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J. Clin. Med., Volume 11, Issue 22 (November-2 2022) – 273 articles

Cover Story (view full-size image): Embolization in pediatric patients has growing indications that have overtaken many surgical strategies, also thanks to the increasing availability of low-profile devices and new materials. Mini-invasive percutaneous procedures allow the management of both congenital and acquired conditions, ranging from the elective treatment of congenital diseases of the cardiovascular system to urgent hemorrhagic conditions. Clinical practice guidelines and recommendations are rarely available and often adapted from adult algorithms. The aim of this review is to summarize the knowledge and the available evidence about indications, techniques, and outcomes of the main embolization procedures performed in the pediatric population, enriched with a set of representative images collected over ten years of experience in a referral center for pediatric interventional radiology. View this paper
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16 pages, 1576 KiB  
Protocol
The Virtual “Enfacement Illusion” on Pain Perception in Patients Suffering from Chronic Migraine: A Study Protocol for a Randomized Controlled Trial
by Sara Bottiroli, Marta Matamala-Gomez, Marta Allena, Elena Guaschino, Natascia Ghiotto, Roberto De Icco, Grazia Sances and Cristina Tassorelli
J. Clin. Med. 2022, 11(22), 6876; https://doi.org/10.3390/jcm11226876 - 21 Nov 2022
Cited by 1 | Viewed by 1614
Abstract
Background: given the limited efficacy, tolerability, and accessibility of pharmacological treatments for chronic migraine (CM), new complementary strategies have gained increasing attention. Body ownership illusions have been proposed as a non-pharmacological strategy for pain relief. Here, we illustrate the protocol for evaluating the [...] Read more.
Background: given the limited efficacy, tolerability, and accessibility of pharmacological treatments for chronic migraine (CM), new complementary strategies have gained increasing attention. Body ownership illusions have been proposed as a non-pharmacological strategy for pain relief. Here, we illustrate the protocol for evaluating the efficacy in decreasing pain perception of the enfacement illusion of a happy face observed through an immersive virtual reality (VR) system in CM. Method: the study is a double-blind randomized controlled trial with two arms, involving 100 female CM patients assigned to the experimental group or the control group. The experimental group will be exposed to the enfacement illusion, whereas the control group will be exposed to a pleasant immersive virtual environment. Both arms of the trial will consist in three VR sessions (20 min each). At the baseline and at the end of the intervention, the patients will fill in questionnaires based on behavioral measures related to their emotional and psychological state and their body satisfaction. Before and after each VR session, the level of pain, the body image perception, and the affective state will be assessed. Discussion: this study will provide knowledge regarding the relationship between internal body representation and pain perception, supporting the effectiveness of the enfacement illusion as a cognitive behavioral intervention in CM. Full article
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12 pages, 3241 KiB  
Article
Does Posterior Tibial Slope Influence Knee Kinematics in Medial Stabilized TKA?
by Leandra Bauer, Christoph Thorwächter, Arnd Steinbrück, Volkmar Jansson, Hannes Traxler, Zumreta Alic, Boris Michael Holzapfel and Matthias Woiczinski
J. Clin. Med. 2022, 11(22), 6875; https://doi.org/10.3390/jcm11226875 - 21 Nov 2022
Cited by 1 | Viewed by 1977
Abstract
Background: During total knee arthroplasty (TKA), one of the key alignment factors to pay attention to is the posterior tibial slope (PTS). The PTS clearly influences the kinematics of the knee joint but must be adapted to the coupling degree of the specific [...] Read more.
Background: During total knee arthroplasty (TKA), one of the key alignment factors to pay attention to is the posterior tibial slope (PTS). The PTS clearly influences the kinematics of the knee joint but must be adapted to the coupling degree of the specific TKA design. So far, there is hardly any literature including clear recommendations for how surgeons should choose the PTS in a medial stabilized (MS) TKA. The aim of the present study is to investigate the effects of different degrees of PTS on femorotibial kinematics in MS TKA. Materials and Methods: An MS TKA was performed in seven fresh-frozen human specimens successively with 0°, 3°, and 6° of PTS. After each modification, weight-bearing deep knee flexion (30–130°) was performed, and femorotibial kinematics were analyzed. Results: A lateral femoral rollback was observed for all three PTS modifications. With an increasing PTS, the tibia was shifted more anteriorly on the lateral side (0° PTS anterior tibial translation −9.09 (±9.19) mm, 3° PTS anterior tibial translation −11.03 (±6.72) mm, 6° PTS anterior tibial translation 11.86 (±9.35) mm). No difference in the tibial rotation was found for the different PTS variants. All PTS variants resulted in internal rotation of the tibia during flexion. With a 3° PTS, the design-specific medial rotation point was achieved more accurately. Conclusions: According to our findings, we recommend a PTS of 3° when implanting the MS prosthesis used in this study. Full article
(This article belongs to the Special Issue Current Concepts and Recent Advances in Total Knee Arthroplasty)
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16 pages, 5773 KiB  
Article
Buckling Susceptibility of a K-File during the Initial Negotiations of Narrow and Curved Canals Using Different Manual Techniques
by Filippo Santarcangelo, Vittorio Dibello, Laura Garcia Aguilar, Adriana Carmelita Colella, Andrea Ballini, Massimo Petruzzi, Vincenzo Solfrizzi and Francesco Panza
J. Clin. Med. 2022, 11(22), 6874; https://doi.org/10.3390/jcm11226874 - 21 Nov 2022
Viewed by 1536
Abstract
(1) Background: One possible way to investigate the potential impact or susceptibility of buckling on different manual techniques is to measure compressive loads during canal negotiation. The higher their values, the easier and quicker the critical load level to buckling is reached, leading [...] Read more.
(1) Background: One possible way to investigate the potential impact or susceptibility of buckling on different manual techniques is to measure compressive loads during canal negotiation. The higher their values, the easier and quicker the critical load level to buckling is reached, leading to possible instrument lateral deformation. The objective of the present study was to investigate the impacts of compressive loads on a small K-file manipulated with different techniques for canal negotiation in simulated narrow and curved canals. (2) Methods: The tooth model selected was a plastic double-curved premolar 23 mm long (DRSK Group AB, Kasernvagen 2, SE-281 35, Hassleholm, Sweden) with an extremely narrow canal lumen to mimic a very difficult anatomical scenario. An experienced endodontist performed the negotiation of 90 of these artificial teeth randomly assigned to 3 different groups of 30 blocks each, respectively, using 3 different techniques: Group A: watch winding/pull (WW) motion; Group B: balanced forces (BF) technique; Group C: envelope of motion (EOM). The measurement system was based on the use of a dynamometer, Instron, Ltd. (model 2525-818 2kN f.s.), linked to a data acquisition unit HBM MGC+ to test all the compression and tensile loads, including all the peaks. (3) Results: All data acquired were processed by the CATMAN AP HBM software. Multiple comparisons for the highest compressive loads estimated the mean difference between WW vs. BF techniques of 3.60 [95% confidence interval (CI): 2.85 to 4.35, p < 0.001], WW vs. EOM of −1.76 (95% CI: −2.11 to 1.40, p < 0.001), and BF vs. EOM −5.36 (95% CI: −6.04 to −4.67, p < 0.001). (4) Conclusions: In conclusion, among the tested manual motions, the BF technique (Group B) was the most susceptible to buckling with the highest compressive load. WW motion (Group A) and EOM (Group C) were less susceptible to buckling than the BF technique. Therefore, a pressure-free manipulation of manual files, such as WW motion or EOM, can help reduce the susceptibility to buckling during the negotiation of narrow-curved canals. Full article
(This article belongs to the Special Issue The State of the Art in Endodontics—Part II)
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8 pages, 2086 KiB  
Article
Long-Term Outcomes following Common Femoral Endarterectomy
by Takuya Hashimoto, Satoshi Yamamoto, Masaru Kimura, Masaya Sano, Osamu Sato and Juno Deguchi
J. Clin. Med. 2022, 11(22), 6873; https://doi.org/10.3390/jcm11226873 - 21 Nov 2022
Cited by 3 | Viewed by 2262
Abstract
Thromboendarterectomy of the common femoral artery (CFA) for occlusive disease is a crucial procedure in vascular surgery. As an outcome reference for emerging endovascular procedures and new devices, we need more robust evidence of the outcome of this gold standard technique. The purpose [...] Read more.
