Journal of Clinical Medicine

11 pages, 1423 KiB

Open AccessArticle

Analysis of the Effects of Epidural Anesthesia on the Nociception Level Index (NOL^®) during Abdominal Surgery

by Alexander Ziebart, David-Jonas Rothgerber, Sophia Woldt, Katharina Mackert, Julia Heiden, Michael Schuster, Jens Kamuf, Eva-Verena Griemert and Robert Ruemmler

J. Clin. Med. 2024, 13(16), 4968; https://doi.org/10.3390/jcm13164968 - 22 Aug 2024

Viewed by 651

Abstract

Background: The NOL^® system (PMD-200™ Nociception Level Monitor; Medasense Ltd., Ramat Gan, Israel) is used for the real-time detection of physiological nociception in anesthetized patients by assessing the parameters indicative of sympathetic activity, such as photoplethysmography, skin conductance, peripheral temperature, and [...] Read more.

Background: The NOL^® system (PMD-200™ Nociception Level Monitor; Medasense Ltd., Ramat Gan, Israel) is used for the real-time detection of physiological nociception in anesthetized patients by assessing the parameters indicative of sympathetic activity, such as photoplethysmography, skin conductance, peripheral temperature, and accelerometry, which are quantified into the NOL^®-Index. This index is more sensitive than traditional clinical parameters in estimating pain and stress responses. While its effectiveness in general anesthesia is well documented, its efficacy in epidural anesthesia needs further investigation. Methods: This retrospective study analyzed NOL^®-Index dynamics compared to conventional parameters after epidural administration of bupivacaine. Following ethics committee approval, 119 NOL^® measurements were retrospectively analyzed after thoracic epidural catheter administration in 40 patients undergoing abdominal and urological surgery. The NOL-Index^® was assessed at 0, 1, 3, and 5 min post application and compared to heart rate, blood pressure, and bispectral index dynamics. Results: This study showed a significant decrease in the NOL^®-Index post-local-anesthetic administration with better sensitivity than classical clinical parameters (0 min = 38 ± 11; 1 min = 22 ± 13*; 3 min = 17 ± 11*; 5 min = 12 ± 10*). Higher doses of local anesthetics led to a significant, dose-dependent decrease in NOL^®-Index (low dose, 5 min = 15 ± 10*; high dose, 5 min = 8 ± 8*). Conclusions: This study is the first to demonstrate the effectiveness of the NOL^®-Index in measuring nociceptive effects following epidural administration, highlighting its potential superiority over conventional parameters and its sensitivity to dose variations. Full article

(This article belongs to the Section Anesthesiology)

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18 pages, 3360 KiB

Open AccessArticle

Automated Quality Control Solution for Radiographic Imaging of Lung Diseases

by Christoph Kleefeld, Jorge Patricio Castillo Lopez, Paulo R. Costa, Isabelle Fitton, Ahmed Mohamed, Csilla Pesznyak, Ricardo Ruggeri, Ioannis Tsalafoutas, Ioannis Tsougos, Jeannie Hsiu Ding Wong, Urban Zdesar, Olivera Ciraj-Bjelac and Virginia Tsapaki

J. Clin. Med. 2024, 13(16), 4967; https://doi.org/10.3390/jcm13164967 - 22 Aug 2024

Viewed by 1071

Abstract

Background/Objectives: Radiography is an essential and low-cost diagnostic method in pulmonary medicine that is used for the early detection and monitoring of lung diseases. An adequate and consistent image quality (IQ) is crucial to ensure accurate diagnosis and effective patient management. This [...] Read more.

Background/Objectives: Radiography is an essential and low-cost diagnostic method in pulmonary medicine that is used for the early detection and monitoring of lung diseases. An adequate and consistent image quality (IQ) is crucial to ensure accurate diagnosis and effective patient management. This pilot study evaluates the feasibility and effectiveness of the International Atomic Energy Agency (IAEA)’s remote and automated quality control (QC) methodology, which has been tested in multiple imaging centers. Methods: The data, collected between April and December 2022, included 47 longitudinal data sets from 22 digital radiographic units. Participants submitted metadata on the radiography setup, exposure parameters, and imaging modes. The database comprised 968 exposures, each representing multiple image quality parameters and metadata of image acquisition parameters. Python scripts were developed to collate, analyze, and visualize image quality data. Results: The pilot survey identified several critical issues affecting the future implementation of the IAEA method, as follows: (1) difficulty in accessing raw images due to manufacturer restrictions, (2) variability in IQ parameters even among identical X-ray systems and image acquisitions, (3) inconsistencies in phantom construction affecting IQ values, (4) vendor-dependent DICOM tag reporting, and (5) large variability in SNR values compared to other IQ metrics, making SNR less reliable for image quality assessment. Conclusions: Cross-comparisons among radiography systems must be taken with cautious because of the dependence on phantom construction and acquisition mode variations. Awareness of these factors will generate reliable and standardized quality control programs, which are crucial for accurate and fair evaluations, especially in high-frequency chest imaging. Full article

(This article belongs to the Section Pulmonology)

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14 pages, 697 KiB

Open AccessArticle

The Role of Vitamin D Metabolism Genes and Their Genomic Background in Shaping Cyclosporine A Dosage Parameters after Kidney Transplantation

by Katarzyna Kotowska, Bartosz Wojciuk, Jerzy Sieńko, Anna Bogacz, Iga Stukan, Sylwester Drożdżal, Bogusław Czerny, Karol Tejchman, Grzegorz Trybek, Bogusław Machaliński and Maciej Kotowski

J. Clin. Med. 2024, 13(16), 4966; https://doi.org/10.3390/jcm13164966 - 22 Aug 2024

Viewed by 747

Abstract

Background: Kidney transplantation is followed by immunosuppressive therapy involving calcineurin inhibitors (CNIs) such as cyclosporin A. However, long-term high CNIs doses can lead to vitamin D deficiency, and genetic variations influencing vitamin D levels can indirectly impact the necessary CNIs dosage. This study [...] Read more.

Background: Kidney transplantation is followed by immunosuppressive therapy involving calcineurin inhibitors (CNIs) such as cyclosporin A. However, long-term high CNIs doses can lead to vitamin D deficiency, and genetic variations influencing vitamin D levels can indirectly impact the necessary CNIs dosage. This study investigates the impact of genetic variations of vitamin D binding protein (DBP) rs2282679 and CYP2R1 hydroxylase rs10741657 polymorphisms on the cyclosporin A dosage in kidney transplant recipients. Additional polymorphisims of genes that are predicted to influence the pharmacogenetic profile were included. Methods: Gene polymorphisms in 177 kidney transplant recipients were analyzed using data mining techniques, including the Random Forest algorithm and Classification and Regression Trees (C&RT). The relationship between the concentration/dose (C/D) ratio of cyclosporin A and genetic profiles was assessed to determine the predictive value of DBP rs2282679 and CYP2R1 rs10741657 polymorphisms. Results: Polymorphic variants of the DBP (rs2282679) demonstrated a strong predictive value for the cyclosporin A C/D ratio in post-kidney transplantation patients. By contrast, the CYP2R1 polymorphism (rs10741657) did not show predictive significance. Additionally, the immune response genes rs231775 CTLA4 and rs1800896 IL10 were identified as predictors of cyclosporin A response, though these did not result in statistically significant differences. Conclusions:DBP rs2282679 polymorphisms can significantly predict the cyclosporin A C/D ratio, potentially enhancing the accuracy of CNI dosing. This can help identify patient groups at risk of vitamin D deficiency, ultimately improving the management of kidney transplant recipients. Understanding these genetic influences allows for more personalized and effective treatment strategies, contributing to better long-term outcomes for patients. Full article

(This article belongs to the Special Issue Kidney Transplantation: Current Challenges and Future Perspectives)

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10 pages, 432 KiB

Open AccessArticle

Perioperative Use of IgM-Enriched Immunoglobulins in Liver Transplantation Recipients at High Risk for Infections: A Preliminary Study

by Erika Roat, Martina Tosi, Irene Coloretti, Filippo Bondi, Giovanni Chierego, Stefano De Julis, Marta Talamonti, Emanuela Biagioni, Stefano Busani, Stefano Di Sandro, Erika Franceschini, Gian Piero Guerrini, Marianna Meschiari, Fabrizio Di Benedetto, Cristina Mussini and Massimo Girardis

J. Clin. Med. 2024, 13(16), 4965; https://doi.org/10.3390/jcm13164965 - 22 Aug 2024

Viewed by 764

Abstract

Background: Infections frequently occur after orthotopic liver transplantation (OLT) and are associated with increased mortality. In 2018, we introduced perioperative administration of intravenous immunoglobulin enriched in IgM as an optional therapy in recipients at a high risk of infection. This preliminary study [...] Read more.

