Journal of Clinical Medicine

14 pages, 652 KiB

Open AccessReview

Use of Surface Electromyography to Evaluate Effects of Therapeutic Methods on Masticatory Muscle Activity in Patients with Temporomandibular Disorders: A Narrative Review

by Tomasz Dorosz, Aleksandra Mańko and Michał Ginszt

J. Clin. Med. 2024, 13(3), 920; https://doi.org/10.3390/jcm13030920 - 5 Feb 2024

Viewed by 844

Abstract

The presented narrative review aims to present the impact of therapeutic methods on the masticatory muscle activity measured using surface electromyography (sEMG) in patients with temporomandibular disorders (TMDs). Original interventional studies with baseline data for diagnosed TMD groups with full-text articles in English [...] Read more.

The presented narrative review aims to present the impact of therapeutic methods on the masticatory muscle activity measured using surface electromyography (sEMG) in patients with temporomandibular disorders (TMDs). Original interventional studies with baseline data for diagnosed TMD groups with full-text articles in English published in scientific journals in the last ten years were included in the evaluation process. The following narrative review considered only clinical, controlled, and randomized studies. Articles that included the following parameters were qualified for this review: adult participants, diagnosis of temporomandibular disorder, the presence of a musculoskeletal dysfunction, no other severe comorbidities, use of therapeutic interventions, and sEMG measurement before and after the intervention. Ten papers were accepted and analyzed for the final evaluation in the presented review. Several studies using surface electromyographic examination prove the effectiveness of various therapies to normalize the bioelectrical activity of the masticatory muscles, either reduction during rest or increase during a functional task in patients diagnosed with temporomandibular disorders. This narrative review shows the influence of manual and physical treatments on electromyographic masticatory muscle activity, including soft tissue mobilization, transcutaneous electrical nerve stimulation, low-level laser therapy, and moist heat therapy. Changes in masticatory muscle activity coincided with changes in TMD-associated pain and range of mandibular mobility. Full article

(This article belongs to the Special Issue Multidisciplinary Approach to Diagnosing and Treatment of Temporomandibular Disorders—Patient Care Challenges)

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15 pages, 1422 KiB

Open AccessArticle

Efficacy and Safety of a Probiotic Containing Saccharomyces boulardii CNCM I-745 in the Treatment of Small Intestinal Bacterial Overgrowth in Decompensated Cirrhosis: Randomized, Placebo-Controlled Study

by Irina Efremova, Roman Maslennikov, Maria Zharkova, Elena Poluektova, Nona Benuni, Aleksandr Kotusov, Tatyana Demina, Aleksandra Ivleva, Farida Adzhieva, Taisiya Krylova and Vladimir Ivashkin

J. Clin. Med. 2024, 13(3), 919; https://doi.org/10.3390/jcm13030919 - 5 Feb 2024

Cited by 1 | Viewed by 1860

Abstract

(1) Background: The aim was to evaluate the effectiveness of the probiotic containing Saccharomyces boulardii in the treatment of small intestinal bacterial overgrowth (SIBO) in patients with decompensated cirrhosis. (2) Methods: This was a blinded, randomized, placebo-controlled study. (3) Results: [...] Read more.

(1) Background: The aim was to evaluate the effectiveness of the probiotic containing Saccharomyces boulardii in the treatment of small intestinal bacterial overgrowth (SIBO) in patients with decompensated cirrhosis. (2) Methods: This was a blinded, randomized, placebo-controlled study. (3) Results: After 3 months of treatment, SIBO was absent in 80.0% of patients in the probiotic group and in 23.1% of patients in the placebo group (p = 0.002). The patients with eliminated SIBO had decreased frequency of ascites and hepatic encephalopathy, the increased platelets and albumin levels, the decreased blood levels of total bilirubin, biomarkers of bacterial translocation (lipopolysaccharide [LPS]) and systemic inflammation (C-reactive protein), and positive changes in markers of hyperdynamic circulation compared with the state at inclusion. There were no significant changes in the claudin 3 level (the intestinal barrier biomarker) in these patients. No significant changes were observed in the group of patients with persistent SIBO. The serum level of nitrate (endothelial dysfunction biomarker) was lower in patients with eradicated SIBO than in patients with persistent SIBO. One (5.3%) patient with eradicated SIBO and six (42.9%) patients with persistent SIBO died within the first year of follow-up (p = 0.007). (4) Conclusions: SIBO eradication was an independent predictor of a favorable prognosis during the first year of follow-up. Full article

(This article belongs to the Collection Clinical Research in Hepatology)

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9 pages, 513 KiB

Open AccessArticle

No Harmful Effect of Endovascular Treatment before Decompressive Surgery—Implications for Handling Patients with Space-Occupying Brain Infarction

by Johann Otto Pelz, Simone Engelmann, Cordula Scherlach, Peggy Bungert-Kahl, Alhuda Dabbagh, Dirk Lindner and Dominik Michalski

J. Clin. Med. 2024, 13(3), 918; https://doi.org/10.3390/jcm13030918 - 5 Feb 2024

Viewed by 589

Abstract

This study explored short- and mid-term functional outcomes in patients undergoing decompressive hemicraniectomy (DHC) due to space-occupying cerebral infarction and asked whether there is a potentially harmful effect of a priorly performed endovascular treatment (EVT). Medical records were screened for patients requiring DHC [...] Read more.

This study explored short- and mid-term functional outcomes in patients undergoing decompressive hemicraniectomy (DHC) due to space-occupying cerebral infarction and asked whether there is a potentially harmful effect of a priorly performed endovascular treatment (EVT). Medical records were screened for patients requiring DHC due to space-occupying cerebral infarction between January 2016 and July 2021. Functional outcomes at hospital discharge and at 3 months were assessed by the modified Rankin Scale (mRS). Out of 65 patients with DHC, 39 underwent EVT before DHC. Both groups, i.e., EVT + DHC and DHC alone, had similar volumes (280 ± 90 mL vs. 269 ± 73 mL, t-test, p = 0.633) and proportions of edema and infarction (22.1 ± 6.5% vs. 22.1 ± 6.1%, t-test, p = 0.989) before the surgical intervention. Patients undergoing EVT + DHC tended to have a better functional outcome at hospital discharge compared to DHC alone (mRS 4.8 ± 0.8 vs. 5.2 ± 0.7, Mann–Whitney-U, p = 0.061), while the functional outcome after 3 months was similar (mRS 4.6 ± 1.1 vs. 4.8 ± 0.9, Mann–Whitney-U, p = 0.352). In patients initially presenting with a relevant infarct demarcation (Alberta Stroke Program Early CT Score ≤ 5), the outcome was similar at hospital discharge and after 3 months between patients with EVT + DHC and DHC alone. This study provided no evidence for a harmful effect of EVT before DHC in patients with space-occupying brain infarction. Full article

(This article belongs to the Special Issue Neurocritical Care: New Insights and Challenges)

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12 pages, 548 KiB

Open AccessArticle

Quality Indicators and Clinical Outcomes of Acute Stroke: Results from a Prospective Multicenter Registry in Greece (SUN4P)

by Eleni Korompoki, George Ntaios, Argyro Tountopoulou, Georgios Mavraganis, Evangelos Tsampalas, Ioannis Kalliontzakis, Sofia Vassilopoulou, Efstathios Manios, Christos Savopoulos, Haralampos Milionis, Athanasios Protogerou, Nikolaos Kakaletsis, Petros Galanis, Daphne Kaitelidou, Olga Siskou, Konstantinos Vemmos and on behalf of the SUN4P Project Collaborators

J. Clin. Med. 2024, 13(3), 917; https://doi.org/10.3390/jcm13030917 - 5 Feb 2024

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Abstract

Aim: The Stroke Units Necessity for Patients (SUN4P) project aims to provide essential data on stroke healthcare in Greece. Herein, we present results on established quality indicators and outcomes after first-ever stroke occurrences. Methods: This prospective multicenter study included consecutive patients admitted to [...] Read more.

