Journal of Clinical Medicine

10 pages, 1132 KiB

Open AccessArticle

Radioactive Iodine Treatment and the Risk of Long-Term Cardiovascular Morbidity and Mortality in Thyroid Cancer Patients: A Nationwide Cohort Study

by Chun-Hao Kao, Chi-Hsiang Chung, Wu-Chien Chien, Daniel Hueng-Yuan Shen, Li-Fan Lin, Chuang-Hsin Chiu, Cheng-Yi Cheng, Chien-An Sun and Ping-Ying Chang

J. Clin. Med. 2021, 10(17), 4032; https://doi.org/10.3390/jcm10174032 - 06 Sep 2021

Cited by 3 | Viewed by 2733

Abstract

(1) Background: This study aimed to investigate the association between radioactive iodine (RAI) and long-term cardiovascular disease (CVD) morbidity/mortality in thyroid cancer. (2) Methods: The study was conducted using data from the Taiwan National Health Insurance Database during 2000–2015. Thyroid cancer patients aged [...] Read more.

(1) Background: This study aimed to investigate the association between radioactive iodine (RAI) and long-term cardiovascular disease (CVD) morbidity/mortality in thyroid cancer. (2) Methods: The study was conducted using data from the Taiwan National Health Insurance Database during 2000–2015. Thyroid cancer patients aged ≥20 years were categorized into RAI (thyroidectomy with RAI) and non-RAI (thyroidectomy only) groups. The Cox proportional hazard regression model and Kaplan–Meier method were used for analysis. (3) Results: A total of 13,310 patients were included. Kaplan–Meier analysis demonstrated that the two groups had similar cumulative risks of CVD (log-rank p = 0.72) and CVD-specific mortality (log-rank p = 0.62). On Cox regression analysis of different RAI doses, the risk of CVD was higher in the cumulative dosage >3.7 GBq (hazard ratio = 1.69, 95% confidence interval = 1.24–2.40, p < 0.001). (4) Conclusions: RAI was not associated with an increased risk of CVD in thyroid cancer. However, CVD surveillance is indicated in the patients receiving the cumulative RAI dosage above 3.7 GBq. Full article

(This article belongs to the Section Cardiovascular Medicine)

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14 pages, 970 KiB

Open AccessArticle

Changes in Physical Fitness and Body Composition Associated with Physical Exercise in Patients with Myasthenia Gravis: A Longitudinal Prospective Study

by Che-Cheng Chang, Yen-Kung Chen, Hou-Chang Chiu and Jiann-Horng Yeh

J. Clin. Med. 2021, 10(17), 4031; https://doi.org/10.3390/jcm10174031 - 06 Sep 2021

Cited by 7 | Viewed by 2940

Abstract

There is a lack of guidelines for physical exercise in patients with myasthenia gravis (MG). A few pilot studies have shown that exercise can be safely applied to patients with MG. However, how physical exercise affects body composition, disease function, and disease severity [...] Read more.

There is a lack of guidelines for physical exercise in patients with myasthenia gravis (MG). A few pilot studies have shown that exercise can be safely applied to patients with MG. However, how physical exercise affects body composition, disease function, and disease severity remains unknown. In this prospective study, we enrolled 34 patients with MG with stable condition and evaluated the disease severity, physical fitness parameters, and body composition (measured using whole-body dual-energy X-ray absorptiometry (DXA)), before and after conducting a 24-week physical exercise regimen of aerobic and resistance strength training. The outcomes were measured by DXA, quantitative MG (QMG) score, quality of life score, handgrip strength and walking speed. During the training regimen, participants were free to decide how many exercise sessions per week and regularly reported their weekly exercise time. The physical exercise program was well tolerated by the participants, the parameters of the QMG score and handgrip strength improved, and participants’ body composition did not change significantly. The high exercise group experienced greater deterioration in muscle mass in the arms, but exhibited a greater improvement in forced vital capacity, walking speed, and symptom severity. The group with low QMG scores improved more in terms of physical fitness, including walking speed. These findings indicate that physical exercise is well tolerated by patients with MG, and is accompanied by improved muscular and physical functions. We propose that physical exercise is safe, effective, and appropriate for patients with well-regulated MG. Full article

(This article belongs to the Special Issue Myasthenia Gravis: Clinical Manifestations, Epidemiology, Pathophysiology, Diagnosis, Current and Future Therapies)

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10 pages, 3033 KiB

Open AccessArticle

Clinical Significance of Variable Histomorphologic Findings Related to Mucosal Inflammation in Negative Appendectomy

by Euno Choi, Youngeun Yoo, Ji Min Kim, Sun Hee Sung, Dakeun Lee and Sanghui Park

J. Clin. Med. 2021, 10(17), 4030; https://doi.org/10.3390/jcm10174030 - 06 Sep 2021

Cited by 1 | Viewed by 1753

Abstract

The aim of the study was to investigate the clinical significance of various histomorphologic findings related to mucosal inflammation in negative appendectomy. We reviewed histopathologic findings of 118 negative appendectomies and correlated them with the appendicitis inflammatory response (AIR) score and appendiceal diameter. [...] Read more.

The aim of the study was to investigate the clinical significance of various histomorphologic findings related to mucosal inflammation in negative appendectomy. We reviewed histopathologic findings of 118 negative appendectomies and correlated them with the appendicitis inflammatory response (AIR) score and appendiceal diameter. Among 118 patients with negative appendectomy, 94 (80%), 73 (78%) and 89 (75%) patients displayed mucosal inflammation, high neutrophil score (neutrophil count ≥10/5 high power field and surface epithelial flattening, respectively. Out of 118 patients with negative appendectomy, mucosal inflammation, high neutrophil score and surface epithelial flattening were associated with higher risk group according to the appendicitis inflammatory response (AIR) score (p < 0.05, respectively). In addition, mucosal inflammation, high neutrophil score and surface epithelial flattening were frequently detected in 118 negative appendectomies, compared with 24 incidental appendectomies (p < 0.05, respectively). In an analysis of 77 negative appendectomy patients with appendiceal diameter data available, increased appendiceal diameter was positively correlated with luminal inflammation, high neutrophil score and surface epithelial flattening (p < 0.05, respectively). In conclusion, mucosal inflammation, high neutrophil score and surface epithelial flattening in negative appendectomy may be relevant to patients’ signs and symptoms, especially in cases with no other cause of the abdominal pain. Full article

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

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11 pages, 2439 KiB

Open AccessArticle

Reduction of Phantom Limb Pain and Improved Proprioception through a TSR-Based Surgical Technique: A Case Series of Four Patients with Lower Limb Amputation

by Alexander Gardetto, Eva-Maria Baur, Cosima Prahm, Vinzenz Smekal, Johannes Jeschke, Gerfried Peternell, Michael T. Pedrini and Jonas Kolbenschlag

J. Clin. Med. 2021, 10(17), 4029; https://doi.org/10.3390/jcm10174029 - 06 Sep 2021

Cited by 12 | Viewed by 7095

Abstract

Four patients underwent targeted sensory reinnervation (TSR), a surgical technique in which a defined skin area is first selectively denervated and then surgically reinnervated by another sensory nerve. In our case, either the area of the lateral femoral cutaneous nerve or the saphenous [...] Read more.

Four patients underwent targeted sensory reinnervation (TSR), a surgical technique in which a defined skin area is first selectively denervated and then surgically reinnervated by another sensory nerve. In our case, either the area of the lateral femoral cutaneous nerve or the saphenous nerve was reinnervated by the sural nerve. Patients were then fitted with a special prosthetic device capable of transferring the sense of pressure from the sole of the prosthesis to the newly wired skin area. Pain reduction after TSR was highly significant in all patients. In three patients, permanent pain medication could even be discontinued, in one patient the pain medication has been significantly reduced. Two of the four patients were completely pain-free after the surgical intervention. Surgical rewiring of existing sensory nerves by TSR can provide the brain with new afferent signals seeming to originate from the missing limb. These signals help to reduce phantom limb pain and to restore a more normal body image. In combination with special prosthetic devices, the amputee can be provided with sensory feedback from the prosthesis, thus improving gait and balance. Full article

(This article belongs to the Special Issue Updates in Aesthetic and Reconstructive Surgery)

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19 pages, 883 KiB

Open AccessArticle

The Acute Effects of Aerobic Exercise on Nocturnal and Pre-Sleep Arousal in Patients with Unipolar Depression: Preplanned Secondary Analysis of a Randomized Controlled Trial

by Gavin Brupbacher, Thea Zander-Schellenberg, Doris Straus, Hildburg Porschke, Denis Infanger, Markus Gerber, Roland von Känel and Arno Schmidt-Trucksäss

J. Clin. Med. 2021, 10(17), 4028; https://doi.org/10.3390/jcm10174028 - 06 Sep 2021

Cited by 3 | Viewed by 3231

Abstract

Unipolar depression is associated with insomnia and autonomic arousal. The aim of this study was to quantify the effect of a single bout of aerobic exercise on nocturnal heart rate variability and pre-sleep arousal in patients with depression. This study was designed as [...] Read more.

