Journal of Clinical Medicine

11 pages, 302 KiB

Open AccessArticle

Consideration of Psychosocial Factors in Acute Low Back Pain by Physical Therapists

by Emilia Otero-Ketterer, Cecilia Peñacoba-Puente, Ricardo Ortega-Santiago, Fernando Galán-del-Río and Juan Antonio Valera-Calero

J. Clin. Med. 2023, 12(11), 3865; https://doi.org/10.3390/jcm12113865 - 05 Jun 2023

Cited by 2 | Viewed by 2105

Abstract

Clinical guidelines consistently recommend screening psychosocial (PS) factors in patients with low back pain (LBP), regardless of its mechanical nature, as recognized contributors to pain chronicity. However, the ability of physiotherapists (PTs) in identifying these factors remains controversial. This study aimed to assess [...] Read more.

Clinical guidelines consistently recommend screening psychosocial (PS) factors in patients with low back pain (LBP), regardless of its mechanical nature, as recognized contributors to pain chronicity. However, the ability of physiotherapists (PTs) in identifying these factors remains controversial. This study aimed to assess the current identification of psychosocial risk factors by physical therapists (PTs) and which characteristics of PTs are associated with the identification of the main risk for chronicity (physical or psychosocial). A cross-sectional descriptive study surveying Spanish PTs in public and private health services was conducted, including questions on PT characteristics and three low back pain (LBP) patient vignettes with different biopsychosocial (BPS) clinical presentations. From 484 respondents, the majority of PTs agreed regarding the main risk for chronicity for each vignette (PS 95.7% for vignette A, PS and physical 83.5% for vignette B and PS 66% for vignette C). Female PTs were more likely to rate psychosocial compared with males (p < 0.05). PTs with higher levels of social and emotional intelligence (both, p < 0.05) were more likely to identify the main risk for chronicity. However, only gender and social information processing for vignette A (p = 0.024) and emotional clarity for vignette B (p = 0.006) were able to predict the identification of psychosocial and physical risk, respectively. The main risk for chronicity was correctly identified by a large majority of PTs through patient vignettes. Gender, social and emotional intelligence played a relevant role in the recognition of psychosocial risk and biopsychosocial factors. Full article

(This article belongs to the Section Clinical Rehabilitation)

8 pages, 240 KiB

Open AccessBrief Report

Bronchopulmonary Dysplasia: Ongoing Challenges from Definitions to Clinical Care

by Sushma Nuthakki, Kaashif Ahmad, Gloria Johnson and Milenka Cuevas Guaman

J. Clin. Med. 2023, 12(11), 3864; https://doi.org/10.3390/jcm12113864 - 05 Jun 2023

Cited by 3 | Viewed by 1279

Abstract

Bronchopulmonary dysplasia (BPD) is the most common complication of extreme prematurity. Its etiology is multifactorial and is attributed to genetic susceptibility to prenatal and postnatal factors. As advancements in neonatology have led to the increased survival of premature infants, a parallel increase in [...] Read more.

Bronchopulmonary dysplasia (BPD) is the most common complication of extreme prematurity. Its etiology is multifactorial and is attributed to genetic susceptibility to prenatal and postnatal factors. As advancements in neonatology have led to the increased survival of premature infants, a parallel increase in the incidence of BPD has occurred. Over time, the definition and diagnostic criteria for BPD have evolved, as have management strategies. However, challenges continue to exist in the management of these infants, which is not surprising given the complexity of the disease. We summarize the key diagnostic criteria and provide insight into the challenges related to various aspects of BPD definitions, data comparisons, and clinical care implementation. Full article

(This article belongs to the Special Issue Challenges in Bronchopulmonary Dysplasia)

16 pages, 1803 KiB

Open AccessArticle

Maternal Preconception Glucose Homeostasis and Insulin Resistance Are Associated with Singleton and Twin Birthweight of Neonates Conceived by PCOS Women Undergoing IVF/ICSI Cycles

by Huahua Jiang, Yaxin Guo, Lixue Chen, Huifeng Shi, Ning Huang, Hongbin Chi, Rui Yang, Xiaoyu Long and Jie Qiao

J. Clin. Med. 2023, 12(11), 3863; https://doi.org/10.3390/jcm12113863 - 05 Jun 2023

Viewed by 1235

Abstract

Polycystic ovary syndrome (PCOS) can induce fertility and metabolism disorders, which may increase the prevalence of glucose metabolism disorders and cause health hazards to women and their offspring. We aim to evaluate the effect of maternal preconception glucose metabolism on neonatal birthweight in [...] Read more.

Polycystic ovary syndrome (PCOS) can induce fertility and metabolism disorders, which may increase the prevalence of glucose metabolism disorders and cause health hazards to women and their offspring. We aim to evaluate the effect of maternal preconception glucose metabolism on neonatal birthweight in PCOS women undergoing IVF/ICSI cycles. We retrospectively analyzed 269 PCOS women who delivered 190 singletons and 79 twins via IVF/ICSI at a reproductive center. The effects of maternal preconception glucose metabolism indicators on singleton and twin birthweight were evaluated using generalized linear models and generalized estimate equations, respectively. The potential nonlinear associations were evaluated using generalized additive models. The analyses were further stratified by maternal preconception BMI and delivery mode to evaluate the possible interaction effects. Among PCOS women, maternal preconception fasting plasma glucose (FPG) and glycohemoglobin (HbA1c) had significant negative associations with singleton birthweight (all p for trends = 0.04). We also found an overweight-specific association between elevated maternal preconception 2 h plasma insulin (2hPI) and twin birthweight (p for interactions = 0.05) and a caesarean-specific association between maternal preconception HbA1c and singleton birthweight (p for interactions = 0.02) in PCOS women. Maternal preconception glucose metabolism may affect neonatal birthweight, suggesting the importance of preconception glucose and insulin management for PCOS women. Further large prospective cohorts and animal studies are needed to confirm these findings and investigate the potential mechanisms. Full article

(This article belongs to the Special Issue Polycystic Ovary Syndrome: Aetiology, Diagnosis, Treatment and Future Perspectives)

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10 pages, 403 KiB

Open AccessArticle

Effect of Midface Surgery on Ocular Outcomes in Patients with Orbital and Midface Malformations

by Parinaz Rostamzad, Mieke M. Pleumeekers, Sarah L. Versnel and Sjoukje E. Loudon

J. Clin. Med. 2023, 12(11), 3862; https://doi.org/10.3390/jcm12113862 - 05 Jun 2023

Viewed by 964

Abstract

(1) Background: Orbital and midface malformations occur in multiple craniofacial disorders. Depending on the deformity, surgical corrections include orbital box osteotomy (OBO), Le Fort III (LFIII), monobloc (MB), and facial bipartition (FB). The aim of this study was to determine the effect of [...] Read more.

