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J. Clin. Med., Volume 12, Issue 7 (April-1 2023) – 305 articles

Cover Story (view full-size image): Stress is an important factor in the development, triggering, and maintenance of psychotic symptoms. Still, little is known about the neural correlates of cognitively regulating stressful events in schizophrenia. The current study aimed at investigating the cognitive downregulation of negative, stressful reactions during a neuroimaging psychosocial stress paradigm (nonregulated stress versus cognitively regulated stress). In a randomized, repeated-measures within-subject design, we assessed subjective reactions and neural activation in schizophrenia patients (SZPs) and matched healthy controls in a neuroimaging psychosocial stress paradigm. Considering the strong association between mental health and stress, the investigation of cognitive regulation in individuals vulnerable to stress, including SZPs, has crucial implications for improving stress intervention trainings. View this paper
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17 pages, 4264 KiB  
Systematic Review
Psychological Outcomes and Quality of Life of Fibromyalgia Patients with Vitamin D Supplementation—A Meta-Analysis
by Chia-Chun Yang, Sheng-Ta Tsai, Berne Ting, Ying-Chih Cheng, Chin-Kun Wang, Jane Pei-Chen Chang and Kuan-Pin Su
J. Clin. Med. 2023, 12(7), 2750; https://doi.org/10.3390/jcm12072750 - 06 Apr 2023
Cited by 4 | Viewed by 3834
Abstract
The efficacy of current pharmaceutical treatments for fibromyalgia are limited. Vitamin D has shown promise in relieving pain. However, there is a lack of comprehensive analysis of psychological outcomes with vitamin D supplementation in fibromyalgia. This study aimed to investigate the impact of [...] Read more.
The efficacy of current pharmaceutical treatments for fibromyalgia are limited. Vitamin D has shown promise in relieving pain. However, there is a lack of comprehensive analysis of psychological outcomes with vitamin D supplementation in fibromyalgia. This study aimed to investigate the impact of vitamin D supplementation on psychological outcomes and quality of life in fibromyalgia patients, given the unmet clinical need for effective treatment options. A meta-analysis of randomized controlled trials comparing vitamin D to placebo and prospective studies examining changes before and after vitamin D supplementation for patients with fibromyalgia was conducted to evaluate the effects of vitamin D on psychological outcomes, quality of life, and pain scores in patients with fibromyalgia. Databases were searched for relevant articles published from earliest available date to October 31, 2022. (PROSPERO number, CRD42022369889). We included 8 trials with a total of 694 participants and found that vitamin D supplementation had significant positive effects on physical function (standard mean differences (SMD) = 0.44, 95% CI = [0.10, 0.77 ]), role limitations due to emotional health (SMD = 0.57, 95% CI = [0.32, 0.82]), social function (SMD = 0.50, 95% CI = [0.08, 0.93]), and general health (SMD = 0.36, 95% CI = [0.11, 0.61]). Improvement of the Fibromyalgia Impact Questionnaire (FIQ) scores was noted (SMD = −0.414, 95% CI = [−0.808, −0.021]), but not on the Visual Analog Scale (VAS) (SMD = −0.15, 95% CI = [−0.771, 0.471]) and the Beck’s Depression Inventory (BDI) scores (SMD = −0.456, 95% CI = [−1.27, 0.30]). In conclusion, vitamin D supplementation might be an alternative option for improvement of psychological outcomes and quality of life in patients with fibromyalgia. Full article
(This article belongs to the Section Mental Health)
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16 pages, 2022 KiB  
Article
Cognitive Stress Regulation in Schizophrenia Patients and Healthy Individuals: Brain and Behavior
by Lydia Kogler, Christina Regenbogen, Veronika I. Müller, Nils Kohn, Frank Schneider, Ruben C. Gur and Birgit Derntl
J. Clin. Med. 2023, 12(7), 2749; https://doi.org/10.3390/jcm12072749 - 06 Apr 2023
Viewed by 1239
Abstract
Stress is an important factor in the development, triggering, and maintenance of psychotic symptoms. Still, little is known about the neural correlates of cognitively regulating stressful events in schizophrenia. The current study aimed at investigating the cognitive down-regulation of negative, stressful reactions during [...] Read more.
Stress is an important factor in the development, triggering, and maintenance of psychotic symptoms. Still, little is known about the neural correlates of cognitively regulating stressful events in schizophrenia. The current study aimed at investigating the cognitive down-regulation of negative, stressful reactions during a neuroimaging psychosocial stress paradigm (non-regulated stress versus cognitively regulated stress). In a randomized, repeated-measures within-subject design, we assessed subjective reactions and neural activation in schizophrenia patients (SZP) and matched healthy controls in a neuroimaging psychosocial stress paradigm. In general, SZP exhibited an increased anticipation of stress compared to controls (p = 0.020). During non-regulated stress, SZP showed increased negative affect (p = 0.033) and stronger activation of the left parietal operculum/posterior insula (p < 0.001) and right inferior frontal gyrus/anterior insula (p = 0.005) than controls. Contrarily, stress regulation compared to non-regulated stress led to increased subjective reactions in controls (p = 0.003) but less deactivation in SZP in the ventral anterior cingulate cortex (p = 0.027). Our data demonstrate stronger reactions to and anticipation of stress in patients and difficulties with cognitive stress regulation in both groups. Considering the strong association between mental health and stress, the investigation of cognitive regulation in individuals vulnerable to stress, including SZP, has crucial implications for improving stress intervention trainings. Full article
(This article belongs to the Section Mental Health)
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13 pages, 1627 KiB  
Systematic Review
The Effect of Domiciliary Professional Oral Care on Root Caries Progression in Care-Dependent Older Adults: A Systematic Review
by Elisabeth Morén, Pia Skott, Kristina Edman, Nivetha Gavriilidou, Inger Wårdh and Helena Domeij
J. Clin. Med. 2023, 12(7), 2748; https://doi.org/10.3390/jcm12072748 - 06 Apr 2023
Viewed by 1564
Abstract
With care dependency, untreated root caries lesions (RCLs) and irregular dental visits are common. RCLs, if left untreated, could lead to pain, tooth loss, difficulties eating, and impact on general health. Therefore, there is a need for prevention and effective treatment for RCLs, [...] Read more.
With care dependency, untreated root caries lesions (RCLs) and irregular dental visits are common. RCLs, if left untreated, could lead to pain, tooth loss, difficulties eating, and impact on general health. Therefore, there is a need for prevention and effective treatment for RCLs, and especially in those with care dependency. The aim of this systematic review was to investigate the effect of domiciliary professional oral care on root caries development and progression, in comparison with self-performed or nurse-assisted oral care. A literature search was conducted in four databases in November 2022. Two authors independently screened the literature throughout the review process. Five of the identified studies were found to be relevant. Four of these were assessed as having moderate risk of bias and were included in the review, while one study had high risk of bias and was excluded from further analyses. Due to heterogenicity of the included studies (and of the interventions and outcomes), no meta-analysis or synthesis without meta-analysis (SWiM) was performed. The participation of dental personnel performing mechanical plaque removal and fluoride, or chlorhexidine application seems beneficial for care-dependent older adults with risk of RCLs development and progression. However, future studies are needed. Full article
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10 pages, 5518 KiB  
Article
Return to Sports and Functional Outcomes after Autologous Platelet-Rich Fibrin Matrix (PRFM) and Debridement in Midportion Achilles Tendinopathy: A Case Series with 24-Month Follow-Up
by Venanzio Iacono, Simone Natali, Luca De Berardinis, Daniele Screpis, Antonio Pompilio Gigante and Claudio Zorzi
J. Clin. Med. 2023, 12(7), 2747; https://doi.org/10.3390/jcm12072747 - 06 Apr 2023
Viewed by 1209
Abstract
(1) Background: Achilles tendinopathy (AT) is characterized by load-induced tendon pain, stiffness, and functional impairment that may affect the tendon midportion or insertion. Platelet-rich fibrin matrix (PRFM) is a promising adjunctive therapy for AT. We analyzed 24-month pain and functional outcomes in a [...] Read more.
