Journal of Clinical Medicine

10 pages, 1792 KiB

Open AccessArticle

Fibrosis Burden of Missed and Added Populations According to the New Definition of Metabolic Dysfunction-Associated Fatty Liver

by Huiyul Park, Eileen L. Yoon, Mimi Kim, Jung-Hwan Kim, Seon Cho, Dae Won Jun and Eun-Hee Nah

J. Clin. Med. 2021, 10(19), 4625; https://doi.org/10.3390/jcm10194625 - 08 Oct 2021

Cited by 7 | Viewed by 1809

Abstract

Recently, the classification of fatty liver and the definition for non-alcoholic fatty liver disease (NAFLD) have been challenged. Herein, we aim to evaluate the burden of hepatic fibrosis in the missed and added populations following the proposal of the new definition of metabolic [...] Read more.

Recently, the classification of fatty liver and the definition for non-alcoholic fatty liver disease (NAFLD) have been challenged. Herein, we aim to evaluate the burden of hepatic fibrosis in the missed and added populations following the proposal of the new definition of metabolic dysfunction-associated fatty liver (MAFLD) in a health check-up cohort. A total of 6775 subjects underwent both magnetic resonance elastography (MRE) and an abdominal ultrasound at 13 nationwide health check-up centers in Korea. Significant and advanced hepatic fibrosis was defined as ≥3.0 kPa and ≥3.6 kPa in the MRE test, respectively. The prevalence of sonographic fatty liver (FL) was 47.4%. Among the subjects with sonographic FL, 77.3% and 94% are compatible with NAFLD and with the new MAFLD definitions, respectively. Moreover, 72% of FL cases belong to both the NAFLD and MAFLD definitions, whereas 1.4% is compatible with neither. The population compatible with the MAFLD definition has the following coexisting liver diseases: alcohol-related (71.9%), hepatitis B (23.9%), hepatitis C (0.4%), and both alcohol and viral hepatitis (2.8%). The prevalence of significant and advanced hepatic fibrosis is considerable in the MAFLD-only group. However, the prevalence of significant and advanced hepatic fibrosis is similar in the NAFLD-only group, and neither the NAFLD nor MAFLD group compared to healthy controls. The added population (MAFLD-only group), according to the new MAFLD definition, has a higher metabolic and fibrosis burden when compared to those in the missed population (NAFLD-only group). Full article

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

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11 pages, 530 KiB

Open AccessReview

Dysphoria and Irritability—Diagnostic Pitfalls in the Assessment of Interictal Dysphoric Disorder in Epilepsy

by Agata M. Grzegorzewska, Mariusz S. Wiglusz, Wiesław J. Cubała, Katarzyna Jakuszkowiak-Wojten, Adam Włodarczyk and Joanna Szarmach

J. Clin. Med. 2021, 10(19), 4624; https://doi.org/10.3390/jcm10194624 - 08 Oct 2021

Cited by 4 | Viewed by 1836

Abstract

This article aims to review the concept of epilepsy-specific psychiatric disturbance, Interictal Dysphoric Disorder (IDD), focusing on issues related to its core symptoms and methodological pitfalls. In the psychiatric literature, an epilepsy-specific pleomorphic mood disorder has been long recognized and described as IDD, [...] Read more.

This article aims to review the concept of epilepsy-specific psychiatric disturbance, Interictal Dysphoric Disorder (IDD), focusing on issues related to its core symptoms and methodological pitfalls. In the psychiatric literature, an epilepsy-specific pleomorphic mood disorder has been long recognized and described as IDD, a condition characterized by eight symptoms, which are grouped into four labile depressive symptoms, two labile affective symptoms, and two specific symptoms. The existence of IDD is still a matter of debate because of several methodological issues. The main features of IDD, such as dysphoria and irritability, lack precise and clear definition. This review article explores the different definitions and approaches towards both terms described in the psychiatric literature and the rationale for modifying the diagnostic process of IDD. Full article

(This article belongs to the Special Issue Current Challenges and Advances in the Treatment of Epilepsy)

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22 pages, 1456 KiB

Open AccessReview

Emerging Comorbidities in Inflammatory Bowel Disease: Eating Disorders, Alcohol and Narcotics Misuse

by Paweł Kuźnicki and Katarzyna Neubauer

J. Clin. Med. 2021, 10(19), 4623; https://doi.org/10.3390/jcm10194623 - 08 Oct 2021

Cited by 8 | Viewed by 5381

Abstract

Inflammatory bowel disease (IBD) is a chronic and potentially devastating condition of the digestive tract which is exemplified by increasing prevalence worldwide, byzantine pathogenesis with a poorly defined role of the environmental factors, and complex clinical demonstration. As a systemic disease, IBD may [...] Read more.

Inflammatory bowel disease (IBD) is a chronic and potentially devastating condition of the digestive tract which is exemplified by increasing prevalence worldwide, byzantine pathogenesis with a poorly defined role of the environmental factors, and complex clinical demonstration. As a systemic disease, IBD may progress with a wide spectrum of extraintestinal manifestations (EMs) and comorbidities affecting different organs and systems, from anaemia, undernutrition, and cancer to those which are often neglected like anxiety and depression. Evolving IBD epidemiology and changing environment are reflected by an expanding list of IBD-related comorbidities. In contrast to the well-established role of smoking the connection between alcohol and IBD is still debatable on many levels, from pathogenesis to complications. Furthermore, little is known about narcotics use in IBD patients, even if there are obvious factors that may predispose them to narcotics as well as alcohol misuse. Last but not least, the question arises what is the prevalence of eating disorders in IBD. In our paper, we aimed to discuss the current knowledge on alcohol and drugs misuse and eating disorders as emerging extraintestinal comorbidities in IBD. Full article

(This article belongs to the Special Issue Advances in Inflammatory Bowel Disease)

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9 pages, 743 KiB

Open AccessArticle

Lack of Salivary Long Non-Coding RNA XIST Expression Is Associated with Increased Risk of Oral Squamous Cell Carcinoma: A Cross-Sectional Study

by Tzong-Ming Shieh, Chung-Ji Liu, Shih-Min Hsia, Valendriyani Ningrum, Chiu-Chu Liao, Wan-Chen Lan and Yin-Hwa Shih

J. Clin. Med. 2021, 10(19), 4622; https://doi.org/10.3390/jcm10194622 - 08 Oct 2021

Cited by 12 | Viewed by 1801

Abstract

Studies have shown that there is a disparity between males and females in south-east Asia with regard to oral cancer morbidity. A previous study found that oral cancer tissue showed loss of heterozygosity of the X-linked lncRNA XIST gene. We suggest that XIST [...] Read more.

Studies have shown that there is a disparity between males and females in south-east Asia with regard to oral cancer morbidity. A previous study found that oral cancer tissue showed loss of heterozygosity of the X-linked lncRNA XIST gene. We suggest that XIST may play an important role in oral cancer morbidity when associated with sex. Saliva contains proteins and RNAs that are potential biomarkers for the diagnosis of diseases. This study investigated salivary XIST expression and the correlation to clinical–pathological data among oral squamous cell carcinoma patients. Salivary XIST expression was only observed in females, and a high proportion of females with OSCC lack salivary lncRNA XIST expression (88%). The expression showed no correlation with alcohol consumption, betel quid chewing, or cigarette smoking habits. People lacking salivary lncRNA XIST expression had a significantly increased odds ratio of suffering from OSCC (OR = 19.556, p < 0.001), particularly females (OR = 33.733, p < 0.001). The ROC curve showed that salivary lncRNA XIST expression has acceptable discrimination accuracy to predict the risk of OSCC (AUC = 0.73, p < 0.01). Lack of salivary lncRNA XIST expression was associated with an increased risk of OSCC. We provided an insight into the role of salivary lncRNA XIST as a biomarker to predict the morbidity of OSCC. Full article

(This article belongs to the Topic State-of-the-Art Dentistry and Oral Health)

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14 pages, 1161 KiB

Open AccessArticle

NOTCH3 rs1043996 Polymorphism Is Associated with the Occurrence of Alcoholic Liver Cirrhosis Independently of PNPLA3 and TM6SF2 Polymorphisms

by Ana Bainrauch, Dino Šisl, Antonio Markotić, Ana Ostojić, Slavko Gašparov, Valerija Bralić Lang, Nataša Kovačić, Danka Grčević, Anna Mrzljak and Tomislav Kelava

J. Clin. Med. 2021, 10(19), 4621; https://doi.org/10.3390/jcm10194621 - 08 Oct 2021

Cited by 1 | Viewed by 1690

Abstract

Alcoholic liver cirrhosis (ALC) is the most common indication for liver transplantation (LT) in Croatia and presents a risk factor for the development of hepatocellular carcinoma (HCC). However, genetic susceptibility has not yet been systematically studied. We aimed to investigate the contribution of [...] Read more.

