Journal of Clinical Medicine

11 pages, 2649 KiB

Open AccessReview

The Effects of Statin Treatment on Serum Ferritin Levels: A Systematic Review and Meta-Analysis

by Tannaz Jamialahmadi, Mitra Abbasifard, Željko Reiner, Manfredi Rizzo, Ali H. Eid and Amirhossein Sahebkar

J. Clin. Med. 2022, 11(17), 5251; https://doi.org/10.3390/jcm11175251 - 05 Sep 2022

Cited by 4 | Viewed by 2626

Abstract

Background: Statins are the most widely used drugs for decreasing elevated serum LDL-cholesterol (LDL-C) and thus for the prevention of atherosclerotic cardiovascular disease (ASCVD), but they have also some pleiotropic effects, including anti-inflammatory properties. Atherosclerosis is a low-grade inflammatory disease, and elevated ferritin [...] Read more.

Background: Statins are the most widely used drugs for decreasing elevated serum LDL-cholesterol (LDL-C) and thus for the prevention of atherosclerotic cardiovascular disease (ASCVD), but they have also some pleiotropic effects, including anti-inflammatory properties. Atherosclerosis is a low-grade inflammatory disease, and elevated ferritin is considered to be one of the markers of inflammation. Since the results of studies on the effects of statins on serum ferritin levels are conflicting, this meta-analysis was performed. Methods: A literature search was performed using major electronic databases (MEDLINE/PubMed, Scopus, Embase, and ISI Web of Science) from inception up to 5 March 2022 to find studies evaluating the effect of different statins on serum ferritin levels. The effect size was determined using weighted mean differences (WMDs) and the corresponding 95% confidence intervals (CIs). Results: The meta-analysis of nine studies (1611 patients) analyzing the effects of statins on serum ferritin levels that were included showed a significant decrease in circulating ferritin levels caused by statins. The results did not suggest any significant association between the changes in concentrations of serum ferritin and the duration of treatment with statins. Conclusions: Statin therapy decreases the circulating concentrations of ferritin, which might be beneficial for the prevention and/or progression of ASCVD. This effect might be explained by the anti-inflammatory effects and maybe some other pleiotropic effects of statins and not by their lipid-lowering effects. Full article

(This article belongs to the Topic Biomarkers in Cardiovascular Disease—Chances and Risks)

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3 pages, 200 KiB

Open AccessEditorial

Statin Intolerance—We Know Everything, We Know Nothing

by Maciej Banach

J. Clin. Med. 2022, 11(17), 5250; https://doi.org/10.3390/jcm11175250 - 05 Sep 2022

Viewed by 1656

Abstract

Lipid disorders are the most common risk factors of cardiovascular disease (CVD) [...] Full article

(This article belongs to the Section Cardiology)

8 pages, 2878 KiB

Open AccessArticle

The Clinical Utility of Dual-Energy Computed Tomography in the Diagnosis of Gout—A Cross-Sectional Study

by Maria Sotniczuk, Anna Nowakowska-Płaza, Jakub Wroński, Małgorzata Wisłowska and Iwona Sudoł-Szopińska

J. Clin. Med. 2022, 11(17), 5249; https://doi.org/10.3390/jcm11175249 - 05 Sep 2022

Cited by 1 | Viewed by 1844

Abstract

Dual-energy computed tomography (DECT) is an imaging technique that detects monosodium urate (MSU) deposits. This study aimed to assess the clinical utility of DECT in the diagnosis of gout. A total of 120 patients with clinical suspicion of gout who underwent DECT were [...] Read more.

Dual-energy computed tomography (DECT) is an imaging technique that detects monosodium urate (MSU) deposits. This study aimed to assess the clinical utility of DECT in the diagnosis of gout. A total of 120 patients with clinical suspicion of gout who underwent DECT were retrospectively enrolled. The sensitivity and specificity of DECT alone, American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria without DECT, and ACR/EULAR criteria with DECT were assessed. Additionally, an analysis of gout risk factors was performed. When artifacts were excluded, any MSU volume provided the best diagnostic value of DECT (AUC = 0.872, 95% CI 0.806–0.938). DECT alone had a sensitivity of 90.4% and specificity of 74.5%. Although ACR/EULAR criteria without DECT provided better diagnostic accuracy than DECT alone (AUC = 0.926, 95% CI 0.878–0.974), the best value was obtained when combing both (AUC = 0.957, 95% CI 0.924–0.991), with 100% sensitivity and 76.6% specificity. In univariate analysis, risk factors for gout were male sex, presence of tophi, presence of MSU deposits on DECT, increased uric acid in serum (each p < 0.001), and decreased glomerular filtration rate (GFR) (p = 0.029). After logistic regression, only increased serum uric acid (p = 0.034) and decreased GFR (p = 0.018) remained independent risk factors for gout. Our results suggest that DECT significantly increases the sensitivity of the ACR/EULAR criteria in the diagnosis of gout. Full article

(This article belongs to the Special Issue Diagnostic Imaging of Arthritis)

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9 pages, 256 KiB

Open AccessArticle

Electrocardiographic Abnormalities in Hospitalized Patients with COVID-19 and the Associations with Clinical Outcome

by Francesco Carubbi, Alessia Alunno, Augusto Carducci, Davide Grassi and Claudio Ferri

J. Clin. Med. 2022, 11(17), 5248; https://doi.org/10.3390/jcm11175248 - 05 Sep 2022

Cited by 1 | Viewed by 1232

Abstract

The cardiovascular (CV) system can often be affected during SARS-CoV-2 infection and several acute manifestations, such as myocardial infarction, pericarditis, myocarditis and arrhythmias have been described. We provide a retrospective overview of electrocardiographic (ECG) features and their relationship with clinical outcomes in a [...] Read more.

The cardiovascular (CV) system can often be affected during SARS-CoV-2 infection and several acute manifestations, such as myocardial infarction, pericarditis, myocarditis and arrhythmias have been described. We provide a retrospective overview of electrocardiographic (ECG) features and their relationship with clinical outcomes in a cohort of patients admitted to our COVID-19 Unit between November 2020 and May 2021. Resting standard 12-lead ECGs were performed in all patients at admission and in those recovering from SARS-CoV-2 infection also at discharge. Clinical and serological records alongside ECG measurements were retrospectively evaluated and statistical analysis was performed to identify relationships between variables. A total of 123 patients (44% females) with a mean age of 73.9 years were enrolled. Ninety-five (77%) patients recovered from SARS-CoV-2 infection and were discharged while 28 (23%) died in hospital. Almost 90% of patients displayed at least one CV risk factor and 41 (33%) patients had at least one previous CV event. We observed that heart rate, corrected QT interval dispersion (QTcd) and inverted T waves are independently associated with in-hospital death and inverted T waves show the strongest association. This association remained significant even after correcting for the number of CV risk factors at baseline and for the type of CV risk factor at baseline. Our study demonstrated that some ECG abnormalities at admission are independently associated with in-hospital death regardless of pre-existing CV risk factors. These findings may be of particular relevance in clinical settings with limited access to advanced techniques, such as cardiac magnetic resonance and could help improve the outcomes of patients with cardiac involvement related to SARS-CoV-2 infection. Full article

(This article belongs to the Section Cardiovascular Medicine)

7 pages, 1607 KiB

Open AccessCommunication

Hydrodynamic Analysis of the Clinical Findings in Pachychoroid-Spectrum Diseases

by Okihiro Nishi and Tsutomu Yasukawa

J. Clin. Med. 2022, 11(17), 5247; https://doi.org/10.3390/jcm11175247 - 05 Sep 2022

Viewed by 1139

Abstract

We wish to demonstrate that theorems of fluid dynamics may be employed to hydrodynamically analyze the clinical presentations seen within the pachychoroid-spectrum diseases (PSD). Methods: We employed both the Equation of Continuity Q = A · V in which Q represents blood flow [...] Read more.

