Journal of Clinical Medicine

15 pages, 1630 KiB

Open AccessArticle

Mechanical Dyssynchrony Combined with Septal Scarring Reliably Identifies Responders to Cardiac Resynchronization Therapy

by Jürgen Duchenne, Camilla K. Larsen, Marta Cvijic, Elena Galli, John M. Aalen, Boudewijn Klop, Oana Mirea, Alexis Puvrez, Stéphanie Bézy, Laurine Wouters, Lennert Minten, Per A. Sirnes, Faraz H. Khan, Gabor Voros, Rik Willems, Martin Penicka, Erik Kongsgård, Einar Hopp, Jan Bogaert, Otto A. Smiseth, Erwan Donal and Jens-Uwe Voigt Show full author list Hide full author list

J. Clin. Med. 2023, 12(18), 6108; https://doi.org/10.3390/jcm12186108 - 21 Sep 2023

Cited by 3 | Viewed by 1248

Abstract

Background and aim: The presence of mechanical dyssynchrony on echocardiography is associated with reverse remodelling and decreased mortality after cardiac resynchronization therapy (CRT). Contrarily, myocardial scar reduces the effect of CRT. This study investigated how well a combined assessment of different markers of [...] Read more.

Background and aim: The presence of mechanical dyssynchrony on echocardiography is associated with reverse remodelling and decreased mortality after cardiac resynchronization therapy (CRT). Contrarily, myocardial scar reduces the effect of CRT. This study investigated how well a combined assessment of different markers of mechanical dyssynchrony and scarring identifies CRT responders. Methods: In a prospective multicentre study of 170 CRT recipients, septal flash (SF), apical rocking (ApRock), systolic stretch index (SSI), and lateral-to-septal (LW-S) work differences were assessed using echocardiography. Myocardial scarring was quantified using cardiac magnetic resonance imaging (CMR) or excluded based on a coronary angiogram and clinical history. The primary endpoint was a CRT response, defined as a ≥15% reduction in LV end-systolic volume 12 months after implantation. The secondary endpoint was time-to-death. Results: The combined assessment of mechanical dyssynchrony and septal scarring showed AUCs ranging between 0.81 (95%CI: 0.74–0.88) and 0.86 (95%CI: 0.79–0.91) for predicting a CRT response, without significant differences between the markers, but significantly higher than mechanical dyssynchrony alone. QRS morphology, QRS duration, and LV ejection fraction were not superior in their prediction. Predictive power was similar in the subgroups of patients with ischemic cardiomyopathy. The combined assessments significantly predicted all-cause mortality at 44 ± 13 months after CRT with a hazard ratio ranging from 0.28 (95%CI: 0.12–0.67) to 0.20 (95%CI: 0.08–0.49). Conclusions: The combined assessment of mechanical dyssynchrony and septal scarring identified CRT responders with high predictive power. Both visual and quantitative markers were highly feasible and demonstrated similar results. This work demonstrates the value of imaging LV mechanics and scarring in CRT candidates, which can already be achieved in a clinical routine. Full article

(This article belongs to the Special Issue Finding New Insights in Cardiac Resynchronization Therapy and the Pathophysiology behind Left Ventricular Dyssynchrony)

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Graphical abstract

34 pages, 2035 KiB

Open AccessReview

A Modern Approach to Treat Molar/Incisor Pattern Periodontitis—Review

by Taewan J. Kim, Caroline G. Littlejohn, Kristen H. Richey, Neda Falsafi, Chenshuang Li, Tun-Jan Wang, Bradley Lander and Yu-Cheng Chang

J. Clin. Med. 2023, 12(18), 6107; https://doi.org/10.3390/jcm12186107 - 21 Sep 2023

Cited by 4 | Viewed by 6978

Abstract

Molar–incisor pattern periodontitis (MIPP) is a severe form of periodontal disease characterized by rapid attachment loss and bone destruction affecting the molars and incisors. Formerly referred to as aggressive periodontitis, the terminology for this condition was revised after the 2017 workshop on the [...] Read more.

Molar–incisor pattern periodontitis (MIPP) is a severe form of periodontal disease characterized by rapid attachment loss and bone destruction affecting the molars and incisors. Formerly referred to as aggressive periodontitis, the terminology for this condition was revised after the 2017 workshop on the classification of periodontal and peri-implant diseases and conditions. Despite the modification in nomenclature, the treatment strategies for MIPP remain a critical area of investigation. The core principles of MIPP treatment involve controlling local and systemic risk factors, managing inflammation, and arresting disease progression. Traditional non-surgical periodontal therapy, including scaling and root planing, is commonly employed as an initial step together with the prescription of antibiotics. Surgical intervention may be necessary to address the severe attachment loss. Surgical techniques like resective and regenerative procedures can aid in achieving periodontal health and improving esthetic outcomes. This review article aims to provide an overview of the current understanding and advancements in the treatment modalities of MIPP. Through an extensive analysis of the existing literature, we discuss various modern therapeutic approaches that have been explored for managing this challenging periodontal condition. Full article

(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)

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13 pages, 693 KiB

Open AccessArticle

Serum YKL-40 Levels, Leukocyte Profiles, and Acute Exacerbations of Advanced COPD

by Romana Olivia Popețiu, Imola Donath-Miklos, Simona Maria Borta, Larisa Alexandra Rus, Anamaria Vîlcea, Dragoș Vasile Nica and Maria Pușchiță

J. Clin. Med. 2023, 12(18), 6106; https://doi.org/10.3390/jcm12186106 - 21 Sep 2023

Cited by 3 | Viewed by 1252

Abstract

Little information exists on YKL-40—a key protein in tissue remodeling—and complete blood count (CBC) parameters during acute exacerbations of advanced chronic obstructive pulmonary disease (COPD). This pilot exploratory study (August 2020–January 2021) investigated the connection between serum YKL-40 levels and CBC profile in [...] Read more.

Little information exists on YKL-40—a key protein in tissue remodeling—and complete blood count (CBC) parameters during acute exacerbations of advanced chronic obstructive pulmonary disease (COPD). This pilot exploratory study (August 2020–January 2021) investigated the connection between serum YKL-40 levels and CBC profile in sex- and age-matched individuals with severe COPD (GOLD stage III, n = 23, median age = 66 years, 65.21% males) and very severe COPD (GOLD stage IV, n = 24, median age = 66.5 years, 74.81% males). The measured parameters were serum YKL-40, absolute leukocyte count (ALLC), absolute neutrophil count (ANC), neutrophil percentage, absolute lymphocyte count (ALC), lymphocyte percentage, neutrophil-to-lymphocyte ratio (NLR), absolute eosinophil count (AEC), eosinophil percentage, absolute monocyte count (AMC), monocyte percentage, absolute basophil count (ABC), basophil percentage, hemoglobin levels, and hematocrit concentrations. No significant inter-group differences were observed. However, high YKL-40 subjects (n = 23)—as stratified via median YKL-40 (3934.5 pg/mL)—showed significantly increased neutrophil percentage and NLR but significantly lower lymphocyte-, eosinophil-, and basophil-related parameters compared to low YKL-40 patients (n = 24). These results reveal multidimensional, YKL-40-associated changes in leukocyte profile of patients with advanced COPD during acute exacerbations, with potential implications for personalized treatment. Full article

(This article belongs to the Section Pulmonology)

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18 pages, 2047 KiB

Open AccessFeature PaperReview

Heart Failure in Patients with Chronic Kidney Disease

by Andrew Xanthopoulos, Adamantia Papamichail, Alexandros Briasoulis, Konstantinos Loritis, Angeliki Bourazana, Dimitrios E. Magouliotis, Pantelis Sarafidis, Ioannis Stefanidis, John Skoularigis and Filippos Triposkiadis

J. Clin. Med. 2023, 12(18), 6105; https://doi.org/10.3390/jcm12186105 - 21 Sep 2023

Cited by 10 | Viewed by 3293

Abstract

The function of the kidney is tightly linked to the function of the heart. Dysfunction/disease of the kidney may initiate, accentuate, or precipitate of the cardiac dysfunction/disease and vice versa, contributing to a negative spiral. Further, the reciprocal association between the heart and [...] Read more.

