Journal of Clinical Medicine

16 pages, 419 KiB

Open AccessArticle

The Predictive Power of the Transplant Evaluation Rating Scale (TERS) for Psychosocial Outcomes in Living-Donor Kidney Transplant Recipients: A Two-Year Prospective Study

by Ernst Peter Richter, Betty Schlegel and Hendrik Berth

J. Clin. Med. 2024, 13(23), 7076; https://doi.org/10.3390/jcm13237076 (registering DOI) - 22 Nov 2024

Abstract

Background/Objectives: The Transplant Evaluation Rating Scale (TERS) assesses the psychosocial risk of transplant candidates; however, its predictive value for outcomes in living-donor kidney transplant (LDKT) recipients remains unclear. This study evaluated the predictive power of the TERS for psychosocial outcomes in LDKT recipients [...] Read more.

Background/Objectives: The Transplant Evaluation Rating Scale (TERS) assesses the psychosocial risk of transplant candidates; however, its predictive value for outcomes in living-donor kidney transplant (LDKT) recipients remains unclear. This study evaluated the predictive power of the TERS for psychosocial outcomes in LDKT recipients over two years post-transplant. Methods: In this prospective single-center cohort study, 107 LDKT recipients completed assessments pre-transplant (T0), 6 months post-transplant (T1), and 24 months post-transplant (T2). The outcomes measured were mental distress, physical complaints, and perceived social support. Linear mixed-effects models were used to examine the relationship between the pre-transplant TERS scores and outcomes over time. Results: Higher TERS scores predicted increased physical complaints (p < 0.001) and lower perceived social support (p = 0.035) at all time points. Additionally, higher TERS scores were associated with greater mental distress between T0 and T2 (p < 0.001). A hierarchical partitioning revealed that the TERS accounted for 11.9% of the variance in mental distress, 14.6% of that in physical complaints, and 6.0% of that in perceived social support. Conclusions: The pre-transplant psychosocial risk, as measured by the TERS, significantly predicted the psychosocial outcomes in the LDKT recipients over two years, with small-to-medium effect sizes. The TERS may serve as a valuable tool for identifying patients who could benefit from targeted psychosocial interventions to improve their long-term outcomes. Full article

(This article belongs to the Section Mental Health)

16 pages, 1032 KiB

Open AccessReview

Hybrid Aortic Arch Replacement with Frozen Elephant Trunk (FET) Technique: Surgical Considerations, Pearls, and Pitfalls

by Dimos Karangelis, Theodora M. Stougiannou, Konstantinos C. Christodoulou, Henri Bartolozzi, Maria Eleni Malafi, Fotios Mitropoulos, Dimitrios Mikroulis and Martin Bena

J. Clin. Med. 2024, 13(23), 7075; https://doi.org/10.3390/jcm13237075 - 22 Nov 2024

Abstract

The involvement of the aortic arch in thoracic aortic aneurysms (TAA), or acute aortic dissections (AAD), represents a challenging clinical entity, mandating a meticulous surgical plan, tailored to each individual case. The advent of endovascular techniques and the introduction of modern arch protheses [...] Read more.

The involvement of the aortic arch in thoracic aortic aneurysms (TAA), or acute aortic dissections (AAD), represents a challenging clinical entity, mandating a meticulous surgical plan, tailored to each individual case. The advent of endovascular techniques and the introduction of modern arch protheses have led to the implementation of the frozen elephant trunk (FET) technique. This one-step hybrid operation consists of a total aortic arch replacement combined with an antegrade delivery of a stent–graft for the descending aorta, which acts as a proximal landing zone facilitating a potential distal endovascular reintervention. In this manner, this technique addresses acute and chronic arch disease with an acceptable morbidity and mortality. Several FET prosthetic devices are available on the global market and have exhibited favourable outcomes, although with some disadvantages in complex cases; similarly, the hybrid procedure described in this review has also been associated with complications, such as coagulopathy and neurological and graft-related events. The purpose of this review is to thus provide key insights into successful hybrid aortic arch replacements and to discuss useful tips and relevant considerations regarding its use. Full article

(This article belongs to the Special Issue Current Practice and Future Perspectives in Aortic Surgery)

12 pages, 444 KiB

Open AccessArticle

Real-World Clinical Effectiveness and Safety of Antifibrotics in Progressive Pulmonary Fibrosis Associated with Rheumatoid Arthritis

by Javier Narváez, Martí Aguilar-Coll, Vanesa Vicens-Zygmunt, Juan José Alegre, Guadalupe Bermudo and María Molina-Molina

J. Clin. Med. 2024, 13(23), 7074; https://doi.org/10.3390/jcm13237074 - 22 Nov 2024

Abstract

Background/Objectives: Interstitial lung disease (ILD) is one of the most severe complications of rheumatoid arthritis (RA). Real-world data on antifibrotic treatment are needed. Our objective was to evaluate the real-world effectiveness and tolerability of antifibrotic agents in patients with progressive fibrosing RA-ILD. [...] Read more.

Background/Objectives: Interstitial lung disease (ILD) is one of the most severe complications of rheumatoid arthritis (RA). Real-world data on antifibrotic treatment are needed. Our objective was to evaluate the real-world effectiveness and tolerability of antifibrotic agents in patients with progressive fibrosing RA-ILD. Methods: A longitudinal, retrospective, observational study was conducted on a cohort of RA-ILD patients treated with either nintedanib or pirfenidone. The data collected included pulmonary function test (PFT) results, adverse events (AEs), tolerability, and drug retention. Results: Twenty-seven patients were included; 25 (92.5%) initiated nintedanib, while two initiated pirfenidone. The median follow-up duration was 25 months (IQR 7–27). The mean decline in %pFVC and %pDLCO from ILD diagnosis to the initiation of antifibrotic therapy were −8.9% and −14.8%, respectively. After 6 months of treatment, most patients achieved stabilization in PFT: a ∆%pFVC of +1.2% (p = 0.611 compared with baseline) and a ∆%pDLCO of +3.9% (p = 0.400). Eighteen patients completed one year of therapy, with a modest improvement in %pFVC (+4.7%; p = 0.023) and stabilization in %pDLCO (−3.8%; p = 0.175). This trend persisted among the nine patients who completed 2 years of treatment (%pFVC +7.7%; p = 0.037 and %pDLCO −2.2%; p = 0.621). During the follow-up period, 15% of patients died, and 4% underwent lung transplantation. Adverse events occurred in 81% of patients, leading to discontinuation in 18.5% of cases. The most frequent adverse events were gastrointestinal events and hepatitis, leading to a permanent dose reduction of 40% for nintedanib and 14% for pirfenidone. A second antifibrotic agent was prescribed for 18.5% of the patients. At the end of the follow-up period, 63% of the total cohort remained on antifibrotic therapy. Conclusions: According to our results, antifibrotic initiation was associated with a modest improvement in the trajectory of %pFVC and stabilization in %pDLCO. The discontinuation rate in our cohort (37%) was higher than that reported in clinical trials but similar to that reported in previously published real-world studies. Full article

(This article belongs to the Special Issue Rheumatoid Arthritis: Clinical Updates on Diagnosis and Treatment)

11 pages, 867 KiB

Open AccessArticle

Incidence and Treatment of Arginine Vasopressin Deficiency (Central Diabetes Insipidus) in the Setting of Brain Death and Associations with Renal Function and Hemodynamics in Organ Donors

by Marleen Weiß, Fabian Rücker, Volker Thieme, Karsten Hochmuth, Dominik Michalski, Björn Nashan, Hans-Michael Tautenhahn, Robert Werdehausen and Svitlana Ziganshyna

J. Clin. Med. 2024, 13(23), 7073; https://doi.org/10.3390/jcm13237073 - 22 Nov 2024

Abstract

Background/Objectives: Arginine vasopressin deficiency (AVP-D) is a common condition in the setting of brain death. The aim of this study was to analyze the frequency of AVP-D in organ donors, its treatment, as well as the impact of AVP-D on hemodynamics and [...] Read more.

