Journal of Clinical Medicine

14 pages, 1613 KiB

Open AccessArticle

Impact of Pretreatment Systemic Inflammatory Markers on Treatment Persistence with Biologics and Conventional Systemic Therapy: A Retrospective Study of Patients with Psoriasis Vulgaris and Psoriatic Arthritis

by Eiki Sugimoto, Hiroki Matsuda, Sayaka Shibata, Yuka Mizuno, Asumi Koyama, Lixin Li, Haruka Taira, Yukiko Ito, Kentaro Awaji, Takashi Yamashita and Shinichi Sato

J. Clin. Med. 2023, 12(8), 3046; https://doi.org/10.3390/jcm12083046 - 21 Apr 2023

Cited by 16 | Viewed by 2992

Abstract

Systemic inflammation plays a central role in the pathophysiology of psoriasis. This study examined accessible systemic inflammatory markers in patients with psoriasis vulgaris and psoriatic arthritis. We aimed to evaluate their association with psoriasis severity, the presence of arthritis, and drug continuation rates. [...] Read more.

Systemic inflammation plays a central role in the pathophysiology of psoriasis. This study examined accessible systemic inflammatory markers in patients with psoriasis vulgaris and psoriatic arthritis. We aimed to evaluate their association with psoriasis severity, the presence of arthritis, and drug continuation rates. The findings revealed that neutrophil, monocyte, and platelet count, neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, systemic inflammation response index, systemic immune/inflammation index (SII), and CRP were positively correlated with Psoriasis Area and Severity Index scores. Patients presenting with higher platelet/lymphocyte ratio (PLR) or CRP values were more likely to be diagnosed with psoriatic arthritis than with psoriasis vulgaris in the multivariate regression analysis. Importantly, patients with higher pretreatment neutrophil or platelet count, PLR, and SII were associated with lower treatment continuation rates of conventional systemic agents. Higher pretreatment scores of systemic inflammatory markers did not affect treatment retention rates of biologics. These findings suggest that several accessible systemic inflammatory markers may effectively assess underlying systemic inflammation and may provide an indication for a therapeutic approach in patients with psoriasis vulgaris and psoriatic arthritis. Full article

(This article belongs to the Special Issue Psoriasis and Psoriatic Arthritis: How to Treat in the Era of Biologics and Small Molecule Inhibitors: 2nd Edition)

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12 pages, 508 KiB

Open AccessReview

High Myopia Prevalence across Racial Groups in the United States: A Systematic Scoping Review

by Bryana Banashefski, Michelle K. Rhee and Gareth M. C. Lema

J. Clin. Med. 2023, 12(8), 3045; https://doi.org/10.3390/jcm12083045 - 21 Apr 2023

Cited by 4 | Viewed by 2446

Abstract

High myopia is a significant public health issue globally and in the United States (US), where it affects ~4% of the population or 13 million people. This is a potentially blinding condition, but complications can be prevented with early intervention in childhood. Several [...] Read more.

High myopia is a significant public health issue globally and in the United States (US), where it affects ~4% of the population or 13 million people. This is a potentially blinding condition, but complications can be prevented with early intervention in childhood. Several countries have developed robust data on high myopia, but the United States' data on high myopia remains lacking. Further, underrepresented populations are at particular risk of complications due to reduced access to optometric and ophthalmic care. We performed a systematic scoping review of population-based studies that investigated the prevalence of high myopia across racial and ethnic groups in the US to identify the impact of high myopia on underrepresented communities. Only four studies were identified that met inclusion criteria, which highlights the need to further investigate the topic in the United States. The prevalence of high myopia ranged from a low of 1.8% among Hispanic populations to a high of 11.8% among Chinese populations. Our study demonstrated a paucity of high myopia data in the United States and variable rates of high myopia depending on the time and location of each study. More complete prevalence data will help identify opportunities for community-based interventions to prevent debilitating and blinding complications of high myopia. Full article

(This article belongs to the Special Issue Risk Factors and Management Approaches to Reduce Disparities in Eye Diseases)

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3 pages, 181 KiB

Open AccessEditorial

Acute and Chronic Effect of Physiological Factors on Arterial Stiffness

by Shigehiko Ogoh

J. Clin. Med. 2023, 12(8), 3044; https://doi.org/10.3390/jcm12083044 - 21 Apr 2023

Cited by 1 | Viewed by 973

Abstract

Arterial stiffness is a disease of the arterial media, and it is well known that it is accelerated by aging [...] Full article

(This article belongs to the Section Vascular Medicine)

21 pages, 1097 KiB

Open AccessReview

Potential Role of Innate Lymphoid Cells in the Pathogenesis and Treatment of Skin Diseases

by Francesco Borgia, Federica Li Pomi, Clara Alessandrello, Mario Vaccaro and Sebastiano Gangemi

J. Clin. Med. 2023, 12(8), 3043; https://doi.org/10.3390/jcm12083043 - 21 Apr 2023

Cited by 5 | Viewed by 2663

Abstract

Group 2 innate lymphoid cells (ILC2s) are lymphoid cells that are resident in mucosal tissues, especially the skin, which, once stimulated by epithelial cell-derived cytokines, release IL-5, IL-13, and IL-4, as the effectors of type 2 immune responses. This research aims to evaluate [...] Read more.

Group 2 innate lymphoid cells (ILC2s) are lymphoid cells that are resident in mucosal tissues, especially the skin, which, once stimulated by epithelial cell-derived cytokines, release IL-5, IL-13, and IL-4, as the effectors of type 2 immune responses. This research aims to evaluate the role of ILC2s in the pathogenesis of skin diseases, with a particular focus on inflammatory cutaneous disorders, in order to also elucidate potential therapeutic perspectives. The research has been conducted in articles, excluding reviews and meta-analyses, on both animals and humans. The results showed that ILC2s play a crucial role in the pathogenesis of systemic skin manifestations, prognosis, and severity, while a potential antimelanoma role is emerging from the new research. Future perspectives could include the development of new antibodies targeting or stimulating ILC2 release. This evidence could add a new therapeutic approach to inflammatory cutaneous conditions, including allergic ones. Full article

(This article belongs to the Special Issue Clinical Management of Allergic and Inflammatory Skin Diseases: A Diagnostic and Therapeutic Perspective)

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20 pages, 4951 KiB

Open AccessArticle

Validation of “Neurit.Space”: Three Digital Tests for the Neuropsychological Evaluation of Unilateral Spatial Neglect

by Gemma Massetti, Federica Albini, Carlotta Casati, Carlo Toneatto, Stefano Terruzzi, Roberta Etzi, Luigi Tesio, Alberto Gallace and Giuseppe Vallar

J. Clin. Med. 2023, 12(8), 3042; https://doi.org/10.3390/jcm12083042 - 21 Apr 2023

Cited by 4 | Viewed by 1757

Abstract

Patients suffering from Unilateral Spatial Neglect (USN) fail to pay attention to, respond to, and report sensory events occurring in the contralesional side of space. The traditional neuropsychological assessment of USN is based on paper-and-pencil tests, whose data recording and scoring may be [...] Read more.

Patients suffering from Unilateral Spatial Neglect (USN) fail to pay attention to, respond to, and report sensory events occurring in the contralesional side of space. The traditional neuropsychological assessment of USN is based on paper-and-pencil tests, whose data recording and scoring may be subjected to human error. The utilization of technological devices can be expected to improve the assessment of USN. Therefore, we built Neurit.Space, a modified digital version of three paper-and-pencil tests, widely used to detect signs of USN, namely: Bells Cancellation, Line Bisection and Five Elements Drawing Test. Administration and data processing is fully automatic. Twelve right brain-damaged patients (six with and six without USN) and 12 age- and education-balanced healthy participants were enrolled in the study. All participants were administered both the computerized and the paper-and-pencil versions of the tests. The results of this preliminary study showed good sensitivity, specificity, and usability of Neurit.Space, suggesting that these digital tests are a promising tool for the evaluation of USN, both in clinical and in research settings. Full article

(This article belongs to the Special Issue Neuropsychological Assessment: Past and Future)

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9 pages, 1665 KiB

Open AccessArticle

Anatomical Analysis of the Gonadal Veins and Spine in Lateral Lumbar Interbody Fusion

by Yujiro Kagami, Hiroaki Nakashima, Kotaro Satake, Kenyu Ito, Mikito Tsushima, Naoki Segi, Hiroyuki Tomita, Jun Ouchida, Yoshinori Morita, Yukihito Ode, Shiro Imagama and Tokumi Kanemura

J. Clin. Med. 2023, 12(8), 3041; https://doi.org/10.3390/jcm12083041 - 21 Apr 2023

Cited by 1 | Viewed by 1209

Abstract

Background: The current study aimed to investigate the anatomical position of the gonadal veins (GVs) from the viewpoint of spine surgery and the risk factors associated with lateral lumbar interbody fusion (LLIF). Methods: This retrospective study included 99 consecutive patients. The GV locations [...] Read more.

