Journal of Clinical Medicine

7 pages, 1083 KiB

Open AccessTechnical Note

Surgical Techniques of Gastrojejunostomy in Robotic Pancreatoduodenectomy: Robot-Sewn versus Stapled Gastrojejunostomy Anastomosis

by Kosei Takagi, Yuzo Umeda, Ryuichi Yoshida, Tomokazu Fuji, Kazuya Yasui, Jiro Kimura, Nanako Hata, Takahito Yagi and Toshiyoshi Fujiwara

J. Clin. Med. 2023, 12(2), 732; https://doi.org/10.3390/jcm12020732 - 16 Jan 2023

Cited by 3 | Viewed by 2536

Abstract

Background: Delayed gastric emptying (DGE) is a major complication of pancreatoduodenectomy (PD). Several efforts have been made to decrease the incidence of DGE. However, the optimal anastomotic method for gastro/duodenojejunostomy (GJ) remains debatable. Moreover, few studies have reported the impact of GJ surgical [...] Read more.

Background: Delayed gastric emptying (DGE) is a major complication of pancreatoduodenectomy (PD). Several efforts have been made to decrease the incidence of DGE. However, the optimal anastomotic method for gastro/duodenojejunostomy (GJ) remains debatable. Moreover, few studies have reported the impact of GJ surgical techniques on outcomes following robotic pancreatoduodenectomy (RPD). This study aimed to investigate the surgical outcomes of robot-sewn and stapled GJ anastomoses in RPD. Methods: Forty patients who underwent RPD at the Okayama University Hospital between September 2020 and October 2022 were included. The outcomes between robot-sewn and stapled anastomoses were compared. Results: The mean [standard deviation (SD)] operative and GJ time were 428 (63.5) and 34.0 (15.0) minutes, respectively. Postoperative outcomes included an overall incidence of DGE of 15.0%, and the mean postoperative hospital stays were 11.6 (5.3) days in length. The stapled group (n = 21) had significantly shorter GJ time than the robot-sewn group (n = 19) (22.7 min versus 46.5 min, p < 0.001). Moreover, stapled GJ cases were significantly associated with a lower incidence of DGE (0% versus 21%, p = 0.01). Although not significant, the stapled group tended to have shorter postoperative hospital stays (9.9 days versus 13.5 days, p = 0.08). Conclusions: Our findings suggest that stapled GJ anastomosis might decrease anastomotic GJ time and incidence of DGE after RPD. Surgeons should select a suitable method for GJ anastomosis based on their experiences with RPD. Full article

(This article belongs to the Section General Surgery)

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12 pages, 2561 KiB

Open AccessCase Report

First Clinical Results of a New Generation of Ablative Solid-State Lasers

by Bojan Pajic, Brigitte Pajic-Eggspuehler, Zeljka Cvejic, Christian Rathjen and Viktor Ruff

J. Clin. Med. 2023, 12(2), 731; https://doi.org/10.3390/jcm12020731 - 16 Jan 2023

Cited by 2 | Viewed by 2268

Abstract

In the early 2000s, solid-state lasers emerged as an alternative technology to excimer systems in refractive surgery. Despite some technological limits at the time, good clinical results could be achieved with solid-state laser systems. This prospective case series reports clinical outcomes of five [...] Read more.

In the early 2000s, solid-state lasers emerged as an alternative technology to excimer systems in refractive surgery. Despite some technological limits at the time, good clinical results could be achieved with solid-state laser systems. This prospective case series reports clinical outcomes of five eyes treated with a newly developed solid-state laser system (AquariuZ) in three patients. Patients underwent preoperative examination, including corneal topo-and tomography, aberrometry, and confocal microscopy. All patients received a femtosecond LASIK with the Ziemer LDV Z8, a refractive treatment with the AquariuZ solid-state ablation laser, and were then followed up for a period of up to 12 months. The applied aspheric optimized profiles did not induce higher-order aberrations nor spherical aberration in any of these operated subjects. No eye lost BCVA lines throughout the duration of the follow-up. Six months after surgery, the safety index of patient 1 was 5, and for patients 2 and 3, it equaled 1. Confocal laser microscopy imaging findings were comparable to those seen typically for excimer lasers. The obtained results are encouraging and confirm that the new solid-state laser system is safe. Full article

(This article belongs to the Special Issue Corneal Surgery: From Innovation to Clinical Praxis)

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13 pages, 2143 KiB

Open AccessArticle

Pre-Transplant Total Lymphocyte Count Determines Anti-Thymocyte Globulin Exposure, Modifying Graft-versus-Host Disease Incidence and Post-Transplant Thymic Restoration: A Single-Center Retrospective Study

by Antonio Giacomo Grasso, Roberto Simeone, Alessandra Maestro, Davide Zanon and Natalia Maximova

J. Clin. Med. 2023, 12(2), 730; https://doi.org/10.3390/jcm12020730 - 16 Jan 2023

Cited by 2 | Viewed by 2634

Abstract

The use of anti-thymocyte globulin (ATG) as part of conditioning to prevent graft-versus-host disease (GVHD) may severely impair immune reconstitution (IR). We analyzed relationships between ATG exposure, the recipient lymphocyte count, IR, and transplant outcome. We retrospectively reviewed patients aged ≤ 18 years [...] Read more.

The use of anti-thymocyte globulin (ATG) as part of conditioning to prevent graft-versus-host disease (GVHD) may severely impair immune reconstitution (IR). We analyzed relationships between ATG exposure, the recipient lymphocyte count, IR, and transplant outcome. We retrospectively reviewed patients aged ≤ 18 years who underwent allogeneic HSCT between April 2005 and April 2020. The outcomes of interest included the incidence of GVHD, overall survival (OS), and IR. IR was analyzed through thymic magnetic resonance imaging (MRI) and by quantifying T CD4+ and recent thymic emigrants (RTEs). The ATG-exposed group was split into a low ATG/lymphocyte ratio subgroup (ratio < 0.01) and a high ATG/lymphocyte ratio subgroup (ratio > 0.01). The low ratio subgroup had a higher incidence of GVHD (29 [59%] vs. 7 [16.6%]) but a better IR in both laboratory and MRI imaging assessments (p < 0.0001). The median thymic volume in the low ratio subgroup was significantly higher (14.7 cm³ vs. 4.5 cm³, p < 0.001). This was associated with a better OS and lower transplant-related mortality (TRM) (80.4% vs. 58.0%, p = 0.031) and (13.1% vs. 33.0%, p = 0.035). An individualized approach to ATG dosing allows for the obtainment of rapid thymic reconstitution and the best transplant-related outcomes. Full article

(This article belongs to the Special Issue Advances in Pediatric Cancer Therapy)

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13 pages, 1336 KiB

Open AccessArticle

Favorable Prognosis in Patients with Recovered Pulmonary Hypertension after TAVI: An Analysis of the LAPLACE-TAVI Registry

by Takuma Koike, Hiroshi Iwata, Yuichi Chikata, Shinichiro Doi, Ryo Naito, Hidetoshi Yasuda, Takehiro Funamizu, Hirohisa Endo, Sakiko Miyazaki, Shinya Okazaki, Ryosuke Higuchi, Itaru Takamisawa, Kei Sato, Harutoshi Tamura, Hiroaki Yokoyama, Tetsuya Tobaru, Shuichiro Takanashi, Minoru Tabata and Tohru Minamino

J. Clin. Med. 2023, 12(2), 729; https://doi.org/10.3390/jcm12020729 - 16 Jan 2023

Cited by 2 | Viewed by 1772

Abstract

Pulmonary hypertension (PH) is a common complication of aortic stenosis (AS). Despite the established association between PH and poor outcomes in patients with AS, the prognostic implication of a change in PH after transcatheter aortic valve implantation (TAVI) has been rarely evaluated. This [...] Read more.

