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J. Clin. Med., Volume 11, Issue 15 (August-1 2022) – 388 articles

Cover Story (view full-size image): Sex differences in cardiovascular disease (CVD) prevalence, disease presentation, and response to therapy have been well characterized, but the underlying mechanisms are poorly understood. In this review, we discuss how sympathetic nervous system (SNS) hyperactivity, typical of the postmenopausal period in women, and the consequent catecholamine secretion, from the postganglionic sympathetic fibers and the adrenal chromaffin cells, negatively impact β-adrenergic receptor (β1-, β2-, β3, β4-AR) signaling and augment the risk of adverse vascular and cardiac effects. Further, we explore how estrogen or phytoestrogen therapies may impact SNS overactivation, preserving β-ARs responsiveness and density, therefore ameliorating most CVD risk factors. View this paper
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21 pages, 610 KiB  
Review
Level of Physical Activity in Pregnant Populations from Different Geographic Regions: A Systematic Review
by Cristina Silva-Jose, Miguel Sánchez-Polán, Rubén Barakat, Javier Gil-Ares and Ignacio Refoyo
J. Clin. Med. 2022, 11(15), 4638; https://doi.org/10.3390/jcm11154638 - 8 Aug 2022
Cited by 12 | Viewed by 2384
Abstract
The aim of this study was to examine the level of physical activity during pregnancy in different populations worldwide. An intensive search was carried out from February until May 2021. The inclusion criteria were original studies of healthy pregnant women, and the main [...] Read more.
The aim of this study was to examine the level of physical activity during pregnancy in different populations worldwide. An intensive search was carried out from February until May 2021. The inclusion criteria were original studies of healthy pregnant women, and the main study variable was the assessment of physical activity. A total of 110 out of 1451 studies were assessed for inclusion, using the Newcastle–Ottawa Scale for quality, and for the risk of bias. The 44 analyzed articles were divided into 5 tables according to the characteristics of the intervention and the validated instrument used to measure physical activity (PA). A total of 59.09% of the studies indicated that participants had a low level of physical activity during pregnancy. In addition, the median quality score of the studies was 7.12, and 77.27% of the studies were cataloged as having a high-quality score. Although international guidelines recommend that women without a contraindication engage in prenatal physical activity, the results of the present study show that the level of PA is too low for women to achieve scientifically proven maternal-fetal benefits. Failure to achieve the recommended levels of weekly physical activity could pose significant risks to maternal well-being. Full article
(This article belongs to the Special Issue Exercise Intervention during Pregnancy & Maternal Health)
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11 pages, 1169 KiB  
Article
Effect of Sinus Perforation with Flaplessly Placed Mini Dental Implants for Oral Rehabilitation: A 5-Year Clinical and Radiological Follow-Up
by Luc Van Doorne, Geert Hommez, Ewald Bronkhorst, Gert Meijer and Hugo De Bruyn
J. Clin. Med. 2022, 11(15), 4637; https://doi.org/10.3390/jcm11154637 - 8 Aug 2022
Cited by 1 | Viewed by 3769
Abstract
Background: Flaplessly placed one-piece mini dental implants (MDI) are an option to support maxillary overdentures. Evenly distribution of the implants over the atrophic alveolar process implies a risk of accidental sinus perforation in the posterior area which could induce sinus-related pathology. Methods: Thirty-one [...] Read more.
Background: Flaplessly placed one-piece mini dental implants (MDI) are an option to support maxillary overdentures. Evenly distribution of the implants over the atrophic alveolar process implies a risk of accidental sinus perforation in the posterior area which could induce sinus-related pathology. Methods: Thirty-one patients received 5–6 maxillary MDIs. Schneiderian membrane swelling was assessed with CBCT at the deepest point of the sinus in the mid-sagittal plane prior to surgery (baseline), after 2 and 5 years. Additionally, subjective patient-reported rhinosinusitis complaints, the effect of smoking, and gender differences were investigated. Results: Mean thickness of the Schneiderian membrane was 2.87 mm at baseline, 3.15 mm at 2 years, and 4.30 mm at 5 years in 27 of 31 initially treated patients. MDI perforation was detected in 21/54 sinuses. At 2 years, perforation length does not affect membrane thickness whereas baseline swelling does. In smokers, each perforated mm induced 0.87 mm additional swelling. After 5 years, the effect of baseline swelling becomes smaller whereas perforation length became statistically significant, with 0.53 mm increase for every perforated mm. The effect of smoking lost its significance. No relations between gender, membrane thickness changes, or subjective clinical sinus complaints and MDI perforation were found. Conclusion: Accidental MDI sinus perforation induces Schneiderian membrane swelling but does not interfere with clinical sinusal outcome after 5 years. Full article
(This article belongs to the Special Issue Clinical Advances in Osseointegrated Oral Implants)
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14 pages, 1185 KiB  
Article
Atypical 15q11.2-q13 Deletions and the Prader-Willi Phenotype
by Lionne N. Grootjen, Alicia F. Juriaans, Gerthe F. Kerkhof and Anita C. S. Hokken-Koelega
J. Clin. Med. 2022, 11(15), 4636; https://doi.org/10.3390/jcm11154636 - 8 Aug 2022
Cited by 5 | Viewed by 1933
Abstract
Background: Prader-Willi syndrome (PWS) is a rare genetic disorder resulting from the lack of expression of the PWS region (locus q11-q13) on the paternally derived chromosome 15, as a result of a type I or II paternal deletion (50%), maternal uniparental disomy (43%), [...] Read more.
Background: Prader-Willi syndrome (PWS) is a rare genetic disorder resulting from the lack of expression of the PWS region (locus q11-q13) on the paternally derived chromosome 15, as a result of a type I or II paternal deletion (50%), maternal uniparental disomy (43%), imprinting defect (4%) or translocation (<1%). In very rare cases, atypical deletions, smaller or larger than the typical deletion, are identified. These patients may have distinct phenotypical features and provide further information regarding the genotype–phenotype correlation in PWS. Methods: A prospective study in eight patients (six males and two females) with an atypical deletion in the PWS region accompanies an overview of reported cases. Results: All patients had hypotonia (100%) and many had typical PWS facial characteristics (75%), social and emotional developmental delays (75%), intellectual disabilities (50%), neonatal feeding problems and tube feeding (63%), history of obesity (50%), hyperphagia (50%) and scoliosis (50%). All males had cryptorchidism. Two patients had two separate deletions in the PWS critical region. Conclusions: Our findings provide further insight into PWS genotype–phenotype correlations; our results imply that inclusion of both SNURF-SNPRN and SNORD-116 genes in the deletion leads to a more complete PWS phenotype. A larger deletion, extending further upstream and downstream from these genes, does not cause a more severe phenotype. Conventional PWS methylation testing may miss small deletions, which can be identified using targeted next generation sequencing. PWS’s phenotypic diversity might be caused by differentially methylated regions outside the 15q11.2 locus. Full article
(This article belongs to the Special Issue Endocrinology and Metabolic Diseases: Prader-Willi Syndrome)
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11 pages, 851 KiB  
Article
Predictive Markers of Crohn’s Disease in Small Bowel Capsule Endoscopy: A Retrospective Study of Small Bowel Capsule Endoscopy
by Juho Mattila, Teppo Stenholm, Eliisa Löyttyniemi and Jukka Koffert
J. Clin. Med. 2022, 11(15), 4635; https://doi.org/10.3390/jcm11154635 - 8 Aug 2022
Cited by 1 | Viewed by 1465
Abstract
To distinguish between functional gastrointestinal disorders like irritable bowel syndrome (IBS) and mild small bowel Crohn′s disease (CD) can be a burden. The diagnosis of CD often requires small bowel capsule endoscopy (SBCE). The main goal of this research was to find predictive [...] Read more.
