Journal of Clinical Medicine

18 pages, 1412 KiB

Open AccessArticle

Prevalence, Severity of Extension, and Risk Factors of Gingivitis in a 3-Month Pregnant Population: A Multicenter Cross-Sectional Study

by Jocelyne Gare, Aida Kanoute, Giovanna Orsini, Lucio Souza Gonçalves, Fahad Ali Alshehri, Denis Bourgeois and Florence Carrouel

J. Clin. Med. 2023, 12(9), 3349; https://doi.org/10.3390/jcm12093349 - 8 May 2023

Cited by 4 | Viewed by 6197

Abstract

The scope of this study was to assess the prevalence, severity of extension, and risk factors of gingivitis among pregnant women. In this cross-sectional study, 220 nulliparous women at 3 months of pregnancy were recruited in 2022 at the first obstetrical visit in [...] Read more.

The scope of this study was to assess the prevalence, severity of extension, and risk factors of gingivitis among pregnant women. In this cross-sectional study, 220 nulliparous women at 3 months of pregnancy were recruited in 2022 at the first obstetrical visit in Dakar, Senegal. Demographic characteristics, lifestyle habits, prenatal clinical status, and oral clinical parameters were recorded. Multivariable logistic regression modeling was used to assess relationships between gingivitis and risk factors. Eighty-eight percent of women had gingivitis, 15% were classified as moderate and 73% as severe. A total of 66.7% (95% CI [28.8–92.1]) of the sites had bleeding on interdental brushing. The odds for gingivitis decreased significantly for women consuming more than five portions of fruits and vegetables per day (OR = 0.15; 95% CI [0.03–0.66]) and increased in women who had a professional activity (OR = 6.75; 95% CI [1.27–35.87]) and high education. Concomitantly, the percentage of dental plaque (OR = 131.6; 95% CI [10.80–1619.71] and the severity of clinical attachment loss (OR = 7.70; 95% CI [3.16–18.92]) were important risk factors. Inverse associations were observed with increasing body mass index (OR = 0.76; 95% CI [0.63–0.93]). Our results underline that gingivitis cases and bleeding were particularly high among 3-month pregnant women. Literacy and adequate oral hygiene actions to modify behaviors and to achieve meticulous biofilm disorganization could make a favorable change in the gingival health outcome. Additionally, further research is necessary to precisely determine the role of biofilm-induced gingivitis and systemic-induced gingivitis in improving gingival conditions. Full article

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

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Graphical abstract

12 pages, 275 KiB

Open AccessReview

Treat-to-Target in Systemic Lupus Erythematosus: Reality or Pipe Dream

by Dina Zucchi, Chiara Cardelli, Elena Elefante, Chiara Tani and Marta Mosca

J. Clin. Med. 2023, 12(9), 3348; https://doi.org/10.3390/jcm12093348 - 8 May 2023

Cited by 7 | Viewed by 2687

Abstract

Treat-to-target is a therapeutic approach based on adjustments to treatment at set intervals in order to achieve well-defined, clinically relevant targets. This approach has been successfully applied to many chronic conditions, and in rheumatology promising results have emerged for rheumatoid arthritis. For systemic [...] Read more.

Treat-to-target is a therapeutic approach based on adjustments to treatment at set intervals in order to achieve well-defined, clinically relevant targets. This approach has been successfully applied to many chronic conditions, and in rheumatology promising results have emerged for rheumatoid arthritis. For systemic lupus erythematosus (SLE), defining the most meaningful treatment targets has been challenging, due to disease complexity and heterogeneity. Control of disease activity, the reduction of damage accrual and the patient’s quality of life should be considered as the main targets in SLE, and several new drugs are emerging to achieve these targets. This review is focused on describing the target to achieve in SLE and the methods to do so, and it is also aimed at discussing if treat-to-target could be a promising approach also for this complex disease. Full article

(This article belongs to the Special Issue Lupus and Scleroderma: New Aspects and Considerations)

11 pages, 545 KiB

Open AccessArticle

Hospitalisation Due to Community-Acquired Acute Kidney Injury and the Role of Medications: A Retrospective Audit

by Henna Duong, Wubshet Tesfaye, Connie Van, Kamal Sud and Ronald L. Castelino

J. Clin. Med. 2023, 12(9), 3347; https://doi.org/10.3390/jcm12093347 - 8 May 2023

Cited by 4 | Viewed by 2123

Abstract

The aim of this study is to assess the use of high-risk medications in patients with community-acquired acute kidney injury (CA-AKI) and the differences in the characteristics and outcomes of CA-AKI based on the use of these medications. This is a retrospective audit [...] Read more.

The aim of this study is to assess the use of high-risk medications in patients with community-acquired acute kidney injury (CA-AKI) and the differences in the characteristics and outcomes of CA-AKI based on the use of these medications. This is a retrospective audit of adults (≥35 years) with CA-AKI admitted to a large tertiary care hospital over a two-year period. We investigated the prevalence of SADMANS (sulfonylureas; angiotensin converting enzyme inhibitors; diuretics; metformin; angiotensin receptor blockers; nonsteroidal anti-inflammatory drugs; and sodium glucose co-transporter 2 inhibitors) medications use in people with CA-AKI prior to hospitalisation. Outcomes including CA-AKI severity, kidney function recovery and in-hospital mortality were examined and stratified by use of SADMANS medications. The study included 329 patients, with a mean (SD) age of 75 (12) years and a 52% proportion of females, who were hospitalised with CA-AKI. Most patients (77.5%) were taking at least one regular SADMANS medication upon admission. Overall, 40% of patients (n = 132) and 41% of those on SADMANS (n = 104) had hypovolaemia or associated symptoms such as vomiting and diarrhoea during admission. Over two-thirds (68.1%) had mild AKI on admission and patients who were taking SADMANS medications were more likely to have mild AKI. Patients on SADMANS had more comorbidities and a higher medication burden, but there were no differences in AKI severity on admission or outcomes such as length of hospitalisation, ICU admission, need for dialysis, recovery rates and mortality between the two groups. However, the high prevalence of SADMANS medications use among patients with CA-AKI indicates a potential for preventability of CA-AKI-led hospitalisations. Future studies are needed to gain better insights into the role of withholding this group of medications, especially during an acute illness. Full article

(This article belongs to the Section Pharmacology)

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9 pages, 943 KiB

Open AccessArticle

Clinical Analysis of Repeat Penetrating Keratoplasty in Children

by Yajie Sun, Qi Lin, Peng Song, Xu Li and Zhiqiang Pan

J. Clin. Med. 2023, 12(9), 3346; https://doi.org/10.3390/jcm12093346 - 8 May 2023

Cited by 1 | Viewed by 1495

Abstract

(1) Background: To analyze the indications, graft survival, and graft failure-related risk factors of repeat penetrating keratoplasty (RPK) in children. (2) Methods: In this case series, children younger than 12 years who received RPK at Beijing Tongren Hospital were reviewed. The indications for [...] Read more.