Background: The current study aimed to investigate the anatomical position of the gonadal veins (GVs) from the viewpoint of spine surgery and the risk factors associated with lateral lumbar interbody fusion (LLIF). Methods: This retrospective study included 99 consecutive patients. The GV locations were divided into the ventral (V), dorsal medial (DM), and dorsal lateral (DL) sides based on lumbar disk levels on axial contrast-enhanced computed tomography images. The DM region surrounded by the vertebral body and psoas muscle had the highest risk of GV injury. The GV at each intervertebral disk level was examined in terms of laterality and sex. The patients were divided into group M (which included those with GV in the DM region at any vertebral level) and group O (which included those without GV in the DM region at any vertebral level). Then, the two groups were compared. Results: In the case of lower lumbar levels and in women, the GVs were commonly observed in the DM region. Group M had a higher incidence of degenerative scoliosis than group O and a significantly larger Cobb angle. Conclusions: We should pay close attention to the GV location on the preoperative image when using LLIF, particularly in female patients with degenerative scoliosis. Full article

(This article belongs to the Special Issue Lumbar Spine Surgery: Causes, Complications and Management)

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13 pages, 424 KiB

Open AccessArticle

Waist Circumference and Cardiovascular Risk Profiles after Autologous Breast Reconstruction: A Nationwide Population-Based Cohort Study

by Jeong Yeop Ryu, Myeong Jae Kang, Hyun Geun Cho, Jung Dug Yang and Joon Seok Lee

J. Clin. Med. 2023, 12(8), 3040; https://doi.org/10.3390/jcm12083040 - 21 Apr 2023

Cited by 1 | Viewed by 1742

Abstract

To date, few studies have examined changes in waist circumference and cardiovascular risk profile (CVRP) after autologous breast reconstruction. Therefore, this study aimed to investigate the effect of flap surgery using autologous tissue on waist circumference and CVRP through a nationwide population-based cohort [...] Read more.

To date, few studies have examined changes in waist circumference and cardiovascular risk profile (CVRP) after autologous breast reconstruction. Therefore, this study aimed to investigate the effect of flap surgery using autologous tissue on waist circumference and CVRP through a nationwide population-based cohort study. In total, 6926 patients who underwent autologous breast reconstruction between 2015 and 2019 were considered. Of them, we evaluated 3444 patients who underwent the complete Korean National Health Insurance Service Health Screening (NHIS-HealS) before and after surgery. Body measurements, including waist circumference, weight, and body mass index; and CVRP, including blood pressure, fasting blood glucose, and cholesterol levels, were analyzed by type of surgery up to 3–4 years postoperatively. The body measurements of patients who underwent abdominal-based breast reconstruction were reduced 1–2 years after surgery, but returned to preoperative values 3–4 years after surgery. Regardless of the type of surgery, CVRP was worsened at both 1–2 years and 3–4 years after surgery, except for low-density lipoprotein values. Autologous breast reconstruction did not ameliorate the deterioration of CVRP over time. In addition, the abdominoplasty effect of abdominal-based breast reconstruction disappeared 1–2 years after surgery. Full article

(This article belongs to the Section Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine)

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14 pages, 2792 KiB

Open AccessSystematic Review

Intense Pulsed Light Therapy in the Treatment of Dry Eye Diseases: A Systematic Review and Meta-Analysis

by Lilian Demolin, Majda Es-Safi, Muhammad Shahnawaz Soyfoo and Elie Motulsky

J. Clin. Med. 2023, 12(8), 3039; https://doi.org/10.3390/jcm12083039 - 21 Apr 2023

Cited by 6 | Viewed by 5370

Abstract

Background: Intense pulsed light therapy (IPL) is a recently developed way of treating dry eye disease (DED). During the last decade, there was a multiplication of trials studying IPL efficacy. The goal of this review is to summarize the most important and significant [...] Read more.

Background: Intense pulsed light therapy (IPL) is a recently developed way of treating dry eye disease (DED). During the last decade, there was a multiplication of trials studying IPL efficacy. The goal of this review is to summarize the most important and significant results of these trials estimating effect sizes. Methods: The PubMed and sciencedirect databases were searched using a PICO model-based approach. Randomized controlled trials including at least 20 patients with DED and no other eye condition, with a control group and break-up time or symptom scores data available for extraction were included in this review. Statistical analysis evaluated the tear break-up time (TBUT), non-invasive break-up time (NIBUT), ocular surface disease index (OSDI), and standard patient evaluation of eye dryness (SPEED). Three comparisons were carried on for each outcome: longest follow-up values vs. baseline in the treatment group, longest follow-up values in the treatment group vs. control group, and changes from baseline in the treatment group vs. control group. A subgroup analysis was carried on. Results: Eleven randomized controlled trials, published between 2015 and 2021 were included in this systematic review with 759 patients in total. The longest follow-up values vs. baseline in the treatment group analyses were significantly in favor of IPL for all the parameters studied for instance: NIBUT (effect size (ES), 2.02; 95% confidence interval (CI), (1.43; 2.62)), TBUT (ES, 1.83; 95% CI, (0.96; 2.69)), OSDI (ES, −1.38; 95% CI, (−2.12; −0.64)) and SPEED (ES, −1.15; 95% CI, (−1.72; −0.57)). The longest follow-up values in the treatment group vs. control group analyses, and, the change from baseline in the treatment group vs. control group analyses, were both significantly in favor of IPL for NIBUT, TBUT, and SPEED but not for OSDI. Conclusions: IPL seems to have a positive effect on tear stability evaluated by the break-up times. However, the effect on DED symptoms is less clear. Some confounding factors such as the age and the IPL device used influence the results indicating that the ideal settings still need to be found and personalized for the patient. Full article

(This article belongs to the Section Ophthalmology)

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16 pages, 8302 KiB

Open AccessReview

Malignant Bone and Soft Tissue Lesions of the Foot

by Andrea Angelini, Carlo Biz, Mariachiara Cerchiaro, Valentina Longhi and Pietro Ruggieri

J. Clin. Med. 2023, 12(8), 3038; https://doi.org/10.3390/jcm12083038 - 21 Apr 2023

Cited by 5 | Viewed by 5305

Abstract

Malignant tumors of the foot are rare pathologies that can involve the skin, soft tissue, or bone. Due to their rarity, they are often misdiagnosed, resulting in inadequate excision and poor outcomes. A correct approach with a careful examination and radiological study, followed [...] Read more.

Malignant tumors of the foot are rare pathologies that can involve the skin, soft tissue, or bone. Due to their rarity, they are often misdiagnosed, resulting in inadequate excision and poor outcomes. A correct approach with a careful examination and radiological study, followed by a properly performed biopsy, is thus mandatory to avoid these pitfalls. The present article reviews the most common malignant bone and soft tissue lesions of the foot region, discussing their clinicopathological presentation, imaging features, and current concepts in treatment. Full article

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

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23 pages, 2687 KiB

Open AccessSystematic Review

Multidimensional Interventions on Supporting Disease Management for Hospitalized Patients with Heart Failure: The Role of Clinical and Community Pharmacists

by Magdalena Jasińska-Stroschein and Magdalena Waszyk-Nowaczyk

J. Clin. Med. 2023, 12(8), 3037; https://doi.org/10.3390/jcm12083037 - 21 Apr 2023

Cited by 5 | Viewed by 2101

Abstract

Background: existing trials on the role of clinical pharmacists in managing chronic disease patients have focused on variety of interventions, including preparing patients for the transition from hospital to home. However, little quantitative evidence is available regarding the effect of multidimensional interventions on [...] Read more.

