Journal of Clinical Medicine

11 pages, 263 KiB

Open AccessArticle

The Association between Lifestyle Choices and Schizophrenia Symptoms

by Sylwia Kalinowska, Beata Trześniowska-Drukała, Karolina Kłoda, Krzysztof Safranow, Błażej Misiak, Agnieszka Cyran and Jerzy Samochowiec

J. Clin. Med. 2021, 10(1), 165; https://doi.org/10.3390/jcm10010165 - 05 Jan 2021

Cited by 14 | Viewed by 4786

Abstract

Due to poor eating habits, insufficient physical activity, and nicotine use, schizophrenia patients are at increased risk of lifestyle diseases. Factors contributing to unhealthy behaviors include lower socioeconomic status and level of education as well as social isolation. Schizophrenia manifestations such as amotivation, [...] Read more.

Due to poor eating habits, insufficient physical activity, and nicotine use, schizophrenia patients are at increased risk of lifestyle diseases. Factors contributing to unhealthy behaviors include lower socioeconomic status and level of education as well as social isolation. Schizophrenia manifestations such as amotivation, apathy, and cognitive deficits can further hinder development of proper health habits. The aim of this study was to assess the possible association between lifestyle-related choices and schizophrenia symptoms severity. This observational study enrolled 106 patients with schizophrenia (42 Males/64 Females), 18–69 years (mean: 41.89 ± 9.7 years). Mean duration of schizophrenia was 14.61 ± 9.7 years. Multiple significant correlations were found between patients’ lifestyle and their biochemical laboratory parameters (lipid profile and fasting glucose). Most importantly, a significant link emerged between presented habits and schizophrenia symptom severity. There were also significant gender differences in the intake of sweets and sweet beverages. Quite unexpectedly, a behavioral shift towards more healthy lifestyle choices was observed after completion of questionnaires on lifestyle and health habits. There are clear benefits to systematic provision of educational interventions concerning physical activity and proper eating habits to schizophrenia patients. These simple preventive measures could significantly improve both mental and physical health outcomes in schizophrenia patient populations. Full article

(This article belongs to the Special Issue Hot Topics in Schizophrenia Research - Part I)

19 pages, 430 KiB

Open AccessReview

Infectious Complications in Autoimmune Hemolytic Anemia

by Juri Alessandro Giannotta, Bruno Fattizzo, Francesca Cavallaro and Wilma Barcellini

J. Clin. Med. 2021, 10(1), 164; https://doi.org/10.3390/jcm10010164 - 05 Jan 2021

Cited by 17 | Viewed by 6990

Abstract

Autoimmune hemolytic anemia (AIHA) may be frequently challenged by infectious complications, mainly as a result of immunosuppressive treatments administered. Furthermore, infectious agents are known triggers of AIHA onset and relapse. Although being risk factors for mortality, infections are an underestimated issue in AIHA. [...] Read more.

Autoimmune hemolytic anemia (AIHA) may be frequently challenged by infectious complications, mainly as a result of immunosuppressive treatments administered. Furthermore, infectious agents are known triggers of AIHA onset and relapse. Although being risk factors for mortality, infections are an underestimated issue in AIHA. This review will collect the available evidence on the frequency and type of infectious complications in AIHA, detailing the risk related to each treatment (i.e., steroids, rituximab, splenectomy, classic immunosuppressive agents, and new target drugs). Moreover, we will briefly discuss the infectious complications in AIHA secondary to other diseases that harbor an intrinsic infectious risk (e.g., primary immunodeficiencies, systemic autoimmune diseases, lymphoproliferative disorders, solid organ and hematopoietic stem cell transplants). Finally, viral and bacterial reactivations during immune suppressive therapies will be discussed, along with suggested screening and prophylactic strategies. Full article

(This article belongs to the Special Issue Diagnosis and Management of Autoimmune Hemolytic Anemias)

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15 pages, 2805 KiB

Open AccessArticle

Video Feedback and Video Modeling in Teaching Laparoscopic Surgery: A Visionary Concept from Kiel

by Ibrahim Alkatout, Juhi Dhanawat, Johannes Ackermann, Damaris Freytag, Göntje Peters, Nicolai Maass, Liselotte Mettler and Julian Maria Pape

J. Clin. Med. 2021, 10(1), 163; https://doi.org/10.3390/jcm10010163 - 05 Jan 2021

Cited by 8 | Viewed by 3204

Abstract

Learning curves for endoscopic surgery are long and flat. Various techniques and methods are now available for surgical endoscopic training, such as pelvitrainers, virtual trainers, and body donor surgery. Video modeling and video feedback are commonly used in professional training. We report, for [...] Read more.

Learning curves for endoscopic surgery are long and flat. Various techniques and methods are now available for surgical endoscopic training, such as pelvitrainers, virtual trainers, and body donor surgery. Video modeling and video feedback are commonly used in professional training. We report, for the first time, the application of video modeling and video feedback for endoscopic training in gynecology. The purpose is to present an innovative method of training. Attendees (residents and specialists) of minimally invasive surgery courses were asked to perform specific tasks, which were video recorded in a multimodular concept. Feedback was given later by an expert at a joint meeting. The attendees were asked to fill a questionnaire in order to assess video feedback given by the expert. The advantages of video feedback and video modeling for the development of surgical skills were given a high rating (median 84%, interquartile ranges (IQR) 72.5–97.5%, n = 37). The question as to whether the attendees would recommend such training was also answered very positively (median 100%, IQR 89.5–100%, n = 37). We noted a clear difference between subjective perception and objective feedback (58%, IQR 40.5–76%, n = 37). Video feedback and video modeling are easy to implement in surgical training setups, and help trainees at all levels of education. Full article

(This article belongs to the Special Issue Recent Advances in Minimally Invasive Surgery)

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9 pages, 408 KiB

Open AccessArticle

Female Sex and Outcomes after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Propensity Score Matched Cohort Analysis

by Christian-Alexander Behrendt, Thea Kreutzburg, Jenny Kuchenbecker, Giuseppe Panuccio, Mark Dankhoff, Konstantinos Spanos, George Kouvelos, Sebastian Debus, Frederik Peters and Tilo Kölbel

J. Clin. Med. 2021, 10(1), 162; https://doi.org/10.3390/jcm10010162 - 05 Jan 2021

Cited by 20 | Viewed by 3103

Abstract

Objective: Previous studies have showed a potential disadvantage of female patients who underwent abdominal aortic aneurysm (AAA) repair. The current study aims to determine sex-specific perioperative and long-term outcomes using propensity score matched unselected nationwide health insurance claims data. Methods: Insurance claims from [...] Read more.

