Journal of Clinical Medicine

11 pages, 1037 KiB

Open AccessArticle

The Effect of Revascularization on Lower Limb Circulation Parameters in Symptomatic Peripheral Arterial Disease

by Andreas L. H. Gerken, Martin Sigl, Elisa Israel, Christel Weiß, Christoph Reißfelder and Kay Schwenke

J. Clin. Med. 2024, 13(13), 3991; https://doi.org/10.3390/jcm13133991 - 8 Jul 2024

Viewed by 831

Abstract

Background: The prevalence of peripheral arterial disease and the number of revascularization procedures performed in symptomatic patients are steadily increasing. However, uncertainties remain regarding hemodynamic monitoring after revascularization and the prediction of clinical outcomes. This study aimed to investigate hemodynamic parameters with a [...] Read more.

Background: The prevalence of peripheral arterial disease and the number of revascularization procedures performed in symptomatic patients are steadily increasing. However, uncertainties remain regarding hemodynamic monitoring after revascularization and the prediction of clinical outcomes. This study aimed to investigate hemodynamic parameters with a focus on the microvasculature. Methods: This prospective, single-center study included 29 patients (15 with intermittent claudication [IC] and 14 with chronic limb-threatening ischemia [CLTI]). Before and after the revascularization procedure, in addition to the ankle–brachial index (ABI), microperfusion parameters, including microvascular blood flow, capillary oxygen saturation (SO₂), and relative hemoglobin content (rHb), were assessed with lightguide spectrophotometry combined with laser Doppler flowmetry using an oxygen-to-see (O2C) device in the horizontal and elevated leg positions. Results: At baseline, SO₂ in the elevated leg position was significantly lower in patients with CLTI than in those with IC (p = 0.0189), whereas the other microcirculatory parameters and ABI values were not significantly different. Patients with diabetes mellitus had a higher flow rate than those without in the horizontal leg position (p = 0.0162) but not in the elevated leg position. After successful revascularization, the flow increased immediately and significantly in both positions, whereas SO₂, rHb, and the ABI did not. Conclusions: Elevated leg SO₂ was significantly lower in CLTI than in clinically compensated peripheral arterial disease, whereas microvascular flow was a suitable surrogate parameter indicating successful revascularization. In studies using surgical or interventional revascularization procedures, noninvasive hemodynamic monitoring of the microcirculation at the foot level might be beneficial. Full article

(This article belongs to the Special Issue Clinical Advances and Challenges in Vascular and Endovascular Medicine)

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10 pages, 491 KiB

Open AccessArticle

Total IgE Trends in Children with Allergic Diseases

by Nikolaos Katsanakis, Paraskevi Xepapadaki, Ioannis-Alexios Koumprentziotis, Pavlos Vidalis, John Lakoumentas, Maria Kritikou and Nikolaos G. Papadopoulos

J. Clin. Med. 2024, 13(13), 3990; https://doi.org/10.3390/jcm13133990 - 8 Jul 2024

Viewed by 589

Abstract

Background/Objectives: The importance of non-invasive biomarkers for the diagnosis and monitoring of allergic diseases in childhood is currently unknown. From this perspective, data on the role of the total (t) immunoglobulin E (IgE) in relation to different allergic diseases across different age groups [...] Read more.

Background/Objectives: The importance of non-invasive biomarkers for the diagnosis and monitoring of allergic diseases in childhood is currently unknown. From this perspective, data on the role of the total (t) immunoglobulin E (IgE) in relation to different allergic diseases across different age groups until adulthood remain unclear. The potential association of tIgE levels with types of allergic diseases diagnosed in an specialized tertiary allergy center, in relation to sex and the age group spanning from birth to 20 years, are evaluated in the present study. Methods: In this retrospective study, the tIgE values were obtained from children assessed for allergy-associated symptoms in our department from January 2015 to December 2020. The tIgE values were analyzed in relation to age and diagnosis. Results: Data from 2127 patients (1321 boys (62.1%)), with a median age of 6.31 (3.01–9.95) years, were available. The tIgE median values for the studied population were 132 (37.7–367.5) kU/lt. The tIgE values showed a significant increase from 0–2 years to 2–5 and 5–12 years, but not from 5–12 to 12–20 years. Boys exhibited significantly higher tIgE values compared to girls. Furthermore, the tIgE levels were significantly increased in children with asthma, allergic rhinitis, food allergy, and atopic dermatitis in comparison to children without these diagnoses. Conclusions: The total IgE values exhibit a significant and progressive longitudinal increase in children with allergic diseases, particularly notable in the 0–2 and 5–12 age groups, in boys, and in children diagnosed with atopic conditions. Full article

(This article belongs to the Special Issue Allergic and Eosinophilic Diseases: Diagnosis, Treatment, and Management)

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12 pages, 2365 KiB

Open AccessArticle

Seven-Year Experience of Intramural Surgery in the Middle East: A Safety and Feasibility Analysis

by Gabriela Restrepo-Rodas, Juan S. Barajas-Gamboa, Jerry T. Dang, Maja I. Piechowska-Jóźwiak, Mohammed Khan, Gabriel Diaz Del Gobbo, Mohammed Abdallah, Cristobal Moreno, Carlos Abril, Juan Pablo Pantoja, Alfredo D. Guerron, Ricard Corcelles, Matthew Kroh and John Rodriguez

J. Clin. Med. 2024, 13(13), 3989; https://doi.org/10.3390/jcm13133989 - 8 Jul 2024

Viewed by 670

Abstract

Background: Intramural surgery techniques, particularly esophageal peroral endoscopic myotomy (E-POEM), gastric peroral endoscopic myotomy (G-POEM), and peroral endoscopic myotomy for Zenker’s (Z-POEM), have emerged as forefront minimally invasive endoscopic procedures. While several studies have reported on the outcomes in North America and Asia, [...] Read more.

Background: Intramural surgery techniques, particularly esophageal peroral endoscopic myotomy (E-POEM), gastric peroral endoscopic myotomy (G-POEM), and peroral endoscopic myotomy for Zenker’s (Z-POEM), have emerged as forefront minimally invasive endoscopic procedures. While several studies have reported on the outcomes in North America and Asia, evidence in the Middle East and North Africa remains limited. This study aims to evaluate the feasibility and safety of intramural surgery techniques within this region. Methods: This retrospective cohort study was conducted with approval from the institutional review board. All patients who underwent esophageal peroral endoscopic myotomy, gastric peroral endoscopic myotomy, and peroral endoscopic myotomy for Zenker’s from January 2016 to August 2023 were included. Results: In total, 119 patients underwent intramural surgery procedures during this period. The esophageal peroral endoscopic myotomy group had 81 (68%) patients, the gastric peroral endoscopic myotomy had 34 (28.6%) patients, and the peroral endoscopic myotomy for Zenker’s had 4 (3.4%) patients. The full cohort was 48.7% female, with a mean overall age of 40.5 years. The mean overall body mass index was 27.5 kg/m². The chief complaint was dysphagia (n = 80, 67.2%). All cases were successfully completed endoscopically. During the first 30 days, the most common complications were nausea/vomiting requiring admission (n = 4, 4.76%) and pneumomediastinum (n = 2, 2.38%). At a follow-up of 19 months, there were four mortalities; the causes of death were cardiac arrest (three cases) and end-stage prostate cancer (one case). Conclusions: Intramural surgery techniques are safe and technically feasible with low complication rates. Our study suggests that clinical success in the Middle East and Northern Africa population is comparable to larger international series. Full article

(This article belongs to the Section General Surgery)

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19 pages, 751 KiB

Open AccessArticle

Physical Health in Patients with Post-COVID-19 6 and 12 Months after an Inpatient Rehabilitation: An Observational Study

by Katrin Müller, Marcel Ottiger, Iris Poppele, Alois Wastlhuber, Michael Stegbauer and Torsten Schlesinger

J. Clin. Med. 2024, 13(13), 3988; https://doi.org/10.3390/jcm13133988 - 8 Jul 2024

Viewed by 1206

Abstract

Background: Rehabilitation is an effective and feasible approach for post-COVID patients to improve physical health. However, knowledge regarding the long-term impact of rehabilitation on the physical health of these patients is lacking. Methods: Changes in physical health of 127 patients with COVID-19 as [...] Read more.

Background: Rehabilitation is an effective and feasible approach for post-COVID patients to improve physical health. However, knowledge regarding the long-term impact of rehabilitation on the physical health of these patients is lacking. Methods: Changes in physical health of 127 patients with COVID-19 as an occupational disease or work accident were assessed in a longitudinal observational study. Post-COVID symptoms, functional status, functional exercise capacity, endurance capacity, physical performance, quadricep strength, handgrip strength, motor balance ability, and self-reported physical performance were examined at the beginning as well as 6 and 12 months after the rehabilitation. Group differences concerning sex, age, acute COVID status, comorbidities prior to COVID-19, and aftercare interventions were also analysed. Results: Even 12 months after rehabilitation, the prevalence of post-COVID symptoms (28.6–94.7%) remained remarkably high in the study population. Significant improvements in various aspects of physical health were observed 6 (r = 0.288–0.755) and 12 months (r = 0.189–0.681) after the rehabilitation. Participants demonstrated enhanced endurance, strength, and balance function, as well as improvement in subjective physical ability. Significant group differences were observed between younger and older patients, those with mild–moderate and severe–critical COVID-19, and patients with and without pre-existing cardiovascular disease, metabolic disease, psychological disease, neuro-sensory disease, musculoskeletal disease, and exercising in an outpatient group. Conclusions: The study identifies persistent challenges in COVID-19 recovery, despite significant improvements in physical health 6 and 12 months after rehabilitation. Further research and the implementation of standardised approaches are required to enhance the outcomes of post-COVID rehabilitation, with a focus on developing personalised care strategies for long-term recovery. 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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17 pages, 582 KiB

Open AccessArticle

Safety of High-Dose Vitamin C in Non-Intensive Care Hospitalized Patients with COVID-19: An Open-Label Clinical Study

by Salvatore Corrao, Massimo Raspanti, Federica Agugliaro, Francesco Gervasi, Francesca Di Bernardo, Giuseppe Natoli and Christiano Argano

J. Clin. Med. 2024, 13(13), 3987; https://doi.org/10.3390/jcm13133987 - 8 Jul 2024

Cited by 1 | Viewed by 1343

Abstract

Background: Vitamin C has been used as an antioxidant and has been proven effective in boosting immunity in different diseases, including coronavirus disease (COVID-19). An increasing awareness was directed to the role of intravenous vitamin C in COVID-19. Methods: In this [...] Read more.