Aim: The Stroke Units Necessity for Patients (SUN4P) project aims to provide essential data on stroke healthcare in Greece. Herein, we present results on established quality indicators and outcomes after first-ever stroke occurrences. Methods: This prospective multicenter study included consecutive patients admitted to nine hospitals across Greece in 2019–2021. Descriptive statistics were used to present patients’ characteristics, key performance measures and stroke outcomes. Results: Among 892 patients, 755 had ischemic stroke (IS) (mean age 75.6 ± 13.6, 48.7% males) and 137 had hemorrhagic stroke (HS) (mean age 75.8 ± 13.2, 57.7% males). Of those, 15.4% of IS and 8% of HS patients were treated in the acute stroke unit (ASU) and 20.7% and 33.8% were admitted to the intensive care unit (ICU) or high-dependency unit (HDU), respectively. A total of 35 (4.6%) out of 125 eligible patients received intravenous alteplase with a door-to needle time of 60 min (21–90). The time to first scan for IS patients was 60 min (31–105) with 53.2% undergoing a CT scan within 60 min post presentation. Furthermore, 94.4% were discharged on antiplatelets, 69.8% on lipid-lowering therapy and 61.6% on antihypertensives. Oral anticoagulants (OAC) were initiated in 73.2% of the 153 IS patients with atrial fibrillation (AF). Among the 687 IS patients who survived, 85.4% were discharged home, 12% were transferred to rehabilitation centers, 1.2% to nursing homes and 1.3% to another hospital. Conclusions: The SUN4P Registry is the first study to provide data from a prospectively collected cohort of consecutive patients from nine representative national hospitals. It represents an important step in the evaluation and improvement of the quality of acute stroke care in Greece. Full article

(This article belongs to the Section Clinical Neurology)

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10 pages, 707 KiB

Open AccessArticle

The Impact of Extracorporeal Magnetic Stimulation as Addition to Mirabegron in Overactive Bladder Treatment in Women: A Single-Centre Randomized Sham-Controlled Study

by Uros Bele, Tamara Serdinšek, Evgenija Homšak and Igor But

J. Clin. Med. 2024, 13(3), 916; https://doi.org/10.3390/jcm13030916 - 5 Feb 2024

Viewed by 538

Abstract

(1) Background: The purpose of our prospective, single-blinded, randomized, sham-controlled study was to investigate the effect of the additional extracorporeal magnetic stimulation (ExMI) to pharmacological treatment in overactive bladder syndrome (OAB) in women. (2) Methods: We recruited 56 women with OAB, who were [...] Read more.

(1) Background: The purpose of our prospective, single-blinded, randomized, sham-controlled study was to investigate the effect of the additional extracorporeal magnetic stimulation (ExMI) to pharmacological treatment in overactive bladder syndrome (OAB) in women. (2) Methods: We recruited 56 women with OAB, who were allocated into two study groups: the active group received mirabegron 50 mg daily and a total of 16 sessions of ExMI in 8 weeks, whereas the sham group received mirabegron 50 mg daily and sham stimulation following the same treatment protocol. Treatment success was evaluated after 4 and 8 weeks. (3) Results: Both groups experienced significant reduction in daytime urinary frequency, nocturia, and number of weekly incontinence episodes after 8 weeks. There were no statistically significant differences in end-point daytime urinary frequency and nocturia between groups. However, the overall average reduction rate in weekly number of incontinence episodes was 43.7% in treatment group and 24.2% in the control group. The number of urinary incontinence episodes in the treatment and control group was reduced for 3.8 ± 11.8 vs. 2.5 ± 4.3 episodes at week 4 and additional 3.3 ± 6 vs. 0.4 ± 3.2 episodes at week 8, respectively (p = 0.013). Moreover, IIQ-7 score showed a significantly greater score reduction and patients’ evaluated improvement of symptoms was higher in the active group. (4) Conclusions: The addition of ExMI to mirabegron in OAB treatment further improves the weekly incontinence episode reduction rate and also leads to grater improvement in symptoms. Full article

(This article belongs to the Section Nephrology & Urology)

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14 pages, 1815 KiB

Open AccessReview

Current Trends and Beyond Conventional Approaches: Advancements in Breast Cancer Surgery through Three-Dimensional Imaging, Virtual Reality, Augmented Reality, and the Emerging Metaverse

by Weronika Magdalena Żydowicz, Jaroslaw Skokowski, Luigi Marano and Karol Polom

J. Clin. Med. 2024, 13(3), 915; https://doi.org/10.3390/jcm13030915 - 5 Feb 2024

Viewed by 1262

Abstract

Breast cancer stands as the most prevalent cancer globally, necessitating comprehensive care. A multidisciplinary approach proves crucial for precise diagnosis and treatment, ultimately leading to effective disease management. While surgical interventions continue to evolve and remain integral for curative treatment, imaging assumes a [...] Read more.

Breast cancer stands as the most prevalent cancer globally, necessitating comprehensive care. A multidisciplinary approach proves crucial for precise diagnosis and treatment, ultimately leading to effective disease management. While surgical interventions continue to evolve and remain integral for curative treatment, imaging assumes a fundamental role in breast cancer detection. Advanced imaging techniques not only facilitate improved diagnosis but also contribute significantly to the overall enhancement of breast cancer management. This review article aims to provide an overview of innovative technologies such as virtual reality, augmented reality, and three-dimensional imaging, utilized in the medical field to elevate the diagnosis and treatment of breast cancer. Additionally, the article delves into an emerging technology known as the metaverse, still under development. Through the analysis of impactful research and comparison of their findings, this study offers valuable insights into the advantages of each innovative technique. The goal is to provide physicians, surgeons, and radiologists with information on how to enhance breast cancer management. Full article

(This article belongs to the Special Issue Clinical Practice Guidelines for the Diagnosis, Treatment and Management of Breast Cancer)

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10 pages, 621 KiB

Open AccessArticle

Gender Difference in REM Sleep Behavior Disorder in Japanese Population: Polysomnography and Sleep Questionnaire Study

by Mamiko Mano, Atsuhiko Nomura and Ryujiro Sasanabe

J. Clin. Med. 2024, 13(3), 914; https://doi.org/10.3390/jcm13030914 - 5 Feb 2024

Viewed by 885

Abstract

Rapid eye movement (REM) sleep behavior disorder (RBD) is generally common among males and is an established risk factor for neurodegenerative diseases. As the population ages, the prevalence of α-synucleinopathy (such as Parkinson’s disease) is increasing. Additionally, the number of female patients is [...] Read more.

Rapid eye movement (REM) sleep behavior disorder (RBD) is generally common among males and is an established risk factor for neurodegenerative diseases. As the population ages, the prevalence of α-synucleinopathy (such as Parkinson’s disease) is increasing. Additionally, the number of female patients is increasing in Japan. Therefore, we aimed to clarify the clinical characteristics of RBD from the perspective of gender differences in the Japanese population. The proportion of male RBD patients (65.2%) was significantly higher than that of female patients (34.8%). Additionally, female patients (70.5 ± 8.2 years) were significantly older than male patients (67.9 ± 8.0 years, p < 0.05). The mean score on the RBD Screening Questionnaire was significantly higher in male patients than in female (8.6 ± 2.9 vs. 7.7 ± 3.1, p < 0.05), while the mean score on the Pittsburgh Sleep Quality Index was significantly higher in males (5.9 ± 3.8 vs. 7.2 ± 3.600, p < 0.001). The Self-rating Depression Scale in females was 41.7 ± 8.5, and they were more likely to show depressive tendencies than males. In polysomnography, higher rates of obstructive sleep apnea and longer duration of stage N1 sleep were detected in males. After adjusting for age, BMI, and polysomnographic parameters, we found that female RBD patients had significantly worse sleep quality and rates of depression compared to male patients. Full article

(This article belongs to the Special Issue Editorial Board Members’ Collection Series: Sleep and Neuropsychiatric Disorders)

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12 pages, 1368 KiB

Open AccessArticle

Impact of the Order of Movement on the Median Nerve Root Function: A Neurophysiological Study with Implications for Neurodynamic Exercise Sequencing

by Dalia Ibrahim, Amal Ahbouch, Raneen Mohammed Qadah, Meeyoung Kim, Saud M. Alrawaili and Ibrahim M. Moustafa

J. Clin. Med. 2024, 13(3), 913; https://doi.org/10.3390/jcm13030913 - 5 Feb 2024

Viewed by 799

Abstract

Background: Neurodynamic exercise is a common clinical practice used to restore neural dynamic balance. The order in which movements are performed during these exercises is believed to play a crucial role in their effectiveness. This study aimed to investigate the impact of different [...] Read more.