The function of the kidney is tightly linked to the function of the heart. Dysfunction/disease of the kidney may initiate, accentuate, or precipitate of the cardiac dysfunction/disease and vice versa, contributing to a negative spiral. Further, the reciprocal association between the heart and the kidney may occur on top of other entities, usually diabetes, hypertension, and atherosclerosis, simultaneously affecting the two organs. Chronic kidney disease (CKD) can influence cardiac function through altered hemodynamics and salt and water retention, leading to venous congestion and therefore, not surprisingly, to heart failure (HF). Management of HF in CKD is challenging due to several factors, including complex interplays between these two conditions, the effect of kidney dysfunction on the metabolism of HF medications, the effect of HF medications on kidney function, and the high risk for anemia and hyperkalemia. As a result, in most HF trials, patients with severe renal impairment (i.e., eGFR 30 mL/min/1.73 m² or less) are excluded. The present review discusses the epidemiology, pathophysiology, and current medical management in patients with HF developing in the context of CKD. Full article

(This article belongs to the Special Issue Review Special Issue Series: Recent Advances in Cardiovascular Medicine)

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11 pages, 1003 KiB

Open AccessArticle

Umbilical Granuloma: Frequency, Associated Factors, 10-Year Treatment Trends, and Effectiveness at a Single Hospital in Japan

by Shigeo Iijima

J. Clin. Med. 2023, 12(18), 6104; https://doi.org/10.3390/jcm12186104 - 21 Sep 2023

Cited by 1 | Viewed by 1628

Abstract

Umbilical granuloma (UG) is a common problem during the neonatal period; however, its epidemiology and etiology are poorly studied, and the best treatment option has not yet been established. We examined the medical records of neonates who were born and underwent 1-month evaluations [...] Read more.

Umbilical granuloma (UG) is a common problem during the neonatal period; however, its epidemiology and etiology are poorly studied, and the best treatment option has not yet been established. We examined the medical records of neonates who were born and underwent 1-month evaluations at our hospital between 2013 and 2022 to investigate the frequency of—and factors associated with—UG, as well as the annual trends of UG treatments and their efficacy. Of the 6680 eligible neonates, 395 (5.9%) had UG. The annual incidence rate ranged from 3.8% to 7.3%. Gestational age, birth weight, and incidence of meconium-stained amniotic fluid were significantly associated with UG. Silver nitrate cauterization was the predominant UG treatment from 2013 to 2016. Silver nitrate cauterization and topical betamethasone valerate were nearly equally applied in 2017. Betamethasone application became predominant in 2018. The healing rates during the initial treatment period were 91% for silver nitrate cauterization, 97.7% for betamethasone application, 60% for ethanol disinfection, and 88% for ligation; these rates were significantly different (p < 0.001). Topical steroid application may be the most effective treatment. If steroid application is ineffective, then silver nitrate cauterization and ligation may be important treatment options. Full article

(This article belongs to the Special Issue Pathogenesis, Diagnostics, and Therapeutics in Neonatal and Pediatric Diseases: Prospective and Retrospective Clinical Studies)

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12 pages, 1804 KiB

Open AccessArticle

COVID-19 Outcomes in Kidney Transplant Recipients in a German Transplant Center

by Michael Mikhailov, Klemens Budde, Fabian Halleck, Georgios Eleftheriadis, Marcel G. Naik, Eva Schrezenmeier, Friederike Bachmann, Mira Choi, Wiebke Duettmann, Ellen von Hoerschelmann, Nadine Koch, Lutz Liefeldt, Christian Lücht, Henriette Straub-Hohenbleicher, Johannes Waiser, Ulrike Weber, Bianca Zukunft and Bilgin Osmanodja

J. Clin. Med. 2023, 12(18), 6103; https://doi.org/10.3390/jcm12186103 - 21 Sep 2023

Cited by 1 | Viewed by 1261

Abstract

Kidney transplant recipients (KTRs) show higher morbidity and mortality from COVID-19 than the general population and have an impaired response to vaccination. We analyzed COVID-19 incidence and clinical outcomes in a single-center cohort of approximately 2500 KTRs. Between 1 February 2020 and 1 [...] Read more.

Kidney transplant recipients (KTRs) show higher morbidity and mortality from COVID-19 than the general population and have an impaired response to vaccination. We analyzed COVID-19 incidence and clinical outcomes in a single-center cohort of approximately 2500 KTRs. Between 1 February 2020 and 1 July 2022, 578 KTRs were infected with SARS-CoV-2, with 25 (4%) recurrent infections. In total, 208 KTRs (36%) were hospitalized, and 39 (7%) died. Among vaccinated patients, infection with the Omicron variant had a mortality of 2%. Unvaccinated patients infected with the Omicron variant showed mortality (9% vs. 11%) and morbidity (hospitalization 52% vs. 54%, ICU admission 12% vs. 18%) comparable to the pre-Omicron era. Multivariable analysis revealed that being unvaccinated (OR = 2.15, 95% CI [1.38, 3.35]), infection in the pre-Omicron era (OR = 3.06, 95% CI [1.92, 4.87]), and higher patient age (OR = 1.04, 95% CI [1.03, 1.06]) are independent risk factors for COVID-19 hospitalization, whereas a steroid-free immunosuppressive regimen was found to reduce the risk of COVID-19 hospitalization (OR = 0.51, 95% CI [0.33, 0.79]). This suggests that both virological changes in the Omicron variant and vaccination reduce the risk for morbidity and mortality from COVID-19 in KTRs. Our data extend the knowledge from the general population to KTRs and provide important insights into outcomes during the Omicron era. Full article

(This article belongs to the Section Nephrology & Urology)

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17 pages, 2865 KiB

Open AccessArticle

Hand Eczema in the Polish Female Population

by Agnieszka Polecka, Andrzej Awchimkow, Natalia Owsianko, Anna Baran, Justyna Magdalena Hermanowicz and Iwona Flisiak

J. Clin. Med. 2023, 12(18), 6102; https://doi.org/10.3390/jcm12186102 - 21 Sep 2023

Cited by 1 | Viewed by 1104

Abstract

Background: This study aims to investigate the prevalence of hand eczema, its association with disinfectant usage during the COVID-19 pandemic, and potential correlations with age and dermatological history on hand symptoms in the Polish female population. Methods: A personalized online questionnaire was administered [...] Read more.

Background: This study aims to investigate the prevalence of hand eczema, its association with disinfectant usage during the COVID-19 pandemic, and potential correlations with age and dermatological history on hand symptoms in the Polish female population. Methods: A personalized online questionnaire was administered from January to March 2021 to 142 participants, including individuals with hand eczema. The questionnaire addressed demographics, dermatological history, disinfectant usage, and symptoms experienced during the pandemic. Results: The prevalence of hand eczema was higher in younger adults (aged 18–35), with significant exacerbations reported due to increased disinfectant usage. Respondents with a dermatological history were more susceptible to new skin symptoms during the pandemic. The quality of life was substantially impacted, particularly in individuals with hand skin dermatoses. Conclusions: The COVID-19 pandemic had a considerable influence on hand eczema, affecting prevalence, symptoms, and quality of life. Disinfectant usage emerged as a key factor in exacerbating hand skin lesions. Further research is warranted to explore the influence of specific disinfecting agents and improve treatment guidelines for personalized management of hand eczema. Despite limitations in the online survey method, these findings highlight the importance of proactive healthcare support for individuals with hand eczema during challenging times. Full article

(This article belongs to the Section Dermatology)

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19 pages, 721 KiB

Open AccessReview

Neuropsychiatric and Neuropsychological Aspects of Alcohol-Related Cognitive Disorders: An In-Depth Review of Wernicke’s Encephalopathy and Korsakoff’s Syndrome

by Lucian Eva, Felix-Mircea Brehar, Ioan-Alexandru Florian, Razvan-Adrian Covache-Busuioc, Horia Petre Costin, David-Ioan Dumitrascu, Bogdan-Gabriel Bratu, Luca-Andrei Glavan and Alexandru Vlad Ciurea

J. Clin. Med. 2023, 12(18), 6101; https://doi.org/10.3390/jcm12186101 - 21 Sep 2023

Cited by 3 | Viewed by 4555

Abstract

Alcohol-related cognitive disorders have long been an area of study, yet they continue to pose challenges in the diagnosis, treatment, and understanding of underlying neuropsychiatric mechanisms. The present article offers a comprehensive review of Wernicke’s Encephalopathy and Korsakoff’s Syndrome, two conditions often seen [...] Read more.

