding risk factors for PJI and identify those that contribute to infection by performing a meta-analysis. We [...] Read more.

Periprosthetic joint infection (PJI) after shoulder arthroplasty is a devastating complication that requires several additional surgeries. The purpose of this study was to assess the evidence regarding risk factors for PJI and identify those that contribute to infection by performing a meta-analysis. We searched the PubMed, Embase, and Cochrane Library databases for studies that assessed the risk factors for infection after shoulder arthroplasty. After performing screening and quality assessment on the articles, we obtained two case-control studies and six retrospective cohort studies (total of 420 infected cases and 28,464 controls). Review Manager 5.4 was used to assess the heterogeneity and odds ratio for 20 different factors that broadly included demographic factors, perioperative factors, and comorbidities. Factors that are markedly associated with PJI after shoulder arthroplasty were male sex, operation history, revision arthroplasty, acute trauma, and non-osteoarthritis as a preoperative diagnosis. Statistical analysis revealed that diabetes mellitus, liver disease, alcohol overuse, iron-deficiency anemia, and rheumatoid arthritis were risk factors for PJI after shoulder arthroplasty. The result of analysis shows that several specific factors can be targeted to prevent infections after shoulder arthroplasty. Surgeons should consider the risk factors and perform the appropriate management for patients. Full article

(This article belongs to the Section Orthopedics)

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2 pages, 188 KiB

Open AccessReply

Reply to Borgia et al. Comment on “Marasca et al. Teledermatology and Inflammatory Skin Conditions during COVID-19 Era: New Perspectives and Applications. J. Clin. Med. 2022, 11, 1511”

by Luca Potestio, Luigi Fornaro, Fabrizio Martora, Vincenzo Picone, Gabriella Fabbrocini and Claudio Marasca

J. Clin. Med. 2022, 11(14), 4244; https://doi.org/10.3390/jcm11144244 - 21 Jul 2022

Viewed by 1198

Abstract

Telemedicine can be defined as a modern technology supporting health care from a distance [...] Full article

12 pages, 1336 KiB

Open AccessReview

Blood Biomarkers for Triaging Patients for Suspected Stroke: Every Minute Counts

by Radhika Kiritsinh Jadav, Reza Mortazavi and Kwang Choon Yee

J. Clin. Med. 2022, 11(14), 4243; https://doi.org/10.3390/jcm11144243 - 21 Jul 2022

Cited by 2 | Viewed by 3283

Abstract

Early stroke diagnosis remains a big challenge in healthcare partly due to the lack of reliable diagnostic blood biomarkers, which in turn leads to increased rates of mortality and disability. Current screening methods are optimised to identify patients with a high risk of [...] Read more.

Early stroke diagnosis remains a big challenge in healthcare partly due to the lack of reliable diagnostic blood biomarkers, which in turn leads to increased rates of mortality and disability. Current screening methods are optimised to identify patients with a high risk of cardio-vascular disease, especially among the elderly. However, in young adults and children, these methods suffer low sensitivity and specificity and contribute to further delays in their triage and diagnosis. Accordingly, there is an urgent need to develop reliable blood biomarkers for triaging patients suspected of stroke in all age groups, especially children and young adults. This review explores some of the existing blood biomarkers, as single biomarkers or biomarker panels, and examines their sensitivity and specificity for predicting stroke. A review was performed on PubMed and Web of Science for journal articles published in English during the period 2001 to 2021, which contained information regarding biomarkers of stroke. In this review article, we provide comparative information on the availability, clinical usefulness, and time-window periods of seven single blood biomarkers and five biomarker panels that have been used for predicting stroke in emergency situations. The outcomes of this review can be used in future research for developing more effective stroke biomarkers. Full article

(This article belongs to the Special Issue Management of Venous and Arterial Thrombosis)

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12 pages, 3680 KiB

Open AccessArticle

Subarachnoid Haemorrhage—Incidence of Hospitalization, Management and Case Fatality Rate—In the Silesian Province, Poland, in the Years 2009–2019

by Beata Łabuz-Roszak, Michał Skrzypek, Anna Starostka-Tatar, Anetta Lasek-Bal, Mariusz Gąsior and Marek Gierlotka

J. Clin. Med. 2022, 11(14), 4242; https://doi.org/10.3390/jcm11144242 - 21 Jul 2022

Cited by 1 | Viewed by 1451

Abstract

Little is known about the epidemiology of subarachnoid haemorrhage (SAH) in Poland, and until now no such research has been conducted for Silesia, which is the second largest province with circa 4.5 million inhabitants. Therefore, the current study was done to assess the [...] Read more.

Little is known about the epidemiology of subarachnoid haemorrhage (SAH) in Poland, and until now no such research has been conducted for Silesia, which is the second largest province with circa 4.5 million inhabitants. Therefore, the current study was done to assess the data on SAH in the Silesian Province, Poland. The study was based on the data obtained from the administrative databases of the only public health insurer in Poland (the National Health Fund, NHF) from 2009 to 2019. The SAH cases were selected based on primary diagnosis coded in ICD-10 as I60. The total number of SAH cases was 2014 (41.8% men, 58.2% women). The number of SAH hospitalizations decreased from 199 in 2009 to 166 cases in 2019; p < 0.05. The median age increased from 58 in 2009 to 62 years in 2019; p < 0.001. Endovascular treatment or clipping of the aneurysm was performed in 866 cases (43%). An increase in in-hospital mortality was observed from 31% in 2009 to 38% in 2019 (p = 0.013). Despite the number of stroke units increasing, in-hospital mortality in SAH patients is high, and the number of vascular interventions seems insufficient. Better organization for care of SAH patients is needed in Poland. Full article

(This article belongs to the Special Issue Intracerebral Hemorrhage: Advances in Preclinical Approaches, Diagnoses and Treatment)

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11 pages, 1159 KiB

Open AccessArticle

PAXgene Fixation for Pancreatic Cancer: Implications for Molecular and Surgical Pathology

by Ryan DeCoste, Yutaka Amemiya, Sarah Nersesian, Lauren Westhaver, Stacey N. Lee, Michael D. Carter, Heidi L. Sapp, Ashley E. Stueck, Thomas Arnason, Jeanette Boudreau, Arun Seth and Weei-Yuarn Huang

J. Clin. Med. 2022, 11(14), 4241; https://doi.org/10.3390/jcm11144241 - 21 Jul 2022

Viewed by 1761

Abstract

Genomic profiling of pancreatic cancer using small core biopsies has taken an increasingly prominent role in precision medicine. However, if not appropriately preserved, nucleic acids (NA) from pancreatic tissues are known to be susceptible to degradation due to high intrinsic levels of nucleases. [...] Read more.