(1) Background: Orbital and midface malformations occur in multiple craniofacial disorders. Depending on the deformity, surgical corrections include orbital box osteotomy (OBO), Le Fort III (LFIII), monobloc (MB), and facial bipartition (FB). The aim of this study was to determine the effect of these procedures on ocular outcomes. (2) Methods: A retrospective analysis was performed. All patients with craniofacial disorders who had previously undergone midface surgery were included. The Wilcoxon signed ranks test was used for statistical analysis. (3) Results: In total, 63 patients were included: two patients were treated by OBO, 20 by LFIII, 26 by MB, and 15 by FB. Pre-operatively, strabismus was present in 39 patients (61.9%), in whom exotropia was most common (n = 27; 42.9%), followed by esotropia (n = 11; 17.5%). Postoperatively, strabismus significantly worsened (p = 0.035) in the overall population (n = 63). Pre-operative binocular vision (n = 33) was absent in nine patients (27.3%), poor in eight (24.2%), moderate in 15 (45.5%), and good in one (3.0%). Postoperatively, binocular vision significantly improved (p < 0.001). Before surgery, the mean visual acuity (VA) in the better eye was 0.16 LogMAR (Logarithm of the Minimum Angle of Resolution), and 0.31 LogMAR in the worse eye. Furthermore, pre-operative astigmatism was present in 46 patients (73.0%) and hypermetropia in 37 patients (58.7%). No statistical difference was found for VA (n = 51; p = 0.058) postoperatively. (4) Conclusions: Midface surgery has a direct and indirect substantial effect on several ocular outcomes. This study emphasizes the importance of appropriate ophthalmological evaluation in patients with craniofacial disorders undergoing midface surgery. Full article

(This article belongs to the Section Ophthalmology)

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17 pages, 374 KiB

Open AccessArticle

Evaluation of the Factors Associated with Reinfections towards SARS-CoV-2 Using a Case Control Design

by Giuseppe La Torre, Gianluca Paglione, Lavinia Camilla Barone, Vittoria Cammalleri, Augusto Faticoni, Mattia Marte, Roberta Noemi Pocino, Carlo Maria Previte, Andrea Bongiovanni, Corrado Colaprico, Eleonora Ricci, Valentin Imeshtari, Maria Vittoria Manai, David Shaholli, Vanessa India Barletta, Giovanna Carluccio, Luca Moretti, Francesca Vezza, Lorenzo Volpicelli, Anna Paola Massetti, Lilia Cinti, Piergiorgio Roberto, Anna Napoli, Guido Antonelli, Claudio Maria Mastroianni and Sabina Sernia Show full author list Hide full author list

J. Clin. Med. 2023, 12(11), 3861; https://doi.org/10.3390/jcm12113861 - 05 Jun 2023

Viewed by 857

Abstract

Objective: The risk of reinfection with SARS-CoV-2 has been rapidly increased with the circulation of concerns about variants. So, the aim of our study was to evaluate the factors that increase the risk of this reinfection in healthcare workers compared to those who [...] Read more.

Objective: The risk of reinfection with SARS-CoV-2 has been rapidly increased with the circulation of concerns about variants. So, the aim of our study was to evaluate the factors that increase the risk of this reinfection in healthcare workers compared to those who have never been positive and those who have had only one positivity. Methods: A case-control study was carried out at the Teaching Hospital Policlinico Umberto I in Rome, Sapienza University of Rome, in the period between 6 March 2020 and 3 June 2022. Cases are healthcare workers who have developed a reinfection with the SARS-CoV-2 virus, while controls were either healthcare workers who tested positive once or those who have never tested positive for SARS-CoV-2. Results: 134 cases and 267 controls were recruited. Female gender is associated with a higher odds of developing reinfection (OR: 2.42; 95% CI: 1.38–4.25). Moreover, moderate or high alcohol consumption is associated with higher odds of reinfection (OR: 1.49; 95% CI: 1.19–1.87). Diabetes is also associated with higher odds of reinfection (OR: 3.45; 95% CI: 1.41–8.46). Finally, subjects with increased red blood cell counts have higher odds of reinfection (OR: 1.69; 95% CI: 1.21–2.25). Conclusion: From the prevention point of view, these findings indicate that particular attention should be paid to subjects with diabetes mellitus, women and alcoholic drinkers. These results could also suggest that contact tracing represents a fundamental approach model against the SARS-CoV-2 pandemic, together with the health information of participants. Full article

(This article belongs to the Section Epidemiology & Public Health)

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13 pages, 1135 KiB

Open AccessArticle

Simultaneous Surgical Approach with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Patients with Concurrent Peritoneal and Liver Metastases of Colon Cancer Origin

by Rafael Morales-Soriano, Cristina Pineño-Flores, José Miguel Morón-Canis, Francisco Javier Molina-Romero, José Carlos Rodriguez-Pino, Julia Loyola-Miró, Francisco Xavier Gonzalez-Argente, Elías Palma-Zamora, Mónica Guillot-Morales, Sandra Giménez, Melchor Alvarez-Mon, Miguel A. Ortega and Juan José Segura-Sampedro

J. Clin. Med. 2023, 12(11), 3860; https://doi.org/10.3390/jcm12113860 - 05 Jun 2023

Cited by 1 | Viewed by 1130

Abstract

Background: Simultaneous liver resection and peritoneal cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial today. The aim of the study was to analyze the postoperative outcomes and survival of patients with advanced metastatic colon cancer (peritoneal and/or liver metastases). Methods: Retrospective observational [...] Read more.

Background: Simultaneous liver resection and peritoneal cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial today. The aim of the study was to analyze the postoperative outcomes and survival of patients with advanced metastatic colon cancer (peritoneal and/or liver metastases). Methods: Retrospective observational study from a prospective maintained data base. Patients who underwent a simultaneous peritoneal cytoreduction and liver resection plus HIPEC were studied. Postoperative outcomes and overall and disease free survival were analyzed. Univariate and multivariate analyses were performed. Results: From January 2010 to October 2022, 22 patients operated with peritoneal and liver metastasis (LR+) were compared with 87 patients operated with peritoneal metastasis alone (LR−). LR+ group presented higher serious morbidity (36.4 vs. 14.9%; p: 0.034). Postoperative mortality did not reach statistical difference. Median overall and disease free survival was similar. Peritoneal carcinomatosis index was the only predictive factor of survival. Conclusions: Simultaneous peritoneal and liver resection is associated with increased postoperative morbidity and hospital stay, but with similar postoperative mortality and OS and disease free survival. These results reflect the evolution of these patients, considered inoperable until recently, and justify the trend to incorporate this surgical strategy within a multimodal therapeutic plan in highly selected patients. Full article

(This article belongs to the Special Issue Advances in Diagnosis and Treatment of Peritoneum Cancer)

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5 pages, 715 KiB

Open AccessEditorial

Left Atrial Appendage Occlusion in Patients with Failure of Antithrombotic Therapy: Good Vibes from Early Studies

by Alberto Preda, Matteo Baroni, Marisa Varrenti, Sara Vargiu, Marco Carbonaro, Federica Giordano, Lorenzo Gigli and Patrizio Mazzone

J. Clin. Med. 2023, 12(11), 3859; https://doi.org/10.3390/jcm12113859 - 05 Jun 2023

Cited by 4 | Viewed by 1407

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and predisposes patients to an increased risk of cardioembolic events (CE), such as ischemic stroke, TIA, or systemic embolism [...] Full article

(This article belongs to the Topic Atrial Fibrillation: State-of-the-Art Techniques and Future Perspectives for Diagnosis, Rhythm Control, and Stroke Prophylaxis)

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10 pages, 1771 KiB

Open AccessArticle

The Effect of Age on Peri-Operative Outcomes after FEVAR

by Amun Georg Hofmann, Maria Elisabeth Leinweber, Afshin Assadian, Juergen Falkensammer and Fadi Taher

J. Clin. Med. 2023, 12(11), 3858; https://doi.org/10.3390/jcm12113858 - 05 Jun 2023

Cited by 1 | Viewed by 822

Abstract

Introduction: Fenestrated endovascular aortic repair (FEVAR) has become a popular custom-made treatment option for juxtarenal and pararenal aneurysms. It has been previously investigated whether octogenarians as a distinct subgroup are at increased risk for adverse outcomes after FEVAR. With diverging results and an [...] Read more.