Objective: Previous studies have showed a potential disadvantage of female patients who underwent abdominal aortic aneurysm (AAA) repair. The current study aims to determine sex-specific perioperative and long-term outcomes using propensity score matched unselected nationwide health insurance claims data. Methods: Insurance claims from a large German fund were used, covering around 8% of the insured German population. Patients who underwent endovascular aortic repair (EVAR) for intact AAA from 1 January 2011 to 30 April 2017 were included in the cohort. A 1:2 female to male propensity score matching was applied to adjust for confounding variables. Perioperative and long-term outcomes after 5 years were determined using matching and regression methods. Results: Among a total of 3736 patients (19.3% females, mean 75 years) undergoing EVAR for intact AAA, we identified 1863 matched patients. Before matching, females were more likely to be previously diagnosed with hypothyroidism, electrolyte disorders, rheumatoid disorders, and depression, while males were more often diabetics. In the matched sample, 23.4% of the females and 25.8% of the males died during a median follow-up of 776 and 792 days, respectively. Perioperatively, females were more likely to exhibit acute limb ischemia (5.3% vs. 3.2%, p = 0.031) and major bleeding (22.0% vs. 15.9%, p = 0.001) before they were discharged to rehabilitation (5.5% vs. 1.5%, p < 0.001) when compared to males. No statistically significant difference in perioperative (odds ratio 1.12, 95% CI 0.54–2.16) or long-term mortality (hazard ratio 0.91, 95% CI 0.76–1.08) was observed between sexes. This was also true regarding aortic reintervention rates after 1 year (2.0% vs. 2.9%) and 5 years (10.9% vs. 8.1%). Conclusion: The current retrospective matched analysis of insurance claims revealed high early access-related morbidity in females when compared to their male counterparts. Short-term or long-term survival and reintervention outcomes were similar between sexes. Full article

(This article belongs to the Section Vascular Medicine)

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17 pages, 792 KiB

Open AccessArticle

Predictive Value of Subacute Heart Rate Variability for Determining Outcome Following Adolescent Concussion

by Colt A. Coffman, Jacob J. M. Kay, Kat M. Saba, Adam T. Harrison, Jeffrey P. Holloway, Michael F. LaFountaine and Robert Davis Moore

J. Clin. Med. 2021, 10(1), 161; https://doi.org/10.3390/jcm10010161 - 05 Jan 2021

Cited by 5 | Viewed by 2741

Abstract

Objective assessments of concussion recovery are crucial for facilitating effective clinical management. However, predictive tools for determining adolescent concussion outcomes are currently limited. Research suggests that heart rate variability (HRV) represents an indirect and objective marker of central and peripheral nervous system integration. [...] Read more.

Objective assessments of concussion recovery are crucial for facilitating effective clinical management. However, predictive tools for determining adolescent concussion outcomes are currently limited. Research suggests that heart rate variability (HRV) represents an indirect and objective marker of central and peripheral nervous system integration. Therefore, it may effectively identify underlying deficits and reliably predict the symptomology following concussion. Thus, the present study sought to evaluate the relationship between HRV and adolescent concussion outcomes. Furthermore, we sought to examine its predictive value for assessing outcomes. Fifty-five concussed adolescents (12–17 years old) recruited from a local sports medicine clinic were assessed during the initial subacute evaluation (within 15 days postinjury) and instructed to follow up for a post-acute evaluation. Self-reported clinical and depressive symptoms, neurobehavioral function, and cognitive performance were collected at each timepoint. Short-term HRV metrics via photoplethysmography were obtained under resting conditions and physiological stress. Regression analyses demonstrated significant associations between HRV metrics, clinical symptoms, neurobehavioral function, and cognitive performance at the subacute evaluation. Importantly, the analyses illustrated that subacute HRV metrics significantly predicted diminished post-acute neurobehavioral function and cognitive performance. These findings indicate that subacute HRV metrics may serve as a viable predictive biomarker for identifying underlying neurological dysfunction following concussion and predict late cognitive outcomes. Full article

(This article belongs to the Special Issue Children Behavior and Psychophysiology)

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10 pages, 4100 KiB

Open AccessArticle

Three-Dimensional Quantification of Bone Mineral Density in the Distal Femur and Proximal Tibia Based on Computed Tomography: In Vitro Evaluation of an Extended Standardization Method

by Hugo Babel, Patrick Omoumi, Killian Cosendey, Hugues Cadas, Brigitte M. Jolles and Julien Favre

J. Clin. Med. 2021, 10(1), 160; https://doi.org/10.3390/jcm10010160 - 05 Jan 2021

Cited by 3 | Viewed by 2193

Abstract

While alterations in bone mineral density (BMD) are of interest in a number of musculoskeletal conditions affecting the knee, their analysis is limited by a lack of tools able to take full advantage of modern imaging modalities. This study introduced a new method, [...] Read more.

While alterations in bone mineral density (BMD) are of interest in a number of musculoskeletal conditions affecting the knee, their analysis is limited by a lack of tools able to take full advantage of modern imaging modalities. This study introduced a new method, combining computed tomography (CT) and computational anatomy algorithms, to produce standardized three-dimensional BMD quantification in the distal femur and proximal tibia. The method was evaluated on ten cadaveric knees CT-scanned twice and processed following three different experimental settings to assess the influence of different scans and operators. The median reliability (intraclass correlation coefficient (ICC)) ranged from 0.96 to 0.99 and the median reproducibility (precision error (RMSSD)) ranged from 3.97 to 10.75 mg/cc for the different experimental settings. In conclusion, this paper presented a method to standardize three-dimensional knee BMD with excellent reliability and adequate reproducibility to be used in research and clinical applications. The perspectives offered by this novel method are further reinforced by the fact it relies on conventional CT scan of the knee. The standardization method introduced in this work is not limited to BMD and could be adapted to quantify other bone parameters in three dimension based on CT images or images acquired using different modalities. Full article

(This article belongs to the Section Orthopedics)

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10 pages, 2330 KiB

Open AccessArticle

Interaction between Pain, Disability, Mechanosensitivity and Cranio-Cervical Angle in Subjects with Cervicogenic Headache: A Cross-Sectional Study

by Patricia Martínez-Merinero, Fernando Aneiros Tarancón, Javier Montañez-Aguilera, Susana Nuñez-Nagy, Daniel Pecos-Martín, Rubén Fernández-Matías, Alexander Achalandabaso-Ochoa, Samuel Fernández-Carnero and Tomás Gallego-Izquierdo

J. Clin. Med. 2021, 10(1), 159; https://doi.org/10.3390/jcm10010159 - 05 Jan 2021

Cited by 4 | Viewed by 4074

Abstract

The relationship between the forward head posture and mechanosensitivity in subjects with a cervicogenic headache (CGH) remains uncertain. The aim of the study was to evaluate if there was a relationship between the tissue mechanosensitivity and cranio-cervical angle (CCA) that was moderated by [...] Read more.

The relationship between the forward head posture and mechanosensitivity in subjects with a cervicogenic headache (CGH) remains uncertain. The aim of the study was to evaluate if there was a relationship between the tissue mechanosensitivity and cranio-cervical angle (CCA) that was moderated by pain intensity and/or disability in subjects with CGH. A convenience sample of 102 subjects was recruited. The CCA was measured with photographs, using a postural assessment software. The pain intensity was measured with a visual analogue scale (VAS), and the disability was measured with the Northwick Park Questionnaire. The pressure pain threshold (PPT) was measured at the spinous process of C2, the upper trapezius and splenius capitis muscles, and the median nerve. Simple moderation multiple regression analyses were constructed. There was a positive relationship between PPT at C2 and CCA, but a nonsignificant relationship for the PPT measured at the muscles and median nerve. The effect of PPT at C2 over CCA was moderated by pain intensity (R² = 0.17; R² change = 0.06; p < 0.05) but not disability. The Johnson–Neyman analysis revealed a cut-off point for the statistical significance of 4.66 cm in VAS. There seems to be a positive relationship between PPT at C2 and CCA, which is positively moderated by pain intensity in subjects with CGH. Full article

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

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10 pages, 639 KiB

Open AccessArticle

Dynamic Changes of Generic Quality of Life after Different Treatments for Localized Prostate Cancer

by Yao-Lin Kao, Chien-Hui Ou, Sheng-Hsiang Lin, Sheng-Mao Chang, Jung-Der Wang and Yuh-Shyan Tsai

J. Clin. Med. 2021, 10(1), 158; https://doi.org/10.3390/jcm10010158 - 05 Jan 2021

Cited by 5 | Viewed by 2104

Abstract

Generic quality of life (QoL) is an important issue in decision making related to the primary treatment of localized prostate cancer (PC). This study assessed the dynamic changes of QoL in patients with localized PC under different treatment modalities. From 2013 to 2018, [...] Read more.

