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Medicina, Volume 59, Issue 2 (February 2023) – 236 articles

Cover Story (view full-size image): Originally for diabetes, recent sodium glucose cotransporter 2 inhibitor (SGLT2i) trials have demonstrated impressive cardiovascular and renal benefits, regardless of diabetic status. Benefits include reductions in heart attacks, strokes, cardiovascular deaths, hospitalizations for heart failure, and deaths, in addition to the delayed onset of dialysis. The cardiorenal benefits and safety of these disease-modifying agents have led to the rapid adoption of SGLT2i as a foundational therapy in cardiovascular and renal guidelines. View this paper
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11 pages, 3053 KiB  
Article
Anatomical and Biomechanical Characteristics of the Anterolateral Ligament: A Descriptive Korean Cadaveric Study Using a Triaxial Accelerometer
by Dae Keun Suh, Il-Yup Cho, Sehyun Noh, Dong Joo Yoon and Ki-Mo Jang
Medicina 2023, 59(2), 419; https://doi.org/10.3390/medicina59020419 - 20 Feb 2023
Cited by 2 | Viewed by 1605
Abstract
Background and Objectives: The anterolateral ligament (ALL) could be the potential anatomical structure responsible for rotational instability after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to investigate the anatomical and biomechanical characteristics of the ALL in Korean cadaveric [...] Read more.
Background and Objectives: The anterolateral ligament (ALL) could be the potential anatomical structure responsible for rotational instability after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to investigate the anatomical and biomechanical characteristics of the ALL in Korean cadaveric knee joints. Materials and Methods: Twenty fresh-frozen cadaveric knees were dissected and tested. Femoral and tibial footprints of the ALL were recorded. Pivot shift and Lachman tests were measured with KiRA. Results: The prevalence of ALL was 100%. The average distance of the tibial footprint to the tip of the fibular head was 19.85 ± 3.41 mm; from the tibial footprint to Gerdy’s tubercle (GT) was 18.3 ± 4.19 mm; from the femoral footprint to the lateral femoral epicondyle was 10.25 ± 2.97 mm. ALL’s footprint distance was the longest at 30° of flexion (47.83 ± 8.05 mm, p < 0.01) in a knee with intact ALL–ACL and neutral rotation. During internal rotation, the footprint distance was the longest at 30° of flexion (50.05 ± 8.88 mm, p < 0.01). Internal rotation produced a significant increase at all three angles after ACL–ALL were transected (p = 0.022), where the footprint distance was the longest at 30° of flexion (52.05 ± 7.60 mm). No significant difference was observed in KiRA measurements between intact ALL–ACL and ALL-transected knees for pivot shift and Lachman tests. However, ACL–ALL-transected knees showed significant differences compared to the intact ALL–ACL and ALL-transected knees (p < 0.01). Conclusions: The ALL was identified as a distinct ligament structure with a 100% prevalence in this cadaveric study. The ALL plays a protective role in internal rotational stability. An isolated ALL transection did not significantly affect the ALL footprint distances or functional stability tests. Therefore, the ALL is thought to act as a secondary supportive stabilizer for rotational stability of the knee joint in conjunction with the ACL. Full article
(This article belongs to the Special Issue Orthopedic Surgeries in Sports Medicine)
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7 pages, 1684 KiB  
Case Report
Mixed Primary Hepatocellular Carcinoma and Hepatic Neuroendocrine Carcinoma: Case Report and Literature Review
by Woo Young Shin, Keon Young Lee and Kyeong Deok Kim
Medicina 2023, 59(2), 418; https://doi.org/10.3390/medicina59020418 - 20 Feb 2023
Cited by 4 | Viewed by 1908
Abstract
Mixed hepatocellular carcinoma with neuroendocrine carcinoma (HCC-NEC) is extremely rare, comprising about 0.46% of primary hepatic tumors. A 63-year-old man who was a chronic alcoholic presented with a nine-centimeter-sized hepatic mass. His serum alpha-fetoprotein and protein induced by vitamin K antagonist-II levels were [...] Read more.
Mixed hepatocellular carcinoma with neuroendocrine carcinoma (HCC-NEC) is extremely rare, comprising about 0.46% of primary hepatic tumors. A 63-year-old man who was a chronic alcoholic presented with a nine-centimeter-sized hepatic mass. His serum alpha-fetoprotein and protein induced by vitamin K antagonist-II levels were 22,815 ng/mL and 183 mAU/mL, respectively. The patient underwent a right hemihepatectomy, including the middle hepatic vein. The tumor consisted of poorly differentiated HCC (20%) and large- and small-cell-type NEC (80%) components as per the pathological examination. Immunohistochemically chromogranin and synaptophysin were positive in the areas of NEC and negative in the areas of HCC. Adjuvant chemotherapy with a combination of cisplatin and etoposide was administered after surgery. At postoperative 5 months, the patient complained of right flank pain, and CT showed a new mass measuring 7.3 cm in the right adrenal gland. Postoperatively, after 6.5 months, more recurred masses were noted on the posterior aspect of the right kidney and both lungs. Although the regimen was changed from etoposide to irinotecan, additional recurred masses were developed in the liver, lung, and brain. He passed away 12 months after the surgery. After reviewing and analyzing previous literature, the 1 and 2 year overall survival rates are 57.3 and 43.6%, respectively, and the 1 and 2 year disease-free survival rates are 36.2 and 29.0%, respectively. Mixed HCC-NEC is a very rare tumor, and the surgical outcome is poor. Full article
(This article belongs to the Section Surgery)
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7 pages, 483 KiB  
Article
Predictive Values of Hematological Parameters for Determining Imminent Brain Death: A Retrospective Study
by Eralp Çevikkalp and Mevlüt Özgür Taşkapılıoğlu
Medicina 2023, 59(2), 417; https://doi.org/10.3390/medicina59020417 - 20 Feb 2023
Viewed by 1250
Abstract
Background and Objectives: The inflammatory cells released after intracranial hemorrhage, such as monocytes, macrophages, and neutrophils, activate the inflammatory system. These parameters can be used to evaluate the clinical course of diseases. This study aims to evaluate these parameters as possible predictors [...] Read more.
Background and Objectives: The inflammatory cells released after intracranial hemorrhage, such as monocytes, macrophages, and neutrophils, activate the inflammatory system. These parameters can be used to evaluate the clinical course of diseases. This study aims to evaluate these parameters as possible predictors for evaluating the development of brain death. Materials and Methods: Patients with a Glasgow coma scale score below 7 were assigned to Group BD (patients with brain death) and Group ICH (intracranial hemorrhage). The neutrophil, lymphocyte, platelet, monocyte counts, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-neutrophil ratio (PNR) were measured at admission. Results: A high WBC count, neutrophil count, NLR, and PLR and a low lymphocyte count, LMR, and PNR were found to be significant for determining brain death. The area under the curve (AUC) values of NLR, PNR, PLR, and LMR to discriminate brain death were 0.63, 0.61, 0.56, and 0.61, respectively. Conclusion: NLR, PNR, PLR, and LMR are easily accessible and reliable parameters that can be used to predict the development of brain death and can be estimated by a simple complete blood count test. Full article
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11 pages, 350 KiB  
Article
Factors Affecting Sleep Quality of College Students during the Coronavirus Disease 2019 Pandemic: A Cross-Sectional Study
by Mihyoung Kwon and Jihyun Oh
Medicina 2023, 59(2), 416; https://doi.org/10.3390/medicina59020416 - 20 Feb 2023
Viewed by 2700
Abstract
Background and Objectives: The purpose of this study was to identify the correlation between college students’ fear of coronavirus disease 2019 (COVID-19), intolerance of uncertainty, and sleep quality during the COVID-19 pandemic, and to identify factors affecting sleep quality. Materials and Methods: Data [...] Read more.
