Journal of Clinical Medicine

14 pages, 1079 KiB

Open AccessArticle

The Influence of Angle Alpha, Angle Kappa, and Optical Aberrations on Visual Outcomes after the Implantation of a High-Addition Trifocal IOL

by Guadalupe Cervantes-Coste, André Tapia, Claudia Corredor-Ortega, Mariana Osorio, Rafael Valdez, Martha Massaro, Cecilio Velasco-Barona and Roberto Gonzalez-Salinas

J. Clin. Med. 2022, 11(3), 896; https://doi.org/10.3390/jcm11030896 - 8 Feb 2022

Cited by 24 | Viewed by 4524

Abstract

The aim of our investigation was to examine the possible correlations between optical aberrations, angle kappa, angle alpha, and visual outcomes following cataract surgery. In total, 56 eyes of 28 patients were implanted with the Liberty 677MY trifocal intraocular lens (IOL). Pre- and [...] Read more.

The aim of our investigation was to examine the possible correlations between optical aberrations, angle kappa, angle alpha, and visual outcomes following cataract surgery. In total, 56 eyes of 28 patients were implanted with the Liberty 677MY trifocal intraocular lens (IOL). Pre- and postoperative higher-order aberrations, coma, astigmatism, angle alpha, and angle kappa were registered, along with uncorrected and corrected visual acuities at multiple distances. Visual acuity and contrast sensitivity defocus curves were plotted, and the areas under the curve were calculated 1 and 3 months postoperatively. Excellent visual outcomes were found at all distances. Patients reported low levels of dysphotopsia, and 96.4% of patients achieved complete spectacle independence. While angle kappa significantly decreased during cataract surgery (p = 0.0007), angle alpha remained unchanged (p = 0.5158). Angle alpha correlated with postoperative HOAs and had a negative impact on near vision (p = 0.0543). Preoperative corneal HOA and coma had a strong adverse effect on future intermediate and near vision. Residual astigmatism significantly affected postoperative intermediate vision (p = 0.0091). Our results suggest that angle kappa is not an optimal predictive factor for future visual outcomes, while angle alpha and the preoperative screening of optical aberrations might help patient selection prior to multifocal IOL implantation. Full article

(This article belongs to the Special Issue Hot Topics in PRESBYOPIA 2021)

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16 pages, 635 KiB

Open AccessArticle

A Systematic Literature Review of the Relationship between Serum Ferritin and Outcomes in Myelodysplastic Syndromes

by Esther Natalie Oliva, Krystal Huey, Sohan Deshpande, Monica Turner, Madhura Chitnis, Emma Schiller, Derek Tang, Aylin Yucel, Christina Hughes and Farrukh Shah

J. Clin. Med. 2022, 11(3), 895; https://doi.org/10.3390/jcm11030895 - 8 Feb 2022

Cited by 6 | Viewed by 2307

Abstract

Anemia is the most common form of cytopenia in patients with myelodysplastic syndromes (MDS), who require chronic red blood cell transfusions and may present high serum ferritin (SF) levels as a result of iron overload. To better understand the potential effects of high [...] Read more.

Anemia is the most common form of cytopenia in patients with myelodysplastic syndromes (MDS), who require chronic red blood cell transfusions and may present high serum ferritin (SF) levels as a result of iron overload. To better understand the potential effects of high SF levels, we conducted a systematic literature review (SLR) to identify evidence on the relationship between SF levels and clinical, economic, or humanistic outcomes in adult patients with MDS. Of 267 references identified, 21 were included. No studies assessing SF levels and their relationship with humanistic or economic outcomes were identified. Increased SF levels were an indicator of worse overall survival and other worsened outcomes; however, the association was not consistently significant. SF levels were a significant prognostic factor for relapse incidence of MDS and showed a significant positive correlation with number of blood units transfused but were not associated with progression to acute myeloid leukemia or the time to transformation. Higher SF levels were also an indicator of a lower likelihood of leukemia-free survival, relapse-free survival, and event-free survival. The SLR suggests that SF levels are associated with clinical outcomes in MDS, with higher levels correlated with number of blood units transfused, frequently indicating worse outcomes. Full article

(This article belongs to the Section Hematology)

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12 pages, 19309 KiB

Open AccessArticle

Guided Bone Regeneration in the Edentulous Atrophic Maxilla Using Deproteinized Bovine Bone Mineral (DBBM) Combined with Platelet-Rich Fibrin (PRF)—A Prospective Study

by João Manuel Mendez Caramês, Filipe Araújo Vieira, Gonçalo Bártolo Caramês, Ana Catarina Pinto, Helena Cristina Oliveira Francisco and Duarte Nuno da Silva Marques

J. Clin. Med. 2022, 11(3), 894; https://doi.org/10.3390/jcm11030894 - 8 Feb 2022

Cited by 11 | Viewed by 3734

Abstract

Background: Bone regeneration procedures represent a major challenge in oral surgery. This study aimed to evaluate a composite PRF/particulate xenograft in guided bone regeneration. Methods: Edentulous patients with horizontal ridge deficiencies in the anterior maxilla and candidates to an immediate-loading full-arch rehabilitation were [...] Read more.

Background: Bone regeneration procedures represent a major challenge in oral surgery. This study aimed to evaluate a composite PRF/particulate xenograft in guided bone regeneration. Methods: Edentulous patients with horizontal ridge deficiencies in the anterior maxilla and candidates to an immediate-loading full-arch rehabilitation were included. Horizontal linear measurements indicating bone gain were assessed from computer beam computer tomography (CBCT) scans obtained at pre-surgery, post-surgery, and the 12-month follow-up. Mean bone values were presented as mean ± 95% CI. Non-parametric tests were used as appropriate, and the effect size was calculated with Cohen’s d repeated measures. Results: Eighteen patients were rehabilitated with 72 implants. The mean horizontal bone width was 4.47 [4.13–4.80] mm pre-surgically, 9.25 [8.76–9.75] mm post-surgically, and 7.71 [7.28–8.14] mm 12 months after. Conclusions: PRF associated with a xenograft seems to promote an effective horizontal bone gain. Randomized clinical trials are needed to confirm the benefits of this surgical approach. Full article

(This article belongs to the Topic New Frontiers and Boundaries in the Use of Biomaterials in Dentistry)

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14 pages, 1954 KiB

Open AccessArticle

Self-Reported Pain and Emotional Reactivity in Bipolar Disorder: A Prospective FACE-BD Study

by Nathan Risch, Jonathan Dubois, Katia M’bailara, Irena Cussac, Bruno Etain, Raoul Belzeaux, Caroline Dubertret, Emmanuel Haffen, Raymund Schwan, Ludovic Samalin, Paul Roux, Mircea Polosan, Marion Leboyer, Philippe Courtet, Emilie Olié and on behalf of the FondaMental Advanced Centers of Expertise in Bipolar Disorders (FACE-BD) Collaborators

J. Clin. Med. 2022, 11(3), 893; https://doi.org/10.3390/jcm11030893 - 8 Feb 2022

Cited by 2 | Viewed by 3542

Abstract

In patients with bipolar disorder (BD), pain prevalence is close to 30%. It is important to determine whether pain influences BD course and to identify factors associated with pain in BD in order to guide BD management. This naturalistic, prospective study used data [...] Read more.

