Journal of Clinical Medicine

10 pages, 784 KiB

Open AccessArticle

Shock Index for Early Detection of Low Plasma Fibrinogen in Trauma: A Prospective Observational Cohort Pilot Study

by Josef Škola, Marcela Bílská, Michala Horáková, Václav Tégl, Jan Beneš, Roman Škulec and Vladimír Černý

J. Clin. Med. 2023, 12(4), 1707; https://doi.org/10.3390/jcm12041707 - 20 Feb 2023

Cited by 2 | Viewed by 1744

Abstract

Shock index (a ratio between heart rate and systolic blood pressure) predicts transfusion requirements and the need for haemostatic resuscitation in severe trauma patients. In the present study, we aimed to determine whether prehospital and on-admission shock index values can be used to [...] Read more.

Shock index (a ratio between heart rate and systolic blood pressure) predicts transfusion requirements and the need for haemostatic resuscitation in severe trauma patients. In the present study, we aimed to determine whether prehospital and on-admission shock index values can be used to predict low plasma fibrinogen in trauma patients. Between January 2016 and February 2017, trauma patients admitted from the helicopter emergency medical service into two large trauma centres in the Czech Republic were prospectively assessed for demographic, laboratory and trauma-associated variables and shock index at scene, during transport and at admission to the emergency department. Hypofibrinogenemia defined as fibrinogen plasma level of 1.5 g·L^−l was deemed as a cut-off for further analysis. Three hundred and twenty-two patients were screened for eligibility. Of these, 264 (83%) were included for further analysis. The hypofibrinogenemia was predicted by the worst prehospital shock index with the area under the receiver operating characteristics curve (AUROC) of 0.79 (95% CI 0.64–0.91) and by the admission shock index with AUROC of 0.79 (95% CI 0.66–0.91). For predicting hypofibrinogenemia, the prehospital shock index ≥ 1 has 0.5 sensitivity (95% CI 0.19–0.81), 0.88 specificity (95% CI 0.83–0.92) and a negative predictive value of 0.98 (0.96–0.99). The shock index may help to identify trauma patients at risk of hypofibrinogenemia early in the prehospital course. Full article

(This article belongs to the Section Emergency Medicine)

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11 pages, 1499 KiB

Open AccessArticle

Transcutaneous Carbon Dioxide Monitoring More Accurately Detects Hypercapnia than End-Tidal Carbon Dioxide Monitoring during Non-Intubated Video-Assisted Thoracic Surgery: A Retrospective Cohort Study

by Hyun Jung Lee, Jae Hee Woo, Sooyoung Cho, Sunyoung Moon and Sook Whan Sung

J. Clin. Med. 2023, 12(4), 1706; https://doi.org/10.3390/jcm12041706 - 20 Feb 2023

Viewed by 2946

Abstract

Transcutaneous carbon dioxide (PtcCO₂) monitoring is known to be effective at estimating the arterial partial pressure of carbon dioxide (PaCO₂) in patients with sedation-induced respiratory depression. We aimed to investigate the accuracy of PtcCO₂ monitoring to measure PaCO [...] Read more.

Transcutaneous carbon dioxide (PtcCO₂) monitoring is known to be effective at estimating the arterial partial pressure of carbon dioxide (PaCO₂) in patients with sedation-induced respiratory depression. We aimed to investigate the accuracy of PtcCO₂ monitoring to measure PaCO₂ and its sensitivity to detect hypercapnia (PaCO₂ > 60 mmHg) compared to nasal end-tidal carbon dioxide (PetCO₂) monitoring during non-intubated video-assisted thoracoscopic surgery (VATS). This retrospective study included patients undergoing non-intubated VATS from December 2019 to May 2021. Datasets of PetCO₂, PtcCO₂, and PaCO₂ measured simultaneously were extracted from patient records. Overall, 111 datasets of CO₂ monitoring during one-lung ventilation (OLV) were collected from 43 patients. PtcCO₂ had higher sensitivity and predictive power for hypercapnia during OLV than PetCO₂ (84.6% vs. 15.4%, p < 0.001; area under the receiver operating characteristic curve; 0.912 vs. 0.776, p = 0.002). Moreover, PtcCO₂ was more in agreement with PaCO₂ than PetCO₂, indicated by a lower bias (bias ± standard deviation; −1.6 ± 6.5 mmHg vs. 14.3 ± 8.4 mmHg, p < 0.001) and narrower limit of agreement (−14.3–11.2 mmHg vs. −2.2–30.7 mmHg). These results suggest that concurrent PtcCO₂ monitoring allows anesthesiologists to provide safer respiratory management for patients undergoing non-intubated VATS. Full article

(This article belongs to the Section Anesthesiology)

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15 pages, 2199 KiB

Open AccessArticle

Non-Diabetic Kidney Disease in Type 2 Diabetes Mellitus: A Changing Spectrum with Therapeutic Ascendancy

by Narayan Prasad, Vamsidhar Veeranki, Dharmendra Bhadauria, Ravi Kushwaha, Jeyakumar Meyyappan, Anupama Kaul, Manas Patel, Manas Behera, Monika Yachha, Vinita Agrawal and Manoj Jain

J. Clin. Med. 2023, 12(4), 1705; https://doi.org/10.3390/jcm12041705 - 20 Feb 2023

Cited by 3 | Viewed by 3285

Abstract

Background and objectives: Owing to changing epidemiology and therapeutic practices, a change in the spectrum of renal involvement in Type-2 diabetes mellitus (T2DM) has also been noted. The treatment of non-diabetic kidney disease (NDKD) differs from diabetic kidney disease (DKD) and the reversibility [...] Read more.

Background and objectives: Owing to changing epidemiology and therapeutic practices, a change in the spectrum of renal involvement in Type-2 diabetes mellitus (T2DM) has also been noted. The treatment of non-diabetic kidney disease (NDKD) differs from diabetic kidney disease (DKD) and the reversibility of NDKD in many cases to normal, prompts biopsy for rapid and accurate diagnosis. Data are scarce on kidney biopsy findings in T2DM. Study design & setting: In this observational study, we prospectively collected the data of kidney biopsies of patients aged

\geq

18 years with T2DM admitted between 1 August 2005 and 31 July 2022. The clinical, demographic and histopathological data were evaluated. The spectrum of kidney involvement in the form of DKD and/or NDKD was studied. The impact of these findings with the use of drugs retarding disease progression was also analyzed. Results: A total of 5485 biopsies were performed during the study period and of these 538 patients had T2DM. The mean age of the study population was 56.9

\pm

11.5 years and 81% were males. The mean duration of DM was 6.4

\pm

6.1 years. Diabetic retinopathy (DR) was noted in 29.7%. The most common indication for biopsy was an acute rise in creatinine (147, 27.3%). Amongst the 538 diabetic patients who underwent biopsy, histological features only of DKD were noted in 166 patients (33%), NDKD alone in 262 (49%) and NDKD with DKD lesions in 110 (20%). On multivariate analysis, duration of DM less than 5 years, absence of CAD, absence of DR, oliguria at presentation, an acute rise in creatinine and low C3 were associated with NDKD. Conclusions: The prevalence of NDKD among diabetics and ATIN in particular might be on an increasing trend in the current era of changing T2DM epidemiological patterns. The use of anti-pro-teinuric agents was associated with lesser degrees of histopathological chronicity in T2DM. Full article

(This article belongs to the Special Issue Diabetic Kidney Disease: Epidemiology, Risk Factors for Disease Progression and Cardiovascular Complications, Novel Diagnostics and Treatments)

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13 pages, 1590 KiB

Open AccessArticle

Tumor Immune Microenvironment Heterogeneity at the Invasion Front and Tumor Center in Oral Squamous Cell Carcinoma as a Perspective of Managing This Cancer Entity

by Andreas Mamilos, Alexander Lein, Lina Winter, Tobias Ettl, Julian Künzel, Torsten E. Reichert, Gerrit Spanier and Christoph Brochhausen

J. Clin. Med. 2023, 12(4), 1704; https://doi.org/10.3390/jcm12041704 - 20 Feb 2023

Cited by 1 | Viewed by 1729

Abstract

Background: Evaluating the tumor microenvironment and its influence on clinical management and therapy response is becoming increasingly important. However, only a few studies deal with the spatial distribution of immune cells within the tumor. This study aimed to describe the topology of immune [...] Read more.