Background: Neurodynamic exercise is a common clinical practice used to restore neural dynamic balance. The order in which movements are performed during these exercises is believed to play a crucial role in their effectiveness. This study aimed to investigate the impact of different sequences of neurodynamic exercise on nerve root function, with a specific focus on the median nerve. Methods: Participants were assigned randomly to three experimental groups, each undergoing a different test sequence: standard, proximal-to-distal, and distal-to-proximal. Dermatomal somatosensory evoked potentials (DSSEPs) were recorded at key levels (C6, C7, C8, and T1). Results: The findings revealed a significant influence of the movement sequence on DSSEP amplitudes. The execution of neurodynamic exercise in the proximal-to-distal sequence was associated with a notable reduction in amplitudes (p < 0.05). Conversely, the distal-to-proximal sequence resulted in increased amplitudes compared to the standard sequence (p < 0.05). Conclusions: This study underscores the importance of carefully considering the order of movements during neurodynamic exercising, particularly when evaluating nerve roots that lack the protective perineurium. The choice of sequence appears to have a substantial impact on nerve function, with implications for optimizing clinical neurodynamic exercise techniques. Full article

(This article belongs to the Special Issue Musculoskeletal Disorders: Clinical Rehabilitation and Physiotherapy)

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12 pages, 1489 KiB

Open AccessFeature PaperArticle

Comparison of Incidence or Recurrence of Anterior Uveitis in Patients with Ankylosing Spondylitis Treated with Tumor Necrosis Factor Inhibitors

by Hyeon Yoon Kwon, Yu Jeong Kim, Tae-Hwan Kim and Seong Joon Ahn

J. Clin. Med. 2024, 13(3), 912; https://doi.org/10.3390/jcm13030912 - 5 Feb 2024

Viewed by 814

Abstract

Background: Anterior uveitis (AU) is a significant concern in patients with ankylosing spondylitis (AS), and the choice of tumor necrosis factor inhibitors (TNFi) as a treatment modality raises questions regarding its effects on AU. We compared the effects of TNFi on AU [...] Read more.

Background: Anterior uveitis (AU) is a significant concern in patients with ankylosing spondylitis (AS), and the choice of tumor necrosis factor inhibitors (TNFi) as a treatment modality raises questions regarding its effects on AU. We compared the effects of TNFi on AU in patients with AS. Methods: Patients diagnosed with AS and treated with at least one TNFi, including anti-TNFα antibodies (adalimumab and infliximab) or a soluble TNF receptor molecule (etanercept), between January 2010 and December 2022, were retrospectively reviewed. We compared the recurrence rate of AU in patients with a history of uveitis and the incidence of new-onset AU in those without a history of uveitis among the three TNFi groups. We also compared the effects of two different TNFi agents in patients who underwent TNFi switching. Results: Within two years of treatment initiation, there was no significant difference in AU recurrence among the three TNFi groups. However, the incidence of new-onset AU was significantly higher in the etanercept group than in the adalimumab group (26.4% vs. 6.3%; p = 0.024). After two years, the AU recurrence rate was significantly lower in the adalimumab group than in the other groups (p < 0.001). Among patients who underwent anti-TNFi switching, adalimumab treatment was associated with a significantly lower incidence of uveitis than etanercept (p = 0.023). Conclusion: In the short-term period following TNFi therapy, etanercept induced new-onset AU more frequently than adalimumab in patients with AS. Adalimumab recipients experienced fewer AU recurrences during the subsequent long-term period compared to other TNFi recipients. Full article

(This article belongs to the Special Issue Clinical Advances in the Diagnosis and Treatment of Uveitis—2nd Edition)

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11 pages, 510 KiB

Open AccessArticle

Ileal Conduit versus Cutaneous Ureterostomy after Open Radical Cystectomy: Comparison of 90-Day Morbidity and Tube Dependence at Intermediate Term Follow-Up

by Parth U. Thakker, Justin Manuel Refugia, Dylan Wolff, Randy Casals, Corey Able, Davis Temple, Alejandro R. Rodríguez and Matvey Tsivian

J. Clin. Med. 2024, 13(3), 911; https://doi.org/10.3390/jcm13030911 - 5 Feb 2024

Viewed by 765

Abstract

Background: This study aims to compare perioperative morbidity and drainage tube dependence following open radical cystectomy (ORC) with ileal conduit (IC) or cutaneous ureterostomy (CU) for bladder cancer. Methods: A single-center, retrospective cohort study of patients undergoing ORC with IC or [...] Read more.

Background: This study aims to compare perioperative morbidity and drainage tube dependence following open radical cystectomy (ORC) with ileal conduit (IC) or cutaneous ureterostomy (CU) for bladder cancer. Methods: A single-center, retrospective cohort study of patients undergoing ORC with IC or CU urinary diversion between 2020 and 2023 was carried out. The 90-day perioperative morbidity, as per Clavien–Dindo (C.D.) complication rates (Minor C.D. I–II, Major C.D. III–V), and urinary drainage tube dependence (ureteral stent or nephrostomy tube) after tube-free trial were assessed. Results: The study included 56 patients (IC: 26, CU: 30) with a 14-month median follow-up. At 90 days after IC or CU, the frequencies of any, minor, and major C.D. complications were similar (any—69% vs. 77%; minor—61% vs. 73%; major—46% vs. 30%, respectively, p > 0.2). Tube-free trial was performed in 86% of patients with similar rates of tube replacement (19% IC vs. 32% CU, p = 0.34) and tube-free survival at 12 months was assessed (76% IC vs. 70% CU, p = 0.31). Conclusions: Compared to the ORC+IC, ORC+CU has similar rates of both 90-day perioperative complications and 12-month tube-free dependence. CU should be offered to select patients as an alternative to IC urinary diversion after RC. Full article

(This article belongs to the Special Issue Bladder Cancer: Surgical Treatment and Prognosis)

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13 pages, 996 KiB

Open AccessReview

Trans-Arterial Stem Cell Injection (TASI): The Role of Interventional Radiology in Regenerative Medicine

by Makoto Taninokuchi Tomassoni, Yinghui Zhou, Lorenzo Braccischi, Francesco Modestino, Junji Fukuda and Cristina Mosconi

J. Clin. Med. 2024, 13(3), 910; https://doi.org/10.3390/jcm13030910 - 5 Feb 2024

Viewed by 743

Abstract

Regenerative medicine is taking a step forward in treating multiple diseases. The possibility of renewing damaged tissues with stem cells has become a topic of interest in recent decades. Still a relatively new research topic, many issues in this discipline are being addressed, [...] Read more.

Regenerative medicine is taking a step forward in treating multiple diseases. The possibility of renewing damaged tissues with stem cells has become a topic of interest in recent decades. Still a relatively new research topic, many issues in this discipline are being addressed, from cell culturing to the study of different graft materials, and, moreover, cell delivery. For instance, direct intravenous injection has a big downfall regarding its lack of precision and poorly targeted treatment. Trans-arterial and direct percutaneous infusion to the aimed tissue/organ are both considered ideal for reaching the desired region but require image guidance to be performed safely and precisely. In this context, interventional radiology becomes pivotal for providing different cell delivery possibilities in every case. In this review, we analyze different basic stem cell therapy concepts and the current and future role of interventional radiology with a focus on trans-arterial delivery. Full article

(This article belongs to the Special Issue Technological Advancements and Clinical Innovations in Diagnostic and Interventional Radiology)

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8 pages, 6417 KiB

Open AccessArticle

Recurrent Sialolithiasis following Intraoral Deep Hilar/Intraparenchymal Stone Removal from Wharton’s Duct

by Konstantinos Tarazis, Konstantinos Garefis, Angelos Chatziavramidis and Iordanis Konstantinidis

J. Clin. Med. 2024, 13(3), 909; https://doi.org/10.3390/jcm13030909 - 5 Feb 2024

Viewed by 553

Abstract

(1) Background: Submandibular gland (SMG) sialolithiasis treatment has shifted significantly, favouring minimal invasiveness. Nonetheless, transoral stone removal remains viable for distal, deep hilar, and intraparenchymal stones. However, data are limited regarding recurrence and revision surgery; (2) Patients/Methods: This retrospective study included 226 patients [...] Read more.

