Journal of Clinical Medicine

17 pages, 3867 KiB

Open AccessArticle

Algorithms for Automated Calibration of Transcutaneous Spinal Cord Stimulation to Facilitate Clinical Applications

by Christina Salchow-Hömmen, Thomas Schauer, Philipp Müller, Andrea A. Kühn, Ursula S. Hofstoetter and Nikolaus Wenger

J. Clin. Med. 2021, 10(22), 5464; https://doi.org/10.3390/jcm10225464 - 22 Nov 2021

Cited by 5 | Viewed by 2348

Abstract

Transcutaneous spinal cord stimulation (tSCS) is a promising intervention that can benefit spasticity control and augment voluntary movement in spinal cord injury (SCI) and multiple sclerosis. Current applications require expert knowledge and rely on the thorough visual analysis of electromyographic (EMG) responses from [...] Read more.

Transcutaneous spinal cord stimulation (tSCS) is a promising intervention that can benefit spasticity control and augment voluntary movement in spinal cord injury (SCI) and multiple sclerosis. Current applications require expert knowledge and rely on the thorough visual analysis of electromyographic (EMG) responses from lower-limb muscles to optimize attainable treatment effects. Here, we devised an automated tSCS setup by combining an electrode array placed over low-thoracic to mid-lumbar vertebrae, synchronized EMG recordings, and a self-operating stimulation protocol to systematically test various stimulation sites and amplitudes. A built-in calibration procedure classifies the evoked responses as reflexes or direct motor responses and identifies stimulation thresholds as recommendations for tSCS therapy. We tested our setup in 15 individuals (five neurologically intact, five SCI, and five Parkinson’s disease) and validated the results against blinded ratings from two clinical experts. Congruent results were obtained in 13 cases for electrode positions and in eight for tSCS amplitudes, with deviations of a maximum of one position and 5 to 10 mA in amplitude in the remaining cases. Despite these minor deviations, the calibration found clinically suitable tSCS settings in 13 individuals. In the remaining two cases, the automatic setup and both experts agreed that no reflex responses could be detected. The presented technological developments may facilitate the dissemination of tSCS into non-academic environments and broaden its use for diagnostic and therapeutic purposes. Full article

(This article belongs to the Special Issue Spinal Cord Injury and Transcutaneous Spinal Cord Stimulation)

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17 pages, 608 KiB

Open AccessReview

Simple Serum Pancreatic Ductal Adenocarcinoma (PDAC) Protein Biomarkers—Is There Anything in Sight?

by Monika Kapszewicz and Ewa Małecka-Wojciesko

J. Clin. Med. 2021, 10(22), 5463; https://doi.org/10.3390/jcm10225463 - 22 Nov 2021

Cited by 10 | Viewed by 2135

Abstract

A poor PDAC prognosis is due to a lack of effective treatment and late diagnosis. The early detection of PDAC could significantly decrease mortality and save lives. Idealbiomarkers for PDAC should be cost-effective, detectable in easily accessible biological material, and present in sufficient [...] Read more.

A poor PDAC prognosis is due to a lack of effective treatment and late diagnosis. The early detection of PDAC could significantly decrease mortality and save lives. Idealbiomarkers for PDAC should be cost-effective, detectable in easily accessible biological material, and present in sufficient concentration in the earliest possible phase of the disease. This review addresses newly selected, simple protein biomarkers—new ones such as thrombospondin-2, insulin-linked binding protein 2, lysophosphatidic acid, and autotaxin and conventional ones such as Ca19-9, inflammatory factors, and coagulation factors. Their possible use in the early detection of PDAC, differentiation from benign diseases, prognosis, and treatment response prediction is discussed. We also address the usefulness of possible combinations of biomarkers in diagnostic panels. Full article

(This article belongs to the Special Issue Pancreatic Cancer: Biomarkers, Risk Factors, Early Detection)

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15 pages, 1147 KiB

Open AccessArticle

Effect of Violet Light-Transmitting Eyeglasses on Axial Elongation in Myopic Children: A Randomized Controlled Trial

by Kiwako Mori, Hidemasa Torii, Yutaka Hara, Michiko Hara, Erisa Yotsukura, Akiko Hanyuda, Kazuno Negishi, Toshihide Kurihara and Kazuo Tsubota

J. Clin. Med. 2021, 10(22), 5462; https://doi.org/10.3390/jcm10225462 - 22 Nov 2021

Cited by 15 | Viewed by 3359

Abstract

The fact that outdoor light environment is an important suppressive factor against myopia led us to invent violet light-transmitting eyeglasses (VL glasses) which can transmit violet light (VL), 360–400 nm in wavelength, for the suppression of myopia, and can meanwhile block harmful ultraviolet [...] Read more.

The fact that outdoor light environment is an important suppressive factor against myopia led us to invent violet light-transmitting eyeglasses (VL glasses) which can transmit violet light (VL), 360–400 nm in wavelength, for the suppression of myopia, and can meanwhile block harmful ultraviolet waves from sunlight. The current study is a double-blinded randomized clinical trial to investigate the myopia-suppressive effect of VL glasses compared to conventional eyeglasses (placebo glasses) that do not transmit VL. The subjects were children aged from 6 to 12 years old, the population in which myopia progression is generally accelerated, and the myopia suppressive effect was followed up for two years in a city in Japan. Periodical ophthalmic examinations, interviews, and measurements of reflection and axial length under mydriasis were performed at the initial visit (the baseline) and at 1, 6, 12, 18, and 24 months. The mean change in axial length in the VL glasses group was significantly smaller than in the placebo glasses group when time for near-work was less than 180 min and when the subjects were limited to those who had never used eyeglasses before this trial (p < 0.01); however, this change was not significant without subgrouping. The suppressive rate for axial elongation in the VL glasses group was 21.4% for two years. Full article

(This article belongs to the Special Issue Ophthalmic Optics and Visual Function)

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12 pages, 1068 KiB

Open AccessArticle

Local Vibration Reduces Muscle Damage after Prolonged Exercise in Men

by Anna Piotrowska, Wanda Pilch, Łukasz Tota, Marcin Maciejczyk, Dariusz Mucha, Monika Bigosińska, Przemysław Bujas, Szczepan Wiecha, Ewa Sadowska-Krępa and Tomasz Pałka

J. Clin. Med. 2021, 10(22), 5461; https://doi.org/10.3390/jcm10225461 - 22 Nov 2021

Cited by 6 | Viewed by 2365

Abstract

Prolonged exercise can lead to muscle damage, with soreness, swelling, and ultimately reduced strength as a consequence. It has been shown that whole-body vibration (WBV) improves recovery by reducing the levels of stress hormones and the activities of creatine kinase (CK) and lactate [...] Read more.

Prolonged exercise can lead to muscle damage, with soreness, swelling, and ultimately reduced strength as a consequence. It has been shown that whole-body vibration (WBV) improves recovery by reducing the levels of stress hormones and the activities of creatine kinase (CK) and lactate dehydrogenase (LDH). The aim of the study was to demonstrate the effect of local vibration treatment applied after exercise on the level of selected markers of muscle fiber damage. The study involved 12 untrained men, aged 21.7 ± 1.05 years, with a VO₂peak of 46.12 ± 3.67 mL·kg⁻¹·min⁻¹. A maximal intensity test to volitional exhaustion was performed to determine VO₂peak and individual exercise loads for prolonged exercise. The subjects were to perform 180 min of physical effort with an intensity of 50 ± 2% VO₂peak. After exercise, they underwent a 60 min vibration treatment or placebo therapy using a mattress. Blood samples were taken before, immediately after the recovery procedure, and 24 h after the end of the exercise test. Myoglobin (Mb) levels as well as the activities of CK and LDH were recorded. Immediately after the hour-long recovery procedure (vibration or placebo), the mean concentrations of the determined indices were significantly different from baseline values. In the vibration group, significantly lower values of Mb (p = 0.005), CK (p = 0.030), and LDH (p = 0.005) were seen. Differences were also present 24 h after the end of the exercise test. The results of the vibration group compared to the control group differed in respect to Mb (p = 0.002), CK (p = 0.029), and LDH (p = 0.014). After prolonged physical effort, topical vibration improved post-workout recovery manifested by lower CK and LDH activity and lower Mb concentration compared to a control group. Full article

(This article belongs to the Special Issue Health, Quality of Life and Sport Rehabilitation)

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12 pages, 475 KiB

Open AccessArticle

Comparison of Indexes to Measure Comorbidity Burden and Predict All-Cause Mortality in Rheumatoid Arthritis

by Yun-Ju Huang, Jung-Sheng Chen, Shue-Fen Luo and Chang-Fu Kuo

J. Clin. Med. 2021, 10(22), 5460; https://doi.org/10.3390/jcm10225460 - 22 Nov 2021

Cited by 9 | Viewed by 2085

Abstract

Objectives: To examine the comorbidity burden in patients with rheumatoid arthritis (RA) patients using a nationwide population-based cohort by assessing the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), Multimorbidity Index (MMI), and Rheumatic Disease Comorbidity Index (RDCI) scores and to investigate their [...] Read more.

