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J. Clin. Med., Volume 13, Issue 12 (June-2 2024) – 273 articles

Cover Story (view full-size image): Human cytomegalovirus (hCMV) is the most common etiological agent of congenital infections seen in newborns. Ocular complications of congenital CMV (cCMV) are a topic rarely addressed in the literature. English-language literature published between April 2000 and November 2023 was analyzed for ocular complications of cCMV. Ophthalmic complications of cCMV can cause severe visual disturbances. Ophthalmic diagnosis in newborns should include hCMV PCR testing, which has the highest sensitivity and specificity. In the symptomatic form of cCMV, treatment should be instituted according to recommendations. A consensus should be established for the screening of primary hCMV infection in pregnant women, the way in which to define the symptomatic form of cCMV, and the appropriateness and standards of treatment for primary hCMV infection in pregnant women. View this paper
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15 pages, 1687 KiB  
Article
Changes in Cardiac Structure and Function of Recipients after Kidney Transplantation
by Suleyman Akkaya and Umit Cakmak
J. Clin. Med. 2024, 13(12), 3629; https://doi.org/10.3390/jcm13123629 - 20 Jun 2024
Viewed by 1086
Abstract
Background: Chronic kidney disease (CKD) elevates the risk of cardiovascular disease (CVD) and mortality. Uremic cardiomyopathy, frequently observed in CKD and end-stage renal disease (ESRD), involves alterations in cardiac structure and function, which may reverse post-kidney transplantation, although data remain controversial. This study [...] Read more.
Background: Chronic kidney disease (CKD) elevates the risk of cardiovascular disease (CVD) and mortality. Uremic cardiomyopathy, frequently observed in CKD and end-stage renal disease (ESRD), involves alterations in cardiac structure and function, which may reverse post-kidney transplantation, although data remain controversial. This study examines the relationship between graft function and changes in cardiac parameters pre- and post-transplantation in kidney transplant recipients. Methods: A total of 145 pediatric and adult recipients of living or deceased donor kidney transplants were enrolled at Gazi Yaşargil Training and Research Hospital. This cohort study utilized transthoracic echocardiographic (TTE) imaging pre-transplant and at least two years post-transplant. Echocardiographic parameters were analyzed using standard techniques. Results: The mean age of the participants was 35 years, with 60% male. The average dialysis duration prior to transplantation was 27 months. Most recipients (83.4%) received kidneys from living donors. Left ventricular diastolic dysfunction increased significantly post-transplant (p < 0.05), while other cardiac dimensions and functions, such as ejection fraction and pulmonary artery pressure, showed no significant change (p > 0.05). Notably, diastolic dysfunction worsened in patients with dysfunctional grafts (GFR < 45), correlating with increased pulmonary artery pressure post-transplant. The rate of antihypertensive drug use and the prevalence of diabetes mellitus increased significantly post-transplant (p < 0.05). Conclusions: This study demonstrates that left ventricular diastolic dysfunction present before kidney transplantation continues to persist post-transplantation in patients with end-stage renal disease undergoing chronic kidney disease treatment. Furthermore, it shows an increased rate of pulmonary artery pressure and pericardial effusion in patients with dysfunctional grafts after transplantation. Further research is required to explore strategies to reverse uremic cardiomyopathy and reduce cardiovascular risk in these patients. Full article
(This article belongs to the Section Nephrology & Urology)
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<p>Trends in diastolic dysfunction pre- and post-kidney transplantation. This bar chart depicts the percentage of patients with and without diastolic dysfunction before and after kidney transplantation (<b>left</b> graph) and impact of GFR on diastolic dysfunction pre- and post-transplantation. The graph illustrates the prevalence of diastolic dysfunction among patients with different levels of GFR before and after kidney transplantation (<b>right</b> graph).</p> Full article ">Figure 2
<p>Comparison of maximum pulmonary artery pressure (PAB Max) before and after kidney transplantation (TX) (<b>left</b> graph) and pericardial effusion rates before and after kidney transplantation. The chart details the percentage of patients experiencing pericardial effusion, categorized by GFR (<b>right</b> graph).</p> Full article ">
13 pages, 1958 KiB  
Article
Validation of Tracheal Sound-Based Respiratory Effort Monitoring for Obstructive Sleep Apnoea Diagnosis
by Mireia Muñoz Rojo, Renard Xaviero Adhi Pramono, Nikesh Devani, Matthew Thomas, Swapna Mandal and Esther Rodriguez-Villegas
J. Clin. Med. 2024, 13(12), 3628; https://doi.org/10.3390/jcm13123628 - 20 Jun 2024
Viewed by 747
Abstract
Background: Respiratory effort is considered important in the context of the diagnosis of obstructive sleep apnoea (OSA), as well as other sleep disorders. However, current monitoring techniques can be obtrusive and interfere with a patient’s natural sleep. This study examines the reliability of [...] Read more.
Background: Respiratory effort is considered important in the context of the diagnosis of obstructive sleep apnoea (OSA), as well as other sleep disorders. However, current monitoring techniques can be obtrusive and interfere with a patient’s natural sleep. This study examines the reliability of an unobtrusive tracheal sound-based approach to monitor respiratory effort in the context of OSA, using manually marked respiratory inductance plethysmography (RIP) signals as a gold standard for validation. Methods: In total, 150 patients were trained on the use of type III cardiorespiratory polygraphy, which they took to use at home, alongside a neck-worn AcuPebble system. The respiratory effort channels obtained from the tracheal sound recordings were compared to the effort measured by the RIP bands during automatic and manual marking experiments. A total of 133 central apnoeas, 218 obstructive apnoeas, 263 obstructive hypopneas, and 270 normal breathing randomly selected segments were shuffled and blindly marked by a Registered Polysomnographic Technologist (RPSGT) in both types of channels. The RIP signals had previously also been independently marked by another expert clinician in the context of diagnosing those patients, and without access to the effort channel of AcuPebble. The classification achieved with the acoustically obtained effort was assessed with statistical metrics and the average amplitude distributions per respiratory event type for each of the different channels were also studied to assess the overlap between event types. Results: The performance of the acoustic effort channel was evaluated for the events where both scorers were in agreement in the marking of the gold standard reference channel, showing an average sensitivity of 90.5%, a specificity of 98.6%, and an accuracy of 96.8% against the reference standard with blind expert marking. In addition, a comparison using the Embla Remlogic 4.0 automatic software of the reference standard for classification, as opposed to the expert marking, showed that the acoustic channels outperformed the RIP channels (acoustic sensitivity: 71.9%; acoustic specificity: 97.2%; RIP sensitivity: 70.1%; RIP specificity: 76.1%). The amplitude trends across different event types also showed that the acoustic channels exhibited a better differentiation between the amplitude distributions of different event types, which can help when doing manual interpretation. Conclusions: The results prove that the acoustically obtained effort channel extracted using AcuPebble is an accurate, reliable, and more patient-friendly alternative to RIP in the context of OSA. Full article
(This article belongs to the Section Pulmonology)
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<p>Respiratory flow, abdomen, thorax, and effort channels obtained from the acoustic signal during a central apnoea, an obstructive apnoea, an obstructive hypopnoea, and a period of normal breathing. A slight shift in the oscillations of the second effort signal can be observed with respect to the first effort signal during the obstructive apnoea event. This mirrors the paradoxical effort oscillation observed during the same event between the signals recorded with the abdominal and thoracic bands.</p> Full article ">Figure 2
<p>Block diagram detailing the flow of data used for analysis in both validation studies. The number of events and the type of events included in each validation analysis are shown.</p> Full article ">Figure 3
<p>Distribution of average amplitude values of RIP effort (<b>a</b>) and acoustic effort (<b>b</b>) during normal breathing and different respiratory events. The distribution has been summarised in five centiles (5th, 25th, 50th, 75th, and 95th) for each event type.</p> Full article ">Figure 4
<p>Confusion matrices for the effort channel from acoustics (<b>a</b>) and the RIP effort channel (<b>b</b>).</p> Full article ">Figure 5
<p>Confusion matrix showing the classification achieved by the manual marker when using the acoustic channels as a measure of respiratory effort, when considering only the events that were classified in the same way by both scorers.</p> Full article ">
15 pages, 10380 KiB  
Article
Bone Scintigraphy for Guidance of Targeted Treatment of Vertebral Compression Fractures
by Elite Arnon-Sheleg, Daniel Weiner, Saeda Haj, Alon Rod and Nimrod Rahamimov
J. Clin. Med. 2024, 13(12), 3627; https://doi.org/10.3390/jcm13123627 - 20 Jun 2024
Viewed by 548
Abstract
Background: Vertebral compression fractures (VCFs) are prevalent in the elderly population and might be the source of back pain if they are fresh and yet unhealed. In many cases, it is a diagnostic challenge to differentiate fresh VCFs from healed united fractures, which [...] Read more.
Background: Vertebral compression fractures (VCFs) are prevalent in the elderly population and might be the source of back pain if they are fresh and yet unhealed. In many cases, it is a diagnostic challenge to differentiate fresh VCFs from healed united fractures, which retain similar radiographic characteristics but no longer generate pain. This information is crucial for appropriate management. The aim of this study was to evaluate the role of bone scintigraphy (BS) in identifying fresh VCFs appropriate for targeted treatment when compared to the findings of Computerized Tomography (CT). Methods: We retrospectively reviewed 190 patients with back pain suspected to stem from a recent VCF that underwent both a CT and a BS and compared the imaging patterns per vertebra. Results: The studies were concordant in the majority of cases (95.5%), diagnosing 84.4% normal vertebrae, 6.4% acute VCFs, and 4.7% chronic VCFs. However, in 37 patients, 45 occult acute VCFs were only detected on BS and not on CT. Multivariate logistic regression analysis revealed that these patients were older and had lower bone density compared to the rest of the study population. Additionally, 40 patients had acute VCFs visible on CT, but with no increased or low intensity uptake on BS. These cases were associated with a shorter time period between trauma and BS, a higher prevalence of male patients, and a higher bone density. Acute VCFs with no increased uptake or low levels of uptake were found only within the first six days of the trauma. Conclusions: BS detects radiologically occult fractures and can differentiate if a radiographically evident VCF is indeed clinically active, guiding possible treatment options. To avoid missing acute VCFs, BS should be performed six days or more after the injury. Full article
(This article belongs to the Special Issue Acute Trauma and Trauma Care in Orthopedics)
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<p>Patterns of vertebrae appearance on sagittal spine CT. (<b>A</b>) Normal vertebra—retained height and continuous cortex. (<b>B</b>) Acute VCF showing a “step defect” in the anterior border and a “zone of impaction” caused by impaction of the trabeculae. (<b>C</b>) Non-union fracture—a non-healed fracture with an intervertebral cleft (white arrow). (<b>D</b>) Ankylotic fracture—a transverse fracture below an ankylotic spine segment. (<b>E</b>) Chronic fracture showing loss of height and smooth cortical borders. (<b>F</b>) State after percutaneous vertebroplasty (Post VP)—chronic fracture with loss of height and hyperdense cement in the vertebral body.</p> Full article ">Figure 2
<p>Distribution of VCFs according to type and location on CT.</p> Full article ">Figure 3
<p>Distribution of VCFs according to uptake intensity and location on bone scintigraphy.</p> Full article ">Figure 4
<p>Radiotracer uptake intensity according to time after trauma.</p> Full article ">Figure 5
<p>Occult fractures. A 78-year-old female complaining of back pain, without known trauma. CT was acquired on the day of admission and bone scintigraphy was performed 2 days after the CT. (<b>A</b>)—Sagittal spine CT shows a non-union fracture in L4. No other fractures are demonstrated. Bone density measured in L3 was 7 HUs, consistent with severe osteoporosis. (<b>B</b>)—Planar anterior and posterior bone scintigraphy shows high-intensity uptake in L2 and L3, suggestive of acute fractures. (<b>C</b>)—Axial, coronal, and sagittal SPECT show high-intensity uptake in L2 and L3.</p> Full article ">Figure 6
<p>High-intensity uptake in an acute fracture, no uptake in chronic fractures post-vertebroplasty. A 77-year-old female after trauma. CT was acquired on the day of injury and bone scintigraphy was performed 3 days after the injury. (<b>A</b>,<b>B</b>)—Sagittal spine CT (enlarged in B) show an acute fracture in T11 (white arrow) and chronic fractures after vertebroplasty in T12 and L3. (<b>C</b>)—Planar anterior and posterior bone scintigraphy show high-intensity uptake in T11 (black arrow), indicating an acute fracture and no increased uptake in T12 and L3, consistent with chronic fractures. Note also, high-intensity uptake is seen in the anterior aspect of the left acetabulum (black arrow head), consistent with an acute fracture.</p> Full article ">Figure 7
<p>Low-intensity uptake in an acute ankylotic VCF. A 72-year-old male. CT was acquired on the day of injury and bone scintigraphy was performed 3 days after the injury. (<b>A</b>)—Coronal, axial, and sagittal spine CT show an acute ankylotic fracture in L2 and a fracture involving an osteophyte in L1 (white arrow). (<b>B</b>)—Planar anterior and posterior bone scintigraphy do not show any increased uptake in L2. (<b>C</b>)—Coronal, sagittal, axial, and MIP SPECT show only low-intensity uptake in L2 (black arrow).</p> Full article ">Figure 8
<p>VCF diagnostic flow-chart. When MRI is unavailable or contraindicated. ** Bone scan should be obtained at least 48 h after injury or onset of pain.</p> Full article ">
11 pages, 1089 KiB  
Article
Assessing the Impact of Simulated Color Vision Deficiency on Ophthalmologists’ Ability to Differentiate between Choroidal Melanoma and Choroidal Nevus
by Yacoub A. Yousef, Fawzieh Alkhatib, Mutasem Elfalah, Saif Aldeen AlRyalat, Mona Mohammad, Omar AlHabahbeh, Reem AlJabari, Sandrine Zweifel, Ibrahim AlNawiaseh, Robert Rejdak and Mario Damiano Toro
J. Clin. Med. 2024, 13(12), 3626; https://doi.org/10.3390/jcm13123626 - 20 Jun 2024
Viewed by 655
Abstract
Background: Color vision deficiency (CVD) is an often-overlooked issue within the medical community, and its consequences remain insufficiently explored. We aim to evaluate how CVD affects diagnostic accuracy and distinguish between malignant choroidal melanoma and benign choroidal nevus among ophthalmologists. Methods: In this [...] Read more.
