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Volume 10
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J. Clin. Med., Volume 10, Issue 8 (April-2 2021) – 256 articles

Cover Story (view full-size image): Many who survive critical illness suffer from chronic organ dysfunction and induced frailty, representing the chronic critical illness (CCI) phenotype. Persistent and worsening cardiovascular and renal disease are primary drivers of CCI and have pathophysiologic synergy in cardio-renal syndromes. In addition to pharmacologic therapies, special consideration should be given to behavioral modifications that avoid the pitfalls of polypharmacy and suboptimal renal and hepatic dosing. Smoking cessation, dietary modifications, and increased physical activity are advised. Coordinated, patient-centered care bundles may improve compliance and patient outcomes. Further research is needed to clarify pathophysiologic mechanisms of cardio-renal syndromes in CCI and develop targeted therapies. View this paper
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8 pages, 223 KiB  
Article
Efficacy and Safety of Inhalation Sedation during Office Probing for Congenital Nasolacrimal Duct Obstruction
by Chunghyun Lee, Su-Min Jeong, Gye Jung Kim, Eun-Young Joo, Myung Hee Song and Ho-Seok Sa
J. Clin. Med. 2021, 10(8), 1800; https://doi.org/10.3390/jcm10081800 - 20 Apr 2021
Cited by 3 | Viewed by 1667
Abstract
We compared the effectiveness of inhaled sevoflurane versus physical restraint during probing in children with congenital nasolacrimal duct obstruction (CNLDO). We performed a retrospective review of children with CNLDO who underwent office probing procedures by a single surgeon under sedation or restraint. Patients’ [...] Read more.
We compared the effectiveness of inhaled sevoflurane versus physical restraint during probing in children with congenital nasolacrimal duct obstruction (CNLDO). We performed a retrospective review of children with CNLDO who underwent office probing procedures by a single surgeon under sedation or restraint. Patients’ characteristics at the time of probing, including age, sex, laterality, previous non-surgical treatment, presence of dacryocystitis, outcomes of probing, and complications were compared between the sedation and restraint groups. A multivariable logistic regression analysis was performed to investigate the prognostic factors associated with the success of probing. A subgroup analysis by 12 months of age was also conducted. The overall success rate was 88.6% in 202 eyes of 180 consecutive children (mean age, 15.1 ± 7.7 months). The sedation group had a marginally higher success rates than the restraint group (93.8% vs. 85.1%, p = 0.056). The success rate was not significantly different between the two groups in children aged <12 months (90.9% vs. 93.1%, p = 0.739), but it was significantly higher in the sedation group (94.7% vs. 77.8%. p = 0.006) in children aged ≥12 months. Inhalation sedation was the most potent factor associated with success (adjusted odds ratio = 5.56, 95% confidence interval = 1.33–23.13, p = 0.018) in children aged ≥12 months. There were no surgical or sedation-related complications intra- and postoperatively. Inhaled sevoflurane sedation resulted in more successful, controlled, painless probing, particularly in children aged ≥12 months. It represents a safe, efficient alternative to general anesthesia. Full article
(This article belongs to the Special Issue Updates in Ocular Surgery)
18 pages, 643 KiB  
Article
Structural Equation Modeling of a Global Stress Index in Healthy Soldiers
by Tanja Maier, Melanie Kugelmann, Dae-Sup Rhee, Sebastian Brill, Harald Gündel, Benedikt Friemert, Horst-Peter Becker, Christiane Waller and Manuela Rappel
J. Clin. Med. 2021, 10(8), 1799; https://doi.org/10.3390/jcm10081799 - 20 Apr 2021
Cited by 2 | Viewed by 2563
Abstract
Accumulation of stress is a prognostic trigger for cardiovascular disease. Classical scores for cardiovascular risk estimation typically do not consider psychosocial stress. The aim of this study was to develop a global stress index (GSI) from healthy participants by combining individual measures of [...] Read more.
Accumulation of stress is a prognostic trigger for cardiovascular disease. Classical scores for cardiovascular risk estimation typically do not consider psychosocial stress. The aim of this study was to develop a global stress index (GSI) from healthy participants by combining individual measures of acute and chronic stress from childhood to adult life. One-hundred and ninety-two female and male soldiers completed the Perceived Stress Scale (PSS4), Trier Inventory for Chronic Stress (TICS), Hospital Anxiety and Depression Scale (HADS), Childhood Trauma Questionnaire (CTQ), Posttraumatic Diagnostic Scale Checklist (PDS), and the Deployment Risk and Resilience Inventory (DRRI-2). The underlying structure for the GSI was examined through structural equation modeling. The final hierarchical multilevel model revealed fair fit by taking modification indices into account. The highest order had a g-factor called the GSI. On a second level the latent variables stress, HADS and CTQ were directly loading on the GSI. A third level with the six CTQ subscales was implemented. On the lowest hierarchical level all manifest variables and the DRRI-2/PDS sum scores were located. The presented GSI serves as a valuable and individual stress profile for soldiers and could potentially complement classical cardiovascular risk factors. Full article
(This article belongs to the Special Issue Effects of Stress and Psychological Trauma on the Development and Progression of Cardiovascular Diseases)
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20 pages, 386 KiB  
Review
Cardiovascular Disease in Type 1 Diabetes Mellitus: Epidemiology and Management of Cardiovascular Risk
by Cristina Colom, Anna Rull, José Luis Sanchez-Quesada and Antonio Pérez
J. Clin. Med. 2021, 10(8), 1798; https://doi.org/10.3390/jcm10081798 - 20 Apr 2021
Cited by 19 | Viewed by 4323
Abstract
Cardiovascular disease (CVD) is a major cause of mortality in type 1 diabetes mellitus (T1DM) patients, and cardiovascular risk (CVR) remains high even in T1DM patients with good metabolic control. The underlying mechanisms remain poorly understood and known risk factors seem to operate [...] Read more.
Cardiovascular disease (CVD) is a major cause of mortality in type 1 diabetes mellitus (T1DM) patients, and cardiovascular risk (CVR) remains high even in T1DM patients with good metabolic control. The underlying mechanisms remain poorly understood and known risk factors seem to operate differently in T1DM and type 2 diabetes mellitus (T2DM) patients. However, evidence of cardiovascular risk assessment and management in T1DM patients often is extrapolated from studies on T2DM patients or the general population. In this review, we examine the existing literature about the prevalence of clinical and subclinical CVD, as well as current knowledge about potential risk factors involved in the development and progression of atherosclerosis in T1DM patients. We also discuss current approaches to the stratification and therapeutic management of CVR in T1DM patients. Chronic hyperglycemia plays an important role, but it is likely that other potential factors are involved in increased atherosclerosis and CVD in T1DM patients. Evidence on the estimation of 10-year and lifetime risk of CVD, as well as the efficiency and age at which current cardiovascular medications should be initiated in young T1DM patients, is very limited and clearly insufficient to establish evidence-based therapeutic approaches to CVD management. Full article
(This article belongs to the Special Issue Lipids, Lipoproteins, and Atherothrombotic Disease: Clinical Pharmacology Now and in the Future)
18 pages, 4686 KiB  
Article
Non-Invasive and Quantitative Estimation of Left Atrial Fibrosis Based on P Waves of the 12-Lead ECG—A Large-Scale Computational Study Covering Anatomical Variability
by Claudia Nagel, Giorgio Luongo, Luca Azzolin, Steffen Schuler, Olaf Dössel and Axel Loewe
J. Clin. Med. 2021, 10(8), 1797; https://doi.org/10.3390/jcm10081797 - 20 Apr 2021
Cited by 21 | Viewed by 3673
Abstract
The arrhythmogenesis of atrial fibrillation is associated with the presence of fibrotic atrial tissue. Not only fibrosis but also physiological anatomical variability of the atria and the thorax reflect in altered morphology of the P wave in the 12-lead electrocardiogram (ECG). Distinguishing between [...] Read more.
