Next Issue
Volume 12, July-1
Previous Issue
Volume 12, June-1
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
5.4
3.9
Journals
JCM
Volume 12
Issue 12
share announcement

J. Clin. Med., Volume 12, Issue 12 (June-2 2023) – 306 articles

Cover Story (view full-size image): Type 2 diabetes (T2DM) is one of the main public health care problems worldwide. It is associated with a marked increased risk of developing atherosclerotic vascular disease, heart failure, chronic kidney disease and death. It is essential to act during the early phases of the disease, through the intensification of lifestyle changes and the prescription of those drugs that have been shown to reduce these complications, with the aim not only of achieving an adequate metabolic control, but also a comprehensive vascular risk control. In this consensus document, developed by the different specialists that treat these patients (endocrinologists, primary care physicians, internists, nephrologists and cardiologists), a more appropriate approach in the management of patients with T2DM or its complications is provided. View this paper
  • Issues are regarded as officially published after their release is announced to the table of contents alert mailing list.
  • You may sign up for e-mail alerts to receive table of contents of newly released issues.
  • PDF is the official format for papers published in both, html and pdf forms. To view the papers in pdf format, click on the "PDF Full-text" link, and use the free Adobe Reader to open them.
Order results
Result details
Section
Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:
21 pages, 669 KiB  
Review
Clinical Efficacy of Topical or Oral Soy Supplementation in Dermatology: A Systematic Review
by Nicole Natarelli, Nimrit Gahoonia, Jessica Maloh and Raja K. Sivamani
J. Clin. Med. 2023, 12(12), 4171; https://doi.org/10.3390/jcm12124171 - 20 Jun 2023
Cited by 3 | Viewed by 2124
Abstract
Soybean, a legume native to Southeast Asia, serves many nutritional and medical purposes due to its rich source of phytochemicals and its antioxidant activity. Many animal and in vitro studies have demonstrated its potential impact on dermatologic health. The objective of this review [...] Read more.
Soybean, a legume native to Southeast Asia, serves many nutritional and medical purposes due to its rich source of phytochemicals and its antioxidant activity. Many animal and in vitro studies have demonstrated its potential impact on dermatologic health. The objective of this review is to investigate the clinical response of soy-based oral supplementation or topical application on dermatologic outcomes. A systematic review of studies assessing soy supplementation or application was performed in January 2023. Databases included PubMed, Embase, Cochrane, and Natural Medicines, and studies assessing any formulation that included soybean or associated products were included. Thirty studies met the inclusion criteria and are included in the review; 13 of these studies assessed oral supplementation and 17 assessed topical application. Topical and oral supplementation demonstrated efficacious results for a variety of dermatologic parameters, including chronological or photoaging parameters, skin barrier status, hydration, hyperpigmentation, dermal network composition, erythema, hair and nail parameters, acne lesion counts, and vulvar lichen sclerosis scores. Factors associated with aging, such as wrinkle area and depth, were most frequently assessed among the studies, and both topical and oral studies demonstrated efficacy. Effects are likely mediated by dermal compositional changes, such as increased collagen and/or elastic fiber numbers. Transepidermal water loss measurements, an indicator of skin barrier status, were frequently obtained among the studies, although improvement was more likely achieved with topical application compared to oral supplementation. The results of this review highlight the utility of soy-based products for a variety of dermatologic applications, although future studies are required to determine optimal formulations and application routes for intended outcomes. Full article
(This article belongs to the Section Dermatology)
►▼ Show Figures

Figure 1

11 pages, 6239 KiB  
Article
Total Globulin Fraction at Diagnosis Could Forecast All-Cause Mortality during the Disease Course in Patients with Antineutrophil Cytoplasmic Antibody-Associated Vasculitis
by Jang-Woo Ha, Sung-Soo Ahn, Jason-Jungsik Song, Yong-Beom Park and Sang-Won Lee
J. Clin. Med. 2023, 12(12), 4170; https://doi.org/10.3390/jcm12124170 - 20 Jun 2023
Viewed by 964
Abstract
Total globulin fraction (TGF) is calculated by subtracting serum albumin levels from serum total protein levels. The present study examined whether TGF at diagnosis could forecast all-cause mortality during the disease course in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The present [...] Read more.
Total globulin fraction (TGF) is calculated by subtracting serum albumin levels from serum total protein levels. The present study examined whether TGF at diagnosis could forecast all-cause mortality during the disease course in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The present study included 283 patients with AAV. The variables at AAV diagnosis such as demographic data, AAV-specific data including the Birmingham vasculitis activity score (BVAS), five-factor score (FFS), and laboratory data including ANCA, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were collected. The number of deceased patients during the follow-up duration based on all-cause mortality was counted. The median age of the 283 AAV patients was 60 years, and 35.7% were men. ANCAs were detected in 228 patients, and the median TGF was 2.9. A total of 39 patients (13.8%) died within a median follow-up duration of 46.9 months. TGF at AAV diagnosis was significantly correlated with ESR and CRP rather than AAV activity. Patients with ANCA positivity exhibited a significantly higher median TGF at AAV diagnosis than those without. Patients with TGF ≥ 3.1 g/dL at AAV diagnosis exhibited a significantly lower cumulative survival rate than those without. Furthermore, in the multivariable Cox hazards model analysis, TGF ≥ 3.1 g/dL (hazard ratio 2.611) was independently associated with all-cause mortality, along with age, male sex, and body mass index. The present study is the first to demonstrate that TGF at AAV diagnosis can forecast all-cause mortality during the disease course in AAV patients. Full article
(This article belongs to the Special Issue Immune-Mediated Rheumatic Diseases)
►▼ Show Figures

Figure 1

9 pages, 1619 KiB  
Article
Bony Sacral Volume after Sacro-Iliac Screw Fixation of Pelvic Fractures Is Dependent on Reduction of the Anterior Pelvic Ring
by Florian Baumann, Stefano Pagano, Volker Alt and Viola Freigang
J. Clin. Med. 2023, 12(12), 4169; https://doi.org/10.3390/jcm12124169 - 20 Jun 2023
Viewed by 780
Abstract
Pelvic ring injuries are uncommon but serious injuries. Percutaneous sacro-iliac screw fixation (SSF) is the standard treatment for posterior stabilization of pelvic fractures. Compression forces of the SSF might cause deformity of the sacrum and the pelvic ring. The aim of this radio-volumetric [...] Read more.
Pelvic ring injuries are uncommon but serious injuries. Percutaneous sacro-iliac screw fixation (SSF) is the standard treatment for posterior stabilization of pelvic fractures. Compression forces of the SSF might cause deformity of the sacrum and the pelvic ring. The aim of this radio-volumetric study is to evaluate the morphometry of the sacrum and pelvic ring in SSF for posterior pelvic fractures. (1) Methods: We conducted a radio-volumetric study measuring the bony sacral volume before and after SSF for a pelvic fracture based on a three-dimensional reconstruction of the pre- and postoperative computed tomography scan of 19 patients with a C-type pelvic fracture. In addition to the bony sacral volume, we assessed the pelvic deformity and the load bearing axis. We compared the results of patients without anterior stabilization (Group A) to patients who had additional ORIF of the anterior pelvic ring. (2) Results: Median age of the patients was 41.2 years (±17.8). All patients received percutaneous SSF with partially threaded 7.3 mm screws. The sacral volume decreased from 202.9 to 194.3 cm3 in group A (non-operative treatment anterior, n = 10) and an increase of sacral volume from 229.8 to 250.4 cm3 in group B (anterior ORIF; n = 9). Evaluation of the pelvic deformity also reflected this trend by a decrease of the ipsilateral load-bearing angle in group A (37.0° to 36.4°) and an increase of this angle in group B (36.3 to 39.9°). (3) Conclusions: Bony sacral volume and pelvic deformity after sacro-iliac screw fixation in pelvic fractures depend on treatment of the anterior pelvic ring. Reduction and fixation of the anterior fracture shows an increase of the bony sacral volume and the load bearing angle leading to a closer to normal reconstruction of the pelvic anatomy. Full article
(This article belongs to the Special Issue Fractures of the Pelvis and Acetabulum: Novel Insights in Diagnostics and Treatment)
►▼ Show Figures