Alcohol-related cognitive disorders have long been an area of study, yet they continue to pose challenges in the diagnosis, treatment, and understanding of underlying neuropsychiatric mechanisms. The present article offers a comprehensive review of Wernicke’s Encephalopathy and Korsakoff’s Syndrome, two conditions often seen on a continuum of alcohol-related brain damage. Drawing on current medical literature, neuroimaging studies, and clinical case reports, we explore the neuropsychiatric and neuropsychological profiles, symptomatology, and differential diagnoses of these disorders. We delve into the biochemical pathways implicated in the development of WE and KS, notably thiamine deficiency and its impact on neurotransmitter systems and neural networks. The article also addresses the challenges in early diagnosis, often complicated by non-specific symptoms and co-occurring psychiatric conditions. Furthermore, we review the current state of treatment protocols, including pharmacological and non-pharmacological interventions. Finally, the article highlights gaps in current knowledge and suggests directions for future research to improve diagnosis, treatment, and patient outcomes. Understanding the nuanced interplay between the neuropsychiatric and neuropsychological aspects of WE and KS is crucial for both clinicians and researchers alike, in order to provide effective treatment and to advance our understanding of these complex conditions. Full article

(This article belongs to the Special Issue Wernicke's Encephalopathy and Korsakoff's Syndrome)

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17 pages, 3063 KiB

Open AccessArticle

Comparison of Surgical Risk Scores in a European Cohort of Patients with Advanced Chronic Liver Disease

by Lidia Canillas, Amalia Pelegrina, Elena Colominas-González, Aina Salis, César J. Enríquez-Rodríguez, Xavier Duran, Antonia Caro, Juan Álvarez and José A. Carrión

J. Clin. Med. 2023, 12(18), 6100; https://doi.org/10.3390/jcm12186100 - 21 Sep 2023

Cited by 2 | Viewed by 1231

Abstract

Patients with advanced chronic liver disease (ACLD) or cirrhosis undergoing surgery have an increased risk of morbidity and mortality in contrast to the general population. This is a retrospective, observational study to evaluate the predictive capacity of surgical risk scores in European patients [...] Read more.

Patients with advanced chronic liver disease (ACLD) or cirrhosis undergoing surgery have an increased risk of morbidity and mortality in contrast to the general population. This is a retrospective, observational study to evaluate the predictive capacity of surgical risk scores in European patients with ACLD. Cirrhosis was defined by the presence of thrombocytopenia with <150,000/uL and splenomegaly, and AST-to-Platelet Ratio Index >2, a nodular liver edge seen via ultrasound, transient elastography of >15 kPa, and/or signs of portal hypertension. We assessed variables related to 90-day mortality and the discrimination and calibration of current surgical scores (Child-Pugh, MELD-Na, MRS, NSQIP, and VOCAL-Penn). Only patients with ACLD and major surgeries included in VOCAL-Penn were considered (n = 512). The mortality rate at 90 days after surgery was 9.8%. Baseline disparities between the H. Mar and VOCAL-Penn cohorts were identified. Etiology, obesity, and platelet count were not associated with mortality. The VOCAL-Penn showed the best discrimination (C-statistic_90D = 0.876) and overall predictive capacity (Brier_90D = 0.054), but calibration was not excellent in our cohort. VOCAL-Penn was suboptimal in patients with diabetes (C-statistic_30D = 0.770), without signs of portal hypertension (C-statistic_30D = 0.555), or with abdominal wall (C-statistic_30D = 0.608) or urgent (C-statistic_180D = 0.692) surgeries. Our European cohort has shown a mortality rate after surgery similar to those described in American studies. However, some variables included in the VOCAL-Penn score were not associated with mortality, and VOCAL-Penn’s discriminative ability decreases in patients with diabetes, without signs of portal hypertension, and with abdominal wall or urgent surgeries. These results should be validated in larger multicenter and prospective studies. Full article

(This article belongs to the Topic Advances in Gastrointestinal and Liver Disease: From Physiological Mechanisms to Clinical Practice)

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13 pages, 2716 KiB

Open AccessArticle

Effect of High-Intensity Rosuvastatin vs. Combination of Low-Intensity Rosuvastatin and Ezetimibe on HbA1c Levels in Patients without Diabetes: A Randomized IDEAL Trial

by Jeongcheon Choe, Sun-Hack Lee, Jinhee Ahn, Hyewon Lee, Jun-Hyok Oh, Junghyun Choi, Hancheol Lee, Kwangsoo Cha and Jinsup Park

J. Clin. Med. 2023, 12(18), 6099; https://doi.org/10.3390/jcm12186099 - 21 Sep 2023

Cited by 1 | Viewed by 2157

Abstract

There is a dearth of studies investigating whether the combination of low-intensity statins with ezetimibe can reduce the risk of diabetes in patients requiring statin therapy. Therefore, we aimed to evaluate the effects of combination therapy on the prevention of glycated hemoglobin (HbA1c) [...] Read more.

There is a dearth of studies investigating whether the combination of low-intensity statins with ezetimibe can reduce the risk of diabetes in patients requiring statin therapy. Therefore, we aimed to evaluate the effects of combination therapy on the prevention of glycated hemoglobin (HbA1c) elevation in patients without diabetes. Sixty-eight patients were randomly assigned in a 1:1 ratio to receive a combination of low-intensity rosuvastatin (5 mg/day) and ezetimibe (10 mg/day) or high-intensity rosuvastatin (20 mg/day). The primary endpoint was the absolute difference in the HbA1c levels at 12 weeks. The HbA1c level showed an overall elevation of 0.11% at 12 weeks compared to that at baseline (mean ± standard deviation: 5.78 ± 0.3%, 95% confidence interval [CI]: 5.86–6.07, p = 0.044). The HbA1c levels did not differ between the groups at 12 weeks (least square mean difference: 0.001, 95% CI: 0.164–0.16, p = 0.999). Our study found that the combination of low-intensity rosuvastatin and ezetimibe did not yield significant differences in HbA1c levels compared to high-intensity rosuvastatin alone after 12 weeks in patients without diabetes. This suggests that the combination of low-intensity rosuvastatin and ezetimibe may not be an effective strategy for preventing HbA1c elevation in patients without diabetes requiring statins. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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14 pages, 3448 KiB

Open AccessReview

Outcomes of CAR-T Cell Therapy Recipients Admitted to the ICU: In Search for a Standard of Care—A Brief Overview and Meta-Analysis of Proportions

by Catalin Constantinescu, Vlad Moisoiu, Bogdan Tigu, David Kegyes and Ciprian Tomuleasa

J. Clin. Med. 2023, 12(18), 6098; https://doi.org/10.3390/jcm12186098 - 21 Sep 2023

Cited by 1 | Viewed by 1840

Abstract

Objective: Our primary objective was to describe the baseline characteristics, main reasons for intensive care unit (ICU) admission, and interventions required in the ICU across patients who received CAR-T cell immunotherapy. The secondary objectives were to evaluate different outcomes (ICU mortality) across patients [...] Read more.