Unipolar depression is associated with insomnia and autonomic arousal. The aim of this study was to quantify the effect of a single bout of aerobic exercise on nocturnal heart rate variability and pre-sleep arousal in patients with depression. This study was designed as a two-arm, parallel-group, randomized, outcome assessor-blinded, controlled, superiority trial. Patients with a primary diagnosis of unipolar depression aged 18–65 years were included. The intervention consisted of a single 30 min moderate-intensity aerobic exercise bout. The control group sat and read for 30 min. The primary outcome of interest was RMSSD during the sleep period assessed with polysomnography. Secondary outcomes were additional heart rate variability outcomes during the sleep and pre-sleep period as well as subjective pre-sleep arousal. A total of 92 patients were randomized to either the exercise (N = 46) or the control (N = 46) group. Intent-to-treat analysis ANCOVA of follow-up sleep period RMSSD, adjusted for baseline levels and minimization factors, did not detect a significant effect of the allocation (β = 0.12, p = 0.94). There was no evidence for significant differences between both groups in any other heart rate variability measure nor in measures of cognitive or somatic pre-sleep arousal. As this is the first trial of its kind in this population, the findings need to be confirmed in further studies. Patients with depression should be encouraged to exercise regularly in order to profit from the known benefits on sleep and depressive symptoms, which are supported by extensive literature. Full article

(This article belongs to the Special Issue Effects of Stress and Psychological Trauma on the Development and Progression of Cardiovascular Diseases)

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16 pages, 1173 KiB

Open AccessArticle

Dissociation and Suicidality in Eating Disorders: The Mediating Function of Body Image Disturbances, and the Moderating Role of Depression and Anxiety

by Yael Doreen Lewis, Shirley Kapon, Adi Enoch-Levy, Amit Yaroslavsky, Eliezer Witztum and Daniel Stein

J. Clin. Med. 2021, 10(17), 4027; https://doi.org/10.3390/jcm10174027 - 06 Sep 2021

Cited by 6 | Viewed by 3020

Abstract

In patients with eating disorders (EDs), elevated dissociation may increase the risk of suicide. Bodily related disturbances, depression, and anxiety may intervene in the association between dissociation and suicidality. In this study we aimed to examine the influence of bodily related disturbances, depression, [...] Read more.

In patients with eating disorders (EDs), elevated dissociation may increase the risk of suicide. Bodily related disturbances, depression, and anxiety may intervene in the association between dissociation and suicidality. In this study we aimed to examine the influence of bodily related disturbances, depression, anxiety, severity of ED symptoms, body mass index (BMI), and type and duration of the ED on the relationship between elevated dissociation and elevated suicidality. The study included 172 inpatients: 65 with anorexia nervosa restricting type, 60 with anorexia nervosa binge/purge type, and 37 with bulimia nervosa. Participants were assessed using self-rating questionnaires for dissociation, suicidality, bodily related parameters, and severity of ED symptomatology, depression, and anxiety. We found that dissociation and suicidality were directly associated. In addition, depression and anxiety moderated the mediating role of body image parameters in the association between increased dissociation and increased suicidality. Thus, only in inpatients with high depression and anxiety, i.e., above the median range, body image disturbances were found to mediate the association between dissociation and suicidality. ED-related parameters did not moderate these relationships. Our study demonstrates that in inpatients with EDs, increased dissociation may be significantly associated with increased suicidality, both directly and via the intervening influence of body image, depression, and anxiety. Full article

(This article belongs to the Special Issue Special Updated Research on Eating Disorders: Medical Perspectives)

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9 pages, 1989 KiB

Open AccessArticle

The Relationship between Serum Uric Acid and Ejection Fraction of the Left Ventricle

by Vlad-Sabin Ivan, Roxana Buzas, Adina-Flavia Cuțina Morgovan, Paul Ciubotaru, Melania Ardelean, Daniel Goje, Ciprian Ilie Roșca, Romulus Timar and Daniel Lighezan

J. Clin. Med. 2021, 10(17), 4026; https://doi.org/10.3390/jcm10174026 - 06 Sep 2021

Cited by 4 | Viewed by 1820

Abstract

Study basis: As a byproduct of protein metabolism, serum uric acid is a controversial risk factor and is the focus of several recent studies in the field of cardiovascular disease. Whether serum uric acid is involved in the development of these pathologies alone [...] Read more.

Study basis: As a byproduct of protein metabolism, serum uric acid is a controversial risk factor and is the focus of several recent studies in the field of cardiovascular disease. Whether serum uric acid is involved in the development of these pathologies alone or in conjunction with other factors is a matter of debate. Objective: The objective of this study is to assess the direct relationship between serum uric acid and the ejection fraction. Methods: A retrospective study of 303 patients with heart failure, classified according to the ESC guidelines, was conducted, and several parameters, along with the relationship between serum uric acid and ejection fraction, were characterized. Results: A direct relationship between the level of serum uric acid and the ejection fraction was established (p = 0.03); patients with higher uric acid had an increased risk of having a lower ejection fraction. Conclusions: Serum uric acid, even when asymptomatic, is linked with the level of the ejection fraction of the left ventricle. Full article

(This article belongs to the Section Cardiology)

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21 pages, 4374 KiB

Open AccessArticle

Changes in Stress, Coping Styles, and Life Satisfaction between the First and Second Waves of the COVID-19 Pandemic: A Longitudinal Cross-Lagged Study in a Sample of University Students

by Aleksandra Maria Rogowska, Cezary Kuśnierz and Dominika Ochnik

J. Clin. Med. 2021, 10(17), 4025; https://doi.org/10.3390/jcm10174025 - 06 Sep 2021

Cited by 39 | Viewed by 7485 | Correction

Abstract

In this study, we aimed to explain the interplay mechanism between stress, life satisfaction, and coping styles among university students. A cohort study was performed during the first (wave 1; W1) and second (wave 2; W2) waves of the Coronavirus disease 2019 (COVID-19) [...] Read more.

In this study, we aimed to explain the interplay mechanism between stress, life satisfaction, and coping styles among university students. A cohort study was performed during the first (wave 1; W1) and second (wave 2; W2) waves of the Coronavirus disease 2019 (COVID-19) pandemic. The total sample included 231 university students, of which 59.31% were women. The Satisfaction with Life Scale (SWLS), Perceived Stress Scale (PSS), and Coping Inventory for Stressful Situations (CISS) were included in one online survey. Stress, emotion-oriented, and avoidance-oriented coping styles increased from W1 to W2 of the COVID-19 pandemic, while life satisfaction and task-oriented coping decreased. The partial mediation effect of all three coping styles during W1 and W2 (in a cross-sectional approach) on the relationship between perceived stress and life satisfaction was confirmed in this study. The task-oriented and emotion-oriented coping styles can play a mediating role in the reciprocal relationship between life satisfaction and perceived stress during W1 and W2 of the pandemic. There were no mutual interactions between stress and life satisfaction from a longitudinal approach. Coping styles changed subsequently due to stressful environmental changes related to lockdown during the COVID-19 pandemic. Having a wide range of coping strategies from which to choose during an unstable situation should help manage stress and well-being. Full article

(This article belongs to the Special Issue The Impact of the COVID-19 Emergency on the Quality of Life of the General Population)

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17 pages, 2222 KiB

Open AccessArticle

Portomesenteric Vein Thrombosis after Bariatric Surgery: An Online Survey

by Francesco Maria Carrano, Sylvia Weiner, Moustafa Elshafei, Saleem Ahmed, Toghrul Talishinskiy, Valeria Tognoni, Kamal Mahawar and Nicola Di Lorenzo

J. Clin. Med. 2021, 10(17), 4024; https://doi.org/10.3390/jcm10174024 - 06 Sep 2021

Cited by 7 | Viewed by 2168

Abstract

Portomesenteric vein thrombosis (PMVT) is a rare post-operative complication of bariatric procedures, occurring in between 0.3% and 1% of cases. A structured questionnaire consisting of 27 items was available online to members of the International Federation for the Surgery of Obesity and Metabolic [...] Read more.