In patients with bipolar disorder (BD), pain prevalence is close to 30%. It is important to determine whether pain influences BD course and to identify factors associated with pain in BD in order to guide BD management. This naturalistic, prospective study used data on 880 patients with BD from the French FACE-BD cohort who were divided into two groups according to the presence or absence of pain. Multivariate models were used to test whether pain was associated with affective states and personality traits while controlling for confounders. Then, multivariate models were used to test whether pain at baseline predicted global life functioning and depressive symptomatology at one year. At baseline, 22% of patients self-reported pain. The pain was associated with depressive symptomatology, levels of emotional reactivity in a quadratic relationship, and a composite variable of personality traits (affective lability, affective intensity, hostility/anger, and impulsivity). At one year, the pain was predictive of depression and lower global life functioning. Pain worsens mental health and well-being in patients with BD. The role of emotions, depression, and personality traits in pain has to be elucidated to better understand the high prevalence of pain in BD and to promote specific therapeutic strategies for patients experiencing pain. Full article

(This article belongs to the Special Issue The Clinical Management of Bipolar Disorders)

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11 pages, 960 KiB

Open AccessArticle

A New System for Periprosthetic Fracture Stabilization—A Biomechanical Comparison

by Daniel Rau, Gabriele Rußow, Mark Heyland, Dag Wulsten, Clemens Kösters, Werner Schmölz and Sven Märdian

J. Clin. Med. 2022, 11(3), 892; https://doi.org/10.3390/jcm11030892 - 8 Feb 2022

Cited by 1 | Viewed by 2817

Abstract

In recent years, an increase in periprosthetic femur fractures has become apparent due to the increased number of hip replacements. In the case of Vancouver type B1 fractures, locking plate systems offer safe procedures. This study compared the distal lateral femur plate (LOQTEQ [...] Read more.

In recent years, an increase in periprosthetic femur fractures has become apparent due to the increased number of hip replacements. In the case of Vancouver type B1 fractures, locking plate systems offer safe procedures. This study compared the distal lateral femur plate (LOQTEQ^®, aap Implantate AG) with a standard L.I.S.S. LCP^® (DePuy Synthes) regarding their biomechanical properties in fixation of periprosthetic femur fractures after hip arthroplasty. We hypothesized that the new LOQTEQ system has superior stability and durability in comparison. Eighteen artificial left femurs were randomized in two groups (Group A: LOQTEQ^®; Group B: L.I.S.S. LCP^®) and tested until failure. Failure was defined as 10° varus deformity and catastrophic implant failure (loosening, breakage, progressive bending). Axial stiffness, loads of failure, cycles of failure, modes of failure were recorded. The axial stiffness in Group A with 73.4 N/mm (SD +/− 3.0) was significantly higher (p = 0.001) than in Group B (40.7 N/mm (SD +/− 2.8)). Group A resists more cycles than Group B until 10° varus deformity. Catastrophic failure mode was plate breakage in Group A and bending in Group B. In conclusion, LOQTEQ^® provides higher primary stability and tends to have higher durability. Full article

(This article belongs to the Special Issue Management of Periprosthetic Fractures: Current Experience and Future Developments)

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14 pages, 759 KiB

Open AccessArticle

Kidney Function According to Different Equations in Patients Admitted to a Cardiology Unit and Impact on Outcome

by Vincenzo Livio Malavasi, Anna Chiara Valenti, Sara Ruggerini, Marcella Manicardi, Carlotta Orlandi, Daria Sgreccia, Marco Vitolo, Marco Proietti, Gregory Y. H. Lip and Giuseppe Boriani

J. Clin. Med. 2022, 11(3), 891; https://doi.org/10.3390/jcm11030891 - 8 Feb 2022

Cited by 9 | Viewed by 2428

Abstract

Background: This paper aims to evaluate the concordance between the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula and alternative equations and to assess their predictive power for all-cause mortality in unselected patients discharged alive from a cardiology ward. Methods: We retrospectively included patients [...] Read more.

Background: This paper aims to evaluate the concordance between the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula and alternative equations and to assess their predictive power for all-cause mortality in unselected patients discharged alive from a cardiology ward. Methods: We retrospectively included patients admitted to our Cardiology Division independently of their diagnosis. The total population was classified according to Kidney Disease: Improving Global Outcomes (KDIGO) categories, as follows: G1 (estimated glomerular filtration rate (eGFR) ≥90 mL/min/1.73 m²); G2 (eGFR 89–60 mL/min/1.73 m²); G3a (eGFR 59–45 mL/min/1.73 m²); G3b (eGFR 44–30 mL/min/1.73 m²); G4 (eGFR 29–15 mL/min/1.73 m²); G5 (eGFR <15 mL/min/1.73 m²). Cockcroft-Gault (CG), CG adjusted for body surface area (CG-BSA), Modification of Diet in Renal Disease (MDRD), Berlin Initiative Study (BIS-1), and Full Age Spectrum (FAS) equations were also assessed. Results: A total of 806 patients were included. Good agreement was found between the CKD-EPI formula and CG-BSA, MDRD, BIS-1, and FAS equations. In subjects younger than 65 years or aged ≥85 years, CKD-EPI and MDRD showed the highest agreement (Cohen’s kappa (K) 0.881 and 0.588, respectively) while CG showed the lowest. After a median follow-up of 407 days, overall mortality was 8.2%. The risk of death was higher in lower eGFR classes (G3b HR4.35; 95%CI 1.05–17.80; G4 HR7.13; 95%CI 1.63–31.23; G5 HR25.91; 95%CI 6.63–101.21). The discriminant capability of death prediction tested with ROC curves showed the best results for BIS-1 and FAS equations. Conclusion: In our cohort, the concordance between CKD-EPI and other equations decreased with age, with the MDRD formula showing the best agreement in both younger and older patients. Overall, mortality rates increased with the renal function decreasing. In patients aged ≥75 years, the best discriminant capability for death prediction was found for BIS-1 and FAS equations. Full article

(This article belongs to the Special Issue Clinical Care for Older Adults with Cardiovascular Disease: Current Challenges and Perspectives Ahead)

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14 pages, 5863 KiB

Open AccessArticle

Effects of Moderate Alcohol Consumption in Non-Alcoholic Fatty Liver Disease

by Peter Lemmer, Paul Manka, Jan Best, Alisan Kahraman, Julia Kälsch, Ramiro Vilchez-Vargas, Alexander Link, Hsin Chiang, Guido Gerken, Ali Canbay, Lars P. Bechmann and Svenja Sydor

J. Clin. Med. 2022, 11(3), 890; https://doi.org/10.3390/jcm11030890 - 8 Feb 2022

Cited by 11 | Viewed by 3447

Abstract

Alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) have emerged as leading causes of chronic liver diseases worldwide. ALD and NAFLD share several pathophysiological patterns as well as histological features, while clinically, they are distinguished by the amount of alcohol consumed [...] Read more.

Alcoholic liver disease (ALD) and non-alcoholic fatty liver disease (NAFLD) have emerged as leading causes of chronic liver diseases worldwide. ALD and NAFLD share several pathophysiological patterns as well as histological features, while clinically, they are distinguished by the amount of alcohol consumed daily. However, NAFLD coexists with moderate alcohol consumption in a growing proportion of the population. Here, we investigated the effects of moderate alcohol consumption on liver injury, lipid metabolism, and gut microbiota in 30 NAFLD-patients. We anonymously assessed drinking habits, applying the AUDIT- and CAGE-questionnaires and compared subgroups of abstainers vs. low to harmful alcohol consumers (AUDIT) and Cage 0–1 vs. Cage 2–4. Patients who did not drink any alcohol had lower levels of γGT, ALT, triglycerides, and total cholesterol. While the abundance of Bacteroidaceae, Bifidobacteriaceae, Streptococcaceae, and Ruminococcaceae was higher in the low to harmful alcohol drinking cohort, the abundance of Rikenellaceae was higher in the abstainers. Our study suggests that even moderate alcohol consumption has an impact on the liver and lipid metabolism, as well as on the composition of gut microbiota. Full article

(This article belongs to the Collection Clinical Research in Hepatology)

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27 pages, 1299 KiB

Open AccessReview

The Immune-Centric Revolution in the Diabetic Foot: Monocytes and Lymphocytes Role in Wound Healing and Tissue Regeneration—A Narrative Review

by Laura Rehak, Laura Giurato, Marco Meloni, Andrea Panunzi, Giada Maria Manti and Luigi Uccioli

J. Clin. Med. 2022, 11(3), 889; https://doi.org/10.3390/jcm11030889 - 8 Feb 2022

Cited by 43 | Viewed by 9275

Abstract

Monocytes and lymphocytes play a key role in physiologic wound healing and might be involved in the impaired mechanisms observed in diabetes. Skin wound macrophages are represented by tissue resident macrophages and infiltrating peripheral blood recruited monocytes which play a leading role during [...] Read more.