Background: Infections frequently occur after orthotopic liver transplantation (OLT) and are associated with increased mortality. In 2018, we introduced perioperative administration of intravenous immunoglobulin enriched in IgM as an optional therapy in recipients at a high risk of infection. This preliminary study evaluated whether this preparation reduced infections in the early post-transplantation period. Methods: Adult patients with a high risk of postoperative infections who underwent OLT between January 2014 and December 2021 in our center were included in the study. The primary outcome was the occurrence of new postoperative bacterial and fungal infections within the first 30 days after OLT. Results: Ninety recipients at a high risk of postoperative infections who underwent OLT were included, of whom 51 (57%) received IgM preparation. Patients treated and not treated with IgM were similar in terms of demographics, model of end-stage liver disease score, and risk factors for postoperative infections. The occurrence of new infections was lower (absolute risk reduction (ARR) 21.2%; p = 0.038) in patients who received IgM than in those who did not. Multivariate analysis adjusted for confounders (OR 0.348; p = 0.033) and propensity score-based matching analysis (ARR 21.2%, p = 0.067) confirmed an association between IgM preparation and lower occurrence of postoperative infections. The 90-day mortality rate was lower (ARR 13.4%, p = 0.018) in patients who received IgM preparation. Conclusions: In OLT recipients at high risk for infections, perioperative administration of an IgM-enriched preparation seems to reduce the development of new infections within the first 30 days after OLT. Full article

(This article belongs to the Section Infectious Diseases)

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7 pages, 469 KiB

Open AccessBrief Report

Adherence to Secondary Prevention Measures after Acute Myocardial Infarction and Its Impact on Patient Outcome—A Nationwide Perspective

by Andreas Hammer, Hana Sinkovec, Marko Todorovic, Florian Katsch, Walter Gall, Georg Duftschmid, Georg Heinze, Alexander Niessner and Patrick Sulzgruber

J. Clin. Med. 2024, 13(16), 4964; https://doi.org/10.3390/jcm13164964 - 22 Aug 2024

Viewed by 787

Abstract

Objectives: Secondary prevention is crucial for reducing morbidity and mortality in patients following acute myocardial infraction (MI). However, adherence to cardiac rehabilitation (CR) and pharmacotherapy remains suboptimal despite strong guideline recommendations. This study investigated the adherence to CR, dual antiplatelet therapy (DAPT), and [...] Read more.

Objectives: Secondary prevention is crucial for reducing morbidity and mortality in patients following acute myocardial infraction (MI). However, adherence to cardiac rehabilitation (CR) and pharmacotherapy remains suboptimal despite strong guideline recommendations. This study investigated the adherence to CR, dual antiplatelet therapy (DAPT), and statins following acute MI and evaluated their impact on patient outcomes from a nationwide perspective in Austria. Methods: In this national observational study, all patients diagnosed with acute MI, defined as STEMI or NSTEMI, between April 2011 and August 2015 in Austria were included. Patient characteristics and comorbidities were derived from the Austrian national health insurance system using ICD-10 codes. Adherence to CR, high-intensity statins, and DAPT was assessed based on health insurance records and pharmacy prescription submissions. Cox Regression hazard analysis was used to explore the impact of non-adherence to CR on mortality. Results: Among 16,518 acute MI patients, only 13.4% adhered to the recommended CR programs, which was associated with a significantly lower risk of mortality (adjusted hazard ratio [HR] 0.73; 95% CI: 0.54–0.98; p = 0.036). In contrast, 66.4% of 23,240 patients did not comply with high-intensity statin therapy, correlating with an increased mortality risk (adjusted HR 1.16; 95% CI: 1.06–1.25; p < 0.001). Furthermore, among 22,331 patients analyzed for DAPT adherence, only 29.3% followed the guidelines, yet this adherence was linked to a 21% reduction in mortality over the observation period (adjusted HR 0.79; 95% CI: 0.72–0.88; p < 0.001). Conclusions: This nationwide study reveals alarmingly low adherence to CR and secondary preventive medications among acute MI patients, which is significantly linked to higher mortality rates. Enhanced efforts to promote awareness and adherence are crucial, involving structured referrals and personalized follow-ups to improve patient outcomes. Addressing these gaps through comprehensive healthcare strategies could substantially enhance cardiovascular health. Full article

(This article belongs to the Section Cardiology)

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13 pages, 1080 KiB

Open AccessArticle

Interstitial Lung Disease Phenotypes and Predictive Risk Factors in Primary Sjögren’s Syndrome

by Gaetano La Rocca, Francesco Ferro, Gianluca Sambataro, Elena Elefante, Giovanni Fulvio, Inmaculada Concepción Navarro, Michele Moretti, Chiara Romei, Marta Mosca and Chiara Baldini

J. Clin. Med. 2024, 13(16), 4963; https://doi.org/10.3390/jcm13164963 - 22 Aug 2024

Viewed by 738

Abstract

Background/Objectives: The prevalence of Interstitial Lung Disease (ILD) and risk factors for its development in patients with primary Sjögren’s syndrome (pSS) are still debated, possibly due to the existence of heterogeneous pSS-related ILD phenotypes. The aims of this study were: 1. To investigate [...] Read more.

Background/Objectives: The prevalence of Interstitial Lung Disease (ILD) and risk factors for its development in patients with primary Sjögren’s syndrome (pSS) are still debated, possibly due to the existence of heterogeneous pSS-related ILD phenotypes. The aims of this study were: 1. To investigate the prevalence and predictive factors for ILD development in a single-center pSS cohort; 2. To characterize different pSS-ILD phenotypes. Methods: Clinical, laboratory and imaging data of pSS patients attending our center from January 2019 to September 2023 were retrospectively analyzed. ILD presence was confirmed on HRCT. Results: Forty-three out of 474 enrolled pSS patients presented ILD (M:F = 6:37), accounting for an overall ILD prevalence of 9.1%. In 19 cases, ILD was the first manifestation of pSS (ILD-onset), while in 24 ILD was diagnosed after pSS (ILD-incident). Compared to ILD-onset, ILD-incident patients more often presented pSS-related hematologic abnormalities (p = 0.012), cutaneous involvement (p = 0.027), inflammatory arthralgias (p = 0.026), C4 hypocomplementemia (p = 0.012) and positive RF (p = 0.031). On the other hand, ILD-onset patients were significantly older at pSS diagnosis (p = 0.008) and presented more severe fibrosis on HRCT (p = 0.008). On the univariate analysis, higher ESSDAI (p = 0.011), Raynaud’s phenomenon (p = 0.009), anti-Ro52 (p = 0.031), hypergammaglobulinemia (p = 0.011), Rheumatoid Factor (RF) (p = 0.038) and C4 hypocomplementemia (p = 0.044) at baseline were associated to ILD development during follow-up. On the multivariate analysis, the ESSDAI at baseline (p = 0.05) and Raynaud’s phenomenon (p = 0.013) at baseline were the only independent predictors of ILD development. Conclusions: ILD is a relatively common and clinically heterogenous pSS manifestation. Elevated disease activity at pSS onset is a risk factor for ILD development, prompting careful follow-up and intriguingly suggesting that immunomodulatory therapies may prevent ILD. Full article

(This article belongs to the Section Immunology)

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31 pages, 872 KiB

Open AccessReview

Analysis of Research Trends in Ultrasound-Guided Acupuncture and Dry-Needling: A Scoping Review

by Hyunwook Shin, Hyeonjun Woo, Yunhee Han, Seungkwan Choi, Jungho Jo, Seojae Jeon, Wonbae Ha and Junghan Lee

J. Clin. Med. 2024, 13(16), 4962; https://doi.org/10.3390/jcm13164962 - 22 Aug 2024

Viewed by 1064

Abstract

Background: This study aimed to summarize the current status of research on ultrasound-guided acupuncture and dry-needling treatment and the specific treatment methods applied to patients. Methods: A scoping review was conducted, surveying three English databases (PubMed, Embase, and the Cochrane Library) for studies [...] Read more.

Background: This study aimed to summarize the current status of research on ultrasound-guided acupuncture and dry-needling treatment and the specific treatment methods applied to patients. Methods: A scoping review was conducted, surveying three English databases (PubMed, Embase, and the Cochrane Library) for studies published up to May 2024. All studies related to ultrasound-guided acupuncture and dry-needling treatment were considered. Literature was selected using selection and exclusion criteria, and extracted and organized using EndNote. Results: A total of 107 eligible studies were included. Among the 107 studies, non-comparative studies accounted for the largest proportion (n = 47, 43.9%), followed by randomized controlled trials (RCTs; n = 41, 38.3%). Diseases of the musculoskeletal system or connective tissue (15 diseases of the musculoskeletal system or connective tissue) accounted for most (n = 48, 55.8%) of the 86 diseases studied, followed by symptoms, signs, or clinical conditions not otherwise classified (n = 17, 19.8%). Conclusions: Ultrasound-guided acupuncture and dry-needling have been actively studied and applied for the treatment of various diseases. However, higher-quality studies are needed for further applications in research and clinical practice. Full article

(This article belongs to the Section Nuclear Medicine & Radiology)

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13 pages, 742 KiB

Open AccessReview

Effects of Environmental Conditions on Athlete’s Cardiovascular System

by Andrea Segreti, Mihail Celeski, Emiliano Guerra, Simone Pasquale Crispino, Francesca Vespasiano, Lorenzo Buzzelli, Chiara Fossati, Rocco Papalia, Fabio Pigozzi and Francesco Grigioni

J. Clin. Med. 2024, 13(16), 4961; https://doi.org/10.3390/jcm13164961 - 22 Aug 2024

Cited by 1 | Viewed by 1177

Abstract

Environmental factors such as extreme temperatures, humidity, wind, pollution, altitude, and diving can significantly impact athletes’ cardiovascular systems, potentially hindering their performance, particularly in outdoor sports. The urgency of this issue is heightened by the increasing prevalence of climate change and its associated [...] Read more.