Genomic profiling of pancreatic cancer using small core biopsies has taken an increasingly prominent role in precision medicine. However, if not appropriately preserved, nucleic acids (NA) from pancreatic tissues are known to be susceptible to degradation due to high intrinsic levels of nucleases. PAXgene fixation (PreAnalytix, Switzerland) represents a novel formalin-free tissue preservation method. We sought to compare the NA and histomorphological preservation of pancreatic cancer tissues preserved with PAXgene-fixed paraffin-embedding (PFPE) and formalin-fixed paraffin-embedding (FFPE). Tissues from 19 patients were obtained prospectively from pancreaticoduodenectomy specimens and evaluated by four gastrointestinal pathologists. The extracted NA were quantified by Nanodrop and Qubit and assessed for quality by qPCR, targeted next-generation sequencing (NGS) assay, and RNA-sequencing. Our results demonstrated that, when assessed blindly for morphological quality, the four pathologists deemed the PFPE slides adequate for diagnostic purposes. PFPE tissues enable greater yields of less fragmented and more amplifiable DNA. PFPE tissues demonstrated significantly improved quality control (QC) metrics in a targeted NGS assay including Median Absolute Pair-wise Difference (MAPD) scores. Our results support the use of PAXgene fixative for the processing of specimens from pancreatic cancers with the potential benefits of improved yields for more amplifiable DNA in low-yield biopsy specimens and its ideal use for amplicon-based NGS assays. Full article

(This article belongs to the Section Oncology)

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2 pages, 170 KiB

Open AccessEditorial

A Rounded Approach to the Management and Treatment of Obstructive Lung Diseases

by Silvano Dragonieri and Andras Bikov

J. Clin. Med. 2022, 11(14), 4240; https://doi.org/10.3390/jcm11144240 - 21 Jul 2022

Viewed by 1185

Abstract

Obstructive lung diseases are characterized by obstruction to airflow, inflamed and easily collapsible airways, and difficulties in exhaling, with a socio-economic burden in terms of medical visits and hospitalizations [...] Full article

(This article belongs to the Special Issue Pathophysiology, Diagnosis and Novel Treatment of Obstructive Lung Diseases)

8 pages, 2152 KiB

Open AccessBrief Report

Central Giant Cell Granuloma in the Mandibular Condyle in a Teenager. A Case Report with Literature Review

by André Luís Costa Cantanhede, Sergio Olate, Adriano Freitas de Assis and Márcio de Moraes

J. Clin. Med. 2022, 11(14), 4239; https://doi.org/10.3390/jcm11144239 - 21 Jul 2022

Cited by 2 | Viewed by 2960

Abstract

Central giant cell granulomas (CGCG) are not common in the mandibular condyle. In teenagers, the problem is more complex because of difficulties in diagnosis and treatment involving the potential growth of the mandibular process and development of the face. In this short communication [...] Read more.

Central giant cell granulomas (CGCG) are not common in the mandibular condyle. In teenagers, the problem is more complex because of difficulties in diagnosis and treatment involving the potential growth of the mandibular process and development of the face. In this short communication a case is presented of an eleven-year-old female under diagnosis of central giant cell granuloma affecting the mandibular condyle treated surgically in two steps using a condylectomy and vertical ramus osteotomy at the first time and later orthognathic surgery, showing the clinical evolution after 13 years of follow-up. In addition, we performed a review of the scientific reports related to CGCG in the mandibular condyle to compare this treatment with others, in terms of follow-up and results. We concluded that the CGCG affecting the mandibular head can be properly treated with low condilectomy, vertical mandibular ramus sliding osteotomy, and discopexy. Full article

(This article belongs to the Special Issue State of the Art in Craniofacial Surgery)

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16 pages, 1182 KiB

Open AccessArticle

A Multi-Disciplinary Team Approach to Genomic Testing for Drug-Resistant Epilepsy Patients—The GENIE Study

by Lata Vadlamudi, Carmen Maree Bennett, Melanie Tom, Ghusoon Abdulrasool, Kristian Brion, Ben Lundie, Hnin Aung, Chiyan Lau, Jonathan Rodgers, Kate Riney and Louisa Gordon

J. Clin. Med. 2022, 11(14), 4238; https://doi.org/10.3390/jcm11144238 - 21 Jul 2022

Cited by 7 | Viewed by 2260

Abstract

Background. The genomic era has led to enormous progress in clinical care and a multi-disciplinary team (MDT) approach is imperative for integration of genomics into epilepsy patient care. Methods. The MDT approach involved patient selection, genomic testing choice, variant discussions and return of [...] Read more.

Background. The genomic era has led to enormous progress in clinical care and a multi-disciplinary team (MDT) approach is imperative for integration of genomics into epilepsy patient care. Methods. The MDT approach involved patient selection, genomic testing choice, variant discussions and return of results. Genomics analysis included cytogenomic testing and whole exome sequencing (WES). Neurologist surveys were undertaken at baseline and after genomic testing to determine if genomic diagnoses would alter their management, and if there was a change in confidence in genomic testing and neurologist perceptions of the MDT approach. Results. The total diagnostic yield from all genomic testing was 17% (11/66), with four diagnoses from cytogenomic analyses. All chromosomal microarray (CMA) diagnoses were in patients seen by adult neurologists. Diagnostic yield for WES was 11% (7/62). The most common gene with pathogenic variants was DCX, reported in three patients, of which two were mosaic. The genomic diagnosis impacted management in 82% (9/11). There was increased confidence with integrating genomics into clinical care (Pearson chi square = 83, p = 0.004) and qualitative comments were highly supportive of the MDT approach. Conclusions. We demonstrated diagnostic yield from genomic testing, and the impact on management in a cohort with drug-resistant epilepsy. The MDT approach increased confidence in genomic testing and neurologists valued the input from this approach. The utility of CMA was demonstrated in epilepsy patients seen by adult neurologists as was the importance of considering mosaicism for previously undiagnosed patients. Full article

(This article belongs to the Section Clinical Neurology)

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10 pages, 3524 KiB

Open AccessArticle

Thrombelastography Compared with Multiple Impedance Aggregometry to Assess High On-Clopidogrel Reactivity in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

by Diona Gjermeni, Hannah Vetter, Sofia Szabó, Viktoria Anfang, Stefan Leggewie, David Hesselbarth, Daniel Duerschmied, Dietmar Trenk and Christoph B. Olivier

J. Clin. Med. 2022, 11(14), 4237; https://doi.org/10.3390/jcm11144237 - 21 Jul 2022

Cited by 2 | Viewed by 2434

Abstract

Background: High on-clopidogrel platelet reactivity (HPR) following percutaneous coronary intervention (PCI) is associated with increased ischemic risk. It is unclear whether conventional definitions of HPR apply to patients with concomitant oral anticoagulation (OAC). This study aimed to compare the performance of multiple platelet [...] Read more.

