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J. Clin. Med., Volume 11, Issue 11 (June-1 2022) – 300 articles

Cover Story (view full-size image): This study reports an innovative 3D printing preoperative planning technique for the endovascular treatment of intracranial aneurysms and presents an illustrative case of its successful application in clinical practice. This technique addresses the challenging problem of the correct selection of a flow disrupter in order to achieve the embolization of an intracranial aneurysm. The results suggest a promising future role of 3D printing, allowing a reduction in procedure time, complication rates, radiation exposure, and costs, while it could facilitate a patient’s education and the training of junior operators. View this paper
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10 pages, 391 KiB  
Article
Oral and Dental Considerations of Combat-Induced Post Traumatic Stress Disorder (PTSD)—A Cross-Sectional Study
by Nirit Tagger-Green, Carlos Nemcovsky, Naama Fridenberg, Orr Green, Liat Chaushu and Roni Kolerman
J. Clin. Med. 2022, 11(11), 3249; https://doi.org/10.3390/jcm11113249 - 6 Jun 2022
Viewed by 2325
Abstract
Objective: This study compared dental, periodontal, oral, and joint/muscle tenderness among Israeli combat-induced post-traumatic stress disorder (Ci-PTSD) war veterans to non-PTSD patients. Study design: This retrospective three-arm study compared oral and facial manifestations between 100 Israeli veterans with Ci- PTSD (study group) and [...] Read more.
Objective: This study compared dental, periodontal, oral, and joint/muscle tenderness among Israeli combat-induced post-traumatic stress disorder (Ci-PTSD) war veterans to non-PTSD patients. Study design: This retrospective three-arm study compared oral and facial manifestations between 100 Israeli veterans with Ci- PTSD (study group) and 103 non-PTSD periodontal patients (Control group). The study group was further divided into two subgroups of individuals who received psychiatric medications (40 patients) or did not (60 patients). All patients underwent complete dental, oral, and periodontal examinations, including assessing signs of parafunction. Results: All PTSD patients had poor oral hygiene. The plaque index (PI) was higher in the PTSD group compared to the control group (0.72 ± 0.28 vs. 0.45 ± 0.29, respectively, p < 0.001). The decayed, missing, and filled teeth score (DMFt) was higher in the PTSD population than in the controls (19.97 ± 8.07 vs. 13.05 ± 6.23 p < 0.05). Severe periodontal disease was more common among the PTSD subgroup taking medications (med -group) (62.5%) compared to the nonmedicated group (non-med group) (30.0%) and the controls (27.2%) (p = 0.001). Heavy smoking was more prevalent in the medicated PTSD patients than in other groups. Conclusions: The present study shows higher morbidities in combat-induced PTSD patients, including oral, dental, and periodontal manifestations, especially in medicated patients. Full article
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18 pages, 3413 KiB  
Article
Retinal Vascular Study Using OCTA in Subjects at High Genetic Risk of Developing Alzheimer’s Disease and Cardiovascular Risk Factors
by Inés López-Cuenca, Elena Salobrar-García, Lidia Sánchez-Puebla, Eva Espejel, Lucía García del Arco, Pilar Rojas, Lorena Elvira-Hurtado, José A. Fernández-Albarral, Federico Ramírez-Toraño, Ana Barabash, Juan J. Salazar, José M. Ramírez, Rosa de Hoz and Ana I. Ramírez
J. Clin. Med. 2022, 11(11), 3248; https://doi.org/10.3390/jcm11113248 - 6 Jun 2022
Cited by 6 | Viewed by 2617
Abstract
In 103 subjects with a high genetic risk of developing Alzheimer’s disease (AD), family history (FH) of AD and ApoE ɛ4 characterization (ApoE ɛ4) were analyzed for changes in the retinal vascular network by OCTA (optical coherence tomography angiography), and AngioTool and Erlangen-Angio-Tool [...] Read more.
In 103 subjects with a high genetic risk of developing Alzheimer’s disease (AD), family history (FH) of AD and ApoE ɛ4 characterization (ApoE ɛ4) were analyzed for changes in the retinal vascular network by OCTA (optical coherence tomography angiography), and AngioTool and Erlangen-Angio-Tool (EA-Tool) as imaging analysis software. Retinal vascularization was analyzed by measuring hypercholesterolemia (HCL) and high blood pressure (HBP). Angio-Tool showed a statistically significant higher percentage of area occupied by vessels in the FH+ ApoE ɛ4- group vs. in the FH+ ApoE ɛ4+ group, and EA-Tool showed statistically significant higher vascular densities in the C3 ring in the FH+ ApoE ɛ4+ group when compared with: i)FH- ApoE ɛ4- in sectors H3, H4, H10 and H11; and ii) FH+ ApoE ɛ4- in sectors H4 and H12. In participants with HCL and HBP, statistically significant changes were found, in particular using EA-Tool, both in the macular area, mainly in the deep plexus, and in the peripapillary area. In conclusion, OCTA in subjects with genetic risk factors for the development of AD showed an apparent increase in vascular density in some sectors of the retina, which was one of the first vascular changes detectable. These changes constitute a promising biomarker for monitoring the progression of pathological neuronal degeneration. Full article
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15 pages, 2011 KiB  
Review
Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors Use for Atherogenic Dyslipidemia in Solid Organ Transplant Patients
by Gianluigi Cuomo, Giuseppe Cioffi, Anna Di Lorenzo, Francesca Paola Iannone, Giuseppe Cudemo, Anna Maria Iannicelli, Mario Pacileo, Antonello D’Andrea, Carlo Vigorito, Gabriella Iannuzzo and Francesco Giallauria
J. Clin. Med. 2022, 11(11), 3247; https://doi.org/10.3390/jcm11113247 - 6 Jun 2022
Cited by 2 | Viewed by 2608
Abstract
Dyslipidemia is a widespread risk factor in solid organ transplant patients, due to many reasons, such as the use of immunosuppressive drugs, with a consequent increase in cardiovascular diseases in this population. PCSK9 is an enzyme mainly known for its role in altering [...] Read more.
Dyslipidemia is a widespread risk factor in solid organ transplant patients, due to many reasons, such as the use of immunosuppressive drugs, with a consequent increase in cardiovascular diseases in this population. PCSK9 is an enzyme mainly known for its role in altering LDL levels, consequently increasing cardiovascular risk. Monoclonal antibody PCSK9 inhibitors demonstrated remarkable efficacy in the general population in reducing LDL cholesterol levels and preventing cardiovascular disease. In transplant patients, these drugs are still poorly used, despite having comparable efficacy to the general population and giving fewer drug interactions with immunosuppressants. Furthermore, there is enough evidence that PCSK9 also plays a role in other pathways, such as inflammation, which is particularly dangerous for graft survival. In this review, the current evidence on the function of PCSK9 and the use of its inhibitors will be discussed, particularly in transplant patients, in which they may provide additional benefits. Full article
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9 pages, 3602 KiB  
Review
How Bronchoscopic Dye Marking Can Help Minimally Invasive Lung Surgery
by Matthieu Sarsam, Jean-Marc Baste, Luc Thiberville, Mathieu Salaun and Samy Lachkar
J. Clin. Med. 2022, 11(11), 3246; https://doi.org/10.3390/jcm11113246 - 6 Jun 2022
Cited by 5 | Viewed by 1815
Abstract
In the era of increasing availability of high-resolution chest computed tomography, the diagnosis and management of solitary pulmonary nodules (SPNs) has become a common challenging clinical problem. Meanwhile, surgical techniques have improved, and minimally invasive approaches such as robot- and video-assisted surgery are [...] Read more.
