Journal of Clinical Medicine

13 pages, 2069 KiB

Open AccessArticle

Severity of Post-Operative Pain after Instrumentation of Root Canals by XP-Endo and SAF Full Sequences Compared to Manual Instrumentation: A Randomized Clinical Trial

by Ajinkya M. Pawar, Anuj Bhardwaj, Alessio Zanza, Dian Agustin Wahjuningrum, Suraj Arora, Alexander Maniangat Luke, Mohmed Isaqali Karobari, Rodolfo Reda and Luca Testarelli

J. Clin. Med. 2022, 11(23), 7251; https://doi.org/10.3390/jcm11237251 - 6 Dec 2022

Cited by 8 | Viewed by 2467

Abstract

This investigation aimed to examine the post-operative pain experienced following single-visit root canal treatment using the XP-endo shaper sequence (XPS), full-sequence self-adjusting file (SAF), and manual K-files (HKF). A randomized equivalence parallel design, double-blinded clinical study was conducted on 120 patients with symptomatic [...] Read more.

This investigation aimed to examine the post-operative pain experienced following single-visit root canal treatment using the XP-endo shaper sequence (XPS), full-sequence self-adjusting file (SAF), and manual K-files (HKF). A randomized equivalence parallel design, double-blinded clinical study was conducted on 120 patients with symptomatic irreversible pulpitis, with or without clinical signs of apical periodontitis. Only teeth with fully formed roots and no periapical lesions were incorporated in the study. Patients were apportioned to one of three groups (n = 40) randomly: Group 1—XPS, Group 2—SAF, and Group 3—HKF. Pre- and post-instrumentation pain was rated utilizing Visual Analog Scale (VAS) with a spectrum of 0–100 mm. The descriptive statistics and one-way ANOVA with 95% confidence intervals were used for statistical analysis. The mean VAS scores before instrumentation were consistent in all three groups. At 6, 24, 48, and 72 h, patients with root canals instrumented by SAF had the lowest post-instrumentation mean VAS score, followed by XPS. For all time intervals, the patients in the HKF group had the highest VAS score. The full-sequence SAF instrumentation resulted in less post-operative pain than the XP-endo plus protocol, while manual instrumentation with K-files resulted in the highest post-operative pain. Full article

(This article belongs to the Special Issue The State of the Art in Endodontics—Part II)

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10 pages, 974 KiB

Open AccessArticle

Variation in Prevertebral Soft Tissue Swelling after Staged Combined Multilevel Anterior–Posterior Complex Cervical Spine Surgery: Anterior Then Posterior (AP) versus Posterior Then Anterior–Posterior (PAP) Surgery

by Dong-Chan Eun, Anthony A. Suguitan, Kyung-Soo Suk, Hak-Sun Kim, Ji-Won Kwon, Seong-Hwan Moon, Yong-Ho Lee and Byung Ho Lee

J. Clin. Med. 2022, 11(23), 7250; https://doi.org/10.3390/jcm11237250 - 6 Dec 2022

Cited by 5 | Viewed by 2676

Abstract

The influence of the sequence of surgery in the development of prevertebral soft tissue swelling (PSTS) in staged combined multilevel anterior–posterior complex spine surgery was examined. This study was conducted as a retrospective study of patients who underwent staged combined multilevel anterior–posterior complex [...] Read more.

The influence of the sequence of surgery in the development of prevertebral soft tissue swelling (PSTS) in staged combined multilevel anterior–posterior complex spine surgery was examined. This study was conducted as a retrospective study of patients who underwent staged combined multilevel anterior–posterior complex cervical spine surgery from March 2014 to February 2021. Eighty-two patients were identified, of which fifty-seven were included in the final analysis after screening. PSTS was measured from routine serial monitoring lateral cervical radiographs prior to and after surgery for five consecutive days at each cervical level from C2 to C7 in patients who underwent anterior then posterior (AP) and posterior then anterior–posterior (PAP) surgery. The mean PSTS measurements significantly differed from the preoperative to postoperative monitoring days at all cervical levels (p = 0.0000) using repeated measures analysis of variance in both groups. PSTS was significantly greater in PAP than in AP at level C2 on postoperative day (POD) 1 (p = 0.0001). PSTS was more prominent at levels C2–4 during PODs 2–4 for both groups. In staged combined multilevel anterior–posterior complex spine surgery, PSTS is an inevitable complication. Therefore, surgeons should monitor PSTS after surgery when performing anterior–posterior complex cervical spine surgery, especially in the immediate postoperative period after PAP surgery. Full article

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

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12 pages, 244 KiB

Open AccessReview

Comparison of Current International Guidelines for the Management of Dyslipidemia

by Sevda Aygun and Lale Tokgozoglu

J. Clin. Med. 2022, 11(23), 7249; https://doi.org/10.3390/jcm11237249 - 6 Dec 2022

Cited by 24 | Viewed by 8609

Abstract

The dyslipidemia guidelines of the three major societies have been revised recently in light of new evidence. LDL-C is the primary target in the ESC, AHA/ACC/Multisociety and Canadian Cardiovascular Society (CCS) guidelines. These guidelines uniformly recommend intensifying lipid-lowering treatment with increased risk; however, [...] Read more.

The dyslipidemia guidelines of the three major societies have been revised recently in light of new evidence. LDL-C is the primary target in the ESC, AHA/ACC/Multisociety and Canadian Cardiovascular Society (CCS) guidelines. These guidelines uniformly recommend intensifying lipid-lowering treatment with increased risk; however, the risk estimation systems are different across the guidelines. The ESC guidelines have LDL-C goals which have become more stringent over the years and advocate the use of statin and, if necessary, non-statin therapies to obtain these goals. AHA/ACC/Multisociety guidelines have LDL-C thresholds and advocate combination therapy less liberally and for selected patients. All three guidelines acknowledge the importance of shared decision making. Despite some divergent approaches and recommendations, the main principles and messages are the same across the guidelines. To combat the epidemic of cardiovascular disease, our focus should be not on the differences but on implementing the guidelines in our region. Full article

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

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Graphical abstract

8 pages, 475 KiB

Open AccessSystematic Review

Acute Pancreatitis Associated with Atypical Bacterial Pneumonia: Systematic Literature Review

by Gwendolyn Graf, Giulia A. M. Vassalli, Lisa Kottanattu, Mario G. Bianchetti, Carlo Agostoni, Gregorio P. Milani, Sebastiano A. G. Lava, Pietro B. Faré and Simone Janett

J. Clin. Med. 2022, 11(23), 7248; https://doi.org/10.3390/jcm11237248 - 6 Dec 2022

Cited by 5 | Viewed by 3187

Abstract

Background: Extra-pulmonary features sometimes occur in association with atypical bacterial pneumonia and include neurologic manifestations, diarrhea, rashes, altered liver enzymes, or kidney injury, among other conditions. Acute pancreatitis has been associated with atypical pneumonias since 1973. Methods: We performed a systematic review of [...] Read more.