Thromboendarterectomy of the common femoral artery (CFA) for occlusive disease is a crucial procedure in vascular surgery. As an outcome reference for emerging endovascular procedures and new devices, we need more robust evidence of the outcome of this gold standard technique. The purpose of this study was to report 10-year results after femoral endarterectomy (FEA). A retrospective review of medical records at our institution identified eighty consecutive patients (91 limbs) who underwent FEA for CFA lesions. Indications for FEA included 50 limbs (55%) for intermittent claudication (IC) and 39 limbs (43%) with chronic limb-threatening ischemia (CLTI). Two limbs (2%) underwent FEA to prevent hemodynamic steal during extra-anatomical bypass. Adjunctive procedures included endovascular therapy in 32%. CFAs were closed with patch angioplasty in 44%. With a mean follow-up period of 39 months, the survival rates at 3 and 8 years were 85% and 77%, respectively. Limb salvage rates were 92% and 87%. Primary patencies were 98% and 84%. Freedom from target lesion revascularization was 95% at 3 years and 91% at 8 years. Our findings support the durability of FEA, with comparable long-term procedural results in CLTI patients as well as IC patients. Since the FEA is a gate maneuver for hybrid revascularization in CLTI patients, our findings support a strategy combining open and endovascular approaches. Femoral endarterectomy remains a durable solution for common femoral occlusive disease in IC and CLTI in the era of endovascular therapy. Full article
(This article belongs to the Special Issue Clinical Frontiers in Peripheral Artery Disease)
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13 pages, 2147 KiB  
Article
Detailed Correlation between Central Incisor Movement and Alveolar Bone Resorption in Adults with Orthodontic Premolar Extraction Treatment: A Retrospective Cohort CBCT Study
by Chenghao Zhang, Ling Ji, Zhihe Zhao and Wen Liao
J. Clin. Med. 2022, 11(22), 6872; https://doi.org/10.3390/jcm11226872 - 21 Nov 2022
Cited by 1 | Viewed by 1398
Abstract
Background: This study aims to explore the detailed correlation between the movement of maxillary and mandibular central incisors and alveolar bone resorption in adults who had orthodontic premolar extraction treatment. Methods: A total of 63 adult patients (mean age, 24.41 years) who received [...] Read more.
Background: This study aims to explore the detailed correlation between the movement of maxillary and mandibular central incisors and alveolar bone resorption in adults who had orthodontic premolar extraction treatment. Methods: A total of 63 adult patients (mean age, 24.41 years) who received orthodontic treatment with the extraction of four first premolars were included in this study. CBCT images were obtained before and after treatment. Three-dimensional evaluations of the movement of 252 central incisors (126 maxillary and 126 mandibular incisors) and alveolar bone changes were conducted. Four points were used to describe the incisor movement: C (cusp point), R (root apex point), M (mid-point of root neck), and L (labial cementoenamel junction point). The thickness of labial and palatal alveolar bone was assessed at the crestal, mid-root, and apical levels of incisors. The results were analyzed with Spearman’s correlation and multilinear regression. Results: Matching the measurements of central incisor movement and alveolar bone resorption, significant correlations could be observed. For maxillary central incisors, the labial alveolar bone resorption at the crestal level was correlated with the movement of Point L (r = 0.290, p < 0.05), and the labial alveolar bone resorption at the apical level was correlated with Point M (r = 0.387, p < 0.05). For mandibular central incisors, the labial alveolar bone resorption at the apical level was correlated with the movement of Point M (r = 0.493, p < 0.05) and R (r = 0.498, p < 0.01); the palatal alveolar bone resorption at the mid-root level with Point M (r = -0.170, p < 0.01); and the palatal alveolar bone resorption at the apical level with Point R (r = 0.177, p < 0.01). Conclusions: This study investigated the concrete correlations between central incisor movement and alveolar bone resorption in adults after orthodontic treatment with premolar extraction. It is potentially helpful for orthodontists to have a relatively accurate prediction of alveolar bone resorption based on the specific movements of central incisors and to reduce the risk of alveolar bone resorption by better adjusting the three-dimensional movement types of incisors. Full article
(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)
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18 pages, 3260 KiB  
Review
Evolving Role of Catheter Ablation for Atrial Fibrillation: Early and Effective Rhythm Control
by Shaojie Chen, Yuehui Yin, Zhiyu Ling, Christian Meyer, Helmut Pürerfellner, Martin Martinek, Márcio Galindo Kiuchi, Piotr Futyma, Lin Zhu, Alexandra Schratter, Jiazhi Wang, Willem-Jan Acou, Philipp Sommer, Feifan Ouyang, Shaowen Liu, Julian K. R. Chun and Boris Schmidt
J. Clin. Med. 2022, 11(22), 6871; https://doi.org/10.3390/jcm11226871 - 21 Nov 2022
Cited by 5 | Viewed by 2320
Abstract
Catheter Ablation (CA) is an effective therapeutic option in treating atrial fibrillation (AF). Importantly, recent data show that CA as a rhythm control strategy not only significantly reduces AF burden, but also substantially improves clinical hard endpoints. Since AF is a progressive disease, [...] Read more.
Catheter Ablation (CA) is an effective therapeutic option in treating atrial fibrillation (AF). Importantly, recent data show that CA as a rhythm control strategy not only significantly reduces AF burden, but also substantially improves clinical hard endpoints. Since AF is a progressive disease, the time of Diagnosis-to-Intervention appears crucial. Recent evidence shows that earlier rhythm control is associated with a lower risk of adverse cardiovascular outcomes in patients with early AF. Particularly, CA as an initial first line rhythm control strategy is associated with significant reduction of arrhythmia recurrence and rehospitalization in patients with paroxysmal AF. CA is shown to significantly lower the risk of progression from paroxysmal AF to persistent AF. When treating persistent AF, the overall clinical success after ablation remains unsatisfactory, however the ablation outcome in patients with “early” persistent AF appears better than those with “late” persistent AF. “Adjunctive” ablation on top of pulmonary vein isolation (PVI), e.g., ablation of atrial low voltage area, left atrial posterior wall, vein of Marshall, left atrial appendage, etc., may further reduce arrhythmia recurrence in selected patient group. New ablation concepts or new ablation technologies have been developing to optimize therapeutic effects or safety profile and may ultimately improve the clinical outcome. Full article
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14 pages, 633 KiB  
Review
Risk Factors and Corresponding Management for Suture Anchor Pullout during Arthroscopic Rotator Cuff Repair
by Xiangwei Li, Yujia Xiao, Han Shu, Xianding Sun and Mao Nie
J. Clin. Med. 2022, 11(22), 6870; https://doi.org/10.3390/jcm11226870 - 21 Nov 2022
Cited by 4 | Viewed by 2867
Abstract
Introduction: Due to the aging of the population, the incidence of rotator cuff tears is growing. For rotator cuff repair, arthroscopic suture-anchor repair has gradually replaced open transosseous repair, so suture anchors are now considered increasingly important in rotator cuff tear reconstruction. There [...] Read more.
