Journal of Clinical Medicine

10 pages, 12371 KiB

Open AccessArticle

Optimal Timing of Cholecystectomy for Patients with Concurrent Acute Cholecystitis and Acute Cholangitis after Successful Biliary Drainage by Interventional Endoscopic Retrograde Cholangiopancreatography

by Yau-Ren Chang, Chi-Huan Wu, Huan-Wu Chen, Yu-Liang Hung, Chia-Hsiang Hu, Ruo-Yi Huang, Min-Jung Wu, Hao-Wei Kou, Ming-Yang Chen, Chun-Yi Tsai, Shang-Yu Wang, Keng-Hao Liu, Jun-Te Hsu, Chun-Nan Yeh, Nai-Jen Liu and Yi-Yin Jan

J. Clin. Med. 2022, 11(21), 6603; https://doi.org/10.3390/jcm11216603 - 07 Nov 2022

Viewed by 2283

Abstract

Background: Concurrent acute cholecystitis and acute cholangitis is a unique clinical situation. We tried to investigate the optimal timing of cholecystectomy after adequate biliary drainage under this condition. Methods: From January 2012 to November 2017, we retrospectively screened all in-hospitalized patients [...] Read more.

Background: Concurrent acute cholecystitis and acute cholangitis is a unique clinical situation. We tried to investigate the optimal timing of cholecystectomy after adequate biliary drainage under this condition. Methods: From January 2012 to November 2017, we retrospectively screened all in-hospitalized patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and then identified patients with concurrent acute cholecystitis and acute cholangitis from the cohort. The selected patients were stratified into two groups: one-stage intervention (OSI) group (intended laparoscopic cholecystectomy at the same hospitalization) vs. two-stage intervention (TSI) group (interval intended laparoscopic cholecystectomy). Interrogated outcomes included recurrent biliary events, length of hospitalization, and surgical outcomes. Results: There were 147 patients ultimately enrolled for analysis (OSI vs. TSI, 96 vs. 51). Regarding surgical outcomes, there was no significant difference between the OSI group and TSI group, including intraoperative blood transfusion (1.0% vs. 2.0%, p = 1.000), conversion to open procedure (3.1% vs. 7.8%, p = 0.236), postoperative complication (6.3% vs. 11.8%, p = 0.342), operation time (118.0 min vs. 125.8 min, p = 0.869), and postoperative days until discharge (3.37 days vs. 4.02 days, p = 0.643). In the RBE analysis, the OSI group presented a significantly lower incidence of overall RBE (5.2% vs. 41.2%, p < 0.001) than the TSI group. Conclusions: Patients with an initial diagnosis of concurrent acute cholecystitis and cholangitis undergoing cholecystectomy after ERCP drainage during the same hospitalization period may receive some benefit in terms of clinical outcomes. Full article

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

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12 pages, 636 KiB

Open AccessArticle

Extended Pharmacist Assessment of Medication Safety for Nursing Home Residents—A Cross-Sectional and Prospective Study

by Christian Führling and Renke Maas

J. Clin. Med. 2022, 11(21), 6602; https://doi.org/10.3390/jcm11216602 - 07 Nov 2022

Cited by 1 | Viewed by 1403

Abstract

In the routine pharmacist’s medication review in ambulatory care and nursing homes in Germany, clinical diagnoses are often insufficiently considered as they are frequently not accessible to pharmacists and their electronic support tools. This may leave a significant proportion of medication-related problems (MRP) [...] Read more.

In the routine pharmacist’s medication review in ambulatory care and nursing homes in Germany, clinical diagnoses are often insufficiently considered as they are frequently not accessible to pharmacists and their electronic support tools. This may leave a significant proportion of medication-related problems (MRP) undetected and unresolved. Moreover, limited and incomplete data may promote spurious alerts of low clinical relevance. In order to assess the impact of improved data availability, we conducted a study (German Clinical Trials Register DRKS00025346) to evaluate the impact of an extended pharmacist’s medication review, made possible by diagnosis data being routinely available to the pharmacist. At six nursing homes in the Nuremberg metropolitan area, 338 patients treated by 32 physicians were enrolled. A pharmacist’s medication review, considering only the medication data, identified 114 potential MRPs, and additional consideration of diagnoses further identified 69 potential MRPs. The physicians adapted the therapy in response to 69.9% of alerts. The observed gain in MRP identified indicates that efforts should be intensified to facilitate and improve consideration of drug–diagnosis-related MRP by improving data sharing and communication between pharmacists and physicians caring for nursing home residents. Full article

(This article belongs to the Section Pharmacology)

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9 pages, 261 KiB

Open AccessArticle

Surgical and Medical Aspects of the Initial Treatment of Biliary Atresia: Position Paper

by Mark Davenport, Omid Madadi-Sanjani, Christophe Chardot, Henkjan J. Verkade, Saul J. Karpen and Claus Petersen

J. Clin. Med. 2022, 11(21), 6601; https://doi.org/10.3390/jcm11216601 - 07 Nov 2022

Cited by 2 | Viewed by 1599

Abstract

Biliary atresia, a fibro-obliterative disease of the newborn, is usually initially treated by Kasai portoenterostomy, although there are many variations in technique and different options for post-operative adjuvant medical therapy. A questionnaire on such topics (e.g., open vs. laparoscopic; the need for liver [...] Read more.

Biliary atresia, a fibro-obliterative disease of the newborn, is usually initially treated by Kasai portoenterostomy, although there are many variations in technique and different options for post-operative adjuvant medical therapy. A questionnaire on such topics (e.g., open vs. laparoscopic; the need for liver mobilisation; use of post-operative steroids; use of post-operative anti-viral therapy, etc.) was circulated to delegates (n = 43) of an international webinar (Biliary Atresia and Related Diseases—BARD) held in June 2021. Respondents were mostly European, but included some from North America, and represented 18 different countries overall. The results of this survey are presented here, together with a commentary and review from an expert panel convened for the meeting on current trends in practice. Full article

(This article belongs to the Special Issue Biliary Atresia: Aetiology, Diagnosis and Treatment)

11 pages, 2573 KiB

Open AccessArticle

Prediction Value of KREBS Von Den Lungen-6 (KL-6) Biomarker in COVID-19 Patients: A Systematic Review and Meta-Analysis

by Michal Matuszewski, Lukasz Szarpak, Zubaid Rafique, Frank W. Peacock, Michal Pruc, Piotr Szwed, Francesco Chirico, Alla Navolokina, Jerzy R. Ladny and Andrea Denegri

J. Clin. Med. 2022, 11(21), 6600; https://doi.org/10.3390/jcm11216600 - 07 Nov 2022

Cited by 6 | Viewed by 1797

Abstract

The SARS-CoV-2 (COVID-19) pandemic is a major issue that necessitates the use of cutting-edge disease prediction models. The aim of the study was to assess the existing evidence regarding association between Krebs von den Lungen-6 levels and COVID-19 severity. A literature search was [...] Read more.