Background: Evaluating the tumor microenvironment and its influence on clinical management and therapy response is becoming increasingly important. However, only a few studies deal with the spatial distribution of immune cells within the tumor. This study aimed to describe the topology of immune cells in the microenvironment of oral squamous cell carcinoma (OSCC) sectioned by tumor invasion front and tumor center and to test their prognostic relevance regarding patient survival. Methods: A total of 55 OSCC patient specimens were collected retrospectively. The cancer tissue was immunohistochemically stained using an automated tissue stainer Ventana Benchmark Ultra (Roche) and analyzed using discrete expression marker profiles on immune cells. We investigated CD4+ lymphocytes, CD8+ lymphocytes, CD68+ macrophages, CD163+ macrophages, and M1 macrophages regarding their spatial distribution. Results: The statistical analysis revealed that the quantity and distribution of CD4+ (p = 0.007), CD8+ (p < 0.001), CD68+ (p < 0.001), CD163+ cells (p = 0.004), and M1 (p < 0.001) macrophages were significantly higher at the invasion front compared to the tumor center in all observed cases. However, high and low immune cell counts in the tumor center and invasion front were not associated with overall survival. Conclusion: Our results show two distinct immune microenvironments of the tumor center compared to the invasion front. Future studies are needed to explore how these results can be leveraged to improve patient therapy and outcome. Full article

(This article belongs to the Special Issue New Frontiers in Head and Neck Oncology: Treatment and Reconstruction)

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10 pages, 2118 KiB

Open AccessArticle

Dental Implant Surface Decontamination and Surface Change of an Electrolytic Method versus Mechanical Approaches: A Pilot In Vitro Study

by Mariana Anselmo Assunção, João Botelho, Vanessa Machado, Luís Proença, António P. A. Matos, José João Mendes, Lucinda J. Bessa, Nuno Taveira and Alexandre Santos

J. Clin. Med. 2023, 12(4), 1703; https://doi.org/10.3390/jcm12041703 - 20 Feb 2023

Cited by 1 | Viewed by 2372

Abstract

Dental implants are the preferred fixed oral rehabilitation for replacing lost teeth. When peri-implant tissues become inflamed, the removal of plaque accumulating around the implant becomes imperative. Recently, several new strategies have been developed for this purpose, with electrolytic decontamination showing increased potential [...] Read more.

Dental implants are the preferred fixed oral rehabilitation for replacing lost teeth. When peri-implant tissues become inflamed, the removal of plaque accumulating around the implant becomes imperative. Recently, several new strategies have been developed for this purpose, with electrolytic decontamination showing increased potential compared to traditional mechanical strategies. In this in vitro pilot study, we compare the efficacy of an electrolytic decontaminant (Galvosurge^®) with an erythritol jet system (PerioFlow^®) and two titanium brushes (R-Brush™ and i-Brush™) in removing Pseudomonas aeruginosa PAO1 biofilms from implants. Changes in the implant surface after each approach were also evaluated. Twenty titanium SLA implants were inoculated with P. aeruginosa and then randomly assigned to each treatment group. After treatment, decontamination efficacy was assessed by quantifying colony-forming units (log10 CFU/cm²) from each implant surface. Scanning electron microscopy was used to analyse changes in the implant surface. With the exception of R-Brush, all treatment strategies were similarly effective in removing P. aeruginosa from implants. Major surface changes were observed only in implants treated with titanium brushes. In conclusion, this pilot study suggests that electrolytic decontamination, erythritol-chlorhexidine particle jet system and i-Brush™ brushing have similar performance in removing P. aeruginosa biofilm from dental implants. Further studies are needed to evaluate the removal of more complex biofilms. Titanium brushes caused significant changes to the implant surface, the effects of which need to be evaluated. Full article

(This article belongs to the Special Issue Recent Advances in Dental Implantology: Part II)

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11 pages, 280 KiB

Open AccessReview

Exploring Pharmacological Treatments for Chronic Idiopathic Constipation in Adults: A Look Back to the Future

by Gabrio Bassotti, Vincenzo Villanacci and Maura Corsetti

J. Clin. Med. 2023, 12(4), 1702; https://doi.org/10.3390/jcm12041702 - 20 Feb 2023

Cited by 3 | Viewed by 1651

Abstract

Despite great progress in pharmaceutical research, the medical treatment of chronic idiopathic constipation is far from ideal. The aim of the present article was to review literature data, focusing on poorly studied or commercially unavailable/unapproved drugs potentially useful for the treatment of chronic [...] Read more.

Despite great progress in pharmaceutical research, the medical treatment of chronic idiopathic constipation is far from ideal. The aim of the present article was to review literature data, focusing on poorly studied or commercially unavailable/unapproved drugs potentially useful for the treatment of chronic idiopathic constipation in adults. An extensive online literature search was conducted using the keywords “chronic constipation”, “colon”, “constipation”, “drugs”, “laxatives”, and “treatment”, in various combinations between January 1960 and December 2022. The literature search showed the presence of some drugs whose efficacy has only recently been demonstrated by modern investigations, and which are likely to be incorporated into future guidelines, of others that are proven effective and potentially effective on constipated patients but limited by small or relatively old studies, or by side effects which could be used in experienced hands, and of others that might be useful but lack a solid scientific background. Looking into the future for patients with chronic constipation might add some more tools to the therapeutic portfolio, especially for certain subgroups of these patients. Full article

(This article belongs to the Special Issue New Insights in Management of Constipation)

10 pages, 1751 KiB

Open AccessArticle

Oral Cell Lysates Reduce the Inflammatory Response of Activated Macrophages

by Layla Panahipour, Azarakhsh Oladzad Abbasabadi and Reinhard Gruber

J. Clin. Med. 2023, 12(4), 1701; https://doi.org/10.3390/jcm12041701 - 20 Feb 2023

Cited by 2 | Viewed by 952

Abstract

Necrotic cell damage occurs as a consequence of invasive dental procedures. Loss of membrane integrity being the hallmark of necrotic cells leads to the release of cytoplasmic and membranous components. Macrophages are predestined to respond to lysates originating from necrotic cells. Here, we [...] Read more.

Necrotic cell damage occurs as a consequence of invasive dental procedures. Loss of membrane integrity being the hallmark of necrotic cells leads to the release of cytoplasmic and membranous components. Macrophages are predestined to respond to lysates originating from necrotic cells. Here, we implement necrotic lysates from human gingival fibroblasts, HSC2, and TR146 oral epithelial cell lines, and RAW264.7 macrophage cell lines to be tested for their potential to modulate the inflammatory response of macrophages. To this aim, necrotic cell lysates were prepared by sonication or freezing/thawing of the respective cell suspension. Necrotic cell lysates were tested for their potential to modulate the lipopolysaccharide (LPS)-induced expression of inflammatory cytokines using RAW264.7 macrophages as a bioassay. We show here that all necrotic cell lysates, independent of the origin and the preparation way, reduced the expression of IL1 and IL6 in LPS-induced RAW264.7 macrophages, most obviously shown for TR146 cells. This finding was supported in a bioassay when macrophages were exposed to poly (I:C) HMW, an agonist of TLR-3. Consistently, all necrotic lysates from gingival fibroblasts, HSC2, TR146, and RAW264.7 cells reduced the nuclear translocation of p65 in LPS-exposed macrophages. This screening approach supports the overall concept that necrotic cell lysates can modulate the inflammatory capacity of macrophages. Full article

(This article belongs to the Special Issue Experimental Dental Research—New Concepts for Future Patient Needs: Part II)

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9 pages, 542 KiB

Open AccessArticle

Comparing the Clinical Manifestations of Bell’s Palsy between Pre-COVID-19 Pandemic and COVID-19 Pandemic Periods

by Gang Won Choi, Dong Keon Yon, Yong Sung Choi, Jinseok Lee, Ki Ho Park, Young Ju Lee, Dong Choon Park, Sang Hoon Kim, Jae Young Byun and Seung Geun Yeo

J. Clin. Med. 2023, 12(4), 1700; https://doi.org/10.3390/jcm12041700 - 20 Feb 2023

Cited by 1 | Viewed by 1594

Abstract

Background: COVID-19 has been shown to affect the onset and severity of various diseases. We examined whether the clinical characteristics of Bell’s palsy differed between before and during the COVID-19 pandemic. Methods: From January 2005 to December 2021, 1839 patients were diagnosed and [...] Read more.