Background/Objectives: Arginine vasopressin deficiency (AVP-D) is a common condition in the setting of brain death. The aim of this study was to analyze the frequency of AVP-D in organ donors, its treatment, as well as the impact of AVP-D on hemodynamics and renal function. Methods: This single-center, retrospective study included 63 organ donors treated between 2017 and 2022. We used standard criteria to examine the incidence of AVP-D and the KDIGO criteria to determine the rate of acute kidney injury (AKI). Results: AVP-D occurred in 79% of the examined organ donors, of which 94% received desmopressin. Overall, 30% of organ donors developed AKI. AKI was present in 77% of donors who did not meet AVP-D criteria and in only 18% of donors with AVP-D (p < 0.001). Mean arterial blood pressure did not differ between organ donors with and without AVP-D or with and without desmopressin therapy. In organ donors with AVP-D, norepinephrine requirement in the period 24 h prior to AVP-D diagnosis was lower than 24 h afterwards (p = 0.03). AVP-D diagnosis was associated with a higher rate of kidney transplantation compared to cases without AVP-D diagnosis (88% vs. 54%, p = 0.01). Conclusions: AVP-D is common among brain death organ donors and may remain undiagnosed in cases with previous kidney injury. These observations highlight the importance of recognizing AVP-D and administering appropriate therapy in potential organ donors to prevent AKI. Full article

(This article belongs to the Section Nephrology & Urology)

17 pages, 465 KiB

Open AccessArticle

Do Acute Illness Perceptions Moderate the Association of Pre-Collision Welfare Benefits and Later Neck Pain or Disability Following Whiplash Trauma? A Prospective Multicentre Cohort Study

by Tina B. W. Carstensen, Sophie L. Ravn, Tonny E. Andersen, Solbjørg M. M. Sæther, Eva Ørnbøl, Kaare B. Wellnitz, Helge Kasch and Lisbeth Frostholm

J. Clin. Med. 2024, 13(23), 7072; https://doi.org/10.3390/jcm13237072 - 22 Nov 2024

Abstract

Objectives: Whiplash trauma is a worldwide significant public health issue, with post-collision chronic pain and physical and mental disability; the prevalence of whiplash trauma in the Japanese general population is estimated at 1.2% and in the Danish general population the whiplash condition [...] Read more.

Objectives: Whiplash trauma is a worldwide significant public health issue, with post-collision chronic pain and physical and mental disability; the prevalence of whiplash trauma in the Japanese general population is estimated at 1.2% and in the Danish general population the whiplash condition has been reported to be 2.9%. Pre-collision welfare benefits and illness perceptions have been found to predict poor recovery after whiplash trauma. In this study, we examined whether illness perceptions measured shortly post-collision moderated the effect of welfare benefits five years before the collision on neck pain and neck-related disability one-year post-collision. Methods: Patients consulting emergency rooms or general practices with neck pain after acute whiplash trauma were invited to complete questionnaires during the week after the collision and at three and 12-months post-collision. Further, we obtained register data on the number of weeks on three types of welfare benefits (sick leave benefits, unemployment benefits, and social assistance benefits) for a five-year period before the collision. Multiple logistic regression was applied. Results: 740 patients were included. We did not find a significant moderating effect of illness perceptions on the association between pre-collision welfare benefits and chronic neck pain and related disability. However, there was a trend towards illness perceptions at baseline and at the three-month follow-up having a moderating effect on the relationship between long-term sick leave and neck pain one year after the whiplash collision. Conclusions: Regarding long-term sick leave, we might have overlooked a substantial moderating effect due to methodological matters and recommend a replication of this study on a larger sample, also focusing on other recovery outcomes. Full article

(This article belongs to the Section Mental Health)

13 pages, 521 KiB

Open AccessArticle

Association Between Sarcopenic Obesity and Activities of Daily Living in Individuals with Spinal Cord Injury

by Ryu Ishimoto, Hirotaka Mutsuzaki, Yukiyo Shimizu, Ryoko Takeuchi, Shuji Matsumoto and Yasushi Hada

J. Clin. Med. 2024, 13(23), 7071; https://doi.org/10.3390/jcm13237071 - 22 Nov 2024

Abstract

Background/Objectives: Sarcopenic obesity adversely affects physical function and activities of daily living (ADL) in older individuals and patients undergoing rehabilitation. This condition is also common in individuals with spinal cord injury (SCI); however, its relationship with ADL in this group remains unclear. [...] Read more.

Background/Objectives: Sarcopenic obesity adversely affects physical function and activities of daily living (ADL) in older individuals and patients undergoing rehabilitation. This condition is also common in individuals with spinal cord injury (SCI); however, its relationship with ADL in this group remains unclear. Hence, this study examined the association between sarcopenic obesity and ADL in individuals with SCI. Methods: This retrospective cross-sectional study identified sarcopenia using the low skeletal muscle mass index (SMI) and Asian Working Group for Sarcopenia reference values. Obesity was defined as a body fat percentage (%BF) exceeding 25% in men and 35% in women. Sarcopenic obesity was identified when both the sarcopenia and obesity criteria were met. The primary outcome, ADL, was measured using the Functional Independence Measure (FIM). Multiple linear regression models were used to analyze the associations among the SMI, %BF, and FIM scores, after adjusting for age, sex, lesion level, injury severity, comorbidities, and injury duration. Results: Of 82 participants (median age: 63.5 years; 18.3% women), 62.2% had sarcopenic obesity. Participants with sarcopenic obesity (54 vs. 69 points, p = 0.006) had significantly lower FIM motor scores than those without this condition. Multiple linear regression analysis revealed that SMI (β = 0.416, p < 0.001) and %BF (β = −0.325, p = 0.009) were independently associated with the FIM motor scores. Conclusions: Decreased SMI and increased %BF in patients with SCI were independently associated with decreased ADL independence. Routine body composition assessments are necessary for early detection and intervention in this population. Full article

(This article belongs to the Special Issue Clinical Management and Rehabilitation of Spinal Cord Injury)

21 pages, 2338 KiB

Open AccessReview

The Clinical Usefulness of Evaluating the Lens and Intraocular Lenses Using Optical Coherence Tomography: An Updated Literature Review

by José Ignacio Fernández-Vigo, Lucía De-Pablo-Gómez-de-Liaño, Ignacio Almorín-Fernández-Vigo, Beatriz De-Pablo-Gómez-de-Liaño, Ana Macarro-Merino, Julián García-Feijóo and José Ángel Fernández-Vigo

J. Clin. Med. 2024, 13(23), 7070; https://doi.org/10.3390/jcm13237070 - 22 Nov 2024

Abstract

The Lens Dysfunction Syndrome includes two widespread ocular disorders: presbyopia and cataract. Understanding its etiology, onset, progression, impact, prevention, and treatment remains a significant scientific challenge. The lens is a fundamental structure of the ocular dioptric system that allows for focus adjustment or [...] Read more.

The Lens Dysfunction Syndrome includes two widespread ocular disorders: presbyopia and cataract. Understanding its etiology, onset, progression, impact, prevention, and treatment remains a significant scientific challenge. The lens is a fundamental structure of the ocular dioptric system that allows for focus adjustment or accommodation to view objects at different distances. Its opacification, primarily related to aging, leads to the development of cataracts. Traditionally, lens alterations have been diagnosed using a slit lamp and later with devices based on the Scheimpflug camera. However, both methods have significant limitations. In recent years, optical coherence tomography (OCT) has become a valuable tool for assessing the lens and pseudophakic intraocular lenses (IOLs) in clinical practice, providing a highly detailed non-invasive evaluation of these structures. Its clinical utility has been described in assessing the shape, location or position, and size of the lens, as well as in determining the degree and type of cataract and its various components. Regarding pseudophakic IOLs, OCT allows for the accurate assessment of their position and centering, as well as for detecting possible complications, including the presence of glistening or IOL opacification. Furthermore, OCT enables the evaluation of the posterior capsule and its associated pathologies, including late capsular distension syndrome. This review highlights the key applications of OCT in the assessment of the lens and pseudophakic IOLs. Full article

(This article belongs to the Special Issue Clinical Utility of Optical Coherence Tomography in Ophthalmology: 2nd Edition)

11 pages, 479 KiB

Open AccessArticle

Screening for Fabry Disease-Related Mutations Among 829 Kidney Transplant Recipients

by Marina Kljajic, Armin Atic, Ivan Pecin, Bojan Jelakovic and Nikolina Basic-Jukic

J. Clin. Med. 2024, 13(23), 7069; https://doi.org/10.3390/jcm13237069 - 22 Nov 2024

Abstract

Background/Objectives: Fabry disease (FD) is a genetic lysosomal storage disease caused by a pathogenic variant in GLA gene coding for a functional alpha-galactosidase A enzyme whose disfunction leads to globotriaosylceramide (Gb3) accumulation in cells, which results in multiple organ disorders. The aim [...] Read more.