Objectives: To examine the comorbidity burden in patients with rheumatoid arthritis (RA) patients using a nationwide population-based cohort by assessing the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), Multimorbidity Index (MMI), and Rheumatic Disease Comorbidity Index (RDCI) scores and to investigate their predictive ability for all-cause mortality. Methods: We identified 24,767 RA patients diagnosed from 1998 to 2008 in Taiwan and followed up until 31 December 2013. The incidence of comorbidities was estimated in three periods (before, during, and after the diagnostic period). The incidence rate ratios were calculated by comparing during vs. before and after vs. before the diagnostic period. One- and 5-year mortality rates were calculated and discriminated by low and high-score groups and modified models for each index. Results: The mean score at diagnosis was 0.8 in CCI, 2.8 in ECI, 0.7 in MMI, and 1.3 in RDCI, and annual percentage changes are 11.0%, 11.3%, 9.7%, and 6.8%, respectively. The incidence of any increase in the comorbidity index was significantly higher in the periods of “during” and “after” the RA diagnosis (incidence rate ratios for different indexes: 1.33–2.77). The mortality rate significantly differed between the high and low-score groups measured by each index (adjusted hazard ratios: 2.5–4.3 for different indexes). CCI was slightly better in the prediction of 1- and 5-year mortality rates. Conclusions: Comorbidities are common before and after RA diagnosis, and the rate of accumulation accelerates after RA diagnosis. All four comorbidity indexes are useful to measure the temporal changes and to predict mortality. Full article

(This article belongs to the Collection Systemic Manifestations and Complications of Rheumatoid Arthritis)

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11 pages, 15277 KiB

Open AccessArticle

Quantitative Detection of Disseminated Melanoma Cells by Trp-1 Transcript Analysis Reveals Stochastic Distribution of Pulmonary Metastases

by Lenka Kyjacova, Rafael Saup, Melanie Rothley, Anja Schmaus, Tabea Wagner, Anja Boßerhoff, Boyan K. Garvalov, Wilko Thiele and Jonathan P. Sleeman

J. Clin. Med. 2021, 10(22), 5459; https://doi.org/10.3390/jcm10225459 - 22 Nov 2021

Cited by 2 | Viewed by 1842

Abstract

A better understanding of the process of melanoma metastasis is required to underpin the development of novel therapies that will improve patient outcomes. The use of appropriate animal models is indispensable for investigating the mechanisms of melanoma metastasis. However, reliable and practicable quantification [...] Read more.

A better understanding of the process of melanoma metastasis is required to underpin the development of novel therapies that will improve patient outcomes. The use of appropriate animal models is indispensable for investigating the mechanisms of melanoma metastasis. However, reliable and practicable quantification of metastases in experimental mice remains a challenge, particularly if the metastatic burden is low. Here, we describe a qRT-PCR-based protocol that employs the melanocytic marker Trp-1 for the sensitive quantification of melanoma metastases in the murine lung. Using this protocol, we were able to detect the presence of as few as 100 disseminated melanoma cells in lung tissue. This allowed us to quantify metastatic burden in a spontaneous syngeneic B16-F10 metastasis model, even in the absence of visible metastases, as well as in the autochthonous Tg(Grm1)/Cyld^−/− melanoma model. Importantly, we also observed an uneven distribution of disseminated melanoma cells amongst the five lobes of the murine lung, which varied considerably from animal to animal. Together, our findings demonstrate that the qRT-PCR-based detection of Trp-1 allows the quantification of low pulmonary metastatic burden in both transplantable and autochthonous murine melanoma models, and show that the analysis of lung metastasis in such models needs to take into account the stochastic distribution of metastatic lesions amongst the lung lobes. Full article

(This article belongs to the Special Issue New Advances in Melanoma)

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9 pages, 1011 KiB

Open AccessReview

Pregnancy as a Risk Factor of Severe COVID-19

by Aleksander Celewicz, Marta Celewicz, Michał Michalczyk, Paula Woźniakowska-Gondek, Kamila Krejczy, Marcin Misiek and Rafał Rzepka

J. Clin. Med. 2021, 10(22), 5458; https://doi.org/10.3390/jcm10225458 - 22 Nov 2021

Cited by 28 | Viewed by 3187

Abstract

Since first being identified in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as an etiological agent behind Coronavirus disease 19 (COVID-19), has caused three waves of a global pandemic, with a fourth in progress. Despite its high percentage of asymptomatic and [...] Read more.

Since first being identified in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as an etiological agent behind Coronavirus disease 19 (COVID-19), has caused three waves of a global pandemic, with a fourth in progress. Despite its high percentage of asymptomatic and low-symptomatic courses of illness, the SARS-CoV-2 pandemic has claimed a higher death toll than the SARS-CoV and MERS-CoV epidemics because of its high infectivity when compared to the other coronaviruses. High COVID-19 mortality is associated with age and other coexisting morbidities, as well as healthcare quality. According to several studies, pregnant women are at a higher risk of severe COVID-19 infection and adverse pregnancy outcomes (caesarean delivery, pre-term birth, low birth weight, preeclampsia, ICU admission, and need for mechanical ventilation). In our review of recent literature, we focused on the effects of COVID-19 in pregnant women, emphasizing the subcellular pathophysiology of SARS-CoV-2. In this paper, we concentrate on the pathophysiology of sub-cellular changes in COVID-19 and endeavor to highlight the aspects that manifest in physiological pregnancy and potentially create a higher risk of SARS-CoV-2 infection and acute COVID-19 symptoms. Understanding how pregnancy-associated changes can cause a synergistic effect with COVID-19 may point us in the right direction for future prophylaxis and treatment for women undergoing COVID-19 during pregnancy. Full article

(This article belongs to the Special Issue COVID-19 and Pregnancy)

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30 pages, 45812 KiB

Open AccessArticle

What Every Internist-Endocrinologist Should Know about Rare Genetic Syndromes in Order to Prevent Needless Diagnostics, Missed Diagnoses and Medical Complications: Five Years of ‘Internal Medicine for Rare Genetic Syndromes’

by Anna G. W. Rosenberg, Minke R. A. Pater, Karlijn Pellikaan, Kirsten Davidse, Anja A. Kattentidt-Mouravieva, Rogier Kersseboom, Anja G. Bos-Roubos, Agnies van Eeghen, José M. C. Veen, Jiske J. van der Meulen, Nina van Aalst-van Wieringen, Franciska M. E. Hoekstra, Aart J. van der Lely and Laura C. G. de Graaff

J. Clin. Med. 2021, 10(22), 5457; https://doi.org/10.3390/jcm10225457 - 22 Nov 2021

Cited by 7 | Viewed by 3227

Abstract

Patients with complex rare genetic syndromes (CRGS) have combined medical problems affecting multiple organ systems. Pediatric multidisciplinary (MD) care has improved life expectancy, however, transfer to internal medicine is hindered by the lack of adequate MD care for adults. We have launched an [...] Read more.

Patients with complex rare genetic syndromes (CRGS) have combined medical problems affecting multiple organ systems. Pediatric multidisciplinary (MD) care has improved life expectancy, however, transfer to internal medicine is hindered by the lack of adequate MD care for adults. We have launched an MD outpatient clinic providing syndrome-specific care for adults with CRGS, which, to our knowledge, is the first one worldwide in the field of internal medicine. Between 2015 and 2020, we have treated 720 adults with over 60 syndromes. Eighty-nine percent of the syndromes were associated with endocrine problems. We describe case series of missed diagnoses and patients who had undergone extensive diagnostic testing for symptoms that could actually be explained by their syndrome. Based on our experiences and review of the literature, we provide an algorithm for the clinical approach of health problems in CRGS adults. We conclude that missed diagnoses and needless invasive tests seem common in CRGS adults. Due to the increased life expectancy, an increasing number of patients with CRGS will transfer to adult endocrinology. Internist-endocrinologists (in training) should be aware of their special needs and medical pitfalls of CRGS will help prevent the burden of unnecessary diagnostics and under- and overtreatment. Full article

(This article belongs to the Special Issue Endocrinology and Metabolic Diseases: Prader-Willi Syndrome)

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15 pages, 751 KiB

Open AccessArticle

Low Brachial Artery Flow-Mediated Dilation Predicts Worse Prognosis in Hospitalized Patients with COVID-19

by Vanessa Bianconi, Massimo Raffaele Mannarino, Filippo Figorilli, Elisabetta Schiaroli, Elena Cosentini, Giuseppe Batori, Ettore Marini, Amirhossein Sahebkar, Francesco Grignani, Anna Gidari, Daniela Francisci and Matteo Pirro

J. Clin. Med. 2021, 10(22), 5456; https://doi.org/10.3390/jcm10225456 - 22 Nov 2021

Cited by 17 | Viewed by 1874

Abstract

Background: Endothelial injury can be induced by coronavirus disease 2019 (COVID-19) and seems to exert a crucial pathogenic role in its most severe clinical manifestations. We aimed to investigate the association between brachial artery flow-mediated dilation (bFMD), a potential clinical and non-invasive measure [...] Read more.

