Journal of Clinical Medicine

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Open AccessReview

A Review of Multidisciplinary Interventions in Atopic Dermatitis

by Sara C. Spielman, Jennifer S. LeBovidge, Karol G. Timmons and Lynda C. Schneider

J. Clin. Med. 2015, 4(5), 1156-1170; https://doi.org/10.3390/jcm4051156 - 21 May 2015

Cited by 25 | Viewed by 6423

Multidisciplinary interventions have been developed for patients with atopic dermatitis (AD) and their families, with the aim of improving outcomes such as disease control, adherence, and quality of life. We reviewed the content of different multidisciplinary approaches to intervention for AD and evidence [...] Read more.

Multidisciplinary interventions have been developed for patients with atopic dermatitis (AD) and their families, with the aim of improving outcomes such as disease control, adherence, and quality of life. We reviewed the content of different multidisciplinary approaches to intervention for AD and evidence for their impact on key outcome measures. We also provided data from our multidisciplinary outpatient program for pediatric AD. Studies included in the review suggest benefits of multidisciplinary interventions as models of treatment or adjuncts to standard medical care, with a positive impact on outcomes including disease severity and itching/scratching. There were limitations to existing studies, including heterogeneous methods used to assess quality of life outcomes across studies and lack of controlled studies assessing the outcome of clinical care programs. Further research will be useful in assessing the impact of multidisciplinary interventions on important outcomes such as treatment adherence and sleep, identifying the elements of multidisciplinary interventions that are most critical for improved outcomes, and identifying the best candidates for multidisciplinary intervention approaches. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Open AccessReview

Human Papillomavirus: Current and Future RNAi Therapeutic Strategies for Cervical Cancer

by Hun Soon Jung, Nirmal Rajasekaran, Woong Ju and Young Kee Shin

J. Clin. Med. 2015, 4(5), 1126-1155; https://doi.org/10.3390/jcm4051126 - 21 May 2015

Cited by 40 | Viewed by 15422

Abstract

Human papillomaviruses (HPVs) are small DNA viruses; some oncogenic ones can cause different types of cancer, in particular cervical cancer. HPV-associated carcinogenesis provides a classical model system for RNA interference (RNAi) based cancer therapies, because the viral oncogenes E6 and E7 that cause [...] Read more.

Human papillomaviruses (HPVs) are small DNA viruses; some oncogenic ones can cause different types of cancer, in particular cervical cancer. HPV-associated carcinogenesis provides a classical model system for RNA interference (RNAi) based cancer therapies, because the viral oncogenes E6 and E7 that cause cervical cancer are expressed only in cancerous cells. Previous studies on the development of therapeutic RNAi facilitated the advancement of therapeutic siRNAs and demonstrated its versatility by siRNA-mediated depletion of single or multiple cellular/viral targets. Sequence-specific gene silencing using RNAi shows promise as a novel therapeutic approach for the treatment of a variety of diseases that currently lack effective treatments. However, siRNA-based targeting requires further validation of its efficacy in vitro and in vivo, for its potential off-target effects, and of the design of conventional therapies to be used in combination with siRNAs and their drug delivery vehicles. In this review we discuss what is currently known about HPV-associated carcinogenesis and the potential for combining siRNA with other treatment strategies for the development of future therapies. Finally, we present our assessment of the most promising path to the development of RNAi therapeutic strategies for clinical settings. Full article

(This article belongs to the Special Issue Clinical Advances of Human Papillomaviruses)

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Open AccessArticle

Pattern of Investigation Reflects Risk Profile in Emergency Medical Admissions

by Seán Cournane, Declan Byrne, Deirdre O'Riordan, Niall Sheehy and Bernard Silke

J. Clin. Med. 2015, 4(5), 1113-1125; https://doi.org/10.3390/jcm4051113 - 21 May 2015

Cited by 5 | Viewed by 4515

Abstract

Demand for hospital resources may increase over time; we have examined all emergency admissions (51,136 episodes) from 2005 to 2013 for underlying trends and whether resource utilization and clinical risk are correlated. We used logistic regression of the resource indicator against 30-day in-hospital [...] Read more.