Alcoholic liver cirrhosis (ALC) is the most common indication for liver transplantation (LT) in Croatia and presents a risk factor for the development of hepatocellular carcinoma (HCC). However, genetic susceptibility has not yet been systematically studied. We aimed to investigate the contribution of the risk polymorphisms PNPLA3 rs738409, EGF rs4444903, TM6SF2 rs58542926, MTHFR rs1801133, previously identified in other populations and, additionally, the contribution of Notch-related polymorphisms (NOTCH1 rs3124591, NOTCH3 rs1043996 and rs1044116, NOTCH4 rs422951). The study included 401 patients. The ALC group consisted of 260 LT candidates, 128 of whom had histopathologically confirmed HCC, and 132 of whom were without HCC. The control group included 141 patients without liver disease. Genotyping was performed by PCR using Taqman assays. The patients’ susceptibility to ALC was significantly associated with PNPLA3 rs738409, TM6SF2 rs58542926, and NOTCH3 rs1043996 polymorphisms. These polymorphisms remained significantly associated with ALC occurrence in a logistic regression model, even after additional model adjustment for sex and age. Cirrhotic patients with the PNPLA3 GG genotype demonstrated higher activity of ALT aminotransferases than patients with CC or CG genotypes. The susceptibility to the development of HCC in ALC was significantly associated with PNPLA3 rs738409 and EGF rs4444903 polymorphisms, and logistic regression confirmed these polymorphisms as independent predictors. Full article

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

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19 pages, 874 KiB

Open AccessReview

Diabetes, Vascular Aging and Stroke: Old Dogs, New Tricks?

by Theano Penlioglou, Anca Pantea Stoian and Nikolaos Papanas

J. Clin. Med. 2021, 10(19), 4620; https://doi.org/10.3390/jcm10194620 - 08 Oct 2021

Cited by 13 | Viewed by 2879

Abstract

Background: Stroke remains a leading cause of death and disability throughout the world. It is well established that Diabetes Mellitus (DM) is a risk factor for stroke, while other risk factors include dyslipidaemia and hypertension. Given that the global prevalence of diabetes steadily [...] Read more.

Background: Stroke remains a leading cause of death and disability throughout the world. It is well established that Diabetes Mellitus (DM) is a risk factor for stroke, while other risk factors include dyslipidaemia and hypertension. Given that the global prevalence of diabetes steadily increases, the need for adequate glycaemic control and prevention of DM-related cardiovascular events remains a challenge for the medical community. Therefore, a re-examination of the latest data related to this issue is of particular importance. Objective: This review aims to summarise the latest data on the relationship between DM and stroke, including epidemiology, risk factors, pathogenesis, prevention and biomarkers. Methods: For this purpose, comprehensive research was performed on the platforms PubMed, Google Scholar and EMBASE with a combination of the following keywords: diabetes mellitus, stroke, macrovascular complications, diabetic stroke, cardiovascular disease. Conclusions: Much progress has been made in stroke in people with DM in terms of prevention and early diagnosis. In the field of prevention, the adaptation of the daily habits and the regulation of co-morbidity of individuals play a particularly important role. Simultaneously, the most significant revolution has been brought by the relatively new treatment options that offer protection to the cardiovascular system. Moreover, many prognostic and diagnostic biomarkers have been identified, paving the way for early and accurate diagnoses. However, to date, there are crucial points that remain controversial and need further clarification. Full article

(This article belongs to the Special Issue Chronic Diabetic Complications: Current Challenges and Opportunities)

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15 pages, 1671 KiB

Open AccessReview

Current Status of Endoscopic Biliary Drainage in Patients with Distal Malignant Biliary Obstruction

by Yuki Tanisaka, Masafumi Mizuide, Akashi Fujita, Tomoya Ogawa, Hiromune Katsuda, Youichi Saito, Kazuya Miyaguchi, Ryuhei Jinushi, Rie Terada, Yuya Nakano, Tomoaki Tashima, Yumi Mashimo and Shomei Ryozawa

J. Clin. Med. 2021, 10(19), 4619; https://doi.org/10.3390/jcm10194619 - 08 Oct 2021

Cited by 4 | Viewed by 2281

Abstract

Distal malignant biliary obstruction is caused by various malignant diseases that require biliary drainage. In patients with operable situations, preoperative biliary drainage is required to control jaundice and cholangitis until surgery. In view of tract seeding, endoscopic biliary drainage is the first choice. [...] Read more.

Distal malignant biliary obstruction is caused by various malignant diseases that require biliary drainage. In patients with operable situations, preoperative biliary drainage is required to control jaundice and cholangitis until surgery. In view of tract seeding, endoscopic biliary drainage is the first choice. Since neoadjuvant therapies are being developed, the time to surgery is increasing, especially in pancreatic cancer cases. Therefore, it requires long stent patency. Recently, preoperative biliary drainage using self-expandable metal stents has been reported as a useful modality to secure long stent patency. In patients with unresectable distal malignant biliary obstruction, self-expandable metal stent is the first choice for maintaining long stent patency. Although there are many comparison studies between a covered and an uncovered self-expandable metal stent, their use is still controversial. Recently, endoscopic ultrasound-guided biliary drainage has been performed as an alternative treatment. The clinical success and stent patency are favorable. We should take into consideration that both endoscopic retrograde cholangiopancreatography-guided biliary drainage and endoscopic ultrasound-guided biliary drainage have advantages and disadvantages and chose the drainage method depending on the patient’s situation or the expertise of the endoscopist. Here, we discuss the current status of endoscopic biliary drainage in patients with distal malignant biliary obstruction. Full article

(This article belongs to the Special Issue Recent Advances and Future Trends in Digestive Endoscopy)

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12 pages, 3721 KiB

Open AccessArticle

Cardiometabolic Disorders and the Risk of Critical COVID-19 as Compared to Influenza Pneumonia

by Antoine Fayol, Marine Livrozet, Héléna Pereira, Jean-Luc Diehl, David Lebeaux, Jean-Benoit Arlet, Bernard Cholley, Claire Carette, Jean-Baptiste Carves, Sébastien Czernichow, Caroline Hauw, Sophie-Rym Hamada, Anne-Sophie Jannot, Geoffroy Volle, Nihar Masurkar, Tristan Mirault, Benjamin Planquette, Olivier Sanchez, Gilles Châtellier, Michel Azizi and Jean-Sébastien Hulot Show full author list Hide full author list

J. Clin. Med. 2021, 10(19), 4618; https://doi.org/10.3390/jcm10194618 - 08 Oct 2021

Cited by 4 | Viewed by 2075

Abstract

We aimed to compare the influence of cardiometabolic disorders on the incidence of severe COVID-19 vs. non-COVID pneumonia. We included all consecutive patients admitted with SARS-CoV-2-positive pneumonia between 12 March 2020 and 1 April 2020 and compared them to patients with influenza pneumonia [...] Read more.