Background: High on-clopidogrel platelet reactivity (HPR) following percutaneous coronary intervention (PCI) is associated with increased ischemic risk. It is unclear whether conventional definitions of HPR apply to patients with concomitant oral anticoagulation (OAC). This study aimed to compare the performance of multiple platelet aggregometry (MEA) and thrombelastography (TEG) to detect HPR in patients with atrial fibrillation (AF) and indication for an OAC. Methods: In this observational single-center cohort study, MEA and TEG were performed in patients with AF with an indication for OAC on day 1 to 3 after PCI. The primary outcome was HPR as assessed by MEA (ADP area under the curve ≥ 46 units [U]) or TEG (MA_ADP ≥ 47 mm), respectively. The secondary exploratory outcomes were a composite of all-cause death, myocardial infarction (MI) or stroke and bleeding, as defined by the International Society on Thrombosis and Hemostasis, at 6 months. Results: Platelet function of 39 patients was analyzed. The median age was 78 (interquartile range [IQR] was 72–82) years. 25 (64%) patients were male, and 19 (49%) presented with acute coronary syndrome. All patients received acetylsalicylic acid and clopidogrel prior to PCI. Median (IQR) ADP-induced aggregation, MA_ADP, TRAP-induced aggregation, and MA_thrombin were 9 (6–15) U, 50 (43–60) mm, 54 (35–77) U and 65 (60–67) mm, respectively. The rate of HPR was significantly higher if assessed by TEG compared with MEA (25 [64%] vs. 1 [3%]; p < 0.001). Within 6 months, four (10%) deaths, one (3%) MI and nine (23%) bleeding events occurred. Conclusion: In patients with AF undergoing PCI, the rates of HPR detected by TEG were significantly higher compared with MEA. Conventional cut-off values for HPR as proposed by consensus documents may need to be re-evaluated for this population at high ischemic and bleeding risk. Further studies are needed to assess the association with outcomes. Full article

(This article belongs to the Special Issue Clinical Research on Viscoelastic Testing)

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14 pages, 673 KiB

Open AccessReview

Effectiveness of Therapies Based on Mirror Neuron System to Treat Gait in Patients with Parkinson’s Disease—A Systematic Review

by Silvia Lahuerta-Martín, Rocío Llamas-Ramos and Inés Llamas-Ramos

J. Clin. Med. 2022, 11(14), 4236; https://doi.org/10.3390/jcm11144236 - 21 Jul 2022

Cited by 13 | Viewed by 3026

Abstract

Parkinson’s disease (PD) is a neurodegenerative disease that alters gait patterns from early stages. The visuo-motor training strategies such as action observation (AO) and motor imagery (MI) that are based on the activity of the mirror neuron system (MNS) facilitate motor re-learning. The [...] Read more.

Parkinson’s disease (PD) is a neurodegenerative disease that alters gait patterns from early stages. The visuo-motor training strategies such as action observation (AO) and motor imagery (MI) that are based on the activity of the mirror neuron system (MNS) facilitate motor re-learning. The main purpose of this systematic review was to analyze the current scientific evidence about the effectiveness of MNS’s treatments (AO and MI) to treat gait in patients with PD. Searches were completed from the databases PubMed, Web of Science, and PEDro between November and December 2021. The following keywords were used: “Parkinson disease”, “mirror neurons”, “gait”, “action observation”, and “motor imagery”. Randomized control trials of the last 5 years written in English or Spanish were included. Two independent reviewers screened the articles and applied the eligibility criteria, and a third reviewer assisted in this process. A total of six articles were included for final revision. The risk of bias was assessed with the PEDro Scale. The effects of AO and MI using different outcome measures were referenced in terms of disease severity, quality of life, balance, and gait. Training with AO and MI are effective in improving disease severity, quality of life, balance, and gait in patients with PD. Full article

(This article belongs to the Special Issue The Diagnosis, Treatment and Management of Movement Disorders and Dementias)

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8 pages, 754 KiB

Open AccessArticle

Association between Education Attainment and Guideline-Directed Medication Therapy in Patients with Heart Failure and Reduced Ejection Fraction

by Juan Long, Fanfang Zeng, Lili Wang and Honglei Zhao

J. Clin. Med. 2022, 11(14), 4235; https://doi.org/10.3390/jcm11144235 - 21 Jul 2022

Cited by 4 | Viewed by 1855

Abstract

Objective: The aim of the current study was to evaluate association of education attainment and guideline-directed medications therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF). Method: HFrEF patients were enrolled, and baseline characteristics were recorded. Based on highest educational [...] Read more.