Introduction: Fenestrated endovascular aortic repair (FEVAR) has become a popular custom-made treatment option for juxtarenal and pararenal aneurysms. It has been previously investigated whether octogenarians as a distinct subgroup are at increased risk for adverse outcomes after FEVAR. With diverging results and an inconclusive understanding of age as a risk factor in general, an analysis of the historical data of a single center was conducted to add to the available body of evidence and further investigate the effect of age as a continuous risk factor. Methods: A retrospective data analysis of a prospectively maintained single-center database of all patients who underwent FEVAR at a single department of vascular surgery was performed. The main endpoint was post-operative survival. In addition to association analyses, potential confounders such as co-morbidities, complication rates, or aneurysm diameter were examined. In terms of sensitivity analyses, logistic regression models were created for the dependent variables of interest. Results: During the observation period from April 2013 to November 2020, 40 patients over the age of 80 and 191 patients under the age of 80 were treated by FEVAR. The 30-day survival showed no significant difference between the groups (95.1% in octogenarians and 94.3% in patients under 80 years of age). The sensitivity analyses conducted also showed no difference between the two groups, and complication and technical success rates were comparable. The aneurysm diameter was 67 ± 13 mm in the study group and 61 ± 15 mm in those under 80 years of age. Additionally, the sensitivity analyses showed that age as a continuous variable exhibits no effect on the outcomes of interest. Discussion: In the present study, age was not associated with adverse peri-operative outcomes after FEVAR, including mortality, lower technical success rates, complications, or length of hospital stay. Essentially, the most highly associated factor with hospital and ICU length of stay was time spent in surgery. However, octogenarians had a significantly larger aortic diameter at the time of treatment, which might indicate the potential introduction of bias by pre-interventional patient selection. Nevertheless, the usefulness of research on octogenarians as a distinct subgroup might be questionable regarding the scalability of results, and future studies might focus on age as a continuous risk factor instead. Full article

(This article belongs to the Section Vascular Medicine)

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2 pages, 160 KiB

Open AccessEditorial

Severe Asthma in the Era of Biologics: Continuous Challenges

by Pinelopi Schoini, Petros Bakakos and Stelios Loukides

J. Clin. Med. 2023, 12(11), 3857; https://doi.org/10.3390/jcm12113857 - 05 Jun 2023

Viewed by 771

Abstract

Asthma is a heterogenous disease characterized by different phenotypes and endotypes [...] Full article

(This article belongs to the Special Issue Advances in Asthma)

16 pages, 2622 KiB

Open AccessArticle

Effect of Obesity on Masticatory Muscle Activity and Rhythmic Jaw Movements Evoked by Electrical Stimulation of Different Cortical Masticatory Areas

by Ruixin Li, Chiho Kato, Akiyo Fujita, Yasunori Abe, Takuya Ogawa, Hideyuki Ishidori, Eri Misawa, Hidemasa Okihara, Satoshi Kokai and Takashi Ono

J. Clin. Med. 2023, 12(11), 3856; https://doi.org/10.3390/jcm12113856 - 05 Jun 2023

Viewed by 1057

Abstract

This study investigates rhythmic jaw movement (RJM) patterns and masticatory muscle activities during electrical stimulation in two cortical masticatory areas in obese male Zucker rats (OZRs), compared to their counterparts—lean male Zucker rats (LZRs) (seven each). At the age of 10 weeks, electromyographic [...] Read more.

This study investigates rhythmic jaw movement (RJM) patterns and masticatory muscle activities during electrical stimulation in two cortical masticatory areas in obese male Zucker rats (OZRs), compared to their counterparts—lean male Zucker rats (LZRs) (seven each). At the age of 10 weeks, electromyographic (EMG) activity of the right anterior digastric muscle (RAD) and masseter muscles, and RJMs were recorded during repetitive intracortical micro-stimulation in the left anterior and posterior parts of the cortical masticatory area (A-area and P-area, respectively). Only P-area-elicited RJMs, which showed a more lateral shift and slower jaw-opening pattern than A-area-elicited RJMs, were affected by obesity. During P-area stimulation, the jaw-opening duration was significantly shorter (p < 0.01) in OZRs (24.3 ms) than LZRs (27.9 ms), the jaw-opening speed was significantly faster (p < 0.05) in OZRs (67.5 mm/s) than LZRs (50.8 mm/s), and the RAD EMG duration was significantly shorter (p < 0.01) in OZRs (5.2 ms) than LZR (6.9 ms). The two groups had no significant difference in the EMG peak-to-peak amplitude and EMG frequency parameters. This study shows that obesity affects the coordinated movement of masticatory components during cortical stimulation. While other factors may be involved, functional change in digastric muscle is partly involved in the mechanism. Full article

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

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11 pages, 4535 KiB

Open AccessArticle

Intraoperative Hemodynamics of Parasylvian Cortical Arteries for Predicting Postoperative Symptomatic Cerebral Hyperperfusion after Direct Revascularization in Patients with Moyamoya Disease: A Preliminary Study

by Zhiyong Shi, Lingyun Wu, Yi Wang, Wei Li, Juan Wang, Yongbo Yang and Chunhua Hang

J. Clin. Med. 2023, 12(11), 3855; https://doi.org/10.3390/jcm12113855 - 05 Jun 2023

Cited by 1 | Viewed by 1022

Abstract

Objective. The search for methods by which to predict the risks of cerebral hyperperfusion syn-drome (CHS) in adults with moyamoya disease (MMD), including those utilizing new biomarkers, still deserves further research. The objective of this study was to investigate the association between [...] Read more.

Objective. The search for methods by which to predict the risks of cerebral hyperperfusion syn-drome (CHS) in adults with moyamoya disease (MMD), including those utilizing new biomarkers, still deserves further research. The objective of this study was to investigate the association between the hemodynamics of parasylvian cortical arteries (PSCAs) and postoperative CHS. Methods. A consecutive number of adults with MMD who had undergone direct bypass between September 2020 and December 2022 were recruited. Intraoperative microvascular doppler ultrasonography (MDU) was performed to evaluate the hemodynamics of PSCAs. The intraoperative flow direction, mean value of velocity (MVV) of recipient artery (RA) and bypass graft were recorded. According to flow direction after bypass, RA was divided into entering sylvian (RA.ES) and leaving sylvian (RA.LS) subtypes. Univariate, multivariate, and ROC analyses of the risk factors for postoperative CHS were performed. Results. A total of 16 (15.09%) cases in 106 consecutive hemispheres (101 patients) sat-isfied the postoperative CHS criteria. According to univariate analysis, advanced Suzuki stage, MVV of RA before bypass, and fold increase of MVV in RA.ES after bypass were significantly associated with postoperative CHS (p < 0.05). Multivariate analysis indicated that left-operated hemisphere (OR (95%CI), 4.58 (1.05–19.97), p = 0.043), advanced Suzuki stage (OR (95%CI), 5.47 (1.99–15.05), p = 0.017), and fold increase of MVV in RA.ES (OR (95%CI), 1.17 (1.06–1.30), p = 0.003) were statistically significantly associated with the occurrence of CHS. The cut-off value of fold increase of MVV in RA.ES was 2.7-fold (p < 0.05). Conclusions. Left-operated hemisphere, advanced Suzuki stage, and postoperative fold increase of MVV in RA.ES were potential risk factors for postoperative CHS. Intraoperative MDU was useful for evaluating hemodynamics and predicting CHS. Full article

(This article belongs to the Special Issue Advances in Neurosurgery: Intraoperative Neurophysiology)

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13 pages, 2057 KiB

Open AccessArticle

Sagittal Spinal Alignment in People with Chronic Spinal Cord Injury and Normal Individual: A Comparison Study Using 3D Ultrasound Imaging

by Niraj Singh Tharu, Timothy Tin-Yan Lee, Kelly Ka-Lee Lai, Ting-Er Lau, Chui-Yi Chan and Yong-Ping Zheng

J. Clin. Med. 2023, 12(11), 3854; https://doi.org/10.3390/jcm12113854 - 05 Jun 2023

Viewed by 1209

Abstract

The aim of this study was to compare the sagittal spinal alignment of people with chronic spinal cord injury (SCI) with normal individuals and to determine whether transcutaneous electrical spinal cord stimulation (TSCS) could cause a change in the thoracic kyphosis (TK) and [...] Read more.