Background: existing trials on the role of clinical pharmacists in managing chronic disease patients have focused on variety of interventions, including preparing patients for the transition from hospital to home. However, little quantitative evidence is available regarding the effect of multidimensional interventions on supporting disease management for hospitalized patients with heart failure (HF). The present paper reviews the effects of inpatient, discharge and/or after-discharge interventions performed on hospitalized HF patients by multidisciplinary teams, including pharmacists. Methods: articles were identified through search engines in three electronic databases following the PRISMA Protocol. Randomized controlled trials (RCTs) or non-randomized intervention studies conducted in the period 1992–2022 were included. In all studies, baseline characteristics of patients as well as study end-points were described in relation to a control group i.e., usual care and a group of subjects that received care from a clinical and/or community pharmacist, as well as other health professionals (Intervention). Study outcomes included all-cause hospital 30-day re-admission or emergency room (ER) visits, all-cause hospitalization within >30 days after discharge, specific-cause hospitalization rates, medication adherence and mortality. The secondary outcomes included adverse events and quality of life. Quality assessment was carried out using RoB 2 Risk of Bias Tool. Publication bias across studies was determined using the funnel plot and Egger’s regression test. Results: a total of 34 protocols were included in the review, while the data from 33 trials were included in further quantitative analyses. The heterogeneity between studies was high. Pharmacist-led interventions, usually performed within interprofessional care teams, reduced the rates of 30-day all-cause hospital re-admission (odds ratio, OR = 0.78; 95% CI 0.62–0.98; p = 0.03) and all-cause hospitalization >30 days after discharge (OR = 0.73; 95% CI 0.63–0.86; p = 0.0001). Subjects hospitalized primarily due to heart failure demonstrated reduced risk of hospital admission within longer periods, i.e., from 60 to 365 days after discharge (OR = 0.64; 95% CI 0.51–0.81; p = 0.0002). The rate of all-cause hospitalization was reduced by multidimensional interventions taken by pharmacists: reviews of medicine lists and/or their reconciliation at discharge (OR = 0.63; 95% CI 0.43–0.91; p = 0.014), as well as interventions that were based mainly on patient education and counseling (OR = 0.65; 95% CI 0.49–0.88; p = 0.0047). In conclusion, given that HF patients often have complex treatment regimens and multiple comorbid conditions, our findings highlight the need for greater involvement from skilled clinical and community pharmacists in disease management. Full article

(This article belongs to the Special Issue Advances in Acute and Chronic Heart Failure)

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8 pages, 490 KiB

Open AccessArticle

Risk Factors for Perineal Wound Breakdown in Early Postpartum: A Retrospective Case–Control Study

by Amandine Puissegur, Marie Accoceberry, Marion Rouzaire, Bruno Pereira, Marie Herault, Clément Bruhat, Amélie Delabaere and Denis Gallot

J. Clin. Med. 2023, 12(8), 3036; https://doi.org/10.3390/jcm12083036 - 21 Apr 2023

Cited by 2 | Viewed by 3342

Abstract

We conducted a retrospective case–control study in patients presenting a perineal tear (second degree or higher) or episiotomy complicated by wound breakdown during maternity stay to identify risk factors associated with wound breakdown in early postpartum with a view to improving the quality [...] Read more.

We conducted a retrospective case–control study in patients presenting a perineal tear (second degree or higher) or episiotomy complicated by wound breakdown during maternity stay to identify risk factors associated with wound breakdown in early postpartum with a view to improving the quality of care. We collected ante- and intrapartum characteristics and outcomes at the postpartum visit. In all, 84 cases and 249 control subjects were included. In univariate analysis, primiparity, absence of history of vaginal delivery, a longer second phase of labour, instrumental delivery, and a higher degree of laceration emerged as risk factors for early perineal suture breakdown postpartum. Gestational diabetes, peripartum fever, streptococcus B, and suture technique did not emerge as risk factors for perineal breakdown. Multivariate analysis confirmed that instrumental delivery (OR = 2.18 [1.07; 4.41], p = 0.03) and a longer second phase of labour (OR = 1.72 [1.23; 2.42], p = 0.001) were risk factors for early perineal suture breakdown. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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10 pages, 2441 KiB

Open AccessArticle

Identification of Distinct Clinical Phenotypes of Critically Ill COVID-19 Patients: Results from a Cohort Observational Study

by José Pedro Cidade, Vicente Cés de Souza Dantas, Alessandra de Figueiredo Thompson, Renata Carnevale Carneiro Chermont de Miranda, Rafaela Mamfrim, Henrique Caroli, Gabriela Escudini, Natalia Oliveira, Taiza Castro and Pedro Póvoa

J. Clin. Med. 2023, 12(8), 3035; https://doi.org/10.3390/jcm12083035 - 21 Apr 2023

Cited by 3 | Viewed by 1588

Abstract

Purpose: COVID-19 presents complex pathophysiology, and evidence collected points towards an intricate interaction between viral-dependent and individual immunological mechanisms. Identifying phenotypes through clinical and biological markers may provide a better understanding of the subjacent mechanisms and an early patient-tailored characterization of illness [...] Read more.

Purpose: COVID-19 presents complex pathophysiology, and evidence collected points towards an intricate interaction between viral-dependent and individual immunological mechanisms. Identifying phenotypes through clinical and biological markers may provide a better understanding of the subjacent mechanisms and an early patient-tailored characterization of illness severity. Methods: A multicenter prospective cohort study was performed in 5 hospitals in Portugal and Brazil for one year between 2020–2021. All adult patients with an Intensive Care Unit admission with SARS-CoV-2 pneumonia were eligible. COVID-19 was diagnosed using clinical and radiologic criteria with a SARS-CoV-2 positive RT-PCR test. A two-step hierarchical cluster analysis was made using several class-defining variables. Results: 814 patients were included. The cluster analysis revealed a three-class model, allowing for the definition of three distinct COVID-19 phenotypes: 407 patients in phenotype A, 244 patients in phenotype B, and 163 patients in phenotype C. Patients included in phenotype A were significantly older, with higher baseline inflammatory biomarkers profile, and a significantly higher requirement of organ support and mortality rate. Phenotypes B and C demonstrated some overlapping clinical characteristics but different outcomes. Phenotype C patients presented a lower mortality rate, with consistently lower C-reactive protein, but higher procalcitonin and interleukin-6 serum levels, describing an immunological profile significantly different from phenotype B. Conclusions: Severe COVID-19 patients exhibit three different clinical phenotypes with distinct profiles and outcomes. Their identification could have an impact on patients’ care, justifying different therapy responses and inconsistencies identified across different randomized control trial results. Full article

(This article belongs to the Special Issue Intensive Care Management of COVID-19 Patients)

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11 pages, 1608 KiB

Open AccessArticle

Determination of Correlated Color Temperature in Ex Vivo Porcine Eyes during Intraocular Illumination

by Nicole Fehler and Martin Hessling

J. Clin. Med. 2023, 12(8), 3034; https://doi.org/10.3390/jcm12083034 - 21 Apr 2023

Viewed by 1337

Abstract

(1) Background: In ophthalmic surgery, white light is mostly applied to illuminate the intraocular space, and ophthalmologists are comfortable working with it. Diaphanoscopic illumination changes the spectral composition of light, resulting in a change in the correlated color temperature (CCT) of the intraocular [...] Read more.