Monocytes and lymphocytes play a key role in physiologic wound healing and might be involved in the impaired mechanisms observed in diabetes. Skin wound macrophages are represented by tissue resident macrophages and infiltrating peripheral blood recruited monocytes which play a leading role during the inflammatory phase of wound repair. The impaired transition of diabetic wound macrophages from pro-inflammatory M1 phenotypes to anti-inflammatory pro-regenerative M2 phenotypes might represent a key issue for impaired diabetic wound healing. This review will focus on the role of immune system cells in normal skin and diabetic wound repair. Furthermore, it will give an insight into therapy able to immuno-modulate wound healing processes toward to a regenerative anti-inflammatory fashion. Different approaches, such as cell therapy, exosome, and dermal substitute able to promote the M1 to M2 switch and able to positively influence healing processes in chronic wounds will be discussed. Full article

(This article belongs to the Special Issue Diabetic Foot Complications: Current Challenges and Future Prospects—Part II)

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9 pages, 2434 KiB

Open AccessArticle

Comparison of Medical and Surgical Treatment in Severe Bell’s Palsy

by Yong Kim, Seung Geun Yeo, Hwa Sung Rim, Jongha Lee, Dokyoung Kim, Sung Soo Kim, Dong Choon Park, Jae Yong Byun and Sang Hoon Kim

J. Clin. Med. 2022, 11(3), 888; https://doi.org/10.3390/jcm11030888 - 8 Feb 2022

Cited by 3 | Viewed by 2510

Abstract

(1) Background: The effectiveness of decompression surgery for Bell’s palsy is controversial. This study investigated the effects of facial nerve decompression in patients with severe Bell’s palsy who were expected to have a poor prognosis. (2) Methods: We retrospectively reviewed 1721 patients with [...] Read more.

(1) Background: The effectiveness of decompression surgery for Bell’s palsy is controversial. This study investigated the effects of facial nerve decompression in patients with severe Bell’s palsy who were expected to have a poor prognosis. (2) Methods: We retrospectively reviewed 1721 patients with Bell’s palsy who visited the Kyung Hee University Hospital between January 2005 and December 2021. Of these, 45 patients with severe Bell’s palsy were divided into two groups; 30 patients were treated conservatively with steroids and antiviral agents alone, while 15 patients underwent additional decompressive surgery after the conservative treatment. Outcomes were measured using House–Brackmann (H–B) grade for least 6 months after treatment was finished and conducted until full recovery was achieved. (3) Results: There was no significant difference in the rate of favorable recovery (H–B grade 1 or 2) between the surgery group and the conservative treatment group (75% vs. 70.0%, p > 0.05). Although H–B grade improvement occurred in both groups, the degree of improvement was not significantly different between groups. (4) Conclusions: Facial nerve decompression surgery in severe Bell’s palsy patients did not significantly improve prognosis beyond that offered by conservative treatment alone. Additional surgical decompression may not be necessary in patients with severe Bell’s palsy if they receive sufficient conservative treatment. Full article

(This article belongs to the Special Issue Diagnosis and Management of Peripheral Nerve Injuries)

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9 pages, 235 KiB

Open AccessArticle

Predictors for Prehospital First-Pass Intubation Success in Germany

by Lukas Reinert, Steffen Herdtle, Christian Hohenstein, Wilhelm Behringer and Jasmin Arrich

J. Clin. Med. 2022, 11(3), 887; https://doi.org/10.3390/jcm11030887 - 8 Feb 2022

Cited by 6 | Viewed by 2742

Abstract

(1) Background: Endotracheal intubation in the prehospital setting is an important skill for emergency physicians, paramedics, and other members of the EMS providing airway management. Its success determines complications and patient mortality. The aim of this study was to find predictors for first-pass [...] Read more.

(1) Background: Endotracheal intubation in the prehospital setting is an important skill for emergency physicians, paramedics, and other members of the EMS providing airway management. Its success determines complications and patient mortality. The aim of this study was to find predictors for first-pass intubation success in the prehospital emergency setting. (2) The study was based on a retrospective analysis of a population-based registry of prehospital advanced airway management in Germany. Cases of endotracheal intubation by the emergency medical services in the cities of Tübingen and Jena between 2016 and 2019 were included. The outcome of interest was first-pass intubation success. Univariate and multivariable regression analysis were used to analyse the influence of predefined predictors, including the characteristics of patients, the intubating staff, and the clinical situation. (3) Results: A total of 308 patients were analysed. After adjustment for multiple confounders, the direct vocal cord view, a less favourable Cormack–Lehane classification, the general practitioner as medical specialty, and location and type of EMS were independent predictors for first-pass intubation success. (4) Conclusions: In physician-led emergency medical services, the laryngoscopic view, medical specialty, type of EMS, and career level are associated with FPS. The latter points towards the importance of experience and regular training in endotracheal intubation. Full article

(This article belongs to the Section Emergency Medicine)

11 pages, 1173 KiB

Open AccessArticle

The Ratio of Hemoglobin to Red Cell Distribution Width: A Strong Predictor of Clinical Outcome in Patients with Heart Failure

by Eldad Rahamim, Donna R. Zwas, Andre Keren, Gabby Elbaz-Greener, Mahsati Ibrahimli, Offer Amir and Israel Gotsman

J. Clin. Med. 2022, 11(3), 886; https://doi.org/10.3390/jcm11030886 - 8 Feb 2022

Cited by 22 | Viewed by 2913

Abstract

Background: Hemoglobin (Hb) is a standard and widely available clinical parameter that predicts clinical outcomes in heart failure (HF) patients. Red cell distribution width (RDW) is also a routinely measured clinical parameter that is predictive of clinical outcomes in HF. The ratio between [...] Read more.

Background: Hemoglobin (Hb) is a standard and widely available clinical parameter that predicts clinical outcomes in heart failure (HF) patients. Red cell distribution width (RDW) is also a routinely measured clinical parameter that is predictive of clinical outcomes in HF. The ratio between Hb and RDW has yet to be evaluated in HF. Methods: We evaluated the predictive value of the Hb/RDW ratio on clinical outcomes in patients with HF. All patients diagnosed with chronic HF at a health maintenance organization were evaluated for Hb/RDW ratio and followed for cardiac-related hospitalizations and death. Results: The study cohort included 6888 HF patients. The mean Hb/RDW ratio was 0.85 ± 0.18; median was 0.85 (interquartile range 0.72–0.98). Patients with a lower Hb/RDW ratio were more likely to be women and had more comorbidities. The overall two year-mortality rate was 23.2%. Decreasing quantiles of the Hb/RDW ratio were associated with reduced survival rates and reduced event-free survival from death or cardiovascular-hospitalizations. Multivariable Cox regression analysis after adjustment for significant predictors demonstrated that low Hb/RDW ratio was a significant predictor of mortality, with a graded increased risk as Hb/RDW ratio decreased. Lower Hb/RDW ratio was also a significant independent predictor of the combined endpoint of death or cardiovascular hospitalizations. A sensitivity analysis evaluating Hb/RDW ratio as a continuous parameter using restricted cubic splines demonstrated a continuous increase in the mortality risk with decreasing Hb/RDW ratio, p < 0.0001 for the linear model. Conclusions: Hb/RDW ratio is a significant prognostic tool for predicting HF mortality and cardiovascular hospitalizations. Full article

(This article belongs to the Special Issue Cardiovascular Disease in 2021 and beyond—What Have We Learned and How Do We Move On?)

