Journal of Clinical Medicine

12 pages, 441 KiB

Open AccessArticle

Anxiety and Depression Levels in Parents after Counselling for Fetal Heart Disease

by Gizem Seyda Erbas, Christoph Herrmann-Lingen, Eva Ostermayer, Alexander Kovacevic, Renate Oberhoffer-Fritz, Peter Ewert and Annette Wacker-Gussmann

J. Clin. Med. 2023, 12(1), 394; https://doi.org/10.3390/jcm12010394 - 03 Jan 2023

Cited by 3 | Viewed by 2768

Abstract

The progress in fetal cardiology allows for the early diagnosis of congenital heart defects, but there is still a lack of data on the psychological situation of parents expecting a child with a congenital heart defect. In this cross-sectional study, 77 parents (45 [...] Read more.

The progress in fetal cardiology allows for the early diagnosis of congenital heart defects, but there is still a lack of data on the psychological situation of parents expecting a child with a congenital heart defect. In this cross-sectional study, 77 parents (45 women and 32 men) expecting a child with a heart defect were interviewed with different questionnaires. The standardized Hospital Anxiety and Depression Scale (HADS) questionnaire was used to assess the psychological state of the parents. Various statistical procedures were performed to determine the prevalence, risk factors, and predictors of anxiety and depression. The prevalence for prenatal anxiety was 11.8% and for depressed mood 6.6%, whereas the postnatal prevalence was 25% for anxiety and 16.7% for depressed mood. The mother is influential in protecting against depression as a contact person (p = 0.035). Women were more affected by anxiety and depression than men (p = 0.036). A significant and positive correlation was observed between anxiety and depression before birth (ρ = 0.649, p < 0.001) and after birth (ρ = 0.808, p < 0.001). The level of education correlated negatively with depression (p = 0.016) and anxiety (p = 0.017) before birth. Significantly higher anxiety and depression scores were not observed among health and social workers (p = 0.084), first-time mothers (p = 0.190), and parents whose pregnancies were due to medical assistance (p = 0.051). Close collaboration between maternal-fetal care units, pediatric cardiologists and psychiatric/psychosomatic disciplines is a possible strategy to reduce stress in parents. Therefore, an expert team of professionals, educating with understandable terms and sufficient knowledge about fetal heart disease in parenting counseling, is required. The support of affected parents can positively impact the treatment of the child and should be integrated into the daily routine of the clinic. Full article

(This article belongs to the Section Cardiovascular Medicine)

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12 pages, 1131 KiB

Open AccessArticle

Positional End-Point Nystagmus during Positional Testing: Prevalence, Characteristics and Differences with Benign Paroxysmal Positional Vertigo

by Emilio Domínguez-Durán, Lucia Prieto-Sanchez-de-Puerta, Daniel Iván Martín-Jiménez and Serafin Sanchez-Gomez

J. Clin. Med. 2023, 12(1), 393; https://doi.org/10.3390/jcm12010393 - 03 Jan 2023

Viewed by 1895

Abstract

Background: Some individuals present positional end-point nystagmus when the Dix–Hallpike tests are performed on them if they unintentionally look towards the examined ear. Objective: To describe the prevalence and the characteristics of end-point nystagmus during positional testing in healthy subjects. Methods: Sixty healthy [...] Read more.

Background: Some individuals present positional end-point nystagmus when the Dix–Hallpike tests are performed on them if they unintentionally look towards the examined ear. Objective: To describe the prevalence and the characteristics of end-point nystagmus during positional testing in healthy subjects. Methods: Sixty healthy subjects were included. Eight positional tests were performed on them, two Pagnini–McClure tests and six Dix–Hallpike tests, while keeping the eyes in different positions; one on each side. Two independent observers filled in a questionnaire about the presence of positional nystagmus, its latency, duration, direction, and sense. Results and conclusions: Of the subjects, 65% showed positional end-point nystagmus. This nystagmus had a short latency and last for as long as the head is maintained in the test position. They can show any direction or sense, but the most common are torsional clockwise in left tests and anticlockwise in right tests. Unlike BPPV, this nystagmus did not appear with the eyes in the straight-ahead position, it is asymptomatic, and its intensity does not decline. Full article

(This article belongs to the Section Otolaryngology)

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1 pages, 161 KiB

Open AccessCorrection

Correction: Sasaki et al. Automatic Determination of the Center of Macular Hole Using Optical Coherence Tomography En Face Images. J. Clin. Med. 2022, 11, 3167

by Takanori Sasaki, Takuhei Shoji, Junji Kanno, Hirokazu Ishii, Yuji Yoshikawa, Hisashi Ibuki and Kei Shinoda

J. Clin. Med. 2023, 12(1), 392; https://doi.org/10.3390/jcm12010392 - 03 Jan 2023

Viewed by 929

Abstract

There was an error in the original publication [...] Full article

(This article belongs to the Section Ophthalmology)

11 pages, 1331 KiB

Open AccessArticle

Picking Up the Threads: Long-Term Outcomes of the Sutured Haemorrhoidopexy: A Retrospective Single-Centre Cohort Study

by Sara Z. Kuiper, Kayleigh A. M. Van Dam, Merel L. Kimman, Litza Mitalas, Paula G. M. Koot, Jarno Melenhorst, Sander M. J. Van Kuijk, Carmen D. Dirksen and Stephanie O. Breukink

J. Clin. Med. 2023, 12(1), 391; https://doi.org/10.3390/jcm12010391 - 03 Jan 2023

Viewed by 1770

Abstract

Background: This study aimed to assess the short- and long-term safety and efficacy of the sutured haemorrhoidopexy (SH) in patients with haemorrhoidal disease (HD). Methods: A retrospective study was performed, assessing the following treatment characteristics: number of sutures needed; operation time; perioperative complications; [...] Read more.

Background: This study aimed to assess the short- and long-term safety and efficacy of the sutured haemorrhoidopexy (SH) in patients with haemorrhoidal disease (HD). Methods: A retrospective study was performed, assessing the following treatment characteristics: number of sutures needed; operation time; perioperative complications; postoperative pain; hospital stay. The short- and long-term postoperative complications, HD recurrence and data on current HD symptoms were assessed according to the Core Outcome Set for HD. Results: Between January 2009 and December 2021, 149 patients with HD underwent a SH. One-hundred and forty-five patients were included, with a mean age of 61 years (±12.8), of which 70 were women (48.3%). Patients were predominantly diagnosed with grade III (37.2%) HD and the median follow-up was nine years (5–11). Perioperative complications occurred in four cases (2.8%). In two patients (1.4%), short-term postoperative complications were reported, and in seven patients (6.2%), long-term complications were reported. The cumulative efficacy in terms of freedom of recurrence was 88.3% (95% CI, 83.1–93.5) at six months, 80.0% (95% CI, 73.5–86.5) at one year, and 67.7% (95% CI, 59.7–75.7) at five years. Conclusions: Sutured haemorrhoidopexy is a safe treatment for patients with HD and can be proposed as a minimally invasive surgical treatment if basic and outpatient procedures fail. Full article

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

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7 pages, 245 KiB

Open AccessArticle

Long-Lasting Therapies with High Doses of D-chiro-inositol: The Downside

by Maurizio Nordio, Maria Salomè Bezerra Espinola, Gabriele Bilotta, Elena Capoccia and Mario Montanino Oliva

J. Clin. Med. 2023, 12(1), 390; https://doi.org/10.3390/jcm12010390 - 03 Jan 2023

Cited by 9 | Viewed by 2543

Abstract

Background: Recent studies reported possible concerns following long-lasting treatments with high doses of D-chiro-inositol in women. However, to date, no clinical trial has investigated or validated these concerns. We addressed this issue both retrospectively and with a prospective pilot study. Methods: For the [...] Read more.

