Journal of Clinical Medicine

12 pages, 1113 KiB

Open AccessArticle

Sequential Approach for a Critical-View COlectomy (SACCO): A Laparoscopic Technique to Reduce Operative Time and Complications in IBD Acute Severe Colitis

by Gianluca Matteo Sampietro, Francesco Colombo and Fabio Corsi

J. Clin. Med. 2020, 9(10), 3382; https://doi.org/10.3390/jcm9103382 - 21 Oct 2020

Cited by 8 | Viewed by 3587

Abstract

Acute severe colitis is the major indication for surgery in inflammatory bowel diseases (IBD), and in particular, in ulcerative colitis (UC). A laparoscopic approach for abdominal colectomy is recommended, due to better perioperative and long-term outcomes. However, costs, time-spending, and outcomes are still [...] Read more.

Acute severe colitis is the major indication for surgery in inflammatory bowel diseases (IBD), and in particular, in ulcerative colitis (UC). A laparoscopic approach for abdominal colectomy is recommended, due to better perioperative and long-term outcomes. However, costs, time-spending, and outcomes are still a topic of improvement. We designed a standardized 10-steps, sequential approach to laparoscopic colectomy, based on the philosophy of the “critical view of safety”, with the aim to improve perioperative outcomes (operative duration, estimated blood loss, complications, readmissions, reoperations, and length of postoperative stay). We performed a retrospective cohort study using data from a prospectively maintained clinical database. We included all the consecutive, unselected patients undergoing laparoscopic subtotal colectomy (SCo) for IBD between 2008 and 2019 in a tertiary IBD Italian Centre. Starting from 2015, we regularly adopted the novel Sequential Approach for a Critical-View Colectomy (SACCo) technique. We included 59 (40.6%) patients treated with different laparoscopic approaches, and 86 patients (59.4%) operated on by the SACCo procedure. The mean operating time was significantly shorter for the SACCo group (144 vs. 224 min; p < 0.0001). The SACCo technique presented a trend to fewer major complications (6.8% vs. 8.3%), less readmissions (2.3% vs. 13.5%; p = 0.01), and shorter postoperative hospital stay (7.2 vs. 8.8 days; p = 0.003). Laparoscopic SACCo-technique is a safe and reproducible surgical approach for acute severe colitis and may improve the outcomes of this demanding procedure. Full article

(This article belongs to the Special Issue An Update on Ulcerative Colitis: From Pathophysiology to Clinical Management)

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16 pages, 299 KiB

Open AccessReview

Use of Sublingual Immunotherapy for Aeroallergens in Children with Asthma

by Carlo Caffarelli, Carla Mastrorilli, Michela Procaccianti and Angelica Santoro

J. Clin. Med. 2020, 9(10), 3381; https://doi.org/10.3390/jcm9103381 - 21 Oct 2020

Cited by 10 | Viewed by 3248

Abstract

Asthma is a heterogeneous disease that in children is often allergen-driven with a type 2 inflammation. Sublingual immunotherapy represents an important progress in the use of personalized medicine in children with allergic asthma. It is a viable option for house dust mite-driven asthma [...] Read more.

Asthma is a heterogeneous disease that in children is often allergen-driven with a type 2 inflammation. Sublingual immunotherapy represents an important progress in the use of personalized medicine in children with allergic asthma. It is a viable option for house dust mite-driven asthma and in subjects with the asthma associated with allergic rhinitis. The use and indications for isolated asthma caused by other allergens are still controversial owing to heterogeneity of commercially available products and methodological limitations of studies in children. Nevertheless, most studies and meta-analyses found the efficacy of sublingual immunotherapy. Sublingual immunotherapy is safe but cannot be recommended in children with uncontrolled asthma. Full article

(This article belongs to the Special Issue Asthma and Allergic Inflammation: Risks, Mechanisms, and New Treatments)

10 pages, 2957 KiB

Open AccessReview

Partial Achilles Tendon Rupture—A Neglected Entity: A Narrative Literature Review on Diagnostics and Treatment Options

by Matthias Gatz, Christoph Spang and Håkan Alfredson

J. Clin. Med. 2020, 9(10), 3380; https://doi.org/10.3390/jcm9103380 - 21 Oct 2020

Cited by 14 | Viewed by 11940

Abstract

Partial ruptures in the Achilles tendon are rather uncommon and are often misinterpreted as aggravated Achilles tendinopathy, and not always considered as a differential diagnosis. The aim of this literature review was to characterize typical symptoms, to provide an overview of available diagnosis [...] Read more.

Partial ruptures in the Achilles tendon are rather uncommon and are often misinterpreted as aggravated Achilles tendinopathy, and not always considered as a differential diagnosis. The aim of this literature review was to characterize typical symptoms, to provide an overview of available diagnosis and treatment options, and to give reference points for future research. There were few studies and sparse knowledge of scientific value, making it difficult to give evidence-based recommendations. Based on the few studies and the authors’ clinical experience, a diagnosis should be based on a patient’s history with a typical sharp onset of pain and inability to fully load the tendon. Previous intratendinous cortisone injections might be present. Clinical findings are a localized tender region in the tendon and often weakness during heel raises. Ultrasound and Doppler examinations show a region with an irregular and bulging superficial tendon line, often together with localized high blood flow. Magnetic resonance Imaging (MRI) shows a hyperintense signal in the tendon on T1 and T2-weighted sequences. First-line therapy should be a conservative approach using a 2 cm heel lift for the first 6 weeks and avoiding tendon stretching (for 12 weeks). This is followed by a reduced heel lift of 1 cm and progressive tendon loading at weeks 7–12. After 12 weeks, the heel lift can be removed if pain-free, and the patient can gradually start eccentric exercises lowering the heel below floor level and gradually returning to previous sport level. If conservative management has a poor effect, surgical exploration and the excision of the partial rupture and suturing is required. Augmentation procedures or anchor applications might be useful for partial ruptures in the Achilles insertion, but this depends on the size and exact location. After surgery, the 12 to 14-week rehabilitation program used in conservative management can be recommended before the patient’s return to full tendon loading activities. Full article

(This article belongs to the Section Orthopedics)

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13 pages, 4405 KiB

Open AccessArticle

The HLA Variant rs6903608 Is Associated with Disease Onset and Relapse of Immune-Mediated Thrombotic Thrombocytopenic Purpura in Caucasians

by Ilaria Mancini, Elisa Giacomini, Silvia Pontiggia, Andrea Artoni, Barbara Ferrari, Emanuela Pappalardo, Roberta Gualtierotti, Silvia Maria Trisolini, Saveria Capria, Luca Facchini, Katia Codeluppi, Erminia Rinaldi, Domenico Pastore, Simona Campus, Cinzia Caria, Aldo Caddori, Daniela Nicolosi, Gaetano Giuffrida, Vanessa Agostini, Umberto Roncarati, Clara Mannarella, Alberto Fragasso, Gian Marco Podda, Simone Birocchi, Anna Maria Cerbone, Antonella Tufano, Giuseppe Menna, Michele Pizzuti, Michela Ronchi, Alessandro De Fanti, Sergio Amarri, Marzia Defina, Monica Bocchia, Silvia Cerù, Salvatore Gattillo, Frits R. Rosendaal and Flora Peyvandi Show full author list Hide full author list

J. Clin. Med. 2020, 9(10), 3379; https://doi.org/10.3390/jcm9103379 - 21 Oct 2020

Cited by 7 | Viewed by 2476

Abstract

Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening thrombotic microangiopathy caused by severe ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin motifs 13) deficiency, recurring in 30–50% of patients. The common human leukocyte antigen (HLA) variant rs6903608 was found to be associated with [...] Read more.

Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening thrombotic microangiopathy caused by severe ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin motifs 13) deficiency, recurring in 30–50% of patients. The common human leukocyte antigen (HLA) variant rs6903608 was found to be associated with prevalent iTTP, but whether this variant is associated with disease relapse is unknown. To estimate the impact of rs6903608 on iTTP onset and relapse, we performed a case-control and cohort study in 161 Italian patients with a first iTTP episode between 2002 and 2018, and in 456 Italian controls. Variation in rs6903608 was strongly associated with iTTP onset (homozygotes odds ratio (OR) 4.68 (95% confidence interval (CI) 2.67 to 8.23); heterozygotes OR 1.64 (95%CI 0.95 to 2.83)), which occurred over three years earlier for each extra risk allele (β −3.34, 95%CI −6.69 to 0.02). Of 153 survivors (median follow-up 4.9 years (95%CI 3.7 to 6.1)), 44 (29%) relapsed. The risk allele homozygotes had a 46% (95%CI 36 to 57%) absolute risk of relapse by year 6, which was significantly higher than both heterozygotes (22% (95%CI 16 to 29%)) and reference allele homozygotes (30% (95%CI 23 to 39%)). In conclusion, HLA variant rs6903608 is a risk factor for both iTTP onset and relapse. This newly identified biomarker may help with recognizing patients at high risk of relapse, who would benefit from close monitoring or intensified immunosuppressive therapy. Full article

(This article belongs to the Section Hematology)

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11 pages, 1180 KiB

Open AccessArticle

The Impact of Preoperative Inflammatory Markers on the Prognosis of Patients Undergoing Surgical Resection of Pulmonary Oligometastases

by Francesco Londero, William Grossi, Orlando Parise, Jacqueline Cinel, Gianmarco Parise, Gianluca Masullo, Cecilia Tetta, Linda Renata Micali, Emanuela Mauro, Angelo Morelli, Jos G. Maessen and Sandro Gelsomino

J. Clin. Med. 2020, 9(10), 3378; https://doi.org/10.3390/jcm9103378 - 21 Oct 2020

Cited by 1 | Viewed by 1733

Abstract

The aim of this study was to assess the prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels in patients undergoing resection of pulmonary oligometastases. A retrospective analysis on 141 patients undergoing a first pulmonary metastasectomy in a single center [...] Read more.

The aim of this study was to assess the prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels in patients undergoing resection of pulmonary oligometastases. A retrospective analysis on 141 patients undergoing a first pulmonary metastasectomy in a single center was carried out. Two distinct analysis were performed subdividing patients according to their NLR ratio and CRP level. The main outcomes were survival and time to recurrence. At completion of follow-up 74 patients were still alive (52.5%). Subdividing patients according to their NLR yielded a significant difference in five-year progression-free survival (PFS, NLR < 4:32% vs. NLR ≥ 4:18%, p = 0.01). When subdivided by their CRP levels, patients with preoperative CRP < 5 mg/L demonstrated higher values of five-year overall survival (OS, 57% vs. 34%, p = 0.006) and five-year PFS (35% vs. 22%, p = 0.04). At multivariate analysis, level of neutrophils (p = 0.009) and lung comorbidities (p = 0.021) were independent predictors of death, whereas preoperative CRP (p = 0.002), multiple metastases (p = 0.003) and presence of lung comorbidities (p = 0.001) were independent predictors of recurrence. NLR and CRP are important predictors of prognostic outcome in patients undergoing pulmonary metastasectomy. Full article

(This article belongs to the Section Oncology)

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10 pages, 939 KiB

Open AccessArticle

Myocardial Infarction in Centenarians. Data from The Polish Registry of Acute Coronary Syndromes

by Jacek Piegza, Lech Poloński, Aneta Desperak, Andrzej Wester, Marianna Janion, Wiesław Mazurek, Wojciech Wojakowski, Adam Witkowski, Dariusz Dudek and Mariusz Gąsior

J. Clin. Med. 2020, 9(10), 3377; https://doi.org/10.3390/jcm9103377 - 21 Oct 2020

Cited by 4 | Viewed by 2234

Abstract

Background: There are no data regarding the mortality rate, risks and benefits of particular reperfusion methods and pharmacological treatment complications in patients aged over 100 years with acute coronary syndromes. We sought to assess the treatment of myocardial infarction (MI) in patients older [...] Read more.

Background: There are no data regarding the mortality rate, risks and benefits of particular reperfusion methods and pharmacological treatment complications in patients aged over 100 years with acute coronary syndromes. We sought to assess the treatment of myocardial infarction (MI) in patients older than 100 years and to determine prognostic factors for this group. Methods: Among the 716,566 patients recorded between 2003 and 2018 in the Polish Registry of Acute Coronary Syndromes, 104 patients aged ≥100 with MI were included. The patients were categorized into two groups: group 1 received conservative treatment (64 patients), and group 2 received invasive strategy (40 patients). Results: The frequencies of in-hospital mortality, MI and stroke were similar in both arms. No difference in the frequency of the combined endpoint (death, reinfarction, stroke) was noted. Invasive treatment was more advantageous for 12-month outcomes; 50 patients in group 1 (79%) and 23 patients in group 2 (57.50%) died (p = 0.017). The multivariate analysis identified the lower left ventricular ejection fraction (EF) (Hazard Ratio (HR) = 0.96; 95% Confidence Interval (CI): 0.94–0.99; p = 0.012), lack of coronary angiography (HR = 0.49; 95% CI: 0.24–0.99; p = 0.048) and cardiac arrest (HR = 4.61; 95% CI: 1.64–12.99; p = 0.0038) as predictors of 12-month mortality in this group. Conclusions: Invasive MI treatment may be beneficial for selected very old patients. Full article

(This article belongs to the Special Issue Clinical Updates and Future Perspectives on the Management of Myocardial Infarction in Elderly Patients)

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3 pages, 194 KiB

Open AccessEditorial

Biomarkers for Non-Small Cell Lung Cancer: From the Bench to the Bedside

by Ramon Andrade de Mello and Giovanna Araújo Amaral

J. Clin. Med. 2020, 9(10), 3376; https://doi.org/10.3390/jcm9103376 - 21 Oct 2020

Cited by 2 | Viewed by 1858

Abstract

Lung cancer (LC) is inarguably one of the biggest battles to be fought in the field of oncology, and non-small cell lung cancer accounts for over 85% of all lung cancer cases [...] Full article

(This article belongs to the Collection Biomarker for Non-small Cell Lung Cancer: From the Bench to the Bedside)

13 pages, 1344 KiB

Open AccessArticle

The Relevance of Fetal Abdominal Subcutaneous Tissue Recording in Predicting Perinatal Outcome of GDM Pregnancies: A Retrospective Study

by Friederike Weschenfelder, Nadin Baum, Thomas Lehmann, Ekkehard Schleußner and Tanja Groten

J. Clin. Med. 2020, 9(10), 3375; https://doi.org/10.3390/jcm9103375 - 21 Oct 2020

Cited by 3 | Viewed by 3155

Abstract

Guidelines on the management of gestational diabetes (GDM) instruct physicians to involve ultrasound-based monitoring of fetal growth in addition to blood glucose. So far, glucose control besides clinical parameters like maternal body mass index (BMI) and gestational weight gain have been shown to [...] Read more.

Guidelines on the management of gestational diabetes (GDM) instruct physicians to involve ultrasound-based monitoring of fetal growth in addition to blood glucose. So far, glucose control besides clinical parameters like maternal body mass index (BMI) and gestational weight gain have been shown to predict neonatal outcome. We aimed to evaluate the discriminative ability of fetal abdominal subcutaneous tissue (FAST) in addition to standard ultrasound parameters like abdominal circumference (AC) and estimated fetal weight (EFW) for perinatal complications like large for gestational age (LGA), hypoglycemia, hyperbilirubinemia, mode of delivery and admission to neonatal intensive care unit (NICU). Ultrasound data and neonatal outcome was collected of 805 GDM cases from 2012 to 2016: 3205 FAST, 3195 AC-measurements and 3190 EFW calculations were included. AC, EFW and FAST increased linear with gestational age. Combining ultrasound and clinical parameters improved predictive power for LGA. In the subgroup where fetuses grow with an AC > 75th additional adding of FAST to standard ultrasound parameters increased predictive power for hypoglycemia. Our results confirm inclusion of ultrasound parameters to be beneficial in monitoring GDM pregnancies. Additional FAST determination revealed to be of potential clinical relevance in the subgroup AC > 75th percentile. Full article

(This article belongs to the Special Issue New Prospects for Prenatal Diagnosis and Fetal Therapy)

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12 pages, 1039 KiB

Open AccessArticle

The Added Value of Radiographs in Diagnosing Knee Osteoarthritis Is Similar for General Practitioners and Secondary Care Physicians; Data from the CHECK Early Osteoarthritis Cohort

by Qiuke Wang, Jos Runhaar, Margreet Kloppenburg, Maarten Boers, Johannes W. J. Bijlsma, Sita M. A. Bierma-Zeinstra and The CREDO Expert Group

J. Clin. Med. 2020, 9(10), 3374; https://doi.org/10.3390/jcm9103374 - 21 Oct 2020

Cited by 6 | Viewed by 2363

Abstract

Objective: The purpose of this study was to evaluate the added value of radiographs for diagnosing knee osteoarthritis (KOA) by general practitioners (GPs) and secondary care physicians (SPs). Methods: Seventeen GPs and nineteen SPs were recruited to evaluate 1185 knees from the CHECK [...] Read more.

