Journal of Clinical Medicine

21 pages, 630 KiB

Open AccessFeature PaperReview

Erectile Dysfunction Is a Hallmark of Cardiovascular Disease: Unavoidable Matter of Fact or Opportunity to Improve Men’s Health?

by Dimitri Yannas, Francesca Frizza, Linda Vignozzi, Giovanni Corona, Mario Maggi and Giulia Rastrelli

J. Clin. Med. 2021, 10(10), 2221; https://doi.org/10.3390/jcm10102221 - 20 May 2021

Cited by 17 | Viewed by 3855

Abstract

Erectile dysfunction (ED) is an early manifestation of cardiovascular (CV) disease. For this reason, men with ED should be carefully assessed for CV risk factors in order to prevent future major adverse CV events (MACE). Traditional risk factors are not found in all [...] Read more.

Erectile dysfunction (ED) is an early manifestation of cardiovascular (CV) disease. For this reason, men with ED should be carefully assessed for CV risk factors in order to prevent future major adverse CV events (MACE). Traditional risk factors are not found in all subjects at high CV risk. In fact, a relevant proportion of MACE occurs in men who are apparently risk factor free. In men with ED, it is important to take into account not only traditional risk factors but also unconventional ones. Several parameters that derive from good clinical assessment of subjects with ED have proven to be valuable predictors of MACE. These include family history of cardiometabolic events, alcohol abuse, fatherhood, decreased partner’s sexual interest, severe impairment in erection during intercourse or during masturbation, impaired fasting glucose, increased triglycerides, obesity even without metabolic complications, decreased penile blood flows or impaired response to an intra-cavernosal injection test. Recognizing these risk factors may help in identifying, among subjects with ED, those who merit stricter lifestyle or pharmacological interventions to minimize their CV risk. Effective correction of risk factors in ED men considered as high risk, besides reducing CV risk, is also able to improve erectile function. Full article

(This article belongs to the Special Issue Erectile Dysfunction in Men with Chronic Diseases: From Pathophysiology to Clinical Management)

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16 pages, 998 KiB

Open AccessArticle

Subgroups of Children with Autism Spectrum Disorder without Intellectual Disability: A Longitudinal Examination of Executive and Socio-Adaptive Behaviors in Adolescence

by Rocio Rosello, Carmen Berenguer, Jose Martinez-Raga, Ana Miranda and Samuele Cortese

J. Clin. Med. 2021, 10(10), 2220; https://doi.org/10.3390/jcm10102220 - 20 May 2021

Cited by 5 | Viewed by 2876

Abstract

Within the autistic spectrum, there is remarkable variability in the etiology, presentation, and treatment response. This prospective study was designed to identify, through cluster analysis, subgroups of individuals with ASD without intellectual disability (ID) based on the severity of the core symptoms in [...] Read more.

Within the autistic spectrum, there is remarkable variability in the etiology, presentation, and treatment response. This prospective study was designed to identify, through cluster analysis, subgroups of individuals with ASD without intellectual disability (ID) based on the severity of the core symptoms in childhood. The secondary aim was to explore whether these subgroups and a group with typical development (TD) differ in cognitive, adaptive, and social aspects measured in adolescence. The sample at baseline was comprised of 52 children with ASD without ID and 37 children with TD, aged 7–11. Among the ASD group, three clusters were identified. Cluster 1 (40%), ‘high severity’, presented high symptom severity on the DSM-5 criteria and the Social Communication Questionnaire. Cluster 2 (34%) showed ‘moderate severity’ on most of the scores. Cluster 3 (25%) corresponded to ‘low severity’, showing moderate social impairment and low restrictive, repetitive patterns of behavior, interests and activities. At 5-year follow-up, 45 adolescents with ASD without ID and 27 adolescents with TD were assessed. All clusters had significantly more difficulties in EF, ToM, socialization and adaptive behavior compared to TD. Social and adaptive trajectories between the ASD subgroups were relatively different; Cluster 1 showed poorer socialization and daily living skills than the other two subgroups. These findings highlight the importance of fully assessing social, cognitive, and adaptive profiles to develop care plans tailored to specific needs. Full article

(This article belongs to the Special Issue Advances in Autism Spectrum Disorder: Etiopathogenesis, Clinical Phenotypes, Diagnosis and Treatment)

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21 pages, 12463 KiB

Open AccessArticle

Ras, TrkB, and ShcA Protein Expression Patterns in Pediatric Brain Tumors

by Monika Prill, Agnieszka Karkucinska-Wieckowska, Magdalena Lebiedzinska-Arciszewska, Giampaolo Morciano, Agata Charzynska, Michal Dabrowski, Maciej Pronicki, Paolo Pinton, Wieslawa Grajkowska and Mariusz R. Wieckowski

J. Clin. Med. 2021, 10(10), 2219; https://doi.org/10.3390/jcm10102219 - 20 May 2021

Viewed by 2683

Abstract

Numerous papers have reported altered expression patterns of Ras and/or ShcA proteins in different types of cancers. Their level can be potentially associated with oncogenic processes. We analyzed samples of pediatric brain tumors reflecting different groups such as choroid plexus tumors, diffuse astrocytic [...] Read more.

Numerous papers have reported altered expression patterns of Ras and/or ShcA proteins in different types of cancers. Their level can be potentially associated with oncogenic processes. We analyzed samples of pediatric brain tumors reflecting different groups such as choroid plexus tumors, diffuse astrocytic and oligodendroglial tumors, embryonal tumors, ependymal tumors, and other astrocytic tumors as well as tumor malignancy grade, in order to characterize the expression profile of Ras, TrkB, and three isoforms of ShcA, namely, p66Shc, p52Shc, and p46Shc proteins. The main aim of our study was to evaluate the potential correlation between the type of pediatric brain tumors, tumor malignancy grade, and the expression patterns of the investigated proteins. Full article

(This article belongs to the Section Clinical Neurology)

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12 pages, 270 KiB

Open AccessArticle

Asymptomatic Carotid Atherosclerosis Cardiovascular Risk Factors and Common Hypertriglyceridemia Genetic Variants in Patients with Systemic Erythematosus Lupus

by Marta Fanlo-Maresma, Beatriz Candás-Estébanez, Virginia Esteve-Luque, Ariadna Padró-Miquel, Francesc Escrihuela-Vidal, Monica Carratini-Moraes, Emili Corbella, Xavier Corbella and Xavier Pintó

J. Clin. Med. 2021, 10(10), 2218; https://doi.org/10.3390/jcm10102218 - 20 May 2021

Cited by 5 | Viewed by 1671

Abstract

SLE is associated with increased cardiovascular risk. The objective of this study was to determine the prevalence of asymptomatic carotid atherosclerosis to analyze its relationship with dyslipidemia and related genetic factors in a population of patients with SLE. Seventy-one SLE female patients were [...] Read more.

SLE is associated with increased cardiovascular risk. The objective of this study was to determine the prevalence of asymptomatic carotid atherosclerosis to analyze its relationship with dyslipidemia and related genetic factors in a population of patients with SLE. Seventy-one SLE female patients were recruited. Carotid ultrasound, laboratory profiles, and genetic analysis of the ZPR1, APOA5, and GCKR genes were performed. SLE patients were divided into two groups according to the presence or absence of carotid plaques. Patients with carotid plaque had higher plasma TG (1.5 vs. 0.9 mmol/L, p = 0.001), Non-HDL-C (3.5 vs. 3.1 mmol/L, p = 0.025), and apoB concentrations (1.0 vs. 0.9 g/L, p = 0.010) and a higher prevalence of hypertension (80 vs. 37.5%, p = 0.003) than patients without carotid plaque. The GCKR C-allele was present in 83.3% and 16.7% (p = 0.047) of patients with and without carotid plaque, respectively. The GCKR CC genotype (OR = 0.026; 95% CI: 0.001 to 0.473, p = 0.014), an increase of 1 mmol/L in TG concentrations (OR = 12.550; 95% CI: 1.703 to 92.475, p = 0.013) and to be hypertensive (OR = 9.691; 95% CI: 1.703 to 84.874, p = 0.040) were independently associated with carotid atherosclerosis. In summary, plasma TG concentrations, CGKR CC homozygosity, and hypertension are independent predictors of carotid atherosclerosis in women with SLE. Full article

(This article belongs to the Section Immunology)

14 pages, 2967 KiB

Open AccessArticle

TRAP5b and RANKL/OPG Predict Bone Pathology in Patients with Gaucher Disease

by Margarita Ivanova, Julia Dao, Lauren Noll, Jacqueline Fikry and Ozlem Goker-Alpan

J. Clin. Med. 2021, 10(10), 2217; https://doi.org/10.3390/jcm10102217 - 20 May 2021

Cited by 9 | Viewed by 3236

Abstract

Background and objective: Bone involvement occurs in 75% of patients with Gaucher disease (GD), and comprises structural changes, debilitating pain, and bone density abnormalities. Osteoporosis is a silent manifestation of GD until a pathologic fracture occurs. Thus, early diagnosis is crucial for identifying [...] Read more.