Introduction: Due to the aging of the population, the incidence of rotator cuff tears is growing. For rotator cuff repair, arthroscopic suture-anchor repair has gradually replaced open transosseous repair, so suture anchors are now considered increasingly important in rotator cuff tear reconstruction. There are some but limited studies of suture anchor pullout after arthroscopic rotator cuff repair. However, there is no body of knowledge in this area, which makes it difficult for clinicians to predict the risk of anchor pullout comprehensively and manage it accordingly. Methods: The literature search included rotator cuff repair as well as anchor pullout strength. A review of the literature was performed including all articles published in PubMed until September 2021. Articles of all in vitro biomechanical and clinical trial levels in English were included. After assessing all abstracts (n = 275), the full text and the bibliographies of the relevant articles were analyzed for the questions posed (n = 80). Articles including outcomes without the area of interest were excluded (n = 22). The final literature research revealed 58 relevant articles. Narrative synthesis was undertaken to bring together the findings from studies included in this review. Result: Based on the presented studies, the overall incidence of anchor pullout is not low, and the incidence of intraoperative anchor pullout is slightly higher than in the early postoperative period. The risk factors for anchor pullout are mainly related to bone quality, insertion depth, insertion angle, size of rotator cuff tear, preoperative corticosteroid injections, anchor design, the materials used to produce anchors, etc. In response to the above issues, we have introduced and evaluated management techniques. They include changing the implant site of anchors, cement augmentation for suture anchors, increasing the number of suture limbs, using all-suture anchors, using an arthroscopic transosseous knotless anchor, the Buddy anchor technique, Steinmann pin anchoring, and transosseous suture repair technology. Discussion: However, not many of the management techniques have been widely used in clinical practice. Most of them come from in vitro biomechanical studies, so in vivo randomized controlled trials with larger sample sizes are needed to see if they can help patients in the long run. Full article
(This article belongs to the Special Issue Advancements in Sports Medicine)
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5 pages, 206 KiB  
Editorial
Clinical Heterogeneity, Unmet Needs and Long-Term Outcomes in Patients with Systemic Lupus Erythematosus
by Christopher Sjöwall and Ioannis Parodis
J. Clin. Med. 2022, 11(22), 6869; https://doi.org/10.3390/jcm11226869 - 21 Nov 2022
Viewed by 1336
Abstract
The clinical presentation of systemic lupus erythematosus (SLE) is highly heterogeneous, ranging from mild disease limited to skin and joint involvement to life-threatening conditions with renal impairment, severe cytopenias, central nervous system disease, and thromboembolic events [...] Full article
10 pages, 254 KiB  
Article
Sufentanil vs. Dexmedetomidine as Neuraxial Adjuvants in Cesarean Section: A Mono-Centric Retrospective Comparative Study
by Antonio Coviello, Carmine Iacovazzo, Anella D’Abrunzo, Marilena Ianniello, Maria Grazia Frigo, Annachiara Marra, Pasquale Buonanno, Maria Silvia Barone, Giuseppe Servillo and Maria Vargas
J. Clin. Med. 2022, 11(22), 6868; https://doi.org/10.3390/jcm11226868 - 21 Nov 2022
Cited by 2 | Viewed by 2280
Abstract
Spinal anesthesia is the best choice for caesarean delivery. This technique is characterized by a complete and predictable nerve block with a fast onset and few complications. Several intrathecal adjuvants are used in order to improve the quality and duration of anesthesia and [...] Read more.
Spinal anesthesia is the best choice for caesarean delivery. This technique is characterized by a complete and predictable nerve block with a fast onset and few complications. Several intrathecal adjuvants are used in order to improve the quality and duration of anesthesia and reduce its side effects. Sixty-two patients who underwent caesarean delivery under spinal anesthesia were included in this medical records review. In this retrospective study, after adopting exclusion criteria, we assessed 24 patients who received Hyperbaric Bupivacaine 0.5% 10 mg and dexmedetomidine 10 μg (G1), and 28 patients who received an institutional standard treatment with Hyperbaric Bupivacaine 0.5% 10 mg and sufentanil 5 μg (G2). We evaluated the difference in terms of motor and sensory block, postoperative pain, and adverse effects during the first 24 h following delivery and neonatal outcome. Our study found that the sufentanil group had a significantly lower requirement for analgesia than the dexmedetomidine group. Postoperative pain, assessed with the VAS scale, was stronger in G1 than in G2 (4 ± 2 vs. 2 ± 1, p-value < 0.01). Differences between the two groups regarding the intraoperative degree of motor and sensory block, motor recovery time, and neonatal Apgar scores were not noticed. Pruritus and shivering were observed only in G2. Itching and shivering did not occur in the dexmedetomidine group. Postoperative analgesia was superior in the sufentanil group, but the incidence of side effects was higher. Adjuvant dexmedetomidine prevented postoperative shivering. Full article
(This article belongs to the Special Issue Recent Advances in Obstetric Anesthesiology)
11 pages, 1043 KiB  
Article
Long-Term Assessment of Pelvic Organ Prolapse Reoperation Risk in Obese Women: Vaginal and Laparoscopic Approaches
by Marine Lallemant, Géraldine Giraudet, Victoire Delporte, Hélène Behal, Chrystele Rubod, Sophie Delplanque, Yohan Kerbage and Michel Cosson
J. Clin. Med. 2022, 11(22), 6867; https://doi.org/10.3390/jcm11226867 - 21 Nov 2022
Viewed by 1184
Abstract
The aim of this study was to compare reoperation risks after pelvic organ prolapse repair at 5-year follow-up between obese, overweight, and normal-weight women and to assess these risks accounting for the surgical procedure. We performed a retrospective chart review of all the [...] Read more.
The aim of this study was to compare reoperation risks after pelvic organ prolapse repair at 5-year follow-up between obese, overweight, and normal-weight women and to assess these risks accounting for the surgical procedure. We performed a retrospective chart review of all the women who underwent POP repair by transvaginal mesh surgery between January 2005 and January 2009 or laparoscopic sacrocolpopexy between January 2003 and December 2013 at the Gynecologic Surgery Department of the Lille University Hospital. During the study period, 744 women who underwent POP repair were divided into three groups: 382 (51%), 240 (32%), and 122 (16%) in the nonobese group (BMI < 25 kg/m²), overweight group (25 kg/m² ≤ BMI < 30 kg/m²), and obese group (BMI ≥ 30 kg/m²), respectively. The primary outcome was global reoperation. The median duration of follow-up was 87 months. The risks of global reoperation did not significantly differ between the three BMI groups (adjusted HR (95% CI): 1.12 (0.69 to 1.82) for overweight women and 0.90 (0.46 to 1.74) for obese women compared to normal-weight women, adjusted p = 0.80), nor among the women who underwent transvaginal mesh surgery or laparoscopic sacrocolpopexy. The risks of reoperation for POP recurrence, stress urinary incontinence, or mesh-related complications did not significantly differ between the three BMI groups in the overall population nor accounting for the surgical procedure. In conclusion, obesity does not seem to be a risk factor of reoperation for POP recurrence, SUI, or mesh-related complications in the long term regardless of the surgical approach. Full article
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20 pages, 1906 KiB  
Article
The Association of Sex with Unplanned Cardiac Readmissions following Percutaneous Coronary Intervention in Australia: Results from a Multicentre Outcomes Registry (GenesisCare Cardiovascular Outcomes Registry)
by Andre Conradie, John Atherton, Enayet Chowdhury, MyNgan Duong, Nisha Schwarz, Stephen Worthley and David Eccleston
J. Clin. Med. 2022, 11(22), 6866; https://doi.org/10.3390/jcm11226866 - 21 Nov 2022
Cited by 2 | Viewed by 1121
Abstract
Background and aim: Unplanned cardiac readmissions in patients with percutaneous intervention (PCI) is very common and is seen as a quality indicator of in-hospital care. Most studies have reported on the 30-day cardiac readmission rates, with very limited information being available on 1-year [...] Read more.
Background and aim: Unplanned cardiac readmissions in patients with percutaneous intervention (PCI) is very common and is seen as a quality indicator of in-hospital care. Most studies have reported on the 30-day cardiac readmission rates, with very limited information being available on 1-year readmission rates and their association with mortality. The aim of this study was to investigate the impact of biological sex at 1-year post-PCI on unplanned cardiac readmissions. Methods and results: Patients enrolled into the GenesisCare Cardiovascular Outcomes Registry (GCOR-PCI) from December 2008 to December 2020 were included in the study. A total of 13,996 patients completed 12 months of follow-up and were assessed for unplanned cardiac readmissions. All patients with unplanned cardiac readmissions in the first year of post-PCI were followed in year 2 (post-PCI) for survival status. The rate of unplanned cardiac readmissions was 10.1%. Women had a 29% higher risk of unplanned cardiac readmission (HR 1.29, 95% CI 1.11 to 1.48; p = 0.001), and female sex was identified as an independent predictor of unplanned cardiac readmissions. Any unplanned cardiac readmission in the first year was associated with a 2.5-fold higher risk of mortality (HR 2.50, 95% CI 1.67 to 3.75; p < 0.001), which was similar for men and women. Conclusion: Unplanned cardiac readmissions in the first year post-PCI was strongly associated with increased all-cause mortality. Whilst the incidence of all-cause mortality was similar between women and men, a higher incidence of unplanned cardiac readmissions was observed for women, suggesting distinct predictors of unplanned cardiac readmissions exist between women and men. Full article
(This article belongs to the Special Issue Clinical Frontiers in Percutaneous Coronary Intervention)
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19 pages, 6559 KiB  
Review
COVID-19 Infection in Rheumatic Patients on Chronic Antimalarial Drugs: A Systematic Review and Meta-Analysis
by Isabela Landsteiner de Sampaio Amêndola, Jonathan Aires Pinheiro, Pedro Póvoa, Vicente Cés de Souza Dantas and Rodrigo Bernardo Serafim
J. Clin. Med. 2022, 11(22), 6865; https://doi.org/10.3390/jcm11226865 - 21 Nov 2022
Viewed by 2676
Abstract
The ongoing chronic use of hydroxychloroquine or chloroquine (HCQ/CQ) in rheumatic patients might impact their outcomes after a SARS-CoV-2 infection. Therefore, we sought to assess the mortality in rheumatic patients with chronic HCQ/CQ use who developed a COVID-19 infection through a comparison between [...] Read more.