Generic quality of life (QoL) is an important issue in decision making related to the primary treatment of localized prostate cancer (PC). This study assessed the dynamic changes of QoL in patients with localized PC under different treatment modalities. From 2013 to 2018, we prospectively assessed QoL scores in patients with localized PC under unitary treatment using the World Health Organization Quality of Life (WHOQOL) BREF version. The trajectories of the QoL scores after different treatments were estimated using a kernel-smoothing method. Dynamic changes in the major determinants were analyzed using a mixed effects model. The clinical features of the participants in our institute were compared with PC patients in Taiwan’s cancer registry. A total of 196 patients were enrolled with 491 repeated assessments. The participants shared similar clinical characteristics with the PC patients in Taiwan as a whole. Patients with lower household incomes showed statistically significant lower scores on all four domains and related facets, while PC survivors with comorbidities of anxiety and/or diabetes appeared to be affected on the physical domain and related facets. After controlling for these determinants, patients under active surveillance or observation demonstrated significantly higher QoL scores in the physical and social domains, as well as several facets belonging to these domains, in mixed models compared with patients undergoing radical prostatectomy or radiotherapy within the first year. The generic QoL scores were higher within the first year in patients receiving active surveillance or observation after controlling other significant factors. The difference diminished after one year of post management. More studies are needed to corroborate our findings. Full article

(This article belongs to the Section Oncology)

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14 pages, 1372 KiB

Open AccessArticle

by Marit V. Forslund, Paul B. Perrin, Solrun Sigurdardottir, Emilie I. Howe, Marleen R. van Walsem, Juan Carlos Arango-Lasprilla, Juan Lu, Alba Aza, Tone Jerstad, Cecilie Røe and Nada Andelic

J. Clin. Med. 2021, 10(1), 157; https://doi.org/10.3390/jcm10010157 - 05 Jan 2021

Cited by 11 | Viewed by 2563

Abstract

Traumatic brain injury (TBI) has a long-lasting impact on participation and health-related quality of life (HRQL). We aimed to describe the physical and mental health trajectories and to identify their predictors across the first 10 years after TBI. A prospective longitudinal cohort of [...] Read more.

Traumatic brain injury (TBI) has a long-lasting impact on participation and health-related quality of life (HRQL). We aimed to describe the physical and mental health trajectories and to identify their predictors across the first 10 years after TBI. A prospective longitudinal cohort of 97 individuals with moderate to severe TBI (age 16–55 years) in Norway were followed up at 1, 2, 5, and 10 years post-injury. Their socio-demographic and injury characteristics were recorded at baseline; their responses to the 36-Item Short Form Health Survey (SF-36) were collected at each follow-up. The Physical (PCS) and Mental Component Summary (MCS) scores were used as the outcome measures of physical and mental health. The predictors of the trajectories were described and examined using hierarchical linear modelling. The subscale scores showed a stable or increasing trend, but only the Role Physical and Role Emotional subscales showed clinically relevant positive changes from 1 to 10 years post-injury. Longer time, male gender, employment pre-injury, and shorter length of post-traumatic amnesia were significant predictors of better physical health trajectories; longer time, male gender, and employment pre-injury were significant predictors of better mental health trajectories. At-risk individuals may be targeted to receive rehabilitation interventions to improve their long-term quality of life outcomes. Full article

(This article belongs to the Special Issue Traumatic Brain Injury: Recent Developments and Emerging Trends)

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19 pages, 927 KiB

Open AccessReview

SARS-CoV-2 Infection and Oral Health: Therapeutic Opportunities and Challenges

by Christopher J. Coke, Brandon Davison, Niariah Fields, Jared Fletcher, Joseph Rollings, Leilani Roberson, Kishore B. Challagundla, Chethan Sampath, James Cade, Cherae Farmer-Dixon and Pandu R. Gangula

J. Clin. Med. 2021, 10(1), 156; https://doi.org/10.3390/jcm10010156 - 05 Jan 2021

Cited by 25 | Viewed by 8110

Abstract

The novel corona virus, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), and the disease it causes, COVID-19 (Coronavirus Disease-2019) have had multi-faceted effects on a number of lives on a global scale both directly and indirectly. A growing body of evidence suggest that COVID-19 [...] Read more.

The novel corona virus, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), and the disease it causes, COVID-19 (Coronavirus Disease-2019) have had multi-faceted effects on a number of lives on a global scale both directly and indirectly. A growing body of evidence suggest that COVID-19 patients experience several oral health problems such as dry mouth, mucosal blistering, mouth rash, lip necrosis, and loss of taste and smell. Periodontal disease (PD), a severe inflammatory gum disease, may worsen the symptoms associated with COVID-19. Routine dental and periodontal treatment may help decrease the symptoms of COVID-19. PD is more prevalent among patients experiencing metabolic diseases such as obesity, diabetes mellitus and cardiovascular risk. Studies have shown that these patients are highly susceptible for SARS-CoV-2 infection. Pro-inflammatory cytokines and oxidative stress known to contribute to the development of PD and other metabolic diseases are highly elevated among COVID-19 patients. Periodontal health may help to determine the severity of COVID-19 infection. Accumulating evidence shows that African-Americans (AAs) and vulnerable populations are disproportionately susceptible to PD, metabolic diseases and COVID-19 compared to other ethnicities in the United States. Dentistry and dental healthcare professionals are particularly susceptible to this virus due to the transferability via the oral cavity and the use of aerosol creating instruments that are ubiquitous in this field. In this review, we attempt to provide a comprehensive and updated source of information about SARS-CoV-2/COVID-19 and the various effects it has had on the dental profession and patients visits to dental clinics. Finally, this review is a valuable resource for the management of oral hygiene and reduction of the severity of infection. Full article

(This article belongs to the Collection Impact of COVID-19 on the Dental Community)

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9 pages, 255 KiB

Open AccessArticle

The Association between Body Composition Measurements and Surgical Complications after Living Kidney Donation

by Lisa B. Westenberg, Marco van Londen, Camilo G. Sotomayor, Cyril Moers, Robert C. Minnee, Stephan J. L. Bakker and Robert A. Pol

J. Clin. Med. 2021, 10(1), 155; https://doi.org/10.3390/jcm10010155 - 05 Jan 2021

Cited by 6 | Viewed by 2122

Abstract

Obesity is considered a risk factor for peri- and postoperative complications. Little is known about this risk in overweight living kidney donors. The aim of this study was to assess if anthropometric body measures and/or surgical determinants are associated with an increased incidence [...] Read more.

