Journal of Clinical Medicine

12 pages, 740 KiB

Open AccessArticle

Daytime Variation of Chloral Hydrate-Associated Sedation Outcomes: A Propensity-Matched Cohort Study

by Yu Cui, Langtao Guo, Li Xu, Qixia Mu, Qunying Wu, Lu Kang, Qin Chen, Yani He and Hong Liu

J. Clin. Med. 2023, 12(3), 1245; https://doi.org/10.3390/jcm12031245 - 03 Feb 2023

Viewed by 1547

Abstract

Background: Physiological processes influencing a drugs’ efficacy change substantially over the course of the day. However, it is unclear whether there is an association between the sedative success rate of chloral hydrate and the time of day. We conducted a retrospective study of [...] Read more.

Background: Physiological processes influencing a drugs’ efficacy change substantially over the course of the day. However, it is unclear whether there is an association between the sedative success rate of chloral hydrate and the time of day. We conducted a retrospective study of 41,831 cases, to determine if there was a difference in sedation success rate with chloral hydrate in children seen in the morning and afternoon. Methods: Patients who accepted the sedation service were included. Eligible patients were divided into two cohorts of morning and afternoon cases, according to the time of day when the initial dose of chloral hydrate was administered. To ensure that the two groups were comparable, a propensity score matching method was utilized. Results: The success rate with the initial dose of chloral hydrate was higher in patients who received sedation services in the afternoon. In the subgroup analysis, the afternoon cases had a higher sedation success rate compared to the morning cases in male patients; whereas, in female patients, no difference was detected between the morning versus afternoon cases. Conclusions: These results show that the afternoon cases had a higher sedation success rate than the morning cases, despite the afternoon cases receiving relatively lower initial dose than the morning cases. However, the clinical significance remains to be discussed, and further prospective studies are needed to validate the findings. Full article

(This article belongs to the Section Pharmacology)

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15 pages, 1303 KiB

Open AccessReview

The Relationship between Social Support and Anxiety Symptoms in Informal Carers: A Systematic Review and Meta-Analysis

by Emilia Priego-Cubero, Vasiliki Orgeta, Catalina López-Martínez and Rafael del-Pino-Casado

J. Clin. Med. 2023, 12(3), 1244; https://doi.org/10.3390/jcm12031244 - 03 Feb 2023

Cited by 5 | Viewed by 1647

Abstract

Background: Providing care can be challenging for informal carers and increases the risk of mental health problems, such as experiencing clinical symptoms of anxiety. While strengthening social support for informal carers is a common recommendation to reduce this risk, no systematic review or [...] Read more.

Background: Providing care can be challenging for informal carers and increases the risk of mental health problems, such as experiencing clinical symptoms of anxiety. While strengthening social support for informal carers is a common recommendation to reduce this risk, no systematic review or meta-analysis to date has examined the relationship between social support and anxiety symptoms in informal carers. The aim of our study was to systematically review the current evidence on the association between perceived and received social support and anxiety symptoms in informal carers of dependent adults and older people, and to comment on the quality of the evidence. Methods: We searched PubMed, CINAHL (EBSCO), PsycINFO (ProQuest), Scopus, and LILACS up to 31 March 2021 for articles reporting on the association between caregiver anxiety symptoms and social support. A random-effects model was used to pool estimates, and each study was rated for quality using pre-specified criteria. Publication bias was assessed using a funnel plot and Egger’s regression test, which was adjusted using trim and fill analysis. Results: From the 2180 identified articles, 35 studies met our inclusion criteria, reporting on 5036 informal carers in total. We found a moderate negative association between perceived social support and caregiver anxiety symptoms (r = −0.31, 95% CI = −0.35, −0.27) and a small, negative association between received social support and caregiver anxiety (r = −0.15, 95% CI = −0.22, −0.08). Conclusion: The levels of perceived social support showed a significant negative association with caregiver anxiety symptoms. Policymakers and those working directly with informal carers should consider the development of targeted social support interventions that specifically enhance the levels of perceived social support to reduce symptoms of anxiety in informal carers. Full article

(This article belongs to the Section Mental Health)

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21 pages, 853 KiB

Open AccessReview

Post-Inflammatory Hypopigmentation: Review of the Etiology, Clinical Manifestations, and Treatment Options

by Medha Rao, Katherine Young, Ladonya Jackson-Cowan, Arianne Kourosh and Nicholas Theodosakis

J. Clin. Med. 2023, 12(3), 1243; https://doi.org/10.3390/jcm12031243 - 03 Feb 2023

Cited by 3 | Viewed by 6645

Abstract

Post-inflammatory hypopigmentation is a common acquired pigmentary disorder that is more prominent in skin of color, leading to great cosmetic and psychosocial implications. Often, a diagnosis with a pigmentary disorder can negatively impact an individual’s health-related quality of life and may result in [...] Read more.

Post-inflammatory hypopigmentation is a common acquired pigmentary disorder that is more prominent in skin of color, leading to great cosmetic and psychosocial implications. Often, a diagnosis with a pigmentary disorder can negatively impact an individual’s health-related quality of life and may result in stigma. Although most cases of post-inflammatory hypopigmentation resolve spontaneously over time, a systematic diagnostic approach can help with identifying the underlying etiology and informing treatment strategies. It can be due to cutaneous inflammation, sequelae of inflammatory or infectious dermatoses, or dermatologic procedures. Therefore, a thorough understanding of the epidemiology, patient history, physical exam findings, and clinical features of post-inflammatory hypopigmentation phenomenon can explain the primary cause to providers and allow for patient education. It is also important to understand the various therapeutic approaches available and the efficacy of these options, which will inform providers to choose the appropriate therapy for patients. Although algorithms exist for classifying acquired disorders of hypopigmentation, there are no established algorithms for the diagnosis and treatment of post-inflammatory hypopigmentation, which warrants further exploration and discourse. Full article

(This article belongs to the Special Issue Skin Pigmentation Disorders: Clinical Management and Treatment)

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11 pages, 1513 KiB

Open AccessArticle

Relationships between 25-Hydroxyvitamin D Levels and Obstructive Sleep Apnea Severity in Children: An Observational Study

by Cristian Locci, Antonella Ruiu, Laura Saderi, Giovanni Sotgiu, Stefania Bassu, Marco Zaffanello and Roberto Antonucci

J. Clin. Med. 2023, 12(3), 1242; https://doi.org/10.3390/jcm12031242 - 03 Feb 2023

Cited by 1 | Viewed by 1541

Abstract

The prevalence of hypovitaminosis D is increasing worldwide. Vitamin D deficiency is supposed to play a role in sleep disturbances, but the complex relationships between hypovitaminosis D and pediatric obstructive sleep apnea syndrome (OSAS) are still incompletely understood. This study was aimed to [...] Read more.

The prevalence of hypovitaminosis D is increasing worldwide. Vitamin D deficiency is supposed to play a role in sleep disturbances, but the complex relationships between hypovitaminosis D and pediatric obstructive sleep apnea syndrome (OSAS) are still incompletely understood. This study was aimed to retrospectively investigate the vitamin D status and significant clinical, laboratory, and instrumental variables in a cohort of pediatric patients with OSAS and to assess the possible relationship between serum vitamin D levels and OSAS severity. We consecutively enrolled all children aged 2–14 years admitted to our Pediatric Clinic from 1 July 2018 to 30 November 2020 for sleep-disordered breathing. Each patient underwent standard overnight in-hospital polygraphic evaluation, measurement of serum 25-hydroxyvitamin D (25(OH)D) levels, and clinical and laboratory investigation. A total of 127 children with OSAS were included. The 25(OH)D levels and BMI of OSAS patients were compared with those of an age-matched control group: the serum 25(OH)D levels were significantly lower in OSAS patients than in controls (22.4 vs. 25.5 ng/mL; p-value = 0.009), whereas no differences in the BMI percentile were found between the two groups. The mean value of 25(OH)D was not significantly lower (20.9 ng/mL) in the severe OSAS group compared with the mild (23.0 ng/mL) and moderate (23.3 ng/mL) OSAS groups (p-value = 0.28). Our findings indicate a relationship between vitamin D status and OSAS in children and suggest that severe cases of OSAS have lower vitamin D levels. Future, more extensive prospective studies are needed to confirm such preliminary findings. Full article

(This article belongs to the Special Issue Pediatric Sleep-Disordered Breathing and Long-Term Complications: Clinical and Health Implications)

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6 pages, 230 KiB

Open AccessArticle

Does Post-COVID-19 Erectile Dysfunction Improve over Time?

by Alper Gök, Mehmet Altan, Ahmet Emin Doğan, Aşır Eraslan, Fahrettin Şamil Uysal, Ufuk Öztürk, Ardan Muammer Saguner and Muhammet Abdurrahim İmamoğlu

J. Clin. Med. 2023, 12(3), 1241; https://doi.org/10.3390/jcm12031241 - 03 Feb 2023

Cited by 2 | Viewed by 3255

Abstract

Background: Some studies have shown that there may be an increase in the frequency of erectile dysfunction after COVID-19. However, no long-term study has investigated whether this is permanent or temporary. In this study, we aimed to examine whether there was an increase [...] Read more.