(1) Background: Submandibular gland (SMG) sialolithiasis treatment has shifted significantly, favouring minimal invasiveness. Nonetheless, transoral stone removal remains viable for distal, deep hilar, and intraparenchymal stones. However, data are limited regarding recurrence and revision surgery; (2) Patients/Methods: This retrospective study included 226 patients with SMG stones treated using Wharton’s duct slitting and marsupialisation over nine years; 138 had deep hilar or intraparenchymal stones, while 88 had distal stones. Of the former group, 18 experienced symptom recurrence post-surgery, 12 with stones and 6 with duct stenosis; (3) Results: Of the 126 patients without recurrent stones, 71% were male and 29% were female. Their mean age was 51.02 ± 9.36 years. The stones of the 126 patients without recurrence had a diameter of 8.3 mm ± SD: 4 mm, which was significantly smaller than those of the patients who experienced recurrence (13.8 mm ± SD: 2.4 mm; p < 0.05). The mean estimated stone growth recurrence rate was 8.4 ± SD: 1.8 mm per year. A secondary operation was performed 34 ± SD: 14.7 months after the first. Of the patients with recurrence, 91.7% were treated under general anaesthesia. The preferred treatment for 58.4% of patients was intraoral revision operation; the remainder underwent total gland resection. The mean follow-up period was 43 ± SD: 18 months; (4) Conclusions: The rate of revision surgery was relatively low. In recurrent SMG sialolithiasis, new stones may grow faster than the primary stones, which are already larger than those in patients without recurrence. The slitting and marsupialisation of Wharton’s duct can treat recurrent cases. Full article

(This article belongs to the Special Issue Current and Future Trends in Otorhinolaryngology–Head and Neck Surgery)

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10 pages, 608 KiB

Open AccessArticle

Is the Elite Female Athlete’s Pelvic Floor Stronger?

by María Barbaño Acevedo-Gómez, Elena Sonsoles Rodríguez-López, Ángel Oliva-Pascual-Vaca, Tomás Fernández-Rodríguez, Ángel Basas-García and Cristina Ojedo-Martín

J. Clin. Med. 2024, 13(3), 908; https://doi.org/10.3390/jcm13030908 - 4 Feb 2024

Viewed by 804

Abstract

Background: Exercise can stress the pelvic floor muscles (PFMs). This study sought to assess the strength of the PFMs according to the level of physical exercise. Methods: An analytical observational study was carried out using digital palpation and dynamometry measurements to [...] Read more.

Background: Exercise can stress the pelvic floor muscles (PFMs). This study sought to assess the strength of the PFMs according to the level of physical exercise. Methods: An analytical observational study was carried out using digital palpation and dynamometry measurements to assess PF strength. Healthy nulliparous women were stratified according to physical exercise (physically active and sedentary) and level of physical exercise (elite, amateur, and sedentary). Results: Fifty-four women were analyzed, with a mean age of 25.64 (5.33) years and a BMI of 21.41 (2.96) kg/m². Differences in the passive force and strength were observed between both groups of women (p < 0.05), and the strength was around two times higher in physically active women (p < 0.05). The strength was similar between elite female athletes and sedentary women (p > 0.05), but statistical differences were found with amateurs (p < 0.05). The PFM strength (p = 0.019) of elite female athletes (0.34 N) was almost half that of amateurs (0.63 N) and twice as strong as that of sedentary women (0.20 N). However, these differences were not significant using digital palpation (p = 0.398). Conclusions: Women who exercise generally have greater PFM strength than women who do not exercise. Physical exercise could strengthen the PFM; however, the high intensity demanded by high-level sports does not seem to proportionally increase the strength of the PFMs. Full article

(This article belongs to the Section Sports Medicine)

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12 pages, 1000 KiB

Open AccessFeature PaperArticle

Safety and Efficacy of PCSK9 Inhibitors in Patients with Acute Coronary Syndrome Who Underwent Coronary Artery Bypass Grafts: A Comparative Retrospective Analysis

by Giuseppe Nasso, Claudio Larosa, Francesco Bartolomucci, Mario Siro Brigiani, Gaetano Contegiacomo, Maria Antonietta Demola, Walter Vignaroli, Alessandra Tripoli, Cataldo Girasoli, Rosanna Lisco, Marialisa Trivigno, Roberto Michele Tunzi, Tommaso Loizzo, Dritan Hila, Rosalba Franchino, Vincenzo Amodeo, Simone Ventra, Giuseppe Diaferia, Giacomo Schinco, Felice Eugenio Agrò, Maddalena Zingaro, Isabella Rosa, Roberto Lorusso, Armando Del Prete, Giuseppe Santarpino and Giuseppe Speziale Show full author list Hide full author list

J. Clin. Med. 2024, 13(3), 907; https://doi.org/10.3390/jcm13030907 - 4 Feb 2024

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Abstract

Background. The in-hospital reduction in low-density lipoprotein cholesterol (LDL-C) levels following acute coronary syndrome (ACS) is recommended in the current clinical guidelines. However, the efficacy of proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitors in those patients undergoing coronary artery bypass graft (CABG) [...] Read more.

Background. The in-hospital reduction in low-density lipoprotein cholesterol (LDL-C) levels following acute coronary syndrome (ACS) is recommended in the current clinical guidelines. However, the efficacy of proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitors in those patients undergoing coronary artery bypass graft (CABG) has never been demonstrated. Methods. From January 2022 to July 2023, we retrospectively analyzed 74 ACS patients characterized by higher LDL-C levels than guideline targets and who underwent coronary bypass surgery. In the first period (January 2022–January 2023), the patients increased their statin dosage and/or added Ezetimibe (Group STEZE, 43 patients). At a later time (February 2023–July 2023), the patients received not only statins and Ezetimibe but also Evolocumab 140 mg every 2 weeks starting as early as possible (Group STEVO, 31 patients). After one and three months post-discharge, the patients underwent clinical and laboratory controls with an evaluation of the efficacy lipid measurements and every adverse event. Results. The two groups did not differ in terms of preoperative risk factors and Euroscore II (STEVO: 2.14 ± 0.75 vs. STEZE: 2.05 ± 0.6, p = 0.29). Also, there was no difference between the groups in terms of ACS (ST-, Instable angina, or NSTE) and time of symptoms onset regarding total cholesterol, LDL-C, and HDL-C trends from the preprocedural period to 3-month follow-up, but there was a more significant reduction in LDL-C and total cholesterol in the STEVO group (p = 0.01 and p = 0.04, respectively) and no difference in HDL-C rise (p = 0.12). No deaths were reported. In three STEZE group patients, angina recurrence posed the need for percutaneous re-revascularization. No STEVO patients developed significant adverse events. The statistical difference in these serious events, 7% in STEZE vs. 0% in STEVO, was not significant (p = 0.26). Conclusions. Evolocumab initiated “as soon as possible” in ACS patients submitted to CABG with high-intensity statin therapy and Ezetimibe was well tolerated and resulted in a substantial and significant reduction in LDL-C levels at discharge, 1 month, and 3 months. This result is associated with a reduction but without a statistical difference between groups. Full article

(This article belongs to the Special Issue Primary and Secondary Cardiovascular Disease Risk Factors, Prevention and Therapy)

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10 pages, 2377 KiB

Open AccessArticle

Mandibular Third Molar Impaction and Bone Change Distal to the Second Molar: A Panoramic Radiographic Study

by Hassan Assiri Ahmed, Jose López-López, Sonia Egido-Moreno, Xavier Roselló Llabrés, Mohammed Hameed and Albert Estrugo-Devesa

J. Clin. Med. 2024, 13(3), 906; https://doi.org/10.3390/jcm13030906 - 4 Feb 2024

Viewed by 597

Abstract

Background: The mandibular third molar is the most frequently impacted tooth. An impacted mandibular third molar (IMTM) can have negative consequences on the adjacent mandibular second molar (MSM), such as bone loss. An IMTM can be identified using orthopantomography (OPG). Our objective is [...] Read more.