The arrhythmogenesis of atrial fibrillation is associated with the presence of fibrotic atrial tissue. Not only fibrosis but also physiological anatomical variability of the atria and the thorax reflect in altered morphology of the P wave in the 12-lead electrocardiogram (ECG). Distinguishing between the effects on the P wave induced by local atrial substrate changes and those caused by healthy anatomical variations is important to gauge the potential of the 12-lead ECG as a non-invasive and cost-effective tool for the early detection of fibrotic atrial cardiomyopathy to stratify atrial fibrillation propensity. In this work, we realized 54,000 combinations of different atria and thorax geometries from statistical shape models capturing anatomical variability in the general population. For each atrial model, 10 different volume fractions (0–45%) were defined as fibrotic. Electrophysiological simulations in sinus rhythm were conducted for each model combination and the respective 12-lead ECGs were computed. P wave features (duration, amplitude, dispersion, terminal force in V1) were extracted and compared between the healthy and the diseased model cohorts. All investigated feature values systematically in- or decreased with the left atrial volume fraction covered by fibrotic tissue, however value ranges overlapped between the healthy and the diseased cohort. Using all extracted P wave features as input values, the amount of the fibrotic left atrial volume fraction was estimated by a neural network with an absolute root mean square error of 8.78%. Our simulation results suggest that although all investigated P wave features highly vary for different anatomical properties, the combination of these features can contribute to non-invasively estimate the volume fraction of atrial fibrosis using ECG-based machine learning approaches. Full article
(This article belongs to the Special Issue Arrhythmogenic Fibrotic Atrial Cardiomyopathy (FAM) and Atrial Fibrillation: Pathophysiology, Diagnosis, Treatment and Consequences for Prevention of Ischemic Stroke)
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19 pages, 1753 KiB  
Review
Exercise Testing, Physical Training and Fatigue in Patients with Mitochondrial Myopathy Related to mtDNA Mutations
by Tina D. Jeppesen, Karen L. Madsen, Nanna S. Poulsen, Nicoline Løkken and John Vissing
J. Clin. Med. 2021, 10(8), 1796; https://doi.org/10.3390/jcm10081796 - 20 Apr 2021
Cited by 7 | Viewed by 2750
Abstract
Mutations in mitochondrial DNA (mtDNA) cause disruption of the oxidative phosphorylation chain and impair energy production in cells throughout the human body. Primary mitochondrial disorders due to mtDNA mutations can present with symptoms from adult-onset mono-organ affection to death in infancy due to [...] Read more.
Mutations in mitochondrial DNA (mtDNA) cause disruption of the oxidative phosphorylation chain and impair energy production in cells throughout the human body. Primary mitochondrial disorders due to mtDNA mutations can present with symptoms from adult-onset mono-organ affection to death in infancy due to multi-organ involvement. The heterogeneous phenotypes that patients with a mutation of mtDNA can present with are thought, at least to some extent, to be a result of differences in mtDNA mutation load among patients and even among tissues in the individual. The most common symptom in patients with mitochondrial myopathy (MM) is exercise intolerance. Since mitochondrial function can be assessed directly in skeletal muscle, exercise studies can be used to elucidate the physiological consequences of defective mitochondria due to mtDNA mutations. Moreover, exercise tests have been developed for diagnostic purposes for mitochondrial myopathy. In this review, we present the rationale for exercise testing of patients with MM due to mutations in mtDNA, evaluate the diagnostic yield of exercise tests for MM and touch upon how exercise tests can be used as tools for follow-up to assess disease course or effects of treatment interventions. Full article
(This article belongs to the Special Issue Mitochondrial Disorders: Molecular, Clinical and Therapeutic Advances)
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12 pages, 288 KiB  
Article
Sex Differences in the Incidence and Outcomes of Acute Myocardial Infarction in Spain, 2016–2018: A Matched-Pair Analysis
by José M. de Miguel-Yanes, Rodrigo Jiménez-García, Valentin Hernandez-Barrera, Javier de Miguel-Díez, Nuria Muñoz-Rivas, Manuel Méndez-Bailón, Napoleón Pérez-Farinós, Marta López-Herranz and Ana Lopez-de-Andres
J. Clin. Med. 2021, 10(8), 1795; https://doi.org/10.3390/jcm10081795 - 20 Apr 2021
Cited by 15 | Viewed by 1889
Abstract
(1) Background: Our aim was to analyze the incidence, procedures, and in-hospital outcomes of myocardial infarction (MI) in Spain (2016–2018) according to sex. (2) Methods: We estimated the incidence of an ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) according [...] Read more.
(1) Background: Our aim was to analyze the incidence, procedures, and in-hospital outcomes of myocardial infarction (MI) in Spain (2016–2018) according to sex. (2) Methods: We estimated the incidence of an ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) according to sex using the Spanish National Hospital Discharge Database. A matched-pair analysis was used. (3) Results: MI was coded in 156,826 patients aged ≥18 years (111,842 men and 44,984 women). Men showed higher incidence rates (205.0 vs. 77.8 per 100,000; p < 0.001; IRR = 2.81(95%CI:2.78–2.84)). After matching, the use of coronary artery by-pass grafting (CABG) (1.0% vs. 0.7%; p < 0.001) and percutaneous coronary intervention (PCI) (57.8% vs. 52.3%; p < 0.001) was higher among men with an STEMI, whereas the in-hospital mortality (IHM) remained higher among women (11.2% vs. 10.1%; p < 0.001). Likewise, CABG (1.9% vs. 3.3%; p < 0.001) and PCI (33.8% vs. 41.9%; p < 0.001) were less often used among women with an NSTEMI, but no sex-related differences were found in IHM. After adjusting for confounders, IHM was more than twofold higher for both men and women with an STEMI than those with an NSTEMI. Women with an STEMI had a 21% higher mortality risk than men (OR = 1.21(95%CI:1.13–1.29). (4) Conclusion: Men had higher incidence rates of MI than women. Women underwent invasive procedures less often and had a higher IHM when admitted for an STEMI. Full article
(This article belongs to the Section Cardiology)
16 pages, 1945 KiB  
Article
Radiological and Clinical Efficacy of Intra-Arterial 90Y-DOTATATE in Patients with Unresectable, Progressive, Liver Dominant Neuroendocrine Neoplasms
by Agnieszka Kolasińska-Ćwikła, Mirosław L. Nowicki, Artur J. Sankowski, Jakub M. Pałucki, John R. Buscombe, Lidia Glinka and Jarosław B. Ćwikła
J. Clin. Med. 2021, 10(8), 1794; https://doi.org/10.3390/jcm10081794 - 20 Apr 2021
Cited by 5 | Viewed by 1771
Abstract
This study was performed to determine if intra-arterial (i.a.) administration of 90Y DOTATATE can provide an effective and safe alternative to the accepted standard for i.v. of peptide receptor radionuclide therapy (PRRT) in liver-dominant metastases of gastrointestinal pancreatic neuroendocrine neoplasm (GEP-NEN). A [...] Read more.