Background and Objectives: The purpose of this study was to identify the correlation between college students’ fear of coronavirus disease 2019 (COVID-19), intolerance of uncertainty, and sleep quality during the COVID-19 pandemic, and to identify factors affecting sleep quality. Materials and Methods: Data were collected through an online survey of 310 college students from three universities located in three regions in Korea. Results: The average sleep quality score of college students was 4.76 ± 2.86 points, the average fear of COVID-19 was 14.01 ± 5.05 points, and the average intolerance of uncertainty was 31.50 ± 7.92 points. Fear of COVID-19 and intolerance of uncertainty were positively correlated (r = 0.302, p < 0.001). Sleep quality was positively correlated with fear of COVID-19 (r = 0.246, p < 0.001). Sleep quality was positively correlated with intolerance of uncertainty (r = 0.212, p < 0.001). Health status was the most powerful factor that affected sleep quality (β = 0.377, p < 0.001). The next most powerful factors that affected sleep quality were fear of COVID-19 (β = 0.164, p = 0.003) and intolerance of uncertainty (β = 0.122, p = 0.027), respectively. Conclusions: These results are expected to be used as basic data for the development of health intervention programs to protect and improve the psychological well-being of college students by improving their sleep quality. Full article
(This article belongs to the Special Issue The Burden of COVID-19 Pandemic on Mental Health)
11 pages, 827 KiB  
Article
Extremely Low Activity of Serum Alanine Aminotransferase Is Associated with Long-Term Overall-Cause Mortality in the Elderly Patients Undergoing Percutaneous Coronary Intervention after Acute Coronary Syndrome
by Doo Young Kim, Si-Woon Park, Hyung-Wook Han, Myeong-Kon Kim and Ha-Jung Kim
Medicina 2023, 59(2), 415; https://doi.org/10.3390/medicina59020415 - 20 Feb 2023
Viewed by 1512
Abstract
Background and Objectives: Recent studies revealed that the extremely low activity of serum alanine aminotransferase (ALT) is associated with frailty and contributes to increased mortality after acute physical stress. We aimed to investigate whether the extremely low activity of serum ALT (<10 [...] Read more.
Background and Objectives: Recent studies revealed that the extremely low activity of serum alanine aminotransferase (ALT) is associated with frailty and contributes to increased mortality after acute physical stress. We aimed to investigate whether the extremely low activity of serum ALT (<10 U/L) at the time of diagnosis can be used to predict overall-cause mortality in elderly patients that underwent percutaneous coronary intervention (PCI) after acute coronary syndrome (ACS) diagnosis. Materials and Methods: A retrospective medical record review was performed on 1597 patients diagnosed with ACS who underwent PCI at a single university hospital from February 2014 to March 2020. The associations between the extremely low activity of serum ALT and mortality were assessed using a stepwise Cox regression (forward: conditional). Results: A total of 210 elderly patients were analyzed in this study. The number of deaths was 64 (30.5%), the mean survival time was 25.0 ± 18.9 months, and the mean age was 76.9 ± 7.6 years. The mean door-to-PCI time was 74.0 ± 20.9 min. The results of stepwise Cox regression analysis showed that the extremely low activity of serum ALT (adjusted hazard ratio: 5.157, 95% confidence interval: 3.001–8.862, p < 0.001) was the independent risk factor for long-term overall-cause mortality in the elderly who underwent PCI after ACS diagnosis. Conclusions: The extremely low activity of serum ALT at ACS diagnosis is a significant risk factor for increased long-term overall-cause mortality in the elderly who underwent PCI after ACS diagnosis. It is noteworthy that a simple laboratory test at the time of diagnosis was found to be a significant risk factor for mortality. Full article
(This article belongs to the Section Emergency Medicine)
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16 pages, 4910 KiB  
Article
Identification of a Novel Gene Signature Based on Kinesin Family Members to Predict Prognosis in Glioma
by Dongxiao Pan, Xixi Fang and Jiping Li
Medicina 2023, 59(2), 414; https://doi.org/10.3390/medicina59020414 - 20 Feb 2023
Viewed by 1826
Abstract
Background and Objectives: Extensive research indicates that the kinesin superfamily (KIFs) regulates tumor progression. Nonetheless, the potential prognostic and therapeutic role of KIFs in glioma has been limited. Materials and Methods: Four independent cohorts from The Cancer Genome Atlas (TCGA) database and the [...] Read more.
Background and Objectives: Extensive research indicates that the kinesin superfamily (KIFs) regulates tumor progression. Nonetheless, the potential prognostic and therapeutic role of KIFs in glioma has been limited. Materials and Methods: Four independent cohorts from The Cancer Genome Atlas (TCGA) database and the Chinese Glioma Genome Atlas (CGGA) database were generated into a large combination cohort for identification of the prognostic signature. Following that, systematic analyses of multi-omics data were performed to determine the differences between the two groups. In addition, IDH1 was selected for the differential expression analysis. Results: The signature consists of five KIFs (KIF4A, KIF26A, KIF1A, KIF13A, and KIF13B) that were successfully identified. Receiver operating characteristic (ROC) curves indicated the signature had a suitable performance in prognosis prediction with the promising predictive area under the ROC curve (AUC) values. We then explored the genomic features differences, including immune features and tumor mutation status between high- and low-risk groups, from which we found that patients in the high-risk group had a higher level of immune checkpoint modules, and IDH1 was identified mutated more frequently in the low-risk group. Results of gene set enrichment analysis (GSEA) analysis showed that the E2F target, mitotic spindle, EMT, G2M checkpoint, and TNFa signaling were significantly activated in high-risk patients, partially explaining the differential prognosis between the two groups. Moreover, we also verified the five signature genes in the Human Protein Atlas (HPA) database. Conclusion: According to this study, we were able to classify glioma patients based on KIFs in a novel way. More importantly, the discovered KIFs-based signature and related characteristics may serve as a candidate for stratification indicators in the future for gliomas. Full article
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16 pages, 2901 KiB  
Article
A Preliminary Comparison of Plasma Tryptophan Metabolites and Medium- and Long-Chain Fatty Acids in Adult Patients with Major Depressive Disorder and Schizophrenia
by Jun-Chang Liu, Huan Yu, Rui Li, Cui-Hong Zhou, Qing-Qing Shi, Li Guo and Hong He
Medicina 2023, 59(2), 413; https://doi.org/10.3390/medicina59020413 - 20 Feb 2023
Cited by 2 | Viewed by 1874
Abstract
Background and Objectives: Disturbance of tryptophan (Trp) and fatty acid (FA) metabolism plays a role in the pathogenesis of psychiatric disorders. However, quantitative analysis and comparison of plasma Trp metabolites and medium- and long-chain fatty acids (MCFAs and LCFAs) in adult patients [...] Read more.
Background and Objectives: Disturbance of tryptophan (Trp) and fatty acid (FA) metabolism plays a role in the pathogenesis of psychiatric disorders. However, quantitative analysis and comparison of plasma Trp metabolites and medium- and long-chain fatty acids (MCFAs and LCFAs) in adult patients with major depressive disorder (MDD) and schizophrenia (SCH) are limited. Materials and Methods: Clinical symptoms were assessed and the level of Trp metabolites and MCFAs and LCFAs for plasma samples from patients with MDD (n = 24) or SCH (n = 22) and healthy controls (HC, n = 23) were obtained and analyzed. Results: We observed changes in Trp metabolites and MCFAs and LCFAs with MDD and SCH and found that Trp and its metabolites, such as N-formyl-kynurenine (NKY), 5-hydroxyindole-3-acetic acid (5-HIAA), and indole, as well as omega-3 polyunsaturated fatty acids (N3) and the ratio of N3 to omega-6 polyunsaturated fatty acids (N3: N6), decreased in both MDD and SCH patients. Meanwhile, levels of saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) decreased in SCH patients, and there was a significant difference in the composition of MCFAs and LCFAs between MDD and SCH patients. Moreover, the top 10 differential molecules could distinguish the two groups of diseases from HC and each other with high reliability. Conclusions: This study provides a further understanding of dysfunctional Trp and FA metabolism in adult patients with SCH or MDD and might develop combinatorial classifiers to distinguish between these disorders. Full article
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12 pages, 834 KiB  
Review
Computer Vision Syndrome: An Ophthalmic Pathology of the Modern Era
by Irina Andreea Pavel, Camelia Margareta Bogdanici, Vlad Constantin Donica, Nicoleta Anton, Bogdan Savu, Cristina Petronela Chiriac, Cristian Dan Pavel and Silvia Cristina Salavastru
Medicina 2023, 59(2), 412; https://doi.org/10.3390/medicina59020412 - 20 Feb 2023
Cited by 12 | Viewed by 5297
Abstract
Digital device usage has increased significantly in last decade among all age groups, both for educational and recreational purposes. Computer vision syndrome (CVS), also known as digital eye strain (DES), represents a range of ocular, musculoskeletal, and behavioral conditions caused by prolonged use [...] Read more.