In the era of increasing availability of high-resolution chest computed tomography, the diagnosis and management of solitary pulmonary nodules (SPNs) has become a common challenging clinical problem. Meanwhile, surgical techniques have improved, and minimally invasive approaches such as robot- and video-assisted surgery are becoming standard, rendering the palpation of such lesions more difficult, not to mention pure ground-glass opacities, which cannot be felt even in open surgery. In this article, we explore the role of bronchoscopy in helping surgeons achieve successful minimally invasive resections in such cases. Full article
(This article belongs to the Special Issue Interventional Pulmonology: A New World)
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16 pages, 1323 KiB  
Review
Blood Biomarkers of Response to Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer
by Yolanda Lage Alfranca, María Eugenia Olmedo Garcia, Ana Gómez Rueda, Pablo Álvarez Ballesteros, Diana Rosero Rodríguez and Marisa Torres Velasco
J. Clin. Med. 2022, 11(11), 3245; https://doi.org/10.3390/jcm11113245 - 6 Jun 2022
Cited by 7 | Viewed by 2487
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment landscape of non-small cell lung cancer (NSCLC), either used in monotherapy or in combination with chemotherapy. While some patients achieve durable responses, some will not get benefit from this treatment. Early identification of non- responder [...] Read more.
Immune checkpoint inhibitors (ICIs) have revolutionized the treatment landscape of non-small cell lung cancer (NSCLC), either used in monotherapy or in combination with chemotherapy. While some patients achieve durable responses, some will not get benefit from this treatment. Early identification of non- responder patients could avoid unnecessary treatment, potentially serious immune-related adverse events and reduce treatment costs. PD-L1 expression using immunohistochemistry is the only approved biomarker for the selection of patients that can benefit from immunotherapy. However, application of PD-L1 as a biomarker of treatment efficacy shows many deficiencies probably due to the complexity of the tumor microenvironment and the technical limitations of the samples. Thus, there is an urgent need to find other biomarkers, ideally blood biomarkers to help us to identify different subgroups of patients in a minimal invasive way. In this review, we summarize the emerging blood-based markers that could help to predict the response to ICIs in NSCLC. Full article
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13 pages, 922 KiB  
Article
Predicting the Poor Clinical and Radiographic Outcomes after the Anatomical Reduction and Internal Fixation of Posterior Wall Acetabular Fractures: A Retrospective Analysis
by Sung-Yen Lin, Cheng-Jung Ho, Wen-Chih Liu, Jr-Kai Chen, Hung-Pin Tu, Tien-Ching Lee, Je-Ken Chang, Chung-Hwan Chen and Cheng-Chang Lu
J. Clin. Med. 2022, 11(11), 3244; https://doi.org/10.3390/jcm11113244 - 6 Jun 2022
Cited by 2 | Viewed by 2627
Abstract
Anatomical reduction is the fundamental principle of hip function restoration after posterior acetabular wall fractures (PWFs). Some patients exhibit poor outcomes despite anatomical reduction, and the prognostic factors leading to poor outcomes remain elusive. This study aimed to investigate the clinical and radiographic [...] Read more.
Anatomical reduction is the fundamental principle of hip function restoration after posterior acetabular wall fractures (PWFs). Some patients exhibit poor outcomes despite anatomical reduction, and the prognostic factors leading to poor outcomes remain elusive. This study aimed to investigate the clinical and radiographic outcomes in patients with PWFs who had undergone anatomical reduction and internal fixation and to identify the predictors that impair clinical and radiologic outcomes. The clinical records of 60 patients with elementary PWFs who had undergone anatomical reduction and internal fixation between January 2005 and July 2015 were reviewed retrospectively. The Harris hip score (HHS) and modified Merle d’Aubigné clinical hip scores (MMAS) were used to evaluate the clinical outcome. Preoperative and final follow-up radiographs were cross checked to identify poor radiographic outcomes that included the presence of advanced osteoarthritis and osteonecrosis, as well as the need for conversion to total hip arthroplasty. Acetabular dome comminution was assessed from computerized tomography, and the outcomes were further evaluated according to the involvement of fragment comminution. The fracture comminution and age were negatively correlated with functional outcomes (correlation coefficients were −0.41 and −0.39 in HHS and MMAS, respectively) and were significantly related to the severity of osteoarthritis and osteonecrosis as well as the need for total hip arthroplasty. Regarding the radiographic factors, significantly worse post-operative HHS and MMAS were found in the fracture comminution group. In the subanalysis of the status of fracture comminution, patients with fragment comminution involving the acetabular dome had significantly lower functional scores than those with other fracture patterns. In conclusion, age, fracture comminution, and dome comminution were the prognostic indicators of advanced osteoarthritis and poor functional scores after the anatomical reduction and internal fixation of PWFs. We emphasized the relevance of acetabular dome comminution as an important contributing factor to clinical and radiographic outcomes. Full article
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13 pages, 1630 KiB  
Article
Characterization of Choroidal Morphology and Vasculature in the Phenotype of Pachychoroid Diseases by Swept-Source OCT and OCTA
by Bingjie Qiu, Xinyuan Zhang, Zhiqing Li, Jay Chhablani, Hao Fan, Yanhong Wang and Rui Xie
J. Clin. Med. 2022, 11(11), 3243; https://doi.org/10.3390/jcm11113243 - 6 Jun 2022
Cited by 7 | Viewed by 1784
Abstract
The objective of this study was to characterize the choroidal morphology and vasculature in pachychoroid diseases (PCD). A total of 49 eyes with polypoidal choroidal vasculopathy (PCV), 43 eyes with neovascular age-related macular degeneration (nAMD), and 50 eyes with central serous chorioretinopathy (CSC), [...] Read more.
The objective of this study was to characterize the choroidal morphology and vasculature in pachychoroid diseases (PCD). A total of 49 eyes with polypoidal choroidal vasculopathy (PCV), 43 eyes with neovascular age-related macular degeneration (nAMD), and 50 eyes with central serous chorioretinopathy (CSC), along with 80 healthy eyes, were enrolled in this nested case-control study. The swept-source optical coherent tomography (OCT), OCT angiography, and En face images were quantitatively analyzed. Multivariate logistic regression models showed that older age and increased vessel density (VD) in the choriocapillaris (CC) layer were independent risk factors for both PCV (page < 0.001, pVD = 0.004), and nAMD (page < 0.001, pVD = 0.005). Decreased VD in the Sattler’s layer was an independent risk factor for PCV (p = 0.014). Increased VD in the Haller’s layer was an independent risk factor for CSC (p = 0.001). The proportion of the diffuse type of collateral circulation in the Sattler’ layer in CSC group was significantly higher than in the other three groups (p < 0.001). We concluded that the involvement of the blood flow in the CC, Haller’s, and Sattler’s layers are differently affected in CSC, nAMD, and PCV eyes, indicating the different pathological mechanism underlying the phenotype of PCD. The age-dependent establishment of collateral circulation in the Sattler’s layer may play a compensatory role regarding ischemic injury in the development of PCD. Full article
(This article belongs to the Section Ophthalmology)
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13 pages, 867 KiB  
Article
In Search for the Missing Link in APECED-like Conditions: Analysis of the AIRE Gene in a Series of 48 Patients
by Alessandra Fierabracci, Eugenia Belcastro, Elena Carbone, Olivia Pagliarosi, Alessia Palma, Lucia Pacillo, Carmela Giancotta, Paola Zangari, Andrea Finocchi, Caterina Cancrini, Domenico Vittorio Delfino, Marco Cappa and Corrado Betterle
J. Clin. Med. 2022, 11(11), 3242; https://doi.org/10.3390/jcm11113242 - 6 Jun 2022
Cited by 4 | Viewed by 2027
Abstract
Autoimmune diseases are a heterogeneous group of disorders of the immune system. They can cluster in the same individual, revealing various preferential associations for polyendocrine autoimmune syndromes. Clinical observation, together with advances in genetics and the understanding of pathophysiological processes, has further highlighted [...] Read more.