We aimed to compare the influence of cardiometabolic disorders on the incidence of severe COVID-19 vs. non-COVID pneumonia. We included all consecutive patients admitted with SARS-CoV-2-positive pneumonia between 12 March 2020 and 1 April 2020 and compared them to patients with influenza pneumonia hospitalized between December 2017 and December 2019 at the same tertiary hospital in Paris. Patients with COVID-19 were significantly younger and more frequently male. In the analysis adjusted for age and sex, patients with COVID-19 were more likely to be obese (adjOR: 2.25; 95% CI 1.24–4.09; p = 0.0076) and receive diuretics (adjOR: 2.13; 95% CI 1.12–4.03; p = 0.021) but were less likely to be smokers (adjOR: 0.40; 95% CI 0.24–0.64; p = 0.0002), have COPD (adjOR: 0.25; 95% CI 0.11–0.56; p = 0.0008), or have a previous or active cancer diagnosis (adjOR: 0.54, 95% CI 0.32–0.91; p = 0.020). The rate of ICU admission was significantly higher in patients with COVID-19 (32.4% vs. 5.2% p < 0.0001). Obesity was significantly associated with the risk of direct ICU admission in patients with COVID-19 but not in patients with influenza pneumonia. Likewise, pre-existing hypertension was significantly associated with mortality in patients with COVID-19 but not in patients with influenza pneumonia. Cardiometabolic disorders differentially influenced the risk of presenting with severe COVID-19 or influenza pneumonia. Full article

(This article belongs to the Special Issue COVID-19 and the Cardiovascular System: Implications for Risk Assessment, Diagnosis, and Treatment Options)

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12 pages, 2364 KiB

Open AccessReview

Bone Biopsy for Histomorphometry in Chronic Kidney Disease (CKD): State-of-the-Art and New Perspectives

by Luca Dalle Carbonare, Maria Teresa Valenti, Sandro Giannini, Maurizio Gallieni, Francesca Stefani, Roberto Ciresa, Cristina Politi and Maria Fusaro

J. Clin. Med. 2021, 10(19), 4617; https://doi.org/10.3390/jcm10194617 - 08 Oct 2021

Cited by 14 | Viewed by 3039

Abstract

The use of bone biopsy for histomorphometric analysis is a quantitative histological examination aimed at obtaining quantitative information on bone remodeling, structure and microarchitecture. The labeling with tetracycline before the procedure also allows for a dynamic analysis of the osteoblastic activity and mineralization [...] Read more.

The use of bone biopsy for histomorphometric analysis is a quantitative histological examination aimed at obtaining quantitative information on bone remodeling, structure and microarchitecture. The labeling with tetracycline before the procedure also allows for a dynamic analysis of the osteoblastic activity and mineralization process. In the nephrological setting, bone biopsy is indicated to confirm the diagnosis of subclinical or focal osteomalacia and to characterize the different forms of renal osteodystrophy (ROD). Even if bone biopsy is the gold standard for the diagnosis and specific classification of ROD, the use of this approach is very limited. The main reasons for this are the lack of widespread expertise in performing or interpreting bone biopsy results and the cost, invasiveness and potential pain associated with the procedure. In this regard, the sedation, in addition to local anesthesia routinely applied in Italian protocol, significantly reduces pain and ameliorates the pain perception of patients. Concerning the lack of widespread expertise, in Italy a Hub/Spokes model is proposed to standardize the analyses, optimizing the approach to CKD patients and reducing the costs of the procedure. In addition, new tools offer the possibility to evaluate the osteogenic potential or the ability to form bone under normal and pathological conditions, analyzing mesenchymal stem cells and their ability to differentiate in the osteogenic lineage. In the same way, circulating microRNAs are suggested as a tool for exploring osteogenic potential. The combination of different diagnostic approaches and the optimization of the bioptic procedure represent a concrete solution to spread the use of bone biopsy and optimize CKD patient management. Full article

(This article belongs to the Section Nephrology & Urology)

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8 pages, 499 KiB

Open AccessArticle

Diagnostic Yield of Transabdominal Ultrasonography for Evaluation of Pancreatic Cystic Lesions Compared with Endoscopic Ultrasonography

by Yu Ji Li, Gil Ho Lee, Min Jae Yang, Jae Chul Hwang, Byung Moo Yoo, Soon Sun Kim, Sun Gyo Lim and Jin Hong Kim

J. Clin. Med. 2021, 10(19), 4616; https://doi.org/10.3390/jcm10194616 - 08 Oct 2021

Cited by 2 | Viewed by 1623

Abstract

Detection rates of pancreatic cystic lesions (PCLs) have increased, resulting in greater requirements for regular monitoring using imaging modalities. We aimed to evaluate the capability of ultrasonography (US) for morphological characterization of PCLs as a reference standard using endoscopic ultrasonography (EUS). A retrospective [...] Read more.

Detection rates of pancreatic cystic lesions (PCLs) have increased, resulting in greater requirements for regular monitoring using imaging modalities. We aimed to evaluate the capability of ultrasonography (US) for morphological characterization of PCLs as a reference standard using endoscopic ultrasonography (EUS). A retrospective analysis was conducted of 102 PCLs from 92 patients who underwent US immediately prior to EUS between January 2014 and May 2017. The intermodality reliability and agreement of the PCL morphologic findings of the two techniques were analyzed and compared using the intraclass correlation coefficient and κ values. The success rates of US for delineating PCLs in the head, body, and tail of the pancreas were 77.8%, 91.8%, and 70.6%, respectively. The intraclass correlation coefficient for US and the corresponding EUS lesion size showed very good reliability (0.978; p < 0.001). The κ value between modalities was 0.882 for pancreatic duct dilation, indicating good agreement. The κ values for solid components and cystic wall and septal thickening were 0.481 and 0.395, respectively, indicating moderate agreement. US may be useful for monitoring PCL growth and changes in pancreatic duct dilation, but it has limited use in the diagnosis and surveillance of mural nodules or cystic wall thickness changes. Full article

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

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9 pages, 839 KiB

Open AccessArticle

Serum Levels of Chemerin in Patients with Inflammatory Bowel Disease as an Indicator of Anti-TNF Treatment Efficacy

by Marcin Sochal, Jakub Fichna, Agata Gabryelska, Renata Talar-Wojnarowska, Piotr Białasiewicz and Ewa Małecka-Wojciesko

J. Clin. Med. 2021, 10(19), 4615; https://doi.org/10.3390/jcm10194615 - 08 Oct 2021

Cited by 3 | Viewed by 1605

Abstract

Chemerin belongs to the adipokines—proteins secreted by white adipose tissue. It plays an important role in angiogenesis and metabolism and its levels correlate with inflammation severity in many clinical states. Circulating chemerin levels in IBD are only rarely evaluated, with inconsistent results. The [...] Read more.

Chemerin belongs to the adipokines—proteins secreted by white adipose tissue. It plays an important role in angiogenesis and metabolism and its levels correlate with inflammation severity in many clinical states. Circulating chemerin levels in IBD are only rarely evaluated, with inconsistent results. The possible impact of anti-TNF therapy treatment in IBD on chemerin levels has not been addressed. The study aim was to evaluate the serum levels of chemerin in patients with inflammatory bowel disease (IBD), depending on disease severity as well as anti-TNF treatment. Serum chemerin was measured with ELISA in 77 patients with IBD as well as in 42 healthy controls (HCs). Twenty-six participants who underwent anti-TNF therapy were re-examined after 14 weeks. Overall, IBD patients had significantly higher serum chemerin levels than HCs. In patients with IBD exacerbation, chemerin levels were significantly higher compared to the remission group. Serum chemerin levels were significantly higher in UC patients compared to CD. Chemerin correlated with the severity of CD, but not with UC. Serum levels of chemerin decreased significantly after 14 weeks of anti-TNF treatment. Chemerin correlated with the clinical severity of IBD, and its levels decreased after anti-TNF treatment, which suggests its relationship with disease activity. It may be assumed that chemerin levels may possibly be useful for anti-TNF clinical course and treatment monitoring. Full article

(This article belongs to the Special Issue Advances in Inflammatory Bowel Disease)

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8 pages, 441 KiB

Open AccessReview

The Impact of Infectious Complications after Esophagectomy for Esophageal Cancer on Cancer Prognosis and Treatment Strategy

by Eisuke Booka, Hirotoshi Kikuchi, Yoshihiro Hiramatsu and Hiroya Takeuchi

J. Clin. Med. 2021, 10(19), 4614; https://doi.org/10.3390/jcm10194614 - 08 Oct 2021

Cited by 10 | Viewed by 1693

Abstract

Despite advances in the perioperative management of esophagectomy, it is still a highly invasive procedure for esophageal cancer and is associated with severe postoperative complications. The two major postoperative infectious complications after esophagectomy are pulmonary complications and anastomotic leakage. We previously reported that [...] Read more.