Environmental factors such as extreme temperatures, humidity, wind, pollution, altitude, and diving can significantly impact athletes’ cardiovascular systems, potentially hindering their performance, particularly in outdoor sports. The urgency of this issue is heightened by the increasing prevalence of climate change and its associated conditions, including fluctuating pollution levels, temperature variations, and the spread of infectious diseases. Despite its critical importance, this topic is often overlooked in sports medicine. This narrative review seeks to address this gap by providing a comprehensive, evidence-based evaluation of how athletes respond to environmental stresses. A thorough assessment of current knowledge is essential to better prepare athletes for competition under environmental stress and to minimize the harmful effects of these factors. Specifically, adaptative strategies and preventative measures are vital to mitigating these environmental influences and ensuring athletes’ safety. Full article

(This article belongs to the Special Issue The Epidemiology and Effects of Cardiovascular Risk Factors in Athletes)

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12 pages, 252 KiB

Open AccessArticle

Somatic Structure and Ultrasound Parameters of the Calcaneus Bone in Combat Sports Athletes in Relation to Vitamin D₃ Levels

by Janusz Brudecki, Łukasz Rydzik, Wojciech Wąsacz, Pavel Ruzbarsky, Wojciech Czarny, Marlena Warowna and Tadeusz Ambroży

J. Clin. Med. 2024, 13(16), 4960; https://doi.org/10.3390/jcm13164960 - 22 Aug 2024

Viewed by 521

Abstract

Background/Objectives: Physical activity is widely recognized for its beneficial effects on bone density during adolescence, which could lead to enhanced bone density in later life, thus acting as a health-promoting activity with long-lasting implications. However, not all studies are conclusive regarding the [...] Read more.

Background/Objectives: Physical activity is widely recognized for its beneficial effects on bone density during adolescence, which could lead to enhanced bone density in later life, thus acting as a health-promoting activity with long-lasting implications. However, not all studies are conclusive regarding the type, intensity, duration, and frequency of the most effective physical activities. This study focuses on combat sports athletes and examines the relationship between their somatic build and heel bone parameters using ultrasound (USG) and their vitamin D3 levels. Methods: The study included 40 male athletes specializing in various combat sports. The measurements of body height, body mass, skinfold thickness, and bone widths at multiple sites were performed to estimate the somatic build. The USG parameters of the heel bone and the blood levels of vitamin D3 were also recorded. Statistical significance was determined using one-way ANOVA, with differences among sports disciplines also examined. Results: The study found significant differences in the body composition and USG bone parameters among athletes from different combat sports (p ≤ 0.05). The calcaneus stiffness index (SI) and speed of sound (SOS) were significantly higher in athletes with normal vitamin D3 levels compared to those with below-normal levels (p = 0.0015 and p = 0.001, respectively). These findings suggest that vitamin D3 may influence bone stiffness and density. Conclusions: The study underscores the importance of maintaining adequate vitamin D3 levels to support bone mineralization in athletes, particularly those training indoors with limited exposure to sunlight. It also highlights the potential of using USG as a non-invasive method to assess bone health, aiding in the optimization of training programs to prevent injuries and improve performance. Full article

(This article belongs to the Section Sports Medicine)

15 pages, 3149 KiB

Open AccessSystematic Review

Primary Cauda Equina Lymphoma Mimicking Meningioma

by Pierfrancesco Lapolla, Vincenza Maiola, Pietro Familiari, Gabriella Tomei, Dominella Gangemi, Sara Ienzi, Roberto Arcese, Mauro Palmieri, Michela Relucenti, Andrea Mingoli, Gioia Brachini, Stefania Annarita Nottola, Giancarlo D’Andrea, Biagia La Pira and Placido Bruzzaniti

J. Clin. Med. 2024, 13(16), 4959; https://doi.org/10.3390/jcm13164959 - 22 Aug 2024

Viewed by 874

Abstract

Background: Spinal cord lymphomas represent a minority of extranodal lymphomas and often pose diagnostic challenges by imitating primary spinal tumors or inflammatory/infective lesions. This paper presents a unique case of primary cauda equina lymphoma (PCEL) and conducts a comprehensive review to delineate [...] Read more.

Background: Spinal cord lymphomas represent a minority of extranodal lymphomas and often pose diagnostic challenges by imitating primary spinal tumors or inflammatory/infective lesions. This paper presents a unique case of primary cauda equina lymphoma (PCEL) and conducts a comprehensive review to delineate the clinical and radiological characteristics of this rare entity. Case Report: A 74-year-old male presented with progressive paresthesia, motor weakness, and symptoms indicative of cauda equina syndrome. Neurological examination revealed paraparesis and sphincter dysfunction. Imaging studies initially suggested an intradural meningioma. However, surgical intervention revealed a diffuse large B-cell lymphoma infiltrating the cauda equina. Findings: A systematic review of the pertinent literature identified 18 primary cauda equina lymphoma cases. These cases exhibited diverse clinical presentations, treatments, and outcomes. The mean age at diagnosis was 61.25 years for women and 50 years for men, with an average follow-up of 16.2 months. Notably, 35% of patients were alive at 18 months, highlighting the challenging prognosis associated with PCEL. Discussion: Primary spinal cord lymphomas, especially within the cauda equina, remain rare and diagnostically complex due to their nonspecific clinical manifestations. The review highlights the need to consider spinal cord lymphoma in patients with neurological symptoms, even without a history of systemic lymphoma. Diagnostic Approaches: Magnetic resonance imaging (MRI) serves as the primary diagnostic tool but lacks specificity. Histopathological examination remains the gold standard for definitive diagnosis. The review underscores the importance of timely biopsy in suspected cases to facilitate accurate diagnosis and appropriate management. Management and Prognosis: Current management involves biopsy and chemotherapy; however, optimal treatment strategies remain ambiguous due to the rarity of PCEL. Despite aggressive therapeutic interventions, prognosis remains poor, emphasizing the urgency for enhanced diagnostic and treatment modalities. Conclusions: Primary cauda equina lymphoma poses diagnostic and therapeutic challenges, necessitating a high index of suspicion in patients with atypical spinal cord symptoms. Collaborative efforts between neurosurgical, oncological, and infectious diseases teams are imperative for timely diagnosis and management. Advancements in diagnostic precision and therapeutic options are crucial for improving patient outcomes. Full article

(This article belongs to the Section Hematology)

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8 pages, 365 KiB

Open AccessArticle

Characteristics and Outcome of Patients with or without Previous Implantable Cardioverter Defibrillator Interventions Undergoing Ablation for Ventricular Tachycardia

by Gianluigi Bencardino, Maria Lucia Narducci, Roberto Scacciavillani, Francesca Augusta Gabrielli, Gemma Pelargonio, Massimo Massetti, Filippo Crea and Gaetano Antonio Lanza

J. Clin. Med. 2024, 13(16), 4958; https://doi.org/10.3390/jcm13164958 - 22 Aug 2024

Viewed by 570

Abstract

Background: Catheter ablation (CA) is a well-established treatment in patients with ventricular tachycardia and appropriate implantable cardioverter defibrillator (ICD) therapies. Methods: We enrolled 57 consecutive carriers of ICD undergoing CA for electrical storm (ES). Our aim was to investigate differences in clinical, device-related, [...] Read more.