Background: Endothelial injury can be induced by coronavirus disease 2019 (COVID-19) and seems to exert a crucial pathogenic role in its most severe clinical manifestations. We aimed to investigate the association between brachial artery flow-mediated dilation (bFMD), a potential clinical and non-invasive measure of endothelial function, and in-hospital prognosis of COVID-19 patients. Methods: Brachial artery flow-mediated dilation was assessed in hospitalized COVID-19 patients within 48 h of hospital admission. The association between bFMD and either intensive care unit (ICU) admission or in-hospital death was explored using univariable and multivariable analyses. Results: Four hundred and eight patients were enrolled. Significantly lower bFMD values emerged in COVID-19 patients with either radiographic signs of pneumonia, respiratory distress, or the need for non-invasive ventilation compared with patients without these signs (p < 0.001, p = 0.001, and p < 0.001, respectively). Forty-two (10%) patients were admitted to the ICU, 76 (19%) patients died, and 118 (29%) patients met the composite endpoint of ICU admission/in-hospital death. At unadjusted Cox regression analysis showed that low bFMD (<4.4%, the median value) was associated with a higher risk for the composite endpoint of ICU admission/in-hospital death compared with high bFMD (≥4.4%, the median value) (HR 1.675, 95% CI 1.155–2.428, p = 0.007). Multi-adjusted Cox regression analyses showed that low bFMD was independently associated with a 1.519- to 1.658-fold increased risk for the composite endpoint of ICU admission/in-hospital death. Conclusions: Low bFMD predicts an unfavorable in-hospital prognosis in COVID-19 patients. The measurement of bFMD may be clinically useful in the prognostic stratification of COVID-19 patients upon hospital admission. Full article

(This article belongs to the Section Cardiology)

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12 pages, 663 KiB

Open AccessArticle

Multi-Parametric Diagnostic Approach and Potential Markers of Early Onset Subclinical Cardiovascular Disease in a Cohort of Children, Adolescents and Young Adults Vertically Infected with HIV on cART

by Biagio Castaldi, Gloria Lanzoni, Osvalda Rampon, Daniele Donà, Angela Di Candia, Ornella Milanesi, Carlo Giaquinto and Giovanni Di Salvo

J. Clin. Med. 2021, 10(22), 5455; https://doi.org/10.3390/jcm10225455 - 22 Nov 2021

Cited by 3 | Viewed by 1528

Abstract

Background: HIV infection and lifelong cART are responsible of an increase in cardiovascular risk. The aim of this study was to describe the subclinical cardiovascular disease and to identify early markers of cardiovascular damage in adolescents and young adults vertically infected with HIV [...] Read more.

Background: HIV infection and lifelong cART are responsible of an increase in cardiovascular risk. The aim of this study was to describe the subclinical cardiovascular disease and to identify early markers of cardiovascular damage in adolescents and young adults vertically infected with HIV on cART, through an innovative multi-parametric approach. Methods: We enrolled 52 patients vertically infected with HIV. Demographic records, traditional cardiovascular risk factors, laboratory findings and echocardiographic measurements were collected in a one-year routine follow up. The echocardiographic examination included measurements of the 2D and 3D ejection fraction (EF), E/A ratio, E/E′ ratio, carotid intima media thickness (cIMT), flow-mediated dilation (FMD) and global longitudinal strain (GLS). Results: At the time of enrolment, all the patients were on cART therapy. The viral load was suppressed in 95% of them. EF was normal in 94.2% of patients (66 ± 7.2%), and GLS (mean value: −20.0 ± 2.5%) was reduced in 29% of patients. The cIMT mean value was higher than the 95th centile for sex and age in 73%, and FMD was impaired in 45% of patients. Clinically evident disease was found in three patients: dilative cardiomyopathy in one, thoracic-abdominal aneurysm Crawford type II with a bilateral carotid dilation in one and carotid plaque with 30% of stenosis in a third patient. Conclusions: This study confirms the presence of clinical and subclinical cardiovascular disease in a very young population vertically infected with HIV, underlining the importance of an early, multi-parametric cardiovascular follow up. Full article

(This article belongs to the Section Cardiology)

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11 pages, 19430 KiB

Open AccessArticle

Topical Cyclosporine in Oral Lichen Planus—A Series of 21 Open-Label, Biphasic, Single-Patient Observations

by Babak Monshi, Christina Ellersdorfer, Michael Edelmayer, Gabriella Dvorak, Clemens Ganger, Christian Ulm, Klemens Rappersberger and Igor Vujic

J. Clin. Med. 2021, 10(22), 5454; https://doi.org/10.3390/jcm10225454 - 22 Nov 2021

Cited by 5 | Viewed by 2892

Abstract

Topical cyclosporine (CSA) has been reported as an alternative treatment in steroid-refractory oral lichen planus (OLP), but evidence is limited and conflicting. An N-of-1 trial setting could be appropriate to evaluate interindividual differences in treatment response. We studied a series of 21 open-label, [...] Read more.

Topical cyclosporine (CSA) has been reported as an alternative treatment in steroid-refractory oral lichen planus (OLP), but evidence is limited and conflicting. An N-of-1 trial setting could be appropriate to evaluate interindividual differences in treatment response. We studied a series of 21 open-label, biphasic single-patient observations. Patients (15 women, 6 men) with OLP recalcitrant to topical steroids received four weeks of CSA mouth rinse (200 mg/twice daily) followed by four weeks of drug withdrawal. Pain (visual analogue scale (VAS) score), disease extent (physicians’ global assessment (PGA) score) and quality of life (Dermatology Life Quality Index (DLQI) score,) were assessed at baseline (T0), after four weeks of treatment (T1) and after another four weeks without treatment (T2). Median age was 58 years (interquartile range/IQR = 52–67) and median disease duration was 18 months (IQR = 12–44). Median baseline VAS score decreased significantly at T1 (p = 0.0003) and increased at T2 (p = 0.032) (T0 = 5 (IQR = 3–6.5); T1 = 2 (IQR = 0.5–3.4); T2 = 3 (IQR = 2–4.8)). Similarly, median baseline PGA score decreased significantly at T1 (p = 0.001) and increased at T2 (p = 0.007) (T0 = 2 (IQR = 1.3–2.5); T1 = 1 (IQR = 1–2); T2 = 2 (IQR = 1–2)). Median baseline DLQI score also decreased significantly at T1 (p =.027) but did not change at T2 (p = 0.5) (T0 = 2.5 (IQR = 1–5.8); T1 = 1 (IQR = 0–3); T2 = 1 (IQR = 1–4)). CSA responders (n = 16) had significantly higher median baseline VAS scores (5.2 (IQR = 5–6.5)) than nonresponders (n =5) (2 (IQR = 2–3.5) (p = 0.02). In our study, pain, disease extent and quality of life of patients with OLP improved significantly during therapy with low-dose CSA mouth rinse and exacerbated after drug withdrawal. Remarkably, patients with high initial VAS scores seemed to profit most. Full article

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

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14 pages, 276 KiB

Open AccessArticle

Assessing the Impact of Gender and COPD on the Incidence and Mortality of Hospital-Acquired Pneumonia. A Retrospective Cohort Study Using the Spanish National Discharge Database (2016–2019)

by Javier de-Miguel-Diez, Rodrigo Jimenez-Garcia, Valentin Hernandez-Barrera, Jose M. de-Miguel-Yanes, David Carabantes-Alarcon and Ana Lopez-de-Andres

J. Clin. Med. 2021, 10(22), 5453; https://doi.org/10.3390/jcm10225453 - 22 Nov 2021

Cited by 5 | Viewed by 1582

Abstract

Background: We aim to analyze incidence and outcomes of patients hospitalized with hospital-acquired pneumonia (HAP) according to chronic obstructive pulmonary disease (COPD) status and sex in Spain (2016–2019). Methods: We conducted a retrospective cohort study using national hospital discharge data of patients ≥40 [...] Read more.