(1) Background: To analyze the indications, graft survival, and graft failure-related risk factors of repeat penetrating keratoplasty (RPK) in children. (2) Methods: In this case series, children younger than 12 years who received RPK at Beijing Tongren Hospital were reviewed. The indications for RPK, postoperative complications, and graft survival were analyzed. The analysis of the potential variables associated with graft survival was performed using Cox proportional hazards regression. (3) Results: A total of 30 RPK eyes of 29 children were included in this study. The mean follow-up time was 26.98 ± 18.75 months. The most common indication for RPK was a vascularized corneal scar (86.67%). Postoperative complications occurred in 27 eyes (90%), including immune rejection (46.67%), epithelial defects (36.67%), and glaucoma (26.67%). About 60% of the regrafts remained clear one year after RPK, while the overall graft survival rate was 30% at the last visit. The most common cause of regraft failure was irreversible immune rejection (8/21). The significant risks of graft failure included an age of less than 60 months at surgery (p = 0.009), corneal vascularization (p = 0.018), and a postoperative epithelial defect (p = 0.037). (4) Conclusions: A vascularized corneal scar is the most common indication of RPK in children. Immune rejection is the most prevalent complication, and irreversible immune rejection always causes regraft failure. Full article

(This article belongs to the Section Ophthalmology)

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20 pages, 719 KiB

Open AccessSystematic Review

Treatment Modalities for Internet Addiction in Children and Adolescents: A Systematic Review of Randomized Controlled Trials (RCTs)

by Shahana Ayub, Lakshit Jain, Shanli Parnia, Anil Bachu, Rabeea Farhan, Harendra Kumar, Amanda Sullivan and Saeed Ahmed

J. Clin. Med. 2023, 12(9), 3345; https://doi.org/10.3390/jcm12093345 - 8 May 2023

Cited by 9 | Viewed by 6564

Abstract

Background: In recent years, the use of the internet among children and adolescents has dramatically increased, leading to growing concerns regarding the potential risks of excessive internet use and addiction. Addressing these concerns, this systematic review aims to summarize current evidence on the [...] Read more.

Background: In recent years, the use of the internet among children and adolescents has dramatically increased, leading to growing concerns regarding the potential risks of excessive internet use and addiction. Addressing these concerns, this systematic review aims to summarize current evidence on the effectiveness of treatment interventions for internet addiction among children and adolescents. Method: We performed a systematic review using PubMed, Web of Science, PsycInfo, and Google Scholar with search terms including “internet addiction”, “problematic internet use”, “children” or “adolescents”, “treatment” and “randomized controlled trial”. We found 10 Randomized Controlled Trials (RCTs) meeting the criteria and included them in this systematic review. Results: This systematic review analyzed 10 randomized controlled trials focused on treatment interventions for internet addiction in adolescents and young adults. The interventions used were diverse, including cognitive-behavioral therapy (CBT), medication, electro-acupuncture (EA), and solution-focused approaches. The measures used to assess the effectiveness of the interventions also varied, but most studies reported moderate to large effect sizes for at least some outcomes. Overall, the studies suggest that interventions such as CBT and EA can be effective in reducing symptoms of internet addiction, internet gaming disorder, and unspecified internet use disorders. School-based programs and brief manualized CBT programs also show promise, though more research is needed to determine their long-term effectiveness. Conclusion: Promising treatment approaches for internet addiction are emerging, but inconsistencies in conceptualization, language, and diagnostic criteria present some challenges. The growing recognition of problematic internet use, as shown by the DSM-5′s recognition of Internet Gaming Disorder, highlights the need for a multidisciplinary approach and standardized criteria to facilitate accurate reporting across studies. Continued research is needed to identify effective treatments and diagnostic criteria for internet addiction, with the potential to offer practical insights into effective medications and therapies. Full article

(This article belongs to the Special Issue Substance and Behavioral Addictions: Updates on Etiology and Clinical Interventions)

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15 pages, 556 KiB

Open AccessArticle

Hospital Memories and Six-Month Psychological Outcome: A Prospective Study in Critical Ill Patients with COVID-19 Respiratory Failure

by Matteo Pozzi, Claudio Ripa, Valeria Meroni, Daniela Ferlicca, Alice Annoni, Marta Villa, Maria Grazia Strepparava, Emanuele Rezoagli, Simone Piva, Alberto Lucchini, Giacomo Bellani, Giuseppe Foti and the Monza Follow-Up Study Group

J. Clin. Med. 2023, 12(9), 3344; https://doi.org/10.3390/jcm12093344 - 8 May 2023

Cited by 3 | Viewed by 1611

Abstract

ICU survivors suffer from various long-term physical and psychological impairments. Memories from the critical illness may influence long-term psychological outcome. In particular, the role of ICU memories in COVID-19 critically ill patients is unknown. In a prospective observational study, we aimed to investigate [...] Read more.

ICU survivors suffer from various long-term physical and psychological impairments. Memories from the critical illness may influence long-term psychological outcome. In particular, the role of ICU memories in COVID-19 critically ill patients is unknown. In a prospective observational study, we aimed to investigate patients’ memories from the experience of critical illness and their association with a six-month psychological outcome involving quality of life evaluation. Patients’ memories were investigated with ICU Memory tool, while psychological outcome and quality of life were evaluated by means of a battery of validated questionnaires during an in-person interview at the follow-up clinic. 149 adult patients were enrolled. 60% retained memories from pre-ICU days spent on a general ward, while 70% reported memories from the in-ICU period. Delusional memories (i.e., memories of facts that never happened) were reported by 69% of patients. According to a multivariable analysis, the lack of pre-ICU memories was an independent predictor of worse psychological outcomes in terms of anxiety, depression and Post-traumatic Stress Disorder (PTDS). Factors associated with long-term outcome in ICU survivors are not still fully understood and patients’ experience during the day spent before ICU admission may be associated with psychological sequelae. Full article

(This article belongs to the Special Issue Lung Injury and the Intensive Care Unit: Pathophysiology, Clinical Practice and Treatment for Better Outcomes)

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14 pages, 2153 KiB

Open AccessArticle

The Gastropack Access System as a Model to Access Gastroenterology Services for Gastroscopy Appropriateness in Patients with Upper Gastrointestinal Symptoms: A Comparison with the Open Access System

by Liza Ceroni, Francesca Lodato, Paolo Tubertini, Giovanni Marasco, Alessia Gazzola, Maurizio Biselli, Cristiano Fabbri, Federica Buonfiglioli, Francesco Ferrara, Ramona Schiumerini, Andrea Fabbri, Alessandra Tassoni, Carlo Descovich, Sandra Mondini, Cesare Tosetti, Valerio Veduti, Mario De Negri, Alessandro Fini, Stefano Guicciardi, Massimo Romanelli, Giuseppe Giovanni Navarra, Giovanni Barbara, Vincenzo Cennamo and on behalf of Gastropack System Study Group Show full author list Hide full author list

J. Clin. Med. 2023, 12(9), 3343; https://doi.org/10.3390/jcm12093343 - 8 May 2023

Cited by 1 | Viewed by 1671

Abstract

Esophagogastroduodenoscopy (EGD) appropriateness in Open-Access System (OAS) is a relevant issue. The Gastropack Access System (GAS) is a new system to access gastroenterological services, based on the partnership between Gastroenterologists and GPs. This study aims to evaluate if GAS is superior to OAS [...] Read more.