Obesity is considered a risk factor for peri- and postoperative complications. Little is known about this risk in overweight living kidney donors. The aim of this study was to assess if anthropometric body measures and/or surgical determinants are associated with an increased incidence of peri- and postoperative complications after nephrectomy. We included 776 living kidney donors who donated between 2008 and 2018 at the University Medical Center Groningen. Prenephrectomy measures of body composition were body mass index (BMI), body surface area (BSA), waist circumference, weight, and waist–hip ratio. Incidence and severity of peri- and postoperative complications were assessed using the Comprehensive Complication Index. Mean donor age was 53 ± 11 years; 382 (49%) were male, and mean BMI at donor screening was 26.2 ± 3.41 kg/m². In total, 77 donors (10%) experienced peri- and postoperative complications following donor nephrectomy. Male sex was significantly associated with fewer surgical complications (OR 0.59, 0.37–0.96 95%CI, p = 0.03) in binomial logistic regression analyses. Older age (OR: 1.03, 1.01–1.05 95%CI, p = 0.02) and a longer duration of surgery (OR: 1.01, 1.00–1.01 95%CI, p = 0.02) were significantly associated with more surgical complications in binomial logistic regression analyses. Multinomial logistic regression analyses did not identify any prenephrectomy measure of body composition associated with a higher risk of surgical complications. This study shows that higher prenephrectomy BMI and other anthropometric measures of body composition are not significantly associated with peri- and postoperative complications following living donor nephrectomy. Full article

(This article belongs to the Special Issue Progress and Recent Advances in Solid Organ Transplantation)

10 pages, 2163 KiB

Open AccessReview

The Role of Speckle Strain Echocardiography in the Diagnosis of Early Subclinical Cardiac Injury in Cancer Patients—Is There More Than Just Left Ventricle Global Longitudinal Strain?

by Michal Laufer-Perl, Dan Gilon, Livia Kapusta and Zaza Iakobishvili

J. Clin. Med. 2021, 10(1), 154; https://doi.org/10.3390/jcm10010154 - 05 Jan 2021

Cited by 9 | Viewed by 3240

Abstract

With the improvement in survival rate, cardiotoxicity has emerged as a significant adverse effect of cancer therapy. Early diagnosis of subclinical cardiac injury may allow the initiation of cardioprotective therapy and preventing the interruption of optimal cancer therapy and the development of irreversible [...] Read more.

With the improvement in survival rate, cardiotoxicity has emerged as a significant adverse effect of cancer therapy. Early diagnosis of subclinical cardiac injury may allow the initiation of cardioprotective therapy and preventing the interruption of optimal cancer therapy and the development of irreversible cardiac dysfunction. In this article, we review the role of two-dimensional speckle tracking echocardiography (2D-STE), beyond the common left ventricle global longitudinal strain in the diagnosis of early subclinical cardiac injury in patients treated with cancer therapies. Full article

(This article belongs to the Special Issue Early Diagnosis, Monitoring, Prevention and Treatment of Cardiotoxicity)

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8 pages, 743 KiB

Open AccessArticle

Risk of Cancer Following the Use of N-Nitrosodimethylamine (NDMA) Contaminated Ranitidine Products: A Nationwide Cohort Study in South Korea

by Hong Jin Yoon, Jie-Hyun Kim, Gi Hyeon Seo and Hyojin Park

J. Clin. Med. 2021, 10(1), 153; https://doi.org/10.3390/jcm10010153 - 05 Jan 2021

Cited by 23 | Viewed by 6173

Abstract

N-nitrosodimethylamine (NDMA), a known carcinogenic agent, was recently detected in some products of ranitidine. Several studies have investigated the detectability of NDMA, in drugs and their risks. However, only a few epidemiological studies have evaluated cancer risk from the use of such individual [...] Read more.

N-nitrosodimethylamine (NDMA), a known carcinogenic agent, was recently detected in some products of ranitidine. Several studies have investigated the detectability of NDMA, in drugs and their risks. However, only a few epidemiological studies have evaluated cancer risk from the use of such individual drugs. This study investigates the risk of cancer in ranitidine users. We conducted an observational population-based cohort study using the Health Insurance Review and Assessment databases, which contain information about the use of medicines in South Korea. The primary study cohort consisted of ranitidine users (n = 88,416). For controls, we enrolled users of famotidine, another H₂-receptor antagonist in which no NDMA has been detected. A 4:1 matched cohort was constructed to compare cancer outcomes of the two groups. Our matched cohort comprised of 40,488 ranitidine users and 10,122 famotidine users. There was no statistical difference in the overall cancer risk between the ranitidine and famotidine groups (7.45% vs. 7.56%, HR 0.99, 95% CI 0.91–1.07, p = 0.716). Additionally, no significant differences were observed in the analysis of 11 single cancer outcomes. We found no evidence that exposure to NDMA through ranitidine increases the risk of cancer. Full article

(This article belongs to the Section Pharmacology)

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28 pages, 1843 KiB

Open AccessReview

Denosumab Discontinuation and the Rebound Phenomenon: A Narrative Review

by Athanasios D. Anastasilakis, Polyzois Makras, Maria P. Yavropoulou, Gaia Tabacco, Anda Mihaela Naciu and Andrea Palermo

J. Clin. Med. 2021, 10(1), 152; https://doi.org/10.3390/jcm10010152 - 04 Jan 2021

Cited by 85 | Viewed by 9480

Abstract

Denosumab is a potent antiresorptive agent that substantially increases bone mineral density and reduces fracture rates at all skeletal sites for as long as it is administered. However, its favorable skeletal effects reverse quickly upon its discontinuation, because of a vast increase of [...] Read more.

Denosumab is a potent antiresorptive agent that substantially increases bone mineral density and reduces fracture rates at all skeletal sites for as long as it is administered. However, its favorable skeletal effects reverse quickly upon its discontinuation, because of a vast increase of osteoclast number and activity, which leads to a subsequent profound increase of bone turnover above pre-treatment values, a phenomenon commonly described as “rebound phenomenon”. More importantly, most patients experience rapid, profound bone loss due to this burst of bone resorption that may lead in a minority of these patients to occurrence of fractures, especially multiple vertebral fractures. Therefore, subsequent antiresorptive treatment is mandatory, although the optimal regimen is yet to be clarified. In the present review, we outline what is currently known regarding the negative effects of denosumab discontinuation on different aspects of bone status, the factors that may affect them, and strategies to prevent them. Full article

(This article belongs to the Special Issue Osteoporosis Treatment: Recent Developments and Ongoing Challenges)

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13 pages, 2907 KiB

Open AccessArticle

Changes in Visual Function and Correlations with Inner Retinal Structure in Acute and Chronic Leber’s Hereditary Optic Neuropathy Patients after Treatment with Idebenone

by Berthold Pemp, Christoph Mitsch, Karl Kircher and Andreas Reitner

J. Clin. Med. 2021, 10(1), 151; https://doi.org/10.3390/jcm10010151 - 04 Jan 2021

Cited by 20 | Viewed by 3065

Abstract

Progressive impairment and degeneration of retinal ganglion cells (RGC) and nerve fibers in Leber’s hereditary optic neuropathy (LHON) usually cause permanent visual loss. Idebenone is currently the only approved treatment. However, its therapeutic potential in different stages of LHON has not been definitely [...] Read more.

Progressive impairment and degeneration of retinal ganglion cells (RGC) and nerve fibers in Leber’s hereditary optic neuropathy (LHON) usually cause permanent visual loss. Idebenone is currently the only approved treatment. However, its therapeutic potential in different stages of LHON has not been definitely clarified. We aimed to investigate the changes in visual function and correlations with retinal structure in acute and in chronic LHON patients after treatment with idebenone. Twenty-three genetically confirmed LHON patients were followed during treatment using logMAR charts, automated perimetry and optical coherence tomography (OCT). Mean visual acuity improved significantly in acute patients treated within 1 year from onset (−0.52 ± 0.46 logMAR from nadir), in early chronic patients who started after 1–5 years (−0.39 ± 0.27 logMAR from baseline), and in late chronic patients with treatment initiation after >5 years (−0.33 ± 0.28 logMAR from baseline, p < 0.001 all groups). In acute and in chronic patients, strong correlations between OCT and visual function parameters were present only after treatment. This and the sustained visual recovery after treatment may indicate a reactivated signal transduction in dysfunctional RGC that survive the acute phase. Our results support previous evidence that idebenone has therapeutic potential in promoting visual recovery in LHON. Full article

(This article belongs to the Special Issue Leber Hereditary Optic Neuropathy: Treatment Frontier)

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11 pages, 609 KiB

Open AccessArticle

Predictors of Short Latency Period Exceeding 48 h after Preterm Premature Rupture of Membranes

by Marion Rouzaire, Marion Corvaisier, Virginie Roumeau, Aurélien Mulliez, Feras Sendy, Amélie Delabaere and Denis Gallot

J. Clin. Med. 2021, 10(1), 150; https://doi.org/10.3390/jcm10010150 - 04 Jan 2021

Cited by 5 | Viewed by 3028

Abstract

Background: Preterm premature rupture of membranes (PPROM) is a complication responsible for a third of preterm births. Clinical management is initially hospital based, but homecare management is possible if patients are clinically stable 48 h after PPROM. This study set out to determine [...] Read more.