Pulmonary hypertension (PH) is a common complication of aortic stenosis (AS). Despite the established association between PH and poor outcomes in patients with AS, the prognostic implication of a change in PH after transcatheter aortic valve implantation (TAVI) has been rarely evaluated. This study analyzed a prospective multi-center TAVI registry database involving six Japanese centers and used the transtricuspid pressure gradient (TRPG) obtained by echocardiography to estimate pulmonary artery systolic pressure. The participants (n = 2056) were first divided into two groups by TRPG before TAVI, a PH (−) group (TRPG < 30 mmHg) (n = 1407, 61.9%) and a PH (+) group (TRPG ≥ 30 mmHg) (n = 649, 28.6%). Next, by TRPG after (4.1 ± 5.3 days) TAVI, the PH (+) group was further subdivided into two groups, Recovered PH (TRPG < 30 mmHg, n = 253) and Persistent PH (TRPG after TAVI ≥ 30 mmHg, n = 396). The median follow-up duration was 1.8 years. The primary and secondary endpoints were the composite and each of cardiovascular (CV) death and heart failure hospitalization, respectively. Unadjusted Kaplan-Meier estimates with log-rank comparisons showed significantly higher cumulative incidences of primary and secondary endpoints in the Persistent PH group compared to other groups. Moreover, adjusted multivariate Cox-proportional hazard analyses showed that a decreased (−10 mmHg) TRPG after TAVI was linearly associated with a reduced risk of the primary endpoint (hazard ratio (HR): 0.76, 95% confidence interval (CI): 0.64–0.90, p = 0.0020). The findings in the present study indicate that the recovery of PH may partly contributes to the prognostic benefit of TAVI procedure in patients with AS and elevated pulmonary artery systolic pressure. Full article

(This article belongs to the Special Issue Approaches and Challenges in Transcatheter Valve Treatment)

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11 pages, 294 KiB

Open AccessArticle

Risk Factors Involved in the High Incidence of Bladder Cancer in an Industrialized Area in North-Eastern Spain: A Case–Control Study

by José M. Caballero, José M. Gili, Juan C. Pereira, Alba Gomáriz, Carlos Castillo and Montserrat Martín-Baranera

J. Clin. Med. 2023, 12(2), 728; https://doi.org/10.3390/jcm12020728 - 16 Jan 2023

Cited by 4 | Viewed by 2106

Abstract

Bladder cancer (BC) is the most common of the malignancies affecting the urinary tract. Smoking and exposure to occupational and environmental carcinogens are responsible for most cases. Vallès Occidental is a highly industrialized area in north-eastern Spain with one of the highest incidences [...] Read more.

Bladder cancer (BC) is the most common of the malignancies affecting the urinary tract. Smoking and exposure to occupational and environmental carcinogens are responsible for most cases. Vallès Occidental is a highly industrialized area in north-eastern Spain with one of the highest incidences of BC in men. We carried out a case–control study in order to identify the specific risk factors involved in this area. Three hundred and six participants were included (153 cases BC and 153 controls matched for age and sex): in each group, 89.5% (n = 137) were male and the mean age was 71 years (range 30–91; SD = 10.6). There were no differences between groups in family history, body mass index, or dietary habits. Independent risk factors for CV were smoking (OR 2.08; 95% CI 1.30–3.32; p = 0.002), the use of analgesics in nonsmokers (OR 10.00; 95% CI 1.28–78.12; p = 0.028), and profession (OR: 8.63; 95% CI 1.04–71.94; p = 0.046). The consumption of black and blond tobacco, the use of analgesics in nonsmokers, and occupational exposures are risk factors for the development of BC in this area, despite the reduction in smoking in the population and the extensive measures taken in the last few decades in major industries to prevent exposure to occupational carcinogens. Full article

(This article belongs to the Special Issue Urothelial Carcinoma: Clinical Diagnosis and Treatment)

18 pages, 2866 KiB

Open AccessReview

Resin Infiltration of Non-Cavitated Proximal Caries Lesions in Primary and Permanent Teeth: A Systematic Review and Scenario Analysis of Randomized Controlled Trials

by Marcus Cebula, Gerd Göstemeyer, Joachim Krois, Vinay Pitchika, Sebastian Paris, Falk Schwendicke and Susanne Effenberger

J. Clin. Med. 2023, 12(2), 727; https://doi.org/10.3390/jcm12020727 - 16 Jan 2023

Cited by 4 | Viewed by 3341

Abstract

The present study aimed to meta-analyze and evaluate the certainty of evidence for resin infiltration of proximal carious lesions in primary and permanent teeth. While resin infiltration has been shown efficacious for caries management, the certainty of evidence remains unclear. The protocol was [...] Read more.

The present study aimed to meta-analyze and evaluate the certainty of evidence for resin infiltration of proximal carious lesions in primary and permanent teeth. While resin infiltration has been shown efficacious for caries management, the certainty of evidence remains unclear. The protocol was registered with PROSPERO (CRD42018080895), and PRISMA guidelines have been followed. The databases PubMed, Embase, and Cochrane CENTRAL were systematically screened, complemented by hand searches and cross-referencing. Eleven relevant articles were identified and included, i.e., randomized controlled trials (RCTs) comparing the progression of resin infiltrated proximal caries lesions (combined with non-invasive measures) in primary or permanent teeth with non-invasive measures. Random-effects meta-analyses and trial sequential analyses (TSA) were performed for per-protocol (PP), intention-to-treat (ITT), and best/worst case (BC/WC) scenarios. Six included trials assessed lesions in permanent teeth and five trails assessed lesions in primary teeth. The trials had a high or unclear risk of bias. Risk of caries progression was significantly reduced for infiltrated lesions in the PP, ITT, and BC scenarios in both permanent teeth and primary teeth, but not in the WC scenario. According to the TSA, firm evidence was reached for all of the scenarios except the WC. In conclusion, there is firm evidence for resin infiltration arresting proximal caries lesions in permanent and primary teeth. Full article

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

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16 pages, 17620 KiB

Open AccessArticle

Web-Based Nomograms for Overall Survival and Cancer-Specific Survival of Bladder Cancer Patients with Bone Metastasis: A Retrospective Cohort Study from SEER Database

by Sheng Yang, Hongmin Zhou, Chaobo Feng, Ningze Xu, Yunshan Fan, Zhi Zhou, Yunfei Xu, Guoxin Fan, Xiang Liao and Shisheng He

J. Clin. Med. 2023, 12(2), 726; https://doi.org/10.3390/jcm12020726 - 16 Jan 2023

Cited by 2 | Viewed by 2355

Abstract

Background: Our study aimed to explore the prognostic factors of bladder cancer with bone metastasis (BCBM) and develop prediction models to predict the overall survival (OS) and cancer-specific survival (CSS) of BCBM patients. Methods: A total of 1438 patients with BCBM were obtained [...] Read more.

Background: Our study aimed to explore the prognostic factors of bladder cancer with bone metastasis (BCBM) and develop prediction models to predict the overall survival (OS) and cancer-specific survival (CSS) of BCBM patients. Methods: A total of 1438 patients with BCBM were obtained from the SEER database. Patients from 2010 to 2016 were randomly divided into training and validation datasets (7:3), while patients from 2017 were divided for external testing. Nomograms were established using prognostic factors identified through Cox regression analyses and validated internally and externally. The concordance index (C-index), calibration plots, and time-dependent receiver operating characteristic (ROC) curves were used to evaluate the discrimination and calibration of nomogram models, while decision curve analyses (DCA) and Kaplan-Meier (KM) curves were used to estimate the clinical applicability. Results: Marital status, tumor metastasis (brain, liver, and lung), primary site surgery, and chemotherapy were indicated as independent prognostic factors for OS and CSS. Calibration plots and the overall C-index showed a novel agreement between the observed and predicted outcomes. Nomograms revealed significant advantages in OS and CSS predictions. AUCs for internal and external validation were listed as follows: for OS, 3-month AUCs were 0.853 and 0.849; 6-month AUCs were 0.873 and 0.832; 12-month AUCs were 0.825 and 0.805; for CSS, 3-month AUCs were 0.849 and 0.847; 6-month AUCs were 0.870 and 0.824; 12-month AUCs were 0.815 and 0.797, respectively. DCA curves demonstrated good clinical benefit, and KM curves showed distinct stratification performance. Conclusion: The nomograms as web-based tools were proved to be accurate, efficient, and clinically beneficial, which might help in patient management and clinical decision-making for BCBM patients. Full article

(This article belongs to the Section Orthopedics)

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11 pages, 528 KiB

Open AccessArticle

Lower Serum Uric Acid Levels May Lower the Incidence of Diabetic Chronic Complications in U.S. Adults Aged 40 and Over

by Yingdong Han, Shuolin Wang, He Zhao, Yu Cao, Xinxin Han, Hong Di, Yue Yin, Juan Wu, Yun Zhang and Xuejun Zeng

J. Clin. Med. 2023, 12(2), 725; https://doi.org/10.3390/jcm12020725 - 16 Jan 2023

Cited by 4 | Viewed by 1851

Abstract

Previous studies have generally reported the association between serum uric acid (SUA) and diabetic complications, but large-scale research exploring the above association in U.S. adults with diabetes is limited. To explore the association between SUA and chronic complications of diabetes among U.S. patients [...] Read more.