Background: Some studies have shown that there may be an increase in the frequency of erectile dysfunction after COVID-19. However, no long-term study has investigated whether this is permanent or temporary. In this study, we aimed to examine whether there was an increase in the frequency of erectile dysfunction among individuals with a history of COVID-19, and, if there was, whether their condition improved over time. Materials and methods: In this study, a total of 125 healthy male healthcare workers, 95 with and 30 without a history of COVID-19, were evaluated in terms of erectile function. Four study groups were formed. The first three groups consisted of individuals with a history of COVID-19 confirmed by the polymerase chain reaction (PCR) test at different times, who recovered from the disease (time elapsed since COVID-19 positivity: <6 months for Group 1, 6 to 12 months for Group 2, and >12 months for Group 3). The individuals in Group 4 did not have a history of COVID-19 diagnosis. In order to evaluate the erectile function of the participants, they were asked to complete the five-item International Index of Erectile Function questionnaire (IIEF-5). Then, statistical analyses were performed to evaluate whether there was a difference between the groups in terms of the IIEF-5 scores. Results: There was a statistically significant difference between the groups in terms of the IIEF-5 scores (p < 0.001), and this difference was determined to be caused by the significantly higher IIEF-5 scores of Groups 3 and 4 compared to Group 1 (p = 0.004 and p < 0.001, respectively). In addition, the IIEF-5 score of Group 4 was statistically significantly higher than that of Group 2 (p < 0.001). However, the IIEF-5 scores did not statistically significantly differ between Groups 1 and 2, Groups 2 and 3, and Groups 3 and 4 (p > 0.999, p = 0.204, and p = 0.592, respectively). Conclusion: There may be deterioration in erectile function after COVID-19; however, this tends to improve over time, especially from the first year after active infection. Given that vascular, hormonal, and/or psychogenic factors may lead to the development of erectile dysfunction after COVID-19, we consider that in order to easily manage this process, it is important to determine the underlying cause, initiate appropriate treatment, and inform couples that this situation can be temporary. Full article

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

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11 pages, 1152 KiB

Open AccessArticle

Mild Acquired von Willebrand Syndrome and Cholestasis in Pediatric and Adult Patients with Fontan Circulation

by Katharina Meinel, Felicitas Korak, Martin Dusleag, Tanja Strini, Daniela Baumgartner, Ante Burmas, Hannes Sallmon, Barbara Zieger, Axel Schlagenhauf and Martin Koestenberger

J. Clin. Med. 2023, 12(3), 1240; https://doi.org/10.3390/jcm12031240 - 03 Feb 2023

Viewed by 1184

Abstract

Background: Hemodynamic alterations in Fontan patients (FP) are associated with hemostatic dysbalance and Fontan-associated liver disease. Studies of other hepatopathologies indicate an interplay between cholestasis, tissue factor (TF), and von Willebrand factor (VWF). Hence, we hypothesized a relationship between the accumulation of bile [...] Read more.

Background: Hemodynamic alterations in Fontan patients (FP) are associated with hemostatic dysbalance and Fontan-associated liver disease. Studies of other hepatopathologies indicate an interplay between cholestasis, tissue factor (TF), and von Willebrand factor (VWF). Hence, we hypothesized a relationship between the accumulation of bile acids (BA) and these hemostatic factors in FP. Methods: We included 34 FP (Phenprocoumon n = 15, acetylsalicylic acid (ASA) n = 16). BA were assessed by mass spectrometry. TF activity and VWF antigen (VWF:Ag) were determined by chromogenic assays. VWF collagen-binding activity (VWF:CB) was assessed via ELISA. Results: Cholestasis was observed in 6/34 FP (total BA ≥ 10 µM). BA levels and TF activity did not correlate (p = 0.724). Cholestatic FP had lower platelet counts (p = 0.013) from which 5/6 FP were not treated with ASA. VWF:Ag levels were increased in 9/34 FP and significantly lower in FP receiving ASA (p = 0.044). Acquired von Willebrand syndrome (AVWS) was observed in 10/34-FP, with a higher incidence in cholestatic FP (4/6) (p = 0.048). Conclusions: Cholestasis is unexpectedly infrequent in FP and seems to be less frequent under ASA therapy. Therefore, ASA may reduce the risk of advanced liver fibrosis. FP should be screened for AVWS to avoid bleeding events, especially in cholestatic states. Full article

(This article belongs to the Special Issue Clinical Research Advances in Congenital Heart Disease)

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17 pages, 839 KiB

Open AccessArticle

Planned Extracorporeal Life Support Employment during Liver Transplantation: The Potential of ECMO and CRRT as Preventive Therapies—Case Reports and Literature Review

by Cristiana Laici, Amedeo Bianchini, Noemi Miglionico, Niccolò Bambagiotti, Giovanni Vitale, Guido Fallani, Matteo Ravaioli and Antonio Siniscalchi

J. Clin. Med. 2023, 12(3), 1239; https://doi.org/10.3390/jcm12031239 - 03 Feb 2023

Cited by 2 | Viewed by 2306

Abstract

Liver Transplantation (LT) has become the gold standard treatment for End-Stage Liver Disease (ESLD). One of the main strategies to manage life-threatening complications, such as cardio-respiratory failure, is Extracorporeal Membrane Oxygenation (ECMO) in the peri-transplantation period, with different configurations of the technique and [...] Read more.

Liver Transplantation (LT) has become the gold standard treatment for End-Stage Liver Disease (ESLD). One of the main strategies to manage life-threatening complications, such as cardio-respiratory failure, is Extracorporeal Membrane Oxygenation (ECMO) in the peri-transplantation period, with different configurations of the technique and in combination with other extracorporeal care devices such as Continuous Renal Replacement Therapy (CRRT). This retrospective study includes three clinical cases of planned ECMO support strategies in LT and evaluates their application compared with current literature exploring PubMed/Medline. The three LT supported with ECMO and CRRT were performed at IRCCS Polyclinic S. Orsola-Malpighi, Bologna. All three cases of patients with compromised organ function analysed produced positive outcomes. The planned use of ECMO and CRRT support in peri-transplantation has allowed the patients to overcome contraindications and successfully undergo LT. In recent years, only a few reports have documented successful LT outcomes performed with intraoperative ECMO in critically ESLD patients. However, the management of LT with ECMO and/or CRRT assistance is an emerging challenge, with the need for more published evidence on this topic to guide treatment choices in patients with severe, acute and reversible respiratory and cardiovascular failure after LT. Full article

(This article belongs to the Special Issue Liver Transplantation: Current Challenges and New Perspectives)

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18 pages, 4336 KiB

Open AccessEditor’s ChoiceReview

Stent Thrombosis and Restenosis with Contemporary Drug-Eluting Stents: Predictors and Current Evidence

by Francesco Condello, Carmen Spaccarotella, Sabato Sorrentino, Ciro Indolfi, Giulio G. Stefanini and Alberto Polimeni

J. Clin. Med. 2023, 12(3), 1238; https://doi.org/10.3390/jcm12031238 - 03 Feb 2023

Cited by 16 | Viewed by 3868

Abstract

Iterations in stent technologies, advances in pharmacotherapy, and awareness of the implications of implantation techniques have markedly reduced the risk of stent failure, both in the form of stent thrombosis (ST) and in-stent restenosis (ISR). However, given the number of percutaneous coronary interventions [...] Read more.