Background: We aim to analyze incidence and outcomes of patients hospitalized with hospital-acquired pneumonia (HAP) according to chronic obstructive pulmonary disease (COPD) status and sex in Spain (2016–2019). Methods: We conducted a retrospective cohort study using national hospital discharge data of patients ≥40 years with a primary diagnosis of HAP, using the specific diagnostics of non-ventilator (NV)-HAP and ventilator-associated pneumonia (VAP). Results: We identified 37,029 patients with HAP ((NV)-HAP 87.28%, VAP 12.72%), 13.40% with COPD. HAP incidence increased over time, but only in subjects without COPD (p < 0.001). In women, incidence of HAP and (NV)-HAP was similar regardless of COPD status, but VAP incidence was lower in COPD women (p = 0.007). In men, the incidence of (NV)-HAP was significantly higher in those with COPD, while VAP incidence was lower in COPD men (p < 0.001). The in-hospital mortality (IHM) was similar in men and women with and without COPD. The risk of dying in hospital increased with age, congestive heart failure, cancer, and dialysis among men and women with COPD. Men that underwent surgery had a lower risk of IHM. VAP increased 2.58-times the probability of dying in men and women. Finally, sex was not associated with IHM among COPD patients. Conclusions: Incidence of HAP was significantly higher in COPD patients than in those without COPD, at the expense of (NV)-HAP but not of VAP. When stratifying by sex, we found that the difference was caused by men. IHM was similar in COPD and non-COPD patients, with no significant change overtime. In addition, sex was not associated with IHM. Full article

(This article belongs to the Special Issue Living with Chronic Obstructive Pulmonary Disease)

17 pages, 2415 KiB

Open AccessArticle

Plasma Levels and Diagnostic Utility of VEGF in a Three-Year Follow-Up of Patients with Breast Cancer

by Grażyna E. Będkowska, Ewa Gacuta, Monika Zbucka-Krętowska, Paweł Ławicki, Maciej Szmitkowski, Adam Lemancewicz, Joanna Motyka, Agnieszka Kobus, Monika Chorąży, Marlena Paniczko and Sławomir Ławicki

J. Clin. Med. 2021, 10(22), 5452; https://doi.org/10.3390/jcm10225452 - 22 Nov 2021

Cited by 7 | Viewed by 1396

Abstract

Breast cancer is the most common malignancy in women globally. The increasing worldwide incidence of this type of cancer illustrates the challenge it represents for healthcare providers. Therefore, new tumor markers are constantly being sought. The aim of this study was to assess [...] Read more.

Breast cancer is the most common malignancy in women globally. The increasing worldwide incidence of this type of cancer illustrates the challenge it represents for healthcare providers. Therefore, new tumor markers are constantly being sought. The aim of this study was to assess plasma concentrations and the diagnostic power of VEGF in 100 patients with early-stage breast cancer, both before and after surgical treatment and during a three-year follow-up. The control groups included 50 subjects with benign breast tumors (fibroadenoma) and 50 healthy women. The VEGF concentration was determined using enzyme-linked immunosorbent assay (ELISA) and the CA 15-3 concentration was determined by chemiluminescent microparticle immunoassay (CMIA). We observed significantly higher preoperative plasma concentrations of VEGF and CA 15-3 in patients with breast cancer. VEGF, similar to CA 15-3, demonstrated high diagnostic utility in the assessment of the long-term efficacy of surgical removal of the tumor. Determinations of VEGF had the highest diagnostic usefulness in the detection of breast cancer recurrence (SE 40%, SP 92%, PPV 67%, NPV 79%). Additionally, the highest values of SE, NPV and AUC were observed during the combined analysis with CA 15-3 (60%; 84%; 0.7074, respectively). Our study suggests a promising diagnostic utility of VEGF in the early stages of breast cancer and in the evaluation of the efficacy of the surgical treatment of breast cancer as well as the detection of breast cancer recurrence, particularly in a combined analysis with CA 15-3 as a new diagnostic panel. Full article

(This article belongs to the Special Issue New Therapeutic Approaches, Biomarkers for Diagnosis, Prognosis and Therapy Prediction in Breast Cancer and Breast Cancer Recurrence)

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14 pages, 690 KiB

Open AccessArticle

Clinical Outcomes in Older Patients Aged over 75 Years Who Underwent Early Surgical Treatment for Pyogenic Vertebral Osteomyelitis

by Jeong Hwan Lee, Jihye Kim and Tae-Hwan Kim

J. Clin. Med. 2021, 10(22), 5451; https://doi.org/10.3390/jcm10225451 - 22 Nov 2021

Cited by 7 | Viewed by 1658

Abstract

Older patients with pyogenic vertebral osteomyelitis (PVO) usually have more medical comorbidities compared with younger patients, and present with advanced infections from different causative organisms. To aid surgical decision-making, we compared surgical outcomes of older patients with PVO to those who underwent nonoperative [...] Read more.

Older patients with pyogenic vertebral osteomyelitis (PVO) usually have more medical comorbidities compared with younger patients, and present with advanced infections from different causative organisms. To aid surgical decision-making, we compared surgical outcomes of older patients with PVO to those who underwent nonoperative treatment. We identified the risk factors for adverse post-operative outcomes, and analyzed the clinical risks from further spinal instrumentation. This retrospective comparative study included 439 patients aged ≥75 years with PVO. Multivariable analysis was performed to compare treatment outcomes among three groups: 194, 130, and 115 patients in the non-operative, non-instrumented, and instrumented groups, respectively. The risk factors for adverse outcomes after surgical treatment were evaluated using a logistic regression model, and the estimates of the multivariable models were internally validated using bootstrap samples. Recurrence and mortality of these patients were closely associated with neurologic deficits, and increased surgical invasiveness, resulting from additional spinal instrumentation, did not increase the risk of recurrence or mortality. We propose that surgical treatment for these patients should focus on improving neurologic deficits through immediate and sufficient removal of abscesses. Spinal instrumentation can be performed if indicated, within reasonable clinical risk. Full article

(This article belongs to the Section Orthopedics)

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22 pages, 4428 KiB

Open AccessArticle

An Automated System for ECG Arrhythmia Detection Using Machine Learning Techniques

by Mohamed Sraitih, Younes Jabrane and Amir Hajjam El Hassani

J. Clin. Med. 2021, 10(22), 5450; https://doi.org/10.3390/jcm10225450 - 22 Nov 2021

Cited by 38 | Viewed by 3331

Abstract

The new advances in multiple types of devices and machine learning models provide opportunities for practical automatic computer-aided diagnosis (CAD) systems for ECG classification methods to be practicable in an actual clinical environment. This imposes the requirements for the ECG arrhythmia classification methods [...] Read more.

The new advances in multiple types of devices and machine learning models provide opportunities for practical automatic computer-aided diagnosis (CAD) systems for ECG classification methods to be practicable in an actual clinical environment. This imposes the requirements for the ECG arrhythmia classification methods that are inter-patient. We aim in this paper to design and investigate an automatic classification system using a new comprehensive ECG database inter-patient paradigm separation to improve the minority arrhythmical classes detection without performing any features extraction. We investigated four supervised machine learning models: support vector machine (SVM), k-nearest neighbors (KNN), Random Forest (RF), and the ensemble of these three methods. We test the performance of these techniques in classifying: Normal beat (NOR), Left Bundle Branch Block Beat (LBBB), Right Bundle Branch Block Beat (RBBB), Premature Atrial Contraction (PAC), and Premature Ventricular Contraction (PVC), using inter-patient real ECG records from MIT-DB after segmentation and normalization of the data, and measuring four metrics: accuracy, precision, recall, and f1-score. The experimental results emphasized that with applying no complicated data pre-processing or feature engineering methods, the SVM classifier outperforms the other methods using our proposed inter-patient paradigm, in terms of all metrics used in experiments, achieving an accuracy of 0.83 and in terms of computational cost, which remains a very important factor in implementing classification models for ECG arrhythmia. This method is more realistic in a clinical environment, where varieties of ECG signals are collected from different patients. Full article

(This article belongs to the Special Issue Ehealth, Telemedicine and AI in Clinical Medicine)

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7 pages, 2024 KiB

Open AccessArticle

Sophocarpine Alleviates Injury-Induced Intima Hyperplasia of Carotid Arteries by Suppressing Inflammation in a Rat Model

by Genhuan Yang, Rong Zeng, Xitao Song, Changwei Liu and Leng Ni

J. Clin. Med. 2021, 10(22), 5449; https://doi.org/10.3390/jcm10225449 - 22 Nov 2021

Cited by 3 | Viewed by 1622

Abstract

Introduction: Balloon angioplasty is a commonly applied procedure for treating atherosclerotic vascular diseases. However, the maintenance of long-term lumen patency is relatively difficult due to the occurrence of restenosis. Previous research has shown that the occurrence of vascular wall inflammation is associated with [...] Read more.