To distinguish between functional gastrointestinal disorders like irritable bowel syndrome (IBS) and mild small bowel Crohn′s disease (CD) can be a burden. The diagnosis of CD often requires small bowel capsule endoscopy (SBCE). The main goal of this research was to find predictive markers to rule out clinically significant small bowel CD without SBCE. A retrospective study of 374 patients who underwent SBCE for suspected small bowel CD in Turku University Hospital in 2012–2020 was conducted. We gathered the patient′s laboratory, imaging and endoscopic findings at the time of SBCE. SBCE findings were graded along CECDAI (Capsule Endoscopy Crohn’s Disease Activity Index)-scoring system. Fecal calprotectin (FC), serum albumin and ESR were significantly different with patients diagnosed with CD and those with not. Hb and CRP had no significant differences between the two groups. Sensitivity, specificity, PPV and NPV for FC < 50 ug/g were 96.4%, 19.6%, 34.6% and 92.5% and for CECDAI (cut-off value 3) 98.2%, 90.3%, 81.1% and 99.1%, respectively. A CECDAI-score of 3 would be a reasonable cut-off value for small bowel CD. Small bowel CD is possible with FC < 100 ug/g. Our results suggest a follow-up with FC before SBCE for patients with no endoscopic ileitis, negative imaging results and FC < 50 ug/g before SBCE. Full article
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
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15 pages, 2350 KiB  
Review
Bleeding Patterns of Oral Contraceptives with a Cyclic Dosing Regimen: An Overview
by David F. Archer, Diana Mansour and Jean-Michel Foidart
J. Clin. Med. 2022, 11(15), 4634; https://doi.org/10.3390/jcm11154634 - 8 Aug 2022
Cited by 10 | Viewed by 3232
Abstract
Bleeding irregularities are one of the major reasons for discontinuation of oral contraceptives (OCs), and therefore clinicians need to set expectations during consultations. In this review we provide an overview of bleeding data of recently marketed cyclic combined OCs (COCs) and one progestin-only [...] Read more.
Bleeding irregularities are one of the major reasons for discontinuation of oral contraceptives (OCs), and therefore clinicians need to set expectations during consultations. In this review we provide an overview of bleeding data of recently marketed cyclic combined OCs (COCs) and one progestin-only pill (POP). We evaluated data from phase 3 trials (≥12 months) used to gain regulatory approval. Overall, each type of OC has its own specific bleeding pattern. These patterns however were assessed by using different bleeding definitions, which hampers comparisons between products. In COCs, the estrogen balances the effects of the progestin on the endometrium, resulting in a regular bleeding pattern. However, this balance seems lost if a too low dose of ethinylestradiol (EE) (e.g., 10 µg in EE/norethindrone acetate 1 mg) is used in an attempt to lower the risk of venous thromboembolism. Replacement of EE by 17β-estradiol (E2) or E2 valerate could lead to suboptimal bleeding profile due to destabilization of the endometrium. Replacement of EE with estetrol (E4) 15 mg in the combination with drospirenone (DRSP) 3 mg is associated with a predictable and regular scheduled bleeding profile, while the POP containing DRSP 4 mg in a 24/4 regimen is associated with a higher rate of unscheduled and absence of scheduled bleeding than combined products. Full article
(This article belongs to the Special Issue New Insights into Contraception)
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10 pages, 4517 KiB  
Article
Pain Extent Is Not Associated with Sensory-Associated Symptoms, Cognitive or Psychological Variables in COVID-19 Survivors Suffering from Post-COVID Pain
by César Fernández-de-las-Peñas, Stella Fuensalida-Novo, Ricardo Ortega-Santiago, Juan A. Valera-Calero, Corrado Cescon, Marco Derboni, Vincenzo Giuffrida and Marco Barbero
J. Clin. Med. 2022, 11(15), 4633; https://doi.org/10.3390/jcm11154633 - 8 Aug 2022
Cited by 2 | Viewed by 2261
Abstract
We aimed to investigate the relationship between pain extent, as a sign of sensitization, and sensory-related, cognitive and psychological variables in hospitalized COVID-19 survivors with post-COVID pain. One hundred and forty-six (67 males, 79 females) previously hospitalized COVID-19 survivors with post-COVID pain completed [...] Read more.
We aimed to investigate the relationship between pain extent, as a sign of sensitization, and sensory-related, cognitive and psychological variables in hospitalized COVID-19 survivors with post-COVID pain. One hundred and forty-six (67 males, 79 females) previously hospitalized COVID-19 survivors with post-COVID pain completed demographic (age, sex, height, weight), sensory-related (Central Sensitization Inventory, Self-Report Leeds Assessment of Neuropathic Symptoms), cognitive (Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia) and psychological (Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index) variables. Pain extent and frequency maps were calculated from pain drawings using customized software. After conducting a correlation analysis to determine the relationships between variables, a stepwise linear regression model was performed to identify pain extent predictors, if available. Pain extent was significantly and weakly associated with pain intensity (r = −0.201, p = 0.014): the larger the pain extent, the lower the pain intensity. No other significant association was observed between pain extent and sensory-related, cognitive, or psychological variables in individuals with post-COVID pain. Females had higher pain intensity, more sensitization-associated symptoms, higher anxiety, lower sleep quality, and higher kinesiophobia levels than males. Sex differences correlation analyses revealed that pain extent was associated with pain intensity in males, but not in females. Pain extent was not associated with any of the measured variables and was also not related to the presence of sensitization-associated symptoms in our sample of COVID-19 survivors with long-term post-COVID pain. Full article
(This article belongs to the Section Epidemiology & Public Health)
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12 pages, 1019 KiB  
Article
Association of Meibomian Gland Dysfunction with Oral Statin Use
by Sun-Kyoung Park, Ji-Hye Lee, Ho-Sik Hwang, Hyun-Seung Kim, Kyung-Do Han and Kyung-Sun Na
J. Clin. Med. 2022, 11(15), 4632; https://doi.org/10.3390/jcm11154632 - 8 Aug 2022
Cited by 1 | Viewed by 2089
Abstract
This retrospective cross-sectional study aimed to determine the association of oral statin use, dry eye disease (DED), and meibomian gland dysfunction (MGD). A total of 93 subjects were included and divided into two groups: statin users (n = 45) and nonstatin users [...] Read more.
This retrospective cross-sectional study aimed to determine the association of oral statin use, dry eye disease (DED), and meibomian gland dysfunction (MGD). A total of 93 subjects were included and divided into two groups: statin users (n = 45) and nonstatin users (n = 47). Significant differences were observed in the total cholesterol (p = 0.013), low-density lipoprotein (LDL) (p = 0.005), and meiboscore (p = 0.000) levels between the two groups. For stratified analysis, the statin group was divided into subgroups according to the type or dose of statin and total duration of statin use. However, there were no differences in clinical features between the subgroups. In multiple regression analysis, meiboscore was significantly associated with age (slope = 0.05, p = 0.00) and statin use (slope = −1.19, p = 0.00), with an R2 of 0.44. Thus, older adults and participants who do not use statin appeared to have higher scores. In conclusion, although the mechanism is unclear, statins may exert a protective effect on the meibomian gland. Further lipidomic studies are required to determine the pharmacological effects of statins on the meibomian gland and other meibum components. Full article
(This article belongs to the Special Issue Clinical Advances in Meibomian Gland Dysfunction and Dry Eye Disease)
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12 pages, 298 KiB  
Review
New Era in Systemic Sclerosis Treatment: Recently Approved Therapeutics
by Satoshi Ebata, Asako Yoshizaki-Ogawa, Shinichi Sato and Ayumi Yoshizaki
J. Clin. Med. 2022, 11(15), 4631; https://doi.org/10.3390/jcm11154631 - 8 Aug 2022
Cited by 18 | Viewed by 4308
Abstract
Systemic sclerosis (SSc) is a chronic autoimmune disease with a poor prognosis. Among the various complications of SSc, treatment options for the fibrotic lesions, skin sclerosis, and SSc-associated interstitial lung disease (SSc-ILD) have been limited. However, since 2019, the efficacy and safety of [...] Read more.
Systemic sclerosis (SSc) is a chronic autoimmune disease with a poor prognosis. Among the various complications of SSc, treatment options for the fibrotic lesions, skin sclerosis, and SSc-associated interstitial lung disease (SSc-ILD) have been limited. However, since 2019, the efficacy and safety of nintedanib, tocilizumab, and rituximab for SSc or SSc-ILD have been demonstrated in double-blind, randomized, placebo-controlled trials, respectively. The antifibrotic agent nintedanib was approved for SSc-ILD in all regions of the United States, Europe, and Japan after the SENSCIS study confirmed that it suppressed the reduction in forced vital capacity (FVC), a measure of SSc-ILD. Tocilizumab, an anti-interleukin-6 receptor antibody, was approved for the treatment of SSc-ILD in the United States after the FocuSSced study showed that it inhibited the decrease in FVC. Rituximab, an anti-CD20 antibody, showed improvement in both modified Rodnan skin score, a measure of skin sclerosis, and FVC in the DESIRES study, and was approved in Japan for the treatment of SSc itself. With the development of these three drugs, SSc treatment is entering a new era. This paper outlines the latest advances in SSc therapeutics, focusing on nintedanib, tocilizumab, and rituximab. Full article
(This article belongs to the Special Issue 10th Anniversary of JCM – New Era in Dermatology)
21 pages, 959 KiB  
Review
microRNAs in Subarachnoid Hemorrhage (Review of Literature)
by Marianna Makowska, Beata Smolarz and Hanna Romanowicz
J. Clin. Med. 2022, 11(15), 4630; https://doi.org/10.3390/jcm11154630 - 8 Aug 2022
Cited by 2 | Viewed by 1844
Abstract
Recently, many studies have shown that microRNAs (miRNAs) in extracellular bioliquids are strongly associated with subarachnoid hemorrhage (SAH) and its complications. The article presents issues related to the occurrence of subarachnoid hemorrhage (epidemiology, symptoms, differential diagnosis, examination, and treatment of the patient) and [...] Read more.