Iterations in stent technologies, advances in pharmacotherapy, and awareness of the implications of implantation techniques have markedly reduced the risk of stent failure, both in the form of stent thrombosis (ST) and in-stent restenosis (ISR). However, given the number of percutaneous coronary interventions (PCI) performed worldwide every year, ST and ISR, albeit occurring at a fairly low rate, represent a public health problem even with contemporary DES platforms. The understanding of mechanisms and risk factors for these two PCI complications has been of fundamental importance for the parallel evolution of stent technologies. Risk factors associated with ST and ISR are usually divided into patient-, lesion-, device- and procedure-related. A number of studies have shown how certain risk factors are related to early (1 month) versus late/very late ST (between 1 month and 1 year and >1 year, respectively). However, more research is required to conclusively show the role of time-dependence of risk factors also in the incidence of ISR (early [1 year] or late [>1 year]). A thorough risk assessment is required due to the complex etiology of ST and ISR. The most effective strategy to treat ST and ISR is still to prevent them; hence, it is crucial to identify patient-, lesion-, device- and procedure-related predictors. Full article

(This article belongs to the Special Issue Advances in the Diagnosis and Treatment of Coronary Artery Disease)

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16 pages, 1566 KiB

Open AccessReview

Current Therapeutic Strategies for Patients with Hypopharyngeal Carcinoma: Oncologic and Functional Outcomes

by Alexandre Bozec, Gilles Poissonnet, Olivier Dassonville and Dorian Culié

J. Clin. Med. 2023, 12(3), 1237; https://doi.org/10.3390/jcm12031237 - 03 Feb 2023

Cited by 5 | Viewed by 3830

Abstract

Hypopharyngeal cancer is usually diagnosed at an advanced stage and is associated with a high risk of recurrence and poor survival rates. Although they differ greatly in terms of prognosis, hypopharyngeal cancers are usually treated together with laryngeal cancers in clinical trials. Therefore, [...] Read more.

Hypopharyngeal cancer is usually diagnosed at an advanced stage and is associated with a high risk of recurrence and poor survival rates. Although they differ greatly in terms of prognosis, hypopharyngeal cancers are usually treated together with laryngeal cancers in clinical trials. Therefore, there are very few studies that focus specifically on patients with hypopharyngeal carcinoma. As a result, the therapeutic management of these patients is highly debated, and their clinical outcomes are poorly reported. The aim of this review is therefore to discuss the current therapeutic options in patients with hypopharyngeal carcinoma and their oncologic and functional outcomes. Patients with early-stage tumors can be treated either by conservative surgery (including transoral robot-assisted surgery) or by RT alone. However, most patients are diagnosed with locally advanced tumors that cannot be treated surgically without total laryngectomy. In this situation, the critical issue is to select the patients eligible for a larynx preservation therapeutic program. However, radical surgery with total laryngectomy still plays an important role in the management of patients with hypopharyngeal carcinoma, either as the primary treatment modality (T4 resectable primary tumor, contraindication to larynx preservation therapies) or, more commonly, as salvage treatment. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Management in Head and Neck Squamous Cell Carcinoma)

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11 pages, 2281 KiB

Open AccessEssay

Prevalence and Impact of Arrhythmia on Outcomes in Restrictive Cardiomyopathy—A Report from the Beijing Municipal Health Commission Information Center (BMHCIC) Database

by Haiyan Wang, Sitong Liu, Xilin Zhang, Jianpeng Zheng, Feng Lu, Gregory Y. H. Lip and Ying Bai

J. Clin. Med. 2023, 12(3), 1236; https://doi.org/10.3390/jcm12031236 - 03 Feb 2023

Cited by 1 | Viewed by 1338

Abstract

Background: Data on the outcomes of restrictive cardiomyopathy (RCM) are limited, when the condition is complicated with arrhythmia. This study was designed to investigate the prevalence of atrial fibrillation (AF), ventricular tachycardia (VT) and bradycardia (BC) and their impact on adverse outcomes (intra-cardiac [...] Read more.

Background: Data on the outcomes of restrictive cardiomyopathy (RCM) are limited, when the condition is complicated with arrhythmia. This study was designed to investigate the prevalence of atrial fibrillation (AF), ventricular tachycardia (VT) and bradycardia (BC) and their impact on adverse outcomes (intra-cardiac thrombus, stroke and systematic embolism [SSE], heart failure and death) of RCM. Methods and Results: The retrospective cohort study used data collected from the Beijing Municipal Health Commission Information Center (BMHCIC) database from 1 January 2010 to 31 December 2020. There were 745 (64.9%) patients with AF, 117 (10.2%) patients with VT and 311 (27.1%) patients with bradycardia. The presence of AF was associated with an increased risk of SSE (adjusted HR:1.37, 95%CI:1.02–1.83, p = 0.04) and heart failure (aHR:1.36, 95%CI:1.17–1.58, p < 0.001). VT was associated with an increased risk of intracardiac thrombus (aHR:2.34, 95%CI:1.36–4.01, p = 0.002) and death (aHR:2.07, 95%CI:1.19–3.59, p = 0.01). Bradycardia did not increase the adverse outcomes in RCM. The results remained consistent and steady when AF, VT and bradycardia were adjusted as competing factors. Conclusions: Cardiac arrhythmia are highly prevalent and associated with adverse outcomes in patients with RCM. AF and VT are more likely to be associated with intracardiac thrombosis, and the presence of AF increased the risk of SSE and HF. The presence of VT increased the risk of death. Full article

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

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10 pages, 1939 KiB

Open AccessArticle

Dependence of Left Ventricular Rotational Mechanics on Left Atrial Volumes in Non-Smoker Healthy Adults: Analysis Based on the Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Healthy Study

by Attila Nemes, Árpád Kormányos, Zoltán Ruzsa, Alexandru Achim, Nóra Ambrus and Csaba Lengyel

J. Clin. Med. 2023, 12(3), 1235; https://doi.org/10.3390/jcm12031235 - 03 Feb 2023

Cited by 5 | Viewed by 1200

Abstract

Introduction: As has been established, the left ventricle (LV) and the left atrium (LA) form an organic unit of the left heart; however, little is known about the dependence of LV rotational parameters on LA volumes, even in healthy circumstances. Therefore, the [...] Read more.

Introduction: As has been established, the left ventricle (LV) and the left atrium (LA) form an organic unit of the left heart; however, little is known about the dependence of LV rotational parameters on LA volumes, even in healthy circumstances. Therefore, the present study aimed to assess the associations between basal and apical LV rotations and LA volumes and volume-based functional properties throughout the cardiac cycle in healthy adults by three-dimensional speckle-tracking echocardiography. Methods: The present study comprised 167 healthy adults (age: 33.4 ± 12.6 years, 77 males) with normally directed LV rotational mechanics. All subjects underwent complete two-dimensional Doppler echocardiography with three-dimensional speckle-tracking echocardiography (3DSTE)-derived data acquisition. The 3DSTE-derived LA volumes and LV rotational parameters were determined at a later date. Results: An increasing end-systolic maximum LA volume (Vmax) was associated with increasing pre-atrial-contraction early (VpreA) and minimum end-diastolic (Vmin) LA volumes, and all stroke volumes were increased as well. Systolic basal left ventricular rotation (LVrot) was highest in the case of the highest systolic Vmax and early-diastolic VpreA. Apical LVrot did not show obvious associations with any increasing LA volumes. The highest systolic basal LVrot was associated with significantly increased diastolic VpreA and Vmin. Reduced diastolic LA volumes (VpreA, Vmin) were seen in the case of increased apical LVrot. An increasing basal LVrot was associated with the tendentious lowering of the apical LVrot and the significant elevation of LV twist. Similarly, an increasing apical LVrot was associated with the tendentious lowering of basal LVrot and the significant elevation of LV twist. Conclusions: Strong associations and adaptations between 3DSTE-derived LA volumes throughout the cardiac cycle and LV rotational mechanics were evidenced, even in healthy circumstances. Full article

(This article belongs to the Special Issue Clinical Implications of Transitioning from 2D to Fully Automated 3D Echocardiography)

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10 pages, 2572 KiB

Open AccessArticle

Short-Term Outcomes of Surgery and Rehabilitation on Activities of Daily Living after Displaced Femoral Neck Fractures: Structural Equation Modeling

by Kazutaka Yokoyama, Hiroyuki Katoh, Seiji Bito, Yoshinari Fujita and Keita Yamauchi

J. Clin. Med. 2023, 12(3), 1234; https://doi.org/10.3390/jcm12031234 - 03 Feb 2023

Viewed by 1294

Abstract

In order to explore the factors affecting patients’ level of activities of daily living (ADL) on discharge after undergoing bipolar hemiarthroplasty or total hip arthroplasty for displaced femoral neck fractures at an acute care hospital, patient data were analyzed with the following statistical [...] Read more.