Background: Extra-pulmonary features sometimes occur in association with atypical bacterial pneumonia and include neurologic manifestations, diarrhea, rashes, altered liver enzymes, or kidney injury, among other conditions. Acute pancreatitis has been associated with atypical pneumonias since 1973. Methods: We performed a systematic review of the literature in the Excerpta Medica, National Library of Medicine, and Web of Science databases. We retained 27 reports published between 1973 and 2022 describing subjects with an otherwise unexplained pancreatitis temporally associated with an atypical pneumonia. Results: The reports included 33 subjects (19 males, and 14 females; 8 children and 25 adults) with acute pancreatitis temporally associated with atypical pneumonia caused by Mycoplasma pneumoniae (n = 18), Legionella species (n = 14), or Coxiella burnetii (n = 1). Approximately 90% of patients (n = 29) concurrently presented with respiratory and pancreatic diseases. No cases associated with Chlamydophila pneumoniae, Chlamydophila psittaci, or Francisella species were found. Conclusions: Acute pancreatitis has been associated with various infectious agents. The present review documents the association with atypical pneumonia induced by Mycoplasma pneumoniae, Legionella species, and Coxiella burnetii. Full article

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

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15 pages, 2122 KiB

Open AccessArticle

Peripheral Blood Mononuclear Cells Mitochondrial Respiration and Superoxide Anion after Heart Transplantation

by Abrar Alfatni, Anne-Laure Charles, François Sauer, Marianne Riou, Fabienne Goupilleau, Samy Talha, Alain Meyer, Emmanuel Andres, Michel Kindo, Jean-Philippe Mazzucotelli, Eric Epailly and Bernard Geny

J. Clin. Med. 2022, 11(23), 7247; https://doi.org/10.3390/jcm11237247 - 6 Dec 2022

Cited by 3 | Viewed by 1818

Abstract

Introduction: The mitochondrial function of circulating peripheral blood mononuclear cells (PBMCs) is an interesting new approach to cardiac diseases. Thus, PBMC’s mitochondrial respiration decreases in relation to heart failure severity. However, no data are available on heart-transplanted patients (Htx). Population and Methods: We [...] Read more.

Introduction: The mitochondrial function of circulating peripheral blood mononuclear cells (PBMCs) is an interesting new approach to cardiac diseases. Thus, PBMC’s mitochondrial respiration decreases in relation to heart failure severity. However, no data are available on heart-transplanted patients (Htx). Population and Methods: We determined PBMCs mitochondrial respiration by high-resolution respirometry (Oroboros Instruments) and superoxide anion production using electron paramagnetic resonance (Bruker-Biospin) in 20 healthy subjects and 20 matched Htx and investigated clinical, biological, echocardiographic, coronarography and biopsy characteristics. Results: PBMCs mitochondrial respiratory chain complex II respiration was decreased in Htx (4.69 ± 0.84 vs. 7.69 ± 1.00 pmol/s/million cell in controls and Htx patients, respectively; p = 0.007) and complex IV respiration was increased (24.58 ± 2.57 vs. 15.68 ± 1.67 pmol/s/million cell; p = 0.0035). Superoxide anion production was also increased in Htx (1.47 ± 0.10 vs. 1.15 ± 0.10 µmol/min; p = 0.041). The leucocyte-to-lymphocyte ratio was increased in Htx, whom complex II correlated with leucocyte number (r = 0.51, p = 0.02) and with the left ventricular posterior wall peak early diastolic myocardial velocity (r = −0.62, p = 0.005). Complex IV was increased in the two patients with acute rejection and correlated negatively with Htx’s isovolumetric relation time (r = −0.45, p = 0.045). Discussion: Although presenting with normal systolic function, Htx demonstrated abnormal PBMC’s mitochondrial respiration. Unlike immunosuppressive therapies, subclinical diastolic dysfunction might be involved in these changes. Additionally, lymphopenia might reduce complex II, and acute rejection enhances complex IV respirations. Conclusion: PBMC’s mitochondrial respiration appears modified in Htx, potentially linked to cellular shift, mild diastolic dysfunction and/or acute rejection. Full article

(This article belongs to the Special Issue Therapeutic Advances in Mitochondrial Dysfunction and Oxidative Stress in Chronic Diseases)

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18 pages, 1104 KiB

Open AccessReview

Minimal Hepatic Encephalopathy Affects Daily Life of Cirrhotic Patients: A Viewpoint on Clinical Consequences and Therapeutic Opportunities

by Jessica Faccioli, Silvia Nardelli, Stefania Gioia, Oliviero Riggio and Lorenzo Ridola

J. Clin. Med. 2022, 11(23), 7246; https://doi.org/10.3390/jcm11237246 - 6 Dec 2022

Cited by 8 | Viewed by 4766

Abstract

Minimal hepatic encephalopathy (MHE) is a frequent complication of hepatic encephalopathy (HE) and can affect up to 80% of patients with liver cirrhosis. It is characterized by the lack of obvious clinical signs and the presence of alterations detectable using psychometric or electrophysiological [...] Read more.

Minimal hepatic encephalopathy (MHE) is a frequent complication of hepatic encephalopathy (HE) and can affect up to 80% of patients with liver cirrhosis. It is characterized by the lack of obvious clinical signs and the presence of alterations detectable using psychometric or electrophysiological testing focused on attention, working memory, psychomotor speed and visuospatial ability. Ideally, each patient should be tested for this condition because, despite the absence of symptoms, it has severe repercussions on daily life activities. It may be responsible for an inability to drive, sleep disturbances, risk of falls and inability to work. Some studies have highlighted its prognostically unfavorable role on mortality and risk of “overt” HE (OHE). Finally, MHE severely affects the lives of patients and caregivers, altering their quality of life and their socioeconomic status. Several treatments have been proposed for MHE treatment, including non-absorbable disaccharides, poorly absorbable antibiotics, such as rifaximin, probiotics and branched-chain amino acids, with promising results. For this reason, early diagnosis and intervention with appropriate measures is essential, with the aim of improving both performance on psychometric tests, as well as clinical aspects related to this condition. Full article

(This article belongs to the Special Issue Hepatic Encephalopathy: Clinical Challenges and Opportunities)

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12 pages, 977 KiB

Open AccessReview

A Theranostic Approach in SIRT: Value of Pre-Therapy Imaging in Treatment Planning

by Philippe d’Abadie, Stephan Walrand, Renaud Lhommel, Michel Hesse and François Jamar

J. Clin. Med. 2022, 11(23), 7245; https://doi.org/10.3390/jcm11237245 - 6 Dec 2022

Cited by 4 | Viewed by 1930

Abstract

Selective internal radiation therapy (SIRT) is one of the treatment options for liver tumors. Microspheres labelled with a therapeutic radionuclide (⁹⁰Y or ¹⁶⁶Ho) are injected into the liver artery feeding the tumor(s), usually achieving a high tumor absorbed dose and [...] Read more.

Selective internal radiation therapy (SIRT) is one of the treatment options for liver tumors. Microspheres labelled with a therapeutic radionuclide (⁹⁰Y or ¹⁶⁶Ho) are injected into the liver artery feeding the tumor(s), usually achieving a high tumor absorbed dose and a high tumor control rate. This treatment adopts a theranostic approach with a mandatory simulation phase, using a surrogate to radioactive microspheres (^99mTc-macroaggregated albumin, MAA) or a scout dose of ¹⁶⁶Ho microspheres, imaged by SPECT/CT. This pre-therapy imaging aims to evaluate the tumor targeting and detect potential contraindications to SIRT, i.e., digestive extrahepatic uptake or excessive lung shunt. Moreover, the absorbed doses to the tumor(s) and the healthy liver can be estimated and used for planning the therapeutic activity for SIRT optimization. The aim of this review is to evaluate the accuracy of this theranostic approach using pre-therapy imaging for simulating the biodistribution of the microspheres. This review synthesizes the recent publications demonstrating the advantages and limitations of pre-therapy imaging in SIRT, particularly for activity planning. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM - Nuclear Medicine & Radiology)

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16 pages, 3053 KiB

Open AccessArticle

Phase 1 and 2 Randomized Clinical Studies Determine Lack of Efficacy for Anti-IL-17C Antibody MOR106 in Moderate–Severe Atopic Dermatitis

by Diamant Thaçi, Dave Singh, Mark Lee, Helen Timmis, Dominique Jacobs, Paul Passier, Susanne Rohrer, Johan Beetens, De Phung, Eric Sondag, Goran Babic, Guido Würth, Pia Kloepfer, Stefan Härtle and Silke Hüttner

J. Clin. Med. 2022, 11(23), 7244; https://doi.org/10.3390/jcm11237244 - 6 Dec 2022

Cited by 5 | Viewed by 2031

Abstract

Interleukin 17C (IL-17C) modulates epithelial inflammation and has a possible role in atopic dermatitis (AD) pathology. Four randomized clinical studies (Phase 1 and 2) investigated the safety, tolerability, efficacy, and pharmacokinetic profile of the anti-IL-17C monoclonal antibody MOR106 for up to 12 weeks [...] Read more.