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10 pages, 1413 KiB

Open AccessArticle

Forced Diuresis with Matched Isotonic Intravenous Hydration Prevents Renal Contrast Media Accumulation

by Yael Ben-Haim, Ehud Chorin, Aviram Hochstadt, Merav Ingbir, Yaron Arbel, Shafik Khoury, Amir Halkin, Ariel Finkelstein, Shmuel Banai and Maayan Konigstein

J. Clin. Med. 2022, 11(3), 885; https://doi.org/10.3390/jcm11030885 - 8 Feb 2022

Cited by 3 | Viewed by 1916

Abstract

The accumulation of contrast media in the kidneys might lead to contrast-induced acute kidney injury. In this prospective, controlled observational study, we aimed to evaluate whether forced diuresis with matched isotonic intravenous hydration prevents the accumulation of contrast media in the kidneys of [...] Read more.

The accumulation of contrast media in the kidneys might lead to contrast-induced acute kidney injury. In this prospective, controlled observational study, we aimed to evaluate whether forced diuresis with matched isotonic intravenous hydration prevents the accumulation of contrast media in the kidneys of patients undergoing cardiac interventional procedures. We compared the intensity of contrast media accumulation as observed in nephrograms following these procedures, with and without peri-procedural controlled renal flushing. The study group consisted of 25 patients with impaired renal function treated with the RenalGuard system. The two control groups included 25 patients with normal kidney function and 8 patients with impaired renal function undergoing similar procedures with routine pre-procedural hydration, but without controlled renal flushing. Renal contrast media accumulation at the end of each procedure was scored by blinded cardiologists. The renal contrast accumulation score (CAS) in the study group was significantly lower, with a median score of 0 (IQR (0–0)) compared with 1.5 (IQR (1–2)) in the normal renal function control group and 1 (IQR (0.38–1.62)) in the impaired renal function control group (p < 0.001 and 0.003, respectively). In a multivariate analysis of CAS, RenalGuard treatment was independently associated with lower CAS compared to both control groups. In conclusion, RenalGuard use prevents renal contrast accumulation in patients with impaired renal function undergoing cardiac procedures with intra-arterial contrast media injection. Full article

(This article belongs to the Special Issue New Insights into Cardio-Renal Interactions: Novel Definitions, Pathophysiology and Management)

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13 pages, 873 KiB

Open AccessArticle

Results of the pToWin Study: Using the pCONUS Device for the Treatment of Wide-Neck Intracranial Aneurysms

by Marta Aguilar Pérez, Hans Henkes, Wiebke Kurre, Carlos Bleise, Pedro Nicolás Lylyk, Javier Lundquist, Francis Turjman, Hanan Alhazmi, Christian Loehr, Stephan Felber, Hannes Deutschmann, Stephan Lowens, Luigi Delehaye, Markus Möhlenbruch, Jörg Hattingen and Pedro Lylyk

J. Clin. Med. 2022, 11(3), 884; https://doi.org/10.3390/jcm11030884 - 8 Feb 2022

Cited by 9 | Viewed by 2339

Abstract

Coil embolization has become a well-established option for the treatment of intracranial aneurysms. Yet, wide-neck bifurcation aneurysms (WNBAs) remain a challenge. The pCONUS is the first generation of a stent-like implant for the bridging of WNBAs to enable coiling. The pToWin study was [...] Read more.

Coil embolization has become a well-established option for the treatment of intracranial aneurysms. Yet, wide-neck bifurcation aneurysms (WNBAs) remain a challenge. The pCONUS is the first generation of a stent-like implant for the bridging of WNBAs to enable coiling. The pToWin study was a prospective, single-arm, multicenter study conducted to analyze the safety and efficacy of the pCONUS in the treatment of WNBAs. The primary effectiveness endpoint was the rate of adequate occlusion of the aneurysm at 3–6 and 7–12 months. The primary safety endpoint was the occurrence of major ipsilateral stroke or neurological death during the follow-up. A total of 115 patients were included. Aneurysm locations were the middle cerebral artery in 52 (45.2%), the anterior communicating artery in 35 (30.4%), the basilar artery in 23 (20%), the internal carotid artery terminus in three (2.6%), and the pericallosal artery in two (1.7%) patients. Treatment was successfully performed in all but one patient. The morbi-mortality rate was 1.9% and 2.3% at 3–6 and 7–12 months, respectively. Of the aneurysms, 75.0% and 65.6% showed adequate occlusion at 3–6 and 7–12 months, respectively. pCONUS offers a safe and reasonably effective treatment of WNBAs, demonstrated by acceptable adequate aneurysm occlusion and low rates of adverse neurologic events. Full article

(This article belongs to the Special Issue Hemorrhagic Stroke)

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16 pages, 1219 KiB

Open AccessFeature PaperReview

Antimicrobial Meshes for Hernia Repair: Current Progress and Perspectives

by Simona Mirel, Alexandra Pusta, Mihaela Moldovan and Septimiu Moldovan

J. Clin. Med. 2022, 11(3), 883; https://doi.org/10.3390/jcm11030883 - 8 Feb 2022

Cited by 18 | Viewed by 4013

Abstract

Recent advances in the development of biomaterials have given rise to new options for surgery. New-generation medical devices can control chemical breakdown and resorption, prevent post-operative adhesion, and stimulate tissue regeneration. For the fabrication of medical devices, numerous biomaterials can be employed, including [...] Read more.

Recent advances in the development of biomaterials have given rise to new options for surgery. New-generation medical devices can control chemical breakdown and resorption, prevent post-operative adhesion, and stimulate tissue regeneration. For the fabrication of medical devices, numerous biomaterials can be employed, including non-degradable biomaterials (silicone, polypropylene, expanded polytetrafluoroethylene) or biodegradable polymers, including implants and three-dimensional scaffolds for tissue engineering, which require particular physicochemical and biological properties. Based on the combination of new generation technologies and cell-based therapies, the biocompatible and bioactive properties of some of these medical products can lead to progress in the repair of injured or harmed tissue and in tissue regeneration. An important aspect in the use of these prosthetic devices is the associated infection risk, due to the medical complications and socio-economic impact. This paper provides the latest achievements in the field of antimicrobial surgical meshes for hernia repair and discusses the perspectives in the development of these innovative biomaterials. Full article

(This article belongs to the Special Issue Mesh Implants for Hernia Repair)

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1 pages, 156 KiB

Open AccessCorrection

Correction: Ratka et al. The Effect of In Vitro Electrolytic Cleaning on Biofilm-Contaminated Implant Surfaces. J. Clin. Med. 2019, 8, 1397

by Christoph Ratka, Paul Weigl, Dirk Henrich, Felix Koch, Markus Schlee and Holger Zipprich

J. Clin. Med. 2022, 11(3), 882; https://doi.org/10.3390/jcm11030882 - 8 Feb 2022

Viewed by 1170

Abstract

There was an error in the original article [...] Full article

(This article belongs to the Special Issue Osseointegrated Oral implants: Mechanisms of Implant Anchorage, Threats and Long-Term Survival Rates)

15 pages, 1589 KiB

Open AccessArticle

Development and Validation of the Acute PNeumonia Early Assessment Score for Safely Discharging Low-Risk SARS-CoV-2-Infected Patients from the Emergency Department

by Sergio Venturini, Elisa Pontoni, Rossella Carnelos, Domenico Arcidiacono, Silvia Da Ros, Laura De Santi, Daniele Orso, Francesco Cugini, Sara Fossati, Astrid Callegari, Walter Mancini, Maurizio Tonizzo, Alessandro Grembiale, Massimo Crapis and GianLuca Colussi

J. Clin. Med. 2022, 11(3), 881; https://doi.org/10.3390/jcm11030881 - 8 Feb 2022

Cited by 3 | Viewed by 2100

Abstract

A continuous demand for assistance and an overcrowded emergency department (ED) require early and safe discharge of low-risk severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients. We developed (n = 128) and validated (n = 330) the acute PNeumonia early assessment [...] Read more.