Digital device usage has increased significantly in last decade among all age groups, both for educational and recreational purposes. Computer vision syndrome (CVS), also known as digital eye strain (DES), represents a range of ocular, musculoskeletal, and behavioral conditions caused by prolonged use of devices with digital screens. This paper reviews the principal environmental, ocular, and musculoskeletal causes for this condition. Due to the high prevalence of DES and frequent usage of digital devices, it is important that eye care practitioners be able to provide advice and management options based on quality research evidence. Full article
(This article belongs to the Section Ophthalmology)
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12 pages, 540 KiB  
Systematic Review
Robotic Single-Site Hysterectomy in Gynecologic Benign Pathology: A Systematic Review of the Literature
by Gaetano Riemma, Francesca Pasanisi, Antonella Reino, Maria Cristina Solazzo and Carlo Ronsini
Medicina 2023, 59(2), 411; https://doi.org/10.3390/medicina59020411 - 20 Feb 2023
Cited by 3 | Viewed by 1743
Abstract
Background and objectives: Total hysterectomy is one of the most common gynecologic surgical procedures and it is mainly performed for benign pathologies. The introduction of robotic single-site surgery (RSS) as an acceptable alternative to laparoendoscopic surgery combines the advantages of robotics with the [...] Read more.
Background and objectives: Total hysterectomy is one of the most common gynecologic surgical procedures and it is mainly performed for benign pathologies. The introduction of robotic single-site surgery (RSS) as an acceptable alternative to laparoendoscopic surgery combines the advantages of robotics with the aesthetic result of a single incision. This study aims to review the existing literature on a single-site robotic hysterectomy in patients with benign pathologies and verify its safety and feasibility. Materials and Methods: Following the recommendations in the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, FP and AR systematically screened the PubMed, Embase, and Scopus databases. No temporal or geographical limitation was discriminatory. Studies containing data about feasibility and safety were included. Results: From 219, only eight studies met the inclusion criteria, and a total of 212 patients were included with a mean patient age of 45.42 years old (range 28–49.5 years old) and a mean BMI of 25.74 kg/m2 (range 22–28.5 kg/m2). The mean presurgical time, including port placement and docking time, was 15.56 (range 3–30) minutes. Mean console time was reported in six studies and is 83.21 min (range 25–180 min). The mean operative time is 136.6 min (range 60–294 min) and the mean blood loss is 43.68 mL (range 15–300 mL). Only two patients in the total analyzed had intraoperative complications and no conversion to LPT occurred. The median hospital stay was 1.71 days (range 0.96–3.5 days). The postoperative complication rate was estimated at 1.4% (vaginal bleeding). Conclusions: Our review supports the safety and feasibility of robotic single-site hysterectomy for benign gynecological diseases. Full article
(This article belongs to the Special Issue Effects of Abdominal Hysterectomy on Gynecological Patients)
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15 pages, 670 KiB  
Article
Clinical Trial to Assess Physiology and Activity of Masticatory Muscles of Complete Denture Wearer Following Vitamin D Intervention
by Shraddha Rathi, Saurabh Chaturvedi, Sabzar Abdullah, Geeta Rajput, Nasser M. Alqahtani, Mudita Chaturvedi, Vishwanath Gurumurthy, Ravinder Saini, Shashit Shetty Bavabeedu and Giuseppe Minervini
Medicina 2023, 59(2), 410; https://doi.org/10.3390/medicina59020410 - 20 Feb 2023
Cited by 50 | Viewed by 2933
Abstract
Background and Objectives: Little information is available on the role of Vitamin D as a micro-nutrient deficiency with masticatory muscle efficiency and its effect on the function of removable prosthesis. The aim of this study was to evaluate the role of vitamin [...] Read more.
Background and Objectives: Little information is available on the role of Vitamin D as a micro-nutrient deficiency with masticatory muscle efficiency and its effect on the function of removable prosthesis. The aim of this study was to evaluate the role of vitamin D on masticatory muscle activity among completely edentulous patients and its effect on the retention of removable complete dentures (RCDs). Materials and Methods: A non-randomized clinical control trial was conducted on completely edentulous patients (60.53 ± 7.01 years) in the Indian population between 2017 and 2019. Subjects were evaluated for temporomandibular disorders according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Serum Vitamin D (S Vit D) levels, Ultrasonography (USG), and surface Electromyography (sEMG) readings of the masseter muscle were recorded at enrolment (Level 0), after 3 months of Vitamin D therapy (Level 3), and after consecutive 3 months of maintenance therapy, i.e., after 6 months from baseline (Level 6). The fabrication of new RCDs was done for all after the enrolment, and the retention of RCDs was assessed by asking a question regarding denture retention and asking respondents to mark their satisfaction on a 5-point Likert scale. Data were analysed using ANOVA, Paired’-test and Pearson correlation coefficients. A p-value less than 0.05 indicated a statistically significant association. Results: Between enrolment and a six-month follow-up, S Vit D levels showed an increase from 16.03 ± 5.68 ng/mL to 31.35 ± 9.28 ng/mL, showing an increase of 15.32 ± 9.38 ng/mL (95.57% rise). Statistically significant values were observed for USG and sEMG. Conclusions: Results showed that S Vit D affects masticatory muscle activity by improving its thickness and boosting its tonicity. Healthy muscles assist in the retention of RCDs, consequently aiding in mastication, speech, and phonetics, hence improving patient satisfaction. Clinical implication: Acknowledging the fact that the prevalence of Vitamin D deficiency is worldwide. We suggest Vitamin D therapy as a nutritional intervention among the elderly completely edentulous population, following dietary counselling, and consider Vitamin D therapy to be an adjunct to nutritional counselling for improving masticatory muscle activity and efficiency, which aids in RCD retention and stability. Consequently, improving oral health-related quality of life for individuals. Full article
(This article belongs to the Special Issue Experimental and Clinical Researches in Oral Medicine)
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2 pages, 240 KiB  
Comment
Comment on Marra et al. Metastatic Renal Cell Carcinoma to the Soft Tissue 27 Years after Radical Nephrectomy: A Case Report. Medicina 2023, 59, 150
by Pietro De Luca, Luca de Campora and Angelo Camaioni
Medicina 2023, 59(2), 409; https://doi.org/10.3390/medicina59020409 - 20 Feb 2023
Cited by 1 | Viewed by 933
Abstract
Recently, Marra et al. [...] Full article
9 pages, 310 KiB  
Case Report
COVID-19-Associated Acute Psychotic Disorder—Longitudinal Case Report and Brief Review of Literature
by Maria Gabriela Puiu, Vlad Dionisie, Andra Ioana Dobrin and Mirela Manea
Medicina 2023, 59(2), 408; https://doi.org/10.3390/medicina59020408 - 19 Feb 2023
Cited by 1 | Viewed by 1744
Abstract
Even though since the beginning of the COVID-19 pandemic, the literature became more and more abundant on data and hypotheses about the various consequences on people’s lives, more clarity needs to be added to the existing information. Besides the stressful experiences related to [...] Read more.