Esophagogastroduodenoscopy (EGD) appropriateness in Open-Access System (OAS) is a relevant issue. The Gastropack Access System (GAS) is a new system to access gastroenterological services, based on the partnership between Gastroenterologists and GPs. This study aims to evaluate if GAS is superior to OAS in terms of EGDS appropriateness. Secondarily, we evaluated the diagnostic yield of EGDS according to ASGE guidelines. The GAS was developed in an area of Bologna where General Practitioners (GPs) could decide to directly prescribe EGDS through OAS or referring to GAS, where EGDS can be scheduled after contact between GPs and specialists sharing a patient’s clinical information. Between 2016 and 2019, 2179 cases (M:F = 861:1318, median age 61, IQR 47.72) were referred to GAS and 1467 patients (65%) had a prescription for EGDS; conversely, 874 EGDS were prescribed through OAS (M:F = 383:491; median age 58 yrs, IQR 45.68). Indication was appropriate in 92% in GAS (1312/1424) versus 71% in OAS (618/874), p < 0.001. The rate of clinically significant endoscopic findings (CSEF) was significantly higher in GAS (49% vs. 34.8%, p < 0.001). Adherence to ASGE guidelines was not related to CSEF; however, surveillance for pre-malignant conditions was independently related to CSEF. All neoplasm were observed in appropriate EGD. GAS is an innovative method showing extremely high rates of appropriateness. ASGE guidelines confirmed their validity for cancer detection, but their performance for the detection of other conditions needs to be refined. Full article

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

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Graphical abstract

12 pages, 846 KiB

Open AccessArticle

Role of Lung Ultrasound in the Follow-Up of Children with Previous SARS-CoV-2 Infection: A Case-Control Assessment of Children with Long COVID or Fully Recovered

by Danilo Buonsenso, Rosa Morello, Francesco Mariani, Cristina De Rose, Rossella Cortese, Luigi Vetrugno and Piero Valentini

J. Clin. Med. 2023, 12(9), 3342; https://doi.org/10.3390/jcm12093342 - 8 May 2023

Cited by 4 | Viewed by 1888

Abstract

Lung ultrasound (LUS) can detect lower respiratory tract involvement in children with acute SARS-CoV-2 infection. However, its role in follow-up assessments is still unclear. To describe LUS findings in children after SARS-CoV-2 infection, we conducted a prospective study in a population of pediatric [...] Read more.

Lung ultrasound (LUS) can detect lower respiratory tract involvement in children with acute SARS-CoV-2 infection. However, its role in follow-up assessments is still unclear. To describe LUS findings in children after SARS-CoV-2 infection, we conducted a prospective study in a population of pediatric patients referred to the post-COVID unit in a tertiary center during the study period from February 2021 to May 2022. Children were classified as recovered from acute infection or with persisting symptoms. LUS was performed in all children and a LUS score (ranging from 0 to 36 points) was calculated according to the Italian Academy of Thoracic Ultrasound. Six hundred forty-seven children (304 females, 47%) were enrolled. The median follow-up evaluation was two months. The median age was 7.9 (IQR: 6) years. At the follow-up evaluation, 251 patients (38.8%) had persistent symptoms, of whom 104 (16.1%) had at least one respiratory symptom. The median LUS level was 2 (IQR: 4). LUS findings and LUS scores did not differ in children with Long COVID compared to the group of children fully recovered from the initial infection. In conclusion, after SARS-CoV-2 infection, LUS was mostly normal or showed minimal artifacts in all groups of children. Full article

(This article belongs to the Section Clinical Pediatrics)

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21 pages, 1895 KiB

Open AccessReview

Obesity, Preserved Ejection Fraction Heart Failure, and Left Ventricular Remodeling

by Jason Stencel, Hamid R. Alai, Aneesh Dhore-patil, Daniela Urina-Jassir and Thierry H. Le Jemtel

J. Clin. Med. 2023, 12(9), 3341; https://doi.org/10.3390/jcm12093341 - 8 May 2023

Cited by 6 | Viewed by 3273

Abstract

Owing to the overwhelming obesity epidemic, preserved ejection fraction heart failure commonly ensues in patients with severe obesity and the obese phenotype of preserved ejection fraction heart failure is now commonplace in clinical practice. Severe obesity and preserved ejection fraction heart failure share [...] Read more.

Owing to the overwhelming obesity epidemic, preserved ejection fraction heart failure commonly ensues in patients with severe obesity and the obese phenotype of preserved ejection fraction heart failure is now commonplace in clinical practice. Severe obesity and preserved ejection fraction heart failure share congruent cardiovascular, immune, and renal derangements that make it difficult to ascertain whether the obese phenotype of preserved ejection fraction heart failure is the convergence of two highly prevalent conditions or severe obesity enables the development and progression of the syndrome of preserved ejection fraction heart failure. Nevertheless, the obese phenotype of preserved ejection fraction heart failure provides a unique opportunity to assess whether sustained and sizeable loss of excess body weight via metabolic bariatric surgery reverses the concentric left ventricular remodeling that patients with preserved ejection fraction heart failure commonly display. Full article

(This article belongs to the Section Cardiovascular Medicine)

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16 pages, 316 KiB

Open AccessEditor’s ChoiceReview

Corticosteroids in ARDS

by Emmanuelle Kuperminc, Nicholas Heming, Miguel Carlos and Djillali Annane

J. Clin. Med. 2023, 12(9), 3340; https://doi.org/10.3390/jcm12093340 - 8 May 2023

Cited by 10 | Viewed by 10426

Abstract

Acute respiratory distress syndrome (ARDS) is frequently associated with sepsis. ARDS and sepsis exhibit a common pathobiology, namely excessive inflammation. Corticosteroids are powerful anti-inflammatory agents that are routinely used in septic shock and in oxygen-dependent SARS-CoV-2 related acute respiratory failure. Recently, corticosteroids were [...] Read more.

Acute respiratory distress syndrome (ARDS) is frequently associated with sepsis. ARDS and sepsis exhibit a common pathobiology, namely excessive inflammation. Corticosteroids are powerful anti-inflammatory agents that are routinely used in septic shock and in oxygen-dependent SARS-CoV-2 related acute respiratory failure. Recently, corticosteroids were found to reduce mortality in severe community-acquired pneumonia. Corticosteroids may therefore also have a role to play in the treatment of ARDS. This narrative review was undertaken following a PubMed search for English language reports published before January 2023 using the terms acute respiratory distress syndrome, sepsis and steroids. Additional reports were identified by examining the reference lists of selected articles and based on personnel knowledge of the authors of the field. High-quality research is needed to fully understand the role of corticosteroids in the treatment of ARDS and to determine the optimal timing, dosing and duration of treatment. Full article

(This article belongs to the Special Issue New Insights into Acute Respiratory Distress Syndrome)

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Graphical abstract

9 pages, 2826 KiB

Open AccessArticle

Association of the Calcification Score of the Abdominal Aorta, Common Iliac, and Renal Arteries with Outcomes in Living Kidney Donors

by Luís Costa Ribeiro, Manuela Almeida, Jorge Malheiro, Filipa Silva, Diogo Nunes-Carneiro, La Salete Martins, Sofia Pedroso and Miguel Silva-Ramos

J. Clin. Med. 2023, 12(9), 3339; https://doi.org/10.3390/jcm12093339 - 8 May 2023

Cited by 1 | Viewed by 1481

Abstract

Background: Vascular calcification is an ever-more-common finding in protocoled pre-transplant imaging in living kidney donors. We intended to explore whether a connection could be found between the Agatston calcification score, prior to kidney donation, and post-donation renal function. Methods: This is a retrospective [...] Read more.

Background: Vascular calcification is an ever-more-common finding in protocoled pre-transplant imaging in living kidney donors. We intended to explore whether a connection could be found between the Agatston calcification score, prior to kidney donation, and post-donation renal function. Methods: This is a retrospective analysis of 156 living kidney donors who underwent living donor nephrectomy between January 2010 and December 2016. We quantified the total calcification score (TCaScore) by calculating the Agatston score for each vessel, abdominal aorta, common iliac, and renal arteries. Donors were placed into two different groups based on their TCaScore: <100 TCaScore group and ≥100 TCaScore group. The relationship between TCaScore, 1-year eGFR, proteinuria, and risk of 1 measurement of decreased renal function (eGFR < 60 mL/min/1.73 m²) over 5 years of follow-up was investigated. Results: The ≥100 TCaScore group consisted of 29 (19%) donors, with a median (interquartile range) calcification score of 164 (117–358). This group was significantly older, 56.7 ± 6.9 vs. 45.5 ± 10.6 (p < 0.001), had a higher average BMI (p < 0.019), and had a lower preoperative eGFR (p < 0.014). The 1-year eGFR was similarly diminished, 69.9 ± 15.7 vs. 76.3 ± 15.5 (p < 0.048), while also having an increased risk of decreased renal function during the follow-up, 22% vs. 48% (p < 0.007). Conclusions: Our study, through univariate analyses, found a relationship between a TCaScore > 100, lower 1-year eGFR, and decreased renal function in 5 years. However, a higher-than-expected vascular calcification should not be an excluding factor in donors, although they may require closer monitoring during follow-up. Full article