This study was performed to determine if intra-arterial (i.a.) administration of 90Y DOTATATE can provide an effective and safe alternative to the accepted standard for i.v. of peptide receptor radionuclide therapy (PRRT) in liver-dominant metastases of gastrointestinal pancreatic neuroendocrine neoplasm (GEP-NEN). A single site, prospective, preliminary case series study included 39 patients with histologically proven liver-dominant NEN. PRRT in the form of 1.15GBq 90Y DOTATATE was given selectively into the liver via radiological catheterization of the hepatic artery, up to four times. The endpoint was radiological response (RECIST). Secondary endpoints assessed clinical well-being post-treatment, progression-free survival (PFS), overall survival (OS), and toxicity. Partial response (PR) was noted in 13% of subjects six weeks post-therapy, increasing to 24% at six months and dropping to 13% at 36 months. Disease progression (DP) was not seen at six weeks, was 5% at six months, and 47% at 36 months. Clinical response based on PS seen in 74% of patients at six weeks, 69% at six months, and 39% at 36 months had PFS and OS, respectively, of 22.7 months and 38.2 months. There was no difference in OS/PFS between those with RECIST PR and SD. One patient had significant toxicity (3%). Use of i.a. PRRT appears to be safe and effective in treating patients with liver-dominant NEN. In addition, the best OS (51 vs. 22 months) was seen when i.a. was used as an upfront treatment of bulky GEP-NEN liver metastases and not after i.v. 90Y DOTATATE. The use of i.a. 90Y DOTATATE PRRT appears to be safe and effective in treating patients with liver-dominant NEN. Full article
(This article belongs to the Section Oncology)
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9 pages, 286 KiB  
Article
Effect of Physiotherapy Treatment in the Autonomic Activation and Pain Perception in Male Patients with Non-Specific Subacute Low Back Pain
by Vanesa Abuín-Porras, Vicente Javier Clemente-Suárez, Gonzalo Jaén-Crespo, Emmanuel Navarro-Flores, Helios Pareja-Galeano and Carlos Romero-Morales
J. Clin. Med. 2021, 10(8), 1793; https://doi.org/10.3390/jcm10081793 - 20 Apr 2021
Cited by 5 | Viewed by 3158
Abstract
Introduction: Physiotherapy treatment is a common intervention for low back pain (LBP) patients. These interventions have been related to physiological effects in the central nervous system. Thus, the aim of this study was to analyze the effect of physiotherapy treatment in patients with [...] Read more.
Introduction: Physiotherapy treatment is a common intervention for low back pain (LBP) patients. These interventions have been related to physiological effects in the central nervous system. Thus, the aim of this study was to analyze the effect of physiotherapy treatment in patients with LBP in the autonomic nervous system activation and subjective pain perception of patients. Methods: A total of 30 male subjects diagnosed with non-specific subacute LBP received a 50 min session consisting of (a) a manual therapy based on joint mobilization and soft tissues techniques in the lumbo-pelvic area, (b) a stretching program, and (c) motor control exercises of the core muscles. The autonomic modification of participants was assessed prior to and after the physiotherapy treatment. Results: Heart rate variability (HRV) analysis reported a significant increase in average RR (p = 0.001), RMSSD (p = 0.008), LRMSSD (p = 0.001), SDNN (p = 0.005), and PNN50 (p = 0.024) after the session. Frequency-domain measures showed a significant increase in LF (p = 0.030) and HF (p = 0.014), and a decrease in LF/HF ratio (p = 0.046). A significant decrease was found in minimum HR values (p = 0.001) and average HR (p = 0.001). Moreover, maximal HR decreased its value from 116.7 ± 26.1 to 113.7 ± 40.8 after intervention. In addition, subjective pain perception (VAS scores) was significantly lower (p = 0.001) in the post-session assessment. Conclusions: Physiotherapy treatment produced an increase in parasympathetic nervous system activation and a decrease in subjective pain perception in non-specific subacute LBP patients. Full article
(This article belongs to the Section Orthopedics)
18 pages, 2731 KiB  
Article
Nasal Turbinate Mesenchymal Stromal Cells Preserve Characteristics of Their Neural Crest Origin and Exert Distinct Paracrine Activity
by Hyun-Jee Kim, Sungho Shin, Seon-Yeong Jeong, Sun-Ung Lim, Dae-Won Lee, Yunhee-Kim Kwon, Jiyeon Kang, Sung-Won Kim, Chan-Kwon Jung, Cheolju Lee and Il-Hoan Oh
J. Clin. Med. 2021, 10(8), 1792; https://doi.org/10.3390/jcm10081792 - 20 Apr 2021
Cited by 4 | Viewed by 2583
Abstract
The sources of mesenchymal stromal cells (MSCs) for cell therapy trials are expanding, increasing the need for their characterization. Here, we characterized multi-donor, turbinate-derived MSCs (TB-MSCs) that develop from the neural crest, and compared them to bone marrow-derived MSCs (BM-MSCs). TB-MSCs had higher [...] Read more.
The sources of mesenchymal stromal cells (MSCs) for cell therapy trials are expanding, increasing the need for their characterization. Here, we characterized multi-donor, turbinate-derived MSCs (TB-MSCs) that develop from the neural crest, and compared them to bone marrow-derived MSCs (BM-MSCs). TB-MSCs had higher proliferation potential and higher self-renewal of colony forming cells, but lower potential for multi-lineage differentiation than BM-MSCs. TB-MSCs expressed higher levels of neural crest markers and lower levels of pericyte-specific markers. These neural crest-like properties of TB-MSCs were reflected by their propensity to differentiate into neuronal cells and proliferative response to nerve growth factors. Proteomics (LC–MS/MS) analysis revealed a distinct secretome profile of TB-MSCs compared to BM and adipose tissue-derived MSCs, exhibiting enrichments of factors for cell-extracellular matrix interaction and neurogenic signaling. However, TB-MSCs and BM-MSCs exhibited comparable suppressive effects on the allo-immune response and comparable stimulatory effects on hematopoietic stem cell self-renewal. In contrast, TB-MSCs stimulated growth and metastasis of breast cancer cells more than BM-MSCs. Altogether, our multi-donor characterization of TB-MSCs reveals distinct cell autonomous and paracrine properties, reflecting their unique developmental origin. These findings support using TB-MSCs as an alternative source of MSCs with distinct biological characteristics for optimal applications in cell therapy. Full article
(This article belongs to the Special Issue Therapies Based on Mesenchymal Stem Cells (MSCs) and MSC-Derived Exosomes)
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10 pages, 650 KiB  
Article
Predictors of Brain Natriuretic Peptide Serum Level Elevation in Patients with Symptomatic Chronic Subdural Hematoma: A Prospective Study
by Mehdi Chihi, Ramazan Jabbarli, Ahmet Parlak, Marvin Darkwah-Oppong, Oliver Gembruch, Karsten Henning Wrede, Ulrich Sure and Homajoun Maslehaty
J. Clin. Med. 2021, 10(8), 1791; https://doi.org/10.3390/jcm10081791 - 20 Apr 2021
Cited by 1 | Viewed by 1782
Abstract
Background: Brain natriuretic peptide serum levels (BNP) on admission are frequently elevated in patients with symptomatic chronic subdural hematoma (cSDH) and predict unfavorable long-term functional outcomes. However, the reasons for these elevated levels remain unclear. Therefore, we aimed to identify the predictors of [...] Read more.
Background: Brain natriuretic peptide serum levels (BNP) on admission are frequently elevated in patients with symptomatic chronic subdural hematoma (cSDH) and predict unfavorable long-term functional outcomes. However, the reasons for these elevated levels remain unclear. Therefore, we aimed to identify the predictors of BNP elevation. Methods: Patients with unilateral symptomatic cSDH who were surgically treated in our department between November 2016 and May 2020 were enrolled. Patients’ symptoms and neurological deficits were prospectively assessed using a study questionnaire. On initial computer tomography, hematoma volumes and midline shift (MLS) values were measured to analyze the degree of brain compression. Results: In total, 100 patients were analyzed. Linear regression analysis showed that higher BNP levels were significantly associated with smaller hematoma volumes (p = 0.003) and littler MLS values (p = 0.022). Multivariate analysis revealed that presence of a neurological deficit (p = 0.041), a hematoma volume < 140 mL (p = 0.047), advanced age (p = 0.023), and head trauma within 24 h of admission (p = 0.001) were independent predictors of BNP elevation. Conclusion: In symptomatic cSDH, BNP elevation is related, among others, to the presence of neurological deficits and smaller hematoma volumes. Whether BNP elevation may coincide with the early stage of hematoma growth, i.e., immaturity of cSDH neomembrane, requires further investigations. Full article
(This article belongs to the Section Brain Injury)
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10 pages, 5233 KiB  
Article
Clinical Characteristics of Primary Repair for Perforated Peptic Ulcer: 10-Year Experience in a Single Center
by Yun-Suk Choi, Yoon-Seok Heo and Jin-Wook Yi
J. Clin. Med. 2021, 10(8), 1790; https://doi.org/10.3390/jcm10081790 - 20 Apr 2021
Cited by 3 | Viewed by 2025
Abstract
Background: Perforated peptic ulcer (PPU) is a disease whose incidence is decreasing. However, PPU still requires emergency surgery. The aim of this study was to review the clinical characteristics of patients who received primary repair for PPU and identify the predisposing factors associated [...] Read more.