(1) Background: In ophthalmic surgery, white light is mostly applied to illuminate the intraocular space, and ophthalmologists are comfortable working with it. Diaphanoscopic illumination changes the spectral composition of light, resulting in a change in the correlated color temperature (CCT) of the intraocular illumination. This color change makes it difficult for surgeons to recognize the structures in the eye. CCT during intraocular illumination has not yet been measured before, and it is the aim of this study to perform such measurement. (2) Methods: CCT was measured inside ex vivo porcine eyes during diaphanoscopic illumination and endoillumination using a current ophthalmic illumination system with a detection fiber inside the eye. By applying pressure on the eye with a diaphanoscopic fiber, the dependency of CCT on pressure was examined. (3) Results: The intraocular CCT values during endoillumination were 3923 K and 5407 K for the halogen and xenon lamps, respectively. During diaphanoscopic illumination, a strong unwanted red shift was observed, resulting in 2199 K and 2675 K for the xenon and the halogen lamps, respectively. Regarding different applied pressures, the CCT did not differ considerably. (4) Conclusions: This red shift should be compensated for in the development of new illumination systems since surgeons are used to white light illumination, which also simplifies the identification of retinal structures. Full article

(This article belongs to the Section Ophthalmology)

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11 pages, 856 KiB

Open AccessArticle

Optimal Heart Rate May Improve Systolic and Diastolic Function in Patients with Fontan Circulation

by Keiichi Hirono, Teruhiko Imamura, Kaori Tsuboi, Shinya Takarada, Mako Okabe, Hideyuki Nakaoka, Keijiro Ibuki and Sayaka Ozawa

J. Clin. Med. 2023, 12(8), 3033; https://doi.org/10.3390/jcm12083033 - 21 Apr 2023

Viewed by 1510

Abstract

(1) Background: The optimal heart rate, at which the E-wave and A-wave stand adjacent without any overlaps in the Doppler transmitral flow echocardiography, is associated with maximum cardiac output and favorable clinical outcomes in adult patients with systolic heart failure. However, the clinical [...] Read more.

(1) Background: The optimal heart rate, at which the E-wave and A-wave stand adjacent without any overlaps in the Doppler transmitral flow echocardiography, is associated with maximum cardiac output and favorable clinical outcomes in adult patients with systolic heart failure. However, the clinical implication of the echocardiographic overlap length in patients with Fontan circulation remains unknown. We investigated the relationship between heart rate (HR) and hemodynamics in Fontan surgery patients with and without beta-blockers. (2) Methods and Results: A total of 26 patients (median age 1.8 years, 13 males) were enrolled. At baseline, the plasma N-terminal pro-B-type natriuretic peptide was 2439 ± 3483 pg/mL, the fraction area change was 33.5 ± 11.4%, the cardiac index was 3.55 ± 0.90 L/min/m², and the overlap length was 45.2 ± 59.0 msec. Overlap length was importantly decreased after the one-year follow-up (7.60 ± 78.57 msec, p = 0.0069). Positive correlations were noted between the overlap length and A-wave and E/A ratio (p = 0.0021 and p = 0.0046, respectively). Ventricular end-diastolic pressure was significantly correlated with the overlap length in non-beta-blocker patients (p = 0.0483). (3) Conclusion: Overlap length may reflect the status of ventricular dysfunction. Hemodynamic preservation at lower HR could be critical for cardiac reverse remodeling. Full article

(This article belongs to the Special Issue Congenital Heart Disease: Clinical Practice, Prognosis and Outcome)

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8 pages, 453 KiB

Open AccessBrief Report

Getting It Right in Obstructive Lung Disease

by Annalisa Carlucci and Barbara Fusar Poli

J. Clin. Med. 2023, 12(8), 3032; https://doi.org/10.3390/jcm12083032 - 21 Apr 2023

Cited by 1 | Viewed by 1464

Abstract

Chronic hypercapnic respiratory failure in obstructive lung diseases may benefit from nocturnal Home non-invasive ventilation (HNIV). It has been shown that in patients with persistence of hypercapnia after an acute episode of chronic obstructive pulmonary disease (COPD) exacerbation requiring mechanical ventilation, HNIV may [...] Read more.

Chronic hypercapnic respiratory failure in obstructive lung diseases may benefit from nocturnal Home non-invasive ventilation (HNIV). It has been shown that in patients with persistence of hypercapnia after an acute episode of chronic obstructive pulmonary disease (COPD) exacerbation requiring mechanical ventilation, HNIV may improve the risk for new admission and survival. The ability to reach these aims depends on the correct timing of enrolling patients, as well as a correct definition of ventilatory needing and setting of the ventilator. This review tries to define a possible home treatment path of hypercapnic respiratory failure in COPD by analyzing the main studies published in recent years. Full article

(This article belongs to the Special Issue Non-invasive Respiratory Support: How to Get It Right in Clinical Medicine—Volume I)

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15 pages, 3021 KiB

Open AccessReview

Advances in Canaloplasty—Modified Techniques Yield Strong Pressure Reduction with Low Risk Profile

by Peter Szurman

J. Clin. Med. 2023, 12(8), 3031; https://doi.org/10.3390/jcm12083031 - 21 Apr 2023

Viewed by 1854

Abstract

For decades, trabeculectomy (TE) was considered the gold standard for surgical treatment of open-angle glaucoma owing to its powerful intraocular pressure (IOP)-lowering potency. However, owing to the invasive nature and high-risk profile of TE, this standard is changing, and minimally invasive procedures are [...] Read more.

For decades, trabeculectomy (TE) was considered the gold standard for surgical treatment of open-angle glaucoma owing to its powerful intraocular pressure (IOP)-lowering potency. However, owing to the invasive nature and high-risk profile of TE, this standard is changing, and minimally invasive procedures are becoming more preferable. In particular, canaloplasty (CP) has been established as a much gentler alternative in everyday life and is under development as a full-fledged replacement. This technique involves probing Schlemm’s canal with a microcatheter and inserting a pouch suture that places the trabecular meshwork under permanent tension. It aims to restore the natural outflow pathways of the aqueous humor and is independent of external wound healing. This physiological approach results in a significantly lower complication rate and allows considerably simplified perioperative management. There is now extensive evidence that canaloplasty achieves sufficient pressure reduction as well as a significant reduction in postoperative glaucoma medications. Unlike MIGS procedures, the indication is not only mild to moderate glaucoma; today, even advanced glaucoma benefits from the very low hypotony rate, which largely avoids a wipeout phenomenon. However, approximately half of patients are not completely medication-free after canaloplasty. As a consequence, a number of canaloplasty modifications have been developed with the goal of further enhancing the IOP-lowering effect while avoiding the risk of serious complications. By combining canaloplasty with the newly developed suprachoroidal drainage procedure, the individual improvements in trabecular facility and uveoscleral outflow facility appear to have an additive effect. Thus, for the first time, an IOP-lowering effect comparable to a successful trabeculectomy can be achieved. Other implant modifications also enhance the potential of canaloplasty or offer additional benefits such as the possibility of telemetric IOP self-measurement by the patient. This article reviews the modifications of canaloplasty, which has the potential to become a new gold standard in glaucoma surgery via stepwise refinement. Full article

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

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18 pages, 4229 KiB

Open AccessArticle

A Prospective Study of Renal Blood Flow during Retrograde Intrarenal Surgery

by Krzysztof Balawender

J. Clin. Med. 2023, 12(8), 3030; https://doi.org/10.3390/jcm12083030 - 21 Apr 2023

Cited by 1 | Viewed by 1470

Abstract

(I) Introduction: The use of Doppler ultrasound allows us to indirectly assess the effect of increased intrarenal pressure on renal blood flow during retrograde intrarenal surgery (RIRS). On the basis of vascular flow spectra from selected blood vessels in the kidney, it is [...] Read more.

(I) Introduction: The use of Doppler ultrasound allows us to indirectly assess the effect of increased intrarenal pressure on renal blood flow during retrograde intrarenal surgery (RIRS). On the basis of vascular flow spectra from selected blood vessels in the kidney, it is possible to determine Doppler parameters that reflect the renal perfusion status, which indirectly shows the degree of vasoconstriction and reflects the resistance of kidney tissue. (II) Materials and methods: A total of 56 patients were included in the study. The study assessed the changes of three Doppler parameters of intrarenal blood flow: resistive index-RI, pulsatility index-PI, and acceleration time-AT in the ipsilateral and contralateral kidneys during RIRS. The effects of mean stone volume, energy used, and pre-stenting were examined as predictors and calculated at two time intervals. (III) Results: The mean value of RI and PI was significantly higher in the ipsilateral kidney than in the contralateral kidney just after RIRS. The mean value of the acceleration time was not significantly different before and after RIRS. The values of all three parameters 24 h after the procedure were comparable to their values immediately after the RIRS. The size of the stone exposed to laser lithotripsy, the value of the energy used, and pre-stenting are not factors that significantly influence Doppler parameters during RIRS. (IV) Conclusions: The significant increase in RI and PI after RIRS in the ipsilateral kidney suggests a vasoconstriction of the interlobar arteries generated by increased intrarenal pressure during the procedure. Full article

(This article belongs to the Special Issue Recent Advances in Clinical Management of Urolithiasis)

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13 pages, 695 KiB

Open AccessArticle

Deprescribing Strategies: A Prospective Study on Proton Pump Inhibitors

by Giulia Calvini, Giammarco Baiardi, Francesca Mattioli, Giulia Milano, Francesca Calautti, Alessia Zunino, Carla Elda Fraguglia, Fabio Caccavale, Francesca Lantieri and Giancarlo Antonucci

J. Clin. Med. 2023, 12(8), 3029; https://doi.org/10.3390/jcm12083029 - 21 Apr 2023

Cited by 2 | Viewed by 1555

Abstract

Proton pump inhibitors (PPIs) are among the most controversially prescribed drugs in polypharmacy. This observational prospective study assessed the PPI prescriptive trend during hospitalization before and after implementation of a prescribing/deprescribing algorithm in a real-life hospital setting and the related clinical–economic benefit at [...] Read more.