The aim of this study was to compare the sagittal spinal alignment of people with chronic spinal cord injury (SCI) with normal individuals and to determine whether transcutaneous electrical spinal cord stimulation (TSCS) could cause a change in the thoracic kyphosis (TK) and lumbar lordosis (LL) to re-establish normal sagittal spinal alignment. A case series study was conducted, wherein twelve individuals with SCI and ten neurologically intact subjects were scanned using 3D ultrasonography. In addition, three people with SCI having complete tetraplegia participated further to receive a 12-week treatment (TSCS with task-specific rehabilitation) after evaluation of sagittal spinal profile. Pre- and post-assessments were conducted to evaluate the differences in sagittal spinal alignment. The results showed that the TK and LL values for a person with SCI in a dependent seated posture were greater than those of normal subjects for: standing (by TK: 6.8° ± 1.6°; LL: 21.2° ± 1.9°), sitting straight (by TK: 10.0° ± 4.0°; LL: 1.7° ± 2.6°), and relaxed sitting (by TK: 3.9° ± 0.3°; LL: 7.7° ± 1.4°), respectively, indicating an increased risk for spinal deformity. In addition, TK decreased by 10.3° ± 2.3° after the TSCS treatment, showing a reversible change. These results suggest that the TSCS treatment could be used to restore normal sagittal spinal alignment for individuals with chronic SCI. Full article

(This article belongs to the Section Clinical Neurology)

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10 pages, 1768 KiB

Open AccessArticle

Incidence and Prognostic Factors of Painful Vertebral Compression Fracture Caused by Spine Stereotactic Body Radiotherapy

by Kei Ito, Kentaro Taguchi, Yujiro Nakajima, Hiroaki Ogawa, Shurei Sugita and Keiko Nemoto Murofushi

J. Clin. Med. 2023, 12(11), 3853; https://doi.org/10.3390/jcm12113853 - 05 Jun 2023

Cited by 2 | Viewed by 1139

Abstract

Most studies of vertebral compression fractures (VCF) caused by stereotactic body radiotherapy (SBRT) do not discuss the symptoms of this complication. In this paper, we aimed to determine the rate and prognostic factors of painful VCF caused by SBRT for spinal metastases. Spinal [...] Read more.

Most studies of vertebral compression fractures (VCF) caused by stereotactic body radiotherapy (SBRT) do not discuss the symptoms of this complication. In this paper, we aimed to determine the rate and prognostic factors of painful VCF caused by SBRT for spinal metastases. Spinal segments with VCF in patients treated with spine SBRT between 2013 and 2021 were retrospectively reviewed. The primary endpoint was the rate of painful VCF (grades 2–3). Patient demographic and clinical characteristics were evaluated as prognosticators. In total, 779 spinal segments in 391 patients were analyzed. The median follow-up after SBRT was 18 (range: 1–107) months. Sixty iatrogenic VCFs (7.7%) were identified. The rate of painful VCF was 2.4% (19/779). Eight (1.0%) VCFs required surgery for internal fixation or spinal canal decompression. The painful VCF rate was significantly higher in patients with no posterolateral tumor involvement than in those with bilateral or unilateral involvement (50% vs. 23%; p = 0.042); it was also higher in patients with spine without fixation than in those with fixation (44% vs. 0%; p < 0.001). Painful VCFs were confirmed in only 2.4% of all the irradiated spinal segments. The absence of posterolateral tumor involvement and no fixation was significantly associated with painful VCF. Full article

(This article belongs to the Special Issue Current Management and Treatment of Primary and Metastatic Spinal Tumors)

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13 pages, 2019 KiB

Open AccessArticle

Association between HbA1c Levels and Fetal Macrosomia and Large for Gestational Age Babies in Women with Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of 17,711 Women

by Sudipta Sarker Mou, Clare Gillies, Jiamiao Hu, Marianna Danielli, Bassel Hamameeh Al Wattar, Kamlesh Khunti and Bee Kang Tan

J. Clin. Med. 2023, 12(11), 3852; https://doi.org/10.3390/jcm12113852 - 05 Jun 2023

Cited by 3 | Viewed by 3105

Abstract

Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy. GDM is associated with serious maternal and fetal complications, in particular, fetal macrosomia and large for gestational age (LGA), which predisposes to a higher risk of childhood obesity and type 2 [...] Read more.

Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy. GDM is associated with serious maternal and fetal complications, in particular, fetal macrosomia and large for gestational age (LGA), which predisposes to a higher risk of childhood obesity and type 2 diabetes mellitus later in life. Early prediction and diagnosis of GDM leads to early interventions such as diet and lifestyle, which could mitigate the maternal and fetal complications associated with GDM. Glycated haemoglobin A1c (HbA1c) has been widely used for monitoring, screening for and diagnosing diabetes and prediabetes. Increasing evidence has also showed that HbA1c could indicate fetal glucose supply. Thus, we hypothesise that the HbA1c level at around 24 to 28 weeks may predict the development of fetal macrosomia or an LGA baby in women with GDM, which could be useful for better prevention of fetal macrosomia and LGA. We searched MEDLINE, EMBASE, Cochrane and Google Scholar databases from inception to November 2022 for relevant studies that reported at least one HbA1c level during 24–28 weeks of pregnancy and fetal macrosomia or an LGA baby. We excluded studies that were not published in the English language. No other search filters were applied during the search. Two independent reviewers selected eligible studies for meta-analysis. Two independent reviewers performed data collection and analyses. The PROSPERO registration number is CRD42018086175. A total of 23 studies were included in this systematic review. Of these, 8 papers reported data of 17,711 women with GDM that allowed for inclusion in a meta-analysis. The obtained results demonstrated the prevalence of fetal macrosomia was 7.4% and of LGA, 13.36%. Meta-analyses showed that the estimated pooled risk ratio (RR) for LGA in women with high HbA1c values compared to normal or low values was 1.70 (95% CI: 1.23–2.35), p = 0.001; and the pooled RR for fetal macrosomia was 1.45 (95% CI: 0.80 to 2.63), p = 0.215. Further research is needed to evaluate the utility of HbA1c levels in predicting the delivery of a baby with fetal macrosomia or LGA in pregnant women. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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13 pages, 574 KiB

Open AccessArticle

Managing Vulvodynia with Central Sensitization: Challenges and Strategies

by Cristina Rubal, Augusto Pereira, Laura Calles Sastre, Belén Almoguera Pérez-Cejuela, Sofía Herrero Gámiz, Pilar Chaves and Tirso Pérez Medina

J. Clin. Med. 2023, 12(11), 3851; https://doi.org/10.3390/jcm12113851 - 05 Jun 2023

Cited by 2 | Viewed by 1220

Abstract

Background: Vulvodynia is defined as a chronic idiopathic vulvar pain condition. This study aimed to investigate the effect of central sensitization on the prognosis of neuromodulator treatment for vulvodynia. Method: A total of 105 patients with vulvodynia who underwent pelvic mapping pain [...] Read more.