In order to explore the factors affecting patients’ level of activities of daily living (ADL) on discharge after undergoing bipolar hemiarthroplasty or total hip arthroplasty for displaced femoral neck fractures at an acute care hospital, patient data were analyzed with the following statistical tools: multiple regression analysis (MRA), structural equation modeling (SEM), and simultaneous analysis of several groups (SASG). The Barthel Index (BI) on discharge was set as the objective variable, while age, sex, degree of dementia, BI on admission, number of days from admission to surgery, surgical option, and number of rehabilitation units per day were set as explanatory variables. Factors such as age, sex, degree of dementia, BI on admission, and number of rehabilitation units per day were significant in MRA. While not significant in MRA, the number of days from admission to surgery was significant in SEM. According to the SASG, the number of rehabilitation units per day was significant for patients without dementia but not for patients with dementia. Analysis of real-world data suggests that early surgery and rehabilitation affect ADL on discharge to a greater degree than the surgical method. For patients without dementia, longer daily rehabilitation was significantly associated with better ADL on discharge. Full article

(This article belongs to the Section Orthopedics)

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10 pages, 679 KiB

Open AccessArticle

Opportunistic Genetic Screening for Familial Hypercholesterolemia in Heart Transplant Patients

by María Salgado, Beatriz Díaz-Molina, Elías Cuesta-Llavona, Andrea Aparicio, María Fernández, Vanesa Alonso, Pablo Avanzas, Isaac Pascual, David Neuhalfen, Eliecer Coto, Juan Gómez and Rebeca Lorca

J. Clin. Med. 2023, 12(3), 1233; https://doi.org/10.3390/jcm12031233 - 03 Feb 2023

Cited by 1 | Viewed by 1491

Abstract

Heart transplantation remains the gold standard for the treatment of advanced heart failure (HF). Identification of the etiology of HF is mandatory, as the specific pathology can determine subsequent treatment. Early identification of familial hypercholesterolemia (FH), the most common genetic disorder associated with [...] Read more.

Heart transplantation remains the gold standard for the treatment of advanced heart failure (HF). Identification of the etiology of HF is mandatory, as the specific pathology can determine subsequent treatment. Early identification of familial hypercholesterolemia (FH), the most common genetic disorder associated with premature cardiovascular disease, has a potential important impact on clinical management and public health. We evaluated the genetic information in the genes associated with FH in a cohort of 140 heart-transplanted patients. All patients underwent NGS genetic testing including LDLR, APOB, and PCSK9. We identified four carriers of rare pathogenic variants in LDLR and APOB. Although all four identified carriers had dyslipidemia, only the one carrying the pathogenic variant LDLR c.676T>C was transplanted due to CAD. Another patient with heart valvular disease was carrier of the controversial LDLR c.2096C>T. Two additional patients with non-ischemic dilated cardiomyopathy were carriers of variants in APOB (c.4672A>G and c.5600G>A). In our cohort, we identified the genetic cause of FH in patients that otherwise would not have been diagnosed. Opportunistic genetic testing for FH provides important information to perform personalized medicine and risk stratification not only for patients but also for relatives at concealed high cardiovascular risk. Including the LDLR gene in standard NGS cardiovascular diagnostics panels should be considered. Full article

(This article belongs to the Special Issue Dyslipidemia and Cardiovascular Disease)

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14 pages, 3408 KiB

Open AccessArticle

Echocardiographic Parameters to Predict Malignant Events in Arrhythmic Mitral Valve Prolapse Population

by Alessandro Vairo, Paolo Desalvo, Andrea Rinaudo, Francesco Piroli, Anna Tribuzio, Andrea Ballatore, Gianluca Marcelli, Lorenzo Pistelli, Veronica Dusi, Nicolò Montali, Gianluca Alunni, Cristina Barbero, Stefano Salizzoni, Marco Pocar, Mauro Rinaldi, Fiorenzo Gaita, Gaetano Maria De Ferrari and Carla Giustetto

J. Clin. Med. 2023, 12(3), 1232; https://doi.org/10.3390/jcm12031232 - 03 Feb 2023

Cited by 2 | Viewed by 3681

Abstract

Bileaflet Mitral Valve Prolapse (bMVP) has been linked to major arrhythmic events and sudden cardiac death (SCD). Consistent predictors in this field are still lacking. Echocardiography is the best tool for the analysis of the prolapse and its impact on the ventricular mechanics. [...] Read more.

Bileaflet Mitral Valve Prolapse (bMVP) has been linked to major arrhythmic events and sudden cardiac death (SCD). Consistent predictors in this field are still lacking. Echocardiography is the best tool for the analysis of the prolapse and its impact on the ventricular mechanics. The aim of this study was to find new echocardiographic predictors of malignant events within an arrhythmic MVP population. We evaluated 22 patients with arrhythmic bMVP with a transthoracic echocardiogram focused on mitral valve anatomy and ventricular contraction. Six of them had major arrhythmic events that required ICD implantation (ICD-MVP group), while sixteen presented with a high arrhythmic burden without major events (A-MVP group). The best predictors of malignant events were the Anterior Mitral Leaflet (AML) greater length and greater Mechanical Dispersion (MD) of basal and mid-ventricular segments, while other significant predictors were the larger mitral valve annulus (MVA) indexed area, lower MVA anteroposterior diameter/AML length ratio, higher inferolateral basal segment S3 velocity. Full article

(This article belongs to the Special Issue The Development and Application of Echocardiography in Heart Disease)

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16 pages, 256 KiB

Open AccessArticle

A Qualitative Study Exploring Professional Perspectives of a Challenging Rehabilitation Environment for Geriatric Rehabilitation

by Lian M. J. Tijsen, Els W. C. Derksen, Wilco P. Achterberg and Bianca I. Buijck

J. Clin. Med. 2023, 12(3), 1231; https://doi.org/10.3390/jcm12031231 - 03 Feb 2023

Cited by 1 | Viewed by 1735

Abstract

There is a trend towards the formalization of the rehabilitation process for older rehabilitants in a Challenging Rehabilitation Environment (CRE). This concept involves the comprehensive organization of care, support, and environment on rehabilitation wards. So far, literature on the principles of the CRE [...] Read more.

There is a trend towards the formalization of the rehabilitation process for older rehabilitants in a Challenging Rehabilitation Environment (CRE). This concept involves the comprehensive organization of care, support, and environment on rehabilitation wards. So far, literature on the principles of the CRE is scarce. This study aims to explore the perspectives regarding the CRE of healthcare professionals through a qualitative study. Therefore, between 2018 and 2020, six international and 69 Dutch professionals were interviewed in focus groups, and 180 professionals attended workshops on two Dutch congresses. Data were thematically analyzed using ATLAS.ti. Seven themes emerged regarding the rehabilitation processes: (1) rehabilitant (attention for cognitive functioning and resilience); (2) goals (setting personal goals); (3) exercise (increasing exercise intensity); (4) daily schedule (following the daily rhythm); (5) involving the client system (involving informal caregivers); (6) nutrition (influences rehabilitation capability); and (7) technology (makes rehabilitation more safe and challenging). Regarding organizational aspects, four main themes were identified: (1) environmental aspects (encourages exercises); (2) staff aspects (interdisciplinary team); (3) organizational aspects (implementing CRE requires a shared vision); and (4) factors outside the ward (a well-prepared discharge process). To offer effective rehabilitation, all elements of the CRE should be applied. To improve the CRE, specific interventions need to be developed and implemented. Consequently, the effectiveness and efficiency of the CRE need to be measured with validated tools. Full article

(This article belongs to the Section Clinical Rehabilitation)

27 pages, 1113 KiB

Open AccessReview

Review of the Literature on Partial Resections of the Gallbladder, 1898–2022: The Outline of the Conception of Subtotal Cholecystectomy and a Suggestion to Use the Terms ‘Subtotal Open-Tract Cholecystectomy’ and ‘Subtotal Closed-Tract Cholecystectomy’

by Raimundas Lunevicius

J. Clin. Med. 2023, 12(3), 1230; https://doi.org/10.3390/jcm12031230 - 03 Feb 2023

Cited by 1 | Viewed by 2794

Abstract

Current descriptions of the history of subtotal cholecystectomy require more details and accuracy. This study presented a narrative review of the articles on partial resections of the gallbladder published between 1898 and 2022. The Scale for the Assessment of Narrative Review Articles items [...] Read more.