Despite advances in the perioperative management of esophagectomy, it is still a highly invasive procedure for esophageal cancer and is associated with severe postoperative complications. The two major postoperative infectious complications after esophagectomy are pulmonary complications and anastomotic leakage. We previously reported that postoperative infectious complications after esophagectomy adversely affect long-term survival significantly in a single institution and meta-analysis. Additionally, we reviewed the mechanisms of proinflammatory cytokines, such as C-X-C motif ligand 8 (CXCL8) and its cognate receptor, C-X-C chemokine receptor 2 (CXCR2), in contributing to tumorigenesis and tumor progression. Moreover, we previously reported that introducing minimally invasive esophagectomy, including robot assistance, laparoscopic gastric mobilization, and multidisciplinary team management, significantly reduced postoperative infectious complications after esophagectomy. Further, this review also suggests future treatment strategies for esophageal cancer, considering the adverse effect of postoperative infectious complications after esophagectomy. Full article

(This article belongs to the Special Issue Host Immune Status and Proliferation of Cancers)

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13 pages, 272 KiB

Open AccessArticle

Sleep Quality and Eating Disorder-Related Psychopathologies in Patients with Night Eating Syndrome and Binge Eating Disorders

by Orna Tzischinsky, Itay Tokatly Latzer, Sigal Alon and Yael Latzer

J. Clin. Med. 2021, 10(19), 4613; https://doi.org/10.3390/jcm10194613 - 08 Oct 2021

Cited by 7 | Viewed by 2771

Abstract

Night eating syndrome (NES) is an eating disorder (ED) characterized by nocturnal ingestion (NI), evening hyperphagia, morning anorexia, as well as mood and sleep disturbances. This study compared subjective and objective sleep quality and ED-related psychopathologies in patients seeking treatment for ED. Method: [...] Read more.

Night eating syndrome (NES) is an eating disorder (ED) characterized by nocturnal ingestion (NI), evening hyperphagia, morning anorexia, as well as mood and sleep disturbances. This study compared subjective and objective sleep quality and ED-related psychopathologies in patients seeking treatment for ED. Method: The sample was composed of 170 women, aged 18–68, who were referred for an ED assessment from 2011 to 2020. The participants were divided into three subgroups: NES-NI only (n = 30), NES+ binge eating (BE) (including binge eating disorders or bulimia nervosa (n = 52), and BE-only (n = 88). The measures consisted of a psychiatric evaluation, objective sleep monitoring measured by an actigraph for 1 week, a subjective sleep self-report, and ED-related psychopathology questionnaires. Results: Objective sleep monitoring revealed significant group differences, with higher sleep efficiency in participants with BE-only and longer sleep durations for the NES-NI only group. Subjectively, the BE-only group described a significantly lower sleep quality than either the NES-NI only or the NES+BE groups. ED-related psychopathology was lower in the NES-NI-only group. A stepwise linear regression revealed that general psychopathology (the brief symptom inventory total score) was a significant predictor of subjective sleep quality. Conclusion: NES-NI-only was correlated with less psychopathology, but with more subjective and objective sleep disturbances. These results lend weight to the supposition that NES lies on a continuum of ED psychopathologies, and that NES-NI-only appears to be a separate entity from NES+BE and BE-only in terms of its psychopathology. Full article

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

11 pages, 2074 KiB

Open AccessArticle

Predictive Model for the Assessment of Preoperative Frailty Risk in the Elderly

by Sang-Wook Lee, Jae-Sik Nam, Ye-Jee Kim, Min-Ju Kim, Jeong-Hyun Choi, Eun-Ho Lee, Kyoung-Woon Joung and In-Cheol Choi

J. Clin. Med. 2021, 10(19), 4612; https://doi.org/10.3390/jcm10194612 - 08 Oct 2021

Cited by 4 | Viewed by 1514

Abstract

Adequate preoperative evaluation of frailty can greatly assist in the efficient allocation of hospital resources and planning treatments. However, most of the previous frailty evaluation methods, which are complicated, time-consuming, and can have inter-evaluator error, are difficult to apply in urgent situations. Thus, [...] Read more.

Adequate preoperative evaluation of frailty can greatly assist in the efficient allocation of hospital resources and planning treatments. However, most of the previous frailty evaluation methods, which are complicated, time-consuming, and can have inter-evaluator error, are difficult to apply in urgent situations. Thus, the authors aimed to develop and validate a predictive model for pre-operative frailty risk of elderly patients by using diagnostic and operation codes, which can be obtained easily and quickly from electronic records. We extracted the development cohort of 1762 people who were hospitalized for emergency operations at a single institution between 1 January 2012 and 31 December 2016. The temporal validation cohort from 1 January 2017 to 31 December 2018 in the same center was set. External validation was conducted on 6432 patients aged 75 years or older from 2012 to 2015 who had emergency surgery in the Korean national health insurance database. We developed the Operation Frailty Risk Score (OFRS) by assessing the association of Operation Group and Hospital Frailty Risk Score with the 90-day mortality through logistic regression analysis. We validated the OFRS in both the temporal validation cohort and two external validation cohorts. In the temporal validation cohort and the external validation cohort I and II, the c-statistics for OFRS to predict 90-day mortality were 0.728, 0.626, and 0.619, respectively. OFRS from these diagnostic codes and operation codes may help evaluate the peri-operative frailty risk before emergency surgery for elderly patients where history-taking and pre-operative testing cannot be performed. Full article

(This article belongs to the Special Issue Advances in Geriatric Diseases)

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10 pages, 1121 KiB

Open AccessArticle

Why Did All Patients with Atrial Fibrillation and High Risk of Stroke Not Receive Oral Anticoagulants? Results of the Polish Atrial Fibrillation (POL-AF) Registry

by Anna Szpotowicz, Iwona Gorczyca, Olga Jelonek, Beata Uziębło-Życzkowska, Małgorzata Maciorowska, Maciej Wójcik, Robert Błaszczyk, Agnieszka Kapłon-Cieślicka, Monika Gawałko, Monika Budnik, Tomasz Tokarek, Renata Rajtar-Salwa, Jacek Bil, Michał Wojewódzki, Janusz Bednarski, Elwira Bakuła-Ostalska, Anna Tomaszuk-Kazberuk, Anna Szyszkowska, Marcin Wełnicki, Artur Mamcarz, Małgorzata Krzciuk and Beata Wożakowska-Kapłon Show full author list Hide full author list

J. Clin. Med. 2021, 10(19), 4611; https://doi.org/10.3390/jcm10194611 - 08 Oct 2021

Cited by 2 | Viewed by 1585

Abstract

Background: Most atrial fibrillation (AF) patients are at high risk of thromboembolic, and the use of oral anticoagulants (OACs) is advised in such cases. The aim of the study was to evaluate the frequency at which OACs were used in patients with AF [...] Read more.