Background: COVID-19 has been shown to affect the onset and severity of various diseases. We examined whether the clinical characteristics of Bell’s palsy differed between before and during the COVID-19 pandemic. Methods: From January 2005 to December 2021, 1839 patients were diagnosed and treated for Bell’s palsy at Kyung Hee University Hospital. These patients were divided into a pre-COVID period group and COVID-19 period group, and the clinical characteristics of the two groups were compared. Results: There were 1719 patients in the pre-COVID period group and 120 patients in the COVID-19 period group. There were no between-group differences in sex (p = 0.103) or in the presence of underlying hypertension (p = 0.632) or diabetes (p = 0.807). Regarding symptoms, there were no significant between-group differences in otalgia, dizziness, tinnitus, hyperacusis, or hearing loss (p = 0.304, p = 0.59, p = 0.351, p = 0.605, and p = 0.949). There were also no significant between-group differences in electroneurography results (p = 0.398), electromyography results (p = 0.331), House–Brackmann Grade at visit (p = 0.634), or recovery rate after treatment (p = 0.525). Conclusions: Contrary to our expectation that Bell’s palsy cases during the COVID-19 pandemic would show different clinical features than those occurring before COVID-19, the present study found no differences in clinical features or prognosis. Full article

(This article belongs to the Section Clinical Neurology)

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9 pages, 521 KiB

Open AccessArticle

Endoscopic Grading as a Predictor to Develop Strictures in Corrosive Esophagitis in Children

by Ioana Badiu Tisa, Lia Pepelea, Alexandru Pirvan, Iulia Lupan, Gabriel Samasca and Madalina Adriana Bordea

J. Clin. Med. 2023, 12(4), 1699; https://doi.org/10.3390/jcm12041699 - 20 Feb 2023

Cited by 1 | Viewed by 1712

Abstract

Introduction. The incidence of corrosive esophagitis, also known as caustic esophagitis in children, is still increasing in developing countries, according to different clinical reports. Acids and alkalis are, in the same manner, involved in the pathogenesis of corrosive esophagitis in children. The aim [...] Read more.

Introduction. The incidence of corrosive esophagitis, also known as caustic esophagitis in children, is still increasing in developing countries, according to different clinical reports. Acids and alkalis are, in the same manner, involved in the pathogenesis of corrosive esophagitis in children. The aim of our study was to determine the incidence and endoscopic grading of corrosive esophagitis in a cohort of children from a developing country. Materials and methods. We performed a retrospective analysis of all pediatric patients who were admitted for corrosive ingestion at Pediatric Clinic II, Emergency Hospital for Children, Cluj-Napoca, over 10 years. Results. A total of 22 patients consisting of 13 (59.09%) girls and 9 boys (40.91%) were found in the present research. The majority of children lived in rural areas (69.2%). The results of laboratory tests were not well correlated with the degree of the injury. White blood cell counts over 20,000 cells/mm³, an increase in the C-reactive protein level and hypoalbuminemia were noticed only in three patients with strictures. The lesions were associated with increased levels of the pro-inflammatory cytokines, including interleukin (IL)-2, IL-5 and Interferon-gamma. Severe late complications such as strictures have been noticed in children with grade 3A injuries. The endoscopic dilation was done after the six months endoscopy. None of the patients treated with endoscopic dilation required surgical intervention for esophageal or pyloric perforation or dilation failure. The majority of complications (such as malnutrition) were noticed in children with grade 3A injuries. In consequence, prolonged hospitalization has been required. The second endoscopy (done six months after ingestion) revealed stricture as the most common late complication (n = 13, 60.60%: eight patients with grade 2B and five with grade 3A). Conclusion. There is a low incidence of corrosive esophagitis in children in our geographic area. Endoscopic grading is a predictor of late complications such as strictures. Grade 2B and 3A corrosive esophagitis are likely to develop strictures. It is crucial to avoid strictures and to prevent malnutrition. Full article

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

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17 pages, 1584 KiB

Open AccessReview

Cardioplegia in Open Heart Surgery: Age Matters

by Jovana Bradić, Marijana Andjić, Jovana Novaković, Nevena Jeremić and Vladimir Jakovljević

J. Clin. Med. 2023, 12(4), 1698; https://doi.org/10.3390/jcm12041698 - 20 Feb 2023

Cited by 7 | Viewed by 5803

Abstract

Introduction: Cardioplegia is a pharmacological approach essential for the protection of the heart from ischemia–reperfusion (I–R) injury. Over the years, numerous cardioplegic solutions have been developed, with each cardioplegic approach having its advantages and disadvantages. Cardioplegic solutions can be divided into crystalloid and [...] Read more.

Introduction: Cardioplegia is a pharmacological approach essential for the protection of the heart from ischemia–reperfusion (I–R) injury. Over the years, numerous cardioplegic solutions have been developed, with each cardioplegic approach having its advantages and disadvantages. Cardioplegic solutions can be divided into crystalloid and blood cardioplegic solutions, and an experienced surgeon chooses the type of solution based on the individual needs of patients in order to provide optimal heart protection. Importantly, the pediatric immature myocardium is structurally, physiologically, and metabolically different from the adult heart, and consequently its needs to achieve cardioplegic arrest strongly differ. Therefore, the present review aimed to provide a summary of the cardioplegic solutions available to pediatric patients with a special focus on emphasizing differences in heart injury after various cardioplegic solutions, the dosing strategies, and regimens. Material and methods: The PubMed database was searched using the terms cardioplegia, I–R, and pediatric population, and studies that investigated the influence of cardioplegic strategies on markers of cardiac muscle damage were further analyzed in this review. Conclusions: A large body of evidence suggested more prominent benefits achieved with blood compared to those with crystalloid cardioplegia in pediatric myocardium preservation. However, standardized and uniform protocols have not been established so far, and an experienced surgeon chooses the type of cardioplegia solution based on the individual needs of patients, while the severity of myocardial damage strongly depends on the type and duration of the surgical procedure, overall patient condition, and presence of comorbidities, etc. Full article

(This article belongs to the Section Cardiology)

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9 pages, 266 KiB

Open AccessArticle

Intravitreal Dexamethasone Implant at the Time of Silicone Oil Removal to Treat Persistent Macular Edema after Rhegmatogenous Retinal Detachment Repair

by Francesco Pignatelli, Annalisa Nacucchi, Alfredo Niro, Samuele Gigliola, Fedele Passidomo, Rossella Donghia and Giuseppe Addabbo

J. Clin. Med. 2023, 12(4), 1697; https://doi.org/10.3390/jcm12041697 - 20 Feb 2023

Cited by 1 | Viewed by 1045

Abstract

Background: An intravitreal dexamethasone implant (DEX-I) was found to be effective and safe for the treatment of cystoid macular edema (CME) after vitrectomy for rhegmatogenous retinal detachment (RRD) and in silicone oil (SO)-filled eyes. We aimed to investigate the efficacy and safety of [...] Read more.

Background: An intravitreal dexamethasone implant (DEX-I) was found to be effective and safe for the treatment of cystoid macular edema (CME) after vitrectomy for rhegmatogenous retinal detachment (RRD) and in silicone oil (SO)-filled eyes. We aimed to investigate the efficacy and safety of DEX-I at the time of SO removal for the treatment of recalcitrant CME after successful RRD repair. Methods: A retrospective review of the medical records was performed on 24 consecutive patients (24 eyes) with recalcitrant CME after RRD repair who were treated with a single 0.7-mg DEX-I at the time of SO removal. The main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT). A regression model was performed to assess the relationship between BCVA and CMT at 6 months and independent variables. Results: In all 24 patients, CME occurred after RRD repair and remained despite topical therapy. The mean time of CME onset was 27.4 ± 7.7 days after vitrectomy. The mean time between vitrectomy and DEX-I was 106.8 ± 10.1 days. The mean CMT was significantly decreased from 429.6 ± 59.1 µm at baseline to 294 ± 46.4 µm at month 6 (p < 0.0001). The mean BCVA significantly improved from 0.99 ± 0.3 at baseline to 0.60 ± 0.3 at month 6 (p < 0.0001). An elevation of intraocular pressure was observed in one (4.1%) eye, which was medically managed. A univariate regression model revealed a relationship between month-6 BCVA after DEX-I and gender (β = −0.27; p = 0.03) and macular status (β = −0.45; p = 0.001) when RRD occurred. No relationship between month-6 CMT and independent variables was found. Conclusions: DEX-I at the time of SO removal had an acceptable safety profile and achieved favorable outcomes in eyes affected by recalcitrant CME that occurred after RRD repair. RRD-related macular status is significantly associated with visual acuity after DEX-I. Full article

(This article belongs to the Special Issue Latest Advances and Prospects in Macular Edema)

11 pages, 1351 KiB

Open AccessArticle

Mortality and Associated Causes in Hemophagocytic Lymphohistiocytosis: A Multiple-Cause-of-Death Analysis in France

by Solène La Marle, Gaëlle Richard-Colmant, Mathieu Fauvernier, Hervé Ghesquières, Arnaud Hot, Pascal Sève and Yvan Jamilloux

J. Clin. Med. 2023, 12(4), 1696; https://doi.org/10.3390/jcm12041696 - 20 Feb 2023

Cited by 5 | Viewed by 2318

Abstract

Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome with an overall mortality rate of 40%. A multiple-cause-of-death analysis allows for the characterization of mortality and associated causes over an extended period. Death certificates, collected between 2000 and 2016 by the French Epidemiological Centre [...] Read more.

Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome with an overall mortality rate of 40%. A multiple-cause-of-death analysis allows for the characterization of mortality and associated causes over an extended period. Death certificates, collected between 2000 and 2016 by the French Epidemiological Centre for the Medical Causes of Death (CepiDC, Inserm), containing the ICD10 codes for HLH (D76.1/2), were used to calculate HLH-related mortality rates and to compare them with the general population (observed/expected ratios, O/E). HLH was mentioned in 2072 death certificates as the underlying cause of death (UCD, n = 232) or as a non-underlying cause of death (NUCD, n = 1840). The mean age at death was 62.4 years. The age-standardized mortality rate was 1.93/million person-years and increased over the study period. When HLH was an NUCD, the most frequently associated UCDs were hematological diseases (42%), infections (39.4%), and solid tumors (10.4%). As compared to the general population, HLH decedents were more likely to have associated CMV infections or hematological diseases. The increase in mean age at death over the study period indicates progress in diagnostic and therapeutic management. This study suggests that the prognosis of HLH may be at least partially related to coexisting infections and hematological malignancies (either as causes of HLH or as complications). Full article

(This article belongs to the Special Issue Cytokine Storms, Hemophagocytic Lymphohistiocytosis and Hyperferritinemic Syndromes: Clinical Management)

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13 pages, 1840 KiB

Open AccessArticle

Prediction of Blood Risk Score in Diabetes Using Deep Neural Networks

by J. Quetzalcóatl Toledo-Marín, Taqdir Ali, Tibor van Rooij, Matthias Görges and Wyeth W. Wasserman

J. Clin. Med. 2023, 12(4), 1695; https://doi.org/10.3390/jcm12041695 - 20 Feb 2023

Viewed by 1574

Abstract

Improving the prediction of blood glucose concentration may improve the quality of life of people living with type 1 diabetes by enabling them to better manage their care. Given the anticipated benefits of such a prediction, numerous methods have been proposed. Rather than [...] Read more.

Improving the prediction of blood glucose concentration may improve the quality of life of people living with type 1 diabetes by enabling them to better manage their care. Given the anticipated benefits of such a prediction, numerous methods have been proposed. Rather than attempting to predict glucose concentration, a deep learning framework for prediction is proposed in which prediction is performed using a scale for hypo- and hyper-glycemia risk. Using the blood glucose risk score formula proposed by Kovatchev et al., models with different architectures were trained, including, a recurrent neural network (RNN), a gated recurrent unit (GRU), a long short-term memory (LSTM) network, and an encoder-like convolutional neural network (CNN). The models were trained using the OpenAPS Data Commons data set, comprising 139 individuals, each with tens of thousands of continuous glucose monitor (CGM) data points. The training set was composed of 7% of the data set, while the remaining was used for testing. Performance comparisons between the different architectures are presented and discussed. To evaluate these predictions, performance results are compared with the last measurement (LM) prediction, through a sample-and-hold approach continuing the last known measurement forward. The results obtained are competitive when compared to other deep learning methods. A root mean squared error (RMSE) of 16 mg/dL, 24 mg/dL, and 37 mg/dL were obtained for CNN prediction horizons of 15, 30, and 60 min, respectively. However, no significant improvements were found for the deep learning models compared to LM prediction. Performance was found to be highly dependent on architecture and the prediction horizon. Lastly, a metric to assess model performance by weighing each prediction point error with the corresponding blood glucose risk score is proposed. Two main conclusions are drawn. Firstly, going forward, there is a need to benchmark model performance using LM prediction to enable the comparison between results obtained from different data sets. Secondly, model-agnostic data-driven deep learning models may only be meaningful when combined with mechanistic physiological models; here, it is argued that neural ordinary differential equations may combine the best of both approaches. These findings are based on the OpenAPS Data Commons data set and are to be validated in other independent data sets. Full article

(This article belongs to the Special Issue The Convergence of Human and Artificial Intelligence on Clinical Care - Part II)

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10 pages, 1734 KiB

Open AccessArticle

Clinical and Functional Results of Cementless Unicompartmental Knee Arthroplasty with a Minimum Follow Up of 5 Years—A Consecutive Cohort of 201 Patients

by Benjamin Panzram, Frederik Barbian, Tobias Reiner, Mustafa Hariri, Tobias Renkawitz and Tilman Walker

J. Clin. Med. 2023, 12(4), 1694; https://doi.org/10.3390/jcm12041694 - 20 Feb 2023

Cited by 1 | Viewed by 1165

Abstract

The number of unicompartmental knee replacements (UKR) is increasing. Alongside various advantages, the revision rate of cemented UKR is higher compared to total knee arthroplasty (TKR). In contrast, cementless fixation shows reduced revision rates, compared to the cemented UKR. However, most of the [...] Read more.

The number of unicompartmental knee replacements (UKR) is increasing. Alongside various advantages, the revision rate of cemented UKR is higher compared to total knee arthroplasty (TKR). In contrast, cementless fixation shows reduced revision rates, compared to the cemented UKR. However, most of the recent literature is based on designer-dependent studies. In this retrospective, single-center cohort study, we investigated patients who underwent cementless Oxford UKR (OUKR) between 2012 and 2016 in our hospital with a minimum follow-up of five years. Clinical outcome was evaluated using the OKS, AKSS-O, AKSS-F, FFbH-OA, UCLA, SF-36, EQ-5D-3L, FJS, ROM, pain, and satisfaction measures. Survival analysis was performed with reoperation and revision as endpoints. We included 201 patients (216 knees) for clinical evaluation. All outcome parameters increased significantly from pre- to postoperative stages. The five-year survival rate was 96.1% for revision surgery and 94.9% for reoperation. The main reasons for revision were the progression of osteoarthritis, inlay dislocation, and tibial overstuffing. Two iatrogenic tibial fractures appeared. Cementless OUKR shows excellent clinical outcome and high survival rates after five years. The tibial plateau fracture in cementless UKR represents a serious complication and requires modification of the surgical technique. Full article

(This article belongs to the Section Orthopedics)

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15 pages, 279 KiB

Open AccessArticle

“I Have Eight Different Files at Eight Different Places”: Perspectives of Youths and Their Family Caregivers on Transitioning from Pediatric to Adult Rehabilitation and Community Services

by Kristina M. Kokorelias, Tin-Suet Joan Lee, Mark Bayley, Emily Seto, Alene Toulany, Michelle L. A. Nelson, Gina Dimitropoulos, Melanie Penner, Robert Simpson and Sarah E. P. Munce

J. Clin. Med. 2023, 12(4), 1693; https://doi.org/10.3390/jcm12041693 - 20 Feb 2023

Cited by 2 | Viewed by 1464

Abstract

Introduction: The number of young adults (youth) living with childhood-onset disabilities, and requiring transitional support to adult community and rehabilitation services, is increasing. We explored facilitators and barriers to accessing and sustaining community and rehabilitation services during the transition from pediatric to adult [...] Read more.

Introduction: The number of young adults (youth) living with childhood-onset disabilities, and requiring transitional support to adult community and rehabilitation services, is increasing. We explored facilitators and barriers to accessing and sustaining community and rehabilitation services during the transition from pediatric to adult care. Methods: A qualitative descriptive study was conducted in Ontario, Canada. Data were collected through interviews with youth (n = 11) and family caregivers (n = 7). The data were coded and analyzed using thematic analysis. Results: Youth and caregivers face many types of transitions from pediatric to adult community and rehabilitation services, e.g., those related to education, living arrangements, and employment. This transition is marked by feelings of isolation. Supportive social networks, continuity of care (i.e., same care providers), and advocacy all contribute to positive experiences. Lack of knowledge about resources, changing parental involvement without preparation, and a lack of system responses to evolving needs were barriers to positive transitions. Financial circumstances were described as either a barrier or facilitator to service access. Conclusions: This study demonstrated that continuity of care, support from providers, and social networks all contribute markedly to the positive experience of transitioning from pediatric to adult services for individuals with childhood-onset disabilities and family caregivers. Future transitional interventions should incorporate these considerations. Full article

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

13 pages, 2646 KiB

Open AccessArticle

Association of Serum BAFF Levels with Cardiovascular Events in ST-Segment Elevation Myocardial Infarction

by Ziyang Wang, Yueying Wang, Yuke Cui, Zhiyong Chen, Lei Yi, Zhengbin Zhu, Jingwei Ni, Run Du, Xiaoqun Wang, Jinzhou Zhu, Fenghua Ding, Weiwei Quan, Ruiyan Zhang, Jian Hu and Xiaoxiang Yan

J. Clin. Med. 2023, 12(4), 1692; https://doi.org/10.3390/jcm12041692 - 20 Feb 2023

Cited by 3 | Viewed by 1384

Abstract

Objectives: The B cell activating factor (BAFF) is a B cell survival factor involved in atherosclerosis and ischemia-reperfusion (IR) injury. This study sought to investigate whether BAFF is a potential predictor of poor outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Methods: [...] Read more.