The SARS-CoV-2 (COVID-19) pandemic is a major issue that necessitates the use of cutting-edge disease prediction models. The aim of the study was to assess the existing evidence regarding association between Krebs von den Lungen-6 levels and COVID-19 severity. A literature search was performed on Web of Science, PubMed, Scopus and Cochrane Central Register of Controlled Trials databases from 1 January 2020 up to 2 August 2022. The electronic database search was supplemented by searching Google Scholar. In addition, reference lists of relative articles were also reviewed. KL-6 levels among COVID-19 positive vs. negative patients varied and amounted to 443.37 ± 249.33 vs. 205.73 ± 86.8 U/mL (MD = 275.33; 95%CI: 144.57 to 406.09; p < 0.001). The KL-6 level was 402.82 ± 261.16 U/mL in the severe group and was statistically significantly higher than in the non-severe group (297.38 ± 90.46 U/mL; MD = 192.45; 95%CI: 118.19 to 266.72; p < 0.001). The KL-6 level in the mild group was 272.28 ± 95.42 U/mL, compared to 268.04 ± 55.04 U/mL in the moderate COVID-19 group (MD = −12.58; 95%CI: −21.59 to −3.57; p = 0.006). Our meta-analysis indicates a significant association between increased KL-6 levels and SARS-CoV-2 infection. Moreover, KL-6 levels are significantly higher in patients with a more severe course of COVID-19, indicating that KL-6 may be a useful predictor to identify patients at risk for severe COVID-19. Full article

(This article belongs to the Special Issue COVID-19: Clinical Advances and Challenges)

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11 pages, 1464 KiB

Open AccessArticle

Use of Maximum Tongue Pressure Values to Examine the Presence of Dysphagia after Extubation and Prevent Aspiration Pneumonia in Elderly Emergency Patients

by Ryo Ichibayashi, Hideki Sekiya, Kosuke Kaneko and Mitsuru Honda

J. Clin. Med. 2022, 11(21), 6599; https://doi.org/10.3390/jcm11216599 - 07 Nov 2022

Cited by 1 | Viewed by 1523

Abstract

Background: Tongue pressure values in patients with dysphagia are reported to be significantly lower than those in healthy controls. The aim of this study was to measure the maximum tongue pressure (MTP) values after extubation in order to assess the presence of post-extubation [...] Read more.

Background: Tongue pressure values in patients with dysphagia are reported to be significantly lower than those in healthy controls. The aim of this study was to measure the maximum tongue pressure (MTP) values after extubation in order to assess the presence of post-extubation dysphagia for the safe initiation of oral intake in elderly patients. Methods: Data from 90 patients who were extubated after mechanical ventilation under tracheal intubation were collected retrospectively. The patients were divided into two groups as follows: normal group (those who did not develop aspiration pneumonia after extubation; median age 62 years) and aspiration group (those who developed aspiration during the evaluation period; median age 75 years). The MTP values were measured at 6 h, 24 h, 3 days, and 7 days after extubation. Results: The values were significantly increased 24 h after extubation in the normal group (p < 0.05). Alternatively, no increase was observed even after 1 week of extubation in the aspiration group, and the values were significantly lower than those in the normal group. The cutoff values at 6 and 24 h after extubation, which were measured using the receiver operator characteristic (ROC) curve, were 17.8 and 23.2 kpa, respectively; furthermore, the results of these assessments were strongly related to the development of aspiration 6 h after extubation (χ²-value: 6.125; p = 0.0133). Conclusions: The presence of post-extubation dysphagia in patients who are intubated for ≥24 h can be predicted based on age and the MTP values at 6 h after extubation. Full article

(This article belongs to the Special Issue Recent Advances in Pneumonia in Older People)

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8 pages, 1502 KiB

Open AccessCase Report

Enlarged Abdominal Lymph Node as a Cause of Polyhydramnios in the Course of Congenital Neonatal Leukaemia: A Case Report and Review of the Literature on Foetal Abdominal Tumours with Coexisting Polyhydramnios

by Daria Salloum, Paweł Jan Stanirowski, Aleksandra Symonides, Paweł Krajewski, Dorota Bomba-Opoń and Mirosław Wielgoś

J. Clin. Med. 2022, 11(21), 6598; https://doi.org/10.3390/jcm11216598 - 07 Nov 2022

Viewed by 1389

Abstract

Polyhydramnios represents a complication found in 0.2–2% of pregnancies, and it is usually diagnosed between 31 and 36 weeks of pregnancy. Although most cases of polyhydramnios are idiopathic, maternal diabetes or foetal malformations constitute frequent causes of the excessive accumulation of the amniotic [...] Read more.

Polyhydramnios represents a complication found in 0.2–2% of pregnancies, and it is usually diagnosed between 31 and 36 weeks of pregnancy. Although most cases of polyhydramnios are idiopathic, maternal diabetes or foetal malformations constitute frequent causes of the excessive accumulation of the amniotic fluid. Considering the latter, polyhydramnios may rarely be caused by foetal abdominal tumours, with the incidence rate of 2–14 cases per 100,000 live births. Congenital neonatal leukaemia (CNL) is a rare disease with a reported incidence rate of 5–8.6 cases per million live births. In the prenatal period, the ultrasound abnormalities associated with CNL include hepatomegaly and splenomegaly. In this paper, we presented a case of polyhydramnios caused by mechanical pressure on the foetal gastrointestinal tract by an enlarged lymph node in the course of CNL, as well as reviewing the available literature on foetal abdominal tumours with concurrent polyhydramnios. Full article

(This article belongs to the Special Issue Update on Prenatal Diagnosis and Maternal Fetal Medicine)

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10 pages, 1040 KiB

Open AccessArticle

Reticulated Platelets and Their Relationship with Endothelial Progenitor Cells during the Acute Phase of ST-Elevation Myocardial Infarction

by Nili Schamroth Pravda, Mark Kheifets, Maya Wiessman, Dorit Leshem-Lev, Hana Vaknin Assa, Ran Kornowski, Yeela Talmor-Barkan and Leor Perl

J. Clin. Med. 2022, 11(21), 6597; https://doi.org/10.3390/jcm11216597 - 07 Nov 2022

Viewed by 1085

Abstract

Introduction: Endothelial progenitor cells (EPC) and reticulated platelets (RP) have central roles in the thrombotic and angiogenetic interactions during ST-elevation myocardial infarction (STEMI). The EPC and RP response in patients with STEMI treated by primary percutaneous intervention (PPCI) has not yet been investigated. [...] Read more.

Introduction: Endothelial progenitor cells (EPC) and reticulated platelets (RP) have central roles in the thrombotic and angiogenetic interactions during ST-elevation myocardial infarction (STEMI). The EPC and RP response in patients with STEMI treated by primary percutaneous intervention (PPCI) has not yet been investigated. Methods: We assessed EPC quantification by the expression of CD133⁺ and CD34⁺, and EPC function by the capacity of the cells to form colony-forming units (CFU) and MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) during the acute phase of STEMI. These measurements were correlated with RP at baseline and after 24 h following PPCI. Results: Our cohort included 89 consecutive STEMI-diagnosed patients enrolled between December 2018 and July 2021. At baseline, there was a strong positive correlation between reticulated platelet quantity and MTT levels (R = 0.766 and R² = 0.586, p < 0.001), CD34⁺ levels (R = 0.602, and R² = 0.362, p < 0.001); CD133⁺ levels (R = 0.666 and R² = 0.443, p < 0.001) and CFU levels (R = 0.437, R² = 0.191, p < 0.001). The multiple linear regression showed that levels of MTT (adjusted R² = 0.793; p < 0.001), CD34⁺ and CD133⁺ (adjusted R² = 0.654; p < 0.001 and adjusted R² = 0.627; p < 0.001, respectively) had strong independent correlations with RP response. At 24 h after PPCI, the correlation between RP quantity and EPC markers was not significant, except for MTT levels (R = 0.465, R² = 0.216, p < 0.001). Conclusions: In patients with STEMI, higher levels of RP at baseline are significantly correlated with a more potent EPC response. The translational significance of these findings needs further investigation. Full article

(This article belongs to the Special Issue Antithrombotic Therapy for Transcatheter Coronary and Structural Heart Interventions)

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13 pages, 10421 KiB

Open AccessArticle

Improvement of Mucosal Lesion Diagnosis with Machine Learning Based on Medical and Semiological Data: An Observational Study

by Antoine Dubuc, Anissa Zitouni, Charlotte Thomas, Philippe Kémoun, Sarah Cousty, Paul Monsarrat and Sara Laurencin

J. Clin. Med. 2022, 11(21), 6596; https://doi.org/10.3390/jcm11216596 - 07 Nov 2022

Viewed by 1498

Abstract

Despite artificial intelligence used in skin dermatology diagnosis is booming, application in oral pathology remains to be developed. Early diagnosis and therefore early management, remain key points in the successful management of oral mucosa cancers. The objective was to develop and evaluate a [...] Read more.