Background: Vulvodynia is defined as a chronic idiopathic vulvar pain condition. This study aimed to investigate the effect of central sensitization on the prognosis of neuromodulator treatment for vulvodynia. Method: A total of 105 patients with vulvodynia who underwent pelvic mapping pain exploration were included and scored according to the Convergence PP Criteria for pelvic pain and central sensitization. The patients were treated according to chronic pelvic pain guidelines, and their response to treatment was evaluated. Results: A total of 35 out 105 patients (33%) with vulvodynia had central sensitization, which was associated with comorbidities, dyspareunia, pain with micturition, and pain with defecation. Dyspareunia and pain with defecation were independent prognostic factors for central sensitization. Patients with central sensitization experienced more pain during intercourse, urination, or defecation, had more comorbidities, and responded worse to treatment. They required more treatment, with a longer response time (over 2 months). Patients with localized vulvodynia were treated with physiotherapy and lidocaine, while patients with generalized vulvodynia were treated with neuromodulators. Amitriptyline was effective in treating patients with generalized spontaneous vulvodynia and dyspareunia. Conclusions: Overall, this study highlights the importance of considering central sensitization in the diagnosis and treatment of vulvodynia and the need for individualized treatment based on the patient’s symptoms and underlying mechanisms. Vulvodynia patients with central sensitization had more pain during intercourse, urination, or defecation, and responded worse to treatment, requiring more time and medication. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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11 pages, 612 KiB

Open AccessReview

Psoriatic Arthritis: Development, Detection and Prevention: A Scoping Review

by Agnieszka Kimak, Ewa Robak, Joanna Makowska and Anna Woźniacka

J. Clin. Med. 2023, 12(11), 3850; https://doi.org/10.3390/jcm12113850 - 05 Jun 2023

Cited by 3 | Viewed by 1794

Abstract

Psoriatic arthritis is a heterogenous chronic inflammatory disease that develops over time in some patients with psoriasis. The course of the disease is variable, with a broad clinical spectrum. The management of PsA has changed tremendously over the last decade, thanks to earlier [...] Read more.

Psoriatic arthritis is a heterogenous chronic inflammatory disease that develops over time in some patients with psoriasis. The course of the disease is variable, with a broad clinical spectrum. The management of PsA has changed tremendously over the last decade, thanks to earlier diagnosis, a multidisciplinary approach and progress in pharmacological therapies. Therefore, screening for risk factors and the early signs of arthritis is highly important and recommended. Currently, research is focused on finding soluble biomarkers and developing imaging techniques that can improve the prediction of psoriatic arthritis. Among imaging modalities, ultrasonography seems to be the most accurate in detecting subclinical inflammation. Early intervention is based on the assumption that it is possible to prevent or delay psoriatic arthritis if systemic treatment for psoriasis can be administered early enough. This review article provides an overview of the current perspectives and evidence regarding the diagnosis, management and prevention of psoriatic arthritis. Full article

(This article belongs to the Section Dermatology)

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3 pages, 168 KiB

Open AccessEditorial

Total Hip Arthroplasty: So Hip It Hurts

by Lukas A. Holzer

J. Clin. Med. 2023, 12(11), 3849; https://doi.org/10.3390/jcm12113849 - 05 Jun 2023

Viewed by 987

Abstract

Total hip arthroplasty (THA) has become a standard surgical intervention for patients with hip joint disorders [...] Full article

(This article belongs to the Special Issue Hip Surgery: Clinical Treatment and Management)

14 pages, 492 KiB

Open AccessArticle

The Relationship between Body Mass Index and In-Hospital Mortality in Bacteremic Sepsis

by Shalom Lebovitz, Guy Rozen, Zahi Abu Ghosh, Maya Korem, Hila Elinav, Hiba Zayyad, Shemy Carasso, David Planer, Offer Amir and Gabby Elbaz-Greener

J. Clin. Med. 2023, 12(11), 3848; https://doi.org/10.3390/jcm12113848 - 04 Jun 2023

Cited by 2 | Viewed by 1501

Abstract

Background: The association between Body Mass Index (BMI) and clinical outcomes following sepsis continues to be debated. We aimed to investigate the relationship between BMI and in-hospital clinical course and mortality in patients hospitalized with bacteremic sepsis using real-world data. Methods: A sampled [...] Read more.

Background: The association between Body Mass Index (BMI) and clinical outcomes following sepsis continues to be debated. We aimed to investigate the relationship between BMI and in-hospital clinical course and mortality in patients hospitalized with bacteremic sepsis using real-world data. Methods: A sampled cohort of patients hospitalized with bacteremic sepsis between October 2015 and December 2016 was identified in the National Inpatient Sample (NIS) database. In-hospital mortality and length of stay were defined as the relevant outcomes. Patients were divided into 6 BMI (kg/m²) subgroups; (1) underweight ≤ 19, (2) normal-weight 20–25, (3) over-weight 26–30, (4) obese I 31–35, (5) obese II 36–39, and (6) obese stage III ≥ 40. A multivariable logistic regression model was used to find predictors of mortality, and a linear regression model was used to find predictors of an extended length of stay (LOS). Results: An estimated total of 90,760 hospitalizations for bacteremic sepsis across the U.S. were analyzed. The data showed a reverse-J-shaped relationship between BMI and study population outcomes, with the underweight patients (BMI ≤ 19 kg/m²) suffering from higher mortality and longer LOS as did the normal-weight patients (BMI 20–25 kg/m²) when compared to the higher BMI groups. The seemingly protective effect of a higher BMI diminished in the highest BMI group (BMI ≥ 40 kg/m²). In the multivariable regression model, BMI subgroups of ≤19 kg/m² and ≥40 kg/m² were found to be independent predictors of mortality. Conclusions: A reverse-J-shaped relationship between BMI and mortality was documented, confirming the “obesity paradox” in the real-world setting in patients hospitalized for sepsis and bacteremia. Full article

(This article belongs to the Special Issue (Cardio-)Vascular System in Health and Disease: Current Update and Perspectives—Volume II)

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16 pages, 2191 KiB

Open AccessSystematic Review

CAD/CAM Abutments in the Esthetic Zone: A Systematic Review and Meta-Analysis of Soft Tissue Stability

by Diego Lops, Eugenio Romeo, Magda Mensi, Giuseppe Troiano, Khrystyna Zhurakivska, Massimo Del Fabbro and Antonino Palazzolo

J. Clin. Med. 2023, 12(11), 3847; https://doi.org/10.3390/jcm12113847 - 04 Jun 2023

Viewed by 1220

Abstract

Computer-aided design and computer-aided manufacturing customized abutments are increasingly used in everyday clinical practice. Nevertheless, solid scientific evidence is currently lacking regarding their potential advantages in terms of soft tissue stability. The main aim of this systematic review and meta-analysis was to compare [...] Read more.

Computer-aided design and computer-aided manufacturing customized abutments are increasingly used in everyday clinical practice. Nevertheless, solid scientific evidence is currently lacking regarding their potential advantages in terms of soft tissue stability. The main aim of this systematic review and meta-analysis was to compare the soft tissue outcomes of prefabricated versus customized (CAD/CAM) abutments. The present review was registered with PROSPERO (CRD42020161875) and the protocol was developed according to the PRISMA statement. An electronic search was performed on three databases (PubMed, Embase and Cochrane Central) up to May 2023. Data extraction was followed by qualitative and quantitative analysis of the included studies. Three randomized controlled clinical trials and three controlled clinical trials (number of patients = 230; number of dental implants = 230) with a follow-up of between 12 and 36 months were included. No significant differences were observed between prefabricated versus customized (CAD/CAM) abutments regarding midfacial mucosal recession, interproximal papillae and pink aesthetic score (PES) after 12 months. Conclusion: The potential benefits of CAD/CAM abutments on soft tissues should be better clarified in future investigations. The usage of customized CAD/CAM abutments in everyday clinical practice should be based on a careful case-by-case evaluation (CRD42020161875). Full article

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

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11 pages, 1019 KiB

Open AccessArticle

Better Handgrip Strength Is Related to the Lower Prevalence of Pain and Anxiety in Community-Dwelling Older Adults

by Natalia Sosowska, Agnieszka Guligowska, Bartłomiej Sołtysik, Ewa Borowiak, Tomasz Kostka and Joanna Kostka

J. Clin. Med. 2023, 12(11), 3846; https://doi.org/10.3390/jcm12113846 - 04 Jun 2023

Viewed by 1418

Abstract

Although handgrip strength (HGS) may be treated as a biomarker of many health problems, there is little evidence on the potential role of HGS in the prevention of pain or anxiety in older adults. We investigated the relationship of HGS to the presence [...] Read more.