Portomesenteric vein thrombosis (PMVT) is a rare post-operative complication of bariatric procedures, occurring in between 0.3% and 1% of cases. A structured questionnaire consisting of 27 items was available online to members of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) to investigate the occurrence of PMVT. A total of 89 bariatric surgeons from 61 countries participated. Twenty-six (29.21%) reported at least one case of PMVT (46.15% males; 53.84% females). The surgery most associated with PMVT occurrence was sleeve gastrectomy (84.6%), followed by Roux-en-Y gastric bypass (RYGB) (7.69%), and laparoscopic adjustable gastric banding (LAGB) (7.69%). The time gap between surgery and PMVT was 19.28 ± 8.72 days. The predominant symptom was abdominal pain in 96.15% of patients, followed by fever in 26.9%. Complete occlusion of the portal vein was reported in 34.6% of cases, with involvement of the portal system in 69%, extension to the superior mesenteric district in 23%, and extension to the splenic vein in two patients (7.7%). Our survey, which is the largest regarding PMVT to date, revealed a diffuse lack of standardization in the choice, duration, and dosing of prophylaxis regimens as well as treatment modalities, reflecting the literature gap on the topic. Full article

(This article belongs to the Special Issue Portal Vein Thrombosis)

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Graphical abstract

11 pages, 5104 KiB

Open AccessArticle

Psychometric Validation of the Cardiff Wound Impact Schedule Questionnaire in a Spanish Population with Diabetic Foot Ulcer

by Minerva Granado-Casas, Dolores Martinez-Gonzalez, Montserrat Martínez-Alonso, Montserrat Dòria, Nuria Alcubierre, Joan Valls, Josep Julve, José Verdú-Soriano and Didac Mauricio

J. Clin. Med. 2021, 10(17), 4023; https://doi.org/10.3390/jcm10174023 - 06 Sep 2021

Cited by 3 | Viewed by 2330

Abstract

Diabetic foot ulcers (DFU) negatively affect the quality of life (QoL) of people with diabetes. The Cardiff Wound Impact Schedule (CWIS) questionnaire has been designed to measure the QoL of people with chronic foot wounds. However, no studies have been specifically designed to [...] Read more.

Diabetic foot ulcers (DFU) negatively affect the quality of life (QoL) of people with diabetes. The Cardiff Wound Impact Schedule (CWIS) questionnaire has been designed to measure the QoL of people with chronic foot wounds. However, no studies have been specifically designed to validate this instrument in a Spanish population. In this prospective study, a total of 141 subjects with DFU were recruited. DFU was determined by performing physical examinations. Medical records were exhaustively reviewed to collect clinical variables. The CWIS was transculturally adapted by a group of experts and a group of patients with DFU. The SF-36 and EQ-5D generic instruments were used as reference tools. The questionnaires were administered at 7 days and 4, 12, and 26 weeks after the baseline assessment by personal interview with each of the study subjects. The psychometric properties of the instrument were assessed using statistical methods. The content validity had an average of 3.63 (90.7% of the maximum score of 4). The internal consistency of the CWIS subscales had a standardized Cronbach’s alpha range from 0.715 to 0.797. The reproducibility was moderate with an intraclass correlation coefficient (ICC) range from 0.606 to 0.868. Significant correlations between CWIS domains and SF-36 and EQ-5D subscales were observed, demonstrating a good criterion validity of the CWIS questionnaire (p < 0.001). However, the construct validity of the CWIS was not validated with a comparative fit index (CFI) of 0.69, a root mean square error of approximation (RMSEA) of 0.09, and a standardized root mean square residual (SRMR) of 0.10. The sensitivity to changes over time was optimal in the three domains (i.e., social life, well-being, and physical symptoms) (p < 0.001). In conclusion, the Spanish version of the CWIS shows acceptable psychometric properties to assess the QoL of subjects with DFU, except for its construct validity. Full article

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

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15 pages, 1376 KiB

Open AccessArticle

The Prognostic Role of Right Ventricular Stroke Work Index during Liver Transplantation

by Young Hyun Jeong, Seong-Mi Yang, Hyeyeon Cho, Jae-Woo Ju, Hwan Suk Jang, Ho-Jin Lee and Won Ho Kim

J. Clin. Med. 2021, 10(17), 4022; https://doi.org/10.3390/jcm10174022 - 06 Sep 2021

Cited by 2 | Viewed by 1716

Abstract

Right heart-associated hemodynamic parameters including intraoperative pulmonary vascular resistance (PVR) were reported to be associated with patient survival after liver transplantation. We investigated whether intraoperative stroke work indexes of both ventricles could have a better prognostic value than PVR. We reviewed 683 cases [...] Read more.

Right heart-associated hemodynamic parameters including intraoperative pulmonary vascular resistance (PVR) were reported to be associated with patient survival after liver transplantation. We investigated whether intraoperative stroke work indexes of both ventricles could have a better prognostic value than PVR. We reviewed 683 cases at a tertiary care academic medical center. We collected intraoperative variables of baseline central venous pressure, baseline right ventricle end-diastolic volume, mixed venous oxygen saturation, intraoperative PVR and right and left ventricular stroke work indexes. Time-weighted means or area under the curve of intraoperative right and left ventricular stroke work indexes were calculated as exposure variables. One-year all-cause mortality or graft failure was our primary outcome. Cox proportional hazard regression analysis was performed to evaluate the association between exposure variables and one-year all-cause mortality or graft failure. Kaplan–Meier survival curve analysis of our primary outcome was performed for different time-weighted mean ventricular stroke work index groups. Cubic spline curve analysis was performed to evaluate the linear relationship between our exposure variables and primary outcome. Time-weighted mean right ventricular stroke work index was significantly associated with one-year all-cause mortality or graft failure (hazard ratio 1.21, 95% confidence interval (CI) 1.12–1.36, p < 0.001). However, there was no significant association between time-weighted mean left ventricular stroke work index, time-weighted mean PVR, PVR at the end of surgery and one-year mortality. Area under the curve of right ventricular stroke work index was also significantly associated with one-year mortality or graft failure (hazard ratio 1.24, 95% CI 1.15–1.37, p < 0.001). Kaplan–Meier survival curve analysis showed a significant difference in the survival between different mean right ventricular stroke work index groups (Log-rank test: p = 0.002). Cubic spline function curve showed the gradual increase in the risk of mortality with a positive slope with time-weighted mean right ventricular stroke work index. In conclusion, intraoperative elevated right ventricular stroke work index was significantly associated with poor patient or graft survival after liver transplantation. Intraoperative right ventricular stroke work index could be an intraoperative hemodynamic goal and prognostic marker for mortality after liver transplantation. Full article

(This article belongs to the Special Issue Delivery of Anesthesia: Pre-Operative and Post-Operative)

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14 pages, 1348 KiB

Open AccessArticle

Is Obesity a Risk or Protective Factor for Open-Angle Glaucoma in Adults? A Two-Database, Asian, Matched-Cohort Study

by Wei-Dar Chen, Li-Ju Lai, Kang-Lung Lee, Tzeng-Ji Chen, Chia-Yen Liu and Yao-Hsu Yang

J. Clin. Med. 2021, 10(17), 4021; https://doi.org/10.3390/jcm10174021 - 06 Sep 2021

Cited by 6 | Viewed by 1831

Abstract

Obesity contributes to multiple systemic disorders; however, extensive discussion regarding obesity and open-angle glaucoma (OAG) remains limited, and conclusions in the existing literature diverge. This study aims to analyze the risk of OAG among obese adults in Taiwan. In this study, adults (aged [...] Read more.

Obesity contributes to multiple systemic disorders; however, extensive discussion regarding obesity and open-angle glaucoma (OAG) remains limited, and conclusions in the existing literature diverge. This study aims to analyze the risk of OAG among obese adults in Taiwan. In this study, adults (aged ≥18 years) with a diagnostic code of obesity or morbid obesity registered in the Longitudinal Health Insurance Database (LHID) 2000 and LHID2005 from 1 January 2001 to 31 December 2010 were included. All adults were traced until the diagnosis of OAG, the occurrence of death, or 31 December 2013. Risk of OAG was significantly higher in obese adults than in non-obese adults after multivariable adjustment (adjusted hazard ratio (aHR): 1.43 (95% confidence interval (CI) 1.11–1.84)/aHR: 1.54 (95% CI 1.23–1.94) in the LHID2000/LHID2005). Both databases demonstrated that young obese adults (aged ≤40 years) had a remarkably increased risk of OAG compared with young non-obese adults (aHR 3.08 (95% CI 1.82–5.21)/aHR 3.81 (95% CI 2.26–6.42) in the LHID2000/LHID2005). This two-database matched-cohort study suggests that obese adults have an increased risk of OAG. In young adults, in particular, obesity could be a potential risk factor of OAG. Full article

(This article belongs to the Special Issue Recent Clinical Research on Glaucoma)

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8 pages, 1815 KiB

Open AccessFeature PaperArticle

Comparison of Safety and Efficiency between Tiger-2 Catheter with Right Radial Artery Access and Judkins Catheter with Left Radial Artery Access

by Katarzyna Klimek, Mateusz Świątek, Konrad Klocek, Michał Tworek, Maciej Zwolski, Krzysztof Milewski and Adam Janas

J. Clin. Med. 2021, 10(17), 4020; https://doi.org/10.3390/jcm10174020 - 06 Sep 2021

Viewed by 1963

Abstract

We sought to compare the safety and efficiency of Tiger-2 in the right radial and Judkins catheter in the left radial access. We retrospectively collected data of 487 patients, involving 172 patients after coronary angiography with Judkins on the left radial artery and [...] Read more.