Figure 1

11 pages, 422 KiB  
Article
The Impact of Frailty on Postoperative Complications in Total En Bloc Spondylectomy for Spinal Tumors
by Masafumi Kawai, Satoru Demura, Satoshi Kato, Noriaki Yokogawa, Takaki Shimizu, Yuki Kurokawa, Motoya Kobayashi, Yohei Yamada, Satoshi Nagatani, Takaaki Uto and Hideki Murakami
J. Clin. Med. 2023, 12(12), 4168; https://doi.org/10.3390/jcm12124168 - 20 Jun 2023
Viewed by 786
Abstract
Total en bloc spondylectomy (TES) is an effective treatment for spinal tumors. However, its complication rate is high, and the corresponding risk factors remain unclear. This study aimed to clarify the risk factors for postoperative complications after TES, including the patient’s general condition, [...] Read more.
Total en bloc spondylectomy (TES) is an effective treatment for spinal tumors. However, its complication rate is high, and the corresponding risk factors remain unclear. This study aimed to clarify the risk factors for postoperative complications after TES, including the patient’s general condition, such as frailty and their levels of inflammatory biomarkers. We included 169 patients who underwent TES at our hospital from January 2011–December 2021. The complication group comprised patients who experienced postoperative complications that required additional intensive treatments. We analyzed the relationship between early complications and the following factors: age, sex, body mass index, type of tumor, location of tumor, American Society of Anesthesiologists score, physical status, frailty (categorized by the 5-factor Modified Frailty Index [mFI-5]), neutrophil-to-lymphocyte ratio, C-reactive protein/albumin ratio, preoperative chemotherapy, preoperative radiotherapy, surgical approach, and the number of resected vertebrae. Of the 169 patients, 86 (50.1%) were included in the complication group. Multivariate analysis showed that high mFI-5 scores (odds ratio [OR] = 2.99, p < 0.001) and an increased number of resected vertebrae (OR = 1.87, p = 0.018) were risk factors for postoperative complications. Frailty and the number of resected vertebrae were independent risk factors for postoperative complications after TES for spinal tumors. Full article
(This article belongs to the Section Oncology)
►▼ Show Figures

Figure 1

13 pages, 2121 KiB  
Article
Adduction Manipulation of the Glenohumeral Joint versus Physiotherapy for Atraumatic Rotator Cuff Tears: A Randomized Controlled Trial
by Hiroshi Karasuno, Junichiro Hamada, Yuichiro Yano, Hiroaki Tsutsui, Yoshihiro Hagiwara, Kazuhiro Endo and Takashi Saito
J. Clin. Med. 2023, 12(12), 4167; https://doi.org/10.3390/jcm12124167 - 20 Jun 2023
Viewed by 1185
Abstract
Background: Atraumatic rotator cuff tears (ARCTs) are frequently concomitant with adduction restriction of the glenohumeral joint (GHJ). Adduction manipulation (AM) removes the restriction and relieves pain. The present study aimed to investigate the clinical efficacy of AM versus physiotherapy (PT) in ARCTs. Methods: [...] Read more.
Background: Atraumatic rotator cuff tears (ARCTs) are frequently concomitant with adduction restriction of the glenohumeral joint (GHJ). Adduction manipulation (AM) removes the restriction and relieves pain. The present study aimed to investigate the clinical efficacy of AM versus physiotherapy (PT) in ARCTs. Methods: Eighty-eight patients with adduction restriction were allocated to the AM and PT groups (n = 44 per group). The glenohumeral adduction angle (GAA) was calculated using X-rays at the first and last follow-up appointments. We recorded pain severity (visual analog scale, VAS), flexion, abduction, external rotation (ER), internal rotation (IR), and American Shoulder and Elbow Society (ASES) and Constant scores at baseline and at 1-, 3-, 6-, and 12- month follow-ups. Results: Forty-three patients (23 males, average age 71.3 years) in the AM group and 41 (16 males, average age 70.7 years) in the PT group were consequently analyzed. At the 1-month follow-up, VAS, shoulder motion except ER, ASES and Constant scores were much better in the AM group than in the PT group, whereas those in the PT group improved gradually up to 12 months. At the final follow-up, flexion, abduction, and Constant score were significantly better in the AM group than in the PT group. The GAA at the initial and final examinations was −21.6° and −3.2°, respectively, in the AM group, and −21.1° and −14.4°, respectively, in the PT group. Conclusions: The AM procedure, which had better clinical efficacy than PT, is recommended as the first conservative treatment option for ARCTs. Full article
(This article belongs to the Special Issue Clinical Challenges and Advances in Shoulder and Elbow Surgery)
►▼ Show Figures

Figure 1

9 pages, 966 KiB  
Article
High Myopia and Thickness of Extraocular and Masticatory Muscles—7T MRI, Preliminary Study
by Grzegorz Zieliński, Anna Matysik-Woźniak, Anna Pankowska, Radosław Pietura, Robert Rejdak and Kamil Jonak
J. Clin. Med. 2023, 12(12), 4166; https://doi.org/10.3390/jcm12124166 - 20 Jun 2023
Cited by 4 | Viewed by 1078
Abstract
(1) Background: Myopia is one of the most common refractive errors in the world. The aim of this study was to evaluate the transverse dimensions of selected masticatory muscles (temporalis muscle and masseter muscle) versus the transverse dimensions of selected extraocular muscles (superior [...] Read more.
(1) Background: Myopia is one of the most common refractive errors in the world. The aim of this study was to evaluate the transverse dimensions of selected masticatory muscles (temporalis muscle and masseter muscle) versus the transverse dimensions of selected extraocular muscles (superior rectus, inferior rectus, medial rectus and lateral rectus) in emmetropic and high myopic subjects. (2) Methods: Twenty-seven individuals were included in the analysis, resulting in 24 eyeballs of patients with high myopia and 30 eyeballs of emmetropic subjects. A 7 Tesla resonance was used to analyze the described muscles. (3) Results: Statistical analysis showed differences in all analyzed extraocular muscles and all analyzed masticatory muscles between emmetropic subjects and high myopic subjects. In the high myopic subject group, statistical analysis showed four correlations. The three negative correlations were between the lateral rectus muscle and an axial length eyeball, refractive error and an axial length eyeball, and the inferior rectus muscle and visual acuity. The positive correlation was between the lateral rectus muscle and the medial rectus muscle. (4) Conclusions: The high myopic subjects are characterized by a larger cross-sectional area of extraocular muscles and masticatory muscles compared to the emmetropic subjects. Correlations were observed between the thickness of the extraocular muscles and the masticatory muscles. The lateral rectus muscle was related to the length of the eyeball. The phenomenon requires further study. Full article
(This article belongs to the Section Ophthalmology)
►▼ Show Figures

Figure 1

16 pages, 2176 KiB  
Review
Anti-Inflammatory Drug Therapy in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis of Prospective Randomized and Placebo-Controlled Trials
by Johannes Wach, Martin Vychopen, Agi Güresir and Erdem Güresir
J. Clin. Med. 2023, 12(12), 4165; https://doi.org/10.3390/jcm12124165 - 20 Jun 2023
Cited by 2 | Viewed by 1276
Abstract
Emerging evidence suggests that neuroinflammation may play a potential role in aneurysmal subarachnoid hemorrhage (aSAH). We aim to analyze the influence of anti-inflammatory therapy on survival and outcome in aSAH. Eligible randomized placebo-controlled prospective trials (RCTs) were searched in PubMed until March 2023. [...] Read more.
Emerging evidence suggests that neuroinflammation may play a potential role in aneurysmal subarachnoid hemorrhage (aSAH). We aim to analyze the influence of anti-inflammatory therapy on survival and outcome in aSAH. Eligible randomized placebo-controlled prospective trials (RCTs) were searched in PubMed until March 2023. After screening the available studies for inclusion and exclusion criteria, we strictly extracted the main outcome measures. Dichotomous data were determined and extracted by odds ratio (OR) with 95% confidence intervals (CIs). Neurological outcome was graded using the modified Rankin Scale (mRS). We created funnel plots to analyze publication bias. From 967 articles identified during the initial screening, we included 14 RCTs in our meta-analysis. Our results illustrate that anti-inflammatory therapy yields an equivalent probability of survival compared to placebo or conventional management (OR: 0.81, 95% CI: 0.55–1.19, p = 0.28). Generally, anti-inflammatory therapy trended to be associated with a better neurologic outcome (mRS ≤ 2) compared to placebo or conventional treatment (OR: 1.48, 95% CI: 0.95–2.32, p = 0.08). Our meta-analysis showed no increased mortality form anti-inflammatory therapy. Anti-inflammatory therapy in aSAH patients tends to improve the neurological outcome. However, multicenter, rigorous, designed, prospective randomized studies are still needed to investigate the effect of fighting inflammation in improving neurological functioning after aSAH. Full article
(This article belongs to the Special Issue Clinical Advances in Cerebral Aneurysm Treatment)
►▼ Show Figures