Background: Perforated peptic ulcer (PPU) is a disease whose incidence is decreasing. However, PPU still requires emergency surgery. The aim of this study was to review the clinical characteristics of patients who received primary repair for PPU and identify the predisposing factors associated with severe complications. Method: From January 2011 to December 2020, a total of 75 patients underwent primary repair for PPU in our hospital. We reviewed the patients’ data, including general characteristics and perioperative complications. Surgical complications were evaluated using the Clavien-Dindo Classification (CDC) system, with which we classified patients into the mild complication (CDC 0–III, n = 61) and severe complication (CDC IV–V, n = 14) groups. Result: Fifty patients had gastric perforation, and twenty-five patients had duodenal perforation. Among surgical complications, leakage or fistula were the most common (5/75, 6.7%), followed by wound problems (4/75, 5.3%). Of the medical complications, infection (9/75, 12%) and pulmonary disorder (7/75, 9.3%) were common. Eight patients died within thirty days after surgery (8/75, 10.7%). Liver cirrhosis was the most significant predisposing factor for severe complications (HR = 44.392, p = 0.003). Conclusion: PPU is still a surgically important disease that has significant mortality, above 10%. Liver cirrhosis is the most important underlying disease associated with severe complications. Full article
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
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11 pages, 23316 KiB  
Review
Neurocognitive Status after Aortic Valve Replacement: Differences between TAVI and Surgery
by Nicholas Aroney, Tiffany Patterson, Christopher Allen, Simon Redwood and Bernard Prendergast
J. Clin. Med. 2021, 10(8), 1789; https://doi.org/10.3390/jcm10081789 - 20 Apr 2021
Cited by 3 | Viewed by 2565
Abstract
Over the past decade, indications for transcatheter aortic valve implantation (TAVI) have progressed rapidly—procedural numbers now exceed those of surgical aortic valve replacement (SAVR) in many countries, and TAVI is now a realistic and attractive alternative to SAVR in low-risk patients. Neurocognitive outcomes [...] Read more.
Over the past decade, indications for transcatheter aortic valve implantation (TAVI) have progressed rapidly—procedural numbers now exceed those of surgical aortic valve replacement (SAVR) in many countries, and TAVI is now a realistic and attractive alternative to SAVR in low-risk patients. Neurocognitive outcomes after TAVI and SAVR remain an issue and sit firmly under the spotlight as TAVI moves into low-risk cohorts. Cognitive decline and stroke carry a significant burden and predict future functional decline, reduced mobility, poor quality of life and increased mortality. Early TAVI trials used varying neurocognitive definitions, and outcomes differed significantly as a result. Recent international consensus statements defining endpoints following TAVI and SAVR have standardised neurological outcomes and facilitate interpretation and comparison between trials. The latest TAVI and SAVR trials have demonstrated more consistent and favourable neurocognitive outcomes for TAVI patients, and cerebral embolic protection devices offer the prospect of further refinement and improvement. Full article
(This article belongs to the Special Issue Surgical or Transcatheter Aortic Valve Replacement in Intermediate-Risk Patients)
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14 pages, 2306 KiB  
Article
Effectiveness of Clinical Pharmacist Service on Drug-Related Problems and Patient Outcomes for Hospitalized Patients with Chronic Kidney Disease: A Randomized Controlled Trial
by Yun-Kyoung Song, Sohyun Jeong, Nayoung Han, Heejin Na, Ha Young Jang, Minji Sohn, Yon Su Kim, Kwon-Wook Joo, Kook-Hwan Oh, Dong Ki Kim, Hajeong Lee, Jung Mi Oh and DrugTEAM Study Group
J. Clin. Med. 2021, 10(8), 1788; https://doi.org/10.3390/jcm10081788 - 20 Apr 2021
Cited by 11 | Viewed by 3482
Abstract
(1) Background: The study aimed to analyze the effectiveness of clinical pharmacist services on drug-related problems (DRPs) and patient outcomes in inpatients with chronic kidney disease (CKD). (2) Methods: In a randomized controlled trial, the participants in the intervention group received pharmacist services, [...] Read more.
(1) Background: The study aimed to analyze the effectiveness of clinical pharmacist services on drug-related problems (DRPs) and patient outcomes in inpatients with chronic kidney disease (CKD). (2) Methods: In a randomized controlled trial, the participants in the intervention group received pharmacist services, including medication reconciliation, medication evaluation and management, and discharge pharmaceutical care transition services. Participants in the control group received usual care. The primary outcome was the number of DRPs per patient at discharge. (3) Results: The baseline characteristics of 100 participants included the following: mean age, 52.5 years; median eGFR, 9.2 mL/min/1.73 m2. The number of DRPs in the intervention group during hospitalization increased significantly with decreasing eGFR (PR, 0.970; 95% CI, 0.951–0.989) and an increasing number of unintentional medication discrepancies at admission (PR, 1.294; 95% CI, 1.034–1.620). At discharge, the number of DRPs per patient was 0.94 ± 1.03 and 1.96 ± 1.25 in the intervention and control groups, respectively (p < 0.001). The service had a significant effect on the reduction of the unintentional discrepancies at discharge (p < 0.001). (4) Conclusion: Hospital pharmacists play an important role in the prevention of DRPs at discharge and unintentional medication discrepancies in inpatients with CKD. Full article
(This article belongs to the Section Nephrology & Urology)
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14 pages, 602 KiB  
Article
Bidirectional Association between Metabolic Control in Type-2 Diabetes Mellitus and Periodontitis Inflammatory Burden: A Cross-Sectional Study in an Italian Population
by Federica Romano, Stefano Perotto, Sara Elamin Osman Mohamed, Sara Bernardi, Marta Giraudi, Paola Caropreso, Giulio Mengozzi, Giacomo Baima, Filippo Citterio, Giovanni Nicolao Berta, Marilena Durazzo, Gabriella Gruden and Mario Aimetti
J. Clin. Med. 2021, 10(8), 1787; https://doi.org/10.3390/jcm10081787 - 20 Apr 2021
Cited by 22 | Viewed by 2533
Abstract
This study assessed the periodontal conditions of type 2 diabetes (T2DM) patients attending an Outpatient Center in North Italy and explored the associations between metabolic control and periodontitis. Periodontal health of 104 T2DM patients (61 men and 43 women, mean age of 65.3 [...] Read more.
This study assessed the periodontal conditions of type 2 diabetes (T2DM) patients attending an Outpatient Center in North Italy and explored the associations between metabolic control and periodontitis. Periodontal health of 104 T2DM patients (61 men and 43 women, mean age of 65.3 ± 10.1 years) was assessed according to CDC/AAP periodontitis case definitions and Periodontal Inflamed Surface Area (PISA) Index. Data on sociodemographic factors, lifestyle behaviors, laboratory tests, and glycated hemoglobin (HbA1c) levels were collected by interview and medical records. Poor glycemic control (HbA1c ≥ 7%), family history of T2DM, and C-reactive protein levels were predictors of severe periodontitis. An increase in HbA1c of 1% was associated with a rise in PISA of 89.6 mm2. On the other hand, predictors of poor glycemic control were severe periodontitis, waist circumference, unbalanced diet, and sedentary lifestyle. A rise in PISA of 10 mm2 increased the odds of having HbA1c ≥ 7% by 2%. There is a strong bidirectional connection between periodontitis and poor glycemic control. The inflammatory burden posed by periodontitis represents the strongest predictor of poor glycemic control. Full article
(This article belongs to the Special Issue Periodontitis: Current Status and the Future)
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11 pages, 2456 KiB  
Article
Clinical Value and Time Course of Pericoronary Fat Inflammation in Patients with Angiographically Nonobstructive Coronaries: A Preliminary Report
by Valeria Pergola, Marco Previtero, Annagrazia Cecere, Vittorio Storer, Teresa Castiello, Anna Baritussio, Giulio Cabrelle, Donato Mele, Raffaella Motta, Alida Patrizia Caforio, Sabino Iliceto and Martina Perazzolo Marra
J. Clin. Med. 2021, 10(8), 1786; https://doi.org/10.3390/jcm10081786 - 20 Apr 2021
Cited by 15 | Viewed by 2131
Abstract
The introduction of high-sensitivity cardiac troponin allowed identifying a proportion of subjects with chest pain and electrocardiographic changes suggestive of myocardial infarction showing <50% coronary artery stenosis. PFAI is a coronary CT marker proved to predict outcome in ischemic heart disease. Based on [...] Read more.