Demand for hospital resources may increase over time; we have examined all emergency admissions (51,136 episodes) from 2005 to 2013 for underlying trends and whether resource utilization and clinical risk are correlated. We used logistic regression of the resource indicator against 30-day in-hospital mortality and adjusted this risk estimate for other outcome predictors. Generally, resource indicators predicted an increased risk of a 30-day in-hospital death. For CT Brain the Odds Ratio (OR) was 1.37 (95% CI: 1.27, 1.50), CT Abdomen 3.48 (95% CI: 3.02, 4.02) and CT Chest, Thorax, Abdomen and Pelvis 2.50 (95% CI: 2.10, 2.97). Services allied to medicine including Physiotherapy 2.57 (95% CI: 2.35, 2.81), Dietetics 2.53 (95% CI: 2.27, 2.82), Speech and Language 5.29 (95% CI: 4.57, 6.05), Occupational Therapy 2.65 (95% CI: 2.38, 2.94) and Social Work 1.65 (95% CI: 1.48, 1.83) all predicted an increased risk. The in-hospital 30-day mortality increased with resource utilization, from 4.7% (none) to 27.0% (five resources). In acute medical illness, the use of radiological investigations and allied professionals increased over time. Resource utilization was calibrated from case complexity/30-day in-hospital mortality suggesting that complexity determined the need for and validated the use of these resources. Full article

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Open AccessReview

Intracranial CNS Manifestations of Myeloid Sarcoma in Patients with Acute Myeloid Leukemia: Review of the Literature and Three Case Reports from the Author’s Institution

by Gustavo M. Cervantes and Zuzan Cayci

J. Clin. Med. 2015, 4(5), 1102-1112; https://doi.org/10.3390/jcm4051102 - 21 May 2015

Cited by 41 | Viewed by 10601

Abstract

Myeloid sarcoma (MS) of the central nervous system (CNS) is a rare presentation of leukemic mass infiltration outside of the bone marrow. It may involve the subperiosteum and dura mater and, on rare occasions, can also invade the brain parenchyma. The disease is [...] Read more.

Myeloid sarcoma (MS) of the central nervous system (CNS) is a rare presentation of leukemic mass infiltration outside of the bone marrow. It may involve the subperiosteum and dura mater and, on rare occasions, can also invade the brain parenchyma. The disease is most commonly seen in children or young adults; however, it has been described in multiple age groups. MS can be seen in patients with acute myeloid leukemia (AML), chronic myeloid leukemia and other myeloproliferative disorders. This entity has the potential to be underdiagnosed if the MS appearance precedes the first diagnosis of leukemia. The main reason is that their appearance on CT and MRI has a broad differential diagnosis, and proper diagnosis of MS can only be made if the imaging findings are correlated with the clinical history and laboratory findings. Herein, we describe the intracranial CNS manifestations of MS in patients with AML on CT and MRI involving the brain and/or meninges. This study is based on a systematic review of the literature. In addition, three case reports from the author’s institution with AML and intracranial involvement of MS are included. Our aim is to enhance the awareness of this entity among both clinicians and radiologists. Full article

(This article belongs to the Special Issue AML in the Molecular Age: From Biology to Clinical Management)

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Open AccessReview

Individualized Treatment of Neovascular Age-Related Macular Degeneration: What are Patients Gaining? Or Losing?

by Michael W. Stewart

J. Clin. Med. 2015, 4(5), 1079-1101; https://doi.org/10.3390/jcm4051079 - 21 May 2015

Cited by 33 | Viewed by 6714

Abstract

The widespread use of drugs that bind diffusible vascular endothelial growth factor (VEGF) has revolutionized the treatment of neovascular age-related macular degeneration (AMD). The pivotal ranibizumab and aflibercept registration trials featured monthly intravitreal injections for 12 months, during which visual acuities and macular [...] Read more.

The widespread use of drugs that bind diffusible vascular endothelial growth factor (VEGF) has revolutionized the treatment of neovascular age-related macular degeneration (AMD). The pivotal ranibizumab and aflibercept registration trials featured monthly intravitreal injections for 12 months, during which visual acuities and macular edema rapidly improved for the first 3 months and modest gains or stabilization continued until the primary endpoint. In many subsequent trials, patients were evaluated monthly and treated as-needed (PRN) according to the results of visual acuity (VA) testing, fundus examinations and optical coherence tomography scans. Compared to monthly-treated control groups, PRN treated patients require fewer injections during the first year but they also experience smaller VA gains (1–3 letters). A small number of prospective trials that directly compared monthly with PRN therapy showed that VA gains with discontinuous therapy lag slightly behind those achieved with monthly injections. Physicians recognize that monthly office visits with frequent intraocular injections challenge patients’ compliance, accrue high drug and professional service costs, and clog office schedules with frequently returning patients. To decrease the numbers of both office visits and anti-VEGF injections without sacrificing VA gains, physicians have embraced the treat-and-extend strategy. Treat-and-extend has not been studied as rigorously as PRN but it has become popular among both vitreoretinal specialists and patients. Despite the possible risks associated with discontinuous therapy (decreased VA and increased macular fluid), most physicians individualize treatment (PRN or treat-and-extend) for the majority of their patients. This review chapter explores the many advantages of individualized therapy, while balancing these against suboptimal responses due to the decreased frequency of anti-VEGF injections. Full article

(This article belongs to the Special Issue Age-Related Macular Disease)

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Open AccessReview

MicroRNAs as Signaling Mediators and Biomarkers of Drug- and Chemical-Induced Liver Injury

by Mitchell R. McGill and Hartmut Jaeschke

J. Clin. Med. 2015, 4(5), 1063-1078; https://doi.org/10.3390/jcm4051063 - 20 May 2015

Cited by 38 | Viewed by 6967

Abstract

Drug-induced liver injury (DILI) is major problem for both the drug industry and for clinicians. There are two basic categories of DILI: intrinsic and idiosyncratic. The former is the chief cause of acute liver failure in several developed countries, while the latter is [...] Read more.