Background/Objectives: Fabry disease (FD) is a genetic lysosomal storage disease caused by a pathogenic variant in GLA gene coding for a functional alpha-galactosidase A enzyme whose disfunction leads to globotriaosylceramide (Gb3) accumulation in cells, which results in multiple organ disorders. The aim of this study was to identify mutations associated with Fabry disease among 829 kidney transplant recipients and to investigate the correlation between the factors such as age, dialysis vintage, eGFR, proteinuria and corticosteroid dose and the deviations in alpha-galactosidase A and lyso-Gb3 levels. Methods: Dry blood spot samples were collected for genetic analysis. The GLA genetic variants were analysed by an amplicon-based next-generation sequencing approach in all female patients and in male patients with reduced alpha-galactosidase A levels. Alpha-galactosidase A and Lyso-Gb3 were not determined in female patients. Pearson’s correlation coefficient was used to assess the relationship between the above-mentioned factors with the activity of alpha-galactosidase A and Lyso-Gb3. Results: Genetic testing was performed in 476 patients, all female patients (333), 69 male patients with decreased level of alpha-galactosidase A activity and 61 male patients with no interpretable results of alpha-galactosidase A activity due to preanalytical error. In 3 (0.4%) male patients, hemizygous mutations associated with Fabry disease were found, and those were c.427G>A p.(Ala143Thr), c.1181T>C p.(Leu394Pro), and c.352C>T p.(Arg118Cys). The dose of corticosteroid therapy seemed to be positively correlated to alpha-galactosidase A activity and negatively to Lyso-Gb3 levels in blood. Conclusions: Genetic testing of individuals with chronic kidney disease and reporting of genetic variants associated with the Fabry phenotype are important to improve the overall knowledge of the disease. Further research is needed to define factors influencing levels of alpha-galactosidase A and Lyso-Gb3. Full article

(This article belongs to the Section Nephrology & Urology)

23 pages, 541 KiB

Open AccessSystematic Review

The Potential of Automated Assessment of Cognitive Function Using Non-Neuroimaging Data: A Systematic Review

by Eyitomilayo Yemisi Babatope, Alejandro Álvaro Ramírez-Acosta, José Alberto Avila-Funes and Mireya García-Vázquez

J. Clin. Med. 2024, 13(23), 7068; https://doi.org/10.3390/jcm13237068 - 22 Nov 2024

Abstract

Background/Objectives: The growing incidence of cognitive impairment among older adults has a significant impact on individuals, family members, caregivers, and society. Current conventional cognitive assessment tools are faced with some limitations. Recent evidence suggests that automating cognitive assessment holds promise, potentially resulting in [...] Read more.

Background/Objectives: The growing incidence of cognitive impairment among older adults has a significant impact on individuals, family members, caregivers, and society. Current conventional cognitive assessment tools are faced with some limitations. Recent evidence suggests that automating cognitive assessment holds promise, potentially resulting in earlier diagnosis, timely intervention, improved patient outcomes, and higher chances of response to treatment. Despite the advantages of automated assessment and technological advancements, automated cognitive assessment has yet to gain widespread use, especially in low and lower middle-income countries. This review highlights the potential of automated cognitive assessment tools and presents an overview of existing tools. Methods: This review includes 87 studies carried out with non-neuroimaging data alongside their performance metrics. Results: The identified articles automated the cognitive assessment process and were grouped into five categories either based on the tools’ design or the data analysis approach. These categories include game-based, digital versions of conventional tools, original computerized tests and batteries, virtual reality/wearable sensors/smart home technologies, and artificial intelligence-based (AI-based) tools. These categories are further explained, and evaluation of their strengths and limitations is discussed to strengthen their adoption in clinical practice. Conclusions: The comparative metrics of both conventional and automated approaches of assessment suggest that the automated approach is a strong alternative to the conventional approach. Additionally, the results of the review show that the use of automated assessment tools is more prominent in countries ranked as high-income and upper middle-income countries. This trend merits further social and economic studies to understand the impact of this global reality. Full article

(This article belongs to the Section Clinical Neurology)

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11 pages, 366 KiB

Open AccessArticle

Management of Clinically Negative Neck in Early-Stage (T1-2N0) Oral Squamous-Cell Carcinoma (OSCC): Ten Years of a Single Institution’s Experience

by Danilo Di Giorgio, Marco Della Monaca, Riccardo Nocini, Andrea Battisti, Federica Orsina Ferri, Paolo Priore, Valentina Terenzi and Valentino Valentini

J. Clin. Med. 2024, 13(23), 7067; https://doi.org/10.3390/jcm13237067 - 22 Nov 2024

Abstract

Background/Objectives: Oral cavity squamous-cell carcinoma is among the most frequent head and neck neoplasms. Early-stage T1/T2N0 accounts for 40/45% of new diagnoses. Of these, about 30% of cases hide occult metastases in the neck. The management of clinically N0 neck is of [...] Read more.

Background/Objectives: Oral cavity squamous-cell carcinoma is among the most frequent head and neck neoplasms. Early-stage T1/T2N0 accounts for 40/45% of new diagnoses. Of these, about 30% of cases hide occult metastases in the neck. The management of clinically N0 neck is of paramount importance and is still being debated. Methods: The medical records of patients with a clinical diagnosis of early-stage T1-T2N0 carcinoma of the oral cavity between 2011 and 2021 were retrospectively analysed. The inclusion criteria were complete medical and radiological records, pT1-2 pathology staging, and a minimum follow-up of 24 months. Biographical, management, and survival data were analysed using IBM SPSS Statistics [28.0.1.1]; IBM Corp., Armonk, NY, USA). Results: A total of 121 patients met the inclusion criteria. The tongue was the most affected site, with 52 cases. All patients underwent resection of the primary tumour; for neck management, 47 (38.8%) underwent elective neck dissection, 36 underwent follow-up, and 11 underwent sentinel lymph node biopsy. A total of 59 cases were staged as T1 and 62 as T2; in 97 (80.2%) cases, the neck was confirmed as N0; in 10 (8.3%), N1; in 1 case, N2a; in 8, N2b; in 2, N2c; and in 3, N3b. The mean DOI was 4.8 mm. In a Cox regression, a statistically significant association was shown between overall survival and pN staging (p < 0.05). Kaplan–Meier analysis showed a statistically significant difference between different regimens of management of the neck in terms of overall survival, disease-free survival, and disease-specific survival in favour of elective neck dissection and sentinel lymph node biopsy compared to watchful policy (p < 0.05). Conclusions: Elective neck dissection and sentinel lymph node biopsy proved to be safe and oncologically effective in the treatment of clinically N0 early-stage oral carcinoma. Full article

(This article belongs to the Section Otolaryngology)

11 pages, 449 KiB

Open AccessArticle

How Did the COVID-19 Pandemic Affect Emergency Dental Trauma Settings in Permanent Dentition? A Retrospective Study

by Florian Dudde, Manfred Giese, Oliver Schuck and Christina Krüger

J. Clin. Med. 2024, 13(23), 7066; https://doi.org/10.3390/jcm13237066 - 22 Nov 2024

Abstract

Background: The purpose of this study was to examine how the COVID-19 pandemic influenced the patterns, distribution, and circumstances of dental trauma (DT) cases at a German cranio-maxillofacial trauma center. Materials and Methods: This retrospective analysis compared DT cases [...] Read more.

Background: The purpose of this study was to examine how the COVID-19 pandemic influenced the patterns, distribution, and circumstances of dental trauma (DT) cases at a German cranio-maxillofacial trauma center. Materials and Methods: This retrospective analysis compared DT cases from the PreCovid (PC) period (February 2019–January 2020) with those from the IntraCovid (IC) period (February 2020–January 2021). It included an examination of baseline characteristics, types of DT, circumstances leading to DT, and the treatment approaches applied. Results: In the IC period, there was an increase in the number of DT, a significant increase in uncomplicated crown fractures, crown–root fractures, subluxations, avulsions, alveolar fractures, combined tooth fractures and dislocations, and concomitant soft tissue injuries. There were no differences regarding the location of DT. During the IC period there was a significant reduction in sports accidents, road traffic accidents, interpersonal violence, and alcohol-related DT. Simultaneously, there was a marked increase in falls, syncopal episodes, home accidents, and DT incidents occurring on weekdays. Furthermore, during the IC period, the number of cases of DT increased in the morning and decreased at nighttime. Conclusion: The COVID-19 pandemic significantly affected the types of DT, the treatment approaches, and the circumstances under which DT occurred. Investigating these impacts can help to predict the effects of a future pandemic on DT and/or maxillofacial trauma and possibly reduce these effects through establishing appropriate preventive measures. Full article

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

21 pages, 3538 KiB

Open AccessArticle

Global and Regional Sex-Related Differences, Asymmetry, and Peak Age of Brain Myelination in Healthy Adults

by Marina Y. Khodanovich, Mikhail V. Svetlik, Anna V. Naumova, Anna V. Usova, Valentina Y. Pashkevich, Marina V. Moshkina, Maria M. Shadrina, Daria A. Kamaeva, Victoria B. Obukhovskaya, Nadezhda G. Kataeva, Anastasia Y. Levina, Yana A. Tumentceva and Vasily L. Yarnykh

J. Clin. Med. 2024, 13(23), 7065; https://doi.org/10.3390/jcm13237065 - 22 Nov 2024

Abstract

Background: The fundamental question of normal brain myelination in human is still poorly understood. Methods: Age-dependent global, regional, and interhemispheric sex-related differences in brain myelination of 42 (19 men, 23 women) healthy adults (19–67 years) were explored using the MRI method of [...] Read more.