Background: Color vision deficiency (CVD) is an often-overlooked issue within the medical community, and its consequences remain insufficiently explored. We aim to evaluate how CVD affects diagnostic accuracy and distinguish between malignant choroidal melanoma and benign choroidal nevus among ophthalmologists. Methods: In this cross-sectional study, we engaged ophthalmologists through a web-based survey distributed via the professional ophthalmology society’s social media channels. The survey encompassed a series of three fundus images representing normal fundus, choroidal nevus, and choroidal melanoma. Each image underwent simulation for the three primary types of CVD—protanopia, deuteranopia, and tritanopia—alongside a non-simulated version. Results: The study included 41 participants, averaging 40 years of age (±9.2), comprising 28 (68%) men and 13 (32%) women. Significantly lower rates of identifying orange pigments were observed in simulated protanopia images compared to non-simulated ones (p = 0.038). In simulated deutranopia images, the recognition of melanotic lesions was notably reduced compared to non-simulated images (p = 0.048). No such limitation was observed for tritanopia. However, participants retained their ability to identify subretinal fluid and estimate tumor thickness in simulated and non-simulated images. Concerning simulated images of choroidal nevi, participants misdiagnosed nevi as choroidal melanoma in 37% of cases in simulated protanopia nevi images and 41% in simulated deutranopia nevi images. This resulted in unnecessary referrals of benign lesions as malignant, emphasizing the potential for mistaken diagnoses. Nevertheless, almost all simulated images of malignant melanoma were correctly referred for specialized oncological treatment. Conclusions: The simulated CVD conditions of protanopia and deuteranopia affected the accuracy of identifying the melanotic nature of the choroidal tumor and the presence of orange pigments. This limitation led to challenges in correctly diagnosing choroidal melanoma and choroidal nevus, resulting in extra referrals for nevus cases. However, participants were safe and could still determine the possible risk of eyes with choroidal melanoma, so most referred melanoma cases to specialized oncologists as needed. Full article
(This article belongs to the Collection Recent Advances of Examination and Treatment for Retinal and Choroidal Diseases)
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<p>Fundus images for normal fundus (<b>A</b>) and images with simulated protanopia (<b>B</b>), deuteranopia (<b>C</b>), and tritanopia (<b>D</b>).</p> Full article ">Figure 2
<p>Fundus images for choroidal nevus (<b>A</b>) and images with simulated protanopia (<b>B</b>), deuteranopia (<b>C</b>), and tritanopia (<b>D</b>).</p> Full article ">Figure 3
<p>Fundus images for malignant melanoma (<b>A</b>) and images with simulated protanopia (<b>B</b>), deuteranopia (<b>C</b>), and tritanopia (<b>D</b>).</p> Full article ">
10 pages, 3152 KiB  
Article
The ‘Radiant Effect’: Recent Sonographic Image-Enhancing Technique and Its Impact on Nuchal Translucency Measurements
by Arne Bergsch, Jan Degenhardt, Rüdiger Stressig, Heiko Dudwiesus, Oliver Graupner and Jochen Ritgen
J. Clin. Med. 2024, 13(12), 3625; https://doi.org/10.3390/jcm13123625 - 20 Jun 2024
Viewed by 501
Abstract
Background: This study assesses the effects of the ‘Radiant’ image enhancement technique on fetal nuchal translucency (NT) measurements during first-trimester sonographic exams. Methods: A retrospective analysis of 263 ultrasound images of first-trimester midsagittal sections was conducted. NT measurements were obtained using [...] Read more.
Background: This study assesses the effects of the ‘Radiant’ image enhancement technique on fetal nuchal translucency (NT) measurements during first-trimester sonographic exams. Methods: A retrospective analysis of 263 ultrasound images of first-trimester midsagittal sections was conducted. NT measurements were obtained using a semi-automatic tool. Statistical methods were applied to compare NT measurements with and without ‘Radiant’ enhancement. An in vitro setup with predefined line distances provided additional data. Results: Incremental increases in NT measurements were observed with varying levels of ‘Radiant’ application: an average increase of 0.19 mm with ‘Radiant min’, 0.24 mm with ‘Radiant mid’, and 0.30 mm with ‘Radiant max.’ The in vitro results supported these findings, showing consistent effects on line thickness and measurement accuracy, with the smallest mean deviation occurring at the ‘Radiant mid’ setting. Conclusions: ‘Radiant’ image enhancement leads to significant increases in NT measurements. To avoid systematic biases in clinical assessments, it is advisable to disable ‘Radiant’ during NT measurement procedures. Further studies are necessary to corroborate these findings and to consider updates to the NT reference tables based on this technology. Full article
(This article belongs to the Special Issue Advances in Prenatal Diagnosis and Maternal Fetal Medicine)
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<p>Placement of condom on metal slice with predefined thicknesses.</p> Full article ">Figure 2
<p>The metal frame locks the spanned condom in place.</p> Full article ">Figure 3
<p>Probe placement in a standardized position. The bucket holds distilled water and is insulated to prevent ultrasonic reverberations. The metal frame is positioned inside. <a href="#jcm-13-03625-f001" class="html-fig">Figure 1</a>, <a href="#jcm-13-03625-f002" class="html-fig">Figure 2</a> and <a href="#jcm-13-03625-f003" class="html-fig">Figure 3</a> were provided with kind permission from H. Dudwiesus.</p> Full article ">Figure 4
<p>B-mode-image of the in vitro setup. The two horizontal lines are the membranes of a condom, with a predefined distance in between. The cone-like structures below are sound-absorbing foam.</p> Full article ">Figure 5
<p>Mean ΔNT values, by mode of ‘Radiant’.</p> Full article ">Figure 6
<p>Correlation between Native NT and ΔNT (for ‘Radiant max’).</p> Full article ">Figure 7
<p>In vitro measurement of a 2.5 mm distance with and without ‘Radiant’. (<b>a</b>,<b>b</b>) Settings with ‘Harmonic Imaging’ and ‘Radiant off’, whole picture, and zoomed-in section below. (<b>c</b>,<b>d</b>) The same object with ‘Harmonic Imaging’ and ‘Radiant max’.</p> Full article ">
11 pages, 1224 KiB  
Article
Overlapping Pattern of the Four Individual Components of Dyslipidemia in Adults: Analysis of Nationally Representative Data
by Wenxiao Zheng, Jiayue Zhang, Ying Jiang, Shuting Wang and Zuyao Yang
J. Clin. Med. 2024, 13(12), 3624; https://doi.org/10.3390/jcm13123624 - 20 Jun 2024
Cited by 1 | Viewed by 863
Abstract
Background/Objectives: Dyslipidemia is a well-established risk factor for cardiovascular disease (CVD). However, among available drug treatments, only those targeted at lowering LDL-C and consequently TC have demonstrated efficacy in preventing CVD. This is to say that the benefit for those with isolated [...] Read more.
Background/Objectives: Dyslipidemia is a well-established risk factor for cardiovascular disease (CVD). However, among available drug treatments, only those targeted at lowering LDL-C and consequently TC have demonstrated efficacy in preventing CVD. This is to say that the benefit for those with isolated high TG or low HDL-C is limited. The objective of this study is to examine the overlapping pattern of the four dyslipidemia components in US adult populations, which is important for quantifying the proportion of those who are less likely to benefit from lipid-lowering drugs and for a more precise use of the drug. Methods: A total of 7822 participants aged over 20 with abnormalities in any of the four lipid parameters, excluding those on lipid-lowering medications, were included from the National Health and Nutrition Examination Survey (NHANES) cycles spanning 1999–2000 through 2017–2018. The proportions of different combinations of them were calculated and presented using area-proportional Euler plots. Results: High TC, high LDL-C, high TG, and low HDL-C were seen in 32.8% (95% CI: 31.3%–34.2%), 28.1% (95% CI: 26.6%–29.6%), 26.7% (95% CI: 25.4%–28.0%), and 65.9% (95% CI: 64.0%–67.7%) of the people with dyslipidemia, respectively. The proportions of dyslipidemia cases attributable to “high LDL-C or high TC” (irrespective of HDL-C and TG levels), “normal LDL-C, normal TC, but high TG” (irrespective of HDL-C level), and “normal LDL-C, normal TC, normal TG, but low HDL-C” (i.e., isolated low HDL-C) accounted for 37.5% (95% CI: 35.9%–39.1%), 18.3% (95% CI: 17.2%–19.4%), and 44.2% (95% CI: 42.5%–46.0%), respectively. Conclusions: Some two-thirds of those with dyslipidemia had low HDL-C or high TG but normal LDL-C and normal TC. As these people are less likely to benefit from currently available drug treatments in terms of CVD prevention, it is important to identify other effective strategies or interventions targeted at them in order to achieve more precise and cost-effective management of dyslipidemia. Full article
(This article belongs to the Section Cardiovascular Medicine)
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<p>Flow diagram of inclusion and exclusion of participants.</p> Full article ">Figure 2
<p>Weighted percentage of people with different combinations of high LDL-C, high TC, high TG, and low HDL-C among participants with dyslipidemia but not on medications in the overall population (<b>A</b>); stratified by sex (<b>B</b>); stratified by age group (<b>C</b>); and stratified by race (<b>D</b>). The percentages may not add up to 100% because of rounding.</p> Full article ">
15 pages, 2701 KiB  
Case Report
Raghib Syndrome and Pulmonary Arterial Hypertension in a Pediatric Patient: Case Report and Literature Review
by Liliana Gozar, Maria Oana Săsăran, Marius Cătălin Cosma, Daniela Toma, Andreea Georgiana Nan and Horea Gozar
J. Clin. Med. 2024, 13(12), 3623; https://doi.org/10.3390/jcm13123623 - 20 Jun 2024
Viewed by 895
Abstract
Background: Raghib syndrome is a rare malformation complex consisting of the drainage of the left superior vena cava (LSVC) into the left atrium, ostial atresia of the coronary sinus and an atrial septal defect (ASD). Case Report: This report aims to present the [...] Read more.