We sought to compare the safety and efficiency of Tiger-2 in the right radial and Judkins catheter in the left radial access. We retrospectively collected data of 487 patients, involving 172 patients after coronary angiography with Judkins on the left radial artery and 315 patients with Tiger-2 on the right radial artery access. There were no differences in baseline characteristics, except for hypertension ratio and mean age. There was a difference in pulse absence on the radial artery. The volume of contrast used was higher in the Judkins group. Both groups differed in the amount of drugs administered (NTG and heparin). Fluorescence times were comparable between groups. Radiation dosage and AK was significantly greater in the Tiger-2 group. The Tiger-2 catheters were significantly more often changed to another type of catheter (100 changes) than the Judkins (12 changes). However, there was no statistical difference in access site change. Judkins with left radial access seems to be a safer option because of the lower radiation exposure and less incidence of complications than Tiger-2 with right radial access, however, it requires a higher volume of contrast. Full article

(This article belongs to the Section Vascular Medicine)

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15 pages, 1981 KiB

Open AccessArticle

Anakinra versus Baricitinib: Different Strategies for Patients Hospitalized with COVID-19

by José A García-García, Marta Pérez-Quintana, Consuelo Ramos-Giráldez, Isabel Cebrián-González, María L Martín-Ponce, José del Valle-Villagrán, María A Navarro-Puerto, Jorge Sánchez-Villegas, Rocío Gómez-Herreros, Isabel Manoja-Bustos, Daniel León-Martí, Lucía Serrano-Rodríguez, Alejandra de Miguel-Albarreal, María J Velasco-Romero, Francisco Mula-Falcón, Pilar Fernández-Pérez, Isabel Melguizo-Moya, María J Pérez-Quintana, Guillermo Romero-Molina, Salvador Vergara-López, José L Marenco-de la Fuente, Jorge Marín-Martín and José A Mira-Escarti Show full author list Hide full author list

J. Clin. Med. 2021, 10(17), 4019; https://doi.org/10.3390/jcm10174019 - 06 Sep 2021

Cited by 12 | Viewed by 2631

Abstract

Background: Immunomodulatory drugs have been used in patients with severe COVID-19. The objective of this study was to evaluate the effects of two different strategies, based either on an interleukin-1 inhibitor, anakinra, or on a JAK inhibitor, such as baricitinib, on the survival [...] Read more.

Background: Immunomodulatory drugs have been used in patients with severe COVID-19. The objective of this study was to evaluate the effects of two different strategies, based either on an interleukin-1 inhibitor, anakinra, or on a JAK inhibitor, such as baricitinib, on the survival of patients hospitalized with COVID-19 pneumonia. Methods: Individuals admitted to two hospitals because of COVID-19 were included if they fulfilled the clinical, radiological, and laboratory criteria for moderate-to-severe disease. Patients were classified according to the first immunomodulatory drug prescribed: anakinra or baricitinib. All subjects were concomitantly treated with corticosteroids, in addition to standard care. The main outcomes were the need for invasive mechanical ventilation (IMV) and in-hospital death. Statistical analysis included propensity score matching and Cox regression model. Results: The study subjects included 125 and 217 individuals in the anakinra and baricitinib groups, respectively. IMV was required in 13 (10.4%) and 10 (4.6%) patients, respectively (p = 0.039). During this period, 22 (17.6%) and 36 (16.6%) individuals died in both groups (p = 0.811). Older age, low functional status, high comorbidity, need for IMV, elevated lactate dehydrogenase, and use of a high flow of oxygen at initially were found to be associated with worse clinical outcomes. No differences according to the immunomodulatory therapy used were observed. For most of the deceased individuals, early interruption of anakinra or baricitinib had occurred at the time of their admission to the intensive care unit. Conclusions: Similar mortality is observed in patients treated with anakinra or baricitinib plus corticosteroids. Full article

(This article belongs to the Special Issue COVID-19: Clinical Advances and Challenges)

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11 pages, 944 KiB

Open AccessArticle

Role of Serum E-Selectin as a Biomarker of Infection Severity in Coronavirus Disease 2019

by Alessandra Oliva, Emanuele Rando, Dania Al Ismail, Massimiliano De Angelis, Francesca Cancelli, Maria Claudia Miele, Raissa Aronica, Vera Mauro, Federica Di Timoteo, Lorenzo Loffredo and Claudio M. Mastroianni

J. Clin. Med. 2021, 10(17), 4018; https://doi.org/10.3390/jcm10174018 - 06 Sep 2021

Cited by 13 | Viewed by 2203

Abstract

Introduction: E-selectin is a recognized marker of endothelial activation; however, its place in Coronavirus Disease 2019 (COVID-19) has not been fully explored. Aims of the study are to compare sE-selectin values among the Intensive Care Unit (ICU)-admitted and non-admitted, survived and non-survived patients [...] Read more.

Introduction: E-selectin is a recognized marker of endothelial activation; however, its place in Coronavirus Disease 2019 (COVID-19) has not been fully explored. Aims of the study are to compare sE-selectin values among the Intensive Care Unit (ICU)-admitted and non-admitted, survived and non-survived patients and those with or without thrombosis. Methods: A single-center study of patients with COVID-19 hospitalized at Policlinico Umberto I (Rome) from March to May 2020 was performed. Simple and multiple logistic regression models were developed. Results: One hundred patients were included, with a median age (IQR) of 65 years (58–78). Twenty-nine (29%) were admitted to ICU, twenty-eight (28%) died and nineteen (19%) had a thrombotic event. The median value (IQR) of sE-selectin was 26.1 ng/mL (18.1–35). sE-selectin values did not differ between deceased and survivors (p = 0.06) and among patients with or without a thrombotic event (p = 0.22). Compared with patients who did not receive ICU treatments, patients requiring ICU care had higher levels of sE-selectin (36.6 vs. 24.1 ng/mL; p < 0.001). In the multiple logistic regression model, sE-selectin levels > 33 ng/mL, PaO₂/FiO₂ < 200 and PaO₂/FiO₂ 200–300 were significantly associated with an increased risk of ICU admission. sE-selectin values significantly correlated with a neutrophil count (R = 0.32 (p = 0.001)) and the number of days from the symptoms onset to hospitalization (R = 0.28 (p = 0.004)). Conclusions: sE-selectin levels are predictive of ICU admission in COVID-19 patients. Since data on the relation between sE-selectin and COVID-19 are scarce, this study aims to contribute toward the comprehension of the pathogenic aspects of COVID-19 disease, giving a possible clinical marker able to predict its severity. Full article

(This article belongs to the Collection Coronavirus Disease 2019: Clinical Presentation, Pathogenesis and Treatment)

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17 pages, 3945 KiB

Open AccessArticle

Impact of the ¹⁸F-FDG-PET/MRI on Metastatic Staging in Patients with Hepatocellular Carcinoma: Initial Results from 104 Patients

by Mathilde Vermersch, Sébastien Mulé, Julia Chalaye, Athena Galletto Pregliasco, Berivan Emsen, Giuliana Amaddeo, Aurélien Monnet, Alto Stemmer, Laurence Baranes, Alexis Laurent, Vincent Leroy, Emmanuel Itti and Alain Luciani

J. Clin. Med. 2021, 10(17), 4017; https://doi.org/10.3390/jcm10174017 - 06 Sep 2021

Cited by 5 | Viewed by 2080

Abstract

Optimal HCC therapeutic management relies on accurate tumor staging. Our aim was to assess the impact of ¹⁸F-FDG-WB-PET/MRI on HCC metastatic staging, compared with the standard of care CT-CAP/liver MRI combination, in patients with HCC referred on a curative intent or before [...] Read more.