We wish to demonstrate that theorems of fluid dynamics may be employed to hydrodynamically analyze the clinical presentations seen within the pachychoroid-spectrum diseases (PSD). Methods: We employed both the Equation of Continuity Q = A · V in which Q represents blood flow volume, A the sectional area of a vessel, and V blood flow velocity as well as Bernoulli’s Principle 1/2 V² + P/ρ = constant where V represents blood flow velocity, P static blood pressure and ρ blood density. The Equation of Continuity states that a decrease in flow volume occurs simultaneously with a decrease in the flow velocity and/or sectional area, and vice versa. Bernoulli’s Principle states that a decrease in the velocity of a fluid occurs simultaneously with an increase in static pressure, and vice versa. Results: Hyperpermeability of the choriocapillaris, as visualized on fluorescein angiography and indocyanine green angiography (ICGA), causes a fluid exudation and, therefore, a decrease in the blood flow volume Q which elicits a simultaneous decrease in the blood flow velocity V clinically observable in filling delay into the choriocapillaris on ICGA. An increase in the static blood pressure P will simultaneously occur in venules in accord with Bernoulli’s Principle. Conclusions: A decrease in the blood flow velocity in the choriocapillaris due to its hyperpermeability will hydrodynamically elicit an increase in the blood pressure in venules. This blood pressure rise may expand Sattler and Haller veins, forming pachyveins. The primary lesion of PSD can be in pigment epithelium and choriocapillaris. Full article

(This article belongs to the Special Issue Macular Edema: Pathogenesis, Diagnosis, and Treatment)

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13 pages, 275 KiB

Open AccessArticle

Evaluation of Visual and Patient—Reported Outcomes, Spectacle Dependence after Bilateral Implantation with a Non-Diffractive Extended Depth of Focus Intraocular Lens Compared to Other Intraocular Lenses

by Anna Dołowiec-Kwapisz, Halina Piotrowska and Marta Misiuk-Hojło

J. Clin. Med. 2022, 11(17), 5246; https://doi.org/10.3390/jcm11175246 - 05 Sep 2022

Cited by 2 | Viewed by 1680

Abstract

Purpose: To evaluate postoperative outcomes, spectacle dependance and the occurrence of the photic phenomena in patients after cataract surgery following the implantation of a non-diffractive extended depth of focus (EDOF) intraocular lens was compared to monofocal and multifocal lenses. Methods: We [...] Read more.

Purpose: To evaluate postoperative outcomes, spectacle dependance and the occurrence of the photic phenomena in patients after cataract surgery following the implantation of a non-diffractive extended depth of focus (EDOF) intraocular lens was compared to monofocal and multifocal lenses. Methods: We enrolled patients with bilateral cataracts who wanted to reduce their dependence on glasses in the study. They were followed for 6 months. The study group in which the EDOF lens was implanted consisted of 70 eyes in 35 patients. The control groups consisted of: 52 eyes in 26 patients in whom a multifocal was implanted and 52 eyes in 26 patients with implanted monofocal lens. After a total of 2 weeks, 2 months and 6 months post-surgery the following were evaluated: uncorrected and corrected visual acuity at 4 m, 80 cm, 40 cm, manifest refraction expressed as mean refractive spherical equivalent (MRSE), contrast sensitivity, intraocular pressure. A questionnaire on independence from ocular correction, the occurrence of photic phenomena, and patient satisfaction was also completed. Results: Monocular and binocular visual acuity and MRSE 6 months after the procedure were compared between three groups. All of the main analyses, except for comparisons of uncorrected distance visual acuity (both monocular and binocular) level, were significant. Contrast sensitivity was lower among patients with multifocal lens than among patients with EDOF lens. Halo and glare after 6 months were seen more often among patients with multifocal lens than among patients with the other lens (65% of eyes with multifocal lens vs. 6% of eyes with EDOF lens and 0% of eyes with monofocal lens). Glasses were needed by 35% of patients with EDOF lens, and by 96% of patients with monofocal lens and in none of the patients with multifocal lens. Conclusions: Most patients qualify for the implantation of a non-diffractive EDOF lens. Post-operative visual acuity improves at any distance. The best monocular visual acuity for intermediate distances is provided by an EDOF lens, and for near distance by a multifocal lens. The EDOF lens definitely increases independence from spectacle correction compared to monofocal lenses; however, the greatest degree of independence from spectacles is provided by multifocal lenses. The incidence of photic phenomena is slightly higher than that of a monofocal lens, and much lower for a multifocal lens. Full article

(This article belongs to the Special Issue Current Challenges and Advances in Cataract Surgery)

15 pages, 1640 KiB

Open AccessReview

Hereditary Hemorrhagic Telangiectasia: Genetics, Pathophysiology, Diagnosis, and Management

by Adrian Viteri-Noël, Andrés González-García, José Luis Patier, Martin Fabregate, Nuria Bara-Ledesma, Mónica López-Rodríguez, Vicente Gómez del Olmo and Luis Manzano

J. Clin. Med. 2022, 11(17), 5245; https://doi.org/10.3390/jcm11175245 - 05 Sep 2022

Cited by 8 | Viewed by 2787

Abstract

Hereditary hemorrhagic telangiectasia is an inherited disease related to an alteration in angiogenesis, manifesting as cutaneous telangiectasias and epistaxis. As complications, it presents vascular malformations in organs such as the lung, liver, digestive tract, and brain. Currently, diagnosis can be made using the [...] Read more.

Hereditary hemorrhagic telangiectasia is an inherited disease related to an alteration in angiogenesis, manifesting as cutaneous telangiectasias and epistaxis. As complications, it presents vascular malformations in organs such as the lung, liver, digestive tract, and brain. Currently, diagnosis can be made using the Curaçao criteria or by identifying the affected gene. In recent years, there has been an advance in the understanding of the pathophysiology of the disease, which has allowed the use of new therapeutic strategies to improve the quality of life of patients. This article reviews some of the main and most current evidence on the pathophysiology, clinical manifestations, diagnostic approach, screening for complications, and therapeutic options, both pharmacological and surgical. Full article

(This article belongs to the Special Issue Hereditary Hemorrhagic Telangiectasia: Recent Advances and Future Challenges)

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16 pages, 1327 KiB

Open AccessArticle

DSL_child-Algorithm-Based Hearing Aid Fitting Can Improve Speech Comprehension in Mildly Distressed Patients with Chronic Tinnitus and Mild-to-Moderate Hearing Loss

by Benjamin Boecking, Leonie Rausch, Stamatina Psatha, Amarjargal Nyamaa, Juliane Dettling-Papargyris, Christine Funk, Kevin Oppel, Petra Brueggemann, Matthias Rose and Birgit Mazurek

J. Clin. Med. 2022, 11(17), 5244; https://doi.org/10.3390/jcm11175244 - 05 Sep 2022

Cited by 5 | Viewed by 2037

Abstract

Background: Patients with chronic tinnitus and mild-to-moderate hearing loss (HL) can experience difficulties with speech comprehension (SC). The present study investigated SC benefits of a two-component hearing therapy. Methods: One-hundred-seventy-seven gender-stratified patients underwent binaural DSL_child-algorithm-based hearing aid (HA) fitting and conducted [...] Read more.