(This article belongs to the Special Issue Recent Advances of Kidney Transplantation)

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9 pages, 2984 KiB

Open AccessBrief Report

A Trend towards Diaphragmatic Muscle Waste after Invasive Mechanical Ventilation in Multiple Trauma Patients—What to Expect?

by Liliana Mirea, Cristian Cobilinschi, Raluca Ungureanu, Ana-Maria Cotae, Raluca Darie, Radu Tincu, Oana Avram, Sorin Constantinescu, Costin Minoiu, Alexandru Baetu and Ioana Marina Grintescu

J. Clin. Med. 2023, 12(9), 3338; https://doi.org/10.3390/jcm12093338 - 8 May 2023

Cited by 1 | Viewed by 1434

Abstract

Considering the prioritization of life-threatening injuries in trauma care, secondary dysfunctions such as ventilator-induced diaphragmatic dysfunction (VIDD) are often overlooked. VIDD is an entity induced by muscle inactivity during invasive mechanical ventilation, associated with a profound loss of diaphragm muscle mass. In order [...] Read more.

Considering the prioritization of life-threatening injuries in trauma care, secondary dysfunctions such as ventilator-induced diaphragmatic dysfunction (VIDD) are often overlooked. VIDD is an entity induced by muscle inactivity during invasive mechanical ventilation, associated with a profound loss of diaphragm muscle mass. In order to assess the incidence of VIDD in polytrauma patients, we performed an observational, retrospective, longitudinal study that included 24 polytraumatized patients. All included patients were mechanically ventilated for at least 48 h and underwent two chest CT scans during their ICU stay. Diaphragmatic thickness was measured by two independent radiologists on coronal and axial images at the level of celiac plexus. The thickness of the diaphragm was significantly decreased on both the left and right sides (left side: −0.82 mm axial p = 0.034; −0.79 mm coronal p = 0.05; right side: −0.94 mm axial p = 0.016; −0.91 coronal p = 0.013). In addition, we obtained a positive correlation between the number of days of mechanical ventilation and the difference between the two measurements of the diaphragm thickness on both sides (r =0.5; p = 0.02). There was no statistically significant correlation between the body mass indexes on admission, the use of vitamin C or N-acetyl cysteine, and the differences in diaphragmatic thickness. Full article

(This article belongs to the Special Issue Key Advances in the Treatment of the Critically Ill)

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19 pages, 4282 KiB

Open AccessReview

Utility of MRI in Quantifying Tissue Injury in Cervical Spondylotic Myelopathy

by Ali Fahim Khan, Grace Haynes, Esmaeil Mohammadi, Fauziyya Muhammad, Sanaa Hameed and Zachary A. Smith

J. Clin. Med. 2023, 12(9), 3337; https://doi.org/10.3390/jcm12093337 - 8 May 2023

Cited by 10 | Viewed by 3283

Abstract

Cervical spondylotic myelopathy (CSM) is a progressive disease that worsens over time if untreated. However, the rate of progression can vary among individuals and may be influenced by various factors, such as the age of the patients, underlying conditions, and the severity and [...] Read more.

Cervical spondylotic myelopathy (CSM) is a progressive disease that worsens over time if untreated. However, the rate of progression can vary among individuals and may be influenced by various factors, such as the age of the patients, underlying conditions, and the severity and location of the spinal cord compression. Early diagnosis and prompt treatment can help slow the progression of CSM and improve symptoms. There has been an increased use of magnetic resonance imaging (MRI) methods in diagnosing and managing CSM. MRI methods provide detailed images and quantitative structural and functional data of the cervical spinal cord and brain, allowing for an accurate evaluation of the extent and location of tissue injury. This review aims to provide an understanding of the use of MRI methods in interrogating functional and structural changes in the central nervous system in CSM. Further, we identified several challenges hindering the clinical utility of these neuroimaging methods. Full article

(This article belongs to the Special Issue Latest Developments in Minimally Invasive Spinal Treatment)

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11 pages, 621 KiB

Open AccessEditor’s ChoiceArticle

Smoking Increases the Risk of Hepatocellular Carcinoma and Cardiovascular Disease in Patients with Metabolic-Associated Fatty Liver Disease

by Jeong-Ju Yoo, Man Young Park, Eun Ju Cho, Su Jong Yu, Sang Gyune Kim, Yoon Jun Kim, Young Seok Kim and Jung-Hwan Yoon

J. Clin. Med. 2023, 12(9), 3336; https://doi.org/10.3390/jcm12093336 - 8 May 2023

Cited by 8 | Viewed by 2430

Abstract

The association of smoking with hepatocellular carcinoma (HCC) or cardiovascular disease (CVD) has been reported, but the study of its relationship with metabolic-associated fatty liver disease (MAFLD) is limited. We aimed to investigate the effect of smoking on the incidence of HCC or [...] Read more.

The association of smoking with hepatocellular carcinoma (HCC) or cardiovascular disease (CVD) has been reported, but the study of its relationship with metabolic-associated fatty liver disease (MAFLD) is limited. We aimed to investigate the effect of smoking on the incidence of HCC or CVD in MAFLD patients. Using the Korean nationwide health screening database, we analyzed subjects between 2001 and 2015. A total of 283,088 subjects including 110,863 MAFLD patients and 172,225 controls were analyzed. Smoking status was divided by non-smoker, ex-smoker, or current smoker. In the follow-up period, a total of 2903 (1.0%) subjects developed HCC, and the MAFLD group (1723, 1.6%) had a significantly higher incidence than the control group (1180, 0.7%). In the MAFLD group, current smokers showed significantly higher risk of HCC compared to non-smokers (adjusted HR 1.24, 95% CI 1.08–1.41), whereas the control group did not (adjusted HR 1.07, 95% CI 0.89–1.30). A total of 18,984 (6.7%) patients developed CVD, and the incidence was significantly higher in the MAFLD group (8688, 7.8%) than in the control group (10,296, 6.0%), similar to HCC. The risk of CVD in current smokers increased by 22% compared to non-smokers in the MAFLD group (adjusted HR 1.22, 95% CI 1.15–1.30) and by 21% (adjusted HR 1.21, 95% CI 1.13–1.29) in the control group. Based on sex stratification, men showed increased incidence of both HCC and CVD by smoking, whereas women had only increased risk of CVD. Smoking significantly increases the incidence of HCC and CVD in MAFLD patients; thus, it is highly recommended to quit smoking completely in the population with MAFLD. Full article

(This article belongs to the Section Cardiovascular Medicine)

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10 pages, 1249 KiB

Open AccessArticle

The Liver Can Deliver: Utility of Hepatic Function Tests as Predictors of Outcome in COVID-19, Influenza and RSV Infections

by Einat Ritter, Eden Shusterman, Lior Prozan, Orli Kehat, Ahuva Weiss Meilik, Oren Shibolet and Jacob Nadav Ablin

J. Clin. Med. 2023, 12(9), 3335; https://doi.org/10.3390/jcm12093335 - 8 May 2023

Viewed by 2159

Abstract

Background: liver test abnormalities have been described in patients with Coronavirus-2019 (COVID-19), and hepatic involvement may correlate with disease severity. With the relaxing of COVID-19 restrictions, seasonal respiratory viruses now circulate alongside SARS-CoV-2. Aims: we aimed to compare patterns of abnormal liver function [...] Read more.