Background: Recent studies reported possible concerns following long-lasting treatments with high doses of D-chiro-inositol in women. However, to date, no clinical trial has investigated or validated these concerns. We addressed this issue both retrospectively and with a prospective pilot study. Methods: For the retrospective analysis, we searched our databases for insulin-resistant women who took 1200 mg/day D-chiro-inositol for 6 months. In our prospective study, we enrolled 10 healthy women to supplement with the same therapeutic scheme. We performed statistical analyses through the Wilcoxon Signed-Rank Test. A p-value < 0.05 was considered significant. Results: Twenty women underwent 6 months of 1200 mg/day D-chiro-inositol. The treatment significantly decreased BMI, glycemia, insulinemia, HOMA-IR, serum levels of LH, total testosterone, and DHEAS. Serum estradiol rose and menstrual abnormalities occurred following the treatment. In our prospective study, we observed increases in serum levels of total testosterone and asprosin in healthy women. Conclusions: This is the first clinical evidence demonstrating that long-term treatments with high dosages of D-chiro-inositol can predispose women to hormonal and menstrual abnormalities. Moreover, the accumulation of D-chiro-inositol following such treatment regimen may lead to detrimental effects in non-reproductive tissues, as demonstrated by the increase in asprosin levels. Full article

(This article belongs to the Section Obstetrics & Gynecology)

13 pages, 2212 KiB

Open AccessArticle

Effects of Low-Immersive vs. High-Immersive Exercise Environment on Postural Stability and Reaction and Motor Time of Healthy Young Adults

by Julia Ciążyńska and Janusz Maciaszek

J. Clin. Med. 2023, 12(1), 389; https://doi.org/10.3390/jcm12010389 - 03 Jan 2023

Cited by 1 | Viewed by 1838

Abstract

(1) Background: Many young adults spend their time playing games and watching television. This type of spending time should be used effectively, so it’s worth adding exercise and immersion to them. Bearing in mind that the video games and physical exercise also improve [...] Read more.

(1) Background: Many young adults spend their time playing games and watching television. This type of spending time should be used effectively, so it’s worth adding exercise and immersion to them. Bearing in mind that the video games and physical exercise also improve postural stability, motor time (MT) and reaction time (RT), it is worth reaching for new technologies with immersion that are widely available and can be used, for example, as a remote intervention. This study aimed to compare the effects of a low vs. high-immersive exercise environment on postural stability, RT and MT in young adults. (2) Methods: Ninety-three participants were randomly divided into a control group (CG; n = 48) and experimental group (EG; n = 45). The CG exercised according to the Tabata self-made video display on a television set, and the EG exercised according to the Audio Trip exergame. In addition to the postural stability, RT and MT, we monitored the heart rate, breath rate and energy expenditure for safety reasons and to note any differences. (3) Results: Significant differences were observed for both groups in RT (F(2.182) = 3.14, p = 0.046, η² = 0.03) and MT (F(2.182) = 3.07, p = 0.049, η² = 0.03) and in postural stability in eyes closed (EC): F(2.182) = 3.66, p = 0.028, η² = 0.04 and eyes open in one leg (EO-OL): F(2.182) = 5.814, p = 0.04, η² = 0.07. (4) Conclusions: The inclusion of a higher immersion produces greater improvements in RT, MT. Additionally, after a low-immersive exercise environment, participants have higher center of pressure (COP) path length values with EC and EO-OL tests, which testifies to less postural stability. Regarding COP trajectory, a smaller area surface means better performance for high-immersive participants after 30 min of exercise. Full article

(This article belongs to the Special Issue Emerging Technology Applications to Promote Physical Activity and Health—Volume II)

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14 pages, 558 KiB

Open AccessArticle

Exploring Associations between Healthcare Use and Demographics, Pain and Pain Cognitions in People Scheduled for Surgery for Lumbar Radiculopathy: A Cross-Sectional Study

by Eva Huysmans, Lisa Goudman, Iris Coppieters, Anneleen Malfliet, Wouter Van Bogaert, Jo Nijs, Maarten Moens, Ronald Buyl, Kelly Ickmans and Koen Putman

J. Clin. Med. 2023, 12(1), 388; https://doi.org/10.3390/jcm12010388 - 03 Jan 2023

Viewed by 1625

Abstract

This cross-sectional study explored associations between demographics, pain intensity and cognitions on the one hand and healthcare use (HCU) on the other hand in people undergoing surgery for lumbar radiculopathy. HCU during the 2 months preceding surgery was evaluated using a retrospective questionnaire. [...] Read more.

This cross-sectional study explored associations between demographics, pain intensity and cognitions on the one hand and healthcare use (HCU) on the other hand in people undergoing surgery for lumbar radiculopathy. HCU during the 2 months preceding surgery was evaluated using a retrospective questionnaire. Demographics included sex, age and level of education and equivalent income. Back and leg pain intensity were evaluated using a visual analogue scale. Pain cognitions were assessed with the Tampa scale of kinesiophobia, the pain catastrophizing scale and the pain vigilance and awareness questionnaire. The sample comprised 120 participants (52% males; 49 years (Quartile (Q)1–Q3: 37.3–57.43)). The number of visits to the general practitioner was associated with sex (incidence rate ratio (IRR) for males = 0.811; p = 0.050), pain catastrophizing (IRR = 1.010; p = 0.041), pain magnification (IRR = 1.058; p = 0.004) and leg pain intensity (IRR = 1.004; p = 0.038). The number of neurosurgeon visits was associated with level of education (IRR moderate education = 1.518; p = 0.016 (reference: low education)). Receiving zero physiotherapy visits was associated with higher back pain intensity (Beta = 0.018; p = 0.028). Highest level of analgesics used was associated with sex (IRR for males = 0.502; p = 0.047) and leg pain (IRR = 1.014; p = 0.034). Only the association between general practitioner visits and pain magnification remained significant in multivariable analyses (IRR = 1.061; p = 0.033). The results suggest a rather indirect relationship between HCU and demographics, pain intensity and cognitions, involving a potential interplay between several patient- and healthcare system-related factors. Full article

(This article belongs to the Section Clinical Neurology)

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8 pages, 461 KiB

Open AccessArticle

Transcatheter Aortic Valve Replacement for Bicuspid vs. Tricuspid Aortic Stenosis among Patients at Low Surgical Risk in China: From the Multicenter National NTCVR Database

by Nanchao Hong, Wenzhi Pan, Xianbao Liu, Daxin Zhou, Jianan Wang and Junbo Ge

J. Clin. Med. 2023, 12(1), 387; https://doi.org/10.3390/jcm12010387 - 03 Jan 2023

Cited by 1 | Viewed by 1696

Abstract

Background: This study aims to compare the outcomes of transcatheter aortic valve replacement (TAVR) with self-expandable valves for bicuspid aortic valve (BAV) vs. tricuspid aortic valve (TAV) stenosis patients who are at low surgical risk. Methods: Participants were enrolled from 36 centers in [...] Read more.

Background: This study aims to compare the outcomes of transcatheter aortic valve replacement (TAVR) with self-expandable valves for bicuspid aortic valve (BAV) vs. tricuspid aortic valve (TAV) stenosis patients who are at low surgical risk. Methods: Participants were enrolled from 36 centers in China between January 2017 and December 2021. The primary endpoint event was all-cause mortality and all stroke at 30 days. Results: Among 389 patients at low surgical risk that underwent TAVR, 229 patients were BAV stenosis (mean age, 72.9 years; 65.1% men). There was no significant difference in the rate of all-cause death between two populations at 30 days. However, the rate of all stroke was significantly higher in the BAV group at 30 days (3.3% vs. 0%; odds ratio (OR), 0.97 (95% confidence interval (CI), 0.94 to 0.99); p = 0.044). By multivariate logistic regression analysis, trans-carotid access was associated with a higher all stroke rate at 30 days (OR, 29.20 (95% CI, 3.97 to 215.1); p = 0.001). Conclusions: In this national registry-based study, patients treated for BAV vs. TAV stenosis had no significant difference in all-cause mortality at 30 days, but trans-carotid access was associated with a higher all stroke rate after TAVR at 30 days. Full article

(This article belongs to the Special Issue Clinical and Procedural Update on Transcatheter Aortic Valve Replacement (TAVR))

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12 pages, 1673 KiB

Open AccessArticle

Pleural Effusions on MRI in Autosomal Dominant Polycystic Kidney Disease

by Jin Liu, Xiaorui Yin, Hreedi Dev, Xianfu Luo, Jon D. Blumenfeld, Hanna Rennert and Martin R. Prince

J. Clin. Med. 2023, 12(1), 386; https://doi.org/10.3390/jcm12010386 - 03 Jan 2023

Cited by 2 | Viewed by 2944

Abstract

Autosomal dominant polycystic kidney disease (ADPKD) has cystic fluid accumulations in the kidneys, liver, pancreas, arachnoid spaces as well as non-cystic fluid accumulations including pericardial effusions, dural ectasia and free fluid in the male pelvis. Here, we investigate the possible association of ADPKD [...] Read more.