Background and objective: Bone involvement occurs in 75% of patients with Gaucher disease (GD), and comprises structural changes, debilitating pain, and bone density abnormalities. Osteoporosis is a silent manifestation of GD until a pathologic fracture occurs. Thus, early diagnosis is crucial for identifying high-risk patients in order to prevent irreversible complications. Methods: Thirty-three patients with GD were assessed prospectively to identify predictive markers associated with bone density abnormalities, osteopenia (OSN), and osteoporosis (OSR). Subjects were categorized into three cohorts based on T- or Z-scores of bone mineral density (BMD). The first GD cohort consisted of those with no bone complications (Z-score ≥ −0.9; T-scores ≥ −1), the second was the OSN group (−1.8 ≥ Z-score ≥ −1; −2.5 ≥ T-score ≥ −1), and the third was the OSR group (Z-score ≤ −1.9; T-scores ≤ −2.5). Serum levels of TRAP5b, RANKL, OPG, and RANK were quantified by enzyme-linked immunosorbent assays. Results: TRAP5b levels were increased in GD patients, and showed a positive correlation with GD biomarkers, including plasma glucosylsphingosine (lyso-Gb1) and macrophage activation markers CCL18 and chitotriosidase. The highest level of TRAP5b was measured in patients with osteoporosis. The elevation of RANKL and RANKL/OPG ratio correlated with osteopenia in GD. Conclusion: TRAP5b, RANKL, and RANKL/OPG elevation indicate osteoclast activation in GD. TRAP5b is a potential bone biomarker for GD with the ability to predict the progression of bone density abnormalities. Full article

(This article belongs to the Special Issue Osteoporosis and Related Bone Metabolic Disease)

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9 pages, 13025 KiB

Open AccessArticle

Secondary Sutureless Posterior Chamber Lens Implantation with Two Specifically Designed IOLs: Iris Claw Lens versus Sutureless Trans-Scleral Plugs Fixated Lens

by Daniel Seknazi, Donato Colantuono, Rachid Tahiri, Francesca Amoroso, Alexandra Miere and Eric H. Souied

J. Clin. Med. 2021, 10(10), 2216; https://doi.org/10.3390/jcm10102216 - 20 May 2021

Cited by 9 | Viewed by 2797

Abstract

Background. The management of patients with aphakia and/or lack of capsular support remains debated. The sutureless posterior chamber IOL (PCIOL) fixation is a very useful surgical option. The purpose of the study was to compare the early outcomes as well as post-operative best [...] Read more.

Background. The management of patients with aphakia and/or lack of capsular support remains debated. The sutureless posterior chamber IOL (PCIOL) fixation is a very useful surgical option. The purpose of the study was to compare the early outcomes as well as post-operative best corrected visual acuity, refractive errors and complications of two different techniques of sutureless PCIOL secondary implantation. Methods. Patients who underwent secondary implantation from December 2019 to January 2021 in the Department of Ophthalmology of Creteil Hospital, and in the Granville Ophthalmology Center, were retrospectively included. Eyes implanted with the iris claw lens (Artisan Aphakia IOL model 205, Ophtec BV, Groningen, The Netherlands) were included in group 1, and eyes implanted with a newly developed sutureless trans-scleral plugs fixated lens (STSPFL, Carlevale lens, Soleko, Pontecorvo, Italy) were included in group 2. Results. Twenty-two eyes of 22 patients were enrolled in group 1, and twenty eyes of 20 patients in group 2. No difference was found in visual acuity between two groups (0.35 +/− 0.29 logmar for group 1 and 0.23 +/− 0.51 logmar for group 2) (p = 0.15) at mean post-operative follow up (6.19 +/− 3.44 months for group 1 and 6.42 +/− 3.96 months for group 2) (p = 0.13). Both the mean refractive error (MRE) and induced astigmatism (IA) were greater in group 1 compared to group 2, respectively: the MRE was 0.99 +/− 0.57 vs. 0.46 +/− 0.36 (p < 0.01), and IA was 1.72 +/− 0.96 vs. 0.72 +/− 0.52 (p < 0.01). Conclusions. No significant differences in terms of the recovery of visual acuity were found between the two groups. Group 2 (STPFL) gives better results in our sample due to less post-operative induced astigmatism and less refractive error. Full article

(This article belongs to the Special Issue Updates in Ocular Surgery)

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15 pages, 612 KiB

Open AccessArticle

A Randomized Controlled Trial Evaluating Integrative Psychotherapeutic Group Treatment Compared to Self-Help Groups in Functional Vertigo/Dizziness

by Karina Limburg, Katharina Radziej, Heribert Sattel, Peter Henningsen, Marianne Dieterich, Thomas Probst, Rachel Dale and Claas Lahmann

J. Clin. Med. 2021, 10(10), 2215; https://doi.org/10.3390/jcm10102215 - 20 May 2021

Cited by 5 | Viewed by 2437

Abstract

We tested the efficacy of an integrative psychotherapeutic group treatment (IPGT) in reducing vertigo/dizziness-related impairment along with depression, anxiety, and somatization by conducting a randomized controlled superiority trial comparing IPGT to self-help groups moderated by a clinical psychologist (SHG). Adult patients with functional [...] Read more.

We tested the efficacy of an integrative psychotherapeutic group treatment (IPGT) in reducing vertigo/dizziness-related impairment along with depression, anxiety, and somatization by conducting a randomized controlled superiority trial comparing IPGT to self-help groups moderated by a clinical psychologist (SHG). Adult patients with functional vertigo and dizziness symptoms were randomly allocated to either the IPGT or SHG as active control group. Outcomes were assessed at baseline (t0), after treatment lasting 16 weeks (t1), and 12 months after treatment (t2). A total of 81 patients were assigned to IPGT and 78 patients were assigned to SHG. Vertigo-related impairment was reduced in both conditions (IPGT: t0–t1: d = 1.10, t0–t2: d = 1.06; SHG: t0–t1: d = 0.86, t0–t2: d = 1.29), showing the efficiency of both IPGT and SHG. Clinically relevant improvements were also obtained for depression in both groups. Linear mixed model analyses revealed no differences between groups for all outcomes (effect of group for the primary outcome: b = −1.15, SE = 2.13, t = −0.54, p = 0.59). Attrition rates were higher in SHG (52.6%) than in IPGT (28.4%). Both conditions improved primary and secondary outcomes while IPGT was better accepted by patients than SHG. Trial registration: ClinicalTrials.gov, Identifier: NCT02320851. Full article

(This article belongs to the Special Issue Persistent Imbalance and Dizziness Syndromes: Latest Advances and Prospects)

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13 pages, 1263 KiB

Open AccessArticle

Risk Categories in COVID-19 Based on Degrees of Inflammation: Data on More Than 17,000 Patients from the Spanish SEMI-COVID-19 Registry

by Manuel Rubio-Rivas, Xavier Corbella, Francesc Formiga, Estela Menéndez Fernández, María Dolores Martín Escalante, Isolina Baños Fernández, Francisco Arnalich Fernández, Esther Del Corral-Beamonte, Antonio Lalueza, Alejandro Parra Virto, Emilia Roy Vallejo, José Loureiro-Amigo, Ana María Álvarez Suárez, Jesica Abadía-Otero, María Navarro De La Chica, Raquel Estévez González, Almudena Hernández Milián, María Areses Manrique, Julio César Blázquez Encinar, Amara González Noya, Ruth González Ferrer, María Pérez Aguilera, Ricardo Gil Sánchez, Jesús Millán Núñez-Cortés, José Manuel Casas-Rojo and on behalf of the SEMI-COVID-19 Network Show full author list Hide full author list

J. Clin. Med. 2021, 10(10), 2214; https://doi.org/10.3390/jcm10102214 - 20 May 2021

Cited by 15 | Viewed by 4968

Abstract

(1) Background: The inflammation or cytokine storm that accompanies COVID-19 marks the prognosis. This study aimed to identify three risk categories based on inflammatory parameters on admission. (2) Methods: Retrospective cohort study of patients diagnosed with COVID-19, collected and followed-up from 1 March [...] Read more.