Autoimmune diseases are a heterogeneous group of disorders of the immune system. They can cluster in the same individual, revealing various preferential associations for polyendocrine autoimmune syndromes. Clinical observation, together with advances in genetics and the understanding of pathophysiological processes, has further highlighted that autoimmunity can be associated with immunodeficiency; autoimmunity may even be the first primary immunodeficiency manifestation. Analysis of susceptibility genes for the development of these complex phenotypes is a fundamental issue. In this manuscript, we revised the clinical and immunologic features and the presence of AIRE gene variations in a cohort of 48 patients affected by high polyautoimmunity complexity, i.e., APECED-like conditions, also including patients affected by primary immunodeficiency. Our results evidenced a significant association of the S278R polymorphism of the AIRE gene with APECED-like conditions, including both patients affected by autoimmunity and immunodeficiency and patients with polyautoimmunity compared to healthy controls. A trend of association was also observed with the IVS9+6 G>A polymorphism. The results of this genetic analysis emphasize the need to look for additional genetic determinants playing in concert with AIRE polymorphisms. This will help to improve the diagnostic workup and ensure a precision medicine approach to targeted therapies in APECED-like patients. Full article
(This article belongs to the Section Immunology)
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14 pages, 704 KiB  
Article
Efficacy of a Novel Intra-Articular Administration of Platelet-Rich Plasma One-Week Prior to Hyaluronic Acid versus Platelet-Rich Plasma Alone in Knee Osteoarthritis: A Prospective, Randomized, Double-Blind, Controlled Trial
by Yung-Tsan Wu, Tsung-Ying Li, Kuei-Chen Lee, King Hei Stanley Lam, Chih-Ya Chang, Cheng-Kuang Chang and Liang-Cheng Chen
J. Clin. Med. 2022, 11(11), 3241; https://doi.org/10.3390/jcm11113241 - 6 Jun 2022
Cited by 6 | Viewed by 3148
Abstract
Recent studies have suggested that the combined injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) may have additive benefits for knee osteoarthritis over PRP alone, but there is insufficient evidence to support this combined injection. Moreover, the simultaneous injection of PRP and [...] Read more.
Recent studies have suggested that the combined injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) may have additive benefits for knee osteoarthritis over PRP alone, but there is insufficient evidence to support this combined injection. Moreover, the simultaneous injection of PRP and HA may offset the combined effect. Hence, the aim of this prospective, randomized, double-blind study was to assess their combined efficacy with a novel injection protocol. Forty-six study subjects with unilateral knee osteoarthritis were randomized to receive either a single-dose injection of HA (intervention group) or normal saline (control group) 1 week after a single-dose injection of leukocyte-poor PRP. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and static balance and the risk of falls measured by Biodex Balance System were, respectively, the primary and secondary outcome measures. Evaluations were performed at baseline, 1 month, 3 months, 6 months, and 12 months post-injection. The intervention group exhibited significant declines in WOMAC pain, stiffness, and total scores, as well as static balance, compared to the control group (p < 0.05). These randomized double-blind control trials, with novel protocol of intra-articular injection of PRP 1-week prior to HA, provide greater symptom relief and improve static balance compared to PRP alone in patients with knee osteoarthritis. Full article
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16 pages, 3567 KiB  
Article
Quality of Life in the First Year after Ischemic Stroke Treated with Acute Revascularization Therapy
by Aboudou Matinou Do Rego, Gauthier Duloquin, Marie Sauvant, Simon Amaral, Quentin Thomas, Hervé Devilliers and Yannick Béjot
J. Clin. Med. 2022, 11(11), 3240; https://doi.org/10.3390/jcm11113240 - 6 Jun 2022
Cited by 3 | Viewed by 1634
Abstract
(1) Background: we aimed to describe the disease-specific quality of life (QoL) of ischemic stroke patients treated with acute revascularization therapy, its evolution from 6 months to 12 months, and associated factors. (2) Methods: QoL was assessed with the SS-QoL in consecutive patients [...] Read more.
(1) Background: we aimed to describe the disease-specific quality of life (QoL) of ischemic stroke patients treated with acute revascularization therapy, its evolution from 6 months to 12 months, and associated factors. (2) Methods: QoL was assessed with the SS-QoL in consecutive patients treated with either intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT). Variables associated with QoL scores and its evolution were studied using multivariate mixed models, and interaction with time. Analyses were performed in four domains of SS-QoL: self-care, mobility, mood, and social roles. (3) Results: Among the 501 included patients (mean (sd) age 68.9 (14.5), 49% women), lower post-stroke QoL was independently related to lower level of school education, prestroke mRS > 2, and 24 h NIHSS score > 4. Independent predictors of unfavorable evolution of QoL over time were age <75 years (Mobility p = 0.0194 and Mood p = 0.0015), NIHSS score ≤ 4, (Self-care p = 0.0053 and Mood p = 0.0048), and modified Rankin Scale score ≤ 2 (Social roles, p = 0.0006). Revascularization therapy had no significant effect on the QoL scores, but patients treated with MT (alone or as bridging therapy) had significantly greater improvement in mobility score between 6 and 12 months than patients treated with IVT alone (p = 0.0072). (4) Conclusion: QoL evolution over one year had only slight variation and was associated with the modalities of acute treatment, age, and stroke severity. Full article
(This article belongs to the Section Clinical Neurology)
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17 pages, 1868 KiB  
Review
Colistin Monotherapy versus Colistin plus Meropenem Combination Therapy for the Treatment of Multidrug-Resistant Acinetobacter baumannii Infection: A Meta-Analysis
by Chienhsiu Huang, Ihung Chen and Tiju Tang
J. Clin. Med. 2022, 11(11), 3239; https://doi.org/10.3390/jcm11113239 - 6 Jun 2022
Cited by 11 | Viewed by 4374
Abstract
(1) Introduction: Colistin combination therapy with other antibiotics is a way to enhance colistin activity. The purpose of this meta-analysis was to compare the efficacy and safety of treatment with colistin monotherapy versus colistin plus meropenem combination therapy in patients with drug-resistant Acinetobacter [...] Read more.