Background: Vitamin C has been used as an antioxidant and has been proven effective in boosting immunity in different diseases, including coronavirus disease (COVID-19). An increasing awareness was directed to the role of intravenous vitamin C in COVID-19. Methods: In this study, we aimed to assess the safety of high-dose intravenous vitamin C added to the conventional regimens for patients with different stages of COVID-19. An open-label clinical trial was conducted on patients with COVID-19. One hundred four patients underwent high-dose intravenous administration of vitamin C (in addition to conventional therapy), precisely 10 g in 250 cc of saline solution in slow infusion (60 drops/min) for three consecutive days. At the same time, 42 patients took the standard-of-care therapy. Results: This study showed the safety of high-dose intravenous administration of vitamin C. No adverse reactions were found. When we evaluated the renal function indices and estimated the glomerular filtration rate (eGRF, calculated with the CKD-EPI Creatinine Equation) as the main side effect and contraindication related to chronic renal failure, no statistically significant differences between the two groups were found. High-dose vitamin C treatment was not associated with a statistically significant reduction in mortality and admission to the intensive care unit, even if the result was bound to the statistical significance. On the contrary, age was independently associated with admission to the intensive care unit and in-hospital mortality as well as noninvasive ventilation (N.I.V.) and continuous positive airway pressure (CPAP) (OR 2.17, 95% CI 1.41–3.35; OR 7.50, 95% CI 1.97–28.54; OR 8.84, 95% CI 2.62–29.88, respectively). When considering the length of hospital stay, treatment with high-dose vitamin C predicts shorter hospitalization (OR −4.95 CI −0.21–−9.69). Conclusions: Our findings showed that an intravenous high dose of vitamin C is configured as a safe and promising therapy for patients with moderate to severe COVID-19. Full article

(This article belongs to the Special Issue COVID-19 Treatments and Therapeutics)

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11 pages, 2329 KiB

Open AccessArticle

Reliability of EuroSCORE II on Prediction of Thirty-Day Mortality and Long-Term Results in Patients Treated with Sutureless Valves

by Lorenzo Di Bacco, Michele D’Alonzo, Massimo Baudo, Andrea Montisci, Marco Di Eusanio, Thierry Folliguet, Marco Solinas, Antonio Miceli, Theodor Fischlein, Fabrizio Rosati and Claudio Muneretto

J. Clin. Med. 2024, 13(13), 3986; https://doi.org/10.3390/jcm13133986 - 8 Jul 2024

Viewed by 636

Abstract

Background: EuroSCORE II (ES2) is a reliable tool for preoperative cardiac surgery mortality risk prediction; however, a patient’s age, a surgical procedure’s weight and the new devices available may cause its accuracy to drift. We sought to investigate ES2 performance related to the [...] Read more.

Background: EuroSCORE II (ES2) is a reliable tool for preoperative cardiac surgery mortality risk prediction; however, a patient’s age, a surgical procedure’s weight and the new devices available may cause its accuracy to drift. We sought to investigate ES2 performance related to the surgical risk and late mortality estimation in patients who underwent aortic valve replacement (AVR) with sutureless valves. Methods: Between 2012 and 2021, a total of 1126 patients with isolated aortic stenosis who underwent surgical AVR by means of sutureless valves were retrospectively collected from six European centers. Patients were stratified into three groups according to the EuroSCORE II risk classes (ES2 < 4%, ES2 4–8% and ES2 > 8%). The accuracy of ES2 in estimating mortality risk was assessed using the standardized mortality ratio (O/E ratio), ROC curves (AUC) and Hosmer–Lemeshow (HL) test for goodness-of-fit. Results: The overall observed mortality was 3.0% (predicted mortality ES2: 5.39%) with an observed/expected (O/E) ratio of 0.64 (confidential interval (CI): 0.49–0.89). In our population, ES2 showed a moderate discriminating power (AUC 0.65, 95%CI 0.56–0.72, p < 0.001; HL p = 0.798). Good accuracy was found in patients with ES2 < 4% (O/E ratio 0.54, 95%CI 0.23–1.20, AUC 0.75, p < 0.001, HL p = 0.999) and for patients with an age < 75 years (O/E ratio 0.98, 95%CI 0.45–1.96, AUC 0.76, p = 0.004, HL p = 0.762). Moderate discrimination was observed for ES2 in the estimation of long-term risk of mortality (AUC 0.64, 95%CI: 0.60–0.68, p < 0.001). Conclusions: EuroSCORE II showed good accuracy in patients with an age < 75 years and patients with ES2 < 4%, while overestimating risk in the other subgroups. A recalibration of the model should be taken into account based on the complexity of actual patients and impact of new technologies. Full article

(This article belongs to the Section Cardiovascular Medicine)

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11 pages, 235 KiB

Open AccessArticle

Refractive Errors, Amplitude of Accommodation, and Myopia Progression in Kazakhstani Medical Students: 5-Year Follow-Up

by Yuliya Semenova, Malika Urazhanova, Lisa Lim and Nazerke Kaiyrzhanova

J. Clin. Med. 2024, 13(13), 3985; https://doi.org/10.3390/jcm13133985 - 8 Jul 2024

Viewed by 760

Abstract

Background/Objectives: this longitudinal study aimed to investigate the refractive errors, the amplitude of accommodation, and myopia progression in Kazakhstani medical students as they progressed from the first to the fifth course of their studies. Methods: A total of 696 students from Semey Medical [...] Read more.

Background/Objectives: this longitudinal study aimed to investigate the refractive errors, the amplitude of accommodation, and myopia progression in Kazakhstani medical students as they progressed from the first to the fifth course of their studies. Methods: A total of 696 students from Semey Medical University underwent non-cycloplegic and cycloplegic autorefraction in the first course, and 655 were available for examination in the fifth year of study. The amplitude of accommodation was measured before the instillation of cycloplegics using the push-up and push-down methods. A self-administered questionnaire was applied to evaluate the risk factors associated with myopia progression. Results: In the first course, the median spherical equivalent was −0.75 Diopters before cycloplegia and −0.25 Diopters after cycloplegia. In the fifth course, it constituted −1.125 Diopters before cycloplegia and −0.5 Diopters after cycloplegia. The proportion of students with myopia following cycloplegic refraction increased from 44.7% in the first course to 47.5% in the fifth course. The proportion of emmetropic students declined from 31.5% to 30.3%, and hyperopia decreased from 23.8% to 16.8%. The dioptric power of accommodative excess increased from 0.375 in the first year to 0.50 in the fifth year. The hours spent on near-work activities, such as reading books, writing, working at a computer, and using a mobile device, were significantly associated with a myopia progression of ≥0.5 Diopters. Conclusions: the findings of this study suggest implications for public health policy and educational practice. Full article

(This article belongs to the Special Issue Advanced Research in Myopia and Other Visual Disorders)

17 pages, 286 KiB

Open AccessReview

Evolution of Pulmonary Embolism Response Teams in the United States: A Review of the Literature

by Vidish Pandya, Akhil Avunoori Chandra, Andrea Scotti, Manaf Assafin, Aldo L. Schenone, Azeem Latib, Leandro Slipczuk and Asma Khaliq

J. Clin. Med. 2024, 13(13), 3984; https://doi.org/10.3390/jcm13133984 - 8 Jul 2024

Cited by 1 | Viewed by 1027

Abstract

Pulmonary embolism (PE) is a significant cause of cardiovascular mortality, with varying presentations and management challenges. Traditional treatment approaches often differ, particularly for submassive/intermediate-risk PEs, because of the lack of clear guidelines and comparative data on treatment efficacy. The introduction of pulmonary embolism [...] Read more.

Pulmonary embolism (PE) is a significant cause of cardiovascular mortality, with varying presentations and management challenges. Traditional treatment approaches often differ, particularly for submassive/intermediate-risk PEs, because of the lack of clear guidelines and comparative data on treatment efficacy. The introduction of pulmonary embolism response teams (PERTs) aims to standardize and improve outcomes in acute PE management through multidisciplinary collaboration. This review examines the conception, evolution, and operational mechanisms of PERTs while providing a critical analysis of their implementation and efficacy using retrospective trials and recent randomized trials. The study also explores the integration of advanced therapeutic devices and treatment protocols facilitated by PERTs. PERT programs have significantly influenced the management of both massive and submassive PEs, with notable improvements in clinical outcomes such as decreased mortality and reduced length of hospital stay. The utilization of advanced therapies, including catheter-directed thrombolysis and mechanical thrombectomy, has increased under PERT guidance. Evidence from various studies, including those from the National PERT Consortium, underscores the benefits of these multidisciplinary teams in managing complex PE cases, despite some studies showing no significant difference in mortality. PERT programs have demonstrated potentials to reduce morbidity and mortality, streamlining the use of healthcare resources and fostering a model of sustainable practice across medical centers. PERT program implementation appears to have improved PE treatment protocols and innovated advanced therapy options, which will be further refined as they are employed in clinical practice. The continued expansion of the capabilities of PERTs and the forthcoming results from ongoing randomized trials are expected to further define and optimize management protocols for acute PEs. Full article

(This article belongs to the Special Issue Recent Advances in Pulmonary Embolism and Thrombosis)

12 pages, 254 KiB

Open AccessArticle

A Real-World Safety Profile in Neurological, Skin, and Sexual Disorders of Anti-Seizure Medications Using the Pharmacovigilance Database of the Korea Adverse Event Reporting System (KAERS)

by Dajeong Kim and Sukhyang Lee

J. Clin. Med. 2024, 13(13), 3983; https://doi.org/10.3390/jcm13133983 - 8 Jul 2024

Viewed by 789

Abstract

(1) Background: The utilization of high-quality evidence regarding the safety of anti-seizure medications (ASMs) is constrained by the absence of standardized reporting. This study aims to examine the safety profile of ASMs using real-world data. (2) Methods: The data were collected [...] Read more.

(1) Background: The utilization of high-quality evidence regarding the safety of anti-seizure medications (ASMs) is constrained by the absence of standardized reporting. This study aims to examine the safety profile of ASMs using real-world data. (2) Methods: The data were collected from the Korea Adverse Event Reporting System Database (KAERS-DB) between 2012 and 2021. In total, 46,963 adverse drug reaction (ADR)–drug pairs were analyzed. (3) Results: At the system organ class level, the most frequently reported classes for sodium channel blockers (SCBs) were skin (37.9%), neurological (16.7%), and psychiatric disorders (9.7%). For non-SCBs, these were neurological (31.2%), gastrointestinal (22.0%), and psychiatric disorders (18.2%). The most common ADRs induced by SCBs were rash (17.8%), pruritus (8.2%), and dizziness (6.7%). Non-SCBs were associated with dizziness (23.7%), somnolence (13.0%), and nausea (6.3%). Rash, pruritus, and urticaria occurred, on average, two days later with SCBs compared to non-SCBs. Sexual/reproductive disorders were reported at a frequency of 0.23%. SCBs were reported as the cause more frequently than non-SCBs (59.8% vs. 40.2%, Fisher’s exact test, p < 0.0001). (4) Conclusions: Based on real-world data, the safety profiles of ASMs were identified. The ADRs induced by SCBs exhibited different patterns when compared to those induced by non-SCBs. Full article

(This article belongs to the Section Pharmacology)

13 pages, 1123 KiB

Open AccessArticle

Influence of Neoadjuvant Therapy on Success of Endoscopic Vacuum Therapy in Anastomotic Leakage after Rectal Resection Because of Rectal Cancer

by Rahel M. Strobel, Julia E. Wellner, Konrad Neumann, Susanne D. Otto, Sophie M. Eschlboeck, Claudia Seifarth, Christian H. W. Schineis, Katharina Beyer, Martin E. Kreis and Johannes C. Lauscher

J. Clin. Med. 2024, 13(13), 3982; https://doi.org/10.3390/jcm13133982 - 8 Jul 2024

Viewed by 749

Abstract

Background: For locally advanced rectal cancer, neoadjuvant therapy (NT) is an established element of therapy. Endoscopic vacuum therapy (EVT) has been a relevant treatment option for anastomotic leakage after rectal resection since 2008. The aim was to evaluate the influence of NT on [...] Read more.