Background: Patients with chronic tinnitus and mild-to-moderate hearing loss (HL) can experience difficulties with speech comprehension (SC). The present study investigated SC benefits of a two-component hearing therapy. Methods: One-hundred-seventy-seven gender-stratified patients underwent binaural DSL_child-algorithm-based hearing aid (HA) fitting and conducted auditory training exercises. SC was measured at four timepoints under three noise interference conditions each (0, 55, and 65 dB): after screening (t₀; without HAs), HA- fitting (t₁), additional auditory training (t₂), and at 70-day follow-up (t₃). Repeated-measure analyses of covariance investigated the effects of HAs (t₀–t₁), auditory training (t₁–t₂), and the stability of the combined effect (t₂–t₃) on SC per noise interference level and HL subgroup. Correlational analyses examined associations between SC, age, and psychological indices. Results: Patients showed mildly elevated tinnitus-related distress, which was negatively associated with SC in patients with mild but not moderate HL. At 0 dB, the intervention lastingly improved SC for patients with mild and moderate HL; at 55 dB, for patients with mild HL only. These effects were mainly driven by HAs. Conclusions: The here-investigated treatment demonstrates some SC-benefit under conditions of no or little noise interference. The auditory training component warrants further investigation regarding non-audiological treatment outcomes. Full article

(This article belongs to the Section Otolaryngology)

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14 pages, 904 KiB

Open AccessReview

Rapid Maxillary Expansion (RME): An Otolaryngologic Perspective

by Luca Cerritelli, Stavros Hatzopoulos, Andrea Catalano, Chiara Bianchini, Giovanni Cammaroto, Giuseppe Meccariello, Giannicola Iannella, Claudio Vicini, Stefano Pelucchi, Piotr Henryk Skarzynski and Andrea Ciorba

J. Clin. Med. 2022, 11(17), 5243; https://doi.org/10.3390/jcm11175243 - 05 Sep 2022

Cited by 8 | Viewed by 2347

Abstract

Background. To evaluate the possible effects of Rapid Maxillary Expansion (RME), such as nasal breathing problems, middle ear function, Obstructive Sleep Apnea (OSA) in the otolaryngology field. RME has already been introduced in orthodontics to expand the maxilla of young patients affected [...] Read more.

Background. To evaluate the possible effects of Rapid Maxillary Expansion (RME), such as nasal breathing problems, middle ear function, Obstructive Sleep Apnea (OSA) in the otolaryngology field. RME has already been introduced in orthodontics to expand the maxilla of young patients affected by transversal maxillary constriction. Methods. A literature search was performed using different databases (Medline/PubMed, EMBASE, and CINAHL), from May 2005 to November 2021, according to the PRISMA guidelines. Results. The application of RME in children has shown good results on nasal function, reducing nasal resistances, independently from a previous adenotonsillectomy. These results are not only related to the increasing of nasal transverse diameters and volume, but also to the stiffening of airway muscles, enabling the nasal filtrum function and avoiding mouth opening, thereby decreasing respiratory infections. Positive effects have also been reported for the treatment of conductive hearing loss and of OSA, with the reduction of Apnea Hypopnea Index (AHI), possibly due to (i) an increased pharyngeal dimensions, (ii) a new tongue posture, and (iii) reduced nasal respiratory problems. Conclusions. Otolaryngologists should be aware of the indications and benefits of the RME treatment, considering its possible multiple beneficial effects. Full article

(This article belongs to the Section Otolaryngology)

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10 pages, 1491 KiB

Open AccessReview

Motorized Intramedullary Nail Lengthening in the Older Population

by Kenneth P. Powell, Ahmed I. Hammouda, Larysa P. Hlukha, Jessica C. Rivera, Minoo Patel, S. Robert Rozbruch, Janet D. Conway and John E. Herzenberg

J. Clin. Med. 2022, 11(17), 5242; https://doi.org/10.3390/jcm11175242 - 05 Sep 2022

Cited by 3 | Viewed by 1995

Abstract

Limb lengthening has not been widely employed in the elderly population due to concerns that outcomes will be inferior. The purpose of this multicenter, retrospective case-control series was to report the bone healing outcomes and complications of lower limb lengthening in older patients [...] Read more.

Limb lengthening has not been widely employed in the elderly population due to concerns that outcomes will be inferior. The purpose of this multicenter, retrospective case-control series was to report the bone healing outcomes and complications of lower limb lengthening in older patients (≥60 years) using magnetic intramedullary lengthening nail (MILN). Our hypothesis was that healing parameters including consolidation days, the consolidation index, maturation days, and the maturation index, as well as the number of adverse events reported in the older population, would be no different to those of the general adult population. We retrospectively reviewed charts and radiographs from patients ≥60 years of age with limb-length discrepancies who underwent femoral or tibial lengthening using a MILN. Parameters were compared among the age categories “≤19 years,” “20–39 years,” “40–59 years,” or “≥60 years” and propensity-matched cohorts for the age groups 20–59 years and ≥60 years. Complications were reported as percentages for each age category. In the study period, 354 MILN were placed in 257 patients. Sixteen nails were placed in patients 60 years of age or older (mean 65 ± 5 years; range 60–72 years). Comparisons of healing parameters showed no difference between those aged 60+ and the younger cohort. Complication percentages were not statistically significant (p = 0.816). Limb lengthening with MILN may therefore be considered a safe and feasible option for a generally healthy elderly population. Full article

(This article belongs to the Special Issue Orthopedic Surgery in Elderly Patients: Past, Present, and Future)

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14 pages, 571 KiB

Open AccessReview

Mechanical Circulatory Support Devices for the Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction—A Review

by Sharon Bruoha, Chaim Yosefy, Louay Taha, Danny Dvir, Mony Shuvy, Rami Jubeh, Shemy Carasso, Michael Glikson and Elad Asher

J. Clin. Med. 2022, 11(17), 5241; https://doi.org/10.3390/jcm11175241 - 05 Sep 2022

Cited by 6 | Viewed by 3170

Abstract

Cardiogenic shock complicating acute myocardial infarction is a complex clinical condition associated with dismal prognosis. Routine early target vessel revascularization remains the most effective treatment to substantially improve outcomes, but mortality remains high. Temporary circulatory support devices have emerged with the aim to [...] Read more.

Cardiogenic shock complicating acute myocardial infarction is a complex clinical condition associated with dismal prognosis. Routine early target vessel revascularization remains the most effective treatment to substantially improve outcomes, but mortality remains high. Temporary circulatory support devices have emerged with the aim to enhance cardiac unloading and improve end-organ perfusion. However, quality evidence to guide device selection, optimal installation timing, and post-implantation management are scarce, stressing the importance of multidisciplinary expert care. This review focuses on the contemporary use of short-term support devices in the setting of cardiogenic shock following acute myocardial infarction, including the common challenges associated this practice. Full article

(This article belongs to the Special Issue Clinical Frontiers in Cardiogenic Shock)

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11 pages, 2576 KiB

Open AccessArticle

Evaluation of the Influence of Short Tourniquet Ischemia on Tissue Oxygen Saturation and Skin Temperature Using Two Portable Imaging Modalities

by Wibke Müller-Seubert, Helen Herold, Stephanie Graf, Ingo Ludolph and Raymund E. Horch

J. Clin. Med. 2022, 11(17), 5240; https://doi.org/10.3390/jcm11175240 - 05 Sep 2022

Cited by 3 | Viewed by 1273

Abstract

Background: The exact influence of tourniquet ischemia on a treated extremity remains unclear. Methods: Twenty patients received an operation on one hand under tourniquet ischemia. Twenty healthy volunteers received 10 min of tourniquet ischemia on one of their arms. Measurements of tissue oxygen [...] Read more.