Figure 1

8 pages, 705 KiB  
Article
Pneumatic Compression Combined with Standard Treatment after Total Hip Arthroplasty and Its Effects on Edema of the Operated Limb and on Physical Outcomes: A Pilot Clinical Randomized Controlled Study
by Vittoria Carnevale Pellino, Alessandro Gatti, Matteo Vandoni, Pamela Patanè, Massimiliano Febbi, Stefania Ballarin, Caterina Cavallo and Luca Marin
J. Clin. Med. 2023, 12(12), 4164; https://doi.org/10.3390/jcm12124164 - 20 Jun 2023
Cited by 1 | Viewed by 1455
Abstract
Total hip arthroplasty (THA) is one of the most successful orthopedic procedures and is highly effective at improving function and quality of life. However, patients commonly experience edema immediately after hospitalization and also after discharge, which can lead to health consequences and a [...] Read more.
Total hip arthroplasty (THA) is one of the most successful orthopedic procedures and is highly effective at improving function and quality of life. However, patients commonly experience edema immediately after hospitalization and also after discharge, which can lead to health consequences and a lower quality of life. For these reasons, the aim of this study (NCT05312060) was to evaluate the effectiveness of a specific intermittent leg pneumatic compression on lower limb edema and physical outcomes in patients after total hip arthroplasty, compared to standard conservative treatment. A total of 47 patients were enrolled and randomly allocated into two groups: the pneumatic compression group (PG = 24) and the control group (CG = 23). The CG performed the standard venous thromboembolism therapy, which included pharmacological prophylaxis, compressive stockings, and electrostimulation, while the PG combined pneumatic compression with standard VTE therapy. We evaluated thigh and calf circumferences, knee and ankle ranges of motion, pain, and walking autonomy. Our results showed a greater reduction in thigh and calf circumferences for PG (p < 0.001), while other outcomes were similar for the two groups (p > 0.05). The combination of standard therapy with pneumatic leg compression was more effective at reducing lower limb edema and thigh and calf circumferences than standard treatment. Our results suggest that pressotherapy treatment is a valuable and efficient option for managing lower limb edema after THA. Full article
(This article belongs to the Topic The Use of New Technologies for Health and Clinical Practice)
►▼ Show Figures

Graphical abstract

11 pages, 429 KiB  
Article
Single-Center Real-World Experience with Sutureless Aortic Valve Prosthesis in Isolated and Combined Procedures
by Alina Zubarevich, Lukman Amanov, Arian Arjomandi Rad, Eleftherios T. Beltsios, Marcin Szczechowicz, Anja Osswald, Arjang Ruhparwar and Alexander Weymann
J. Clin. Med. 2023, 12(12), 4163; https://doi.org/10.3390/jcm12124163 - 20 Jun 2023
Viewed by 663
Abstract
Introduction: Due to their favourable hemodynamic performance and the ability to enable minimally invasive access procedures, sutureless aortic valve prostheses have found their place in the armamentarium of cardiothoracic surgeons. In this study, we sought to review our institutional experience of sutureless aortic [...] Read more.
Introduction: Due to their favourable hemodynamic performance and the ability to enable minimally invasive access procedures, sutureless aortic valve prostheses have found their place in the armamentarium of cardiothoracic surgeons. In this study, we sought to review our institutional experience of sutureless aortic valve replacement (SU-AVR). Methods: We carried out a retrospective analysis of 200 consecutive patients who underwent an SU-AVR with a Perceval valve between December 2019 and February 2023. Results: The mean age of patients was 69.3 ± 8.1 years, and patients showed a moderate-risk profile with a mean logistic EuroSCORE-II of 5.2 ± 8.1%. An isolated SU-AVR was performed in 85 (42.5%) patients, concomitant CABG was performed in 75 (37.5%) and 40 patients (20%) underwent a multivalve procedure involving SU-AVR. The cardiopulmonary bypass (CPB) and cross-clamp (CC) times were 82.1 ± 35.1 and 55.5 ± 27.8 min, respectively. In-hospital, 30-day, 6-month and 1-year mortality rates were 4.5%, 6.5%, 7.5% and 8.2%, respectively. The postoperative transvalvular mean pressure gradient was 6.3 ± 1.6 mmHg and stayed stable over the follow-up time. We reported no cases of paravalvular leakage, and the incidence of stroke was 0.5%. Conclusions: With their favourable hemodynamic performance and shorter CC and CPB times, sutureless aortic valve prostheses facilitate minimally invasive access surgery, being a safe and durable promising approach for the surgical AVR. Full article
(This article belongs to the Section Cardiovascular Medicine)
►▼ Show Figures

Figure 1

11 pages, 843 KiB  
Article
Patients with Clinically Suspected Gallstone Disease: A More Selective Ultrasound May Improve Treatment Related Outcomes
by Floris M. Thunnissen, Daan J. Comes, Remy W. F. Geenen, Deniece Riviere, Carmen S. S. Latenstein, Marten A. Lantinga, Henk J. Schers, Cornelis J. H. M. van Laarhoven, Joost P. H. Drenth, Femke Atsma and Philip R. de Reuver
J. Clin. Med. 2023, 12(12), 4162; https://doi.org/10.3390/jcm12124162 - 20 Jun 2023
Viewed by 966
Abstract
This study aimed to quantify the confirmation of gallstones on ultrasound (US) in patients with suspicion of gallstone disease. To aid general practitioners (GPs) in diagnostic workup, a model to predict gallstones was developed. A prospective cohort study was conducted in two Dutch [...] Read more.
This study aimed to quantify the confirmation of gallstones on ultrasound (US) in patients with suspicion of gallstone disease. To aid general practitioners (GPs) in diagnostic workup, a model to predict gallstones was developed. A prospective cohort study was conducted in two Dutch general hospitals. Patients (≥18 years) were eligible for inclusion when referred by GPs for US with suspicion of gallstones. The primary outcome was the confirmation of gallstones on US. A multivariable regression model was developed to predict the presence of gallstones. In total, 177 patients were referred with a clinical suspicion of gallstones. Gallstones were found in 64 of 177 patients (36.2%). Patients with gallstones reported higher pain scores (VAS 8.0 vs. 6.0, p < 0.001), less frequent pain (21.9% vs. 54.9%, p < 0.001), and more often met criteria for biliary colic (62.5% vs. 44.2%, p = 0.023). Predictors for the presence of gallstones were a higher pain score, frequency of pain less than weekly, biliary colic, and an absence of heartburn. The model showed good discrimination between patients with and without gallstones (C-statistic 0.73, range: 0.68–0.76). Clinical diagnosis of symptomatic gallstone disease is challenging. The model developed in this study may aid in the selection of patients for referral and improve treatment related outcomes. Full article
(This article belongs to the Section Gastroenterology & Hepatopancreatobiliary Medicine)
►▼ Show Figures

Figure 1

18 pages, 3472 KiB  
Article
The Role of Pathogenesis Associated with the Tumor Microclimate in the Differential Diagnosis of Uterine Myocytic Tumors
by Madalina Bosoteanu, Mariana Deacu, Mariana Aschie, Sorin Vamesu, Georgeta Camelia Cozaru, Anca Florentina Mitroi, Raluca Ioana Voda, Cristian Ionut Orasanu, Sabina Elena Vlad, Roxana Cleopatra Penciu and Sergiu Ioachim Chirila
J. Clin. Med. 2023, 12(12), 4161; https://doi.org/10.3390/jcm12124161 - 20 Jun 2023
Cited by 1 | Viewed by 1141
Abstract
Myocytic tumors of the uterus present vast morphological heterogeneity, which makes differential diagnosis between the different entities necessary. This study aims to enrich the existing data and highlight new potential therapeutic targets regarding aspects related to the pathogenic process and the tumor microenvironment [...] Read more.
Myocytic tumors of the uterus present vast morphological heterogeneity, which makes differential diagnosis between the different entities necessary. This study aims to enrich the existing data and highlight new potential therapeutic targets regarding aspects related to the pathogenic process and the tumor microenvironment in order to improve the quality of life of women. We performed a 5-year retrospective study, including particular cases of uterine myocyte tumors. Immunohistochemical analyses of pathogenic pathways (p53, RB1, and PTEN) and tumor microclimate using markers (CD8, PD-L1, and CD105), as well as genetic testing of the PTEN gene, were performed. The data were statistically analyzed using the appropriate parameters. In cases of atypical leiomyoma, a significant association was observed between PTEN deletion and an increased number of PD-L1+ T lymphocytes. For malignant lesions and STUMP, PTEN deletion was associated with the advanced disease stage. Advanced cases were also associated with an increased mean CD8+ T cell count. An increased number of lymphocytes was associated with an increased percentage of RB1+ nuclei. The study corroborated clinical and histogenetic data, highlighting the importance of the differential diagnosis of these tumors to improve the management of patients and increase their quality of life. Full article
(This article belongs to the Section Obstetrics & Gynecology)
►▼ Show Figures