Background: Most atrial fibrillation (AF) patients are at high risk of thromboembolic, and the use of oral anticoagulants (OACs) is advised in such cases. The aim of the study was to evaluate the frequency at which OACs were used in patients with AF and high risk thromboembolic complications, and identify factors that result in OACs not being used in the researched group of patients. Methods: The prospective, multicenter and non-interventional POL-AF registry is a study that includes AF patients from ten Polish cardiology centers. They were consecutively hospitalized between January and December of 2019. All the patients in the study were of high stroke risk. Results: A total of 3614 patients with AF and high stroke risk were included. Among the total study population, 91.5% received OAC therapy; antiplatelet therapy was prescribed for 3.7% of patients, heparin for 2.7%, and 2.1% of patients did not receive any stroke prevention therapy. Independent predictors of no OAC prescription were intracranial bleeding (OR 0.15, 95%CI 0.07–0.35, p < 0.001), gastrointestinal bleeding (OR 0.25, 95%CI 0.17–0.37, p < 0.001), cancer (OR 0.37, 95%CI 0.25–0.55, p < 0.001), hospitalization due to acute coronary syndrome (OR 0.48, 95%CI 0.33–0.69, p < 0.001), and anemia (OR 0.62, 95%CI 0.48–0.81, p < 0.001). Conclusions: Most AF patients with a high thromboembolic risk received OACs. The factors predisposing a lack of OAC use in these patients were conditions that significantly increased the risk of bleeding complications. Full article

(This article belongs to the Section Cardiology)

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17 pages, 997 KiB

Open AccessArticle

Evolution of the Use of Corticosteroids for the Treatment of Hospitalised COVID-19 Patients in Spain between March and November 2020: SEMI-COVID National Registry

by David Balaz, Philip Erick Wikman-Jorgensen, Vicente Giner Galvañ, Manuel Rubio-Rivas, Borja de Miguel Campo, Mariam Noureddine López, Juan Francisco López Caleya, Ricardo Gómez Huelgas, Paula María Pesqueira Fontán, Manuel Méndez Bailón, Mar Fernández-Garcés, Ana Fernández Cruz, Gema María García García, Nicolás Rhyman, Luis Corral-Gudino, Aquiles Lozano Rodríguez-Mancheño, María Navarro De La Chica, Andrea Torregrosa García, José Nicolás Alcalá, Pablo Díaz Jiménez, Leticia Esther Royo Trallero, Pere Comas Casanova, 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(19), 4610; https://doi.org/10.3390/jcm10194610 - 08 Oct 2021

Cited by 4 | Viewed by 2554

Abstract

Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence [...] Read more.

Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations. Material and methods: A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID-19 Registry from March to November 2020. Results: CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7–160) vs. 49.3 (16–109) mg/dL; p < 0.001), ferritin (791 (393–1534) vs. 470 (236–996) µg/dL; p < 0.001), D dimer (750 (430–1400) vs. 617 (345–1180) µg/dL; p < 0.001), and lower Sp0₂/Fi0₂ (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%. Conclusions: Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%. Full article

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

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15 pages, 2285 KiB

Open AccessArticle

Involvement of Cutaneous Sensory Corpuscles in Non-Painful and Painful Diabetic Neuropathy

by Yolanda García-Mesa, Jorge Feito, Mario González-Gay, Irene Martínez, Jorge García-Piqueras, José Martín-Cruces, Eliseo Viña, Teresa Cobo and Olivia García-Suárez

J. Clin. Med. 2021, 10(19), 4609; https://doi.org/10.3390/jcm10194609 - 08 Oct 2021

Cited by 11 | Viewed by 2643

Abstract

Distal diabetic sensorimotor polyneuropathy (DDSP) is the most prevalent form of diabetic neuropathy, and some of the patients develop gradual pain. Specialized sensory structures present in the skin encode different modalities of somatosensitivity such as temperature, touch, and pain. The cutaneous sensory structures [...] Read more.

Distal diabetic sensorimotor polyneuropathy (DDSP) is the most prevalent form of diabetic neuropathy, and some of the patients develop gradual pain. Specialized sensory structures present in the skin encode different modalities of somatosensitivity such as temperature, touch, and pain. The cutaneous sensory structures responsible for the qualities of mechanosensitivity (fine touch, vibration) are collectively known as cutaneous mechanoreceptors (Meissner corpuscles, Pacinian corpuscles, and Merkel cell–axonal complexes), which results are altered during diabetes. Here, we used immunohistochemistry to analyze the density, localization within the dermis, arrangement of corpuscular components (axons and Schwann-like cells), and expression of putative mechanoproteins (PIEZO2, ASIC2, and TRPV4) in cutaneous mechanoreceptors of subjects suffering clinically diagnosed non-painful and painful distal diabetic sensorimotor polyneuropathy. The number of Meissner corpuscles, Pacinian corpuscles, and Merkel cells was found to be severely decreased in the non-painful presentation of the disease, and almost disappeared in the painful presentation. Furthermore, there was a marked reduction in the expression of axonal and Schwann-like cell markers (with are characteristics of corpuscular denervation) as well as of all investigated mechanoproteins in the non-painful distal diabetic sensorimotor polyneuropathy, and these were absent in the painful form. Taken together, these alterations might explain, at least partly, the impairment of mechanosensitivity system associated with distal diabetic sensorimotor polyneuropathy. Furthermore, our results support that an increasing severity of DDSP may increase the risk of developing painful neuropathic symptoms. However, why the absence of cutaneous mechanoreceptors is associated with pain remains to be elucidated. Full article

(This article belongs to the Special Issue Innervation of the Human Skin: From the Structure and Function to the Pathology)

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12 pages, 8559 KiB

Open AccessArticle

Heterozygous Arrhythmogenic Cardiomyopathy-desmoplakin Mutation Carriers Exhibit a Subclinical Cutaneous Phenotype with Cell Membrane Disruption and Lack of Intercellular Adhesion

by Eva Cabrera-Borrego, Trinidad Montero-Vilchez, Francisco José Bermúdez-Jiménez, Jesús Tercedor-Sánchez, Luis Tercedor-Sánchez, Manuel Sánchez-Díaz, Rosa Macías-Ruiz, María Molina-Jiménez, Francisco Javier Cañizares-García, Eduardo Fernández-Segura, Angel Fernandez-Flores, Salvador Arias-Santiago and Juan Jiménez-Jáimez

J. Clin. Med. 2021, 10(19), 4608; https://doi.org/10.3390/jcm10194608 - 08 Oct 2021

Cited by 4 | Viewed by 1601

Abstract

Genetic variants that result in truncation in desmoplakin (DSP) are a known cause of arrhythmogenic cardiomyopathy (AC). In homozygous carriers, the combined involvement of skin and heart muscle is well defined, however, this is not the case in heterozygous carriers. The [...] Read more.

Genetic variants that result in truncation in desmoplakin (DSP) are a known cause of arrhythmogenic cardiomyopathy (AC). In homozygous carriers, the combined involvement of skin and heart muscle is well defined, however, this is not the case in heterozygous carriers. The aim of this work is to describe cutaneous findings and analyze the molecular and ultrastructural cutaneous changes in this group of patients. Four women and eight men with a mean age of 48 ± 14 years were included. Eight met definitive criteria for AC, one was borderline and three were silent carriers. No relevant macroscopic changes in skin and hair were detected. However, significantly lower skin temperature (29.56 vs. 30.97 °C, p = 0.036) and higher transepidermal water loss (TEWL) (37.62 vs. 23.95 g m 2 h 1, p = 0.028) were observed compared to sex- and age-matched controls. Histopathology of the skin biopsy showed widening of intercellular spaces and acantholysis of keratinocytes in the spinous layer. Immunohistochemistry showed a strongly reduced expression of DSP in all samples. Trichogram showed regular nodules (thickening) compatible with pseudomonilethrix. Therefore, regardless of cardiac involvement, heterozygous patients with truncation-type variants in DSP have lower skin temperature and higher TEWL, constant microscopic skin involvement with specific patterns and pseudomonilethrix in the trichogram. Full article

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

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7 pages, 1621 KiB

Open AccessArticle

Triglyceride and Small Dense LDL-Cholesterol in Patients with Acute Coronary Syndrome

by Masakazu Hori, Teruhiko Imamura, Nikhil Narang, Hiroshi Onoda, Shuhei Tanaka, Ryuichi Ushijima, Mitsuo Sobajima, Nobuyuki Fukuda, Hiroshi Ueno and Koichiro Kinugawa

J. Clin. Med. 2021, 10(19), 4607; https://doi.org/10.3390/jcm10194607 - 08 Oct 2021

Cited by 3 | Viewed by 2055

Abstract

Background: Small dense LDL-cholesterol is an established risk factor for atherosclerosis but is not routinely measured in daily practice. The association between small dense LDL-cholesterol and triglyceride, which in turn is routinely measured, in patients with acute coronary syndrome remains unknown. Methods: Consecutive [...] Read more.