The introduction of high-sensitivity cardiac troponin allowed identifying a proportion of subjects with chest pain and electrocardiographic changes suggestive of myocardial infarction showing <50% coronary artery stenosis. PFAI is a coronary CT marker proved to predict outcome in ischemic heart disease. Based on CMR findings, patients were divided into myocarditis (n = 15), MINOCA (n = 14) and TTS (n = 9) groups. The aim was to estimate the value of pFAI in these groups compared to 12 controls. To evaluate the coronary inflammation “time course,” 20 patients underwent CMR and coronary CT scan within 8 days from the onset, the others within 60 days. There were higher values of pFAI in myocarditis (−86.45 HU), MINOCA (−84.63 HU) and TTS (−84.79 HU) compared to controls (−96.02 HU; p = 0.0077). Among patients who underwent CT within 8 days from onset, the MINOCA had a significantly higher pFAI value (−76.91 HU) compared to the control group (−96.02 HU; p = 0.0001). In the group that underwent CT later than 8 days, elevated pFAI values persisted only in the myocarditis and TTS groups, and there was no difference between MINOCA and controls. Our study shows that in patients with a diagnosis of MINOCA, there is acute coronary inflammation, which is more evident within one week from the acute event but tends to disappear with time. Full article
(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Coronary Artery Disease)
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20 pages, 2286 KiB  
Review
Trends of Stem Cell Therapies in Age-Related Macular Degeneration
by Tadao Maeda, Sunao Sugita, Yasuo Kurimoto and Masayo Takahashi
J. Clin. Med. 2021, 10(8), 1785; https://doi.org/10.3390/jcm10081785 - 20 Apr 2021
Cited by 21 | Viewed by 6397
Abstract
Age-related macular degeneration (AMD) is a highly prevalent irreversible impairment in the elderly population worldwide. Stem cell therapies have been considered potentially viable for treating AMD through the direct replacement of degenerated cells or secretion of trophic factors that facilitate the survival of [...] Read more.
Age-related macular degeneration (AMD) is a highly prevalent irreversible impairment in the elderly population worldwide. Stem cell therapies have been considered potentially viable for treating AMD through the direct replacement of degenerated cells or secretion of trophic factors that facilitate the survival of existing cells. Among them, the safety of pluripotent stem cell-derived retinal pigment epithelial (RPE) cell transplantation against AMD, and some hereditary retinal degenerative diseases, has been discussed to a certain extent in clinical studies of RPE cell transplantation. Preparations are in progress for its clinical application. On the other hand, clinical trials using somatic stem cells are also being conducted, though these had controversial outcomes. Retinal regenerative medicine using stem cells is expected to make steady progress toward practical use while new technologies are incorporated from various fields, thereby making the role of ophthalmologists in this field increasingly important. Full article
(This article belongs to the Special Issue Age-Related Macular Degeneration: Advances in Management and Diagnosis)
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11 pages, 693 KiB  
Article
Clinical History and Detectable Troponin Concentrations below the 99th Percentile for Risk Stratification of Patients with Chest Pain and First Normal Troponin
by Agustín Fernández-Cisnal, Ernesto Valero, Sergio García-Blas, Vicente Pernias, Adela Pozo, Arturo Carratalá, Jessika González, José Noceda, Gema Miñana, Julio Núñez and Juan Sanchis
J. Clin. Med. 2021, 10(8), 1784; https://doi.org/10.3390/jcm10081784 - 20 Apr 2021
Cited by 2 | Viewed by 1910
Abstract
Decision-making is challenging in patients with chest pain and normal high-sensitivity cardiac troponin T (hs-cTnT; <99th percentile; <14 ng/L) at hospital arrival. Most of these patients might be discharged early. We investigated clinical data and hs-cTnT concentrations for risk stratification. This is a [...] Read more.
Decision-making is challenging in patients with chest pain and normal high-sensitivity cardiac troponin T (hs-cTnT; <99th percentile; <14 ng/L) at hospital arrival. Most of these patients might be discharged early. We investigated clinical data and hs-cTnT concentrations for risk stratification. This is a retrospective study including 4476 consecutive patients presenting to the emergency department with chest pain and first normal hs-cTnT. The primary endpoint was one-year death or acute myocardial infarction, and the secondary endpoint added urgent revascularization. The number of primary and secondary endpoints was 173 (3.9%) and 252 (5.6%). Mean hs-cTnT concentrations were 6.9 ± 2.5 ng/L. Undetectable (<5 ng/L) hs-cTnT (n = 1847, 41%) had optimal negative predictive value (99.1%) but suboptimal sensitivity (90.2%) and discrimination accuracy (AUC = 0.664) for the primary endpoint. Multivariable analysis was used to identify the predictive clinical variables. The clinical model showed good discrimination accuracy (AUC = 0.810). The addition of undetectable hs-cTnT (≥ or <5 ng/L; HR, hazard ratio = 3.80; 95% CI, confidence interval 2.27–6.35; p = 0.00001) outperformed the clinical model alone (AUC = 0.836, p = 0.002 compared to the clinical model). Measurable hs-cTnT concentrations (between detection limit and 99th percentile; per 0.1 ng/L, HR = 1.13; CI 1.06–1.20; p = 0.0001) provided further predictive information (AUC = 0.844; p = 0.05 compared to the clinical plus undetectable hs-cTnT model). The results were reproducible for the secondary endpoint and 30-day events. Clinical assessment, undetectable hs-cTnT and measurable hs-cTnT concentrations must be considered for decision-making after a single negative hs-cTnT result in patients presenting to the emergency department with acute chest pain. Full article
(This article belongs to the Special Issue Improving the Diagnosis of Acute Myocardial Infarction)
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19 pages, 1943 KiB  
Review
Role of Proteasomes in Inflammation
by Carl Christoph Goetzke, Frédéric Ebstein and Tilmann Kallinich
J. Clin. Med. 2021, 10(8), 1783; https://doi.org/10.3390/jcm10081783 - 20 Apr 2021
Cited by 45 | Viewed by 5017
Abstract
The ubiquitin–proteasome system (UPS) is involved in multiple cellular functions including the regulation of protein homeostasis, major histocompatibility (MHC) class I antigen processing, cell cycle proliferation and signaling. In humans, proteasome loss-of-function mutations result in autoinflammation dominated by a prominent type I interferon [...] Read more.
The ubiquitin–proteasome system (UPS) is involved in multiple cellular functions including the regulation of protein homeostasis, major histocompatibility (MHC) class I antigen processing, cell cycle proliferation and signaling. In humans, proteasome loss-of-function mutations result in autoinflammation dominated by a prominent type I interferon (IFN) gene signature. These genomic alterations typically cause the development of proteasome-associated autoinflammatory syndromes (PRAAS) by impairing proteasome activity and perturbing protein homeostasis. However, an abnormal increased proteasomal activity can also be found in other human inflammatory diseases. In this review, we cast a light on the different clinical aspects of proteasomal activity in human disease and summarize the currently studied therapeutic approaches. Full article
(This article belongs to the Special Issue Systemic Autoinflammatory Diseases—Clinical Rheumatic Challenges)
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17 pages, 1261 KiB  
Article
Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data
by Ignacio Ricci-Cabello, Aina María Yañez-Juan, Maria A. Fiol-deRoque, Alfonso Leiva, Joan Llobera Canaves, Fabrice B. R. Parmentier and Jose M. Valderas
J. Clin. Med. 2021, 10(8), 1782; https://doi.org/10.3390/jcm10081782 - 20 Apr 2021
Cited by 1 | Viewed by 2615
Abstract
We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 [...] Read more.