Objective: Our primary objective was to describe the baseline characteristics, main reasons for intensive care unit (ICU) admission, and interventions required in the ICU across patients who received CAR-T cell immunotherapy. The secondary objectives were to evaluate different outcomes (ICU mortality) across patients admitted to the ICU after having received CAR-T cell therapy. Materials and Methods. We performed a medical literature review, which included MEDLINE, Embase, and Cochrane Library, of studies published from the inception of the databases until 2022. We conducted a systematic review with meta-analyses of proportions of several studies, including CAR-T cell-treated patients who required ICU admission. Outcomes in the meta-analysis were evaluated using the random-effects model. Results: We included four studies and analyzed several outcomes, including baseline characteristics and ICU-related findings. CAR-T cell recipients admitted to the ICU are predominantly males (62% CI-95% (57–66)). Of the total CAR-T cell recipients, 4% CI-95% (3–5) die in the hospital, and 6% CI-95% (4–9) of those admitted to the ICU subsequently die. One of the main reasons for ICU admission is acute kidney injury (AKI) in 15% CI-95% (10–19) of cases and acute respiratory failure in 10% CI-95% (6–13) of cases. Regarding the interventions initiated in the ICU, 18% CI-95% (13–22) of the CAR-T recipients required invasive mechanical ventilation during their ICU stay, 23% CI-95% (16–30) required infusion of vasoactive drugs, and 1% CI-95% (0.1–3) required renal replacement therapy (RRT). 18% CI-95% (13–22) of the initially discharged patients were readmitted to the ICU within 30 days, and the mean length of hospital stay is 22 days CI-95% (19–25). The results paint a current state of matter in CAR-T cell recipients admitted to the ICU. Conclusions: To better understand immunotherapy-related complications from an ICU standpoint, acknowledge the deteriorating patient on the ward, reduce the ICU admission rate, advance ICU care, and improve the outcomes of these patients, a standard of care and research regarding CAR-T cell-based immunotherapies should be created. Studies that are looking from the perspective of intensive care are highly warranted because the available literature regarding this area is scarce. Full article

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

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10 pages, 282 KiB

Open AccessFeature PaperArticle

Perinatal Outcomes of Monochorionic Twin Pregnancies Conceived Naturally Versus through Assisted Reproductive Techniques

by Alicia Martínez-Varea, Martha Martínez-Gómez, Blanca Novillo, Josep Domenech, José Morales-Roselló and Vicente Diago-Almela

J. Clin. Med. 2023, 12(18), 6097; https://doi.org/10.3390/jcm12186097 - 21 Sep 2023

Cited by 1 | Viewed by 1441

Abstract

Objective: It has been reported that monochorionic twin pregnancies conceived through assisted reproductive techniques (ART) display a higher risk of second-trimester miscarriage, cesarean delivery, and neonatal death than those conceived naturally. The aim of this study was to compare the perinatal outcomes [...] Read more.

Objective: It has been reported that monochorionic twin pregnancies conceived through assisted reproductive techniques (ART) display a higher risk of second-trimester miscarriage, cesarean delivery, and neonatal death than those conceived naturally. The aim of this study was to compare the perinatal outcomes of monochorionic diamniotic (MCDA) twin pregnancies conceived naturally and through ART in a tertiary hospital. Methods: This was a retrospective cohort study of all MCDA twin pregnancies that received obstetric care and delivered at La Fe University and Polytechnic Hospital between 2015 and 2021. MCDA pregnancies that were referred to the tertiary hospital for specialized management, follow-up, and delivery were also included. The study was approved by The Health Research Institute Hospital La Fe (IIS La Fe). Results: Among the 184 MCDA pregnancies, 149 (81%) had a natural conception, and 35 (19%) were conceived through ART. Patients with an MCDA pregnancy who conceived through ART had a significantly older maternal age (38.0 [35.5–42.5] vs. 32.0 [29.0–36.0], p < 0.001) and an elevated rate of nulliparity (80.0% vs. 50.3%, p = 0.001). Regarding pregnancy complications, MCDA pregnancies through ART were associated with a significantly higher incidence of gestational diabetes (22.9% vs. 2.7%, p < 0.001), hypertensive disorders during pregnancy (22.9% vs. 9.4%, p = 0.04), and other pregnancy complications such as threatened labor or preterm prelabor rupture of membranes (14.3% vs. 36.2%, p = 0.015), than naturally conceived MCDA pregnancies. No differences were found in the incidence of twin-to-twin transfusion syndrome (20% vs. 33.6%, p = 0.155). MCDA pregnancies through natural conception had a greater rate of vaginal delivery than MCDA through ART (16.8% vs. 2.9%, p = 0.032). When adjusted for confounding factors, MCDA pregnancies through ART were only more likely to develop gestational diabetes than those naturally conceived (aOR 7.86, 95% CI 1.55–39.87). No differences were found regarding neonatal outcomes between groups. Conclusions: Compared with naturally conceived MCDA twin pregnancies, those conceived through ART displayed a significantly higher risk of developing gestational diabetes. No differences regarding other pregnancy complications, mode of delivery, or neonatal outcomes were found between groups. Full article

(This article belongs to the Special Issue Clinical Management of Twin and Multiple Pregnancies)

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7 pages, 261 KiB

Open AccessArticle

by Maximiliano Barahona, Felipe Bustos, Tomás Navarro, Pablo Chamorro, Macarena Alejandra Barahona, Sebastián Carvajal, Julian Brañes, Jaime Hinzpeter, Cristian Barrientos and Carlos Infante

J. Clin. Med. 2023, 12(18), 6096; https://doi.org/10.3390/jcm12186096 - 21 Sep 2023

Cited by 4 | Viewed by 1130

Abstract

Background: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are effective treatments for severe knee and hip osteoarthritis. Historically, TKA has been associated with lower satisfaction than THA, but recent advances in knee surgery have led to lower dissatisfaction rates. This study [...] Read more.

Background: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are effective treatments for severe knee and hip osteoarthritis. Historically, TKA has been associated with lower satisfaction than THA, but recent advances in knee surgery have led to lower dissatisfaction rates. This study aimed to compare the satisfaction and self-reported improvement in the quality of life of two cohorts of patients who underwent TKA and THA, respectively. Methods: This observational study compared two previously published cohorts of patients who underwent THA and TKA in a single university center. The Goodman scale was used to assess satisfaction and self-perception of improved quality of life after TKA and THA at a minimum one-year follow-up. Propensity score matching was used to balance age, gender, and follow-up between groups. Significance was set at 0.05. Results: The study included a total of 105 THAs and 131 TKAs. Both groups had high levels of satisfaction with pain relief, ability to do house/yard work, and overall satisfaction, with above 90% satisfaction rates. Regarding improvement in quality of life, both groups had 86% of patients reporting improvement as “much better.” After propensity score matching, no significant difference was found between THA and TKA for any of the comparisons made using the Goodman scale. Conclusions: The study showed that both TKA and THA resulted in high levels of satisfaction and improvement in quality of life. There was no significant difference in satisfaction rates between TKA and THA, contrary to the historical trend of lower satisfaction rates for TKA. Full article

(This article belongs to the Special Issue Latest Advances in Clinical Diagnosis and Treatment of Hip and Knee Osteoarthritis)

14 pages, 1076 KiB

Open AccessArticle

Bariatric Surgery Outcomes in Patients with Chronic Kidney Disease

by Adriana Pané, Maria Claro, Alicia Molina-Andujar, Romina Olbeyra, Bárbara Romano-Andrioni, Laura Boswell, Enrique Montagud-Marrahi, Amanda Jiménez, Ainitze Ibarzabal, Judith Viaplana, Pedro Ventura-Aguiar, Antonio J. Amor, Josep Vidal, Lilliam Flores and Ana de Hollanda

J. Clin. Med. 2023, 12(18), 6095; https://doi.org/10.3390/jcm12186095 - 21 Sep 2023

Cited by 2 | Viewed by 1616

Abstract

Obesity increases the risk of developing chronic kidney disease (CKD), which has a major negative impact on global health. Bariatric surgery (BS) has demonstrated a substantial improvement of obesity-related comorbidities and thus, it has emerged as a potential therapeutic tool in order to [...] Read more.