Drug-induced liver injury (DILI) is major problem for both the drug industry and for clinicians. There are two basic categories of DILI: intrinsic and idiosyncratic. The former is the chief cause of acute liver failure in several developed countries, while the latter is the most common reason for post-marketing drug withdrawal and a major reason for failure to approve new drugs in the U.S. Although considerably more progress has been made in the study of intrinsic DILI, our understanding of both forms of drug hepatotoxicity remains incomplete. Recent work involving microRNAs (miRNAs) has advanced our knowledge of DILI in two ways: (1) possible roles of miRNAs in the pathophysiological mechanisms of DILI have been identified, and (2) circulating miRNA profiles have shown promise for the detection and diagnosis of DILI in clinical settings. The purpose of this review is to summarize major findings in these two areas of research. Taken together, exciting progress has been made in the study of miRNAs in DILI. Possible mechanisms through which miRNA species contribute to the basic mechanisms of DILI are beginning to emerge, and new miRNA-based biomarkers have the potential to greatly improve diagnosis of liver injury and prediction of patient outcomes. Full article

(This article belongs to the Special Issue MicroRNAs: Novel Biomarkers for Liver Diseases)

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Open AccessReview

Neuropsychology of Neuroendocrine Dysregulation after Traumatic Brain Injury

by Josef Zihl and Osborne F. X. Almeida

J. Clin. Med. 2015, 4(5), 1051-1062; https://doi.org/10.3390/jcm4051051 - 20 May 2015

Cited by 14 | Viewed by 8842

Abstract

Endocrine dysfunction is a common effect of traumatic brain injury (TBI). In addition to affecting the regulation of important body functions, the disruption of endocrine physiology can significantly impair mental functions, such as attention, memory, executive function, and mood. This mini-review focuses on [...] Read more.

Endocrine dysfunction is a common effect of traumatic brain injury (TBI). In addition to affecting the regulation of important body functions, the disruption of endocrine physiology can significantly impair mental functions, such as attention, memory, executive function, and mood. This mini-review focuses on alterations in mental functioning that are associated with neuroendocrine disturbances in adults who suffered TBI. It summarizes the contribution of hormones to the regulation of mental functions, the consequences of TBI on mental health and neuroendocrine homeostasis, and the effects of hormone substitution on mental dysfunction caused by TBI. The available empirical evidence suggests that comprehensive assessment of mental functions should be standard in TBI subjects presenting with hormone deficiency and that hormone replacement therapy should be accompanied by pre- and post-assessments. Full article

(This article belongs to the Special Issue Neuroendocrine Disturbances after Brain Damage)

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Open AccessReview

Vitamin D and the Development of Atopic Eczema

by Debra J. Palmer

J. Clin. Med. 2015, 4(5), 1036-1050; https://doi.org/10.3390/jcm4051036 - 20 May 2015

Cited by 23 | Viewed by 14355

Abstract

A “vitamin D hypothesis” has been proposed to explain the increased prevalence of eczema in regions with higher latitude. This review focuses on the current available evidence with regard to the possible effect of vitamin D on the development of atopic eczema. Observational [...] Read more.

A “vitamin D hypothesis” has been proposed to explain the increased prevalence of eczema in regions with higher latitude. This review focuses on the current available evidence with regard to the possible effect of vitamin D on the development of atopic eczema. Observational studies have indicated a link between vitamin D status and eczema outcomes, including lower serum vitamin D levels associated with increased incidence and severity of eczema symptoms. Vitamin D is known to have a regulatory influence on both the immune system and skin barrier function, both critical in the pathogenesis of eczema. However heterogeneous results have been found in studies to date investigating the effect of vitamin D status during pregnancy and infancy on the prevention of eczema outcomes. Well-designed, adequately powered, randomised controlled trials are needed. The study design of any new intervention trials should measure vitamin D levels at multiple time points during the intervention, ultraviolet (UV) radiation exposure via the use of individual UV dosimeters, and investigate the role of individual genetic polymorphisms. In conclusion, the current available evidence does not allow firm conclusions to be made on whether vitamin D status affects the development of atopic eczema. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Open AccessReview

Hypothalamic-Pituitary Autoimmunity and Traumatic Brain Injury

by Federica Guaraldi, Silvia Grottoli, Emanuela Arvat and Ezio Ghigo

J. Clin. Med. 2015, 4(5), 1025-1035; https://doi.org/10.3390/jcm4051025 - 19 May 2015

Cited by 27 | Viewed by 6280

Abstract

Background: Traumatic brain injury (TBI) is a leading cause of secondary hypopituitarism in children and adults, and is responsible for impaired quality of life, disabilities and compromised development. Alterations of pituitary function can occur at any time after the traumatic event, presenting in [...] Read more.