Autosomal dominant polycystic kidney disease (ADPKD) has cystic fluid accumulations in the kidneys, liver, pancreas, arachnoid spaces as well as non-cystic fluid accumulations including pericardial effusions, dural ectasia and free fluid in the male pelvis. Here, we investigate the possible association of ADPKD with pleural effusion. ADPKD subjects (n = 268) and age-gender matched controls without ADPKD (n = 268) undergoing body magnetic resonance imaging from mid-thorax down into the pelvis were independently evaluated for pleural effusion by 3 blinded expert observers. Subjects with conditions associated with pleural effusion were excluded from both populations. Clinical and laboratory data as well as kidney, liver and spleen volume, pleural fluid volume, free pelvic fluid and polycystic kidney disease genotype were evaluated. Pleural effusions were observed in 56 of 268 (21%) ADPKD subjects compared with 21 of 268 (8%) in controls (p < 0.0001). In a subpopulation controlling for renal function by matching estimated glomerular filtration rate (eGFR), 28 of 110 (25%) ADPKD subjects had pleural effusions compared to 5 of 110 (5%) controls (p < 0.001). Pleural effusions in ADPKD subjects were more prevalent in females (37/141; 26%) than males (19/127,15%; p = 0.02) and in males were weakly correlated with the presence of free pelvic fluid (r = 0.24, p = 0.02). ADPKD subjects with pleural effusions were younger (48 ± 14 years old vs. 43 ± 14 years old) and weighed less (77 vs. 70 kg; p ≤ 0.02) than those without pleural effusions. For ADPKD subjects with pleural effusions, the mean volume of fluid layering dependently in the posterior–inferior thorax was 19 mL and was not considered to be clinically significant. Pleural effusion is associated with ADPKD, but its role in the pathogenesis of ADPKD requires further evaluation. Full article

(This article belongs to the Section Nuclear Medicine & Radiology)

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12 pages, 1850 KiB

Open AccessArticle

Segmentation-Assisted Fully Convolutional Neural Network Enhances Deep Learning Performance to Identify Proliferative Diabetic Retinopathy

by Minhaj Alam, Emma J. Zhao, Carson K. Lam and Daniel L. Rubin

J. Clin. Med. 2023, 12(1), 385; https://doi.org/10.3390/jcm12010385 - 03 Jan 2023

Cited by 7 | Viewed by 1814

Abstract

With the progression of diabetic retinopathy (DR) from the non-proliferative (NPDR) to proliferative (PDR) stage, the possibility of vision impairment increases significantly. Therefore, it is clinically important to detect the progression to PDR stage for proper intervention. We propose a segmentation-assisted DR classification [...] Read more.

With the progression of diabetic retinopathy (DR) from the non-proliferative (NPDR) to proliferative (PDR) stage, the possibility of vision impairment increases significantly. Therefore, it is clinically important to detect the progression to PDR stage for proper intervention. We propose a segmentation-assisted DR classification methodology, that builds on (and improves) current methods by using a fully convolutional network (FCN) to segment retinal neovascularizations (NV) in retinal images prior to image classification. This study utilizes the Kaggle EyePacs dataset, containing retinal photographs from patients with varying degrees of DR (mild, moderate, severe NPDR and PDR. Two graders annotated the NV (a board-certified ophthalmologist and a trained medical student). Segmentation was performed by training an FCN to locate neovascularization on 669 retinal fundus photographs labeled with PDR status according to NV presence. The trained segmentation model was used to locate probable NV in images from the classification dataset. Finally, a CNN was trained to classify the combined images and probability maps into categories of PDR. The mean accuracy of segmentation-assisted classification was 87.71% on the test set (SD = 7.71%). Segmentation-assisted classification of PDR achieved accuracy that was 7.74% better than classification alone. Our study shows that segmentation assistance improves identification of the most severe stage of diabetic retinopathy and has the potential to improve deep learning performance in other imaging problems with limited data availability. Full article

(This article belongs to the Section Ophthalmology)

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12 pages, 1185 KiB

Open AccessArticle

Proteomics Characterization of Clear Cell Renal Cell Carcinoma

by Jesús Miranda-Poma, Lucía Trilla-Fuertes, Rocío López-Vacas, Elena López-Camacho, Eugenia García-Fernández, Ana Pertejo, María I. Lumbreras-Herrera, Andrea Zapater-Moros, Mariana Díaz-Almirón, Antje Dittmann, Juan Ángel Fresno Vara, Enrique Espinosa, Pilar González-Peramato, Álvaro Pinto-Marín and Angelo Gámez-Pozo

J. Clin. Med. 2023, 12(1), 384; https://doi.org/10.3390/jcm12010384 - 03 Jan 2023

Viewed by 1927

Abstract

Purpose: To explore the tumor proteome of patients diagnosed with localized clear cell renal cancer (ccRCC) and treated with surgery. Material and methods: A total of 165 FFPE tumor samples from patients diagnosed with ccRCC were analyzed using DIA-proteomics. Proteomics ccRCC subtypes were [...] Read more.

Purpose: To explore the tumor proteome of patients diagnosed with localized clear cell renal cancer (ccRCC) and treated with surgery. Material and methods: A total of 165 FFPE tumor samples from patients diagnosed with ccRCC were analyzed using DIA-proteomics. Proteomics ccRCC subtypes were defined using a consensus cluster algorithm (CCA) and characterized by a functional approach using probabilistic graphical models and survival analyses. Results: We identified and quantified 3091 proteins, including 2026 high-confidence proteins. Two proteomics subtypes of ccRCC (CC1 and CC2) were identified by CC using the high-confidence proteins only. Characterization of molecular differences between CC1 and CC2 was performed in two steps. First, we defined 514 proteins showing differential expression between the two subtypes using a significance analysis of microarrays analysis. Proteins overexpressed in CC1 were mainly related to translation and ribosome, while proteins overexpressed in CC2 were mainly related to focal adhesion and membrane. Second, a functional analysis using probabilistic graphical models was performed. CC1 subtype is characterized by an increased expression of proteins related to glycolysis, mitochondria, translation, adhesion proteins related to cytoskeleton and actin, nucleosome, and spliceosome, while CC2 subtype showed higher expression of proteins involved in focal adhesion, extracellular matrix, and collagen organization. Conclusions: ccRCC tumors can be classified in two different proteomics subtypes. CC1 and CC2 present specific proteomics profiles, reflecting alterations of different molecular pathways in each subtype. The knowledge generated in this type of studies could help in the development of new drugs targeting subtype-specific deregulated pathways. Full article

(This article belongs to the Section Oncology)

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7 pages, 2382 KiB

Open AccessArticle

Prophylactic Femoral Neck Fixation in an Osteoporosis Femur Model: A Novel Surgical Technique with Biomechanical Study

by Kyeong-Hyeon Park, Chang-Wug Oh, Joon-Woo Kim, Hee-Jun Kim, Dong-Hyun Kim, Jin-Han Lee, Won-Ki Hong and Jong-Keon Oh

J. Clin. Med. 2023, 12(1), 383; https://doi.org/10.3390/jcm12010383 - 03 Jan 2023

Cited by 1 | Viewed by 1602

Abstract

Intramedullary nailing (IMN) is a popular treatment for elderly patients with femoral shaft fractures. Recently, prophylactic neck fixation has been increasingly used to prevent proximal femoral fractures during IMN. Therefore, this study aimed to investigate the biomechanical strength of prophylactic neck fixation in [...] Read more.