Despite artificial intelligence used in skin dermatology diagnosis is booming, application in oral pathology remains to be developed. Early diagnosis and therefore early management, remain key points in the successful management of oral mucosa cancers. The objective was to develop and evaluate a machine learning algorithm that allows the prediction of oral mucosa lesions diagnosis. This cohort study included patients followed between January 2015 and December 2020 in the oral mucosal pathology consultation of the Toulouse University Hospital. Photographs and demographic and medical data were collected from each patient to constitute clinical cases. A machine learning model was then developed and optimized and compared to 5 models classically used in the field. A total of 299 patients representing 1242 records of oral mucosa lesions were used to train and evaluate machine learning models. Our model reached a mean accuracy of 0.84 for diagnostic prediction. The specificity and sensitivity range from 0.89 to 1.00 and 0.72 to 0.92, respectively. The other models were proven to be less efficient in performing this task. These results suggest the utility of machine learning-based tools in diagnosing oral mucosal lesions with high accuracy. Moreover, the results of this study confirm that the consideration of clinical data and medical history, in addition to the lesion itself, appears to play an important role. Full article

(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)

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12 pages, 585 KiB

Open AccessArticle

Adverse Birth and Child Outcomes in Children Fathered by Men Treated with Antidiabetics Prior to Conception: A Nationwide Cohort Study

by Bente Mertz Nørgård, Jens Fedder, Line Riis Jølving, Per Damkier and Jan Nielsen

J. Clin. Med. 2022, 11(21), 6595; https://doi.org/10.3390/jcm11216595 - 07 Nov 2022

Cited by 2 | Viewed by 1471

Abstract

Background: The safety of fathers’ use of antidiabetic drugs in terms of child outcomes is an important clinical question. We aimed to assess the risk of adverse birth and early childhood outcomes after fathers’ use of antidiabetics prior to conception. Methods: A nationwide [...] Read more.

Background: The safety of fathers’ use of antidiabetic drugs in terms of child outcomes is an important clinical question. We aimed to assess the risk of adverse birth and early childhood outcomes after fathers’ use of antidiabetics prior to conception. Methods: A nationwide cohort study based on Danish health registries. The study comprised all live born singleton children in Denmark (1997 through 2018). Children were categorized according to fathers’ filled prescriptions for antidiabetic drugs three months prior to conception. Exposed cohorts: children born after paternal use of insulin or non-insulin anti-hyperglycemic agents. The unexposed constituted children born by fathers not treated with antidiabetics prior to conception. We examined adverse birth outcomes (preterm birth, small for gestational age (SGA)), and adverse childhood outcomes in the first year of life (major congenital malformations (MCMs), and infections diagnosed at a hospital). Results: A total of 1,318,684 children were included. In all, 5527 children were born after paternal use of insulin, 2121 after use of non-insulin anti-hyperglycemic agents, and 1,311,036 were unexposed. After fathers’ use of insulin we did not find increased risk of adverse outcomes. After fathers’ use of metformin, the adjusted OR of MCMs was 1.40 (95% CI 1.11–1.76). After fathers’ use of sulfonylureas, the adjusted OR of SGA was 1.80 (95% CI 1.11–2.93), and for child gastrointestinal infections the adjusted HR was 1.76 (95% CI 1.04–2.99). Conclusions: Fathers’ use of insulin was reassuring. Metformin and sulfonylureas were associated with selected adverse outcomes. Our findings suggest an additional 14 MCMs per 1000 fathers exposed to metformin prior to conception. As there is no meaningful supporting biological rationale, these findings should be confirmed in a different population prior to clinical consequences being drawn. Full article

(This article belongs to the Section Reproductive Medicine & Andrology)

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11 pages, 7948 KiB

Open AccessCase Report

Autonomous Robotic Surgery for Immediately Loaded Implant-Supported Maxillary Full-Arch Prosthesis: A Case Report

by Shuo Yang, Jiahao Chen, An Li, Ping Li and Shulan Xu

J. Clin. Med. 2022, 11(21), 6594; https://doi.org/10.3390/jcm11216594 - 07 Nov 2022

Cited by 25 | Viewed by 3309

Abstract

Robotic systems have emerged in dental implant surgery due to their accuracy. Autonomous robotic surgery may offer unprecedented advantages over conventional alternatives. This clinical protocol was used to show the feasibility of autonomous robotic surgery for immediately loaded implant-supported full-arch prostheses in the [...] Read more.

Robotic systems have emerged in dental implant surgery due to their accuracy. Autonomous robotic surgery may offer unprecedented advantages over conventional alternatives. This clinical protocol was used to show the feasibility of autonomous robotic surgery for immediately loaded implant-supported full-arch prostheses in the maxilla. This case report demonstrated the surgical protocol and outcomes in detail, highlighting the pros and cons of the autonomous robotic system. Within the limitations of this study, autonomous robotic surgery could be a feasible alternative to computer-assisted guided implant surgery. Full article

(This article belongs to the Special Issue Current Trends and Future Directions in Prosthetic and Implant Dentistry in the Digital Era—Part II)

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19 pages, 6679 KiB

Open AccessReview

Efficacy of the Adjunct Use of Povidone-Iodine or Sodium Hypochlorite with Non-Surgical Management of Periodontitis: A Systematic Review and Meta-Analysis

by Marwan El Mobadder, Samir Nammour, Zuzanna Grzech-Leśniak and Kinga Grzech-Leśniak

J. Clin. Med. 2022, 11(21), 6593; https://doi.org/10.3390/jcm11216593 - 07 Nov 2022

Cited by 3 | Viewed by 1665

Abstract

This systematic review sought to assess the efficacy of combining either sodium hypochlorite or povidone-iodine as disinfection solutions with non-surgical treatment of periodontitis. An electronic search was conducted through PubMed, Scopus, Web of Science, CENTRAL, and Google Scholar from inception until 10 September [...] Read more.

This systematic review sought to assess the efficacy of combining either sodium hypochlorite or povidone-iodine as disinfection solutions with non-surgical treatment of periodontitis. An electronic search was conducted through PubMed, Scopus, Web of Science, CENTRAL, and Google Scholar from inception until 10 September 2022. Outcomes included clinical outcomes (probing pocket depth, plaque index, clinical attachment level, relative-horizontal attachment level, bleeding on probing, gingival recession, the position of gingival margin) and biochemical (BAPNA level) properties. A subgroup analysis was conducted according to the assessment timepoint. Ten studies reporting the use of povidone-iodine and five studies reporting the use of sodium hypochlorite were included in this review. Overall, in the meta-analysis of povidone-iodine, no significant changes were noted in any of the assessed outcomes; however, minor changes were noted in probing pocket depth and clinical attachment level at a specific timepoint. Regarding sodium hypochlorite, a significant reduction in all clinical outcomes, except for bleeding on probing, was noted. In conclusion, the use of povidone-iodine does not result in an improvement in clinical outcomes, whereas sodium hypochlorite has promising properties that result in significant improvement in probing pocket depth and clinical attachment level. However, more studies are needed to confirm these observations. Full article

(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)

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14 pages, 1815 KiB

Open AccessArticle

Cardiac Troponin I Reveals Diagnostic and Prognostic Superiority to Aminoterminal Pro-B-Type Natriuretic Peptide in Sepsis and Septic Shock

by Jan Forner, Tobias Schupp, Kathrin Weidner, Jonas Rusnak, Schanas Jawhar, Floriana Dulatahu, Lea Marie Brück, Michael Behnes, Ursula Hoffmann, Thomas Bertsch, Maximilian Kittel and Ibrahim Akin

J. Clin. Med. 2022, 11(21), 6592; https://doi.org/10.3390/jcm11216592 - 07 Nov 2022

Cited by 9 | Viewed by 1393

Abstract

Data regarding the prognostic value of cardiac biomarkers in patients suffering from sepsis or septic shock is scarce. Studies investigating the prognostic role of cardiac biomarkers in patients with sepsis and septic shock were commonly published prior to the sepsis-3 criteria and were [...] Read more.