Background: Traumatic brain injury (TBI) is a leading cause of secondary hypopituitarism in children and adults, and is responsible for impaired quality of life, disabilities and compromised development. Alterations of pituitary function can occur at any time after the traumatic event, presenting in various ways and evolving during time, so they require appropriate screening for early detection and treatment. Although the exact pathophysiology is unknown, several mechanisms have been hypothesized, including hypothalamic-pituitary autoimmunity (HP-A). The aim of this study was to systematically review literature on the association between HP-A and TBI-induced hypopituitarism. Major pitfalls related to the HP-A investigation were also discussed. Methods: The PubMed database was searched with a string developed for this purpose, without temporal or language limits, for original articles assessing the association of HP-A and TBI-induced hypopituitarism. Results: Three articles from the same group met the inclusion criteria. Anti-pituitary and anti-hypothalamic antibodies were detected using indirect immunofluorescence in a significant number of patients with acute and chronic TBI. Elevated antibody titer was associated with an increased risk of persistent hypopituitarism, especially somatotroph and gonadotroph deficiency, while no correlations were found with clinical parameters. Conclusion: HPA seems to contribute to TBI-induced pituitary damage, although major methodological issues need to be overcome and larger studies are warranted to confirm these preliminary data. Full article

(This article belongs to the Special Issue Neuroendocrine Disturbances after Brain Damage)

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Open AccessReview

Biomarkers of Renal Disease and Progression in Patients with Diabetes

by Radovan Hojs, Robert Ekart, Sebastjan Bevc and Nina Hojs

J. Clin. Med. 2015, 4(5), 1010-1024; https://doi.org/10.3390/jcm4051010 - 19 May 2015

Cited by 40 | Viewed by 6818

Abstract

Diabetes prevalence is increasing worldwide, mainly due to the increase in type 2 diabetes. Diabetic nephropathy occurs in up to 40% of people with type 1 or type 2 diabetes. It is important to identify patients at risk of diabetic nephropathy and those [...] Read more.

Diabetes prevalence is increasing worldwide, mainly due to the increase in type 2 diabetes. Diabetic nephropathy occurs in up to 40% of people with type 1 or type 2 diabetes. It is important to identify patients at risk of diabetic nephropathy and those who will progress to end stage renal disease. In clinical practice, most commonly used markers of renal disease and progression are serum creatinine, estimated glomerular filtration rate and proteinuria or albuminuria. Unfortunately, they are all insensitive. This review summarizes the evidence regarding the prognostic value and benefits of targeting some novel risk markers for development of diabetic nephropathy and its progression. It is focused mainly on tubular biomarkers (neutrophil-gelatinase associated lipocalin, kidney injury molecule 1, liver-fatty acid-binding protein, N-acetyl-beta-d-glucosaminidase), markers of inflammation (pro-inflammatory cytokines, tumour necrosis factor-α and tumour necrosis factor-α receptors, adhesion molecules, chemokines) and markers of oxidative stress. Despite the promise of some of these new biomarkers, further large, multicenter prospective studies are still needed before they can be used in everyday clinical practice. Full article

(This article belongs to the Special Issue Diabetic Nephropathy)

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Open AccessReview

Renal Biopsy in Type 2 Diabetic Patients

by Eugenia Espinel, Irene Agraz, Meritxell Ibernon, Natalia Ramos, Joan Fort and Daniel Serón

J. Clin. Med. 2015, 4(5), 998-1009; https://doi.org/10.3390/jcm4050998 - 18 May 2015

Cited by 50 | Viewed by 9501

Abstract

The majority of diabetic patients with renal involvement are not biopsied. Studies evaluating histological findings in renal biopsies performed in diabetic patients have shown that approximately one third of the cases will show pure diabetic nephropathy, one third a non-diabetic condition and another [...] Read more.