Background: The fundamental question of normal brain myelination in human is still poorly understood. Methods: Age-dependent global, regional, and interhemispheric sex-related differences in brain myelination of 42 (19 men, 23 women) healthy adults (19–67 years) were explored using the MRI method of fast macromolecular fraction (MPF) mapping. Results: Higher brain myelination in males compared to females was found in global white matter (WM), most WM tracts, juxtacortical WM regions, and putamen. The largest differences between men and women, exceeding 4%, were observed bilaterally in the frontal juxtacortical WM; angular, inferior occipital, and cuneus WM; external capsule; and inferior and superior fronto-orbital fasciculi. The majority of hemispheric differences in MPF were common to men and women. Sex-specific interhemispheric differences were found in juxtacortical WM; men more often had left-sided asymmetry, while women had right-sided asymmetry. Most regions of deep gray matter (GM), juxtacortical WM, and WM tracts (except for projection pathways) showed a later peak age of myelination in women compared to men, with a difference of 3.5 years on average. Body mass index (BMI) was associated with higher MPF and later peak age of myelination independent of age and sex. Conclusions: MPF mapping showed high sensitivity to assess sex-related differences in normal brain myelination, providing the basis for using this method in clinics. Full article

(This article belongs to the Special Issue Neuroimaging in 2024 and Beyond)

22 pages, 5073 KiB

Open AccessArticle

The Pattern of Cytokines, Chemokines, and Growth Factors of the Maxillary and Mandibular Periosteum After Exposure to Titanium Fixations—Ti6Al4V

by Bożena Antonowicz, Mateusz Maciejczyk, Jan Borys, Kamila Łukaszuk, Sara Zięba, Edyta Gołaś, Małgorzata Żendzian-Piotrowska and Anna Zalewska

J. Clin. Med. 2024, 13(23), 7064; https://doi.org/10.3390/jcm13237064 - 22 Nov 2024

Abstract

Objectives: Titanium miniplates and screws are commonly used in the surgical management of dentofacial deformities. Despite the opinion of the biocompatibility of these bone fixations, some patients experience symptoms of chronic inflammation around titanium implants even many years after their application. The aim [...] Read more.

Objectives: Titanium miniplates and screws are commonly used in the surgical management of dentofacial deformities. Despite the opinion of the biocompatibility of these bone fixations, some patients experience symptoms of chronic inflammation around titanium implants even many years after their application. The aim of this study was to examine the levels of cytokines, chemokines, and growth factors released from the maxilla and mandible periosteum surrounding titanium fixations 11 months after the implantation procedure. Methods: From the study group (n = 20) consisting of patients with maxillofacial defects who underwent bimaxillary osteotomy, fragments of the periosteum of the maxilla and mandible adjacent to the titanium miniplates and screws were taken during routine bone fixation removal procedures. From the control group subjects (n = 20), fragments of healthy maxillary and mandibular periosteum were taken prior to surgical treatment of dentofacial deformities. The examination of cytokines, chemokines, and growth factors levels released from the periosteum of jaws was performed using the Bio-Plex Pro Human Cytokine Screening Panel (48-Plex). Results: The study group was characterized by a significant increase in the concentration of most of the tested-for proinflammatory cytokines/chemokines/growth factors compared to the control group, with greater amounts of inflammatory factors released from the periosteum covering the titanium implants in the mandible than from the periosteal cells surrounding the titanium implants in the maxilla. Conclusions: Prolonged exposure to titanium miniplates and screws leads to a disturbance of immune homeostasis in the periosteal cells of the maxilla and mandible. The data obtained indicate the need to remove fixations after the bone fragments have healed. Full article

(This article belongs to the Special Issue State-of-the-Art Innovations in Oral and Maxillofacial Surgery)

10 pages, 12686 KiB

Open AccessArticle

Title: Is Celiac Trunk Revascularization Necessary After High-Flow Pancreaticoduodenal Arterial Arcades Aneurysm Retrograde Embolization?

by Mohamed Salim Jazzar, Hicham Kobeiter, Mario Ghosn, Raphael Amar, Youssef Zaarour, Athena Galletto Pregliasco, Pascal Desgranges, Vania Tacher, Mostafa El Hajjam and Haytham Derbel

J. Clin. Med. 2024, 13(23), 7063; https://doi.org/10.3390/jcm13237063 - 22 Nov 2024

Abstract

Background and Objective: High-flow pancreaticoduodenal artery (PDA) aneurysms secondary to celiac trunk occlusion or stenosis have a high risk of rupture. Embolization offers a less invasive alternative to surgery. We evaluated the effectiveness and safety of retrograde embolization via the superior mesenteric artery [...] Read more.

Background and Objective: High-flow pancreaticoduodenal artery (PDA) aneurysms secondary to celiac trunk occlusion or stenosis have a high risk of rupture. Embolization offers a less invasive alternative to surgery. We evaluated the effectiveness and safety of retrograde embolization via the superior mesenteric artery of high-flow PDA aneurysms without celiac trunk revascularization. Methods: This retrospective bicentric study included patients who underwent embolization of high-flow PDA aneurysms due to significant celiac trunk stenosis or occlusion. All patients underwent pre-interventional dynamic contrast-enhanced computed tomography. Retrograde embolization was performed using microcoils and/or liquid agents without celiac trunk revascularization. Follow up involved clinical and radiological assessment at one month. Technical and clinical success were evaluated, and complications were categorized as minor or major. Results: Twenty-three patients (mean age 65 ± 14 years; 52% male) were included. Emergency embolization was required in 12 patients (52%). The technical success rate was 100%. Patients were monitored for a median of 16 months. Clinical success was 87%. No hemorrhagic recurrences were observed. Minor complications occurred in two cases. One major complication involved splenic infarction due to glue migration, requiring splenectomy and intensive unit care admission. Conclusions: Retrograde embolization of high-flow PDA aneurysms is effective and safe without needing celiac trunk revascularization. Full article

(This article belongs to the Special Issue Application of Interventional Therapy in Cardiovascular and Cerebrovascular Diseases)

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16 pages, 16653 KiB

Open AccessArticle

Periodontal Breakdown, Orthodontic Movements and Pulpal Ischemia Correlations—A Comparison Between Five Study Methods

by Radu-Andrei Moga, Cristian Doru Olteanu and Ada Gabriela Delean

J. Clin. Med. 2024, 13(23), 7062; https://doi.org/10.3390/jcm13237062 - 22 Nov 2024

Abstract

Background/Objectives: This study assessed the biomechanical behavior of dental pulp and the neuro-vascular bundle/NVB as well as the ischemic risks during orthodontic movements in a gradual horizontal periodontal breakdown, using five methods and aiming to identify the most accurate one. Methods: [...] Read more.