A continuous demand for assistance and an overcrowded emergency department (ED) require early and safe discharge of low-risk severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients. We developed (n = 128) and validated (n = 330) the acute PNeumonia early assessment (aPNea) score in a tertiary hospital and preliminarily tested the score on an external secondary hospital (n = 97). The score’s performance was compared to that of the National Early Warning Score 2 (NEWS2). The composite outcome of either death or oral intubation within 30 days from admission occurred in 101 and 28 patients in the two hospitals, respectively. The area under the receiver operating characteristic (AUROC) curve of the aPNea model was 0.86 (95% confidence interval (CI), 0.78–0.93) and 0.79 (95% CI, 0.73–0.89) for the development and validation cohorts, respectively. The aPNea score discriminated low-risk patients better than NEWS2 at a 10% outcome probability, corresponding to five cut-off points and one cut-off point, respectively. aPNea’s cut-off reduced the number of unnecessary hospitalizations without missing outcomes by 27% (95% CI, 9–41) in the validation cohort. NEWS2 was not significant. In the external cohort, aPNea’s cut-off had 93% sensitivity (95% CI, 83–102) and a 94% negative predictive value (95% CI, 87–102). In conclusion, the aPNea score appears to be appropriate for discharging low-risk SARS-CoV-2-infected patients from the ED. 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, 649 KiB

Open AccessArticle

Characteristics and Outcomes of Bloodstream Infections in a Tertiary-Care Pediatric Hematology–Oncology Unit: A 10-Year Study

by Davide Mattei, Valentina Baretta, Annarita Mazzariol, Laura Maccacaro, Rita Balter, Ada Zaccaron, Elisa Bonetti, Matteo Chinello, Virginia Vitale, Giulia Caddeo, Maria Pia Esposto, Vincenza Pezzella, Davide Gibellini, Gloria Tridello and Simone Cesaro

J. Clin. Med. 2022, 11(3), 880; https://doi.org/10.3390/jcm11030880 - 8 Feb 2022

Cited by 14 | Viewed by 2938

Abstract

Bloodstream infections (BSIs) after chemotherapy or hematopoietic stem cell transplantation (HSCT) are a leading cause of morbidity and mortality. Data on 154 BSIs that occurred in 111 onco-hematological patients (57 hematological malignancies, 28 solid tumors, and 26 non-malignant hematological diseases) were retrospectively collected [...] Read more.

Bloodstream infections (BSIs) after chemotherapy or hematopoietic stem cell transplantation (HSCT) are a leading cause of morbidity and mortality. Data on 154 BSIs that occurred in 111 onco-hematological patients (57 hematological malignancies, 28 solid tumors, and 26 non-malignant hematological diseases) were retrospectively collected and analyzed. Monomicrobial Gram-positive (GP), Gram-negative (GN), and fungal BSIs accounted for 50% (77/154), 38.3% (59/144), and 3.2% (5/154) of all episodes. Polymicrobial infections were 7.8% (12/154), while mixed bacterial–fungal infections were 0.6% (1/154). The most frequent GN isolates were Escherichia coli (46.9%), followed by Pseudomonas aeruginosa (21.9%), Klebsiella species (18.8%), and Enterobacter species (6.3%). Overall, 18.8% (12/64) of GN organisms were multidrug-resistant (seven Escherichia coli, three Klebsiella pneumoniae, and two Enterobacter cloacae), whereas GP resistance to glycopeptides was observed in 1% (1/97). Initial empirical antibiotic therapy was deemed inappropriate in 12.3% of BSIs (19/154). The 30-day mortality was 7.1% (11/154), while the bacteremia-attributable mortality was 3.9% (6/154). In multivariate analysis, septic shock was significantly associated with 30-day mortality (p = 0.0001). Attentive analysis of epidemiology and continuous microbiological surveillance are essential for the appropriate treatment of bacterial infections in pediatric onco-hematological patients. Full article

(This article belongs to the Section Hematology)

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2 pages, 169 KiB

Open AccessEditorial

Inherited Cancer Genetic Epidemiology to Improve Precision Medicine

by Pål Møller and Dafydd Gareth Evans

J. Clin. Med. 2022, 11(3), 879; https://doi.org/10.3390/jcm11030879 - 8 Feb 2022

Viewed by 1583

Abstract

Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems [...] Full article

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

16 pages, 1194 KiB

Open AccessArticle

Influence of Body Mass Index, Cancer Type and Treatment on Long-Term Metabolic and Liver Outcomes in Childhood Cancer Survivors

by Agostino Milluzzo, Lucia Manuella, Emanuela Cannata, Giovanna Russo, Sandro La Vignera, Francesco Purrello, Andrea Di Cataldo and Laura Sciacca

J. Clin. Med. 2022, 11(3), 878; https://doi.org/10.3390/jcm11030878 - 7 Feb 2022

Cited by 4 | Viewed by 3834

Abstract

In the last decade, the survival of subjects affected by cancer in childhood has significantly improved. The increased lifespan of childhood cancer survivors (CCS) led to a greater risk for long-term, therapy-related morbidity. To identify the clinical predictors of metabolic adverse outcomes in [...] Read more.

In the last decade, the survival of subjects affected by cancer in childhood has significantly improved. The increased lifespan of childhood cancer survivors (CCS) led to a greater risk for long-term, therapy-related morbidity. To identify the clinical predictors of metabolic adverse outcomes in CCS (average off-therapy period: 12 years), we recruited 126 survivors of different childhood cancers (86.5% hematological cancers) who received at least anticancer chemotherapy, consecutively approached during their annual oncohematological outpatient visit. At examination, anthropometric measures and cancer-related history were collected. Moreover, a fasting venous sample was carried out for measuring fasting plasma glucose and insulin, glycated hemoglobin, lipid panel, and transaminases. We calculated the indexes of insulin resistance (HOMA-IR, McAuley, and QUICKI) and secretion (HOMA-β), liver steatosis (Hepatic Steatosis Index) and fibrosis (FIB-4 and NAFLD fibrosis score), and visceral fat dysfunction (Visceral Adiposity Index). More than one-third of the subjects (37.3%) did not have normal weight, with 11.1% of them affected by obesity. At recruitment, obese subjects were at significantly higher risk for impaired fasting glucose, metabolic syndrome, visceral adipose dysfunction, and liver steatosis/fibrosis. Subjects who received bone marrow transplantation were prone to insulin resistance, while survivors of lymphoma presented a visceral adipose dysfunction These results suggest a carefully metabolic monitoring of CCS, particularly in subgroups at higher risk, to early detect these conditions, promptly begin therapeutic interventions, and mitigate the dysmetabolic-related health burden. Full article

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

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11 pages, 1143 KiB

Open AccessArticle

Incidence of SARS-CoV-2 Infection and Related Mortality by Education Level during Three Phases of the 2020 Pandemic: A Population-Based Cohort Study in Rome

by Laura Angelici, Chiara Sorge, Mirko Di Martino, Giovanna Cappai, Massimo Stafoggia, Nera Agabiti, Enrico Girardi, Simone Lanini, Emanuele Nicastri, Marina Davoli and Giulia Cesaroni

J. Clin. Med. 2022, 11(3), 877; https://doi.org/10.3390/jcm11030877 - 7 Feb 2022

Cited by 8 | Viewed by 2067

Abstract

Evidence on social determinants of health on the risk of SARS-CoV-2 infection and adverse outcomes is still limited. Therefore, this work investigates educational disparities in the incidence of infection and mortality within 30 days of the onset of infection during 2020 in Rome, [...] Read more.