Objective: The aim of the current study was to evaluate association of education attainment and guideline-directed medications therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF). Method: HFrEF patients were enrolled, and baseline characteristics were recorded. Based on highest educational attainment, patients were divided into low and high education attainment groups. Data on GDMT use at admission, discharge and follow-up were collected and between-group differences were evaluated. Results: A total of 336 patients were recruited, and 59.8% (n = 201) were defined as low education attainment. Patients with low education attainment were older and more likely to be female, obese and smokers. In addition, they had a higher prevalence of hypertension and valvular heart disease. Patients with low education attainment also had lower physical and mental component scores (PCS, 50.5 ± 6.4 vs. 56.3 ± 7.8), (MSC, 48.4 ± 6.0 vs. 54.7 ± 5.6) but higher serum NT-proBNP levels (1148.6 ± 233.4 vs. 1050.8 ± 205.6 pg/mL). Significant differences in GDMT use at admission, discharge and follow-up were observed. In the unadjusted model, high education attainment was associated with 2-fold odds of GDMT use at discharge. With adjustment for covariates, the high education attainment group remained significantly associated with being 22% more likely to receive GMDT at discharge. Similar findings were observed in associations between high education attainment and GDMT use at follow-up. After adjustment for PCS and MCS, high education attainment was still significantly associated with GDMT use at follow-up, with odds ratio of 1.13 and a 95% confidence interval of 1.08–1.28. Conclusion: HFrEF patients are under-treated. Education attainment is significantly associated with GDMT use at discharge and follow-up. Full article

(This article belongs to the Section Cardiology)

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12 pages, 1091 KiB

Open AccessArticle

Hematocrit Self-Testing in Patients with Polycythemia Vera and Other Hematological Conditions: Assessing the Accuracy of the StatStrip Xpress^® 2 LAC/Hb/Hct Device and User Opinion about the Device in Real-World Clinical Practice

by Alicia Rovó, Claudia Baierlein-Leimbach, Cesare Medri, Ioannis Chanias, Loreen Errass, Theresa Fehr, Therese Triemer, Daphne B. McCarthy-Pontier and Thomas Lehmann

J. Clin. Med. 2022, 11(14), 4234; https://doi.org/10.3390/jcm11144234 - 21 Jul 2022

Viewed by 2493

Abstract

Maintaining hematocrit (Hct) levels below 45% can reduce morbidity and mortality in patients with polycythemia vera (PV). A device that patients can use to self-monitor Hct levels could enable timely interventions if Hct levels increase above 45%, and could improve quality of life [...] Read more.

Maintaining hematocrit (Hct) levels below 45% can reduce morbidity and mortality in patients with polycythemia vera (PV). A device that patients can use to self-monitor Hct levels could enable timely interventions if Hct levels increase above 45%, and could improve quality of life (QoL). This study evaluated the accuracy of the StatStrip Xpress^® 2 LAC/Hb/Hct meter (Hb/Hct meter) when used by healthcare professionals (HCPs) or patients in clinical practice. Blood samples from 68 visits for 60 patients with PV or other hematological conditions were collected and analyzed by HCPs using a laboratory hematological analyzer, and by patients (self-test) and HCPs (professional test) using the Hb/Hct meter at two Swiss centers. Accuracy was assessed as the mean difference in readings between two users/methods (mdiff, 90% confidence interval; Spearman correlation [r]). The Hct values were similar between the professional test and analyzer (n = 66 comparisons, mdiff = 0.1% [−0.5 to 0.8]; r = 0.95, p < 0.001), the self-test and professional test (n = 62 comparisons, mdiff = −0.2% [−1.1 to 0.7]; r = 0.93, p < 0.001), and the self-test and analyzer (n = 63 comparisons, mdiff = 0.0% [−0.8 to 0.7]; r = 0.94, p < 0.001). The hemoglobin values across users/methods were also similar. Reporting their opinion on the Hb/Hct meter at visit 1, 100% of the patients found it easy to use, and 97% were willing to use it at home. Of the patients with PV, approximately 71% and 56%, respectively, stated that they would feel safer using a self-testing device, and that it would improve their QoL. These findings demonstrate the potential of the Hb/Hct meter for HCP and patient use in real-world settings. Full article

(This article belongs to the Special Issue Infectious Complications after Chemotherapy and Hematopoietic Stem Cell Transplantation)

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15 pages, 2016 KiB

Open AccessArticle

Prognostic Role of Lung Ultrasound in Children with Bronchiolitis: Multicentric Prospective Study

by Laura Gori, Antonella Amendolea, Danilo Buonsenso, Stefano Salvadori, Maria Chiara Supino, Anna Maria Musolino, Paolo Adamoli, Alfina Domenica Coco, Gian Luca Trobia, Carlotta Biagi, Marco Lucherini, Alberto Leonardi, Giuseppe Limoli, Matteo Giampietri, Tiziana Virginia Sciacca, Rosa Morello, Francesco Tursi, Gino Soldati and Ecobron Group

J. Clin. Med. 2022, 11(14), 4233; https://doi.org/10.3390/jcm11144233 - 21 Jul 2022

Cited by 14 | Viewed by 3358

Abstract

There is increasing recognition of the role of lung ultrasound (LUS) to assess bronchiolitis severity in children. However, available studies are limited to small, single-center cohorts. We aimed to assess a qualitative and quantitative LUS protocol to evaluate the course of bronchiolitis at [...] Read more.

There is increasing recognition of the role of lung ultrasound (LUS) to assess bronchiolitis severity in children. However, available studies are limited to small, single-center cohorts. We aimed to assess a qualitative and quantitative LUS protocol to evaluate the course of bronchiolitis at diagnosis and during follow-up. This is a prospective, multicenter study. Children with bronchiolitis were stratified according to clinical severity and underwent four LUS evaluations at set intervals. LUS was classified according to four models: (1) positive/negative; (2) main LUS pattern (normal/interstitial/consolidative/mixed) (3) LUS score; (4) LUS score with cutoff. Two hundred and thirty-three children were enrolled. The baseline LUS was significantly associated with bronchiolitis severity, using both the qualitative (positive/negative LUS p < 0.001; consolidated/normal LUS pattern or mixed/normal LUS p < 0.001) and quantitative models (cutoff score > 9 p < 0.001; LUS mean score p < 0.001). During follow-up, all LUS results according to all LUS models improved (p < 0.001). Better cut off value was declared at a value of >9 points. Conclusions: Our study supports the role of a comprehensive qualitative and quantitative LUS protocol for the identification of severe cases of bronchiolitis and provides data on the evolution of lung aeration during follow-up. Full article

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

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15 pages, 1259 KiB

Open AccessReview

Atopic Dermatitis and Food Allergy: A Complex Interplay What We Know and What We Would Like to Learn

by Niki Papapostolou, Paraskevi Xepapadaki, Stamatis Gregoriou and Michael Makris