Even though since the beginning of the COVID-19 pandemic, the literature became more and more abundant on data and hypotheses about the various consequences on people’s lives, more clarity needs to be added to the existing information. Besides the stressful experiences related to the COVID-19 pandemic, SARS-CoV-2 infection has been proven to impact brain functioning through direct and indirect pathogenic mechanisms. In this context, we report a case of a patient presenting with a first episode of psychosis following COVID-19. In our case, a 28-year-old male patient with no personal or family psychiatric history developed psychotic symptoms (delusions, hallucinations, and disorganized behaviour) that required antipsychotic treatment and inpatient hospitalization one week after he was discharged from the hospital after COVID-19. At the six-month and one-year follow-up, the patient was in remission without any psychotic signs or symptoms. A brief review of the literature is also provided. The case presented in this article outlines the possibility that the post-COVD-19 recovery period might be a crucial time for the onset of acute psychotic disorder, and therefore, routine psychiatric assessments should be carried out during all phases of the disease. A clearer picture of the impact of the COVID-19 pandemic on mental health will most likely be revealed in the future as many consequences need long-term evaluation. Full article
(This article belongs to the Special Issue The Burden of COVID-19 Pandemic on Mental Health)
13 pages, 664 KiB  
Review
Cardiopulmonary Cement Embolism Following Cement-Augmented Pedicle Screw Fixation: A Narrative Review
by Tadatsugu Morimoto, Takaomi Kobayashi, Hirohito Hirata, Masatsugu Tsukamoto, Tomohito Yoshihara, Yu Toda and Masaaki Mawatari
Medicina 2023, 59(2), 407; https://doi.org/10.3390/medicina59020407 - 19 Feb 2023
Cited by 4 | Viewed by 1765
Abstract
Fixation using cement-augmented pedicle screws (CAPS) is being increasingly performed. However, CAPS-associated cement leakage is a critical problem that can lead to cardiopulmonary cement embolism (CPCE). This narrative review aimed to explore the incidence of and risk factors and treatment strategies for CPCE [...] Read more.
Fixation using cement-augmented pedicle screws (CAPS) is being increasingly performed. However, CAPS-associated cement leakage is a critical problem that can lead to cardiopulmonary cement embolism (CPCE). This narrative review aimed to explore the incidence of and risk factors and treatment strategies for CPCE and cement leakage-related complications after CAPS fixation. Data were extracted from each article, including characteristics of CPCE after CAPS fixation (incidence, location, diagnostic method and criteria, treatment, and outcome and prognosis). Overall, 28 case series and 14 case reports that met the inclusion criteria were included. Of the 1974 cases included in the review, CPCE was noted in 123, symptomatic CPCE in 35, and death in six, respectively. The frequencies of PCE and symptomatic PCE after CAPS fixation were 6% (range: 0–28.6%) and 1.3% (range: 0–26%), respectively. The range of frequencies of PCE and symptomatic PCE after CAPS fixation may have been wide because the definition of CPCE and data collection methods differed among the reports analyzed. Since PCE due to large cement emboli may be primarily related to the surgical technique, improved technique, such as minimizing the number of CAPSs by injecting low-volume high-viscosity cement at low velocity and pressure, and careful observation of cement leakage during CAPS insertion may reduce PCE associated with cement leakage. Spinal surgeons should pay more attention to the occurrence of CPCE during and after CAPS insertion, which can cause serious complications in some patients. Full article
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11 pages, 542 KiB  
Article
Diagnostic Tests in the Prediction of Neonatal Outcome in Early Placental Fetal Growth Restriction
by Vesna Mandić-Marković, Mirjana Bogavac, Željko Miković, Milan Panić, Dejan M. Pavlović, Jelena Mitrović and Milica Mandić
Medicina 2023, 59(2), 406; https://doi.org/10.3390/medicina59020406 - 19 Feb 2023
Cited by 1 | Viewed by 1606
Abstract
Background and Objectives: Monitoring pregnancies with fetal growth restriction (FGR) presents a challenge, especially concerning the time of delivery in cases of early preterm pregnancies below 32 weeks. The aim of our study was to compare different diagnostic parameters in growth-restricted preterm [...] Read more.
Background and Objectives: Monitoring pregnancies with fetal growth restriction (FGR) presents a challenge, especially concerning the time of delivery in cases of early preterm pregnancies below 32 weeks. The aim of our study was to compare different diagnostic parameters in growth-restricted preterm neonates with and without morbidity/mortality and to determine sensitivity and specificity of diagnostic parameters for monitoring preterm pregnancies with early preterm fetal growth restriction below 32 weeks. Materials and Methods: Our clinical study evaluated 120 cases of early preterm deliveries, with gestational age ≤ 32 + 0 weeks, with prenatally diagnosed placental FGR. All the patients were divided into three groups of 40 cases each based on neonatal condition,: I—Neonates with morbidity/mortality (NMM); II—Neonates without morbidity with acidosis/asphyxia (NAA); III—Neonates without neonatal morbidity/acidosis/asphyxia (NWMAA). Results: Amniotic fluid index (AFI) was lower in NMM, while NWMAA had higher biophysical profile scores (BPS). UA PI was lower in NWMAA. NWMAA had higher MCA PI and CPR and fewer cases with CPR <5th percentile. NMM had higher DV PI, and more often had ductus venosus (DV) PI > 95th‰ or absent/reversed A wave, and pulsatile blood flow in umbilical vein (UV). The incidence of pathological fetal heart rate monitoring (FHRM) was higher in NMM and NAA, although the difference was not statistically significant. ROC calculated by defining a bad outcome as NMM and a good outcome as NAA and NWMAA showed the best sensitivity in DV PIi. ROC calculated by defined bad outcome in NMM and NAA and good outcome in NWMAA showed the best sensitivity in MCA PI. Conclusions: In early fetal growth restriction normal cerebral blood flow strongly predicts good outcomes, while pathological venous blood flow is associated with bad outcomes. In fetal growth restriction before 32 weeks, individualized expectant management remains the best option for the optimal timing of delivery. Full article
(This article belongs to the Section Obstetrics and Gynecology)
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17 pages, 560 KiB  
Review
Emergency Management of Electrical Storm: A Practical Overview
by Fabrizio Guarracini, Eleonora Bonvicini, Sofia Zanon, Marta Martin, Giulia Casagranda, Marianna Mochen, Alessio Coser, Silvia Quintarelli, Stefano Branzoli, Patrizio Mazzone, Roberto Bonmassari and Massimiliano Marini
Medicina 2023, 59(2), 405; https://doi.org/10.3390/medicina59020405 - 19 Feb 2023
Cited by 3 | Viewed by 4102
Abstract
Electrical storm is a medical emergency characterized by ventricular arrythmia recurrence that can lead to hemodynamic instability. The incidence of this clinical condition is rising, mainly in implantable cardioverter defibrillator patients, and its prognosis is often poor. Early acknowledgment, management and treatment have [...] Read more.
Electrical storm is a medical emergency characterized by ventricular arrythmia recurrence that can lead to hemodynamic instability. The incidence of this clinical condition is rising, mainly in implantable cardioverter defibrillator patients, and its prognosis is often poor. Early acknowledgment, management and treatment have a key role in reducing mortality in the acute phase and improving the quality of life of these patients. In an emergency setting, several measures can be employed. Anti-arrhythmic drugs, based on the underlying disease, are often the first step to control the arrhythmic burden; besides that, new therapeutic strategies have been developed with high efficacy, such as deep sedation, early catheter ablation, neuraxial modulation and mechanical hemodynamic support. The aim of this review is to provide practical indications for the management of electrical storm in acute settings. Full article
(This article belongs to the Section Emergency Medicine)
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11 pages, 473 KiB  
Hypothesis
Dynamic Loading—A New Marker for Abdominal Aneurysm Growth?
by John Friesen, Lucas Stein, Farzin Adili and Peter F. Pelz
Medicina 2023, 59(2), 404; https://doi.org/10.3390/medicina59020404 - 19 Feb 2023
Viewed by 1309
Abstract
The growing possibilities of non-invasive heart rate and blood pressure measurement with mobile devices allow vital data to be continuously collected and used to assess patients’ health status. When it comes to the risk assessment of abdominal aortic aneurysms (AAA), the continuous tracking [...] Read more.