(1) Background: The inflammation or cytokine storm that accompanies COVID-19 marks the prognosis. This study aimed to identify three risk categories based on inflammatory parameters on admission. (2) Methods: Retrospective cohort study of patients diagnosed with COVID-19, collected and followed-up from 1 March to 31 July 2020, from the nationwide Spanish SEMI-COVID-19 Registry. The three categories of low, intermediate, and high risk were determined by taking into consideration the terciles of the total lymphocyte count and the values of C-reactive protein, lactate dehydrogenase, ferritin, and D-dimer taken at the time of admission. (3) Results: A total of 17,122 patients were included in the study. The high-risk group was older (57.9 vs. 64.2 vs. 70.4 years; p < 0.001) and predominantly male (37.5% vs. 46.9% vs. 60.1%; p < 0.001). They had a higher degree of dependence in daily tasks prior to admission (moderate-severe dependency in 10.8% vs. 14.1% vs. 17%; p < 0.001), arterial hypertension (36.9% vs. 45.2% vs. 52.8%; p < 0.001), dyslipidemia (28.4% vs. 37% vs. 40.6%; p < 0.001), diabetes mellitus (11.9% vs. 17.1% vs. 20.5%; p < 0.001), ischemic heart disease (3.7% vs. 6.5% vs. 8.4%; p < 0.001), heart failure (3.4% vs. 5.2% vs. 7.6%; p < 0.001), liver disease (1.1% vs. 3% vs. 3.9%; p = 0.002), chronic renal failure (2.3% vs. 3.6% vs. 6.7%; p < 0.001), cancer (6.5% vs. 7.2% vs. 11.1%; p < 0.001), and chronic obstructive pulmonary disease (5.7% vs. 5.4% vs. 7.1%; p < 0.001). They presented more frequently with fever, dyspnea, and vomiting. These patients more frequently required high flow nasal cannula (3.1% vs. 4.4% vs. 9.7%; p < 0.001), non-invasive mechanical ventilation (0.9% vs. 3% vs. 6.3%; p < 0.001), invasive mechanical ventilation (0.6% vs. 2.7% vs. 8.7%; p < 0.001), and ICU admission (0.9% vs. 3.6% vs. 10.6%; p < 0.001), and had a higher percentage of in-hospital mortality (2.3% vs. 6.2% vs. 23.9%; p < 0.001). The three risk categories proved to be an independent risk factor in multivariate analyses. (4) Conclusion: The present study identifies three risk categories for the requirement of high flow nasal cannula, mechanical ventilation, ICU admission, and in-hospital mortality based on lymphopenia and inflammatory parameters. Full article

(This article belongs to the Special Issue Clinical Health Care during the COVID-19 Pandemic: Therapeutic and Management Strategies)

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12 pages, 1112 KiB

Open AccessArticle

Autologous Peripheral Blood Mononuclear Cells for Limb Salvage in Diabetic Foot Patients with No-Option Critical Limb Ischemia

by Alessia Scatena, Pasquale Petruzzi, Filippo Maioli, Francesca Lucaroni, Cristina Ambrosone, Giorgio Ventoruzzo, Francesco Liistro, Danilo Tacconi, Marianna Di Filippi, Nico Attempati, Leonardo Palombi, Leonardo Ercolini and Leonardo Bolognese

J. Clin. Med. 2021, 10(10), 2213; https://doi.org/10.3390/jcm10102213 - 20 May 2021

Cited by 17 | Viewed by 2394

Abstract

Peripheral blood mononuclear cells (PBMNCs) are reported to prevent major amputation and healing in no-option critical limb ischemia (NO-CLI). The aim of this study is to evaluate PBMNC treatment in comparison to standard treatment in NO-CLI patients with diabetic foot ulcers (DFUs). The [...] Read more.

Peripheral blood mononuclear cells (PBMNCs) are reported to prevent major amputation and healing in no-option critical limb ischemia (NO-CLI). The aim of this study is to evaluate PBMNC treatment in comparison to standard treatment in NO-CLI patients with diabetic foot ulcers (DFUs). The study included 76 NO-CLI patients admitted to our centers because of CLI with DFUs. All patients were treated with the same standard care (control group), but 38 patients were also treated with autologous PBMNC implants. Major amputations, overall mortality, and number of healed patients were evaluated as the primary endpoint. Only 4 out 38 amputations (10.5%) were observed in the PBMNC group, while 15 out of 38 amputations (39.5%) were recorded in the control group (p = 0.0037). The Kaplan–Meier curves and the log-rank test results showed a significantly lower amputation rate in the PBMNCs group vs. the control group (p = 0.000). At two years follow-up, nearly 80% of the PBMNCs group was still alive vs. only 20% of the control group (p = 0.000). In the PBMNC group, 33 patients healed (86.6%) while only one patient healed in the control group (p = 0.000). PBMNCs showed a positive clinical outcome at two years follow-up in patients with DFUs and NO-CLI, significantly reducing the amputation rate and improving survival and wound healing. According to our study results, intramuscular and peri-lesional injection of autologous PBMNCs could prevent amputations in NO-CLI diabetic patients. Full article

(This article belongs to the Special Issue Diabetic Foot Complications: Current Challenges and Future Prospects—Part II)

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17 pages, 3474 KiB

Open AccessReview

Arrhythmogenic Left Ventricular Cardiomyopathy: Genotype-Phenotype Correlations and New Diagnostic Criteria

by Giulia Mattesi, Alberto Cipriani, Barbara Bauce, Ilaria Rigato, Alessandro Zorzi and Domenico Corrado

J. Clin. Med. 2021, 10(10), 2212; https://doi.org/10.3390/jcm10102212 - 20 May 2021

Cited by 20 | Viewed by 3745

Abstract

Arrhythmogenic cardiomyopathy (ACM) is an inherited heart muscle disease characterized by loss of ventricular myocardium and fibrofatty replacement, which predisposes to scar-related ventricular arrhythmias and sudden cardiac death, particularly in the young and athletes. Although in its original description the disease was characterized [...] Read more.

Arrhythmogenic cardiomyopathy (ACM) is an inherited heart muscle disease characterized by loss of ventricular myocardium and fibrofatty replacement, which predisposes to scar-related ventricular arrhythmias and sudden cardiac death, particularly in the young and athletes. Although in its original description the disease was characterized by an exclusive or at least predominant right ventricle (RV) involvement, it has been demonstrated that the fibrofatty scar can also localize in the left ventricle (LV), with the LV lesion that can equalize or even overcome that of the RV. While the right-dominant form is typically associated with mutations in genes encoding for desmosomal proteins, other (non-desmosomal) mutations have been showed to cause the biventricular and left-dominant variants. This has led to a critical evaluation of the 2010 International Task Force criteria, which exclusively addressed the right phenotypic manifestations of ACM. An International Expert consensus document has been recently developed to provide upgraded criteria (“the Padua Criteria”) for the diagnosis of the whole spectrum of ACM phenotypes, particularly left-dominant forms, highlighting the use of cardiac magnetic resonance. This review aims to offer an overview of the current knowledge on the genetic basis, the phenotypic expressions, and the diagnosis of left-sided variants, both biventricular and left-dominant, of ACM. Full article

(This article belongs to the Special Issue Clinical and Research of Genetic Cardiomyopathies)

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17 pages, 1925 KiB

Open AccessArticle

Left Ventricle Phenotyping Utilizing Tissue Doppler Imaging in Premature Infants with Varying Severity of Bronchopulmonary Dysplasia

by Eunice Torres, Philip T. Levy, Afif El-Khuffash, Hongjie Gu, Aaron Hamvas and Gautam K. Singh

J. Clin. Med. 2021, 10(10), 2211; https://doi.org/10.3390/jcm10102211 - 20 May 2021

Cited by 3 | Viewed by 2187

Abstract

Bronchopulmonary dysplasia (BPD) is characterized by alveolar-capillary simplification and is associated with pulmonary hypertension (PH) in preterm infants. The contribution of left ventricle (LV) disease towards this severe BPD-PH phenotype is not well established. We aimed to describe the longitudinal trajectory of the [...] Read more.