J. Clin. Med. 2022, 11(14), 4232; https://doi.org/10.3390/jcm11144232 - 21 Jul 2022

Cited by 24 | Viewed by 7010

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by intense pruritus, eczematous lesions, and relapsing course. It presents with great clinical heterogeneity, while underlying pathogenetic mechanisms involve a complex interplay between a dysfunctional skin barrier, immune dysregulation, microbiome dysbiosis, genetic and [...] Read more.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by intense pruritus, eczematous lesions, and relapsing course. It presents with great clinical heterogeneity, while underlying pathogenetic mechanisms involve a complex interplay between a dysfunctional skin barrier, immune dysregulation, microbiome dysbiosis, genetic and environmental factors. All these interactions are shaping the landscape of AD endotypes and phenotypes. In the “era of allergy epidemic”, the role of food allergy (FA) in the prevention and management of AD is a recently explored “era”. Increasing evidence supports that AD predisposes to FA and not vice versa, while food allergens are presumed as one of the triggers of AD exacerbations. AD management should focus on skin care combined with topical and/or systemic treatments; however, in the presence of suspected food allergy, a thorough allergy evaluation should be performed. Food-elimination diets in food-allergic cases may have a beneficial effect on AD morbidity; however, prolonged, unnecessary diets are highly discouraged since they can lead to loss of tolerance and potentially increase the risk of IgE-mediated food allergy. Preventive AD strategies with the use of topical emollients and anti-inflammatory agents as well as early introduction of food allergens in high-risk infants seem promising in managing and preventing food allergy in AD patients. The current review aims to overview data on the complex AD/FA relationship and provide the most recent developments on whether food allergy interventions change the AD course and vice versa. Full article

(This article belongs to the Section Dermatology)

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11 pages, 1767 KiB

Open AccessArticle

Associations between Biomarkers of Complement Activation, Galactose-Deficient IgA1 Antibody and the Updated Oxford Pathology Classification of IgA Nephropathy

by Yun-Ting Juan, Wen-Chih Chiang, Wei-Chou Lin, Cheng-Wen Yang, San-Fang Chou, Ruo-Wei Hung and Yen-Ling Chiu

J. Clin. Med. 2022, 11(14), 4231; https://doi.org/10.3390/jcm11144231 - 21 Jul 2022

Cited by 8 | Viewed by 1966

Abstract

Our prior study indicates a close relationship between alternative complement pathway activation, galactose-deficient IgA1 (Gd-IgA1) concentration and clinical severity of IgA nephropathy (IgAN). Nonetheless, the relationship between complement factors and the updated Oxford classification of IgAN remains unclear. This study enrolled eighty-four previously [...] Read more.

Our prior study indicates a close relationship between alternative complement pathway activation, galactose-deficient IgA1 (Gd-IgA1) concentration and clinical severity of IgA nephropathy (IgAN). Nonetheless, the relationship between complement factors and the updated Oxford classification of IgAN remains unclear. This study enrolled eighty-four previously untreated, biopsy-diagnosed IgAN patients. The clinical and laboratory findings were collected at the time of biopsy. Plasma levels of complement factor C5a, factor Ba and Gd-IgA1 were measured and analyzed. It was found that the levels of proteinuria positively correlated with the updated Oxford classification of mesangial hypercellularity (M), endocapillary hypercellularity (E), tubular atrophy/interstitial fibrosis (T) and crescents (C). In addition, plasma Gd-IgA1 titer was significantly elevated in IgAN patients with tubular atrophy/interstitial fibrosis (T). In separate multivariable logistic regression models, both Gd-IgA1 and factor Ba independently predict higher T scores. The results indicate that both the levels of Gd-IgA1 antibody and biomarkers of the alternative complement pathway activation reflect the Oxford classification of IgAN. Whether these biomarkers can be used to guide therapeutic decisions requires further study. Full article

(This article belongs to the Section Nephrology & Urology)

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12 pages, 5289 KiB

Open AccessArticle

Evaluating the Roles of Different Types of Laser Therapy in Becker’s Nevus Treatment

by Muhammad K. Al-Bakaa, Muhsin A. Al-Dhalimi, Prabhatchandra Dube and Fatimah K. Khalaf

J. Clin. Med. 2022, 11(14), 4230; https://doi.org/10.3390/jcm11144230 - 21 Jul 2022

Cited by 2 | Viewed by 5895

Abstract

Becker’s nevus (BN) is a cutaneous hamartoma of benign nature that develops through adolescence and affects mostly young men. The nevus is usually located unilaterally and is characterized by hypertrichosis and hyperpigmentation. Despite recent advances in treatment modalities, no effective treatment has been [...] Read more.

Becker’s nevus (BN) is a cutaneous hamartoma of benign nature that develops through adolescence and affects mostly young men. The nevus is usually located unilaterally and is characterized by hypertrichosis and hyperpigmentation. Despite recent advances in treatment modalities, no effective treatment has been established for BN hyperpigmentation. We sought to assess the efficacy and safety of fractional Erbium: YAG 2940 nm and Q-switched Nd: YAG 1064 nm lasers in the treatment of BN hyperpigmentation. Twenty-three patients with BN were included in a prospective, randomized-controlled, observer-blinded, split-lesion comparative technique trial. In each patient, two similar square test regions were randomized to either be treated with a fractional Erbium: YAG 2940 nm laser or with a Q-switched Nd: YAG 1064 nm laser. Each patient was treated with three sessions at six-week intervals. At the follow-up, clearance of hyperpigmentation was assessed by physician global assessment, visual analogue scale, grade of improvement, patient global assessment, and patient satisfaction. Regions treated with the fractional Erbium: YAG 2940 nm laser demonstrated significantly better improvement compared to ones treated with the Q-switched Nd: YAG 1064 nm (p-value = 0.001) laser. Adverse effects such as repigmentation and hypertrophic scarring were not reported during the follow-up period. The outcomes were cosmetically acceptable with overall high satisfaction among the included patients. Our data suggest a superior role for the fractional Erbium: YAG (2940 nm) laser in the treatment of BN hyperpigmentation compared to the Q-switched Nd: YAG (1064 nm) laser, along with being a safer method and having no reported side effects. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM – New Era in Dermatology)

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10 pages, 921 KiB

Open AccessArticle

Detecting Sepsis in Patients with Severe Subarachnoid Hemorrhage during Critical Care

by Armin Niklas Flinspach, Jürgen Konczalla, Volker Seifert, Kai Zacharowski, Eva Herrmann, Ümniye Balaban and Elisabeth Hannah Adam

J. Clin. Med. 2022, 11(14), 4229; https://doi.org/10.3390/jcm11144229 - 21 Jul 2022

Cited by 4 | Viewed by 1943

Abstract

Introduction: Sepsis and septic shock continue to have a very high mortality rate. Therefore, the last consensus-based sepsis guideline introduced the sepsis related organ failure assessment (SOFA) score to ensure a rapid diagnosis and treatment of sepsis. In neurosurgical patients, especially those patients [...] Read more.