Evidence on social determinants of health on the risk of SARS-CoV-2 infection and adverse outcomes is still limited. Therefore, this work investigates educational disparities in the incidence of infection and mortality within 30 days of the onset of infection during 2020 in Rome, with particular attention to changes in socioeconomic inequalities over time. A cohort of 1,538,231 residents in Rome on 1 January 2020, aged 35+, followed from 1 March to 31 December 2020, were considered. Cumulative incidence and mortality rates by education were estimated. Multivariable log-binomial and Cox regression models were used to investigate educational disparities in the incidence of SARS-CoV-2 infection and mortality during the entire study period and in three phases of the pandemic. During 2020, there were 47,736 incident cases and 2281 deaths. The association between education and the incidence of infection changed over time. Till May 2020, low- and medium-educated individuals had a lower risk of infection than that of the highly educated. However, there was no evidence of an association between education and the incidence of SARS-CoV-2 infection during the summer. Lastly, low-educated adults had a 25% higher risk of infection from September to December than that of the highly educated. Similarly, there was substantial evidence of educational inequalities in mortality within 30 days of the onset of infection in the last term of 2020. In Rome, social inequalities in COVID-19 appeared in the last term of 2020, and they strengthen the need for monitoring inequalities emerging from this pandemic. Full article

(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)

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8 pages, 585 KiB

Open AccessCommunication

Safety Measures for Maintaining Low Endophthalmitis Rate after Intravitreal Anti-Vascular Endothelial Growth Factor Injection before and during the COVID-19 Pandemic

by Koji Tanaka, Hiroyuki Shimada, Ryusaburo Mori, Yorihisa Kitagawa, Hajime Onoe, Kazuki Tamura and Hiroyuki Nakashizuka

J. Clin. Med. 2022, 11(3), 876; https://doi.org/10.3390/jcm11030876 - 7 Feb 2022

Cited by 9 | Viewed by 4941

Abstract

During the COVID-19 pandemic, intravitreal injections are performed with patients wearing masks. The risk of endophthalmitis after intravitreal injection is reported to increase due to an influx of exhaled air containing oral bacteria from the upper part of the mask onto the ocular [...] Read more.

During the COVID-19 pandemic, intravitreal injections are performed with patients wearing masks. The risk of endophthalmitis after intravitreal injection is reported to increase due to an influx of exhaled air containing oral bacteria from the upper part of the mask onto the ocular surface. We retrospectively investigated the incidence of endophthalmitis when intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections were performed using the same infection control measures before and during the pandemic. Vitreoretinal specialists performed intravitreal injections of anti-VEGF agents in the outpatient room of a university hospital. Infection control measures before and during the pandemic included covering the patient’s eye with adhesive face drape and irrigating the ocular surface with 0.25% povidone-iodine before draping, and immediately before and after injection. Before the COVID-19 pandemic (February 2016 to December 2019), one case of endophthalmitis occurred among 31,173 injections performed (0.0032%; 95% confidence interval (CI), 0.000008–0.017872%). During the COVID-19 pandemic (January 2020 to August 2021), one case of endophthalmitis occurred among 14,725 injections performed (0.0068%; 95% CI, 0.000017–0.037832%). There was no significant difference between the two periods (Fisher’s exact test: p = 0.5387). Even during the COVID-19 pandemic, very low incidence of endophthalmitis after intravitreal injection can be maintained by implementing basic infection prophylactic measures, including face draping and 0.25% povidone-iodine irrigation, established before COVID-19 pandemic. Full article

(This article belongs to the Section Ophthalmology)

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9 pages, 1290 KiB

Open AccessArticle

Possible Existence of Cochlear Synaptopathy in Patients Completely Recovered from Idiopathic Sudden Sensorineural Hearing Loss

by Hee Won Seo, Seung Yeol Lee, Hayoung Byun, Seung Hwan Lee and Jae Ho Chung

J. Clin. Med. 2022, 11(3), 875; https://doi.org/10.3390/jcm11030875 - 7 Feb 2022

Cited by 2 | Viewed by 3967

Abstract

Cochlear synaptopathy refers to a subclinical hearing pathology which could potentially explain hearing difficulties within the normal hearing threshold; it is also called “hidden hearing loss”. We hypothesized that a temporary threshold shift in sudden sensorineural hearing loss (ISSNHL) also affects the function [...] Read more.

Cochlear synaptopathy refers to a subclinical hearing pathology which could potentially explain hearing difficulties within the normal hearing threshold; it is also called “hidden hearing loss”. We hypothesized that a temporary threshold shift in sudden sensorineural hearing loss (ISSNHL) also affects the function in the synapse. The aim of the study was to evaluate the presence of cochlear synaptopathy in patients who had completely recovered from unilateral SSNHL Nineteen patients who had completely recovered from ISSNHL from January 2018 to June 2021 were assessed. Complete recovery was established by pure tone audiometry (PTA) 3 months after treatment, according to the American Academy of Otolaryngology–Head and Neck Surgery criteria. Subjects completed the pure tone audiometry, speech audiometry and auditory brain stem response (ABR) test, and completed a questionnaire regarding hearing loss after hearing recovery. The ABR amplitudes of wave I and wave V, and the ratio of wave I/V of both ears (recovered side and healthy side) were assessed. A visual analog scale (VAS) and a hidden hearing loss questionnaire were used to evaluate subjective hearing difficulty. The ABR waves I of the recovered ears had a significantly lower amplitude (p = 0.002) than those of the healthy side, whereas there was no difference in wave V (p = 0.985) or in the ratio of wave I/V (p = 0.107). Some patients still felt mild hearing difficulty although their PTA results were normal, but there was no clear relationship between the VAS score, wave I amplitude and speech recognition scores. The present findings point to the possible existence of cochlear synaptopathy in ears that have completely recovered from unilateral sudden sensorineural hearing loss. We suggest that the causes of cochlear synaptopathy and of idiopathic sudden hearing loss may have something in common. Full article

(This article belongs to the Section Otolaryngology)

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2 pages, 159 KiB

Open AccessEditorial

Advances in Neuromodulation for Chronic Pain

by Maarten Moens and Lisa Goudman

J. Clin. Med. 2022, 11(3), 874; https://doi.org/10.3390/jcm11030874 - 7 Feb 2022

Viewed by 1792

Abstract

In the past decade, neuromodulation as a treatment option for pain took a huge interest in innovating and developing more effective paradigms to conquer chronic pain syndromes [...] Full article

(This article belongs to the Special Issue Advances in Neuromodulation for Pain Management)

29 pages, 1875 KiB

Open AccessArticle

Usefulness of the C₂HEST Score in Predicting the Clinical Outcomes of COVID-19 in Diabetic and Non-Diabetic Cohorts

by Damian Gajecki, Adrian Doroszko, Małgorzata Trocha, Katarzyna Giniewicz, Krzysztof Kujawa, Marek Skarupski, Jakub Gawryś, Tomasz Matys, Ewa Szahidewicz-Krupska, Piotr Rola, Barbara Stachowska, Jowita Halupczok-Żyła, Barbara Adamik, Krzysztof Kaliszewski, Katarzyna Kilis-Pstrusinska, Krzysztof Letachowicz, Agnieszka Matera-Witkiewicz, Michał Pomorski, Marcin Protasiewicz, Marcin Madziarski, Klaudia Konikowska, Agata Remiorz, Maja Orłowska, Krzysztof Proc, Małgorzata Szymala-Pedzik, Joanna Zorawska, Karolina Lindner, Janusz Sokołowski, Ewa A. Jankowska and Katarzyna Madziarska Show full author list Hide full author list

J. Clin. Med. 2022, 11(3), 873; https://doi.org/10.3390/jcm11030873 - 7 Feb 2022

Cited by 4 | Viewed by 3026

Abstract

Background: Diabetes mellitus is among the most frequent comorbidities worsening COVID-19 outcome. Nevertheless, there are no data regarding the optimal risk stratification of patients with diabetes and COVID-19. Since individual C₂HEST components reflect the comorbidities, we assumed that the score could [...] Read more.