Background: Small dense LDL-cholesterol is an established risk factor for atherosclerosis but is not routinely measured in daily practice. The association between small dense LDL-cholesterol and triglyceride, which in turn is routinely measured, in patients with acute coronary syndrome remains unknown. Methods: Consecutive patients with acute coronary syndrome who were admitted to our institute were prospectively included, and serum samples were obtained on admission. The association between small dense LDL-cholesterol and triglyceride was investigated. Results: Among 55 patients (median 71 years old, 64% men), median (interquartile range) small dense LDL-cholesterol was 23.6 (17.0, 36.0) and triglyceride was 101 (60, 134) mg/dL. Triglyceride level correlated with small dense LDL-cholesterol (r = 0.67, p < 0.001) and was an independent determinant of small dense LDL-cholesterol together with body mass index (p = 0.010 and p = 0.008, respectively). Those with high triglyceride and high body mass index had a 3-fold level of small dense LDL-cholesterol compared with those with low triglyceride and low body mass index (45.8 [35.0, 54.0] mg/dL versus 15.0 [11.6, 23.7] mg/dL, p = 0.001). Conclusions: Triglyceride level was a major determinant of small dense LDL-cholesterol in patients with acute coronary syndrome. Triglyceride level might be a useful and practical biomarker for risk stratification for patients with acute coronary syndrome together with body mass index. Full article

(This article belongs to the Section Cardiology)

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17 pages, 3271 KiB

Open AccessArticle

Long-Term SARS-CoV-2 Specific Immunity Is Affected by the Severity of Initial COVID-19 and Patient Age

by Margarethe Konik, Monika Lindemann, Markus Zettler, Lara Meller, Sebastian Dolff, Vera Rebmann, Peter A. Horn, Ulf Dittmer, Adalbert Krawczyk, Leonie Schipper, Mirko Trilling, Olympia Evdoxia Anastasiou, Sina Schwarzkopf, Laura Thümmler, Christian Taube, Christoph Schöbel, Thorsten Brenner, Eva-Maria Skoda, Benjamin Wilde, Anja Gäckler, Oliver Witzke and Hana Rohn Show full author list Hide full author list

J. Clin. Med. 2021, 10(19), 4606; https://doi.org/10.3390/jcm10194606 - 08 Oct 2021

Cited by 9 | Viewed by 2422

Abstract

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently the greatest medical challenge. Although crucial to the future management of the pandemic, the factors affecting the persistence of long-term SARS-CoV-2 immunity are not well understood. [...] Read more.

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently the greatest medical challenge. Although crucial to the future management of the pandemic, the factors affecting the persistence of long-term SARS-CoV-2 immunity are not well understood. Therefore, we determined the extent of important correlates of SARS-CoV-2 specific protection in 200 unvaccinated convalescents after COVID-19. To investigate the effective memory response against the virus, SARS-CoV-2 specific T cell and humoral immunity (including virus-neutralizing antibodies) was determined over a period of one to eleven months. SARS-CoV-2 specific immune responses were present in 90% of individual patients. Notably, immunosuppressed patients did not have long-term SARS-CoV-2 specific T cell immunity. In our cohort, the severity of the initial illness influenced SARS-CoV-2 specific T cell immune responses and patients’ humoral immune responses to Spike (S) protein over the long-term, whereas the patients’ age influenced Membrane (M) protein-specific T cell responses. Thus, our study not only demonstrated the long-term persistence of SARS-CoV-2 specific immunity, it also determined COVID-19 severity and patient age as significant factors affecting long-term immunity. Full article

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

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17 pages, 9150 KiB

Open AccessArticle

A Retrospective Cohort Study of Clinical Factors Associated with Transitions of Care among COVID-19 Patients

by Dennis Swearingen, Gregory Boverman, Kristen Tgavalekos, David P. Noren, Shreyas Ravindranath, Erina Ghosh, Minnan Xu, Lisa Wondrely, Pam Thompson, J. David Cowden and Corneliu Antonescu

J. Clin. Med. 2021, 10(19), 4605; https://doi.org/10.3390/jcm10194605 - 08 Oct 2021

Cited by 3 | Viewed by 2145

Abstract

Coronavirus Disease 2019 (COVID-19) is an international health crisis. In this article, we report on patient characteristics associated with care transitions of: 1) hospital admission from the emergency department (ED) and 2) escalation to the intensive care unit (ICU). Analysis of data from [...] Read more.

Coronavirus Disease 2019 (COVID-19) is an international health crisis. In this article, we report on patient characteristics associated with care transitions of: 1) hospital admission from the emergency department (ED) and 2) escalation to the intensive care unit (ICU). Analysis of data from the electronic medical record (EMR) was performed for patients with COVID-19 seen in the ED of a large Western U.S. Health System from April to August of 2020, totaling 10,079 encounters. Of these, 5172 resulted in admission as an inpatient within 72 h. Inpatient encounters (n = 6079) were also considered for patients with positive COVID-19 test results, of which 970 resulted in a transfer to the ICU or in-hospital mortality. Laboratory results, vital signs, symptoms, and comorbidities were investigated for each of these care transitions. Different top risk factors were found, but two factors common to hospital admission and ICU transfer were respiratory rate and the need for oxygen support. Comorbidities common to both settings were cerebrovascular disease and congestive heart failure. Regarding laboratory results, the neutrophil-to-lymphocyte ratio was associated with transitions to higher levels of care, along with the ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT). Full article

(This article belongs to the Special Issue Emergency and Intensive Care Medicine for COVID-19 Infections)

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14 pages, 412 KiB

Open AccessReview

Understanding the Influence of Personality Traits on Risk of Suicidal Behaviour in Schizophrenia Spectrum Disorders: A Systematic Review

by Manuel Canal-Rivero, Rosa Ayesa-Arriola, Esther Setién-Suero, Benedicto Crespo-Facorro, Celso Arango, Rina Dutta and Javier-David Lopez-Morinigo

J. Clin. Med. 2021, 10(19), 4604; https://doi.org/10.3390/jcm10194604 - 08 Oct 2021

Cited by 1 | Viewed by 2387

Abstract

Risk of suicidal behaviour (SB) in schizophrenia spectrum disorders (SSD) is a major concern, particularly in early stages of the illness, when suicide accounts for a high number of premature deaths. Although some risk factors for SB in SSD are well understood, the [...] Read more.

Risk of suicidal behaviour (SB) in schizophrenia spectrum disorders (SSD) is a major concern, particularly in early stages of the illness, when suicide accounts for a high number of premature deaths. Although some risk factors for SB in SSD are well understood, the extent to which personality traits may affect this risk remains unclear, which may have implications for prevention. We conducted a systematic review of previous studies indexed in MEDLINE, PsycINFO and Embase examining the relationship between personality traits and SB in samples of patients with SSD. Seven studies fulfilled predetermined selection criteria. Harm avoidance, passive-dependent, schizoid and schizotypal personality traits increased the risk of SB, while self-directedness, cooperativeness, excluding persistence and self-transcendence acted as protective factors. Although only seven studies were retrieved from three major databases after applying predetermined selection criteria, we found some evidence to support that personality issues may contribute to SB in patients with SSD. Personality traits may therefore become part of routine suicide risk assessment and interventions targeting these personality-related factors may contribute to prevention of SB in SSD. Full article

(This article belongs to the Special Issue Dissecting the Relationship between Personality Disorders and Suicide)

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2 pages, 195 KiB

Open AccessEditorial

Needling Interventions for the Management of Musculoskeletal Pain Syndromes

by César Fernández-de-las-Peñas

J. Clin. Med. 2021, 10(19), 4603; https://doi.org/10.3390/jcm10194603 - 07 Oct 2021

Viewed by 1371

Abstract

Needling interventions consist of the use of filiform needles for the management of different conditions of the neuromusculoskeletal system [...] Full article

(This article belongs to the Special Issue Needling Interventions for the Management of Musculoskeletal Pain Syndromes)

12 pages, 441 KiB

Open AccessArticle

Self-Injuries and Their Functions with Respect to Suicide Risk in Adolescents with Conduct Disorder: Findings from a Path Analysis

by Monika Szewczuk-Bogusławska, Małgorzata Kaczmarek-Fojtar, Joanna Halicka-Masłowska and Błażej Misiak

J. Clin. Med. 2021, 10(19), 4602; https://doi.org/10.3390/jcm10194602 - 07 Oct 2021

Cited by 2 | Viewed by 1627

Abstract

Non-suicidal self-injuries (NSSIs) have been identified as one of the most predictive factors of suicidal behaviours in adolescents. However, it remains unknown whether certain functions of NSSIs are associated with suicide risk, and what are the underlying mechanisms. Therefore, we aimed to investigate [...] Read more.