Background: Catheter ablation (CA) is a well-established treatment in patients with ventricular tachycardia and appropriate implantable cardioverter defibrillator (ICD) therapies. Methods: We enrolled 57 consecutive carriers of ICD undergoing CA for electrical storm (ES). Our aim was to investigate differences in clinical, device-related, and electroanatomic features among patients who had history of appropriate ICD interventions before the ES compared to those who had not. The primary endpoint was a composite of death from any cause and recurrences of sustained VT, ventricular fibrillation, appropriate ICD therapy, or ES. Results: During a median follow up of 39 months, 28 patients (49%) met the primary endpoint. Those with previous ICD interventions had a higher prevalence of late potentials and a greater unipolar low-voltage area at electroanatomic mapping. Patients who met the primary endpoint had a higher prevalence of ATP/shock episodes preceding the ES event. At Cox regression analysis, non-ischemic dilated cardiomyopathy (NIDCM), QRS duration, and previous ATP and/or shock before the ES were associated with arrhythmic recurrences and/or death. At multivariate analysis, NIDCM and previous shock were associated with arrhythmic recurrences and/or death. Conclusions: A history of recurrent ICD therapies predicts worse outcomes when CA is needed because of ES. Although more studies are needed to definitively address this question, our data speak in support of an early referral for CA of ES. Full article

(This article belongs to the Section Cardiology)

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11 pages, 627 KiB

Open AccessArticle

Skin Microvascular Dysfunction in Type 2 Diabetes Mellitus Using Laser Speckle Contrast Analysis and Association with Carotid Intima-Media Thickness

by Stamatina Lamprou, Nikolaos Koletsos, Ioanna Zografou, Antonios Lazaridis, Gesthimani Mintziori, Christina Maria Trakatelli, Vasilios Kotsis, Eugenia Gkaliagkousi, Michael Doumas and Areti Triantafyllou

J. Clin. Med. 2024, 13(16), 4957; https://doi.org/10.3390/jcm13164957 - 22 Aug 2024

Viewed by 599

Abstract

Background: It is established that diabetes mellitus (DM) is characterized by increased cardiovascular risk associated with subclinical atherosclerosis as well as microvascular alterations. Laser speckle contrast analysis (LASCA) is an innovative, non-invasive method for assessing skin microvascular function. Objectives: We sought to assess [...] Read more.

Background: It is established that diabetes mellitus (DM) is characterized by increased cardiovascular risk associated with subclinical atherosclerosis as well as microvascular alterations. Laser speckle contrast analysis (LASCA) is an innovative, non-invasive method for assessing skin microvascular function. Objectives: We sought to assess skin microvascular function in patients with type 2 DM and matched controls. Methods: Consecutive patients with DM and individuals matched for age, sex and BMI were included in the study. Skin microvascular perfusion was assessed, using LASCA, during baseline, a 5 min occlusion period and a 5 min reperfusion period. Carotid intima-media thickness (cIMT) was measured as a surrogate marker of macrocirculation. Results: In total, 18 patients with DM and 22 in the control group were enrolled. No statistically significant differences were observed in baseline flux, peak flux and percentage decrease during arterial occlusion. During reperfusion, individuals with DM exhibited a smaller peak magnitude compared to controls (147.0 ± 64.7% vs. 189.4 ± 46.0%, respectively; p < 0.05). Moreover, cIMT was higher in patients with DM compared to controls (0.68 ± 0.09 mm vs. 0.60 ± 0.08 mm, respectively, p < 0.01) and was negatively correlated with skin microvascular reactivity in the univariate analysis. In the multivariate analysis, glucose and office systolic blood pressure levels remained significant predictors of microvascular reactivity. Conclusions: Our study shows that patients with type 2 DM exhibit impaired skin microvascular function compared to controls. Furthermore, glucose levels and blood pressure play a key role in microvascular dysfunction. However, additional studies are needed to address the clinical significance of early microvascular changes in DM. Full article

(This article belongs to the Special Issue Type 2 Diabetes: Epidemiology and Clinical Advances)

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10 pages, 768 KiB

Open AccessProject Report

Radiographic Knee Osteoarthritis Is a Risk Factor for the Development of Dementia: Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study

by Yuji Endo, Hiroshi Kobayashi, Kazuyuki Watanabe, Koji Otani, Kenichi Otoshi, Hironori Numazaki, Miho Sekiguchi, Mari Sato, Takuya Nikaido, Rei Ono, Shin-ichi Konno and Yoshihiro Matsumoto

J. Clin. Med. 2024, 13(16), 4956; https://doi.org/10.3390/jcm13164956 - 22 Aug 2024

Viewed by 1037

Abstract

Objective: Osteoarthritis is linked to dementia, but no longitudinal studies have established this connection. This prospective cohort study from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS) aimed to determine if knee osteoarthritis (KOA) independently predicts dementia in adults aged [...] Read more.

Objective: Osteoarthritis is linked to dementia, but no longitudinal studies have established this connection. This prospective cohort study from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS) aimed to determine if knee osteoarthritis (KOA) independently predicts dementia in adults aged 65 and above. Methods: Participants were classified by the Kellgren–Laurence scale into no/minimal KOA (grades 0 and I) and definitive KOA (grade II or higher). We analyzed dementia incidence from 2009 to 2015 using long-term care insurance data, adjusting for age, sex, vascular risks, depressive symptoms, and activity levels. Results: Out of 1089 participants (58.9% female, average age 72.5), 72.0% had definitive KOA. Dementia occurrence was significantly higher in the definitive group (8.4%) compared to the no/minimal group (3.0%) (p < 0.001). A log-rank test and Cox regression analysis confirmed these findings, showing an adjusted hazard ratio of 2.29 (confidence interval: 1.12–4.68) for dementia in those with definitive KOA. Conclusions: These results suggest that KOA is a significant risk factor for dementia, highlighting the importance of addressing contributing factors in KOA patients to potentially slow the progression of dementia. Full article

(This article belongs to the Special Issue Knee Osteoarthritis: Clinical Updates and Perspectives)

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11 pages, 741 KiB

Open AccessReview

Dynamic Repair Surgery for Late-Stage Facial Paralysis: Advances in Restoring Movement and Function

by Qing Sun, Xing Li, Zhihui Zhu, Xiting Xiang and Tao Zhang

J. Clin. Med. 2024, 13(16), 4955; https://doi.org/10.3390/jcm13164955 - 22 Aug 2024

Viewed by 875

Abstract

Purpose: Facial paralysis results from congenital or acquired facial nerve damage, leading to significant cosmetic and functional deficits. Surgical resection of parotid and midface tumors can cause facial paralysis, necessitating effective treatment strategies. This review addresses the challenge of restoring movement and function [...] Read more.

Purpose: Facial paralysis results from congenital or acquired facial nerve damage, leading to significant cosmetic and functional deficits. Surgical resection of parotid and midface tumors can cause facial paralysis, necessitating effective treatment strategies. This review addresses the challenge of restoring movement and function in late-stage facial paralysis, focusing on dynamic repair techniques involving nerve and muscle transplantation. Methods: The review encompasses studies on dynamic repair surgery for late facial paralysis, including techniques such as local muscle flap with pedicle transfer, vascularized nerve flap with pedicle transfer, and multiple muscle flap procedures. A systematic literature search was conducted using PubMed, Web of Science, and Google Scholar, covering studies from 2000 to 2024. Keywords included “dynamic repair”, “late-stage facial paralysis”, “nerve and muscle transplantation”, “muscle flap”, and “tendon transposition”. Included were clinical studies, systematic reviews, and meta-analyses reporting surgical outcomes. Exclusion criteria included studies with insufficient data and non-peer-reviewed articles. Results: Dynamic repair techniques involving nerve and muscle transplantation are essential for treating late-stage facial paralysis. Each surgical method has strengths and limitations. The masseter muscle flap demonstrates high success rates, although it can cause horizontal tension and jaw contour issues. The temporalis muscle flap is effective for smile restoration but may lead to temporal concavity. The gracilis muscle flap is widely used, especially with dual nerve innervation, showing high success in spontaneous smiles but requiring a longer recovery period. The latissimus dorsi flap is effective but can cause edema and shoulder issues. The serratus anterior free flap offers flexibility with precise vector positioning but may not achieve adequate lip elevation and can cause cheek swelling. Combined multi-flap surgeries provide more natural facial expressions but increase surgical complexity and require advanced microsurgical skills. Conclusions: Dual nerve innervation shows promise for restoring spontaneous smiles. One-stage surgery offers faster recovery and reduced financial burden. Comprehensive patient evaluation is crucial to select the most suitable surgical method. Dynamic repair techniques involving nerve and muscle transplantation provide effective solutions for restoring function and aesthetics in late-stage facial paralysis. Future research should focus on long-term outcomes, patient satisfaction, and standardizing surgical protocols to optimize treatment strategies. Full article

(This article belongs to the Special Issue Craniofacial and Reconstructive Plastic Surgery)

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10 pages, 497 KiB

Open AccessArticle

Impact of Exposure to Hand-Held Vibrating Tools on Patient-Reported Outcome Measures after Open Carpal Tunnel Release: A Retrospective Cohort Study with Matched Controls

by Malin Zimmerman, Lisa Åselius, Erik Dahlin, Gert S. Andersson and Lars B. Dahlin

J. Clin. Med. 2024, 13(16), 4954; https://doi.org/10.3390/jcm13164954 - 22 Aug 2024

Viewed by 564

Abstract

Objectives: Vibration exposure is a known risk factor for developing carpal tunnel syndrome (CTS), and insufficient outcomes for surgery for CTS have been reported after such exposure. We aim to investigate whether vibration exposure affects patient-reported outcomes following open carpal tunnel release. [...] Read more.