Interleukin 17C (IL-17C) modulates epithelial inflammation and has a possible role in atopic dermatitis (AD) pathology. Four randomized clinical studies (Phase 1 and 2) investigated the safety, tolerability, efficacy, and pharmacokinetic profile of the anti-IL-17C monoclonal antibody MOR106 for up to 12 weeks (NCT03568071: n = 207 adults with moderate–severe AD; NCT03689829 Part 1: n = 32 healthy males; NCT03689829 Part 2: n = 44 adults with moderate–severe AD; and NCT03864627: n = 76 adults with moderate–severe AD). In these studies, MOR106 was either administered intravenously (i.v.) every 2 or 4 weeks at doses between 1–10 mg/kg, or subcutaneously (s.c.), either as a single dose or doses every 2 weeks at 320 mg. Overall, MOR106 was well-tolerated, and the safety profile was consistent with monoclonal antibodies approved for AD. Bioavailability following s.c. dosing was 55%, and steady-state drug levels were reached at 2–4 weeks. Ongoing studies were terminated following a futility analysis of the Phase 2 placebo-controlled dose-finding study (NCT03568071) due to a low probability for achieving the primary efficacy endpoint. Cumulatively, MOR106 demonstrated ineffectiveness for the treatment of AD, but its safety and pharmacokinetic characteristics warrant further drug development in other indications. Funding: sponsored by Galapagos NV; funded by Novartis AG. Full article

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

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25 pages, 1616 KiB

Open AccessSystematic Review

Pressure Pain Threshold of the Upper Trapezius Trigger Point: A Systematic Review with Meta-Analysis of Baseline Values and Their Modification after Physical Therapy

by Tommaso Geri, Alice Botticchio, Giacomo Rossettini, Sanaz Pournajaf, Leonardo Pellicciari, Stefano Di Antonio and Matteo Castaldo

J. Clin. Med. 2022, 11(23), 7243; https://doi.org/10.3390/jcm11237243 - 6 Dec 2022

Cited by 9 | Viewed by 3385

Abstract

Background: Myofascial trigger points (TrP) are diagnosed upon the presence of clinical signs among which hypersensitivity is considered one of the most important. The detection of the pressure pain threshold (PPT) is used to quantify the degree of hypersensitivity. However, there is a [...] Read more.

Background: Myofascial trigger points (TrP) are diagnosed upon the presence of clinical signs among which hypersensitivity is considered one of the most important. The detection of the pressure pain threshold (PPT) is used to quantify the degree of hypersensitivity. However, there is a lack of normative data about how hypersensitive a TrP is. Therefore, the objective was to quantify the PPT for myofascial TrP in the upper trapezius muscle and its modification after manual or instrumental physical therapy interventions. Methods: A systematic review and meta-analysis were conducted among three databases (MEDLINE, Cochrane Library, and PEDro). Two independent reviewers conducted the electronic search and assessed the methodological quality of the included studies. Results: Eleven studies with a high-risk bias indicated that the PPT at TrP sites was 105.11 kPa lower (95% CI: −148.93; −61.28) at active TrP sites (Chi-squared = 1.07, df = 1 (p = 0.30), I² = 7%) compared to the PPT of the upper trapezius muscles of healthy subjects. In addition, the PPT of TrP was also lower than the reference values coming from the pain-free population. Moreover, the PPT increased after both manual and instrumental treatment by 28.36 kPa (95% CI: 10.75; 45.96) and 75.49 kPa (95% CI: 18.02; 132.95), respectively. Conclusions: The results of the present study show that TrP has a decreased PPT when compared to healthy muscles and that physical therapy may increase the PPT. However, the clinical relevance of this decreased PPT needs to be further elucidated. Further, the high risk of bias in all the retrieved studies undermines the validity of the results. Full article

(This article belongs to the Section Clinical Neurology)

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23 pages, 616 KiB

Open AccessArticle

Becoming a Teenager after Early Surgical Ventricular Septal Defect (VSD) Repair: Longitudinal Biopsychological Data on Mental Health and Maternal Involvement

by Laura Lang, Jennifer Gerlach, Anne-Christine Plank, Ariawan Purbojo, Robert A. Cesnjevar, Oliver Kratz, Gunther H. Moll and Anna Eichler

J. Clin. Med. 2022, 11(23), 7242; https://doi.org/10.3390/jcm11237242 - 6 Dec 2022

Cited by 4 | Viewed by 2400

Abstract

Beside somatic strains of congenital heart diseases (CHD), affected children often show developmental impairments in the long term. Ventricular septal defect (VSD) is the most common congenital heart defect and early surgical repair is associated with positive somatic outcomes. However, psychological adjustment is [...] Read more.

Beside somatic strains of congenital heart diseases (CHD), affected children often show developmental impairments in the long term. Ventricular septal defect (VSD) is the most common congenital heart defect and early surgical repair is associated with positive somatic outcomes. However, psychological adjustment is of lifelong relevance. We investigated 24 children with a surgically-corrected isolated VSD and their mothers from primary school (6–9 years) to adolescence (10–14 years) and compared them to controls. Both times, mothers reported child internalizing/externalizing problems, mothers and children rated child quality of life, and children performed neurodevelopmental tests. Adolescents also rated internalizing/externalizing problems themselves, and their hair cortisol levels were analyzed. Maternal anxiety and proactive parenting behavior were considered as moderators. Results revealed no group differences in child neurodevelopment (language, cognition), externalizing problems, and cortisol levels at any time. In reports from mothers, internalizing problems (depression, anxiety) were elevated in children with a VSD at both times—when mothers reported anxiety symptoms themselves. In adolescent reports, VSD patients’ quality of life was increased and internalizing problems were decreased—proactive parenting behavior went along with decreased symptoms in VSD-affected adolescents and with increased symptoms in controls. The findings pronounce the crucial role of parenting behavior and the influence of maternal anxieties on child mental health after surgical VSD repair and might highlight the need for parent-centered interventions. Full article

(This article belongs to the Special Issue Clinical Research Advances in Congenital Heart Disease)

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17 pages, 2138 KiB

Open AccessArticle

Reduced Skeletal Muscle Mass Is Associated with an Increased Risk of Asthma Control and Exacerbation

by Shuwen Zhang, Xin Zhang, Ke Deng, Changyong Wang, Lisa G. Wood, Huajing Wan, Lei Liu, Ji Wang, Li Zhang, Ying Liu, Gaiping Cheng, Peter G. Gibson, Brian G. Oliver, Fengming Luo, Vanessa M. McDonald, Weimin Li and Gang Wang

J. Clin. Med. 2022, 11(23), 7241; https://doi.org/10.3390/jcm11237241 - 6 Dec 2022

Cited by 3 | Viewed by 1940

Abstract

Background: Skeletal muscle mass (SMM) has been suggested to be associated with multiple health-related outcomes. However, the potential influence of SMM on asthma has not been largely explored. Objective: To study the association between SMM and clinical features of asthma, including asthma control [...] Read more.