Introduction: Balloon angioplasty is a commonly applied procedure for treating atherosclerotic vascular diseases. However, the maintenance of long-term lumen patency is relatively difficult due to the occurrence of restenosis. Previous research has shown that the occurrence of vascular wall inflammation is associated with higher rates of restenosis. Sophocarpine (SPC) can exert various therapeutic effects such as anti-oxidation, anti-inflammation, anti-tumor, antivirus and immune regulation. This study aimed to investigate whether SPC can alleviate intimal hyperplasia following balloon injury in a rat carotid artery model. Methods: Twenty Sprague–Dawley rats were randomly assigned to four groups: (i) control, (ii) balloon injury, (iii) balloon injury followed by saline injection, and (iv) balloon injury followed by SPC administration. Each group contained five rats. A high-pressure balloon of 3 mm × 20 mm was placed in the carotid artery. The balloon was inflated to a pressure of 8 atmospheres to carry out rat carotid artery balloon injury model. The areas of neointimal and media were determined by Verhoeff_Van Gieson staining, and the intima-to-media (I:M) ratios were subsequently evaluated. After that, the protein levels of IL-6, IL-1β, MCP-1, NF-κB, TNF-α, VCAM-1, ICAM-1 and eNOS were measured. Results: The ratio of I:M was remarkably higher in the balloon injury group than in the control group (p < 0.01). SPC could significantly decrease the ratio of I:M compared with the balloon injury group (p < 0.01). Besides, the protein levels of IL-6, IL-1β, MCP-1, NF-κB, TNF-α, ICAM-1 and VCAM-1 were increased in rat carotid arteries exposed to balloon injury (p < 0.01), and treatment with SPC could attenuate these effects (p < 0.05). Furthermore, balloon injury inhibited the protein expression of eNOS (p < 0.01), and SPC could elevate its level (p < 0.05). Conclusions: SPC could alleviate an intimal hyperplasia in balloon-injured carotid artery, and the mechanisms underlying this protective effect might be due to its inhibitory potency against inflammation signals. Our study also implies the potential applicability of SPC in treating restenosis after balloon angioplasty. Full article

(This article belongs to the Section Vascular Medicine)

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15 pages, 2283 KiB

Open AccessArticle

Immediate Post-Procedural and Discharge Assessment of Mitral Valve Function Following Transcatheter Edge-to-Edge Mitral Valve Repair: Correlation and Association with Outcomes

by Doron Sudarsky, Fabio Kusniec, Liza Grosman-Rimon, Ala Lubovich, Wadia Kinany, Evgeni Hazanov, Michael Gelbstein, Edo Y. Birati and Shemy Carasso

J. Clin. Med. 2021, 10(22), 5448; https://doi.org/10.3390/jcm10225448 - 22 Nov 2021

Cited by 2 | Viewed by 1437

Abstract

The correlation between residual mitral regurgitation (rMR) grade or mitral valve pressure gradient (MVPG), at transcatheter edge-to-edge mitral valve repair (TEEMr) completion and at discharge, is unknown. Furthermore, there is disagreement regarding rMR grade or MVPG from which prognosis diverts. We retrospectively studied [...] Read more.

The correlation between residual mitral regurgitation (rMR) grade or mitral valve pressure gradient (MVPG), at transcatheter edge-to-edge mitral valve repair (TEEMr) completion and at discharge, is unknown. Furthermore, there is disagreement regarding rMR grade or MVPG from which prognosis diverts. We retrospectively studied 82 patients that underwent TEEMr. We tested the correlation between rMR or MVPG and evaluated their association, with outcomes. Moderate or less rMR (rMR ≤ 2) at TEEMr completion was associated with improved survival, whereas mild or less rMR (rMR ≤ 1) was not. Patients with rMR ≤ 1 at discharge demonstrated a longer time of survival, of first heart failure hospitalization and of both. The correlation for both rMR grade (r = 0.5, p < 0.001) and MVPG (r = 0.51, p < 0.001), between TEEMr completion and discharge, was moderate. MR ≤ 2 at TMEER completion was the strongest predictor for survival (HR 0.08, p < 0.001) whereas rMR ≤ 1 at discharge was independently associated with a lower risk of the combined endpoint (HR 4.17, p = 0.012). MVPG was not associated with adverse events. We conclude that the assessments for rMR grade and MVPG, at the completion of TEEMr and at discharge, should be distinctly reported. Improved outcome is expected with rMR ≤ 2 at TEEMr completion and rMR ≤ 1 at discharge. Higher MVPG is not associated with unfavorable outcomes. Full article

(This article belongs to the Special Issue Cardiovascular Disease in 2021 and beyond—What Have We Learned and How Do We Move On?)

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11 pages, 2221 KiB

Open AccessArticle

Correlation between Preoperative Serum Levels of Calcium, Phosphate, and Intact Parathyroid Hormone and Radiological Outcomes in Spinal Interbody Fusion among End-Stage Renal Disease Patients

by Ting-Yu Shih, Yun-Che Wu, Sheng-Chieh Tseng, Kun-Hui Chen, Chien-Chou Pan and Cheng-Hung Lee

J. Clin. Med. 2021, 10(22), 5447; https://doi.org/10.3390/jcm10225447 - 22 Nov 2021

Cited by 1 | Viewed by 1743

Abstract

Spinal fusion surgery for end-stage renal disease (ESRD) patients is a clinical challenge. This study aimed to investigate whether postoperative radiological outcomes are related to preoperative serum calcium, phosphate, or intact parathyroid hormone (iPTH) levels in patients with ESRD who underwent spinal interbody [...] Read more.

Spinal fusion surgery for end-stage renal disease (ESRD) patients is a clinical challenge. This study aimed to investigate whether postoperative radiological outcomes are related to preoperative serum calcium, phosphate, or intact parathyroid hormone (iPTH) levels in patients with ESRD who underwent spinal interbody fusion surgery. This study included 62-consecutive patients with ESRD who underwent anterior cervical discectomy and fusion (ACDF) or transforaminal lumbar interbody fusion (TLIF) surgery for symptomatic spinal disorder. The most recent preoperative serum calcium, phosphate, and iPTH levels were recorded, and the postoperative radiographic outcomes were assessed. A significant correlation was found between the occurrence of cage subsidence and higher blood phosphate, calcium–phosphate product (Ca × P), and iPTH levels in the TLIF group. The occurrence of pedicle screw loosening was related to higher blood phosphate and Ca × P product in the TLIF group. However, no correlation was found between the fusion grades and the serum levels in either the TLIF or ACDF groups. These results indicated that higher preoperative serum phosphate and Ca × P product are risk factors for both cage subsidence and screw loosening in patients with ESRD who underwent TLIF surgery. Higher iPTH levels are also a possible risk factor for cage subsidence. Full article

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

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9 pages, 261 KiB

Open AccessArticle

The Use of HSQoL-24 in an Assessment of Quality-of-Life Impairment among Hidradenitis Suppurativa Patients: First Look at Real-Life Data

by Piotr K. Krajewski, Servando E. Marrón, Manuel Gomez-Barrera, Lucía Tomas-Aragones, Yolanda Gilaberte-Calzada and Jacek C. Szepietowski

J. Clin. Med. 2021, 10(22), 5446; https://doi.org/10.3390/jcm10225446 - 22 Nov 2021

Cited by 1 | Viewed by 1665

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with well-documented effects on patients’ quality of life (QoL). The aim of this study was to evaluate the QoL of patients with HS via the use of a newly developed questionnaire: Hidradenitis Suppurativa Quality [...] Read more.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with well-documented effects on patients’ quality of life (QoL). The aim of this study was to evaluate the QoL of patients with HS via the use of a newly developed questionnaire: Hidradenitis Suppurativa Quality of Life-24 (HSQoL-24). This study was performed on a population of 342 HS patients. Their QoL was assessed via the HSQoL-24 questionnaire. The perceived impairment of QoL due to HS in the studied group was considered to be serious (mean HSQoL-24 score: 58.3 ± 21.0 points). Women tended to experience a significantly higher impact from the disease than men (61.6 ± 19.2 points vs. 51.1 ± 23.1 points, p < 0.001). The HS severity had an effect on the perceived QoL, with statistically significant differences being evident between the self-assessed HS severity groups. The level of QoL impairment correlated positively with the number of affected body areas (r = 0.285, p < 0.001) and the duration of the disease (r = 0.173, p = 0.001), while the patients’ age at disease onset correlated negatively with the HSQoL-24 global score (r = −0.182, p = 0.001). Patients living in their family house scored higher than other groups. The least affected were patients who lived alone. The study shows that the HSQoL-24 questionnaire is a reliable, HS-specific tool for measuring the QoL among patients with HS in real-life clinical settings. Full article

(This article belongs to the Special Issue Hidradenitis Suppurativa (HS): Research Advances in Pathogenesis, Diagnosis and Treatment)

18 pages, 1164 KiB

Open AccessArticle

Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction

by Tomasz Fabiszak, Michał Kasprzak, Marek Koziński and Jacek Kubica

J. Clin. Med. 2021, 10(22), 5445; https://doi.org/10.3390/jcm10225445 - 22 Nov 2021

Cited by 6 | Viewed by 1682

Abstract

Objective: To assess the performance of ten electrocardiographic (ECG) parameters regarding the prediction of left ventricular systolic dysfunction (LVSD) after a first ST-segment-elevation myocardial infarction (STEMI). Methods: We analyzed 249 patients (74.7% males) treated with primary percutaneous coronary intervention (PCI) included into a [...] Read more.