Objectives: The B cell activating factor (BAFF) is a B cell survival factor involved in atherosclerosis and ischemia-reperfusion (IR) injury. This study sought to investigate whether BAFF is a potential predictor of poor outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Methods: We prospectively enrolled 299 patients with STEMI, and serum levels of BAFF were measured. All subjects were followed for three years. The primary endpoint was major adverse cardiovascular events (MACEs), including cardiovascular death, nonfatal reinfarction, hospitalization for heart failure (HF), and stroke. Multivariable Cox proportional hazards models were constructed to analyze the predictive value of BAFF for MACEs. Results: In multivariate analysis, BAFF was independently associated with risk of MACEs (adjusted HR 1.525, 95% CI 1.085–2.145; p = 0.015) and cardiovascular death (adjusted hazard ratio [HR] 3.632, 95% confidence interval [CI] 1.132–11.650, p = 0.030) after adjustment for traditional risk factors. Kaplan-Meier survival curves demonstrated that patients with BAFF levels above the cut-off value (1.46 ng/mL) were more likely to have MACEs (log-rank p < 0.0001) and cardiovascular death (log-rank p < 0.0001). In subgroup analysis, the impact of high BAFF on MACEs development was stronger in patients without dyslipidemia. Furthermore, the C-statistic and Integrated Discrimination Improvement (IDI) values for MACEs were improved with BAFF as an independent risk factor or when combined with cardiac troponin I. Conclusions: This study suggests that higher BAFF levels in the acute phase are an independent predictor of the incidence of MACEs in patients with STEMI. Full article

(This article belongs to the Section Cardiology)

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15 pages, 2330 KiB

Open AccessArticle

Predictability of Radiologically Measured Psoas Muscle Area for Intraoperative Hypotension in Older Adult Patients Undergoing Femur Fracture Surgery

by Youn Young Lee, Jae Hee Woo, In-Young Yoon, Hyun Jung Lee, Sang-Mee Ahn, Ji Seon Chae and Youn Jin Kim

J. Clin. Med. 2023, 12(4), 1691; https://doi.org/10.3390/jcm12041691 - 20 Feb 2023

Viewed by 1381

Abstract

This retrospective study aimed to determine the predictive value of radiologically measured psoas muscle area (PMA) for intraoperative hypotension (IOH) using receiver operating characteristic (ROC) curves in older adult patients with hip fractures. The cross-sectional axial area of the psoas muscle was measured [...] Read more.

This retrospective study aimed to determine the predictive value of radiologically measured psoas muscle area (PMA) for intraoperative hypotension (IOH) using receiver operating characteristic (ROC) curves in older adult patients with hip fractures. The cross-sectional axial area of the psoas muscle was measured by CT at the level of the 4th lumbar vertebrae and normalized by body surface area (BSA). The modified frailty index (mFI) was used to assess frailty. IOH was defined as an absolute threshold of mean arterial blood pressure (MAP) < 65 mmHg or a relative decrease in MAP > 30% from baseline MAP. Among the 403 patients, 286 (71.7%) had developed IOH. PMA normalized by BSA in male patients was 6.90 ± 0.73 in the no-IOH group and 4.95 ± 1.20 in the IOH group (p < 0.001). PMA normalized by BSA in female patients was 5.18 ± 0.81 in the no-IOH group and 3.78 ± 0.75 in the IOH group (p < 0.001). The ROC curves showed that the area under the curve for PMA normalized by BSA and modified frailty index (mFI) were 0.94 for male patients, 0.91 for female patients, and 0.81 for mFI (p < 0.001). In multivariate logistic regression, low PMA normalized by BSA, high baseline systolic blood pressure, and old age were significant independent predictors of IOH (adjusted odds ratio: 3.86, 1.03, and 1.06, respectively). PMA measured by computed tomography showed an excellent predictive value for IOH. Low PMA was associated with developing IOH in older adult patients with hip fractures. Full article

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

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10 pages, 289 KiB

Open AccessArticle

Methods for the Inclusion of Real-World Evidence in a Rare Events Meta-Analysis of Randomized Controlled Trials

by Minghong Yao, Yuning Wang, Fan Mei, Kang Zou, Ling Li and Xin Sun

J. Clin. Med. 2023, 12(4), 1690; https://doi.org/10.3390/jcm12041690 - 20 Feb 2023

Cited by 3 | Viewed by 1319

Abstract

Background: Many rare events meta-analyses of randomized controlled trials (RCTs) have lower statistical power, and real-world evidence (RWE) is becoming widely recognized as a valuable source of evidence. The purpose of this study is to investigate methods for including RWE in a rare [...] Read more.

Background: Many rare events meta-analyses of randomized controlled trials (RCTs) have lower statistical power, and real-world evidence (RWE) is becoming widely recognized as a valuable source of evidence. The purpose of this study is to investigate methods for including RWE in a rare events meta-analysis of RCTs and the impact on the level of uncertainty around the estimates. Methods: Four methods for the inclusion of RWE in evidence synthesis were investigated by applying them to two previously published rare events meta-analyses: the naïve data synthesis (NDS), the design-adjusted synthesis (DAS), the use of RWE as prior information (RPI), and the three-level hierarchical models (THMs). We gauged the effect of the inclusion of RWE by varying the degree of confidence placed in RWE. Results: This study showed that the inclusion of RWE in a rare events meta-analysis of RCTs could increase the precision of the estimates, but this depended on the method of inclusion and the level of confidence placed in RWE. NDS cannot consider the bias of RWE, and its results may be misleading. DAS resulted in stable estimates for the two examples, regardless of whether we placed high- or low-level confidence in RWE. The results of the RPI approach were sensitive to the confidence level placed in RWE. The THM was effective in allowing for accommodating differences between study types, while it had a conservative result compared with other methods. Conclusion: The inclusion of RWE in a rare events meta-analysis of RCTs could increase the level of certainty of the estimates and enhance the decision-making process. DAS might be appropriate for inclusion of RWE in a rare event meta-analysis of RCTs, but further evaluation in different scenarios of empirical or simulation studies is still warranted. Full article

(This article belongs to the Special Issue Advances in Clinical Trials and Evidence Synthesis (CTES))

8 pages, 520 KiB

Open AccessArticle

Efficacy of 1-Year Cavacurmin^® Therapy in Reducing Prostate Growth in Men Suffering from Lower Urinary Tract Symptoms

by Giulio Milanese, Edoardo Agostini, Maria Vittoria De Angelis, Eugenio Pretore, Andrea Benedetto Galosi and Daniele Castellani

J. Clin. Med. 2023, 12(4), 1689; https://doi.org/10.3390/jcm12041689 - 20 Feb 2023

Cited by 2 | Viewed by 1809

Abstract

We aim to assess the effect of Cavacurmin^® on prostate volume (PV), lower urinary tract symptoms (LUTS) and micturition parameters in men after 1 year of therapy. From September 2020 to October 2021, data from 20 men with LUTS/benign prostatic hyperplasia and [...] Read more.

We aim to assess the effect of Cavacurmin^® on prostate volume (PV), lower urinary tract symptoms (LUTS) and micturition parameters in men after 1 year of therapy. From September 2020 to October 2021, data from 20 men with LUTS/benign prostatic hyperplasia and PV ≥40 mL who were on therapy with α1-adrenoceptor antagonists plus Cavacurmin^® were retrospectively compared with 20 men on only α1-adrenoceptor antagonists. Patients were evaluated at baseline and after 1 year using the International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), maximum urinary flow (Qmax) and PV. A Mann–Whitney U-test and Chi-square were used to assess the difference between the two groups. A comparison of paired data was performed with the Wilcoxon signed-rank test. Statistical significance was set at p-value < 0.05. There was no statistically significant difference in baseline characteristics between the two groups. At the 1-year follow-up, PV [55.0 (15.0) vs. 62.5 (18.0) mL, p = 0.04)], PSA [2.5 (1.5) ng/mL vs. 3.05 (2.7) vs. p = 0.009] and IPSS [13.5 (3.75) vs. 18 (9.25) p = 0.009] were significantly lower in the Cavacurmin^® group. Qmax was significantly higher in the Cavacurmin^® group [15.85 (2.9) vs. 14.5 (4.2), p = 0.022]. PV was reduced to 2 (5.75) mL in the Cavacurmin^® group from baseline, while it increased to 12 (6.75) mL in the α1-adrenoceptor antagonists group (p < 0.001). PSA decreased in the Cavacurmin^® group [−0.45 (0.55) ng/mL], whereas it increased in the α1-adrenoceptor antagonists group [0.5 (0.30) ng/mL, p < 0.001]. In conclusion, one-year Cavacurmin^® therapy was able to block prostate growth with a concomitant decrease in PSA value from baseline. The association of Cavacurmin^® with α1-adrenoceptor antagonists had a more beneficial effect compared to patients on α1-adrenoceptor antagonists alone but this needs further larger studies to be confirmed, particularly in the long-term. Full article

(This article belongs to the Section Nephrology & Urology)

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17 pages, 3419 KiB

Open AccessArticle

Preimplantation Genetic Testing (PGT) and Prenatal Diagnosis of Schaaf-Yang Syndrome: A Report of Three Families and a Research on Genotype–Phenotype Correlations

by Naixin Xu, Weihui Shi, Xianling Cao, Xuanyou Zhou, Hefeng Huang, Songchang Chen and Chenming Xu

J. Clin. Med. 2023, 12(4), 1688; https://doi.org/10.3390/jcm12041688 - 20 Feb 2023

Cited by 1 | Viewed by 1818

Abstract

Schaaf-Yang Syndrome (SYS) is a genetic disorder caused by truncating pathogenic variants in the paternal allele of the maternally imprinted, paternally expressed gene MAGEL2 and is characterized by genital hypoplasia, neonatal hypotonia, developmental delay, intellectual disability, autism spectrum disorder (ASD), and other features. [...] Read more.