Recently, many studies have shown that microRNAs (miRNAs) in extracellular bioliquids are strongly associated with subarachnoid hemorrhage (SAH) and its complications. The article presents issues related to the occurrence of subarachnoid hemorrhage (epidemiology, symptoms, differential diagnosis, examination, and treatment of the patient) and a review of current research on the correlation between miRNAs and the complications of SAH. The potential use of miRNAs as biomarkers in the treatment of SAH is presented. Full article
(This article belongs to the Section Clinical Neurology)
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11 pages, 267 KiB  
Article
Long-Term Results of Surgical Treatment and Patient-Reported Outcomes in Congenital Adrenal Hyperplasia—A Multicenter European Registry Study
by Susanne Krege, Henrik Falhammar, Hildegard Lax, Robert Roehle, Hedi Claahsen-van der Grinten, Barbara Kortmann, Lise Duranteau and Agneta Nordenskjöld
J. Clin. Med. 2022, 11(15), 4629; https://doi.org/10.3390/jcm11154629 - 8 Aug 2022
Cited by 10 | Viewed by 2402
Abstract
Representatives for congenital adrenal hyperplasia (CAH) continue to desire early feminizing surgery in girls with 46,XX-CAH. The aim of this analysis, which included 174 46,XX- individuals with salt-wasting (SW) or simple-virilizing (SV) CAH, a female gender identity, and an age > 16 years [...] Read more.
Representatives for congenital adrenal hyperplasia (CAH) continue to desire early feminizing surgery in girls with 46,XX-CAH. The aim of this analysis, which included 174 46,XX- individuals with salt-wasting (SW) or simple-virilizing (SV) CAH, a female gender identity, and an age > 16 years participating in a multicenter cross-sectional clinical evaluation study (dsd-LIFE), was to evaluate the long-term results of surgery and patient-reported outcomes (PRO). The gynecological examination (n = 84) revealed some shortcomings concerning surgical feminization. A clitoris was absent in 9.5% of cases, while a clitoral hood was missing in 36.7% of cases. Though all women had large labia, they didn’t look normal in 22.6% of cases. Small labia were absent in 23.8% of cases. There was no introitus vaginae, and the urethra and vagina had no separate opening in 5.1% of cases. A mucosal lining was missing in 15.4% of cases. Furthermore, 86.2% of the women had scars at the region of their external genitalia. A vaginal stenosis was described in 16.5% of cases, and a meatal stenosis was described in 2.6% of cases. Additionally, PRO data showed a very-/high satisfaction rate of 21.3%/40.2% with cosmesis and 23.8%/38.1% with functionality, while 3.3%/10.7% showed a very-/low satisfaction with cosmesis as well as 5.6%/10.3% with functionality. The remaining women—24.6% and 23.8%—were indifferent. Satisfaction concerning sex life was very-/high in 9.6%/27.7%. In 12.0%/16.9% it was very-/low. Furthermore, 33.7% had no opinion. Furthermore, 27.0%/31.6% of the women reported that clitoriplasty, but not clitoridectomy, had a very-/positive influence on their lives, while 1.3%/8.9% felt it to be very-/negative, and 28.4% were indifferent. Vaginoplasty had a very-/positive influence in 25.7%/33.8% and a very-/negative effect in 3.6%/6.8%. 29.7% had no opinion. Additionally, 75.7% of the women preferred feminizing surgery during infancy/childhood, especially concerning clitoreduction. In conclusion, though the majority of the participants (76%) preferred early feminizing surgery and 60% described a positive effect on their lives, about 10% felt it to have been negative. About 15% of the women suffered from insufficient cosmesis and functionality after surgery. Sex life was even described as poor in nearly 30%. Therefore, the decision about early genital surgery in 46,XX-CAH girls should be considered carefully. Parents should get detailed information about possible complications of surgery and should receive support to understand that postponing surgery does not inevitably cause harm for their child. Importantly, genital surgery when performed in children should only be performed in expert centers with a specialized team including surgeons who are trained in feminizing surgery. Full article
(This article belongs to the Special Issue Management of Complex Female Genital Malformations)
19 pages, 5686 KiB  
Article
Anti-Hypertensive Activity of Some Selected Unani Formulations: An Evidence-Based Approach for Verification of Traditional Unani Claims Using LC-MS/MS for the Evaluation of Clinically Relevant Blood Parameters in Laboratory Rats
by Md. Adil Shaharyar, Rudranil Bhowmik, Obaid Afzal, Abdulmalik S. A. Altamimi, Sami I. Alzarea, Waleed Hassan Almalki, Sk Zeeshan Ali, Pallab Mandal, Avishek Mandal, Mohd Ayoob, Imran Kazmi and Sanmoy Karmakar
J. Clin. Med. 2022, 11(15), 4628; https://doi.org/10.3390/jcm11154628 - 8 Aug 2022
Viewed by 2841
Abstract
Background: Systemic arterial hypertension, which is associated with an increased risk of cardiovascular disease(CVD), is the most significant modifiable risk factor for mortality and morbidity worldwide. WHO has recognized Unanipathy as an alternate system of medicine. The aim of the present study is [...] Read more.
Background: Systemic arterial hypertension, which is associated with an increased risk of cardiovascular disease(CVD), is the most significant modifiable risk factor for mortality and morbidity worldwide. WHO has recognized Unanipathy as an alternate system of medicine. The aim of the present study is to investigate the anti-hypertensive activity of some selected unani formulations using L-NAME model. Method: Group I or hypertensive control group: L-NAME administered for 7 days and left for the next 7 days; Group II or KASgroup: L-NAME administered (i.p) for 7 days and L-NAME + KAS (1000 mg/kg b.w) for the next 7 days; Group III or DMM group: L-NAME administered (i.p) for 7 days and L-NAME + DMM (2000 mg/kg b.w) for the next 7 days; Group IV or MSR group: L-NAME administered (i.p) for 7 days and L-NAME + MSR (300 mg/kg b.w) for the next 7 days; Group V or HJ group: L-NAME administered (i.p) for 7 days and L-NAME + HJ (113 mg/kg b.w) for the next 7 days; Group VI or KGS group: L-NAME administered (i.p) for 7 days and L-NAME +KGS (2000 mg/kg b.w) for the next 7 days. Non-invasive systolic blood pressure and RR-interval (ECG) was measured. Plasma was investigated forsodium, potassium, nitrite, ANP, adrenaline, noradrenaline and aldosterone on day 0, 7 and 14 using LC-MS/MS. Result: Treatment showed a non-significant lowreduction in SBP (systolic blood pressure) of KAS, MSR and HJ while that of DMM was quite significant (p < 0.05), but in the case of KGS, SBP increased. DMM on day 14 significantly (p < 0.05) reduced plasma nitrite while no significant plasma Na+ was noted. In the case of both DMM and KGS, potassium increased significantly (p < 0.05) on day 14. No significant changes in plasma ANP and aldosterone was observed against DMM and KGS while blood levels of adrenaline and noradrenaline significantly (p < 0.05) changed. No significant change in body weight was found. Conclusions: L-NAME KAS, MSR and HJ showed no change in SBP while DMM showed a significant reduction in SBP with decreased plasma nitrite. Probably, DMM may have anti-hypertensive activity mediated through NO inhibition while KGS may involve central sympathomimetic action. Full article
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13 pages, 872 KiB  
Article
Long-Term Outcomes Associated with NAFLD, ASCVD, and All-Cause Mortality of Patients with Metabolic Syndrome
by Suchanart Jitrukthai, Chayanis Kositamongkol, Punyisa Boonchai, Euarat Mepramoon, Pinyapat Ariyakunaphan, Pongpol Nimitpunya, Weerachai Srivanichakorn, Thanet Chaisathaphol, Chaiwat Washirasaksiri, Chonticha Auesomwang, Tullaya Sitasuwan, Rungsima Tinmanee, Naruemit Sayabovorn, Phunchai Charatcharoenwitthaya and Pochamana Phisalprapa
J. Clin. Med. 2022, 11(15), 4627; https://doi.org/10.3390/jcm11154627 - 8 Aug 2022
Cited by 2 | Viewed by 1708
Abstract
Metabolic syndrome (MetS) patients are at higher risk for nonalcoholic fatty liver disease (NAFLD), atherosclerotic cardiovascular diseases (ASCVD), and death. Given a lack of longitudinal data on patients with MetS in Southeast Asia, this study investigated the incidence of NAFLD and ASCVD and [...] Read more.