The ongoing chronic use of hydroxychloroquine or chloroquine (HCQ/CQ) in rheumatic patients might impact their outcomes after a SARS-CoV-2 infection. Therefore, we sought to assess the mortality in rheumatic patients with chronic HCQ/CQ use who developed a COVID-19 infection through a comparison between individuals chronically using HCQ/CQ with those not taking these drugs. We performed a systematic review and meta-analysis of studies on PubMed, Embase, and Cochrane Central. We included full-length reports, prospective observational cohorts, and clinical trials of adult patients (aged ≥ 18 years) who were diagnosed with a COVID-19 infection. Case studies, case series, letters, comments, and editorials were excluded. The main outcome was all-cause mortality. This study is registered with PROSPERO (CRD42022341678). We identified 541 studies, of which 20 studies were included, comprising 236,997 patients. All-cause mortality was significantly lower in patients with prior chronic use of HCQ/CQ compared to those with no previous usage (OR 0.76; 95% CI 0.62–0.94; p = 0.01). There was a considerably lower incidence of hospitalization among patients with chronic HCQ/CQ use compared to their counterparts without HCQ/CQ usage (OR 0.80; 95% CI 0.65–0.99; p = 0.04). All-cause mortality and hospitalization were significantly lower in rheumatic patients with chronic HCQ/CQ use who developed a COVID-19 infection. Full article
(This article belongs to the Section Immunology)
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11 pages, 2199 KiB  
Article
Sublingual Sufentanil Tablet System (SSTS-Zalviso®) for Postoperative Analgesia after Orthopedic Surgery: A Retrospective Study
by Andrea Angelini, Gian Mario Parise, Mariachiara Cerchiaro, Francesco Ambrosio, Paolo Navalesi and Pietro Ruggieri
J. Clin. Med. 2022, 11(22), 6864; https://doi.org/10.3390/jcm11226864 - 21 Nov 2022
Cited by 2 | Viewed by 1482
Abstract
Background: The aim of this study is to compare sublingual sufentanil and the administration device for its delivery (SSST-Zalviso®) with the traditional strategies used for the control of postoperative pain to establish if there is an actual benefit for the patient [...] Read more.
Background: The aim of this study is to compare sublingual sufentanil and the administration device for its delivery (SSST-Zalviso®) with the traditional strategies used for the control of postoperative pain to establish if there is an actual benefit for the patient and healthcare personnel. Materials and Methods: A retrospective study was conducted to compare the efficacy of SSTS in the management of postoperative pain after orthopedic surgery between October 2018 and June 2020. We analyzed 50 patients who underwent a total knee arthroplasty (TKA). The control group consisted of 21 patients who underwent TKA and during the hospitalized recovery received a continuous femoral nerve block (cFNB). The statistical study was conducted with a level of significance p = 0.05 using “U” test, Mann–Whitney, to verify if patients had a better control of pain and fewer calls for rescue analgesia. Results: Patients involved in the study showed a significant reduction in pain intensity with the use of SSTS in the 24 h following surgery (p = 0.0568), also a drastic drop of the calls for rescue analgesia (p < 0.0001) reduces the number of calls for its control. Conclusions: This study demonstrates how SSTS might reduce pain intensity in the first 24 h after surgery and reduce the number of calls for its control, indicating better analgesic coverage and implying reduced interventions from healthcare personnel. This could allow a redistribution of resources and a reduction in the use of analgesic drugs in wards where the SSTS is used. Full article
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19 pages, 598 KiB  
Review
Irisin and Bone in Sickness and in Health: A Narrative Review of the Literature
by Elena Tsourdi, Athanasios D. Anastasilakis, Lorenz C. Hofbauer, Martina Rauner and Franziska Lademann
J. Clin. Med. 2022, 11(22), 6863; https://doi.org/10.3390/jcm11226863 - 21 Nov 2022
Cited by 2 | Viewed by 2201
Abstract
Irisin is a hormone-like myokine produced by the skeletal muscle in response to exercise. Upon its release into the circulation, it is involved in the browning process and thermogenesis, but recent evidence indicates that this myokine could also regulate the functions of osteoblasts, [...] Read more.
Irisin is a hormone-like myokine produced by the skeletal muscle in response to exercise. Upon its release into the circulation, it is involved in the browning process and thermogenesis, but recent evidence indicates that this myokine could also regulate the functions of osteoblasts, osteoclasts, and osteocytes. Most human studies have reported that serum irisin levels decrease with age and in conditions involving bone diseases, including both primary and secondary osteoporosis. However, it should be emphasized that recent findings have called into question the importance of circulating irisin, as well as the validity and reproducibility of current methods of irisin measurement. In this review, we summarize data pertaining to the role of irisin in the bone homeostasis of healthy children and adults, as well as in the context of primary and secondary osteoporosis. Additional research is required to address methodological issues, and functional studies are required to clarify whether muscle and bone damage per se affect circulating levels of irisin or whether the modulation of this myokine is caused by the inherent mechanisms of underlying diseases, such as genetic or inflammatory causes. These investigations would shed further light on the effects of irisin on bone homeostasis and bone disease. Full article
(This article belongs to the Section Orthopedics)
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12 pages, 1079 KiB  
Article
Effect of Propofol versus Sevoflurane Anesthesia on Acute Kidney Injury after Lung Transplantation Surgery: A Prospective Randomized Controlled Trial
by Young Song, Hyo-Chae Paik, Namo Kim, Heejae Jung, Jin-Gu Lee and Young-chul Yoo
J. Clin. Med. 2022, 11(22), 6862; https://doi.org/10.3390/jcm11226862 - 21 Nov 2022
Cited by 4 | Viewed by 1596
Abstract
This prospective randomized controlled trial aimed to compare the effects of sevoflurane and propofol anesthesia on the occurrence of acute kidney injury (AKI) following lung transplantation (LTx) surgery. Sixty adult patients undergoing bilateral LTx were randomized to receive either inhalation of sevoflurane or [...] Read more.
This prospective randomized controlled trial aimed to compare the effects of sevoflurane and propofol anesthesia on the occurrence of acute kidney injury (AKI) following lung transplantation (LTx) surgery. Sixty adult patients undergoing bilateral LTx were randomized to receive either inhalation of sevoflurane or continuous infusion of propofol for general anesthesia. The primary outcomes were AKI incidence according to the Acute Kidney Injury Network (AKIN) criteria and blood biomarker of kidney injury, including neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C levels within 48 h of surgery. Serum interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and superoxide dismutase were measured before and after surgery. The post-operative 30-day morbidity and long-term mortality were also assessed. Significantly fewer patients in the propofol group developed AKI compared with the sevoflurane group (13% vs. 38%, p = 0.030). NGAL levels were significantly lower in the propofol group at immediately after, 24 h, and 48 h post-operation. IL-6 levels were significantly lower in the propofol group immediately after surgery. AKI occurrence was significantly associated with a lower 5-year survival rate. Total intravenous anesthesia with propofol reduced the AKI incidence in LTx compared with sevoflurane, which is understood to be mediated by the attenuation of inflammatory responses. Full article
(This article belongs to the Section Anesthesiology)
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10 pages, 1371 KiB  
Article
Influence of Fracture Reduction on the Functional Outcome after Intramedullary Nail Osteosynthesis in Proximal Humerus Fractures
by Annika Hättich, Tim Jodokus Harloff, Hatice Sari, Carsten Schlickewei, Christopher Cramer, André Strahl, Karl-Heinz Frosch, Konrad Mader and Till Orla Klatte
J. Clin. Med. 2022, 11(22), 6861; https://doi.org/10.3390/jcm11226861 - 21 Nov 2022
Cited by 3 | Viewed by 1366
Abstract
Background: Optimal treatment of proximal humeral fractures (PHF) is still controversial. Therefore, we aim to investigate the influence of fracture reduction after intramedullary nailing of a PHF on the clinical outcome. Methods: Patients treated with intramedullary nail for PHF from 2013–2018, (minimum follow-up [...] Read more.