The growing possibilities of non-invasive heart rate and blood pressure measurement with mobile devices allow vital data to be continuously collected and used to assess patients’ health status. When it comes to the risk assessment of abdominal aortic aneurysms (AAA), the continuous tracking of blood pressure and heart rate could enable a more patient-specific approach. The use of a load function and an energy function, with continuous blood pressure, heart rate, and aneurysm stiffness as input parameters, can quantify dynamic load on AAA. We hypothesise that these load functions correlate with aneurysm growth and outline a possible study procedure in which the hypothesis could be tested for validity. Subsequently, uncertainty quantification of input quantities and derived quantities is performed. Full article
(This article belongs to the Special Issue New Perspectives in Vascular and Endovascular Surgery)
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10 pages, 1997 KiB  
Article
“Bring Your Own Device”—A New Approach to Wearable Outcome Assessment in Trauma
by Benedikt J. Braun, Tina Histing, Maximilian M. Menger, Julian Platte, Bernd Grimm, Andrew M. Hanflik, Peter H. Richter, Sureshan Sivananthan, Seth R. Yarboro, Boyko Gueorguiev, Dmitry Pokhvashchev and Meir T. Marmor
Medicina 2023, 59(2), 403; https://doi.org/10.3390/medicina59020403 - 19 Feb 2023
Cited by 2 | Viewed by 1726
Abstract
Background and Objectives: Outcome data from wearable devices are increasingly used in both research and clinics. Traditionally, a dedicated device is chosen for a given study or clinical application to collect outcome data as soon as the patient is included in a [...] Read more.
Background and Objectives: Outcome data from wearable devices are increasingly used in both research and clinics. Traditionally, a dedicated device is chosen for a given study or clinical application to collect outcome data as soon as the patient is included in a study or undergoes a procedure. The current study introduces a new measurement strategy, whereby patients’ own devices are utilized, allowing for both a pre-injury baseline measure and ability to show achievable results. Materials and Methods: Patients with a pre-existing musculoskeletal injury of the upper and lower extremity were included in this exploratory, proof-of-concept study. They were followed up for a minimum of 6 weeks after injury, and their wearable outcome data (from a smartphone and/or a body-worn sensor) were continuously acquired during this period. A descriptive analysis of the screening characteristics and the observed and achievable outcome patterns was performed. Results: A total of 432 patients was continuously screened for the study, and their screening was analyzed. The highest success rate for successful inclusion was in younger patients. Forty-eight patients were included in the analysis. The most prevalent outcome was step count. Three distinctive activity data patterns were observed: patients recovering, patients with slow or no recovery, and patients needing additional measures to determine treatment outcomes. Conclusions: Measuring outcomes in trauma patients with the Bring Your Own Device (BYOD) strategy is feasible. With this approach, patients were able to provide continuous activity data without any dedicated equipment given to them. The measurement technique is especially suited to particular patient groups. Our study’s screening log and inclusion characteristics can help inform future studies wishing to employ the BYOD design. Full article
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9 pages, 343 KiB  
Article
The Effect of Proton Pump Inhibitors on Early Implant Failure A Retrospective Cohort Study
by Daya Masri, Noga Retzkin, Sérgio Luís Scombatti de Souza, Gil S. Slutzkey, Nirit Tagger-Green, Sarit Naishlos and Liat Chaushu
Medicina 2023, 59(2), 402; https://doi.org/10.3390/medicina59020402 - 18 Feb 2023
Cited by 1 | Viewed by 1864
Abstract
Background and Objectives: Maintenance of a firm and long-term stable osseointegration is the primary goal of implant dentistry. Time is used to define implant failure characteristics. Early implant failure (EIF) occurs up to one year after loading. Recent studies indicated an association [...] Read more.
Background and Objectives: Maintenance of a firm and long-term stable osseointegration is the primary goal of implant dentistry. Time is used to define implant failure characteristics. Early implant failure (EIF) occurs up to one year after loading. Recent studies indicated an association between proton pump inhibitors (PPI) therapy and failure of osseointegration. The present study assessed whether the use of PPIs is a risk factor to EIF. Materials and methods: A retrospective cohort study including 687 patients and 2971 dental implants. The study group (PPIs users) comprised 17.3% (119) individuals and 18.7% (555) implants. The remaining cohort (82.7% (568) individuals and 81.3% (2416) implants) served as control. The information was taken from the patients’ files. The following information was collected: age, gender, physical status, systemic diseases, HbA1C values before and after implant-supported prosthesis delivery in cases of diabetes mellitus, smoking, implant location, number of implants per individual, bone augmentation, implant brand, length and width, and EIF. EIF was defined as implant removal within a period of up to 12 months from loading. Results: EIF in PPIs vs. non-PPIs users was 19.3% vs. 14.3% (p = 0.16) at patient level and 5.4% vs. 3.5% at implant level (p = 0.03). Univariate analysis yielded factors significantly associated with PPIs use, including older age, physical status of the American Society of Anesthesiology (ASA) 3, hypertension, hyperlipidemia, diabetes mellitus, osteoporosis, cardiovascular accident (CVA), location (anterior mandible), shorter and narrower implants, and higher number of implants per individual. Multivariate analysis yielded statistically significant OR of 1.91; p = 0.01 for EIF following PPIs use and 2.3; p < 0.001 for location in anterior mandible. Conclusions: Patients and their healthcare providers are advised to carefully consider the potential risks of taking PPIs prior to dental implant surgery. Further research is needed to confirm these risks and elucidate systemic and local factors that may be involved in such outcomes. Full article
(This article belongs to the Special Issue Advances in Oral Implantology and Related Surgeries)
6 pages, 1402 KiB  
Case Report
Therapeutic Strategy for Patients with Concomitant Pulmonary Artery Hypertension and Hypertrophic Obstructive Cardiomyopathy: A Rare Case Report
by Toshihide Izumida, Teruhiko Imamura, Shuhei Tanaka, Shuji Joho and Koichiro Kinugawa
Medicina 2023, 59(2), 401; https://doi.org/10.3390/medicina59020401 - 18 Feb 2023
Viewed by 1250
Abstract
Combined cases of hypertrophic obstructive cardiomyopathy (HOCM) and pulmonary arterial hypertension (PAH) are rare and have a management dilemma. Although preload is crucial in the management of HOCM, anti-PAH agents dramatically change the preload, leading to improving or worsening heart failure in patients [...] Read more.
Combined cases of hypertrophic obstructive cardiomyopathy (HOCM) and pulmonary arterial hypertension (PAH) are rare and have a management dilemma. Although preload is crucial in the management of HOCM, anti-PAH agents dramatically change the preload, leading to improving or worsening heart failure in patients with HOCM. We had a 74-year-old woman with Sjogren-syndrome-associated PAH. Her heart failure worsened following the initiation of anti-PAH agents due to an incremental preload on the left ventricle, whereas HOCM clinically developed following the termination of anti-PAH agents and progressing anorexia due to the progression of the left ventricular outflow obstruction. Careful monitoring of the left ventricular outflow obstruction during initiation/termination of anti-PAH agents and medical intervention to the HOCM are highly recommended. Full article
(This article belongs to the Section Cardiology)
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8 pages, 264 KiB  
Article
A Comparison of Two Hormonal Fertility Monitoring Systems for Ovulation Detection: A Pilot Study
by Qiyan Mu and Richard Jerome Fehring
Medicina 2023, 59(2), 400; https://doi.org/10.3390/medicina59020400 - 18 Feb 2023
Viewed by 2522
Abstract
Background and Objectives: Accuracy in detecting ovulation and estimating the fertile window in the menstrual cycle is essential for women to avoid or achieve pregnancy. There has been a rapid growth in fertility apps and home ovulation testing kits in recent years. [...] Read more.