The majority of diabetic patients with renal involvement are not biopsied. Studies evaluating histological findings in renal biopsies performed in diabetic patients have shown that approximately one third of the cases will show pure diabetic nephropathy, one third a non-diabetic condition and another third will show diabetic nephropathy with a superimposed disease. Early diagnosis of treatable non-diabetic diseases in diabetic patients is important to ameliorate renal prognosis. The publication of the International Consensus Document for the classification of type 1 and type 2 diabetes has provided common criteria for the classification of diabetic nephropathy and its utility to stratify risk for renal failure has already been demonstrated in different retrospective studies. The availability of new drugs with the potential to modify the natural history of diabetic nephropathy has raised the question whether renal biopsies may allow a better design of clinical trials aimed to delay the progression of chronic kidney disease in diabetic patients. Full article

(This article belongs to the Special Issue Diabetic Nephropathy)

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Open AccessArticle

Clinical Characteristics, Treatments, and Prognosis of Atopic Eczema in the Elderly

by Ryoji Tanei

J. Clin. Med. 2015, 4(5), 979-997; https://doi.org/10.3390/jcm4050979 - 18 May 2015

Cited by 30 | Viewed by 12799

Abstract

Atopic eczema (AE) in the elderly is gradually increasing and has been added to the classification of AE in recent years. This investigation retrospectively analyzed 60 patients with elderly AE. Among the clinical characteristics, a male predominance, existence of several patterns of onset [...] Read more.

Atopic eczema (AE) in the elderly is gradually increasing and has been added to the classification of AE in recent years. This investigation retrospectively analyzed 60 patients with elderly AE. Among the clinical characteristics, a male predominance, existence of several patterns of onset and clinical course, and associations with immunoglobulin (Ig)E-allergic-status and asthmatic complication were observed. The highest positive-rate and positive-score for serum-specific IgE against Dermatophagoides farinae were 83.8% and 2.65 in patients with IgE-allergic AE, and a lower incidence of lichenified eczema in the elbow and knee folds were observed. In terms of treatments and outcomes, clinical improvement and clinical remission were observed in 80.8% and 36.5% of cases, respectively, using standard treatments and combined therapy with oral corticosteroid in severe cases. As for complications and final prognosis, most elderly AE patients reached the end of life with AE, but patients with IgE-allergic AE showed significantly lower incidences of complications of malignancy and death from malignancy. These results indicate that AE in the elderly represents a new subgroup of AE with specific features. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Open AccessArticle

The Importance of Acidification in Atopic Eczema: An Underexplored Avenue for Treatment

by David J. Panther and Sharon E. Jacob

J. Clin. Med. 2015, 4(5), 970-978; https://doi.org/10.3390/jcm4050970 - 18 May 2015

Cited by 74 | Viewed by 10173

Abstract

Atopic dermatitis is a form of dermatitis commonly seen in children and adults. Its pathophysiology is complex and is centered on the barrier function of the epidermis. An important aspect of the skin’s barrier is pH, which in turn affects a number of [...] Read more.

Atopic dermatitis is a form of dermatitis commonly seen in children and adults. Its pathophysiology is complex and is centered on the barrier function of the epidermis. An important aspect of the skin’s barrier is pH, which in turn affects a number of parameters such as the skin flora, protease function, and mediators of inflammation and pruritus. Normal pH for non-neonatal skin is acidic and ranges from 4 to 6. Skin pH in atopic dermatitis patients is often increased into the neutral to basic range, and the resulting cascade of changes contributes to the phenotype of atopic dermatitis. Therefore, the maintenance of normal skin pH remains an important topic in understanding and treating atopic dermatitis. This article will review skin pH and its impact on normal barrier function, pathological pH changes in atopic dermatitis, and the therapeutic considerations related to restoring and maintaining pH balance. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Open AccessArticle

Addisonian Crisis after Missed Diagnosis of Posttraumatic Hypopituitarism

by Christine Streetz-van der Werf, Wolfram Karges, Marcus Blaum and Ilonka Kreitschmann-Andermahr

J. Clin. Med. 2015, 4(5), 965-969; https://doi.org/10.3390/jcm4050965 - 15 May 2015

Cited by 3 | Viewed by 10692

Abstract

We report a case of a previously undiagnosed panhypopituitarism initially presenting as a full-blown Addisonian crisis with hypoglycemia, hyponatremia, hypotension and neuropsychological symptoms, more than 30 years after a severe traumatic brain injury (TBI). The patient also displayed clearly visible pathognomonic clinical signs [...] Read more.

We report a case of a previously undiagnosed panhypopituitarism initially presenting as a full-blown Addisonian crisis with hypoglycemia, hyponatremia, hypotension and neuropsychological symptoms, more than 30 years after a severe traumatic brain injury (TBI). The patient also displayed clearly visible pathognomonic clinical signs of long-standing pituitary dysfunction. The case highlights the importance of being aware of endocrine sequelae even decades after serious TBI. Full article

(This article belongs to the Special Issue Neuroendocrine Disturbances after Brain Damage)

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Open AccessReview

Hypoglycemia in Patients with Diabetes and Renal Disease

by Mazen Alsahli and John E. Gerich

J. Clin. Med. 2015, 4(5), 948-964; https://doi.org/10.3390/jcm4050948 - 13 May 2015

Cited by 89 | Viewed by 13485

Abstract

This article summarizes our current knowledge of the epidemiology, pathogenesis, and morbidity of hypoglycemia in patients with diabetic kidney disease and reviews therapeutic limitations in this situation. Full article