Background: Raghib syndrome is a rare malformation complex consisting of the drainage of the left superior vena cava (LSVC) into the left atrium, ostial atresia of the coronary sinus and an atrial septal defect (ASD). Case Report: This report aims to present the case of a child newly diagnosed with Raghib syndrome, complicated by pulmonary arterial hypertension, and to review previously published cases with the same diagnosis. A six-year-old female patient presented with signs and symptoms of heart failure (Ross III), reduced exercise tolerance and severe delay in stature and ponderal development. The imagistic work-up included echocardiography, followed by computer tomography (CT) and magnetic resonance imaging (MRI), through which a diagnosis of Raghib syndrome was established, complicated by pulmonary hypertension. As in other cases presented in the literature, MRI allowed for an accurate diagnosis, detecting the absent coronary sinus. The decision regarding the surgical closure of the ASD was made, with the patient having a favorable clinical evolution but with the persistence of elevated pulmonary artery pressure, for which Sildenafil therapy was instituted. Conclusions: The malformation complex consisting of an atrial septal defect, ostium atresia of the coronary sinus, uncovered coronary sinus, and persistent left superior vena cava, as identified through multiple imagistic investigations, was suggestive of the rare diagnosis of Raghib syndrome in this case. Among the limited number of cases of Raghib syndrome available in the literature, the present case is distinguished by the severity of the pulmonary artery hypertension at a very young age and in the absence of other concurrent cardiac malformations. Full article
(This article belongs to the Special Issue Congenital Heart Disease: Diagnosis, Clinical Characteristics, Prognostic Implications, and Management)
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<p>Preoperative echocardiography. (<b>A</b>) Parasternal short axis: the severely dilated PA; (<b>B</b>) 4 chamber view: large ASD, with severely dilated right atrium and right ventricle; (<b>C</b>) short axis view at the ventricles: large right ventricle and the small left ventricle; and (<b>D</b>,<b>E</b>) pulsed tricuspid and pulmonary Doppler highlights elevated pressure in the PA. Legend: ASD—atrial septal defect; PA—pulmonary artery.</p> Full article ">Figure 2
<p>Angio CT: LSVC drains into the left atrium. Legend: AO—aorta; LA—left atrium; LSVC—left superior vena cava; PA—pulmonary artery.</p> Full article ">Figure 3
<p>MRI: LSVC drains into the left atrium. Legend: AO—aorta; LA—left atrium; LSVC—left superior vena cava; PA—pulmonary artery.</p> Full article ">Figure 4
<p>Postoperative echocardiography: (<b>A</b>) 4 chamber view; and (<b>B</b>) short axis view at the ventricles.</p> Full article ">Figure 5
<p>The last echocardiography, performed 1 year postoperatively; 4 chamber view.</p> Full article ">
14 pages, 6167 KiB  
Article
Lower Abdominal vs. Lateral Thigh Perforator Flaps in Microsurgical Sarcoma Reconstruction: The Aesthetics of Donor Site Matters
by Beniamino Brunetti, Rosa Salzillo, Riccardo De Bernardis, Valeria Petrucci, Matteo Pazzaglia, Chiara Camilloni, Alessandra Putti, Marco Morelli Coppola, Stefania Tenna and Paolo Persichetti
J. Clin. Med. 2024, 13(12), 3622; https://doi.org/10.3390/jcm13123622 - 20 Jun 2024
Viewed by 650
Abstract
Introduction: Sarcoma resection often leaves patients with big defects only amenable through microsurgical reconstruction. In such cases, it is hard for the surgeon to uphold low donor-site morbidity with an aesthetic result. The purpose of this study was to investigate the clinical outcome [...] Read more.
Introduction: Sarcoma resection often leaves patients with big defects only amenable through microsurgical reconstruction. In such cases, it is hard for the surgeon to uphold low donor-site morbidity with an aesthetic result. The purpose of this study was to investigate the clinical outcome and the patient’s perception regarding the donor site in a cohort of patients undergoing microsurgical reconstruction with lateral thigh and lower abdominal perforator flaps. Methods: A retrospective evaluation of all patients who underwent sarcoma reconstruction with flaps harvested from the lower abdominal region (deep inferior epigastric artery perforator flap, superficial circumflex iliac artery perforator flap) or lateral thigh region (anterolateral thigh perforator flap and its variations) was performed. Only patients with defects greater than 100 cm2 were included. Patient demographics and operative variables were recorded, together with complications. Patient satisfaction and quality of life with the donor site were registered using the SCAR-Q questionnaire, which was administered at least six months post-operatively. Results: Eighteen anterolateral thigh (ALT) perforator flaps and twenty-two deep inferior epigastric artery perforator (DIEP) and superficial circumflex iliac artery perforator (SCIP) flap procedures were performed. The two groups were homogeneous for major post-operative complications (p > 0.999). Patient satisfaction with the donor site measured using the SCAR-Q questionnaire showed significantly higher scores in the DIEP/SCIP group when compared with the thigh group (p < 0.001), indicating a superiority of the lower abdominal area as an aesthetic donor site. Conclusions: The DIEP and SCIP flaps are a versatile option for reconstructing large soft-tissue defects following sarcoma resection. Therefore, flaps harvested from the lower abdomen yield a higher patient satisfaction with the donor site, which is a feature worth considering when planning a reconstructive procedure. Full article
(This article belongs to the Special Issue Clinical Progress in Microsurgical Reconstruction)
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<p>(<b>A</b>) Flap selection for a lower limb reconstruction with an extensive defect expected (13 × 13 cm). (<b>B</b>) A free ALT flap is one of the most common reconstructive options employed in sarcoma patients, but its donor site will require skin grafting for defects exceeding 8–9 cm in width. (<b>C</b>) The lower abdominal region (DIEP flap) allows the harvesting of larger flaps (10–17 cm in width) while achieving primary closure of the donor site in an aesthetic abdominoplasty fashion.</p> Full article ">Figure 2
<p>(<b>A</b>) A young male patient affected by NF-1 presenting with a huge malignant peripheral nerve sheet tumor (MPNST) involving the brachial plexus and proximal upper arm. (<b>B</b>) Intra-operative view of the extensive defect with exposure of the major neuro-vascular structures. (<b>C</b>) The reconstruction was performed with a 26 × 15 cm free ALT flap anastomosed to subclavian vessels.</p> Full article ">Figure 3
<p>(<b>A</b>,<b>B</b>): Intra-operative view of the ALT flap based on 2 septo-cutaneous perforators. The donor site was closed with a split-thickness skin graft. (<b>C</b>): Hypertrophic scars with a poor aesthetic result at the ALT donor site, 3 months post-operatively.</p> Full article ">Figure 4
<p>(<b>A</b>) Recurrent liposarcoma after irradiation in the right flank, with the 14 × 12 cm planned resection. (<b>B</b>,<b>C</b>) Intra-operative view of the transplanted SCIP flap after revascularization. The left superficial circumflex iliac artery perforator was anastomosed to its contralateral counterpart in a perforator-to-perforator fashion. The flap vein (SCIV) was of a bigger caliber and required anastomosis to a saphenous vein branch of adequate size.</p> Full article ">Figure 5
<p>(<b>A</b>) Pre-operative frontal view with SCIP flap planning. (<b>B</b>) Six-month post-operative view showing a well-integrated flap allowing a like-for-like reconstruction with tissues of a similar color and texture from the contralateral side. The contour was restored, and the donor site was closed primarily in an aesthetic fashion. (<b>C</b>) Pre-operative frontal view with patient wearing underwear. (<b>D</b>) Six-month post-operative view with underwear, showing how the aesthetic approach employed allowed to us hide both the donor and recipient sites in well-concealed anatomical regions. The patient was very satisfied with the aesthetic result of the reconstruction.</p> Full article ">Figure 6
<p>(<b>A</b>) a case of chondrosarcoma involving the sternal manubrium and the first 2 ribs bilaterally in a 60-year-old female patient. The extensive defect measured 13 × 13 cm. The patient was scheduled for DIEP flap reconstruction, which was the only available donor site to allow primary closure in an aesthetically acceptable fashion in the supine operative position. (<b>B</b>) Intra-operative view of the extensive defect with exposure of both the lungs and aortic arch. The left internal mammary vessels were prepared for anastomoses. (<b>C</b>) Six-month post-operative view showing a well-settled flap with aesthetic improvement of the abdominal contour after closure in an abdominoplasty fashion. (<b>D</b>) Excised tumor. (<b>E</b>) Pre-operative CT showing the degree of local infiltration.</p> Full article ">Figure 7
<p>(<b>A</b>) a young female patient presented with an irradiated recurrent undifferentiated sarcoma involving the proximal right upper arm. The defect was almost completely circumferential, measuring 16 × 14 cm. The patient was scheduled for DIEP flap reconstruction, which was the only available donor site to allow primary closure in an aesthetically acceptable fashion in the supine operative position. (<b>B</b>) Intra-operative view of the extensive defect with exposure of the major neuro-vascular structures. (<b>C</b>) The patient was very thin and narrow waisted and the defect quite extensive. To safely cover the entire defect, all the lower abdominal tissue was required. Therefore, a bipedicled bilateral DIEP flap was harvested.</p> Full article ">Figure 8
<p>Intra-operative view of the flap after revascularization. Two sets of end-to-end anastomoses were performed, with one pedicle anastomosed to the thoracoacromial vessels, which were rerouted from the upper trunk to the proximal part of the defect, and the other pedicle was anastomosed with a brachial artery recurrent branch, located in the distal part of the defect. The use of both DIEP pedicles allowed us to transfer the entire abdominal pannus with 100% flap survival.</p> Full article ">Figure 9
<p>(<b>A</b>) Pre-operative frontal view. (<b>B</b>) Six-month post-operative frontal view showing a well-settled flap with aesthetic improvement of the abdominal contour after closure in an abdominoplasty fashion. The patient was very happy with the aesthetic strategy adopted for reconstructing such a complex defect. (<b>C</b>) Pre-operative three-quarters view. (<b>D</b>) Six-month post-operative three-quarters view. Noteworthy is the improvement of the abdominal silhouette.</p> Full article ">
22 pages, 1431 KiB  
Systematic Review
Effects of Exercise Rehabilitation on Cardiorespiratory Fitness in Long-COVID-19 Survivors: A Meta-Analysis
by Sothida Nantakool, Piangkwan Sa-nguanmoo, Supatcha Konghakote and Busaba Chuatrakoon
J. Clin. Med. 2024, 13(12), 3621; https://doi.org/10.3390/jcm13123621 - 20 Jun 2024
Viewed by 742
Abstract
Background: Poor cardiorespiratory fitness poses the highest risk of mortality. Long-COVID-19 survivors exhibit a reduced cardiorespiratory fitness (CRF). While exercise rehabilitation, such as cardiopulmonary exercise, is used for long-COVID-19 survivors, the effects of exercise on CRF in this population remain inconclusive. In [...] Read more.