Previous studies have generally reported the association between serum uric acid (SUA) and diabetic complications, but large-scale research exploring the above association in U.S. adults with diabetes is limited. To explore the association between SUA and chronic complications of diabetes among U.S. patients aged ≥40, we used data from the National Health and Nutrition Examination Survey 1999–2008. SUA was divided into three levels: T1 (SUA ≥ 420 μmol/L), T2 (300 ≤ SUA < 420 μmol/L), and T3 (SUA < 300 μmol/L). Binary logistic regression and restricted cubic spline analysis were applied to evaluate the association between SUA and chronic complications of diabetes. A trend test was performed as the SUA increased substantially. After full-adjusted confounding factors, patients in the T3 group had a lower risk of diabetic kidney disease, cardiovascular disease, and peripheral neuropathy compared with the T1 group, with a OR (95% CIs) of 0.33 (0.21–0.52), 0.56 (0.36–0.87), and 0.49 (0.27–0.89), respectively. The restricted cubic spline showed a significant positive relationship between SUA and cardiovascular disease and diabetic kidney disease in diabetes patients, but not peripheral neuropathy. Maintaining a SUA of less than 300 μmol/L might be protective against the risk of cardiovascular disease, diabetic kidney disease, and peripheral neuropathy other than diabetic retinopathy compared with a SUA of more than 420 μmol/L in U.S. diabetes patients aged 40 and over. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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9 pages, 1230 KiB

Open AccessArticle

The Value of the First Clinical Impression as Assessed by 18 Observations in Patients Presenting to the Emergency Department

by Thomas Tschoellitsch, Stefan Krummenacker, Martin W. Dünser, Roland Stöger and Jens Meier

J. Clin. Med. 2023, 12(2), 724; https://doi.org/10.3390/jcm12020724 - 16 Jan 2023

Cited by 1 | Viewed by 1643

Abstract

The first clinical impression of emergency patients conveys a myriad of information that has been incompletely elucidated. In this prospective, observational study, the value of the first clinical impression, assessed by 18 observations, to predict the need for timely medical attention, the need [...] Read more.

The first clinical impression of emergency patients conveys a myriad of information that has been incompletely elucidated. In this prospective, observational study, the value of the first clinical impression, assessed by 18 observations, to predict the need for timely medical attention, the need for hospital admission, and in-hospital mortality in 1506 adult patients presenting to the triage desk of an emergency department was determined. Machine learning models were used for statistical analysis. The first clinical impression could predict the need for timely medical attention [area under the receiver operating characteristic curve (AUC ROC), 0.73; p = 0.01] and hospital admission (AUC ROC, 0.8; p = 0.004), but not in-hospital mortality (AUC ROC, 0.72; p = 0.13). The five most important features informing the prediction models were age, ability to walk, admission by emergency medical services, lying on a stretcher, breathing pattern, and bringing a suitcase. The inability to walk at triage presentation was highly predictive of both the need for timely medical attention (p < 0.001) and the need for hospital admission (p < 0.001). In conclusion, the first clinical impression of emergency patients presenting to the triage desk can predict the need for timely medical attention and hospital admission. Important components of the first clinical impression were identified. Full article

(This article belongs to the Special Issue Patient Blood Management in Critical Care Medicine)

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8 pages, 767 KiB

Open AccessArticle

The Urine Calcium/Creatinine Ratio and Uricemia during Hyponatremia of Different Origins: Clinical Implications

by Guy Decaux and Wim Musch

J. Clin. Med. 2023, 12(2), 723; https://doi.org/10.3390/jcm12020723 - 16 Jan 2023

Cited by 1 | Viewed by 2614

Abstract

Background: Chronic hyponatremia is known to be associated with osteoporosis. It has been shown that chronic hyponatremia increases bone resorption in an attempt to release body stores of exchangeable sodium by different mechanisms. We wanted to know the calciuria of patients with hyponatremia [...] Read more.

Background: Chronic hyponatremia is known to be associated with osteoporosis. It has been shown that chronic hyponatremia increases bone resorption in an attempt to release body stores of exchangeable sodium by different mechanisms. We wanted to know the calciuria of patients with hyponatremia of different origins. Material and Methods: We made a retrospective study of 114 consecutive patients with asymptomatic hyponatremia of different origins with the usual serum and urine chemistry. Result: In hyponatremia due to SIADH, we had a high urine calcium/creatinine ratio of 0.23 ± 0.096 while in patients with salt depletion the UCa/UCr ratio was low (0.056 ± 0.038), in patients with hyponatremia secondary to thiazide intake the value was also low (0.075 ± 0.047) as in hypervolemic patients (0.034 ± 0.01). In hyponatremia due to polydipsia, the value was high (0.205 ± 0.10). Correction of hyponatremia in the euvolemic patients was associated with a significant decrease in the UCa/UCr ratio. In patients with hyponatremia secondary to thiazide intake, we noted that in the patients with low uric acid levels (<4 mg/dL, suggesting euvolemia) we also observed a low UCa/UCr (<0.10). In nine patients with chronic SIADH (SNa 125.1 ± 3.6 mEq/L), the 24 h urine calcium excretion was 275 ± 112 mg and decreased to 122 ± 77 mg (p < 0.01) after at least 2 weeks of treatment. Conclusions: Patients with chronic hyponatremia due to SIADH usually have a high UCa/UCr ratio (>0.15). This is also observed in hyponatremia secondary to polydipsia. Patients with thiazide-induced hyponatremia usually have low UCa/UCr levels and this is the case even among those with a biochemistry similar to that in SIADH (uric acid < 4 mg/dL). Full article

(This article belongs to the Section Nephrology & Urology)

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9 pages, 602 KiB

Open AccessArticle

Comparison of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Patients with Completely Lower Pole Renal Tumors

by Wenlei Zhao, Yancai Ding, Dong Chen, Yundong Xuan, Zhiqiang Chen, Xupeng Zhao, Bin Jiang, Baojun Wang, Hongzhao Li, Chengliang Yin, Xin Ma, Gang Guo, Liangyou Gu and Xu Zhang

J. Clin. Med. 2023, 12(2), 722; https://doi.org/10.3390/jcm12020722 - 16 Jan 2023

Cited by 2 | Viewed by 1921

Abstract

(1) Background: For completely lower pole renal tumors, we compared the perioperative outcomes of robotic partial nephrectomy via transperitoneal and retroperitoneal approaches. (2) Methods: Complete lower pole renal tumors were defined as tumors that received 1 point for the “L” element of the [...] Read more.

(1) Background: For completely lower pole renal tumors, we compared the perioperative outcomes of robotic partial nephrectomy via transperitoneal and retroperitoneal approaches. (2) Methods: Complete lower pole renal tumors were defined as tumors that received 1 point for the “L” element of the R.E.N.A.L. and located at the lower pole of kidney. After confirming consistency in baseline characteristics, oncological and functional benefits were compared. Pentafecta achievement was used to represent the perioperative optimal outcome, followed by multivariate analysis of factors associated with the lack of pentafecta achievement. (3) Results: Among 151 patients identified, 116 (77%) underwent robotic partial nephrectomy via a transperitoneal approach and 35 (23%) via a retroperitoneal approach. Patients undergoing transperitoneal robotic partial nephrectomy experienced more blood loss than those undergoing retroperitoneal robotic partial nephrectomy (50 mL vs. 40 mL, p = 0.015). No significant differences were identified for operative time (120 min vs. 120 min), ischemia time (19 min vs. 20 min), positive surgical margins (0.0% vs. 2.86%), postoperative rate of complication (12.07% vs. 5.71%). No significant differences were identified in pathologic variables, eGFR decline in postoperative 12-month (3.9% vs. 5.4%) functional follow-up. Multivariate cox analysis showed that tumor size (OR: 0.523; 95% CI: 0.371–0.736; p < 0.001) alone was independently correlated to the achievement of pentafecta. (4) Conclusions: For completely lower pole renal tumors, transperitoneal and retroperitoneal robotic partial nephrectomy provide similar outcomes. These two surgical approaches remain feasible options for these cases. Full article

(This article belongs to the Section Nephrology & Urology)

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30 pages, 1902 KiB

Open AccessSystematic Review

Reliability and Validity of Non-Instrumental Clinical Assessments for Adults with Oropharyngeal Dysphagia: A Systematic Review

by Reinie Cordier, Renée Speyer, Matthew Martinez and Lauren Parsons

J. Clin. Med. 2023, 12(2), 721; https://doi.org/10.3390/jcm12020721 - 16 Jan 2023

Cited by 4 | Viewed by 4947

Abstract

This systematic review on non-instrumental clinical assessment in adult oropharyngeal dysphagia (OD) provides an overview of published measures with reported reliability and validity. In alignment with PRISMA, four databases (CINAHL, Embase, PsycINFO, and PubMed) were searched, resulting in a total of 16 measures [...] Read more.