We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 patients in 69 primary care centres in Spain. We constructed generalized structural equation models to examine the associations between multimorbidity constructs and patient-reported patient safety (PREOS-PC questionnaire). These associations were modelled through direct and indirect (mediated by increased interactions with healthcare) pathways. For women, a consistent association between higher levels of the multimorbidity constructs and lower levels of patient safety was observed via either pathway. The findings for men replicated these observations for polypharmacy, morbidity burden and patient complexity via indirect pathways. However, direct pathways showed unexpected associations between higher levels of multimorbidity and better safety. The consistent association between multimorbidity constructs and worse patient safety among women makes it advisable to target this group for the development of interventions, with particular attention to the role of comorbidity discordance. Further research, particularly qualitative research, is needed for clarifying the complex associations among men. Full article
(This article belongs to the Special Issue Multimorbidity Development and Evolution: Clinical Implications)
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19 pages, 878 KiB  
Article
Evaluation of the Analgesic Efficacy of a Bioelectronic Device in Non-Specific Chronic Low Back Pain with Neuropathic Component. A Randomized Trial
by Carlos de Teresa, Alfonso Varela-López, Susana Rios-Álvarez, Rafael Gálvez, Coralie Maire, Santos Gracia-Villar, Maurizio Battino and José L. Quiles
J. Clin. Med. 2021, 10(8), 1781; https://doi.org/10.3390/jcm10081781 - 20 Apr 2021
Cited by 1 | Viewed by 2432
Abstract
Low energy pulsed electromagnetic signals (PEMS) therapy, in the field of bioelectronics, has been suggested as a promising analgesic therapy with special interest in treating conditions with poor response to pharmacotherapy. This study evaluated the effectiveness of PEMS therapy on the treatment of [...] Read more.
Low energy pulsed electromagnetic signals (PEMS) therapy, in the field of bioelectronics, has been suggested as a promising analgesic therapy with special interest in treating conditions with poor response to pharmacotherapy. This study evaluated the effectiveness of PEMS therapy on the treatment of chronic low back pain patients with a neuropathic component. A group of 64 individuals with such condition was allocated to a 2-week treatment period (10 twenty-minute sessions on consecutive days) with an active PEMS therapy device or an inactive device in random order. The pain was assessed on a visual analog scale, and the functional status was assessed using the SF-12 questionnaire. The visual analog scale scores were lower after treatment than at baseline but only in the group treated with the active device. According to the DN4 score, neuropathic pain decreased in both experimental groups with respect to baseline, but this was only significant for the group treated with the active device. Similarly, an improvement in the SF-12 and Medical Outcomes Study (MOS) sleep scale components was reported. The study demonstrated that low-energy PEMS therapy was efficient in reducing pain and improving function in chronic low back pain patients with a neuropathic component. Full article
(This article belongs to the Section Sports Medicine)
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12 pages, 1609 KiB  
Article
Antithrombotic Management and Long-Term Outcomes of Patients with Atrial Fibrillation. Insights from CRAFT Trial
by Paweł Balsam, Piotr Lodziński, Monika Gawałko, Leszek Kraj, Andrzej Śliwczyński, Cezary Maciejewski, Bartosz Krzowski, Agata Tymińska, Krzysztof Ozierański, Marcin Grabowski, Janusz Bednarski and Grzegorz Opolski
J. Clin. Med. 2021, 10(8), 1780; https://doi.org/10.3390/jcm10081780 - 19 Apr 2021
Cited by 2 | Viewed by 1664
Abstract
Background: We aimed to compare long-term outcomes in Polish patients with atrial fibrillation (AF) according to oral anticoagulation (OAC) type and to evaluate the predictive value of common thromboembolic and bleeding risk scores. Methods: Data from the CRAFT trial (NCT02987062) were included. The [...] Read more.
Background: We aimed to compare long-term outcomes in Polish patients with atrial fibrillation (AF) according to oral anticoagulation (OAC) type and to evaluate the predictive value of common thromboembolic and bleeding risk scores. Methods: Data from the CRAFT trial (NCT02987062) were included. The primary study endpoint was major adverse event (MAE; all-cause death, thromboembolic and hemorrhagic event) during the mean four-year follow-up period. Results: Out of 2983 patients with available follow-up data, 1686 (56%) were prescribed with vitamin K antagonist (VKA), 891 (30%) with rivaroxaban and 406 (14%) with dabigatran. Predominance of elderly and female patients with previous history of thromboembolic and hemorrhagic events was observed within rivaroxaban (vs. other OAC) group. Higher rate of MAEs and its components was observed in patients on VKA followed by rivaroxaban as compared to patients on dabigatran (43% vs. 42% vs. 31%, p < 0.01). After group matching based on clinical characteristics, higher risk of hemorrhagic events in VKA (vs. dabigatran) and rivaroxaban (vs. dabigatran) group were observed. The available thromboembolic (CHA2DS2-VASs, ATRIA, R2CHADS2) and bleeding (HAS-BLED, ATRIA, ORBIT) risk scores showed poor prediction value. Conclusions: Despite no difference in the thromboembolic event rate, treatment with VKA and rivaroxaban was associated with a significant increase in the risk of hemorrhagic events. Full article
(This article belongs to the Section Cardiology)
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7 pages, 1966 KiB  
Article
Analysis of Chronic Tinnitus in Noise-Induced Hearing Loss and Presbycusis
by Hee Jin Kang, Dae Woong Kang, Sung Su Kim, Tong In Oh, Sang Hoon Kim and Seung Geun Yeo
J. Clin. Med. 2021, 10(8), 1779; https://doi.org/10.3390/jcm10081779 - 19 Apr 2021
Cited by 11 | Viewed by 2849
Abstract
Introduction: The most frequent causes of tinnitus associated with hearing loss are noise-induced hearing loss and presbycusis. The mechanism of tinnitus is not yet clear, although several hypotheses have been suggested. Therefore, we aimed to analyze characteristics of chronic tinnitus between noise-induced hearing [...] Read more.
Introduction: The most frequent causes of tinnitus associated with hearing loss are noise-induced hearing loss and presbycusis. The mechanism of tinnitus is not yet clear, although several hypotheses have been suggested. Therefore, we aimed to analyze characteristics of chronic tinnitus between noise-induced hearing loss and presbycusis. Materials and Methods: This paper is a retrospective chart review and outpatient clinic-based study of 248 patients with chronic tinnitus from 2015 to 2020 with noise-induced or presbycusis. Pure tone audiometry (PTA), auditory brainstem response (ABR), distortion product otoacoustic emissions (DPOAE), transient evoked otoacoustic emissions (TEOAE), and tinnitograms were conducted. Results: PTA showed that hearing thresholds at all frequencies were higher in patients with noise-induced hearing loss than the presbycusis group. ABR tests showed that patients with presbycusis had longer wave I and III latencies (p < 0.05 each) than patients with noise-induced hearing loss. TEOAE tests showed lower values in patients with noise-induced hearing loss than presbycusis at 1.5, 2, 3, and 4 kHz (p < 0.05 each). DPOAE tests showed that response rates in both ears at 1.5, 2, and 3 kHz were significantly higher in patients with presbycusis than noise-induced hearing loss (p < 0.05 each). Discussion: This study showed that hearing thresholds were higher, the loudness of tinnitus was smaller, and the degree of damage to outer hair cells was lower in patients with presbycusis than with noise-induced hearing loss. Moreover, wave I and III latencies were more prolonged in patients with presbycusis despite their having lower hearing thresholds. These phenomena may reflect the effects of aging or degeneration of the central nervous system with age. Further studies are needed to evaluate the etiologies of tinnitus. Full article
(This article belongs to the Topic Brain, Hearing and Tinnitus Science)
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11 pages, 1202 KiB  
Article
Antibodies to Citrullinated Proteins (ACPA) Associate with Markers of Osteoclast Activation and Bone Destruction in the Bone Marrow of Patients with Rheumatoid Arthritis
by Weronika Kurowska, Iwona Slowinska, Zbigniew Krogulec, Piotr Syrowka and Wlodzimierz Maslinski
J. Clin. Med. 2021, 10(8), 1778; https://doi.org/10.3390/jcm10081778 - 19 Apr 2021
Cited by 12 | Viewed by 2270
Abstract
Normalizing bone metabolism is a challenge in rheumatoid arthritis (RA). Studies in mice suggest that anti-citrullinated protein antibodies (ACPAs) can trigger osteoclast activation and bone resorption in the bone marrow. However, data on the presence and role of ACPAs in human bone marrow [...] Read more.