Obesity increases the risk of developing chronic kidney disease (CKD), which has a major negative impact on global health. Bariatric surgery (BS) has demonstrated a substantial improvement of obesity-related comorbidities and thus, it has emerged as a potential therapeutic tool in order to prevent end-stage renal disease. A limited number of publications to date have examined the beneficial effects and risks of BS in patients with non-advanced stages of CKD. We aimed to investigate the safety of BS in patients with CKD stages 3–4 (directly related or not to obesity) and both the metabolic/renal outcomes post-BS. A total of 57 individuals were included (n = 19 for CKD-group; n = 38 for patients with obesity, but normal eGFR [control-group]). Weight loss and obesity comorbidities resolution after BS were similar in both groups. Renal function (eGFR [CKD-EPI]) improved significantly at the 1-year follow-up: Δ10.2 (5.2–14.9) (p < 0.001) for CKD-group and Δ4.0 (−3.9–9.0) mL/min/1.73 m² (p = 0.043) for controls. Although this improvement tended to decrease in the 5-year follow-up, eGFR remained above its basal value for the CKD-group. Noteworthy, eGFR also improved in those patients who presented CKD not directly attributed to obesity. For patients with CKD, BS appears to be safe and effective regarding weight loss and obesity comorbidities resolution, irrespective of the main cause of CKD (related or not to obesity). Full article

(This article belongs to the Section General Surgery)

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24 pages, 2938 KiB

Open AccessArticle

Subfertility as Overlapping of Nutritional, Endocrine, Immune, and Cardiometabolic Dysregulations—A Study Focused on Biochemical Endophenotypes of Subfertile Couples

by Tadeusz Wasilewski, Jolanta Wasilewska, Marta Łukaszewicz-Zając and Barbara Mroczko

J. Clin. Med. 2023, 12(18), 6094; https://doi.org/10.3390/jcm12186094 - 21 Sep 2023

Cited by 1 | Viewed by 2219

Abstract

Subfertility is a global health issue, and as many as 30% of cases are attributed to unexplained reasons. A hypercaloric, high-fat diet stimulates the expansion of pro-inflammatory gut microbiota with a consequent rise in circulating lipopolysaccharides. Adverse gut microbiota remodeling can exacerbate insulin [...] Read more.

Subfertility is a global health issue, and as many as 30% of cases are attributed to unexplained reasons. A hypercaloric, high-fat diet stimulates the expansion of pro-inflammatory gut microbiota with a consequent rise in circulating lipopolysaccharides. Adverse gut microbiota remodeling can exacerbate insulin resistance, while sex and thyroid hormones may influence the variability in gut microbiota. This cross-sectional study included 150 participants and was designed to determine a biochemical, nutritional-related pattern that may distinguish subfertile from fertile individuals and couples. A panel of 28 biomarkers was assessed. Four biochemical phenotypes of unexplained subfertility were found, including two metabolic and two immune, when assessed using binary logistic regression models. Two phenotypes were distinguished in women: cardio-metabolic with atherogenic dyslipidemia (_LowHDL-cholesterol: OR = 10.9; p < 0.05) and autoimmune thyroid disorder (_Highanti-thyroid-peroxidase: OR = 5.5; p < 0.05) and two in men: hepato-metabolic with elevated liver injury enzymes (_HighHOMA-IR: OR = 6.1; p < 0.05) and immune type-2 response (_HighIgE: OR = 6.4; p < 0.05). The chances of a couple’s subfertility rose with the number of laboratory components of metabolic syndrome in the couple (OR = 1.7; p < 0.05) and if at least one partner had an elevated total IgE level (>100 kU/L) (OR = 6.5; p < 0.05). This study found that unexplained subfertility may be accompanied by mutually overlapping immune and metabolic dysregulations in individuals and couples. We propose one-time laboratory diagnostics taking into account the lipid profile, insulin resistance, anti-thyroid-peroxidase, and total IgE in both males and females with unexplained subfertility. This may allow for a one-time assessment of targeted medical and nutritional interventions and help optimize patients’ health. The gut–organ axes related to subfertility are discussed in the context of the obtained results. Full article

(This article belongs to the Section Reproductive Medicine & Andrology)

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5 pages, 212 KiB

Open AccessEditorial

Hypertrophic Cardiomyopathy—Current Challenges and Future Perspectives

by Emanuele Monda, Giuseppe Limongelli and Francesco Pelliccia

J. Clin. Med. 2023, 12(18), 6093; https://doi.org/10.3390/jcm12186093 - 21 Sep 2023

Cited by 2 | Viewed by 1229

Abstract

Hypertrophic cardiomyopathy (HCM) is a myocardial disorder characterized by left ventricular (LV) hypertrophy, which cannot be entirely attributed to loading conditions such as valve or congenital heart disease or hypertension [...] Full article

(This article belongs to the Special Issue Hypertrophic Cardiomyopathy—Current Challenges and Future Perspectives)

15 pages, 5819 KiB

Open AccessReview

Nonspecific Gastrointestinal Symptoms as the First Sign of Ganglioneuroblastoma Intermixed—Case Report and Literature Review

by Łukasz Lipiński, Justyna Lipińska, Maria Kowalczuk, Izabela Kopeć, Magdalena Maria Woźniak, Joanna Mitek-Palusińska and Małgorzata Mitura-Lesiuk

J. Clin. Med. 2023, 12(18), 6092; https://doi.org/10.3390/jcm12186092 - 21 Sep 2023

Viewed by 1652

Abstract

Nonspecific gastrointestinal symptoms remain a problem for pediatricians because, out of a thousand trivial cases, there are rare diseases that require in-depth diagnostics and extensive knowledge to identify them. These complaints may be caused by a neoplastic process. We present the case of [...] Read more.

Nonspecific gastrointestinal symptoms remain a problem for pediatricians because, out of a thousand trivial cases, there are rare diseases that require in-depth diagnostics and extensive knowledge to identify them. These complaints may be caused by a neoplastic process. We present the case of a 5-year-old boy whose diagnostic pathway lasted about 3 months. He was admitted to hospital due to severe abdominal pain. Physical examination revealed a bloated, hard, and painful abdomen. In the standing X-ray, the features of intestinal obstruction were visualized. An ultrasound examination showed a possible malignant lesion in the location of the left adrenal gland. After the surgical removal of the pathological mass and histopathological examination, the diagnosis of ganglioneuroblastoma intermixed was made. This tumor, along with neuroblastoma, ganglioneuroma, and ganglioneuroblastoma nodular, belongs to neuroblastic tumors (NTs), which originate from primitive cells of the sympathetic nervous system. NTs are quite rare, but they are still the majority of extracranial solid tumors in children, and their symptoms often appear relatively late when the neoplastic process is already advanced. The purpose of this review is to present current information about ganglioneuroblastoma, with a special emphasis on nonspecific gastrointestinal symptoms as first sign of this tumor and its diagnostics. Full article

(This article belongs to the Section Oncology)

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8 pages, 1406 KiB

Open AccessArticle

Retroperitoneal Single-Port Robot-Assisted Nephroureterectomy with Bladder Cuff Excision: Initial Experience and Description of the Technique

by Seokhwan Bang, Hyuk Jin Cho, U-Syn Ha, Ji Youl Lee and Sung-Hoo Hong

J. Clin. Med. 2023, 12(18), 6091; https://doi.org/10.3390/jcm12186091 - 21 Sep 2023

Cited by 2 | Viewed by 1614

Abstract

Background: With the introduction of the single-port (SP) robot, surgery that was difficult to attempt is becoming possible. Nephroureterectomy (NUx) for upper tract urothelial carcinoma also seems to be able to attempt a retroperitoneal (RP) approach. Purpose: to investigate the feasibility of SP [...] Read more.