Objective: To assess the performance of ten electrocardiographic (ECG) parameters regarding the prediction of left ventricular systolic dysfunction (LVSD) after a first ST-segment-elevation myocardial infarction (STEMI). Methods: We analyzed 249 patients (74.7% males) treated with primary percutaneous coronary intervention (PCI) included into a single-center cohort study. We sought associations between baseline and post-PCI ECG parameters and the presence of LVSD (defined as left ventricular ejection fraction [LVEF] ≤ 40% on echocardiography) 6 months after STEMI. Results: Patients presenting with LVSD (n = 52) had significantly higher values of heart rate, number of leads with ST-segment elevation and pathological Q-waves, as well as total and maximal ST-segment elevation at baseline and directly after PCI compared with patients without LVSD. They also showed a significantly higher prevalence of anterior STEMI and considerably wider QRS complex after PCI, while QRS duration measurement at baseline showed no significant difference. Additionally, patients presenting with LVSD after 6 months showed markedly more severe ischemia on admission, as assessed with the Sclarovsky-Birnbaum ischemia score, smaller reciprocal ST-segment depression at baseline and less profound ST-segment resolution post PCI. In multivariate regression analysis adjusted for demographic, clinical, biochemical and angiographic variables, anterior location of STEMI (OR 17.78; 95% CI 6.45–48.96; p < 0.001), post-PCI QRS duration (OR 1.56; 95% CI 1.22–2.00; p < 0.001) expressed per increments of 10 ms and impaired post-PCI flow in the infarct-related artery (IRA; TIMI 3 vs. <3; OR 0.14; 95% CI 0.04–0.46; p = 0.001) were identified as independent predictors of LVSD (Nagelkerke’s pseudo R² for the logistic regression model = 0.462). Similarly, in multiple regression analysis, anterior location of STEMI, wider post-PCI QRS, higher baseline number of pathological Q-waves and a higher baseline Sclarovsky-Birnbaum ischemia score, together with impaired post-PCI flow in the IRA, higher values of body mass index and glucose concentration on admission were independently associated with lower values of LVEF at 6 months (corrected R² = 0.448; p < 0.00001). Conclusions: According to our study, baseline and post-PCI ECG parameters are of modest value for the prediction of LVSD occurrence 6 months after a first STEMI. Full article

(This article belongs to the Special Issue Advances in the Management of Cardiovascular Disease)

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14 pages, 626 KiB

Open AccessArticle

Feasibility and Clinical Outcomes of a Step Up Noninvasive Respiratory Support Strategy in Patients with Severe COVID-19 Pneumonia

by Silvia Coppola, Pierachille Santus, Giovanni Sotgiu, Michele Mondoni, Alessia Gandola, Marina Saad, Giuseppe Francesco Sferrazza Papa, Stefano Centanni, Laura Saderi, Davide Alberto Chiumello and Dejan Radovanovic

J. Clin. Med. 2021, 10(22), 5444; https://doi.org/10.3390/jcm10225444 - 22 Nov 2021

Cited by 8 | Viewed by 1756

Abstract

The best noninvasive respiratory strategy in patients with Coronavirus Disease 2019 (COVID-19) pneumonia is still discussed. We aimed at assessing the rate of endotracheal intubation (ETI) in patients treated with continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) if CPAP failed. Secondary [...] Read more.

The best noninvasive respiratory strategy in patients with Coronavirus Disease 2019 (COVID-19) pneumonia is still discussed. We aimed at assessing the rate of endotracheal intubation (ETI) in patients treated with continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) if CPAP failed. Secondary outcomes were in-hospital mortality and in-hospital length of stay (LOS). A retrospective, observational, multicenter study was conducted in intermediate-high dependency respiratory units of two Italian university hospitals. Consecutive patients with COVID-19 treated with CPAP were enrolled. Thoraco-abdominal asynchrony or hemodynamic instability led to ETI. Patients showing SpO₂ ≤ 94%, respiratory rate ≥ 30 bpm or accessory muscle activation on CPAP received NIV. Respiratory distress and desaturation despite NIV eventually led to ETI. 156 patients were included. The overall rate of ETI was 30%, mortality 18% and median LOS 24 (17–32) days. Among patients that failed CPAP (n = 63), 28% were intubated, while the remaining 72% received NIV, of which 65% were intubated. Patients intubated after CPAP showed lower baseline PaO₂/FiO₂, lower lymphocyte counts and higher D-dimer values compared with patients intubated after CPAP + NIV. Mortality was 22% with CPAP + ETI, and 20% with CPAP + NIV + ETI. In the case of CPAP failure, a NIV trial appears feasible, does not deteriorate respiratory status and may reduce the need for ETI in COVID-19 patients. Full article

(This article belongs to the Section Intensive Care)

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12 pages, 2750 KiB

Open AccessArticle

Establishing Irreversible Electroporation Electric Field Potential Threshold in A Suspension In Vitro Model for Cardiac and Neuronal Cells

by Sahar Avazzadeh, Barry O’Brien, Ken Coffey, Martin O’Halloran, David Keane and Leo R. Quinlan

J. Clin. Med. 2021, 10(22), 5443; https://doi.org/10.3390/jcm10225443 - 22 Nov 2021

Cited by 21 | Viewed by 2485

Abstract

Aims: Irreversible electroporation is an ablation technique being adapted for the treatment of atrial fibrillation. Currently, there are many differences reported in the in vitro and pre-clinical literature for the effective voltage threshold for ablation. The aim of this study is a direct [...] Read more.

Aims: Irreversible electroporation is an ablation technique being adapted for the treatment of atrial fibrillation. Currently, there are many differences reported in the in vitro and pre-clinical literature for the effective voltage threshold for ablation. The aim of this study is a direct comparison of different cell types within the cardiovascular system and identification of optimal voltage thresholds for selective cell ablation. Methods: Monophasic voltage pulses were delivered in a cuvette suspension model. Cell viability and live–dead measurements of three different neuronal lines, cardiomyocytes, and cardiac fibroblasts were assessed under different voltage conditions. The immediate effects of voltage and the evolution of cell death was measured at three different time points post ablation. Results: All neuronal and atrial cardiomyocyte lines showed cell viability of less than 20% at an electric field of 1000 V/cm when at least 30 pulses were applied with no significant difference amongst them. In contrast, cardiac fibroblasts showed an optimal threshold at 1250 V/cm with a minimum of 50 pulses. Cell death overtime showed an immediate or delayed cell death with a proportion of cell membranes re-sealing after three hours but no significant difference was observed between treatments after 24 h. Conclusions: The present data suggest that understanding the optimal threshold of irreversible electroporation is vital for achieving a safe ablation modality without any side-effect in nearby cells. Moreover, the evolution of cell death post electroporation is key to obtaining a full understanding of the effects of IRE and selection of an optimal ablation threshold. Full article

(This article belongs to the Special Issue New Perspective in Atrial Fibrillation)

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10 pages, 945 KiB

Open AccessArticle

Wearable Cardioverter-Defibrillator Used as a Telemonitoring System in a Real-Life Heart Failure Unit Setting

by Christian Blockhaus, Stephan List, Hans-Peter Waibler, Jan-Erik Gülker, Heinrich Klues, Alexander Bufe, Melchior Seyfarth, Buelent Koektuerk and Dong-In Shin

J. Clin. Med. 2021, 10(22), 5435; https://doi.org/10.3390/jcm10225435 - 22 Nov 2021

Cited by 4 | Viewed by 1627

Abstract

Background: In patients with reduced left ventricular ejection fraction (LVEF) who are at risk of sudden cardiac death, a wearable cardioverter-defibrillator (WCD) is recommended as a bridge to the recovery of LVEF or as a bridge to the implantation of a device. In [...] Read more.