Normalizing bone metabolism is a challenge in rheumatoid arthritis (RA). Studies in mice suggest that anti-citrullinated protein antibodies (ACPAs) can trigger osteoclast activation and bone resorption in the bone marrow. However, data on the presence and role of ACPAs in human bone marrow are scarce. We investigated whether ACPAs can contribute to osteoclast activation and bone erosion in RA bone marrow. Anti-cyclic citrullinated peptide antibodies (anti-CCP Abs), osteoclast activation indicators–the tartrate-resistant acid phosphatase 5b (TRAP5b) and cathepsin K, and bone degradation marker–C-terminal telopeptide of type I collagen (CTX-I) were measured in the bone marrow and peripheral blood of RA patients using ELISAs. We found that ACPAs present in RA bone marrow was associated with increased amounts of TRAP5b, cathepsin K and CTX-I in this location. Levels of IL-8, the key mediator of anti-citrullinated protein antibody (ACPA)-induced bone resorption, were also elevated in bone marrow containing anti-CCP Abs and positively correlated with TRAP5b and cathepsin K concentrations. Higher levels of TRAP5b, cathepsin K, CTX-I and IL-8 in bone marrow compared to peripheral blood indicate local generation of these molecules. Our results complement data from animal studies and highlight the relevance of ACPAs and bone marrow in bone resorption in RA. Full article
(This article belongs to the Collection Systemic Manifestations and Complications of Rheumatoid Arthritis)
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25 pages, 2054 KiB  
Review
Bone Metastases from Gastric Cancer: What We Know and How to Deal with Them
by Angelica Petrillo, Emilio Francesco Giunta, Annalisa Pappalardo, Davide Bosso, Laura Attademo, Cinzia Cardalesi, Anna Diana, Antonietta Fabbrocini, Teresa Fabozzi, Pasqualina Giordano, Margaret Ottaviano, Mario Rosanova, Antonia Silvestri, Piera Federico and Bruno Daniele
J. Clin. Med. 2021, 10(8), 1777; https://doi.org/10.3390/jcm10081777 - 19 Apr 2021
Cited by 9 | Viewed by 4140
Abstract
Gastric cancer (GC) is the third cause of cancer-related death worldwide; the prognosis is poor especially in the case of metastatic disease. Liver, lymph nodes, peritoneum, and lung are the most frequent sites of metastases from GC; however, bone metastases from GC have [...] Read more.
Gastric cancer (GC) is the third cause of cancer-related death worldwide; the prognosis is poor especially in the case of metastatic disease. Liver, lymph nodes, peritoneum, and lung are the most frequent sites of metastases from GC; however, bone metastases from GC have been reported in the literature. Nevertheless, it is unclear how the metastatic sites may affect the prognosis. In particular, knowledge about the impact of bone metastases on GC patients’ outcome is scant, and this may be related to the rarity of bone lesions and/or their underestimation at the time of diagnosis. In fact, there is still a lack of specific recommendation for their detection at the diagnosis. Then, the majority of the evidences in this field came from retrospective analysis on very heterogeneous study populations. In this context, the aim of this narrative review is to delineate an overview about the evidences existing about bone metastases in GC patients, focusing on their incidence and biology, the prognostic role of bone involvement, and their possible implication in the treatment choice. Full article
(This article belongs to the Special Issue Multimodality Treatments in Metastatic Gastric Cancer)
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15 pages, 1223 KiB  
Article
Is Smiling the Key? Machine Learning Analytics Detect Subtle Patterns in Micro-Expressions of Infants with ASD
by Gianpaolo Alvari, Cesare Furlanello and Paola Venuti
J. Clin. Med. 2021, 10(8), 1776; https://doi.org/10.3390/jcm10081776 - 19 Apr 2021
Cited by 11 | Viewed by 3207
Abstract
Time is a key factor to consider in Autism Spectrum Disorder. Detecting the condition as early as possible is crucial in terms of treatment success. Despite advances in the literature, it is still difficult to identify early markers able to effectively forecast the [...] Read more.
Time is a key factor to consider in Autism Spectrum Disorder. Detecting the condition as early as possible is crucial in terms of treatment success. Despite advances in the literature, it is still difficult to identify early markers able to effectively forecast the manifestation of symptoms. Artificial intelligence (AI) provides effective alternatives for behavior screening. To this end, we investigated facial expressions in 18 autistic and 15 typical infants during their first ecological interactions, between 6 and 12 months of age. We employed Openface, an AI-based software designed to systematically analyze facial micro-movements in images in order to extract the subtle dynamics of Social Smiles in unconstrained Home Videos. Reduced frequency and activation intensity of Social Smiles was computed for children with autism. Machine Learning models enabled us to map facial behavior consistently, exposing early differences hardly detectable by non-expert naked eye. This outcome contributes to enhancing the potential of AI as a supportive tool for the clinical framework. Full article
(This article belongs to the Special Issue Motor Skills in Children with Autism Spectrum Disorders)
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11 pages, 1501 KiB  
Article
Sex Differences in Lipid Profile across the Life Span in Patients with Type 2 Diabetes: A Primary Care-Based Study
by Martina Ambrož, Sieta T. de Vries, Priya Vart, Robin P. F. Dullaart, Jeanine Roeters van Lennep, Petra Denig and Klaas Hoogenberg
J. Clin. Med. 2021, 10(8), 1775; https://doi.org/10.3390/jcm10081775 - 19 Apr 2021
Cited by 4 | Viewed by 2040
Abstract
We assessed sex differences across the life span in the lipid profile of type 2 diabetes (T2D) patients treated and not treated with statins. We used the Groningen Initiative to ANalyze Type 2 diabetes Treatment database, which includes T2D patients from the north [...] Read more.
We assessed sex differences across the life span in the lipid profile of type 2 diabetes (T2D) patients treated and not treated with statins. We used the Groningen Initiative to ANalyze Type 2 diabetes Treatment database, which includes T2D patients from the north of the Netherlands. Patients with a full lipid profile determined between 2010 and 2012 were included. We excluded patients treated with other lipid-lowering drugs than statins. Sex differences in low- and high-density lipoprotein cholesterol (LDL-c and HDL-c) and triglyceride (TG) levels across 11 age groups stratified by statin treatment were assessed using linear regression. We included 26,849 patients (51% women, 55% treated with statins). Without statins, women had significantly lower LDL-c levels than men before the age of 45 years, similar levels between 45 and 49 years, and higher levels thereafter. With statins, similar LDL-c levels were shown up to the age of 55, and higher levels in women thereafter. Women had significantly higher HDL-c levels than men, regardless of age or statin treatment. Men had significantly higher TG levels up to the age of 55 and 60, depending on whether they did not take or took statins, respectively, and similar levels thereafter. When managing cardiovascular risk in patients with T2D, attention is needed for the menopausal status of women and for TG levels in younger men. Full article
(This article belongs to the Section Endocrinology & Metabolism)
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11 pages, 2642 KiB  
Article
The Use of a Light-Emitting Diode Device for Neck Rejuvenation and Its Safety on Thyroid Glands
by Young In Lee, Eunjung Lee, Kee-Hyun Nam, Dong Yeob Shin, Jihee Kim, Jangmi Suk, Jin Young Kwak and Ju Hee Lee
J. Clin. Med. 2021, 10(8), 1774; https://doi.org/10.3390/jcm10081774 - 19 Apr 2021
Cited by 6 | Viewed by 3160
Abstract
Home-use light-emitting diodes (LEDs) are attracting growing attention regarding their anti-aging effects. Although most previous studies on the use of LED devices as a form of low-level laser therapy reported no significant adverse events, questions regarding the safety of using a light source [...] Read more.