Background: Optimal treatment of proximal humeral fractures (PHF) is still controversial. Therefore, we aim to investigate the influence of fracture reduction after intramedullary nailing of a PHF on the clinical outcome. Methods: Patients treated with intramedullary nail for PHF from 2013–2018, (minimum follow-up 12 months) were retrospectively included. Constant Score (CS), DASH and Simple Shoulder Test (SST) were collected. Postoperative radiographs were used to determine head-shaft-alignment (HSA), head-shaft-displacement (HSD), integrity of the medial hinge and the cranialization of the greater tuberosity (CGT). The results of fracture reduction were categorized as either “anatomical”, “acceptable” or as “malreduction”. Malreduction exists when at least one of the following parameters are present: HSA > 150/< 110°, HSD >5 mm, CTM > 5 mm or lack of integrity of the medial hinge. Results: 42 patients (mean age 65.5 ± 14.1 years, 15 male, 27 female) with a mean follow-up time of 43 months were included. The average CS was 60 ± 30, DASH 49.8 ± 24.3 and SST 62.9 ± 26.9. There was an “anatomic” reduction in 9 (21.4%), “acceptable” in 7 (16.6%) and a “malreduction” in 26 (62%) patients. Comparing the combined “anatomical” and “acceptable” reduction group with the “malreduction” group, worse scores were observed in the “malreduction” group (CS 67.2 vs. 55.2, DASH 45.2 vs. 51.9, SST: 69.3 vs. 58.6) without statistical significance (CS: p = 0.095, DASH: p = 0.307, SST: p = 0.400). By means of multiple logistic regression analyses no statistically significant risk factors were identified for lower DASH, CS and SST scores. Conclusions: Anatomical fracture reduction using intramedullary nails has a positive effect on postoperative outcome for the 3 scores recorded, without reaching statistical significance. Full article
(This article belongs to the Section Orthopedics)
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9 pages, 2349 KiB  
Article
Effectiveness and Safety of Ultrasound-Guided Local Paricalcitol Injection in Treating Secondary Hyperparathyroidism in ESRD: A Retrospective Study
by Shuqin Xie, Yuan Yu, Yi Liu, Siliang Zhang, Shiyi Yuan, Kui Fan, Bin Tang, Qin Zhou, Yuqing Sun, Rui Liu, Dan Cao, Yong Chen, Yelei Wang, Guangjun Liu, Huan Ma, Chenghui Tao, Li Zeng and Ling Zhong
J. Clin. Med. 2022, 11(22), 6860; https://doi.org/10.3390/jcm11226860 - 21 Nov 2022
Cited by 1 | Viewed by 1431
Abstract
Purpose: To compare the safety and efficacy of percutaneous paricalcitol injection with intravenously administered paricalcitol in treating parathyroid hyperplasia in patients with secondary hyperparathyroidism (SHPT). Methods: This study was approved by the Ethics Committee of our institution. We retrospectively collected data on patients [...] Read more.
Purpose: To compare the safety and efficacy of percutaneous paricalcitol injection with intravenously administered paricalcitol in treating parathyroid hyperplasia in patients with secondary hyperparathyroidism (SHPT). Methods: This study was approved by the Ethics Committee of our institution. We retrospectively collected data on patients who received percutaneous paricalcitol injection (24 patients) and intravenously administered paricalcitol (22 patients) based on their intact parathyroid hormone (iPTH) level. Serum iPTH, calcium, phosphorus, and the volume of the parathyroid gland were measured at several indicated time points after treatment, and adverse events associated with the two treatments were evaluated. Results: After 6 months of follow-up, we found that patients from the percutaneous injection group had significantly decreased levels of iPTH (from 1887.81 ± 726.81 pg/mL to 631.06 ± 393.06 pg/mL), phosphate (from 1.94 ± 0.36 mmol/L to 1.71 ± 0.34 mmol/L), and volume of the parathyroid gland (from 0.87 ± 0.50 cm3 to 0.60 ± 0.36 cm3), with relief from ostealgia within 48–72 h. In the intravenously administered group, the levels of iPTH decreased from 686.87 ± 260.44 pg/mL to 388.47 ± 167.36 pg/mL; while there was no significant change in phosphate levels, the volume of the parathyroid gland and ostealgia relief were observed at the end of follow-up. The serum calcium level did not significantly change, and no severe complications were observed in both groups. In vitro fluorescence-activated single cell sorting (FACS) analysis indicated that paricalcitol induced parathyroid cell apoptosis in a dose-dependent manner. Conclusions: Percutaneous paricalcitol injection is a selective treatment for SHPT in ESRD. Full article
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10 pages, 982 KiB  
Article
Adherence to Annual Fundus Exams among Chinese Population with Diagnosed Diabetes
by Yifan Zhou, Xiaowen Li, Qinglei Sun, Jin Wei, Haiyun Liu, Keyan Wang and Jianfeng Luo
J. Clin. Med. 2022, 11(22), 6859; https://doi.org/10.3390/jcm11226859 - 21 Nov 2022
Cited by 1 | Viewed by 1321
Abstract
Adherence to annual fundus examinations in the Chinese population with diabetes and its correlates have not been investigated. The present study obtained data for the first nationally representative survey in China, China Health and Retirement Longitudinal Survey (CHARLS), which collected a wide range [...] Read more.
Adherence to annual fundus examinations in the Chinese population with diabetes and its correlates have not been investigated. The present study obtained data for the first nationally representative survey in China, China Health and Retirement Longitudinal Survey (CHARLS), which collected a wide range of data every 2 years, including demographic, socioeconomic, medical and lifestyle-related information. The adherence rates to annual fundus exams across four waves (2011–2018) were assessed. Univariate and multivariable logistic regressions were used to determine factors associated with adherence. The adherence rates to annual fundus examinations of ou study population were 23.6% in 2011, 15.3% in 2013, 17.5% in 2015 and 21.5% in 2018, respectively. Consistent results over four waves showed that non-adherent patients had a relatively lower educational level, insufficient diabetes medication use, fewer non-medication treatments and irregular physical examination compared to those who were adherent to the annual fundus exam (all p values < 0.05). These variables were further identified as factors associated with adherence according to univariate and multivariate logistic regression analyses (all p values < 0.05). The present study provides explicit evidence that the adherence rate to annual fundus examinations among Chinese population with diabetes is worryingly low. Insufficient educational attainment, especially specific diabetes education, has a negative impact on patients’ adherence to clinical guideline for eye health. Full article
(This article belongs to the Special Issue Advances in Vision Disorders: Causes and Epidemiology)
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8 pages, 777 KiB  
Brief Report
Childhood Pemphigus Vulgaris during COVID-19 Outbreak Successfully Treated with Prednisone and Azathioprine: A Case Report and Literature Review
by Pamela Vezzoli, Michele Parietti, Andrea Carugno, Marco Di Mercurio, Chiara Benaglia, Martina Zussino, Riccardo Cavalli, Paolo Sena and Emilio Berti
J. Clin. Med. 2022, 11(22), 6858; https://doi.org/10.3390/jcm11226858 - 21 Nov 2022
Cited by 1 | Viewed by 3350
Abstract
Introduction: pemphigus vulgaris is a rare autoimmune blistering disease that involves the skin and mucous membranes and rarely occurs in pediatric age. Methods: we present a case of childhood pemphigus in a 9-year-old patient from Burkina Faso, which initially manifested with erosive lesions [...] Read more.