Background: The mandibular third molar is the most frequently impacted tooth. An impacted mandibular third molar (IMTM) can have negative consequences on the adjacent mandibular second molar (MSM), such as bone loss. An IMTM can be identified using orthopantomography (OPG). Our objective is to compare changes in bone level distal to the mandibular second molar (MSM) in patients with an extracted IMTM versus non-extracted IMTM using OPG. Methods: In this retrospective case–control study, 160 orthopantomograms (OPGs) of 80 patients who attended Dental Hospital of the University of Barcelona (HOUB) were randomly selected. Participants were stratified into a study group and control group. Results: Males and females experienced bone gain in the study group and bone loss in the control group. However, the difference in bone-level change was not statistically significant regarding gender in the study group. Within the study group, the age group of 29–39 years demonstrated significant (p-value = 0.042) bone gain after extraction compared to other age groups. However, the control group demonstrated bone loss in all age groups in which the difference is not statistically significant (p-value 0.794). Conclusions: Bone improvements distal to the MSM were observed after the extraction of an IMTM compared to when an IMTM was not extracted. Full article

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

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13 pages, 9165 KiB

Open AccessArticle

Optimal Plate Choice for High-Neck Mandibular Condyle Fracture: A Mechanistic Analysis of 16 Options

by Jakub Okulski, Marcin Kozakiewicz, Michał Krasowski, Rafał Zieliński and Piotr Szymor

J. Clin. Med. 2024, 13(3), 905; https://doi.org/10.3390/jcm13030905 - 4 Feb 2024

Viewed by 616

Abstract

(1) Background: Mandibular fractures are common, with the condylar process being a frequent site of injury, accounting for 25–45% of cases. This research aims to assess the mechanical suitability of various plates for high-neck condyle fractures. (2) Methods: Polyurethane models mimicking [...] Read more.

(1) Background: Mandibular fractures are common, with the condylar process being a frequent site of injury, accounting for 25–45% of cases. This research aims to assess the mechanical suitability of various plates for high-neck condyle fractures. (2) Methods: Polyurethane models mimicking high-neck condyle fractures were utilized in this study. Sixteen distinct plate designs, constructed from titanium sheets, were tested. The figures underwent force assessments on a durability testing apparatus, and the relationship between used force and fracture movement was documented. (3) Results: For high-neck breaking, the two straight plates emerged as the most effective, aligning with established osteosynthesis standards. The second-best plate exhibited nearly half the strength of the gold standard. (4) Conclusions: In response to the aim of this study, considering the mechanical aspects, the double plain plate stands out as the optimal choice for osteosynthesis in cases of high-neck fractures of the mandibular condylar process. In addition, the authors propose the Mechanical Excellence Factor (MEF) as a superior metric for appraising a plate’s mechanical force, surpassing the conventional Plate Design Factor (PDF). Full article

(This article belongs to the Special Issue Treatment of Facial Fracture)

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10 pages, 235 KiB

Open AccessArticle

Two-Stage Exchange Arthroplasty for Periprosthetic Reverse Shoulder Arthroplasty Infection Provides Comparable Functional Outcomes to Primary Reverse Shoulder Arthroplasty

by Maristella Francesca Saccomanno, Alexandre Lädermann and Philippe Collin

J. Clin. Med. 2024, 13(3), 904; https://doi.org/10.3390/jcm13030904 - 4 Feb 2024

Viewed by 577

Abstract

This study aimed to compare functional outcomes after two-stage revision reverse shoulder arthroplasty (RSA) for periprosthetic joint infection (PJI) with the results of primary RSA. Patients affected by PJI and treated by means of two-stage revision RSA were 1:1 matched with a group [...] Read more.

This study aimed to compare functional outcomes after two-stage revision reverse shoulder arthroplasty (RSA) for periprosthetic joint infection (PJI) with the results of primary RSA. Patients affected by PJI and treated by means of two-stage revision RSA were 1:1 matched with a group of patients who were treated electively with RSA without developing any complications. Out of 1477 RSAs performed between 2009 and 2021, 16 patients developed a PJI. Each matched cohort comprised 16 patients (3 females, 13 males). The mean age was 69.13 ± 5.43 years old in the PJI group and 70.28 ± 5.04 (p = 0.543) in the matched cohort. The mean follow-up was 41.23 ± 26.9 months in the PJI group and 28.5 ± 20.2 (p = 0.142) in the matched group. Only one patient showed recurrent PJI five years after revision RSA. Comparison between the PJI patients and matched patients did not show any significant differences at the latest follow-up, nor for subjective shoulder value (SSV) (p = 0.101) or Constant score (p = 0.134). Two-stage exchange RSA for PJI allows for appropriate control of the disease and good functional outcomes. Comparison with an age- and sex-matched cohort of uninfected patients showed no significant differences, thus confirming the idea that revision surgeries may lead to satisfactory functional outcomes, as expected after primary surgery. Full article

(This article belongs to the Special Issue Advances, New Technologies and Optimization of Reverse Shoulder Arthroplasty)

10 pages, 246 KiB

Open AccessReview

Dipeptidyl-Peptidase-4 and Glucagon-like-Peptide-1, a Link in the Connection between Periodontitis and Diabetes Mellitus—What Do We Know So Far?—A Scoping Review

by Theodora Claudia Gheonea, Petra Șurlin, Flavia Mirela Nicolae, Dorin Nicolae Gheorghe, Dora Maria Popescu and Ion Rogoveanu

J. Clin. Med. 2024, 13(3), 903; https://doi.org/10.3390/jcm13030903 - 4 Feb 2024

Viewed by 1009

Abstract

Periodontitis is a common condition affecting the tissues surrounding and supporting teeth. In addition to oral health concerns, periodontal disease increases the chance of developing systemic illnesses including type 2 diabetes mellitus. Porphyromonas gingivalis, a key-stone pathogen that has been linked to the [...] Read more.

Periodontitis is a common condition affecting the tissues surrounding and supporting teeth. In addition to oral health concerns, periodontal disease increases the chance of developing systemic illnesses including type 2 diabetes mellitus. Porphyromonas gingivalis, a key-stone pathogen that has been linked to the pathophysiology of periodontal disease, can generate a series of dipeptide producing exopeptidases, dipeptidyl peptidases (DPP). DPP-4 levels in gingival crevicular fluid have been shown to increase during active periodontal disease, which may lead to their association with the disease’s progression. Following oral glucose administration, mice injected with DPP-4 had higher blood glucose than the control group. DPP-4 inhibitors are used to treat patients with type 2 diabetes mellitus in order to extend the half-life of incretins. Elevated glucagon-like peptide-1 (GLP-1) levels following periodontal therapy could be considered new and applicable real-world evidence confirming the experimental findings of a beneficial interaction between oral microbiota and incretin axis. GLP-1 receptor agonist exendin-4 enhanced the osteoblast proliferation and development of these stem cells and inhibited the effects of glucose on the cells. In addition to lowering blood sugar, liraglutide, a GLP-1 receptor agonist, also possesses anti-inflammatory and bone-protective properties. These findings support the use of GLP-1 in the management and prevention of diabetic periodontitis. Full article

(This article belongs to the Special Issue Periodontal and Other Associated Oral Diseases: Diagnosis and Management in the Context of Systemic Pathology)

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15 pages, 3431 KiB

Open AccessArticle

Effectiveness of Rehabilitation for Disk Displacement of the Temporomandibular Joint—A Cross-Sectional Study

by Małgorzata Kulesa-Mrowiecka, Patryk Ciężarek and Małgorzata Pihut

J. Clin. Med. 2024, 13(3), 902; https://doi.org/10.3390/jcm13030902 - 4 Feb 2024

Cited by 1 | Viewed by 695

Abstract

(1) Background: Dislocations of articular disk can occur as a result of parafunctions in the Temporo Mandibular Joint (TMJ), which limits the opening of the mandible and other movements. The aim of this study was to evaluate the effectiveness of rehabilitation in [...] Read more.