(1) Background: Achilles tendinopathy (AT) is characterized by load-induced tendon pain, stiffness, and functional impairment that may affect the tendon midportion or insertion. Platelet-rich fibrin matrix (PRFM) is a promising adjunctive therapy for AT. We analyzed 24-month pain and functional outcomes in a cohort of patients managed by tendon debridement and autologous PRFM application to determine whether the combined treatment ensured an early return to sports/work and satisfactory clinical outcomes and functional scores. (2) Methods: The 24-month outcomes of 32 sport-practicing patients with chronic midportion AT treated with debridement and autologous PRFM were evaluated in terms of time to return to sports/work. The AOFAS and VISA-A were computed preoperatively and at 6 and 24 months. Blazina scores were evaluated preoperatively and at 6 months; ankle range of motion was assessed at 1, 6, 12, 24 months; and patient satisfaction was assessed at 24 months. (3) Results: Altogether, all patients had resumed their sport(s) activity, at the same or higher level, after 25.41 days (±5.37). Regarding work, all patients were able to return to their jobs after 16.41 days (±2.43). Ankle dorsiflexion and plantarflexion increased significantly: the AOFAS rose from 54.56 (±6.47) to 97.06 (±4.06) and 98.88 (±2.21) at 6 and 12 months, respectively, and the mean VISA-A score rose from 69.16 (±7.35) preoperatively to 95.03 (±4.67) and 97.28 (±2.43) at 6 and 12 months, respectively, after treatment. There were no complications. Most (90.62%) patients were very satisfied. (4) Conclusions: In symptomatic midportion AT, surgical debridement and autologous PRFM ensured a fast return to sports/work (4 weeks), significantly improving AOFAS and VISA-A and Blazina scores already at 6 months and providing excellent clinical outcomes at 24 months. Full article
(This article belongs to the Section Orthopedics)
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14 pages, 580 KiB  
Article
Odontostomatological Traits in North-Eastern Italy’s Isolated Populations: An Epidemiological Cross-Sectional Study
by Valentina Luppieri, Alessandro Pecori, Beatrice Spedicati, Riccardo Schito, Lucia Pozzan, Aurora Santin, Giorgia Girotto, Milena Cadenaro and Maria Pina Concas
J. Clin. Med. 2023, 12(7), 2746; https://doi.org/10.3390/jcm12072746 - 06 Apr 2023
Cited by 1 | Viewed by 1006
Abstract
Malocclusions and temporomandibular disorders (TMDs) are oral health problems that are spread worldwide. To date, few studies focused on their prevalence and associated risk factors are available. This study aims to define the prevalence and distribution of odontostomatological traits and evaluate specific risk [...] Read more.
Malocclusions and temporomandibular disorders (TMDs) are oral health problems that are spread worldwide. To date, few studies focused on their prevalence and associated risk factors are available. This study aims to define the prevalence and distribution of odontostomatological traits and evaluate specific risk factors in isolated villages in north-eastern Italy, taking advantage of their environmental homogeneity. Nine hundred and forty-four participants aged six to eighty-nine years were enrolled. Thirty-one odontostomatological phenotypes, classified into five domains (airways, bad habits, extraoral and intraoral parameters, TMDs, and teeth), were evaluated. A descriptive statistical analysis was performed; mixed logistic models were used to test the relationships among the traits. According to the study’s findings, Angle’s class I was prevalent (65.3%) followed by class II malocclusion (24.3%); class III and reversed overjet were the least frequent malocclusions (10.4% and 1.8%, respectively). Temporomandibular joint (TMJ) click/noise was prevalent among TMDs (34.7%). The statistically significant (p-value < 0.05) risk factors were ankyloglossia for phonetic issues (OR 1.90) and bruxism for TMJ click/noise (OR 1.70) and pain (OR 2.20). Overall, this work provides a picture of the prevalence of malocclusions and TMDs in a large Italian sample and reveals risk factors to take into account in the development of preventive strategies and treatments. Full article
(This article belongs to the Section Dentistry, Oral Surgery and Oral Medicine)
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14 pages, 617 KiB  
Article
The Influence of External Breast Prostheses on the Body Postures of Women Who Have Undergone Mastectomies
by Anna Koralewska, Małgorzata Domagalska-Szopa, Jan Siwiec and Andrzej Szopa
J. Clin. Med. 2023, 12(7), 2745; https://doi.org/10.3390/jcm12072745 - 06 Apr 2023
Cited by 1 | Viewed by 1621
Abstract
Most women who have had a mastectomy and have not opted for breast reconstruction choose to use an external breast prosthesis. This study aimed to assess the impacts of external breast prostheses on the body postures of women after unilateral mastectomies. An additional [...] Read more.
Most women who have had a mastectomy and have not opted for breast reconstruction choose to use an external breast prosthesis. This study aimed to assess the impacts of external breast prostheses on the body postures of women after unilateral mastectomies. An additional aim was to identify whether postural asymmetry depended on the side of mastectomy. This study involved 52 women after unilateral mastectomy and consisted of two parts: (1) anthropometric measurement and (2) assessment of body posture using the moiré topography method. The posturometric indices showed that the body posture of the subjects in the sagittal plane is characterized by forward trunk inclination and a tendency to excessive kyphosis. There were no significant differences between parameters characterizing body posture with and without external breast prosthesis. The lack of external breast prosthesis had a significant effect only on excessive forward trunk inclination. Significant differences were found in the posturometric parameters in the transverse plane between the groups of patients after left- and right-sided mastectomy. The obtained results did not fully confirm the hypothesis that the external breast prosthesis affects the body posture of women after unilateral mastectomy. Full article
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10 pages, 30039 KiB  
Article
The Impact of Color Vision Deficiency on the Capability of Ophthalmologists to Diagnose Benign and Malignant Choroidal Tumors
by Mutasem Elfalah, Saif Aldeen AlRyalat, Nakhleh E. Abu-Yaghi, Mona Mohammad, Ibrahim AlNawiaseh, Deema Rayyan, Moath Albliwi, Mohammad Elfalah, Fawaz AlSarairah and Yacoub A. Yousef
J. Clin. Med. 2023, 12(7), 2744; https://doi.org/10.3390/jcm12072744 - 06 Apr 2023
Viewed by 1733
Abstract
Background: Color vision deficiency (CVD) is an under-reported problem among medical personnel, and its impact is still not well characterized. We aim to assess the impact of CVD among ophthalmologists on the accuracy of diagnosing different benign and malignant choroidal lesions. Methods: This [...] Read more.
Background: Color vision deficiency (CVD) is an under-reported problem among medical personnel, and its impact is still not well characterized. We aim to assess the impact of CVD among ophthalmologists on the accuracy of diagnosing different benign and malignant choroidal lesions. Methods: This is a cross-sectional study conducted on ophthalmologists. We used a web-based survey to collect responses through professional ophthalmology society social media. The survey included a set of five images for normal fundus, choroidal nevus, circumscribed choroidal hemangioma, choroidal metastasis, and choroidal melanoma, wherein each image simulated the three main types of CVD: protanopia, deuteranopia, and tritanopia, in addition to a non-simulated image. Results: Forty-one participants were included, with a mean age of 40 (±9.2) years. They were 28 (68%) men and 13 (32%) women. Participants showed significantly low accuracy for definite diagnosis for circumscribed choroidal hemangioma, nevus, melanoma, and metastasis when the images simulated protanopia and deuteranopia, but not tritanopia. Nevertheless, participants maintained the capability to recognize the nature of the lesions for both simulated and non-simulated images if they were benign or malignant, thereby ensuring immediate referral for specialized care. The exception was with simulated choroidal nevi images, wherein participants incorrectly assigned simulated protanopia and deuteranopia nevi images to malignant lesions. Conclusion: Protanopia and deuteranopia affected the accuracy of diagnosing several choroidal lesions; however, ophthalmologists with those two simulated CVDs were still able to discriminate between benign and malignant tumors. Full article
(This article belongs to the Special Issue Advances in Vision Disorders: Causes and Epidemiology)
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8 pages, 245 KiB  
Communication
Ovarian Stimulation with FSH Alone versus FSH plus a GnRH Antagonist for Elective Freezing in an Oocyte Donor/Recipient Programme: A Protocol for a Pilot Multicenter Observational Study
by Ioannis E. Messinis, Christina I. Messini, Evangelos G. Papanikolaou, Evangelos Makrakis, Dimitrios Loutradis, Nikolaos Christoforidis, Theodosis Arkoulis, Georgios Anifandis, Alexandros Daponte and Charalampos Siristatidis
J. Clin. Med. 2023, 12(7), 2743; https://doi.org/10.3390/jcm12072743 - 06 Apr 2023
Cited by 1 | Viewed by 1110
Abstract
Preliminary data have shown that it is possible to attempt in vitro fertilization (IVF) treatment in fresh cycles without the use of a gonadotropin-releasing hormone (GnRH) antagonist or any other medication to prevent the luteinizing hormone (LH) surge during ovarian stimulation. To date, [...] Read more.