Home-use light-emitting diodes (LEDs) are attracting growing attention regarding their anti-aging effects. Although most previous studies on the use of LED devices as a form of low-level laser therapy reported no significant adverse events, questions regarding the safety of using a light source on secretory tissues have been raised. This study aimed to assess the safety and efficacy of a home-use LED device for neck skin rejuvenation, particularly regarding its effect on thyroid gland morphology and function. Thyroid function tests and ultrasonographic analyses showed no significant changes after 16 weeks of LED use. Evaluation using the Lemperle wrinkle scale and global improvement scales by both investigators and subjects showed significant improvement after 16 weeks of daily application, as well as 8 weeks after discontinuation. Biophysical parameters, such as hydration, elasticity, and density, also showed significant improvements. Hence, the long-term use of the LED device was safe and effective for neck rejuvenation, and showed no significant side effects on the adjacent thyroid and parathyroid glands. Full article
(This article belongs to the Section Otolaryngology)
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19 pages, 2443 KiB  
Article
New Rehabilitation Concept for Maxillary Edentulism: A Clinical Retrospective Study of Implant Crown Retained Removable Partial Dentures
by Soo-Yeon Yoo, Seong-Kyun Kim, Seong-Joo Heo, Jai-Young Koak and Hye-Rin Jeon
J. Clin. Med. 2021, 10(8), 1773; https://doi.org/10.3390/jcm10081773 - 19 Apr 2021
Cited by 5 | Viewed by 5645
Abstract
There have been no studies of implant-crown-retained removable partial dentures (IC-RPD) for the treatment of maxillary edentulism. The purpose of this study was to perform clinical and radiographic evaluations of implants in IC-RPD compared to implant overdentures (IOD) in maxillary edentulous patients. Twenty [...] Read more.
There have been no studies of implant-crown-retained removable partial dentures (IC-RPD) for the treatment of maxillary edentulism. The purpose of this study was to perform clinical and radiographic evaluations of implants in IC-RPD compared to implant overdentures (IOD) in maxillary edentulous patients. Twenty IC-RPDs with 74 splinted implant crowns and 18 IODs with 71 implants retained with magnet attachments were observed in 38 patients. We statistically analyzed survival rates and marginal bone loss (MBL) of implants based on multiple variables including first year pathologic condition, location of placed implant, age, and sex in both treatments. Patient reported oral measurements (PROMs) regarding functional/esthetic improvement after IC-RPD or IOD treatments and prosthetic complications were also statistically analyzed. After a median observation period of 47.1 months (up to 147 months), we observed 97.3% implant survival rates for IC-RPD and 70.4% for IOD (p < 0.001). Among variables, first year pathologic condition (p < 0.001) and sex (p = 0.027) influenced implant survival rates. The MBL of implants for IC-RPD and IOD groups at the final check-up were 1.12 ± 1.19 mm and 3.31 ± 1.71 mm, respectively (p < 0.001). In both groups, patients with peri-implantitis (p < 0.001) and patients older than 65 years (p = 0.029) showed significantly higher implant MBL regardless of treatment modality. Functional and esthetic satisfaction were significantly improved (p < 0.001) after both treatments. The IOD group showed more frequent prosthetic complications compared to the IC-RPD group. Within the limitations of a retrospective study, we concluded that RPD with few splinted implant crowns is a feasible alternative treatment modality for maxillary edentulous patients with anatomical limitations. Full article
(This article belongs to the Special Issue Experimental Dental Research—New Concepts for Future Patient Needs)
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9 pages, 9114 KiB  
Article
Can Deep Learning Using Weight Bearing Knee Anterio-Posterior Radiograph Alone Replace a Whole-Leg Radiograph in the Interpretation of Weight Bearing Line Ratio?
by Hyun-Doo Moon, Han-Gyeol Choi, Kyong-Joon Lee, Dong-Jun Choi, Hyun-Jin Yoo and Yong-Seuk Lee
J. Clin. Med. 2021, 10(8), 1772; https://doi.org/10.3390/jcm10081772 - 19 Apr 2021
Cited by 3 | Viewed by 2243
Abstract
Weight bearing whole-leg radiograph (WLR) is essential to assess lower limb alignment such as weight bearing line (WBL) ratio. The purpose of this study was to develop a deep learning (DL) model that predicts the WBL ratio using knee standing AP alone. Total [...] Read more.
Weight bearing whole-leg radiograph (WLR) is essential to assess lower limb alignment such as weight bearing line (WBL) ratio. The purpose of this study was to develop a deep learning (DL) model that predicts the WBL ratio using knee standing AP alone. Total of 3997 knee AP & WLRs were used. WBL ratio was used for labeling and analysis of prediction accuracy. The WBL ratio was divided into seven categories (0, 0.1, 0.2, 0.3, 0.4, 0.5, and 0.6). After training, performance of the DL model was evaluated. Final performance was evaluated using 386 subjects as a test set. Cumulative score (CS) within error range 0.1 was set with showing maximum CS in the validation set (95% CI, 0.924–0.970). In the test set, mean absolute error was 0.054 (95% CI, 0.048–0.061) and CS was 0.951 (95% CI, 0.924–0.970). Developed DL algorithm could predict the WBL ratio on knee standing AP alone with comparable accuracy as the degree primary physician can assess the alignment. It can be the basis for developing an automated lower limb alignment assessment tool that can be used easily and cost-effectively in primary clinics. Full article
(This article belongs to the Special Issue Diagnosis and Management of Knee Injuries)
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10 pages, 259 KiB  
Article
Seroprevalence of Antibodies against SARS-CoV-2 in Children with Juvenile Idiopathic Arthritis a Case-Control Study
by Violetta Opoka-Winiarska, Ewelina Grywalska, Izabela Korona-Glowniak, Katarzyna Matuska, Anna Malm and Jacek Roliński
J. Clin. Med. 2021, 10(8), 1771; https://doi.org/10.3390/jcm10081771 - 19 Apr 2021
Cited by 3 | Viewed by 2252
Abstract
There is limited data on the effect of the novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) on pediatric rheumatology. We examined the prevalence of antibodies against SARS-CoV-2 in children with juvenile idiopathic arthritis (JIA) and a negative history of [...] Read more.
There is limited data on the effect of the novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) on pediatric rheumatology. We examined the prevalence of antibodies against SARS-CoV-2 in children with juvenile idiopathic arthritis (JIA) and a negative history of COVID-19 and the correlation of the presence of these antibodies with disease activity measured by juvenile arthritis disease activity score (JADAS). In total, 62 patients diagnosed with JIA, under treatment with various antirheumatic drugs, and 32 healthy children (control group) were included. Serum samples were analyzed for inflammatory markers and antibodies and their state evaluated with the juvenile arthritis disease activity score (JADAS). JIA patients do not have a higher seroprevalence of anti-SARS-CoV-2 antibodies than healthy subjects. We found anti-SARS-CoV-2 antibodies in JIA patients who did not have a history of COVID-19. The study showed no unequivocal correlation between the presence of SARS-CoV-2 antibodies and JIA activity; therefore, this relationship requires further observation. We also identified a possible link between patients’ humoral immune response and disease-modifying antirheumatic treatment, which will be confirmed in follow-up studies. Full article
(This article belongs to the Special Issue Advances in Adult-Onset Still’s Disease and Systemic Juvenile Idiopathic Arthritis)
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