Intramedullary nailing (IMN) is a popular treatment for elderly patients with femoral shaft fractures. Recently, prophylactic neck fixation has been increasingly used to prevent proximal femoral fractures during IMN. Therefore, this study aimed to investigate the biomechanical strength of prophylactic neck fixation in osteoporotic femoral fractures. An osteoporotic femur model was created to simulate the union of femoral shaft fractures with IMN. Two study groups comprising six specimens each were created for IMN with two standard proximal locking screws (SN group) and IMN with two reconstruction proximal locking screws (RN group). Axial loading was conducted to measure the stiffness, load-to-failure, and failure modes. There were no statistically significant differences in stiffness between the two groups. However, the load-to-failure in the RN group was significantly higher than that in the SN group (p < 0.05). Femoral neck fractures occurred in all specimens in the SN group. Five constructs in the RN group showed subtrochanteric fractures without femoral neck fractures. However, one construct was observed in both subtrochanteric and femoral neck fractures. Therefore, prophylactic neck fixation may be considered an alternative biomechanical solution to prevent proximal femoral fractures when performing IMN for osteoporotic femoral fractures. Full article

(This article belongs to the Special Issue Advance in Orthopedic Trauma Surgery)

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13 pages, 877 KiB

Open AccessArticle

Intraoperative Cell Savage, Infection and Organ Failure in Infective Endocarditis Patients—A Retrospective Single Center Evaluation

by Christoph Sponholz, Oliver Sommerfeld, Caroline Moehl, Thomas Lehmann, Marcus Franz, Michael Bauer, Torsten Doenst, Gloria Faerber and Mahmoud Diab

J. Clin. Med. 2023, 12(1), 382; https://doi.org/10.3390/jcm12010382 - 03 Jan 2023

Cited by 2 | Viewed by 1455

Abstract

Surgery is indicated in about 50% of infective endocarditis patients, and bleeding or the transfusion of blood a common finding. The intraoperative use of cell salvage may reduce the perioperative transfusion requirement, but its use is limited in the underlying disease. In this [...] Read more.

Surgery is indicated in about 50% of infective endocarditis patients, and bleeding or the transfusion of blood a common finding. The intraoperative use of cell salvage may reduce the perioperative transfusion requirement, but its use is limited in the underlying disease. In this retrospective study, we therefore evaluated n = 335 patients fulfilling the modified Duke criteria for infective endocarditis characterized by the use of intraoperative cell salvage with autologous blood retransfusion. Inflammation markers and organ dysfunction, including catecholamine dependency, were evaluated by using linear regression analysis. Between 2015 and 2020, 335 patients underwent surgery for left-sided heart valve endocarditis. Intraoperative cell salvage was used in 40.3% of the cases, especially in complex scenarios and reoperation. Intraoperative cell salvage significantly altered the white blood cell count after surgery. On average, leucocytes were 3.0 Gpt/L higher in patients with intraoperative cell salvage compared to patients without after adjustment for confounders (95% CI: 0.39–5.54). Although the difference in WBC was statistically significant, i.e., higher in the ICS group compared to the no-ICS group, this difference may be clinically unimportant. Organ dysfunction, including hemodynamic instability and lactate values, were comparable between groups. In conclusion, intraoperative cell salvage enhanced the re-transfusion of autologous blood, with minor effects on the postoperative course of inflammatory markers, but was not associated with increased hemodynamic instability or organ dysfunction in general. The restriction of intraoperative cell salvage in surgery for infective endocarditis should be re-evaluated, and more prospective data in this topic are needed. Full article

(This article belongs to the Special Issue Anesthetic Management in Perioperative Period)

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13 pages, 651 KiB

Open AccessSystematic Review

Clinicopathologic Profile, Management and Outcome of Sinonasal Ameloblastoma—A Systematic Review

by Vini Mehta, Gargi S. Sarode, Vishnu Teja Obulareddy, Tanvi Sharma, Shruti Kokane, Marco Cicciù and Giuseppe Minervini

J. Clin. Med. 2023, 12(1), 381; https://doi.org/10.3390/jcm12010381 - 03 Jan 2023

Cited by 8 | Viewed by 1720

Abstract

Sinonasal ameloblastoma (SNA) is considered to be a subtype of ameloblastoma. It differs from gnathic ameloblastoma in terms of clinicopathologic features, management and prognosis. Thus, the objective of the present review was to study the complications, survival, recurrence rate and outcomes following the [...] Read more.

Sinonasal ameloblastoma (SNA) is considered to be a subtype of ameloblastoma. It differs from gnathic ameloblastoma in terms of clinicopathologic features, management and prognosis. Thus, the objective of the present review was to study the complications, survival, recurrence rate and outcomes following the management of SNA. The electronic search process was conducted on PubMed-Medline, Embase, and Scopus. Google Scholar was used to search grey literature. Quality assessment of the case reports (CR) and case series (CS) was done based on CARE guidelines. The initial search resulted in 2111 articles. 15 studies (13 CR and 2 CS) were found to meet the eligibility criteria. The majority of the studies described histological features of SNA, which were consistent with ameloblastomas of gnathic origin. There were no SNA-related deaths reported in the included studies. Five studies described endoscopic surgeries to remove SNAs, and three SNAs were treated with post-surgery radiotherapy. Data from included studies suggest that sinonasal ameloblastomas are histologically similar to gnathic ameloblastomas, but their clinical presentation is different. They may cause complete or partial obstruction of the nasal cavity and the sinus. They appear to affect an older demographic, and their resection may be accompanied by the excision of a large portion of the maxilla, necessitating maxillofacial prosthetic rehabilitation. Full article

(This article belongs to the Section Oncology)

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11 pages, 262 KiB

Open AccessArticle

High Level of Blood Eosinophils and Localization of Bronchiectasis in Patients with Severe Asthma: A Pilot Study

by Vitaliano Nicola Quaranta, Silvano Dragonieri, Maria Rosaria Vulpi, Nunzio Crimi, Claudia Crimi, Pierachille Santus, Francesco Menzella, Corrado Pelaia, Giulia Scioscia, Cristiano Caruso, Elena Bargagli, Nicola Scichilone and Giovanna Elisiana Carpagnano

J. Clin. Med. 2023, 12(1), 380; https://doi.org/10.3390/jcm12010380 - 03 Jan 2023

Cited by 3 | Viewed by 1634

Abstract

Background. Severe asthma and bronchiectasis are heterogeneous diseases that frequently coexist. The location of bronchiectasis is generally determined by specific underlying pathophysiological mechanisms. The aim of this study was to determine whether in a population suffering from both severe asthma and bronchiectasis there [...] Read more.