Introduction: Sepsis and septic shock continue to have a very high mortality rate. Therefore, the last consensus-based sepsis guideline introduced the sepsis related organ failure assessment (SOFA) score to ensure a rapid diagnosis and treatment of sepsis. In neurosurgical patients, especially those patients with subarachnoid hemorrhage (SAH), there are considerable difficulties in interpreting the SOFA score. Therefore, our study was designed to evaluate the applicability of the SOFA for critical care patients with subarachnoid hemorrhage. Methods: Our retrospective monocentric study was registered (NCT05246969) and approved by the local ethics committee (# 211/18). Patients admitted to the Department of Neurosurgery at the Frankfurt University Hospital were enrolled during the study period. Results: We included 57 patients with 85 sepsis episodes of which 141 patients had SOFA score-positive results and 243 SIRS positive detections. We failed to detect a correlation between the clinical diagnosis of sepsis and positive SOFA or SIRS scores. Moreover, a significant proportion of sepsis that was incorrectly detected via the SOFA score could be attributed to cerebral vasospasms (p < 0.01) or a decrease in Glasgow Coma Scale (p < 0.01). Similarly, a positive SIRS score was often not attributed to a septic episode (49.0%). Discussion: Regardless of the fact that SAH is a rare disease, the relevance of sepsis detection should be given special attention in light of the long duration of therapy and sepsis prevalence. Among the six modules represented by the SOFA score, two highly modules were practically eliminated. However, to enable early diagnosis of sepsis, the investigator’s clinical views and synopsis of various scores and laboratory parameters should be highlighted. Conclusions: In special patient populations, such as in critically ill SAH patients, the SOFA score can be limited regarding its applicability. In particular, it is very important to differentiate between CVS and sepsis. Full article

(This article belongs to the Section Intensive Care)

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13 pages, 1115 KiB

Open AccessArticle

Multi-Center Comparison of Two Self-Expanding Transcatheter Heart Valves: A Propensity Matched Analysis

by Johannes Blumenstein, Clemens Eckel, Oliver Husser, Won-Keun Kim, Matthias Renker, Yeong-Hoon Choi, Christian W. Hamm, Hani Al-Terki, Dagmar Sötemann, Leon Körbi, Vedat Tiyerili, Christina Grothusen, Luise Gaede, Guido Dohmen and Helge Möllmann

J. Clin. Med. 2022, 11(14), 4228; https://doi.org/10.3390/jcm11144228 - 21 Jul 2022

Cited by 4 | Viewed by 1805

Abstract

Background: During the last years, several transcatheter aortic heart valves entered the clinical market and are commercially available. The prostheses differ regarding several technical and functional aspects. However, little is known regarding head-to-head comparative data of the ACURATE neo and the PORTICO valve [...] Read more.

Background: During the last years, several transcatheter aortic heart valves entered the clinical market and are commercially available. The prostheses differ regarding several technical and functional aspects. However, little is known regarding head-to-head comparative data of the ACURATE neo and the PORTICO valve prostheses. Objectives: The aim of this study was to compare two self-expanding transcatheter aortic heart valves (THV), the ACURATE neo and the PORTICO, with regard to in-hospital and 30-day outcomes, as well as early device failures. Methods: A total of 1591 consecutive patients with severe native aortic valve stenosis from two centers were included in the analyses and matched by 1:1 nearest neighbor matching to identify one patient treated with PORTICO (n = 344) for each patient treated with ACURATE neo (n = 344). Results: In-hospital complications were comparable between both valves, including any kind of stroke (ACURATE neo = 3.5% vs. PORTICO = 3.8%; p = 1.0), major vascular complications (ACURATE neo = 4.5% vs. PORTICO = 5.4%; p = 0.99) or life-threatening bleeding (ACURATE neo = 1% vs. PORTICO = 2%; p = 0.68). The rate of device failure defined by the VARC-2 criteria were comparable, including elevated gradients and moderate-to-severe paravalvular leakage (ACURATE neo = 7.3% vs. PORTICO = 7.6%; p = 1.0). However, the need for permanent pacemaker implantation (PPI) was significantly more frequent after the use of PORTICO THV (9.5% vs. 18.7%; p = 0.002). Conclusions: In this two-center case-matched comparison, short-term clinical and hemodynamic outcomes showed comparable results between PORTICO and ACURATE neo prostheses. However, PORTICO was associated with a significant higher incidence of PPI. Full article

(This article belongs to the Special Issue Transcatheter Aortic Valve Replacement in 2021 and Beyond)

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7 pages, 797 KiB

Open AccessArticle

Levosimendan as a “Bridge to Optimization” in Patients with Advanced Heart Failure with Reduced Ejection—A Single-Center Study

by Daniele Masarone, Michelle M. Kittleson, Maria L. Martucci, Fabio Valente, Rita Gravino, Marina Verrengia, Ernesto Ammendola, Carla Contaldi, Vito Di Palma, Angelo Caiazzo, Andrea Petraio, Piero Pollesello and Giuseppe Pacileo

J. Clin. Med. 2022, 11(14), 4227; https://doi.org/10.3390/jcm11144227 - 21 Jul 2022

Cited by 8 | Viewed by 2635

Abstract

Background: Patients with advanced heart failure with reduced ejection fraction often cannot tolerate target doses of guideline-directed medical therapy due to symptomatic hypotension, renal dysfunction, and associated electrolyte abnormalities. While levosimendan can facilitate the titration of β-blockers in patients with advanced HFrEF, [...] Read more.