(1) Introduction: Colistin combination therapy with other antibiotics is a way to enhance colistin activity. The purpose of this meta-analysis was to compare the efficacy and safety of treatment with colistin monotherapy versus colistin plus meropenem combination therapy in patients with drug-resistant Acinetobacter baumannii infection. (2) Methods: All studies were included if they reported one or more of the following outcomes: clinical improvement, complete microbiological response, 14-day mortality, hospital mortality, or nephrotoxicity. (3) Results: Three randomized controlled trials and seven retrospective studies were included in the meta-analysis. Colistin monotherapy has similar rates of clinical improvement, 14-day mortality, hospital mortality, and nephrotoxicity as colistin plus meropenem combination therapy. Regarding complete microbiological response, the colistin plus meropenem combination was better than colistin monotherapy. (4) Discussion: Previous meta-analyses demonstrated heterogeneity in study quality and a lack of evidence supporting the use of colistin-based combination therapy. Our meta-analysis clearly showed that colistin combined with meropenem was not superior to colistin monotherapy for the treatment of Acinetobacter baumannii infection. (5) Conclusions: The efficacy and safety of treatment with colistin monotherapy and that of colistin plus meropenem combination therapy in patients with drug-resistant Acinetobacter baumannii infection were comparable. The majority of the evidence was obtained from nonrandomized studies, and high-quality randomized controlled trials are needed to confirm the role of colistin plus meropenem combination therapy in the treatment of multidrug-resistant Acinetobacter baumannii infection. Full article
(This article belongs to the Topic Infectious Diseases)
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10 pages, 1329 KiB  
Article
The European Institute of Oncology Thyroid Imaging Reporting and Data System for Classification of Thyroid Nodules: A Prospective Study
by Elvio De Fiori, Carolina Lanza, Serena Carriero, Francesca Tettamanzi, Samuele Frassoni, Vincenzo Bagnardi and Giovanni Mauri
J. Clin. Med. 2022, 11(11), 3238; https://doi.org/10.3390/jcm11113238 - 6 Jun 2022
Cited by 2 | Viewed by 3538
Abstract
Background: To evaluate the performance, quality and effectiveness of “IEO-TIRADS” in assigning a TI-RADS score to thyroid nodules (TN) when compared with “EU-TIRADS” and the US risk score calculated with the S-Detect software (“S-Detect”). The primary objective is the evaluation of diagnostic accuracy [...] Read more.
Background: To evaluate the performance, quality and effectiveness of “IEO-TIRADS” in assigning a TI-RADS score to thyroid nodules (TN) when compared with “EU-TIRADS” and the US risk score calculated with the S-Detect software (“S-Detect”). The primary objective is the evaluation of diagnostic accuracy (DA) by “IEO-TIRADS”, “S-Detect” and “EU-TIRADS”, and the secondary objective is to evaluate the diagnostic performances of the scores, using the histological report as the gold standard. Methods: A radiologist collected all three scores of the TNs detected and determined the risk of malignancy. The results of all the scores were compared with the histological specimens. The sensitivity (SE), specificity (SP), and diagnostic accuracy (DA), with their 95% confidence interval (95% CI), were calculated for each method. Results: 140 TNs were observed in 93 patients and classified according to all three scores. “IEO-TIRADS” has an SE of 73.6%, an SP of 59.2% and a DA of 68.6%. “EU-TIRADS” has an SE of 90.1%, an SP of 32.7% and a DA of 70.0%. “S-Detect” has an SE of 67.0%, an SP of 69.4% and a DA of 67.9%. Conclusion: “IEO-TIRADS” has a similar diagnostic performance to “S-Detect” and “EU-TIRADS”. Providing a comparable DA with other reporting systems, IEO-TIRADS holds the potential of being applied in clinical practice. Full article
(This article belongs to the Topic Diagnostic Imaging and Pathology in Cancer Research)
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1 pages, 158 KiB  
Correction
Correction: Woo et al. The Fate of Antibiotic Impregnated Cement Space in Treatment for Forefoot Osteomyelitis. J. Clin. Med. 2022, 11, 1976
by Inha Woo, Jeongjin Park, Hyungyu Seok, Tae-gon Kim, Jun Sung Moon, Seung Min Chung and Chul Hyun Park
J. Clin. Med. 2022, 11(11), 3237; https://doi.org/10.3390/jcm11113237 - 6 Jun 2022
Cited by 1 | Viewed by 988
Abstract
In the published publication [...] Full article
11 pages, 1085 KiB  
Article
Fifteen-Year Differences in Indications for Cardiac Resynchronization Therapy in International Guidelines—Insights from the Heart Failure Registries of the European Society of Cardiology
by Agata Tymińska, Krzysztof Ozierański, Emil Brociek, Agnieszka Kapłon-Cieślicka, Paweł Balsam, Michał Marchel, Maria G. Crespo-Leiro, Aldo P. Maggioni, Jarosław Drożdż, Grzegorz Opolski and Marcin Grabowski
J. Clin. Med. 2022, 11(11), 3236; https://doi.org/10.3390/jcm11113236 - 6 Jun 2022
Cited by 2 | Viewed by 2521
Abstract
Cardiac resynchronization therapy (CRT) applied to selected patients with heart failure (HF) improves their prognosis. In recent years, eligibility criteria for CRT have regularly changed. This study aimed to investigate the changes in eligibility of real-life HF patients for CRT over the past [...] Read more.
Cardiac resynchronization therapy (CRT) applied to selected patients with heart failure (HF) improves their prognosis. In recent years, eligibility criteria for CRT have regularly changed. This study aimed to investigate the changes in eligibility of real-life HF patients for CRT over the past fifteen years. We reviewed European and North American guidelines from this period and applied them to HF patients from the ESC-HF Pilot and ESC-Long-Term Registries. Taking into consideration the criteria assessed in this study (including all classes of recommendations i.e., class I, IIa and IIb, as well as patients with AF and SR), the 2013 (ESC) guidelines would have qualified the most patients for CRT (266, 18.3%), while the 2015 (ESC) guidelines would have qualified the least (115, 7.9%; p-value for differences between all analyzed papers <0.0001). There were only 26 patients (1.8%) who would be eligible for CRT using the class I recommendations across all of the guidelines. These results demonstrate the variability in recommendations for CRT over the years. Moreover, this data indicates underuse of this form of pacing in HF and highlights the need for more studies in order to improve the outcomes of HF patients and further personalize their management. Full article
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9 pages, 1112 KiB  
Article
Relationship between the Use of Fentanyl-Based Intravenous Patient-Controlled Analgesia and Clinically Significant Events in Laparoscopic Gynecological Surgery: A Single-Center Retrospective Cohort Study
by Miho Hamada, Chikashi Takeda, Li Dong, Akiko Hirotsu, Izumi Shizuya and Toshiyuki Mizota
J. Clin. Med. 2022, 11(11), 3235; https://doi.org/10.3390/jcm11113235 - 6 Jun 2022
Viewed by 1627
Abstract
Background: This study examined the relationship between the use of fentanyl-based intravenous patient-controlled analgesia (ivPCA) and the incidence of a clinically significant event (CSE), while considering both the analgesic effects and side effects in laparoscopic gynecological surgery. Methods: This study included 816 patients [...] Read more.