Bronchopulmonary dysplasia (BPD) is characterized by alveolar-capillary simplification and is associated with pulmonary hypertension (PH) in preterm infants. The contribution of left ventricle (LV) disease towards this severe BPD-PH phenotype is not well established. We aimed to describe the longitudinal trajectory of the LV function as measured by tissue Doppler imaging (TDI) and its association with BPD-PH. We retrospectively assessed prospectively acquired clinical and echocardiographic data from 77 preterm infants born between 2011 and 2013. We characterized the LV function by measuring systolic and diastolic myocardial velocities (s’, e’, a’), isovolumetric relaxation time (IVRT), and myocardial performance index with TDI at three time periods from 32 and 36 weeks, postmenstrual age through one year of age. We also measured post systolic motion (PSM), a marker of myocardial dysfunction that results from asynchronous movement of the ventricular walls, and not previously described in preterm infants. Patients were stratified into groups according to BPD severity and the presence of PH and compared over time. Conventional TDI measures of the LV function were similar between groups, but the septal PSM was significantly prolonged over the first year of age in patients with BPD-PH. PSM provides a novel objective way to assess the hemodynamic impact of lung and pulmonary vascular disease severity on LV function in preterm infants with BPD and PH. Full article

(This article belongs to the Special Issue Clinical Research into the Cardiovascular Health of People Born Preterm)

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11 pages, 1486 KiB

Open AccessArticle

Association of GRACE Risk Score with Coronary Artery Disease Complexity in Patients with Acute Coronary Syndrome

by Georgios Sofidis, Nikolaos Otountzidis, Nikolaos Stalikas, Efstratios Karagiannidis, Andreas S. Papazoglou, Dimitrios V. Moysidis, Eleftherios Panteris, Olga Deda, Anastasios Kartas, Thomas Zegkos, Paraskevi Daskalaki, Niki Theodoridou, Leandros Stefanopoulos, Haralambos Karvounis, Helen Gika, Georgios Theodoridis and Georgios Sianos

J. Clin. Med. 2021, 10(10), 2210; https://doi.org/10.3390/jcm10102210 - 20 May 2021

Cited by 8 | Viewed by 4041

Abstract

The GRACE score constitutes a useful tool for risk stratification in patients with acute coronary syndrome (ACS), while the SYNTAX score determines the complexity of coronary artery disease (CAD). This study sought to correlate these scores and assess the accuracy of the GRACE [...] Read more.

The GRACE score constitutes a useful tool for risk stratification in patients with acute coronary syndrome (ACS), while the SYNTAX score determines the complexity of coronary artery disease (CAD). This study sought to correlate these scores and assess the accuracy of the GRACE score in predicting the extent of CAD. A total of 539 patients with ACS undergoing coronary angiography were included in this analysis. The patients were classified into those with a SYNTAX score < 33 and a SYNTAX score ≥ 33. Spearman’s correlation and receiver operator characteristic analysis were conducted to investigate the role of the GRACE score as a predictor of the SYNTAX score. There was a significantly positive correlation between the SYNTAX and the GRACE scores (r = 0.32, p < 0.001). The GRACE score predicted severe CAD (SYNTAX ≥ 33) moderately well (the area under the curve was 0.595 (0.522–0.667)). A GRACE score of 126 was documented as the optimal cut-off for the prediction of a SYNTAX score ≥ 33 (sensitivity = 53.5% and specificity = 66%). Therefore, our study reports a significantly positive correlation between the GRACE and the SYNTAX score in patients with ACS. Notably, NSTEMI patients with a high-risk coronary anatomy have higher calculated GRACE scores. A multidisciplinary approach by a heart team could possibly alter the therapeutic approach and management in patients presenting with ACS and a high calculated GRACE score. Full article

(This article belongs to the Special Issue Management of Acute Coronary Syndromes and Prevention of Atherosclerosis)

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13 pages, 1409 KiB

Open AccessArticle

Osteoglycin as a Potential Biomarker of Mild Kidney Function Impairment in Type 2 Diabetes Patients

by Sheila González-Salvatierra, Cristina García-Fontana, Francisco Andújar-Vera, Alejandro Borja Grau-Perales, Luis Martínez-Heredia, María Dolores Avilés-Pérez, María Hayón-Ponce, Iván Iglesias-Baena, Blanca Riquelme-Gallego, Manuel Muñoz-Torres and Beatriz García-Fontana

J. Clin. Med. 2021, 10(10), 2209; https://doi.org/10.3390/jcm10102209 - 20 May 2021

Cited by 7 | Viewed by 1988

Abstract

Osteoglycin (OGN) could be a biomarker of mild kidney function impairment in type 2 diabetes (T2D). Our study aimed to determine the association between serum OGN and impaired kidney function risk in T2D patients and to analyze its potential role as an estimator [...] Read more.

Osteoglycin (OGN) could be a biomarker of mild kidney function impairment in type 2 diabetes (T2D). Our study aimed to determine the association between serum OGN and impaired kidney function risk in T2D patients and to analyze its potential role as an estimator of kidney disturbances in this population. This cross-sectional study included 147 T2D patients (65 ± 8 years, 58.5% males), and 75 healthy controls (63 ± 10 years, 36% males). Circulating OGN levels were determined by ELISA. Linear regression modeling was performed to determine the variables influencing circulating OGN, and an ROC curve was plotted to assess the usefulness of OGN as an estimator of diabetic kidney disease risk. Circulating OGN was significantly increased in T2D patients compared to controls (18.41 (14.45–23.27) ng/mL vs. 8.74 (7.03–12.35) ng/mL; p < 0.001). We found a progressive increase in serum OGN according to the severity of kidney impairment in T2D patients (normal kidney function: 16.14 (12.13–20.48) ng/mL; mildly impaired kidney function: 19.15 (15.78–25.90) ng/mL; moderate impaired kidney function: 21.80 (15.06–29.22) ng/mL; p = 0.006). Circulating OGN was an independent estimator of mildly impaired kidney function risk in T2D patients. We suggest that serum OGN could act as an albuminuria-independent biomarker of incipient kidney dysfunction in T2D patients. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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16 pages, 1552 KiB

Open AccessArticle

Influence of Psychological Biomarkers on Therapeutic Adherence by Patients with Non-Alcoholic Fatty Liver Disease: A Moderated Mediation Model

by Jesús Funuyet-Salas, Agustín Martín-Rodríguez, María Ángeles Pérez-San-Gregorio and Manuel Romero-Gómez

J. Clin. Med. 2021, 10(10), 2208; https://doi.org/10.3390/jcm10102208 - 20 May 2021

Cited by 8 | Viewed by 2332

Abstract

Our aim was to analyze whether depressive symptoms mediated the association between physical quality of life (QoL) and adherence to physical activity in patients with non-alcoholic fatty liver disease (NAFLD), as well as the association between social support and adherence to diet. We [...] Read more.

Our aim was to analyze whether depressive symptoms mediated the association between physical quality of life (QoL) and adherence to physical activity in patients with non-alcoholic fatty liver disease (NAFLD), as well as the association between social support and adherence to diet. We also examined whether self-efficacy exerted a moderating role in these associations. QoL (SF-12), social support (MSPSS), depressive symptoms (HADS), self-efficacy (GSE), physical activity (IPAQ) and diet (MEDAS) were evaluated in 413 biopsy-proven NAFLD patients. Mediation and moderated mediation models were conducted using the SPSS PROCESS v3.5 macro. Results showed that depressive symptoms mediated the relationship between physical QoL and adherence to physical activity (indirect effect = 6.248, CI = 1.917–10.727), as well as the relationship between social support and adherence to diet (indirect effect = 0.148, CI = 0.035–0.275). Self-efficacy also moderated the indirect effects of QoL and social support on therapeutic adherence through depressive symptoms. Specifically, the higher self-efficacy was, the lower the negative impact on the NAFLD patient’s mental health. In conclusion, self-efficacy is defined as a protective factor for therapeutic adherence by NAFLD patients with a psychosocial risk profile. Self-efficacy should, therefore, be a main psychological target in future multidisciplinary NAFLD approaches. Full article

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

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11 pages, 548 KiB

Open AccessArticle

Biomarkers to Guide the Timing of Surgery: Neutrophil and Monocyte L-Selectin Predict Postoperative Sepsis in Orthopaedic Trauma Patients

by Gabrielle Daisy Briggs, Karla Lemmert, Natalie Jane Lott, Theo de Malmanche and Zsolt Janos Balogh

J. Clin. Med. 2021, 10(10), 2207; https://doi.org/10.3390/jcm10102207 - 20 May 2021

Cited by 5 | Viewed by 1613

Abstract

Deciding whether to delay non-lifesaving orthopaedic trauma surgery to prevent multiple organ failure (MOF) or sepsis is frequently disputed and largely based on expert opinion. We hypothesise that neutrophils and monocytes differentially express activation markers prior to patients developing these complications. Peripheral blood [...] Read more.