Optimal HCC therapeutic management relies on accurate tumor staging. Our aim was to assess the impact of ¹⁸F-FDG-WB-PET/MRI on HCC metastatic staging, compared with the standard of care CT-CAP/liver MRI combination, in patients with HCC referred on a curative intent or before transarterial radioembolization. One hundred and four consecutive patients followed for HCC were retrospectively included. The WB-PET/MRI was compared with the standard of care CT-CAP/liver MRI combination for HCC metastatic staging, with pathology, followup, and multidisciplinary board assessment as a reference standard. Thirty metastases were identified within 14 metastatic sites in 11 patients. The sensitivity of WB-PET/MRI for metastatic sites and metastatic patients was significantly higher than that of the CT-CAP/liver MRI combination (respectively 100% vs. 43%, p = 0.002; and 100% vs. 45%, p = 0.01). Metastatic sites missed by CT-CAP were bone (n = 5) and distant lymph node (n = 3) in BCLC C patients. For the remaining 93 nonmetastatic patients, three BCLC A patients identified as potentially metastatic on the CT-CAP/liver MRI combination were correctly ruled out with the WB-PET/MRI without significant increase in specificity (100% vs. 97%; p = 0.25). The WB-PET/MRI may improve HCC metastatic staging and could be performed as a “one-stop-shop” examination for HCC staging with a significant impact on therapeutic management in about 10% of patients especially in locally advanced HCC. Full article

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

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14 pages, 2107 KiB

Open AccessArticle

The Occurrence of Pain-Induced Depression Is Different between Rat Models of Inflammatory and Neuropathic Pain

by Yung-Chi Hsu, Kuo-Hsing Ma, Shu-Lin Guo, Bo-Feng Lin, Chien-Sung Tsai and Chun-Chang Yeh

J. Clin. Med. 2021, 10(17), 4016; https://doi.org/10.3390/jcm10174016 - 06 Sep 2021

Cited by 3 | Viewed by 2353

Abstract

Various pain conditions may be associated with depressed mood. However, the effect of inflammatory or neuropathic pain on depression-like behavior and its associated time frame has not been well established in rat models. This frontward study investigated the differences in pain behavior, depression-like [...] Read more.

Various pain conditions may be associated with depressed mood. However, the effect of inflammatory or neuropathic pain on depression-like behavior and its associated time frame has not been well established in rat models. This frontward study investigated the differences in pain behavior, depression-like behavior, and serotonin transporter (SERT) distribution in the brain between rats subjected to spared nerve injury (SNI)-induced neuropathic pain or complete Freund’s adjuvant (CFA)-induced inflammatory pain. A dynamic plantar aesthesiometer and an acetone spray test were used to evaluate mechanical and cold allodynia responses, and depression-like behavior was examined using a forced swimming test and sucrose preference test. We also investigated SERT expression by using positron emission tomography. We found that the inflammation-induced pain was less severe than neuropathic pain from days 3 to 28 after induced pain; however, the CFA-injected rats exhibited more noticeable depression-like behavior and had significantly reduced SERT expression in the brain regions (thalamus and striatum) at an early stage (on days 14, 21, and 28 in two groups of CFA-injected rats versus day 28 in SNI rats). We speculated that not only the pain response after initial injury but also the subsequent neuroinflammation may have been the crucial factors influencing depression-like behavior in rats. Full article

(This article belongs to the Section Anesthesiology)

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22 pages, 1076 KiB

Open AccessReview

COVID-19 in Liver Transplant Recipients: A Systematic Review

by Chiara Becchetti, Sarah Gabriela Gschwend, Jean-François Dufour and Vanessa Banz

J. Clin. Med. 2021, 10(17), 4015; https://doi.org/10.3390/jcm10174015 - 05 Sep 2021

Cited by 17 | Viewed by 2861

Abstract

Liver transplant (LT) recipients are considered a vulnerable population amidst the COVID-19 pandemic. To date, available data have been heterogeneous and scarce. Therefore, we conducted a systematic literature review identifying English-language articles published in PubMed between November 2019 and 30 May 2021. We [...] Read more.

Liver transplant (LT) recipients are considered a vulnerable population amidst the COVID-19 pandemic. To date, available data have been heterogeneous and scarce. Therefore, we conducted a systematic literature review identifying English-language articles published in PubMed between November 2019 and 30 May 2021. We aimed to explore three areas: (1) outcome and clinical course; (2) immunological response after COVID-19 in LT recipients; and (3) vaccination response. After systematic selection, 35, 4, and 5 articles, respectively, were considered suitable for each area of analysis. Despite the heterogeneity of the reports included in this study, we found that gastrointestinal symptoms were common in LT recipients. The outcome of the LT population was not per se worse compared to the general population, although careful management of immunosuppressive therapy is required. While a complete therapy discontinuation is not encouraged, caution needs to be taken with use of mycophenolate mofetil (MMF), favoring tacrolimus (TAC) use. Although data conflicted about acquired immunity after SARS-CoV-2 infection, vaccine immunogenicity appeared to be low, suggesting that the level of surveillance should be kept high in this population. Full article

(This article belongs to the Special Issue New Therapies of Liver Diseases)

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11 pages, 557 KiB

Open AccessArticle

Adverse Features of Rectourethral Fistula Requiring Extirpative Surgery and Permanent Dual Diversion: Our Experience and Recommendations

by Francisco E. Martins, João Felicio, Tiago Ribeiro Oliveira, Natália Martins, Vítor Oliveira and Artur Palmas

J. Clin. Med. 2021, 10(17), 4014; https://doi.org/10.3390/jcm10174014 - 05 Sep 2021

Cited by 6 | Viewed by 2221

Abstract

Introduction: To report a series of men with a rectourethral fistula (RUF) resulting from pelvic cancer treatments and explore their therapeutic differences and impact on the functional outcomes and quality of life highlighting the adverse features that should determine permanent urinary or dual [...] Read more.

Introduction: To report a series of men with a rectourethral fistula (RUF) resulting from pelvic cancer treatments and explore their therapeutic differences and impact on the functional outcomes and quality of life highlighting the adverse features that should determine permanent urinary or dual diversion. Methods: A retrospective database search was performed in four centers to identify patients with RUF resulting from pelvic cancer treatment. Medical records were analyzed for the demographics, comorbidities, diagnostic evaluation, fistula characteristics, surgical approaches and outcomes. The endpoints analyzed included a successful fistula closure following a repair and the impact of the potential adverse features on outcomes. Results: Twenty-three patients, aged 57–79 years (median 68), underwent an RUF reconstruction. The median follow-up (FU) was 54 months (range 18–115). The patients were divided into two groups according to the etiology: radiation/energy-ablation treatments with or without surgery (G1, n = 10) and surgery only (G2, n = 13). All of the patients underwent a temporary diverting colostomy and suprapubic cystostomy. Overall, a successful RUF closure was achieved in 18 (78%) patients. An interposition flap was used in six (60%) patients and one (7.7%) patient in groups G1 and G2, respectively (p = 0.019). The RUF was managed successfully in all 13 patients in group G2 as opposed to 5/10 (50%) in group G1 (p = 0.008). The patients in the radiation/energy-ablation group were more likely to require permanent dual diversion (50% vs. 0%, p < 0.0075). Conclusion: Radiation/energy-ablation therapies are associated with a more severe RUF and more complex reconstructions. Most of these patients require an abdominoperineal approach and flap interposition. The failure of an RUF repair with the need for permanent dual diversion, eventually combined with extirpative surgery, is higher after previous radiation/energy-ablation treatment. Therefore, permanent dual diversion as the primary treatment should always be included in the decision-making process as reconstruction may be futile in specific settings. Full article

(This article belongs to the Special Issue Urethral Strictures: State of the Art and New Perspectives)

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10 pages, 776 KiB

Open AccessArticle

The Surgical Management of Brain Metastases in Non-Small Cell Lung Cancer (NSCLC): Identification of the Early Laboratory and Clinical Determinants of Survival

by Matthias Schneider, Niklas Schäfer, Christian Bode, Lars Eichhorn, Frank A. Giordano, Erdem Güresir, Muriel Heimann, Yon-Dschun Ko, Jennifer Landsberg, Felix Lehmann, Alexander Radbruch, Christina Schaub, Katjana S. Schwab, Johannes Weller, Ulrich Herrlinger, Hartmut Vatter and Patrick Schuss

J. Clin. Med. 2021, 10(17), 4013; https://doi.org/10.3390/jcm10174013 - 05 Sep 2021

Cited by 1 | Viewed by 2386

Abstract

Background: Brain metastases (BM) indicate advanced states of cancer disease and cranial surgery represents a common treatment modality. In the present study, we aimed to identify the risk factors for a reduced survival in patients receiving a surgical treatment of BM derived from [...] Read more.