Background: In patients with reduced left ventricular ejection fraction (LVEF) who are at risk of sudden cardiac death, a wearable cardioverter-defibrillator (WCD) is recommended as a bridge to the recovery of LVEF or as a bridge to the implantation of a device. In addition to its function to detect and treat malignant arrhythmia, WCD can be used via an online platform as a telemonitoring system to supervise patients’ physical activity, compliance, and heart rate. Methods: We retrospectively analyzed 173 patients with regard to compliance and heart rate after discharge. Results: Mean WCD wearing time was 59.75 ± 35.6 days; the daily wearing time was 21.19 ± 4.65 h. We found significant differences concerning the patients’ compliance. Men showed less compliance than women, and younger patients showed less compliance than patients who were older. Furthermore, we analyzed the heart rate from discharge until the end of WCD prescription and found a significant decrease from discharge to 4, 8, or 12 weeks. Conclusion: WCD can be used as a telemonitoring system to help the involved heart failure unit or physicians attend to and adjust the medical therapy. Furthermore, specific patient groups should be educated more intensively with respect to compliance. Full article

(This article belongs to the Section Cardiovascular Medicine)

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9 pages, 923 KiB

Open AccessArticle

Use of Coronary CT Angiography to Predict Obstructive Lesions in Patients with Chest Pain without Enzyme and ST-Segment Elevation

by June-sung Kim, Youn-Jung Kim, Yo Sep Shin, Shin Ahn and Won Young Kim

J. Clin. Med. 2021, 10(22), 5442; https://doi.org/10.3390/jcm10225442 - 21 Nov 2021

Cited by 1 | Viewed by 1513

Abstract

It is challenging to rule out acute coronary syndrome among chest pain patients without both ST-segment elevation in electrocardiography and troponin elevation at emergency departments (ED). The purpose of this study was to develop a prediction model for rapidly determining the occurrence of [...] Read more.

It is challenging to rule out acute coronary syndrome among chest pain patients without both ST-segment elevation in electrocardiography and troponin elevation at emergency departments (ED). The purpose of this study was to develop a prediction model for rapidly determining the occurrence of significant stenosis in coronary computed tomography angiography (CCTA). Retrospective observational cohort study was conducted with 904 patients who had presented with chest pain without troponin elevation and ST-segment changes and underwent CCTA between January 2017 and December 2018. The primary endpoint was the presence of significant stenosis on CCTA, defined as narrowing above 70% diameter. The logistic regression model was used for development a new predictive model. One hundred and thirty-four patients (14.8%) were shown severe stenosis. The independent associated factors for significant stenosis were age ≥65 years, male, diabetes, history of acute coronary syndrome, and typical chest pain. Based these results, we developed a new prediction model. The area under the curve was 0.782 (95% confidence interval 0.742–0.822). Moreover, score of ≥5 was chosen as cut-off values with 86.6% sensitivity and 56.4% specificity. In conclusion, among chest pain patients without ST changes and troponin elevation, the new score will be helpful to identify potential candidate for CCTA such as patients with significant stenosis. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Risk Factors, Comorbidities, and Prevention)

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14 pages, 1370 KiB

Open AccessArticle

Clinical Outcomes following Large Vessel Coronary Artery Perforation Treated with Covered Stent Implantation: Comparison between Polytetrafluoroethylene- and Polyurethane-Covered Stents (CRACK-II Registry)

by Jerzy Bartuś, Rafał Januszek, Damian Hudziak, Michalina Kołodziejczak, Łukasz Kuźma, Mateusz Tajstra, Tomasz Figatowski, Tomasz Pawłowski, Monika Gruz-Kwapisz, Malwina Smolarek-Nicpoń, Agnieszka Skoczyńska, Brunon Tomasiewicz, Adrian Włodarczak, Jan Kulczycki, Krzysztof Plens, Miłosz Jaguszewski, Sławomir Dobrzycki, Andrzej Ochała, Mariusz Gąsior, Krzysztof Reczuch, Stanisław Bartuś, Wojciech Wojakowski and Wojciech Wańha Show full author list Hide full author list

J. Clin. Med. 2021, 10(22), 5441; https://doi.org/10.3390/jcm10225441 - 21 Nov 2021

Cited by 5 | Viewed by 1908

Abstract

Data on the clinical outcomes comparing synthetic fluorocarbon polymer polytetrafluoroethylene- (PTFE, GraftMaster) and polyurethane- (Papyrus) covered stents (CSs) to seal coronary artery perforations (CAPs) are limited. We aimed to evaluate 30-day and 1-year clinical outcomes after PCI complicated by CAP and treated with [...] Read more.

Data on the clinical outcomes comparing synthetic fluorocarbon polymer polytetrafluoroethylene- (PTFE, GraftMaster) and polyurethane- (Papyrus) covered stents (CSs) to seal coronary artery perforations (CAPs) are limited. We aimed to evaluate 30-day and 1-year clinical outcomes after PCI complicated by CAP and treated with CS. We assessed 106 consecutive patients with successful CAP sealing (122 CSs): GraftMaster (51 patients, 57 CSs) or Papyrus CS (55 patients, 65 CSs). The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as the composite of cardiac death, target lesion revascularisation (TLR), and myocardial infarction (MI). The mean age of subjects was 69 ± 9.6 years (53.8% males). No significant differences were identified between the GraftMaster and Papyrus groups at the 30-day follow-up for MACE, cardiac death, MI and stent thrombosis (ST), while significantly lower rate of TLR and TVR (p = 0.02) were confirmed in the Papyrus group. At one year, differences remained similar between stents for MACE, a trend towards a lower rate of TLR (p = 0.07), MI (p = 0.08), and ST (p = 0.08), and higher for cardiac death (p = 0.07) was observed in the Papyrus group. This real-life registry of CAP illustrated that the use of Papyrus CS is associated with lower rates of TLR and TVR at 30-day follow-up in comparison to the GraftMaster CSs and no significant differences between both assessed CS at one year of follow-up. Full article

(This article belongs to the Section Cardiovascular Medicine)

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12 pages, 671 KiB

Open AccessArticle

Clinical Characteristics, Complications and Outcomes of Patients with Severe Acute Respiratory Distress Syndrome Related to COVID-19 or Influenza Requiring Extracorporeal Membrane Oxygenation—A Retrospective Cohort Study

by Kevin Roedl, Ahmel Kahn, Dominik Jarczak, Marlene Fischer, Olaf Boenisch, Geraldine de Heer, Christoph Burdelski, Daniel Frings, Barbara Sensen, Axel Nierhaus, Stephan Braune, Yalin Yildirim, Alexander Bernhardt, Hermann Reichenspurner, Stefan Kluge and Dominic Wichmann

J. Clin. Med. 2021, 10(22), 5440; https://doi.org/10.3390/jcm10225440 - 21 Nov 2021

Cited by 12 | Viewed by 2567

Abstract

Extracorporeal membrane oxygenation (ECMO) represents a viable therapy option for patients with refractory acute respiratory distress syndrome (ARDS). Currently, veno-venous (vv) ECMO is frequently used in patients suffering from coronavirus disease 2019 (COVID-19). VV-ECMO was also frequently utilised during the influenza pandemic and [...] Read more.

Extracorporeal membrane oxygenation (ECMO) represents a viable therapy option for patients with refractory acute respiratory distress syndrome (ARDS). Currently, veno-venous (vv) ECMO is frequently used in patients suffering from coronavirus disease 2019 (COVID-19). VV-ECMO was also frequently utilised during the influenza pandemic and experience with this complex and invasive treatment has increased worldwide since. However, data on comparison of clinical characteristics and outcome of patients with COVID-19 and influenza-related severe ARDS treated with vv-ECMO are scarce. This is a retrospective analysis of all consecutive patients treated with vv/(veno-arterial)va-ECMO between January 2009 and January 2021 at the University Medical Centre Hamburg-Eppendorf in Germany. All patients with confirmed COVID-19 or influenza were included. Patient characteristics, parameters related to ICU and vv/va-ECMO as well as clinical outcomes were compared. Mortality was assessed up to 90 days after vv/va-ECMO initiation. Overall, 113 patients were included, 52 (46%) with COVID-19 and 61 (54%) with influenza-related ARDS. Median age of patients with COVID-19 and influenza was 58 (IQR 53–64) and 52 (39–58) years (p < 0.001), 35% and 31% (p = 0.695) were female, respectively. Charlson Comorbidity Index was 3 (1–5) and 2 (0–5) points in the two groups (p = 0.309). Median SAPS II score pre-ECMO was 27 (24–36) vs. 32 (28–41) points (p = 0.009), and SOFA score was 13 (11–14) vs. 12 (8–15) points (p = 0.853), respectively. Median P/F ratio pre-ECMO was 64 (46–78) and 73 (56–104) (p = 0.089); pH was 7.20 (7.16–7.29) and 7.26 (7.18–7.33) (p = 0.166). Median days on vv/va-ECMO were 17 (7–27) and 11 (7–20) (p = 0.295), respectively. Seventy-one percent and sixty-nine percent had renal replacement therapy (p = 0.790). Ninety-four percent of patients with COVID-19 and seventy-seven percent with influenza experienced vv/va-ECMO-associated bleeding events (p = 0.004). Thirty-four percent and fifty-five percent were successfully weaned from ECMO (p = 0.025). Ninety-day mortality was 65% and 57% in patients with COVID-19 and influenza, respectively (p = 0.156). Median length of ICU stay was 24 (13–44) and 28 (16–14) days (p = 0.470), respectively. Despite similar disease severity, the use of vv/va-ECMO in ARDS related to COVID-19 and influenza resulted in similar outcomes at 90 days. A significant higher rate of bleeding complications and thrombosis was observed in patients with COVID-19. Full article

(This article belongs to the Special Issue COVID-19 in the ICU: One Year Later: Recent Advances in Critical Care)

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9 pages, 878 KiB

Open AccessArticle

Starting A New Robotic Surgery Program for Mitral Valve Repair. Lessons Learned from The First Nine Months

by Antonio Piperata, Olivier Busuttil, Nicolas d’Ostrevy, Jean-Luc Jansens, Saud Taymoor, Besart Cuko, Thomas Modine, Mathieu Pernot and Louis Labrousse

J. Clin. Med. 2021, 10(22), 5439; https://doi.org/10.3390/jcm10225439 - 21 Nov 2021

Cited by 5 | Viewed by 2075

Abstract

(1) Background: Although transcatheter technology is rapidly growing and represents a promising strategy, the surgical approach remains the best way to repair a degenerative mitral valve regurgitation. In this context, robotic surgery is technologically the most advanced method of minimally invasive mitral valve [...] Read more.