Deciding whether to delay non-lifesaving orthopaedic trauma surgery to prevent multiple organ failure (MOF) or sepsis is frequently disputed and largely based on expert opinion. We hypothesise that neutrophils and monocytes differentially express activation markers prior to patients developing these complications. Peripheral blood from 20 healthy controls and 162 patients requiring major orthopaedic intervention was collected perioperatively. Neutrophil and monocyte L-selectin, CD64, CD11, CD18, and CXCR1 expression were measured using flow cytometry. The predictive ability for MOF and sepsis was assessed using the Receiver Operating Characteristic (ROC) comparing to C-reactive protein (CRP). Neutrophil and monocyte L-selectin were significantly higher in patients who developed sepsis. Neutrophil L-selectin (AUC 0.692 [95%CI 0.574–0.810]) and monocyte L-selectin (AUC 0.761 [95%CI 0.632–0.891]) were significant predictors of sepsis and were not significantly different to CRP (AUC 0.772 [95%CI 0.650–0.853]). Monocyte L-selectin was predictive of MOF preoperatively and postoperatively (preop AUC 0.790 [95%CI 0.622–0.958]). CD64 and CRP were predictive of MOF at one-day postop (AUC 0.808 [95%CI 0.643–0.974] and AUC 0.809 [95%CI 0.662–0.956], respectively). In the perioperative period, elevated neutrophil and monocyte L-selectin are predictors of postoperative sepsis. Larger validation studies should focus on these biomarkers for deciding the timing of long bone/pelvic fracture fixation. Full article

(This article belongs to the Section Orthopedics)

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9 pages, 1286 KiB

Open AccessArticle

Findings of Brain Magnetic Resonance Imaging in Girls with Central Precocious Puberty Compared with Girls with Chronic or Recurrent Headache

by Shin-Hee Kim, Moon Bae Ahn, Won Kyoung Cho, Kyoung Soon Cho, Min Ho Jung and Byung-Kyu Suh

J. Clin. Med. 2021, 10(10), 2206; https://doi.org/10.3390/jcm10102206 - 19 May 2021

Cited by 4 | Viewed by 2040

Abstract

In the present study, the results of brain magnetic resonance imaging (MRI) in girls with central precocious puberty (CPP) were compared those in with girls evaluated for headaches. A total of 295 girls with CPP who underwent sellar MRI were enrolled. A total [...] Read more.

In the present study, the results of brain magnetic resonance imaging (MRI) in girls with central precocious puberty (CPP) were compared those in with girls evaluated for headaches. A total of 295 girls with CPP who underwent sellar MRI were enrolled. A total of 205 age-matched girls with chronic or recurrent headaches without neurological abnormality who had brain MRI were included as controls. The positive MRI findings were categorized as incidental non-hypothalamic–pituitary (H–P), incidental H–P, or pathological. Positive MRI findings were observed in 39 girls (13.2%) with CPP; 8 (2.7%) were classified as incidental non-H–P lesions, 30 (10.2%) as incidental H–P lesions, and 1 (0.3%) as a pathological lesion (tuber cinereum hamartoma). The prevalence of positive MRI findings in girls with CPP did not differ from girls with headaches (13.2% vs. 12.2%, p = 0.74). The prevalence of incidental H–P lesions in girls with CPP <6 years of age, 6–6.9 years of age, and 7–7.9 years of age was 21.2%, 13.5%, and 9.6%, respectively (p = 0.21). Known pathological lesions were detected in only one (3.0%) girl with CPP aged <6 years and in no girls with CPP aged 6–7.9 years. Microadenomas were detected in no girls with CPP aged <6 years and in 5 (1.9%) girls with CPP aged of 6–7.9 years. Our findings call into question the routine use of brain MRI in girls with CPP, especially in girls 6 years or older. Current guidelines recommend a follow-up MRI in cases of microadenoma, but few data exist to support this recommendation for children. Full article

(This article belongs to the Section Clinical Neurology)

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12 pages, 948 KiB

Open AccessArticle

Platelet Receptor Activity for Predicting Survival in Patients with Intracranial Bleeding

by Barbara Dragan, Barbara Adamik, Malgorzata Burzynska, Szymon Lukasz Dragan and Waldemar Gozdzik

J. Clin. Med. 2021, 10(10), 2205; https://doi.org/10.3390/jcm10102205 - 19 May 2021

Cited by 3 | Viewed by 2002

Abstract

Blood coagulation disorders in patients with intracranial bleeding as a result of head injuries or ruptured aneurysms are a diagnostic and therapeutic problem and appropriate assessments are needed to limit CNS damage and to implement preventive measures. The aim of the study was [...] Read more.

Blood coagulation disorders in patients with intracranial bleeding as a result of head injuries or ruptured aneurysms are a diagnostic and therapeutic problem and appropriate assessments are needed to limit CNS damage and to implement preventive measures. The aim of the study was to monitor changes in platelet aggregation and to assess the importance of platelet dysfunction for predicting survival. Platelet receptor function analysis was performed using the agonists arachidonic acid (ASPI), adenosine diphosphate (ADP), collagen (COL), thrombin receptor activating protein (TRAP), ristocetin (RISTO) upon admission to the ICU and on days 2, 3, and 5. On admission, the ASPI, ADP, COL, TRAP, and RISTO tests indicated there was reduced platelet aggregation, despite there being a normal platelet count. In ‘Non-survivors’, the platelet response to all agonists was suppressed throughout the study period, while in ‘Survivors’ it improved. Measuring platelet function in ICU patients with intracranial bleeding is a strong predictor related to outcome: patients with impaired platelet aggregation had a lower 28-day survival rate compared to patients with normal platelet aggregation (log-rank test p = 0.014). The results indicated that measuring platelet aggregation can be helpful in the early detection, diagnosis, and treatment of bleeding disorders. Full article

(This article belongs to the Collection Neuroscience in Anesthesiology)

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10 pages, 9367 KiB

Open AccessArticle

Feasibility and Safety of the Left Distal Radial Approach in Percutaneous Coronary Intervention for Bifurcation Lesions

by Oh-Hyun Lee, Ji Woong Roh, Eui Im, Deok-Kyu Cho, Myung Ho Jeong, Donghoon Choi and Yongcheol Kim

J. Clin. Med. 2021, 10(10), 2204; https://doi.org/10.3390/jcm10102204 - 19 May 2021

Cited by 4 | Viewed by 5500

Abstract

Recently, the left distal radial approach (DRA) for percutaneous coronary intervention (PCI) has been shown to be a feasible option, but there are limited data regarding the feasibility of performing bifurcation PCI via the left DRA. Therefore, this study aimed to describe our [...] Read more.

Recently, the left distal radial approach (DRA) for percutaneous coronary intervention (PCI) has been shown to be a feasible option, but there are limited data regarding the feasibility of performing bifurcation PCI via the left DRA. Therefore, this study aimed to describe our experience with the contemporary left DRA to perform PCI of bifurcation lesions. Between December 2017 and December 2019, we identified 106 patients treated with bifurcation PCI via the left DRA. We evaluated the success rate of PCI, access-site complications including major bleeding requiring surgery or transfusion, hematoma, distal and forearm radial artery occlusion, and 30-day mortality. Eleven patients (10.4%) treated with left main bifurcation and true bifurcations accounted for 39.6% of cases, with the left anterior descending artery/diagonal branch being the most frequent bifurcation site (57.5%, 61/106). PCI was performed using a 6-French guiding catheter in 101 (95.3%) cases. Successful PCI for bifurcation lesions via the left DRA was achieved in all 106 patients without access-site cross-over. There was no major bleeding, distal and forearm radial artery occlusion, forearm hematoma, or mortality at 30 days. The left DRA is a safe and feasible alternative access site for bifurcation PCI in selected patients. Full article

(This article belongs to the Special Issue Latest Advances in Complex Coronary Interventions)

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14 pages, 2402 KiB

Open AccessReview

Faecal Calprotectin in Assessment of Mucosal Healing in Adults with Inflammatory Bowel Disease: A Meta-Analysis

by Mariusz A. Bromke, Katarzyna Neubauer, Radosław Kempiński and Małgorzata Krzystek-Korpacka

J. Clin. Med. 2021, 10(10), 2203; https://doi.org/10.3390/jcm10102203 - 19 May 2021

Cited by 16 | Viewed by 2817

Abstract

Achieving mucosal healing in patients with inflammatory bowel disease is related to a higher incidence of sustained clinical remission and it translates to lower rates of hospitalisation and surgery. The assessment methods of disease activity and response to therapy are limited and mainly [...] Read more.