(1) Background: Dislocations of articular disk can occur as a result of parafunctions in the Temporo Mandibular Joint (TMJ), which limits the opening of the mandible and other movements. The aim of this study was to evaluate the effectiveness of rehabilitation in patients with disk displacement of the TMJ. A total of 327 subjects with Temporo Mandibular Disorders underwent stomathognatic physiotherapy. (2) Methods: Based on the results obtained by a manual functional analysis, 35 patients who were identified with articular disk locking (disk displacement without reduction) were included in the study. The study group (N = 35) was subjected to passive repositioning of the articular disk, reposition splints, and physiotherapy. The patient’s TMJs were then examined before the therapy, immediately after the therapy, and during the follow-up visit 3–6 weeks after the therapy. The Diagnostic Criteria for the Most Common Intra-articular Temporomandibular Disorders was used to evaluate the effects of rehabilitation on the patients’ range of motions and the Numeric Pain Rating Scale (NPRS). For the statistical analysis, Pearson’s r correlation coefficient test and Wilcoxon signed-rank test were used. (3) Results: The results showed a significant improvement in the range of motion of the mandible movements. The level of improvement was dependent on the time from the incident until undergoing rehabilitation. (4) Conclusions: The stomatognathic physiotherapy applied increased the range of motion of the mandible and reduced pain levels to the expected range. Full article

(This article belongs to the Topic Advances in Dental Health)

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12 pages, 290 KiB

Open AccessFeature PaperArticle

Malondialdehyde Serum Levels in a Full Characterized Series of 430 Rheumatoid Arthritis Patients

by Nayra Merino de Paz, Juan Carlos Quevedo-Abeledo, Fuensanta Gómez-Bernal, Antonia de Vera-González, Pedro Abreu-González, Candelaria Martín-González, Miguel Ángel González-Gay and Iván Ferraz-Amaro

J. Clin. Med. 2024, 13(3), 901; https://doi.org/10.3390/jcm13030901 - 4 Feb 2024

Cited by 1 | Viewed by 761

Abstract

Background. Oxidative stress has been involved in the pathogenesis of rheumatoid arthritis (RA). The serum malondialdehyde (MDA) level is a reliable biomarker of oxidative stress status. In the present work, we aimed to analyze how a comprehensive characterization of the disease characteristics [...] Read more.

Background. Oxidative stress has been involved in the pathogenesis of rheumatoid arthritis (RA). The serum malondialdehyde (MDA) level is a reliable biomarker of oxidative stress status. In the present work, we aimed to analyze how a comprehensive characterization of the disease characteristics in RA, including a lipid profile, insulin resistance, and subclinical atherosclerosis, relates to serum MDA levels. Methods. In a cross-sectional study that included 430 RA patients, serum MDA levels were evaluated. Multivariable analysis was performed to examine the relationship of MDA with disease activity scores and disease characteristics, including subclinical carotid atherosclerosis, a comprehensive lipid molecule profile, and indices of insulin resistance and beta cell function indices. Results. The erythrocyte sedimentation rate (ESR) showed a significant and positive relationship with MDA. However, this did not occur for other acute phase reactants such as C-reactive protein or interleukin-6. Although the DAS28-ESR score (Disease Activity Score in 28 joints) had a positive and significant association with MDA serum levels, other disease activity scores that do not use the erythrocyte sedimentation rate in their formula did not show a significant relationship with MDA. Other disease characteristics, such as disease duration and the existence of rheumatoid factor and antibodies against citrullinated protein, were not related to serum MDA levels. This also occurred for lipid profiles, insulin resistance indices, and subclinical carotid atherosclerosis, for which no associations with circulating MDA were found. Conclusions. The disease characteristics are not related to circulating MDA levels in patients with RA. Full article

(This article belongs to the Special Issue Targeted Treatment in Rheumatoid Arthritis)

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10 pages, 5179 KiB

Open AccessArticle

Artificial Intelligence Language Model Performance for Rapid Intraoperative Queries in Plastic Surgery: ChatGPT and the Deep Inferior Epigastric Perforator Flap

by Connor J. Atkinson, Ishith Seth, Yi Xie, Richard J. Ross, David J. Hunter-Smith, Warren M. Rozen and Roberto Cuomo

J. Clin. Med. 2024, 13(3), 900; https://doi.org/10.3390/jcm13030900 - 4 Feb 2024

Cited by 2 | Viewed by 834

Abstract

Background: The integration of artificial intelligence in healthcare has led to the development of large language models that can address various medical queries, including intraoperatively. This study investigates the potential of ChatGPT in addressing intraoperative questions during the deep inferior epigastric perforator [...] Read more.

Background: The integration of artificial intelligence in healthcare has led to the development of large language models that can address various medical queries, including intraoperatively. This study investigates the potential of ChatGPT in addressing intraoperative questions during the deep inferior epigastric perforator flap procedure. Methods: A series of six intraoperative questions specific to the DIEP flap procedure, derived from real-world clinical scenarios, were proposed to ChatGPT. A panel of four experienced board-certified plastic surgeons evaluated ChatGPT’s performance in providing accurate, relevant, and comprehensible responses. Results: The Likert scale demonstrated to be medically accurate, systematic in presentation, and logical when providing alternative solutions. The mean readability score of the Flesch Reading Ease Score was 28.7 (±0.8), the Flesch–Kincaid Grade Level was 12.4 (±0.5), and the Coleman–Liau Index was 14.5 (±0.5). Suitability-wise, the DISCERN score of ChatGPT was 48 (±2.5) indicating suitable and comprehensible language for experts. Conclusions: Generative AI tools such as ChatGPT can serve as a supplementary tool for surgeons to offer valuable insights and foster intraoperative problem-solving abilities. However, it lacks consideration of individual patient factors and surgical nuances. Nevertheless, further refinement of its training data and rigorous scrutiny under experts to ensure the accuracy and up-to-date nature of the information holds the potential for it to be utilized in the surgical field. Full article

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

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12 pages, 872 KiB

Open AccessArticle

One Anastomosis Gastric Bypass vs. Sleeve Gastrectomy in the Remission of Type 2 Diabetes Mellitus: A Retrospective Analysis on 3 Years of Follow-Up

by Claudio Gambardella, Federico Maria Mongardini, Maddalena Paolicelli, Francesco Saverio Lucido, Salvatore Tolone, Luigi Brusciano, Simona Parisi, Rosetta Esposito, Francesco Iovino, Luca Nazzaro, Francesco Pizza and Ludovico Docimo

J. Clin. Med. 2024, 13(3), 899; https://doi.org/10.3390/jcm13030899 - 4 Feb 2024

Viewed by 742

Abstract

Background. Obesity is a prevalent condition associated with various comorbidities, impacting mortality, fertility, and quality of life. Its relationship with type 2 diabetes mellitus (DMII) is well established, with nearly 44% prevalence. Bariatric surgery has proven crucial for treating both obesity and DMII. [...] Read more.

Background. Obesity is a prevalent condition associated with various comorbidities, impacting mortality, fertility, and quality of life. Its relationship with type 2 diabetes mellitus (DMII) is well established, with nearly 44% prevalence. Bariatric surgery has proven crucial for treating both obesity and DMII. The comparison between surgical techniques, such as sleeve gastrectomy (SG) and one anastomosis gastric bypass (OAGB), remains controversial in terms of glycemic control efficacy. This retrospective study aimed to assess DMII remission efficacy between SG and OAGB after 36 months. Methods. From January 2016 to September 2020, 201 patients who underwent SG and OAGB for morbid obesity associated with DMII were accurately followed-up with for 36 months, focusing on %HbA1c, DMII remission, anthropometric results, and nutrient deficiency. Results. Although DMII remission did not exhibit statistical significance between the groups (82% vs. 93%, SG vs. OAGB, p = 0.051), OAGB demonstrated a more robust association with glycemic control (Odds Ratio 0.51) throughout the entire follow-up and yielded superior anthropometric outcomes. Notably, nutrient deficiencies, excluding cholecalciferol, iron, and riboflavin, did not show significant intergroup differences. Conclusions. This study contributes valuable insights into the extended-term efficacy of SG and OAGB in DMII remission. The nuanced findings underscore the multifaceted nature of metabolic outcomes, suggesting that factors beyond weight loss influence diabetes resolution. Larger comparative studies are warranted to comprehensively address this issue. Full article

(This article belongs to the Special Issue Clinical Updates on Bariatric Surgery)

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13 pages, 275 KiB

Open AccessReview

Tele-Monitoring Applications in Respiratory Allergy

by Xenofon Aggelidis, Maria Kritikou, Michael Makris, Michael Miligkos, Niki Papapostolou, Nikolaos G. Papadopoulos and Paraskevi Xepapadaki

J. Clin. Med. 2024, 13(3), 898; https://doi.org/10.3390/jcm13030898 - 4 Feb 2024

Viewed by 1690

Abstract

Respiratory allergic diseases affect over 500 million people globally and pose a substantial burden in terms of morbidity, mortality, and healthcare costs. Restrictive factors such as geographical disparities, infectious pandemics, limitations in resources, and shortages of allergy specialists in underserved areas impede effective [...] Read more.