(This article belongs to the Special Issue Diabetic Nephropathy)

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Open AccessReview

Hyponatremia Associated with Heart Failure: Pathological Role of Vasopressin-Dependent Impaired Water Excretion

by San-e Ishikawa

J. Clin. Med. 2015, 4(5), 933-947; https://doi.org/10.3390/jcm4050933 - 8 May 2015

Cited by 24 | Viewed by 12731

Abstract

An exaggerated increase in circulatory blood volume is linked to congestive heart failure. Despite this increase, reduction of the “effective circulatory blood volume” in congestive heart failure is associated with decreased cardiac output, and can weaken the sensitivity of baroreceptors. Thereafter, tonic inhibition [...] Read more.

An exaggerated increase in circulatory blood volume is linked to congestive heart failure. Despite this increase, reduction of the “effective circulatory blood volume” in congestive heart failure is associated with decreased cardiac output, and can weaken the sensitivity of baroreceptors. Thereafter, tonic inhibition of the baroreceptor-mediated afferent pathway of vagal nerves is removed, providing an increase in non-osmotic release of arginine vasopressin (AVP). In the renal collecting duct, the aquaporin-2 (AQP2) water channel is regulated by sustained elevation of AVP release, and this leads to augmented hydroosmotic action of AVP, that results in exaggerated water retention and dilutional hyponatremia. Hyponatremia is also a predictor for worsening heart failure in patients with known/new onset heart failure. Therefore, such a dilutional hyponatremia associated with organ damage is predictive of the short- and long-term outcome of heart failure. Full article

(This article belongs to the Special Issue Hyponatremia: Advances in Diagnosis and Management)

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Open AccessReview

Current Cervical Carcinoma Screening Guidelines

by Megan J. Schlichte and Jacqueline Guidry

J. Clin. Med. 2015, 4(5), 918-932; https://doi.org/10.3390/jcm4050918 - 7 May 2015

Cited by 36 | Viewed by 7645

Abstract

A formidable threat to the health of women, cervical carcinoma can be prevented in many cases with adequate screening. The current guidelines for cervical carcinoma screening were created as joint recommendations of the American Cancer Society (ACS), the American Society for Colposcopy and [...] Read more.

A formidable threat to the health of women, cervical carcinoma can be prevented in many cases with adequate screening. The current guidelines for cervical carcinoma screening were created as joint recommendations of the American Cancer Society (ACS), the American Society for Colposcopy and Cervical Pathology (ASCCP) and the American Society for Clinical Pathology (ASCP) in 2012, and later accepted and promoted by the American Congress of Obstetricians and Gynecologists (ACOG). The 2012 recommendations underscore the utility of molecular testing as an adjunct to cytology screening for certain women and provide guidance to clinicians based on different risk-benefit considerations for different ages. This manuscript will review screening techniques and current recommendations for cervical cancer screening and human papilloma virus (HPV) testing, as well as possible future screening strategies. Full article

(This article belongs to the Special Issue Clinical Advances of Human Papillomaviruses)

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Open AccessReview

Diagnosis of Atopic Dermatitis: Mimics, Overlaps, and Complications

by Elaine C. Siegfried and Adelaide A. Hebert

J. Clin. Med. 2015, 4(5), 884-917; https://doi.org/10.3390/jcm4050884 - 6 May 2015

Cited by 84 | Viewed by 54465

Abstract

Atopic dermatitis (AD) is one of the most common skin diseases affecting infants and children. A smaller subset of adults has persistent or new-onset AD. AD is characterized by pruritus, erythema, induration, and scale, but these features are also typical of several other [...] Read more.

Atopic dermatitis (AD) is one of the most common skin diseases affecting infants and children. A smaller subset of adults has persistent or new-onset AD. AD is characterized by pruritus, erythema, induration, and scale, but these features are also typical of several other conditions that can mimic, coexist with, or complicate AD. These include inflammatory skin conditions, infections, infestations, malignancies, genetic disorders, immunodeficiency disorders, nutritional disorders, graft-versus-host disease, and drug eruptions. Familiarity of the spectrum of these diseases and their distinguishing features is critical for correct and timely diagnosis and optimal treatment. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Open AccessReview

Can Novel Treatment of Age-Related Macular Degeneration Be Developed by Better Understanding of Sorsby’s Fundus Dystrophy

by Hanae C. Y. Gourier and N. Victor Chong

J. Clin. Med. 2015, 4(5), 874-883; https://doi.org/10.3390/jcm4050874 - 4 May 2015

Cited by 12 | Viewed by 6726

Abstract

Sorsby’s Fundus Dystrophy (SFD) is a rare autosomal dominant maculopathy that shares many clinical features with Age-Related Macular Degeneration (AMD). It is caused by a mutation in a single gene, TIMP-3, which accumulates in Bruch’s membrane (BM). BM thickening and TIMP-3 accumulation can [...] Read more.