Although handgrip strength (HGS) may be treated as a biomarker of many health problems, there is little evidence on the potential role of HGS in the prevention of pain or anxiety in older adults. We investigated the relationship of HGS to the presence of pain and anxiety among community-dwelling older adults. The study was performed in 2038 outpatients, aged 60 to 106 years. The Jamar hand-held hydraulic dynamometer was used to measure HGS. The prevalence of pain and anxiety was assessed with the Euroqol 5D questionnaire. Symptoms of depression were recorded with 15-item Geriatric Depression Scale (GDS). In the multivariate logistic regression model taking into account age, sex, BMI and concomitant diseases, the significant influence of HGS on the presence of pain (odds ratio [OR] = 0.988) in the entire study population and among men (OR = 0.983) was found. HGS was a significant independent predictor for the presence of anxiety in the entire study population (OR = 0.987), in women (OR = 0.985) and in men (OR = 0.988). In the fully adjusted model with included GDS, 1 kg higher HGS was still associated with 1.2% and 1.3% lower probability of the presence of pain and anxiety, respectively. We conclude that low HGS is associated with the presence of pain and anxiety among older adults, independent of age, sex, depression symptoms and concomitant chronic diseases. Future research should assess whether improvement of HGS would alleviate psychological dysfunction in older adults. Full article

(This article belongs to the Special Issue Advances in Geriatric Diseases)

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14 pages, 3801 KiB

Open AccessArticle

Exploration of Optimal pH in Hypothermic Machine Perfusion for Rat Liver Grafts Retrieved after Circulatory Death

by Sodai Sakamoto, Hiroki Bochimoto, Kengo Shibata, Nur Khatijah Mohd Zin, Moto Fukai, Kosei Nakamura, Takahisa Ishikawa, Masato Fujiyoshi, Tsuyoshi Shimamura and Akinobu Taketomi

J. Clin. Med. 2023, 12(11), 3845; https://doi.org/10.3390/jcm12113845 - 04 Jun 2023

Viewed by 1261

Abstract

Ex vivo hypothermic machine perfusion (HMP) is a strategy for controlling ischemia-reperfusion injury in donation after circulatory death (DCD) liver transplantation. The pH of blood increases with a decrease in temperature and water dissociation, leading to a decrease in [H⁺]. This [...] Read more.

Ex vivo hypothermic machine perfusion (HMP) is a strategy for controlling ischemia-reperfusion injury in donation after circulatory death (DCD) liver transplantation. The pH of blood increases with a decrease in temperature and water dissociation, leading to a decrease in [H⁺]. This study aimed to verify the optimal pH of HMP for DCD livers. Rat livers were retrieved 30 min post-cardiac arrest and subjected to 3-h cold storage (CS) in UW solution (CS group) or HMP with UW-gluconate solution (machine perfusion [MP] group) of pH 7.4 (original), 7.6, 7.8, and 8.0 (MP-pH 7.6, 7.8, 8.0 groups, respectively) at 7–10 °C. The livers were subjected to normothermic perfusion to simulate reperfusion after HMP. All HMP groups showed greater graft protection compared to the CS group due to the lower levels of liver enzymes in the former. The MP-pH 7.8 group showed significant protection, evidenced by bile production, diminished tissue injury, and reduced flavin mononucleotide leakage, and further analysis by scanning electron microscopy revealed a well-preserved structure of the mitochondrial cristae. Therefore, the optimum pH of 7.8 enhanced the protective effect of HMP by preserving the structure and function of the mitochondria, leading to reduced reperfusion injury in the DCD liver. Full article

(This article belongs to the Special Issue JSOPB 2022–2023 Congress Special Issue – Update on Organ Preservation and Transplantation)

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12 pages, 2087 KiB

Open AccessArticle

Glucagon-like Peptide-1 Acts as Signaling Mediator to Modulate Human Sperm Performance via Targeting Akt, JNK and IRS-1 Cell Signaling Cascades: Novel Insights into Sperm Physiopathology

by Roberto Castiglione, Adele Vivacqua, Marta Santoro, Daniela De Rose, Giuseppina Peluso, Salvatore Panza, Saveria Aquila and Rosario D’Agata

J. Clin. Med. 2023, 12(11), 3844; https://doi.org/10.3390/jcm12113844 - 04 Jun 2023

Cited by 2 | Viewed by 1331

Abstract

Recent evidence suggests that the male gonad is a potential target of glucagon-like peptide-1 (GLP-1). We investigated the effects of glucagon-like peptide-1 (GLP-1) on sperm function and the molecular mechanisms through which it may act. Semen samples of healthy men were incubated in [...] Read more.

Recent evidence suggests that the male gonad is a potential target of glucagon-like peptide-1 (GLP-1). We investigated the effects of glucagon-like peptide-1 (GLP-1) on sperm function and the molecular mechanisms through which it may act. Semen samples of healthy men were incubated in the presence or absence of a GLP-1 mimetic analog, exendin-4 (Exe). In a different analysis, sperm were exposed to tumor necrosis factor (TNF-α) alone and, in some tubes, TNF-α was added after previous exposure to exendin-4 (Exe). Sperm parameters and protein-kinase B (p-Akt), insulin receptor substrate-1 (p-IRS-1 Ser312), and c Jun N-terminal protein kinase (p-JNK Thr183/Tyr185) were considered and evaluated. Sperm parameters, when incubated for 4 h in a simple defined balanced salt solution lacking protein, declined progressively with incubation time. The maximum decline was associated with a significant decrease in phosphorylated protein kinase B (p-Akt), concomitantly to an increase in insulin receptor substrate-1 (p-IRS-1 Ser312) and c Jun N-terminal protein kinase (p-JNK Thr183/Tyr185). Preincubation with exendin-4 (Exe) prevented this decline and maintained sperm motility (progressive—PM and total—TM). TNF-α exposure resulted in decreased sperm motility (PM and TM) and viability (V) in a concentration-dependent manner. Exe addition attenuated this TNF-α negative effect on sperm parameters. Glucagon-like peptide-1 (GLP-1) also acts by reducing levels of the “negative” kinases p-IRS-1Ser312 and p-JNK. An imbalance involving these three kinases in sperm, as it occurs in somatic cells, is a novel scenario that may participate in sperm physiopathology. Full article

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

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30 pages, 5600 KiB

Open AccessArticle

Development of Machine-Learning Models for Tinnitus-Related Distress Classification Using Wavelet-Transformed Auditory Evoked Potential Signals and Clinical Data

by Ourania Manta, Michail Sarafidis, Winfried Schlee, Birgit Mazurek, George K. Matsopoulos and Dimitrios D. Koutsouris

J. Clin. Med. 2023, 12(11), 3843; https://doi.org/10.3390/jcm12113843 - 04 Jun 2023

Cited by 1 | Viewed by 1810

Abstract

Tinnitus is a highly prevalent condition, affecting more than 1 in 7 adults in the EU and causing negative effects on sufferers’ quality of life. In this study, we utilised data collected within the “UNITI” project, the largest EU tinnitus-related research programme. Initially, [...] Read more.