Background: Poor cardiorespiratory fitness poses the highest risk of mortality. Long-COVID-19 survivors exhibit a reduced cardiorespiratory fitness (CRF). While exercise rehabilitation, such as cardiopulmonary exercise, is used for long-COVID-19 survivors, the effects of exercise on CRF in this population remain inconclusive. In this study, we aim to systematically summarise and synthesise whether exercise rehabilitation improves CRF among long-COVID-19 survivors. Methods: A comprehensive search was performed through PubMed, CINAHL, Embase, Scopus, and the Cochrane Library (since their inception to November 2023) and study reference lists. Studies presenting the effects of exercise rehabilitation on CRF (peak oxygen consumption (VO2peak) and six-minute walk distance (6MWD)) in long-COVID-19 survivors were identified. The standardised mean difference (SMD), mean difference (MD), and 95% confidence interval (CI) were used for analyses. The certainty of evidence was measured using a Grading of Recommendation Assessment, Development and Evaluation approach. Results: Twelve eligible studies (five RCTs and seven non-RCTs) with 682 participants were analysed. The meta-analysis showed significantly improved 6MWDs (MD 76.47, 95% CI 59.19–93.71, low certainty) and significantly greater 6MWDs (SMD 0.85, 95% CI 0.11–1.59, very low certainty) in the exercise rehabilitation group compared to the control group. A significantly improved 6MWD was found in subgroups of young to middle-aged adults and subgroups of patients who undertook aerobic exercise combined with resistance and respiratory exercise and centre-based training programs. Conclusions: Exercise rehabilitation is effective for improving CRF, as measured by the 6MWD in long-COVID-19 survivors. Improvements are likely to be more pronounced in specific subgroups of young to middle-aged adults and patients undertaking aerobic exercise combined with resistance and respiratory exercise and centre-based training programs. However, recommendations for clinical practice are limited due to the very low evidence certainty. Full article
(This article belongs to the Special Issue Long COVID: Current Approaches and Clinical Challenges in Treatment and Rehabilitation—2nd Edition)
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<p>Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 diagram.</p> Full article ">Figure 2
<p>SMD and mean difference are calculated from the random-effects model. (<b>a</b>) Meta-analysis of randomised controlled trials for VO<sub>2peak</sub> between exercise rehabilitation group and control group. (<b>b</b>) Meta-analysis of non-randomised controlled trials for VO<sub>2peak</sub> between exercise rehabilitation group and control group. CI, confidence interval; Effect, mean difference between pre and post intervention; N, number of participants; SD, standard deviation; SMD, standardised mean difference; VO<sub>2peak</sub>, peak oxygen consumption [<a href="#B23-jcm-13-03621" class="html-bibr">23</a>,<a href="#B29-jcm-13-03621" class="html-bibr">29</a>,<a href="#B41-jcm-13-03621" class="html-bibr">41</a>,<a href="#B42-jcm-13-03621" class="html-bibr">42</a>,<a href="#B44-jcm-13-03621" class="html-bibr">44</a>].</p> Full article ">Figure 3
<p>SMD and mean difference are calculated from the random-effects model. (<b>a</b>) Meta-analysis of randomised controlled trials for 6MWD between exercise rehabilitation group and control group. (<b>b</b>) Meta-analysis of non-randomised controlled trials for 6MWD between exercise rehabilitation group and control group. CI, confidence interval; Effect, mean difference between pre and post intervention; N, number of participants; SD, standard deviation; SMD, standardised mean difference; 6MWD, six-minute walk distance [<a href="#B20-jcm-13-03621" class="html-bibr">20</a>,<a href="#B21-jcm-13-03621" class="html-bibr">21</a>,<a href="#B22-jcm-13-03621" class="html-bibr">22</a>,<a href="#B39-jcm-13-03621" class="html-bibr">39</a>,<a href="#B40-jcm-13-03621" class="html-bibr">40</a>,<a href="#B42-jcm-13-03621" class="html-bibr">42</a>,<a href="#B43-jcm-13-03621" class="html-bibr">43</a>,<a href="#B44-jcm-13-03621" class="html-bibr">44</a>,<a href="#B45-jcm-13-03621" class="html-bibr">45</a>].</p> Full article ">
12 pages, 551 KiB  
Article
Prognostic Role of OX40, LAG-3, TIM-3 and PD-L1 Expression in Bone and Soft Tissue Sarcomas
by Bediz Kurt İnci, Elif Acar, Fatih Gürler, Ayşegül İlhan, Fatih Yıldız, Fisun Ardıç, Berna Öksüzoğlu, Nuriye Özdemir, Ahmet Özet, Güldal Esendağlı and Ozan Yazıcı
J. Clin. Med. 2024, 13(12), 3620; https://doi.org/10.3390/jcm13123620 - 20 Jun 2024
Viewed by 765
Abstract
Introduction: The current study aims to evaluate the OX40, TIM-3, LAG-3, and PD-L1 targeted pathways in the regulation of T-cell activity in sarcoma patients to determine their relationship with overall survival (OS). Method: This study included one hundred and eleven patients with bone [...] Read more.
Introduction: The current study aims to evaluate the OX40, TIM-3, LAG-3, and PD-L1 targeted pathways in the regulation of T-cell activity in sarcoma patients to determine their relationship with overall survival (OS). Method: This study included one hundred and eleven patients with bone and soft tissue sarcoma diagnosed in two centers between 2010 and 2020. OX40, LAG-3, TIM-3 and PD-L1 expression levels were evaluated immunohistochemically from pathology preparations. Results: PD-L1 staining was detected in tumor cells, OX40, LAG-3, TIM-3 staining was detected in inflammatory cells in tumor tissue. In univariate analysis, no significant relationship was found between OX40, TIM-3, LAG-3, and PD-L1 staining and overall survival (respectively: p = 0.12, p = 0.49, p = 0.31, p = 0.95). When grade and stage at diagnosis, which were found to be significant in univariate analysis, along with OX-40, TIM-3, LAG-3, and PD-L1, were evaluated in multivariate analysis, a positive effect of OX-40 staining on overall survival was determined (p = 0.009). Considering the correlation between PDL-1 and OX40, TIM-3, and LAG-3 staining, a significant positive correlation was found between PDL-1 and TIM-3 and LAG-3 staining (respectively; p = 0.002, p = 0.001). Conclusions: There was no significant relationship between the PDL-1 staining percentage of tumor cells and OX40, TIM-3, and LAG-3 staining in inflammatory cells with the OS of sarcoma patients. However, detecting a significant positive correlation between PDL-1 staining and TIM-3 and LAG-3 staining also holds promise for finding effective targetable combination therapies that can prolong survival in sarcoma patients in the future. Full article
(This article belongs to the Section Oncology)
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<p>Overall survival analysis.</p> Full article ">
12 pages, 1331 KiB  
Article
Are Age and Trauma Mechanism Associated with Volume Change in the Fractures of the Bony Orbit?
by Ella Starck, Niilo Lusila, Juho Suojanen and Eeva Kormi
J. Clin. Med. 2024, 13(12), 3618; https://doi.org/10.3390/jcm13123618 - 20 Jun 2024
Viewed by 513
Abstract
Blowout fractures are common midfacial fractures in which one or several of the bones of orbital vault break. This is usually caused by a direct trauma to the eye with a blunt object such as a fist. Fracturing of the fragile orbital bones [...] Read more.
Blowout fractures are common midfacial fractures in which one or several of the bones of orbital vault break. This is usually caused by a direct trauma to the eye with a blunt object such as a fist. Fracturing of the fragile orbital bones can lead to changes in the orbital volume, which may cause enophthalmos, diplopia, and impaired facial aesthetics. Objectives: The aim of this study is to investigate whether there is an association between volume change of the bony orbit and age, gender, or trauma mechanism. Methods: A retrospective study of patients with unilateral blowout or blow-in fractures treated and examined in Päijät-Häme Central Hospital, Lahti, Finland was conducted. Altogether, 127 patients met the inclusion criteria. Their computed tomographs (CT) were measured with an orbit-specific automated segmentation-based volume measurement tool, and the relative orbital volume change between fractured and intact orbital vault was calculated. Thereafter, a statistical analysis was performed. A p-value less than 0.05 was considered significant. Results: We found that relative increase in orbital volume and age have a statistically significant association (p = 0.022). Trauma mechanism and gender showed no significant role. Conclusions: Patient’s age is associated with increased volume change in fractures of the bony orbit. Full article
(This article belongs to the Section Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine)
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<p>Orbital volume is measured from CT scans with an automated segmentation tool in which a virtual triangle mesh expands from a starting point in the bony orbit to another on the other side. The volume of the fractured orbit (red) is compared to the intact (blue) one to obtain the relative orbital volume change.</p> Full article ">Figure 2
<p>Relative volume change increased along with patient’s age. Each blue dot represents individual patient, and red line shows average relative (%) volume change compared to age.</p> Full article ">Figure 3
<p>Relative volume change and trauma mechanism have no correlation. Blue box represents 50% of the patients and median; whiskers represent highest and lowest 25 percentages; stars and dots demonstrate the measurement outliers.</p> Full article ">Figure 4
<p>Trauma mechanisms’ association with age: 1. fall, 2. assault, 3. sports, 4. traffic, 5. others. Blue box represents 50% of the patients and median; whiskers represent highest and lowest 25 percentages.</p> Full article ">Figure 5
<p>Females and males have distinct age profiles. Females more frequently suffer orbital traumas as young adults and in older age, whereas male are more susceptible to trauma in middle age.</p> Full article ">
10 pages, 1210 KiB  
Article
Comparison between the Efficacy of Sacral Erector Spina Plane Block and Pudendal Block on Catheter-Related Bladder Discomfort: A Prospective Randomized Study
by Bilge Olgun Keleş, Elvan Tekir Yılmaz and Ali Altınbaş
J. Clin. Med. 2024, 13(12), 3617; https://doi.org/10.3390/jcm13123617 - 20 Jun 2024
Viewed by 719
Abstract
Objective: Catheter-related bladder discomfort (CRBD) due to indwelling urinary catheterization in patients undergoing transurethral resection of the prostate (TURP) is difficult to tolerate and needs to be treated. This randomized prospective study aimed to compare the efficacy of sacral erector spinae plane block [...] Read more.
Objective: Catheter-related bladder discomfort (CRBD) due to indwelling urinary catheterization in patients undergoing transurethral resection of the prostate (TURP) is difficult to tolerate and needs to be treated. This randomized prospective study aimed to compare the efficacy of sacral erector spinae plane block (SESPB) and pudendal nerve block (PNB) in reducing the incidence and score of CRBD. Methods: This study was conducted between November and December 2023. ASA I-III, fifty-four TURP patients were divided into two groups: Group 1 received SESPB (n = 27) and Group 2 received PNB (n = 27) under ultrasound guidance at the end of surgery. The incidence of CRBD, CRBD score, numerical rating scale (NRS) score, use of rescue analgesics, block performance time, first call for analgesics, patient satisfaction, and side effects were recorded for 24 h. Results: The incidence of CRBD was lowest at 33.3% and highest at 48.1% in Group 1 and lowest at 25.9% and highest at 48.1% in Group 2, with no significant difference between the groups at all measurement times. CRBD scores and NRS scores were low and similar between the two groups. Block performance times were 9 ± 1.7 min in SESPB and 20 ± 2.5 min in PNB, and there was a significant difference between the mean times (p < 0.001). Patient satisfaction was adequate and similar in both groups. Conclusions: SESPB demonstrated a similar decreasing effect to PNB on the incidence and scores of CRBD in the first 24 h following TURP operations. The duration of SESPB administration was shorter than PNB. Full article
(This article belongs to the Section Nephrology & Urology)
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<p>Patient position and sonoanatomy during ultrasound-guided sacral erector spinae plane block. (<b>a</b>) Patient in lateral decubitis position. The dashed white lines represent Truffier’s line, a transverse line connecting the upper parts of the crista iliacae. S1–2–3: Level of 1st, 2nd, and 3rd sacral vertebrae median crests. (<b>b</b>) ESM: Erector Spinae Muscles, LA: Local Anesthetic, MSC: Median Sacral Crest, S2–S3: Level of sacral vertebrae.</p> Full article ">Figure 2
<p>Patient position and sonoanatomy during ultrasound-guided pudendal nerve block. (<b>a</b>) Patient in lithotomy position, IT: Ischial Tuberosity. (<b>b</b>) Dashed white lines represent the distribution of local anesthetic, dashed red figure shows the pudendal artery, STP: Superficial transverse perineal muscle.</p> Full article ">Figure 3
<p>Consort flow diagram.</p> Full article ">
11 pages, 3695 KiB  
Article
The Migration Pattern of a Short-Tapered Femoral Stem Correlates with the Occurrence of Cortical Hypertrophies: A 10-Year Longitudinal Study Using Ein Bild Röntgen Analyse–Femoral Component Analysis
by Tobias Freitag, Michael Fuchs, David Friedrich, Ralf Bieger, Heiko Reichel and Moritz Oltmanns
J. Clin. Med. 2024, 13(12), 3616; https://doi.org/10.3390/jcm13123616 - 20 Jun 2024
Viewed by 402
Abstract
Background: Shorter hip stems have shown promising mid-term results but lack long-term data. High rates of distal cortical hypertrophy (CH) have been described, suggesting a more diaphyseal load transmission. This study aimed to determine patient-specific and surgery-related factors influencing CH and their impact [...] Read more.