Schaaf-Yang Syndrome (SYS) is a genetic disorder caused by truncating pathogenic variants in the paternal allele of the maternally imprinted, paternally expressed gene MAGEL2 and is characterized by genital hypoplasia, neonatal hypotonia, developmental delay, intellectual disability, autism spectrum disorder (ASD), and other features. In this study, eleven SYS patients from three families were enrolled and comprehensive clinical features were gathered regarding each family. Whole-exome sequencing (WES) was performed for the definitive molecular diagnosis of the disease. Identified variants were validated using Sanger sequencing. Three couples underwent PGT for monogenic diseases (PGT-M) and/or a prenatal diagnosis. Haplotype analysis was performed to deduce the embryo’s genotype by using the short tandem repeats (STRs) identified in each sample. The prenatal diagnosis results showed that the fetus in each case did not carry pathogenic variants, and all the babies of the three families were born at full term and were healthy. We also performed a review of SYS cases. In addition to the 11 patients in our study, a total of 127 SYS patients were included in 11 papers. We summarized all variant sites and clinical symptoms thus far, and conducted a genotype–phenotype correlation analysis. Our results also indicated that the variation in phenotypic severity may depend on the specific location of the truncating variant, suggestive of a genotype–phenotype association. Full article

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

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13 pages, 1891 KiB

Open AccessSystematic Review

Automated Capture of Intraoperative Adverse Events Using Artificial Intelligence: A Systematic Review and Meta-Analysis

by Michael B. Eppler, Aref S. Sayegh, Marissa Maas, Abhishek Venkat, Sij Hemal, Mihir M. Desai, Andrew J. Hung, Teodor Grantcharov, Giovanni E. Cacciamani and Mitchell G. Goldenberg

J. Clin. Med. 2023, 12(4), 1687; https://doi.org/10.3390/jcm12041687 - 20 Feb 2023

Cited by 6 | Viewed by 2544

Abstract

Intraoperative adverse events (iAEs) impact the outcomes of surgery, and yet are not routinely collected, graded, and reported. Advancements in artificial intelligence (AI) have the potential to power real-time, automatic detection of these events and disrupt the landscape of surgical safety through the [...] Read more.

Intraoperative adverse events (iAEs) impact the outcomes of surgery, and yet are not routinely collected, graded, and reported. Advancements in artificial intelligence (AI) have the potential to power real-time, automatic detection of these events and disrupt the landscape of surgical safety through the prediction and mitigation of iAEs. We sought to understand the current implementation of AI in this space. A literature review was performed to PRISMA-DTA standards. Included articles were from all surgical specialties and reported the automatic identification of iAEs in real-time. Details on surgical specialty, adverse events, technology used for detecting iAEs, AI algorithm/validation, and reference standards/conventional parameters were extracted. A meta-analysis of algorithms with available data was conducted using a hierarchical summary receiver operating characteristic curve (ROC). The QUADAS-2 tool was used to assess the article risk of bias and clinical applicability. A total of 2982 studies were identified by searching PubMed, Scopus, Web of Science, and IEEE Xplore, with 13 articles included for data extraction. The AI algorithms detected bleeding (n = 7), vessel injury (n = 1), perfusion deficiencies (n = 1), thermal damage (n = 1), and EMG abnormalities (n = 1), among other iAEs. Nine of the thirteen articles described at least one validation method for the detection system; five explained using cross-validation and seven divided the dataset into training and validation cohorts. Meta-analysis showed the algorithms were both sensitive and specific across included iAEs (detection OR 14.74, CI 4.7–46.2). There was heterogeneity in reported outcome statistics and article bias risk. There is a need for standardization of iAE definitions, detection, and reporting to enhance surgical care for all patients. The heterogeneous applications of AI in the literature highlights the pluripotent nature of this technology. Applications of these algorithms across a breadth of urologic procedures should be investigated to assess the generalizability of these data. Full article

(This article belongs to the Section General Surgery)

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13 pages, 4316 KiB

Open AccessSystematic Review

Effect of Digitalis on ICD or CRT-D Recipients: A Systematic Review and Meta-Analysis

by Wen Zhuo, Hualong Liu, Linghua Fu, Weiguo Fan and Kui Hong

J. Clin. Med. 2023, 12(4), 1686; https://doi.org/10.3390/jcm12041686 - 20 Feb 2023

Viewed by 1391

Abstract

Background: Digitalis has been widely utilized for heart failure therapy and several studies have demonstrated an association of digitalis and adverse outcome events in patients receiving implantable cardioverter defibrillators (ICDs) or cardiac resynchronization therapy defibrillators (CRT-Ds). Hence, we conducted this meta-analysis to assess [...] Read more.

Background: Digitalis has been widely utilized for heart failure therapy and several studies have demonstrated an association of digitalis and adverse outcome events in patients receiving implantable cardioverter defibrillators (ICDs) or cardiac resynchronization therapy defibrillators (CRT-Ds). Hence, we conducted this meta-analysis to assess the effect of digitalis on ICD or CRT-D recipients. Methods: We systematically retrieved relevant studies using the Cochrane Library, PubMed, and Embase database. A random effect model was used to pool the effect estimates (hazard ratios (HRs) and 95% confidence intervals (CIs)) when the studies were of high heterogeneity, otherwise a fixed effect model was used. Results: Twenty-one articles containing 44,761 ICD or CRT-D recipients were included. Digitalis was associated with an increased rate of appropriate shocks (HR = 1.65, 95% CI: 1.46–1.86, p < 0.001) and a shortened time to first appropriate shock (HR = 1.76, 95% CI: 1.17–2.65, p = 0.007) in ICD or CRT-D recipients. Furthermore, the all-cause mortality increased in ICD recipients with digitalis therapy (HR = 1.70, 95% CI: 1.34–2.16, p < 0.01), but the all-cause mortality was unchanged in CRT-D recipients (HR = 1.55, 95% CI: 0.92–2.60, p = 0.10) or patients who received ICD or CRT-D therapy (HR = 1.09, 95% CI: 0.80–1.48, p = 0.20). The sensitivity analyses confirmed the robustness of the results. Conclusion: ICD recipients with digitalis therapy may tend to have higher mortality rates, but digitalis may not be associated with the mortality rate of CRT-D recipients. Further studies are required to confirm the effects of digitalis on ICD or CRT-D recipients. Full article

(This article belongs to the Special Issue Advances in Cardiac Pacing and Cardiac Resynchronization Therapy)

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20 pages, 639 KiB

Open AccessEditor’s ChoiceReview

Chronic Low Back Pain: A Narrative Review of Recent International Guidelines for Diagnosis and Conservative Treatment

by Vanina Nicol, Claire Verdaguer, Camille Daste, Hélène Bisseriex, Éric Lapeyre, Marie-Martine Lefèvre-Colau, François Rannou, Alexandra Rören, Julia Facione and Christelle Nguyen

J. Clin. Med. 2023, 12(4), 1685; https://doi.org/10.3390/jcm12041685 - 20 Feb 2023

Cited by 15 | Viewed by 6862

Abstract

Chronic low back pain (cLBP) is a public and occupational health problem that is a major professional, economic and social burden. We aimed to provide a critical overview of current international recommendations regarding the management of non-specific cLBP. We conducted a narrative review [...] Read more.