Background. Severe asthma and bronchiectasis are heterogeneous diseases that frequently coexist. The location of bronchiectasis is generally determined by specific underlying pathophysiological mechanisms. The aim of this study was to determine whether in a population suffering from both severe asthma and bronchiectasis there was a correlation between eosinophilic inflammation and localization of bronchiectasis. Methods. We enrolled 41 patients with coexisting bronchiectasis from eight different severe asthma center outpatient clinics and collected the following data: baseline characteristics, Asthma Control Test, Asthma Control Questionnaire, IgE level, blood count, high-resolution computed tomography and bronchiectasis-related parameters, skin prick test, FeNO50 and flow-volume spirometry. The study was retrospectively registered. Results. The presence of eosinophils > 1000 cells/μL was related to distribution of lower pulmonary bronchiectasis (9.1% upper lobes vs. 53.3% lower lobes, p = 0.014). Indeed, the presence of eosinophilic counts > 1000 increased the probability of lower localization of bronchiectasis compared to upper lobes (ODD 0.088 (0.010–0.772), p = 0.028). Conclusions. An increase in blood eosinophils > 1000 cells/μL seems to be associated with lower preferential localization of bronchiectasis with sparing of the upper lung lobes. This could represent a new potential radiological phenotype that could have a dedicated therapeutic strategy in the future. Full article

(This article belongs to the Special Issue Prevention and Biomarkers of Respiratory Diseases)

14 pages, 1608 KiB

Open AccessReview

Gliflozins: From Antidiabetic Drugs to Cornerstone in Heart Failure Therapy—A Boost to Their Utilization and Multidisciplinary Approach in the Management of Heart Failure

by Lorenzo Pistelli, Francesca Parisi, Michele Correale, Federica Cocuzza, Francesca Campanella, Tommaso de Ferrari, Pasquale Crea, Rosalba De Sarro, Olga La Cognata, Simona Ceratti, Tonino Recupero, Gaetano Ruocco, Alberto Palazzuoli, Egidio Imbalzano and Giuseppe Dattilo

J. Clin. Med. 2023, 12(1), 379; https://doi.org/10.3390/jcm12010379 - 03 Jan 2023

Cited by 5 | Viewed by 3804

Abstract

Heart failure (HF) is a complex, multifactorial, progressive clinical condition affecting 64.3 million people worldwide, with a strong impact in terms of morbidity, mortality and public health costs. In the last 50 years, along with a better understanding of HF physiopathology and in [...] Read more.

Heart failure (HF) is a complex, multifactorial, progressive clinical condition affecting 64.3 million people worldwide, with a strong impact in terms of morbidity, mortality and public health costs. In the last 50 years, along with a better understanding of HF physiopathology and in agreement with the four main models of HF, many therapeutic options have been developed. Recently, the European Society of Cardiology (ESC) HF guidelines enthusiastically introduced inhibitors of the sodium-glucose cotransporter (SGLT2i) as first line therapy for HF with reduced ejection fraction (HFrEF) in order to reduce hospitalizations and mortality. Despite drugs developed as hypoglycemic agents, data from the EMPA-REG OUTCOME trial encouraged the evaluation of the possible cardiovascular effects, showing SGLT2i beneficial effects on loading conditions, neurohormonal axes, heart cells’ biochemistry and vascular stiffness, determining an improvement of each HF model. We want to give a boost to their use by increasing the knowledge of SGLT2-I and understanding the probable mechanisms of this new class of drugs, highlighting strengths and weaknesses, and providing a brief comment on major trials that made Gliflozins a cornerstone in HF therapy. Finally, aspects that may hinder SGLT2-i widespread utilization among different types of specialists, despite the guidelines’ indications, will be discussed. Full article

(This article belongs to the Section Cardiology)

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5 pages, 600 KiB

Open AccessCommunication

IgG and IgE Autoantibodies to IgE Receptors in Chronic Spontaneous Urticaria and Their Role in the Response to Omalizumab

by Carlo Alberto Maronese, Silvia Mariel Ferrucci, Chiara Moltrasio, Maurizio Lorini, Vincenzo Carbonelli, Riccardo Asero, Angelo Valerio Marzano and Massimo Cugno

J. Clin. Med. 2023, 12(1), 378; https://doi.org/10.3390/jcm12010378 - 03 Jan 2023

Cited by 11 | Viewed by 1817

Abstract

Background: Chronic spontaneous urticaria (CSU) is defined as the recurrence of unprovoked transient wheals and itch for more than 6 weeks. Currently, there is an unmet need concerning response prediction in CSU. The present study investigated biomarkers of type I and type IIb [...] Read more.

Background: Chronic spontaneous urticaria (CSU) is defined as the recurrence of unprovoked transient wheals and itch for more than 6 weeks. Currently, there is an unmet need concerning response prediction in CSU. The present study investigated biomarkers of type I and type IIb autoimmunity as potential predictors of response to omalizumab in CSU. Materials and methods: Differences in levels of IgG and IgE autoantibodies targeting the high- and low-affinity IgE receptors (FcεRI and FcεRII, respectively), as well as spontaneous and specifically triggered leukotriene C (LTC)4 release by basophils from the investigated subjects, were evaluated in 18 consecutive, prospectively enrolled CSU patients and 18 age- and sex-matched, healthy non-atopic controls. Results: The patients with CSU had higher levels of anti-FcεRI IgE (542 (386.25–776.5) vs. 375 (355–418), optical density (OD), p = 0.008), and IgG (297 (214.5–431.25) vs. 193.5 (118–275) OD, p = 0.004) autoantibodies relative to the controls. Simultaneous anti-FcεRI IgG and IgE positivity (i.e., both autoantibody levels above the respective cut-offs) was recorded only in late- and non-responders (3/8 and 1/2, respectively). Discussion: Significantly higher anti-FcεRI IgE autoantibody levels were found in the CSU patients as compared to the controls, supporting FcεRI as an autoallergic target of IgE (autoallergen) in the complex pathophysiological scenario of CSU. The co-occurrence of anti-FcεRI IgG and IgE autoantibodies was documented only in late- and non-responders, but not in early ones, crediting the co-existence of autoimmune and autoallergic mechanisms as a driver of late/poor response to omalizumab. Full article

(This article belongs to the Section Immunology)

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13 pages, 516 KiB

Open AccessArticle

Urine 3-Nitrotyrosine and Serum HDL as Potential Biomarkers of Depression

by Aleksander Nobis, Daniel Zalewski, Eliza Samaryn, Mateusz Maciejczyk, Anna Zalewska and Napoleon Waszkiewicz

J. Clin. Med. 2023, 12(1), 377; https://doi.org/10.3390/jcm12010377 - 03 Jan 2023

Cited by 3 | Viewed by 1594

Abstract

Depression (MDD) is a leading psychiatric entity worldwide, with a high impact on individual life and public health. In recent years, efforts have been made to elucidate its biological underpinnings. MDD biomarker research provides promise for a better understanding of the biochemical processes [...] Read more.

Depression (MDD) is a leading psychiatric entity worldwide, with a high impact on individual life and public health. In recent years, efforts have been made to elucidate its biological underpinnings. MDD biomarker research provides promise for a better understanding of the biochemical processes involved in its pathogenesis. Oxidative and nitrosative stress (O&NS) and lipid disturbances are reported as major factors favoring the occurrence of depression. A total of 29 patients with MDD and 30 healthy volunteers were examined using the Hamilton Depression Scale (HAM-D), the Hamilton Anxiety Scale (HAM-A), and the Beck Depression Inventory (BDI). Blood and urine were collected to search for potential MDD biomarkers. O&NS parameters and β-amyloid were assessed in the urine, while cholesterol fractions were assessed in the blood. The group of depressed patients was characterized by higher concentrations of urine superoxide dismutase (SOD), 3-nitrotyrosine (3-NT), catalase (CAT), reduced glutathione (GSH), tryptophan (TRY), and serum triglycerides (TGA), along with lower levels of serum high-density lipoprotein (HDL). Elevated urine 3-NT and decreased serum HDL, considered together, were found to have the greatest potential as markers of depression. The study supports the importance of oxidative stress and cholesterol disturbances in MDD. Further research is required to assess their clinical usefulness as markers. Full article

(This article belongs to the Section Mental Health)

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13 pages, 4871 KiB

Open AccessArticle

Involvement of Pharmacists in the Emergency Department to Correct Errors in the Medication History and the Impact on Adverse Drug Event Detection

by Clara Goulas, Laura Lohan, Marion Laureau, Damien Perier, Véronique Pinzani, Marie Faucanie, Valérie Macioce, Grégory Marin, Isabelle Giraud, Maxime Villiet, Mustapha Sebbane and Cyril Breuker

J. Clin. Med. 2023, 12(1), 376; https://doi.org/10.3390/jcm12010376 - 03 Jan 2023

Viewed by 2052

Abstract

(1) Incomplete or wrong medication histories can lead to missed diagnoses of Adverse Drug Effects (ADEs). We aimed to evaluate pharmacist-identified ED errors in the medication histories obtained by physicians, and their consequences for ADE detection. (2) This prospective monocentric study was carried [...] Read more.