Background: Preterm premature rupture of membranes (PPROM) is a complication responsible for a third of preterm births. Clinical management is initially hospital based, but homecare management is possible if patients are clinically stable 48 h after PPROM. This study set out to determine factors that are predictive of short latency (delivery ≤ 7 days) exceeding 48 h after PPROM, enabling estimation of the prevalence of maternal and neonatal complications and comparison of maternal and fetal outcomes between inpatient and outpatient management. Method: This was a monocentric retrospective study conducted between 1 January 2010 and 28 February 2017 on all patients experiencing PPROM at 24 to 34 weeks + 6 days and who gave birth after 48 h. Maternal, obstetric, fetal, and neonatal variables were included in the data collected. The primary endpoint was latency, defined as the number of days between rupture of membranes and delivery. Results: 170 consecutive patients were analyzed. Short latency could be predicted by the need for tocolysis, a cervical length less than 25 mm at admission and the existence of anamnios. Outpatient follow-up was not found to lead to increased maternal morbidity or neonatal mortality. Conclusion: Our study highlights predictive factors of short latency exceeding 48 h after PPROM. Knowledge of these factors may provide justification for outpatient monitoring of patients presenting with a long cervix, absence of need for tocolysis and persistence of amniotic fluid and, thus, no risk factors after 48 h of admission. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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13 pages, 1809 KiB

Open AccessReview

Molecular Subtyping and Precision Medicine for Pancreatic Cancer

by Fieke E. M. Froeling, Raffaella Casolino, Antonio Pea, Andrew V. Biankin, David K. Chang and on behalf of Precision-Panc

J. Clin. Med. 2021, 10(1), 149; https://doi.org/10.3390/jcm10010149 - 04 Jan 2021

Cited by 27 | Viewed by 4808

Abstract

Substantial progress in recent years has dramatically increased our knowledge of the molecular basis of cancer, revealing new potential therapeutic targets and paving the way for effective personalised medicine for the treatment of many tumour types. However, pancreatic cancer has been lagging behind [...] Read more.

Substantial progress in recent years has dramatically increased our knowledge of the molecular basis of cancer, revealing new potential therapeutic targets and paving the way for effective personalised medicine for the treatment of many tumour types. However, pancreatic cancer has been lagging behind in this success and continues to be one of the most lethal solid malignancies. Its molecular heterogeneity and the unselected design of the majority of clinical trials to date can in part explain the reason for our failure to make a significant change in the survival outcomes for patients with pancreatic cancer. A changing paradigm in drug development is required to validate the new molecular taxonomy and to rapidly translate preclinical discovery into clinical trials. Here, we review the molecular subtyping of pancreatic cancer, the challenges in identifying effective treatment regimens according to defined low-prevalence molecular subgroups and we illustrate a new model of translational therapeutic development that was established in the U.K. (Precision-Panc) as a potentially effective solution to improve outcomes for patients with pancreatic cancer. Full article

(This article belongs to the Special Issue Current Standards and New Innovative Approaches for Treatment of Pancreatic Cancer)

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12 pages, 243 KiB

Open AccessReview

Assessing the Severity of Traumatic Brain Injury—Time for a Change?

by Olli Tenovuo, Ramon Diaz-Arrastia, Lee E. Goldstein, David J. Sharp, Joukje van der Naalt and Nathan D. Zasler

J. Clin. Med. 2021, 10(1), 148; https://doi.org/10.3390/jcm10010148 - 04 Jan 2021

Cited by 49 | Viewed by 8890

Abstract

Traumatic brain injury (TBI) has been described to be man’s most complex disease, in man’s most complex organ. Despite this vast complexity, variability, and individuality, we still classify the severity of TBI based on non-specific, often unreliable, and pathophysiologically poorly understood measures. Current [...] Read more.

Traumatic brain injury (TBI) has been described to be man’s most complex disease, in man’s most complex organ. Despite this vast complexity, variability, and individuality, we still classify the severity of TBI based on non-specific, often unreliable, and pathophysiologically poorly understood measures. Current classifications are primarily based on clinical evaluations, which are non-specific and poorly predictive of long-term disability. Brain imaging results have also been used, yet there are multiple ways of doing brain imaging, at different timepoints in this very dynamic injury. Severity itself is a vague concept. All prediction models based on combining variables that can be assessed during the acute phase have reached only modest predictive values for later outcome. Yet, these early labels of severity often determine how the patient is treated by the healthcare system at large. This opinion paper examines the problems and provides caveats regarding the use of current severity labels and the many practical and scientific issues that arise from doing so. The objective of this paper is to show the causes and consequences of current practice and propose a new approach based on risk classification. A new approach based on multimodal quantifiable data (including imaging and biomarkers) and risk-labels would be of benefit both for the patients and for TBI clinical research and should be a priority for international efforts in the field. Full article

(This article belongs to the Special Issue Traumatic Brain Injury: Recent Developments and Emerging Trends)

27 pages, 964 KiB

Open AccessReview

Effects of Exogenous Androgens on Platelet Activity and Their Thrombogenic Potential in Supraphysiological Administration: A Literature Review

by Adrian Eugen Roşca, Ana-Maria Vlădăreanu, Alina Mititelu, Bogdan Ovidiu Popescu, Corin Badiu, Constantin Căruntu, Suzana Elena Voiculescu, Minodora Onisâi, Şerban Gologan, Radu Mirica and Leon Zăgrean

J. Clin. Med. 2021, 10(1), 147; https://doi.org/10.3390/jcm10010147 - 04 Jan 2021

Cited by 15 | Viewed by 3659

Abstract

Anabolic androgenic steroids (AAS), simply called “androgens”, represent the most widespread drugs used to enhance performance and appearance in a sporting environment. High-dosage and/or long-term AAS administration has been associated frequently with significant alterations in the cardiovascular system, some of these with severe [...] Read more.

Anabolic androgenic steroids (AAS), simply called “androgens”, represent the most widespread drugs used to enhance performance and appearance in a sporting environment. High-dosage and/or long-term AAS administration has been associated frequently with significant alterations in the cardiovascular system, some of these with severe endpoints. The induction of a prothrombotic state is probably the most life-threatening consequence, suggested by numerous case reports in AAS-abusing athletes, and by a considerable number of human and animal studies assessing the influence of exogenous androgens on hemostasis. Despite over fifty years of research, data regarding the thrombogenic potential of exogenous androgens are still scarce. The main reason is the limited possibility of conducting human prospective studies. However, human observational studies conducted in athletes or patients, in vitro human studies, and animal experiments have pointed out that androgens in supraphysiological doses induce enhanced platelet activity and thrombopoiesis, leading to increased platelet aggregation. If this tendency overlaps previously existing coagulation and/or fibrinolysis dysfunctions, it may lead to a thrombotic diathesis, which could explain the multitude of thromboembolic events reported in the AAS-abusing population. The influence of androgen excess on the platelet activity and fluid–coagulant balance remains a subject of debate, urging for supplementary studies in order to clarify the effects on hemostasis, and to provide new compelling evidence for their claimed thrombogenic potential. Full article

(This article belongs to the Special Issue New Approaches in Fundamental and Clinical Biochemistry)

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13 pages, 10402 KiB

Open AccessArticle

Transcutaneous Electrical Acupoint Stimulation Reduces Postoperative Analgesic Requirement in Patients Undergoing Inguinal Hernia Repair: A Randomized, Placebo-Controlled Study

by Mateusz Szmit, Siddarth Agrawal, Waldemar Goździk, Andrzej Kübler, Anil Agrawal, Piotr Pruchnicki, Marta Woźniak, Matylda Nowak, Bartłomiej Bartoszewicz and Jerzy Rudnicki

J. Clin. Med. 2021, 10(1), 146; https://doi.org/10.3390/jcm10010146 - 04 Jan 2021

Cited by 22 | Viewed by 3335

Abstract

Given the rising rate of opioid-related adverse drug events during postsurgical pain management, a nonpharmacologic therapy that could decrease analgesic medication requirements would be of immense value. We designed a prospective, placebo-and-randomized controlled trial to assess the clinical effect of transcutaneous acupoint electrical [...] Read more.