(1) Background: Although transcatheter technology is rapidly growing and represents a promising strategy, the surgical approach remains the best way to repair a degenerative mitral valve regurgitation. In this context, robotic surgery is technologically the most advanced method of minimally invasive mitral valve repair. The aim of this study is to present the preliminary results of the initial single-center experience with a new robotic mitral valve repair program. (2) Methods: We retrospectively reviewed the records of patients who underwent robotic mitral valve repair at our Institution between January and September 2021. (3) Results: A total of 29 patients underwent mitral valve repair with annuloplasty and chordal implantation to treat degenerative mitral regurgitation. The procedure’s success was achieved in 97% of patients. The 30-day cardiac-related mortality was 0%. The median CPB and cross-clamp times were 189 and 111 min, respectively, with a progressive reduction from the beginning of the robotic program. (4) Conclusions: Considering all the limitations related to the small sample, the presented results of robotic mitral valve repair appear to be encouraging and acceptable. A careful patient selection, a dedicated team, and a robust experience in surgical mitral valve repair are the fundamentals to start a new robotic mitral surgery program. Full article

(This article belongs to the Special Issue New Techniques in Robotic Surgical Management of Mitral Valve Repair)

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7 pages, 575 KiB

Open AccessArticle

Evaluation of the Outcome of Local Surgery for Stomal Prolapse

by Makoto Kosuge, Masahisa Ohkuma, Muneyuki Koyama, Yasunobu Kobayashi, Takafumi Nakano, Yasuhiro Takano, Yuya Shimoyama, Naoki Takada, Tomotaka Kumamoto, Yuta Imaizumi, Hiroshi Sugano, Seiichiro Eto, Yasuhiro Takeda, Saori Yatabe and Ken Eto

J. Clin. Med. 2021, 10(22), 5438; https://doi.org/10.3390/jcm10225438 - 21 Nov 2021

Cited by 4 | Viewed by 3256

Abstract

We reviewed the results of local surgical treatment of stoma prolapse, a long-term complication of stoma construction. Fifteen patients treated for stomal prolapse between 2009 and 2020 at the authors’ and affiliated hospitals were included in this study. The treatment comprised local laparotomic [...] Read more.

We reviewed the results of local surgical treatment of stoma prolapse, a long-term complication of stoma construction. Fifteen patients treated for stomal prolapse between 2009 and 2020 at the authors’ and affiliated hospitals were included in this study. The treatment comprised local laparotomic stomal reconstruction (LLSR) in nine patients and stapling repair (SR) in six. We compared and evaluated the clinical and surgical information and postoperative complications. Operation time was significantly shorter in the SR group than in the LLSR group: 20 and 53 min, respectively (p = 0.036). The duration of postoperative hospitalization was shorter in the SR group than in the LLSR group: 5.5 and 8 days, respectively; the difference was not significant (p = 0.088). No short-term complications were found in either group. Regarding long-term, postoperative complications, parastomal hernias developed after 2.5 years in one patient in the LLSR group and after 6 months in one patient in the SR group; both patients had histories of parastomal hernia surgery and had relatively high body mass indices. Local surgery for stomal prolapse was minimally invasive and performed safely. In patients with a history of surgery for parastomal hernia, attention must be paid to the potential of parastomal hernia developing as a postoperative complication. Full article

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

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9 pages, 559 KiB

Open AccessArticle

Can Cranioplasty Be Considered a Tool to Improve Cognitive Recovery Following Traumatic Brain Injury? A 5-Years Retrospective Study

by Francesco Corallo, Viviana Lo Buono, Rocco Salvatore Calabrò and Maria Cristina De Cola

J. Clin. Med. 2021, 10(22), 5437; https://doi.org/10.3390/jcm10225437 - 21 Nov 2021

Cited by 5 | Viewed by 2062

Abstract

Cranioplasty (CP) is a neurosurgical intervention of skull repairing following a decompressive craniectomy. Unfortunately, the impact of cranioplasty on cognitive and motor function is still controversial. Fifteen TBI subjects aged 26–54 years with CP after decompressive craniectomy were selected in this observational retrospective [...] Read more.

Cranioplasty (CP) is a neurosurgical intervention of skull repairing following a decompressive craniectomy. Unfortunately, the impact of cranioplasty on cognitive and motor function is still controversial. Fifteen TBI subjects aged 26–54 years with CP after decompressive craniectomy were selected in this observational retrospective study. As per routine clinical practice, a neuropsychological evaluation carried out immediately before the cranioplasty (Pre CP) and one month after the cranioplasty (T0) was used to measure changes due to CP surgery. This assessment was performed each year for 5 years after discharge in order to investigate long-term cognitive changes (T1-T5). Before cranioplasty, about 53.3% of subjects presented a mild to severe cognitive impairment and about 40.0% a normal cognition. After CP, we found a significant improvement in all neuropsychological test scores. The more significant differences in cognitive recovery were detected after four years from CP. Notably, we found significant differences between T4 and T0-T1, as well as between T5 and T0-T1-T2 in all battery tests. This retrospective study further suggests the importance of CP in the complex management of patients with TBI showing how these patients might improve their cognitive function over a long period after the surgical procedure. Full article

(This article belongs to the Special Issue Traumatic Brain Injury: Clinical Characteristics and Outcomes)

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14 pages, 1976 KiB

Open AccessArticle

Retinal Changes before and after Silicone Oil Removal in Eyes with Rhegmatogenous Retinal Detachment Using Swept-Source Optical Coherence Tomography

by Jungwook Lee, Heeyoon Cho, Minho Kang, Rimkyung Hong, Mincheol Seong and Yongun Shin

J. Clin. Med. 2021, 10(22), 5436; https://doi.org/10.3390/jcm10225436 - 21 Nov 2021

Cited by 14 | Viewed by 2808

Abstract

This study aimed to evaluate and compare the retinal and choroidal thickness and vessel density (VD) changes between silicone oil (SO) tamponade and after SO removal using swept-source optical coherence tomography (SS-OCT) and OCT angiography (OCTA). Thirty patients who underwent pars plana vitrectomy [...] Read more.

This study aimed to evaluate and compare the retinal and choroidal thickness and vessel density (VD) changes between silicone oil (SO) tamponade and after SO removal using swept-source optical coherence tomography (SS-OCT) and OCT angiography (OCTA). Thirty patients who underwent pars plana vitrectomy for retinal detachment (RD) with SO tamponade were included. SS-OCT and OCTA were conducted before RD surgery, during SO tamponade, and after SO removal. A 3-dimensional volumetric wide scan protocol was used for the analysis. The segmented retina, choroidal thickness map, and peripapillary thickness were then measured. For the OCTA analysis, 4.5 × 4.5 mm scans were used. Superficial and deep capillary plexus VDs in unaffected fellow eyes and eyes after SO removal were compared. During the SO tamponade period, the thickness of the parafoveal total retina, ganglion cell-inner plexiform layer, and peripapillary retinal nerve fiber layer (ppRNFL) were significantly thinner than those of unaffected fellow eyes (p < 0.05). The parafoveal layer thickness thinning recovered up to three to six months after SO removal. Moreover, six months after SO removal, the parafoveal thickness was not significantly different compared to that of unaffected fellow eyes (p > 0.05). However, the ppRNFL thickness was significantly decreased during SO tamponade and remained unrecovered six months after SO removal. There was no significant difference in the VD on the OCTA. Thus, SO tamponade and removal for RD resulted in a change in the retinal and peripapillary thickness. This may be due to the mechanical pressure effect of SO. Full article

(This article belongs to the Section Ophthalmology)

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J. Clin. Med., Volume 10, Issue 22 (November-2 2021) – 252 articles

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