Background and Objectives: Accuracy in detecting ovulation and estimating the fertile window in the menstrual cycle is essential for women to avoid or achieve pregnancy. There has been a rapid growth in fertility apps and home ovulation testing kits in recent years. Nevertheless, there lacks information on how well these apps perform in helping users understand their fertility in the menstrual cycle. This pilot study aimed to evaluate and compare the beginning, peak, and length of the fertile window as determined by a new luteinizing hormone (LH) fertility tracking app with the Clearblue Fertility Monitor (CBFM). Materials and Methods: A total of 30 women were randomized into either a quantitative Premom or a qualitative Easy@Home (EAH) LH testing system. The results of the two testing systems were compared with the results from the CBFM over three menstrual cycles of use. Potential LH levels for estimating the beginning of the fertile window were calculated along with user acceptability and satisfaction. Results: The estimates of peak fertility by the Premom and EAH LH testing were highly correlated with the CBFM peak results (R = 0.99, p < 0.001). The participants had higher satisfaction and ease-of-use ratings with the CBFM compared to the Premom and EAH LH testing systems. LH 95% confidence levels for estimating the beginning of the fertile window were provided for both the Premom and EAH LH testing results. Conclusions: Our pilot study findings suggest that the Premom and EAH LH fertility testing app can accurately detect impending ovulation for women and are easy to use at home. However, successful utilization of these low-cost LH testing tools and apps for fertility self-monitoring and family planning needs further evaluation with a large and more diverse population. Full article
(This article belongs to the Special Issue Quantitative Hormone Monitoring of the Menstrual Cycle)
10 pages, 4501 KiB  
Case Report
CDHR1-Related Cone–Rod Dystrophy: Clinical Characteristics, Imaging Findings, and Genetic Test Results—A Case Report
by Małgorzata Sobolewska, Marta Świerczyńska, Mariola Dorecka, Dorota Wyględowska-Promieńska, Maciej R. Krawczyński and Ewa Mrukwa-Kominek
Medicina 2023, 59(2), 399; https://doi.org/10.3390/medicina59020399 - 17 Feb 2023
Viewed by 2029
Abstract
Background: Cone–rod dystrophies (CRDs) are a heterogeneous group of inherited retinal diseases (IRDs) characterized by cone photoreceptor loss, that is followed by subsequent rod photoreceptor impairment. Case presentation: A 49-year-old man complaining of diminution of vision in both eyes (OU) was referred to [...] Read more.
Background: Cone–rod dystrophies (CRDs) are a heterogeneous group of inherited retinal diseases (IRDs) characterized by cone photoreceptor loss, that is followed by subsequent rod photoreceptor impairment. Case presentation: A 49-year-old man complaining of diminution of vision in both eyes (OU) was referred to our outpatient clinic. He reported visual loss for 5 years, but it was most progressive during the last few months. The best-corrected visual acuity (BCVA) at presentation was 0.4 in the right eye (RE) and 1.0 in the left eye (LE). Fundus fluorescein angiography (FFA) revealed granular hyperfluorescence in the macula and concomitant areas of capillary atrophy. Flash full-field electroretinography (ffERG) showed lowering of a and b waves as well as prolonged peak time in light-adapted conditions. However, outcomes of dark-adapted ERGs were within normal limits. Based on the constellation of clinical, angiographic, and electrophysiological tests findings, a diagnosis of IRD was suspected. Genetic testing showed a homozygous, pathogenic c.783G>A mutation in the cadherin-related family member 1 (CDHR1) gene, which confirmed CRD type 15 (CRD15). Conclusions: We demonstrate the clinical characteristics, retinal imaging outcomes, and genetic test results of a patient with CRD15. Our case contributes to expanding our knowledge of the clinical involvement of the pathogenic mutation c.783G>A in CDHR1 variants. Full article
(This article belongs to the Special Issue Evolving Concepts in Clinical Ophthalmology)
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11 pages, 778 KiB  
Review
Placental Growth Factor and Pregnancy-Associated Plasma Protein-A as Potential Early Predictors of Gestational Diabetes Mellitus
by Vesselina Yanachkova, Radiana Staynova, Teodora Stankova and Zdravko Kamenov
Medicina 2023, 59(2), 398; https://doi.org/10.3390/medicina59020398 - 17 Feb 2023
Cited by 6 | Viewed by 2686
Abstract
Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications and one of the main causes of adverse pregnancy outcomes. An early diagnosis of GDM is of fundamental importance in clinical practice. However, the major professional organizations recommend universal screening for [...] Read more.
Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications and one of the main causes of adverse pregnancy outcomes. An early diagnosis of GDM is of fundamental importance in clinical practice. However, the major professional organizations recommend universal screening for GDM, using a 75 g oral glucose tolerance test at 24–28 weeks of gestation. A selective screening at an early stage of pregnancy is recommended only if there are maternal risk factors for diabetes. As a result, the GDM diagnosis is often delayed and established after the appearance of complications. The manifestation of GDM is directly related to insulin resistance, which is closely associated with endothelial dysfunction. The placenta, the placental peptides and hormones play a pivotal role in the manifestation and progression of insulin resistance during pregnancy. Recently, the placental growth factor (PlGF) and plasma-associated protein-A (PAPP-A), have been shown to significantly affect both insulin sensitivity and endothelial function. The principal function of PAPP-A appears to be the cleavage of circulating insulin-like growth factor binding protein-4 while PlGF has been shown to play a central role in the development and maturation of the placental vascular system and circulation. On one hand, these factors are widely used as early predictors (11–13 weeks of gestation) of complications during pregnancy, such as preeclampsia and fetal aneuploidies, in most countries. On the other hand, there is increasing evidence for their predictive role in the development of carbohydrate disorders, but some studies are rather controversial. Therefore, this review aims to summarize the available literature about the potential of serum levels of PlGF and PAPP-A as early predictors in the diagnosis of GDM. Full article
(This article belongs to the Section Endocrinology)
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14 pages, 1314 KiB  
Article
Protective Effect of Neutral Electrolyzed Saline on Gentamicin-Induced Nephrotoxicity: Evaluation of Histopathologic Parameters in a Murine Model
by Nomely S. Aurelien-Cabezas, Brenda A. Paz-Michel, Ivan Jacinto-Cortes, Osiris G. Delgado-Enciso, Daniel A. Montes-Galindo, Ariana Cabrera-Licona, Sergio A. Zaizar-Fregoso, Juan Paz-Garcia, Gabriel Ceja-Espiritu, Valery Melnikov, Jose Guzman-Esquivel, Iram P. Rodriguez-Sanchez, Margarita L. Martinez-Fierro and Ivan Delgado-Enciso
Medicina 2023, 59(2), 397; https://doi.org/10.3390/medicina59020397 - 17 Feb 2023
Cited by 2 | Viewed by 2211
Abstract
Background and Objectives: Gentamicin (GM) is a nephrotoxic aminoglycoside. Neutral electrolyzed saline (SES) is a compound with anti-inflammatory, antioxidant, and immunomodulatory properties. The objective of the present study was to evaluate whether kidney damage by GM can be prevented and/or reversed through [...] Read more.