Current descriptions of the history of subtotal cholecystectomy require more details and accuracy. This study presented a narrative review of the articles on partial resections of the gallbladder published between 1898 and 2022. The Scale for the Assessment of Narrative Review Articles items guided the style and content of this paper. The systematic literature search yielded 165 publications. Of them, 27 were published between 1898 and 1984. The evolution of the partial resections of the gallbladder began in the last decade of the 19th century when Kehr and Mayo performed them. The technique of partial resection of the gallbladder leaving the hepatic wall in situ was well known in the 3rd and 4th decades of the 20th century. In 1931, Estes emphasised the term ‘partial cholecystectomy’. In 1947, Morse and Barb introduced the term ‘subtotal cholecystectomy’. Madding and Farrow popularised it in 1955–1959. Bornman and Terblanche revitalised it in 1985. This term became dominant in 2014. From a subtotal cholecystectomy technical execution perspective, it is either a single-stage (when it includes only the resectional component) or two-stage (when it also entails closure of the remnant of the gallbladder or cystic duct) operation. Recent papers on classifications of partial resections of the gallbladder indicate the extent of gallbladder resection. Subtotal cholecystectomy is an umbrella term for incomplete cholecystectomies. ‘Subtotal open-tract cholecystectomy’ and ‘subtotal closed-tract cholecystectomy’ are terms that characterise the type of completion of subtotal cholecystectomy. Full article

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

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8 pages, 1037 KiB

Open AccessOpinion

Proposed Implementation of a Patient-Centered Self-Assessment Tool for Patients with Neuroendocrine Tumors among Academic and Community Practice Sites: The City of Hope Model

by Christiana Joy Crook, Lisa Yen, Kathleen Ta, Misagh Karimi, Danny Nguyen, Richard T. Lee and Daneng Li

J. Clin. Med. 2023, 12(3), 1229; https://doi.org/10.3390/jcm12031229 - 03 Feb 2023

Viewed by 1640

Abstract

Neuroendocrine tumors are a rare type of cancer found in hormone-producing cells throughout the body. Research on disease-specific patient education assessments in this population is lacking. We previously demonstrated the feasibility and validity of NET VITALS, a patient-centered self-assessment designed to improve patients’ [...] Read more.

Neuroendocrine tumors are a rare type of cancer found in hormone-producing cells throughout the body. Research on disease-specific patient education assessments in this population is lacking. We previously demonstrated the feasibility and validity of NET VITALS, a patient-centered self-assessment designed to improve patients’ knowledge of their neuroendocrine tumor diagnosis/treatment and facilitate communication with their physician. In this report, we provide a brief overview of patient assessments that have been used for patients with neuroendocrine tumors. We summarize NET VITALS and present a proposed infrastructure for its implementation into standard clinical care in both academic and community practice settings at City of Hope. Incorporating NET VITALS into standard of care treatment for patients with neuroendocrine tumors may improve patients’ overall clinical care experience. 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, 1318 KiB

Open AccessPerspective

Retinopathy of Prematurity in the 21st Century and the Complex Impact of Supplemental Oxygen

by Sarah H. Rodriguez, Anna L. Ells, Michael P. Blair, Parag K. Shah, C. Armitage Harper 3rd, Maria Ana Martinez-Castellanos, S. Grace Prakalapakorn, Erima Denis, Rebecca C. Lusobya, Mark J. Greenwald, Sherwin J. Isenberg, Scott R. Lambert, Yvonne E. Vaucher, Ann Carroll and Lucy Namakula

J. Clin. Med. 2023, 12(3), 1228; https://doi.org/10.3390/jcm12031228 - 03 Feb 2023

Cited by 1 | Viewed by 2520

Abstract

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. Not only do the epidemiologic determinants and distributions of patients with ROP vary worldwide, but clinical differences have also been described. The Third Edition of the International Classification of ROP (ICROP3) acknowledges [...] Read more.

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. Not only do the epidemiologic determinants and distributions of patients with ROP vary worldwide, but clinical differences have also been described. The Third Edition of the International Classification of ROP (ICROP3) acknowledges that aggressive ROP (AROP) can occur in larger preterm infants and involve areas of the more anterior retina, particularly in low-resource settings with unmonitored oxygen supplementation. As sub-specialty training programs are underway to address an epidemic of ROP in sub-Saharan Africa, recognizing characteristic retinal pathology in preterm infants exposed to unmonitored supplemental oxygen is important to proper diagnosis and treatment. This paper describes specific features associated with various ROP presentations: oxygen-induced retinopathy in animal models, traditional ROP seen in high-income countries with modern oxygen management, and ROP related to excessive oxygen supplementation in low- and middle-income countries: oxygen-associated ROP (OA-ROP). Full article

(This article belongs to the Special Issue Updates on Microbiome and Retina Disease)

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12 pages, 2063 KiB

Open AccessArticle

A Nomogram Model Based on Neuroendocrine Markers for Predicting the Prognosis of Neuroendocrine Carcinoma of Cervix

by Mingzhu Jia, Jiangchuan Pi, Juan Zou, Min Feng, Huiling Chen, Changsheng Lin, Shuqi Yang, Ying Deng and Xue Xiao

J. Clin. Med. 2023, 12(3), 1227; https://doi.org/10.3390/jcm12031227 - 03 Feb 2023

Cited by 2 | Viewed by 1220

Abstract

Background: Combining traditional clinical parameters with neuroendocrine markers to construct a nomogram model to predict the postoperative recurrence of neuroendocrine carcinoma of cervix (NECC). Methods: A total of 257 patients were included in this study. Univariate and multivariate Cox regression analyses were used [...] Read more.

Background: Combining traditional clinical parameters with neuroendocrine markers to construct a nomogram model to predict the postoperative recurrence of neuroendocrine carcinoma of cervix (NECC). Methods: A total of 257 patients were included in this study. Univariate and multivariate Cox regression analyses were used to establish a nomogram model in the training cohorts, which was further validated in the validation cohorts. The calibration curve was used to conduct the internal and external verification of the model. Results: Overall, 41 relapse cases were observed in the training (23 cases) and validation (18 cases) cohorts. The univariate analysis preliminarily showed that FIGO stage, stromal invasion, nerve invasion, lymph vascular space invasion, lymph node involvement, cervical–uterine junction invasion and CgA were correlated with NECC recurrence. The multivariate analysis further confirmed that FIGO stage (p = 0.023), stromal invasion (p = 0.002), lymph vascular space invasion (p = 0.039) and lymph node involvement (p = 0.00) were independent risk factors for NECC recurrence, which were ultimately included in the nomogram model. In addition, superior consistency indices were demonstrated in the training (0.863, 95% CI 0.784–0.942) and validation (0.884, 95% CI 0.758–1.010) cohorts. Conclusions: The established nomogram model combining traditional clinical parameters with neuroendocrine markers can reliably and accurately predict the recurrence risks in NECC patients. Full article

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

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13 pages, 2392 KiB

Open AccessArticle

The Study of a Validated Assessment Scale for a Localized Submental Fat Volume

by Joon-Seok Oh, Jinil Choi, Jong-Woo Choi, Dae-Hyun Lew, Tai-Suk Roh, Seung-Yong Song, Young-Seok Kim, Hojin Park, Sang-Woong Youn, Shinhyuk Kang, Jihyun Park, Jeongseok Oh and Chan-Yeong Heo

J. Clin. Med. 2023, 12(3), 1226; https://doi.org/10.3390/jcm12031226 - 03 Feb 2023

Viewed by 2118

Abstract

Background: This aim of this study was to develop an objective tool for rating submental fat applied to Koreans. Methods: The study was conducted between April 2019 and October 2019. A total of 92 subjects were enrolled in the study. Clinical photos of [...] Read more.

Background: This aim of this study was to develop an objective tool for rating submental fat applied to Koreans. Methods: The study was conducted between April 2019 and October 2019. A total of 92 subjects were enrolled in the study. Clinical photos of the subjects were categorized using validated CR-SMFRS by three plastic surgeons and one dermatologist. The categorized photos were then shown to six different plastic surgeons for evaluation. Results: The Cohen’s kappa value for the six raters were 0.830, 0.742, 0.703, 0.907, 0.862, and 0.793 with statistical significance (p < 0.001). ICC value was between 0.860 and 0.966 (p < 0.001). Since the Cohen’s value and ICC were above 0.6 for all raters, the ratings performed by all six raters were used in the analysis. The ICC values between raters were between 0.899 and 0.902. Conclusions: We came up with a set of reference photos that can be used for submental fat rating scale applicable to Korean subjects. Level of Evidence: II. Full article

(This article belongs to the Section Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine)

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12 pages, 2415 KiB

Open AccessArticle

Cellular and Humoral Responses to Recombinant and Inactivated SARS-CoV-2 Vaccines in CKD Patients: An Observational Study

by Siliang Zhang, Jiaoxia He, Bin Tang, Qin Zhou, Yudong Hu, Yuan Yu, Jianwei Chen, Yi Liu, Chunmeng Li, Hong Ren and Xiaohui Liao

J. Clin. Med. 2023, 12(3), 1225; https://doi.org/10.3390/jcm12031225 - 03 Feb 2023

Cited by 1 | Viewed by 1890

Abstract

Background: It remains unclear what B cell and humoral responses are mounted by chronic kidney disease (CKD) patients in response to recombinant and inactivated SARS-CoV-2 vaccines. In this study, we aimed to explore the cellular and humoral responses, and the safety of recombinant [...] Read more.