Background: With the introduction of the single-port (SP) robot, surgery that was difficult to attempt is becoming possible. Nephroureterectomy (NUx) for upper tract urothelial carcinoma also seems to be able to attempt a retroperitoneal (RP) approach. Purpose: to investigate the feasibility of SP robotic RP NUx with bladder cuff excision. Design, setting, and participants: we sequentially analyzed 20 patients who underwent SP robot NUx from January 2021 to December 2022. Surgical procedure: all patients were diagnosed with upper tract urothelial carcinoma (UTUC) and were operated upon by a single expert using the da Vinci SP platform (Intuitive Surgical, Sunnyvale, CA, USA) with retroperitoneal approach. Results and limitations: A total of 20 patients underwent SP robotic NUx with bladder cuff excision. The mean age of patients was 69.45 ± 8.68 years, and the mean body mass index (BMI) was 25.37 ± 3.00 kg/m². The mean tumor size was 2.42 ± 1.03 cm on a CT scan, with right-sided tumors in eight patients (40%) and left-sided tumors in 12 patients (60%). The median console time was 106 min and 40 s, and the expected blood loss was 122.50 ± 75.18 mL. Final pathology showed that all of the patients were diagnosed as having urothelial carcinoma; one patient was classified as Ta (5.00%), three patients were classified as T1 (15.00%), seven patients were classified as T2 (35.00%), eight patients were classified as T3 (40.00%), and one patient was classified as T4 (5.00%). None of these 20 patients showed any complications based on the Clavien–Dindo scale. Conclusions: SP robotic NUx using a retroperitoneal approach provides feasible perioperative and postoperative outcomes for UTUC. Full article

(This article belongs to the Special Issue Robot-Assisted Surgery in Urology)

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13 pages, 1034 KiB

Open AccessArticle

The Challenging Differentiation of Psoriatic Arthritis from Other Arthropathies and Nonspecific Arthralgias in Patients with Psoriasis: Results of a Cross-Sectional Rheumatologic Assessment of a Large Dermatologic Cohort

by Alberto Floris, Cristina Mugheddu, Leonardo Sichi, Martina Dessì, Jasmine Anedda, Alessia Frau, Andrea Pau, Simone Aldo Lari, Jessica Sorgia, Laura Li Volsi, Maria Teresa Paladino, Mattia Congia, Elisabetta Chessa, Maria Maddalena Angioni, Caterina Ferreli, Matteo Piga, Laura Atzori and Alberto Cauli

J. Clin. Med. 2023, 12(18), 6090; https://doi.org/10.3390/jcm12186090 - 21 Sep 2023

Cited by 3 | Viewed by 1297

Abstract

Aiming to identify the potential challenges in the classification of musculoskeletal manifestations in patients with psoriasis (PsO), this study analyzed the outcomes of a cross-sectional rheumatologic assessment of 1057 PsO patients. In total, 209 had a previous diagnosis of psoriatic arthritis (PsA). Out [...] Read more.

Aiming to identify the potential challenges in the classification of musculoskeletal manifestations in patients with psoriasis (PsO), this study analyzed the outcomes of a cross-sectional rheumatologic assessment of 1057 PsO patients. In total, 209 had a previous diagnosis of psoriatic arthritis (PsA). Out of the remaining 848 subjects, 293 (35%) were classified as suspected PsA cases according to the rheumatologist’s judgment and/or Early PsA Screening Questionnaire score (EARP) ≥ 3. However, only 14% received a PsA diagnosis, 49% had a PsA-alternative diagnosis, and the remaining 37% had nonspecific arthralgias. Most of the newly diagnosed PsA patients had a symptoms duration ≥1 year (72%) and moderate disease activity (55%) with active oligoarthritis (85%), dactylitis, or enthesitis (35%) as the most frequent clinical pattern. The most frequent PsA-alternative diagnoses were osteoarthritis and fibromyalgia (44% and 41%). The only factors with significant (p < 0.05) utility in discriminating PsA from other diseases and nonspecific arthralgias were young age and EARP score with a history of morning stiffness, swollen joints, or dactylitis. These results demonstrated a high prevalence of suspected musculoskeletal symptoms in PsO patients, with, however, only a small proportion due to PsA. Close collaboration between the dermatologist and rheumatologist plays a crucial role in the differential diagnosis of PsA, as well as in monitoring nonspecific arthralgias for the potential transition to overt PsA. Full article

(This article belongs to the Section Dermatology)

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13 pages, 1226 KiB

Open AccessArticle

Cardiovascular Safety Evaluation of Febuxostat and Allopurinol: Findings from the FDA Adverse Event Reporting System

by Yang Bai, Bin Wu, Liangwen Gou, Zhenwei Fang, Ting Xu, Tiejun Zhang and Yuwen Li

J. Clin. Med. 2023, 12(18), 6089; https://doi.org/10.3390/jcm12186089 - 20 Sep 2023

Cited by 3 | Viewed by 5790

Abstract

Background: Febuxostat and allopurinol are the most commonly used uric acid-lowering medications, and their safety is of great concern, especially the cardiovascular adverse reactions associated with febuxostat. We propose to study the cardiovascular toxicity of febuxostat and allopurinol using the FDA Adverse Event [...] Read more.

Background: Febuxostat and allopurinol are the most commonly used uric acid-lowering medications, and their safety is of great concern, especially the cardiovascular adverse reactions associated with febuxostat. We propose to study the cardiovascular toxicity of febuxostat and allopurinol using the FDA Adverse Event Reporting System (FAERS) database. Methods: A total of 64 quarters of FAERS data were downloaded from 2004 to 2019. Febuxostat- and allopurinol-related cardiovascular adverse events were extracted after data cleaning. Signal detection was conducted by reporting odds ratio (ROR) and proportional reporting ratio (PRR). Results: There were 2939 and 25,219 reports of febuxostat- and allopurinol-related cardiovascular adverse events (CVAEs), respectively. The most frequent CVAEs with febuxostat and allopurinol were edema peripheral (14.38%) and peripheral swelling (8.76%), respectively. In elderly gout patients, febuxostat is associated with an increased risk of heart failure, ischemic heart disease, hypertension, and cardiomyopathy. Febuxostat in combination with acetic acid derivatives nonsteroidal anti-inflammatory drug (NSAIDS) also increases the risk of cardiovascular adverse events. Conclusions: Compared with allopurinol, febuxostat may increase cardiovascular toxicity in patients with gout. Full article

(This article belongs to the Special Issue Clinical, Translational and Experimental Pharmacotherapeutics Advances)

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16 pages, 1810 KiB

Open AccessReview

The Symptoms of Pulmonary Sarcoidosis

by Marc A. Judson

J. Clin. Med. 2023, 12(18), 6088; https://doi.org/10.3390/jcm12186088 - 20 Sep 2023

Cited by 3 | Viewed by 3176

Abstract

The aim of this manuscript is to provide a comprehensive review of the etiology, measurement, and treatment of common pulmonary symptoms associated with sarcoidosis. The assessment of symptoms associated with pulmonary sarcoidosis is an important component of disease management. Some symptoms of pulmonary [...] Read more.

The aim of this manuscript is to provide a comprehensive review of the etiology, measurement, and treatment of common pulmonary symptoms associated with sarcoidosis. The assessment of symptoms associated with pulmonary sarcoidosis is an important component of disease management. Some symptoms of pulmonary sarcoidosis are sensitive but nonspecific markers of disease activity, and the absence of such symptoms provides evidence that the disease is quiescent. Although quantifiable objective measurements of pulmonary physiology and chest imaging are important in the assessment of pulmonary sarcoidosis, they correlate poorly with the patient’s quality of life. Because the symptoms of pulmonary sarcoidosis directly relate to how the patient feels, they are reasonable endpoints in terms of clinical research and individual patient care. Recently, the symptoms of pulmonary sarcoidosis are capable of being quantified via patient-reported outcome measures and electronic devices. We conclude that a thorough assessment of the symptoms associated with pulmonary sarcoidosis improves patient care because it is a useful screen for manifestations of the disease, provides insight into the pathophysiology of manifestations of sarcoidosis, and may assist in optimizing treatment. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Pulmonary Sarcoidosis)

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8 pages, 640 KiB

Open AccessArticle

The “Woggle” Technique for Venous Access Site Management: An Old Technique for a New Need

by Gabriele Tumminello, Lucia Barbieri, Carlo Avallone, Nello Bellissimo, Luca Mircoli, Federico Colombo, Marco Vicenzi, Massimiliano Ruscica and Stefano Carugo

J. Clin. Med. 2023, 12(18), 6087; https://doi.org/10.3390/jcm12186087 - 20 Sep 2023

Cited by 1 | Viewed by 2285

Abstract

Background: Several closure devices are routinely used for percutaneous arterial access, while a relatively low number is available for the management of large bore venous accesses. The Woggle technique is a modification of the purse-string suture which was introduced several years ago in [...] Read more.