Background: The exact influence of tourniquet ischemia on a treated extremity remains unclear. Methods: Twenty patients received an operation on one hand under tourniquet ischemia. Twenty healthy volunteers received 10 min of tourniquet ischemia on one of their arms. Measurements of tissue oxygen saturation using near-infrared reflectance-based imaging and skin temperature of the dorsum of the hand were performed at five different timepoints (t0 was performed just before the application of the tourniquet ischemia, t1 directly after the application of the tourniquet ischemia, t2 before the release of the ischemia, t3 directly after the release of the ischemia, and t4 on the following day). Results: In both groups, tissue oxygen saturation dropped after the application of the tourniquet ischemia compared to t0 and increased after the release of the tourniquet ischemia. In the patient group, tissue oxygen saturation at t4 was higher compared to t0; in contrast, the level of tissue oxygen saturation in the participant group dropped slightly at t4 compared to t0. The measured skin temperature in the patient group showed an increase during the observation period, while it continuously decreased in the group of healthy participants. Conclusions: Short-term ischemia did not appear to permanently restrict perfusion in this study design. The non-invasive imaging modalities used were easy to handle and allowed repetitive measurement. Full article

(This article belongs to the Special Issue Wound Healing and Plastic Surgery: Challenges and Innovations)

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13 pages, 1659 KiB

Open AccessArticle

Invasiveness of Ventilation Therapy Is Associated to Prevalence of Secondary Bacterial and Fungal Infections in Critically Ill COVID-19 Patients

by Marie Louise de Hesselle, Stefan Borgmann, Siegbert Rieg, Jörg Janne Vehreshild, Christoph D. Spinner, Carolin E. M. Koll, Martin Hower, Melanie Stecher, Daniel Ebert, Frank Hanses, Julia Schumann and on behalf of the SAREL Investigators

J. Clin. Med. 2022, 11(17), 5239; https://doi.org/10.3390/jcm11175239 - 05 Sep 2022

Cited by 7 | Viewed by 1473

Abstract

Superinfections are a fundamental critical care problem, and their significance in severe COVID-19 cases needs to be determined. This study analyzed data from the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) cohort focusing on intensive care patients. A retrospective analysis of patient [...] Read more.

Superinfections are a fundamental critical care problem, and their significance in severe COVID-19 cases needs to be determined. This study analyzed data from the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) cohort focusing on intensive care patients. A retrospective analysis of patient data from 840 cases of COVID-19 with critical courses demonstrated that co-infections were frequently present and were primarily of nosocomial origin. Furthermore, our analysis showed that invasive therapy procedures accompanied an increased risk for healthcare-associated infections. Non-ventilated ICU patients were rarely affected by secondary infections. The risk of infection, however, increased even when non-invasive ventilation was used. A further, significant increase in infection rates was seen with the use of invasive ventilation and even more so with extracorporeal membrane oxygenation (ECMO) therapy. The marked differences among ICU techniques used for the treatment of COVID-19-induced respiratory failure in terms of secondary infection risk profile should be taken into account for the optimal management of critically ill COVID-19 patients, as well as for adequate antimicrobial therapy. Full article

(This article belongs to the Special Issue Infection, Super Infection and Antimicrobial Management in ICU)

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12 pages, 1532 KiB

Open AccessArticle

Optimization of Laboratory Diagnostics of Primary Biliary Cholangitis: When Solid-Phase Assays and Immunofluorescence Combine

by Federica Gaiani, Roberta Minerba, Alessandra Picanza, Annalisa Russo, Alessandra Melegari, Elena De Santis, Tommaso Trenti, Lucia Belloni, Silvia Peveri, Rosalia Aloe, Carlo Ferrari, Luigi Laghi, Gian Luigi de’Angelis and Chiara Bonaguri

J. Clin. Med. 2022, 11(17), 5238; https://doi.org/10.3390/jcm11175238 - 05 Sep 2022

Cited by 5 | Viewed by 1390

Abstract

The laboratory diagnostics of primary biliary cholangitis (PBC) have substantially improved, thanks to innovative analytical opportunities, such as enzyme-linked immunosorbent assays (ELISA) and multiple immunodot liver profile tests, based on recombinant or purified antigens. This study aimed to identify the best diagnostic test [...] Read more.

The laboratory diagnostics of primary biliary cholangitis (PBC) have substantially improved, thanks to innovative analytical opportunities, such as enzyme-linked immunosorbent assays (ELISA) and multiple immunodot liver profile tests, based on recombinant or purified antigens. This study aimed to identify the best diagnostic test combination to optimize PBC diagnosis. Between January 2014 and March 2017, 164 PBC patients were recruited at the hospitals of Parma, Modena, Reggio-Emilia, and Piacenza. Antinuclear antibodies (ANA) and anti-mitochondrial antibodies (AMA) were assayed by indirect immunofluorescence (IIF), ELISA, and immunodot assays (PBC Screen, MIT3, M2, gp210, and sp100). AMA-IIF resulted in 89.6% positive cases. Using multiple immunodot liver profiles, AMA-M2 sensitivity was 94.5%, while anti-gp210 and anti-sp100 antibodies were positive in 16.5% and 17.7% of patients, respectively. PBC screening yielded positive results in 94.5% of cases; MIT3, sp100, and gp210 were detected by individual ELISA test in 89.0%, 17.1%, and 18.9% of patients, respectively. The association of PBC screening with IIF-AMA improved the diagnostic sensitivity from 89.6% to 98.2% (p < 0.01). When multiple immunodot liver profile testing was integrated with AMA-IIF, the diagnostic sensitivity increased from 89.1% to 98.8% (p < 0.01). The combination of IIF with solid-phase methods significantly improved diagnostic efficacy in PBC patients. Full article

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

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12 pages, 15040 KiB

Open AccessArticle

Correlation between Pulmonary Artery Pressure and Vortex Duration Determined by 4D Flow MRI in Main Pulmonary Artery in Patients with Suspicion of Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

by Jean-François Deux, Lindsey A. Crowe, Léon Genecand, Anne-Lise Hachulla, Carl G. Glessgen, Stéphane Noble, Maurice Beghetti, Jin Ning, Daniel Giese, Frédéric Lador and Jean-Paul Vallée

J. Clin. Med. 2022, 11(17), 5237; https://doi.org/10.3390/jcm11175237 - 05 Sep 2022

Cited by 3 | Viewed by 1623

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the causes of pulmonary hypertension (PH) and requires invasive measurement of the mean pulmonary artery pressure (mPAP) during right heart catheterisation (RHC) for the diagnosis. 4D flow MRI could provide non-invasive parameters to estimate the [...] Read more.

Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the causes of pulmonary hypertension (PH) and requires invasive measurement of the mean pulmonary artery pressure (mPAP) during right heart catheterisation (RHC) for the diagnosis. 4D flow MRI could provide non-invasive parameters to estimate the mPAP. Twenty-five patients with suspected CTEPH underwent cardiac MRI. Mean vortex duration (%), pulmonary distensibility, right ventricular volumes and function were measured using 4D flow MRI and cine sequences, and compared with the mPAP measured by RHC. The mPAP measured during RHC was 33 ± 16 mmHg (10–66 mmHg). PH (defined as mPAP > 20 mmHg) was present in 19 of 25 patients (76%). A vortical flow was observed in all but two patients (92%) on 4D flow images, and vortex duration showed good correlation with the mPAP (r = 0.805; p < 0.0001). Youden index analysis showed that a vortex duration of 8.6% of the cardiac cycle provided a 95% sensitivity and an 83% specificity to detect PH. Reliability for the measurement of vortex duration was excellent for both intra-observer ICC = 0.823 and inter-observer ICC = 0.788. Vortex duration could be a useful parameter to non-invasively estimate mPAP in patients with suspected CTEPH. Full article

(This article belongs to the Section Pulmonology)

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13 pages, 309 KiB

Open AccessArticle

Psychosocial Distress among Family Members of COVID-19 Patients Admitted to Hospital and Isolation Facilities in the Philippines: A Prospective Cohort Study

by Leilanie Apostol-Nicodemus, Ian Kim B. Tabios, Anna Guia O. Limpoco, Gabriele Dominique P. Domingo and Ourlad Alzeus G. Tantengco

J. Clin. Med. 2022, 11(17), 5236; https://doi.org/10.3390/jcm11175236 - 05 Sep 2022

Cited by 5 | Viewed by 3967

Abstract

This study determined the psychosocial impact of COVID-19 on families of adult COVID-19 patients in isolation facilities in Metro Manila, Philippines. This prospective cohort study was conducted in COVID-19 healthcare facilities. Data collection was undertaken 2 weeks and 8 weeks after discharge. Logistic [...] Read more.