Background: For locally advanced rectal cancer, neoadjuvant therapy (NT) is an established element of therapy. Endoscopic vacuum therapy (EVT) has been a relevant treatment option for anastomotic leakage after rectal resection since 2008. The aim was to evaluate the influence of NT on the duration and success of EVT in anastomotic leakage after rectal resection for rectal cancer. Methods: This was a monocentric, retrospective cohort study including patients who underwent rectal resection with primary anastomosis because of histologically proven carcinoma of the rectum in the Department for General and Visceral Surgery of Charité—Universitätsmedizin Berlin, Campus Benjamin Franklin over a period of ten years (2012 to 2022). Results: Overall, 243 patients were included, of which 47 patients (19.3%) suffered from anastomotic leakage grade B with consecutive EVT. A total of 29 (61.7%) patients received NT and 18 patients (38.3%) did not. The median duration of EVT until the removal of the sponge did not differ between patients with and without NT: 24.0 days (95% CI 6.44–41.56) versus 20.0 days (95% CI 17.03–22.97); p = 0.273. The median duration from insertion of EVT until complete healing was 74.0 days with NT (95% CI 10.07–137.93) versus 62.0 days without NT (95% CI 45.99–78.01); p = 0.490. Treatment failure—including early persistence and late onset of recurrent anastomotic leakage—was evident in 27.6% of patients with NT versus 27.8% without NT; p = 0.989. Ostomy was reversed in 19 patients (79.2%) with NT compared to 11 patients (68.8%) without NT; p = 0.456. Overall, continuity was restored in 75% of patients in the long term after EVT. Conclusion: This trial comprised—to our knowledge—the largest study cohort to analyze the outcome of EVT in anastomotic leakage after rectal resection for rectal cancer. We conclude that neoadjuvant therapy neither prolongs EVT nor the time to healing from anastomotic leakage. The rates of treatment failure of EVT and permanent ostomy were not higher when neoadjuvant therapy was used. Full article

(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)

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9 pages, 832 KiB

Open AccessArticle

Oncologic Outcomes of Patients with Early-Stage Cervical Cancer after Minimally Invasive Radical Hysterectomy and Sentinel Lymph Node Biopsy

by Tomohito Tanaka, Ruri Nishie, Hikaru Murakami, Hiromitsu Tsuchihashi, Akihiko Toji, Shoko Ueda, Natsuko Morita, Sousuke Hashida, Shinichi Terada, Hiroshi Maruoka, Kohei Taniguchi, Kazumasa Komura and Masahide Ohmichi

J. Clin. Med. 2024, 13(13), 3981; https://doi.org/10.3390/jcm13133981 - 8 Jul 2024

Viewed by 793

Abstract

Background: The sentinel lymph node is the first node that cancer cells reach when migrating from the primary site. However, oncological outcomes after sentinel lymph node biopsy (SNB) have not been reported for cervical cancer. In this study, oncological outcomes were compared [...] Read more.

Background: The sentinel lymph node is the first node that cancer cells reach when migrating from the primary site. However, oncological outcomes after sentinel lymph node biopsy (SNB) have not been reported for cervical cancer. In this study, oncological outcomes were compared between patients receiving SNB and pelvic lymphadenectomy (PLD) for early-stage cervical cancer. Methods: One hundred and four patients with clinical stage 1A2, 1B1, and 2A1 cervical cancer were included in this study. All patients underwent laparoscopic or robot-assisted radical hysterectomy with SNB or PLD. Fifty-two patients with tumors ≤2 cm underwent SNB. Disease-free survival (DFS) and overall survival (OS) were compared between the groups. Results: The median (interquartile range) tumor size was 12 (7–20) mm in the SNB group and 20 (13–25) mm in the PLD group. Lymph node metastasis occurred in one patient in the SNB group and in nine patients in the PLD group. The median follow-up periods were 42 (24–60) and 82 (19–101) months in the SNB group and PLD group, respectively. The 3-year DFS rates were 100% in SNB and 91.5% in PLD. The 3-year OS was 100% in both groups. Conclusions: SNB was sufficient in cervical cancer patients with tumors ≤2 cm, suggesting that PLD might not be necessary for these patients. Full article

(This article belongs to the Special Issue Gynecological Cancers: Surgical Treatment and Novel Radiotherapy)

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11 pages, 617 KiB

Open AccessArticle

Prediction of Back Disability Using Clinical, Functional, and Biomechanical Variables in Adults with Chronic Nonspecific Low Back Pain

by Omar M. Elabd, Paul A. Oakley and Aliaa M. Elabd

J. Clin. Med. 2024, 13(13), 3980; https://doi.org/10.3390/jcm13133980 - 8 Jul 2024

Viewed by 987

Abstract

Background: Researchers are focusing on understanding the etiology and predisposing factors of chronic nonspecific low back pain (CNSLBP), a costly prevalent and disabling disorder. Related clinical, functional, and biomechanical variables are often studied, but in isolation. We aimed to identify key factors for [...] Read more.

Background: Researchers are focusing on understanding the etiology and predisposing factors of chronic nonspecific low back pain (CNSLBP), a costly prevalent and disabling disorder. Related clinical, functional, and biomechanical variables are often studied, but in isolation. We aimed to identify key factors for managing CNSLBP by examining the relationship between back disability and related clinical, functional, and biomechanical variables and developed prediction models to estimate disability using various variables. Methods: We performed a cross-sectional correlational study on 100 recruited patients with CNSLBP. Clinical variables of pain intensity (visual analog score), back extensor endurance (Sorenson test), functional variables of the back performance scale, 6 min walk test, and the biomechanical variable C7-S1 sagittal vertical axis were analyzed to predict disability (Oswestry disability index). Results: All variables independently, as well as in multi-correlation, were significantly correlated to disability (p < 0.05). The bivariate regression models were significant between back disability and pain intensity (Y = 11.24 + 2.189x), Sorensen results (Y = 105.48 − 0.911x), the back performance scale (Y = 6.65 + 2.486x), 6 min walk test (Y = 49.20 − 0.060x), and sagittal vertical axis (Y = 0.72 + 4.23x). The multi-regression model showed significant contributions from pain (p = 0.001) and Sorensen results (p = 0.028) in predicting back disability, whereas no significant effect was found for other variables. Conclusions: A multidisciplinary approach is essential not only for the management of but also for the assessment of chronic nonspecific low back pain, including its clinical, functional, and biomechanical characteristics. However, special emphasis should be placed on clinical characteristics, including the intensity of pain and back extensor endurance. Full article

(This article belongs to the Special Issue Structural Rehabilitation of the Spine and Posture: Analysis, Techniques, and Outcomes in Clinical Research)

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11 pages, 2878 KiB

Open AccessArticle

Multimorbidity in Incident Heart Failure: Characterisation and Impact on 1-Year Outcomes

by Anyuli Gracia Gutiérrez, Aida Moreno-Juste, Clara Laguna-Berna, Alejandro Santos-Mejías, Beatriz Poblador-Plou, Antonio Gimeno-Miguel and Fernando J. Ruiz Laiglesia

J. Clin. Med. 2024, 13(13), 3979; https://doi.org/10.3390/jcm13133979 - 8 Jul 2024

Viewed by 802

Abstract

Background/Objectives: Heart failure (HF) is usually accompanied by other comorbidities, which, altogether, have a major impact on patients and healthcare systems. Our aim was to analyse the demographic and clinical characteristics of incident HF patients and the effect of comorbidities on one-year [...] Read more.

Background/Objectives: Heart failure (HF) is usually accompanied by other comorbidities, which, altogether, have a major impact on patients and healthcare systems. Our aim was to analyse the demographic and clinical characteristics of incident HF patients and the effect of comorbidities on one-year health outcomes. Methods: This was an observational, retrospective, population-based study of incident HF patients between 2014 and 2018 in the EpiChron Cohort, Spain. The included population contained all primary and hospital care patients with a diagnosis of HF. All chronic diseases in their electronic health records were pooled into three comorbidity clusters (cardiovascular, mental, other physical). These comorbidity groups and the health outcomes were analysed until 31 December 2018. A descriptive analysis was performed. Cox regression models and survival curves were calculated to determine the hazard risk (HR) of all-cause mortality, all-cause and HF-related hospital admissions, hospital readmissions, and emergency room visits for each comorbidity group. Results: In total, 13,062 incident HF patients were identified (mean age = 82.0 years; 54.8% women; 93.7% multimorbid; mean of 4.52 ± 2.06 chronic diseases). After one-year follow-up, there were 3316 deaths (25.3%) and 4630 all-cause hospitalisations (35.4%). After adjusting by gender, age, and inpatient/outpatient status, the mental cluster was associated (HR; 95% confidence interval) with a higher HR of death (1.08; 1.01–1.16) and all-cause hospitalisation (1.09; 1.02–1.16). Conclusions: Cardiovascular comorbidities are the most common and studied ones in HF patients; however, they are not the most strongly associated with negative impacts on health outcomes in these patients. Our findings suggest the importance of a holistic and integral approach in the care of HF patients and the need to take into account the entire spectrum of comorbidities for improving HF management in clinical practice. Full article

(This article belongs to the Section Cardiology)

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13 pages, 864 KiB

Open AccessArticle

Intra- and Early Post-Operative Factors Affecting Spinal Cord Ischemia in Patients Undergoing Fenestrated and Branched Endovascular Aortic Repair

by Allegra Doering, Petroula Nana, José I. Torrealba, Giuseppe Panuccio, Constantin Trepte, Viorel Chindris and Tilo Kölbel

J. Clin. Med. 2024, 13(13), 3978; https://doi.org/10.3390/jcm13133978 - 8 Jul 2024

Viewed by 653

Abstract

Background: Spinal cord ischemia (SCI) is a severe complication after fenestrated/branched endovascular repair (f/bEVAR). The underlying causes of SCI are still under investigation. This study aimed to evaluate intra- and early post-operative parameters that may affect SCI evolution. Methods: A single-center retrospective [...] Read more.