Background: Brain metastases (BM) indicate advanced states of cancer disease and cranial surgery represents a common treatment modality. In the present study, we aimed to identify the risk factors for a reduced survival in patients receiving a surgical treatment of BM derived from non-small cell lung cancer (NSCLC). Methods: A total of 154 patients with NSCLC that had been surgically treated for BM at the authors’ institution between 2013 and 2018 were included for a further analysis. A multivariate analysis was performed to identify the predictors of a poor overall survival (OS). Results: The median overall survival (mOS) was 11 months (95% CI 8.2–13.8). An age > 65 years, the infratentorial location of BM, elevated preoperative C-reactive protein levels, a perioperative red blood cell transfusion, postoperative prolonged mechanical ventilation (>48 h) and the occurrence of postoperative adverse events were identified as independent factors of a poor OS. Conclusions: The present study identified several predictors for a worsened OS in patients that underwent surgery for BM of NSCLC. These findings might guide a better risk/benefit assessment in the course of metastatic NSCLC therapy and might help to more sufficiently cope with the challenges of cancer therapy in these advanced stages of disease. Full article

(This article belongs to the Special Issue Lung Cancer: Symptoms, Treatment, and Early Diagnosis)

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10 pages, 236 KiB

Open AccessArticle

Direct Lateral Corpectomy and Reconstruction Using an Expandable Cage Improves Local Kyphosis but Not Global Sagittal Alignment

by Hidetomi Terai, Shinji Takahashi, Hiroyuki Yasuda, Sadahiko Konishi, Takafumi Maeno, Hiroshi Kono, Akira Matsumura, Takashi Namikawa, Minori Kato, Masatoshi Hoshino, Koji Tamai, Hiromitsu Toyoda, Akinobu Suzuki and Hiroaki Nakamura

J. Clin. Med. 2021, 10(17), 4012; https://doi.org/10.3390/jcm10174012 - 05 Sep 2021

Cited by 2 | Viewed by 1575

Abstract

Recently, an expandable cage equipped with rectangular footplates has been used for anterior vertebral replacement in osteoporotic vertebral fracture (OVF). However, the postoperative changes in global alignment have not been elucidated. The purpose of this study was to evaluate local and global spinal [...] Read more.

Recently, an expandable cage equipped with rectangular footplates has been used for anterior vertebral replacement in osteoporotic vertebral fracture (OVF). However, the postoperative changes in global alignment have not been elucidated. The purpose of this study was to evaluate local and global spinal alignment after anterior and posterior spinal fixation (APSF) using an expandable cage in elderly OVF patients. This retrospective multicenter review assessed 54 consecutive patients who underwent APSF for OVF. Clinical outcomes were compared between postoperative sagittal vertical axis (SVA) > 95 mm and ≤95 mm groups to investigate the impact of malalignment. SVA improved by only 18.7 mm (from 111.8 mm to 93.1 mm). VAS score of back pain at final follow-up was significantly higher in patients with SVA > 95 mm than SVA ≤ 95 mm (42.4 vs. 22.6, p = 0.007). Adjacent vertebral fracture after surgery was significantly more frequent in the SVA > 95 mm (37% vs. 11%, p = 0.038). Multiple logistic regression showed significantly increased OR for developing adjacent vertebral fracture (OR = 4.76, 95% CI 1.10–20.58). APSF using the newly developed cage improves local kyphotic angle but not SVA. The main cause for the spinal malalignment after surgery was postoperative development of adjacent vertebral fractures. Full article

(This article belongs to the Special Issue Current Advances in Spinal Diseases of Elderly Patients)

14 pages, 1340 KiB

Open AccessArticle

A Multicenter Randomized Controlled Prospective Study to Assess Efficacy of Laparoscopic Electrochemotherapy in the Treatment of Locally Advanced Pancreatic Cancer

by Francesco Izzo, Vincenza Granata, Roberta Fusco, Valeria D’Alessio, Antonella Petrillo, Secondo Lastoria, Mauro Piccirillo, Vittorio Albino, Andrea Belli, Guglielmo Nasti, Antonio Avallone, Renato Patrone, Francesca Grassi, Maddalena Leongito and Raffaele Palaia

J. Clin. Med. 2021, 10(17), 4011; https://doi.org/10.3390/jcm10174011 - 05 Sep 2021

Cited by 13 | Viewed by 2261

Abstract

Background: Eighty percent of patients with pancreatic adenocarcinoma present a locally advanced or metastatic disease at diagnosis and are not eligible for surgery if not with palliative intent. In cases of locally advanced disease (LAPC), the combination of chemo and radiotherapy is the [...] Read more.

Background: Eighty percent of patients with pancreatic adenocarcinoma present a locally advanced or metastatic disease at diagnosis and are not eligible for surgery if not with palliative intent. In cases of locally advanced disease (LAPC), the combination of chemo and radiotherapy is the only therapeutic option and correlates with a median survival of 15 months (10 months without treatment), with partial remission of disease in 50% of cases. The feasibility and safety of Electrochemotherapy (ECT) have been demonstrated in the treatment of deep tumors. Aim: The aim of the study is to evaluate the efficacy of electrochemotherapy (ECT) followed by conventional systemic treatment compared to the only conventional systemic treatment in LAPC in terms of objective response and overall survival. Patients and Methods: This study is a phase IIb prospective multicenter randomized controlled trial with two arms. The study will include 90 patients: 45 in the control group and 45 in the experimental group. Patients with LAPC in the control arm will receive conventional chemotherapy (FOLFOXIRI). Patients with LAPC in the experimental arm will be subjected to Electrochemotherapy and subsequently to FOLFOXIRI. The objective response at 30, 90, and 180 days from treatment will be based on the computed tomography (CT), magnetic resonance (MR), and positron emission tomography/CT response (PET/CT). The objective long-term treatment response will be evaluated with the modified response evaluation criteria in solid tumors (m-RECIST) criteria, which will take into account the difference in vascularization, determined by the images obtained by CT and MR of the tumor treated before and after ECT. Conclusions: Not resectable liver metastasis, pancreatic tumors, and locally advanced renal carcinomas can be treated with laparoscopic electrodes. ECT could represent an effective therapeutic option for patients not eligible for surgery susceptible to be managed only with palliative therapies. Full article

(This article belongs to the Special Issue Updates on the Treatment of Pancreatic Diseases)

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12 pages, 1518 KiB

Open AccessArticle

Troponin I Levels in Neonatal Hypoxic–Ischemic Encephalopathy Are Related to Cardiopulmonary Comorbidity and Neurodevelopmental Outcomes

by Inn-Chi Lee, Chin-Sheng Yu, Swee-Hee Wong and Ko-Huang Lue

J. Clin. Med. 2021, 10(17), 4010; https://doi.org/10.3390/jcm10174010 - 05 Sep 2021

Cited by 4 | Viewed by 3273

Abstract

Troponin I is a biomarker for cardiac injury in children. The role of troponin I in neonatal Hypoxic–Ischemic encephalopathy (HIE) may have valuable clinical implications. Troponin I levels were measured within 6 h of birth to determine their relationship to HIE stage, short-term [...] Read more.

Troponin I is a biomarker for cardiac injury in children. The role of troponin I in neonatal Hypoxic–Ischemic encephalopathy (HIE) may have valuable clinical implications. Troponin I levels were measured within 6 h of birth to determine their relationship to HIE stage, short-term cardiac functional outcomes, and neurodevelopmental outcomes at 1 year. Seventy-three patients were divided into two groups: mild HIE and moderate to severe HIE. Troponin I levels within 6 h of birth were obtained in 61 patients, and were significantly higher in patients with moderate to severe HIE than in patients with mild HIE (Mann–Whitney U test, U = 146, p = 0.001). A troponin I cut-off level of ≥60 pg/mL predicted moderate to severe HIE with a specificity of 81.1% and a negative prediction rate of 76.9%. A troponin I cut-off level of ≥180 pg/mL was significantly (χ² (1, n = 61) = 33.1, p = 0.001, odds ratio 96.8) related with hypotension during first admission and significantly (χ² (1, n = 61) = 5.3, p = 0.021, odds ratio 4.53) related with abnormal neurodevelopmental outcomes at 1 year. Early troponin I level may be a useful biomarker for predicting moderate to severe HIE, and initialization of hypothermia therapy. Full article

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

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18 pages, 755 KiB

Open AccessReview

Genetic Factors of Non-Obstructive Azoospermia: Consequences on Patients’ and Offspring Health

by Csilla Krausz and Francesca Cioppi

J. Clin. Med. 2021, 10(17), 4009; https://doi.org/10.3390/jcm10174009 - 05 Sep 2021

Cited by 21 | Viewed by 5242

Abstract

Non-Obstructive Azoospermia (NOA) affects about 1% of men in the general population and is characterized by clinical heterogeneity implying the involvement of several different acquired and genetic factors. NOA men are at higher risk to be carriers of known genetic anomalies such as [...] Read more.