Respiratory allergic diseases affect over 500 million people globally and pose a substantial burden in terms of morbidity, mortality, and healthcare costs. Restrictive factors such as geographical disparities, infectious pandemics, limitations in resources, and shortages of allergy specialists in underserved areas impede effective management. Telemedicine encompasses real-time visits, store-and-forward option triage, and computer-based technologies for establishing efficient doctor-patient communication. Recent advances in digital technology, including designated applications, informative materials, digital examination devices, wearables, digital inhalers, and integrated platforms, facilitate personalized and evidence-based care delivery. The integration of telemonitoring in respiratory allergy care has shown beneficial effects on disease control, adherence, and quality of life. While the COVID-19 pandemic accelerated the adoption of telemedicine, certain concerns regarding technical requirements, platform quality, safety, reimbursement, and regulatory considerations remain unresolved. The integration of artificial intelligence (AI) in telemonitoring applications holds promise for data analysis, pattern recognition, and personalized treatment plans. Striking the balance between AI-enabled insights and human expertise is crucial for optimizing the benefits of telemonitoring. While telemonitoring exhibits potential for enhancing patient care and healthcare delivery, critical considerations have to be addressed in order to ensure the successful integration of telemonitoring into the healthcare landscape. Full article

(This article belongs to the Special Issue Allergic Asthma: Causes, Diagnosis and Treatment)

14 pages, 554 KiB

Open AccessArticle

Carboplatin plus Paclitaxel in Combination with the Histone Deacetylate Inhibitor, Vorinostat, in Patients with Recurrent Platinum-Sensitive Ovarian Cancer

by Hanieh Meteran, Anja Ør Knudsen, Trine Lembrecht Jørgensen, Dorte Nielsen and Jørn Herrstedt

J. Clin. Med. 2024, 13(3), 897; https://doi.org/10.3390/jcm13030897 - 3 Feb 2024

Viewed by 783

Abstract

Background: This phase II study evaluated the efficacy and safety of the histone deacetylase (HDAC) inhibitor, vorinostat, administered in combination with paclitaxel and carboplatin in patients with platinum sensitive recurrent ovarian cancer. Methods: Women with recurrent platinum-sensitive ovarian, peritoneal, or Fallopian tube carcinoma, [...] Read more.

Background: This phase II study evaluated the efficacy and safety of the histone deacetylase (HDAC) inhibitor, vorinostat, administered in combination with paclitaxel and carboplatin in patients with platinum sensitive recurrent ovarian cancer. Methods: Women with recurrent platinum-sensitive ovarian, peritoneal, or Fallopian tube carcinoma, a performance status of 0–2, and good overall organ function were eligible. Patients received 6 courses of paclitaxel (175 mg/m²) and carboplatin area under the curve (AUC) of 5.0 mg/mL/min administered via intravenous infusion on day 1 of a 3-week schedule. In addition, patients received vorinostat 400 mg orally once daily on days −4 through 10 of Cycle 1 and days 1 through 14 of each subsequent treatment cycle. The primary endpoints were progression-free survival (PFS) and adverse events. The secondary endpoints were the objective response rate and overall survival. Results: Fifty-five patients were included. CR was obtained in 14 patients (26.4%) and PR in 19 patients (35.8%), resulting in an ORR of 62.2%. Twenty patients (37.7%) had SD. The median duration of response (DoR) was 12.6 (range 6–128) months. The median PFS was 11.6 months (95% CI, 10.3–18.0; p < 0.001). Median OS was 40.6 months (95% Cl, 25.1–56.1). The most common treatment-related adverse events (all grades) were fatigue, anemia, thrombocytopenia, neutropenia, anorexia, nausea, pain, sensory neuropathy, myalgia, stomatitis and diarrhea. Conclusions: Vorinostat combined with carboplatin plus paclitaxel was tolerable and generated significant responses including a long median overall survival in recurrent platinum-sensitive ovarian cancer. Full article

(This article belongs to the Special Issue Gynecologic Oncology: Diagnosis, Targeted Therapies, and Management)

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15 pages, 5090 KiB

Open AccessReview

Mitral Annular Calcification-Related Valvular Disease: A Challenging Entity

by Abdulrahman S. Museedi and Thierry H. Le Jemtel

J. Clin. Med. 2024, 13(3), 896; https://doi.org/10.3390/jcm13030896 - 3 Feb 2024

Viewed by 1056

Abstract

Mitral valve annular calcification-related valvular disease is increasingly common due to the rising prevalence of age-related mitral annular calcifications. Mitral annular calcification alters the structure and function of the mitral valve annulus, which in turn causes mitral valve regurgitation, stenosis, or both. As [...] Read more.

Mitral valve annular calcification-related valvular disease is increasingly common due to the rising prevalence of age-related mitral annular calcifications. Mitral annular calcification alters the structure and function of the mitral valve annulus, which in turn causes mitral valve regurgitation, stenosis, or both. As it frequently coexists with comorbid conditions and overlapping symptoms, mitral annular calcification-related valvular disease poses significant diagnostic and therapeutic challenges. For instance, left ventricular diastolic dysfunction hinders the assessment of mitral valvular disease. Detection of mitral annular calcifications and assessment of related mitral valve disease hinge on two-dimensional echocardiography. Comprehensive assessment of mitral annular calcifications and related mitral valve disease may require multidetector computed tomography and three-dimensional echocardiography. Invasive hemodynamic testing with exercise helps identify the cause of symptoms in patients with comorbid conditions, and transcatheter interventions have emerged as a viable therapeutic option for older patients. After an outline of the normal mitral annulus, we examine how mitral annular calcifications lead to mitral valve disease and how to accurately assess mitral regurgitation and stenosis. Lastly, we review surgical and transcatheter approaches to the management of mitral annular calcification-related mitral valve regurgitation, stenosis, or both. Full article

(This article belongs to the Section Cardiology)

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15 pages, 301 KiB

Open AccessReview

Altered Autonomic Function in Metabolic Syndrome: Interactive Effects of Multiple Components

by Joseph Mannozzi, Louis Massoud, Jon Stavres, Mohamed-Hussein Al-Hassan and Donal S. O’Leary

J. Clin. Med. 2024, 13(3), 895; https://doi.org/10.3390/jcm13030895 - 3 Feb 2024

Viewed by 763

Abstract

Metabolic syndrome (MetS) describes a set of disorders that collectively influence cardiovascular health, and includes hypertension, obesity, insulin resistance, diabetes, and dyslipidemia. All these components (hypertension, obesity, dyslipidemia, and prediabetes/diabetes) have been shown to modify autonomic function. The major autonomic dysfunction that has [...] Read more.

Metabolic syndrome (MetS) describes a set of disorders that collectively influence cardiovascular health, and includes hypertension, obesity, insulin resistance, diabetes, and dyslipidemia. All these components (hypertension, obesity, dyslipidemia, and prediabetes/diabetes) have been shown to modify autonomic function. The major autonomic dysfunction that has been documented with each of these components is in the control of sympathetic outflow to the heart and periphery at rest and during exercise through modulation of the arterial baroreflex and the muscle metaboreflex. Many studies have described MetS components in singularity or in combination with the other major components of metabolic syndrome. However, many studies lack the capability to study all the factors of metabolic syndrome in one model or have not focused on studying the effects of how each component as it arises influences overall autonomic function. The goal of this review is to describe the current understanding of major aspects of metabolic syndrome that most likely contribute to the consequent/associated autonomic alterations during exercise and discuss their effects, as well as bring light to alternative mechanisms of study. Full article

(This article belongs to the Special Issue New Advances in Cardiorenal Syndrome)

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17 pages, 14359 KiB

Open AccessArticle

Diagnostic Imaging of Agminated Blue Lesions and Blue Lesions with Satellitosis: Case Series with a Concise Review of the Current Literature

by Carmen Cantisani, Giovanni Paolino, Antonio Di Guardo, Vito Gomes, Andrea Carugno, Maria Elisabetta Greco, Noah Musolff, Giulia Azzella, Giovanni Rossi, Giuseppe Soda, Caterina Longo and Giovanni Pellacani

J. Clin. Med. 2024, 13(3), 894; https://doi.org/10.3390/jcm13030894 - 3 Feb 2024

Viewed by 716

Abstract

Background: Agmination and/or satellitosis in pigmented blue lesions is a phenomenon rarely mentioned in the literature and not well known. This phenomenon can be expressed by several benign and malignant pigmented blue lesions, such as blue nevi, Spitz nevi, melanocytoma and melanoma. On [...] Read more.