This systematic review on non-instrumental clinical assessment in adult oropharyngeal dysphagia (OD) provides an overview of published measures with reported reliability and validity. In alignment with PRISMA, four databases (CINAHL, Embase, PsycINFO, and PubMed) were searched, resulting in a total of 16 measures and 32 psychometric studies included. The included measures assessed any aspect of swallowing, consisted of at least one specific subscale relating to swallowing, were developed by clinical observation, targeted adults, and were developed in English. The included psychometric studies focused on adults, reported on measures for OD-related conditions, described non-instrumental clinical assessments, reported on validity or reliability, and were published in English. Methodological quality was assessed using the standard quality assessment QualSyst. Most measures targeted only restricted subdomains within the conceptual framework of non-instrumental clinical assessments. Across the 16 measures, hypothesis testing and reliability were the most reported psychometrics, whilst structural validity and content validity were the least reported. Overall, data on the reliability and validity of the included measures proved incomplete and frequently did not meet current psychometric standards. Future research should focus on the development of comprehensive non-instrumental clinical assessments for adults with OD using contemporary psychometric research methods. Full article

(This article belongs to the Section Otolaryngology)

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3 pages, 190 KiB

Open AccessEditorial

Advance of Thrombolysis and Thrombectomy in Acute Ischemic Stroke

by Hyo Suk Nam and Byung Moon Kim

J. Clin. Med. 2023, 12(2), 720; https://doi.org/10.3390/jcm12020720 - 16 Jan 2023

Cited by 2 | Viewed by 1759

Abstract

Globally, stroke remains the second leading cause of death, and the third-leading cause of death and disability, in the world [...] Full article

(This article belongs to the Special Issue Thrombolysis and Thrombectomy in Acute Ischemic Stroke)

11 pages, 532 KiB

Open AccessReview

Efficacy and Safety of Pulsed Field Ablation in Atrial Fibrillation: A Systematic Review

by Jurgen Shtembari, Dhan Bahadur Shrestha, Bishnu Deep Pathak, Bishal Dhakal, Binit Upadhaya Regmi, Nimesh K. Patel, Ghanshyam Palamaner Subash Shantha, Gautham Kalahasty, Karoly Kaszala and Jayanthi N. Koneru

J. Clin. Med. 2023, 12(2), 719; https://doi.org/10.3390/jcm12020719 - 16 Jan 2023

Cited by 12 | Viewed by 4596

Abstract

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with high morbidity and mortality. AF treatment is guided by a patient–provider risk–benefit discussion regarding drug versus ablation or combination. Thermal ablation has a high rate of adverse events compared to pulsed [...] Read more.

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia associated with high morbidity and mortality. AF treatment is guided by a patient–provider risk–benefit discussion regarding drug versus ablation or combination. Thermal ablation has a high rate of adverse events compared to pulsed field ablation (PFA). In this systematic review, we aimed to determine the safety and efficacy of PFA. Methods: The electronic search for relevant articles in English was completed in PubMed, PubMed Central, Cochrane library, Scopus, and Embase databases till July 2022. The screening was completed via the use of Covidence software. The risk of bias assessment and data extraction from the included studies was performed, and the narrative synthesis was performed accordingly. Results: A total of six studies were selected for review and 1897 patients receiving PFA were involved in these studies. Our review was focused on pulmonary vein isolation success, major adverse events, and arrhythmia recurrence. Successful pulmonary vein isolation (PVI) was completed in 100% of cases except in two studies. In one of them, six out of seven patients (86%) in the epicardial cohort had successful PVI. In the MANIFEST-PF survey, the acute PVI success rate was 99.9%. The major complications were rare and included pericardial tamponade, vascular complications requiring surgery, and stroke. The atrial arrhythmia recurrence was higher in the thermal group than in the PFA group (39% vs. 11%). Conclusions: The success rate of PVI by PFA is high, and major adverse events are low. PFA is found to decrease the recurrence of atrial arrhythmia compared to thermal ablation. Substantial randomized controlled trials (RCTs) are needed to validate the efficacy and safety of PFA over conventional methods. Full article

(This article belongs to the Special Issue Therapeutic Innovations in the Management of Patients with Atrial Fibrillation)

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16 pages, 1306 KiB

Open AccessArticle

Dynamics of Peripheral Blood Immune Cells during the Perioperative Period after Digestive System Resections: A Systematic Analysis of the Literature

by Markus Bo Schoenberg, Yongsheng Han, Xiaokang Li, Xinyu Li, Julian Nikolaus Bucher, Nikolaus Börner, Dominik Koch, Markus Otto Guba, Jens Werner and Alexandr V. Bazhin

J. Clin. Med. 2023, 12(2), 718; https://doi.org/10.3390/jcm12020718 - 16 Jan 2023

Cited by 2 | Viewed by 1815

Abstract

An operation in itself is a kind of trauma and may lead to immunosuppression followed by a bounce back. Not many studies exist that describe dynamics of the distribution of peripheral blood (PB) immune cells during the perioperative period. Considering this scarcity, we [...] Read more.

An operation in itself is a kind of trauma and may lead to immunosuppression followed by a bounce back. Not many studies exist that describe dynamics of the distribution of peripheral blood (PB) immune cells during the perioperative period. Considering this scarcity, we aggregated the data on the dynamics of immune cells in patients with digestive system resections during the perioperative period and the relationship with short- and long-term prognoses. By the systematic retrieval of documents, we collected perioperative period data on white blood cells (WBC), lymphocytes, neutrophil–lymphocyte ratio (NLR), CD4⁺ T cells, CD8⁺ T cells, helper T cells (Th), B cells, natural killer cells (NK), dendritic cells (DCs), regulatory T cells (Tregs), regulatory B cells (Bregs), and Myeloid derived suppressor cells (MDSC). The frequency and distribution of these immune cells and the relationship with the patient’s prognosis were summarized. A total of 1916 patients’ data were included. Compared with before surgery, WBC, lymphocytes, CD4⁺ cells, CD8⁺ T cells, MDSC, and NK cells decreased after surgery, and then returned to preoperative levels. After operation DCs increased, then gradually recovered to the preoperative level. No significant changes were found in B cell levels during the perioperative period. Compared with the preoperative time-point, Tregs and Bregs both increased postoperatively. Only high levels of the preoperative and/or postoperative NLR were found to be related to the patient’s prognosis. In summary, the surgery itself can cause changes in peripheral blood immune cells, which might change the immunogenicity. Therefore, the immunosuppression caused by the surgical trauma should be minimized. In oncological patients this might even influence long-term results. Full article

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

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19 pages, 699 KiB

Open AccessReview

Chemotherapy in Well Differentiated Neuroendocrine Tumors (NET) G1, G2, and G3: A Narrative Review

by Arianna Zappi, Irene Persano, Linda Galvani, Elena Parlagreco, Elisa Andrini, Davide Campana, Maria Pia Brizzi, Giuseppe Lamberti and Anna La Salvia

J. Clin. Med. 2023, 12(2), 717; https://doi.org/10.3390/jcm12020717 - 16 Jan 2023

Cited by 8 | Viewed by 4302

Abstract

Neuroendocrine tumors (NETs) are rare neoplasms with a wide spectrum of clinical behavior, from the long survival of well-differentiated NETs to the dismal prognosis of high-grade neuroendocrine carcinomas (NECs), being G3 NETs a recently recognized intermediate entity. While the role of chemotherapy is [...] Read more.