Background: Shorter hip stems have shown promising mid-term results but lack long-term data. High rates of distal cortical hypertrophy (CH) have been described, suggesting a more diaphyseal load transmission. This study aimed to determine patient-specific and surgery-related factors influencing CH and their impact on 10-year outcomes. Methods: It included 100 consecutive total hip arthroplasties (THAs) using the Fitmore stem (Zimmer, Warsaw, Indiana), with clinical and radiographic follow-ups at 1, 2, 5, and at least 10 years post-surgery. Results: No revisions were performed due to aseptic loosening after a mean of 11.6 years (range: 10–13.5 years). CH was observed in 26% of hips, primarily in Gruen zones 3 and 5. There was no significant difference in the Harris Hip Score between patients with and without CH. Larger stem sizes and greater axial subsidence significantly correlated with CH occurrence (OD 1.80, (1.13–1.92), p = 0.004; OD 1.47, (1.04–2.08), p = 0.028). The Fitmore stem demonstrated excellent survival rates and favorable outcomes over 10 years. Conclusions: Despite a lower CH rate compared to other studies, significant correlations with stem size and subsidence were identified. This study underscores the importance of patient selection and achieving high primary stability to maintain the metaphyseal anchoring concept. Full article
(This article belongs to the Special Issue State of the Art in Hip Replacement Surgery)
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<p>Photograph in two planes of Fitmore hip stem.</p> Full article ">Figure 2
<p>(<b>a</b>,<b>b</b>) X-rays taken 5 days postoperatively (<b>a</b>) in a 57-year-old male and after 11 years (<b>b</b>) of a representative case of cortical hypertrophy typically in zones 3 and 5 according to Gruen.</p> Full article ">Figure 3
<p>Graph showing individual axial stem migration over time (<span class="html-italic">n</span> = 77).</p> Full article ">Figure 4
<p>Kaplan–Meier survival curve for endpoint “all stem revisions” (98%; 95%-CI; 72.3–99.6%; <span class="html-italic">n</span> = 100).</p> Full article ">Figure 5
<p>Histogram depicting the distribution and ratio of hips with and without cortical hypertrophy (CH) based on the size of the femoral implant used. The utilization of larger implant dimensions was correlated with a higher rate of CHs (<span class="html-italic">n</span> = 77).</p> Full article ">Figure 6
<p>Histogram illustrating the distribution and ratio of hips with and without cortical hypertrophy (CH) based on the amount of axial stem migration. The subcategories of 2–3 mm and &gt;3 mm subsidence exhibited a higher proportion of hips with CHs (<span class="html-italic">n</span> = 77).</p> Full article ">
10 pages, 587 KiB  
Article
Improving Spiritual Well-Being of Polish Pain Outpatients: A Feasibility Mixed Methods Study
by Maciej Wiktor Klimasiński, Ewa Baum, Katarzyna Wieczorowska-Tobis and Bogusław Stelcer
J. Clin. Med. 2024, 13(12), 3615; https://doi.org/10.3390/jcm13123615 - 20 Jun 2024
Viewed by 497
Abstract
Introduction: A physician in a chronic pain treatment clinic must recognize that the relationship between pain and spirituality is bidirectional. Chronic pain can decrease the level of spiritual well-being, and low spiritual well-being can also significantly intensify the perception of pain and [...] Read more.
Introduction: A physician in a chronic pain treatment clinic must recognize that the relationship between pain and spirituality is bidirectional. Chronic pain can decrease the level of spiritual well-being, and low spiritual well-being can also significantly intensify the perception of pain and worsen coping with it. Currently, for many scientific and medical communities, it is evident that spiritual care is an indispensable element of holistic medicine. Objective: The authors developed a non-religious spiritual care model provided by a physician at a chronic pain treatment clinic from May 2022 to February 2024. Method: The study utilized a mixed-method approach to conduct the research. The analysis consisted of twelve patients. A FACIT-Sp-12 questionnaire evaluated the individual’s spiritual well-being before the intervention. The intervention involved asking patients open-ended questions about their life history, experiences, and spiritual beliefs and the physician’s use of active listening and empathetic responses to what patients shared (relationship-building activities). The intervention aimed to assist patients in accepting the limitations of an incurable chronic disease, affirming the value of their lives, enhancing inner harmony, and increasing their sense of belonging to something greater. After the intervention, a re-assessment of the patient’s spiritual well-being was conducted using the FACIT-Sp-12 questionnaire. Researchers collected qualitative data through a confidential survey that included the following instructions: “Please express an anonymous opinion on how you perceive the spiritual care provided by the physician”. Results: There was an increase in spiritual well-being, assessed using the FACIT-Sp-12 scale, in 9 out of 12 patients. The median, as well as the average, level of spiritual well-being increased in a statistically significant way after the intervention (p < 0.05). This was primarily due to the higher value of the peace subscale of the questionnaire. Qualitative analysis revealed benefits reported by patients (personal development, gratitude, satisfaction, support, hope) resulting from physician’s actions. Conclusions: Both qualitative and quantitative data showed that establishing a relationship with the doctor improves the spiritual well-being of patients. Therefore, this model can be recommended for physicians in chronic pain treatment clinics. Full article
(This article belongs to the Section Anesthesiology)
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<p>The individual data for the total FACIT-Sp-12 questionnaire score performed twice for all participants.</p> Full article ">
13 pages, 1931 KiB  
Article
Correlations between the Frankfort Plane and the Presence of Myofascial Trigger Points in Posterior Cervical Musculature: An Exploratory Study
by Darío Sánchez-Guilabert and Ángel Martínez-Carrasco
J. Clin. Med. 2024, 13(12), 3614; https://doi.org/10.3390/jcm13123614 - 20 Jun 2024
Viewed by 771
Abstract
Neck pain is a pathology with a high impact in terms of physical disability in modern society. The position of the head is related to neck pain. The Frankfort plane determines the position of the skull in space. The profile photograph of the [...] Read more.
Neck pain is a pathology with a high impact in terms of physical disability in modern society. The position of the head is related to neck pain. The Frankfort plane determines the position of the skull in space. The profile photograph of the subjects was used to determine the Frankfort plane and to study its degree of inclination. Myofascial pain syndrome is one of the most common causes of musculoskeletal pain. Trigger points are hyperirritable spots located in a palpable taut band of skeletal muscle that is painful on compression or stretch and causes a local twitch in response to snapping or palpation of the band. Objectives: The aim of this study was to analyze the relationship between the Frankfort plane and the presence of myofascial trigger points causing cervical myofascial pain. Methods: This is a cross-sectional descriptive observational study. All subjects underwent a photographic study to determine the degree of Frankfort plane inclination, and the posterior cervical musculature was palpated to find myofascial trigger points that were measured with a pressure algometer in three cervical locations on the right and left sides. Results: Our study included 47 subjects who had suffered at least one episode of cervical pain in their lifetimes. The mean age was 22.3 ± 2.9 years. Statistically significant results were found in the first right location and sports practice (p = 0.007), in the second right location and gender (p = 0.0097), in the second right location and sports practice (p = 0.0486), in the third right location and gender (p = 0.0098), and in the first, second, and third left locations and gender (p = 0.0083; p = 0.024; p = 0.0016, respectively). In the correlation between the Frankfort plane and the presence of myofascial trigger points, all locations were positive, with the first right location being statistically significant (p = 0.048). Conclusions: A positive relationship was found between the Frankfort plane and the presence of myofascial trigger points. The greater the angle of the Frankfort plane, the less the myofascial pain. Full article
(This article belongs to the Special Issue Physiotherapy Update in the Management of Musculoskeletal Pain)
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<p>Flowchart of the study.</p> Full article ">Figure 2
<p>(<b>a</b>,<b>b</b>) Photographic study of the Frankfort plane.</p> Full article ">Figure 3
<p>Frankfort plane in degrees using Adobe Photoshop.</p> Full article ">Figure 4
<p>(<b>a</b>) MTrPs locations [<a href="#B16-jcm-13-03614" class="html-bibr">16</a>]. (<b>b</b>) Measurement with analog algometer.</p> Full article ">Figure 5
<p>Spearman correlation coefficients for Frankfort plane and pressure pain threshold associations with continuous results. Interpretation of the correlation matrix: Each row-column pair represents a correlation of the two variables; all correlations were positive and are shown in blue. The color intensity is proportional to the correlation coefficients: 0 = no correlation, −1 = perfect inverse correlation, and 1 = perfect direct correlation.</p> Full article ">
11 pages, 13590 KiB  
Article
The Chimeric LFC and DCIA Flap in Combined Mandibular and Condylar Head and Neck Reconstruction—A Case Series
by Christoph Steiner, Maximilian Neubert, Gian B. Bottini, Shinnosuke Nogami, Katharina Zeman-Kuhnert and Alexander Gaggl
J. Clin. Med. 2024, 13(12), 3613; https://doi.org/10.3390/jcm13123613 - 20 Jun 2024
Viewed by 853
Abstract
Background: Defects of the ascending ramus of the mandible, including the condylar head and neck or the whole temporomandibular joint (TMJ), are difficult to reconstruct. Reconstruction is mainly based on the use of alloplastic joint prosthesis, costochondral grafting, distraction osteogenesis of the [...] Read more.
Background: Defects of the ascending ramus of the mandible, including the condylar head and neck or the whole temporomandibular joint (TMJ), are difficult to reconstruct. Reconstruction is mainly based on the use of alloplastic joint prosthesis, costochondral grafting, distraction osteogenesis of the dorsal part of the mandibular ramus, or osseous microvascular flaps of various origin. With the objective of developing a method that overcomes the restrictions of these methods, we recently introduced a sequential chimeric flap consisting of a lateral femoral condyle flap (LFC) and deep circumflex iliac artery flap (DCIA) for reconstruction of up to half of the mandible and the condylar head and neck. Methods: The chimeric flap was used in four patients with the following diagnoses: therapy-refractory osteomyelitis, extended recurrent odontogenic keratozyst, Goldenhar syndrome, and adenocarcinoma of the parotid gland. After a diagnostic workup, LFC and DCIA flaps were harvested in all patients and used in a sequential chimeric design for the reconstruction of the mandibular body and condylar head and neck. Results: Follow-up from at least 24 months up to 70 month after surgery showed a successful reconstruction in all four patients. The LFC provided a cartilaginous joint surface, allowing for a satisfactory masticatory function with a stable occlusion and unrestricted mouth opening and preserved or regained lateral and medial excursions in all patients. The DCIA allowed for a bony reconstruction anatomically resembling a non-atrophied mandibular body. No flap-related complications were observed. Conclusions: The sequential chimeric LFC and DCIA flap is an appropriate method for reconstructing up to half of the mandible and the condylar head and neck. It is suitable in cases where alloplastic joint replacement cannot be used or where other methods have failed. Due to the necessity of harvesting two flaps, the burden of care is increased, and a careful indication is required. The technique is reserved for maxillofacial surgeons who have already gained significant experience in the field of microsurgery. Full article
(This article belongs to the Special Issue Clinical Progress in Microsurgical Reconstruction)
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<p>In-house printed 3D cutting guide for mandibular resection and template for the assembly of the sequential chimeric LFC and DCIA flap.</p> Full article ">Figure 2
<p>Harvesting the LFC.</p> Full article ">Figure 3
<p>The osteochondral LFC.</p> Full article ">Figure 4
<p>A skin perforator flap harvested together with the LFC for concomitant skin replacement after extended resections.</p> Full article ">Figure 5
<p>The sequential chimeric LFC and DCIA flap ready for transfer to the recipient site. Note the DCIA replacing the body and parts of the ramus of the mandible and the LFC replacing the condylar neck and head.</p> Full article ">Figure 6
<p>The sequential chimeric LFC and DCIA flap: an overview of the bony and vascular anatomy.</p> Full article ">Figure 7
<p>The 3D reconstruction of a CT scan showing an anatomically correct reconstruction of the right mandible up to the condylar head with the sequential chimeric LFC and DCIA flap.</p> Full article ">Figure 8
<p>Sagittal CT view of the LFC in relation to the articular fossa, showing a good position.</p> Full article ">
13 pages, 463 KiB  
Review
The Role of Viscoelastic Testing in Assessing Hemostasis: A Challenge to Standard Laboratory Assays?
by Benjamin Reardon, Leonardo Pasalic and Emmanuel J. Favaloro
J. Clin. Med. 2024, 13(12), 3612; https://doi.org/10.3390/jcm13123612 - 20 Jun 2024
Viewed by 1289
Abstract
Viscoelastic testing is increasingly being used in clinical and research settings to assess hemostasis. Indeed, there are potential situations in which viscoelastic testing is reportedly superior to standard routine laboratory testing for hemostasis. We report the current testing platforms and terminology, as well [...] Read more.
Viscoelastic testing is increasingly being used in clinical and research settings to assess hemostasis. Indeed, there are potential situations in which viscoelastic testing is reportedly superior to standard routine laboratory testing for hemostasis. We report the current testing platforms and terminology, as well as providing a concise narrative review of the published evidence to guide its use in various clinical settings. Notably, there is increasing evidence of the potential utility of viscoelastic testing for assessment of direct oral anticoagulants, and bleeding associated with chronic liver disease, orthotopic liver transplantation, cardiac surgery, trauma, obstetrics and pediatrics. Full article
(This article belongs to the Section Hematology)
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<p>Typical VET waveform (source [<a href="#B22-jcm-13-03612" class="html-bibr">22</a>]).</p> Full article ">
35 pages, 2611 KiB  
Review
Novel Treatment Strategies for Hormone Receptor (HR)-Positive, HER2-Negative Metastatic Breast Cancer
by Antonella Ferro, Michela Campora, Alessia Caldara, Delia De Lisi, Martina Lorenzi, Sara Monteverdi, Raluca Mihai, Alessandra Bisio, Mariachiara Dipasquale, Orazio Caffo and Yari Ciribilli
J. Clin. Med. 2024, 13(12), 3611; https://doi.org/10.3390/jcm13123611 - 20 Jun 2024
Viewed by 1796
Abstract
Estrogen receptor (ER)-positive breast cancer (BC) is the most common BC subtype. Endocrine therapy (ET) targeting ER signaling still remains the mainstay treatment option for hormone receptor (HR)-positive BC either in the early or in advanced setting, including different strategies, such as the [...] Read more.