Background: Several closure devices are routinely used for percutaneous arterial access, while a relatively low number is available for the management of large bore venous accesses. The Woggle technique is a modification of the purse-string suture which was introduced several years ago in patients undergoing hemodialysis. Methods: A population of 45 patients who underwent transvenous femoral structural heart interventions was retrospectively evaluated. The Woggle technique consists of a purge string suture with a collar to maintain the tension as stable over time and a suture lock to tighten the suture. Results: Sheaths magnitude ranged from 8 French (F) to 14 F. A rapid post-procedural hemostasis was achieved in the whole population, and in 95% of cases, definite hemostasis was obtained after the first single release; the mean time of release was 302 ± 83 min. Although no relevant bleedings were reported, a significant reduction in hemoglobin levels was found in the whole population. This decrement was statistically significant only in the group with sheaths higher than 12 F. A single mild local hematoma was recorded in the group in which smaller sheaths were used. Seventy-two percent of patients were pre-treated with a dual antiplatelet therapy. Conclusions: The Woggle technique has shown to be a simple, effective, and safe approach for the management of large bore venous in percutaneous structural heart interventions. Full article

(This article belongs to the Special Issue Risk and Complications of Cardiac Catheterization and Coronary Intervention)

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12 pages, 1257 KiB

Open AccessCase Report

Real-Time Neuropsychological Testing (RTNT) and Music Listening during Glioblastoma Excision in Awake Surgery: A Case Report

by Grazia D’Onofrio, Nadia Icolaro, Elena Fazzari, Domenico Catapano, Antonello Curcio, Antonio Izzi, Aldo Manuali, Giuliano Bisceglia, Angelo Tancredi, Vincenzo Marchello, Andreaserena Recchia, Maria Pia Tonti, Luca Pazienza, Vincenzo Carotenuto, Costanzo De Bonis, Luciano Savarese, Alfredo Del Gaudio and Leonardo Pio Gorgoglione

J. Clin. Med. 2023, 12(18), 6086; https://doi.org/10.3390/jcm12186086 - 20 Sep 2023

Cited by 1 | Viewed by 1551

Abstract

In this case report, real-time neuropsychological testing (RTNT) and music listening were applied for resections in the left temporal–parietal lobe during awake surgery (AS). The case is based on a 66-year-old with glioblastoma and alterations in expressive language and memory deficit. Neuropsychological assessment [...] Read more.

In this case report, real-time neuropsychological testing (RTNT) and music listening were applied for resections in the left temporal–parietal lobe during awake surgery (AS). The case is based on a 66-year-old with glioblastoma and alterations in expressive language and memory deficit. Neuropsychological assessment was run at baseline (2–3 days before surgery), discharge from hospital (2–3 days after surgery), and follow-up (1 month and 3 months). RTNT was started before beginning the anesthetic approach (T0) and during tumor excision (T1 and T2). At T0, T1, and T2 (before performing neuropsychological tests), music listening was applied. Before AS and after music listening, the patient reported a decrease in depression and anxiety. During AS, an improvement was shown in all cognitive parameters collected at T0, T1, and T2. After the excision and music listening, the patient reported a further decrease in depression and anxiety. Three days post surgery, and at follow-ups of one month and three months, the patient reported a further improvement in cognitive aspects, the absence of depression, and a reduction in anxiety symptoms. In conclusion, RTNT has been useful in detecting cognitive function levels during tumor excision. Music listening during AS decreased the patient’s anxiety and depression symptoms. Full article

(This article belongs to the Special Issue A Multidisciplinary Approach in Head and Neck Malignancies)

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23 pages, 4064 KiB

Open AccessSystematic Review

Endovascular and Open Surgical Treatment of Ruptured Splenic Artery Aneurysms: A Case Report and a Systematic Literature Review

by Luigi Federico Rinaldi, Chiara Brioschi and Enrico Maria Marone

J. Clin. Med. 2023, 12(18), 6085; https://doi.org/10.3390/jcm12186085 - 20 Sep 2023

Cited by 2 | Viewed by 1939

Abstract

Background: Ruptured splenic artery aneurysms (r-SAA), although rare, are burdened by high morbidity and mortality, even despite emergent surgical repair. It is suggested that endovascular treatment can achieve reduction in peri-operative death and complication rates, as in other vascular diseases, but evidence of [...] Read more.

Background: Ruptured splenic artery aneurysms (r-SAA), although rare, are burdened by high morbidity and mortality, even despite emergent surgical repair. It is suggested that endovascular treatment can achieve reduction in peri-operative death and complication rates, as in other vascular diseases, but evidence of such benefits is still lacking in this particular setting. We report a case of an r-SAA treated by trans-arterial embolization and then converted to open surgery for persistent bleeding, and we provide a systematic review of current results of open and endovascular repair of r-SAAs. Materials and Methods: A 50-year-old male presenting in shock for a giant r-SAA underwent emergent coil embolization and recovered hemodynamic stability. On the following day, he underwent laparotomy for evacuation of the huge intraperitoneal hematoma, but residual bleeding was noted from the splenic artery, which was ligated after coil removal, and a splenectomy was performed. A systematic literature review of the reported mortality and complications of r-SAA undergoing open (OSR) or endovascular (EVT) treatment was performed using the main search databases. All primary examples of research published since 1990 were included regardless of sample size. The main outcome measures were mortality and reinterventions. Secondary outcomes were post-operative complications. Results: We selected 129 studies reporting on 350 patients—185 treated with OSR and 165 with EVT. Hemodynamically unstable patients and ruptures during pregnancy were more frequently treated with open repair. Overall, there were 37 deaths (mortality: 10.6%)—24 in the OSR group and 13 in the EVTr group (mortality: 12.9% and 7.8% respectively, p-value: 0.84). There were 37 reinterventions after failed or complicated endovascular repair —6 treated with endovascular re-embolization and 31 with laparotomy and splenectomy (22.4%); there were 3 (1.6%) reinterventions after open repair. Overall complication rates were 7.3% in the EVT group (n: 12) and 4.2% in the OSR group (n: 7), and did not require reintervention. No significant differences in overall complications or in any specific complication rate were observed between the two groups. Conclusions: Current results of r-SAA treatment show equipoise terms of morbidity and mortality between open and endovascular repair; however, in case of hemodynamic instability and rupture during pregnancy, open surgery might still be safer. Moreover, endovascular repair is still burdened by a significantly higher rate of reinterventions, mostly with conversions to open surgery. Full article

(This article belongs to the Special Issue "Visceral Aneurysm" in 2022: Recent Advances and Treatment)

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10 pages, 459 KiB

Open AccessReview

Common Diagnostic Challenges and Pitfalls in Segmental Colitis Associated with Diverticulosis (SCAD)

by Caterina Sbarigia, Camilla Ritieni, Bruno Annibale and Marilia Carabotti

J. Clin. Med. 2023, 12(18), 6084; https://doi.org/10.3390/jcm12186084 - 20 Sep 2023

Cited by 1 | Viewed by 2203

Abstract

Segmental colitis associated with diverticulosis (SCAD) is characterized by inflammation involving the sigmoid inter-diverticular mucosa, sparing the proximal colon and rectum. Due to the heterogeneity of clinical manifestations and endoscopic and histological findings, SCAD diagnosis might be challenging in clinical practice. This narrative [...] Read more.