Data regarding the prognostic value of cardiac biomarkers in patients suffering from sepsis or septic shock is scarce. Studies investigating the prognostic role of cardiac biomarkers in patients with sepsis and septic shock were commonly published prior to the sepsis-3 criteria and were often not restricted to septic patients only, too. This study investigated the diagnostic and prognostic value of the aminoterminal pro-B-type Natriuretic Peptide (NT-pro BNP) and cardiac troponin I (cTNI) in patients with sepsis and septic shock. Consecutive patients with sepsis and septic shock were included from 2019 to 2021. Blood samples were retrieved from the day of disease onset (i.e., day 1), day 2 and 3. Firstly, the diagnostic value of the NT-pro BNP and cTNI to diagnose sepsis or septic shock was tested. Secondly, the prognostic value of the NT-pro BNP and cTNI was examined with regard to the 30-day all-cause mortality. The statistical analyses included univariable t-tests, Spearman’s correlations, C-statistics, Kaplan–Meier analyses and Cox proportional regression analyses. A total of 162 patients were included prospectively, of which 57% had a sepsis and 43% a septic shock. The overall rate of all-cause mortality at 30 days was 53%. With an area under the curve (AUC) of 0.658 on day 1 and 0.885 on day 3, cTNI expressed a better diagnostic value than NT-pro BNP, especially on day 3 (ΔAUCd3 = 0.404; p = 0.022). Furthermore, cTNI displayed a moderate but slightly better prognostic value than NT-pro BNP on all examined days (AUC for cTNI, d1 = 0.635; 95% CI 0.541–0.729; p = 0.007 vs. AUC for NT-pro BNP, d1 = 0.582; 95% CI 0.477–0.687; p = 0.132). In conclusion, cTNI was a reliable diagnostic parameter for the diagnosis of sepsis and septic shock, as well as a reliable prognostic tool with regard to 30-day all-cause mortality in patients suffering from sepsis and septic shock. Full article

(This article belongs to the Section Intensive Care)

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27 pages, 1792 KiB

Open AccessReview

Current Strategies to Control Recurrent and Residual Caries with Resin Composite Restorations: Operator- and Material-Related Factors

by Moataz Elgezawi, Rasha Haridy, Moamen A. Abdalla, Katrin Heck, Miriam Draenert and Dalia Kaisarly

J. Clin. Med. 2022, 11(21), 6591; https://doi.org/10.3390/jcm11216591 - 07 Nov 2022

Cited by 9 | Viewed by 5293

Abstract

This review addresses the rationale of recurrent and/or residual caries associated with resin composite restorations alongside current strategies and evidence-based recommendations to arrest residual caries and restrain recurrent caries. The PubMed and MEDLINE databases were searched for composite-associated recurrent/residual caries focusing on predisposing [...] Read more.

This review addresses the rationale of recurrent and/or residual caries associated with resin composite restorations alongside current strategies and evidence-based recommendations to arrest residual caries and restrain recurrent caries. The PubMed and MEDLINE databases were searched for composite-associated recurrent/residual caries focusing on predisposing factors related to materials and operator’s skills; patient-related factors were out of scope. Recurrent caries and fractures are the main reasons for the failure of resin composites. Recurrent and residual caries are evaluated differently with no exact distinguishment, especially for wall lesions. Recurrent caries correlates to patient factors, the operator’s skills of cavity preparation, and material selection and insertion. Material-related factors are significant. Strong evidence validates the minimally invasive management of deep caries, with concerns regarding residual infected dentin. Promising technologies promote resin composites with antibacterial and remineralizing potentials. Insertion techniques influence adaptation, marginal seal, and proximal contact tightness. A reliable diagnostic method for recurrent or residual caries is urgently required. Ongoing endeavors cannot eliminate recurrent caries or precisely validate residual caries. The operator’s responsibility to precisely diagnose original caries and remaining tooth structure, consider oral environmental conditions, accurately prepare cavities, and select and apply restorative materials are integral aspects. Recurrent caries around composites requires a triad of attention where the operator’s skills are cornerstones. Full article

(This article belongs to the Special Issue Recent Advances in the Management of Dental Caries)

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20 pages, 1372 KiB

Open AccessReview

PSMA Expression in Solid Tumors beyond the Prostate Gland: Ready for Theranostic Applications?

by Chiara Lauri, Lorenzo Chiurchioni, Vincenzo Marcello Russo, Luca Zannini and Alberto Signore

J. Clin. Med. 2022, 11(21), 6590; https://doi.org/10.3390/jcm11216590 - 07 Nov 2022

Cited by 14 | Viewed by 3206

Abstract

In the past decades, the expanding use of prostate-specific membrane antigen (PSMA) imaging for prostate cancer has led to the incidental detection of a lot of extra-prostatic malignancies showing an increased uptake of PSMA. Due to these incidental findings, the increasing amount of [...] Read more.

In the past decades, the expanding use of prostate-specific membrane antigen (PSMA) imaging for prostate cancer has led to the incidental detection of a lot of extra-prostatic malignancies showing an increased uptake of PSMA. Due to these incidental findings, the increasing amount of immunohistochemistry studies and the deeper knowledge of the mechanisms of expression of this antigen, it is now clear that “PSMA” is a misnomer, since it is not specific to the prostate gland. Nevertheless, this lack of specificity could represent an interesting opportunity to bring new insights on the biology of PSMA and its sites of expression to image and treat new conditions, particularly several cancers. In this review, we will describe the main extra-prostatic cancers that exhibit PSMA expression and that can be studied with PSMA-based positron emission tomography–computed tomography (PET/CT) as an additional or alternative tool to conventional imaging. In particular, we will focus on cancers in which a radioligand therapy with ¹⁷⁷lutetium has been attempted, aiming to provide an overview of the possible future theragnostic applications of PSMA. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM - Nuclear Medicine & Radiology)

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10 pages, 1419 KiB

Open AccessArticle

Decline in Walking Independence and Related Factors in Hospitalization for Dialysis Initiation: A Retrospective Cohort Study

by Yuma Hirano, Tomoyuki Fujikura, Kenichi Kono, Naro Ohashi, Tomoya Yamaguchi, Wataru Hanajima, Hideo Yasuda and Katsuya Yamauchi

J. Clin. Med. 2022, 11(21), 6589; https://doi.org/10.3390/jcm11216589 - 07 Nov 2022

Cited by 2 | Viewed by 1429

Abstract

Patients with chronic kidney disease require intervention planning because their physical function declines with worsening disease. Providers can work closely with patients during the induction phase of dialysis. This single-center, retrospective observational study aimed to investigate the rate of decline in walking independence [...] Read more.

Patients with chronic kidney disease require intervention planning because their physical function declines with worsening disease. Providers can work closely with patients during the induction phase of dialysis. This single-center, retrospective observational study aimed to investigate the rate of decline in walking independence during the induction phase of dialysis and the factors that influence this decline, and to provide information on prevention and treatment during this period. Of the 354 patients who were newly initiated on hemodialysis between April 2018 and January 2022, 285 were included in the analysis. The functional independence measure-walking score was used to sort patients into decreased walking independence (DWI; n = 46) and maintained walking independence (no DWI; n = 239) groups, and patient characteristics were compared. After adjusting for various factors by logistic regression analysis, we observed that age, high Charlson comorbidity index (CCI), C-reactive protein, and emergency dialysis start (EDS) were significant predictors of DWI. Even during the very short period of dialysis induction, as many as 16.1% of patients had DWI, which was associated with older age, higher CCI, higher inflammation, and EDS. Therefore, we recommend the early identification of patients with these characteristics and early rehabilitation. Full article

(This article belongs to the Special Issue Recent Progress in Rehabilitation Medicine)

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18 pages, 2381 KiB

Open AccessArticle

Management and Clinical Outcome of Aortic Graft Infections: A Single-Center Retrospective Study

by Jinting Ge, Chengxin Weng, Jichun Zhao, Ding Yuan, Bin Huang and Tiehao Wang

J. Clin. Med. 2022, 11(21), 6588; https://doi.org/10.3390/jcm11216588 - 07 Nov 2022

Cited by 2 | Viewed by 1477

Abstract

Background: This study aimed to evaluate the outcome of various treatment options for aortic graft infection (AGI) patients and identify factors affecting their prognosis. Methods: The data of AGI patients from January 2008 to December 2019 were retrospectively collected and analyzed. The primary [...] Read more.