Proton pump inhibitors (PPIs) are among the most controversially prescribed drugs in polypharmacy. This observational prospective study assessed the PPI prescriptive trend during hospitalization before and after implementation of a prescribing/deprescribing algorithm in a real-life hospital setting and the related clinical–economic benefit at discharge. PPI prescriptive trends were compared between three quarters of 2019 (9 months) and the same period of 2018 by a chi-square test with a Yate’s correction. The proportions of treated patients in the two years (1120 discharged patients in 2018 and 1107 in 2019) were compared by the Cochran–Armitage trend test. DDDs (defined daily doses) were compared between 2018 and 2019 by the non-parametric Mann–Whitney test and normalizing DDD/DOT (days of therapy) and DDD/100 bd (bed days) for each patient. Multivariate logistic regression was performed on PPI prescriptions at discharge. The distribution of patients with PPIs at discharge was significantly different in the two years (p = 0.0121). There was a downward trend in the number of PPI prescriptions (29.9%) in the third trimester of 2019 compared to the others of the same year (first trimester: 34.1%, second trimester: 36.0%) and by contrast with the same periods of 2018 (29.4, 36.0, and 34.7%) (p = 0.0124). DDDs/patient did not differ between 2018 and 2019 nor across the three trimesters. However, both DDD/DOT and DDD/100 bd showed a decrease in the third trimester of 2019, with a marked difference for DDD/DOT (p = 0.0107). The reduction in consumption detected in the last phase of 2019 in terms of DDD/DOT was 0.09 with a consequent containment of pharmaceutical spending. The development and implementation of multidisciplinary prescribing/deprescribing protocols in both hospital and community settings could lead to a reduction in the misuse of PPIs, with significant savings in healthcare resources. Full article

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

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10 pages, 616 KiB

Open AccessArticle

Coronary Artery Disease and Prognosis of Heart Failure with Reduced Ejection Fraction

by Lourdes Vicent, Jesús Álvarez-García, Rafael Vazquez-Garcia, José R. González-Juanatey, Miguel Rivera, Javier Segovia, Domingo Pascual-Figal, Ramón Bover, Fernando Worner, Francisco Fernández-Avilés, Albert Ariza-Sole and Manuel Martínez-Sellés

J. Clin. Med. 2023, 12(8), 3028; https://doi.org/10.3390/jcm12083028 - 21 Apr 2023

Cited by 2 | Viewed by 1894

Abstract

Our aim was to determine the prognostic impact of coronary artery disease (CAD) on heart failure with reduced ejection fraction (HFrEF) mortality and readmissions. From a prospective multicenter registry that included 1831 patients hospitalized due to heart failure, 583 had a left ventricular [...] Read more.

Our aim was to determine the prognostic impact of coronary artery disease (CAD) on heart failure with reduced ejection fraction (HFrEF) mortality and readmissions. From a prospective multicenter registry that included 1831 patients hospitalized due to heart failure, 583 had a left ventricular ejection fraction of <40%. In total, 266 patients (45.6%) had coronary artery disease as main etiology and 137 (23.5%) had idiopathic dilated cardiomyopathy (DCM), and they are the focus of this study. Significant differences were found in Charlson index (CAD 4.4 ± 2.8, idiopathic DCM 2.9 ± 2.4, p < 0.001), and in the number of previous hospitalizations (1.1 ± 1, 0.8 ± 1.2, respectively, p = 0.015). One-year mortality was similar in the two groups: idiopathic DCM (hazard ratio [HR] = 1), CAD (HR 1.50; 95% CI 0.83–2.70, p = 0.182). Mortality/readmissions were also comparable: CAD (HR 0.96; 95% CI 0.64–1.41, p = 0.81). Patients with idiopathic DCM had a higher probability of receiving a heart transplant than those with CAD (HR 4.6; 95% CI 1.4–13.4, p = 0.012). The prognosis of HFrEF is similar in patients with CAD etiology and in those with idiopathic DCM. Patients with idiopathic DCM were more prone to receive heart transplant. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Ischaemic Heart Disease)

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16 pages, 1135 KiB

Open AccessArticle

The Interaction Effect of Anti-RgpA and Anti-PPAD Antibody Titers: An Indicator for Rheumatoid Arthritis Diagnosis

by Diana Marcela Castillo, Gloria Inés Lafaurie, Consuelo Romero-Sánchez, Nathaly Andrea Delgadillo, Yormaris Castillo, Wilson Bautista-Molano, César Pacheco-Tena, Juan Manuel Bello-Gualtero, Philippe Chalem-Choueka and Jaime E. Castellanos

J. Clin. Med. 2023, 12(8), 3027; https://doi.org/10.3390/jcm12083027 - 21 Apr 2023

Cited by 3 | Viewed by 2057

Abstract

Porphyromonas gingivalis secretes virulence factors like Arg-gingipains and peptidyl arginine deiminase (PPAD), that are associated with rheumatoid arthritis (RA) pathogenesis. However, there is no information regarding the antibody titers for these bacterial enzymes as systemic indicators or biomarkers in RA. In this cross-sectional [...] Read more.

Porphyromonas gingivalis secretes virulence factors like Arg-gingipains and peptidyl arginine deiminase (PPAD), that are associated with rheumatoid arthritis (RA) pathogenesis. However, there is no information regarding the antibody titers for these bacterial enzymes as systemic indicators or biomarkers in RA. In this cross-sectional study, 255 individuals were evaluated: 143 were diagnosed with RA, and 112 were without RA. Logistic regression models adjusted for age, sex, basal metabolic index, smoking, and periodontitis severity were used to evaluate the association of RA with rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPAs), erythrocyte sedimentation rate, high sensitivity C-reactive protein, anti-RgpA, anti-PPAD, and double positive anti-RgpA/anti-PPAD. It was found that RF (odds ratio [OR] 10.6; 95% confidence interval [CI] 4.4–25), ACPAs (OR 13.7; 95% CI 5.1–35), and anti-RgpA/anti-PPAD double positivity (OR 6.63; 95% CI 1.61–27) were associated with RA diagnoses. Anti-RgpA was also associated with RA (OR 4.09; 95% CI 1.2–13.9). The combination of anti-RgpA/anti-PPAD showed a high specificity of 93.7% and 82.5% PPV in identifying individuals with RA. RgpA antibodies were associated with the periodontal inflammatory index in RA individuals (p < 0.05). The double positivity of the anti-RgpA/anti-PPAD antibodies enhanced the diagnosis of RA. Therefore, RgpA antibodies and anti-RgpA/anti-PPAD may be biomarkers for RA. Full article

(This article belongs to the Special Issue Rheumatoid Arthritis: Pathogenesis, Diagnosis and Therapies—Part II)

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13 pages, 1110 KiB

Open AccessArticle

Time Trends of Environmental and Socioeconomic Risk Factors in Patients with Inflammatory Bowel Disease over 40 Years: A Population-Based Inception Cohort 1977–2020

by Panu Wetwittayakhlang, Lorant Gonczi, Petra A. Golovics, Zsuzsanna Kurti, Tunde Pandur, Gyula David, Zsuzsanna Erdelyi, Istvan Szita, Laszlo Lakatos and Peter L. Lakatos

J. Clin. Med. 2023, 12(8), 3026; https://doi.org/10.3390/jcm12083026 - 21 Apr 2023

Cited by 5 | Viewed by 1776

Abstract

Background: Data from population-based studies investigating trends in environmental factors associated with inflammatory bowel disease (IBD) is lacking. We aimed to assess long-term time trends of environmental and socioeconomic factors in IBD patients from a well-defined population-based cohort from Veszprem, Hungary. Methods: Patients [...] Read more.