Preliminary data have shown that it is possible to attempt in vitro fertilization (IVF) treatment in fresh cycles without the use of a gonadotropin-releasing hormone (GnRH) antagonist or any other medication to prevent the luteinizing hormone (LH) surge during ovarian stimulation. To date, there is no information on this topic in the context of a prospective controlled trial. However, as prevention of the LH surge is an established procedure in fresh cycles, the question is whether such a study can be performed in frozen cycles. We aim to perform a pilot study in order to compare the efficacy of a protocol using FSH alone with that of a protocol using follicle-stimulating hormone (FSH) plus a GnRH antagonist for controlled ovarian hyperstimulation (COH) in cycles of elective freezing in the context of a donor/recipient program. This is a seven-center, two-arm prospective pilot cohort study conducted at the respective Assisted Reproductive Units in Greece. The hypothesis to be tested is that an ovarian stimulation protocol that includes FSH alone without any LH surge prevention regimens is not inferior to a protocol including FSH plus a GnRH antagonist in terms of the clinical outcome in a donor/recipient model. The results of the present study are expected to show whether the addition of the GnRH antagonist is necessary in terms of the frequency of LH secretory peaks and progesterone elevations >1 ng/mL during the administration of the GnRH antagonist according to the adopted frequency of blood sampling in all Units. Full article
(This article belongs to the Section Reproductive Medicine & Andrology)
7 pages, 391 KiB  
Article
Low-Dose Propofol with Peribulbar Anaesthesia for Cataract Surgery
by Mahmoud Ahmed, Yamini Krishna, Petya Popova, Rose Herbert, Gediminas Sidaras, Anshoo Choudhary and Stephen B. Kaye
J. Clin. Med. 2023, 12(7), 2742; https://doi.org/10.3390/jcm12072742 - 06 Apr 2023
Viewed by 1105
Abstract
In this paper, we investigate the effect of sedation using low-dose propofol on patient reported outcome measures (PROMS) in patients undergoing cataract surgery. This is a randomised, single-blinded observational prospective study. Patients undergoing elective cataract surgery using peribulbar anaesthesia over consecutive cataract lists [...] Read more.
In this paper, we investigate the effect of sedation using low-dose propofol on patient reported outcome measures (PROMS) in patients undergoing cataract surgery. This is a randomised, single-blinded observational prospective study. Patients undergoing elective cataract surgery using peribulbar anaesthesia over consecutive cataract lists were selected for this trial. Patients were randomised to receive either no sedation or low-dose propofol (20 to 30 mg followed by 10 mg increments until the patient developed slurred speech alone) prior to the administration of local anaesthesia. Pain, satisfaction, anxiety, needle recall, pulse, and blood pressure (BP) were measured. A total of 97 patients were included, 50 of whom received propofol. There were 4 senior surgeons and anaesthetists. There were no ocular or systemic complications and all patients had uncomplicated surgery. Anxiety (p = 0.026), needle recall (p < 0.001), difference in systolic BP (p = 0.043), and pulse (p = 0.046) were dependent on patient age (p < 0.001) and the use of propofol (p = 0.007). Lower pain was associated with propofol (p = 0.008), as well as lower anxiety (p = 0.002), and increased patient age (p = 0.014). The administration of propofol was significantly associated with lower needle recall (p < 0.001), pre- to post-operative difference in systolic BP (p = 0.029), and mean BP (p = 0.044). Low-dose propofol given immediately prior to administration of local anaesthesia was associated with reduced pain and needle recall, as well as lower BP. Full article
(This article belongs to the Section Ophthalmology)
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10 pages, 455 KiB  
Article
Serum Cardiotrophin-1 Concentration Is Negatively Associated with Controlled Attenuation Parameters in Subjects with Non-Alcoholic Fatty Liver Disease
by Yi-Chun Liao, Juei-Seng Wu, Hsuan-Wen Chou, Hsin-Yu Kuo, Chun-Te Lee, Hung-Tsung Wu, Chung-Hao Li and Horng-Yih Ou
J. Clin. Med. 2023, 12(7), 2741; https://doi.org/10.3390/jcm12072741 - 06 Apr 2023
Viewed by 1229
Abstract
Background: Since non-alcoholic fatty liver disease (NAFLD) is highly associated with obesity, cardiovascular disease, and diabetes, biomarkers for the diagnosis of NAFLD have become an important issue. Although cardiotrophin-1 (CT-1) has a protective effect on the liver in NAFLD animal models, the serum [...] Read more.
Background: Since non-alcoholic fatty liver disease (NAFLD) is highly associated with obesity, cardiovascular disease, and diabetes, biomarkers for the diagnosis of NAFLD have become an important issue. Although cardiotrophin-1 (CT-1) has a protective effect on the liver in NAFLD animal models, the serum levels of CT-1 in human subjects with NAFLD were still unknown. Objective: The present study aimed to investigate the relationship between the circulating concentration of CT-1 and the severity of hepatic steatosis graded by the value of the controlled attenuation parameter (CAP) in humans. Design and Methods: The study was designed as a cross-sectional study, and a total of 182 subjects were enrolled. Hepatic steatosis measurement was carried out with a Firoscan® device and recorded by CAP. The enrolled study subjects were categorized into CAP < 238 dB/m, 238 ≤ CAP ≤ 259 dB/m, 260 ≤ CAP ≤ 290 dB/m, and CAP > 290 dB/m. Serum CT-1 concentrations were determined by enzyme-linked immunosorbent assay. The association between the serum CT-1 concentration and NAFLD was examined by multivariate linear regression analysis. Results: Body mass index, percentage of body fat, systolic and diastolic blood pressure, alanine aminotransferase (ALT), cholesterol, triglyceride, hemoglobin A1c and homeostatic model assessment for insulin resistance (HOMA-IR) were significantly increased in groups with higher CAP value, whereas high-density lipoprotein cholesterol was significantly decreased. In addition, serum CT-1 concentrations were significantly decreased in subjects with higher CAP values. In multivariate linear regression models, including age, sex, body fat percentage, CAP, high sensitivity- C reactive protein, uric acid, creatinine, ALT, total cholesterol, and HOMA-IR, only age, CAP and uric acid independently associated with CT-1 levels. Moreover, having NAFLD was independently associated with CT-1 after adjustment for sex, obesity and type 2 diabetes. Conclusions: Serum CT-1 concentrations are decreased in subjects with NAFLD and negatively associated with CAP. Full article
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10 pages, 254 KiB  
Article
Association between Estimated Cardiorespiratory Fitness and Abnormal Glucose Risk: A Cohort Study
by Robert A. Sloan, Youngdeok Kim, Jonathan Kenyon, Marco Visentini-Scarzanella, Susumu S. Sawada, Xuemei Sui, I-Min Lee, Jonathan N. Myers and Carl J. Lavie
J. Clin. Med. 2023, 12(7), 2740; https://doi.org/10.3390/jcm12072740 - 06 Apr 2023
Cited by 2 | Viewed by 1419
Abstract
Background: Cardiorespiratory fitness (CRF) is a predictor of chronic disease that is impractical to routinely measure in primary care settings. We used a new estimated cardiorespiratory fitness (eCRF) algorithm that uses information routinely documented in electronic health care records to predict abnormal blood [...] Read more.