Background: Diabetes mellitus is among the most frequent comorbidities worsening COVID-19 outcome. Nevertheless, there are no data regarding the optimal risk stratification of patients with diabetes and COVID-19. Since individual C₂HEST components reflect the comorbidities, we assumed that the score could predict COVID-19 outcomes. Material and Methods: A total of 2184 medical records of patients hospitalized for COVID-19 at the medical university center were analyzed, including 473 diabetic patients and 1666 patients without any glucose or metabolic abnormalities. The variables of patients’ baseline characteristics were retrieved to calculate the C₂HEST score and subsequently the diabetic and non-diabetic subjects were assigned to the following categories: low-, medium- or high-risk. The measured outcomes included: in-hospital mortality; 3-month and 6-month all-cause mortality; non-fatal end of hospitalization (discharged home/sudden-deterioration/rehabilitation) and adverse in-hospital clinical events. Results: A total of 194 deaths (41%) were reported in the diabetic cohort, including 115 in-hospital deaths (24.3%). The 3-month and 6-month in-hospital mortality was highest in the high-risk C₂HEST stratum. The C₂HEST score revealed to be more sensitive in non-diabetic-group. The estimated six-month survival probability for high-risk subjects reached 0.4 in both cohorts whereas for the low-risk group, the six-month survival probability was 0.7 in the diabetic vs. 0.85 in the non-diabetic group—levels which were maintained during whole observation period. In both cohorts, receiver operating characteristics revealed that C₂HEST predicts the following: cardiogenic shock; acute heart failure; myocardial injury; and in-hospital acute kidney injury. Conclusions: We demonstrated the usefulness and performance of the C₂HEST score in predicting the adverse COVID-19 outcomes in hospitalized diabetic subjects. Full article

(This article belongs to the Special Issue COVID-19: Special Populations and Risk Factors)

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16 pages, 2460 KiB

Open AccessReview

Evolution and New Horizons of Endoscopy in Inflammatory Bowel Diseases

by Tommaso Lorenzo Parigi, Elisabetta Mastrorocco, Leonardo Da Rio, Mariangela Allocca, Ferdinando D’Amico, Alessandra Zilli, Gionata Fiorino, Silvio Danese and Federica Furfaro

J. Clin. Med. 2022, 11(3), 872; https://doi.org/10.3390/jcm11030872 - 7 Feb 2022

Cited by 8 | Viewed by 3659

Abstract

Endoscopy is the mainstay of inflammatory bowel disease (IBD) evaluation and the pillar of colorectal cancer surveillance. Endoscopic equipment, both hardware and software, are advancing at an incredible pace. Virtual chromoendoscopy is now widely available, allowing the detection of subtle inflammatory changes, thus [...] Read more.

Endoscopy is the mainstay of inflammatory bowel disease (IBD) evaluation and the pillar of colorectal cancer surveillance. Endoscopic equipment, both hardware and software, are advancing at an incredible pace. Virtual chromoendoscopy is now widely available, allowing the detection of subtle inflammatory changes, thus reducing the gap between endoscopic and histologic assessment. The progress in the field of artificial intelligence (AI) has been remarkable, and numerous applications are now in an advanced stage of development. Computer-aided diagnosis (CAD) systems are likely to reshape most of the evaluations that are now prerogative of human endoscopists. Furthermore, sophisticated tools such as endocytoscopy and probe-based confocal laser endomicroscopy (pCLE) are enhancing our assessment of inflammation and dysplasia. Finally, pCLE combined with molecular labeling could pave the way to a new paradigm of personalized medicine. This review aims to summarize the main changes that occurred in the field of IBD endoscopy and to explore the most promising novelties. Full article

(This article belongs to the Special Issue Evolution and New Horizons of Endoscopy in Inflammatory Bowel Diseases)

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13 pages, 618 KiB

Open AccessArticle

The Relation between Negative Automatic Thoughts and Psychological Inflexibility in Schizophrenia

by Cosmin O. Popa, Adrian V. Rus, Wesley C. Lee, Cristiana Cojocaru, Alina Schenk, Vitalie Văcăraș, Peter Olah, Simona Mureșan, Simona Szasz and Cristina Bredicean

J. Clin. Med. 2022, 11(3), 871; https://doi.org/10.3390/jcm11030871 - 7 Feb 2022

Cited by 8 | Viewed by 2970

Abstract

Background: Schizophrenia is one of the most severe disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) spectrum. Negative automatic thoughts (NAT), cognitive fusion (CF), and experiential avoidance (EA), as part of psychological inflexibility (PI), can be considered important dysfunctional cognitive [...] Read more.

Background: Schizophrenia is one of the most severe disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) spectrum. Negative automatic thoughts (NAT), cognitive fusion (CF), and experiential avoidance (EA), as part of psychological inflexibility (PI), can be considered important dysfunctional cognitive processes in schizophrenia. Methods: In the present study, two samples were included: a target group consisting of 41 people with schizophrenia (23 females; aged 44.98 ± 11.74), and a control group consisting of 40 individuals with end-stage chronic kidney disease (CKD) (27 males; aged 60.38 ± 9.14). Results: Differences were found between the two groups, with patients with schizophrenia showing an increased frequency of NAT, as well as higher levels of CF and EA (psychological inflexibility), compared to the control group. NAT were the mediator in the relation between the schizophrenia diagnosis and CF, as well as EA. Conclusion: Individuals with schizophrenia present a specific dysfunctional pattern of cognitive functioning, in which negative automatic thoughts represent a distinctive pathway to cognitive fusion and experiential avoidance. Full article

(This article belongs to the Special Issue Cognitive Behavioral Therapy: Clinical Aspects and New Approaches)

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9 pages, 231 KiB

Open AccessArticle

Factors Associated with Hepatitis B Medication Adherence and Persistence among Underserved Chinese and Vietnamese Americans

by Aisha Bhimla, Lin Zhu, Wenyue Lu, Sarit Golub, Chibuzo Enemchukwu, Elizabeth Handorf, Yin Tan, Ming-Chin Yeh, Minhhuyen T. Nguyen, Min Qi Wang and Grace X. Ma

J. Clin. Med. 2022, 11(3), 870; https://doi.org/10.3390/jcm11030870 - 7 Feb 2022

Cited by 5 | Viewed by 2453

Abstract

Background: Hepatitis B virus (HBV) infection disproportionately affects Asian Americans in the United States, while this population faces low adherence to HBV treatment. Using the information–motivation–behavioral skills model (IMB), the study aims to examine medication adherence and persistence among Chinese and Vietnamese people [...] Read more.