Background: Skeletal muscle mass (SMM) has been suggested to be associated with multiple health-related outcomes. However, the potential influence of SMM on asthma has not been largely explored. Objective: To study the association between SMM and clinical features of asthma, including asthma control and exacerbation, and to construct a model based on SMM to predict the risk of asthma exacerbation (AEx). Methods: In this prospective cohort study, we consecutively recruited patients with asthma (n = 334), classified as the SMM ^Normal group (n = 223), SMM ^Low group (n = 88), and SMM ^High group (n = 23). We investigated the association between SMM and clinical asthma characteristics and explored the association between SMM and asthma control and AEx within a 12-month follow-up period. Based on SMM, an exacerbation prediction model was developed, and the overall performance was externally validated in an independent cohort (n = 157). Results: Compared with the SMM ^Normal group, SMM ^Low group exhibited more airway obstruction and worse asthma control, while SMM ^High group had a reduced eosinophil percentage in induced sputum. Furthermore, SMM ^Low group was at a significantly increased risk of moderate-to-severe exacerbation compared with the SMM ^Normal group (relative risk _adjusted 2.02 [95% confidence interval (CI), 1.35–2.68]; p = 0.002). In addition, a model involving SMM was developed which predicted AEx (area under the curve: 0.750, 95% CI: 0.691–0.810). Conclusions: Low SMM was an independent risk factor for future AEx. Furthermore, a model involving SMM for predicting the risk of AEx in patients with asthma indicated that assessment of SMM has potential clinical implications for asthma management. Full article

(This article belongs to the Special Issue Clinical Advances in Allergy and Asthma: Issues, Strategies, and Future Directions)

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27 pages, 474 KiB

Open AccessReview

Current Medical and Surgical Treatment of Hidradenitis Suppurativa—A Comprehensive Review

by Lennart Ocker, Nessr Abu Rached, Caroline Seifert, Christina Scheel and Falk G. Bechara

J. Clin. Med. 2022, 11(23), 7240; https://doi.org/10.3390/jcm11237240 - 6 Dec 2022

Cited by 29 | Viewed by 5217

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease presenting with recurrent inflammatory lesions in intertriginous body regions. HS has a pronounced impact on patients’ quality of life and is associated with a variety of comorbidities. Treatment of HS is often complex, requiring [...] Read more.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease presenting with recurrent inflammatory lesions in intertriginous body regions. HS has a pronounced impact on patients’ quality of life and is associated with a variety of comorbidities. Treatment of HS is often complex, requiring an individual approach with medical and surgical treatments available. However, especially in moderate-to-severe HS, there is an urgent need for new treatment approaches. In recent years, increased research has led to the identification of new potential therapeutic targets. This review aims to give a comprehensive and practical overview of current treatment options for HS. Furthermore, the clinically most advanced novel treatment approaches will be discussed. Full article

(This article belongs to the Special Issue New Insights on Acne, Rosacea, and Hidradenitis Suppurativa: Etiology and Treatment)

17 pages, 650 KiB

Open AccessReview

Long-Term Effects of Breast Cancer Therapy and Care: Calm after the Storm?

by Chiara Tommasi, Rita Balsano, Matilde Corianò, Benedetta Pellegrino, Giorgio Saba, Fabio Bardanzellu, Nerina Denaro, Matteo Ramundo, Ilaria Toma, Alessandro Fusaro, Serafina Martella, Marco Maria Aiello, Mario Scartozzi, Antonino Musolino and Cinzia Solinas

J. Clin. Med. 2022, 11(23), 7239; https://doi.org/10.3390/jcm11237239 - 6 Dec 2022

Cited by 14 | Viewed by 3791

Abstract

Breast cancer is still a lethal disease and the leading cause of death in women, undermining patients’ survival and quality of life. Modern techniques of surgery and radiotherapy allow for the obtaining of good results in terms of survival, however they cause long-term [...] Read more.

Breast cancer is still a lethal disease and the leading cause of death in women, undermining patients’ survival and quality of life. Modern techniques of surgery and radiotherapy allow for the obtaining of good results in terms of survival, however they cause long-term side effects that persist over time, such as lymphedema and neuropathy. Similarly, the advent of new therapies such as endocrine therapy revolutionized breast cancer outcomes, but side effects are still present even in years of follow-up after cure. Besides the side effects of medical and surgical therapy, breast cancer is a real disruption in patients’ lives considering quality of life-related aspects such as the distortion of body image, the psychological consequences of the diagnosis, and the impact on family dynamics. Therefore, the doctor-patient relationship is central to providing the best support both during treatment and afterwards. The aim of this review is to summarize the consequences of medical and surgical treatment on breast cancer patients and to emphasize the importance of early prevention of side effects to improve patients’ quality of life. Full article

(This article belongs to the Special Issue Current Updates and Advances in Breast Cancer)

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14 pages, 615 KiB

Open AccessSystematic Review

SARS-CoV-2 Infection and Outcomes in Children with Inflammatory Bowel Diseases: A Systematic Review

by Anastasia Batsiou, Petros Mantzios, Daniele Piovani, Andreas G. Tsantes, Paschalia Kopanou Taliaka, Paraskevi Liakou, Nicoletta Iacovidou, Argirios E. Tsantes, Stefanos Bonovas and Rozeta Sokou

J. Clin. Med. 2022, 11(23), 7238; https://doi.org/10.3390/jcm11237238 - 6 Dec 2022

Cited by 4 | Viewed by 1544

Abstract

The impact of COVID-19 on pediatric patients with inflammatory bowel disease (PIBD) is still not clear and the knowledge acquired over the last 2 years is still evolving. This study aims to investigate the risk and clinical outcomes of COVID-19 in patients with [...] Read more.

The impact of COVID-19 on pediatric patients with inflammatory bowel disease (PIBD) is still not clear and the knowledge acquired over the last 2 years is still evolving. This study aims to investigate the risk and clinical outcomes of COVID-19 in patients with PIBD. A systematic search of PubMed and Scopus databases was conducted to identify studies published up until September 2022. Out of the 475 articles screened, 14 studies were included in the review. Of the 4006 children with PIBD included, 390 (9.7%) tested positive for COVID-19. Among those with COVID-19, 5.9% (0–16.7%) needed hospitalization, 0.6% (0–1%) were admitted to the pediatric intensive care unit (PICU), and no deaths were reported. Among the included studies, only four presented details regarding patients’ symptoms, with 21% (0–25%) presenting gastrointestinal (GI) symptoms. An association between PIBD activity or specific treatment and COVID-19 outcome could not be established. The prevalence of COVID-19 in patients with PIBD was low; therefore, the initial concerns regarding higher infection risk and worse prognosis in this population are not supported by the currently available data. Further research is needed to determine the natural history of the infection and the optimal treatment for these patients. Much is still unclear and additional studies should be performed in order to optimize prevention and care for this special group of patients. Full article

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

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15 pages, 8241 KiB

Open AccessArticle

Development of a Cryopreservation Technique for Xenogeneic Kidney Grafts: Evaluation Using a Mouse Model

by Tsuyoshi Takamura, Hiroshi Nagashima, Hitomi Matsunari, Shuichiro Yamanaka, Yatsumu Saito, Yoshitaka Kinoshita, Toshinari Fujimoto, Kei Matsumoto, Kazuaki Nakano, Hirotaka James Okano, Eiji Kobayashi and Takashi Yokoo

J. Clin. Med. 2022, 11(23), 7237; https://doi.org/10.3390/jcm11237237 - 6 Dec 2022

Cited by 2 | Viewed by 2278

Abstract

To align the xeno-metanephros and renal progenitor cell timing for transplantation treatments, cryopreservation techniques and an efficient transportation of regenerated renal products such as xeno-metanephroi and renal progenitor cells should be established. Therefore, we propose a novel method of xenogeneic regenerative medicine for [...] Read more.