Background: This study examined the relationship between the use of fentanyl-based intravenous patient-controlled analgesia (ivPCA) and the incidence of a clinically significant event (CSE), while considering both the analgesic effects and side effects in laparoscopic gynecological surgery. Methods: This study included 816 patients undergoing laparoscopic gynecological surgery under general anesthesia at Kyoto University Hospital between 2012 and 2018. The primary exposure was the use of fentanyl-based ivPCA. We defined an outcome measure—CSE—that integrates severe wound pain and vomiting assumed to negatively affect patient recovery. We performed multivariable logistic regression analysis to assess the independent relationship between ivPCA use and CSE. Results: Multivariable logistic regression analysis revealed that fentanyl-based ivPCA was independently associated with increased CSE (adjusted odds ratio (95% confidence interval): 1.80 (1.24–2.61), p = 0.002). Use of ivPCA was associated with a reduced incidence of postoperative severe wound pain (adjusted odds ratio (95% confidence interval): 0.50 (0.27–0.90), p = 0.022), but was also associated with an increased incidence of vomiting (adjusted odds ratio (95% confidence interval): 2.65 (1.79–3.92), p < 0.001). Conclusion: The use of fentanyl-based ivPCA in laparoscopic gynecological surgery is associated with increased CSE. Full article
(This article belongs to the Section Anesthesiology)
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11 pages, 1267 KiB  
Article
Prediction of Carotid In-Stent Restenosis by Computed Tomography Angiography Carotid Plaque-Based Radiomics
by Xiaoqing Cheng, Zheng Dong, Jia Liu, Hongxia Li, Changsheng Zhou, Fandong Zhang, Churan Wang, Zhiqiang Zhang and Guangming Lu
J. Clin. Med. 2022, 11(11), 3234; https://doi.org/10.3390/jcm11113234 - 6 Jun 2022
Cited by 4 | Viewed by 1856
Abstract
In-stent restenosis (ISR) after carotid artery stenting (CAS) critically influences long-term CAS benefits and safety. The study was aimed at screening preoperative ISR-predictive features and developing predictive models. Thus, we retrospectively analyzed clinical and imaging data of 221 patients who underwent pre-CAS carotid [...] Read more.
In-stent restenosis (ISR) after carotid artery stenting (CAS) critically influences long-term CAS benefits and safety. The study was aimed at screening preoperative ISR-predictive features and developing predictive models. Thus, we retrospectively analyzed clinical and imaging data of 221 patients who underwent pre-CAS carotid computed tomography angiography (CTA) and whose digital subtraction angiography data for verifying ISR presence were available. Carotid plaque characteristics determined using CTA were used to build a traditional model. Backward elimination (likelihood ratio) was used for the radiomics model. Furthermore, a combined model was built using the traditional and radiomics features. Five-fold cross-validation was used to evaluate the accuracy of the trained classifier and stability of the selected features. Follow-up angiography showed ISR in 30 patients. Carotid plaque length and thickness were independently associated with ISR (multivariate analysis); regarding the conventional model, the area under the curve (AUC) was 0.84 and 0.82 in the training and validation cohorts, respectively. The corresponding AUC values for the radiomics-based model were 0.87 and 0.82, and those for the optimal combined model were 0.88 and 0.83. Plaque length and thickness could independently predict post-CAS ISR, and the combination of radiomics and plaque features afforded the best predictive performance. Full article
(This article belongs to the Special Issue Computational Neuroradiology and AI in Neuroradiology)
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24 pages, 644 KiB  
Review
Pharmacologic Management for Ventricular Arrhythmias: Overview of Anti-Arrhythmic Drugs
by John Larson, Lucas Rich, Amrish Deshmukh, Erin C. Judge and Jackson J. Liang
J. Clin. Med. 2022, 11(11), 3233; https://doi.org/10.3390/jcm11113233 - 6 Jun 2022
Cited by 10 | Viewed by 13091
Abstract
Ventricular arrhythmias (Vas) are a life-threatening condition and preventable cause of sudden cardiac death (SCD). With the increased utilization of implantable cardiac defibrillators (ICD), the focus of VA management has shifted toward reduction of morbidity from VAs and ICD therapies. Anti-arrhythmic drugs (AADs) [...] Read more.
Ventricular arrhythmias (Vas) are a life-threatening condition and preventable cause of sudden cardiac death (SCD). With the increased utilization of implantable cardiac defibrillators (ICD), the focus of VA management has shifted toward reduction of morbidity from VAs and ICD therapies. Anti-arrhythmic drugs (AADs) can be an important adjunct therapy in the treatment of recurrent VAs. In the treatment of VAs secondary to structural heart disease, amiodarone remains the most well studied and current guideline-directed pharmacologic therapy. Beta blockers also serve as an important adjunct and are a largely underutilized medication with strong evidentiary support. In patients with defined syndromes in structurally normal hearts, AADs can offer tailored therapies in prevention of SCD and improvement in quality of life. Further clinical trials are warranted to investigate the role of newer therapeutic options and for the direct comparison of established AADs. Full article
(This article belongs to the Special Issue Management of Complex Arrhythmias)
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12 pages, 1874 KiB  
Article
Predictors and Consequences of Sac Shrinkage after Endovascular Infrarenal Aortic Aneurysm Repair
by Sébastien Michel Vedani, Séverine Petitprez, Eva Weinz, Jean-Marc Corpataux, Sébastien Déglise, Céline Deslarzes-Dubuis, Elisabeth Côté, Jean-Baptiste Ricco and François Saucy
J. Clin. Med. 2022, 11(11), 3232; https://doi.org/10.3390/jcm11113232 - 6 Jun 2022
Cited by 6 | Viewed by 2089
Abstract
Background: Aneurysm shrinkage has been proposed as a marker of successful endovascular aneurysm repair (EVAR). We evaluated the impact of sac shrinkage on secondary interventions, on survival and its association with endoleaks, and on compliance with instructions for use (IFU). Methods: This observational [...] Read more.
Background: Aneurysm shrinkage has been proposed as a marker of successful endovascular aneurysm repair (EVAR). We evaluated the impact of sac shrinkage on secondary interventions, on survival and its association with endoleaks, and on compliance with instructions for use (IFU). Methods: This observational retrospective study was conducted on all consecutive patients receiving EVAR for an infrarenal abdominal aortic aneurysm (AAA) using exclusively Endurant II/IIs endograft from 2014 to 2018. Sixty patients were entered in the study. Aneurysm sac shrinkage was defined as decrease ≥5 mm of the maximum aortic diameter. Univariate methods and Kaplan–Meier plots assessed the potential impact of shrinkage. Results: Twenty-six patients (43.3%) experienced shrinkage at one year, and thirty-four (56.7%) had no shrinkage. Shrinkage was not significantly associated with any demographics or morbidity, except hypertension (p = 0.01). No aneurysm characteristics were associated with shrinkage. Non-compliance with instructions for use (IFU) in 13 patients (21.6%) was not associated with shrinkage. Three years after EVAR, freedom from secondary intervention was 85 ± 2% for the entire series, 92.3 ± 5.0% for the shrinkage group and 83.3 ± 9% for the no-shrinkage group (Logrank: p = 0.49). Survival at 3 years was not significantly different between the two groups (85.9 ± 7.0% vs. 79.0 ± 9.0%, Logrank; p = 0.59). Strict compliance with IFU was associated with less reinterventions at 3 years (92.1 ± 5.9% vs. 73.8 ± 15%, Logrank: p = 0.03). Similarly, survival at 3 years did not significantly differ between strict compliance with IFU and non-compliance (81.8 ± 7.0% vs. 78.6 ± 13.0%, Logrank; p = 0.32). Conclusion: This study suggests that shrinkage ≥5 mm at 1-year is not significantly associated with a better survival rate or a lower risk of secondary intervention than no-shrinkage. In this series, the risk of secondary intervention regardless of shrinkage seems to be linked more to non-compliance with IFU. Considering the small number of patients, these results must be confirmed by extensive prospective studies. Full article
(This article belongs to the Special Issue Pathogenesis and Treatment of Abdominal Aortic Aneurysm)
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11 pages, 1381 KiB  
Article
Benchmark of Intraoperative Activity in Cardiac Surgery: A Comparison between Pre- and Post-Operative Prognostic Models
by Anna Zamperoni, Greta Carrara, Massimiliano Greco, Carlotta Rossi, Elena Garbero, Giovanni Nattino, Giuseppe Minniti, Paolo Del Sarto, Guido Bertolini, Stefano Finazzi and Cardiac Surgical Intensive Care Writing Committee (GiViTI)
J. Clin. Med. 2022, 11(11), 3231; https://doi.org/10.3390/jcm11113231 - 6 Jun 2022
Cited by 1 | Viewed by 1704
Abstract
Objectives: Despite its large diffusion and improvements in safety, the risks of complications after cardiac surgery remain high. Published predictive perioperative scores (EUROSCORE, STS, ACEF) assess risk on preoperative data only, not accounting for the intraopertive period. We propose a double-fold model, including [...] Read more.