Metabolic syndrome (MetS) patients are at higher risk for nonalcoholic fatty liver disease (NAFLD), atherosclerotic cardiovascular diseases (ASCVD), and death. Given a lack of longitudinal data on patients with MetS in Southeast Asia, this study investigated the incidence of NAFLD and ASCVD and the all-cause mortality rate during a 10-year follow-up of Thai patients with MetS. Retrospective data were collected on 496 MetS patients with ultrasonography or transient elastography results. The patients had been followed up continuously by a university hospital between October 2011 and November 2021, and their mean age was 61.0 ± 10.9 years. Patients with secondary causes of hepatic steatosis were excluded. Cox proportional hazards regression models with time-varying covariates were adopted. During the 10-year follow-up, 17 patients (11.2%) developed NAFLD, and 27 (6.4%) developed ASCVD. The NAFLD and ASCVD incidence rates were 21.7 and 10.9 events per 1000 person years, respectively. The mortality rate was 14.2 deaths per 1000 person years. The prevalence of hypertension, dyslipidemia, ASCVD, NAFLD, advanced fibrosis, and cirrhosis at baseline was significantly higher in the nonsurvival group. The NAFLD incidence and mortality rate of patients with MetS were lower than those in previous studies. Intensive, holistic, and continuous care should be considered for better outcomes. Full article
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
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10 pages, 620 KiB  
Article
Radiologic Evaluation of Uterine Vasculature of Uterus Transplant Living Donor Candidates: DUETS Classification
by Jakub Kristek, Liza Johannesson, Matthew Paul Clemons, Dana Kautznerova, Jaroslav Chlupac, Jiri Fronek, Giuliano Testa and Gregory dePrisco
J. Clin. Med. 2022, 11(15), 4626; https://doi.org/10.3390/jcm11154626 - 8 Aug 2022
Cited by 4 | Viewed by 1583
Abstract
Uterus transplantation is a treatment solution for women suffering from absolute uterine factor infertility. As much as 19.5% of uterus-transplanted patients underwent urgent graft hysterectomy due to thrombosis/hypoperfusion. The necessity to identify candidates with high-quality uterine vasculature is paramount. We retrospectively evaluated and [...] Read more.
Uterus transplantation is a treatment solution for women suffering from absolute uterine factor infertility. As much as 19.5% of uterus-transplanted patients underwent urgent graft hysterectomy due to thrombosis/hypoperfusion. The necessity to identify candidates with high-quality uterine vasculature is paramount. We retrospectively evaluated and compared the imaging results with actual vascular findings from the back table. In this article, we present a novel radiologic grading scale (DUETS classification) for evaluating both uterine arteries and veins concerning their suitability for uterus procurement and transplantation. This classification defines several criteria for arteries (caliber, tapering, atherosclerosis, tortuosity, segment, take-off, and course) and veins (caliber, tapering, plethora, fenestrations, duplication/multiplicity, dominant route of venous drainage, radiologist’s confidence with imaging and assessment). In conclusion, magnetic resonance angiography can provide reliable information on uterine venous characteristics if performed consistently according to a well-established protocol and assessed by a dedicated radiologist. The caliber of uterine arteries seems to be inversely related to the time passed since the last delivery. We recommend that the radiologist comments on the reliability and confidence of the imaging study. It cannot be over-emphasized that the most crucial aspect of surgical imaging is the necessity of high-quality communication between a surgeon and a radiologist. Full article
(This article belongs to the Special Issue Uterus and Ovarian Transplantation)
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15 pages, 3816 KiB  
Article
Swin Transformer Improves the IDH Mutation Status Prediction of Gliomas Free of MRI-Based Tumor Segmentation
by Jiangfen Wu, Qian Xu, Yiqing Shen, Weidao Chen, Kai Xu and Xian-Rong Qi
J. Clin. Med. 2022, 11(15), 4625; https://doi.org/10.3390/jcm11154625 - 8 Aug 2022
Cited by 5 | Viewed by 2056
Abstract
Background: Deep learning (DL) could predict isocitrate dehydrogenase (IDH) mutation status from MRIs. Yet, previous work focused on CNNs with refined tumor segmentation. To bridge the gap, this study aimed to evaluate the feasibility of developing a Transformer-based network to predict the IDH [...] Read more.
Background: Deep learning (DL) could predict isocitrate dehydrogenase (IDH) mutation status from MRIs. Yet, previous work focused on CNNs with refined tumor segmentation. To bridge the gap, this study aimed to evaluate the feasibility of developing a Transformer-based network to predict the IDH mutation status free of refined tumor segmentation. Methods: A total of 493 glioma patients were recruited from two independent institutions for model development (TCIA; N = 259) and external test (AHXZ; N = 234). IDH mutation status was predicted directly from T2 images with a Swin Transformer and conventional ResNet. Furthermore, to investigate the necessity of refined tumor segmentation, seven strategies for the model input image were explored: (i) whole tumor slice; (ii–iii) tumor mask and/or not edema; (iv–vii) tumor bounding box of 0.8, 1.0, 1.2, 1.5 times. Performance comparison was made among the networks of different architectures along with different image input strategies, using area under the curve (AUC) and accuracy (ACC). Finally, to further boost the performance, a hybrid model was built by incorporating the images with clinical features. Results: With the seven proposed input strategies, seven Swin Transformer models and seven ResNet models were built, respectively. Based on the seven Swin Transformer models, an averaged AUC of 0.965 (internal test) and 0.842 (external test) were achieved, outperforming 0.922 and 0.805 resulting from the seven ResNet models, respectively. When a bounding box of 1.0 times was used, Swin Transformer (AUC = 0.868, ACC = 80.7%), achieved the best results against the one that used tumor segmentation (Tumor + Edema, AUC = 0.862, ACC = 78.5%). The hybrid model that integrated age and location features into images yielded improved performance (AUC = 0.878, Accuracy = 82.0%) over the model that used images only. Conclusions: Swin Transformer outperforms the CNN-based ResNet in IDH prediction. Using bounding box input images benefits the DL networks in IDH prediction and makes the IDH prediction free of refined glioma segmentation feasible. Full article
(This article belongs to the Special Issue Computational Neuroradiology and AI in Neuroradiology)
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8 pages, 5287 KiB  
Case Report
A Case of 123I-Metaiodobenzylguanidine Scintigraphy-Negative Pheochromocytoma with a Tumor-Developing Mutation in the RET Gene
by Haremaru Kubo, Yuya Tsurutani, Takashi Sunouchi, Yoshitomo Hoshino, Rei Hirose, Sho Katsuragawa, Noriko Kimura, Jun Saito and Tetsuo Nishikawa
J. Clin. Med. 2022, 11(15), 4624; https://doi.org/10.3390/jcm11154624 - 8 Aug 2022
Cited by 1 | Viewed by 1435
Abstract
Pheochromocytoma (PCC) is rare catecholamine-producing endocrine tumor that metastasizes in approximately 10% of cases. As a functional imaging of PCC, 123I-metaiodobenzylguanidine (MIBG) scintigraphy was established, and some cases of PCC exhibit negative accumulation on MIBG scintigraphy, indicating a high risk of metastasis. [...] Read more.