Neuroendocrine tumors (NETs) are rare neoplasms with a wide spectrum of clinical behavior, from the long survival of well-differentiated NETs to the dismal prognosis of high-grade neuroendocrine carcinomas (NECs), being G3 NETs a recently recognized intermediate entity. While the role of chemotherapy is well established in NECs, data on NETs mostly derives from small studies, experts’ opinions, and extrapolating results from small-cell lung cancer studies. This narrative review aims to summarize available evidence about the use of chemotherapy in the setting of G1-2 NETs and G3 NETs. We performed literature research in PubMed Library for all articles published up to September 2022 about the efficacy of chemotherapy in NETs. Treatment regimens with STZ-5FU, CAPTEM, and anti-metabolite-based treatment are the most active and tolerated in gastroenteropancreatic NETs (GEP-NETs) G1-G2, while platinum-based regimens (FOLFOX/XELOX) and TEM/CAPTEM showed the best activity in thoracic NETs. Solid evidence about chemotherapy efficacy in G3 NETs is still lacking. Literature data support the use of chemotherapy in low-intermediate grade NETs after the failure of other therapies or if tumor shrinkage is needed. Studies assessing G3 NETs independently from NECs are needed to better understand the role of chemotherapy in this setting. Full article

(This article belongs to the Special Issue Neuroendocrine Tumors: Challenges and Future Perspectives)

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22 pages, 395 KiB

Open AccessArticle

Resilience, Stress, Well-Being, and Sleep Quality in Multiple Sclerosis

by Anne Marie Novak and Shahar Lev-Ari

J. Clin. Med. 2023, 12(2), 716; https://doi.org/10.3390/jcm12020716 - 16 Jan 2023

Cited by 13 | Viewed by 3620

Abstract

(1) Background: Multiple Sclerosis (MS) is a chronic, progressive, immune-mediated disorder that affects the Central Nervous System and is the most common cause of non-traumatic neurological disability in young adults. The study aimed to assess the levels of stress, resilience, well-being, sleep quality, [...] Read more.

(1) Background: Multiple Sclerosis (MS) is a chronic, progressive, immune-mediated disorder that affects the Central Nervous System and is the most common cause of non-traumatic neurological disability in young adults. The study aimed to assess the levels of stress, resilience, well-being, sleep quality, and fatigue in Israeli people with MS (PwMS), and to examine the associations between these factors and the sociodemographic and clinical characteristics. These factors had never before been studied in conjunction in PwMS, nor had they been systematically addressed in Israel, the unique geopolitical situation of which may pose unique challenges. (2) Methods: This was a survey-based, cross-sectional study conducted through an Internet platform. (3) Results: Israeli PwMS who participated in the study were experiencing relatively high levels of stress and low resilience, poor sleep quality, and severe fatigue. The analysis revealed significant associations between resilience and stress, well-being, and anxiety, as well as stress and well-being, resilience, sleep quality, fatigue, and Clinically Isolated Syndrome (CIS). (4) Conclusions: the Israeli PwMS who participated in the study were experiencing higher levels of stress, lower resilience and worse sleep quality than PwMS in other countries, as compared to results previously reported in literature. The findings of this study ought to serve as a call to action for the MS care providers in Israel and warrant further research into the possible causes of the phenomenon and strategies to address it. Full article

(This article belongs to the Special Issue Innovative Opportunities in Neurological Diseases Diagnosis, Management and Therapy)

7 pages, 994 KiB

Open AccessBrief Report

Developing a Deep Learning Model to Evaluate Bulbar Conjunctival Injection with Color Anterior Segment Photographs

by Shanshan Wei, Yuexin Wang, Faqiang Shi, Siman Sun and Xuemin Li

J. Clin. Med. 2023, 12(2), 715; https://doi.org/10.3390/jcm12020715 - 16 Jan 2023

Cited by 1 | Viewed by 3489

Abstract

The present research aims to evaluate the feasibility of a deep-learning model in identifying bulbar conjunctival injection grading. Methods: We collected 1401 color anterior segment photographs demonstrating the cornea and bulbar conjunctival. The ground truth was bulbar conjunctival injection scores labeled by human [...] Read more.

The present research aims to evaluate the feasibility of a deep-learning model in identifying bulbar conjunctival injection grading. Methods: We collected 1401 color anterior segment photographs demonstrating the cornea and bulbar conjunctival. The ground truth was bulbar conjunctival injection scores labeled by human ophthalmologists. Two convolutional neural network-based models were constructed and trained. Accuracy, precision, recall, F1-score, Kappa, and the area under the curve (AUC) were calculated to evaluate the efficiency of the deep learning models. The micro-average and macro-average AUC values for model grading bulbar conjunctival injection were 0.98 and 0.98, respectively. The deep learning model achieved a high accuracy of 87.12%, a precision of 87.13%, a recall of 87.12%, an F1-score of 87.07%, and Cohen’s Kappa of 0.8153. The deep learning model demonstrated excellent performance in evaluating the severity of bulbar conjunctival injection, and it has the potential to help evaluate ocular surface diseases and determine disease progression and recovery. Full article

(This article belongs to the Section Ophthalmology)

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13 pages, 255 KiB

Open AccessArticle

In-Hospital Predictors of Need for Ventilatory Support and Mortality in Chest Trauma: A Multicenter Retrospective Study

by Elisa Reitano, Francesco Gavelli, Giacomo Iannantuoni, Silvia Fattori, Chiara Airoldi, Simone Matranga, Stefano Piero Bernardo Cioffi, Silvia Ingala, Francesco Virdis, Martina Rizzo, Nicole Marcomini, Alberto Motta, Andrea Spota, Matteo Maestrone, Roberta Ragozzino, Michele Altomare, Luigi Mario Castello, Francesco Della Corte, Rosanna Vaschetto, Gian Carlo Avanzi, Osvaldo Chiara and Stefania Cimbanassi Show full author list Hide full author list

J. Clin. Med. 2023, 12(2), 714; https://doi.org/10.3390/jcm12020714 - 16 Jan 2023

Viewed by 1887

Abstract

Chest trauma management often requires the use of invasive and non-invasive ventilation. To date, only a few studies investigated the predictors of the need for ventilatory support. Data on 1080 patients with chest trauma managed in two different centers were retrospectively analyzed. Univariate [...] Read more.

Chest trauma management often requires the use of invasive and non-invasive ventilation. To date, only a few studies investigated the predictors of the need for ventilatory support. Data on 1080 patients with chest trauma managed in two different centers were retrospectively analyzed. Univariate and multivariate analyses were performed to identify the predictors of tracheal intubation (TI), non-invasive mechanical ventilation (NIMV), and mortality. Rib fractures (p = 0.0001) fracture of the scapula, clavicle, or sternum (p = 0.045), hemothorax (p = 0.0035) pulmonary contusion (p = 0.0241), and a high Injury Severity Score (ISS) (p ≤ 0001) emerged as independent predictors of the need of TI. Rib fractures (p = 0.0009) hemothorax (p = 0.0027), pulmonary contusion (p = 0.0160) and a high ISS (p = 0.0001) were independent predictors of NIMV. The center of trauma care (p = 0.0279), age (p < 0.0001) peripheral oxygen saturation in the emergency department (p = 0.0010), ISS (p < 0.0001), and Revised Trauma Score (RTS) (p < 0.0001) were independent predictors of outcome. In conclusion, patients who do not require TI, while mandating ventilatory support with selected types of injuries and severity scores, are more likely to be subjected to NIMV. Trauma team expertise and the level of the trauma center could influence patient outcomes. Full article

(This article belongs to the Special Issue Evaluation and Management of Major Trauma)

10 pages, 4153 KiB

Open AccessCase Report

Same Clinical Reality of Spontaneous Rupture of the Common Iliac Artery with Pseudoaneurysm Formation—Comparison of Two Therapeutical Solutions, Endovascular Stent-Graft and Open Surgical Correction, for Two Cases and Review of the Literature

by Horațiu Moldovan, Robert Tiganasu, Lucian Câlmâc, Cristian Voica, Marian Broască, Camelia Diaconu, Vlad Ichim, Mihai Cacoveanu, Liliana Mirea, Claudia Nica, Costin Minoiu, Irina Dobra, Daniela Gheorghiță, Lucian Dorobanțu, Adrian Molnar and Luminița Iliuță

J. Clin. Med. 2023, 12(2), 713; https://doi.org/10.3390/jcm12020713 - 16 Jan 2023

Viewed by 2498

Abstract

The incidence of isolated iliac artery aneurysms is approximately 2% and common iliac artery pseudoaneurysms are even rarer. A pseudoaneurysm is a localized hemorrhage as opposed to an actual aneurysm, which affects the entire vascular wall. They are typically asymptomatic and only detectable [...] Read more.