Background: Data from population-based studies investigating trends in environmental factors associated with inflammatory bowel disease (IBD) is lacking. We aimed to assess long-term time trends of environmental and socioeconomic factors in IBD patients from a well-defined population-based cohort from Veszprem, Hungary. Methods: Patients were included between 1 January 1977, and 31 December 2020. Trends of environmental and socioeconomic factors were evaluated in three periods based on the decade of diagnosis, representing different therapeutic eras: cohort-A,1977–1995; cohort-B,1996–2008 (immunomodulator era); and cohort-C, 2009–2020 (biological era). Results: A total of 2240 incident patients with IBD were included (ulcerative colitis (UC) 61.2%, male 51.2%, median age at diagnosis: 35 years (IQR 29–49)). Rates of active smoking significantly decreased over time in Crohn’s disease (CD): 60.2%, 49.9%, and 38.6% in cohorts A/B/C (p < 0.001). In UC, the rates were low and stable: 15.4%, 15.4%, and 14.5% in cohorts A/B/C (p = 0.981). Oral contraceptive use was more common in CD compared to UC (25.0% vs. 11.6%, p < 0.001). In UC, prevalence of appendectomy before diagnosis decreased over time: 6.4%, 5.5%, and 2.3% in cohorts A/B/C (p = 0.013). No significant changes were found in the socio-geographic characteristics of the IBD population (urban living: UC, 59.8%/64.8%/ 62.5% (p = 0.309) and CD, 62.5%/ 62.0%/ 59.0% (p = 0.636), in cohorts A/B/C). A greater percentage of patients had completed secondary school as the highest education level in later cohorts in both UC (42.9%/50.2%/51.6%, p < 0.001) and CD (49.2%/51.7%/59.5%, p = 0.002). A higher percentage of skilled workers (34.4%/36.2%/38.9%, p = 0.027) was found in UC, but not in CD (p = 0.454). Conclusion: The association between trends of known environmental factors and IBD is complex. Smoking has become less prevalent in CD, but no other major changes occurred in socioeconomic factors over the last four decades that could explain the sharp increase in IBD incidence. Full article

(This article belongs to the Special Issue Pathogenesis, Clinical Presentation and Treatment of Inflammatory Bowel Disease and Its Complications)

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20 pages, 1523 KiB

Open AccessReview

Review of Osteoradionecrosis of the Jaw: Radiotherapy Modality, Technique, and Dose as Risk Factors

by Erkan Topkan, Ahmet Kucuk, Efsun Somay, Busra Yilmaz, Berrin Pehlivan and Ugur Selek

J. Clin. Med. 2023, 12(8), 3025; https://doi.org/10.3390/jcm12083025 - 21 Apr 2023

Cited by 26 | Viewed by 5220

Abstract

Radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) is the cornerstone of organ-sparing or adjuvant therapy for nearly all head and neck cancers. Unfortunately, aggressive RT or CCRT can result in severe late toxicities, such as osteoradionecrosis of the jaws (ORNJ). The incidence of ORNJ [...] Read more.

Radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) is the cornerstone of organ-sparing or adjuvant therapy for nearly all head and neck cancers. Unfortunately, aggressive RT or CCRT can result in severe late toxicities, such as osteoradionecrosis of the jaws (ORNJ). The incidence of ORNJ is currently less than 5–6% due to advances in dental preventive care programs, RT planning systems, and RT techniques. Although numerous patient-, tumor-, and treatment-related factors may influence the incidence rates of ORNJ, RT modality (equipment), technique, and dose-volume-related factors are three of the most influential factors. This is mainly because different RT equipment and techniques have different levels of success at delivering the prescribed dose to the focal volume of the treatment while keeping the “organ at risk” safe. ORNJ risk is ultimately determined by mandibular dose, despite the RT technique and method being known predictors. Regardless of the photon delivery method, the radiobiological effects will be identical if the total dose, dose per fraction, and dose distribution within the tissue remain constant. Therefore, contemporary RT procedures mitigate this risk by reducing mandibular dosages rather than altering the ionizing radiation behavior in irradiated tissues. In light of the paucity of studies that have examined the impact of RT modality, technique, and dose-volume-related parameters, as well as their radiobiological bases, the present review aims to provide a comprehensive overview of the published literature on these specific issues to establish a common language among related disciplines and provide a more reliable comparison of research results. Full article

(This article belongs to the Special Issue Radiation Therapy for Head and Neck Cancer)

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10 pages, 477 KiB

Open AccessArticle

by Emyal Alyaydin, Julia Kirsten Vogel, Peter Luedike, Tienush Rassaf, Rolf Alexander Jánosi and Maria Papathanasiou

J. Clin. Med. 2023, 12(8), 3024; https://doi.org/10.3390/jcm12083024 - 21 Apr 2023

Cited by 3 | Viewed by 2154

Abstract

(1) Background: The transcoronary ablation of septal hypertrophy (TASH) is an established therapy for hypertrophic obstructive cardiomyopathy (HOCM). Previous studies on this topic are characterised by a consistent male predominance and show a worse prognosis in females. (2) Methods: This study is a [...] Read more.

(1) Background: The transcoronary ablation of septal hypertrophy (TASH) is an established therapy for hypertrophic obstructive cardiomyopathy (HOCM). Previous studies on this topic are characterised by a consistent male predominance and show a worse prognosis in females. (2) Methods: This study is a retrospective analysis of all TASH procedures conducted between 2006 and 2021 at a tertiary academic centre. A solution of 75 µm microspheres (Embozene^®, Boston Scientific, Marlborough, MA, USA) was used as an embolising agent. The outcomes of interest were left ventricular outflow tract (LVOT) gradient reduction and symptom improvement among males vs. that among females. Secondarily, we analysed the sex-related differences in procedural safety outcomes and mortality. (3) Results: The study population consisted of 76 patients, with a median age of 61 years. Females comprised 57% of the cohort. We observed no sex-related differences in the baseline LVOT gradients at rest or under provocation (p = 0.560 and p = 0.208, respectively). Females were significantly older at the time of the procedure (p < 0.001), had lower tricuspid annular systolic excursion (TAPSE) (p = 0.009), presented a worse clinical status according to the NYHA functional classification (for NYHA ≥ 3, p < 0.001), and were more often on diuretics (p < 0.001). We did not observe sex-related differences in absolute gradient reduction at rest (p = 0.147) and under provocation (p = 0.709). There was a reduction in the NYHA class by a median value of 1 (p = 0.636) at follow-up for both sexes. Postprocedural access site complications were documented in four cases (two of which concerned females), and complete atrioventricular block was noted in five patients (three of which concerned females). The 10-year survival rates were comparable between the sexes (85% in females and 88% in males). The female sex was not associated with enhanced mortality according to multivariate analysis after adjusting for the confounding variables (HR 0.94; 95% CI 0.376–2.350; p = 0.895), but we observed age-related differences in long-term mortality (HR 1.035; 95% CI 1.007–1.063; p = 0.015). (4) Conclusions: TASH is safe and effective in both sexes, irrespective of their clinical differences. Women present at an advanced age and with more severe symptoms. An advanced age at the time of the intervention is an independent predictor of mortality. Full article

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

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13 pages, 1747 KiB

Open AccessArticle

The Inflammatory Bowel Disease—Disk Tool for Assessing Disability in Inflammatory Bowel Disease Patients: Validation of the Greek Version

by Anastasia Katsoula, Georgios Axiaris, Afroditi Mpitouli, Maria Palatianou, Angeliki Christidou, Nikolaos Dimitriadis, Andreas Nakos, Ploutarchos Pastras, Panagiotis Kourkoulis, Pantelis Karatzas, Miltiadis Moutzoukis, Charalampos Zlatinoudis, Athanasios Philippidis, Anastasia Kourikou, Georgios Kokkotis, Antonios Gklavas, Angeliki Machaira, Aikaterini Mantaka, Persefoni Talimtzi, Evaggelia Anagnostopoulou, Ioannis E. Koutroubakis, Ioannis Papaconstantinou, Georgios Bamias, Spilios Manolakopoulos, Nicoletta Mathou, Konstantina Paraskeva, Andreas Protopappas, Eftychia Tsironi, Konstantinos H. Katsanos, Dimitrios K. Christodoulou, Georgios Papatheodoridis, Georgios Michalopoulos, Georgios Theocharis, Christos Triantos, Ioannis Pachiadakis, Konstantinos Soufleris, Nikolaos Viazis, Gerassimos J. Mantzaris, Georgios Tribonias, Maria Tzouvala, Angeliki Theodoropoulou, Konstantinos Karmiris, Evanthia Zampeli, Spyridon Michopoulos, Anna-Bettina Haidich and Olga Giouleme Show full author list Hide full author list