Tinnitus is a highly prevalent condition, affecting more than 1 in 7 adults in the EU and causing negative effects on sufferers’ quality of life. In this study, we utilised data collected within the “UNITI” project, the largest EU tinnitus-related research programme. Initially, we extracted characteristics from both auditory brainstem response (ABR) and auditory middle latency response (AMLR) signals, which were derived from tinnitus patients. We then combined these features with the patients’ clinical data, and integrated them to build machine learning models for the classification of individuals and their ears according to their level of tinnitus-related distress. Several models were developed and tested on different datasets to determine the most relevant features and achieve high performances. Specifically, seven widely used classifiers were utilised on all generated datasets: random forest (RF), linear, radial, and polynomial support vector machines (SVM), naive bayes (NB), neural networks (NN), and linear discriminant analysis (LDA). Results showed that features extracted from the wavelet-scattering transformed AMLR signals were the most informative data. In combination with the 15 LASSO-selected clinical features, the SVM classifier achieved optimal performance with an AUC value, sensitivity, and specificity of 92.53%, 84.84%, and 83.04%, respectively, indicating high discrimination performance between the two groups. Full article

(This article belongs to the Section Otolaryngology)

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13 pages, 295 KiB

Open AccessReview

A Review of Ambient Air Pollution as a Risk Factor for Posterior Segment Ocular Diseases

by Agne Markeviciute, Jessie Huang-Lung, Reda Zemaitiene and Andrzej Grzybowski

J. Clin. Med. 2023, 12(11), 3842; https://doi.org/10.3390/jcm12113842 - 04 Jun 2023

Viewed by 1632

Abstract

Purpose. To review the most recent evidence on the association of ambient air pollution with posterior segment ocular diseases. Methods. A search of the most recently published medical literature was performed in PubMed and Google Scholar on 10 December 2022. Articles published between [...] Read more.

Purpose. To review the most recent evidence on the association of ambient air pollution with posterior segment ocular diseases. Methods. A search of the most recently published medical literature was performed in PubMed and Google Scholar on 10 December 2022. Articles published between 2018 and December 2022 were included in this rapid review. Studies that evaluated the association between ambient air pollutants (nitrogen dioxide (NO₂), carbon monoxide (CO), sulfur dioxide (SO₂), ozone (O₃), particulate matters (PM_s), total hydrocarbons (THC), nonmethane hydrocarbons (NMHC), benzene), and ocular posterior segment diseases (glaucoma, age-related macular degeneration (AMD), and retinal vascular diseases) were included. Results. Nineteen research articles met the inclusion criteria. Significant associations were found between PM_2.5 and glaucoma, including primary open angle, primary angle closure, and normal tension glaucoma. An increased risk of AMD was linked to increased exposure to PM_2.5, NO₂, and CO. Single studies suggested that increased exposure to PM_2.5 and PM₁₀ is associated with diabetic retinopathy; THC and NMHC increased the risk of retinal vein occlusion; and CO, NO₂, and PM₁₀ are linked to an increased risk of central retinal artery occlusion. Conclusions. There is increasing evidence that toxic air pollutants have an impact on posterior segment ocular diseases, hence determining it as a potential modifiable risk factor for visual impairment. Full article

(This article belongs to the Section Ophthalmology)

11 pages, 1409 KiB

Open AccessArticle

Scapular Kinematics and Patterns of Scapular Dyskinesis in Rotator Cuff Tears: A Prospective Cohort Study

by Umile Giuseppe Longo, Laura Risi Ambrogioni, Vincenzo Candela, Alessandra Berton, Daniela Lo Presti and Vincenzo Denaro

J. Clin. Med. 2023, 12(11), 3841; https://doi.org/10.3390/jcm12113841 - 04 Jun 2023

Cited by 1 | Viewed by 1244

Abstract

Scapular dyskinesis (SD) is a condition of loss of normal mobility or function of the scapula. SD is frequently observed in patients with other shoulder disorders, such as rotator cuff (RC) tears. This study evaluates the different presentations in clinical outcomes and range [...] Read more.

Scapular dyskinesis (SD) is a condition of loss of normal mobility or function of the scapula. SD is frequently observed in patients with other shoulder disorders, such as rotator cuff (RC) tears. This study evaluates the different presentations in clinical outcomes and range of motions (ROMs) in patients suffering from RC tears with and without SD. A total of 52 patients were enrolled, of which 32 patients with RC tears and SD (group A) and 20 patients with RC tears without SD (group B). Statistically significant differences between the groups in terms of clinical outcomes were identified. There were statistically significant differences in terms of flexion (p = 0.019), extension (p = 0.015), abduction (p = 0.005), and external rotation at 90° (p = 0.003) and at 0° (p = 0.025). In conclusion, this prospective study demonstrated that SD influences the clinical presentation of patients with RC tears in terms of clinical outcomes and ROMs, apart from internal rotation. Further studies will need to show whether these differences occur regardless of SD type. Full article

(This article belongs to the Section Sports Medicine)

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12 pages, 804 KiB

Open AccessArticle

Referrals, Symptoms and Treatment of Patients Referred to a Secondary Spine Centre—How Can We Help?

by Ruud Droeghaag, Daphne Nabben, Anouk Smeets, Wouter van Hemert, Narender van Orshoven, Henk van Santbrink, Jasper Most and Inez Curfs

J. Clin. Med. 2023, 12(11), 3840; https://doi.org/10.3390/jcm12113840 - 04 Jun 2023

Viewed by 812

Abstract

Introduction: Spinal disorders are amongst the conditions with the highest burden of disease. To limit the increase of healthcare-related costs in the ageing population, the selection of different types of care for patients with spinal disorders should be optimized. The first step is [...] Read more.

Introduction: Spinal disorders are amongst the conditions with the highest burden of disease. To limit the increase of healthcare-related costs in the ageing population, the selection of different types of care for patients with spinal disorders should be optimized. The first step is to investigate the characteristics of these patients and the relationship with treatment. Research Question: The primary aim of this study was to provide insights in the characteristics, symptoms, diagnosis and treatment of patients referred to a specialized spinal health care centre. The secondary aim was to perform an in-depth analysis of resource utilization for a representative subgroup of patients. Methods: This study describes the characteristics of 4855 patients referred to a secondary spine centre. Moreover, an extensive analysis of a representative subgroup of patients (~20%) is performed. Results: The mean age was 58.1, 56% of patients were female, and the mean BMI was 28. In addition, 28% of patients used opioids. Mean self-reported health status was 53.3 (EuroQol 5D Visual Analogue Scale), and pain ranged from 5.8 to 6.7 (Visual Analogue Scale neck/back/arm/leg). Additional imaging was received by 67.7% of patients. Surgical treatment was indicated for 4.9% of patients. The majority (83%) of non-surgically treated patients received out-of-hospital treatment; 25% of patients received no additional imaging or in-hospital treatment. Conclusion: The vast majority of patients received non-surgical treatments. We observed that ~10% of patients did not receive in-hospital imaging or treatment and had acceptable or good questionnaire scores at the time of referral. These findings suggest that there is potential for improvement in efficacy of referral, diagnosis, and treatment. Future studies should aim to develop an evidence base for improved patient selection for clinical pathways. The efficacy of chosen treatments requires investigation of large cohorts. Full article

(This article belongs to the Section General Surgery)

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8 pages, 2773 KiB

Open AccessCase Report

Complete Pathologic Response to PARP Inhibitor Olaparib in a Patient with Stage IVB Recurrent Endometrioid Endometrial Adenocarcinoma

by Rosemary Noel Senguttuvan, Christina Wei, Mustafa Raoof, Thanh H. Dellinger and Edward Wenge Wang

J. Clin. Med. 2023, 12(11), 3839; https://doi.org/10.3390/jcm12113839 - 04 Jun 2023

Cited by 3 | Viewed by 1818

Abstract

Treatment for endometrial cancer is rapidly evolving with the increased use and integration of somatic tumor RNA sequencing in clinical practice. There is a paucity of data regarding PARP inhibition in endometrial cancer given that mutations in homologous recombination genes are rare, and [...] Read more.