Objective: The purpose of this study was to evaluate the added value of radiographs for diagnosing knee osteoarthritis (KOA) by general practitioners (GPs) and secondary care physicians (SPs). Methods: Seventeen GPs and nineteen SPs were recruited to evaluate 1185 knees from the CHECK cohort (presenters with knee pain in primary care) for the presence of clinically relevant osteoarthritis (OA) during follow-up. Experts were required to make diagnoses independently, first based on clinical data only and then on clinical plus radiographic data, and to provide certainty scores (ranging from 1 to 100, where 1 was “certainly no OA” and 100 was “certainly OA”). Next, experts held consensus meetings to agree on the final diagnosis. With the final diagnosis as gold standard, diagnostic indicators were calculated (sensitivity, specificity, positive/negative predictive value, accuracy and positive/negative likelihood ratio) for all knees, as well as for clinically “certain” and “uncertain” knees, respectively. Student paired t-tests compared certainty scores. Results: Most diagnoses of GPs (86%) and SPs (82%) were “consistent” after assessment of radiographic data. Diagnostic indicators improved similarly for GPs and SPs after evaluating the radiographic data, but only improved relevantly in clinically “uncertain” knees. Radiographs added some certainty to “consistent” OA knees (GP 69 vs. 72, p < 0.001; SP 70 vs. 77, p < 0.001), but not to the consistent no OA knees (GP 21 vs. 22, p = 0.16; SP 20 vs. 21, p = 0.04). Conclusions: The added value of radiographs is similar for GP and SP, in terms of diagnostic accuracy and certainty. Radiographs appear to be redundant when clinicians are certain of their clinical diagnosis. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Musculoskeletal Disorders)

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10 pages, 2227 KiB

Open AccessArticle

3D Exoscope-Assisted Microvascular Anastomosis: An Evaluation on Latex Vessel Models

by Valentina Pinto, Federico A. Giorgini, Maria Elisa Lozano Miralles, Achille Tarsitano, Maria Martina Panella, Riccardo Cipriani and Marco Pignatti

J. Clin. Med. 2020, 9(10), 3373; https://doi.org/10.3390/jcm9103373 - 21 Oct 2020

Cited by 9 | Viewed by 3034

Abstract

Background. Over the last few years, advances in technologies and digital imaging have led to the introduction of systems that enable a new approach to microsurgery and supermicrosurgery. The exoscope is a new magnification system that provides a 3D image of the surgical [...] Read more.

Background. Over the last few years, advances in technologies and digital imaging have led to the introduction of systems that enable a new approach to microsurgery and supermicrosurgery. The exoscope is a new magnification system that provides a 3D image of the surgical field: microsurgical procedures can be performed with the aid of this instrument. Here, we describe our preliminary experience with a high-definition 3D exoscope (VITOM^®, Karl Storz, Tuttlingen, Germany), evaluating the characteristics of the instrument, and also its use as a magnification device for microanastomosis training. Methods. Six microsurgeons with various levels of experience were asked to perform three end-to-end anastomoses and two end-to-side anastomoses on latex vessel models, using, as a magnification system, the VITOM^® 3D 4K exoscope. None of the surgeons involved had previous experience with the exoscope, with robotic surgery, with endoscopic surgery, nor with training simulators. Results. The results of the reported evaluation of the tool’s qualities, (VITOM Quality Assessment Tool) included: a good focusing of the surgical field; high image quality; strong luminance; good magnification; clear stereoscopy; and excellent freedom of movement. The exoscope proved to be user-friendly. A constant reduction in the time needed to perform the microsurgical anastomosis at each exercise was recorded. Among other advantages were the easy switching from the magnified image to the macroscopic view, superior ergonomics allowing a relaxed posture while performing the anastomosis, adequate space, and a convenient setting for the assistants to view the operating field. Conclusions. Our study showed that the exoscope VITOM 3D can be successfully used as a magnification tool for microsurgical anastomosis on synthetic vessels, and that it can also be helpful during training courses in microsurgery. Full article

(This article belongs to the Special Issue Innovation in Head and Neck Reconstructive Surgery)

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26 pages, 2877 KiB

Open AccessReview

Rapid Antibody-Based COVID-19 Mass Surveillance: Relevance, Challenges, and Prospects in a Pandemic and Post-Pandemic World

by Robin Augustine, Suvarthi Das, Anwarul Hasan, Abhilash S, Shaheen Abdul Salam, Priya Augustine, Yogesh Bharat Dalvi, Ruby Varghese, Rosita Primavera, Hadi Mohamad Yassine, Avnesh S. Thakor and Bhavesh D. Kevadiya

J. Clin. Med. 2020, 9(10), 3372; https://doi.org/10.3390/jcm9103372 - 21 Oct 2020

Cited by 53 | Viewed by 16697

Abstract

The aggressive outbreak of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) as COVID-19 (coronavirus disease-2019) pandemic demands rapid and simplified testing tools for its effective management. Increased mass testing and surveillance are crucial for controlling the disease spread, obtaining better pandemic statistics, and [...] Read more.

The aggressive outbreak of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) as COVID-19 (coronavirus disease-2019) pandemic demands rapid and simplified testing tools for its effective management. Increased mass testing and surveillance are crucial for controlling the disease spread, obtaining better pandemic statistics, and developing realistic epidemiological models. Despite the advantages of nucleic acid- and antigen-based tests such as accuracy, specificity, and non-invasive approaches of sample collection, they can only detect active infections. Antibodies (immunoglobulins) are produced by the host immune system within a few days after infection and persist in the blood for at least several weeks after infection resolution. Antibody-based tests have provided a substitute and effective method of ultra-rapid detection for multiple contagious disease outbreaks in the past, including viral diseases such as SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). Thus, although not highly suitable for early diagnosis, antibody-based methods can be utilized to detect past infections hidden in the population, including asymptomatic ones. In an active community spread scenario of a disease that can provide a bigger window for mass detections and a practical approach for continuous surveillance. These factors encouraged researchers to investigate means of improving antibody-based rapid tests and employ them as reliable, reproducible, sensitive, specific, and economic tools for COVID-19 mass testing and surveillance. The development and integration of such immunoglobulin-based tests can transform the pandemic diagnosis by moving the same out of the clinics and laboratories into community testing sites and homes. This review discusses the principle, technology, and strategies being used in antibody-based testing at present. It also underlines the immense prospect of immunoglobulin-based testing and the efficacy of repeated planned deployment in pandemic management and post-pandemic sustainable screenings globally. Full article

(This article belongs to the Special Issue Coronavirus Disease 2019 (COVID-19) Pandemic: Current Knowledge and Future Perspectives)

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19 pages, 310 KiB

Open AccessArticle

Stressful Life Events and the Clinical Expression of Obsessive–Compulsive Disorder (OCD): An Exploratory Study

by André Kracker Imthon, César Antônio Caldart, Maria Conceição do Rosário, Leonardo F. Fontenelle, Euripedes Constantino Miguel and Ygor Arzeno Ferrão

J. Clin. Med. 2020, 9(10), 3371; https://doi.org/10.3390/jcm9103371 - 21 Oct 2020

Cited by 22 | Viewed by 7024

Abstract

Background: In obsessive–compulsive disorder (OCD), symptom content and severity appear to fluctuate over the course of the life cycle in accordance with stressful life events. The objective of this paper was to compare OCD patients with and without reported stressful life events (SLEs) [...] Read more.