Given the rising rate of opioid-related adverse drug events during postsurgical pain management, a nonpharmacologic therapy that could decrease analgesic medication requirements would be of immense value. We designed a prospective, placebo-and-randomized controlled trial to assess the clinical effect of transcutaneous acupoint electrical stimulation (TEAS) on the postoperative patient-controlled analgesia (PCA) requirement for morphine, as well as side effects and recovery profile after inguinal hernia repair. Seventy-one subjects undergoing inguinal hernia repair with a standardized anesthetic technique were randomly assigned to one of three analgesic treatment regimens: PCA + TEAS (n = 24); PCA + sham-TEAS (no electrical stimulation) (n = 24), and PCA only (n = 23). The postoperative PCA requirement, pain scores, opioid-related side effects, and blood cortisol levels were recorded. TEAS treatment resulted in a twofold decrease in the analgesic requirement and decreased pain level reported by the patients. In addition, a significant reduction of cortisol level was reported in the TEAS group at 24 h postoperatively compared to the sham and control groups. We conclude that TEAS is a safe and effective option for reducing analgesic consumption and postoperative pain following inguinal hernia repair. Full article

(This article belongs to the Special Issue State-of-the-Art Research on Acupuncture Treatment)

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18 pages, 1192 KiB

Open AccessReview

Composition and Clinical Significance of Exosomes in Tuberculosis: A Systematic Literature Review

by Fantahun Biadglegne, Brigitte König, Arne C. Rodloff, Anca Dorhoi and Ulrich Sack

J. Clin. Med. 2021, 10(1), 145; https://doi.org/10.3390/jcm10010145 - 04 Jan 2021

Cited by 11 | Viewed by 4146

Abstract

Tuberculosis (TB) remains a major health issue worldwide. In order to contain TB infections, improved vaccines as well as accurate and reliable diagnostic tools are desirable. Exosomes are employed for the diagnosis of various diseases. At present, research on exosomes in TB is [...] Read more.

Tuberculosis (TB) remains a major health issue worldwide. In order to contain TB infections, improved vaccines as well as accurate and reliable diagnostic tools are desirable. Exosomes are employed for the diagnosis of various diseases. At present, research on exosomes in TB is still at the preliminary stage. Recent studies have described isolation and characterization of Mycobacterium tuberculosis (Mtb) derived exosomes in vivo and in vitro. Mtb-derived exosomes (Mtbexo) may be critical for TB pathogenesis by delivering mycobacterial-derived components to the recipient cells. Proteomic and transcriptomic analysis of Mtbexo have revealed a variety of proteins and miRNA, which are utilized by the TB bacteria for pathogenesis. Exosomes have been isolated in body fluids, are amenable for fast detection, and could contribute as diagnostic or prognostic biomarker to disease control. Extraction of exosomes from biological fluids is essential for the exosome research and requires careful standardization for TB. In this review, we summarized the different studies on Mtbexo molecules, including protein and miRNA and the methods used to detect exosomes in biological fluids and cell culture supernatants. Thus, the detection of Mtbexo molecules in biological fluids may have a potential to expedite the diagnosis of TB infection. Moreover, the analysis of Mtbexo may generate new aspects in vaccine development. Full article

(This article belongs to the Special Issue Tuberculosis, Drug and Diagnostics Development)

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8 pages, 2742 KiB

Open AccessArticle

Identification of Skin Lesions by Using Single-Step Multiframe Detector

by Yu-Ping Hsiao, Chih-Wei Chiu, Chih-Wei Lu, Hong Thai Nguyen, Yu Sheng Tseng, Shang-Chin Hsieh and Hsiang-Chen Wang

J. Clin. Med. 2021, 10(1), 144; https://doi.org/10.3390/jcm10010144 - 04 Jan 2021

Cited by 11 | Viewed by 3086

Abstract

An artificial intelligence algorithm to detect mycosis fungoides (MF), psoriasis (PSO), and atopic dermatitis (AD) is demonstrated. Results showed that 10 s was consumed by the single shot multibox detector (SSD) model to analyze 292 test images, among which 273 images were correctly [...] Read more.

An artificial intelligence algorithm to detect mycosis fungoides (MF), psoriasis (PSO), and atopic dermatitis (AD) is demonstrated. Results showed that 10 s was consumed by the single shot multibox detector (SSD) model to analyze 292 test images, among which 273 images were correctly detected. Verification of ground truth samples of this research come from pathological tissue slices and OCT analysis. The SSD diagnosis accuracy rate was 93%. The sensitivity values of the SSD model in diagnosing the skin lesions according to the symptoms of PSO, AD, MF, and normal were 96%, 80%, 94%, and 95%, and the corresponding precision were 96%, 86%, 98%, and 90%. The highest sensitivity rate was found in MF probably because of the spread of cancer cells in the skin and relatively large lesions of MF. Many differences were found in the accuracy between AD and the other diseases. The collected AD images were all in the elbow or arm and other joints, the area with AD was small, and the features were not obvious. Hence, the proposed SSD could be used to identify the four diseases by using skin image detection, but the diagnosis of AD was relatively poor. Full article

(This article belongs to the Special Issue Chronic Inflammatory Skin Diseases: An Update for Clinician)

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13 pages, 268 KiB

Open AccessReview

Laxative Use in the Community: A Literature Review

by Barry L. Werth and Sybèle-Anne Christopher

J. Clin. Med. 2021, 10(1), 143; https://doi.org/10.3390/jcm10010143 - 04 Jan 2021

Cited by 9 | Viewed by 3257

Abstract

Laxatives are widely available without prescription and, as a consequence, they are commonly used for self-management of constipation by community-dwelling adults. However, it is not clear to what extent laxatives are used. Nor is it clear how laxatives are chosen, how they are [...] Read more.