To align the xeno-metanephros and renal progenitor cell timing for transplantation treatments, cryopreservation techniques and an efficient transportation of regenerated renal products such as xeno-metanephroi and renal progenitor cells should be established. Therefore, we propose a novel method of xenogeneic regenerative medicine for patients with chronic kidney disease by grafting porcine fetal kidneys injected with human renal progenitor cells. To develop a useful cryopreserve system of porcine fetal kidney and human renal progenitor cells, we examined the cryopreservation of a fetal kidney implanted with renal progenitor cells in a mouse model. First, we developed a new method for direct cell injection under the capsule of the metanephros using gelatin as a support for unzipped fetal kidneys. Then, we confirmed in vitro that the nephrons derived from the transplanted cells were regenerated even after cryopreservation before and after cell transplantation. Furthermore, the cryopreserved chimeric metanephroi grew, and regenerated nephrons were observed in NOD. We confirmed that even in cryopreserved chimeric metanephroi, transplanted cell-derived nephrons as well as fresh transplants grew. Full article

(This article belongs to the Special Issue Selected Papers from the JSOPB 2021-2022)

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12 pages, 753 KiB

Open AccessArticle

Starting Home Telemonitoring and Oxygen Therapy Directly after Emergency Department Assessment Appears to Be Safe in COVID-19 Patients

by Rosaline van den Berg, Celisa Meccanici, Netty de Graaf, Eric van Thiel and Suzanne Schol-Gelok

J. Clin. Med. 2022, 11(23), 7236; https://doi.org/10.3390/jcm11237236 - 6 Dec 2022

Cited by 5 | Viewed by 2185

Abstract

Background: Since data on the safety and effectiveness of home telemonitoring and oxygen therapy started directly after Emergency Department (ED) assessment in COVID-19 patients are sparse but could have many advantages, we evaluated these parameters in this study. Methods: All COVID-19 patients ≥18 [...] Read more.

Background: Since data on the safety and effectiveness of home telemonitoring and oxygen therapy started directly after Emergency Department (ED) assessment in COVID-19 patients are sparse but could have many advantages, we evaluated these parameters in this study. Methods: All COVID-19 patients ≥18 years eligible for receiving home telemonitoring (November 2020-February 2022, Albert Schweitzer hospital, the Netherlands) were included: patients started directly after ED assessment (ED group) or after hospital admission (admission group). Safety (number of ED reassessments and hospital readmissions) and effectiveness (number of phone calls, duration of oxygen usage and home telemonitoring) were described in both groups. Results: 278 patients were included (n = 65 ED group, n = 213 admission group). ED group: 23.8% (n = 15) was reassessed, 15.9% (n = 10) was admitted and 7.7% (n = 5) ICU admitted. Admission group: 15.8% (n = 37) was reassessed, 6.5% (n = 14) was readmitted and 2.4% (n = 5) ICU (re)admitted. Ten patients died, of whom 7 due to COVID-19 (1 in ED group; 6 in the admission group). ED group: median duration of oxygen therapy was 9 (IQR 7–13) days; the total duration of home telemonitoring was 14 (IQR 9–18) days. Admission group: duration of oxygen therapy was 10 (IQR 6–16) days; total duration of home telemonitoring was 14 (IQR 10–20) days. Conclusion: it appears to be safe to start home telemonitoring and oxygen therapy directly after ED assessment. Full article

(This article belongs to the Special Issue Clinical Health Care during the COVID-19 Pandemic: Therapeutic and Management Strategies)

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12 pages, 253 KiB

Open AccessArticle

Quality of Life in Oral Cancer Patients in Greek Clinical Practice: A Cohort Study

by Maria Lavdaniti, Ioannis Tilaveridis, Dimitra Palitzika, Athanasios Kyrgidis, Stefanos Triaridis, Konstantinos Vachtsevanos, Angeliki Kosintzi and Konstantinos Antoniades

J. Clin. Med. 2022, 11(23), 7235; https://doi.org/10.3390/jcm11237235 - 6 Dec 2022

Cited by 6 | Viewed by 1684

Abstract

Cancer of the oral cavity is one of the most common cancers all over the world. Oral cancer and its treatment impacts on patients’ Quality of Life (QOL). The purpose of the present study was to assess oral cancer patients’ QOL after the [...] Read more.

Cancer of the oral cavity is one of the most common cancers all over the world. Oral cancer and its treatment impacts on patients’ Quality of Life (QOL). The purpose of the present study was to assess oral cancer patients’ QOL after the completion of surgical therapy, and to investigate factors affecting it. This was a prospective cohort study, conducted at the Department of Oral & Maxillofacial Surgery, of a large general public hospital in Northern Greece. The sample consisted of 135 consecutive eligible cancer patients. Three distinct questionnaires were used. The first one included questions regarding the participants’ demographic characteristics and relevant clinical information. The second comprised the European Organization for Research and Treatment core module (EORTC QLQ-C30) and its head and neck module EORTC QLQ-H&N35. The third was the Functional Assessment of Cancer Therapy–General (FACT-G) assessment of quality of life. We also included the physician-completed Karnofsky scale to assess the functional status of the participants. We found that location of the tumor affects QOL and specifically social contact (H = 17.89, p = 0.001), on the first assessment, and nutritional supplements (H = 22.49, p = 0.000), on the fourth assessment. QOL in patients deteriorates immediately after treatment but significantly improves over time. Health care professionals should take into account these results and arrange care plans in order to find ways to increase patients’ QOL. Full article

(This article belongs to the Special Issue Patient-Reported-Outcome Measures in Diseases of the Head and Neck)

9 pages, 271 KiB

Open AccessArticle

Does Obesity Influence Women’s Decision Making about the Mode of Delivery?

by Maciej Walędziak and Anna Różańska-Walędziak

J. Clin. Med. 2022, 11(23), 7234; https://doi.org/10.3390/jcm11237234 - 6 Dec 2022

Viewed by 1450

Abstract

Introduction: The ratio of cesarean deliveries (CDs) has been increasing worldwide, with a growing problem of cesarean delivery on maternal request (CDMR) and an alarmingly increasing rate of CD in the private sector. There are numerous factors influencing women’s preferences for the mode [...] Read more.

Introduction: The ratio of cesarean deliveries (CDs) has been increasing worldwide, with a growing problem of cesarean delivery on maternal request (CDMR) and an alarmingly increasing rate of CD in the private sector. There are numerous factors influencing women’s preferences for the mode of delivery and their opinion about shared decision making (SDM). Material and method: The study was designed as an online survey, filled in by 1040 women. The questionnaire included questions about women’s preferences for the mode of delivery, their opinions about CDMR and the process of decision making regarding the mode of delivery. Results: There were no statistically significant differences found between women with a BMI ≤ 25 kg/m² and >25 kg/m², nor with a BMI ≤ 30 kg/m² and >30 kg/m², on the subject of the preferred method of delivery, and the opinion regarding SDM and CDMR without medical indications. More than 85% of women in all groups, who preferred CD as the mode of delivery, wanted to have CDMR. Conclusion: We have not found obesity and overweight to be a factor influencing women’s preferred mode of delivery, their opinion about SDM and their preference for CDMR without medical indications. However, the sample size of women with morbid obesity with a BMI ≥ 35 kg/m² was too small for the results to be considered significant in this group, and it will therefore be subject to further studies. Full article

(This article belongs to the Section Obstetrics & Gynecology)

5 pages, 204 KiB

Open AccessEditorial

Editorial: Recent Advances in Thyroid Surgery

by Gregorio Scerrino, Pierina Richiusa, Giuseppa Graceffa, Eleonora Lori, Salvatore Sorrenti and Nunzia Cinzia Paladino

J. Clin. Med. 2022, 11(23), 7233; https://doi.org/10.3390/jcm11237233 - 6 Dec 2022

Cited by 3 | Viewed by 1997

Abstract

Thyroid surgery has been, since its earliest application, one of the most notable fields in medicine, illustrated by the fact that the Nobel Prize in Medicine was won, for the first time, for thyroid surgery by Emil Theodor Kocher (1841–1917) in 1909, for [...] Read more.