Figure 1

14 pages, 1085 KiB  
Article
Diagnostic Usefulness of Spiroergometry and Risk Factors of Long COVID in Patients with Normal Left Ventricular Ejection Fraction
by Katarzyna Gryglewska-Wawrzak, Agata Sakowicz, Maciej Banach, Ibadete Bytyçi and Agata Bielecka-Dabrowa
J. Clin. Med. 2023, 12(12), 4160; https://doi.org/10.3390/jcm12124160 - 20 Jun 2023
Cited by 3 | Viewed by 1375
Abstract
The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic has brought forth various clinical manifestations and long-term complications, including a condition known as long COVID. Long COVID refers to a persistent set of symptoms that continue beyond the acute phase of the disease. [...] Read more.
The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic has brought forth various clinical manifestations and long-term complications, including a condition known as long COVID. Long COVID refers to a persistent set of symptoms that continue beyond the acute phase of the disease. This study investigated the risk factors and the utility of spiroergometry parameters for diagnosing patients with long COVID symptoms. The 146 patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with normal left ventricular ejection fraction and without respiratory diseases were included and divided into two groups: the group demonstrating long COVID symptoms [n = 44] and the group without long COVID symptoms [n = 102]. The clinical examinations, laboratory test results, echocardiography, non-invasive body mass analysis, and spiroergometry were evaluated. ClinicalTrials.gov Identifier: NCT04828629. Patients with long COVID symptoms had significantly higher age [58 (vs.) 44 years; p < 0.0001], metabolic age [53 vs. 45 years; p = 0.02)], left atrial diameter (LA) [37 vs. 35 mm; p = 0.04], left ventricular mass index (LVMI) [83 vs. 74 g/m2, p = 0.04], left diastolic filling velocity (A) [69 vs. 64 cm/s, p = 0.01], the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion (E/E’) [7.35 vs. 6.05; p = 0.01], and a lower ratio of early to late diastolic transmitral flow velocity (E/A) [1.05 vs. 1.31; p = 0.01] compared to the control group. In cardiopulmonary exercise testing (CPET), long COVID patients presented lower forced vital capacity (FVC) [3.6 vs. 4.3 L; p < 0.0001], maximal oxygen consumption measured during incremental exercise indexed per kilogram (VO2max) [21 vs. 23 mL/min/kg; p = 0.04], respiratory exchange ratio (RER) [1.0 vs. 1.1; p = 0.04], forced expiratory volume in one second (FEV1) [2.90 vs. 3.25 L; p = 0.04], and a higher ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC%) [106 vs. 100%; p = 0.0002]. The laboratory results pointed out that patients with long COVID symptoms also had a lower rate of red blood cells (RBC) [4.4 vs. 4.6 × 106/uL; p = 0.01]; a higher level of glucose [92 vs. 90 mg/dL; p = 0.03]; a lower glomerular filtration rate (GFR) estimate by Modification of Diet in Renal Disease (MDRD) [88 vs. 95; p = 0.03]; and a higher level of hypersensitive cardiac Troponin T (hs-cTnT) [6.1 vs. 3.9 pg/mL; p = 0.04]. On the multivariate model, only FEV1/FVC% (OR 6.27, 95% CI: 2.64–14.86; p < 0.001) independently predicted the long COVID symptoms. Using the ROC analysis, the FEV1/FVC% ≥ 103 was the most powerful predictor of spiroergometry parameters (0.67 sensitive, 0.71 specific, AUC of 0.73; p < 0.001) in predicting the symptoms of long COVID. Spiroergometry parameters are useful in diagnosing long COVID and differentiating it from cardiovascular disease. Full article
(This article belongs to the Special Issue JCM-Advances in Cardiology, Part 2)
►▼ Show Figures

Graphical abstract

14 pages, 2307 KiB  
Article
Identification of Perioperative Procedural and Hemodynamic Risk Factors for Developing Colonic Ischemia after Ruptured Infrarenal Abdominal Aortic Aneurysm Surgery: A Single-Centre Retrospective Cohort Study
by Safwan Omran, Larissa Schawe, Frank Konietschke, Stefan Angermair, Benjamin Weixler, Sascha Treskatsch, Andreas Greiner and Christian Berger
J. Clin. Med. 2023, 12(12), 4159; https://doi.org/10.3390/jcm12124159 - 20 Jun 2023
Cited by 1 | Viewed by 971
Abstract
(1) Background: This retrospective study evaluated perioperative and intensive care unit (ICU) variables to predict colonic ischemia (CI) after infrarenal ruptured abdominal aortic aneurysm (RAAA) surgery. (2) Materials and Methods: We retrospectively analyzed the data of the patients treated for infrarenal RAAA from [...] Read more.
(1) Background: This retrospective study evaluated perioperative and intensive care unit (ICU) variables to predict colonic ischemia (CI) after infrarenal ruptured abdominal aortic aneurysm (RAAA) surgery. (2) Materials and Methods: We retrospectively analyzed the data of the patients treated for infrarenal RAAA from January 2011 to December 2020 in our hospital. (3) Results: A total of 135 (82% male) patients were admitted to ICU after treatment of infrarenal RAAA. The median age of all patients was 75 years (IQR 68–81 years). Of those, 24 (18%) patients developed CI, including 22 (92%) cases within the first three postoperative days. CI was found more often after open repair compared to endovascular treatment (22% vs. 5%, p = 0.021). Laboratory findings in the first seven PODs revealed statistically significant differences between CI and non-CI patients for serum lactate, minimum pH, serum bicarbonate, and platelet count. Norepinephrine (NE) was used in 92 (68%) patients during ICU stay. The highest daily dose of norepinephrine was administered to CI patients at POD1. Multivariable analysis revealed that NE > 64 µg/kg (RD 0.40, 95% CI: 0.25–0.55, p < 0.001), operating time ≥ 200 min (RD 0.18, 95% CI: 0.05–0.31, p = 0.042), and pH < 7.3 (RD 0.21, 95% CI: 0.07–0.35, p = 0.019), significantly predicted the development of CI. A total of 23 (17%) patients died during the hospital stay, including 8 (33%) patients from the CI group and 15 (7%) from the non-CI group (p = 0.032). (4) Conclusions: CI after RAAA is a sever complication occurring most frequently within the first 3 postoperative days. Our study identified many surrogate markers associated with colonic ischemia after aortic RAAA, including norepinephrine dose > 64 µg/kg, operating time ≥ 200 min, and PH < 7.3. Future studies are needed to support these results. Full article
(This article belongs to the Special Issue Open and Endovascular Management of Complex Aortic Aneurysms)
►▼ Show Figures

Figure 1

18 pages, 1010 KiB  
Article
Treatment of COVID-19 during the Acute Phase in Hospitalized Patients Decreases Post-Acute Sequelae of COVID-19
by Diana Badenes Bonet, Oswaldo Antonio Caguana Vélez, Xavier Duran Jordà, Merce Comas Serrano, Margarita Posso Rivera, Mireia Admetlló, Anna Herranz Blasco, Elisa Cuadrado Godia, Ester Marco Navarro, Gemma Martin Ezquerra, Zenaida Pineiro Aguin, Maria Cinta Cumpli Gargallo, Jose Gregorio Gonzalez Garcia, Eva Balcells Vilarnau, Diego Rodriguez Chiaradia, Xavier Castells, Joaquim Gea, Juan P. Horcajada and Judit Villar-García
J. Clin. Med. 2023, 12(12), 4158; https://doi.org/10.3390/jcm12124158 - 20 Jun 2023
Cited by 4 | Viewed by 1423
Abstract
Background: The post-acute sequelae of SARS-CoV-2 (PASC) infection have caused a significant impact on our health system, but there is limited evidence of approved drugs focused on its prevention. Our objective was to identify risk factors that can determine the presence of PASC, [...] Read more.
Background: The post-acute sequelae of SARS-CoV-2 (PASC) infection have caused a significant impact on our health system, but there is limited evidence of approved drugs focused on its prevention. Our objective was to identify risk factors that can determine the presence of PASC, with special attention to the treatment received in the acute phase, and to describe the profile of persistent symptoms in a multidisciplinary Post-Coronavirus Disease-19 (COVID-19) Unit. Methods: This one-year prospective observational study included patients following an acute COVID-19 infection, irrespective of whether they required hospital admission. A standardized symptom questionnaire and blood sampling were performed at the first follow-up visit, and demographic and clinical electronic data were collected. We compared subjects with PASC with those who had fully recovered. Multivariate logistic regression was performed to identify factors associated with PASC in hospitalized patients, and Kaplan–Meier curves were used to assess duration of symptoms according to disease severity and treatments received in the acute phase. Results: 1966 patients were evaluated; 1081 had mild disease, 542 moderate and 343 severe; around one third of the subjects had PASC, and were more frequently female, with obesity, asthma, and eosinophilia during acute COVID-19 disease. Patients who received treatment with dexamethasone and remdesivir during the course of the acute illness showed a lower median duration of symptoms, compared with those who received none of these treatments. Conclusion: Treatment with dexamethasone and/or remdesivir may be useful to reduce the impact of PASC secondary to SARS-CoV-2 infection. In addition, we identified female gender, obesity, asthma, and disease severity as risk factors for having PASC. Full article
(This article belongs to the Special Issue Epidemiology and Clinical Characteristics of COVID-19)
►▼ Show Figures