The incidence of isolated iliac artery aneurysms is approximately 2% and common iliac artery pseudoaneurysms are even rarer. A pseudoaneurysm is a localized hemorrhage as opposed to an actual aneurysm, which affects the entire vascular wall. They are typically asymptomatic and only detectable accidentally while looking for other causes. If large and symptomatic, they typically exhibit pressure symptoms as a result of the compression of the structures around them. Common symptoms include generalized stomach pain, urological problems, gastrointestinal bleeding, and neurological symptoms such as leg paralysis or sciatica-like back pain. Rarely, they may exhibit hemodynamic instability together with an aneurysm rupture, which has a high fatality rate. Due to the unique presentation, the diagnosis is typically rarely made and there is little experience with treating it. We report two cases of common iliac artery pseudoaneurysm found in two patients who had no notable medical history and who we chose to repair through the endovascular technique in the first case, an approach that has gained more ground for vascular repair worldwide, making it the current go-to method, and for the second case we chose a more traditional approach, through open surgery. Full article

(This article belongs to the Section Clinical Neurology)

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12 pages, 1628 KiB

Open AccessArticle

Diagnostic Efficacy of Serum Asialo α1-Acid Glycoprotein Levels for Advanced Liver Fibrosis and Cirrhosis in Patients with Chronic Hepatitis B Compared to That in Healthy Subjects: A Prospective Study

by Yoonseok Lee, Seryun Bae, Ji Hoon Kim, Minjung Kwak, So Yeon Jeon, Taehyung Kim, Sun Young Yim, Young-Sun Lee, Young Kul Jung, Yeon Seok Seo, Hyung Joon Yim, Jong Eun Yeon and Kwan Soo Byun

J. Clin. Med. 2023, 12(2), 712; https://doi.org/10.3390/jcm12020712 - 16 Jan 2023

Cited by 3 | Viewed by 1709

Abstract

Background: Serum asialo α1-acid gycoprotein (AsAGP) is a novel biomarker specific to liver fibrosis. Aim: To evaluate the diagnostic efficacy of serum AsAGP levels in classifying the severity of liver fibrosis and differentiating liver cirrhosis (LC) in patients with chronic hepatitis B (CHB) [...] Read more.

Background: Serum asialo α1-acid gycoprotein (AsAGP) is a novel biomarker specific to liver fibrosis. Aim: To evaluate the diagnostic efficacy of serum AsAGP levels in classifying the severity of liver fibrosis and differentiating liver cirrhosis (LC) in patients with chronic hepatitis B (CHB) from healthy controls. Methods: Overall, 206 subjects were prospectively enrolled. LC was diagnosed based on liver stiffness levels (>11 kPa) measured using transient elastography. Serum AsAGP levels were measured using an antibody-lectin sandwich immunoassay. We investigated the diagnostic performance by comparing serum AsAGP levels among healthy control, CHB, and CHB with LC groups. Sensitivity, specificity, and optimal AsAGP cut-off values were also calculated. Results: Serum AsAGP levels were significantly different between healthy controls, CHB patients, and CHB patients with LC (1.04 ± 0.31 µg/mL, 1.12 ± 0.34 µg/mL, 1.51 ± 0.43 µg/mL respectively; p < 0.001). Serum AsAGP levels positively correlated with liver stiffness (r = 0.46, p < 0.001). AUROC of healthy control versus CHB with LC was 0.821 (p < 0.001, optimal cut-off 1.036 µg/mL). AUROC of healthy control versus CHB was 0.624 (p = 0.049, optimal cut-off level 0.934 µg/mL). AUROC of CHB versus CHB with LC was 0.765, (p < 0.001, optimal cut-off 1.260 µg/mL). Conclusions: Serum AsAGP levels in CHB patients with LC were significantly higher than those in healthy controls and CHB patients. AsAGP levels showed good diagnostic performance in predicting advanced fibrosis and cirrhosis, which suggests a potential role as a biomarker for predicting the progression of liver disease in CHB. Full article

(This article belongs to the Topic Liver Fibrosis and Cirrhosis)

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12 pages, 2367 KiB

Open AccessArticle

Negative Pressure Wound Therapy with Instillation: Analysis of the Rinsing Fluid as a Monitoring Tool and Approach to the Inflammatory Process: A Pilot Study

by Niklas Biermann, Stefan Wallner, Teresa Martini, Steffen Spoerl, Lukas Prantl and Christian D. Taeger

J. Clin. Med. 2023, 12(2), 711; https://doi.org/10.3390/jcm12020711 - 16 Jan 2023

Cited by 2 | Viewed by 1946

Abstract

Background: Negative pressure wound therapy with instillation (NPWTi) is an established wound conditioning tool. Previous investigations discovered that the rinsing fluid is a suitable monitoring tool containing various cells and cytokines. Methods: The aim of this pilot study was to analyze rinsing fluid [...] Read more.

Background: Negative pressure wound therapy with instillation (NPWTi) is an established wound conditioning tool. Previous investigations discovered that the rinsing fluid is a suitable monitoring tool containing various cells and cytokines. Methods: The aim of this pilot study was to analyze rinsing fluid samples from patients treated with NPWTi and link them to the clinical course, including microbiological contamination. In 31 consecutive patients with acute and chronic wounds, laboratory analysis was performed to evaluate IL-6, IL-8, bFGF, Tnf-a, and VEGF. Results: IL-6 showed a significant increase to 1540 pg/mL on day two and 860 pg/mL on day four (p = 0.01 and p = 0.04, resp.). IL-8 steadily increased from a median of 2370 pg/mL to a maximum of 19,400 pg/mL on day three (p = 0.01). The median bFGF showed a steady decline from 22 pg/mL to 10 pg/m (p = 0.35) on day three. The median Tnf-a increased from 11 pg/mL to 44 pg/mL (p = 001). The median VEGF values fluctuated but showed an overall increase from 35 pg/mL to 250 pg/mL (p = 0.07). Regarding IL-8, diabetic and non-diabetic patients both showed a gradual increase with non-significant higher median values for the diabetics. The subgroup analysis of IL-6 showed increasing and higher values in cases with bacterial superinfections (p = 0.07). Conclusion: We were able to use an established wound conditioning tool to gather important information about the inflammatory response during NPWTi treatment. Cytokine and cell courses were mostly consistent with the literature, especially in diabetic patients, and should be further investigated. Full article

(This article belongs to the Special Issue Wound Healing and Plastic Surgery: Challenges and Innovations)

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21 pages, 1838 KiB

Open AccessArticle

T Cells Immunophenotyping and CD38 Overexpression as Hallmarks of the Severity of COVID-19 and Predictors of Patients’ Outcomes

by Nesrin I. Tarbiah, Nuha A. Alkhattabi, Abdullah J. Alsahafi, Hani S. Aljahdali, Husam M. Joharjy, Maryam H. Al-Zahrani, Aliaa M. Sabban, Rana A. Alghamdi, Maha J. Balgoon and Reham A. Khalifa

J. Clin. Med. 2023, 12(2), 710; https://doi.org/10.3390/jcm12020710 - 16 Jan 2023

Cited by 4 | Viewed by 2566

Abstract

Background: By the end of 2019, the COVID-19 pandemic spread all around the world with a wide spectrum of clinical presentations ranging from mild to moderate to severe or critical cases. T cell subtype dysregulation is mostly involved in the immunopathogenic mechanism. The [...] Read more.

Background: By the end of 2019, the COVID-19 pandemic spread all around the world with a wide spectrum of clinical presentations ranging from mild to moderate to severe or critical cases. T cell subtype dysregulation is mostly involved in the immunopathogenic mechanism. The present study aimed to highlight the role of monitoring T cell subtypes and their activation (expression of CD38) in COVID-19 patients compared to healthy subjects and their role in predicting severity and patients’ outcomes. Materials: The study involved 70 adult COVID-19 confirmed cases stratified into three groups: a mild/asymptomatic group, a clinically moderate group, and a clinically severe/critical group. Flow cytometry analysis was used for the assessment of CD3⁺ cells for total T cell count, CD4⁺ cells for helper T cells (Th), CD8⁺ cells for cytotoxic T cells (Tc), CD4⁺CD25⁺ cells for regulatory T cells (T reg), and CD38 expression in CD4⁺ T cells and CD8⁺ T cells for T cell activation. Results: A statistically significant difference was found between COVID-19 cases and healthy controls as regards low counts of all the targeted T cell subtypes, with the lowest counts detected among patients of the severe/critical group. Furthermore, CD38 overexpression was observed in both CD4⁺ and CD8⁺ T cells. Conclusion: Decreased T cell count, specifically CD8⁺ T cell (Tc), with T cell overactivation which was indicated by CD38 overexpression on CD4⁺ and CD8⁺ T cells had a substantial prognostic role in predicting severity and mortality among COVID-19 patients. These findings can provide a preliminary tool for clinicians to identify high-risk patients requiring vigilant monitoring, customized supportive therapy, or ICU admission. Studies on larger patient groups are needed. Full article

(This article belongs to the Topic Fighting against COVID-19: Latest Advances, Challenges and Methodologies)

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24 pages, 905 KiB

Open AccessReview

KRAS Mutations in Solid Tumors: Characteristics, Current Therapeutic Strategy, and Potential Treatment Exploration

by Yunkai Yang, Huan Zhang, Shanshan Huang and Qian Chu

J. Clin. Med. 2023, 12(2), 709; https://doi.org/10.3390/jcm12020709 - 16 Jan 2023

Cited by 15 | Viewed by 6530

Abstract

Kristen rat sarcoma (KRAS) gene is one of the most common mutated oncogenes in solid tumors. Yet, KRAS inhibitors did not follow suit with the development of targeted therapy, for the structure of KRAS has been considered as being implausible to target for [...] Read more.