Background: Spinal cord ischemia (SCI) is a severe complication after fenestrated/branched endovascular repair (f/bEVAR). The underlying causes of SCI are still under investigation. This study aimed to evaluate intra- and early post-operative parameters that may affect SCI evolution. Methods: A single-center retrospective analysis was conducted including SCI patients with complete anesthesiologic records (1 January 2011 to 31 December 2023). Values of intra-operative glucose, hemoglobin, lactate, activated clotting time (ACT), and the need for transfusion were collected. The cohort was compared to a matched cohort of non-SCI patients. Results: Fifty-one patients with SCI and complete anesthesiologic records were included (mean age: 69.8 ± 6.2 years; 39.2% male). Intra-operative glucose value < 110 mg/dL (AUC: 0.73; sensitivity 91%, specificity of 83%) and hemoglobin value > 8.5 mg/dL (AUC: 0.61; sensitivity 83%, specificity 78%) were protective for Grade 3 SCI. Twenty-three patients with SCI were matched to 23 patients without SCI. SCI patients presented significantly higher glucose levels intra-operatively (glucose mean value: SCI 150 ± 46 mg/dL vs. non-SCI: 122 ± 30 mg/dL, p = 0.005). ACT (SCI 259 ± 31 svs. non-SCI 288 ± 28 s, p = 0.001), volume input (SCI 4030 ± 1430 mL vs. non-SCI 3020 ± 113 mL, p = 0.009), and need for transfusion (SCI: 52.5% vs. 4.3%, p < 0.001) were related to SCI. Higher glucose levels were detected among patients with SCI, at 24 (SCI: 142 ± 30 mg/dL vs. non-SCI: 118 ± 26 mg/dL, p=0.004) and 48 h (SCI: 140 ± 29 mg/dL vs. non-SCI: 112 ± 20 mg/dL, p < 0.001) post-operatively. Conclusions: SCI is a multifactorial complication after f/bEVAR. Intra-operative and early post-operative glucose levels may be related to SCI evolution. Targeted glucose < 110 mg/dL may be protective for Grade 3 SCI. Full article

(This article belongs to the Special Issue Aortic Aneurysm: Latest Insights into Therapeutic Approaches)

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21 pages, 1314 KiB

Open AccessReview

Revolutionizing Gastrointestinal Disorder Management: Cutting-Edge Advances and Future Prospects

by Chahat Suri, Babita Pande, Tarun Sahu, Lakkakula Suhasini Sahithi and Henu Kumar Verma

J. Clin. Med. 2024, 13(13), 3977; https://doi.org/10.3390/jcm13133977 - 8 Jul 2024

Viewed by 1397

Abstract

In recent years, remarkable strides have been made in the management of gastrointestinal disorders, transforming the landscape of patient care and outcomes. This article explores the latest breakthroughs in the field, encompassing innovative diagnostic techniques, personalized treatment approaches, and novel therapeutic interventions. Additionally, [...] Read more.

In recent years, remarkable strides have been made in the management of gastrointestinal disorders, transforming the landscape of patient care and outcomes. This article explores the latest breakthroughs in the field, encompassing innovative diagnostic techniques, personalized treatment approaches, and novel therapeutic interventions. Additionally, this article emphasizes the use of precision medicine tailored to individual genetic and microbiome profiles, and the application of artificial intelligence in disease prediction and monitoring. This review highlights the dynamic progress in managing conditions such as inflammatory bowel disease, gastroesophageal reflux disease, irritable bowel syndrome, and gastrointestinal cancers. By delving into these advancements, we offer a glimpse into the promising future of gastroenterology, where multidisciplinary collaborations and cutting-edge technologies converge to provide more effective, patient-centric solutions for individuals grappling with gastrointestinal disorders. Full article

(This article belongs to the Special Issue Diagnosis, Treatment, and Management of Gastrointestinal Oncology)

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13 pages, 5158 KiB

Open AccessReview

US-Guided Interventional Procedures for Total Hip Arthroplasty

by Domenico Albano, Roberto Cintioli, Carmelo Messina, Francesca Serpi, Salvatore Gitto, Laura Mascitti, Giacomo Vignati, Pierluigi Glielmo, Paolo Vitali, Luigi Zagra, Žiga Snoj and Luca Maria Sconfienza

J. Clin. Med. 2024, 13(13), 3976; https://doi.org/10.3390/jcm13133976 - 8 Jul 2024

Viewed by 872

Abstract

In patients with total hip arthroplasty (THA) with recurrent pain, symptoms may be caused by several conditions involving not just the joint, but also the surrounding soft tissues including tendons, muscles, bursae, and peripheral nerves. US and US-guided interventional procedures are important tools [...] Read more.

In patients with total hip arthroplasty (THA) with recurrent pain, symptoms may be caused by several conditions involving not just the joint, but also the surrounding soft tissues including tendons, muscles, bursae, and peripheral nerves. US and US-guided interventional procedures are important tools in the diagnostic work-up of patients with painful THA given that it is possible to reach a prompt diagnosis both directly identifying the pathological changes of periprosthetic structures and indirectly evaluating the response and pain relief to local injection of anesthetics under US monitoring. Then, US guidance can be used for the aspiration of fluid from the joint or periarticular collections, or alternatively to follow the biopsy needle to collect samples for culture analysis in the suspicion of prosthetic joint infection. Furthermore, US-guided percutaneous interventions may be used to treat several conditions with well-established minimally invasive procedures that involve injections of corticosteroid, local anesthetics, and platelet-rich plasma or other autologous products. In this review, we will discuss the clinical and technical applications of US-guided percutaneous interventional procedures in painful THA that can be used in routine daily practice for diagnostic and therapeutic purposes. Full article

(This article belongs to the Special Issue Total Joint Arthroplasty: Management and Future Opportunities)

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US-guided joint aspiration. (a) US image with convex probe on the long axis of the prosthetic neck and the needle (arrows) introduced with caudocranial approach to reach the prosthesis surrounded by effusion (asterisks); (b) six milliliters of synovial fluid has been collected in the syringe. F—femur; N—prosthetic neck; C—prosthetic cup; A—acetabulum. Full article ">Figure 2
US-guided periprosthetic biopsy. Ultrasound in the long axis (a) and short axis (b) of the THA showing the hypoechoic synovium (asterisks) surrounding the prosthesis. The needle (arrows) is introduced from the lateral aspect of the hip (c), with the in-plane technique, with a perpendicular direction compared to the classical joint aspiration, advancing horizontally to be tangent to the prosthetic neck. N—prosthetic neck, F—femur; C—prosthetic cup. Full article ">Figure 3
US-guided iliopsoas bursa injection. (a) The iliopsoas tendon (T) is scanned in the short axis at the acetabulum level; (b) the needle (arrows) is introduced laterally to reach the inferior part of the tendon; (c) once the target has been reached, the solution can be injected distending the iliopsoas bursa (asterisks). T—iliopsoas tendon; A—acetabulum; C—prosthetic cup. Full article ">Figure 4
US-guided trochanteric injection. (a) US image shows the trochanteric bursa distended by effusion (asterisks); (b) when the bursa is distended, it is an easy target for the procedure, introducing the needle (arrows) with the in-plane approach into the bursa under US monitoring. Full article ">Figure 5
US-guided injection of the LFCN. (a) The LFCN (arrowhead) is identified in the short axis superficial to the sartorius muscle (S), sliding the probe distal to the anterior superior iliac spine and the needle (arrows) is introduced with an in-plane lateral to medial approach, placing the tip just below the nerve. (b) The mixture of local anesthetic and corticosteroid can be injected, monitoring the spread of the solution (asterisk) around the nerve. Full article ">

13 pages, 3589 KiB

Open AccessArticle

Assessment of Blood Flow Velocity in Retinal Vasculitis Using the Retinal Function Imager—A Pilot Study

by Nicole Stuebiger, Wen-Hsiang Lee, Johannes Birtel, Vasyl Druchkiv, Janet L. Davis and Delia Cabrera DeBuc

J. Clin. Med. 2024, 13(13), 3975; https://doi.org/10.3390/jcm13133975 - 8 Jul 2024

Viewed by 716

Abstract

Background: This pilot study aimed to evaluate the Retinal Function Imager (RFI) for visualizing retinal vasculature and assessment of blood flow characteristics in patients with retinal vasculitis. The RFI is a non-invasive imaging device measuring the blood flow velocity (BFV) in secondary and [...] Read more.

Background: This pilot study aimed to evaluate the Retinal Function Imager (RFI) for visualizing retinal vasculature and assessment of blood flow characteristics in patients with retinal vasculitis. The RFI is a non-invasive imaging device measuring the blood flow velocity (BFV) in secondary and tertiary retinal vessels using hemoglobin as an intrinsic motion-contrast agent. Methods: To test the feasibility of the RFI for patients with retinal vasculitis, capillary perfusion maps (nCPMs) were generated from 15 eyes of eight patients (five females; mean age: 49 ± 12 years) with a mean uveitis duration of 74 ± 85 months. Five of these patients had birdshot chorioretinopathy, and three had primarily non-occlusive venous retinal vasculitis of unknown origin. To reflect that the BFV may be more reduced in patients with prolonged disease, patients were classified into a short-term (uveitis duration: 8–15 months) and a long-term uveitis group (uveitis duration: 60–264 months). Data were compared with healthy controls (16 eyes of 11 patients; mean age 45 ± 12 years; 8 females). Results: The mean BFV in the controls was 3.79 ± 0.50 mm/s in the retinal arteries and 2.35 ± 0.44 mm/s in the retinal veins, which was significantly higher compared to the retinal vasculitis group. Patients revealed an arterial BFV of 2.75 ± 0.74 mm/s (p < 0.001) and a venous BFV of 1.75 ± 0.51 mm/s (p = 0.016). In the short-term group, a trend towards a decreased venular and arteriolar BFV was seen, while a significant reduction was observed in the long-term group. The patients’ microvasculature anatomy revealed by the nCPMs appeared unevenly distributed and a lower number of blood vessels were seen, along with a lower degree of complexity of their branching patterns, when compared with controls. Conclusions: This study demonstrated a reduction in venular and arteriolar BFVs in patients with retinal vasculitis. BFV alterations were already observed in early disease stages and became more pronounced in progressed disease. Additionally, we showed that retinal microvasculature changes may be observed by nCPMs. Retinal imaging with the RFI may serve as a diagnostic and quantifying tool in retinal vasculitis. Full article

(This article belongs to the Special Issue Clinical Advances in the Diagnosis and Treatment of Uveitis—2nd Edition)