Background: This study aimed to evaluate the outcome of various treatment options for aortic graft infection (AGI) patients and identify factors affecting their prognosis. Methods: The data of AGI patients from January 2008 to December 2019 were retrospectively collected and analyzed. The primary endpoints were 30-day mortality and perioperative complication-related morbidity; the secondary endpoints were re-infection (RI) rates, primary and secondary graft patency, overall mortality, duration of antibiotic therapy, and the number of antibiotic types used in treatment. Results: There was no significant difference in the 30-day mortality and perioperative-related complications between the conservative treatment, in-situ reconstruction (ISR), and extra-anatomic reconstruction (EAR) groups. The ISR group had lower re-infection rates and better overall survival rates than the EAR and conservative treatment groups. Different bypass graft conduits had no significant influence on the RI rate or primary and secondary graft patency. AGI patients infected with high-virulence pathogens had higher RI and overall mortality rates than those infected with low virulence pathogens, but this was not statistically significant. Initial procedures prior to the AGI also had no influence on the prognosis of AGI patients. Patients undergoing ISR or EAR surgery received antibiotic therapy for a longer duration than patients undergoing conservative treatment. Patients without RI received more types of antibiotics than patients with RI. Conclusions: ISR had lower RI rates and better overall survival rates than EAR and conservative treatment and may be a better choice for patients with AGI. Several factors were found to have no influence on patients’ prognosis however, further studies are required. Full article

(This article belongs to the Section Vascular Medicine)

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11 pages, 316 KiB

Open AccessStudy Protocol

Effects of Microencapsulated Sodium Butyrate, Probiotics and Short Chain Fructooligosaccharides in Patients with Irritable Bowel Syndrome: A Study Protocol of a Randomized Double-Blind Placebo-Controlled Trial

by Anita Gąsiorowska, Marek Romanowski, Ewa Walecka-Kapica, Aleksandra Kaczka, Cezary Chojnacki, Milena Padysz, Marta Siedlecka, Joanna B. Bierła, Robert E. Steinert and Bożena Cukrowska

J. Clin. Med. 2022, 11(21), 6587; https://doi.org/10.3390/jcm11216587 - 07 Nov 2022

Cited by 1 | Viewed by 3697

Abstract

Irritable bowel syndrome (IBS) is a functional gastrointestinal disease in the pathogenesis of which gut dysbiosis may play an important role. Thus, probiotics, prebiotics, or microbiota metabolites, such as butyric acid, are considered to be effective therapy for IBS. However, there are still [...] Read more.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disease in the pathogenesis of which gut dysbiosis may play an important role. Thus, probiotics, prebiotics, or microbiota metabolites, such as butyric acid, are considered to be effective therapy for IBS. However, there are still no trials presenting the efficacy of these three biotic components administered simultaneously. This study aims to evaluate the effects of the product comprising sodium butyrate, probiotics, and short-chain fructooligosaccharides (scFOS) on the severity of clinical IBS symptoms and the quality of life (IBS-QOL). This is a randomized double-blind placebo-controlled trial conducted in 120 adults with IBS diagnosed according to Rome IV criteria. The intervention group (n = 60) will receive a mixture of the following components: 300 mg of colon-targeted microencapsulated sodium butyrate combined with probiotic Lactobacillus strains (L. rhamnosus and L. acidophilus) and Bifidobacterium strains (B. longum, B. bifidum, B. lactis), and 64 mg of prebiotic scFOS. The control group (n = 60) will receive a placebo (maltodextrin). The primary outcomes will be changes in IBS symptoms with the use of the IBS-Severity Scoring System (IBS-SSS), IBS-Global Improvement Scale (IBS-GIS), IBS-Adequate Relief (IBS-AR), and IBS-QOL after 12 weeks of intervention. The secondary outcomes will be the type of stools, patient-recorded symptoms, adverse events, anthropometric and nutritional parameters, and inflammatory cytokine levels. The findings will provide the first evidence of the use of a combination of three biotic compounds in IBS. The study was registered in the clinicaltrials.gov registry under the number NCT05013060. Full article

(This article belongs to the Special Issue The Role of Gut Microbiome in Health and Disease: A Clinical Update)

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12 pages, 299 KiB

Open AccessArticle

COVID-19 Fear and Anxiety among Patients with Chronic Heart Failure: A Cross Sectional Study

by Osama Alkouri, Yousef Khader, Issa M. Hweidi, Muntaha K. Gharaibeh, Mohamad Jarrah, Khaldoun M. Hamdan, Amina Al Marzouqi and Khaldoun Khamaiseh

J. Clin. Med. 2022, 11(21), 6586; https://doi.org/10.3390/jcm11216586 - 07 Nov 2022

Cited by 6 | Viewed by 1650

Abstract

Although the current management of COVID-19 is mainly focused on efficacious vaccine and infection control, the most common psychological reactions (such as fear and anxiety) associated with the COVID-19 pandemic have not been investigated and even neglected in patients with heart failure who [...] Read more.

Although the current management of COVID-19 is mainly focused on efficacious vaccine and infection control, the most common psychological reactions (such as fear and anxiety) associated with the COVID-19 pandemic have not been investigated and even neglected in patients with heart failure who are at greater risk for morbidity and mortality. We assessed COVID-19 related fear and anxiety among patients with heart failure and determined their associated factors. A cross sectional survey was conducted among 300 consecutive patients with heart failure during the period of March 2021–June 2021. Almost 50.7% of patients had fear of COVID-19 and 36.3% had coronavirus anxiety. Age > 55 was significantly associated with increased odds of fear (OR = 2.6) and anxiety (OR = 4.3). Patients with angina were more likely to have fear (OR = 3.0) and anxiety (OR = 2.2) and patients with chronic lung disease were more likely to have fear (OR = 3.0) and anxiety (OR = 3.3). Increased age, having angina, and having chronic lung disease were associated with increased odds of fear of COVID-19 and coronavirus anxiety. Psychological support needs to be integrated in patient care with special attention to physiological risk factors that are associated with COVID-19 comorbidities. Full article

(This article belongs to the Topic Fighting against COVID-19: Latest Advances, Challenges and Methodologies)

13 pages, 939 KiB

Open AccessArticle

Ureterovesical Anastomosis Complications in Kidney Transplantation: Definition, Risk Factor Analysis, and Prediction by Quantitative Fluorescence Angiography with Indocyanine Green

by Andreas L. H. Gerken, Kai Nowak, Alexander Meyer, Maximilian C. Kriegmair, Christel Weiss, Bernhard K. Krämer, Pauline Glossner, Katharina Heller, Ioannis Karampinis, Frank Kunath, Nuh N. Rahbari, Kay Schwenke, Christoph Reissfelder, Werner Lang and Ulrich Rother

J. Clin. Med. 2022, 11(21), 6585; https://doi.org/10.3390/jcm11216585 - 07 Nov 2022

Cited by 1 | Viewed by 1187

Abstract

Ureteral stenosis and urinary leakage are relevant problems after kidney transplantation. A standardized definition of ureterovesical anastomosis complications after kidney transplantation has not yet been established. This study was designed to demonstrate the predictive power of quantitative indocyanine green (ICG) fluorescence angiography. This [...] Read more.