Pheochromocytoma (PCC) is rare catecholamine-producing endocrine tumor that metastasizes in approximately 10% of cases. As a functional imaging of PCC, 123I-metaiodobenzylguanidine (MIBG) scintigraphy was established, and some cases of PCC exhibit negative accumulation on MIBG scintigraphy, indicating a high risk of metastasis. Additionally, germline genetic variants of PCC are evident in approximately 30% of cases, although the genotype-phenotype correlation in PCC, especially the association between genetic mutations and MIBG scintigraphy, remains unclear. A 33-year-old man was admitted to our hospital for further examination for hypertension. He was diagnosed with sporadic PCC, and left adrenalectomy was performed. The adrenal tumor was negative on MIBG scintigraphy. Histology of the tumor revealed a moderately differentiated PCC. Target gene testing revealed a mutation in RET (c.2071G > A). This mutation has been reported to be a tumor-developing gene involved in the pathogenesis of PCC. Moreover, the RET mutation is the only gene mutation reported in a previous study of PCC with negative results on MIBG scintigraphy, except for the SDHB gene mutation, which is a common mutation in metastatic PCC. Correctively, the present RET gene mutation may be associated to MIBG-scintigraphy negative PCC and its pathophysiology. Clinicians should follow such cases more cautiously in clinical practice. Full article
(This article belongs to the Section Endocrinology & Metabolism)
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13 pages, 921 KiB  
Protocol
Rationale and Design of JenaMACS—Acute Hemodynamic Impact of Ventricular Unloading Using the Impella CP Assist Device in Patients with Cardiogenic Shock
by Franz Haertel, Karsten Lenk, Michael Fritzenwanger, Ruediger Pfeifer, Marcus Franz, Nedim Memisevic, Sylvia Otto, Bernward Lauer, Oliver Weingärtner, Daniel Kretzschmar, Gudrun Dannberg, Julian Westphal, Laura Baez, Jurgen Bogoviku, P. Christian Schulze and Sven Moebius-Winkler
J. Clin. Med. 2022, 11(15), 4623; https://doi.org/10.3390/jcm11154623 - 8 Aug 2022
Cited by 1 | Viewed by 1680
Abstract
Introduction: Cardiogenic shock due to myocardial infarction or heart failure entails a reduction in end organ perfusion. Patients who cannot be stabilized with inotropes and who experience increasing circulatory failure are in need of an extracorporeal mechanical support system. Today, small, percutaneously implantable [...] Read more.
Introduction: Cardiogenic shock due to myocardial infarction or heart failure entails a reduction in end organ perfusion. Patients who cannot be stabilized with inotropes and who experience increasing circulatory failure are in need of an extracorporeal mechanical support system. Today, small, percutaneously implantable cardiac assist devices are available and might be a solution to reduce mortality and complications. A temporary, ventricular, continuous flow propeller pump using magnetic levitation (Impella®) has been approved for that purpose. Methods and Study Design: JenaMACS (Jena Mechanical Assist Circulatory Support) is a monocenter, proof-of-concept study to determine whether treatment with an Impella CP® leads to improvement of hemodynamic parameters in patients with cardiogenic shock requiring extracorporeal, hemodynamic support. The primary outcomes of JenaMACS are changes in hemodynamic parameters measured by pulmonary artery catheterization and changes in echocardiographic parameters of left and right heart function before and after Impella® implantation at different support levels after 24 h of support. Secondary outcome measures are hemodynamic and echocardiographic changes over time as well as clinical endpoints such as mortality or time to hemodynamic stabilization. Further, laboratory and clinical safety endpoints including severe bleeding, stroke, neurological outcome, peripheral ischemic complications and occurrence of sepsis will be assessed. JenaMACS addresses essential questions of extracorporeal, mechanical, cardiac support with an Impella CP® device in patients with cardiogenic shock. Knowledge of the acute and subacute hemodynamic and echocardiographic effects may help to optimize therapy and improve the outcome in those patients. Conclusion: The JenaMACS study will address essential questions of extracorporeal, mechanical, cardiac support with an Impella CP® assist device in patients with cardiogenic shock. Knowledge of the acute and subacute hemodynamic and echocardiographic effects may help to optimize therapy and may improve outcome in those patients. Ethics and Dissemination: The protocol was approved by the institutional review board and ethics committee of the University Hospital of Jena. Written informed consent will be obtained from all participants of the study. The results of this study will be published in a renowned international medical journal, irrespective of the outcomes of the study. Strengths and Limitations: JenaMACS is an innovative approach to characterize the effect of additional left ventricular mechanical unloading during cardiogenic shock via a minimally invasive cardiac assist system (Impella CP®) 24 h after onset and will provide valuable data for acute interventional strategies or future prospective trials. However, JenaMACS, due to its proof-of-concept design, is limited by its single center protocol, with a small sample size and without a comparison group. Full article
(This article belongs to the Section Cardiovascular Medicine)
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10 pages, 971 KiB  
Article
Bone Turnover Markers and Bone Mineral Density in Children with Hypophosphatemic Rickets
by Izabela Michałus, Anna Łupińska, Izabela Woch, Katarzyna Wieczorek-Szukała, Danuta Chlebna-Sokół and Andrzej Lewiński
J. Clin. Med. 2022, 11(15), 4622; https://doi.org/10.3390/jcm11154622 - 8 Aug 2022
Viewed by 1436
Abstract
Hypophosphatemic rickets is a rare disease that results in bone deformities. However, little is known about bone turnover and bone mass disorders in this disease. This retrospective study included 12 children aged 1–16 years diagnosed with hypophosphatemic rickets. Parameters of calcium-phosphate metabolism and [...] Read more.
Hypophosphatemic rickets is a rare disease that results in bone deformities. However, little is known about bone turnover and bone mass disorders in this disease. This retrospective study included 12 children aged 1–16 years diagnosed with hypophosphatemic rickets. Parameters of calcium-phosphate metabolism and bone turnover markers were analysed. Bone mineral density was assessed with the use of dual-energy X-ray absorptiometry, and indices of quantitative ultrasound examination of tibiae and radial bones were analysed. In the majority of patients, hypophosphatemia and hyperphosphaturia were present. The assessed bone turnover markers showed increased bone formation. Increased pyridinoline levels were found in 5 out of 12 patients. Bone mineral density was decreased only in one patient. Decreased values of quantitative ultrasound examination were observed in all the analysed patients. Conclusions: (1) Bone metabolism disturbances, reflected in the increased values of bone turnover markers and worse bone quality, were found in the group of patients with hypophosphatemic rickets. (2) It is crucial to determine bone turnover markers, dual-energy X-ray absorptiometry findings and indices of quantitative ultrasound examination in order to monitor progress of the disease, as well as treatment effects. Full article
(This article belongs to the Special Issue Secondary Osteoporosis and Metabolic Bone Diseases)
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11 pages, 782 KiB  
Article
Physical Exercise to Improve Functional Capacity: Randomized Clinical Trial in Bariatric Surgery Population
by María José Aguilar-Cordero, Raquel Rodríguez-Blanque, Cristina Levet Hernández, Javiera Inzunza-Noack, Juan Carlos Sánchez-García and Jessica Noack-Segovia
J. Clin. Med. 2022, 11(15), 4621; https://doi.org/10.3390/jcm11154621 - 8 Aug 2022
Cited by 1 | Viewed by 1535
Abstract
Background: Bariatric surgery is a safe and effective method to lose weight over time. However, some patients fail to achieve healthy weight losses. We aimed to determine if a moderate-intensity physical exercise intervention in patients who underwent bariatric surgery increases their functional capacity [...] Read more.
Background: Bariatric surgery is a safe and effective method to lose weight over time. However, some patients fail to achieve healthy weight losses. We aimed to determine if a moderate-intensity physical exercise intervention in patients who underwent bariatric surgery increases their functional capacity thus improving bariatric surgery results. Methods: We conducted a parallel-group non-blinded randomized controlled trial at a surgery clinic in Talca, Chile. A total of 43 participants with obesity and scheduled bariatric surgery completed the six months follow-up. A physical exercise program was conducted in exercise group participants one month after bariatric surgery. Walked distance in the six-minute walk test, BMI, Borg scale of perceptive exertion results and cardiovascular variables were evaluated. Results: Patients’ weight significantly decreased after bariatric surgery but there was no difference between the groups of study. The exercise group progressed from a base value of 550 ± 75 m walked in the six-minute walk test to a sixth-month value of 649.6 ± 68.5 m (p < 0.05), whilst the control group yielded base values of 554.4 ± 35.1 and a sixth-month walked distance of 591.1 ± 75.34 (p > 0.05). Conclusions: Physical exercise in obese patients undergoing bariatric surgery increased functional capacity independently of weight losses resulting from bariatric surgery. Full article
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12 pages, 831 KiB  
Article
Factors Associated with and Prognosis Impact of Perceived Sleep Quality and Estimated Quantity in Patients Receiving Non-Invasive Ventilation for Acute Respiratory Failure
by Matthieu Lê Dinh, Michael Darmon, Achille Kouatchet, Samir Jaber, Ferhat Meziani, Sebastien Perbet, Gerald Chanques, Elie Azoulay and Alexandre Demoule
J. Clin. Med. 2022, 11(15), 4620; https://doi.org/10.3390/jcm11154620 - 8 Aug 2022
Cited by 2 | Viewed by 1370
Abstract
Background. The objectives of this study were (1) to determine factors associated with impaired sleep and (2) to evaluate the relationship between impaired sleep and the outcome. Methods. Secondary analysis of a prospective observational cohort study in 54 intensive care units in France [...] Read more.