Thyroid surgery has been, since its earliest application, one of the most notable fields in medicine, illustrated by the fact that the Nobel Prize in Medicine was won, for the first time, for thyroid surgery by Emil Theodor Kocher (1841–1917) in 1909, for his contributions to thyroid physiology, pathology, and surgery [...] Full article

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

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11 pages, 1030 KiB

Open AccessArticle

The Relationship between Serum Adiponectin, Urinary Albumin/Creatinine Ratio and Type 2 Diabetes: A Population-Based Cross-Sectional Study

by Shoma Ono, Satoru Mizushiri, Yuki Nishiya, Ayumi Tamura, Kiho Hamaura, Ryoma Ito, Akihide Terada, Jutaro Tanabe, Miyuki Yanagimachi, Kyi Mar Wai, Kaori Sawada, Kazushige Ihara and Makoto Daimon

J. Clin. Med. 2022, 11(23), 7232; https://doi.org/10.3390/jcm11237232 - 5 Dec 2022

Cited by 3 | Viewed by 1457

Abstract

The relationship between serum adiponectin concentration (S-Adipo) and various diseases, such as type 2 diabetes (T2D) is conflicting. We hypothesized that the extent of kidney damage in patients with T2D may be responsible for this inconsistency and, thus, examined association between S-Adipo and [...] Read more.

The relationship between serum adiponectin concentration (S-Adipo) and various diseases, such as type 2 diabetes (T2D) is conflicting. We hypothesized that the extent of kidney damage in patients with T2D may be responsible for this inconsistency and, thus, examined association between S-Adipo and T2D after consideration for the extent of kidney damage present. Of the 1816 participants in the population-based Iwaki study of Japanese people, 1751 participants with a complete dataset were included. Multivariate logistic regression analyses revealed that low S-Adipo was independently associated with T2D (<0.001), as was high urinary albumin to creatinine ratio (uACR) (<0.001). Principal components analysis showed that the relative value of S-Adipo to uACR (adiponectin relative excess) was significantly associated with T2D (odds ratio: 0.49, p < 0.001). Receiver operating curve analyses revealed that an index of adiponectin relative excess the ratio of S-Adipo to uACR was superior to S-Adipo per se as a marker of T2D (area under the curve: 0.746 vs. 0.579, p < 0.001). This finding indicates that the relationship between S-Adipo and T2D should be evaluated according to the extent of kidney damage present and may warrant similar analyses of the relationships between S-Adipo and other medicalconditions, such as cardiovascular disease. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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12 pages, 1495 KiB

Open AccessArticle

Machine Learning Model Development and Validation for Predicting Outcome in Stage 4 Solid Cancer Patients with Septic Shock Visiting the Emergency Department: A Multi-Center, Prospective Cohort Study

by Byuk Sung Ko, Sanghoon Jeon, Donghee Son, Sung-Hyuk Choi, Tae Gun Shin, You Hwan Jo, Seung Mok Ryoo, Youn-Jung Kim, Yoo Seok Park, Woon Yong Kwon, Gil Joon Suh, Tae Ho Lim and Won Young Kim

J. Clin. Med. 2022, 11(23), 7231; https://doi.org/10.3390/jcm11237231 - 5 Dec 2022

Cited by 3 | Viewed by 1880

Abstract

A reliable prognostic score for minimizing futile treatments in advanced cancer patients with septic shock is rare. A machine learning (ML) model to classify the risk of advanced cancer patients with septic shock is proposed and compared with the existing scoring systems. A [...] Read more.

A reliable prognostic score for minimizing futile treatments in advanced cancer patients with septic shock is rare. A machine learning (ML) model to classify the risk of advanced cancer patients with septic shock is proposed and compared with the existing scoring systems. A multi-center, retrospective, observational study of the septic shock registry in patients with stage 4 cancer was divided into a training set and a test set in a 7:3 ratio. The primary outcome was 28-day mortality. The best ML model was determined using a stratified 10-fold cross-validation in the training set. A total of 897 patients were included, and the 28-day mortality was 26.4%. The best ML model in the training set was balanced random forest (BRF), with an area under the curve (AUC) of 0.821 to predict 28-day mortality. The AUC of the BRF to predict the 28-day mortality in the test set was 0.859. The AUC of the BRF was significantly higher than those of the Sequential Organ Failure Assessment score and the Acute Physiology and Chronic Health Evaluation II score (both p < 0.001). The ML model outperformed the existing scores for predicting 28-day mortality in stage 4 cancer patients with septic shock. However, further studies are needed to improve the prediction algorithm and to validate it in various countries. This model might support clinicians in real-time to adopt appropriate levels of care. Full article

(This article belongs to the Section Intensive Care)

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14 pages, 391 KiB

Open AccessArticle

Inpatient Geriatric Rehabilitation: Definitions and Appropriate Admission Criteria, as Established by Maltese National Experts

by Francesca Muscat, Liberato Camilleri, Conrad Attard and Stephen Lungaro Mifsud

J. Clin. Med. 2022, 11(23), 7230; https://doi.org/10.3390/jcm11237230 - 5 Dec 2022

Cited by 2 | Viewed by 1784

Abstract

(1) Background: The importance of having an appropriate admissions system for geriatric rehabilitation is on the increase. However, the process of admitting patients to inpatient rehabilitation is a complex process. This is yet to be standardised across the European Union, as the approach [...] Read more.

(1) Background: The importance of having an appropriate admissions system for geriatric rehabilitation is on the increase. However, the process of admitting patients to inpatient rehabilitation is a complex process. This is yet to be standardised across the European Union, as the approach to geriatric rehabilitation tends to vary from one Member State to another. (2) Objective: To discuss evidence-based practice with clinical experts, in order to define geriatric rehabilitation and admission criteria based on the Maltese population. (3) Method: The study entailed conducting four panel sessions using a purposive sample of thirteen local clinicians with extensive knowledge in clinical rehabilitation and healthcare management. A total of 48 items, based on the literature and clinical experience, were presented to the panel. Data analysis was done quantitatively and qualitatively, using IBM SPSS Statistics Version 24 and thematic analysis. (4) Results: The panel formulated a definition of rehabilitation, which shared common elements with the definition provided by the World Health Organization (WHO) and other sources/literature. The panel agreed on a list of eight criteria for appropriate inpatient geriatric rehabilitation admission in Malta. Consensus was also reached on: the need for a consultant-led multidisciplinary approach to assessment; the adoption of a standardised assessment processes for an equitable chance for all older adults assessed; the benefit of digital health in assessments; and the consideration that most patients would have some form of rehabilitation potential, depending on availability of resources. (5) Conclusion: Inpatient geriatric rehabilitation hospitals should have a unified strategy for rehabilitation services. The conclusions reached by the panel, could be useful in supporting the clinical evidence and establishing future rehabilitation guidelines and standards for inpatient rehabilitation. Full article

(This article belongs to the Special Issue Updates on Rehabilitation Care for Geriatric Disease)

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10 pages, 458 KiB

Open AccessArticle

A Comparative Study of Urinary Tests and Cultures for the Effectiveness of Fosfomycin in Catheter-Related Urinary Tract Infections

by Jung Ki Jo, Dong Seob Kim, Younghun Sim, Soorack Ryu and Kyu Shik Kim

J. Clin. Med. 2022, 11(23), 7229; https://doi.org/10.3390/jcm11237229 - 5 Dec 2022

Cited by 1 | Viewed by 2017

Abstract

As the elderly population increases due to an aging society, the number of patients with catheters is increasing, and treatment for urinary infections is needed. The current study analyzed the effectiveness of fosfomycin, the primary antibiotic used to treat urinary tract infections (UTIs), [...] Read more.