Background: liver test abnormalities have been described in patients with Coronavirus-2019 (COVID-19), and hepatic involvement may correlate with disease severity. With the relaxing of COVID-19 restrictions, seasonal respiratory viruses now circulate alongside SARS-CoV-2. Aims: we aimed to compare patterns of abnormal liver function tests in patients suffering from COVID-19 infection and seasonal respiratory viruses: respiratory syncytial virus (RSV) and influenza (A and B). Methods: a retrospective cohort study was performed including 4140 patients admitted to a tertiary medical center between 2010–2020. Liver test abnormalities were classified as hepatocellular, cholestatic or mixed type. Clinical outcomes were defined as 30-day mortality and mechanical ventilation. Results: liver function abnormalities were mild to moderate in most patients, and mainly cholestatic. Hepatocellular injury was far less frequent but had a strong association with adverse clinical outcome in RSV, COVID-19 and influenza (odds ratio 5.29 (CI 1.2–22), 3.45 (CI 1.7–7), 3.1 (CI 1.7–6), respectively) COVID-19 and influenza patients whose liver functions did not improve or alternatively worsened after 48 h had a significantly higher risk of death or ventilation. Conclusion: liver function test abnormalities are frequent among patients with COVID-19 and seasonal respiratory viruses, and are associated with poor clinical outcome. The late liver tests’ peak had a twofold risk for adverse outcome. Though cholestatic injury was more common, hepatocellular injury had the greatest prognostic significance 48 h after admission. Our study may provide a viral specific auxiliary prognostic tool for clinicians facing patients with a respiratory virus. Full article

(This article belongs to the Special Issue Clinical Impact of COVID-19 on Liver Diseases)

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13 pages, 814 KiB

Open AccessArticle

Efficacy and Safety of Chemotherapy in Elderly Patients with Unresectable Pancreatic Cancer

by Byung Soo Kwan, Ok Jae Lee, Hyun Jin Kim, Kwang Min Kim, Sang Goon Shim, Dae Hyeon Cho, Sung Min Kong, Jun Young Kim and Jun Ho Ji

J. Clin. Med. 2023, 12(9), 3334; https://doi.org/10.3390/jcm12093334 - 8 May 2023

Cited by 1 | Viewed by 2098

Abstract

Background/Aims: The incidence of pancreatic cancer (PC) is gradually increasing among elderly individuals, but there are insufficient clinical data on elderly individuals. To determine the efficacy and safety of chemotherapy, we compared the. the outcomes of elderly patients with unresectable PC. Methods: We [...] Read more.

Background/Aims: The incidence of pancreatic cancer (PC) is gradually increasing among elderly individuals, but there are insufficient clinical data on elderly individuals. To determine the efficacy and safety of chemotherapy, we compared the. the outcomes of elderly patients with unresectable PC. Methods: We enrolled patients aged 75 years or older diagnosed with PC from 1 January 2010 to 30 November 2021. Propensity score matching (PSM) was used to reduce the heterogeneity of the study population. For efficacy evaluation, the median overall survival (OS) was estimated for the chemotherapy and nonchemotherapy groups. Chemotherapy tolerability evaluations were also investigated. Results: The study included 115 patients, 47 of whom received chemotherapy and 68 who did not. After PSM, compared with the nonchemotherapy group, the chemotherapy group had more myocardial infarctions (14.6 vs. 0.0%, p < 0.001) and chronic obstructive pulmonary disease (4.4 vs. 0.0%, p = 0.043). The primary endpoint, median OS, was significantly different in the with vs. without chemotherapy groups (203 vs. 106 days, p = 0.013). In the chemotherapy group, 10 patients (21.3%) discontinued treatment due to adverse events. However, there were no reports of death due to severe adverse events. Conclusions: This study demonstrated that chemotherapy improved median OS among elderly patients. These data could support the use of chemotherapy for elderly patients with unresectable PC. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Pancreatic Cancer)

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11 pages, 1377 KiB

Open AccessArticle

Quantitative Assessment of Upper Limb Movement in Post-Stroke Adults for Identification of Sensitive Measures in Reaching and Lifting Activities

by Monika Błaszczyszyn, Agnieszka Szczęsna, Mariusz Konieczny, Paweł Pakosz, Stefan Balko and Zbigniew Borysiuk

J. Clin. Med. 2023, 12(9), 3333; https://doi.org/10.3390/jcm12093333 - 8 May 2023

Cited by 2 | Viewed by 1916

Abstract

Background: The assumption of this work is the achievement of objective results of the movement structure, which forms the basis for in-depth analysis and, consequently, for determining the upper limb movements that are most affected by stroke compared to healthy people. Methods: An [...] Read more.

Background: The assumption of this work is the achievement of objective results of the movement structure, which forms the basis for in-depth analysis and, consequently, for determining the upper limb movements that are most affected by stroke compared to healthy people. Methods: An analysis of relevant and systematically identified features of upper limb movement in post-stroke adults is presented based on scalable hypothesis tests. The basic features were calculated using movements defined by the x, y, and z coordinates (i.e., 3D trajectory time series) and compared to the results of post-stroke patients with healthy controls of similar age. Results: After automatic feature selection, out of the 1004 common features of upper limb movement, the most differentiated were the upper arm movements in reaching kinematics. In terms of movement type, movements in the frontal plane (shoulder abduction and adduction) were the most sensitive to changes. The largest number of discriminating features was determined on the basis of acceleration time series. Conclusions: In the 3D assessment of functional activities of the upper limb, the upper arm turned out to be the most differentiated body segment, especially during abduction and adduction movements. The results indicate a special need to pay attention to abduction and adduction movements to improve the activities of daily living of the upper limbs after a stroke. Full article

(This article belongs to the Section Clinical Rehabilitation)

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11 pages, 506 KiB

Open AccessArticle

The Presence of Myosteatosis Is Associated with Age, Severity of Liver Disease and Poor Outcome and May Represent a Prodromal Phase of Sarcopenia in Patients with Liver Cirrhosis

by Eleni Geladari, Theodoros Alexopoulos, Meropi D. Kontogianni, Larisa Vasilieva, Iliana Mani, Roxane Tenta, Vasilios Sevastianos, Ioannis Vlachogiannakos and Alexandra Alexopoulou

J. Clin. Med. 2023, 12(9), 3332; https://doi.org/10.3390/jcm12093332 - 7 May 2023

Cited by 11 | Viewed by 2093

Abstract

Background/Aims: Myosteatosis implies impaired muscle quality. The aim of the study was to investigate the association of myosteatosis with other muscle abnormalities and its role in the prognosis of liver cirrhosis (LC). Method: Skeletal muscle index (SMI) and myosteatosis were measured by computed [...] Read more.