Background. The objectives of this study were (1) to determine factors associated with impaired sleep and (2) to evaluate the relationship between impaired sleep and the outcome. Methods. Secondary analysis of a prospective observational cohort study in 54 intensive care units in France and Belgium. Sleep quality was quantified by the patients with a semi-quantitative scale. Results. Among the 389 patients included, 40% reported poor sleep during the first night in the ICU and the median (interquartile) total sleep time was 4 h (2–5). Factors independently associated with poor sleep quality were the SOFA score (odds ratio [OR] 0.90, p = 0.037), anxiety (OR 0.43, p = 0.001) and the presence of air leaks (OR 0.52, p = 0.013). Factors independently associated with short-estimated sleep duration (<4 h) were the SOFA score (1.13, p = 0.005), dyspnea on admission (1.13, p = 0.031) and the presence of air leaks (1.92, p = 0.008). Non-invasive ventilation failure was independently associated with poor sleep quality (OR 3.02, p = 0.021) and short sleep duration (OR 0.77, p = 0.001). Sleep quality and duration were not associated with an increase in mortality or length of stay. Conclusions. The sleep of patients with ARF requiring NIV is impaired and is associated with a high rate of NIV failure. Full article
(This article belongs to the Section Intensive Care)
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15 pages, 886 KiB  
Article
Middle Cerebral Artery M2 Thrombectomy: Safety and Technical Considerations in the German Stroke Registry (GSR)
by Moriz Herzberg, Franziska Dorn, Christoph Trumm, Lars Kellert, Steffen Tiedt, Katharina Feil, Clemens Küpper, Frank Wollenweber, Thomas Liebig and Hanna Zimmermann
J. Clin. Med. 2022, 11(15), 4619; https://doi.org/10.3390/jcm11154619 - 8 Aug 2022
Cited by 4 | Viewed by 1907
Abstract
There is ongoing debate concerning the safety and efficacy of various mechanical thrombectomy (MT) approaches for M2 occlusions. We compared these for MT in M2 versus M1 occlusions. Subgroup analyses of different technical approaches within the M2 MT cohort were also performed. Patients [...] Read more.
There is ongoing debate concerning the safety and efficacy of various mechanical thrombectomy (MT) approaches for M2 occlusions. We compared these for MT in M2 versus M1 occlusions. Subgroup analyses of different technical approaches within the M2 MT cohort were also performed. Patients were included from the German Stroke Registry (GSR), a multicenter registry of consecutive MT patients. Primary outcomes were reperfusion success events. Secondary outcomes were early clinical improvement (improvement in NIHSS score > 4) and independent survival at 90 days (mRS 0–2). Out of 3804 patients, 2689 presented with M1 (71%) and 1115 with isolated M2 occlusions (29%). The mean age was 76 (CI 65–82) and 77 (CI 66–83) years, respectively. Except for baseline NIHSS (15 (CI 10–18) vs. 11 (CI 6–16), p < 0.001) and ASPECTS (9 (CI 7–10) vs. 9 (CI 8–10, p < 0.001), baseline demographics were balanced. Apart from a more frequent use of dedicated small vessel stent retrievers (svSR) in M2 (17.4% vs. 3.0; p < 0.001), intraprocedural aspects were balanced. There was no difference in ICH at 24 h (11%; p = 1.0), adverse events (14.4% vs. 18.1%; p = 0.63), clinical improvement (62.5% vs. 61.4 %; p = 0.57), mortality (26.9% vs. 22.9%; p = 0.23). In M2 MT, conventional stent retriever (cSR) achieved higher rates of mTICI3 (54.0% vs. 37.7–42.0%; p < 0.001), requiring more MT-maneuvers (7, CI 2–8) vs. 2 (CI 2–7)/(CI 2–2); p < 0.001) and without impact on efficacy and outcome. Real-life MT in M2 can be performed with equal safety and efficacy as in M1 occlusions. Different recanalization techniques including the use of svSR did not result in significant differences regarding safety, efficacy and outcome. Full article
(This article belongs to the Special Issue Stroke Management - Diagnostic and Therapy)
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8 pages, 1172 KiB  
Article
Complete Right Bundle Branch Block as a Predictor of Cardiovascular Events in Type 2 Diabetes
by Katsuhiro Ono, Sadahiko Uchimoto, Masamune Miyazaki, Natsuki Honda, Katsuhito Mori, Tomoaki Morioka, Takumi Imai, Tetsuo Shoji and Masanori Emoto
J. Clin. Med. 2022, 11(15), 4618; https://doi.org/10.3390/jcm11154618 - 8 Aug 2022
Viewed by 2127
Abstract
Complete right bundle branch block (CRBBB) is generally regarded as a clinically insignificant abnormality on an electrocardiogram, although its predictive value for cardiovascular events in type 2 diabetes mellitus (T2DM) is unknown. We examined the association of CRBBB with cardiovascular events during a [...] Read more.
Complete right bundle branch block (CRBBB) is generally regarded as a clinically insignificant abnormality on an electrocardiogram, although its predictive value for cardiovascular events in type 2 diabetes mellitus (T2DM) is unknown. We examined the association of CRBBB with cardiovascular events during a 6-year follow-up in a single-center cohort study. The Fine–Gray model was used to analyze the independent association between CRBBB and composite cardiovascular events including cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for heart failure during follow up. We analyzed the data of 370 T2DM patients including 62 patients with pre-existing heart disease. CRBBB was found in 34 patients (9.2%). The composite cardiovascular outcome was recorded in 32 patients. When analyzed with the Fine–Gray model with inverse probability of treatment weighting, CRBBB was significantly associated with a higher risk of the cardiovascular outcome (hazard ratio, 2.55; 95% confidence interval, 1.04 to 6.26; p = 0.041). This association remained significant even after further adjustment for each of the potential confounders. This study suggested that CRBBB was an independent predictor of cardiovascular events in T2DM. Further studies with a larger sample size are warranted. Full article
(This article belongs to the Section Endocrinology & Metabolism)
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16 pages, 309 KiB  
Article
Mental Health Condition among University Students of Bangladesh during the Critical COVID-19 Period
by Md Mostafizur Rahman, Asikunnaby, Saadmaan Jubayer Khan, Anuva Arony, Zahid Al Mamun, Nawwar Fatima Procheta, Mohammed Sadman Sakib, Komal Raj Aryal, Farzana Rahman and Abu Reza Md. Towfiqul Islam
J. Clin. Med. 2022, 11(15), 4617; https://doi.org/10.3390/jcm11154617 - 8 Aug 2022
Cited by 4 | Viewed by 3335
Abstract
Bangladesh’s education sector has been in a state of flux since COVID-19. During the pandemic, all university campuses were closed. There was a mental health issue among the students. This study aims to examine the mental health condition and the determinants that contribute [...] Read more.