This study determined the psychosocial impact of COVID-19 on families of adult COVID-19 patients in isolation facilities in Metro Manila, Philippines. This prospective cohort study was conducted in COVID-19 healthcare facilities. Data collection was undertaken 2 weeks and 8 weeks after discharge. Logistic regression was performed to determine the socioeconomic and clinical factors influencing anxiety, depression, and family function. Based on HADS-P, 43.2% of the participants had anxiety symptoms, and 16.2% had depression symptoms 2 weeks after the discharge of their relative with COVID-19 infection. The prevalence of anxiety and depression significantly decreased to 24.3% and 5.4%, respectively, 8 weeks after discharge. The percentage of participants with a perceived moderate family dysfunction was 9.5% in the 2nd week and 6.8% in the 8th week post discharge. Participants with perceived severe family dysfunction increased from none to 4.1%. The most inadequate family resources for the participants were economic, medical, and educational resources. Patient anxiety (p = 0.010) and perceived inadequate family resources (p = 0.032) were associated with anxiety symptoms among family members. Patient anxiety (p = 0.013) and low educational attainment (p = 0.002) were associated with anxiety symptoms among family members 8 weeks after discharge. On the other hand, patient depression (p = 0.013) was a factor related to depressive symptoms among family members 2 weeks after discharge. This study provided an in-depth understanding of the mental health status of family members caring for relatives with COVID-19 infection. This can be used to guide healthcare professionals caring for COVID-19 patients and their family members. Full article

(This article belongs to the Special Issue Mental Health Challenges during the COVID-19 Pandemic)

14 pages, 3790 KiB

Open AccessArticle

Biomechanical Study of Arthroscopic All-Inside Anterior Talofibular Ligament Suture Augmentation Repair, Plus Suture Augmentation Repair and Anterior Tibiofibular Ligament’s Distal Fascicle Transfer Augmentation Repair

by Lei Xiao, Boyuan Zheng, Yijuan Zhou, Dahai Hu, Jieruo Li, Xiaofei Zheng, Huige Hou and Huajun Wang

J. Clin. Med. 2022, 11(17), 5235; https://doi.org/10.3390/jcm11175235 - 05 Sep 2022

Cited by 3 | Viewed by 1530

Abstract

Objective: To explore the biomechanical efficacy of arthroscopic all-inside anterior talofibular ligament (ATFL) suture augmentation repair, plus suture augmentation repair and anterior tibiofibular ligament-distal fascicle (ATiFL-DF) transfer augmentation repair, so as to provide a basis for the accurate selection of ATFL repair in [...] Read more.

Objective: To explore the biomechanical efficacy of arthroscopic all-inside anterior talofibular ligament (ATFL) suture augmentation repair, plus suture augmentation repair and anterior tibiofibular ligament-distal fascicle (ATiFL-DF) transfer augmentation repair, so as to provide a basis for the accurate selection of ATFL repair in clinical practice. Methods: Twenty-four (12 pairs) fresh frozen human cadaver ankle specimens were used. Six of the ankle specimens were set as the normal group, and the other 18 ankle specimens were used to establish ATFL injury models. The ATFL was then repaired using arthroscopic all-inside ATFL suture augmentation repair (suture augmentation group), plus suture augmentation repair (plus suture augmentation group) and ATiFL-DF transfer augmentation repair (biological augmentation group), respectively. After the repaired ATFL was separated, the ankle specimens were fixed on an electronic universal testing machine with a customized fixture for the tensile test, and the ultimate failure load (N) and stiffness (N/mm) of the ankle specimens were compared. Results: The ultimate failure load of the plus suture augmentation group (229.3 ± 66.7 N) was significantly higher than that in the normal group (148.2 ± 39.4 N, p = 0.045) and the biological augmentation group (131.3 ± 38.8 N, p = 0.013). There was no statistical difference in ultimate failure load between the suture augmentation group (167.2 ± 47.2 N), the normal group and the biological augmentation group. The stiffness of the plus suture augmentation group (26.2 ± 8.2 N/mm) was significantly higher than that in the normal group (12.1 ± 3.8 N/mm, p = 0.005) and the biological augmentation group (12.7 ± 5.2 N/mm, p = 0.007). The stiffness of the suture augmentation group (23.6 ± 7.0 N/mm) was significantly higher than that in the normal group (p = 0.024) and the biological augmentation group (p = 0.033). There was no statistical difference in stiffness between the plus suture augmentation group and the suture augmentation group, and no statistical difference in stiffness between the normal group and the biological augmentation group. Conclusions: The tensile strength and rigidity of plus suture augmentation repair were significantly better than those of normal ATFL, suture augmentation repair and ATiFL-DF transfer augmentation repair. Suture augmentation repair can obtain tensile strength similar to normal ATFL and ATiFL-DF transfer augmentation repair, and suture augmentation repair can obtain rigidity significantly better than normal ATFL and ATiFL-DF transfer augmentation repair. ATiFL-DF transfer augmentation repair can obtain tensile strength and rigidity similar to normal ATFL. Full article

(This article belongs to the Special Issue Minimally Invasive Treatment with Arthroscopy in Arthropathy)

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24 pages, 429 KiB

Open AccessReview

Retinal and Corneal Changes Associated with Intraocular Silicone Oil Tamponade

by Mariantonia Ferrara, Giulia Coco, Tania Sorrentino, Kirti M. Jasani, George Moussa, Francesco Morescalchi, Felipe Dhawahir-Scala, Francesco Semeraro, David H. W. Steel, Vito Romano and Mario R. Romano

J. Clin. Med. 2022, 11(17), 5234; https://doi.org/10.3390/jcm11175234 - 05 Sep 2022

Cited by 16 | Viewed by 2396

Abstract

Silicone oils (SO) are used as long-term intraocular tamponades and have an irreplaceable role in vitreoretinal surgery. They can, however, be associated with multiple and potentially severe complications, involving different ocular tissues, in particular retina and cornea. Recent advances in ophthalmic imaging have [...] Read more.

Silicone oils (SO) are used as long-term intraocular tamponades and have an irreplaceable role in vitreoretinal surgery. They can, however, be associated with multiple and potentially severe complications, involving different ocular tissues, in particular retina and cornea. Recent advances in ophthalmic imaging have allowed the precise characterization of retinal and corneal microstructural changes, at a subclinical level. This detailed analysis of SO-related retinal and corneal changes has improved our understanding of their pathogenesis and offer the potential for optimized monitoring and management of patients with SO-filled eyes. This review aims to provide clinicians and ophthalmic scientists with an updated and comprehensive overview of the corneal and retinal changes associated with SO tamponade. Full article

(This article belongs to the Section Ophthalmology)

8 pages, 501 KiB

Open AccessArticle

The Safety and Efficacy of Vela Laser En-Bloc Endoscopic Resection versus Conventional Transurethral Resection of Bladder Tumor—A Single Center Experience

by Che-Wei Chang, Tsz-Yi Tang, Jiun-Hung Geng, Jhen-Hao Jhan, Hsun-Shuan Wang, Jung-Tsung Shen and Yung-Chin Lee

J. Clin. Med. 2022, 11(17), 5233; https://doi.org/10.3390/jcm11175233 - 05 Sep 2022

Cited by 3 | Viewed by 1510

Abstract

(1) Background: The current gold standard treatment of bladder cancer is conventional transurethral resection of the bladder tumor (CTURBT) using monopolar or bipolar resectoscopes. Laser en-bloc resection of the bladder tumor (LERBT) could achieve a higher quality of the specimen, reduce perioperative complications, [...] Read more.