Kristen rat sarcoma (KRAS) gene is one of the most common mutated oncogenes in solid tumors. Yet, KRAS inhibitors did not follow suit with the development of targeted therapy, for the structure of KRAS has been considered as being implausible to target for decades. Chemotherapy was the initial recommended therapy for KRAS-mutant cancer patients, which was then replaced by or combined with immunotherapy. KRAS G12C inhibitors became the most recent breakthrough in targeted therapy, with Sotorasib being approved by the Food and Drug Administration (FDA) based on its significant efficacy in multiple clinical studies. However, the subtypes of the KRAS mutations are complex, and the development of inhibitors targeting non-G12C subtypes is still at a relatively early stage. In addition, the monotherapy of KRAS inhibitors has accumulated possible resistance, acquiring the exploration of combination therapies or next-generation KRAS inhibitors. Thus, other non-target, conventional therapies have also been considered as being promising. Here in this review, we went through the characteristics of KRAS mutations in cancer patients, and the prognostic effect that it poses on different therapies and advanced therapeutic strategy, as well as cutting-edge research on the mechanisms of drug resistance, tumor development, and the immune microenvironment. Full article

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

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12 pages, 277 KiB

Open AccessArticle

Risk Factors for Early Mortality in Older Patients with Traumatic Cervical Spine Injuries—A Multicenter Retrospective Study of 1512 Cases

by Motoya Kobayashi, Noriaki Yokogawa, Satoshi Kato, Takeshi Sasagawa, Hiroyuki Tsuchiya, Hiroaki Nakashima, Naoki Segi, Sadayuki Ito, Toru Funayama, Fumihiko Eto, Akihiro Yamaji, Junichi Yamane, Satoshi Nori, Takeo Furuya, Atsushi Yunde, Hideaki Nakajima, Tomohiro Yamada, Tomohiko Hasegawa, Yoshinori Terashima, Ryosuke Hirota, Hidenori Suzuki, Yasuaki Imajo, Shota Ikegami, Masashi Uehara, Hitoshi Tonomura, Munehiro Sakata, Ko Hashimoto, Yoshito Onoda, Kenichi Kawaguchi, Yohei Haruta, Nobuyuki Suzuki, Kenji Kato, Hiroshi Uei, Hirokatsu Sawada, Kazuo Nakanishi, Kosuke Misaki, Hidetomi Terai, Koji Tamai, Akiyoshi Kuroda, Gen Inoue, Kenichiro Kakutani, Yuji Kakiuchi, Katsuhito Kiyasu, Hiroyuki Tominaga, Hiroto Tokumoto, Yoichi Iizuka, Eiji Takasawa, Koji Akeda, Norihiko Takegami, Haruki Funao, Yasushi Oshima, Takashi Kaito, Daisuke Sakai, Toshitaka Yoshii, Tetsuro Ohba, Bungo Otsuki, Shoji Seki, Masashi Miyazaki, Masayuki Ishihara, Seiji Okada, Shiro Imagama and Kota Watanabe Show full author list Hide full author list

J. Clin. Med. 2023, 12(2), 708; https://doi.org/10.3390/jcm12020708 - 16 Jan 2023

Cited by 3 | Viewed by 2328

Abstract

For older patients with decreased reserve function, traumatic cervical spine injuries frequently lead to early mortality. However, the prognostic factors for early mortality remain unclear. This study included patients aged ≥65 years and hospitalized for treatment of traumatic cervical spine injuries in 78 [...] Read more.

For older patients with decreased reserve function, traumatic cervical spine injuries frequently lead to early mortality. However, the prognostic factors for early mortality remain unclear. This study included patients aged ≥65 years and hospitalized for treatment of traumatic cervical spine injuries in 78 hospitals between 2010 and 2020. Early mortality was defined as death within 90 days after injury. We evaluated the relationship between early mortality and the following factors: age, sex, body mass index, history of drinking and smoking, injury mechanisms, presence of a cervical spine fracture and dislocation, cervical ossification of the posterior longitudinal ligament, diffuse idiopathic skeletal hyperostosis, American Spinal Injury Association Impairment Scale, concomitant injury, pre-existing comorbidities, steroid administration, and treatment plan. Overall, 1512 patients (mean age, 75.8 ± 6.9 years) were included in the study. The early mortality rate was 4.0%. Multivariate analysis identified older age (OR = 1.1, p < 0.001), male sex (OR = 3.7, p = 0.009), cervical spine fracture (OR = 4.2, p < 0.001), complete motor paralysis (OR = 8.4, p < 0.001), and chronic kidney disease (OR = 5.3, p < 0.001) as risk factors for early mortality. Older age, male sex, cervical spine fracture, complete motor paralysis, and chronic kidney disease are prognostic factors for early mortality in older patients with traumatic cervical spine injuries. Full article

(This article belongs to the Special Issue Minimally Invasive Spinal Treatment: State of the Art)

11 pages, 451 KiB

Open AccessSystematic Review

Local Tendon Transfers for Chronic Ruptures of the Achilles Tendon: A Systematic Review

by Nicola Maffulli, Salvatore Ziello, Gianluca Maisto, Filippo Migliorini and Francesco Oliva

J. Clin. Med. 2023, 12(2), 707; https://doi.org/10.3390/jcm12020707 - 16 Jan 2023

Cited by 11 | Viewed by 2509

Abstract

Introduction: A rupture of the Achilles tendon with a delay in diagnosis or treatment for more than 6 weeks is considered a chronic tear. Local tendon transfer procedures can be used in chronic Achilles tendon ruptures. This study evaluated the outcome, return to [...] Read more.

Introduction: A rupture of the Achilles tendon with a delay in diagnosis or treatment for more than 6 weeks is considered a chronic tear. Local tendon transfer procedures can be used in chronic Achilles tendon ruptures. This study evaluated the outcome, return to sport, and complications of local tendon transfer in patients with chronic Achilles tendon rupture. Material and methods: The present study was conducted according to the PRISMA 2020 guidelines. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in November 2022. Results: Data were retrieved from 23 articles (463 patients, mean age 50.9 ± 13.5 years). The mean duration of the follow-up was 58.3 ± 76.8 months. The VAS improved by 1.8/10 (p = 0.4), the AOFAS by 33.4/100 (p < 0.0001), and the ATRS by 32.5/100 (p = 0.0001) points. Patients were able to return to sport after a mean of 19.6 ± 16.4 weeks. A total of 79% of patients were able to return to their previous activities. The rate of complications was 13.3%. Conclusions: The use of local tendon transfer for chronic Achilles tendon ruptures using the FHL or PB tendon resulted in good clinical outcomes and a reliable return to daily activities and sports. The rate of complications reflects the chronicity of the condition and the technical complexity of the procedure. Level of evidence: IV. Full article

(This article belongs to the Special Issue Updates in the Orthopedic Management of Foot Disorders)

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14 pages, 2640 KiB

Open AccessArticle

Post-COVID-19 Symptoms and Heart Disease: Incidence, Prognostic Factors, Outcomes and Vaccination: Results from a Multi-Center International Prospective Registry (HOPE 2)

by Ivan J. Núñez-Gil, Gisela Feltes, María C. Viana-Llamas, Sergio Raposeiras-Roubin, Rodolfo Romero, Emilio Alfonso-Rodríguez, Aitor Uribarri, Francesco Santoro, Víctor Becerra-Muñoz, Martino Pepe, Alex F. Castro-Mejía, Jaime Signes-Costa, Adelina Gonzalez, Francisco Marín, Javier Lopez-País, Enrico Cerrato, Olalla Vázquez-Cancela, Carolina Espejo-Paeres, Álvaro López Masjuan, Lazar Velicki, Ibrahim El-Battrawy, Harish Ramakrishna, Antonio Fernandez-Ortiz and Julián Perez-Villacastín Show full author list Hide full author list

J. Clin. Med. 2023, 12(2), 706; https://doi.org/10.3390/jcm12020706 - 16 Jan 2023

Cited by 11 | Viewed by 3343

Abstract

Background: Heart disease is linked to worse acute outcomes after coronavirus disease 2019 (COVID-19), although long-term outcomes and prognostic factor data are lacking. We aim to characterize the outcomes and the impact of underlying heart diseases after surviving COVID-19 hospitalization. Methods: We conducted [...] Read more.