Bangladesh’s education sector has been in a state of flux since COVID-19. During the pandemic, all university campuses were closed. There was a mental health issue among the students. This study aims to examine the mental health condition and the determinants that contribute to adverse mental health conditions among university students of Bangladesh. A survey was performed online among university students in Bangladesh, in mid-June 2020 when averaging 3345 affected cases of the population daily. The convenience sampling technique was used and the survey gathered data from 365 university students. The relationship between general information and Depression, Anxiety, and Stress Scale 21 (DASS-21) subscales of university students was determined. The questionnaire was administered to respondents during the pandemic, which ensured fast replies. Linear regression models were used for statistical analysis. University students indicated normal levels of depression (30.41%), anxiety (43.29%), and stress (47.40%). However, a disproportionate number of extremely depressed, anxious, and stressed university students suggested a mental health status of concern. There were significant connections between the individual’s opinion of social satisfaction, mental health concerns, and the present location’s safety with an undesirable mental health condition. Female students were shown to be much more anxious and stressed than male students. Capital Dhaka city students were more depressed and anxious than students outside of Dhaka. Financial and psychological support for students may help mitigate the psychological impact. Authorities should make effective efforts to reduce mental health problems among these students. This research may aid organizations, health care providers, and social workers in their attempts to prepare for and respond to pandemics. Full article
(This article belongs to the Special Issue Psychological Distress and Panic during Global Pandemic)
10 pages, 2336 KiB  
Systematic Review
Xpert MTB/RIF Assay for the Diagnosis of Lymph Node Tuberculosis in Children: A Systematic Review and Meta-Analysis
by Hao-Kai Chen, Rui-Si Liu, Yi-Xuan Wang, En-Xiang Quan, Yuan-Hua Liu and Xu-Guang Guo
J. Clin. Med. 2022, 11(15), 4616; https://doi.org/10.3390/jcm11154616 - 8 Aug 2022
Cited by 2 | Viewed by 1659
Abstract
Background: Lymph node tuberculosis (LNTB) is the leading type of extrapulmonary tuberculosis (EPTB) causing death in children. The Xpert MTB/RIF assay is a novel rapid test for the diagnosis of LNTB. Although previous evidence suggests that Xpert is reliably accurate in diagnosing [...] Read more.
Background: Lymph node tuberculosis (LNTB) is the leading type of extrapulmonary tuberculosis (EPTB) causing death in children. The Xpert MTB/RIF assay is a novel rapid test for the diagnosis of LNTB. Although previous evidence suggests that Xpert is reliably accurate in diagnosing EPTB in children, information is lacking for the specific type of LNTB in children. The aim of this study was to systematically assess the accuracy and reliability of Xpert for the diagnosis of LNTB in children. Methods: We systematically searched four databases, Embase, Cochrane Library, PubMed, and Web of Science, which extracted relevant data according to predefined inclusion and exclusion criteria. The data were analyzed by meta-Disc 1.4 and Stata 12.0 software to determine sensitivity, specificity, diagnostic odds ratio (DOR), etc. Results: A total of 646 samples from 8 studies were included in the analysis. The pooled sensitivity, specificity, negative likelihood ratio (NLR), positive likelihood ratio (PLR,) and combined diagnostic odds ratio (DOR) of Xpert for all samples were 0.79 (95% CI 0.70, 0.87), 0.90 (95% CI 0.86, 0.92), 0.29 (95% CI 0.19, 0.43), 7.20 (95% CI 3.32, 15.60), and 37.56 (95% CI 13.04, 108.15), respectively. The area under the curve (AUC) of the summary receiver operating characteristic (sROC) curve was 0.9050. Conclusion: Overall, Xpert showed moderate sensitivity and high specificity compared with culture in the diagnosis of LNTB in children. In addition, after analyzing the combined diagnostic odds ratio and positive LR, our study showed that Xpert has excellent diagnostic accuracy. Full article
(This article belongs to the Special Issue Tuberculosis: Clinical and Laboratory Updates and Perspectives)
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16 pages, 1723 KiB  
Article
Evaluation of Baseline Characteristics and Prognostic Factors in Multisystemic Inflammatory Syndrome in Children: Is It Possible to Foresee the Prognosis in the First Step?
by Benhur Sirvan Cetin, Ayşenur Paç Kısaarslan, Sedanur Tekin, Merve Basol Goksuluk, Ali Baykan, Başak Nur Akyıldız, Yılmaz Seçilmiş, Hakan Poyrazoglu and on behalf of the Erciyes MIS-C Study Group
J. Clin. Med. 2022, 11(15), 4615; https://doi.org/10.3390/jcm11154615 - 8 Aug 2022
Cited by 1 | Viewed by 1595
Abstract
Background: Two years after the first cases, critical gaps remain in identifying prognostic factors in multisystem inflammatory syndrome in children (MIS-C). Methods: This retrospective study included 99 patients with MIS-C hospitalized between August 2020 and March 2022 in a pediatric tertiary center. The [...] Read more.
Background: Two years after the first cases, critical gaps remain in identifying prognostic factors in multisystem inflammatory syndrome in children (MIS-C). Methods: This retrospective study included 99 patients with MIS-C hospitalized between August 2020 and March 2022 in a pediatric tertiary center. The patients were divided into two groups according to clinical severity (low- and high-risk). Prognostic values of baseline clinical and laboratory characteristics were evaluated with advanced statistical analysis, including machine learning. Results: Sixty-three patients were male, and the median age was 83 (3–205) months. Fifty-nine patients (59.6%) were low-risk cases. Patients aged six years and over tended to be at higher risk. Involvement of aortic or tricuspid valve or >1 valve was more frequent in the high-risk group. Mortality in previously healthy children was 3.2%. Intensive care unit admission and mortality rate in the high-risk group were 37.5% and 7.5%, respectively. At admission, high-risk patients were more likely to have reduced lymphocyte count and total protein level and increased brain natriuretic peptide (BNP), ferritin, D-dimer, and troponin concentrations. The multiple logistic regression model showed that BNP, total protein, and troponin were associated with higher risk. When the laboratory parameters were used together, BNP, total protein, ferritin, and D-dimer provided the highest contribution to the discrimination of the risk groups (100%, 89.6%, 85.6%, and 55.8%, respectively). Conclusions: Our study widely evaluates and points to some clinical and laboratory parameters that, at admission, may indicate a more severe course. Modeling studies with larger sample groups are strongly needed. Full article
(This article belongs to the Special Issue Diagnosis and Management of COVID-19 in Pediatric Patients)
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20 pages, 2155 KiB  
Review
Relationship between Pachychoroid and Polypoidal Choroidal Vasculopathy
by Kenji Yamashiro, Yasuo Yanagi, Hideki Koizumi, Hidetaka Matsumoto, Chui Ming Gemmy Cheung, Fumi Gomi, Tomohiro Iida and Akitaka Tsujikawa
J. Clin. Med. 2022, 11(15), 4614; https://doi.org/10.3390/jcm11154614 - 8 Aug 2022
Cited by 13 | Viewed by 2658
Abstract
Previous clinical studies have suggested that pachychoroid can induce macular neovascularization (MNV) to develop pachychoroid neovasculopathy (PNV) and that PNV can progress to polypoidal choroidal vasculopathy (PCV). Recent studies based on the pachychoroid concept are now gradually revealing the true nature of, at [...] Read more.
Previous clinical studies have suggested that pachychoroid can induce macular neovascularization (MNV) to develop pachychoroid neovasculopathy (PNV) and that PNV can progress to polypoidal choroidal vasculopathy (PCV). Recent studies based on the pachychoroid concept are now gradually revealing the true nature of, at least some part of, PCV. However, previous studies on PNV and/or PCV have used different frameworks for the classification of PNV, PCV, and neovascular age-related macular degeneration (nAMD). These have hampered the rapid overhaul of the understanding of PCV. Some investigators have assumed that all PCV is pachychoroid-driven whereas other investigators have classified PCV into “pachychoroid PCV” and “non-pachychoroid PCV”. Furthermore, since there is no consensus as to whether PNV includes PCV, some studies have included PCV with PNV, while other studies have excluded PCV from PNV. To address these gaps, we summarize previous studies on PCV and pachychoroid. Even before the proposal of the pachychoroid concept, previous studies had suggested that PCV could be divided into two subtypes, of which one was characterized by pachychoroid features. Previous studies had also provided keys to understand relationship between PCV and PNV. We here recommend a refined conceptual framework for future studies on PNV, PCV, and nAMD. Considering the current inconsistent understanding of PCV, we should be cautious about using the term PCV until we understand the true nature of PCV. Full article
(This article belongs to the Special Issue Recent Clinical Advances in Macular Degeneration and Retinal Diseases)
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12 pages, 503 KiB  
Article
Risk Factors for Cervical Lymph Node Metastasis in Middle Eastern Papillary Thyroid Microcarcinoma
by Sandeep Kumar Parvathareddy, Abdul K. Siraj, Padmanaban Annaiyappanaidu, Nabil Siraj, Saif S. Al-Sobhi, Fouad Al-Dayel and Khawla S. Al-Kuraya
J. Clin. Med. 2022, 11(15), 4613; https://doi.org/10.3390/jcm11154613 - 8 Aug 2022
Cited by 5 | Viewed by 1346
Abstract
Papillary thyroid microcarcinoma (PTMC) typically has an indolent course and excellent prognosis. Nonetheless, a subset of PTMC carries a risk of lymph node metastasis (LNM) and local recurrence. PTC from the Middle Eastern population is unique with respect to demographic and clinico-pathological characteristics [...] Read more.