Introduction: pemphigus vulgaris is a rare autoimmune blistering disease that involves the skin and mucous membranes and rarely occurs in pediatric age. Methods: we present a case of childhood pemphigus in a 9-year-old patient from Burkina Faso, which initially manifested with erosive lesions symmetrically distributed in the oral cavity. After a few months, we also observed hyperchromic lesions of the back. Histopathological examination of skin samples showed intraepidermal acantholysis, while direct immunofluorescence showed deposits of complement (C3) and immunoglobulins G (IgG) in the epidermidis; an ELISA test highlighted the presence of circulating autoantibodies against desmoglein 3. Results: the follow-up of this patient was made difficult by the advent of the COVID-19 outbreak. However, after about one year of combined therapy with systemic steroids and azathioprine the patient reached clinical remission. Full article
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13 pages, 420 KiB  
Article
Relationship between Periodontal Condition of the Pregnant Woman with Preterm Birth and Low Birth Weight
by Guillermo Gallagher-Cobos, Teresa Almerich-Torres, José María Montiel-Company, José Enrique Iranzo-Cortés, Carlos Bellot-Arcís, José Carmelo Ortolá-Siscar and José Manuel Almerich-Silla
J. Clin. Med. 2022, 11(22), 6857; https://doi.org/10.3390/jcm11226857 - 21 Nov 2022
Cited by 7 | Viewed by 2719
Abstract
The aim of this study was to determine the association between the mother’s periodontal condition and perinatal complications, such as preterm birth (PTB) and/or low birth weight (LBW), in a cohort of women in Valencia, Spain. Other related factors, such as tobacco, were [...] Read more.
The aim of this study was to determine the association between the mother’s periodontal condition and perinatal complications, such as preterm birth (PTB) and/or low birth weight (LBW), in a cohort of women in Valencia, Spain. Other related factors, such as tobacco, were also analysed. A prospective cohort study was carried out in a sample of 102 women with a single foetus and ages ranging between 18 and 42 years. Sociodemographic and obstetric variables, caries status, percentage of bleeding, clinical attachment loss (CAL), and probing pocket depth (PPD) data have been collected and analysed. The mean age was 32.4 years, and the BMI was normal. The average weight of new-borns (NB) was 3034 g. A total of 9.8% of the women smoked during their pregnancy. Bleeding percentage was 16.43% (SD 14.81%) and PPDs > 3 mm 8.8 (SD 11.08). The mean of CAL > 0 mm was 1.14 (SD 2.83). The frequency of PTB and LBW was 26%. No statistically significant differences were found between probing depth > 3 mm or CAL > 1 mm, with PTB and/or LBW. Periodontal disease in the mother was not statistically significantly related to either PTB or LBW. Tobacco use during pregnancy showed a statistical significance linked to LBW, but not with PTB. Full article
(This article belongs to the Special Issue Periodontal Diseases: Symptoms, Causes, Treatment, and Prevention)
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11 pages, 805 KiB  
Article
Triple Antiplatelet Therapy with Cilostazol and Favorable Early Clinical Outcomes after Acute Myocardial Infarction Compared to Dual Antiplatelet Therapy with Standard or Potent P2Y12 Inhibitors
by Sungwook Byun, Su Nam Lee, Sungmin Lim, Eun Ho Choo, Ik Jun Choi, Chan Joon Kim, Donggyu Moon, Mahn-Won Park, Chul Soo Park, Youngkeun Ahn, Myung-Ho Jeong and Kiyuk Chang
J. Clin. Med. 2022, 11(22), 6856; https://doi.org/10.3390/jcm11226856 - 21 Nov 2022
Viewed by 2191
Abstract
Current guidelines for the management of acute myocardial infarction (AMI) recommend potent P2Y12 inhibitors rather than clopidogrel to prevent ischemic events. However, their ischemic benefits are offset by an increased major bleeding risk. We compared the efficacy and safety of triple antiplatelet therapy [...] Read more.
Current guidelines for the management of acute myocardial infarction (AMI) recommend potent P2Y12 inhibitors rather than clopidogrel to prevent ischemic events. However, their ischemic benefits are offset by an increased major bleeding risk. We compared the efficacy and safety of triple antiplatelet therapy with cilostazol in the first month after AMI. This study investigated 16,643 AMI patients who received percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in nationwide, real-world, multicenter registries in Korea. Patients were divided into DAPT (aspirin and clopidogrel, n = 11,285), Triple (aspirin, clopidogrel and cilostazol, n = 2547), and Potent (aspirin and ticagrelor/prasugrel, n = 2811) groups. The primary outcomes were net adverse clinical events (NACE), a composite of death from any cause, myocardial infarction (MI), stroke, and TIMI major bleeding one month after AMI. After adjusting for covariates, there were no statistically significant differences in the risk of death from any cause, MI, or stroke between the three groups. However, the risk of TIMI major bleeding was significantly greater in the Potent group than in the DAPT and Triple groups (p < 0.001). Accordingly, NACE was significantly higher in the DAPT (HR 1.265; 95% CI 1.006–1.591, p = 0.044) and Potent groups (HR 1.515; 95% CI 1.142–2.011, p = 0.004) than in the Triple group. Triple antiplatelet therapy with cilostazol was associated with an improved net clinical outcome in the first month after AMI without increasing the risk of bleeding compared to potent or standard P2Y12 inhibitor-based DAPT. Full article
(This article belongs to the Section Cardiology)
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11 pages, 874 KiB  
Article
The Safety Profile of COVID-19 Vaccines in Patients Diagnosed with Multiple Sclerosis: A Retrospective Observational Study
by Giorgia Teresa Maniscalco, Cristina Scavone, Annamaria Mascolo, Valentino Manzo, Elio Prestipino, Gaspare Guglielmi, Maria Luisa Aiezza, Santolo Cozzolino, Adele Bracco, Ornella Moreggia, Daniele Di Giulio Cesare, Antonio Rosario Ziello, Angela Falco, Marida Massa, Massimo Majolo, Eliana Raiola, Roberto Soprano, Giuseppe Russo, Giuseppe Longo, Vincenzo Andreone and Annalisa Capuanoadd Show full author list remove Hide full author list
J. Clin. Med. 2022, 11(22), 6855; https://doi.org/10.3390/jcm11226855 - 21 Nov 2022
Cited by 7 | Viewed by 2704
Abstract
In the current COVID-19 pandemic, patients diagnosed with multiple sclerosis (MS) are considered to be one of the highest priority categories, being recognized as extremely vulnerable people. For this reason, mRNA-based COVID-19 vaccines are strongly recommended for these patients. Despite encouraging results on [...] Read more.
In the current COVID-19 pandemic, patients diagnosed with multiple sclerosis (MS) are considered to be one of the highest priority categories, being recognized as extremely vulnerable people. For this reason, mRNA-based COVID-19 vaccines are strongly recommended for these patients. Despite encouraging results on the efficacy and safety profile of mRNA-based COVID-19 vaccines, to date, in frail populations, including patients diagnosed with MS, this information is rather limited. We carried out a retrospective observational study with the aim to evaluate the safety profile of mRNA-based COVID-19 vaccines by retrieving real-life data of MS patients who were treated and vaccinated at the Multiple Sclerosis Center of the Hospital A.O.R.N. A. Cardarelli. Three-hundred and ten medical records of MS patients who received the first dose of the mRNA-based COVID-19 vaccine were retrieved (63% female; mean age: 45.9 years). Of these patients, 288 also received the second dose. All patients received the Pfizer-BioNTech vaccine. Relapsing-Remitting Multiple Sclerosis (RRSM) was the most common form of MS. The Expanded Disability Status Scale (EDSS) values were <3.0 in 70% of patients. The majority of patients received a Disease Modifying Therapy (DMT) during the study period, mainly interferon beta 1-a, dimethyl fumarate, and natalizumab and fingolimod. Overall, 913 AEFIs were identified, of which 539 were after the first dose of the vaccine and 374 after the second dose. The majority of these AEFIs were classified as short-term since they occurred within the first 72 h. The most common identified adverse events were pain at injection site, flu-like symptoms, and headache. Fever was reported more frequently after the second dose than after the first dose. SARS-CoV-2 infection occurred in 3 patients after the first dose. Using historical data of previous years (2017–2020), the relapses’ rate during 2021 was found to be lower. Lastly, the results of the multivariable analysis that assessed factors associated with the occurrence of AEFIs revealed a statistical significance for age, sex, and therapy with ocrelizumab (p < 0.05). In conclusion, our results indicated that Pfizer-BioNTech vaccine was safe for MS patients, being associated with AEFIs already detected in the general population. Larger observational studies with longer follow-up and epidemiological studies are strongly needed. Full article
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8 pages, 872 KiB  
Article
Comparing a Fully Automated Cephalometric Tracing Method to a Manual Tracing Method for Orthodontic Diagnosis
by Ioannis A. Tsolakis, Apostolos I. Tsolakis, Tarek Elshebiny, Stefanos Matthaios and J. Martin Palomo
J. Clin. Med. 2022, 11(22), 6854; https://doi.org/10.3390/jcm11226854 - 20 Nov 2022
Cited by 15 | Viewed by 2754
Abstract
Background: This study aims to compare an automated cephalometric analysis based on the latest deep learning method of automatically identifying cephalometric landmarks with a manual tracing method using broadly accepted cephalometric software. Methods: A total of 100 cephalometric X-rays taken using a CS8100SC [...] Read more.