Estrogen receptor (ER)-positive breast cancer (BC) is the most common BC subtype. Endocrine therapy (ET) targeting ER signaling still remains the mainstay treatment option for hormone receptor (HR)-positive BC either in the early or in advanced setting, including different strategies, such as the suppression of estrogen production or directly blocking the ER pathway through SERMs—selective estrogen receptor modulators—or SERDs—selective estrogen receptor degraders. Nevertheless, the development of de novo or acquired endocrine resistance still remains challenging for oncologists. The use of novel ET combined with targeted drugs, such as cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors, has significantly improved long-term outcome rates, thus changing the therapeutic algorithm for metastatic BC (MBC) and recently the therapeutic strategy in the adjuvant setting for early high-risk BC. Eluding the resistance to CDK4/6 inhibitors combined with ET is currently an unmet medical need, and there is disagreement concerning the best course of action for patients who continue to progress after this combination approach. Genetic changes in the tumor along its growth uncovered by genomic profiling of recurrent and/or metastatic lesions through tumor and/or liquid biopsies may predict the response or resistance to specific agents, suggesting the best therapeutic strategy for each patient by targeting the altered ER-dependent pathway (novel oral SERDs and a new generation of anti-estrogen agents) or alternative ER-independent signaling pathways such as PI3K/AKT/mTOR or tyrosine kinase receptors (HER2 mutations or HER2 low status) or by inhibiting pathways weakened through germline BRCA1/2 mutations. These agents are being investigated as single molecules and in combination with other target therapies, offering promising weapons to overcome or avoid treatment failure and propose increasingly more personalized treatment approaches. This review presents novel insights into ET and other targeted therapies for managing metastatic HR+/HER2− BC by exploring potential strategies based on clinical evidence and genomic profiling following the failure of the CDK4/6i and ET combination. Full article
(This article belongs to the Special Issue Breast Cancer: Novel Insights into Hormone Therapy)
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Full article ">Figure 1
<p>A schematic representation of the main mechanisms of resistance to ET (<b>A</b>) and CDK4/6i (<b>B</b>) treatments. In red are the most frequent alterations found in HR<sup>+</sup>/HER2<sup>−</sup> MBC refractory to those therapies. Created with <a href="http://BioRender.com" target="_blank">BioRender.com</a>.</p> Full article ">Figure 2
<p>A scheme representing the different therapeutic strategies and the targets for ER<sup>+</sup>/HER2<sup>−</sup> MBC refractory to first-line treatments. Created with <a href="http://BioRender.com" target="_blank">BioRender.com</a>.</p> Full article ">Figure 3
<p>A potential algorithm for the treatment of HR<sup>+</sup>/HER2-negative MBC.</p> Full article ">
10 pages, 499 KiB  
Article
Clinical Characteristics of Cutaneous Pain in Psoriasis
by Magdalena Kotewicz, Piotr K. Krajewski, Andrzej K. Jaworek and Jacek C. Szepietowski
J. Clin. Med. 2024, 13(12), 3610; https://doi.org/10.3390/jcm13123610 - 20 Jun 2024
Viewed by 757
Abstract
Background: Psoriasis is a common inflammatory disease that is often associated with itch and pain. This study aimed to evaluate the clinical characteristics of skin pain among patients with psoriasis. Materials: A total of 106 patients diagnosed with psoriasis were included in the [...] Read more.
Background: Psoriasis is a common inflammatory disease that is often associated with itch and pain. This study aimed to evaluate the clinical characteristics of skin pain among patients with psoriasis. Materials: A total of 106 patients diagnosed with psoriasis were included in the study (34% female; mean age 42.1 ± 13.0 years). Disease severity was assessed using the Psoriasis Area and Severity Index (PASI). Itch severity was evaluated using the numeric rating scale (NRS) and 4-Item Itch Score (4IIS). The intensity of skin pain was measured through the NRS, short-form McGill pain questionnaire (SF-MPQ), visual analog scale (VAS), and Douleur Neuropathique-4 questionnaire (DN4). Results: In the past week, 84.9% of psoriasis patients reported itch, while 50% of them reported skin pain. The average NRS for itch was 4.52 ± 2.88 points, and the 4IIS yielded a mean score of 6.79 ± 4.37 points. In terms of the intensity of cutaneous pain, the mean NRS was 2.42 ± 2.96 points; the SF-MPQ score averaged 4.84 ± 7.51 points; and the VAS score was 1.92 ± 2.65 points. Furthermore, 17% of adult psoriasis patients reported neuropathic pain. In 84.9% of the participants, skin pain was concurrent with areas affected by itch, while 18.9% of patients exhibited cutaneous pain encompassing all itchy areas. The pain NRS demonstrated significant correlations with the SF-MPQ (r = 0.531, p < 0.001), VAS (r = 0.779, p < 0.001), itch NRS (r = 0.551, p < 0.001), and 4IIS (r = 0.569, p < 0.001). No association was found between the pain NRS and PASI or disease duration. Conclusions: Skin pain of mild intensity and itch of moderate intensity are prevalent symptoms in psoriasis patients. Strong correlations between skin pain and itch can be explained by the process of neurogenic inflammation. Full article
(This article belongs to the Special Issue Chronic Inflammatory Skin Diseases: An Update for Clinician—Part II)
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<p>Skin pain intensity in the past week assessed with the NRS (numerical rating scale) in (<b>a</b>) the whole population, (<b>b</b>) females, and (<b>c</b>) males.</p> Full article ">
12 pages, 3333 KiB  
Article
Is Feto-Maternal Transfusion after Cesarean Delivery Different in Singleton and Twin Pregnancy?
by Anna Stachurska-Skrodzka, Damian Mielecki, Anna Fijałkowska, Kinga Żebrowska, Monika Kasperczak and Katarzyna Kosińska-Kaczyńska
J. Clin. Med. 2024, 13(12), 3609; https://doi.org/10.3390/jcm13123609 - 20 Jun 2024
Viewed by 589
Abstract
Background: The aim of the study was to investigate if feto-maternal transfusion was related to the size of the fetal-maternal interface, and, therefore, was larger in twin pregnancy in comparison with singleton pregnancy. Methods: Blood samples from women with singleton (n [...] Read more.
Background: The aim of the study was to investigate if feto-maternal transfusion was related to the size of the fetal-maternal interface, and, therefore, was larger in twin pregnancy in comparison with singleton pregnancy. Methods: Blood samples from women with singleton (n = 11), and monochorionic (n = 11) and dichorionic (n = 13) twin gestations were tested. Flow cytometry tests with hemoglobin F, glycophorin A, and hemoglobin F and carbonic anhydrase simultaneous staining were used to detect fetal red blood cells and maternal F cells. Results: In all cases, the volume of feto-maternal transfusion was estimated to be low. The highest rate of fetal red blood cells in the maternal circulation was observed in the blood of women with dichorionic twin gestations both before and after delivery. An increase in fetal red blood cells was observed after cesarean section in singletons and twins. The median rate of maternal F cells was 2.23% in singleton, 2.1% in monochorionic and 3.95% in dichorionic pregnancy. Conclusions: Feto-maternal transfusion during pregnancy may be related to the multiplicity and chorionicity of pregnancy. Full article
(This article belongs to the Section Obstetrics & Gynecology)
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<p>Procedure diagram of fetal hemoglobin staining.</p> Full article ">Figure 2
<p>Procedure diagram of fetal hemoglobin and carbonic anhydrase staining.</p> Full article ">Figure 3
<p>Box and whisker plots of fetal RBC ratios in singleton and twin pregnancy before delivery based on fetal hemoglobin staining. x—mean; blue line—median; blue circle—outliers.</p> Full article ">Figure 4
<p>Box and whisker plots of fetal RBC ratios in singleton and twin pregnancy before delivery based on fetal hemoglobin and carbonic anhydrase staining. x—mean; blue line—median; blue circle—outliers.</p> Full article ">Figure 5
<p>Fetal RBC ratios in singleton and twin pregnancy before and after delivery based on fetal hemoglobin staining. Lines present the fetal RBC rates before and after delivery in each patient.</p> Full article ">Figure 6
<p>The fetal RBC ratios in singleton and twin pregnancy before and after delivery based on fetal hemoglobin and carbonic anhydrase staining. Lines present the fetal RBC rates before and after delivery in each patient.</p> Full article ">Figure 7
<p>Box and whisker plots of fetal RBC ratios in singleton and twin pregnancy after delivery based on fetal hemoglobin staining. x—mean; blue line—median; blue circle—outliers.</p> Full article ">Figure 8
<p>Box and whisker plots of fetal RBC ratios in singleton and twin pregnancy after delivery based on fetal hemoglobin and carbonic anhydrase staining. x—mean; blue line—median; blue circle—outliers.</p> Full article ">Figure 9
<p>Box and whisker plots of maternal F cell ratios in singleton and twin pregnancy based on fetal hemoglobin staining. x—mean; blue line—median; blue circle—outliers.</p> Full article ">Figure 10
<p>Box and whisker plots of maternal F cell ratios in singleton and twin pregnancy based on fetal hemoglobin and carbonic anhydrase staining. x—mean; blue line—median; blue circle—outliers.</p> Full article ">
3 pages, 180 KiB  
Comment
Comment on Salazar et al. Weight Regain after Metabolic Surgery: Beyond the Surgical Failure. J. Clin. Med. 2024, 13, 1143
by Athanasios G. Pantelis
J. Clin. Med. 2024, 13(12), 3608; https://doi.org/10.3390/jcm13123608 - 20 Jun 2024
Cited by 1 | Viewed by 634
Abstract
I read the article by Salazar J. [...] Full article
(This article belongs to the Special Issue Clinical Advances in Obesity and Bariatric Surgery)
11 pages, 515 KiB  
Article
In Patients with Cardiogenic Shock, Extracorporeal Membrane Oxygenation Is Associated with Very High All-Cause Inpatient Mortality Rate
by Mohammad Reza Movahed, Arman Soltani Moghadam and Mehrtash Hashemzadeh
J. Clin. Med. 2024, 13(12), 3607; https://doi.org/10.3390/jcm13123607 - 20 Jun 2024
Viewed by 792
Abstract
Background: The goal of this study was to evaluate the effect of extracorporeal membrane oxygenation (ECMO) on mortality in patients with cardiogenic shock excluding Impella and IABP use. Method: The large Nationwide Inpatient Sample (NIS) database was utilized to study any association between [...] Read more.
Background: The goal of this study was to evaluate the effect of extracorporeal membrane oxygenation (ECMO) on mortality in patients with cardiogenic shock excluding Impella and IABP use. Method: The large Nationwide Inpatient Sample (NIS) database was utilized to study any association between the use of ECMO in adults over the age of 18 and mortality and complications with a diagnosis of cardiogenic shocks. Results: ICD-10 codes for ECMO and cardiogenic shock for the available years 2016–2020 were utilized. A total of 796,585 (age 66.5 ± 14.4) patients had a diagnosis of cardiogenic shock excluding Impella. Of these patients, 13,160 (age 53.7 ± 15.4) were treated with ECMO without IABP use. Total inpatient mortality without any device was 32.7%. It was 47.9% with ECMO. In a multivariate analysis adjusting for 47 variables such as age, gender, race, lactic acidosis, three-vessel intervention, left main myocardial infarction, cardiomyopathy, systolic heart failure, acute ST-elevation myocardial infarction, peripheral vascular disease, chronic renal disease, etc., ECMO utilization remained highly associated with mortality (OR: 1.78, CI: 1.6–1.9, p < 0.001). Evaluating teaching hospitals only revealed similar findings. Major complications were also high in the ECMO cohort. Conclusions: In patients with cardiogenic shock, the use of ECMO was associated with the high in-hospital mortality regardless of comorbid condition, high-risk futures, or type of hospital. Full article
(This article belongs to the Special Issue Clinical Management of Cardiogenic Shock and Cardiac Arrest)
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<p>Mortality trends over years with ECMO.</p> Full article ">
10 pages, 1134 KiB  
Article
Efficacy of Vonoprazan vs. Intravenous Proton Pump Inhibitor in Prevention of Re-Bleeding of High-Risk Peptic Ulcers: A Randomized Controlled Pilot Study
by Tanawat Pattarapuntakul, Thanawin Wong, Panu Wetwittayakhlang, Nisa Netinatsunton, Suriya Keeratichananont, Apichat Kaewdech, Sawangpong Jandee, Naichaya Chamroonkul, Pimsiri Sripongpun and Peter L. Lakatos
J. Clin. Med. 2024, 13(12), 3606; https://doi.org/10.3390/jcm13123606 - 20 Jun 2024
Viewed by 1381
Abstract
Background: Proton pump inhibitor (PPI) therapy is well-established for its effectiveness in reducing re-bleeding in high-risk peptic ulcer patients following endoscopic hemostasis. Vonoprazan (VPZ) has demonstrated the capacity to achieve gastric pH levels exceeding 4, comparable to PPIs. This study aims to [...] Read more.