Background: Patients with advanced heart failure with reduced ejection fraction often cannot tolerate target doses of guideline-directed medical therapy due to symptomatic hypotension, renal dysfunction, and associated electrolyte abnormalities. While levosimendan can facilitate the titration of β-blockers in patients with advanced HFrEF, it is unclear whether ambulatory levosimendan infusions would offer the same benefit. In this prospective study, we investigate the effects of intermittent ambulatory levosimendan infusions on the uptitration of disease-modifying drugs. Methods: We enrolled 37 patients with advanced HFrEF who received repeated ambulatory infusions of levosimendan between January 2018 and January 2021. The demographic, clinical, and laboratory data were acquired 24 h before the first and the last ambulatory levosimendan infusion. Results: At the 1 year follow-up, the enrolled patients were on significantly higher doses of guideline-directed medical therapy, including bisoprolol (3.2 ± 2.8 mg vs. 5.9 ± 4.1 mg; p = 0.02), sacubitril/valsartan (41.67 ± 32.48 mg vs. 68.5 ± 35.72 mg; p = 0.01), and eplerenone (12.7 ± 8.5 mg vs. 22.8 ± 13.6 mg; p = 0.03). Furthermore, a substantial decrease in the furosemide dose was observed (123.2 ± 32.48 mg vs. 81.6 ± 19.47 mg; p < 0.0001). Conclusions: Levosimendan facilitates the optimization of disease-modifying heart failure medications in previously intolerant advanced HFrEF patients. Full article

(This article belongs to the Special Issue New Advances in Pharmacologic and Non-pharmacologic Therapy in Heart Failure and Heart Transplant)

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16 pages, 284 KiB

Open AccessArticle

Understanding Client Difficulties in Transdiagnostic Internet-Delivered Cognitive Behaviour Therapy: A Qualitative Analysis of Homework Reflections

by Vanessa Peynenburg, Andrew Wilhelms, Ram Sapkota, Marcie Nugent, Katherine Owens, Nick Titov, Blake Dear and Heather Hadjisatvropoulos

J. Clin. Med. 2022, 11(14), 4226; https://doi.org/10.3390/jcm11144226 - 21 Jul 2022

Cited by 2 | Viewed by 1963

Abstract

Internet-delivered cognitive behaviour therapy (ICBT) is helpful for many clients, but less is known about the challenges clients face during ICBT, such as difficulties with skill practice, development, or maintenance. Understanding client difficulties can help therapists support clients with skill development and prevent [...] Read more.

Internet-delivered cognitive behaviour therapy (ICBT) is helpful for many clients, but less is known about the challenges clients face during ICBT, such as difficulties with skill practice, development, or maintenance. Understanding client difficulties can help therapists support clients with skill development and prevent treatment drop-out, but has not been systematically studied. This study included a conventional content analysis of clients’ responses to a homework reflection question about difficulties with lessons and skills. Data was drawn from a previously published trial of 301 clients who were randomly assigned to receive homework reflection questions during ICBT. A decreasing number of clients responded to the question about skill difficulties with each lesson. Clients who answered the question about difficulties were more engaged with ICBT (i.e., more lessons completed, logins, days enrolled in ICBT, and messages sent to therapists). Clients shared skill-specific challenges (including initial challenges and more advanced challenges), generic challenges (content or skills being cognitively draining or emotionally draining, contextual challenges, forgetfulness, limited time, and lack of familiarity with the skill), or no challenges. Thought challenging (59.6%) and graded exposure (57.5%) were associated with the greatest number of skill-specific challenges. Findings can help therapists anticipate and address common client challenges during ICBT. Full article

(This article belongs to the Special Issue Clinical Applications of Cyberpsychology and Virtual Reality for Mental Disorders)

4 pages, 194 KiB

Open AccessEditorial

Special Issue “Human Papillomavirus Clinical Research: From Infection to Cancer”

by Steven F. Gameiro and Joe S. Mymryk

J. Clin. Med. 2022, 11(14), 4225; https://doi.org/10.3390/jcm11144225 - 21 Jul 2022

Cited by 1 | Viewed by 1469

Abstract

Papillomaviruses (PVs) are ubiquitous intracellular pathogens that have co-evolved with many different species [...] Full article

(This article belongs to the Section Infectious Diseases)

18 pages, 5851 KiB

Open AccessReview

Acute on Chronic Thromboembolic Pulmonary Hypertension: Case Series and Review of Management

by Isabelle Opitz, Miriam Patella, Olivia Lauk, Ilhan Inci, Dominique Bettex, Thomas Horisberger, Reto Schüpbach, Dagmar I. Keller, Thomas Frauenfelder, Nils Kucher, John Granton, Thomas Pfammatter, Marc de Perrot and Silvia Ulrich

J. Clin. Med. 2022, 11(14), 4224; https://doi.org/10.3390/jcm11144224 - 21 Jul 2022

Cited by 5 | Viewed by 4053

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is a distinct form of precapillary pulmonary hypertension classified as group 4 by the World Symposium on Pulmonary Hypertension (WSPH) and should be excluded during an episode of acute pulmonary embolism (PE). Patients presenting to emergency departments with [...] Read more.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a distinct form of precapillary pulmonary hypertension classified as group 4 by the World Symposium on Pulmonary Hypertension (WSPH) and should be excluded during an episode of acute pulmonary embolism (PE). Patients presenting to emergency departments with sudden onset of signs and symptoms of acute PE may already have a pre-existing CTEPH condition decompensated by the new PE episode. Identifying an underlying and undiagnosed CTEPH during acute PE, while challenging, is an important consideration as it will alter the patients’ acute and long-term management. Differential diagnosis and evaluation require an interdisciplinary expert team. Analysis of the clinical condition, the CT angiogram, and the hemodynamic situation are important considerations; patients with CTEPH usually have significantly higher sPAP at the time of index PE, which is unusual and unattainable in the context of acute PE and a naïve right ventricle. The imaging may reveal signs of chronic disease such as right ventricle hypertrophy bronchial collaterals and atypical morphology of the thrombus. There is no standard for the management of acute on chronic CTEPH. Herein, we provide a diagnostic and management algorithm informed by several case descriptions and a review of the literature. Full article

(This article belongs to the Special Issue Chronic Thromboembolic Pulmonary Hypertension: Medical, Surgical, Endovascular Treatment and Beyond)

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9 pages, 1100 KiB

Open AccessArticle

The Presence of Bacteremia Indicates Higher Inflammatory Response and Augments Disease Severity in Adult Patients with Urinary Tract Infections

by Chien-Chin Hsu, Pei-Chen Lin and Kuo-Tai Chen

J. Clin. Med. 2022, 11(14), 4223; https://doi.org/10.3390/jcm11144223 - 21 Jul 2022

Viewed by 2186

Abstract

Background: This study investigated the association between the presence of bacteremia and increase in the requirement for intensive care in adult patients with urinary tract infection (UTI). The study also analyzed the differences in clinical features between patients with versus without bacteremia. Methods: [...] Read more.