Objectives: Vibration exposure is a known risk factor for developing carpal tunnel syndrome (CTS), and insufficient outcomes for surgery for CTS have been reported after such exposure. We aim to investigate whether vibration exposure affects patient-reported outcomes following open carpal tunnel release. Methods: From a population surgically treated for CTS (n = 962), we identified patients who reported previous or present vibration exposure, had undergone preoperative electrophysiology testing and answered the Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) questionnaire before and at 12 months post-surgery (n = 23). We then matched the patients with controls based on age, sex, diabetes status, type of diabetes and smoking (n = 23). Results: Most of the patients included were men (17/23; 74% in each group) and had a mean age of 61 years. The preoperative electrophysiology results were slightly worse among vibration-exposed individuals, although the differences were not statistically significant. The QuickDASH scores did not differ between the two groups (preoperative QuickDASH scores in vibration-exposed individuals: median 45 [interquartile range; IQR 30–61]; non-exposed individuals: 43 [25–64], p = 0.68; postoperative 12 months QuickDASH score in vibration-exposed individuals: 20 [2–45]; non-exposed individuals: 14 [5–34], p = 0.87). Conclusions: When controlling for known confounders, vibration-exposed individuals can expect the same symptom relief following open carpal tunnel release as non-exposed individuals. Individual assessments and treatment of CTS are warranted if there is a history of vibration exposure. Full article

(This article belongs to the Section Orthopedics)

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9 pages, 229 KiB

Open AccessArticle

Occult Serologically Confirmed Cases of SARS-CoV-2 Coronavirus among the General Population in the Era of the Fourth Vaccination

by Mori Hay Levy, Neta Cohen, Rotem Marom, Hanoch Goldshmidt, David Zeltser, Michal Mizrahi, Yanay Simhon, Ronni Gamzu, Nadir Arber, Shahar Lev-Ari, Tali Capua and Esther Saiag

J. Clin. Med. 2024, 13(16), 4953; https://doi.org/10.3390/jcm13164953 - 22 Aug 2024

Viewed by 744

Abstract

Background: Asymptomatic SARS-CoV-2 infection can significantly increase the spread of the COVID-19 pandemic. We aimed to investigate the epidemiological and clinical predictors of occult serologically confirmed SARS-CoV-2 cases among the general population during the fourth vaccination era in Israel. Methods: We conducted a [...] Read more.

Background: Asymptomatic SARS-CoV-2 infection can significantly increase the spread of the COVID-19 pandemic. We aimed to investigate the epidemiological and clinical predictors of occult serologically confirmed SARS-CoV-2 cases among the general population during the fourth vaccination era in Israel. Methods: We conducted a cross-sectional study among individuals aged ≥18 years who had not been tested for COVID-19 in the preceding 5 months. Occult serologically confirmed cases were based on the presence of anti-N IgG antibodies. Potential risk factors were examined. Multivariable regression analysis identified independent predictors of subclinical SARS-CoV-2 infection. Results: This study included 504 participants. The prevalence of occult serologically confirmed SARS-CoV-2 was 12.5%. Chronic disease was found to be an independent predictor for the absence of occult disease (aOR) 0.4 [95% (CI): 0.18–0.87], p-value = 0.02). No significant differences were observed in age, sex, marital status, number of children, vaccination status, or exposure to COVID-19 infection between participants with and without SARS-CoV-2 sub-infection. Conclusions: We found a lower prevalence of occult serologically confirmed SARS-CoV-2 cases, compared to previous reports, and a negative correlation between chronic disease and occult SARS-CoV-2. Continued research, surveillance, and intervention strategies are needed to optimize long-term health outcomes and provide valuable insights for public health policymakers and clinicians. Full article

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

15 pages, 442 KiB

Open AccessReview

Impact of Phlebotomy on Quality of Life in Low-Risk Polycythemia Vera

by Nathan Visweshwar, Bradley Fletcher, Michael Jaglal, Damian A. Laber, Ankita Patel, Jennifer Eatrides, Geetha Rajasekharan Rathnakumar, Keshav Visweswaran Iyer, Irmel Ayala and Arumugam Manoharan

J. Clin. Med. 2024, 13(16), 4952; https://doi.org/10.3390/jcm13164952 - 22 Aug 2024

Viewed by 1638

Abstract

Polycythemia vera is an indolent myeloproliferative disorder that predisposes patients to venous and arterial thrombosis and can transform into myelofibrosis and acute myeloid leukemia. Consistent phlebotomy prevents life-threatening cerebrovascular and coronary artery disease and prolongs survival in low-risk polycythemia vera (patients under 60 [...] Read more.

Polycythemia vera is an indolent myeloproliferative disorder that predisposes patients to venous and arterial thrombosis and can transform into myelofibrosis and acute myeloid leukemia. Consistent phlebotomy prevents life-threatening cerebrovascular and coronary artery disease and prolongs survival in low-risk polycythemia vera (patients under 60 years without thrombosis). However, despite its effectiveness in preventing serious complications, phlebotomy does not necessarily enhance the quality of life (QoL). This review assesses QoL issues associated with low-risk PV, explores alternative management strategies such as erythrocytapheresis, and discusses the roles of hydroxyurea, peginterferon, ruxolitinib, and other novel agents in potentially improving disease management and patient outcomes. Full article

(This article belongs to the Special Issue Myeloproliferative Neoplasms (MPN): Recent Advances, Current Practices and Future Perspectives)

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17 pages, 768 KiB

Open AccessReview

Osteoporosis and Bone Fragility in Children: Diagnostic and Treatment Strategies

by Giuseppe Cannalire, Giacomo Biasucci, Lorenzo Bertolini, Viviana Patianna, Maddalena Petraroli, Simone Pilloni, Susanna Esposito and Maria Elisabeth Street

J. Clin. Med. 2024, 13(16), 4951; https://doi.org/10.3390/jcm13164951 - 22 Aug 2024

Viewed by 1185

Abstract

The incidence of osteoporosis in children is increasing because of the increased survival rate of children with chronic diseases and the increased use of bone-damaging drugs. As childhood bone fragility has several etiologies, its management requires a thorough evaluation of all potentially contributing [...] Read more.

The incidence of osteoporosis in children is increasing because of the increased survival rate of children with chronic diseases and the increased use of bone-damaging drugs. As childhood bone fragility has several etiologies, its management requires a thorough evaluation of all potentially contributing pathogenetic mechanisms. This review focuses on the main causes of primary and secondary osteoporosis and on the benefits and limits of the different radiological methods currently used in clinical practice for the study of bone quality. The therapeutic and preventive strategies currently available and the most novel diagnostic and treatment strategies are also presented. Optimal management of underlying systemic conditions is key for the treatment of bone fragility in childhood. DXA still represents the gold standard for the radiologic evaluation of bone health in children, although other imaging techniques such as computed tomography and ultrasound evaluations, as well as REMS, are increasingly studied and used. Bisphosphonate therapy is the gold standard for pharmacological treatment in both primary and secondary pediatric osteoporosis. Evidence and experience are building up relative to the use of monoclonal antibodies such as denosumab in cases of poor response to bisphosphonates in specific conditions such as osteogenesis imperfecta, juvenile Paget’s disease and in some cases of secondary osteoporosis. Lifestyle interventions including adequate nutrition with adequate calcium and vitamin D intake, as well as physical activity, are recommended for prevention. Full article

(This article belongs to the Special Issue Update in Osteoporosis and Related Bone Metabolic Disease—2nd Edition)

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12 pages, 8841 KiB

Open AccessArticle

A Modified Triangular Arthroscopic Suture-Based Fixation for Tibial Eminence Fractures: Technique, Outcome and Literature Review

by Guy Morag, Gil Rachevski, Oleg Dolkart, Ehud Rath, Jeremy Dubin, Ofir Chechik, Michael Drexler and Ran Atzmon

J. Clin. Med. 2024, 13(16), 4950; https://doi.org/10.3390/jcm13164950 - 22 Aug 2024

Viewed by 540

Abstract

Objectives: Tibial eminence fractures account for 2% to 5% of all knee injuries. Low-grade fractures, such as Type I, are typically treated conservatively, whereas high-grade fractures, such as Types III and IV, usually require surgical intervention. This paper describes a modified surgical arthroscopic [...] Read more.