Laxatives are widely available without prescription and, as a consequence, they are commonly used for self-management of constipation by community-dwelling adults. However, it is not clear to what extent laxatives are used. Nor is it clear how laxatives are chosen, how they are used and whether consumers are satisfied with their performance. This review of published literature in the last 30 years shows the prevalence of laxative use in community-dwelling adults varied widely from 1% to 18%. The prevalence of laxative use in adults with any constipation (including both chronic and sporadic constipation) also varied widely from 3% to 59%. Apart from any geographical differences and differences in research methodologies, this wide range of estimated prevalence may be largely attributed to different definitions used for laxatives. This review also shows that laxative choice varies, and healthcare professionals are infrequently involved in selection. Consequently, satisfaction levels with laxatives are reported to be low and this may be because the laxatives chosen may not always be appropriate for the intended use. To improve constipation management in community and primary healthcare settings, further research is required to determine the true prevalence of laxative use and to fully understand laxative utilisation. Full article

(This article belongs to the Special Issue Neurogenic Bowel Dysfunction)

9 pages, 721 KiB

Open AccessArticle

Effect of Coronal Alignment on 10-Year Survivorship of a Single Contemporary Total Knee Arthroplasty

by Meagan E. Tibbo, Afton K. Limberg, Kevin I. Perry, Mark W. Pagnano, Michael J. Stuart, Arlen D. Hanssen and Matthew P. Abdel

J. Clin. Med. 2021, 10(1), 142; https://doi.org/10.3390/jcm10010142 - 04 Jan 2021

Cited by 10 | Viewed by 2725

Abstract

Debate remains regarding the utility of mechanical axis alignment as a predictor of durability after total knee arthroplasty (TKA). Our study aimed to assess the effects of coronal alignment on implant durability, clinical outcomes, and radiographic results with a single fixed-bearing TKA design. [...] Read more.

Debate remains regarding the utility of mechanical axis alignment as a predictor of durability after total knee arthroplasty (TKA). Our study aimed to assess the effects of coronal alignment on implant durability, clinical outcomes, and radiographic results with a single fixed-bearing TKA design. All patients undergoing primary cemented TKA of a single design (Stryker Triathlon) from 2005–2007 with >10 years of follow-up and available pre-operative and post-operative hip–knee–ankle radiographs were included (n = 89). Radiographs were measured to determine coronal alignment and assessed for loosening. Mean preoperative mechanical axis alignment was −6° ± 6.7° (varus, range, −16°–23°), while mean post-operative alignment was −1° ± 2.7° (varus, range, −3°–15°). The aligned group was defined as knees with a post-operative mechanical axis of 0° ± 3° (n = 73) and the outlier group as those outside this range (n = 16). No patients underwent revision. Ten-year survivorship free from any reoperation was 99% and 100% in the aligned and outlier groups, respectively (p = 0.64). Knee Society scores improved significantly in both groups (p < 0.001) and did not differ at final follow-up (p = 0.15). No knees demonstrated radiographic evidence of loosening. Post-operative mechanical axis alignment within 3° of neutral was not associated with improved implant durability, clinical outcomes, or radiographic results at 10 years following primary TKA. Full article

(This article belongs to the Special Issue Recent Advances in Arthroplasty - Part I)

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14 pages, 1068 KiB

Open AccessArticle

Progression of Interstitial Fibrosis and Tubular Atrophy in Low Immunological Risk Renal Transplants Monitored by Sequential Surveillance Biopsies: The Influence of TAC Exposure and Metabolism

by Betty Chamoun, Irina B. Torres, Alejandra Gabaldón, Joana Sellarés, Manel Perelló, Eva Castellá, Xavier Guri, Maite Salcedo, Nestor G. Toapanta, Ignacio Cidraque, Francesc Moreso and Daniel Seron

J. Clin. Med. 2021, 10(1), 141; https://doi.org/10.3390/jcm10010141 - 04 Jan 2021

Cited by 7 | Viewed by 2566

Abstract

The combination of tacrolimus (TAC) and mycophenolate is the most widely employed maintenance immunosuppression in renal transplants. Different surrogates of tacrolimus exposure or metabolism such as tacrolimus trough levels (TAC-C₀), coefficient of variation of tacrolimus (CV-TAC-C₀), time in therapeutic [...] Read more.

The combination of tacrolimus (TAC) and mycophenolate is the most widely employed maintenance immunosuppression in renal transplants. Different surrogates of tacrolimus exposure or metabolism such as tacrolimus trough levels (TAC-C₀), coefficient of variation of tacrolimus (CV-TAC-C₀), time in therapeutic range (TTR), and tacrolimus concentration dose ratio (C/D) have been associated with graft outcomes. We explore in a cohort of low immunological risk renal transplants (n = 85) treated with TAC, mycophenolate mofetil (MMF), and steroids and then monitored by paired surveillance biopsies the association between histological lesions and TAC-C₀ at the time of biopsy as well as CV-TAC-C₀, TTR, and C/D during follow up. Interstitial inflammation (i-Banff score ≥ 1) in the first surveillance biopsy was associated with TAC-C₀ (odds ratio (OR): 0.69, 95% confidence interval (CI): 0.50–0.96; p = 0.027). In the second surveillance biopsy, inflammation was associated with time below the therapeutic range (OR: 1.05 and 95% CI: 1.01–1.10; p = 0.023). Interstitial inflammation in scarred areas (i-IFTA score ≥ 1) was not associated with surrogates of TAC exposure/metabolism. Progression of interstitial fibrosis/tubular atrophy (IF/TA) was observed in 35 cases (41.2%). Multivariate regression logistic analysis showed that mean C/D (OR: 0.48; 95% CI: 0.25–0.92; p = 0.026) and IF/TA in the first biopsy (OR: 0.43, 95% CI: 0.24–0.77, p = 0.005) were associated with IF/TA progression between biopsies. A low C/D ratio is associated with IF/TA progression, suggesting that TAC nephrotoxicity may contribute to fibrosis progression in well immunosuppressed patients. Our data support that TAC exposure is associated with inflammation in healthy kidney areas but not in scarred tissue. Full article

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

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13 pages, 1855 KiB

Open AccessReview

Coagulative Disorders in Critically Ill COVID-19 Patients with Acute Distress Respiratory Syndrome: A Critical Review

by Chiara Robba, Denise Battaglini, Lorenzo Ball, Alberto Valbusa, Italo Porto, Roberta Della Bona, Giovanni La Malfa, Nicolò Patroniti, Iole Brunetti, Maurizio Loconte, Matteo Bassetti, Daniele R. Giacobbe, Antonio Vena, Claudia Lucia M. Silva, Patricia R. M. Rocco and Paolo Pelosi

J. Clin. Med. 2021, 10(1), 140; https://doi.org/10.3390/jcm10010140 - 03 Jan 2021

Cited by 25 | Viewed by 6526

Abstract

In critically ill patients with acute respiratory distress syndrome (ARDS) coronavirus disease 2019 (COVID-19), a high incidence of thromboembolic and hemorrhagic events is reported. COVID-19 may lead to impairment of the coagulation cascade, with an imbalance in platelet function and the regulatory mechanisms [...] Read more.

In critically ill patients with acute respiratory distress syndrome (ARDS) coronavirus disease 2019 (COVID-19), a high incidence of thromboembolic and hemorrhagic events is reported. COVID-19 may lead to impairment of the coagulation cascade, with an imbalance in platelet function and the regulatory mechanisms of coagulation and fibrinolysis. Clinical manifestations vary from a rise in laboratory markers and subclinical microthrombi to thromboembolic events, bleeding, and disseminated intravascular coagulation. After an inflammatory trigger, the mechanism for activation of the coagulation cascade in COVID-19 is the tissue factor pathway, which causes endotoxin and tumor necrosis factor-mediated production of interleukins and platelet activation. The consequent massive infiltration of activated platelets may be responsible for inflammatory infiltrates in the endothelial space, as well as thrombocytopenia. The variety of clinical presentations of the coagulopathy confronts the clinician with the difficult questions of whether and how to provide optimal supportive care. In addition to coagulation tests, advanced laboratory tests such as protein C, protein S, antithrombin, tissue factor pathway inhibitors, D-dimers, activated factor Xa, and quantification of specific coagulation factors can be useful, as can thromboelastography or thromboelastometry. Treatment should be tailored, focusing on the estimated risk of bleeding and thrombosis. The aim of this review is to explore the pathophysiology and clinical evidence of coagulation disorders in severe ARDS-related COVID-19 patients. Full article

(This article belongs to the Special Issue Acute Respiratory Distress Syndrome (ARDS))

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17 pages, 343 KiB

Open AccessReview

Virtual Body Ownership Illusions for Mental Health: A Narrative Review

by Marta Matamala-Gomez, Antonella Maselli, Clelia Malighetti, Olivia Realdon, Fabrizia Mantovani and Giuseppe Riva

J. Clin. Med. 2021, 10(1), 139; https://doi.org/10.3390/jcm10010139 - 03 Jan 2021

Cited by 45 | Viewed by 6586

Abstract

Over the last 20 years, virtual reality (VR) has been widely used to promote mental health in populations presenting different clinical conditions. Mental health does not refer only to the absence of psychiatric disorders but to the absence of a wide range of [...] Read more.