Background and Objectives: Gentamicin (GM) is a nephrotoxic aminoglycoside. Neutral electrolyzed saline (SES) is a compound with anti-inflammatory, antioxidant, and immunomodulatory properties. The objective of the present study was to evaluate whether kidney damage by GM can be prevented and/or reversed through the administration of SES. Materials and Methods: The study was carried out as a prospective, single-blind, five-arm, parallel-group, randomized, preclinical trial. The nephrotoxicity model was established in male BALB/c mice by administering GM at a dose of 100 mg/kg/day intraperitoneally for 30 days, concomitantly administering (+) SES or placebo (physiologic saline solution), and then administering SES for another 30 days after the initial 30 days of GM plus SES or placebo. At the end of the test, the mice were euthanized, and renal tissues were evaluated histopathologically. Results: The GM + placebo group showed significant tubular injury, interstitial fibrosis, and increased interstitial infiltrate of inflammatory cells compared with the group without GM. Tubular injury and interstitial fibrosis were lower in the groups that received concomitant GM + SES compared with the GM + placebo group. SES administration for 30 days after the GM administration periods (GM + placebo and GM + SES for 30 days) did not reduce nephrotoxicity. Conclusions: Intraperitoneal administration of SES prevents gentamicin-induced histologic nephrotoxicity when administered concomitantly, but it cannot reverse the damage when administered later. Full article
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11 pages, 320 KiB  
Review
Hemoglobin-Based Oxygen Carriers: Where Are We Now in 2023?
by Lin Chen, Zeyong Yang and Henry Liu
Medicina 2023, 59(2), 396; https://doi.org/10.3390/medicina59020396 - 17 Feb 2023
Cited by 8 | Viewed by 4557
Abstract
The pursuit for blood a substitute has spanned over a century, but a majority of the efforts have been disappointing. As of today, there is no widely accepted product used as an alternative to human blood in clinical settings with severe anemic condition(s). [...] Read more.
The pursuit for blood a substitute has spanned over a century, but a majority of the efforts have been disappointing. As of today, there is no widely accepted product used as an alternative to human blood in clinical settings with severe anemic condition(s). Blood substitutes are currently also termed oxygen therapeutics. There are two major categories of oxygen therapeutics, hemoglobin-based and perfluorocarbon-based products. In this article, we reviewed the most developed but failed products and products still in active clinical research in the category of hemoglobin-based oxygen carriers. Among all of the discussed hemoglobin-based oxygen therapeutics, HemAssist, PolyHeme, Hemolink, Hemospan, and Hemoximer were discontinued. Hemopure is in clinical use in South Africa and Russia. Oxyglobin, the sister product of Hemopure, has been approved for veterinary use in the European Union and the United States. HemO2life has recently been approved for organ preservation in organ transplantation in the European Union. OxyVita and Sanguinate are still undergoing active clinical studies. The field of oxygen therapeutics seems to be entering a phase of rapid growth in the coming 10–20 years. Full article
(This article belongs to the Special Issue Updates on Perioperative Anesthetic Management)
11 pages, 1364 KiB  
Article
The Effect of Postinduction Blood Glucose on Intraoperative Hypothermia
by Zhangtian Shen, Kosuke Kuroda and Hiroshi Morimatsu
Medicina 2023, 59(2), 395; https://doi.org/10.3390/medicina59020395 - 17 Feb 2023
Cited by 1 | Viewed by 1470
Abstract
Background and Objectives: Hypothermia frequently occurs in patients undergoing surgery and is associated with adverse complications. Therefore, this study aimed to investigate the postinduction blood glucose and occurrence of intraoperative hypothermia in patients undergoing laparoscopic surgery. Materials and Methods: This retrospective [...] Read more.
Background and Objectives: Hypothermia frequently occurs in patients undergoing surgery and is associated with adverse complications. Therefore, this study aimed to investigate the postinduction blood glucose and occurrence of intraoperative hypothermia in patients undergoing laparoscopic surgery. Materials and Methods: This retrospective observational study included 334 patients aged ≥20 years who had undergone elective laparoscopic surgery. The primary outcome of this study was the incidence of intraoperative hypothermia. Stratified analysis revealed differences between patients with and without diabetes. Results: Hypothermia occurred in 200 (59.9%) patients. In multivariate analysis, out-of-range postinduction glucose was independently associated with hypothermia (>150 mg/dL: odds ratio 2.17, 95% confidence interval (1.02, 4.61), p = 0.045; <110 mg/dL: odds ratio 2.02, 95% confidence interval (1.15, 3.55), p = 0.015), whereas preoperative HbA1c >6% was not significantly associated with hypothermia (odds ratio 1.02, 95% confidence interval (0.56, 1.84), p = 0.961). Considering only patients with diabetes, the incidence of hypothermia was lower (p = 0.002), the duration of hypothermia was shorter (p = 0.007), and the minimum temperature was higher (p = 0.006) in those with a postinduction glucose level of 110–150 mg/dL. Conclusions: The postinduction glucose level is independently associated with intraoperative hypothermia. Out-of-range postinduction glucose appeared to have an impact on the development of hypothermia in patients with diabetes, especially those with a postinduction glucose level <110 mg/dL. Full article
(This article belongs to the Section Intensive Care/ Anesthesiology)
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7 pages, 4165 KiB  
Case Report
Point-of-Care Ultrasonography Helped to Rapidly Detect Pneumomediastinum in a Vomiting Female
by Yun-Hao Chen, Po-Chen Lin, Yu-Long Chen, Giou-Teng Yiang and Meng-Yu Wu
Medicina 2023, 59(2), 394; https://doi.org/10.3390/medicina59020394 - 17 Feb 2023
Cited by 2 | Viewed by 1711
Abstract
Vomiting-induced pneumomediastinum is a rare presentation and can be a result of alveolar rupture (Mackler effect) or Boerhaave syndrome. Patients diagnosed with Boerhaave syndrome may present with the classic Mackler triad of vomiting, chest pain, and subcutaneous emphysema. However, there exists a large [...] Read more.
Vomiting-induced pneumomediastinum is a rare presentation and can be a result of alveolar rupture (Mackler effect) or Boerhaave syndrome. Patients diagnosed with Boerhaave syndrome may present with the classic Mackler triad of vomiting, chest pain, and subcutaneous emphysema. However, there exists a large overlap of symptoms accompanying Boerhaave syndrome and the Macklin effect, including retrosternal chest pain, neck discomfort, cough, sore throat, dysphagia, dysphonia, and dyspnea. Boerhaave syndrome is a dangerous condition. Delayed diagnosis of Boerhaave syndrome may worsen sepsis and cause mortality. Therefore, early diagnosis and timely management are important to prevent further complications. Here, we present a case of vomiting-induced pneumomediastinum, which supports the use of bedside ultrasonography to aid in the diagnosis and rapid differentiation of etiology of pneumomediastinum. Full article
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15 pages, 1387 KiB  
Article
Knowledge Mapping and Research Hotspots of Comorbidities in Psoriasis: A Bibliometric Analysis from 2004 to 2022
by Shan Huang and Yanping Bai
Medicina 2023, 59(2), 393; https://doi.org/10.3390/medicina59020393 - 17 Feb 2023
Cited by 5 | Viewed by 2088
Abstract
Background and Objectives: Psoriasis is a chronic inflammatory disease whose impact on health is not only limited to the skin, but is also associated with multiple comorbidities. Early screening for comorbidities along with appropriate treatment plans can provide a positive prognosis for [...] Read more.