Non-suicidal self-injuries (NSSIs) have been identified as one of the most predictive factors of suicidal behaviours in adolescents. However, it remains unknown whether certain functions of NSSIs are associated with suicide risk, and what are the underlying mechanisms. Therefore, we aimed to investigate the association between functions of NSSIs and suicide risk in adolescents with conduct disorder (CD), which shares some common characteristics with NSSIs. Participants were 215 adolescents (155 females, 72.1%) with CD. Functions of NSSIs, depressive symptoms, the levels of impulsivity, anxiety, self-esteem and aggression were examined. There were 77 adolescents with lifetime history of NSSIs (35.8%). Among them, adolescents with lifetime history of suicide attempt were significantly more likely to report anti-dissociation and anti-suicide function of NSSIs. They had significantly higher levels of anxiety as well as significantly lower self-esteem. Higher lifetime number of NSSIs was associated with higher odds of reporting anti-dissociation and anti-suicide functions. Moreover, these two functions fully mediated the association between lifetime number of NSSIs and suicide risk after co-varying for depressive and anxiety symptoms as well as self-esteem. The present findings indicate that anti-suicide and anti-dissociation functions of NSSIs might be crucial predictors of suicide risk in adolescents with CD. Full article

(This article belongs to the Section Mental Health)

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16 pages, 2360 KiB

Open AccessReview

Caval Valve Implantation (CAVI): An Emerging Therapy for Treating Severe Tricuspid Regurgitation

by Omar Abdul-Jawad Altisent, Rimantas Benetis, Egle Rumbinaite, Vaida Mizarien, Pau Codina, Francisco Gual-Capllonch, Giosafat Spitaleri, Eduard Fernandez-Nofrerias, Antoni Bayes-Genis and Rishi Puri

J. Clin. Med. 2021, 10(19), 4601; https://doi.org/10.3390/jcm10194601 - 07 Oct 2021

Cited by 21 | Viewed by 4142

Abstract

Severe tricuspid regurgitation remains a challenging heart-valve disease to effectively treat with high morbidity and mortality at mid-term. Currently guideline-directed medical treatment is limited to escalating dose of diuretics, and the rationale and timing of open-heart surgery remains controversial. Emerging percutaneous therapies for [...] Read more.

Severe tricuspid regurgitation remains a challenging heart-valve disease to effectively treat with high morbidity and mortality at mid-term. Currently guideline-directed medical treatment is limited to escalating dose of diuretics, and the rationale and timing of open-heart surgery remains controversial. Emerging percutaneous therapies for severe tricuspid regurgitation continue to show promising results in early feasibility studies. However, randomized trial data is lacking. Additionally, many patients are deemed unsuitable for these emerging therapies due to anatomical or imaging constraints. Given the technical simplicity of the bicaval valve implantation (CAVI) technique compared to other transcatheter devices, CAVI is postulated as a suitable alternative for a wide variety of patients affected with severe+ tricuspid regurgitation. In this review we illustrate the current evidence and ongoing uncertainties of CAVI, focusing on the novel CAVI-specific devices. Full article

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

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12 pages, 4327 KiB

Open AccessArticle

Biomechanical Value of a Protective Proximal Humeral Cerclage in Reverse Total Shoulder Arthroplasty

by Philipp A. Michel, J. Christoph Katthagen, Benedikt Schliemann, Sina Wilkens, Andre Frank, Lukas F. Heilmann, Felix Dyrna and Michael J. Raschke

J. Clin. Med. 2021, 10(19), 4600; https://doi.org/10.3390/jcm10194600 - 06 Oct 2021

Cited by 3 | Viewed by 2308

Abstract

Reverse shoulder arthroplasty (RSA) is a commonly performed salvage procedure for failed proximal humeral fracture fixation. The rate of intraoperative periprosthetic fractures is higher compared to primary RSA. The goal of this study was to investigate the biomechanical value of a protective cerclage [...] Read more.

Reverse shoulder arthroplasty (RSA) is a commonly performed salvage procedure for failed proximal humeral fracture fixation. The rate of intraoperative periprosthetic fractures is higher compared to primary RSA. The goal of this study was to investigate the biomechanical value of a protective cerclage during stem impaction in a revision surgery setting. Twenty-eight fresh-frozen human humeri were used to assess different configurations for steel wire and FiberTape cerclages. A custom-built biomechanical test setup simulated the mallet strikes during the stem impaction process with the Univers Revers prothesis stem. The mallet energy until the occurrence of a first crack was not different between groups. The total energy until progression of the fracture distally to the cerclage was significantly higher in the cerclage groups compared to the native humerus (9.5 J vs. 3.5 J, respectively; p = 0.0125). There was no difference between the steel wire and FiberTape groups (11.4 J vs. 8.6 J, respectively; p = 0.2695). All fractures were located at the concave side of the stem at the metaphyseal calcar region. This study demonstrates that a protective cerclage can successfully delay the occurrence of a fracture during stem impaction in reverse shoulder arthroplasty. A FiberTape cerclage is biomechanically equally efficient compared to a steel wire cerclage. Full article

(This article belongs to the Special Issue Management of Periprosthetic Fractures: Current Experience and Future Developments)

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12 pages, 294 KiB

Open AccessArticle

Acute Kidney Disease and Mortality in Acute Kidney Injury Patients with COVID-19

by Filipe Marques, Joana Gameiro, João Oliveira, José Agapito Fonseca, Inês Duarte, João Bernardo, Carolina Branco, Claúdia Costa, Carolina Carreiro, Sandra Braz and José António Lopes

J. Clin. Med. 2021, 10(19), 4599; https://doi.org/10.3390/jcm10194599 - 06 Oct 2021

Cited by 18 | Viewed by 2167

Abstract

Background: The incidence of AKI in coronavirus disease 2019 (COVID-19) patients is variable and has been associated with worse prognosis. A significant number of patients develop persistent kidney damage defined as Acute Kidney Disease (AKD). There is a lack of evidence on the [...] Read more.

Background: The incidence of AKI in coronavirus disease 2019 (COVID-19) patients is variable and has been associated with worse prognosis. A significant number of patients develop persistent kidney damage defined as Acute Kidney Disease (AKD). There is a lack of evidence on the real impact of AKD on COVID-19 patients. We aim to identify risk factors for the development of AKD and its impact on mortality in COVID-19 patients. Methods: Retrospective analysis of COVID-19 patients with AKI admitted at the Centro Hospitalar Universitário Lisboa Norte between March and August of 2020. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to define AKI. AKD was defined by presenting at least KDIGO Stage 1 criteria for >7 days after an AKI initiating event. Results: In 339 COVID-19 patients with AKI, 25.7% patients developed AKD (n = 87). The mean age was 71.7 ± 17.0 years, baseline SCr was 1.03 ± 0.44 mg/dL, and the majority of patients were classified as KDIGO stage 3 AKI (54.3%). The in-hospital mortality was 18.0% (n = 61). Presence of hypertension (p = 0.006), CKD (p < 0.001), lower hemoglobin (p = 0.034) and lower CRP (p = 0.004) at the hospital admission and nephrotoxin exposure (p < 0.001) were independent risk factors for the development of AKD. Older age (p = 0.003), higher serum ferritin at admission (p = 0.008) and development of AKD (p = 0.029) were independent predictors of in-hospital mortality in COVID-19-AKI patients. Conclusions: AKD was significantly associated with in-hospital mortality in this population of COVID-19-AKI patients. Considering the significant risk of mortality in AKI patients, it is of paramount importance to identify the subset of higher risk patients. Full article