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Figure 1
Fundus and blood velocity map in a healthy subject. Velocities are measured in veins (violet; positive values) and in arteries (red; negative values) and presented in millimeters per second average ± standard deviation (SD). Full article ">Figure 2
Fluoresceine- (A,D) and indocyanine-green angiography (B) of a patient (OD, #7) with birdshot chorioretinopathy. (A) shows slight leakage of the inflamed venous vessels (white arrow) in the FA. The characteristic dark dots (inflammatory changes in the choriocapillaris) are visible in indocyanine-green angiography (B). (C) shows the fundus of patient (OD, #8) with non-occlusive retinal vasculitis of unknown origin; (D) the characteristic dye leakage through the disrupted tight endothelial junctions of the inflamed retinal veins when performing fluorescein angiography. Full article ">Figure 3
Box–Whisker Plot of the distributional characteristics of the BFV (in mm/s) in the patient and the control group (data see <a href="#jcm-13-03975-t002" class="html-table">Table 2</a>) with the mean BFV ± 95% confidence interval (red), the median of the BFV and the upper and lower quartiles (25% and 75% quartiles), the corresponding whiskers (black), and the individual patient eyes (grey). Comparing the patients arterial and venous BFVs to the control group, both are significantly lower in the patient group. Full article ">Figure 4
Box–Whisker Plot of the distributional characteristics of the BFV (in mm/s) in the short- term patient group, in the long-term patient group, and in the control group (data see <a href="#jcm-13-03975-t002" class="html-table">Table 2</a>) with the mean BFV ± 95% confidence interval (red), the median of the BFV and the upper and lower quartiles (25% and 75% quartiles), the corresponding whiskers (black), and the individual patient eyes (grey). Compared to controls no significant reduction in the blood flow velocity was seen in patients with short-term uveitis, while a significant decrease in the arteriolar and of the venular blood flow velocity was observed in patients with long-term uveitis. Full article ">Figure 5
(A–D) Blood flow velocity maps and non-invasive capillary perfusion maps. (A) shows the BFV map of a healthy volunteer (OD), (B) the nCPM of the same eye; the red circle demonstrates the foveolar avascular zone (FAZ). (C) presents the BFV map of a BSCR patient (OD, pat.#7) and (D) the nCPM of the same eye. The FAZ (red circle) in (D) shows a larger diameter when compared to the FAZ of the healthy volunteer in (B). Full article ">

13 pages, 257 KiB

Open AccessArticle

Cognitive Distortions as Barriers to Seeking Smoking Cessation Treatment: A Comparative Study

by Selim Arpacıoğlu, Erkal Erzincan, Mine Ergelen, Beyza Arpacıoğlu, Salih Cihat Paltun, Murat Yalçın and Rabia Bilici

J. Clin. Med. 2024, 13(13), 3974; https://doi.org/10.3390/jcm13133974 - 7 Jul 2024

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Abstract

Background/Objectives: Despite the availability of effective pharmacotherapy and evidence-based treatments, a substantial proportion of smokers do not seek treatment. This study aims to explore the cognitive distortions associated with not seeking evidence-based smoking cessation treatment and to identify cognitive barriers. Methods: The research [...] Read more.

Background/Objectives: Despite the availability of effective pharmacotherapy and evidence-based treatments, a substantial proportion of smokers do not seek treatment. This study aims to explore the cognitive distortions associated with not seeking evidence-based smoking cessation treatment and to identify cognitive barriers. Methods: The research conducted in Istanbul between October and December 2017 employs a cross-sectional design and includes two groups: a treatment-seeking group comprising 156 patients diagnosed with tobacco use disorder and a non-treatment seeking group of 78 patients with tobacco use disorder who had never sought professional help for smoking cessation. A comprehensive data collection process was used, including sociodemographic information, cognitive distortion assessment using the cognitive distortions scale, a smoking-related cognitive distortions interview and the Fagerström Test for Nicotine Dependence. Results: While no significant sociodemographic differences were observed between the treatment-seeking and non-treatment-seeking groups, the study found that higher nicotine dependence was associated with a higher likelihood of seeking treatment. The treatment-seeking group displayed significantly higher levels of “all-or-nothing thinking” cognitive distortions related to smoking and smoking cessation. Conversely, the non-treatment-seeking group exhibited elevated levels of cognitive distortions such as “labeling”, “mental filtering”, “should statements” and “minimizing the positive” regarding receiving smoking cessation treatment. Conclusions: Understanding the cognitive distortions associated with treatment-seeking behavior for tobacco use disorder is crucial for developing targeted public-based interventions, public service announcements for tobacco use prevention and encouraging individuals to seek evidence-based treatment. Addressing these cognitive distortions can also potentially enhance the effectiveness of smoking cessation programs and reduce the global burden of tobacco-related diseases and mortality. Full article

(This article belongs to the Special Issue Psychiatry and Addiction: A Multi-faceted Issue)

14 pages, 285 KiB

Open AccessReview

Emerging Evidence in Out-of-Hospital Cardiac Arrest—A Critical Appraisal of the Cardiac Arrest Center

by Felix Memenga and Christoph Sinning

J. Clin. Med. 2024, 13(13), 3973; https://doi.org/10.3390/jcm13133973 - 7 Jul 2024

Viewed by 1161

Abstract

The morbidity and mortality of out-of-hospital cardiac arrest (OHCA) due to presumed cardiac causes have remained unwaveringly high over the last few decades. Less than 10% of patients survive until hospital discharge. Treatment of OHCA patients has traditionally relied on expert opinions. However, [...] Read more.

The morbidity and mortality of out-of-hospital cardiac arrest (OHCA) due to presumed cardiac causes have remained unwaveringly high over the last few decades. Less than 10% of patients survive until hospital discharge. Treatment of OHCA patients has traditionally relied on expert opinions. However, there is growing evidence on managing OHCA patients favorably during the prehospital phase, coronary and intensive care, and even beyond hospital discharge. To improve outcomes in OHCA, experts have proposed the establishment of cardiac arrest centers (CACs) as pivotal elements. CACs are expert facilities that pool resources and staff, provide infrastructure, treatment pathways, and networks to deliver comprehensive and guideline-recommended post-cardiac arrest care, as well as promote research. This review aims to address knowledge gaps in the 2020 consensus on CACs of major European medical associations, considering novel evidence on critical issues in both pre- and in-hospital OHCA management, such as the timing of coronary angiography and the use of extracorporeal cardiopulmonary resuscitation (eCPR). The goal is to harmonize new evidence with the concept of CACs. Full article

(This article belongs to the Special Issue New Insights and Prospects of Cardiac Arrest)

17 pages, 2621 KiB

Open AccessArticle

Algorithm-Guided Treatment of Ulna Impaction Syndrome: A 10-Year Follow-Up Study of Ulna Shortening Osteotomy and Wafer Procedure

by Irene Mesas Aranda, Elisabeth Maria Haas-Lützenberger, Sara Imam, Riccardo E. Giunta and Elias Volkmer

J. Clin. Med. 2024, 13(13), 3972; https://doi.org/10.3390/jcm13133972 - 7 Jul 2024

Viewed by 791

Abstract

Background: Ulnar impaction syndrome (UIS) is a common degenerative wrist condition which results from positive ulnar variance, leading to an overload on the ulnar carpus. Ulnar shortening osteotomy (USO) and the arthroscopic wafer procedure (AWP) are established therapies for UIS if conservative [...] Read more.

Background: Ulnar impaction syndrome (UIS) is a common degenerative wrist condition which results from positive ulnar variance, leading to an overload on the ulnar carpus. Ulnar shortening osteotomy (USO) and the arthroscopic wafer procedure (AWP) are established therapies for UIS if conservative management fails. This study assessed an algorithm-guided treatment of UIS over a period of 10 years. Methods: This prospective observational study compared the outcome of 54 patients who underwent either USO or AWP for UIS based on a predefined treatment algorithm. The mean follow-up period was 10 years. Primary outcome parameters were the visual analogue scale (VAS) for pain and the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), whereas secondary outcome parameters were grip and pinch strength and range of motion. Results: The median preoperative ulnar variance was 2.6 mm in the USO group and 2.0 mm in the AWP group. The postoperative average ulnar variance was 0 mm in both groups. The preoperative pain at rest was 3.4 in the USO group and 2.3 in the AWP group. One year after surgery, there was a significant reduction to VAS 0.7 and 0.2, respectively. These results persisted to the 10-year follow-up (VAS 0.9 and 0.2). The pain in motion also decreased significantly in the first year (from 6.8 and 6.7 to 2.2 and 2.1), as well as after 10 years (2.4 and 1.0). The preoperative DASH score averaged 31.3 in the USO group and 35.8 in the AWP group. At the 10-year follow-up, the DASH of both groups decreased significantly to 4.35 in the AWP group compared to 12.7 in the USO group. Conclusions: Our data show that, when using our algorithm, both USO and AWP, two common operative treatment options of UIS, reliably reduce pain and significantly reduce the DASH score over at least a period of ten years. The results after 10 years differ from short-term results in so far as after one year, the USO group showed to some degree similar outcome parameters compared to AWP, whereas at the 10-year follow-up, AWP reached slightly better primary outcome parameters. The algorithm presented, thus, produced excellent short- and long-term outcomes. Our findings and the applied algorithm can assist in decision-making and patient education. Full article

(This article belongs to the Special Issue Clinical Advances in Plastic Surgery)

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12 pages, 251 KiB

Open AccessArticle

Predictors of Headaches and Quality of Life in Women with Ophthalmologically Resolved Idiopathic Intracranial Hypertension

by Anat Horev, Sapir Aharoni-Bar, Mark Katson, Erez Tsumi, Tamir Regev, Yair Zlotnik, Ron Biederko, Gal Ifergane, Ilan Shelef, Tal Eliav, Gal Ben-Arie and Asaf Honig

J. Clin. Med. 2024, 13(13), 3971; https://doi.org/10.3390/jcm13133971 - 7 Jul 2024

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Abstract

Background/objectives: The aim of this study was to evaluate the long-term outcomes of a cohort of ophthalmologically resolved female idiopathic intracranial hypertension (IIH) patients. Methods: Our cross-sectional study included adult females with at least 6 months of ophthalmologically resolved IIH. Patients with papilledema [...] Read more.