Ureteral stenosis and urinary leakage are relevant problems after kidney transplantation. A standardized definition of ureterovesical anastomosis complications after kidney transplantation has not yet been established. This study was designed to demonstrate the predictive power of quantitative indocyanine green (ICG) fluorescence angiography. This bicentric historic cohort study, conducted between November 2015 and December 2019, included 196 kidney transplantations. The associations between quantitative perfusion parameters of near-infrared fluorescence angiography with ICG and the occurrence of different grades of ureterovesical anastomosis complications in the context of donor, recipient, periprocedural, and postoperative characteristics were evaluated. Post-transplant ureterovesical anastomosis complications occurred in 18%. Complications were defined and graded into three categories. They were associated with the time on dialysis (p = 0.0025), the type of donation (p = 0.0404), and the number of postoperative dialysis sessions (p = 0.0173). Median ICG ingress at the proximal ureteral third was 14.00 (5.00–33.00) AU in patients with and 23.50 (4.00–117.00) AU in patients without complications (p = 0.0001, cutoff: 16 AU, sensitivity 70%, specificity 70%, AUC = 0.725, p = 0.0011). The proposed definition and grading of post-transplant ureterovesical anastomosis complications is intended to enable valid comparisons between studies. ICG Fluorescence angiography allows intraoperative quantitative assessment of ureteral microperfusion during kidney transplantation and is able to predict the incidence of ureterovesical anastomosis complications. Registration number: NCT-02775838. Full article

(This article belongs to the Section Clinical Guidelines)

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2 pages, 179 KiB

Open AccessEditorial

Left Main Coronary Artery Percutaneous Coronary Intervention

by Arnaud Ferrante and Paul Guedeney

J. Clin. Med. 2022, 11(21), 6584; https://doi.org/10.3390/jcm11216584 - 07 Nov 2022

Viewed by 892

Abstract

Left main coronary artery (LMCA) revascularization remains a critical part of coronary artery disease (CAD) management as it improves patients’ prognoses by reducing all-cause and cardiac mortality [...] Full article

(This article belongs to the Section Cardiology)

12 pages, 652 KiB

Open AccessArticle

Long-Term Follow-Up of Catheter Ablation for Premature Ventricular Complexes in the Modern Era: The Importance of Localization and Substrate

by Simone Gulletta, Alessio Gasperetti, Marco Schiavone, Gabriele Paglino, Pasquale Vergara, Paolo Compagnucci, Caterina Bisceglia, Manuela Cireddu, Nicolai Fierro, Giuseppe D’Angelo, Simone Sala, Lorenzo Rampa, Michela Casella, Patrizio Mazzone, Antonio Dello Russo, Giovanni Battista Forleo and Paolo Della Bella

J. Clin. Med. 2022, 11(21), 6583; https://doi.org/10.3390/jcm11216583 - 06 Nov 2022

Cited by 2 | Viewed by 2173

Abstract

Background: Large-scale studies evaluating long-term recurrence rates in both idiopathic and non-idiopathic PVC catheter ablation (CA) patients have not been reported. Objective: To evaluate the efficacy and safety of idiopathic and non-idiopathic PVC CA, investigating the predictors of acute and long-term efficacy. Methods: [...] Read more.

Background: Large-scale studies evaluating long-term recurrence rates in both idiopathic and non-idiopathic PVC catheter ablation (CA) patients have not been reported. Objective: To evaluate the efficacy and safety of idiopathic and non-idiopathic PVC CA, investigating the predictors of acute and long-term efficacy. Methods: This retrospective multicentric study included 439 patients who underwent PVC CA at three institutions from April-2015 to December-2021. Clinical success at 6 months’ follow-up, defined as a reduction of at least 80% of the pre-procedural PVC burden, was deemed the primary outcome. The secondary aims of the study were: clinical success at the last available follow-up, predictors of arrhythmic recurrences at long-term follow-up, and safety outcomes. Results: The median age was 51 years, with 24.9% patients being affected suffering from structural heart disease. The median pre-procedural PVC burden was 20.1%. PVCs originating from the RVOT were the most common index PVC observed (29.1%), followed by coronary cusp (CC) and non-outflow tract (OT) LV PVCs (23.1% and 19.0%). The primary outcome at 6 months was reached in 85.1% cases, with a significant reduction in the 24 h% PVC burden (−91.4% [−83.4; −96.7], p < 0.001); long-term efficacy was observed in 82.1% of cases at almost 3-year follow-up. The presence of underlying structural heart disease and non-OT LV region origin (aHR 1.77 [1.07–2.93], p = 0.027 and aHR = 1.96 [1.22–3.14], p = 0.005) was independently associated with recurrences. Conclusion: CA of both idiopathic and non-idiopathic PVCs showed a very good acute and long-term procedural success rate, with an overall low complication. Predictors of arrhythmic recurrence at follow-up were underlying structural heart disease and non-OT LV origin. Full article

(This article belongs to the Special Issue Advances in Cardiac Electrophysiology and Pacing)

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11 pages, 1271 KiB

Open AccessArticle

End-Stage Renal Disease Patients Undergoing Hemodialysis Have Higher Possibility of Return of Spontaneous Circulation during Out-of-Hospital Cardiac Arrest and Non-Inferior Short-Term Survival

by Ming-Shun Hsieh, Amrita Chattopadhyay, Tzu-Pin Lu, Shu-Hui Liao, Chia-Ming Chang, Yi-Chen Lee, Wei-En Lo, Jia-Jun Wu, Vivian Chia-Rong Hsieh, Sung-Yuan Hu and Chorng-Kuang How

J. Clin. Med. 2022, 11(21), 6582; https://doi.org/10.3390/jcm11216582 - 06 Nov 2022

Viewed by 1515

Abstract

End-stage renal disease (ESRD) patients on long-term hemodialysis (HD) have an elevated risk of sudden cardiac death. This study hypothesizes, for the first time, that these patients have a higher odds of return of spontaneous circulation (ROSC) and subsequent better hospital-outcomes, post out-of-hospital [...] Read more.

End-stage renal disease (ESRD) patients on long-term hemodialysis (HD) have an elevated risk of sudden cardiac death. This study hypothesizes, for the first time, that these patients have a higher odds of return of spontaneous circulation (ROSC) and subsequent better hospital-outcomes, post out-of-hospital cardiac arrest (OHCA), as opposed to non-ESRD patients. A national database from Taiwan was utilized, in which 101,876 ESRD patients undergoing HD and propensity score-matched non-ESRD patients were used to conduct two analyses: (i) Cox-proportional-hazards-regression for OHCA incidence and (ii) logistic-regression analysis of attaining ROSC after OHCA, both for ESRD patients in comparison to non-ESRD patients. Kaplan-Meier analyses were conducted to determine the difference of survival rates after ROSC between the two cohorts. ESRD patients were found to be at a higher risk of OHCA (adjusted-HR = 2.11, 95% CI: (1.89–2.36), p < 0.001); however, they were at higher odds of attaining ROSC (adjusted-OR = 2.47, 95% CI: 1.90–3.21, p < 0.001), as opposed to non-ESRDs. Further, Kaplan-Meier analysis demonstrated ESRD patients with a better 30-day hospital survival rate than non-ESRD patients. Although ESRD patients had a higher risk of OHCA, they demonstrated higher possibility of ROSC and a better short-term hospital outcome than non-ESRDs. Chronic toxin tolerance and the training of vascular-compliance during regular HD may be possible explanations for better outcomes in ESRD patients. Full article

(This article belongs to the Section Emergency Medicine)

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10 pages, 1396 KiB

Open AccessArticle

Impact of the COVID-19 Pandemic on Solid Organ Transplant and Rejection Episodes in Brazil’s Unified Healthcare System

by Luis Gustavo Modelli de Andrade, Abner Macola Pacheco Barbosa, Naila Camila da Rocha, Marilia Mastrocolla de Almeida Cardoso, Juliana Tereza Coneglian de Almeida, Juliana Machado-Rugolo, Lucas Frederico Arantes, Daniela Ferreira Salomão Pontes and Gustavo Fernandes Ferreira

J. Clin. Med. 2022, 11(21), 6581; https://doi.org/10.3390/jcm11216581 - 06 Nov 2022

Cited by 5 | Viewed by 1606

Abstract

Background: Brazil has the world’s largest public organ transplant program, which was severely affected by the COVID-19 pandemic. The primary aim of the study was to evaluate differences in solid organ transplants and rejection episodes during the COVID-19 pandemic compared to the five [...] Read more.