Treatment for endometrial cancer is rapidly evolving with the increased use and integration of somatic tumor RNA sequencing in clinical practice. There is a paucity of data regarding PARP inhibition in endometrial cancer given that mutations in homologous recombination genes are rare, and currently no FDA approval exists. A 50-year-old gravida 1 para 1 woman with a diagnosis of stage IVB poorly differentiated endometrioid endometrial adenocarcinoma presented to our comprehensive cancer center. Following surgical staging, she was placed on adjuvant chemotherapy with carboplatin/paclitaxel which was held multiple times due to poor performance status and complications. CT scan of the abdomen and pelvis following cycles 3 of adjuvant chemotherapy showed recurrent progressive disease. She received one cycle of liposomal doxorubicin but discontinued it due to severe cutaneous toxicity. Based on the BRIP1 mutation identified, the patient was placed on compassionate use of Olaparib in January 2020. Imaging during this surveillance period showed a significant decrease in hepatic, peritoneal, and extraperitoneal metastases, and eventually the patient had a clinical complete response in a year. The most recent CT A/P in December 2022 showed no sites of active recurrent or metastatic disease in the abdomen or pelvis. We present a unique case of a patient with recurrent stage IVB poorly differentiated endometrioid endometrial adenocarcinoma with multiple somatic gene mutations including BRIP1, who had a pathologic complete response following compassionate use of Olaparib for 3 years. To our knowledge, this is the first reported case of high grade endometrioid endometrial cancer that has shown a pathologic complete response to a PARP inhibitor. Full article

(This article belongs to the Special Issue Integrating Clinical and Translational Research Networks—Building Team Medicine - Series 2)

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10 pages, 667 KiB

Open AccessReview

Microcirculatory Disease in Patients after Heart Transplantation

by Sylwia Iwańczyk, Patrycja Woźniak, Anna Smukowska-Gorynia, Aleksander Araszkiewicz, Alicja Nowak, Maurycy Jankowski, Aneta Konwerska, Tomasz Urbanowicz and Maciej Lesiak

J. Clin. Med. 2023, 12(11), 3838; https://doi.org/10.3390/jcm12113838 - 04 Jun 2023

Viewed by 1149

Abstract

Although the treatment and prognosis of patients after heart transplantation have significantly improved, late graft dysfunction remains a critical problem. Two main subtypes of late graft dysfunction are currently described: acute allograft rejection and cardiac allograft vasculopathy, and microvascular dysfunction appears to be [...] Read more.

Although the treatment and prognosis of patients after heart transplantation have significantly improved, late graft dysfunction remains a critical problem. Two main subtypes of late graft dysfunction are currently described: acute allograft rejection and cardiac allograft vasculopathy, and microvascular dysfunction appears to be the first stage of both. Studies revealed that coronary microcirculation dysfunction, assessed by invasive methods in the early post-transplant period, correlates with a higher risk of late graft dysfunction and death during long-term follow-up. The index of microcirculatory resistance, measured early after heart transplantation, might identify the patients at higher risk of acute cellular rejection and major adverse cardiovascular events. It may also allow optimization and enhancement of post-transplantation management. Moreover, cardiac allograft vasculopathy is an independent prognostic factor for transplant rejection and survival rate. The studies showed that the index of microcirculatory resistance correlates with anatomic changes and reflects the deteriorating physiology of the epicardial arteries. In conclusion, invasive assessment of the coronary microcirculation, including the measurement of the microcirculatory resistance index, is a promising approach to predict graft dysfunction, especially the acute allograft rejection subtype, during the first year after heart transplantation. However, further advanced studies are needed to fully grasp the importance of microcirculatory dysfunction in patients after heart transplantation. Full article

(This article belongs to the Section Cardiovascular Medicine)

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11 pages, 1356 KiB

Open AccessArticle

Anterior Quadratus Lumborum Block and Quadriceps Strength: A Prospective Cohort Study

by Yuma Kadoya, Nobuhiro Tanaka, Takanori Suzuka, Takayuki Yamanaka, Masato Iwata, Naoki Ozu and Masahiko Kawaguchi

J. Clin. Med. 2023, 12(11), 3837; https://doi.org/10.3390/jcm12113837 - 03 Jun 2023

Cited by 1 | Viewed by 1020

Abstract

The decrease in quadriceps strength after anterior quadratus lumborum block (AQLB) has not been quantified. This prospective cohort study investigated the incidence of quadriceps weakness after AQLB. We enrolled patients undergoing robot-assisted partial nephrectomy, and AQLB was performed at the L2 level with [...] Read more.

The decrease in quadriceps strength after anterior quadratus lumborum block (AQLB) has not been quantified. This prospective cohort study investigated the incidence of quadriceps weakness after AQLB. We enrolled patients undergoing robot-assisted partial nephrectomy, and AQLB was performed at the L2 level with 30 mL of 0.375% ropivacaine. We evaluated each quadriceps’ maximal voluntary isometric contraction using a handheld dynamometer preoperatively and postoperatively at 1 and 4 days. The incidence of muscle weakness was defined as a 25% reduction in muscle strength compared with the preoperative baseline, and “muscle weakness possibly caused by nerve block” was defined as a 25% reduction compared with the non-block side. We also assessed the numerical rating scale and quality of recovery-15 scores. Thirty participants were analyzed. The incidence of muscle weakness compared with preoperative baseline and the non-block side was 13.3% and 30.0%, respectively. Patients with a numerical rating scale ≥ 4 or quality of recovery-15 score < 122, which was classified as moderate or poor, had decreased muscle strength with relative risks of 1.75 and 2.33, respectively. All patients ambulated within 24 h after surgery. The incidence of quadriceps weakness possibly caused by nerve block was 13.3%; however, all patients could ambulate after 1 day. Full article

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

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12 pages, 2424 KiB

Open AccessArticle

Evaluation of Ocular Perfusion in Patients with End-Stage Renal Disease Receiving Hemodialysis Using Optical Coherence Tomography Angiography

by Larissa Lahme, Jens Julian Storp, Elena Marchiori, Eliane Esser, Nicole Eter, Natasa Mihailovic and Maged Alnawaiseh

J. Clin. Med. 2023, 12(11), 3836; https://doi.org/10.3390/jcm12113836 - 03 Jun 2023

Cited by 3 | Viewed by 935

Abstract

Hemodialysis (HD) is known to affect ocular blood flow. This case-control study aims to evaluate macular and peripapillary vasculature in patients with end-stage renal disease (ESRD) receiving HD in comparison to matched controls. A total of 24 eyes of 24 ESRD patients receiving [...] Read more.

Hemodialysis (HD) is known to affect ocular blood flow. This case-control study aims to evaluate macular and peripapillary vasculature in patients with end-stage renal disease (ESRD) receiving HD in comparison to matched controls. A total of 24 eyes of 24 ESRD patients receiving HD and 24 eyes of 24 healthy, age- and gender-matched control subjects were prospectively included in this study. Optical coherence tomography angiography was used to image the superficial (SCP), deep (DCP), and choriocapillary (CC) macular vascular plexus, as well as the radial peripapillary capillaries (RPC) of the optic disc. In addition, retinal thickness (RT) and retinal volume (RV) were compared between both groups. Flow density (FD) values of each retinal layer and data of parameters related to the foveal avascular zone (FAZ), as well as RT and RV, were analyzed using Mann–Whitney U tests. There was no significant difference in FAZ parameters between the two groups. Whole en face FD of the SCP and CC was noticeably reduced in the HD group in comparison to the control group. FD was negatively correlated with the duration of HD treatment. RT and RV were significantly smaller in the study group than in controls. Retinal microcirculation appears altered in patients with ESRD undergoing HD. Concurrently, the DCP appears more resilient towards hemodynamic changes in comparison to the other microvascular retinal layers. OCTA is a useful, non-invasive tool to investigate retinal microcirculation in ESRD patients. Full article

(This article belongs to the Topic Optical Coherence Tomography (OCT) and OCT Angiography – Recent Advances)

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J. Clin. Med., Volume 12, Issue 11 (June-1 2023) – 259 articles

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