Achieving mucosal healing in patients with inflammatory bowel disease is related to a higher incidence of sustained clinical remission and it translates to lower rates of hospitalisation and surgery. The assessment methods of disease activity and response to therapy are limited and mainly rely on colonoscopy. This meta-analysis reviews the effectiveness of using faecal calprotectin as a marker for mucosal healing in inflammatory bowel disease. Two meta-analyses were conducted in parallel. The analysis on the use of faecal calprotectin in monitoring mucosal healing in colonic Crohn’s disease is based on 16 publications (17 studies). The data set for diagnostic values of faecal calprotectin in ulcerative colitis is composed of 35 original publications (total 49 studies). The DOR for the use of faecal calprotectin in Crohn’s disease is estimated to be 11.20 and the area under the sROCis 0.829. In cases of ulcerative colitis, the DOR is 14.48, while the AUC sROC is 0.858. Heterogeneity of the studies was moderatetosubstantial. Collected data show overall good sensitivity and specificity of the faecal calprotectin test, as well as a good DOR. Thus, monitoring of mucosal healing with a non-invasive faecal calprotectin test may represent an attractive option for physicians and patients with inflammatory bowel disease. Full article

(This article belongs to the Special Issue Treatment and Management of Chronic Inflammatory Bowel Diseases: Optimizing Present and Future Therapeutic Choices)

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3 pages, 154 KiB

Open AccessEditorial

Recent Advances in Gestational Diabetes Mellitus

by Katrien Benhalima

J. Clin. Med. 2021, 10(10), 2202; https://doi.org/10.3390/jcm10102202 - 19 May 2021

Cited by 4 | Viewed by 2494

Abstract

The incidence of gestational diabetes mellitus (GDM) and overt diabetes in pregnancy is rising globally [...] Full article

(This article belongs to the Special Issue Recent Advances in Gestational Diabetes Mellitus)

11 pages, 631 KiB

Open AccessReview

Clinical Manifestations of COVID-19 in the Feet: A Review of Reviews

by Ana Maria Jimenez-Cebrian, Aurora Castro-Mendez, Blanca García-Podadera, Rita Romero-Galisteo, Miguel Medina-Alcántara, Irene Garcia-Paya, Joaquín Páez-Moguer and Antonio Córdoba-Fernández

J. Clin. Med. 2021, 10(10), 2201; https://doi.org/10.3390/jcm10102201 - 19 May 2021

Cited by 11 | Viewed by 5381

Abstract

There is a lack of scientific evidence about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical manifestations are not thoroughly understood; classically, the virus manifests itself at the pulmonary level but can manifest at other levels. To the best of our [...] Read more.

There is a lack of scientific evidence about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical manifestations are not thoroughly understood; classically, the virus manifests itself at the pulmonary level but can manifest at other levels. To the best of our knowledge, systematic reviews and non-systematic reviews about COVID-19 symptoms in the feet have not been published. The aim of this review of reviews was to analyze and synthesize the published reviews on manifestations of COVID-19 at the foot level. Methods: a review of reviews was conducted; the eligibility criteria included studies published in English or Spanish, involving children and adults with COVID-19, and reporting foot manifestations. PubMed, SciELO, Science Direct, Cochrane Database of Systematic Review, and Google Scholar were analyzed. Two authors independently performed the screening and quality assessment of the studies with AMSTAR 1, and finally, nine reviews were analyzed (one systematic and eight narratives studies). The main clinical manifestations at the foot level in patients with COVID-19 were vascular (edema, exanthems, chilblains, ischemia, and distal necrosis), dermatological (vesicular, maculopapular, papulosquamous, urticarial skin breakouts, and recurrent herpes), and neurological (muscular weakness in lower limbs, paresis, areflexias, ataxia, and difficulty walking). Erythema pernio or “COVID toes” was shown as the most characteristic lesion of this disease, especially in asymptomatic children and young people, so this typical manifestation may be considered important in patients who are positive for COVID-19. This finding does not allow for strong conclusions due to the scarce literature and methodological quality in this regard. Future studies are necessary. Full article

(This article belongs to the Section Epidemiology & Public Health)

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14 pages, 14604 KiB

Open AccessArticle

Feasibility and Long-Term Efficacy of PEComa Treatment—20 Years of Experience

by Aleksandra Sobiborowicz, Tomasz Świtaj, Paweł Teterycz, Mateusz J. Spałek, Anna Szumera-Ciećkiewicz, Michał Wągrodzki, Marcin Zdzienicki, Anna M. Czarnecka and Piotr Rutkowski

J. Clin. Med. 2021, 10(10), 2200; https://doi.org/10.3390/jcm10102200 - 19 May 2021

Cited by 13 | Viewed by 2876

Abstract

Perivascular epithelioid cell tumors (PEComas) represent a family of rare mesenchymal neoplasms, some of which are malignant. There are no specific management guidelines for PEComas, and factors correlating with the disease course are not well defined. This analysis aimed to describe the outcomes [...] Read more.

Perivascular epithelioid cell tumors (PEComas) represent a family of rare mesenchymal neoplasms, some of which are malignant. There are no specific management guidelines for PEComas, and factors correlating with the disease course are not well defined. This analysis aimed to describe the outcomes of PEComa patients treated radically, including those treated exclusively in the national reference sarcoma center. The secondary aim of the study was to analyze factors associated with PEComa treatment efficacy. We performed an analysis of 27 patients subsequently treated radically for PEComa between 1999 and 2019 who were in follow-up in the national sarcoma reference center. The proportional-hazards model was used to compare the risk of death. The median age at diagnosis was 45 (21–67) years, and 67% of patients were female. The median follow-up period was 68 months (95% CI: 39–101). At the time of analysis, eleven patients (40.7%) experienced progression of the disease and four (14.8%) died. Surgery in the reference sarcoma center was associated with a longer disease control (log-rank p < 0.001). The 5-year-OS rate was 88% (95% CI: 74–100) for the whole analyzed group. We concluded that PEComa treatment should be managed in reference sarcoma centers by a multidisciplinary tumor board with an experienced surgical team. Microscopically radical resection is associated with a longer disease-free survival. Patients requiring long-term follow-ups as late recurrence may be expected. Full article

(This article belongs to the Special Issue Novel Pathogenic Mechanisms and Therapeutic Approaches for Sarcomas)

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11 pages, 517 KiB

Open AccessArticle

Pretreatment Neutrophil-to-Lymphocyte Ratio Combined with Platelet-to-Lymphocyte Ratio as a Predictor of Survival Outcomes after Definitive Concurrent Chemoradiotherapy for Cervical Cancer

by Jeong Won Lee and Ki Ho Seol

J. Clin. Med. 2021, 10(10), 2199; https://doi.org/10.3390/jcm10102199 - 19 May 2021

Cited by 10 | Viewed by 2025

Abstract

The aim of the study was to evaluate pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic factors for predicting clinical outcomes after definitive concurrent chemoradiotherapy (CCRT) for cervical cancer. The cases were divided into two groups based on the values of [...] Read more.

The aim of the study was to evaluate pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic factors for predicting clinical outcomes after definitive concurrent chemoradiotherapy (CCRT) for cervical cancer. The cases were divided into two groups based on the values of NLR and PLR: High NLR-PLR (high value in both NLR and PLR) and Low NLR-PLR (low value in either NLR or PLR). The relationships between survival outcomes and the pretreatment NLR-PLR were investigated. Of the 148 patients enrolled in the study, 30 patients died during the median follow-up of 75 months. Based on receiver operating curves, NLR and PLR cut-off values for survival analysis were 2.34 and 148.89. The 10-year overall survival and disease-free survival rates for high NLR-PLR vs. low NLR-PLR were 63.6% vs. 86.2% (p = 0.001) and 63.3% vs. 77.5% (p = 0.026), respectively. Based on a multivariate analysis, independent predictors of overall survival were high NLR-PLR (hazard ratio [HR], 2.435; 95% confidence interval [CI], 1.106–5.361; p = 0.027) and stage (HR 2.659; 95% CI, 1.146–6.613; p = 0.024). Increases in both NLR and PLR are associated with poor survival. Elevation in both NLR and PLR before initiation of CCRT may be a useful biomarker for predicting clinical outcomes. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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10 pages, 935 KiB

Open AccessArticle

Effectiveness of 0.66% Povidone-Iodine Eye Drops on Ocular Surface Flora before Cataract Surgery: A Nationwide Microbiological Study

by Rosario Musumeci, Pasquale Troiano, Marianna Martinelli, Matteo Piovella, Claudio Carbonara, Scipione Rossi, Giovanni Alessio, Luisa Molteni, Claudio Giuseppe Molteni, Laura Saderi, Giovanni Sotgiu and Clementina Elvezia Cocuzza

J. Clin. Med. 2021, 10(10), 2198; https://doi.org/10.3390/jcm10102198 - 19 May 2021

Cited by 8 | Viewed by 2441

Abstract

A multicenter, nonrandomized, prospective, controlled study was conducted to evaluate, as perioperative prophylactic treatment, the anti-infective effectiveness of 0.66% povidone-iodine eye drops (IODIM^®) against the bacterial flora of the conjunctival surface of patients who undergo cataract surgery. Eye drops containing 0.66% [...] Read more.