Background: Cardiorespiratory fitness (CRF) is a predictor of chronic disease that is impractical to routinely measure in primary care settings. We used a new estimated cardiorespiratory fitness (eCRF) algorithm that uses information routinely documented in electronic health care records to predict abnormal blood glucose incidence. Methods: Participants were adults (17.8% female) 20–81 years old at baseline from the Aerobics Center Longitudinal Study between 1979 and 2006. eCRF was based on sex, age, body mass index, resting heart rate, resting blood pressure, and smoking status. CRF was measured by maximal treadmill testing. Cox proportional hazards regression models were established using eCRF and CRF as independent variables predicting the abnormal blood glucose incidence while adjusting for covariates (age, sex, exam year, waist girth, heavy drinking, smoking, and family history of diabetes mellitus and lipids). Results: Of 8602 participants at risk at baseline, 3580 (41.6%) developed abnormal blood glucose during an average of 4.9 years follow-up. The average eCRF of 12.03 ± 1.75 METs was equivalent to the CRF of 12.15 ± 2.40 METs within the 10% equivalence limit. In fully adjusted models, the estimated risks were the same (HRs = 0.96), eCRF (95% CIs = 0.93−0.99), and CRF (95% CI of 0.94−0.98). Each 1-MET increase was associated with a 4% reduced risk. Conclusions: Higher eCRF is associated with a lower risk of abnormal glucose. eCRF can be a vital sign used for research and prevention. Full article
(This article belongs to the Section Sports Medicine)
4 pages, 207 KiB  
Editorial
Group A Streptococcus Is Still at Large
by Qinghua Lu, Dingle Yu and Yonghong Yang
J. Clin. Med. 2023, 12(7), 2739; https://doi.org/10.3390/jcm12072739 - 06 Apr 2023
Cited by 5 | Viewed by 1141
Abstract
Group A Streptococcus (GAS) is a major human pathogen that can cause diseases, ranging from mild to severe systemic and invasive diseases [...] Full article
(This article belongs to the Section Infectious Diseases)
12 pages, 978 KiB  
Article
Determinants of Lipid Parameters in Patients without Diagnosed Cardiovascular Disease—Results of the Polish Arm of the EUROASPIRE V Survey
by Jakub Ratajczak, Aldona Kubica, Piotr Michalski, Łukasz Pietrzykowski, Aleksandra Białczyk, Agata Kosobucka-Ozdoba, Katarzyna Bergmann, Krzysztof Buczkowski, Magdalena Krintus, Piotr Jankowski and Jacek Kubica
J. Clin. Med. 2023, 12(7), 2738; https://doi.org/10.3390/jcm12072738 - 06 Apr 2023
Cited by 2 | Viewed by 1123
Abstract
To assess the determinants of lipid parameters in primary care patients without diagnosed cardiovascular disease (CVD), a cross-sectional study was conducted during 2018–2019 with a total of 200 patients. The following lipid parameters were measured: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density [...] Read more.
To assess the determinants of lipid parameters in primary care patients without diagnosed cardiovascular disease (CVD), a cross-sectional study was conducted during 2018–2019 with a total of 200 patients. The following lipid parameters were measured: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), small, dense LDL (sdLDL-C), and lipoprotein (a) (Lp(a)). Predictors of elevated and adequately controlled lipid parameters were assessed with logistic regression analysis. Older age was related to higher risk of TC ≥ 6.2 mmol/L [OR 1.03 (95% CI 1.0–1.05)], sdLDL-C ≥ 1.0 mmol/L [OR 1.05 (95% CI 1.0–1.1)], and decreased risk of Lp(a) ≥ 50 mg/dL [OR 0.97 (95% CI 0.94–0.99)]. Patients with diabetes mellitus (DM) had increased probability of TG ≥ 2.25 mmol/L [OR 3.77 (95% CI 1.34–10.6)] and Lp(a) ≥ 50 mg/dL [OR 2.97 (1.34–6.10)] as well as adequate control of TG and Lp(a). Higher material status was related to lower risk of TC ≥ 6.2 mmol/L [OR 0.19 (95% CI 0.04–0.82)] and LDL-C ≥ 3.6 mmol/L [OR 0.33 (95% CI 0.12–0.92)]. High BMI was related to increased [OR 1.14 (95% CI 1.02–1.29)], and female gender [OR 0.33 (95% CI 0.12–0.96)] and hypertension [OR 0.29 (95% CI 0.1–0.87)] to decreased risk of TG ≥ 2.25 mmol/L [OR 1.14 (95% CI 1.02–1.29)]. Taking lipid-lowering drugs (LLD) was associated with LDL-C < 2.6 mmol/L [OR 2.1 (95% CI 1.05–4.19)] and Lp(a) < 30 mg/dL [OR 0.48 (95% CI 0.25–0.93)]. Physical activity was related to LDL-C < 2.6 mmol/L [OR 2.02 (95% CI 1.02–3.98)]. Higher abdominal circumference was associated with decreased risk of TG < 1.7 mmol/L [OR 0.96 (95% CI 0.93–0.99)]. Elevated lipid parameters were related to age, gender, material status, BMI, history of DM, and hypertension. Adequate control was associated with age, education, physical activity, LLD, history of DM, and abdominal circumference. Full article
(This article belongs to the Section Cardiology)
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11 pages, 4089 KiB  
Article
Role of Epithelial-to-Mesenchymal Transition of Retinal Pigment Epithelial Cells in Glaucoma Cupping
by Eabha O’Driscoll, Emily Hughes, Mustapha Irnaten, Markus Kuehn, Deborah Wallace and Colm O’Brien
J. Clin. Med. 2023, 12(7), 2737; https://doi.org/10.3390/jcm12072737 - 06 Apr 2023
Viewed by 1386
Abstract
Optic nerve head (ONH) cupping is a clinical feature of glaucoma associated with extracellular matrix (ECM) remodelling and lamina cribrosa (LC) fibrosis. Peripapillary atrophy (PPA) occurs commonly in glaucoma, and is characterised by the loss of retinal pigment epithelium (RPE) adjacent to the [...] Read more.
Optic nerve head (ONH) cupping is a clinical feature of glaucoma associated with extracellular matrix (ECM) remodelling and lamina cribrosa (LC) fibrosis. Peripapillary atrophy (PPA) occurs commonly in glaucoma, and is characterised by the loss of retinal pigment epithelium (RPE) adjacent to the ONH. Under pro-fibrotic conditions, epithelial cells throughout the body can differentiate into fibroblast-like cells through epithelial-to-mesenchymal transition (EMT) and contribute to ECM fibrosis. This is investigated here in the context of glaucoma and PPA. Human-donor ONH sections were assessed for the presence of the RPE cell-specific marker RPE65 using immunofluorescence. We examined the EMT response of ARPE-19 cells to the following glaucoma-related stimuli: cyclic mechanical stretch, mechanical stiffness, transforming growth factor beta (TGFβ), and tumour necrosis factor alpha (TNFα). The gene expression was measured using the PCR of the epithelial tight junction marker zona occludens 1 (ZO-1) and the mesenchymal markers alpha smooth muscle actin (αSMA) and vimentin. A scratch assay was used to assess the ARPE-19 migration. Significant RPE-65 staining was demonstrated in the glaucomatous ONH. The cyclic stretching and substrate stiffness of the ARPE-19 cells caused a significant decrease in ZO-1 (p = 0.04), and an increase in αSMA (p = 0.04). The scratch assays demonstrated increased migration of ARPE19 in the presence of TNFα (p = 0.02). Furthermore, ARPE-19 cells undergo an EMT-like transition (gain of αSMA, loss of ZO-1 and increased migration) in response to glaucomatous stimuli. This suggests that during PPA, RPE cells have the potential to migrate into the ONH and differentiate into fibroblast-like cells, contributing to glaucomatous ONH cupping. Full article
(This article belongs to the Section Ophthalmology)
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8 pages, 232 KiB  
Review
Endoscopic Ultrasound-Guided Biliary Drainage
by John B. Doyle and Amrita Sethi
J. Clin. Med. 2023, 12(7), 2736; https://doi.org/10.3390/jcm12072736 - 06 Apr 2023
Cited by 3 | Viewed by 2337
Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are currently first- and second-line therapeutic options, respectively, for the relief of biliary obstruction. In recent years, however, endoscopic ultrasound-guided biliary drainage (EUS-BD) has become an established alternative therapy for biliary obstruction. There [...] Read more.
Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) are currently first- and second-line therapeutic options, respectively, for the relief of biliary obstruction. In recent years, however, endoscopic ultrasound-guided biliary drainage (EUS-BD) has become an established alternative therapy for biliary obstruction. There are multiple different techniques for EUS-BD, which can be distinguished based on the access point within the biliary tree (intrahepatic versus extrahepatic) and the location of stent placement (transenteric versus transpapillary). The clinical and technical success rates of biliary drainage for EUS-BD are similar to both ERCP and PTBD, and complication rates are favorable for EUS-BD relative to PTBD. As EUS-BD becomes more widely practiced and endoscopic tools continue to advance, the outcomes will likely improve, and the breadth of indications for EUS-BD will continue to expand. Full article
16 pages, 1759 KiB  
Systematic Review
Comparison of the Administration Route of Stem Cell Therapy for Ischemic Stroke: A Systematic Review and Meta-Analysis of the Clinical Outcomes and Safety
by Asra Al Fauzi, Ahmad Muslim Hidayat Thamrin, Andhika Tomy Permana, I. G. M. Aswin R. Ranuh, Hanik Badriyah Hidayati, Muhammad Hamdan, Joni Wahyuhadi, Nur Setiawan Suroto, Pudji Lestari and Poodipedi Sarat Chandra
J. Clin. Med. 2023, 12(7), 2735; https://doi.org/10.3390/jcm12072735 - 06 Apr 2023
Cited by 2 | Viewed by 1992
Abstract
Stem cell treatment is emerging as an appealing alternative for stroke patients, but there still needs to be an agreement on the protocols in place, including the route of administration. This systematic review aimed to assess the efficacy and safety of the administration [...] Read more.
Stem cell treatment is emerging as an appealing alternative for stroke patients, but there still needs to be an agreement on the protocols in place, including the route of administration. This systematic review aimed to assess the efficacy and safety of the administration routes of stem cell treatment for ischemic stroke. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search was undertaken using the PubMed, Scopus, and Cochrane databases. A total of 21 publications on stem cell therapy for ischemic stroke were included. Efficacy outcomes were measured using the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS), and the Barthel index (BI). Intracerebral administration showed a better outcome than other routes, but a greater number of adverse events followed due to its invasiveness. Adverse events were shown to be related to the natural history of stroke not to the treatment. However, further investigation is required, since studies have yet to compare the different administration methods directly. Full article
(This article belongs to the Section Pharmacology)
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5 pages, 197 KiB  
Editorial
Artificial Intelligence in Cardiology: Why So Many Great Promises and Expectations, but Still a Limited Clinical Impact?
by Gian Luigi Nicolosi
J. Clin. Med. 2023, 12(7), 2734; https://doi.org/10.3390/jcm12072734 - 06 Apr 2023
Viewed by 1243
Abstract
Looking at the extremely large amount of literature, as summarized in two recent reviews on applications of Artificial Intelligence in Cardiology, both in the adult and pediatric age groups, published in the Journal of Clinical Medicine [...] Full article
(This article belongs to the Section Cardiology)
13 pages, 581 KiB  
Article
Opioids for Osteoarthritis: Cross-Sectional Survey of Patient Perspectives and Satisfaction
by Thomas J. Schnitzer, Rebecca L. Robinson, Lars Viktrup, Joseph C. Cappelleri, Andrew G. Bushmakin, Leslie Tive, Mia Berry, Chloe Walker and James Jackson
J. Clin. Med. 2023, 12(7), 2733; https://doi.org/10.3390/jcm12072733 - 06 Apr 2023
Viewed by 1595
Abstract
Patients often take opioids to relieve osteoarthritis (OA) pain despite limited benefits and potential harms. This study aimed to compare cross-sectional perspectives of patients that were taking prescription opioid (N = 471) or nonopioid medications (N = 185) for OA in terms of [...] Read more.
Patients often take opioids to relieve osteoarthritis (OA) pain despite limited benefits and potential harms. This study aimed to compare cross-sectional perspectives of patients that were taking prescription opioid (N = 471) or nonopioid medications (N = 185) for OA in terms of satisfaction, expectations of effectiveness, and concerns. Patients prescribed opioids (>7 days) reported more prior treatments (2.47 vs. 1.74), greater mean pain intensity (5.47 vs. 4.11), and worse quality of life (EQ-5D-5L index value mean 0.45 vs. 0.71) than patients prescribed nonopioid medications (all p < 0.0001). Based on linear regression models adjusting for demographics and pain intensity, patients prescribed opioids were less satisfied with overall regimen (3.40 vs. 3.67, p = 0.0322), had less belief that medications were meeting effectiveness expectations (2.72 vs. 3.13, p < 0.0001), and had more concerns about treatments being “not very good” (3.66 vs. 3.22, p = 0.0026) and addiction (3.30 vs. 2.65, p < 0.0001) than patients prescribed nonopioid regimens. When the models were replicated for subgroups with ≥30 days’ medication regimen duration, the findings were consistent with the main analyses. Patients have concerns about the risk of opioid addiction, but those with greater disease burden and more prior treatments continue taking opioid regimens. Full article
(This article belongs to the Special Issue Pharmacological Management of Chronic Pain)
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16 pages, 2939 KiB  
Systematic Review
Comparison of Outcomes of Active Surveillance in Intermediate-Risk Versus Low-Risk Localised Prostate Cancer Patients: A Systematic Review and Meta-Analysis
by Subhabrata Mukherjee, Dimitrios Papadopoulos, Joseph M. Norris, Mudassir Wani and Sanjeev Madaan
J. Clin. Med. 2023, 12(7), 2732; https://doi.org/10.3390/jcm12072732 - 06 Apr 2023
Cited by 3 | Viewed by 1638
Abstract
Currently, there is no clear consensus regarding the role of active surveillance (AS) in the management of intermediate-risk prostate cancer (IRPC) patients. We aim to analyse data from the available literature on the outcomes of AS in the management of IRPC patients and [...] Read more.
Currently, there is no clear consensus regarding the role of active surveillance (AS) in the management of intermediate-risk prostate cancer (IRPC) patients. We aim to analyse data from the available literature on the outcomes of AS in the management of IRPC patients and compare them with low-risk prostate cancer (LRPC) patients. A comprehensive literature search was performed, and relevant data were extracted. Our primary outcome was treatment-free survival, and secondary outcomes were metastasis-free survival, cancer-specific survival, and overall survival. The DerSimonian–Laird random-effects method was used for the meta-analysis. Out of 712 studies identified following an initial search, 25 studies were included in the systematic review. We found that both IRPC and LRPC patients had nearly similar 5, 10, and 15 year treatment-free survival rate, 5 and 10 year metastasis-free survival rate, and 5 year overall survival rate. However, cancer-specific survival rates at 5, 10, and 15 years were significantly lower in IRPC compared to LRPC group. Furthermore, IRPC patients had significantly inferior long-term overall survival rate (10 and 15 year) and metastasis-free survival rate (15 year) compared to LRPC patients. Both the clinicians and the patients can consider this information during the informed decision-making process before choosing AS. Full article
(This article belongs to the Section Nephrology & Urology)
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16 pages, 326 KiB  
Review
Assessment of Impact of Human Leukocyte Antigen-Type and Cytokine-Type Responses on Outcomes after Targeted Therapy Currently Used to Treat Chronic Lymphocytic Leukemia
by Mihaela Andreescu, Nicoleta Berbec and Alina Daniela Tanase
J. Clin. Med. 2023, 12(7), 2731; https://doi.org/10.3390/jcm12072731 - 06 Apr 2023
Cited by 1 | Viewed by 1624
Abstract
Tumor growth and metastasis are reliant on intricate interactions between the host immune system and various counter-regulatory immune escape mechanisms employed by the tumor. Tumors can resist immune surveillance by modifying the expression of human leukocyte antigen (HLA) molecules, which results in the [...] Read more.