Background/objectives: The aim of this study was to evaluate the long-term outcomes of a cohort of ophthalmologically resolved female idiopathic intracranial hypertension (IIH) patients. Methods: Our cross-sectional study included adult females with at least 6 months of ophthalmologically resolved IIH. Patients with papilledema or who underwent IIH-targeted surgical intervention were excluded. Participants completed a questionnaire consisting of medical information, the Migraine Disability Assessment Scale (MIDAS) and the Headache Impact Test (HIT-6). Electronic medical records and the results of imaging upon diagnosis were retrospectively reviewed. Results: One-hundred-and-four participants (mean age 35.5 ± 11.9 years) were included (7.85 ± 7 years post-IIH diagnosis). Patients with moderate–severe disability according to the MIDAS scale (n = 68, 65.4%) were younger (32.4 ± 8.9 vs. 41.5 ± 14.4 year-old, p < 0.001), had a shorter time interval from IIH diagnosis (5.9 ± 5.3 vs. 11.7 ± 8.5 years, p < 0.001), and had lower FARB scores (indicating a more narrowed transverse-sigmoid junction; 1.28 ± 1.82 vs. 2.47 ± 2.3, p = 0.02) in comparison to patients with low–mild disability scores. In multivariate analysis, a lower FARB score (OR 1.28, 95% CI 0.89–1.75, p = 0.12) and younger age (OR 1.09, 95% CI 0.98–1.19, p = 0.13) showed a trend toward an association with a moderate–severe MIDAS score. Moreover, in the sub-analysis of patients with a moderate–severe MIDAS scale score, the 10 patients with the highest MIDAS scores had a low FARB score (1.6 ± 1.1 vs. 2.7 ± 2.4, p = 0.041). Conclusions: High numbers of patients with ophthalmologically resolved IIH continue to suffer from related symptoms. Symptoms may be associated with the length of time from the diagnosis of IIH and a lower FARB score. Full article

(This article belongs to the Special Issue Headache Disorders: New Advances in Management and Treatment Strategies)

13 pages, 2726 KiB

Open AccessArticle

Epithelial Remodeling and Epithelial Wavefront Aberrometry after Spherical vs. Cylindrical Myopic Small Incision Lenticule Extraction (SMILE)

by Barbara S. Brunner, Lukas Feldhaus, Wolfgang J. Mayer, Jakob Siedlecki, Martin Dirisamer, Siegfried G. Priglinger, Stefan Kassumeh and Nikolaus Luft

J. Clin. Med. 2024, 13(13), 3970; https://doi.org/10.3390/jcm13133970 - 7 Jul 2024

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Abstract

Background/Objectives: To compare the epithelial thickness changes and the changes in epithelial wavefront aberrometry following spherical versus astigmatic myopic small incision lenticule extraction (SMILE). Methods: Eighty-six eyes of 86 patients who underwent SMILE were included in this retrospective study. A total [...] Read more.

Background/Objectives: To compare the epithelial thickness changes and the changes in epithelial wavefront aberrometry following spherical versus astigmatic myopic small incision lenticule extraction (SMILE). Methods: Eighty-six eyes of 86 patients who underwent SMILE were included in this retrospective study. A total of 43 eyes underwent myopic spherical correction (spherical group) and 43 eyes underwent myopic cylindrical correction (cylindrical group). The groups were matched according to the spherical equivalent of surgically corrected refraction. Subjective manifest refraction as well as high-resolution anterior segment optical coherence tomography (MS-39; CSO; Florence, Italy) were obtained preoperatively as well as 3 months postoperatively. The latter was utilized for computing epithelial wavefront aberrometry in addition to epithelial thickness mapping. Results: Epithelial thickness increased significantly in both groups after SMILE (p < 0.01). In the cylindrical group, epithelial thickening was more pronounced on the flat meridian compared to the steep meridian (p = 0.04). In both groups, epithelial wavefront aberrometry showed a significant postoperative increase in the epithelium’s spherical refractive power, causing a myopization of −0.24 ± 0.42 diopters (D) in the spherical group (p < 0.01) and −0.41 ± 0.52 D in the cylindrical group (p < 0.0001). While no significant changes in epithelial cylindrical refractive power were observed in the spherical group, a significant increase was noted in the cylindrical group from −0.21 ± 0.24 D to −0.37 ± 0.31 D (p = 0.01). In both groups, epithelial higher-order aberrations increased significantly (p < 0.001). Conclusions: Postoperative epithelial remodeling after SMILE alters lower-order (sphere and cylinder) and higher-order aberrations of the corneal epithelial wavefront and might contribute to refractive undercorrection, especially in astigmatic corrections. Epithelial wavefront aberrometry can be used to quantify the refractive effect of epithelial remodeling processes after keratorefractive surgery. Full article

(This article belongs to the Special Issue Refractive Surgery—Where Are We Now?)

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Refractive outcome in the spherical myopic group after 3 months. (A) Cumulative visual acuity. (B) Change in CDVA. (C) Postoperative spherical equivalent refraction. (D) Refractive astigmatism. Full article ">Figure 2
Refractive outcome in the astigmatic myopic group after 3 months. (A) Cumulative visual acuity. (B) Change in CDVA. (C) Postoperative spherical equivalent refraction. (D) Refractive astigmatism. Full article ">Figure 3
Epithelial thickness changes 3 months after SMILE. Depicted is the epithelial thickness change in the flat and steep meridian for both the spherical (n = 43) and the cylindrical group (n = 43). * p < 0.05. Full article ">Figure 4
Representative epithelial thickness map of an eye with myopia and with-the-rule astigmatism. (A) Preoperatively and (B) three months postoperatively. An increase in the epithelial thickness majorly on the flat meridian (horizontal) can be observed. Full article ">Figure 5
Epithelial refractive power changes 3 months after SMILE. (A) Spherical and cylindrical power pre- and postoperatively of the spherical group (n = 43). (B) Spherical and cylindrical power pre- and postoperatively in the cylindrical group (n = 43). * p < 0.05, ** p < 0.01, **** p < 0.0001. Full article ">Figure 6
Representative corneal epithelial wavefront aberrometry. (A) Preoperatively and (B) three months after SMILE. WFE = wavefront error; HOAs = higher-order aberrations; RMS = root mean square. Full article ">

53 pages, 1398 KiB

Open AccessArticle

Prediction of Osteoporotic Hip Fracture Outcome: Comparative Accuracy of 27 Immune–Inflammatory–Metabolic Markers and Related Conceptual Issues

by Alexander Fisher, Leon Fisher and Wichat Srikusalanukul

J. Clin. Med. 2024, 13(13), 3969; https://doi.org/10.3390/jcm13133969 - 7 Jul 2024

Viewed by 695

Abstract

Objectives: This study, based on the concept of immuno-inflammatory–metabolic (IIM) dysregulation, investigated and compared the prognostic impact of 27 indices at admission for prediction of postoperative myocardial injury (PMI) and/or hospital death in hip fracture (HF) patients. Methods: In consecutive HF [...] Read more.

Objectives: This study, based on the concept of immuno-inflammatory–metabolic (IIM) dysregulation, investigated and compared the prognostic impact of 27 indices at admission for prediction of postoperative myocardial injury (PMI) and/or hospital death in hip fracture (HF) patients. Methods: In consecutive HF patient (n = 1273, mean age 82.9 ± 8.7 years, 73.5% females) demographics, medical history, laboratory parameters, and outcomes were recorded prospectively. Multiple logistic regression and receiver-operating characteristic analyses (the area under the curve, AUC) were used to establish the predictive role for each biomarker. Results: Among 27 IIM biomarkers, 10 indices were significantly associated with development of PMI and 16 were indicative of a fatal outcome; in the subset of patients aged >80 years with ischaemic heart disease (IHD, the highest risk group: 90.2% of all deaths), the corresponding figures were 26 and 20. In the latter group, the five strongest preoperative predictors for PMI were anaemia (AUC 0.7879), monocyte/eosinophil ratio > 13.0 (AUC 0.7814), neutrophil/lymphocyte ratio > 7.5 (AUC 0.7784), eosinophil count < 1.1 × 10⁹/L (AUC 0.7780), and neutrophil/albumin × 10 > 2.4 (AUC 0.7732); additionally, sensitivity was 83.1–75.4% and specificity was 82.1–75.0%. The highest predictors of in-hospital death were platelet/lymphocyte ratio > 280.0 (AUC 0.8390), lymphocyte/monocyte ratio < 1.1 (AUC 0.8375), albumin < 33 g/L (AUC 0.7889), red cell distribution width > 14.5% (AUC 0.7739), and anaemia (AUC 0.7604), sensitivity 88.2% and above, and specificity 85.1–79.3%. Internal validation confirmed the predictive value of the models. Conclusions: Comparison of 27 IIM indices in HF patients identified several simple, widely available, and inexpensive parameters highly predictive for PMI and/or in-hospital death. The applicability of IIM biomarkers to diagnose and predict risks for chronic diseases, including OP/OF, in the preclinical stages is discussed. Full article

(This article belongs to the Special Issue Clinical Management and Future Perspectives in Osteoporosis and Fractures)

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16 pages, 8058 KiB

Open AccessArticle

3D Printing for Customized Bone Reconstruction in Spheno-Orbital Meningiomas: A Systematic Literature Review and Institutional Experience

by Simona Serioli, Alberto Pietrantoni, Alberto Benato, Marco Galeazzi, Amedeo Piazza, Liverana Lauretti, Pier Paolo Mattogno, Alessandro Olivi, Marco Maria Fontanella and Francesco Doglietto

J. Clin. Med. 2024, 13(13), 3968; https://doi.org/10.3390/jcm13133968 - 6 Jul 2024

Viewed by 898

Abstract

Background: The treatment of spheno-orbital meningiomas (SOMs) requires extensive bone resections, creating significant defects in a complex geometrical space. Bone reconstruction represents a fundamental step that optimizes long-term aesthetic and functional outcomes. In recent years, 3D printing technology has also been exploited [...] Read more.

Background: The treatment of spheno-orbital meningiomas (SOMs) requires extensive bone resections, creating significant defects in a complex geometrical space. Bone reconstruction represents a fundamental step that optimizes long-term aesthetic and functional outcomes. In recent years, 3D printing technology has also been exploited for complex skull base reconstructions, but reports remain scarce. Methods: We retrospectively analyzed four consecutive patients who underwent SOM resection and one-step 3D PEEK customized reconstruction from 2019 to 2023. A systematic review of 3D printing customized implants for SOM was then performed. Results: All patients underwent a frontotemporal craniotomy, removal of SOM, and reconstruction of the superolateral orbital wall and pterional region. The aesthetic outcome was extremely satisfactory in all cases. No orbital implant malposition or infectious complications were documented. Eleven papers were included in the literature review, describing 27 patients. Most (23) patients underwent a single-stage reconstruction; in three cases, the implant was positioned to correct postoperative delayed enophthalmos. Porous titanium was the most used material (16 patients), while PEEK was used in three cases. Prosthesis malposition was described in two (7.4%) patients. Conclusions: Single-step reconstruction with a personalized 3D PEEK prosthesis represents a valid reconstruction technique for the treatment of SOMs with good aesthetic outcomes. Full article

(This article belongs to the Special Issue State of the Art—Treatment of Skull Base Diseases (Second Edition))