Background/Objectives: This study assessed the biomechanical behavior of dental pulp and the neuro-vascular bundle/NVB as well as the ischemic risks during orthodontic movements in a gradual horizontal periodontal breakdown, using five methods and aiming to identify the most accurate one. Methods: Seventy-two models of second lower premolar (from nine patients) were subjected to 3 N of intrusion, extrusion, rotation, tipping, and translation. Five numerical methods, Tresca, Von Mises/VM, Maximum and Minimum Principal, and hydrostatic pressure were used in a total of 1800 numerical simulations. The results were color-coded projections of the stress areas that were then correlated with maximum physiological hydrostatic pressure/MHP and known clinical biomechanical behavior. Results: During periodontal breakdown, all five methods displayed, for all movements, quantitative stresses lower than MHP, suggesting that 3 N are not inducing any local tissular ischemic risks for the healthy intact tissues. All five methods displayed rotation as the most stressful movement during periodontal breakdown, while translation was the least. The NVB was more exposed to ischemic risks than dental pulp during the periodontal breakdown due to constant tissular deformations. Only VM and Tresca methods showed translation as more prone to expose dental pulp (both coronal and radicular) to ischemic risks (than the other movements) during the periodontal breakdown simulation. However, all five methods showed intrusion and extrusion as more prone to expose the NVB to higher ischemic risks than the other movements during the periodontal breakdown simulation. Conclusions: During periodontal breakdown, Tresca and Von Mises were more accurate, with Tresca being the most accurate of all. Full article

(This article belongs to the Special Issue Surgical and Non-surgical Endodontics in 2024 and Beyond)

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8 pages, 451 KiB

Open AccessArticle

Maternal Morbidity Associated with Early Preterm Birth in Low-Risk Singleton Pregnancies

by Moti Gulersen, Erez Lenchner, Alisha Goyal, Amos Grunebaum, Frank A. Chervenak and Eran Bornstein

J. Clin. Med. 2024, 13(23), 7061; https://doi.org/10.3390/jcm13237061 - 22 Nov 2024

Abstract

Background/Objectives: While neonatal morbidities associated with early preterm birth are known, the risks of maternal morbidities in these births remain unclear. Thus, we set out to assess the risk of maternal morbidities associated with early preterm births. Methods: Retrospective cohort study utilizing the [...] Read more.

Background/Objectives: While neonatal morbidities associated with early preterm birth are known, the risks of maternal morbidities in these births remain unclear. Thus, we set out to assess the risk of maternal morbidities associated with early preterm births. Methods: Retrospective cohort study utilizing the United States (US) Natality Live Birth database from the Centers for Disease Control and Prevention (2016–2021). Low-risk singleton pregnancies were included. High-risk conditions such as out-of-hospital births, fetal anomalies, pregestational and gestational diabetes, and hypertensive disorders of pregnancy were excluded. The rates of several maternal morbidities were compared among three gestational age at birth groups: 23 0/7–27 6/7 (i.e., extreme preterm), 28 0/7–33 6/7 (i.e., early preterm), and 37 0/7–41 6/7 (i.e., term, reference group) weeks. Multivariable logistic regression was used to adjust outcomes for potential confounders. Data were presented as adjusted odds ratios (aORs) with a 95% confidence interval (CI). Results: 18,797,394 live births were analyzed. Extreme and early preterm birth were associated with increased odds of maternal transfusion (aOR 3.32, 95% CI 3.13–3.53 and aOR 2.96, 95% CI 2.86–3.07), uterine rupture (aOR 3.75, 95% CI 3.14–4.48 and aOR 4.13, 95% CI 3.76–4.54), unplanned hysterectomy (aOR 5.60, 95% CI 4.85–6.48 and aOR 5.92, 95% CI 5.47–6.40), and maternal admission to the intensive care unit (ICU, aOR 10.58, 95% CI 9.97–11.54 and aOR 10.13, 95% CI 9.77–10.50) compared to term birth. The odds of third- or fourth-degree perineal lacerations were decreased in both preterm birth groups compared to term birth. Conclusions: In addition to the known prematurity-related neonatal morbidities, extreme and early preterm births also impose a risk for maternal morbidities. Higher odds of maternal transfusion, uterine rupture, unplanned hysterectomy, and maternal admission to the ICU were detected in our cohort. These data should be taken into consideration when caring for patients with preterm births. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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12 pages, 642 KiB

Open AccessArticle

The Effect of Bio-Electromagnetic Energy Regulation Therapy on Erectile Dysfunction in Patients with Multiple Sclerosis: A Triple-Blind Randomized Clinical Trial

by Abdulaziz Ali Y. Alzharani, Ali M. Alshami, Turki Abualait, Hatem Al Azman, Foziah Jabbar Alshamrani, Yahya Hilal Alzahrani and Youssef A. Althobaiti

J. Clin. Med. 2024, 13(23), 7060; https://doi.org/10.3390/jcm13237060 - 22 Nov 2024

Abstract

Objectives: To evaluate the effect of bio-electromagnetic energy regulation (BEMER) therapy on erectile dysfunction (ED) in patients with multiple sclerosis (MS). Methods: A triple-blind randomized clinical trial was conducted in two different centers. Fifty-two male participants with MS were randomly allocated into [...] Read more.

Objectives: To evaluate the effect of bio-electromagnetic energy regulation (BEMER) therapy on erectile dysfunction (ED) in patients with multiple sclerosis (MS). Methods: A triple-blind randomized clinical trial was conducted in two different centers. Fifty-two male participants with MS were randomly allocated into two groups. Patients received either three weeks of BEMER with pelvic floor exercises or sham BEMER with pelvic floor exercises. The primary measure was the International Index of Erectile Function—Erectile Function (IIEF-EF). Secondary measures included the Sexual Health Inventory for Men (SHIM), Erection Hardness Scale (EHS), Arizona Sexual Experience Scale (AXES), Modified Fatigue Impact Scale (MFIS), and Multiple Sclerosis, Intimacy, and Sexuality Questionnaire (MSISQ-19). Results: Compared to the sham BEMER group, the BEMER group showed better improvements in the IIEF-EF (mean difference [MD]: −6.9, p < 0.001), SHIM (MD: −6.1, p < 0.001), EHS (MD: −0.4, p = 0.022), AXES (MD: 2.9, p = 0.030), MSISQ-19 (MD: 15.0, p < 0.001), and MFIS (MD: 31.0, p < 0.001). Conclusions: BEMER therapy improved erectile function and sexual satisfaction and reduced fatigue in patients with MS after three weeks of intervention. Long-term follow-up studies are warranted to ascertain the sustained benefits of BEMER therapy for MS-related ED. Full article

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

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9 pages, 1402 KiB

Open AccessArticle

Changes in the Epidemiology of Thoracic and Cardiovascular Diseases in Korea During the COVID-19 Pandemic: A Nationwide Analysis

by Jung Ho Park, Hong Kyu Lee, Hyoung Soo Kim, Kunil Kim, Yong Joon Ra and Jeong Wook Kang

J. Clin. Med. 2024, 13(23), 7059; https://doi.org/10.3390/jcm13237059 - 22 Nov 2024

Abstract

Background/Objectives: There is limited evidence regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on the epidemiology of thoracic and cardiovascular diseases. This study aimed to investigate changes in medical visits for these conditions during the COVID-19 pandemic. Methods: We analyzed the [...] Read more.

Background/Objectives: There is limited evidence regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on the epidemiology of thoracic and cardiovascular diseases. This study aimed to investigate changes in medical visits for these conditions during the COVID-19 pandemic. Methods: We analyzed the entire Korean population (~50 million) for monthly medical visits for 15 common thoracic and cardiovascular conditions, including pneumothorax, large bullae, lung cancer, esophageal cancer, thymoma, empyema, mediastinitis, esophageal rupture, multiple rib fractures, hemothorax, rib mass, varicose vein, pectus excavatum, aortic dissection, aortic aneurysm, and valve disease from January 2019 to December 2021. Data were obtained from the Korean National Health Insurance Service using the International Classification of Disease (ICD)-10 codes. Variations in the mean monthly medical visits of 15 frequent thoracic and cardiovascular diseases before and during the COVID-19 pandemic were compared using the Mann–Whitney U test, while changes in variance were assessed using Levene’s test. Results: The mean monthly number of medical visits for pneumothorax and large bullae significantly decreased during the COVID-19 pandemic compared to before the pandemic (by 10.1% and 12.8%; both p < 0.001). On the contrary, there was a significant increase in the mean monthly counts of medical visits for lung cancer, esophageal cancer, thymoma, and valve disease diagnosis (by 6.6%, 5.3%, 8.8%, and 5.0%, respectively; all p < 0.05). Conclusions: In Korea, the number of diagnosed cases of pneumothorax significantly decreased during the COVID-19 pandemic compared to before COVID-19, while diagnoses of thoracic cancers and valve disease increased. Full article

(This article belongs to the Special Issue Clinical Consequences of COVID-19: 2nd Edition)

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14 pages, 6295 KiB

Open AccessArticle

Scratch-Based Isolation of Primary Cells (SCIP): A Novel Method to Obtain a Large Number of Human Dental Pulp Cells Through One-Step Cultivation

by Yuki Kiyokawa, Masahiko Terajima, Masahiro Sato, Emi Inada, Yuria Hori, Ryo Bando, Yoko Iwase, Naoko Kubota, Tomoya Murakami, Hiroko Tsugane, Satoshi Watanabe, Takahiro Sonomura, Miho Terunuma, Takeyasu Maeda, Hirofumi Noguchi and Issei Saitoh

J. Clin. Med. 2024, 13(23), 7058; https://doi.org/10.3390/jcm13237058 - 22 Nov 2024

Abstract

Background: Dental pulp (DP) is a connective tissue composed of various cell types, including fibroblasts, neurons, adipocytes, endothelial cells, and odontoblasts. It contains a rich supply of pluripotent stem cells, making it an important resource for cell-based regenerative medicine. However, current stem cell [...] Read more.