Objectives: Tibial eminence fractures account for 2% to 5% of all knee injuries. Low-grade fractures, such as Type I, are typically treated conservatively, whereas high-grade fractures, such as Types III and IV, usually require surgical intervention. This paper describes a modified surgical arthroscopic technique, which employs pull-through triangle suture fixation for Type II and Type III arthroscopic intercondylar eminence avulsion fractures. In addition, we examined the efficacy and complication rate compared to the existing literature. Methods: Data were prospectively collected for knee arthroscopy surgeries and retrospectively analyzed with a minimum two-year follow-up. Twenty-three consecutive adults underwent arthroscopic treatment of displaced intercondylar Type II and Type III eminence fractures, as evidenced by clinical examination and imaging studies between May/2008 and May/2021. The patient’s knee evaluation was performed using clinical symptoms and physical examination, along with International Knee Documentation Committee (IKDC) questionnaire and Tegner Activity Score. Compared to the literature, post-hoc power was calculated based on the mean Tegner Activity Score in our analysis. Results: fifteen females and eight males (mean age 33.9 years, range 19–56 years) were enrolled. The average postoperative follow-up was 35.4 months (27–53). The post-hoc power was 95% confidence in terms of the Tegner Activity Score. The mean ± standard deviation postoperative Tegner Activity Score was 8.2 ± 1.7 (6.8–10.0). Fifteen patients were classified as IKDC A (normal), six as IKDC B (nearly normal), and two as IKDC C (abnormal). The mean IKDC subjective score was 72.7 ± 23 (23–100). Twenty-four patients achieved normal flexion degrees compared with the unaffected side, while one patient achieved a flexion of only 0–90°. The group’s mean flexion range of motion was 123 ± 16° (90–150°). Conclusion: This study presents a modified surgical arthroscopic suture fixation technique for tibial eminence fractures. The procedure is relatively simple and requires no more than basic arthroscopy equipment. The clinical and radiographic results indicate that this technique is safe, efficient, enables early initiation of rehabilitation, and has a lower complication rate in a variety of aspects compared with other fixation techniques used for tibial eminence fractures. Full article

(This article belongs to the Section Orthopedics)

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15 pages, 1593 KiB

Open AccessArticle

A Novel Deep Learning Approach for the Automatic Diagnosis of Acute Appendicitis

by Kamil Dogan and Turab Selcuk

J. Clin. Med. 2024, 13(16), 4949; https://doi.org/10.3390/jcm13164949 - 22 Aug 2024

Cited by 1 | Viewed by 691

Abstract

Background: Acute appendicitis (AA) is a major cause of acute abdominal pain requiring surgical intervention. Approximately 20% of AA cases are diagnosed neither early nor accurately, leading to an increased risk of appendiceal perforation and postoperative sequelae. AA can be identified with good [...] Read more.

Background: Acute appendicitis (AA) is a major cause of acute abdominal pain requiring surgical intervention. Approximately 20% of AA cases are diagnosed neither early nor accurately, leading to an increased risk of appendiceal perforation and postoperative sequelae. AA can be identified with good accuracy using computed tomography (CT). However, some studies have found that a false-negative AA diagnosis made using CT can cause surgical therapy to be delayed. Deep learning experiments are aimed at minimizing false-negative diagnoses. However, the success rates reported in these studies are far from 100%. In addition, the methods used to divide patients into groups do not adequately reflect situations in which accurate radiological diagnosis is difficult. Therefore, in this study, we propose a novel deep-learning approach for the automatic diagnosis of AA using CT based on establishing a new strategy for classification according to the difficulties encountered in radiological diagnosis. Methods: A total of 266 patients with a pathological diagnosis of AA who underwent appendectomy were divided into two groups based on CT images and radiology reports. A deep learning analysis was performed on the CT images and clinical and laboratory parameters that contributed to the diagnosis of both the patient and age- and sex-adjusted control groups. Results: The deep learning diagnosis success rate was 96% for the group with advanced radiological findings and 83.3% for the group with radiologically suspicious findings that could be considered normal. Conclusions: Using deep learning, successful results can be achieved in cases in which the appendix diameter has not increased significantly and there is no significant edema effect. Full article

(This article belongs to the Special Issue Update on the Diagnosis and Treatment of Appendicitis)

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14 pages, 2073 KiB

Open AccessSystematic Review

A Systematic Review of Ongoing Registered Research Studies on Post-Operative Atrial Fibrillation after Cardiac Surgery

by Ivy Quan, Emilie P. Belley-Côté, Jessica Spence, Austine Wang, Karen Sidhom, Michael Ke Wang, David Conen, Bryan Sun, Aadithya Udaya Shankar, Richard P. Whitlock, P. J. Devereaux, Jeff S. Healey and William F. McIntyre

J. Clin. Med. 2024, 13(16), 4948; https://doi.org/10.3390/jcm13164948 - 22 Aug 2024

Cited by 1 | Viewed by 883

Abstract

Background/Objectives: New-onset atrial fibrillation (AF) after cardiac surgery is associated with patient-important outcomes. Uncertainty persists regarding its prevention, detection, and management. This review seeks to identify, compile, and describe ongoing registered research studies involving patients with or at risk for post-operative AF (POAF) [...] Read more.

Background/Objectives: New-onset atrial fibrillation (AF) after cardiac surgery is associated with patient-important outcomes. Uncertainty persists regarding its prevention, detection, and management. This review seeks to identify, compile, and describe ongoing registered research studies involving patients with or at risk for post-operative AF (POAF) after cardiac surgery. Methods: We searched clinical trial registries in January 2023 for studies focusing on POAF prediction, prevention, detection, or management. We extracted data from each record and performed descriptive analyses. Results: In total, 121 studies met the eligibility criteria, including 82 randomized trials. Prevention studies are the most common (n = 77, 63.6%), followed by prediction (n = 21, 17.4%), management (n = 16, 13.2%), and detection studies (n = 7, 5.8%). POAF after cardiac surgery is an area of active research. Conclusions: There are many ongoing randomized prevention studies. However, two major clinical gaps persist; future randomized trials should compare rate and rhythm control in patients who develop POAF, and long-term follow-up studies should investigate strategies to monitor for AF recurrence in patients with POAF. Full article

(This article belongs to the Section Cardiology)

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11 pages, 1168 KiB

Open AccessArticle

Treatment of Lichen Planopilaris and Frontal Fibrosing Alopecia: A Retrospective, Real-Life Analysis in a Tertiary Center in Germany

by Henner Stege, Maximilian Haist, Michael Schultheis, Johannes Pawlowski, Miriam Wittmann, Stephan Grabbe and Florian Butsch

J. Clin. Med. 2024, 13(16), 4947; https://doi.org/10.3390/jcm13164947 - 22 Aug 2024

Viewed by 966

Abstract

Background: Lichen planopilaris (LPP) is an inflammatory cicatricial alopecia characterized by an irreversible destruction of the hair follicle resulting in its permeant destruction. The clinical presentation of LPP is a progressive patchy scarring alopecia. A variety of systemic agents is used to treat [...] Read more.

Background: Lichen planopilaris (LPP) is an inflammatory cicatricial alopecia characterized by an irreversible destruction of the hair follicle resulting in its permeant destruction. The clinical presentation of LPP is a progressive patchy scarring alopecia. A variety of systemic agents is used to treat LPP with varying success. The aim of this retrospective, real-life analysis was to evaluate the treatment of hydroxychloroquine for LPP. Method: In this retrospective, single-center study, we analyzed 110 patients with LPP and frontal fibrosing alopecia (FFA) who received treatment over a 12-month period from March 2014 to March 2021 at the Department of Dermatology, University of Mainz Medical Center. Patient records were analyzed for response to treatment, co-morbidities, disease progression-free survival (DPFS), and safety. Clinical parameters associated with treatment response were determined with Cox regression modelling and logistic regression. Results: Overall, 77 of 110 patients were treated with a systemic agent. There was a clear association between LPP and the occurrence of Hashimoto thyroiditis. Topical treatment with corticosteroids did not improve clinical symptoms in the majority of patients (15 out of 101). In 71% of patients treated with systemic cyclosporine A and 62% of patients treated with hydroxychloroquine, we observed a significant resolution of the inflammatory process, which correlated with a robust durable clinical response (p < 0.001). Toxicity was observed in 17% (n = 9) of patients receiving systemic treatment with hydroxychloroquine and correlated with the duration of systemic treatment (p < 0.001). Treatment discontinuation was associated with a flare-up of clinical symptoms (29%), which required the re-initiation of second-line therapy in 13 out of 51 patients. Overall, the initiation of second-line treatment, either hydroxychloroquine or Cyclosporine A (CsA), yielded positive results, especially in the patient cohort treated with hydroxychloroquine (overall response rate, ORR = 100%), who showed disease progression during CsA or retinoids. Conclusions: Our results from this contemporary cohort of patients with LPP and FFA indicate that hydroxychloroquine and cyclosporine are effective systemic agents in decreasing clinical symptoms. However, our data also show that the discontinuation of treatment is often associated with the exacerbation of clinical symptoms. Response rates to second-line treatment were especially favorable in the patient cohort with hydroxychloroquine. Full article

(This article belongs to the Special Issue Chronic Inflammatory Skin Diseases: An Update for Clinician—Part II)

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11 pages, 649 KiB

Open AccessArticle

Association between Atherogenic Dyslipidemia and Subclinical Myocardial Injury in the General Population

by Nada S. Elbadawi, Moaze H. Sobih, Mai Z. Soliman, Mohamed A. Mostafa, Richard Kazibwe and Elsayed Z. Soliman

J. Clin. Med. 2024, 13(16), 4946; https://doi.org/10.3390/jcm13164946 - 22 Aug 2024

Viewed by 804

Abstract

Background: Subclinical myocardial injury (SCMI) is associated with an increased risk of poor cardiovascular disease (CVD) outcomes. Understanding the underlying risk factors for SCMI is crucial for the prevention and management of CVD. We hypothesized that atherogenic dyslipidemia, a combination of high triglycerides [...] Read more.