Figure 1

10 pages, 252 KiB  
Article
Increased Risk of Developing Systemic Lupus Erythematosus and Rheumatoid Arthritis in Patients with Primary Sjögren’s Syndrome—A Secondary Cohort Analysis of Nationwide, Population-Based Claims Data
by Malcolm Koo, Chia-Wen Hsu and Ming-Chi Lu
J. Clin. Med. 2023, 12(12), 4157; https://doi.org/10.3390/jcm12124157 - 20 Jun 2023
Cited by 1 | Viewed by 909
Abstract
Background: This retrospective cohort study aimed to examine the risk of developing systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) in patients with primary Sjögren’s syndrome (pSS) compared to controls using data from a nationwide health claims database. Methods: Four distinct cohorts of [...] Read more.
Background: This retrospective cohort study aimed to examine the risk of developing systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) in patients with primary Sjögren’s syndrome (pSS) compared to controls using data from a nationwide health claims database. Methods: Four distinct cohorts of patients with newly diagnosed pSS were established using Taiwan’s National Health Insurance Research Database. Cohorts I and II were created to evaluate the risk of developing SLE and RA, respectively. Cohorts III and IV were assembled similarly to Cohorts I and II but employed a stricter definition, based on catastrophic illness certificate (CIC) status, for identifying patients with pSS. Comparison cohorts of patients without pSS were formed by frequency matching for sex, 5-year age interval, and index year. Incident rate ratios (IRR) for SLE or RA development were determined using Poisson regression models. Results: Patients with pSS, selected from just outpatient visits or with additional CIC status showed a significantly higher risk of developing SLE or RA compared with the controls. When stratified by age group or sex, the risk of developing SLE was notably higher in the young age group (adjusted IRR 47.24, p = 0.002) and women (adjusted IRR 7.63, p = 0.003) among patients with pSS. In addition, both men and women with pSS, irrespective of age, showed a significantly elevated risk of developing RA. Conclusions: Patients with pSS exhibited an elevated risk of developing SLE and RA. Rheumatologists should carefully monitor patients with pSS for potential SLE and RA development. Full article
(This article belongs to the Special Issue Sjögren’s Syndrome: An Update on Pathogenesis, Clinical Insights, and Treatment)
13 pages, 637 KiB  
Systematic Review
Temporomandibular Joint Dysfunctions: A Systematic Review of Treatment Approaches
by Blanca González-Sánchez, Pablo García Monterey, María del Valle Ramírez-Durán, Elisa Mª Garrido-Ardila, Juan Rodríguez-Mansilla and María Jiménez-Palomares
J. Clin. Med. 2023, 12(12), 4156; https://doi.org/10.3390/jcm12124156 - 20 Jun 2023
Cited by 4 | Viewed by 3874
Abstract
Temporomandibular disorders (TMDs) encompass a diverse array of conditions affecting both the structure and function of the jaw. The aetiology of TMDs is multifactorial and may arise from muscular and joint disorders, degenerative processes, or a combination of various symptoms. The objective of [...] Read more.
Temporomandibular disorders (TMDs) encompass a diverse array of conditions affecting both the structure and function of the jaw. The aetiology of TMDs is multifactorial and may arise from muscular and joint disorders, degenerative processes, or a combination of various symptoms. The objective of this review was to analyse the physiotherapy treatment techniques used for the management of temporomandibular disorders. This review also aimed to compare the effectiveness of the differenttreatment methods used and identify the dysfunctions for which physiotherapy interventions are applied as the main treatment. A systematic literature review was conducted using the PubMed, ScienceDirect, Dialnet, and PEDro databases. After applying the inclusion criteria, 15 out of 656 articles were included. The application of different physiotherapy techniques, both alone and in combination, is effective in controlling the primary symptoms of TMD in patients. These symptoms include pain, functionality, and quality of life. The use of physiotherapy as a conservative intervention method for TMDs is supported by sufficient scientific evidence. The combination of different therapies within physiotherapy achieves the best results in treatment. Therapeutic exercise protocols, in combination with manual therapy techniques, are the most commonly utilized method for addressing TMDs and thus provide the best results according to the analysed studies. Full article
(This article belongs to the Special Issue "Temporomandibular Disorders": Functional and Conservative Treatment)
►▼ Show Figures

Figure 1

13 pages, 2763 KiB  
Article
Impact on Spine Surgery during the First Two Years of COVID-19 Pandemic: A Nationwide Study in South Korea
by Chang-Min Ha, Yunjin Nam, Sungjoon Lee, Se-Jun Park, Sun-Ho Lee and Eun-Sang Kim
J. Clin. Med. 2023, 12(12), 4155; https://doi.org/10.3390/jcm12124155 - 20 Jun 2023
Viewed by 845
Abstract
Since December 2019, the novel coronavirus (COVID-19) has infected people worldwide. Owing to its rapid spread, elective surgeries, including spine surgery, have been re-scheduled. We analyzed nationwide data to investigate changes in the volume of spine surgery during the first two years of [...] Read more.
Since December 2019, the novel coronavirus (COVID-19) has infected people worldwide. Owing to its rapid spread, elective surgeries, including spine surgery, have been re-scheduled. We analyzed nationwide data to investigate changes in the volume of spine surgery during the first two years of the pandemic. Nationwide data from January 2016 to December 2021 were obtained. We compared the total number of patients who underwent spine surgery and related medical expenses before and during the COVID-19 pandemic. In February and September, the number of patients was significantly smaller compared to January and August, respectively. Despite the pandemic, the proportion of patients undergoing spine surgery for degenerative diseases in 2021 was the highest. In contrast, the proportions of patients undergoing spine surgery for tumors showed a continuous decrease from 2019 to 2021. Although the number of spine surgeries performed at tertiary hospitals was lowest in 2020, it was not significantly smaller than that in 2019.The number of patients who underwent spine surgery in March 2020, during the first outbreak, decreased compared to the previous month, which differed from the trend observed in the pre-COVID-19 period. However, as the pandemic continues, the impact of COVID-19 on spine surgery has become less evident. Full article
(This article belongs to the Section Orthopedics)
►▼ Show Figures

Figure 1

14 pages, 744 KiB  
Article
Mental Health of Children and Adolescents before and during the COVID-19 Pandemic: How Did the Lockdown Modify Psychiatric Emergencies in Tuscany, Italy?
by Simone Tavano, Saverio Caini, Idanna Sforzi, Caterina Silvestri, Fabio Voller and Tiziana Pisano
J. Clin. Med. 2023, 12(12), 4154; https://doi.org/10.3390/jcm12124154 - 20 Jun 2023
Cited by 2 | Viewed by 1266
Abstract
The COVID-19 pandemic has deeply impacted several aspects of the lives of children and adolescents. We analyzed the trends of psychiatric disorders in the emergency room. The analysis comprised the pre-pandemic (2018–2019) and the pandemic years (2020–2021). We conducted a retrospective observational epidemiological [...] Read more.
The COVID-19 pandemic has deeply impacted several aspects of the lives of children and adolescents. We analyzed the trends of psychiatric disorders in the emergency room. The analysis comprised the pre-pandemic (2018–2019) and the pandemic years (2020–2021). We conducted a retrospective observational epidemiological study that compared admissions during the two periods on a sample of 1311 patients aged between 4 and 18, focusing on new admissions vs. relapse, demographic variables, lockdown severity, presentation of psychiatric symptoms, diagnosis, severity, and outcome. Over the two-year pandemic period, we observed a 33% decrease in admissions to the emergency room for non-psychiatric disorders and a 200% increase in admissions for psychiatric emergencies. This increase is concentrated in periods with fewer restrictions and in the second year of the pandemic. We also observed a greater impact of psychiatric disorders on female patients, a greater severity of psychiatric disorders, a change in diagnoses associated with the presentation of symptoms, and an increase in hospitalizations. The children’s psychiatric emergency service faced an “emergency within the emergency”. In the future, it will be necessary to continue the follow-up of these patients, strengthen the field of study of gender psychiatry, and intensify our efforts towards prevention. Full article
(This article belongs to the Special Issue Psychotherapy and Clinical Psychology during COVID-19)
►▼ Show Figures