As the elderly population increases due to an aging society, the number of patients with catheters is increasing, and treatment for urinary infections is needed. The current study analyzed the effectiveness of fosfomycin, the primary antibiotic used to treat urinary tract infections (UTIs), in these patients. Patients who received fosfomycin as the primary antibiotic for a UTI were selected, and the results of urine tests and cultures before and after fosfomycin administration were compared and analyzed. The degree of UTI in patients with a catheter was found to be more severe (p = 0.020), and the infecting strains were found to be different depending on whether a catheter was present (p = 0.014). There was a difference in the treatment success rate depending on whether or not a catheter was present (53.6% vs. 70.4%), but it was found that the treatment rate was more than 50% regardless of whether a catheter was present. The bacterial type, as well as the treatment rate based on the bacterium, differed depending on the presence of a catheter. Fosfomycin has a success rate of more than 50%, even in patients with catheters; therefore, it can be considered the primary antibiotic for treating UTIs. Full article

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

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9 pages, 775 KiB

Open AccessArticle

Risk of Pacing-Induced Cardiomyopathy in Patients with High-Degree Atrioventricular Block—Impact of Right Ventricular Lead Position Confirmed by Computed Tomography

by Patricia Zerlang Fruelund, Anders Sommer, Jens Brøndum Frøkjær, Søren Lundbye-Christensen, Tomas Zaremba, Peter Søgaard, Claus Graff, Søren Vraa, Aksayan Arunanthy Mahalingasivam, Anna Margrethe Thøgersen, Michael Rangel Pedersen and Sam Riahi

J. Clin. Med. 2022, 11(23), 7228; https://doi.org/10.3390/jcm11237228 - 5 Dec 2022

Cited by 5 | Viewed by 1844

Abstract

Prospective studies applying fluoroscopy for assessment of right ventricular (RV) lead position have failed to show clear benefits from RV septal pacing. We investigated the impact of different RV lead positions verified by computed tomography (CT) on the risk of pacing-induced cardiomyopathy (PICM). [...] Read more.

Prospective studies applying fluoroscopy for assessment of right ventricular (RV) lead position have failed to show clear benefits from RV septal pacing. We investigated the impact of different RV lead positions verified by computed tomography (CT) on the risk of pacing-induced cardiomyopathy (PICM). We retrospectively included 153 patients who underwent routine fluoroscopy-guided pacemaker implantation between March 2012 and May 2020. All patients had normal pre-implant left ventricular ejection fraction (LVEF). Patients attended a follow-up visit including contrast-enhanced cardiac CT and transthoracic echocardiography. Patients were classified as septal or non-septal based on CT analysis. The primary endpoint was PICM (LVEF < 50% with ≥10% decrease after implantation). Based on CT, 48 (31.4%) leads were septal and 105 (68.6%) were non-septal. Over a median follow-up of 3.1 years, 16 patients (33.3%) in the septal group developed PICM compared to 31 (29.5%) in the non-septal group (p = 0.6). Overall, 13.1% deteriorated to LVEF ≤ 40%, 5.9% were upgraded to cardiac resynchronization therapy device, and 14.4% developed new-onset atrial fibrillation, with no significant differences between the groups. This study demonstrated a high risk of PICM despite normal pre-implant left ventricular systolic function with no significant difference between CT-verified RV septal or non-septal lead position. Full article

(This article belongs to the Special Issue Advances in Cardiac Pacing and Cardiac Resynchronization Therapy)

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33 pages, 359 KiB

Open AccessReview

Bisphenol-A and Female Fertility: An Update of Existing Epidemiological Studies

by Konstantinos Stavridis, Olga Triantafyllidou, Maria Pisimisi and Nikolaos Vlahos

J. Clin. Med. 2022, 11(23), 7227; https://doi.org/10.3390/jcm11237227 - 5 Dec 2022

Cited by 14 | Viewed by 5430

Abstract

Humans interfere with a variety of endocrine disruptors on a daily basis, which may result in adverse health effects. Among them, Bisphenol-A (BPA) is the most debated endocrine disruptor, despite being widely studied, regarding its effects on fertility. The aim of this review [...] Read more.

Humans interfere with a variety of endocrine disruptors on a daily basis, which may result in adverse health effects. Among them, Bisphenol-A (BPA) is the most debated endocrine disruptor, despite being widely studied, regarding its effects on fertility. The aim of this review was to investigate the interrelation of BPA and female fertility. PubMed (Medline) was searched from 2013 until 2022 to identify epidemiological studies that report the association of BPA with fertility parameters, in vitro fertilization (IVF) outcomes, polycystic ovarian syndrome (PCOS) and endometriosis. Regarding general fertility, most studies report an inverse association between BPA and ovarian reserve markers, namely antral follicle count (AFC) and anti-Müllerian hormone (AMH). The BPA and estradiol (E2) levels did not correlate significantly in the majority of studies. No definite conclusions can be reached regarding BPA and IVF endpoints or endometriosis. Lastly, most studies report higher prevalence of PCOS in women with higher BPA concentrations, although no casualty has been proven. Although most studies fail to reach definite conclusion regarding the impact of BPA on fertility, there is accumulating evidence suggesting a negative role of BPA in female reproductive health. Full article

(This article belongs to the Section Obstetrics & Gynecology)

12 pages, 636 KiB

Open AccessReview

Which Antibiotic for Urinary Tract Infections in Pregnancy? A Literature Review of International Guidelines

by Mariela Corrales, Elizabeth Corrales-Acosta and Juan Guillermo Corrales-Riveros

J. Clin. Med. 2022, 11(23), 7226; https://doi.org/10.3390/jcm11237226 - 5 Dec 2022

Cited by 11 | Viewed by 10726

Abstract

Urinary tract infection (UTI) is considered to be a major problem in pregnant women. It is also one of the most prevalent infections during pregnancy, being diagnosed in as many as 50–60% of all gestations. Therefore, UTI treatment during pregnancy is extremely important [...] Read more.

Urinary tract infection (UTI) is considered to be a major problem in pregnant women. It is also one of the most prevalent infections during pregnancy, being diagnosed in as many as 50–60% of all gestations. Therefore, UTI treatment during pregnancy is extremely important and management guidelines have been published worldwide to assist physicians in selecting the right antibiotic for each patient, taking into account the maternal and fetal safety profile. A review of the literature was carried out and all international guidelines giving recommendations about antibiotic treatments for pregnancy-related UTI were selected. The search came back with 13 guidelines from 4 different continents (8 from Europe, 3 from South America, 1 from North America and 1 from Oceania). Our review demonstrated concordance between guidelines with regard to several aspects in the antibiotic treatment of UTI during pregnancy and in the follow-up after treatment. Nonetheless, there are some areas of discordance, as in the case of antenatal screening for bacteriuria and the use of fluoroquinolones in lower or upper UTI. Given the current evidence that we have from international guidelines, they all agree on several key points about antibiotic use. Full article

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

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13 pages, 2210 KiB

Open AccessArticle

Long-Term Follow-Up of Biological Reconstruction with Free Fibular Graft after Resection of Extremity Diaphyseal Bone Tumors

by Zhaohui Li, Zhen Pan, Hua Guo, Xiang Fei, Dongdong Cheng and Qingcheng Yang

J. Clin. Med. 2022, 11(23), 7225; https://doi.org/10.3390/jcm11237225 - 5 Dec 2022

Cited by 7 | Viewed by 2293

Abstract

This study aimed to evaluate the clinical outcomes and complications of reconstruction with a composite free fibula inside other biological grafts. We retrospectively reviewed 26 patients who underwent reconstruction after bone tumor resection of the diaphysis of the long bone. Surgical data, time [...] Read more.