Background: Brazil has the world’s largest public organ transplant program, which was severely affected by the COVID-19 pandemic. The primary aim of the study was to evaluate differences in solid organ transplants and rejection episodes during the COVID-19 pandemic compared to the five years before the pandemic in the country. Methods: A seven-year database was built by downloading data from the DATASUS server. The pandemic period was defined as March 2020 to December 2021. The pre-pandemic period was from January 2015 to March 2020. Results: During the pandemic, the number of solid organ transplants decreased by 19.3% in 2020 and 22.6% in 2021 compared to 2019. We found a decrease for each evaluated organ, which was more pronounced for lung, pancreas, and kidney transplants. The seasonal plot of rejection data indicated a high rejection rate between 2018 and 2021. There was also an 18% (IRR 1.18 (95% CI 1.01 to 1.37), p = 0.04) increase in the rejection rate during the COVID-19 pandemic. Conclusions: The total number of organ transplants performed in 2021 represents a setback of six years. Transplant procedures were concentrated in the Southeast region of the country, and a higher proportion of rejections occurred during the pandemic. Together, these findings could have an impact on transplant procedures and outcomes in Brazil. Full article

(This article belongs to the Section Nephrology & Urology)

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9 pages, 226 KiB

Open AccessSystematic Review

Bilateral Knee Arthroplasty in Patients Affected by Windswept Deformity: A Systematic Review

by Eugenio Cammisa, Iacopo Sassoli, Matteo La Verde, Stefano Fratini, Vito Gaetano Rinaldi, Giada Lullini, Vittorio Vaccari, Stefano Zaffagnini and Giulio Maria Marcheggiani Muccioli

J. Clin. Med. 2022, 11(21), 6580; https://doi.org/10.3390/jcm11216580 - 06 Nov 2022

Cited by 3 | Viewed by 1391

Abstract

Background: “Windswept” deformity (WSD) consists of a non-frequent condition in which the patient presents a valgus deformity in one knee and a varus deformity in the other. We performed a review of the available literature to aggregate the accessible data on the outcomes [...] Read more.

Background: “Windswept” deformity (WSD) consists of a non-frequent condition in which the patient presents a valgus deformity in one knee and a varus deformity in the other. We performed a review of the available literature to aggregate the accessible data on the outcomes of bilateral knee arthroplasty in patients with WSD and to discuss the surgical challenges that this condition might pose. Methods: A systematic review of the literature following the PRISMA guidelines was conducted. The relevant studies between 1979 and 2021 were identified. Four studies with a total of 68 patients were included for analysis. The mean follow-up for varus knees was 3.3 years, 3.1 years for valgus knees. The quality and rigor of the included studies was assessed using the Methodological index for non-randomized studies (MINORS). Results: All the studies reported improvement in knee function following knee replacement surgery, and a reduction in axial deviation of both knees, with similar results in valgus and varus knees in terms of patient satisfaction. The most relevant data were that unicompartmental knee arthroplasty (UKA) allowed for limited axial correction with slightly inferior functional results. Kinematic alignment (KA) allowed for similar results in both knees. Conclusion: The present review shows how satisfactory results can be achieved in both knees in patients with WSD and osteoarthrosis (OA). However, the operating surgeon should be aware of the importance of the implant choice in terms of functional outcomes. In the absence of extra-articular deformities, calipered KA total knee arthroplasty (TKA) can be performed on both knees with good axial correction and functional outcome. Level of evidence: II —Systematic review of cohort studies. Full article

(This article belongs to the Special Issue Joint Repair and Replacement: Clinical Updates and Perspectives)

11 pages, 2062 KiB

Open AccessArticle

Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Hypothalamic Hamartoma: Surgical Approach and Treatment Outcomes

by Yuan Yao, Xiu Wang, Wenhan Hu, Chao Zhang, Lin Sang, Zhong Zheng, Jiajie Mo, Chang Liu, Jiaji Qiu, Xiaoqiu Shao, Jianguo Zhang and Kai Zhang

J. Clin. Med. 2022, 11(21), 6579; https://doi.org/10.3390/jcm11216579 - 06 Nov 2022

Cited by 3 | Viewed by 1454

Abstract

Hypothalamic hamartoma (HH) is a rare lesion consisting of normal neurons and neuroglia arranged in an abnormal pattern which usually causes gelastic seizures (GS). Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has been developed as a minimally invasive approach to treat HH and [...] Read more.

Hypothalamic hamartoma (HH) is a rare lesion consisting of normal neurons and neuroglia arranged in an abnormal pattern which usually causes gelastic seizures (GS). Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has been developed as a minimally invasive approach to treat HH and gradually become a first-line treatment. In total, this study enrolled 47 consecutive HH patients that underwent one round of ablation. Patients were followed for at least one year. Patients’ medical records and surgical information were carefully reviewed, and univariate analyses were performed. Of the treated patients, 72.3% remained GS-free in this study, with an overall Engel class I rate of 68.1%. Long-term postoperative complications occurred in six patients. Factors associated with GS prognosis included Delalande classification (p = 0.033), HH volume (p = 0.01), and the ablation rate of the HH body (p = 0.035). The disconnection rate was 0.73 ± 0.14 in the Engel class Ia group as compared to 0.62 ± 0.13 in the Engel Ib–Engel IV group (p = 0.046). MRgLITT represents a safe and effective surgical procedure. Patients with larger or Delalande type IV HH may require multiple rounds of ablation. In addition to assessing the degree of disconnection, ablation volume should also be carefully considered for patients undergoing this procedure. Full article

(This article belongs to the Section Clinical Neurology)

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10 pages, 1701 KiB

Open AccessArticle

Clinical Outcomes and Prevalence of Sarcopenia in Patients with Moderate to Severe COVID-19

by Shuhei Yamamoto, Yasunari Sakai, Keiji Matsumori, Ryuji Osawa, Shun Ito, Daichi Tsukakoshi, Tomoki Ohno, Hiroaki Ohta, Takashi Ichiyama, Masamichi Komatsu, Yosuke Wada, Masayuki Hanaoka, Shota Ikegami and Hiroshi Horiuchi

J. Clin. Med. 2022, 11(21), 6578; https://doi.org/10.3390/jcm11216578 - 06 Nov 2022

Viewed by 1601

Abstract

Background: The purpose of this study was to investigate the effectiveness and clinical outcomes of inpatient rehabilitation for patients with severe COVID-19 in Japan. Methods: Patients with severe COVID-19 who underwent rehabilitation during hospitalization were included. The Medical Research Council (MRC) score and [...] Read more.

Background: The purpose of this study was to investigate the effectiveness and clinical outcomes of inpatient rehabilitation for patients with severe COVID-19 in Japan. Methods: Patients with severe COVID-19 who underwent rehabilitation during hospitalization were included. The Medical Research Council (MRC) score and short physical performance battery (SPPB), such as physical function assessment and the intensive care unit (ICU) mobility scale, the functional status score for the ICU, and Barthel index as activities of daily living (ADLs) were evaluated at admission and discharge or transfer from the hospital. The correlation between SPPB at discharge and each factor at admission were also analyzed. Furthermore, the prevalence of sarcopenia was evaluated by defining SPPB of <9 points at discharge as sarcopenia. Results: The median age of the total of 23 patients was 59 years (interquartile range (IQR): 47–67), 73.9% were male, and the median PaO₂/FiO₂ at admission was 172.0 (IQR: 123.0–209.0). All physical function and ADL parameters were significantly improved from the time of admission to discharge (p = 0.014 for the MRC score and p < 0.001 for all others). Moreover, SPPB at discharge significantly correlated with WBC (Spearman’s rho = −0.473, p = 0.041), C-reactive protein (Spearman’s rho = −0.468, p = 0.044), and exhibited a significant trend with PaO₂/FiO₂ (Spearman’s rho = 0.429, p = 0.067) and age (Spearman’s rho = 0.409, p = 0.083). Although the median Barthel index at discharge was 90 points, 47% of patients had sarcopenia as defined by an SPPB of <9 points. Conclusions: Early rehabilitation for patients with severe COVID-19 improved physical function and ADLs during hospitalization. However, 47% of patients had the same level of sarcopenia at discharge. Full article