Background/Aims: Myosteatosis implies impaired muscle quality. The aim of the study was to investigate the association of myosteatosis with other muscle abnormalities and its role in the prognosis of liver cirrhosis (LC). Method: Skeletal muscle index (SMI) and myosteatosis were measured by computed tomography. Myosteatosis was defined as muscle radiodensity and evaluated according to dry body mass index (BMI). Median values and interquartile range were used for continuous and count (percentage) for categorical variables. Results: A total of 197 consecutive patients were included (age 61 (IQR 52–68); 67% male; MELD score 11 (interquartile range 7.5–16)). Myosteatosis was identified in 73.6% and sarcopenia in 44.6% of patients. Myosteatosis was positively associated with age (p = 0.024) and Child–Pugh (p = 0.017) and inversely associated with SMI (p = 0.026). Patients with myosteatosis exhibited lower 360-day survival (log-rank p = 0.001) compared to those without it. MELD (p < 0.001) and myosteatosis (p = 0.048) emerged as negative prognostic factors of survival in multivariate model. Individuals combining low muscle strength and impaired muscle quality and quantity displayed more advanced LC, impaired muscle performance, lower BMI (p < 0.001 each) and a three times higher mortality rate compared to those with low muscle quality alone. Conclusions: The presence of myosteatosis was associated with advanced age, low skeletal mass and more severe LC. Myosteatosis was associated with poor prognosis and may represent a prodromal phase of muscle degeneration before the development of sarcopenia. Full article

(This article belongs to the Special Issue Established and Novel Approaches for Sarcopenia)

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11 pages, 589 KiB

Open AccessArticle

Really Asymptomatic? Health-Related Quality of Life and Objective Clinical Foot Characteristics among 5–10-Year-Old Children with a Flexible FlatFoot

by Saidas Žukauskas, Vidmantas Barauskas, Ramunė Degliūtė-Muller and Emilis Čekanauskas

J. Clin. Med. 2023, 12(9), 3331; https://doi.org/10.3390/jcm12093331 - 7 May 2023

Cited by 1 | Viewed by 1967

Abstract

The potential effects of asymptomatic flexible flatfoot (FF) on children’s health-related quality of life (QoL) and objective clinical foot characteristics have been poorly investigated in the literature. Therefore, this study aimed to analyse these indicators, comparing the children with asymptomatic FF and a [...] Read more.

The potential effects of asymptomatic flexible flatfoot (FF) on children’s health-related quality of life (QoL) and objective clinical foot characteristics have been poorly investigated in the literature. Therefore, this study aimed to analyse these indicators, comparing the children with asymptomatic FF and a control group. Methods: In total, 351 children were enrolled in this cross-sectional study—160 children with asymptomatic FF and 191 controls (children with normal feet). The children and their parents completed the Paediatric Quality of Life Inventory (PedsQL^TM 4.0). The objective foot characteristics included clinical foot posture measures, footprints, general hyperlaxity, and X-ray measurements. Results: Children with asymptomatic FF had a significantly lower QoL (overall and all four dimensions). The parents’ assessment of the QoL of their children with asymptomatic FF in most cases was lower compared to their children’s self-reported QoL. Moreover, almost all clinical foot measures also had significantly worse profiles among asymptomatic FF cases compared to the controls. This was observed with the Foot Posture Index-6 (FPI-6), the navicular drop (ND) test, the Chippaux–Smirak Index (CSI), Staheli’s Index (SI), the Beighton scale, and radiological angles (except the talo-first metatarsal angle). Conclusion: The findings suggest that asymptomatic FF not always reflects a normal foot development. This condition is related to decreased health-related quality of life, so the 5–10-year-old children’s and their parents’ complaints should be considered more closely in identification, treatment, and monitoring plans. Full article

(This article belongs to the Topic Children’s Diseases, Family Management, and Quality of Life)

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11 pages, 850 KiB

Open AccessArticle

Value of Fractional Exhaled Nitric Oxide in Diagnosing Mild Asthma Responsive to Inhaled Corticosteroids

by Natasa Karamarkovic Lazarusic, Eugenija Kasap Basioli, Ena Tolic, Martina Dokoza and Gordana Pavlisa

J. Clin. Med. 2023, 12(9), 3330; https://doi.org/10.3390/jcm12093330 - 7 May 2023

Viewed by 1517

Abstract

Background: Mild asthma is often characterized by normal spirometric values and a negative bronchodilation test (BDT), which makes accurate diagnosis challenging. The aim of our study was to evaluate the diagnostic accuracy of fractional exhaled nitric oxide (FeNO) in mild asthma. Methods: In [...] Read more.

Background: Mild asthma is often characterized by normal spirometric values and a negative bronchodilation test (BDT), which makes accurate diagnosis challenging. The aim of our study was to evaluate the diagnostic accuracy of fractional exhaled nitric oxide (FeNO) in mild asthma. Methods: In adults with symptoms suggestive of asthma and normal spirometry values, BDT, FeNO, BPT and skin prick testing were performed. Patients with positive BPT started inhaled corticosteroid (ICS) therapy. Those with positive response to ICS were considered asthmatics. Results: There were 142 asthmatics and 140 non-asthmatics. No significant difference was found in BDT between the groups, p = 0.233. Median FeNO levels were significantly higher in the asthma group (49.5 ppb) than in the non-asthma group (23 ppb), p < 0.001. BPT was positive in 145 (51.42%) and negative in 137 (48.58%) patients. Positive response to ICS treatment was recorded in 142/145 (97.9%) patients. In diagnosing asthma, FeNO ≥ 25 ppb had a sensitivity of 75.4% and specificity of 47.9%. Conclusions: FeNO has insufficient sensitivity and specificity in mild asthma and the application of BPT is often necessary to establish an accurate diagnosis. Full article

(This article belongs to the Section Pulmonology)

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8 pages, 682 KiB

Open AccessBrief Report

Intrapartum Maternal Fever and Long-Term Infectious Morbidity of the Offspring

by Omri Zamstein, Tamar Wainstock and Eyal Sheiner

J. Clin. Med. 2023, 12(9), 3329; https://doi.org/10.3390/jcm12093329 - 7 May 2023

Cited by 3 | Viewed by 2112

Abstract

Maternal intrapartum fever can lead to various maternal and neonatal complications and is attributed to various etiologies including infectious and non-infectious processes. In this study, we evaluated whether intrapartum fever affects the offspring’s tendency to long-term infectious morbidity. A population-based cohort analysis including [...] Read more.

Maternal intrapartum fever can lead to various maternal and neonatal complications and is attributed to various etiologies including infectious and non-infectious processes. In this study, we evaluated whether intrapartum fever affects the offspring’s tendency to long-term infectious morbidity. A population-based cohort analysis including deliveries between 1991 and 2021 was conducted. The incidence of hospitalizations of the offspring up to the age of 18 years, due to various infectious conditions, was compared between pregnancies complicated by intrapartum fever and those that were not. A Kaplan–Meier survival curve was used to assess cumulative hospitalization incidence. A Cox proportional hazards model was used to control for confounders. Overall, 538 of the 356,356 included pregnancies were complicated with fever. A higher rate of pediatric hospitalizations due to various infectious conditions was found among the exposed group, which was significant for viral, fungal and ENT infections (p < 0.05 for all). The total number of infectious-related hospitalizations was significantly higher (30.1% vs. 24.1%; OR = 1.36; p = 0.001), as was the cumulative incidence of hospitalizations. This association remained significant after controlling for confounders using a Cox proportional hazards model (adjusted HR = 1.21; 95% CI 1.04–1.41, p = 0.016). To conclude, fever diagnosed close to delivery may influence offspring susceptibility to pediatric infections. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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18 pages, 1688 KiB

Open AccessReview

Choice of the Dialysis Modality: Practical Considerations

by Massimo Torreggiani, Giorgina Barbara Piccoli, Maria Rita Moio, Ferruccio Conte, Lorenza Magagnoli, Paola Ciceri and Mario Cozzolino

J. Clin. Med. 2023, 12(9), 3328; https://doi.org/10.3390/jcm12093328 - 7 May 2023

Cited by 7 | Viewed by 3190

Abstract

Chronic kidney disease and the need for kidney replacement therapy have increased dramatically in recent decades. Forecasts for the coming years predict an even greater increase, especially in low- and middle-income countries, due to the rise in metabolic and cardiovascular diseases and the [...] Read more.