Background and Objectives: Psoriasis is a chronic inflammatory disease whose impact on health is not only limited to the skin, but is also associated with multiple comorbidities. Early screening for comorbidities along with appropriate treatment plans can provide a positive prognosis for patients. This study aimed to summarize the knowledge structure in the field of psoriasis comorbidities and further explore its research hotspots and trends through bibliometrics. Materials and Methods: A search was conducted in the core collection of the Web of Science for literature on comorbidities of psoriasis from 2004 to 2022. VOSviewer and CiteSpace software were used for collaborative network analysis, co-citation analysis of references, and keyword co-occurrence analysis on these publications. Results: A total of 1803 papers written by 6741 authors from 81 countries was included. The publications have shown a progressive increase since 2004. The United States and Europe were at the forefront of this field. The most prolific institution was the University of California, and the most productive author was A. Armstrong. Research has focused on “psoriatic arthritis”, “metabolic syndrome”, “cardiovascular disease”, “psychosomatic disease”, “inflammatory bowel disease”, “prevalence”, “quality of life”, and “risk factor” in the past 18 years. Keywords such as “biologics” and “systemic inflammation”, have been widely used recently, suggesting current research hotspots and trends. Conclusions: Over the past 18 years, tremendous progress has been made in research on psoriasis comorbidity. However, collaborations among countries, institutions, and investigators are inadequate, and the study of the mechanisms of interaction between psoriasis and comorbidities and management of comorbidities is insufficient. The treatment of comorbidities with biologic agents, screening of comorbidities, and multidisciplinary co-management are predicted to be the focus of future research. Full article
(This article belongs to the Section Dermatology)
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14 pages, 2031 KiB  
Systematic Review
Acupuncture for Treating Attention Deficit Hyperactivity Disorder in Children: A Systematic Review and Meta-Analysis
by Lin Ang, Jung Tae Kim, Kibong Kim, Hye Won Lee, Jun-Yong Choi, Eunseop Kim and Myeong Soo Lee
Medicina 2023, 59(2), 392; https://doi.org/10.3390/medicina59020392 - 17 Feb 2023
Cited by 3 | Viewed by 4110
Abstract
Background and Objectives: Attention-deficit hyperactivity disorder (ADHD) is a common childhood disorder characterized by inattention, hyperactivity, and impulsivity. However, it is uncertain whether the use of acupuncture (AT) in children with ADHD is supported by the current evidence. This review aims to [...] Read more.
Background and Objectives: Attention-deficit hyperactivity disorder (ADHD) is a common childhood disorder characterized by inattention, hyperactivity, and impulsivity. However, it is uncertain whether the use of acupuncture (AT) in children with ADHD is supported by the current evidence. This review aims to provide updated evidence of the effectiveness of acupuncture in children with ADHD. Methods: Nine databases were searched from their inception to 28 July 2022. Two authors independently screened potentially eligible studies. The quality assessment of the selected studies was performed using Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). The characteristics of the included studies were presented in a tabular form, and a meta-analysis was performed on the treatment effects of AT on ADHD symptoms. Results: Fourteen studies involving 1185 patients evaluating the efficacy of AT for ADHD treatment were included in this review. Compared to conventional medicine alone, the meta-analysis indicated that AT as an add-on to conventional medicine has a positive effect on improving conduct problems, learning problems, hyperactivity–impulsivity, and hyperactivity symptoms in ADHD patients. Similarly, AT alone was found to improve learning problems, hyperactivity–impulsivity, and hyperactivity symptoms in ADHD patients and exhibited better total treatment efficacy than conventional medicine alone. No major adverse events were reported. The risk of bias of the included studies was generally concerning. Conclusions: Evidence on the effectiveness of AT for ADHD patients is currently too limited to provide recommendations for its usage. More studies with the proper methodology are needed for the validation of AT interventions in treating children with ADHD. Full article
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10 pages, 649 KiB  
Article
The Relationship between Exertional Desaturation and Pulmonary Function, Exercise Capacity, or Medical Costs in Chronic Obstructive Pulmonary Disease Patients
by Meng-Lin Tsai, Chin-Ling Li, Hui-Chuan Chang, Yuh-Chyn Tsai, Ching-Wan Tseng and Shih-Feng Liu
Medicina 2023, 59(2), 391; https://doi.org/10.3390/medicina59020391 - 17 Feb 2023
Viewed by 1554
Abstract
Background and Objectives: Exertional desaturation (ED) is common and is associated with poorer clinical outcomes in chronic obstructive pulmonary disease (COPD). The age, dyspnea, airflow obstruction (ADO) and body mass index, airflow obstruction, dyspnea, and exercise (BODE) indexes are used to predict the [...] Read more.
Background and Objectives: Exertional desaturation (ED) is common and is associated with poorer clinical outcomes in chronic obstructive pulmonary disease (COPD). The age, dyspnea, airflow obstruction (ADO) and body mass index, airflow obstruction, dyspnea, and exercise (BODE) indexes are used to predict the prognosis of COPD patients. This study aimed to investigate the relationship between these indexes, pulmonary function, medical costs, and ED in COPD patients. Materials and Methods: Data were collected from the electronic database of the Kaohsiung Chang Gung Memorial Hospital. This retrospective study included 396 patients categorized as either ED (n = 231) or non-ED (n = 165). Variables (including age, smoking history, body mass index (BMI), pulmonary function test, maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), six minutes walking test distance (6MWD), SpO2, COPD Assessment Test (CAT) score, ADO index, BODE index, Charlson comorbidity index (CCI), and medical costs) were compared between the two groups, and their correlations were assessed. ED was defined as SpO2 less than 90% or SpO2 decrease of more than 4% compared to baseline levels during 6MWT. Results: A significant statistical difference was found regarding a lower score of the ADO index and the BODE index (both p < 0.001), better pulmonary function (forced expiratory volume in the first second (FEV1), p < 0.001; FEV1/ forced vital capacity (FVC), p < 0.001; diffusion capacity of the lung for carbon monoxide (DLCO), p < 0.001), and higher minimal oxygen saturation (p < 0.001) in non-ED COPD patients. No difference was found in the distance of the 6MWT (p = 0.825) and respiratory muscle strength (MIP; MEP, p = 0.86; 0.751). However, the adjusted multivariate logistic regression analysis showed that only SpO2 (minimal) had a significant difference between of the ED and non-ED group (p < 0.001). There was either no difference in the medical expenses between ED and non-ED COPD patients. Conclusions: SpO2 (minimal) during the 6MWT is the independent factor for ED. ED is related to BODE and ADO indices, but is not related to medical expense. Full article
(This article belongs to the Section Pulmonary)
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13 pages, 1370 KiB  
Article
Anterior Screw Insertion Results in Greater Tibial Tunnel Enlargement Rates after Single-Bundle Anterior Cruciate Ligament Reconstruction than Posterior Insertion: A Retrospective Study
by Yangang Kong, Lifeng Yin, Hua Zhang, Wenlong Yan, Jiaxing Chen, Aiguo Zhou and Jian Zhang
Medicina 2023, 59(2), 390; https://doi.org/10.3390/medicina59020390 - 17 Feb 2023
Cited by 2 | Viewed by 1813
Abstract
Background and Objectives: Tunnel enlargement (TE) is a widely reported phenomenon after anterior cruciate ligament reconstruction (ACLR). Given the paucity of knowledge in the literature, it remains unclear whether screw position in the tunnel affects TE. This retrospective cohort study evaluated differences [...] Read more.
Background and Objectives: Tunnel enlargement (TE) is a widely reported phenomenon after anterior cruciate ligament reconstruction (ACLR). Given the paucity of knowledge in the literature, it remains unclear whether screw position in the tunnel affects TE. This retrospective cohort study evaluated differences in postoperative tunnel enlargement rates (TER) and clinical results between anterior and posterior tibial interference screw insertion during single-bundle ACLR using autologous hamstring grafts. Materials and Methods: A group of consecutive patients that underwent primary arthroscopic single-bundle ACLR in our hospital were screened and divided into two groups based on the position of the tibial interference screw (determined by Computer Tomography within 3 days after surgery): anterior screw position group (A) and posterior screw position group (B). The bone tunnel size was measured using magnetic resonance imaging (MRI) performed 1 year after surgery. International Knee Documentation Committee (IKDC) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used for clinical results 1 year postoperatively. Results: 87 patients were included. The TER of Group A is higher than that of Group B (43.17% vs. 33.80%, p = 0.024). Group A showed a significant increase (12.1%) in enlargement rates at the joint line level than group B (43.77% vs. 31.67%, p = 0.004). Moreover, KOOS and IKDC scores improved in both groups. There were no significant differences in clinical outcomes between the two groups. Conclusions: One year after ACLR, patients with posterior screw showed significantly lower TE than patients with anterior screw. However, the position of screw did not lead to differences in clinical results over our follow-up period. Posterior screw position in the tibial tunnel maybe a better choice in terms of reducing TE. Whether the different screw positions affect the long-term TE and long-term clinical outcomes needs to be confirmed by further studies. Full article
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