(1) Background: The current gold standard treatment of bladder cancer is conventional transurethral resection of the bladder tumor (CTURBT) using monopolar or bipolar resectoscopes. Laser en-bloc resection of the bladder tumor (LERBT) could achieve a higher quality of the specimen, reduce perioperative complications, and decrease the recurrence rate. Here, we compare the efficacy and safety of en-bloc Vela laser resection versus the conventional monopolar/bipolar resection; (2) Methods: A total of 100 clinically cT1-2 patients with bladder cancer were retrospectively reviewed in this study. Among these patients, 50 patients received LERBT, and 50 patients received CTURBT. The baseline characteristics, operation variables, and clinical outcomes were collected. The primary performance was the presence of muscle layer in the specimen. Perioperative complications and recurrence-free survival (RFS) were also compared. Independent t-test, Chi-square test, Kaplan–Meier curves, and the Cox-regression model were used in the analysis; (3) Results: The median age of the patients in the laser and resectoscope groups was 69.2 and 68.0 years old, respectively. The statistical difference in the presence of the detrusor muscle was 92.0% in the laser group and 70.0% in the CTURBT group (p = 0.005). A lower incidence of bladder perforation (p = 0.041) and major surgical complications (p = 0.046) in the LEBRT group was observed. We found no differences in operation duration, catheterization time, and hospitalization time after adjustment. Additionally, there was no statistical difference in RFS after a median follow-up time of 25 months; (4) Conclusions: Endoscopic laser en-bloc resection of bladder tumor with Vela laser is an effective method with higher muscle inclusion rate and fewer complications. Full article

(This article belongs to the Section Nephrology & Urology)

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10 pages, 252 KiB

Open AccessArticle

Factors Associated with Elevated Tumor Necrosis Factor-α in Aqueous Humor of Patients with Open-Angle Glaucoma

by Younhea Jung, Kyoung Ohn, Heejong Shin, Si Eun Oh, Chan Kee Park and Hae-Young Lopilly Park

J. Clin. Med. 2022, 11(17), 5232; https://doi.org/10.3390/jcm11175232 - 05 Sep 2022

Cited by 4 | Viewed by 1017

Abstract

Tumor necrosis factor-alpha (TNF-α) is an important modulator of neuroinflammation, secreted from activated glial cells in response to intraocular stress. The purpose of this study was to investigate the clinical factors associated with elevated TNF-α and its level in aqueous humor of patients [...] Read more.

Tumor necrosis factor-alpha (TNF-α) is an important modulator of neuroinflammation, secreted from activated glial cells in response to intraocular stress. The purpose of this study was to investigate the clinical factors associated with elevated TNF-α and its level in aqueous humor of patients with open-angle glaucoma (OAG). Aqueous humor was collected from 73 OAG eyes, and TNF-α level was analyzed using the singleplex bead immunoassay method. Patients were divided into TNF-α-positive and TNF-α-negative groups according to the TNF-α level of 10 pg/mL, and baseline clinical characteristics were compared. The TNF-α-positive group showed higher baseline IOP, greater IOP fluctuation, and higher systolic blood pressure than the TNF-α-negative group (p = 0.007, p < 0.001, and p = 0.009, respectively). In the multivariate logistic regression analysis, IOP fluctuation (p = 0.037) and systolic blood pressure (p = 0.016) were all independently associated with positive TNF-α level. In normal-tension glaucoma (NTG) patients, presence of central scotoma (p = 0.029) was significantly associated with positive TNF-α level. In conclusion, positive TNF-α level in OAG patients was associated with greater IOP fluctuation and higher systolic blood pressure. In NTG patients, positive TNF-α level was associated with the presence of central scotoma. IOP factors and vascular factors, including blood pressure and presence of central scotoma, may indicate glaucoma pathogenesis related to TNF-α elevation in OAG patients. Full article

(This article belongs to the Section Ophthalmology)

16 pages, 567 KiB

Open AccessArticle

by Andre Conradie, John Atherton, Enayet Chowdhury, MyNgan Duong, Nisha Schwarz, Stephen Worthley and David Eccleston

J. Clin. Med. 2022, 11(17), 5231; https://doi.org/10.3390/jcm11175231 - 05 Sep 2022

Cited by 5 | Viewed by 1533

Abstract

Background and aim: poor quality of life (QoL) has been identified as an independent risk factor for mortality and major cardiac events (MACE) in patients with cardiovascular disease (CVD). The aim of this study was to assess health-related quality of life (HRQoL) at [...] Read more.

Background and aim: poor quality of life (QoL) has been identified as an independent risk factor for mortality and major cardiac events (MACE) in patients with cardiovascular disease (CVD). The aim of this study was to assess health-related quality of life (HRQoL) at baseline and its association with outcome in patients with coronary artery disease presenting for percutaneous coronary intervention (PCI). The outcome was measured by mortality and MACE at 1-year, and whether there was any difference for sex and different age groups. Methods and results: all patients prospectively enrolled into the GenesisCare Outcome Registry (GCOR) over a 11-year period were included in the study. The EQ-5D-5L and VAS patient survey were used for assessment of baseline HRQoL. Of the 15,198 patients, only 6591 (43.4%) completed the self-assessment. Women had significantly more impairment of all five dimensions of the EQ-5D-5L survey, and their self-reported QoL was significantly lower than men (68.3 in women vs. 71.9 in men, p < 0.001). Poor QoL was strongly associated with increased mortality (HR 2.85; 95% CI 1.76 to 4.62, p < 0.001) and MACE (HR 1.40; 95% CI 1.10 to 1.79, p = 0.01). A similar trend was noted for women and men, but did not reach significance in women due to the smaller number of female patients. Conclusion: poor HRQoL is associated with subsequent mortality and MACE in patients undergoing PCI. By not assessing quality of life as a standard of care, an opportunity is lost to identify high-risk patients who may benefit from targeted interventions to improve health outcomes. Full article

(This article belongs to the Special Issue Clinical Frontiers in Percutaneous Coronary Intervention)

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9 pages, 590 KiB

Open AccessArticle

Change in Physical and Mental Quality-of-Life between the Short- and Mid-Term Periods after Cervical Laminoplasty for Cervical Spondylotic Myelopathy: A Retrospective Cohort Study with Minimum 5 Years Follow-up

by Koji Tamai, Akinobu Suzuki, Hidetomi Terai, Minori Kato, Hiromitsu Toyoda, Shinji Takahashi, Akito Yabu, Yuta Sawada, Masayoshi Iwamae and Hiroaki Nakamura

J. Clin. Med. 2022, 11(17), 5230; https://doi.org/10.3390/jcm11175230 - 04 Sep 2022

Cited by 3 | Viewed by 1188

Abstract

The mid-term surgical outcomes of cervical spondylotic myelopathy (CSM), evaluated using the cervical Japanese Orthopedic Association (cJOA) score, are reported to be satisfactory. However, there remains room for improvement in quality-of-life (QOL), especially after short-term follow-up. We aimed to demonstrate changes in mental [...] Read more.