J. Clin. Med. 2023, 12(8), 3023; https://doi.org/10.3390/jcm12083023 - 21 Apr 2023

Cited by 1 | Viewed by 2104

Abstract

Background: The Inflammatory Bowel Disease-Disk (IBD-Disk) is a physician-administered tool that evaluates the functional status of patients with Inflammatory Bowel Disease (IBD). The aim of our study was to validate the content of the IBD-Disk in a Greek cohort of IBD patients. Methods: [...] Read more.

Background: The Inflammatory Bowel Disease-Disk (IBD-Disk) is a physician-administered tool that evaluates the functional status of patients with Inflammatory Bowel Disease (IBD). The aim of our study was to validate the content of the IBD-Disk in a Greek cohort of IBD patients. Methods: Two questionnaires [the IBD Disk and the IBD-Disability Index (IBD-DI)] were translated into Greek and administered to IBD patients at baseline visit, after 4 weeks and 6 months. Validation of the IBD Disk included measuring of concurrent validity, reproducibility, and internal consistency. Results: A total of 300 patients were included at baseline and 269 at follow-up. There was a good correlation between the total scores of the IBD-Disk and IBD-DI at baseline (Pearson correlation 0.87, p < 0.001). Reproducibility of the total IBD-Disk score was very good [intra-class correlation coefficient (ICC), 95% confidence interval (CI) 0.89 (0.86–0.91)]. Cronbach’s coefficient alpha for all items achieved 0.90 (95%CI 0.88–0.92), demonstrating a very good homogeneity of the IBD-Disk items. Female gender and extraintestinal manifestations were significantly associated with a higher IBD-Disk total score. Conclusions: The Greek version of the IBD-Disk proved to be a reliable and valid tool in detecting and assessing IBD-related disability in a Greek cohort of IBD patients. Full article

(This article belongs to the Special Issue New Proactive Approaches and Precision Medicine in Crohn's Disease)

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14 pages, 8240 KiB

Open AccessArticle

Antegrade Intramedullary Femoral Lengthening and Distal Temporary Hemiepiphysiodesis for Combined Correction of Leg Length Discrepancy and Coronal Angular Deformity in Skeletally Immature Patients

by Andrea Laufer, Adrien Frommer, Georg Gosheger, Gregor Toporowski, Jan Duedal Rölfing, Carina Antfang, Robert Roedl and Bjoern Vogt

J. Clin. Med. 2023, 12(8), 3022; https://doi.org/10.3390/jcm12083022 - 21 Apr 2023

Cited by 6 | Viewed by 1692

Abstract

Leg length discrepancies (LLD) are frequently associated with coronal malalignment. Temporary hemiepiphysiodesis (HED) is a well-established procedure for the correction of limb malalignment in skeletally immature patients. For treatment of LLD > 2 cm, lengthening with intramedullary devices gains increasing popularity. However, no [...] Read more.

Leg length discrepancies (LLD) are frequently associated with coronal malalignment. Temporary hemiepiphysiodesis (HED) is a well-established procedure for the correction of limb malalignment in skeletally immature patients. For treatment of LLD > 2 cm, lengthening with intramedullary devices gains increasing popularity. However, no studies have investigated the combined application of HED and intramedullary lengthening in skeletally immature patients. This retrospective single-center study evaluated the clinical and radiological outcomes of femoral lengthening with an antegrade intramedullary lengthening nail combined with temporary HED performed in 25 patients (14 females) between 2014 and 2019. Temporary HED through the implantation of flexible staples of the distal femur and/or proximal tibia was either performed prior (n = 11), simultaneously (n = 10) or subsequently (n = 4) to femoral lengthening. The mean follow-up period was 3.7 years (±1.4). The median initial LLD was 39.0 mm (35.0–45.0). Twenty-one patients (84%) presented valgus and four (16%) showed varus malalignment. Leg length equalization was achieved in 13 of the skeletally mature patients (62%). The median LLD of the eight patients with residual LLD > 10 mm at skeletal maturity was 15.5 mm (12.8–21.8). Limb realignment was observed in nine of seventeen skeletally mature patients (53%) in the valgus group, and in one of four patients (25%) in the varus group. Combining antegrade femoral lengthening and temporary HED is a viable option to correct LLD and coronal limb malalignment in skeletally immature patients; however, achieving limb length equalization and realignment may be difficult in cases of severe LLD and angular deformity, in particular. Full article

(This article belongs to the Special Issue Deformity Correction, Bone Lengthening and Correction Osteotomies of the Lower Limb)

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15 pages, 3309 KiB

Open AccessEditor’s ChoiceArticle

Transalbugineal Artificial Urinary Sphincter: A Refined Implantation Technique to Improve Surgical Outcomes

by Emilio Sacco, Filippo Marino, Carlo Gandi, Riccardo Bientinesi, Angelo Totaro, Stefano Moretto, Filippo Gavi, Marco Campetella and Marco Racioppi

J. Clin. Med. 2023, 12(8), 3021; https://doi.org/10.3390/jcm12083021 - 21 Apr 2023

Cited by 8 | Viewed by 1663

Abstract

The artificial urinary sphincter (AUS) implantation is an effective treatment of post-prostatectomy urinary incontinence (PPI). Still, it may result in troublesome complications such as intraoperative urethral lesion and postoperative erosion. Based on the multilayered structure of the tunica albuginea of the corpora cavernosa, [...] Read more.

The artificial urinary sphincter (AUS) implantation is an effective treatment of post-prostatectomy urinary incontinence (PPI). Still, it may result in troublesome complications such as intraoperative urethral lesion and postoperative erosion. Based on the multilayered structure of the tunica albuginea of the corpora cavernosa, we evaluated an alternative transalbugineal surgical technique of AUS cuff placement with the aim to decrease perioperative morbidity while preserving the integrity of the corpora cavernosa. A retrospective study was conducted in a tertiary referral center from September 2012 to October 2021, including 47 consecutive patients undergoing AUS (AMS800^®) transalbugineal implantation. At a median (IQR) follow-up of 60 (24–84) months, no intraoperative urethral injury and only one noniatrogenic erosion occurred. The actuarial 12 mo and 5 yr overall erosion-free rates were 95.74% (95% CI: 84.04–98.92) and 91.76% (95% CI: 75.23–97.43), respectively. In preoperatively potent patients, the IIEF-5 score remained unchanged. The social continence (0–1 pads per day) rate was 82.98% (CI 95%: 68.83–91.10) at 12 mos and 76.81% (CI 95%: 60.56–87.04) at 5 yrs follow-up. Our technically refined approach to AUS implantation may help to avoid intraoperative urethral lesions and lower the risk of subsequent erosion without compromising sexual function in potent patients. Prospective and adequately powered studies are necessary to achieve more compelling evidence. Full article

(This article belongs to the Special Issue Latest Advances in Urinary Incontinence)

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11 pages, 1678 KiB

Open AccessArticle

Use of Recombinant Activated Factor VII in Bleeding Lung Transplant Patients Undergoing Perioperative ECMO Therapy

by Daniel Laxar, Eva Schaden, Marion Wiegele, Konrad Hötzenecker, Stefan Schwarz and Johannes Gratz

J. Clin. Med. 2023, 12(8), 3020; https://doi.org/10.3390/jcm12083020 - 21 Apr 2023

Cited by 1 | Viewed by 1474

Abstract

Background: Hemostasis in critically ill patients represents a fragile balance between hypocoagulation and hypercoagulation, and is influenced by various factors. Perioperative use of extracorporeal membrane oxygenation (ECMO)—increasingly used in lung transplantation—further destabilizes this balance, not least due to systemic anticoagulation. In the case [...] Read more.