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PRISMA flowchart. Full article ">Figure 2
Pre- and postoperative neuroradiology; surgical planning and intraoperative image. (A–F). Coronal (A), and axial (B,C) CT scans and brain MRI T1-weighted sequences with contrast (coronal—(D); axial—(E,F)) show the right spheno-orbital meningioma with the typical features of hyperostosis at the level of the superior and lateral walls of the orbit, and sphenoid wing, with the tumor-induced remodeling of the middle cranial fossa. The lesion caused compression of the orbital cavity with associated exophthalmos. (G,H) Three-dimensional digital reconstruction of the tumor (in red) and the skull prosthesis based on the patient’s anatomy and tumor extension. (I) Intraoperative image of the prosthesis positioned at the end of the tumor removal with the reconstruction of the pterional region and orbital rim. (J–O) Postoperative coronal (J) and axial (K,L) CT scans and brain MRI three years after surgery (coronal—(M); axial—(N,O)) show complete removal of the lesion and optimal positioning of the prosthesis. The resolution of the pre-operative exophthalmos is also shown. Full article ">Figure 3
Pre- and postoperative neuroradiology, surgical planning with cutting guide, and intraoperative image. (A–F). Coronal (A), and axial (B,C) CT scans and brain MRI T1-weighted sequence with contrast (coronal—(D); axial—(E,F)) document the left spheno-orbital meningioma with hyperostosis at the level of the superior and lateral walls of the orbit, as well as the frontal bone in the pterional region. The lesion causes significant mass effect on the lateral and superior rectus muscle with exophthalmos and orbital dystopia. (G,H) Three-dimensional digital reconstruction of the CT of the patient, highlighting the extension of the tumor (in red) and the custom-made prosthesis (H). (I) Intraoperative image of the positioning of the implant with the reconstruction of the pterion. (J–O) Immediate postoperative CT scan with coronal (J) and axial (K,L) images. Brain MRI with contrast at four months after surgery (coronal—(M); axial—(N,O)) documents resolution of exophthalmos and temporal swelling and shows a residue into the orbit in tight contact with the lateral rectus muscle. Full article ">

11 pages, 255 KiB

Open AccessFeature PaperArticle

Associations of Intact and C-Terminal FGF23 with Inflammatory Markers in Older Patients Affected by Advanced Chronic Kidney Disease

by Matteo Abinti, Simone Vettoretti, Lara Caldiroli, Deborah Mattinzoli, Masami Ikehata, Silvia Armelloni, Paolo Molinari, Carlo Maria Alfieri, Giuseppe Castellano and Piergiorgio Messa

J. Clin. Med. 2024, 13(13), 3967; https://doi.org/10.3390/jcm13133967 - 6 Jul 2024

Viewed by 689

Abstract

Background: In patients with chronic kidney disease (CKD), Fibroblast Growth Factor 23 (FGF23) is markedly increased and has been proposed to interact with systemic inflammation. Methods: In this cross-sectional study, we evaluated the correlations of intact FGF23, c-terminal FGF23, and the [...] Read more.

Background: In patients with chronic kidney disease (CKD), Fibroblast Growth Factor 23 (FGF23) is markedly increased and has been proposed to interact with systemic inflammation. Methods: In this cross-sectional study, we evaluated the correlations of intact FGF23, c-terminal FGF23, and the FGF23 ratio (c-terminal to intact) with some inflammatory cytokines in 111 elderly patients with advanced CKD not yet in dialysis. Results: Estimated glomerular filtration rate (eGFR) was inversely correlated with intact FGF23 and c-terminal FGF23, as well as with interleukin 6 (IL-6), tumor necrosis factor alpha (TNFα), and monocyte chemoattractant protein-1 (MCP-1). Intact FGF23 levels were directly correlated with IL-6 (r = 0.403; p < 0.001) and TNFα (r = 0.401; p < 0.001) while c-terminal FGF23 was directly correlated with MCP-1 (r = 0.264; p = 0.005). The FGF23 ratio was, instead, inversely correlated with IL-6 (r = −0.326; p < 0.001). Multivariate analysis revealed that intact FGF23 was directly associated with TNFα [B = 0.012 (95% CI 0.006, 0.019); p = 0.003] and c-terminal FGF23 was directly associated with MCP-1 [B = 0.001 (95% CI 0.000, 0.002); p = 0.038], while the FGF23 ratio was inversely correlated with IL-6 [B = −0.028 (95% CI −0.047, −0.010); p = 0.002]. Conclusions: Our data demonstrate that, in CKD patients, intact FGF23 and the metabolites deriving from its proteolytic cleavage are differently associated with some inflammatory pathways. In particular, intact FGF23 is mainly associated with IL-6 and TNFα, c-terminal FGF23 with MCP-1, and the FGF23 ratio with IL6. Full article

(This article belongs to the Special Issue Chronic Kidney Disease: Clinical Updates and Perspectives, Opportunities and Challenges)

12 pages, 1977 KiB

Open AccessArticle

Young Women with Early-Stage Breast Cancer Treated with Upfront Surgery: Overview of Oncological Outcomes

by Lorenzo Scardina, Beatrice Carnassale, Alba Di Leone, Alejandro Martin Sanchez, Ersilia Biondi, Francesca Moschella, Sabatino D’Archi, Antonio Franco, Flavia De Lauretis, Enrico Di Guglielmo, Eleonora Petrazzuolo, Stefano Magno, Riccardo Masetti and Gianluca Franceschini

J. Clin. Med. 2024, 13(13), 3966; https://doi.org/10.3390/jcm13133966 - 6 Jul 2024

Viewed by 817

Abstract

Background: Breast cancer in young women aged < 40 years is rare and often aggressive with less favorable survival rates. The lack of systematic screening, later stage at diagnosis, and a more aggressive disease biology may all contribute to their poor prognosis. [...] Read more.

Background: Breast cancer in young women aged < 40 years is rare and often aggressive with less favorable survival rates. The lack of systematic screening, later stage at diagnosis, and a more aggressive disease biology may all contribute to their poor prognosis. Data on the best management remain conflicting, especially those regarding surgical management, either breast-conserving or mastectomy. To our knowledge, there are limited studies surrounding the treatment of young women with early breast cancer, and this analysis evaluated the oncological outcomes for those patients who underwent surgery upfront. Methods: We conducted a retrospective study including 130 young women with early breast cancer from a total of 373 consecutive patients treated with upfront surgery between January 2016 and December 2021 at our institution. Local recurrence-free survival (LR-FS), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were evaluated. Results: The median follow-up was 61.1 months (range, 25–95). A total of 92 (70.8%) patients underwent breast-conserving surgery, while 38 (29.2%) patients underwent conservative mastectomy with immediate implant breast reconstruction. In total, 8 of 130 patients (6.2%) developed a local recurrence in the treated breast, an7 (5.4%) patients presented distant metastasis. Overall, two (1.6%) patients died due to breast cancer recurrence. Conclusions: The results of our study interestingly support breast-conserving surgery in young patients with early-stage breast cancer. While appropriate breast-conserving surgery can achieve favorable oncological outcomes and can always be considered a valid alternative to conservative mastectomy in upfront surgery, a younger age at diagnosis should never be used alone to choose the type of surgery. Full article

(This article belongs to the Special Issue Emerging Trends and Debates in Breast Cancer: Impact of Research on Surgical Strategies)

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11 pages, 858 KiB

Open AccessArticle

Final Results from the First European Real-World Experience on Lusutrombopag Treatment in Cirrhotic Patients with Severe Thrombocytopenia: Insights from the REAl-World Lusutrombopag Treatment in ITalY Study

by Paolo Gallo, Antonio De Vincentis, Francesca Terracciani, Andrea Falcomatà, Valeria Pace Palitti, Maurizio Russello, Anthony Vignone, Domenico Alvaro, Raffaella Tortora, Marco Biolato, Maurizio Pompili, Vincenza Calvaruso, Veneziano Marzia, Marco Tizzani, Alessandro Caneglias, Francesco Frigo, Marcantonio Gesualdo, Alfredo Marzano, Valerio Rosato, Ernesto Claar, Rosanna Villani, Antonio Izzi, Raffaele Cozzolongo, Antonio Cozzolino, Aldo Airoldi, Chiara Mazzarelli, Marco Distefano, Claudia Iegri, Stefano Fagiuoli, Vincenzo Messina, Enrico Ragone, Rodolfo Sacco, Pierluigi Cacciatore, Flora Masutti, Saveria Lory Crocé, Alessandra Moretti, Valentina Flagiello, Giulia Di Pasquale, Antonio Picardi and Umberto Vespasiani-Gentilucci Show full author list Hide full author list

J. Clin. Med. 2024, 13(13), 3965; https://doi.org/10.3390/jcm13133965 - 6 Jul 2024

Viewed by 750

Abstract

Background and aims: Management of severe thrombocytopenia poses significant challenges in patients with chronic liver disease. Here, we aimed to evaluate the first real-world European post-marketing cohort of cirrhotic patients treated with lusutrombopag, a thrombopoietin receptor agonist, verifying the efficacy and safety of [...] Read more.

Background and aims: Management of severe thrombocytopenia poses significant challenges in patients with chronic liver disease. Here, we aimed to evaluate the first real-world European post-marketing cohort of cirrhotic patients treated with lusutrombopag, a thrombopoietin receptor agonist, verifying the efficacy and safety of the drug. Methods: In the REAl-world Lusutrombopag treatment in ITalY (REALITY) study, we collected data from consecutive cirrhotic patients treated with lusutrombopag in 19 Italian hepatology centers, mostly joined to the “Club Epatologi Ospedalieri” (CLEO). Primary and secondary efficacy endpoints were the ability of lusutrombopag to avoid platelet transfusions and to raise the platelet count to ≥50,000/μL, respectively. Treatment-associated adverse events were also collected. Results: A total of 66 patients and 73 cycles of treatment were included in the study, since 5 patients received multiple doses of lusutrombopag over time for different invasive procedures. Fourteen patients (19%) had a history of portal vein thrombosis (PVT). Lusutrombopag determined a significant increase in platelet count [from 37,000 (33,000–44,000/μL) to 58,000 (49,000–82,000), p < 0.001]. The primary endpoint was met in 84% of patients and the secondary endpoint in 74% of patients. Baseline platelet count was the only independent factor associated with response in multivariate logistic regression analysis (OR for any 1000 uL of 1.13, CI95% 1.04–1.26, p 0.01), with a good discrimination power (AUROC: 0.78). Notably, a baseline platelet count ≤ 29,000/μL was identified as the threshold for identifying patients unlikely to respond to the drug (sensitivity of 91%). Finally, de novo PVT was observed in four patients (5%), none of whom had undergone repeated treatment, and no other safety or hemorrhagic events were recorded in the entire population analyzed. Conclusions: In this first European real-world series, lusutrombopag demonstrated efficacy and safety consistent with the results of registrational studies. According to our results, patients with baseline platelet counts ≤29,000/μL are unlikely to respond to the drug. Full article

(This article belongs to the Special Issue Updates in Liver Cirrhosis)

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18 pages, 804 KiB

Open AccessSystematic Review

Work-Related Musculoskeletal Disorders: A Systematic Review and Meta-Analysis

by Chiara Greggi, Virginia Veronica Visconti, Marco Albanese, Beatrice Gasperini, Angela Chiavoghilefu, Caterina Prezioso, Benedetta Persechino, Sergio Iavicoli, Elena Gasbarra, Riccardo Iundusi and Umberto Tarantino

J. Clin. Med. 2024, 13(13), 3964; https://doi.org/10.3390/jcm13133964 - 6 Jul 2024

Viewed by 1722

Abstract

Background: Musculoskeletal disorders (MSDs) involve muscles, nerves, tendons, joints, cartilage, and spinal discs. These conditions can be triggered by both the work environment and the type of work performed, factors that, in some cases, can also exacerbate pre-existing conditions. This systematic review aims [...] Read more.