Background: Agmination and/or satellitosis in pigmented blue lesions is a phenomenon rarely mentioned in the literature and not well known. This phenomenon can be expressed by several benign and malignant pigmented blue lesions, such as blue nevi, Spitz nevi, melanocytoma and melanoma. On this spectrum, dermoscopy, reflectance confocal microscopy (RCM) and dynamic Optical coherence tomography (D-OCT) represent non-invasive imaging technologies, which may help clinicians in the diagnosis of melanoma and non-melanoma skin cancers in daily clinical practice. Methods: Currently, in the literature there is a lack of new data about agminated blue lesions and blues lesions with satellitosis, as well as the lack of a recent and updated review of the literature about this topic. Therefore, considering that clinicians must be confident with the diagnosis of these rare skin lesions, we decided to carry out this work. Results: In this paper, four new cases of agminated pigmented cutaneous lesions were described. Moreover, a review of the current literature on this topic was performed. Conclusions: A clinical–pathological correlation is often needed to reach a correct diagnosis; currently, dermoscopy and non-invasive diagnostic techniques, such as reflectance confocal microscopy and optical coherence tomography, due to the depth of these skin lesions in the dermis, can only make a partial and limited contribution. Full article

(This article belongs to the Section Dermatology)

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10 pages, 221 KiB

Open AccessArticle

The Relationship between Sleep Parameters Measured by Polysomnography and Selected Neurotrophic Factors

by Marcin Sochal, Agata Binienda, Aleksandra Tarasiuk, Agata Gabryelska, Piotr Białasiewicz, Marta Ditmer, Szymon Turkiewicz, Filip Franciszek Karuga, Jakub Fichna and Adam Wysokiński

J. Clin. Med. 2024, 13(3), 893; https://doi.org/10.3390/jcm13030893 - 3 Feb 2024

Viewed by 658

Abstract

Background: The molecular underpinnings of insufficient sleep remain underexplored, with disruptions in the neurotrophic signaling pathway emerging as a potential explanation. Neurotrophins (NTs), including brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT3), neurotrophin 4 (NT4), and glial-cell-line-derived growth factor (GDNF), play crucial roles in nerve [...] Read more.

Background: The molecular underpinnings of insufficient sleep remain underexplored, with disruptions in the neurotrophic signaling pathway emerging as a potential explanation. Neurotrophins (NTs), including brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT3), neurotrophin 4 (NT4), and glial-cell-line-derived growth factor (GDNF), play crucial roles in nerve cell growth and repair. However, their associations with sleep patterns are poorly understood. This study aimed to investigate the relationship between the chosen neurotrophins and objective sleep parameters. Methods: The study involved 81 participants subjected to polysomnography (PSG). Blood samples were collected after PSG. The mRNA expression and serum protein concentrations of BDNF, GDNF, NT3, and NT4 were measured using real-time quantitative reverse-transcription PCR (qRT-PCR) or enzyme-linked immunosorbent assay (ELISA) methods, respectively. Results: BDNF and NT3 proteins were negatively correlated with NREM events, while NT4 protein positively correlated with REM events. Electroencephalography power analysis revealed BDNF protein’s negative correlation with delta waves during rapid eye movement and non-rapid eye movement sleep. Conclusion: The study highlights associations between neurotrophins and sleep, emphasizing BDNF’s role in regulating NREM and REM sleep. The EEG power analysis implicated BDNF in delta wave modulation, shedding light on potential neurotrophic mechanisms underlying sleep effects on cognitive and mood processes. Full article

(This article belongs to the Section Mental Health)

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13 pages, 12394 KiB

Open AccessArticle

Clinical and Radiographic Outcomes of Hip Revision Surgery and Cerclage Wires Fixation for Vancouver B2 and B3 Fractures: A Retrospective Cohort Study

by Vincenzo Di Matteo, Francesco La Camera, Carla Carfì, Emanuela Morenghi, Guido Grappiolo and Mattia Loppini

J. Clin. Med. 2024, 13(3), 892; https://doi.org/10.3390/jcm13030892 - 3 Feb 2024

Viewed by 525

Abstract

Background: The number of patients presenting with periprosthetic hip fractures has increased in recent decades. Methods: Patients who underwent hip revision arthroplasty procedures for Vancouver type B2 and B3 fractures between 2010 and 2021 were included. The primary intended outcome of this study [...] Read more.

Background: The number of patients presenting with periprosthetic hip fractures has increased in recent decades. Methods: Patients who underwent hip revision arthroplasty procedures for Vancouver type B2 and B3 fractures between 2010 and 2021 were included. The primary intended outcome of this study was to determine the reintervention-free survival rate. The secondary intended outcome was to determine clinical and radiographic assessment outcomes at the time of follow-up, and the correlation between time to surgery and postoperative Harris hip score (HHS). Results: A total of 49 patients with mean age of 71.2 ± 2.3 (37–88) years old were included. Overall, the Kaplan-Meier method estimated a survival rate of 95.8% (CI 84.2% to 98.9%) at one year, 91.1% (CI 77.9% to 96.6%) at two years, and 88.5% (CI 74.4% to 95.1%) at three, and up to 10, years. The mean limb length discrepancy (LLD) improved from −13.3 ± 10.5 (range −39 to +10) mm at the preoperative stage to −1.16 ± 6.7 (range −17 to +15) mm, p < 0.001 postoperative. The mean HHS improved from 31.1 ± 7.7 (range 10 to 43) preoperative to 85.5 ± 14.8 (range 60 to 100), p < 0.001 postoperative. Postoperative HHS was not affected by preoperative time to surgery. Conclusions: Revision arthroplasty is an effective treatment for Vancouver type B2 and B3 fractures. Full article

(This article belongs to the Special Issue Clinical Management and Outcome of Periprosthetic Fracture)

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11 pages, 8340 KiB

Open AccessArticle

The Diagnostic Value of CEUS in Assessing Non-Ossified Thyroid Cartilage Invasion in Patients with Laryngeal Squamous Cell Carcinoma

by Milda Pucėtaitė, Davide Farina, Silvija Ryškienė, Dalia Mitraitė, Rytis Tarasevičius, Saulius Lukoševičius, Evaldas Padervinskis and Saulius Vaitkus

J. Clin. Med. 2024, 13(3), 891; https://doi.org/10.3390/jcm13030891 - 3 Feb 2024

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Abstract

Background: Accurate assessment of thyroid cartilage invasion in squamous cell carcinoma (SCC) of the larynx remains a challenge in clinical practice. The aim of this study was to assess the diagnostic performance of contrast-enhanced ultrasound (CEUS), contrast-enhanced computed tomography (CECT), and magnetic resonance [...] Read more.

Background: Accurate assessment of thyroid cartilage invasion in squamous cell carcinoma (SCC) of the larynx remains a challenge in clinical practice. The aim of this study was to assess the diagnostic performance of contrast-enhanced ultrasound (CEUS), contrast-enhanced computed tomography (CECT), and magnetic resonance imaging (MRI) in the detection of non-ossified thyroid cartilage invasion in patients with SCC. Methods: CEUS, CECT, and MRI scans of 27 male patients with histologically proven SCC were evaluated and compared. A total of 31 cases were assessed via CEUS and CECT. The MR images of five patients and six cases were excluded (one patient had two suspected sites), leaving twenty-five cases for analysis via MRI. Results: CEUS showed the highest accuracy and specificity compared with CECT and MRI (87.1% vs. 64.5% and 76.0% as well as 84.0% vs. 64.0% and 72.7%, respectively). The sensitivity and negative predictive value of CEUS and MRI were the same (100%). CEUS yielded four false-positive findings. However, there were no statistically significant differences among the imaging modalities (p > 0.05). Conclusions: CEUS showed better diagnostic performance than CECT and MRI. Therefore, CEUS has the potential to accurately assess non-ossified thyroid cartilage invasion and guide appropriate treatment decisions, hopefully leading to improved patient outcomes. Full article

(This article belongs to the Special Issue Clinical Advances in Head and Neck Imaging including Dentistry)

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J. Clin. Med., Volume 13, Issue 3 (February-1 2024) – 280 articles

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