Tumor growth and metastasis are reliant on intricate interactions between the host immune system and various counter-regulatory immune escape mechanisms employed by the tumor. Tumors can resist immune surveillance by modifying the expression of human leukocyte antigen (HLA) molecules, which results in the impaired presentation of tumor-associated antigens, subsequently evading detection and destruction by the immune system. The management of chronic lymphocytic leukemia (CLL) is based on symptom severity and includes various types of targeted therapies, including rituximab, obinutuzumab, ibrutinib, acalabrutinib, zanubrutinib, idelalisib, and venetoclax. These therapies rely on the recognition of specific peptides presented by HLAs on the surface of tumor cells by T cells, leading to an immune response. HLA class I molecules are found in most human cell types and interact with T-cell receptors (TCRs) to activate T cells, which play a vital role in inducing adaptive immune responses. However, tumor cells may evade T-cell attack by downregulating HLA expression, limiting the efficacy of HLA-dependent immunotherapy. The prognosis of CLL largely depends on the presence or absence of genetic abnormalities, such as del(17p), TP53 point mutations, and IGHV somatic hypermutation status. These oral targeted therapies alone or in combination with anti-CD20 antibodies have replaced chemoimmunotherapy as the primary treatment for CLL. In this review, we summarize the current clinical evidence on the impact of HLA- and cytokine-type responses on outcomes after targeted therapies currently used to treat CLL. Full article
(This article belongs to the Section Hematology)
15 pages, 2333 KiB  
Article
Electrical Storm Has Worse Prognosis Compared to Sustained Ventricular Tachycardia after VT Ablation
by Julian Mueller, Ivaylo Chakarov, Philipp Halbfass, Karin Nentwich, Elena Ene, Artur Berkovitz, Kai Sonne, Sebastian Barth, Christian Waechter, Tobias Schupp, Michael Behnes, Ibrahim Akin and Thomas Deneke
J. Clin. Med. 2023, 12(7), 2730; https://doi.org/10.3390/jcm12072730 - 06 Apr 2023
Viewed by 1542
Abstract
Background: Electrical storm (ES) represents a serious heart rhythm disorder. This study investigates the impact of ES on acute ablation success and long-term outcomes after VT ablation compared to non-ES patients. Methods: In this large single-centre study, patients presenting with ES and undergoing [...] Read more.
Background: Electrical storm (ES) represents a serious heart rhythm disorder. This study investigates the impact of ES on acute ablation success and long-term outcomes after VT ablation compared to non-ES patients. Methods: In this large single-centre study, patients presenting with ES and undergoing VT ablation from June 2018 to April 2021 were compared to patients undergoing VT ablation due to ventricular tachyarrhythmias but without ES. The primary prognostic outcome was VT recurrence, and secondary endpoints were rehospitalization rates and cardiovascular mortality, all after a median follow-up of 22 months. Results: A total of 311 patients underwent a first VT ablation due to ventricular tachyarrhythmias and were included (63 ± 14 years; 86% male). Of these, 108 presented with ES. In the ES cohort, dilated cardiomyopathy as underlying heart disease was significantly higher (p = 0.008). Major complications were equal across both groups (all p > 0.05). Ablation of the clinical VT was achieved in 94% of all patients (p > 0.05). Noninducibility of any VT was achieved in 91% without ES and in 76% with ES (p = 0.001). Patients with ES revealed increased VT recurrence rates during follow-up (65% vs. 40%; log rank p = 0.001; HR 1.841, 95% CI 1.289–2.628; p = 0.001). Furthermore, ES patients suffered from increased rehospitalization rates (73% vs. 48%; log rank p = 0.001; HR 1.948, 95% CI 1.415–2.682; p = 0.001) and cardiovascular mortality (18% vs. 9%; log rank p = 0.045; HR 1.948, 95% CI 1.004–3.780; p = 0.049). After multivariable adjustment, ES was a strong independent predictor of VT recurrence and rehospitalization rates, but not for mortality. In a propensity score-matched cohort, patients with ES still had a higher risk of VT recurrences and rehospitalizations compared to non-ES patients. Conclusions: VT ablation in patients with ES is challenging and these patients reveal the highest risk for recurrent VTs, rehospitalization and cardiovascular mortality. These patients need close follow-ups and optimal guideline-directed therapy. Full article
(This article belongs to the Section Cardiology)
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14 pages, 4447 KiB  
Article
Determination of Relative Weightings for Sacroiliac Joint Pathologies in the OMERACT Juvenile Arthritis Magnetic Resonance Imaging Sacroiliac Joint Score
by Tarimobo M. Otobo, Mirkamal Tolend, Arthur B. Meyers, Iwona Sudol-Szopinska, Sayali Joshi, Jennifer Stimec, Nele Herregods, Jacob L. Jaremko, Shirley M. L. Tse, Nigil Haroon, Rahim Moineddin, Nikolay Tzaribachev, Simone Appenzeller, Michal Znajdek, Manuela Perez, Aloysius E. Ligha, Lennart Jans, Emilio J. Inarejos Clemente, Pamela Weiss, Olympia Papakonstantinou, Eva Kirkhus, Marion A. J. van Rossum, Dax G. Rumsey, John Carrino, Jonathan D. Akikusa, Philip G. Conaghan and Andrea S. Doriaadd Show full author list remove Hide full author list
J. Clin. Med. 2023, 12(7), 2729; https://doi.org/10.3390/jcm12072729 - 06 Apr 2023
Viewed by 1399
Abstract
This study aims to determine the relative weights (point value) of items of the juvenile idiopathic arthritis magnetic resonance imaging-sacroiliac joint scoring system (JAMRIS-SIJ). An adaptive multicriteria decision analysis was performed using the 1000Minds web application to determine the relative weights of the [...] Read more.
This study aims to determine the relative weights (point value) of items of the juvenile idiopathic arthritis magnetic resonance imaging-sacroiliac joint scoring system (JAMRIS-SIJ). An adaptive multicriteria decision analysis was performed using the 1000Minds web application to determine the relative weights of the items in the JAMRIS-SIJ inflammation and damage domains. Experts in imaging and rheumatology independently completed a conjoint analysis survey (CAS) to determine the point value of the measurement items of the JAMRIS-SIJ. Each CAS survey question asked the expert to compare two hypothetical patient profiles, which were otherwise similar but different at two items at a time, and to select which item showed a more severe stage of inflammation or osteochondral damage. In addition, experts ranked 14 JAMRIS-SIJ grade only or image + grade patient vignettes while blinded to the CAS-derived weights. The validity of the weighted JAMRIS-SIJ was tested by comparing the expert CAS-weighted score and the image + grade ranking method. Seventeen experts completed the CAS (11 radiologists and 6 rheumatologists). Considering the point value for inflammation domain items, osteitis (24.7%) and bone marrow edema (24.3%) had higher group-averaged percentage weights compared to inflammation in erosion cavity (16.9%), joint space enhancement (13.1%), joint space fluid (9.1%), capsulitis (7.3%), and enthesitis (4.6%). Similarly, concerning the damage domain, ankylosis (41.3%) and erosion (25.1%) showed higher group-averaged weights compared to backfill (13.9%), sclerosis (10.7%), and fat metaplasia lesion (9.1%). The Spearman correlation coefficients of the CAS-weighted vignette order and unweighted JAMRIS-SIJ grade only order vignettes for all experts were 0.79 for inflammation and 0.80 for damage. The correlations of image vignettes among imaging experts to CAS were 0.75 for inflammation and 0.90 for damage. The multicriteria decision analysis identified differences in relative weights among the JAMRIS-SIJ measurement items. The determination of the relative weights provided expert-driven score scaling and face validity for the JAMRIS-SIJ, enabling the future evaluation of its longitudinal construct validity. Full article
(This article belongs to the Section Nuclear Medicine & Radiology)
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10 pages, 1091 KiB  
Article
Predicting Cardiac Arrest in Children with Heart Disease: A Novel Machine Learning Algorithm
by Priscilla Yu, Michael Skinner, Ivie Esangbedo, Javier J. Lasa, Xilong Li, Sriraam Natarajan and Lakshmi Raman
J. Clin. Med. 2023, 12(7), 2728; https://doi.org/10.3390/jcm12072728 - 06 Apr 2023
Cited by 2 | Viewed by 1871
Abstract
Background: Children with congenital and acquired heart disease are at a higher risk of cardiac arrest compared to those without heart disease. Although the monitoring of cardiopulmonary resuscitation quality and extracorporeal resuscitation technologies have advanced, survival after cardiac arrest in this population has [...] Read more.