Background: This study investigated the association between the presence of bacteremia and increase in the requirement for intensive care in adult patients with urinary tract infection (UTI). The study also analyzed the differences in clinical features between patients with versus without bacteremia. Methods: We conducted a retrospective screening of the medical records of adult patients admitted during a 4-month period at a single medical center. We excluded patients with concomitant infections and patients whose urine and blood samples were not collected in the emergency department (ED). The included patients were allocated to two groups—bacteremia and nonbacteremia groups—according to the blood culture results for samples collected in the ED. Results: The study cohort comprised 637 patients, including 158 (24.8%) patients in the bacteremia group and 479 (75.2%) patients in the nonbacteremia group. Compared with the patients in the nonbacteremia group, those in the bacteremia group satisfied more systemic inflammatory response syndrome (SIRS) criteria; they had a higher white cell count, C-reactive protein level, and sequential organ failure assessment (SOFA) scores; and had a greater requirement for intensive care (bacteremia vs. nonbacteremia; SIRS: 79.1% vs. 49.9%, p = 0.000; leukocytosis: 68.2% vs. 57.6%, p = 0.000; elevation of CRP: 96.2% vs. 78.6%, p = 0.000; SOFA: 39.2% vs. 23.2%, p = 0.000; requirement for intensive care: 13.9% vs. 4.4%, p = 0.000, respectively). According to the results of multivariate logistic regression, bacteremia and sepsis were independent factors associated with the requirement for intensive care. Conclusions: Bacteremia increased the requirement for intensive care in patients with UTI. Physicians can identify bacteremia using inflammatory markers, the SIRS criteria, and SOFA scores. Full article

(This article belongs to the Special Issue Clinical Advances in Bacteremia: From Pathophysiology to New Therapeutic Possibilities)

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20 pages, 869 KiB

Open AccessReview

Key Components, Current Practice and Clinical Outcomes of ERAS Programs in Patients Undergoing Orthopedic Surgery: A Systematic Review

by Francesca Salamanna, Deyanira Contartese, Silvia Brogini, Andrea Visani, Konstantinos Martikos, Cristiana Griffoni, Alessandro Ricci, Alessandro Gasbarrini and Milena Fini

J. Clin. Med. 2022, 11(14), 4222; https://doi.org/10.3390/jcm11144222 - 20 Jul 2022

Cited by 11 | Viewed by 4289

Abstract

Enhanced recovery after surgery (ERAS) protocols have led to improvements in outcomes in several surgical fields, through multimodal optimization of patient pathways, reductions in complications, improved patient experiences and reductions in the length of stay. However, their use has not been uniformly recognized [...] Read more.

Enhanced recovery after surgery (ERAS) protocols have led to improvements in outcomes in several surgical fields, through multimodal optimization of patient pathways, reductions in complications, improved patient experiences and reductions in the length of stay. However, their use has not been uniformly recognized in all orthopedic fields, and there is still no consensus on the best implementation process. Here, we evaluated pre-, peri-, and post-operative key elements and clinical evidence of ERAS protocols, measurements, and associated outcomes in patients undergoing different orthopedic surgical procedures. A systematic literature search on PubMed, Scopus, and Web of Science Core Collection databases was conducted to identify clinical studies, from 2012 to 2022. Out of the 1154 studies retrieved, 174 (25 on spine surgery, 4 on thorax surgery, 2 on elbow surgery and 143 on hip and/or knee surgery) were considered eligible for this review. Results showed that ERAS protocols improve the recovery from orthopedic surgery, decreasing the length of hospital stays (LOS) and the readmission rates. Comparative studies between ERAS and non-ERAS protocols also showed improvement in patient pain scores, satisfaction, and range of motion. Although ERAS protocols in orthopedic surgery are safe and effective, future studies focusing on specific ERAS elements, in particular for elbow, thorax and spine, are mandatory to optimize the protocols. Full article

(This article belongs to the Section Orthopedics)

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10 pages, 2448 KiB

Open AccessArticle

Repeated Femtosecond Laser-Assisted Astigmatic Keratotomies in Post-Keratoplasty Eyes

by Nadav Levinger, Shmuel Levinger, Nir Erdinest, Asaf Achiron, Naomi London, Omer Trivizki, Eliya Levinger and Irina S. Barequet

J. Clin. Med. 2022, 11(14), 4221; https://doi.org/10.3390/jcm11144221 - 20 Jul 2022

Cited by 1 | Viewed by 1650

Abstract

Visual rehabilitation after a keratoplasty is often compromised due to high amounts of residual astigmatism. Femtosecond laser-assisted astigmatic keratotomy (FLAK) is gaining popularity in decreasing this astigmatism. Though one set of two incisions suffices in most cases, sometimes the treatment proves insufficient and [...] Read more.

Visual rehabilitation after a keratoplasty is often compromised due to high amounts of residual astigmatism. Femtosecond laser-assisted astigmatic keratotomy (FLAK) is gaining popularity in decreasing this astigmatism. Though one set of two incisions suffices in most cases, sometimes the treatment proves insufficient and additional treatment is required. This case series evaluates the outcomes in patients who underwent two consecutive FLAK sets to correct post-keratoplasty residual astigmatism. All repeated FLAK cases performed on post-keratoplasty eyes were reviewed in a high-volume clinic as a non-comparative retrospective case series. The data extracted include the procedure parameters, time between procedures, refraction including sphere, astigmatism, spherical equivalent (SE), and uncorrected and best-spectacle-corrected distance visual acuity (UDVA, BSDVA, respectively). Eleven eyes of eleven patients aged 25.5 ± 10 treated with more than one FLAK procedure were identified. The average follow-up time was 6 months after the first FLAK and 24 ± 10 months after the second. The second FLAK was performed six months after the first. The preoperative mean astigmatism was −9.59 ± 2.36 D. At the final follow-up, the mean astigmatism decreased to −5.38 ± 1.79 D (p = 0.001). Repeated FLAK procedures achieved a significant and stable reduction of astigmatism in post-keratoplasty eyes. This procedure shows safety and effectivity in these complex eyes and may prevent the need for a further keratoplasty. Full article

(This article belongs to the Special Issue State of the Art of Corneal Transplantation)

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