Sorsby’s Fundus Dystrophy (SFD) is a rare autosomal dominant maculopathy that shares many clinical features with Age-Related Macular Degeneration (AMD). It is caused by a mutation in a single gene, TIMP-3, which accumulates in Bruch’s membrane (BM). BM thickening and TIMP-3 accumulation can also be found in AMD. From our understanding of the pathophysiology of SFD we hypothesize that BM thickening could be responsible for making the elastic layer vulnerable to invasion by choriocapillaris, thereby leading to choroidal neovascularization in some cases of AMD, whilst in others it could deprive the retinal pigment epithelium of its blood supply, thereby causing geographic atrophy. Full article

(This article belongs to the Special Issue Age-Related Macular Disease)

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Open AccessReview

Immune Pathways in Atopic Dermatitis, and Definition of Biomarkers through Broad and Targeted Therapeutics

by Yasaman Mansouri and Emma Guttman-Yassky

J. Clin. Med. 2015, 4(5), 858-873; https://doi.org/10.3390/jcm4050858 - 29 Apr 2015

Cited by 109 | Viewed by 11196

Abstract

Atopic dermatitis (AD) is the most common inflammatory skin disease. Recent research findings have provided an insight into the complex pathogenic mechanisms involved in this disease. Despite a rising prevalence, effective and safe therapeutics for patients with moderate-to-severe AD are still lacking. Biomarkers [...] Read more.

Atopic dermatitis (AD) is the most common inflammatory skin disease. Recent research findings have provided an insight into the complex pathogenic mechanisms involved in this disease. Despite a rising prevalence, effective and safe therapeutics for patients with moderate-to-severe AD are still lacking. Biomarkers of lesional, nonlesional skin, and blood have been developed for baseline as well as after treatment with broad and specific treatments (i.e., cyclosporine A and dupilumab). These biomarkers will help with the development of novel targeted therapeutics and assessment of disease reversal, with the promise of a more personalized treatment approach. Since AD involves more than one subtype (i.e., intrinsic/extrinsic, pediatric/adult, etc.), these molecular fingerprints needs to be validated in all subpopulations with AD. Full article

(This article belongs to the Special Issue Epidemiology and Treatment of Atopic Eczema)

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Neuroendocrine Disturbances after Brain Damage: An Important and Often Undiagnosed Disorder

by Fatih Tanriverdi and Fahrettin Kelestimur

J. Clin. Med. 2015, 4(5), 847-857; https://doi.org/10.3390/jcm4050847 - 28 Apr 2015

Cited by 25 | Viewed by 7251

Abstract

Traumatic brain injury (TBI) is a common and significant public health problem all over the world. Until recently, TBI has been recognized as an uncommon cause of hypopituitarism. The studies conducted during the last 15 years revealed that TBI is a serious cause [...] Read more.

Traumatic brain injury (TBI) is a common and significant public health problem all over the world. Until recently, TBI has been recognized as an uncommon cause of hypopituitarism. The studies conducted during the last 15 years revealed that TBI is a serious cause of hypopituitarism. Although the underlying pathophysiology has not yet been fully clarified, new data indicate that genetic predisposition, autoimmunity and neuroinflammatory changes may play a role in the development of hypopituitarism. Combative sports, including boxing and kickboxing, both of which are characterized by chronic repetitive head trauma, have been shown as new causes of neuroendocrine abnormalities, mainly hypopituitarism, for the first time during the last 10 years. Most patients with TBI-induced pituitary dysfunction remain undiagnosed and untreated because of the non-specific and subtle clinical manifestations of hypopituitarism. Replacement of the deficient hormones, of which GH is the commonest hormone lost, may not only reverse the clinical manifestations and neurocognitive dysfunction, but may also help posttraumatic disabled patients resistant to classical treatment who have undiagnosed hypopituitarism and GH deficiency in particular. Therefore, early diagnosis, which depends on the awareness of TBI as a cause of neuroendocrine abnormalities among the medical community, is crucially important. Full article

(This article belongs to the Special Issue Neuroendocrine Disturbances after Brain Damage)

174 KiB

Open AccessReview

Advancements in Pharmacotherapy for Noncancerous Manifestations of HPV

by Ramya Kollipara, Erfon Ekhlassi, Christopher Downing, Jacqueline Guidry, Michael Lee and Stephen K. Tyring

J. Clin. Med. 2015, 4(5), 832-846; https://doi.org/10.3390/jcm4050832 - 24 Apr 2015

Cited by 39 | Viewed by 9635

Abstract

Human papillomavirus (HPV) is the most common sexually transmitted disease. Via infection of the basal epithelial cells, HPV causes numerous malignancies and noncancerous cutaneous manifestations. Noncancerous cutaneous manifestations of HPV, including common, plantar, plane, and anogenital warts, are among the most common reasons [...] Read more.