Chronic low back pain (cLBP) is a public and occupational health problem that is a major professional, economic and social burden. We aimed to provide a critical overview of current international recommendations regarding the management of non-specific cLBP. We conducted a narrative review of international guidelines for the diagnosis and conservative treatment of people with non-specific cLBP. Our literature search yielded five reviews of guidelines published between 2018 and 2021. In these five reviews, we identified eight international guidelines that fulfilled our selection criteria. We added the 2021 French guidelines into our analysis. Regarding diagnosis, most international guidelines recommend searching for so-called yellow, blue and black flags, in order to stratify the risk of chronicity and/or persistent disability. The relevance of clinical examination and imaging are under debate. Regarding management, most international guidelines recommend non-pharmacological treatments, including exercise therapy, physical activity, physiotherapy and education; however, multidisciplinary rehabilitation, in selected cases, is the core treatment recommended for people with non-specific cLBP. Oral, topical or injected pharmacological treatments are under debate, and may be offered to selected and well-phenotyped patients. The diagnosis of people with cLBP may lack precision. All guidelines recommend multimodal management. In clinical practice, the management of individuals with non-specific cLBP should combine non-pharmacological and pharmacological treatments. Future research should focus on improving tailorization. Full article

(This article belongs to the Section Clinical Rehabilitation)

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12 pages, 576 KiB

Open AccessArticle

Early vs. Late Readmission following Percutaneous Coronary Intervention: Predictors and Impact on Long-Term Outcomes

by David Eccleston, My-Ngan Duong, Enayet Chowdhury, Nisha Schwarz, Christopher Reid, Danny Liew, Andre Conradie and Stephen G. Worthley

J. Clin. Med. 2023, 12(4), 1684; https://doi.org/10.3390/jcm12041684 - 20 Feb 2023

Cited by 1 | Viewed by 1031

Abstract

Background: Readmissions within 1 year after percutaneous coronary intervention (PCI) are common (18.6–50.4% in international series) and a burden to patients and health services, however their long-term implications are not well characterised. We compared predictors of 30-day (early) and 31-day to 1-year (late) [...] Read more.

Background: Readmissions within 1 year after percutaneous coronary intervention (PCI) are common (18.6–50.4% in international series) and a burden to patients and health services, however their long-term implications are not well characterised. We compared predictors of 30-day (early) and 31-day to 1-year (late) unplanned readmission and the impact of unplanned readmission on long-term clinical outcomes post-PCI. Methods: Patients enrolled in the GenesisCare Cardiovascular Outcomes Registry (GCOR-PCI) from 2008 to 2020 were included in the study. Multivariate logistic regression analysis was performed to identify predictors of early and late unplanned readmission. A Cox proportion hazards regression model was used to explore the impact of any unplanned readmission during the first year post-PCI on the clinical outcomes at 3 years. Finally, patients with early and late unplanned readmission were compared to determine which group was at the highest risk of adverse long-term outcomes. Results: The study comprised 16,911 consecutively enrolled patients who underwent PCI between 2009–2020. Of these, 1422 patients (8.5%) experienced unplanned readmission within 1-year post-PCI. Overall, the mean age was 68.9 ± 10.5 years, 76.4% were male and 45.9% presented with acute coronary syndromes. Predictors of unplanned readmission included increasing age, female gender, previous CABG, renal impairment and PCI for acute coronary syndromes. Unplanned readmission within 1 year of PCI was associated with an increased risk of MACE (adjusted HR 1.84 (1.42–2.37), p < 0.001) and death over a 3-year follow-up (adjusted HR 1.864 (1.34–2.59), p < 0.001) compared with those without readmission within 1-year post-PCI. Late compared with early unplanned readmission within the first year of PCI was more frequently associated with subsequent unplanned readmission, MACE and death between 1 and 3 years post-PCI. Conclusions: Unplanned readmissions in the first year following PCI, particularly those occurring more than 30 days after discharge, were associated with a significantly higher risk of adverse outcomes, such as MACE and death at 3 years. Strategies to identify patients at high risk of readmission and interventions to reduce their greater risk of adverse events should be implemented post-PCI Full article

(This article belongs to the Section Cardiology)

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15 pages, 1152 KiB

Open AccessReview

Research Progress of Fecal Microbiota Transplantation in Liver Diseases

by Yuanyuan Zhao, Chen Gong, Jing Xu, Dong Chen, Bo Yang, Zhishui Chen and Lai Wei

J. Clin. Med. 2023, 12(4), 1683; https://doi.org/10.3390/jcm12041683 - 20 Feb 2023

Cited by 9 | Viewed by 3101

Abstract

A growing body of evidence suggested that gut microbiota is associated with liver diseases through the gut–liver axis. The imbalance of gut microbiota could be correlated with the occurrence, development, and prognosis of a series of liver diseases, including alcoholic liver disease (ALD), [...] Read more.

A growing body of evidence suggested that gut microbiota is associated with liver diseases through the gut–liver axis. The imbalance of gut microbiota could be correlated with the occurrence, development, and prognosis of a series of liver diseases, including alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), viral hepatitis, cirrhosis, primary sclerosing cholangitis (PSC), and hepatocellular carcinoma (HCC). Fecal microbiota transplantation (FMT) seems to be a method to normalize the patient’s gut microbiota. This method has been traced back to the 4th century. In recent decade, FMT has been highly regarded in several clinical trials. As a novel approach to reconstruct the intestinal microecological balance, FMT has been used to treat the chronic liver diseases. Therefore, in this review, the role of FMT in the treatment of liver diseases was summarized. In addition, the relationship between gut and liver was explored through the gut–liver axis, and the definition, objectives, advantages, and procedures of FMT were described. Finally, the clinical value of FMT therapy in liver transplant (LT) recipients was briefly discussed. Full article

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

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8 pages, 9750 KiB

Open AccessArticle

Application of an Intraoperative Limb Positioner for Adjustable Traction in Both-Column Fractures of the Acetabulum: A Technical Note with Clinical Outcome

by Joon-Woo Kim, Chang-Wug Oh, Kyeong-Hyeon Park, Won-Ki Hong, Sung-Hyuk Yoon, Gwang-Sub Lee and Jong-Keon Oh

J. Clin. Med. 2023, 12(4), 1682; https://doi.org/10.3390/jcm12041682 - 20 Feb 2023

Viewed by 1222

Abstract

Traction of the ipsilateral leg is usually required to facilitate fracture reduction while operating both-column acetabular fractures. However, it is challenging to maintain constant traction manually during the operation. Herein, we surgically treated such injuries while maintaining traction using an intraoperative limb positioner [...] Read more.

Traction of the ipsilateral leg is usually required to facilitate fracture reduction while operating both-column acetabular fractures. However, it is challenging to maintain constant traction manually during the operation. Herein, we surgically treated such injuries while maintaining traction using an intraoperative limb positioner and investigated the outcomes. This study included 19 patients with both-column acetabular fractures. Surgery was performed after the patient’s condition had stabilized, at an average of 10.4 days after injury. The Steinmann pin was transfixed to the distal femur and connected to a traction stirrup; subsequently, the construct was affixed to the limb positioner. A manual traction force was applied through the stirrup and maintained with the limb positioner. Using a modified Stoppa approach combined with the lateral window of the ilioinguinal approach, the fracture was reduced, and plates were applied. Primary union was achieved in all cases at an average of 17.3 weeks. The quality of reduction at the final follow-up was found to be excellent, good, and poor in 10, 8, and 1 patients, respectively. The average Merle d’Aubigné score at the final follow-up was 16.6. Surgical treatment of both-column acetabular fracture using intraoperative traction with a limb positioner yields satisfactory radiological and clinical outcomes. Full article

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

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12 pages, 609 KiB

Open AccessArticle

Causal Inference of Central Nervous System-Regulated Hormones in COVID-19: A Bidirectional Two-Sample Mendelian Randomization Study

by Yuxuan Sun, Ziyi Ding, Yawei Guo, Jinqiu Yuan, Chengming Zhu, Yihang Pan and Rui Sun

J. Clin. Med. 2023, 12(4), 1681; https://doi.org/10.3390/jcm12041681 - 20 Feb 2023

Cited by 2 | Viewed by 2083

Abstract

We assessed the causal association of three COVID-19 phenotypes with insulin-like growth factor 1, estrogen, testosterone, dehydroepiandrosterone (DHEA), thyroid-stimulating hormone, thyrotropin-releasing hormone, luteinizing hormone (LH), and follicle-stimulating hormone. We used bidirectional two-sample univariate and multivariable Mendelian randomization (MR) analyses to evaluate the direction, [...] Read more.