Objectives: Despite its large diffusion and improvements in safety, the risks of complications after cardiac surgery remain high. Published predictive perioperative scores (EUROSCORE, STS, ACEF) assess risk on preoperative data only, not accounting for the intraopertive period. We propose a double-fold model, including data collected before surgery and data collected at the end of surgery, to evaluate patient risk evolution over time and assess the direct contribution of surgery. Methods: A total of 15,882 cardiac surgery patients from a Margherita-Prosafe cohort study were included in the analysis. Probability of death was estimated using two logistic regression models (preoperative data only vs. post-operative data, also including information at discharge from the operatory theatre), testing calibration and discrimination of each model. Results: Pre-operative and post-operative models were built and demonstrate good discrimination and calibration with AUC = 0.81 and 0.87, respectively. Relative difference in pre- and post-operative mortality in separate centers ranged from −0.36 (95% CI: −0.44–−0.28) to 0.58 (95% CI: 0.46–0.71). The usefulness of this two-fold preoperative model to benchmark medical care in single hospital is exemplified in four cases. Conclusions: Predicted post-operative mortality differs from predicted pre-operative mortality, and the distance between the two models represent the impact of surgery on patient outcomes. A double-fold model can assess the impact of the intra-operative team and the evolution of patient risk over time, and benchmark different hospitals on patients subgroups to promote an improvement in medical care in each center. Full article
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9 pages, 1951 KiB  
Editorial
Will Coiling Survive through the Next Decade?
by Hans Henkes, Joachim Klisch and Pedro Lylyk
J. Clin. Med. 2022, 11(11), 3230; https://doi.org/10.3390/jcm11113230 - 6 Jun 2022
Cited by 2 | Viewed by 1780
Abstract
During the past three decades, neuroendovascular therapy has evolved from a focus on new disease concepts to revised treatment strategies and, ultimately, to versatile new technologies [...] Full article
(This article belongs to the Special Issue Hemorrhagic Stroke)
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16 pages, 1205 KiB  
Article
Time-Limited Therapy with Belatacept in Kidney Transplant Recipients
by Thibault Letellier, Delphine Kervella, Abderrahmane Sadek, Christophe Masset, Claire Garandeau, Cynthia Fourgeux, Victor Gourain, Jeremie Poschmann, Gilles Blancho, Simon Ville and on behalf of the Divat Consortium
J. Clin. Med. 2022, 11(11), 3229; https://doi.org/10.3390/jcm11113229 - 6 Jun 2022
Viewed by 1724
Abstract
Introduction: In kidney transplant recipients, belatacept is usually pursued indefinitely after it has been started. In the setting of the belatacept shortage and after having evaluated the benefit–risk ratio, we established a strategy consisting of time-limited belatacept therapy/transient calcineurin inhibitor withdrawal, whose results [...] Read more.
Introduction: In kidney transplant recipients, belatacept is usually pursued indefinitely after it has been started. In the setting of the belatacept shortage and after having evaluated the benefit–risk ratio, we established a strategy consisting of time-limited belatacept therapy/transient calcineurin inhibitor withdrawal, whose results are analyzed in that study. Methods: We considered all the kidney transplant recipients that had been switched from conventional immunosuppressive therapy to belatacept and then for whom belatacept has been withdrawn intentionally. Furthermore, in the first 8 patients, we assessed changes in peripheral blood mononuclear cells (PBMC) transcriptome using RNAseq before and 3 months after belatacept withdrawal. Results: Over the study period, 28 out of 94 patients had belatacept intentionally withdrawn including 25 (89%) switched to low-dose CNI. One rejection due to poor compliance occurred. The eGFR after 12 months remained stable from 48 ± 19 mL.1.73 m−2 to 46 ± 17 mL.1.73 m−2 (p = 0.68). However, patients that resumed belatacept/withdrew CNIs (n = 10) had a trend towards a better eGFR comparing with the others (n = 15): 54 ± 20 mL.1.73 m−2 vs. eGFR 43 ± 16 mL.1.73 m−2, respectively (p = 0.15). The only factor associated with belatacept resumption was when the withdrawal took place during the COVID-19 outbreak. Transcriptome analysis of PBMCs, did not support rebound in alloimmune response. Conclusions: These findings underpin the use of belatacept as part of a time-limited therapy, in selected kidney transplant recipients, possibly as an approach to allow efficient vaccination against SARS-CoV-2. Full article
(This article belongs to the Special Issue Challenges in the Management of Renal Patients in the COVID-19 Era)
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10 pages, 279 KiB  
Article
The Burden on Cohabitants of Patients with Chronic Spontaneous Urticaria: A Cross-Sectional Study
by Manuel Sánchez-Díaz, Maria-Carmen Salazar-Nievas, Alejandro Molina-Leyva and Salvador Arias-Santiago
J. Clin. Med. 2022, 11(11), 3228; https://doi.org/10.3390/jcm11113228 - 6 Jun 2022
Cited by 6 | Viewed by 1820
Abstract
Chronic Spontaneous Urticaria (CSU) has been associated with patients’ poor quality of life. Despite being a chronic disease that could alter the quality of life of the people who live with patients, the potential burden on their cohabitants has not been studied to [...] Read more.
Chronic Spontaneous Urticaria (CSU) has been associated with patients’ poor quality of life. Despite being a chronic disease that could alter the quality of life of the people who live with patients, the potential burden on their cohabitants has not been studied to date. The aim of this study is to analyze the relationship between the patient’s quality of life, disease control, disease duration and family quality of life and the cohabitant’s mood disturbances, sexual dysfunction, type D personality and sleep quality. A cross-sectional study including patients suffering from CSU and their cohabitants was performed. Sociodemographic variables and disease activity, quality of life, sleep, sexual disfunction, anxiety, depression and type D personality were collected using validated questionnaires. Sixty-two subjects, 31 CSU patients and 31 cohabitants, were included in the study. Worse disease control and poorer quality of life in patients were associated with poorer family quality of life and higher rates of anxiety among the cohabitants (p < 0.05). Patients’ poor quality of life was associated with reduced sexual satisfaction among the cohabitants (p < 0.05). Long disease duration (>10 years) was associated with an increased prevalence of type D personality among the cohabitants (prevalence ratio: 2.59, CI 95% 1.03–7.21). CSU seems to have an impact on the quality of life of cohabitants, especially in terms of increased rates of anxiety, poorer quality of life and reduced sexual satisfaction. The prolonged course of the disease could be associated with the increased presence of non-adaptative personality traits. Full article
(This article belongs to the Special Issue Urticaria: Clinical Updates on the Cause, Diagnosis, and Treatment)
14 pages, 2041 KiB  
Review
The Interventricular Septum: Structure, Function, Dysfunction, and Diseases
by Filippos Triposkiadis, Andrew Xanthopoulos, Konstantinos Dean Boudoulas, Grigorios Giamouzis, Harisios Boudoulas and John Skoularigis
J. Clin. Med. 2022, 11(11), 3227; https://doi.org/10.3390/jcm11113227 - 6 Jun 2022
Cited by 6 | Viewed by 6389
Abstract
Vertebrates developed pulmonary circulation and septated the heart into venous and arterial compartments, as the adaptation from aquatic to terrestrial life requires more oxygen and energy. The interventricular septum (IVS) accommodates the ventricular portion of the conduction system and contributes to the mechanical [...] Read more.