Human papillomavirus (HPV) is the most common sexually transmitted disease. Via infection of the basal epithelial cells, HPV causes numerous malignancies and noncancerous cutaneous manifestations. Noncancerous cutaneous manifestations of HPV, including common, plantar, plane, and anogenital warts, are among the most common reasons for an office visit. Although there are various therapies available, they are notoriously difficult to treat. HPV treatments can be grouped into destructive (cantharidin, salicylic acid), virucidal (cidofovir, interferon-α), antimitotic (bleomycin, podophyllotoxin, 5-fluorouracil), immunotherapy (Candida antigen, contact allergen immunotherapy, imiquimod) or miscellaneous (trichloroacetic acid, polyphenon E). The mechanism of action, recent efficacy data, safety profile and recommended regimen for each of these treatment modalities is discussed. Full article

(This article belongs to the Special Issue Clinical Advances of Human Papillomaviruses)

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Open AccessReview

Advancements in the Management of HPV-Associated Head and Neck Squamous Cell Carcinoma

by Ross Zeitlin, Harrison P. Nguyen, David Rafferty and Stephen Tyring

J. Clin. Med. 2015, 4(5), 822-831; https://doi.org/10.3390/jcm4050822 - 24 Apr 2015

Cited by 1 | Viewed by 5708

Abstract

Head and neck carcinomas have long been linked to alcohol and tobacco abuse; however, within the last two decades, the human papillomavirus (HPV) has emerged as a third etiology and is specifically associated with head and neck squamous cell carcinomas (HNSCC). In this [...] Read more.

Head and neck carcinomas have long been linked to alcohol and tobacco abuse; however, within the last two decades, the human papillomavirus (HPV) has emerged as a third etiology and is specifically associated with head and neck squamous cell carcinomas (HNSCC). In this anatomical region, the oncogenic HPV-16 mediates transformation and immortalization of epithelium, most commonly in the oropharynx. Nevertheless, the recent identification of novel HPV mechanisms thought to be specific to oropharyngeal carcinogenesis has coincided with observations that HPV-associated HNSCC has differing clinical behavior—in terms of natural history, therapeutic response, and prognosis—than HPV-negative head and neck tumors. Taken together with the growing incidence of HPV transmission in younger populations, these discoveries have sparked a rapid expansion in both laboratory and clinical studies on the infection and disease. Herein, we review the clinical characteristics of HPV-associated HNSCC, with particular emphasis on recent advancements in our understanding of the management of this infectious malignancy. Full article

(This article belongs to the Special Issue Clinical Advances of Human Papillomaviruses)

1217 KiB

Open AccessReview

Polypoidal Choroidal Vasculopathy in Asians

by Chee Wai Wong, Tien Y. Wong and Chui Ming Gemmy Cheung

J. Clin. Med. 2015, 4(5), 782-821; https://doi.org/10.3390/jcm4050782 - 24 Apr 2015

Cited by 90 | Viewed by 15799

Abstract

Age related macular degeneration (AMD) in Asians has been suggested to differ from their Western counterparts in terms of epidemiology, pathogenesis, clinical presentation and treatment. In particular, polypoidal choroidal vasculopathy (PCV) appears to be the predominant subtype of exudative AMD in Asian populations, [...] Read more.

Age related macular degeneration (AMD) in Asians has been suggested to differ from their Western counterparts in terms of epidemiology, pathogenesis, clinical presentation and treatment. In particular, polypoidal choroidal vasculopathy (PCV) appears to be the predominant subtype of exudative AMD in Asian populations, in contrast to choroidal neovascularization secondary to AMD (CNV-AMD) in Western populations. Epidemiological data on PCV has been largely limited to hospital-based studies and there are currently no data on the incidence of PCV. Similarities and differences in risk factor profile between PCV and CNV-AMD point to some shared pathogenic mechanisms but also differential underlying mechanisms leading to the development of each phenotype. Serum biomarkers such as CRP, homocysteine and matrix metalloproteinases suggest underlying inflammation, atherosclerosis and deranged extracellular matrix metabolism as possible pathogenic mechanisms. In addition, recent advances in genome sequencing have revealed differences in genetic determinants of each subtype. While the standard of care for CNV-AMD is anti-vascular endothelial growth factor (VEGF) therapy, photodynamic therapy (PDT) has been the mainstay of treatment for PCV, although long-term visual prognosis remains unsatisfactory. The optimal treatment for PCV requires further clarification, particularly with different types of anti-VEGF agents and possible benefits of reduced fluence PDT. Full article

(This article belongs to the Special Issue Age-Related Macular Disease)

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J. Clin. Med., Volume 4, Issue 5 (May 2015) – 24 articles , Pages 782-1170

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