Background: Dental pulp (DP) is a connective tissue composed of various cell types, including fibroblasts, neurons, adipocytes, endothelial cells, and odontoblasts. It contains a rich supply of pluripotent stem cells, making it an important resource for cell-based regenerative medicine. However, current stem cell collection methods rely heavily on the enzymatic digestion of dissected DP tissue to isolate and propagate primary cells, which often results in low recovery rates and reduced cell survival, particularly from deciduous teeth. Methods: We developed a novel and efficient method to obtain a sufficient number of cells through a one-step cultivation process of isolated DP. After the brief digestion of DP with proteolytic enzymes, it was scratched onto a culture dish and cultured in a suitable medium. By day 2, the cells began to spread radially from DP, and by day 10, they reached a semi-confluent state. Cells harvested through trypsinization consistently yielded over 1 million cells, and after re-cultivation, the cells could be propagated for more than ten passages. Results: The proliferative and differentiation capacities of the cells after the 10th passage were comparable to those from the first passage. The cells expressed alkaline phosphatase as an undifferentiation marker. Similarly, they also maintained the constitutive expression of stem cell-specific markers and differentiation-related markers, even after the 10th passage. Conclusions: This method, termed “scratch-based isolation of primary cells from human dental pulps (SCIP)”, enables the efficient isolation of a large number of DP cells with minimal equipment and operator variability, while preserving cell integrity. Its simplicity, high success rate, and adaptability for patients with genetic diseases make it a valuable tool for regenerative medicine research and clinical applications. Full article

(This article belongs to the Special Issue JSOPB 2023–2024 Congress Special Issue—Update on Organ Preservation and Transplantation)

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15 pages, 3694 KiB

Open AccessArticle

Comparative Analysis of M4CXR, an LLM-Based Chest X-Ray Report Generation Model, and ChatGPT in Radiological Interpretation

by Ro Woon Lee, Kyu Hong Lee, Jae Sung Yun, Myung Sub Kim and Hyun Seok Choi

J. Clin. Med. 2024, 13(23), 7057; https://doi.org/10.3390/jcm13237057 - 22 Nov 2024

Abstract

Background/Objectives: This study investigated the diagnostic capabilities of two AI-based tools, M4CXR (research-only version) and ChatGPT-4o, in chest X-ray interpretation. M4CXR is a specialized cloud-based system using advanced large language models (LLMs) for generating comprehensive radiology reports, while ChatGPT, built on the GPT-4 [...] Read more.

Background/Objectives: This study investigated the diagnostic capabilities of two AI-based tools, M4CXR (research-only version) and ChatGPT-4o, in chest X-ray interpretation. M4CXR is a specialized cloud-based system using advanced large language models (LLMs) for generating comprehensive radiology reports, while ChatGPT, built on the GPT-4 architecture, offers potential in settings with limited radiological expertise. Methods: This study evaluated 826 anonymized chest X-ray images from Inha University Hospital. Two experienced radiologists independently assessed the performance of M4CXR and ChatGPT across multiple diagnostic parameters. The evaluation focused on diagnostic accuracy, false findings, location accuracy, count accuracy, and the presence of hallucinations. Interobserver agreement was quantified using Cohen’s kappa coefficient. Results: M4CXR consistently demonstrated superior performance compared to ChatGPT across all evaluation metrics. For diagnostic accuracy, M4CXR achieved approximately 60–62% acceptability ratings compared to ChatGPT’s 42–45%. Both systems showed high interobserver agreement rates, with M4CXR generally displaying stronger consistency. Notably, M4CXR showed better performance in anatomical localization (76–77.5% accuracy) compared to ChatGPT (36–36.5%) and demonstrated fewer instances of hallucination. Conclusions: The findings highlight the complementary potential of these AI technologies in medical diagnostics. While M4CXR shows stronger performance in specialized radiological analysis, the integration of both systems could potentially optimize diagnostic workflows. This study emphasizes the role of AI in augmenting human expertise rather than replacing it, suggesting that a combined approach leveraging both AI capabilities and clinical judgment could enhance patient care outcomes. Full article

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

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9 pages, 1094 KiB

Open AccessArticle

Sensitive LC-MS/MS Assay for Total Testosterone Quantification on Unit Resolution and High-Resolution Instruments

by Jill K. Wolken, Meghan M. Peterson, Wenjing Cao, Keith Challoner and Zhicheng Jin

J. Clin. Med. 2024, 13(23), 7056; https://doi.org/10.3390/jcm13237056 - 22 Nov 2024

Abstract

Background: Testosterone is an androgenic hormone that plays important roles in both males and females. The circulating levels of total testosterone vary from 1 to 1480 ng/dL. High-throughput immunoassays often lack accuracy in lower concentration ranges (below 100 ng/dL), particularly when used [...] Read more.

Background: Testosterone is an androgenic hormone that plays important roles in both males and females. The circulating levels of total testosterone vary from 1 to 1480 ng/dL. High-throughput immunoassays often lack accuracy in lower concentration ranges (below 100 ng/dL), particularly when used for females or children. To address this limitation, we developed a total testosterone LC-MS/MS assay on three instruments. Methods: Sample preparation began with the dilution and conditioning of 200 µL of serum. A supported liquid extraction cartridge was used to extract the analyte from biological matrices. Chromatographic separation was achieved using a C18 column with a runtime of 5 min per sample. This assay was validated on a Triple Quad 6500 and an API 4500 instrument. Results: Method validation was carried out according to the CLSI C62-ED2 guideline and our hospital protocol. The within-day coefficient of variation (CV) was less than 10% and the between-day CV was less than 15%. The assay had a limit of quantitation of 0.5 ng/dL with an analyte measure range of 2–1200 ng/dL. A comparison using Deming regression and Bland–Altman plots showed that this assay correlated well with a reference method. The results from the API 4500 and an Orbitrap were consistent with those from the TQ 6500. Both serum-separator tubes (BD) and serum-activator tubes were found to be suitable. Conclusions: We successfully developed and validated a robust total testosterone LC-MS/MS assay for routine clinical testing. This assay was harmonized across two triple quadrupole instruments and one high-resolution mass spectrometer. Full article

(This article belongs to the Special Issue Clinical Advances in Specimen Collection and Laboratory Testing in Population Health)

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12 pages, 607 KiB

Open AccessArticle

Personalizing Prediction of High Opioid Use in the Neurointensive Care Unit: Development and Validation of a Stratified Risk Model for Acute Brain Injury Due to Stroke or Traumatic Brain Injury

by Wei Yun Wang, Ian C. Holland, Christine T. Fong, Samuel N. Blacker and Abhijit V. Lele

J. Clin. Med. 2024, 13(23), 7055; https://doi.org/10.3390/jcm13237055 - 22 Nov 2024

Abstract

Background/Objectives: This study aimed to develop and validate a stratified risk model for predicting high opioid use in patients with acute brain injury due to stroke or traumatic brain injury (TBI) admitted to a neurocritical care intensive care unit. Methods: We examined [...] Read more.