Background: Heart disease is linked to worse acute outcomes after coronavirus disease 2019 (COVID-19), although long-term outcomes and prognostic factor data are lacking. We aim to characterize the outcomes and the impact of underlying heart diseases after surviving COVID-19 hospitalization. Methods: We conducted an analysis of the prospective registry HOPE-2 (Health Outcome Predictive Evaluation for COVID-19-2, NCT04778020). We selected patients discharged alive and considered the primary end-point all-cause mortality during follow-up. As secondary main end-points, we included any readmission or any post-COVID-19 symptom. Clinical features and follow-up events are compared between those with and without cardiovascular disease. Factors with p < 0.05 in the univariate analysis were entered into the multivariate analysis to determine independent prognostic factors. Results: HOPE-2 closed on 31 December 2021, with 9299 patients hospitalized with COVID-19, and 1805 died during this acute phase. Finally, 7014 patients with heart disease data were included in the present analysis, from 56 centers in 8 countries. Heart disease (+) patients were older (73 vs. 58 years old), more frequently male (63 vs. 56%), had more comorbidities than their counterparts, and suffered more frequently from post-COVID-19 complications and higher mortality (OR _{heart disease}: 2.63, 95% CI: 1.81–3.84). Vaccination was found to be an independent protector factor (HR _{all-cause death}: 0.09; 95% CI: 0.04–0.19). Conclusions: After surviving the acute phase, patients with underlying heart disease continue to present a more complex clinical profile and worse outcomes including increased mortality. The COVID-19 vaccine could benefit survival in patients with heart disease during follow-up. Full article

(This article belongs to the Section Cardiovascular Medicine)

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15 pages, 1887 KiB

Open AccessArticle

Estimating Prevalence and Characteristics of Statin Intolerance among High and Very High Cardiovascular Risk Patients in Germany (2017 to 2020)

by Klaus G. Parhofer, Anastassia Anastassopoulou, Henry Calver, Christian Becker, Anirudh S. Rathore, Raj Dave and Cosmin Zamfir

J. Clin. Med. 2023, 12(2), 705; https://doi.org/10.3390/jcm12020705 - 16 Jan 2023

Cited by 2 | Viewed by 2577

Abstract

Statin intolerance (SI) (partial and absolute) could lead to suboptimal lipid management. The lack of a widely accepted definition of SI results into poor understanding of patient profiles and characteristics. This study aims to estimate SI and better understand patient characteristics, as reflected [...] Read more.

Statin intolerance (SI) (partial and absolute) could lead to suboptimal lipid management. The lack of a widely accepted definition of SI results into poor understanding of patient profiles and characteristics. This study aims to estimate SI and better understand patient characteristics, as reflected in clinical practice in Germany using supervised machine learning (ML) techniques. This retrospective cohort study utilized patient records from an outpatient setting in Germany in the IQVIA™ Disease Analyzer. Patients with a high cardiovascular risk, atherosclerotic cardiovascular disease, or hypercholesterolemia, and those on lipid-lowering therapies between 2017 and 2020 were included, and categorized as having “absolute” or “partial” SI. ML techniques were applied to calibrate prevalence estimates, derived from different rules and levels of confidence (high and low). The study included 292,603 patients, 6.4% and 2.8% had with high confidence absolute and partial SI, respectively. After deploying ML, SI prevalence increased approximately by 27% and 57% (p < 0.00001) in absolute and partial SI, respectively, eliciting a maximum estimate of 12.5% SI with high confidence. The use of advanced analytics to provide a complementary perspective to current prevalence estimates may inform the identification, optimal treatment, and pragmatic, patient-centered management of SI in Germany. Full article

(This article belongs to the Section Cardiology)

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23 pages, 2897 KiB

Open AccessSystematic Review

Survival Outcomes of Hepatectomy in Gastric Cancer Liver Metastasis: A Systematic Review and Meta-Analysis

by Danny Conde Monroy, Milciades Ibañez-Pinilla, Juan Carlos Sabogal, Carlos Rey Chaves, Andrés Isaza-Restrepo, Felipe Girón, Marco Vanegas, Rafael Ibañez-Villalba, Lutz Mirow and Timo Siepmann

J. Clin. Med. 2023, 12(2), 704; https://doi.org/10.3390/jcm12020704 - 16 Jan 2023

Cited by 7 | Viewed by 3220

Abstract

Gastric cancer liver metastasis (GCLM) is a contraindication for surgical treatment in current guidelines. However, the results of recent studies are questioning this paradigm. We assessed survival outcomes and their predictors following hepatectomy for GCLM in a systematic review of studies published from [...] Read more.

Gastric cancer liver metastasis (GCLM) is a contraindication for surgical treatment in current guidelines. However, the results of recent studies are questioning this paradigm. We assessed survival outcomes and their predictors following hepatectomy for GCLM in a systematic review of studies published from 2000 to 2022 according to PRISMA guidelines. We identified 42,160 references in four databases. Of these, 55 articles providing data from 1990 patients fulfilled our criteria and were included. We performed a meta-analysis using random-effects models to assess overall survival (OS) and disease-free survival (DFS) at one, three, and five years post-surgery. We studied the impact of potential prognostic factors on survival outcomes via meta-regression. One, three, and five years after surgery, OS was 69.79%, 34.79%, and 24.68%, whereas DFS was 41.39%, 23.23%, and 20.18%, respectively. Metachronous presentation, well-to-moderate differentiation, small hepatic tumoral size, early nodal stage, R0 resection, unilobar compromisation, and solitary lesions were associated with higher overall survival. Metachronous presentation, smaller primary tumoral size, and solitary metastasis were linked to longer DFS. The results of our meta-analysis suggest that hepatectomy leads to favorable survival outcomes in patients with GCLM and provides data that might help select patients who will benefit most from surgical treatment. Full article

(This article belongs to the Special Issue Advances in Treatment of Gastroesophageal Cancer)

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24 pages, 4198 KiB

Open AccessSystematic Review

A Systematic Review and Meta-Analysis of the Brief Cognitive Assessment for Multiple Sclerosis (BICAMS) International Validations

by Hannah Potticary and Dawn Langdon

J. Clin. Med. 2023, 12(2), 703; https://doi.org/10.3390/jcm12020703 - 16 Jan 2023

Cited by 9 | Viewed by 2715

Abstract

Cognitive impairment is a prevalent and debilitating symptom of multiple sclerosis (MS) but is not routinely addressed in clinical care. The Brief Cognitive Assessment for Multiple Sclerosis (BICAMS) was developed in 2012 to screen and monitor MS patients’ cognition. This systematic review and [...] Read more.

Cognitive impairment is a prevalent and debilitating symptom of multiple sclerosis (MS) but is not routinely addressed in clinical care. The Brief Cognitive Assessment for Multiple Sclerosis (BICAMS) was developed in 2012 to screen and monitor MS patients’ cognition. This systematic review and meta-analysis aimed to identify, synthesise, and critically appraise current BICAMS’ international validations. The literature search was conducted using PubMed, PsycINFO and Web of Science electronic databases in August 2022. Quantitative, peer-reviewed adult studies, which followed the BICAMS international validation protocol and were published in English, were included. The search identified a total of 203 studies, of which 26 were eligible for inclusion. These reported a total of 2833 adults with MS and 2382 healthy controls (HC). The meta-analysis showed that BICAMS identified impaired cognitive functioning in adults with MS compared to HC for all three subtests: information processing speed (g = 0.854, 95% CI = 0.765, 0.944, p < 0.001), immediate verbal recall (g = 0.566, 95% CI = 0.459, 0.673, p < 0.001) and immediate visual recall (g = 0.566, 95% CI = 0.487, 0.645, p < 0.001). Recruitment sites and strategies limit the generalisability of results. BICAMS is a valid and feasible international MS cognitive assessment. Full article

(This article belongs to the Section Clinical Neurology)

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J. Clin. Med., Volume 12, Issue 2 (January-2 2023) – 338 articles

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