Background: Children with congenital and acquired heart disease are at a higher risk of cardiac arrest compared to those without heart disease. Although the monitoring of cardiopulmonary resuscitation quality and extracorporeal resuscitation technologies have advanced, survival after cardiac arrest in this population has not improved. Cardiac arrest prevention, using predictive algorithms with machine learning, has the potential to reduce cardiac arrest rates. However, few studies have evaluated the use of these algorithms in predicting cardiac arrest in children with heart disease. Methods: We collected demographic, laboratory, and vital sign information from the electronic health records (EHR) of all the patients that were admitted to a single-center pediatric cardiac intensive care unit (CICU), between 2010 and 2019, who had a cardiac arrest during their CICU admission, as well as a comparator group of randomly selected non-cardiac-arrest controls. We compared traditional logistic regression modeling against a novel adaptation of a machine learning algorithm (functional gradient boosting), using time series data to predict the risk of cardiac arrest. Results: A total of 160 unique cardiac arrest events were matched to non-cardiac-arrest time periods. Using 11 different variables (vital signs and laboratory values) from the EHR, our algorithm’s peak performance for the prediction of cardiac arrest was at one hour prior to the cardiac arrest (AUROC of 0.85 [0.79,0.90]), a performance that was similar to our previously published multivariable logistic regression model. Conclusions: Our novel machine learning predictive algorithm, which was developed using retrospective data that were collected from the EHR and predicted cardiac arrest in the children that were admitted to a single-center pediatric cardiac intensive care unit, demonstrated a performance that was similar to that of a traditional logistic regression model. While these results are encouraging, future research, including prospective validations with multicenter data, is warranted prior to the implementation of this algorithm as a real-time clinical decision support tool. Full article
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3 pages, 189 KiB  
Editorial
COVID-19 and Gastrointestinal Disease: Current Insights and Future Management
by Jonathan Kopel and Hemant Goyal
J. Clin. Med. 2023, 12(7), 2727; https://doi.org/10.3390/jcm12072727 - 06 Apr 2023
Viewed by 943
Abstract
The first case of coronavirus disease 2019 (COVID-19) was reported in Wuhan, Hubei Province, China, in December 2019, marking a pivotal moment in human history [...] Full article
30 pages, 863 KiB  
Systematic Review
Secondary IgA Nephropathy and IgA-Associated Nephropathy: A Systematic Review of Case Reports
by Maciej Tota, Vanessa Baron, Katie Musial, Bouchra Derrough, Andrzej Konieczny, Magdalena Krajewska, Kultigin Turkmen and Mariusz Kusztal
J. Clin. Med. 2023, 12(7), 2726; https://doi.org/10.3390/jcm12072726 - 06 Apr 2023
Cited by 1 | Viewed by 3844
Abstract
Primary (pIgAN), secondary IgA nephropathy (sIgAN), and IgA-associated nephropathy can be distinguished. While pIgAN has been thoroughly studied, information about the etiology of sIgAN remains scarce. As concerns sIgAN, several studies suggest that different etiologic factors play a role and ultimately lead to [...] Read more.
Primary (pIgAN), secondary IgA nephropathy (sIgAN), and IgA-associated nephropathy can be distinguished. While pIgAN has been thoroughly studied, information about the etiology of sIgAN remains scarce. As concerns sIgAN, several studies suggest that different etiologic factors play a role and ultimately lead to a pathophysiologic process similar to that of pIgAN. In this article, we review a vast number of cases in order to determine the novel putative underlying diseases of sIgAN. Moreover, updates on the common pathophysiology of primary disorders and sIgAN are presented. We identified liver, gastrointestinal, oncological, dermatological, autoimmune, and respiratory diseases, as well as infectious, iatrogenic, and environmental factors, as triggers of sIgAN. As novel biological therapies for listed underlying diseases emerge, we suggest implementing drug-induced sIgAN as a new significant category. Clinicians should acknowledge the possibility of sIgAN progression in patients treated with TNF-α inhibitors, IL-12/IL-23-inhibitors, immune checkpoint inhibitors, CTLA-4, oral anticoagulants, thioureylene derivatives, and anti-vascular endothelial growth factor drugs. Full article
(This article belongs to the Special Issue IgA Nephropathy: Recent Advances and Prospects)
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10 pages, 1635 KiB  
Article
Real-World Use and Predictors of Response to Disopyramide in Patients with Obstructive Hypertrophic Cardiomyopathy
by Niccolò Maurizi, Chiara Chiriatti, Carlo Fumagalli, Mattia Targetti, Silvia Passantino, Panagiotis Antiochos, Ioannis Skalidis, Chiara Chiti, Giulia Biagioni, Alessia Tomberli, Sara Giovani, Raffaele Coppini, Franco Cecchi and Iacopo Olivotto
J. Clin. Med. 2023, 12(7), 2725; https://doi.org/10.3390/jcm12072725 - 06 Apr 2023
Cited by 5 | Viewed by 2134
Abstract
Background: Although disopyramide has been widely used to reduce left ventricular outflow obstruction (LVOTO) and to improve symptoms in patients with obstructive hypertrophic cardiomyopathy (oHCM), its use in real world as well as patient characteristics associated with a positive treatment response are still [...] Read more.
Background: Although disopyramide has been widely used to reduce left ventricular outflow obstruction (LVOTO) and to improve symptoms in patients with obstructive hypertrophic cardiomyopathy (oHCM), its use in real world as well as patient characteristics associated with a positive treatment response are still unclear. Methods: From 1980 to 2021, 1527 patients with HCM were evaluated and 372 (23%) had a LVOTO with active follow-up. The efficacy and safety of disopyramide were assessed systematically during 12 months (2-, 6-, and 12-month visits). Responders were patients with a final NYHA = I and a LVOTO < 30 mmHg; incomplete responders were those patients with NYHA > I and a LVOTO < 30 mmHg; and non-responders were symptomatic patients with no change in functional class NYHA and a LVOT gradient > 30 mmHg. Results: Two-hundred-fifty-four (66%) patients were in functional class NYHA I/II and 118 (34%) in NYHA III/IV. A total of 118/372 (32%, 55 ± 16 years) underwent disopyramide therapy. Twenty-eight (24%) patients responded to therapy, 39 (33%) were incomplete responders, and 51 (43%) did not respond. Responder were mainly patients in functional NYHA class I/II (24/28, 86%), whereas incomplete responders and non-responders were more often in functional NYHA class III/IV (50/54 (93%)). An independent predictor of response to disopyramide treatment was the presence of NYHA I/II at the initiation of therapy (HR 1.5 (95% CI 1.1–4.5), p = 0.03). No major life-threatening arrhythmic events or syncope occurred, despite 19 (16%) patients showing reduced QTc from baseline, 19 (16%) having no difference, while 80 (69%) patients had prolonged QTc interval. Thirty-one (26%) patients experienced side effects, in particular, 29 of the anticholinergic type. Conclusions: Disopyramide was underused in oHCM but effective in reducing LVOTO gradients and symptoms in slightly symptomatic patients with less severe disease phenotype with a safe pro-arrhythmic profile. Full article
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10 pages, 678 KiB  
Article
Smell Dysfunction in Patients with Primary Sjögren’s Syndrome: Impact on Quality of Life
by Minan Y. Al-Ezzi, Khalid S. Khan and Anwar R. Tappuni
J. Clin. Med. 2023, 12(7), 2724; https://doi.org/10.3390/jcm12072724 - 06 Apr 2023
Viewed by 1221
Abstract
Objectives: Patients with primary Sjögren’s syndrome (pSS) often report smell and taste disturbances. However, the correlation between smell impairment and mucosal dryness is not well understood. The objectives of this study were to investigate the following: (1) the prevalence of smell hypofunction in [...] Read more.