Non-Obstructive Azoospermia (NOA) affects about 1% of men in the general population and is characterized by clinical heterogeneity implying the involvement of several different acquired and genetic factors. NOA men are at higher risk to be carriers of known genetic anomalies such as karyotype abnormalities and Y-chromosome microdeletions in respect to oligo-normozoospermic men. In recent years, a growing number of novel monogenic causes have been identified through Whole Exome Sequencing (WES). Genetic testing is useful for diagnostic and pre-TESE prognostic purposes as well as for its potential relevance for general health. Several epidemiological observations show a link between azoospermia and higher morbidity and mortality rate, suggesting a common etiology for NOA and some chronic diseases, including cancer. Since on average 50% of NOA patients has a positive TESE outcome, the identification of genetic factors in NOA patients has relevance also to the offspring’s health. Although still debated, the observed increased risk of certain neurodevelopmental disorders, as well as impaired cardiometabolic and reproductive health profile in children conceived with ICSI from NOA fathers may indicate the involvement of transmissible genetic factors. This review provides an update on the reproductive and general health consequences of known genetic factors causing NOA, including offspring’s health. Full article

(This article belongs to the Special Issue Update on the Management of Non-Obstructive Azoospermia: Current Evidence and Unmet Needs)

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13 pages, 584 KiB

Open AccessArticle

Metabolic Effects of Gastrectomy and Duodenal Bypass in Early Gastric Cancer Patients with T2DM: A Prospective Single-Center Cohort Study

by Young Ki Lee, Eun Kyung Lee, You Jin Lee, Bang Wool Eom, Hong Man Yoon, Young-Il Kim, Soo Jeong Cho, Jong Yeul Lee, Chan Gyoo Kim, Sun-Young Kong, Min Kyong Yoo, Yul Hwangbo, Young-Woo Kim, Il Ju Choi, Hak Jin Kim, Mi Hyang Kwak and Keun Won Ryu

J. Clin. Med. 2021, 10(17), 4008; https://doi.org/10.3390/jcm10174008 - 04 Sep 2021

Cited by 1 | Viewed by 1900

Abstract

We evaluated the metabolic effects of gastrectomies and endoscopic submucosal dissections (ESDs) in early gastric cancer (EGC) patients with type 2 diabetes mellitus (T2DM). Forty-one EGC patients with T2DM undergoing gastrectomy or ESD were prospectively evaluated. Metabolic parameters in the patients who underwent [...] Read more.

We evaluated the metabolic effects of gastrectomies and endoscopic submucosal dissections (ESDs) in early gastric cancer (EGC) patients with type 2 diabetes mellitus (T2DM). Forty-one EGC patients with T2DM undergoing gastrectomy or ESD were prospectively evaluated. Metabolic parameters in the patients who underwent gastrectomy with and without a duodenal bypass (groups 1 and 2, n = 24 and n = 5, respectively) were compared with those in patients who underwent ESD (control, n = 12). After 1 year, the proportions of improved/equivocal/worsened glycemic control were 62.5%/29.2%/8.3% in group 1, 40.0%/60.0%/0.0% in group 2, and 16.7%/50.0%/33.3% in the controls, respectively (p = 0.046). The multivariable ordered logistic regression analysis results showed that both groups had better 1-year glycemic control. Groups 1 and 2 showed a significant reduction in postprandial glucose (−97.9 and −67.8 mg/dL), body mass index (−2.1 and −2.3 kg/m²), and glycosylated hemoglobin (group 1 only, −0.5% point) (all p < 0.05). Furthermore, improvements in group 1 were more prominent when preoperative leptin levels were high (p for interaction < 0.05). Metabolic improvements in both groups were also observed for insulin resistance, leptin, plasminogen activator inhibitor-1, and resistin. Gastrectomy improved glycemic control and various metabolic parameters in EGC patients with T2DM. Patients with high leptin levels may experience greater metabolic benefits from gastrectomy with duodenal bypass. Full article

(This article belongs to the Special Issue Gastrointestinal Malignancies: Screening, Diagnosis, and Treatment)

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12 pages, 260 KiB

Open AccessArticle

Computed Tomography Structured Reporting in the Staging of Lymphoma: A Delphi Consensus Proposal

by Vincenza Granata, Silvia Pradella, Diletta Cozzi, Roberta Fusco, Lorenzo Faggioni, Francesca Coppola, Roberta Grassi, Nicola Maggialetti, Duccio Buccicardi, Giorgia Viola Lacasella, Marco Montella, Eleonora Ciaghi, Francesco Bellifemine, Massimo De Filippo, Marco Rengo, Chandra Bortolotto, Roberto Prost, Carmelo Barresi, Salvatore Cappabianca, Luca Brunese, Emanuele Neri, Roberto Grassi and Vittorio Miele Show full author list Hide full author list

J. Clin. Med. 2021, 10(17), 4007; https://doi.org/10.3390/jcm10174007 - 04 Sep 2021

Cited by 15 | Viewed by 2586

Abstract

Structured reporting (SR) in radiology is becoming increasingly necessary and has been recognized recently by major scientific societies. This study aims to build structured CT-based reports for lymphoma patients during the staging phase to improve communication between radiologists, members of multidisciplinary teams, and [...] Read more.

Structured reporting (SR) in radiology is becoming increasingly necessary and has been recognized recently by major scientific societies. This study aims to build structured CT-based reports for lymphoma patients during the staging phase to improve communication between radiologists, members of multidisciplinary teams, and patients. A panel of expert radiologists, members of the Italian Society of Medical and Interventional Radiology (SIRM), was established. A modified Delphi process was used to develop the SR and to assess a level of agreement for all report sections. The Cronbach’s alpha (Cα) correlation coefficient was used to assess internal consistency for each section and to measure quality analysis according to the average inter-item correlation. The final SR version was divided into four sections: (a) Patient Clinical Data, (b) Clinical Evaluation, (c) Imaging Protocol, and (d) Report, including n = 13 items in the “Patient Clinical Data” section, n = 8 items in the “Clinical Evaluation” section, n = 9 items in the “Imaging Protocol” section, and n = 32 items in the “Report” section. Overall, 62 items were included in the final version of the SR. A dedicated section of significant images was added as part of the report. In the first Delphi round, all sections received more than a good rating (≥3). The overall mean score of the experts and the sum of score for structured report were 4.4 (range 1–5) and 1524 (mean value of 101.6 and standard deviation of 11.8). The Cα correlation coefficient was 0.89 in the first round. In the second Delphi round, all sections received more than an excellent rating (≥4). The overall mean score of the experts and the sum of scores for structured report were 4.9 (range 3–5) and 1694 (mean value of 112.9 and standard deviation of 4.0). The Cα correlation coefficient was 0.87 in this round. The highest overall means value, highest sum of scores of the panelists, and smallest standard deviation values of the evaluations in this round reflect the increase of the internal consistency and agreement among experts in the second round compared to first round. The accurate statement of imaging data given to referring physicians is critical for patient care; the information contained affects both the decision-making process and the subsequent treatment. The radiology report is the most important source of clinical imaging information. It conveys critical information about the patient’s health and the radiologist’s interpretation of medical findings. It also communicates information to the referring physicians and records this information for future clinical and research use. The present SR was generated based on a multi-round consensus-building Delphi exercise and uses standardized terminology and structures, in order to adhere to diagnostic/therapeutic recommendations and facilitate enrolment in clinical trials, to reduce any ambiguity that may arise from non-conventional language, and to enable better communication between radiologists and clinicians. Full article

(This article belongs to the Special Issue Lymphoma：New Diagnosis and Current Treatment Strategies)

8 pages, 590 KiB

Open AccessArticle

Analysis of Patient Factors Affecting In Vitro Characteristics of Subacromial Bursal Connective Tissue Progenitor Cells during Rotator Cuff Repair

by Daichi Morikawa, Benjamin C. Hawthorne, Mary Beth R. McCarthy, Nicholas Bellas, Jeremiah D. Johnson, Maxwell T. Trudeau, Kyle V. Murphy, Michael R. Mancini, Matthew R. LeVasseur, Mark P. Cote and Augustus D. Mazzocca

J. Clin. Med. 2021, 10(17), 4006; https://doi.org/10.3390/jcm10174006 - 04 Sep 2021

Cited by 3 | Viewed by 1531

Abstract

Unsatisfactory failure rates following rotator cuff (RC) repair have led orthopaedic surgeons to explore biological augmentation of the healing enthesis. The subacromial bursa (SB) contains abundant connective tissue progenitor cells (CTPs) that may aid in this process. The purpose of the study was [...] Read more.