Chronic kidney disease and the need for kidney replacement therapy have increased dramatically in recent decades. Forecasts for the coming years predict an even greater increase, especially in low- and middle-income countries, due to the rise in metabolic and cardiovascular diseases and the aging population. Access to kidney replacement treatments may not be available to all patients, making it especially strategic to set up therapy programs that can ensure the best possible treatment for the greatest number of patients. The choice of the “ideal” kidney replacement therapy often conflicts with medical availability and the patient’s tolerance. This paper discusses the pros and cons of various kidney replacement therapy options and their real-world applicability limits. Full article

(This article belongs to the Section Nephrology & Urology)

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13 pages, 680 KiB

Open AccessArticle

Early Re-Exploration versus Conservative Management for Postoperative Bleeding in Stable Patients after Coronary Artery Bypass Grafting: A Propensity Matched Study

by Cristiano Spadaccio, David Rose, Antonio Nenna, Rebecca Taylor and Mohamad Nidal Bittar

J. Clin. Med. 2023, 12(9), 3327; https://doi.org/10.3390/jcm12093327 - 7 May 2023

Cited by 3 | Viewed by 2527

Abstract

Background: Postoperative bleeding requiring re-exploration in cardiac surgery has been associated with complications impacting short-term outcomes and perioperative survival. Many aspects of decision-making for re-exploration still remain controversial, especially in hemodynamically stable patients with significant but not acutely cumulating chest drain output. We [...] Read more.

Background: Postoperative bleeding requiring re-exploration in cardiac surgery has been associated with complications impacting short-term outcomes and perioperative survival. Many aspects of decision-making for re-exploration still remain controversial, especially in hemodynamically stable patients with significant but not acutely cumulating chest drain output. We investigated the impact of re-exploratory surgery on short-term outcomes in a “borderline population” of CABG patients who experienced significant non-acute bleeding, but that were not in critically hemodynamic unstable conditions. Methods: A prospectively collected database of 8287 patients undergoing primary isolated elective CABG was retrospectively interrogated. A population of hemodynamically stable patients experiencing significant non-acute or rapidly cumulating bleeding (>1000 mL of blood loss in 12 h, <200 mL per hour in the first 5 h) with normal platelet and coagulation tests was identified (N = 1642). Patients belonging to this group were re-explored (N = 252) or treated conservatively (N = 1390) based on the decision of the consultant surgeon. Clinical outcomes according to the decision-making strategy were compared using a propensity score matching (PSM) approach. Results: After PSM, reoperated patients exhibited significantly higher overall blood product consumption (88.4% vs. 52.6% for red packed cells, p = 0.001). The reoperated group experienced higher rates of respiratory complications (odds ratio 5.8 [4.29–7.86] with p = 0.001 for prolonged ventilation), prolonged stay in intensive care unit (coefficient 1.66 [0.64–2.67] with p = 0.001) and overall length of stay in hospital (coefficient 2.16 [0.42–3.91] with p = 0.015) when compared to conservative management. Reoperated patients had significantly increased risk of multiorgan failure (odds ratio 4.59 [1.37–15.42] with p = 0.014) and a trend towards increased perioperative mortality (odds ratio 3.12 [1.08–8.99] with p = 0.035). Conclusions: Conservative management in hemodynamically stable patients experiencing significant but non-critical or emergency bleeding might be a safe and viable option and might be advantageous in terms of reduction of postoperative morbidities and hospital stay. Full article

(This article belongs to the Section Cardiovascular Medicine)

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15 pages, 1765 KiB

Open AccessReview

Injectable Platelet-Rich Fibrin (I-PRF) Administered to Temporomandibular Joint Cavities: A Scoping Review

by Marcin Sielski, Kamila Chęcińska, Maciej Chęciński and Maciej Sikora

J. Clin. Med. 2023, 12(9), 3326; https://doi.org/10.3390/jcm12093326 - 7 May 2023

Cited by 10 | Viewed by 2983

Abstract

The aim of this review was to systematically map the research on the intra-articular administration of injectable platelet-rich fibrin (I-PRF) to the temporomandibular joints (TMJs). Medical databases covered by the ACM, BASE, Google, NLM, and ResearchGate were searched on 23 February 2023. The [...] Read more.

The aim of this review was to systematically map the research on the intra-articular administration of injectable platelet-rich fibrin (I-PRF) to the temporomandibular joints (TMJs). Medical databases covered by the ACM, BASE, Google, NLM, and ResearchGate were searched on 23 February 2023. The assessment of the level of evidence was based on the Oxford Center for Evidence-Based Medicine 2011 scale. The risk of bias was assessed for randomized controlled trials with the RoB2 tool. Extracted data were tabulated, and the changes in effect values were calculated. A total of eight studies qualified, of which five trials on 213 patients were randomized and controlled (RCTs). In each of the RTC study groups, arthrocentesis was performed, and 1–2 mL per joint of I-PRF (700 rpm/3 min/60 g centrifugation) was administered. Articular pain in three months decreased to 0–25% of the initial pre-interventional values in the study and 38–50% in the control groups. Mandible mobility increased to 121–153% and 115–120% in the I-PRF groups and controls, respectively. The main limitations of the evidence were the small number of RCTs and the lack of any RCT study groups receiving I-PRF without prior arthrocentesis. In conclusion, supplementing the temporomandibular joint rinsing with I-PRF administration further relieves pain and improves mandible mobility. The lack of RCTs on the intra-articular administration of I-PRF as a stand-alone procedure encourages further research. This research received no external funding. The review protocol has not been previously published. Full article

(This article belongs to the Special Issue Updates and Challenges in Maxillo-Facial Surgery)

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21 pages, 363 KiB

Open AccessReview

Endoscopic Ultrasound-Guided Local Ablative Therapies for the Treatment of Pancreatic Neuroendocrine Tumors and Cystic Lesions: A Review of the Current Literature

by Alexander M. Prete and Tamas A. Gonda

J. Clin. Med. 2023, 12(9), 3325; https://doi.org/10.3390/jcm12093325 - 7 May 2023

Cited by 6 | Viewed by 3190

Abstract

Since its emergence as a diagnostic modality in the 1980s, endoscopic ultrasound (EUS) has provided the clinician profound access to gastrointestinal organs to aid in the direct visualization, sampling, and subsequent identification of pancreatic pathology. In recent years, advancements in EUS as an [...] Read more.

Since its emergence as a diagnostic modality in the 1980s, endoscopic ultrasound (EUS) has provided the clinician profound access to gastrointestinal organs to aid in the direct visualization, sampling, and subsequent identification of pancreatic pathology. In recent years, advancements in EUS as an interventional technique have promoted the use of local ablative therapies as a minimally invasive alternative to the surgical management of pancreatic neuroendocrine tumors (pNETs) and pancreatic cystic neoplasms (PCNs), especially for those deemed to be poor operative candidates. EUS-guided local therapies have demonstrated promising efficacy in addressing a spectrum of pancreatic neoplasms, while also balancing local adverse effects on healthy parenchyma. This article serves as a review of the current literature detailing the mechanisms, outcomes, complications, and limitations of EUS-guided local ablative therapies such as chemical ablation and radiofrequency ablation (RFA) for the treatment of pNETs and PCNs, as well as a discussion of future applications of EUS-guided techniques to address a broader scope of pancreatic pathology. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Diagnosis and Treatment of Gastrointestinal Diseases)

11 pages, 3024 KiB

Open AccessReview

Evolution of Concepts: Can Personalized Hip Arthroplasty Improve Joint Stability?

by Sivan Sivaloganathan, William G. Blakeney, Charles Rivière and Pascal-André Vendittoli

J. Clin. Med. 2023, 12(9), 3324; https://doi.org/10.3390/jcm12093324 - 7 May 2023

Cited by 2 | Viewed by 2089

Abstract

Hip arthroplasty procedures are successful and reproducible. However, within the first two post-operative years, hip dislocations are the most common cause for revisions. This is despite the majority of the dislocations having the acetabular component within what is described as the ‘safe zone’. [...] Read more.