Background: Hemostasis in critically ill patients represents a fragile balance between hypocoagulation and hypercoagulation, and is influenced by various factors. Perioperative use of extracorporeal membrane oxygenation (ECMO)—increasingly used in lung transplantation—further destabilizes this balance, not least due to systemic anticoagulation. In the case of massive hemorrhage, guidelines recommend considering recombinant activated Factor VII (rFVIIa) as an ultima ratio treatment only after several preconditions of hemostasis have been established. These conditions are calcium levels ≥ 0.9 mmol/L, fibrinogen levels ≥ 1.5 g/L, hematocrit ≥ 24%, platelet count ≥ 50 G/L, core body temperature ≥ 35 °C, and pH ≥ 7.2. Objectives: This is the first study to examine the effect of rFVIIa on bleeding lung transplant patients undergoing ECMO therapy. The fulfillment of guideline-recommended preconditions prior to the administration of rFVIIa and its efficacy alongside the incidence of thromboembolic events were investigated. Methods: In a high-volume lung transplant center, all lung transplant recipients receiving rFVIIa during ECMO therapy between 2013 and 2020 were screened for the effect of rFVIIa on hemorrhage, fulfillment of recommended preconditions, and incidence of thromboembolic events. Results and Discussion: Of the 17 patients who received 50 doses of rFVIIa, bleeding ceased in four patients without surgical intervention. Only 14% of rFVIIa administrations resulted in hemorrhage control, whereas 71% of patients required revision surgery for bleeding control. Overall, 84% of all recommended preconditions were fulfilled; however, fulfillment was not associated with rFVIIa efficacy. The incidence of thromboembolic events within five days of rFVIIa administration was comparable to cohorts not receiving rFVIIa. Full article

(This article belongs to the Special Issue Extracorporeal Membrane Oxygenation (ECMO): Current Progress and Clinical Challenges)

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15 pages, 1023 KiB

Open AccessArticle

Syringomyelia Associated with Chiari 1 Malformation in Adults: Positive Outcome Predictors after Posterior Fossa Decompression with Duraplasty

by Palma Ciaramitaro, Giuseppe Migliaretti, Marilena Ferraris, Andrea Garnero, Giovanni Morana, Paolo Carucci, Ilaria Stura, Fulvio Massaro and Diego Garbossa

J. Clin. Med. 2023, 12(8), 3019; https://doi.org/10.3390/jcm12083019 - 21 Apr 2023

Cited by 7 | Viewed by 2029

Abstract

Background: Syringomyelia (Syr) in patients with Chiari 1 malformation (CM1) may be attributable to abnormal dynamics of cerebrospinal fluid (CSF) in the upper cervical segment; fourth ventricle enlargement has been reported in association with a worse clinical and radiological presentation, independently of the [...] Read more.

Background: Syringomyelia (Syr) in patients with Chiari 1 malformation (CM1) may be attributable to abnormal dynamics of cerebrospinal fluid (CSF) in the upper cervical segment; fourth ventricle enlargement has been reported in association with a worse clinical and radiological presentation, independently of the posterior fossa volume. In this study, we analyzed presurgery hydrodynamic markers to evaluate if their changes could be associated with clinical and radiological improvement after posterior fossa decompression and duraplasty (PFDD). As a primary endpoint, we aimed to correlate improvement in the fourth ventricle area with positive clinical outcomes. Methods: In total, in this study, we enrolled 36 consecutive adults with Syr and CM1 who were followed by a multidisciplinary team. All the patients were prospectively evaluated with clinical scales and neuroimaging, including CSF flow, the fourth ventricle area, and the Vaquero Index by using a phase-contrast MRI before (T0) and after surgical treatment (T1-Tlast, with a range of 12–108 months). The CSF flow at the craniocervical junction (CCJ), the fourth ventricle area, and the Vaquero Index changes were statistically analyzed and compared to the clinical and quality of life improvement after surgery. The good outcome prediction ability of presurgical radiological variables was tested. Results: Surgery was associated with positive clinical and radiological outcomes in more than 90% of cases. The fourth ventricle area significantly reduced after surgery (T0-Tlast, p = 0.0093), but no significant associations with clinical improvement were found. The presurgical presence of CSF flow at the CCJ was able to predict a good outcome (AUC = 0.68, 95% CI 0.50–0.87 and LH+ = 2.1, IC 95% 1.16–3.07) and was also significantly associated with post-surgical pain relief (rho = 0.61 and p = 0.0144). Conclusions: Presurgery CSF flow at the CCJ is proposed as a radiological marker with the ability to predict a positive outcome after PFDD in adults with syringomyelia and CM1. Measurements of the fourth ventricle area could be useful additional information for evaluating surgical long-term follow-up; further experience on larger cohorts is required to better define the prognostic yield of this radiological parameter. Full article

(This article belongs to the Special Issue Chiari 1 Malformation, Syringomyelia and Related Disorders: Advances in Diagnosis and Treatment for Adults and Children)

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4 pages, 349 KiB

Open AccessEditorial

Revolutionizing Chronic Kidney Disease Management with Machine Learning and Artificial Intelligence

by Pajaree Krisanapan, Supawit Tangpanithandee, Charat Thongprayoon, Pattharawin Pattharanitima and Wisit Cheungpasitporn

J. Clin. Med. 2023, 12(8), 3018; https://doi.org/10.3390/jcm12083018 - 21 Apr 2023

Cited by 14 | Viewed by 2907

Abstract

Chronic kidney disease (CKD) poses a significant public health challenge, affecting approximately 11% to 13% of the global population [...] Full article

(This article belongs to the Section Nephrology & Urology)

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Strain Analysis in Patients with Frequent Premature Ventricular Complexes and Preserved Left Ventricular Function Undergoing Ablation

by Sina Jamé, Zhigang Liu, Theodore Kolias, Jackson Liang, Troy Labounty, Michael Ghannam, Rakesh Latchamsetty, Krit Jongnarangsin, Fred Morady and Frank Bogun

J. Clin. Med. 2023, 12(8), 3017; https://doi.org/10.3390/jcm12083017 - 21 Apr 2023

Cited by 2 | Viewed by 1414

Abstract

Background: Frequent premature ventricular complexes (PVCs) can cause PVC-induced cardiomyopathy. The value of PVC ablation in patients with preserved left ventricular function in the low–normal range (ejection fraction: 50–55%) is not established. Strain analysis has been used to estimate changes in left ventricular [...] Read more.

Background: Frequent premature ventricular complexes (PVCs) can cause PVC-induced cardiomyopathy. The value of PVC ablation in patients with preserved left ventricular function in the low–normal range (ejection fraction: 50–55%) is not established. Strain analysis has been used to estimate changes in left ventricular function beyond assessment of the ejection fraction (EF). Longitudinal strain has been proposed as a method to detect changes over time in the setting of frequent asymptomatic premature ventricular complexes and preserved left ventricular (LV) function. A decrease in strain may be evidence of PVC-induced cardiomyopathy. Objective: In this study, we assessed the role of PVC ablation in patients with low–normal EF and the effect on EF and myocardial strain before and after PVC ablation. Methods: A total of 70 consecutive patients with either low–normal EF (0.5–<0.55, n = 35) or high–normal EF (≥0.55; n = 35), using available imaging and Holter data, were referred for ablation due to frequent PVCs. EF and longitudinal strain were assessed pre- and post-ablation. Results: There was a significant increase in EF (53.2 ± 0.4% to 58.3 ± 0.5%, p < 0.001) and improvement in longitudinal strain (−15.2 ± 3.3 to −16.6 ± 3, p = 0.007) post-ablation in patients with low–normal EF and successful ablation. There was no change in EF or longitudinal strain in patients with high–normal EF and a successful ablation pre- vs. post-ablation. Conclusions: Patients with frequent PVCs and low–normal LV EF compared to patients with frequent PVCs and high–normal LV EF have evidence of PVC-induced cardiomyopathy and may benefit from ablation despite a preserved left ventricular EF. Full article

(This article belongs to the Section Cardiology)

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J. Clin. Med., Volume 12, Issue 8 (April-2 2023) – 296 articles

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