Background: In obsessive–compulsive disorder (OCD), symptom content and severity appear to fluctuate over the course of the life cycle in accordance with stressful life events. The objective of this paper was to compare OCD patients with and without reported stressful life events (SLEs) in terms of the sociodemographics of patients and the clinical characteristics of OCD. Methods: This was a cross-sectional study involving 1001 patients with OCD. Data concerning SLEs were collected via the Yale OCD Natural History Questionnaire, while for OCD symptoms, the Dimensional Yale–Brown Obsessive–Compulsive Scale was used. Results: Of the 1001 OCD patients, 605 (60.5%) reported experiencing at least one SLE in their lifetime. Self-declared nonwhite skin color (odds ratio (OR) = 1.51), the presence of a sensory phenomenon (OR = 1.47), and comorbidity with post-traumatic stress disorder (PTSD) (OR = 2.38) were some of the logistic regression variables related to the reported SLEs with relevant statistical significance and risk (i.e., OR) values. Conclusions: Our results indicate that SLEs may make Brazilian OCD patients vulnerable to the onset or exacerbation of obsessive–compulsive symptoms. The positive association of the occurrence of SLEs and sensory phenomena in this population could corroborate that environmental influences impact the neurobiology associated with OCD, and likely with other psychiatric disorders as well. Full article

(This article belongs to the Special Issue Compulsive and Impulsive Disorders: Symptoms, Mechanisms and Therapeutic Approaches)

13 pages, 1208 KiB

Open AccessArticle

Ischemic and Bleeding Events Associated with Thrombocytopenia and Thrombocytosis after Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

by Ji Woong Roh, Sungmin Lim, Youngdeok Hwang, Kwan Yong Lee, Eun Ho Choo, Ik Jun Choi, Byung-Hee Hwang, Chan Joon Kim, Mahn-Won Park, Dong-Bin Kim, Jong-Min Lee, Chul Soo Park, Hee-Yeol Kim, Ki-Dong Yoo, Doo Soo Jeon, Ho Joong Youn, Wook Sung Chung, Min Chul Kim, Myung Ho Jeong, Youngkeun Ahn and Kiyuk Chang Show full author list Hide full author list

J. Clin. Med. 2020, 9(10), 3370; https://doi.org/10.3390/jcm9103370 - 21 Oct 2020

Cited by 9 | Viewed by 2450

Abstract

The early and late ischemic and bleeding clinical outcomes according to baseline platelet count after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) remain unclear. Overall, 10,667 patients from the Cardiovascular Risk and identification of potential high-risk population in AMI [...] Read more.

The early and late ischemic and bleeding clinical outcomes according to baseline platelet count after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) remain unclear. Overall, 10,667 patients from the Cardiovascular Risk and identification of potential high-risk population in AMI (COREA-AMI) I and II registries were classified according to the following universal criteria on baseline platelet counts: (1) moderate to severe thrombocytopenia (platelet < 100 K/μL, n = 101), (2) mild thrombocytopenia (platelet = 100~149 K/μL, n = 631), (3) normal reference (platelet = 150~450 K/μL, n = 9832), and (4) thrombocytosis (platelet > 450 K/μL, n = 103). The primary endpoint was the occurrence of major adverse cardiovascular events (MACE). The secondary outcome was Bleeding Academic Research Consortium (BARC) 2, 3, and 5 bleeding. After adjusting for confounders, the moderate to severe thrombocytopenia (HR, 2.03; 95% CI, 1.49–2.78); p < 0.001), mild thrombocytopenia (HR, 1.15; 95% CI, 1.01–1.34; p = 0.045), and thrombocytosis groups (HR, 1.47; 95% CI, 1.07–2.03; p = 0.019) showed higher 5-year MACE rates than the normal reference. In BARC 2, 3, and 5 bleeding outcomes, the bleedings rates were higher than the normal range in the moderate to severe thrombocytopenia (HR, 2.18; 95% CI, 1.36–3.49; p = 0.001) and mild thrombocytopenia (HR, 1.41; 95% CI, 1.12–1.78; p = 0.004) groups. Patients with AMI had higher 5-year MACE rates after PCI if they had lower- or higher-than-normal platelet counts. Thrombocytopenia revealed higher early and late bleeding rates whereas thrombocytosis showed long-term bleeding trends, although these trends were not statistically significant. Full article

(This article belongs to the Special Issue Acute Coronary Syndromes: Precision Treatment)

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20 pages, 749 KiB

Open AccessReview

Clinical Application of Virtual Reality for Upper Limb Motor Rehabilitation in Stroke: Review of Technologies and Clinical Evidence

by Won-Seok Kim, Sungmin Cho, Jeonghun Ku, Yuhee Kim, Kiwon Lee, Han-Jeong Hwang and Nam-Jong Paik

J. Clin. Med. 2020, 9(10), 3369; https://doi.org/10.3390/jcm9103369 - 21 Oct 2020

Cited by 120 | Viewed by 15977

Abstract

Neurorehabilitation for stroke is important for upper limb motor recovery. Conventional rehabilitation such as occupational therapy has been used, but novel technologies are expected to open new opportunities for better recovery. Virtual reality (VR) is a technology with a set of informatics that [...] Read more.

Neurorehabilitation for stroke is important for upper limb motor recovery. Conventional rehabilitation such as occupational therapy has been used, but novel technologies are expected to open new opportunities for better recovery. Virtual reality (VR) is a technology with a set of informatics that provides interactive environments to patients. VR can enhance neuroplasticity and recovery after a stroke by providing more intensive, repetitive, and engaging training due to several advantages, including: (1) tasks with various difficulty levels for rehabilitation, (2) augmented real-time feedback, (3) more immersive and engaging experiences, (4) more standardized rehabilitation, and (5) safe simulation of real-world activities of daily living. In this comprehensive narrative review of the application of VR in motor rehabilitation after stroke, mainly for the upper limbs, we cover: (1) the technologies used in VR rehabilitation, including sensors; (2) the clinical application of and evidence for VR in stroke rehabilitation; and (3) considerations for VR application in stroke rehabilitation. Meta-analyses for upper limb VR rehabilitation after stroke were identified by an online search of Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Library, and KoreaMed. We expect that this review will provide insights into successful clinical applications or trials of VR for motor rehabilitation after stroke. Full article

(This article belongs to the Special Issue Novel Technology Application for Clinical Neurorehabilitation)

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12 pages, 663 KiB

Open AccessArticle

Distinct Expression Patterns of VEGFR 1-3 in Gastroenteropancreatic Neuroendocrine Neoplasms: Supporting Clinical Relevance, but not a Prognostic Factor

by Florian Bösch, Annelore Altendorf-Hofmann, Sven Jacob, Christoph J. Auernhammer, Christine Spitzweg, Stefan Boeck, Gabriele Schubert-Fritschle, Jens Werner, Thomas Kirchner, Martin K. Angele and Thomas Knösel

J. Clin. Med. 2020, 9(10), 3368; https://doi.org/10.3390/jcm9103368 - 21 Oct 2020

Cited by 4 | Viewed by 2110

Abstract

Introduction: Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are an increasing tumor entity. Since many patients are diagnosed at an advanced stage, treatment is still challenging and dependent on many tumor and patient specific factors. Therefore, the aim of the present study was to elucidate the [...] Read more.

Introduction: Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are an increasing tumor entity. Since many patients are diagnosed at an advanced stage, treatment is still challenging and dependent on many tumor and patient specific factors. Therefore, the aim of the present study was to elucidate the expression rates and the prognostic value of vascular endothelial growth factor receptor (VEGFR) 1-3 in GEP-NENs. A potential association to immune checkpoint markers was further investigated. Material and Methods: The expression levels of VEGFR 1-3 were analyzed by immunohistochemistry and correlated with the expression of the checkpoint markers PD-1 and PD-L1. Furthermore, the tumor samples of 249 GEP-NEN patients were studied and correlated with overall survival rates and clinicopathological features. Kaplan–Meier analyses and the log rank test were used for survival analyses. Categorical variables were compared by the χ2 test. Results: The most common primary tumor site was the small intestine (50.6%), followed by the pancreas (25.7%). VEGFR 1 was highly expressed in 59%, VEGFR 2 in 6.4%, and VEGFR 3 in 61.8% of the analyzed samples. The expression of VEGFR 1-3 was not significantly associated with survival rates. Pancreatic NENs had the highest expression of VEGFR 1 and 3 in 80% of the cases. VEGFR 1-3 positivity correlated with the expression levels of immune checkpoint markers. Discussion: VEGFR 1-3 show a distinct expression pattern in different subgroups of neuroendocrine neoplasias indicating a conceivable target. Moreover, there was a substantial association between VEGFRs and immune checkpoint markers. Taken together, anti-VEGFR therapy represents a promising therapeutic approach in GEP-NEN patients and should be addressed in future studies. Full article

(This article belongs to the Special Issue Neuroendocrine Tumors and Therapeutic Optimization)

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19 pages, 316 KiB

Open AccessArticle

Changes in Metabolic Profile in the Women with a History of PCOS—A Long-Term Follow-Up Study

by Małgorzata Jacewicz-Święcka and Irina Kowalska

J. Clin. Med. 2020, 9(10), 3367; https://doi.org/10.3390/jcm9103367 - 20 Oct 2020

Cited by 9 | Viewed by 3268

Abstract

Data concerning metabolic consequences in women with polycystic ovary syndrome (PCOS) are delivered mainly by cross-sectional studies. In this research, we re-examined 31 Caucasian PCOS women after a median period of 120.9 months to evaluate the changes in metabolic syndrome components. Clinical examination, [...] Read more.