(1) Incomplete or wrong medication histories can lead to missed diagnoses of Adverse Drug Effects (ADEs). We aimed to evaluate pharmacist-identified ED errors in the medication histories obtained by physicians, and their consequences for ADE detection. (2) This prospective monocentric study was carried out in an ED of a university hospital. We included adult patients presenting with an ADE detected in the ED. The best possible medication histories collected by pharmacists were used to identify errors in the medication histories obtained by physicians. We described these errors, and identified those related to medications involved in ADEs. We also identified the ADEs that could not have been detected without the pharmacists’ interventions. (3) Of 735 patients presenting with an ADE, 93.1% had at least one error on the medication list obtained by physicians. Of the 1047 medications involved in ADEs, 51.3% were associated with an error in the medication history. In total, 23.1% of the medications involved in ADEs were missing in the physicians’ medication histories and were corrected by the pharmacists. (4) Medication histories obtained by ED physicians were often incomplete, and half the medications involved in ADEs were not identified, or were incorrectly characterized in the physicians’ medication histories. Full article

(This article belongs to the Special Issue Prediction, Detection and Prevention of Medication Errors and Adverse Drug Reactions)

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11 pages, 602 KiB

Open AccessReview

Acute Kidney Injury: Medical Causes and Pathogenesis

by Faruk Turgut, Alaa S. Awad and Emaad M. Abdel-Rahman

J. Clin. Med. 2023, 12(1), 375; https://doi.org/10.3390/jcm12010375 - 03 Jan 2023

Cited by 17 | Viewed by 12453

Abstract

Acute kidney injury (AKI) is a common clinical syndrome characterized by a sudden decline in or loss of kidney function. AKI is not only associated with substantial morbidity and mortality but also with increased risk of chronic kidney disease (CKD). AKI is classically [...] Read more.

Acute kidney injury (AKI) is a common clinical syndrome characterized by a sudden decline in or loss of kidney function. AKI is not only associated with substantial morbidity and mortality but also with increased risk of chronic kidney disease (CKD). AKI is classically defined and staged based on serum creatinine concentration and urine output rates. The etiology of AKI is conceptually classified into three general categories: prerenal, intrarenal, and postrenal. Although this classification may be useful for establishing a differential diagnosis, AKI has mostly multifactorial, and pathophysiologic features that can be divided into different categories. Acute tubular necrosis, caused by either ischemia or nephrotoxicity, is common in the setting of AKI. The timely and accurate identification of AKI and a better understanding of the pathophysiological mechanisms that cause kidney dysfunction are essential. In this review, we consider various medical causes of AKI and summarize the most recent updates in the pathogenesis of AKI. Full article

(This article belongs to the Section Nephrology & Urology)

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11 pages, 481 KiB

Open AccessArticle

Neuropsychological and Behavioral Profile in Sleep-Related Hypermotor Epilepsy (SHE) and Disorders of Arousal (DOA): A Multimodal Analysis

by Monica Puligheddu, Patrizia Congiu, Michela Figorilli, Ludovica Tamburrino, Patrizia Pisanu, Roberta Coa, Maria Giuseppina Mascia, Davide Fonti, Rosamaria Lecca, Enzo Grossi and Antonella Gagliano

J. Clin. Med. 2023, 12(1), 374; https://doi.org/10.3390/jcm12010374 - 03 Jan 2023

Cited by 1 | Viewed by 2517

Abstract

Study Objectives: Disorder of arousal (DOA) and sleep-related hypermotor epilepsy (SHE) are complex, often bizarre, involuntary sleep behaviors, whose differential diagnosis may be challenging because they share some clinical features, such as sleep fragmentation. Mounting evidence highlights the critical role of sleep in [...] Read more.

Study Objectives: Disorder of arousal (DOA) and sleep-related hypermotor epilepsy (SHE) are complex, often bizarre, involuntary sleep behaviors, whose differential diagnosis may be challenging because they share some clinical features, such as sleep fragmentation. Mounting evidence highlights the critical role of sleep in cognitive functions. Controversial findings are raised about the cognitive profile in SHE; however, no studies have investigated the cognitive profile in DOA. This study aimed to assess whether sleep instability affects cognitive functions in patients with SHE or DOA. Methods: This study analyzed 11 patients with DOA, 11 patients with SHE, and 22 healthy controls (HC). They underwent full-night video polysomnography (vPSG) and comprehensive neuropsychological and behavioral evaluation. Differences in the variables of interest among the SHE group, DOA group, and their respective control groups were evaluated. The auto-contractive map (auto-CM) system was used to evaluate the strength of association across the collected data. Results: The SHE group had reduced sleep efficiency and increased wake after sleep onset (WASO); both the SHE and DOA groups showed increased % of N2 and REM sleep compared to the HC group. Neuropsychological and behavioral evaluations showed a different cognitive profile in the SHE group with respect to the HC group. The auto-CM showed that Pittsburgh Sleep Quality Index (PSQI), Beck depression inventory (BDI), MWCST_PE, Epworth sleepiness scale (ESS), WASO, N1, and % REM were strictly correlated with SHE, whereas the SE and arousal index (AI) were strictly related to DOA. Conclusions: Patients with SHE and DOA present different cognitive and psychiatric profiles, with subtle and selective cognitive impairments only in those with SHE, supporting the discriminative power of cognitive and psychiatric assessment in these two conditions. Full article

(This article belongs to the Special Issue 10th Anniversary of JCM—Research Updates in Developmental Psychopathology and Pediatric Neurology)

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21 pages, 1799 KiB

Open AccessArticle

Effects of Chokeberries (Aronia spp.) on Cytoprotective and Cardiometabolic Markers and Semen Quality in 109 Mildly Hypercholesterolemic Danish Men: A Prospective, Double-Blinded, Randomized, Crossover Trial

by Julie Sangild, Anne Faldborg, Cecilie Schousboe, Maja Døvling Kaspersen Fedder, Lars Porskjær Christensen, Astrid Komal Lausdahl, Eva Christensen Arnspang, Søren Gregersen, Henrik Byrial Jakobsen, Ulla Breth Knudsen and Jens Fedder

J. Clin. Med. 2023, 12(1), 373; https://doi.org/10.3390/jcm12010373 - 03 Jan 2023

Cited by 2 | Viewed by 2637

Abstract

Background: Chokeberries (Aronia spp.) are known to exhibit both direct and indirect antioxidant properties and have been associated with beneficial effects on human health, including cardiovascular risk factors (inflammation, serum lipids, sugars, blood pressure), oxidative stress, and semen quality. This prospective, double-blinded, [...] Read more.

Background: Chokeberries (Aronia spp.) are known to exhibit both direct and indirect antioxidant properties and have been associated with beneficial effects on human health, including cardiovascular risk factors (inflammation, serum lipids, sugars, blood pressure), oxidative stress, and semen quality. This prospective, double-blinded, randomized, crossover clinical trial was conducted to elucidate the effects of Aronia supplementation on these health targets in mildly hypercholesterolemic men. Methods: The standardized Aronia supplementation comprised three wild Aronia spp. (A. arbutifolia, A prunifolia and A. melanocarpa) and the Aronia hybrid × Sorbaronia mitschurinii (standardized to 150 mg anthocyanins daily). Participants (n = 109) were healthy men with respect to all outcome targets except for the total cholesterol level (5.0–7.0 mM). Participants were randomized to supplementation with either Aronia or placebo for 90 days, followed by a wash-out period and lastly the complementary supplementation. Effects on the health parameters were compared among both the whole group of men and in subgroups according to age, body mass index (BMI), lifestyle, dietary habits, and serum glutathione levels at baseline. The study is registered in ClinicalTrials.gov.: NCT03405753. Results: Glutathione levels were significantly improved after 90 days intake of Aronia supplementation compared to placebo in the subgroup of men with a low level of glutathione at baseline (p = 0.038) and a high coffee intake (p = 0.045). A significant decrease in levels of sperm DNA fragmentation and an increase in the percentage of motile sperm were observed in men aged >40 and in men with BMI > 25. Further, these parameters were significantly improved in the dietary subgroup defined by a high level of coffee intake. Total cholesterol and low-density lipoprotein-cholesterol levels decreased significantly in men <40 years after Aronia supplementation. No statistically significant effects were observed regarding blood pressure, markers of blood sugar regulation, hemoglobin A1c, superoxide dismutase, catalase, isoprostane levels, high sensitivity C reactive protein, or other semen parameters. Conclusions: This study demonstrated a significant increase in glutathione levels and improvement of cytoprotective targets following Aronia supplementation in specific subgroups of men >40 years of age and BMI > 25 but did not demonstrate a significant effect in the overall analysis. The observed concurrent increase in glutathione levels and improvement of cytoprotective targets following Aronia supplementation in subgroups of men, suggests that the endogenous phase II antioxidant glutathione is involved in the modulation of the observed cytoprotective effects. This study is a good foundation for further investigation of these cytoprotective effects in groups with oxidative stress in a dose–response study. Full article