Vertebrates developed pulmonary circulation and septated the heart into venous and arterial compartments, as the adaptation from aquatic to terrestrial life requires more oxygen and energy. The interventricular septum (IVS) accommodates the ventricular portion of the conduction system and contributes to the mechanical function of both ventricles. Conditions or diseases that affect IVS structure and function (e.g., hypertrophy, defects, other) may lead to ventricular pump failure and/or ventricular arrhythmias with grave consequences. IVS structure and function can be evaluated today using current imaging techniques. Effective therapies can be provided in most cases, although definitions of underlying etiologies may not always be easy, particularly in the elderly due to overlap between genetic and acquired causes of IVS hypertrophy, the most common being IVS abnormality. In this review, state-of-the-art information regarding IVS morphology, physiology, physiopathology, and disease is presented. Full article
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8 pages, 1261 KiB  
Review
Alternative Insertion Site of Nexplanon: Description of a Case Report and Systematic Review of the Literature
by Guglielmo Stabile, Carmelina Foti, Denise Mordeglia, Davide De Santo, Francesco Paolo Mangino, Antonio Simone Laganà and Giuseppe Ricci
J. Clin. Med. 2022, 11(11), 3226; https://doi.org/10.3390/jcm11113226 - 6 Jun 2022
Cited by 4 | Viewed by 4348
Abstract
The etonogestrel (ENG) implant is among the most effective reversible contraceptives. It can be a good option for patients with different chronic diseases due to no clinically significant effects on lipid metabolism or liver function. Some limitations in the use of this type [...] Read more.
The etonogestrel (ENG) implant is among the most effective reversible contraceptives. It can be a good option for patients with different chronic diseases due to no clinically significant effects on lipid metabolism or liver function. Some limitations in the use of this type of device are represented by social and psychiatric disorders, where the easy accessibility of the device becomes a negative feature. In these patients several cases of self-removal or damage to the device have been reported. We report the successful insertion of the Nexplanon® device into the scapular region in a young woman with a chronic psychiatric disorder. To verify the presence in the literature of other possible implantation sites, we performed a systematic review of the literature on Pubmed, Google scholar and Scopus from 2000 to 2021 using different combinations of the following terms: (Nexplanon), (contraceptive implant), (insertion). Two manuscripts with three cases were detected. Nexplanon® was implanted in the upper back. In all cases, there were no complications during the insertions and the follow up demonstrated no side effects with contraceptive efficacy. Our report and review is a further confirmation that the scapular region can become a valid insertion site, maintaining good efficacy and safety of the subcutaneous device. Full article
(This article belongs to the Special Issue New Insights into Contraception)
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10 pages, 1849 KiB  
Article
Sneaky Diagnosis of Pleural Malignant Mesothelioma in Thoracic Surgery: All That Glitters Is Not Gold
by Riccardo Orlandi, Francesca Bono, Diego Luigi Cortinovis, Giuseppe Cardillo, Ugo Cioffi, Angelo Guttadauro, Emanuele Pirondini, Stefania Canova, Enrico Mario Cassina and Federico Raveglia
J. Clin. Med. 2022, 11(11), 3225; https://doi.org/10.3390/jcm11113225 - 6 Jun 2022
Cited by 1 | Viewed by 1706
Abstract
Malignant Pleural Mesothelioma (MPM) is a highly aggressive disease whose diagnosis could be challenging and confusing. It could occur with atypical presentations on every examined level. Here, we present three unconventional cases of the complex diagnostic process of MPM that we have experienced [...] Read more.
Malignant Pleural Mesothelioma (MPM) is a highly aggressive disease whose diagnosis could be challenging and confusing. It could occur with atypical presentations on every examined level. Here, we present three unconventional cases of the complex diagnostic process of MPM that we have experienced during routine practice: a patient with reactive mesothelial hyperplasia mimicking MPM, an unexpected presentation of MPM with persistent unilateral hydropneumothorax, a rare case of MPM in situ. Then, we review the relevant literature on each of these topics. Definitive biomarkers to confidently distinguish MPM from other pleural affections are still demanded. Patients presenting with persistent hydropneumothorax must always be investigated for MPM. MPM in situ is now a reality, and this raises questions about its management. Full article
(This article belongs to the Section Oncology)
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9 pages, 643 KiB  
Article
Hypertriglyceridemia and Other Risk Factors of Chronic Kidney Disease in Type 2 Diabetes: A Hospital-Based Clinic Population in Greece
by Ilias N. Migdalis, Ioannis M. Ioannidis, Nikolaos Papanas, Athanasios E. Raptis, Alexios E. Sotiropoulos, George D. Dimitriadis and on behalf of the Hellenic Diabetic Nephropathy Study (HDNS)
J. Clin. Med. 2022, 11(11), 3224; https://doi.org/10.3390/jcm11113224 - 6 Jun 2022
Cited by 1 | Viewed by 1786
Abstract
Aims/Introduction: Several reports indicate an increasing prevalence of chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM). Hyperglycemia and hypertension are the main risk factors for CKD development and progression. However, despite the achievement of recommended targets for blood glucose and blood [...] Read more.
Aims/Introduction: Several reports indicate an increasing prevalence of chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM). Hyperglycemia and hypertension are the main risk factors for CKD development and progression. However, despite the achievement of recommended targets for blood glucose and blood pressure (BP), the residual risk of diabetic chronic kidney disease (DCKD) remains relatively high. The aim of this study is to examine dyslipidemia and other major risk factors to provide support for the prevention and treatment of DCKD. Materials and Methods: Participants are from the Redit-2-Diag study that examines 1759 subjects within a period of 6 months. DCKD severity is staged according to KDIGO criteria. Results: An increase in hemoglobin A1c (1 unit) and systolic blood pressure (1 mm Hg) increases the probability of being classified into a higher CKD stage by 14% and 26%, respectively. Moreover, an increase of triglycerides by 88.5 mg/dL increases the risk of classification to a worse CKD stage by 24%. Conclusions: Elevated triglycerides, systolic blood pressure, and poor glycemic control increase the risk of CKD in T2DM and should be addressed in the treatment strategies. Full article
(This article belongs to the Section Nephrology & Urology)
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23 pages, 803 KiB  
Review
Cell-Derived Exosomes as Therapeutic Strategies and Exosome-Derived microRNAs as Biomarkers for Traumatic Brain Injury
by Jing Wang, Junwen Wang, Xinyan Li and Kai Shu
J. Clin. Med. 2022, 11(11), 3223; https://doi.org/10.3390/jcm11113223 - 5 Jun 2022
Cited by 14 | Viewed by 4312
Abstract
Traumatic brain injury (TBI) is a complex, life-threatening condition that causes mortality and disability worldwide. No effective treatment has been clinically verified to date. Achieving effective drug delivery across the blood–brain barrier (BBB) presents a major challenge to therapeutic drug development for TBI. [...] Read more.