Papillary thyroid microcarcinoma (PTMC) typically has an indolent course and excellent prognosis. Nonetheless, a subset of PTMC carries a risk of lymph node metastasis (LNM) and local recurrence. PTC from the Middle Eastern population is unique with respect to demographic and clinico-pathological characteristics as compared to other ethnicities of the world. The risk factors of LNM in PTMC patients of Middle Eastern ethnicity have not been fully explored. The present study aims to investigate the influencing factors of LNM in Middle Eastern PTMC patients and its predictive impact on patient’s outcome. A total of 226 confirmed PTMC cases were selected in this retrospective study. The correlation between clinico-pathological, as well as molecular, characteristics and LNM was evaluated. Multivariate analysis was performed by logistic regression and Cox proportional hazards models. Among the 226 patients, the rate of LNM was 43.8% (99/226). Bilaterality, multifocality, gross extrathyroidal extension (ETE), and intermediate-to-high American Thyroid Association (ATA) risk tumors were significantly associated with LNM in PTMC. Multivariate logistic regression analysis showed that bilaterality and gross ETE were independent predictive factors for LNM in PTMC. The recurrence-free survival (RFS) was shorter in PTMC with LNM compared to those without LNM (p = 0.0051) and was significant on multivariate analysis. In conclusion, our study showed that bilaterality and gross ETE were independent influencing factors of LNM in Saudi patients with PTMC. LNM was also associated with shorter RFS. The identification of risk factors for LNM in patients of Middle Eastern ethnicity could help the individualization of clinical management for PTMC patients. Full article
(This article belongs to the Section Oncology)
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11 pages, 840 KiB  
Review
Endoprosthetic Reconstruction in Ewing’s Sarcoma Patients: A Systematic Review of Postoperative Complications and Functional Outcomes
by Jude Abu El Afieh, Marena Gray, Matthew Seah and Wasim Khan
J. Clin. Med. 2022, 11(15), 4612; https://doi.org/10.3390/jcm11154612 - 8 Aug 2022
Cited by 5 | Viewed by 1769
Abstract
Ewing’s sarcoma (ES) is a rare primary bone cancer managed by radiotherapy, chemotherapy and surgical resection. The existing literature on limb salvage surgery with endoprostheses combines data for ES patients with osteosarcoma. This review aimed to evaluate surgical and functional outcomes of endoprosthetic [...] Read more.
Ewing’s sarcoma (ES) is a rare primary bone cancer managed by radiotherapy, chemotherapy and surgical resection. The existing literature on limb salvage surgery with endoprostheses combines data for ES patients with osteosarcoma. This review aimed to evaluate surgical and functional outcomes of endoprosthetic reconstruction in exclusively Ewing’s patients. We believe that this is the first comprehensive review to evaluate the outcomes of limb salvage surgery with endoprostheses exclusively in Ewing’s sarcoma patients. Clinical data and outcomes were collected from PubMed, Embase, Medline and Scopus. The inclusion criteria were studies on limb salvage surgery in ES patients, where individual patient data was available. Seventeen studies with a total of 57 Ewing’s patients were included in this review. Fifty-three of the ES patients preserved the limb after limb salvage with endoprostheses. The average five-year implant survivorship was 85.9% based on four studies in this review. Postoperative complications were categorised by Henderson’s failure modes. Soft tissue failure was the most common, occurring in 35.1% of patients, followed by deep infection in 15.7% of patients. There was a suggestion of ‘good’ functional outcomes with limb salvage surgery. The salient limitation of this review is the variability and rarity of the patient population. Homogenous data in a larger population is necessary to provide more insight into outcomes of limb reconstruction in ES. Full article
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11 pages, 286 KiB  
Review
Newer and Emerging LDL-C Lowering Agents and Implications for ASCVD Residual Risk
by Rishi Rikhi and Michael D. Shapiro
J. Clin. Med. 2022, 11(15), 4611; https://doi.org/10.3390/jcm11154611 - 8 Aug 2022
Cited by 6 | Viewed by 2523
Abstract
Multiple lines of evidence demonstrate that low-density lipoprotein-cholesterol causes atherosclerotic cardiovascular disease. Thus, targeting and lowering low-density lipoprotein-cholesterol is the principal strategy to reduce cardiovascular disease risk in primary and secondary prevention. Statin therapy is the foundation of lipid-lowering treatment, but adherence rates [...] Read more.
Multiple lines of evidence demonstrate that low-density lipoprotein-cholesterol causes atherosclerotic cardiovascular disease. Thus, targeting and lowering low-density lipoprotein-cholesterol is the principal strategy to reduce cardiovascular disease risk in primary and secondary prevention. Statin therapy is the foundation of lipid-lowering treatment, but adherence rates are low, and many individuals do not attain target low-density lipoprotein-cholesterol values. Additionally, most statin-treated patients are still at considerable atherosclerotic cardiovascular disease risk, emphasizing the need for more aggressive low-density lipoprotein-cholesterol-lowering therapies. The purpose of this review is to discuss new and emerging approaches to further lower low-density lipoprotein-cholesterol, including inhibition of ATP-citrate lyase, proprotein convertase subtilisin-kexin type 9, angiopoietin-related protein 3, and cholesteryl ester transfer protein. Full article
(This article belongs to the Special Issue New Advances in Dyslipidemia)
4 pages, 693 KiB  
Editorial
Classification, Diagnosis, and Treatment of Coronary Microvascular Dysfunction
by Vincenzo Sucato, Cristina Madaudo and Alfredo Ruggero Galassi
J. Clin. Med. 2022, 11(15), 4610; https://doi.org/10.3390/jcm11154610 - 8 Aug 2022
Cited by 6 | Viewed by 3459
Abstract
Coronary microvascular dysfunction represents a widespread disease which is highly disabling for the patient, who constantly presents angina [...] Full article
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11 pages, 965 KiB  
Article
The Effect of Stabilization Procedures on Sports Discipline and Performance Level in Non-Elite Athletes after Acute Syndesmotic Injury: A Prospective Randomized Trial
by Christian Colcuc, Dirk Wähnert, Florian J. Raimann, Thomas Stein, Sanjay Weber-Spickschen, Reinhard Hoffmann and Sebastian Fischer
J. Clin. Med. 2022, 11(15), 4609; https://doi.org/10.3390/jcm11154609 - 8 Aug 2022
Cited by 2 | Viewed by 1572
Abstract
Background: Suture button devices for tibiofibular syndesmosis injuries provide semirigid dynamic stabilization. The effect of stabilization procedures on sports discipline and performance level in non-elite athletes after acute syndesmotic injury has not been clarified in sports medicine research to date. Methods: A total [...] Read more.
Background: Suture button devices for tibiofibular syndesmosis injuries provide semirigid dynamic stabilization. The effect of stabilization procedures on sports discipline and performance level in non-elite athletes after acute syndesmotic injury has not been clarified in sports medicine research to date. Methods: A total of 47 of 56 eligible patients were analyzed and completed the 1-year follow-up. The average age was 35.5 years (range, 18–60 years). The screw fixation and knotless suture button groups comprised 26 and 21 patients, respectively. Nine patients were lost to follow-up. Patients underwent clinical and radiological evaluations preoperatively and twice during the 1-year postoperative follow-up. Function was measured using the FADI sports scale, the FAAM sports module, and a visual analogue scale for pain and function in sports. Questionnaires were completed to assess preoperative and postoperative sports levels and to evaluate the sports discipline. Results: All scores increased during the follow-up, but no significant differences were found in the FADI score, the FAAM sports module score and or the VAS score for pain and function during sport (p ≤ 0.05). Using Spearman’s rank correlation coefficient, we found no significant correlation between the groups for age, injury mechanism, or body mass index. Differences were identified in sports discipline and performance level between the groups during the follow-up period. Conclusion: No statistically significant differences could be demonstrated between the two stabilization methods in terms of return to previous sport level and return to the original sport discipline, so both procedures can be regarded as equivalent at present. Full article
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