Background/Objectives: This study aimed to develop and validate a stratified risk model for predicting high opioid use in patients with acute brain injury due to stroke or traumatic brain injury (TBI) admitted to a neurocritical care intensive care unit. Methods: We examined the factors associated with the use of high-opioids (≥75th quartile, ≥17.5 oral morphine equivalent/ICU day) in a retrospective cohort study including patients with acute ischemic stroke, spontaneous intracerebral hemorrhage, spontaneous subarachnoid hemorrhage, and TBI. We then developed, trained, and validated a risk model to predict high-dose opioids. Results: Among 2490 patients aged 45–64 years (β = −0.25), aged 65–80 years (β = −0.97), and aged ≥80 years (β = −1.17), a history of anxiety/depression (β = 0.57), a history of illicit drug use (β = 0.79), admission diagnosis (β = 1.21), lowest Glasgow Coma Scale Score (GCSL) [GCSL 3–8 (β = −0.90], {GCS L 9–12 ((β = −0.34)], mechanical ventilation (β = 1.21), intracranial pressure monitoring (β = 0.69), craniotomy/craniectomy (β = 0.6), and paroxysmal sympathetic hyperactivity (β = 1.12) were found to be significant predictors of high-dose opioid use. When validated, the model demonstrated an area under the curve ranging from 0.72 to 0.82, accuracy ranging from 0.68 to 0.91, precision ranging from 0.71 to 0.94, recall ranging from 0.75 to 1, and F1 ranging from 0.74 to 0.95. Conclusions: A personalized stratified risk model may allow clinicians to predict the risk of high opioid use in patients with acute brain injury due to stroke or TBI. Findings need validation in multi-center cohorts. Full article

(This article belongs to the Special Issue Neurocritical Care: Clinical Advances and Practice Updates)

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18 pages, 1098 KiB

Open AccessArticle

Hypotension with and Without Hypertensive Episodes During Endoscopic Adrenalectomy for Pheochromocytoma or Paraganglioma—Should Perioperative Treatment Be Individualized?

by Akos Tiboldi, Jonas Gernhold, Christian Scheuba, Philipp Riss, Wolfgang Raber, Barbara Kabon, Bruno Niederle and Martin B. Niederle

J. Clin. Med. 2024, 13(23), 7054; https://doi.org/10.3390/jcm13237054 - 22 Nov 2024

Abstract

Background: Hemodynamic instability is common during adrenalectomy for pheochromocytoma and paraganglioma (PPGL). Most analyses focus on the risk factors for intraoperative hypertension, but hypotension is a frequent and undesirable phenomenon during PPGL surgery. This study aimed to analyze the risk factors for [...] Read more.

Background: Hemodynamic instability is common during adrenalectomy for pheochromocytoma and paraganglioma (PPGL). Most analyses focus on the risk factors for intraoperative hypertension, but hypotension is a frequent and undesirable phenomenon during PPGL surgery. This study aimed to analyze the risk factors for hypotensive episodes during the removal of PPGL, and whether these episodes are always associated with concomitant intraoperative hypertensive events. Methods: A consecutive series of 121 patients (91.7% receiving preoperative alpha-blockade) treated with transperitoneal endoscopic adrenalectomy at a university hospital were analyzed, and pre- and intraoperative risk factors for intraoperative hypotension with or without intraoperative hypertension were analyzed using univariable and multivariable logistic regression analyses. Results: In total, 58 (56.2%) patients presented with intraoperative hypotension. Of these, 25 (20.7%) patients showed only hypotensive episodes but no hypertensive episodes (group 1), and 43 (35.5%) patients had both intraoperative hypotension and hypertension (group 2). The remaining 53 patients did not present with hypotension at all (group 3). When comparing group 1 (hypotension only) to all other patients with incidental diagnosis, higher age and lower preoperative diastolic arterial blood pressure (ABP) were significant risk factors for intraoperative hypotension; only the latter two were still significant in multivariate analysis. The significant risk factors for hypotension independent of hypertension (group 1 + 2 vs. group 3) were age and incidental diagnosis, pre-existing diabetes mellitus, and intraoperative use of remifentanil. Incidental diagnosis and use of remifentanil reached the level of significance in multivariate analysis. Conclusions: Since older age, incidental diagnosis of PPGL, lower preoperative ABP, and diabetes mellitus are risk factors for intraoperative hypotension, preoperative alpha-blocker treatment should be individualized for those at risk for hypotension. In addition, remifentanil should be used cautiously in the risk group. Full article

(This article belongs to the Section General Surgery)

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16 pages, 1923 KiB

Open AccessSystematic Review

The Impact of Neurological Complications in Endocarditis: A Systematic Review and Meta-Analysis

by Federico Sanguettoli, Federico Marchini, Federica Frascaro, Luca Zanarelli, Gianluca Campo, Christoph Sinning, Timothy C. Tan and Rita Pavasini

J. Clin. Med. 2024, 13(23), 7053; https://doi.org/10.3390/jcm13237053 - 22 Nov 2024

Abstract

Background: Infective endocarditis (IE) is associated with significant neurological complications (NCs). The impact of neurological sequelae due to IE, however, is not well characterized. Thus, the aim of this systematic review and meta-analysis is to determine whether patients who experienced NCs from IE [...] Read more.

Background: Infective endocarditis (IE) is associated with significant neurological complications (NCs). The impact of neurological sequelae due to IE, however, is not well characterized. Thus, the aim of this systematic review and meta-analysis is to determine whether patients who experienced NCs from IE had worse outcomes compared to those without neurological complications. Methods: We conducted a systematic and comprehensive literature search of MEDLINE, Cochrane Library, Google Scholar, and BioMed Central (PROSPERO registration ID: CRD42024518651). Data on the primary outcome of all-cause mortality and the secondary outcome of surgical timing were extracted from 25 observational studies on patients with confirmed IE, both with and without NC. Results: In the pooled total of patients with IE, NCs were present in 23.7% (60.8% ischaemic stroke and 16.4% haemorrhagic stroke). All-cause mortality was significantly higher in patients with IE and NCs (OR 1.78, CI 1.47–2.17, p < 0.0001) compared to those without, particularly in those with major neurological events (OR 2.18, CI 1.53–3.10, p < 0.0001). Conversely, minor or asymptomatic strokes showed no significant correlation with mortality (OR 1.10, CI 0.82–1.47, p = 0.543). There was no significant difference in the timing of surgical intervention (standardized mean difference −0.53, CI −1.67 to 0.61, p = 0.359) between the two patient groups. Conclusions: Major NCs due to infective endocarditis were associated with a significantly increased all-cause mortality. This underscores the critical importance of early recognition and management strategies tailored to the severity of neurological events. Full article

(This article belongs to the Section Cardiovascular Medicine)

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13 pages, 1755 KiB

Open AccessArticle

Sentinel Lymph Node Detection in Early-Stage Oral Squamous Cell Carcinoma Using Magnetic Resonance Lymphography: A Pilot Study

by Dominique N. V. Donders, Rutger Mahieu, Roosmarijn S. Tellman, Marielle E. P. Philippens, Robert J. J. van Es, Ellen M. Van Cann, Gerben E. Breimer, Remco de Bree and Bart de Keizer

J. Clin. Med. 2024, 13(23), 7052; https://doi.org/10.3390/jcm13237052 - 22 Nov 2024

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Abstract

Objectives: To assess the efficacy of magnetic resonance (MR) lymphography with gadobutrol contrast for sentinel lymph node (SLN) mapping in early-stage oral squamous cell carcinoma (OSCC). Methods: This pilot study compared the identification of SLNs by MR lymphography using a gadolinium-based contrast agent [...] Read more.

Objectives: To assess the efficacy of magnetic resonance (MR) lymphography with gadobutrol contrast for sentinel lymph node (SLN) mapping in early-stage oral squamous cell carcinoma (OSCC). Methods: This pilot study compared the identification of SLNs by MR lymphography using a gadolinium-based contrast agent (gadobutrol) to conventional [^99mTc]Tc-nanocolloid lymphoscintigraphy (including single-photon emission computed tomography/computed tomography (SPECT/CT)) in 10 early-stage OSCC patients undergoing SLN biopsy. The patients initially underwent conventional lymphoscintigraphy following the peritumoral administration of indocyanine green [^99mTc]Tc-nanocolloid (120 megabecquerel; ~0.5 mL). Subsequently, 0.5–1.0 mL gadobutrol was peritumorally injected, and MR imaging was acquired for 30 min. The following day, the identified SLNs were harvested and subjected to a histopathological assessment. The MR lymphography and [^99mTc]Tc-nanocolloid lymphoscintigraphy results were evaluated and compared with respect to those of the SLN identification. The reference standard consisted of a histopathological evaluation of the harvested SLNs, complementary neck dissection specimens, and follow-up data. Results: The MR lymphography detected 16 out of 27 SLNs identified by [^99mTc]Tc-nanocolloid lymphoscintigraphy, revealing an additional SLN that did not harbor metastasis. MR lymphography failed to identify any SLNs in one patient. Of the seven histopathologically positive SLNs detected by [^99mTc]Tc-nanocolloid lymphoscintigraphy, three were identified by MR lymphography. All patients remained disease-free after a median follow-up of 16 months. Compared to [^99mTc]Tc-nanocolloid lymphoscintigraphy, MR lymphography using gadobutrol achieved an SLN identification rate of 59%, a sensitivity of 75%, and a negative predictive value of 86%. Conclusions: MR lymphography using gadobutrol demonstrates limited reliability for SLN mapping in early-stage OSCC. Full article

(This article belongs to the Section Oncology)

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9 pages, 241 KiB

Open AccessArticle

Salivary Nitrate Level and Lipid Profile in Patients with Hypertension: A Cross-Sectional Study in a Saudi Sub-Population

by Khalil Ibrahim Assiri, Ali Mosfer A. Alqahtani, Abdullah Alqarni, Hassan Ahmed Assiri, Saeed Alassiri, Samiunnisa Begum Shaik, Ali Azhar Dawasaz and Mohammad Shahul Hameed

J. Clin. Med. 2024, 13(23), 7051; https://doi.org/10.3390/jcm13237051 - 22 Nov 2024

Viewed by 65

Abstract

Background: The use of salivary biomarkers offers a non-invasive approach to understanding the metabolic and inflammatory status of hypertensive patients. This study aimed to quantify the salivary nitric oxide (NO), total cholesterol, triglycerides, high-density lipoproteins (HDL), and low-density lipoproteins (LDL) levels in [...] Read more.