Background: This study aims to compare an automated cephalometric analysis based on the latest deep learning method of automatically identifying cephalometric landmarks with a manual tracing method using broadly accepted cephalometric software. Methods: A total of 100 cephalometric X-rays taken using a CS8100SC cephalostat were collected from a private practice. The X-rays were taken in maximum image size (18 × 24 cm lateral image). All cephalometric X-rays were first manually traced using the Dolphin 3D Imaging program version 11.0 and then automatically, using the Artificial Intelligence CS imaging V8 software. The American Board of Orthodontics analysis and the European Board of Orthodontics analysis were used for the cephalometric measurements. This resulted in the identification of 16 cephalometric landmarks, used for 16 angular and 2 linear measurements. Results: All measurements showed great reproducibility with high intra-class reliability (>0.97). The two methods showed great agreement, with an ICC range of 0.70–0.92. Mean values of SNA, SNB, ANB, SN-MP, U1-SN, L1-NB, SNPg, ANPg, SN/ANS-PNS, SN/GoGn, U1/ANS-PNS, L1-APg, U1-NA, and L1-GoGn landmarks had no significant differences between the two methods (p > 0.0027), while the mean values of FMA, L1-MP, ANS-PNS/GoGn, and U1-L1 were statistically significantly different (p < 0.0027). Conclusions: The automatic cephalometric tracing method using CS imaging V8 software is reliable and accurate for all cephalometric measurements. Full article
(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)
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7 pages, 240 KiB  
Review
Turner Syndrome: Ocular Manifestations and Considerations for Corneal Refractive Surgery
by Majid Moshirfar, Mark T. Parsons, Chap-Kay Lau, Nicholas A. Chartrand, Yasmyne C. Ronquillo and Phillip C. Hoopes
J. Clin. Med. 2022, 11(22), 6853; https://doi.org/10.3390/jcm11226853 - 20 Nov 2022
Viewed by 1555
Abstract
Turner Syndrome (TS) is the most common sex chromosome abnormality in females and is associated with physical changes, hormone deficiencies, increased risk of autoimmune disease, and ocular complications. In this article, we review the main ocular findings associated with TS and discuss their [...] Read more.
Turner Syndrome (TS) is the most common sex chromosome abnormality in females and is associated with physical changes, hormone deficiencies, increased risk of autoimmune disease, and ocular complications. In this article, we review the main ocular findings associated with TS and discuss their significance for the patient considering refractive surgery. We also present four cases of TS to highlight the clinical findings that may be present in these patients. The most common ocular manifestations include refractive errors, strabismus, and amblyopia. Less commonly, patients with TS may present with keratoconus, cataracts, glaucoma, uveitis, or other disorders of the posterior segment. When considering corneal refractive surgery in a TS patient, clinicians should perform a thorough ocular history, ask patients about hormone therapy and autoimmune conditions, and pay particular attention to any of the associated ocular symptoms of TS. Full article
(This article belongs to the Special Issue Corneal Surgery: From Innovation to Clinical Praxis)
12 pages, 1733 KiB  
Article
Changes in Serum Creatinine May Cause Hypoglycemia among Non-Critically Ill Patients Admitted to Internal Medicine Units
by Boris Zingerman, Israel Khanimov, Mordechai Shimonov, Mona Boaz, Benaya Rozen-Zvi and Eyal Leibovitz
J. Clin. Med. 2022, 11(22), 6852; https://doi.org/10.3390/jcm11226852 - 20 Nov 2022
Viewed by 1294
Abstract
Background: The association between changes in serum creatinine levels and hypoglycemia during hospitalization was investigated. Methods: This was a retrospective analysis of medical charts. Patients were categorized as having significant change in creatinine (SCIC) when serum creatinine levels rose or dropped ≥ 0.3 [...] Read more.
Background: The association between changes in serum creatinine levels and hypoglycemia during hospitalization was investigated. Methods: This was a retrospective analysis of medical charts. Patients were categorized as having significant change in creatinine (SCIC) when serum creatinine levels rose or dropped ≥ 0.3 mg/dL from admission values at any time during their hospitalization. Patients were considered hypoglycemic if they had at least one documented glucose level ≤ 70 mg/dL during the hospitalization. Multiple logistic, linear and Cox regression analyses were used to ascertain the association between incident SCIC, severity and timing with incident hypoglycemia. Results: Included were 25,400 (mean age 69.9 ± 18.0, 49.3% were males). The rate of SCIC was 22.2%, and 62.2% of them were diagnosed upon admission. Patients with SCIC had a higher incidence of hypoglycemia compared to patients without (13.1% vs. 4.1%, respectively, p < 0.001). Patients with SCIC had an increased risk of hypoglycemia (OR 1.853, 95% CI 1.586–2.166, p < 0.001). The magnitude of SCIC was associated with the incidence (OR 1.316, 95% CI 1.197–1.447, p < 0.001) and the number of events (HR 0.054, 95% CI 0.021–0.087, p = 0.001). More than 60% of patients with hypoglycemia had their first event documented during days 0–6 after SCIC occurrence. Of those, the majority of events occurred on day 0–1, and the rate showed a gradual decrease throughout the first 5 days from SCIC occurrence. The results were similar for patients with and without DM. Conclusions: Changes in creatinine during hospitalization may cause hypoglycemia among patients admitted to internal medicine departments, regardless of DM status. Full article
(This article belongs to the Special Issue Epidemiology, Complications and Management of Diabetes)
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13 pages, 477 KiB  
Article
The Impact of Prehospital and Hospital Care on Clinical Outcomes in Out-of-Hospital Cardiac Arrest
by Yotam Deri, Baruch Berzon, Debra West, Matan Machloof, Refael Strugo, Tomer Kaplan and Shelly Soffer
J. Clin. Med. 2022, 11(22), 6851; https://doi.org/10.3390/jcm11226851 - 20 Nov 2022
Cited by 2 | Viewed by 2119
Abstract
Background: In recent years, several actions have been made to shorten the chain of survival in out-of-hospital cardiac arrest (OHCA). These include placing defibrillators in public places, training first responders, and providing dispatcher-assisted CPR (DA-CPR). In this work, we aimed to evaluate [...] Read more.