Data concerning metabolic consequences in women with polycystic ovary syndrome (PCOS) are delivered mainly by cross-sectional studies. In this research, we re-examined 31 Caucasian PCOS women after a median period of 120.9 months to evaluate the changes in metabolic syndrome components. Clinical examination, oral glucose tolerance test with estimations of glucose and insulin, lipids, sex hormone-binding globulin (SHBG) and sex hormones assessments were performed on two occasions. Additionally, the euglycaemic hyperinsulinaemic clamp technique was used at the baseline to assess insulin sensitivity (M-clamp value). In the end, the median age of participants was 35. We observed an increase in glucose concentrations, a decrease in insulin concentrations and no changes in insulin resistance markers. Final mean glucose, mean insulin, Matsuda index and body mass index (BMI) were correlated with baseline M-clamp value and SHBG (p < 0.01). During the follow-up, no one in the sample developed diabetes. The annualised incidence rate for conversion from normoglycaemia to prediabetes totalled 4.5%. Baseline BMI, free androgen index, fasting glucose and M-clamp value were identified as prediabetes predictors in young PCOS women (respectively, OR = 1.17, OR = 1.42, OR = 1.2, OR = 0.73, p < 0.05). Prediabetes appeared in 76.47% of the women with a final BMI of ≥ 25 kg/m² and in 7.14% of the normal-weight women (p = 0.0001). In conclusion, we report a high rate of adverse change in glucose metabolism in overweight and obese participants, a deterioration in β-cell function and strong correlations between metabolic parameters assessed in the third and the fourth decade in PCOS women, emphasising the role of early intervention to prevent cardiometabolic diseases. Full article

(This article belongs to the Special Issue Polycystic Ovary Syndrome in Gynecologic Endocrinology)

8 pages, 867 KiB

Open AccessArticle

Evaluation of Strip Meniscometry and Association with Clinical and Demographic Variables in a Community Eye Study (in Bangladesh)

by Mamunur A.K.M. Rashid, Zhang Zhe Thia, Calesta Hui Yi Teo, Sumaiya Mamun, Hon Shing Ong and Louis Tong

J. Clin. Med. 2020, 9(10), 3366; https://doi.org/10.3390/jcm9103366 - 20 Oct 2020

Cited by 5 | Viewed by 2746

Abstract

Strip meniscometry (SM) is a relatively new technique for evaluating inferior tear meniscus. We described SM in an epidemiology study and its potential associations with clinical and tear parameters. This cross-sectional study involved 1050 factory garment workers in Gazipur, Bangladesh. The Ocular Surface [...] Read more.

Strip meniscometry (SM) is a relatively new technique for evaluating inferior tear meniscus. We described SM in an epidemiology study and its potential associations with clinical and tear parameters. This cross-sectional study involved 1050 factory garment workers in Gazipur, Bangladesh. The Ocular Surface Disease Index (OSDI) questionnaire and a standard examination for dry eye and meibomian gland dysfunction (MGD), including the five-second SM, were performed by a single ophthalmologist. The participants’ ages were 35.56 ± 12.12 years (range 18–59), with 53.8% women. The overall SM was 7.7 ± 3.6 mm, with skewness of 0.126 and kurtosis of 1.84 in frequency distribution. SM values were significantly lower in men than women, and significantly correlated with schirmers (r = 0.71) and tear break up time (TBUT) (r = 0.89). A lower SM value was associated with higher OSDI, lower Schirmer test, increased MG severity and lower TBUT. In multivariable analysis, when adjusted by age, SM values remained associated with schirmers and TBUT, and inversely associated with OSDI. In a separate regression model, higher SM was associated with increasing age, reduced severity of MGD grading, and increased TBUT. To conclude, SM is a rapid clinical test associated with dry eye symptoms and signs, with findings affected by both tear secretion and tear stability. Full article

(This article belongs to the Special Issue Cutting-Edge Topics in Dry Eye Disease)

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11 pages, 833 KiB

Open AccessArticle

Association between Carotid Artery Calcification and Periodontal Disease Progression in Japanese Men and Women: A Cross-Sectional Study

by Nanae Dewake, Yasuaki Ishioka, Keiichi Uchida, Akira Taguchi, Yukihito Higashi, Akihiro Yoshida and Nobuo Yoshinari

J. Clin. Med. 2020, 9(10), 3365; https://doi.org/10.3390/jcm9103365 - 20 Oct 2020

Cited by 8 | Viewed by 2837

Abstract

Objective: To evaluate the association between alveolar bone loss (ABL) detected on panoramic radiographs and carotid artery calcification (CAC) detected on computed tomography (CT). Methods: The study subjects included 295 patients (mean age ± SD: 64.6 ± 11.8 years) who visited the Matsumoto [...] Read more.

Objective: To evaluate the association between alveolar bone loss (ABL) detected on panoramic radiographs and carotid artery calcification (CAC) detected on computed tomography (CT). Methods: The study subjects included 295 patients (mean age ± SD: 64.6 ± 11.8 years) who visited the Matsumoto Dental University Hospital. The rate of ABL and the number of present teeth were measured on panoramic radiographs. Univariate analyses with t-tests and chi-squared tests were performed to evaluate the differences in age, gender, history of diseases, number of present teeth, and the ABL between subjects, with and without CAC. Moreover, multivariate logistic regression analysis, with forward selection and receiver operating characteristic curve (ROC) analysis, was performed. Results: The number of subjects without and with CAC was 174 and 121, respectively. Univariate analyses revealed that CAC was significantly associated with age, hypertension, osteoporosis, number of present teeth, and ABL. Multivariate logistic regression analysis adjusted for covariates revealed that the presence of CAC was significantly associated with ABL (OR = 1.233, 95% CI = 1.167–1.303). In the ROC analysis for predicting the presence of CAC, the the area under the ROC curve was the highest at 0.932 (95% CI = 0.904–0.960) for ABL, which was significant. Conclusions: Our results suggest that the measurement of ABL on panoramic radiographs may be an effective approach to identifying patients with an increased risk of CAC. Full article

(This article belongs to the Special Issue Prevention and Treatment of Periodontitis)

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12 pages, 2297 KiB

Open AccessArticle

Increased Diagnostic Certainty of Periprosthetic Joint Infections by Combining Microbiological Results with Histopathological Samples Gained via a Minimally Invasive Punching Technique

by Andreas Enz, Johanna Becker, Philipp Warnke, Friedrich Prall, Christoph Lutter, Wolfram Mittelmeier and Annett Klinder

J. Clin. Med. 2020, 9(10), 3364; https://doi.org/10.3390/jcm9103364 - 20 Oct 2020

Cited by 9 | Viewed by 2459

Abstract

Background: The diagnosis of low-grade infections of endoprostheses is challenging. There are still no unified guidelines for standardised diagnostic approaches, recommendations are categorised into major and minor criteria. Additional histopathological samples might sustain the diagnosis. However, ambulatory preoperative biopsy collection is not widespread. [...] Read more.