(This article belongs to the Special Issue Prevention and Treatment of Acute Kidney Injury)

16 pages, 3907 KiB

Open AccessArticle

MRI Protocol for Pituitary Assessment in Children with Growth or Puberty Disorders—Is Gadolinium Contrast Administration Actually Needed?

by Marta Michali-Stolarska, Andrzej Tukiendorf, Anna Zacharzewska-Gondek, Jagoda Jacków-Nowicka, Joanna Chrzanowska, Grzegorz Trybek and Joanna Bladowska

J. Clin. Med. 2021, 10(19), 4598; https://doi.org/10.3390/jcm10194598 - 06 Oct 2021

Cited by 1 | Viewed by 2481

Abstract

The aim of this study was to assess the diagnostic value of non-contrast pituitary MRI in children with growth or puberty disorders (GPDs) and to determine the criteria indicating the necessity to perform post-contrast examination. A retrospective study included re-analysis of 567 contrast-enhanced [...] Read more.

The aim of this study was to assess the diagnostic value of non-contrast pituitary MRI in children with growth or puberty disorders (GPDs) and to determine the criteria indicating the necessity to perform post-contrast examination. A retrospective study included re-analysis of 567 contrast-enhanced pituitary MRIs of children treated in a tertiary reference center. Two sets of sequences were created from each MRI examination: Set 1, including common sequences without contrast administration, and Set 2, which included common pre- and post-contrast sequences (conventional MRI examination). The differences in the visibility of pituitary lesions between pairs of sets were statistically analyzed. The overall frequency of Rathke’s cleft cysts was 11.6%, ectopic posterior pituitary 3.5%, and microadenomas 0.9%. Lesions visible without contrast administration accounted for 85% of cases. Lesions not visible before and diagnosed only after contrast injection accounted for only 0.18% of all patients. Statistical analysis showed the advantage of the antero-posterior (AP) pituitary dimension over the other criteria in determining the appropriateness of using contrast in pituitary MRIs. The AP dimension was the most significant factor in logistic regression analysis: OR = 2.23, 95% CI, 1.35–3.71, p-value = 0.002, and in ROC analysis: AUC: 72.9% with a cut-off value of 7.5 mm, with sensitivity/specificity rates of 69.2%/73.5%. In most cases, the use of gadolinium-based contrast agent (GBCA) in pituitary MRI in children with GPD is unnecessary. The advantages of GBCA omission include shortening the time of MRI examination and of general anesthesia; saving time for other examinations, thus increasing the availability of MRI for waiting children; and acceleration in their further clinical management. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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13 pages, 963 KiB

Open AccessArticle

Effect of Bone Morphogenetic Protein-2 in the Treatment of Long Bone Non-Unions

by Thomas Fuchs, Josef Stolberg-Stolberg, Philipp A. Michel, Patric Garcia, Susanne Amler, Dirk Wähnert and Michael J. Raschke

J. Clin. Med. 2021, 10(19), 4597; https://doi.org/10.3390/jcm10194597 - 06 Oct 2021

Cited by 10 | Viewed by 2192

Abstract

Background: Delayed fracture healing continues to cause significant patient morbidity and an economic burden to society. Biological stimulation of non-unions includes application of recombinant bone morphogenetic protein-2 (rhBMP-2). However, rhBMP-2 use continues to be a matter of controversy as literature shows scarce evidence [...] Read more.

Background: Delayed fracture healing continues to cause significant patient morbidity and an economic burden to society. Biological stimulation of non-unions includes application of recombinant bone morphogenetic protein-2 (rhBMP-2). However, rhBMP-2 use continues to be a matter of controversy as literature shows scarce evidence for treatment effectiveness. Questions: The objective of this study was to evaluate the effectiveness of rhBMP-2 treatment on long bone non-unions measuring union rate and time to union. Furthermore, we assess risk factors for treatment failure. Methods and patients: A total of 91 patients with non-unions of long bones were treated with rhBMP-2 (n = 72) or standard care without BMP (n = 19) at our institution. Patient characteristics, comorbidities, nicotine consumption, and complications were recorded. Bone healing was assessed by plane X-rays and clinical examination. Patients were followed up with for 24 months. Results: Overall, there was significantly faster bone healing after rhBMP-2 application compared to the no-BMP group (p < 0.001; HR = 2.78; 95% CI 1.4–5.6). Union rates differed significantly between rhBMP-2 compared to the no-BMP group (89% vs. 47%; p < 0.001). At the humerus, there was neither a significantly higher union rate in the rhBMP-2 (83%) compared to the no-BMP group (50%) (p = 0.26; n = 12) nor a faster bone healing with a median time of 9 months in both groups (HR = 2.01; 95% CI 0.49–8.61; p = 0.315). The 33 femora treated using rhBMP-2 healed significantly faster than 9 femora in the no-BMP group (HR = 2.93; 95% CI 1.00–8.4; p = 0.023) with significant differences in union rate with 85% and 44%, respectively (p = 0.022). Regarding tibia non-unions, 25 out of 27 (93%) healed with a median of 9 months after rhBMP-2 application with no significant difference in the no-BMP group (33%) in time to union (p = 0.097) but a significantly higher union rate (p = 0.039). There was no effect of comorbidities, age, sex, soft tissue damage, or nicotine use on time to union, union rate, or secondary interventions. Conclusion: Consistent with the literature, overall, significantly higher union rates with reduced time to union were achieved after rhBMP-2 application. Femoral and tibial non-unions in particular seem to profit from rhBMP-2 application. Full article

(This article belongs to the Special Issue Epidemiology, Risk Factors, Prevalence and Incidence of Musculoskeletal Pathologies/Injuries and Related Surgeries)

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11 pages, 1019 KiB

Open AccessArticle

Long-Term Impact of Economic Downturn and Loneliness on Psychological Distress: Triple Crises of COVID-19 Pandemic

by Shuyan Liu, Matthias N. Haucke, Stephan Heinzel and Andreas Heinz

J. Clin. Med. 2021, 10(19), 4596; https://doi.org/10.3390/jcm10194596 - 06 Oct 2021

Cited by 25 | Viewed by 4079

Abstract

Background: The COVID-19 crisis poses global mental health and global economy challenges. However, there is a lack of longitudinal research investigating whether financial instability and social disruption may increase the risk of developing mental health problems over time that may potentially outlast the [...] Read more.

Background: The COVID-19 crisis poses global mental health and global economy challenges. However, there is a lack of longitudinal research investigating whether financial instability and social disruption may increase the risk of developing mental health problems over time that may potentially outlast the pandemic. Methods: We conducted an online survey for members of the general population (n = 2703) in Germany during the twelve months spanning from April 2020 to March 2021. We investigated the development of COVID-19 related psychological distress, the number of unemployed people, federal government debt, income distribution, and loneliness over the time period. Results: Over a period of twelve months, 53.6% of respondents in Germany reported experiencing psychological distress, varying from mild levels, 34.2%, to severe levels, 19.4%, of distress. High federal government debt, high incident COVID-19 cases, low incomes, and the prevalence of loneliness were found to be associated with increased long-term mental health problems. Psychological distress scores were most strongly increased in female and young respondents as well as those who reported fewer years of education, low income, and higher loneliness. Conclusions: Our study highlights factors that have a long-term impact on mental health amid the COVID-19 pandemic. We suggest that specific mental-health services could be offered to support high-risk groups experiencing financial fragility and loneliness. For purposes of safeguarding their mental health there is a need to monitor and track such risk factors in real time. Full article

(This article belongs to the Special Issue Psychological Distress and Panic during Global Pandemic)

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J. Clin. Med., Volume 10, Issue 19 (October-1 2021) – 338 articles

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