Background: Hepatitis B virus (HBV) infection disproportionately affects Asian Americans in the United States, while this population faces low adherence to HBV treatment. Using the information–motivation–behavioral skills model (IMB), the study aims to examine medication adherence and persistence among Chinese and Vietnamese people with HBV. Methodology: Study participants were recruited between March 2019 and March 2020 and were enrolled through multiple recruitment approaches in the Greater Philadelphia Area and New York City. The study is an assessment of the baseline data on medication adherence, HBV-related knowledge, motivation of HBV medication treatment, self-efficacy about HBV medication treatment, and socioeconomic status. Results: Among 165 participants, 77.6% were Chinese and 22.4% were Vietnamese Americans. HBV-related knowledge/information, motivation, and self-efficacy were all positively associated with having medium/high medication adherence. Multilevel mixed-effects generalized linear regression revealed that living more than 10 years in the U.S. (OR = 4.24; p = 0.028) and greater information–knowledge about HBV (OR = 1.46; p = 0.004) were statistically associated with higher odds of medium/high medication adherence. Moreover, greater HBV-related knowledge/information (OR = 1.49; p = 0.023) and greater motivation towards HBV treatment adherence (OR = 1.10; p = 0.036) were both associated with a higher likelihood of medication persistence. Conclusion: Our findings provided significant implications in designing behavioral interventions focused on self-efficacy, information, and motivation to promote better medication adherence among Asian Americans living with HBV. Full article

(This article belongs to the Topic Infectious Diseases)

4 pages, 172 KiB

Open AccessArticle

MRI-Linac Economics II: Rationalizing Schedules

by Peter A. S. Johnstone, John Kerstiens, Stuart Wasserman and Stephen A. Rosenberg

J. Clin. Med. 2022, 11(3), 869; https://doi.org/10.3390/jcm11030869 - 7 Feb 2022

Cited by 7 | Viewed by 1768

Abstract

Objective: Two benefits of MR-guided radiotherapy (MRgRT) are the ability to track target structures while treatment is being delivered and the ability to adapt plans daily for some lesions based on changing anatomy. These unique capacities come at two costs: increased capital for [...] Read more.

Objective: Two benefits of MR-guided radiotherapy (MRgRT) are the ability to track target structures while treatment is being delivered and the ability to adapt plans daily for some lesions based on changing anatomy. These unique capacities come at two costs: increased capital for acquisition and greatly decreased workflow. An adaptive gated stereotactic body radiotherapy (MRgART) treatment routinely takes ~90 min to perform and requires the presence of both a physician and a physicist. This may significantly limit daily capacity. We previously described how “simple cases” were necessary for proton facilities to allow for debt management. In this manuscript, we seek to determine the optimal scheduling of different MRgRT plans to recoup capital costs. Materials/Methods: We assumed an MR-linac (MRL) was completely scheduled with patients over workdays of varying duration. Treatment times and reimbursement data from our facility for varying complexities of patients were extrapolated for varying numbers treated daily. We then derived the number of adaptive and non-adaptive patients required daily to optimize the schedules. HOPPS data were used to model reimbursement. Results: A single MRL treating 14 non-gated, non-adaptive IMRT patients over an 8 h workday would take about 4.8 years to cover initial acquisition and installation costs. However, such patients may be more quickly and efficiently treated with a conventional linear accelerator, while MRgART cases may only be treated with an MRL. By treating four of these daily, that same MRL room would cover costs in 2.4 years. Personnel, maintenance costs, and profit further complicate any business case for treating non-adaptive patients or for extending hours. Conclusions: In our previously published paper discussing proton therapy, we noted that debt is not variable with capacity; this remains true with MRgRT. Different from protons, a clinically optimal case load of adaptive patients provides an optimal business case as well. This requires a large patient cadre to ensure continuing throughput. As improvements in MRgRT are brought to the clinic, shorter adaptive and non-adaptive treatment times will help improve the timeframe to recoup costs but will require even more appropriate patients. Full article

(This article belongs to the Collection Advances of MRI in Radiation Oncology)

15 pages, 1072 KiB

Open AccessReview

Multimodality Imaging in Cardiomyopathies with Hypertrophic Phenotypes

by Emanuele Monda, Giuseppe Palmiero, Michele Lioncino, Marta Rubino, Annapaola Cirillo, Adelaide Fusco, Martina Caiazza, Federica Verrillo, Gaetano Diana, Alfredo Mauriello, Michele Iavarone, Maria Angela Losi, Maria Luisa De Rimini, Santo Dellegrottaglie, Antonello D’Andrea, Eduardo Bossone, Giuseppe Pacileo and Giuseppe Limongelli

J. Clin. Med. 2022, 11(3), 868; https://doi.org/10.3390/jcm11030868 - 7 Feb 2022

Cited by 21 | Viewed by 5136

Abstract

Multimodality imaging is a comprehensive strategy to investigate left ventricular hypertrophy (LVH), providing morphologic, functional, and often clinical information to clinicians. Hypertrophic cardiomyopathy (HCM) is defined by an increased LV wall thickness not only explainable by abnormal loading conditions. In the context of [...] Read more.

Multimodality imaging is a comprehensive strategy to investigate left ventricular hypertrophy (LVH), providing morphologic, functional, and often clinical information to clinicians. Hypertrophic cardiomyopathy (HCM) is defined by an increased LV wall thickness not only explainable by abnormal loading conditions. In the context of HCM, multimodality imaging, by different imaging techniques, such as echocardiography, cardiac magnetic resonance, cardiac computer tomography, and cardiac nuclear imaging, provides essential information for diagnosis, sudden cardiac death stratification, and management. Furthermore, it is essential to uncover the specific cause of HCM, such as Fabry disease and cardiac amyloidosis, which can benefit of specific treatments. This review aims to elucidate the current role of multimodality imaging in adult patients with HCM. Full article

(This article belongs to the Special Issue Multimodality Imaging in Cardiomyopathies)

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10 pages, 1550 KiB

Open AccessArticle

Additional Lymphaticovenular Anastomosis on the Posterior Side for Treatment of Primary Lower Extremity Lymphedema

by Akitatsu Hayashi, Giuseppe Visconti, Chia-Shen (Johnson) Yang, Nobuko Hayashi and Hidehiko Yoshimatsu

J. Clin. Med. 2022, 11(3), 867; https://doi.org/10.3390/jcm11030867 - 7 Feb 2022

Cited by 5 | Viewed by 2054

Abstract

The efficacy of lymphaticovenular anastomosis (LVA) for the treatment of primary lymphedema has been reported. Previous research suggested the efficacy of LVA on the anterior side of the lower limb, but no research has yet underlined the effectiveness of LVA on the posterior [...] Read more.

The efficacy of lymphaticovenular anastomosis (LVA) for the treatment of primary lymphedema has been reported. Previous research suggested the efficacy of LVA on the anterior side of the lower limb, but no research has yet underlined the effectiveness of LVA on the posterior side. In the present study, we aimed to investigate the efficacy of LVA on the posterior side of the lower leg for treatment of primary lymphedema, i.e., whether further improvement of primary lower extremity lymphedema could be expected by performing LVA on the posterior side of the lower limb in addition to the LVA on the anterior side, which is usually performed. Forty-five patients with primary lower extremity lymphedema who underwent LVA twice between March 2018 and September 2020 were retrospectively investigated. Patients were classified into two groups: those who underwent LVA on the posterior side in the second operation (PoLVA group) and those who underwent LVA on the medial and anterior sides again in the second operation (MeLVA group). All patients underwent LVA on the medial and anterior sides in the first operation, but no sufficient improvement was observed. The following factors in the second operation were compared between the two groups: skin incision length, the number of anastomoses, the diameters of the lymphatic vessels, the time required for the dissection of the lymphatic vessels and veins and the reduction in volume. LVA resulted in 227 anastomoses (106 anastomoses in the PoLVA group and 121 anastomoses in the MeLVA group) in 26 patients with primary lymphedema of the lower extremities in two surgeries. The reduction in lower extremity lymphedema index was significantly greater in the PoLVA group than that in the MeLVA group (10.5 ± 4.5 vs. 5.5 ± 3.6; p = 0.008), and the number of anastomoses in the PoLVA group was significantly lower than that in the MeLVA group (3.5 ± 0.6 vs. 4.6 ± 1.0; p = 0.038). LVA on the posterior side subsequent to LVA on the medial and anterior sides resulted in the further improvement of primary lower extremity lymphedema with fewer numbers of anastomoses. Full article

(This article belongs to the Special Issue Surgical Management of Lymphedema: Past, Present, and Future)

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