Background: It remains unclear what B cell and humoral responses are mounted by chronic kidney disease (CKD) patients in response to recombinant and inactivated SARS-CoV-2 vaccines. In this study, we aimed to explore the cellular and humoral responses, and the safety of recombinant and inactivated SARS-CoV-2 vaccines in CKD patients. Methods: 79 CKD and 420 non-CKD individuals, who completed a full course of vaccination, were enrolled in the study. Adverse events (AEs) were collected via a questionnaire. Cellular and humoral responses were detected at 1, 3, and 6 months, including IgG antibody against the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein (anti-RBD-IgG), neutralizing antibodies (NAbs), the positive rate of NAbs and anti-RBD-IgG, RBD-atypical memory B cells (MBCs) (CD3 − CD19 + RBD + CD21 − CD27−), RBD-activated MBCs (CD3 − CD19 + RBD + CD21 − CD27+), RBD-resting MBCs (CD3 − CD19 + RBD + CD21 + CD27+), and RBD-intermediate MBCs (CD3 − CD19 + RBD + CD21 + CD27−). Results: We found no differences in the positivity rates of NAbs (70.89% vs. 79.49%, p = 0.212) and anti-RBD IgG (72.15% vs. 83.33%, p = 0.092) between the CKD and control groups. A total of 22 CKD individuals completed the full follow-up (1, 3, and 6 months). Significant and sustained declines were found at 3 months in anti-RBD IgG (26.64 BAU/mL vs. 9.08 BAU/mL, p < 0.001) and NAbs (161.60 IU/mL vs. 68.45 IU/mL p < 0.001), and at 6 months in anti-RBD IgG (9.08 BAU/mL vs. 5.40 BAU/mL, p = 0.064) and NAbs (68.45 IU/mL vs. 51.03 IU/mL, p = 0.001). Significant differences were identified in MBC subgroups between CKD patients and healthy controls, including RBD-specific atypical MBCs (60.5% vs. 17.9%, p < 0.001), RBD-specific activated MBCs (36.3% vs. 14.8%, p < 0.001), RBD-specific intermediate MBCs (1.24% vs. 42.6%, p < 0.001), and resting MBCs (1.34% vs. 22.4%, p < 0.001). Most AEs in CKD patients were mild (grade 1 and 2) and self-limiting. One patient with CKD presented with a recurrence of nephrotic syndrome after vaccination. Conclusions: The recombinant and inactivated SARS-CoV-2 vaccine was well-tolerated and showed a good response in the CKD cohort. Our study also revealed differences in MBC subtypes after SARS-CoV-2 vaccination between CKD patients and healthy controls. Full article

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

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15 pages, 1273 KiB

Open AccessArticle

Use of Direct Acting Oral Anticoagulants in Elderly Patients with Atrial Fibrillation: A Multicenter, Cross-Sectional Study in Spain

by Pablo Díez-Villanueva, Juan Cosín-Sales, Vanesa Roldán-Schilling, Vivencio Barrios, Diana Riba-Artés and Olga Gavín-Sebastián

J. Clin. Med. 2023, 12(3), 1224; https://doi.org/10.3390/jcm12031224 - 03 Feb 2023

Cited by 2 | Viewed by 2688

Abstract

Non-vitamin K antagonist oral anticoagulants (NOACs) have substantially improved anticoagulation. However, data on NOAC use among elderly patients are scarce. We sought to describe NOAC use among elderly AF patients in Spain. We performed a non-interventional, multicenter, multispecialty, cross-sectional study in elderly (≥75 [...] Read more.

Non-vitamin K antagonist oral anticoagulants (NOACs) have substantially improved anticoagulation. However, data on NOAC use among elderly patients are scarce. We sought to describe NOAC use among elderly AF patients in Spain. We performed a non-interventional, multicenter, multispecialty, cross-sectional study in elderly (≥75 years) AF patients treated with NOACs for stroke prevention. Patients’ characteristics by NOAC treatment were compared using standardized differences (SDD). NOAC dosing was classified according to the Spanish summary of products characteristics (SmPC) into appropriate (recommended dose) and inappropriate (under and overdosed). Multivariate logistic regression analyses were used to explore factors associated with inappropriate dosing. 500 patients were included. Mean (SD) age was 81.5 (4.7) years, and 50% were women. Mean (SD) creatinine clearance was 57.4 mL/min (18.8), and 23.6% were frail. Dabigatran treatment totaled 38.4%, rivaroxaban 15.2%, apixaban 33.2%, and edoxaban 13.2%. Almost one-fourth of elderly patients treated with NOACs in Spain were inappropriately dosed (underdosing 14.4% and overdosing 9.6%). Underdosing was significantly associated with weight (OR = 1.03, 95%CI = 1.0–1.1), while higher a EHRA score decreased the risk of underdosing (OR = 0.47, 95%CI = 0.2–1.0). Overdosing was significantly associated with a history of ischemic stroke (OR = 2.95, 95%CI = 1.1–7.7). Addressing incorrect dosing among elderly AF patients is relevant to improve patient outcomes. Full article

(This article belongs to the Section Cardiology)

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14 pages, 1084 KiB

Open AccessArticle

Trends in Unhealthy Lifestyle Factors among Adults with Stroke in the United States between 1999 and 2018

by Yuting Liu, Haochen Wang, Bingqing Bai, Fengyao Liu, Yilin Chen, Yu Wang, Yanting Liang, Xiaohe Shi, Xueju Yu, Chao Wu, Lan Guo, Huan Ma and Qingshan Geng

J. Clin. Med. 2023, 12(3), 1223; https://doi.org/10.3390/jcm12031223 - 03 Feb 2023

Cited by 4 | Viewed by 1932

Abstract

BACKGROUND: Unhealthy lifestyle factors are risk factors for stroke, and they play a key role in stroke secondary prevention. A better understanding of these factors may aid with improvements in public health policy. OBJECTIVE: Our objective was to comprehensively understand the trends in [...] Read more.

BACKGROUND: Unhealthy lifestyle factors are risk factors for stroke, and they play a key role in stroke secondary prevention. A better understanding of these factors may aid with improvements in public health policy. OBJECTIVE: Our objective was to comprehensively understand the trends in unhealthy lifestyle factors in people who have previously had a stroke in the US. METHODS: Utilizing data from the biannual United States National Health and Nutrition Examination Surveys (NHANESs) between 1999 and 2018, we collated data on unhealthy lifestyle factors (smoking, alcohol drinking, depression, unhealthy diet, high BMI, physical inactivity, and sedentary behavior) in adults with a history of stroke. The Joinpoint Regression model was used to calculate the annual percentage change (APC) and average annual percentage change (AAPC) to identify trends. Logistic regression modeling was used to identify the influence of sociodemographic factors (age, sex, race/ethnicity, marital status, employment status, family income, and highest education level). RESULTS: The analysis included 2017 respondents with a history of stroke. Current alcohol drinking (39.3% (95% confidence interval: 29.8, 48.7) to 57.4% (45.7, 69.0) p = 0.008) and obesity (39.2% (28.3, 50.2) to 49.4% (38.9, 59.8) p = 0.029) increased significantly from 1999 to 2018. The prevalence of smoking and depression remained generally stable. The proportion of respondents with an unhealthy diet decreased from 1999 (44.5% (32.4, 56.5)) to 2011 (29.0% (17.5, 40.4) p = 0.019), but then returned to its original prevalence in 2018 (42.0% (31.4, 52.7)). From 2007 to 2018, the proportion of respondents who were physically inactive decreased significantly, from 70.4% (64.4, 76.3) to 55.1% (46.1, 64.2; p = 0.017). After a gradual increase in sedentary activity from 2007 to 2012, this declined from 2013 to 2018, with no statistical significance. We found stroke survivors who were widowed, divorced, separated, or unemployed were at a higher risk of having unhealthy lifestyles than those who were employed or had other marital statuses. CONCLUSIONS: A modest reduction in the prevalence of physical inactivity was observed in Americans with a history of stroke between 1999 and 2018. The prevalences of smoking, drinking, depression, poor diet, obesity, and sedentary behavior were stable or increasing. Full article

(This article belongs to the Section Clinical Neurology)

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10 pages, 500 KiB

Open AccessArticle

Effect of Supplemental Oxygen on von Willebrand Factor Activity and Ristocetin Cofactor Activity in Patients at Risk for Cardiovascular Complications Undergoing Moderate-to High-Risk Major Noncardiac Surgery—A Secondary Analysis of a Randomized Trial

by Katharina Horvath, Alexander Taschner, Nikolas Adamowitsch, Markus Falkner von Sonnenburg, Edith Fleischmann, Barbara Kabon, Melanie Fraunschiel, Christian Reiterer and Alexandra Graf

J. Clin. Med. 2023, 12(3), 1222; https://doi.org/10.3390/jcm12031222 - 03 Feb 2023

Viewed by 1062

Abstract

Increased von Willebrand Factor (vWF) activity mediates platelet adhesion and might be a contributor to the development of thrombotic complications after surgery. Although in vitro studies have shown that hyperoxia induces endovascular damage, the effect of perioperative supplemental oxygen as a possible trigger [...] Read more.