Graphical abstract

11 pages, 2074 KiB  
Article
Simultaneously Assessed Three-Dimensional Speckle-Tracking Echocardiography-Derived Left Ventricular and Left Atrial Volumes Are Associated in Healthy Adults—Findings from the MAGYAR-Healthy Study
by Attila Nemes, Árpád Kormányos, Zoltán Ruzsa, Alexandru Achim, Nóra Ambrus and Csaba Lengyel
J. Clin. Med. 2023, 12(12), 4153; https://doi.org/10.3390/jcm12124153 - 20 Jun 2023
Viewed by 656
Abstract
Introduction: The left atrium (LA) has a significant role in regulating blood flow from veins to the left ventricle (LV). LV performance is affected by several factors including preload, which is partly, but highly, dependent on LA volumes. The aim of the present [...] Read more.
Introduction: The left atrium (LA) has a significant role in regulating blood flow from veins to the left ventricle (LV). LV performance is affected by several factors including preload, which is partly, but highly, dependent on LA volumes. The aim of the present study is to perform simultaneous assessment of LA and LV volume changes during the cardiac cycle in healthy circumstances. Therefore, LA and LV volumes and volume-based functional properties were determined in healthy adults, and the associations of these parameters were examined. Methods: The present study consists of 164 healthy adults (age: 33.0 ± 12.3 years, 82 males) being in sinus rhythm. All subjects have undergone complete two-dimensional Doppler echocardiography with three-dimensional speckle-tracking echocardiography (3DSTE). Results: Increased end-systolic maximum LA volume was associated with higher LV volumes and reduced LV ejection fraction. Very high early pre-atrial contraction and late diastolic LA volumes were associated with increased LV volumes, reduced LV ejection fraction and increased LV mass. Increased LA volumes were associated with increased LV mass. Higher LV volumes were associated with tendentiously higher LA volumes. Higher LV end-diastolic volume was associated with tendentiously higher all LA stroke volumes (SVs) and total and active LA emptying fractions (EFs). Higher LV end-systolic volume was associated with tendentiously higher all LA SVs but preserved all LA EFs. Conclusions: 3DSTE is capable of simultaneous assessment of LA and LV volumes and volume-based functional properties for (patho)physiologic studies. Moreover, 3DSTE-derived LV and LA volumes and functional properties show strong associations. Full article
(This article belongs to the Section Cardiovascular Medicine)
►▼ Show Figures

Figure 1

17 pages, 841 KiB  
Article
Intraoperative Visualization and Treatment of Salivary Gland Dysfunction in Sjögren’s Syndrome Patients Using Contrast-Enhanced Ultrasound Sialendoscopy (CEUSS)
by K. Hakki Karagozoglu, Anissa Mahraoui, Joseph C. J. Bot, Seunghee Cha, Jean-Pierre T. F. Ho, Marco N. Helder, Henk S. Brand, Imke H. Bartelink, Arjan Vissink, Gary A. Weisman and Derk Hendrik Jan Jager
J. Clin. Med. 2023, 12(12), 4152; https://doi.org/10.3390/jcm12124152 - 20 Jun 2023
Cited by 1 | Viewed by 881
Abstract
In sialendoscopy, ducts are dilated and the salivary glands are irrigated with saline. Contrast-enhanced ultrasound sialendoscopy (CEUSS), using microbubbles, may facilitate the monitoring of irrigation solution penetration in the ductal system and parenchyma. It is imperative to test CEUSS for its safety and [...] Read more.
In sialendoscopy, ducts are dilated and the salivary glands are irrigated with saline. Contrast-enhanced ultrasound sialendoscopy (CEUSS), using microbubbles, may facilitate the monitoring of irrigation solution penetration in the ductal system and parenchyma. It is imperative to test CEUSS for its safety and feasibility in Sjögren’s syndrome (SS) patients. CEUSS was performed on 10 SS patients. The primary outcomes were safety, determined by the occurrence of (serious) adverse events ((S)AEs), and feasibility. The secondary outcomes were unstimulated and stimulated whole saliva (UWS and SWS) flow rates, xerostomia inventory (XI), clinical oral dryness score, pain, EULAR Sjögren’s syndrome patient reported index (ESSPRI), and gland topographical alterations. CEUSS was technically feasible in all patients. Neither SAEs nor systemic reactions related to the procedure were observed. The main AEs were postoperative pain (two patients) and swelling (two patients). Eight weeks after CEUSS, the median UWS and SWS flow had increased significantly from 0.10 to 0.22 mL/min (p = 0.028) and 0.41 to 0.61 mL/min (p = 0.047), respectively. Sixteen weeks after CEUSS, the mean XI was reduced from 45.2 to 34.2 (p = 0.02). We conclude that CEUSS is a safe and feasible treatment for SS patients. It has the potential to increase salivary secretion and reduce xerostomia, but this needs further investigation. Full article
(This article belongs to the Special Issue New Perspectives in Diseases of the Salivary Glands: Diagnostic Approach and Treatment Strategies)
►▼ Show Figures

Figure 1

17 pages, 703 KiB  
Review
Megaprosthesis in Non-Oncologic Settings—A Systematic Review of the Literature
by Andrea Sambri, Stefania Claudia Parisi, Renato Zunarelli, Lorenzo Di Prinzio, Lorenzo Morante, Gianluca Lonardo, Marta Bortoli, Andrea Montanari, Roberto De Cristofaro, Michele Fiore and Massimiliano De Paolis
J. Clin. Med. 2023, 12(12), 4151; https://doi.org/10.3390/jcm12124151 - 20 Jun 2023
Cited by 3 | Viewed by 1250
Abstract
Modular megaprostheses (MPs) are commonly used after bone-tumor resection, but they can offer a limb salvage solution in massive bone defects. The aim of this systematic review of the Literature is to provide a comprehensive data collection concerning the use of MPs in [...] Read more.
Modular megaprostheses (MPs) are commonly used after bone-tumor resection, but they can offer a limb salvage solution in massive bone defects. The aim of this systematic review of the Literature is to provide a comprehensive data collection concerning the use of MPs in non-oncologic cases, and to provide an overview of this topic, especially from an epidemiologic point of view. Three different databases (PubMed, Scopus, and Web of Science) were searched for relevant articles, and further references were obtained by cross-referencing. Sixty-nine studies met the inclusion criteria, reporting on cases of MP in non-oncologic cases. A total of 2598 MPs were retrieved. Among these, 1353 (52.1%) were distal femur MPs, 941 (36.2%) were proximal femur MPs, 29 (1.4%) were proximal tibia MPs and 259 (10.0%) were total femur MPs. Megaprostheses were most commonly used to treat periprosthetic fractures (1158 cases, 44.6%), in particular in the distal femur (859, 74.2%). Overall, complications were observed in 513 cases (19.7%). Type I (soft tissue failures) and type IV (infection) according to the Henderson classification were the most frequent (158 and 213, respectively). In conclusion, patients with severe post-traumatic deformities and/or significant bone loss who have had previous septic complications should be considered as oncologic patients, not because of the disease, but because of the limited therapeutic options available. The benefits of this treatment include relatively short operative times and immediate weight-bearing, thus making MP particularly attractive in the lower limb. Full article
(This article belongs to the Section Orthopedics)
►▼ Show Figures

Figure 1

13 pages, 750 KiB  
Systematic Review
The Efficacy of Probiotics, Prebiotics, and Synbiotics in Patients Who Have Undergone Abdominal Operation, in Terms of Bowel Function Post-Operatively: A Network Meta-Analysis
by Orestis Ioannidis, Christos Chatzakis, Maria Tirta, Elissavet Anestiadou, Konstantinos Zapsalis, Savvas Symeonidis, Stefanos Bitsianis, Efstathios Kotidis, Manousos George Pramateftakis, Ioannis Mantzoros and Stamatios Angelopoulos
J. Clin. Med. 2023, 12(12), 4150; https://doi.org/10.3390/jcm12124150 - 20 Jun 2023
Cited by 3 | Viewed by 1614
Abstract
Background: Abdominal operations may lead to post-operative bowel dysfunction, while administration of probiotics, prebiotics and synbiotics may limit its manifestation. Τhe study aimed to assess the efficacy of probiotics, prebiotics and synbiotics in patients who undergone abdominal operation, in terms of bowel function [...] Read more.
Background: Abdominal operations may lead to post-operative bowel dysfunction, while administration of probiotics, prebiotics and synbiotics may limit its manifestation. Τhe study aimed to assess the efficacy of probiotics, prebiotics and synbiotics in patients who undergone abdominal operation, in terms of bowel function post-operatively. Methods: PubMed, Scopus, Cochrane Central Register of Controlled Trials (Central), Embase, US Registry of clinical trials, and sources of grey literature were searched. The relative effect sizes were estimated, and we obtained the relative ranking of the interventions using cumulative ranking curves. Results: In total, 30 studies were included in the analysis. For the outcome of post-operative ileus, probiotics was superior to placebo/no intervention (relative risk, RR: 0.38; 95%CI: 0.14–0.98) with the highest SUCRA (surface under the cumulative ranking) value (92.1%). For time to first flatus, probiotics (MD: −0.47; 95%CI: −0.78 to −0.17) and synbiotics (MD: −0.53; 95%CI: −0.96 to −0.09) were superior to placebo/no intervention. For time to first defecation and for post-operative abdominal distension probiotics were superior to placebo/no intervention. For post-operative hospitalization days, synbiotics were superior to placebo/no intervention (MD: −3.07; 95%CI: −4.80 to −1.34). Conclusions: Administration of probiotics in patients who had undergone abdominal surgery reduced the prevalence of post-operative ileus, time to first flatus, time to first defecation, and prevalence of post-operative abdominal distension. Synbiotics reduce time to first flatus and post-operative hospitalization days. Full article
(This article belongs to the Section General Surgery)
►▼ Show Figures