Background: Proton pump inhibitor (PPI) therapy is well-established for its effectiveness in reducing re-bleeding in high-risk peptic ulcer patients following endoscopic hemostasis. Vonoprazan (VPZ) has demonstrated the capacity to achieve gastric pH levels exceeding 4, comparable to PPIs. This study aims to evaluate the comparative efficacy of intravenous PPI infusion versus VPZ in preventing re-bleeding after endoscopic hemostasis in patients with high-risk peptic ulcers. Methods: A randomized, double-blind, controlled, and double-dummy design was employed. Patients with peptic ulcer bleeding (Forrest class IA/IB or IIA/IIB) who underwent endoscopic hemostasis were randomly assigned to either the PPI group or the VPZ group. Re-bleeding rates at 3, 7, and 30 days, the number of blood transfusions required, length of hospitalization, and ulcer healing rate at 56 days were assessed. Results: A total of 44 eligible patients were enrolled, including 20 patients (PPI group, n = 11; VPZ group, n = 9) with high-risk peptic ulcers. The mean age was 66 years, with 70% being male. Re-bleeding within 72 h occurred in 9.1% of the PPI group versus 0% in the VPZ group (p = 1.000). There was no significant difference in re-bleeding rates within 7 days and 30 days (18.2% vs. 11.1%, p = 1.000). Additionally, the ulcer healing rate did not significantly differ between the groups (87.5% vs. 77.8%). Conclusions: This pilot study demonstrates comparable efficacy between oral vonoprazan and continuous PPI infusion in preventing recurrent bleeding events among high-risk peptic ulcer patients following successful endoscopic hemostasis. Full article
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
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<p>Study protocol.</p> Full article ">Figure 2
<p>Study flow chart and randomization.</p> Full article ">Figure 3
<p>Kaplan–Meier curve for probability of clinical peptic ulcer re-bleeding.</p> Full article ">
14 pages, 5743 KiB  
Article
Reliability of the AI-Assisted Assessment of the Proximity of the Root Apices to Mandibular Canal
by Wojciech Kazimierczak, Natalia Kazimierczak, Kamila Kędziora, Marta Szcześniak and Zbigniew Serafin
J. Clin. Med. 2024, 13(12), 3605; https://doi.org/10.3390/jcm13123605 - 20 Jun 2024
Viewed by 733
Abstract
Background: This study evaluates the diagnostic accuracy of an AI-assisted tool in assessing the proximity of the mandibular canal (MC) to the root apices (RAs) of mandibular teeth using computed tomography (CT). Methods: This study involved 57 patients aged 18–30 whose [...] Read more.
Background: This study evaluates the diagnostic accuracy of an AI-assisted tool in assessing the proximity of the mandibular canal (MC) to the root apices (RAs) of mandibular teeth using computed tomography (CT). Methods: This study involved 57 patients aged 18–30 whose CT scans were analyzed by both AI and human experts. The primary aim was to measure the closest distance between the MC and RAs and to assess the AI tool’s diagnostic performance. The results indicated significant variability in RA-MC distances, with third molars showing the smallest mean distances and first molars the greatest. Diagnostic accuracy metrics for the AI tool were assessed at three thresholds (0 mm, 0.5 mm, and 1 mm). Results: The AI demonstrated high specificity but generally low diagnostic accuracy, with the highest metrics at the 0.5 mm threshold with 40.91% sensitivity and 97.06% specificity. Conclusions: This study underscores the limited potential of tested AI programs in reducing iatrogenic damage to the inferior alveolar nerve (IAN) during dental procedures. Significant differences in RA-MC distances between evaluated teeth were found. Full article
(This article belongs to the Special Issue Emerging Technologies for Dental Imaging)
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<p>Sample case of measurements of RA-MC distance of tooth 47 using MPRs. (<b>A</b>) Sagittal plane; (<b>B</b>) axial plane; (<b>C</b>) coronal plane; RA-MC distance marked with green color.</p> Full article ">Figure 2
<p>Bilateral direct RA-MC communication of third molars. (<b>A</b>) Axial plane; (<b>B</b>) coronal plane. The course of MC is marked in orange. RA-MC proximity detected by CephX.</p> Full article ">Figure 3
<p>Sample RA-MC proximity alert provided by CephX.</p> Full article ">Figure 4
<p>Three-dimensional model presenting teeth and MC segmentation results. RA-MC proximity detected by AI program.</p> Full article ">Figure 5
<p>Diagnostic accuracy metrics of AI program for RA-MC proximity.</p> Full article ">Figure 6
<p>Correlation between mean RA-MC distances and AI’s diagnosis on RA-MC proximity.</p> Full article ">
19 pages, 543 KiB  
Systematic Review
Combined Central and Peripheral Demyelination (CCPD) Associated with MOG Antibodies: Report of Four New Cases and Narrative Review of the Literature
by Marianna Papadopoulou, Dimitrios Tzanetakos, Christos Moschovos, Anastasia Korona, George Vartzelis, Konstantinos Voudris, Stella Fanouraki, Evangelia-Makrina Dimitriadou, Georgios Papadimas, John S. Tzartos, Sotirios Giannopoulos and Georgios Tsivgoulis
J. Clin. Med. 2024, 13(12), 3604; https://doi.org/10.3390/jcm13123604 - 20 Jun 2024
Viewed by 835
Abstract
Background/Objectives: Myelin oligodendrocyte glycoprotein (MOG) is exclusively expressed in the central nervous system (CNS) and is found on the outer surface of oligodendrocytes. Antibodies to MOG are associated with CNS demyelination, whereas peripheral nervous system (PNS) demyelination is seldom reported to be [...] Read more.
Background/Objectives: Myelin oligodendrocyte glycoprotein (MOG) is exclusively expressed in the central nervous system (CNS) and is found on the outer surface of oligodendrocytes. Antibodies to MOG are associated with CNS demyelination, whereas peripheral nervous system (PNS) demyelination is seldom reported to be related to MOG-IgG. Methods: The database of patients seen in our neurological academic center was searched for MOG-IgG seropositivity and concomitant demyelinating polyneuropathy. For the purpose of the review, in March 2024, we searched for case reports and case series in the following databases: PubMed, Scopus, Cochrane, and ScienceDirect. Inclusion criteria were MOG-IgG seropositivity and demyelinating polyneuropathy. Exclusion criteria were type of publication other than case reports and case series, unconfirmed diagnosis of demyelinating polyneuropathy, and other diseases causing demyelination in either the CNS or PNS. Critical appraisal of the selected case reports and case series was realized by JBI. Results: Four new cases were identified with MOG-IgG and confirmed demyelinating polyneuropathy. This review identified 22 cases that have been published since 2018. Clinical, imaging, neurophysiological, and immunological characteristics, as well as treatment options and outcomes are presented and compared to those of other cases with combined central and peripheral demyelination (CCPD). Conclusions: The pathogenetic mechanism is unclear; thus, different hypotheses are discussed. New case reporting and large cohort studies will help further the exploration of the underlying mechanism and guide more effective therapeutic interventions. Full article
(This article belongs to the Section Clinical Neurology)
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<p>Possible mechanisms by which MOG-IgGs might attack peripheral myelin. 1. Roots are at the transition zone where CNS shifts to PNS; 2. Non-detectable MOG exists in Schwann cell; 3. MOG-IgGs recognize and attack other myelin antigens through mimicry.</p> Full article ">
6 pages, 546 KiB  
Brief Report
Discontinuation of Palliative Brain Radiotherapy in Patients with Brain Metastases: A Case–Control Study
by Paul Windisch, Jamie Lütscher, Robert Förster, Daniel R. Zwahlen and Christina Schröder
J. Clin. Med. 2024, 13(12), 3603; https://doi.org/10.3390/jcm13123603 - 20 Jun 2024
Viewed by 656
Abstract
Background: Discontinuation of radiotherapy is rarely discussed in the scientific literature. The goal of this study was, therefore, to estimate the frequency of and reasons for treatment discontinuations in patients receiving radiotherapy for brain metastases from solid tumors and to identify factors [...] Read more.
Background: Discontinuation of radiotherapy is rarely discussed in the scientific literature. The goal of this study was, therefore, to estimate the frequency of and reasons for treatment discontinuations in patients receiving radiotherapy for brain metastases from solid tumors and to identify factors predicting said discontinuations. Methods: All patients treated for brain metastases from solid tumors between 2010 and 2020 at our institution were retrospectively reviewed. In addition to collecting relevant patient characteristics, the Recursive Partitioning Analysis (RPA) and disease-specific Graded Prognostic Assessment (GPA) groups for each patient were calculated to assess the performance of these scores in predicting treatment discontinuations. Results: Out of 468 patients who underwent cranial radiotherapy, 35 treatments (7.5%) were discontinued. The most frequent reason was clinical deterioration, which was documented in 26 (74.3%) of discontinued treatments. Patients whose radiotherapy was discontinued had, on average, more leptomeningeal disease (20.0% vs. 12.6%), worse ECOG performance status (mean ECOG performance status 1.86 vs. 1.39), and more uncontrolled extracranial metastases (85.3% vs. 70.8%). The frequencies of treatment discontinuation increased with worse prognosis and differed significantly across RPA groups (p = 0.037) but not across GPA groups (p = 0.612). Conclusions: Treatment discontinuation occurred in 7.5% of cases, mostly due to clinical deterioration. Poor performance status, as well as more advanced disease and, in turn, poor prognosis, were associated with higher discontinuation rates. Full article
(This article belongs to the Section Oncology)
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<p>(<b>A</b>) Histograms of selected patient characteristics depending on whether the radiotherapy was completed (left) or discontinued (right). (<b>B</b>) Histograms of completed and discontinued radiotherapies by Recursive Partitioning analysis (left) and Graded Prognostic Assessment group (right). RT = Radiotherapy, ECOG = Eastern Cooperative Oncology Group, RPA = Recursive Partitioning Analysis, GPA = Graded Prognostic Assessment.</p> Full article ">
20 pages, 2410 KiB  
Article
Diagnostic Performance of F-18 FDG PET/CT in the Detection of Recurrent Colorectal Cancer: Correlation with Biochemical Markers and Conventional Imaging Modalities
by Jasna Mihailović, Jelena Roganović, Ivana Starčević, Ivan Nikolić, Nataša Prvulović Bunović and Zoran Nikin
J. Clin. Med. 2024, 13(12), 3602; https://doi.org/10.3390/jcm13123602 - 20 Jun 2024
Viewed by 938
Abstract
Background/Objectives: Although the role of PET/CT imaging is well established in oncology, its diagnostic value in routine monitoring for recurrent colorectal cancer (CRC) is still controversial. The aim was to evaluate the diagnostic value of F-18 FDG PET/CT in detecting recurrent CRC [...] Read more.