Traumatic brain injury (TBI) is a complex, life-threatening condition that causes mortality and disability worldwide. No effective treatment has been clinically verified to date. Achieving effective drug delivery across the blood–brain barrier (BBB) presents a major challenge to therapeutic drug development for TBI. Furthermore, the field of TBI biomarkers is rapidly developing to cope with the many aspects of TBI pathology and enhance clinical management of TBI. Exosomes (Exos) are endogenous extracellular vesicles (EVs) containing various biological materials, including lipids, proteins, microRNAs, and other nucleic acids. Compelling evidence exists that Exos, such as stem cell-derived Exos and even neuron or glial cell-derived Exos, are promising TBI treatment strategies because they pass through the BBB and have the potential to deliver molecules to target lesions. Meanwhile, Exos have decreased safety risks from intravenous injection or orthotopic transplantation of viable cells, such as microvascular occlusion or imbalanced growth of transplanted cells. These unique characteristics also create Exos contents, especially Exos-derived microRNAs, as appealing biomarkers in TBI. In this review, we explore the potential impact of cell-derived Exos and exosome-derived microRNAs on the diagnosis, therapy, and prognosis prediction of TBI. The associated challenges and opportunities are also discussed. Full article
(This article belongs to the Special Issue Advances in Neurotrauma)
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13 pages, 1178 KiB  
Article
Menstrual Cycle Changes Joint Laxity in Females—Differences between Eumenorrhea and Oligomenorrhea
by Sae Maruyama, Chie Sekine, Mayuu Shagawa, Hirotake Yokota, Ryo Hirabayashi, Ryoya Togashi, Yuki Yamada, Rena Hamano, Atsushi Ito, Daisuke Sato and Mutsuaki Edama
J. Clin. Med. 2022, 11(11), 3222; https://doi.org/10.3390/jcm11113222 - 5 Jun 2022
Cited by 7 | Viewed by 3317
Abstract
The purpose of this study was to investigate the changes in anterior knee laxity (AKL), stiffness, general joint laxity (GJL), and genu recurvatum (GR) during the menstrual cycle in female non-athletes and female athletes with normal and irregular menstrual cycles. Participants were 19 [...] Read more.
The purpose of this study was to investigate the changes in anterior knee laxity (AKL), stiffness, general joint laxity (GJL), and genu recurvatum (GR) during the menstrual cycle in female non-athletes and female athletes with normal and irregular menstrual cycles. Participants were 19 female non-athletes (eumenorrhea, n = 11; oligomenorrhea, n = 8) and 15 female athletes (eumenorrhea, n = 8; oligomenorrhea, n = 7). AKL was measured as the amount of anterior tibial displacement at 67 N–133 N. Stiffness was calculated as change in (Δ)force/Δ anterior displacement. The Beighton method was used to evaluate the GJL. The GR was measured as the maximum angle of passive knee joint extension. AKL, stiffness, GJL, and GR were measured twice in four phases during the menstrual cycle. Stiffness was significantly higher in oligomenorrhea groups than in eumenorrhea groups, although no significant differences between menstrual cycle phases were evident in female non-athletes. GR was significantly higher in the late follicular, ovulation, and luteal phases than in the early follicular phase, although no significant differences between groups were seen in female athletes. Estradiol may affect the stiffness of the periarticular muscles in the knee, suggesting that GR in female athletes may change during the menstrual cycle. Full article
(This article belongs to the Special Issue Health, Quality of Life and Sport Rehabilitation)
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17 pages, 4086 KiB  
Article
Tips and Details for Successful Robotic Myomectomy: Single-Center Experience with the First 125 Cases
by Lei Dou and Yi Zhang
J. Clin. Med. 2022, 11(11), 3221; https://doi.org/10.3390/jcm11113221 - 5 Jun 2022
Cited by 1 | Viewed by 4432
Abstract
With the continuous development of minimally invasive and precise surgical techniques, laparoscopic myomectomy has become a mainstream surgical method due to its aesthetic outcomes and rapid postoperative recovery. However, during laparoscopic myomectomy, clinicians often encounter unfavorable factors, such as limited vision, inaccurate suturing, [...] Read more.
With the continuous development of minimally invasive and precise surgical techniques, laparoscopic myomectomy has become a mainstream surgical method due to its aesthetic outcomes and rapid postoperative recovery. However, during laparoscopic myomectomy, clinicians often encounter unfavorable factors, such as limited vision, inaccurate suturing, difficulty in removing tumors, and susceptibility to fatigue in the operating position. In recent years, robot-assisted surgery has been widely used in gynecology. The advantages of this technique, such as a three-dimensional surgical view, reducing the surgeon’s tremor, and the seven degrees of freedom of the robotic arms, compensate for the defects in laparoscopic surgery. The Department of Gynecology in our hospital has accumulated a wealth of experience since robot-assisted surgery was first carried out in 2017. In this article, the surgical skills of the robotic myomectomy process are described in detail. Full article
(This article belongs to the Special Issue Advances in Robot-Assisted Minimally Invasive Surgery)
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9 pages, 855 KiB  
Article
Potential of Hematologic Parameters in Predicting Mortality of Patients with Traumatic Brain Injury
by Sol Bi Kim, Youngjoon Park, Ju Won Ahn, Jeongmin Sim, Jeongman Park, Yu Jin Kim, So Jung Hwang, Kyoung Su Sung and Jaejoon Lim
J. Clin. Med. 2022, 11(11), 3220; https://doi.org/10.3390/jcm11113220 - 5 Jun 2022
Cited by 1 | Viewed by 1626
Abstract
Traumatic brain injury (TBI) occurs frequently, and acute TBI requiring surgical treatment is closely related to patient survival. Models for predicting the prognosis of patients with TBI do not consider various factors of patient status; therefore, it is difficult to predict the prognosis [...] Read more.
Traumatic brain injury (TBI) occurs frequently, and acute TBI requiring surgical treatment is closely related to patient survival. Models for predicting the prognosis of patients with TBI do not consider various factors of patient status; therefore, it is difficult to predict the prognosis more accurately. In this study, we created a model that can predict the survival of patients with TBI by adding hematologic parameters along with existing non-hematologic parameters. The best-fitting model was created using the Akaike information criterion (AIC), and hematologic factors including preoperative hematocrit, preoperative C-reactive protein (CRP), postoperative white blood cell (WBC) count, and postoperative hemoglobin were selected to predict the prognosis. Among several prediction models, the model that included age, Glasgow Coma Scale, Injury Severity Score, preoperative hematocrit, preoperative CRP, postoperative WBC count, postoperative hemoglobin, and postoperative CRP showed the highest area under the curve and the lowest corrected AIC for a finite sample size. Our study showed a new prediction model for mortality in patients with TBI using non-hematologic and hematologic parameters. This prediction model could be useful for the management of patients with TBI. Full article
(This article belongs to the Section Brain Injury)
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