Figure 1

11 pages, 6269 KiB  
Article
Mandibular Flexure and Its Significance: An In Vivo Cone Beam-Computed Tomography Proof-of-Concept Study
by Jimmy Londono, Todd R. Schoenbaum, Alma Veronica Varilla Ortiz, Guillermo Franco-Romero, Vanessa Villalobos, Paolo Carosi, Eitan Mijiritsky and Alessandro Pozzi
J. Clin. Med. 2023, 12(12), 4149; https://doi.org/10.3390/jcm12124149 - 20 Jun 2023
Viewed by 1027
Abstract
The aim of this study was to assess intra-arch mandibular dimensional changes that may occur during mouth opening using cone beam-computed tomography (CBCT). Fifteen patients in need of any type of treatment whose execution considered a pre- and post-CBCT assessment consented and were [...] Read more.
The aim of this study was to assess intra-arch mandibular dimensional changes that may occur during mouth opening using cone beam-computed tomography (CBCT). Fifteen patients in need of any type of treatment whose execution considered a pre- and post-CBCT assessment consented and were enrolled. CBCTs were taken with the following settings: 90 kV, 8 mA, field of view (FOV) 140 by 100 mm (height and diameter), Voxel size 0.25 mm (high resolution). The pre-CBCT was executed in the maximum mandibular opening (MO), while the post-CBCT was in the maximum intercuspation (MI). A thermoplastic stent with radiopaque fiducial markers (steel ball bearings) was fabricated for each patient. Measurements were made using radiographic markers between contralateral canines and contralateral first molars and between ipsilateral canines and first molars on both sides. Paired t-tests were performed to evaluate the difference between open and closed positions on these four measurements. In the MO position were registered a significative tightening of the mandible at the canine (−0.49 mm, SD 0.54 mm; p < 0.001) and molar points (−0.81 mm, SD 0.63 mm; p < 0.001) and a significative shortening of the mandible on the right (−0.84 mm, SD 0.80 mm; p < 0.001) and left sides (−0.87 mm, SD 0.49 mm; p < 0.001). Within the study limitations, mandibular flexure determined a significant shortening and tightening between maximum intercuspation to maximum opening positions. Mandibular dimensional changes should be considered in light of other patient factors in the treatment planning of implant positioning and long-span complete arch implant-supported fixed prostheses in order to avoid technical complications. Full article
(This article belongs to the Special Issue Recent Advances in Dental Implantology: Part II)
►▼ Show Figures

Figure 1

11 pages, 261 KiB  
Article
Autologous Peripheral Blood Mononuclear Cells in Patients with Small Artery Disease and Diabetic Foot Ulcers: Efficacy, Safety, and Economic Evaluation
by Benedetta Ragghianti, Bianca Maria Berardi, Edoardo Mannucci and Matteo Monami
J. Clin. Med. 2023, 12(12), 4148; https://doi.org/10.3390/jcm12124148 - 20 Jun 2023
Cited by 1 | Viewed by 821
Abstract
Background: diabetic foot ulcers (DFU) represent the main cause of major amputations and hospitalisations in diabetic patients. The aim of this study was to assess the safety and cost-efficacy of intramuscular injection of peripheral blood mononuclear cells (PBMNCs) in diabetic patients with no-option [...] Read more.
Background: diabetic foot ulcers (DFU) represent the main cause of major amputations and hospitalisations in diabetic patients. The aim of this study was to assess the safety and cost-efficacy of intramuscular injection of peripheral blood mononuclear cells (PBMNCs) in diabetic patients with no-option chronic limb-threatening ischemia (CLTI) and small artery disease (SAD). Methods: a retrospective study was carried out on a series of type 2 diabetic patients with DFU grade Texas 3 and no-option CLTI and SAD. All patients had undergone at least a previous revascularization and were allocated to a surgery waiting list for major amputation. The principal endpoint evaluated at 90 days was a composite of TcPO2 values at the first toe ≥30 mmHg and/or TcPO2 increase of at least 50% from baseline and/or ulcer healing. Secondary endpoints were individual components of the primary endpoint, any serious and non-serious adverse events, and direct costs at one year. Results: the composite endpoint was achieved in nine patients (60.0%); one patient (6.7%) healed within ninety days and 26.7% and 46.7% showed TcPO2 ≥ 30 mmHg and a TcPO2 increase of at least 50% at ninety days, respectively. At one year, three (20.0%) patients underwent a major amputation (all diagnosed SAD grade III). One patient died after seven months, and seven patients (46.7%) healed. The overall median and mean cost per patient were EUR 8238 ± 7798 and EUR 4426 (3798; 8262), respectively. Conclusions: the use of PBMNCs implants in no-option CLTI diabetic patients with SAD seems to be of help in reducing the risk of major amputation. Full article
(This article belongs to the Section Endocrinology & Metabolism)
13 pages, 623 KiB  
Article
Trabecular Bone Score Significantly Influences Treatment Decisions in Secondary Osteoporosis
by Leith Al-Hashimi, Jens Klotsche, Sarah Ohrndorf, Timo Gaber and Paula Hoff
J. Clin. Med. 2023, 12(12), 4147; https://doi.org/10.3390/jcm12124147 - 20 Jun 2023
Viewed by 1564
Abstract
The trabecular bone score (TBS) can be determined in addition to the Dual Energy X-ray Absorptiometry (DXA) for bone mineral density (BMD) measurement to diagnose, evaluate, and stratify bone loss and decide on appropriate treatment in patients at risk. Especially in patients with [...] Read more.
The trabecular bone score (TBS) can be determined in addition to the Dual Energy X-ray Absorptiometry (DXA) for bone mineral density (BMD) measurement to diagnose, evaluate, and stratify bone loss and decide on appropriate treatment in patients at risk. Especially in patients with secondary osteoporosis, TBS detects restricted bone quality. To investigate the influence of an additional evaluation of TBS on patients’ treatment strategy decisions, we enrolled 292 patients, with a high proportion of patients with secondary osteoporosis, from one outpatient unit over one year. Patients eligible for BMD measurement had the option to opt-in for TBS measurement. We analyzed demographic data, leading diagnoses, bone metabolism parameters, and results of BMD and TBS measurements. More than 90% of patients consented to TBS measurement. TBS measurement influenced the decision in approximately 40% of patients with a treatment indication for anti-osteoporotic drugs. We demonstrate that depending on the underlying disease/risk spectrum, 21–25.5% of patients had an unremarkable BMD measurement with poor bone quality shown in the TBS measurement. In patients with secondary osteoporosis, the use of TBS supplementary to DXA seems useful to better assess fracture risk and, thus, to initiate therapy for osteoporosis in these patients in time. Full article
(This article belongs to the Special Issue Update in Osteoporosis and Related Bone Metabolic Disease)
►▼ Show Figures

Graphical abstract

17 pages, 2320 KiB  
Article
CABG Patients Develop Global DNA Hypermethylation, That Negatively Affect the Mitochondrial Function and Promote Post-Surgical Cognitive Decline: A Proof of Concept in Small Cohort
by Sri Rahavi Boovarahan, Suresh Babu Kale, Priyanka N. Prem, Sriram Ravindran, Akshayakeerthi Arthanarisami, Jeyashri Rengaraju, Nemat Ali, Senthilkumar Ramalingam, Mohamed Mohany, Abdullah F. AlAsmari, Salim S. Al-Rejaie, Mohammad Waseem and Gino A. Kurian
J. Clin. Med. 2023, 12(12), 4146; https://doi.org/10.3390/jcm12124146 - 20 Jun 2023
Viewed by 1097
Abstract
Global DNA hypermethylation and mitochondrial dysfunction are reported to be associated with the development of mild cognitive decline (MCI). The present study aims to generate preliminary data that connect the above association with post-surgical coronary artery bypass grafting (CABG) cognitive decline in patients. [...] Read more.
Global DNA hypermethylation and mitochondrial dysfunction are reported to be associated with the development of mild cognitive decline (MCI). The present study aims to generate preliminary data that connect the above association with post-surgical coronary artery bypass grafting (CABG) cognitive decline in patients. Data were collected from 70 CABG patients and 25 age-matched controls. Cognitive function was assessed using the Montreal Cognitive Assessment (MOCA) test on day 1 (before surgery) and on the day of discharge. Similarly, blood was collected before and one day after the CABG procedure for mitochondrial functional analysis and expression of DNA methylation genes. Test analysis score suggested 31 (44%) patients had MCI before discharge. These patients showed a significant decrease in complex I activity and an increase in malondialdehyde levels (p < 0.001) from the control blood samples. Post-surgical samples showed a significant reduction in blood MT-ND1 mRNA expression from control and from pre-surgical samples (p < 0.005), along with elevated DNMT1 gene expression (p < 0.047), with an insignificant increase in TET1 and TET3 gene expression. Correlation analysis showed a significant positive relation between cognitive decline and elevated blood DNMT1 and declined blood complex I activity, signifying that cognitive decline experienced by post-surgical CABG patients is associated with increased DNMT1 expression and declined complex I activity. Based on the data, we conclude that both DNA hypermethylation and mitochondrial dysfunction are associated with post-CABG MCI, where the former is negatively correlated, and the latter is positively correlated with post-surgical MCI in CABG cases. Additionally, a multimarker approach that comprises MOCA, DNA methylation, DNMT, and NQR activities can be utilized to stratify the population that is sensitive to developing post-CABG MCI. Full article
(This article belongs to the Section General Surgery)
►▼ Show Figures