Over the last 20 years, virtual reality (VR) has been widely used to promote mental health in populations presenting different clinical conditions. Mental health does not refer only to the absence of psychiatric disorders but to the absence of a wide range of clinical conditions that influence people’s general and social well-being such as chronic pain, neurological disorders that lead to motor o perceptual impairments, psychological disorders that alter behaviour and social cognition, or physical conditions like eating disorders or present in amputees. It is known that an accurate perception of oneself and of the surrounding environment are both key elements to enjoy mental health and well-being, and that both can be distorted in patients suffering from the clinical conditions mentioned above. In the past few years, multiple studies have shown the effectiveness of VR to modulate such perceptual distortions of oneself and of the surrounding environment through virtual body ownership illusions. This narrative review aims to review clinical studies that have explored the manipulation of embodied virtual bodies in VR for improving mental health, and to discuss the current state of the art and the challenges for future research in the context of clinical care. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

16 pages, 259 KiB

Open AccessReview

Complementary and Integrative Medicines as Prophylactic Agents for Pediatric Migraine: A Narrative Literature Review

by Gaku Yamanaka, Kanako Kanou, Tomoko Takamatsu, Mika Takeshita, Shinichiro Morichi, Shinji Suzuki, Yu Ishida, Yusuke Watanabe, Soken Go, Shingo Oana and Hisashi Kawashima

J. Clin. Med. 2021, 10(1), 138; https://doi.org/10.3390/jcm10010138 - 03 Jan 2021

Cited by 10 | Viewed by 3644

Abstract

Complementary and integrative medicines (CIMs) are increasingly used as a preventive antimigraine therapy. In this review, we aimed to summarize the evidence for the efficacy and safety of eight CIMs (riboflavin, coenzyme Q10, magnesium, melatonin, polyunsaturated fatty acids, and combination therapy of feverfew, [...] Read more.

Complementary and integrative medicines (CIMs) are increasingly used as a preventive antimigraine therapy. In this review, we aimed to summarize the evidence for the efficacy and safety of eight CIMs (riboflavin, coenzyme Q10, magnesium, melatonin, polyunsaturated fatty acids, and combination therapy of feverfew, vitamin D, and ginkgolide B) in pediatric migraine prevention. The level of evidence for riboflavin was relatively high; it was investigated by many studies with five/seven studies demonstrating its efficacy. Five studies investigated the use of melatonin, with one reporting negative results. There was insufficient evidence on the effectiveness of coenzyme Q10, magnesium, and polyunsaturated fatty acids. Combination therapy showed positive potential; however, reports on the individual antimigraine effects of the CIMs were lacking. A definitive conclusion was not reached regarding the specific integrative drugs clinicians should choose for pediatric migraines, owing to low-quality evidence and a limited number of studies. Integrative medications are becoming more common for pediatric migraine prevention as they do not produce serious side effects, and underlying research data suggest their efficacy in preventing migraine. Additional studies are warranted to confirm the role of CIMs in treating patients with migraines. Full article

(This article belongs to the Special Issue Clinical Treatment and Medication Management of Migraine)

10 pages, 261 KiB

Open AccessArticle

Validity and Reliability of a Tool for Accelerometric Assessment of Balance in Scholar Children

by Jesús García-Liñeira, Raquel Leirós-Rodríguez, Vicente Romo-Pérez and Jose L. García-Soidán

J. Clin. Med. 2021, 10(1), 137; https://doi.org/10.3390/jcm10010137 - 03 Jan 2021

Cited by 5 | Viewed by 2680

Abstract

In Pediatrics, balance is assessed through low-sensitivity clinical tests which identify developmental alterations at already advanced stages that cannot be detected at earlier stages. Therefore, the aim of this study was to develop an easily applicable quantitative tool that can be used to [...] Read more.

In Pediatrics, balance is assessed through low-sensitivity clinical tests which identify developmental alterations at already advanced stages that cannot be detected at earlier stages. Therefore, the aim of this study was to develop an easily applicable quantitative tool that can be used to evaluate postural control. Consequently, a cross-sectional study was carried out with 91 healthy children. All of them performed a series of six accelerometric functional tests and four clinical tests of balance (Modified Flamingo Test, Bar Test, Babinski–Weil Test, and Fukuda Stepping Test). The Bar Test obtained mild inverse correlations with accelerations produced in the mediolateral axis and the root mean square of all the tests in monopodal support. The Flamingo Test obtained direct correlations with the root mean square of the tests in monopodal support and with the mediolateral axis of the monopodal tests and gait. The pediatric balance assessment scale consists of three factors and eleven items extracted from five accelerometric functional tests: the monopodal balance test with six items, normal gait test with three items, and bipodal balance test with two items. This tool is easy to apply and allows analysis in the evaluation of the balance state based on the accelerations of the center of mass. Full article

(This article belongs to the Special Issue Pediatric Neurology—Current Challenges and Future Perspectives)

14 pages, 470 KiB

Open AccessArticle

A Psychosocial Genomics Pilot Study in Oncology for Verifying Clinical, Inflammatory and Psychological Effects of Mind-Body Transformations-Therapy (MBT-T) in Breast Cancer Patients: Preliminary Results

by Mauro Cozzolino, Stefania Cocco, Michela Piezzo, Giovanna Celia, Susan Costantini, Valentina Abate, Francesca Capone, Daniela Barberio, Laura Girelli, Elisa Cavicchiolo, Paolo Antonio Ascierto, Gabriele Madonna, Alfredo Budillon and Michelino De Laurentiis

J. Clin. Med. 2021, 10(1), 136; https://doi.org/10.3390/jcm10010136 - 03 Jan 2021

Cited by 12 | Viewed by 2955

Abstract

Several studies have highlighted the key role of chronic inflammation in breast cancer development, progression, metastasis, and therapeutic outcome. These processes are mediated through a variety of cytokines and hormones that exert their biological actions either locally or distantly via systemic circulation. Recent [...] Read more.

Several studies have highlighted the key role of chronic inflammation in breast cancer development, progression, metastasis, and therapeutic outcome. These processes are mediated through a variety of cytokines and hormones that exert their biological actions either locally or distantly via systemic circulation. Recent findings suggest that positive psychosocial experiences, including psychotherapeutic interventions and therapeutic mind-body protocols, can modulate the inflammatory response by reducing the expression of genes/proteins associated with inflammation and stress-related pathways. Our preliminary results indicate that a specific mind-body therapy (MBT-T) could induce a significant reduction of the release of different cytokines and chemokines, such as SCGFβ, SDF-1α, MCP3, GROα, LIF, and IL-18, in the sera of breast cancer patients compared to a control group, suggesting that MBT-T could represent a promising approach to improve the wellness and outcome of breast cancer patients. Full article

(This article belongs to the Special Issue Uncovering the Links between Inflammation and Recurrence in Cancer Patients)

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