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

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12 pages, 747 KiB

Open AccessReview

Violent and Complex Behaviors and Non-Restorative Sleep Are the Main Features of Disorders of Arousal in Adulthood: Real Picture or a More Severe Phenotype?

by Greta Mainieri, Giuseppe Loddo, Luca Baldelli, Angelica Montini, Susanna Mondini and Federica Provini

J. Clin. Med. 2023, 12(1), 372; https://doi.org/10.3390/jcm12010372 - 03 Jan 2023

Cited by 3 | Viewed by 2250

Abstract

Disorders of arousal (DoA) are NREM parasomnias characterized by motor and emotional behaviors emerging from incomplete arousals from deep sleep. DoA are largely present in pediatric populations, a period during which they are labeled as self-limited manifestations. However, an extensive literature has shown [...] Read more.

Disorders of arousal (DoA) are NREM parasomnias characterized by motor and emotional behaviors emerging from incomplete arousals from deep sleep. DoA are largely present in pediatric populations, a period during which they are labeled as self-limited manifestations. However, an extensive literature has shown that DoA can persist in adulthood, with different characteristics from childhood DoA. Adult DoA patients usually report excessive daily sleepiness, sleep-related violence during DoA episodes or potentially harmful behaviors, which are rare in childhood. The semeiological features of DoA episodes in adulthood may complicate differential diagnoses with other motor manifestations during sleep, in particular sleep-related hypermotor epilepsy. However, it cannot be excluded that adults with DoA attending sleep centers constitute a more severe phenotype, thus not being representative of adult DoA in the general population. Video-polysomnographic studies of DoA document a spectrum of motor patterns of different complexities, the simplest of which may often go unnoticed. Despite the different complexities of the episodes, neurophysiologic studies showed the co-existence of deep sleep and wakefulness during DoA episodes or even before their onset. These aspects make DoA an ideal model to investigate the mechanisms regulating local sleep, sleep arousal and cognitive functions including spatial and temporal orientation, attention or memory. Full article

(This article belongs to the Special Issue Update on Parasomnias and Disruptive Sleep-Related Disorders)

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2 pages, 176 KiB

Open AccessEditorial

Latest Advances and Future Challenges in Pancreatic Surgery

by Gaëtan-Romain Joliat

J. Clin. Med. 2023, 12(1), 371; https://doi.org/10.3390/jcm12010371 - 03 Jan 2023

Cited by 3 | Viewed by 1208

Abstract

The field of pancreatic surgery has considerably evolved in recent decades [...] Full article

(This article belongs to the Special Issue Surgery for Pancreatic Diseases: Recent Progress and Future Directions)

12 pages, 2997 KiB

Open AccessArticle

Kaiso Protein Expression Correlates with Overall Survival in TNBC Patients

by Artur Bocian, Piotr Kędzierawski, Janusz Kopczyński, Olga Wabik, Anna Wawruszak, Michał Kiełbus, Paulina Miziak and Andrzej Stepulak

J. Clin. Med. 2023, 12(1), 370; https://doi.org/10.3390/jcm12010370 - 03 Jan 2023

Cited by 1 | Viewed by 1601

Abstract

Triple-negative breast cancers (TNBCs) are histologically heterogenic invasive carcinomas of no specific type that lack distinctive histological characteristics. The prognosis for women with TNBC is poor. Regardless of the applied treatments, recurrences and deaths are observed 3–5 years after the diagnosis. Thus, new [...] Read more.

Triple-negative breast cancers (TNBCs) are histologically heterogenic invasive carcinomas of no specific type that lack distinctive histological characteristics. The prognosis for women with TNBC is poor. Regardless of the applied treatments, recurrences and deaths are observed 3–5 years after the diagnosis. Thus, new diagnostic markers and targets for personalized treatment are needed. The subject of our study—the Kaiso transcription factor has been found to correlate with the invasion and progression of breast cancer. The publicly available TCGA breast cancer cohort containing Illumina HiSeq RNAseq and clinical data was explored in the study. Additionally, Kaiso protein expression was assessed in formalin-fixed and paraffin-embedded tissue archive specimens using the tissue microarray technique. In this retrospective study, Kaiso protein expression (nuclear localization) was compared with several clinical factors in the cohort of 103 patients with TNBC with long follow-up time. In univariate and multivariate analysis, high Kaiso protein but not mRNA expression was correlated with better overall survival and disease-free survival, as well as with premenopausal age. The use of radiotherapy was correlated with better disease-free survival (DFS) and overall survival (OS). However, given the heterogeneity of TNBC and context-dependent molecular diversity of Kaiso signaling in cancer progression, these results must be taken with caution and require further studies. Full article

(This article belongs to the Collection Current Updates and Advances in Breast Cancer)

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17 pages, 1500 KiB

Open AccessArticle

Effect of Exercise Interventions on Irisin and Interleukin-6 Concentrations and Indicators of Carbohydrate Metabolism in Males with Metabolic Syndrome

by Karol Makiel, Agnieszka Suder, Aneta Targosz, Marcin Maciejczyk and Alon Haim

J. Clin. Med. 2023, 12(1), 369; https://doi.org/10.3390/jcm12010369 - 03 Jan 2023

Cited by 6 | Viewed by 2868

Abstract

Irisin (IR) is a biomarker that is associated with metabolic syndrome (MetS). However, the available evidence on the association of IR, physical activity, and MetS status are contradictory. Therefore, the present study aimed to investigate the effect of exercise intervention on IR and [...] Read more.

Irisin (IR) is a biomarker that is associated with metabolic syndrome (MetS). However, the available evidence on the association of IR, physical activity, and MetS status are contradictory. Therefore, the present study aimed to investigate the effect of exercise intervention on IR and interleukin-6 (IL-6) levels and indicators of carbohydrate metabolism in males with MetS. The study included 62 males with MetS (age 36.6 ± 6.9 years, BMI 33.6 ± 4.4 kg/m²) randomly assigned to: examined group 1 (EG1, n = 21) with aerobic exercise intervention, examined group 2 (EG2, n = 21) with combined aerobic and resistance exercise intervention, both for 12 weeks, and the control group (CG, n = 20) without intervention. Anthropometric measurements, body composition (body fat [BF], fat free mass [FFM]) as well as a biochemical blood analysis (irisin [IR], interleukin-6 [IL-6], insulin [INS] and glucose [GL]) were performed at baseline, 6 and 12 weeks of intervention, and 4 weeks after ending the intervention (follow-up). Intergroup and intragroup comparisons were performed. In EG1, an increase in IR level was observed as well as decreases in IL-6, BF, and GL levels in relation to the initial measurement. In EG2, decreases in IL-6, BF, and INS levels were observed as well as an increase in FFM level. In CG, no changes were found. Aerobic-resistance exercise led to a greater reduction in the concentrations of IL-6 and INS and more favorable changes in body composition (BF and FFM) than the use of aerobic training alone in males with MetS. Full article

(This article belongs to the Topic Exercise and Chronic Disease)

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14 pages, 1520 KiB

Open AccessArticle

Clinical Use of Gastric Antisecretory Drugs in Hospitalized Pediatric Patients

by Cristian Locci, Laura Cuzzolin, Gianluca Cheri, Laura Saderi, Giovanni Sotgiu and Roberto Antonucci

J. Clin. Med. 2023, 12(1), 368; https://doi.org/10.3390/jcm12010368 - 03 Jan 2023

Cited by 1 | Viewed by 1375

Abstract

Antisecretory drugs are frequently used in the treatment of pediatric gastrointestinal disorders. This study was aimed to assess the prescribing patterns and the safety of ranitidine and proton pump inhibitors (PPIs) in a cohort of Italian pediatric patients. Children aged >1 month to [...] Read more.