Figure 1

11 pages, 2202 KiB  
Article
Exploring the Validity of an Optoelectronic Integrated Cone Beam Computed Tomography Jaw Tracking System
by Hayo C. van der Helm, Arjan J. A. Dieters, Pieter U. Dijkstra, Wicher J. van der Meer and Anne Marie Kuijpers-Jagtman
J. Clin. Med. 2023, 12(12), 4145; https://doi.org/10.3390/jcm12124145 - 20 Jun 2023
Cited by 1 | Viewed by 953
Abstract
Jaw motion tracking functionalities of cone beam computed tomography (CBCT)-scanners can visualize, record, and analyze movements of the mandible. In this explorative study, the validity of the 4D-Jaw Motion module (4D-JM) of the ProMax 3D Mid CBCT scanner (Planmeca, Helsinki, Finland) was tested [...] Read more.
Jaw motion tracking functionalities of cone beam computed tomography (CBCT)-scanners can visualize, record, and analyze movements of the mandible. In this explorative study, the validity of the 4D-Jaw Motion module (4D-JM) of the ProMax 3D Mid CBCT scanner (Planmeca, Helsinki, Finland) was tested in vitro. The validity of the 4D-JM was accepted if values differed less than 0.6 mm (three voxels sizes) from the gold standard. Three dry human skulls were used. CBCT scans, the gold standard, were taken in eight jaw positions and exported as three-dimensional (3D) models. Individualized 3D-printed dental wafers ensured the correct positioning of the mandible. Jaw positions were recorded with the 4D-JM tracking device and exported as 3D models. The coordinates of six reference points for both superimposed 3D models were obtained. The differences in the x, y and z-axis and the corresponding vector differences between gold standard 3D models and 4D-JM models were calculated. For the mandible 10% and for the maxilla 90% of the vector differences fell within 0.6 mm of the gold standard. With an increasing vertical jaw opening, larger differences between the gold standard and the 4D-JM 3D models were found. The smallest differences of the mandible were observed on the x axis. In this study, the 4D-JM validity was not acceptable by the authors’ predefined standards. Full article
(This article belongs to the Special Issue New Diagnostic, Pharmacological and Therapeutic Trends in Dentistry)
►▼ Show Figures

Figure 1

12 pages, 673 KiB  
Review
A Narrative Review of the Association of Obstructive Sleep Apnea with Hypertension: How to Treat Both When They Coexist?
by Servet Altay, Selma Fırat, Yüksel Peker and The TURCOSACT Collaborators
J. Clin. Med. 2023, 12(12), 4144; https://doi.org/10.3390/jcm12124144 - 20 Jun 2023
Cited by 2 | Viewed by 1417
Abstract
Hypertension (HT) is a worldwide public health issue and an essential risk factor for cardiovascular and cerebrovascular diseases. Obstructive sleep apnea (OSA) is a condition characterized by recurrent episodes of apnea and hypopnea as a consequence of partial or complete obstruction of the [...] Read more.
Hypertension (HT) is a worldwide public health issue and an essential risk factor for cardiovascular and cerebrovascular diseases. Obstructive sleep apnea (OSA) is a condition characterized by recurrent episodes of apnea and hypopnea as a consequence of partial or complete obstruction of the upper airways due to anatomic and/or functional disturbances. There is mounting evidence of a relationship between OSA and HT. In patients with OSA, HT is predominantly nocturnal and characterized by high diastolic blood pressure and usually by a nondipping pattern. Optimizing the blood pressure control is recommended in the current guidelines as the first treatment option in hypertensive patients with OSA. Continuous positive airway pressure (CPAP) therapy may reduce blood pressure, albeit only slightly as a stand-alone treatment. CPAP, as an add-on treatment to antihypertensive medication, appears to be an efficient treatment modality when both conditions coexist. This narrative review aims to summarize the current perspectives on the association of OSA with HT and the treatment options available for adults with OSA-related HT. Full article
(This article belongs to the Special Issue Current Perspectives on the Treatment of Obstructive Sleep Apnea—Part II)
►▼ Show Figures

Figure 1

12 pages, 2423 KiB  
Article
Long-Term Results with 187 Frozen Elephant Trunk Procedures
by Zsuzsanna Arnold, Daniela Geisler, Thomas Aschacher, Bernhard Winkler, Verena Lenz, Ingo Crailsheim, Sandra Folkmann, Marieluise Harrer, Reinhard Moidl, Martin Grabenwöger and Gabriel Weiss
J. Clin. Med. 2023, 12(12), 4143; https://doi.org/10.3390/jcm12124143 - 20 Jun 2023
Cited by 1 | Viewed by 1032
Abstract
The frozen elephant trunk (FET) technique is an established therapeutic option in the treatment of complex aortic diseases. We report our long-term clinical outcomes after FET repair. A total of 187 consecutive patients underwent FET repair at our department between 8/2005 and 3/2023. [...] Read more.
The frozen elephant trunk (FET) technique is an established therapeutic option in the treatment of complex aortic diseases. We report our long-term clinical outcomes after FET repair. A total of 187 consecutive patients underwent FET repair at our department between 8/2005 and 3/2023. Indications included acute and chronic aortic dissections and thoracic aneurysms. Endpoints included operative morbidity and mortality, long-term survival, and the need for reinterventions. Operative mortality, spinal cord injury and permanent stroke rates were: 9.6%, 2.7% and 10.2%, respectively. At five years, overall survival was 69.9 ± 3.9% and freedom from aortic-related death was 82.5 ± 3.0%, whereas at ten years, overall survival was 53.0 ± 5.5% and freedom from aortic-related death was 75.8 ± 4.8%. Sixty-one reinterventions on the thoracic aorta were necessary. Freedom from secondary interventions at ten years was 44.7 ± 6.4% overall (63.1 ± 10.0% for acute dissections, 40.8 ± 10.3% for chronic dissections and 28.9 ± 13.1% for aneurysms, respectively). The high reintervention rate for chronic dissections and for aneurysms is related to the pre-existing aortic pathology. Late aortic growth of untreated segments with potentially fatal outcome occurs even after ten years, so careful annual follow-up is mandatory in this patient cohort. Full article
(This article belongs to the Special Issue Clinical Advances in Aortic Surgery)
►▼ Show Figures

Graphical abstract

12 pages, 877 KiB  
Article
Successful Preventive Treatment of Oncogenic Transforming HPV Infections in Low-Grade Cytology (ASC-US/LSIL) Patients with an Adsorptive and Antioxidant Vaginal Gel
by Attila Louis Major, Ivanna Mayboroda and Alexandra Riger
J. Clin. Med. 2023, 12(12), 4142; https://doi.org/10.3390/jcm12124142 - 20 Jun 2023
Viewed by 1693
Abstract
Objective: This study aimed to investigate the preventive effect of a vaginal gel on p16/Ki-67-positive abnormal cytological cervical findings (ASC-US, LSIL) and hr-HPV in women. Methods: The study included 134 women with p16/Ki-67-positive ASC-US or LSIL. Participants were selected from a randomized controlled [...] Read more.
Objective: This study aimed to investigate the preventive effect of a vaginal gel on p16/Ki-67-positive abnormal cytological cervical findings (ASC-US, LSIL) and hr-HPV in women. Methods: The study included 134 women with p16/Ki-67-positive ASC-US or LSIL. Participants were selected from a randomized controlled trial that focused on women with histological diagnoses of p16-positive CIN1 lesions or CIN2. In the treatment group (TG), 57 patients applied the vaginal gel daily for three months, while 77 patients in the “watchful wait” control group (CG) received no treatment. The study’s endpoints were cytological development, p16/Ki-67 and hr-HPV clearances. Results: At three months, cytopathological results improved in 74% (42/57) of patients in the TG, compared with 18% (14/77) in the CG. Progression occurred in 7% (4/57) of TG patients compared with 18% (14/77) of CG patients. The p16/Ki-67 status changed statistically significantly in favor of the TG (p < 0.001), with 83% (47/57) becoming negative, compared with 18% (14/77) in the CG. The prevalence of hr-HPV decreased significantly in the TG by 51%, and by 9% in the CG (p < 0.001). Conclusions: Topical application of the gel resulted in statistically significant clearance of hr-HPV and p16/Ki-67 concomitant with amelioration of cytological findings, thus providing effective prevention and protection against oncogenic development. Trial registration: ISRCTN11009040, on 10 December 2019. Full article
(This article belongs to the Section Obstetrics & Gynecology)
►▼ Show Figures

Figure 1

Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:
 
Displaying articles 1-306
Previous Issue
Next Issue
Back to TopTop