Background: In recent years, several actions have been made to shorten the chain of survival in out-of-hospital cardiac arrest (OHCA). These include placing defibrillators in public places, training first responders, and providing dispatcher-assisted CPR (DA-CPR). In this work, we aimed to evaluate the impact of these changes on patients’ outcomes, including achieving return of spontaneous circulation (ROSC), survival to discharge, and survival with favorable neurological function. Methods: We retrospectively retrieved data of all calls to the national emergency medical service in Ashdod city, Israel, of individuals who underwent OHCA at the age of 18 and older between the years 2018 and 2021. Data was collected on prehospital and hospital interventions. The association between pre-hospital and hospital interventions to ROSC, survival to discharge, and neurological outcomes was evaluated. Logistic regression was used for multivariable analysis. Results: During the years 2018–2021, there were 1253 OHCA cases in the city of Ashdod. ROSC was achieved in 207 cases (32%), survival to discharge was attained in 48 cases (7.4%), and survival with favorable neurological function was obtained in 26 cases (4%). Factors significantly associated with good prognosis were shockable rhythm, witnessed arrest, DA-CPR, use of AED, and treatment for STEMI. All patients that failed to achieve ROSC outside of the hospital setting had a poor prognosis. Conclusions: This study demonstrates the prognostic role of the initial rhythm and the use of AED in OHCA. Hospital management, including STEMI documentation and catheterization, was also an important prognostication factors. Additionally, when ROSC is not achieved in the field, hospital transfer should be considered. Full article
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14 pages, 975 KiB  
Review
Bladder Management Strategies for Urological Complications in Patients with Chronic Spinal Cord Injury
by Yu-Chen Chen, Yin-Chien Ou, Ju-Chuan Hu, Min-Hsin Yang, Wei-Yu Lin, Shi-Wei Huang, Wei-Yu Lin, Chih-Chieh Lin, Victor C. Lin, Yao-Chi Chuang and Hann-Chorng Kuo
J. Clin. Med. 2022, 11(22), 6850; https://doi.org/10.3390/jcm11226850 - 20 Nov 2022
Cited by 3 | Viewed by 2614
Abstract
Neurogenic lower urinary tract dysfunction, common in patients with chronic spinal cord injury, inevitably results in urological complications. To address neurogenic lower urinary tract dysfunction after spinal cord injury, proper and adequate bladder management is important in spinal cord injury rehabilitation, with the [...] Read more.
Neurogenic lower urinary tract dysfunction, common in patients with chronic spinal cord injury, inevitably results in urological complications. To address neurogenic lower urinary tract dysfunction after spinal cord injury, proper and adequate bladder management is important in spinal cord injury rehabilitation, with the goal and priorities of the protection of upper urinary tract function, maintaining continence, preserving lower urinary tract function, improvement of SCI patients’ quality of life, achieving compatibility with patients’ lifestyles, and decreasing urological complications. This concise review aims to help urologists address neurogenic lower urinary tract dysfunction by focusing on the risks of long-term urological complications and the effects of different bladder management strategies on these complications based on scientifically supported knowledge. Full article
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25 pages, 1081 KiB  
Review
Clinical Application of Serum microRNAs in Atherosclerotic Coronary Artery Disease
by Anna Kabłak-Ziembicka, Rafał Badacz and Tadeusz Przewłocki
J. Clin. Med. 2022, 11(22), 6849; https://doi.org/10.3390/jcm11226849 - 20 Nov 2022
Cited by 13 | Viewed by 2447
Abstract
MicroRNAs (miRs) are promising diagnostic, prognostic and therapeutic biomolecules for atherosclerotic cardiovascular disease. Atherosclerotic occlusive disease concerns a large population of patients, carrying the highest incidence of fatal and non-fatal adverse events, such as myocardial infarction, ischemic stroke, and limb ischemia, worldwide. Consistently, [...] Read more.
MicroRNAs (miRs) are promising diagnostic, prognostic and therapeutic biomolecules for atherosclerotic cardiovascular disease. Atherosclerotic occlusive disease concerns a large population of patients, carrying the highest incidence of fatal and non-fatal adverse events, such as myocardial infarction, ischemic stroke, and limb ischemia, worldwide. Consistently, miRs are involved in regulation and pathogenesis of atherosclerotic coronary artery disease (CAD), acute coronary syndromes (ACS), both with ST-segment (STEMI) and non-ST segment elevation myocardial infarctions (NSTEMI), as well as cardiac remodeling and fibrosis following ACS. However, the genetic and molecular mechanisms underlying adverse outcomes in CAD are multifactorial, and sometimes difficult to interpret for clinicians. Therefore, in the present review paper we have focused on the clinical meaning and the interpretation of various miRs findings, and their potential application in routine clinical practice. Full article
(This article belongs to the Special Issue The Prevention and Treatment of Atherosclerosis—Part II)
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13 pages, 2198 KiB  
Article
Reoperation for Recurrent and Persistent Cushing’s Disease without Visible MRI Findings
by Baofeng Wang, Shuying Zheng, Jie Ren, Zhihong Zhong, Hong Jiang, Qingfang Sun, Tingwei Su, Weiqing Wang, Yuhao Sun and Liuguan Bian
J. Clin. Med. 2022, 11(22), 6848; https://doi.org/10.3390/jcm11226848 - 20 Nov 2022
Cited by 2 | Viewed by 1384
Abstract
Purpose: Transsphenoidal surgery is the first-line treatment for Cushing’s disease (CD), even with negative preoperative magnetic resonance imaging (MRI) results. Some patients with persistent or recurring hypercortisolism have negative MRI findings after the initial surgery. We aimed to analyze the efficacy of repeat [...] Read more.
Purpose: Transsphenoidal surgery is the first-line treatment for Cushing’s disease (CD), even with negative preoperative magnetic resonance imaging (MRI) results. Some patients with persistent or recurring hypercortisolism have negative MRI findings after the initial surgery. We aimed to analyze the efficacy of repeat surgery in two groups of patients and determine if there is an association between positive MRI findings and early remission. Patients and Methods: Clinical, imaging, and biochemical information of 42 patients who underwent repeat surgery by a single neurosurgeon between 2002 and 2021 was retrospectively analyzed. We compared the endocrinological, histopathological, and surgical outcomes before and after repeat surgery among 14 CD patients with negative MRI findings and 28 patients with positive MRI findings. Results: Immediate remission was achieved in 29 patients (69.0%) who underwent repeat surgery. Among all patients, 28 (66.7%) had MRI findings consistent with solid lesions. There was no significant difference in remission rates between the recurrence and persistence groups (77.8% vs. 57.1%, odds ratio = 2.625, 95% confidence interval = 0.651 to 10.586). Patients in remission after repeat surgery were not associated with positive MRI findings (odds ratio = 3.667, 95% confidence interval = 0.920 to 14.622). Conclusions: In terms of recurrence, repeat surgery in patients with either positive or negative MRI findings showed reasonable remission rates. For persistent disease with positive MRI findings, repeat surgery is still an option; however, more solid evidence is needed to determine if negative MRI findings are predictors for failed reoperations for persistent hypercortisolism. Full article
(This article belongs to the Special Issue Pituitary Tumors: Diagnosis and Treatment)
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12 pages, 620 KiB  
Article
Differences in Sex and the Incidence and In-Hospital Mortality among People Admitted for Infective Endocarditis in Spain, 2016–2020
by Jose M. De Miguel-Yanes, Rodrigo Jimenez-Garcia, Javier De Miguel-Diez, Valentin Hernández-Barrera, David Carabantes-Alarcon, Jose J. Zamorano-Leon, Concepción Noriega and Ana Lopez-de-Andres
J. Clin. Med. 2022, 11(22), 6847; https://doi.org/10.3390/jcm11226847 - 20 Nov 2022
Cited by 2 | Viewed by 1373
Abstract
(1) Background: A description of the trends and outcomes during hospitalization for infective endocarditis (IE) according to sex. (2) Methods: Using Spanish national hospital discharge data (2016–2020), we built Poisson regression models to compare the age-adjusted time trends for the incidence rate. We [...] Read more.
(1) Background: A description of the trends and outcomes during hospitalization for infective endocarditis (IE) according to sex. (2) Methods: Using Spanish national hospital discharge data (2016–2020), we built Poisson regression models to compare the age-adjusted time trends for the incidence rate. We used propensity score matching (PSM) to compare the clinical characteristics and the in-hospital mortality (IHM) between men and women hospitalized with IE. (3) Results: We identified 10,459 hospitalizations for IE (33.26% women). The incidence of IE remained stable during this five-year period. The age-adjusted incidence of IE was two-fold higher among men vs. women (IRR = 2.08; 95%CI 2.0–2.17). Before PSM, women with IE were significantly older than men (70.25 vs. 66.24 years; p < 0.001) and had lower comorbidity according to the Charlson comorbidity index (mean 1.38 vs. 1.43; p = 0.019). After PSM, the IHM among women admitted for IE remained >3 points higher than that among men (19.52% vs. 15.98%; p < 0.001). (4) Conclusions: The incidence of IE was two-fold higher among men than among women. IHM was significantly higher among women after accounting for the potential confounders. Full article
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