Increased von Willebrand Factor (vWF) activity mediates platelet adhesion and might be a contributor to the development of thrombotic complications after surgery. Although in vitro studies have shown that hyperoxia induces endovascular damage, the effect of perioperative supplemental oxygen as a possible trigger for increased vWF activity has not been investigated yet. We tested our primary hypothesis that the perioperative administration of 80% oxygen concentration increases postoperative vWF activity as compared to 30% oxygen concentration in patients at risk of cardiovascular complications undergoing major noncardiac surgery. A total of 260 patients were randomly assigned to receive 80% versus 30% oxygen throughout surgery and for two hours postoperatively. We assessed vWF activity and Ristocetin cofactor activity in all patients shortly before the induction of anesthesia, within two hours after surgery and on the first and third postoperative day. Patient characteristics were similar in both groups. We found no significant difference in vWF activity in the overall perioperative time course between both randomization groups. We observed significantly increased vWF activity in the overall study population throughout the postoperative time course. Perioperative supplemental oxygen showed no significant effect on postoperative vWF and Ristocetin cofactor activity in cardiac risk patients undergoing major noncardiac surgery. In conclusion, we found no significant influence of supplemental oxygen in patients undergoing major non-cardiac surgery on postoperative vWF activity and Ristocetin cofactor activity. Full article

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

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13 pages, 636 KiB

Open AccessEditor’s ChoiceReview

PCOS in Adolescents—Ongoing Riddles in Diagnosis and Treatment

by Blazej Meczekalski, Olga Niwczyk, Anna Kostrzak, Marzena Maciejewska-Jeske, Gregory Bala and Anna Szeliga

J. Clin. Med. 2023, 12(3), 1221; https://doi.org/10.3390/jcm12031221 - 03 Feb 2023

Cited by 8 | Viewed by 5158

Abstract

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. A diagnosis of PCOS is established when a patient exhibits two of three Rotterdam criteria: oligoovulation or anovulation, excess androgen activity, and polycystic ovarian morphology. The [...] Read more.

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. A diagnosis of PCOS is established when a patient exhibits two of three Rotterdam criteria: oligoovulation or anovulation, excess androgen activity, and polycystic ovarian morphology. The pathogenesis of PCOS, as it affects adolescents, is often discussed in terms of a “two-hit” theory. This refers to a stepwise process in which the first “hit” is an inborn congenitally programmed predisposition, while the second “hit” arises from a provocative factor such as insulin resistance. The dynamic physiological and anatomical changes which occur in puberty make for a challenging diagnosis in this group of patients. It is important to be mindful of the physiological particularities in adolescence which often mimic the symptoms of PCOS. In their first-year post-menarche, approximately 75% of menstruating adolescents report their cycle to last between 21–45 days. Recent studies have shown that regular menstrual cyclicity is only achieved within 2–3 years post-menarche. Anovulation, as a crucial diagnostic element for PCOS, features in about half of early-post-menarchal adolescents. Hirsutism and acne are the most common clinical manifestations of hyperandrogenism, and mild features are developed by most adolescents as a result of elevated androgen levels. Distinguishing between a pathological sign and normal features of maturation is often difficult. A polycystic ovarian morphology (PCOM) through ultrasound has been found in up to 40%, 35%, and 33.3% of patients when assessed at 2, 3, and 4 years, respectively, after menarche. PCOM in adolescence is not associated with future abnormalities in ovulatory rate or menstrual cycle duration. For this reason, international guidelines recommend against the use of pelvic ultrasound until 8 years post-menarche. The primary aim of management is focused mainly on improving hormonal and metabolic status, the prevention of future comorbid complications, and generally improving the overall quality of life in young women with PCOS. Considerable controversy surrounds the choice of optimal pharmacological treatment to address PCOS in adolescents. Reliable studies, which include this sub-section of the population, are very limited. There is a lack of robust and reliable trials in the literature addressing the use of combined oral contraceptives. Further work needs to be undertaken in order to provide safe and effective care to the adolescent population in this regard. Full article

(This article belongs to the Section Obstetrics & Gynecology)

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14 pages, 1630 KiB

Open AccessArticle

Machine Learning Predictive Models for Evaluating Risk Factors Affecting Sperm Count: Predictions Based on Health Screening Indicators

by Hung-Hsiang Huang, Shang-Ju Hsieh, Ming-Shu Chen, Mao-Jhen Jhou, Tzu-Chi Liu, Hsiang-Li Shen, Chih-Te Yang, Chung-Chih Hung, Ya-Yen Yu and Chi-Jie Lu

J. Clin. Med. 2023, 12(3), 1220; https://doi.org/10.3390/jcm12031220 - 03 Feb 2023

Cited by 3 | Viewed by 2584

Abstract

In many countries, especially developed nations, the fertility rate and birth rate have continually declined. Taiwan’s fertility rate has paralleled this trend and reached its nadir in 2022. Therefore, the government uses many strategies to encourage more married couples to have children. However, [...] Read more.

In many countries, especially developed nations, the fertility rate and birth rate have continually declined. Taiwan’s fertility rate has paralleled this trend and reached its nadir in 2022. Therefore, the government uses many strategies to encourage more married couples to have children. However, couples marrying at an older age may have declining physical status, as well as hypertension and other metabolic syndrome symptoms, in addition to possibly being overweight, which have been the focus of the studies for their influences on male and female gamete quality. Many previous studies based on infertile people are not truly representative of the general population. This study proposed a framework using five machine learning (ML) predictive algorithms—random forest, stochastic gradient boosting, least absolute shrinkage and selection operator regression, ridge regression, and extreme gradient boosting—to identify the major risk factors affecting male sperm count based on a major health screening database in Taiwan. Unlike traditional multiple linear regression, ML algorithms do not need statistical assumptions and can capture non-linear relationships or complex interactions between dependent and independent variables to generate promising performance. We analyzed annual health screening data of 1375 males from 2010 to 2017, including data on health screening indicators, sourced from the MJ Group, a major health screening center in Taiwan. The symmetric mean absolute percentage error, relative absolute error, root relative squared error, and root mean squared error were used as performance evaluation metrics. Our results show that sleep time (ST), alpha-fetoprotein (AFP), body fat (BF), systolic blood pressure (SBP), and blood urea nitrogen (BUN) are the top five risk factors associated with sperm count. ST is a known risk factor influencing reproductive hormone balance, which can affect spermatogenesis and final sperm count. BF and SBP are risk factors associated with metabolic syndrome, another known risk factor of altered male reproductive hormone systems. However, AFP has not been the focus of previous studies on male fertility or semen quality. BUN, the index for kidney function, is also identified as a risk factor by our established ML model. Our results support previous findings that metabolic syndrome has negative impacts on sperm count and semen quality. Sleep duration also has an impact on sperm generation in the testes. AFP and BUN are two novel risk factors linked to sperm counts. These findings could help healthcare personnel and law makers create strategies for creating environments to increase the country’s fertility rate. This study should also be of value to follow-up research. Full article

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17 pages, 333 KiB

Open AccessArticle

Heart Rate Asymmetry, Its Compensation, and Heart Rate Variability in Healthy Adults during 48-h Holter ECG Recordings

by Greta Sibrecht, Jarosław Piskorski, Tomasz Krauze and Przemysław Guzik

J. Clin. Med. 2023, 12(3), 1219; https://doi.org/10.3390/jcm12031219 - 03 Feb 2023

Cited by 2 | Viewed by 1498

Abstract

Heart rate asymmetry (HRA) reflects different contributions of heart rate (HR) decelerations and accelerations to heart rate variability (HRV). In this study, we examined various properties of HRA, including its compensation and HRV, in 48-h electrocardiogram (ECG) recordings in healthy adults. Furthermore, we [...] Read more.