Background: The use of salivary biomarkers offers a non-invasive approach to understanding the metabolic and inflammatory status of hypertensive patients. This study aimed to quantify the salivary nitric oxide (NO), total cholesterol, triglycerides, high-density lipoproteins (HDL), and low-density lipoproteins (LDL) levels in hypertensive individuals and healthy controls in a sub-population in Saudi Arabia. Methods: This cross-sectional study comprised 40 hypertensive patients (test group, 40–50 years old) and 40 age-matched healthy controls who visited the dental hospital in the College of Dentistry, King Khalid University, for dental treatment. Nitric oxide, total cholesterol, triglycerides, HDL, and LDL levels in saliva were assessed. An independent sample t-test was used to compare the results between the hypertensive and control groups. Results: The mean triglyceride and cholesterol levels in the test group were significantly higher (p < 0.05) than those in the control group. Alternatively, the NO level in the test group was significantly (p = 0.014) lower than that in the controls. The triglyceride level was significantly correlated with age in the test group (p = 0.04). Conclusions: This study demonstrated significant differences in the nitrate levels and lipid profiles between hypertensive patients and healthy individuals in a sub-population in Saudi Arabia. The findings indicate that saliva can be used as a non-invasive diagnostic tool for assessing nitrate levels and the lipid profile. However, additional studies with larger sample sizes and more precise testing parameters are required to validate the findings. Full article

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

9 pages, 2519 KiB

Open AccessArticle

Comparative Evaluation of Sodium Hypochlorite Gel Penetration Using Er,Cr:YSGG Laser and Passive Ultrasonic Activation After Apicoectomy: An In Vitro Study with Confocal Laser Scanning Microscopy

by Joseph Di Franco, Haitham Elafifi Ebeid, Pablo Betancourt, Antonio Pallarés-Sabater and Alberto Casino Alegre

J. Clin. Med. 2024, 13(23), 7050; https://doi.org/10.3390/jcm13237050 - 22 Nov 2024

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Abstract

Background: Lasers from the erbium family have been investigated to activate irrigation with sodium hypochlorite (NaOCl), improving the disinfection depth of the dentinal tubules of the root canal walls during root canal treatment. However, the possibility of laser-activated irrigation (LAI) in retro-cavity preparation [...] Read more.

Background: Lasers from the erbium family have been investigated to activate irrigation with sodium hypochlorite (NaOCl), improving the disinfection depth of the dentinal tubules of the root canal walls during root canal treatment. However, the possibility of laser-activated irrigation (LAI) in retro-cavity preparation has not been investigated to the date. The aim of our experimental study is to evaluate the efficacy of NaOCl gel penetration inside the dentinal tubules when activated during retro-cavity preparation, comparing passive ultrasonic activation (PUI) and Er,Cr:YSGG LAI. Materials and Methods: Fifty extracted mature single-root human teeth were divided into four groups (control, PUI, and two LAI groups with different NaOCl concentrations). After conventional endodontic treatment and root end resection, NaOCl gel (impregnated with rhodamine dye for confocal laser scanning microscopy (CLSM) analysis) was applied and activated according to the study group. The penetration index and mean penetration length were measured using computer software. Results: Both penetration index and mean penetration length were found to have increased in the PUI group compared to the control samples. However, LAI had a better penetration that was statistically significant compared to both the PUI and control groups. The difference in NaOCl concentration in the laser groups did not affect the penetration values. Conclusions: Within the limitations of our in vitro study using NaOCl gel activation in the retro-cavity after apicectomy, Er,Cr:YSGG LAI significantly enhanced NaOCl gel penetration capacity compared to PUI, regardless of its concentration. LAI can enhance its penetration in a safe way, avoiding its extrusion to the surrounding periapical tissues. Full article

(This article belongs to the Special Issue Clinical Research of Novel Therapeutic Approaches in Dentistry)

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10 pages, 1467 KiB

Open AccessArticle

Short-Term Effects of Cooled Radiofrequency Ablation on Walking Ability in Japanese Patients with Knee Osteoarthritis

by Kentaro Hiromura, Hironori Kitajima, Chie Hatakenaka, Yoshiaki Shimizu, Terumasa Miyagaki, Masayuki Mori, Kazuhei Nakashima, Atsushi Fuku, Hiroaki Hirata, Yoshiyuki Tachi and Ayumi Kaneuji

J. Clin. Med. 2024, 13(23), 7049; https://doi.org/10.3390/jcm13237049 - 22 Nov 2024

Abstract

Background/Objectives: Knee osteoarthritis (KOA) is a degenerative joint disease typically managed with conservative treatments, such as anti-inflammatory medications and intra-articular hyaluronic acid injections; however, advanced cases may eventually require surgical intervention. Recently, cooled radiofrequency ablation (CRFA) has emerged as a novel treatment [...] Read more.

Background/Objectives: Knee osteoarthritis (KOA) is a degenerative joint disease typically managed with conservative treatments, such as anti-inflammatory medications and intra-articular hyaluronic acid injections; however, advanced cases may eventually require surgical intervention. Recently, cooled radiofrequency ablation (CRFA) has emerged as a novel treatment option for alleviating KOA-related pain by temporarily disabling pain-transmitting nerves. This study evaluated the short-term effects of CRFA on pain relief and walking ability in KOA patients, with a specific focus on functional improvements in walking capacity. Methods: This study included 58 patients (71 knees) with KOA who underwent CRFA after experiencing inadequate pain control with conservative treatments. The cohort consisted of 28 men and 30 women, with a mean age of 75.2 years (55–90). Under ultrasound guidance, CRFA was performed on the superior lateral geniculate nerve, superior medial geniculate nerve, and inferior medial geniculate nerve, with each targeted nerve ablated. Pre- and post-procedural evaluations (one month after CRFA) included assessments of visual analog scale (VAS) scores for pain at rest and during walking, range of motion (ROM), knee extensor strength, walking speed, and gait stability. Results: Significant improvements in the mean VAS (rest/walking) and mean walking speed (comfortable/maximum) were observed following CRFA. However, no significant changes were noted in ROM, knee extensor strength, or walking stability. Conclusions: These findings suggest that rehabilitation may be essential to further enhance walking stability. Overall, CRFA appears to be a promising short-term treatment option for reducing VAS pain scores and enhancing walking speed in patients with KOA. Full article

(This article belongs to the Special Issue Etiopathogenesis, Prevention, Modern Diagnostics and Conservative Treatment of Osteoarthritis)

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Reply to Teng et al. Comment on “Drozdowska-Szymczak et al. Incidence and Risk Factors of Cholestasis in Newborns with Hemolytic Disease—A Case-Control Study. J. Clin. Med. 2024, 13, 3190”

by Agnieszka Drozdowska-Szymczak, Natalia Mazanowska, Tomasz Pomianek, Artur Ludwin and Paweł Krajewski

J. Clin. Med. 2024, 13(23), 7048; https://doi.org/10.3390/jcm13237048 - 22 Nov 2024

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Abstract

We would like to express our sincere gratitude for your thoughtful review of our article [...] Full article

(This article belongs to the Section Clinical Pediatrics)

2 pages, 153 KiB

Open AccessComment

Comment on Drozdowska-Szymczak et al. Incidence and Risk Factors of Cholestasis in Newborns with Hemolytic Disease—A Case-Control Study. J. Clin. Med. 2024, 13, 3190

by Jonas Teng, Björn Fischler, Kajsa Bohlin, Marie Reilly and Eleonor Tiblad

J. Clin. Med. 2024, 13(23), 7047; https://doi.org/10.3390/jcm13237047 - 22 Nov 2024

Viewed by 44

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We read with interest the recently published article in the Journal of Clinical Medicine, by Drozdowska-Szymczak et al [...] Full article

(This article belongs to the Section Clinical Pediatrics)

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J. Clin. Med., Volume 13, Issue 23 (December-1 2024) – 76 articles

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