This study aimed to evaluate the clinical outcomes and complications of reconstruction with a composite free fibula inside other biological grafts. We retrospectively reviewed 26 patients who underwent reconstruction after bone tumor resection of the diaphysis of the long bone. Surgical data, time to bony union, functional outcomes, and complications were evaluated in all cases. The median follow-up was 72.5 months. The limb salvage rate was 100%. Primary osseous union was achieved in 90.4% of the junctions. The union rates at the metaphyseal and diaphyseal junctions were 100% and 85.7%, respectively (p = 0.255). The mean time of bony union in the upper (87.5%) and lower (91.7%) extremity was 4.6 ± 1.6 months and 6.9 ± 2 months, respectively. The mean MSTS score was 27.2 ± 3.2, with a mean MSTS rating of 90.7%. Complications occurred in 15.4% of the cases. The administration of vascularized or non-vascularized grafts did not significantly influence the union time (p = 0.875), functional outcome (p = 0.501), or blood loss (p = 0.189), but showed differences in operation time (p = 0.012) in lower extremity reconstruction. A composite free fibula inside other biological grafts provides a reasonable and durable option for osseous oncologic reconstruction of the long bone diaphysis of the extremities with an acceptable rate of complications. A higher union rate was achieved after secondary bone grafting. In lower-extremity reconstruction, two plates may be considered a better option for internal fixation. Vascularizing the fibula did not significantly affect the union time. Full article

(This article belongs to the Special Issue State of the Art: The Current Concept of Multidisciplinary Management of Musculoskeletal Tumor)

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16 pages, 4037 KiB

Open AccessArticle

Screening and Identification of Key Biomarkers in Metastatic Uveal Melanoma: Evidence from a Bioinformatic Analysis

by Tan Wang, Zixing Wang, Jingyuan Yang, Youxin Chen and Hanyi Min

J. Clin. Med. 2022, 11(23), 7224; https://doi.org/10.3390/jcm11237224 - 5 Dec 2022

Cited by 2 | Viewed by 2388

Abstract

Purpose: To identify key biomarkers in the metastasis of uveal melanoma (UM). Methods: The microarray datasets GSE27831 and GSE22138 were downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were identified, and functional enrichment analyses were performed. A protein–protein interaction network [...] Read more.

Purpose: To identify key biomarkers in the metastasis of uveal melanoma (UM). Methods: The microarray datasets GSE27831 and GSE22138 were downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were identified, and functional enrichment analyses were performed. A protein–protein interaction network was constructed, and four algorithms were performed to increase the reliability of hub genes. Biomarker analysis and metastasis-free survival analysis were performed to screen and verify prognostic hub genes. Results: A total of 138 DEGs were identified, consisting of 71 downregulated genes and 67 upregulated genes. Four genes (ROBO1, FMN1, FYN and FXR1) were selected as hub genes. Biomarker analysis and metastasis-free survival analysis showed that ROBO1, FMN1, FYN and FXR1 were factors affecting the metastasis and metastasis-free survival of UM (all p < 0.05). High expression of ROBO1 and low expression of FMN1 were associated with longer metastasis-free survival. Multivariable logistic regression and Cox analyses in GSE 27831 indicated that ROBO1 was an independent factor affecting metastasis and metastasis-free survival of UM (p = 0.010 and p = 0.009), while ROBO1 and FMN1 were independent factors affecting metastasis and metastasis-free survival of UM in GSE22138 (all p < 0.05). Conclusions: ROBO1, FMN1, FYN and FXR1 should be regarded as diagnostic biomarkers for the metastasis of UM, especially ROBO1 and FMN1. High expression of ROBO1 and low expression of FMN1 were associated with longer metastasis-free survival. This study may facilitate the understanding of the molecular mechanisms underlying the metastasis of UM. Full article

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

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16 pages, 8755 KiB

Open AccessArticle

T Cell-Mediated Tumor Killing-Related Classification of the Immune Microenvironment and Prognosis Prediction of Lung Adenocarcinoma

by Peng Ding, Lichao Liu, Yawen Bin, Yu Huang, Lingjuan Chen, Lu Wen, Ruiguang Zhang, Fan Tong and Xiaorong Dong

J. Clin. Med. 2022, 11(23), 7223; https://doi.org/10.3390/jcm11237223 - 5 Dec 2022

Cited by 1 | Viewed by 1875

Abstract

Background: Although immune checkpoint inhibitors (ICI) are a promising therapeutic strategy for lung adenocarcinoma (LUAD), individual subgroups that might benefit from them are yet to be identified. As T cell-mediated tumor killing (TTK) is an underlying mechanism of ICI, we identified subtypes based [...] Read more.

Background: Although immune checkpoint inhibitors (ICI) are a promising therapeutic strategy for lung adenocarcinoma (LUAD), individual subgroups that might benefit from them are yet to be identified. As T cell-mediated tumor killing (TTK) is an underlying mechanism of ICI, we identified subtypes based on genes associated with TTK sensitivity and assessed their predictive significance for LUAD immunotherapies. Methods: Using high-throughput screening techniques, genes regulating the sensitivity of T cell-mediated tumor killing (GSTTK) with differential expression and associations with prognosis were discovered in LUAD. Furthermore, patients with LUAD were divided into subgroups using unsupervised clustering based on GSTTK. Significant differences were observed in the tumor immune microenvironment (TIME), genetic mutation and immunotherapy response across subgroups. Finally, the prognostic significance of a scoring algorithm based on GSTTK was assessed. Results: A total of 6 out of 641 GSTTK exhibited differential expression in LUAD and were associated with prognosis. Patients were grouped into two categories based on the expression of the six GSTTK, which represented different TTK immune microenvironments in LUAD. Immune cell infiltration, survival difference, somatic mutation, functional enrichment and immunotherapy responses also varied between the two categories. Additionally, a scoring algorithm accurately distinguished overall survival rates across populations. Conclusions: TTK had a crucial influence on the development of the varying TIME. Evaluation of the varied TTK modes of different tumors enhanced our understanding of TIME characteristics, wherein the changes in T cell activity in LUAD are reflected. Thus, this study guides the development of more effective therapeutic methods. Full article

(This article belongs to the Special Issue Target and Im-Oncology Therapeutic Approaches for Lung Cancer)

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10 pages, 275 KiB

Open AccessArticle

Muscle Architecture, Morphology, and Mechanical and Functional Properties of Biceps Femoris Long Head in Professional Soccer Players with a Prior Healed Injured Hamstring

by Francisco Javier Nuñez, Ramona Ritzmann, Fernando Hernandez-Abad, Juan Carlos Martinez and Luis Suarez-Arrones

J. Clin. Med. 2022, 11(23), 7222; https://doi.org/10.3390/jcm11237222 - 5 Dec 2022

Cited by 6 | Viewed by 2771

Abstract

Objective: The aim of the present study was to compare the fascicle length, pennation angle, muscle thickness and stiffness of the biceps femoris long head, and eccentric hamstring strength between injured dominant limbs, injured non-dominant limbs, uninjured dominant limbs and uninjured non-dominant legs [...] Read more.

Objective: The aim of the present study was to compare the fascicle length, pennation angle, muscle thickness and stiffness of the biceps femoris long head, and eccentric hamstring strength between injured dominant limbs, injured non-dominant limbs, uninjured dominant limbs and uninjured non-dominant legs in previously injured players, and between dominant and non-dominant legs in uninjured elite soccer players. Materials and Methods: Twenty elite soccer players participated in this study. Ultrasound imaging and MyotonPRO were used to determine the morphological and mechanical properties of the biceps femoris long head. Isokinetic and Nordic hamstring exercises were used to assess eccentric hamstring strength. Results: Previously injured players showed substantially lower fascicle length and muscle thickness, and significantly higher biceps femoris long head stiffness than uninjured players, without differences between limbs. Conclusion: The morphological and mechanical properties of elite soccer players with hamstring injury history were different from those in uninjured players. The lack of differences between limbs showed that these values are characteristics of individual players that must be considered in the design of programs to prevent BFlh injury. Full article

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

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J. Clin. Med., Volume 11, Issue 23 (December-1 2022) – 375 articles

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