A multicenter, nonrandomized, prospective, controlled study was conducted to evaluate, as perioperative prophylactic treatment, the anti-infective effectiveness of 0.66% povidone-iodine eye drops (IODIM^®) against the bacterial flora of the conjunctival surface of patients who undergo cataract surgery. Eye drops containing 0.66% povidone-iodine were applied to the eye undergoing cataract surgery; the untreated contralateral eye was used as control. One hundred and twenty patients set to receive unilateral cataract surgery were enrolled in 5 Italian Ophthalmology Centers and pretreated for three days with 0.66% povidone-iodine eye drops. The contralateral eye, used as control, was left untreated. Conjunctival swabs of both eyes were collected at the baseline visit and after three days of treatment, just before the cataract surgery. A qualitative and quantitative microbiological analysis of bacterial presence was evaluated by means of bacterial culture, followed by identification. Methicillin resistance determination was also performed on staphylococci isolates. Bacterial load before and after treatment of the eye candidate for cataract surgery was evaluated and compared to the untreated eye. A reduction or no regrowth on the culture media of the bacterial load was observed in 100% of the study subjects. A great heterogenicity of bacterial species was found. The 0.66% povidone-iodine eye drops, used for three days prior to cataract surgery, were effective in reducing the conjunctival bacterial load. The 0.66% povidone-iodine eye drops (IODIM^®) might represent a valid perioperative prophylactic antiseptic adjuvant treatment to protect the ocular surface from microbial contamination in preparation of the surgical procedure. Full article

(This article belongs to the Section Ophthalmology)

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13 pages, 10639 KiB

Open AccessArticle

Quality of Life of Patients after Kinesio Tape Applications Following Impacted Mandibular Third Molar Surgeries

by Aleksandra Jaroń, Olga Preuss, Berenika Konkol and Grzegorz Trybek

J. Clin. Med. 2021, 10(10), 2197; https://doi.org/10.3390/jcm10102197 - 19 May 2021

Cited by 12 | Viewed by 2452

Abstract

Today, extraction of the impacted third molar is the most common procedure performed in oral surgery departments. One of the methods currently investigated—in terms reducing the severity of non-infectious complications and decreasing Quality of Life following third molar surgeries—is Kinesio Taping (KT). The [...] Read more.

Today, extraction of the impacted third molar is the most common procedure performed in oral surgery departments. One of the methods currently investigated—in terms reducing the severity of non-infectious complications and decreasing Quality of Life following third molar surgeries—is Kinesio Taping (KT). The aim of the study was to evaluate the impact of Kinesio Tape application on Quality of Life. A total of 100 asymptomatic patients with impacted third lower molar were included. The study participants were randomly divided into two groups: a study group with the application of KT (n = 50) and a control group (without KT) (n = 50). Removal of the impacted third lower molar was performed in each patient in a standardized fashion. For assessment of Quality of Life, the modified University of Washington Quality of Life Questionnaire (UW-QoL v4) was used. Patients with Kinesio Tape application scored higher in all domains. Statistically significant differences between the two groups were found in the following domains: “Activity”, “Mood”, “Health-related QoL during the past 7 days” and “Overall QoL during the past 7 days”. There were no significant differences in significant problems and important issues between groups. Kinesio Taping has a significant impact on Quality of Life after impacted third molar removal. It should be considered as one of the noninvasive methods to reduce postoperative non-infectious complications. Full article

(This article belongs to the Special Issue Advancements and New Technologies in Clinical Dentistry)

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11 pages, 1479 KiB

Open AccessReview

Low Dose Chest CT and Lung Ultrasound for the Diagnosis and Management of COVID-19

by Julie Finance, Laurent Zieleskewicz, Paul Habert, Alexis Jacquier, Philippe Parola, Alain Boussuges, Fabienne Bregeon and Carole Eldin

J. Clin. Med. 2021, 10(10), 2196; https://doi.org/10.3390/jcm10102196 - 19 May 2021

Cited by 11 | Viewed by 5270

Abstract

Background: The COVID-19 pandemic has provided an opportunity to use low- and non-radiating chest imaging techniques on a large scale in the context of an infectious disease, which has never been done before. Previously, low-dose techniques were rarely used for infectious diseases, despite [...] Read more.

Background: The COVID-19 pandemic has provided an opportunity to use low- and non-radiating chest imaging techniques on a large scale in the context of an infectious disease, which has never been done before. Previously, low-dose techniques were rarely used for infectious diseases, despite the recognised danger of ionising radiation. Method: To evaluate the role of low-dose computed tomography (LDCT) and lung ultrasound (LUS) in managing COVID-19 pneumonia, we performed a review of the literature including our cases. Results: Chest LDCT is now performed routinely when diagnosing and assessing the severity of COVID-19, allowing patients to be rapidly triaged. The extent of lung involvement assessed by LDCT is accurate in terms of predicting poor clinical outcomes in COVID-19-infected patients. Infectious disease specialists are less familiar with LUS, but this technique is also of great interest for a rapid diagnosis of patients with COVID-19 and is effective at assessing patient prognosis. Conclusions: COVID-19 is currently accelerating the transition to low-dose and “no-dose” imaging techniques to explore infectious pneumonia and their long-term consequences. Full article

(This article belongs to the Special Issue Global Public Health in COVID-19: Pandemic Research from University Hospital Institute Méditerranée Infection)

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12 pages, 679 KiB

Open AccessArticle

Characteristics and Risk Factors for Intensive Care Unit Cardiac Arrest in Critically Ill Patients with COVID-19—A Retrospective Study

by Kevin Roedl, Gerold Söffker, Dominic Wichmann, Olaf Boenisch, Geraldine de Heer, Christoph Burdelski, Daniel Frings, Barbara Sensen, Axel Nierhaus, Dirk Westermann, Stefan Kluge and Dominik Jarczak

J. Clin. Med. 2021, 10(10), 2195; https://doi.org/10.3390/jcm10102195 - 19 May 2021

Cited by 2 | Viewed by 2170

Abstract

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causing the coronavirus disease 2019 (COVID-19) led to an ongoing pandemic with a surge of critically ill patients. Very little is known about the occurrence and characteristic of cardiac arrest in critically ill patients with COVID-19 [...] Read more.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causing the coronavirus disease 2019 (COVID-19) led to an ongoing pandemic with a surge of critically ill patients. Very little is known about the occurrence and characteristic of cardiac arrest in critically ill patients with COVID-19 treated at the intensive care unit (ICU). The aim was to investigate the incidence and outcome of intensive care unit cardiac arrest (ICU-CA) in critically ill patients with COVID-19. This was a retrospective analysis of prospectively recorded data of all consecutive adult patients with COVID-19 admitted (27 February 2020–14 January 2021) at the University Medical Centre Hamburg-Eppendorf (Germany). Of 183 critically ill patients with COVID-19, 18% (n = 33) had ICU-CA. The median age of the study population was 63 (55–73) years and 66% (n = 120) were male. Demographic characteristics and comorbidities did not differ significantly between patients with and without ICU-CA. Simplified Acute Physiological Score II (SAPS II) (ICU-CA: median 44 points vs. no ICU-CA: 39 points) and Sequential Organ Failure Assessment (SOFA) score (median 12 points vs. 7 points) on admission were significantly higher in patients with ICU-CA. Acute respiratory distress syndrome (ARDS) was present in 91% (n = 30) with and in 63% (n = 94) without ICU-CA (p = 0.002). Mechanical ventilation was more common in patients with ICU-CA (97% vs. 67%). The median stay in ICU before CA was 6 (1–17) days. A total of 33% (n = 11) of ICU-CAs occurred during the first 24 h of ICU stay. The initial rhythm was non-shockable (pulseless electrical activity (PEA)/asystole) in 91% (n = 30); 94% (n = 31) had sustained return of spontaneous circulation (ROSC). The median time to ROSC was 3 (1–5) minutes. Patients with ICU-CA had significantly higher ICU mortality (61% vs. 37%). Multivariable logistic regression showed that the presence of ARDS (odds ratio (OR) 4.268, 95% confidence interval (CI) 1.211–15.036; p = 0.024) and high SAPS II (OR 1.031, 95% CI 0.997–1.065; p = 0.077) were independently associated with the occurrence of ICU-CA. A total of 18% of critically ill patients with COVID-19 suffered from a cardiac arrest within the intensive care unit. The occurrence of ICU-CA was associated with presence of ARDS and severity of illness. Full article