Background: Subclinical myocardial injury (SCMI) is associated with an increased risk of poor cardiovascular disease (CVD) outcomes. Understanding the underlying risk factors for SCMI is crucial for the prevention and management of CVD. We hypothesized that atherogenic dyslipidemia, a combination of high triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C), is associated with an increased risk of SCMI. Methods: This analysis from the third National Health and Nutrition Examination Survey (NHANES-III) included 7093 participants (age 59.3 ± 13.4 years, 52.8% women, and 49.4% White) free of CVD. Atherogenic dyslipidemia was defined as TG ≥ 150 mg/dL and HDL-C < 40 mg/dL in men or <50 mg/dL in women. A validated electrocardiographic-based cardiac infarction injury score (CIIS) ≥ 10 was considered positive for SCMI. Multivariable logistic regression analysis was used to examine the association of different combinations of TG and HDL-C groups, including atherogenic dyslipidemia with SCMI. Results: About 22.5% (n = 1594) of participants had atherogenic dyslipidemia, and 26.3% (n = 1862) had SCMI. Compared to participants with normal TG and normal HDL-C, those with atherogenic dyslipidemia had a higher prevalence of SCMI (31.2% vs. 23.9%, p-value < 0.001). In a multivariable logistic regression model, atherogenic dyslipidemia was associated with the highest odds of SCMI followed by high TG/normal HDL-C, then low HDL-C/normal TG [OR (95% CI): 131 (1.14, 1.52), 1.13 (0.97, 1.33), and 1.01 (0.86, 1.20), respectively). Conclusions: Atherogenic dyslipidemia is associated with a higher risk of SCMI, which highlights the role of nontraditional risk factors in the development of subclinical CVD. Full article

(This article belongs to the Special Issue Primary and Secondary Cardiovascular Disease Risk Factors, Prevention and Therapy)

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11 pages, 254 KiB

Open AccessArticle

Self-Efficacy and Perceived Stress in Women Experiencing Preterm Birth

by Agata Białas, Anna Nowak, Karolina Kamecka, Paweł Rasmus, Dariusz Timler, Michał Marczak, Remigiusz Kozłowski and Anna Lipert

J. Clin. Med. 2024, 13(16), 4945; https://doi.org/10.3390/jcm13164945 - 22 Aug 2024

Viewed by 699

Abstract

Background: Being an unexpected, undesired and life-threatening situation, preterm birth (PTB) is a stress-, anxiety- and depression-generating factor for women delivering prematurely. The aim of this study was to assess the relationship between self-efficacy, coping strategies and perceived stress in mothers who experienced [...] Read more.

Background: Being an unexpected, undesired and life-threatening situation, preterm birth (PTB) is a stress-, anxiety- and depression-generating factor for women delivering prematurely. The aim of this study was to assess the relationship between self-efficacy, coping strategies and perceived stress in mothers who experienced preterm birth and full-term birth, to determine the needs for personalized emotional support. Methods: The study was conducted among 251 women divided into the preterm birth group (PBG) and the full-term birth group (FBG). Data were collected using the following: (1) The State-Trait Anxiety Inventory (STAI) Questionnaire, (2) Generalized Self-Efficacy Scale (GSES) and (3) Coping Inventory for Stressful Situations Questionnaire (CISS), which were distributed online from January 2021 to June 2021. Results: Lower STAI scores were recorded in the preterm birth group (PBG) with high self-efficacy (HSE) when compared to the full-term birth group with HSE. CISS test scores were higher in PBG women with low self-efficacy (LSE) in comparison to women with LSE in FBG (p < 0.001). A positive and strong relationship (0.83; p < 0.05) was found between avoidance-oriented style and strategy of avoidance by engaging in surrogate activities and a positive moderate relationship (0.58; p < 0.05) with the style of looking for social contacts in PBG with LSE. Conclusions: The task-oriented coping style seems to be the most beneficial strategy for mothers, regardless of their preterm or term delivery, as focusing on specific activities increases the sense of self-efficacy and the anxiety level can decrease. Awareness of different styles of coping with stress and a sense of self-efficacy are necessary to plan personalized interventions for premature infants’ mothers. Full article

(This article belongs to the Special Issue Maternal Peripartum Mental Health: Integrating Psychiatric Care into Obstetric Medicine)

11 pages, 1098 KiB

Open AccessArticle

Effect of Inter-Hospital Transfer on Mortality in Patients Admitted through the Emergency Department

by Jei-Joon Song, Si-Jin Lee, Ju-Hyun Song, Sung-Woo Lee, Su-Jin Kim and Kap-Su Han

J. Clin. Med. 2024, 13(16), 4944; https://doi.org/10.3390/jcm13164944 - 22 Aug 2024

Viewed by 919

Abstract

Background: Despite advancements in emergency medical systems, inter-hospital transfer (IHT) remains a critical component. Several studies have analyzed the impact of IHT on patient outcomes. Some studies have reported positive effects, indicating that transfers can improve patient prognosis. However, other studies have suggested [...] Read more.

Background: Despite advancements in emergency medical systems, inter-hospital transfer (IHT) remains a critical component. Several studies have analyzed the impact of IHT on patient outcomes. Some studies have reported positive effects, indicating that transfers can improve patient prognosis. However, other studies have suggested that transfers may worsen outcomes. We investigated whether IHT is associated with in-hospital mortality. Methods: This retrospective observational study utilized data on patient outcomes from the National Emergency Department Information System (NEDIS) from 2016 to 2018, focusing on patients admitted to hospitals after visiting the emergency department (ED). The primary outcome was the in-hospital mortality rate. Results: This study included 2,955,476 adult patients admitted to emergency medical centers, with 832,598 (28.2%) undergoing IHT. The in-hospital mortality rate was significantly higher in the transfer group (6.9%) than in the non-transfer group (4.8%). Multiple logistic regression analysis revealed that IHT was an independent predictor of in-hospital mortality (adjusted odds ratio [aOR] 1.114, 95% confidence interval [CI] 1.101–1.128) after adjusting for variables. Sub-analysis indicated that higher severity scores, shorter symptom onset-to-arrival duration, and diagnoses of infectious or respiratory diseases were significantly associated with increased in-hospital mortality among transferred patients. Conclusions: This study identifies IHT as a significant factor associated with increased in-hospital mortality. Additionally, it suggested the need for policies to mitigate the risks associated with IHT, particularly in critically ill patients, those with the acute phase response, and those with infectious, genitourinary, and respiratory diseases. Full article

(This article belongs to the Section Emergency Medicine)

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13 pages, 267 KiB

Open AccessArticle

Navigating Perceived Stress: Experiences of Nursing Students Completing Internships during the COVID-19 Pandemic in Spain

by María-Ángeles Merino-Godoy, Zaida Montero Aceijas, María Cano Martín, Francisco-Javier Gago-Valiente, Alberto Vega Abengozar, Juan María Pérez Padilla and Emilia Teixeira da Costa

J. Clin. Med. 2024, 13(16), 4943; https://doi.org/10.3390/jcm13164943 - 22 Aug 2024

Viewed by 870

Abstract

Background: University students often experience psychological strains such as academic stress, particularly as they approach the transition into the workforce. This stress may have been heightened for nursing students who completed internships during the COVID-19 pandemic. This study aims to analyze the impact [...] Read more.