Background: The diagnosis of low-grade infections of endoprostheses is challenging. There are still no unified guidelines for standardised diagnostic approaches, recommendations are categorised into major and minor criteria. Additional histopathological samples might sustain the diagnosis. However, ambulatory preoperative biopsy collection is not widespread. Method: 102 patients with hip or knee endoprosthesis and suspected periprosthetic joint infection (PJI) were examined by arthrocentesis with microbiological sample and histopathological punch biopsy. The data were retrospectively analysed for diagnosis concordance. Results: Preoperative microbiology compared to intraoperative results was positive in 51.9% (sensitivity 51.9%, specificity 97.3%). In comparison of preoperative biopsy to intraoperative diagnostic results 51.9% cases were positive (sensitivity 51.9%, specificity 100.0%). The combination of preoperative biopsy and microbiology in comparison to intraoperative results was positive in 70.4% of the cases (sensitivity 70.4%, specificity 97.3%). Conclusion: The diagnosis of PJI is complex. One single method to reliably detect an infection is currently not available. With the present method histopathological samples might be obtained quickly, easily and safely for the preoperative detection of PJI. A combination of microbiological and histopathological sampling increases the sensitivity up to 18.5% to detect periprosthetic infection. Full article

(This article belongs to the Special Issue Advances in Prosthetic Joint Infection Care)

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11 pages, 499 KiB

Open AccessArticle

Clinic Utilization and Characteristics of Patients Accessing a Prostate Cancer Supportive Care Program’s Sexual Rehabilitation Clinic

by Julie Wong, Luke Witherspoon, Eugenia Wu, Sara Sheikholeslami, Wen Liao, Wallace Yuen, Jenna Bentley, Christine Zarowski, Monita Sundar, Stacy Elliott, Celestia S. Higano and Ryan Flannigan

J. Clin. Med. 2020, 9(10), 3363; https://doi.org/10.3390/jcm9103363 - 20 Oct 2020

Cited by 2 | Viewed by 4189

Abstract

Prostate cancer (PC) treatment leads to impairment of sexual function. The Prostate Cancer Supportive Care (PCSC) Program’s Sexual Rehabilitation clinic (SRC) assists patients and their partners with sexual recovery using a biopsychosocial approach to rehabilitation. This study characterizes patients seen in the SRC [...] Read more.

Prostate cancer (PC) treatment leads to impairment of sexual function. The Prostate Cancer Supportive Care (PCSC) Program’s Sexual Rehabilitation clinic (SRC) assists patients and their partners with sexual recovery using a biopsychosocial approach to rehabilitation. This study characterizes patients seen in the SRC between July 2013–1 July 2019. Data was retrospectively abstracted from clinic records. In total, 965 patients were seen over 3391 appointments during the study period. Median age (standard deviation (SD)) was 66 years (SD = 7.1), 82.0% were partnered, yet 81.7% attended appointments alone. 88.0% were treated with surgery, 5.1% with brachytherapy, 3.7% with external beam radiation (EBRT), 1.8% with combined brachytherapy and EBRT, and 1.4% with androgen deprivation therapy. In total, 708 patients (73.4%) attended ≥1 follow-up appointment. Median time (SD) between end of prostate cancer treatment to first SRC appointment was 270 days (range 0–7766). The mean (SD) self-reported overall sexual satisfaction (extracted from International Index of Erectile Function-5 (IIEF-5)) significantly increased both with erectile aids (1.69 (SD = 1.52) to 2.26 (SD = 1.66), p < 0.001, n = 148) and without erectile aids (1.71 (SD = 1.44) to 2.35 (SD = 1.57), p < 0.001, n = 235). This study provides guidance for further investigation to refine treatment, wait-times, support, and/or resource offerings in this type of program. Full article

(This article belongs to the Special Issue Cancer Rehabilitation and Survivorship)

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13 pages, 1528 KiB

Open AccessArticle

Subsidence of Uncemented Short Stems in Reverse Shoulder Arthroplasty—A Multicenter Study

by Anna-K. Tross, Alexandre Lädermann, Thomas Wittmann, Marc Schnetzke, Philip-C. Nolte, Philippe Collin and Patric Raiss

J. Clin. Med. 2020, 9(10), 3362; https://doi.org/10.3390/jcm9103362 - 20 Oct 2020

Cited by 15 | Viewed by 3639

Abstract

Background: The radiological phenomenon of subsidence following the implantation of uncemented short-stem reverse prostheses (USSP) has not yet been described. The purpose of this study was to describe the rate and potential risk factors for subsidence. We hypothesized that subsidence may be a [...] Read more.

Background: The radiological phenomenon of subsidence following the implantation of uncemented short-stem reverse prostheses (USSP) has not yet been described. The purpose of this study was to describe the rate and potential risk factors for subsidence. We hypothesized that subsidence may be a frequent finding and that a subsidence of >5 mm (mm) is associated with an inferior clinical outcome. Methods: A total of 139 patients with an average age of 73 ± 9 years were included. The clinical and radiological outcome was evaluated at a minimum follow-up (FU) of 12 months. Results: No humeral component loosening was present at a mean FU of 18 (range, 12–51) months. Mean Constant Score (CS) and Subjective Shoulder Value (SSV) improved significantly from 34.3 ± 18.0 points and 37.0 ± 19.5% preoperatively to 72.2 ± 13.4 points and 80.3 ± 16.5% at final FU (p < 0.001). The average subsidence of the USSP was 1.4 ± 3.7 mm. Subsidence of >5 mm was present in 15 patients (11%). No association between a subsidence >5 mm and CS or SSV was found (p = 0.456, p = 0.527). However, a subsidence of >5 mm resulted in lower strength at final FU (p = 0.022). Complications occurred in six cases (4.2%), and the revision rate was 3.5% (five cases). Conclusions: Although subsidence of USSP is a frequent radiographic finding it is not associated with loosening of the component or a decrease in the clinical outcome at short term FU. Level of evidence: Level 4, retrospective study. Full article

(This article belongs to the Special Issue Replacement Surgery and Rehabilitation of the Shoulder)

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18 pages, 306 KiB

Open AccessReview

Bone Loss, Osteoporosis, and Fractures in Patients with Rheumatoid Arthritis: A Review

by Patrice Fardellone, Emad Salawati, Laure Le Monnier and Vincent Goëb

J. Clin. Med. 2020, 9(10), 3361; https://doi.org/10.3390/jcm9103361 - 20 Oct 2020

Cited by 51 | Viewed by 4690

Abstract

Rheumatoid arthritis (RA) is often characterized by bone loss and fragility fractures and is a frequent comorbidity. Compared with a matched population, RA patients with fractures have more common risk factors of osteoporosis and fragility fractures but also risk factors resulting from the [...] Read more.

Rheumatoid arthritis (RA) is often characterized by bone loss and fragility fractures and is a frequent comorbidity. Compared with a matched population, RA patients with fractures have more common risk factors of osteoporosis and fragility fractures but also risk factors resulting from the disease itself such as duration, intensity of the inflammation and disability, and cachexia. The inflammatory reaction in the synovium results in the production of numerous cytokines (interleukin-1, interleukin-6, tumor necrosis factor) that activate osteoclasts and mediate cartilage and bone destruction of the joints, but also have a systemic effect leading to generalized bone loss. Regular bone mineral density (BMD) measurement, fracture risk assessment using tools such as the FRAX algorithm, and vertebral fracture assessment (VFA) should be performed for early detection of osteoporosis and accurate treatment in RA patients. Full article

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

14 pages, 2437 KiB

Open AccessReview

Belching in Gastroesophageal Reflux Disease: Literature Review

by Akinari Sawada, Yasuhiro Fujiwara and Daniel Sifrim

J. Clin. Med. 2020, 9(10), 3360; https://doi.org/10.3390/jcm9103360 - 20 Oct 2020

Cited by 12 | Viewed by 8705

Abstract

Belching is a common phenomenon. However, it becomes bothersome if excessive. Impedance–pH monitoring can classify the belching into two types: gastric belching and supragastric belching (SGB). The former is a physiological mechanism to vent swallowed air from the stomach, whereas the latter is [...] Read more.