Unsatisfactory failure rates following rotator cuff (RC) repair have led orthopaedic surgeons to explore biological augmentation of the healing enthesis. The subacromial bursa (SB) contains abundant connective tissue progenitor cells (CTPs) that may aid in this process. The purpose of the study was to investigate the influence of patient demographics and tear characteristics on the number of colony-forming units (CFUs) and nucleated cell count (NCC) of SB-derived CTPs. In this study, we harvested SB tissue over the supraspinatus tendon and muscle in 19 patients during arthroscopic RC repair. NCC of each sample was analyzed on the day of the procedure. After 14 days, CFUs were evaluated under a microscope. Spearman’s rank correlation coefficient was then used to determine the relationship between CFUs or NCC and patient demographics or tear characteristics. The study found no significant correlation between patient demographics and the number of CFUs or NCC of CTPs derived from the SB (p > 0.05). The study did significantly observe that increased tear size was negatively correlated with the number of CFUs (p < 0.05). These results indicated that increased tear size, but not patient demographics, may influence the viability of CTPs and should be considered when augmenting RCrepairs with SB. Full article

(This article belongs to the Special Issue Treatment of Shoulder Joint Disease: Recent Advances in Treatment and Opportunities)

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11 pages, 811 KiB

Open AccessArticle

Balloon-Expandable versus Self-Expandable Valves in Transcatheter Aortic Valve Implantation: Complications and Outcomes from a Large International Patient Cohort

by Astrid C. van Nieuwkerk, Raquel B Santos, Leire Andraka, Didier Tchetche, Fabio S. de Brito, Marco Barbanti, Ran Kornowski, Azeem Latib, Augusto D’Onofrio, Flavio Ribichini, Francisco Ten, Nicolas Dumonteil, Jan Baan, Jan J. Piek, Alexandre Abizaid, Samantha Sartori, Paola D’Errigo, Giuseppe Tarantini, Mattia Lunardi, Katia Orvin, Matteo Pagnesi, Juan Manuel Nogales-Asensio, Angie Ghattas, George Dangas, Roxana Mehran and Ronak Delewi Show full author list Hide full author list

J. Clin. Med. 2021, 10(17), 4005; https://doi.org/10.3390/jcm10174005 - 04 Sep 2021

Cited by 7 | Viewed by 2392

Abstract

Background: Both balloon-expandable (BE) and self-expandable (SE) valves for transcatheter aortic valve implantation (TAVI) are broadly used in clinical practice. However, adequately powered randomized controlled trials comparing these two valve designs are lacking. Methods: The CENTER-study included 12,381 patients undergoing transfemoral TAVI. Patients [...] Read more.

Background: Both balloon-expandable (BE) and self-expandable (SE) valves for transcatheter aortic valve implantation (TAVI) are broadly used in clinical practice. However, adequately powered randomized controlled trials comparing these two valve designs are lacking. Methods: The CENTER-study included 12,381 patients undergoing transfemoral TAVI. Patients undergoing TAVI with a BE-valve (n = 4096) were compared to patients undergoing TAVI with an SE-valve (n = 4096) after propensity score matching. Clinical outcomes including one-year mortality and stroke rates were assessed. Results: In the matched population of n = 5410 patients, the mean age was 81 ± 3 years, 60% was female, and the STS-PROM predicted 30-day mortality was 6.2% (IQR 4.0–12.4). One-year mortality was not different between patients treated with BE- or SE-valves (BE: 16.4% vs. SE: 17.0%, Relative Risk 1.04, 95%CI 0.02–1.21, p = 0.57). One-year stroke rates were also comparable (BE: 4.9% vs. SE: 5.3%, RR 1.09, 95%CI 0.86–1.37, p = 0.48). Conclusion: This study suggests that one-year mortality and stroke rates were comparable in patients with severe aortic valve stenosis undergoing TAVI with either BE or SE-valves. Full article

(This article belongs to the Special Issue Surgical or Transcatheter Aortic Valve Replacement in Intermediate-Risk Patients)

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12 pages, 2613 KiB

Open AccessReview

Transcatheter Tricuspid Valve-in-Valve Procedure—An Illustrative Case Report and Review

by Márcio José Montenegro da Costa, Edgard Freitas Quintella, Luiz Kohn, Maximiliano Otero Lacoste, Gustavo Lycurgo Leite, Leonardo Hadid, Dany David Kruczan, Ricardo Zajdenverg, Hugo de Castro Sabino and Paulo Antônio Marra da Motta

J. Clin. Med. 2021, 10(17), 4004; https://doi.org/10.3390/jcm10174004 - 04 Sep 2021

Cited by 5 | Viewed by 2354

Abstract

Severe tricuspid commitment is no longer understood as merely a marker of disease but is now widely thought of as a significant contributor to cardiac morbidity and mortality. However, isolated tricuspid valve surgery remains rare and to this day continues to be associated [...] Read more.

Severe tricuspid commitment is no longer understood as merely a marker of disease but is now widely thought of as a significant contributor to cardiac morbidity and mortality. However, isolated tricuspid valve surgery remains rare and to this day continues to be associated with the highest surgical risk among all valve procedures and high operative mortality rates, especially in reoperations. Therefore, the development of tricuspid transcatheter procedures is as necessary as it was for the other valves a couple of years ago. Recently, multiple percutaneous therapies have been developed for the management of severe tricuspid disease, initially only repair and more recently replacement, thus creating a new branch for the management of patients who have already undergone surgery and who present with dysfunctional bioprostheses. The purpose of this review and report is to demonstrate current and possible future challenges, and to show that the valve-in-valve procedure of the tricuspid valve is feasible and safe, and now can be performed in all its range, in the smallest to the largest sizes of presentation, without incurring the untoward risks of conventional surgery. Full article

(This article belongs to the Special Issue Transcatheter Mitral and Tricuspid Valve Repair: Advances and Challenges)

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10 pages, 1100 KiB

Open AccessArticle

Induced Dipoles and Possible Modulation of Wireless Effects in Implanted Electrodes. Effects of Implanting Insulated Electrodes on an Animal Test to Screen Antidepressant Activity

by Laura Perez-Caballero, Hector Carceller, Juan Nacher, Vicent Teruel-Marti, Eulalia Pujades, Nieves Casañ-Pastor and Esther Berrocoso

J. Clin. Med. 2021, 10(17), 4003; https://doi.org/10.3390/jcm10174003 - 04 Sep 2021

Cited by 2 | Viewed by 1857

Abstract

There is evidence that Deep Brain Stimulation (DBS) produces health benefits in patients even before initiating stimulation. Furthermore, DBS electrode insertion in rat infralimbic cortex (ILC) provokes antidepressant-like effects before stimulation, due to local inflammation and astrogliosis. Consequently, a significant effect of implanting [...] Read more.

There is evidence that Deep Brain Stimulation (DBS) produces health benefits in patients even before initiating stimulation. Furthermore, DBS electrode insertion in rat infralimbic cortex (ILC) provokes antidepressant-like effects before stimulation, due to local inflammation and astrogliosis. Consequently, a significant effect of implanting electrodes is suspected. External fields, similar in magnitude to the brain’s endogenous fields, induce electric dipoles in conducting materials, in turn influencing neural cell growth through wireless effects. To elucidate if such dipoles influence depressive-like behavior, without external stimulation, the comparative effect of conducting and insulated electrodes along with the glial response is studied in unstressed rats. Naïve and implanted rats with electrically insulated or uninsulated steel electrodes were evaluated in the modified forced swimming test and expression of ILC-glial markers was assessed. An antidepressant-like effect was observed with conducting but not with insulated electrodes. Gliosis was detected in both groups, but astroglial reactivity was larger near uninsulated electrodes. Thus, induced dipoles and antidepressant-like effects were only observed with conducting implants. Such correlation suggests that dipoles induced in electrodes by endogenous fields in turn induce neuron stimulation in a feedback loop between electrodes and neural system. Further research of the effects of unwired conducting implants could open new approaches to regulating neuronal function, and possibly treat neurological disorders. Full article

(This article belongs to the Collection Advances in Neurostimulation: Understanding of the Mechanisms and Clinical Applications)

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J. Clin. Med., Volume 10, Issue 17 (September-1 2021) – 272 articles

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