Antisecretory drugs are frequently used in the treatment of pediatric gastrointestinal disorders. This study was aimed to assess the prescribing patterns and the safety of ranitidine and proton pump inhibitors (PPIs) in a cohort of Italian pediatric patients. Children aged >1 month to <16 years that were admitted to our Pediatric Clinic between 2016 and 2018 were enrolled in this retrospective observational study. All data were obtained from medical records and a parent telephone questionnaire. The exclusion criteria included the use of antisecretory therapy at hospital admission, failure to collect the relevant clinical data, and failure to administer the questionnaire. This study included 461 subjects, who were divided into four age groups: <2 years, 2–5 years, 6–11 years, and ≥12 years. Ranitidine was prescribed in 396 (85.9%) patients, mainly for the acute treatment of gastrointestinal symptoms, and a PPI was given to 65 (14.1%) children to treat gastroesophageal reflux disease, gastritis/ulcer, or for gastroprotection. During the study period, the percentage of patients treated with ranitidine progressively increased, except in the 2–5-year age group. We observed eighty-seven adverse drug reactions (ADRs), 61 of which occurred in the ranitidine group and 26 in the PPI group. The most common ADR was constipation (n = 35), which occurred more frequently in children treated with PPIs and in the 6–11-year age group. Ranitidine was the most used antisecretory drug in all the age groups, especially for acute treatment. Conversely, PPIs were the drugs of choice for prolonged treatments. Further research should be focused on developing an effective and safer alternative to ranitidine. Full article

(This article belongs to the Section Pharmacology)

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14 pages, 987 KiB

Open AccessReview

Juvenile Psoriatic Arthritis: Myth or Reality? An Unending Debate

by Roberta Naddei, Ana Rebollo-Giménez, Marco Burrone, Valentina Natoli, Silvia Rosina, Alessandro Consolaro and Angelo Ravelli

J. Clin. Med. 2023, 12(1), 367; https://doi.org/10.3390/jcm12010367 - 03 Jan 2023

Cited by 3 | Viewed by 11101

Abstract

Juvenile psoriatic arthritis (JPsA) accounts for 1–7% of all cases of juvenile idiopathic arthritis (JIA) and its definition has been a matter of controversy among pediatric rheumatologists for many years. The traditional attribution of JPsA to the spondyloarthropathy group was challenged in the [...] Read more.

Juvenile psoriatic arthritis (JPsA) accounts for 1–7% of all cases of juvenile idiopathic arthritis (JIA) and its definition has been a matter of controversy among pediatric rheumatologists for many years. The traditional attribution of JPsA to the spondyloarthropathy group was challenged in the early 1990s, whereas the recent demonstrations of its heterogenous nature have led to questions about its identification as a distinct category in JIA classification. It has been shown that children with the phenotype of JPsA can be divided in two subgroups, one presenting with the features of early-onset ANA-positive JIA, and another that belongs to the spectrum of spondyloarthropathies. The few studies that have compared the clinical characteristics and genetic determinants of JPsA with those of the other JIA categories have obtained contrasting findings. The debate on the categorization of JPsA as a distinct entity within JIA classification is still ongoing and has prompted the revision of its current classification. Full article

(This article belongs to the Special Issue New Advances in Juvenile Idiopathic Arthritis (JIA))

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11 pages, 1238 KiB

Open AccessArticle

Early Cardiopulmonary Fitness after Heart Transplantation as a Determinant of Post-Transplant Survival

by Thomas C. Hanff, Yuhui Zhang, Robert S. Zhang, Michael V. Genuardi, Maria Molina, Rhondalyn C. McLean, Jeremy A. Mazurek, Monique S. Tanna, Joyce W. Wald, Pavan Atluri, Michael A. Acker, Lee R. Goldberg, Payman Zamani and Edo Y. Birati

J. Clin. Med. 2023, 12(1), 366; https://doi.org/10.3390/jcm12010366 - 03 Jan 2023

Cited by 2 | Viewed by 1578

Abstract

Background: Decreased peak oxygen consumption during exercise (peak Vo₂) is a well-established prognostic marker for mortality in ambulatory heart failure. After heart transplantation, the utility of peak Vo₂ as a marker of post-transplant survival is not well established. [...] Read more.

Background: Decreased peak oxygen consumption during exercise (peak Vo₂) is a well-established prognostic marker for mortality in ambulatory heart failure. After heart transplantation, the utility of peak Vo₂ as a marker of post-transplant survival is not well established. Methods and Results: We performed a retrospective analysis of adult heart transplant recipients at the Hospital of the University of Pennsylvania who underwent cardiopulmonary exercise testing within a year of transplant between the years 2000 to 2011. Using time-to-event models, we analyzed the hazard of mortality over nearly two decades of follow-up as a function of post-transplant percent predicted peak Vo₂ (%Vo₂). A total of 235 patients met inclusion criteria. The median post-transplant %Vo₂ was 49% (IQR 42 to 60). Each standard deviation (±14%) increase in %Vo₂ was associated with a 32% decrease in mortality in adjusted models (HR 0.68, 95% CI 0.53 to 0.87, p = 0.002). A %Vo₂ below 29%, 64% and 88% predicted less than 80% survival at 5, 10, and 15 years, respectively. Conclusions: Post-transplant peak Vo₂ is a highly significant prognostic marker for long-term post-transplant survival. It remains to be seen whether decreased peak Vo₂ post-transplant is modifiable as a target to improve post-transplant longevity. Full article

(This article belongs to the Section Cardiology)

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13 pages, 1133 KiB

Open AccessArticle

Safety of Sirolimus in Patients with Tuberous Sclerosis Complex under Two Years of Age—A Bicenter Retrospective Study

by Dominika Śmiałek, Sergiusz Jóźwiak and Katarzyna Kotulska

J. Clin. Med. 2023, 12(1), 365; https://doi.org/10.3390/jcm12010365 - 03 Jan 2023

Cited by 4 | Viewed by 1779

Abstract

Background: mTOR inhibitors are a novel pharmacotherapy recommended for subependymal giant astrocytomas, refractory epilepsy, and the treatment of the other clinical manifestations of tuberous sclerosis complex (TSC). Clinical trials on everolimus proved it to be effective and safe in children. Despite its common [...] Read more.

Background: mTOR inhibitors are a novel pharmacotherapy recommended for subependymal giant astrocytomas, refractory epilepsy, and the treatment of the other clinical manifestations of tuberous sclerosis complex (TSC). Clinical trials on everolimus proved it to be effective and safe in children. Despite its common use in clinical practice, the research on sirolimus is limited. This study is the first to determine and assess the severity of the adverse effects (AEs) of sirolimus administered to children with TSC under two years of age. Methods: We performed a bicenter retrospective data analysis of medical records of individuals with TSC who initiated therapy with sirolimus under the age of two. Results: Twenty-one patients were included in the study. At least one AE was reported in all participants. The most prevalent AEs were anemia, thrombocytosis, and hyperlipidemia. Infections and mouth ulcerations, often reported in the studies on older patients, were infrequent and of mild or moderate grade. Conclusions: Adverse effects associated with sirolimus use in infants and young children with TSC are frequent yet not life- or health-threatening. Further multicenter prospective clinical trials should determine the long-term safety of sirolimus. Full article

(This article belongs to the Section Clinical Neurology)

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