The mid-term surgical outcomes of cervical spondylotic myelopathy (CSM), evaluated using the cervical Japanese Orthopedic Association (cJOA) score, are reported to be satisfactory. However, there remains room for improvement in quality-of-life (QOL), especially after short-term follow-up. We aimed to demonstrate changes in mental and physical QOL between short- and mid-term follow-ups and determine the predictive factors for deterioration of QOL. In this retrospective cohort study, 80 consecutive patients underwent laminoplasty for CSM. The outcome measures were Short Form-36 Physical Component Summary (PCS), Mental Component Summary (MCS), and cJOA scores. PCS and MCS scores were compared at the 2- and 5-year postoperative time points. Additionally, a multivariate logistic regression model was used to identify the predictive factors for deterioration. Significant factors in the logistic regression analysis were analyzed using receiver-operating characteristic curves. The results showed that MCS scores did not deteriorate after 2 years postoperatively (p = 0.912). Meanwhile, PCS significantly declined between 2 and 5 years postoperatively (p = 0.008). cJOA scores at 2 years postoperatively were significantly associated with PCS deterioration at 2-year follow-up. In conclusion, only physical QOL might show deterioration after short-term follow-up. Such deterioration is likely in patients with a cJOA score <13.0 at 2 years postoperatively. Full article

(This article belongs to the Special Issue Recent Research in Skeletal Diseases)

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15 pages, 2184 KiB

Open AccessArticle

A Novel Method to Combine Maxilla-Based Coordinate System and Mandibular Voxel-Based Superimposition with Cone-Bean Computed Tomography

by Chenghao Zhang, Ling Ji, Yijun Li, Fangwei Pan, Wen Liao and Zhihe Zhao

J. Clin. Med. 2022, 11(17), 5229; https://doi.org/10.3390/jcm11175229 - 04 Sep 2022

Cited by 3 | Viewed by 1528

Abstract

Background: The objective of this study was to propose a method that combines a maxilla-based coordinate system and mandibular voxel-based superimposition for an accurate evaluation of mandibular structural and positional changes and a direct comparison between maxillary and mandibular structural changes with the [...] Read more.

Background: The objective of this study was to propose a method that combines a maxilla-based coordinate system and mandibular voxel-based superimposition for an accurate evaluation of mandibular structural and positional changes and a direct comparison between maxillary and mandibular structural changes with the same 3D vectors. Methods: Mandibular voxel-based superimposition was firstly performed to reorient the mandibles and eliminate the mandibular positional changes. Then, a maxilla-based coordinate system was constructed with four maxillary skeletal landmarks (ANS, PNS, OrL and OrR). After settling the reoriented mandibles into this coordinate system, the mandibular structural changes were accurately evaluated. To assess the accuracy and reproducibility of this method, CBCT images of a skull specimen before and after orthodontic treatment (which was simulated by rearranging the skull and the mandible) were collected. Five mandibular skeletal landmarks, three mandibular dental landmarks and two mandibular measurement planes of this skull were used to evaluate the linear and angular changes in the mandibular structures. Results: There were significant differences in the linear and angular measurements of the mandibular structures of the skull (p ˂ 0.05), which indicated mandibular positional changes after orthodontic treatment. After mandibular voxel-based superimposition, there were no significant differences in the linear and angular measurements of mandibular structures, which indicated that the mandibular positional changes were eliminated. The intraclass correlation coefficient (ICC) value of the inter- and intra-observer agreement of all measurements was 0.99. Conclusions: This method has proven advantages in terms of accuracy, reproducibility and validity; with this method, mandibular structural and positional changes can be accurately evaluated and maxillary and mandibular structural changes can be directly compared with same 3D vectors. Full article

(This article belongs to the Topic Digital Dentistry)

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11 pages, 276 KiB

Open AccessArticle

Determinants of Arterial Pressure of Oxygen and Carbon Dioxide in Patients Supported by Veno-Arterial ECMO

by Stefan Andrei, Maxime Nguyen, Vivien Berthoud, Bastian Durand, Valerian Duclos, Marie-Catherine Morgant, Olivier Bouchot, Belaid Bouhemad and Pierre-Grégoire Guinot

J. Clin. Med. 2022, 11(17), 5228; https://doi.org/10.3390/jcm11175228 - 04 Sep 2022

Cited by 4 | Viewed by 1970

Abstract

Background: The present study aimed to assess the determinants of arterial partial pressure of oxygen (PaO₂) and carbon dioxide (PaCO₂) in the early phase of veno-arterial extracorporeal membrane oxygenation (VA ECMO) support. Even though the guidelines considered both the [...] Read more.

Background: The present study aimed to assess the determinants of arterial partial pressure of oxygen (PaO₂) and carbon dioxide (PaCO₂) in the early phase of veno-arterial extracorporeal membrane oxygenation (VA ECMO) support. Even though the guidelines considered both the risks of hypoxemia and hyperoxemia during ECMO support, there are a lack of data concerning the patients supported by VA ECMO. Methods: This is a retrospective, monocentric, observational cohort study in a university-affiliated cardiac intensive care unit. Hemodynamic parameters, ECMO parameters, ventilator settings, and blood gas analyses were collected at several time points during the first 48 h of VA ECMO support. For each timepoint, the blood samples were drawn simultaneously from the right radial artery catheter, VA ECMO venous line (before the oxygenator), and from VA ECMO arterial line (after the oxygenator). Univariate followed by multivariate mixed-model analyses were performed for longitudinal data analyses. Results: Forty-five patients with femoro-femoral peripheral VA ECMO were included. In multivariate analysis, the patients’ PaO₂ was independently associated with Q_EC, F_DO₂, and time of measurement. The patients’ PaCO₂ was associated with the sweep rate flow and the P_preCO₂. Conclusions: During acute VA ECMO support, the main determinants of patient oxygenation are determined by VA ECMO parameters. Full article

(This article belongs to the Section Intensive Care)

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16 pages, 6836 KiB

Open AccessReview

Sjögren Syndrome: New Insights in the Pathogenesis and Role of Nuclear Medicine

by Anzola Luz Kelly, Rivera Jose Nelson, Ramírez Sara and Signore Alberto

J. Clin. Med. 2022, 11(17), 5227; https://doi.org/10.3390/jcm11175227 - 04 Sep 2022

Cited by 5 | Viewed by 3920

Abstract

In the last years, new insights into the molecular basis of rheumatic conditions have been described, which have generated particular interest in understanding the pathophysiology of these diseases, in which lies the explanation of the diversity of clinical presentation and the difficulty in [...] Read more.

In the last years, new insights into the molecular basis of rheumatic conditions have been described, which have generated particular interest in understanding the pathophysiology of these diseases, in which lies the explanation of the diversity of clinical presentation and the difficulty in diagnostic and therapeutic approaches. In this review, we focus on the new pathophysiological findings for Sjögren syndrome and on the derived new SPECT and PET radiopharmaceuticals to detect inflammation of immunological origin, focusing on their role in diagnosis, prognosis, and the evaluation of therapeutic efficacy. Full article

(This article belongs to the Special Issue Diseases of the Salivary Glands—Part II)

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7 pages, 414 KiB

Open AccessArticle

Quality of Life Changes in Early-Onset Multiple Sclerosis: A 4-Year Follow-Up Study

by Laura Rosa, Maria Petracca, Antonio Carotenuto, Pasquale Dolce, Kyrie Piscopo, Francesca Dicé, Francesca Lauro, Antonio Luca Spiezia, Marcello Moccia, Luigi Lavorgna, Carmine Iacovazzo, Giuseppe Servillo, Nelson Mauro Maldonato, Alessandro Chiodi, Vincenzo Brescia Morra and Roberta Lanzillo

J. Clin. Med. 2022, 11(17), 5226; https://doi.org/10.3390/jcm11175226 - 04 Sep 2022

Cited by 3 | Viewed by 1256

Abstract

This study investigates longitudinal changes in health-related quality of life (HRQoL) in early-onset multiple sclerosis (MS) patients and explores the impact of disease activity (relapses) on such changes. People with MS (PwMS) onset between 12 and 25 years of age were followed longitudinally. [...] Read more.