Hip arthroplasty procedures are successful and reproducible. However, within the first two post-operative years, hip dislocations are the most common cause for revisions. This is despite the majority of the dislocations having the acetabular component within what is described as the ‘safe zone’. The limitations of such boundaries do not take into account the variability of individual hip anatomy and functional pelvic orientation that exist. An alternative concept to address hip instability and improve overall outcomes is functional acetabular orientation. In this review article, we discuss the evolution of concepts, particularly the kinematic alignment technique for hip arthroplasty and the use of large-diameter heads to understand why total hip arthroplasty dislocations occur and how to prevent them. Full article

(This article belongs to the Section Orthopedics)

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4 pages, 205 KiB

Open AccessEditorial

Inhaled Corticosteroids and Bronchiectasis: Friend or Foe?

by Miguel Angel Martinez-Garcia

J. Clin. Med. 2023, 12(9), 3322; https://doi.org/10.3390/jcm12093322 - 7 May 2023

Cited by 1 | Viewed by 2467

Abstract

The three most common chronic inflammatory airway diseases are asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis [...] Full article

(This article belongs to the Section Pulmonology)

16 pages, 1859 KiB

Open AccessEditor’s ChoiceSystematic Review

Efficacy of Sleeve Gastrectomy with Concomitant Hiatal Hernia Repair versus Sleeve–Fundoplication on Gastroesophageal Reflux Disease Resolution: Systematic Review and Meta-Analysis

by Lidia Castagneto-Gissey, Maria Francesca Russo, Vito D’Andrea, Alfredo Genco and Giovanni Casella

J. Clin. Med. 2023, 12(9), 3323; https://doi.org/10.3390/jcm12093323 - 6 May 2023

Cited by 10 | Viewed by 3888

Abstract

(1) Background: There is still disagreement over how sleeve gastrectomy (SG) affects gastroesophageal reflux disease (GERD). The debate regarding the best option for patients undergoing bariatric surgery who are also affected by GERD and/or hiatal hernia continues to divide the community of bariatric [...] Read more.

(1) Background: There is still disagreement over how sleeve gastrectomy (SG) affects gastroesophageal reflux disease (GERD). The debate regarding the best option for patients undergoing bariatric surgery who are also affected by GERD and/or hiatal hernia continues to divide the community of bariatric surgeons. While concomitant hiatal hernia repair (SG + HHR) has been proposed as a means of reducing the risk of GERD following SG with varying degrees of success, the addition of a fundoplication (SG + FP) has been suggested in recent years as a way to improve the lower esophageal sphincter’s competency. The aim of this study is to systematically review and meta-analyze the efficacy of SG + HHR versus SG + FP on GERD remission in patients with obesity. (2) Methods: A systematic review of the literature was conducted, and studies analyzing the effects of SG + HHR versus SG + FP on postoperative GERD were included. The methodological quality of included trials was evaluated. The primary outcome was postoperative GERD rate, erosive esophagitis, and 12-month weight loss. Secondary outcomes included postoperative complications and mortality. The PRISMA guidelines were used to carry out the present systematic review (PROSPERO Registration Number: CRD42023405600). (3) Results: Fifteen articles with a total of 1164 patients were included in the meta-analysis; 554 patients underwent SG + HHR while 610 underwent SG + FP. In the SG + HHR group, 58.5 ± 28.9% of subjects presented clinical GERD symptoms compared to 20.4 ± 17.5% postoperatively (p < 0.001). In the SG + FP group, 64.8 ± 39.4% were affected by GERD preoperatively compared to only 5 ± 8.1% postoperatively (p < 0.001). SG + FP patients had a significantly greater GERD remission compared to SG + HHR (p < 0.001). Weight loss was similar between groups (p = 0.125). The rate of leaks was 0.18% and 0.33% in the SG + HHR and SG + FP, respectively (p = 0.657), while perforations were significantly higher after SG + FP compared to the SG + HHR group (3.1% versus 0%, p = 0.002). The mortality rate was significantly greater in the SG + FP group (0.5% versus 0%, p = 0.002). (4) Conclusions: This study revealed that both SG with concomitant HHR and sleeve–fundoplication are effective in terms of reflux resolution and weight outcomes, with superiority of SG + FP in terms of GERD control, despite a greater overall complication rate. Both strategies can therefore be suggested as a suitable alternative variant to a conventional SG in subjects with obesity and concomitant hiatal hernia and/or GERD. Studies with extended follow-up and direct comparisons of these surgical approaches to conventional SG are warranted. Full article

(This article belongs to the Special Issue Clinical Updates on Bariatric Surgery)

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7 pages, 227 KiB

Open AccessBrief Report

Tinnitus Is Marginally Associated with Body Mass Index, Heart Rate and Arterial Blood Pressure: Results from a Large Clinical Sample

by Berthold Langguth, Jan Bulla, Beate Fischer, Hansjoerg Baurecht, Martin Schecklmann, Steven C. Marcrum and Veronika Vielsmeier

J. Clin. Med. 2023, 12(9), 3321; https://doi.org/10.3390/jcm12093321 - 6 May 2023

Cited by 2 | Viewed by 1640

Abstract

Introduction: This study aimed to explore whether body mass index (BMI), systolic blood pressure (RR syst), diastolic blood pressure (RR diast) or heart rate (HR) are associated with tinnitus status and/or severity. Methods: To that end, we evaluated the influence of tinnitus status [...] Read more.

Introduction: This study aimed to explore whether body mass index (BMI), systolic blood pressure (RR syst), diastolic blood pressure (RR diast) or heart rate (HR) are associated with tinnitus status and/or severity. Methods: To that end, we evaluated the influence of tinnitus status and Tinnitus Handicap Inventory (THI) score on BMI, RR syst, RR diast and HR by comparing data from a large sample of patients presenting to a specialized tertiary referral clinic (N = 1066) with data from a population-based control group (N = 9885) by means of linear models. Results: Tinnitus patients had a significantly lower BMI and higher RR syst, RR diast and HR than non-tinnitus patients; however, the contribution of the case–control status to R² was very small (0.1%, 0.7%, 1.4% and 0.4%, respectively). BMI had little predictive power for the THI score (higher BMI scores were related to higher THI scores; R² = 0.5%) and neither RR syst, RR diast, nor HR showed a statistically significant association with THI. Discussion: Our findings suggest that HR, RR and BMI are at most marginally associated with tinnitus status and severity. Full article

(This article belongs to the Topic Brain, Hearing and Tinnitus Science)

22 pages, 951 KiB

Open AccessReview

Diagnosis and Management of Malnutrition in Patients with Heart Failure

by Alberto Esteban-Fernández, Rocío Villar-Taibo, Mirian Alejo, David Arroyo, Juan Luis Bonilla Palomas, Montserrat Cachero, Clara Joaquin, Manuel Méndez Bailón, José Ángel Pérez-Rivera, Juan Carlos Romero-Vigara and Gema Somoza

J. Clin. Med. 2023, 12(9), 3320; https://doi.org/10.3390/jcm12093320 - 6 May 2023

Cited by 13 | Viewed by 8462

Abstract

Heart failure is a disease with an increasingly greater prevalence due to the aging population, the development of new drugs, and the organization of healthcare processes. Malnutrition has been identified as a poor prognostic factor in these patients, very often linked to frailty [...] Read more.

Heart failure is a disease with an increasingly greater prevalence due to the aging population, the development of new drugs, and the organization of healthcare processes. Malnutrition has been identified as a poor prognostic factor in these patients, very often linked to frailty or to other comorbidities, meaning that early diagnosis and treatment are essential. This paper reviews some important aspects of the pathophysiology, detection, and management of malnutrition in patients with heart failure. Full article

(This article belongs to the Section Cardiovascular Medicine)

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