Objectives: Patients with primary Sjögren’s syndrome (pSS) often report smell and taste disturbances. However, the correlation between smell impairment and mucosal dryness is not well understood. The objectives of this study were to investigate the following: (1) the prevalence of smell hypofunction in patients with SS; (2) the impact of smell hypofunction on their quality of life (QoL); (3) whether the patients’ smell is correlated with xerostomia; and (4) whether the patients’ smell is affected by taste hypofunction, disease duration, age, smoking or self-reported neuropathy. Methodology: An ethically approved cross-sectional study was conducted on 65 female patients with SS and 62 sex-matched healthy controls. Their smell was assessed using the University of Pennsylvania Smell Identification Test. Their taste acuity was assessed using the Taste Strips Test. A visual analogue scale was used for the self-assessment of smell and taste functions. Xerostomia was assessed by the salivary flow rate, clinical oral dryness score and the Xerostomia Inventory. The patients’ QoL and mental health well-being were assessed using validated questionnaires. Results: In the SS group, the patients’ smell function was impaired in 27/65 patients compared with the controls (15/62, p < 0.05), and it did not correlate with the severity of xerostomia, taste acuity (r = 0.05, p = 0.6) or self-reported nasal dryness (r = −0.02, p = 0.7). In the patients’ group, smell hypofunction was not correlated with disease duration (β = 0.1, 95% CI = −0.07–0.1) or smoking (β = −0.02, 95% CI = −8–7). Age was not correlated with the smell function in the patients’ group (β = −0.1, p = 0.5) but was correlated significantly with smell in the healthy participants’ group (β = −0.3, p = 0.02). Neuropathy affected 81.2% of the patients’ group. Their QoL and mental health well-being were not affected by smell hypofunction. Conclusion: Smell hypofunction appears to be a clinical manifestation in patients with SS, but it does not seem to be associated with the severity of mucosal dryness or with taste disturbance. Full article
(This article belongs to the Special Issue Diagnosis and Therapy of Smell and Taste Disorders)
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11 pages, 1221 KiB  
Article
Effect of Flat-Knitted Medical Compression Stockings on Venous Malformations
by Yi Li, Antje Mükke, Ulrich Rother, Rolf Janka, Michael Uder, Werner Lang and Rafael Heiss
J. Clin. Med. 2023, 12(7), 2723; https://doi.org/10.3390/jcm12072723 - 06 Apr 2023
Cited by 3 | Viewed by 1084
Abstract
Venous malformations are one of the most common vascular anomalies. Our study aimed to investigate the effect of medical compression stockings of class I and II on the volume of venous malformations. Patients with venous malformations on upper or lower extremities were enrolled. [...] Read more.
Venous malformations are one of the most common vascular anomalies. Our study aimed to investigate the effect of medical compression stockings of class I and II on the volume of venous malformations. Patients with venous malformations on upper or lower extremities were enrolled. They wore flat-knitted medical compression stockings of class I and II in a randomized order for four weeks each. Magnetic resonance imaging (MRI) and perometry were performed with and without wearing compression stockings. The 12-Item Short Form Survey (SF-12) questionnaire was performed before and after wearing compression stockings for four weeks each. A total of 18 patients completed the evaluations. Both compression classes showed a significant reduction of the volume of the venous malformations in the lesion itself based on MRI in comparison with baseline (both p < 0.001). Measurements taken with perometry did not reveal a significant difference in comparison to baseline (p = 0.09 and p = 0.22). The results of the SF-12 questionnaire demonstrated no significant differences before and after wearing the compression stockings of class I or class II for four weeks or between the two classes of compression therapy. Our results indicate that wearing medical compression stockings of both class I and class II significantly reduces the volume of venous malformation, without compromising the quality of life, while the effect of class II compression stockings on volume reduction was significantly better than that of class I. Full article
(This article belongs to the Section Vascular Medicine)
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13 pages, 963 KiB  
Article
Prevalence of Possible Dementia in Patients with Maxillofacial Defects and Difficulty of Inserting Obturator in Maxillectomy Patients: Toward Better Provision of Supportive Care
by Hongli Yu, Haruka Fujita, Masako Akiyama, Yuka I. Sumita and Noriyuki Wakabayashi
J. Clin. Med. 2023, 12(7), 2722; https://doi.org/10.3390/jcm12072722 - 05 Apr 2023
Cited by 1 | Viewed by 1032
Abstract
As society ages, it is important to understand the prevalence of dementia and the difficulties of inserting prostheses in patients with maxillofacial defects in order to clarify issues in supportive care. We screened 183 patients for dementia using the revised Hasegawa’s dementia scale [...] Read more.
As society ages, it is important to understand the prevalence of dementia and the difficulties of inserting prostheses in patients with maxillofacial defects in order to clarify issues in supportive care. We screened 183 patients for dementia using the revised Hasegawa’s dementia scale (HDS-R) at the Clinic for Maxillofacial prosthetics, Tokyo Medical and Dental University, and investigated age and sex differences in HDS-R score. We asked 47 of the 183 participants about the difficulty of inserting a maxillofacial obturator prosthesis and collected subjective comments, information about the prosthesis, and data from five assessments. Multiple regression analysis was used to reveal factors associated with insertion difficulty. Overall, 8.7% of the participants were judged to have possible dementia. Men were more likely than women to have possible dementia, and the risk increased with age. Of the 47 participants, 26 reported difficulty inserting their prosthesis, 12 of whom attributed it to their oral defect. Fourteen patients advised following doctor’s instructions to practice insertion in order to become accustomed to it. A lower HDS-R score had a significant impact on insertion difficulty. Cognitive function and difficulty inserting maxillary obturator prostheses should be considered in the provision of continuous supportive care to patients with maxillary defects. Full article
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19 pages, 5545 KiB  
Review
Osteoid Osteoma, a Diagnostic Problem: A Series of Atypical and Mimicking Presentations and Review of the Recent Literature
by Justyna Napora, Szymon Wałejko and Tomasz Mazurek
J. Clin. Med. 2023, 12(7), 2721; https://doi.org/10.3390/jcm12072721 - 05 Apr 2023
Cited by 5 | Viewed by 3675
Abstract
Osteoid osteoma (OO) is a common benign bone tumour, usually affecting young people. Typically, it is localised to the diaphyses or metaphyses of long bones. The classical manifestation includes distinctive night pain, almost always present, responding well to non-steroidal anti-inflammatory drugs, sometimes accompanied [...] Read more.
Osteoid osteoma (OO) is a common benign bone tumour, usually affecting young people. Typically, it is localised to the diaphyses or metaphyses of long bones. The classical manifestation includes distinctive night pain, almost always present, responding well to non-steroidal anti-inflammatory drugs, sometimes accompanied by complaints due to physical activity, and a typical picture on additional tests. A characteristic of osteoid osteoma is the presence of a nidus, usually visible on imaging tests. The nidus generally presents as a single, round lytic lesion up to 1 cm in diameter, surrounded by an area of reactive ossification. However, OO is a multifaceted neoplasm, and its diagnosis can cause numerous difficulties. OO can mimic multiple diseases and vice versa, which often leads to a prolonged diagnostic and therapeutic path and associated complications. There are few literature reviews about the differentiation and diagnostic difficulties of osteoid osteoma. Very effective therapies for this tumour are known, such as ablation and resection. Enhanced detection of osteoid osteoma could result in faster diagnosis and less suffering for the patient, avoidance of complications, and reduced costs of incorrect and prolonged treatment. Full article
(This article belongs to the Section Orthopedics)
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