Background: Musculoskeletal disorders (MSDs) involve muscles, nerves, tendons, joints, cartilage, and spinal discs. These conditions can be triggered by both the work environment and the type of work performed, factors that, in some cases, can also exacerbate pre-existing conditions. This systematic review aims to provide an overview of the impact that different work-related activities have on the musculoskeletal system. Methods: A global search of publications was conducted using the following international bibliographic web databases: PubMed and Web of Science. The search strategies combined terms for musculoskeletal disorders and workers. In addition, a meta-analysis was conducted to estimate the prevalence of MSDs within the healthcare sector. Results: A total of 10,805 non-duplicated articles were identified, and finally, 32 studies were reviewed in this article. Once the literature search was completed, occupational figures were categorized into healthcare, farming, industrial, and computer sectors. In the healthcare sector, the prevalence estimate for degenerative diseases of the lumbar spine was 21% (497 out of 2547 physicians and dentists) (95% CI, 17–26%), while for osteoarthritis of the hand, it was 37% (382 out of 1013 dentists) (95% CI, 23–51%). Conclusions: Musculoskeletal disorders significantly impair workers’ quality of life, especially in healthcare sector. These conditions are also associated with high costs for employers, such as absenteeism, lost productivity, and increased costs for healthcare, disability, and workers’ compensation. Full article

(This article belongs to the Section Orthopedics)

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14 pages, 3276 KiB

Open AccessFeature PaperArticle

Comparative Uptake Patterns of Radioactive Iodine and [18F]-Fluorodeoxyglucose (FDG) in Metastatic Differentiated Thyroid Cancers

by Devan Diwanji, Emmanuel Carrodeguas, Youngho Seo, Hyunseok Kang, Myat Han Soe, Janet M. Chiang, Li Zhang, Chienying Liu, Spencer C. Behr and Robert R. Flavell

J. Clin. Med. 2024, 13(13), 3963; https://doi.org/10.3390/jcm13133963 - 6 Jul 2024

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Abstract

Background: Metastatic differentiated thyroid cancer (DTC) represents a molecularly heterogeneous group of cancers with varying radioactive iodine (RAI) and [¹⁸F]-fluorodeoxyglucose (FDG) uptake patterns potentially correlated with the degree of de-differentiation through the so-called “flip-flop” phenomenon. However, it is unknown if RAI [...] Read more.

Background: Metastatic differentiated thyroid cancer (DTC) represents a molecularly heterogeneous group of cancers with varying radioactive iodine (RAI) and [¹⁸F]-fluorodeoxyglucose (FDG) uptake patterns potentially correlated with the degree of de-differentiation through the so-called “flip-flop” phenomenon. However, it is unknown if RAI and FDG uptake patterns correlate with molecular status or metastatic site. Materials and Methods: A retrospective analysis of metastatic DTC patients (n = 46) with radioactive 131-iodine whole body scan (WBS) and FDG-PET imaging between 2008 and 2022 was performed. The inclusion criteria included accessible FDG-PET and WBS studies within 1 year of each other. Studies were interpreted by two blinded radiologists for iodine or FDG uptake in extrathyroidal sites including lungs, lymph nodes, and bone. Cases were stratified by BRAF V600E mutation status, histology, and a combination of tumor genotype and histology. The data were analyzed by McNemar’s Chi-square test. Results: Lung metastasis FDG uptake was significantly more common than iodine uptake (WBS: 52%, FDG: 84%, p = 0.04), but no significant differences were found for lymph or bone metastases. Lung metastasis FDG uptake was significantly more prevalent in the papillary pattern sub-cohort (WBS: 37%, FDG: 89%, p = 0.02) than the follicular pattern sub-cohort (WBS: 75%, FDG: 75%, p = 1.00). Similarly, BRAF V600E+ tumors with lung metastases also demonstrated a preponderance of FDG uptake (WBS: 29%, FDG: 93%, p = 0.02) than BRAF V600E− tumors (WBS: 83%, FDG: 83%, p = 1.00) with lung metastases. Papillary histology featured higher FDG uptake in lung metastasis (WBS: 39%, FDG: 89%, p = 0.03) compared with follicular histology (WBS: 69%, FDG: 77%, p = 1.00). Patients with papillary pattern disease, BRAF V600E+ mutation, or papillary histology had reduced agreement between both modalities in uptake at all metastatic sites compared with those with follicular pattern disease, BRAF V600E− mutation, or follicular histology. Low agreement in lymph node uptake was observed in all patients irrespective of molecular status or histology. Conclusions: The pattern of FDG-PET and radioiodine uptake is dependent on molecular status and metastatic site, with those with papillary histology or BRAF V600E+ mutation featuring increased FDG uptake in distant metastasis. Further study with an expanded cohort may identify which patients may benefit from specific imaging modalities to recognize and surveil metastases. Full article

(This article belongs to the Section Oncology)

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WBS and FDG uptake stratified by molecular subtype. WBS: radioactive iodine whole body scan; FDG: 18Fluorodeoxyglucose-PET; PP: papillary pattern; FP: follicular pattern. (A) No significant differences were observed in lymphatic tissue metastatic radiotracer uptake in any cohort. (B) Significantly increased FDG over iodine uptake was observed in the entire cohort in lung tissue and papillary pattern (PP) sub-cohort, but not in the follicular pattern (FP) sub-cohort. (C) No significant differences in radiotracer uptake were observed in bone in any cohort. (D) Table summary with proportions of patients which have metastases at any given site and proportions of patients that had FDG or WBS positivity. Asterisk (*) indicates p < 0.05; ns = not significant. Full article ">Figure 2
WBS and FDG uptake stratified by BRAF V600E status. WBS: radioactive iodine whole body scan; FDG: 18Fluorodeoxyglucose-PET. Only patients with BRAF testing are included in the cohort analysis (purple and pink for “WBS Tested” and “FDG Tested”, respectively). (A) No significant differences were observed in lymphatic tissue metastatic radiotracer uptake in any cohort. (B) Significantly increased FDG over iodine uptake was observed in the entire BRAF tested cohort in lung tissue and BRAF+ sub-cohort, but not in the BRAF− sub-cohort. (C) No significant differences in radiotracer uptake were observed in bone in any cohort. (D) Table summary with proportions of patients which have metastases at any given site and proportions of patients that had FDG or WBS positivity. Asterisk (*) indicates p < 0.05; ns = not significant. Full article ">Figure 3
Example WBS and FDG PET scans of DTC lung metastasis. RAI WBS: radioactive iodine whole body scan; FDG: 18Fluorodeoxyglucose-PET. (A,B) Top row images are exemplary of DTC lung metastasis with FDG > WBS uptake in a patient with BRAF+ disease, illustrative of the “flip-flop” phenomenon in a less differentiated tumor. Despite clear focal FDG avidity, iodine radiotracer is at background levels in WBS. (C,D) Middle row images demonstrate a concordant BRAF+ case with iodine and FDG radiotracer avidity in the lung. (E,F) Bottom row images demonstrate a BRAF− case showing both low level FDG and iodine avidity in lung metastasis, both clearly above background levels, although more conspicuous by WBS. Full article ">Figure 4
WBS and FDG uptake stratified by histology. (A) No significant differences were observed in lymphatic tissue metastatic radiotracer uptake in any cohort. (B) Significantly increased FDG over iodine uptake was observed in the entire cohort in lung tissue and papillary sub-cohort, but not in the follicular sub-cohort. (C) No significant differences in radiotracer uptake were observed in bone in any cohort. (D) Table summary with proportions of patients which have metastases at any given site and proportions of patients that had FDG or WBS positivity. Asterisk (*) indicates p < 0.05; ns = not significant. Full article ">Figure 5
Agreement between imaging modalities by papillary or follicular pattern. Agreement is measured by percent discordance between WBS and FDG in patients who had positive uptake by at least one imaging modality. Discordance is inversely proportional to agreement. Below each bar chart, pie charts express the classification of each case into WBS+/FDG+, WBS+ only, and FDG+ only at each metastatic site. Discordance is the calculated sum of WBS+ only and FDG+ only. (A) In the entire cohort, percent discordant rates for lymph nodes (79%), lung (64%), and bone (31%). (B) In patients with papillary patterned thyroid cancer, lymph node (88%), lung (74%), and bone (75%). (C) In patients with follicular patterned thyroid cancer, lymph node (63%), lung (42%), and bone (17%). Full article ">Figure 6
Schematic of recommended initial imaging modalities by molecular classification and histology. Full article ">

11 pages, 254 KiB

Open AccessArticle

Long-Term Evaluation of Pulp Vitality Preservation in Direct and Indirect Pulp Capping: A Retrospective Clinical Study

by Mario Alovisi, Andrea Baldi, Allegra Comba, Roberta Gamerro, Gaetano Paolone, Mauro Mandurino, Mario Dioguardi, Andrea Roggia and Nicola Scotti

J. Clin. Med. 2024, 13(13), 3962; https://doi.org/10.3390/jcm13133962 - 6 Jul 2024

Viewed by 972

Abstract

Background: This retrospective clinical study aimed to assess dental pulp tissue reactions to direct and indirect pulp capping after 10 years of follow-up. Methods: A total of 276 permanent teeth with deep carious lesions were evaluated and divided into five groups: Group (1), [...] Read more.

Background: This retrospective clinical study aimed to assess dental pulp tissue reactions to direct and indirect pulp capping after 10 years of follow-up. Methods: A total of 276 permanent teeth with deep carious lesions were evaluated and divided into five groups: Group (1), direct pulp capping with Mineral Trioxide Aggregate cement; Group (2), direct pulp capping with a resin-based glass ionomer; Group (3), direct pulp capping with TheraCal; Group (4), indirect pulp capping with a three-step total-etch adhesive system; and Group (5), indirect pulp capping with a two-step self-etch adhesive system. Results: A 72.5% success rate was achieved overall. A statistically significant difference was found when comparing direct and indirect pulp capping with a success rate of 23.8% and 93.8%, respectively. For direct pulp-capping procedures, the area of pulp exposure was correlated with pulp necrosis (p = 0.035), while bleeding after exposure appeared independent (p = 0.053). Patient age was significantly related to the maintenance of pulp vitality (p = 0.013). A statistically significant correlation between the pulp-capping material and the occurrence of pulp necrosis was discovered (p = 0.017). For the indirect pulp-capping treatments, a significant correlation between patient age (p = 0.021) and the adhesive system (p = 0.019) with pulp necrosis was described. Conclusions: The pulp-capping material, patient age, and the width of the pulp exposure before the procedure should be carefully considered when performing direct pulp-capping treatments. The performance of the etch-and-rinse adhesive systems was superior to the self-etch system during the indirect pulp-capping procedures. Full article

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

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J. Clin. Med., Volume 13, Issue 13 (July-1 2024) – 363 articles

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