(This article belongs to the Special Issue Cardiopulmonary Resuscitation in COVID-19 Pandemic)

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11 pages, 2711 KiB

Open AccessArticle

Association of Perioperative Regional Analgesia with Postoperative Patient-Reported Pain Outcomes and Opioid Requirements: Comparing 22 Different Surgical Groups in 23,911 Patients from the QUIPS Registry

by Marcus Komann, Alexander Avian, Johannes Dreiling, Hans Gerbershagen, Thomas Volk, Claudia Weinmann and Winfried Meißner

J. Clin. Med. 2021, 10(10), 2194; https://doi.org/10.3390/jcm10102194 - 19 May 2021

Cited by 5 | Viewed by 2419

Abstract

(1) Background: In many surgical procedures, regional analgesia (RA) techniques are associated with improved postoperative analgesia compared to systemic pain treatment. As continuous RA requires time and experienced staff, it would be helpful to identify settings in which continuous RA has the largest [...] Read more.

(1) Background: In many surgical procedures, regional analgesia (RA) techniques are associated with improved postoperative analgesia compared to systemic pain treatment. As continuous RA requires time and experienced staff, it would be helpful to identify settings in which continuous RA has the largest benefit. (2) Methods: On the basis of 23,911 data sets from 179 German and Austrian hospitals, we analyzed the association of perioperative RA with patient-reported pain intensity, functional impairment of movement, nausea and opioid use for different surgeries. Regression analyses adjusted for age, sex and preoperative pain were performed for each surgery and the following groups: patients receiving continuous RA (surgery and ward; RA++), RA for surgery only (RA+−) and patients receiving no RA (RA−−). (3) Results: Lower pain scores in the RA++ compared to the RA−− group were observed in 13 out of 22 surgeries. There was no surgery where pain scores for RA++ were higher than for RA−−. If maximal pain, function and side effects were combined, the largest benefit of continuous RA (RA++) was observed in laparoscopic colon and sigmoid surgery, ankle joint arthrodesis, revision (but not primary) surgery of hip replacement, open nephrectomy and shoulder surgery. The benefit of RA+− was lower than that of RA++. (4) Discussion: The additional benefit of RA for the mentioned surgeries is larger than in many other surgeries in clinical routine. The decision to use RA in a given surgery should be based on the expected pain intensity without RA and its additional benefits. Full article

(This article belongs to the Special Issue Management of Perioperative Pain in the 21st Century – Lessons Learned and How to Move On?)

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16 pages, 6181 KiB

Open AccessReview

Supervised Resistance Training on Functional Capacity, Muscle Strength and Vascular Function in Peripheral Artery Disease: An Updated Systematic Review and Meta-Analysis

by Elizabeth E. Blears, Jessica K. Elias, Christian Tapking, Craig Porter and Victoria G. Rontoyanni

J. Clin. Med. 2021, 10(10), 2193; https://doi.org/10.3390/jcm10102193 - 19 May 2021

Cited by 7 | Viewed by 2575

Abstract

Supervised resistance training appears to be a promising alternative exercise modality to supervised walking in patients with peripheral artery disease (PAD). This meta-analysis examined the efficacy of supervised RT for improving walking capacity, and whether adaptations occur at the vascular and/or skeletal muscle [...] Read more.

Supervised resistance training appears to be a promising alternative exercise modality to supervised walking in patients with peripheral artery disease (PAD). This meta-analysis examined the efficacy of supervised RT for improving walking capacity, and whether adaptations occur at the vascular and/or skeletal muscle level in PAD patients. We searched Medline, CINAHL, Scopus, and Cochrane Central Register of Controlled Trials databases for randomized controlled trials (RCTs) in PAD patients testing the effects of supervised RT for ≥4 wk. on walking capacity, vascular function, and muscle strength. Pooled effect estimates were calculated and evaluated using conventional meta-analytic procedures. Six RCTs compared supervised RT to standard care. Overall, supervised RT prolonged claudication onset distance during a 6-min walk test (6-MWT) (101.7 m (59.6, 143.8), p < 0.001) and improved total walking distance during graded treadmill walking (SMD: 0.67 (0.33, 1.01), p < 0.001) and the 6-MWT (49.4 m (3.1, 95.6), p = 0.04). Five RCTS compared supervised RT and supervised intermittent walking, where the differences in functional capacity between the two exercise modalities appear to depend on the intensity of the exercise program. The insufficient evidence on the effects of RT on vascular function and muscle strength permitted only limited exploration. We conclude that RT is effective in prolonging walking performance in PAD patients. Whether RT exerts its influence on functional capacity by promoting blood flow and/or enhancing skeletal muscle strength remains unclear. Full article

(This article belongs to the Special Issue Peripheral Artery Disease: From Diagnosis to Treatment)

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Open AccessReview

Cardiac Rehabilitation in German Speaking Countries of Europe—Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 1

by Bernhard Rauch, Annett Salzwedel, Birna Bjarnason-Wehrens, Christian Albus, Karin Meng, Jean-Paul Schmid, Werner Benzer, Matthes Hackbusch, Katrin Jensen, Bernhard Schwaab, Johann Altenberger, Nicola Benjamin, Kurt Bestehorn, Christa Bongarth, Gesine Dörr, Sarah Eichler, Hans-Peter Einwang, Johannes Falk, Johannes Glatz, Stephan Gielen, Maurizio Grilli, Ekkehard Grünig, Manju Guha, Matthias Hermann, Eike Hoberg, Stefan Höfer, Harald Kaemmerer, Karl-Heinz Ladwig, Wolfgang Mayer-Berger, Maria-Inti Metzendorf, Roland Nebel, Rhoia Clara Neidenbach, Josef Niebauer, Uwe Nixdorff, Renate Oberhoffer, Rona Reibis, Nils Reiss, Daniel Saure, Axel Schlitt, Heinz Völler, Roland von Känel, Susanne Weinbrenner, Ronja Westphal and on behalf of the Cardiac Rehabilitation Guideline Group Show full author list Hide full author list

J. Clin. Med. 2021, 10(10), 2192; https://doi.org/10.3390/jcm10102192 - 19 May 2021

Cited by 21 | Viewed by 4861

Abstract

Background: Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases. Methods: The guidelines address all aspects [...] Read more.

Background: Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases. Methods: The guidelines address all aspects of CR including indications, contents and delivery. By processing the guidelines, every step was externally supervised and moderated by independent members of the “Association of the Scientific Medical Societies in Germany” (AWMF). Four meta-analyses were performed to evaluate the prognostic effect of CR after acute coronary syndrome (ACS), after coronary bypass grafting (CABG), in patients with severe chronic systolic heart failure (HFrEF), and to define the effect of psychological interventions during CR. All other indications for CR-delivery were based on a predefined semi-structured literature search and recommendations were established by a formal consenting process including all medical societies involved in guideline generation. Results: Multidisciplinary CR is associated with a significant reduction in all-cause mortality in patients after ACS and after CABG, whereas HFrEF-patients (left ventricular ejection fraction <40%) especially benefit in terms of exercise capacity and health-related quality of life. Patients with other cardiovascular diseases also benefit from CR-participation, but the scientific evidence is less clear. There is increasing evidence that the beneficial effect of CR strongly depends on “treatment intensity” including medical supervision, treatment of cardiovascular risk factors, information and education, and a minimum of individually adapted exercise volume. Additional psychologic interventions should be performed on the basis of individual needs. Conclusions: These guidelines reinforce the substantial benefit of CR in specific clinical indications, but also describe remaining deficits in CR-delivery in clinical practice as well as in CR-science with respect to methodology and presentation. Full article

(This article belongs to the Section Cardiology)

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J. Clin. Med., Volume 10, Issue 10 (May-2 2021) – 177 articles

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