Belching is a common phenomenon. However, it becomes bothersome if excessive. Impedance–pH monitoring can classify the belching into two types: gastric belching and supragastric belching (SGB). The former is a physiological mechanism to vent swallowed air from the stomach, whereas the latter is a behavioral disorder. Gastroesophageal reflux disease (GERD) is the most relevant condition in both types of belching. Recent findings have raised awareness that excessive SGB possibly sheds light on the pathogenesis of a part of proton pump inhibitor (PPI) refractoriness in GERD. SGB could cause typical reflux symptoms such as heartburn, regurgitation or chest pain in two ways: SGB-induced gastroesophageal reflux or SGB-induced esophageal distension. In PPI-refractory GERD, it is important to detect hidden SGB as a cause of reflux symptoms since SGB requires psychological treatment instead of high dose PPIs or pain modulators. In the case of PPI-refractory GERD with excessive SGB, recent studies imply that the combination of a psychological approach and conventional treatment can improve treatment outcome. Full article

(This article belongs to the Special Issue New Advances in Gastroesophageal Reflux Disease)

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16 pages, 2410 KiB

Open AccessArticle

Clinical Usefulness of New R-R Interval Analysis Using the Wearable Heart Rate Sensor WHS-1 to Identify Obstructive Sleep Apnea: OSA and RRI Analysis Using a Wearable Heartbeat Sensor

by Takuo Arikawa, Toshiaki Nakajima, Hiroko Yazawa, Hiroyuki Kaneda, Akiko Haruyama, Syotaro Obi, Hirohisa Amano, Masashi Sakuma, Shigeru Toyoda, Shichiro Abe, Takeshi Tsutsumi, Taishi Matsui, Akio Nakata, Ryo Shinozaki, Masayuki Miyamoto and Teruo Inoue

J. Clin. Med. 2020, 9(10), 3359; https://doi.org/10.3390/jcm9103359 - 20 Oct 2020

Cited by 13 | Viewed by 4199

Abstract

Obstructive sleep apnea (OSA) is highly associated with cardiovascular diseases, but most patients remain undiagnosed. Cyclic variation of heart rate (CVHR) occurs during the night, and R-R interval (RRI) analysis using a Holter electrocardiogram has been reported to be useful in screening for [...] Read more.

Obstructive sleep apnea (OSA) is highly associated with cardiovascular diseases, but most patients remain undiagnosed. Cyclic variation of heart rate (CVHR) occurs during the night, and R-R interval (RRI) analysis using a Holter electrocardiogram has been reported to be useful in screening for OSA. We investigated the usefulness of RRI analysis to identify OSA using the wearable heart rate sensor WHS-1 and newly developed algorithm. WHS-1 and polysomnography simultaneously applied to 30 cases of OSA. By using the RRI averages calculated for each time series, tachycardia with CVHR was identified. The ratio of integrated RRIs determined by integrated RRIs during CVHR and over all sleep time were calculated by our newly developed method. The patient was diagnosed as OSA according to the predetermined criteria. It correlated with the apnea hypopnea index and 3% oxygen desaturation index. In the multivariate analysis, it was extracted as a factor defining the apnea hypopnea index (r = 0.663, p = 0.003) and 3% oxygen saturation index (r = 0.637, p = 0.008). Twenty-five patients could be identified as OSA. We developed the RRI analysis using the wearable heart rate sensor WHS-1 and a new algorithm, which may become an expeditious and cost-effective screening tool for identifying OSA. Full article

(This article belongs to the Special Issue Sleep-Disordered Breathing in Cardiovascular Disease)

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18 pages, 2241 KiB

Open AccessArticle

Health Outcomes Associated with Adherence to Antidepressant Use during Acute and Continuation Phases of Depression Treatment among Older Adults with Dementia and Major Depressive Disorder

by Sandipan Bhattacharjee, Suniya Naeem, Shannon M. Knapp, Jeannie K. Lee, Asad E. Patanwala, Nina Vadiei, Daniel C. Malone, Wei-Hsuan Lo-Ciganic and William J Burke

J. Clin. Med. 2020, 9(10), 3358; https://doi.org/10.3390/jcm9103358 - 20 Oct 2020

Cited by 6 | Viewed by 3385

Abstract

Objectives: To examine health outcomes associated with adherence to Healthcare Effectiveness Data and Information Set (HEDIS) antidepressant medication management (AMM) during acute and continuation phases of depression treatment among older adults with dementia and major depressive disorder (MDD). Design: Retrospective cohort study. Setting: [...] Read more.

Objectives: To examine health outcomes associated with adherence to Healthcare Effectiveness Data and Information Set (HEDIS) antidepressant medication management (AMM) during acute and continuation phases of depression treatment among older adults with dementia and major depressive disorder (MDD). Design: Retrospective cohort study. Setting: Medicare 5% sample data (2011–2013). Participants: Older adults (aged 65 years or older) with dementia and MDD. Measurements: The first antidepressant prescription claim from 1 May 2011 through 30 April 2012 was considered the index prescription start date (IPSD). Adherence during acute- and continuation-phase AMM was based on HEDIS guidelines. Study outcomes included all-cause mortality, all-cause hospitalization, and falls/factures (with mortality being the competing event for hospitalization and falls/fractures) during follow-up from end of acute-/continuation-phase AMM adherence. Due to the proportionality assumption violation of Cox models, fully non-parametric approaches (Kaplan–Meier and modified Gray’s test) were used for time-to-event analysis adjusting for the inverse probability of treatment weights. Results: Final study samples consisted of 4330 (adherent (N) = 3114 (71.92%)) and 3941 (adherent (N) = 2407 (61.08%)) older adults with dementia and MDD during acute- and continuation-phase treatments, respectively. No significant difference (p > 0.05) between adherent and non-adherent groups was observed for all-cause mortality and falls/fractures in both the acute and continuation phases. There was a significant difference in time to all-cause hospitalization during acute-phase treatment (p = 0.018), with median times of 530 (95% CI: 499–587) and 425 (95% CI: 364–492) days for adherent and non-adherent groups, respectively. Conclusions: Acute-phase adherence to HEDIS AMM was associated with reductions in all-cause hospitalization risk among older adults with dementia and MDD. Full article

(This article belongs to the Special Issue Translational Research in Aging, Geriatrics and Gerontology)

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18 pages, 787 KiB

Open AccessReview

Accuracy of 3-Dimensionally Printed Full-Arch Dental Models: A Systematic Review

by Yasaman Etemad-Shahidi, Omel Baneen Qallandar, Jessica Evenden, Frank Alifui-Segbaya and Khaled Elsayed Ahmed

J. Clin. Med. 2020, 9(10), 3357; https://doi.org/10.3390/jcm9103357 - 20 Oct 2020

Cited by 117 | Viewed by 7397

Abstract

The use of additive manufacturing in dentistry has exponentially increased with dental model construction being the most common use of the technology. Henceforth, identifying the accuracy of additively manufactured dental models is critical. The objective of this study was to systematically review the [...] Read more.

The use of additive manufacturing in dentistry has exponentially increased with dental model construction being the most common use of the technology. Henceforth, identifying the accuracy of additively manufactured dental models is critical. The objective of this study was to systematically review the literature and evaluate the accuracy of full-arch dental models manufactured using different 3D printing technologies. Seven databases were searched, and 2209 articles initially identified of which twenty-eight studies fulfilling the inclusion criteria were analysed. A meta-analysis was not possible due to unclear reporting and heterogeneity of studies. Stereolithography (SLA) was the most investigated technology, followed by digital light processing (DLP). Accuracy of 3D printed models varied widely between <100 to >500 μm with the majority of models deemed of clinically acceptable accuracy. The smallest (3.3 μm) and largest (579 μm) mean errors were produced by SLA printers. For DLP, majority of investigated printers (n = 6/8) produced models with <100 μm accuracy. Manufacturing parameters, including layer thickness, base design, postprocessing and storage, significantly influenced the model’s accuracy. Majority of studies supported the use of 3D printed dental models. Nonetheless, models deemed clinically acceptable for orthodontic purposes may not necessarily be acceptable for the prosthodontic workflow or applications requiring high accuracy. Full article

(This article belongs to the Special Issue Digital Workflows and Material Sciences in Dental Medicine)

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12 pages, 848 KiB

Open AccessArticle

Myocardial Infarction after Kidney Transplantation: A Risk and Specific Profile Analysis from a Nationwide French Medical Information Database

by Romain Didier, Hermann Yao, Mathieu Legendre, Jean Michel Halimi, Jean Michel Rebibou, Julien Herbert, Marianne Zeller, Laurent Fauchier and Yves Cottin

J. Clin. Med. 2020, 9(10), 3356; https://doi.org/10.3390/jcm9103356 - 19 Oct 2020

Cited by 10 | Viewed by 2529

Abstract

Introduction: Renal transplant recipients have a high peri-operative risk for cardiovascular events. The post-transplantation period also carries a risk of myocardial infarction (MI). Coronary artery disease (CAD) is a leading cause of death in these patients. We aimed to assess the risk of [...] Read more.