Background: University students often experience psychological strains such as academic stress, particularly as they approach the transition into the workforce. This stress may have been heightened for nursing students who completed internships during the COVID-19 pandemic. This study aims to analyze the impact of the COVID-19 pandemic on the perceived stress levels of undergraduate nursing students. Methodology: A cross-sectional descriptive observational study was conducted using the Spanish version of the PSS-10 scale, a validated reduction of the English version PSS-14, to evaluate perceived stress. The responses are Likert-type with a total score range of 0 to 40. Questionnaires were distributed electronically to nursing students across all academic years who were engaged in clinical practice. Participation was voluntary. Results: The study included 487 students, the majority of whom were women (78.4%) with an average age of 23.51 years. Most participants were in their third and fourth years (67%). The mean perceived stress score was 20.65 (SD = 5.62) out of a possible 40, indicating moderate stress levels. Statistically significant differences in perceived stress were found between genders, with women reporting higher stress levels than men (Mann–Whitney U = 15,380.000; p < 0.001). Additionally, a significant correlation was observed between the overall perceived stress score and gender, as well as between specific items on the PSS-10 scale and gender, highlighting the importance of gender-specific stress management interventions. Conclusions: Nursing students reported moderate levels of perceived stress, with women experiencing higher stress levels than men. These findings highlight the need for targeted stress management interventions for nursing students, especially during health crises. Addressing gender-specific stressors and fostering a supportive educational environment will enhance students’ well-being, academic success, and professional preparedness. Full article

(This article belongs to the Special Issue The Impact of the COVID-19 Emergency on the Quality of Life of the General Population, Part II)

12 pages, 490 KiB

Open AccessReview

A Narrative Review of the Association between Dental Abnormalities and Chemotherapy

by Tatsuya Akitomo, Yasuko Tsuge, Chieko Mitsuhata and Ryota Nomura

J. Clin. Med. 2024, 13(16), 4942; https://doi.org/10.3390/jcm13164942 - 22 Aug 2024

Cited by 1 | Viewed by 780

Abstract

Dental abnormalities are often detected in childhood and are reported to occur with high prevalence in patients who have undergone cancer treatment or chemotherapy. We performed a literature search of PubMed from 2004 to 2024 using the terms “dental anomaly” and “panoramic examination”, [...] Read more.

Dental abnormalities are often detected in childhood and are reported to occur with high prevalence in patients who have undergone cancer treatment or chemotherapy. We performed a literature search of PubMed from 2004 to 2024 using the terms “dental anomaly” and “panoramic examination”, and 298 potentially relevant articles were found. Thirty-one articles about dental abnormalities matched the eligibility criteria and were extracted for this review. Although the prevalence of tooth agenesis and microdontia in the general population was reported to be approximately 10% and 3%, respectively, the prevalence in patients who had undergone cancer treatment or chemotherapy was higher in all surveys, suggesting that the treatment is related to the occurrence of dental abnormalities. It is important to continue long-term follow-up with patients not only during treatment but also after the completion of treatment. Dental professionals should provide information about dental abnormalities to patients, their guardians, and medical professionals, which may lead to improvement in the quality of life of patients. Full article

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

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10 pages, 806 KiB

Open AccessArticle

P1 and N1 Characteristics in Individuals with Normal Hearing and Hearing Loss, and Cochlear Implant Users: A Pilot Study

by Hye Yoon Seol, Soojin Kang, Sungkean Kim, Jihoo Kim, Euijin Kim, Sung Hwa Hong and Il Joon Moon

J. Clin. Med. 2024, 13(16), 4941; https://doi.org/10.3390/jcm13164941 - 22 Aug 2024

Viewed by 747

Abstract

Background: It has been reported in many previous studies that the lack of auditory input due to hearing loss (HL) can induce changes in the brain. However, most of these studies have focused on individuals with pre-lingual HL and have predominantly compared the [...] Read more.

Background: It has been reported in many previous studies that the lack of auditory input due to hearing loss (HL) can induce changes in the brain. However, most of these studies have focused on individuals with pre-lingual HL and have predominantly compared the characteristics of those with normal hearing (NH) to cochlear implant (CI) users in children. This study examined the visual and auditory evoked potential characteristics in NH listeners, individuals with bilateral HL, and CI users, including those with single-sided deafness. Methods: A total of sixteen participants (seven NH listeners, four individuals with bilateral sensorineural HL, and five CI users) completed speech testing in quiet and noise and evoked potential testing. For speech testing, the Korean version of the Hearing in Noise Test was used to assess individuals’ speech understanding ability in quiet and in noise (noise from the front, +90 degrees, and −90 degrees). For evoked potential testing, visual and auditory (1000 Hz, /ba/, and /da/) evoked potentials were measured. Results: The results showed that CI users understood speech better than those with HL in all conditions except for the noise from +90 and −90 degrees. In the CI group, a decrease in P1 amplitudes was noted across all channels after implantation. The NH group exhibited the highest amplitudes, followed by the HL group, with the CI group (post-CI) showing the lowest amplitudes. In terms of auditory evoked potentials, the smallest amplitude was observed in the pre-CI condition regardless of the type of stimulus. Conclusions: To the best of our knowledge, this is the first study that examined visual and auditory evoked potentials based on various hearing profiles. The characteristics of evoked potentials varied across participant groups, and further studies with CI users are necessary, as there are significant challenges in collecting and analyzing evoked potentials due to artifact issues on the CI side. Full article

(This article belongs to the Special Issue Hearing Disorders: Diagnosis, Management, and Future Opportunities: 3rd Edition)

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11 pages, 3822 KiB

Open AccessArticle

Endovascular Embolization of Intracranial Aneurysms Using Target Tetra Detachable Coils: Angiographic and Clinical Results from a Single Center

by Wook Kim, Tae Keun Jee, Je Young Yeon, Keon Ha Kim, Jong-Soo Kim and Pyoung Jeon

J. Clin. Med. 2024, 13(16), 4940; https://doi.org/10.3390/jcm13164940 - 21 Aug 2024

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Abstract

Background/Objectives: Target tetra detachable coils (TTDCs) aid in achieving effective framing during the coil embolization of small intracranial aneurysms by maintaining a tetrahedral conformation within the aneurysm sac. We aimed to report the initial experience of patients treated for intracranial aneurysms using [...] Read more.

Background/Objectives: Target tetra detachable coils (TTDCs) aid in achieving effective framing during the coil embolization of small intracranial aneurysms by maintaining a tetrahedral conformation within the aneurysm sac. We aimed to report the initial experience of patients treated for intracranial aneurysms using TTDCs, with a specific focus on efficacy and safety. Methods: We retrospectively reviewed the medical records of 41 patients who underwent the coil embolization of intracranial aneurysms sized ≤10 mm with TTDCs between April and May 2023. Post-procedural angiographic and clinical results were reviewed. Results: Of the 46 aneurysms (45 unruptured and 1 ruptured), 33 (71.7%) were treated with the stent-assisted technique and 13 (28.3%) using the simple coil embolization technique. Post-procedural angiography showed complete occlusion in 41 aneurysms (89.1%), neck remnants in 1 (2.2%), and residual aneurysms in 4 (8.7%). The mean packing density was 34.7% (19.3–46.8%), with TTDC coil length comprising a mean of 88.5% of the total coil length. No major device- or procedure-related complications were observed. During the follow-up, 40 aneurysms (93.0%) demonstrated complete occlusion, while neck remnants were observed in 1 (2.3%), and residual aneurysms in 2 (4.7%). No cases of recanalization were observed. Conclusions: The TTDC is a safe and effective device for the endovascular treatment of intracranial aneurysms. Follow-up studies are required to establish long-term results. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Treatment of Cerebrovascular Diseases)

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49 pages, 2032 KiB

Open AccessFeature PaperReview

Non-Obstructive Azoospermia and Intracytoplasmic Sperm Injection: Unveiling the Chances of Success and Possible Consequences for Offspring

by Ahmad Majzoub, Marina C. Viana, Arnold P. P. Achermann, Isadora T. Ferreira, Rita J. Laursen, Peter Humaidan and Sandro C. Esteves

J. Clin. Med. 2024, 13(16), 4939; https://doi.org/10.3390/jcm13164939 - 21 Aug 2024

Viewed by 1098

Abstract

Non-obstructive azoospermia (NOA) is found in up to 15% of infertile men. While several causes for NOA have been identified, the exact etiology remains unknown in many patients. Advances in assisted reproductive technology, including intracytoplasmic sperm injection (ICSI) and testicular sperm retrieval, have [...] Read more.

Non-obstructive azoospermia (NOA) is found in up to 15% of infertile men. While several causes for NOA have been identified, the exact etiology remains unknown in many patients. Advances in assisted reproductive technology, including intracytoplasmic sperm injection (ICSI) and testicular sperm retrieval, have provided hope for these patients. This review summarizes the chances of success with ICSI for NOA patients and examines preoperative factors and laboratory techniques associated with positive outcomes. Furthermore, we reviewed possible consequences for offspring by the use of ICSI with testicular sperm retrieved from NOA patients and the interventions that could potentially mitigate risks. Testicular sperm retrieved from NOA patients may exhibit increased chromosomal abnormalities, and although lower fertilization and pregnancy rates are reported in NOA patients compared to other forms of infertility, the available evidence does not suggest a significant increase in miscarriage rate, congenital malformation, or developmental delay in their offspring compared to the offspring of patients with less severe forms of infertility or the offspring of fertile men. However, due to limited data, NOA patients should receive specialized reproductive care and personalized management. Counseling of NOA patients is essential before initiating any fertility enhancement treatment not only to mitigate health risks associated with NOA but also to enhance the chances of successful outcomes and minimize possible risks to the offspring. Full article

(This article belongs to the Special Issue Review Special Issue Series: Old and New Challenges in the Management of Male Factor Infertility)

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J. Clin. Med., Volume 13, Issue 16 (August-2 2024) – 387 articles

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