Heart rate asymmetry (HRA) reflects different contributions of heart rate (HR) decelerations and accelerations to heart rate variability (HRV). In this study, we examined various properties of HRA, including its compensation and HRV, in 48-h electrocardiogram (ECG) recordings in healthy adults. Furthermore, we compared sex differences in parameters used to quantify HRA and HRV. Variance-based and relative HRA and HRV parameters were computed for Holter ECG recordings lasting up to 48 h in 101 healthy volunteers. The median age of the subjects was 39 years, with 47 of them being men. The prevalence of all forms of HRA was statistically different from randomness (p < 0.0001). Specifically, HR decelerations contributed >50% (C1d) to short-term HRA in 98.02% of subjects, while HR decelerations contributed <50% to long-term HRA in 89.11% of recordings and to total HRA in 88.12% of recordings. Additionally, decelerations accounted for <50% of all changing heartbeats (Porta’s index) in 74.26% of subjects, and HRA compensation was present in 88.12% of volunteers. Our findings suggest that various HRA features are present in most healthy adults. While men had more pronounced HRA expression, the prevalence of short-, long-term, and total HRA and its compensation was similar in both sexes. For HRV, values of variance-based indices were higher in men than in women, but no differences were found for relative measures. In conclusion, our study references HRA and HRV for longer ECG recordings of up to 48 h, which have become increasingly important in clinical ECG monitoring. The findings can help understand and compare the characteristics of HRA and HRV in patients with different diseases. Full article

(This article belongs to the Special Issue Cardiovascular Time Series in the Preclinical and Clinical Settings)

10 pages, 2066 KiB

Open AccessArticle

Acute Modification of Hemodynamic Forces in Patients with Severe Aortic Stenosis after Transcatheter Aortic Valve Implantation

by Alessandro Vairo, Lorenzo Zaccaro, Andrea Ballatore, Lorenzo Airale, Fabrizio D’Ascenzo, Gianluca Alunni, Federico Conrotto, Luca Scudeler, Daniela Mascaretti, Davide Miccoli, Michele La Torre, Mauro Rinaldi, Gianni Pedrizzetti, Stefano Salizzoni and Gaetano Maria De Ferrari

J. Clin. Med. 2023, 12(3), 1218; https://doi.org/10.3390/jcm12031218 - 03 Feb 2023

Cited by 2 | Viewed by 1282

Abstract

Transcatheter aortic valve implantation (TAVI) is the established first-line treatment for patient with severe aortic stenosis not suitable for surgery. Echocardiographic evaluation of hemodynamic forces (HDFs) is a growing field, holding the potential to early predict improvement in LV function. A prospective observational [...] Read more.

Transcatheter aortic valve implantation (TAVI) is the established first-line treatment for patient with severe aortic stenosis not suitable for surgery. Echocardiographic evaluation of hemodynamic forces (HDFs) is a growing field, holding the potential to early predict improvement in LV function. A prospective observational study was conducted. Transthoracic echocardiography was performed before and after TAVI. HDFs were analyzed along with traditional left ventricular (LV) function parameters. Twenty-five consecutive patients undergoing TAVI were enrolled: mean age 83 ± 5 years, 74.5% male, mean LV Ejection Fraction (LVEF) at baseline 57 ± 8%. Post-TAVI echocardiographic evaluation was performed 2.4 ± 1.06 days after the procedure. HDF amplitude parameters improved significantly after the procedure: LV Longitudinal Forces (LF) apex-base [mean difference (MD) 1.79%; 95% CI 1.07–2.5; p-value < 0.001]; LV systolic LF apex-base (MD 2.6%; 95% CI 1.57–3.7; p-value < 0.001); LV impulse (LVim) apex-base (MD 2.9%; 95% CI 1.48–4.3; p-value < 0.001). Similarly, HDFs orientation parameters improved: LVLF angle (MD 1.5°; 95% CI 0.07–2.9; p-value = 0.041); LVim angle (MD 2.16°; 95% CI 0.76–3.56; p-value = 0.004). Conversely, global longitudinal strain and LVEF did not show any significant difference before and after the procedure. Echocardiographic analysis of HDFs could help differentiate patients with LV function recovery after TAVI from patients with persistent hemodynamic dysfunction. Full article

(This article belongs to the Topic Cardiac Imaging: State of the Art)

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11 pages, 1187 KiB

Open AccessArticle

A Neural Network for Automated Image Quality Assessment of Optic Disc Photographs

by Ella Bouris, Tyler Davis, Esteban Morales, Lourdes Grassi, Diana Salazar Vega and Joseph Caprioli

J. Clin. Med. 2023, 12(3), 1217; https://doi.org/10.3390/jcm12031217 - 03 Feb 2023

Cited by 2 | Viewed by 1473

Abstract

This study describes the development of a convolutional neural network (CNN) for automated assessment of optic disc photograph quality. Using a code-free deep learning platform, a total of 2377 optic disc photographs were used to develop a deep CNN capable of determining optic [...] Read more.

This study describes the development of a convolutional neural network (CNN) for automated assessment of optic disc photograph quality. Using a code-free deep learning platform, a total of 2377 optic disc photographs were used to develop a deep CNN capable of determining optic disc photograph quality. Of these, 1002 were good-quality images, 609 were acceptable-quality, and 766 were poor-quality images. The dataset was split 80/10/10 into training, validation, and test sets and balanced for quality. A ternary classification model (good, acceptable, and poor quality) and a binary model (usable, unusable) were developed. In the ternary classification system, the model had an overall accuracy of 91% and an AUC of 0.98. The model had higher predictive accuracy for images of good (93%) and poor quality (96%) than for images of acceptable quality (91%). The binary model performed with an overall accuracy of 98% and an AUC of 0.99. When validated on 292 images not included in the original training/validation/test dataset, the model’s accuracy was 85% on the three-class classification task and 97% on the binary classification task. The proposed system for automated image-quality assessment for optic disc photographs achieves high accuracy in both ternary and binary classification systems, and highlights the success achievable with a code-free platform. There is wide clinical and research potential for such a model, with potential applications ranging from integration into fundus camera software to provide immediate feedback to ophthalmic photographers, to prescreening large databases before their use in research. Full article

(This article belongs to the Special Issue Big Data and Artificial Intelligence-Driven Research in Ophthalmology)

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13 pages, 15510 KiB

Open AccessArticle

A Standardized Operative Protocol for Fixation of Proximal Humeral Fractures Using a Locking Plate to Minimize Surgery-Related Complications

by Sebastian Kwisda, Jan-Philipp Imiolczyk, Tankred Imiolczyk, Magdalena Werth and Markus Scheibel

J. Clin. Med. 2023, 12(3), 1216; https://doi.org/10.3390/jcm12031216 - 03 Feb 2023

Cited by 2 | Viewed by 1777

Abstract

The current literature suggests that up to 55% of complications after plate osteosynthesis treatment for patients with proximal humerus fractures are attributed to the surgical procedure. The hypothesis of this study was that a standardized surgical protocol would minimize surgery-related adverse events. This [...] Read more.

The current literature suggests that up to 55% of complications after plate osteosynthesis treatment for patients with proximal humerus fractures are attributed to the surgical procedure. The hypothesis of this study was that a standardized surgical protocol would minimize surgery-related adverse events. This prospective cohort study included 50 patients with a mean age of 63.2 (range 28–92) years treated by one single surgeon using a previously published standardized surgical protocol. Clinical and radiological follow-up examinations were conducted for up to 24 months using Constant–Murley Score (CS), Subjective Shoulder Value (SSV) and radiographs in true anteroposterior, axial and y-view. Finally, CS was 73.9 (standard deviation [SD]: 14.0) points (89% compared to the uninjured shoulder), and SSV was 83.3% (SD: 16.7) at two years of follow-up. Postoperative radiologic evaluation revealed no primary surgical-related or soft-tissue-related complications (0%). The main complications were secondary, biological complications (20%), largely represented by avascular necrosis (8%). Eight patients underwent revision surgery, mainly for implant removal. In addition, a total of four patients were revised using a hemiarthroplasty (n = 2), reverse shoulder arthroplasty (n = 1) or re-osteosynthesis. The use of our standardized surgical technique on proximal humerus fractures improves fixation with regard to primary stability and prevents primary, surgical-technique-related complications. The subjective grading of a high level of difficulty surgery was associated with more complications. Full article

(This article belongs to the Special Issue Proximal Humeral Fractures—Current Trends and Innovations)

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J. Clin. Med., Volume 12, Issue 3 (February-1 2023) – 513 articles

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