Background/Objectives: Although the role of PET/CT imaging is well established in oncology, its diagnostic value in routine monitoring for recurrent colorectal cancer (CRC) is still controversial. The aim was to evaluate the diagnostic value of F-18 FDG PET/CT in detecting recurrent CRC in correlation with CEA, CA 19-9 levels, and conventional imaging modalities (CIM). Methods: Between 2009 and 2023, a retrospective study was performed including 134 CRC patients referred for PET/CT imaging on the suspicion of recurrence, based on elevated CEA and/or CA 19-9 and/or equivocal CIM findings. According to our institution’s Tumor Board CRC protocol, after the initial treatment, which was dependent on the TNM stage (neoadjuvant therapy, primary resection, or adjuvant treatment), patients underwent a standard 5-year surveillance including CEA and CA 19-9 measurements, CIM, and colonoscopy, every six months. The statistics, including univariate and multivariate analyses were conducted using the IBM SPSS 20.0 statistical software. p-values < 0.05 were considered statistically significant. Results: Recurrent CRC was confirmed in 54/134 (40.3%) patients with elevated tumor markers. PET/CT showed high diagnostic performance in detecting recurrent CRC with sensitivity, specificity, PPV, NPV, and accuracy of 94.4%, 82.5%, 78.5%, 95.7%, and 87.3%, respectively. The CEA showed a high sensitivity of 98.1% but both low specificity and accuracy of 15% and 48.5%, respectively. The sensitivity, specificity, and accuracy for CA 19-9 and CIM for diagnosis of CRC recurrence were 44.4%, 67.5%, 58.2%, and 51.9%, 98.8%, 79.9%, respectively. The AUC for PET/CT, elevated CEA levels, CIM, and elevated CA 19-9 levels was 0.885 (95% CI: 0.824–0.946; p < 0.001), 0.844 (95% CI: 0.772–0.916; p < 0.001), 0.753 (95% CI: 0.612–0.844; p < 0.001), and 0.547 (95% CI: 0.442–0.652; p = 0.358), respectively. Univariate analysis showed that both PET/CT and CIM positive results were highly associated with CRC recurrence (p < 0.001 and p < 0.001, respectively). At the same time, gender, mucinous tumor type, presence of initial lymph node metastasis (N+), and presence of initial distant metastasis (M+) had no significance (p = 0.211, p = 0.158, p = 0.583, and p = 0.201, respectively). Our multivariate analysis showed that independent predictors for CRC recurrence are positive PET/CT scans (p < 0.001), positive CIM results (p = 0.001), and elevated CA 19-9 levels (p = 0.023). Although CA 19-9 was not detected as a statistically significant predictor in the univariate analysis (p = 0.358), in a multivariate analysis it was recognized as a significant predicting factor in detecting the CRC recurrence (p = 0.023). Conclusions: F-18 FDG PET/CT showed high diagnostic efficacy in CRC recurrence detection, in correlation with CEA levels, CA 19-9 levels, and CIM. This imaging modality should be routinely integrated into the post-operative follow-op in patients with elevated tumor markers. Full article
(This article belongs to the Special Issue Nuclear Medicine Procedures in Oncology: New Prospects)
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<p>(<b>a</b>) PET/CT axial image detects a focal area of increased FDG uptake in the right pulmonary lobe, S4, SUVmax 7.50 (white arrow), corresponding to lung metastasis, (<b>b</b>) diagnostic CT scan in axial plane confirms a lesion in the right pulmonary lobe, S4 (white arrow), consistent with a metastatic lesion in the lung, (<b>c</b>) PET/CT axial image shows two hypermetabolic lesions in the liver in S8, SUVmax 8.9 (black arrow) and in S4a, SUVmax 8.0 (arrowhead), corresponding with liver metastases, and (<b>d</b>) diagnostic CT in axial plane shows two heterodense dominantly hypodense lesions in S8 (black arrow) and S4a (arrowhead), consistent with distant metastases in the liver.</p> Full article ">Figure 2
<p>(<b>a</b>) Axial T1W MR image shows focal T1W hypointense lesion in the right iliac bone (white arrow) corresponding with metastasis, and (<b>b</b>) PET/CT axial image does not detect FDG-avid lesion in the region of pelvic bone.</p> Full article ">Figure 3
<p>(<b>a</b>) Diagnostic CT in axial plane shows no lesion in the left pelvic region, and (<b>b</b>) PET/CT axial image detects an FDG-avid ovoid lesion in the left obturator area, SUVmax 7.20 (white arrow), corresponding with lymph node involvement.</p> Full article ">Figure 4
<p>ROC analysis.</p> Full article ">
10 pages, 709 KiB  
Article
The Potential Role of CA-125 as a Biomarker for Short-Term Mortality Risk in Patients with Acute Symptomatic Pulmonary Embolism
by Crhistian-Mario Oblitas, Francisco Galeano-Valle, Marta-Olimpia Lago-Rodríguez, Marina López-Rubio, Jesús Baltasar-Corral, Mercedes García-Gámiz, Angielys Zamora-Trillo, Luis-Antonio Alvarez-Sala Walther and Pablo Demelo-Rodríguez
J. Clin. Med. 2024, 13(12), 3601; https://doi.org/10.3390/jcm13123601 - 20 Jun 2024
Viewed by 974
Abstract
Background: Antigen carbohydrate 125 (CA-125) is a complex glycoprotein extensively studied as a prognostic biomarker in heart failure, yet its potential role in the short-term prognosis of an acute pulmonary embolism (PE) remains unexplored. Methods: In this observational, prospective, single-center study, [...] Read more.
Background: Antigen carbohydrate 125 (CA-125) is a complex glycoprotein extensively studied as a prognostic biomarker in heart failure, yet its potential role in the short-term prognosis of an acute pulmonary embolism (PE) remains unexplored. Methods: In this observational, prospective, single-center study, consecutive patients aged 18 and older with a confirmed acute symptomatic PE and no history of prior anticoagulant therapy were enrolled. Primary and secondary objectives aimed to assess the prognostic capacity of CA-125 at PE diagnosis for 30-day mortality and major bleeding, respectively. Results: A total of 164 patients were included (mean age 69.8 years, SD 17), with 56.1% being male. Within 30 days, 17 patients (10.4%) died and 9 patients (5.5%) suffered major bleeding. ROC curve analysis for 30-day mortality yielded an area under the curve of 0.69 (95% CI 0.53–0.85) with an optimal CA-125 cut-off point of 20 U/mL and a negative predictive value of 96%. Multivariate analysis revealed a significant association between CA-125 levels exceeding 20 U/mL and 30-day mortality (adjusted odds ratio 4.95; 95% CI 1.61–15.2) after adjusting for age, cancer, NT-proBNP > 600 ng/mL, and the simplified pulmonary embolism severity index score. Survival analysis for 30-day mortality exhibited a hazard ratio of 5.47 (95% CI 1.78–16.8). No association between CA-125 levels and 30-day major bleeding was found. Conclusions: CA-125 emerges as a promising surrogate biomarker for short-term mortality prediction in an acute symptomatic PE. Future investigations should explore the integration of CA-125 into PE mortality prediction scores to enhance the prognostic accuracy in this patient population. Full article
(This article belongs to the Section Cardiovascular Medicine)
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<p>Predictive capacity of CA-125 for 30-day mortality (<b>A</b>). Predictive capacity of CA-125 for 30-day major bleeding (<b>B</b>). The red line in each graph represents the ROC (Receiver Operating Characteristic) curve for the CA125 marker in relation to the outcomes of mortality (Panel <b>A</b>) and major bleeding (Panel <b>B</b>). The green diagonal line represents the line of no-discrimination, which corresponds to an AUC (Area Under the Curve) of 0.5.</p> Full article ">Figure 2
<p>Overall survival Kaplan–Meier analyses of 30-day mortality for CA-125 &gt; 20 U/mL showed a hazard ratio of 5.47 (95% CI 1.78–16.8). The absolute numbers of surviving patients on days 0, 5, 10, 15, 20, 25, and 30 comparing levels from above or below the optimal cut-off (<b>A</b>). Overall survival Kaplan–Meier analyses of 30-day major bleeding for CA-125 &gt; 20 U/mL showed a hazard ratio of 1.26 (95% CI 0.34–4.68). The absolute numbers of surviving patients on days 0, 5, 10, 15, 20, 25, and 30 comparing levels from above or below the optimal cut-off (<b>B</b>).</p> Full article ">
9 pages, 493 KiB  
Article
Socioeconomic Status and Clinical Outcomes in Chronic Kidney Disease: Bootstrap Validation of a Simple Indicator
by Annalisa Pitino, Graziella D’Arrigo, Carmela Marino, Patrizia Pizzini, Graziella Caridi, Francesca Mallamaci, Giovanni Tripepi and Carmine Zoccali
J. Clin. Med. 2024, 13(12), 3600; https://doi.org/10.3390/jcm13123600 - 20 Jun 2024
Viewed by 749
Abstract
Background: Chronic Kidney Disease (CKD) is a complex health condition that interacts significantly with socioeconomic determinants, particularly income status and education. This study developed a simple indicator of socioeconomic status (SES), which is composed of income status and education in CKD patients, and [...] Read more.
Background: Chronic Kidney Disease (CKD) is a complex health condition that interacts significantly with socioeconomic determinants, particularly income status and education. This study developed a simple indicator of socioeconomic status (SES), which is composed of income status and education in CKD patients, and evaluated its impact on health outcomes in this population. Methods: This study was conducted on 561 CKD patients, stages 2–5. The composite SES score was developed by combining the regression coefficients of income and education as predictors of the study endpoint in a multivariable Cox model, normalizing these coefficients to derive weights, and then using these weights to calculate an individual percentage score based on each person’s income and education. The composed SES indicator was internally validated through bootstrap analysis. Over a median follow-up time of 36 months, we tracked all-cause death and non-fatal cardiovascular events. Results: Both lack of income (p = 0.020) and low educational level (p = 0.034) were independently related to the combined endpoint. Based on these covariates‘ regression coefficients, a composite socioeconomic score considering income and educational level was generated. In a Cox regression model, a 10% increase in this composite risk score entailed a 25% increase in the hazard ratio (HR) of the combined endpoint [HR (10% increase): 1.25], and the internally validated 95% CI ranged from 1.14 to 1.41 (p < 0.001). Conclusions: This study underscores the significant impact of a simple, bootstrap-validated composite SES indicator on CKD patients’ health outcomes. These findings highlight the importance of considering education and socioeconomic factors in managing and treating CKD patients and inform future research and policy considerations for this population. Full article
(This article belongs to the Special Issue Novelty in the Management of Progression and Complications of CKD)
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<p>Survival curves by income level (top-left), educational level (top-right), and the combined socioeconomic score (the combination of these variables, bottom). Data were adjusted for variables listed in <a href="#jcm-13-03600-t002" class="html-table">Table 2</a>, Model 3.</p> Full article ">
8 pages, 4008 KiB  
Article
Evaluation of a Semi-Automated Wound-Halving Algorithm for Split-Wound Design Studies: A Step towards Enhanced Wound-Healing Assessment
by Paul Julius Georg, Meret Emily Schmid, Sofia Zahia, Sebastian Probst, Simone Cazzaniga, Robert Hunger and Simon Bossart
J. Clin. Med. 2024, 13(12), 3599; https://doi.org/10.3390/jcm13123599 - 20 Jun 2024
Viewed by 759
Abstract
Background: Chronic leg ulcers present a global challenge in healthcare, necessitating precise wound measurement for effective treatment evaluation. This study is the first to validate the “split-wound design” approach for wound studies using objective measures. We further improved this relatively new approach [...] Read more.
Background: Chronic leg ulcers present a global challenge in healthcare, necessitating precise wound measurement for effective treatment evaluation. This study is the first to validate the “split-wound design” approach for wound studies using objective measures. We further improved this relatively new approach and combined it with a semi-automated wound measurement algorithm. Method: The algorithm is capable of plotting an objective halving line that is calculated by splitting the bounding box of the wound surface along the longest side. To evaluate this algorithm, we compared the accuracy of the subjective wound halving of manual operators of different backgrounds with the algorithm-generated halving line and the ground truth, in two separate rounds. Results: The median absolute deviation (MAD) from the ground truth of the manual wound halving was 2% and 3% in the first and second round, respectively. On the other hand, the algorithm-generated halving line showed a significantly lower deviation from the ground truth (MAD = 0.3%, p < 0.001). Conclusions: The data suggest that this wound-halving algorithm is suitable and reliable for conducting wound studies. This innovative combination of a semi-automated algorithm paired with a unique study design offers several advantages, including reduced patient recruitment needs, accelerated study planning, and cost savings, thereby expediting evidence generation in the field of wound care. Our findings highlight a promising path forward for improving wound research and clinical practice. Full article
(This article belongs to the Section Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine)
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<p>Approximation to 50% with 1-pixel wide steps.</p> Full article ">Figure 2
<p>(<b>A</b>) An example of a leg ulcer (<b>B</b>) wound halving performed by the algorithm, (<b>C</b>) manual wound halving of round 1, and (<b>D</b>) manual wound halving of round 2.</p> Full article ">
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