This study investigates longitudinal changes in health-related quality of life (HRQoL) in early-onset multiple sclerosis (MS) patients and explores the impact of disease activity (relapses) on such changes. People with MS (PwMS) onset between 12 and 25 years of age were followed longitudinally. At baseline and at year 4, patients were asked to fill the Paediatric Quality of life inventory (PedsQL). Demographic and clinical features were collected at both time points. Longitudinal within-group comparison of HRQoL total score and sub-scores was performed via paired samples t-test. The effect of relapses on the HRQoL changes over time was explored via linear mixed-effects analysis. No longitudinal changes were observed in the overall PedsQL score, nor in the physical, school and psychological functioning. An increase in the social functioning subscale (p < 0.001) and a decrease in the emotional subscale (p = 0.006) were observed. The change in social functioning, but not the one in the emotional subscale, was affected by the occurrence of relapses (p = 0.044). In conclusion, stimulating the patients to accept their emotional responses to health-related limitations, while preserving their social and relational resources seems key to the preservation of an adequate QoL over time in juvenile-onset MS. Full article

(This article belongs to the Special Issue Multiple Sclerosis: Diagnosis, Management, and Future Opportunities)

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3 pages, 174 KiB

Open AccessEditorial

Clinical Management of Migraine

by Maria Albanese

J. Clin. Med. 2022, 11(17), 5225; https://doi.org/10.3390/jcm11175225 - 04 Sep 2022

Cited by 2 | Viewed by 1246

Abstract

Migraine is one of the most frequent neurological and vascular disorders, with an estimated global prevalence of 14 [...] Full article

(This article belongs to the Special Issue Clinical Management of Migraine)

9 pages, 245 KiB

Open AccessArticle

Aging Combined with High Waist-to-Hip Ratio Is Associated with a Higher Risk of Gastro-Esophageal Reflux Disease

by Lo-Yip Yu, Ying-Chun Lin, Yang-Che Kuo, Hung-Ju Ko, Ming-Jen Chen, Horng-Yuan Wang, Shou-Chuan Shih, Chuan-Chuan Liu and Kuang-Chun Hu

J. Clin. Med. 2022, 11(17), 5224; https://doi.org/10.3390/jcm11175224 - 04 Sep 2022

Cited by 1 | Viewed by 1314

Abstract

Background and Objective: To assess whether the combination of high waist-to-hip ratio (WHR) and elderly age is associated with higher risk of GERD. Material and Methods: A total of 16,996 subjects aged ≥20 years who received esophagogastroduodenoscopy (EGD) between January 2010 [...] Read more.

Background and Objective: To assess whether the combination of high waist-to-hip ratio (WHR) and elderly age is associated with higher risk of GERD. Material and Methods: A total of 16,996 subjects aged ≥20 years who received esophagogastroduodenoscopy (EGD) between January 2010 and December 2019. We evaluated the risk of GERD in different age groups and WHR groups in unadjusted analysis and multivariate logistic regression models for predictors of GERD. Results: There was a trend towards more participants with both age ≥65 years and WHR ≥ 1 (n = 129) (n = 66, 51%) than participants with age < 65 and WHR < 0.9 (n = 10,422) (n = 2814, 27%) presenting with GERD. Participants who had both age ≥ 65 years and high WHR ≥ 1 had the highest risk of any type of GERD (adjusted OR, 2.07; 95% CI, 1.44–2.96, p value < 0.05) based on multivariate logistic regression analysis. Conclusions: The combination of having a high WHR and being elderly was associated with a higher risk of GERD, and preventing central obesity in the elderly population reduced the risk of GERD and the requirement for medical resources. Full article

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

13 pages, 871 KiB

Open AccessReview

Gastrointestinal and Liver Complications in Patients with Diabetes Mellitus—A Review of the Literature

by Ruxandra Mare and Ioan Sporea

J. Clin. Med. 2022, 11(17), 5223; https://doi.org/10.3390/jcm11175223 - 04 Sep 2022

Cited by 6 | Viewed by 1740

Abstract

The number of diabetes mellitus patients has increased over the last few years in developing countries, along with obesity and sedentary lifestyle. Besides macroangiopathy and microangiopathy, damage to the nerve fibers of the peripheral nervous system is the most common chronic complication of [...] Read more.

The number of diabetes mellitus patients has increased over the last few years in developing countries, along with obesity and sedentary lifestyle. Besides macroangiopathy and microangiopathy, damage to the nerve fibers of the peripheral nervous system is the most common chronic complication of diabetes. Digestive complications in diabetic patients represent a consequence of diabetic autonomic neuropathy involving the gastrointestinal tract, but unfortunately not always evaluated by diabetologists. Aside from the complications encountered in the digestive tract, patients with diabetes mellitus are prone to developing liver diseases. This review will describe the prevalence of these complications, the modality of diagnosis, and therapeutical solutions in order to reduce the risk of progression of these complications in diabetic subjects. Full article

(This article belongs to the Special Issue Clinical Epidemiology of Diabetes and Its Complications)

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13 pages, 570 KiB

Open AccessArticle

Treating with Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitors (TKIs) Accompanying Lower Incidence of Second Primary Cancers

by Wen-Ru Chou, Ben-Chang Shia, Yen-Chun Huang, Chieh-Wen Ho and Mingchih Chen

J. Clin. Med. 2022, 11(17), 5222; https://doi.org/10.3390/jcm11175222 - 04 Sep 2022

Cited by 1 | Viewed by 1147

Abstract

Lung cancer survivors are at risk of developing second primary cancers (SPCs). Although some risk factors for the development of SPCs have been addressed, their impacts have not been clarified. This study, based on Taiwan’s National Health Insurance Research Database (NHIRD), a nationwide [...] Read more.

Lung cancer survivors are at risk of developing second primary cancers (SPCs). Although some risk factors for the development of SPCs have been addressed, their impacts have not been clarified. This study, based on Taiwan’s National Health Insurance Research Database (NHIRD), a nationwide database, was designed to investigate the risk factors for SPCs in patients with initial lung cancer and identify the impacts of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) treatment on the development of SPCs. In this study, 37,954 individuals were included, of whom 2819 had SPCs. These patients were further divided into the second primary lung cancers (SPLC) and second primary extrapulmonary cancer (SPEC) groups. Among the patients with lung cancer without SPCs, those aged <65 years accounted for 53.15%. Patients aged ≥65 years accounted for 40.18% and 53.24% in the SPLC and SPEC groups, respectively. Females accounted for 50.3% of patients without SPC, 54% of the SPLC group, and 44.3% of the SPEC group. Univariate and multivariate Cox proportional hazard models showed increased hazard ratios for smoking, hypertension, and diabetes mellitus, and lower HRs for surgery, chemotherapy, radiotherapy, and TKIs. Patients undergoing surgery, chemotherapy, and radiotherapy were associated with a lower risk of SPCs. Treatment with EGFR TKIs was a significant and independent factor associated with lower incidence of SPCs. This study may encourage researchers to establish predictive models based on our results to assess the risk factors for SPCs, and therefore, early screening and intervention could be applied, and the SPCs-related mortality and relevant medical costs could be reduced. Full article

(This article belongs to the Special Issue Target and Im-Oncology Therapeutic Approaches for Lung Cancer)

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