Introduction: Renal transplant recipients have a high peri-operative risk for cardiovascular events. The post-transplantation period also carries a risk of myocardial infarction (MI). Coronary artery disease (CAD) is a leading cause of death in these patients. We aimed to assess the risk of MI, the specific morbidity profile of MI after transplantation as well as the long-term prognosis after MI in renal transplantation (RT) patients regarding cardiovascular (CV) death and all-cause death. Methods: From a French national medical information database, all of the patients seen in French hospitals in 2013 with at least 5-years follow-up were retrospectively identified and patients without transplantation but with previous dialysis at baseline were excluded. There were 17,526 patients with RT and 3,288,857 with no RT. Results: Among these patients, 1020 in the RT group (5.8%), and 93,320 in the non-RT group (2.8%) suffered acute MI during a median follow-up of 5.4 years. After multivariable adjustment, risk of MI was higher in RT patients than in non-RT patients (HR 1.45, IC 95% 1.35–1.55). The mean age was 59.5 years for transplant patients with MI, and 70.6 years for the reference population with MI (p < 0.0001). MI patients with RT (vs. non RT patients) were more likely to have hypertension, diabetes dyslipidemia, and peripheral artery disease (76.0% vs. 48.1%, 38.7% vs. 25.2%, 33.2% vs. 23.2%, and 31.2% vs. 17.3%, respectively, p < 0.0001). Incidence of non ST-elevation MI (NSTEMI) was higher in RT patients while incidence of ST-elevation MI (STEMI) was higher in patients without RT. In unadjusted analysis, risk of all-cause death and CV death within the first month after MI were higher in patients without RT (18% vs. 11.1% p < 0.0001 and 12.3% vs. 7.8%, p < 0.0001, respectively). However, multivariable analysis indicated that risk of all-cause death was higher in patients with RT than in those with no RT (adjusted HR 1.15 IC 95% 1.03–1.28). Conclusions: MI is not an uncommon complication after RT (incidence of around 5.8% after 5 years). RT is independently associated with a 45% higher risk of MI than in patients without RT, with a predominance of NSTEMI. MI in patients with RT is independently associated with a 15% higher risk of all-cause death than that in patients with MI and no RT. Full article

(This article belongs to the Special Issue Clinical Complications after Kidney Transplantation)

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9 pages, 443 KiB

Open AccessArticle

Relative Skeletal Muscle Mass Is an Important Factor in Non-Alcoholic Fatty Liver Disease in Non-Obese Children and Adolescents

by Yoowon Kwon and Su Jin Jeong

J. Clin. Med. 2020, 9(10), 3355; https://doi.org/10.3390/jcm9103355 - 19 Oct 2020

Cited by 29 | Viewed by 3007

Abstract

Recently, sarcopenia was identified as a risk factor for non-alcoholic fatty liver disease (NAFLD) in adults. We here investigated the association between skeletal muscle mass (SMM) and NAFLD in non-obese children and adolescents. A retrospective medical chart review was performed for individuals aged [...] Read more.

Recently, sarcopenia was identified as a risk factor for non-alcoholic fatty liver disease (NAFLD) in adults. We here investigated the association between skeletal muscle mass (SMM) and NAFLD in non-obese children and adolescents. A retrospective medical chart review was performed for individuals aged 9–15 years diagnosed with NAFLD. Healthy volunteers aged 9–15 years were recruited as controls. Participants were subject to laboratory tests, abdominal sonography, and multi-frequency bioelectrical impedance analysis. SMM data were calculated as the skeletal muscle-to-body fat ratio (MFR), and the diagnosis of fatty liver was established by abdominal sonography. The control and NAFLD groups included 73 and 53 individuals, respectively. No significant difference was observed in gender and body mass index (BMI) distribution between the groups. Mean MFR was significantly lower in individuals with NAFLD than in those without (0.83 vs. 1.04, p = 0.005). After adjusting for age, sex, BMI, and serum glucose, the risk of having NAFLD was significantly associated with a decreased MFR (p = 0.016). NAFLD is significantly associated with relatively low SMM in non-obese children and adolescents. Increasing SMM, such as weight training, can be suggested as one of the treatment strategies in pediatric NAFLD without obesity. Full article

(This article belongs to the Special Issue Nonalcoholic Fatty Liver Disease (NAFLD): Updates and Future Directions)

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7 pages, 1549 KiB

Open AccessBrief Report

Decreased Cerebrospinal Fluid Orexin-A (Hypocretin-1) Concentrations in Patients after Generalized Convulsive Status Epilepticus

by Mojdeh Samzadeh, Ewa Papuć, Marzena Furtak-Niczyporuk and Konrad Rejdak

J. Clin. Med. 2020, 9(10), 3354; https://doi.org/10.3390/jcm9103354 - 19 Oct 2020

Cited by 8 | Viewed by 2355

Abstract

The effects of status epilepticus on the orexin/hypocretin system have yet to be investigated. The present study aimed to assay orexin-A/hypocretin-1 in the cerebrospinal fluid (CSF) of patients after generalized convulsive status epilepticus (GCSE). The study groups included 20 GCSE patients, 24 patients [...] Read more.

The effects of status epilepticus on the orexin/hypocretin system have yet to be investigated. The present study aimed to assay orexin-A/hypocretin-1 in the cerebrospinal fluid (CSF) of patients after generalized convulsive status epilepticus (GCSE). The study groups included 20 GCSE patients, 24 patients diagnosed with epilepsy but remaining in remission (ER), and 25 normal controls (CTR). Diagnostic lumbar puncture was performed in GCSE patients within 3–10 days of seizure cessation, as well as in the ER and to CTR subjects. Among all GCSE patients, the outcome was graded according to the modified Rankin Scale (mRS) at 1-month follow-up. Orexin-A levels were measured in unextracted CSF samples, using a commercial radioimmunoassay. There was a significant overall difference in median CSF orexin-A concentrations between GCSE, RE, and CTR patients (p < 0.001). The lowest concentrations were noted in the GCSE group compared to ER (p < 0.001) or CTR (p < 0.001). CSF orexin-A levels in GCSE patients inversely correlated with clinical outcome as assessed on the mRS at 1-month follow-up (r = −0.55; p = 0.1). In conclusion, CSF orexin-A levels may serve as a biomarker of increased turn-over of the peptide or post-SE neuronal damage, and implicates the orexin system in the pathogenesis of SE. Full article

(This article belongs to the Section Clinical Neurology)

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Open AccessArticle

Aging Is Positively Associated with Peri-Sinus Lymphatic Space Volume: Assessment Using 3T Black-Blood MRI

by Mina Park, Jin Woo Kim, Sung Jun Ahn, Yoon Jin Cha and Sang Hyun Suh

J. Clin. Med. 2020, 9(10), 3353; https://doi.org/10.3390/jcm9103353 - 19 Oct 2020

Cited by 24 | Viewed by 2803

Abstract

Objectives: Aging is a major risk factor for many neurological disorders and is associated with dural lymphatic dysfunction. We sought to evaluate the association of aging with the volume of the peri-sinus lymphatic space using contrast-enhanced 3T T1-weighted black-blood magnetic resonance imaging (MRI). [...] Read more.

Objectives: Aging is a major risk factor for many neurological disorders and is associated with dural lymphatic dysfunction. We sought to evaluate the association of aging with the volume of the peri-sinus lymphatic space using contrast-enhanced 3T T1-weighted black-blood magnetic resonance imaging (MRI). Methods: In this retrospective study, 165 presumed neurologically normal subjects underwent brain MRIs for cancer staging between April and November 2018. The parasagittal peri-sinus lymphatic space was evaluated using contrast-enhanced 3D T1-weighted black-blood MRIs, and volumes were measured with semiautomatic method. We compared the volumes of normalized peri-sinus lymphatic spaces between the elderly (≥65 years, n = 72) and non-elderly (n = 93) groups and performed multivariate logistic regression analyses to assess if aging is independently associated with the volume of normalized peri-sinus lymphatic spaces. Results: The normalized peri-sinus lymphatic space volume was significantly higher in the elderly than in the non-elderly (mean, 3323 ± 758.7 mL vs. 2968.7 ± 764.3 mL, p = 0.047). After adjusting the intracranial volume, age age was the strongest factor independently associated with peri-sinus lymphatic space volume (β coefficient, 28.4 (5.7–51.2), p = 0.015) followed by male sex (β coefficient, 672.4 (113.5–1230.8), p = 0.019). Conclusions: We found that the peri-sinus dural lymphatic space volume was higher in the elderly group than in the non-elderly group, and the increased peri-sinus lymphatic space was independently associated with aging. These findings indicate that the peri-sinus lymphatic space may be related with the aging process and lymphatic system dysfunction as well. Full article

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

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J. Clin. Med., Volume 9, Issue 10 (October 2020) – 322 articles

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