Segmental colitis associated with diverticulosis (SCAD) is characterized by inflammation involving the sigmoid inter-diverticular mucosa, sparing the proximal colon and rectum. Due to the heterogeneity of clinical manifestations and endoscopic and histological findings, SCAD diagnosis might be challenging in clinical practice. This narrative review aimed to report the SCAD diagnostic criteria adopted in different studies, highlighting the current challenges and main pitfalls in its diagnosis. We analysed fourteen studies, mainly prospective observational studies. Haematochezia and rectal bleeding were the main complaints leading to diagnosis, followed by diarrhoea. An accurate endoscopic description was performed in 86% of studies, while a standardised biopsy sampling protocol (sigma, proximal colon and rectum) was scarcely adopted, being complete only in 28.5% of studies. The evaluation of concomitant drugs potentially inducing colitis was carried out in only 57% of studies. Great heterogeneity in sigmoid endoscopic (edema, erythema, erosions, ulcers, mucosal friability) and histological findings (chronic and/or acute inflammatory infiltrate) was observed. We showed that SCAD diagnosis is often based on not fully adequate macroscopic colonic description and scant biopsy protocol sampling. An accurate clinical and endoscopic evaluation, with an adequate sampling biopsy protocol, with attention to differential diagnosis, seemed to be crucial for a prompt SCAD diagnosis. Full article

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

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10 pages, 256 KiB

Open AccessReview

Haematopoietic Stem Cell Transplantation for Chronic Granulomatous Disease

by M. A. Slatter and A. R. Gennery

J. Clin. Med. 2023, 12(18), 6083; https://doi.org/10.3390/jcm12186083 - 20 Sep 2023

Cited by 4 | Viewed by 1767

Abstract

Chronic granulomatous disease (CGD) is an inborn error of immunity due to defects in the transport or function of subunits of nicotinamide adenine dinucleotide phosphate oxidase, the enzyme that generates the phagocyte respiratory burst responsible for intracellular killing of engulfed micro-organisms. Patients present [...] Read more.

Chronic granulomatous disease (CGD) is an inborn error of immunity due to defects in the transport or function of subunits of nicotinamide adenine dinucleotide phosphate oxidase, the enzyme that generates the phagocyte respiratory burst responsible for intracellular killing of engulfed micro-organisms. Patients present with infectious or inflammatory complications. Common bacterial pathogens include Staphylococcus aureus and Burkholderia cepacia complex. Fungal pathogens include Aspergillus species, particularly Aspergillus fumigatus. Inflammatory complications most commonly manifest as inflammatory bowel disease or lung disease. Granulomata are the distinguishing histological feature. Haematopoietic stem cell transplantation (HSCT) was first considered for CGD in the early 1970’s. Since then, refinements in transplant technique, donor selection, conditioning regimens, and graft engineering have widened the option of HSCT to most patients with CGD. This review charts the progress made in HSCT for CGD. Full article

(This article belongs to the Section Immunology)

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14 pages, 910 KiB

Open AccessArticle

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

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

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

Cited by 1 | Viewed by 1331

Abstract

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

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

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

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10 pages, 478 KiB

Open AccessReview

Limb Salvage and Survival in Chronic Limb-Threatening Ischemia: The Need for a Fast-Track Team-Based Approach

by Giorgio Ventoruzzo, Giulia Mazzitelli, Umberto Ruzzi, Francesco Liistro, Alessia Scatena and Eugenio Martelli

J. Clin. Med. 2023, 12(18), 6081; https://doi.org/10.3390/jcm12186081 - 20 Sep 2023

Cited by 10 | Viewed by 2185

Abstract

Chronic limb-threatening ischemia (CLTI) represents the end-stage form of peripheral arterial disease (PAD) and is associated with a very poor prognosis and high risk of limb loss and mortality. It can be considered very similar to a terminal cancer disease, reflecting a large [...] Read more.

Chronic limb-threatening ischemia (CLTI) represents the end-stage form of peripheral arterial disease (PAD) and is associated with a very poor prognosis and high risk of limb loss and mortality. It can be considered very similar to a terminal cancer disease, reflecting a large impact on quality of life and healthcare costs. The aim of this study is to offer an overview of the relationship between CLTI, limb salvage, and mortality, with a focus on the need of a fast-track team-based management that is a driver to achieve better survival results. This review can be useful to improve management of this growing impact disease, and to promote the standardisation of care and communication between specialist and non-specialist healthcare professionals. Full article

(This article belongs to the Section Vascular Medicine)

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13 pages, 543 KiB

Open AccessArticle

Relationships between Late-Life Blood Pressure and Cerebral Microinfarcts in Octogenarians: An Observational Autopsy Study

by Mo-Kyung Sin, Yan Cheng, Jeffrey M. Roseman, Edward Zamrini and Ali Ahmed

J. Clin. Med. 2023, 12(18), 6080; https://doi.org/10.3390/jcm12186080 - 20 Sep 2023

Viewed by 1088

Abstract

Mid-life high blood pressure (BP) is a risk factor for cerebral microinfarcts. Less is known about the relationship between late-life BP and cerebral microinfarcts, the examination of which is the objective of the current study. This case–control study analyzed data from 551 participants [...] Read more.

Mid-life high blood pressure (BP) is a risk factor for cerebral microinfarcts. Less is known about the relationship between late-life BP and cerebral microinfarcts, the examination of which is the objective of the current study. This case–control study analyzed data from 551 participants (94.6% aged ≥80 years; 58.6% women) in the Adult Changes in Thought (ACT) study who had autopsy data on microinfarcts and four values of systolic and diastolic blood pressure (SBP and DBP) before death. Using the average of four values, SBP was categorized using 10 mmHg intervals; a trend was defined as a ≥10 mmHg rise or fall from the first to fourth values (average gap of 6.5 years). Multivariable-adjusted regression models were used to examine the associations of BP and microinfarcts, adjusting for age, sex, last BP-to-death time, APOE genotype, and antihypertensive medication use. Microinfarcts were present in 274 (49.7%) participants; there were multiple in 51.8% of the participants, and they were located in cortical areas in 40.5%, subcortical areas in 29.6%, and both areas in 29.9% of the participants. All SBP categories (reference of 100–119 mmHg) and both SBP trends were associated with higher odds of both the presence and number of microinfarcts. The magnitude of these associations was numerically greater for subcortical than cortical microinfarcts. Similar associations were observed with DBP. These hypothesis-generating findings provide new information about the overall relationship between BP and cerebral microinfarcts in octogenarians. Full article

(This article belongs to the Section Cardiovascular Medicine)

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24 pages, 3239 KiB

Open AccessReview

SARS-CoV-2 Syncytium under the Radar: Molecular Insights of the Spike-Induced Syncytia and Potential Strategies to Limit SARS-CoV-2 Replication

by Hashim Ali, Asma Naseem and Zaheenul Islam Siddiqui

J. Clin. Med. 2023, 12(18), 6079; https://doi.org/10.3390/jcm12186079 - 20 Sep 2023

Cited by 3 | Viewed by 2422

Abstract

SARS-CoV-2 infection induces non-physiological syncytia when its spike fusogenic protein on the surface of the host cells interacts with the ACE2 receptor on adjacent cells. Spike-induced syncytia are beneficial for virus replication, transmission, and immune evasion, and contribute to the progression of COVID-19. [...] Read more.

SARS-CoV-2 infection induces non-physiological syncytia when its spike fusogenic protein on the surface of the host cells interacts with the ACE2 receptor on adjacent cells. Spike-induced syncytia are beneficial for virus replication, transmission, and immune evasion, and contribute to the progression of COVID-19. In this review, we highlight the properties of viral fusion proteins, mainly the SARS-CoV-2 spike, and the involvement of the host factors in the fusion process. We also highlight the possible use of anti-fusogenic factors as an antiviral for the development of therapeutics against newly emerging SARS-CoV-2 variants and how the fusogenic property of the spike could be exploited for biomedical applications. Full article

(This article belongs to the Section Infectious Diseases)

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J. Clin. Med., Volume 12, Issue 18 (September-2 2023) – 343 articles

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