(This article belongs to the Topic Fighting against COVID-19: Latest Advances, Challenges and Methodologies)

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12 pages, 1013 KiB

Open AccessArticle

A High Dose, Not Low Dose, of Vitamin D Ameliorates Insulin Resistance in Saudi Women

by Shareefa AlGhamdi, Hanan AlHarthi, Sawsan Khoja, Amin AlJefri and Huda F. AlShaibi

J. Clin. Med. 2022, 11(21), 6577; https://doi.org/10.3390/jcm11216577 - 06 Nov 2022

Cited by 1 | Viewed by 4563

Abstract

Vitamin D has been traditionally seen to be mainly involved in the regulation of bone homeostasis. However, vitamin D has also been clinically linked to various diseases, including metabolic syndrome. The aim of this study was to examine the effect of low and [...] Read more.

Vitamin D has been traditionally seen to be mainly involved in the regulation of bone homeostasis. However, vitamin D has also been clinically linked to various diseases, including metabolic syndrome. The aim of this study was to examine the effect of low and high doses of a vitamin D supplement on the serum levels of 25(OH)D3 and insulin resistance. A total of 120 females were recruited in this study and supplemented weekly with 25,000 IU vitamin D or 50,000 IU vitamin D for three months. Anthropometric measurements were taken at the beginning of the study. Blood samples were collected at the beginning of the study to determine the baseline of the clinical variables and collected again after three months. Insulin resistance was measured using Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). After vitamin D supplementation, a non-significant increase was observed in the serum levels of 25(OH)D3 in the group treated with a low dose of vitamin D (LDVD) and a highly significant increase was seen in the group treated with a high dose of vitamin D (HDVD). In the group treated with a higher dose (HDVD), a significant improvement in insulin sensitivity was observed. The high dose of vitamin D (50,000 IU) supplementation was more effective in both correcting the blood levels of vitamin D and improving the sensitivity of insulin. Full article

(This article belongs to the Section Endocrinology & Metabolism)

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11 pages, 781 KiB

Open AccessArticle

Effects of Perioperative Oral Management in Patients with Cancer

by Yasuhiro Kurasawa, Akihiko Iida, Kaya Narimatsu, Hideki Sekiya, Yutaka Maruoka and Yukihiro Michiwaki

J. Clin. Med. 2022, 11(21), 6576; https://doi.org/10.3390/jcm11216576 - 06 Nov 2022

Cited by 2 | Viewed by 1423

Abstract

Perioperative oral management (POM) is used to prevent pneumonia in patients with cancer. However, the factors that expose hospitalized patients to increased risk of developing pneumonia remain unclear. For example, no study to date has compared the incidence of pneumonia in hospitalized patients [...] Read more.

Perioperative oral management (POM) is used to prevent pneumonia in patients with cancer. However, the factors that expose hospitalized patients to increased risk of developing pneumonia remain unclear. For example, no study to date has compared the incidence of pneumonia in hospitalized patients by cancer primary lesion, or POM implementation, or not. We determined which patients were most likely to benefit from POM and examined the effects of POM on pneumonia prevention and mortality. In a total of 9441 patients with cancer who underwent surgery during hospitalization, there were 8208 patients in the No POM group, and 1233 in the POM group. We examined between-group differences in the incidence of pneumonia and associated outcomes during hospitalization. There was no significant between-group difference in the incidence of pneumonitis, however, patients with lung, or head and neck cancers, demonstrated a lower incidence of postoperative pneumonia. Among patients with lung and pancreatic cancers, mortality was significantly lower in the POM group. POM appears effective at reducing the risk of postoperative pneumonia in patients with certain cancers. Further, mortality was significantly lower in patients with lung and pancreatic cancers who received POM; hence, POM may be an effective adjuvant therapy for patients with cancer. Full article

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

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8 pages, 2730 KiB

Open AccessArticle

Iris Racemose Hemangioma Assessment with Swept Source Optical Coherence Tomography Angiography: A Feasibility Study and Stand-Alone Comparison

by Filippo Confalonieri, Huy Bao Ngo, Helga Halldorsdottir Petersen, Nils Andreas Eide and Goran Petrovski

J. Clin. Med. 2022, 11(21), 6575; https://doi.org/10.3390/jcm11216575 - 06 Nov 2022

Viewed by 1533

Abstract

Purpose: To evaluate arteriovenous malformations (AVM) with swept-source (SS) optical coherence tomography (OCT) angiography (OCTA) in iris racemose hemangioma and compare it with traditional intravenous iris fluorescein angiography (IVFA). Methods: A cross-sectional observational clinical study was conducted on patients with iris racemose hemangioma [...] Read more.

Purpose: To evaluate arteriovenous malformations (AVM) with swept-source (SS) optical coherence tomography (OCT) angiography (OCTA) in iris racemose hemangioma and compare it with traditional intravenous iris fluorescein angiography (IVFA). Methods: A cross-sectional observational clinical study was conducted on patients with iris racemose hemangioma with the ZEISS PLEX Elite 9000 SS OCT & OCTA. Results: Three eyes of three patients were imaged. Iris racemose hemangiomas demonstrated a tortuous, well-defined, and continuous course of the AVM. The ZEISS PLEX Elite 9000 SS OCT & OCTA allowed for a detailed visualization of the ARM and was superior to IVFA in depicting small caliber, fine vessels. Conclusions: SS-OCTA may provide a dye-free, no-injection, cost-effective method comparable to spectral domain OCTA and IVFA for diagnosing and monitoring iris racemose hemangiomas for growth and vascularity. Full article

(This article belongs to the Special Issue Optical Coherence Tomography Imaging: Advances in Ophthalmology)

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25 pages, 999 KiB

Open AccessReview

Filling the Gap: The Immune Therapeutic Armamentarium for Relapsed/Refractory Hodgkin Lymphoma

by Esther Hazane Leroyer, Caroline Ziegler, Charline Moulin, Arnaud Campidelli, Caroline Jacquet, Marie Thérèse Rubio, Pierre Feugier and Simona Pagliuca

J. Clin. Med. 2022, 11(21), 6574; https://doi.org/10.3390/jcm11216574 - 06 Nov 2022

Cited by 4 | Viewed by 2258

Abstract

Despite years of clinical progress which made Hodgkin lymphoma (HL) one of the most curable malignancies with conventional chemotherapy, refractoriness and recurrence may still affect up to 20–30% of patients. The revolution brought by the advent of immunotherapy in all kinds of neoplastic [...] Read more.

Despite years of clinical progress which made Hodgkin lymphoma (HL) one of the most curable malignancies with conventional chemotherapy, refractoriness and recurrence may still affect up to 20–30% of patients. The revolution brought by the advent of immunotherapy in all kinds of neoplastic disorders is more than evident in this disease because anti-CD30 antibodies and checkpoint inhibitors have been able to rescue patients previously remaining without therapeutic options. Autologous hematopoietic cell transplantation still represents a significant step in the treatment algorithm for chemosensitive HL; however, the possibility to induce complete responses after allogeneic transplant procedures in patients receiving reduced-intensity conditioning regimens informs on its sensitivity to immunological control. Furthermore, the investigational application of adoptive T cell transfer therapies paves the way for future indications in this setting. Here, we seek to provide a fresh and up-to-date overview of the new immunotherapeutic agents dominating the scene of relapsed/refractory HL. In this optic, we will also review all the potential molecular mechanisms of tumor resistance, theoretically responsible for treatment failures, and we will discuss the place of allogeneic stem cell transplantation in the era of novel therapies. Full article

(This article belongs to the Section Oncology)

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