We assessed the causal association of three COVID-19 phenotypes with insulin-like growth factor 1, estrogen, testosterone, dehydroepiandrosterone (DHEA), thyroid-stimulating hormone, thyrotropin-releasing hormone, luteinizing hormone (LH), and follicle-stimulating hormone. We used bidirectional two-sample univariate and multivariable Mendelian randomization (MR) analyses to evaluate the direction, specificity, and causality of the association between CNS-regulated hormones and COVID-19 phenotypes. Genetic instruments for CNS-regulated hormones were selected from the largest publicly available genome-wide association studies of the European population. Summary-level data on COVID-19 severity, hospitalization, and susceptibility were obtained from the COVID-19 host genetic initiative. DHEA was associated with increased risks of very severe respiratory syndrome (odds ratio [OR] = 4.21, 95% confidence interval [CI]: 1.41–12.59), consistent with multivariate MR results (OR = 3.72, 95% CI: 1.20–11.51), and hospitalization (OR = 2.31, 95% CI: 1.13–4.72) in univariate MR. LH was associated with very severe respiratory syndrome (OR = 0.83; 95% CI: 0.71–0.96) in univariate MR. Estrogen was negatively associated with very severe respiratory syndrome (OR = 0.09, 95% CI: 0.02–0.51), hospitalization (OR = 0.25, 95% CI: 0.08–0.78), and susceptibility (OR = 0.50, 95% CI: 0.28–0.89) in multivariate MR. We found strong evidence for the causal relationship of DHEA, LH, and estrogen with COVID-19 phenotypes. Full article

(This article belongs to the Special Issue New Advances in Clinical Genetics and Genetic Epidemiology)

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19 pages, 402 KiB

Open AccessPerspective

Supplementary Pharmacotherapy for the Behavioral Abnormalities Caused by Stressors in Humans, Focused on Post-Traumatic Stress Disorder (PTSD)

by Jeffrey Fessel

J. Clin. Med. 2023, 12(4), 1680; https://doi.org/10.3390/jcm12041680 - 20 Feb 2023

Cited by 5 | Viewed by 2244

Abstract

Used as a supplement to psychotherapy, pharmacotherapy that addresses all of the known metabolic and genetic contributions to the pathogenesis of psychiatric conditions caused by stressors would require an inordinate number of drugs. Far simpler is to address the abnormalities caused by those [...] Read more.

Used as a supplement to psychotherapy, pharmacotherapy that addresses all of the known metabolic and genetic contributions to the pathogenesis of psychiatric conditions caused by stressors would require an inordinate number of drugs. Far simpler is to address the abnormalities caused by those metabolic and genetic changes in the cell types of the brain that mediate the behavioral abnormality. Relevant data regarding the changed brain cell types are described in this article and are derived from subjects with the paradigmatic behavioral abnormality of PTSD and from subjects with traumatic brain injury or chronic traumatic encephalopathy. If this analysis is correct, then therapy is required that benefits all of the affected brain cell types; those are astrocytes, oligodendrocytes, synapses and neurons, endothelial cells, and microglia (the pro-inflammatory (M1) subtype requires switching to the anti-inflammatory (M2) subtype). Combinations are advocated using several drugs, erythropoietin, fluoxetine, lithium, and pioglitazone, that benefit all of the five cell types, and that should be used to form a two-drug combination, suggested as pioglitazone with either fluoxetine or lithium. Clemastine, fingolimod, and memantine benefit four of the cell types, and one chosen from those could be added to the two-drug combination to form a three-drug combination. Using low doses of chosen drugs will limit both toxicity and drug-drug interactions. A clinical trial is required to validate both the advocated concept and the choice of drugs. Full article

(This article belongs to the Section Mental Health)

11 pages, 927 KiB

Open AccessArticle

High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation in AIDS Patients with Acute Respiratory Failure: A Randomized Controlled Trial

by Jingjing Hao, Jingyuan Liu, Lin Pu, Chuansheng Li, Ming Zhang, Jianbo Tan, Hongyu Wang, Ningning Yin, Yao Sun, Yufeng Liu, Hebing Guo and Ang Li

J. Clin. Med. 2023, 12(4), 1679; https://doi.org/10.3390/jcm12041679 - 20 Feb 2023

Cited by 1 | Viewed by 2524

Abstract

Background: Acute respiratory failure (ARF) remains the most common diagnosis for intensive care unit (ICU) admission in acquired immunodeficiency syndrome (AIDS) patients. Methods: We conducted a single-center, prospective, open-labeled, randomized controlled trial at the ICU, Beijing Ditan Hospital, China. AIDS patients with ARF [...] Read more.

Background: Acute respiratory failure (ARF) remains the most common diagnosis for intensive care unit (ICU) admission in acquired immunodeficiency syndrome (AIDS) patients. Methods: We conducted a single-center, prospective, open-labeled, randomized controlled trial at the ICU, Beijing Ditan Hospital, China. AIDS patients with ARF were enrolled and randomly assigned in a 1:1 ratio to receive either high-flow nasal cannula (HFNC) oxygen therapy or non-invasive ventilation (NIV) immediately after randomization. The primary outcome was the need for endotracheal intubation on day 28. Results: 120 AIDS patients were enrolled and 56 patients in the HFNC group and 57 patients in the NIV group after secondary exclusion. Pneumocystis pneumonia (PCP) was the main etiology for ARF (94.7%). The intubation rates on day 28 were similar to HFNC and NIV (28.6% vs. 35.1%, p = 0.457). Kaplan–Meier curves showed no statistical difference in cumulative intubation rates between the two groups (log-rank test 0.401, p = 0.527). The number of airway care interventions in the HFNC group was fewer than in the NIV group (6 (5–7) vs. 8 (6–9), p < 0.001). The rate of intolerance in the HFNC group was lower than in the NIV group (1.8% vs. 14.0%, p = 0.032). The VAS scores of device discomfort in the HFNC group were lower than that in the NIV group at 2 h (4 (4–5) vs. 5 (4–7), p = 0.042) and at 24 h (4 (3–4) vs. 4 (3–6), p = 0.036). The respiratory rate in the HFNC group was lower than that in the NIV group at 24 h (25 ± 4/min vs. 27 ± 5/min, p = 0.041). Conclusions: Among AIDS patients with ARF, there was no statistical significance of the intubation rate between HFNC and NIV. HFNC had better tolerance and device comfort, fewer airway care interventions, and a lower respiratory rate than NIV. Clinical Trial Number: Chictr.org (ChiCTR1900022241). Full article

(This article belongs to the Special Issue Acute Respiratory Failure: New Perspectives and Current Clinical Challenges)

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18 pages, 3853 KiB

Open AccessArticle

Endometriosis in Adolescents: Diagnostics, Clinical and Laparoscopic Features

by Elena P. Khashchenko, Elena V. Uvarova, Timur Kh. Fatkhudinov, Vladimir D. Chuprynin, Aleksandra V. Asaturova, Elena A. Kulabukhova, Mikhail Yu. Vysokikh, Elvina Z. Allakhverdieva, Maria N. Alekseeva, Leila V. Adamyan and Gennady T. Sukhikh

J. Clin. Med. 2023, 12(4), 1678; https://doi.org/10.3390/jcm12041678 - 20 Feb 2023

Cited by 4 | Viewed by 2908

Abstract

Background: The early diagnosis of endometriosis in adolescents is not developed. Objective: We aim to conduct clinical, imaging, laparoscopic and histological analyses of peritoneal endometriosis (PE) in adolescents in order to improve early diagnosis. Methods: In total, 134 girls (from menarche to 17 [...] Read more.

Background: The early diagnosis of endometriosis in adolescents is not developed. Objective: We aim to conduct clinical, imaging, laparoscopic and histological analyses of peritoneal endometriosis (PE) in adolescents in order to improve early diagnosis. Methods: In total, 134 girls (from menarche to 17 years old) were included in a case–control study: 90 with laparoscopically (LS) confirmed PE, 44 healthy controls underwent full examination and LS was analyzed in the PE group. Results: Patients with PE were characterized with heredity for endometriosis, persistent dysmenorrhea, decreased daily activity, gastrointestinal symptoms, higher LH, estradiol, prolactin and Ca-125 (<0.05 for each). Ultrasound detected PE in 3.3% and MRI in 78.9%. The most essential MRI signs are as follows: hypointense foci, the heterogeneity of the pelvic tissue (paraovarian, parametrial and rectouterine pouch) and sacro-uterine ligaments lesions (<0.05 for each). Adolescents with PE mostly exhibit initial rASRM stages. Red implants correlated with the rASRM score, and sheer implants correlated with pain (VAS score) (<0.05). In 32.2%, foci consisted of fibrous, adipose and muscle tissue; black lesions were more likely to be histologically verified (0.001). Conclusion: Adolescents exhibit mostly initial PE stages, which are associated with greater pain. Persistent dysmenorrhea and detected MRI parameters predict the laparoscopic confirmation of initial PE in adolescents in 84.3% (OR 15.4; <0.01), justifying the early surgical diagnostics and shortening the time delay and suffering of the young patients. Full article

(This article belongs to the Special Issue Cracking the Enigma of Endometriosis)

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J. Clin. Med., Volume 12, Issue 4 (February-2 2023) – 462 articles

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